Epilepsia temporal farmacorresistente. Análisis de 33 casos intervenidos quirúrgicamente

Abstract

To analyze clinical manifestations, ictal, interictal and intraoperative EEG monitoring in patients with medical treatment refractory temporal epilepsy successfully controlled surgically. Retrospective analysis, 33 patients. Mean age: 36 ± 11.40; number of monthly seizures: 9 ± 14.23; mean duration of disease: 22 years; number of anti-epileptic drugs: 3 ± 0.93; average monitoring duration on Intensive Video-EEG Monitoring Unit: 6.42 ± 3.61 days. Scalp EEG was recorded with surface electrodes placed according to the 10-20 international system. 158 seizures were recorded, most of them focal complex. 82% of patients presented aura. Disturbances of consciousness appeared in 94.3%, being more precocious than the automatisms in the majority of the sample. The most frequent and precocious automatisms were oromandibular. Intercritical: epileptiform activity was observed in 87.9% of cases; sharp waves in 93.1%, increasing with sleepiness in 97%. Polyspikes during REM sleep in 21.2%. Bilateral epileptiform activity in 21.1%. Ictal activity: changes on EEG activity was observed previous to clinical manifestation in more than 69%. Type of ictal onset: flattening (46%), rhythmic slow activity (41.7%). Ictal onset was focal in 48.9%. Detailed knowledge of clinical and electrical manifestations of temporal lobe epilepsies would allow a precocious diagnosis and a reduction of accessing time of these patients to surgical treatment in case of pharmaco-resistance.