Abstract
Outpatient ambulatory EEG is more cost-effective than inpatient EEG telemetry and may provide adequate seizure localization in a presurgical evaluation. A 51-year-old right-handed male had been unable to work or drive since the age of 35 due to intractable partial onset epilepsy. A 72-hour outpatient ambulatory EEG recorded 18 seizures from the right temporal region. No epileptiform activity was seen in the left hemisphere. Magnetic resonance imaging showed right mesial temporal sclerosis as well as an area of encephalomalacia at the medial inferior right temporal lobe. Neuropsychological assessment found that the patient was a good neurosurgery candidate. At this point, the patient was considered to be a candidate for a right temporal lobectomy. A standard right temporal lobectomy was performed. The patient has been seizure-free for 10 months after the surgery. Follow-up EEGs show no epileptiform activity. The patient is preparing to go back to work, and his driver's license was reinstated 9 months postsurgery. Neuropsychological reassessment is pending, but no apparent change in cognition has been noticed by the patient or his family. Cases with a high congruence between diagnostic imaging and the EEG abnormalities identified in the portable EEG may provide enough information regarding seizure frequency and localization to eliminate the need for inpatient EEG telemetry in the evaluation of patients for epilepsy surgery. We believe that the use of aEEG in preoperative planning should be restricted to cases of TLE and to patients with a high frequency of seizures.
Highlights
The electroencephalogram (EEG) is central to the diagnosis of epilepsy [1,2,3]
In a departure from routine, we report a patient who underwent a right temporal lobectomy based on suggestive clinical semiology correlated with an epileptiform focus identified on magnetic resonance imaging (MRI) and a solitary outpatient ambulatory EEG study
The 72-hour outpatient Ambulatory EEG (aEEG) recording identified 18 electrographic seizure events originating from the right temporal focus (Fig. 1)
Summary
The electroencephalogram (EEG) is central to the diagnosis of epilepsy [1,2,3]. Seizures may manifest in the EEG along with interictal events, the combination of which provides useful information in the diagnosis and localization of epileptic brain loci. Seizures can be rare events so capturing them on a short EEG recording is difficult. The trend has shifted in favor of prolonged EEG recordings [1,2]. While long-term inpatient video-EEG (vEEG) telemetry has long been considered the gold standard for preoperative evaluation of patients with epilepsy, it is resource-intensive, time-consuming, costly, and not universally available [3]. Ambulatory EEG (aEEG) enables EEG recording on a portable unit while the patient conducts normal activities of life at home, school, or work. There is concern that the quality of aEEG recordings may be
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