Abstracts

RATIONALE: The role of posterior lesions leading to inadequate results following inferomesial temporal resection is well recognized. Even in the absence of obvious structural lesions posterior temporal-parietal symptoms indicate poor surgical outcome following temporal resection despite well defined focal inferomesial temporal epileptogenic discharges.
METHODS: We reviewed histories, Video-Stereo-EEGs and neuroimaging studies of five patients with temporal, posterior temporal and parietal symptoms at seizure onset but who had anterior and inferomesial interictal epileptiform discharges on scalp EEG.
RESULTS: Including subpial transection when posterior speech areas were involved the five patients had an average of 2.8 operation each, None had a structurally MRI defined lesion. Because of electroclinical incongruity two patients had initial depth electrode studies. Ictal onset were neocortical temporal, posterior temporal or lower central. First surgery was anterior temporal resection in four and face area removal in one. After initial resection three had further depth electrode studies prior to reoperation. There was limited improvement as a result of surgery in this group of individuals.
CONCLUSIONS: Anterior and inferomesial interictal temporal discharges or neocortical temporal seizure onset are misleading in suggesting of anteromesial surgical resection in patients with clinical features suggesting posterior temporo-parietal seizure symptoms.