Abstracts

The coexistence of localization related and generalized epilepsy is rare ([lt]1%). It is not uncommon for focal and generalized epileptiform discharges (Eds) to coexist in patients with localization related epilepsy. However it is not clear how often such discharges coexist when strict criteria are used to define generalized discharges, and whether the latter entail a poorer seizure outcome following surgery. We studied the characteristics of a cohort of patients with this pattern of EEG findings and describe an index case with localization related and generalized epilepsy., Eighteen patients fulfilled our criteria, which required the coexistence of interictal focal and truly generalized EDs in the same or in different EEGs. Generalized EDs with shifting focal fragments, and focal discharges with secondary bilateral synchrony were excluded. We reviewed seizure semiology, history of febrile seizures, family history of epilepsy, AEDs used, type of investigations, whether epilepsy surgery was done and seizures outcomes., Eleven patients (61%) were female. Eight were [lt]10 years old. Generalized EDs consisted of [underline][gt][/underline] 3Hz spike-wave and polyspike-wave. Focal spikes had a variety of distributions. All but two patients had video EEG monitoring. Five patients (27.7%) had a family history of epilepsy, and the neurological examination was abnormal in two patients (11%). Ten patients (55.5%) had normal MRI. Five patients had epilepsy surgery, two of whom had mesial temporal sclerosis(MTS). One patient with left temporal EDs and MTS, underwent a conventional temporal lobe resection. Postoperatively, the patient developed seizures of generalized semiology, confirmed with video EEG. Seizure control was poor in the majority of our patients., The coexistence of focal and strictly defined generalized EDs may be a marker of poor seizure control. In patients with localization related epilepsy, this EEG pattern may indicate poor postoperative seizure outcomes. Rarely, failed epilepsy surgery may indicate the emergence or presence of generalized epilepsy.,