Comparison of Outpatients and Inpatients Video/EEG Monitoring for Presurgical Evaluation in Temporal Lobe Epilepsy (TLE)
Abstract number :
1.092
Submission category :
Year :
2001
Submission ID :
2103
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
A.L.A. Noronha, MD, Neurology, UNICAMP, Campinas, SP, Brazil; F. Cendes, MD, PHD, Neurology, UNICAMP, Campinas, SP, Brazil; E. Kobayashi, MD, Neurology, UNICAMP, Campinas, SP, Brazil; L.H.N. Marques, MD, Neurology, UNICAMP, Campinas, SP, Brazil; C.A.M. Gu
RATIONALE: To evaluate the efficacy outpatient video/EEG monitoring.
METHODS: We performed outpatient video/EEG monitoring for presurgical evaluation in 59 patients with TLE. Inclusion criteria were patients with clinical-EEG diagnosis of TLE, and the frequency of at least two seizures per month. Most patients had unilateral or bilateral hippocampal atrophy on MRI. The outpatient monitoring was performed in the EEG department from morning to early evening during week days under a physician supervision. We used 18-channel digital EEG with anterior temporal and zygomatic electrodes, with seizure and spike detection programs. Patients were kept always with an accompanying person. Medications were not changed in the outpatient group. We compared findings with a group of 12 patients with TLE who were admitted and had antiepileptic medication withdrawn following standard parameters. Five of these 12 patients were also evaluated as outpatients in a different time. We evaluated the number of periods - days and nights, number of seizures recorded, ability to lateralize the interictal and ictal EEG findings, and the proportion of patients who underwent surgery in both groups of patients.
RESULTS: The mean interval between beginning of monitoring and recording the first seizures was 3.5 days for the group of oupatients and 1.8 day for the group of inpatients. The mean number of seizures recorded divided by the number of monitoring periods were 0.6 (range 0 to 5.5) for outpatients and 0.47 (range 0 to 0.83) for inpatients. Lateralization by interictal spiking was obtained in 74% of the outpatients and 75% of the inpatients. Lateralization by ictal EEG was obtained in 48.7% of the outpatients and 50% of the inpatients. The proportion of patients submitted to surgical procedure was 45.8% of outpatients and 58.3% of inpatients.
CONCLUSIONS: Outpatient Video/EEG monitoring for presurgical evaluation is efficient and comparable to inpatient monitoring in individuals with frequent seizures. Therefore the improved cost/benefit of outpatient monitoring, in a selected group of patients, may increase the access to surgery in higher number of individuals with intractable epilepsy.
Support: FAPESP