Abstracts

Rationale: Temporal lobe epilepsy is a frequent diagnostic challenge since recurrence of events is a well known fact after epilepsy surgery. We wanted to identify certain recurrence patterns as a tool for prognostic indicators. Methods: We evaluated patients after temporal lobectomy that had seizure recurrence despite having had a complete epileptogenic resection evidenced by postoperative electrocorticography (EcoG) and or neuroimmaging. Cases had history of refractory epilepsy that became seizure free after temporal lobectomy with at least one year of seizure freedom. We selected a population with a very distinct pattern of recurrence; early sleep onset events. We analyzed the different variables involved in the patient's general pre and post surgical features. Results: A total of 5 patients out of 63 procedures performed in an epilepsy center. The age at the surgery was 17 to 28 years old. 3 cases right temporal lobe, 2 cases on the left. All the cases of grater than 90% improvement in seizure reduction. The seizure pattern was a partial seizure with similar characteristics to the presurgical events, but milder and shorter in duration, all of the events occurring in the first 90 minutes after sleep onset. The cases were treated with low dose topiramate, clonazepam or gabapentin, all but one of them are seizure free, the recurrent case has very rare seizures. Conclusions: Epilepsy surgery is a well recognized option for patients with refractory epilepsy, a fraction of patients operated will have a distinct pattern of early sleep onset induced events, even after being seizure free for more than 1 year, possibly related to stage 1 and 2 of slow wave sleep, and will respond favorably to a low dose or short acting anticonvulsant, if that is the only seizure pattern found.