Abstracts

Rationale: In the puertorrican population, there is scarce information regarding the relative frequency of various types and characteristics of patients with intractable epilepsy. A comprehensive epilepsy program was established in April 2009. We report our data in a group of children and adults who underwent prolonged video-electroencephalographic monitoring in the only Epilepsy Monitoring Unit in Puerto Rico.Methods: A retrospective evaluation of all epilepsy monitoring studies performed from April 2009-April 2011 performed. 153 consecutive patients were analyzed.Results: The majority of patients were females (61%). Two-thirds (66%) of evaluated subjects were adults; infants and elderly patients comprised only 1% of the patients. The most common diagnoses were psychogenic nonepileptic events (39%), localization-related epilepsies (47%) and generalized idiopathic epilepsies (13%). Of the localization-related epilepsies, roughly half (47%) were reliably traced to the temporal lobe and frontal epilepsies represented 17% of the evaluated cases. Childhood absence epilepsy was established in half (50%) of the cases showing generalized epileptiform activity and juvenile myoclonic epilepsy represented only 10% of the idiopathic generalized epilepsies. Conclusions: This study illustrates the wide variety of diagnoses encountered in a population of puertorrican patients evaluated at our epilepsy monitoring unit. More than 40 % of patients had a misdiagnosis. Psychogenic nonepileptic events represent at least one-third of the evaluated cases, a relative frequency that is consistent with results obtained in comprehensive epilepsy centers from other countries. Approximately 1/3 of patients are surgical candidates. Two mesial temporal resection were recently performed. Nine percent of patient had vagus nerve stimulation placed and approximately 10% of patients were referred for epilepsy surgery in level four centers in the United States. Through prolonged video-EEG monitoring, a reliable diagnosis can be established and appropriate therapeutic decisions can be started. The comprehensive epilepsy program in Puerto Rico has reduced need for outside referral to 10-12 %.