Abstracts

Rationale: Epilepsy within the urban immigrant U.S. population is poorly understood and there is sparse information about epilepsy in the Hispanic population, our largest and fastest growing ethnic minority. It is important to recognize: (1) The prevalence of epilepsy in Mexico and Latin America is triple the prevalence of the disease in the U.S. (Burneo et al 2005, Theodore et al 2006); (2) Sociocultural factors such as language barriers, limited education and limited access to educational resources, and traditional beliefs/negative attitudes about epilepsy within the Hispanic population may play important roles in the treatment of intractable epilepsy. Methods: Patients were selected for presurgical evaluation from the Epilepsy Clinics at LAC+USC Medical Center based on criteria of >1 seizure per month and failure of at least 2 anticonvulsants. LAC+USC serves a large population of un(der)insured Hispanic patients with medically intractable epilepsy (Minazad and Kalayjian 2005). Diagnostic evaluation included (1) clinical history and neurological examination; (2) video-EEG monitoring with the goal of least 3 typical seizures; (3) standardized neuropsychological evaluation in Spanish; and (4) epilepsy-protocol MRI. If these basic diagnostic components suggested a single, surgically resectable epileptogenic focus, patients were presented at our multidisciplinary epilepsy surgery conference and referred for further diagnostic testing (e.g. FDG-PET, Wada), resective surgery, Vagus Nerve Stimulation (VNS) therapy, or further medical management. Results: At the time of abstract submission, 102 Hispanic patients have undergone video-EEG monitoring, 51 (50%) have completed all diagnostic testing above. Approximately 60% of patients in this cohort emigrated from Mexico, with the remainder from El Salvador (17%), Guatemala (10%), Honduras (7%) and Ecuador (3%). Detailed neuropsychological data has been analyzed for 29 patients with a mean age of 35.9 ± 1.9 yrs, duration of epilepsy of 24.0 ± 2.0 yrs, current AEDs 2.6 ± 1.9. Epileptic seizures were captured in 80 patients, non-epileptic seizures were captured or presumed in 10 patients, 2 patients were in found to be in simple or complex partial status. Neurocystecercosis (NCC) was found to be the cause of recurrent seizures in only one patient, while MRI revealed mesial temporal sclerosis (MTS) ± malformation of cortical development in the overwhelming majority of patients. Three patients had primary CNS neoplasms. At this time, nine patients have undergone anterior temporal lobe resection with amydgalahippocampectomy. Eight patients are seizure free following surgery (range 2-16 months) and one suffers from rare post-operative seizures. Conclusions: A review of the first 100+ Hispanic patients referred to our epilepsy monitoring unit indicates that NCC is a rare cause of epilepsy among immigrant Hispanic patients. Indeed, habitual seizures were associated with MTS in most patients and surgical outcomes following standard anterior temporal resection are excellent.