Abstracts

Prior studies using various methods of continuous EEG monitoring for selected patients reported that many patients were not aware of their all seizures or a significant portion of their seizures. Therefore, we assessed self-perception of awareness of complex partial seizure (AOCPS) through a thorough interview. Patients with CPSs during sleep only, overt mental retardation, or the total number of CPSs [le]3 were excluded because we considered that they could not give reliable information for AOCPS. We included consecutive 134 patients at our epilepsy clinic, whose CPSs had been observed and given sufficient information for awareness of CPSs by patients and their family members, and investigated the proportion and characteristics of patients without AOCPS compared with those with AOCPS and the change of unawareness of their CPSs during the follow-up. Thirty-one patients (23%) did not have AOCPS completely (n = 23) or incompletely (n = 8). Interictal epileptiform discharges (IEDs) were more frequently detected in patients without AOCPS (94%; complete, 96%) than those with AOCPS (55%), mainly in the temporal region. Bilateral independent IEDs were found in 48% of patients without AOCPS (complete: 52%) compared with 13% of those with AOCPS (p [lt] 0.001). The lateralization of epileptic foci based on ictal semiology, IEDs and structural lesions on MRI was not different between patients without AOCPS and with AOCPS. Eighty-four percent of patients without AOCPS were classified as having temporal lobe epilepsy (TLE) compared with 70% of those with AOCPS (p = 0.093). TLE patients without AOCPS were less likely to have structural lesions involving mesial temporal region and more likely to have normal finding on MRI compared with those with AOCPS. Six of 23 patients with complete unawareness of their seizures had experienced AOCPS even with de novo aura in three patients during the follow-up. Our results suggest that a significant number of epilepsy patients are not aware of their CPSs. Unawareness of CPSs may occur especially in TLE patients with bilateral independent IEDs and without structural lesions involving mesial temporal region.