SEIZURE SEMIOLOGY AND ICTAL SPECT, BUT NOT ICTAL OR INTERICTAL EEG CORRELATE WITH LESION SIDE IN MEDICALLY REFRACTORY EPILEPSY ASSOCIATED WITH EARLY VASCULAR INSULTS
Abstract number :
1.166
Submission category :
Year :
2004
Submission ID :
2046
Source :
www.aesnet.org
Presentation date :
12/2/2004 12:00:00 AM
Published date :
Dec 1, 2004, 06:00 AM
Authors :
1Marcilia L. Martyn, 1Luiz H. Castro, 1Wen H. Tzu, 2Carla R. Ono, and 1Carmen L. Jorge
Patients with early vascular insults present with variable degree of motor weakness and cognitive impairment. Epilepsy may occur and may be refractory to medical treatment. We studied the correlation between presurgical evaluation and post-operative outcome in a series of patients with medically refractory epilepsy secondary to early vascular insults. Retrospective analysis of the presurgical evaluation data (clinical semiology, video-EEG, sodium amytal test and SPECT) and post-operative outcome in a series of patients with early large vascular lesions. Nine patients with medically refractory epilepsy secondary to early vascular lesions were operated between January 2000 and April 2004. 5/9 patients were women, 7/9 were mentally retarded and 8/9 presented a hemiparesis. Epilepsy started in the first year of life in four patients. All cases had porencephalic lesions in the middle cerebral artery territory, 5 on the right hemisphere. Clinical seizure features were concordant with the lesion in 8/9 patients, while ictal EEG was concordant in only 5/9 patients and interictal EEG discharges in only 6/9 patients. All three data were concordant in only 5/9 patients. Ictal SPECT was concordant in all patients. Three patients with left sided lesions underwent the sodium amytal test, which showed right hemisphere language dominance in all. Seven patients underwent hemipherectomy (3 functional, 3 peri-insular and one anatomic). The remaining two patients underwent a bilobar lobectomy. Surgical outcome was excellent in 7/9 patients (Engel 1). No patients developed aphasia or worsening of the motor deficit. Two patients had poor surgical outcome: one had a limited resection (to preserve motor function) and the other presented atypical clinical features (autistic regression) and incongruent presurgical data. In this series, ictal SPECT and ictal semiology were more useful in lateralizing seizure onset than ictal, interictal EEG or all data combined. Incongruent interictal or ictal EEG by itself did not influence surgical or cognitive outcome.