Abstracts

The objective of this study is to emphasize the importance of repeating video-EEG monitoring in patients with epilepsy when they have a change in seizure semiology and to pay special attention to concomitant ECG recordings. We describe two patients who developed a change in their semiology after initial video-EEG monitoring. The first patient is a 25 year old man with stereotypic events since childhood characterized by palpitations at times associated with a sensation of fear. His first EEG-CCTV study was unrevealing. Subsequent interviews with witnesses to his events revealed that brief periods of confusion and pressured out of context speech are at times associated with these events. The second patient is a 60 year old woman who was evaluated for a longstanding history of refractory epilepsy. EEG-CCTV monitoring showed partial seizures originating from the left temporal lobe. A few months later there was a change in the semiology of her seizures, which became more severe and associated with loss of consciousness leading to falls. Both patients had repeat EEG-CCTV studies. During the first patient[apos]s repeat EEG-CTV study, stereotypical events were recorded and consisted of simple partial seizures with or without evolution to complex partial seizures. On one occasion, there was secondary generalization . The study localized the epileptogenic focus to the right temporal lobe. Concomitant ECG showed sinus tachycardia, with the heart rate increasing up to 200 beats per minute. In the second patient the repeat study again localized the epileptogenic focus to the left temporal lobe. However, with the more severe seizures associated with loss of consciousness, concomitant ECG showed bradycardia leading to asystole which lasted as long as 16 seconds. The patient subsequently had a demand pacemaker inserted. Repeating video-EEG monitoring is critical in the evaluation of patients with epilepsy who develop a change in seizure semiology. In addition, concomitant ECG recordings should be reviewed carefully in view of possible arrhythmogenic effects of seizures.