Authors :
Presenting Author: Jorge Burneo, MD, MSPH – Western University
R Grace Couper, MSc – Western University
Richard McLachlan, MD – Western University
Chin-Wei Huang, MD – National Chenk Kung University
Hamoud Alsahli, MD – Prince Sultan Military Medical City
Poul H. Espino, MD – Schulich School of Medicine and Dentistry, Western University
Rationale:
To retrospectively examine whether prolonged video electroencephalography (vEEG) is a necessary diagnostic tool to help localize the seizure focus among patients who have evidence of mesial temporal sclerosis (MTS) on MRI and other clinical and ancillary findings of temporal lobe epilepsyMethods:
Seventy-nine patients with evidence of MTS on presurgical MRI testing were included in the study. Two independent epileptologists determined whether the provided workup information was sufficient to localize and proceed with surgical resection or if the patient would need further diagnostic tests, such as prolonged vEEG or intracranial electrodes to localize the seizure focus. The reviewers then compared their decisions and came up with an agreed verdict for each patient. Final verdicts were then compared to the actual surgical decision.
Results:
There was “fair agreement” between the two epileptologists blinded to the prolonged vEEG results and actual surgical decision, with a Cohen’s kappa of 0.245. After discussion, the epileptologists localized the seizure foci using EEG, MRI, semiology, and neuropsychological assessments for 40 of the 79 patients (50.6%) and required prolonged video-EEG to help localize the seizure focus for the remaining 39 patients.
Conclusions:
Prolonged vEEG may not be required to identify seizure foci localization in patients with evidence of mesial temporal sclerosis on MRI, as epileptologists could identify the seizure focus in half of the study cohort without vEEG.
Funding:
Dr Burneo holds the Jack Cowin Chair in Epilepsy Research at Western University