Is inpatient ictal video‐electroencephalographic monitoring mandatory in mesial temporal lobe epilepsy with unilateral hippocampal sclerosis? A prospective study

Abstract

We performed the first prospective study in a tertiary epilepsy center comparing surgical outcomes in unilateral MTLE-HS patients investigated preoperatively with and without VEEG. Based on the surgical outcome, VEEG is not imperative in patients with unilateral MTLE-HS who have compatible semiology and clearly ipsilateralized IEDs evaluated by a multidisciplinary and experienced epilepsy group.

Unilateral temporal interictal epileptiform discharges correctly predict the epileptogenic zone in lesional temporal lobe epilepsy

“…Some lateralized IEDs from just 1 hour of archived EEG recording 11 or from a few days of EVM admissions 10,12,22 and, more recently, a prospective study were based on at least 10 routine outpatient EEG recordings. 28 Approaches such as overnight sleep EEG 29 or 24-hour EEG recording 30 were shown to increase the yield in relation to routine EEG, but also showed diminishing returns after 18 hours of EEG. 30 One study showed good concordance between IED lateralization in routine EEG and during EVM.…”

“…Previous studies on IED lateralization did not report the total number of spikes that were analyzed and they were based on heterogeneous data. Some lateralized IEDs from just 1 hour of archived EEG recording or from a few days of EVM admissions and, more recently, a prospective study were based on at least 10 routine outpatient EEG recordings . Approaches such as overnight sleep EEG or 24‐hour EEG recording were shown to increase the yield in relation to routine EEG, but also showed diminishing returns after 18 hours of EEG .…”

Post-operative nonketotic hyperglycemic induced focal motor status epilepticus related to treatment with corticosteroids following standard anterior temporal lobectomy

“…A recent prospective study evaluated the utility of inpatient video-EEG monitoring in people with suspected MTLE associated with unilateral MTS [17] . In this study, there was no difference in seizure outcome after surgery between the groups who had video-EEG monitoring and those who did not.…”

“…In this study, there was no difference in seizure outcome after surgery between the groups who had video-EEG monitoring and those who did not. The authors suggested it could be safe to recommend epilepsy surgery without inpatient video-EEG monitoring in people with MTLE with unilateral MRI signs of MTS, clinical semiology consistent with MTLE, no suspicion of nonepileptic events, and adequate outpatient EEGs with lateralized interictal epileptiform activity to MTS [17] . The patient in this case demonstrated many of these characteristics, and this would strengthen the hypothesis of right MTLE as opposed to an epileptic network within the right frontal central region.…”

The role of interictal epileptiform discharges in epilepsy surgery outcome

“…[8] Due to this concordance between interictal findings and ictal EEG and MRI, few studies have emphasized the role of interictal EEG in presurgical evaluation and questioned the need for long-term v-EEG monitoring in patients with TLE. [91011] However, we could not find any study with similar recommendation for patients with extratemporal lobe epilepsy (ETLE). To more exactly address this issue, we conducted this study to investigate the prognostic effect of concordance between IZ with SOZ and MRI lesion on postsurgical outcome of patients with TLE and ETLE.…”