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Cukiert CM; Burattini JA; Mariani PP; Seda L; Forster CR; Cukiert A; Argentoni-Baldochi M; Baise-Zung C; Mello VA.
Epilepsy Surgery Program, Hospital Brigadeiro, São Paulo SP, Brazil
Rationale: Eighthy to ninety percent of the patients with refractory temporal lobe epilepsy submitted to cortico-amygdalo-hippocampectomy would be rendered seizure free after surgery (Engel class I). On the other hand, although not presenting complex partial seizures, some patients persist with simple partial seizures (auras) after surgery. As with many other clinical variables, patient’s perception of the relevance of these events might vary. This paper further investigates the patient’s point of view on this issue.
Methods: Fifty-six patients with refractory temporal lobe epilepsy associated to mesial temporal sclerosis, submitted to cortico-amygdalo-hippocampectomy (complete hippocampal and intratemporal amygdala removal), and that were in Engel class I postoperative but persisted presenting simple partial seizures (auras) were studied. Seventeen patients had bilateral independent EEG discharges and thirty-nine unilateral discharges alone. The frequency and type of the simple partial seizures, their disappearance over time and how they were perceived by the patients (in a scale ranging from 0 to 10; 8-10 being considered very disturbing and “0” not disturbing at all) were studied. Mean follow-up time was 3.8 years (3-10).
Results: Simple partial seizures disappeared spontaneously over time in 47 out of 56 patients. Seven of the patients who remained with simple partial seizures after prolonged follow-up had auditory simple partial seizures and the other 2 patients had vegetative (epigastric) auras. Eight patients in this series found their simple partial seizures very disturbing (4 of them had auditory auras), even after adequate medical counseling. This finding was not related to the pre- or postoperative frequency of auras. There was no relationship between preoperative EEG findings and aura persistence or severity.
Conclusions: Although postoperative auras represent minor medical episodes, they might be perceived as a disturbing event by 12% of the patients submitted to surgery. In the majority of the patients (47/56), auras would disappear during long-term follow-up. Auditory auras seemed to be more resistant and there is a trend towards their persistence, especially in patients with familial temporal lobe epilepsy associated to mesial temporal sclerosis.