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Arthur Cukiert, Cassio Forster, Viviane Ferreira, Leila Frayman, Jose Buratini.
Epilepsy Surgery Program- Hospital Brigadeiro and Sao Paulo Epilepsy Clinic, Sao Paulo SP, Brazil
RATIONALE- The presence of unilateral mesial temporal sclerosis on MRI is an excelent localizing and lateralizing sign in temporal lobe epilepsy. On the other hand, some patients with temporal lobe epilepsy have normal MRIs or bilateral mesial temporal sclerosis. These paper describes the invasive neurophysiological data and surgical results in such patients.
MATERIAL- Three adult patients were included in these series. All had simple and complex partial seizures and bilateral interictal temporal discharges. Ictal recordings were not localizatory in any patient. Two had normal MRIs and bilateral mesial sclerosis (Figure 1) was seen in one. Interictal and ictal SPECT were available in the patients with normal MRI. Ictal SPECT lateralized correctly the epileptogenic side as defined by invasive recording. In one patient, interictal SPECT was normal and in the other one it pointed to the wrong side. All patients were submitted to invasive recordings with subdural plates covering the temporal neocortex from the parahippocampal gyrus to the superior temporal gyrus (Figure 2 and 3), bilaterally.
RESULTS- Seizures arised exclusively from one side in all patients (Figure 4 and 5). They were submitted to a cortico-amygdalo-hippocampectomy with extensive mesial resection. All patients have been seizure-free after surgery.
CONCLUSION- In patients with bitemporal epilepsy with normal or bilateral findings on MRI, invasive recordings remains the gold-standard. Ictal SPECT is probably the best non-invasive parameter.