[Value of the ictal video EEG recording in the presurgical evaluation of temporal lobe epilepsy. Semiology and EEG patterns]

Abstract

Introduction: The surgical treatment of epilepsy has gained increased acceptance in the last decade, especially for temporal lobe seizures. Its success is based upon a strict selection of the candidates, which combines clinical, neurophysiological, neuropsychological and neuroimaging criteria.

Development: The video-EEG recording of the seizures still plays an important role in this selection process, as it provides enough amount of interictal activity, demonstrates the existence of different seizure types and enables to perform an adequate electroclinical correlation. It also helps recognizing patients with concomitant non-epileptic events. The widespread use of ictal video-EEG has allowed the validation of several clinical signs, such as the dystonic posturing of the limb or the postictal speech disturbance among others, as being quite useful in the process of localization and lateralization. In fact, with the proper analysis of the ictal behavior it is possible to achieve confident lateralizing information in the majority of patients with temporal lobe epilepsy.

Conclusions: This knowledge, gathered through the analysis of the semiology is complementary to that obtained with the simultaneous recording of the EEG. When a meaningful electroclinical correlation is possible, and it is also concordant with the data provided by the MRI and neuropsychological testing, a surgical procedure can be warranted without the use of intracranial electrodes.