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. 2013 Mar 6:1:39-41.
doi: 10.1016/j.ebcr.2013.01.001. eCollection 2013.

Outpatient ambulatory EEG as an option for epilepsy surgery evaluation instead of inpatient EEG telemetry

Syed A Rizvi  1 , José F Téllez Zenteno  1 , Sara L Crawford  2 , Adam Wu  3
Affiliations

Outpatient ambulatory EEG as an option for epilepsy surgery evaluation instead of inpatient EEG telemetry

Syed A Rizvi et al. Epilepsy Behav Case Rep. .

Abstract

Outpatient ambulatory EEG is more cost-effective than inpatient EEG telemetry and may provide adequate seizure localization in a presurgical evaluation. A 51-year-old right-handed male had been unable to work or drive since the age of 35 due to intractable partial onset epilepsy. A 72-hour outpatient ambulatory EEG recorded 18 seizures from the right temporal region. No epileptiform activity was seen in the left hemisphere. Magnetic resonance imaging showed right mesial temporal sclerosis as well as an area of encephalomalacia at the medial inferior right temporal lobe. Neuropsychological assessment found that the patient was a good neurosurgery candidate. At this point, the patient was considered to be a candidate for a right temporal lobectomy. A standard right temporal lobectomy was performed. The patient has been seizure-free for 10 months after the surgery. Follow-up EEGs show no epileptiform activity. The patient is preparing to go back to work, and his driver's license was reinstated 9 months postsurgery. Neuropsychological reassessment is pending, but no apparent change in cognition has been noticed by the patient or his family. Cases with a high congruence between diagnostic imaging and the EEG abnormalities identified in the portable EEG may provide enough information regarding seizure frequency and localization to eliminate the need for inpatient EEG telemetry in the evaluation of patients for epilepsy surgery. We believe that the use of aEEG in preoperative planning should be restricted to cases of TLE and to patients with a high frequency of seizures.

Keywords: Ambulatory EEG; Complex partial seizure; Cost-effectiveness; Diagnostic yield; Epilepsy; Portable EEG.

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Figures

Fig. 1
Fig. 1
One of the 18 seizures recorded with the aEEG. The seizure is characterized by rhythmic sharp theta mixed with spikes over the electrodes F8–T4 with spread to Fp2 and T6. The seizure finishes with sharp waves at F8 and T4 and delta. All the seizures were similar.
Fig. 2
Fig. 2
A coronal section shows clear atrophy of the right hippocampus with signal changes consistent with mesial temporal sclerosis.
See this image and copyright information in PMC

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