Temporal lobe resection for epilepsy | Figure 1

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Temporal lobe resection for epilepsy

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Grade School aged boy with epilepsy. Do you have a differential or final diagnosis? Top left: Coronal T1 post contrast; Top right: Coronal FLAIR; Middle left: Axial T2; Middle right: Axial FLAIR; Bottom left: Axial T1 precontrast; Bottom right: Axial T1 postcontrast.\

During my EMU rotation, I saw a case I think it is worth reviewing here. Many times, semiology and EEG findings are congruent, however other times they are less clear, so we need to admit pts to our EMU (Epilepsy monitoring Unit) to get a prolonged EEG. This is a 55F, who had this event overnight. On the EPOCH, you can see the onset from the left temporal chains as there is slowing prior to the myogenic artifact. In this case, given the tonic contraction, the myogenic artifact is quite intense. The most important fact we want to get during EMU admission, is the onset. Once the seizure is spread, there is nothing to see on the EEG, as you can see on this example, but prior to this is key, plus the lateralizing signs that you can get, if you are lucky.\

A 37 yo male, who is a musician, presented with right temporal lobe epilepsy, preoperative workup showed the musical association cortex in the fMRI study was at risk during surgery, so an awake craniotomy for lobectomy was performed, during which the subject continually identified musical notes produced by an iPhone, currently at 4 year follow-up he is seizure-free and continues to be a successful musician.\

37F, who was Dxed with RRMS 2 years back, presented to hospital with a GTC. She was loaded with Dilantin and by the time Neurology saw her, she was stable. We explained to her about the changes that are happening to her brain and encouraging her to consider treatment. Her driving privileges have been revoked. We started her on Keppra and she is awaiting EEG and Epilepsy clinic referral.