Case Study

A 55 year old RHWF with refractory localization-related epilepsy was referred for surgical evaluation after a change in her “provider”.  She had a history of febrile convulsions with weekly focal seizures with and without impaired consciousness on 5 AEDs.  An aura of déjà vu occurred prior to staring, lip smacking, and impaired responsiveness for periods of 30 seconds.  Rare focal seizures evolving to convulsions were noted in addition to daily independent auras.  MRI demonstrated left >> right MTS. Scalp EEG recorded left > right bitemporal spikes (80% left) and 3 left hemisphere-onset seizures.  Neuropsychological testing demonstrated impaired executive function and severe verbal memory deficits.   Wada results were 5/8 left injection and 6/8 right injection.  She underwent iEEG with B/L occipital-temporal depth electrodes…

Figure: Depth iEEG (top), EKG, and scalp EEG (bottom) demonstrating a subclinical seizure from the left depth.  Note the absence of scalp correlate.  23 sbuclinical seizures were recorded in 24 hours. Recording parameters include longitudinal bipolar montage, sensitivity 7 uv, and filters of 1-70. Hz.

What did the EEG Reveal? Click here for answers and discussion.

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