Medial temporal lobe epilepsy is the most common form of localization-related epilepsy in adults, is suggested by the history, and is surgically remediable by temporal lobectomy. Bilateral anterior temporal interictal epileptiform discharges are seen in a significant number of patients but yet unifocal TLE is frequently seen. The interictal EEG demonstrates wicket spikes consisting of intermittent bitemporal bursts of monophasic archiform potentials that bear no relationship to epilepsy. Wickets represent a common reason for the misuse of AEDs in patients without epilepsy1. The above case illustrates the ramifications of a misinterpreted interictal EEG in a patient (now seizure free) with a correct diagnosis but incorrect assumption of the surgical implication.
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