Mesial temporal temporal lobe epilepsy (mTLE) is the most common surgically remediable human epilepsy syndrome with MTS the most frequently encountered pathology. Seizure freedom is obtainable in approximately 70%, though beyond seizure freedom, successful taper from AEDs is a major aim of surgical pursuit. About 50% are able to be successfully tapered from AEDs and are ultimately "cured" of their epilepsy1. Favorable clinical signs for a successful taper in our patient include the presence of MTS and young age at onset. The long seizure duration before surgery, seizure occurrence prior to AED taper, and persistent interictal epileptiform discharges on EEG represent unfavorable signs. The sensitivity of scalp EEG to detect IEDs can be enhanced by obtaining both wakefulness and sleep. In addition, multiple recordings may enhance detection2. We recommended our patient continue her AEDs. No focal seizures with or without awareness were captured on prolonged 3 day CAA-EEG monitoring and she continues on CBZ monotherapy and is married, driving, and employed.
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