5-YEAR OUTCOME AFTER EPILEPSY SURGERY IN NONMONITORED AND MONITORED SURGICAL CANDIDATES

Purpose: We wished to compare outcome 5 years after temporal lobectomy in 28 patients selected for surgery on the basis of interictal EEG pa tterns with that in 46 patients who underwent EEG-video monitoring stu dies as part of their preoperative evaluation during the same era. Met hods: The 28 nonmonitored patients had interictal EEG patterns that de monstrated a consistent, unilateral, anterior-midtemporal epileptiform focus, without discordant findings from other studies. Outcomes were assessed for years 4 and 5 after operation. Results: Twenty-six of 28 (92.9%) nonmonitored patients were seizure-free or had at least 75% re duction in seizures. Twenty-nine of 46 (63.0%) monitored patients were seizure-free or had at least 75% reduction in seizures. Preoperative interictal EEGs of 29 of these patients showed independently localized bitemporal, extratemporal, midposterior temporal, or diffuse epilepti form patterns. The remaining 17 monitored patients had preoperative st rictly unilateral anterior-midtemporal interictal discharges, and thei r outcome was comparable to the nonmonitored group, with 15 (88.8%) se izure-free or with at least 75% reduction in seizures. Conclusions: A proportion of candidates for epilepsy surgery can be selected without ictal recordings provided that interictal EEGs demonstrate consistent unilateral anterior-midtemporal epileptiform discharges and that other data are not discordant.