[Refractory temporal epilepsy. An analysis of 33 cases submitted to surgery]

To analyze clinical manifestations, ictal, interictal and intraoperative EEG monitoring in patients with medical treatment refractory temporal epilepsy successfully controlled surgically.

Retrospective analysis, 33 patients. Mean age: 36 ± 11.40; number of monthly seizures: 9 ± 14.23; mean duration of disease: 22 years; number of anti-epileptic drugs: 3 ± 0.93; average monitoring duration on Intensive Video-EEG Monitoring Unit: 6.42 ± 3.61 days. Scalp EEG was recorded with surface electrodes placed according to the 10-20 international system.

158 seizures were recorded, most of them focal complex. 82% of patients presented aura. Disturbances of consciousness appeared in 94.3%, being more precocious than the automatisms in the majority of the sample. The most frequent and precocious automatisms were oromandibular. Intercritical: epileptiform activity was observed in 87.9% of cases; sharp waves in 93.1%, increasing with sleepiness in 97%. Polyspikes during REM sleep in 21.2%. Bilateral epileptiform activity in 21.1%. Ictal activity: changes on EEG activity was observed previous to clinical manifestation in more than 69%. Type of ictal onset: flattening (46%), rhythmic slow activity (41.7%). Ictal onset was focal in 48.9%.

Detailed knowledge of clinical and electrical manifestations of temporal lobe epilepsies would allow a precocious diagnosis and a reduction of accessing time of these patients to surgical treatment in case of pharmaco-resistance.