Photosensitive temporal lobe epilepsy

Photosensitive temporal lobe epilepsy

Society Proceedings/Electroencephalography the form of hypotension, respiratory compromise, skin problems and delayed recovery after discontinuation o...

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Society Proceedings/Electroencephalography the form of hypotension, respiratory compromise, skin problems and delayed recovery after discontinuation owing to longer half-life. I have utilized intravenous midazolam (VersedR) drip at rates varying from 5 to 20 mg/h, sometimes for several days in 6 patients with intractable partial complex status. Settings included perioperative complications from awake craniotomies for tailored temporal lobectomy as a result of discontinuation of seizure medications to facilitate intraoperative corticography, metastatic brain disease, primary brain tumor and acute exacerbation of chronic partial epilepsy. Clinical and electrographic improvements were spectacular, hypotension was not a significant problem, some patients were awake or easily rousable even at rates of 15 mg/h, thus helping in monitoring the sensorium - a feat impossible with pentobarbital. Intubation was usually needed for reasons other than midazolam drip but patients continued to assist the respirator, improvement in sensorium was rapid after discontinuation and no skin problems were encountered. Improvements were sustained as well. The limited data raise the possibility for a significant advance in the management of intractable partial status, i.e., the use of intravenous midazolam drip. Dr. Verma is a participant

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125. Dacrystic status epilepticus. - RE. Steg, D. Wang and N.N. Futrell (Department of Neurology, School of Medicine, Creigbton University, Omaha, NE)

Crying may occur as an ictal or postictal phenomenon or in association with a non-epileptic seizure. Ictal crying (dacrystic seizure) is a relatively rare epileptic condition. The neuroanatomic localization of crying remains unknown. In the majority of patients with dacrystic seizures, the EEG has revealed evidence of a frontotemporal seizure focus in the non-dominant cerebral hemisphere. We report a case of dacrystic status epilepticus as documented on EEG in a 66-year-old, right-handed male with a right temporal ischemic infarction demonstrated on MRI. The patient exhibited repeated episodes of deviation of the head to the left, accompanied by a mournful facial expression and tearing. An EEG performed during this event revealed ictal discharges occurring repeatedly over the right temporal area. To our knowledge, this is the first reported case of dacrystic status epilepticus in a patient with an ischemic stroke.

126. Photosensitive temporal lobe epilepsy. - W. Gerson, S. Benhadis, J. Harvey and H. Liiders (Department of Neurology, Section of Epilepsy, Cleveland Clinic Foundation, Cleveland, OH)

Photosensitive seizures are well documented in primary generalized epilepsy, and occipital lobe epilepsy. This report investigates a patient with photbsensitive temporal lobe epilepsy. A 28-year-old woman was evaluated for intractable seizures. Seizures were characterized by an indescribable aura, followed by loss of awareness and arrest of activity with prominent gestural and alimentary automatisms. Post&ally, she experienced confusion and amnesia. There was no known etiology. Surface EEG-video monitoring revealed a single interictal spike focus at SP2 and right temporal onset of 2 spontaneous and 3 photo-induced seizures. Analysis of the 5 seizures localized 2 left, 2 right, and 1 not lateralized. PET scan showed right temporal hypometabolism. MRI was normal. Intracarotid amybarbitol procedure revealed left hemisphere dominance for speech and memory. Bitemporal depth-EEG demonstrated bilateral interictal spikes (40% left and 60% right). Ictal depth-EEG recording proved right posterior hippocampal onset in 3 spontaneous and 1 photic-induced seizure. Because of the normal hippocampi and unusual photosensitivity, a subdural EEG evaluation was performed with right occipito-temporal grids. This revealed right

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mesio-basal anterior temporal ictal onset in 3 photic-induced and 1 spontaneous seizure. To our knowledge there are no previous reports of photosensitive temporal lobe epilepsy.

127. D6j1-vu sensation. - F. Matsuo and A.A. Chiba (Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT) Dij‘a-vu sensation is well known for its association with partial complex epilepsy of temporal lobe origin (PCETL). It has been reported as common among the asymptomatic population. Critical assessment contrasting normal and pathological cases, however, is sparse. When associated with PCETL, it may indicate only that the patient reports a sequence of symptoms identical to previous occurrences regardless of content. Some PCETL patients report the ictal symptom as being mundane in content, non-threatening and varying from an attack to the next. The sense of intense familiarity alone seizes them despite rational knowledge that the situation is otherwise normal, leading one patient to feel as though she had seen the scene in a video movie and thus could tell what was going to happen. PCETL cases may differ only in intensity and duration from the control population. Most problematic is that a sizable number of PCETL patients assign a time code of the future, seemingly forced by the lack of retrievable past memory, combined with the strong sense of reality, false as it is. These are representative of issues raised and will be supported by transcripts from clinical interviews and published case reports. Is dkj&vu sensation a simple partial epileptic symptom?

128. Stimulus sensitive epileptiform bursts in suppressed EEGs: report of 4 cases. - A.C. Van Cott b, I. Blatt b and RP. Brenner qb (Departments of ’ Psychiatry and b Neurology, University of Pittsburgh, Pittsburgh, PA) Stimulus sensitive epileptiform bursts in otherwise suppressed EEGs have rarely been described. We report 4 patients who had this unusual pattern following severe hypoxic-ischemic injury. Three men and 1 woman, aged 45-68 years, suffered anoxic-ischemic insult following cardio-respiratory failure. EEGs were performed within 12 h of arrest. In 1 patient, following auditory stimulation, the record consistently showed bursts of polyspikes and sharp waves lasting less than 10 set without clinical accompaniment. There was no cerebral activity between the epileptiform bursts. In the other 3 patients, tactile stimulation consistently elicited bursts of generalized spike and polyspike activity lasting from 1 to 45 set and associated with clinical seizures; at times, these appeared to occur spontaneously. One man had eye fluttering and generalized clonic activity while the woman had clonic movement of her lower extremities associated with the discharges. The other patient had two types of seizures. The first consisted of clonic movement of all extremities accompanied by eye opening and biting movements. He also had myoclonic jerks and eye opening with brief discharges. Response to treatment with antiepileptic drugs was minimal. All patients died within 48 h of the initial EEG records.

129. The correlation of interictal spikes and ictal EEG patterns with postsurgical outcomes in temporal lobe epilepsy patients. - S.B. Hong and H.O. Liiders (The Cleveland Clinic Foundation, Cleveland, OH) We analyzed digitally 2 min EEG every 1 h for interictal spikes (ITS) and reviewed all seizures for ictal EEG patterns (IEP) during long-term monitoring in 50 intractable temporal lobe epilepsy patients who underwent temporal lobectomy. The postoperative follow-ups were 6-35 months. ITS were investigated by 2 methods: (A) grading into (1) unitemporal spikes (lOO%), (2) mainly unitemporal (> 50%) with ipsi-extratemporal, (3) mainly ipsi-extratemporal with some unitemporal (<