• H&P

    • 35-year-old male baseball stadium guard with epilepsy
    • Currently AED regimen: levetiracetam, lacosamide
    • Previous AEDs tried: phenytoin, lamotrigine, carbamazepine
    • Continues to have 2-3 complex partial seizures per month
    • Seizure semiology: feeling of foreboding followed by loss of awareness
    • Video-EEG: right anterior temporal seizures
    • MRI and PET scan shown in figure
    • Neuropsychological testing: Full-scale IQ 80, verbal memory average

    Figure 1

    1. What is the next step in management?

    2. What is the chance that adding another medication to the patient’s regimen will reduce seizure frequency?

    3. When you decide to intervene surgically on a patient with classic mesial temporal sclerosis, which technique do you prefer?

    4. Which of the following describes you?

    5. I practice in one of the following locations.

    6. Please add any suggestions or comments regarding this case:
     
    • Very good case selection for surgery
    • I would want other neuropsych tests like SRTs and language fMRI to possibly avoid Wada. If normal verbal SRTs and fMRI shows left hemisphere dominant for speech, skipping Wada might be a choice.
    • Even the Video-EEG shows right anterior temporal seizures, the MRI shows a Mesial Temporal Sclerosis, so I must perform a right selective amygdalohippocampectomy.
    • I would add up 1 more AED and see the results and if the patient still has seizures I would subject the patient to selective amygdalo-hippocampectomy.
    • I saw lot of times selective amigdalohipocampectomy of Professor Goel and best outcome after surgery with beautifull aproach
    • I would offer the term of "standard temporal lobectomy" should be changed. Temporal lobe cannot be removed "en bloc" because of its microanatomical features. Every center and every hand has its own standard.
    • No comments
    • either standard temporal lobectomy or selective resection may produce similar outcome.
    • results of temporal resection and hyp are better than any other procedure.

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