Non-epileptic seizures in temporal lobectomy candidates with medically refractory seizures

Diagnosis of epileptic seizures is often based on temporal lobe epileptiform abnormalities appearing on interictal EEG, when reported ictal semiologies are consistent with temporal lobe seizures. It is unclear how often such patients have non-epileptic seizures. We studied 145 patients who had temporal interictal EEG spikes and reported ictal semiology characteristic of temporal lobe seizures, with long-term EEG-video-monitoring (LTM) for presurgical evaluation of medically refractory seizures. Nonepileptic seizures were unexpectedly recorded in 12 of these patients (8%). Outcomes after LTM in patients who had both epileptic seizures and nonepileptic seizures demonstrated that the epileptic seizures usually were controlled with medications. Our observations support LTM as useful in diagnosis of non-epileptic seizures in this group of patients. We suggest that ictal recordings always should be performed before epilepsy surgery, in part to avoid unintentional surgical treatment of nonepileptic seizures.