Evaluation of partial epilepsy in Iran: role of video-EEG, EEG, and MRI with epilepsy protocol

Background: we evaluated the diagnostic value of Electroencephalography (EEG), video-EEG monitoring (VEM) and Magnetic resonance imaging (MRI) of the brain with epilepsy protocol in patients with complex partial epilepsy. Methods: Forty-two consecutive patients underwent complete neurological examination, EEG, and MRI with a modified epilepsy protocol. A subset of these patients (n=29) also underwent VEM. Data were presented using descriptive statistics and were analyzed using Chi square and McNemar tests. Results: Twenty-four women and eighteen men entered the study. The mean (±SD) age for patients, was 25.2(±10.1) and mean (±SD) age at onset was 10.9(±8.1). All patients had abnormal ictal or interictal EEG. Fifteen patients had normal MRI. Temporal lobe involvement was the most common involvement in both EEG (27 patients) and MRI (14 patients). Interictal EEG was abnormal in 81% of patients which showed epileptiform discharges in about half of the cases. In half of patients who had lateralized finding on MRI, site of the lesion was congruent between MRI and interictal EEG. Thirty-six patients had symptoms suggesting a specific lobe, of which interictal EEG was able to show the concordant lobe in 22 (61%) patients. McNemar test showed superiority of EEG over MRI in correct diagnosis of the involved lobe based on the clinical manifestations (P<0.01). Conclusion: In our setting, both ictal and interictal EEG perform better than MRI in evaluating complex partial epilepsy. In addition, combination of these tools may increase the yield of showing abnormality to near 100% in patients with complex partial epilepsy.