Discussion
With this case we would like to highlight the importance that video recording had in the diagnosis of our patient. For eight years he had been having seizures that were a source of anxiety and were limiting his quality of life and safety.
Clinically, these were mesial temporal focal seizures, with an epigastric aura followed by suppression of consciousness, limb and oral automatisms and eye blinking. The post-ictalaphasia indicated a probable dominant-lobe temporal focus. Although, semiologically typical, they are difficult to describe by patients, due to their lack of awareness during the episode, and for a lay witness, some details such as the chewing or blinking could seem irrelevant. Also, the fact that our patient’s seizures were brief, and at first widely spaced in time, made difficult any observation by the physicians that were less trained in the area of epilepsy. As reported by Bronen et al (1996), in temporal sclerosis CT scan may be irrelevant and inter-ictal EEG normal according to Cersósino et al (2011). However, epilepsy diagnosis is clinical.
Our patient is a paradigm of a focal temporal lobe epilepsy, whose diagnosis had been missed due to the absence of convulsive activity and presence of subtle clinical aspects that were only identified after video recording.
With recent diffusion of portable video recording technologies such as in mobile phones, we suggest that, in cases where there is description of transient alterations in neurologic status that cannot be accurately characterized, we should encourage patients and caregivers to record these events, in order to increase our capacity to identify and detail seizures.
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