Continuous EEG/video recordings on 4 children with the interictal EEG pattern of multifocal independent epileptiform discharges (MIED) are reported from the Epilepsy Center, The Johns Hopkins University School of Medicine, Baltimore, MD. The predominant seizure pattern consisted of bilateral tonic seizures with fencing postures. Most seizures arose from surgically resectable regions and epilepsy surgery performed in three patients resulted in improved seizure control. One patient had a focal resection of superior frontal-parietal cortex and two had hemidecorticectomies. Because the scalp recorded EEG data did not provide adequate localization, intracranial electrodes were placed in 2 patients prior to the resections. [1]

COMMENT. The presence of bilateral independent or generalized epileptiform discharges as in patients with MIED is not an absolute contraindication to performing a hemispherectomy, according to the experience of these authors. If the majority of seizures do not originate in one hemisphere and the patient is having frequent generalized seizures, then a corpus callosotomy should be considered.