American Board of Internal Medicine (ABIM) Certification Practice Exam

Which of the following findings may be normal in patients diagnosed with temporal lobe epilepsy?

1. Focal findings on MRI

2. Electroencephalographic results

3. Neuropsychological test results

4. Fundoscopic examination

The correct answer is: Electroencephalographic results

Electroencephalographic results can often appear normal in patients diagnosed with temporal lobe epilepsy, especially when there is no active seizure occurring during the EEG recording. Seizures in temporal lobe epilepsy can be focal and may not always produce the characteristic generalized spikes or sharp waves detectable on an EEG. Some patients may exhibit normal EEG findings between seizures, which is a critical point in understanding the condition. This variability in electroencephalographic results highlights the importance of correlating clinical history with test findings when diagnosing epilepsy. In contrast, focal findings on MRI are typically indicative of underlying structural abnormalities, such as hippocampal sclerosis, which is often seen in individuals with temporal lobe epilepsy. Neuropsychological test results might reflect cognitive deficits commonly associated with epilepsy, particularly if there are disruptions in areas of the brain responsible for memory and cognitive processing. Fundoscopic examination is not relevant to the diagnosis of temporal lobe epilepsy, as it primarily assesses the retina and optic disc without providing direct information about seizures or their localization in the brain.