Ictal and postictal semiology in patients with bilateral temporal lobe epilepsy

Bilateral temporal lobe epilepsy is characterized by evidence of seizure onset independently in both temporal lobes. The main aim of the present study was to determine whether patients with evidence of independent bilateral temporal lobe epilepsy (biTLE) can be identified noninvasively on the basis of seizure semiology analysis. Thirteen patients with biTLE, as defined by invasive EEG, were matched with 13 patients with unilateral temporal lobe epilepsy (uniTLE). In all 26 patients, the frequency of predefined clusters of ictal and periictal signs were evaluated: ictal motor signs (IMSs), periictal motor signs (PIMSs), periictal vegetative signs (PIVSs), the frequency of early oroalimentary automatisms (EOAs), and the duration of postictal unresponsiveness (PU). Some other noninvasive and clinical data were also evaluated. A lower frequency of IMSs was noted in the group with biTLE (patients = 46.2%, seizures = 20.7%) than in the group with uniTLE (patients = 92.3%, seizures = 61.0%) (p = 0.030; p < 0.001, respectively). The individual IMS average per seizure was significantly lower in the group with biTLE (0.14; range = 0-1.0) than in the group with uniTLE (0.80; range = 0-2.6) (p = 0.003). Postictal unresponsiveness was longer than 5 min in more patients (75.0%) and seizures (42.9%) in the group with biTLE than in the group with uniTLE (patients = 30.8%, seizures = 18.6%) (p = 0.047; p = 0.002). The frequency of EOAs, PIMSs, PIVSs, and other clinical data did not differ significantly. There is a lower frequency of ictal motor signs and longer duration of postictal unresponsiveness in patients with biTLE.

[1]  M. Brázdil,et al.  Lateralized ictal immobility of the upper limb in patients with temporal lobe epilepsy , 2005, European journal of neurology.

[2]  G. Morris,et al.  Postictal language assessment and lateralization of complex partial seizures , 1991, Annals of neurology.

[3]  D. Ficker,et al.  Postictal language dysfunction in complex partial seizures: Effect of contralateral ictal spread , 2001, Neurology.

[4]  C E Elger,et al.  Prognostic Significance of Ictal and Interictal Epileptiform Activity in Temporal Lobe Epilepsy , 1994, Epilepsia.

[5]  S. Spencer,et al.  Anatomic Correlates of Interhippocampal Seizure Propagation Time , 1992, Epilepsia.

[6]  R. Mattson,et al.  Comparison of bitemporal and unitemporal epilepsy defined by depth electroencephalography , 1991, Annals of neurology.

[7]  E. Pataraia,et al.  Postictal nose wiping: A lateralizing sign in temporal lobe complex partial seizures , 1998, Neurology.

[8]  A. Wyler,et al.  A grading system for mesial temporal pathology (hippocampal sclerosis) from anterior temporal lobectomy , 1992 .

[9]  G. Ojemann,et al.  Outcome following surgery in patients with bitemporal interictal epileptiform patterns , 1997, Neurology.

[10]  P. Gloor,et al.  Results of surgical treatment in patients with bitemporal epileptiform abnormalities , 1989, Annals of neurology.

[11]  George W. Williams,et al.  Psychomotor seizures of temporal lobe onset: Analysis of symptom clusters and sequences , 1995, Epilepsy Research.

[12]  M. Brázdil,et al.  Occurrence and lateralizing value of “rare” peri-ictal vegetative symptoms in temporal lobe epilepsy , 2010, Epilepsy & Behavior.

[13]  G. Barnett,et al.  The value of PET scan (and MRI and Wada test) in patients with bitemporal epileptiform abnormalities. , 1995, Archives of neurology.

[14]  G. Ojemann,et al.  Identifying Potential Surgical Candidates in Patients with Evidence of Bitemporal Epilepsy , 2003, Epilepsia.

[15]  B. Abou-Khalil,et al.  Rhythmic Ictal Nonclonic Hand (RINCH) Motions: A Distinct Contralateral Sign in Temporal Lobe Epilepsy , 2006, Epilepsia.

[16]  J. Phillips,et al.  Outcome Measurement after Vagal Nerve Stimulation Therapy: Proposal of a New Classification , 2007, Epilepsia.

[17]  S. Spencer,et al.  Combined depth and subdural electrode investigation in uncontrolled epilepsy , 1990, Neurology.

[18]  B. Abou-Khalil,et al.  Significance of head turn sequences in temporal lobe onset seizures , 1996, Epilepsy Research.

[19]  C. Adam,et al.  Temporal and Spatial Characteristics of Intracerebral Seizure Propagation: Predictive Value in Surgery for Temporal Lobe Epilepsy , 1994, Epilepsia.

[20]  L. Deecke,et al.  Clinical seizure lateralization in mesial temporal lobe epilepsy , 1998, Neurology.

[21]  T. Walczak,et al.  Temporal Lobectomy and Independent Bitemporal Interictal Activity: What Degree of Lateralization Is Sufficient? , 1991, Epilepsia.

[22]  H. Lüders,et al.  Ictal scalp EEG in temporal lobe epilepsy with unitemporal versus bitemporal interictal epileptiform discharges , 1995, Neurology.

[23]  S. Sato,et al.  Postictal behavior. A clinical and subdural electroencephalographic study. , 1994, Archives of neurology.

[24]  Kwang Ki Kim,et al.  Postictal language function , 2010, Epilepsy & Behavior.

[25]  T L Babb,et al.  Interhemispheric Propagation Time of Human Hippocampal Seizures , 1986, Epilepsia.

[26]  M. Sperling,et al.  Auras and subclinical seizures: Characteristics and prognostic significance , 1990, Annals of neurology.

[27]  D. Spencer,et al.  Temporal lobectomy in patients with bitemporal epilepsy defined by depth electroencephalography , 1991, Annals of neurology.

[28]  Jacqueline A. French,et al.  Characteristics of medial temporal lobe epilepsy , 1993 .

[29]  J. Shih,et al.  Frequency of Bitemporal Independent Interictal Epileptiform Discharges in Temporal Lobe Epilepsy , 2000, Epilepsia.

[30]  M. Brázdil,et al.  Effect of vagal nerve stimulation on patients with bitemporal epilepsy , 2003, European journal of neurology.

[31]  B. Abou-Khalil,et al.  Differentiating Clinical Features of Right and Left Temporal Lobe Seizures , 1994, Epilepsia.

[32]  A Olivier,et al.  Surgical treatment of independent bitemporal lobe epilepsy defined by invasive recordings , 2008, Journal of Neurology, Neurosurgery, and Psychiatry.

[33]  M. Brázdil,et al.  Peri-ictal bed leaving in temporal lobe epilepsy: Incidence and lateralizing value , 2011, Epilepsy & Behavior.

[34]  L F Quesney,et al.  Depth electrode investigations in patients with bitemporal epileptiform abnormalities , 1989, Annals of neurology.

[35]  H. Lüders,et al.  Dystonic posturing in complex partial seizures of temporal lobe onset , 1989, Neurology.

[36]  R. Mattson,et al.  Human Hippocampal Seizure Spread Studied by Depth and Subdural Recording: The Hippocampal Commissure , 1987, Epilepsia.

[37]  R. Mattson,et al.  Characteristics of medial temporal lobe epilepsy: II. Interictal and ictal scalp electroencephalography, neuropsychological testing, neuroimaging, surgical results, and pathology , 1993, Annals of neurology.

[38]  J Gotman,et al.  Relations Between EEG Seizure Morphology, Interhemispheric Spread, and Mesial Temporal Atrophy in Bitemporal Epilepsy , 1997, Epilepsia.

[39]  M. Sperling,et al.  Outcome after temporal lobectomy in bilateral temporal lobe epilepsy , 1997, Annals of neurology.

[40]  Jerome Engel,et al.  Outcome with respect to epileptic seizures. , 1993 .

[41]  Maria Thom,et al.  The clinicopathologic spectrum of focal cortical dysplasias: A consensus classification proposed by an ad hoc Task Force of the ILAE Diagnostic Methods Commission 1 , 2011, Epilepsia.

[42]  N. Barbaro,et al.  Vagus Nerve Stimulation for the Treatment of Bilateral Independent Temporal Lobe Epilepsy , 2001, Epilepsia.

[43]  M. Salinsky,et al.  Laterality and temporal distribution of seizures in patients with bitemporal independent seizures during a trial of responsive neurostimulation , 2011, Epilepsy Research.