Lateralizing value of semiology in medial temporal lobe epilepsy

Acta Neurol Scand. 2015 Dec;132(6):401-9. doi: 10.1111/ane.12409. Epub 2015 Apr 9.

Abstract

Objectives: Analysing the clinical characteristics of seizures constitutes a fundamental aspect of the presurgical evaluation of patients with medial temporal lobe epilepsy and unilateral hippocampal sclerosis (MTLE-HS), the most frequent form of focal epilepsy accessible to surgery. We sought to retrospectively determine whether objective manifestations could have a reliable lateralizing value in a large population of MTLE-HS patients and if their presence could help to identify those patients who would be seizure free after surgery.

Material and methods: We analysed the frequency and predictive lateralizing value of objective ictal and postictal signs in 391 patients with MTLE-HS (183 left/208 right). Data were derived from chart review and not from blinded videoEEG analysis. Correlation between the presence of reliable lateralizing signs and postoperative outcome was performed in a subgroup of 302 patients who underwent surgery.

Results: Contralateral dystonic posturing was the most frequent and reliable lateralizing sign that correctly lateralized the focus in 96% of patients. Unilateral head/eye deviation was noted in 42% of the patients and predicted unilateral focus in 67%. Ipsilateral postictal nose wiping, contralateral clonus and hypokinesia correctly lateralized the focus in 75%, 81%, respectively, and 100 of patients but were less frequently depicted. Postictal aphasia was a strong lateralizing sign for left MLE-HS. The presence of reliable lateralizing signs was not a predictor of seizure freedom.

Conclusion: Seizure semiology is a simple tool that may permit reliable lateralization of the seizure focus in MTLE-HS. The presence of reliable lateralizing signs is not associated with a better postoperative outcome.

Keywords: epilepsy; outcome; semiology; video-EEG.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age of Onset
  • Aphasia / etiology
  • Child
  • Dystonia / etiology
  • Electroencephalography
  • Epilepsy, Temporal Lobe / physiopathology*
  • Epilepsy, Temporal Lobe / surgery
  • Eye Movements
  • Female
  • Functional Laterality
  • Head Movements
  • Hippocampus / pathology
  • Humans
  • Male
  • Middle Aged
  • Neurosurgical Procedures
  • Prognosis
  • Retrospective Studies
  • Sclerosis
  • Seizures / physiopathology*
  • Treatment Outcome
  • Young Adult