The semiology of complex partial seizures (CPS) of temporal lobe origin in adults is well known and is important in establishing seizure localization in patients considered for epilepsy surgery. In contrast, the behavioral features of temporal lobe seizures (TLS) in children described in the literature have not been consistent. In the present study, we investigated children with TLS to compare their attacks to TLS occurring in adults. The study was based on video recordings of 29 children with TLS aged 18 months to 16 years. Children were included, if they became seizure-free after temporal lobectomy (except 4 children with a marked reduction in seizure frequency and 1 with isolated auras), and if clear unitemporal seizure onset in ictal EEG-recordings, unilateral radiological lesions, and corresponding histopathological findings were detected. Children aged > 6 years had TLS with features similar to those of adults. In younger children, typical semiology included symmetric motor phenomena of the limbs, postures similar to frontal lobe seizures in adults, and head nodding as in infantile spasms. We concluded that the clinical features of TLS in younger children can be misleading and should therefore be considered with caution in selecting patients for surgical procedures on the temporal lobe.
Abstract*Animal experiments and lesion studies have shown the importance of temporal lobe structures for language and memory[ We recorded intracranial cognitive potentials from the human lateral and medial temporal lobe in 15 patients with temporal lobe epilepsy undergoing presurgical evaluation\ using a word! and a picture!recognition paradigm[ Neuropsychological testing included word~uency\ verbal reasoning\ sustained attention and a verbal learning memory test "VLMT#\ which was an adapted version of the Rey auditory verbal learning test[ Word!speci_c N399!potentials elicited in the middle temporal gyrus of the dominant left hemisphere "LTL!N399# predicted immediate recall performance after learning\ whereas N399s\ elicited by words but not pictures in the left anterior medial temporal lobe "AMTL!N399#\ predicted delayed recall[ The number of words that were learned but forgotten after a 29!min delay correlated only with N399s elicited by words in the left anterior medial temporal lobe[ Thus\ intracranial recordings indicated that di}erent electrophysiological responses in di}erent temporal lobe structures were linked to memory scores from speci_c neuropsychological tests [
Our findings suggest progressive and interrelated structural-functional pathology of the hippocampus, as prodromal symptoms and behaviours accumulate, and the level of risk for psychosis increases. Given the inverse correlation of learning and memory deficits with social and vocational functioning in established schizophrenia, our findings substantiate the rationale for developing preventive treatment strategies that maintain cognitive capacities in the at-risk mental state.
The shorter time course of the left temporo-parietal Remember old/new effect suggests that the patients' episodic memory impairment was possibly mediated by a dysfunction of the mediotemporal regions. The more widespread frontal Know old/new effect in the patients suggests that the prefrontly mediated processes associated with retrieval of semantic memory may be enhanced compensatorily.
A polymorphism of the apolipoprotein E gene, in particular the epsilon 4 allele (ApoE4), has been associated with impaired neuronal phospholipid metabolism and synapse reorganization and has been implicated in several neurodegenerative disorders. Since selective neuronal cell lose and aberrant axonal reorganization represent hall-marks of Ammon's horn sclerosis (AHS) in patients with chronic temporal lobe epilepsy (TLE), the ApoE polymorphism was studied in 125 patients with TLE. The genotype analysis revealed a frequency of 15.5% for epsilon 4, and 74.8% and 9.8% for epsilon 3 and epsilon 2, respectively. These figures were not significantly different from those reported in the normal European population. In addition, no correlation was found between the ApoE4 allelotype and the age of epilepsy onset, seizure type, febrile seizures, family history of epilepsy, surgical outcome and neuropathological findings in patients with TLE. These data virtually exclude ApoE as a susceptibility gene involved in the pathogenesis of early onset TLE or AHS.
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