Pseudotemporal Ictal Patterns Compared With Mesial and Neocortical Temporal Ictal Patterns

Elwan, Sherif; So, Norman K.; Enatsu, Rei; Bingaman, William

doi:10.1097/wnp.0b013e3182872f70

Cited by 17 publications

(7 citation statements)

References 25 publications

(23 reference statements)

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“…24 In line with this study, the presence of ictal onset as rhythmic theta discharge was more frequently observed in mesial TLE than lateral TLE or TPE. 18,25 The PET scans revealed lateralization value in most of our patients, in concordance to the epileptogenic zone defined by the intracranial monitoring, regardless of the MRI findings. Similarly, it was localized to the seizure onset zone's lobe in 75% of the patients.…”

Section: Facial Contractionsupporting

confidence: 75%

Seizure semiology in temporal lobe vs. temporal plus epilepsy using intracranial EEG monitoring

Khoja¹,

Albaradei²,

Alsulami³

et al. 2021

NSJ

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Objectives: To utilize our tertiary center's experience with Temporal lobe epilepsy )TLE( and Temporal plus epilepsy )TPE( cases and determine whether a correlation exists between ictal semiology signs, their localization/ lateralization value after intracranial electroencephalography )EEG( monitoring, and surgical outcomes.Methods: A retrospective study was conducted among epilepsy patients who underwent resective surgery for TLE or TPE after intracranial EEG monitoring between January 2008 and December 2018 at King Faisal Specialist Hospital in Riyadh, Saudi Arabia. Data were retrieved for 464 patients; 181 had intracranial electrode monitoring.Results: Forty-eight patients with a mean age of 27 years )SD=8.4( were included; 15 patients had TPE. Auras were frequently reported, emotional auras, in the form of fear )35%(. The localization/lateralization value of aura was statistically significant for TPE patients, including visual hallucinations and vertigo, lateralized to the left and right temporo-occipital, respectively )p=0.009 and <0.001(. Early-onset ictal manual automatism, oral automatism, late-onset dystonic posture, and late head-turning were significant for TLE without significant lateralization value. The ictal onset zone's localization was significant between the scalp and intracranial EEG findings in mesial TLE patients. The probability of seizure freedom )Engel class I( was 74%, 60%, and 67% at 2-year follow-up for mesial, lateral TLE, and TPE, respectively. Conclusion:Our results are consistent with previous studies and confirm the importance of ictal semiology signs in TLE and TPE. The addition of intracranial EEG monitoring in these cases helped improve the surgical outcomes.

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Section: Facial Contractionsupporting

confidence: 75%

Seizure semiology in temporal lobe vs. temporal plus epilepsy using intracranial EEG monitoring

Khoja¹,

Albaradei²,

Alsulami³

et al. 2021

NSJ

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“…The reasons for surgery failure are complex and variable, but emerging evidence points to failure to resect epileptogenic areas either within or outside the operated temporal lobe (7,(29)(30)(31). This situation can be defined as a dual pathology combining an extratemporal epileptogenic lesion and temporal epileptogenic zone (32,33).…”

Section: Discussionmentioning

confidence: 99%

FDG-PET Profiles of Extratemporal Metabolism as a Predictor of Surgical Failure in Temporal Lobe Epilepsy

Tang

Liao

et al. 2020

Front. Med.

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Objective: Metabolic abnormality in the extratemporal area on fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) is not an uncommon finding in drug-resistant temporal lobe epilepsy (TLE), however the correlation between extratemporal metabolic abnormalities and surgical long-term prognosis has not been fully elucidated. We aim to investigate FDG-PET extratemporal metabolic profiles predictive of failure in surgery for TLE patients.Methods: Eighty-two patients with unilateral TLE (48 female, 34 male; 25.6 ± 10.6 years old; 37 left TLE, 45 right TLE) and 30 healthy age-matched controls were enrolled. Patients were classified either as experiencing seizure-recurrence (SZR, Engel class II through IV) or seizure-free (SZF, Engel class I) at least 1 year after surgery. Regional cerebral metabolism was evaluated by FDG-PET with statistical parametric mapping (SPM12). Abnormal metabolic profiles and patterns on FDG-PET in SZR group were evaluated and compared with those of healthy control and SZF subjects on SPM12. Volume and intensity as well as special brain areas of abnormal metabolism in temporal and extratemporal regions were quantified and visualized.Results: With a median follow-up of 1.5 years, 60% of patients achieved Engel class I (SZF). SZR was associated with left TLE and widespread hypometabolism in FDG-PET visual assessment (both p < 0.05). All patients had hypometabolism in the ipsilateral temporal lobe but SZR was not correlated with volume or intensity of temporal hypometabolism (median, 1,456 vs. 1,040 mm3; p > 0.05). SZR was correlated with extratemporal metabolic abnormalities that differed according to lateralization: in right TLE, SZR exhibited larger volume in extratemporal areas compared to SZF (median, 11,060 vs. 2,112 mm3; p < 0.05). Surgical failure was characterized by Cingulum_Ant_R/L, Frontal_Inf_Orb_R abnormal metabolism in extratemporal regions. In left TLE, SZR presented a larger involvement of extratemporal areas similar to right TLE but with no significant (median, 5,873 vs. 3,464 mm3; p > 0.05), Cingulum_Ant_ R/L, Parietal_Inf_L, Postcentral_L, and Precuneus_R involved metabolic abnormalities were correlated with SZR.Conclusions: Extratemporal metabolic profiles detected by FDG-PET may indicate a prominent cause of TLE surgery failure and should be considered in predictive models for epilepsy surgery. Seizure control after surgery might be improved by investigating extratemporal areas as candidates for resection or neuromodulation.

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“…The caveat guarding against an overreliance on ictal scalp EEG patterns for localization, is that an Ebersole type I pattern can also be seen in pseudotemporal (so called TLE mimics) epilepsy, indicating that this rhythmic theta pattern can be a result of propagation from extratemporal regions . On the other hand, atypical or nonlocalizing scalp EEG findings may very well demonstrate mesial temporal seizure onset on ICEEG, again reiterating the limited reliability of electroclinical localization in TLE.…”

Section: Electrophysiologic Studies: Scalp and Intracranial Eeg (Iceementioning

confidence: 99%

MRI‐negative temporal lobe epilepsy—What do we know?

et al. 2017

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Temporal lobe epilepsy (TLE) is the most common focal epilepsy in adults. TLE has a high chance of becoming medically refractory, and as such, is frequently considered for further evaluation and surgical intervention. Up to 30% of TLE cases, however, can have normal ("nonlesional" or negative) magnetic resonance imaging (MRI) results, which complicates the presurgical workup and has been associated with worse surgical outcomes. Helped by contributions from advanced imaging techniques and electrical source localization, the number of surgeries performed on MRI-negative TLE has increased over the last decade. Thereby new epidemiologic, clinical, electrophysiologic, neuropathologic, and surgical data of MRI-negative TLE has emerged, showing characteristics that are distinct from those of lesional TLE. This review article summarizes what we know today about MRI-negative TLE, and discusses the comprehensive assessment of patients with MRI-negative TLE in a structured and systematic approach. It also includes a concise description of the most recent developments in structural and functional imaging, and highlights postprocessing imaging techniques that have been shown to add localization value in MRI-negative epilepsies. We evaluate surgical outcomes of MRI-negative TLE, identify prognostic makers of postoperative seizure freedom, and discuss strategies for optimizing the selection of surgical candidates in this group.

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Pseudotemporal Ictal Patterns Compared With Mesial and Neocortical Temporal Ictal Patterns

Abstract: Pseudotemporal ictal patterns are morphologically indistinguishable from true temporal ictal patterns. Although statistically more common in hippocampal sclerosis, rhythmic theta pattern can be seen as a result of propagation from extratemporal sites.

Cited by 17 publications

References 25 publications

Seizure semiology in temporal lobe vs. temporal plus epilepsy using intracranial EEG monitoring

Seizure semiology in temporal lobe vs. temporal plus epilepsy using intracranial EEG monitoring

FDG-PET Profiles of Extratemporal Metabolism as a Predictor of Surgical Failure in Temporal Lobe Epilepsy

MRI‐negative temporal lobe epilepsy—What do we know?

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