Differentiating Clinical Features of Right and Left Temporal Lobe Seizures

Abstract

We reviewed 127 seizures in 19 consecutive patients with temporal lobe epilepsy (TLE) documented by EEG/closed-circuit TV (EEG-CCTV) monitoring. Ten patients had seizure onset in the right temporal lobe (RTL, 54 seizures), and 9 had seizure onset in the left temporal lobe (LTL, 73 seizures). We compared the clinical characteristics in the two groups and analyzed the seizures for frequency of auras, seizures secondarily generalized, automatisms, tonic head deviation, focal posturing and jerking, ictal speech, and postical manifestations. Automatisms overall were more common in the RTL group, but individual categories (extremity, head and trunk, oroalimentary) were comparable among the two groups. Contralateral focal jerking and tonic head deviation were more common in LTL lobe seizures, as were secondarily generalized seizures. In addition to focal motor symptoms, three features were most statistically significant in distinguishing the two groups: Postictal aphasia occurred exclusively in the LTL group, whereas well-formed ictal speech and rapid return to baseline postictally were noted only in RTL seizures.

Clinical and eeg analysis of mesial and lateral temporal lobe seizures

“…Similarly to our results, others reported a great percentage of automatisms during TLS, specially the oromandibular type 5,9,16,18 . There were no differences between the two groups as in the casuistic of O'Brien et al 15 .…”

“…The duration of TLS in this casuistics is similar to that of others 5,9,18 . The low incidence of auras is also reported by other video-EEG studies 9,19 , and it can be related to some patients' inability to report them after secondarily generalized seizures related to antiepileptic drug reduction with a larger incidence of retrograde amnesia 20 .…”

“…Ictal speech occurred mainly during right temporal seizures as reported by others 18,34 suggesting nondominant temporal EA 18,26,35,36 . It seems to result of functional nondominant temporal lobe impairment by epileptic discharges and consequent hyperfunction of the dominant hemisphere for language 35 .…”

“…This feature occurred predominantly in the left temporal seizures as in the casuistics of Fakhoury et al 18 . The presence of FHT exclusively in group 1 patients was not observed in other casuistics 15,16 .…”

“…There were no differences between the two groups as in the casuistic of O'Brien et al 15 . Spitting automatism occurred during right temporal seizures as it is found in the literature 18 , representing a lesser common type of oral motor automatism 23 . Sexual automatisms are more related to right temporal seizures 24 , although in our casuistics they were found in left and right TLS.…”