Brain, Vol. 119, No. 6, 2133-2141, 1996
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Temporal lobe epilepsy caused by mesial temporal sclerosis and temporal neocortical lesions
A clinical and electroencephalographic study of 46 pathologically proven cases
1Royal Melbourne Hospital Melbourne, Australia 2St.vincent's hospital Melbourne, Australia 3Australian computing and communication institute Melbourne, Australia
Correspondence to:
Correspondence to: Dr Mark J. Cook, Department of Clinical Neuroscience, St Vincent's Hospital, Victoria Parade, Fitzroy, 3065 Victoria, Australia
This study aims to determine whether there are important clinico-electrical differences between patients with temporal lobe epilepsy (TLE) secondary to mesial temporal sclerosis (MTS) and those with TLE secondary to a discrete temporal neocortical lesion (NL). The case histories, interictal EEG, seizure semiology, ictal EEG and postoperative outcome of 46 pathologically proven patients (31 MTS and 15 NL) were compared. A history of febrile convulsions (FC) was more common in MTS patients (58% versus 26%, P < 0.05), as was a history of a significant cerebral event at <4 years of age (22% versus 0%, P < 0.05). There were no statistically significant differences in the incidence or nature of auras. No statistically significant differences between the groups were found in the interictal-EEG. With ictal semiology dystonic posturing occurred more frequently in MTS patients (mean 52% versus 26%, P < 0.05). Facial grimacing/ twitching occurred earlier in the seizures of NL patients (median 19 s versus 35 s, P < 0.05). There was an increased frequency of fast rhythmic sharp waves (>4 Hz) in the ictal-EEG of MTS patients (mean 81% versus 60%, P = 0.05). The patients with NL developed bilateral ictal EEG changes more often (mean 55% versus 26%, P < 0.05) and more rapidly (mean 23 s versus 74 s, P < 0.005). The onset of ictal EEG seizure activity was bilateral more often in patients with NL (20% versus 4%, P < 0.005). There were no significant differences between the two groups for any of the video-EEG features, in terms of whether or not the feature occurred at least once in an individual patient. There was a tendency for MTS patients to have a higher seizure-free post-surgical outcome (87% versus 60%, P = 0.057). However, all the NL patients who were not free of seizures had had an incomplete lesion resection. We conclude that there are a number of clinico-electrical differences between patients with mesial TLE (MTLE) and patients with neocortical TLE (NCTLE), but that none of these are sufficient to allow a distinction to be made in an individual patient.
temporal lobe epilepsy; mesial temporal sclerosis; neocortical foreign tissue lesions; mesial temporal lobe epilepsy; neocortical temporal lobe epilepsy
Received March 22, 1996. Revised June 19, 1996. Accepted June 24, 1996.
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