Brain, Vol 120, Issue 1 183-192, Copyright © 1997 by Oxford University Press
A Gil-Nagel and MW Risinger
We have analysed retrospectively the clinical features and
electroencephalograms in 35 patients with complex partial seizures of
temporal lobe origin who were seizure-free after epilepsy surgery. Two
groups were differentiated for statistical analysis: 16 patients had
hippocampal temporal lobe seizures (HTS) and 19 patients had
extrahippocampal temporal lobe seizures (ETS) associated with a small
tumour of the lateral or inferior temporal cortex. All patients in the HTS
group had ictal onset verified with intracranial recordings (depth or
subdural electrodes). In the ETS group, extrahippocampal onset was verified
with intracranial recordings in eight patients and assumed, because of
failure of a previous amygdalohippocampectomy, in one patient. Historical
information, ictal semiology and ictal EEG of typical seizures were
analysed in each patient. The occurrence of early and late oral automatisms
and dystonic posturing of an upper extremity was analysed separately. A
prior history of febrile convulsions was obtained in 13 HTS patients
(81.3%) but in none with ETS (P < 0.0001, Fisher's exact test). An
epigastric aura preceded seizures in five patients with HTS (31.3%) and
none with ETS (P = 0.0135, Fisher's exact test), while an aura with
experiential content was recalled by nine patients with ETS (47.4%) and
none with HTS (P = 0.0015), Fisher's exact test). Early oral automatisms
occurred in 11 patients with HTS (68.8%) and in two with ETS (10.5%) (P =
0.0005, Fisher's exact test). Early motor involvement of the contralateral
upper extremity without oral automatisms occurred in three patients with
HTS (18.8%) and in 10 with ETS (52.6%) (P = 0.0298, Fisher's exact test).
Arrest reaction, vocalization, speech, facial grimace, postictal cough,
late oral automatisms and late motor involvement of the contralateral arm
and hand occurred with similar frequency in both groups. These observations
show that the early clinical features of HTS and ETS are different.
ARTICLES
Ictal semiology in hippocampal versus extrahippocampal temporal lobe epilepsy
Department of Neurology, University of Minnesota, Minneapolis, USA.
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