CHARACTERISTICS OF MEDIAL TEMPORAL-LOBE EPILEPSY - .2. INTERICTAL ANDICTAL SCALP ELECTROENCEPHALOGRAPHY, NEUROPSYCHOLOGICAL TESTING, NEUROIMAGING, SURGICAL RESULTS, AND PATHOLOGY

Citation
Pd. Williamson et al., CHARACTERISTICS OF MEDIAL TEMPORAL-LOBE EPILEPSY - .2. INTERICTAL ANDICTAL SCALP ELECTROENCEPHALOGRAPHY, NEUROPSYCHOLOGICAL TESTING, NEUROIMAGING, SURGICAL RESULTS, AND PATHOLOGY, Annals of neurology, 34(6), 1993, pp. 781-787
Citations number
42
Categorie Soggetti
Clinical Neurology",Neurosciences
Journal title
ISSN journal
03645134
Volume
34
Issue
6
Year of publication
1993
Pages
781 - 787
Database
ISI
SICI code
0364-5134(1993)34:6<781:COMTE->2.0.ZU;2-4
Abstract
Sixty-seven patients with temporal lobe epilepsy without circumscribed , potentially epileptogenic lesions, who were studied with intracrania l electrodes and who became seizure free following temporal lobectomy were retrospectively evaluated with regard to preoperative scalp elect roencephalographic (EEG) findings, neuropsychological test results, ne uroimaging findings, results of surgery, and pathology of resected tis sue. Interictal scalp EEG showed paroxysmal abnormalities during prolo nged monitoring in 64 patients (96%). These were localized in the ante rior temporal region in 60 (94%) of these 64 patients. Bilateral indep endent paroxysmal activity occurred in 42% of the patients and was pre ponderant over the side of seizure origin in half. Ictal EEG changes w ere rarely detected at the time of clinical seizure onset, but lateral ized buildup of rhythmic seizure activity during the seizure occurred in 80% of patients. In 13%, the scalp EEG seizure buildup was, however , contralateral to the side of seizure origin as subsequently determin ed by depth EEG and curative surgery. Lateralized postictal slowing, w hen present, was a very reliable lateralizing finding. Neuropsychologi cal testing provided lateralizing findings concordant with the side of seizure origin in 73% of patients. When neuropsychological testing pr oduced discordant results or nonlateralizing findings, those patients were usually found to have right temporal seizure origin. Intracarotid amobarbital (Amytal) testing demonstrated absent or marginal memory f unctions on the side of seizure onset in 63% of patients, but 26 patie nts (37%) had bilaterally intact memory. In those patients who had mag netic resonance imaging, it was very sensitive in detecting subtle med ial temporal abnormalities. These abnormalities were present in 23 of 28 magnetic resonance images, and corresponded with mesial temporal sc lerosis on pathological examination in all but 2 patients. Eighty-one percent of the 51 patients who had adequate pathological examination o f tissue had mesial temporal sclerosis. Forty-one patients with adequa te pathological examination had histories of febrile seizures and of t hese 38 (93%) had mesial temporal sclerosis.