POSTERIOR TEMPORAL EPILEPSY - ELECTROCLINICAL FEATURES

In the course of evaluating children with posterior temporal lobe epil epsy with subdural electrodes, we observed that their seizures commonl y arose from basal rather than convexity foci and that they followed a stereotyped clinical sequence. Seizures characteristically began with behavioral arrest that coincided with basal temporal seizure discharg es and progressed to motor signs as the seizure activity spread to the ipsilateral cortical convexity. Behavioral automatisms were observed in approximately half the patients, but were never the first or most p rominent ictal manifestation. Focal lesions were identified preoperati vely in 7 patients: We performed tailored temporal lobe resections in 14 patients, 10 (71%) of whom were seizure free (N = 9) or had occasio nal auras (N = 1) at a mean follow-up of 2 years. These findings sugge st that in childhood, posterior temporal seizures frequently arise fro m basal cortex and have a consistent and recognizable ictal and electr ographic semiology. In medically refractory patients, tailored tempora l resection is an effective therapy.