ICTAL SEMIOLOGY IN HIPPOCAMPAL VERSUS EXTRAHIPPOCAMPAL TEMPORAL-LOBE EPILEPSY

We have analysed retrospectively the clinical features and electroence phalograms in 35 patients with complex partial seizures of temporal lo be origin who were seizure-free after epilepsy surgery. Two groups wer e differentiated for statistical analysis: 16 patients had hippocampal temporal lobe seizures (HTS) and 19 patients had extrahippocampal tem poral lobe seizures (ETS) associated with a small tumour of the latera l or inferior temporal cortex. All patients in the HTS group had ictal onset verified with intracranial recordings (depth or subdural electr odes). In the ETS group, extrahippocampal onset was verified with intr acranial recordings in eight patients and assumed because of failure o f a previous amygdalohippocampectomy, in one patient. Historical infor mation, ictal semiology and ictal EEG of typical seizures were analyse d in each patient. The occurrence of early and late oral automatisms a nd 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). Art ep igastric aura preceded seizures in Jive patients with HTS (31.3%) and none with ETS (P = 0.0135, Fisher's exact test), while an aura with ex periential content was recalled by nine patients with ETS (47.4%) and none with HTS (P = 0.0015, Fisher's exact test). Early oral automatism s occurred in II patients with HTS (68.8%) and in two with ETS (10.5%) (P = 0.0005, Fisher's exact test). Early motor involvement of the con tralateral upper extremity without oral automatisms occurred in three patients with HTS (18.8%) and in10 with ETS (52.6%) (P = 0.0298, Fishe r'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 bot h groups. These observations show that the early clinical features of HTS and ETS are different.