SEMIOLOGY OF TEMPORAL-LOBE SEIZURES - VALUE IN LATERALIZING THE SEIZURE FOCUS

Purpose: To determine the lateralizing value of the clinical manifesta tions of seizures in patients with temporal lobe epilepsy (TLE), we ma de a retrospective videotape analysis of complex partial seizures (CPS ) in 55 patients who underwent temporal lobectomy and were seizure-fre e postoperatively for >2 years. Methods: Blinded to clinical details, we reviewed videotapes from video-EEG telemetry monitoring with attent ion paid to seizure semiology. Results: Useful lateralizing features i ncluded unilateral clonic activity (with the seizure focus contralater al in all patients), unilateral dystonic or tonic posturing (with the seizure focus contralateral in 90 and 86%, respectively), unilateral a utomatisms (with the seizure focus ipsilateral in 80%), and ictal spee ch preservation (with the seizure focus contralateral to the language- dominant hemisphere in 80%). Versive head rotation occurring less than or equal to 10 s before seizures secondarily generalized consistently predicted a contralateral focus. Seizure manifestations less predicti ve but suggestive of lateralization included ictal speech arrest and p ostictal speech status, with predictive values of 67%. Seizure manifes tations not providing reliable lateralizing information included eye d eviation, type of aura, and versive head movements occurring at times other than immediately before seizures secondarily generalized. Conclu sions: In TLE, several clinical seizure manifestations are useful in l ateralizing the seizure focus, although some provide no reliable infor mation. Therefore, ictal semiology can assist in the evaluation of pat ients for seizure surgery, providing additional information in the lat eralization of TLE.