S Dupont1,2,3,4, Y Samson3,4,5, V-H Nguyen-Michel1,6, C Zavanone2, V Navarro1,3,4,7, M Baulac1,3,4, C Adam1,3. 1. Epilepsy Unit, Hôpital de la Pitié-Salpêtrière, APHP, Paris, France. 2. Rehabilitation Unit, Hôpital de la Pitié-Salpêtrière, APHP, Paris, France. 3. Centre de Recherche de l'Institut du Cerveau et de la Moëlle Epinière (ICM), UMPC-UMR 7225 CNRS-UMRS 975 INSERM, Paris, France. 4. Université Pierre et Marie Curie, Paris 6, France. 5. Stroke Unit, Hôpital de la Pitié-Salpêtrière, APHP, Paris, France. 6. Neurophysiology Unit of the Charles Foix Hospital, APHP, Paris, France. 7. Neurophysiology Unit, Hôpital de la Pitié-Salpêtrière, APHP, Paris, France.
Abstract
OBJECTIVES: Analysing the clinical characteristics of seizures constitutes a fundamental aspect of the presurgical evaluation of patients with medial temporal lobe epilepsy and unilateral hippocampal sclerosis (MTLE-HS), the most frequent form of focal epilepsy accessible to surgery. We sought to retrospectively determine whether objective manifestations could have a reliable lateralizing value in a large population of MTLE-HS patients and if their presence could help to identify those patients who would be seizure free after surgery. MATERIAL AND METHODS: We analysed the frequency and predictive lateralizing value of objective ictal and postictal signs in 391 patients with MTLE-HS (183 left/208 right). Data were derived from chart review and not from blinded videoEEG analysis. Correlation between the presence of reliable lateralizing signs and postoperative outcome was performed in a subgroup of 302 patients who underwent surgery. RESULTS: Contralateral dystonic posturing was the most frequent and reliable lateralizing sign that correctly lateralized the focus in 96% of patients. Unilateral head/eye deviation was noted in 42% of the patients and predicted unilateral focus in 67%. Ipsilateral postictal nose wiping, contralateral clonus and hypokinesia correctly lateralized the focus in 75%, 81%, respectively, and 100 of patients but were less frequently depicted. Postictal aphasia was a strong lateralizing sign for left MLE-HS. The presence of reliable lateralizing signs was not a predictor of seizure freedom. CONCLUSION: Seizure semiology is a simple tool that may permit reliable lateralization of the seizure focus in MTLE-HS. The presence of reliable lateralizing signs is not associated with a better postoperative outcome.
OBJECTIVES: Analysing the clinical characteristics of seizures constitutes a fundamental aspect of the presurgical evaluation of patients with medial temporal lobe epilepsy and unilateral hippocampal sclerosis (MTLE-HS), the most frequent form of focal epilepsy accessible to surgery. We sought to retrospectively determine whether objective manifestations could have a reliable lateralizing value in a large population of MTLE-HSpatients and if their presence could help to identify those patients who would be seizure free after surgery. MATERIAL AND METHODS: We analysed the frequency and predictive lateralizing value of objective ictal and postictal signs in 391 patients with MTLE-HS (183 left/208 right). Data were derived from chart review and not from blinded videoEEG analysis. Correlation between the presence of reliable lateralizing signs and postoperative outcome was performed in a subgroup of 302 patients who underwent surgery. RESULTS:Contralateral dystonic posturing was the most frequent and reliable lateralizing sign that correctly lateralized the focus in 96% of patients. Unilateral head/eye deviation was noted in 42% of the patients and predicted unilateral focus in 67%. Ipsilateral postictal nose wiping, contralateral clonus and hypokinesia correctly lateralized the focus in 75%, 81%, respectively, and 100 of patients but were less frequently depicted. Postictal aphasia was a strong lateralizing sign for left MLE-HS. The presence of reliable lateralizing signs was not a predictor of seizure freedom. CONCLUSION:Seizure semiology is a simple tool that may permit reliable lateralization of the seizure focus in MTLE-HS. The presence of reliable lateralizing signs is not associated with a better postoperative outcome.
Authors: Christoph Baumgartner; Johannes Koren; Martha Britto-Arias; Simone Schmidt; Susanne Pirker Journal: Clin Auton Res Date: 2019-02-25 Impact factor: 4.435
Authors: Elisaveta Sokolov; Nathaniel D Sisterson; Helweh Hussein; Cheryl Plummer; Danielle Corson; Arun R Antony; Joseph M Mettenburg; Gena R Ghearing; Jullie W Pan; Alexandra Urban; Anto Bagić; R Mark Richardson; Vasileios Kokkinos Journal: Epilepsia Open Date: 2021-11-16