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Acta Neurol Scand. 2015 Dec;132(6):401-9. doi: 10.1111/ane.12409. Epub 2015 Apr 9.

Lateralizing value of semiology in medial temporal lobe epilepsy.

Dupont S1,2,3,4, Samson Y3,4,5, Nguyen-Michel VH1,6, Zavanone C2, Navarro V1,3,4,7, Baulac M1,3,4, Adam C1,3.

Author information

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.

KEYWORDS:

epilepsy; outcome; semiology; video-EEG

PMID:
25855246
DOI:
10.1111/ane.12409
[Indexed for MEDLINE]

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