Ictal stereo-electroencephalography onset patterns of mesial temporal lobe epilepsy and their clinical implications. Issue 9 (September 2020)

• Record Type: Journal Article
• Authors: Feng, Rui; Farrukh Hameed, N.U.; Hu, Jie; Lang, Liqin; He, Juanjuan; Wu, Dongyan; Fan, Zhen; Jiang, Shize; Guo, Qinglong; Liu, Fengtao; Mao, Yiting; Li, Ce; Sun, Bing; Chen, Liang; Pan, Li
• Is Part Of: Clinical neurophysiology. Volume 131:Issue 9(2020:Sep.)
• Page Start: 2079
• Page End: 2085
• Publication Date: 2020-09
• Subjects: Mesial temporal lobe -- Epilepsy -- Stereo-electroencephalography; Neurophysiology -- Periodicals; Electroencephalography -- Periodicals; Electromyography -- Periodicals; Neurology -- Periodicals; 612.8
• DOI: 10.1016/j.clinph.2020.05.033
• Languages: English
• ISSNs: 1388-2457

Abstract

Highlights: Mesial temporal lobe epilepsy is associated with five distinct seizure-onset patterns. Multiple seizure-onset patterns in MTE may not necessarily suggest poor outcome. Patients with multiple seizure-onsets including ones outside the resected temporal lobe have poorer outcome. Abstract: Objective: The differences in mesial temporal epilepsy (MTE) stereo-electroencephalography (SEEG) seizure-onset patterns and their clinical implications remains unclear. Methods: We analyzed consecutive patients with MTE undergoing non-invasive workup, SEEG evaluation and resective surgery. Cases were classified into either mesial temporal sclerosis (MTS) group or non-MTS group based on magnetic resonance imaging (MRI). Seizure-onset patterns of SEEG were classified to analyze their correlation with surgical outcome and clinical subtypes. Results: Twenty-eight patients were studied. Twenty (71.4%) patients had Engel I outcome. Thirteen patients had one seizure-onset pattern, 15 had two or more patterns. Five patterns of seizure-onset were identified and seizure-onset zones differed significantly across the 5 patterns. No difference was observed in surgical outcome between patients with single or multiple seizure-onset patterns. Periodic spike-onset pattern was associated with MTS (P = 0.003) while burst-onset was associated with non-MTS lesions (P = 0.003). Patients with seizure-onsets outside the resected temporal lobe (multiple onsets) had poorer prognosis (P = 0.0046). Conclusion: We identified 5 distinct onset patterns of MTE and correlated two of them with MRI findings. Multiple seizure-onset patterns in MTE may not necessarily suggest poor outcome. Patients with multi-focal seizure-onsets including seizures originating outside the resected temporal lobe have poorer outcome. Significance: This study identifies distinct onset patterns of MTE and their clinical implications.