Bitemporal epilepsy: A specific anatomo-electro-clinical phenotype in the temporal lobe epilepsy spectrum. (September 2015)

• Record Type: Journal Article
• Authors: Didato, Giuseppe; Chiesa, Valentina; Villani, Flavio; Pelliccia, Veronica; Deleo, Francesco; Gozzo, Francesca; Canevini, Maria Paola; Mai, Roberto; Spreafico, Roberto; Cossu, Massimo; Tassi, Laura
• Is Part Of: Seizure. Volume 31(2015)
• Page Start: 112
• Page End: 119
• Publication Date: 2015-09
• Subjects: TLE temporal lobe epilepsy -- BTLE bitemporal epilepsy -- UTLE unitemporal epilepsy -- EZ epileptogenic zone -- EEG electroencephalogram -- MRI magnetic resonance imaging -- PET positron emission tomography -- FDG-PET fluorodeoxyglucose PET -- FS febrile seizures -- VEEG long-term scalp video-EEG -- SEEG long-term intra-cerebral electrode stereo-EEG -- AED anti-epileptic drug -- NL non-lateralisable -- IND independent -- ISA interictal slow activity -- IEDs interictal epileptiform discharges -- LVFA low-voltage fast activity -- PiMS post-ictal memory of seizures -- HD head deviation -- OAs oro-alimentary automatisms -- LOC loss of consciousness -- BD bilateral dystonia -- HS hippocampal sclerosis -- FCD focal cortical dysplasia; Bitemporal epilepsy -- Drug-resistant epilepsy -- Anatomo-electro-clinical features -- Video-EEG monitoring -- Brain MRI; Epilepsy -- Periodicals; Epilepsy -- Periodicals; Seizures -- Periodicals; Épilepsie -- Périodiques; Electronic journals; Electronic journals; 616.853
• DOI: 10.1016/j.seizure.2015.07.013
• Languages: English
• ISSNs: 1059-1311

Abstract

Highlights: Bitemporal epilepsy (BTLE) significantly differs from unitemporal epilepsy (UTLE). BTLE patients had an older age at epilepsy onset and rare positive brain MRI. Interictal/ictal EEG activity and dystonia were more frequently bilateral in BTLE. Head deviation and oroalimentary automatisms were less frequent in BTLE. The identified pattern allows the non-invasive recognition of BTLE. Abstract: Purpose: Temporal lobe epilepsy (TLE) with bilateral ictal involvement (bitemporal epilepsy, BTLE) is an intriguing form of TLE whose characteristics need to be carefully identified as BTLE patients are not good surgical candidates. The purpose of this study was to define the anatomo-electro-clinical features differentiating BTLE from unilateral TLE (UTLE). Methods: Forty-eight BTLE patients underwent long-term video-EEG monitoring (VEEG) and experienced seizures with bilateral temporal lobe involvement. Their main electro-clinical (demographics, interictal and ictal EEG, ictal signs) and neuro-imaging [brain magnetic resonance imaging (MRI)] data were compared with those of a group of 38 UTLE patients. Results: In comparison with the UTLE patients, the BTLE cohort was significantly older at the time of epilepsy onset ( p = 0.023), more frequently experienced bilateral asynchronous interictal epileptiform discharges during wakefulness ( p = 0.001) and sleep ( p < 0.001), bilateral upper limb dystonia ( p = 0.005), and auditory auras ( p = 0.027), and less frequently showed a recognisable initial ictal EEG pattern of focal flattening or low-voltage fast activity ( p < 0.001), post-ictal memory of seizures ( p = 0.001), staring ( p < 0.001), head deviation ( p = 0.004), oro-alimentary automatisms ( p = 0.006), and positive brain MRI ( p < 0.001). MRI revealed neoplastic lesions ( p = 0.007) or alterations other than hippocampal sclerosis ( p = 0.028) only in the UTLE patients. Conclusion: The possibility of recognising BTLE patients during pre-surgical evaluation or being able to suspect bitemporal seizures before VEEG by identifying particular anatomo-electro-clinical patterns is diagnostically important for epileptologists and can help to prevent possible surgical failures.