Ictal Features Differentiating Mesial from Neocortical Temporal Lobe Epilepsies

ABSTRACT

BACKGROUND: The differentiation of mesial temporal lobe epilepsy (MTLE) from neocortical temporal lobe epilepsy (NTLE) is important in surgical planning of temporal lobe epilepsy (TLE). We tried to find clinical semiology separating one from the other. METHODS: We reviewed 136 seizures of 28 patients who had epilepsy surgery and good clinical outcome (Engel class I or II). We compared the following clinical features between MTLE and NTLE; the history of febrile convulsion, staring, automatism, head version, contralateral dystonic (CLD) and tonic (CLT) posturing, secondarily generalized tonic-clonic seizure (SGTC) frequency, the duration of partial seizures (excluding SGTC part) and time to SGTC and the type of aura (abdominl aura, vertiginous aura, visual aura, gustatory aura, and psychic aura etc.). RESULTS: Eighteen men and ten women were included. Mean age was 29.1+ 8.8 years (11-45). Abdominal aura (p = 0.04), oroalimentary (p < 0.01) and gestural automatism (p < 0.01), CLD (p < 0.01), and CLT posturing (p < 0.01) were seen significantly more often in MTLE and the duration of partial seizure (excluding SGTC) (p < 0.01) was longer in MTLE than NTLE. In NTLE, head version (p < 0.01) and SGTC (p < 0.01) occurred more frequently and the evolution time to SGTC (p = 0.04) was shorter. Duration of automatism and staring and occurrence of unilateral blinking were not different between two groups. CONCLUSION: Abdominal aura, oroalimentary and gestural automatism, CLD and CLT posturing, longer partial seizure duration were more suggesting MTLE, while rapid generalization, frequent SGTC and head version were seen more often in NTLE.