Seizure Behaviors of Mesial Temporal Lobe Epielpsy

Kim, Myeong Kyu; Cho, Ki Hyun; Kim, Sei Jong; Kim, Jae Hyoo; Lee, Min Cheol; Woo, Young Jong

Abstract

We analyzed ictal semiology retrospectively from video tapes of 15 seizures in 4 patients with mesial temporal lobe epilepsy who underwent anterior temporal lobectomy. The clinical diagnosis as mesial temporal epilepsy was confirmed by postsurgical outcome. They were postsurgically seizure free or had a grater than 90% reduction in the number of seizure frequency for more than 1 year comparing presurgical state. As a aura of mesial temporal lobe epilepsy, visceral sensation such as epigastric rising sense, fear sense and experiencial symptoms such as deja vu or jamais vu were frequently observed. Unilateral ictal motor manifestations such as unilateral automatism, dystonia, tonic posture, head/eye version, nonversive head movement and jerky head movement were observed in ipsilateral or contralateral to seizure focus. As a ictal language manifestation of nondominant temporal lobe epilepsy confirmed by the results of Wada test, ictal speech and speech arrest were observed. Of the other ictal manifestations, ictal arrest or motionless staring followed by oromandibular automatism was the most common sign. Dystonia, tonic posture and head/eye version which occured just before secondary generalization of seizure were observed only in contralateral to seizure focus, and the majority of unilateral automatism(92%) were ipsilateral. Therefore, it seems to be that these symptoms are useful in localization of epielptogenic lesion. Although there were no lateralizing value, aura such as visceral sensation, fear sense and experiencial symptoms, and ictal arrest or motionless staring followed by oromandi- bular automatism may be useful symptoms or signs in making a clinical diagnosis of medial temporal lobe epilepsy.