J Clin Neurol.  2006 Mar;2(1):42-50. 10.3988/jcn.2006.2.1.42.

The Clinical and Electrophysiological Characteristics of Temporal Lobe Epilepsy with Normal MRI

• Kim SE
• Andermann
• Olivier A

• KMID: 2287702
• DOI: http://doi.org/10.3988/jcn.2006.2.1.42

Abstract

BACKGROUND AND PURPOSE
To identify the clinical and electrophysiological characteristics of temporal lobe epilepsy (TLE) with normal MRI.
METHODS
Twenty-six patients were diagnosed with TLE with normal MRI by stereotaxically implanted depth electrode EEG (SEEG) and quantitative MRI. We divided the patients into anterior or diffuse temporal groups by interictal EEG, into localized, hemispheric or non-lateralized onset groups by ictal scalp EEG, and into focal or regional onset groups by SEEG. The clinical and electrophysiological characteristics were compared with those of 25 TLE patients with unilateral hippocampal atrophy (HA) on MRI. Four patients of TLE with unilateral HA also underwent SEEG.
RESULTS
Patients in the normal MRI group showed a significantly higher frequency of secondarily generalization (225+/-235, median 160 vs 68+/-48, median 50, p<0.05), shorter duration of epilepsy (16+/-10 yrs vs 25.9+/-7.8 yrs, p<0.001), and less favorable surgical outcome (50% vs 88%, p <0.05) than patients in the unilateral HA group. Also, patients with normal MRI frequently showed diffuse temporal (50% vs 20%, p<0.05) discharges on interictal EEG. The ictal seizure patterns of patients with normal MRI showed less localization to one temporal lobe on scalp EEG (28% vs 65%, p<0.001) and a higher frequency of regional onset on SEEG (68% vs 8%, p<0.001) than patients with unilateral HA.
CONCLUSIONS
The characteristics of TLE with normal MRI compared with TLE with unilateral HA are shorter duration of epilepsy, higher frequency of secondarily generalization, and less favorable surgical outcome, suggesting wider areas of temporal lobe involved compared with patients with unilateral HA.

Keyword

Temporal lobe epilepsy; MRI; Intracranial EEG; Hippocampal atrophy; Temporal neocortex

MeSH Terms

Atrophy
Electrodes
Electroencephalography
Epilepsy
Epilepsy, Temporal Lobe*
Generalization (Psychology)
Humans
Magnetic Resonance Imaging*
Scalp
Seizures
Temporal Lobe*

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