深部电极引导伽玛刀治疗颞叶内侧癫痫(附21例临床分析)

目的探索深部电极引导伽玛刀治疗颞叶内侧癫痫的方法,初步评价治疗效果。方法治疗21例颞叶内侧癫痫患者,其中男性13例,女性8例,年龄18~59岁,平均34.2岁,病史3~20年,平均13.5年。用无框架立体定向机器人技术进行深部电极植入,并进行深部电极长程视频脑电监测。本组双侧植入5例,单侧植入16例,植入监测时间1~7天,平均监测2.2天。明确致痫灶后,安装头架,行头颅CT扫描定位,然后拔除深部电极,行头颅核磁扫描。对头颅CT与核磁进行融合,明确致痫灶接触电极的位置,进行伽玛刀治疗。治疗剂量:周边剂量8~13 Gy,平均9.8 Gy;中心剂量16~26 Gy,平均18.2 Gy;50%等剂量曲线。结果随访6~36个月,平均15个月,Engel’s效果分级:Ⅰ级2例,Ⅱ级4例,Ⅲ级9例,Ⅳ级6例(Ⅰ~Ⅲ级为治愈及有效)。有效率为71.4%。手术并发症:颅内积气2例,1周后自行吸收。无其他手术并发症。结论颞叶内侧癫痫深部电极探测明确致痫灶后,应用CT及核磁融合技术,在深部电极引导下进行伽玛刀低剂量治疗,初步治疗结果满意。     

伽玛刀与手术治疗颞叶癫痫的疗效分析

目的探讨伽玛刀与手术治疗颞叶癫痫的疗效,寻求更佳的颞叶癫痫治疗方法。方法回顾性分析我院接受伽玛刀治疗颞叶癫痫患者35例,治疗边缘剂量15~25 Gy,接受手术治疗颞叶癫痫患者102例,随访患者治疗后癫痫控制情况。结果随访时间3~7年,平均4.5年,伽玛刀治疗组EngelⅠ级7例,EngelⅡ级8例,EngelⅢ级9例,EngelⅣ级11例,手术治疗组:EngelⅠ级69例,EngelⅡ级15例,EngelⅢ级10例,EngelⅣ级8例,两者差异有显著统计学意义(P0.0001)。结论手术治疗颞叶癫痫疗效显著优于伽玛刀治疗,伽玛刀术后癫痫缓解率低,并发症多,目前尚不能作为颞叶癫痫的常规治疗。     

Neuropsychological performance and seizure-related risk factors in patients with temporal lobe epilepsy: a retrospective cross-sectional study

The aim of this study was to identify the neuropsychological features in patients with temporal lobe epilepsy (TLE) and their correlation with seizure-related variables. For this purpose, we carried out a retrospective analysis of data from 65 patients with TLE who had undergone a comprehensive neuropsychological assessment. The results suggest that the majority of patients with TLE were impaired in more than one cognitive domain, and among these patients, the mean proportions with defective semantic memory, language, motor/psychomotor speed, verbal episodic memory, and executive function were > 50% each. Moreover, age at seizure onset was the strongest predictor of general intellectual impairment, and number of antiepileptic drugs and seizure frequency could significantly predict deficits in verbal memory, language, and psychomotor speed. However, epilepsy duration was a less potent predictor of cognitive deficit than has been reported in cross-sectional studies.     

伽玛刀治疗颞叶癫痫38例初步报道

目的 探讨伽玛刀治疗颞叶癫痫的方法与效果.方法 1998年1月至2004年12月,应用旋转式伽玛刀治疗颞叶癫痫38例.伽玛刀治疗方法:单侧杏仁核、海马及海马旁回18例,颞叶前部(包括杏仁核、海马、诲马旁回)及额叶后份18例,双侧杏仁核2例.治疗剂量:杏仁核、海马边缘剂量20～35Gy, 50%等剂量曲线.额、前颞叶边缘剂量10～15 Gy,50%等剂量曲线.结果 38例随访1.5～8年,平均3.45年.满意(EngelⅠ)9例(23.68%),显著改善(EngelⅡ)12例(31.57%),良好(Engel Ⅲ)7例(18.43%),无效(Engel Ⅳ)10例(26.32%).总有效率73.68%.3例出现迟发性放射性水肿反应,经应用激素、甘露醇,2例水肿消退,另1例靶区坏死,而行开颅术切除坏死灶.无神经功能障碍,无死亡病例.结论 本组结果初步提示,伽玛刀治疗颞叶癫痫安全、有效.由于伽玛刀治疗癫痫不同于常规手术,疗效评定至少应在治疗后1年以上.伽玛刀用于治疗癫痫,为期尚短,许多问题如适应证的选择、靶点的选择、安全有效的照射剂量、迟发性放射反应的预防、疗效的评定及统计标准等,需不断地探索解决.     

伽玛刀治疗颞叶癫痫的长期随访

目的 探讨颞叶癫痫的伽玛刀治疗的疗效。方法 用PET、SPECT、MRI、EEG检查痫灶位置，应用瑞典ELEKTA公司伽玛刀治疗系统行杏仁核毁损术(90～100Gy)加颞叶内侧或外侧低剂量(中心20Gy，边缘10Gy)伽玛射线照射38例。结果 本组38例经伽玛刀治疗后随访5．1～7．2年，满意26例，显著改善及良好各3例，无效6例，有效率84．2％。其中癫痫完全消失23例，占61％；1例3个月后出现精神症状，经激素、甘露醇治疗第六个月后症状消失；6例(在满意26例中)2年后癫病症状同治疗前。无病残及死亡。结论 伽玛刀行杏仁核毁损术加颞叶内侧或外侧低剂量照射，对颞叶癫痫具有明确的疗效，并发症少见。部分病例的复发可能与杏仁核毁损剂量不足有关。     

Gamma knife surgery for mesial temporal lobe epilepsy

PURPOSE: Gamma knife radiosurgery (GK) allows precise and complete destruction of chosen target structures containing healthy and/or pathologic cells, without significant concomitant or late radiation damage to adjacent tissues. All the well-documented radiosurgery of epilepsy cases are epilepsies associated with tumors or arteriovenous malformations (AVMs). Results prompted the idea to test radiosurgery as a new way of treating epilepsy without space-occupying lesions. METHODS: To evaluate this new method, we selected seven patients with drug-resistant "mesial temporal lobe epilepsy" (MTLE).The preoperative evaluation program was the one we usually perform for patients selected for microsurgery of TLE [video-EEG analysis of seizures, foramen ovale electrode recording, magnetic resonance imaging (MRI) positron emission tomography (PET) scan, neuropsychological testing]. In lieu of microsurgery, the amygdalohippocampectomy was performed by using GK radiosurgery. RESULTS: Morphologic (MRI) signs of destruction of the target took place at 9 months after GK surgery. Since the treatment day, the first patient has been seizure free. Seizure improvement came more gradually for the following patients, and complete cessation of seizures occurred around the tenth month (range, 8-15 months). MRI shows that the amygdaloentorhinohippocampal target was selectively injured. No significant side effect (except one case of homologous quadrantanopia) or morbidity and no mortality was observed. The current follow-up is 24-61 months, and all (but one) patients are seizure free. CONCLUSIONS: This initial experience proves clearly the short-to middle-term efficiency and safety of GK for MTLE surgery. These results need further confirmation of long-term efficiency, but the introduction of GK surgery into epilepsy surgery can reduce dramatically its invasiveness and morbidity.     

Depression in temporal lobe epilepsy surgery patients: an FDG-PET study

PURPOSE: Depression is common in temporal lobe epilepsy (TLE) and after temporal lobectomy, and its etiology is obscure. In nonepileptic depression (including depression associated with other neurologic disorders), a consistent PET imaging finding is frontal lobe hypometabolism. Many TLE patients have hypometabolism involving frontal regions. Thus in data available from routine clinical assessments in an epilepsy surgery unit, we tested the hypothesis that the pattern of hypometabolism, particularly in the frontal lobe, may be associated with the depression seen in patients with TLE and TLE surgery. METHODS: We studied 23 medically refractory TLE patients who underwent anterior temporal lobectomy and who had preoperative FDG-PET scanning. All patients had pre- and postoperative psychiatric assessment. By using statistical parametric mapping (SPM-99), patterns of hypometabolism were compared between patients who had a preoperative history of depression (n=9) versus those who did not (n=14) and between those in whom postoperative depression developed (n=13) versus those in whom it did not (n=10). A significant region of hypometabolism was set at p<0.001 for a cluster of >or=20 contiguous voxels. RESULTS: Patients with a history of depression at any time preoperatively showed focal hypometabolism in ipsilateral orbitofrontal cortex compared with those who did not (t=4.64; p<0.001). Patients in whom depression developed postoperatively also showed hypometabolism in the ipsilateral orbitofrontal region (t=5.10; p<0.001). CONCLUSIONS: Although this study is methodologically limited, and other explanations merit consideration, orbitofrontal cortex dysfunction, already implicated in the pathophysiology of nonepileptic depression, may also be relevant to the depression of TLE and temporal lobectomy.     

Neuropsychological deficits in temporal lobe epilepsy: A comprehensive review

Temporal lobe epilepsy (TLE) is the most prevalent form of complex partial seizures with temporal lobe origin of electrical abnormality. Studies have shown that recurrent seizures affect all aspects of cognitive functioning, including memory, language, praxis, executive functions, and social judgment, among several others. In this article, we will review these cognitive impairments along with their neuropathological correlates in a comprehensive manner. We will see that neuropsychological deficits are prevalent in TLE. Much of the effort has been laid on memory due to the notion that temporal lobe brain structures involved in TLE play a central role in consolidating information into memory. It seems that damage to the mesial structure of the temporal lobe, particularly the amygdale and hippocampus, has the main role in these memory difficulties and the neurobiological plausibility of the role of the temporal lobe in different aspects of memory. Here, we will cover the sub-domains of working memory and episodic memory deficits. This is we will further proceed to evaluate the evidences of executive function deficits in TLE and will see that set-shifting among other EFs is specifically affected in TLE as is social cognition. Finally, critical components of language related deficits are also found in the form of word-finding difficulties. To conclude, TLE affects several of cognitive function domains, but the etiopathogenesis of all these dysfunctions remain elusive. Further well-designed studies are needed for a better understanding of these disorders.     

Efficacy of temporal lobe surgery for epilepsy in patients with negative MRI for mesial temporal lobe sclerosis

Epilepsy surgery is a successful treatment for refractory temporal lobe epilepsy (TLE). Reports suggest fewer seizure-free outcomes for patients with TLE and who have a negative brain MRI (nMRI) for mesial temporal sclerosis. Data were collected prospectively from patients with nMRI who underwent temporal lobe surgery for TLE characterized by unilateral ictal temporal lobe seizure onset based on a scalp video electroencephalogram or invasive subdural electrode recordings. A total of 86 patients were followed for at least 24 months after surgery. Outcome was evaluated using the Engel classification. Seizure control was obtained by 55% (47/86) of patients (Class [CL]-I), 27% (23/86) showed significant improvement (CL-II) and 19% (16/86) were deemed surgical failures. Shorter duration of epilepsy, later onset of seizures, and ictal theta rhythm (5-7 Hz) were the most significant predictors of postoperative seizure control. Although hypometabolism on positron emission tomography scan and significant memory disparity (>2.5/8) were not significant prognosticators independently, cumulatively they were predictors for favorable outcome.     

Neuropsychological tests with lateralizing value in patients with temporal lobe epilepsy: Reconsidering material-specific theory

PURPOSE: To assess the ability of neuropsychological tests to determine the side of seizure onset for preoperative assessment in patients with drug-resistant temporal lobe epilepsy. METHODS: Twenty-nine consecutive patients diagnosed with temporal lobe epilepsy (TLE), in whom the epileptogenic focus was clearly identified and localized to either the right or left hemisphere. Patients underwent a full neuropsychological assessment as part of their pre-surgical investigation, including the Boston Naming Test (BNT) and a variety of Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) and Wechsler Memory Scale-Third Edition (WMS-III) subtests. Two multivariate analyses of variance were carried out to assess differences on memory and language measures between groups according to side of epileptogenic focus. Binary logistic regression analysis was performed to find the sets of tests that best predicted the side of seizure onset (determined by EEG and MRI). RESULTS: Memory multivariate analysis of variance failed to show significant differences between the right- and left-sided groups. Among language measures, only the BNT revealed significant differences between the groups. The neuropsychological measures that best predicted the side of seizure onset were the BNT and Visual Reproduction II. CONCLUSIONS: Language measures predict the side of seizure focus better than memory measures. The results of this study in a sample of drug-resistant temporal lobe epilepsy patients challenge the memory material-specific theory for the side of seizure focus.     

脑电立体定位系统引导伽玛刀治疗颞叶内侧癫痫的前瞻性研究

目的探索脑电立体定位系统引导伽玛刀治疗颞叶内侧癫痫的方法,评价治疗的效果。方法分析363医院头部伽玛刀治疗室2004年1月～2007年12月确诊并行伽玛刀治疗的54例颞叶内侧癫痫患者,男性患者32例,女性患者22例,年龄8～53岁,平均25岁。采用前瞻性研究方法,进行随访观察,对治疗效果进行评价。结果本组共纳入病例54例,平均周边剂量12Gy(8～16Gy),随访1～6年,平均4.2年,疗效按Engel癫痫外科治疗结果分类及谭启富提出的癫痫外科手术结果评价标准分级:21例患者满意(占38.9%),13例显著改善(占24.1%),9例良好(占16.7%),11例效差(占20.3%);其中治疗部位与EEG、偶极子一致者43例,21例效果满意(占48.8%),10例显著改善(占23.3%),良好6例(占13.9%),6例效差(占13.9%);其余11例不一致的患者中,无一例达满意效果,3例显著改善(占27.3%),良好3例(占27.3%),5例效差(占45.4%);无死亡病例。结论长期随访结果显示良好的癫痫控制率及极低的并发症,脑电、偶极子提示位置一致,疗效好;当脑电图显示致痫灶没有局限于颞叶内侧结构,与偶极子定位结果不吻合时应首选开颅手术,术中皮层电极监测验证癫痫源灶部位。故伽玛刀治疗前必须严格选择病例,治疗靶点确定要有充分依据,严格控制剂量、容积,以提高疗效,降低并发症。     

Depression in temporal lobe epilepsy before epilepsy surgery

PURPOSE: This study examined the association of depression with laterality of epilepsy surgery in patients with temporal lobe epilepsy before standard lobectomy. METHODS: Forty-nine patients presented for EEG telemetry for localization of epilepsy and eventual temporal lobectomy. Patients underwent routine neuropsychiatric evaluation blinded for epileptic focus, including ratings on depression. Patients were grouped according to right (n = 25, M = 10/F = 15) and left (n = 24, M = 13/F = 11) temporal lobectomy. Analysis of variance included side of surgery as grouping variable and sex, general depressive, cognitive depressive, and vegetative depressive symptoms as dependent variables. Chi2 analyses included categoric variables of sex, handedness, education, neuropathologic findings, and current affective disorders. t Tests were performed on variables of age, epilepsy duration, and cognitive function. RESULTS: Right and left temporal epilepsy groups did not differ with regard to sex, handedness, age, duration of epilepsy, education, cognitive function, and neuropathology. Patients with right temporal epilepsy rated higher on general, cognitive. and vegetative depression scores. Women scored higher on general, cognitive, and vegetative depression scores. Current affective disorders were more common in the right temporal epilepsy group. CONCLUSIONS: Depression ratings and diagnoses were more prominent in patients with right temporal lobe epilepsy and in women in particular. The strength of this laterality finding lies in the selection of patients, as all underwent epilepsy surgery. The finding on gender difference partly reflects the higher incidence of depression in women and needs further exploration. The laterality finding contrasts with recent findings in epilepsy, stroke, and trauma that associate depression with left hemispheric lesions. However, our results are consistent with findings in electrically hyperactive lesions such as gelastic and dacrystic epilepsy.     

颞叶癫痫患者认知功能及相关因素的分析

目的分析颞叶癫痫患者认知功能的状况,并进一步探讨性别、病程、临床发作、神经电生理及药物等因素对患者认知功能的影响。方法从我院2002～2010年住院部中抽出符合入选标准的55例颞叶癫痫患者及随机抽取的同期48例健康对照者的韦氏成人智力量表、韦氏成人记忆量表、H.R.成人神经心理成套测验记录测验值进行回顾性分析。结果颞叶癫痫患者全量表智商(full intelligence quotient,FIQ)、记忆商(memory quo-tient,MQ)均明显低于健康对照者(P<0.001),脑病损程度(disease quotient,DQ)明显高于健康对照者(P<0.001)。不同文化程度的颞叶癫痫患者IQ、MQ、DQ有显著性差异,文化程度越高,其IQ及MQ越高(P<0.01),DQ越小(P<0.01);不同发作频率的颞叶癫痫患者IQ、MQ及DQ有显著性差异,发作越频繁,其IQ及MQ越低(P<0.01),DQ越高(P<0.01);不同脑电图异常改变的颞叶癫痫患者IQ、MQ和DQ有显著性差异,癫痫样放电越明显,其IQ及MQ越低(P<0.01),DQ越高(P<0.01)。多元逐步回归分析显示,影响患者IQ、MQ及DQ的因素依次为发作频率和脑电图癫痫样放电。结论颞叶癫痫患者存在不同程度的认知功能障碍。关注颞叶癫痫患者认知功能状况,尽早采取有效的治疗方法控制癫痫发作是避免和减少患者认知功能障碍,提高生活质量的重要前提。     

Memory functions following surgery for temporal lobe epilepsy in children

Surgical treatment appears to improve the cognitive prognosis in children undergoing surgery for temporal lobe epilepsy (TLE). The beneficial effects of surgery on memory functions, particularly on material-specific memory, are more difficult to assess because of potentially interacting factors such as age range, intellectual level, left-handedness, type of surgery and seizure outcome. This study investigated memory functions in 20 right-handed children who had left or right-temporal lobe surgery - including hippocampectomy - and became seizure-free. The neuropsychological evaluation included tests measuring verbally and visually mediated episodic memory, everyday memory as well as attention/working memory and language/semantic memory. We also assessed the relationships between age of seizure onset, general cognitive ability and memory functions. Children with TLE showed poor memory efficiency before surgery that tended to improve about 1 year after surgery. We found a material-specific memory effect, especially after surgery-9 (out of 12) children with left TLE had worse verbal memory results while 5 (out of 8) with right TLE had worse visual memory results. Post-operatively, most children had poor everyday memory performance on the Rivermead Behavioural Memory Test. No significant relationship was observed between episodic memory scores and age of epilepsy onset but children with early onset remained with lower Performance IQ values, Rey's figure copy scores and naming performances after surgery. Surgery significantly improved all the attention/working memory scores, some verbal episodic memory tasks and naming test performances. A different pattern of episodic and semantic memory limitations related to left or right TLE was observed.     

伽玛刀治疗颞叶内侧癫的长期随访研究

目的探讨伽玛刀治疗颞叶内侧癫的长期疗效。方法回顾性分析应用伽玛刀治疗的46例顽固性颞叶内侧癫病人的临床资料。伽玛刀治疗范围包括杏仁核、海马及部分海马旁回,周边剂量17～20 Gy。结果随访46例,时间6～10年。术后5年按Engel分级:Ⅰ~Ⅱ级31例,Ⅲ级8例,Ⅳ级7例,有效率为67.4%。术后出现一过性头痛、记忆力下降20例,视野缺损12例,均在3~6个月内逐渐缓解。结论伽玛刀治疗相比传统开颅手术具有损伤轻、并发症少、长期有效率高等优点,是治疗颞叶内侧癫的方法之一。     

Neuropsychological assessment and clinical evaluation in temporal lobe epilepsy with associated cortical dysplasia

Temporal Lobe Epilepsy (TLE) is a chronic neurological disorder, often associated to cognitive deficits. Focal cortical dysplasia (FCD), frequently associated to high risk of epilepsy, can lead to abnormalities in cognition. The aim of this study was to explore neuropsychological performance and to identify potential risk factors for cognitive impairment in TLE subjects with associated FCD. Our sample was composed by 46 TLE patients with FCD (37.76 ± 12.60 years; 29 females and 16 males) and 44 healthy controls (41.05 ± 9.74 years; 25 females and 19 males). All subjects performed a neuropsychological battery associated to a measurement of depression and anxiety. Results showed a poor performance of all domains of cognitive functioning and identified age of epilepsy onset as potential risk factor of cognitive impairment. These findings support the importance to focus on cognitive impairment in TLE patients with FCD to better clarify the impact of epilepsy features and FCD in therapeutic and everyday management.     

Mortality after temporal lobe epilepsy surgery

Purpose: To report mortality, after a longer interval, in a cohort of patients with drug‐resistant epilepsy treated by temporal lobe surgery between 1975 and 1995. A previous audit of these patients ending December 1, 1997 observed a standardized mortality ratio (SMR) of 4.5. Methods: We analyzed mortality in a cohort of 306 patients with temporal lobe epilepsy (TLE) who underwent temporal lobe resections between December 1, 1975 and December 1, 1995. Deaths occurring after December 1,1997 and until December 1, 2009 were evaluated. Medical records, death certificates, postmortem examination reports, coroner officer’s reports, and coroner’s inquest reports were sought, and causes of death were ascertained. Sudden unexpected death in epilepsy (SUDEP) cases were identified. Key Findings: In 3,569 person‐years of follow‐up 19 deaths occurred, [SMR 2.00, 95% confidence interval (CI) 1.27–3.13], 14 men (SMR 2.01, 95% CI 1.19–3.39) and 5 women (SMR 1.68, 95% CI 0.70–4.03). On analysis of subgroups, SMRs were significantly elevated in patients with mesial temporal sclerosis (MTS) (SMR 2.50, 95% CI 1.38–4.51), men with MTS (SMR 3.12, 95% CI 1.56–6.25), men with nonspecific lesions (SMR 2.68, 95% CI 1.00–7.09), and right‐sided resections in MTS (SMR 3.33, 95% CI 1.39–8.00). During follow‐up, six SUDEP cases were observed with a rate of 1/595 person‐years. Significance: In this cohort, the risk for premature death in patients undergoing TLE surgery decreased over time but remained above the standard population. Men had a slightly higher risk than women, as did right‐sided resections in MTS, confirming this observation in the original cohort. Although lower, the risk of SUDEP remained. Without up‐to‐date information on seizure outcome, we were unable to directly relate this to mortality.     

Long-term epilepsy surgery outcomes in patients with MRI-negative temporal lobe epilepsy

Purpose: The outcome of surgery in patients with temporal lobe epilepsy (TLE) and normal high‐resolution magnetic resonance imaging (MRI) has been significantly worse than in patients with unilateral hippocampal damage upon MRI. The purpose of this study was to determine the long‐term outcomes of consecutive true MRI‐negative TLE patients who all underwent standardized preoperative evaluation with intracranial electroencephalography (EEG) electrodes. Methods: In this study we present all adult MRI‐negative TLE surgery candidates evaluated between January 1990 and December 2006 at Kuopio Epilepsy Center in Kuopio University Hospital, which provides a national center for epilepsy surgery in Finland. During this period altogether 146 TLE surgery candidates were evaluated with intracranial electrodes, of whom 64 patients with normal high‐resolution MRI were included in this study. Results: Among the 38 patients who finally underwent surgery, at the latest follow‐up (mean 5.8 years), 15 (40%) were free of disabling seizures (Engel class I) and 6 (16%) were seizure‐free (Engel class IA). Twenty‐one (55%) of 38 patients had poor outcomes (Engel class III–IV). Outcomes did not change compared to 12‐month follow‐up. Histopathologic examination failed to reveal any focal pathology in 68% of our MR‐negative cases. Only patients with noncongruent positron emission tomography (PET) results had worse outcomes (p = 0.044). Discussion: Our results suggest that epilepsy surgery outcomes in MRI‐negative TLE patients are comparable with extratemporal epilepsy surgery in general. Seizure outcomes in the long‐term also remain stable. Modern imaging techniques could further improve the postsurgical seizure‐free rate. However, these patients usually require chronic intracranial EEG evaluation to define epileptogenic areas.     

Hyperkinetic seizures in patients with temporal lobe epilepsy: clinical features and outcome after temporal lobe resection

Purpose: Temporal lobe epilepsy (TLE) is usually associated with automatisms. Hyperkinetic seizures are supposed to be unusual. Because we witnessed several patients with TLE and ictal hyperkinetic symptoms, we retrospectively assessed the number, clinical findings, and seizure outcome in such patients who had undergone temporal lobe resection. Methods: We reviewed medical history, video–electroencephalography (EEG) recording and neuroimaging of adult patients who underwent epilepsy surgery for TLE at the Kork Epilepsy Center over the last 20 years with a minimum postoperative follow‐up of 12 months. Key Findings: Among 294 patients who were resected exclusively in the temporal region, we identified 17 (6%) who presented with hyperkinetic semiology such as violent vocalization, complex movements of the proximal segments of the limbs, rotation of the trunk, pelvic thrusting, or early tonic or dystonic posturing. Most of the patients had a preceding aura. Ictal EEG activity was located in the corresponding temporal region, usually with a wide distribution over temporal electrodes with fast spread to unilateral frontal electrodes and to the contralateral side. Neuroimaging revealed extended lesions in the temporal lobe involving mesial and neocortical structures. Most of the patients underwent classical anterior temporal lobe resection including amygdalo‐hippocampectomy. Fourteen patients (82%) became completely seizure‐free (Engel class Ia). Histopathology showed mainly focal cortical dysplasia plus hippocampal sclerosis. Significance: Hyperkinetic seizure semiology may occasionally occur in patients with TLE and is, therefore, no contradiction to the hypothesis of TLE if scalp EEG patterns and neuroimaging findings correspond. The postoperative seizure outcome is favorable in such patients and not different from outcome data in classical TLE.