Ictal stereo-electroencephalography onset patterns of mesial temporal lobe epilepsy and their clinical implications |
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| Institution: | 1. Neurology Department, University Hospital of Nancy, Nancy, France;2. Neurology Department, University Hospital of Sart-Tilman, Liege, Belgium;3. Medical Faculty, Liege University, Liege, Belgium;4. CRAN, UMR 7039, Lorraine University, Vand?uvre-les-Nancy Cedex, France;5. CNRS, CRAN, UMR 7039, Vand?uvre-les-Nancy Cedex, France;6. Clinical Neurophysiology Department, AP-HM, University Hospital la Timone, Marseille, France;7. Neurology department, University Hospital of Reims, Reims, France;8. INSERM UMR 1106, Institut de Neurosciences des Systemes, Marseille, France;9. Medical Faculty, Aix-Marseille University, Marseille, France;10. Medical Faculty, Lorraine University, Nancy, France;11. Neurosurgery Department, University Hospital of Nancy, Nancy, France;1. APHM, Timone Hospital, Clinical Neurophysiology and Epileptology Department, Marseille 13005, France;2. Aix-Marseille Université, Institut de Neuroscience des Systèmes, UMR_S 1106, Marseille 13005, France;3. APHM, Timone Hospital, Paediatric Neurosurgery Department, Marseille 13005, France;4. APHM, Timone Hospital, Functional and Stereotactical Neurosurgery Department, Marseille 13005, France |
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| Abstract: | ObjectiveThe differences in mesial temporal epilepsy (MTE) stereo-electroencephalography (SEEG) seizure-onset patterns and their clinical implications remains unclear.MethodsWe analyzed consecutive patients with MTE undergoing non-invasive workup, SEEG evaluation and resective surgery. Cases were classified into either mesial temporal sclerosis (MTS) group or non-MTS group based on magnetic resonance imaging (MRI). Seizure-onset patterns of SEEG were classified to analyze their correlation with surgical outcome and clinical subtypes.ResultsTwenty-eight patients were studied. Twenty (71.4%) patients had Engel I outcome. Thirteen patients had one seizure-onset pattern, 15 had two or more patterns. Five patterns of seizure-onset were identified and seizure-onset zones differed significantly across the 5 patterns. No difference was observed in surgical outcome between patients with single or multiple seizure-onset patterns. Periodic spike-onset pattern was associated with MTS (P = 0.003) while burst-onset was associated with non-MTS lesions (P = 0.003). Patients with seizure-onsets outside the resected temporal lobe (multiple onsets) had poorer prognosis (P = 0.0046).ConclusionWe identified 5 distinct onset patterns of MTE and correlated two of them with MRI findings. Multiple seizure-onset patterns in MTE may not necessarily suggest poor outcome. Patients with multi-focal seizure-onsets including seizures originating outside the resected temporal lobe have poorer outcome.SignificanceThis study identifies distinct onset patterns of MTE and their clinical implications. |
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| Keywords: | Mesial temporal lobe Epilepsy Stereo-electroencephalography |
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