Contralateral motor automatisms in neocortical temporal lobe epilepsy

Electroclinical characteristics of posterior lateral temporal epilepsy

The current study aimed to investigate the electroclinical differences between mesial temporal lobe epilepsy (MTLE) and posterior lateral temporal lobe epilepsy (PLTLE). All patients had Engel class I outcomes after surgery for at least one year. In MTLE patients, the epileptogenic zone was inside the boundary of a standard temporal lobectomy, whereas in PLTLE, the epileptogenic zone was behind the boundary of a standard temporal lobectomy. Febrile convulsion, history of psychic aura, oroalimentary automatism, and diffuse interictal epileptiform discharges were more frequent in MTLE. Theta wave and increasing heart rate were more evident at the seizure onset in MTLE, whereas an ictal onset fast rhythm was more evident in PLTLE. Tonic head turning was more frequent in PLTLE. Distinguishing between MTLE and PLTLE was easier than distinguishing MTLE from lateral TLE (LTLE), which may be helpful in planning epilepsy surgery. Combinations of these manifestations and signs can provide vital clues to distinguish between MTLE and PLTLE.

Temporal lobe epilepsy semiology

Epilepsy represents a multifaceted group of disorders divided into two broad categories, partial and generalized, based on the seizure onset zone. The identification of the neuroanatomic site of seizure onset depends on delineation of seizure semiology by a careful history together with video-EEG, and a variety of neuroimaging technologies such as MRI, fMRI, FDG-PET, MEG, or invasive intracranial EEG recording. Temporal lobe epilepsy (TLE) is the commonest form of focal epilepsy and represents almost 2/3 of cases of intractable epilepsy managed surgically. A history of febrile seizures (especially complex febrile seizures) is common in TLE and is frequently associated with mesial temporal sclerosis (the commonest form of TLE). Seizure auras occur in many TLE patients and often exhibit features that are relatively specific for TLE but few are of lateralizing value. Automatisms, however, often have lateralizing significance. Careful study of seizure semiology remains invaluable in addressing the search for the seizure onset zone.