KOCHEN Sara Silvia
Lateralizing value of ictal and postictal manifestations in refractory temporal lobe epilepsy
GIAGANTE B, SILVA W, CONSALVO D, ODDO, KOCHEN S
Objective: To determine the lateralizing value of ictal and postictal manifestations in patients with refractory temporal lobe epilepsy (TLE). Material and Method: We reviewed ictal Video-EEG recordings of patients with TLE who underwent epilepsy surgery and had an Engel class I outcome. We analyzed all clinical manifestations observed during the seizures. Results: We analyzed 81 seizures in 29 patients. The most frequent symptoms with high PPV (p <0.05) observed in the seizures were: unilateral repetitive manual automatisms 54.3%, PPV 88%; immediate postictal consciousness recovery 37%, PPV 75%; well formed ictal language 35.8%, PPV 80%; nose wiping 32%, PPV 92%; unilateral upper limb dystonic posturing 29.6%, PPV 87%; postictal dysnomia/aphasia 27%, PPV 90%. Conclusions: The detailed analysis of semiology during epileptic seizures is a tool of great usefulness for lateralizing the epileptogenic zone in patients with temporal lobe epilepsy. The clinical and non-invasive data, when combined with neuroimaging techniques and neuropsychological data, may allow candidates for epilepsy surgery to avoid invasive neurophysiological monitoring.