ANALISYS OF ICTAL AND POSTICTAL SEMIOLOGY IN PATIENTS WITH HIPPOCAMPAL SCLEROSIS AND PATIENTS WITH HIPPOCAMPAL SCLEROSIS PLUS

BRENDA GIAGANTE, CARLOS MELCON, DAMIAN CONSALVO, SILVIA ODDO, WALTER SILVA, LUCIANA D ALESSIO, PATRICIA SOLIS, ESTELA CENTURION, PABLO SALGADO, PATRICIA SAIDON, SILVIA KOCHEN

N. Orleans

Congreso; Annual Meeting of the American Epilepsy Society; 2004

RATIONALE: Magnetic resonance imaging (MRI) demonstrates abnormalities in the temporo-polar region in 1/3 to 2/3 of patients with hippocampal sclerosis (HS) that had been named HS- Plus.The aim of this study is to compare ictal and postictal clinical symptoms in patients with temporal lobe epilepsy (TLE) and pure HS, and patients with HS-Plus, diagnosed by MRI. METHODS: Blinded to clinical details, we reviewed ictal video-EEG recordings from patients with HS, and from patients with HS-plus. We analyzed all ictal and postictal symptoms. We reviewed 104 seizures in 32 consecutive patients. Patients were differentiated in 2 groups: group 1: HS patients, and group 2: HS-plus patients. Variables (symptoms) were analyzed by Chi-square or Fisher exact tests. To identify the variables that significantly contribute to differentiate the 2 groups we performed a binary logistic regression. RESULTS: Group 1:18 patients, 51 seizures, and group 2:14 patients, 53 seizures. The following symptoms were significantly more frequent in group 1: non-versive early head turning (p=0.013), non-verbal ictal speech (p=0.002), well-formed ictal speech (p<0.001), hyperpnoea (p=0.032); and in group 2 the more significantly frequent symptoms were: presence of an aura (p=0.003), presence of more than one type of aura (p=0.017), forced ocular version before (<10 s) secondary generalization: (p=0 .034), non-versive late (>10 s) head turning (p=0.005), forced head version before (<10 s) secondary generalization (p=0.018), forced unilateral mouth deviation (p=0.015), unilateral clonias (p=0.037), bilateral eye blinking (p=0.007), postictal nosewiping (p<0 .001), and hyper salivation (p=0.031). Using binary logistic regression, the strongest variables selected to differentiate the two groups were: non-versive late head turning (>10 s), forced head version before (<10 s) secondary generalization, bilateral eye blinking, non-verbal ictal speech and postictal nosewiping CONCLUSION: These observations suggest that different networks may be involved during seizures of patients with HS and HS-plus. Preoperative diagnosis of the entire temporal lobe pathology may be relevant for the surgical approach (ie, a temporal lobectomy as opposed to an amygdalohippocampectomy).