Lateralizing value of ictal and postictal semiology.

GIAGANTE B, SILVA W, CONSALVO D, ODDO S, SOLIS P, D`ALESSIO L, CENTURIÓN E, SAIDON P, KOCHEN S.

Santiago de Chile

Congreso; XI Congreso Panamericano de Neurología; 2003

Sociedad Panamericana de Neuroepidemiología

Purpose:  The study goal was to assess the lateralizing value of clinical semiology in patients with intractable temporal lobe epilepsy (TLE). Methods: We reviewed ictal Video-EEG records of patients with TLE, who became seizure free after epilepsy surgery. We analysed the symptoms observed during ictal and postictal periods. We calculated the frequency of presentation ant the positive predictive value (PPV) of laterality in each symptom. Wilcoxon test was used to determine statistical significance. Results: We analysed 81 seizures in 29 patients. The sides of the epileptogenic zone were 38 left side seizures (47%), and 43 right side (53%). Seventy-nine of patients had auras at ictal onset. The most frequent aura was epigastric sensation (60.8%), fear (34.7%), and strange feeling (26%). No one of the auras, had lateralizing value. The most frequent seizure with high PPV observed during the seizures (p<0.005) were: unilateral hand automatisms, (54.3%), PPV 88%; immediate postictal recovery 37%, PPV 75%, ictal speech 35.8 %, PPV 80%, postictal nose wiping 32%, PPV 92%; unilateral dystonic posturing 29.6%, PPV 87%; postictal aphasia 27%, VPP 90%. Conclusion: Seizure semiology is a very useful tool that can be applied in the presurgical diagnosis for more accurate lateralization of the epileptogenic zone.