Variability of presentation in medial temporal lobe epilepsy: a study of 30 operated cases.
BACKGROUND
To evaluate the homogeneity of patients operated on for MTLE.


METHODS
30 consecutive patients prospectively investigated with clinical, EEG, neuropsychology, MRI, FDG-PET criteria and eventually intracranial EEG, who underwent antero-medial temporal resection (follow-up: 24 months).


RESULTS
Clear and well-lateralised MTLE was non-invasively ascertained in 22 patients (73%). Eight patients (27%) had a less pure presentation due to divergent scalp EEG features (bitemporal, widespread or extratemporal), unusual auras or absence of MRI-based hippocampal sclerosis or FDG-PET hypometabolism. They were explored by invasive monitoring which confirmed medial temporal origin of seizures. Outcome was excellent in 95% of the pure cases (Engel's class I) and less favorable in the more difficult ones (65% of class I).


CONCLUSIONS
MTLE criteria, including the strong contribution of brain imaging, permit to select accurately a large percentage of patients. However a consistant number of patients present a less pure presentation suggesting more complex epileptogenic networks.
Adam
C
C
Service de Neurophysiologie, Hôpital de la Pitié-Salpêtrière, Paris, France.
Clemenceau
S
S
Semah
F
F
Hasboun
D
D
Samson
S
S
Aboujaoude
N
N
Samson
Y
Y
Baulac
M
M
D000293:Adolescent; D000328:Adult; D001921:Brain / Q000473:pathology; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000503:physiopathology* / Q000523:psychology / Q000601:surgery; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011569:Psychiatric Status Rating Scales