title: Semiologic and electrophysiologic correlations in temporal lobe seizure subtypes.
abstract: OBJECTIVE
  The International League Against Epilepsy (ILAE) classification distinguishes medial and neocortical temporal lobe epilepsies. Among other criteria, this classification relies on the identification of two different electroclinical patterns, those of medial (limbic) and lateral (neocortical) temporal lobe seizures, depending on the structure initially involved in the seizure activity. Recent electrophysiologic studies have now identified seizures in which medial and neocortical structures are both involved at seizure onset. The purpose of the study was therefore to study the correlations of ictal semiology with the spatiotemporal pattern of discharge in temporal lobe seizures.
  
  
  METHODS
  The 187 stereoelectroencephalography-recorded seizures from 55 patients were analyzed. Patients were classified into three groups according to electrophysiologic findings: medial (M; seizure onset limited to medial structures, n=24), lateral (L; seizure onset limited to lateral structures, n=13), and medial-lateral (ML; seizure onset involving both medial and lateral structures, n=18). Clinical findings were compared between groups.
  
  
  RESULTS
  Initial epigastric sensation, initial fear, delayed oroalimentary and elementary upper limb automatisms, delayed loss of contact, long seizure duration, and absent or rare secondary generalizations were associated with M seizures. Initial auditory illusion or hallucination, initial loss of contact, shorter duration of seizures, and more frequent generalizations were associated with L seizures. Initial epigastric sensation, initial loss of contact, early oroalimentary and verbal automatisms, and long duration of seizures were associated with ML seizures.
  
  
  CONCLUSIONS
  Although the syndrome of mesial temporal epilepsy is now relatively well defined, our findings support the idea that the organization of temporal lobe seizures may be complex and that different patterns exist. We demonstrate three distinct patterns, characterized by both semiologic and electrophysiologic features. This distinction may help to define better the epileptogenic zone and the subsequent surgical procedure.
authors.affiliation: Service de Neurophysiologie Clinique, Hôpital de la Timone, Inserm EMI 99-26, Université de la Méditerranée, Marseille, France.
authors.forename: Louis
authors.initials: L
authors.lastname: Maillard
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Vignal
authors.forename: Martine
authors.initials: M
authors.lastname: Gavaret
authors.forename: Maxime
authors.initials: M
authors.lastname: Guye
authors.forename: Arnaud
authors.initials: A
authors.lastname: Biraben
authors.forename: Aileen
authors.initials: A
authors.lastname: McGonigal
authors.forename: Patrick
authors.initials: P
authors.lastname: Chauvel
authors.forename: Fabrice
authors.initials: F
authors.lastname: Bartolomei
mesh_terms: D001332:Automatism / Q000145:classification / Q000175:diagnosis / Q000503:physiopathology; D001931:Brain Mapping; D003937:Diagnosis, Differential; D004567:Electrodes, Implanted; D004569:Electroencephalography / Q000706:statistics & numerical data*; D004594:Electrophysiology; D004833:Epilepsy, Temporal Lobe / Q000145:classification* / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D008032:Limbic System / Q000503:physiopathology; D019579:Neocortex / Q000503:physiopathology; D012189:Retrospective Studies; D013238:Stereotaxic Techniques; D013702:Temporal Lobe / Q000503:physiopathology*