Facial paresis in patients with mesial temporal sclerosis: clinical and quantitative MRI-based evidence of widespread disease.
OBJECTIVE
To assess the frequency and significance of facial paresis (FP) in a well-defined cohort of mesial temporal lobe epilepsy (MTLE) patients.


METHODS
One hundred consecutive patients with MRI findings consistent with mesial temporal sclerosis (MTS) and concordant electroclinical data underwent facial motor examination at rest, with voluntary expression, and with spontaneous smiling. Hippocampal, amygdaloid, and temporopolar (TP) volumetric measures were acquired. Thirty healthy subjects, matched according to age and sex, were taken as controls.


RESULTS
Central-type FP was found in 46 patients. In 41 (89%) of 46, it was visualized at rest, with voluntary and emotional expression characterizing true facial motor paresis. In 33 (72%) of 46 patients, FP was contralateral to the side of MTS. By using a 2-SD cutoff from the mean of normal controls, we found reduction in TP volume ipsilateral to MTS in 61% of patients with FP and in 33% of those without (p = 0.01). Febrile seizures as initial precipitating injury (IPI) were observed in 34% of the patients and were classified as complex in 12 (26%) of 46 of those with FP and in five (9%) of 54 of those without (p = 0.02). The presence of FP was significantly associated with a shorter latent period and younger age at onset of habitual seizures, in particular, with secondarily generalized tonic-clonic seizures.


CONCLUSIONS
Facial paresis is a reliable lateralizing sign in MTLE and was associated with history of complex febrile seizures as IPI, younger age at onset of disease, and atrophy of temporal pole ipsilateral to MTS, indicating more widespread disease.
Lin
Katia
K
Unidade de Pesquisa e Tratamento das Epilepsias (UNIPETE), Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil. katia.lin@bol.com.br
Carrete
Henrique
H
Lin
Jaime
J
de Oliveira
Pedro Alessandro Leite
PA
Caboclo
Luis Otávio Sales Ferreira
LO
Sakamoto
Américo Ceiki
AC
Yacubian
Elza Márcia Targas
EM
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D001284:Atrophy / Q000473:pathology; D001927:Brain Diseases / Q000473:pathology; D015331:Cohort Studies; D015897:Comorbidity; D035061:Control Groups; D004833:Epilepsy, Temporal Lobe / Q000453:epidemiology* / Q000473:pathology; D005158:Facial Paralysis / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012598:Sclerosis / Q000473:pathology; D003294:Seizures, Febrile / Q000175:diagnosis / Q000453:epidemiology; D013702:Temporal Lobe / Q000473:pathology*