Age-dependent seizure semiology in temporal lobe epilepsy.
OBJECTIVE
To examine the effects of age on different aspects of temporal lobe seizure semiology.


METHODS
We performed a video analysis of 605 archived seizures from 155 consecutive patients (age 10 months to 49 years) selected by seizure freedom after temporal lobectomy. Eighty patients had hippocampal sclerosis (HS). Beside semiological seizure classification, we assessed age dependency of several axes of seizure semiology: (1) aura, (2) number of different lateralizing signs, occurrence of ictal (3) emotional signs, (4) autonomic symptoms, (5) automatisms, and (6) secondary generalization as well as (7) the ratio of motor seizure components.


RESULTS
From the 155 patients, 117 reported aura, 39 had ictal emotional signs, 51 had autonomic symptoms, 130 presented automatisms, while 18 patients showed secondary generalization at least once during their seizures. Altogether 369 (median: 2/patient) different lateralizing signs were recorded. Frequency of HS (p < 0.001), ictal automatisms (p < 0.001), secondary generalization (p = 0.014), number of different lateralizing signs (p < 0.001) increased while the ratio of motor seizure component (p = 0.007) decreased by age. Auras, emotional symptoms, and autonomic signs occurred independently of patients' ages. Hippocampal sclerosis adjusted linear models revealed that the frequency of automatisms and secondarily generalized seizures as well as the number of different lateralizing signs are HS-independent significant variables.


CONCLUSIONS
Our findings support that brain maturation significantly influences the evolution of some important aspects (motor seizures, lateralizing signs) of temporal lobe seizure semiology. Conversely, other aspects (aura, emotional, and autonomic signs) are independent of the maturation process. This is the first report investigating age dependency of epileptic seizure semiology comparing all age groups.
Fogarasi
András
A
Epilepsy Center, Bethesda Children's Hospital, Budapest, HungaryBethel Epilepsy Center, Bielefeld, GermanyEpilepsy Center, National Institute of Psychiatry and Neurology, Budapest, HungaryDepartment of Neurology, University of Pécs, Pécs, HungaryDepartment of Public Health, Karolinska Institute, Stockholm, Sweden, and Department of Behavioral Sciences, Semmelweis University, Budapest, Hungary.
Tuxhorn
Ingrid
I
Epilepsy Center, Bethesda Children's Hospital, Budapest, HungaryBethel Epilepsy Center, Bielefeld, GermanyEpilepsy Center, National Institute of Psychiatry and Neurology, Budapest, HungaryDepartment of Neurology, University of Pécs, Pécs, HungaryDepartment of Public Health, Karolinska Institute, Stockholm, Sweden, and Department of Behavioral Sciences, Semmelweis University, Budapest, Hungary.
Janszky
József
J
Epilepsy Center, Bethesda Children's Hospital, Budapest, HungaryBethel Epilepsy Center, Bielefeld, GermanyEpilepsy Center, National Institute of Psychiatry and Neurology, Budapest, HungaryDepartment of Neurology, University of Pécs, Pécs, HungaryDepartment of Public Health, Karolinska Institute, Stockholm, Sweden, and Department of Behavioral Sciences, Semmelweis University, Budapest, Hungary.
Janszky
Imre
I
Epilepsy Center, Bethesda Children's Hospital, Budapest, HungaryBethel Epilepsy Center, Bielefeld, GermanyEpilepsy Center, National Institute of Psychiatry and Neurology, Budapest, HungaryDepartment of Neurology, University of Pécs, Pécs, HungaryDepartment of Public Health, Karolinska Institute, Stockholm, Sweden, and Department of Behavioral Sciences, Semmelweis University, Budapest, Hungary.
Rásonyi
György
G
Epilepsy Center, Bethesda Children's Hospital, Budapest, HungaryBethel Epilepsy Center, Bielefeld, GermanyEpilepsy Center, National Institute of Psychiatry and Neurology, Budapest, HungaryDepartment of Neurology, University of Pécs, Pécs, HungaryDepartment of Public Health, Karolinska Institute, Stockholm, Sweden, and Department of Behavioral Sciences, Semmelweis University, Budapest, Hungary.
Kelemen
Anna
A
Epilepsy Center, Bethesda Children's Hospital, Budapest, HungaryBethel Epilepsy Center, Bielefeld, GermanyEpilepsy Center, National Institute of Psychiatry and Neurology, Budapest, HungaryDepartment of Neurology, University of Pécs, Pécs, HungaryDepartment of Public Health, Karolinska Institute, Stockholm, Sweden, and Department of Behavioral Sciences, Semmelweis University, Budapest, Hungary.
Halász
Péter
P
Epilepsy Center, Bethesda Children's Hospital, Budapest, HungaryBethel Epilepsy Center, Bielefeld, GermanyEpilepsy Center, National Institute of Psychiatry and Neurology, Budapest, HungaryDepartment of Neurology, University of Pécs, Pécs, HungaryDepartment of Public Health, Karolinska Institute, Stockholm, Sweden, and Department of Behavioral Sciences, Semmelweis University, Budapest, Hungary.
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D038481:Anterior Temporal Lobectomy; D001332:Automatism / Q000175:diagnosis / Q000453:epidemiology; D001342:Autonomic Nervous System Diseases / Q000175:diagnosis / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D004827:Epilepsy / Q000175:diagnosis / Q000453:epidemiology; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006624:Hippocampus / Q000473:pathology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011300:Preoperative Care; D015995:Prevalence; D012598:Sclerosis / Q000473:pathology