title: Seizure semiology identifies patients with bilateral temporal lobe epilepsy.
abstract: OBJECTIVE
  Laterality in temporal lobe epilepsy is usually defined by EEG and imaging results. We investigated whether the analysis of seizure semiology including lateralizing seizure phenomena identifies bilateral independent temporal lobe seizure onset.
  
  
  METHODS
  We investigated the seizure semiology in 17 patients in whom invasive EEG-video-monitoring documented bilateral temporal seizure onset. The results were compared to 20 left and 20 right consecutive temporal lobe epilepsy (TLE) patients who were seizure free after anterior temporal lobe resection. The seizure semiology was analyzed using the semiological seizure classification with particular emphasis on the sequence of seizure phenomena over time and lateralizing seizure phenomena. Statistical analysis included chi-square test or Fisher's exact test.
  
  
  RESULTS
  Bitemporal lobe epilepsy patients had more frequently different seizure semiology (100% vs. 40%; p<0.001) and significantly more often lateralizing seizure phenomena pointing to bilateral seizure onset compared to patients with unilateral TLE (67% vs. 11%; p<0.001). The sensitivity of identical vs. different seizure semiology for the identification of bilateral TLE was high (100%) with a specificity of 60%. Lateralizing seizure phenomena had a low sensitivity (59%) but a high specificity (89%). The combination of lateralizing seizure phenomena and different seizure semiology showed a high specificity (94%) but a low sensitivity (59%).
  
  
  CONCLUSIONS
  The analysis of seizure semiology including lateralizing seizure phenomena adds important clinical information to identify patients with bilateral TLE.
authors.affiliation: Epilepsy Center, Dept. of Neurology, University of Munich, Marchioninistr. 15, 81377 Munich, Germany. Electronic address: annamira.loesch@med.uni-muenchen.de.
authors.forename: Anna Mira
authors.initials: AM
authors.lastname: Loesch
authors.affiliation: Epilepsy Center, Dept. of Neurology, University of Munich, Marchioninistr. 15, 81377 Munich, Germany. Electronic address: berend.feddersen@med.uni-muenchen.de.
authors.forename: Berend
authors.initials: B
authors.lastname: Feddersen
authors.affiliation: Epilepsy Center, Dept. of Neurology, University of Munich, Marchioninistr. 15, 81377 Munich, Germany. Electronic address: irseltezer@yahoo.com.tr.
authors.forename: F Irsel
authors.initials: FI
authors.lastname: Tezer
authors.affiliation: Epilepsy Center, Dept. of Neurology, University of Munich, Marchioninistr. 15, 81377 Munich, Germany. Electronic address: elisabeth.hartl@med.uni-muenchen.de.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Hartl
authors.affiliation: Epilepsy Center, Dept. of Neurology, University of Munich, Marchioninistr. 15, 81377 Munich, Germany. Electronic address: jan.remi@med.uni-muenchen.de.
authors.forename: Jan
authors.initials: J
authors.lastname: Rémi
authors.affiliation: Epilepsy Center, Dept. of Neurology, University of Munich, Marchioninistr. 15, 81377 Munich, Germany. Electronic address: christian.vollmar@med.uni-muenchen.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Vollmar
authors.affiliation: Epilepsy Center, Dept. of Neurology, University of Munich, Marchioninistr. 15, 81377 Munich, Germany. Electronic address: soheyl.noachtar@med.uni-muenchen.de.
authors.forename: Soheyl
authors.initials: S
authors.lastname: Noachtar
mesh_terms: D000293:Adolescent; D000328:Adult; D001921:Brain / Q000503:physiopathology* / Q000601:surgery; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012640:Seizures / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery; D012680:Sensitivity and Specificity; D014741:Video Recording; D055815:Young Adult
keywords: Bitemporal; Epilepsy surgery; Lateralizing seizure phenomena; Semiology; Temporal lobe epilepsy