title: Bitemporal epilepsy: A specific anatomo-electro-clinical phenotype in the temporal lobe epilepsy spectrum.
abstract: OBJECTIVE
  Temporal lobe epilepsy (TLE) with bilateral ictal involvement (bitemporal epilepsy, BTLE) is an intriguing form of TLE whose characteristics need to be carefully identified as BTLE patients are not good surgical candidates. The purpose of this study was to define the anatomo-electro-clinical features differentiating BTLE from unilateral TLE (UTLE).
  
  
  METHODS
  Forty-eight BTLE patients underwent long-term video-EEG monitoring (VEEG) and experienced seizures with bilateral temporal lobe involvement. Their main electro-clinical (demographics, interictal and ictal EEG, ictal signs) and neuro-imaging [brain magnetic resonance imaging (MRI)] data were compared with those of a group of 38 UTLE patients.
  
  
  RESULTS
  In comparison with the UTLE patients, the BTLE cohort was significantly older at the time of epilepsy onset (p = 0.023), more frequently experienced bilateral asynchronous interictal epileptiform discharges during wakefulness (p = 0.001) and sleep (p < 0.001), bilateral upper limb dystonia (p = 0.005), and auditory auras (p = 0.027), and less frequently showed a recognisable initial ictal EEG pattern of focal flattening or low-voltage fast activity (p < 0.001), post-ictal memory of seizures (p = 0.001), staring (p < 0.001), head deviation (p = 0.004), oro-alimentary automatisms (p = 0.006), and positive brain MRI (p < 0.001). MRI revealed neoplastic lesions (p = 0.007) or alterations other than hippocampal sclerosis (p = 0.028) only in the UTLE patients.
  
  
  CONCLUSIONS
  The possibility of recognising BTLE patients during pre-surgical evaluation or being able to suspect bitemporal seizures before VEEG by identifying particular anatomo-electro-clinical patterns is diagnostically important for epileptologists and can help to prevent possible surgical failures.
authors.affiliation: Clinical Epileptology and Experimental Neurophysiology Unit, Foundation IRCCS Carlo Besta Neurological Institute, Via Celoria 11, 20133 Milano, Italy. Electronic address: giuseppe.didato@istituto-besta.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Didato
authors.affiliation: Epilepsy Centre, San Paolo Hospital, Via Di Rudinì 8, 20142 Milano, Italy. Electronic address: valentina.chiesa@ao-sanpaolo.it.
authors.forename: Valentina
authors.initials: V
authors.lastname: Chiesa
authors.affiliation: Clinical Epileptology and Experimental Neurophysiology Unit, Foundation IRCCS Carlo Besta Neurological Institute, Via Celoria 11, 20133 Milano, Italy. Electronic address: fvillani@istituto-besta.it.
authors.forename: Flavio
authors.initials: F
authors.lastname: Villani
authors.affiliation: Claudio Munari Epilepsy Surgery Centre, Niguarda Hospital, Piazza dell'Ospedale Maggiore 3, 20162 Milano, Italy. Electronic address: veronica.pelliccia@libero.it.
authors.forename: Veronica
authors.initials: V
authors.lastname: Pelliccia
authors.affiliation: Clinical Epileptology and Experimental Neurophysiology Unit, Foundation IRCCS Carlo Besta Neurological Institute, Via Celoria 11, 20133 Milano, Italy. Electronic address: deleo.f@istituto-besta.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Deleo
authors.affiliation: Claudio Munari Epilepsy Surgery Centre, Niguarda Hospital, Piazza dell'Ospedale Maggiore 3, 20162 Milano, Italy. Electronic address: francesca.gozzo@ospedaleniguarda.it.
authors.forename: Francesca
authors.initials: F
authors.lastname: Gozzo
authors.affiliation: Epilepsy Centre, San Paolo Hospital, Via Di Rudinì 8, 20142 Milano, Italy; Department of Health Sciences, University of Milan, Italy. Electronic address: maria.canevini@ao-sanpaolo.it.
authors.forename: Maria Paola
authors.initials: MP
authors.lastname: Canevini
authors.affiliation: Claudio Munari Epilepsy Surgery Centre, Niguarda Hospital, Piazza dell'Ospedale Maggiore 3, 20162 Milano, Italy. Electronic address: Roberto.Mai@OspedaleNiguarda.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Mai
authors.affiliation: Clinical Epileptology and Experimental Neurophysiology Unit, Foundation IRCCS Carlo Besta Neurological Institute, Via Celoria 11, 20133 Milano, Italy. Electronic address: spreafico@istituto-besta.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Spreafico
authors.affiliation: Claudio Munari Epilepsy Surgery Centre, Niguarda Hospital, Piazza dell'Ospedale Maggiore 3, 20162 Milano, Italy. Electronic address: massimo.cossu@ospedaleniguarda.it.
authors.forename: Massimo
authors.initials: M
authors.lastname: Cossu
authors.affiliation: Claudio Munari Epilepsy Surgery Centre, Niguarda Hospital, Piazza dell'Ospedale Maggiore 3, 20162 Milano, Italy. Electronic address: Laura.Tassi@OspedaleNiguarda.it.
authors.forename: Laura
authors.initials: L
authors.lastname: Tassi
mesh_terms: D000328:Adult; D001921:Brain / Q000473:pathology* / Q000503:physiopathology*; D003937:Diagnosis, Differential; D004421:Dystonia / Q000473:pathology / Q000503:physiopathology; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis / Q000473:pathology* / Q000503:physiopathology* / Q000628:therapy; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D014741:Video Recording; D055815:Young Adult
keywords: Anatomo-electro-clinical features; Bitemporal epilepsy; Brain MRI; Drug-resistant epilepsy; Video-EEG monitoring