A Comparison of the Semiology of Seizures in Patients with Intractible Epilepsy Due to Endplate Gliosis and Mesial Temporal Sclerosis
Abstract number :
2.047
Submission category :
Year :
2000
Submission ID :
3206
Source :
www.aesnet.org
Presentation date :
12/2/2000 12:00:00 AM
Published date :
Dec 1, 2000, 06:00 AM
Authors :
Morris B Chang, Mark D Holmes, Donald E Born, John W Miller, Regional Epilepsy Ctr, Univ of Washington, Seattle, WA; Dept of Pathology, Univ of Washington, Seattle, WA.
RATIONALE: To identify which semiologic differences, if any, exist between seizures in patients with refractory temporal lobe epilepsy resulting from mesial temporal sclerosis (MTS) and those resulting from endplate gliosis (EPG). METHODS: In this retrospective study, 16 patients with histologically proven EPG were identified, as well as 11 patient controls with histologically proven MTS. Patient longterm video EEG monitoring videotapes were then reviewed in a blinded fashion and representative seizures were analyzed for potentially localizing clinical features. Information regarding seizure duration and presence and types of auras was also gathered when possible. Clinical ictal characteristics were described in accordance with the classification system outlined by Luders et al (Semiological Seizure Classification. Epilepsia 1998;39(9):1006-13). Clinical localization was determined by observation of initial focal signs occurring during the seizure. RESULTS: Of the 16 EPG patients, 11 had left-sided lesions and 5 had right-sided lesions. 5 of 16 were nonlocalizing semiologically; of the remaining 11, semiologic characteristics correlated with the correct side of these lesions in 6 patients (54.5%). Of the 11 MTS patients, 7 had left-sided lesions; 3 of 11 were clinically nonlocalizing and of the remaining 8, lateralizing features were correctly predictive in 6 (75%). All but 3 of the EPG patients had dialeptic seizures, and 2 of these 3 developed into generalized convulsions so rapidly that proper observation for dialeptic features was not possible; all but 1 of the MTS patients had dialeptic seizures. Versive seizures of the head and/or eyes occurred in 7 of the EPG patients, and version direction was correctly predictive of the side of the lesion in 4 (57.1%); such movements occurred in 5 of the MTS patients, with correctly predictive version direction in 4 (80%). CONCLUSIONS: This retrospective study suggests that no significant semiologic differences exist between seizures due to EPG and those due to MTS.