Abstracts

Magnetic resonance imaging (MRI) demonstrates abnormalities in the temporo-polar region in 1/3 to 2/3 of patients with hippocampal sclerosis (HS) that had been named HS- Plus.The aim of this study is to compare ictal and postictal clinical symptoms in patients with temporal lobe epilepsy (TLE) and pure HS, and patients with HS-Plus, diagnosed by MRI. Blinded to clinical details, we reviewed ictal video-EEG recordings from patients with HS, and from patients with HS-plus. We analyzed all ictal and postictal symptoms. We reviewed 104 seizures in 32 consecutive patients. Patients were differentiated in 2 groups: group 1: HS patients, and group 2: HS-plus patients. Variables (symptoms) were analyzed by Chi-square or Fisher exact tests. To identify the variables that significantly contribute to differentiate the 2 groups we performed a binary logistic regression. [underline]Group [/underline][underline]1[/underline]:18 patients, 51 seizures, and [underline]group [/underline][underline]2[/underline]:14 patients, 53 seizures. The following symptoms were significantly more frequent in [underline]group 1[/underline]: non-versive early head turning (p=0.013), non-verbal ictal speech (p=0.002), well-formed ictal speech (p[lt]0.001), hyperpnoea (p=0.032); and in [underline]group 2[/underline] the more significantly frequent symptoms were: presence of an aura (p=0.003), presence of more than one type of aura (p=0.017), forced ocular version before ([lt]10 s) secondary generalization: (p=0 .034), non-versive late ([gt]10 s) head turning (p=0.005), forced head version before ([lt]10 s) secondary generalization (p=0.018), forced unilateral mouth deviation (p=0.015), unilateral clonias (p=0.037), bilateral eye blinking (p=0.007), postictal nosewiping (p[lt]0 .001), and hyper salivation (p=0.031). Using binary logistic regression, the strongest variables selected to differentiate the two groups were: non-versive late head turning ([gt]10 s), forced head version before ([lt]10 s) secondary generalization, bilateral eye blinking, non-verbal ictal speech and postictal nosewiping. These observations suggest that different networks may be involved during seizures of patients with HS and HS-plus. Preoperative diagnosis of the entire temporal lobe pathology may be relevant for the surgical approach (ie, a temporal lobectomy as opposed to an amygdalohippocampectomy). (Supported by Buenos Aires University)