Rationale: The emergence of experiential auras is typical of mesial temporal lobe epilepsy. Prior invasive studies suggested that déjà-vu results from complex interactions between rhinal cortices and the mesial temporal structure. We hypothesize that the epileptogenic zone is not necessarily in the antero-mesial temporal lobe.
Methods: This study is a single-center retrospective review of patients with reported déjà-vu aura who underwent stereo-electroencephalography (SEEG) from 2010 to 2020 and subsequently had epilepsy surgery or ablation. The EEG onsets and evolutions were reviewed, and the epileptogenic zone was defined based on surgical outcome.
Results: We reviewed seizures from 16 patients who had a déjà-vu aura during their stereo-EEG evaluation. We described their non-invasive multi-modal testing as well as their invasive evaluation, discussing ictal onset patterns and electro-clinical correlation. Out of the 16 cases with déjà vu aura, five had a seizure onset outside of the antero-mesial temporal region. These five patients all had lesions that were seen on MRI including polymicrogyria, cavernoma, periventricular nodular heterotopia with SEEG onset in the lesion or the cortex overlying or surrounding the lesion. These were located in the temporal opercular, lateral temporal, and basal temporo-occipital regions. During all the seizures, there was activation of the antero-mesial temporal structures early in the evolution of the ictal pattern almost synchronously to the emergence of the aura.
Twelve patients underwent surgical resection of what was thought to be the epileptogenic zone. Two of these cases (13%), which were lesional (cavernoma and ganglioglioma), had a resection that spared the anterior temporal lobe and were seizure free. The other ten patients underwent an anterior temporal lobectomy. Only five out of the twelve (42%) were seizure free.Conclusions:
Epileptic auras including déjà-vu provide important clues to help localize the onset of a seizure, however, mesial temporal lobe structures aren’t necessarily included in the epileptogenic zone.Funding: None