Characterizing Temporal Pole Epilepsy: Semiology and EEG Findings in SEEG-Guided Surgical Cases
Abstract number :
1.217
Submission category :
3. Neurophysiology / 3A. Video EEG Epilepsy-Monitoring
Year :
2025
Submission ID :
511
Source :
www.aesnet.org
Presentation date :
12/6/2025 12:00:00 AM
Published date :
Authors :
Presenting Author: David Martinez, MD – Cleveland Clinic
Shivanee Sodani, MD – Cleveland Clinic
Balu Krishnan, PhD – Cleveland Clinic
Juan C. Bulacio, MD – Cleveland Clinic, Cleveland, United States
Rationale: Despite being a restricted anatomical structure, the temporal pole (TP) has extensive areas of connectivity, such as the orbitofrontal, parietal cortex, language and visual areas. This widespread connectivity is thought to contribute to the variable semiology and EEG features reported in the literature for TP epilepsies. While SEEG and growing interest in temporal encephaloceles have advanced our understanding of temporal pole epilepsy characteristics, fewer studies have been focused on correlating these features on Engel I surgical patients. This study seeks to identify common semiological and electrophysiological features in patients with TP epilepsy who achieve Engel I outcomes.
Methods: This retrospective single-center study analyzed patients who underwent SEEG-guided temporal pole resection with/without amygdala removal between 2015 and 2023, achieving Engel I surgical outcomes with at least one year of follow-up. Detailed analysis was performed encompassing scalp EEG interictal and ictal findings, ictal semiology, and SEEG findings. Semiological features were coded in a standardized manner for systematic comparison across patients.
Results: Nine cases met the inclusion criteria. For main population characteristics, see Table 1. Among the cases with available scalp EEG data, all but one had interictal epileptiform discharges (IEDs). Of these, 7/8 (87.5%) had ipsilateral frontotemporal IED, and there were no cases with only contralateral IED. From the analyzed scalp seizures (n: 38), 36/38 (94.8%) had a unilateral onset, located over the ipsilateral frontotemporal region in 30/38 (79%) seizures. The average time to bilateral spread was 15.9 seconds, and the average frequency observed at the ictal onset was 3.6 Hz (2-8 Hz). A period without clinical signs was observed in 84.6% of scalp seizures, and the mean duration was 10.2 seconds. The most frequently observed clinical sign was heart rate increase, present in 84% of seizures. For additional semiological findings, see Figure 1.
Conclusions: TP epilepsies exhibit distinct scalp EEG and semiological features that, when present and consistent (especially in the presence of MRI abnormalities), should prompt consideration of surgical resection without the need for SEEG. Interictal findings typically are ipsilateral and localized to the frontotemporal region. Ictal patterns almost always begin unilaterally and are characterized by rhythmic delta activity. A phase of no clinical signs is commonly observed, which is then followed by autonomic changes, unresponsiveness/behavioral arrest, and automotor/complex motor signs.
Funding: None
Neurophysiology