Abstracts

Approximately 30% of patients undergoing epilepsy surgery for intractable temporal lobe epilepsy continue to have seizures despite detailed presurgical evaluation with advanced localizing techniques prior to surgery. Seizure semiology may play a part in determining outcome. We retrospectively reviewed the seizure semiology in 30 (15 right and 15 left) patients who underwent temporal lobectomy. Seizure semiology was studied by reviewing the history and video-EEG monitoring, volumetric MRI with temporal lobe potocol and interictal PET. Eight patients underwent invasive video-EEG monitoring with subdural electrodes. Four patients had ictal and interictal SPECT, and 4 had MR spectroscopy. Surgical outcome was determined by Engel[apos]s classification, with class 1 regarded as good outcome. Presence of auras, onset and evolution of seizures, and occurence of secondary generalization were noted in all patients. Histopathologically all patients had mesial temporal sclerosis. Mean duration of follow-up of all patients was 3.5 years (range 2-7). Twenty one of the 30 patients had a good outcome (12 right, 9 left). All 30 patients has complex partial seizures. Thirteen also had secondary generalized tonic-clonic seizures( seven with good, 6 with poor outcome). Epileptic auras were present in 10 patients with class I outcome and 4 patients with class 2-4 outcome. The auras described in patients with good outcome were deja vu (1), visual hallucination(1), abdominal(5), gustatory(1) and fear(3). The 4 patients with poor outcome had nonspecific light headedness. Thirteen of 21 patients with class 1 outcome had staring spells, 10 of whom had subtle oral-facial and hand automatisms. Nine patients had poor outcome and all had staring spells with prominent motor and/or vocal automatisms, such as grabbing, wandering, yelling, and stomping of feet. Specific auras like deja vu, visual hallucinations, abdominal aura, gustatory aura and fear are associated with good outcome, while nonspecific auras, such as lightheadedness, are associated with poor outcome. Presence of prominent motor and/or vocal automatisms is associated with poor outcome. Occurence of secondarily generalized seizures do not influence outcome. In addition to advanced localizing techniques, semiology may provide valuable information in predicting outcome after epilepsy surgery.