Abstracts

Rationale: With expanding significance of non-invasive presurgical evaluation in TLE patients, the analysis of ictal semiology becomes increasingly important for the selection of these candidates. A wide range of autonomic phenomena have been described to occur in TLE, some of these being assigned valuable information on seizure origin. Hypersalivation has so far been reported in seizures of temporal origin. However, a clear differentiation between mesial and extra-mesial seizure origin has not been presented to date. Several studies have analyzed postictal coughing in TLE with contradictory results concerning its localizing significance. Thus, the clinical value of hypersalivation and postictal coughing in TLE with regard to localization of the seizure focus has not been cleared to date. Methods: We analyzed video/EEG monitoring documented seizures of 107 adult patients for a set of defined seizure phenomena with respect to frequency and sequence of occurrence in relation to epileptogenic origin, comparing mesial versus extramesial and left versus right. Results: Hypersalivation was rare, but occurred exclusively in seizures of mesial origin (9.4%). Comparison between left (11.4%) and right (6.9%) mesial origin was statistically insignificant. Postictal coughing also occurred exclusively in seizures of mesial origin (6.3%). Again, comparison between left (5.7%) and right (6.9%) mesial origin was statistically insignificant. Conclusions: Hypersalivation and postictal coughing are rare seizure phenomena in TLE, but their occurrence strongly support mesial seizure origin. The acquisition of a reliable and valid set of semiological features with lateralizing and / or localizing value is of great importance for seizure classification as well as for optimal patient selection for epilepsy surgery.