The Semiological and Electrographic Features of Temporopolar Epilepsy as Studied by Stereo-electroencephalography
Abstract number :
3.319
Submission category :
9. Surgery / 9A. Adult
Year :
2022
Submission ID :
2205107
Source :
www.aesnet.org
Presentation date :
12/5/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:28 AM
Authors :
Denise Chen, MD – University of Washington; Nigel Pedersen, MD – Associate Professor, Neurology, Emory University; Daniel Drane, PhD – Associate Professor, Neurology, Emory University; Ammar Kheder, MD, MRCP – Associate Professor and Epilepsy Chief, Neurology and Pediatrics, Emory University and Children's Healthcare of Atlanta
Rationale: The temporal pole (TP) is a polymodal cortex with broad cortical connections. It serves as a hub for integrating emotions and behavior with perception. Our study aims to identify the semiological and electrographic features in epilepsy patients who have either pure temporopolar epilepsy or an epilepsy with early involvement of the temporal pole. _x000D_
Methods: We identified 23 patients with medically-intractable temporopolar onset or early involvement (20 female, 3 male patients; aged 26-56 years) undergoing stereo-electroencephalography (SEEG) and with at least two electrode contacts in the TP. Four patients had right hemispheric implantations, two were bi-hemispheric, and 17 were left-sided. An average of four seizures per patient were reviewed (total 96). Semiological features were reviewed in 10-second sequences including the presence of aura, loss of contact and secondary generalization. Total seizure duration and EEG to clinical onset were calculated._x000D_
Results: Aura was present in only nine seizures (9%). Awareness was preserved in 20 seizures (21%). Secondary generalization was observed in 22 of seizures (23%). Fifty seizures (52%) were recorded from sleep. Behavioral arrest during wakefulness and arousal from sleep are the most prominent early sign in this cohort. A mean duration of 5 seconds from EEG onset to clinical signs was observed. The mean duration of seizure spread to the pole was 7 seconds. The mean seizure duration was 80 seconds.
Conclusions: Temporopolar seizures are characterized by lack of aura, early loss of contact with no lateralizing value. Behavioral arrest during wakefulness and arousal from sleep are the most prominent early sign. Onset or early ictal involvement of the temporal pole was evident in all our patients. Sampling TP should be considered when studying temporal lobe epilepsy with SEEG.
Funding: NPP was supported by CURE Epilepsy, NIH R21NS122011, and K08NS105929.
Surgery