1. Bilateral epileptogenesis in temporal lobe epilepsy due to unilateral hippocampal sclerosis: A case series.
- Author
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Mascia A, Casciato S, De Risi M, Quarato PP, Morace R, D'Aniello A, Grammaldo LG, Pavone L, Picardi A, Esposito V, and Di Gennaro G
- Subjects
- Adult, Electroencephalography, Epilepsy, Temporal Lobe pathology, Epilepsy, Temporal Lobe physiopathology, Female, Hippocampus physiopathology, Humans, Male, Middle Aged, Retrospective Studies, Sclerosis pathology, Sclerosis physiopathology, Young Adult, Epilepsy, Temporal Lobe etiology, Hippocampus pathology
- Abstract
Introduction: Bitemporal epilepsy (biTLE), a potential cause of failure in TLE surgery, is rarely associated with unilateral HS and could be suggested by not lateralizing ictal scalp EEG/interictal PET-FDG findings. We evaluated the proportion of biTLE in a population of drug-resistant TLE-HS subjects who underwent intracranial investigation for lateralizing purpose., Methods: We retrospectively included all consecutive refractory TLE-HS patients and not lateralizing ictal scalp EEG/interictal PET-FDG findings, investigated by intracranial bilateral longitudinal hippocampal electrodes. Demographic characteristics, electroclinical findings and seizure outcome were evaluated., Results: We identified 14 subjects (7 males; mean age 39.5 years; mean age at disease onset 14.4 years), 7 of them had biTLE diagnosed after intracranial investigations. In the remaining 7 with unilateral epileptogenesis (uniTLE) anterior temporal lobectomy was performed (6/7 were in Engel class I). Preoperative neuropsychological assessment differentiated biTLE from uniTLE, as it was normal in six uniTLE patients but only in one with biTLE (p < 0.05)., Conclusions: Not lateralizing ictal scalp EEG and functional imaging findings in TLEHS should alert about the possibility of a true biTLE also in presence of unilateral findings at MRI. Intracranial investigations with bilateral longitudinal hippocampal electrodes can localize the EZ with a good risk-benefit profile. Consistently with the warning on memory functions in TLE patients explored by using longitudinal hippocampal electrodes, further studies are needed to better define the optimal investigation strategy., (Copyright © 2021 Elsevier B.V. All rights reserved.)
- Published
- 2021
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