History and seizure semiology in distinguishing frontal lobe seizures and temporal lobe seizures
Introduction
Epileptic seizures are classified on the basis of clinical and electroencephalographic (EEG) features of seizure episodes (Commission on Classification and Terminology of the International League Against Epilepsy, 1981). The reliability of clinical features for distinguishing between frontal lobe seizures (FLS) and temporal lobe seizures (TLS) has not been assessed rigorously. We studied a cohort of patients whose seizure origin had been correctly determined by the location of resective epilepsy surgery that controlled seizures. Our objective was to determine whether historical information and video-recorded seizure semiology could be used to reliably distinguish between FLS and TLS.
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Patients
The study was approved by the Mayo Clinic Institutional Review Board. FLS patients were identified from a database of 68 patients who had undergone frontal lobe epilepsy surgery at Mayo Clinic (Rochester, Minnesota) between 1987 and 1994. After reviewing the medical records, we identified 27 consecutive FLS patients who had excellent post-surgical outcome by being seizure free for at least 2 years after surgery. Video recordings of seizures were available for all patients, but the recordings of
Comparison of HII
Univariate analysis of the HII of FLS and TLS patients is shown in Table 1. FLS patients were significantly more likely to be male or to have had generalized convulsions. Although the overall rate of prior central nervous system insult was not higher in FLS patients, insult had occurred at an older age for FLS patients. Also, significantly more FLS patients had major traumatic head injuries. In contrast, TLS patients were significantly more likely to have a history of febrile convulsions.
Comparison of VSF
Comment
The positive predictive values of individual semiologic features are reported to be as high as 85 to 100% (Wada, 1982, Kotagal et al., 1989, Privitera et al., 1991, Marks and Laxer, 1998, Gallmetzer et al., 2004). However, the reported value of most semiologic features was for lateralization of TLS onset, and many semiologic features may appear in either FLS or TLS. Only 3 previous studies specifically compared the semiologic features of FLS with those of TLS, but none used post-surgical
Conclusion
No single HII or VSF is sufficient for distinguishing between FLS and TLS. A model integrating multiple HII and VSF may assist in this differentiation, but some patients still may be misclassified. The findings in our study underscore the need to integrate VSF with clinical, EEG, and imaging data for identifying seizure type and localizing onset.
Conflict of interest
None.
Acknowledgment
We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. We acknowledge assistance with the statistical analysis from Slave Petrovski, BSc (Hons), BIS, the Department of Medicine, The University of Melbourne.
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Lateralizing and localizing value of seizure semiology: Comparison with scalp EEG, MRI and PET in patients successfully treated with resective epilepsy surgery
2018, SeizureCitation Excerpt :Tuxhorn found that sensory auras are likely to indicate parietal lobe onset if they are well localized in the distal extremity and associated with a sensory march [27]. O’Brien et al. reported that by combining historical information with video analysis, they could correctly distinguish between frontal lobe seizures and temporal lobe seizures [28]. Attention to the progression of symptoms is also useful as shown by Williamson.
Localization value of seizure semiology analyzed by the conditional inference tree method
2015, Epilepsy ResearchCitation Excerpt :Although previous studies showed that the accuracy of the recognition of the seizure type was relatively high, there was marked interobserver variability and inconsistency, which was dependent on the type of ictal semiology (Chee et al., 1993; Rugg-Gunn et al., 2001; Heo et al., 2008; Benbir et al., 2013). Some reports questioned the capacity of clinical semiology descriptions provided by the caregivers (Manford et al., 1996; O’Brien et al., 2008), but these studies did not validate the accuracy of these semiologic descriptions. Our study also shows the inaccuracy of the semiologic descriptions provided by the patients or their caregivers, and the accuracy of individual descriptions was strongly dependent of the types of semiology.
Emergence of semiology in epileptic seizures
2014, Epilepsy and BehaviorCitation Excerpt :Curiously, two trends have evolved in parallel. On the one hand, some papers have seriously questioned the capability and, therefore, the utility of clinical semiology as compared with morphological techniques in localizing the epileptogenic zone [12,13]. The presence of a radiological lesion is regarded as a heavily weighted piece of evidence in favor of the zone of seizure origin more or less independent of clinical seizure presentation [14,15], leading to less emphasis on detailed semiological analysis, especially in mesial temporal lobe epilepsies [15].
Neural network underlying ictal pouting ("chapeau de gendarme") in frontal lobe epilepsy
2014, Epilepsy and Behavior
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Present address: Royal Inland Hospital, Kamloops, British Columbia, Canada.