Elsevier

Epilepsy Research

Volume 82, Issues 2–3, December 2008, Pages 177-182
Epilepsy Research

History and seizure semiology in distinguishing frontal lobe seizures and temporal lobe seizures

https://doi.org/10.1016/j.eplepsyres.2008.08.004Get rights and content

Summary

This study aimed to determine the reliability of clinical history and seizure semiology for distinguishing between frontal lobe seizures (FLS) and temporal lobe seizures (TLS). FLS patients (n = 23) were consecutively identified through an epilepsy surgery database. TLS patients (n = 27) were selected randomly from 238 patients who had undergone temporal lobe surgery for epilepsy. The criterion standard for seizure localization was the location of resective epilepsy surgery that controlled seizures for a minimum of 2 years. Blinded comparisons of 13 historical information items (HII) and 19 video-recorded semiologic features (VSF) were made. We identified 3 HII (sex, history of febrile convulsions, and history of generalized tonic–clonic seizures) and 2 VSF (fencing posturing and postictal confusion) that significantly distinguished between FLS and TLS. The multivariate analysis model correctly identified 87% of FLS patients and 74% of TLS patients. 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.

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.

Section snippets

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.

References (13)

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1

Present address: Royal Inland Hospital, Kamloops, British Columbia, Canada.

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