IRCCS NEUROMED, Pozzilli, Isernia, Italy.
Centre of Behavioural Sciences and Mental Health, Italian National Institute of Health, Rome, Italy.
Clin Neurol Neurosurg. 2021 Sep;208:106868. doi: 10.1016/j.clineuro.2021.106868. Epub 2021 Aug 4.
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.
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.
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).
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.
双颞叶癫痫（biTLE）是颞叶癫痫（TLE）手术失败的潜在原因，很少与单侧海马硬化（HS）相关，其可能表现为发作期头皮脑电图/发作间期 PET-FDG 无偏侧化发现。我们评估了为定位目的接受颅内检查的药物难治性 TLE-HS 患者中 biTLE 的比例。
我们回顾性纳入了所有连续的耐药性 TLE-HS 患者，这些患者的发作期头皮脑电图/发作间期 PET-FDG 无偏侧化发现，且接受了颅内双侧纵向海马电极检查。评估了人口统计学特征、电临床发现和发作结局。
我们确定了 14 名受试者（7 名男性；平均年龄 39.5 岁；疾病发病年龄平均 14.4 岁），其中 7 名在颅内检查后被诊断为 biTLE。在其余 7 名单侧致痫性（uniTLE）患者中，进行了前颞叶切除术（7 名中有 6 名术后达到 Engel Ⅰ级）。术前神经心理学评估将 biTLE 与 uniTLE 区分开来，6 名 uniTLE 患者的评估正常，但只有 1 名 biTLE 患者的评估正常（p<0.05）。
TLEHS 中无偏侧化的发作期头皮脑电图和功能成像发现应该提醒存在单侧 MRI 发现的情况下真正 biTLE 的可能性。双侧纵向海马电极的颅内检查可以以良好的风险效益比定位 EZ。与使用纵向海马电极探索 TLE 患者的记忆功能的警告一致，需要进一步研究以更好地确定最佳的检查策略。
