Lateralizing And Localizing Value Of Ictal Semiology In Epilepsy

Objective To assess the lateralizing/localizing value of peri-ictalheart rate changes in partial seizure.Methods Collecting patients with refractory epilepsy in thedepartment of neurosurgery at Daping Hospital of Third Military MedicalUniversity from June,2010to March,2011. Peri-ictal heart rate changeswere recorded using video-EEG-ECG recordings. As a marker of ictaldischarge onset, heart rate was measured in preictal (1-2min before thedischarge onset), ictal-onset (5sec after the discharge onset), ictal,early-postictal (within5min after the discharge stop), middle-postictal(5-30min) and late-postictal (over30min) periods. Analyze the influence oflateral hemispheric asymmetry, different onset zones and ictal symptoms onthe heart rate changes over10%. Results86partial seizures in38patients with refractory epilepsywere recruited in the study:49seizures (57.0%) with left hemisphere onsetand37seizures (43.0%) with right hemisphere onset;49seizures (57.0%)with temporal lobe (TL) onset and37seizures (43.0%) with extra-temporallobe (extra-TL) onset; the primary ictal symptoms were aura, complexmotor (include automotor and hypermotor), versive and unilateral tonicseizure. The heart rate of most seizures showed a significant increase,whereas the decrease of heart rate occurred lowly. The incidence of heart rateincrease in preictal and ictal-onset phase was significantly more pronouncedin patients with TL onset as compared with extra-TL onset (P<0.01).However, there was no significant difference between left and right side.Complex motor was the primary symptom resulted to ictal heart rateincrease before sGTCS, but there was no significant difference betweenautomotor and hypermotor. The heart rate of57.0%seizures returned tobaseline in the early-postictal phase, but the heart rate of seizures with TLonset and sGTCS recovered delay.Conclusions Heart rate increase of preictal and ictal-onset phaseseizures occurred most frequently with seizures arising from TL, but maynot have reliably lateralizing value. Complex motor was primarilyassociated with heart rate increase of ictal phase. TL onset and sGTCS maybe the factors of long-term cardiac autonomic dysfunction in epilepsy. Objective The study propose a ictal sign based on a large number ofanalysis of long-term video-EEG documented seizures in temporal lobeepilepsy (TLE) defined as tonic-automotor (TA): contralateral tonic activityof upper limbs associated with ipsilateral hand automotor and oftenaccompanied ipsilateral head turning. To assess the occurrence andlateralizing/localizing value of TA in TLE.Methods Collecting patients with refractory TLE undergoneoperation in the department of neurosurgery at Daping Hospital of ThirdMilitary Medical University. All patients completed pre-operativeevaluation, including medical history assessment, long-term video-EEGmonitoring, high-resolution magnetic resonance imaging/spectroscopy(MRI/MRS), and positron emission computed tomography (PET). Allpatients were diagnosed as Engel I in the2-year follow-up after surgery. Analyze the occurrence and lateralizing/localizing value of TA comparedwith unilateral tonic activity and unilateral automotor in TLE.Results129seizures in41patients with TLE were recruited in thestudy:90seizures in30patients with TLE of hippocampal sclerosis(TLE/HS) and39seizures in11patients with TLE of other lesions(TLE/non-HS).24seizures in12patients with TA were observed only inTLE/HS patients and occurred relatively early in the ictal phase, it indicatedthe cerebral structure influenced early. Compared with unilateral tonicactivity and unilateral automotor, TA occurred more frequently in TLE/HSpatients (40%vs10%and16.7%, P<0.05). This study defined thelateralization of TA was base on the side of tonic activity, all TA (100%)were contralateral to the seizure focus.85.7%of patients with unilateraltonic activity was observed in the contralateral side.83.3%of patients withunilateral automotor were related to the ipsilateral side. However, there wasno significant difference in the TLE/HS between left and right side.Conclusions TA may be a more reliable lateralizing sign ofepileptogenic zone and a semiologic marker of TLE/HS patients..