1994 Volume 12 Issue 1 Pages 1-9
Some patients with temporal lobe epilepsy (TLE) continue to have simple partialseizures or auras postoperatively. To scrutinize factors which may correlate withpersistence of auras and to characterize their natural history, we studied 56 TLEpatients who underwent anterior temporal lobectomy after a precise focus determina-tion by long-term intracranial EEG monitoring using bitemporal depth/subduralelectrodes. They were followed for a minimum of 2 years postoperatively. Thirty-onepatients had no postoperative seizures (group 1), 14 patients had auras but no complexpartial seizures (CPSs)(group 2), and 11 patients both auras and CPSs (group 3). Ingroup 2 and 3, history of early brain injury, such as convulsive status, encephalitis andhead trauma was found more frequently; duration of epilepsy was longer and aurasoccurred more frequently than in group 1, preoperatively. Analysis of ictal intracranial EEGs during auras recorded in 18 patients in group 1, 12 in group 2 and 10 in group 3disclosed that ictal discharges, when arising from amygdalo-hippocampal region, wereprone to spread toward the posteromedial structures in group 2 and 3, while in group1 toward anterior basal-temporal area. Auras recurred mostly within a half postoper-ative year in those patients having medial temporal seizure origin and mesial temporalsclerosis, regardless of whether or not CPSs recurred afterwards. Those patientshaving seizures of lateral temporal origin had CPSs as well when they experiencedauras postoperatively. Auras decreased in frequency as years passed. Postoperativepersistence of isolated auras was considered to correlate with a temporomedialepileptogenic zone that extends over posteromedial structures. Nonetheless, the vastmajority of postoperative auras run down.
