Clinical and electrophysiological analysis of 13 patients of temporal lobe epilepsy originating from the temporal pole
Objective To summary the clinical and electrophysiological characteristics of temporal lobe epilepsy(TLE)originating from the temporal pole(TP),and to conduct brain network analysis based on stereo-electroencephalogram(SEEG)and head positron emission tomography-computed tomography(PET-CT).Methods A retrospective analysis was conducted on patients with TLE who underwent SEEG implantation from January 1,2019 to September 1,2023 in Guangdong Sanjiu Brain Hospital.Based on anatomical-electrical-clinical analysis and SEEG findings,patients with seizures originating from the TP were selected.The clinical data,head magnetic resonance imaging(MRI),PET-CT,scalp electroencephalogram were reviewed,and the seizure-induced network was analyzed based on SEEG and head PET-CT.Results A total of 108 cases of TLE were analyzed,of whom 13 cases had an epileptogenic zone located at the TP,accounting for 12％(13/108)of all TLE patients.Among them,8 were males and 5 were females,and age of onset was(11.6±7.8)years.All of them were drug-resistant epilepsy patients,of whom 6 cases had normal cognitive function,4 had mild cognitive abnormalities,and 3 had severe cognitive decline.A total of 59 seizures were recorded,and the occurrence rate of generalized tonic-clonic seizures(GTCS)was 42％(25/59).Seizure symptoms were classified into 3 types:the first type was hypermotor,seen in 9 patients;the second type was complex motor,seen in 2 patients;and the third type was automotor,seen in 2 patients.Head MRI showed that 9 cases had a blurring of the TP on one side,with or without hippocampal sclerosis;2 cases had a mass at the TP without hippocampal sclerosis;2 cases were negative on head MRI.Head PET-CT showed that 13 cases had TP hypometabolism on the lesion side,of whom 11 cases had hypometabolism involving the medial temporal lobe(mTL),posterior orbital gyrus(POG),anterior cingulate gyrus(ACG)and insular lobe at the same time,the other 2 cases combined with ipsilateral hypometabolism of the medial temporal lobe.Pathology showed that 7 cases had microcortical dysplasia of the TP;3 had focal cortical dysplasia Ⅰ or focal cortical dysplasia Ⅱ;2 had benign tumors.Scalp electroencephalogram showed that interictal phase was divided into 3 discharge patterns:bilateral temporal regions with prominent lesion side;bilateral anterior regions with prominent lesion side;lesion-side hemisphere with prominent temporal region.Ictal period showed 4 initial patterns:lesion-side hemispheric rhythmic spikes-slow waves or polyspikes-slow waves;lesion-side anterior region rhythmic slow waves;lesion-side anterior region low voltage fast(LVF)activities,and diffuse LVF with prominent lesion-side hemisphere.SEEG showed that 13 patients received electrode implantation with(9±2)electrodes per patient,divided into 3 seizure patterns:type 1:TP→ adjacent temporal neocortex→POG,ACG and insula→ mTL;type 2:TP→para hippocampal gyrus and the base of temporal lobe→ACG,POG and insula→mTL;type 3:TP→ mTL→insular lobe→POG.Conclusions TLE originating from the TP is relatively rare,with hypermotor or complex motor as the main manifestations,and automotor being relatively less common,which is more likely to be followed by GTCS.The epileptogenic network analysis displays a tendency to spread from the TP to the frontal and insular lobes,as well as to the mTL,with the former pattern being more common.Common etiologies are cortical dysplasia and benign tumors of the TP without hippocampal sclerosis.
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