Differences between mesial and neocorticalmagnetic-resonance-imaging-negative temporal lobe epilepsy
2016
Objective: The aim of this study was to assess clinical and
electrophysiological differences within a group of patients
with magnetic-resonance-imaging-negative temporal lobe epilepsy
(MRI-negative TLE) according to seizure onset zone (SOZ)
localization in invasive EEG (IEEG). Methods: According to SOZ
localization in IEEG, 20 patients with MRI-negative TLE were
divided into either having mesial SOZ-mesial MRI-negative TLE
or neocortical SOZ-neocortical MRI-negative TLE. We evaluated
for differences between these groups in demographic data,
localization of interictal epileptiform discharges (IEDs), and
the ictal onset pattern in semiinvasive EEG and in ictal
semiology. Results: Thirteen of the 20 patients (65%) had
mesial MRI-negative TLE and 7 of the 20 patients (35%) had
neocortical MRI-negative TLE. The differences between mesial
MRI-negative TLE and neocortical MRI-negative TLE were
identified in the distribution of IEDs and in the ictal onset
pattern in semiinvasive EEG. The patients with neocortical
MRI-negative TLE tended to have more IEDs localized outside the
anterotemporal region (p = 0.031) and more seizures without
clear lateralization of ictal activity (p = 0.044). No other
differences regarding demographic data, seizure semiology,
surgical outcome, or histopathological findings were found.
Conclusions: According to the localization of the SOZ,
MRI-negative TLE had two subgroups: mesial MRI-negative TLE and
neocortical MRI-negative TLE. The groups could be partially
distinguished by an analysis of their noninvasive data
(distribution of IEDs and lateralization of ictal activity).
This differentiation might have an impact on the surgical
approach. 2016 Elsevier Inc. All rights reserved.
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