Does the patient's hand hold the key to preventing secondary generalization in mesial temporal lobe epilepsy?

Does the patient's hand hold the key to preventing secondary generalization in mesial temporal lobe epilepsy?

Author Pedroso Uchida, Carina Goncalves Autor UNIFESP Google Scholar
Barsottini, Orlando Graziani Povoas Autor UNIFESP Google Scholar
Sales Ferreira Caboclo, Luis Otavio Autor UNIFESP Google Scholar
Araujo Filho, Gerardo Maria de Autor UNIFESP Google Scholar
Centeno, Ricardo Silva Autor UNIFESP Google Scholar
Carrete Junior, Henrique Autor UNIFESP Google Scholar
Targas Yacubian, Elza Marcia Autor UNIFESP Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Abstract This study aimed to analyze the impact of ictal dystonic posturing (DP) in postoperative seizure outcome and to assess the influence of DP in generalized tonic clonic seizure (GTCS) occurrence during video-EEG monitoring of patients with temporal lobe epilepsy with mesial temporal sclerosis. the impact of DP on surgical outcome remains controversial. Moreover, DP has been recently associated with brain networks avoiding GTCS occurrence.Five hundred twenty-seven seizures of 171 patients who were submitted to standard anterior temporal lobectomy (ATL) between 2002 and 2010, with at least one year of post-surgical follow-up, were retrospectively analyzed and classified as with or without DP and as evolving or not to GTCS. the ictal semiologic correlates of DP, timing elapsed since precedent seizure and antiepileptic drug (AED) intake before each seizure were evaluated. Seizure outcome after ATL was assessed according to Engel's scale.Fifty-eight out of 171 patients (34%) exhibited ictal DP, of which 91.5% were always unilateral and contralateral to the operated side. DP was related to shorter seizures (p = 0.007) and a much lower likelihood of the seizure evolving to GTCS (p = 0.001), even during AED withdrawal (p = 0.002). There was no association between DP and prognosis regarding seizure control as the result of the surgical resection, either in patients with shorter or in those with longer period of follow-up. Our data support the hypothesis that DP reflects a brain network activation that helps avoid GTCS, even during AED withdrawal. (C) 2013 Elsevier B.V. All rights reserved.
Keywords Dystonic posturing
Temporal lobe epilepsy
Mesial temporal sclerosis
Surgical outcome
Generalized tonic-clonic seizures
Video-EEG monitoring
Language English
Sponsor Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
Date 2013-07-01
Published in Epilepsy Research. Amsterdam: Elsevier B.V., v. 105, n. 1-2, p. 125-132, 2013.
ISSN 0920-1211 (Sherpa/Romeo, impact factor)
Publisher Elsevier B.V.
Extent 125-132
Access rights Closed access
Type Article
Web of Science ID WOS:000320737500015

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