An evaluation of the clinical signs meaningful for lateralization in patients with temporal lobe epilepsy

There is a high proportion of resistance to anti-epileptic treatment in patients with temporal lobe epilepsy. In drug resistant TLE patients , resective surgery is applied in order both to control the seizures and to prevent cognitive destruction. Reliable clinical lateralization signs are of great significance in deciding the seizure focus and therefore correct identification and evaluation of the clinical signs is quite important. This study analyses the differences in the clinical signs of TLE seizures in terms of frequency, lateralization values, age and gender.For this study, 55 patients in Gazi University School of Medicine Neurology department, Adult Epilepsy Monitoring Unit who are under observation with drug-resistant TLE , whose epileptic focus are decided through non-invasive analysis and with good seizure control during postoperative observation after Anterior Temporal Lobectomy (ATL) are analysed retrospectively. Patients? behaviour during seizures is evaluated in detail, and any difference in lateralization values in relation to the operation side and age-gender groups is assessed. Versiv head rotation, unilateral dystonic posturing, asymmetric tonic limb posturing and unilateral dystonic posturing-automatism unity are found as the clinical signs with the highest lateralization value (%90-100). According to this analysis, oroalimenter automatisms are more frequent in the group with young age seizure onset (<2 years), whereas secondary generalization and asymmetric tonic posturing is more frequent in the group with later age seizure onset (>2 years) (p<.05). There were differences in male-female groups? clinical signs as well. According to these differences, psychic-autonomic auras and ictal emotional symptoms were associated with the female gender (p<.05). As a result, it is suggested that some frequent clinical signs are quite helpful in lateralizing the seizure focus and of great leading value before the surgery. It should also be considered that lateralization data differs according to the gender and the seizure onset age. Besides, it is difficult to determine the lateralization value of the less frequent clinical signs, and therefore studies with large series are suggested as leading sources for the field.