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Biomedical subjects

C E Elger

Publications and source records attributed to C E Elger.

At least 19 recordsLinked to original sources

Potassium currents in acutely isolated human hippocampal dentate granule cells.

1. Properties of voltage- and Ca(2+)-dependent K+ currents were investigated in thirty-four dentate granule cells acutely isolated from the resected hippocampus of eleven patients with therapy-refractory temporal lobe epilepsy (TLE). 2. When intracellular Ca2+ was strongly buffered with 11.5 mM EGTA-1 mM Ca2+ in the recording pipette, K+ currents (IK) with a slow activation and biexponential time-dependent decay could be elicited, which showed a threshold for activation around -30 mV. 3. A contribution of Ca(2+)-dependent K+ currents became apparent with intracellular solution containing 1 mM BAPTA-0.1 mM Ca2+. Superfusion of low-Ca2+ extracellular solution blocked 43% of outward currents in this recording configuration. Outward current components could also be blocked by substituting 5 mM Ba2+ for extracellular Ca2+ (78%), or by application of 100 microM Cd2+ (25%). 4. The Ca(2+)-dependent K+ currents could be pharmacologically subdivided into two components. One component was sensitive to 500 microM tetraethylammmonium (TEA; 41%) and 10 nM charybdotoxin (CTX; 47.2%). The blocking effects of 10 nM CTX and 500 microM TEA were not additive, suggesting that both agents block the same conductance. A second, smaller outward current component was blocked by 50 nM apamin (13%). 5. A transient A-type K+ current could be observed in six neurones and showed a fast monoexponential time-dependent inactivation with a steady-state voltage dependence that was distinct from that of IK. The A-type current was blocked by 4-aminopyridine (4-AP) but not by TEA or low-Ca2+ solution. 6. We conclude that outward currents in human hippocampal dentate granule cells can be separated into at least four types by their kinetic and pharmacological properties. These include at least one voltage-dependent current similar to those observed in mammalian hippocampal neurones, and two Ca(2+)-dependent K+ currents that most probably correspond to SK- and BK-type currents. A classical A-type current could be detected in some patients with Ammon's horn sclerosis (AHS) but not in patients with lesion-associated TLE.

Epilepsy, Temporal Lobe

Patterns of language dominance in focal left and right hemisphere epilepsies: relation to MRI findings, EEG, sex, and age at onset of epilepsy.

The present study evaluates results of language testing during intracarotid amobarbital procedures in 167 patients with either left (LHE, n = 81) or right hemisphere epilepsies (RHE, n = 86). In both groups there was a high rate of deviance from complete left hemisphere dominance of 24 and 31%, respectively. Whilst complete right hemisphere or incomplete left hemisphere language dominance were the prominent atypical patterns in LHE, RHE was associated with either bilateral dominance or incomplete left dominance. In LHE, atypical language dominance was frequently associated with an extratemporal localization of lesions or epileptic foci. The age at onset of epilepsy and the degree of right hemisphere language dominance correlated significantly in LHE but not in RHE. Finally, atypical dominance in LHE but not in RHE was associated with poorer language and nonlanguage functions, the latter being negatively correlated with the degree of right hemisphere language dominance. Conclusions are: (1) The data contradict the assumption of equipotentiality and favor the supposition of a predetermined left hemisphere superiority in language processing. (2) Atypical language dominance in LHE can largely be explained in terms of a plasticity dependent language shift as a consequence of early left hemisphere epilepsies and lesions. (3) Atypical dominance patterns in RHE appear to reflect the prevalence of genetically determined variants and the possibility of a language transfer from the right to the left hemisphere.

Age of Onset

Nonconvulsive status epilepticus with generalized 'fast activity'.

We report the case of a 55-year-old patient with infrequent generalized tonic-clonic seizures since the age of 40 years and additional frequent episodes of disturbed behaviour and impaired cognition. The latter last from several hours up to one day with sudden onset and end of electroencephalographic (EEG) changes and clinical manifestations. They occurred about once a week before they were successfully treated with valproate and lamotrigine. From clinical, therapeutic and EEG findings we conclude that the patient suffers from nonconvulsive status epileptici, although the ictal EEG showed an untypical pattern of monomorphic generalized alpha rhythm. Many EEG characteristics point towards a primary generalized seizure disorder but a focal origin with secondary bilateral synchrony has to be considered as well. However, this is obviously a rare type which has not been described previously.

Alpha Rhythm

Properties of voltage-activated Ca2+ currents in acutely isolated human hippocampal granule cells.

Properties of Ba2+ currents through voltage-dependent Ca2+ channels (IBa) were investigated in 61 dentate granule cells acutely isolated from the resected hippocampus of nine patients with therapy-refractory temporal lobe epilepsy (TLE). Currents with a high threshold of activation (HVA) peaked at 0 mV, and showed some time-dependent inactivation and a voltage of half-maximal steady-state inactivation (V1/2inact) of -16.4 mV. Application of saturating doses of omega-conotoxin (omega-CgTx) GVIA or nifedipine distinguished characteristic N-type (38%) and L-type (62% of HVA currents) Ca2+ currents. Combined application of both agents blocked HVA currents by > 95%. In a 10-mo-old child but not in adult patients, an omega-agatoxin IVA (omega-AgaTxIVA)-sensitive but omega-CgTx MVIIC-insensitive, noninactivating component of HVA currents (approximately 24%) was present that most probably corresponds to a P-type current. A T-type Ca2+ current could be separated from HVA components on the basis of its steady-state voltage-dependent inactivation (V1/2inact = -71.0 mV). The T-type Ca2+ current isolated by subtraction peaked at more negative potentials (-10 mV), showed a significantly more rapid time-dependent inactivation, and could be selectively blocked by low concentrations of Ni2+. It was insensitive to nifedipine and omega-CgTx GVIA. We conclude that L-, N-, and T-type currents are present in adult human dentate granule cells and an additional P-type current is present in neurons from a 10-mo-old patient. These data may provide a basis for comparison with animal models of epilepsy and for the elucidation of mechanisms of action of drugs intended for use in human disease.

Adult

Altered distribution of the alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionate receptor subunit GluR2(4) and the N-methyl-D-aspartate receptor subunit NMDAR1 in the hippocampus of patients with temporal lobe epilepsy.

In patients with therapy-refractory temporal lobe epilepsy (TLE), alterations of glutamate receptors have been proposed as a mechanism for enhanced excitability. Using commercially available monoclonal antibodies specific for the N-methyl-D-aspartate (NMDA) receptor subunit NMDAR1 and for the alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionate receptor subunit GluR2(4), we have examined the distribution of these polypeptides in human hippocampal tissue that was surgically removed from patients with intractable TLE. Surgical specimens were classified according to the presence of Ammon's horn sclerosis (AHS) or a focal lesion in the temporal lobe. Cell counts and a densitometric analysis of the immunoreactivity patterns were carried out for all hippocampal subfields. NMDAR1 and GluR2(4) levels were markedly reduced in patients with AHS, primarily in those subfields with substantial neuronal cell loss (in particular CA1, CA4 and CA3), compared to those seen in patients with focal lesions and in control specimens obtained at autopsy. In contrast, the molecular layer of the dentate gyrus (DG-ML) showed significantly higher levels of GluR2(4) immunoreactivity in AHS compared to control tissue, while NMDAR1 showed no significant up-regulation in this sublayer. When the receptor staining intensity was normalized for alterations in neuronal density, no significant alterations could be detected except for an increase in GluR2(4) in the DG-ML of patients with AHS. These changes may reflect synaptic reorganization observed in the DG-ML of specimens from patients with chronic intractable TLE.

Adolescent

Preservation of calretinin-immunoreactive neurons in the hippocampus of epilepsy patients with Ammon's horn sclerosis.

Selective neuronal vulnerability and aberrant axonal reorganization in the hippocampus may play an important role for the pathogenesis of pharmaco-resistant temporal lobe epilepsy (TLE). Interneurons containing calcium-binding proteins (CaBPs) are candidates for pathogenetically relevant neurons in the hippocampus of patients with TLE. Here we have examined the cellular localization and distribution of calretinin (CR), a recently discovered CaBP, in the hippocampus of 35 patients with TLE. There was a striking preservation of CR-immunoreactive neurons in TLE patients with Ammon's horn sclerosis (AHS). No significant differences in the distribution of CR-immunoreactive neurons were observed between patients with lesion-associated TLE and control patients without epilepsy. However, a subpopulation of CR-immunoreactive interneurons with morphological features of Cajal-Retzius-like cells, which are only transiently detectable in the normally developing hippocampus, was markedly increased in epilepsy patients with AHS. This increase did not correlate with the duration of the epileptic disorder. Another significant finding was a striking increase and reorganization of CR-immunoreactive neuropil throughout the entire molecular layer of the dentate gyrus (DG-ML) in patients with AHS as compared to patients with focal lesions and control specimens. Ultrastructural analysis identified the CR-immunoreactive axonal profiles as components of an inhibitory, intrinsic neuronal system. The presence of a CR-positive, aberrant cell population, in combination with sprouting of CR-positive axonal processes may significantly alter the gating function of the dentate gyrus and thereby increase hippocampal epileptogenicity in epilepsy patients with AHS.

Adolescent

Cognitive consequences of two-thirds anterior temporal lobectomy on verbal memory in 144 patients: a three-month follow-up study.

Previous studies have shown that left temporal lobectomy for intractable epilepsy can lead to verbal memory deficits. However, patients with left temporal lobe epilepsy (LTLE) frequently have impaired verbal memory preoperatively. The present analysis of 144 patients who underwent temporal lobe resections for either left (n = 68) or right (n = 76) temporal lobe epilepsy (LTLE, RTLE) addressed the questions of (a) whether a left two-thirds anterior temporal lobectomy (ATL) increases deficits in these qualitative aspects of verbal memory already impaired preoperatively, and (b) whether other aspects of verbal memory are additionally affected. We also evaluated possible determinants of preoperative abilities and postoperative changes, using multiple regression analysis. Preoperatively, patients with LTLE differed from patients with RTLE only in poorer performance on measures of long-term consolidation/retrieval (delayed recall). This is related to hippocampal pathology and seizure severity. Only left temporal lobe resections resulted in significant deterioration in verbal learning and memory. Acquisition over learning trials and recognition deteriorated most markedly, whereas performance in long-term consolidation/retrieval showed only minor changes. Preoperative performance levels, chronological age, the extent of the en bloc resection, preoperative performance on figural memory, and preoperative seizure severity were valuable determinants of postoperative changes in acquisition and recognition. In contrast, changes in consolidation/retrieval related only to preoperative ability. Left two-thirds ATL leads to new impairment in addition to preexisting memory deficits. The finding that left temporal lobectomy affects verbal acquisition and recognition more than long-term consolidation/retrieval, including the different determinants of these changes, most likely reflects the differential effects of surgery on mesial temporal and neocortical temporal functions.

Adult

Properties of a delayed rectifier potassium current in dentate granule cells isolated from the hippocampus of patients with chronic temporal lobe epilepsy.

PURPOSE: Properties of potassium outward currents were investigated in human hippocampal dentate gyrus granule cells from 11 hippocampal specimens obtained from patients with temporal lobe epilepsy (TLE) during resective surgery. METHODS: Dentate granule cells were isolated enzymatically and outward currents analyzed by using the whole-cell configuration of the patch-clamp method. Hippocampal specimens were classified neuropathologically with respect to severe segmental cell loss, gliosis, and axonal sprouting (Ammon's horn sclerosis, AHS), or the presence of a focal lesion in the adjacent temporal lobe. RESULTS: A delayed rectifier outward current (IK), but not an A-type potassium current (IA) or inwardly rectifying potassium currents, was observed in all cells. The average current density of IK, the time-dependent decay of IK, and the resting membrane characteristics were not significantly different between patients with and without AHS. The voltage of half-maximal activation V1/2(act) was 5.4 +/- 1.8 mV in AHS compared with -2.9 +/- 1.8 mV in lesion-associated epilepsy (NS). In contrast, V1/2(inact) was shifted in a hyperpolarizing direction in AHS (-67.7 +/- 0.6 mV) compared with that in hippocampi not showing AHS (-47.7 +/- 2.6 mV; p = 0.0017). CONCLUSIONS: The altered steady-state voltage-dependence of IK may result in abnormal excitability of dentate granule cells in AHS and exert a marked influence on input-output properties of the dentate gyrus.

Adult

Surgical treatment of extratemporal epilepsy: clinical, radiologic, and histopathologic findings in 60 patients.

PURPOSE AND METHODS: The aim of this study was to analyze clinical, radiologic, and histopathologic findings in 60 consecutive patients with medically intractable extratemporal epilepsy who were operated on between November 1987 and May 1993. RESULTS: Histologically, there were distinct structural abnormalities in 50 (83%) of the surgical specimens. Signal abnormalities on magnetic resonance imaging (MRI) were present in all patients with neoplastic lesions (n = 17) and in 94% of patients with nonneoplastic focal lesions (n = 32). Overall, structural abnormalities were detected by MRI in 47 (96%) of 49 patients with focal lesions. During a mean follow-up of 4 years, 30 (54%) patients remained completely seizure free, 11 (20%) had < or = 2 seizures per year, seven (12%) showed a seizure reduction of > or = 75%, and eight (14%) had < 75% reduction in seizure frequency. The fraction of seizure-free patients was 12 (80%) of 15 in patients with neoplastic lesions, 16 (52%) of 31 in patients with nonneoplastic focal lesions, and two (20%) of 10 for those without histopathologic abnormalities. The differences in seizure outcome between patients with and without focal lesions were statistically significant (p < 0.05), if seizure-free outcome was compared with persistent seizures. CONCLUSIONS: Focal lesions and particularly neoplasms are associated with improved postoperative seizure control compared with patients without histopathologic abnormalities. We advise caution in considering surgery to treat extratemporal epilepsy in patients who have normal MRI scans, because the outcome with the approach described in this study is poor in such cases.

Adolescent

Dysembryoplastic neuroepithelial tumors: MR and CT evaluation.

PURPOSE: To evaluate dysembryoplastic neuroepithelial tumors (DNTs) on MR and CT studies and to compare DNT with other frequently encountered epileptogenic glioneuronal lesions. METHODS: We analyzed the MR images and CT scans of 16 patients who had complex partial epilepsy and DNT with respect to tumor location, size, CT density, MR signal intensity, mass effect, contrast enhancement, and heterogeneity, and compared these features with CT and MR findings in 51 cases of ganglioglioma and 33 cases of glioneuronal malformation. RESULTS: DNTs were located in the temporal lobe in 14 patients and in the frontal lobe in 2 patients. The cortex was involved in all cases and the subcortical white matter in 10 cases. Fifty percent of the tumors had poorly defined contours. On MR images, 14 DNTs had multiple cysts and 2 had single cysts. Contrast enhancement was observed in 6 DNTs, and mass effect was present in 9. CT scans disclosed moderately hypodense lesions in 7 patients and markedly hypodense cystic lesions in 6 patients. Two DNTs were calcified. Tumor hemorrhage with perifocal edema was observed in 1 case. Contrary to previous reports, slow but definite tumor growth was present during a 13-year period in 2 of 6 patients in whom serial CT or MR studies were obtained. CONCLUSION: A multicystic appearance on MR images is a characteristic feature of DNT and corresponds to its myxoid matrix and multinodular architecture. This feature is rare in gangliogliomas and glioneuronal malformations, and, as such, may help differentiate DNTs from these disorders.

Adolescent

Evaluation of technetium-99m-ECD in childhood epilepsy.

UNLABELLED: In childhood epilepsy, it is difficult, but of critical importance, to determine whether surgical intervention might be beneficial for an individual patient. Because both established procedures-MRI and electroencephalography (EEG)-have limitations, interictal and ictal regional cerebral blood flow (rCBF) SPECT has proven to be a valuable adjunctive method in the presurgical evaluation of children. METHODS: We evaluated the usefulness of the new rCBF tracer 99mTc-ECD in 14 children with focal epilepsy (mean age 9.7 yr). Eleven interictal and 8 ictal studies were performed. Results were correlated with ictal and interictal surface EEG, MRI and histological findings and the postsurgical outcome. RESULTS: On the basis of the presurgical evaluation, nine patients underwent surgery. MRI studies demonstrated pathological features with possible relation to epilepsy in 50%. Overall, interictal 99mTc-ECD SPECT showed areas of hypoperfusion in 80% of patients. Ictal rCBF SPECT was informative in all patients, including one who showed bifrontal hyperperfusion in accordance with EEG results. CONCLUSION: Technetium-99m-ECD has proven to be of value for interictal and ictal rCBF SPECT in childhood epilepsy. No side effects during or after tracer administration were noticed. Ictal and interictal rCBF SPECT showed good correlation with MRI and EEG results in patients in whom correlation with the postoperative situation was possible and presented additional significant information in those patients with normal MRI and uninterpretable EEG results. No false lateralizations occurred. In children with focal epilepsy, interictal rCBF SPECT may accelerate the application of long-term electrocorticography (ECoG) in patients with normal MRI results. Ictal rCBF SPECT may also help to avoid ECoG, if a focal hyperperfusion correlates with a focal MRI abnormality, and the surface EEG gives no contradictory information.

Brain

The relevance of interictal rCBF brain SPECT in temporal lobe epilepsy: diagnostical value and effects of spatial resolution.

Interictal rCBF-SPECT is frequently being used as an adjunctive method for localization of an epileptogenic area during presurgical evaluation of patients suffering from medically refractory temporal lobe epilepsy. This study retrospectively evaluates interictal rCBF-SPECT using Tc-99m-HMPAO in comparison to the results of MRI. The final results of surface EEG and ECoG and the postsurgical clinical results as to seizure frequency were used a a 'gold-standard' for the evaluation of both imaging procedures. As spatial resolution is discussed to be the major reason for higher sensitivity of F-18-DG-PET compared to rCBF-SPECT, special attention has been paid to the spatial resolution of the different SPECT systems being used in this study. In 55 patients the complete data set could be obtained retrospectively, 36 of them being evaluated using SPECT systems with relatively low spatial resolution (Picker Dyna 2000, Elscint Helix) and 19 pt. being evaluated using moderate- to high-resolution SPECT systems (ADAC Genesys, DSI Ceraspect). Overall sensitivity of the interictal rCBF-SPECT was 75%, with 69% for low-resolution systems and 84% for high-resolution systems. Approximately at the same time when our institution installed the ADAC Genesys, the MRI equipment was changed form the 1.5 T Philips Gyroscan S15 to the 1.5 T Philips Gyroscan ACS II, the latter allowing superior imaging opportunities. Overall sensitivity of MRI was 60%, with 56%, for the Gyroscan S15 and 68% for the Gyroscan ACS II. The overall positive predictive value (PPV) was 87% for the interictal rCBF-SPECT and 87% for the MRI. Due to the lack of true negative studies in this population specificity was not calculated. False lateralization using rCBF-SPECT occurred in 5 pts. (9%), however, in 3 pts. the area of hypoperfusion correlated with a detectable MRI pathology, yet EEG/ECoG revealed the epileptogenic focus to be elsewhere. In conclusion, the interictal rCBF-SPECT revealed reasonable sensitivity and PPV in pt. suffering from focal temporal lobe epilepsy and modern SPECT systems showed significantly improved results. Since there is a variety of possible reasons for regional cortical hypoperfusion, the interictal SPECT could add significant information prior to the application of ECoG. This specially appeared to be useful in patients with abnormal MRI scan. Furthermore, in patients presenting with a clear pathology on MRI and a corresponding EEG focus, ECoG could be avoided if the interictal rCBF-SPECT additionally showed localized and singular involvement of the affected temporal lobe. ECoG was mainly applied in those patients with relatively wide-spread hypoperfusion additionally involving frontal or parietal cortical areas.

Adolescent

The clinical and prognostic relevance of the postictal slow focus in the electrocorticogram.

Electrocorticograms of 192 complex partial seizures which were recorded via chronically implanted subdural electrodes during presurgical evaluation of 64 patients with medically intractable epilepsy were visually analysed. The objective was to assess the diagnostic and prognostic relevance of postictal slow foci (PISF) in the electrocorticogram which were defined as focal isoelectric activity or as a focal burst-suppression pattern. The following results were obtained: (1) PISF were seen in a total of 114 of 192 seizures (59.4%), (2) 48 of 64 patients (75%) demonstrated at least 1 PISF in 3 seizures, (3) PISF were more frequent in seizures of temporal lobe origin (66%) than in those of extratemporal origin (33.3%), (4) no PISF developed if the electrographic seizure duration was < 32 sec, (5) PISF were (predominantly) localized in the lobe of seizure origin in 85% of the seizures, (6) there was a strong correlation between frequent occurrence of temporal PISF and favourable seizure outcome following temporal lobe surgery. In conclusion, PISF contribute valuable data as to the localization of the epileptogenic zone during presurgical evaluation of epilepsy and indicate favourable seizure outcome following temporal lobe surgery.

Adolescent

Alterations of intrahippocampal cognitive potentials in temporal lobe epilepsy.

During presurgical evaluation event-related potentials were recorded with depth electrodes located longitudinally within the hippocampus in 25 patients suffering from unilateral temporal lobe epilepsy. Rare stimuli in a visual oddball paradigm elicited a pronounced negativity ("NO") in the hippocampal body. Amplitudes were significantly reduced on the side of the primary epileptogenic area. Visual presentations of words in a recognition paradigm evoked an earlier negativity ("ENW") in anterior and a later negativity ("LNW") in posterior hippocampal structures. Both were sensitive for recognition effects and showed reduced amplitudes on the side of the primary epileptogenic area. Relating the differences of left and right hippocampal "NO" and "ENW" amplitudes proved to be a sensitive method for topological diagnosis and allowed a correct lateralization of the primary epileptogenic area in all patients. Amplitudes of the hippocampal ENW, evoked in the dominant hemisphere by first presentations, strongly correlated with the recognition rate, when the primary epileptogenic area was situated in the contralateral temporal lobe. This correlation was reduced by the presence of ipsilateral epileptogenic foci.

Adolescent

Spatio-temporal dynamics of the primary epileptogenic area in temporal lobe epilepsy characterized by neuronal complexity loss.

Neurons involved in the epileptic processes exhibit high frequency discharges scarcely modulated by physiological brain activity. This behaviour should be accompanied by a loss of complexity in the corresponding electrographic signal. From the theory of non-linear dynamics it is known that the correlation dimension allows a quantitative description of complexity in terms of the number of degrees of freedom. To test whether a relationship exists between spatio-temporal alterations of neuronal complexity and spatial extent and temporal dynamics of the epileptogenic area, a moving-window correlation dimension analysis was applied to intracranially recorded electrocorticograms of 20 patients with unilateral temporal lobe epilepsy. Dimension as a function of time was calculated for interictal activity (n = 98) and seizure activity including the pre- and postictal phase (n = 28) from recording locations within the epileptogenic area, in adjacent areas and in homologous contralateral sites. Pronounced changes of the dimension in time were found, gradually decreasing with increasing distance from the focal area. Extraction of a single value quantifying the dimension variance of interictal activity allowed the primary epileptogenic area to be laterized in exact agreement with the results of the presurgical work-up and the confirmation of the postoperative outcome, without the necessity of observing actual seizure activity.

Adolescent

Relations between verbal and nonverbal memory performance: evidence of confounding effects particularly in patients with right temporal lobe epilepsy.

Confounding left hemisphere verbalization strategies can be suggested as being a major problem in the evaluation of the assumed involvement of right temporo-limbic structures in "nonverbal" visual/figural memory processing. We addressed this issue by evaluating the easily-verbalized Benton-visual-retention-test in 60 patients with either left (LTLE) or right temporal lobe epilepsy (RTLE) and 30 healthy controls. We formally estimated the informational (verbal) content of each item which hypothetically would be needed to solely retain the item from verbal memory. The results indicated confounding of verbal learning and figural memory only in the presence of right temporal lobe dysfunctions. Selective visual/figural learning deficits in RTLE patients became obvious when the verbal load of the figural material exceeded their verbal learning capacity. Instead of excluding verbalization by the use of abstract figural items, its inclusion provides a possibility to control compensatory strategies which overshadow the presence of visual/figural memory deficits.

Adult

Complex partial seizures of temporal lobe origin in children of different age groups.

The semiology of complex partial seizures (CPS) of temporal lobe origin in adults is well known and is important in establishing seizure localization in patients considered for epilepsy surgery. In contrast, the behavioral features of temporal lobe seizures (TLS) in children described in the literature have not been consistent. In the present study, we investigated children with TLS to compare their attacks to TLS occurring in adults. The study was based on video recordings of 29 children with TLS aged 18 months to 16 years. Children were included, if they became seizure-free after temporal lobectomy (except 4 children with a marked reduction in seizure frequency and 1 with isolated auras), and if clear unitemporal seizure onset in ictal EEG-recordings, unilateral radiological lesions, and corresponding histopathological findings were detected. Children aged > 6 years had TLS with features similar to those of adults. In younger children, typical semiology included symmetric motor phenomena of the limbs, postures similar to frontal lobe seizures in adults, and head nodding as in infantile spasms. We concluded that the clinical features of TLS in younger children can be misleading and should therefore be considered with caution in selecting patients for surgical procedures on the temporal lobe.

Adolescent