Somatosensory auras in refractory temporal lobe epilepsy

To determine the prevalence, manifestations, lateralizing value, and surgical prognostic value of somatosensory auras (SSAs) in patients with refractory temporal lobe epilepsy (TLE).

Eighty-one consecutive patients undergoing temporal lobectomy for refractory complex-partial seizures were screened for SSAs. The characteristics of the somatosensory phenomena, occurrence of other aura types, seizure semiology, findings of EEG and imaging studies, temporal lobe neuropathology, and postoperative seizure outcome were determined in each patient with SSAs.

Nine (11%) of 81 patients with refractory temporal lobe seizures reported distinct SSAs as part of their habitual seizures. The most common manifestation of SSAs was tingling (eight of nine, 89%), but sensory loss (one of nine, 11%) and pain (one of nine, 11%) also were reported. Five patients had unilateral somatosensory symptoms, and four patients had bilateral somatosensory symptoms. Seizure origin was in the contralateral temporal lobe in four (80%) of five patients with unilateral SSAs, including all patients with unilateral SSAs affecting a limb. Partial temporal lobe resection produced complete seizure remission in all nine (100%) patients 1 year after surgery and in seven (78%) of nine patients 2 years after surgery.

SSAs occur more frequently than previously appreciated in patients with refractory temporal lobe seizures and usually manifest as either unilateral or bilateral tingling. In patients with temporal lobe seizures, unilateral SSAs involving a limb suggest a seizure origin in the contralateral temporal lobe. The surgical outcome of TLE patients with SSAs is favorable. Thus the presence of SSAs should not serve as a deterrent to temporal lobe resection in patients with clearly defined TLE.