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Published on: September 20, 2024
Age-dependent seizure semiology in temporal lobe epilepsy
András Fogarasi1, Ingrid Tuxhorn1, József Janszky1
1Epilepsy Center, Bethesda Children's Hospital, Budapest, HungaryBethel Epilepsy Center, Bielefeld, GermanyEpilepsy Center, National Institute of Psychiatry and Neurology, Budapest, HungaryDepartment of Neurology, University of Pécs, Pécs, HungaryDepartment of Public Health, Karolinska Institute, Stockholm, Sweden, and Department of Behavioral Sciences, Semmelweis University, Budapest, Hungary.
Objective:
To examine the effects of age on different aspects of temporal lobe seizure semiology.
Methods:
We performed a video analysis of 605 archived seizures from 155 consecutive patients (age 10 months to 49 years) selected by seizure freedom after temporal lobectomy. Eighty patients had hippocampal sclerosis (HS). Beside semiological seizure classification, we assessed age dependency of several axes of seizure semiology: (1) aura, (2) number of different lateralizing signs, occurrence of ictal (3) emotional signs, (4) autonomic symptoms, (5) automatisms, and (6) secondary generalization as well as (7) the ratio of motor seizure components.
Results:
From the 155 patients, 117 reported aura, 39 had ictal emotional signs, 51 had autonomic symptoms, 130 presented automatisms, while 18 patients showed secondary generalization at least once during their seizures. Altogether 369 (median: 2/patient) different lateralizing signs were recorded. Frequency of HS (p < 0.001), ictal automatisms (p < 0.001), secondary generalization (p = 0.014), number of different lateralizing signs (p < 0.001) increased while the ratio of motor seizure component (p = 0.007) decreased by age. Auras, emotional symptoms, and autonomic signs occurred independently of patients' ages. Hippocampal sclerosis adjusted linear models revealed that the frequency of automatisms and secondarily generalized seizures as well as the number of different lateralizing signs are HS-independent significant variables.
Conclusion:
Our findings support that brain maturation significantly influences the evolution of some important aspects (motor seizures, lateralizing signs) of temporal lobe seizure semiology. Conversely, other aspects (aura, emotional, and autonomic signs) are independent of the maturation process. This is the first report investigating age dependency of epileptic seizure semiology comparing all age groups.
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