Peri-ictal bed leaving in temporal lobe epilepsy: incidence and lateralizing value

Area of Science:

• Neurology
• Epileptology

Background:

• Temporal lobe epilepsy (TLE) is a common focal epilepsy.
• Peri-ictal events, including behavioral changes, are increasingly recognized.
• Bed leaving during or shortly after seizures (peri-ictal bed leaving, PBL) has not been well characterized in TLE.

Purpose of the Study:

• To investigate the frequency and lateralizing value of peri-ictal bed leaving (PBL) in patients with temporal lobe epilepsy (TLE).
• To compare PBL characteristics between TLE with hippocampal sclerosis (TLE-HS) and other TLE subtypes.

Main Methods:

• Retrospective analysis of 105 TLE patients (Engel I at 2-year follow-up).
• Histopathological classification into TLE-HS (n=64) and TLE-other (n=38).
• Review of 412 seizures to identify PBL events (occurring during or up to 3 minutes post-seizure).

Main Results:

• PBL occurred in 26.7% of patients and 10.9% of seizures.
• PBL was more frequent in TLE-HS (32.8%) than TLE-other (17.1%).
• PBL was ipsilateral to seizure onset in 71.4% of patients and 71.2% of seizures (P<0.001).
• In TLE-HS, PBL was ipsilateral to seizure onset in 76.2% of patients and 81.2% of seizures (P<0.001).

Conclusions:

• Peri-ictal bed leaving is a relatively common sign in TLE.
• PBL demonstrates significant lateralizing value, particularly in TLE-HS.
• The side of PBL can help lateralize seizure onset to the ipsilateral temporal lobe in TLE-HS patients.