Clinical and anatomical characteristics of basal temporal seizures: A systematic review

This review aimed to characterize the clinical semiology and anatomical correlates of seizures originating in the basal temporal region, an underrecognized epilepsy subtype, and to identify features that distinguish it from other forms of temporal lobe epilepsies (TLE). We performed a systematic review of the literature following PRISMA guidelines. The search included terms related to the basal temporal region (e.g., fusiform gyrus and rhinal cortex) and epilepsy, encompassing clinical, anatomical, and neurophysiological studies. Studies with video-EEG monitoring, SEEG evaluations, and surgical outcomes were prioritized. Semiological features, imaging findings, and post-surgical outcomes were extracted and analyzed. Fifteen studies encompassing 83 patients were analyzed. Most cases involved MRI-detectable lesions. Findings revealed that basal temporal seizures frequently present with language disturbances, motor phenomena, and less pronounced emotional and sensory signs compared to other TLE forms. SEEG identified epileptogenic zones predominantly in the fusiform gyrus, rhinal cortices, and parahippocampal region. Post-surgical outcomes revealed 57% of patients achieving Engel Class I results after 1 year, highlighting the potential benefits of accurate diagnosis and intervention. However, diagnostic challenges persist due to overlapping with other TLE subtypes, emphasizing the importance of advanced imaging and SEEG. Further studies are needed to refine diagnostic criteria and improve understanding of the functional implications of basal temporal epilepsies.