Bitemporal Lobe Epilepsy: Evolving Diagnostic and Treatment Paradigms.

Area of Science:

• Neurology
• Epileptology

Background:

• Bilateral temporal lobe epilepsy (BTLE) is a challenging subset of drug-resistant epilepsy, comprising 20-35% of temporal lobe epilepsy cases.
• Independent seizure onset from both temporal lobes complicates diagnosis and treatment, impacting cognitive function and quality of life.

Purpose of the Study:

• To review diagnostic and therapeutic strategies for bilateral temporal lobe epilepsy (BTLE).
• To highlight the role of advanced neuroimaging and neuromodulation in managing drug-resistant epilepsy.

Main Methods:

• Review of current literature on diagnosis and treatment of BTLE.
• Analysis of stereoelectroencephalography (SEEG) for seizure onset zone (SOZ) localization.
• Evaluation of surgical resection and neuromodulation therapies (VNS, DBS, RNS).

Main Results:

• Scalp EEG lacks specificity for independent seizure foci; SEEG is the gold standard for SOZ localization.
• Surgical resection is generally discouraged due to risks, though unilateral resection may benefit select patients.
• Neuromodulation therapies show promising responder rates (~70%), with RNS offering long-term monitoring benefits.

Conclusions:

• BTLE presents significant diagnostic and therapeutic challenges.
• Individualized approaches integrating advanced diagnostics and neuromodulation are crucial.
• Further research is needed to optimize treatments and improve outcomes for BTLE patients.