Clinical Utility of Postictal EEG Pattern and Semiology in Temporal Lobe Epilepsy

Abstract

We investigated the postictal EEG and semiology in temporal lobe epilepsy in order to evaluate their possible clinical utility, Fifty four well lateralized seizures in 10 patients, recorded during presurgical evaluation, were analysed in regard

to the frequency, pattern and location of the EEG activity (42 seizures with scalp-sphenoidal electrodes, 27 seizures with intracranial electrodes). Postictal EEG changes were very heterogenous, at best categorized to several patterns: ①θ+δ slowing ② attenuation ③ spike activation, among them θ+δslowing was most frequently encountered. The lateralizing value of the earliest pattern was 59.3% using intracranial electrodes but only 23.3% using scalp-sphenoidal electrodes. Postictal semiology also showed a variety of behavioral manifestation such as confusion (81.5%). lip smacking (40.7%), hand automatism (18.5%). Lip smacking was more often seen following the left temporal seizure (16 out of 22, p<0.05). Behavioral distinction between ictal and postictal semiology was not possible. Postictal EEG and semiology appears to be consisting of heterogenous mechanisms and wide spectrum. We feel that the clinical utility is limited.