Hypermotor temporal lobe epilepsy revisited-expanding the spectrum

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Epileptic Disorders Pub Date : 2025-02-17 DOI:10.1002/epd2.20327

Pavan Kumar Rudrabhatla, Jayakumari Nandana, George C. Vilanilam, Bejoy Thomas, Chandrasekharan Kesavadas, Ashalatha Radhakrishnan, Ramshekhar N. Menon

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引用次数: 0

Abstract

Objective

Typical semiology with associated 5As (Antecedent, Aura, Arrest, Automatisms, and Amnesia) is the prototypical seizure manifestation of temporal lobe epilepsy (TLE) in adults. However, patients with TLE can present with seizure phenomenology referred to as “hypermotor TLE” (HMS-TLE) which can mimic extratemporal focal epilepsy. We studied the clinico-electrographic, imaging profile, and surgical outcomes of drug-resistant HMS-TLE patients.

Methods

We analyzed the ictal signs and electroencephalography data of HMS-TLE patients who became seizure free following epilepsy surgery with a minimum follow-up of 1 year and compared them with patients with typical TLE (1:2 ratio). Hypermotor seizures were identified based on the presence of stereotyped ictal complex movements at seizure onset including body rocking, pelvic thrusting, and bimanual and bipedal movements with/without affective components.

Results

Out of 684 patients with drug-resistant TLE who underwent surgery during 2010–2020, 16 patients (2.34%) met criteria for HMS-TLE and were compared with 32 patients with typical TLE. Predominant “hypermotor” components included motor agitation, bicycling/kicking movements, body gyration followed by violent automatisms, and pelvic thrusting. Age at epilepsy onset, age at video telemetry recording, age at surgery, duration of epilepsy at surgery, gender distribution, and presence of aura were comparable between the two groups. History of febrile seizures (31.3% vs. 65.6%; p-value = .024), presence of hippocampal sclerosis on MRI, and histopathology (56.3% vs. 90.6%; p-value = .006 and 50% vs. 96.9%; p-value = .002, respectively) were lower, and temporal neocortical abnormalities on MRI (87.5% vs. 59.4%, p-value = .048), dysplasia on histopathological evaluation (25% vs. 0%, p-value = .003) were higher in HMS-TLE. HMS-TLE group had lower number of patients with focal-onset ictal patterns (37.5% vs. 90.6%, p-value = .0001).

Significance

Hypermotor seizures are rare in TLE, however it does not preclude non-invasive selection for surgery. Hence, physicians should be aware of this subtype of drug-resistant TLE as early intervention can have good surgical outcomes, akin to typical TLE.

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重新审视颞叶亢进型癫痫——扩大频谱。

目的：典型的符号学与相关的5a（前置、先兆、骤停、自动性和失忆）是成人颞叶癫痫（TLE）的典型发作表现。然而，TLE患者可出现癫痫现象，称为“多动性TLE”（HMS-TLE），可模拟颞外局灶性癫痫。我们研究了耐药HMS-TLE患者的临床电图、影像学特征和手术结果。方法：分析经1年以上癫痫手术后无癫痫发作的HMS-TLE患者的生命体征及脑电图资料，并与典型TLE患者进行对比（1:2）。多运动性癫痫发作是根据癫痫发作时出现的典型的直立性复杂运动来确定的，包括身体摇晃、骨盆推力、双手和两足运动，伴有/不伴有情感成分。结果：2010-2020年，684例接受手术治疗的耐药TLE患者中，16例（2.34%）符合HMS-TLE标准，32例为典型TLE。主要的“过度运动”成分包括运动性躁动、骑自行车/踢腿运动、剧烈自动性后的身体旋转和骨盆推力。癫痫发作年龄、视频遥测记录年龄、手术年龄、手术癫痫持续时间、性别分布和先兆的存在在两组之间具有可比性。发热性惊厥史（31.3% vs. 65.6%）；p值= 0.024)，MRI和组织病理学上是否存在海马硬化(56.3% vs. 90.6%；p值= 0.006,50% vs. 96.9%；MRI表现为颞皮质异常（87.5%比59.4%，p值= 0.048），组织病理学评价为发育不良（25%比0%，p值= 0.003）的HMS-TLE患者较高。HMS-TLE组出现局灶性发作的患者较少（37.5% vs. 90.6%， p值= 0.0001）。意义：过度运动性癫痫在TLE中很少见，但这并不排除非侵入性手术的选择。因此，医生应该注意这种耐药TLE亚型，因为早期干预可以获得良好的手术结果，类似于典型的TLE。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Epileptic Disorders 医学-临床神经学

CiteScore

4.10

自引率

8.70%

发文量

138

审稿时长

6-12 weeks

期刊介绍： Epileptic Disorders is the leading forum where all experts and medical studentswho wish to improve their understanding of epilepsy and related disorders can share practical experiences surrounding diagnosis and care, natural history, and management of seizures. Epileptic Disorders is the official E-journal of the International League Against Epilepsy for educational communication. As the journal celebrates its 20th anniversary, it will now be available only as an online version. Its mission is to create educational links between epileptologists and other health professionals in clinical practice and scientists or physicians in research-based institutions. This change is accompanied by an increase in the number of issues per year, from 4 to 6, to ensure regular diffusion of recently published material (high quality Review and Seminar in Epileptology papers; Original Research articles or Case reports of educational value; MultiMedia Teaching Material), to serve the global medical community that cares for those affected by epilepsy.