Complex Partial Seizures with Unilateral Discharges Originating from Temporal Lobe

Abstract

A clinico-electrographic correlative study was carried out to explore whether ictal involvement of bilateral temporal lobes is indispensable for complex partial seizure (CPS). The subjects consisted of 123 CPSs of 24 patients documented by chronic intracranial EEG recordings which were performed as a presurgical evaluation of intractable temporal lobe epilepsy. In the majority of CPSs (89 CPSs, 72%), selfsustained rhythmic discharge involved bilateral temporal lobes; however, in the remaining 34 CPSs (28%), it remained unilateral to the originating side throughout the CPSs. Although bitemporal ictal involvement was not necessary for impairment of consciousness, both mesial (amygdala and hippocampus) and lateral (cortex) temporal lobe structures were consistently involved. In comparison with the CPSs with bilateralized discharges, those with unilateral ones were characterized as follows: 1) responsiveness to external stimuli was partially retained, 2) postictal recovery of consciousness was more prompt and 3) motionless staring characterized by total unresponsiveness was never observed. Based on these findings, the mechanisms underlying impairment of consciousness of CPS was discussed in association with a functional linkage between temporal lobe and brain stem. © 1991, JAPAN EPILEPSY SOCIETY. All rights reserved.