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Mild Non-lesional Temporal Lobe Epilepsy: A Common, Unrecognized Disorder with Onset in Adulthood

Published online by Cambridge University Press:  18 September 2015

Umberto Aguglia ,
Antonio Gambardella ,
Emilio Le Plane ,
Demetrio Messina ,
Rosario L. Oliveri ,
Concetta Russo ,
Mario Zappia  and
Aldo Quattrone
Umberto Aguglia*
Affiliation:
Institute of Neurology, School of Medicine, University of Catanzaro, Italy
Antonio Gambardella
Affiliation:
Institute of Neurology, School of Medicine, University of Catanzaro, Italy Insitute of Experimental Medicine and Biotechnology, National Research Council, Mangone, Casenza, Italy.
Emilio Le Plane
Affiliation:
Institute of Neurology, School of Medicine, University of Catanzaro, Italy
Demetrio Messina
Affiliation:
Institute of Neurology, School of Medicine, University of Catanzaro, Italy
Rosario L. Oliveri
Affiliation:
Institute of Neurology, School of Medicine, University of Catanzaro, Italy Insitute of Experimental Medicine and Biotechnology, National Research Council, Mangone, Casenza, Italy.
Concetta Russo
Affiliation:
Institute of Neurology, School of Medicine, University of Catanzaro, Italy
Mario Zappia
Affiliation:
Institute of Neurology, School of Medicine, University of Catanzaro, Italy
Aldo Quattrone
Affiliation:
Institute of Neurology, School of Medicine, University of Catanzaro, Italy Insitute of Experimental Medicine and Biotechnology, National Research Council, Mangone, Casenza, Italy.
*
Università degli Studi, Clinica Neurologica, Policlinico Materdomini, Via T. Campanella, 88100 Catanzaro (Italy)
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Abstract:

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Objective:

To compare mild vs. severe non-lesional temporal lobe epilepsy (TLE).

Methods:

Data from 104 consecutive patients with non-lesional TLE were reviewed. Seventy-three of the 104 fulfilled the criteria for inclusion in this study of a follow-up period longer than three years at our Institute. Patients were considered to have a mild TLE if they were seizure free for at least three years after appropriate antiepileptic medication, or had rare (≤ 2/year) complex partial or secondarily generalized seizures for at least three years with or without appropriate antiepileptic therapy. Clinical, EEG and MRI data of mild vs. severe non-lesional TLE patients were compared on the basis of a cross-sectional study design.

Results:

Of the 73 patients with non-lesional TLE included in the study, 43 (59%) had mild TLE, and 30 (41%) had severe TLE. Duration of epilepsy was significantly shorter (mean 15.2 ± 10.5 years vs. 26.4 ± 13.2 years) and age at onset was significantly higher (mean 34.3 ± 15.3 years vs. 7.8 ± 6.8 years) in mild than in severe TLE group. Patients with mild TLE had also a significantly higher prevalence of positive family history of epilepsy (37.2% vs. 10%), and a significantly lower occurrence rate of febrile convulsions (FC) (4.7% vs. 33.3%), mesial temporal sclerosis (MTS) (6.9% vs. 36.7%), and intelligence deficiency (0% vs. 20%). In mild TLE there was also a significantly high rate (58.1% vs. 0%) of delayed diagnosis (from 1 to 28 years), because of misdiagnosis (39.5%) or no medical counseling (18.6%).

Conclusions:

Mild non-lesional TLE is a common, unrecognized disorder mainly characterized by both onset in adulthood and high prevalence of familial history of epilepsy. The present findings suggest that mild non-lesional TLE may represent a clinical entity different from severe non-lesional TLE.

Résumé:

RÉSUMÉ: But:

Comparer l'épilepsie temporale (ÉT) légère et sévère, sans lésion du lobe temporal.

Méthodes:

Nous avons révisé les dossiers de 104 patients consécutifs atteints d'ÉT sans lésion. Soixante-treize des 104 remplissaient le critère d'inclu¬sion de cette étude, soit un suivi de plus de trois ans à notre Institut. Les patients étaient considérés comme souffrant d'ÉT légère s'ils n'avaient pas eu de crise depuis au moins 3 ans sous médication antiépileptique appropriée ou avaient eu très peu de crises partielles complexes ou secondairement généralisées (≤ 2/année) pendant au moins 3 ans, avec ou sans traitement antiépileptique approprié. Nous avons comparé les données cliniques, électroencéphalo-graphiques et de RMN des patients avec ÉT légère et sévère, sans lésion, selon un plan d'étude transversale

Résultats:

Parmi les 73 patients inclus dans l'étude, 43 (59%) avaient une ET légère et 30 (41%) avaient une ÉT sévère. La durée de la maladie était significativement plus courte (moyenne 15.2 ± 10.5 ans vs. 26.4 ± 13.2 ans) et l'âge de début était significativement plus élevé (moyenne 34.3 ± 15.3 ans vs. 7.8 ± 6.8 ans) dans les cas d'ÉT légère par rapport aux cas sévères. Les patients atteints d'ÉT légère avaient également une prévalence significativement plus élevée d'une histoire familiale d'épilepsie (37.2% vs. 10%) et une fréquence plus élevée de convulsions fébriles (4.7% vs. 33.3%), de sclérose temporale mésiale (6.9% vs. 36.7%) et de déficit intellectuel (0% vs. 20%). Dans l'ÉT légère, il y avait également un taux significativement élevé de diagnostic tardif (58.1% vs. 0%, de 1 à 28 ans), à cause de diagnostics erronés (39.5%) ou d'absence de consultation médicale (18.6%).

Conclusions:

L'ÉT légère sans lésion est une affec¬tion fréquente, méconnue, caractérisée principalement par un début à l'âge adulte et une prévalence élevée d'une his¬toire familiale d'épilepsie. Nos constatations suggèrent que l'ÉT légère sans lésion pourrait représenter une entité clinique différente de l'ÉT sévère sans lésion.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 25 , Issue 4 , November 1998 , pp. 282 - 286
Copyright
Copyright © Canadian Neurological Sciences Federation 1998

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