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Epileptic Disorders

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Clinical semiology of temporal lobe seizures in preschool children: contribution of invasive recording to anatomical classification Volume 23, numéro 4, August 2021

(Patient 1) shows a six-month-old boy with right temporo mesial ganglioglioma. Episodes started at the age of two months associated with loss of contact, pallor, hypotonia, facial cyanosis, and desaturation, necessitating oxygen treatment at home. No precise diagnosis was made. The neurological examination and the interictal EEG were normal. Seizures recorded on video consisted of staring preceding the desaturation. Right temporal rhythmic delta activity is visible. Note the respiratory arrest and desaturation on the lower two lines of the recording.

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Clinical semiology of temporal lobe seizures in preschool children: contribution of invasive recording to anatomical classification (Patient 26) shows a 5.5-year-old girl with left temporopolar dysplasia and hippocampal sclerosis. During the first months of life, she presented with some faintness described as facial pallor and an upward gaze while drinking from her bottle. At the age of 15 months, she had a complex febrile seizure, 10 days after a vaccination, and two years later started to have focal seizures. From the age of 3.5 years, she had seizures limited to a headache and/or an epigastric sensation. Clinical examination showed right-handedness with normal examination including language, and normal cognitive development. The video shows longer seizures that start in the same way, consisting of motor activity arrest, pallor, chewing, followed by clear-cut aphasia which remained for a couple of minutes post-ictally. This semiology was explained by mesial onset and lateral propagation.

Clinical semiology of temporal lobe seizures in preschool children: contribution of invasive recording to anatomical classification (Patient 19) shows a 25-month-old boy. At one month of life, he had a first epileptic seizure characterized by staring, head deviation to the left and changes in respiratory function. Neurological examination showed right-handedness with normal motor development. He had a mild developmental delay including speech delay. MRI was normal. SEEG was performed at the age of 25 months to explore the hypothesis of an epileptogenic zone either in the right temporal region (which could be internal or within the depth of a sulcus) or insular. The video shows changes in respiratory function, shaking of the head, an often deviated gaze to the right, hypertonia of the left arm and leg, and post-ictal paresis of the left part of the body.

Clinical semiology of temporal lobe seizures in preschool children: contribution of invasive recording to anatomical classification (Patient 17) shows a 4.8-year-old boy with right temporopolar dysplasia. The first seizure started at the age of four months and the description by the parents was: face cyanosis, anarchical gesticulation of the four limbs and clonic movements of the eyelids. From the onset to the time of recording, the seizure rate was high with up to 20 seizures per day. He has developed a mental deficit with a language delay and presented with some autistic spectrum features and aggressiveness. On video recordings, all the seizures were stereotypical: he rushes to his parents, then becomes anarchically agitated, gesticulating the trunk and four limbs, initially symmetrically and secondarily predominant in the right hemibody with hypertonia of the left arm; the eyes are positioned to the right with facial pallor and at the end of the seizure, facial cyanosis and chewing is evident. Post-ictally, he has paresis of the left arm.

Clinical semiology of temporal lobe seizures in preschool children: contribution of invasive recording to anatomical classification (Patient 16) shows a six-year-old boy with left temporopolar dysplasia. Seizures began at age three without any obvious trigger; the first seizures were described as staring, face reddening and chewing and occurred weekly. Neurological examination showed right-handedness with normal cognitive development; he had mild syntaxic and fine motor difficulties with normal behaviour and sociability. SEEG revealed subtle seizures from the temporal pole with minimal propagation that are shown on the video; the patient stopped talking, experienced motor arrest, and had some manual automatisms.

Clinical semiology of temporal lobe seizures in preschool children: contribution of invasive recording to anatomical classification (Patient 5) shows a 2.5-year-old boy with left choroid plexus papilloma and hippocampal sclerosis. The seizures started at the age of 3.5 months. The parents described a reddening of the face, staring, and chewing. At the time of the recording, he was right-handed, with normal neurological examination. He had disabling hyperactivity. The parents reported rare seizures, about one a month, but eight were recorded during sleep over five days. The parents were not aware at all that the child had been having seizures during sleep. On video, recorded seizures were discreet with awakening, tachycardia and chewing.

Clinical semiology of temporal lobe seizures in preschool children: contribution of invasive recording to anatomical classification (Patient 15) shows a four-year-old girl with right amygdala ganglioglioma. Seizures started at the age of 12 months, and were described as staring and pallor. At the time of the recording, the girl was right-handed, with normal neurological examination, good social interactions, and normal schooling. She suffered from attention deficit/ hyperactivity disorder. During the seizures, recorded on video, she was able to warn her mother, saying that she was having a seizure and that she was afraid, after which she grasped her mother and subsequently experienced a loss of contact, modified breathing, and cyanosis.

Clinical semiology of temporal lobe seizures in preschool children: contribution of invasive recording to anatomical classification (Patient 3) shows a nine-month-old boy with left temporo polar dysplasia. At birth, he had episodes with throat noises. No diagnosis was made. At the age of five months, he started having daily seizures with motor arrest, orientation to the left, nausea, chewing and reddening of the face. Clinical examination showed symmetrical motricity and a mild developmental delay. Seizures on video consisted of staring, throat noises, oro-alimentary automatisms, nausea, reddening of the face, paresis of the right arm, orientation to the left, and a suspicion of visual field loss on the right.