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Purpose: Our aim is to examine ictal onset patterns (IOPs), extratemporal early propagations (EPs) and inner relationship between them based on stereo-electroencephalography recordings in the patients with atypical temporal lobe epilepsy, and to evaluate their impact on seizure prognosis and cognitive outcomes after epilepsy surgery. Methods: Forty-three patients were included in this retrospective study. Five to sixteen multilead electrodes were implanted per patient. All of them underwent a standard craniotomy for tailored resection of the hypothetical epileptogenic zone. Post-operative seizure status and cognitive outcomes were evaluated by Engle’s classification, Wechsler intelligence and Wechsler memory scale. Results: Four types of IOPs were identified in the 43 patients. The patients with low frequency highamplitude periodic spikes (LFPS) and spike or poly-spike fast discharges (SpFD) had better seizure outcomes. There were ten patients with extratemporal EPs, who had worse clinical outcomes than those without extratemporal EPs (Engel’s class I: χ2 =10.689, p=0.001; Engel’s class Ia: χ2 =4.251, p=0.039). Three conditions related to IOPs and extratemporal EPs were combined to predict the seizure prognosis after operation. The sensitivity and specificity were 90.0% and 78.6% for Engel’s class I, and were 87.0% and 55.0% for Engel’s class Ia. The patients with LFPS showed more significant improvement in memory quotient (MQ) but not in full intelligence quotient (FIQ) than those with other IOPs. Conclusions: IOPs and extratemporal EPs are closely related to seizure status and cognitive outcomes after epilepsy surgery in atypical TLE patients.

neuropsychiatry

Evaluating the Prognosis of Surgical Treatment in Atypical Temporal Lobe Epilepsy-A Study Based on Ictal Onset Patterns and Extratemporal Early Propagations on Stereo-Electroencephalography