Purpose. Somatosensory (SSA) and pharyngolaryngeal auras (PLA) may suggest an extratemporal onset (e.g., insula, second somatosensory area). We sought to determine the prognostic significance of SSA and PLA in temporal lobe epilepsy (TLE) patients undergoing epilepsy surgery. Methods. Retrospective review of all patients operated for refractory TLE at our institution between January 1980 and July 2007 comparing outcome between patients with SSA/PLA to those without. Results. 158 patients underwent surgery for pharmacoresistant TLE in our institution. Eleven (7%) experienced SSA/PLA as part of their seizures. All but one had lesional (including hippocampal atrophy/sclerosis) TLE. Compared to patients without SSA or PLA, these patients were older , had a higher prevalence of early ictal motor symptoms and prior CNS infection , and were less likely to have a localizing SPECT study . A favorable outcome was achieved in 81.8% of patients with SSA and/or PLA and 90.4% of those without SSA or PLA . Conclusion. Most patients with pharmacoresistant lesional TLE appear to have a favorable outcome following temporal lobectomy, even in the presence of SSA and PLA. 1. Introduction Recent evidence suggests that failure to recognize insular cortex seizures could be responsible for some cases of surgical failure in patients with temporal lobe epilepsy (TLE) [1–5]. Insular seizures may mimic TLE or may coexist with temporal seizures, an entity referred to as temporal plus epilepsy [6–8]. Clinical observation of patients with insular seizures proven by depth recordings and after cortical stimulation using insular contacts has revealed a high prevalence of somatosensory and pharyngolaryngeal auras (SSA and PLA, resp.), including a characteristic sensation of laryngeal constriction (LC) [1–3, 9–15]. In this study, we sought to determine the prevalence and prognostic significance of SSA and PLA in TLE patients undergoing epilepsy surgery. 2. Materials and Methods We performed a retrospective chart review of all patients who underwent surgery for refractory TLE at our institution between January 1980 and July 2007. All patients underwent a comprehensive epilepsy surgical workup, including complete anamnesis and neurological examination, neuropsychological evaluation, and video-electroencephalographic (VEEG) monitoring with scalp electrodes. Magnetic resonance imaging (MRI) were performed in all patients after 1992. Single photon emission computed tomography (SPECT) and 18F fluorodeoxyglucose positron emission tomography (PET) was performed in more recent cases. Invasive VEEG
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