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Seizure localization in temporal lobe epilepsy

A comparison of scalp-sphenoidal EEG and volumetric MRI

Department of Neurology (Dr. Murro), VA Medical Center, Augusta, GA; and the Departments of Neurology (Drs. Murro, Park, King, Gallagher, and Loring, and W. Littleton), Pathology (Dr. Yaghmai), and Radiology (Drs. Toro and Figueroa), and the Section of Neurosurgery (Dr. Smith), Medical College of Georgia, Augusta, GA.

We determined the accuracy of volumetric MRI (based on identification of unilateral hippocampal atrophy) and scalp-sphenoidal EEG (based on concordant interpretations of scalp-sphenoidal ictal EEG by three independent interpreters) for seizure focus localization in 20 patients with temporal lobe epilepsy. All patients became seizure-free or had rare seizures following temporal lobectomy. Among the 20 patients, nine (45%) met both MRI and EEG localization criteria, six (30%) met MRI localization criteria alone, three (15%) met EEG localization criteria alone, and two patients (10%) did not meet either localization criteria. In the 18 patients meeting MRI or EEG localization criteria, the predicted localization agreed with the side of temporal lobectomy. These results suggest that a nonin-vasive approach combining MRI and EEG will correctly localize the side of seizure onset in most patients with temporal lobe epilepsy.

Address correspondence and reprint requests to Dr. Anthony M. Murro, Department of Neurology, VA Medical Center (1271, Augusta, GA 30912.

Received January 12, 1993. Accepted for publication in final form April 26, 1993.

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