Materiały źródłowe

• #1 Temporal Seizure – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK549852/

  Temporal lobe epilepsy is the commonest seizure disorder and affects approximately fifty million people worldwide. The primary objective of this activity is to review the epidemiology, pathophysiology, diagnosis, and management of temporal lobe epilepsy. […] Diagnostic accuracy relies on the use of electroencephalography (EEG) and imaging studies, for which the accuracy is subject to the level of evaluator expertise, as well as the limitation to access to these resources on a global spectrum. […] EEG should be performed in all individuals with suspected temporal lobe epilepsy, as it can assist in the localization of epileptic focus, and potentially elucidate possible epileptic networks. […] An ictal EEG recording of a rhythmic 5 to 7 Hz theta-wave frequency, with peak recordings in sphenoidal and basal temporal electrodes on the ipsilateral side to epileptic focus, is diagnostic.

• #1 Temporal Lobe Epilepsy: Causes, Symptoms, and Treatment

  https://www.healthline.com/health/temporal-lobe-epilepsy

  Temporal lobe epilepsy is one of 20 different kinds of epilepsy. […] Temporal lobe seizures are further classified. If there is a loss of consciousness, theyre called complex partial seizures. If you stay conscious, theyre called simple partial seizures. […] A doctor can diagnose temporal lobe seizures from a detailed description of how the seizures occurred. Its often suggested that a third-party witness describe the seizures, as they may be better able to recall what happened. […] The standard radiological procedure used to diagnose temporal lobe epilepsy is magnetic resonance imaging (MRI), which is performed on the brain. Doctors look for characteristic brain abnormalities associated with temporal lobe epilepsy. […] Doctors will also perform an electroencephalogram (EEG), a test used to measure the brains electrical activity. Sharp waves seen in an EEG in the correct location are typically indicative of temporal lobe epilepsy.

• #1 Effective Documentation & Coding for Temporal Lobe Epilepsy

  https://www.outsourcestrategies.com/blog/document-code-temporal-lobe-epilepsy/

  Temporal Lobe Epilepsy (TLE) is characterized by seizures originating in the temporal lobes of the brain. […] Healthcare providers must ensure accurate documentation and precise coding of temporal lobe epilepsy for effective treatment planning and reimbursement. […] By partnering with a reliable neurology medical billing company, healthcare providers can benefit from accurate code assignment, effective documentation, and clear communication of temporal lobe epilepsy diagnoses. […] After having a seizure, neurologists may review the patient’s symptoms and medical history. They may recommend several tests such as neurological exam, Electroencephalogram (EEG), CT scan, MRI, Positron emission tomography (PET) and blood tests to find the cause of the seizure and the possibility of having another seizure.

• #1 Temporal lobe seizure // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/temporal-lobe-seizure

  Temporal lobe seizures begin in the temporal lobes of the brain. […] Temporal lobe seizures are sometimes called focal seizures with impaired awareness. […] The cause of temporal lobe seizures often isn’t known. […] Temporal lobe seizures are treated with medicine. […] After a seizure, your healthcare professional reviews your symptoms and medical history. You may have tests to find the cause of your seizure. Knowing the cause helps show how likely it is that you’ll have another seizure. […] Tests may include: Neurological exam. Your healthcare professional may test your behavior, motor abilities and mental function. This can show how well your brain and nervous system are working. […] Electroencephalogram, also called EEG. Flat metal discs called electrodes attached to your scalp record the electrical activity of your brain. This shows up as wavy lines on an EEG recording. The EEG may show a pattern that tells whether a seizure is likely to happen again. An EEG also can help rule out other conditions that look like epilepsy.

• #1 Temporal lobe seizure – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/temporal-lobe-seizure/diagnosis-treatment/drc-20378220

  EEG records the electrical activity of the brain through electrodes put on the scalp. EEG results show changes in brain activity. This may help diagnose brain conditions such as epilepsy and other seizure conditions. […] A high-density EEG test can help find the area in the brain where seizures happen. […] After a seizure, your healthcare professional reviews your symptoms and medical history. You may have tests to find the cause of your seizure. Knowing the cause helps show how likely it is that you’ll have another seizure. […] Tests may include: […] Electroencephalogram, also called EEG. Flat metal discs called electrodes attached to your scalp record the electrical activity of your brain. This shows up as wavy lines on an EEG recording. The EEG may show a pattern that tells whether a seizure is likely to happen again. An EEG also can help rule out other conditions that look like epilepsy.

• #1 Temporal lobe epilepsy | Tidsskrift for Den norske legeforening

  https://tidsskriftet.no/en/2023/01/clinical-review/temporal-lobe-epilepsy

  The temporal lobes are the part of the brain most likely to give rise to epileptic seizures. […] All patients who have had a suspected epileptic seizure should undergo a thorough assessment. […] The aim of this article is to illustrate the varying manifestations of temporal lobe seizures, and to provide a reminder that epilepsy surgery can be a good treatment option for those who do not achieve adequate seizure control with medications. […] A thorough medical history usually raises suspicion of the diagnosis. […] Neurological examination is generally unremarkable, and standard electroencephalography (EEG) is either normal or reveals only non-specific abnormalities in around half of patients. […] Repeated recordings, possibly while the patient is sleep-deprived, increase the likelihood of pathological findings.

• #1 Seizure Disorders – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/seizure-disorders/seizure-disorders

  Focal epileptiform discharges in focal-to-bilateral tonic-clonic seizures […] Spikes and slow-wave discharges occurring bilaterally at a rate of 3/second and usually normal background EEG activity in typical absence seizures […] Slow spike and wave discharges usually at a rate of […] Bilateral polyspike and wave abnormality at a rate of 4- to 6-Hz in juvenile myoclonic epilepsy […] However, normal EEG cannot exclude the diagnosis of epileptic seizures, which must be made clinically. EEG is less likely to detect abnormalities if seizures are infrequent. The initial EEG may detect an epileptiform abnormality in only 30 to 55% of patients with a known epileptic seizure disorder. Serial EEG may detect epileptiform abnormalities in up to 80 to 90% of such patients. In general, serial EEG with extended recording times and with tests done after sleep deprivation greatly increases the chance of detecting epileptiform abnormalities in patients with epileptic seizures.

• #1 Temporal lobe epilepsy – Wikipedia

  https://en.wikipedia.org/wiki/Temporal_lobe_epilepsy

  In the field of neurology, temporal lobe epilepsy is an enduring brain disorder that causes unprovoked seizures from the temporal lobe. […] Diagnosis relies on electroencephalographic (EEG) and neuroimaging studies. […] The temporal lobe epileptiform discharge is a pattern seen on the electroencephalogram (EEG) test; temporal lobe epileptiform discharges occur between seizures and confirm the diagnosis of temporal lobe epilepsy. […] Long-term video-EEG monitoring may record the behavior and EEG during a seizure. […] Neuroimaging tests may identify the cause for seizures and the seizure focus, the brain location where seizures begin. […] In newly diagnosed epilepsy, magnetic resonance imaging (MRI) can detect brain lesion in up to 12 to 14% of persons with epilepsy. […] However, for those with chronic epilepsy, MRI can detect brain lesion in 80% of the persons with epilepsy.

• #1 Diagnosis and treatment of temporal lobe epilepsy – PubMed

  https://pubmed.ncbi.nlm.nih.gov/16397445/

  Of the 1,200,000 Americans with partial epilepsy, temporal lobe epilepsy (TLE) occurs in more than 400,000. […] TLE is diagnosed by a history of characteristic partial seizure symptoms. The diagnosis is confirmed by the capture of a typical episode during an electroencephalogram (EEG) or video-EEG, with epileptiform activity over one or both temporal regions. Video-EEG monitoring has revolutionized diagnosis and should be considered in patients in whom diagnosis is uncertain.

• #1 Seizure Disorders – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/seizure-disorders/seizure-disorders

  Inpatient combined video-EEG monitoring, usually for 2 to 7 days, records EEG activity and clinical behavior simultaneously. It is the most sensitive EEG testing available and is thus useful in differentiating epileptic from nonepileptic seizures. […] Ambulatory EEG can be done while patients are at home. It may be useful if seizures recur in patients who cannot be admitted to the hospital for a long time. […] If surgical resection of areas of epileptic foci is being considered, advanced imaging tests to identify such areas are available in epilepsy centers: […] Functional MRI can identify functioning cortex and guide surgical resection. […] If EEG and MRI do not clearly identify the epileptic focus, magnetoencephalography with EEG (called magnetic source imaging) may localize the lesion, avoiding the need for invasive intraoperative mapping procedures.

• #1 Role of short-term video electroencephalogram in monitoring seizure diagnosis | The Egyptian Journal of Neurology, Psychiatry and Neurosurgery | Full Text

  https://ejnpn.springeropen.com/articles/10.1186/s41983-019-0119-2

  The diagnostic value accuracy of short-term video EEG monitoring depends upon the capture of clinical events in question. […] The current study proved the clinical utility of short-term video EEG monitoring in suspected epileptic patients. So video EEG monitoring can be used as a daytime (23h) procedure with a high yield (62.5%) in differentiating the nature of recurrent, paroxysmal behaviors that occur on a daily, weekly, and monthly basis compared to other studies shown in Table 5. […] Short-term video EEG monitoring could lead to crucial changes in both the diagnosis and management in a great portion of the monitored patients.

• #1 Temporal lobe seizure – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/temporal-lobe-seizure/diagnosis-treatment/drc-20378220

  Computerized tomography, also called CT. A CT scan uses X-rays to get cross-sectional images of the brain. CT scans can show what may be causing seizures. The scans can show tumors, bleeding and cysts. […] MRI. An MRI uses powerful magnets and radio waves to show a detailed view of the brain. An MRI can show possible causes of seizures. […] Positron emission tomography, also called PET. PET scans use a small amount of low-dose radioactive material. A healthcare professional puts the material into a vein. The scan shows active areas of the brain. PET scans can show where in the brain the seizure began. […] Single-photon emission computerized tomography, also called SPECT. A SPECT test uses a small amount of low-dose radioactive tracer. A healthcare professional puts the tracer into a vein. This makes a detailed, 3D map of the blood flow in the brain during a seizure. A form of a SPECT test called subtraction ictal SPECT coregistered with magnetic resonance imaging, also called SISCOM, may give even more-detailed results.

• #1 Temporal lobe epilepsy – Wikipedia

  https://en.wikipedia.org/wiki/Temporal_lobe_epilepsy

  3-Tesla MRI scan is advised for those with evidence of focal epilepsy such as temporal lobe epilepsy. […] Abnormalities identified by MRI scan include hippocampal sclerosis, focal cortical dysplasia, other cortical developmental brain malformations, developmental and low-grade tumors, cavernous hemangioma, hypoxic-ischemic brain injury, traumatic brain injury and encephalitis. […] 18F-fluorodeoxyglucose (18F-FDG) brain positron emission tomography (PET) may show a brain region of decreased glucose metabolism at a time between seizures; this hypometabolic region may correspond to the seizure focus, and PET scan is more sensitive for temporal lobe seizure focus localization compared to epilepsy arising from other brain lobes. […] Single-photon emission computed tomography (SPECT) may show a region of decreased blood flow occurring 40-60 seconds after injection during the seizure; this reduced blood flow region may correspond to the seizure focus. […] Computed tomography (CT) scan is less sensitive than MRI scan for identifying small tumors, vascular malformations, cortical developmental brain malformations, and abnormalities in the medial temporal lobe.

• #1 Seizure Disorders – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/seizure-disorders/seizure-disorders

  Single-photon emission CT (SPECT) during the ictal period may detect increased perfusion in the seizure focus and help localize the area to be surgically removed. Because injection of contrast is required at the time of seizure, patients must be admitted for continuous video-EEG monitoring when SPECT is done during the ictal period. […] Neuropsychologic testing may help identify functional deficits before and after surgery and help predict social and psychologic prognosis and capacity for rehabilitation.

• #1 Epilepsy – Symptoms, Diagnosis, Treatmentphone iconphone iconGroup 49

  https://www.barrowneuro.org/condition/epilepsy/

  Neuropsychological Evaluation: Because people with epilepsy often experience cognitive difficulties—problems with memory, understanding spatial patterns, or language functions—a neuropsychological examination helps explain those difficulties by identifying a seizure focus. For example, people with left temporal lobe epilepsy will commonly show a different pattern of results on these tests than those with right temporal lobe epilepsy. […] In the case of epilepsy that’s difficult to diagnose and treat, or if you are considering epilepsy surgery, admission to an inpatient epilepsy monitoring unit (EMU) is recommended. This allows epilepsy specialists to perform an in-depth evaluation over an extended period. […] During inpatient monitoring, brain wave patterns and physical activity are observed 24 hours a day using simultaneous EEG and audio/video monitoring. This information is then used to evaluate and diagnose seizure activity, create a treatment plan, and coordinate ongoing care.

• #1 Seizure Disorders – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/seizure-disorders/seizure-disorders

  Manifestations of other conditions, such as sudden global brain ischemia (eg, due to ventricular arrhythmia), can resemble those of a seizure, including loss of consciousness and some myoclonic jerks. […] Physical examination […] In patients who have lost consciousness, a bitten tongue, incontinence (eg, urine or feces in clothing), or prolonged confusion after loss of consciousness suggest seizure. […] In pseudoseizures, generalized muscular activity and lack of response to verbal stimuli may at first glance suggest generalized tonic-clonic seizures. However, pseudoseizures can usually be distinguished from true seizures by clinical characteristics: […] Pseudoseizures often last longer (several minutes or more). […] Postictal confusion tends to be absent. […] Typical tonic phase activity, followed by clonic phase, usually does not occur.

• #1 TEMPORAL LOBE SEIZURE

  https://www.epilepsydiagnosis.org/seizure/temporal-overview.html

  CAUTION Temporal focal impaired awareness seizures can have similar features to frontal focal impaired awareness seizures, however impaired awareness seizures of temporal origin tend to have a slower onset and progression, and postictal confusion is more pronounced. […] CAUTION Temporal focal impaired awareness seizures need to be distinguished from absence seizures. While both may have automatisms, temporal lobe seizures are typically longer ( 30 seconds), associated with pallor, and followed by postictal confusion. […] Seizures that arise in the mesial temporal lobe may be characterized by distinctive seizure onset features such as an autonomic seizure with rising epigastric sensation or abdominal discomfort, or cognitive seizure with deja vu/jamais vu, or emotional seizure with fear. Unpleasant olfactory and gustatory sensory seizures may also occur. These focal seizure types may occur in isolation or may be followed by the onset of behavioral arrest with slowly progressive impairment of awareness and oral (chewing, lip-smacking, swallowing, tongue movements) and manual automatisms. Autonomic phenomena (pallor, flushing, tachycardia) are common. Upper limb automatisms may be unilateral and may lateralize the seizure to the ipsilateral hemisphere. Unilateral pupillary dilatation can occur, and can also lateralize the seizure to the ipsilateral hemisphere. Contralateral upper limb dystonia may develop and head and eye version to the contralateral side can occur. Whilst seizures tend to have a longer duration than for lateral temporal lobe seizures, evolution to a focal to bilateral tonic-clonic seizure is uncommon.

• #1 Seizure Disorders – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/seizure-disorders/seizure-disorders

  Diagnosis of Seizure Disorders […] Clinical evaluation […] For new-onset seizures, neuroimaging, laboratory testing, and usually EEG […] For known seizure disorders, usually antiseizure medication levels […] For new-onset or known seizure disorders, other testing as clinically indicated […] Evaluation must determine whether the event was a seizure versus another cause of obtundation (eg, a pseudoseizure, syncope), then identify possible causes or precipitants. Patients with new-onset seizures are evaluated in an emergency department; they can sometimes be discharged after thorough evaluation. Those with a known seizure disorder may be evaluated in a physicians office. […] History […] Patients who have had a seizure should be asked about unusual sensations, suggesting an aura and thus a seizure, and about typical seizure manifestations. Patients typically do not remember generalized-onset seizures, so a description of the seizure itself must be obtained from witnesses.

• #1 :: Journal of Epilepsy Research

  https://www.j-epilepsy.org/m/journal/view.php?doi=10.14581/jer.14005

  We describe a female insulinoma patient who presented with recurrent attacks of abnormal behavior, confusion, and seizure. Her interictal EEG showed epileptiform discharges on the left temporal area, therefore she was initially misdiagnosed as temporal lobe epilepsy. […] Since insulinoma shares some common clinical and EEG features with complex partial seizure of temporal lobe origin, insulinoma should be included in the differential diagnosis for medically intractable temporal lobe epilepsy. […] EEG is commonly used for the differential diagnosis of epileptic seizure and non-epileptic seizures. However, EEG can be misleading in insulinoma patients since hypoglycemia can affect EEG, causing diffuse or focal slow activity. […] Taken together, these findings are helpful to explain the phenomenon that hypoglycemic seizure in insulinoma is medically intractable and can present as complex partial seizure with temporal origin.

• #1 TEMPORAL LOBE SEIZURE

  https://www.epilepsydiagnosis.org/seizure/temporal-overview.html

  Lateral temporal lobe seizures may have an initial focal seizure with auditory or vertiginous features. The focal sensory auditory seizure is usually a basic sound such as buzzing or ringing (rather than formed speech). If the sound is heard in only one ear it suggests the seizure is in the contralateral hemisphere. In comparison to mesial temporal lobe seizures, lateral temporal seizures are of shorter duration, and the onset of impaired awareness is an earlier feature (the initial aware phase is not as prolonged). Lateral temporal lobe seizures may spread and motor features such as contralateral upper limb dystonia, facial twitching or grimacing, and head and eye version may occur. Evolution to a focal to bilateral tonic-clonic seizure is more common than in mesial temporal lobe seizures.

• #1 TEMPORAL LOBE SEIZURE

  https://www.epilepsydiagnosis.org/seizure/temporal-overview.html

  Temporal lobe seizures are characterized by behavioral arrest and impaired awareness. Automatisms are common during the seizure, and include oral and/or manual automatisms. There may sensory (auditory), emotional (fear), cognitive (deja vu) or autonomic features (epigastric sensation, tachycardia, colour change) prior to onset of impaired awareness. Postictal confusion typically occurs. […] Specific features suggest seizure onset in the dominant or non-dominant temporal lobe (see hemispheric lateralization). Ictal speech, spitting, vomiting, drinking, urge to urinate and automatisms with preserved consciousness suggest seizure onset in the non-dominant temporal lobe. Postictal speech disturbance suggests a dominant temporal lobe seizure. Upper limb dystonia is a useful lateralizing feature, lateralizing the seizure to the contralateral hemisphere. Conversely, manual automatisms usually occur on the ipsilateral side.

• #1 Neuronal avalanches in temporal lobe epilepsy as a noninvasive diagnostic tool investigating large scale brain dynamics | Scientific Reports

  https://www.nature.com/articles/s41598-024-64870-3

  The epilepsy diagnosis still represents a complex process, with misdiagnosis reaching 40%. […] We aimed at building an automatable workflow, helping the clinicians in the diagnosis of temporal lobe epilepsy (TLE). […] Using a support vector machine, we reached a classification accuracy of TLE versus controls of 0.860.08 (SD) and an area under the curve of 0.930.07. […] The use of NA features increase by around 16% the accuracy of diagnosis prediction compared to ImCoh. […] In the present work, we aimed at identifying a better suited EEG signal feature to train an AI-model-based classification (patients with temporal lobe epilepsy vs. healthy controls). […] We hypothesized that the spreading of the aperiodic activation bursts at the whole-brain level may represent a relevant feature towards the automatic classification of patients with TLE vs. controls.

• #1 Deep learning for the diagnosis of mesial temporal lobe epilepsy | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0282082

  This study aimed to enable the automatic detection of the hippocampus and diagnose mesial temporal lobe epilepsy (MTLE) with the hippocampus as the epileptogenic area using artificial intelligence (AI). […] We compared the diagnostic accuracies of AI and neurosurgical physicians for MTLE with the hippocampus as the epileptogenic area. […] AI detected the hippocampi automatically and diagnosed MTLE with the hippocampus as the epileptogenic area on both T2-weighted imaging (T2WI) and fluid-attenuated inversion recovery (FLAIR) images. […] The diagnostic accuracies of AI based on T2WI and FLAIR data were 99% and 89%, respectively, and those of neurosurgeons based on T2WI and FLAIR data were 94% and 95%, respectively. […] The diagnostic accuracy of AI was statistically higher than that of board-certified neurosurgeons based on T2WI data (p = 0.00129).

• #1 MRI-based deep learning can discriminate between temporal lobe epilepsy, Alzheimer’s disease, and healthy controls | Communications Medicine

  https://www.nature.com/articles/s43856-023-00262-4

  Radiological identification of temporal lobe epilepsy (TLE) is crucial for diagnosis and treatment planning. […] The identification of neuroimaging signs indicative of TLE is crucial during diagnostic evaluation since the presence of MRI abnormalities is commonly associated with a greater likelihood of surgical success. […] We hypothesized that 2D CNN optimized for TLE classification could leverage TLE whole brain atrophy patterns for disease classification. […] Our CNN models had a mean accuracy of 86.84% (SD=1.33%), mean precision of 0.77 (SD=0.03), a mean recall of 0.74 (SD=0.03), and an F1-score of 0.75 (SD=0.025) for disease prediction. […] We observed that a CNN model identified TLE vs. controls and TLE vs. AD at a statistically significant level independent of age. […] Importantly, the machine learning approach achieved high classification accuracy for TLE cases beyond the lesional status identified by human experts.

• #1

  https://link.springer.com/article/10.1007/s00259-020-05108-y

  Epilepsy is one of the most disabling neurological disorders, which affects all age groups and often results in severe consequences. […] Recently, 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) imaging has been used for the evaluation of pediatric epilepsy. […] This study aimed to develop a novel symmetricity-driven deep learning framework of PET imaging for the identification of epileptic foci in pediatric patients with temporal lobe epilepsy (TLE). […] The proposed deep learning framework could detect the epileptic foci accurately with the dice coefficient of 0.51, which was significantly higher than that of SPM (0.24, P0.01) and significantly (or marginally) higher than that of visual assessment (0.310.44,P= 0.0050.27). […] The proposed deep learning framework for 18F-FDG PET imaging could identify epileptic foci accurately and efficiently, which might be applied as a computer-assisted approach for the future diagnosis of epilepsy patients.

• #1 Diagnostic & Treatment Delay in Temporal Lobe Epilepsy

  https://practicalneurology.com/diseases-diagnoses/epilepsy-seizures/diagnostic-treatment-delay-in-temporal-lobe-epilepsy/31835/

  The average 20-year delay of referral to epilepsy centers can be improved. […] Despite the high global burden of epilepsy, there is often a delay in initial diagnosis, even in developed countries. […] Notably, on average there is a delay of more than 20 years between initial diagnosis and surgical management of people who are failed by optimal use of ASMs. […] This case demonstrates misdiagnosis of epilepsy at initial presentation that resulted in a 10-year treatment delay. Diagnostic delay of epilepsy following initial presentation is common. […] In a retrospective study of 220 people with suspected new-onset seizures, there was a median delay of 8.7 months and over 50% of participants had more than 5 events before epilepsy was diagnosed. […] As can be inferred, individuals with nonconvulsive seizures experience greater delays than those with convulsive seizures.

• #1 Diagnostic & Treatment Delay in Temporal Lobe Epilepsy

  https://practicalneurology.com/diseases-diagnoses/epilepsy-seizures/diagnostic-treatment-delay-in-temporal-lobe-epilepsy/31835/

  Avoiding misdiagnosis is important because untreated epilepsy negatively affects patients. […] A single negative EEG can be misleading because only approximately 39% of individuals have epileptiform discharges on EEG after their first unprovoked seizure. […] Whenever doubt exists, the patient needs to be referred to a comprehensive epilepsy center for a consultation with an epileptologist. […] This case is an example of the considerable diagnostic delay in identification of DRE in people already diagnosed with epilepsy. […] Delay in identifying DRE leads to delays in referral to a surgical epilepsy center and multidisciplinary epilepsy management. […] Despite this standardized definition, there has not been an appreciable reduction in time to referral to tertiary epilepsy centers.

• #1 Temporal Lobe Epilepsy: From Etiology to Treatment | Frontiers Research Topic

  https://www.frontiersin.org/research-topics/20585/temporal-lobe-epilepsy-from-etiology-to-treatment/magazine

  Temporal lobe epilepsy (TLE) represents the most common focal epilepsy syndrome in adulthood. […] In tertiary referral centers, many of these patients are eventually evaluated because of pharmacoresistance and therefore represent potential candidates for epilepsy surgery or other precise therapeutic approaches. […] Among the different etiologies, hippocampal sclerosis in adults and focal cortical dysplasia in children are the most common pathologies identified on magnetic resonance imaging (MRI), and have advanced and accurate diagnostic and therapeutic approaches. […] However, in around 20-30% of refractory patients with TLE, brain MRI does not demonstrate any epileptogenic lesion. […] The etiologies behind this non-lesional TLE is being clarified by the identification of new pathologies that do not leave a specific trace in brain MRI, or in which this trace is difficult to identify.

• #1 Temporal Lobe Epilepsy (TLE): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17778-temporal-lobe-seizures

  Temporal lobe epilepsy is a seizure-causing condition that starts in your temporal lobe. A healthcare provider may recommend medications or surgery to manage seizures. Temporal lobe epilepsy (TLE) is a type of epilepsy where seizures begin in the temporal lobe. Seizures are the result of abnormal electrical activity in your brain. Temporal lobe epilepsy is the most common type of focal epilepsy. A healthcare provider can help you manage them and other issues that this condition can cause. A healthcare provider will diagnose temporal lobe epilepsy after reviewing your symptoms, getting a seizure history, performing a neurological examination and ordering tests. Testing helps your provider see what’s going on inside of your brain. Treatment for temporal lobe epilepsy may include: Antiseizure medications, Epilepsy surgery, Neurostimulation. Many antiseizure medications are available to treat temporal lobe seizures. Your healthcare provider may consider surgery if antiseizure medications aren’t successful or if a tumor causes epilepsy symptoms. Neurostimulation devices may be an option if medications aren’t successful or surgery isn’t a safe option. Your outlook varies based on: How many seizures you have, How long you’ve had seizures, Your general health, Whether irreversible complications started. If you’ve had a seizure or think you might’ve had a seizure, you should see a healthcare provider. If you have a temporal lobe epilepsy diagnosis, call your provider if: Your seizure lasts longer than five minutes, A second seizure immediately follows the first, The number and severity of your seizures increase, You experience new symptoms or side effects, Your recovery after your seizure is slower than usual or not complete.

• #1 Temporal Seizure – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK549852/

  Neuroimaging is vital for the identification of organic or structural anomalies, which may precipitate temporal lobe seizures, such as vascular malformations, tumors, and hippocampal sclerosis. […] Approximately 57 percent of focal epileptogenic lesions are missed on standard MRI, making a referral to specialty epileptic clinic beneficial, for evaluation and accessibility to functional neuroimaging modalities. […] Surgical evaluation should not be delayed in individuals refractory to AEDs, given the growing evidence identified in Level I and II studies for the improvement in ictal control after surgical intervention in refractory temporal lobe epilepsy.

• #1 Temporal lobe epilepsy | Tidsskrift for Den norske legeforening

  https://tidsskriftet.no/en/2023/01/clinical-review/temporal-lobe-epilepsy

  In a typical case, focal epileptiform activity is seen over the anterior temporal regions, often in combination with slow-wave activity. […] Magnetic resonance imaging (MRI) of the brain, preferably using a 3 Tesla scanner and an epilepsy protocol, reveals an epileptogenic lesion in around 70 % of this patient population. […] Temporal lobe epilepsy is easy to diagnose if the medical history, seizure characteristics, and EEG and MRI findings are typical. […] In the event of doubt, patients should be referred for diagnostic testing at a university hospital, for example the National Centre for Epilepsy in Oslo.

• #1 Temporal Lobe Epilepsy: From Etiology to Treatment | Frontiers Research Topic

  https://www.frontiersin.org/research-topics/20585/temporal-lobe-epilepsy-from-etiology-to-treatment/magazine

  Difficult to diagnose etiologies in TLE include some forms of autoimmune epilepsies, TLE with a genetic origin, and occult temporal pole encephaloceles, that might be considered both in controlled and refractory non-lesional TLE. […] While significant advances have been made in the diagnosis and treatment of hippocampal sclerosis and cortical dysplasia, diagnosis of other etiologies is challenging, ultimately resulting in held or delayed therapies and worse outcomes. […] This Research Topic focuses on reviewing stablished approaches and novel advances in the translational and clinical research on the etiology, diagnosis and therapy of different causes of TLE. […] In the last decade, the field of focal epilepsy, and particularly of TLE, has experience huge advances that involve not only the characterization of underrecognized or new pathologies but also in the implementation of novel diagnostic modalities that better characterize TLE as a network disease with multiple causes and diverse therapeutic approaches.

• #1 Diagnostic & Treatment Delay in Temporal Lobe Epilepsy

  https://practicalneurology.com/diseases-diagnoses/epilepsy-seizures/diagnostic-treatment-delay-in-temporal-lobe-epilepsy/31835/

  Avoiding delays in DREs is crucial because there are many health consequences associated with undertreated epilepsy including increased risk of sudden unexpected death in epilepsy (SUDEP), psychiatric comorbidities, motor vehicle and other traumatic accidents, and reduced quality of life. […] There are a variety of reasons for delays in identifying DRE and referring individuals to epilepsy centers. […] The ideal treatment goal for epilepsy includes complete seizure freedom and the absence of any side effects. […] Achieving this goal is often daunting in people with DRE. Appropriate and targeted treatment requires a multidisciplinary approach.

• #1 Neuronal avalanches in temporal lobe epilepsy as a noninvasive diagnostic tool investigating large scale brain dynamics | Scientific Reports

  https://www.nature.com/articles/s41598-024-64870-3

  The method proposed in the present work may represent a potential tool for helping clinicians with diagnostics, which translates into the possibility of reducing the misinterpretation of EEG abnormalities by taking into account global brain activities. […] The present pipeline can be fully automated, requiring therefore minimal effort to the clinicians and the technical staff, that is the recording of a minimum of 5 min of resting state EEG. […] The present work does not aim at providing a tool to replace the fundamental knowledge and experience of a clinical expert. […] The present pipeline might be of important help also in the low-income countries where patients have difficulty accessing specialist care. […] In order to translate this pipeline to clinical practice, validation on multiple epilepsy and neurological populations is warranted.

• #2 Diagnosis and treatment of temporal lobe epilepsy – PubMed

  https://pubmed.ncbi.nlm.nih.gov/16397445/

  Of the 1,200,000 Americans with partial epilepsy, temporal lobe epilepsy (TLE) occurs in more than 400,000. […] TLE is diagnosed by a history of characteristic partial seizure symptoms. The diagnosis is confirmed by the capture of a typical episode during an electroencephalogram (EEG) or video-EEG, with epileptiform activity over one or both temporal regions. Video-EEG monitoring has revolutionized diagnosis and should be considered in patients in whom diagnosis is uncertain.

• #2 Understanding Temporal Lobe Seizure — Diagnosis, Treatment, and Prevention

  https://www.webmd.com/epilepsy/understanding-temporal-lobe-seizure-treatment

  If someone has a seizure for the first time, if a seizure lasts longer than 2 to 3 minutes, or if multiple seizures occur one after the other, take them to the emergency room or call 911 immediately. […] If a seizure disorder is suspected, the doctor will begin by taking a thorough medical history, including any birth trauma, serious head injury, medication usage, alcohol intake, or infections of the brain, such as encephalitis or meningitis. […] A test called an electroencephalogram, or EEG, can detect the electrical signals that relay information from one brain cell to another. EEGs may show characteristic, abnormal patterns of a seizure if it occurs while the EEG is hooked up. […] In addition, X-rays, CT scans, and MRIs of the head can help rule out specific causes of seizures.

• #2 Temporal Lobe Epilepsy: Symptoms, Causes, and Treatment | MyEpilepsyTeam

  https://www.myepilepsyteam.com/resources/temporal-lobe-epilepsy-symptoms-causes-and-treatment

  Diagnosing TLE generally starts with a visit to a neurologist. The doctor will likely take a thorough medical history and perform a physical exam. They will want to hear a detailed account of what happened during any seizures the person has experienced. Blood tests may also be done to look for markers of infection. […] Electroencephalogram (EEG) recordings of electrical activity within the brain are a critical component of an epilepsy diagnosis. A neurologist will also likely use CT scans, MRI scans, or single-photon emission computerized tomography imaging to see if there is a structural problem in the brain that may be causing the seizures, such as scarring of temporal lobe structures (including hippocampal sclerosis). […] Diagnosis is confirmed by capturing a typical episode of seizure activity in the temporal lobe region during an EEG.

• #2 Seizure Disorders – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/seizure-disorders/seizure-disorders

  Diagnosis of Seizure Disorders […] Clinical evaluation […] For new-onset seizures, neuroimaging, laboratory testing, and usually EEG […] For known seizure disorders, usually antiseizure medication levels […] For new-onset or known seizure disorders, other testing as clinically indicated […] Evaluation must determine whether the event was a seizure versus another cause of obtundation (eg, a pseudoseizure, syncope), then identify possible causes or precipitants. Patients with new-onset seizures are evaluated in an emergency department; they can sometimes be discharged after thorough evaluation. Those with a known seizure disorder may be evaluated in a physicians office. […] History […] Patients who have had a seizure should be asked about unusual sensations, suggesting an aura and thus a seizure, and about typical seizure manifestations. Patients typically do not remember generalized-onset seizures, so a description of the seizure itself must be obtained from witnesses.

• #2 Temporal lobe epilepsy | Tidsskrift for Den norske legeforening

  https://tidsskriftet.no/en/2023/01/clinical-review/temporal-lobe-epilepsy

  In a typical case, focal epileptiform activity is seen over the anterior temporal regions, often in combination with slow-wave activity. […] Magnetic resonance imaging (MRI) of the brain, preferably using a 3 Tesla scanner and an epilepsy protocol, reveals an epileptogenic lesion in around 70 % of this patient population. […] Temporal lobe epilepsy is easy to diagnose if the medical history, seizure characteristics, and EEG and MRI findings are typical. […] In the event of doubt, patients should be referred for diagnostic testing at a university hospital, for example the National Centre for Epilepsy in Oslo.

• #2 Diagnostic & Treatment Delay in Temporal Lobe Epilepsy

  https://practicalneurology.com/diseases-diagnoses/epilepsy-seizures/diagnostic-treatment-delay-in-temporal-lobe-epilepsy/31835/

  Avoiding misdiagnosis is important because untreated epilepsy negatively affects patients. […] A single negative EEG can be misleading because only approximately 39% of individuals have epileptiform discharges on EEG after their first unprovoked seizure. […] Whenever doubt exists, the patient needs to be referred to a comprehensive epilepsy center for a consultation with an epileptologist. […] This case is an example of the considerable diagnostic delay in identification of DRE in people already diagnosed with epilepsy. […] Delay in identifying DRE leads to delays in referral to a surgical epilepsy center and multidisciplinary epilepsy management. […] Despite this standardized definition, there has not been an appreciable reduction in time to referral to tertiary epilepsy centers.

• #2 Seizure Disorders – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/seizure-disorders/seizure-disorders

  Inpatient combined video-EEG monitoring, usually for 2 to 7 days, records EEG activity and clinical behavior simultaneously. It is the most sensitive EEG testing available and is thus useful in differentiating epileptic from nonepileptic seizures. […] Ambulatory EEG can be done while patients are at home. It may be useful if seizures recur in patients who cannot be admitted to the hospital for a long time. […] If surgical resection of areas of epileptic foci is being considered, advanced imaging tests to identify such areas are available in epilepsy centers: […] Functional MRI can identify functioning cortex and guide surgical resection. […] If EEG and MRI do not clearly identify the epileptic focus, magnetoencephalography with EEG (called magnetic source imaging) may localize the lesion, avoiding the need for invasive intraoperative mapping procedures.

• #2 Role of short-term video electroencephalogram in monitoring seizure diagnosis | The Egyptian Journal of Neurology, Psychiatry and Neurosurgery | Full Text

  https://ejnpn.springeropen.com/articles/10.1186/s41983-019-0119-2

  Determination of the ictal symptomatology differentiates between types of epileptic seizures and also differentiates epileptic from non-epileptic seizures. […] The present study aimed to assess the benefit of Short-term video EEG monitoring in the diagnosis of patients with seizure disorders. […] The provisional diagnosis was altered after short-term video EEG monitoring in 50 patients (62.5%) of the referred patients. […] A change of diagnosis following short-term video EEG monitoring was considered in this study as change in the diagnosis of the disease (the patient was considered to have epilepsy, but proved as pseudo non-epileptic seizure disorders and vice versa) and diagnosis of a form of epilepsy other than the one considered a priori (based on the clinical history and examination previously performed).

• #2 Temporal lobe seizure // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/temporal-lobe-seizure

  MRI. An MRI uses powerful magnets and radio waves to show a detailed view of the brain. An MRI can show possible causes of seizures. […] A high-density EEG test can help find the area in the brain where seizures happen. […] A CT scan can show what may be causing seizures. The scans can show tumors, bleeding and cysts. […] EEG results show changes in brain activity. This may help diagnose brain conditions such as epilepsy and other seizure conditions.

• #2 Temporal lobe epilepsy – Wikipedia

  https://en.wikipedia.org/wiki/Temporal_lobe_epilepsy

  3-Tesla MRI scan is advised for those with evidence of focal epilepsy such as temporal lobe epilepsy. […] Abnormalities identified by MRI scan include hippocampal sclerosis, focal cortical dysplasia, other cortical developmental brain malformations, developmental and low-grade tumors, cavernous hemangioma, hypoxic-ischemic brain injury, traumatic brain injury and encephalitis. […] 18F-fluorodeoxyglucose (18F-FDG) brain positron emission tomography (PET) may show a brain region of decreased glucose metabolism at a time between seizures; this hypometabolic region may correspond to the seizure focus, and PET scan is more sensitive for temporal lobe seizure focus localization compared to epilepsy arising from other brain lobes. […] Single-photon emission computed tomography (SPECT) may show a region of decreased blood flow occurring 40-60 seconds after injection during the seizure; this reduced blood flow region may correspond to the seizure focus. […] Computed tomography (CT) scan is less sensitive than MRI scan for identifying small tumors, vascular malformations, cortical developmental brain malformations, and abnormalities in the medial temporal lobe.

• #2 Temporal Lobe Epilepsy: From Etiology to Treatment | Frontiers Research Topic

  https://www.frontiersin.org/research-topics/20585/temporal-lobe-epilepsy-from-etiology-to-treatment/magazine

  Temporal lobe epilepsy (TLE) represents the most common focal epilepsy syndrome in adulthood. […] In tertiary referral centers, many of these patients are eventually evaluated because of pharmacoresistance and therefore represent potential candidates for epilepsy surgery or other precise therapeutic approaches. […] Among the different etiologies, hippocampal sclerosis in adults and focal cortical dysplasia in children are the most common pathologies identified on magnetic resonance imaging (MRI), and have advanced and accurate diagnostic and therapeutic approaches. […] However, in around 20-30% of refractory patients with TLE, brain MRI does not demonstrate any epileptogenic lesion. […] The etiologies behind this non-lesional TLE is being clarified by the identification of new pathologies that do not leave a specific trace in brain MRI, or in which this trace is difficult to identify.

• #2 Epilepsy – Symptoms, Diagnosis, Treatmentphone iconphone iconGroup 49

  https://www.barrowneuro.org/condition/epilepsy/

  Epilepsy is usually diagnosed after someone experiences two or more seizures at least 24 hours apart that have no other identifiable cause. […] While a physical examination and complete medical history can be enough to indicate epilepsy, diagnostic tests can provide a more complete conclusion and help inform treatment. These tests include: […] Imaging: A computed tomography (CT) scan or magnetic resonance imaging (MRI) can identify whether brain abnormalities, like a lesion or tumor, are responsible for your seizures. […] Electroencephalography: Electroencephalography (EEG), the most common test for diagnosing epilepsy, records the electrical activity in the brain through electrodes on the scalp and then uses that data to look for abnormal patterns in brain waves. […] Magnetoencephalography: Magnetoencephalography (MEG) is a brain-mapping technique that measures the magnetic field generated by nerve cells’ electrical activity and can help identify where in the brain seizures originate.

• #2 Epilepsy – Symptoms, Diagnosis, Treatmentphone iconphone iconGroup 49

  https://www.barrowneuro.org/condition/epilepsy/

  Neuropsychological Evaluation: Because people with epilepsy often experience cognitive difficulties—problems with memory, understanding spatial patterns, or language functions—a neuropsychological examination helps explain those difficulties by identifying a seizure focus. For example, people with left temporal lobe epilepsy will commonly show a different pattern of results on these tests than those with right temporal lobe epilepsy. […] In the case of epilepsy that’s difficult to diagnose and treat, or if you are considering epilepsy surgery, admission to an inpatient epilepsy monitoring unit (EMU) is recommended. This allows epilepsy specialists to perform an in-depth evaluation over an extended period. […] During inpatient monitoring, brain wave patterns and physical activity are observed 24 hours a day using simultaneous EEG and audio/video monitoring. This information is then used to evaluate and diagnose seizure activity, create a treatment plan, and coordinate ongoing care.

• #2 TEMPORAL LOBE SEIZURE

  https://www.epilepsydiagnosis.org/seizure/temporal-overview.html

  Temporal lobe seizures are characterized by behavioral arrest and impaired awareness. Automatisms are common during the seizure, and include oral and/or manual automatisms. There may sensory (auditory), emotional (fear), cognitive (deja vu) or autonomic features (epigastric sensation, tachycardia, colour change) prior to onset of impaired awareness. Postictal confusion typically occurs. […] Specific features suggest seizure onset in the dominant or non-dominant temporal lobe (see hemispheric lateralization). Ictal speech, spitting, vomiting, drinking, urge to urinate and automatisms with preserved consciousness suggest seizure onset in the non-dominant temporal lobe. Postictal speech disturbance suggests a dominant temporal lobe seizure. Upper limb dystonia is a useful lateralizing feature, lateralizing the seizure to the contralateral hemisphere. Conversely, manual automatisms usually occur on the ipsilateral side.

• #2 Seizure Disorders – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/seizure-disorders/seizure-disorders

  The progression of muscular activity does not correspond to true seizure patterns (eg, pseudoseizure movements may include jerks moving from one side to the other and back and exaggerated pelvic thrusting). […] Intensity may wax and wane. […] Vital signs, including temperature, usually remain normal. […] Patients often actively resist passive eye opening. […] Testing […] Testing is done routinely, but normal results do not necessarily exclude a seizure disorder. Thus, the diagnosis may ultimately be clinical. Testing depends on results of the history and neurologic examination. […] If patients have a known seizure disorder but have symptoms or signs of a treatable disorder (eg. trauma, infection, metabolic disorder), additional testing is indicated. However, if examination results are normal or unchanged, little testing is required except for blood levels of antiseizure medications.

• #2 Seizure Disorders – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/seizure-disorders/seizure-disorders

  Syncope mimicking seizure (eg, with myoclonic jerks): ECG may detect unsuspected cardiac arrhythmias. […] Neuroimaging (typically head CT, but sometimes MRI) is usually done immediately to exclude a mass or hemorrhage. CT can be deferred and possibly avoided in children with typical febrile seizures whose neurologic status rapidly returns to normal. […] Follow-up MRI is recommended when CT is negative. It provides better resolution of brain tumors and abscesses and can detect cortical dysplasias, cerebral venous thrombosis, and herpes encephalitis. An epilepsy-protocol MRI of the head uses high-resolution coronal T1 and T2 sequences, which can detect hippocampal atrophy or sclerosis. MRI can detect some common causes of seizures, such as malformations of cortical development in young children and mesial temporal sclerosis, traumatic gliosis, and small tumors in adults.

• #2 :: Journal of Epilepsy Research

  https://www.j-epilepsy.org/m/journal/view.php?doi=10.14581/jer.14005

  Our report reiterates the importance of evaluating the metabolic cause of seizure disorders. Because insulinoma shares some common clinical and EEG characteristics with complex partial seizure of temporal lobe origin, insulinoma should be included in differential diagnosis for medically intractable temporal lobe epilepsy.

• #2 TEMPORAL LOBE SEIZURE

  https://www.epilepsydiagnosis.org/seizure/temporal-overview.html

  Lateral temporal lobe seizures may have an initial focal seizure with auditory or vertiginous features. The focal sensory auditory seizure is usually a basic sound such as buzzing or ringing (rather than formed speech). If the sound is heard in only one ear it suggests the seizure is in the contralateral hemisphere. In comparison to mesial temporal lobe seizures, lateral temporal seizures are of shorter duration, and the onset of impaired awareness is an earlier feature (the initial aware phase is not as prolonged). Lateral temporal lobe seizures may spread and motor features such as contralateral upper limb dystonia, facial twitching or grimacing, and head and eye version may occur. Evolution to a focal to bilateral tonic-clonic seizure is more common than in mesial temporal lobe seizures.

• #2 Mesial temporal sclerosis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/mesial-temporal-sclerosis?lang=us

  Mesial temporal sclerosis, also commonly referred to as hippocampal sclerosis, is the most common association with intractable temporal lobe epilepsy. It is seen in up to 65% of autopsy studies, although significantly less in imaging. Most patients present with temporal lobe epilepsy. MRI is the modality of choice to evaluate the hippocampus, however dedicated temporal lobe epilepsy protocol needs to be performed if good sensitivity and specificity is to be achieved. Coronal volume and coronal high resolution T2WI/FLAIR are best to diagnose mesial temporal sclerosis. Temporal lobe epilepsy is initially managed medically with antiseizure medications. In patients who are refractory to medical management temporal lobectomy or selective amygdalohippocampectomy may be performed. Anterior temporal lobectomy is successful in 75-90% of patients with mesial temporal sclerosis.

• #2 Neuronal avalanches in temporal lobe epilepsy as a noninvasive diagnostic tool investigating large scale brain dynamics | Scientific Reports

  https://www.nature.com/articles/s41598-024-64870-3

  The model of TLE is of particular interest as it represents a rather well-defined group of electroclinical conditions with lower clinical heterogeneity compared to other epilepsy forms. […] We observed that the prediction accuracy of the model trained on the ATMs was larger as compared to the one trained with ImCoh (0.710.12). […] The better classification performance for ATMs versus ImCoh was also confirmed by an increased area under the curve (AUC), both when considering the broadband and the narrowband filtered signal. […] The present work aimed at improving the automatable classification of epileptic patients, utilizing machine learning on information of the brain dynamics derived no- invasively from hdEEG. […] We observed that the model trained with ATMs outperforms the ImCoh across all the classification metrics increasing the performance from 10 to 19% based on the metric of interest.

• #2 Deep learning for the diagnosis of mesial temporal lobe epilepsy | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0282082

  The deep learning-based AI program is highly accurate and can diagnose MTLE better than some board-certified neurosurgeons. […] In this study, we present an alternative diagnosis method using artificial intelligence (AI), which involves automatic detection of the hippocampus and diagnosis of MTLE with the hippocampus as the epileptogenic area. […] We demonstrated that the deep learning-based AI program successfully detects the hippocampus and therefore, epileptic attacks because of MTLE with the hippocampus as the epileptogenic area based on MRI, with an accuracy of 90%. […] The analysis and diagnosis of MTLE based on T2 and FLAIR were performed by six independent investigators who were board-certified neurosurgeons. […] In the AI program, the first step is to automatically detect the hippocampus on conventional T2WI and FLAIR coronal sections.

• #2 MRI-based deep learning can discriminate between temporal lobe epilepsy, Alzheimer’s disease, and healthy controls | Communications Medicine

  https://www.nature.com/articles/s43856-023-00262-4

  CNN overcomes this overreliance on hippocampal imaging findings through examination of subtle, diffuse disease-related pathology that may otherwise go undetected by human visual examination. […] This is critical to the future implementation of AI-based tools in clinical settings because it suggests that the definition of lesional epilepsy may benefit from a human-machine synergistic interpretation and could change practice in many cases.

• #2

  https://link.springer.com/article/10.1007/s00259-020-05108-y

  The temporal lobe epilepsy (TLE) is the most frequent subtype of focal epilepsy, and 80-90% TLE patients show hypometabolism on 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) imaging at the interictal state. […] 18F-FDG PET has played an important role in epileptic patient management, since it has higher detection sensitivity (86% vs. 73-80%) than those of electroencephalogram (EEG), single-photon emission computed tomography (SPECT), or magnetic resonance imaging (MRI). […] However, this analysis method might lead to significant diagnostic bias, since it is highly depended on the physician’s own experience; therefore, computer-aided diagnosis approach is warranted. […] The proposed deep learning method based on a Siamese convolutional neural network (CNN) to track the metabolic symmetricity of 18F-FDG PET images for the detection of epileptic focus.

• #2 Diagnostic & Treatment Delay in Temporal Lobe Epilepsy

  https://practicalneurology.com/diseases-diagnoses/epilepsy-seizures/diagnostic-treatment-delay-in-temporal-lobe-epilepsy/31835/?c4src=top5

  The average 20-year delay of referral to epilepsy centers can be improved. […] Despite the high global burden of epilepsy, there is often a delay in initial diagnosis, even in developed countries. […] Notably, on average there is a delay of more than 20 years between initial diagnosis and surgical management of people who are failed by optimal use of ASMs. […] This case demonstrates misdiagnosis of epilepsy at initial presentation that resulted in a 10-year treatment delay. Diagnostic delay of epilepsy following initial presentation is common. […] As can be inferred, individuals with nonconvulsive seizures experience greater delays than those with convulsive seizures. […] Avoiding misdiagnosis is important because untreated epilepsy negatively affects patients. […] A single negative EEG can be misleading because only approximately 39% of individuals have epileptiform discharges on EEG after their first unprovoked seizure.

• #2 Temporal Lobe Epilepsy: From Etiology to Treatment | Frontiers Research Topic

  https://www.frontiersin.org/research-topics/20585/temporal-lobe-epilepsy-from-etiology-to-treatmentundefined

  Temporal lobe epilepsy (TLE) represents the most common focal epilepsy syndrome in adulthood. […] In tertiary referral centers, many of these patients are eventually evaluated because of pharmacoresistance and therefore represent potential candidates for epilepsy surgery or other precise therapeutic approaches. […] Among the different etiologies, hippocampal sclerosis in adults and focal cortical dysplasia in children are the most common pathologies identified on magnetic resonance imaging (MRI), and have advanced and accurate diagnostic and therapeutic approaches. […] However, in around 20-30% of refractory patients with TLE, brain MRI does not demonstrate any epileptogenic lesion. […] The etiologies behind this non-lesional TLE is being clarified by the identification of new pathologies that do not leave a specific trace in brain MRI, or in which this trace is difficult to identify.

• #2 Diagnostic & Treatment Delay in Temporal Lobe Epilepsy

  https://practicalneurology.com/diseases-diagnoses/epilepsy-seizures/diagnostic-treatment-delay-in-temporal-lobe-epilepsy/31835/?c4src=top5

  Whenever doubt exists, the patient needs to be referred to a comprehensive epilepsy center for a consultation with an epileptologist. […] This case is an example of the considerable diagnostic delay in identification of DRE in people already diagnosed with epilepsy. […] Delay in identifying DRE leads to delays in referral to a surgical epilepsy center and multidisciplinary epilepsy management. […] Despite this standardized definition, there has not been an appreciable reduction in time to referral to tertiary epilepsy centers. […] Avoiding delays in DREs is crucial because there are many health consequences associated with undertreated epilepsy including increased risk of sudden unexpected death in epilepsy (SUDEP), psychiatric comorbidities, motor vehicle and other traumatic accidents, and reduced quality of life.

• #2 Temporal Lobe Epilepsy: From Etiology to Treatment | Frontiers Research Topic

  https://www.frontiersin.org/research-topics/20585/temporal-lobe-epilepsy-from-etiology-to-treatment/magazine

  Difficult to diagnose etiologies in TLE include some forms of autoimmune epilepsies, TLE with a genetic origin, and occult temporal pole encephaloceles, that might be considered both in controlled and refractory non-lesional TLE. […] While significant advances have been made in the diagnosis and treatment of hippocampal sclerosis and cortical dysplasia, diagnosis of other etiologies is challenging, ultimately resulting in held or delayed therapies and worse outcomes. […] This Research Topic focuses on reviewing stablished approaches and novel advances in the translational and clinical research on the etiology, diagnosis and therapy of different causes of TLE. […] In the last decade, the field of focal epilepsy, and particularly of TLE, has experience huge advances that involve not only the characterization of underrecognized or new pathologies but also in the implementation of novel diagnostic modalities that better characterize TLE as a network disease with multiple causes and diverse therapeutic approaches.

• #2 Temporal Lobe Epilepsy: From Etiology to Treatment | Frontiers Research Topic

  https://www.frontiersin.org/research-topics/20585/temporal-lobe-epilepsy-from-etiology-to-treatmentundefined

  While significant advances have been made in the diagnosis and treatment of hippocampal sclerosis and cortical dysplasia, diagnosis of other etiologies is challenging, ultimately resulting in held or delayed therapies and worse outcomes. […] This Research Topic focuses on reviewing stablished approaches and novel advances in the translational and clinical research on the etiology, diagnosis and therapy of different causes of TLE. […] The goals of this review series are: (1) to characterize novel, difficult to recognize types and etiologies, such as temporal plus syndromes, temporal encephalocele, autoimmune epilepsy and genetic TLE; (2) to establish the different patterns of cognitive and psychiatric involvement in TLE and the progressive nature of cognitive decline in some cases; (3) to provide an update on neurophysiological advances in the diagnosis of different forms of TLE, such as electric/magnetic source analysis and electroencephalographic patterns; (4) to discuss the different surgical approaches, with special attention to precision techniques such as stereotactic laser ablation and stereoelectroencephalography-guided radiofrequency thermocoagulation; (5) to outline non-surgical therapeutic approaches, such as immune-modulation and new anti-seizure medication, and (6) experimental research about epileptogenesis in TLE models.

• #2 Temporal Seizure – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK549852/

  Temporal lobe epilepsy is the commonest seizure disorder and affects approximately fifty million people worldwide. The primary objective of this activity is to review the epidemiology, pathophysiology, diagnosis, and management of temporal lobe epilepsy. […] Diagnostic accuracy relies on the use of electroencephalography (EEG) and imaging studies, for which the accuracy is subject to the level of evaluator expertise, as well as the limitation to access to these resources on a global spectrum. […] EEG should be performed in all individuals with suspected temporal lobe epilepsy, as it can assist in the localization of epileptic focus, and potentially elucidate possible epileptic networks. […] An ictal EEG recording of a rhythmic 5 to 7 Hz theta-wave frequency, with peak recordings in sphenoidal and basal temporal electrodes on the ipsilateral side to epileptic focus, is diagnostic.

• #2 Diagnostic & Treatment Delay in Temporal Lobe Epilepsy

  https://practicalneurology.com/diseases-diagnoses/epilepsy-seizures/diagnostic-treatment-delay-in-temporal-lobe-epilepsy/31835/?c4src=top5

  There are a variety of reasons for delays in identifying DRE and referring individuals to epilepsy centers. […] The ideal treatment goal for epilepsy includes complete seizure freedom and the absence of any side effects. […] Achieving this goal is often daunting in people with DRE. Appropriate and targeted treatment (eg, surgical resection, neuromodulation, a combination of both, and continued ASM therapy) requires a multidisciplinary approach.

• #2 Neuronal avalanches in temporal lobe epilepsy as a noninvasive diagnostic tool investigating large scale brain dynamics | Scientific Reports

  https://www.nature.com/articles/s41598-024-64870-3

  To summarize, our results provide evidence that the ATMs better capture the subtle neural dynamics alteration in epilepsy, as compared to classic functional connectivity measures, and that this may be effectively fed to artificial intelligence algorithms to improve automated classification of TLE patients.

• #3 Temporal lobe epilepsy – Wikipedia

  https://en.wikipedia.org/wiki/Temporal_lobe_epilepsy

  In the field of neurology, temporal lobe epilepsy is an enduring brain disorder that causes unprovoked seizures from the temporal lobe. […] Diagnosis relies on electroencephalographic (EEG) and neuroimaging studies. […] The temporal lobe epileptiform discharge is a pattern seen on the electroencephalogram (EEG) test; temporal lobe epileptiform discharges occur between seizures and confirm the diagnosis of temporal lobe epilepsy. […] Long-term video-EEG monitoring may record the behavior and EEG during a seizure. […] Neuroimaging tests may identify the cause for seizures and the seizure focus, the brain location where seizures begin. […] In newly diagnosed epilepsy, magnetic resonance imaging (MRI) can detect brain lesion in up to 12 to 14% of persons with epilepsy. […] However, for those with chronic epilepsy, MRI can detect brain lesion in 80% of the persons with epilepsy.

• #3 Seizure Disorders – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/seizure-disorders/seizure-disorders

  Electroencephalography (EEG) is critical in the diagnosis of epileptic seizures, particularly of focal impaired-awareness seizures or absence status epilepticus, when EEG may be the most definitive indication of a seizure. EEG may detect epileptiform abnormalities (spikes, sharp waves, spike and slow-wave complexes, polyspike and slow-wave complexes). Epileptiform abnormalities may be bilateral, symmetric, and synchronous in patients with generalized-onset seizures and may be localized in patients with focal-onset seizures. […] EEG findings may include the following: […] Epileptiform abnormalities in temporal lobe foci between seizures (interictal) in focal impaired-awareness seizures originating in the temporal lobe […] Interictal bilateral symmetric bursts of 4- to 7-Hz epileptiform activity in primarily generalized tonic-clonic seizures

• #3

  https://link.springer.com/article/10.1007/s00259-020-05108-y

  Epilepsy is one of the most disabling neurological disorders, which affects all age groups and often results in severe consequences. […] Recently, 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) imaging has been used for the evaluation of pediatric epilepsy. […] This study aimed to develop a novel symmetricity-driven deep learning framework of PET imaging for the identification of epileptic foci in pediatric patients with temporal lobe epilepsy (TLE). […] The proposed deep learning framework could detect the epileptic foci accurately with the dice coefficient of 0.51, which was significantly higher than that of SPM (0.24, P0.01) and significantly (or marginally) higher than that of visual assessment (0.310.44,P= 0.0050.27). […] The proposed deep learning framework for 18F-FDG PET imaging could identify epileptic foci accurately and efficiently, which might be applied as a computer-assisted approach for the future diagnosis of epilepsy patients.

• #3 Seizure Disorders – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/seizure-disorders/seizure-disorders

  Single-photon emission CT (SPECT) during the ictal period may detect increased perfusion in the seizure focus and help localize the area to be surgically removed. Because injection of contrast is required at the time of seizure, patients must be admitted for continuous video-EEG monitoring when SPECT is done during the ictal period. […] Neuropsychologic testing may help identify functional deficits before and after surgery and help predict social and psychologic prognosis and capacity for rehabilitation.

• #3 TEMPORAL LOBE SEIZURE

  https://www.epilepsydiagnosis.org/seizure/temporal-overview.html

  CAUTION Temporal focal impaired awareness seizures can have similar features to frontal focal impaired awareness seizures, however impaired awareness seizures of temporal origin tend to have a slower onset and progression, and postictal confusion is more pronounced. […] CAUTION Temporal focal impaired awareness seizures need to be distinguished from absence seizures. While both may have automatisms, temporal lobe seizures are typically longer ( 30 seconds), associated with pallor, and followed by postictal confusion. […] Seizures that arise in the mesial temporal lobe may be characterized by distinctive seizure onset features such as an autonomic seizure with rising epigastric sensation or abdominal discomfort, or cognitive seizure with deja vu/jamais vu, or emotional seizure with fear. Unpleasant olfactory and gustatory sensory seizures may also occur. These focal seizure types may occur in isolation or may be followed by the onset of behavioral arrest with slowly progressive impairment of awareness and oral (chewing, lip-smacking, swallowing, tongue movements) and manual automatisms. Autonomic phenomena (pallor, flushing, tachycardia) are common. Upper limb automatisms may be unilateral and may lateralize the seizure to the ipsilateral hemisphere. Unilateral pupillary dilatation can occur, and can also lateralize the seizure to the ipsilateral hemisphere. Contralateral upper limb dystonia may develop and head and eye version to the contralateral side can occur. Whilst seizures tend to have a longer duration than for lateral temporal lobe seizures, evolution to a focal to bilateral tonic-clonic seizure is uncommon.

• #3 Localisation in focal epilepsy: a practical guide | Practical Neurology

  https://pn.bmj.com/content/21/6/481

  In this paper, we summarise the current literature on localisation of focal seizures and discuss some of its complexities and possible pitfalls. […] Temporal lobe seizures, which depend mainly on activation of brain areas, evolve more slowly, whereas frontal lobe seizures, which may depend on disinhibition, propagate quickly. […] The temporal lobes are the most frequent site of origin of focal seizures; two thirds of people with refractory epilepsy assessed for potential surgery have temporal lobe seizures. […] Focal impaired awareness seizures arising from the temporal lobe can be distinguished clinically from generalised absence seizures that occur in the genetic (idiopathic) generalised epilepsies. […] Auras occur commonly in temporal lobe seizures; some are relatively specific.

• #3 Neuronal avalanches in temporal lobe epilepsy as a noninvasive diagnostic tool investigating large scale brain dynamics | Scientific Reports

  https://www.nature.com/articles/s41598-024-64870-3

  The method proposed in the present work may represent a potential tool for helping clinicians with diagnostics, which translates into the possibility of reducing the misinterpretation of EEG abnormalities by taking into account global brain activities. […] The present pipeline can be fully automated, requiring therefore minimal effort to the clinicians and the technical staff, that is the recording of a minimum of 5 min of resting state EEG. […] The present work does not aim at providing a tool to replace the fundamental knowledge and experience of a clinical expert. […] The present pipeline might be of important help also in the low-income countries where patients have difficulty accessing specialist care. […] In order to translate this pipeline to clinical practice, validation on multiple epilepsy and neurological populations is warranted.

• #3 Deep learning for the diagnosis of mesial temporal lobe epilepsy | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0282082

  The second step is to diagnose MTLE with the hippocampus as the epileptogenic area and predict the probability of the disease. […] The diagnostic accuracy for MTLE by AI was higher than that by physicians for both T2WI and FLAIR (T2, p = 0.0034; effect size 0.3917, FLAIR, p = 0.0006; effect size, 0.4147). […] AI diagnosis was superior in the cross tabulation (p0.001) as well. […] The diagnostic accuracy of the deep learning model for MTLE with the hippocampus as the epileptogenic area based on T2WI was 94.13% (left) and on FLAIR was 94.91% (right). […] AI focused on the color gradient of the area of interest for diagnosing the epileptogenic area in the hippocampus. […] We present a highly accurate deep learning-based AI program that can diagnose MTLE with the hippocampus as the epileptogenic area better than some board-certified neurosurgeons.

• #3

  https://link.springer.com/article/10.1007/s00259-020-05108-y

  The proposed method could accurately detect abnormal PoCs (AUC = 0.93), which is better than the JS-LR (AUC = 0.72). […] The proposed method had higher determination accuracy for both severe and mild abnormalities (94% and 85%, respectively) than physicians blinded (68% and 42%) to the clinical information or unblinded (75% and 59%). […] The proposed deep learning framework for 18F-FDG PET can accurately and efficiently localize epileptic foci and determine metabolic abnormality, which might be applied as a future computer-assisted diagnosis tool for epilepsy patients.

• #3 Diagnostic & Treatment Delay in Temporal Lobe Epilepsy

  https://practicalneurology.com/diseases-diagnoses/epilepsy-seizures/diagnostic-treatment-delay-in-temporal-lobe-epilepsy/31835/

  Avoiding delays in DREs is crucial because there are many health consequences associated with undertreated epilepsy including increased risk of sudden unexpected death in epilepsy (SUDEP), psychiatric comorbidities, motor vehicle and other traumatic accidents, and reduced quality of life. […] There are a variety of reasons for delays in identifying DRE and referring individuals to epilepsy centers. […] The ideal treatment goal for epilepsy includes complete seizure freedom and the absence of any side effects. […] Achieving this goal is often daunting in people with DRE. Appropriate and targeted treatment requires a multidisciplinary approach.

• #3 Silent, subtle and unseen: How seizures happen and why they’re hard to diagnose

  https://theconversation.com/silent-subtle-and-unseen-how-seizures-happen-and-why-theyre-hard-to-diagnose-184740

  Seizures associated with epilepsy, on the other hand, are unprovoked and often very difficult to predict. […] Because untreated seizures become more frequent and severe over time, it is not uncommon for epilepsy to begin with these relatively subtle focal seizures, then worsen as the seizures begin to involve more brain tissue, and eventually progress to convulsions. […] Recent studies have confirmed that delays in diagnosis are common among people who have epilepsy. Undoubtedly, this is because the early subtle and unusual symptoms are not well recognized by patients, families or medical professionals. […] However, even those evaluated for seizures dont always receive the correct diagnosis or treatment. Nearly two-thirds of those participating in the Human Epilepsy Project sought an initial seizure evaluation in an emergency department. About 90% were there only after their first convulsive seizure that is, after the seizure spread and now involved the full brain.

• #3 Diagnostic & Treatment Delay in Temporal Lobe Epilepsy

  https://practicalneurology.com/diseases-diagnoses/epilepsy-seizures/diagnostic-treatment-delay-in-temporal-lobe-epilepsy/31835/?c4src=top5

  Whenever doubt exists, the patient needs to be referred to a comprehensive epilepsy center for a consultation with an epileptologist. […] This case is an example of the considerable diagnostic delay in identification of DRE in people already diagnosed with epilepsy. […] Delay in identifying DRE leads to delays in referral to a surgical epilepsy center and multidisciplinary epilepsy management. […] Despite this standardized definition, there has not been an appreciable reduction in time to referral to tertiary epilepsy centers. […] Avoiding delays in DREs is crucial because there are many health consequences associated with undertreated epilepsy including increased risk of sudden unexpected death in epilepsy (SUDEP), psychiatric comorbidities, motor vehicle and other traumatic accidents, and reduced quality of life.

• #3 Temporal lobe epilepsy | Tidsskrift for Den norske legeforening

  https://tidsskriftet.no/en/2023/01/clinical-review/temporal-lobe-epilepsy

  The temporal lobes are the part of the brain most likely to give rise to epileptic seizures. […] All patients who have had a suspected epileptic seizure should undergo a thorough assessment. […] The aim of this article is to illustrate the varying manifestations of temporal lobe seizures, and to provide a reminder that epilepsy surgery can be a good treatment option for those who do not achieve adequate seizure control with medications. […] A thorough medical history usually raises suspicion of the diagnosis. […] Neurological examination is generally unremarkable, and standard electroencephalography (EEG) is either normal or reveals only non-specific abnormalities in around half of patients. […] Repeated recordings, possibly while the patient is sleep-deprived, increase the likelihood of pathological findings.

• #4 Localisation in focal epilepsy: a practical guide | Practical Neurology

  https://pn.bmj.com/content/21/6/481

  The type of aura can help to differentiate between seizures of mesiotemporal origin vs lateral neocortical origin. […] Seizures arising in the mesial temporal lobe may have the experiential aura described above, but also early autonomic phenomena such as flushing or tachycardia. […] Seizures tend to be longer that those arising from lateral temporal lobe, and they less commonly evolve to bilateral tonic-clonic seizures. […] Auras are less common in seizures arising from temporal neocortex, and often have auditory or vertiginous features. […] Temporal pole seizures tend to have earlier loss of consciousness and more commonly present with hypermotor features. […] Careful analysis of seizure semiology can help to localise seizures, which is particularly important when evaluating people for epilepsy surgery. […] Many seizure symptoms and signs have robust localising and lateralising value.

• #4 Deep learning for the diagnosis of mesial temporal lobe epilepsy | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0282082

  This study aimed to enable the automatic detection of the hippocampus and diagnose mesial temporal lobe epilepsy (MTLE) with the hippocampus as the epileptogenic area using artificial intelligence (AI). […] We compared the diagnostic accuracies of AI and neurosurgical physicians for MTLE with the hippocampus as the epileptogenic area. […] AI detected the hippocampi automatically and diagnosed MTLE with the hippocampus as the epileptogenic area on both T2-weighted imaging (T2WI) and fluid-attenuated inversion recovery (FLAIR) images. […] The diagnostic accuracies of AI based on T2WI and FLAIR data were 99% and 89%, respectively, and those of neurosurgeons based on T2WI and FLAIR data were 94% and 95%, respectively. […] The diagnostic accuracy of AI was statistically higher than that of board-certified neurosurgeons based on T2WI data (p = 0.00129).

• #4 Diagnostic & Treatment Delay in Temporal Lobe Epilepsy

  https://practicalneurology.com/diseases-diagnoses/epilepsy-seizures/diagnostic-treatment-delay-in-temporal-lobe-epilepsy/31835/?c4src=top5

  The average 20-year delay of referral to epilepsy centers can be improved. […] Despite the high global burden of epilepsy, there is often a delay in initial diagnosis, even in developed countries. […] Notably, on average there is a delay of more than 20 years between initial diagnosis and surgical management of people who are failed by optimal use of ASMs. […] This case demonstrates misdiagnosis of epilepsy at initial presentation that resulted in a 10-year treatment delay. Diagnostic delay of epilepsy following initial presentation is common. […] As can be inferred, individuals with nonconvulsive seizures experience greater delays than those with convulsive seizures. […] Avoiding misdiagnosis is important because untreated epilepsy negatively affects patients. […] A single negative EEG can be misleading because only approximately 39% of individuals have epileptiform discharges on EEG after their first unprovoked seizure.

• #4 Temporal lobe epilepsy | Tidsskrift for Den norske legeforening

  https://tidsskriftet.no/en/2023/01/clinical-review/temporal-lobe-epilepsy

  In a typical case, focal epileptiform activity is seen over the anterior temporal regions, often in combination with slow-wave activity. […] Magnetic resonance imaging (MRI) of the brain, preferably using a 3 Tesla scanner and an epilepsy protocol, reveals an epileptogenic lesion in around 70 % of this patient population. […] Temporal lobe epilepsy is easy to diagnose if the medical history, seizure characteristics, and EEG and MRI findings are typical. […] In the event of doubt, patients should be referred for diagnostic testing at a university hospital, for example the National Centre for Epilepsy in Oslo.

• #5 MRI-based deep learning can discriminate between temporal lobe epilepsy, Alzheimer’s disease, and healthy controls | Communications Medicine

  https://www.nature.com/articles/s43856-023-00262-4

  Radiological identification of temporal lobe epilepsy (TLE) is crucial for diagnosis and treatment planning. […] The identification of neuroimaging signs indicative of TLE is crucial during diagnostic evaluation since the presence of MRI abnormalities is commonly associated with a greater likelihood of surgical success. […] We hypothesized that 2D CNN optimized for TLE classification could leverage TLE whole brain atrophy patterns for disease classification. […] Our CNN models had a mean accuracy of 86.84% (SD=1.33%), mean precision of 0.77 (SD=0.03), a mean recall of 0.74 (SD=0.03), and an F1-score of 0.75 (SD=0.025) for disease prediction. […] We observed that a CNN model identified TLE vs. controls and TLE vs. AD at a statistically significant level independent of age. […] Importantly, the machine learning approach achieved high classification accuracy for TLE cases beyond the lesional status identified by human experts.

• #5 Diagnostic & Treatment Delay in Temporal Lobe Epilepsy

  https://practicalneurology.com/diseases-diagnoses/epilepsy-seizures/diagnostic-treatment-delay-in-temporal-lobe-epilepsy/31835/?c4src=top5

  Whenever doubt exists, the patient needs to be referred to a comprehensive epilepsy center for a consultation with an epileptologist. […] This case is an example of the considerable diagnostic delay in identification of DRE in people already diagnosed with epilepsy. […] Delay in identifying DRE leads to delays in referral to a surgical epilepsy center and multidisciplinary epilepsy management. […] Despite this standardized definition, there has not been an appreciable reduction in time to referral to tertiary epilepsy centers. […] Avoiding delays in DREs is crucial because there are many health consequences associated with undertreated epilepsy including increased risk of sudden unexpected death in epilepsy (SUDEP), psychiatric comorbidities, motor vehicle and other traumatic accidents, and reduced quality of life.

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