Ask The Experts Webinar On Demand: From Seizure Semiology to SEEG Hypothesis: Navigating Challenges and Caveats in Temporal Lobe Epilepsy Surgery Planning-Recording: ATEW From Seizure Semiology to SEEG Hypothesis: Navigating Challenges and Caveats in Temporal Lobe Epilepsy Surgery Planning

Recording: ATEW From Seizure Semiology to SEEG Hypothesis: Navigating Challenges and Caveats in Temporal Lobe Epilepsy Surgery Planning

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Video Summary

This webinar, hosted by Dr. Ruba Ramadani and featuring experts Dr. Fabrice Bartholomew and Dr. Jay Singh, explored the role of seizure semiology in planning stereoelectroencephalography (SEEG) for temporal lobe epilepsy surgery. The discussion emphasized that seizure semiology—patient-reported and observed seizure behaviors—is crucial for forming hypotheses about epileptogenic zones, especially in drug-resistant temporal lobe epilepsy.<br /><br />Despite advances in imaging and scalp EEG, semiology remains a highly valuable tool for lateralizing and localizing seizures, with about 70% effectiveness compared to other phase one data. The temporal lobe’s complex cytoarchitecture and connectivity contribute to diverse and evolving semiology patterns across lifespans and seizure propagation networks. Semiology elements such as auras (e.g., déjà vu), automatisms, and emotional responses reflect activation of specific brain networks, including the entorhinal cortex, insula, and opercular regions.<br /><br />Presenters underscored analyzing semiology over the seizure’s temporal progression and considering patterns rather than isolated signs to improve localization accuracy. Variants of temporal lobe epilepsy (mesial, lateral, temporal plus) show differing semiology and surgical implications. SEEG helps differentiate epileptogenic from propagation zones, guiding tailored surgeries that consider individualized brain network involvement.<br /><br />Case studies illustrated how semiology combined with other data informs SEEG implantation strategies, enhancing identification of seizure onset zones and potential extratemporal involvement. The importance of environmental context, ictal assessment standards, and ongoing integration of network neuroscience into semiology interpretation was stressed. Q&A addressed bi-temporal sampling criteria and the limited lateralizing value of ictal hearing loss. Overall, the webinar highlighted the indispensable, evolving role of detailed semiology analysis in optimizing SEEG and surgical planning in temporal lobe epilepsy.

Keywords

seizure semiology

stereoelectroencephalography (SEEG)

temporal lobe epilepsy

epileptogenic zones

drug-resistant epilepsy

auras

automatisms

brain networks

surgical planning

ictal assessment