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NEUROLOGY 1994;44:1074
© 1994 American Academy of Neurology

Late-onset drop attacks in temporal lobe epilepsy

A reevaluation of the concept of temporal lobe syncope

A. Gambardella, MD, D. C. Reutens, MD, FRACP, F. Andermann, MD, FRCP(C), F. Cendes, MD, P. Gloor, MD, PhD, F. Dubeau, MD, FRCP(C) and and A. Olivier, MD, PhD, FRCS(C)

Department of Neurology and Neurosurgery, McGill University and the Montreal Neurological Hospital and Institute, Montreal, PQ, Canada.

We report the clinical, radiologic, and EEG features of six patients with temporal lobe drop attacks (TLDA), all of whom underwent temporal resection. Postoperative follow-up of at least 1 year was available in all. TLDA were never the first manifestation but followed the onset of epilepsy after a long delay ranging from 7 to 43 years (mean, 24.4 years). Seizures were of unilateral temporal origin. In one patient, stereo EEG recording of TLDA showed rapid spread of the ictal discharge away from the temporal lobe in less than 1 second. Postoperatively, three patients were seizure free; one has had no TLDA but experiences sporadic auras; another, despite a reduction of more than 50%, continues to have complex partial seizures and TLDA; and the sixth has had sporadic secondarily generalized seizures upon reduction of antiepileptic medication. In conclusion, drop attacks may occur in temporal lobe epilepsy, usually long after the onset of epilepsy. They lead to increased disability and suggest a rapid spread of the ictal discharge and possible involvement of the pontine reticular formation rather than the presence of bitemporal foci or an extratemporal origin.

Address correspondence and reprint requests to Dr. Frederick Andermann, Montreal Neurological Hospital and Institute, 3801 University Street, Montreal, PQ, Canada H3A 2B4.

Received November 16,1993. Accepted for publication in final form December 27, 1993.




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