Abstracts

Rationale: The ictal phenomena of TLE can be divided into broad categories such as motor, sensory, autonomic, experiential, emotional, cognitive, and psychiatric. Experiential, emotional manifestations are most likely to be associated with lateralization of the seizure foci to the nondominant hemisphere. The aim of this study was to investigate the frequency of ictal religious experiences and its role in lateralization and surgical outcomes of temporal lobe seizures. Methods: Patients who were diagnosed with medically refractory TLE and underwent standard anterior temporal lobectomy (ATL) between the years of 2000 and 2013 at Gazi University Medical Faculty Epilepsy Center were retrospectively evaluated. 358 patients aged over 18 years were included in the study. We observed 11 patients with TLE who had ictal religious speech.Then we compared the clinical features and the surgical outcomes of these patients with 11 TLE patients who had ictal identifiable speech with no religious content. A multidisciplinary presurgical evaluation was performed, which included brain MRI with TLE protocol, long term video EEG monitoring, Florodeoxyglucose positron emission tomography(FDG)-PET, WADA or fMRI and neuropsychological tests. Results: We observed 11(3,07%) patients with TLE who had ictal religious speech(IRS). IRS occurred in 18% of the patients with an epileptogenic focus in the dominant hemisphere and in 82% of patients with an epileptogenic zone in the nondominant hemisphere (p = 0.03). There was no difference with respect to gender, type of seizures, duration of seizure, history of febril convulsions, MRI, FDG-PET scan and histopathological findings of the patients. When we compared the clinical features between two groups there was a difference only in the seizure type. CPS was observed significantly higher in the IRS group. (p=0.04) Finally, IRS were significantly associated with a good seizure outcome (p=0.02). Conclusions: During temporal lobe seizures, ictal speech manifestations can frequently occur although identifiable speech is not common and 83% of those had their seizures from the nondominant side. Literature surveys have revealed that between 0.4% and 3.1% of partial epilepsy patients had ictal religious experiences. However, interestingly, our patients who had ictal identifiable speech with religious theme, always repeated the same words. This study shows that IRS is rare in TLE and can provide an excellent clinical tool for lateralization of seizure onset and surgical outcome.