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Baldini S, Duma GM, Danieli A, Antoniazzi L, Vettorel A, Baggio M, Da Rold M, Bonanni P. Electroencephalographic microstates as a potential neurophysiological marker differentiating bilateral from unilateral temporal lobe epilepsy. Epilepsia 2024; 65:664-674. [PMID: 38265624 DOI: 10.1111/epi.17893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 01/25/2024]
Abstract
OBJECTIVE Electroencephalographic (EEG) microstate abnormalities have been documented in different neurological disorders. We aimed to assess whether EEG microstates are altered also in patients with temporal epilepsy (TLE) and whether they show different activations in patients with unilateral TLE (UTLE) and bilateral TLE (BTLE). METHODS Nineteen patients with UTLE, 12 with BTLE, and 15 healthy controls were enrolled. Resting state high-density electroencephalography (128 channels) was recorded for 15 min with closed eyes. We obtained a set of stable scalp maps representing the EEG activity, named microstates, from which we acquired the following variables: global explained variance (GEV), mean duration (MD), time coverage (TC), and frequency of occurrence (FO). Two-way repeated measures analysis of variance was used to compare groups, and Spearman correlation was performed to study the maps in association with the clinical and neuropsychological data. RESULTS Patients with BTLE and UTLE showed differences in most of the parameters (GEV, MD, TC, FO) of the four microstate maps (A-D) compared to controls. Patients with BTLE showed a significant increase in all parameters for the microstates in Map-A and a decrease in Map-D compared to UTLE and controls. We observed a correlation between Map-A, disease duration, and spatial short-term memory, whereas microstate Map-D was correlated with the global intelligence score and short-term memory performance. SIGNIFICANCE A global alteration of the neural dynamics was observed in patients with TLE compared to controls. A different pattern of EEG microstate abnormalities was identified in BTLE compared to UTLE, which might represent a distinctive biomarker.
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Affiliation(s)
- Sara Baldini
- Clinical Unit of Neurology, Department of Medical Sciences, University Hospital and Health Services of Trieste, University of Trieste, Trieste, Italy
| | - Gian Marco Duma
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Eugenio Medea, Epilepsy Unit, Conegliano, TV, Italy
| | - Alberto Danieli
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Eugenio Medea, Epilepsy Unit, Conegliano, TV, Italy
| | - Lisa Antoniazzi
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Eugenio Medea, Epilepsy Unit, Conegliano, TV, Italy
| | | | - Martina Baggio
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Eugenio Medea, Epilepsy Unit, Conegliano, TV, Italy
| | | | - Paolo Bonanni
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Eugenio Medea, Epilepsy Unit, Conegliano, TV, Italy
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Baggio M, Danieli A, Crescentini C, Duma GM, Da Rold M, Baldini S, Pascoli E, Antoniazzi L, Vestri A, Fabbro F, Bonanni P. Neuropsychological Functioning in Bilateral versus Unilateral Temporal Lobe Epilepsy. Brain Sci 2023; 13:1526. [PMID: 38002486 PMCID: PMC10669306 DOI: 10.3390/brainsci13111526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/12/2023] [Accepted: 10/26/2023] [Indexed: 11/26/2023] Open
Abstract
Although relatively specific anatomo-electro-clinical features of temporal lobe epilepsy (TLE) with bilateral ictal involvement (bitemporal epilepsy-BTLE) have been described, differentiating between BTLE and unilateral TLE (UTLE) remains challenging. Surgery is often the treatment of choice for drug-resistant UTLE, whereas its use is more controversial in BTLE. It is currently unclear whether neuropsychological assessment can contribute to the differential diagnosis. We retrospectively reviewed the neuropsychological evaluation of 46 consecutive patients with refractory TLE. Eighteen patients were diagnosed with BTLE on the basis of ictal electro-clinical data, in particular a video EEG recording of at least one seizure simultaneously involving the two temporal lobes without the possibility of lateralizing its onset or at least two different seizures independently arising from the two temporal lobes. Twenty-eight patients were classified as UTLE. Presurgery evaluation data were used in this study. Compared with UTLE, BTLE was associated with a lower intelligence quotient (IQ) and more severe impairment in long-term memory, the latter remaining significant even after controlling for IQ. No significant differences were found between right and left UTLE. In conclusion, BTLE and UTLE are associated with relatively distinct neuropsychological profiles, further supporting their classification as different disorders within the TLE spectrum.
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Affiliation(s)
- Martina Baggio
- Epilepsy and Clinical Neurophysiology Unit, Scientific Institute, IRCCS E. Medea, Via Costa Alta 37, 31015 Conegliano, Italy; (M.B.); (A.D.); (A.V.); (P.B.)
| | - Alberto Danieli
- Epilepsy and Clinical Neurophysiology Unit, Scientific Institute, IRCCS E. Medea, Via Costa Alta 37, 31015 Conegliano, Italy; (M.B.); (A.D.); (A.V.); (P.B.)
| | - Cristiano Crescentini
- Department of Languages and Literatures, Communication, Education and Society, University of Udine, 33100 Udine, Italy
| | - Gian Marco Duma
- Epilepsy and Clinical Neurophysiology Unit, Scientific Institute, IRCCS E. Medea, Via Costa Alta 37, 31015 Conegliano, Italy; (M.B.); (A.D.); (A.V.); (P.B.)
| | - Martina Da Rold
- Aulss 2 Marca Trevigiana, Piazzale Dell’Ospedale, 1, 31100 Treviso, Italy
| | - Sara Baldini
- Clinical Unit of Neurology, Department of Medical Sciences, University Hospital and Health Services of Trieste, University of Trieste, 34129 Trieste, Italy
| | - Eric Pascoli
- Department of Medicine—DAME, University of Udine, 33100 Udine, Italy
| | - Lisa Antoniazzi
- Epilepsy and Clinical Neurophysiology Unit, Scientific Institute, IRCCS E. Medea, Via Costa Alta 37, 31015 Conegliano, Italy; (M.B.); (A.D.); (A.V.); (P.B.)
| | - Alec Vestri
- Epilepsy and Clinical Neurophysiology Unit, Scientific Institute, IRCCS E. Medea, Via Costa Alta 37, 31015 Conegliano, Italy; (M.B.); (A.D.); (A.V.); (P.B.)
| | - Franco Fabbro
- Department of Languages and Literatures, Communication, Education and Society, University of Udine, 33100 Udine, Italy
- PERCRO Perceptual Robotics Laboratory, Scuola Superiore Sant’Anna, 56010 Pisa, Italy
| | - Paolo Bonanni
- Epilepsy and Clinical Neurophysiology Unit, Scientific Institute, IRCCS E. Medea, Via Costa Alta 37, 31015 Conegliano, Italy; (M.B.); (A.D.); (A.V.); (P.B.)
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Jamali-Dinan SS, Soltanian-Zadeh H, Bowyer SM, Almohri H, Dehghani H, Elisevich K, Nazem-Zadeh MR. A Combination of Particle Swarm Optimization and Minkowski Weighted K-Means Clustering: Application in Lateralization of Temporal Lobe Epilepsy. Brain Topogr 2020; 33:519-532. [PMID: 32347472 DOI: 10.1007/s10548-020-00770-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 04/07/2020] [Indexed: 11/30/2022]
Abstract
K-Means is one of the most popular clustering algorithms that partitions observations into nonoverlapping subgroups based on a predefined similarity metric. Its drawbacks include a sensitivity to noisy features and a dependency of its resulting clusters upon the initial selection of cluster centroids resulting in the algorithm converging to local optima. Minkowski weighted K-Means (MWK-Means) addresses the issue of sensitivity to noisy features, but is sensitive to the initialization of clusters, and so the algorithm may similarly converge to local optima. Particle Swarm Optimization (PSO) uses a globalized search method to solve this issue. We present a hybrid Particle Swarm Optimization (PSO) + MWK-Means clustering algorithm to address all the above problems in a single framework, while maintaining benefits of PSO and MWK Means methods. This study investigated the utility of this approach in lateralizing the epileptogenic hemisphere for temporal lobe epilepsy (TLE) cases using magnetoencephalography (MEG) coherence source imaging (CSI) and diffusion tensor imaging (DTI). Using MEG-CSI, we analyzed preoperative resting state MEG data from 17 adults TLE patients with Engel class I outcomes to determine coherence at 54 anatomical sites and compared the results with 17 age- and gender-matched controls. Fiber-tracking was performed through the same anatomical sites using DTI data. Indices of both MEG coherence and DTI nodal degree were calculated. A PSO + MWK-Means clustering algorithm was applied to identify the side of temporal lobe epileptogenicity and distinguish between normal and TLE cases. The PSO module was aimed at identifying initial cluster centroids and assigning initial feature weights to cluster centroids and, hence, transferring to the MWK-Means module for the final optimal clustering solution. We demonstrated improvements with the use of the PSO + MWK-Means clustering algorithm compared to that of K-Means and MWK-Means independently. PSO + MWK-Means was able to successfully distinguish between normal and TLE in 97.2% and 82.3% of cases for DTI and MEG data, respectively. It also lateralized left and right TLE in 82.3% and 93.6% of cases for DTI and MEG data, respectively. The proposed optimization and clustering methodology for MEG and DTI features, as they relate to focal epileptogenicity, would enhance the identification of the TLE laterality in cases of unilateral epileptogenicity.
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Affiliation(s)
| | - Hamid Soltanian-Zadeh
- Control and Intelligent Processing Center of Excellence (CIPCE), School of Electrical and Computer Engineering, University of Tehran, Tehran, Iran.,Research Administration, Radiology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Susan M Bowyer
- Neurology Departments, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Haidar Almohri
- Department of Industrial and Systems Engineering, Wayne State University, Detroit, MI, USA
| | - Hamed Dehghani
- Medical Physics, and Biomedical Engineering Department, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Kost Elisevich
- Department of Clinical Neurosciences, Spectrum Health, College of Human Medicine, Michigan State University, Grand Rapids, MI, 49503, USA
| | - Mohammad-Reza Nazem-Zadeh
- Medical Physics, and Biomedical Engineering Department, Tehran University of Medical Sciences (TUMS), Tehran, Iran. .,Research Center for Molecular and Cellular Imaging, Research Center for Science and Technology in Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
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Subota A, Khan S, Josephson CB, Manji S, Lukmanji S, Roach P, Wiebe S, Buchhalter J, Federico P, Teskey GC, Lorenzetti DL, Jetté N. Signs and symptoms of the postictal period in epilepsy: A systematic review and meta-analysis. Epilepsy Behav 2019; 94:243-251. [PMID: 30978637 DOI: 10.1016/j.yebeh.2019.03.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 03/08/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The postictal period has many physical, behavioral, and cognitive manifestations associated with it. These signs and symptoms are common, can be quite debilitating, and can have a continued impact long after the seizure has ended. The purpose of this systematic review was to quantify the occurrence of postictal signs and symptoms, along with their frequency and duration in persons with epilepsy. METHODS Cochrane Database of Systematic Reviews, CINAHL, EMBASE, MEDLINE, PsycINFO, Web of Science, and Scopus were searched from inception to November 29, 2017. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting standards were followed. Search terms included subject headings and text words such as convulsion, epilepsy, seizure, postictal, post seizure, seizure recovery, seizure end, Todd's paresis, and Todd's paralysis. Standardized forms were used to collect various study variables. Abstract and full-text review, data abstraction, and quality assessment were all done in duplicate. Study heterogeneity was assessed using the I-squared test, and a random effects model was used to determine estimates. Publication bias was evaluated using funnel plots. RESULTS From 7811 abstracts reviewed, 78 articles met eligibility criteria, with 31 postictal manifestations (signs and/or symptoms) described and 45 studies included in the meta-analysis. The majority of studies described postictal headaches, migraines, and psychoses, with mean weighted frequency of 33.0% [95% confidence interval (CI) 26.0-40.0], 16.0% [95% CI 10.0-22.0], and 4.0% [95% CI 2.0-5.0], respectively. The mean weighted proportions of manifestations ranged from 0.5% (subacute postictal aggression) to 96.2% (postictal unresponsiveness) with symptom duration usually lasting <24 h but up to 2 months for physical and cognitive/behavioral symptoms respectively. SIGNIFICANCE Examining data on the various signs and symptoms of the postictal period will have practical applications for physicians by raising their awareness about these manifestations and informing them about the importance of optimizing their prevention and treatment in epilepsy.
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Affiliation(s)
- Ann Subota
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 1195 1403-29 Street, NW Calgary, AB T2N 2T9, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D10 - 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
| | - Sundus Khan
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 1195 1403-29 Street, NW Calgary, AB T2N 2T9, Canada
| | - Colin B Josephson
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 1195 1403-29 Street, NW Calgary, AB T2N 2T9, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D10 - 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; Hotchkiss Brain Institute, University of Calgary, Room 1A10 - 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; O'Brien Institute of Public Health, University of Calgary, 3rd Floor TRW Building 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
| | - Sofiya Manji
- Hotchkiss Brain Institute, University of Calgary, Room 1A10 - 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - Sara Lukmanji
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 1195 1403-29 Street, NW Calgary, AB T2N 2T9, Canada; Hotchkiss Brain Institute, University of Calgary, Room 1A10 - 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - Pamela Roach
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 1195 1403-29 Street, NW Calgary, AB T2N 2T9, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D10 - 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; Hotchkiss Brain Institute, University of Calgary, Room 1A10 - 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - Samuel Wiebe
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 1195 1403-29 Street, NW Calgary, AB T2N 2T9, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D10 - 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; Hotchkiss Brain Institute, University of Calgary, Room 1A10 - 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; O'Brien Institute of Public Health, University of Calgary, 3rd Floor TRW Building 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
| | - Jeffrey Buchhalter
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 1195 1403-29 Street, NW Calgary, AB T2N 2T9, Canada; The Alberta Children's Hospital Research Institute, Calgary, 293 - 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - Paolo Federico
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 1195 1403-29 Street, NW Calgary, AB T2N 2T9, Canada; Hotchkiss Brain Institute, University of Calgary, Room 1A10 - 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - G Campbell Teskey
- Hotchkiss Brain Institute, University of Calgary, Room 1A10 - 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; Department of Cell Biology and Anatomy, University of Calgary, HMRB 212 - 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - Diane L Lorenzetti
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D10 - 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; Health Sciences Library, University of Calgary, 1450 - 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - Nathalie Jetté
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 1195 1403-29 Street, NW Calgary, AB T2N 2T9, Canada; Icahn School of Medicine at Mount Sinai, Department of Neurology, One Gustave L. Levy Place, Box 1137, New York, NY 10029, USA; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D10 - 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; Hotchkiss Brain Institute, University of Calgary, Room 1A10 - 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada.
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Nazem-Zadeh MR, Elisevich K, Air EL, Schwalb JM, Divine G, Kaur M, Wasade VS, Mahmoudi F, Shokri S, Bagher-Ebadian H, Soltanian-Zadeh H. DTI-based response-driven modeling of mTLE laterality. NEUROIMAGE-CLINICAL 2015; 11:694-706. [PMID: 27330966 PMCID: PMC4900487 DOI: 10.1016/j.nicl.2015.10.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 10/25/2015] [Accepted: 10/27/2015] [Indexed: 12/30/2022]
Abstract
Purpose To develop lateralization models for distinguishing between unilateral and bilateral mesial temporal lobe epilepsy (mTLE) and determining laterality in cases of unilateral mTLE. Background mTLE is the most common form of medically refractory focal epilepsy. Many mTLE patients fail to demonstrate an unambiguous unilateral ictal onset. Intracranial EEG (icEEG) monitoring can be performed to establish whether the ictal origin is unilateral or truly bilateral with independent bitemporal ictal origin. However, because of the expense and risk of intracranial electrode placement, much research has been done to determine if the need for icEEG can be obviated with noninvasive neuroimaging methods, such as diffusion tensor imaging (DTI). Methods Fractional anisotropy (FA) was used to quantify microstructural changes reflected in the diffusivity properties of the corpus callosum, cingulum, and fornix, in a retrospective cohort of 31 patients confirmed to have unilateral (n = 24) or bilateral (n = 7) mTLE. All unilateral mTLE patients underwent resection with an Engel class I outcome. Eleven were reported to have hippocampal sclerosis on pathological analysis; nine had undergone prior icEEG. The bilateral mTLE patients had undergone icEEG demonstrating independent epileptiform activity in both right and left hemispheres. Twenty-three nonepileptic subjects were included as controls. Results In cases of right mTLE, FA showed significant differences from control in all callosal subregions, in both left and right superior cingulate subregions, and in forniceal crura. Comparison of right and left mTLE cases showed significant differences in FA of callosal genu, rostral body, and splenium and the right posteroinferior and superior cingulate subregions. In cases of left mTLE, FA showed significant differences from control only in the callosal isthmus. Significant differences in FA were identified when cases of right mTLE were compared with bilateral mTLE cases in the rostral and midbody callosal subregions and isthmus. Based on 11 FA measurements in the cingulate, callosal and forniceal subregions, a response-driven lateralization model successfully differentiated all cases (n = 54) into groups of unilateral right (n = 12), unilateral left (n = 12), and bilateral mTLE (n = 7), and nonepileptic control (23). Conclusion The proposed response-driven DTI biomarker is intended to lessen diagnostic ambiguity of laterality in cases of mTLE and help optimize selection of surgical candidates. Application of this model shows promise in reducing the need for invasive icEEG in prospective cases. Develop response-driven lateralization model using diffusion tensor imaging Distinguish between unilateral and bilateral mesial temporal lobe epilepsy (mTLE) Determine or lessen diagnostic ambiguity of laterality in cases of unilateral mTLE Optimize selection of surgical candidates Reduction of the need for intracranial EEG
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Affiliation(s)
| | - Kost Elisevich
- Department of Clinical Neurosciences, Spectrum Health Medical Group, Division of Neurosurgery, Michigan State University, Grand Rapids, MI 49503, USA
| | - Ellen L Air
- Neurosurgery Department, Henry Ford Health System, Detroit, MI 48202, USA.
| | - Jason M Schwalb
- Neurosurgery Department, Henry Ford Health System, Detroit, MI 48202, USA.
| | - George Divine
- Public Health Sciences Department, Henry Ford Health System, Detroit, MI 48202, USA.
| | - Manpreet Kaur
- Neurosurgery Department, Henry Ford Health System, Detroit, MI 48202, USA.
| | | | - Fariborz Mahmoudi
- Radiology and Research Administration Department, Henry Ford Health System, Detroit, MI 48202, USA; Computer and IT engineering Faculty, Islamic Azad University, Qazvin Branch, Iran.
| | - Saeed Shokri
- Radiology and Research Administration Department, Henry Ford Health System, Detroit, MI 48202, USA; School of Computer Science, Wayne State University, Detroit, MI 48202, USA.
| | - Hassan Bagher-Ebadian
- Radiology and Research Administration Department, Henry Ford Health System, Detroit, MI 48202, USA; Neurology Department, Henry Ford Health System, Detroit, MI 48202, USA.
| | - Hamid Soltanian-Zadeh
- Radiology and Research Administration Department, Henry Ford Health System, Detroit, MI 48202, USA; Control and Intelligent Processing Center of Excellence (CIPCE), School of Electrical and Computer, University of Tehran, Tehran, Iran.
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Didato G, Chiesa V, Villani F, Pelliccia V, Deleo F, Gozzo F, Canevini MP, Mai R, Spreafico R, Cossu M, Tassi L. Bitemporal epilepsy: A specific anatomo-electro-clinical phenotype in the temporal lobe epilepsy spectrum. Seizure 2015; 31:112-9. [DOI: 10.1016/j.seizure.2015.07.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 07/15/2015] [Accepted: 07/16/2015] [Indexed: 10/23/2022] Open
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