{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T11:23:45Z","timestamp":1787397825212,"version":"build-2736575974"},"reference-count":40,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T00:00:00Z","timestamp":1778889600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T00:00:00Z","timestamp":1778889600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epileptic Disorders"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Temporal lobe epilepsy (TLE) accounts for 50%\u201370% of cases referred for epilepsy surgery. This study was designed to evaluate the distribution of the five hallmark seizure features\u2014antecedent, aura, arrest, automatisms, and amnesia\u2014considered collectively as the \u201c5As,\u201d in individuals with temporal lobe epilepsy. We also analyzed the prognostic significance of 5As, if any, in predicting surgical outcome in drug\u2010resistant TLE patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We included 684 patients who underwent clinical evaluation, neuropsychological assessment, high\u2010resolution MRI, and VEEG monitoring followed by standard anterior temporal lobectomy between January 2009 and December 2018. Patients were followed up at 3, 12, and 36\u2009months, and yearly thereafter after surgery. Outcomes were classified as \u201cgood\u201d if patients remained seizure and aura\u2010free, irrespective of medication, and \u201cpoor\u201d if seizures of any type recurred post\u2010operatively. The predictors determining the outcomes were analyzed using logistic regression, and Kaplan\u2013Meier curves assessed the long\u2010term seizure\u2010free survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 8456 VEEGs were done during this time period. Of them, 1747 were focal epilepsies; TLE were 1068, and surgical management was opted in 709 of them, of whom 684 patients formed this study cohort; 93.7% exhibited behavioral arrest, 88.6% had automatisms, 86.7% experienced amnesia, 74.6% reported auras, and 63.6% had antecedents (initial precipitating injury). All the classic semiological features (5 As) were present in 37.7%. At last follow\u2010up, 47.8% had a good outcome at a mean follow\u2010up of 75.6\u2009months (maximum 14\u2009years). Febrile seizures were associated with better seizure outcome (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.021). Encephalitis (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.026) and behavioral arrest (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.006) were associated with poor outcome. No significant association was found between the presence of aura(s), automatisms, or amnesia with post\u2010operative outcome.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A history of febrile seizures was linked to better post\u2010operative outcomes, whereas encephalitis and behavioral arrest were associated with poorer prognosis. The presence or absence of any combination of classic features (5As) did not significantly affect the success of anterior temporal lobectomy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/epd2.70285","type":"journal-article","created":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T11:20:02Z","timestamp":1778930402000},"page":"1221-1235","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Does classical semiology (\u201c5As\u201d) predict post\u2010operative seizure outcome in patients with temporal lobe epilepsy?"],"prefix":"10.1002","volume":"28","author":[{"given":"Ashalatha","family":"Radhakrishnan","sequence":"first","affiliation":[{"name":"R Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology  Thiruvananthapuram Kerala India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8140-790X","authenticated-orcid":false,"given":"Radhika Lotlikar","family":"Sanjay","sequence":"additional","affiliation":[{"name":"R Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology  Thiruvananthapuram Kerala India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3180-2803","authenticated-orcid":false,"given":"Gurumurthy","family":"Bharanidharan","sequence":"additional","affiliation":[{"name":"R Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology  Thiruvananthapuram Kerala India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ankith","family":"Bhasi","sequence":"additional","affiliation":[{"name":"R Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology  Thiruvananthapuram Kerala India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Swathy","family":"Krishnan","sequence":"additional","affiliation":[{"name":"R Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology  Thiruvananthapuram Kerala India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8083-4264","authenticated-orcid":false,"given":"Kiren","family":"Koshy","sequence":"additional","affiliation":[{"name":"R Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology  Thiruvananthapuram Kerala India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramshekhar N.","family":"Menon","sequence":"additional","affiliation":[{"name":"R Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology  Thiruvananthapuram Kerala India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Preetha","family":"Govind","sequence":"additional","affiliation":[{"name":"R Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology  Thiruvananthapuram Kerala India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Vilanilam","sequence":"additional","affiliation":[{"name":"R Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology  Thiruvananthapuram Kerala India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bejoy","family":"Thomas","sequence":"additional","affiliation":[{"name":"R Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology  Thiruvananthapuram Kerala India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chandrasekharan","family":"Kesavadas","sequence":"additional","affiliation":[{"name":"R Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology  Thiruvananthapuram Kerala India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,16]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1155\/2012\/630853"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.51.5.1256"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1155\/2012\/751510"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.73.5.486"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2022.833293"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00701\u2010017\u20103152\u20103"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1155\/2012\/195073"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13311\u2010014\u20100263\u20104"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1155\/2012\/342928"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/15357597241279746"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/epd2.70172"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.0013\u20109580.2004.48503"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2024.110173"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.3390\/brainsci11091182"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eplepsyres.2018.08.010"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.4103\/abr.abr_25_19"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2010.08.034"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2008.06.022"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1177\/15357597211032562"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.seizure.2021.11.017"},{"issue":"139","key":"e_1_2_13_22_1","first-page":"456","article-title":"Complex partial seizures: the localization value of automatisms","volume":"25","author":"Bertol V","year":"1997","journal-title":"Rev Neurol"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/0013-4694(85)91028-4"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/0278-2626(85)90022-3"},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.17024"},{"key":"e_1_2_13_26_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0206095"},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.seizure.2006.05.003"},{"issue":"1","key":"e_1_2_13_28_1","article-title":"Role of electroencephalography in presurgical evaluation of temporal lobe epilepsy","volume":"2012","author":"Raghavendra S","year":"2012","journal-title":"Epilepsy Res Treat"},{"key":"e_1_2_13_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1059-1311(03)00069-4"},{"key":"e_1_2_13_30_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100041\u20101731474"},{"key":"e_1_2_13_31_1","doi-asserted-by":"publisher","DOI":"10.21037\/apm\u201020\u20101870"},{"key":"e_1_2_13_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2008.11.024"},{"issue":"4","key":"e_1_2_13_33_1","first-page":"305","article-title":"Epilepsy and psychiatric disorders: epidemiological data","volume":"154","author":"Vuilleumier P","year":"1998","journal-title":"Rev Neurol (Paris)"},{"key":"e_1_2_13_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2018.06.046"},{"key":"e_1_2_13_35_1","doi-asserted-by":"publisher","DOI":"10.3988\/jcn.2021.17.2.176"},{"key":"e_1_2_13_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eplepsyres.2007.01.003"},{"key":"e_1_2_13_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eurpsy.2017.01.549"},{"key":"e_1_2_13_38_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2021.775781"},{"key":"e_1_2_13_39_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.410410516"},{"key":"e_1_2_13_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.seizure.2006.10.008"},{"key":"e_1_2_13_41_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awm108"}],"container-title":["Epileptic Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/epd2.70285","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/epd2.70285","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/epd2.70285","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T10:49:06Z","timestamp":1787395746000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/epd2.70285"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,16]]},"references-count":40,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1002\/epd2.70285"],"URL":"https:\/\/doi.org\/10.1002\/epd2.70285","archive":["Portico"],"relation":{},"ISSN":["1294-9361","1950-6945"],"issn-type":[{"value":"1294-9361","type":"print"},{"value":"1950-6945","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,16]]},"assertion":[{"value":"2026-01-31","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-08","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-16","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}