{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T05:59:18Z","timestamp":1789192758051,"version":"build-2803163510"},"reference-count":30,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2014,1,13]],"date-time":"2014-01-13T00:00:00Z","timestamp":1389571200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2014,2]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Secondary generalization of seizures has devastating consequences for patient safety and quality of life. The aim of this intracranial electroencephalography (ic<jats:styled-content style=\"fixed-case\">EEG<\/jats:styled-content>) study was to investigate the differences in onset and propagation patterns of temporal lobe seizures that remained focal versus those with secondary generalization, in order to better understand the mechanism of secondary generalization.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 39 seizures were analyzed in nine patients who met the following criteria: (1) ic<jats:styled-content style=\"fixed-case\">EEG<\/jats:styled-content>\u2010video monitoring with at least one secondarily generalized tonic\u2013clonic seizure (<jats:styled-content style=\"fixed-case\">GTCS<\/jats:styled-content>), (2) pathologically proven hippocampal sclerosis, and (3) no seizures for at least 1\u00a0year after anteromedial temporal lobe resection. Seizures were classified as focal or secondary generalized by behavioral analysis of video. Onset and propagation patterns were compared by analysis of ic<jats:styled-content style=\"fixed-case\">EEG<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We obtained data from 22 focal seizures without generalization (<jats:styled-content style=\"fixed-case\">FS<\/jats:styled-content>), and 17 <jats:styled-content style=\"fixed-case\">GTCS<\/jats:styled-content>. Seizure\u2010onset patterns did not differ between <jats:styled-content style=\"fixed-case\">FS<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">GTCS<\/jats:styled-content>, but there were differences in later propagation. All seizures started with low voltage fast activity, except for seven seizures in one patient (six <jats:styled-content style=\"fixed-case\">FS<\/jats:styled-content>, one <jats:styled-content style=\"fixed-case\">GTCS<\/jats:styled-content>), which started with sharply contoured theta activity. Fifteen of 39 seizures started from the hippocampus, and 24 seizures (including six seizures in a patient without hippocampal contacts) started from other medial temporal lobe areas. We observed involvement or more prominent activation of the posterior\u2010lateral temporal regions in <jats:styled-content style=\"fixed-case\">GTCS<\/jats:styled-content> prior to propagation to the other cortical regions, versus <jats:styled-content style=\"fixed-case\">FS<\/jats:styled-content>, which had no involvement or less prominent activation of the posterior lateral temporal cortex. Occipital contacts were not involved at the time of clinical secondary generalization.<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>The posterior\u2010lateral temporal cortex may serve as an important \u201cgateway\u201d controlling propagation of medial temporal lobe seizures to other cortical regions. Identifying the mechanisms of secondary generalization of focal seizures could lead to improved treatments to confine seizure spread.<\/jats:p><\/jats:sec>","DOI":"10.1111\/epi.12505","type":"journal-article","created":{"date-parts":[[2014,1,13]],"date-time":"2014-01-13T23:02:13Z","timestamp":1389654133000},"page":"289-295","source":"Crossref","is-referenced-by-count":48,"title":["Ictal spread of medial temporal lobe seizures with and without secondary generalization: An intracranial electroencephalography analysis"],"prefix":"10.1111","volume":"55","author":[{"given":"Ji Yeoun","family":"Yoo","sequence":"first","affiliation":[{"name":"Department of Neurology Yale University School of Medicine New Haven Connecticut U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pue","family":"Farooque","sequence":"additional","affiliation":[{"name":"Department of Neurology Yale University School of Medicine New Haven Connecticut 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