Clinical neurophysiology practice · 2026
Direct cortical stimulation-evoked symptoms in the human temporal pole: a cohort study.
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Novitskaya Yulia, Schulze-Bonhage Andreas
Аннотация
OBJECTIVE: The temporal pole is a part of temporolimbic networks and may contribute to seizure generation in temporal lobe epilepsy. Direct cortical stimulation (DCS) during invasive presurgical evaluation in epilepsy patients provides information about its functional organization.
METHODS: We retrospectively analyzed DCS data from epilepsy patients at a tertiary center between 2012 and 2025. Patients with at least one temporopolar DCS session were included. Stimulation-induced symptoms were categorized by modality and frequency.
RESULTS: Fifty patients (58% male, median age 33 years) underwent temporopolar DCS, comprising 157 stimulation trials. Overall, 66% of patients reported at least one symptom across a broad range of modalities. Sensory and motor manifestations were most frequent (75%). Although much less common (24%), cognitive, emotional, and visceral symptoms were significantly more likely to resemble patients' habitual seizure semiology (GLMM, OR = 13.0, 95% CI 2.42-69.7, p = 0.003). Thirteen patients reported ipsilateral painful facial sensations, likely reflecting activation of trigeminal sensory pathways due to current spread near the skull base.
CONCLUSIONS: Temporopolar DCS elicits heterogeneous symptoms, supporting its role as an integrative network node rather than a region with distinct stimulation-induced semiology.
SIGNIFICANCE: The findings limit the localizing value of temporopolar DCS responses in presurgical evaluation.
METHODS: We retrospectively analyzed DCS data from epilepsy patients at a tertiary center between 2012 and 2025. Patients with at least one temporopolar DCS session were included. Stimulation-induced symptoms were categorized by modality and frequency.
RESULTS: Fifty patients (58% male, median age 33 years) underwent temporopolar DCS, comprising 157 stimulation trials. Overall, 66% of patients reported at least one symptom across a broad range of modalities. Sensory and motor manifestations were most frequent (75%). Although much less common (24%), cognitive, emotional, and visceral symptoms were significantly more likely to resemble patients' habitual seizure semiology (GLMM, OR = 13.0, 95% CI 2.42-69.7, p = 0.003). Thirteen patients reported ipsilateral painful facial sensations, likely reflecting activation of trigeminal sensory pathways due to current spread near the skull base.
CONCLUSIONS: Temporopolar DCS elicits heterogeneous symptoms, supporting its role as an integrative network node rather than a region with distinct stimulation-induced semiology.
SIGNIFICANCE: The findings limit the localizing value of temporopolar DCS responses in presurgical evaluation.