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DeFelipe J, DeFelipe-Oroquieta J, Furcila D, Muñoz-Alegre M, Maestú F, Sola RG, Blázquez-Llorca L, Armañanzas R, Kastanaskaute A, Alonso-Nanclares L, Rockland KS, Arellano JI. Neuroanatomical and psychological considerations in temporal lobe epilepsy. Front Neuroanat 2022; 16:995286. [PMID: 36590377 PMCID: PMC9794593 DOI: 10.3389/fnana.2022.995286] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/11/2022] [Indexed: 01/03/2023] Open
Abstract
Temporal lobe epilepsy (TLE) is the most common form of focal epilepsy and is associated with a variety of structural and psychological alterations. Recently, there has been renewed interest in using brain tissue resected during epilepsy surgery, in particular 'non-epileptic' brain samples with normal histology that can be found alongside epileptic tissue in the same epileptic patients - with the aim being to study the normal human brain organization using a variety of methods. An important limitation is that different medical characteristics of the patients may modify the brain tissue. Thus, to better determine how 'normal' the resected tissue is, it is fundamental to know certain clinical, anatomical and psychological characteristics of the patients. Unfortunately, this information is frequently not fully available for the patient from which the resected tissue has been obtained - or is not fully appreciated by the neuroscientists analyzing the brain samples, who are not necessarily experts in epilepsy. In order to present the full picture of TLE in a way that would be accessible to multiple communities (e.g., basic researchers in neuroscience, neurologists, neurosurgeons and psychologists), we have reviewed 34 TLE patients, who were selected due to the availability of detailed clinical, anatomical, and psychological information for each of the patients. Our aim was to convey the full complexity of the disorder, its putative anatomical substrates, and the wide range of individual variability, with a view toward: (1) emphasizing the importance of considering critical patient information when using brain samples for basic research and (2) gaining a better understanding of normal and abnormal brain functioning. In agreement with a large number of previous reports, this study (1) reinforces the notion of substantial individual variability among epileptic patients, and (2) highlights the common but overlooked psychopathological alterations that occur even in patients who become "seizure-free" after surgery. The first point is based on pre- and post-surgical comparisons of patients with hippocampal sclerosis and patients with normal-looking hippocampus in neuropsychological evaluations. The second emerges from our extensive battery of personality and projective tests, in a two-way comparison of these two types of patients with regard to pre- and post-surgical performance.
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Affiliation(s)
- Javier DeFelipe
- Laboratorio Cajal de Circuitos Corticales, Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, Pozuelo de Alarcón, Madrid, Spain,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, Madrid, Spain,Instituto Cajal, Consejo Superior de Investigaciones Científicas, Madrid, Spain,*Correspondence: Javier DeFelipe,
| | - Jesús DeFelipe-Oroquieta
- Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain,Facultad de Educación, Universidad Camilo José Cela, Madrid, Spain
| | - Diana Furcila
- Laboratorio Cajal de Circuitos Corticales, Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, Pozuelo de Alarcón, Madrid, Spain
| | - Mar Muñoz-Alegre
- Facultad de Educación y Psicología, Universidad Francisco de Vitoria, Madrid, Spain
| | - Fernando Maestú
- Department of Experimental Psychology, Complutense University of Madrid, Madrid, Spain,Center for Cognitive and Computational Neuroscience, Complutense University of Madrid, Madrid, Spain
| | - Rafael G. Sola
- Cátedra UAM de “Innovación en Neurocirugía”, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | - Lidia Blázquez-Llorca
- Laboratorio Cajal de Circuitos Corticales, Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, Pozuelo de Alarcón, Madrid, Spain,Sección Departamental de Anatomía y Embriología, Facultad de Veterinaria, Universidad Complutense de Madrid, Madrid, Spain
| | - Rubén Armañanzas
- Institute of Data Science and Artificial Intelligence, Universidad de Navarra, Pamplona, Spain,Tecnun School of Engineering, Universidad de Navarra, Donostia-San Sebastian, Spain
| | - Asta Kastanaskaute
- Laboratorio Cajal de Circuitos Corticales, Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, Pozuelo de Alarcón, Madrid, Spain,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, Madrid, Spain,Instituto Cajal, Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Lidia Alonso-Nanclares
- Laboratorio Cajal de Circuitos Corticales, Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, Pozuelo de Alarcón, Madrid, Spain,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, Madrid, Spain,Instituto Cajal, Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Kathleen S. Rockland
- Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, United States
| | - Jon I. Arellano
- Department of Neuroscience, Yale School of Medicine, New Haven, CT, United States
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Extrahippocampal desynchronization in nonlesional temporal lobe epilepsy. EPILEPSY RESEARCH AND TREATMENT 2012; 2012:823683. [PMID: 22957245 PMCID: PMC3420646 DOI: 10.1155/2012/823683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 09/14/2011] [Accepted: 09/25/2011] [Indexed: 11/17/2022]
Abstract
Although temporal lobe epilepsy (TLE) is traditionally associated with both hypersynchronous activity in the form of interictal epileptic discharges and hippocampal sclerosis, recent findings suggest that desynchronization also plays a central role in the dynamics of this pathology. The objective of this work is to show the imbalance existing between mesial activities in patients suffering from mesial TLE, with normal mesial structures. Foramen ovale recordings from six patients with mesial TLE and one with lateral TLE were analyzed through a cluster analysis and synchronization matrices. None of the patients present findings in the MRI presurgical evaluation. Numerical analysis was carried out in three different situations: awake and sleep interictal and also during the preictal stage. High levels of desynchronization ipsilateral to the epileptic side were present in mesial TLE patients. Low levels of desynchronization were present in the lateral TLE patient during the interictal stage and almost zero in the preictal stage. Implications of these findings in relation with seizure spreading are discussed.
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Ortega GJ, Peco IH, Sola RG, Pastor J. Impaired mesial synchronization in temporal lobe epilepsy. Clin Neurophysiol 2010; 122:1106-16. [PMID: 21185775 DOI: 10.1016/j.clinph.2010.11.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 09/28/2010] [Accepted: 11/04/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Temporal lobe epilepsy is commonly associated with synchronous, hyper-synchronous and des-synchronous activity. The aim of the present work is to explore synchronization activity in both mesial areas in temporal lobe epileptic patients during the interictal state. METHODS Using a cluster technique, we analyzed 17 temporal lobe epilepsy patients' records of foramen ovale electrodes activity during the inter-ictal state. RESULTS There exists a clear tendency in the mesial area of the epileptic side to be organized as isolated clusters of electrical activity as compared with the contra-lateral side, which is organized in the form of large clusters of synchronous activity. The number of desynchronized areas is larger in the epileptic side than in the contra-lateral side in 16 out of 17 temporal lobe epileptic patients. CONCLUSIONS The mesial area responsible for the seizures is less synchronous than the contra-lateral; the different kind of synchronous organization accounts for a lower synchronization activity at the epileptic side, suggesting that this lack of synchronous cluster organization would favour the appearance of seizures. SIGNIFICANCE Our results shed new light regarding synchronization issues in temporal lobe epilepsy and also it would help in reducing drastically the time of study.
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Affiliation(s)
- Guillermo J Ortega
- Department of Neurosurgery, Hospital Universitario de La Princesa, Madrid, Spain.
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Stefan H, Hopfengärtner R, Kreiselmeyer G, Weigel D, Rampp S, Kerling F, Blümcke I, Buchfelder M. Interictal triple ECoG characteristics of temporal lobe epilepsies: An intraoperative ECoG analysis correlated with surgical outcome. Clin Neurophysiol 2008; 119:642-652. [PMID: 18164665 DOI: 10.1016/j.clinph.2007.11.046] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2007] [Revised: 11/22/2007] [Accepted: 11/23/2007] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Recent reports showed that intraoperative ECoG activities can be analysed with respect to more complex spike patterns. We have systematically investigated different characteristic epileptiform activities in intraoperative ECoG and correlated them to postoperative outcome. METHODS Intraoperative ECoG findings of patients with non-tumorous epilepsies (20 patients with Engel outcome 1a, 20 patients with Engel outcome 2-4) were analysed in order to differentiate ECoG characteristics in temporal lobe epilepsies (TLE). RESULTS In addition to focal spiking with or without propagation, focal slowing in the theta or delta range and so-called ictaform ECoG patterns were found. These ictaform patterns occurred in 40% of the patients with TLE. CONCLUSIONS Leading spikes in combination with focal slowing and ictaform patterns can contribute to a better delineation of mesial temporal epileptic activity in the anterior-posterior alignment. They provide an additional information which can be used for the extent of resection. SIGNIFICANCE If the resected area included the anterior mesial regions, where interictal spikes, ictaform activity and slowing were localized, the postoperative outcome was good.
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Affiliation(s)
- H Stefan
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - R Hopfengärtner
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany
| | - G Kreiselmeyer
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany
| | - D Weigel
- Department of Neurosurgery, University Hospital Erlangen, Germany
| | - S Rampp
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany
| | - F Kerling
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany
| | - I Blümcke
- Department of Neuropathology, University Hospital Erlangen, Germany
| | - M Buchfelder
- Department of Neurosurgery, University Hospital Erlangen, Germany
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Pastor J, Sola RG, Hernando-Requejo V, Navarrete EG, Pulido P. Morbidity associated with the use of foramen ovale electrodes. Epilepsia 2008; 49:464-9. [PMID: 18494094 DOI: 10.1111/j.1528-1167.2007.01314.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE The identification of the epileptic zone in patients with mesial temporal lobe epilepsy sometimes requires intracranial recordings, for example, with foramen ovale electrodes (FOE). This paper reviews and analyzes the resulting complications in a series of patients studied with bilateral FOE for presurgical evaluation. METHODS The clinical records of 331 consecutive FOE implantations in 329 patients were reviewed. Complications related to FOE were divided into two groups: those that were non-life-threatening or not directly attributable to FOE, or life-threatening complications and those clearly related to FOE. RESULTS The mean length of hospital stay in the v-EEG unit with FOE was 5.8 +/- 0.2 days (range 1-19) following a bimodal distribution (peaks at 4 and 8 days). Complications were observed in 6.64% of patients, but in 4.83% of cases, complications were non-life-threatening (moderate disaesthesia, cheek bleeding, FOE expulsion). Complications were only severe in 1.81% of patients (clotting or intracranial hemorrhage). One patient died more than 20 days after FOE removal and after several episodes of status epilepticus. Patients suffering from life-threatening complications were more likely to be female (83.3%) than patients experiencing no complications or non-life-threatening complications. Patients with life-threatening complications had a more prolonged stay in the v-EEG unit during monitoring with FOE (8.2 +/- 0.7; n = 6) than the group without complications (5.7 +/- 0.2; n = 309; p < 0.01; Kruskal-Wallis test). DISCUSSION FOE is a reasonably safe intracranial technique for v-EEG monitoring with low rates of potentially severe complications, but its indication should be carefully evaluated, especially if monitoring for more than 8 days is expected.
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Affiliation(s)
- Jesús Pastor
- Clinical Neurophysiology, The Epilepsy Unit, Hospital Universitario de la Princesa, Madrid, Spain.
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Ortega GJ, Menendez de la Prida L, Sola RG, Pastor J. Synchronization Clusters of Interictal Activity in the Lateral Temporal Cortex of Epileptic Patients: Intraoperative Electrocorticographic Analysis. Epilepsia 2008; 49:269-80. [PMID: 17825075 DOI: 10.1111/j.1528-1167.2007.01266.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Drug-resistant temporal lobe epilepsy (TLE) can be treated by tailored surgery guided by electrocorticography (ECoG). Although its value is still controversial, ECoG activity can provide continuous information on intracortical interactions that may be useful to understand the pathophysiology of TLE. The goal of this study is to characterize local interactions in multichannel ECoG recordings of the lateral cortex of TLE patients using three synchronization measures and to link this information with surgical outcome. METHODS Intraoperative ECoG recordings from 29 TLE patients were obtained using grids of 20 electrodes (4 x 5) covering regions T1, T2, and T3 of the lateral temporal lobe. Linear correlation, mutual information, and phase synchronization were calculated to quantify lateral intracortical interactions. Surrogate data files were generated to test results statistically. RESULTS By distributing locally the interactions between the electrodes, we characterized the spatial patterns of ECoG activity. We found clusters of synchronized activity at specific areas of the lateral temporal cortex in most patients. Methodologically, linear correlation and phase synchronization performed better than mutual information for cluster discrimination. ROC analysis suggested that surgical removal of sharply defined synchronization clusters correlated with seizure control. CONCLUSIONS Our results show that synchronous intraoperative ECoG activity emerges from specific cortical areas that are highly differentiated from the rest of the temporal cortex. This suggests that synchronization analysis could be used to functionally map into the temporal cortex of TLE patients. Moreover, our results suggest that these sites might be involved in the circuits that participate in clinical seizures.
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Pastor J, Domínguez-Gadea L, Sola RG, Hernando V, Meilán ML, De Dios E, Martínez-Chacón JL, Martínez M. First true initial ictal SPECT in partial epilepsy verified by electroencephalography. Neuropsychiatr Dis Treat 2008; 4:305-9. [PMID: 18728803 PMCID: PMC2515897 DOI: 10.2147/ndt.s2332] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Drug-resistant epilepsy can sometimes be treated by surgery. In these cases, an accurate identification of the epileptogenic area must be addressed before resection. Ictal SPECT is one of the presurgical evaluations that can be performed, but usually, the increase in the regional cerebral perfusion observed is produced by diffusion of ictal activity. Here we describe a patient studied with v-EEG and foramen ovale electrodes that suffered a seizure after intravenous infusion of etomidate. The sequence of etomidate administration, followed by radiotracer and seizure was good enough for us to suspect that a true initial ictal SPECT was observed. We have implemented a kinetic model with four compartments, previously described (Andersen 1989), in order to estimate the fraction of hydrophilic radiotracer in the brain during the pre-ictal and ictal periods. This model has shown that the fraction of hydrophilic radiotracer during the seizure into the brain would be between 18.9% and 42.3% of total infused. We show the first true initial ictal SPECT demonstrated by bioelectrical recordings of the brain activity, obtained by a correct succession of events and compatible with theoretical data obtained from the kinetic model.
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Affiliation(s)
- Jesús Pastor
- Clinical Neurophysiology, Hospital Universitario "La Princesa" Madrid, Spain.
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