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Cossette-Roberge H, Li J, Citherlet D, Nguyen DK. Localizing and lateralizing value of auditory phenomena in seizures. Epilepsy Behav 2023; 145:109327. [PMID: 37422934 DOI: 10.1016/j.yebeh.2023.109327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/11/2023] [Accepted: 06/15/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Auditory seizures (AS) are a rare type of focal seizures. AS are classically thought to involve a seizure onset zone (SOZ) in the temporal lobe, but there remain uncertainties about their localizing and lateralizing value. We conducted a narrative literature review with the aim of providing an up-to-date description of the lateralizing and localizing value of AS. METHODS The databases PubMed, Scopus, and Google Scholar were searched for literature on AS in December 2022. All cortical stimulation studies, case reports, and case series were analyzed to assess for auditory phenomena that were suggestive of AS and to evaluate if the lateralization and/or localization of the SOZ could be determined. We classified AS according to their semiology (e.g., simple hallucination versus complex hallucination) and the level of evidence with which the SOZ could be predicted. RESULTS A total of 174 cases comprising 200 AS were analyzed from 70 articles. Across all studies, the SOZ of AS were more often in the left (62%) than in the right (38%) hemisphere. AS heard bilaterally followed this trend. Unilaterally heard AS were more often due to a SOZ in the contralateral hemisphere (74%), although they could also be ipsilateral (26%). The SOZ for AS was not limited to the auditory cortex, nor to the temporal lobe. The areas more frequently involved in the temporal lobe were the superior temporal gyrus (STG) and mesiotemporal structures. Extratemporal locations included parietal, frontal, insular, and rarely occipital structures. CONCLUSION Our review highlighted the complexity of AS and their importance in the identification of the SOZ. Due to the limited data and heterogeneous presentation of AS in the literature, the patterns associated with different AS semiologies warrant further research.
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Affiliation(s)
- Hélène Cossette-Roberge
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada; Neurology Division, Centre Hospitalier de l'Université de Sherbrooke (CHUS), Sherbrooke, QC, Canada.
| | - Jimmy Li
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada; Neurology Division, Centre Hospitalier de l'Université de Sherbrooke (CHUS), Sherbrooke, QC, Canada
| | - Daphné Citherlet
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Dang Khoa Nguyen
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada; Department of Neurosciences, Université de Montréal, Montreal, QC, Canada; Neurology Division, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
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Lee D, Lee J, Lee J. Frontal Lobe Epilepsy in a Pediatric Population: Characterization of Clinical Manifestations and Semiology. ANNALS OF CHILD NEUROLOGY 2022. [DOI: 10.26815/acn.2022.00185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Purpose: Frontal lobe epilepsy (FLE) has various clinical presentations depending on the anatomy involved. Seizures are brief and can mimic psychiatric conditions, and patients often cannot describe the aura. Therefore, it is difficult to characterize the semiology, especially in pediatric patients. This study investigated the characteristics of pediatric FLE.Methods: We retrospectively reviewed the data of pediatric patients with FLE who underwent long-term video-electroencephalography (EEG) monitoring between January 2010 and June 2020. Patients’ demographic data, seizure-related clinical presentations, semiology, brain magnetic resonance imaging (MRI), and EEG data were analyzed.Results: Fifty-six patients were included (31 males, 25 females). The age of seizure onset varied from 1 month to 14 years (mean±standard deviation, 6.1±4.4 years). Seizures were classified into nine categories, including focal tonic (30/56), aura (22/56), hypermotor (17/56), focal clonic (15/56), versive (13/56), and bilateral asymmetric tonic (4/56). Seventeen patients (30.4%) had abnormal MRI results, including focal cortical dysplasia, heterotopic gray matter, and neuroepithelial tumors. Ictal EEG changes were commonly observed in the dorsolateral premotor and central cortices. In focal tonic seizures, EEG changes often originated in the premotor cortex. The location of the lesions on MRI and EEG coincided in six cases.Conclusion: In pediatric FLE, various seizure types occur depending on the ictal anatomic origin, and individual patients had multiple semiologies. Brain MRI was normal in two-thirds of patients, and interictal EEG did not reveal epileptiform discharges in approximately 25%. Semiology reported on the basis of home videos and interictal EEG will help localize the ictal onset zone.
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Zhao B, Zhang C, Wang X, Wang Y, Mo J, Zheng Z, Ai L, Zhang K, Zhang J, Shao XQ, Hu W. Orbitofrontal epilepsy: distinct neuronal networks underlying electroclinical subtypes and surgical outcomes. J Neurosurg 2020; 135:255-265. [PMID: 32823264 DOI: 10.3171/2020.5.jns20477] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/14/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to characterize the clinical and electrophysiological findings of epilepsy originating from the orbitofrontal cortex (OFC) as well as its surgical outcomes. METHODS The authors retrospectively reviewed 27 consecutive cases of patients with drug-resistant orbitofrontal epilepsy (OFE) who underwent tailored resective surgery after a detailed presurgical workup. Demographic features, seizure semiology, imaging characteristics, resection site, pathological results, and surgical outcomes were analyzed. Patients were categorized according to semiology. The underlying neural network was further explored through quantitative FDG-PET and ictal stereo-electroencephalography (SEEG) analysis at the group level. FDG-PET studies between the semiology group and the control group were compared using a voxel-based independent t-test. Ictal SEEG was quantified by calculating the energy ratio (ER) of high- and low-frequency bands. An ER comparison between the anterior cingulate cortex (ACC) and the amygdala was performed to differentiate seizure spreading patterns in groups with different semiology. RESULTS Scalp electroencephalography (EEG) and MRI were inconclusive to a large extent. Patients were categorized into the following 3 semiology groups: the frontal group (n = 14), which included patients with hyperactive automatisms with agitated movements; the temporal group (n = 11), which included patients with oroalimentary or manual automatisms; and the other group (n = 2), which included patients with none of the abovementioned or indistinguishable manifestations. Patients in the frontal and temporal groups (n = 23) or in the frontal group only (n = 14) demonstrated significant hypometabolism mainly across the ipsilateral OFC, ACC, and anterior insula (AI), while patients in the temporal group (n = 9) had hypometabolism only in the OFC and AI. The ER results (n = 15) suggested distinct propagation pathways that allowed us to differentiate between the frontal and temporal groups. Pathologies included focal cortical dysplasia, dysembryoplastic neuroepithelial tumor, cavernous malformation, glial scar, and nonspecific findings. At a minimum follow-up of 12 months, 19 patients (70.4%) were seizure free, and Engel class II, III, and IV outcomes were observed in 4 patients (14.8%), 3 patients (11.1%), and 1 patient (3.7%), respectively. CONCLUSIONS The diagnosis of OFE requires careful presurgical evaluation. Based on their electrophysiological and metabolic evidence, the authors propose that varied semiological patterns could be explained by the extent of involvement of a network that includes at least the OFC, ACC, AI, and temporal lobe. Tailored resections for OFE may lead to a good overall outcome.
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Affiliation(s)
| | | | | | | | | | - Zhong Zheng
- 2Department of Neurosurgery, Beijing Fengtai Hospital, Beijing
| | - Lin Ai
- 3Imaging and Nuclear Medicine, and
| | - Kai Zhang
- Departments of1Neurosurgery
- 4Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing; and
- 5Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Jianguo Zhang
- Departments of1Neurosurgery
- 4Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing; and
- 5Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Xiao-Qiu Shao
- 6Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing
| | - Wenhan Hu
- Departments of1Neurosurgery
- 4Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing; and
- 5Beijing Key Laboratory of Neurostimulation, Beijing, China
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4
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Bernal B, Guillen M, Ragheb J, Altman N, Ibrahim GM, LaPlante P, Padilla A, Duchowny M. Functional imaging localization of complex organic hallucinations. Neurocase 2019; 25:91-97. [PMID: 31094654 DOI: 10.1080/13554794.2019.1611866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: fMRI of mental phenomena is quite difficult to perform because lack of patient's cooperation or because the symptoms are stable. In some exceptional cases, however, fMRI and DTI are capable to provide insights on the anatomy of organic hallucinations. Methods: In this report we describe a 14-year-old boy with a left fronto-dorsal tumor who experienced chronic complex brief, frequent and repetitive complex visual and auditory hallucinations. His clinical picture included multiple and severe social and mood problems. During a presurgical fMRI mapping the patient complained of having the visual and auditory hallucinations. A block-design FMRI paradigm was obtained from the event timecourse. Deterministic DTI of the brain was obtained seeding the lesion as ROI. The patient underwent surgery and electrocorticography of the lesional area. Results: The fMRI of the hallucinations showed activation in the left inferior frontal gyrus (IFG) and the peri-lesional area. The tractography of the tumor revealed structural aberrant connectivity to occipital and temporal areas in addition to the expected connectivity with the IFG via the aslant fasciculus and homotopic contralateral areas. Intraoperative EEG demonstrated epileptic discharges in the tumor and neighboring areas. After resection, the patient's hallucinations stopped completely. He regained his normal social life and recover his normal mood. He remained asymptomatic for 90 days. Afterwards, hallucinations reappeared but with less intensity. Conclusions: To our knowledge, this is the first reported case of combined functional and structural connectivity imaging demonstrating brain regions participating in a network involved in the generation of complex auditory and visual hallucinations.
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Affiliation(s)
- Byron Bernal
- a Department of Radiology , Miami Children's Hospital , Miami, FL , USA.,b Brain Institute, Miami Children's Hospital , Miami, FL , USA
| | - Magno Guillen
- a Department of Radiology , Miami Children's Hospital , Miami, FL , USA
| | - John Ragheb
- c Department of Neurosurgery , Miami Children's Hospital , Miami, FL , USA
| | - Nolan Altman
- a Department of Radiology , Miami Children's Hospital , Miami, FL , USA
| | - George M Ibrahim
- c Department of Neurosurgery , Miami Children's Hospital , Miami, FL , USA
| | - Philip LaPlante
- d Department of Psychiatry , Miami Children's Hospital , Miami, FL , USA
| | - Americo Padilla
- d Department of Psychiatry , Miami Children's Hospital , Miami, FL , USA
| | - Michael Duchowny
- e Department of Neurology , Miami Children's Hospital , Miami, FL , USA
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5
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Giannitelli M, Consoli A, Raffin M, Jardri R, Levinson DF, Cohen D, Laurent-Levinson C. An overview of medical risk factors for childhood psychosis: Implications for research and treatment. Schizophr Res 2018; 192:39-49. [PMID: 28526280 DOI: 10.1016/j.schres.2017.05.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 05/05/2017] [Accepted: 05/08/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Psychotic disorders in childhood and early adolescence often progress to chronic schizophrenia, but in many cases there are diagnosable medical and genetic causes or risk factors. We reviewed our clinical experience and the relevant literature to identify these factors and to define their clinical features, appropriate work-up and treatment. METHOD We reviewed the results of comprehensive medical evaluations of 160 psychotic children and adolescents in our center. We also searched the Medline database (January 1994 to December 2015) with the following keywords and combinations: early onset schizophrenia, childhood onset schizophrenia, early onset psychosis, first episode psychosis, inborn errors of metabolism (IEM), genetic syndrome, copy number variants, autoimmune disorders, endocrine diseases, nutritional deficiencies, central nervous system infections, movement disorders, and epilepsy. RESULTS In our center, 12.5% of cases had medical disorders likely to be contributing to psychosis. Based on 66 relevant papers and our experience, we describe the clinical features of multiple genetic syndromes, IEM, and autoimmune, neurological, endocrinological and nutritional disorders that increase the risk of psychotic disorders in childhood and adolescence. We propose an algorithm for systematic laboratory evaluation, informed by clinical examination, emphasizing common and/or treatable factors. CONCLUSIONS In children and early adolescents with psychotic disorders, systematic medical work-up is warranted to identify medical and genetic factors. Not every rare cause can be worked up, thus careful clinical examinations are required to detect medical, neurological and genetic signs. Comprehensive medical evaluation can detect treatable diseases among cases of early-onset psychosis.
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Affiliation(s)
- Marianna Giannitelli
- Sorbonne Universités, UPMC Univ Paris 06, Assistance Publique-Hôpitaux de Paris, Groupe de Recherche Clinique n°15 (PSYDEV), Hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Centre de référence des maladies rares à expression psychiatrique, Department of Child and Adolescent Psychiatry, Hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France; CNRS UMR 7222, Institut des Systèmes Intelligents et Robotiques, Université Pierre et Marie Curie, 1 place Jussieu, 75005 Paris, France
| | - Angèle Consoli
- Sorbonne Universités, UPMC Univ Paris 06, Assistance Publique-Hôpitaux de Paris, Groupe de Recherche Clinique n°15 (PSYDEV), Hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Centre de référence des maladies rares à expression psychiatrique, Department of Child and Adolescent Psychiatry, Hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Marie Raffin
- Sorbonne Universités, UPMC Univ Paris 06, Assistance Publique-Hôpitaux de Paris, Groupe de Recherche Clinique n°15 (PSYDEV), Hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Renaud Jardri
- University of Lille, SCALab, CNRS UMR-9193 & CHU Lille, CURE platform, Fontan Hospital, Lille, France
| | - Douglas F Levinson
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - David Cohen
- Sorbonne Universités, UPMC Univ Paris 06, Assistance Publique-Hôpitaux de Paris, Groupe de Recherche Clinique n°15 (PSYDEV), Hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Centre de référence des maladies rares à expression psychiatrique, Department of Child and Adolescent Psychiatry, Hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France; CNRS UMR 7222, Institut des Systèmes Intelligents et Robotiques, Université Pierre et Marie Curie, 1 place Jussieu, 75005 Paris, France
| | - Claudine Laurent-Levinson
- Sorbonne Universités, UPMC Univ Paris 06, Assistance Publique-Hôpitaux de Paris, Groupe de Recherche Clinique n°15 (PSYDEV), Hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Centre de référence des maladies rares à expression psychiatrique, Department of Child and Adolescent Psychiatry, Hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.
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6
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Chibane IS, Boucher O, Dubeau F, Tran TPY, Mohamed I, McLachlan R, Sadler RM, Desbiens R, Carmant L, Nguyen DK. Orbitofrontal epilepsy: Case series and review of literature. Epilepsy Behav 2017; 76:32-38. [PMID: 28928072 DOI: 10.1016/j.yebeh.2017.08.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/27/2017] [Accepted: 08/27/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Orbitofrontal epilepsy (OFE) is less known and is poorly characterized in comparison with temporal lobe epilepsy, partly because it is rare and possibly because it is unrecognized and therefore underestimated. OBJECTIVE This paper aimed to better characterize seizure semiology, presurgical findings, and surgical outcomes in patients with OFE. METHODS We retrospectively reviewed all confidently established OFE cases from six Canadian epilepsy monitoring units between 1988 and 2014, and in the literature between 1972 and 2017. Inclusion criteria were identification of an epileptogenic lesion localized in the OFC or if the patient was seizure-free after surgical removal of the OFC in nonlesional cases. RESULTS Sixteen cases were identified from our databases. Fifty percent had predominantly sleep-related seizures; 56% had no aura (the remaining had nonspecific or vegetative auras), and 62.5% featured hypermotor (mostly hyperkinetic) behaviors. Interictal epileptiform discharges over frontal and temporal derivations always allowed lateralization. Magnetic resonance imaging (MRI) identified an orbitofrontal lesion in 8/16, positron emission tomography (PET) identified a hypometabolism extending outside the orbital cortex in 4/9, ictal single-photon emission computed tomography (SPECT) identified an orbital hyperperfusion in 1/5, magnetoencephalography (MEG) identified lateral orbital sources in 2/4, and intracranial electroencephalography (EEG) identified an orbitofrontal onset in 9/10. Fourteen patients underwent surgery, all reaching a favorable outcome (71.4% Engel 1; 28.6% Engel 2; mean FU=5.6years). Pre- and postoperative neuropsychological assessments revealed heterogeneous findings. Our review of literature identified 71 possible cases of OFE, 32 with confident focus localization. Extracted data from these cumulated cases supported observations made from our case series. CONCLUSIONS Orbitofrontal epilepsy should be suspected with sleep-related, hyperkinetic seizures with no specific aura, and frontotemporal interictal discharges. Several patients have nonmotor seizures with or without auras which may resemble temporal lobe seizures. Postoperative seizure outcome was favorable, but there is inherent bias as we only included patients with a seizure-free outcome if the MRI was negative. A larger study is required to address identified gaps in knowledge such as identifying discriminative features between medial and lateral OFE, evaluating the value of more recent diagnostic tools, and assessing the neuropsychological outcome of orbital epilepsy surgery.
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Affiliation(s)
- Imane Samah Chibane
- Division of Neurology, CHUM Notre-Dame, Université de Montréal, Québec, Canada
| | - Olivier Boucher
- Department of Psychology, Université de Montréal, Québec, Canada
| | - François Dubeau
- Division of Neurology, Montreal Neurological Hospital and Institute, McGill University, Québec, Canada
| | - Thi Phuoc Yen Tran
- Division of Neurology, CHUM Notre-Dame, Université de Montréal, Québec, Canada; Department of Internal Medicine, Hue University of Medicine and Pharmacy, Hue University, Hue, Viet Nam
| | - Ismail Mohamed
- Department of Paediatrics, Division of Neurology, University of Alabama, Birmingham, AL, USA
| | - Richard McLachlan
- Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
| | - R Mark Sadler
- Department of Medicine, Division of Neurology, Dalhousie University Halifax, Nova Scotia, Canada
| | - Richard Desbiens
- Division of Neurology, CHA Hôpital Enfant-Jésus, Université Laval, Québec, Canada
| | - Lionel Carmant
- Division of Paediatric Neurology, Hôpital Sainte-Justine, Université de Montréal, Québec, Canada
| | - Dang Khoa Nguyen
- Division of Neurology, CHUM Notre-Dame, Université de Montréal, Québec, Canada.
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Gold JA, Sher Y, Maldonado JR. Frontal Lobe Epilepsy: A Primer for Psychiatrists and a Systematic Review of Psychiatric Manifestations. PSYCHOSOMATICS 2016; 57:445-64. [DOI: 10.1016/j.psym.2016.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 05/09/2016] [Accepted: 05/10/2016] [Indexed: 10/21/2022]
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Latini F, Hjortberg M, Aldskogius H, Ryttlefors M. The Classical Pathways of Occipital Lobe Epileptic Propagation Revised in the Light of White Matter Dissection. Behav Neurol 2015; 2015:872645. [PMID: 26063964 PMCID: PMC4430656 DOI: 10.1155/2015/872645] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 04/20/2015] [Indexed: 11/18/2022] Open
Abstract
The clinical evidences of variable epileptic propagation in occipital lobe epilepsy (OLE) have been demonstrated by several studies. However the exact localization of the epileptic focus sometimes represents a problem because of the rapid propagation to frontal, parietal, or temporal regions. Each white matter pathway close to the supposed initial focus can lead the propagation towards a specific direction, explaining the variable semiology of these rare epilepsy syndromes. Some new insights in occipital white matter anatomy are herein described by means of white matter dissection and compared to the classical epileptic patterns, mostly based on the central position of the primary visual cortex. The dissections showed a complex white matter architecture composed by vertical and longitudinal bundles, which are closely interconnected and segregated and are able to support specific high order functions with parallel bidirectional propagation of the electric signal. The same sublobar lesions may hyperactivate different white matter bundles reemphasizing the importance of the ictal semiology as a specific clinical demonstration of the subcortical networks recruited. Merging semiology, white matter anatomy, and electrophysiology may lead us to a better understanding of these complex syndromes and tailored therapeutic options based on individual white matter connectivity.
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Affiliation(s)
- Francesco Latini
- Department of Neuroscience, Section of Neurosurgery, Uppsala University Hospital, 75185 Uppsala, Sweden
| | - Mats Hjortberg
- Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden
| | - Håkan Aldskogius
- Department of Neuroscience, Regenerative Neurobiology, Uppsala University, Uppsala, Sweden
| | - Mats Ryttlefors
- Department of Neuroscience, Section of Neurosurgery, Uppsala University Hospital, 75185 Uppsala, Sweden
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9
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Goyal M, Thompson M, Reddy A, Harrison A, Blount J. Epilepsy surgery in bifrontal injury from prior craniopharyngioma resections. EPILEPSY & BEHAVIOR CASE REPORTS 2015; 2:4-7. [PMID: 25667855 PMCID: PMC4308033 DOI: 10.1016/j.ebcr.2013.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 11/07/2013] [Accepted: 11/08/2013] [Indexed: 11/28/2022]
Abstract
Epilepsy surgery in frontal lobe epilepsy (FLE) has less favorable seizure-free outcomes than temporal lobe epilepsies. Possible contributing factors include fast propagation patterns and large clinically silent areas which are characteristics of the frontal lobes. Bilateral frontal lobe abnormalities on MRI are another relative contraindication to epilepsy surgery. For example, bilateral encephalomalacia may be a presupposition to bilateral or multifocal epilepsy. The possibility of potential disinhibition with already poor reserves may be another deterrent to consideration for resective epilepsy surgery. As such, conventional surgical approaches to intractable epilepsy with bilateral frontal injury may be limited to palliative procedures like vagus nerve stimulation and corpus callosotomy. We present a case in which the epileptogenic zone was a subset of the acquired, bilateral, cystic encephalomalacia. This iatrogenic injury resulted from two prior craniotomies for excision of craniopharyngioma and its recurrence. Following the initial bilateral and subsequent unilateral, subdural grid- and depth electrode-based localization and resection, our patient has remained seizure-free 2 years after epilepsy surgery with marked improvement in her quality of life, as corroborated by her neuropsychological test scores. Our patient's clinical course is testament to the potential role for resective strategies in selected cases of intractable epilepsy associated with bifrontal injury. Reversal of behavioral deficits with frontal lobe epilepsy surgery such as in this patient provides a unique opportunity to further our understanding of the complex nature of frontal lobe function.
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Affiliation(s)
- Monisha Goyal
- University of Alabama, Birmingham, AL, USA ; Children's Hospital of Alabama, Birmingham, AL, USA
| | | | - Alyssa Reddy
- University of Alabama, Birmingham, AL, USA ; Children's Hospital of Alabama, Birmingham, AL, USA
| | | | - Jeffrey Blount
- University of Alabama, Birmingham, AL, USA ; Children's Hospital of Alabama, Birmingham, AL, USA
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10
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Angiocentric glioma manifesting as psychotic symptoms in an adolescent: A case report. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.npbr.2013.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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11
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Manfioli V, Saladini M, Cagnin A. Ictal visual hallucinations due to frontal lobe epilepsy in a patient with bipolar disorder. EPILEPSY & BEHAVIOR CASE REPORTS 2013; 1:146-9. [PMID: 25667849 PMCID: PMC4150638 DOI: 10.1016/j.ebcr.2013.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 08/28/2013] [Accepted: 08/29/2013] [Indexed: 11/21/2022]
Abstract
In ictal psychosis with complex visual hallucinations (VHs), widespread functional changes of cortical networks have been suggested. We describe the clinical and EEG findings of a patient with bipolar disorder who manifested complex VHs associated with intense emotional symptoms caused by frontal epileptic seizures. This description highlights the challenges of diagnosing the epileptic nature of new psychotic phenomena in patients with previous psychiatric disorders and shines light into the role of the frontal cortex in the genesis of complex VHs.
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Affiliation(s)
- Valeria Manfioli
- Department of Neurosciences, Sciences NPSRR, University of Padova, Padova, Italy
| | - Marina Saladini
- Department of Neurosciences, Sciences NPSRR, University of Padova, Padova, Italy
| | - Annachiara Cagnin
- Department of Neurosciences, Sciences NPSRR, University of Padova, Padova, Italy
- IRCCS Ospedale San Camillo, Venice, Italy
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12
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Lax Pericall MT, Taylor E. Psychosis and epilepsy in young people. Epilepsy Behav 2010; 18:450-4. [PMID: 20580321 DOI: 10.1016/j.yebeh.2010.05.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 05/17/2010] [Accepted: 05/19/2010] [Indexed: 10/19/2022]
Abstract
The aim of this study was to describe the clinical characteristics of children and young people under 19 with both epilepsy and a psychotic state (schizophrenia-like psychotic episode, organic delusional disorder, or other brief psychotic episode). In total, the clinical case notes for 17 young people with these characteristics were identified retrospectively from three different sources. Compared with a group of young people with psychosis without epilepsy, children with epilepsy and psychosis more frequently had other neuropsychological problems like learning disability and autism. Both groups had a high rate of family histories of mental illness and social disability. Contrary to the findings in adults with psychosis and epilepsy, in this group of young people, psychosis was associated neither with temporal lobe epilepsy nor with mesial temporal sclerosis. The children with psychosis and epilepsy had a variety of seizure types and structural abnormalities.
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Affiliation(s)
- M T Lax Pericall
- South London and Maudsley NHS Trust, Belgrave Department of Child Psychiatry, King's College Hospital, London, UK.
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13
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Liu GT, Volpe NJ, Galetta SL. Visual hallucinations and illusions. Neuroophthalmology 2010. [DOI: 10.1016/b978-1-4160-2311-1.00012-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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14
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Meppelink AM, de Jong BM, Renken R, Leenders KL, Cornelissen FW, van Laar T. Impaired visual processing preceding image recognition in Parkinson's disease patients with visual hallucinations. Brain 2009; 132:2980-93. [DOI: 10.1093/brain/awp223] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Vignoli A, Canevini MP, Darra F, La Selva L, Fiorini E, Piazzini A, Lazzarotto F, Zucca C, Dalla Bernardina B. Ring chromosome 20 syndrome: a link between epilepsy onset and neuropsychological impairment in three children. Epilepsia 2009; 50:2420-7. [PMID: 19583784 DOI: 10.1111/j.1528-1167.2009.02176.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Ring chromosome 20 [r(20)] syndrome is a well-defined chromosomal disorder characterized by epilepsy, mild-to-moderate mental retardation, and lack of recognizable dysmorphic features. Epilepsy is often the most important clinical manifestation of the syndrome, even if its appearance is not constantly precocious. Seizures are frequently drug resistant. METHODS We describe three children with [r(20)] syndrome in whom the onset of epilepsy (age at onset range: 4 years and 6 months to 9 years and 4 months) determined a kind of epileptic status (age at onset range: 6 years and 10 months to 9 years and 8 months) with dramatic neuropsychological deterioration. This epileptic status lasted for several months because of refractoriness to most antiepileptic drugs (AEDs), but it was treated successfully with a combination of valproate and lamotrigine in two children. RESULTS As soon as seizures stopped, the children showed prompt recovery with partial restoration of the neuropsychological impairment. CONCLUSION This clinical picture can be described as abrupt epileptic encephalopathy.
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Affiliation(s)
- Aglaia Vignoli
- Epilepsy Centre, San Paolo Hospital, University of Milan, Milan, Italy.
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Neurocognitive and behavioral functioning in frontal lobe epilepsy: a review. Epilepsy Behav 2009; 14:19-26. [PMID: 18926928 DOI: 10.1016/j.yebeh.2008.09.013] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Revised: 09/10/2008] [Accepted: 09/16/2008] [Indexed: 11/23/2022]
Abstract
Frontal lobe epilepsy (FLE) is a seizure disorder with a lower prevalence than temporal lobe epilepsy (TLE). Despite its consequences on cognitive and emotional well-being, the neuropsychology of FLE has not been well studied. By contrast, TLE has been studied meticulously, leading to a relevant understanding of memory and the functional characteristics of the temporal and limbic circuits. The neuropsychological studies on FLE report deficits in motor coordination and planning, reduced attention span, and difficulties in response inhibition in complex cognitive tasks. This review aims to illustrate the most relevant neurocognitive dimensions, psychiatric comorbidity, and postoperative neuropsychological outcome of FLE. Methodological suggestions for future research are also included by critically reviewing the existing literature.
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Luat AF, Asano E, Rothermel R, Sood S, Chugani HT. Psychosis as a manifestation of frontal lobe epilepsy. Epilepsy Behav 2008; 12:200-4. [PMID: 17981091 DOI: 10.1016/j.yebeh.2007.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Revised: 08/31/2007] [Accepted: 09/05/2007] [Indexed: 10/22/2022]
Abstract
A 7-year-old girl presented with a cluster of seizures occurring in one day and followed by the development of paranoid delusions. Her electroencephalogram (EEG) revealed a psychomotor variant. Cranial MRI was normal, but the 2-deoxy-2-[(18)F]fluoro-D-glucose (FDG) positron emission tomography (PET) scan showed hypometabolism in the left inferior frontal cortex. Her psychotic symptoms occurred episodically. Three years later, she developed hypermotor seizures associated with a fearful look. Video/EEG monitoring captured seizures of left frontotemporal onset. Her seizures became drug resistant and she underwent epilepsy surgery. Intracranial electrocorticography captured spontaneous and electrically induced seizures with onset in the left inferior frontal region, which was resected. She became seizure-free and her psychosis resolved. This case illustrates that frontal lobe epilepsy can present solely with psychotic symptoms, which may delay the diagnosis of epilepsy. We suggest that these cases may be underdiagnosed. When epilepsy is suspected and if MRI fails to demonstrate an abnormality, FDG PET scanning and video/EEG monitoring should be considered.
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Affiliation(s)
- Aimee F Luat
- Children's Hospital of Michigan-Detroit Medical Center/Wayne State University, Detroit, MI 48201, USA
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Abstract
OBJECTIVE To critically review literature published from 1996 to 2007 on psychopathology in children with epilepsy (CWE). METHOD Using Ovid, we searched Medline and PsychInfo databases for original studies on epidemiology, risk factors, clinical characteristics, treatment, and outcome of psychopathology in CWE, ages 0 to 18 years, using the terms "psychopathology," "emotional and behavioral problems," and "mental health problems." We selectively present the findings of studies that are clinically relevant to mental health professionals. RESULTS Psychopathology occurs in 37% to 77% of CWE, and attention, internalizing, and thought problems may be specific to epilepsy. Cognitive and linguistic deficits, as well as family factors, have moderating effects on psychopathology in CWE. The association of epilepsy-related variables, including antiepileptic drugs, with psychopathology is inconsistent in cognitively normal CWE. Children with symptomatic epilepsy and devastating epilepsy syndromes have high rates of global developmental delay, hyperactivity, and autistic symptoms. The treatment of psychopathology in CWE integrates standard psychiatric practices. CONCLUSIONS Epilepsy is a neuropsychiatric disorder characterized by seizures, psychopathology, cognitive, and linguistic problems. Improved early identification of CWE at risk for psychopathology, evidence-based psychiatric treatment, and multidisciplinary management strategies would advance clinical practice in this highly complex field of pediatric neuropsychiatry.
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