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Ukishiro K, Osawa SI, Kakisaka Y, Jin K, Tominaga T, Endo H, Nakasato N. Remission of startle epilepsy provoked by acoustic stimuli following complete callosotomy: A case study. Epileptic Disord 2024. [PMID: 38713433 DOI: 10.1002/epd2.20238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/23/2024] [Indexed: 05/08/2024]
Abstract
Herein, we present the case of a 21-year-old man with a history of generalized tonic seizures since the age of 4 years. These seizures occurred either spontaneously or could be provoked by auditory stimuli such as the sounds of a vacuum cleaner or an electric shaver. Despite trials with 10 different anti-seizure medications, his seizures remained refractory. Interictal electroencephalography (EEG) revealed generalized epileptiform activity, whereas ictal EEG showed a generalized attenuation pattern. Magnetic resonance imaging revealed extensive chronic infarctions, predominantly in the bilateral cerebral watershed areas. At the age of 17, the patient underwent a one-stage complete callosotomy, which only achieved remission of auditory-provoked seizures. Based on this experience and published reports, we propose that the posterior corpus callosum, particularly the isthmus and anterior splenium, may be involved in seizures caused by unexpected sound stimuli.
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Affiliation(s)
- Kazushi Ukishiro
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shin-Ichiro Osawa
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yosuke Kakisaka
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazutaka Jin
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Teiji Tominaga
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hidenori Endo
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Nobukazu Nakasato
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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Inoue T, Kuki I, Uda T, Kunihiro N, Umaba R, Koh S, Nukui M, Okazaki S, Otsubo H. Comparing late-onset epileptic spasm outcomes after corpus callosotomy and subsequent disconnection surgery between post-encephalitis/encephalopathy and non-encephalitis/encephalopathy. Epilepsia Open 2023; 8:346-359. [PMID: 36692212 PMCID: PMC10235586 DOI: 10.1002/epi4.12698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 01/20/2023] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE We aimed to analyze the efficiency of corpus callosotomy (CC) and subsequent disconnection surgeries in patients with late-onset epileptic spasms (LOES) by comparing post-encephalitis/encephalopathy (PE) and non-encephalitis/encephalopathy (NE). We hypothesized these surgeries can control potential focal onset epileptic spasms (ES) in the NE group but not in the PE group. METHODS We retrospectively included 23 patients (12 with PE and 11 with NE) who initially underwent CC and subsequent disconnection surgeries (five NE). We compared the clinical courses, seizure types, MRI, video-EEG, epilepsy surgery, and seizure outcomes between the two groups. RESULTS The median age of LOES onset in the PE group was 2.8 (range 1.0-10.1 years) and 2.9 years (range 1.1-12.6) in the NE group. Bilateral MRI abnormalities were observed in both groups (PE, n = 12; NE, n = 3; P < 0.05). The PE group presented ES alone (n = 2), ES + focal seizures (FS) (n = 3), ES + generalized seizures (GS) (n = 3), and ES + FS + GS (n = 4) in addition to stimulus-induced startle seizures (SS) (n = 8) (mean 3.1 seizure types/patient). The NE group presented ES alone (n = 1), ES + FS (n = 2), and ES + FS + GS (n = 8) (mean 2.7 seizure types/patient). In the PE group, CC stopped ES (n = 1) and SS (n = 1) and achieved <50% SS (n = 3). In the NE group, CC achieved immediate ES-free status (n = 2) and < 50% ES (n = 1), and additional disconnection surgeries subsided all seizure types (n = 3) based on lateralized interictal/ictal EEG findings. LOES was significantly remitted by surgery in the NE group (6/11 [55%]) compared with the PE group (1/12 [8%]) (P < 0.05). SIGNIFICANCE LOES is a drug-resistant, focal/generalized/unknown onset ES. Lateralization of ES in NE could be achieved after CC and eliminated by further disconnection surgeries because of potential focal onset ES. LOES in PE had little benefit from CC for generalized onset ES. However, CC might reduce SS in patients in the PE group with multiple seizure types.
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Affiliation(s)
- Takeshi Inoue
- Department of Pediatric NeurologyOsaka City General HospitalOsakaJapan
| | - Ichiro Kuki
- Department of Pediatric NeurologyOsaka City General HospitalOsakaJapan
| | - Takehiro Uda
- Department of Pediatric NeurosurgeryOsaka City General HospitalOsakaJapan
- Department of NeurosurgeryOsaka Metropolitan University Graduate School of MedicineOsakaJapan
| | - Noritsugu Kunihiro
- Department of Pediatric NeurosurgeryOsaka City General HospitalOsakaJapan
| | - Ryoko Umaba
- Department of Pediatric NeurosurgeryOsaka City General HospitalOsakaJapan
| | - Saya Koh
- Department of NeurosurgeryOsaka Metropolitan University Graduate School of MedicineOsakaJapan
| | - Megumi Nukui
- Department of Pediatric NeurologyOsaka City General HospitalOsakaJapan
- Department of Pediatric LogopedicsOsaka City General HospitalOsakaJapan
| | - Shin Okazaki
- Department of Pediatric NeurologyOsaka City General HospitalOsakaJapan
- Department of Pediatric LogopedicsOsaka City General HospitalOsakaJapan
| | - Hiroshi Otsubo
- Division of NeurologyThe Hospital for Sick ChildrenTorontoOntarioCanada
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Xu Z, Jiao X, Gong P, Niu Y, Yang Z. Startle-Induced Epileptic Spasms: A Clinical and Video-EEG Study. Front Neurol 2022; 13:878504. [PMID: 35785347 PMCID: PMC9240202 DOI: 10.3389/fneur.2022.878504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThis study aimed to delineate the detailed characteristics of startle-induced epileptic spasms (ES) and explore the brain regions where startle-induced ES originated.MethodsAmong 581 patients with ES registered in our database, 30 were diagnosed with startle-induced ES according to video-electroencephalogram (EEG) and seizure semiology and were included in this study. Patients' clinical characteristics and ictal high-frequency oscillations (HFOs) were analyzed.ResultsMean age at the onset of startle-induced ES was 28.1 months. Half of the patients had structural etiology, two of whom were diagnosed with co-existing structural and genetic etiologies. The focal neuroimaging abnormalities were predominant in the frontal cortex (9/15, 60.0%). Fifteen patients (50%) had prominent interictal epileptiform discharges in the frontal and anterior temporal. Ictal HFOs counts of the startle-induced ES in the anterior region were significantly higher than those in the posterior regions (p < 0.05). Five patients (16.7%) became seizure-free ≥6 months, and ten (33.3%) showed startle-induced ES cessation ≥6 months. All patients except one had mild to severe psychomotor developmental delay after the onset of seizures.ConclusionPatients with startle-induced ES typically had brain lesions and showed drug-resistant. The neuroimaging and EEG findings, including ictal HFOs, support that startle-induced ES often originates from the frontal cortex.
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Ohta K, Okanishi T, Kanai S, Okazaki T, Fujimoto A, Maegaki Y. Intractable startle epilepsy in Schuurs - Hoeijmakers syndrome. Epileptic Disord 2022; 24:606-608. [PMID: 35770753 DOI: 10.1684/epd.2022.1415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 01/23/2022] [Indexed: 11/17/2022]
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Abstract
Reflex seizures (RS) are epileptic events that are objectively and consistently elicited in response to a specific afferent stimulus or by an activity of the patient. The specific stimulus can be a variety of heterogenous intrinsic or extrinsic factors, ranging from the simple to the complex, such as flashing lights or reading a book. These seizures can take a variety of forms, comprising either general or focal onset, with or without secondary generalization. Reflex epilepsies (RE) are classified as a specific syndrome in which all epileptic seizures are precipitated by sensory stimuli. The few designated RE include idiopathic photosensitive occipital lobe epilepsy, other visual sensitive epilepsies, primary reading epilepsy, and startle epilepsy. RS that occurs within other focal or generalized epilepsy syndromes that are associated with distinct spontaneous seizures are classified by the overarching seizure type. Most patients experience spontaneous seizures along with their provoked events. RS originate from stimulation of functional anatomic networks normally functioning for physiological activities, that overlap or coincide with regions of cortical hyperexcitability. Generalized RS typically occur within the setting of IGEs and should be considered as focal seizures with quick secondary generalization via cortico-cortical or cortico-reticular pathways. In aggregate, activation of a critical neuronal mass, supported and sustained by cortico-subcortical and thalamocortical pathways eventually result in a seizure. Treatment includes antiseizure medication, commonly valproate or levetiracetam, along with lifestyle modifications, and when amenable, surgical intervention. High clinical suspicion and careful history taking must be employed in all epilepsy patients to identify reflex triggers.
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Affiliation(s)
- Samrina Hanif
- 1Department of Neurology, Marshall University, Joan C. Edwards School of Medicine, Huntington, WV 25701, USA
| | - Shane T Musick
- 2Department of Neurosurgery, Marshall University, Joan C. Edwards School of Medicine, Huntington, WV 25701, USA
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Abstract
INTRODUCTION There is growing awareness that reflex epileptic seizures offer unique insight into natural seizure generation in humans. In the last years, focus has mostly been on reflex seizures in generalized epilepsies whereas a comprehensive review of their role in focal epilepsies has been missing. Areas covered: This paper reviews reflex seizures strictly in focal epilepsies, not including focal reflex seizures in system epilepsies that also exist. They were categorized according to their triggers which can be sensory or cognitive, simple or complex. Numerous diverse conditions exist some of which are much better investigated than others. They required separate individual literature search in PubMed. Where recent review papers exist, it refers to these, but several conditions have never been reviewed, and here it refer to and discusses original reports. Miscellaneous case reports were only exceptionally included when they contributed aspects otherwise missing. Expert commentary: Research on focal reflex seizures with advanced methods of imaging and neurophysiology to elucidate mechanisms of focal ictogenesis will probably be rapidly increasing and will soon provide much new insight. Sensory and cognitive inhibition, i.e. the counterpart of reflex ictogenesis, is promising but needs more structured and controlled research to establish robust therapeutic approaches.
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Affiliation(s)
- Rūta Mameniškienė
- a Department of Neurology, Institute of Clinical Medicine , Center for Neurology, Vilnius University , Vilnius , Lithuania
| | - Peter Wolf
- b Danish Epilepsy Centre , Dianalund , Denmark.,c Serviço de Neurologia, Departamento de Clínica Médica , Hospital Universitário, Universidade Federal de Santa Catarina (UFSC) , Florianópolis , SC , Brazil
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Wolf P. Reflex epileptic mechanisms in humans: Lessons about natural ictogenesis. Epilepsy Behav 2017; 71:118-123. [PMID: 25958226 DOI: 10.1016/j.yebeh.2015.01.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 01/07/2015] [Accepted: 01/08/2015] [Indexed: 11/17/2022]
Abstract
The definition of reflex epileptic seizures is that specific seizure types can be triggered by certain sensory or cognitive stimuli. Simple triggers are sensory (most often visual, more rarely tactile or proprioceptive; simple audiogenic triggers in humans are practically nonexistent) and act within seconds, whereas complex triggers like praxis, reading and talking, and music are mostly cognitive and work within minutes. The constant relation between a qualitatively, often even quantitatively, well-defined stimulus and a specific epileptic response provides unique possibilities to investigate seizure generation in natural human epilepsies. For several reflex epileptic mechanisms (REMs), this has been done. Reflex epileptic mechanisms have been reported less often in focal lesional epilepsies than in idiopathic "generalized" epilepsies (IGEs) which are primarily genetically determined. The key syndrome of IGE is juvenile myoclonic epilepsy (JME), where more than half of the patients present reflex epileptic traits (photosensitivity, eye closure sensitivity, praxis induction, and language-induced orofacial reflex myocloni). Findings with multimodal investigations of cerebral function concur to indicate that ictogenic mechanisms in IGEs largely (ab)use preexisting functional anatomic networks (CNS subsystems) normally serving highly complex physiological functions (e.g., deliberate complex actions and linguistic communication) which supports the concept of system epilepsy. Whereas REMs in IGEs, thus, are primarily function-related, in focal epilepsies, they are primarily localization-related. This article is part of a Special Issue entitled "Genetic and Reflex Epilepsies, Audiogenic Seizures and Strains: From Experimental Models to the Clinic".
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Affiliation(s)
- Peter Wolf
- Danish Epilepsy Centre Filadelfia, Kolonivej 2, DK-4293 Dianalund, Denmark; Department of Clinical Medicine, Neurological Service, Federal University of Santa Catarina, Florianópolis, SC, Brazil.
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Zeydan B, Gunduz A, Demirbilek V, Dervent A. Visually evoked startle response in a patient with epilepsy: a case report and review of the literature. Neurocase 2017; 23:79-81. [PMID: 28090805 DOI: 10.1080/13554794.2017.1279637] [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] [Indexed: 10/20/2022]
Abstract
Both symptomatic and genetic, cases with hyperekplexia or startle seizures induced by acoustic stimuli, are previously reported. By contrast, startle response induced by visual stimuli is rare. While visual stimuli are more commonly associated with startle seizures, here we present an 11-year-old girl with epilepsy, motor-mental retardation, and spastic tetraparesis, who had repetitive startle responses by photic stimulation during the electroencephalogram recording, without any spike-and-wave discharges associated with the startles. We report this unique case with startle responses induced both by acoustic and photic stimuli and review the literature related to this exceptionally rare combination of symptoms.
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Affiliation(s)
- Burcu Zeydan
- a Department of Neurology , Cerrahpasa School of Medicine, Istanbul University , Istanbul , Turkey
| | - Aysegul Gunduz
- a Department of Neurology , Cerrahpasa School of Medicine, Istanbul University , Istanbul , Turkey
| | - Veysi Demirbilek
- a Department of Neurology , Cerrahpasa School of Medicine, Istanbul University , Istanbul , Turkey
| | - Aysin Dervent
- a Department of Neurology , Cerrahpasa School of Medicine, Istanbul University , Istanbul , Turkey
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Lin K, Guaranha M, Wolf P. Reflex epileptic mechanisms in ictogenesis and therapeutic consequences. Expert Rev Neurother 2016; 16:573-85. [PMID: 26999567 DOI: 10.1586/14737175.2016.1169174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Recent studies of reflex epileptic mechanisms in human epilepsy using advanced methods of neurophysiology and functional neuroimaging have contributed much to elucidate pathophysiological processes of seizure generation. Whereas in lesional focal epilepsies reflex mechanisms usually relate directly to the anatomical focus, in system epilepsies they have helped to define which functional anatomical systems serving physiological function are recruited by the ictogenic mechanisms. Reflex epileptic seizures can often be prevented by avoidance or modification of triggers or by prophylactic benzodiazepine administration. Surgical options apply to focal cases. According to restricted experiences with pharmacotherapy, without controlled studies and little information on new AEDs, reflex seizures in system epilepsies appear to respond best to valproic acid and in focal epilepsies, to carbamazepine.
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Affiliation(s)
- Katia Lin
- a Serviço de Neurologia, Departamento de Clínica Médica , Hospital Universitário, Universidade Federal de Santa Catarina (UFSC) , Florianópolis , SC , Brazil
| | - Mirian Guaranha
- b Hospital São Paulo , Universidade Federal de São Paulo , São Paulo , Brazil
| | - Peter Wolf
- a Serviço de Neurologia, Departamento de Clínica Médica , Hospital Universitário, Universidade Federal de Santa Catarina (UFSC) , Florianópolis , SC , Brazil.,c Danish Epilepsy Centre , Dianalund , Denmark
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Ito Y, Natsume J, Kidokoro H, Ishihara N, Azuma Y, Tsuji T, Okumura A, Kubota T, Ando N, Saitoh S, Miura K, Negoro T, Watanabe K, Kojima S. Seizure characteristics of epilepsy in childhood after acute encephalopathy with biphasic seizures and late reduced diffusion. Epilepsia 2015; 56:1286-93. [DOI: 10.1111/epi.13068] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Yuji Ito
- Department of Pediatrics; Nagoya University Graduate School of Medicine; Aichi Japan
- Brain & Mind Research Center; Nagoya University; Aichi Japan
| | - Jun Natsume
- Department of Pediatrics; Nagoya University Graduate School of Medicine; Aichi Japan
- Brain & Mind Research Center; Nagoya University; Aichi Japan
| | - Hiroyuki Kidokoro
- Department of Pediatrics; Nagoya University Graduate School of Medicine; Aichi Japan
- Brain & Mind Research Center; Nagoya University; Aichi Japan
| | - Naoko Ishihara
- Department of Pediatrics; Nagoya University Graduate School of Medicine; Aichi Japan
- Department of Pediatrics; Fujita Health University School of Medicine; Aichi Japan
| | - Yoshiteru Azuma
- Department of Pediatrics; Nagoya University Graduate School of Medicine; Aichi Japan
| | - Takeshi Tsuji
- Department of Pediatrics; Okazaki City Hospital; Aichi Japan
| | - Akihisa Okumura
- Department of Pediatrics; Juntendo University Faculty of Medicine; Tokyo Japan
- Department of Pediatrics; Aichi Medical University; Aichi Japan
| | - Tetsuo Kubota
- Department of Pediatrics; Anjo Kosei Hospital; Aichi Japan
| | - Naoki Ando
- Department of Pediatrics and Neonatology; Nagoya City University Graduate School of Medical Sciences; Aichi Japan
| | - Shinji Saitoh
- Department of Pediatrics and Neonatology; Nagoya City University Graduate School of Medical Sciences; Aichi Japan
| | - Kiyokuni Miura
- Department of Pediatrics; Nagoya University Graduate School of Medicine; Aichi Japan
| | - Tamiko Negoro
- Department of Pediatrics; Nagoya University Graduate School of Medicine; Aichi Japan
| | - Kazuyoshi Watanabe
- Department of Pediatrics; Nagoya University Graduate School of Medicine; Aichi Japan
| | - Seiji Kojima
- Department of Pediatrics; Nagoya University Graduate School of Medicine; Aichi Japan
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Miró J, Jaraba S, Mora J, Puig O, Castañer S, Rodriguez-Bel L, Santurino M, Plans G, Falip M. Vagus nerve stimulation therapy is effective and safe for startle-induced seizures. J Neurol Sci 2015; 354:124-6. [PMID: 25979636 DOI: 10.1016/j.jns.2015.04.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 04/28/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Júlia Miró
- Epilepsy Unit, Neurology Department, Hospital Universitari de Bellvitge, Spain.
| | - Sònia Jaraba
- Epilepsy Unit, Neurology Department, Hospital Universitari de Bellvitge, Spain
| | - Jaume Mora
- Nuclear Medicine Department, Hospital Universitari de Bellvitge, Spain
| | - Oriol Puig
- Nuclear Medicine Department, Hospital Universitari de Bellvitge, Spain
| | - Sara Castañer
- IDI (Institut de Diagnòstic per la Imatge), Magnetic Resonance Image Unit, Hospital Universitari de Bellvitge, Spain
| | - Laura Rodriguez-Bel
- IDI (Institut de Diagnòstic per la Imatge), Positron Emission Tomography (PET) Unit, Hospital Universitari de Bellvitge, Spain
| | - Mila Santurino
- Epilepsy Unit, Neurology Department, Hospital Universitari de Bellvitge, Spain
| | - Gerard Plans
- Neurosurgery Department, Epilepsy Unit, Hospital Universitari de Bellvitge, Spain
| | - Mercè Falip
- Epilepsy Unit, Neurology Department, Hospital Universitari de Bellvitge, Spain
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Irmen F, Wehner T, Lemieux L. Do reflex seizures and spontaneous seizures form a continuum? - triggering factors and possible common mechanisms. Seizure 2014; 25:72-9. [PMID: 25645641 DOI: 10.1016/j.seizure.2014.12.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 12/06/2014] [Accepted: 12/14/2014] [Indexed: 11/26/2022] Open
Abstract
Recent changes in the understanding and classification of reflex seizures have fuelled a debate on triggering mechanisms of seizures and their conceptual organization. Previous studies and patient reports have listed extrinsic and intrinsic triggers, albeit their multifactorial and dynamic nature is poorly understood. This paper aims to review literature on extrinsic and intrinsic seizure triggers and to discuss common mechanisms among them. Among self-reported seizure triggers, emotional stress is most frequently named. Reflex seizures are typically associated with extrinsic sensory triggers; however, intrinsic cognitive or proprioceptive triggers have also been assessed. The identification of a trigger underlying a seizure may be more difficult if it is intrinsic and complex, and if triggering mechanisms are multifactorial. Therefore, since observability of triggers varies and triggers are also found in non-reflex seizures, the present concept of reflex seizures may be questioned. We suggest the possibility of a conceptual continuum between reflex and spontaneous seizures rather than a dichotomy and discuss evidence to the notion that to some extent most seizures might be triggered.
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Affiliation(s)
- Friederike Irmen
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, United Kingdom
| | - Tim Wehner
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, United Kingdom; National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Louis Lemieux
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, United Kingdom.
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Job AS, De Palma L, Principe A, Hoffmann D, Minotti L, Chabardès S, David O, Kahane P. The pivotal role of the supplementary motor area in startle epilepsy as demonstrated by SEEG epileptogenicity maps. Epilepsia 2014; 55:e85-8. [DOI: 10.1111/epi.12659] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Anne-Sophie Job
- Inserm; U836; Grenoble France
- University Grenoble Alpes; GIN; Grenoble France
- Neurology Department; CHU de Grenoble; Hospital Michallon; Grenoble France
| | - Luca De Palma
- Neurology Department; CHU de Grenoble; Hospital Michallon; Grenoble France
| | - Alessandro Principe
- Epilepsy Unit; Department of Neurology; Hospital del Mar - Parc de Salut Mar; Barcelona Spain
| | - Dominique Hoffmann
- Neurosurgery Department; CHU Grenoble; Hospital Michallon; Grenoble France
| | - Lorella Minotti
- Inserm; U836; Grenoble France
- University Grenoble Alpes; GIN; Grenoble France
- Neurology Department; CHU de Grenoble; Hospital Michallon; Grenoble France
| | - Stephan Chabardès
- Inserm; U836; Grenoble France
- University Grenoble Alpes; GIN; Grenoble France
- Neurosurgery Department; CHU Grenoble; Hospital Michallon; Grenoble France
| | - Olivier David
- Inserm; U836; Grenoble France
- University Grenoble Alpes; GIN; Grenoble France
| | - Philippe Kahane
- Inserm; U836; Grenoble France
- University Grenoble Alpes; GIN; Grenoble France
- Neurology Department; CHU de Grenoble; Hospital Michallon; Grenoble France
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Italiano D, Ferlazzo E, Gasparini S, Spina E, Mondello S, Labate A, Gambardella A, Aguglia U. Generalized versus partial reflex seizures: a review. Seizure 2014; 23:512-20. [PMID: 24766826 DOI: 10.1016/j.seizure.2014.03.014] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 03/24/2014] [Indexed: 11/30/2022] Open
Abstract
In this review we assess our currently available knowledge about reflex seizures with special emphasis on the difference between "generalized" reflex seizures induced by visual stimuli, thinking, praxis and language tasks, and "focal" seizures induced by startle, eating, music, hot water, somatosensory stimuli and orgasm. We discuss in particular evidence from animal, clinical, neurophysiological and neuroimaging studies supporting the concept that "generalized" reflex seizures, usually occurring in the setting of IGE, should be considered as focal seizures with quick secondary generalization. We also review recent advances in genetic and therapeutic approach of reflex seizures.
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Affiliation(s)
- Domenico Italiano
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Edoardo Ferlazzo
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy; Regional Epilepsy Centre, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy.
| | - Sara Gasparini
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Edoardo Spina
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | | | - Angelo Labate
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Antonio Gambardella
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy; National Research Council, Piano Lago di Mangone, Cosenza, Italy
| | - Umberto Aguglia
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy; Regional Epilepsy Centre, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
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Seizure-free after surgery in a patient with non-lesional startle epilepsy: a case report. Epilepsy Behav 2012; 25:700-3. [PMID: 23141145 DOI: 10.1016/j.yebeh.2012.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Revised: 08/31/2012] [Accepted: 09/02/2012] [Indexed: 01/29/2023]
Abstract
We present the case of a patient with startle epilepsy provoked by auditory, somatosensory and visual stimuli during video-electrocorticography (ECoG) recording. Ictal ECoG of all types of seizures triggered by the three kinds of stimuli showed that seizure onset originated from the left supplementary sensorimotor area (SSMA). The patient has been seizure-free after the cortex around the left SSMA only had been resected. Therefore, we speculate that left SSMA is the epileptogenic zone of startle epilepsy in this patient and perhaps the primary cortex to modulate the startle reflex in healthy persons.
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Jeong W, Chung CK, Kim JS. Localization value of magnetoencephalography interictal spikes in adult nonlesional neocortical epilepsy. J Korean Med Sci 2012; 27:1391-7. [PMID: 23166423 PMCID: PMC3492676 DOI: 10.3346/jkms.2012.27.11.1391] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 08/22/2012] [Indexed: 12/01/2022] Open
Abstract
Few studies have included magnetoencephalography (MEG) when assessing the diagnostic value of presurgical modalities in a nonlesional epilepsy population. Here, we compare single photon emission computed tomography (SPECT), positron emission tomography (PET), video-EEG (VEEG), and MEG, with intracranial EEG (iEEG) to determine the value of individual modalities to surgical decisions. We analyzed 23 adult epilepsy patients with no abnormal MRI findings who had undergone surgical resection. Localization of individual presurgical tests was determined for hemispheric and lobar locations based on visual analysis. Each localization result was compared with the ictal onset zone (IOZ) defined by using iEEG. The highest to the lowest hemispheric concordance rates were MEG (83%) > ictal VEEG (78%) > PET (70%) > ictal SPECT (57%). The highest to lowest lobar concordance rates were ictal VEEG = MEG (65%) > PET (57%) > ictal SPECT (52%). Statistical analysis showed MEG to have a higher hemispheric concordance than that of ictal SPECT (P = 0.031). We analyzed the effects of MEG clustered-area resection on surgical outcome. Patients who had resection of MEG clusters showed a better surgical outcome than those without such resection (P = 0.038). It is suggested that MEG-based localization had the highest concordance with the iEEG-defined IOZ. Furthermore, MEG cluster resection has prognostic significance in predicting surgical outcome.
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Affiliation(s)
- Woorim Jeong
- MEG Center, Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Chun Kee Chung
- MEG Center, Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
- Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea
| | - June Sic Kim
- MEG Center, Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
- Research Center for Sensory Organs, Seoul National University, Seoul, Korea
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Affiliation(s)
- Peter Wolf
- Danish Epilepsy Center Filadelfia, Dianalund, Denmark.
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Fernández S, Donaire A, Maestro I, Seres E, Setoain X, Bargalló N, Rumià J, Boget T, Falcón C, Carreño M. Functional neuroimaging in startle epilepsy: Involvement of a mesial frontoparietal network. Epilepsia 2011; 52:1725-32. [DOI: 10.1111/j.1528-1167.2011.03172.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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