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Genetic generalized epilepsy and generalized onset seizures with focal evolution (GOFE). Epilepsy Behav Rep 2022; 19:100555. [PMID: 35706911 PMCID: PMC9189997 DOI: 10.1016/j.ebr.2022.100555] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 05/24/2022] [Accepted: 05/28/2022] [Indexed: 12/03/2022] Open
Abstract
Generalized Onset with Focal Evolution seizure (GOFE) is a rare pattern defined by an evolution from generalized onset to focal activity during the same ictal event. Despite focal clinical features, GOFE refers to Idiopathic Generalized Epilepsy. We found the use of broad-spectrum anti-seizure medications (ASM) was most efficacious in our case series of patients with GOFE.
“Generalized Onset with Focal Evolution” (GOFE) is an underrecognized seizure type defined by an evolution from generalized onset to focal activity during the same ictal event. We aimed to discuss electroclinical aspects of GOFE and to emphasize its link with Genetic Generalized Epilepsy (GGE). Patients were identified retrospectively over 10 years, using the video-EEG data base from the Epilepsy Unit of Strasbourg University Hospital. GOFE was defined, as previously reported, from an EEG point of view with an evolution from generalized onset to focal activity during the same ictal event. Three male patients with GOFE were identified among 51 patients with recorded tonic-clonic seizures. Ages at onset of seizures were 13, 20 and 22 years. Focal clinical features (motor asymmetric phenomenology) could be identified. EEG showed generalized interictal discharges with focal evolution of various localization. Four seizures were recorded characterized by 2–3 s of generalized abnormalities followed by focal (parieto-occipital or frontal) discharges. There were initially uncontrolled seizures with lamotrigine, but all patients reported a good outcome with valproate monotherapy. We emphasize that GOFE presents many similarities with GGE. Recognition of the GOFE entity could bring a therapeutic interest avoiding misdiagnosis of focal epilepsy and consequently inappropriate use of narrow spectrum anti-seizure medicine.
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Sun Y, Li Y, Sun J, Zhang K, Tang L, Wu C, Gao Y, Liu H, Huang S, Hu Z, Xiang J, Wang X. Functional reorganization of brain regions into a network in childhood absence epilepsy: A magnetoencephalography study. Epilepsy Behav 2021; 122:108117. [PMID: 34246893 DOI: 10.1016/j.yebeh.2021.108117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Epilepsy is considered as a network disorder. However, it is unknown how normal brain activity develops into the highly synchronized discharging activity seen in disordered networks. This study aimed to explore the epilepsy brain network and the significant re-combined brain areas in childhood absence epilepsy (CAE). METHODS Twenty-two children with CAE were recruited to study the neural source activity during ictal-onset and interictal periods at frequency bands of 1-30 Hz and 30-80 Hz with magnetoencephalography (MEG) scanning. Accumulated source imaging (ASI) was used to analyze the locations of neural source activity and peak source strength. RESULTS Most of the participants had more active source activity locations in the ictal-onset period rather than in the interictal period, both at 1-30 Hz and 30-80 Hz. The frontal lobe (FL), the temporo-parietal junction (T-P), and the parietal lobe (PL) became the main active areas of source activity during the ictal period, while the precuneus (PC), cuneus, and thalamus were relatively inactive. CONCLUSIONS Some brain areas become more excited and have increased source activity during seizures. These significant brain regions might be re-combined to form an epilepsy network that regulates the process of absence seizures. SIGNIFICANCE The study confirmed that important brain regions are reorganized in an epilepsy network, which provides a basis for exploring the network mechanism of CAE development. Imaging findings may provide a reference for clinical characteristics.
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Affiliation(s)
- Yulei Sun
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Yihan Li
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Jintao Sun
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Ke Zhang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Lu Tang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Caiyun Wu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Yuan Gao
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Hongxing Liu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Shuyang Huang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Zheng Hu
- Department of Neurology, Nanjing Children's Hospital, Nanjing, Jiangsu 210029, China
| | - Jing Xiang
- Division of Neurology, MEG Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Xiaoshan Wang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu 210029, China.
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Spatiotemporal propagation patterns of generalized ictal spikes in childhood absence epilepsy. Clin Neurophysiol 2017; 128:1553-1562. [PMID: 28709121 DOI: 10.1016/j.clinph.2017.05.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 04/29/2017] [Accepted: 05/31/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This work investigates the spatial distribution in time of generalized ictal spikes in the typical absences of childhood absence epilepsy (CAE). METHODS We studied twelve children with CAE, who had more than two typical absences during their routine video-EEG. Seizures were identified, and ictal spikes were marked over the maximum electronegative peak, clustered, waveform-averaged and spatiotemporaly analyzed in 2D electrode space. RESULTS Consistency of spatiotemporal patterns of ictal spikes was high between the absences of the same child, but low between children. Three main discharge patterns were identified: of anterio-posterior propagation, of posterio-anterior propagation and confined to the frontal/prefrontal regions. In 4 patients, the propagation patterns transformed during the seizure into either a lateralized diminished or a non-lateralized reverse direction form. Most spikes originated fronto-temporaly, all maximized over the frontal/prefrontal electrodes and mostly decayed prefrontaly. In 4 patients, lateralized propagation patterns were identified. CONCLUSIONS Ictal spike propagation patterns suggest that epileptogenic CAE networks are personalized, interconnect distal areas in the brain - not the entire cortex - with a tendency to generate bilateral symmetrical discharges, sometimes unsuccessfully. The transformation of propagation patterns during the seizure indicates the existence of dynamic interplay within epileptogenic networks. SIGNIFICANCE Our results support the revised concept of ictogenesis of ILAE definition in genetic (also known as idiopathic) generalized epilepsies. Understanding the focal features in CAE avoids misdiagnosis as focal epilepsy and inappropriate treatment.
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Park KM, Kim TH, Han YH, Mun CW, Shin KJ, Ha SY, Park JS, Kim SE. Brain morphology in juvenile myoclonic epilepsy and absence seizures. Acta Neurol Scand 2016; 133:111-118. [PMID: 25950250 DOI: 10.1111/ane.12436] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2015] [Indexed: 01/12/2023]
Abstract
OBJECTIVE We evaluated the differences in brain morphology among patients with juvenile myoclonic epilepsy according to the occurrence of absence seizures. MATERIALS AND METHODS Twenty-one juvenile myoclonic epilepsy patients with (n = 6) and without (n = 15) absence seizures were enrolled. We analyzed whole-brain T1-weighted magnetic resonance imaging using FreeSurfer 5.1. Measures of cortical morphology, such as thickness, surface area, volume, and curvature, and the volumes of subcortical structures, the cerebellum, and cerebrum, were compared between the groups. Moreover, we quantified correlations between clinical variables and each measures of abnormal brain morphology. RESULTS Compared to normal controls, patients without absence seizures demonstrated thinning of the cortical thickness in the right hemisphere, including the post-central, lingual, orbitofrontal, and lateral occipital cortex. Compared to normal controls, patients with absence seizures had more widespread thinning of the cortical thickness, including the right post-central, lingual, orbitofrontal, and lateral occipital cortexes as well as the right inferior temporal cortex. Additionally, the volume of cerebellar white matter in patients without absence seizures was significantly smaller than that in normal controls. Patients with absence seizures had a much smaller cerebellar white matter volume than normal controls or patients without absence seizures. Moreover, there was significantly positive correlation between the age of seizure onset and the volume of cerebellar white matter in patients with juvenile myoclonic epilepsy. CONCLUSIONS We demonstrated that there were significant brain morphology differences in patients with juvenile myoclonic epilepsy according to the presence of absence seizures. These findings support the hypothesis that juvenile myoclonic epilepsy may be a heterogeneous syndrome.
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Affiliation(s)
- K. M. Park
- Department of Neurology; Haeundae Paik Hospital; Inje University College of Medicine; Busan Korea
| | - T. H. Kim
- Department of Health Science and Technology; Inje University; Gimhae Korea
| | - Y. H. Han
- Centre for Molecular and Cellular Imaging; Samsung Biomedical Research Institute; Seoul Korea
| | - C. W. Mun
- Department of Health Science and Technology; Inje University; Gimhae Korea
- Department of Biomedical Engineering/u-HARC; Inje University; Gimhae Korea
| | - K. J. Shin
- Department of Neurology; Haeundae Paik Hospital; Inje University College of Medicine; Busan Korea
| | - S. Y. Ha
- Department of Neurology; Haeundae Paik Hospital; Inje University College of Medicine; Busan Korea
| | - J. S. Park
- Department of Neurology; Haeundae Paik Hospital; Inje University College of Medicine; Busan Korea
| | - S. E. Kim
- Department of Neurology; Haeundae Paik Hospital; Inje University College of Medicine; Busan Korea
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Yeom JS, Kim YS, Lee JH, Jung S, Kwon OY. Temporal current-source of spikes suggests initial treatment failure in childhood absence epilepsy. Seizure 2015; 31:88-93. [DOI: 10.1016/j.seizure.2015.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 04/01/2015] [Accepted: 07/14/2015] [Indexed: 10/23/2022] Open
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