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Gates S, Hackman DE, Agarwal N, Zhang W, Barnard P, White JR. Postoperative Neurologic Outcome in Patients Undergoing Resective Surgery for Parietal Lobe Epilepsy: A Systematic Review. Neurology 2024; 102:e209322. [PMID: 38815235 DOI: 10.1212/wnl.0000000000209322] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Parietal lobe epilepsy (PLE) surgery can be an effective treatment for selected patients with intractable epilepsy but can be associated with the risk of serious neurologic deficits. We performed a systematic review of the literature to obtain a comprehensive summary of the frequency and types of new postoperative neurologic deficits in patients undergoing PLE resective surgery. METHODS We searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials for articles published between January 1, 1990, and April 28, 2022. We included studies that reported postoperative neurologic outcome following PLE resective surgery confined to the parietal lobe. We required that studies included ≥5 patients. The data collected included demographic information and specific details of postoperative neurologic deficits. When available, individual patient data were collected. We used the Risk of Bias in Nonrandomized Studies of Interventions tool to assess the risk of bias and Grading of Recommendations Assessment, Development, and Evaluation to assess the quality of the evidence. RESULTS Of the 3,461 articles screened, 33 studies met the inclusion criteria. A total of 370 patients were included. One hundred patients (27.0%) had a new deficit noted postoperatively. Approximately half of the patients with deficits experienced only transient deficits. Motor deficits were the most commonly identified deficit. The rates of motor deficits noted after PLE surgery were 5.7%, 3.2%, and 2.2% for transient, long-term, and duration not specified, respectively. Sensory and visual field deficits were also commonly reported. Gerstmann syndrome was noted postoperatively in 4.9% of patients and was almost always transient. Individual patient data added information on parietal lobe subregion postoperative neurologic outcome. DISCUSSION Our systematic review provides a comprehensive summary of the frequency and types of neurologic deficits associated with PLE surgery. A significant percentage of postoperative deficits are transient. In addition to the expected sensory and visual deficits, PLE surgery is associated with a notable risk of motor deficits. The available literature has important deficiencies. Our study highlights gaps in the literature and provides recommendations for future directions. TRIAL REGISTRATION INFORMATION This systematic review was registered on PROSPERO (CRD42022313108, May 26, 2022).
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Affiliation(s)
- Stuart Gates
- From the University of Minnesota Medical School (S.G.), Minneapolis, MN; Dr. Martin Luther King, Jr. Library (D.E.H.), San José State University, San José, CA; Pediatric Epileptology (N.A.), Minnesota Epilepsy Group, Roseville; Pediatric Epileptology (N.A.), Children's Minnesota, Minneapolis; Neurology (W.Z., J.R.W.), Minnesota Epilepsy Group, Roseville; Neurology (W.Z.), United Hospital of Allina Health, St. Paul; Allina Health (P.B.); Center for Orphan Drug Research (J.R.W.), University of Minnesota; and Epileptology (J.R.W.), Abbott Northwestern Hospital, Minneapolis, MN
| | - Dawn E Hackman
- From the University of Minnesota Medical School (S.G.), Minneapolis, MN; Dr. Martin Luther King, Jr. Library (D.E.H.), San José State University, San José, CA; Pediatric Epileptology (N.A.), Minnesota Epilepsy Group, Roseville; Pediatric Epileptology (N.A.), Children's Minnesota, Minneapolis; Neurology (W.Z., J.R.W.), Minnesota Epilepsy Group, Roseville; Neurology (W.Z.), United Hospital of Allina Health, St. Paul; Allina Health (P.B.); Center for Orphan Drug Research (J.R.W.), University of Minnesota; and Epileptology (J.R.W.), Abbott Northwestern Hospital, Minneapolis, MN
| | - Nitin Agarwal
- From the University of Minnesota Medical School (S.G.), Minneapolis, MN; Dr. Martin Luther King, Jr. Library (D.E.H.), San José State University, San José, CA; Pediatric Epileptology (N.A.), Minnesota Epilepsy Group, Roseville; Pediatric Epileptology (N.A.), Children's Minnesota, Minneapolis; Neurology (W.Z., J.R.W.), Minnesota Epilepsy Group, Roseville; Neurology (W.Z.), United Hospital of Allina Health, St. Paul; Allina Health (P.B.); Center for Orphan Drug Research (J.R.W.), University of Minnesota; and Epileptology (J.R.W.), Abbott Northwestern Hospital, Minneapolis, MN
| | - Wenbo Zhang
- From the University of Minnesota Medical School (S.G.), Minneapolis, MN; Dr. Martin Luther King, Jr. Library (D.E.H.), San José State University, San José, CA; Pediatric Epileptology (N.A.), Minnesota Epilepsy Group, Roseville; Pediatric Epileptology (N.A.), Children's Minnesota, Minneapolis; Neurology (W.Z., J.R.W.), Minnesota Epilepsy Group, Roseville; Neurology (W.Z.), United Hospital of Allina Health, St. Paul; Allina Health (P.B.); Center for Orphan Drug Research (J.R.W.), University of Minnesota; and Epileptology (J.R.W.), Abbott Northwestern Hospital, Minneapolis, MN
| | - Pamela Barnard
- From the University of Minnesota Medical School (S.G.), Minneapolis, MN; Dr. Martin Luther King, Jr. Library (D.E.H.), San José State University, San José, CA; Pediatric Epileptology (N.A.), Minnesota Epilepsy Group, Roseville; Pediatric Epileptology (N.A.), Children's Minnesota, Minneapolis; Neurology (W.Z., J.R.W.), Minnesota Epilepsy Group, Roseville; Neurology (W.Z.), United Hospital of Allina Health, St. Paul; Allina Health (P.B.); Center for Orphan Drug Research (J.R.W.), University of Minnesota; and Epileptology (J.R.W.), Abbott Northwestern Hospital, Minneapolis, MN
| | - James R White
- From the University of Minnesota Medical School (S.G.), Minneapolis, MN; Dr. Martin Luther King, Jr. Library (D.E.H.), San José State University, San José, CA; Pediatric Epileptology (N.A.), Minnesota Epilepsy Group, Roseville; Pediatric Epileptology (N.A.), Children's Minnesota, Minneapolis; Neurology (W.Z., J.R.W.), Minnesota Epilepsy Group, Roseville; Neurology (W.Z.), United Hospital of Allina Health, St. Paul; Allina Health (P.B.); Center for Orphan Drug Research (J.R.W.), University of Minnesota; and Epileptology (J.R.W.), Abbott Northwestern Hospital, Minneapolis, MN
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Skandalakis GP, Linn W, Yeh F, Kazim SF, Komaitis S, Neromyliotis E, Dimopoulos D, Drosos E, Hadjipanayis CG, Kongkham PN, Zadeh G, Stranjalis G, Koutsarnakis C, Kogan M, Evans LT, Kalyvas A. Unveiling the axonal connectivity between the precuneus and temporal pole: Structural evidence from the cingulum pathways. Hum Brain Mapp 2024; 45:e26771. [PMID: 38925589 PMCID: PMC11199201 DOI: 10.1002/hbm.26771] [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: 10/30/2023] [Revised: 04/17/2024] [Accepted: 06/08/2024] [Indexed: 06/28/2024] Open
Abstract
Neuroimaging studies have consistently demonstrated concurrent activation of the human precuneus and temporal pole (TP), both during resting-state conditions and various higher-order cognitive functions. However, the precise underlying structural connectivity between these brain regions remains uncertain despite significant advancements in neuroscience research. In this study, we investigated the connectivity of the precuneus and TP by employing parcellation-based fiber micro-dissections in human brains and fiber tractography techniques in a sample of 1065 human subjects and a sample of 41 rhesus macaques. Our results demonstrate the connectivity between the posterior precuneus area POS2 and the areas 35, 36, and TG of the TP via the fifth subcomponent of the cingulum (CB-V) also known as parahippocampal cingulum. This finding contributes to our understanding of the connections within the posteromedial cortices, facilitating a more comprehensive integration of anatomy and function in both normal and pathological brain processes. PRACTITIONER POINTS: Our investigation delves into the intricate architecture and connectivity patterns of subregions within the precuneus and temporal pole, filling a crucial gap in our knowledge. We revealed a direct axonal connection between the posterior precuneus (POS2) and specific areas (35, 35, and TG) of the temporal pole. The direct connections are part of the CB-V pathway and exhibit a significant association with the cingulum, SRF, forceps major, and ILF. Population-based human tractography and rhesus macaque fiber tractography showed consistent results that support micro-dissection outcomes.
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Affiliation(s)
- Georgios P. Skandalakis
- Section of NeurosurgeryDartmouth Hitchcock Medical CenterLebanonNew HampshireUSA
- Department of NeurosurgeryNational and Kapodistrian University of Athens School of MedicineAthensGreece
| | - Wen‐Jieh Linn
- Department of Neurological SurgeryUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Fang‐Cheng Yeh
- Department of Neurological SurgeryUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Syed Faraz Kazim
- Department of NeurosurgeryUniversity of New Mexico HospitalAlbuquerqueNew MexicoUSA
| | - Spyridon Komaitis
- Department of NeurosurgeryNational and Kapodistrian University of Athens School of MedicineAthensGreece
| | - Eleftherios Neromyliotis
- Department of NeurosurgeryNational and Kapodistrian University of Athens School of MedicineAthensGreece
| | - Dimitrios Dimopoulos
- Department of NeurosurgeryNational and Kapodistrian University of Athens School of MedicineAthensGreece
| | - Evangelos Drosos
- Department of NeurosurgeryNational and Kapodistrian University of Athens School of MedicineAthensGreece
| | | | - Paul N. Kongkham
- Department of NeurosurgeryToronto Western Hospital, University Health NetworkTorontoOntarioCanada
| | - Gelareh Zadeh
- Department of NeurosurgeryToronto Western Hospital, University Health NetworkTorontoOntarioCanada
| | - George Stranjalis
- Department of NeurosurgeryNational and Kapodistrian University of Athens School of MedicineAthensGreece
| | - Christos Koutsarnakis
- Department of NeurosurgeryNational and Kapodistrian University of Athens School of MedicineAthensGreece
| | - Michael Kogan
- Department of NeurosurgeryUniversity of New Mexico HospitalAlbuquerqueNew MexicoUSA
| | - Linton T. Evans
- Section of NeurosurgeryDartmouth Hitchcock Medical CenterLebanonNew HampshireUSA
| | - Aristotelis Kalyvas
- Department of NeurosurgeryToronto Western Hospital, University Health NetworkTorontoOntarioCanada
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Wang X, Huang Y, Chen L, Mai J, Fang D, Mo T, Qi X, Zeng H. A Potential Mechanism of Neurological Impairment in Children With Infantile Spasm: Based on Microanatomic Structure Analysis Employing Voxel-Based Morphometry and Surface-Based Morphometry. Pediatr Neurol 2024; 153:116-124. [PMID: 38367486 DOI: 10.1016/j.pediatrneurol.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/09/2023] [Accepted: 12/11/2023] [Indexed: 02/19/2024]
Abstract
BACKGROUND Infantile epileptic spasms syndrome (IESS) would accompany with severe neurological impairment. Our study aimed to explore the potential mechanism by employing voxel-based and surface-based morphometry to detect brain microwould accompany with severe neurological impairment. Our study aimed to explore the potential mechanism by employing voxel-based and surface-based morphometry to detect brain microanatomic structure alteration. METHODS The IESS group had 21 males and 13 females (mean age: 17.7 ± 15.6 months), whereas the healthy controls group had 22 males and 10 females (mean age: 29.4 ± 18.7 months). High-resolution 3D T1WI was performed. Computational Anatomy Toolbox implemented in Statistical Parametric Mapping 12 was used to measure the gray matter and white matter volume, and the cortical thickness separately. Independent sample t test was used to assess between-group differences. IESS group was assessed using the Bayley Scales of Infant Development. RESULTS The IESS group showed a significantly decreased volume of gray matter in right middle temporal gyrus, inferior temporal gyrus, superior temporal gyrus, right fusiform, and bilateral precuneus (P < 0.001). There were no significant between-group differences with respect to white matter volume or cortical thickness (P > 0.001). The results of Bayley Scales of Infant Development showed that the Mental Development Index (MDI) and Psychomotor Development Index scores of children with IESS were almost concentrated in the range of <70. MDI score showed a positive correlation with gray matter reduction area in IESS group. CONCLUSION Children with IESS had impaired cognitive and delayed motor development. And the decreased gray matter in the right temporal lobe, fusiform, and bilateral precuneus could be the potential anatomic basis for impaired function, such as hearing, visual, and language.
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Affiliation(s)
- Xiaoyu Wang
- Department of Radiology, Shenzhen Children's Hospital, Shenzhen, China
| | - Yuchun Huang
- Department of Radiology, Longhua District Shenzhen People's Hospital, Shenzhen, China
| | - Li Chen
- Department of Neurology, Shenzhen Children's Hospital, Shenzhen, China
| | - Jiahui Mai
- Department of Neurology, Shenzhen Children's Hospital, Shenzhen, China
| | - Diangang Fang
- Department of Radiology, Shenzhen Children's Hospital, Shenzhen, China
| | - Tong Mo
- Department of Radiology, Shenzhen Children's Hospital, Shenzhen, China
| | - Xinxin Qi
- China Medical University, Shenyang, China
| | - Hongwu Zeng
- Department of Radiology, Shenzhen Children's Hospital, Shenzhen, China.
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Abstract
PURPOSE OF REVIEW Electrical stimulation of the peripheral and central vestibular system using noninvasive (galvanic vestibular stimulation, GVS) or invasive (intracranial electrical brain stimulation, iEBS) approaches have a long history of use in studying self-motion perception and balance control. The aim of this review is to summarize recent electrophysiological studies of the effects of GVS, and functional mapping of the central vestibular system using iEBS in awake patients. RECENT FINDINGS The use of GVS has become increasingly common in the assessment and treatment of a wide range of clinical disorders including vestibulopathy and Parkinson's disease. The results of recent single unit recording studies have provided new insight into the neural mechanisms underlying GVS-evoked improvements in perceptual and motor responses. Furthermore, the application of iEBS in patients with epilepsy or during awake brain surgery has provided causal evidence of vestibular information processing in mostly the middle cingulate cortex, posterior insula, inferior parietal lobule, amygdala, precuneus, and superior temporal gyrus. SUMMARY Recent studies have established that GVS evokes robust and parallel activation of both canal and otolith afferents that is significantly different from that evoked by natural head motion stimulation. Furthermore, there is evidence that GVS can induce beneficial neural plasticity in the central pathways of patients with vestibular loss. In addition, iEBS studies highlighted an underestimated contribution of areas in the medial part of the cerebral hemispheres to the cortical vestibular network.
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Affiliation(s)
- Christophe Lopez
- Aix Marseille Univ, CNRS, Laboratory of Cognitive Neuroscience (LNC), FR3C, Marseille, France
| | - Kathleen E. Cullen
- Department of Biomedical Engineering, Johns Hopkins University
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University
- Department of Neuroscience, Johns Hopkins University
- Kavli Neuroscience Discovery Institute, Johns Hopkins University, Baltimore 21205 MD, USA
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Lyu D, Stieger JR, Xin C, Ma E, Lusk Z, Aparicio MK, Werbaneth K, Perry CM, Deisseroth K, Buch V, Parvizi J. Causal evidence for the processing of bodily self in the anterior precuneus. Neuron 2023; 111:2502-2512.e4. [PMID: 37295420 DOI: 10.1016/j.neuron.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/05/2023] [Accepted: 05/14/2023] [Indexed: 06/12/2023]
Abstract
To probe the causal importance of the human posteromedial cortex (PMC) in processing the sense of self, we studied a rare cohort of nine patients with electrodes implanted bilaterally in the precuneus, posterior cingulate, and retrosplenial regions with a combination of neuroimaging, intracranial recordings, and direct cortical stimulations. In all participants, the stimulation of specific sites within the anterior precuneus (aPCu) caused dissociative changes in physical and spatial domains. Using single-pulse electrical stimulations and neuroimaging, we present effective and resting-state connectivity of aPCu hot zone with the rest of the brain and show that they are located outside the boundaries of the default mode network (DMN) but connected reciprocally with it. We propose that the function of this subregion of the PMC is integral to a range of cognitive processes that require the self's physical point of reference, given its location within a spatial environment.
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Affiliation(s)
- Dian Lyu
- Laboratory of Behavioral and Cognitive Neuroscience, Stanford University School of Medicine, Stanford, CA, USA; Human Intracranial Cognitive Electrophysiology Program, Stanford University School of Medicine, Stanford, CA, USA; Departments of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA.
| | - James Robert Stieger
- Laboratory of Behavioral and Cognitive Neuroscience, Stanford University School of Medicine, Stanford, CA, USA; Human Intracranial Cognitive Electrophysiology Program, Stanford University School of Medicine, Stanford, CA, USA; Departments of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Cindy Xin
- Laboratory of Behavioral and Cognitive Neuroscience, Stanford University School of Medicine, Stanford, CA, USA; Human Intracranial Cognitive Electrophysiology Program, Stanford University School of Medicine, Stanford, CA, USA; Departments of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Eileen Ma
- Laboratory of Behavioral and Cognitive Neuroscience, Stanford University School of Medicine, Stanford, CA, USA; Human Intracranial Cognitive Electrophysiology Program, Stanford University School of Medicine, Stanford, CA, USA; Departments of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Zoe Lusk
- Laboratory of Behavioral and Cognitive Neuroscience, Stanford University School of Medicine, Stanford, CA, USA; Human Intracranial Cognitive Electrophysiology Program, Stanford University School of Medicine, Stanford, CA, USA; Departments of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Mariel Kalkach Aparicio
- Laboratory of Behavioral and Cognitive Neuroscience, Stanford University School of Medicine, Stanford, CA, USA
| | - Katherine Werbaneth
- Laboratory of Behavioral and Cognitive Neuroscience, Stanford University School of Medicine, Stanford, CA, USA; Human Intracranial Cognitive Electrophysiology Program, Stanford University School of Medicine, Stanford, CA, USA; Departments of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Claire Megan Perry
- Laboratory of Behavioral and Cognitive Neuroscience, Stanford University School of Medicine, Stanford, CA, USA; Human Intracranial Cognitive Electrophysiology Program, Stanford University School of Medicine, Stanford, CA, USA; Departments of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Karl Deisseroth
- Departments of Psychiatry, Stanford University School of Medicine, Stanford, CA, USA; Howard Hughes Medical Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Vivek Buch
- Human Intracranial Cognitive Electrophysiology Program, Stanford University School of Medicine, Stanford, CA, USA; Departments of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Josef Parvizi
- Laboratory of Behavioral and Cognitive Neuroscience, Stanford University School of Medicine, Stanford, CA, USA; Human Intracranial Cognitive Electrophysiology Program, Stanford University School of Medicine, Stanford, CA, USA; Departments of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA; Departments of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA.
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Central precuneus lesions are associated with impaired executive function. Brain Struct Funct 2022; 227:3099-3108. [PMID: 36087124 PMCID: PMC9743014 DOI: 10.1007/s00429-022-02556-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/17/2022] [Indexed: 12/14/2022]
Abstract
The functional roles of the precuneus are unclear. Focal precuneus lesions are rare, making it difficult to identify robust brain-behavior relationships. Distinct functional subdivisions of the precuneus have been proposed based on unique connectivity profiles. This includes an association of the anterior division with bodily awareness, the central region with complex cognition, and the posterior division with visual processing. Our goal was to test the hypothesis that the central precuneus is preferentially involved (compared to the other sectors of the precuneus) in executive function, as estimated from performance on the trail-making test (TMT). 35 patients with focal brain lesions involving the precuneus were included from the University of Iowa and Montpellier University. Multivariate lesion symptom mapping of TMT performance was performed to evaluate whether lesion location was associated with impaired task performance. Lesion symptom mapping revealed a statistically significant association of central precuneus lesions with impaired TMT performance (r = 0.43, p < 0.01). Further, a functional network derived from this precuneus region showed connectivity to other cortical areas implicated in executive function, including the dorsolateral prefrontal cortex and inferior parietal lobe. This analysis provides support for the role of the central precuneus in executive function, consistent with the unique connectivity pattern of the central precuneus with a broader network implicated in cognitive control and executive function.
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Togo M, Matsumoto R, Usami K, Kobayashi K, Takeyama H, Nakae T, Shimotake A, Kikuchi T, Yoshida K, Matsuhashi M, Kunieda T, Miyamoto S, Takahashi R, Ikeda A. Distinct connectivity patterns in human medial parietal cortices: Evidence from standardized connectivity map using cortico-cortical evoked potential. Neuroimage 2022; 263:119639. [PMID: 36155245 DOI: 10.1016/j.neuroimage.2022.119639] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 09/10/2022] [Accepted: 09/19/2022] [Indexed: 11/21/2022] Open
Abstract
The medial parietal cortices are components of the default mode network (DMN), which are active in the resting state. The medial parietal cortices include the precuneus and the dorsal posterior cingulate cortex (dPCC). Few studies have mentioned differences in the connectivity in the medial parietal cortices, and these differences have not yet been precisely elucidated. Electrophysiological connectivity is essential for understanding cortical function or functional differences. Since little is known about electrophysiological connections from the medial parietal cortices in humans, we evaluated distinct connectivity patterns in the medial parietal cortices by constructing a standardized connectivity map using cortico-cortical evoked potential (CCEP). This study included nine patients with partial epilepsy or a brain tumor who underwent chronic intracranial electrode placement covering the medial parietal cortices. Single-pulse electrical stimuli were delivered to the medial parietal cortices (38 pairs of electrodes). Responses were standardized using the z-score of the baseline activity, and a response density map was constructed in the Montreal Neurological Institutes (MNI) space. The precuneus tended to connect with the inferior parietal lobule (IPL), the occipital cortex, superior parietal lobule (SPL), and the dorsal premotor area (PMd) (the four most active regions, in descending order), while the dPCC tended to connect to the middle cingulate cortex, SPL, precuneus, and IPL. The connectivity pattern differs significantly between the precuneus and dPCC stimulation (p<0.05). Regarding each part of the medial parietal cortices, the distributions of parts of CCEP responses resembled those of the functional connectivity database. Based on how the dPCC was connected to the medial frontal area, SPL, and IPL, its connectivity pattern could not be explained by DMN alone, but suggested a mixture of DMN and the frontoparietal cognitive network. These findings improve our understanding of the connectivity profile within the medial parietal cortices. The electrophysiological connectivity is the basis of propagation of electrical activities in patients with epilepsy. In addition, it helps us to better understand the epileptic network arising from the medial parietal cortices.
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Affiliation(s)
- Masaya Togo
- Department of Neurology, Kyoto University Graduate School of Medicine, Japan; Division of Neurology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Riki Matsumoto
- Department of Neurology, Kyoto University Graduate School of Medicine, Japan; Division of Neurology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Kiyohide Usami
- Department of Neurology, Kyoto University Graduate School of Medicine, Japan
| | - Katsuya Kobayashi
- Department of Neurology, Kyoto University Graduate School of Medicine, Japan
| | - Hirofumi Takeyama
- Department of Respiratory Care and Sleep Control Medicine, Kyoto University Graduate School of Medicine, Japan; Department of Neurology, Japanese Red Cross Otsu Hospital, Japan
| | - Takuro Nakae
- Department of Neurosurgery, Shiga General Hospital, Japan
| | - Akihiro Shimotake
- Department of Neurology, Kyoto University Graduate School of Medicine, Japan
| | - Takayuki Kikuchi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Japan
| | - Kazumichi Yoshida
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Japan
| | - Masao Matsuhashi
- Departments of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takeharu Kunieda
- Department of Neurosurgery, Ehime University Graduate School of Medicine, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Japan
| | - Ryosuke Takahashi
- Department of Neurology, Kyoto University Graduate School of Medicine, Japan
| | - Akio Ikeda
- Departments of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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Elisevich L, Abbas S, Burdette D, Heredia G, Elisevich K. The ventral precuneal-posterior cingulate region as a site of epileptogenicity. Epileptic Disord 2022; 24:934-940. [PMID: 35816098 DOI: 10.1684/epd.2022.1457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/18/2022] [Indexed: 11/17/2022]
Abstract
The ventral precuneal and posterior cingulate area (VP-PC) represents a distinct but topographically variable mesial parietal site of epileptogenicity that may manifest as a common temporal lobe-mediated ictal expression. In a review of records of 62 presumptive epilepsy surgery cases, two cases of primary epileptogenicity expressed within the VP-PC were identified and are detailed to bring attention to this electroencephalographically-hidden area of ictal expression. Details of their investigation and surgical treatment illustrate distinctly different approaches addressing the problem and bringing about a seizure-free outcome.
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Affiliation(s)
- Lee Elisevich
- School of Medicine, Central Michigan University, Mount Pleasant MI, USA
| | - Shan Abbas
- Department of Clinical Neurosciences, Spectrum Health, Grand Rapids, MI, USA
- College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - David Burdette
- Department of Clinical Neurosciences, Spectrum Health, Grand Rapids, MI, USA
- College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Gabe Heredia
- Imaging Physics, Department of Radiology, Spectrum Health, Grand Rapids, MI, USA
| | - Kost Elisevich
- Department of Clinical Neurosciences, Spectrum Health, Grand Rapids, MI, USA
- College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
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Jaafar N, Bhatt A, Eid A, Koubeissi MZ. The Temporal Lobe as a Symptomatogenic Zone in Medial Parietal Lobe Epilepsy. Front Neurol 2022; 13:804128. [PMID: 35370889 PMCID: PMC8965346 DOI: 10.3389/fneur.2022.804128] [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: 10/28/2021] [Accepted: 01/26/2022] [Indexed: 11/13/2022] Open
Abstract
Some surgical failures after temporal lobe epilepsy surgery may be due to the presence of an extratemporal epileptogenic zone. Of particular interest is the medial parietal lobe due to its robust connectivity with mesial temporal structures. Seizures in that area may be clinically silent before propagating to the symptomatogenic temporal lobe. In this paper, we present an overview of the anatomical connectivity, semiology, radiology, electroencephalography, neuropsychology, and outcomes in medial parietal lobe epilepsy. We also present two illustrative cases of seizures originating from the precuneus and the posterior cingulate cortex. We conclude that the medial parietal lobe should be strongly considered for sampling by intracranial electrodes in individuals with nonlesional temporal lobe epilepsy, especially if scrutinizing the presurgical data produces discordant findings.
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Affiliation(s)
- Nadim Jaafar
- Department of Neurology, George Washington University, Washington, DC, United States
| | - Amar Bhatt
- Rush Medical College, Rush University, Chicago, IL, United States
| | - Alexandra Eid
- Department of Neurology, George Washington University, Washington, DC, United States
| | - Mohamad Z. Koubeissi
- Department of Neurology, George Washington University, Washington, DC, United States
- *Correspondence: Mohamad Z. Koubeissi
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Fuentealba-Villarroel FJ, Renner J, Hilbig A, Bruton OJ, Rasia-Filho AA. Spindle-Shaped Neurons in the Human Posteromedial (Precuneus) Cortex. Front Synaptic Neurosci 2022; 13:769228. [PMID: 35087390 PMCID: PMC8787311 DOI: 10.3389/fnsyn.2021.769228] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/29/2021] [Indexed: 01/24/2023] Open
Abstract
The human posteromedial cortex (PMC), which includes the precuneus (PC), represents a multimodal brain area implicated in emotion, conscious awareness, spatial cognition, and social behavior. Here, we describe the presence of Nissl-stained elongated spindle-shaped neurons (suggestive of von Economo neurons, VENs) in the cortical layer V of the anterior and central PC of adult humans. The adapted "single-section" Golgi method for postmortem tissue was used to study these neurons close to pyramidal ones in layer V until merging with layer VI polymorphic cells. From three-dimensional (3D) reconstructed images, we describe the cell body, two main longitudinally oriented ascending and descending dendrites as well as the occurrence of spines from proximal to distal segments. The primary dendritic shafts give rise to thin collateral branches with a radial orientation, and pleomorphic spines were observed with a sparse to moderate density along the dendritic length. Other spindle-shaped cells were observed with straight dendritic shafts and rare branches or with an axon emerging from the soma. We discuss the morphology of these cells and those considered VENs in cortical areas forming integrated brain networks for higher-order activities. The presence of spindle-shaped neurons and the current discussion on the morphology of putative VENs address the need for an in-depth neurochemical and transcriptomic characterization of the PC cytoarchitecture. These findings would include these spindle-shaped cells in the synaptic and information processing by the default mode network and for general intelligence in healthy individuals and in neuropsychiatric disorders involving the PC in the context of the PMC functioning.
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Affiliation(s)
- Francisco Javier Fuentealba-Villarroel
- Department of Basic Sciences/Physiology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.,Graduate Program in Neuroscience, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Josué Renner
- Department of Basic Sciences/Physiology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.,Graduate Program in Biosciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Arlete Hilbig
- Department of Medical Clinics/Neurology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Oliver J Bruton
- Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
| | - Alberto A Rasia-Filho
- Department of Basic Sciences/Physiology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.,Graduate Program in Neuroscience, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Graduate Program in Biosciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
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Resting-State MEG Source Space Network Metrics Associated with the Duration of Temporal Lobe Epilepsy. Brain Topogr 2021; 34:731-744. [PMID: 34652579 DOI: 10.1007/s10548-021-00875-9] [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: 05/26/2020] [Accepted: 09/28/2021] [Indexed: 10/20/2022]
Abstract
To evaluate the relationship between the network metrics of 68 brain regions and duration of temporal lobe epilepsy (TLE). Magnetoencephalography (MEG) data from 53 patients with TLE (28 left TLE, 25 right TLE) were recorded between seizures at resting state and analyzed in six frequency bands: delta (0.1-4 Hz), theta (4-8 Hz), lower alpha (8-10 Hz), upper alpha (10-13 Hz), beta (13-30 Hz), and lower gamma (30-48 Hz). Three local network metrics, betweenness centrality, nodal degree, and nodal efficiency, were chosen to analyze the functional brain network. In Left, Right, and All (Left + Right) TLE groups, different metrics provide significant positive or negative correlations with the duration of TLE, in different frequency bands, and in different brain regions. In the Left TLE group, significant correlation between TLE duration and metric exists in the delta, beta, or lower gamma band, with network betweenness centrality, nodal degree, or nodal efficiency, in left caudal middle frontal, left middle temporal, or left supramarginal. In the Right TLE group, significant correlation exists in lower gamma or delta band, with nodal degree, or nodal efficiency, in left precuneus or right temporal pole. In the All TLE group, the significant correlation exists in delta, theta, beta, or lower gamma band, with nodal degree, or betweenness centrality, in either left or right hemisphere. Network metrics for some specific brain regions changed in patients with TLE as the duration of their TLE increased. Further researching these changes may be important for studying the pathogenesis, presurgical evaluation, and clinical treatment of long-term TLE.
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Tanglay O, Young IM, Dadario NB, Briggs RG, Fonseka RD, Dhanaraj V, Hormovas J, Lin YH, Sughrue ME. Anatomy and white-matter connections of the precuneus. Brain Imaging Behav 2021; 16:574-586. [PMID: 34448064 DOI: 10.1007/s11682-021-00529-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
Purpose Advances in neuroimaging have provided an understanding of the precuneus'(PCu) involvement in functions such as visuospatial processing and cognition. While the PCu has been previously determined to be apart of a higher-order default mode network (DMN), recent studies suggest the presence of possible dissociations from this model in order to explain the diverse functions the PCu facilitates, such as in episodic memory. An improved structural model of the white-matter anatomy of the PCu can demonstrate its unique cerebral connections with adjacent regions which can provide additional clarity on its role in integrating information across higher-order cerebral networks like the DMN. Furthermore, this information can provide clinically actionable anatomic information that can support clinical decision making to improve neurologic outcomes such as during cerebral surgery. Here, we sought to derive the relationship between the precuneus and underlying major white-mater bundles by characterizing its macroscopic connectivity. Methods Structural tractography was performed on twenty healthy adult controls from the Human Connectome Project (HCP) utilizing previously demonstrated methodology. All precuneus connections were mapped in both cerebral hemispheres and inter-hemispheric differences in resultant tract volumes were compared with an unpaired, corrected Mann-Whitney U test and a laterality index (LI) was completed. Ten postmortem dissections were then performed to serve as ground truth by using a modified Klingler technique with careful preservation of relevant white matter bundles. Results The precuneus is a heterogenous cortical region with five major types of connections that were present bilaterally. (1) Short association fibers connect the gyri of the precuneus and connect the precuneus to the superior parietal lobule and the occipital cortex. (2) Four distinct parts of the cingulum bundle connect the precuneus to the frontal lobe and the temporal lobe. (3) The middle longitudinal fasciculus from the precuneus connects to the superior temporal gyrus and the dorsolateral temporal pole. (4) Parietopontine fibers travel as part of the corticopontine fibers to connect the precuneus to pontine regions. (5) An extensive commissural bundle connects the precuneus bilaterally. Conclusion We present a summary of the anatomic connections of the precuneus as part of an effort to understand the function of the precuneus and highlight key white-matter pathways to inform surgical decision-making. Our findings support recent models suggesting unique fiber connections integrating at the precuneus which may suggest finer subsystems of the DMN or unique networks, but further study is necessary to refine our model in greater quantitative detail.
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Affiliation(s)
- Onur Tanglay
- Centre for Minimally Invasive Neurosurgery, Suite 19, Level 7 Prince of Wales Private Hospital, Barker Street, Randwick, Sydney, NSW, 2031, Australia
| | | | - Nicholas B Dadario
- Robert Wood Johnson School of Medicine, Rutgers University, New Brunswick, NJ, USA
| | - Robert G Briggs
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - R Dineth Fonseka
- Centre for Minimally Invasive Neurosurgery, Suite 19, Level 7 Prince of Wales Private Hospital, Barker Street, Randwick, Sydney, NSW, 2031, Australia
| | - Vukshitha Dhanaraj
- Centre for Minimally Invasive Neurosurgery, Suite 19, Level 7 Prince of Wales Private Hospital, Barker Street, Randwick, Sydney, NSW, 2031, Australia
| | - Jorge Hormovas
- Centre for Minimally Invasive Neurosurgery, Suite 19, Level 7 Prince of Wales Private Hospital, Barker Street, Randwick, Sydney, NSW, 2031, Australia
| | - Yueh-Hsin Lin
- Centre for Minimally Invasive Neurosurgery, Suite 19, Level 7 Prince of Wales Private Hospital, Barker Street, Randwick, Sydney, NSW, 2031, Australia
| | - Michael E Sughrue
- Centre for Minimally Invasive Neurosurgery, Suite 19, Level 7 Prince of Wales Private Hospital, Barker Street, Randwick, Sydney, NSW, 2031, Australia.
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Abstract
In this manuscript, we report a rare case of a patient with localized seizures originating from the right anterior and dorsal posteromedial cortex (PMC). We mapped the electrophysiological and neuroimaging connectivity of the ictal onset site and replicated seizure auras by stimulating the homotopical PMC site in the left hemisphere. Our findings provide a causal link between PMC and the sense of self and provide unique clues about the pathophysiology of self-dissociation in neuropsychiatric conditions. The posteromedial cortex (PMC) is known to be a core node of the default mode network. Given its anatomical location and blood supply pattern, the effects of targeted disruption of this part of the brain are largely unknown. Here, we report a rare case of a patient (S19_137) with confirmed seizures originating within the PMC. Intracranial recordings confirmed the onset of seizures in the right dorsal posterior cingulate cortex, adjacent to the marginal sulcus, likely corresponding to Brodmann area 31. Upon the onset of seizures, the patient reported a reproducible sense of self-dissociation—a condition he described as a distorted awareness of the position of his body in space and feeling as if he had temporarily become an outside observer to his own thoughts, his “me” having become a separate entity that was listening to different parts of his brain speak to each other. Importantly, 50-Hz electrical stimulation of the seizure zone and a homotopical region within the contralateral PMC induced a subjectively similar state, reproducibly. We supplement our clinical findings with the definition of the patient’s network anatomy at sites of interest using cortico-cortical–evoked potentials, experimental and resting-state electrophysiological connectivity, and individual-level functional imaging. This rare case of patient S19_137 highlights the potential causal importance of the PMC for integrating self-referential information and provides clues for future mechanistic studies of self-dissociation in neuropsychiatric populations.
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Wilenius J, Lauronen L, Kirveskari E, Gaily E, Metsähonkala L, Paetau R. Interictal magnetoencephalography in parietal lobe epilepsy - Comparison of equivalent current dipole and beamformer (SAMepi) analysis. Clin Neurophysiol Pract 2020; 5:64-72. [PMID: 32258834 PMCID: PMC7118275 DOI: 10.1016/j.cnp.2020.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/31/2019] [Accepted: 02/02/2020] [Indexed: 11/18/2022] Open
Abstract
MEG may aid in the localization of the epileptogenic zone in the parietal lobe. SAMepi – a novel kurtosis beamformer – results in localizations similar to those of the ECD analysis. A unifocal result in both the ECD and the SAMepi analysis is associated with a good clinical outcome.
Objective To evaluate a novel analysis method (SAMepi) in the localization of interictal epileptiform magnetoencephalographic (MEG) activity in parietal lobe epilepsy (PLE) patients in comparison with equivalent current dipole (ECD) analysis. Methods We analyzed the preoperative interictal MEG of 17 operated PLE patients utilizing visual analysis and: (1) ECD with a spherical conductor model; (2) ECD with a boundary element method (BEM) conductor model; and (3) SAMepi – a kurtosis beamformer method. Localization results were compared between the three methods, to the location of the resection and to the clinical outcome. Results Fourteen patients had an epileptiform finding in the visual analysis; SAMepi detected spikes in 11 of them. A unifocal finding in both the ECD and in the SAMepi analysis was associated with a better chance of seizure-freedom (p = 0.02). There was no significant difference in the distances from the unifocal MEG localizations to the nearest border of the resection between the different analysis methods. Conclusions Localizations of unifocal interictal spikes detected by SAMepi did not significantly differ from the conventional ECD localizations. Significance SAMepi – a novel semiautomatic analysis method – is useful in localizing interictal epileptiform MEG activity in the presurgical evaluation of parietal lobe epilepsy patients.
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Affiliation(s)
- Juha Wilenius
- HUS Medical Imaging Center, Clinical Neurophysiology, University of Helsinki and Helsinki University Hospital, Finland
- HUS Medical Imaging Center, BioMag Laboratory, University of Helsinki and Helsinki University Hospital, Finland
- Corresponding author at: Department of Clinical Neurophysiology, New Children's Hospital, PO Box 347, 00029 HUS, Finland.
| | - Leena Lauronen
- HUS Medical Imaging Center, Clinical Neurophysiology, University of Helsinki and Helsinki University Hospital, Finland
| | - Erika Kirveskari
- HUS Medical Imaging Center, Clinical Neurophysiology, University of Helsinki and Helsinki University Hospital, Finland
| | - Eija Gaily
- Pediatric Neurology, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Finland
| | - Liisa Metsähonkala
- Pediatric Neurology, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Finland
| | - Ritva Paetau
- HUS Medical Imaging Center, BioMag Laboratory, University of Helsinki and Helsinki University Hospital, Finland
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Parkinson TD, Kornelsen J, Smith SD. Trait Mindfulness and Functional Connectivity in Cognitive and Attentional Resting State Networks. Front Hum Neurosci 2019; 13:112. [PMID: 31031607 PMCID: PMC6473082 DOI: 10.3389/fnhum.2019.00112] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 03/14/2019] [Indexed: 01/31/2023] Open
Abstract
Mindfulness has been described as an orienting of attention to the present moment, with openness and compassion. Individuals displaying high trait mindfulness exhibit this tendency as a more permanent personality attribute. Given the numerous physical and mental health benefits associated with mindfulness, there is a great interest in understanding the neural substrates of this trait. The purpose of the current research was to examine how individual differences in trait mindfulness associated with functional connectivity in five resting-state networks related to cognition and attention: the default mode network (DMN), the salience network (SN), the central executive network (CEN), and the dorsal and ventral attention networks (DAN and VAN). Twenty-eight undergraduate participants completed the Five-Facet Mindfulness Questionnaire (FFMQ), a self-report measure of trait mindfulness which also provides scores on five of its sub-categories (Observing, Describing, Acting with Awareness, Non-judging of Inner Experience, and Non-reactivity to Inner Experience). Participants then underwent a structural MRI scan and a 7-min resting state functional MRI scan. Resting-state data were analyzed using independent-component analyses. An analysis of covariance (ANCOVA) was performed to determine the relationship between each resting state network and each FFMQ score. These analyses indicated that: (1) trait mindfulness and its facets showed increased functional connectivity with neural regions related to attentional control, interoception, and executive function; and (2) trait mindfulness and its facets showed decreased functional connectivity with neural regions related to self-referential processing and mind wandering. These patterns of functional connectivity are consistent with some of the benefits of mindfulness-enhanced attention, self-regulation, and focus on present experience. This study provides support for the notion that non-judgmental attention to the present moment facilitates the integration of regions in neural networks that are related to cognition, attention, and sensation.
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Affiliation(s)
| | | | - Stephen D Smith
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada.,Department of Psychology, University of Winnipeg, Winnipeg, MB, Canada
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Yang Y, Wang H, Zhou W, Qian T, Sun W, Zhao G. Electroclinical characteristics of seizures arising from the precuneus based on stereoelectroencephalography (SEEG). BMC Neurol 2018; 18:110. [PMID: 30103717 PMCID: PMC6088396 DOI: 10.1186/s12883-018-1119-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 08/06/2018] [Indexed: 01/26/2023] Open
Abstract
Background Seizures arising from the precuneus are rare, and few studies have aimed at characterizing the clinical presentation of such seizures within the anatomic context of the frontoparietal circuits. We aimed to characterize the electrophysiological properties and clinical features of seizures arising from the precuneus based on data from stereoelectroencephalography (SEEG). Methods The present retrospective study included 10 patients with medically intractable epilepsy, all of whom were diagnosed with precuneal epilepsy via stereoelectroencephalography (SEEG) at Yuquan Hospital and Xuan Wu Hospital between 2014 and 2016. Clinical semiology, scalp electroencephalography (EEG) findings, magnetic resonance images (MRI), and positron emission tomography (PET) images were analyzed during phase I preoperative evaluations. Following electrode implantation, the semiological sequence, ictal SEEG evolution, and anatomy of the relevant brain structures were analyzed for each seizure. Results Seven of ten patients reported auras, including body image disturbance (2/7), vestibular responses (2/7), somatosensory auras (1/7), visual auras (1/7), and non-specific auras (1/7). Primary motor manifestations included bilateral asymmetric tonic seizures (BATS) (7/10) and hypermotor seizures (HMS) (3/10). In one patient, epileptiform discharge on interictal EEG occurred ipsilateral to the side of the epileptogenic zone (EZ). Discharge was non-lateralized in the remaining nine patients. In six patients, interictal EEG signals were primarily localized in the temporal–parietal–occipital area. In two patients, ictal onset occurred ipsilateral to the EZ, which was mainly located in the temporal–parietal–occipital area. Two patterns of seizure spread were observed. The first pattern was characterized by BATS activity with ictal spread to the supplementary motor area (SMA), paracentral lobule (PCL), precentral gyrus (PrCG), or postcentral gyrus (PoCG). The second pattern was characterized by HMS activity with ictal spread to middle cingulate cortex (MCC) and posterior cingulate cortex (PCC). Conclusion Aura type (e.g., body image disturbance and vestibular response), BATS, and HMS are the main indicators of precuneal epilepsy. Scalp EEG is of little use when attempting to localize precuneal seizures. Our findings indicate that the clinical characteristics of precuneal epilepsy vary among patients, and that the final electro–clinical phenotype depends on the pattern of seizure spread.
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Affiliation(s)
- Yanfeng Yang
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, No 45, Changchun Street, Xicheng District, Beijing, 100053, China.,Department of Neurosurgery, Xuan Wu Hospital, Capital Medical University, No 45, Changchun Street, Xicheng District, Beijing, 100053, China
| | - Haixiang Wang
- Epilepsy Center, Yuquan hospital, Tsinghua University, Beijing, 100049, China
| | - Wenjing Zhou
- Epilepsy Center, Yuquan hospital, Tsinghua University, Beijing, 100049, China
| | - Tianyi Qian
- Department of Radiology, Beijing Key Lab of magnetic resonance imaging (MRI) and Brain Informatics, Xuan Wu Hospital, Capital Medical University, Beijing, 100053, China
| | - Wei Sun
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, No 45, Changchun Street, Xicheng District, Beijing, 100053, China.
| | - Guoguang Zhao
- Department of Neurosurgery, Xuan Wu Hospital, Capital Medical University, No 45, Changchun Street, Xicheng District, Beijing, 100053, China.
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