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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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Suzuki H, Enatsu R, Kanno A, Ochi S, Murahara T, Yazawa S, Shiraishi H, Mikuni N. The Involvement of Sensory-motor Networks in Reflex Seizure. NMC Case Rep J 2017; 4:127-130. [PMID: 29018655 PMCID: PMC5629358 DOI: 10.2176/nmccrj.cr.2017-0031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 04/24/2017] [Indexed: 11/20/2022] Open
Abstract
Reflex seizures are epileptic events triggered by specific external stimuli, or less commonly, internal mental stimuli. Understanding the characteristics of reflex seizures is important to elucidate the mechanisms underlying network abnormalities in epileptic conditions. This report details a patient with medically intractable reflex seizures provoked by sensory stimuli to the patient's right foot. Single-photon emission computed tomography (SPECT) during the seizure induced by sensory stimulation showed hyperperfusion in broad sensory-motor networks (dorsal column-medial lemniscus pathway, left thalamus, bilateral postcentral gyri and posterior parietal cortices, left supplementary motor area (SMA), and left paracentral lobule) and left caudateputamen. The irritative zones and ictal onset zone were localized to the left medial frontoparietal (SMA, anterior and middle cingulate gyrus, and paracentral lobule) and lateral posterior parietal cortices, as evidenced by amelioration of reflex seizures following intracranial electroencephalography and surgical resection of these areas. The neuroradiological and electrophysiological findings in our case study illustrate that the mechanism of reflex seizures may be associated with hyperexcitability of the broad sensory-motor networks, including the basal ganglia. Disconnection of these networks is necessary to treat reflex seizures.
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Affiliation(s)
- Hime Suzuki
- Department of Neurosurgery, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, Japan
| | - Rei Enatsu
- Department of Neurosurgery, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, Japan
| | - Aya Kanno
- Department of Neurosurgery, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, Japan
| | - Satoko Ochi
- Department of Neurosurgery, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, Japan
| | - Takashi Murahara
- Department of Neurology, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, Japan
| | - Shogo Yazawa
- Department of Systems Neuroscience, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, Japan
| | - Hideaki Shiraishi
- Department of Pediatrics, Hokkaido University Graduate, School of Medicine, Sapporo, Hokkaido, Japan
| | - Nobuhiro Mikuni
- Department of Neurosurgery, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, Japan
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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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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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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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Anan M, Kamida T, Abe E, Kubo T, Abe T, Hikawa T, Fujiki M, Kobayashi H, Baba H. A hemispherotomy for intractable startle epilepsy characterized by infantile hemiplegia and drop attacks. J Clin Neurosci 2009; 16:1652-5. [DOI: 10.1016/j.jocn.2009.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Revised: 03/06/2009] [Accepted: 03/11/2009] [Indexed: 10/20/2022]
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García-Morales I, Maestú F, Pérez-Jiménez MA, Elices E, Ortiz T, Alvarez-Linera J, Gil-Nagel A. A clinical and magnetoencephalography study of MRI-negative startle epilepsy. Epilepsy Behav 2009; 16:166-71. [PMID: 19635686 DOI: 10.1016/j.yebeh.2009.06.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2009] [Revised: 06/08/2009] [Accepted: 06/13/2009] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The goal of this study was to investigate clinical findings, ictal semiology, and results of video/electroencephalography (video/EEG), and magnetoencephalography (MEG) in patients with startle epilepsy and normal brain MRI. METHODS Four patients (mean age 12.5 years) with startle epilepsy were investigated with MRI, video/EEG, and MEG. RESULTS Epilepsy diagnosis was established in childhood, and all had spontaneous and reflex seizures. Reflex seizures were triggered by sudden, unexpected sounds and tactile stimuli. The neurological examinations and MRIs were normal. MEG recordings showed focal epileptiform activity. An ictal MEG was obtained in one patient. Source modeling yielded dipole sources in right central frontal region. CONCLUSION The present study demonstrates that the origin of epileptiform activity in startle epilepsy can be localized in brain areas associated with supplementary motor seizures, even in patients with normal brain MRI. MEG adds complementary information to the localization of epileptiform activity and can be useful in planning invasive studies in cases evaluated for epilepsy surgery.
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Affiliation(s)
- Irene García-Morales
- Epilepsy Unit, Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.
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Saeki K, Saito Y, Sugai K, Nakagawa E, Komaki H, Sakuma H, Sasaki M, Kaneko Y. Startle epilepsy associated with gait-induced seizures: Pathomechanism analysis using EEG, MEG, and PET studies. Epilepsia 2009; 50:1274-9. [DOI: 10.1111/j.1528-1167.2008.01890.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Grosso S, Farnetani MA, Bernardoni E, Morgese G, Balestri P. Intractable reflex audiogenic seizures in Aicardi syndrome. Brain Dev 2007; 29:243-6. [PMID: 17084998 DOI: 10.1016/j.braindev.2006.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2006] [Revised: 08/20/2006] [Accepted: 09/02/2006] [Indexed: 11/25/2022]
Abstract
Aicardi syndrome (AS) is a rare disorder which includes the triad of total or partial agenesis of the corpus callosum, infantile spasms, and chorioretinal anomalies. Seizures and electroencephalogram findings observed in AS are polymorphic with both focal and generalized seizures. We first report on a patient affected by AS who presented with reflex audiogenic seizures specifically triggered by the starting tune of a popular television news. No other type of stimuli, either simple or complex, were able to precipitate the seizures in the patient. The severe cortical-subcortical lesions commonly observed in AS are associated with hyperexcitability of the cortices and may well account for the broad electroclinical patterns noted in this group of patients. From our report, the context of these patterns should be extended to include reflex audiogenic seizures.
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Affiliation(s)
- S Grosso
- Department of Pediatrics, Pediatric Neurology Section, University of Siena, Italy.
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Palmini A, Halasz P, Scheffer IE, Takahashi Y, Jimenez AP, Dubeau F, Andermann F, Paglioli-Neto E, da Costa JC, Rosenow F, Fritsch B. Reflex Seizures in Patients with Malformations of Cortical Development and Refractory Epilepsy. Epilepsia 2005; 46:1224-34. [PMID: 16060932 DOI: 10.1111/j.1528-1167.2005.52904.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Malformations of cortical development (MCDs) are usually highly epileptogenic, and their hyperexcitability could facilitate the occurrence of reflex seizures. We sought to characterize reflex seizures in patients with MCDs and refractory epilepsy. METHODS Clinical, electrographic, and neuroimaging data were reviewed in eight patients with MCDs who had reflex seizures reproduced during presurgical evaluation. RESULTS All eight patients had both reflex and spontaneous seizures. In six, however, drop attacks or axial myoclonic seizures occurred only upon specific sensory stimulation. Reflex seizures were induced by more than one type of stimulus in most patients, but anatomofunctional correlations could usually be invoked. Six patients had significant intellectual impairment. Surgical resection controlled seizures in two patients. CONCLUSIONS Reflex seizures in patients with MCDs may be medically refractory and may often manifest as drop attacks or axial myoclonus. Surgical resection of focal lesions can bring reflex seizures under control. Putative mechanisms related to the relatively low frequency of reflex seizures in MCDs are discussed.
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Affiliation(s)
- André Palmini
- Porto Alegre Epilepsy Surgery Program, Hospital São Lucas, Pontificia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.
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Villani F, D'Incerti L, Granata T, Battaglia G, Vitali P, Chiapparini L, Avanzini G. Epileptic and imaging findings in perinatal hypoxic-ischemic encephalopathy with ulegyria. Epilepsy Res 2003; 55:235-43. [PMID: 12972177 DOI: 10.1016/s0920-1211(03)00121-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Hypoxic-ischemic encephalopathy due to fetal or neonatal asphyxia is a major cause of acute mortality and chronic disability involving cerebral palsy, seizures, and mental retardation. The gestational age of the infant is one of the main variables determining the neuropathological picture of hypoxic-ischemic brain injury, and ulegyria (one of its neuropathological correlates) typically affects full-term infants. The damage usually involves the deeper sulcal portion of the convolutions while sparing the crowns, and includes subcortical white matter atrophy and gliosis. The aim of this study was to characterize the electroclinical features of hypoxic-ischemic encephalopathy when ulegyria is one of its main neuropathological features. To this end, nine patients with MRI-proven ulegyria and epilepsy underwent a complete neurological work-up. The ulegyric lesions were mainly distributed in the parasagittal watershed areas and frequently associated with other hypoxic-ischemic lesions. The neurological picture was characterized in most patients by mental retardation, motor deficits, and drug-refractory partial epilepsy. The ulegyria in our patients was associated with a complex clinical picture: epilepsy was a prominent component, and its severity directly correlated with the extent of the ulegyria and the associated hypoxic-ischemic lesions. Drug refractoriness was an almost constant correlate of this form of symptomatic epilepsy.
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Affiliation(s)
- Flavio Villani
- Istituto Nazionale Neurologico, Via Celoria 11, Milan, Italy.
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Chassagnon S, Minotti L, Kremer S, Verceuil L, Hoffmann D, Benabid AL, Kahane P. Restricted frontomesial epileptogenic focus generating dyskinetic behavior and laughter. Epilepsia 2003; 44:859-63. [PMID: 12790903 DOI: 10.1046/j.1528-1157.2003.60802.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Substantial data are missing about the anatomic location of frontal regions supporting gelastic seizures. METHODS We report the results of stereo-electro-encephalographic recordings performed over several distinct functional premotor and executive fields in a patient whose seizures were characterized by dyskinetic behavior and ictal laughter, in the absence of cerebral MRI abnormalities. RESULTS The epileptogenic zone was circumscribed in the anterior and ventral part of the supplementary motor area and the underlying dorsal cingulate cortex. There were no or little spreading to cortical neighboring areas. The patient is seizure-free (follow-up of 27 months) after a stereotactic electric radiofrequency lesion of the epileptogenic focus. CONCLUSION The present data suggest that pericingulate premotor areas are involved in the triggering of the motor component of laughter. In this case, the coexistence of paroxysmal dyskinesias during laughter might reflect the involvement of specific compartment(s) of the basal ganglia.
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Affiliation(s)
- Serge Chassagnon
- Service de Neurologie, Neuropsychologie et explorations fonctionnelles des épilepsies, hospices civils de Strasbourg, Strasbourg, France
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Affiliation(s)
- Patricia G Hosking
- University College Hospitals NHS Trust, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK.
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