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Siadat MR, Elisevich K, Soltanian-Zadeh H, Eetemadi A, Smith B. Curvature analysis of perisylvian epilepsy. Acta Neurol Belg 2023; 123:2303-2313. [PMID: 37368146 DOI: 10.1007/s13760-023-02238-6] [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: 10/05/2022] [Accepted: 03/10/2023] [Indexed: 06/28/2023]
Abstract
PURPOSE We assess whether alterations in the convolutional anatomy of the deep perisylvian area (DPSA) might indicate focal epileptogenicity. MATERIALS AND METHODS The DPSA of each hemisphere was segmented on MRI and a 3D gray-white matter interface (GWMI) geometrical model was constructed. Comparative visual and quantitative assessment of the convolutional anatomy of both the left and right DPSA models was performed. Both the density of thorn-like contours (peak percentage) and coarse interface curvatures was computed using Gaussian curvature and shape index, respectively. The proposed method was applied to a total of 14 subjects; 7 patients with an epileptogenic DPSA and 7 non-epileptic subjects. RESULTS A high peak percentage correlated well with the epileptogenic DPSA. It distinguished between patients and non-epileptic subjects (P = 0.029) and identified laterality of the epileptic focus in all but one case. A diminished regional curvature also identified epileptogenicity (P = 0.016) and, moreover, its laterality (P = 0.001). CONCLUSION An increased peak percentage from a global view of the GWMI of the DPSA provides some indication of a propensity toward a focal or regional DPSA epileptogenicity. A diminished convolutional anatomy (i.e., smoothing effect) appears also to coincide with the epileptogenic site in the DPSA and to distinguish laterality.
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Affiliation(s)
- Mohammad-Reza Siadat
- Department of Computer Science and Engineering, Oakland University, 115 Library Dr., #540, Rochester, MI, 48309, USA.
| | - Kost Elisevich
- Department of Surgery, Michigan State University, East Lansing, MI, 48824, USA
| | - Hamid Soltanian-Zadeh
- Department of Diagnostic Radiology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Ameen Eetemadi
- Department of Computer Science, University of California, Davis, CA, 95616, USA
| | - Brien Smith
- Department of Neurosurgery, Ohio Health, Columbus, OH, 43228, USA
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Dos Santos Heringer L, Rios Carvalho J, Teixeira Oliveira J, Texeira Silva B, de Souza Aguiar Dos Santos DM, Martinez Martinez Toledo AL, Borges Savoldi LM, Magalhães Portela D, Adriani Marques S, Campello Costa Lopes P, Blanco Martinez AM, Mendonça HR. Altered excitatory and inhibitory neocortical circuitry leads to increased convulsive severity after pentylenetetrazol injection in an animal model of schizencephaly, but not of microgyria. Epilepsia Open 2022; 7:462-473. [PMID: 35808864 PMCID: PMC9436300 DOI: 10.1002/epi4.12625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/30/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Malformations of the polymicrogyria spectrum can be mimicked in rodents through neonatal transcranial focal cortical freeze lesions. The animals presenting the malformations present both altered synaptic events and epileptiform activity in the vicinity of the microgyrus, but the comprehension of their contribution to increased predisposition or severity of seizures require further studies. METHODS In order to investigate these issues, we induced both microgyria and schizencephaly in 57 mice and evaluated: their convulsive susceptibility and severity after pentyleneterazol (PTZ) treatment, the quantification of their symmetric and asymmetric synapses, the morphology of their dendritic arbors, and the content of modulators of synaptogenesis, such as SPARC, gephyrin and GAP-43 within the adjacent visual cortex. RESULTS Our results have shown that only schizencephalic animals present increased convulsive severity. Nevertheless, both microgyric and schizencephalic cortices present increased synapse number and dendritic complexity of layer IV and layer V-located neurons. Specifically, the microgyric cortex presented reduced inhibitory synapses, while the schizencephalic cortex presented increased excitatory synapses. This altered synapse number is correlated with decreased content of both the anti-synaptogenic factor SPARC and the inhibitory postsynaptic organizer gephyrin in both malformed groups. Besides, GAP-43 content and dendritic spines number are enhanced exclusively in schizencephalic cortices. SIGNIFICANCE In conclusion, our study supports the hypothesis that the sum of synaptic alterations drives to convulsive aggravation in animals with schizencephaly, but not microgyria after PTZ treatment. These findings reveal that different malformations of cortical development should trigger epilepsy via different mechanisms, requiring further studies for development of specific therapeutic interventions.
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Affiliation(s)
- Luiza Dos Santos Heringer
- Neurodegeneration and Repair Lab, Department of Pathology, Postgraduate Program in Anatomical Pathology, Faculty of Medicine, Universitary Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Brazil, Rio de Janeiro, - RJ
| | - Julia Rios Carvalho
- Neurodegeneration and Repair Lab, Department of Pathology, Postgraduate Program in Anatomical Pathology, Faculty of Medicine, Universitary Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Brazil, Rio de Janeiro, - RJ
| | | | - Bruna Texeira Silva
- Laboratory of Neuroplasticity, Department of Neurobiology, Institute of Biology, Brazil, Niterói, - RJ
| | - Domethila Mariano de Souza Aguiar Dos Santos
- Neurodegeneration and Repair Lab, Department of Pathology, Postgraduate Program in Anatomical Pathology, Faculty of Medicine, Universitary Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Brazil, Rio de Janeiro, - RJ
| | - Anna Lecticia Martinez Martinez Toledo
- Neurodegeneration and Repair Lab, Department of Pathology, Postgraduate Program in Anatomical Pathology, Faculty of Medicine, Universitary Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Brazil, Rio de Janeiro, - RJ
| | - Laura Maria Borges Savoldi
- Neurodegeneration and Repair Lab, Department of Pathology, Postgraduate Program in Anatomical Pathology, Faculty of Medicine, Universitary Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Brazil, Rio de Janeiro, - RJ
| | - Debora Magalhães Portela
- Integrated Lab of Morphology, Institute of Biodiversity and Sustainability NUPEM, Brazil, Macaé, - RJ
| | - Suelen Adriani Marques
- Neurodegeneration and Repair Lab, Department of Pathology, Postgraduate Program in Anatomical Pathology, Faculty of Medicine, Universitary Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Brazil, Rio de Janeiro, - RJ
| | | | - Ana Maria Blanco Martinez
- Neurodegeneration and Repair Lab, Department of Pathology, Postgraduate Program in Anatomical Pathology, Faculty of Medicine, Universitary Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Brazil, Rio de Janeiro, - RJ
| | - Henrique Rocha Mendonça
- Neurodegeneration and Repair Lab, Department of Pathology, Postgraduate Program in Anatomical Pathology, Faculty of Medicine, Universitary Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Brazil, Rio de Janeiro, - RJ.,Integrated Lab of Morphology, Institute of Biodiversity and Sustainability NUPEM, Brazil, Macaé, - RJ
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Melikyan AG, Vorobiev AN, Shishkina LV, Kozlova AB, Vlasov PA, Ayvazyan SO, Shults EI, Korsakova MB, Koptelova AM, Buklina SB, Demin MO, Agrba SB, Shevchenko AM. [Surgical treatment of epilepsy in children with focal cortical dysplasia]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2020; 84:5-20. [PMID: 33095529 DOI: 10.17116/neiro2020840515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Surgery is the first-line treatment option in children with FCD and refractory epilepsy, but the rate of success and patient numbers who became free of seizures vary widely from series to series. STUDY AIMS To elicit variables affecting the outcome and predicting achievement of the long-term seizure-free status. MATERIAL AND METHODS One hundred sixty-nine children with cortical dysplasia and DR-epilepsy underwent surgery Preoperative evaluation included prolonged video-EEG and MRI (in all patients) and neuropsychological testing when possible. Fourteen patients underwent invasive EEG, fMRI and MEG were used also in some cases. Including 27 repeat procedures the list of overall 196 surgeries performed consists of: cortectomy (lesionectomy with or without adjacent epileptogenic cortices) – in 116 cases; lobectomy – in 46; and various disconnective procedures – in 34 patients. Almost routinely employed intraoperative ECOG (134 surgeries) was combined with stimulation and/or SSEP in 47 cases to map eloquent cortex (with CST-tracking in some). A new permanent and not anticipated neurological deficit developed post-surgery in 5 cases (2,5%). Patients were follow-upped using video-EEG and MRI and FU which lasts more than 2 years (median – 3 years) is known in 56 cases. Thirty-two children were free of seizures at the last check (57,2% rate of Engel IA). A list of variables regarding patients’ demography, seizure type, lesion pathology and localization, and those related to surgery and its extent were evaluated to figure out anyone associated with favorable outcome. RESULTS Both Type II FCDs and their anatomically complete excision are positive predictors for favorable outcome and achievement of SF-status (p<0,05). Residual epileptic activity on immediate post-resection ECOG do not affect the outcome. CONCLUSION Patients with Type II FCD, particularly with Type IIb malformations are the best candidates for curative surgery, including cases with lesions in brain eloquent areas. Kids with Type I FCD have much less chances to become free of seizures when attempting focal cortectomy. However, some of them with early onset catastrophic epilepsies may benefit from larger surgeries using lobectomy or various disconnections.
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Affiliation(s)
| | | | | | - A B Kozlova
- Burdenko Neurosurgical Center, Moscow, Russia
| | - P A Vlasov
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - E I Shults
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - A M Koptelova
- Center for Neurocognitive research (MEG-center), MSUPE, Moscow, Russia
| | - S B Buklina
- Burdenko Neurosurgical Center, Moscow, Russia
| | - M O Demin
- Burdenko Neurosurgical Center, Moscow, Russia
| | - S B Agrba
- Burdenko Neurosurgical Center, Moscow, Russia
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Atalar AÇ, Vanlı-Yavuz EN, Yılmaz E, Bebek N, Baykan B. Reflex epileptic features in patients with focal epilepsy of unknown cause. Clin Neurol Neurosurg 2019; 190:105633. [PMID: 31865219 DOI: 10.1016/j.clineuro.2019.105633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 11/09/2019] [Accepted: 12/06/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES There is a gap of knowledge regarding reflex seizures in patients with focal epilepsy of unknown cause (FEUC). We aimed to evaluate the prevalence, demographic and clinical characteristics of reflex seizures in patients with FEUC to provide an insight to the underlying ictogenic mechanisms and to draw attention to this important but under-investigated topic. PATIENTS AND METHODS After carefully questioning for reflex triggers, 186 patients diagnosed according to ILAE criteria and followed-up for a minimum of 5 years were included. The demographic and clinical properties as well as electrophysiological and neuroimaging data of these patients were reevaluated and compared to the patients without reflex seizures. RESULTS The reflex seizure rate was 6.5 % in patients with FEUC. Patients with reflex features had lower monotherapy rates (p = 0.005) and higher major depression rates (p = 0.001) than patients without reflex features. The distribution of the patients according to their reflex triggers were as follows: hot-water induced (n = 3, 25 %), photosensitive (n = 2, 16.7 %), eating- induced (n = 2, 16.7 %), musicogenic (n = 2, 16.7 %), startle induced (n = 2, 16.7 %) and both musicogenic and startle type (n = 1, 8.3 %) respectively. The drug resistance rate of patients with reflex seizures was 25 % (n = 3). One patient with drug resistant reflex seizures showed benefit from epilepsy surgery and became seizure-free during last 3 years of follow-up. CONCLUSION A careful and thoroughly history taking specifically questioning and focusing on seizure inducing factors in patients with FEUC is needed to confirm the presence of reflex seizures in patients with FEUC, who had higher rates of polytherapy and major depression. Elaborative evaluation of reflex features in FEUC might contribute to effective seizure control, ensure new therapeutic approaches, enlighten the obscurity and the resulting anxiety of having a diagnosis of FEUC in epilepsy patients.
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Affiliation(s)
- Arife Çimen Atalar
- Istanbul University, Istanbul Faculty of Medicine, Departments of Neurology and Clinical Neurophysiology Unit, Istanbul, Turkey; Istanbul Education and Research Hospital, Istanbul, Turkey.
| | - Ebru Nur Vanlı-Yavuz
- Istanbul University, Istanbul Faculty of Medicine, Departments of Neurology and Clinical Neurophysiology Unit, Istanbul, Turkey; Koc University Hospital, Department of Neurology, Istanbul, Turkey
| | - Ebru Yılmaz
- Istanbul University, Istanbul Faculty of Medicine, Department of Nuclear Medicine, Istanbul Turkey
| | - Nerses Bebek
- Istanbul University, Istanbul Faculty of Medicine, Departments of Neurology and Clinical Neurophysiology Unit, Istanbul, Turkey
| | - Betül Baykan
- Istanbul University, Istanbul Faculty of Medicine, Departments of Neurology and Clinical Neurophysiology Unit, Istanbul, Turkey
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Cvetkovska E, Babunovska M, Kuzmanovski I, Boskovski B, Kiteva Trencevska G. Micturition and startle-induced reflex seizures in a patient with focal cortical dysplasia in the middle frontal gyrus. Clin Neurophysiol 2018; 130:109-110. [PMID: 30513417 DOI: 10.1016/j.clinph.2018.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 10/21/2018] [Accepted: 10/27/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Emilija Cvetkovska
- University Clinic of Neurology, Medical Faculty, Ss. Cyril and Methodius University, Vodnjanska Str. 17, MK-1000 Skopje, The Former Yugoslav Republic of Macedonia.
| | - Marija Babunovska
- University Clinic of Neurology, Medical Faculty, Ss. Cyril and Methodius University, Vodnjanska Str. 17, MK-1000 Skopje, The Former Yugoslav Republic of Macedonia
| | - Igor Kuzmanovski
- University Clinic of Neurology, Medical Faculty, Ss. Cyril and Methodius University, Vodnjanska Str. 17, MK-1000 Skopje, The Former Yugoslav Republic of Macedonia
| | - Bojan Boskovski
- University Clinic of Neurology, Medical Faculty, Ss. Cyril and Methodius University, Vodnjanska Str. 17, MK-1000 Skopje, The Former Yugoslav Republic of Macedonia
| | - Gordana Kiteva Trencevska
- University Clinic of Neurology, Medical Faculty, Ss. Cyril and Methodius University, Vodnjanska Str. 17, MK-1000 Skopje, The Former Yugoslav Republic of Macedonia
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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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Racicot F, Obaid S, Bouthillier A, Guillon-Létourneau L, Clément JF, Nguyen DK. Praxis-induced reflex seizures mainly precipitated by writing due to a parietal focal cortical dysplasia. EPILEPSY & BEHAVIOR CASE REPORTS 2016; 6:52-4. [PMID: 27630817 PMCID: PMC5014750 DOI: 10.1016/j.ebcr.2016.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 08/05/2016] [Indexed: 11/16/2022]
Abstract
We report the case of a 23-year-old left-handed woman with medically intractable praxis-induced reflex seizures mainly precipitated by writing. Selective resection of subtle end-of-sulcus cortical dysplasia in the right inferior parietal lobule resulted in freedom from seizures. To the best of our knowledge, this is the first case of praxis-induced reflex seizures mainly precipitated by writing in which a focal lesion was found and treated successfully by surgery.
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Affiliation(s)
- Frédéric Racicot
- Division of Neurosurgery, Centre hospitalier de l'Université de Montréal (CHUM) - Hôpital Notre-Dame, 1560 Sherbrooke Street East, Université de Montréal, Montreal, Quebec, Canada
| | - Sami Obaid
- Division of Neurosurgery, Centre hospitalier de l'Université de Montréal (CHUM) - Hôpital Notre-Dame, 1560 Sherbrooke Street East, Université de Montréal, Montreal, Quebec, Canada
| | - Alain Bouthillier
- Division of Neurosurgery, Centre hospitalier de l'Université de Montréal (CHUM) - Hôpital Notre-Dame, 1560 Sherbrooke Street East, Université de Montréal, Montreal, Quebec, Canada
| | - Laurent Guillon-Létourneau
- Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM) - Hôpital Notre-Dame, 1560 Sherbrooke Street East, Université de Montréal, Montreal, Quebec, Canada
| | - Jean-François Clément
- Division of Neurology, Hôpital Charles-Lemoyne, 3120 Boulevard Taschereau, Université de Sherbrooke, Greenfield Park, Quebec, Canada
| | - Dang Khoa Nguyen
- Division of Neurology, Centre hospitalier de l'Université de Montréal (CHUM) - Hôpital Notre-Dame, 1560 Sherbrooke Street East, Université de Montréal, Montreal, Quebec, Canada
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Feyissa AM, Patterson MC, Wong-Kisiel LC. Too Old for a Diaper! A Child With Diaper Changing-Induced Seizures. Pediatr Neurol 2016; 54:91-2. [PMID: 26493735 DOI: 10.1016/j.pediatrneurol.2015.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 09/12/2015] [Indexed: 11/24/2022]
Affiliation(s)
| | - Marc C Patterson
- Division of Child and Adolescent Neurology, Mayo Clinic, Rochester, Minnesota
| | - Lily C Wong-Kisiel
- Divisions of Child and Adolescent Neurology and Epilepsy, Mayo Clinic, Rochester, Minnesota
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Reflex seizures triggered by cutaneous stimuli. Seizure 2015; 33:72-5. [DOI: 10.1016/j.seizure.2015.10.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/03/2015] [Accepted: 10/19/2015] [Indexed: 11/21/2022] Open
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Epileptic spasms and early-onset photosensitive epilepsy in Patau syndrome: An EEG study. Brain Dev 2015; 37:704-13. [PMID: 25459971 DOI: 10.1016/j.braindev.2014.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 10/06/2014] [Accepted: 10/09/2014] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Patau syndrome, trisomy 13, is the third commonest autosomal trisomy. It is associated with a 25-50% prevalence of epilepsy, but detailed electroclinical descriptions are rare. The occurrence of early-onset photosensitivity has recently been reported in single patients. MATERIALS/PATIENTS We collected electroclinical data on 8 infants (age range from 2 months to 3 years and 9 months, median: 17 months) with Patau syndrome referred for an EEG in our Clinical Neurophysiology Department between 1991 and 2011. METHODS All EEGs, case-notes, cytogenetic diagnosis and neuroimaging when available were reviewed; data on the occurrence of seizures, epileptiform discharges, photoparoxysmal response and their characteristics in terms of positive frequencies, latencies, grade and duration were noted and analysed. RESULTS Two patients had been previously diagnosed with epilepsy (one with tonic spasms and one with multiple seizure types). We found 3 patients with photosensitive myoclonic epilepsy (37.5%), and one with non-photosensitive myoclonic epilepsy. We also recorded non-epileptic myoclonic jerks in one patient known to suffer from epileptic spasms. Among photosensitive patients we found self-limited, Waltz's grade 2-4, spike-wave/polyspike-wave discharges in low, medium and high frequency ranges in two patients and in the high frequency range in the third patient, with latencies and duration from less than 1s to a maximum of 9s. CONCLUSIONS In our cohort of Patau syndrome patients, we found a high prevalence of spasms and photic-induced myoclonic jerks. Photosensitivity shows an unusual early age of onset.
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Are Absence Epilepsy and Nocturnal Frontal Lobe Epilepsy System Epilepsies of the Sleep/Wake System? Behav Neurol 2015; 2015:231676. [PMID: 26175547 PMCID: PMC4484558 DOI: 10.1155/2015/231676] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 04/13/2015] [Accepted: 05/05/2015] [Indexed: 12/05/2022] Open
Abstract
System epilepsy is an emerging concept interpreting major nonlesional epilepsies as epileptic dysfunctions of physiological systems. I extend here the concept of reflex epilepsy to epilepsies linked to input dependent physiological systems. Experimental and clinical reseach data were collected to create a coherent explanation of underlying pathomechanism in AE and NFLE. We propose that AE should be interpreted as epilepsy linked to the corticothalamic burst-firing mode of NREM sleep, released by evoked vigilance level oscillations characterized by reactive slow wave response. In the genetic variation of NFLE the ascending cholinergic arousal system plays an essential role being in strong relationship with a gain mutation of the nicotinic acethylcholin receptors, rendering the arousal system hyperexcitable. I try to provide a more unitary interpretation for the variable seizure manifestation integrating them as different degree of pathological arosuals and alarm reactions. As a supporting hypothesis the similarity between arousal parasomnias and FNLE is shown, underpinned by overlaping pathomechanism and shared familiarity, but without epileptic features. Lastly we propose that both AE and NFLE are system epilepsies of the sleep-wake system representing epileptic disorders of the antagonistic sleep/arousal network. This interpretation may throw new light on the pathomechanism of AE and NFLE.
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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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Palmini A, Holthausen H. Focal malformations of cortical development: a most relevant etiology of epilepsy in children. HANDBOOK OF CLINICAL NEUROLOGY 2013; 111:549-565. [PMID: 23622203 DOI: 10.1016/b978-0-444-52891-9.00058-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Malformations of cortical development (MCD) are now well established as a most prevalent and relevant etiology of medically refractory epilepsies in children and adolescents. Focal cortical dysplasia (FCD) and hemimegalencephalies (HMG) occupy a special status because their focality (or in the case of HMG, their unihemispheric distibution) makes them amenable to surgical treatment to attempt seizure control. Since interictal epileptiform discharges and frequent seizures can lead to abnormal development because of brain plasticity during early childhood, the aim of surgical treatment is not only seizure control but also the redirection of development toward more physiological paths. In this review, we propose an "imaging-semiological organization" including (1) patients whose dysplastic lesion surrounds the fronto-rolandic cortex with increased signal and a transmantle sign, (2) multilobar hemispheric lesions, predominating in the anterior or posterior quadrants with large areas of abnormal gyration, increased cortical thickness, and gray-white blurring, (3) anterior temporal dysplasias usually featuring volume reduction combined with blurring of the underlying white matter in the temporal pole, and (4) a very relevant group of patients with refractory seizures, normal or roughly normal intellect, and normal MRI, later shown to harbor microscopic "nidus" of dysplastic cells. Classification takes into account the cortical disorganization, the presence of aberrant cellular elements, and the association with other lesion types.
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Affiliation(s)
- André Palmini
- Neurology Service and Epilepsy Surgery Program, Hospital São Lucas; Faculty of Medicine, Pontificia Universidade Católica do Rio Grande do Sul and Brain Institute of Rio Grande do Sul, Porto Alegre, Brazil.
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Striano S, Coppola A, del Gaudio L, Striano P. Reflex seizures and reflex epilepsies: old models for understanding mechanisms of epileptogenesis. Epilepsy Res 2012; 100:1-11. [PMID: 22361339 DOI: 10.1016/j.eplepsyres.2012.01.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 01/22/2012] [Accepted: 01/27/2012] [Indexed: 11/28/2022]
Abstract
Reflex seizures and epilepsies represent an ancient human model to understand basic mechanisms of epilepsy. The increase of light stimulation makes this issue extremely actual and interesting. In addition, a lot of observations show the frequent occurrence of provoked seizures in malformations of cortical development and in recently defined conditions such as familial or sporadic lateral temporal epilepsy. Advances in morphological and functional neuroimaging techniques, and the possibility of their fusion with EEG (e.g., fMRI-EEG co-registration) offer a unique non-invasive opportunity to investigate cortical areas and brain networks involved in cerebral functions and in epileptic discharges.
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Affiliation(s)
- Salvatore Striano
- Epilepsy Centre, Department of Neurological Sciences, Federico II University, Napoli, Italy.
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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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17
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Kadam SD, White AM, Staley KJ, Dudek FE. Continuous electroencephalographic monitoring with radio-telemetry in a rat model of perinatal hypoxia-ischemia reveals progressive post-stroke epilepsy. J Neurosci 2010; 30:404-15. [PMID: 20053921 PMCID: PMC2903060 DOI: 10.1523/jneurosci.4093-09.2010] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Revised: 10/15/2009] [Accepted: 10/23/2009] [Indexed: 11/21/2022] Open
Abstract
The development of acquired epilepsy after a perinatal hypoxic-ischemic (HI) insult was investigated in rats. After unilateral carotid ligation with hypoxia on postnatal day 7, cortical electroencephalographic and behavioral seizures were recorded with continuous radio-telemetry and video. Chronic recordings were obtained between 2 and 12 months of age in freely behaving HI-treated and sham control rats. The hypotheses were that the acquired epilepsy is directly associated with an ischemic infarct (i.e., no lesion, no epilepsy), and the resultant epilepsy is temporally progressive. Every HI-treated rat with a cerebral infarct developed spontaneous epileptiform discharges and recurrent seizures (100%); in contrast, no spontaneous epileptiform discharges or seizures were detected with continuous monitoring in the HI-treated rats without infarcts. The initial seizures at 2 months generally showed focal onset and were nonconvulsive. Subsequent seizures had focal onsets that propagated to the homotopic contralateral cortex and were nonconvulsive or partial; later seizures often appeared to have bilateral onset and were convulsive. Spontaneous epileptiform discharges were initially lateralized to ipsilateral neocortex but became bilateral over time. The severity and frequency of the spontaneous behavioral and electrographic seizures progressively increased over time. In every epileptic rat, seizures occurred in distinct clusters with seizure-free periods as long as a few weeks. The progressive increase in seizure frequency over time was associated with increases in cluster frequency and seizures within each cluster. Thus, prolonged, continuous seizure monitoring directly demonstrated that the acquired epilepsy after perinatal HI was progressive with seizure clusters and was consistently associated with a cerebral infarct.
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Affiliation(s)
- Shilpa D. Kadam
- Department of Biomedical Sciences, Colorado State University, Fort Collins, Colorado 80523
- Department of Physiology, University of Utah School of Medicine, Salt Lake City, Utah 84108, and
| | - Andrew M. White
- Departments of Pediatrics and Neurology, University of Colorado Health Sciences Center, Denver, Colorado 80262
| | - Kevin J. Staley
- Departments of Pediatrics and Neurology, University of Colorado Health Sciences Center, Denver, Colorado 80262
| | - F. Edward Dudek
- Department of Biomedical Sciences, Colorado State University, Fort Collins, Colorado 80523
- Department of Physiology, University of Utah School of Medicine, Salt Lake City, Utah 84108, and
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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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Gelastic seizures: A case of lateral frontal lobe epilepsy and review of the literature. Epilepsy Behav 2009; 15:249-53. [PMID: 19286474 DOI: 10.1016/j.yebeh.2009.03.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Revised: 01/17/2009] [Accepted: 03/07/2009] [Indexed: 11/27/2022]
Abstract
We describe a 40-year-old patient with gelastic seizures triggered by hand movement. Despite nonlesional magnetic resonance imaging (MRI), electroencephalography (EEG), functional magnetic resonance imaging (fMRI), and diffusion tensor imaging (DTI) are concordant with seizure onset in the right frontocentral area. Seizure semiology and EEG recordings imply involvement of mesial frontal structures remote from seizure initiation site. We reviewed all published cases on gelastic seizures of frontal lobe origin to find characteristic features. For further investigation of the phenomenon of movement-induced seizures, fMRI was performed using a finger tapping paradigm. Interictal fMRI revealed widespread activation of right motor cortex during finger tapping on either side outreaching the anatomical representation of the left finger. In line with this finding DTI revealed fiber track impairment in the right frontocentral region, supporting the hypothesis of a focal derangement. This case highlights the importance of complementary functional investigations in MRI-negative epilepsies.
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Imaging malformations of cortical development. HANDBOOK OF CLINICAL NEUROLOGY 2008. [PMID: 18809040 DOI: 10.1016/s0072-9752(07)87026-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register]
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Villani F, D'Amico D, Pincherle A, Tullo V, Chiapparini L, Bussone G. Prolonged Focal Negative Motor Seizures: A Video-EEG Study. Epilepsia 2006; 47:1949-52. [PMID: 17116038 DOI: 10.1111/j.1528-1167.2006.00804.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Focal negative motor (akinetic) seizures are rare ictal events that are diagnostically challenging because they are difficult to differentiate from postictal Todd paresis, transient ischemic attacks, migraine events, and psychogenic episodes. METHODS We describe a 45-year-old man in whom, after surgical drainage of a right frontoparietal subdural hematoma, prolonged episodes developed with flaccid paralysis of the left arm. RESULTS A video-EEG recording demonstrated a close relation between the focal motor impairment and a clear-cut epileptic ictal discharge involving the right perirolandic cortical areas. CONCLUSIONS On the basis of the electroclinical data, we hypothesize the involvement of the primary motor area in the genesis of the epileptic discharge triggering focal negative seizures.
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Affiliation(s)
- Flavio Villani
- Division of Clinical Epileptology, Instituto Nazionale Neurologico "C. Besta", Milan, Italy.
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Millichap JG. Expert Consensus on Photosensitive Epilepsies. Pediatr Neurol Briefs 2005. [DOI: 10.15844/pedneurbriefs-19-9-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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