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Bertini A, Lenti S, Libelli G, Ronco R, Oliveri S, Montemagno K, Priori A, Bocci T. When the diagnosis is in the patient's hand and in the neurologist's eye. Neurol Sci 2024; 45:4669-4677. [PMID: 38833097 PMCID: PMC11422281 DOI: 10.1007/s10072-024-07626-1] [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: 04/04/2024] [Accepted: 05/25/2024] [Indexed: 06/06/2024]
Abstract
The objective of this study was to encompass current knowledge about pathophysiological mechanisms of those specific hand postures or deformities caused by central nervous system disorders. In the era of high-resolution neuroimaging and molecular biology, clinicians are progressively losing confidence with neurological examination. Careful hand observation is of key importance in order to differentiate neurological from non-neurological conditions, central from peripheral aetiologies, and organic from functional disorders. Localizing the potential anatomical site is essential to properly conduct subsequent exams. We provided a practical guide for clinicians to recognize hand patterns caused by central nervous system disorders, avoiding mimicking conditions, thus optimizing and prompting the diagnostic pathway.
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Affiliation(s)
- Alessandro Bertini
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142, Milan, Italy
- Clinical Neurology Unit, Department of Health Sciences, Azienda Socio-Sanitaria Territoriale Santi Paolo E Carlo, University of Milan, Via Antonio di Rudinì 8, 20142, Milan, Italy
| | - Sveva Lenti
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142, Milan, Italy
- Clinical Neurology Unit, Department of Health Sciences, Azienda Socio-Sanitaria Territoriale Santi Paolo E Carlo, University of Milan, Via Antonio di Rudinì 8, 20142, Milan, Italy
| | - Giorgia Libelli
- Neurology Unit, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Riccardo Ronco
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142, Milan, Italy
- Clinical Neurology Unit, Department of Health Sciences, Azienda Socio-Sanitaria Territoriale Santi Paolo E Carlo, University of Milan, Via Antonio di Rudinì 8, 20142, Milan, Italy
| | - Serena Oliveri
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142, Milan, Italy
- Clinical Neurology Unit, Department of Health Sciences, Azienda Socio-Sanitaria Territoriale Santi Paolo E Carlo, University of Milan, Via Antonio di Rudinì 8, 20142, Milan, Italy
| | - Kora Montemagno
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142, Milan, Italy
| | - Alberto Priori
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142, Milan, Italy
- Clinical Neurology Unit, Department of Health Sciences, Azienda Socio-Sanitaria Territoriale Santi Paolo E Carlo, University of Milan, Via Antonio di Rudinì 8, 20142, Milan, Italy
| | - Tommaso Bocci
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142, Milan, Italy.
- Clinical Neurology Unit, Department of Health Sciences, Azienda Socio-Sanitaria Territoriale Santi Paolo E Carlo, University of Milan, Via Antonio di Rudinì 8, 20142, Milan, Italy.
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Beniczky S, Tatum WO, Blumenfeld H, Stefan H, Mani J, Maillard L, Fahoum F, Vinayan KP, Mayor LC, Vlachou M, Seeck M, Ryvlin P, Kahane P. Seizure semiology: ILAE glossary of terms and their significance. Epileptic Disord 2022; 24:447-495. [PMID: 35770761 DOI: 10.1684/epd.2022.1430] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/19/2022] [Indexed: 11/17/2022]
Abstract
This educational topical review and Task Force report aims to address learning objectives of the International League Against Epilepsy (ILAE) curriculum. We sought to extract detailed features involving semiology from video recordings and interpret semiological signs and symptoms that reflect the likely localization for focal seizures in patients with epilepsy. This glossary was developed by a working group of the ILAE Commission on Diagnostic Methods incorporating the EEG Task Force. This paper identifies commonly used terms to describe seizure semiology, provides definitions, signs and symptoms, and summarizes their clinical value in localizing and lateralizing focal seizures based on consensus in the published literature. Video-EEG examples are included to illustrate important features of semiology in patients with epilepsy.
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Turek G, Skjei K. Seizure semiology, localization, and the 2017 ILAE seizure classification. Epilepsy Behav 2022; 126:108455. [PMID: 34894624 DOI: 10.1016/j.yebeh.2021.108455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/13/2021] [Accepted: 11/16/2021] [Indexed: 11/26/2022]
Abstract
In the study of epilepsy, the term semiology is used to comprise the clinical characteristics of a seizure, both subjective symptoms and objective phenomena. It is produced by activation of the symptomagenic zone, and an accurate and comprehensive understanding of the localizing value of seizure semiology is crucial for presurgical evaluation and planning. Myriad publications in epilepsy journals detail correlations between various semiological features and activation of specific cortical regions. Traditionally these studies involved scalp EEG recorded in epilepsy monitoring units. The increasing use of invasive monitoring, and specifically the use of depth electrodes and stereo-electroencephalography, has advanced our understanding of the characteristics of seizures arising from ictal foci deep to the scalp, including the cingulate, insula and operculum. However, the distinction between seizure onset and symptomogenic zones is not always clear. In 2017 the International League Against Epilepsy (ILAE) published an operational classification of seizure types based heavily on seizure semiology. The current paper provides an updated review of the current body of knowledge relating to seizure semiology, incorporating both scalp EEG studies and more recent stereo-electroencephalography discoveries in the framework of the 2017 ILAE classification.
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Affiliation(s)
- Grant Turek
- Department of Neurology, University of Louisville, 401 E. Chestnut St. Unit 510, Louisville, KY 40202-5710, United States.
| | - Karen Skjei
- Department of Neurology, University of Texas at Austin, Dell Medical School, 1601 Trinity St., Bldg B, Strop Z0700, Austin, TX 78712, United States
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Piffer S, Cantalupo G, Filipponi S, Poretto V, Pellegrini M, Tanel R, Buganza M, Giometto B. Agrypnia excitata as the main feature in anti-leucine-rich glioma-inactivated 1 encephalitis: a detailed clinical and polysomnographic semiological analysis. Eur J Neurol 2021; 29:890-894. [PMID: 34679240 DOI: 10.1111/ene.15152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 08/09/2021] [Accepted: 10/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE The core manifestations of leucine-rich glioma-inactivated 1 (LGI1) autoantibody-mediated encephalitis are limbic encephalitis and faciobrachial dystonic seizures. Agrypnia excitata (AE) is a rare syndrome characterized by sleep-wake cycle disruption, autonomic hyperactivation and episodes of oneiric stupor. Only a few diseases are known to present with AE. An autoimmune etiology must be considered when accompanied by neuromyotonia. A case of anti-LGI1 encephalitis presenting with AE is reported. METHODS Detailed clinical, video-polysomnographic, laboratory, radiological and long-term follow-up assessments were performed. RESULTS A previously healthy 58-year-old man was referred for a rapidly progressive change in mental status, characterized by persistent drowsiness and confusion, accompanied by frequent episodes of unconscious gestures ranging from simple stereotyped movements to more complex actions mimicking various daily activities. Other symptoms included tachycardia, hyperhidrosis, mild hyponatremia, rare faciobrachial dystonic seizures, and a single generalized tonic-clonic seizure, but no neuromyotonia. Prolonged video-polysomnography excluded epileptic activity and showed continuous monomorphic slowing of background activity not consistent with a regular wakefulness or sleep state. A brain magnetic resonance imaging scan was unremarkable. Brain fluorodeoxyglucose positron emission tomography revealed hypermetabolism of the hippocampi, amygdala and basal ganglia. Anti-LGI1 antibodies were detected in the cerebrospinal fluid. The sleep disorder resolved progressively after starting immunotherapy. CONCLUSIONS Agrypnia excitata can be a dominant, treatable manifestation of anti-LGI1 encephalitis. Oneiric stupor episodes are a useful clinical feature for establishing diagnostic suspicion and could provide a window to understanding the mechanisms behind some movement disorders in autoimmune encephalitis.
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Affiliation(s)
- Silvio Piffer
- Department of Emergency, Neurology Unit, Santa Chiara Hospital, Trento, Italy
| | | | - Stefania Filipponi
- Department of Emergency, Neurology Unit, Santa Chiara Hospital, Trento, Italy
| | - Valentina Poretto
- Department of Emergency, Neurology Unit, Santa Chiara Hospital, Trento, Italy
| | - Maria Pellegrini
- Department of Emergency, Neurology Unit, Santa Chiara Hospital, Trento, Italy
| | - Raffaella Tanel
- Department of Emergency, Neurology Unit, Santa Chiara Hospital, Trento, Italy
| | - Manuela Buganza
- Department of Emergency, Neurology Unit, Santa Chiara Hospital, Trento, Italy
| | - Bruno Giometto
- Department of Emergency, Neurology Unit, Santa Chiara Hospital, Trento, Italy
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Abarrategui B, Mai R, Sartori I, Francione S, Pelliccia V, Cossu M, Tassi L. Temporal lobe epilepsy: A never-ending story. Epilepsy Behav 2021; 122:108122. [PMID: 34175663 DOI: 10.1016/j.yebeh.2021.108122] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/30/2021] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Semiology and anatomo-electroclinical correlations remain invaluable for maintaining the level of excellence in temporal lobe epilepsy (TLE) surgery, in parallel to the constantly evolving technical progress. The aim of this study was to address semiological frequent and not so frequent signs, rarities and red flags in a long follow-up surgical series of patients suffering from TLE. METHODS Patients operated within the boundaries of the TL at our center, with presurgical video-EEG recorded seizures and seizure free after a postoperative follow-up of at least 24 months were included. Ictal semiology was systematically described and new red flags were explored by comparing with a second group of patients with the same inclusion criteria but whose outcome had been unfavorable (Engel II-IV). RESULTS Sixty-two patients were included, 46 seizure free and 16 with outcome Engel II-IV. Most seizure-free patients had a classical semiological presentation including aura (69.6%, abdominal the most frequent), followed by loss of responsiveness (90.2%) oral automatisms (90.7%), ipsilateral gestural automatisms (53.5%), contralateral upper limb dystonia (37.5%) or immobility (39.1%), and early ipsilateral non-versive head orientation (33.3%). More infrequent presentations were also present in the group of seizure-free patients: ictal language disturbance (13%), maintenance of responsiveness during seizures (9.8%), and contralateral rhythmic non manipulative automatism (6.9%). The presence of an isolated viscerosensory and/or psychic aura was significantly more frequent in the seizure-free group (p = 0.017), as well as oroalimentary automatisms (p = 0.005). Two signs were only present in the group with outcome Engel II-IV, constituting possible red flags (0.06 < p < 0.07): inferior limbs stepping-like automatisms and postictal dysarthria. CONCLUSION An adequate clinical exam during seizures and a careful analysis of video recordings allow to recognize infrequent but well-characterized ictal signs that are part of the range of semiology in TLE, together with the most frequent and classical ictal presentations. Special attention to the localization hypothesis must be paid in the absence of oroalimentary automatisms or when the signs classified as possible red flags emerge.
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Affiliation(s)
- Belén Abarrategui
- "Claudio Munari" Epilepsy Surgery Center, Niguarda Hospital, 20162 Milano, Italy.
| | - Roberto Mai
- "Claudio Munari" Epilepsy Surgery Center, Niguarda Hospital, 20162 Milano, Italy.
| | - Ivana Sartori
- "Claudio Munari" Epilepsy Surgery Center, Niguarda Hospital, 20162 Milano, Italy.
| | - Stefano Francione
- "Claudio Munari" Epilepsy Surgery Center, Niguarda Hospital, 20162 Milano, Italy.
| | - Veronica Pelliccia
- "Claudio Munari" Epilepsy Surgery Center, Niguarda Hospital, 20162 Milano, Italy.
| | - Massimo Cossu
- "Claudio Munari" Epilepsy Surgery Center, Niguarda Hospital, 20162 Milano, Italy.
| | - Laura Tassi
- "Claudio Munari" Epilepsy Surgery Center, Niguarda Hospital, 20162 Milano, Italy.
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Chowdhury FA, Silva R, Whatley B, Walker MC. Localisation in focal epilepsy: a practical guide. Pract Neurol 2021; 21:481-491. [PMID: 34404748 DOI: 10.1136/practneurol-2019-002341] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 11/03/2022]
Abstract
The semiology of epileptic seizures reflects activation, or dysfunction, of areas of brain (often termed the symptomatogenic zone) as a seizure begins and evolves. Specific semiologies in focal epilepsies provide an insight into the location of the seizure onset zone, which is particularly important for presurgical epilepsy assessment. The correct diagnosis of paroxysmal events also depends on the clinician being familiar with the spectrum of semiologies. Here, we summarise the current literature on localisation in focal epilepsies using illustrative cases and discussing possible pitfalls in localisation.
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Affiliation(s)
- Fahmida A Chowdhury
- Department of Epilepsy, National Hospital for Neurology and Neurosurgery, London, UK .,Department of Clinical and Experimental Epilepsy, Institute of Neurology, London, UK
| | - Rui Silva
- Department of Epilepsy, National Hospital for Neurology and Neurosurgery, London, UK
| | - Benjamin Whatley
- Department of Epilepsy, National Hospital for Neurology and Neurosurgery, London, UK.,Department of Neurology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Matthew C Walker
- Department of Epilepsy, National Hospital for Neurology and Neurosurgery, London, UK.,Department of Clinical and Experimental Epilepsy, Institute of Neurology, London, UK
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Zaher N, Haas K, Sonmezturk H, Arain A, Abou-Khalil B. Rhythmic ictal nonclonic hand (RINCH) motions in general EMU patients with focal epilepsy. Epilepsy Behav 2020; 103:106666. [PMID: 31848102 DOI: 10.1016/j.yebeh.2019.106666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Automatisms are frequently encountered during video-monitoring of patients with focal epilepsy in the EMU and generally thought to have a low lateralizing value in isolation. Rhythmic ictal nonclonic hand (RINCH) motions have been described in small series as a potentially lateralizing semiologic sign. We aimed to expand on prior work and determine the prevalence, characteristics, and lateralizing value of RINCH motions in general epilepsy monitoring unit (EMU) population with focal epilepsy. METHODS All patients with recorded seizures in the EMU were included in our database search. Search was performed to identify seizures with reported RINCH motions. Both electroencephalography (EEG) and video of identified seizures were reviewed. RESULTS We identified RINCH motions in 131 seizures in 71 patients. Overall seizure localization was temporal in 57 patients, frontotemporal in 3 patients, and extratemporal in 7 patients. We estimated RINCH motions to occur in 8.5% of EMU patients with recorded seizures. The most common RINCH motions in descending order were as follows: hand opening and closing, finger rubbing, milking motions, finger flexion/extension, and pill rolling. The mean RINCH motion latency from seizure onset was 34.48 s in temporal lobe epilepsy and 10.31 s in frontal lobe epilepsy. The RINCH motions were contralateral to seizure onset in 61 of 65 (93.8%) with lateralized seizure onset. Dystonic posturing was present in 43% of seizures with RINCH motions. CONCLUSION The RINCH motions are a common sign in focal seizures and should be distinguished from other types of manual automatism as they carry a strong lateralizing value.
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Affiliation(s)
| | - Kevin Haas
- Vanderbilt University Medical Center, USA
| | | | - Amir Arain
- Vanderbilt University Medical Center, USA
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Ravat SH, Bhatti AA, Shah MV, Muzumdar DP, Ravat SH. Ictal asystole: A rare cardiac manifestation of temporal lobe epilepsy, treated with epilepsy surgery. Ann Indian Acad Neurol 2017; 20:55-57. [PMID: 28298843 PMCID: PMC5341269 DOI: 10.4103/0972-2327.199916] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Seizures are associated with fascinatingly varied cardiac and autonomic manifestations, of which ictal tachycardia is common, and asystole and bradycardia are rare. Ictal asystole (IA), an often unsought autonomic phenomenon, occurs most commonly with temporal followed by frontal lobe seizures. Prolonged IA may lead to cerebral anoxic ischemia. As the mysteries of sudden unexplained death in epilepsy are unraveled, it is quite possible that the key to it lays within these seizure-induced cardiac rhythm abnormalities. We present a case of a young male with temporal lobe epilepsy due to left mesial temporal sclerosis with prolonged IA, which was successfully managed with epilepsy surgery.
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Affiliation(s)
- Shreyas Hasmukh Ravat
- Department of Neurology and Neurosurgery, Seth GSMC and KEM Hospital, Mumbai, Maharashtra, India
| | - Amit Ashok Bhatti
- Department of Neurology and Neurosurgery, Seth GSMC and KEM Hospital, Mumbai, Maharashtra, India
| | - Mansi Viraj Shah
- Department of Neurology and Neurosurgery, Seth GSMC and KEM Hospital, Mumbai, Maharashtra, India
| | - Dattatraya P Muzumdar
- Department of Neurology and Neurosurgery, Seth GSMC and KEM Hospital, Mumbai, Maharashtra, India
| | - Sangeeta Hasmukh Ravat
- Department of Neurology and Neurosurgery, Seth GSMC and KEM Hospital, Mumbai, Maharashtra, India
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Řehulka P, Doležalová I, Janoušová E, Tomášek M, Marusič P, Brázdil M, Kuba R. Ictal and postictal semiology in patients with bilateral temporal lobe epilepsy. Epilepsy Behav 2014; 41:40-6. [PMID: 25282104 DOI: 10.1016/j.yebeh.2014.09.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 09/07/2014] [Accepted: 09/10/2014] [Indexed: 11/28/2022]
Abstract
Bilateral temporal lobe epilepsy is characterized by evidence of seizure onset independently in both temporal lobes. The main aim of the present study was to determine whether patients with evidence of independent bilateral temporal lobe epilepsy (biTLE) can be identified noninvasively on the basis of seizure semiology analysis. Thirteen patients with biTLE, as defined by invasive EEG, were matched with 13 patients with unilateral temporal lobe epilepsy (uniTLE). In all 26 patients, the frequency of predefined clusters of ictal and periictal signs were evaluated: ictal motor signs (IMSs), periictal motor signs (PIMSs), periictal vegetative signs (PIVSs), the frequency of early oroalimentary automatisms (EOAs), and the duration of postictal unresponsiveness (PU). Some other noninvasive and clinical data were also evaluated. A lower frequency of IMSs was noted in the group with biTLE (patients = 46.2%, seizures = 20.7%) than in the group with uniTLE (patients = 92.3%, seizures = 61.0%) (p = 0.030; p < 0.001, respectively). The individual IMS average per seizure was significantly lower in the group with biTLE (0.14; range = 0-1.0) than in the group with uniTLE (0.80; range = 0-2.6) (p = 0.003). Postictal unresponsiveness was longer than 5 min in more patients (75.0%) and seizures (42.9%) in the group with biTLE than in the group with uniTLE (patients = 30.8%, seizures = 18.6%) (p = 0.047; p = 0.002). The frequency of EOAs, PIMSs, PIVSs, and other clinical data did not differ significantly. There is a lower frequency of ictal motor signs and longer duration of postictal unresponsiveness in patients with biTLE.
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Affiliation(s)
- Pavel Řehulka
- Brno Epilepsy Center, First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic; Behavioural and Social Neuroscience Research Group, Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic.
| | - Irena Doležalová
- Brno Epilepsy Center, First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic; Behavioural and Social Neuroscience Research Group, Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic
| | - Eva Janoušová
- Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - Martin Tomášek
- Department of Neurology, Charles University in Prague, Second Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | - Petr Marusič
- Department of Neurology, Charles University in Prague, Second Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | - Milan Brázdil
- Brno Epilepsy Center, First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic; Behavioural and Social Neuroscience Research Group, Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic
| | - Robert Kuba
- Brno Epilepsy Center, First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic; Behavioural and Social Neuroscience Research Group, Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic
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Overdijk MJ, Zijlmans M, Gosselaar PH, Olivier A, Leijten FSS, Dubeau F. Finger snapping during seizures. EPILEPSY & BEHAVIOR CASE REPORTS 2014; 2:108-11. [PMID: 25667884 PMCID: PMC4308032 DOI: 10.1016/j.ebcr.2014.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 03/28/2014] [Accepted: 03/29/2014] [Indexed: 11/30/2022]
Abstract
We describe two patients who showed snapping of the right hand fingers during invasive intracranial EEG evaluation for epilepsy surgery. We correlated the EEG changes with the finger-snapping movements in both patients to determine the underlying pathophysiology of this phenomenon. At the time of finger snapping, EEG spread from the supplementary motor area towards the temporal region was seen, suggesting involvement of these sites.
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Affiliation(s)
- M J Overdijk
- Department of Neurology, Medical Center The Hague, The Hague, The Netherlands
| | - M Zijlmans
- Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands ; SEIN, Epilepsy Institute in the Netherlands Foundation, Heemstede, The Netherlands
| | - P H Gosselaar
- Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A Olivier
- Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, Montréal, Canada
| | - F S S Leijten
- SEIN, Epilepsy Institute in the Netherlands Foundation, Heemstede, The Netherlands
| | - F Dubeau
- Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, Montréal, Canada
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Kuba R, Musilová K, Vojvodič N, Tyrlíková I, Rektor I, Brázdil M. Rhythmic ictal nonclonic hand (RINCH) motions in temporal lobe epilepsy: Invasive EEG findings, incidence, and lateralizing value. Epilepsy Res 2013; 106:386-95. [DOI: 10.1016/j.eplepsyres.2013.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 05/14/2013] [Accepted: 06/28/2013] [Indexed: 10/26/2022]
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Does the patient's hand hold the key to preventing secondary generalization in mesial temporal lobe epilepsy? Epilepsy Res 2013; 105:125-32. [PMID: 23490657 DOI: 10.1016/j.eplepsyres.2013.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 12/17/2012] [Accepted: 02/07/2013] [Indexed: 11/23/2022]
Abstract
This study aimed to analyze the impact of ictal dystonic posturing (DP) in postoperative seizure outcome and to assess the influence of DP in generalized tonic-clonic seizure (GTCS) occurrence during video-EEG monitoring of patients with temporal lobe epilepsy with mesial temporal sclerosis. The impact of DP on surgical outcome remains controversial. Moreover, DP has been recently associated with brain networks avoiding GTCS occurrence. Five hundred twenty-seven seizures of 171 patients who were submitted to standard anterior temporal lobectomy (ATL) between 2002 and 2010, with at least one year of post-surgical follow-up, were retrospectively analyzed and classified as with or without DP and as evolving or not to GTCS. The ictal semiologic correlates of DP, timing elapsed since precedent seizure and antiepileptic drug (AED) intake before each seizure were evaluated. Seizure outcome after ATL was assessed according to Engel's scale. Fifty-eight out of 171 patients (34%) exhibited ictal DP, of which 91.5% were always unilateral and contralateral to the operated side. DP was related to shorter seizures (p=0.007) and a much lower likelihood of the seizure evolving to GTCS (p=0.001), even during AED withdrawal (p=0.002). There was no association between DP and prognosis regarding seizure control as the result of the surgical resection, either in patients with shorter or in those with longer period of follow-up. Our data support the hypothesis that DP reflects a brain network activation that helps avoid GTCS, even during AED withdrawal.
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Kelemen A, Fogarasi A, Borbély C, Szűcs A, Fabó D, Jakus R, Rásonyi G, Halász P. Nonmanipulative proximal upper extremity automatisms lateralize contralaterally in temporal lobe epilepsy. Epilepsia 2010; 51:214-20. [DOI: 10.1111/j.1528-1167.2009.02277.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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