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DeFelipe J, DeFelipe-Oroquieta J, Furcila D, Muñoz-Alegre M, Maestú F, Sola RG, Blázquez-Llorca L, Armañanzas R, Kastanaskaute A, Alonso-Nanclares L, Rockland KS, Arellano JI. Neuroanatomical and psychological considerations in temporal lobe epilepsy. Front Neuroanat 2022; 16:995286. [PMID: 36590377 PMCID: PMC9794593 DOI: 10.3389/fnana.2022.995286] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/11/2022] [Indexed: 01/03/2023] Open
Abstract
Temporal lobe epilepsy (TLE) is the most common form of focal epilepsy and is associated with a variety of structural and psychological alterations. Recently, there has been renewed interest in using brain tissue resected during epilepsy surgery, in particular 'non-epileptic' brain samples with normal histology that can be found alongside epileptic tissue in the same epileptic patients - with the aim being to study the normal human brain organization using a variety of methods. An important limitation is that different medical characteristics of the patients may modify the brain tissue. Thus, to better determine how 'normal' the resected tissue is, it is fundamental to know certain clinical, anatomical and psychological characteristics of the patients. Unfortunately, this information is frequently not fully available for the patient from which the resected tissue has been obtained - or is not fully appreciated by the neuroscientists analyzing the brain samples, who are not necessarily experts in epilepsy. In order to present the full picture of TLE in a way that would be accessible to multiple communities (e.g., basic researchers in neuroscience, neurologists, neurosurgeons and psychologists), we have reviewed 34 TLE patients, who were selected due to the availability of detailed clinical, anatomical, and psychological information for each of the patients. Our aim was to convey the full complexity of the disorder, its putative anatomical substrates, and the wide range of individual variability, with a view toward: (1) emphasizing the importance of considering critical patient information when using brain samples for basic research and (2) gaining a better understanding of normal and abnormal brain functioning. In agreement with a large number of previous reports, this study (1) reinforces the notion of substantial individual variability among epileptic patients, and (2) highlights the common but overlooked psychopathological alterations that occur even in patients who become "seizure-free" after surgery. The first point is based on pre- and post-surgical comparisons of patients with hippocampal sclerosis and patients with normal-looking hippocampus in neuropsychological evaluations. The second emerges from our extensive battery of personality and projective tests, in a two-way comparison of these two types of patients with regard to pre- and post-surgical performance.
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Affiliation(s)
- Javier DeFelipe
- Laboratorio Cajal de Circuitos Corticales, Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, Pozuelo de Alarcón, Madrid, Spain,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, Madrid, Spain,Instituto Cajal, Consejo Superior de Investigaciones Científicas, Madrid, Spain,*Correspondence: Javier DeFelipe,
| | - Jesús DeFelipe-Oroquieta
- Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain,Facultad de Educación, Universidad Camilo José Cela, Madrid, Spain
| | - Diana Furcila
- Laboratorio Cajal de Circuitos Corticales, Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, Pozuelo de Alarcón, Madrid, Spain
| | - Mar Muñoz-Alegre
- Facultad de Educación y Psicología, Universidad Francisco de Vitoria, Madrid, Spain
| | - Fernando Maestú
- Department of Experimental Psychology, Complutense University of Madrid, Madrid, Spain,Center for Cognitive and Computational Neuroscience, Complutense University of Madrid, Madrid, Spain
| | - Rafael G. Sola
- Cátedra UAM de “Innovación en Neurocirugía”, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | - Lidia Blázquez-Llorca
- Laboratorio Cajal de Circuitos Corticales, Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, Pozuelo de Alarcón, Madrid, Spain,Sección Departamental de Anatomía y Embriología, Facultad de Veterinaria, Universidad Complutense de Madrid, Madrid, Spain
| | - Rubén Armañanzas
- Institute of Data Science and Artificial Intelligence, Universidad de Navarra, Pamplona, Spain,Tecnun School of Engineering, Universidad de Navarra, Donostia-San Sebastian, Spain
| | - Asta Kastanaskaute
- Laboratorio Cajal de Circuitos Corticales, Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, Pozuelo de Alarcón, Madrid, Spain,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, Madrid, Spain,Instituto Cajal, Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Lidia Alonso-Nanclares
- Laboratorio Cajal de Circuitos Corticales, Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, Pozuelo de Alarcón, Madrid, Spain,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, Madrid, Spain,Instituto Cajal, Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Kathleen S. Rockland
- Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, United States
| | - Jon I. Arellano
- Department of Neuroscience, Yale School of Medicine, New Haven, CT, United States
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Gulati P, Jain P, Lou Smith M, Kerr E, Muthusami P, Shroff M, Whitney R, Carter Snead O, Go C. Reliability and safety of Etomidate speech test in children with drug resistant focal epilepsy. Epilepsy Res 2019; 156:106150. [PMID: 31239182 DOI: 10.1016/j.eplepsyres.2019.106150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/18/2019] [Accepted: 06/09/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To review our experience with the Etomidate speech test (EST) for lateralizing language in children undergoing epilepsy surgery evaluation METHODS: This retrospective study included children (<18 years) with drug refractory focal epilepsy undergoing EST for bilateral or poorly reliable language representation on functional MRI. Data for consecutive children who underwent EST between January 2013 to June 2017 were reviewed. RESULTS Twenty-one children (mean age at EST, 13.1 ± 4.4 years) were studied, with 19-right hemispheric and 20 left hemispheric injections. Six patients had neurological co-morbidities. Duration of ipsilateral EEG slowing was sufficient for speech testing in all children with a single bolus of Etomidate per carotid artery. Language was lateralized to one hemisphere in 17 (80.9%) and bilateral in two cases. EST was unsuccessful in two patients because of diffuse EEG slowing. Contralateral transient frontal EEG slowing was seen in 14 (73.7%) cases. EST was well tolerated in all the patients. CONCLUSIONS The EST was found to be successful and safe in lateralizing language in most of our drug refractory pediatric epilepsy cohort.
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Affiliation(s)
- Pratima Gulati
- Pratima Gulati, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, M5G1X8, Canada.
| | - Puneet Jain
- Pratima Gulati, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, M5G1X8, Canada; Division of Pediatric Neurology, Department of Pediatrics, BL Kapur (BLK) Super Speciality Hospital, Pusa Road, New Delhi 110005 India.
| | - Mary Lou Smith
- Mary Lou Smith, Division of Neurology, The Hospital for Sick Children, Department of Psychology, University of Toronto, Ontario, M5G1X8, Canada.
| | - Elizabeth Kerr
- Division of Neurology, Department of Psychology, University of Toronto, M5G1X8, Ontario, Canada.
| | - Prakash Muthusami
- Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, M5G1X8, Canada.
| | - Manohar Shroff
- Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, M5G1X8, Canada.
| | - Robyn Whitney
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, M5G1X8, Canada.
| | - O Carter Snead
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, M5G1X8, Canada.
| | - Cristina Go
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, M5G1X8, Canada.
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Pacreu S, Vilà E, Moltó L, Bande D, Rueda M, Fernández Candil JL. Anaesthesia management in epilepsy surgery with intraoperative electrocorticography. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2018; 65:108-111. [PMID: 28964504 DOI: 10.1016/j.redar.2017.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 07/27/2017] [Accepted: 07/28/2017] [Indexed: 06/07/2023]
Abstract
Epilepsy surgery is a well-established treatment for patients with drug-resistant epilepsy. The success of surgery depends on precise presurgical localisation of the epileptogenic zone. There are different techniques to determine its location and extension. Despite the improvements in non-invasive diagnostic tests, in patients for whom these tests are inconclusive, invasive techniques such intraoperative electrocorticography will be needed. Intraoperative electrocorticography is used to guide surgical resection of the epileptogenic lesion and to verify that the resection has been completed. However, it can be affected by some of the anaesthetic drugs used by the anaesthesiologist. Our objective with this case is to review which drugs can be used in epilepsy surgery with intraoperative electrocorticography.
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Affiliation(s)
- S Pacreu
- Servicio de Anestesiología y Reanimación, Hospital del Mar, Parc de Salut Mar, Barcelona, España.
| | - E Vilà
- Servicio de Anestesiología y Reanimación, Hospital del Mar, Parc de Salut Mar, Barcelona, España
| | - L Moltó
- Servicio de Anestesiología y Reanimación, Hospital del Mar, Parc de Salut Mar, Barcelona, España
| | - D Bande
- Servicio de Anestesiología y Reanimación, Hospital del Mar, Parc de Salut Mar, Barcelona, España
| | - M Rueda
- Servicio de Anestesiología y Reanimación, Hospital del Mar, Parc de Salut Mar, Barcelona, España
| | - J L Fernández Candil
- Servicio de Anestesiología y Reanimación, Hospital del Mar, Parc de Salut Mar, Barcelona, España
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Etomidate: A Complementary Diagnostic Tool for Pre-Surgical Evaluation in Temporal Lobe Epilepsy. ARCHIVES OF NEUROSCIENCE 2016. [DOI: 10.5812/archneurosci.34915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Schijns OEMG, Hoogland G, Kubben PL, Koehler PJ. The start and development of epilepsy surgery in Europe: a historical review. Neurosurg Rev 2015; 38:447-61. [PMID: 26002272 PMCID: PMC4469771 DOI: 10.1007/s10143-015-0641-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 01/25/2015] [Accepted: 03/14/2015] [Indexed: 11/02/2022]
Abstract
Epilepsy has not always been considered a brain disease, but was believed to be a demonic possession in the past. Therefore, trepanation was done not only for medical but also for religious or spiritual reasons, originating in the Neolithic period (3000 BC). The earliest documentation of trepanation for epilepsy is found in the writings of the Hippocratic Corpus and consisted mainly of just skull surgery. The transition from skull surgery to brain surgery took place in the middle of the nineteenth century when the insight of epilepsy as a cortical disorder of the brain emerged. This led to the start of modern epilepsy surgery. The pioneer countries in which epilepsy surgery was performed in Europe were the UK, Germany, and The Netherlands. Neurosurgical forerunners like Sir Victor Horsley, William Macewen, Fedor Krause, and Otfrid Foerster started with "modern" epilepsy surgery. Initially, epilepsy surgery was mainly done with the purpose to resect traumatic lesions or large surface tumours. In the course of the twentieth century, this changed to highly specialized microscopic navigation-guided surgery to resect lesional and non-lesional epileptogenic cortex. The development of epilepsy surgery in Southern Europe, which has not been described until now, will be elaborated in this manuscript. To summarize, in this paper, we provide (1) a detailed description of the evolution of European epilepsy surgery with special emphasis on the pioneer countries; (2) novel, never published information about the development of epilepsy surgery in Southern Europe; and (3) we review the historical dichotomy of invasive electrode implantation strategy (Anglo-Saxon surface electrodes versus French-Italian stereoencephalography (SEEG) model).
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Affiliation(s)
- Olaf E M G Schijns
- Department of Neurosurgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands,
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Vega-Zelaya L, Pastor J, Tormo I, de Sola RG, Ortega GJ. Assessing the equivalence between etomidate and seizure network dynamics in temporal lobe epilepsy. Clin Neurophysiol 2015; 127:169-178. [PMID: 26070516 DOI: 10.1016/j.clinph.2015.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 04/09/2015] [Accepted: 05/06/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Etomidate mimics some typical epileptic neurophysiological features, such as the appearance of spikes and high frequency oscillations, when it is administrated to epileptic patients. However, little is known about its influence on the underlying cortical network. An assessment of comparable cortical dynamics between seizures and etomidate would allow for a more detailed study of the network parameters underlying the ictal stage by using etomidate as a proxy. The objective of the present work is to show that temporal lobe seizures produce network changes comparable to the ones elicited by etomidate administration. METHODS Scalp and foramen ovale electrodes (FOE) recordings from nine temporal lobe epilepsy patients were analyzed under the complex network perspective. The clustering coefficients, average path lengths, density of links, modularity and spectral entropy were calculated during the pre-ictal and ictal stages and post-etomidate administration. Etomidate administration produced no seizure in any of the analyzed cases. RESULTS The density of lines (six of nine patients) and spectral entropy (eight of nine patients) displayed similar behavior to the preictal-ictal transition when etomidate effects altered the epileptic network (FOE+scalp). When considering only the mesial sub-network, changes induced by etomidate perfusion replicated the same type of imbalance observed during the ictal stage in the nine patient's sample and in eight out of nine regarding the preictal stage. Both statistical significance at a level of 1% and size effects, evaluated by using the standardized mean differences, show similar network changes during the preictal-ictal and preictal-etomidate transitions. CONCLUSIONS Etomidate perfusion in patients with temporal lobe epilepsy induces network changes comparable to the changes resulting from seizures. SIGNIFICANCE The finding reported here could improve the study of network dynamics during the ictal phase, not only with electrophysiological methods, but also in other cases, such as functional magnetic resonance imaging.
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Affiliation(s)
- Lorena Vega-Zelaya
- Clinical Neurophysiology, Hospital Universitario de la Princesa, Madrid, Spain; Instituto de Investigación Sanitaria Hospital Universitario de la Princesa, Madrid, Spain
| | - Jesús Pastor
- Clinical Neurophysiology, Hospital Universitario de la Princesa, Madrid, Spain; Instituto de Investigación Sanitaria Hospital Universitario de la Princesa, Madrid, Spain
| | - Isabel Tormo
- Clinical Neurophysiology, Hospital Universitario de la Princesa, Madrid, Spain
| | - Rafael G de Sola
- Neurosurgery, Hospital Universitario de la Princesa, Madrid, Spain; Instituto de Investigación Sanitaria Hospital Universitario de la Princesa, Madrid, Spain
| | - Guillermo J Ortega
- Neurosurgery, Hospital Universitario de la Princesa, Madrid, Spain; Instituto de Investigación Sanitaria Hospital Universitario de la Princesa, Madrid, Spain.
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Rampp S, Schmitt HJ, Heers M, Schönherr M, Schmitt FC, Hopfengärtner R, Stefan H. Etomidate activates epileptic high frequency oscillations. Clin Neurophysiol 2013; 125:223-30. [PMID: 23911722 DOI: 10.1016/j.clinph.2013.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 07/04/2013] [Accepted: 07/06/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The short acting anesthetic etomidate has been shown to provoke epileptic spikes and rarely seizures. Influence of etomidate on the occurrence of epileptic HFO (high frequency oscillations) however is unknown. An HFO inducing effect of etomidate would allow further validation of the substance as a provocation measure in presurgical evaluation as well as provide insights into the common mechanisms of HFO, spike and seizure generation. METHODS We retrospectively analyzed EEG data from four patients who underwent etomidate activation during invasive video-EEG monitoring with subdural strip electrodes. Spikes were manually selected in raw data, HFO in band pass filtered data (80-250Hz). Rate and spatial distribution of HFO and spikes in three segments were compared: immediately after etomidate administration, as well as during slow wave sleep and while awake. RESULTS Rates of HFO and spikes increased significantly after etomidate administration: Overall average rates of spikes were 9.7/min during sleep, 10/min while awake and 61.4/min after etomidate. Average HFO rates were 9.5/min during sleep, 8.3/min while awake and 24.4/min after etomidate (p<0.001, non-parametric ANOVA). Spatial distributions of HFO and spikes after administration of etomidate were consistent with the seizure onset zone (SOZ) and area of resection when available (SOZ: two patients; resection: one patient; no information: one patient). Except for spurious events, no additional HFO and spike foci were seen with activation. CONCLUSIONS Etomidate administration activates spikes and HFO. Spatial distributions do not extend beyond electrodes showing spikes and HFO without Etomidate and seem consistent with the epileptic network. SIGNIFICANCE Etomidate activation is a safe procedure to provoke not only epileptic spikes but also HFO, which were shown to have a high specificity for the SOZ.
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Affiliation(s)
- S Rampp
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Erlangen, Germany.
| | - H J Schmitt
- Department of Anesthesiology, University Hospital Erlangen, Erlangen, Germany
| | - M Heers
- Ruhr-Epileptology/Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - M Schönherr
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - F C Schmitt
- Department of Neurology, University Hospital Magdeburg, Magdeburg, Germany
| | - R Hopfengärtner
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - H Stefan
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Erlangen, Germany; Interdisciplinary Epilepsy Center, Neurological Clinic, University Hospital Giessen and Marburg, Germany
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Chui J, Manninen P, Valiante T, Venkatraghavan L. The anesthetic considerations of intraoperative electrocorticography during epilepsy surgery. Anesth Analg 2013; 117:479-86. [PMID: 23780418 DOI: 10.1213/ane.0b013e318297390c] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Epilepsy surgery is a well-established therapeutic intervention for patients with medically refractory seizures. Success of epilepsy surgery depends on the accurate localization and complete removal of the epileptogenic zone. Despite the advances in presurgical localization modalities, electrocorticography is still used in approximately 60% to 70% of the epilepsy centers in North America to guide surgical resection of the epileptogenic lesion and to assess for completeness of surgery. In this review, we discuss the principles and intraoperative use of electrocorticography, the effect of anesthetic drugs on electrocorticography, and the use of pharmacoactivation for intraoperative localization of epileptogenic zone.
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Affiliation(s)
- Jason Chui
- Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, 399, Bathurst St., Toronto, Ontario, Canada M5T 2S8
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Chui J, Venkatraghavan L, Manninen P. Presurgical Evaluation of Patients with Epilepsy. Anesth Analg 2013; 116:881-8. [DOI: 10.1213/ane.0b013e31828211af] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Navarrete M, Perea G, Maglio L, Pastor J, Garcia de Sola R, Araque A. Astrocyte Calcium Signal and Gliotransmission in Human Brain Tissue. Cereb Cortex 2012; 23:1240-6. [DOI: 10.1093/cercor/bhs122] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ortega GJ, Peco IH, Sola RG, Pastor J. Impaired mesial synchronization in temporal lobe epilepsy. Clin Neurophysiol 2010; 122:1106-16. [PMID: 21185775 DOI: 10.1016/j.clinph.2010.11.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 09/28/2010] [Accepted: 11/04/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Temporal lobe epilepsy is commonly associated with synchronous, hyper-synchronous and des-synchronous activity. The aim of the present work is to explore synchronization activity in both mesial areas in temporal lobe epileptic patients during the interictal state. METHODS Using a cluster technique, we analyzed 17 temporal lobe epilepsy patients' records of foramen ovale electrodes activity during the inter-ictal state. RESULTS There exists a clear tendency in the mesial area of the epileptic side to be organized as isolated clusters of electrical activity as compared with the contra-lateral side, which is organized in the form of large clusters of synchronous activity. The number of desynchronized areas is larger in the epileptic side than in the contra-lateral side in 16 out of 17 temporal lobe epileptic patients. CONCLUSIONS The mesial area responsible for the seizures is less synchronous than the contra-lateral; the different kind of synchronous organization accounts for a lower synchronization activity at the epileptic side, suggesting that this lack of synchronous cluster organization would favour the appearance of seizures. SIGNIFICANCE Our results shed new light regarding synchronization issues in temporal lobe epilepsy and also it would help in reducing drastically the time of study.
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Affiliation(s)
- Guillermo J Ortega
- Department of Neurosurgery, Hospital Universitario de La Princesa, Madrid, Spain.
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