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Bress KS, Cascio CJ. Sensorimotor regulation of facial expression - An untouched frontier. Neurosci Biobehav Rev 2024; 162:105684. [PMID: 38710425 DOI: 10.1016/j.neubiorev.2024.105684] [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: 01/13/2024] [Revised: 04/16/2024] [Accepted: 04/18/2024] [Indexed: 05/08/2024]
Abstract
Facial expression is a critical form of nonverbal social communication which promotes emotional exchange and affiliation among humans. Facial expressions are generated via precise contraction of the facial muscles, guided by sensory feedback. While the neural pathways underlying facial motor control are well characterized in humans and primates, it remains unknown how tactile and proprioceptive information reaches these pathways to guide facial muscle contraction. Thus, despite the importance of facial expressions for social functioning, little is known about how they are generated as a unique sensorimotor behavior. In this review, we highlight current knowledge about sensory feedback from the face and how it is distinct from other body regions. We describe connectivity between the facial sensory and motor brain systems, and call attention to the other brain systems which influence facial expression behavior, including vision, gustation, emotion, and interoception. Finally, we petition for more research on the sensory basis of facial expressions, asserting that incomplete understanding of sensorimotor mechanisms is a barrier to addressing atypical facial expressivity in clinical populations.
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Affiliation(s)
- Kimberly S Bress
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA; Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA.
| | - Carissa J Cascio
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA; Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA; Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN, USA
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Marx B, Medina-Villalon S, Bartolomei F, Lagarde S. How Can a Focal Seizure Lead to a Dacrystic Behavior? A Case Analyzed with Functional Connectivity in Stereoelectroencephalography. Clin EEG Neurosci 2024; 55:272-277. [PMID: 37340756 DOI: 10.1177/15500594231182808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
We present a case of a patient with focal non-motor emotional seizures with dacrystic expression in the context of drug-resistant magnetic resonance imaging negative epilepsy. The pre-surgical evaluation suggested a hypothesis of a right fronto-temporal epileptogenic zone. Stereoelectroencephalography recorded dacrystic seizures arising from the right anterior operculo-insular (pars orbitalis) area with secondary propagation to temporal and parietal cortices during the dacrystic behavior. We analyzed functional connectivity during the ictal dacrystic behavior and found an increase of the functional connectivity within a large right fronto-temporo-insular network, broadly similar to the "emotional excitatory" network. It suggests that focal seizure, potentially, from various origins but leading to disorganization of these physiological networks may generate dacrystic behavior.
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Affiliation(s)
- Barbara Marx
- APHM, Timone Hospital, Epileptology Department, Member of the ERN EpiCARE, Marseille, France
| | - Samuel Medina-Villalon
- APHM, Timone Hospital, Epileptology Department, Member of the ERN EpiCARE, Marseille, France
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Fabrice Bartolomei
- APHM, Timone Hospital, Epileptology Department, Member of the ERN EpiCARE, Marseille, France
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Stanislas Lagarde
- APHM, Timone Hospital, Epileptology Department, Member of the ERN EpiCARE, Marseille, France
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
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3
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Azman Iste F, Yon MI, Tezer FI, Saygi S. Ictal crying in epileptic seizures and psychogenic nonepileptic seizures: What are the hints to differentiate them? Epilepsy Behav 2023; 147:109385. [PMID: 37619457 DOI: 10.1016/j.yebeh.2023.109385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/19/2023] [Accepted: 07/27/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVES Ictal crying (IC) is a quite rare semiological manifestation of epileptic seizures (ESs) and it has been mostly reported in psychogenic nonepileptic seizures (PNESs). However, labeling IC as a pathognomonic sign of PNES can be harmful. We first aimed to investigate IC frequency in ES and PNES and highlight the differences of IC between ES and PNES. Secondly, we aimed to analyze etiology, detailed semiology, treatment options, and outcome of patients with IC in ES in more detail. METHODS We retrospectively screened all video-EEG monitoring unit reports from Hacettepe University Hospitals' Epilepsy Center over a 20-year period (1996-2017) for the diagnosis of IC. We included the patients with IC who had at least one documented seizure. Patients who had IC with both facial expression and vocalization compatible with crying with or without weeping and subjective feeling of sadness, were included in the study. We classified patients with IC as ES and PNES. Demographic, historical, clinical, neuroimaging, electrophysiological parameters, video-EEG data, treatment options, and prognosis of all patients were recorded. Demographic, clinical, and video-EEG data were compared between ES and PNES. RESULTS During the study period, 1983 patients were investigated. Six patients (all female) with ES and 37 patients (33 female) with PNES were identified. When we compared patients with PNES and ES with IC, the number of ASMs taken and duration of disease were significantly higher in patients with ES than PNES. Longer duration of seizure, longer duration of crying component, late onset of crying component in seizure, early responsiveness after seizure, not occurring during sleep, accompanied by eye closure and weeping, were found significantly higher in patients with PNES. Besides, if we analyze ES group in more detail, all had medical treatment refractory focal epilepsy and two of them whose IC was seen as an early semiological manifestation of their seizures had good outcome after nondominant anterior temporal lobectomy (ATL)+amygdalohippocampectomy (AH). However, three patients had various cortical lesions apart from temporal lobe on MRI and one patient had focal epilepsy with frontal lobe semiology with negative MRI. CONCLUSION Although the most common etiology for IC is PNES and it is rarely seen in ES, it can be harmful to label ictal crying as a pathognomonic sign for PNES. We proposed that there are some semiological differences in terms of IC between PNES and ES. These differences may help to distinguish IC in PNES and ES in daily practice. Moreover, it can be speculated that nondominant temporal lobe involvement may be associated with IC in ES.
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Affiliation(s)
- Filiz Azman Iste
- Hacettepe University Hospital, Department of Neurology, Ankara, Turkey.
| | - M Ilker Yon
- Hacettepe University Hospital, Department of Neurology, Ankara, Turkey.
| | - F Irsel Tezer
- Hacettepe University Hospital, Department of Neurology, Ankara, Turkey.
| | - Serap Saygi
- Hacettepe University Hospital, Department of Neurology, Ankara, Turkey.
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Muacevic A, Adler JR. Behavioral Seizure in a Patient With a Cavernous Malformation Finding in CT: A Case Report. Cureus 2023; 15:e34731. [PMID: 36755771 PMCID: PMC9904422 DOI: 10.7759/cureus.34731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 02/10/2023] Open
Abstract
Behavioral epileptic seizures (BES) are a unique type of seizure that can be presented with or without the classic limb movements of epilepsy. This type of seizure is commonly associated with the frontal and temporal lobes of the brain. Symptoms consist of anxiety, smiling, crying, fear, aggression, irritability, and change in awareness or activity. We report a case of unusual seizure presentation of jerky movements followed by intense fear and crying caused by a right parietal cavernous malformation with chronic bleeding.
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Datta A, Chakrabarti S. The crying child and dacrystic seizures: a diagnostic conundrum. PROGRESS IN NEUROLOGY AND PSYCHIATRY 2023. [DOI: 10.1002/pnp.773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Aarti Datta
- Dr Datta is a Consultant Child and Adolescent Psychiatrist on Harley Street and Dr Chakrabarti is a Consultant Child and Adolescent Psychiatrist at King's College Hospital, London, UK
| | - Sulagna Chakrabarti
- Dr Datta is a Consultant Child and Adolescent Psychiatrist on Harley Street and Dr Chakrabarti is a Consultant Child and Adolescent Psychiatrist at King's College Hospital, London, UK
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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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Medina JC, Galván R, Garfias CY, Arteaga DJ. A Case Report of Dacrystic Seizures in the Psychiatric Emergency Services Department. Cureus 2022; 14:e23632. [PMID: 35494906 PMCID: PMC9050616 DOI: 10.7759/cureus.23632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2022] [Indexed: 11/24/2022] Open
Abstract
Epileptiform syndromes are represented by a variety of clinical scenarios. In this context, dacrystic seizures (DS) are characterized by paroxysmal episodes of stereotyped crying and are considered a rare ictal phenomenon. Their neuroanatomical and pathophysiological findings tend to be nonspecific, and to date, there is no consensus on their treatment. Additionally, most of the existing case reports describe that the patients who suffer from them are usually refractory to conventional care. Also, most of the existing literature is approached from a neurological practice perspective; however, there's evidence of patients with these paroxysms that occasionally end up in the hands of psychiatric services due to the uniqueness of their symptoms. However, there is very little information about this phenomenon due to its rarity. For this reason, this manuscript presents the case of a middle-aged man with these seizures who initially attended a psychiatric emergency service and subsequently received neuropsychiatric management and follow-up.
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Klingbeil J, Wawrzyniak M, Stockert A, Brandt ML, Schneider HR, Metelmann M, Saur D. Pathological laughter and crying: insights from lesion network-symptom-mapping. Brain 2021; 144:3264-3276. [PMID: 34142117 DOI: 10.1093/brain/awab224] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/07/2021] [Accepted: 04/08/2021] [Indexed: 11/15/2022] Open
Abstract
The study of pathological laughter and crying (PLC) allows insights into the neural basis of laughter and crying, two hallmarks of human nature. PLC is defined by brief, intense and frequent episodes of uncontrollable laughter or crying provoked by trivial stimuli. It occurs secondary to CNS disorders such as stroke, tumours or neurodegenerative diseases. Based on case studies reporting various lesions locations, PLC has been conceptualized as dysfunction in a cortico-limbic-subcortico-thalamo-ponto-cerebellar network. To test whether the heterogeneous lesion locations are indeed linked in a common network, we applied 'lesion network-symptom-mapping' (LNSM) to 70 focal lesions identified in a systematic literature search for case reports of PLC. In LNSM normative connectome data (resting state functional MRI, n = 100) is used to identify the brain regions which are likely affected by diaschisis based on the lesion locations. With LNSM we were able to identify a common network specific for PLC when compared with a control cohort (n = 270). This bilateral network is characterized by positive connectivity to the cingulate and temporomesial cortices, striatum, hypothalamus, mesencephalon and pons and negative connectivity to the primary motor and sensory cortices. In the most influential pathophysiological model of PLC, a center for the control and coordination of facial expressions, respiration and vocalization in the periaqueductal grey is assumed which is controlled via two pathways: an emotional system that exerts excitatory control of the periaqueductal grey descending from the temporal and frontal lobes, basal ganglia and hypothalamus and a volitional system descending from the lateral premotor cortices which can suppress laughter or crying. To test whether the positive and negative PLC subnetworks identified in our analyses can indeed be related to an emotional system and a volitional system, we identified lesions causing emotional (n = 15) or volitional facial paresis (n = 46) in a second literature search. Patients with emotional facial paresis show preserved volitional movements but cannot trigger emotional movements in the affected hemiface, while the reverse is true for volitional facial paresis. Importantly, these lesions map differentially onto the PLC subnetworks: the 'positive PLC subnetwork' is part of the emotional system and the 'negative PLC subnetwork' overlaps with the volitional system for the control of facial movements. Based on this network analysis we propose a two-hit model of PLC: a combination of direct lesion and indirect diaschisis effects cause PLC through the loss of inhibitory cortical control of a dysfunctional emotional system.
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Affiliation(s)
- Julian Klingbeil
- Language and Aphasia Laboratory, Department of Neurology, University of Leipzig Medical Centre, 04103 Leipzig, Germany
| | - Max Wawrzyniak
- Language and Aphasia Laboratory, Department of Neurology, University of Leipzig Medical Centre, 04103 Leipzig, Germany
| | - Anika Stockert
- Language and Aphasia Laboratory, Department of Neurology, University of Leipzig Medical Centre, 04103 Leipzig, Germany
| | - Max-Lennart Brandt
- Language and Aphasia Laboratory, Department of Neurology, University of Leipzig Medical Centre, 04103 Leipzig, Germany
| | - Hans-Ralf Schneider
- Language and Aphasia Laboratory, Department of Neurology, University of Leipzig Medical Centre, 04103 Leipzig, Germany
| | - Moritz Metelmann
- Language and Aphasia Laboratory, Department of Neurology, University of Leipzig Medical Centre, 04103 Leipzig, Germany
| | - Dorothee Saur
- Language and Aphasia Laboratory, Department of Neurology, University of Leipzig Medical Centre, 04103 Leipzig, Germany
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Scholly J, Bartolomei F. Gelastic seizures and the hypothalamic hamartoma syndrome: Epileptogenesis beyond the lesion? HANDBOOK OF CLINICAL NEUROLOGY 2021; 182:143-154. [PMID: 34266589 DOI: 10.1016/b978-0-12-819973-2.00010-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The clinicoradiologic syndrome of hypothalamic hamartoma (HH) manifests with a variety of symptoms, including pharmacoresistant epilepsy with multiple seizure types, precocious puberty, behavioral disturbances, and cognitive impairment. Gelastic seizures are an early marker of epilepsy with HH in most of the cases. Despite a high variability, two major epilepsy phenotypes can be distinguished, based on electroclinical features: (i) focal seizures with epigastric or déjà-vu aura, loss of consciousness, and oroalimentary or gestural automatisms suggestive of temporal lobe involvement; and (ii) motor seizures with tonic, atonic, myoclonic, or versive phenomena, suggesting frontoparietal network involvement, with possible evolution toward an epileptic encephalopathy. The underlying physiopathologic mechanisms are not completely elucidated. The well-known intrinsic epileptogenicity of the HH represents the rationale for direct HH-aiming surgical procedures, with variable success in achieving seizure freedom. The concept of kindling-like secondary epileptogenesis has been suggested as a possible putative mechanism since the very beginnings of the hamartocentric era. Accordingly, a cortical area with enhanced epileptogenic properties due to an independent stage of secondary epileptogenesis would be responsible for seizures persisting after hamartoma ablation. However, recent intracerebral stereotactic EEG (SEEG) explorations demonstrated more complex, both reciprocal and hierarchical, relationships within the hypothalamo-cortical epileptogenic networks. Network formation may be due to either secondary epileptogenesis or widespread epileptogenicity present at the outset. A short time window from epilepsy onset to surgery seems to be crucial to cure epilepsy by direct surgery addressing a hamartoma. SEEG exploration may be reasonably proposed in cases where clinical data suggest an extension of the epileptogenic zone outside the limits of the HH, especially in focal seizures with impaired awareness and absence of gelastic seizures, or after a failure of the direct HH-aiming procedure.
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Affiliation(s)
- Julia Scholly
- Department of Epileptology and Cerebral Rhythmology, Aix Marseille University, Hôpital Timone, Marseille, France; Center for Magnetic Resonance in Biology and Medicine, Aix Marseille University, Hôpital Timone, Marseille, France
| | - Fabrice Bartolomei
- Department of Epileptology and Cerebral Rhythmology, Aix Marseille University, Hôpital Timone, Marseille, France; Institut de Neurosciences des Systèmes, Aix Marseille University, Marseille, France.
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Alomari SO, Houshiemy MNE, Bsat S, Moussalem CK, Allouh M, Omeis IA. Hypothalamic hamartomas: A comprehensive review of the literature - Part 1: Neurobiological features, clinical presentations and advancements in diagnostic tools. Clin Neurol Neurosurg 2020; 197:106076. [PMID: 32717559 DOI: 10.1016/j.clineuro.2020.106076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/25/2020] [Accepted: 07/06/2020] [Indexed: 10/23/2022]
Abstract
Hypothalamic hamartomas (HH) are rare, non-neoplastic heterotopic tissues which contains normal neurons and glia including oligodendrocytes and fibrillary astrocytes but in an abnormal distribution. They arise from the floor of the third ventricle, tuber cinereum, or mammillary bodies. Estimated incidence ranges from 1 in 50,000-1 in 1,000,000. Hypothalamic hamartomas are associated with different clinical presentations including various types of seizures, most characteristically; the gelastic seizures, precocious puberty, cognitive impairment, and behavioral changes. In this review, the authors discuss advancements in different diagnostic elements of hypothalamic hamartoma; including clinical features, EEG findings, and neuroimaging techniques. Moreover, different classifications described in the literature will be discussed.
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Affiliation(s)
- Safwan O Alomari
- Division of Neurosurgery, Department of Surgery, American University of Beirut Medical Center, Lebanon
| | - Mohammed N El Houshiemy
- Division of Neurosurgery, Department of Surgery, American University of Beirut Medical Center, Lebanon
| | - Shadi Bsat
- Division of Neurosurgery, Department of Surgery, American University of Beirut Medical Center, Lebanon
| | - Charbel K Moussalem
- Division of Neurosurgery, Department of Surgery, American University of Beirut Medical Center, Lebanon
| | - Mohammed Allouh
- Anatomy Department, College of Medicine and Health Sciences, United Arab Emirates University, United Arab Emirates
| | - Ibrahim A Omeis
- Division of Neurosurgery, Department of Surgery, American University of Beirut Medical Center, Lebanon.
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Raybarman C. Dacrystic Epilepsy. Indian J Pediatr 2018; 85:563-564. [PMID: 29170920 DOI: 10.1007/s12098-017-2543-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 11/10/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Chandan Raybarman
- Pediatric and Neurology Care Clinic , Somen Sukanta Sarani, Krishna Nagar, Agartala, Tripura, 799001, India.
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12
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13
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[Psychogenic non epileptic seizures : Differential diagnostic features]. Herzschrittmacherther Elektrophysiol 2018; 29:155-160. [PMID: 29761337 DOI: 10.1007/s00399-018-0557-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/03/2018] [Indexed: 10/16/2022]
Abstract
Psychogenic nonepileptic seizures (PNES) are to be considered in the differential diagnosis of a transient loss of consciousness. Their discrimination from syncope, epileptic seizures or vascular events can be difficult and requires profound knowledge about the semiology and clinical presentation of PNES and their differential diagnoses. Erroneous diagnoses and the resulting therapies lead to elevated morbidity, elevated costs and a poorer outcome. The aim of the present article is to provide an overview on PNES and their delineation from the clinical pictures of epilepsy and syncope.
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Gadoth A, Singh J, Britton JW, Flanagan EP, Pittock SJ. Dacrystic seizures-a cry for help. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2017. [PMID: 28642892 PMCID: PMC5473955 DOI: 10.1212/nxi.0000000000000372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Avi Gadoth
- Department of Laboratory Medicine and Pathology (A.G., E.P.F., S.J.P.) and Department of Neurology (A.G., J.S., J.W.B., E.P.F., S.J.P.), Mayo Clinic, Rochester, MN
| | - Jaysingh Singh
- Department of Laboratory Medicine and Pathology (A.G., E.P.F., S.J.P.) and Department of Neurology (A.G., J.S., J.W.B., E.P.F., S.J.P.), Mayo Clinic, Rochester, MN
| | - Jeffrey W Britton
- Department of Laboratory Medicine and Pathology (A.G., E.P.F., S.J.P.) and Department of Neurology (A.G., J.S., J.W.B., E.P.F., S.J.P.), Mayo Clinic, Rochester, MN
| | - Eoin P Flanagan
- Department of Laboratory Medicine and Pathology (A.G., E.P.F., S.J.P.) and Department of Neurology (A.G., J.S., J.W.B., E.P.F., S.J.P.), Mayo Clinic, Rochester, MN
| | - Sean J Pittock
- Department of Laboratory Medicine and Pathology (A.G., E.P.F., S.J.P.) and Department of Neurology (A.G., J.S., J.W.B., E.P.F., S.J.P.), Mayo Clinic, Rochester, MN
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Striano S, Striano P. Clinical features and evolution of the gelastic seizures-hypothalamic hamartoma syndrome. Epilepsia 2017; 58 Suppl 2:12-15. [DOI: 10.1111/epi.13753] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Salvatore Striano
- Department of Neurosciences, Reproductive and Odontostomatological Sciences; Epilepsy Center; School of Medicine; Federico II University; Napoli Italy
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health; Institute “G. Gaslini”; University of Genova; Genova Italy
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Ictal laughter and crying: Should they be classified as automatisms? EPILEPSY & BEHAVIOR CASE REPORTS 2017; 7:31-33. [PMID: 28239548 PMCID: PMC5318346 DOI: 10.1016/j.ebcr.2016.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/19/2016] [Accepted: 11/25/2016] [Indexed: 11/21/2022]
Abstract
Gelastic seizures (GS) describe ictal laughter and are associated with hypothalamic lesions, as well as other cortical areas. Dacrystic seizures (DS), characterized by ictal crying, also have been reported in hypothalamic lesions and focal epilepsy. We describe a young girl with drug resistant focal dyscognitive seizures associated with gelastic and dacrystic features. However, neither laughter nor crying was correlated with a stereotyped electroencephalographic (EEG) pattern or involvement of a particular brain region. Additionally, based on the variety of epileptogenic foci associated with GS and DS in the literature, laughter and crying appear to represent ictal or peri-ictal automatisms. Case report of focal dyscognitive seizures with gelastic and dacrystic features Patient seizure free after resection of parietal and insular cortical dysplasia She underwent scalp (sEEG) and intracranial (icEEG) video-EEG monitoring. Gelastic/dacrystic features not linked to specific EEG pattern or cortical area Gelastic/dacrystic symptoms represent automatisms without localizing significance.
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Sánchez Fernández I, Loddenkemper T. Seizures caused by brain tumors in children. Seizure 2016; 44:98-107. [PMID: 28017579 DOI: 10.1016/j.seizure.2016.11.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 11/23/2016] [Accepted: 11/30/2016] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To review the epidemiology, clinical features, and treatment of seizures secondary to pediatric brain tumors. METHOD Literature review. RESULTS Pediatric brain tumors are the most common solid pediatric tumor and the most common cause of death in pediatric cancer. Seizures are one of the most common symptoms of pediatric brain tumors. Factors associated with increased risk of seizures include supratentorial location, gray matter involvement, low-grade, and certain histological features-especially dysembryoplastic neuroepithelial tumor, ganglioglioma, and oligodendroglioma. Leukemic infiltration of the brain, brain metastases of solid tumors, and brain injury secondary to chemotherapy or radiotherapy can also cause seizures. Mechanisms by which brain tumors cause seizures include metabolic, and neurotransmitter changes in peritumoral brain, morphologic changes - including malformation of cortical development - in peritumoral brain, and presence of peritumoral blood products, gliosis, and necrosis. As there is a high degree of uncertainty on how effective different antiepileptic drugs are for seizures caused by brain tumors, choices are often driven by the interaction and side effect profile. Classic antiepileptic drugs - phenobarbital, phenytoin, or carbamazepine - should be avoided as they may alter the metabolism of chemotherapeutic agents. Newer drugs - valproate, lamotrigine, topiramate, zonisamide, and levetiracetam - may be the preferred option in patients with tumors because of their very limited interaction with chemotherapy. CONCLUSION Seizures are a common presentation of pediatric brain tumors, especially in supratentorial tumors with gray matter involvement. Antiepileptic drug therapy is usually driven by the interaction and side effect profile and newer drugs with few interactions are generally preferred.
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Affiliation(s)
- Iván Sánchez Fernández
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Child Neurology, Hospital Sant Joan de Déu, Universidad de Barcelona, Spain.
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
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Asadi-Pooya AA, Wyeth D, Sperling MR. Ictal crying. Epilepsy Behav 2016; 59:1-3. [PMID: 27084975 DOI: 10.1016/j.yebeh.2016.03.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 03/07/2016] [Accepted: 03/08/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to describe a series of patients with ictal crying to estimate its occurrence and characterize the clinical features and the underlying etiology. METHODS We retrospectively reviewed all the long-term video-EEG reports from Jefferson Comprehensive Epilepsy Center over a 12-year period (2004-2015) for the occurrence of the terms "cry" or "sob" or "weep" in the text body. All the extracted reports were reviewed, and patients with at least one episode of documented ictal crying at the epilepsy monitoring unit (EMU) were included in the study. RESULTS During the study period, 5133 patients were investigated at our EMU. Thirty-two patients (0.6%) had at least one documented seizure accompanied by crying. Twenty-seven patients (26 women and one man) had psychogenic nonepileptic seizures (PNES), and five patients (0.1%) had epilepsy. Among patients with epileptic ictal crying, four patients had focal epilepsy (two had definite, and two had probable frontal lobe epilepsy), while one patient had Lennox-Gastaut syndrome. CONCLUSION Ictal crying is a rare finding among patients evaluated at the EMUs. The most common underlying etiology for ictal crying is PNES. However, ictal crying is not a specific sign for PNES. Epileptic ictal crying is often a rare type of partial seizure in patients with focal epilepsy. Dacrystic seizures do not provide clinical value in predicting localization of the epileptogenic zone.
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Affiliation(s)
- Ali A Asadi-Pooya
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Dale Wyeth
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Michael R Sperling
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
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Kovac S, Diehl B, Wehner T, Fois C, Toms N, Walker MC, Duncan JS. Gelastic seizures: Incidence, clinical and EEG features in adult patients undergoing video-EEG telemetry. Epilepsia 2014; 56:e1-5. [DOI: 10.1111/epi.12868] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Stjepana Kovac
- Institute of Neurology; National Hospital for Neurology and Neurosurgery; London United Kingdom
- Department of Clinical Neurophysiology; National Hospital for Neurology and Neurosurgery; London United Kingdom
| | - Beate Diehl
- Institute of Neurology; National Hospital for Neurology and Neurosurgery; London United Kingdom
- Department of Clinical Neurophysiology; National Hospital for Neurology and Neurosurgery; London United Kingdom
| | - Tim Wehner
- Institute of Neurology; National Hospital for Neurology and Neurosurgery; London United Kingdom
- Department of Clinical Neurophysiology; National Hospital for Neurology and Neurosurgery; London United Kingdom
| | - Chiara Fois
- Institute of Neurology; National Hospital for Neurology and Neurosurgery; London United Kingdom
- Department of Clinical and Experimental Medicine; University of Sassari; Sassari Italy
| | - Nathan Toms
- Department of Clinical Neurophysiology; National Hospital for Neurology and Neurosurgery; London United Kingdom
| | - Matthew C. Walker
- Institute of Neurology; National Hospital for Neurology and Neurosurgery; London United Kingdom
| | - John S. Duncan
- Institute of Neurology; National Hospital for Neurology and Neurosurgery; London United Kingdom
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Millichap JG. Dacrystic Seizures: A Multicenter Video-EEG Study. Pediatr Neurol Briefs 2012. [DOI: 10.15844/pedneurbriefs-26-12-1] [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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