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Wu S, Nordli DR. Motor seizure semiology. HANDBOOK OF CLINICAL NEUROLOGY 2023; 196:295-304. [PMID: 37620075 DOI: 10.1016/b978-0-323-98817-9.00014-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Motor semiology is a major component of epilepsy evaluation, which provides essential information on seizure classification and helps in seizure localization. The typical motor seizures include tonic, clonic, tonic-clonic, myoclonic, atonic, epileptic spasms, automatisms, and hyperkinetic seizures. Compared to the "positive" motor signs, negative motor phenomena, for example, atonic seizures and Todd's paralysis are also crucial in seizure analysis. Several motor signs, for example, version, unilateral dystonia, figure 4 sign, M2e sign, and asymmetric clonic ending, are commonly observed and have significant clinical value in seizure localization. The purpose of this chapter is to review the localization value and pathophysiology associated with the well-defined motor seizure semiology using updated knowledge from intracranial electroencephalographic recordings, particularly stereoelectroencephalography.
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Affiliation(s)
- Shasha Wu
- Department of Neurology and the Comprehensive Epilepsy Center, The University of Chicago, Chicago, IL, United States.
| | - Douglas R Nordli
- Department of Pediatrics and the Comprehensive Epilepsy Center, The University of Chicago, Chicago, IL, United States
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2
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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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Vinti V, Dell'Isola GB, Tascini G, Mencaroni E, Cara GD, Striano P, Verrotti A. Temporal Lobe Epilepsy and Psychiatric Comorbidity. Front Neurol 2021; 12:775781. [PMID: 34917019 PMCID: PMC8669948 DOI: 10.3389/fneur.2021.775781] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/28/2021] [Indexed: 12/14/2022] Open
Abstract
Most focal seizures originate in the temporal lobe and are commonly divided into mesial and lateral temporal epilepsy, depending upon the neuronal circuitry involved. The hallmark features of the mesial temporal epilepsy are aura, unconsciousness, and automatisms. Symptoms often overlap with the lateral temporal epilepsy. However, the latter present a less evident psychomotor arrest, frequent clones and dystonic postures, and common focal to bilateral tonic–clonic seizures. Sclerosis of the hippocampus is the most frequent cause of temporal lobe epilepsy (TLE). TLE is among all epilepsies the most frequently associated with psychiatric comorbidity. Anxiety, depression, and interictal dysphoria are recurrent psychiatric disorders in pediatric patients with TLE. In addition, these alterations are often combined with cognitive, learning, and behavioral impairment. These comorbidities occur more frequently in TLE with hippocampal sclerosis and with pharmacoresistance. According to the bidirectional hypothesis, the close relationship between TLE and psychiatric features should lead to considering common pathophysiology underlying these disorders. Psychiatric comorbidities considerably reduce the quality of life of these children and their families. Thus, early detection and appropriate management and therapeutic strategies could improve the prognosis of these patients. The aim of this review is to analyze TLE correlation with psychiatric disorders and its underlying conditions.
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Affiliation(s)
- Valerio Vinti
- Department of Pediatrics, University of Perugia, Perugia, Italy
| | | | - Giorgia Tascini
- Department of Pediatrics, University of Perugia, Perugia, Italy
| | | | | | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, Istituto di Ricovero e Cura a Carattere Scientifico Giannina Gaslini (IRCCS "G. Gaslini") Institute, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
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Yang B, Mo J, Zhang C, Wang X, Sang L, Zheng Z, Gao D, Zhao X, Wang Y, Liu C, Zhao B, Guo Z, Shao X, Zhang J, Zhang K, Hu W. Clinical features of automatisms and correlation with the seizure onset zones: A cluster analysis of 74 surgically-treated cases. Seizure 2021; 94:82-89. [PMID: 34872021 DOI: 10.1016/j.seizure.2021.11.015] [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: 08/06/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To identify semiologic features of automatisms correlating to different seizure onset zones (SOZ). METHODS In total, 204 seizures from 74 patients with either oral or manual automatisms were assessed. Patients were divided into four groups depending on the SOZ into frontal, posterior, neocortical temporal, and mesial temporal cortex groups. A k-means analysis was applied on 11 semiologic features on a multi-criteria scale. Then, the resulting clinical patterns were correlated with the SOZs determined by presurgical anatomy-electroclinical data (25 cases with stereo-EEG). RESULTS Four clinical patterns of automatisms with different accompanying symptoms were identified. The clinical features of clusters 1 and 4 were mostly found in temporal epilepsy whereas clusters 2 and 3 were more frequent in extratemporal epilepsy. Cluster 1 was significantly correlated with mesial temporal lobe epilepsy (p = .017) and was characterised by aura, postictal confusion, short automatisms delay. Cluster 3 included 1/3 patients with frontal lobe epilepsy and was characterised by emotionality. Cluster 4 was related to neocortical temporal lobe epilepsy and characterised by dystonia and short automatism delay (p = .011). CONCLUSION The distinct semiologic patterns of automatisms may provide information which may allow clinicians to define the SOZs. These findings could improve diagnostic accuracy and surgical outcome.
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Affiliation(s)
- Bowen Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jiajie Mo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chao Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiu Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lin Sang
- Department of Neurosurgery, Beijing Fengtai Hospital, Beijing, China
| | - Zhong Zheng
- Department of Neurosurgery, Beijing Fengtai Hospital, Beijing, China
| | - Dongmei Gao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xuemin Zhao
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Yao Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chang Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Baotian Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhihao Guo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoqiu Shao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Kai Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Beijing Key Laboratory of Neurostimulation, Beijing, China.
| | - Wenhan Hu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Beijing Key Laboratory of Neurostimulation, Beijing, China.
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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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Rosenow F, Akamatsu N, Bast T, Bauer S, Baumgartner C, Benbadis S, Bermeo-Ovalle A, Beyenburg S, Bleasel A, Bozorgi A, Brázdil M, Carreño M, Delanty N, Devereaux M, Duncan J, Fernandez-Baca Vaca G, Francione S, García Losarcos N, Ghanma L, Gil-Nagel A, Hamer H, Holthausen H, Omidi SJ, Kahane P, Kalamangalam G, Kanner A, Knake S, Kovac S, Krakow K, Krämer G, Kurlemann G, Lacuey N, Landazuri P, Lim SH, Londoño LV, LoRusso G, Luders H, Mani J, Matsumoto R, Miller J, Noachtar S, O'Dwyer R, Palmini A, Park J, Reif PS, Remi J, Sakamoto AC, Schmitz B, Schubert-Bast S, Schuele S, Shahid A, Steinhoff B, Strzelczyk A, Szabo CA, Tandon N, Terada K, Toledo M, van Emde Boas W, Walker M, Widdess-Walsh P. Could the 2017 ILAE and the four-dimensional epilepsy classifications be merged to a new "Integrated Epilepsy Classification"? Seizure 2020; 78:31-37. [PMID: 32155575 DOI: 10.1016/j.seizure.2020.02.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 02/29/2020] [Indexed: 11/30/2022] Open
Abstract
Over the last few decades the ILAE classifications for seizures and epilepsies (ILAE-EC) have been updated repeatedly to reflect the substantial progress that has been made in diagnosis and understanding of the etiology of epilepsies and seizures and to correct some of the shortcomings of the terminology used by the original taxonomy from the 1980s. However, these proposals have not been universally accepted or used in routine clinical practice. During the same period, a separate classification known as the "Four-dimensional epilepsy classification" (4D-EC) was developed which includes a seizure classification based exclusively on ictal symptomatology, which has been tested and adapted over the years. The extensive arguments for and against these two classification systems made in the past have mainly focused on the shortcomings of each system, presuming that they are incompatible. As a further more detailed discussion of the differences seemed relatively unproductive, we here review and assess the concordance between these two approaches that has evolved over time, to consider whether a classification incorporating the best aspects of the two approaches is feasible. To facilitate further discussion in this direction we outline a concrete proposal showing how such a compromise could be accomplished, the "Integrated Epilepsy Classification". This consists of five categories derived to different degrees from both of the classification systems: 1) a "Headline" summarizing localization and etiology for the less specialized users, 2) "Seizure type(s)", 3) "Epilepsy type" (focal, generalized or unknown allowing to add the epilepsy syndrome if available), 4) "Etiology", and 5) "Comorbidities & patient preferences".
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Affiliation(s)
- Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, University Hospital Frankfurt and Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Germany.
| | - Naoki Akamatsu
- Department of Neurology, School of Medicine, International University of Health and Welfare, Fukuoka, Japan
| | - Thomas Bast
- Epilepsy Center Kork, Kehl, Germany; Medical Faculty of the University of Freiburg, Germany
| | - Sebastian Bauer
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, University Hospital Frankfurt and Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Germany
| | - Christoph Baumgartner
- Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhuegel, Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Selim Benbadis
- University of South Florida and Tampa General Hospital, Tampa, FL, USA
| | - Adriana Bermeo-Ovalle
- Rush University Medical Center, Department of Neurological Sciences, Section of Epilepsy, Chicago, IL, USA
| | - Stefan Beyenburg
- Département des Neurosciences, Service de Neurologie Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Andrew Bleasel
- University of Sydney, Westmead Clinical School, Sydney, Australia
| | | | - Milan Brázdil
- Brno Epilepsy Center, Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Mar Carreño
- Epilepsy Unit, Hospital Clinic, Barcelona, Spain
| | - Norman Delanty
- Department of Neurology, Beaumont Hospital, and FutureNeuro Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Michael Devereaux
- Epilepsy Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - John Duncan
- Institute of Neurology, University College London, London, UK
| | | | - Stefano Francione
- "Claudio Munari" Epilepsy Surgery Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | - Lauren Ghanma
- Epilepsy Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | | | - Hajo Hamer
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | | | - Shirin Jamal Omidi
- Neurology Department, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Philippe Kahane
- Neurology Department, Grenoble-Alpes University Hospital, Grenoble, France
| | - Giri Kalamangalam
- University of Florida, Department of Neurology, Gainesville, Florida, USA
| | - Andrés Kanner
- University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Susanne Knake
- Epilepsy Center Hessen, Philipps-University Marburg, Marburg, Germany
| | - Stjepana Kovac
- of Neurology with Institute of Translational Neurology, University of Muenster, Muenster, Germany
| | - Karsten Krakow
- Asklepios Hospital for Neurology Falkenstein, Koenigstein-Falkenstein, Germany
| | | | | | - Nuria Lacuey
- The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Patrick Landazuri
- Epilepsy Division, Department of Neurology, University of Kansas Medical Center, Kansas City, USA
| | - Shi Hui Lim
- National Neuroscience Institute, Singapore and Duke-National University of Singapore Medical School, Singapore
| | | | - Giorgio LoRusso
- "Claudio Munari" Epilepsy Surgery Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Hans Luders
- Epilepsy Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jayanti Mani
- Department of Brain and Nervous System, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
| | - Riki Matsumoto
- Division of Neurology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Jonathan Miller
- Functional and Restorative Neurosurgery Center, Department of Neurological Surgery, University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Soheyl Noachtar
- Epilepsy Center, Department of Neurology, University of Munich Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Rebecca O'Dwyer
- Epilepsy Section, Department of Neurological Sciences, Rush University Medical Center, Chicago, USA
| | - André Palmini
- School of Medicine, Pontificia Universidade Católica do Rio Grande do Sul (PUCRS); Porto Alegre Epilepsy Surgery Program, Hospital São Lucas da PUCRS, Porto Alegre, Brazil
| | - Jun Park
- Epilepsy Center, UH Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Philipp S Reif
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, University Hospital Frankfurt and Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Germany
| | - Jan Remi
- Epilepsy Center, Department of Neurology, University of Munich Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Americo C Sakamoto
- Department of Neurosciences and Behavioral Sciences, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Bettina Schmitz
- Department of Neurology, Vivantes Humboldt-Klinikum, Berlin, Germany
| | - Susanne Schubert-Bast
- Epilepsy Center, Department Neuropediatrics and Epilepsy Center Frankfurt Rhine-Main, University Children's Hospital, Goethe University Frankfurt, Frankfurt, Germany
| | - Stephan Schuele
- Epilepsy Center, Northwestern University, Feinberg School of Medicine; Northwestern Memorial Hospital, Chicago, IL, USA
| | - Asim Shahid
- Epilepsy Center, UH Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Bernhard Steinhoff
- Epilepsy Center Kork, Kehl, Germany; Medical Faculty of the University of Freiburg, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, University Hospital Frankfurt and Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Germany
| | - C Akos Szabo
- South Texas Comprehensive Epilepsy Center and Department of Neurology, UT Health San Antonio, San Antonio, TX, USA
| | - Nitin Tandon
- Department of Neurosurgery, McGovern Medical School at UT Health, Texas Epilepsy Neurotechnologies and Neuroinformatics Institute, UT Health, Memorial Hermann Hospital, Texas Medical Center, Houston, TX, USA
| | - Kiyohito Terada
- Department of Neurology, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
| | - Manuel Toledo
- Epilepsy Unit, Vall dHebron Hospital, Barcelona, Spain
| | - Walter van Emde Boas
- Formerly Department EEG & EMU, Dutch Epilepsy Clinics Foundation SEIN, Heemstede & Zwolle, The Netherlands
| | - Matthew Walker
- Institute of Neurology, University College London, London, UK
| | - Peter Widdess-Walsh
- Department of Neurology, Beaumont Hospital, and FutureNeuro Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
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Lee JJ, Kang K, Park JM, Lee WW, Kwon O, Kim BK. Epilepsy Mimicking Affective Disorder in a Patient with Amygdala Enlargement. J Epilepsy Res 2019; 9:83-86. [PMID: 31482060 PMCID: PMC6706644 DOI: 10.14581/jer.19009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/14/2019] [Accepted: 06/25/2019] [Indexed: 11/03/2022] Open
Abstract
Affective disorders are commonly associated with epilepsy. Affective symptoms rarely occur concomitantly with seizure occurrence, which can lead to misdiagnosis. Here, we describe a 69-year-old man who experiencedintermittent manifestations of unpleasant mood and aggressive behavior. He had temporal lobe epilepsy with amygdala enlargement. After successful treatment with an antiepileptic drug, hissymptoms resolved. Additionally, the amygdala enlargement decreased when checked at 5 years after treatment. We discuss the clinical characteristics and differential points of the case.
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Affiliation(s)
- Jung-Ju Lee
- Department of Neurology, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, Korea
| | - Kyusik Kang
- Department of Neurology, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, Korea
| | - Jong-Moo Park
- Department of Neurology, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, Korea
| | - Woong-Woo Lee
- Department of Neurology, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, Korea
| | - Ohyun Kwon
- Department of Neurology, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, Korea
| | - Byeong-Kun Kim
- Department of Neurology, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, Korea
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9
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Park HR, Seong MJ, Shon YM, Joo EY, Seo DW, Hong SB. SPECT perfusion changes during ictal automatisms with preserved responsiveness in patients with right temporal lobe epilepsy. Epilepsy Behav 2018; 80:11-14. [PMID: 29396356 DOI: 10.1016/j.yebeh.2017.12.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 12/23/2017] [Accepted: 12/24/2017] [Indexed: 10/18/2022]
Abstract
Ictal automatism with preserved responsiveness (APR) has been reported, particularly in nondominant temporal lobe epilepsy (TLE), but its pathophysiology remains poorly understood. This study sought to investigate the relationship between APRs and increased cerebral blood flow (CBF) using ictal single photon emission computed tomography (SPECT) in TLE. Forty-seven subjects with right mesial TLE (15 with and 32 without APR) were enrolled. Patients with APR (APR+) were subdivided into four groups according to degree of responsiveness during seizures. Cerebral blood flow changes during these seizures were semiquantitatively assessed by subtraction ictal SPECT coregistered to MRI (SISCOM). Hyperperfusion in temporal regions did not vary significantly between the APR+ and APR- groups. Cerebral blood flow changes in the frontal area, insula, cingulum, and occipital area were also nonsignificant. However, hyperperfusion in the ipsilateral parietal areas was more frequent in the APR- group than in the APR+ group. Furthermore, hyperperfusion of the contralateral basal ganglia showed an inclination to be more common in the APR- group, but without statistical significance. The study suggested that the involvement of the parietal association cortex during seizure may play an important role in ictal loss of consciousness in TLE. Further studies will be needed to elucidate the pathophysiology of changes in consciousness during temporal lobe seizures.
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Affiliation(s)
- Hea Ree Park
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea; Neuroscience Center, Samsung Medical Center, Republic of Korea
| | - Min Jae Seong
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea; Neuroscience Center, Samsung Medical Center, Republic of Korea
| | - Young-Min Shon
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea; Neuroscience Center, Samsung Medical Center, Republic of Korea.
| | - Eun Yeon Joo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea; Neuroscience Center, Samsung Medical Center, Republic of Korea
| | - Dae-Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea; Neuroscience Center, Samsung Medical Center, Republic of Korea
| | - Seung Bong Hong
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea; Neuroscience Center, Samsung Medical Center, Republic of Korea
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Arango-Jaramillo E, Lozano-García L, Benjumea-Cuartas V, Andrade-Machado R. Periictal sign of the cross or Signum Crucis as a lateralizing sign in focal epilepsies: Not only a right temporal lobe epilepsy feature. Epilepsy Behav 2018; 78:52-56. [PMID: 29175220 DOI: 10.1016/j.yebeh.2017.09.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/28/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The sign of the cross (SC) is a catholic ritual that has been described as an automatism during the ictal phase in patients with right temporal lobe epilepsy. OBJECTIVE The study aimed to describe the prevalence of the SC and analyze the characteristics of patients who presented this phenomenon during the video-electroencephalography (VEEG) admission in our Epilepsy department. METHODS This is a retrospective analysis of 1308 recorded seizures; 14 patients presented the SC during the admission. Seizure semiology, electroencephalography (EEG), etiology, neuroimaging, and surgical findings were analyzed. RESULTS A prevalence of 1.1% was found, and the sign was not only an ictal finding (21% was postictal) but also exclusive of patients with temporal lobe epilepsy (15% were extratemporal) in contrast to what has been reported so far. The localizing and lateralizing value of the ictal SC was low (sensitivity 75%, specificity 33.3%, positive predictive value 60%, negative predictive value 50% for a right temporal epileptogenic zone (EZ)) compared with other previously described signs. Regardless of the lateralization of the EZ, the sign was always performed with the right hand supporting the hypothesis of a possible learned behavioral automatism. CONCLUSION The SC is a rare ictal or postictal manifestation that occurs in patients with temporal and extratemporal epilepsies without clear localizing and lateralizing value compared with previously described signs.
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Affiliation(s)
| | | | - Vanessa Benjumea-Cuartas
- Department of Epilepsy, Neurocentro, Epilepsy and Parkinson Institute, Carrera 9 #25-25, Pereira, Colombia
| | - René Andrade-Machado
- Neurological Institute of Colombia, CES University, Calle 55 #46-36, Medellín, Colombia.
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Wieser HG. Presurgical diagnosis of epilepsies – concepts and diagnostic tools. JOURNAL OF EPILEPTOLOGY 2016. [DOI: 10.1515/joepi-2016-0014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
SummaryIntroduction.Numerous reviews of the currently established concepts, strategies and diagnostic tools used in epilepsy surgery have been published. The focus concept which was initially developed by Forster, Penfield and Jasper and popularised and enriched by Lüders, is still fundamental for epilepsy surgery.Aim.To present different conceptual views of the focus concept and to discuss more recent network hypothesis, emphasizing so-called “critical modes of an epileptogenic circuit”.Method.A literature search was conducted using keywords: presurgical evaluation, epileptic focus concepts, cortical zones, diagnostic tools.Review and remarks.The theoretical concepts of the epileptic focus are opposed to the network hypothesis. The definitions of the various cortical zones have been conceptualized in the presurgical evaluation of candidates for epilepsy surgery: the seizure onset zone versus the epileptogenic zone, the symptomatogenic zone, the irritative and functional deficit zones are characterized. The epileptogenic lesion, the “eloquent cortex” and secondary epileptogenesis (mirror focus) are dealt with. The current diagnostic techniques used in the definition of these cortical zones, such as video-EEG monitoring, non-invasive and invasive EEG recording techniques, magnetic resonance imaging, ictal single photon emission computed tomography, and positron emission tomography, are discussed and illustrated. Potential modern surrogate markers of epileptogenicity, such asHigh frequency oscillations, Ictal slow waves/DC shifts, Magnetic resonance spectroscopy, Functional MRI,the use ofMagnetized nanoparticlesin MRI,Transcranial magnetic stimulation,Optical intrinsic signalimaging, andSeizure predictionare discussed. Particular emphasis is put on the EEG: Scalp EEG, semi-invasive and invasive EEG (Stereoelectroencephalography) and intraoperative electrocorticography are illustrated. Ictal SPECT and18F-FDG PET are very helpful and several other procedures, such as dipole source localization and spike-triggered functional MRI are already widely used. The most important lateralizing and localizing ictal signs and symptoms are summarized. It is anticipated that the other clinically valid surrogate markers of epileptogenesis and epileptogenicity will be further developed in the near future. Until then the concordance of the results of seizure semiology, localization of epileptogenicity by EEG and MRI remains the most important prerequisite for successful epilepsy surgery.Conclusions and future perspectives.Resective epilepsy surgery is a widely accepted and successful therapeutic approach, rendering up to 80% of selected patients seizure free. Although other therapies, such as radiosurgery, and responsive neurostimulation will increasingly play a role in patients with an unresectable lesion, it is unlikely that they will replace selective resective surgery. The hope is that new diagnostic techniques will be developed that permit more direct definition and measurement of the epileptogenic zone.
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Affiliation(s)
- James W. Jordan
- Neurological Institute University Hospitals Case Western Medical Center Cleveland, Ohio
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Loesch AM, Feddersen B, Tezer FI, Hartl E, Rémi J, Vollmar C, Noachtar S. Seizure semiology identifies patients with bilateral temporal lobe epilepsy. Epilepsy Res 2015; 109:197-202. [DOI: 10.1016/j.eplepsyres.2014.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 10/14/2014] [Accepted: 11/11/2014] [Indexed: 10/24/2022]
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Falsaperla R, Striano P, Parisi P, Lubrano R, Mahmood F, Pavone P, Vitaliti G. Usefulness of video-EEG in the paediatric emergency department. Expert Rev Neurother 2014; 14:769-785. [PMID: 24917085 DOI: 10.1586/14737175.2014.923757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Over the past two decades the EEG has technically improved from the use of analog to digital machines and more recently to video-EEG systems. Despite these advances, recording a technically acceptable EEG in an electrically hostile environment such as the emergency department (ED) remains a challenge, particularly with infants or young children. In 1996, a meeting of French experts established a set of guidelines for performing an EEG in the ED based on a review of the available literature. The authors highlighted the most suitable indications for an emergency EEG including clinical suspicion of cerebral death, convulsive and myoclonic status epilepticus, focal or generalized relapsing convulsive seizures as well as follow-up of known convulsive patients. They further recommended emergency EEG in the presence of doubt regarding the epileptic nature of the presentation as well as during the initiation or modification of sedation following brain injury. Subsequently, proposals for expanding the use of EEG in emergency patients have been advocated including trauma, vascular and anoxic-ischemic injury due to cardiorespiratory arrest, postinfective encephalopathy and nonconvulsive status epilepticus. The aim of this review is to show the diagnostic importance of video-EEG, as well as highlighting the predictive prognostic factors for positive and negative outcomes, when utilized in the pediatric ED for seizures as well as other neurological presentations.
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Affiliation(s)
- Raffaele Falsaperla
- Pediatric Acute and Emergency Operative Unit and Department, Policlinico-Vittorio Emanuele University Hospital, University of Catania, Via Plebiscito 628, 95124 Catania, Italy
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Lüders H, Amina S, Bailey C, Baumgartner C, Benbadis S, Bermeo A, Carreño M, Devereaux M, Diehl B, Eccher M, Edwards J, Fastenau P, Fernandez Baca-Vaca G, Godoy J, Hamer H, Hong SB, Ikeda A, Kahane P, Kaiboriboon K, Kalamangalam G, Lardizabal D, Lhatoo S, Lüders J, Mani J, Mayor C, Mesa Latorre T, Miller J, Morris HH, Noachtar S, O'Donovan C, Park J, Perez-Jimenez MA, Rona S, Rosenow F, Shahid A, Schuele S, Skidmore C, Steinhoff B, Szabó CÁ, Sweet J, Tandon N, Tanner A, Tsuji S. Proposal: different types of alteration and loss of consciousness in epilepsy. Epilepsia 2014; 55:1140-4. [PMID: 24981417 DOI: 10.1111/epi.12595] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2014] [Indexed: 12/01/2022]
Abstract
There are at least five types of alterations of consciousness that occur during epileptic seizures: auras with illusions or hallucinations, dyscognitive seizures, epileptic delirium, dialeptic seizures, and epileptic coma. Each of these types of alterations of consciousness has a specific semiology and a distinct pathophysiologic mechanism. In this proposal we emphasize the need to clearly define each of these alterations/loss of consciousness and to apply this terminology in semiologic descriptions and classifications of epileptic seizures. The proposal is a consensus opinion of experienced epileptologists, and it is hoped that it will lead to systematic studies that will allow a scientific characterization of the different types of alterations/loss of consciousness described in this article.
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Affiliation(s)
- Hans Lüders
- Neurology, Case Medical Center, Cleveland, Ohio, U.S.A
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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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18
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Bone B, Fogarasi A, Schulz R, Gyimesi C, Kalmar Z, Kovacs N, Ebner A, Janszky J. Secondarily generalized seizures in temporal lobe epilepsy. Epilepsia 2012; 53:817-24. [DOI: 10.1111/j.1528-1167.2012.03435.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Epilepsy, mental health disorder, or both? EPILEPSY RESEARCH AND TREATMENT 2011; 2012:163731. [PMID: 22934158 PMCID: PMC3420407 DOI: 10.1155/2012/163731] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 11/02/2011] [Indexed: 01/28/2023]
Abstract
Temporal lobe epilepsy (TLE), a subset of the seizure disorder family, represents a complex neuropsychiatric illness, where the neurological presentation may be complemented by varying severity of affective, behavioral, psychotic, or personality abnormalities, which, in turn, may not only lead to misdiagnosis, but also affect the management. This paper outlines a spectrum of mental health presentations, including psychosis, mood, anxiety, panic, and dissociative states, associated with epilepsy that make the correct diagnosis a challenge.
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20
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Musilová K, Kuba R, Brázdil M, Tyrlíková I, Rektor I. Occurrence and lateralizing value of "rare" peri-ictal vegetative symptoms in temporal lobe epilepsy. Epilepsy Behav 2010; 19:372-5. [PMID: 20800552 DOI: 10.1016/j.yebeh.2010.07.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 07/08/2010] [Accepted: 07/08/2010] [Indexed: 10/19/2022]
Abstract
We retrospectively investigated rare peri-ictal vegetative symptoms (PIVS) in 380 seizures of 97 patients with temporal lobe epilepsy (TLE): 234 seizures of 60 patients with TLE with mesiotemporal sclerosis (TLE/MTS) and 146 seizures of 37 patients with TLE with other lesions (TLE/non-MTS) who were at least 2 years after epilepsy surgery and classified as Engel I. We assessed the following PIVS: peri-ictal cough (pC), peri-ictal water drinking (pWD), peri-ictal vomiting (pV), and peri-ictal spitting (pS). We observed pC in 24.7% of patients and 10% of seizures; pWD in 14.4% of patients and 5.9% of seizures; pV and pS occurred more rarely. Both pWD and pC occurred significantly more often in those with TLE of the non- language-dominant hemisphere. The limited occurrence of pV and pS made it impossible to perform statistical analysis for these symptoms. In patients with TLE, pC and pWD were quite frequent; we observed pV and pS less frequently. Both pC and pWD have a significant lateralizing value in TLE.
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Affiliation(s)
- K Musilová
- Epilepsy Centre Brno, First Department of Neurology, St Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Abstract
Multiple Auras: Clinical Significance and Pathophysiology. Widdess-Walsh P, Kotagal P, Jeha L, Wu G, Burgess R. Neurology 2007;69(8):755–761. Erratum in: Neurology 2007;69(19):1890. Background Patients with partial epilepsy may report multiple types of aura during their seizures. The significance of the occurrence of multiple auras in the same patient is not known. Methods The clinical and electrophysiologic characteristics of patients with more than one aura type (abdominal, auditory, autonomic, gustatory, olfactory, psychic, somatosensory, and visual auras), evaluated in the Cleveland Clinic epilepsy monitoring unit between 1989 and 2005, were studied. Results Thirty-one patients experienced multiple aura types during a seizure. Ninety percent of patients with at least two aura types ( n = 31) and 100% of patients with at least three aura types ( n = 12) had seizures arising from the right/nondominant hemisphere. EEG seizures remained restricted in all patients during their auras. Twenty patients had epilepsy surgery with seizure freedom in 53%. Subdural EEG recordings in six patients showed either a march of sequential auras, or in one case, several ictal onset zones resulting in separate isolated auras. Ictal SPECT in six patients with right-sided seizures showed a lack of activation in brainstem structures. Conclusions Most patients who report multiple aura types have localized epilepsy in the nondominant hemisphere, and are good surgical candidates. A common mechanism for multiple auras may be a spreading but restricted EEG seizure activating sequential symptomatogenic zones, but without the ictal activation of deeper structures or contralateral spread to cause loss of awareness and amnesia for the auras.
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22
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Mirzadjanova Z, Peters AS, Rémi J, Bilgin C, Silva Cunha JP, Noachtar S. Significance of lateralization of upper limb automatisms in temporal lobe epilepsy: A quantitative movement analysis. Epilepsia 2010; 51:2140-6. [DOI: 10.1111/j.1528-1167.2010.02599.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Tai P, Poochikian-Sarkissian S, Andrade D, Valiante T, del Campo M, Wennberg R. Postictal wandering is common after temporal lobe seizures. Neurology 2010; 74:932-3. [PMID: 20231671 DOI: 10.1212/wnl.0b013e3181d561b4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- P Tai
- Division of Neurology, Krembil Neuroscience Centre, University of Toronto, Toronto Western Hospital, Toronto, Canada
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Unnwongse K, Lachhwani D, Tang-Wai R, Matley K, O’Connor T, Nair D, Bingaman W, Wyllie E, Diehl B. Oral automatisms induced by stimulation of the mesial frontal cortex. Epilepsia 2009; 50:1620-3. [DOI: 10.1111/j.1528-1167.2008.01975.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Noachtar S, Peters AS. Semiology of epileptic seizures: a critical review. Epilepsy Behav 2009; 15:2-9. [PMID: 19236941 DOI: 10.1016/j.yebeh.2009.02.029] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 02/19/2009] [Indexed: 10/21/2022]
Abstract
Epileptic seizures are characterized by a variety of symptoms. Their typical semiology served for a long time as the major tool to classify epilepsy syndromes. The signs and symptoms of epileptic seizures include the following spheres: sensorial sphere, consciousness, motor and autonomic spheres. Most seizures involve more than one sphere, however, some like for instance aura (sensorial sphere) or dialeptic seizures (consciousness) involve only one sphere. The predominant clinical features of a seizure determines the seizure classification. The following review gives an introduction into the semiological seizure classification. This approach enables us to better identify the epileptogenic zone of our patients and to choose the most effective medical or surgical treatment.
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Affiliation(s)
- Soheyl Noachtar
- Epilepsy Center, Department of Neurology, University of Munich, Marchioninistrasse 15, 81377 Munich, Germany.
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Approach to pediatric epilepsy surgery: State of the art, Part I: General principles and presurgical workup. Eur J Paediatr Neurol 2009; 13:102-14. [PMID: 18692417 DOI: 10.1016/j.ejpn.2008.05.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2007] [Revised: 03/13/2008] [Accepted: 05/08/2008] [Indexed: 11/22/2022]
Abstract
In 1990, the National Institute of Health adopted epilepsy surgery in children as an option when medications fail. In the past few years several concepts have become increasingly recognized as key to a successful approach to epilepsy surgery in children. These include the concepts of neuronal plasticity, the epileptogenic lesion, the ictal onset, symptomatogenic, irritative, and epileptogenic zones. In addition, several techniques have increasingly been utilized to delineate the above areas in an attempt to determine, in each patient, the epileptogenic zone, defined as the zone the resection of which leads to seizure freedom. When seizure semiology (which defines the symptomatogenic zone), ictal EEG (which identifies the ictal onset zone), and structural imaging (which identifies the epileptogenic lesion) can be reconciled to infer the location of the epileptogenic zone, surgery is usually, subsequently, undertaken. When these diagnostic modalities are discordant, not definitive, or when the epileptogenic zone is close to eloquent cortex, invasive EEG, complemented by other imaging techniques may be needed. These include magnetoencephalography, single photon emission tomography, various types of positron emission tomography, various magnetic resonance imaging modalities (functional, diffusion weighted, other) and other emerging and experimental techniques. While MRI, video-EEG, and neuropsychological assessments are well established components of the presurgical evaluation, the use of the new emerging imaging technologies is dictated by the degree of anatomo-electro-clinical correlations, and, awaiting multicentric studies and more detailed guidelines, remains center-dependent.
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Abstract
Although the precise mechanisms for control of consciousness are not fully understood, emerging data show that conscious information processing depends on the activation of certain networks in the brain and that the impairment of consciousness is related to abnormal activity in these systems. Epilepsy can lead to transient impairment of consciousness, providing a window into the mechanisms necessary for normal consciousness. Thus, despite differences in behavioral manifestations, cause, and electrophysiology, generalized tonic-clonic, absence, and partial seizures engage similar anatomical structures and pathways. We review prior concepts of impaired consciousness in epilepsy, focusing especially on temporal lobe complex partial seizures, which are a common and debilitating form of epileptic unconsciousness. We discuss a "network inhibition hypothesis" in which focal temporal lobe seizure activity disrupts normal cortical-subcortical interactions, leading to depressed neocortical function and impaired consciousness. This review of the major prior theories of impaired consciousness in epilepsy allows us to put more recent data into context and to reach a better understanding of the mechanisms important for normal consciousness.
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MESH Headings
- Consciousness Disorders/diagnosis
- Consciousness Disorders/etiology
- Consciousness Disorders/physiopathology
- Consciousness Disorders/psychology
- Epilepsy/complications
- Epilepsy/physiopathology
- Epilepsy/psychology
- Epilepsy, Complex Partial/complications
- Epilepsy, Complex Partial/physiopathology
- Epilepsy, Complex Partial/psychology
- Epilepsy, Temporal Lobe/complications
- Epilepsy, Temporal Lobe/physiopathology
- Epilepsy, Temporal Lobe/psychology
- Functional Laterality/physiology
- Humans
- Models, Neurological
- Models, Psychological
- Neocortex/physiopathology
- Nerve Net/physiopathology
- Tomography, Emission-Computed, Single-Photon
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Affiliation(s)
- Lissa Yu
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut 06520, USA
| | - Hal Blumenfeld
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut 06520, USA
- Department of Neurobiology, Yale University School of Medicine, New Haven, Connecticut 06520, USA
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut 06520, USA
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Englot DJ, Blumenfeld H. Consciousness and epilepsy: why are complex-partial seizures complex? PROGRESS IN BRAIN RESEARCH 2009; 177:147-70. [PMID: 19818900 DOI: 10.1016/s0079-6123(09)17711-7] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Why do complex-partial seizures in temporal lobe epilepsy (TLE) cause a loss of consciousness? Abnormal function of the medial temporal lobe is expected to cause memory loss, but it is unclear why profoundly impaired consciousness is so common in temporal lobe seizures. Recent exciting advances in behavioral, electrophysiological, and neuroimaging techniques spanning both human patients and animal models may allow new insights into this old question. While behavioral automatisms are often associated with diminished consciousness during temporal lobe seizures, impaired consciousness without ictal motor activity has also been described. Some have argued that electrographic lateralization of seizure activity to the left temporal lobe is most likely to cause impaired consciousness, but the evidence remains equivocal. Other data correlates ictal consciousness in TLE with bilateral temporal lobe involvement of seizure spiking. Nevertheless, it remains unclear why bilateral temporal seizures should impair responsiveness. Recent evidence has shown that impaired consciousness during temporal lobe seizures is correlated with large-amplitude slow EEG activity and neuroimaging signal decreases in the frontal and parietal association cortices. This abnormal decreased function in the neocortex contrasts with fast polyspike activity and elevated cerebral blood flow in limbic and other subcortical structures ictally. Our laboratory has thus proposed the "network inhibition hypothesis," in which seizure activity propagates to subcortical regions necessary for cortical activation, allowing the cortex to descend into an inhibited state of unconsciousness during complex-partial temporal lobe seizures. Supporting this hypothesis, recent rat studies during partial limbic seizures have shown that behavioral arrest is associated with frontal cortical slow waves, decreased neuronal firing, and hypometabolism. Animal studies further demonstrate that cortical deactivation and behavioral changes depend on seizure spread to subcortical structures including the lateral septum. Understanding the contributions of network inhibition to impaired consciousness in TLE is an important goal, as recurrent limbic seizures often result in cortical dysfunction during and between epileptic events that adversely affects patients' quality of life.
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Affiliation(s)
- Dario J Englot
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
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Querol Pascual MR. Temporal Lobe Epilepsy: Clinical Semiology and Neurophysiological Studies. Semin Ultrasound CT MR 2007; 28:416-23. [DOI: 10.1053/j.sult.2007.09.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Gyimesi C, Fogarasi A, Kovács N, Toth V, Magalova V, Schulz R, Ebner A, Janszky J. Patients' ability to react before complex partial seizures. Epilepsy Behav 2007; 10:183-6. [PMID: 17088108 DOI: 10.1016/j.yebeh.2006.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Revised: 10/01/2006] [Accepted: 10/06/2006] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of the study described here was to investigate the pathophysiology of patients' ability to react during the conscious (aura) phase of complex partial seizures (CPS) originating from the temporal lobe. METHODS We reviewed video recordings of CPS experienced by 130 adult patients who had undergone epilepsy surgery for intractable medial temporal lobe epilepsy. All patients were instructed to push the alarm button when they felt an aura. We defined the preictal reactivity as the ability to push the alarm button before the complex partial (unconscious) phase of seizures. RESULTS Seventy-seven patients (59%) pushed the alarm button before seizures. Patients with preictal reactivity were significantly younger, more often had lateralized EEG seizure patterns, and had a better postoperative outcome. Patients who did not push the alarm button had secondarily generalized seizures more often. CONCLUSIONS Ability to react before CPS is associated with a circumscribed region involved at seizure onset and spread, and with a seizure-free postoperative outcome.
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Affiliation(s)
- C Gyimesi
- Epilepsy Center Bethel, Bielefeld, Germany
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Janszky J, Fogarasi A, Magalova V, Gyimesi C, Kovács N, Schulz R, Ebner A. Unilateral hand automatisms in temporal lobe epilepsy. Seizure 2006; 15:393-6. [PMID: 16757187 DOI: 10.1016/j.seizure.2006.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2006] [Revised: 03/28/2006] [Accepted: 05/03/2006] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To analyse the lateralising value of unilateral manual automatism (UMA), its relation to contralateral dystonia and the hand by which the UMA was performed. METHODS In this retrospective study, we reviewed video recordings of 141 patients (mean age 34.1+/-10) who had consecutively undergone presurgical evaluations with ictal video-EEG recordings and high-resolution MRI, had had epilepsy surgery due to intractable medial temporal lobe epilepsy with complex partial seizures due to unilateral medial temporal lobe lesions. The video recordings were prospectively reviewed by one of the authors blinded to patient's clinical data except the diagnosis of medial temporal lobe epilepsy. Altogether 310 archived seizures were analysed. RESULTS Hand automatisms occurred in 86.5% of patients. UMA occurred in 53% of patients. If UMA was accompanied by contralateral hand dystonia, it had a high lateralising value to the ipsilateral epileptic focus (EF), it was ipsilateral in 85% of patients. Conversely, if UMA occurred without contralateral dystonia, it had only a limited lateralising value because it was ipsilateral to the EF in only 63% of patients. However, we found that left-sided UMA without dystonia had a high lateralising value to the left hemisphere (ipsilateral to the EF in 82%), while right-sided UMA without dystonia has practically no lateralising value. CONCLUSIONS UMA with contralateral dystonia has a high lateralising value to the ipsilateral hemisphere. Left-sided UMA without contralateral dystonia has a lateralising value to the left hemisphere. Right-sided UMA without contralateral dystonia has no lateralising value.
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Affiliation(s)
- J Janszky
- Epilepsy Center Bethel, Bielefeld, Germany.
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Fogarasi A, Rásonyi G, Kelemen A, Janszky J, Halász P. Electrode manipulation automatism during temporal lobe seizures. Seizure 2006; 15:416-9. [PMID: 16784877 DOI: 10.1016/j.seizure.2006.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Revised: 03/20/2006] [Accepted: 04/11/2006] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To describe clinical characteristics and lateralizing value of peri-ictal electrode manipulation automatism (EMA) in patients with temporal lobe epilepsy (TLE) and compare our data with ictal manual automatisms described in the literature. METHODS Two-hundred and five videotaped seizures of 55 consecutive patients with refractory TLE and postoperatively seizure-free outcome were analyzed and EMA (tugging, scratching or adjusting the electrodes and cables) were monitored. RESULTS Twenty-eight (51%) patients showed EMA during 47 (23%) seizures. Ictal start was noted in 22 seizures and in 19/22 cases EMA finished before the end of seizure. Ictal EMAs were always associated with automotor seizure components. During 25 seizures, exclusively postictal EMAs were observed. Electrode manipulation was presented during 24/112 left-sided and 23/93 right-sided seizures (p = 0.742). Peri-ictal EMA was unilateral (completed by one hand) in 24/47 seizures (10 ictal, 14 postictal); it was done by the hand ipsilateral to the seizure onset zone in 17/24 and by contralateral hand in 7/24 cases (p = 0.064). We observed concomitant contralateral dystonic posturing during 3/10 seizures with unilateral ictal EMA. Unilateral hand automatism, temporally independent from the EMA appeared in 30 (64%) of the 47 seizures. CONCLUSION Peri-ictal EMA is a frequent phenomenon but shows no lateralizing value in TLE. The mechanism of EMA is in many ways dissimilar from that of earlier described manual automatisms.
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Affiliation(s)
- A Fogarasi
- Epilepsy Center, National Institute of Psychiatry and Neurology, Budapest, Hungary.
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Loddenkemper T, Kotagal P. Lateralizing signs during seizures in focal epilepsy. Epilepsy Behav 2005; 7:1-17. [PMID: 15975856 DOI: 10.1016/j.yebeh.2005.04.004] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2005] [Accepted: 04/14/2005] [Indexed: 11/27/2022]
Abstract
This article reviews lateralizing semiological signs during epileptic seizures with respect to prediction of the side of the epileptogenic zone and, therefore, presurgical diagnostic value. The lateralizing significance of semiological signs and symptoms can frequently be concluded from knowledge of the cortical representation. Visual, auditory, painful, and autonomic auras, as well as ictal motor manifestations, e.g., version, clonic and tonic activity, unilateral epileptic spasms, dystonic posturing and unilateral automatisms, automatisms with preserved responsiveness, ictal spitting and vomiting, emotional facial asymmetry, unilateral eye blinking, ictal nystagmus, and akinesia, have been shown to have lateralizing value. Furthermore, ictal language manifestations and postictal features, such as Todd's palsy, postictal aphasia, postictal nosewiping, postictal memory dysfunction, as well as peri-ictal water drinking, peri-ictal headache, and ipsilateral tongue biting, are reviewed. Knowledge and recognition of semiological lateralizing signs during seizures is an important component of the presurgical evaluation of epilepsy surgery candidates and adds further information to video/EEG monitoring, neuroimaging, functional mapping, and neuropsychological evaluation.
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Affiliation(s)
- Tobias Loddenkemper
- Department of Neurology, The Cleveland Clinic Foundation, Cleveland, OH, USA
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Kutlu G, Bilir E, Erdem A, Gomceli YB, Leventoglu A, Kurt GS, Karatas A, Serdaroglu A. Temporal lobe ictal behavioral patterns in hippocampal sclerosis and other structural abnormalities. Epilepsy Behav 2005; 6:353-9. [PMID: 15820343 DOI: 10.1016/j.yebeh.2004.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2004] [Revised: 12/28/2004] [Accepted: 12/28/2004] [Indexed: 11/17/2022]
Abstract
Ictal behavioral characteristics may provide clues in determining the nature of the epileptic focus. We defined ictal behavioral characteristics in patients with intractable temporal lobe epilepsy (TLE) who underwent anterior temporal lobectomy (ATL) and lived seizure-free for 2 years of follow-up. Video/EEG data on 282 seizures observed in 48 patients who suffered from TLE and underwent ATL were analyzed. All patients were seizure-free after surgery. We divided the patients into two groups on the basis of the pathological examination. Two hundred and two seizures in 35 patients with hippocampal sclerosis (Group 1) and eighty seizures in 13 patients with other pathological findings, such as tumors, cavernoma, and hamartoma (Group 2), were analyzed. Ictal behavior characteristics were evaluated for each of the seizures recorded in the two groups. Behavioral arrest, bilateral hand automatisms, oral and leg automatisms, and ictal aggression were significantly more frequent in Group 2 (P<0.05), whereas contralateral dystonia of the upper extremity (P<0.05), ipsilateral hand automatisms (P<0.05), ipsilateral hand automatisms in the presence of contralateral dystonia of the upper extremity (P<0.001), contralateral forced head deviation (P<0.05), and secondary generalization (P<0.05) were more significant in Group 1. There was no significant difference in vocalization and ipsilateral nonforced head deviation between the two groups (P>0.05). The number of seizures observed during ictal speech, crying, and postictal nose wiping was not large enough, so differences could not be analyzed. It was concluded that although ictal behavioral characteristics differed between the two groups, certain behavioral patterns may be helpful in differentiating between hippocampal sclerosis and other pathology.
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Affiliation(s)
- Gulnihal Kutlu
- Department of Neurology, Ankara Training and Research Hospital, Ministry of Health, Ankara, Turkey.
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Kutlu G, Bilir E, Erdem A, Gomceli YB, Kurt GS, Serdaroglu A. Hush sign: a new clinical sign in temporal lobe epilepsy. Epilepsy Behav 2005; 6:452-5. [PMID: 15820360 DOI: 10.1016/j.yebeh.2005.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2004] [Revised: 12/02/2004] [Accepted: 01/17/2005] [Indexed: 10/25/2022]
Abstract
Neurologists have been analyzing the clinical behaviors that occur during seizures for many years. Several ictal behaviors have been defined in temporal lobe epilepsy (TLE). Ictal behaviors are especially important in the evaluation of epilepsy surgery candidates. We propose a new lateralizing sign in TLE originating from the nondominant hemisphere-the "hush" sign. Our patients were 30- and 21-year old women (Cases 1 and 2, respectively). Their epileptogenic foci were localized to the right mesial temporal region after noninvasive presurgical investigations. Case 1 had no cranial MRI abnormality, whereas cranial MRI revealed right hippocampal atrophy in Case 2. These women repeatedly moved their right index fingers to their mouth while puckering their lips during complex partial seizures. We have named this ictal behavior the "hush" sign. Anterior temporal lobectomy with amygdalohippocampectomy was performed in both patients, and pathological examinations revealed hippocampal sclerosis. The "hush" sign no longer occurred after seizures were controlled. They were seizure free as of 30 and 31 months of follow-up, respectively. We believe that the "hush" sign may be supportive of a diagnosis of TLE originating from the nondominant hemisphere. This sign may occur as a result of ictal activation of a specific brain region in this hemisphere.
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Affiliation(s)
- Gulnihal Kutlu
- Department of Neurology, Ministry of Health, Ankara Training and Research Hospital, Ankara, Turkey.
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Fogarasi A, Janszky J, Siegler Z, Tuxhorn I. Ictal Smile Lateralizes to the Right Hemisphere in Childhood Epilepsy. Epilepsia 2005; 46:449-51. [PMID: 15730544 DOI: 10.1111/j.0013-9580.2005.47704.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To analyze the localizing and lateralizing value of ictal smile (IS) in childhood epilepsy. METHODS Incidence of IS in 309 videotaped seizures of 114 consecutive patients younger than 12 years with refractory frontal, temporal, or posterior cortex epilepsy were assessed. RESULTS Among patients with right-sided epileptogenic zone, 12 (21%) of 57 had IS, whereas in patients with left-sided epilepsy, IS occurred only in one patient (1.8%; p < 0.01, chi(2) test). The incidence of IS was 11%, 3%, and 26% in the frontal, temporal, and posterior cortex subgroups, respectively. Logistic regression revealed that the localization of the epileptogenic region in the posterior cortex (p < 0.01), focal cortical dysplasia etiology (p = 0.012), and right-sided lateralization (p = 0.025) were independently associated with the presence of IS. CONCLUSIONS Childhood IS lateralizes to the right hemisphere and localizes more frequently in the posterior cortex epilepsy.
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Fauser S, Wuwer Y, Gierschner C, Schulze-Bonhage A. The localizing and lateralizing value of ictal/postictal coughing in patients with focal epilepsies. Seizure 2004; 13:403-10. [PMID: 15276144 DOI: 10.1016/j.seizure.2003.09.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Postictal coughing has so far been reported to indicate a temporal origin of focal epilepsy. A trend towards non-dominant hemisphere lateralization and mesial temporal localization has been suggested. However, postictal coughing has also been reported in a few patients with extratemporal epilepsies. We have retrospectively evaluated the localizing and lateralizing value of ictal/postictal coughing in 197 patients with temporal and extratemporal epilepsy who received presurgical video-EEG long-term recordings from 1999 to 2001. There was no statistical significant difference in percentage of coughing patients in both groups. However, only patients belonging to the temporal group presented with coughing as a regular element of seizure semiology (simple partial and complex partial seizures) whereas in the extratemporal group coughing occurred more sporadically. Within the temporal group a statistically significant tendency to left-sided seizure onset and a statistically not significant preponderance of mesial seizure onset was observed. Additional vegetative signs were observed only in about half of the patients. These results suggest that coughing occurs in both temporal and extratemporal lobe epilepsy and may only be indicative of temporal lobe seizure onset if representing a regular semiologic element. Coughing may be due to two different mechanisms, one dependent and the other independent from additional vegetative symptoms.
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Affiliation(s)
- Susanne Fauser
- Epilepsy Center, University of Freiburg, Breisacher Street 64, 79106 Freiburg, Germany.
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Abstract
PURPOSE Inpatient video-EEG monitoring (VEM) is widely used for the diagnosis, seizure classification, and presurgical evaluation of patients with seizure disorders. It is resource intensive and relatively expensive, so its utility continues to be debated. Few studies have specifically evaluated the utility of inpatient VEM in altering diagnosis or management of patients with seizure disorders. We sought to assess the proportion of patients for whom the preadmission diagnosis and management were altered after inpatient VEM of patients admitted for diagnostic and presurgical evaluation of seizure disorders. METHODS Data from a consecutive cohort of patients admitted over a 3-year period to an inpatient VEM unit in a tertiary referral hospital were retrospectively analyzed. The preadmission diagnosis and management by the referring neurologist was compared with the diagnosis and management after the VEM. RESULTS Of 131 patients, 91 (70%) were admitted for diagnostic evaluation and 39 (30%) for a presurgical workup. Mean evaluative period was 5.6 days. Mean number of seizures recorded was 2.9. No seizures were recorded in 31% of patients. Interictal EEG showed epileptiform changes in 56 (43%). In 76 (58%), the diagnosis was altered as a result of the VEM, with the greatest change being an increase in the nonepileptic diagnosis group (7% to 31%) and the generalized diagnosis group (5% to 11%). Management was changed after the VEM in 95 (73%). CONCLUSIONS The results of this study demonstrate that inpatient VEM has a high yield in changing diagnosis and management. Future long-term cost-benefit studies of the management changes resulting from VEM evaluation will aid in further reinforcing its role.
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Affiliation(s)
- Daniel F Ghougassian
- The Epilepsy Program of the Alfred Hospital, The Department of Clinical Neurosciences, St. Vincent's Hospital Melbourne, Victoria, Australia.
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Janszky J, Schulz R, Ebner A. Simple partial seizures (isolated auras) in medial temporal lobe epilepsy. Seizure 2004; 13:247-9. [PMID: 15121134 DOI: 10.1016/s1059-1311(03)00192-4] [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: 10/27/2022] Open
Abstract
We analysed whether the medial temporal lobe epilepsy (MTLE) with isolated auras makes any difference in the clinical picture in comparison with MTLE in which only complex partial seizures (CPS) occur. We included 100 patients (aged 16-59 years) with unilateral medial temporal lobe lesions who consecutively underwent presurgical evaluation due to intractable MTLE and who became completely aura- and seizure-free after the anterior temporal resection. Preoperatively, isolated auras were present in 70 patients. These patients were categorised into the IA group. The remaining 30 patients in whom the auras preceded seizures were categorised into the NIA group. We found no difference between the two groups for the age at onset, epilepsy duration or aura types. Conversely, a right-sided epileptogenic region (61%) occurred more frequently in the IA group than in the NIA group (27%, P = 0.001). Conclusively, isolated auras show affinity to the right hemisphere. One explanation may be that seizures stop more quickly in the right hemisphere. Another hypothesis is that consciousness can be disturbed much easier by the ictal activity in left temporal seizures: auras evolve more frequently to CPS due to the disturbance of consciousness.
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Affiliation(s)
- J Janszky
- Epilepsy Centre Bethel, Bielefeld, Germany.
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Giagante B, Oddo S, Silva W, Consalvo D, Centurion E, D'Alessio L, Solis P, Salgado P, Seoane E, Saidon P, Kochen S. Clinical-electroencephalogram patterns at seizure onset in patients with hippocampal sclerosis. Clin Neurophysiol 2004; 114:2286-93. [PMID: 14652088 DOI: 10.1016/s1388-2457(03)00284-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this study is to identify specific clinical-electroencephalogram (EEG) patterns at seizure onset in patients with hippocampal sclerosis (HS). METHODS Sixty-six ictal video-EEG recordings corresponding to 26 patients with HS have been reviewed, focusing on the EEG features found during the first 30 ictal s. The EEG activity has been classified into the following groups: (A) according to spatial distribution: type 1: temporal electrodes on one side; type 2: temporal and adjacent frontal electrodes on one side; and type 3: non-lateralizing electrographic activity; and (B) according to morphology; subtype (a): regular 5-9 Hz rhythmic activity (RA); subtype (b): low-voltage rapid activity, followed by a 5-9 Hz RA; and subtype (c): irregular EEG sharp waves. We analyzed the clinical symptoms sequence and established the relationship with the ictal EEG patterns. RESULTS Considering spatial distribution and morphology, the most frequent ictal EEG patterns were type 1 (57%), type 2 (37%), and subtype (a): 62%; subtype (b): 27%; and subtype (c): 11%. The sequence of clinical symptoms observed was: aura-->behavioral arrest-->oro-alimentary automatisms-->unilateral hand automatisms. All seizures with aura and including two or more symptoms of the clinical sequence (65%) were associated with a 1a, 1b, 2a or 2b EEG pattern. CONCLUSIONS The identification of a specific clinical-EEG pattern provides a useful tool for the epileptogenic zone localization in non-invasive pre-surgical assessment of patients with hippocampal sclerosis. SIGNIFICANCE The identification of a specific clinical-EEG pattern associated to neuroimaging findings and neuropsychological testing allows indicating surgery for the treatment of epilepsy in patients with hippocampal sclerosis, without performing any further complementary studies.
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Affiliation(s)
- B Giagante
- Centro de Epilepsia, División Neurología, Hospital 'JM. Ramos Mejia Instituto de Biología Celular y Neurociencias, Dr. Eduardo De Robertis, Facultad de Medicina, Universidad de Buenos Aires, Argentina.
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Janszky J, Balogh A, Hollo A, Szucs A, Borbely C, Barsi P, Vajda J, Halasz P. Automatisms with preserved responsiveness and ictal aphasia: contradictory lateralising signs during a dominant temporal lobe seizure. Seizure 2003; 12:182-5. [PMID: 12651087 DOI: 10.1016/s1059-1311(02)00191-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The 25-year-old right-handed woman suffering from temporal lobe epilepsy (TLE) was referred to our centre for presurgical evaluation. MRI showed a right-sided hippocampal sclerosis. During video-EEG-recorded seizures, abdominal aura was followed by oral automatisms, during which she was completely reactive to external stimuli, although she was unable to speak. Ictal EEG showed right temporal seizure pattern, without contralateral propagation. She had abnormal speech postictally. Speech-activated functional transcranial Doppler sonography revealed right-sided speech dominance. She has become seizure free after a right-sided amygdalo-hippocampectomy. In our patient, contradictory clinical ictal lateralising signs (automatisms with preserved responsiveness vs. ictal and postictal dysphasia) occurred during right-, speech-dominant-sided seizures. This is the first report when automatisms with preserved consciousness occurred during a seizure originating and involving the speech-dominant hemisphere.
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Affiliation(s)
- J Janszky
- National Institute of Psychiatry and Neurology, Budapest, Hungary.
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Visalli RJ, Fairhurst J, Srinivas S, Hu W, Feld B, DiGrandi M, Curran K, Ross A, Bloom JD, van Zeijl M, Jones TR, O'Connell J, Cohen JI. Identification of small molecule compounds that selectively inhibit varicella-zoster virus replication. J Virol 2003; 77:2349-58. [PMID: 12551972 PMCID: PMC141108 DOI: 10.1128/jvi.77.4.2349-2358.2003] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A series of nonnucleoside, N-alpha-methylbenzyl-N'-arylthiourea analogs were identified which demonstrated selective activity against varicella-zoster virus (VZV) but were inactive against other human herpesviruses, including herpes simplex virus. Representative compounds had potent activity against VZV early-passage clinical isolates and an acyclovir-resistant isolate. Resistant viruses generated against one inhibitor were also resistant to other compounds in the series, suggesting that this group of related small molecules was acting on the same virus-specific target. Sequencing of the VZV ORF54 gene from two independently derived resistant viruses revealed mutations in ORF54 compared to the parental VZV strain Ellen sequence. Recombinant VZV in which the wild-type ORF54 sequence was replaced with the ORF54 gene from either of the resistant viruses became resistant to the series of inhibitor compounds. Treatment of VZV-infected cells with the inhibitor impaired morphogenesis of capsids. Inhibitor-treated cells lacked DNA-containing dense-core capsids in the nucleus, and only incomplete virions were present on the cell surface. These data suggest that the VZV-specific thiourea inhibitor series block virus replication by interfering with the function of the ORF54 protein and/or other proteins that interact with the ORF54 protein.
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Affiliation(s)
- Robert J Visalli
- Infectious Diseases Section, Department of Molecular Biology/Virology, Wyeth Vaccines, Pearl River, NY 1096, USA.
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Loddenkemper T, Foldvary N, Raja S, Neme S, Lüders HO. Ictal urinary urge: further evidence for lateralization to the nondominant hemisphere. Epilepsia 2003; 44:124-6. [PMID: 12581239 DOI: 10.1046/j.1528-1157.2003.26202.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the lateralizing value of ictal urinary urgency. METHODS A retrospective database search was performed for patients with ictal urinary urgency admitted to the Epilepsy Monitoring Unit at the Cleveland Clinic between 1994 and 2001. RESULTS Six patients were identified; intracarotid amytal test demonstrated left hemispheric speech dominance in five cases. The sixth patient continued to speak during right temporal seizures. EEG and imaging data supported right temporal or frontotemporal epilepsy in all six cases. Two patients were seizure free after focal right hemispheric resection. CONCLUSIONS Ictal urinary urge appears to be a lateralizing sign for nondominant temporal lobe epilepsy.
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Affiliation(s)
- Tobias Loddenkemper
- Section of Epilepsy and Sleep Disorders, Department of Neurology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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Henkel A, Noachtar S, Pfänder M, Lüders HO. The localizing value of the abdominal aura and its evolution: a study in focal epilepsies. Neurology 2002; 58:271-6. [PMID: 11805256 DOI: 10.1212/wnl.58.2.271] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the localizing value of abdominal aura and its evolution into other seizure types. METHODS The seizures of 491 consecutive patients with focal epilepsies were prospectively classified according to a recently introduced semiologic seizure classification. All patients underwent prolonged EEG video monitoring and MRI scan. Two hundred twenty-three patients (45%) had temporal lobe epilepsies (TLE); 113 patients (23%) had extratemporal epilepsies; and for 155 (32%) patients, the epilepsy could not be localized to one lobe. RESULTS Abdominal auras were more frequent with TLE (117 of 223 patients, 52%) than in extratemporal epilepsy (13 of 113 patients, 12%, p < 0.0001) and more frequent in mesial TLE (70 of 110 patients, 64%) than in neocortical TLE (16 of 41 patients, 39%, p = 0.007). No preponderance to one side existed. Abdominal auras were followed by ictal oral and manual automatisms (automotor seizure) in at least one seizure evolution in all patients with TLE (117 patients, 100%). In contrast, only two patients with extratemporal epilepsy (2 of 13 patients, 15%, p < 0.0001) had abdominal auras evolving into automotor seizures. An abdominal aura is associated with TLE with a probability of 73.6%. The evolution of an abdominal aura into an automotor seizure, however, increases the probability of TLE to 98.3%. CONCLUSIONS These results demonstrate that evolution of abdominal aura into automotor seizure permits differentiation between temporal lobe epilepsy and extratemporal epilepsy, showing that analysis of seizure evolution provides more localizing information than does the frequency of particular seizure types.
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Affiliation(s)
- Anja Henkel
- Department of Neurology, University of Munich, Germany
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Park SA, Heo K, Koh R, Chang JW, Lee BI. Ictal automatisms with preserved responsiveness in a patient with left mesial temporal lobe epilepsy. Epilepsia 2001; 42:1078-81. [PMID: 11554896 DOI: 10.1046/j.1528-1157.2001.0420081078.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe the possible mechanism of ictal automatisms with preserved responsiveness (APRs) in a patient with left mesial temporal lobe epilepsy, which had not been reported previously. METHODS Ictal EEGs recorded from bilateral foramen ovale electrodes with scalp-sphenoidal electrodes were analyzed in respect to the ictal semiology. RESULTS The patient had a right hemispheric language dominance in the dextral. Electroclinical analysis revealed that the onset of oroalimentary automatisms coincided with the involvement of the left mesial and lateral temporal structures by spreading ictal discharges. The ictal discharge spreading was limited to the ipsilateral hemisphere throughout the seizure, which explained the intact consciousness and preserved responsiveness of the patient. CONCLUSIONS This case suggests that APRs take place in seizures originating from the nondominant temporal lobe, during which ipsilateral mesial and lateral temporal structures are diffusely involved without spreading to the contralateral side.
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Affiliation(s)
- S A Park
- Departments of Neurology, Yonsei University College of Medicine, Seoul, Korea
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Abstract
Approximately 30-40% of patients with focal epilepsy continue to have seizures despite appropriate medical therapy. Surgical treatments should be considered in this important subset of patients. Recent advances in neuroimaging technology have revolutionized the identification and evaluation of surgical candidates. The goal of the presurgical evaluation (video EEG monitoring, neuroimaging, and neuropsychological assessment) is to delineate the epileptogenic zone. Surgery is recommended when this has been adequately identified and the proposed procedure is expected to result in a high likelihood of seizure freedom and a low risk of neurologic and cognitive morbidity.
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Affiliation(s)
- N Foldvary
- Department of Neurology, Section of Epilepsy and Sleep Disorders, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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Janszky J, Fogarasi A, Jokeit H, Ebner A. Lateralizing value of unilateral motor and somatosensory manifestations in frontal lobe seizures. Epilepsy Res 2001; 43:125-33. [PMID: 11164701 DOI: 10.1016/s0920-1211(00)00186-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the lateralizing value of unilateral somatosensory aura, unilateral tonic posturing, head version, non-forced head turning, ictal cloni, dystonic posturing, and postictal nose wiping in seizures originating in the frontal lobe. METHODS We included patients who had consecutively undergone presurgical evaluation with ictal video-EEG monitoring at our institution, had had resective epilepsy surgery involving the frontal lobe, and had remained seizure-free >1 year after operation. Twenty-seven patients aged 1-42 years (mean 18) met the inclusion criteria. Fifteen patients had right-sided, 12 patients had left-sided epileptogenic regions. Seizures recorded during EEG-video monitoring were re-evaluated by two investigators in order to identify lateralization signs in frontal lobe seizures. One of the investigators was blind to patients' clinical data. RESULTS We analyzed 153 seizures of 27 patients. The most common unilateral phenomenon was the unilateral tonic posturing occurring in 48% of all the patients and in 25% of all seizures. Somatosensory aura and head version appeared exclusively contralateral whereas clonus occurred in 92% and unilateral tonic posturing in 89% of seizures contralateral to the epileptogenic region. Ictal non-forced head turning and postictal nose wiping showed no lateralizing significance. Dystonic posturing did not occur. CONCLUSIONS Somatosensory aura, head version, ictal cloni, and tonic posturing are reliable lateralizing signs in frontal seizures. These signs may help in identifying the epileptogenic region during presurgical evaluation of patients suffering from frontal lobe epilepsy.
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Affiliation(s)
- J Janszky
- Epilepsy Center Bethel, Mara Krankenhaus, Maraweg 21, 33617, Bielefeld, Germany.
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Schulz R, Ebner A. Prächirurgische Intensivdiagnostik epileptischer Anfälle im Schlaf und ihre Differentialdiagnose. SOMNOLOGIE 2000. [DOI: 10.1007/s11818-000-0003-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Baumgartner C, Olbrich A, Lindinger G, Pataraia E, Gröppel G, Bacher J, Aull S, Serles W, Hoffmann M, Leutmezer F, Czech T, Prayer D, Pietrzyk U, Asenbaum S, Podreka I. Regional cerebral blood flow during temporal lobe seizures associated with ictal vomiting: an ictal SPECT study in two patients. Epilepsia 1999; 40:1085-91. [PMID: 10448820 DOI: 10.1111/j.1528-1157.1999.tb00823.x] [Citation(s) in RCA: 14] [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 Ictal vomiting represents a rare clinical manifestation during seizures originating from the temporal lobes of the nondominant hemisphere. The precise anatomic structures responsible for generation of ictal vomiting remain to be clarified. Ictal single photon emission computed tomography (SPECT), which allows one to visualize the three-dimensional dynamic changes of regional cerebral blood flow (rCBF) associated with the ongoing epileptic activity, should be useful to study the brain areas activated during ictal vomiting. METHODS We performed ictal Tc-HMPAO SPECT scans in two patients with mesial temporal lobe epilepsy (MTLE) whose seizures were characterized by ictal retching and vomiting. MTLE was documented by typical clinical seizure semiology, interictal and ictal EEG findings, hippocampal atrophy on magnetic resonance imaging (MRI) scan, and a seizure-free outcome after selective amydalohippocampectomy. In both patients, seizures originated in the nondominant temporal lobe. We obtained accurate anatomic reference of rCBF changes visible on SPECT by a special coregistration technique of MRI and SPECT. We used ictal SPECT studies in 10 patients with MTLE who had seizures without ictal vomiting as controls. RESULTS In the two patients with ictal vomiting, we found a significant hyperperfusion of the nondominant temporal lobe (inferior, medial, and lateral superior) and of the occipital region on ictal SPECT. In patients without ictal vomiting, on the contrary, these brain regions never were hyperperfused simultaneously. CONCLUSIONS Ictal SPECT provides further evidence that activation of a complex cortical network, including the medial and lateral superior aspects of the temporal lobe, and maybe the occipital lobes, is responsible for the generation of ictal vomiting.
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Affiliation(s)
- C Baumgartner
- Universitätskliniken für Neurologie, Krankenanstalt Rudolfstiftung, Vienna, Austria
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Alarcon G, Elwes RD, Polkey CE, Binnie CD. Ictal oroalimentary automatisms with preserved consciousness: implications for the pathophysiology of automatisms and relevance to the international classification of seizures. Epilepsia 1998; 39:1119-27. [PMID: 9776335 DOI: 10.1111/j.1528-1157.1998.tb01300.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A patient showing seizures presenting ictal automatisms with preserved consciousness is reported. A 30-year-old, right-handed man with normal development and without family history of epilepsy was referred for surgical treatment of epilepsy. At 15 he began to have seizures, starting with an epigastric aura, occasionally developing automatisms (lip-smacking, chewing), sometimes followed by tonic-clonic convulsions. At the time of referral, he averaged six convulsive seizures per year and one nonconvulsive per week. His sleep EEG showed sharpened slow activity over the right anterior quadrant magnetic resonance imaging (MRI) showed a benign lesion in the mesial aspect of the right occipital lobe. Simultaneous video monitoring and intracranial EEG with subdural strips recording from the right temporal and occipital lobes was undertaken. During one seizure, he had pronounced oroalimentary automatisms while holding a conversation with a technician, answering her questions, and explaining details of his seizures. Memory of this event was preserved. At seizure onset, spike activity was seen at the mesial occipital strips. At midseizure, high-voltage sharpened delta was seen throughout the right hemisphere. Left-sided scalp electrodes remained relatively uninvolved. The lesion, a dysembryoplastic neuroepithelial tumour was removed. Surgery was followed by abolition of seizures described. Because it is agreed that complex partial seizures require impaired consciousness, a history of automatisms with retained consciousness usually suggests nonepileptic attacks. This case suggests that automatisms in epileptic seizures can take place with minimal loss of consciousness, particularly if there is widespread but unilateral involvement. The need for a revision of the International Classification is suggested.
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Affiliation(s)
- G Alarcon
- Institute of Epileptology, King's College Hospital, London, England
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