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Florean I, Vergobbi P, Tomasino B, Nilo A, Guarracino I, Skrap M, Verriello L, Valente M, Ius T, Pauletto G. An "epileptic scent": Olfactory auras in tumor-related epilepsy. Epilepsy Behav 2024; 151:109642. [PMID: 38242066 DOI: 10.1016/j.yebeh.2024.109642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 01/07/2024] [Accepted: 01/10/2024] [Indexed: 01/21/2024]
Abstract
OBJECTIVES To characterize a profile for patients with tumor-related epilepsy presenting olfactory auras. MATERIALS AND METHODS We conducted a monocentric, retrospective study on patients who underwent surgery in the Neurosurgery Unit of Udine University Hospital (Udine, Italy), between the 1st of January 2010 and the 1st of January 2019, for primary brain tumors (PBTs) involving the temporal lobe and the insula. All patients were affected by tumor-related epilepsy; the study group presented olfactory auras as well. We collected neuroradiological, neuropsychological and neurophysiological data from patients' medical charts. RESULTS The subtraction analysis of MRI data shows maximum lesion overlay in left olfactory cortex, left and right hippocampus, left amygdala, right rolandic operculum, right inferior frontal gyrus and right middle temporal gyrus. The presence of olfactory auras did not influence seizure outcome (p = 0.500) or tumor recurrence after surgery (p = 0.185). The type of auras (elementary vs. complex), also, did not influence seizure control (p = 0.222). DISCUSSION In presence of olfactory auras, anterior and mesial temporal regions are mainly involved, such as olfactory cortex, amygdala, and anterior hippocampus, together with right rolandic operculum, right inferior frontal gyrus and right middle temporal gyrus, suggesting their possible role in the genesis of olfactory auras. Post-surgical seizure outcome and disease relapse are not influenced by neither the presence nor the type of olfactory auras. CONCLUSIONS Olfactory auras are rare event, however they may be often underestimated by the patients and under-investigated by the clinicians, even when their occurrence can represent a useful localizing tool.
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Affiliation(s)
- Irene Florean
- Department of Medical Area, University of Udine, Udine, Italy.
| | - Pietro Vergobbi
- Department of Medical Area, University of Udine, Udine, Italy.
| | - Barbara Tomasino
- Scientific Institute, IRCCS E. Medea, Department/Unit Pasian di Prato, Udine, Italy.
| | - Annacarmen Nilo
- Department of Medical Area, University of Udine, Udine, Italy; Clinical Neurology Unit, Head-Neck and Neurosciences Department, Santa Maria della Misericordia University Hospital, Udine, Italy.
| | - Ilaria Guarracino
- Scientific Institute, IRCCS E. Medea, Department/Unit Pasian di Prato, Udine, Italy.
| | - Miran Skrap
- Neurosurgery Unit, Head-Neck and Neurosciences Department, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Lorenzo Verriello
- Neurology Unit, Head-Neck and Neurosciences Department, Santa Maria della Misericordia University Hospital, Udine, Italy.
| | - Mariarosaria Valente
- Department of Medical Area, University of Udine, Udine, Italy; Clinical Neurology Unit, Head-Neck and Neurosciences Department, Santa Maria della Misericordia University Hospital, Udine, Italy.
| | - Tamara Ius
- Neurosurgery Unit, Head-Neck and Neurosciences Department, Santa Maria della Misericordia University Hospital, Udine, Italy.
| | - Giada Pauletto
- Neurology Unit, Head-Neck and Neurosciences Department, Santa Maria della Misericordia University Hospital, Udine, Italy.
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Wu J, Liu P, Geng C, Liu C, Li J, Zhu Q, Li A. Principal neurons in the olfactory cortex mediate bidirectional modulation of seizures. J Physiol 2023; 601:3557-3584. [PMID: 37384845 DOI: 10.1113/jp284731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/15/2023] [Indexed: 07/01/2023] Open
Abstract
Although the piriform cortex (PC) has been previously implicated as a critical node for seizure generation and propagation, the underlying neural mechanism has remained unclear. Here, we found increased excitability in PC neurons during amygdala kindling acquisition. Optogenetic or chemogenetic activation of PC pyramidal neurons promoted kindling progression, whereas inhibition of these neurons retarded seizure activities induced by electrical kindling in the amygdala. Furthermore, chemogenetic inhibition of PC pyramidal neurons alleviated the severity of kainic acid-induced acute seizures. These results demonstrate that PC pyramidal neurons bidirectionally modulate seizures in temporal lobe epilepsy, providing evidence for the efficacy of PC pyramidal neurons as a potential therapeutic target for epileptogenesis. KEY POINTS: While the piriform cortex (PC) is an important olfactory centre critically involved in olfactory processing and plays a crucial role in epilepsy due to its close connection with the limbic system, how the PC regulates epileptogenesis is largely unknown. In this study, we evaluated the neuronal activity and the role of pyramidal neurons in the PC in the mouse amygdala kindling model of epilepsy. PC pyramidal neurons are hyperexcited during epileptogenesis. Optogenetic and chemogenetic activation of PC pyramidal neurons significantly promoted seizures in the amygdala kindling model, whereas selective inhibition of these neurons produced an anti-epileptic effect for both electrical kindling and kainic acid-induced acute seizures. The results of the present study indicate that PC pyramidal neurons bidirectionally modulate seizure activity.
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Affiliation(s)
- Jing Wu
- Jiangsu Key Laboratory of Brain Disease and Bioinformation, Research Center for Biochemistry and Molecular Biology, Xuzhou Medical University, Xuzhou, China
| | - Penglai Liu
- Jiangsu Key Laboratory of Brain Disease and Bioinformation, Research Center for Biochemistry and Molecular Biology, Xuzhou Medical University, Xuzhou, China
| | - Chi Geng
- Jiangsu Key Laboratory of Brain Disease and Bioinformation, Research Center for Biochemistry and Molecular Biology, Xuzhou Medical University, Xuzhou, China
| | - Changyu Liu
- Jiangsu Key Laboratory of Brain Disease and Bioinformation, Research Center for Biochemistry and Molecular Biology, Xuzhou Medical University, Xuzhou, China
| | - Jiaxin Li
- Jiangsu Key Laboratory of Brain Disease and Bioinformation, Research Center for Biochemistry and Molecular Biology, Xuzhou Medical University, Xuzhou, China
| | - Qiuju Zhu
- Jiangsu Key Laboratory of Brain Disease and Bioinformation, Research Center for Biochemistry and Molecular Biology, Xuzhou Medical University, Xuzhou, China
| | - Anan Li
- Jiangsu Key Laboratory of Brain Disease and Bioinformation, Research Center for Biochemistry and Molecular Biology, Xuzhou Medical University, Xuzhou, China
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Tsuboki S, Todaka T, Hasegawa S, Kaku Y, Ohmori Y, Mukasa A. Olfactory hallucinations caused by an unruptured posterior communicating artery aneurysm improved by clipping: A case report with literature review. Surg Neurol Int 2023; 14:152. [PMID: 37151441 PMCID: PMC10159313 DOI: 10.25259/sni_173_2023] [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: 02/20/2023] [Accepted: 04/12/2023] [Indexed: 05/09/2023] Open
Abstract
Background Unruptured cerebral aneurysms that lead to epilepsy are rare and olfactory hallucinations caused by such an aneurysm are extremely rare. Various treatments have been proposed, including wrapping, clipping with or without cortical resection, and coil embolization, but there is no consensus on the best approach. Case Description We present a case of a 69-year-old female who experienced olfactory hallucinations caused by a posterior communicating artery aneurysm and was treated with clipping without cortical resection, with a positive outcome. Conclusion According to our knowledge, there has been only one report of a posterior communicating artery aneurysm presenting with olfactory hallucinations has been reported, where clipping and cortical resection were performed. This is the first report of a posterior communicating artery aneurysm with olfactory hallucinations that was effectively treated with clipping alone. There have been a few similar reports of large middle cerebral artery aneurysms, most of which are believed to be caused by entorhinal cortex compression. Although a definitive treatment protocol for this condition remains elusive, we suggest that elimination of the pulsatile compressive stress exerted on the cerebral cortex through surgical clipping or coil embolization is crucial for achieving efficacious seizure management.
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Affiliation(s)
- Shimpei Tsuboki
- Department of Neurosurgery, Japanese Red Cross Kumamoto Hospital, Kumamoto City, Japan
| | - Tatemi Todaka
- Department of Neurosurgery, Japanese Red Cross Kumamoto Hospital, Kumamoto City, Japan
| | - Shu Hasegawa
- Department of Neurosurgery, Japanese Red Cross Kumamoto Hospital, Kumamoto City, Japan
| | - Yasuyuki Kaku
- Department of Neurosurgery, Kumamoto University Hospital, Kumamoto City, Japan
| | - Yuki Ohmori
- Department of Neurosurgery, Kumamoto University Hospital, Kumamoto City, Japan
| | - Akitake Mukasa
- Department of Neurosurgery, Kumamoto University Hospital, Kumamoto City, Japan
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4
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Li Z, Chen L, Xu C, Chen Z, Wang Y. Non-invasive sensory neuromodulation in epilepsy: Updates and future perspectives. Neurobiol Dis 2023; 179:106049. [PMID: 36813206 DOI: 10.1016/j.nbd.2023.106049] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
Epilepsy, one of the most common neurological disorders, often is not well controlled by current pharmacological and surgical treatments. Sensory neuromodulation, including multi-sensory stimulation, auditory stimulation, olfactory stimulation, is a kind of novel noninvasive mind-body intervention and receives continued attention as complementary safe treatment of epilepsy. In this review, we summarize the recent advances of sensory neuromodulation, including enriched environment therapy, music therapy, olfactory therapy, other mind-body interventions, for the treatment of epilepsy based on the evidence from both clinical and preclinical studies. We also discuss their possible anti-epileptic mechanisms on neural circuit level and propose perspectives on possible research directions for future studies.
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Affiliation(s)
- Zhongxia Li
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China; Zhejiang Rehabilitation Medical Center Department, The Third Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Liying Chen
- Department of Pharmacy, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Cenglin Xu
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Zhong Chen
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yi Wang
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China; Zhejiang Rehabilitation Medical Center Department, The Third Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China.
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5
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Jones GD, Kariuki SM, Ngugi AK, Mwesige AK, Masanja H, Owusu-Agyei S, Wagner R, Cross JH, Sander JW, Newton CR, Sen A. Development and validation of a diagnostic aid for convulsive epilepsy in sub-Saharan Africa: a retrospective case-control study. Lancet Digit Health 2023; 5:e185-e193. [PMID: 36963908 DOI: 10.1016/s2589-7500(22)00255-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/21/2022] [Accepted: 12/20/2022] [Indexed: 03/26/2023]
Abstract
BACKGROUND Identification of convulsive epilepsy in sub-Saharan Africa relies on access to resources that are often unavailable. Infrastructure and resource requirements can further complicate case verification. Using machine-learning techniques, we have developed and tested a region-specific questionnaire panel and predictive model to identify people who have had a convulsive seizure. These findings have been implemented into a free app for health-care workers in Kenya, Uganda, Ghana, Tanzania, and South Africa. METHODS In this retrospective case-control study, we used data from the Studies of the Epidemiology of Epilepsy in Demographic Sites in Kenya, Uganda, Ghana, Tanzania, and South Africa. We randomly split these individuals using a 7:3 ratio into a training dataset and a validation dataset. We used information gain and correlation-based feature selection to identify eight binary features to predict convulsive seizures. We then assessed several machine-learning algorithms to create a multivariate prediction model. We validated the best-performing model with the internal dataset and a prospectively collected external-validation dataset. We additionally evaluated a leave-one-site-out model (LOSO), in which the model was trained on data from all sites except one that, in turn, formed the validation dataset. We used these features to develop a questionnaire-based predictive panel that we implemented into a multilingual app (the Epilepsy Diagnostic Companion) for health-care workers in each geographical region. FINDINGS We analysed epilepsy-specific data from 4097 people, of whom 1985 (48·5%) had convulsive epilepsy, and 2112 were controls. From 170 clinical variables, we initially identified 20 candidate predictor features. Eight features were removed, six because of negligible information gain and two following review by a panel of qualified neurologists. Correlation-based feature selection identified eight variables that demonstrated predictive value; all were associated with an increased risk of an epileptic convulsion except one. The logistic regression, support vector, and naive Bayes models performed similarly, outperforming the decision-tree model. We chose the logistic regression model for its interpretability and implementability. The area under the receiver operator curve (AUC) was 0·92 (95% CI 0·91-0·94, sensitivity 85·0%, specificity 93·7%) in the internal-validation dataset and 0·95 (0·92-0·98, sensitivity 97·5%, specificity 82·4%) in the external-validation dataset. Similar results were observed for the LOSO model (AUC 0·94, 0·93-0·96, sensitivity 88·2%, specificity 95·3%). INTERPRETATION On the basis of these findings, we developed the Epilepsy Diagnostic Companion as a predictive model and app offering a validated culture-specific and region-specific solution to confirm the diagnosis of a convulsive epileptic seizure in people with suspected epilepsy. The questionnaire panel is simple and accessible for health-care workers without specialist knowledge to administer. This tool can be iteratively updated and could lead to earlier, more accurate diagnosis of seizures and improve care for people with epilepsy. FUNDING The Wellcome Trust, the UK National Institute of Health Research, and the Oxford NIHR Biomedical Research Centre.
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Affiliation(s)
- Gabriel Davis Jones
- Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK; The Alan Turing Institute, London, UK
| | - Symon M Kariuki
- KEMRI and Wellcome Trust Research Programme, Centre for Geographic Medicine Research Coast, Kilifi, Kenya; Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems, INDEPTH Network, Accra, Ghana
| | - Anthony K Ngugi
- Department of Population Health, Aga Khan University, Nairobi, Kenya; Brain and Mind Institute, Aga Khan University, Nairobi, Kenya; Centre for Global Health Equity, University of Michigan, Ann Arbor, MI, USA
| | - Angelina Kakooza Mwesige
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - Ryan Wagner
- MRC and Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - J Helen Cross
- Developmental Neurosciences, University College London NIHR BRC Great Ormond Street Institute of Child Health, London, UK
| | - Josemir W Sander
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK; Stichting Epilepsie Instellingen Nederland, Heemstede, Netherlands
| | - Charles R Newton
- KEMRI and Wellcome Trust Research Programme, Centre for Geographic Medicine Research Coast, Kilifi, Kenya; Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems, INDEPTH Network, Accra, Ghana; Department of Psychiatry, University of Oxford, Oxford, UK
| | - Arjune Sen
- Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.
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6
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Limbic and olfactory cortical circuits in focal seizures. Neurobiol Dis 2023; 178:106007. [PMID: 36682502 DOI: 10.1016/j.nbd.2023.106007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023] Open
Abstract
Epilepsies affecting the limbic regions are common and generate seizures often resistant to pharmacological treatment. Clinical evidence demonstrates that diverse regions of the mesial portion of the temporal lobe participate in limbic seizures; these include the hippocampus, the entorhinal, perirhinal and parahippocampal regions and the piriform cortex. The network mechanisms involved in the generation of olfactory-limbic epileptiform patterns will be here examined, with particular emphasis on acute interictal and ictal epileptiform discharges obtained by treatment with pro-convulsive drugs and by high-frequency stimulations on in vitro preparations, such as brain slices and the isolated guinea pig brain. The interactions within olfactory-limbic circuits can be summarized as follows: independent, region-specific seizure-like events (SLE) are generated in the olfactory and in the limbic cortex; SLEs generated in the hippocampal-parahippocampal regions tend to remain within these areas; the perirhinal region controls the neocortical propagation and the generalization of limbic seizures; interictal spiking in the olfactory regions prevents the invasion by SLEs generated in limbic regions. The potential relevance of these observations for human focal epilepsy is discussed.
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7
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Prentice RN, Rizwan SB. Translational Considerations in the Development of Intranasal Treatments for Epilepsy. Pharmaceutics 2023; 15:pharmaceutics15010233. [PMID: 36678862 PMCID: PMC9865314 DOI: 10.3390/pharmaceutics15010233] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/09/2022] [Accepted: 11/29/2022] [Indexed: 01/13/2023] Open
Abstract
Epilepsy is a common and serious neurological disorder, to which a high proportion of patients continue to be considered "drug-resistant", despite the availability of a host of anti-seizure drugs. Investigation into new treatment strategies is therefore of great importance. One such strategy is the use of the nose to deliver drugs directly to the brain with the help of pharmaceutical formulation to overcome the physical challenges presented by this route. The following review explores intranasal delivery of anti-seizure drugs, covering the link between the nose and seizures, pathways from the nose to the brain, current formulations in clinical use, animal seizure models and their proposed application in studying intranasal treatments, and a critical discussion of relevant pre-clinical studies in the literature.
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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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9
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Baron M, Devor M. Might pain be experienced in the brainstem rather than in the cerebral cortex? Behav Brain Res 2022; 427:113861. [DOI: 10.1016/j.bbr.2022.113861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/09/2022] [Accepted: 03/23/2022] [Indexed: 11/02/2022]
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10
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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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11
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Traub RD, Tu Y, Whittington MA. Cell assembly formation and structure in a piriform cortex model. Rev Neurosci 2021; 33:111-132. [PMID: 34271607 DOI: 10.1515/revneuro-2021-0056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/19/2021] [Indexed: 11/15/2022]
Abstract
The piriform cortex is rich in recurrent excitatory synaptic connections between pyramidal neurons. We asked how such connections could shape cortical responses to olfactory lateral olfactory tract (LOT) inputs. For this, we constructed a computational network model of anterior piriform cortex with 2000 multicompartment, multiconductance neurons (500 semilunar, 1000 layer 2 and 500 layer 3 pyramids; 200 superficial interneurons of two types; 500 deep interneurons of three types; 500 LOT afferents), incorporating published and unpublished data. With a given distribution of LOT firing patterns, and increasing the strength of recurrent excitation, a small number of firing patterns were observed in pyramidal cell networks: first, sparse firings; then temporally and spatially concentrated epochs of action potentials, wherein each neuron fires one or two spikes; then more synchronized events, associated with bursts of action potentials in some pyramidal neurons. We suggest that one function of anterior piriform cortex is to transform ongoing streams of input spikes into temporally focused spike patterns, called here "cell assemblies", that are salient for downstream projection areas.
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Affiliation(s)
- Roger D Traub
- AI Foundations, IBM T.J. Watson Research Center, Yorktown Heights, NY10598, USA
| | - Yuhai Tu
- AI Foundations, IBM T.J. Watson Research Center, Yorktown Heights, NY10598, USA
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12
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Marashly A. Seizure Semiology in Focal and Generalized Epilepsies: Distinctive and Overlapping Features. JOURNAL OF PEDIATRIC EPILEPSY 2021. [DOI: 10.1055/s-0040-1722300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AbstractStudying seizure semiology is the first step in evaluating any patient with epilepsy which leads the way to further investigations and management, particularly in differentiating focal and generalized epilepsies. While the usefulness of semiological analysis has been confirmed through decades' worth of research and clinical practice, there remains some instances when the line between focal and generalized semiological features is blurred leading to difficulties identifying the type of epilepsy at hand. This in turn can lead to delayed or wrong diagnoses with significant implications.In this review article, we explain the role of semiology in epilepsy, specifically in differentiating focal versus generalized epilepsies and cover the semiological features for both groups. We also discuss the occasional overlapping semiology between the two groups and provide case examples.
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Affiliation(s)
- Ahmad Marashly
- Division of Pediatric Neurology, University of Washington/Seattle Children's Hospital, Seattle, Washington
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13
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Taşcı İ, Balgetir F, Müngen B, Gönen M. Epileptic olfactory auras: a clinical spectrum. Neurol Sci 2021; 42:3397-3401. [PMID: 33428053 DOI: 10.1007/s10072-020-04999-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/14/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the relative frequency of olfactory aura in a large number of patients with focal epilepsy, and examine the full clinical spectrum of epileptic olfactory auras (OAs) and their relationship to hemispheric lateralization and localization of epileptogenic focus. METHODS This retrospective study was based on the medical records of 1384 patients with focal epilepsy. Of these, 71 (5.1%) patients were present with OAs, comprising 25 (35.2%) men and 46 (64.8%) women with a mean age of 35.43 ± 12.89 years. These 71 patients were classified according to the clinical features of the OAs, and the electroencephalography and magnetic resonance imaging findings were examined. RESULTS The relative frequency of OAs was 5.1% in the focal epileptic patients. The clinical spectrum of OAs in our cases was outlined as follows, complex OAs and elementary OAs. Elementary OAs were divided into three subgroups: elementary neutral OAs, elementary unpleasant OAs, and elementary pleasant OAs. In our cases, there was no difference between the right and left hemispheres in terms of lateralization of the epileptogenic focus. In all the 71 patients, the epileptogenic zone was most commonly localized in the temporal lobe (n = 58; 81.7%). CONCLUSIONS The relative frequency of OAs in focal epilepsies is likely to be found higher than expected. Elementary OAs occur much more frequently than complex OAs. Among the elementary OAs, elementary unpleasant OAs and elementary neutral OAs are the most common types, whereas elementary pleasant OAs are extremely rare.
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Affiliation(s)
- İrem Taşcı
- Malatya Teaching and Research Hospital, Neurology Clinic, Malatya, Turkey
| | - Ferhat Balgetir
- Department of Neurology, College of Medicine, Fırat University, Elazig, Turkey.
| | - Bülent Müngen
- Department of Neurology, College of Medicine, Fırat University, Elazig, Turkey
| | - Murat Gönen
- Department of Neurology, College of Medicine, Fırat University, Elazig, Turkey
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14
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Ciurleo R, De Salvo S, Bonanno L, Marino S, Bramanti P, Caminiti F. Parosmia and Neurological Disorders: A Neglected Association. Front Neurol 2020; 11:543275. [PMID: 33240192 PMCID: PMC7681001 DOI: 10.3389/fneur.2020.543275] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 10/07/2020] [Indexed: 11/30/2022] Open
Abstract
Parosmia is a distorted olfactory sensation in the presence of an odor. This olfactory disorder can affect the quality of life of most patients who experience it. Qualitative olfactory dysfunctions, such as parosmia and phantosmia, may be clinical conditions secondary to neurological diseases. The incidence of parosmia is underestimated, as well as its association with neurological diseases, due to poor self-reporting of patients and lack of objective methods for its measure. In this paper, we show selected clinical cases of parosmia associated with neurological disorders, such as traumatic brain injury and multiple sclerosis. These clinical cases show how the correct diagnosis of parosmia can represent the tip of the iceberg of important underlying neurological disorders and be a good prognostic indicator of their progression or recovery.
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Affiliation(s)
- Rosella Ciurleo
- Istituto di Ricovero e Cura a Carattere Scientifico Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Simona De Salvo
- Istituto di Ricovero e Cura a Carattere Scientifico Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Lilla Bonanno
- Istituto di Ricovero e Cura a Carattere Scientifico Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Silvia Marino
- Istituto di Ricovero e Cura a Carattere Scientifico Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Placido Bramanti
- Istituto di Ricovero e Cura a Carattere Scientifico Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Fabrizia Caminiti
- Istituto di Ricovero e Cura a Carattere Scientifico Centro Neurolesi "Bonino-Pulejo", Messina, Italy
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15
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Morosanu CO, Clamp PJ, Teo MK. Phantosmia as the first presentation of a cavernous sinus - clinoidal meningioma. Br J Neurosurg 2020; 37:1-7. [PMID: 33050720 DOI: 10.1080/02688697.2020.1834510] [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: 06/21/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Abstract
Cavernous sinus meningiomas (CSM) are complex skull base lesions that, due to their particular anatomical location, render surgical management difficult. Their symptomatology is versatile, and the clinical outcome is difficult to predict. We present the case of a 57-year old female patient who experienced phantosmia - an abnormal, persistent, olfactory sensation of cigarette smell for 18 months. MRI was performed and revealed a left cavernous sinus meningioma, extending into the left temporal fossa, with olfactory and optic nerve distortion. To our knowledge, this is the first reported case of phantosmia as the initial presentation of a lesion in the cavernous sinus.
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Affiliation(s)
| | - Philip J Clamp
- Department of Otolaryngology and Head & Neck Surgery, Bristol Royal Infirmary, Bristol, UK
| | - Mario K Teo
- Department of Neurosurgery, Southmead Hospital, Bristol, UK
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16
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Heo K, Kim KM, Han SM, Cho KH, Chu MK. Nasal pain as an aura: Amygdala origin? Seizure 2020; 83:13-16. [PMID: 33075671 DOI: 10.1016/j.seizure.2020.09.028] [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: 05/26/2020] [Revised: 08/26/2020] [Accepted: 09/30/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Nasal pain, as an epileptic aura, has been poorly recognized. This study aims to demonstrate clinical features of patients with epilepsy who have nasal pain as an aura. METHODS We retrospectively investigated consecutive patients who visited the epilepsy clinic of tertiary hospital from April 2000 to September 2019. All included patients underwent epilepsy-dedicated, high-resolution magnetic resonance imaging (MRI) examinations. All MRI studies were analyzed by visual inspection. RESULTS Seven patients who presented nasal pain as an aura, were identified. Four patients reported nasal pain as the first aura. Four patients had right amygdala enlargement (isolated amygdala enlargement in three patients; amygdala enlargement in addition to hippocampal sclerosis in one patient), and one patient with compression of an internal carotid-posterior communicating artery aneurysm to right amygdala on brain MRI. Interictal epileptiform or ictal discharges on EEG were found in the right temporal region in five patients. In all four patients with amygdala enlargement, amygdala enlargement was ipsilateral to EEG anomalies. In all patients, nasal pain was accompanied by ictal semiological features, such as autonomic, olfactory, abdominal, or psychic auras, and focal impaired awareness seizures, which are typically associated with mesial temporal lobe epilepsy. CONCLUSIONS Our findings suggest that nasal pain can occur as an epileptic aura in patients with temporal lobe epilepsy with probable involvement of the amygdala.
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Affiliation(s)
- Kyoung Heo
- Department of Neurology, Epilepsy Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Kyung Min Kim
- Department of Neurology, Epilepsy Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Min Han
- Department of Neurology, Epilepsy Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyoo Ho Cho
- Department of Neurology, Epilepsy Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Kyung Chu
- Department of Neurology, Epilepsy Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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17
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Delfino-Pereira P, Berti Dutra P, Cortes de Oliveira JA, Casanova Turatti IC, Fernandes A, Peporine Lopes N, Garcia-Cairasco N. Are Predator Smell (TMT)-Induced Behavioral Alterations in Rats Able to Inhibit Seizures? Chem Senses 2020; 45:347-357. [DOI: 10.1093/chemse/bjaa023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Abstract
We aimed to evaluate the chemical and behavioral effects of 2,5-dihydro-2,4,5-trimethylthiazoline (TMT) after olfactory exposure and to verify their influence in the expression of acute audiogenic seizures in the Wistar Audiogenic Rat (WAR) strain. PROTOCOL 1: TMT gas chromatography was applied to define odor saturation in a chamber to different concentrations, time required for saturation and desaturation, and if saturation was homogeneous. Also, male Adult Wistar rats were exposed to saline (SAL) or to different TMT concentrations and their behaviors were evaluated (neuroethology). PROTOCOL 2: Male adult WARs were exposed for 15 s to SAL or TMT, followed by sound stimulation for 1 min or until tonic–clonic convulsion. Behavioral analysis included latencies (wild running and tonic–clonic convulsion), seizure severity indexes, and neuroethology. Gas chromatography established a saturation homogeneous to different concentrations of TMT, indicating that saturation and desaturation occurred in 30 min. TMT triggered fear-like or aversion-like reactions associated with reduction in motor activity and in grooming behavior, in the 2 highest concentrations. Pure TMT presented anticonvulsant properties, such as less-severe seizure phenotype, as well as a decrease in tonic–clonic convulsion expression. TMT elicited fear-like or aversion-like behaviors in Wistar and WAR and can be utilized in a quantifiable and controllable way. Our results suggested possible antagonism between “fear-related” or “aversion-related” and “seizure-related” networks.
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Affiliation(s)
- Polianna Delfino-Pereira
- Neurosciences and Behavioral Sciences Departament, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Poliana Berti Dutra
- Neurosciences and Behavioral Sciences Departament, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- Physiology Departament, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Izabel Cristina Casanova Turatti
- Physics and Chemistry Departament, Ribeirão Preto School of Pharmaceutical Sciences, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Artur Fernandes
- Physiology Departament, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Norberto Peporine Lopes
- Physics and Chemistry Departament, Ribeirão Preto School of Pharmaceutical Sciences, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Norberto Garcia-Cairasco
- Neurosciences and Behavioral Sciences Departament, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- Physiology Departament, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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18
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Anatomical imaging of the piriform cortex in epilepsy. Exp Neurol 2019; 320:113013. [DOI: 10.1016/j.expneurol.2019.113013] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 06/08/2019] [Accepted: 07/15/2019] [Indexed: 11/23/2022]
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19
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Khurshid K, Crow AJD, Rupert PE, Minniti NL, Carswell MA, Mechanic-Hamilton DJ, Kamath V, Doty RL, Moberg PJ, Roalf DR. A Quantitative Meta-analysis of Olfactory Dysfunction in Epilepsy. Neuropsychol Rev 2019; 29:328-337. [PMID: 31144106 PMCID: PMC6766414 DOI: 10.1007/s11065-019-09406-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 04/11/2019] [Indexed: 11/25/2022]
Abstract
Olfactory dysfunction in epilepsy is well-documented in several olfactory domains. However, the clinical specificity of these deficits remains unknown. The aim of this systematic meta-analysis was to determine which domains of olfactory ability were most impaired in individuals with epilepsy, and to assess moderating factors affecting olfactory ability. Extant peer-reviewed literature on olfaction in epilepsy were identified via a computerized literature search using PubMed, MEDLINE, PsycInfo, and Google Scholar databases. Twenty-one articles met inclusion criteria. These studies included a total of 912 patients with epilepsy and 794 healthy comparison subjects. Included studies measured olfaction using tests of odor identification, discrimination, memory, and detection threshold in patients with different types of epilepsy, including temporal lobe epilepsy (TLE), mixed frontal epilepsy (M-F), and mixed epilepsy (MIX). Olfactory deficits were robust in patients with epilepsy when compared to healthy individuals, with effect sizes in the moderate to large range for several olfactory domains, including odor identification (d = -1.59), memory (d = -1.10), discrimination (d = -1.04), and detection threshold (d = -0.58). Olfactory deficits were most prominent in patients with TLE and M-F epilepsy. Amongst patients with epilepsy, sex, age, smoking status, education, handedness, and age of illness onset were significantly related to olfactory performance. Overall, these meta-analytic findings indicate that the olfactory system is compromised in epilepsy and suggest that detailed neurobiological investigations of the olfactory system may provide further insight into this disorder.
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Affiliation(s)
- Kiran Khurshid
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Andrew J D Crow
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Petra E Rupert
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nancy L Minniti
- Department of Physical Medicine and Rehabilitation, Temple University Hospital, Philadelphia, PA, USA
| | | | - Dawn J Mechanic-Hamilton
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Vidyulata Kamath
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Richard L Doty
- Smell & Taste Center, Department of Otorhinolaryngology: Head & Neck Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Paul J Moberg
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Smell & Taste Center, Department of Otorhinolaryngology: Head & Neck Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - David R Roalf
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
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20
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Mbizvo GK, Derry C, Davenport R. Ictal asystole: a diagnostic and management conundrum. J R Coll Physicians Edinb 2019; 49:128-131. [PMID: 31188342 DOI: 10.4997/jrcpe.2019.209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We report two cases of adults presenting with transient loss of consciousness (TLoC) followed by a rapid recovery. Careful history taking revealed a stereotyped prodrome of déjà vu, raising the possibility of these events being focal seizures rather than syncope. The patients were commenced on antiepileptic drugs (AEDs) at the same time as having cardiac monitoring organised. This confirmed asystole during the seizure symptoms, resulting in TLoC. It was assumed that the cardiac arrhythmia explained the entire picture, a permanent pacemaker (PPM) was inserted, and the AEDs were withdrawn in one patient and not commenced in the other. However, they both subsequently presented with worsening seizures, including generalised tonic-clonic seizures, despite a functioning pacemaker. The seizures improved on restarting AEDs. The cases illustrate the diagnostic and management difficulties of patients presenting with ictal asystole, a condition that requires input from various medical specialities. There is no strong evidence base for the management of ictal asystole, but we favour a combined approach of AEDs and PPM insertion.
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Affiliation(s)
- Gashirai K Mbizvo
- Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, The University of Edinburgh Child Life and Health, 20 Sylvan Place, Edinburgh EH9 1UW, UK, .,Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
| | - Chris Derry
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK.,Department of Clinical Neurosciences and Sleep Medicine, Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Richard Davenport
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
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21
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Abstract
Neurolocalization of taste disorders requires a knowledge of the functional anatomy involved in mediating taste information from the peripheral mucosal surfaces through numerous peripheral cranial nerves to complex subcortical and cortical brain regions. Our understanding of this functional anatomy has advanced in recent years. Taste is an experience that is both innate and learned, and the "taste" experience involves the integration of information from other sensory modalities, such as olfaction and somatosensation. Normal taste perception is influenced by different neurophysiologic states, which involve endocrine function, emotions, and even attitudes and expectations toward eating. At its core, the normal effective ability to taste is a reflection of the proper function of many organ systems within the body and may be considered a marker for good health. Clinical taste disorders, on the other hand, involve the dysfunction of the normal neural taste pathways and/or aberrant influences on multisensory integration and cortical taste processing. The number of disease processes, which can adversely affect taste, are numerous and quite varied in their presentation. There may be contributory involvement of other organ systems within the body, and the appropriate management of taste disorders often requires a multidisciplinary approach to fully understand the disorder. Depending on the underlying cause, taste disorders can be effectively managed when identified. Treatments may include correcting underlying metabolic disturbances, eliminating infections, changing offending medications, replenishing nutritional deficiencies, operating on structural impairments, calming autoimmune processes, and even stabilizing electrochemical interactions.
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Affiliation(s)
- Steven M Bromley
- South Jersey MS Center and Bromley Neurology, PC, Audubon, NJ, United States.
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22
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Young JC, Vaughan DN, Paolini AG, Jackson GD. Electrical stimulation of the piriform cortex for the treatment of epilepsy: A review of the supporting evidence. Epilepsy Behav 2018; 88:152-161. [PMID: 30269034 DOI: 10.1016/j.yebeh.2018.09.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/04/2018] [Accepted: 09/09/2018] [Indexed: 10/28/2022]
Abstract
In this review, we consider how the piriform cortex is engaged in both focal and generalized epilepsy networks and postulate the various neural pathways that can be effectively neuromodulated by stimulation at this site. This highlights the common involvement of the piriform cortex in epilepsy. We address both current and future preclinical studies of deep brain stimulation (DBS) of the piriform cortex, with attention to the critical features of these trials that will enable them to be of greatest utility in informing clinical translation. Although recent DBS trials have utilized thalamic targets, electrical stimulation of the piriform cortex may also be a useful intervention for people with epilepsy. However, more work is required to develop a solid foundation for this approach before considering human trials.
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Affiliation(s)
- James C Young
- The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, 245 Burgundy Street, Heidelberg, Victoria 3084, Australia; Florey Department of Neuroscience and Mental Health, The University of Melbourne, Melbourne, 30 Royal Parade, Parkville, Victoria 3052, Australia.
| | - David N Vaughan
- The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, 245 Burgundy Street, Heidelberg, Victoria 3084, Australia; Florey Department of Neuroscience and Mental Health, The University of Melbourne, Melbourne, 30 Royal Parade, Parkville, Victoria 3052, Australia; Department of Neurology, Austin Health, Melbourne, 145 Studley Road, Heidelberg, Victoria 3084, Australia
| | - Antonio G Paolini
- The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, 245 Burgundy Street, Heidelberg, Victoria 3084, Australia; ISN Psychology - Institute for Social Neuroscience, Melbourne, Level 6/10 Martin Street, Heidelberg, Victoria 3084, Australia; School of Psychology and Public Health, La Trobe University, Melbourne, Plenty Road and Kingsbury Drive, Bundoora, VIC 3068, Australia
| | - Graeme D Jackson
- The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, 245 Burgundy Street, Heidelberg, Victoria 3084, Australia; Florey Department of Neuroscience and Mental Health, The University of Melbourne, Melbourne, 30 Royal Parade, Parkville, Victoria 3052, Australia; Department of Neurology, Austin Health, Melbourne, 145 Studley Road, Heidelberg, Victoria 3084, Australia
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23
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Kajikawa S, Kobayashi K, Usami K, Matsumoto R, Ikeda A, Takahashi R. [A case series of 4 epilepsy patients with promnesia]. Rinsho Shinkeigaku 2018; 58:513-516. [PMID: 30068809 DOI: 10.5692/clinicalneurol.cn-001149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Promnesia is a feeling of familiarity and foreknowledge and is a manifestation of simple partial seizures (focal aware seizures). It is similar to déjà vu and has been reported to be a rare symptom in patients with temporal lobe epilepsy. Here, we investigated the clinical characteristics in 4 patients with partial epilepsy presenting promnesia. Three out of 4 patients showed abnormal electroencephalography (EEG) and/or MRI findings in the temporal lobe. Furthermore, in 2 patients, promnesia was the only aura. It is important to actively obtain medical history of patients about promnesia because this is useful for identifying the epileptic focus. Further cases need to be analyzed to evaluate the sensitivity and specificity of promnesia for diagnosis and therapy of partial epilepsy.
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Affiliation(s)
- Shunsuke Kajikawa
- Department of Neurology, Kyoto University Graduate School of Medicine
| | - Katsuya Kobayashi
- Department of Neurology, Kyoto University Graduate School of Medicine
| | | | - Riki Matsumoto
- Department of Neurology, Kyoto University Graduate School of Medicine
| | - Akio Ikeda
- Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine
| | - Ryosuke Takahashi
- Department of Neurology, Kyoto University Graduate School of Medicine
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24
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Abstract
PURPOSE OF REVIEW This article aims to educate clinical neurologists on the importance of taste and smell disorders in clinical neurology. These disorders commonly occur in head trauma, multiple sclerosis, seizure disorders, and neurodegenerative diseases such as idiopathic Parkinson disease and dementia, mild cognitive impairment, and Alzheimer disease, just to name a few. This article covers the basic anatomy of smell and taste, notes the important points of taking a proper history, and discusses smell and taste testing, which are inexpensive, minimally time-consuming procedures. Recurrent bad smells and tastes are not uncommon in these disorders, which cause major impairment in quality of life, including loss of appetite, decreased eating, and weight loss. The diagnosis and treatment of these disorders will also be discussed. RECENT FINDINGS Despite past widespread negative prognoses of taste and smell disorders, more recent work in the last 10 years has shown an improved prognosis for smell and taste recovery in most disorders, and recommendations for changes in food preparation have helped many patients enjoy their food and increase their appetite. Recent experimental evidence has shown that smell loss and testing can assist in separating idiopathic Parkinson disease from other parkinsonian syndromes, can suggest which patients with rapid eye movement (REM) sleep behavior disorder will more likely develop Parkinson disease, and can be predictive of the progression of cognitive impairment and Alzheimer dementia. SUMMARY This article discusses the common smell and taste disorders that a clinical neurologist will encounter in practice. The anatomy and function of smell and taste will be reviewed, followed by office evaluation and testing. The common disorders will be reviewed, along with their prognosis and management.
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25
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Delfino-Pereira P, Bertti-Dutra P, de Lima Umeoka EH, de Oliveira JAC, Santos VR, Fernandes A, Marroni SS, Del Vecchio F, Garcia-Cairasco N. Intense olfactory stimulation blocks seizures in an experimental model of epilepsy. Epilepsy Behav 2018; 79:213-224. [PMID: 29346088 DOI: 10.1016/j.yebeh.2017.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 12/11/2017] [Accepted: 12/11/2017] [Indexed: 10/18/2022]
Abstract
There are reports of patients whose epileptic seizures are prevented by means of olfactory stimulation. Similar findings were described in animal models of epilepsy, such as the electrical kindling of amygdala, where olfactory stimulation with toluene (TOL) suppressed seizures in most rats, even when the stimuli were 20% above the threshold to evoke seizures in already kindled animals. The Wistar Audiogenic Rat (WAR) strain is a model of tonic-clonic seizures induced by acute acoustic stimulation, although it also expresses limbic seizures when repeated acoustic stimulation occurs - a process known as audiogenic kindling (AK). The aim of this study was to evaluate whether or not the olfactory stimulation with TOL would interfere on the behavioral expression of brainstem (acute) and limbic (chronic) seizures in the WAR strain. For this, animals were exposed to TOL or saline (SAL) and subsequently exposed to acoustic stimulation in two conditions that generated: I) acute audiogenic seizures (only one acoustic stimulus, without previous seizure experience before of the odor test) and II) after AK (20 acoustic stimuli [2 daily] before of the protocol test). We observed a decrease in the seizure severity index of animals exposed only to TOL in both conditions, with TOL presented 20s before the acoustic stimulation in both protocols. These findings were confirmed by behavioral sequential analysis (neuroethology), which clearly indicated an exacerbation of clusters of specific behaviors such as exploration and grooming (self-cleaning), as well as significant decrease in the expression of brainstem and limbic seizures in response to TOL. Thus, these data demonstrate that TOL, a strong olfactory stimulus, has anticonvulsant properties, detected by the decrease of acute and AK seizures in WARs.
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Affiliation(s)
- Polianna Delfino-Pereira
- Neurosciences and Behavioral Sciences Department, Ribeirão Preto School of Medicine, Universiy of São Paulo, Hospital das Clínicas, Campus Universitário S/N, 4° Andar, Ribeirão Preto, SP CEP: 14048-900, Brazil
| | - Poliana Bertti-Dutra
- Neurosciences and Behavioral Sciences Department, Ribeirão Preto School of Medicine, Universiy of São Paulo, Hospital das Clínicas, Campus Universitário S/N, 4° Andar, Ribeirão Preto, SP CEP: 14048-900, Brazil; Physiology Department, Ribeirão Preto School of Medicine, University of São Paulo, Prédio Central, Avenida Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP CEP: 14049-900, Brazil
| | - Eduardo Henrique de Lima Umeoka
- Neurosciences and Behavioral Sciences Department, Ribeirão Preto School of Medicine, Universiy of São Paulo, Hospital das Clínicas, Campus Universitário S/N, 4° Andar, Ribeirão Preto, SP CEP: 14048-900, Brazil; Physiology Department, Ribeirão Preto School of Medicine, University of São Paulo, Prédio Central, Avenida Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP CEP: 14049-900, Brazil
| | - José Antônio Cortes de Oliveira
- Physiology Department, Ribeirão Preto School of Medicine, University of São Paulo, Prédio Central, Avenida Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP CEP: 14049-900, Brazil
| | - Victor Rodrigues Santos
- Physiology Department, Ribeirão Preto School of Medicine, University of São Paulo, Prédio Central, Avenida Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP CEP: 14049-900, Brazil
| | - Artur Fernandes
- Physiology Department, Ribeirão Preto School of Medicine, University of São Paulo, Prédio Central, Avenida Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP CEP: 14049-900, Brazil; Genetics Department, Ribeirão Preto School of Medicine, University of São Paulo, Avenida Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP CEP: 14049-900, Brazil
| | - Simone Saldanha Marroni
- Neurosciences and Behavioral Sciences Department, Ribeirão Preto School of Medicine, Universiy of São Paulo, Hospital das Clínicas, Campus Universitário S/N, 4° Andar, Ribeirão Preto, SP CEP: 14048-900, Brazil; Physiology Department, Ribeirão Preto School of Medicine, University of São Paulo, Prédio Central, Avenida Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP CEP: 14049-900, Brazil
| | - Flávio Del Vecchio
- Physiology Department, Ribeirão Preto School of Medicine, University of São Paulo, Prédio Central, Avenida Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP CEP: 14049-900, Brazil
| | - Norberto Garcia-Cairasco
- Neurosciences and Behavioral Sciences Department, Ribeirão Preto School of Medicine, Universiy of São Paulo, Hospital das Clínicas, Campus Universitário S/N, 4° Andar, Ribeirão Preto, SP CEP: 14048-900, Brazil; Physiology Department, Ribeirão Preto School of Medicine, University of São Paulo, Prédio Central, Avenida Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP CEP: 14049-900, Brazil.
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26
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Mazzola L, Royet JP, Catenoix H, Montavont A, Isnard J, Mauguière F. Gustatory and olfactory responses to stimulation of the human insula. Ann Neurol 2017; 82:360-370. [DOI: 10.1002/ana.25010] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 08/04/2017] [Accepted: 08/04/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Laure Mazzola
- Neurology Department; University Hospital; Saint-Étienne
- Central Integration of Pain Team, Lyon Neuroscience Research Center, National Institute of Health and Medical Research Unit 1028; National Center for Scientific Research Mixed Unit of Research 5292; Lyon
- Jean Monnet University; Saint-Étienne
| | - Jean-Pierre Royet
- Olfaction: From Coding to Memory Team, Lyon Neuroscience Research Center, National Institute of Health and Medical Research Unit 1028, National Center for Scientific Research Mixed Unit of Research 5292; University of Lyon; Lyon
- Claude Bernard University Lyon 1; University of Lyon; Lyon
| | - Hélène Catenoix
- Functional Neurology and Epilepsy Department, Neurological Hospital; Civil Hospices of Lyon; Lyon France
| | - Alexandra Montavont
- Functional Neurology and Epilepsy Department, Neurological Hospital; Civil Hospices of Lyon; Lyon France
| | - Jean Isnard
- Central Integration of Pain Team, Lyon Neuroscience Research Center, National Institute of Health and Medical Research Unit 1028; National Center for Scientific Research Mixed Unit of Research 5292; Lyon
- Functional Neurology and Epilepsy Department, Neurological Hospital; Civil Hospices of Lyon; Lyon France
| | - François Mauguière
- Central Integration of Pain Team, Lyon Neuroscience Research Center, National Institute of Health and Medical Research Unit 1028; National Center for Scientific Research Mixed Unit of Research 5292; Lyon
- Claude Bernard University Lyon 1; University of Lyon; Lyon
- Functional Neurology and Epilepsy Department, Neurological Hospital; Civil Hospices of Lyon; Lyon France
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27
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Akimoto J, Ichimasu N, Haraoka R, Fukami S, Kohno M. A case of unruptured aneurysm of the internal carotid artery presenting as olfactory hallucinations. Surg Neurol Int 2017; 8:197. [PMID: 28904824 PMCID: PMC5590341 DOI: 10.4103/sni.sni_134_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 06/17/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Olfactory hallucination, a symptom of medial temporal lobe epilepsy, is rarely associated with unruptured intracranial aneurysms. CASE DESCRIPTION We encountered this situation in a 70-year-old woman with an unruptured aneurysm at the bifurcation of the internal carotid and posterior communicating artery. We were able to achieve epileptic control by craniotomy clipping and medial temporal lesionectomy. CONCLUSION According to our knowledge, previous reports are limited to cases of large middle cerebral artery aneurysms compressing the lateral orbitofrontal cortex, and this is apparently the first report of a case where olfactory hallucinations occurred from direct stimulation of the entorhinal cortex by an internal carotid and posterior communicating artery bifurcation aneurysm. We examined the pathophysiology underlying the development of olfactory hallucinations. We found craniotomy clipping and focal resection to be useful from the standpoint of seizure control. Whether seizure control can also be obtained with intracranial aneurysm coiling should be investigated in the future.
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Affiliation(s)
- Jiro Akimoto
- Department of Neurosurgery, Tokyo Medical University, Shinjukuku, Tokyo, Japan
| | - Norio Ichimasu
- Department of Neurosurgery, Tokyo Medical University, Shinjukuku, Tokyo, Japan
| | - Rei Haraoka
- Department of Neurosurgery, Tokyo Medical University, Shinjukuku, Tokyo, Japan
| | - Shinjiro Fukami
- Department of Neurosurgery, Tokyo Medical University, Shinjukuku, Tokyo, Japan
| | - Michihiro Kohno
- Department of Neurosurgery, Tokyo Medical University, Shinjukuku, Tokyo, Japan
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Sjölund S, Larsson M, Olofsson JK, Seubert J, Laukka EJ. Phantom Smells: Prevalence and Correlates in a Population-Based Sample of Older Adults. Chem Senses 2017; 42:309-318. [PMID: 28334095 PMCID: PMC5863552 DOI: 10.1093/chemse/bjx006] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Loss of olfactory function is common in old age, but evidence regarding qualitative olfactory dysfunction in the general older population is scarce. The current study investigates the prevalence and correlates of phantom smell experiences (phantosmia) in a population-based study (Swedish National Study on Aging and Care in Kungsholmen [SNAC-K]) of Swedish adults (n = 2569) aged between 60 and 90 years. Phantosmia was assessed through a standardized interview and defined as reporting having experienced an odor percept in the absence of any stimuli in the surrounding environment that could emit the odor. The relationships between phantosmia and demographic, genetic, health-related, and behavioral variables were analyzed with hierarchical logistic regression analyses. The overall prevalence of phantom smells was 4.9%, and was associated with female gender, carrying the met allele of the BDNF gene, higher vascular risk burden, and reporting distorted smell sensations (parosmia). Olfactory dysfunction was, however, not related to phantosmia. The most frequently reported phantom smell was smoky/burnt. A novel finding was that some individuals reported phantom smells with an autobiographical connotation. The results from this study indicate that the prevalence of phantosmia in the general older population is not negligible and that some factors that are beneficial for preserved olfactory function, such as female gender and the BDNF met allele, are also associated with the occurrence of phantom smells.
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Affiliation(s)
- Sara Sjölund
- Gösta Ekman's Laboratory, Department of Psychology, Stockholm University, Frescati Hagväg 9 A, 10691 Stockholm, Sweden
| | - Maria Larsson
- Gösta Ekman's Laboratory, Department of Psychology, Stockholm University, Frescati Hagväg 9 A, 10691 Stockholm, Sweden
| | - Jonas K Olofsson
- Gösta Ekman's Laboratory, Department of Psychology, Stockholm University, Frescati Hagväg 9 A, 10691 Stockholm, Sweden
| | - Janina Seubert
- Department of Clinical Neuroscience, Psychology Division, Karolinska Institutet, Nobels väg 9, 17165 Stockholm, Sweden.,Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Gävlegatan 16, 11330 Stockholm, Sweden
| | - Erika J Laukka
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Gävlegatan 16, 11330 Stockholm, Sweden
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Sarnat HB, Flores-Sarnat L, Wei XC. Olfactory Development, Part 1: Function, From Fetal Perception to Adult Wine-Tasting. J Child Neurol 2017; 32:566-578. [PMID: 28424010 DOI: 10.1177/0883073817690867] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Discrimination of odorous molecules in amniotic fluid occur after 30 weeks' gestation; fetuses exhibit differential responses to maternal diet. Olfactory reflexes enable reliable neonatal testing. Olfactory bulbs can be demonstrated reliably by MRI after 30 weeks' gestation, and their hypoplasia or aplasia also documented by late prenatal and postnatal MRI. Olfactory axons project from nasal epithelium to telencephalon before olfactory bulbs form. Fetal olfactory maturation remains incomplete at term for neuronal differentiation, synaptogenesis, myelination, and persistence of the transitory fetal ventricular recess. Immaturity does not signify nonfunction. Olfaction is the only sensory system without thalamic projection because of its own intrinsic thalamic equivalent. Diverse malformations of the olfactory bulb can be diagnosed by clinical examination, imaging, and neuropathology. Some epileptic auras might be primarily generated in the olfactory bulb. Cranial nerve 1 should be tested in all neonates and especially in patients with brain malformations, endocrinopathies, chromosomopathies, and genetic/metabolic diseases.
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Affiliation(s)
- Harvey B Sarnat
- 1 Department of Paediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.,2 Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.,3 Department of Pathology and Laboratory Medicine (Neuropathology), University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.,5 Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Laura Flores-Sarnat
- 1 Department of Paediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.,2 Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.,3 Department of Pathology and Laboratory Medicine (Neuropathology), University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.,5 Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Xing-Chang Wei
- 4 Department of Radiology and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.,5 Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
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Savage SA, Butler CR, Milton F, Han Y, Zeman AZ. On the nose: Olfactory disturbances in patients with transient epileptic amnesia. Epilepsy Behav 2017; 66:113-119. [PMID: 28038387 PMCID: PMC6197428 DOI: 10.1016/j.yebeh.2016.09.043] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 09/29/2016] [Accepted: 09/30/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE While olfactory hallucinations are relatively rare in epilepsy, a high prevalence (up to 42%) has been reported in one form - Transient Epileptic Amnesia (TEA). TEA is characterized by recurring amnestic seizures and is commonly associated with persistent interictal memory deficits. Despite reports of changes in smell, olfactory ability has not been objectively assessed in this group. The aim of this study was to measure olfactory ability in patients with TEA and explore whether olfactory symptoms relate to other clinical variables. METHODS Fifty-five participants with TEA were recruited from The Impairment of Memory in Epilepsy project database. The presence of olfactory symptoms was obtained via case notes and clinical interview. Participants completed questionnaires to evaluate their olfaction and memory function subjectively. Olfactory ability was measured using the University of Pennsylvania Smell Identification Test (UPSIT). TEA participants' performance was compared to 50 matched healthy control participants. A subset of TEA participants (n=26) also completed a battery of memory tests including standard neuropsychological measures, and assessment of accelerated long-term forgetting and autobiographical memory. RESULTS Olfactory hallucinations were reported in 55% of patients with TEA. A significant reduction in smell identification (UPSIT) was found between patients with TEA and healthy controls (p<0.001). Epilepsy variables, including history of olfactory hallucinations, were not predictive of olfactory ability. Patients reported ongoing memory difficulties and performed below normative values on objective tests. While no correlation was found between objective measures of memory and olfactory performance, subjective complaints of route finding difficulty was associated with UPSIT score. CONCLUSIONS Impairments in odor identification are common in patients with TEA and exceed changes that occur in normal aging. Olfactory hallucinations occurs in approximately half of patients with TEA, but do not always coincide with reduced sense of smell. Olfactory impairment and interictal memory problems both occur frequently in TEA but are not closely associated.
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Affiliation(s)
- Sharon A. Savage
- Cognitive & Behavioural Neurology, University of Exeter Medical School, College House, St Luke’s Campus, Exeter, EX1 2LU, UK,corresponding author:
| | - Christopher R. Butler
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, John Radcliffe Hospital, OX3 9DU, UK
| | - Fraser Milton
- Discipline of Psychology, University of Exeter, Washington Singer Laboratories, Exeter, EX4 4QG, UK
| | - Yang Han
- Health Statistics, University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, EX1 2LU, UK
| | - Adam Z. Zeman
- Cognitive & Behavioural Neurology, University of Exeter Medical School, College House, St Luke’s Campus, Exeter, EX1 2LU, UK
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Palacios E, Clavijo-Prado C. Semiología de la crisis epiléptica: un reto clínico. REPERTORIO DE MEDICINA Y CIRUGÍA 2016. [DOI: 10.1016/j.reper.2016.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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32
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Jion YI, Grosberg BM, Evans RW. Phantosmia and Migraine With and Without Headache. Headache 2016; 56:1494-1502. [DOI: 10.1111/head.12890] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2016] [Indexed: 01/03/2023]
Affiliation(s)
| | - Brian M. Grosberg
- Hartford Healthcare Headache Center; Wethersfield CT USA (B.M. Grosberg)
| | - Randolph W. Evans
- Department of Neurology; Baylor College of Medicine; Houston TX USA (R.W. Evans)
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Caminiti F, De Salvo S, Nunnari D, Bramanti P, Ciurleo R, Granata F, Marino S. Effect of the antiepileptic therapy on olfactory disorders associated with mesial temporal sclerosis. Neurocase 2016; 22:357-61. [PMID: 27347726 DOI: 10.1080/13554794.2016.1176203] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Parosmia has been described in neurological disorders, including temporal epilepsy. We reported a case of parosmia associated with unilateral hyposmia and mesial temporal sclerosis. We assessed the olfactory function by using Sniffin' sticks test and olfactory event-related potentials (OERPs). The findings of unilateral deficit of identification associated with parosmia only in the side ipsilateral to mesial temporal sclerosis area, that involves temporal olfactory regions responsible for higher level of smell processing, suggest a central genesis of olfactory disorders. The administration of levetiracetam restored olfactory function, OERP N1-P2 amplitude, and mesial temporal sclerosis-related electroencephalographic findings.
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Affiliation(s)
| | | | | | | | | | - Francesca Granata
- b Department of Biomedical Sciences and Morphological and Functional Imaging , University of Messina , Messina , Italy
| | - Silvia Marino
- a IRCCS Centro Neurolesi "Bonino-Pulejo" , Messina , Italy.,b Department of Biomedical Sciences and Morphological and Functional Imaging , University of Messina , Messina , Italy
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Bagatti D. Music and Medicine: The Tragic Case of Gershwin's Brain Tumor and the Challenges of Neurosurgery in the First Half of the 20th Century. World Neurosurg 2016; 85:298-304. [DOI: 10.1016/j.wneu.2015.07.054] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 07/24/2015] [Accepted: 07/25/2015] [Indexed: 12/01/2022]
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35
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Yilmazer-Hanke D, O'Loughlin E, McDermott K. Contribution of amygdala pathology to comorbid emotional disturbances in temporal lobe epilepsy. J Neurosci Res 2015; 94:486-503. [DOI: 10.1002/jnr.23689] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 10/07/2015] [Accepted: 10/16/2015] [Indexed: 12/19/2022]
Affiliation(s)
- Deniz Yilmazer-Hanke
- Department of Biomedical Sciences, School of Medicine; Creighton University; Omaha Nebraska
- Department of Anatomy and Neuroscience; University College; Cork Ireland
| | - Elaine O'Loughlin
- Department of Anatomy and Neuroscience; University College; Cork Ireland
- Ann Romney Centre for Neurologic Diseases, Brigham and Women's Hospital; Harvard Medical School; Boston Massachusetts
| | - Kieran McDermott
- Department of Anatomy and Neuroscience; University College; Cork Ireland
- Graduate Entry Medical School; University of Limerick; Limerick Ireland
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36
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Du X, Usui N, Terada K, Baba K, Matsuda K, Tottori T, Inoue Y. Semiological and electroencephalographic features of epilepsy with amygdalar lesion. Epilepsy Res 2015; 111:45-53. [DOI: 10.1016/j.eplepsyres.2015.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 01/13/2015] [Accepted: 01/19/2015] [Indexed: 10/24/2022]
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37
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Affiliation(s)
- James W. Jordan
- Neurological Institute University Hospitals Case Western Medical Center Cleveland, Ohio
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38
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Vaughan DN, Jackson GD. The piriform cortex and human focal epilepsy. Front Neurol 2014; 5:259. [PMID: 25538678 PMCID: PMC4259123 DOI: 10.3389/fneur.2014.00259] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 11/22/2014] [Indexed: 11/28/2022] Open
Abstract
It is surprising that the piriform cortex, when compared to the hippocampus, has been given relatively little significance in human epilepsy. Like the hippocampus, it has a phylogenetically preserved three-layered cortex that is vulnerable to excitotoxic injury, has broad connections to both limbic and cortical areas, and is highly epileptogenic – being critical to the kindling process. The well-known phenomenon of early olfactory auras in temporal lobe epilepsy highlights its clinical relevance in human beings. Perhaps because it is anatomically indistinct and difficult to approach surgically, as it clasps the middle cerebral artery, it has, until now, been understandably neglected. In this review, we emphasize how its unique anatomical and functional properties, as primary olfactory cortex, predispose it to involvement in focal epilepsy. From recent convergent findings in human neuroimaging, clinical epileptology, and experimental animal models, we make the case that the piriform cortex is likely to play a facilitating and amplifying role in human focal epileptogenesis, and may influence progression to epileptic intractability.
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Affiliation(s)
- David N Vaughan
- Florey Institute of Neuroscience and Mental Health , Heidelberg, VIC , Australia ; Department of Neurology, Austin Health , Heidelberg, VIC , Australia
| | - Graeme D Jackson
- Florey Institute of Neuroscience and Mental Health , Heidelberg, VIC , Australia ; Department of Neurology, Austin Health , Heidelberg, VIC , Australia ; Department of Medicine, University of Melbourne , Melbourne, VIC , Australia
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39
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Restrepo D, Hellier JL, Salcedo E. Complex metabolically demanding sensory processing in the olfactory system: implications for epilepsy. Epilepsy Behav 2014; 38:37-42. [PMID: 24113565 PMCID: PMC3979506 DOI: 10.1016/j.yebeh.2013.08.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 08/26/2013] [Indexed: 12/23/2022]
Abstract
Although the olfactory system is not generally associated with seizures, sharp application of odor eliciting activity in a large number of olfactory sensory neurons (OSNs) has been shown to elicit seizures. This is most likely due to increased ictal activity in the anterior piriform cortex-an area of the olfactory system that has limited GABAergic interneuron inhibition of pyramidal output cell activity. Such hyperexcitability in a well-characterized and highly accessible system makes olfaction a potentially powerful model system to examine epileptogenesis.
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Affiliation(s)
- Diego Restrepo
- Department of Cell and Developmental Biology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; Center for Neuroscience, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; Rocky Mountain Taste and Smell Center, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
| | - Jennifer L. Hellier
- Department of Cell and Developmental Biology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045,Rocky Mountain Taste and Smell Center, University of Colorado Anschutz Medical Campus, Aurora, CO 80045,Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - Ernesto Salcedo
- Department of Cell and Developmental Biology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045,Rocky Mountain Taste and Smell Center, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
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40
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Hamasaki T, Otsubo H, Uchikawa H, Yamada K, Kuratsu JI. Olfactory auras caused by a very focal isolated epileptic network in the amygdala. EPILEPSY & BEHAVIOR CASE REPORTS 2014; 2:142-4. [PMID: 25667893 PMCID: PMC4307874 DOI: 10.1016/j.ebcr.2014.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 07/09/2014] [Accepted: 07/11/2014] [Indexed: 11/19/2022]
Abstract
Epileptic olfactory auras manifesting as simple partial seizures are rare. We report a patient who presented with olfactory auras after hemorrhage from a cavernous angioma in the left mesial temporal region. His olfactory auras persisted 12 years after two surgeries for a cavernous angioma. Intracranial depth electrodes revealed a very focal isolated epileptogenic zone in the amygdala. Olfactory auras were successfully treated by focus resection.
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Affiliation(s)
- Tadashi Hamasaki
- Department of Neurosurgery, Kumamoto University Medical School, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
- Corresponding author. Tel.: + 81 96 373 5219; fax: + 81 96 371 8064.
| | - Hiroshi Otsubo
- Division of Neurology, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Hiroki Uchikawa
- Department of Neurosurgery, Kumamoto University Medical School, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Kazumichi Yamada
- Department of Neurosurgery, Kumamoto University Medical School, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Jun-ichi Kuratsu
- Department of Neurosurgery, Kumamoto University Medical School, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
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42
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Henkin RI, Potolicchio SJ, Levy LM. Olfactory Hallucinations without Clinical Motor Activity: A Comparison of Unirhinal with Birhinal Phantosmia. Brain Sci 2013; 3:1483-553. [PMID: 24961619 PMCID: PMC4061890 DOI: 10.3390/brainsci3041483] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 10/11/2013] [Accepted: 10/12/2013] [Indexed: 01/14/2023] Open
Abstract
Olfactory hallucinations without subsequent myoclonic activity have not been well characterized or understood. Herein we describe, in a retrospective study, two major forms of olfactory hallucinations labeled phantosmias: one, unirhinal, the other, birhinal. To describe these disorders we performed several procedures to elucidate similarities and differences between these processes. From 1272, patients evaluated for taste and smell dysfunction at The Taste and Smell Clinic, Washington, DC with clinical history, neurological and otolaryngological examinations, evaluations of taste and smell function, EEG and neuroradiological studies 40 exhibited cyclic unirhinal phantosmia (CUP) usually without hyposmia whereas 88 exhibited non-cyclic birhinal phantosmia with associated symptomology (BPAS) with hyposmia. Patients with CUP developed phantosmia spontaneously or after laughing, coughing or shouting initially with spontaneous inhibition and subsequently with Valsalva maneuvers, sleep or nasal water inhalation; they had frequent EEG changes usually ipsilateral sharp waves. Patients with BPAS developed phantosmia secondary to several clinical events usually after hyposmia onset with few EEG changes; their phantosmia could not be initiated or inhibited by any physiological maneuver. CUP is uncommonly encountered and represents a newly defined clinical syndrome. BPAS is commonly encountered, has been observed previously but has not been clearly defined. Mechanisms responsible for phantosmia in each group were related to decreased gamma-aminobutyric acid (GABA) activity in specific brain regions. Treatment which activated brain GABA inhibited phantosmia in both groups.
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Affiliation(s)
- Robert I Henkin
- Center for Molecular Nutrition and Sensory Disorders, The Taste and Smell Clinic, 5125 MacArthur Blvd, NW, Suite 20, Washington, DC 20016, USA.
| | - Samuel J Potolicchio
- Department of Neurology, The George Washington University Medical Center, 2150 Pennsylvania Avenue, NW, 7th Floor, Washington, DC 20037, USA.
| | - Lucien M Levy
- Department of Radiology, The George Washington University Medical Center, 900 23rd Street, NW, Washington, DC 20037, USA.
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Keller A, Malaspina D. Hidden consequences of olfactory dysfunction: a patient report series. BMC EAR, NOSE, AND THROAT DISORDERS 2013; 13:8. [PMID: 23875929 PMCID: PMC3733708 DOI: 10.1186/1472-6815-13-8] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 07/15/2013] [Indexed: 01/28/2023]
Abstract
BACKGROUND The negative consequences of olfactory dysfunction for the quality of life are not widely appreciated and the condition is therefore often ignored or trivialized. METHODS 1,000 patients with olfactory dysfunction participated in an online study by submitting accounts of their subjective experiences of how they have been affected by their condition. In addition, they were given the chance to answer 43 specific questions about the consequences of their olfactory dysfunction. RESULTS Although there are less practical problems associated with impaired or distorted odor perception than with impairments in visual or auditory perception, many affected individuals report experiencing olfactory dysfunction as a debilitating condition. Smell loss-induced social isolation and smell loss-induced anhedonia can severely affect quality of life. CONCLUSIONS Olfactory dysfunction is a serious condition for those affected by it and it deserves more attention from doctors who treat affected patients as well as from scientist who research treatment options.
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Affiliation(s)
- Andreas Keller
- Laboratory of Neurogenetics and Behavior, Rockefeller University, New York, NY, USA
| | - Dolores Malaspina
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
- Creedmoor Psychiatric Center, New York State Office of Mental Health, New York, NY, USA
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Tufenkjian K, Lüders HO. Seizure semiology: its value and limitations in localizing the epileptogenic zone. J Clin Neurol 2012; 8:243-50. [PMID: 23323131 PMCID: PMC3540282 DOI: 10.3988/jcn.2012.8.4.243] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 09/10/2012] [Accepted: 09/10/2012] [Indexed: 11/17/2022] Open
Abstract
Epilepsy surgery has become an important treatment option in patients with medically refractory epilepsy. The ability to precisely localize the epileptogenic zone is crucial for surgical success. The tools available for localization of the epileptogenic zone are limited. Seizure semiology is a simple and cost effective tool that allows localization of the symptomatogenic zone which either overlaps or is in close proximity of the epileptogenic zone. This becomes particularly important in cases of MRI negative focal epilepsy. The ability to video record seizures made it possible to discover new localizing signs and quantify the sensitivity and specificity of others. Ideally the signs used for localization should fulfill these criteria; 1) Easy to identify and have a high inter-rater reliability, 2) It has to be the first or one of the earlier components of the seizure in order to have localizing value. Later symptoms or signs are more likely to be due to ictal spread and may have only a lateralizing value. 3) The symptomatogenic zone corresponding to the recorded ictal symptom has to be clearly defined and well documented. Reproducibility of the initial ictal symptoms with cortical stimulation identifies the corresponding symptomatogenic zone. Unfortunately, however, not all ictal symptoms can be reproduced by focal cortical stimulation. Therefore, the problem the clinician faces is trying to deduce the epileptogenic zone from the seizure semiology. The semiological classification system is particularly useful in this regard. We present the known localizing and lateralizing signs based on this system.
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Affiliation(s)
- Krikor Tufenkjian
- Epilepsy Center, Department of Neurology, University Hospitals Case Medical Center, Cleveland, OH, USA
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45
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Stevenson RJ, Langdon R. A preliminary investigation of olfactory function in olfactory and auditory-verbal hallucinators with schizophrenia, and normal controls. Cogn Neuropsychiatry 2012; 17:315-33. [PMID: 22181045 DOI: 10.1080/13546805.2011.633748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
INTRODUCTION It is well established that people with schizophrenia have impaired olfactory perception. However, another olfactory abnormality that occurs in schizophrenia--olfactory hallucinations (OHs)--has received almost no attention. METHODS This preliminary study compared a small sample of olfactory (OH; n=14) and auditory-verbal (AVH; n=11) hallucinators with schizophrenia, with matched healthy controls (NC; n=21), on tests of odour detection threshold, identification, and hedonics, and bespoke tests relating to possible causes of OHs. RESULTS Both OH and AVH participants were equally impaired on tests of odour identification, but neither had any impairment in detection. However, although the AVH group had hedonic impairments, these were not evident in the OH and NC groups. Examination of the possible causes of OHs revealed abnormalities in olfactory habituation. In addition, we observed a far greater rate of past episodes of brief unconsciousness in the OH group. CONCLUSIONS The presence of habituation deficits and past episodes of brief unconsciousness, and absence of olfactory affective impairment, have not been identified before as correlates of OHs, suggesting these factors may be worthy of further investigation.
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Neuropsychological characteristics associated with olfactory hallucinations in schizophrenia. J Int Neuropsychol Soc 2012; 18:799-808. [PMID: 22613466 DOI: 10.1017/s1355617712000471] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Olfactory hallucinations (OHs) are present in a significant minority of people with schizophrenia, yet these symptoms are under-researched and poorly understood. This study aimed to identify the neuropsychological impairments that associate with OHs in schizophrenia. Patients with schizophrenia or schizoaffective disorder were classified into an OH group and a group with auditory-verbal hallucinations (AVHs) and no lifetime history of OHs. Patients were age- and gender-matched to a healthy control group. All participants were assessed using: a test of odor identification; decision-making and socio-emotional tests of orbitofrontal cortex (OFC) and amygdala function; and a battery of standardized executive tests. Patients, as a whole, performed more poorly than controls on the tests of odor identification, emotion processing and executive function, consistent with previous research. Only two tests of OFC functioning: the Object Alternation Task, taken from Oscar-Berman and Zola-Morgan's (1980a, 1980b) Comparative Neuropsychological Tasks, and a test of "faux pas" understanding discriminated between the OH and AVH patients. Findings provide the first preliminary support for OH-specific neuropsychological impairments associated with OFC dysfunction in schizophrenia. (JINS, 2012, 18, 1-10).
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47
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Ye BS, Cho YJ, Jang SH, Lee MK, Lee BI, Heo K. The localizing and lateralizing value of auras in lesional partial epilepsy patients. Yonsei Med J 2012; 53:477-85. [PMID: 22476989 PMCID: PMC3343447 DOI: 10.3349/ymj.2012.53.3.477] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE We investigated the localizing and lateralizing values of auras in patients with lesional partial epilepsy on an outpatient basis. MATERIALS AND METHODS A total of 276 subjects were retrospectively selected for this study if they had a unilateral single lobar lesion based on magnetic resonance image (MRI) results, and their scalp electroencephalography (EEG) findings were not discordant with the MRI-defined lobar localization and lateralization. According to the lesion locations, subjects were considered as having mesial temporal (MTLE), lateral temporal (LTLE), frontal (FLE), parietal (PLE), or occipital (OLE) lobe epilepsies. Auras were classified into 13 categories. RESULTS A hundred and seventy-six subjects (63.8%) had experienced at least one aura. FLE subjects had the fewest number of auras. Epigastric and psychic auras were frequent among MTLE subjects, while visual auras were common in those with PLE and OLE. Somatosensory auras and whole body sensations were more frequent in the subjects with PLE than those without. Autonomic auras were more common in MTLE subjects than in LTLE subjects. Dysphasic auras were more frequently found in left-sided epilepsies. Five pairs of aura categories showed concurrent tendencies, which were the epigastric and autonomic auras, autonomic and emotional auras, visual and vestibular auras, auditory and vestibular auras, and whole-body sensation and auditory auras. Autonomic and emotional auras had a concurrent tendency in left-sided epilepsies, but not in right-sided epilepsies. CONCLUSION Our results support the previously known localizing value of auras, and suggest that dysphasic auras and the association of emotional and autonomic auras may have a lateralizing value.
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Affiliation(s)
- Byoung Seok Ye
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Yang-Je Cho
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hyun Jang
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Moon Kyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Byung In Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Kyoung Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
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48
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Abstract
Qualitative olfactory disorders such as parosmia and phantosmia are not well investigated. In particular, the causes and treatment options for phantosmia are largely unknown. We report a case of long lasting phantosmia that disappeared under anti-depressive treatment, raising the question to what extent certain forms of qualitative olfactory disorders are an early symptom of depression.
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Affiliation(s)
- Basile N Landis
- Smell & Taste Clinic, Department of Otorhinolaryngology, University of Dresden Medical School ('Technische Universität Dresden'), Dresden, Germany.
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49
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Abstract
Much has been discovered over the last few decades about the anatomy and physiology of the human taste system, most notably its receptor mechanisms and intermodal factors that influence its function. While the taste system works in concert with the olfactory, somatosensory, auditory, and visual sensory systems to establish the overall gestalt of flavor, its primary specialization is to ensure that the organism obtains energy, maintains proper electrolyte balance, and avoids ingestion of toxic substances. Despite its focus on inborn functions, taste-like its sister sense of smell-is remarkably malleable, reflecting the need to adapt to changing circumstances and general nutrient availability. It is now widely appreciated that taste dysfunction is common in many diseases and disorders, and is a frequent side effect of a number of medications. This interdisciplinary review examines salient aspects of the human gustatory system, including its anatomy, physiology, and pathophysiology. WIREs Cogn Sci 2012, 3:29-46. doi: 10.1002/wcs.156 For further resources related to this article, please visit the WIREs website.
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Affiliation(s)
- Richard L Doty
- Smell & Taste Center, University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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50
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Abstract
This study is an 11-part investigation of the psychology and neuropsychology of early Christian asceticism as represented by Evagrius Ponticus (AD 345–399), the tradition's first ascetical theologian and possibly its most influential. Evagrius's biography is reviewed in the first section. The living circumstances and perceptual consequences of desert asceticism are considered in the second. Penitence, dispassion, and the mysticism of “pure prayer” are discussed in the third. Austerities are addressed in the fourth section, particularly fasting, prostrations, and prolonged standing. Ascetical perspectives on sleep, dreams, and the hypnogogic state are analyzed in the fifth. The depressive syndrome of acedia is discussed in the sixth. Evagrius's reports of auditory, olfactory, and visual hallucinations are analyzed in the seventh. Multiple complementary interpretations of demonic phenomena are developed in the eighth section. Evagrius's psychotherapy for anger is reviewed in the ninth. Interpersonal relations among ascetics are considered in the tenth section. The study concludes with a summary.
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