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Cossette-Roberge H, Li J, Citherlet D, Nguyen DK. Localizing and lateralizing value of auditory phenomena in seizures. Epilepsy Behav 2023; 145:109327. [PMID: 37422934 DOI: 10.1016/j.yebeh.2023.109327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/11/2023] [Accepted: 06/15/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Auditory seizures (AS) are a rare type of focal seizures. AS are classically thought to involve a seizure onset zone (SOZ) in the temporal lobe, but there remain uncertainties about their localizing and lateralizing value. We conducted a narrative literature review with the aim of providing an up-to-date description of the lateralizing and localizing value of AS. METHODS The databases PubMed, Scopus, and Google Scholar were searched for literature on AS in December 2022. All cortical stimulation studies, case reports, and case series were analyzed to assess for auditory phenomena that were suggestive of AS and to evaluate if the lateralization and/or localization of the SOZ could be determined. We classified AS according to their semiology (e.g., simple hallucination versus complex hallucination) and the level of evidence with which the SOZ could be predicted. RESULTS A total of 174 cases comprising 200 AS were analyzed from 70 articles. Across all studies, the SOZ of AS were more often in the left (62%) than in the right (38%) hemisphere. AS heard bilaterally followed this trend. Unilaterally heard AS were more often due to a SOZ in the contralateral hemisphere (74%), although they could also be ipsilateral (26%). The SOZ for AS was not limited to the auditory cortex, nor to the temporal lobe. The areas more frequently involved in the temporal lobe were the superior temporal gyrus (STG) and mesiotemporal structures. Extratemporal locations included parietal, frontal, insular, and rarely occipital structures. CONCLUSION Our review highlighted the complexity of AS and their importance in the identification of the SOZ. Due to the limited data and heterogeneous presentation of AS in the literature, the patterns associated with different AS semiologies warrant further research.
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Affiliation(s)
- Hélène Cossette-Roberge
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada; Neurology Division, Centre Hospitalier de l'Université de Sherbrooke (CHUS), Sherbrooke, QC, Canada.
| | - Jimmy Li
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada; Neurology Division, Centre Hospitalier de l'Université de Sherbrooke (CHUS), Sherbrooke, QC, Canada
| | - Daphné Citherlet
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Dang Khoa Nguyen
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada; Department of Neurosciences, Université de Montréal, Montreal, QC, Canada; Neurology Division, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
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You L, Zhang Y, Zhang D, Wang L, Liu X, Peng C, Qi Y, Qian R. Stereoelectroencephalography-based research on the value of drug-resistant temporal lobe epilepsy auras: A retrospective single-center study. Epilepsy Behav 2023; 138:108981. [PMID: 36470058 DOI: 10.1016/j.yebeh.2022.108981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/25/2022] [Accepted: 10/27/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE To explore the localization value of drug-resistant temporal lobe epilepsy (TLE) aura for preoperative evaluation, based on stereoelectroencephalography (SEEG), and its prognostic value on the surgical outcome. METHODS The data of patients with drug-resistant TLE who had SEEG electrodes implanted during preoperative evaluation at the First Affiliated Hospital of the University of Science and Technology of China (Hefei, China) were retrospectively analyzed. The patients were divided into aura-positive and aura-negative groups according to the presence of aura in seizures. To explore the clinical features of aura, we evaluated the localizing and prognostic values of aura for the outcome of anterior temporal lobectomy based on SEEG. RESULTS Among forty patients, twenty-seven patients were in the aura-positive group and ten (25.0%) patients had multiple auras. The most common TLE aura was abdominal aura [thirteen (34.2%) patients]. The postoperative seizure frequency was significantly reduced in the preoperative aura-positive patients compared to the preoperative aura-negative patients (P = 0.011). Patients with abdominal (P = 0.029) and single (P = 0.036) auras had better surgical prognoses than aura-negative patients. In the preoperative evaluation, aura-positive patients had a better surgical outcome if the laterality of positron emission tomography-computed tomography (PET-CT) hypometabolism was concordant with the epileptogenic focus identified with SEEG (P = 0.031). A good postoperative epileptic outcome in aura-positive patients was observed among those with hippocampal sclerotic medial temporal lobe epilepsy (P = 0.025). CONCLUSION Epileptic aura is valuable for the localization of the epileptogenic focus. Abdominal aura and single aura were good predictors of better surgical outcomes. Among patients with a preoperative diagnosis of hippocampal sclerosis or with laterality of PET-CT hypometabolism concordant with the epileptogenic focus identified using SEEG, those with aura are likely to benefit from surgery.
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Affiliation(s)
- Longfei You
- Department of Neurosurgery, Anhui Provincial Hospital, WanNan Medical College, Wuhu, PR China
| | - Yiming Zhang
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, PR China
| | - Dong Zhang
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, PR China
| | - Lanlan Wang
- Department of Nerve Electrophysiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, PR China
| | - Xiang Liu
- Department of Nerve Electrophysiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, PR China; Anhui Provincial Institute of Stereotactic Neurosurgery, 9 Lujiang Road, Hefei, Anhui Province 230001, PR China
| | - Chang Peng
- Department of Neurosurgery, Anhui Provincial Hospital, WanNan Medical College, Wuhu, PR China
| | - Yinbao Qi
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, PR China
| | - Ruobing Qian
- Department of Neurosurgery, Anhui Provincial Hospital, WanNan Medical College, Wuhu, PR China; Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, PR China; Anhui Provincial Institute of Stereotactic Neurosurgery, 9 Lujiang Road, Hefei, Anhui Province 230001, PR China.
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Erturk Cetin O, Sirin NG, Elmali AD, Baykan B, Bebek N. Different faces of frontal lobe epilepsy: The clinical, electrophysiologic, and imaging experience of a tertiary center. Clin Neurol Neurosurg 2021; 203:106532. [PMID: 33618170 DOI: 10.1016/j.clineuro.2021.106532] [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: 12/04/2020] [Revised: 01/23/2021] [Accepted: 01/25/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Frontal lobe epilepsy (FLE) is the second most common epilepsy among drug-resistant focal epilepsies. Semiologic and electrophysiologic features of FLE present some difficulties because frontal lobe seizures are brief, accompanied by complex motor activities and emotional signs. The rich connectivity of the frontal lobe with other areas leads to the rapid and widespread propagation of seizure activity, which contribute to the difficulty of evaluating the semiologic and EEG patterns of the seizure. In this study, we investigated semiologic, interictal, ictal, and postictal EEG characteristics; the imaging data of patients with FLE and the possible contribution of these data to localization and lateralization of seizures. MATERIALS AND METHODS The medical records of patients who were diagnosed as having FLE between 2010 and 2019 in our clinic were evaluated retrospectively. The diagnosis of FLE was considered either when patients had a structural lesion in the frontal region or seizure semiology and EEG characteristics were compatible with FLE. Clinical, electrophysiologic, and imaging features were investigated in these patients. RESULTS We have evaluated 146 seizures in 36 patients (17 lesional and 19 non-lesional according to MRI). There were 110 focal motor or nonmotor seizures, 18 bilateral tonic-clonic seizures, and 18 subclinical seizures. There were 16 patients with aura. The most common semiologic feature was hyperkinetic movements. Among the interictal EEGs, 30.5 % included focal anomalies. Among the ictal EEGs, 69.1 % were non-localizing or lateralizing. The most common ictal pattern was rhythmic theta activity (21.2 %). In four patients, who had non-localizing or lateralizing EEG, the postictal EEG was informative. Our study showed a low percentage of localized FDG-PET, which, however, involved visual analysis. CONCLUSION Our results support the previously known difficulties in the determination of the epileptogenic zone of FLE. Semiologic and electrophysiologic correlation studies, longer postictal records, and quantitative analysis of FDG-PET may contribute to a better characterization of the disease.
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Affiliation(s)
- Ozdem Erturk Cetin
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey; Istanbul University, Graduate School of Health Sciences, Department of Neuroscience, Istanbul, Turkey; University of Health Sciences, Sancaktepe Training and Research Hospital, Department of Neurology, Istanbul, Turkey.
| | - Nermin Gorkem Sirin
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey.
| | - Ayse Deniz Elmali
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey.
| | - Betul Baykan
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey.
| | - Nerses Bebek
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey.
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Yin F, Ni D, Xu C, Yan X, Ma K, Zhang X, Gao R, Zhang G. Auras in intractable frontal lobe epilepsy: Clinical characteristics, values, and limitations. Epilepsy Behav 2021; 115:107724. [PMID: 33423014 DOI: 10.1016/j.yebeh.2020.107724] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 12/16/2020] [Accepted: 12/16/2020] [Indexed: 12/18/2022]
Abstract
Auras are essential in preoperative evaluation and can provide valuable information for delineating seizure onset zones. Frontal lobe epilepsy (FLE) is the second most common focal epilepsy, while a few studies have focused on auras in FLE. To better understand FLE, we analyzed the clinical characteristics, values, and limitations of auras in FLE. The incidence rate of aura in FLE was 37.9% in our study. We included 54 patients and 76 auras in 11 categories were reported. The rate of auras in the decreasing order are as follows: autonomic aura; emotional aura; somatosensory aura; psychic aura; cephalic aura; abdominal aura; whole-body sensory aura, visual aura; auditory aura; and vestibular and unclassified aura. A significant number of aura types can be reported by FLE patients; autonomic aura was the most frequent category and somatosensory auras are most likely associated with the contralateral motor areas.
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Affiliation(s)
- Fangzhao Yin
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China; Department of Functional Neurology, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China
| | - Duanyu Ni
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China; Department of Functional Neurology, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China
| | - Cuiping Xu
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China; Department of Functional Neurology, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China
| | - Xiaoming Yan
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China; Department of Functional Neurology, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China
| | - Kai Ma
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China; Department of Functional Neurology, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China
| | - Xi Zhang
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China; Department of Functional Neurology, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China
| | - Runshi Gao
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China; Department of Functional Neurology, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China
| | - Guojun Zhang
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China; Department of Functional Neurology, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China.
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5
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Porat Rein A, Kramer U, Hausman Kedem M, Fattal-Valevski A, Mitelpunkt A. Early prediction of encephalopathic transformation in children with benign epilepsy with centro-temporal spikes. Brain Dev 2021; 43:268-279. [PMID: 32912653 DOI: 10.1016/j.braindev.2020.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 08/06/2020] [Accepted: 08/18/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Most children with Benign epilepsy with centro-temporal spikes (BECTS) undergo remission during late adolescence and do not require treatment. In a small group of patients, the condition may evolve to encephalopathic syndromes including epileptic encephalopathy with continuous spike-and-wave during sleep (ECSWS), or Landau-Kleffner Syndrome (LKS). Development of prediction models for early identification of at-risk children is of utmost importance. AIM To develop a predictive model of encephalopathic transformation using data-driven approaches, reveal complex interactions to identify potential risk factors. METHODS Data were collected from a cohort of 91 patients diagnosed with BECTS treated between the years 2005-2017 at a pediatric neurology institute. Data on the initial presentation was collected based on a novel BECTS ontology and used to discover potential risk factors and to build a predictive model. Statistical and machine learning methods were compared. RESULTS A subgroup of 18 children had encephalopathic transformation. The least absolute shrinkage and selection operator (LASSO) regression Model with Elastic Net was able to successfully detect children with ECSWS or LKS. Sensitivity and specificity were 0.83 and 0.44. The most notable risk factors were fronto-temporal and temporo-parietal localization of epileptic foci, semiology of seizure involving dysarthria or somatosensory auras. CONCLUSION Novel prediction model for early identification of patients with BECTS at risk for ECSWS or LKS. This model can be used as a screening tool and assist physicians to consider special management for children predicted at high-risk. Clinical application of machine learning methods opens new frontiers of personalized patient care and treatment.
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Affiliation(s)
- Adi Porat Rein
- Sackler Faculty of Medicine, Tel-Aviv University, Israel.
| | - Uri Kramer
- Sackler Faculty of Medicine, Tel-Aviv University, Israel; Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Israel
| | - Moran Hausman Kedem
- Sackler Faculty of Medicine, Tel-Aviv University, Israel; Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Israel
| | - Aviva Fattal-Valevski
- Sackler Faculty of Medicine, Tel-Aviv University, Israel; Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Israel
| | - Alexis Mitelpunkt
- Sackler Faculty of Medicine, Tel-Aviv University, Israel; Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Israel
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6
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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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7
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Li L, Huang H, Jia Y, Wang Y, Huang Z. The localizing and lateralizing value of palpitation aura in patients with focal epilepsy. Epilepsy Behav 2019; 97:291-295. [PMID: 31182392 DOI: 10.1016/j.yebeh.2019.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 05/06/2019] [Accepted: 05/06/2019] [Indexed: 11/25/2022]
Abstract
The semiology of auras is essential to presurgical evaluation of patients with focal epilepsy. To assess the localizing and lateralizing value of palpitation aura in focal epilepsy, we retrospectively analyzed the demography, electroclinical, neuroimaging, surgical, pathology data, and outcomes of 114 patients with focal epilepsy and the palpitation aura occurrence in relation to epileptogenic (temporal vs extratemporal, left vs right) origin. Out of 114 patients (mean age, 23.44 ± 9.69 years), 17 (14.9%) patients experienced palpitation as the first aura. Twelve had temporal, one had parietal, one had occipital lobe, and three had multiple lobes junction onset seizures. Palpitation aura was observed more frequently in temporal epilepsy: 22.2% of temporal lobe epilepsy (TLE) and 8.3% of extratemporal lobe epilepsy (EX-TLE) exhibited palpitation aura (p = 0.038). However, palpitation aura had no difference between the left or right side: 16.4% with right-sided epilepsy and 13.2% with left-sided epilepsy exhibited palpitation aura (p = 0.634). Thus, our study suggested that palpitation was a frequent aura in patients with focal epilepsy. It is more commonly seen with temporal lobe origin, but it has no lateralizing value.
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Affiliation(s)
- Liping Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Comprehensive Epilepsy Center of Beijing, The Beijing Key Laboratory of Neuromodulation, 45 Changchun Street, 100053 Beijing, China
| | - Hao Huang
- Department of Neurology, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, 563003 Zunyi Guizhou, China
| | - Yu Jia
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Comprehensive Epilepsy Center of Beijing, The Beijing Key Laboratory of Neuromodulation, 45 Changchun Street, 100053 Beijing, China
| | - Yuping Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Comprehensive Epilepsy Center of Beijing, The Beijing Key Laboratory of Neuromodulation, 45 Changchun Street, 100053 Beijing, China.
| | - Zhaoyang Huang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Comprehensive Epilepsy Center of Beijing, The Beijing Key Laboratory of Neuromodulation, 45 Changchun Street, 100053 Beijing, China.
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8
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Hintz M, Krenz V, Schulze-Bonhage A. Age-dependent semiology of frontal lobe seizures. Epilepsy Res 2019; 149:83-87. [DOI: 10.1016/j.eplepsyres.2018.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 10/05/2018] [Accepted: 10/19/2018] [Indexed: 10/28/2022]
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9
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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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10
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Adry RARC, Meguins LC, Pereira CU, Silva Júnior SC, Araújo Filho GM, Marques LHN. Auras as a prognostic factor in anterior temporal lobe resections for mesial temporal sclerosis. Eur J Neurol 2018; 25:1372-1377. [DOI: 10.1111/ene.13740] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 06/19/2018] [Indexed: 11/30/2022]
Affiliation(s)
- R. A. R. C. Adry
- Serviço de Neurocirurgia; Departamento de Ciências Neurológicas; Hospital de Base de São José do Rio Preto - Faculdade de Medicina de São José do Rio Preto; São José do Rio Preto
| | - L. C. Meguins
- Serviço de Neurocirurgia; Departamento de Ciências Neurológicas; Hospital de Base de São José do Rio Preto - Faculdade de Medicina de São José do Rio Preto; São José do Rio Preto
| | | | - S. C. Silva Júnior
- Serviço de Neurocirurgia; Departamento de Ciências Neurológicas; Hospital de Base de São José do Rio Preto - Faculdade de Medicina de São José do Rio Preto; São José do Rio Preto
| | - G. M. Araújo Filho
- Serviço de Psiquiatria; Departamento de Psiquiatria e Psicologia Médica; Hospital de Base de São José do Rio Preto - Faculdade de Medicina de São José do Rio Preto; São José do Rio Preto
| | - L. H. N. Marques
- Serviço de Neurologia; Departamento de Ciências Neurológicas; Hospital de Base de São José do Rio Preto - Faculdade de Medicina de São José do Rio Preto; São José do Rio Preto Brazil
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11
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Harroud A, Boucher O, Tran TPY, Harris L, Hall J, Dubeau F, Mohamed I, Bouthillier A, Nguyen DK. Precuneal epilepsy: Clinical features and surgical outcome. Epilepsy Behav 2017. [PMID: 28623753 DOI: 10.1016/j.yebeh.2017.05.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The precuneus is a complex and highly connected structure located in the medial portion of the superior parietal lobule. The clinical presentation of precuneal epilepsy is poorly characterized, mostly because these patients have seldom been distinguished from those with other types of parietal lobe epilepsy. The present study aims to improve the understanding of precuneal epilepsy by detailing its clinical features and surgical outcomes. METHODS Six previously unreported cases of drug-resistant precuneal epilepsy investigated between 2002 and 2014 were retrospectively studied. Seizure focus was confirmed by presence of a lesion, intracranial monitoring, or post-operative seizure control when applicable. RESULTS Seizures arising from the precuneus have heterogeneous presentations, including body movement sensation, visual auras, eye movements, vestibular manifestations, and complex motor behaviors. Two patients with an anterior precuneus lesion described body movement sensations whereas two others with a posterior precuneus lesion experienced visual symptoms. Two of the five patients who underwent epilepsy surgery achieved good seizure control (Engel IA). One patient underwent gamma knife surgery with an Engel IV outcome. Surgical complications included contralateral visual field impairment, limb hypoesthesia and hemispatial neglect. One patient developed late-onset epilepsia partialis continua from a Rolandic subdural grid-related contusion. SIGNIFICANCE In absence of a clear precuneal epileptogenic lesion, recognition of a precuneal focus is challenging. Magnetoencephalography may sometimes localize the generator but invasive EEG remains in well-selected cases necessary to identify the seizure focus. Surgical failures may be explained by the widespread connectivity of the precuneus with distant and adjacent structures. Different ictal manifestations of precuneal epilepsy in this series provide a clinical correlate to the described functional subdivisions of the precuneus.
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Affiliation(s)
- Adil Harroud
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Québec, Canada
| | - Olivier Boucher
- Departement of Psychology, Université de Montréal, Montreal, Canada
| | - Thi Phuoc Yen Tran
- Department of Internal Medicine, Hue University of Medicine and Pharmacy, Hue, Vietnam
| | - Louis Harris
- Division of Neurology, CHUM Notre-Dame, Université de Montréal, Montreal, Canada
| | - Jeffery Hall
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Québec, Canada
| | - François Dubeau
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Québec, Canada
| | - Ismail Mohamed
- Division of Pediatric Neurology, UAB School of Medicine, AL, United States
| | - Alain Bouthillier
- Division of Neurosurgery, CHUM Notre-Dame, Université de Montréal, Montreal, Canada
| | - Dang Khoa Nguyen
- Division of Neurology, CHUM Notre-Dame, Université de Montréal, Montreal, Canada.
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Abstract
Background: An aura is usually considered to be the initial clinical sign of a seizure. The types of abnormal neuron activities (i.e., localized and generalized firing) play an important role in the diagnosis of epilepsy. The goal of this study was to investigate the types of auras and its correlation with the localization and treatment of epilepsy. Methods: The 426 epileptic patients with auras from a single center were reviewed with reference to International League Against Epilepsy (ILAE, 1981) classification; the clinical manifestations and incidence of auras were analyzed in this retrospective study, as well as the results of electroencephalogram (EEG), brain magnetic resonance imaging (MRI) and the treatment methods. Results: Among the 426 epileptic patients, six different types of auras were defined, including autonomic auras, sensory auras, mental and affective auras, aura as vertigo, cognitive auras, and unspeakable feelings. Duration of auras ranged from 2 s to 7 min; the median duration of auras was 64.2 s. Abnormal EEG was observed in 297 (69.72%) patients. Moreover, abnormal brain MRI was observed in 125 (29.34%) patients. Nineteen (4.46%) epilepsy patients with auras underwent both surgeries and antiepileptic drugs (AEDs) while others were treated only with AEDs. Conclusions: This study suggested that auras played an important role in the diagnosis, classification, and localization of epilepsy. Epileptic aura could help differentiate partial seizure from generalized seizure.
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Affiliation(s)
- Yang Liu
- Department of Neurology, Peking University First Hospital, Beijing 100034, China, India
| | - Xiao-Ming Guo
- Department of Neurology, Peking University First Hospital, Beijing 100034, China, India
| | - Xun Wu
- Department of Neurology, Peking University First Hospital, Beijing 100034, China, India
| | - Ping Li
- Department of Neurology, University at Buffalo, Buffalo, New York 14203, USA
| | - Wei-Wei Wang
- Department of Neurology, Peking University First Hospital, Beijing 100034, China, India
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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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Fauser S, Essang C, Altenmüller DM, Staack A, Steinhoff BJ, Strobl K, Bast T, Schubert-Bast S, Doostkam S, Zentner J, Schulze-Bonhage A. Is there evidence for clinical differences related to the new classification of temporal lobe cortical dysplasia? Epilepsia 2013; 54:909-17. [PMID: 23551067 DOI: 10.1111/epi.12147] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE The new International League Against Epilepsy (ILAE) classification for focal cortical dysplasia (FCD) differentiates between patients with isolated FCD (type 1) and FCD with an associated hippocampal sclerosis (HS) (type 3a). In contrast to the former FCD classification by Palmini, which considered only histologic features, the novel ILAE classification also relies on magnetic resonance imaging (MRI) findings and presumed pathogenesis. We investigated in a cohort of 100 patients with exclusively temporal FCD if the new subdivision of FCD is reflected in clinical characteristics. METHODS Thirty-one patients with FCD type 1 and 50 patients with FCD type 3a in the temporal lobe were included. In all patients MRI and histology of the FCD were available. Both patient groups were compared to 19 patients with temporal FCD type 2 with clearly different histologic appearance. KEY FINDINGS Patients with FCD type 1 and type 3a presented with similar clinical features in many respects. In univariate analyses, no statistically significant differences were found as to age at epilepsy onset (p = 0.07) and epilepsy surgery (p = 0.14), a normal appearing neocortical temporal lobe (p = 0.08) or diagnosis of FCD by visual inspection of MRI (p = 0.08), preoperative seizure frequency (p = 0.06), and the predominance of an epigastric aura (p = 0.08). The postoperative outcome was nearly identical 1 year (p = 0.8) and 2 (p = 0.8), 3 (p = 0.8), 5 (p = 0.7), and 8 (p = 1.0) years postoperatively. Only febrile seizures (p = 0.025) and an aura (p = 0.03) were significantly more frequently reported in patients with FCD type 3a. Similar results were obtained from a multivariate logistic regression analysis. Patients with FCD type 2 were more different: Compared to FCD type 3a, age at epilepsy surgery was significantly lower (p = 0.004) and auras (p = 0.005) were significantly less frequently reported. Epigastric auras (p = 0.04) and febrile seizures (p = 0.025) occurred significantly less frequently in patients with FCD type 2 without HS compared to FCD type 3a. The diagnosis of an FCD was significantly more frequently made (p = 0.03) by visual inspection of the MRI compared to FCD type 1. SIGNIFICANCE Clinical features did not allow to clear separation of temporal FCD types 1 and 3a. Statistically significant differences were seen in a history of febrile seizures and the occurrence of auras more common in FCD type 3a. However, FCD type 2 in the same localization but with different histology presented with further differences such as more frequent FCD diagnosis by visual inspection of MRI, earlier operation, and less frequent epigastric auras.
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Affiliation(s)
- Susanne Fauser
- Epilepsy Center, University of Freiburg, Freiburg, Germany.
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