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Desale P, Dhande R, Parihar P, Nimodia D, Bhangale PN, Shinde D. Navigating Neural Landscapes: A Comprehensive Review of Magnetic Resonance Imaging (MRI) and Magnetic Resonance Spectroscopy (MRS) Applications in Epilepsy. Cureus 2024; 16:e56927. [PMID: 38665706 PMCID: PMC11043648 DOI: 10.7759/cureus.56927] [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: 11/28/2023] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
This review comprehensively explores the evolving role of neuroimaging, specifically magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS), in epilepsy research and clinical practice. Beginning with a concise overview of epilepsy, the discussion emphasizes the crucial importance of neuroimaging in diagnosing and managing this complex neurological disorder. The review delves into the applications of advanced MRI techniques, including high-field MRI, resting-state fMRI, and connectomics, highlighting their impact on refining our understanding of epilepsy's structural and functional dimensions. Additionally, it examines the integration of machine learning in the analysis of intricate neuroimaging data. Moving to the clinical domain, the review outlines the utility of neuroimaging in pre-surgical evaluations and the monitoring of treatment responses and disease progression. Despite significant strides, challenges and limitations are discussed in the routine clinical incorporation of neuroimaging. The review explores promising developments in MRI and MRS technology, potential advancements in imaging biomarkers, and the implications for personalized medicine in epilepsy management. The conclusion underscores the transformative potential of neuroimaging and advocates for continued exploration, collaboration, and technological innovation to propel the field toward a future where tailored, effective interventions improve outcomes for individuals with epilepsy.
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Affiliation(s)
- Prasad Desale
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Rajasbala Dhande
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pratapsingh Parihar
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Devyansh Nimodia
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Paritosh N Bhangale
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Dhanajay Shinde
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Son H, Park KI, Shin DS, Moon J, Lee ST, Jung KH, Jung KY, Chu K, Lee SK. Lesion Detection Through MRI Postprocessing in Pathology-Proven Focal Cortical Dysplasia: Experience at a Single Institution in the Republic of Korea. J Clin Neurol 2023; 19:288-295. [PMID: 37151142 PMCID: PMC10169920 DOI: 10.3988/jcn.2022.0317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/01/2022] [Accepted: 10/07/2022] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND AND PURPOSE Focal cortical dysplasia (FCD) is one of the most common causes of drug-resistant epilepsy, and necessitates a multimodal evaluation to ensure optimal surgical treatment. This study aimed to determine the supportive value of the morphometric analysis program (MAP) in detecting FCD using data from a single institution in Korea. METHODS To develop a standard reference for the MAP, normal-looking MRIs by two scanners that are frequently used in this center were chosen. Patients with drug-resistant epilepsy and FCD after surgery were candidates for the analysis. The three-dimensional T1-weighted MRI scans of the patients were analyzed as test cases using the MAP. RESULTS The MRI scans of 87 patients were included in the analysis. The radiologist detected abnormal findings correlated with FCD (RAD positive [RAD(+)]) in 34 cases (39.1%), while the MAP could detect FCD in 25.3% of cases. A combination of the MAP (MAP[+] cases) with interpretations by the radiologist increased the detection to 42.5% (37 cases). The lesion detection rate was not different according to the type of reference scanners except in one case. MAP(+)/RAD(-) presented in three cases, all of which had FCD type IIa. The detection rate was slightly higher using the same kind of scanner as a reference, but not significantly (35.0% vs. 22.4% p=0.26). CONCLUSIONS The results of postprocessing in the MAP for detecting FCD did not depend on the type of reference scanner, and the MAP was the strongest in detecting FCD IIa. We suggested that the MAP could be widely utilized without developing institutional standards and could become an effective tool for detecting FCD lesions.
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Affiliation(s)
- Hyoshin Son
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung-Il Park
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
- Department of Neurology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Dae-Seop Shin
- Department of Neurology, Soonchunhyang University Hospital, Gumi, Korea
| | - Jangsup Moon
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
- Department of Genomic Medicine, Seoul National University Hospital, Seoul, Korea
| | - Soon-Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - Keun-Hwa Jung
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - Ki-Young Jung
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - Kon Chu
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Kun Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
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3
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Miller KJ, Fine AL. Decision-making in stereotactic epilepsy surgery. Epilepsia 2022; 63:2782-2801. [PMID: 35908245 PMCID: PMC9669234 DOI: 10.1111/epi.17381] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 11/27/2022]
Abstract
Surgery can cure or significantly improve both the frequency and the intensity of seizures in patients with medication-refractory epilepsy. The set of diagnostic and therapeutic interventions involved in the path from initial consultation to definitive surgery is complex and includes a multidisciplinary team of neurologists, neurosurgeons, neuroradiologists, and neuropsychologists, supported by a very large epilepsy-dedicated clinical architecture. In recent years, new practices and technologies have emerged that dramatically expand the scope of interventions performed. Stereoelectroencephalography has become widely adopted for seizure localization; stereotactic laser ablation has enabled more focal, less invasive, and less destructive interventions; and new brain stimulation devices have unlocked treatment of eloquent foci and multifocal onset etiologies. This article articulates and illustrates the full framework for how epilepsy patients are considered for surgical intervention, with particular attention given to stereotactic approaches.
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Affiliation(s)
- Kai J. Miller
- Neurosurgery, Mayo Clinic, 200 First St., Rochester, MN, 55902
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Frazzini V, Cousyn L, Navarro V. Semiology, EEG, and neuroimaging findings in temporal lobe epilepsies. HANDBOOK OF CLINICAL NEUROLOGY 2022; 187:489-518. [PMID: 35964989 DOI: 10.1016/b978-0-12-823493-8.00021-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Temporal lobe epilepsy (TLE) is the most common type of focal epilepsy. First descriptions of TLE date back in time and detailed portraits of epileptic seizures of temporal origin can be found in early medical reports as well as in the works of various artists and dramatists. Depending on the seizure onset zone, several subtypes of TLE have been identified, each one associated with peculiar ictal semiology. TLE can result from multiple etiological causes, ranging from genetic to lesional ones. While the diagnosis of TLE relies on detailed analysis of clinical as well as electroencephalographic (EEG) features, the lesions responsible for seizure generation can be highlighted by multiple brain imaging modalities or, in selected cases, by genetic investigations. TLE is the most common cause of refractory epilepsy and despite the great advances in diagnostic tools, no lesion is found in around one-third of patients. Surgical treatment is a safe and effective option, requiring presurgical investigations to accurately identify the seizure onset zone (SOZ). In selected cases, presurgical investigations need intracerebral investigations (such as stereoelectroencephalography) or dedicated metabolic imaging techniques (interictal PET and ictal SPECT) to correctly identify the brain structures to be removed.
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Affiliation(s)
- Valerio Frazzini
- AP-HP, Department of Neurology and Department of Clinical Neurophysiology, Epilepsy and EEG Unit, Reference Center for Rare Epilepsies, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Université, Paris Brain Institute, Team "Dynamics of Neuronal Networks and Neuronal Excitability", Paris, France
| | - Louis Cousyn
- AP-HP, Department of Neurology and Department of Clinical Neurophysiology, Epilepsy and EEG Unit, Reference Center for Rare Epilepsies, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Université, Paris Brain Institute, Team "Dynamics of Neuronal Networks and Neuronal Excitability", Paris, France
| | - Vincent Navarro
- AP-HP, Department of Neurology and Department of Clinical Neurophysiology, Epilepsy and EEG Unit, Reference Center for Rare Epilepsies, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Université, Paris Brain Institute, Team "Dynamics of Neuronal Networks and Neuronal Excitability", Paris, France.
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5
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Zhang K, Zhang J, Ma Y, Shao X, Hu W, Zhao B. The cultivation of epilepsy neurosurgeons: requirements and challenges. Chin Neurosurg J 2016. [DOI: 10.1186/s41016-016-0037-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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6
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Mouthaan BE, Rados M, Barsi P, Boon P, Carmichael DW, Carrette E, Craiu D, Cross JH, Diehl B, Dimova P, Fabo D, Francione S, Gaskin V, Gil-Nagel A, Grigoreva E, Guekht A, Hirsch E, Hecimovic H, Helmstaedter C, Jung J, Kalviainen R, Kelemen A, Kimiskidis V, Kobulashvili T, Krsek P, Kuchukhidze G, Larsson PG, Leitinger M, Lossius MI, Luzin R, Malmgren K, Mameniskiene R, Marusic P, Metin B, Özkara C, Pecina H, Quesada CM, Rugg-Gunn F, Rydenhag B, Ryvlin P, Scholly J, Seeck M, Staack AM, Steinhoff BJ, Stepanov V, Tarta-Arsene O, Trinka E, Uzan M, Vogt VL, Vos SB, Vulliémoz S, Huiskamp G, Leijten FSS, Van Eijsden P, Braun KPJ. Current use of imaging and electromagnetic source localization procedures in epilepsy surgery centers across Europe. Epilepsia 2016; 57:770-6. [PMID: 27012361 DOI: 10.1111/epi.13347] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE In 2014 the European Union-funded E-PILEPSY project was launched to improve awareness of, and accessibility to, epilepsy surgery across Europe. We aimed to investigate the current use of neuroimaging, electromagnetic source localization, and imaging postprocessing procedures in participating centers. METHODS A survey on the clinical use of imaging, electromagnetic source localization, and postprocessing methods in epilepsy surgery candidates was distributed among the 25 centers of the consortium. A descriptive analysis was performed, and results were compared to existing guidelines and recommendations. RESULTS Response rate was 96%. Standard epilepsy magnetic resonance imaging (MRI) protocols are acquired at 3 Tesla by 15 centers and at 1.5 Tesla by 9 centers. Three centers perform 3T MRI only if indicated. Twenty-six different MRI sequences were reported. Six centers follow all guideline-recommended MRI sequences with the proposed slice orientation and slice thickness or voxel size. Additional sequences are used by 22 centers. MRI postprocessing methods are used in 16 centers. Interictal positron emission tomography (PET) is available in 22 centers; all using 18F-fluorodeoxyglucose (FDG). Seventeen centers perform PET postprocessing. Single-photon emission computed tomography (SPECT) is used by 19 centers, of which 15 perform postprocessing. Four centers perform neither PET nor SPECT in children. Seven centers apply magnetoencephalography (MEG) source localization, and nine apply electroencephalography (EEG) source localization. Fourteen combinations of inverse methods and volume conduction models are used. SIGNIFICANCE We report a large variation in the presurgical diagnostic workup among epilepsy surgery centers across Europe. This diversity underscores the need for high-quality systematic reviews, evidence-based recommendations, and harmonization of available diagnostic presurgical methods.
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Affiliation(s)
- Brian E Mouthaan
- Department of (Child) Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Matea Rados
- Department of (Child) Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Péter Barsi
- MR Research Center, Semmelweis University, Budapest, Hungary
| | - Paul Boon
- Department of Neurology, Reference Center for Refractory Epilepsy, Ghent University Hospital, Ghent, Belgium
| | - David W Carmichael
- University College London Institute of Child Health, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Evelien Carrette
- Department of Neurology, Reference Center for Refractory Epilepsy, Ghent University Hospital, Ghent, Belgium
| | - Dana Craiu
- Pediatric Neurology Clinic, "Alexandru Obregia" Clinical Psychiatric Hospital, Bucharest, Romania.,Department 6, Pediatric Neurology Clinic, "Carol Davila" University of Medicine, Bucharest, Romania
| | - J Helen Cross
- University College London Institute of Child Health, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Beate Diehl
- National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom.,Department of Clinical and Experimental Epilepsy, University College London, London, United Kingdom
| | - Petia Dimova
- Department of Neurosurgery, Epilepsy Surgery Center, St. Ivan Rilski University Hospital, Sofia, Bulgaria
| | - Daniel Fabo
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Stefano Francione
- Claudio Munari Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Vladislav Gaskin
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department of Moscow, Moscow, Russia.,Department of Neurology and Neurosurgery of Russian National Research Medical University, Moscow, Russia
| | - Antonio Gil-Nagel
- Department of Neuroimaging, Center for Biomedical Technology, Technical University of Madrid, Pozuelo de Alarcón, Spain
| | - Elena Grigoreva
- Scientific Research Institute of Emergency Care named after N.V. Sklifosovsky, Moscow, Russia
| | - Alla Guekht
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department of Moscow, Moscow, Russia.,Department of Neurology and Neurosurgery of Russian National Research Medical University, Moscow, Russia
| | - Edouard Hirsch
- Medical and Surgical Epilepsy Unit, Hautepierre Hospital, University of Strasbourg, Strasbourg, France
| | - Hrvoje Hecimovic
- Department of Neurology, Zagreb Epilepsy Center, University Hospital, Zagreb, Croatia
| | - Christoph Helmstaedter
- Department of Epileptology, University Medical Center, University of Bonn, Bonn, Germany
| | - Julien Jung
- Department of Functional Neurology and Epileptology, Institute of Epilepsies (IDEE), Hospices Civils de Lyon, Lyon, France
| | - Reetta Kalviainen
- Department of Neurology, Kuopio University Hospital, Kuopio, Finland.,School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Anna Kelemen
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Vasilios Kimiskidis
- Laboratory of Clinical Neurophysiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Teia Kobulashvili
- Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, and Center for Cognitive Neuroscience, Salzburg, Austria
| | - Pavel Krsek
- Department of Pediatric Neurology, 2nd Faculty of Medicine, Motol University Hospital, Charles University in Prague, Prague, Czech Republic
| | - Giorgi Kuchukhidze
- Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, and Center for Cognitive Neuroscience, Salzburg, Austria.,Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Pål G Larsson
- Department of Neurosurgery, Clinic of Surgery and Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Markus Leitinger
- Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, and Center for Cognitive Neuroscience, Salzburg, Austria
| | - Morten I Lossius
- Department of Complex Epilepsy, National Center for Epilepsy (SSE), Oslo, Norway
| | - Roman Luzin
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department of Moscow, Moscow, Russia.,Department of Neurology and Neurosurgery of Russian National Research Medical University, Moscow, Russia
| | - Kristina Malmgren
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Ruta Mameniskiene
- Clinic of Neurology and Neurosurgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Center of Neurology, Vilnius University Hospital Santariškių Klinikos, Vilnius, Lithuania
| | - Petr Marusic
- Department of Neurology, 2nd Faculty of Medicine, Motol University Hospital, Charles University in Prague, Prague, Czech Republic
| | - Baris Metin
- Department of Psychology, Uskudar University, Uskudar, Istanbul, Turkey
| | - Cigdem Özkara
- Division of Clinical Electro-Neurophysiology, Department of Neurology, Cerrahpaa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Hrvoje Pecina
- Department of Neurology, Zagreb Epilepsy Center, University Hospital, Zagreb, Croatia
| | - Carlos M Quesada
- Department of Epileptology, University Medical Center, University of Bonn, Bonn, Germany
| | - Fergus Rugg-Gunn
- National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom.,Department of Clinical and Experimental Epilepsy, University College London, London, United Kingdom
| | - Bertil Rydenhag
- Clinic of Neurology and Neurosurgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Center of Neurology, Vilnius University Hospital Santariškių Klinikos, Vilnius, Lithuania
| | - Philippe Ryvlin
- Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Julia Scholly
- Medical and Surgical Epilepsy Unit, Hautepierre Hospital, University of Strasbourg, Strasbourg, France
| | - Margitta Seeck
- EEG and Epilepsy Unit, Department of Clinical Neurosciences, University Hospital of Geneva, Geneva, Switzerland
| | | | | | - Valentin Stepanov
- Scientific Research Institute of Emergency Care named after N.V. Sklifosovsky, Moscow, Russia
| | - Oana Tarta-Arsene
- Pediatric Neurology Clinic, "Alexandru Obregia" Clinical Psychiatric Hospital, Bucharest, Romania.,Department 6, Pediatric Neurology Clinic, "Carol Davila" University of Medicine, Bucharest, Romania
| | - Eugen Trinka
- Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, and Center for Cognitive Neuroscience, Salzburg, Austria
| | - Mustafa Uzan
- Division of Clinical Electro-Neurophysiology, Department of Neurology, Cerrahpaa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Viola L Vogt
- Department of Epileptology, University Medical Center, University of Bonn, Bonn, Germany
| | - Sjoerd B Vos
- Translational Imaging Group, CMIC, University College London, London, United Kingdom.,MRI Unit, Epilepsy Society, Chalfont St Peter, United Kingdom
| | - Serge Vulliémoz
- EEG and Epilepsy Unit, Department of Clinical Neurosciences, University Hospital of Geneva, Geneva, Switzerland
| | - Geertjan Huiskamp
- Department of (Child) Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frans S S Leijten
- Department of (Child) Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pieter Van Eijsden
- Department of (Child) Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kees P J Braun
- Department of (Child) Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
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van Mierlo P, Papadopoulou M, Carrette E, Boon P, Vandenberghe S, Vonck K, Marinazzo D. Functional brain connectivity from EEG in epilepsy: seizure prediction and epileptogenic focus localization. Prog Neurobiol 2014; 121:19-35. [PMID: 25014528 DOI: 10.1016/j.pneurobio.2014.06.004] [Citation(s) in RCA: 143] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 06/21/2014] [Accepted: 06/29/2014] [Indexed: 11/26/2022]
Abstract
Today, neuroimaging techniques are frequently used to investigate the integration of functionally specialized brain regions in a network. Functional connectivity, which quantifies the statistical dependencies among the dynamics of simultaneously recorded signals, allows to infer the dynamical interactions of segregated brain regions. In this review we discuss how the functional connectivity patterns obtained from intracranial and scalp electroencephalographic (EEG) recordings reveal information about the dynamics of the epileptic brain and can be used to predict upcoming seizures and to localize the seizure onset zone. The added value of extracting information that is not visibly identifiable in the EEG data using functional connectivity analysis is stressed. Despite the fact that many studies have showed promising results, we must conclude that functional connectivity analysis has not made its way into clinical practice yet.
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Affiliation(s)
- Pieter van Mierlo
- Medical Imaging and Signal Processing Group, Department of Electronics and Information Systems, Ghent University - iMinds Medical IT Department, Ghent, Belgium.
| | - Margarita Papadopoulou
- Department of Data Analysis, Faculty of Psychology and Pedagogical Sciences, Ghent University, Ghent, Belgium
| | - Evelien Carrette
- Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology, Ghent University, Ghent, Belgium
| | - Paul Boon
- Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology, Ghent University, Ghent, Belgium
| | - Stefaan Vandenberghe
- Medical Imaging and Signal Processing Group, Department of Electronics and Information Systems, Ghent University - iMinds Medical IT Department, Ghent, Belgium
| | - Kristl Vonck
- Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology, Ghent University, Ghent, Belgium
| | - Daniele Marinazzo
- Department of Data Analysis, Faculty of Psychology and Pedagogical Sciences, Ghent University, Ghent, Belgium
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Balik V, Trojanec R, Holzerova M, Tuckova L, Sulla I, Megova M, Vaverka M, Hrabalek L, Ehrmann J. An adult multifocal medulloblastoma with diffuse acute postoperative cerebellar swelling: immunohistochemical and molecular genetics analysis. Neurosurg Rev 2014; 38:1-10; discussion 10. [PMID: 24913771 DOI: 10.1007/s10143-014-0556-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 03/25/2014] [Accepted: 04/13/2014] [Indexed: 11/30/2022]
Abstract
Medulloblastoma (MB), the most common malignant tumor typically affecting children, occurs only exceptionally in adults. Multifocal presentation of this malignancy in adulthood is even much rarer—only four cases with favorable postoperative course have been reported, so far. The study illustrates a very rare rapid postoperative clinical deterioration due to diffuse cerebellar swelling (DCS) in an adult multifocal MB (MMB). To the best of their knowledge, authors for the first time performed genetic analysis of MMB and demonstrated expression patterns of selected markers that put the patient within the sonic hedgehog (SHH) molecular subgroup and at least partially explain her unsatisfactory clinical course. Herein, authors summarized the relevant literature concerning this issue with the aim to determine features that would facilitate diagnosis and therapy of such a scarce clinical entity.
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Affiliation(s)
- Vladimir Balik
- Department of Neurosurgery, University Hospital Olomouc and Faculty of Medicine and Dentistry, University Hospital Olomouc and Palacky University, Olomouc, Czech Republic,
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10
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Comparison of MRI features and surgical outcome among the subtypes of focal cortical dysplasia. Seizure 2012; 21:789-94. [DOI: 10.1016/j.seizure.2012.09.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 09/07/2012] [Accepted: 09/13/2012] [Indexed: 11/21/2022] Open
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Extrahippocampal desynchronization in nonlesional temporal lobe epilepsy. EPILEPSY RESEARCH AND TREATMENT 2012; 2012:823683. [PMID: 22957245 PMCID: PMC3420646 DOI: 10.1155/2012/823683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 09/14/2011] [Accepted: 09/25/2011] [Indexed: 11/17/2022]
Abstract
Although temporal lobe epilepsy (TLE) is traditionally associated with both hypersynchronous activity in the form of interictal epileptic discharges and hippocampal sclerosis, recent findings suggest that desynchronization also plays a central role in the dynamics of this pathology. The objective of this work is to show the imbalance existing between mesial activities in patients suffering from mesial TLE, with normal mesial structures. Foramen ovale recordings from six patients with mesial TLE and one with lateral TLE were analyzed through a cluster analysis and synchronization matrices. None of the patients present findings in the MRI presurgical evaluation. Numerical analysis was carried out in three different situations: awake and sleep interictal and also during the preictal stage. High levels of desynchronization ipsilateral to the epileptic side were present in mesial TLE patients. Low levels of desynchronization were present in the lateral TLE patient during the interictal stage and almost zero in the preictal stage. Implications of these findings in relation with seizure spreading are discussed.
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Auvin S, Bellavoine V, Merdariu D, Delanoë C, Elmaleh-Bergés M, Gressens P, Boespflug-Tanguy O. Hemiconvulsion-hemiplegia-epilepsy syndrome: current understandings. Eur J Paediatr Neurol 2012; 16:413-21. [PMID: 22341151 DOI: 10.1016/j.ejpn.2012.01.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 01/03/2012] [Accepted: 01/07/2012] [Indexed: 11/30/2022]
Abstract
Hemiconvulsion-Hemiplegia (HH) syndrome is an uncommon consequence of prolonged focal febrile convulsive seizures in infancy and early childhood. It is characterized by the occurrence of prolonged clonic seizures with unilateral predominance occurring in a child and followed by the development of hemiplegia. Neuroradiological studies showed unilateral edematous swelling of the epileptic hemisphere at the time of initial status epilepticus (SE). This acute phase is followed by characteristic cerebral hemiatrophy with subsequent appearance of epilepsy, so called Hemiconvulsion-Hemiplegia-Epilepsy (HHE) syndrome. The etiologies and the underlying mechanisms remain to be understood. Using a review of the literature, we summarized the data of the last 20 years. It appears that idiopathic HH/HHE syndrome is the most common reported form. The basic science data suggest that immature brain is relatively resistant to SE-induced cell injury. Several factors might contribute to the pathogenesis of HH/HHE syndrome: 1. prolonged febrile seizure in which inflammation may worsen the level of cell injury; 2. inflammation and prolonged ictal activity that act on blood-brain-barrier permeability; 3. predisposing factors facilitating prolonged seizure such as genetic factors or focal epileptogenic lesion. However, these factors cannot explain the elective involvement of an entire hemisphere. We draw new hypothesis that may explain the involvement of one hemisphere such as maturation of brain structure such as corpus callosum or genetic factors (CACNA1A gene) that are specifically discussed. An early diagnosis and a better understanding of the underlying mechanisms of HHE are needed to improve the outcome of this condition.
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Yasuda CL, Cendes F. Neuroimaging for the prediction of response to medical and surgical treatment in epilepsy. ACTA ACUST UNITED AC 2012; 6:295-308. [PMID: 23480740 DOI: 10.1517/17530059.2012.683408] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Approximately 30% of patients with epilepsy do not respond to adequate medication and are candidates for surgical treatment. Outcome predictors can improve the selection of more suitable treatment options for each patient. Therefore, the authors aimed to review the role of neuroimaging studies in predicting outcomes for both clinical and surgical treatment of epilepsy. AREAS COVERED This review analyzes studies that investigated different neuroimaging techniques as predictors of clinical and surgical treatment outcome in epilepsy. Studies involving both structural (i.e., T1-weighted images and diffusion tensor images) and functional MRI (fMRI) were identified, as well as other modalities such as spectroscopy, PET, SPECT and MEG. The authors also evaluated the importance of fMRI in predicting memory outcome after surgical resections in temporal lobe epilepsy. EXPERT OPINION The identification of reliable biomarkers to predict response to medical and surgical treatments are much needed in order to provide more adequate patient counseling about prognosis and treatment options individually. Different neuroimaging techniques may provide combined measurements that potentially may become these biomarkers in the near future.
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Affiliation(s)
- Clarissa Lin Yasuda
- University of Campinas/UNICAMP, Department of Neurology, Neuroimaging Laboratory , Cidade Universitária Zeferino Vaz, Rua Tessália Vieira de Camargo, 126. Cx postal 6111, Campinas, SP. CEP 13083-970 , Brazil
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Pail M, Mareček R, Hermanová M, Slaná B, Tyrlíková I, Kuba R, Brázdil M. The role of voxel-based morphometry in the detection of cortical dysplasia within the temporal pole in patients with intractable mesial temporal lobe epilepsy. Epilepsia 2012; 53:1004-12. [DOI: 10.1111/j.1528-1167.2012.03456.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Kim DW, Lee SK, Chung CK, Koh YC, Choe G, Lim SD. Clinical features and pathological characteristics of amygdala enlargement in mesial temporal lobe epilepsy. J Clin Neurosci 2012; 19:509-12. [PMID: 22321366 DOI: 10.1016/j.jocn.2011.05.042] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 05/30/2011] [Accepted: 05/30/2011] [Indexed: 11/30/2022]
Abstract
Although the hippocampus is considered an important site of seizures in mesial temporal lobe epilepsy (mTLE), the amygdala may also have a significant role. Amygdala enlargement is occasionally found in patients with mTLE, and volumetric detection of amygdala enlargement has been documented in "image-negative" patients with TLE. However, only limited data have been reported on the clinical features, surgical outcomes, and pathological characteristics in patients with mTLE with amygdala enlargement. We recruited 12 patients who had undergone surgical treatment for refractory epilepsy with radiological evidence of amygdala enlargement, and 11 became seizure free. All patients showed homogenously increased amygdala volumes on MRI without enhancement and underwent surgical treatment for mTLE. Pathology results revealed that eight patients had focal cortical dysplasia (FCD), two had ganglioglioma, one had oligodendroglioma, and one had astrocytoma. The clinical features and MRI findings were largely indistinguishable between the patients with brain tumors and those with FCD, but the patients with brain tumors tended to be younger at the time of seizure onset. Our study shows that surgical treatment of epilepsy in patients with amygdala enlargement usually has a favorable outcome. FCD was the most frequent pathological diagnosis in these patients. However, a brain tumor should be considered in the differential diagnosis, especially in young patients, because it is often difficult to differentiate FCD from a brain tumor on radiological features.
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Affiliation(s)
- Dong Wook Kim
- Department of Neurology, Konkuk University Medical Center, Konkuk University College of Medicine, Seoul, Republic of Korea
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Mühlebner A, Coras R, Kobow K, Feucht M, Czech T, Stefan H, Weigel D, Buchfelder M, Holthausen H, Pieper T, Kudernatsch M, Blümcke I. Neuropathologic measurements in focal cortical dysplasias: validation of the ILAE 2011 classification system and diagnostic implications for MRI. Acta Neuropathol 2012; 123:259-72. [PMID: 22120580 DOI: 10.1007/s00401-011-0920-1] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Revised: 10/19/2011] [Accepted: 10/26/2011] [Indexed: 01/05/2023]
Abstract
Focal cortical dysplasias (FCD) which represent a composite group of cortical malformations are increasingly recognized as morphological substrate for severe therapy-refractory epilepsy in children and young adults. However, presurgical evaluation remains challenging as not all FCD variants can be reliably detected by high-resolution magnetic resonance imaging (MRI). Here, we studied a cohort of 52 epilepsy patients with neuropathological evidence for FCD using the 2011 classification of the International League against Epilepsy (ILAE) and systematically analysed those histopathologic features applicable also for MRI diagnostics. Histopathologic parameters included quantitative measurements of cellular profiles, cortical thickness, heterotopic neurons in white matter, and myelination that were compared between FCD subtypes and age-/localization-matched controls (n = 36) using multivariate analysis. Dysmorphic neurons in both FCD Type II variants showed significantly increased diameter of their cell bodies and nuclei. Cortical thickness was also increased with a distinct loss of myelin content specifying FCD Type IIb from IIa. The data further suggested that myelination deficits in FCD Type IIb result from compromised oligodendroglial lineage differentiation and we concluded that the "transmantle sign" is a unique finding in FCD Type IIb. In contrast, FCD Type Ia was characterized by a smaller cortical ribbon and higher neuronal densities, but these parameters failed to reach statistical significance (considering age- and location-dependent variability in controls). All FCD variants showed abnormal grey-white matter boundaries with increased numbers of heterotopic neurons. Similar results were obtained also at deep white matter location. Thus, many FCD variants may indeed escape visual MRI inspection, but suspicious areas with increased or decreased cortical thickness as well as grey-white matter blurring may be uncovered using post-processing protocols of neuroimaging data. The systematic analysis of well-specified histopathological features could be helpful to improve sensitivity and specificity in MRI detection during pre-surgical work-up of patients with drug-resistant focal epilepsies.
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Lee JY, Joo EY, Park HS, Song P, Young Byun S, Seo DW, Hong SB. Repeated ictal SPECT in partial epilepsy patients: SISCOM analysis. Epilepsia 2011; 52:2249-56. [DOI: 10.1111/j.1528-1167.2011.03257.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Schwartz TH, Hong SB, Bagshaw AP, Chauvel P, Bénar CG. Preictal changes in cerebral haemodynamics: review of findings and insights from intracerebral EEG. Epilepsy Res 2011; 97:252-66. [PMID: 21855297 DOI: 10.1016/j.eplepsyres.2011.07.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 06/29/2011] [Accepted: 07/27/2011] [Indexed: 12/29/2022]
Abstract
The possibility of recording changes in brain signals occurring before epileptic seizures is of considerable interest, both as markers for seizure anticipation and as a window into the mechanisms of seizure generation. Several studies have reported preictal changes on electrophysiological traces. More recently, observations have been made of changes occurring on haemodynamic signals before interictal events or before seizures, often without concurrent changes observed on electrophysiology. We present here a critical review of these findings, in optical imaging, SPECT and fMRI, followed by a discussion based on data from intracerebral EEG.
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Affiliation(s)
- Theodore H Schwartz
- Department of Neurosurgery, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, USA
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Jung DE, Lee JS. Multimodal neuroimaging in presurgical evaluation of childhood epilepsy. KOREAN JOURNAL OF PEDIATRICS 2010; 53:779-85. [PMID: 21189974 PMCID: PMC3004492 DOI: 10.3345/kjp.2010.53.8.779] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2010] [Revised: 07/12/2010] [Accepted: 07/15/2010] [Indexed: 11/27/2022]
Abstract
In pre-surgical evaluation of pediatric epilepsy, the combined use of multiple imaging modalities for precise localization of the epileptogenic focus is a worthwhile endeavor. Advanced neuroimaging by high field Magnetic resonance imaging (MRI), diffusion tensor images, and MR spectroscopy have the potential to identify subtle lesions. 18F-FDG positron emission tomography and single photon emission tomography provide visualization of metabolic alterations of the brain in the ictal and interictal states. These techniques may have localizing value for patients which exhibit normal MRI scans. Functional MRI is helpful for non-invasively identifying areas of eloquent cortex. These advances are improving our ability to noninvasively detect epileptogenic foci which have gone undetected in the past and whose accurate localization is crucial for a favorable outcome following surgical resection.
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Affiliation(s)
- Da Eun Jung
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
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Cho JW, Hong SB, Lee JH, Kang JW, Lee MJ, Lee JY, Park HS, Suh M, Joo EY, Seo DW. Contralateral hyperperfusion and ipsilateral hypoperfusion by ictal SPECT in patients with mesial temporal lobe epilepsy. Epilepsy Res 2010; 88:247-54. [DOI: 10.1016/j.eplepsyres.2009.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2009] [Revised: 11/30/2009] [Accepted: 12/10/2009] [Indexed: 11/16/2022]
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Joo EY, Tae WS, Kim ST, Hong SB. Gray matter concentration abnormality in brains of narcolepsy patients. Korean J Radiol 2010; 10:552-8. [PMID: 19885310 PMCID: PMC2770823 DOI: 10.3348/kjr.2009.10.6.552] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Accepted: 06/08/2009] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate gray matter concentration changes in the brains of narcoleptic patients. MATERIALS AND METHODS Twenty-nine narcoleptic patient with cataplexy and 29 age and sex-matched normal subjects (mean age, 31 years old) underwent volumetric MRIs. The MRIs were spatially normalized to a standard T1 template and subdivided into gray matter, white matter, and cerebrospinal fluid (CSF). These segmented images were then smoothed using a 12-mm full width at half maximum (FWHM) isotropic Gaussian kernel. An optimized voxel-based morphometry protocol was used to analyze brain tissue concentrations using SPM2 (statistical parametric mapping). A one-way analysis of variance was applied to the concentration analysis of gray matter images. RESULTS Narcoleptics with cataplexy showed reduced gray matter concentration in bilateral thalami, left gyrus rectus, bilateral frontopolar gyri, bilateral short insular gyri, bilateral superior frontal gyri, and right superior temporal and left inferior temporal gyri compared to normal subjects (uncorrected p < 0.001). Furthermore, small volume correction revealed gray matter concentration reduction in bilateral nuclei accumbens, hypothalami, and thalami (false discovery rate corrected p < 0.05). CONCLUSION Gray matter concentration reductions were observed in brain regions related to excessive daytime sleepiness, cognition, attention, and memory in narcoleptics with cataplexy.
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Affiliation(s)
- Eun Yeon Joo
- Department of Neurology, Sleep Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
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Tae WS, Joo EY, Kim ST, Hong SB. Gray, white matter concentration changes and their correlation with heterotopic neurons in temporal lobe epilepsy. Korean J Radiol 2009; 11:25-36. [PMID: 20046492 PMCID: PMC2799647 DOI: 10.3348/kjr.2010.11.1.25] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Accepted: 08/27/2009] [Indexed: 11/15/2022] Open
Abstract
Objective To identify changes in gray and white matter concentrations (GMC, WMC), and their relation to heterotopic neuron numbers in mesial temporal lobe epilepsy (mTLE). Materials and Methods The gray matter or white matter concentrations of 16 left and 15 right mTLE patients who achieved an excellent surgical outcome were compared with those of 24 healthy volunteers for the left group and with 23 healthy volunteers for the right group, by optimized voxel-based morphometry using unmodulated and modulated images. A histologic count of heterotopic neurons was obtained in the white matter of the anterior temporal lobe originating from the patients' surgical specimens. In addition, the number of heterotopic neurons were tested to determine if there was a correlation with the GMC or WMC. Results The GMCs of the left and right mTLE groups were reduced in the ipsilateral hippocampi, bilateral thalami, precentral gyri, and in the cerebellum. The WMCs were reduced in the ipsilateral white matter of the anterior temporal lobe, bilateral parahippocampal gyri, and internal capsules, but increased in the pons and bilateral precentral gyri. The heterotopic neuron counts in the left mTLE group showed a positive correlation (r = 0.819, p < 0.0001) with GMCs and a negative correlation (r = -0.839, p < 0.0001) with WMCs in the white matter of the anterior temporal lobe. Conclusion The present study shows the abnormalities of the cortico-thalamo-hippocampal network including a gray matter volume reduction in the anterior frontal lobes and an abnormality of brain tissue concentration in the pontine area. Furthermore, heterotopic neuron numbers were significantly correlated with GMC or WMC in the left white matter of anterior temporal lobe.
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Affiliation(s)
- Woo Suk Tae
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
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Ye BS, Cho YJ, Jang SH, Lee BI, Heo K, Jung HH, Chang JW, Kim SH. Neurocutaneous melanosis presenting as chronic partial epilepsy. J Clin Neurol 2008; 4:134-7. [PMID: 19513317 PMCID: PMC2686876 DOI: 10.3988/jcn.2008.4.3.134] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2008] [Revised: 06/13/2008] [Accepted: 06/23/2008] [Indexed: 11/18/2022] Open
Abstract
Background Neurocutaneous melanosis (NCM) is a rare neurocutaneous syndrome characterized by the presence of multiple congenital melanocytic nevi (CMN) and the proliferation of melanocytes in the central nervous system, usually involving the leptomeninges. Chronic partial epilepsy as a sole manifestation is rare in NCM. Case Report A 32-year-old man suffering from chronic partial epilepsy presented with multiple CMN on his trunk and scalp. Brain MRI demonstrated a focal lesion in the right amygdala that was consistent with interictal epileptiform discharges in the right temporal region on electroencephalography (EEG). An anterior temporal lobectomy was performed, and the pathology investigation revealed numerous melanophages in the amygdala. The patient was seizure-free after surgery. Conclusions We report a patient with NCM presenting as chronic partial epilepsy who was successfully treated by anterior temporal lobectomy.
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Affiliation(s)
- Byoung Seok Ye
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
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