Highlights ► Transient prosopagnosia from human brain intracerebral stimulation is reported. ► The recognition impairment is specific to faces. ► The area stimulated is functionally defined as the ...right ‘occipital face area’. ► A face-sensitive N170 potential is recorded directly in this area.
Several studies have described cranio–cerebral correlations in accordance with the 10–20 electrode placement system. These studies have made a significant contribution to human brain imaging ...techniques, such as near-infrared spectroscopy and trans-magnetic stimulation. With the recent development of high resolution EEG, an extension of the 10–20 system has been proposed. This new configuration, namely the 10–10 system, allows the placement of a high number (64–256) of EEG electrodes. Here, we describe the cranio–cerebral correlations with the 10–10 system. Thanks to the development of a new EEG-MRI sensor and an automated algorithm which enables the projection of electrode positions onto the cortical surface, we studied the cortical projections in 16 healthy subjects using the Talairach stereotactic system and estimated the variability of cortical projections in a statistical way. We found that the cortical projections of the 10–10 system could be estimated with
a grand standard deviation of 4.6 mm in
x, 7.1 mm in
y and 7.8 mm in
z. We demonstrated that the variability of projections is greatest in the central region and parietal lobe and least in the frontal and temporal lobes. Knowledge of cranio–cerebral correlations with the 10–10 system should enable to increase the precision of surface brain imaging and should help electrophysiological analyses, such as localization of superficial focal cortical generators.
Occipital lobe seizure are underrepresented in epilepsy surgery cases series. This may reflect the fear for post-surgical functional deficits but also the doubt about the ability of ...anatomo-electro-clinical correlations to localize precisely the epileptogenic zone in occipital lobe seizure.
In this expert opinion paper, we review first the general clinical characteristics of occipital lobe seizures, describe the repertoire of visual phenomena and oculo-motor signes in occipital seizures, describe inter-ictal and ictal EEG and finally the possible schemes of epileptogenic zone organization.
Visual and oculo-motor semiology points towards occipital onset seizures but is neither pathognomonic nor constant. Eyes version and unilateral ictal discharge have a strong lateralizing value but inter-ictal spikes as well as eyes version can be falsely lateralizing.
Although visual and oculo-motor phenomena are characteristic of occipital lobe seizures, they may be discrete, overlooked and should therefore be carefully assessed. There are no clear electro-clinical correlations of a sublobar organization of occipital seizures but the clinical pattern of propagation might help to differentiate complex occipito-temporal from occipito-parietal initial epileptogenic network.
Abstract This prospective study investigated and compared psychiatric features of 25 consecutive patients with psychogenic nonepileptic seizures (PNES) on the basis of presence of reported trauma. ...The “trauma” group comprised 19 patients (76%) and the “no-trauma” group comprised 6 patients (34%). We compared history of PNES, psychiatric comorbidity, alexithymia, and symptoms of dissociation. The study clearly characterized two distinct profiles of patients with PNES on the basis of trauma history. Patients with trauma had at least one psychiatric comorbidity or antecedent (vs 0% in the no-trauma group NT, P < 0.001) and a higher median score of dissociation ( P < 0.001). Patients without trauma had more frequent “frustration situations” as a factor triggering PNES and subsequent sick leaves as perpetuating factors ( P = 0.001). Trauma antecedents correlated with a high rate of psychiatric comorbidity and a strong dissociative mechanism. Patients without trauma had no psychiatric comorbidity and a weaker dissociative mechanism.
Surgery is an effective treatment for drug-resistant temporal-lobe epilepsy (TLE), but is still underutilized for older patients because of a perceived higher rate of perioperative complications, ...cognitive decline and worse seizure outcome.
We retrospectively screened all patients operated on in our institution for drug-resistant TLE between 2007 and 2019. Data of patients aged ≥50 years versus <50 years at surgery were compared. The primary endpoint was freedom from disabling seizure (Engel I) at 2 years postoperatively.
In patients aged ≥50 years (n=19), mean age at surgery was 54.9 years and mean disease duration was 36.6 years. At 2 years postoperatively, rates of Engel I seizure outcome were not significantly different between the two groups (73.9% in the <50 years group versus 94.4% in the ≥50 years group). Although surgical complications were significantly (47.4%) in the older patients, neurological deficit was permanent in only 5.3% of cases. At 1 year postoperatively, neuropsychological outcome did not significantly differ between the two groups.
Patients aged ≥50 years had an excellent seizure outcome at 2 years postoperatively. Early postoperative complications were more frequent in patients aged ≥50 years but were mostly transient. Cognitive outcome was similar to that in younger patients. These findings strongly suggest that age ≥50 years should not be an exclusion criterion for resective epilepsy surgery in patients with drug-resistant TLE.
Abstract Objectives Type 1 schizencephaly (SZ) is a cerebral malformation characterised by a cleft lined and surrounded by a polymicrogyric cortex, extending from the pial region to the ...peri-ventricular heterotopia. Our purpose was to combine and compare dipole source imaging technique and Stereo-EEG (SEEG) technique in determining the irritative and epileptogenic zones in a case of type 1 schizencephaly. Methods High-resolution (64-channel) video-EEG with electrical source imaging and SEEG recordings were performed during a pre-surgical evaluation for medically intractable epilepsy. Results Anatomo-electro-clinical correlations based on SEEG and source localisation identified two irritative and epileptogenic zones partially overlapping the polymicrogyric cortex surrounding the SZ: an anterior medio-lateral network primarily involving dysplasic limbic structures and a lateral network involving the anterior and middle part of the cleft and polymicrogyric cortex. The most posterior part (at the temporo-parieto-occipital junction) displayed a normal background activity. Conclusions Both epileptogenic and electrophysiologically normal cortices coexisted within the same widespread malformation: only the anterior part belonged to the anterior medio-lateral epileptogenic network defined by the SEEG. Significance In cases of widespread cortical malformation such as SZ, source localization techniques can help to define the irritative zone and relevant targets for SEEG.
Using results from cortical stimulations, as well as the symptoms of spontaneous epileptic seizures recorded by stereoelectroencephalography we re-studied the phenomenon of the dreamy state, as ...described by Jackson (Jackson JH. Selected writings of John Hughlins Jackson. Vol 1. On epilepsy and epileptiform convulsions. Taylor J, editor. London: Hodder and Stoughton; 1931). A total of 15 sensations of déjà vécu, 35 visual hallucinations consisting of the image of a scene and 5 ‘feelings of strangeness’ occurred. These were recorded during 40 stimulations in 16 subjects, and 15 seizures in 5 subjects. Forty-five per cent of dreamy states were evoked by stimulation of the amygdala, 37.5% by the hippocampus and 17.5% by the para-hippocampal gyrus. During both spontaneous and provoked dreamy state, the electrical discharge was localized within mesial temporal lobe structures, without involvement of the temporal neocortex. Early spread of the discharge to the temporal neocortex appeared to prevent the occurrence of the dreamy state. Semiological analysis showed a clinical continuity between déjà vécu and visual hallucinations, the latter often consisting of a personal memory that was ‘relived’ by the subject; such memories could be recent, distant or from childhood. With one exception, the particular memory evoked differed from one seizure to another, but were always drawn from the same period of the subject's life. Given the role of the amygdala and hippocampus in autobiographic memory, their pathological activation during seizures may trigger memory recall. This study of the dreamy state is in keeping with other evidence demonstrating the constant and central role of the amygdala and hippocampus (right as much as left) in the recall of recent and distant memories. It demonstrates the existence of large neural networks that produce recall of memories via activation of the hippocampus, amygdala and rhinal cortex.
The optimal timing of surgery after preoperative radiotherapy in rectal cancer is unknown. The aim of this trial was to evaluate the role of the interval between preoperative radiotherapy and ...surgery.
Patients with rectal carcinoma accessible to rectal digital examination, staged T2 to T3, NX, M0, were randomized before radiotherapy (39 Gy in 13 fractions) into two groups: in the short interval (SI) group, surgery had to be performed within 2 weeks after completion of radiation therapy, compared with 6 to 8 weeks in the long interval (LI) group. Between 1991 and 1995, 201 patients were enrolled onto the study.
A long interval between preoperative radiotherapy and surgery was associated with a significantly better clinical tumor response (53. 1% in the SI group v 71.7% in the LI group, P =.007) and pathologic downstaging (10.3% in the SI group v 26% in the LI group, P =.005). At a median follow-up of 33 months, there were no differences in morbidity, local relapse, and short-term survival between the two groups. Sphincter-preserving surgery was performed in 76% of cases in the LI group versus 68% in the SI group (P = 0.27).
A long interval between preoperative irradiation and surgery provides increased tumor downstaging with no detrimental effect on toxicity and early clinical results. When sphincter preservation is questionable, a long interval may increase the chance of a successful sphincter-saving surgery.
Fear as the main feature of epileptic seizures Biraben, A; Taussig, D; Thomas, P ...
Journal of neurology, neurosurgery and psychiatry,
02/2001, Letnik:
70, Številka:
2
Journal Article
Recenzirano
Odprti dostop
OBJECTIVES There are circumstances in which partial seizures may be misdiagnosed as acute psychiatric disturbances. In particular, when fear is the prominent feature the patient may be considered for ...years as having panic attacks. Eight patients in whom fear was the main symptom of the seizures are reported on. Patients who had a proved lack of consciousness during the fits and patients in whom fear was just fear of having a seizure were excluded. The ictal involvement of temporal limbic and frontal structures in those patients with fear of particular intensity was studied. METHODS The localisation of the epileptogenic zone was assessed by prolonged interictal EEG recordings as well as ictal video-EEG recording of at least one seizure in every patient; five had ictal SPECT and four had chronic stereotactic implantation of depth electrodes (SEEG). In six patients, a cortical resection was performed with an Engel's class 1 outcome (minimum 28 months follow up, except for two patients). RESULTS Localisations of primary epileptogenic zones were right temporal in three patients, left temporal in three, bitemporal in one, and frontal in one. In all cases, diagnosis of epileptic seizures could be clinically evoked because of the stereotypy of fits and of associated symptoms. The association of a fear sensation, autonomic symptoms, and coordinated behaviour suggests disturbance of a particular system. The SEEG data argue for temporolimbic and prefrontal lobe involvement in the expression of ictal fear. CONCLUSIONS In intense ictal fear, with coordinated behaviour and autonomic features, the discharge may involve or interfere with a physiological complex information processing network. This network involves orbitoprefrontal, anterior cingulate, and temporal limbic cortices.
Spatial localization of scalp EEG electrodes is a major step for dipole source localization and must be accurate, reproducible and practical. Several methods have been proposed in the last 15 years. ...The most widely used method is currently electromagnetic digitization. Nevertheless, this method is difficult to use in a clinical environment and has not been validated with a high number of electrodes. In this paper, we introduce a new automatic method for localizing and labeling EEG sensors using MRI. First, we design a new scalp EEG sensor. Secondly, we validate this new technique on a head phantom and then in a clinical environment with volunteers and patients. For this, we compare the reproducibility, accuracy and performance of our method with electromagnetic digitization. We demonstrate that our method provides better reproducibility with a significant difference (
p
<
0.01). Concerning precision, both methods are equally accurate with no statistical differences. To conclude, our method offers the possibility of using MRI volume for both source localization and spatial localization of EEG sensors. Automation makes this method very reproducible and easy to handle in a routine clinical environment.
PDF
