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Al-Mufargi Y, Alabri H, Gujjar A. Peri-ictal Water Drinking in an Omani Patient with Bilateral Mesial Temporal Sclerosis. Sultan Qaboos Univ Med J 2024; 24:279-282. [PMID: 38828239 PMCID: PMC11139365 DOI: 10.18295/squmj.5.2023.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/10/2023] [Accepted: 05/09/2023] [Indexed: 06/05/2024] Open
Abstract
Peri-ictal water drinking (PIWD) is a rare vegetative manifestation of temporal lobe epilepsy without a definite lateralisation value. We report a case of PIWD in a 22-year-old Omani male patient with post-concussion syndrome and epilepsy presented to a tertiary care hospital in Muscat, Oman, in 2021 for evaluation of paroxysmal events. His behaviour of PIWD was misinterpreted by his family until characterised in the epilepsy-monitoring unit as a manifestation of epilepsy that was treated medically. To the best of the authors' knowledge, this is the second reported case in the region.
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Affiliation(s)
- Younis Al-Mufargi
- Department of Human Clinical Anatomy, Sultan Qaboos University, Muscat, Oman
| | - Haifa Alabri
- Department of Medicine, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
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2
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Assessing epilepsy-related autonomic manifestations: Beyond cardiac and respiratory investigations. Neurophysiol Clin 2023; 53:102850. [PMID: 36913775 DOI: 10.1016/j.neucli.2023.102850] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/15/2023] [Accepted: 02/19/2023] [Indexed: 03/13/2023] Open
Abstract
The Autonomic Nervous System (ANS) regulates many critical physiological functions. Its control relies on cortical input, especially limbic areas, which are often involved in epilepsy. Peri-ictal autonomic dysfunction is now well documented, but inter-ictal dysregulation is less studied. In this review, we discuss the available data on epilepsy-related autonomic dysfunction and the objective tests available. Epilepsy is associated with sympathetic-parasympathetic imbalance and a shift towards sympathetic dominance. Objective tests report alterations in heart rate, baroreflex function, cerebral autoregulation, sweat glands activity, thermoregulation, gastrointestinal and urinary function. However, some tests have found contradictory results and many tests suffer from a lack of sensitivity and reproducibility. Further study on interictal ANS function is required to further understand autonomic dysregulation and the potential association with clinically-relevant complications, including risk of Sudden Unexpected Death In Epilepsy (SUDEP).
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Tanno Y, Matsudaira T, Usui N, Ogawa H, Tokumoto K, Kawaguchi N, Kondo A, Nishida T, Takahashi Y. Periictal water drinking revisited: Occurrence and lateralizing value in surgically confirmed patients with focal epilepsy. Epilepsia Open 2023; 8:173-182. [PMID: 36648337 PMCID: PMC9977749 DOI: 10.1002/epi4.12690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Periictal water drinking (PIWD), which is a rare seizure-related autonomic behavior, has been reported in temporal lobe epilepsy (TLE) but only rarely in extra-TLE. Additionally, the lateralizing value of PIWD is controversial. We aimed to clarify the occurrence and lateralizing value of PIWD in patients with focal epilepsy. METHODS This retrospective study included 240 focal epilepsy patients aged >10 years with a favorable postoperative seizure outcome (Engel class I). PIWD was defined as water drinking behavior during a seizure or within 2 min in the postictal phase. The occurrence of PIWD documented on video-electroencephalogram monitoring was assessed. The lateralizing value of PIWD was analyzed among patients whose language dominant hemisphere was identified. RESULTS Twenty-three (9.5%) patients exhibited PIWD. PIWD occurred more frequently in frontal lobe epilepsy (FLE; eight of 41 patients, 19.5%) than in TLE (15 of 188 patients, 8%). The occurrence of PIWD was significantly different between FLE and extra-FLE (P = 0.035), with a low positive predictive value (34.8%). In FLE with PIWD, all but one patient underwent resective surgery involving the medial frontal lobe. In 194 patients whose language dominant hemisphere was determined, the lateralizing value of PIWD in FLE and TLE showed no statistical significance (P = 0.69 and P = 0.27, respectively). SIGNIFICANCE Periictal water drinking occurred more often in FLE than TLE. Thus, PIWD might not be a specific periictal symptom in TLE. There was no evidence for the lateralizing value of PIWD in FLE and TLE. These findings can provide useful clinical clues for preoperative evaluations to estimate the epileptogenic zone based on seizure semiology and allow for a better understanding of pathophysiological insights into PIWD.
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Affiliation(s)
- Yuhei Tanno
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
| | - Takashi Matsudaira
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
| | - Naotaka Usui
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
| | - Hiroshi Ogawa
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
| | - Kentaro Tokumoto
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
| | - Norihiko Kawaguchi
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
| | - Akihiko Kondo
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
| | - Takuji Nishida
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
| | - Yukitoshi Takahashi
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
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Al-Beltagi M, Saeed NK. Epilepsy and the gut: Perpetrator or victim? World J Gastrointest Pathophysiol 2022; 13:143-156. [PMID: 36187601 PMCID: PMC9516455 DOI: 10.4291/wjgp.v13.i5.143] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/08/2022] [Accepted: 08/25/2022] [Indexed: 02/07/2023] Open
Abstract
The brain and the gut are linked together with a complex, bi-path link known as the gut-brain axis through the central and enteric nervous systems. So, the brain directly affects and controls the gut through various neurocrine and endocrine processes, and the gut impacts the brain via different mechanisms. Epilepsy is a central nervous system (CNS) disorder with abnormal brain activity, causing repeated seizures due to a transient excessive or synchronous alteration in the brain’s electrical activity. Due to the strong relationship between the enteric and the CNS, gastrointestinal dysfunction may increase the risk of epilepsy. Meanwhile, about 2.5% of patients with epilepsy were misdiagnosed as having gastrointestinal disorders, especially in children below the age of one year. Gut dysbiosis also has a significant role in epileptogenesis. Epilepsy, in turn, affects the gastrointestinal tract in different forms, such as abdominal aura, epilepsy with abdominal pain, and the adverse effects of medications on the gut and the gut microbiota. Epilepsy with abdominal pain, a type of temporal lobe epilepsy, is an uncommon cause of abdominal pain. Epilepsy also can present with postictal states with gastrointestinal manifestations such as postictal hypersalivation, hyperphagia, or compulsive water drinking. At the same time, antiseizure medications have many gastrointestinal side effects. On the other hand, some antiseizure medications may improve some gastrointestinal diseases. Many gut manipulations were used successfully to manage epilepsy. Prebiotics, probiotics, synbiotics, postbiotics, a ketogenic diet, fecal microbiota transplantation, and vagus nerve stimulation were used successfully to treat some patients with epilepsy. Other manipulations, such as omental transposition, still need more studies. This narrative review will discuss the different ways the gut and epilepsy affect each other.
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Affiliation(s)
- Mohammed Al-Beltagi
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31527, Algharbia, Egypt
- Department of Pediatrics, University Medical Center, King Abdulla Medica City, Arabian Gulf University, Manama 26671, Bahrain
- Department of Pediatrics, University Medical Center, King Abdulla Medical City, Dr. Sulaiman Al Habib Medical Group, Manama 26671, Bahrain
| | - Nermin Kamal Saeed
- Medical Microbiology Section, Department of Pathology, Salmaniya Medical Complex, Ministry of Health, Kingdom of Bahrain, Manama 26612, Bahrain
- Department of Microbiology, Irish Royal College of Surgeon, Busaiteen 15503, Muharraq, Bahrain
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Scalia B, Caine A, Pittaway R, Cherubini GB. Feline temporal lobe epilepsy: seven cases of hippocampal and piriform lobe necrosis in England and literature review. J Feline Med Surg 2022; 24:596-608. [PMID: 34355984 PMCID: PMC11104249 DOI: 10.1177/1098612x211035049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
CASE SERIES SUMMARY Seven cases of feline hippocampal and piriform lobe necrosis (FHN) are described, with particular emphasis on clinical, radiographic and histopathological correlations. FHN is an uncommon acute epileptic condition resembling human autoimmune limbic encephalitis and temporal lobe epilepsy. Seizures are typically focal and feature uni- or bilateral orofacial or head twitching, hypersalivation, lip smacking, mydriasis, vocalisation and motionless staring, with inter-ictal behavioural changes such as unprovoked aggression and rapid running. Emerging evidence supports an autoimmune aetiology, although disruption of hippocampal architecture secondary to brain neoplasia has also been recognised. Most commonly, however, the underlying cause remains unknown. Diagnosis is achieved clinically and with brain MRI; electroencephalography and voltage-gated potassium channel-complex autoantibodies are currently the subject of research. Affected cats are frequently refractory to conventional antiepileptic treatment. RELEVANCE AND NOVEL INFORMATION Following a review of the literature, including potential complicating factors and comparisons with human medicine, the hippocampus and piriform lobe are proposed as the neuroanatomical localisation for focal seizures with orofacial involvement in cats, regardless of aetiology.
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Affiliation(s)
| | - Abby Caine
- Dick White Referrals, Six Mile Bottom, UK
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Beniczky S, Tatum WO, Blumenfeld H, Stefan H, Mani J, Maillard L, Fahoum F, Vinayan KP, Mayor LC, Vlachou M, Seeck M, Ryvlin P, Kahane P. Seizure semiology: ILAE glossary of terms and their significance. Epileptic Disord 2022; 24:447-495. [PMID: 35770761 DOI: 10.1684/epd.2022.1430] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/19/2022] [Indexed: 11/17/2022]
Abstract
This educational topical review and Task Force report aims to address learning objectives of the International League Against Epilepsy (ILAE) curriculum. We sought to extract detailed features involving semiology from video recordings and interpret semiological signs and symptoms that reflect the likely localization for focal seizures in patients with epilepsy. This glossary was developed by a working group of the ILAE Commission on Diagnostic Methods incorporating the EEG Task Force. This paper identifies commonly used terms to describe seizure semiology, provides definitions, signs and symptoms, and summarizes their clinical value in localizing and lateralizing focal seizures based on consensus in the published literature. Video-EEG examples are included to illustrate important features of semiology in patients with epilepsy.
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Turek G, Skjei K. Seizure semiology, localization, and the 2017 ILAE seizure classification. Epilepsy Behav 2022; 126:108455. [PMID: 34894624 DOI: 10.1016/j.yebeh.2021.108455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/13/2021] [Accepted: 11/16/2021] [Indexed: 11/26/2022]
Abstract
In the study of epilepsy, the term semiology is used to comprise the clinical characteristics of a seizure, both subjective symptoms and objective phenomena. It is produced by activation of the symptomagenic zone, and an accurate and comprehensive understanding of the localizing value of seizure semiology is crucial for presurgical evaluation and planning. Myriad publications in epilepsy journals detail correlations between various semiological features and activation of specific cortical regions. Traditionally these studies involved scalp EEG recorded in epilepsy monitoring units. The increasing use of invasive monitoring, and specifically the use of depth electrodes and stereo-electroencephalography, has advanced our understanding of the characteristics of seizures arising from ictal foci deep to the scalp, including the cingulate, insula and operculum. However, the distinction between seizure onset and symptomogenic zones is not always clear. In 2017 the International League Against Epilepsy (ILAE) published an operational classification of seizure types based heavily on seizure semiology. The current paper provides an updated review of the current body of knowledge relating to seizure semiology, incorporating both scalp EEG studies and more recent stereo-electroencephalography discoveries in the framework of the 2017 ILAE classification.
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Affiliation(s)
- Grant Turek
- Department of Neurology, University of Louisville, 401 E. Chestnut St. Unit 510, Louisville, KY 40202-5710, United States.
| | - Karen Skjei
- Department of Neurology, University of Texas at Austin, Dell Medical School, 1601 Trinity St., Bldg B, Strop Z0700, Austin, TX 78712, United States
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Shaker KK, Al Mahdawi AM, Hamdan FB. Interictal autonomic dysfunction in patients with epilepsy. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00422-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Abstract
Background
Autonomic nervous system (ANS) symptoms are frequently present in people with epilepsy (PwE). They are generally more prominent when they originate from the temporal lobe. We aim to investigate the alterations of autonomic functions during the interictal period in patient with temporal lobe epilepsy (TLE) and idiopathic generalized epilepsy (IGE) using heart-based tests, blood pressure (BP)-based tests and sympathetic skin response (SSR). Forty-eight PwE with disease duration ranging from 2 to 15 years and 51 healthy individuals were studied. Long-term electroencephalography (EEG) monitoring, the heart rate variability (HRV) during normal breathing, deep breathing, Valsalva maneuver and standing, BP responses during standing, to isometric hand grip and to mental arithmetic, and the SSR was recorded for all participants.
Results
31 patients with TLE and 17 with IGE showed lower RR-IV values during deep breathing, Valsalva maneuver and standing, but not during rest, impaired BP responses during standing, isometric hand grip, and mental arithmetic. Also, prolonged SSR latencies. Within PwE group, no difference was noticed between males and females, nor between the left and right temporal lobes.
Conclusion
Abnormal autonomic (sympathetic and parasympathetic) regulatory functions suggest that epilepsy may alter the autonomic function and this is not only in TLE but rather in IGE too. These autonomic changes are irrespective of the localization of epilepsy between the two hemispheres. The ANS changes in epileptic patients, particularly those with autonomic symptoms, confirm that electrophysiologic measures of autonomic function may be of value in preventing sudden unexpected death in epilepsy.
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9
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Autonomic manifestations of epilepsy: emerging pathways to sudden death? Nat Rev Neurol 2021; 17:774-788. [PMID: 34716432 DOI: 10.1038/s41582-021-00574-w] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 12/24/2022]
Abstract
Epileptic networks are intimately connected with the autonomic nervous system, as exemplified by a plethora of ictal (during a seizure) autonomic manifestations, including epigastric sensations, palpitations, goosebumps and syncope (fainting). Ictal autonomic changes might serve as diagnostic clues, provide targets for seizure detection and help us to understand the mechanisms that underlie sudden unexpected death in epilepsy (SUDEP). Autonomic alterations are generally more prominent in focal seizures originating from the temporal lobe, demonstrating the importance of limbic structures to the autonomic nervous system, and are particularly pronounced in focal-to-bilateral and generalized tonic-clonic seizures. The presence, type and severity of autonomic features are determined by the seizure onset zone, propagation pathways, lateralization and timing of the seizures, and the presence of interictal autonomic dysfunction. Evidence is mounting that not all autonomic manifestations are linked to SUDEP. In addition, experimental and clinical data emphasize the heterogeneity of SUDEP and its infrequent overlap with sudden cardiac death. Here, we review the spectrum and diagnostic value of the mostly benign and self-limiting autonomic manifestations of epilepsy. In particular, we focus on presentations that are likely to contribute to SUDEP and discuss how wearable devices might help to prevent SUDEP.
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10
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Alanazi GM. A Young man with Peri-ictal water drinking. ACTA ACUST UNITED AC 2021; 26:85-88. [PMID: 33530048 PMCID: PMC8015488 DOI: 10.17712/nsj.2021.1.20200074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/06/2020] [Indexed: 11/20/2022]
Abstract
Neuro-vegetative features have been linked to epilepsy arising from the temporal lobe, which can be seen during ictal events and play an important role in determining the focal side of the lesion. Among the rare known features is peri-ictal water drinking (PIWD). Here, we present the case of a 31-year-old male with refractory temporal epilepsy, having episodes of PIWD. The patient was considered a candidate for resective surgery and was investigated accordingly, including long-term video electroencephalogram (EEG), brain magnetic resonance imaging (MRI), and neuropsychology assessment, which pointed towards a lesioned temporal lobe over the non-dominant hemisphere. The patient had an excellent outcome following right anterior temporal lobectomy. The lateralization significance of PIWD has not yet been established definitively in the literature, partly due to a limited number of published cases. This case highlights the previously observed association between PIWD and the involvement of the non-dominant hemisphere in epilepsy patients.
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Affiliation(s)
- Ghalib M Alanazi
- From the Department of Pediatric Neurology, Epilepsy Monitoring Unit, National Neuroscience Institute, King Fahad Medical City, Riyadh, Kingdom Of Saudi Arabia
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11
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Pottkämper JCM, Hofmeijer J, van Waarde JA, van Putten MJAM. The postictal state - What do we know? Epilepsia 2020; 61:1045-1061. [PMID: 32396219 PMCID: PMC7317965 DOI: 10.1111/epi.16519] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 04/05/2020] [Accepted: 04/08/2020] [Indexed: 02/06/2023]
Abstract
This narrative review provides a broad and comprehensive overview of the most important discoveries on the postictal state over the past decades as well as recent developments. After a description and definition of the postictal state, we discuss postictal sypmtoms, their clinical manifestations, and related findings. Moreover, pathophysiological advances are reviewed, followed by current treatment options.
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Affiliation(s)
- Julia C M Pottkämper
- Clinical Neurophysiology, Technical Medical Centre, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands.,Department of Psychiatry, Rijnstate Hospital, Arnhem, The Netherlands.,Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Jeannette Hofmeijer
- Clinical Neurophysiology, Technical Medical Centre, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands.,Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands
| | | | - Michel J A M van Putten
- Clinical Neurophysiology, Technical Medical Centre, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
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12
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Subota A, Khan S, Josephson CB, Manji S, Lukmanji S, Roach P, Wiebe S, Buchhalter J, Federico P, Teskey GC, Lorenzetti DL, Jetté N. Signs and symptoms of the postictal period in epilepsy: A systematic review and meta-analysis. Epilepsy Behav 2019; 94:243-251. [PMID: 30978637 DOI: 10.1016/j.yebeh.2019.03.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 03/08/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The postictal period has many physical, behavioral, and cognitive manifestations associated with it. These signs and symptoms are common, can be quite debilitating, and can have a continued impact long after the seizure has ended. The purpose of this systematic review was to quantify the occurrence of postictal signs and symptoms, along with their frequency and duration in persons with epilepsy. METHODS Cochrane Database of Systematic Reviews, CINAHL, EMBASE, MEDLINE, PsycINFO, Web of Science, and Scopus were searched from inception to November 29, 2017. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting standards were followed. Search terms included subject headings and text words such as convulsion, epilepsy, seizure, postictal, post seizure, seizure recovery, seizure end, Todd's paresis, and Todd's paralysis. Standardized forms were used to collect various study variables. Abstract and full-text review, data abstraction, and quality assessment were all done in duplicate. Study heterogeneity was assessed using the I-squared test, and a random effects model was used to determine estimates. Publication bias was evaluated using funnel plots. RESULTS From 7811 abstracts reviewed, 78 articles met eligibility criteria, with 31 postictal manifestations (signs and/or symptoms) described and 45 studies included in the meta-analysis. The majority of studies described postictal headaches, migraines, and psychoses, with mean weighted frequency of 33.0% [95% confidence interval (CI) 26.0-40.0], 16.0% [95% CI 10.0-22.0], and 4.0% [95% CI 2.0-5.0], respectively. The mean weighted proportions of manifestations ranged from 0.5% (subacute postictal aggression) to 96.2% (postictal unresponsiveness) with symptom duration usually lasting <24 h but up to 2 months for physical and cognitive/behavioral symptoms respectively. SIGNIFICANCE Examining data on the various signs and symptoms of the postictal period will have practical applications for physicians by raising their awareness about these manifestations and informing them about the importance of optimizing their prevention and treatment in epilepsy.
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Affiliation(s)
- Ann Subota
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 1195 1403-29 Street, NW Calgary, AB T2N 2T9, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D10 - 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
| | - Sundus Khan
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 1195 1403-29 Street, NW Calgary, AB T2N 2T9, Canada
| | - Colin B Josephson
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 1195 1403-29 Street, NW Calgary, AB T2N 2T9, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D10 - 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; Hotchkiss Brain Institute, University of Calgary, Room 1A10 - 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; O'Brien Institute of Public Health, University of Calgary, 3rd Floor TRW Building 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
| | - Sofiya Manji
- Hotchkiss Brain Institute, University of Calgary, Room 1A10 - 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - Sara Lukmanji
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 1195 1403-29 Street, NW Calgary, AB T2N 2T9, Canada; Hotchkiss Brain Institute, University of Calgary, Room 1A10 - 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - Pamela Roach
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 1195 1403-29 Street, NW Calgary, AB T2N 2T9, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D10 - 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; Hotchkiss Brain Institute, University of Calgary, Room 1A10 - 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - Samuel Wiebe
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 1195 1403-29 Street, NW Calgary, AB T2N 2T9, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D10 - 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; Hotchkiss Brain Institute, University of Calgary, Room 1A10 - 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; O'Brien Institute of Public Health, University of Calgary, 3rd Floor TRW Building 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
| | - Jeffrey Buchhalter
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 1195 1403-29 Street, NW Calgary, AB T2N 2T9, Canada; The Alberta Children's Hospital Research Institute, Calgary, 293 - 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - Paolo Federico
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 1195 1403-29 Street, NW Calgary, AB T2N 2T9, Canada; Hotchkiss Brain Institute, University of Calgary, Room 1A10 - 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - G Campbell Teskey
- Hotchkiss Brain Institute, University of Calgary, Room 1A10 - 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; Department of Cell Biology and Anatomy, University of Calgary, HMRB 212 - 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - Diane L Lorenzetti
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D10 - 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; Health Sciences Library, University of Calgary, 1450 - 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - Nathalie Jetté
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 1195 1403-29 Street, NW Calgary, AB T2N 2T9, Canada; Icahn School of Medicine at Mount Sinai, Department of Neurology, One Gustave L. Levy Place, Box 1137, New York, NY 10029, USA; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D10 - 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; Hotchkiss Brain Institute, University of Calgary, Room 1A10 - 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada.
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Baumgartner C, Koren J, Britto-Arias M, Schmidt S, Pirker S. Epidemiology and pathophysiology of autonomic seizures: a systematic review. Clin Auton Res 2019; 29:137-150. [DOI: 10.1007/s10286-019-00596-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 01/25/2019] [Indexed: 02/07/2023]
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14
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Tényi D, Bóné B, Horváth R, Komoly S, Illés Z, Beier CP, Kelemen A, Kovács N, Darnai G, Janszky J. Ictal piloerection is associated with high-grade glioma and autoimmune encephalitis-Results from a systematic review. Seizure 2018; 64:1-5. [PMID: 30497014 DOI: 10.1016/j.seizure.2018.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 11/15/2018] [Accepted: 11/18/2018] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To comprehensively analyze ictal piloerection (IP) in a large number of subjects. METHODS We performed a systematic review on case report studies of patients diagnosed with IP (1929-2017) with additional cases included from the Department of Neurology of University of Pécs, the National Institute of Clinical Neurosciences, and Odense University Hospital. Each included case was characterized regarding patient history, IP seizure characteristics, diagnostic work-up, and therapy. Comparative analyses were also carried out based on sex and pathology. RESULTS Altogether, 109 cases were included. We observed a strong male predominance (p < 0.001). The mean age at onset of epilepsy was 39.5 ± 20.7 years (median: 38, IQR:24-57). The seizure onset zone was temporal (p < 0.001), and was lateralized to the ipsilateral hemisphere in unilateral localization (p = 0.001). The seizure was accompanied by cold shiver in 53%, and by other autonomic symptoms in 47% of cases. In 53% of patients, IP never progressed into complex partial or generalized tonic-clonic seizure; 16% of the patients reported occasional, and 31% regular generalization. Seizure frequency was higher among females (median:25/day, IQR:3-60) than among males (median:3/day, IQR:1-11) (p = 0.017). The two most common underlying pathologies were limbic encephalitis (23%) and astrocytoma (23%, among them 64% WHO III-IV astrocytoma). CONCLUSION IP was particularly associated with autoimmune encephalitis and high-grade glioma, suggesting IP's particular clinical importance in directing diagnostic work-up.
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Affiliation(s)
- Dalma Tényi
- Department of Neurology, University of Pécs, H-7623, Rét u. 2., Pécs, Hungary
| | - Beáta Bóné
- Department of Neurology, University of Pécs, H-7623, Rét u. 2., Pécs, Hungary
| | - Réka Horváth
- Department of Neurology, University of Pécs, H-7623, Rét u. 2., Pécs, Hungary
| | - Sámuel Komoly
- Department of Neurology, University of Pécs, H-7623, Rét u. 2., Pécs, Hungary
| | - Zsolt Illés
- Department of Neurology, University of Pécs, H-7623, Rét u. 2., Pécs, Hungary; Department of Neurology, Odense University Hospital, Odense, and Department for Clinical Research, University of Southern Denmark, Odense C, DK-5000, Winsløwparken 19, Denmark
| | - Christoph P Beier
- Department of Neurology, Odense University Hospital, Odense, and Department for Clinical Research, University of Southern Denmark, Odense C, DK-5000, Winsløwparken 19, Denmark
| | - Anna Kelemen
- National Institute of Clinical Neurosciences, H-1145, Amerikai út 57, Budapest, Hungary
| | - Norbert Kovács
- Department of Neurology, University of Pécs, H-7623, Rét u. 2., Pécs, Hungary; PTE-MTA Clinical Neuroscience MR Research Group, H-7623, Rét u. 2, Hungary
| | - Gergely Darnai
- Department of Neurology, University of Pécs, H-7623, Rét u. 2., Pécs, Hungary
| | - József Janszky
- Department of Neurology, University of Pécs, H-7623, Rét u. 2., Pécs, Hungary; PTE-MTA Clinical Neuroscience MR Research Group, H-7623, Rét u. 2, Hungary.
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Huang S, Al-Abri H, Sachdeva A, Alkhachroum AM, Shatzman S, Lüders H. Recurrent focal seizures as a feature of status epilepticus presenting as a peri-ictal water drinking. EPILEPSY & BEHAVIOR CASE REPORTS 2018; 10:129-132. [PMID: 30416962 PMCID: PMC6216106 DOI: 10.1016/j.ebcr.2018.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 09/04/2018] [Accepted: 09/05/2018] [Indexed: 11/23/2022]
Abstract
We report a case of focal status epilepticus (SE) associated with peri-ictal water drinking (PIWD) behavior in a nine-year-old left-handed boy with epilepsy. We reviewed prior cases of epileptic peri-ictal water drinking. Only one adult patient with status epilepticus and PIWD has been reported previously. This is the first reported case of PIWD SE in a pediatric patient with frontal lobe epilepsy. We found PIWD to have no lateralizing value. We report a case of focal status epilepticus (SE) associated with peri-ictal water drinking (PIWD). PIWD is a rare autonomic symptom. We found PIWD to have no lateralizing value.
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Affiliation(s)
- Shuo Huang
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Haifa Al-Abri
- University Hospitals - Cleveland Medical Center, Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Alok Sachdeva
- Michael Aldrich Sleep Disorders Center, Department of Neurology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Ayham M Alkhachroum
- Neurocritical Care, New York-Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - Stephanie Shatzman
- University Hospitals - Cleveland Medical Center, Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Hans Lüders
- University Hospitals - Cleveland Medical Center, Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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16
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Arango-Jaramillo E, Lozano-García L, Benjumea-Cuartas V, Andrade-Machado R. Periictal sign of the cross or Signum Crucis as a lateralizing sign in focal epilepsies: Not only a right temporal lobe epilepsy feature. Epilepsy Behav 2018; 78:52-56. [PMID: 29175220 DOI: 10.1016/j.yebeh.2017.09.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/28/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The sign of the cross (SC) is a catholic ritual that has been described as an automatism during the ictal phase in patients with right temporal lobe epilepsy. OBJECTIVE The study aimed to describe the prevalence of the SC and analyze the characteristics of patients who presented this phenomenon during the video-electroencephalography (VEEG) admission in our Epilepsy department. METHODS This is a retrospective analysis of 1308 recorded seizures; 14 patients presented the SC during the admission. Seizure semiology, electroencephalography (EEG), etiology, neuroimaging, and surgical findings were analyzed. RESULTS A prevalence of 1.1% was found, and the sign was not only an ictal finding (21% was postictal) but also exclusive of patients with temporal lobe epilepsy (15% were extratemporal) in contrast to what has been reported so far. The localizing and lateralizing value of the ictal SC was low (sensitivity 75%, specificity 33.3%, positive predictive value 60%, negative predictive value 50% for a right temporal epileptogenic zone (EZ)) compared with other previously described signs. Regardless of the lateralization of the EZ, the sign was always performed with the right hand supporting the hypothesis of a possible learned behavioral automatism. CONCLUSION The SC is a rare ictal or postictal manifestation that occurs in patients with temporal and extratemporal epilepsies without clear localizing and lateralizing value compared with previously described signs.
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Affiliation(s)
| | | | - Vanessa Benjumea-Cuartas
- Department of Epilepsy, Neurocentro, Epilepsy and Parkinson Institute, Carrera 9 #25-25, Pereira, Colombia
| | - René Andrade-Machado
- Neurological Institute of Colombia, CES University, Calle 55 #46-36, Medellín, Colombia.
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Abstract
BACKGROUND Ictal urinary urge is a rare autonomic symptom usually lateralizing to the non-dominant hemisphere and localizing to the temporal lobe. CASE REPORT A 12-year-old boy was referred with desire to void and contraction of the left arm. The history of the case revealed tickling and an unpleasant rising feeling in the stomach and sense of fear lasting for 1 year. He had been evaluated and treated several times with the diagnosis of gastroesophageal reflux and cystitis. His cranial MRI displayed an intra-axial mass formation on the right temporal lobe. Pathological findings were consistent with a low-grade glial mass. CONCLUSION Ictal urinary urge has a considerable value both for localization and lateralization of seizures.
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18
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Ataoğlu EE, Yıldırım İ, Bilir E. An evaluation of lateralizing signs in patients with temporal lobe epilepsy. Epilepsy Behav 2015; 47:115-9. [PMID: 25989878 DOI: 10.1016/j.yebeh.2015.04.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 03/23/2015] [Accepted: 04/08/2015] [Indexed: 10/23/2022]
Abstract
Resective epilepsy surgery has been accepted as an effective treatment for patients with medically intractable temporal lobe epilepsy (TLE) to control the seizures and to limit cognitive dysfunction. Complete resection of the epileptic zone, and therefore the success of the surgery, depends on the identification of the seizure focus. Reliable lateralizing semiologic signs, together with other presurgical assessments, are of great importance for an accurate identification of the seizure focus. In this respect, this study evaluated the frequency of semiologic signs in medically intractable temporal lobe epilepsy (TLE) together with the lateralizing values and variations according to the age and gender groups. Two hundred seventy-three seizures of 55 patients of the Adult Epilepsy Monitoring Unit of Gazi University Faculty of Medicine with the diagnosis of medically intractable TLE, whose epileptic foci were detected through noninvasive presurgical procedures and seizures were controlled successfully after anterior temporal lobectomy (ATL), were analyzed retrospectively. Seizure semiologies of the patients were evaluated in terms of lateralizing values, and it was inquired whether age/gender causes any variation. Versive head rotation, unilateral dystonic limb posturing, asymmetric tonic limb posturing, and the combination of unilateral hand automatisms and dystonic posturing were determined as the semiologic signs with the highest lateralizing values (90-100%). While hand automatisms were observed frequently in the group with early seizure-onset age (onset age ≤ 2), asymmetric tonic limb posturing was detected as more frequent in the group with later seizure-onset age (onset age > 2; p < .005). In addition to this, semiologic signs were noted to be different between male and female groups; psychic and autonomic auras and ictal emotional signs were associated with women (p < .005).
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Affiliation(s)
- Esra Erkoç Ataoğlu
- Department of Neurology, Ministry of Health, Zekai Tahir Burak Women's Health Research and Education Hospital, 06830 Ankara, Turkey.
| | - İrem Yıldırım
- Department of Neurology, Gazi University Faculty of Medicine, 06830 Ankara, Turkey
| | - Erhan Bilir
- Department of Neurology, Gazi University Faculty of Medicine, 06830 Ankara, Turkey
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Luef G, Madersbacher H. Sexual dysfunction in patients with epilepsy. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:383-94. [DOI: 10.1016/b978-0-444-63247-0.00022-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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20
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Errguig L, Lahjouji F, Belaidi H, Jiddane M, Elkhamlichi A, Dakka T, Ouazzani R. Peri-ictal water drinking and other ictal vegetative symptoms: Localizing and lateralizing the epileptogenic zone in temporal lobe epilepsy? Two case reports and review of the literature. Rev Neurol (Paris) 2013; 169:903-10. [PMID: 24138873 DOI: 10.1016/j.neurol.2013.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 05/14/2013] [Accepted: 06/11/2013] [Indexed: 11/30/2022]
Abstract
Peri-ictal behavior disorders can be helpful in localizing and lateralizing seizure onset in partial epilepsies, especially those originating in the temporal lobe. In this paper, we present the case of two right-handed women aged 36 and 42 years who presented with partial seizures of mesial temporal type. Both of the patients had drug resistant epilepsy and undergone presurgical evaluation tests including brain magnetic resonance imaging, video-EEG monitoring and neuropsychological testing. The two patients had hippocampal sclerosis in the right temporal lobe and exhibited PIWD behavior concomitant with right temporal lobe discharges documented during video-EEG recordings. Anterior temporal lobectomy was performed in one case with an excellent outcome after surgery. The patient was free of seizures at 3 years follow-up. We reviewed other publications of peri-ictal autonomic symptoms considered to have a lateralizing significance, such as peri-ictal vomiting, urinary urge, ictal pilo-erection. Clinicians should search for these symptoms, even if not spontaneously reported by the patient, because they are often under-estimated, both by the patients themselves and by physicians. Additionally, patients with lateralizing auras during seizures have a significantly better outcome after epilepsy surgery than those without lateralizing features.
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Affiliation(s)
- L Errguig
- Department of Clinical Neurophysiology, Hôpital des Spécialités Centre Hospitalier Ibn Sina, Rabat Institut BP 6220, Rabat, Maroc; Laboratory of physiology, faculty of medicine and pharmacy of Rabat, university Med V Souissi, Rue Lamfadel Cherkaoui, Rabat Institut BP 6527, Rabat, Maroc.
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Oguz KK, Tezer I, Sanverdi E, Has AC, Bilginer B, Dolgun A, Saygi S. Effect of patient sex on white matter alterations in unilateral medial temporal lobe epilepsy with hippocampal sclerosis assessed by diffusion tensor imaging. AJNR Am J Neuroradiol 2013; 34:1010-5. [PMID: 23153868 DOI: 10.3174/ajnr.a3328] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Studies shows ictal behavior and symptoms are affected by patient sex in temporal lobe epilepsy. The purpose of our study was to determine whether alterations in the WM as assessed by DTI display different patterns in male and female patients with unilateral HS. MATERIALS AND METHODS Patients with unilateral HS were categorized as women with right HS (n=12), men with right HS (n=10), women with left HS (n=12), and men with left HS (n=10). DTI of the brain along 64 noncollinear directions was obtained from 44 patients and 37 sex-matched control participants. We used TBSS to analyze whole-brain WM. Regions with significant changes of FA and MD, and their mean FA, MD, total number of significant voxels, and asymmetry indices were determined for each group. RESULTS All groups showed bilateral and extensive reductions of FA and elevated MD in the WM, more prominent ipsilateral to the affected hippocampus. The total number of voxels with decreased FA in patients compared with that of control participants was higher in women with right HS (24,727 vs 5,459) and in men with left HS (27,332 vs 14,013) than in their counterparts. Changes in MD associated with right HS were more extensive in both men and women (right vs left HS, women: 16,926 vs 5,458; men: 5,389 vs 4,764) than in those with left HS. In patients with right HS, the ipsilateral cingulum, uncinate fasciculus, internal and external capsules, and right acoustic radiation were involved extensively in women. CONCLUSIONS Women and men showed different patterns in extent of WM alterations associated with HS.
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Affiliation(s)
- K K Oguz
- Bilkent University, National Magnetic Resonance Research Center, Bilkent, Ankara, Turkey.
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22
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Vanhaesebrouck AE, Posch B, Baker S, Plessas IN, Palmer AC, Constantino-Casas F. Temporal lobe epilepsy in a cat with a pyriform lobe oligodendroglioma and hippocampal necrosis. J Feline Med Surg 2012; 14:932-7. [PMID: 22791561 PMCID: PMC11108005 DOI: 10.1177/1098612x12454419] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
A 14-year-old male domestic shorthair cat presented with an acute onset of aggressive behaviour, fear and hypersalivation. Neurological examination revealed bilateral mydriasis and left-sided facial twitching and hemiparesis. Magnetic resonance imaging (MRI) showed moderate bilateral symmetrical T2-hyperintensity along the entire hippocampus and bilateral asymmetric T2-hyperintensity in the pyriform lobes. Marked bilateral contrast enhancement of the hippocampus was evident on post-contrast T1-weighted images. The partial complex seizures were refractory to medical treatment and the cat was euthanased 4 days after admission. The clinical and MRI findings were consistent with feline hippocampal necrosis (FHN). On histopathology, neuronal necrosis and astrocytosis were present in the hippocampi and pyriform lobes. In addition, an oligodendroglioma was detected in the right pyriform lobe. Contrary to previous reports of FHN in which no underlying cause could be identified, we believe that in this case the seizure focus arose from a neoplastic lesion within the right pyriform lobe. This unique case report represents the so-called 'dual pathology' of temporal lobe epilepsy in humans, in which an extrahippocampal lesion within the temporal lobe results in hippocampal sclerosis.
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Evaluation of Heart Rate Variation Analysis during Rest and Tilting in Patients with Temporal Lobe Epilepsy. Neurol Res Int 2011; 2011:829365. [PMID: 21789280 PMCID: PMC3140779 DOI: 10.1155/2011/829365] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Revised: 03/15/2011] [Accepted: 05/24/2011] [Indexed: 11/17/2022] Open
Abstract
Objective. To evaluate spectral heart rate (HR) variation using short-term ECG recordings at rest and during the tilt table test. Methods. The values of spectral components of total power (TP), high-frequency power (HF), low-frequency power (LF) and LF: HF ratio were measured at rest and during the head-up tilt in patients with temporal lobe epilepsy (TLE) and their control subjects. Results. Compared to the control subjects, patients with TLE had lower HF (P < 0.05) and LF : HF ratio (P < 0.05) at rest and lower TP (P < 0.001), HF (P < 0.05), and LF (P < 0.05) during the head-up tilt. Upon changing from supine to standing position TP (P < 0.05) and LF (P < 0.05) were attenuated in patients with TLE compared to the control subjects. Conclusion. These results suggest that spectral analysis of HR variation from ECG recordings of short duration may add value to assessment of autonomic nervous system function using autonomic cardiac tests in patients with TLE.
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Musilová K, Kuba R, Brázdil M, Tyrlíková I, Rektor I. Occurrence and lateralizing value of "rare" peri-ictal vegetative symptoms in temporal lobe epilepsy. Epilepsy Behav 2010; 19:372-5. [PMID: 20800552 DOI: 10.1016/j.yebeh.2010.07.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 07/08/2010] [Accepted: 07/08/2010] [Indexed: 10/19/2022]
Abstract
We retrospectively investigated rare peri-ictal vegetative symptoms (PIVS) in 380 seizures of 97 patients with temporal lobe epilepsy (TLE): 234 seizures of 60 patients with TLE with mesiotemporal sclerosis (TLE/MTS) and 146 seizures of 37 patients with TLE with other lesions (TLE/non-MTS) who were at least 2 years after epilepsy surgery and classified as Engel I. We assessed the following PIVS: peri-ictal cough (pC), peri-ictal water drinking (pWD), peri-ictal vomiting (pV), and peri-ictal spitting (pS). We observed pC in 24.7% of patients and 10% of seizures; pWD in 14.4% of patients and 5.9% of seizures; pV and pS occurred more rarely. Both pWD and pC occurred significantly more often in those with TLE of the non- language-dominant hemisphere. The limited occurrence of pV and pS made it impossible to perform statistical analysis for these symptoms. In patients with TLE, pC and pWD were quite frequent; we observed pV and pS less frequently. Both pC and pWD have a significant lateralizing value in TLE.
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Affiliation(s)
- K Musilová
- Epilepsy Centre Brno, First Department of Neurology, St Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Rémi J, Noachtar S. Clinical features of the postictal state: correlation with seizure variables. Epilepsy Behav 2010; 19:114-7. [PMID: 20692875 DOI: 10.1016/j.yebeh.2010.06.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Accepted: 06/17/2010] [Indexed: 11/16/2022]
Abstract
The postictal period is defined by changes in behavior, motor function, and neuropsychological performance that last until the return to a presumed baseline. The postictal period has not received as much attention as the time of seizure onset or the seizure itself. It may offer information that could be helpful in the definition of the epileptogenic zone and its lateralization. Here we review different behavioral, neuropsychological, and EEG phenomena of the postictal state and discuss several semiological features of the postictal period with respect to patient characteristics, seizure duration, influences of drug treatment, and secondary generalization. Further evaluation may reveal information that could be helpful particularly with respect to resective epilepsy surgery, possibly allowing better localization and lateralization.
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Affiliation(s)
- Jan Rémi
- Epilepsy Center, Department of Neurology, University of Munich, Munich, Germany
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26
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Jansen K, Lagae L. Cardiac changes in epilepsy. Seizure 2010; 19:455-60. [PMID: 20688543 DOI: 10.1016/j.seizure.2010.07.008] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 07/05/2010] [Accepted: 07/09/2010] [Indexed: 11/19/2022] Open
Abstract
Epilepsy and seizures can have a dramatic effect on the autonomic nervous system by involvement of the central autonomic control centers. The peri-ictal changes can lead to short-term alteration of cardiac functions in patients with seizures, and are partially hemispheric specific. Changes in heart rhythm, conduction and even subtle signs of ischemia have been reported. Ictal asystole and the lock-step phenomenon during seizures play an important role in the pathophysiology of SUDEP. In patients with longlasting epilepsy and multiple seizures, there are now convincing arguments for a chronic dysfunction of the autonomic nervous system. In this sense, heart rate variability can be considered as a biomarker of autonomic dysfunction in epilepsy. Early recognition of these short- and long-term cardiac effects will become useful in predicting seizures and in guiding more individualized treatment in the near future.
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Affiliation(s)
- K Jansen
- University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
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Hoffmann JM, Elger CE, Kleefuss-Lie AA. The localizing value of hypersalivation and postictal coughing in temporal lobe epilepsy. Epilepsy Res 2009; 87:144-7. [DOI: 10.1016/j.eplepsyres.2009.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2009] [Revised: 08/05/2009] [Accepted: 08/09/2009] [Indexed: 12/16/2022]
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Toth V, Fogarasi A, Karadi K, Kovacs N, Ebner A, Janszky J. Ictal affective symptoms in temporal lobe epilepsy are related to gender and age. Epilepsia 2009; 51:1126-32. [DOI: 10.1111/j.1528-1167.2009.02396.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Szucs A, Fogarasi A, Rásonyi G, Kelemen A, Narula L, Tóth V, Janszky J, Halász P. Peri-ictal water drinking in temporal lobe epilepsy: Is it a reliable lateralizing sign? Epilepsy Behav 2007; 11:578-81. [PMID: 17910938 DOI: 10.1016/j.yebeh.2007.07.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2007] [Revised: 07/19/2007] [Accepted: 07/21/2007] [Indexed: 11/18/2022]
Abstract
Peri-ictal water drinking has been reported to be a lateralizing sign to the right side in temporal lobe epilepsy (TLE). As peri-ictal water drinking is relatively common in our own patients with TLE, we wanted to evaluate its lateralization value for ourselves. We reviewed the data for 55 adult patients with TLE who had undergone epilepsy surgery with a favorable postoperative outcome in our center. Eight patients exhibited peri-ictal water drinking behavior. Five of them had a left temporal and three a right temporal epileptogenic region. We also analyzed cases of peri-ictal water drinking in the literature and found that the reported data do not support this behavior as a laterality indicator. In conclusion, we could not find any evidence for the lateralization value of peri-ictal water drinking in TLE.
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Affiliation(s)
- Anna Szucs
- Epilepsy Center, National Institute of Psychiatry and Neurology, H-1021 Budapest, Hungary
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