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Shenyan O, Lisi M, Greenwood JA, Skipper JI, Dekker TM. Visual hallucinations induced by Ganzflicker and Ganzfeld differ in frequency, complexity, and content. Sci Rep 2024; 14:2353. [PMID: 38287084 PMCID: PMC10825158 DOI: 10.1038/s41598-024-52372-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/17/2024] [Indexed: 01/31/2024] Open
Abstract
Visual hallucinations can be phenomenologically divided into those of a simple or complex nature. Both simple and complex hallucinations can occur in pathological and non-pathological states, and can also be induced experimentally by visual stimulation or deprivation-for example using a high-frequency, eyes-open flicker (Ganzflicker) and perceptual deprivation (Ganzfeld). Here we leverage the differences in visual stimulation that these two techniques involve to investigate the role of bottom-up and top-down processes in shifting the complexity of visual hallucinations, and to assess whether these techniques involve a shared underlying hallucinatory mechanism despite their differences. For each technique, we measured the frequency and complexity of the hallucinations produced, utilising button presses, retrospective drawing, interviews, and questionnaires. For both experimental techniques, simple hallucinations were more common than complex hallucinations. Crucially, we found that Ganzflicker was more effective than Ganzfeld at eliciting simple hallucinations, while complex hallucinations remained equivalent across the two conditions. As a result, the likelihood that an experienced hallucination was complex was higher during Ganzfeld. Despite these differences, we found a correlation between the frequency and total time spent hallucinating in Ganzflicker and Ganzfeld conditions, suggesting some shared mechanisms between the two methodologies. We attribute the tendency to experience frequent simple hallucinations in both conditions to a shared low-level core hallucinatory mechanism, such as excitability of visual cortex, potentially amplified in Ganzflicker compared to Ganzfeld due to heightened bottom-up input. The tendency to experience complex hallucinations, in contrast, may be related to top-down processes less affected by visual stimulation.
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Affiliation(s)
- Oris Shenyan
- Experimental Psychology, Division of Psychology and Language Sciences, University College London, London, UK.
- Institute of Ophthalmology, University College London, London, UK.
| | - Matteo Lisi
- Department of Psychology, Royal Holloway University, London, UK
| | - John A Greenwood
- Experimental Psychology, Division of Psychology and Language Sciences, University College London, London, UK
| | - Jeremy I Skipper
- Experimental Psychology, Division of Psychology and Language Sciences, University College London, London, UK
| | - Tessa M Dekker
- Experimental Psychology, Division of Psychology and Language Sciences, University College London, London, UK
- Institute of Ophthalmology, University College London, London, UK
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Fein AS, Kelly SM, Louie E, Young MG, Jain R, William CM, Galetta SL, Grossman SN. Occipital Nocardia Abscess Presenting With Positive Visual Phenomenon and Quadrantanopsia. J Neuroophthalmol 2023; 43:430-433. [PMID: 37440372 DOI: 10.1097/wno.0000000000001938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
ABSTRACT A 74-year-old man with chronic obstructive pulmonary disease, glaucoma, and Stage IIIB squamous cell lung cancer experienced several minutes of flashing lights in his right visual hemifield, followed by onset of a right visual field defect. On examination, the patient had a right homonymous hemianopsia that was most dense inferiorly by confrontation testing. Emergent CT scan of the head revealed a 2.5 × 3 cm hypodensity in the left occipital lobe, which was interpreted as an acute stroke. Continuous EEG monitoring captured left posterior quadrant seizures that were temporally correlated to the positive visual phenomena. Subsequent MRI of the brain with and without contrast revealed a conglomerate of centrally necrotic and peripherally enhancing mass lesions. On biopsy, a thick purulent material was drained and Gram stain of the sample revealed gram-positive beaded rods, which speciated to Nocardia farcinica . The patient was treated with a six-week course of intravenous meropenem and a one-year course of oral trimethroprim-sulfamethoxazole. On follow-up, the patient experienced resolution of the right visual field deficit.
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Affiliation(s)
- Alexander S Fein
- Department of Neurology (ASF, SMK, SLG, SNG), New York University Grossman School of Medicine, New York, New York; Division of Infectious Diseases (EL), Department of Medicine, New York University Grossman School of Medicine, New York, New York; and Departments of Radiology (MGY, RJ) and Department of Pathology (CMW), New York University Grossman School of Medicine, New York, New York
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Cossette-Roberge H, Li J, Citherlet D, Nguyen DK. Localizing and lateralizing value of auditory phenomena in seizures. Epilepsy Behav 2023; 145:109327. [PMID: 37422934 DOI: 10.1016/j.yebeh.2023.109327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/11/2023] [Accepted: 06/15/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Auditory seizures (AS) are a rare type of focal seizures. AS are classically thought to involve a seizure onset zone (SOZ) in the temporal lobe, but there remain uncertainties about their localizing and lateralizing value. We conducted a narrative literature review with the aim of providing an up-to-date description of the lateralizing and localizing value of AS. METHODS The databases PubMed, Scopus, and Google Scholar were searched for literature on AS in December 2022. All cortical stimulation studies, case reports, and case series were analyzed to assess for auditory phenomena that were suggestive of AS and to evaluate if the lateralization and/or localization of the SOZ could be determined. We classified AS according to their semiology (e.g., simple hallucination versus complex hallucination) and the level of evidence with which the SOZ could be predicted. RESULTS A total of 174 cases comprising 200 AS were analyzed from 70 articles. Across all studies, the SOZ of AS were more often in the left (62%) than in the right (38%) hemisphere. AS heard bilaterally followed this trend. Unilaterally heard AS were more often due to a SOZ in the contralateral hemisphere (74%), although they could also be ipsilateral (26%). The SOZ for AS was not limited to the auditory cortex, nor to the temporal lobe. The areas more frequently involved in the temporal lobe were the superior temporal gyrus (STG) and mesiotemporal structures. Extratemporal locations included parietal, frontal, insular, and rarely occipital structures. CONCLUSION Our review highlighted the complexity of AS and their importance in the identification of the SOZ. Due to the limited data and heterogeneous presentation of AS in the literature, the patterns associated with different AS semiologies warrant further research.
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Affiliation(s)
- Hélène Cossette-Roberge
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada; Neurology Division, Centre Hospitalier de l'Université de Sherbrooke (CHUS), Sherbrooke, QC, Canada.
| | - Jimmy Li
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada; Neurology Division, Centre Hospitalier de l'Université de Sherbrooke (CHUS), Sherbrooke, QC, Canada
| | - Daphné Citherlet
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Dang Khoa Nguyen
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada; Department of Neurosciences, Université de Montréal, Montreal, QC, Canada; Neurology Division, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
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Cassady M, Baslet G. Dissociation in patients with epilepsy and functional seizures: A narrative review of the literature. Seizure 2023; 110:220-230. [PMID: 37433243 DOI: 10.1016/j.seizure.2023.06.020] [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: 05/03/2023] [Revised: 06/18/2023] [Accepted: 06/24/2023] [Indexed: 07/13/2023] Open
Abstract
Dissociation is a "disruption of the usually integrated functions of consciousness, memory, identity or perception of the environment" according to DSM-5. It is commonly seen in psychiatric disorders including primary dissociative disorders, post-traumatic stress disorder, depression, and panic disorder. Dissociative phenomena are also described in the context of substance intoxication, sleep deprivation and medical illnesses including traumatic brain injury, migraines, and epilepsy. Patients with epilepsy have higher rates of dissociative experiences as measured on the Dissociative Experiences Scale compared to healthy controls. Ictal symptoms, especially in focal epilepsy of temporal lobe origin, may include dissociative-like experiences such as déjà vu/jamais vu, depersonalization, derealization and what has been described as a "dreamy state". These descriptions are common in the setting of seizures that originate from mesial temporal lobe epilepsy and may involve the amygdala and hippocampus. Other ictal dissociative phenomena include autoscopy and out of body experiences, which are thought to be due to disruptions in networks responsible for the integration of one's own body and extra-personal space and involve the temporoparietal junction and posterior insula. In this narrative review, we will summarize the updated literature on dissociative experiences in epilepsy, as well as dissociative experiences in functional seizures. Using a case example, we will review the differential diagnosis of dissociative symptoms. We will also review neurobiological underpinnings of dissociative symptoms across different diagnostic entities and discuss how ictal symptoms may shed light on the neurobiology of complex mental processes including the subjective nature of consciousness and self-identity.
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Affiliation(s)
- Maureen Cassady
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Gaston Baslet
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Nelson EA, Ghosh D, Pineda DM, Antoniello D. Auditory Hallucinations Associated With an Arteriovenous Malformation of the Brain. J Neuropsychiatry Clin Neurosci 2022; 34:89-92. [PMID: 34565168 DOI: 10.1176/appi.neuropsych.20120306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Eric Andrew Nelson
- Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Bronx, N.Y. (Nelson); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, N.Y. (Nelson); Department of Neurology, Montefiore Medical Center, Bronx, N.Y. (Ghosh, Pineda, Antoniello); and Department of Neurology, Albert Einstein College of Medicine, Bronx, N.Y. (Ghosh, Pineda, Antoniello)
| | - Dina Ghosh
- Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Bronx, N.Y. (Nelson); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, N.Y. (Nelson); Department of Neurology, Montefiore Medical Center, Bronx, N.Y. (Ghosh, Pineda, Antoniello); and Department of Neurology, Albert Einstein College of Medicine, Bronx, N.Y. (Ghosh, Pineda, Antoniello)
| | - Dan Michael Pineda
- Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Bronx, N.Y. (Nelson); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, N.Y. (Nelson); Department of Neurology, Montefiore Medical Center, Bronx, N.Y. (Ghosh, Pineda, Antoniello); and Department of Neurology, Albert Einstein College of Medicine, Bronx, N.Y. (Ghosh, Pineda, Antoniello)
| | - Daniel Antoniello
- Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Bronx, N.Y. (Nelson); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, N.Y. (Nelson); Department of Neurology, Montefiore Medical Center, Bronx, N.Y. (Ghosh, Pineda, Antoniello); and Department of Neurology, Albert Einstein College of Medicine, Bronx, N.Y. (Ghosh, Pineda, Antoniello)
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Visual Release Hallucinations After Facial Allotransplantation. Harv Rev Psychiatry 2021; 29:327-334. [PMID: 34033593 DOI: 10.1097/hrp.0000000000000296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Seitz RJ. Beliefs: A challenge in neuropsychological disorders. J Neuropsychol 2021; 16:21-37. [PMID: 33969626 DOI: 10.1111/jnp.12249] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 03/11/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Beliefs have recently been defined as the neural product of perception of objects and events in the external world and of an affirmative internal affective state reflecting personal meaning. It is, however, undetermined in which way diseases of the brain affect these integrative processes. METHODS Here, the formation and updating of abnormal beliefs in cerebral disorders are described. RESULTS It will be shown that well-defined neuropsychological syndromes resulting from brain lesions also interfere with the neural processes that enable the formation, up-dating and communication of beliefs. Similarly, in neuropsychiatric disorders abnormal and delusional beliefs appear to be caused by altered perception and/or misattribution of aversive meaning. CONCLUSION Given the importance of beliefs for ordinary social behaviour, abnormal beliefs are a challenge in neuropsychological disorders.
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Affiliation(s)
- Rüdiger J Seitz
- Department of Neurology, Centre of Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany.,Florey Neuroscience Institutes, Melbourne, Victoria, Australia
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Taşcı İ, Balgetir F, Müngen B, Gönen M. Epileptic olfactory auras: a clinical spectrum. Neurol Sci 2021; 42:3397-3401. [PMID: 33428053 DOI: 10.1007/s10072-020-04999-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/14/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the relative frequency of olfactory aura in a large number of patients with focal epilepsy, and examine the full clinical spectrum of epileptic olfactory auras (OAs) and their relationship to hemispheric lateralization and localization of epileptogenic focus. METHODS This retrospective study was based on the medical records of 1384 patients with focal epilepsy. Of these, 71 (5.1%) patients were present with OAs, comprising 25 (35.2%) men and 46 (64.8%) women with a mean age of 35.43 ± 12.89 years. These 71 patients were classified according to the clinical features of the OAs, and the electroencephalography and magnetic resonance imaging findings were examined. RESULTS The relative frequency of OAs was 5.1% in the focal epileptic patients. The clinical spectrum of OAs in our cases was outlined as follows, complex OAs and elementary OAs. Elementary OAs were divided into three subgroups: elementary neutral OAs, elementary unpleasant OAs, and elementary pleasant OAs. In our cases, there was no difference between the right and left hemispheres in terms of lateralization of the epileptogenic focus. In all the 71 patients, the epileptogenic zone was most commonly localized in the temporal lobe (n = 58; 81.7%). CONCLUSIONS The relative frequency of OAs in focal epilepsies is likely to be found higher than expected. Elementary OAs occur much more frequently than complex OAs. Among the elementary OAs, elementary unpleasant OAs and elementary neutral OAs are the most common types, whereas elementary pleasant OAs are extremely rare.
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Affiliation(s)
- İrem Taşcı
- Malatya Teaching and Research Hospital, Neurology Clinic, Malatya, Turkey
| | - Ferhat Balgetir
- Department of Neurology, College of Medicine, Fırat University, Elazig, Turkey.
| | - Bülent Müngen
- Department of Neurology, College of Medicine, Fırat University, Elazig, Turkey
| | - Murat Gönen
- Department of Neurology, College of Medicine, Fırat University, Elazig, Turkey
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Graf W, Kasper BS, Sharma S, Kasper EM. Lost in Transition: The Long and Winding Road Toward Epilepsy Surgery—An Analysis of Obstacles Prior to Surgery and Call for Orchestrated Health Care Efforts in Epilepsy. JOURNAL OF PEDIATRIC NEUROLOGY 2020. [DOI: 10.1055/s-0040-1715503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractDifficult-to-treat epilepsy is defined as ongoing seizures despite adequate pharmacological treatment. This condition is affecting a significant percentage of epilepsy patients and is estimated to be as high as one-third of all patients. Epilepsy surgery, targeting the removal of the key parts of cerebral convolutions responsible for seizure generation and often including a structural lesion, can be a very successful approach. However, this necessitates careful patient selection by comprehensive investigations, proving the localization of the epileptogenic zone as well as measures to make such surgeries safe. With careful selection as a prerequisite, the percentage of patients achieving seizure freedom by neurosurgical intervention is high, approximating two-thirds of all epilepsy surgeries performed. In contrast, the average duration of a patient's pharmacoresistant focal epilepsy prior to surgery anywhere around the globe is around 20 years. Given that typical patients are ∼30 to 40 years of age at the time of surgery, many patients have been living with chronic seizures since childhood or adolescence. This means that most of these patients have been going through several stages of medical care for years or even decades, both as children and adults, without ever being fully investigated and/or selected for surgery which is concerning. Yet, there is no set standard for a timeline leading toward successful surgery in epilepsy. It is obvious that the average transit period from the moment of first seizure manifestation until the day of successful surgery takes much too long. This is the reason why we see these patients lost in transition.
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Affiliation(s)
- Wolfgang Graf
- Department of Neurology, Epilepsy Center, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Burkhard S. Kasper
- Department of Neurology, Epilepsy Center, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Sunjay Sharma
- Division of Neurosurgery, McMaster University, Hamilton, Canada
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Stassen QEM, Grinwis GCM, van Rhijn NC, Beukers M, Verhoeven-Duif NM, Leegwater PAJ. Focal epilepsy with fear-related behavior as primary presentation in Boerboel dogs. J Vet Intern Med 2018; 33:694-700. [PMID: 30580458 PMCID: PMC6430876 DOI: 10.1111/jvim.15346] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 10/05/2018] [Indexed: 11/27/2022] Open
Abstract
Background Focal seizures with fear as a primary ictal manifestation, their diagnostic challenges, and impact on quality of life are well described in human medicine. Reports focusing on ictal fear‐like behavior in animals are scarce. Objective To describe the clinical and histopathological characteristics of a novel focal epilepsy in Boerboel dogs. Animals Five client‐owned Boerboel littermates presented for evaluation of sudden episodes of severe fear‐related behavior. Methods Clinical examination, complete blood cell count, routine blood biochemistry, and urinalysis were performed in all dogs. Magnetic resonance imaging (MRI) scans of the brain were performed in 3 affected Boerboels. In addition, in 2 affected Boerboels, metabolic screening, cerebrospinal fluid (CSF) analysis, and necropsy were performed. Results Onset of signs was 3 months of age in all affected Boerboels. All Boerboels howled loudly, had an extremely fearful facial expression and trembled during seizures. All affected Boerboels also had autonomic or motor signs. Results of laboratory investigations, diagnostic imaging, and metabolic screening were generally unremarkable. Histopathology showed moderate numbers of single large vacuoles in the perikaryon of neurons throughout the brain, specifically in the deeper cerebral cortical regions. Family history, pedigree analysis, and the homogenous phenotype were suggestive of autosomal recessive inheritance. Conclusions and Clinical Importance The observed paroxysmal fear‐related behavior represents a newly recognized hereditary focal epilepsy in dogs with distinctive clinical and histopathologic features. Veterinarians should be aware that sudden episodes of unusual behavior can represent focal epilepsy.
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Affiliation(s)
- Quirine E M Stassen
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Guy C M Grinwis
- Department of Pathobiology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Nieke C van Rhijn
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Martjin Beukers
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Nanda M Verhoeven-Duif
- Department of Genetics and Center for Molecular Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Peter A J Leegwater
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
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Epileptic auditory illusions as reliable findings in the determination of the lateralization and localization of epileptogenic zone. Epilepsy Behav 2018; 88:21-24. [PMID: 30212724 DOI: 10.1016/j.yebeh.2018.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 08/15/2018] [Accepted: 08/15/2018] [Indexed: 11/20/2022]
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12
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Demarquay G, Ducros A, Montavont A, Mauguiere F. Migraine with brainstem aura: Why not a cortical origin? Cephalalgia 2017; 38:1687-1695. [PMID: 29073774 DOI: 10.1177/0333102417738251] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Migraine with brainstem aura is defined as a migraine with aura including at least two of the following symptoms: dysarthria, vertigo, tinnitus, hypacusis, diplopia, ataxia and/or decreased level of consciousness. Aim The aim of this study is to review data coming from clinical observations and functional mapping that support the role of the cerebral cortex in the initiation of brainstem aura symptoms. Results Vertigo can result from a vestibular cortex dysfunction, while tinnitus and hypacusis can originate within the auditory cortex. Diplopia can reflect a parieto-occipital involvement. Dysarthria can be caused by dysfunctions located in precentral gyri. Ataxia can reflect abnormal processing of vestibular, sensory, or visual inputs by the parietal lobe. Alteration of consciousness can be caused by abnormal neural activation within specific consciousness networks that include prefrontal and posterior parietal cortices. Conclusion Any symptom of so-called brainstem aura can originate within the cortex. Based on these data, we suggest that brainstem aura could have a cortical origin. This hypothesis would explain the co-occurrence of typical and brainstem aura during attacks and would fit with the theory of cortical spreading depression. We propose that migraine with brainstem aura should be classified as a typical migraine aura.
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Affiliation(s)
- Geneviève Demarquay
- 1 Department of Neurology, Hospices Civils de Lyon, Lyon, France.,2 Lyon Neuroscience Research Center (CRNL), Brain Dynamics and Cognition Team (Dycog), INSERM U1028, CNRS UMR5292, Lyon, France
| | - Anne Ducros
- 3 Department of Neurology, Montpellier University Hospital, France.,4 Medical School of Montpellier University (UM), France
| | | | - François Mauguiere
- 1 Department of Neurology, Hospices Civils de Lyon, Lyon, France.,5 Lyon Neuroscience Research Center (CRNL), Neuropain team, INSERM U1028, CNRS UMR5292, Lyon, France.,6 Lyon 1 University, Lyon, France
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Kasper BS, Vaccarella M. Is epilepsy surgery a threat to a patient's self? A conversation. Epilepsy Behav 2017; 75:264-268. [PMID: 28827042 DOI: 10.1016/j.yebeh.2017.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 05/19/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Burkhard S Kasper
- Friedrich-Alexander University Erlangen-Nuremberg, Dept. Neurology, Epilepsy Center, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Maria Vaccarella
- Lecturer in Medical Humanities, Department of English, University of Bristol, 3/5 Woodland Road, Bristol, BS8 1TB, United Kingdom.
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14
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Jion YI, Grosberg BM, Evans RW. Phantosmia and Migraine With and Without Headache. Headache 2016; 56:1494-1502. [DOI: 10.1111/head.12890] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2016] [Indexed: 01/03/2023]
Affiliation(s)
| | - Brian M. Grosberg
- Hartford Healthcare Headache Center; Wethersfield CT USA (B.M. Grosberg)
| | - Randolph W. Evans
- Department of Neurology; Baylor College of Medicine; Houston TX USA (R.W. Evans)
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15
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Kellehear A. Unusual perceptions at the end of life: limitations to the diagnosis of hallucinations in palliative medicine. BMJ Support Palliat Care 2016; 7:238-246. [DOI: 10.1136/bmjspcare-2015-001083] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 01/12/2016] [Accepted: 01/13/2016] [Indexed: 01/10/2023]
Abstract
The diagnosis of hallucination for unusual perceptions such as deathbed visions, near-death experiences, or visions of the bereaved, is unhelpful in palliative medicine both academically and clinically. This paper reviews the broad prevalence data about unusual perceptions in the general population as background to identifying the more narrow epidemiological source from which the much smaller focus on hallucinations seem to emerge. Major debates and limitations of current hallucination research are reviewed to show that current academic and clinical certainties are largely confined to unusual perceptions that can be readily linked to psychopathology, quite specific organic disease states and psychoactive drug use. Current state-of-the-art in hallucination studies does not warrant broad or uncritical use of this type of diagnosis in end-of-life care. Conclusions from interdisciplinary (as opposed to single discipline) hallucination studies suggest that the way forward for clinical and research work in palliative medicine may lie in a more biographical and cultural approach to unusual perceptions at the end of life.
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Abstract
Although not included as a disorder in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition), olfactory reference disorder (ORD) is being considered for inclusion as a discrete disorder in the ICD-11 (International Classification of Diseases, 11th edition). ORD is likely underdiagnosed and undertreated. The purpose of this paper is to provide information to clinicians and researchers on the epidemiology, clinical presentation and treatment options for this condition. A narrative overview of the literature as retrieved from a computerized database search is provided. ORD is a condition that is characterized by the erroneous belief that one emits a foul or unpleasant body odour, resulting in significant distress and impairment. It is often accompanied by referential thinking and repetitive behaviours aimed at camouflaging the perceived odour. Level of insight varies, with some patients having concerns that are delusional. Patients usually do not spontaneously report their symptoms and so screening in suspected cases is crucial. The literature regarding ORD treatment remains limited.
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Latini F, Hjortberg M, Aldskogius H, Ryttlefors M. The Classical Pathways of Occipital Lobe Epileptic Propagation Revised in the Light of White Matter Dissection. Behav Neurol 2015; 2015:872645. [PMID: 26063964 PMCID: PMC4430656 DOI: 10.1155/2015/872645] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 04/20/2015] [Indexed: 11/18/2022] Open
Abstract
The clinical evidences of variable epileptic propagation in occipital lobe epilepsy (OLE) have been demonstrated by several studies. However the exact localization of the epileptic focus sometimes represents a problem because of the rapid propagation to frontal, parietal, or temporal regions. Each white matter pathway close to the supposed initial focus can lead the propagation towards a specific direction, explaining the variable semiology of these rare epilepsy syndromes. Some new insights in occipital white matter anatomy are herein described by means of white matter dissection and compared to the classical epileptic patterns, mostly based on the central position of the primary visual cortex. The dissections showed a complex white matter architecture composed by vertical and longitudinal bundles, which are closely interconnected and segregated and are able to support specific high order functions with parallel bidirectional propagation of the electric signal. The same sublobar lesions may hyperactivate different white matter bundles reemphasizing the importance of the ictal semiology as a specific clinical demonstration of the subcortical networks recruited. Merging semiology, white matter anatomy, and electrophysiology may lead us to a better understanding of these complex syndromes and tailored therapeutic options based on individual white matter connectivity.
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Affiliation(s)
- Francesco Latini
- Department of Neuroscience, Section of Neurosurgery, Uppsala University Hospital, 75185 Uppsala, Sweden
| | - Mats Hjortberg
- Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden
| | - Håkan Aldskogius
- Department of Neuroscience, Regenerative Neurobiology, Uppsala University, Uppsala, Sweden
| | - Mats Ryttlefors
- Department of Neuroscience, Section of Neurosurgery, Uppsala University Hospital, 75185 Uppsala, Sweden
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Occipital seizures and visual pseudohallucinations associated with the addition of bupropion to clozapine: a case report. J Clin Psychopharmacol 2015; 35:97-9. [PMID: 25502485 DOI: 10.1097/jcp.0000000000000265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Vaughan DN, Jackson GD. The piriform cortex and human focal epilepsy. Front Neurol 2014; 5:259. [PMID: 25538678 PMCID: PMC4259123 DOI: 10.3389/fneur.2014.00259] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 11/22/2014] [Indexed: 11/28/2022] Open
Abstract
It is surprising that the piriform cortex, when compared to the hippocampus, has been given relatively little significance in human epilepsy. Like the hippocampus, it has a phylogenetically preserved three-layered cortex that is vulnerable to excitotoxic injury, has broad connections to both limbic and cortical areas, and is highly epileptogenic – being critical to the kindling process. The well-known phenomenon of early olfactory auras in temporal lobe epilepsy highlights its clinical relevance in human beings. Perhaps because it is anatomically indistinct and difficult to approach surgically, as it clasps the middle cerebral artery, it has, until now, been understandably neglected. In this review, we emphasize how its unique anatomical and functional properties, as primary olfactory cortex, predispose it to involvement in focal epilepsy. From recent convergent findings in human neuroimaging, clinical epileptology, and experimental animal models, we make the case that the piriform cortex is likely to play a facilitating and amplifying role in human focal epileptogenesis, and may influence progression to epileptic intractability.
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Affiliation(s)
- David N Vaughan
- Florey Institute of Neuroscience and Mental Health , Heidelberg, VIC , Australia ; Department of Neurology, Austin Health , Heidelberg, VIC , Australia
| | - Graeme D Jackson
- Florey Institute of Neuroscience and Mental Health , Heidelberg, VIC , Australia ; Department of Neurology, Austin Health , Heidelberg, VIC , Australia ; Department of Medicine, University of Melbourne , Melbourne, VIC , Australia
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21
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Can hyper-synchrony in meditation lead to seizures? Similarities in meditative and epileptic brain states. Med Hypotheses 2014; 83:465-72. [DOI: 10.1016/j.mehy.2014.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 07/07/2014] [Accepted: 07/22/2014] [Indexed: 11/21/2022]
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22
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Complex visual hallucinations as the sole manifestation of symptomatic temporo-occipital lobe epilepsy due to old intracerebral hemorrhage. Seizure 2014; 23:244-6. [DOI: 10.1016/j.seizure.2013.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Revised: 10/31/2013] [Accepted: 11/01/2013] [Indexed: 11/22/2022] Open
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Abstract
This study investigated (1) the incidence of posttraumatic stress disorder following epileptic seizure (post-epileptic seizure PTSD) and psychiatric co-morbidity and (2) the extent to which alexithymia traits related to the severity of the preceding outcomes. Seventy-one people with epilepsy participated in the study and completed the Posttraumatic Stress Diagnostic Scale, Hospital Anxiety and Depression Scale (HADS), and Toronto Alexithymia Scale. The control group comprised 71 people without epilepsy who completed the HADS. Fifty-one percent met the diagnostic criteria for full-PTSD; 30 % for partial-PTSD and 19 % for no-PTSD. The epilepsy group reported significantly more anxiety and depression than the control with demographic variables controlled for. Difficulty identifying feelings predicted post-epileptic seizure PTSD, anxiety and depression. It was positively correlated with post-epileptic seizure PTSD and depression, while it was negatively correlated with anxiety. People can develop PTSD and psychiatric co-morbid symptoms following epileptic seizures. The severity of these symptoms was related to difficulty in identifying internal feelings and emotions.
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Affiliation(s)
- Man Cheung Chung
- Natural Science and Public Health, Zayed University, PO Box 144534, Abu Dhabi, UAE.
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25
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de Laat SAA, Hillegers MHJ, Jansen FE, Braun KP, de Graeff-Meeder ER. Hallucinations after withdrawal of valproic acid. Pediatrics 2012; 130:e236-8. [PMID: 22689876 DOI: 10.1542/peds.2011-2608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We report 2 children with a history of epilepsy in whom valproic acid (VPA) withdrawal was identified as a potential cause of hallucinations. After a restart of VPA, the hallucinations disappeared. We suggest mechanisms for the occurrence of the hallucinations and a possible control of a predisposition to hallucinations by VPA.
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Diagnostic challenge in neuropsychiatry: two case reports. Open Med (Wars) 2012. [DOI: 10.2478/s11536-011-0151-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
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Diagnostic challenge in neuropsychiatry: two case reports. Open Med (Wars) 2012. [DOI: 10.2478/s11536-011-0141-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
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