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Mithani K, Richards OL, Ebden M, Malik N, Greuter L, Suresh H, Niazi F, Gouveia FV, Widjaja E, Weiss S, Donner E, Otsubo H, Ochi A, Jain P, Yau I, Kerr EN, Rutka JT, Drake JM, Weil AG, Ibrahim GM. Intraoperative changes in large-scale thalamic circuitry following laser ablation of hypothalamic hamartomas. Neuroimage Clin 2024; 42:103613. [PMID: 38714093 PMCID: PMC11098953 DOI: 10.1016/j.nicl.2024.103613] [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: 02/29/2024] [Revised: 04/08/2024] [Accepted: 04/28/2024] [Indexed: 05/09/2024]
Abstract
BACKGROUND AND OBJECTIVES Gelastic seizures due to hypothalamic hamartomas (HH) are challenging to treat, in part due to an incomplete understanding of seizure propagation pathways. Although magnetic resonance imaging-guided laser interstitial thermal therapy (MRgLITT) is a promising intervention to disconnect HH from ictal propagation networks, the optimal site of ablation to achieve seizure freedom is not known. In this study, we investigated intraoperative post-ablation changes in resting-state functional connectivity to identify large-scale networks associated with successful disconnection of HH. METHODS Children who underwent MRgLITT for HH at two institutions were consecutively recruited and followed for a minimum of one year. Seizure freedom was defined as Engel score of 1A at the last available follow-up. Immediate pre- and post- ablation resting-state functional MRI scans were acquired while maintaining a constant depth of general anesthetic. Multivariable generalized linear models were used to identify intraoperative changes in large-scale connectivity associated with seizure outcomes. RESULTS Twelve patients underwent MRgLITT for HH, five of whom were seizure-free at their last follow-up. Intraprocedural changes in thalamocortical circuitry involving the anterior cingulate cortex were associated with seizure-freedom. Children who were seizure-free demonstrated an increase and decrease in connectivity to the pregenual and dorsal anterior cingulate cortices, respectively. In addition, children who became seizure-free demonstrated increased thalamic connectivity to the periaqueductal gray immediately following MRgLITT. DISCUSSION Successful disconnection of HH is associated with intraoperative, large-scale changes in thalamocortical connectivity. These changes provide novel insights into the large-scale basis of gelastic seizures and may represent intraoperative biomarkers of treatment success.
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Affiliation(s)
- Karim Mithani
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Oliver L Richards
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mark Ebden
- Neurosciences & Mental Health, SickKids Research Institute, Toronto, Ontario, Canada
| | - Noor Malik
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ladina Greuter
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hrishikesh Suresh
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Farbod Niazi
- Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | | | - Elysa Widjaja
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shelly Weiss
- Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elizabeth Donner
- Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hiroshi Otsubo
- Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ayako Ochi
- Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Puneet Jain
- Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ivanna Yau
- Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elizabeth N Kerr
- Department of Psychology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - James T Rutka
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - James M Drake
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alexander G Weil
- Division of Neurosurgery, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - George M Ibrahim
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada; Neurosciences & Mental Health, SickKids Research Institute, Toronto, Ontario, Canada
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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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Demir AB, Öz BY, Yıldız MO, Türk BG, Tanrıverdi T, Bekar A, Yeni N, Bora İ. A clinical evaluation of gelastic and dacrystic seizures: a multicenter study. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:1204-1212. [PMID: 36580957 PMCID: PMC9800159 DOI: 10.1055/s-0042-1758755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Gelastic seizures are extremely rare, short-lasting, unprovoked, and uncontrollable laughing attacks. We conducted this retrospective evaluation to determine whether these symptoms, manifesting in different forms, such as cheerful laughter, laughing, smiling, and sobbing had any value in terms of etiology or localization. METHODS A total of 31 patients who exhibited bouts of laughing or crying and who were under follow-up between 2000 and 2019 at tertiary epilepsy centers were included in the study. Laughing seizures were divided into three groups in terms of semiology (i.e., laughter with mirth, laughter without mirth, and smile). Dacrystic seizures were accompanied by some gelastic seizures and were divided into two groups in terms of semiology (i.e., weeping loudly [motor and voice-sobbing] and crying). RESULTS Of the 27 patients with laughing seizures, 12 had seizures that manifested with smiling, 7 had seizures that manifested with laughing and mirth, and 8 had seizures that manifested with laughter without mirth. Dacrystic-gelastic seizures were observed in four patients, among whom 2 patients had crying and laughter without mirth and 2 patients had weeping loudly and laughter without mirth episodes. CONCLUSION Gelastic and dacrystic seizures often suggest hypothalamic hamartomas, in the literature. This rare ictal behavior can originate from different cortical locations and lesions of a different nature. However, we found that gelastic seizures with smiling were a more homogenous group with regard to location in the temporal lobe, which we aimed to show by evaluating the patients included in this study.
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Affiliation(s)
- Aylin Bican Demir
- Bursa Uludag University, Faculty of Medicine, Epilepsy Center, Department of Neurology, Bursa, Turkey.,Address for correspondence Aylin Bican Demir
| | - Başak Yılmaz Öz
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Epilepsy Center, Department of Neurology, Istanbul, Turkey.
| | - Mustafa Onur Yıldız
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Epilepsy Center, Department of Neurology, Istanbul, Turkey.
| | - Bengi Gül Türk
- Dr Selahattin Cizrelioglu Cizre State Hospital, Department of Neurology, Hakkari, Turkey.
| | - Taner Tanrıverdi
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Epilepsy Center, Department of Neurosurgery, Istanbul, Turkey.
| | - Ahmet Bekar
- Bursa Uludag University, Faculty of Medicine, Epilepsy Center, Department of Neurosurgery, Bursa, Turkey.
| | - Naz Yeni
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Epilepsy Center, Department of Neurology, Istanbul, Turkey.
| | - İbrahim Bora
- Bursa Uludag University, Faculty of Medicine, Epilepsy Center, Department of Neurology, Bursa, Turkey.
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Alonso-Frech F, Fernandez-Garcia C, Gómez-Mayordomo V, Monje MHG, Delgado-Suarez C, Villanueva-Iza C, Catalan-Alonso MJ. Non-motor Adverse Effects Avoided by Directional Stimulation in Parkinson's Disease: A Case Report. Front Neurol 2022; 12:786166. [PMID: 35173666 PMCID: PMC8843015 DOI: 10.3389/fneur.2021.786166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/29/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Deep brain stimulation (DBS) is widely used for treatment of advanced, medication-refractory Parkinson's disease (PD). However, a significant proportion of patients may suffer adverse effects; up to 10% will present one or more transient or permanent neurobehavioral events. Patient and Methods In our case study, a 44-year-old woman diagnosed with PD 6 years previously who was suffering from motor fluctuations, dyskinesia, and freezing of gait episodes was submitted for DBS and implanted with directional electrodes. Intraoperative local field potentials (LFPs) were recorded. After surgery, conventional monopolar revision was performed. Preoperative 3T MRI studies and postoperative 3D and X-ray data were integrated using the Guide DTI software application (Brainlab), and diffusion tensor imaging tractography traced from cortical areas to each subthalamic nucleus (STN) using Elements software (Brainlab). Results We observed that left STN stimulation in the ring mode significantly improved motor symptoms, but the patient presented uncontrollable mirthful laughter. Stimulation was then switched to the directional mode; laughter remained when using the more posteromedial contact (3-C+) but not 2-C+ or 4-C+ at the same parameters. Interestingly, LFP recordings showed the highest beta-band activity over contacts 4 and 2, and very scarce beta power over contact 3. The orientation of the directional leads was selected based on the 3D postoperative X-rays. Associative fibers showed the shortest distance to contact number 3. Conclusion Stimulation of the STN can affect motor and associative loops. The use of directional electrodes is a good option to avoid not only undesirable capsular or lemniscal effects, but also limbic/associative events. Oscillatory activity in the beta range that preferentially takes place over the somatomotor STN region and is closely related to motor improvement, provides a reliable guide for optimizing the DBS programming. The importance of the exact location of electrical stimulation to determine the non-motor symptoms such as mood, apathy, attention, and memory, as well as the usefulness of biological markers such as LFP for optimal programming, is discussed in relation to this case.
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Affiliation(s)
- Fernando Alonso-Frech
- Department of Neurology, San Carlos Research Health Institute (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
- *Correspondence: Fernando Alonso-Frech
| | - Carla Fernandez-Garcia
- Department of Neurosurgery, San Carlos Research Health Institute (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
- Carla Fernandez-Garcia
| | - Victor Gómez-Mayordomo
- Department of Neurology, San Carlos Research Health Institute (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Mariana H. G. Monje
- Department of Neurology, San Carlos Research Health Institute (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
| | | | - Clara Villanueva-Iza
- Department of Neurology, San Carlos Research Health Institute (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Maria Jose Catalan-Alonso
- Department of Neurology, San Carlos Research Health Institute (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
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Hu L, Ding F, Wang S, Wang S. MRI-Negative Occipital Lobe Epilepsy Presenting as Gelastic Seizures. Neurol India 2022; 69:1813-1816. [PMID: 34979696 DOI: 10.4103/0028-3886.333525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Although gelastic seizures (GSs) with extrahypothalamic epileptogenic zones such as the frontal, temporal, or parietal lobes have been previously reported, reports of GSs arising from the occipital region are rare. Herein, we describe the seizure propagation pattern of mirthless GSs confirmed by intracranial EEG in a case of MRI-negative occipital lobe epilepsy. In this patient, EEG onset was localized to the right occipital lobe while the onset of laughter coincided with seizure propagation to the right basal temporal region. This finding suggested that the symptomatogenic area for GSs in the occipital lobe may reside in the basal temporal region, and the basal temporal region may play a role in laughing behaviors. This case demonstrated that an elaborate analysis of electroclinical features combined with imaging findings may lead to successful seizure localization.
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Affiliation(s)
- Lingli Hu
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Fang Ding
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Shan Wang
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Shuang Wang
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Abstract
PURPOSE OF REVIEW The increased identification of seizures with insular ictal onset, promoted by the international development of stereo-electroencephalography (SEEG), has led to the recent description of larger cohorts of patients with insular or insulo-opercular epilepsies than those previously available. These new series have consolidated and extended our knowledge of the rich ictal semiology and diverse anatomo-clinical correlations that characterized insular seizures. In parallel, some experiences have been gained in the surgical treatment of insular epilepsies using minimal invasive procedures. RECENT FINDINGS The large majority of patients present with auras (mostly somatosensory and laryngeal) and motor signs (predominantly elementary and orofacial), an underlying focal cortical dysplasia, and an excellent postoperative seizure outcome. Many other subjective and objective ictal signs, known to occur in other forms of epilepsies, are also observed and clustered in five patterns, reflecting the functional anatomy of the insula and its overlying opercula, as well as preferential propagation pathways to frontal or temporal brain regions. A nocturnal predominance of seizure is frequently reported, whereas secondary generalization is infrequent. Some rare ictal signs are highly suggestive of an insular origin, including somatic pain, reflex seizures, choking spells, and vomiting. Minimal invasive surgical techniques have been applied to the treatment of insular epilepsies, including Magnetic Resonance Imaging-guided laser ablation (laser interstitial thermal therapy (LITT)), radiofrequency thermocoagulation (RFTC), gamma knife radiosurgery, and responsive neurostimulation. Rates of seizure freedom (about 50%) appear lower than that reported with open-surgery (about 80%) with yet a significant proportion of transient neurological deficit for LITT and RFTC. SUMMARY Significant progress has been made in the identification and surgical treatment of insular and insulo-opercular epilepsies, including more precise anatomo-clinical correlations to optimally plan SEEG investigations, and experience in using minimal invasive surgery to reduce peri-operative morbidity.
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Gelastic seizures not associated with hypothalamic hamartoma: A long-term follow-up study. Epilepsy Behav 2020; 103:106578. [PMID: 31680025 DOI: 10.1016/j.yebeh.2019.106578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/14/2019] [Accepted: 09/18/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The objective of the study was to describe the electroclinical features, seizure semiology, and the long-term evolution of gelastic seizures (GS) not associated with hypothalamic hamartoma (HH). METHODS We reviewed video-electroencephalogram (video-EEG) recordings from pediatric patients with GS without HH admitted to 14 Italian epilepsy centers from 1994 to 2013. We collected information about age at onset, seizures semiology, EEG and magnetic resonance imaging (MRI) findings, treatment, and clinical outcome in terms of seizure control after a long-term follow-up. RESULTS A total of 30 pediatric patients were stratified into two groups according to neuroimaging findings: group 1 including 19 children (63.3%) with unremarkable neuroimaging and group 2 including 11 children with structural brain abnormalities (36.7%). At the follow-up, patients of group 1 showed better clinical outcome both in terms of seizure control and use of AED polytherapy. Our patients showed remarkable clinical heterogeneity, including seizure semiology and epilepsy severity. Electroencephalogram recordings showed abnormalities mainly in the frontal, temporal, and frontotemporal regions without relevant differences between the two groups. Overall, carbamazepine showed good efficacy to control GS. CONCLUSIONS Patients with nonlesional GS have a more favorable outcome with better drug response, less need of polytherapy, and good long-term prognosis, both in terms of seizure control and EEG findings.
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Mainka T, Balint B, Gövert F, Kurvits L, van Riesen C, Kühn AA, Tijssen MAJ, Lees AJ, Müller-Vahl K, Bhatia KP, Ganos C. The spectrum of involuntary vocalizations in humans: A video atlas. Mov Disord 2019; 34:1774-1791. [PMID: 31651053 DOI: 10.1002/mds.27855] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/22/2019] [Accepted: 08/21/2019] [Indexed: 12/11/2022] Open
Abstract
In clinical practice, involuntary vocalizing behaviors are typically associated with Tourette syndrome and other tic disorders. However, they may also be encountered throughout the entire tenor of neuropsychiatry, movement disorders, and neurodevelopmental syndromes. Importantly, involuntary vocalizing behaviors may often constitute a predominant clinical sign, and, therefore, their early recognition and appropriate classification are necessary to guide diagnosis and treatment. Clinical literature and video-documented cases on the topic are surprisingly scarce. Here, we pooled data from 5 expert centers of movement disorders, with instructive video material to cover the entire range of involuntary vocalizations in humans. Medical literature was also reviewed to document the range of possible etiologies associated with the different types of vocalizing behaviors and to explore treatment options. We propose a phenomenological classification of involuntary vocalizations within different categorical domains, including (1) tics and tic-like vocalizations, (2) vocalizations as part of stereotypies, (3) vocalizations as part of dystonia or chorea, (4) continuous vocalizing behaviors such as groaning or grunting, (5) pathological laughter and crying, (6) vocalizations resembling physiological reflexes, and (7) other vocalizations, for example, those associated with exaggerated startle responses, as part of epilepsy and sleep-related phenomena. We provide comprehensive lists of their associated etiologies, including neurodevelopmental, neurodegenerative, neuroimmunological, and structural causes and clinical clues. We then expand on the pathophysiology of the different vocalizing behaviors and comment on available treatment options. Finally, we present an algorithmic approach that covers the wide range of involuntary vocalizations in humans, with the ultimate goal of improving diagnostic accuracy and guiding appropriate treatment. © 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Tina Mainka
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Bettina Balint
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, UK.,Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Felix Gövert
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Lille Kurvits
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Christoph van Riesen
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany.,Department of Neurology, University Medicine Göttingen, Göttingen, Germany
| | - Andrea A Kühn
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Marina A J Tijssen
- Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Andrew J Lees
- Reta Lila Weston Institute of Neurological Studies, UCL, Institute of Neurology, London, UK
| | - Kirsten Müller-Vahl
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, UK
| | - Christos Ganos
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
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Isnard J, Hagiwara K, Montavont A, Catenoix H, Mazzola L, Ostrowsky-Coste K, Guenot M, Rheims S. Semiology of insular lobe seizures. Rev Neurol (Paris) 2019; 175:144-149. [DOI: 10.1016/j.neurol.2018.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 11/12/2018] [Accepted: 12/07/2018] [Indexed: 12/22/2022]
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Kausar MA. A review on Respiratory allergy caused by insects. Bioinformation 2018; 14:540-553. [PMID: 31223213 PMCID: PMC6563666 DOI: 10.6026/97320630014540] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 12/20/2018] [Accepted: 12/20/2018] [Indexed: 02/08/2023] Open
Abstract
Hypersensitivity or allergy encompasses a wide range of immunological reactions that generally have adverse consequences involving one or many organ systems of the body. Allergens are usually glycoprotein or chemically complex low molecular weight substances. The common allergens include pollen, fungal spores, house dust mite and house dust, animal danders, drugs, foods, insect emanations, and detritus, etc. Information on the role of insects in respiratory allergy is increasing in the literature. There are about 30 million living species of insects. These insects can broadly be classified as stinging insects, biting insects and non-stinging and non-biting insects. All materials form insets namely wings, scales, saliva; dried feces and venom can cause allergic diseases, such as rhinitis, conjunctivitis, asthma and urticaria. There are wide varieties of insects such as moths, butterflies, bees, wasps, hornets, yellow jackets, flies, beetles, cockroaches, and mosquitoes. Exposure to emanations and detritus of these insects may lead to several allergies in some genetically predisposed individuals. Therefore, it is of interest to review allergies caused by various insect's stings and bites and their adverse effect on the human body.
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Affiliation(s)
- Mohd Adnan Kausar
- Department of Biochemistry, College of Medicine, University of Hail, Hail, Saudi Arabia, KSA
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Chibane IS, Boucher O, Dubeau F, Tran TPY, Mohamed I, McLachlan R, Sadler RM, Desbiens R, Carmant L, Nguyen DK. Orbitofrontal epilepsy: Case series and review of literature. Epilepsy Behav 2017; 76:32-38. [PMID: 28928072 DOI: 10.1016/j.yebeh.2017.08.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/27/2017] [Accepted: 08/27/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Orbitofrontal epilepsy (OFE) is less known and is poorly characterized in comparison with temporal lobe epilepsy, partly because it is rare and possibly because it is unrecognized and therefore underestimated. OBJECTIVE This paper aimed to better characterize seizure semiology, presurgical findings, and surgical outcomes in patients with OFE. METHODS We retrospectively reviewed all confidently established OFE cases from six Canadian epilepsy monitoring units between 1988 and 2014, and in the literature between 1972 and 2017. Inclusion criteria were identification of an epileptogenic lesion localized in the OFC or if the patient was seizure-free after surgical removal of the OFC in nonlesional cases. RESULTS Sixteen cases were identified from our databases. Fifty percent had predominantly sleep-related seizures; 56% had no aura (the remaining had nonspecific or vegetative auras), and 62.5% featured hypermotor (mostly hyperkinetic) behaviors. Interictal epileptiform discharges over frontal and temporal derivations always allowed lateralization. Magnetic resonance imaging (MRI) identified an orbitofrontal lesion in 8/16, positron emission tomography (PET) identified a hypometabolism extending outside the orbital cortex in 4/9, ictal single-photon emission computed tomography (SPECT) identified an orbital hyperperfusion in 1/5, magnetoencephalography (MEG) identified lateral orbital sources in 2/4, and intracranial electroencephalography (EEG) identified an orbitofrontal onset in 9/10. Fourteen patients underwent surgery, all reaching a favorable outcome (71.4% Engel 1; 28.6% Engel 2; mean FU=5.6years). Pre- and postoperative neuropsychological assessments revealed heterogeneous findings. Our review of literature identified 71 possible cases of OFE, 32 with confident focus localization. Extracted data from these cumulated cases supported observations made from our case series. CONCLUSIONS Orbitofrontal epilepsy should be suspected with sleep-related, hyperkinetic seizures with no specific aura, and frontotemporal interictal discharges. Several patients have nonmotor seizures with or without auras which may resemble temporal lobe seizures. Postoperative seizure outcome was favorable, but there is inherent bias as we only included patients with a seizure-free outcome if the MRI was negative. A larger study is required to address identified gaps in knowledge such as identifying discriminative features between medial and lateral OFE, evaluating the value of more recent diagnostic tools, and assessing the neuropsychological outcome of orbital epilepsy surgery.
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Affiliation(s)
- Imane Samah Chibane
- Division of Neurology, CHUM Notre-Dame, Université de Montréal, Québec, Canada
| | - Olivier Boucher
- Department of Psychology, Université de Montréal, Québec, Canada
| | - François Dubeau
- Division of Neurology, Montreal Neurological Hospital and Institute, McGill University, Québec, Canada
| | - Thi Phuoc Yen Tran
- Division of Neurology, CHUM Notre-Dame, Université de Montréal, Québec, Canada; Department of Internal Medicine, Hue University of Medicine and Pharmacy, Hue University, Hue, Viet Nam
| | - Ismail Mohamed
- Department of Paediatrics, Division of Neurology, University of Alabama, Birmingham, AL, USA
| | - Richard McLachlan
- Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
| | - R Mark Sadler
- Department of Medicine, Division of Neurology, Dalhousie University Halifax, Nova Scotia, Canada
| | - Richard Desbiens
- Division of Neurology, CHA Hôpital Enfant-Jésus, Université Laval, Québec, Canada
| | - Lionel Carmant
- Division of Paediatric Neurology, Hôpital Sainte-Justine, Université de Montréal, Québec, Canada
| | - Dang Khoa Nguyen
- Division of Neurology, CHUM Notre-Dame, Université de Montréal, Québec, Canada.
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Striano S, Striano P. Clinical features and evolution of the gelastic seizures-hypothalamic hamartoma syndrome. Epilepsia 2017; 58 Suppl 2:12-15. [DOI: 10.1111/epi.13753] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Salvatore Striano
- Department of Neurosciences, Reproductive and Odontostomatological Sciences; Epilepsy Center; School of Medicine; Federico II University; Napoli Italy
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health; Institute “G. Gaslini”; University of Genova; Genova Italy
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Marashly A, Lew S, Koop J. Successful surgical management of New Onset Refractory Status Epilepticus (NORSE) presenting with gelastic seizures in a 3 year old girl. EPILEPSY & BEHAVIOR CASE REPORTS 2017; 8:18-26. [PMID: 28725554 PMCID: PMC5501888 DOI: 10.1016/j.ebcr.2017.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/10/2017] [Accepted: 05/18/2017] [Indexed: 11/18/2022]
Abstract
Gelastic seizures (GS) are typically associated with hypothalamic hamartomas and present during childhood. However it is now known that GS can be found in focal epilepsies arising from other regions in the brain, including mesial and neocortical frontal, temporal and parietal regions. GS have rarely been described as the presenting manifestation of New Onset Refractory Status Epilepticus (NORSE). In this article we describe a previously healthy 3-year-old who presented with an explosive onset of GS that were refractory to multiple anti-seizure medications. These seizures arose from the right frontal region. An extensive metabolic and immunological evaluation was negative. Her brain magnetic resonance imaging (MRI) was negative, however the Positron Emission Tomography (PET) scan showed a hypermetabolic region in the right frontal inferior gyrus. She underwent a depth electrode evaluation that revealed a widespread irritative zone involving the PET “lesion” as well as mesial and neocortical regions in the right frontal lobe. The seizure onset zone was widespread and non-localizable. However the GS were associated with a clear ictal epileptiform discharge on invasive EEG arising from the depth of the superior frontal gyrus, which was not overlapping with the PET hypermetabolic region. She underwent a right frontal lobectomy sparing the primary motor region in the pre-central gyrus. She has remained seizure free for 15 months since. The pathological analysis showed focal cortical dysplasia type II in the region of the PET scan hypermetabolism. This case expands the clinical spectrum of GS to include cases of NORSE. Additionally the case highlights the role of resective surgery in GS presenting as NORSE and the potentially excellent outcome that can be achieved by early intervention.
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Affiliation(s)
- Ahmad Marashly
- Division of Pediatric Neurology, Children's Hospital of Wisconsin/Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sean Lew
- Division of Pediatric Neurosurgery, Children's Hospital of Wisconsin/Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer Koop
- Division of Pediatric Neuropsychology, Children's Hospital of Wisconsin/Medical College of Wisconsin, Milwaukee, WI, USA
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Gelastic seizures caused by subtle focal cortical dysplasia in the inferior frontal gyrus: Three case reports. J Neurol Sci 2017; 376:140-142. [DOI: 10.1016/j.jns.2017.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 02/12/2017] [Accepted: 03/07/2017] [Indexed: 11/22/2022]
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Ictal laughter and crying: Should they be classified as automatisms? EPILEPSY & BEHAVIOR CASE REPORTS 2017; 7:31-33. [PMID: 28239548 PMCID: PMC5318346 DOI: 10.1016/j.ebcr.2016.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/19/2016] [Accepted: 11/25/2016] [Indexed: 11/21/2022]
Abstract
Gelastic seizures (GS) describe ictal laughter and are associated with hypothalamic lesions, as well as other cortical areas. Dacrystic seizures (DS), characterized by ictal crying, also have been reported in hypothalamic lesions and focal epilepsy. We describe a young girl with drug resistant focal dyscognitive seizures associated with gelastic and dacrystic features. However, neither laughter nor crying was correlated with a stereotyped electroencephalographic (EEG) pattern or involvement of a particular brain region. Additionally, based on the variety of epileptogenic foci associated with GS and DS in the literature, laughter and crying appear to represent ictal or peri-ictal automatisms. Case report of focal dyscognitive seizures with gelastic and dacrystic features Patient seizure free after resection of parietal and insular cortical dysplasia She underwent scalp (sEEG) and intracranial (icEEG) video-EEG monitoring. Gelastic/dacrystic features not linked to specific EEG pattern or cortical area Gelastic/dacrystic symptoms represent automatisms without localizing significance.
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Gutierrez C, Asadi-Pooya AA, Skidmore CT, Tobochnik SD, LoPinto-Khoury C, Sperling MR. Clinical features and postoperative seizure outcome in patients with drug-resistant gelastic seizures without hypothalamic hamartoma. Epilepsy Behav 2016; 64:90-93. [PMID: 27736662 DOI: 10.1016/j.yebeh.2016.09.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 09/20/2016] [Accepted: 09/20/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The objective of this study was to describe the clinical characteristics and surgical outcome in patients with gelastic seizures without hypothalamic hamartoma. METHODS We retrospectively reviewed all the video-EEG reports over a 5-year period (2007-2011) for the occurrence of the terms "laugh" or "giggle" in the text body. All the patients with at least one documented gelastic seizure at the epilepsy monitoring unit were studied. In patients who underwent epilepsy surgery, seizure outcomes were analyzed. RESULTS Sixteen patients (10 females and 6 males) with a mean age of 46.3years were studied. Seven patients had invasive intracranial EEG recordings. Seizure onset zone was in a temporal lobe in four patients and the frontal lobe in one patient. Two patients did not have gelastic seizures during their intracranial EEG monitoring. Nine patients underwent resective epilepsy surgery for their seizures. Six patients (67%) were seizure-free after surgery. CONCLUSION In adult patients, gelastic seizures can be seen in patients with focal epilepsy without hypothalamic hamartoma. Nonhypothalamic hamartoma gelastic seizures originating from the temporal lobe can be amenable to surgery.
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Affiliation(s)
- Camilo Gutierrez
- Temple University Comprehensive Epilepsy Center, Department of Neurology, Temple University Hospital, Philadelphia, PA, USA.
| | - Ali A Asadi-Pooya
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Christopher T Skidmore
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Steven D Tobochnik
- Neurological Institute of New York, Columbia University Medical Center, New York, NY, USA
| | | | - Michael R Sperling
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
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Abstract
Humor, or the perception or elicitation of mirth and funniness, is distinguishable from laughter and can be differentially disturbed by neuropsychiatric disease. The authors describe two patients with constant joking, or Witzelsucht, in the absence of pseudobulbar affect and review the literature on pathological humor. These patients had involvement of frontal structures, impaired appreciation of nonsimple humor, and a compulsion for disinhibited joking. Current neuroscience suggests that impaired humor integration from right lateral frontal injury and disinhibition from orbitofrontal damage results in disinhibited humor, preferentially activating limbic and subcortical reward centers. Additional frontal-subcortical circuit dysfunction may promote pathological joking as a compulsion.
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Affiliation(s)
- Elias Granadillo
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles (UCLA),Neurology Service, Neurobehavior Unit, V.A. Greater Los Angeles Healthcare System
| | - Mario F. Mendez
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles (UCLA),Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles (UCLA),Neurology Service, Neurobehavior Unit, V.A. Greater Los Angeles Healthcare System
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Jimenez-Sanders R, Behrouz R, Tsakadze N. Allergic encephalitis with gelastic status epilepticus induced by wasp sting. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2015; 2:e114. [PMID: 26015991 PMCID: PMC4436594 DOI: 10.1212/nxi.0000000000000114] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 03/25/2015] [Indexed: 11/24/2022]
Affiliation(s)
- Rebecca Jimenez-Sanders
- Department of Neurology (R.J.-S., N.T.), University of South Florida Morsani College of Medicine, Tampa, FL; and Department of Neurology (R.B.), The Ohio State University College of Medicine, Columbus, OH
| | - Réza Behrouz
- Department of Neurology (R.J.-S., N.T.), University of South Florida Morsani College of Medicine, Tampa, FL; and Department of Neurology (R.B.), The Ohio State University College of Medicine, Columbus, OH
| | - Nina Tsakadze
- Department of Neurology (R.J.-S., N.T.), University of South Florida Morsani College of Medicine, Tampa, FL; and Department of Neurology (R.B.), The Ohio State University College of Medicine, Columbus, OH
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Kovac S, Diehl B, Wehner T, Fois C, Toms N, Walker MC, Duncan JS. Gelastic seizures: Incidence, clinical and EEG features in adult patients undergoing video-EEG telemetry. Epilepsia 2014; 56:e1-5. [DOI: 10.1111/epi.12868] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Stjepana Kovac
- Institute of Neurology; National Hospital for Neurology and Neurosurgery; London United Kingdom
- Department of Clinical Neurophysiology; National Hospital for Neurology and Neurosurgery; London United Kingdom
| | - Beate Diehl
- Institute of Neurology; National Hospital for Neurology and Neurosurgery; London United Kingdom
- Department of Clinical Neurophysiology; National Hospital for Neurology and Neurosurgery; London United Kingdom
| | - Tim Wehner
- Institute of Neurology; National Hospital for Neurology and Neurosurgery; London United Kingdom
- Department of Clinical Neurophysiology; National Hospital for Neurology and Neurosurgery; London United Kingdom
| | - Chiara Fois
- Institute of Neurology; National Hospital for Neurology and Neurosurgery; London United Kingdom
- Department of Clinical and Experimental Medicine; University of Sassari; Sassari Italy
| | - Nathan Toms
- Department of Clinical Neurophysiology; National Hospital for Neurology and Neurosurgery; London United Kingdom
| | - Matthew C. Walker
- Institute of Neurology; National Hospital for Neurology and Neurosurgery; London United Kingdom
| | - John S. Duncan
- Institute of Neurology; National Hospital for Neurology and Neurosurgery; London United Kingdom
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