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Vogrig A, Bellizzi F, Burini A, Gigli GL, Girardi L, Honnorat J, Valente M. Sudden unexpected death in epilepsy and ictal asystole in patients with autoimmune encephalitis: a systematic review. Neurol Sci 2024; 45:2811-2823. [PMID: 38194197 PMCID: PMC11081980 DOI: 10.1007/s10072-023-07280-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/18/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVE As autoimmune encephalitis (AE) often involves the mesial temporal structures which are known to be involved in both sudden unexpected death in epilepsy (SUDEP) and ictal asystole (IA), it may represent a good model to study the physiopathology of these phenomena. Herein, we systematically reviewed the occurrence of SUDEP and IA in AE. METHODS We searched 4 databases (MEDLINE, Scopus, Embase, and Web of Science) for studies published between database inception and December 20, 2022, according to the PRISMA guidelines. We selected articles reporting cases of definite/probable/possible/near-SUDEP or IA in patients with possible/definite AE, or with histopathological signs of AE. RESULTS Of 230 records assessed, we included 11 cases: 7 SUDEP/near-SUDEP and 4 IA. All patients with IA were female. The median age at AE onset was 30 years (range: 15-65), and the median delay between AE onset and SUDEP was 11 months; 0.9 months for IA. All the patients presented new-onset seizures, and 10/11 also manifested psychiatric, cognitive, or amnesic disorders. In patients with SUDEP, 2/7 were antibody-positive (1 anti-LGI1, 1 anti-GABABR); all IA cases were antibody-positive (3 anti-NMDAR, 1 anti-GAD65). Six patients received steroid bolus, 3 intravenous immunoglobulin, and 3 plasmapheresis. A pacemaker was implanted in 3 patients with IA. The 6 survivors improved after treatment. DISCUSSION SUDEP and IA can be linked to AE, suggesting a role of the limbic system in their pathogenesis. IA tends to manifest in female patients with temporal lobe seizures early in AE, highlighting the importance of early diagnosis and treatment.
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Affiliation(s)
- Alberto Vogrig
- Clinical Neurology, Department of Medicine (DAME), University of Udine, Udine, Italy.
- Clinical Neurology, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Piazzale Santa Maria della Misericordia, 15, 33010, Udine, Italy.
| | - Fabrizio Bellizzi
- Clinical Neurology, Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Alessandra Burini
- Clinical Neurology, Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Gian Luigi Gigli
- Clinical Neurology, Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Luca Girardi
- Department of Environmental Systems Science, Swiss Federal Institute of Technology (ETH) Zürich, Zurich, Switzerland
| | - Jérôme Honnorat
- French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospital for Neurology and Neurosurgery Pierre Wertheimer, Lyon University Hospital, Lyon, France
- MeLiS Institute - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France
| | - Mariarosaria Valente
- Clinical Neurology, Department of Medicine (DAME), University of Udine, Udine, Italy
- Clinical Neurology, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Piazzale Santa Maria della Misericordia, 15, 33010, Udine, Italy
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Di Giacomo R, Burini A, Visani E, Doniselli FM, Cuccarini V, Garbelli R, Marucci G, De Santis D, Didato G, Deleo F, Pastori C, Stabile A, Villani F, Rizzi M, Girardi L, de Curtis M. Distinctive electro-clinical, neuroimaging and histopathological features of temporal encephaloceles associated to epilepsy. Neurol Sci 2023; 44:4451-4463. [PMID: 37458845 DOI: 10.1007/s10072-023-06939-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/30/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE Encephaloceles (ENCs) may cause clinical complications, including drug-resistant epilepsy that can be cured with epilepsy surgery. METHODS We describe clinical, diagnostic, and neuropathological findings of 12 patients with temporal ENC and epilepsy evaluated for surgery and compare them with a control group of 26 temporal lobe epilepsy (TLE) patients. RESULTS Six patients had unilateral and 6 bilateral temporal ENCs. Compared to TLEs, ENCs showed i) later epilepsy onset, ii) higher prevalence of psychiatric comorbidities, iii) no history of febrile convulsions, and iv) ictal semiology differences. Seven patients had MRI signs of gliosis, and 9 of intracranial hypertension. Interictal EEG analysis in ENCs demonstrated significant differences with controls: prominent activity in the beta/gamma frequency bands in frontal regions, interictal short sequences of low-voltage fast activity, and less frequent and more localized interictal epileptiform discharges. Ictal EEG patterns analyzed in 9 ENCs showed delayed and slower contralateral spread compared to TLEs. All ENCs that underwent surgery (7 lobectomies and 1 lesionectomy) are in Engel class I. Neuropathological examination revealed 4 patterns: herniated brain fragments, focal layer I distortion, white matter septa extending into the cortex, and altered gyral profile. CONCLUSIONS AND SIGNIFICANCE The described peculiarities might help clinicians to suspect the presence of largely underdiagnosed ENCs.
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Affiliation(s)
- Roberta Di Giacomo
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
| | - Alessandra Burini
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Department of Medicine (DAME), Neurology Unit, University of Udine, Udine, Italy
| | - Elisa Visani
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Valeria Cuccarini
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Rita Garbelli
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Gianluca Marucci
- Neuropathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Dalia De Santis
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giuseppe Didato
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Deleo
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Chiara Pastori
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Andrea Stabile
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Flavio Villani
- Clinical Neurophysiology Unit and Epilepsy Center, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Michele Rizzi
- Neurosurgery Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Luca Girardi
- Department of Enviromental System Science, Swiss Federal Institute (ETH) Zürich, Zurich, Switzerland
| | - Marco de Curtis
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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You L, Zhang Y, Zhang D, Wang L, Liu X, Peng C, Qi Y, Qian R. Stereoelectroencephalography-based research on the value of drug-resistant temporal lobe epilepsy auras: A retrospective single-center study. Epilepsy Behav 2023; 138:108981. [PMID: 36470058 DOI: 10.1016/j.yebeh.2022.108981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/25/2022] [Accepted: 10/27/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE To explore the localization value of drug-resistant temporal lobe epilepsy (TLE) aura for preoperative evaluation, based on stereoelectroencephalography (SEEG), and its prognostic value on the surgical outcome. METHODS The data of patients with drug-resistant TLE who had SEEG electrodes implanted during preoperative evaluation at the First Affiliated Hospital of the University of Science and Technology of China (Hefei, China) were retrospectively analyzed. The patients were divided into aura-positive and aura-negative groups according to the presence of aura in seizures. To explore the clinical features of aura, we evaluated the localizing and prognostic values of aura for the outcome of anterior temporal lobectomy based on SEEG. RESULTS Among forty patients, twenty-seven patients were in the aura-positive group and ten (25.0%) patients had multiple auras. The most common TLE aura was abdominal aura [thirteen (34.2%) patients]. The postoperative seizure frequency was significantly reduced in the preoperative aura-positive patients compared to the preoperative aura-negative patients (P = 0.011). Patients with abdominal (P = 0.029) and single (P = 0.036) auras had better surgical prognoses than aura-negative patients. In the preoperative evaluation, aura-positive patients had a better surgical outcome if the laterality of positron emission tomography-computed tomography (PET-CT) hypometabolism was concordant with the epileptogenic focus identified with SEEG (P = 0.031). A good postoperative epileptic outcome in aura-positive patients was observed among those with hippocampal sclerotic medial temporal lobe epilepsy (P = 0.025). CONCLUSION Epileptic aura is valuable for the localization of the epileptogenic focus. Abdominal aura and single aura were good predictors of better surgical outcomes. Among patients with a preoperative diagnosis of hippocampal sclerosis or with laterality of PET-CT hypometabolism concordant with the epileptogenic focus identified using SEEG, those with aura are likely to benefit from surgery.
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Affiliation(s)
- Longfei You
- Department of Neurosurgery, Anhui Provincial Hospital, WanNan Medical College, Wuhu, PR China
| | - Yiming Zhang
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, PR China
| | - Dong Zhang
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, PR China
| | - Lanlan Wang
- Department of Nerve Electrophysiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, PR China
| | - Xiang Liu
- Department of Nerve Electrophysiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, PR China; Anhui Provincial Institute of Stereotactic Neurosurgery, 9 Lujiang Road, Hefei, Anhui Province 230001, PR China
| | - Chang Peng
- Department of Neurosurgery, Anhui Provincial Hospital, WanNan Medical College, Wuhu, PR China
| | - Yinbao Qi
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, PR China
| | - Ruobing Qian
- Department of Neurosurgery, Anhui Provincial Hospital, WanNan Medical College, Wuhu, PR China; Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, PR China; Anhui Provincial Institute of Stereotactic Neurosurgery, 9 Lujiang Road, Hefei, Anhui Province 230001, PR China.
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Cao Q, Cui T, Wang Q, Li ZM, Fan SH, Xiao ZM, Pan SQ, Zhou Q, Lu ZN, Shao XQ. The localization and lateralization of fear aura and its surgical prognostic value in patients with focal epilepsy. Ann Clin Transl Neurol 2022; 9:1116-1124. [PMID: 35699312 PMCID: PMC9380142 DOI: 10.1002/acn3.51607] [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: 02/24/2022] [Revised: 05/17/2022] [Accepted: 05/30/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Fear aura has traditionally been considered relevant to epileptic discharges from mesial temporal areas, and few studies have investigated its effect on surgical outcome in drug-resistant epilepsy. We aim to assess the localizing and lateralizing value as well as prognostic significance of fear aura in patients with focal epilepsy. METHODS The occurrence of fear aura in relation to epileptogenic origin and its association with postoperative outcome were analyzed in 146 consecutive patients undergoing resective surgery for intractable epilepsy. RESULTS Ninety-four (64.4%) patients reported auras, and 31 (21.2%) reported fear aura in their seizures. One hundred ten (75.3%) patients had an Engel class I outcome until last follow-up, of whom 24 experienced fear aura preoperatively. Fear aura appeared more frequently during temporal and frontal lobe seizures, but did not lateralize the seizure onset zone. There were no significant baseline differences between patients with and without fear aura. No correlation was found between postoperative outcome and the presence of auras. Occurrence of fear aura failed to show predictive value in surgical outcome whether in pooled or subgroup analysis. INTERPRETATION This study advances our understanding of the origin of fear aura, and is helpful for presurgical evaluation and outcome prediction. Without lateralizing value, fear aura is more commonly seen with temporal or frontal origin. When taken as a whole, auras do not have a significant impact on seizure outcome in focal epilepsy. Patients with fear aura are no more likely to become seizure-free than those without fear aura.
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Affiliation(s)
- Qian Cao
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Tao Cui
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
| | - Qun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China.,Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, 100070, China
| | - Zhi-Mei Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
| | - Shang-Hua Fan
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Zhe-Man Xiao
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Song-Qing Pan
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Qin Zhou
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Zu-Neng Lu
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Xiao-Qiu Shao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
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Jo H, Kim J, Kim D, Hwang Y, Seo D, Hong S, Shon YM. Lateralizing Characteristics of Morphometric Changes to Hippocampus and Amygdala in Unilateral Temporal Lobe Epilepsy with Hippocampal Sclerosis. Medicina (B Aires) 2022; 58:medicina58040480. [PMID: 35454319 PMCID: PMC9029741 DOI: 10.3390/medicina58040480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 11/16/2022] Open
Abstract
Background andObjective: In the present study, a detailed investigation of substructural volume change in the hippocampus (HC) and amygdala (AMG) was performed and the association with clinical features in patients with mesial temporal lobe epilepsy with hippocampal sclerosis (TLE-HS) determined. Methods: The present study included 22 patients with left-sided TLE-HS (LTLE-HS) and 26 patients with right-sided TLE-HS (RTLE-HS). In addition, 28 healthy controls underwent high-resolution T2-weighted image (T2WI) and T1-weighted image (T1WI) MRI scanning. Subfield analysis of HC and AMG was performed using FreeSurfer version 6.0. Results: Patients with TLE-HS showed a decrease in the volume of substructures in both HC and AMG, and this change was observed on the contralateral side and the ipsilateral side with HS. The volume reduction pattern of substructures showed laterality-dependent characteristics. Patients with LTLE-HS had smaller volumes of the ipsilateral subiculum (SUB), contralateral SUB, and ipsilateral cortical nucleus of AMG than patients with RTLE-HS. Patients with RTLE-HS had reduced ipsilateral cornu ammonis (CA) 2/3 and contralateral cortico-amygdaloid transition area (CAT) volumes. The relationship between clinical variables and subregions was different based on the lateralization of the seizure focus. Focal to bilateral tonic-clonic seizures (FTBTCS) was associated with contralateral and ipsilateral side subregions only in LTLE-HS. The abdominal FAS was associated with the volume reduction of AMG subregions only in LTLE-HS, but the volume reduction was less than in patients without FAS. Conclusions: The results indicate that unilateral TLE-HS is a bilateral disease that shows different laterality-dependent characteristics based on the subfield analysis of HC and AMG. Subfield volumes of HC and AMG were associated with clinical variables, and the more damaged substructures depended on laterality in TLE-HS. These findings support the evidence that LTLE-HS and RTLE-HS are disparate epilepsy entities rather than simply identical syndromes harboring a mesial temporal lesion. In addition, the presence of FAS supports good localization value, and abdominal FAS has a high localization value, especially in patients with LTLE-HS.
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Affiliation(s)
- Hyunjin Jo
- Samsung Medical Center, Department of Neurology, Sungkyunkwan University School of Medicine, Seoul 06355, Korea; (H.J.); (J.K.); (D.S.); (S.H.)
| | - Jeongsik Kim
- Samsung Medical Center, Department of Neurology, Sungkyunkwan University School of Medicine, Seoul 06355, Korea; (H.J.); (J.K.); (D.S.); (S.H.)
| | - Dongyeop Kim
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul 03760, Korea;
| | - Yoonha Hwang
- Department of Neurology, The Catholic University of Korea Eunpyeong St. Mary’s Hospital, Seoul 07345, Korea;
| | - Daewon Seo
- Samsung Medical Center, Department of Neurology, Sungkyunkwan University School of Medicine, Seoul 06355, Korea; (H.J.); (J.K.); (D.S.); (S.H.)
| | - Seungbong Hong
- Samsung Medical Center, Department of Neurology, Sungkyunkwan University School of Medicine, Seoul 06355, Korea; (H.J.); (J.K.); (D.S.); (S.H.)
| | - Young-Min Shon
- Samsung Medical Center, Department of Neurology, Sungkyunkwan University School of Medicine, Seoul 06355, Korea; (H.J.); (J.K.); (D.S.); (S.H.)
- Department of Medical Device Management and Research, Samsung Advanced Institute for Health Sciences & Technology (SAHIST), Sunkyunkwan University, Seoul 06355, Korea
- Correspondence: ; Tel.: +82-2-3410-2701
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Asadi‐Pooya AA, Farazdaghi M, Shahpari M. Clinical significance of bilateral epileptiform discharges in temporal lobe epilepsy. Acta Neurol Scand 2021; 143:608-613. [PMID: 33590883 DOI: 10.1111/ane.13402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/17/2020] [Accepted: 01/27/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of the current study was to investigate the rate and clinical significance of bitemporal interictal epileptiform discharges (IEDs) in a large cohort of patients with temporal lobe epilepsy (TLE). METHODS The data used in this study were collected at the Epilepsy Care Unit, Namazi Hospital, Shiraz University of Medical sciences, Shiraz, Iran, from 2008 to 2020. Inclusion criteria were a confirmed diagnosis of TLE based on the clinical grounds (history and the described seizure semiology) and a 2-hour interictal video-electroencephalography (EEG) monitoring. The EEG recording of each patient included both sleep (about 90 minutes) and wakefulness (about 30 minutes). RESULTS 532 patients were included in this study [420 patients (79%) had unilateral IEDs, and 112 patients (21%) had bilateral IEDs]. Patients with bilateral IEDs less often had auras with their seizures and had higher frequencies of seizures (as a trend for focal to bilateral tonic-clonic seizures and significantly in focal seizures with impaired awareness) compared with those who had unilateral IEDs. Patients with bilateral epileptiform discharges showed a trend to experiencing ictal injury more frequently. Brain MRI findings were different between these two groups (p = 0.0001). CONCLUSION It is important to recognize that a patient with TLE has unilateral vs. bilateral IEDs. Bilateral IEDs in a patient with TLE may suggest a more severe disease (with a higher risk for ictal injuries and other significant consequences of frequent seizures). It may also suggest a somewhat different etiology.
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Affiliation(s)
- Ali A. Asadi‐Pooya
- Epilepsy Research Center Shiraz University of Medical Sciences Shiraz Iran
- Department of Neurology Jefferson Comprehensive Epilepsy Center Thomas Jefferson University Philadelphia PA USA
| | - Mohsen Farazdaghi
- Epilepsy Research Center Shiraz University of Medical Sciences Shiraz Iran
| | - Marzieh Shahpari
- Epilepsy Research Center Shiraz University of Medical Sciences Shiraz Iran
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Yin F, Ni D, Xu C, Yan X, Ma K, Zhang X, Gao R, Zhang G. Auras in intractable frontal lobe epilepsy: Clinical characteristics, values, and limitations. Epilepsy Behav 2021; 115:107724. [PMID: 33423014 DOI: 10.1016/j.yebeh.2020.107724] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 12/16/2020] [Accepted: 12/16/2020] [Indexed: 12/18/2022]
Abstract
Auras are essential in preoperative evaluation and can provide valuable information for delineating seizure onset zones. Frontal lobe epilepsy (FLE) is the second most common focal epilepsy, while a few studies have focused on auras in FLE. To better understand FLE, we analyzed the clinical characteristics, values, and limitations of auras in FLE. The incidence rate of aura in FLE was 37.9% in our study. We included 54 patients and 76 auras in 11 categories were reported. The rate of auras in the decreasing order are as follows: autonomic aura; emotional aura; somatosensory aura; psychic aura; cephalic aura; abdominal aura; whole-body sensory aura, visual aura; auditory aura; and vestibular and unclassified aura. A significant number of aura types can be reported by FLE patients; autonomic aura was the most frequent category and somatosensory auras are most likely associated with the contralateral motor areas.
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Affiliation(s)
- Fangzhao Yin
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China; Department of Functional Neurology, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China
| | - Duanyu Ni
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China; Department of Functional Neurology, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China
| | - Cuiping Xu
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China; Department of Functional Neurology, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China
| | - Xiaoming Yan
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China; Department of Functional Neurology, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China
| | - Kai Ma
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China; Department of Functional Neurology, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China
| | - Xi Zhang
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China; Department of Functional Neurology, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China
| | - Runshi Gao
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China; Department of Functional Neurology, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China
| | - Guojun Zhang
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China; Department of Functional Neurology, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China.
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Arifin MT, Hanaya R, Bakhtiar Y, Bintoro AC, Iida K, Kurisu K, Arita K, Bunyamin J, Askoro R, Brillantika SP, Muttaqin Z. Preoperative sensory aura predicts risk for seizure in temporal lobe epilepsy surgery. Epilepsy Behav 2020; 111:107255. [PMID: 32759061 DOI: 10.1016/j.yebeh.2020.107255] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patients with temporal lobe epilepsy (TLE) often report viscerosensory and experiential auras, with substantial epilepsy localization. However, few previous studies have investigated the epileptic preoperative aura, particularly with regard to its effect on surgical outcomes in patients with drug-resistant epilepsy. OBJECTIVE This study investigated the potential role of preoperative aura in predicting outcomes after surgery for TLE. MATERIAL AND METHODS This study included consecutive patients diagnosed with TLE who underwent anterior temporal lobectomy (ATL) for drug-resistant TLE during the period from January 1999 to December 2017. Data pertaining to patient age at the time of surgery, sex, age at initial seizure onset, duration of epilepsy, presence of preoperative aura, comprehensive clinical semiology, side of surgery, and type of pathology were analyzed. Preoperative auras were classified as autonomic, sensory, mental and affective, or multiple manifestations. Patients were followed at 3 and 12 months after surgery and at regular intervals thereafter. RESULTS AND CONCLUSIONS A total of 498 patients were included in the study. Positive preoperative aura was observed in 386 patients (77.51%). The correlation of each variable with seizure outcomes was analyzed, and the only variable found to correlate with seizure outcome was the presence of preoperative aura. Compared with those with negative preoperative aura, those with positive preoperative aura were 1.74-fold more likely to be seizure-free after surgery for TLE. The analysis of patient data suggested a later onset of initial seizure in those with positive preoperative aura, compared with those without (p = 0.04, 95% confidence interval (CI): 0.55-3.24). Patients with a shorter duration of disease prior to TLE surgery were more likely to achieve seizure-free status postoperatively. Preoperative sensory aura was a good predictor that a patient would be seizure-free during follow-up (p = 0.022).
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Affiliation(s)
| | - Ryosuke Hanaya
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan
| | - Yuriz Bakhtiar
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Indonesia
| | - Aris Catur Bintoro
- Department of Neurology, Faculty of Medicine, Diponegoro University, Indonesia
| | - Koji Iida
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Kazunori Arita
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan
| | - Jacob Bunyamin
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Indonesia
| | - Rofat Askoro
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Indonesia
| | - Surya P Brillantika
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Indonesia
| | - Zainal Muttaqin
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Indonesia
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Zare M, Mehvari Habibabadi J, Moein H, Barekatain M, Basiratnia R, Tofangsazi L. The Relationship between Aura and Postoperative Outcomes of Epilepsy Surgery in Patients with Mesial Temporal Sclerosis. Adv Biomed Res 2020; 9:3. [PMID: 32055537 PMCID: PMC7003553 DOI: 10.4103/abr.abr_25_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 07/09/2019] [Accepted: 11/12/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND We conducted a study to evaluate the relationship between aura types and postoperative outcomes in patients with mesial temporal sclerosis (MTS) to predict the prognosis of patients, accordingly. MATERIALS AND METHODS In this cross-sectional study, 99 patients with MTS-temporal lobe epilepsy were enrolled based on inclusion and exclusion criteria. The types of aura were evaluated, and the outcomes were categorized according to the Engel scale. Preoperative and postoperative results of patients were compared and analyzed with the Kruskal-Wallis test. RESULTS About 73.7% of patients had seizure-free after their surgeries. The most of patients (n = 81) were in Class I of Evaluating Engel criteria. About 36.3% had not experienced any aura before their seizures, and among those with aura, the most prevalent aura was abdominal aura in 29 patients (29.3%) followed by other types of aura and affective aura. Most of the patients in Class I, II, III, and IV of Engel scale had an abdominal aura, without aura, effective aura, and abdominal aura, respectively, but this difference was not statistically significant (P = 0.691). CONCLUSION According to this study, the type of aura cannot predict postoperative outcomes in MTS patients. More studies are needed to evaluate this relation in better-planned studies with greater sample size.
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Affiliation(s)
- Mohammad Zare
- From the Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Jafar Mehvari Habibabadi
- From the Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Houshang Moein
- Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Barekatain
- Department of Psychiatric, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza Basiratnia
- Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ladan Tofangsazi
- From the Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Postsurgical outcome in patients with olfactory auras and drug-resistant epilepsy. Epilepsy Behav 2017; 68:8-10. [PMID: 28109994 DOI: 10.1016/j.yebeh.2016.12.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 12/19/2016] [Accepted: 12/19/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVES We investigated the clinical features associated with olfactory auras in patients with drug-resistant epilepsy and also hypothesized that this type of aura may predict worse postsurgical outcome in patients with drug-resistant temporal lobe epilepsy (TLE). METHODS In this retrospective analysis, data from all patients with drug-resistant epilepsy who underwent epilepsy surgery were reviewed. Patients were prospectively registered in a database from 1986 through 2016. We assessed outcome in the first 5years after surgery to produce a Kaplan-Meier estimate of seizure recurrence. Post-surgical outcome was classified into two groups; 1) seizure-free, with or without auras; or 2) relapse of complex partial or secondarily generalized seizures. We also investigated the clinical features of patients with TLE and olfactory auras compared with those without olfactory auras. RESULTS We studied 1186 patients. Thirty-seven patients (3.1%) reported olfactory auras with their seizures. Thirty-two patients had temporal lobe surgery. Intracranial video-EEG recording was performed in four patients. Three patients with lateral temporal neocortical seizures reported olfactory auras with their seizures; two of them were seizure-free after surgery. There were no significant clinical differences between patients with TLE and olfactory auras compared with those without. Seizure outcome after surgery was not significantly different between these two groups (p=0.3; Cox-Mantel test). CONCLUSION The rarity of olfactory auras makes it difficult to propose new diagnostic and treatment strategies. A multicenter approach, which can enroll more patients, is needed to devise better therapies for patients with drug-resistant epilepsy and this symptom.
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Asadi-Pooya AA, Wyeth D, Nei M, Sharan AD, Sperling MR. Postsurgical outcome in patients with auditory auras and drug-resistant epilepsy. Epilepsy Behav 2017; 66:49-52. [PMID: 28033545 DOI: 10.1016/j.yebeh.2016.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 10/05/2016] [Accepted: 10/08/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE We assessed whether patients with auditory auras have similar outcomes after epilepsy surgery as patients without auditory auras, and hypothesized that patients with non-dominant hemisphere foci might fare better after temporal lobe surgery than patients with dominant resections. METHODS In this retrospective study, outcome after temporal resection was assessed for patients with drug-resistant epilepsy. Preoperative demographic data, clinical data, and surgical outcome were prospectively registered in a database from 1986 through 2016. Seizure outcome was classified as either seizure-free or relapsed. RESULTS Data were available in 1186 patients. Forty five patients (3.8%) reported auditory auras; 42 patients (93%) had temporal lobe epilepsy (TLE), and three patients (7%) had extratemporal epilepsy. Since most patients with auditory auras had TLE and in order to have comparable groups, we selected 41 patients with auditory auras and compared them with patients without auditory auras who had temporal lobe resections (767 patients). There were no significant demographic or clinical differences between TLE patients with auditory auras and those without. Patients who had auditory auras were more likely to relapse after temporal lobe surgery than those without (p=0.03). Among patients who had auditory auras and temporal lobe surgery, side of surgery was not related to postoperative outcome (p=0.3). CONCLUSION Auditory auras are rare among patients with drug-resistant TLE. The presence of an auditory aura in a patient with drug-resistant TLE carries a worse prognosis for a postoperative seizure free outcome and this is not related to the side of surgery.
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Affiliation(s)
- Ali A Asadi-Pooya
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Dale Wyeth
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Maromi Nei
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Ashwini D Sharan
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Michael R Sperling
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
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Asadi-Pooya AA, Nei M, Sharan A, Sperling MR. Seizure clusters in drug-resistant focal epilepsy. Epilepsia 2016; 57:e187-90. [PMID: 27417685 DOI: 10.1111/epi.13465] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2016] [Indexed: 01/19/2023]
Abstract
We investigated clinical factors associated with seizure clustering in patients with drug-resistant focal epilepsy and any association between seizure clustering and outcome after surgery. We performed a retrospective study including patients with a diagnosis of drug-resistant focal epilepsy who underwent epilepsy surgery. Patients were prospectively registered in a database from 1986 until 2015. Seizure cluster was defined as two or more seizures occurring within 2 days. Potential risk factors for seizure clustering were assessed. To investigate any potential association between seizure clusters and seizure outcome after surgery, time to event analysis was used to produce a Kaplan-Meier estimate of seizure recurrence. We studied 764 patients. Seizure clusters were reported in 23.6% of patients with temporal lobe epilepsy (TLE) and 16.9% of extratemporal patients (p = 0.2). We could not identify any significant clinical factors associated with seizure clustering. Among patients with TLE, those who had history of seizure clusters fared better after surgery (p < 0.01). We found that seizure clusters relate to prognosis after temporal lobe surgery in drug-resistant TLE. These data may provide added value for surgical prognostication when combined with other data types. A better understanding of the neurobiology underlying seizure clusters is needed.
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Affiliation(s)
- Ali A Asadi-Pooya
- Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Maromi Nei
- Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Ashwini Sharan
- Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Michael R Sperling
- Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
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Martinoni M, Berti PP, Marucci G, Rubboli G, Volpi L, Riguzzi P, Marliani F, Toni F, Bisulli F, Tinuper P, Michelucci R, Baruzzi A, Giulioni M. Pathology-Based Approach to Seizure Outcome After Surgery for Pharmacoresistant Medial Temporal Lobe Epilepsy. World Neurosurg 2016; 90:448-453. [PMID: 26968448 DOI: 10.1016/j.wneu.2016.02.072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 02/14/2016] [Accepted: 02/15/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND Hippocampal sclerosis (HS) is the most common cause of drug-resistant medial temporal lobe epilepsy (MTLE). Structural abnormalities such as HS, granule cell pathology (GCP), and focal cortical dysplasia (FCD) have been classified histopathologically, possibly allowing a more accurate assessment of prognostic seizure and neuropsychologic outcomes. We correlated seizure outcome with comprehensive temporal lobe pathologic findings, identified according to the most recent classification systems of HS, GCP, and FCD. METHODS All the 83 patients who underwent anterior temporal lobectomy (ATL) for drug-resistant MTLE and with a proven diagnosis of HS between April 2001 and May 2014 were collected. Patients were divided in 2 main groups: 1) isolated HS with/without GCP (HS +/- GCP); and 2) HS associated with FCD with/without GCP (HS+FCD +/- GCP). Patients were followed up at least 1 year, and seizure outcome was reported in accordance with Engel classification. RESULTS Group I: HS +/- GCP: Statistical analysis confirmed a better outcome in HS + GCP patients than in HS-no GCP (P < 0.05). Moreover, a better outcome for the patients affected by GCP type I was observed (P < 0.05). Group II: HS+FCD +/- GCP: Patients with HS variant type I presented a better seizure outcome than the patients with HS type II (Engel class IA HS type I vs. type II: 69% vs. 40%). CONCLUSIONS A pathology-based approach to epilepsy surgery might improve the interpretation of the results, could predict which cases will enjoy a better seizure outcome, and could help to the comprehension of the causes of failures.
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Affiliation(s)
- Matteo Martinoni
- IRCCS Institute of Neurological Science of Bologna, Division of Neurosurgery, Bellaria Hospital, Bologna, Italy.
| | - Pier Paolo Berti
- IRCCS Institute of Neurological Science of Bologna, Division of Neurosurgery, Bellaria Hospital, Bologna, Italy
| | - Gianluca Marucci
- Section of Pathology, "M. Malpighi," Bellaria Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Guido Rubboli
- IRCCS Institute of Neurological Science of Bologna, Division of Neurology, Bellaria Hospital, Bologna, Italy; Danish Epilepsy Centre, Dianalund, Denmark
| | - Lilia Volpi
- IRCCS Institute of Neurological Science of Bologna, Division of Neurology, Bellaria Hospital, Bologna, Italy
| | - Patrizia Riguzzi
- IRCCS Institute of Neurological Science of Bologna, Division of Neurology, Bellaria Hospital, Bologna, Italy
| | - Federica Marliani
- IRCCS Institute of Neurological Science of Bologna, Division of Neuroradiology, Bellaria Hospital, Bologna, Italy
| | - Francesco Toni
- IRCCS Institute of Neurological Science of Bologna, Division of Neuroradiology, Bellaria Hospital, Bologna, Italy
| | - Francesca Bisulli
- IRCCS Institute of Neurological Science of Bologna, Division of Neurology, Bellaria Hospital, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Paolo Tinuper
- IRCCS Institute of Neurological Science of Bologna, Division of Neurology, Bellaria Hospital, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Roberto Michelucci
- IRCCS Institute of Neurological Science of Bologna, Division of Neurology, Bellaria Hospital, Bologna, Italy
| | - Agostino Baruzzi
- IRCCS Institute of Neurological Science of Bologna, Division of Neurology, Bellaria Hospital, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Marco Giulioni
- IRCCS Institute of Neurological Science of Bologna, Division of Neurosurgery, Bellaria Hospital, Bologna, Italy
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Auras in patients with temporal lobe epilepsy and mesial temporal sclerosis. J Neurol Sci 2016; 364:24-6. [PMID: 27084209 DOI: 10.1016/j.jns.2016.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 02/18/2016] [Accepted: 03/02/2016] [Indexed: 11/23/2022]
Abstract
We investigated auras in patients with drug-resistant temporal lobe epilepsy (TLE) and mesial temporal sclerosis (MTS). We also investigated the clinical differences between patients with MTS and abdominal auras and those with MTS and non-mesial temporal auras. All patients with drug-resistant TLE and unilateral MTS who underwent epilepsy surgery at Jefferson Comprehensive Epilepsy Center from 1986 through 2014 were evaluated. Patients with good postoperative seizure outcome were investigated. One hundred forty-nine patients (71 males and 78 females) were studied. Thirty-one patients (20.8%) reported no auras, while 29 patients (19.5%) reported abdominal aura, and 30 patients (20.1%) reported non-mesial temporal auras; 16 patients (10.7%) had sensory auras, 11 patients (7.4%) had auditory auras, and five patients (3.4%) reported visual auras. A history of preoperative tonic-clonic seizures was strongly associated with non-mesial temporal auras (odds ratio 3.8; 95% CI: 1.15-12.98; p=0.02). About one-fifth of patients who had MTS in their MRI and responded well to surgery reported auras that are historically associated with non-mesial temporal structures. However, the presence of presumed non-mesial temporal auras in a patient with MTS may herald a more widespread epileptogenic zone.
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Asadi-Pooya AA, Rostami C, Rabiei AH, Sperling MR. Factors associated with tonic–clonic seizures in patients with drug-resistant mesial temporal epilepsy. J Neurol Sci 2015; 359:452-4. [DOI: 10.1016/j.jns.2015.10.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 09/15/2015] [Accepted: 10/12/2015] [Indexed: 10/22/2022]
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