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Das Pektezel L, Tezer FI, Saygi S. Electroclinical Presentations of Fixation-off Sensitivity in Adults With Symptomatic Epilepsy. J Clin Neurophysiol 2023; 40:244-249. [PMID: 34280943 DOI: 10.1097/wnp.0000000000000880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Fixation-off sensitivity (FOS) is a discharge pattern on EEG that occurs owing to the loss of central vision or fixation. Knowledge regarding the relationship between FOS and symptomatic epilepsy is limited. Therefore, we aimed to evaluate the electroclinical features of FOS in adult patients with symptomatic epilepsy. METHODS Outpatient video-EEG records of the Hacettepe University Faculty of Medicine were reviewed from 2009 to 2019. Patients aged >18 years with symptomatic epilepsy with a FOS pattern were included. Demographic, clinical, EEG, and neuroimaging data were retrospectively evaluated from an electronic database and patient files. RESULTS Eight patients (50% female) were included in this study; seven (87%) had refractory epilepsy. Prominent risk factors were family history of epilepsy in five patients and prenatal/natal insult in four patients. Notable MRI signs included cortical developmental malformation, posterior gliosis, and frontoparietal porencephalic cyst. The FOS pattern was generalized with posterior emphasis in two patients and lateralized or localized in six patients: frontocentroparietal ( n = 1) and temporoparietooccipital ( n = 5). Fixation-off sensitivity discharges were found to be increased by hyperventilation and decreased by drowsiness and sleep in 50% of patients. Fixation-off sensitivity disappeared in one patient with good seizure control. CONCLUSIONS In this study, the disappearance of FOS in an epileptic patient with a structural lesion and detection of FOS activity related to a frontoparietal porencephalic cyst were remarkable. Family history of epilepsy was also substantially high. Our results indicate that the underlying mechanism of FOS is much more complicated than previously thought.
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Affiliation(s)
- Leyla Das Pektezel
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Karkare KD, Menon RN, Radhakrishnan A, Cherian A, Thomas SV. Electroclinical characteristics and syndromic associations of “eye-condition” related visual sensitive epilepsies—A cross-sectional study. Seizure 2018; 58:62-71. [DOI: 10.1016/j.seizure.2018.03.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 03/26/2018] [Accepted: 03/30/2018] [Indexed: 12/21/2022] Open
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Solana AB, Martínez K, Hernández-Tamames JA, San Antonio-Arce V, Toledano R, García-Morales I, Alvárez-Linera J, Gil-Nágel A, Del Pozo F. Altered brain rhythms and functional network disruptions involved in patients with generalized fixation-off epilepsy. Brain Imaging Behav 2015; 10:373-86. [PMID: 26001771 DOI: 10.1007/s11682-015-9404-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Generalized Fixation-off Sensitivity (CGE-FoS) patients present abnormal EEG patterns when losing fixation. In the present work, we studied two CGE-FoS epileptic patients with simultaneous EEG-fMRI. We aim to identify brain areas that are specifically related to the pathology by identifying the brain networks that are related to the EEG brain altered rhythms. Three main analyses were performed: EEG standalone, where the voltage fluctuations in delta, alpha, and beta EEG bands were obtained; fMRI standalone, where resting-state fMRI ICA analyses for opened and closed eyes conditions were computed per subject; and, EEG-informed fMRI, where EEG delta, alpha and beta oscillations were used to analyze fMRI. Patient 1 showed EEG abnormalities for lower beta band EEG brain rhythm. Fluctuations of this rhythm were correlated with a brain network mainly composed by temporo-frontal areas only found in the closed eyes condition. Patient 2 presented alterations in all the EEG brain rhythms (delta, alpha, beta) under study when closing eyes. Several biologically relevant brain networks highly correlated (r > 0.7) to each other in the closed eyes condition were found. EEG-informed fMRI results in patient 2 showed hypersynchronized patterns in the fMRI correlation spatial maps. The obtained findings allow a differential diagnosis for each patient and different profiles with respect to healthy volunteers. The results suggest a different disruption in the functional brain networks of these patients that depends on their altered brain rhythms. This knowledge could be used to treat these patients by novel brain stimulation approaches targeting specific altered brain networks in each patient.
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Affiliation(s)
- Ana Beatriz Solana
- Department of Neuroimaging, Center for Biomedical Technology, Universidad Politécnica de Madrid, Autopista M40 Km.38, 28223, Pozuelo de Alarcón, Spain. .,GE Global Research, Freisinger Landstrasse 50, 85748, Garching bei Munich, Bayern, Germany.
| | - Kenia Martínez
- Research Unit, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón (IISGM), Calle Doctor Esquerdo, 46, 28007, Madrid, Spain
| | | | | | - Rafael Toledano
- Department of Neurology, Hospital Ruber Internacional, Calle de la Maso, 38, 28034, Madrid, Spain
| | - Irene García-Morales
- Department of Neurology, Hospital Ruber Internacional, Calle de la Maso, 38, 28034, Madrid, Spain
| | - Juan Alvárez-Linera
- Department of Neuroradiology, Hospital Ruber Internacional, Calle de la Maso, 38, 28034, Madrid, Spain
| | - Antonio Gil-Nágel
- Department of Neurology, Hospital Ruber Internacional, Calle de la Maso, 38, 28034, Madrid, Spain
| | - Francisco Del Pozo
- Department of Neuroimaging, Center for Biomedical Technology, Universidad Politécnica de Madrid, Autopista M40 Km.38, 28223, Pozuelo de Alarcón, Spain
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Formaggio E, Storti SF, Boscolo Galazzo I, Bongiovanni LG, Cerini R, Fiaschi A, Manganotti P. Reproducibility of EEG-fMRI results in a patient with fixation-off sensitivity. Clin EEG Neurosci 2014; 45:212-7. [PMID: 24048241 DOI: 10.1177/1550059413497946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Blood oxygenation level-dependent (BOLD) activation associated with interictal epileptiform discharges in a patient with fixation-off sensitivity (FOS) was studied using a combined electroencephalography-functional magnetic resonance imaging (EEG-fMRI) technique. An automatic approach for combined EEG-fMRI analysis and a subject-specific hemodynamic response function was used to improve general linear model analysis of the fMRI data. The EEG showed the typical features of FOS, with continuous epileptiform discharges during elimination of central vision by eye opening and closing and fixation; modification of this pattern was clearly visible and recognizable. During all 3 recording sessions EEG-fMRI activations indicated a BOLD signal decrease related to epileptiform activity in the parietal areas. This study can further our understanding of this EEG phenomenon and can provide some insight into the reliability of the EEG-fMRI technique in localizing the irritative zone.
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Affiliation(s)
- Emanuela Formaggio
- Department of Neurophysiology, Foundation IRCCS San Camillo Hospital, Venice, Italy
| | - Silvia Francesca Storti
- Clinical Neurophysiology and Functional Neuroimaging Unit, Department of Neurological and Movement Sciences, University Hospital, Verona, Italy
| | - Ilaria Boscolo Galazzo
- Clinical Neurophysiology and Functional Neuroimaging Unit, Department of Neurological and Movement Sciences, University Hospital, Verona, Italy
| | - Luigi Giuseppe Bongiovanni
- Clinical Neurophysiology and Functional Neuroimaging Unit, Department of Neurological and Movement Sciences, University Hospital, Verona, Italy
| | - Roberto Cerini
- Department of Pathology and Diagnostics, Section of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Antonio Fiaschi
- Department of Neurophysiology, Foundation IRCCS San Camillo Hospital, Venice, Italy
- Clinical Neurophysiology and Functional Neuroimaging Unit, Department of Neurological and Movement Sciences, University Hospital, Verona, Italy
| | - Paolo Manganotti
- Department of Neurophysiology, Foundation IRCCS San Camillo Hospital, Venice, Italy
- Clinical Neurophysiology and Functional Neuroimaging Unit, Department of Neurological and Movement Sciences, University Hospital, Verona, Italy
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Fattouch J, Casciato S, Lapenta L, Morano A, Fanella M, Lombardi L, Manfredi M, Giallonardo AT, Di Bonaventura C. The spectrum of epileptic syndromes with fixation off sensitivity persisting in adult life. Epilepsia 2013; 54 Suppl 7:59-65. [DOI: 10.1111/epi.12310] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jinane Fattouch
- Epilepsy Unit; Department of Neurological Sciences; University of Rome “La Sapienza”; Rome Italy
| | - Sara Casciato
- Epilepsy Unit; Department of Neurological Sciences; University of Rome “La Sapienza”; Rome Italy
| | - Leonardo Lapenta
- Epilepsy Unit; Department of Neurological Sciences; University of Rome “La Sapienza”; Rome Italy
| | - Alessandra Morano
- Epilepsy Unit; Department of Neurological Sciences; University of Rome “La Sapienza”; Rome Italy
| | - Martina Fanella
- Epilepsy Unit; Department of Neurological Sciences; University of Rome “La Sapienza”; Rome Italy
| | - Laura Lombardi
- Epilepsy Unit; Department of Neurological Sciences; University of Rome “La Sapienza”; Rome Italy
| | - Mario Manfredi
- Epilepsy Unit; Department of Neurological Sciences; University of Rome “La Sapienza”; Rome Italy
| | - Anna Teresa Giallonardo
- Epilepsy Unit; Department of Neurological Sciences; University of Rome “La Sapienza”; Rome Italy
| | - Carlo Di Bonaventura
- Epilepsy Unit; Department of Neurological Sciences; University of Rome “La Sapienza”; Rome Italy
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