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Konomatsu K, Kakisaka Y, Sato S, Kubota T, Soga T, Ukishiro K, Jin K, Mugikura S, Aoki M, Nakasato N. "Caterpillar sign" in corpus callosum associated with curvilinear pericallosal lipoma in MRI: A case report. Radiol Case Rep 2024; 19:2058-2061. [PMID: 38523692 PMCID: PMC10958131 DOI: 10.1016/j.radcr.2024.02.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/09/2024] [Accepted: 02/15/2024] [Indexed: 03/26/2024] Open
Abstract
Lipoma of the corpus callosum, also known as pericallosal lipoma, is a rare congenital brain abnormality associated with corpus callosum dysgenesis or agenesis. Two morphological types are described: tubulonodular and curvilinear, with the latter being mostly asymptomatic. We present the case of a 30-year-old woman with epilepsy, whose magnetic resonance imaging revealed a "caterpillar sign" in the corpus callosum associated with a curvilinear pericallosal lipoma. The "caterpillar sign" in the corpus callosum showed low signal intensity on magnetization prepared rapid acquisition with gradient echo, high signal on fluid-attenuated inversion recovery, and low on susceptibility-weighted imaging, possibly indicating abnormal blood vessels penetrating from the ventricle to the posterior callosal vein. We need to be conscious of this unusual finding, particularly when considering surgical intervention in the corpus callosum in cases of pericallosal lipoma, to avoid vascular complications.
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Affiliation(s)
- Kazutoshi Konomatsu
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Departments of Neurology Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yosuke Kakisaka
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Shiho Sato
- Departments of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Takafumi Kubota
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Departments of Neurology Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Temma Soga
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Departments of Neurology Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kazushi Ukishiro
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kazutaka Jin
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Shunji Mugikura
- Division of Image Statistics, Tohoku Medical Megabank Organization, Sendai, Miyagi, Japan
| | - Masashi Aoki
- Departments of Neurology Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Nobukazu Nakasato
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Konomatsu K, Kakisaka Y, Jin K, Aiba T, Takahashi S, Ueda H, Kubota T, Soga T, Ukishiro K, Aoki M, Nakasato N. Genetic generalized epilepsy with catecholaminergic polymorphic ventricular tachycardia complicated by ryanodine receptor 2 variant: A case report. Seizure 2024; 117:284-287. [PMID: 38583245 DOI: 10.1016/j.seizure.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/09/2024] Open
Affiliation(s)
- Kazutoshi Konomatsu
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; Departments of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
| | - Yosuke Kakisaka
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kazutaka Jin
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Shin Takahashi
- Department of Cardiology, National Hospital Organization, Morioka Medical Center, Morioka, Iwate, Japan
| | - Hironobu Ueda
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University School of Medicine, Morioka, Iwate, Japan
| | - Takafumi Kubota
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; Departments of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Temma Soga
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; Departments of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kazushi Ukishiro
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Masashi Aoki
- Departments of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Nobukazu Nakasato
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Kakinuma K, Osawa SI, Katsuse K, Hosokawa H, Ukishiro K, Jin K, Niizuma K, Tominaga T, Endo H, Nakasato N, Suzuki K. Assessment of language lateralization in epilepsy patients using the super-selective Wada test. Acta Neurochir (Wien) 2024; 166:77. [PMID: 38340149 PMCID: PMC10858922 DOI: 10.1007/s00701-024-05957-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/28/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND The classical Wada test (cWada), performed by injecting a short-acting anesthetic through the intracarotid route, helps determine language dominance. In the cWada, adverse effects are observed in 10-30% of trials, hindering accurate assessments. In this study, we assessed the effectiveness of the super-selective Wada test (ssWada), a more selective approach for anesthetic infusion into the middle cerebral artery (MCA). METHODS We retrospectively examined the data of 17 patients with epilepsy who underwent ssWada via anesthetic injection into one M1 segment of the MCA and at least one contralateral trial. RESULTS The ssWada identified 12 patients with left language dominance, 3 with right language dominance, and 2 with bilateral language distribution. Nine trials on the language dominant side resulted in global aphasia for patients with left- or right language dominance. Of the 13 trials conducted on the non-dominant language side, 12 revealed intact language function and one resulted in confusion. Among these, the outcomes of global aphasia or no language impairment were confirmed in the contralateral trials. Among the 22 trials of unilateral M1 injections in patients with unilateral language dominance, 21 (95.5%) showed either global aphasia or no language impairment, indicating language dominance. CONCLUSIONS The ssWada yields clear results, with a high rate of over 90% in determining the language dominant hemisphere with few side effects.
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Affiliation(s)
- Kazuo Kakinuma
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba-ku, Sendai, 980-8575, Japan.
| | - Shin-Ichiro Osawa
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan
| | - Kazuto Katsuse
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba-ku, Sendai, 980-8575, Japan
- Department of Neurology, The University of Tokyo Graduate School of Medicine Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Hiroaki Hosokawa
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba-ku, Sendai, 980-8575, Japan
- Department of Rehabilitation, National Hospital Organization Sendai Nishitaga Hospital, Taihaku-ku, Sendai, Japan
| | - Kazushi Ukishiro
- Department of Epileptology, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan
| | - Kazutaka Jin
- Department of Epileptology, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan
| | - Kuniyasu Niizuma
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan
- Department of Neurosurgical Engineering and Translational Neuroscience, Tohoku University Graduate School of Biomedical Engineering, Aoba-ku, Sendai, Japan
- Department of Neurosurgical Engineering and Translational Neuroscience, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan
| | - Hidenori Endo
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan
| | - Nobukazu Nakasato
- Department of Epileptology, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan
| | - Kyoko Suzuki
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba-ku, Sendai, 980-8575, Japan
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Otomo M, Osawa SI, Suzuki K, Kakinuma K, Ukishiro K, Suzuki H, Niizuma K, Narita N, Nakasato N, Tominaga T. Bilateral and asymmetrical localization of language function identified by the superselective infusion of propofol in an epilepsy patient with a mild malformation of cortical development: illustrative case. J Neurosurg Case Lessons 2023; 6:CASE23451. [PMID: 38145562 PMCID: PMC10751223 DOI: 10.3171/case23451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 11/16/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Atypical localization of language function can result in unexpected postsurgical deficits after cortical resection, but it is difficult to predict the risk in the presurgical evaluation. The authors experienced a rare case of the bilateral and independent existence of different components of language function identified by segmented evaluation of anatomical anterior and posterior language areas using the superselective infusion of propofol. OBSERVATIONS A 32-year-old right-handed female presented with drug-resistant epilepsy. Comprehensive epilepsy evaluation suggested that the epileptic foci involved the whole left frontal lobe but provided less evidence of structural abnormality. To estimate the extent of functional deterioration likely to be caused by an extended left frontal lobectomy, the authors evaluated segmented cortical function in the ipsi- and contralateral hemispheres by the superselective infusion of propofol into the branches of the intracranial artery. The results revealed bilateral and asymmetrical localization of language function because the patient presented with different components of aphasia in each hemisphere. Based on the authors' assessment of her functional tolerance, an extended left frontal lobectomy was performed and resulted in neurological deficits within the anticipated range. LESSONS An accurate understanding of the correlations between vascular and functional anatomy and the highly specific evaluation of language function provides more advanced presurgical assessment, allowing more tailored planning of cortical resection.
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Affiliation(s)
| | | | | | | | | | - Hiroyoshi Suzuki
- Department of Pathology, Sendai Medical Center, Sendai, Miyagi, Japan
| | - Kuniyasu Niizuma
- Departments of Neurosurgery
- Neurosurgical Engineering and Translational Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Department of Neurosurgical Engineering and Translational Neuroscience, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Miyagi, Japan; and
| | - Norio Narita
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
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Konomatsu K, Kakisaka Y, Jin K, Ukishiro K, Sakata A, Shimogawa T, Morioka T, Kubota T, Soga T, Aoki M, Nakasato N. Dynamic electro-clinical changes corresponding to immediate recovery after glucose administration from insulinoma-induced hypoglycemia: Report of two cases. Epileptic Disord 2023; 25:900-903. [PMID: 37632394 DOI: 10.1002/epd2.20155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/07/2023] [Accepted: 08/21/2023] [Indexed: 08/28/2023]
Affiliation(s)
- Kazutoshi Konomatsu
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yosuke Kakisaka
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kazutaka Jin
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kazushi Ukishiro
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Ayumi Sakata
- Department of Clinical Chemistry and Laboratory Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Takafumi Shimogawa
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takato Morioka
- Department of Neurosurgery, Hachisuga Hospital, Munakata, Japan
| | - Takafumi Kubota
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Temma Soga
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Nobukazu Nakasato
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Kubota T, Jin K, Honoki K, Soga T, Ukishiro K, Kakisaka Y, Aoki M, Nakasato N. Temporomandibular joint dislocation during epileptic seizures in the epilepsy monitoring unit: A case report. Epileptic Disord 2023; 25:904-906. [PMID: 37658277 DOI: 10.1002/epd2.20158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/08/2023] [Accepted: 08/28/2023] [Indexed: 09/03/2023]
Affiliation(s)
- Takafumi Kubota
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Neurology, National Hospital Organization Sendai Medical Center, Sendai, Japan
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazutaka Jin
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Keigo Honoki
- Department of Orthopedic Surgery, Teine Keijinkai Hospital, Sapporo, Japan
| | - Temma Soga
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazushi Ukishiro
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yosuke Kakisaka
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Nobukazu Nakasato
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Konomatsu K, Kakisaka Y, Ishida M, Soga T, Ukishiro K, Osawa SI, Jin K, Aoki M, Nakasato N. Referral odyssey plot to visualize causes of surgical delay in mesial temporal lobe epilepsy with hippocampal sclerosis. Epilepsy Behav 2023; 147:109434. [PMID: 37716330 DOI: 10.1016/j.yebeh.2023.109434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/26/2023] [Accepted: 08/31/2023] [Indexed: 09/18/2023]
Abstract
The "odyssey plot" was used to visualize referral delays in epilepsy surgery. Participants were 36 patients (19 males; 13-67 years, median 27 years) with mesial temporal lobe epilepsy with hippocampal sclerosis (HS) who underwent resection surgery. The "referral odyssey plot" included five clinical episodes: seizure onset (T1), first visits to a non-epileptologist (T2) and to an epileptologist (T3), first admission to our epilepsy monitoring unit (EMU) (T4), and resection surgery (T5). For each patient, we identified the first seizure type: the physician who first diagnosed focal aware seizure (FAS), focal impaired awareness seizure (FIAS), focal to bilateral tonic-clonic seizure (FBTCS), and radiologically suspected HS. Within the overall delay (T1-T5, median 18 years; interquartile range [IQR] 14), non-epileptologist's delay (T2-T3, 11.5 years; IQR 12.25) was far (p < 0.0001) longer than patient's (T1-T2, 0 year; IQR 2.25), epileptologist's (T3-T4, 1 year; IQR 4), or after-EMU delay (T4-T5, 1 year; IQR 1). FAS onset cases had significantly longer T1-T2 (N = 5, median 7 years; IQR 6) than FIAS (N = 22, 0 year; IQR 1, p < 0.005) or FBTCS onset cases (N = 9, 0 year; IQR 0, p < 0.001). FAS was correctly diagnosed first by non-epileptologists in 17.9%, by out-patient epileptologists in 35.7%, and at the EMU in 46.4%. FIAS was correctly diagnosed first by non-epileptologists in 94.4% and by out-patient epileptologists in 5.6%. Non-epileptologists diagnosed FBTCS in all cases. HS was diagnosed by non-epileptologists in 13.9%, by out-patient epileptologists in 47.2%, and at the EMU in 38.9%. Early referral to epileptologists is most critical for early surgery. Early utilization of the EMU is highly recommended because FAS is often overlooked by outpatient epileptologists. The odyssey plot will be useful to improve the healthcare system for other types of epilepsy.
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Affiliation(s)
- Kazutoshi Konomatsu
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; Departments of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yosuke Kakisaka
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
| | - Makoto Ishida
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Temma Soga
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; Departments of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kazushi Ukishiro
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Shin-Ichiro Osawa
- Departments of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kazutaka Jin
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Masashi Aoki
- Departments of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Nobukazu Nakasato
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Osawa SI, Suzuki K, Asano E, Ukishiro K, Agari D, Kakinuma K, Kochi R, Jin K, Nakasato N, Tominaga T. Causal Involvement of Medial Inferior Frontal Gyrus of Non-dominant Hemisphere in Higher Order Auditory Perception: A single case study. Cortex 2023; 163:57-65. [PMID: 37060887 DOI: 10.1016/j.cortex.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 10/12/2022] [Accepted: 02/13/2023] [Indexed: 03/31/2023]
Abstract
The medial side of the operculum is invisible from the lateral surface of cerebral cortex, and its functions remain largely unexplored using direct evidence. Non-invasive and invasive studies have proved functions on peri-sylvian area including the inferior frontal gyrus (IFG) and superior temporal gyrus within the language-dominant hemisphere for semantic processing during verbal communication. However, within the non-dominant hemisphere, there was less evidence of its functions except for pitch or prosody processing. Here we add direct evidence for the functions of the non-dominant hemisphere, the causal involvement of the medial IFG for subjective auditory perception, which is affected by the context of the condition, regarded as a contribution in higher order auditory perception. The phenomenon was clearly distinguished from absolute and invariant pitch perception which is regarded as lower order auditory perception. Electrical stimulation of the medial surface of pars triangularis of IFG in non-dominant hemisphere via depth electrode in an epilepsy patient rapidly and reproducibly elicited perception of pitch changes of auditory input. Pitches were perceived as either higher or lower than those given without stimulation and there was no selectivity for sound type. The patient perceived sounds as higher when she had greater control over the situation when her eyes were open and there were self-cues, and as lower when her eyes were closed and there were investigator-cues. Time-frequency analysis of electrocorticography signals during auditory naming demonstrated medial IFG activation, characterized by low-gamma band augmentation during her own vocal response. The overall evidence provides a neural substrate for altered perception of other vocal tones according to the condition context.
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Ohseto H, Soga T, Kakisaka Y, Jin K, Ukishiro K, Konomatsu K, Kubota T, Fujimori J, Nakasato N. Ictal chest discomfort in a patient with temporal lobe seizures and amygdala enlargement. Epilepsy Behav Rep 2022; 21:100578. [PMID: 36606273 PMCID: PMC9807991 DOI: 10.1016/j.ebr.2022.100578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/11/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Chest discomfort is the representative symptom of dangerous coronary artery disease (CAD), but rarely occurs in patients with seizures. We treated a 74-year-old man with right mesial temporal lobe epilepsy and amygdala enlargement, who was initially suspected of CAD and underwent repeated cardiac angiography because of recurrent episodes of paroxysmal chest discomfort starting from 68 years old. He visited an epileptologist and underwent long-term video electroencephalography monitoring (LTVEM), which confirmed right temporal seizure onset during a habitual episodes of "chest discomfort," stereotyped movement of chest rubbing with the right hand, followed by impaired conscousness. Brain magnetic resonance imaging revealed right amygdala enlargement. The present case emphasizes the importance of the wide range of symptoms, such as chest discomfort, which may associated with epielpsy and result in a delayed diagnosis. LTVEM is useful for diagnosis of epilepsy with unusual seizure semiology by recording ictal EEG changes during chest discomfort.
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Key Words
- AMPAR, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor
- Amygdala enlargement
- CAD, coronary artery disease
- CAG, coronary angiography
- CASPAR2, contactin-associated-protein-receptor-2
- Chest discomfort
- EEG, electroencephalography
- GABABR, γ-aminobutyric acid-B receptor
- LGI-1, leucine-rich glioma-inactivated ptotein-1
- LTVEM, long-term video electroencephalography monitoring
- MRI, magnetic resonance imaging
- Mesial temporal lobe epilepsy
- NMDA, N-methyl-D-aspartate receptor
- TLE, temporal lobe epilepsy
- mTLE, mesial temporal lobe epilepsy
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Affiliation(s)
- Hisashi Ohseto
- Department of Graduate Medical Education Center, Tohoku University Hospital, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573, Japan
| | - Temma Soga
- Department of Epileptology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573, Japan,Department of Neurology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573, Japan,Corresponding author at: Department of Epileptology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573, Japan.
| | - Yosuke Kakisaka
- Department of Epileptology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573, Japan
| | - Kazutaka Jin
- Department of Epileptology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573, Japan
| | - Kazushi Ukishiro
- Department of Epileptology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573, Japan
| | - Kazutoshi Konomatsu
- Department of Epileptology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573, Japan,Department of Neurology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573, Japan
| | - Takafumi Kubota
- Department of Neurology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573, Japan
| | - Juichi Fujimori
- Division of Neurology, Tohoku Medical and Pharmaceutical University, 1-15-1 Fukumuro, Miyagino-ku, Sendai, Miyagi 983-8536, Japan
| | - Nobukazu Nakasato
- Department of Epileptology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573, Japan
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Kakinuma K, Osawa SI, Hosokawa H, Oyafuso M, Ota S, Kobayashi E, Kawakami N, Ukishiro K, Jin K, Ishida M, Sato T, Sakamoto M, Niizuma K, Tominaga T, Nakasato N, Suzuki K. Determination of language areas in patients with epilepsy using the super-selective Wada test. IBRO Neurosci Rep 2022; 13:156-163. [PMID: 36039070 PMCID: PMC9418183 DOI: 10.1016/j.ibneur.2022.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 08/08/2022] [Indexed: 11/19/2022] Open
Abstract
The Wada test is the gold standard for determining language-dominant hemisphere. However, the precise determination of language areas in each patient requires more invasive methods, such as electrocortical stimulation. Some studies have reported the use of anesthetic injection into selective cerebral arteries to predict postoperative function. To assess the function of the anterior and posterior language areas separately, we developed an advanced test named the “super-selective Wada test” (ssWada). The ssWada procedure is as follows: an endovascular neurosurgeon identifies the arterial branches of the middle cerebral artery (MCA) perfusing the anterior language area of the inferior frontal gyrus and the posterior language area of the posterior part of the superior temporal gyrus using angiography. Behavioral neurologists assess language symptoms before and after propofol administration using a microcatheter tip in the selected arterial branch. From 30 serial patients with epilepsy who underwent ssWada test at Tohoku University Hospital, we retrospectively reviewed patients in whom multiple areas in the bilateral MCA region was examined. Eight cases were identified in this study. All eight cases had been considered for resection of the area overlapping the classical language area. Three of the eight cases were left-dominant, and the within-hemisphere distribution was also considered typical. One case was determined to be left-dominant but atypical in the intra-hemispheric functional distribution. Two cases were right-dominant, and the intra-hemispheric functional distribution was considered a mirror image of the typical pattern. The remaining two cases were considered atypical, not only in terms of bilateral language function, but also in terms of anterior-posterior functional distribution. This case series demonstrates the potential utility of ssWada in revealing separate function of the anterior and posterior language areas. The ssWada allows simulation of local surgical brain resection and detailed investigation of language function, which potentially contributes to planning the resection area. Although indications for ssWada are quite limited, it could play a complementary role to noninvasive testing because it provides information related to resection using a different approach. The super-selective Wada test (ssWada) injects anesthetic locally into the brain. The ssWada simulates states of post-resection functional impairment. The ssWada successfully localized different components of language separately.
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Affiliation(s)
- Kazuo Kakinuma
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan
- Corresponding author.
| | - Shin-ichiro Osawa
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan
| | - Hiroaki Hosokawa
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan
- Department of Rehabilitation, National Hospital Organization Sendai-Nishitaga Hospital, 2-11-11 Kagitorihoncho, Taihaku, Sendai, Miyagi 982-8555, Japan
| | - Marie Oyafuso
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan
| | - Shoko Ota
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan
| | - Erena Kobayashi
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan
- Department of Neurology and Stroke Medicine, Yokohama City University School of Medicine, Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama, Kanagawa 236-0004, Japan
| | - Nobuko Kawakami
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan
| | - Kazushi Ukishiro
- Department of Epileptology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan
| | - Kazutaka Jin
- Department of Epileptology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan
| | - Makoto Ishida
- Department of Epileptology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan
| | - Takafumi Sato
- Clinical Physiological Laboratory, Tohoku University Hospital, 1-1 Seiryo, Aoba, Sendai, Miyagi 980-8574, Japan
| | - Mika Sakamoto
- Clinical Physiological Laboratory, Tohoku University Hospital, 1-1 Seiryo, Aoba, Sendai, Miyagi 980-8574, Japan
| | - Kuniyasu Niizuma
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan
- Department of Neurosurgical Engineering and Translational Neuroscience, Graduate School of Biomedical Engineering, Tohoku University, 2-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan
- Department of Neurosurgical Engineering and Translational Neuroscience, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan
| | - Nobukazu Nakasato
- Department of Epileptology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan
| | - Kyoko Suzuki
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan
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11
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Ukishiro K, Osawa SI, Iwasaki M, Kakisaka Y, Jin K, Uematsu M, Yamamoto T, Tominaga T, Nakasato N. Age-Related Recovery of Daily Living Activity After 1-Stage Complete Corpus Callosotomy: A Retrospective Analysis of 41 Cases. Neurosurgery 2022; 90:547-551. [PMID: 35129138 DOI: 10.1227/neu.0000000000001871] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 11/07/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Recovery time after corpus callosotomy (CC) is known to be longer in elderly than in younger patients. OBJECTIVE To evaluate the relationship between patient age and recovery time of activities of daily living (ADL) after 1-stage complete CC. METHODS This study included 41 patients (22 women; aged 13 months-34 years, median 7 years) who underwent 1-stage complete CC for medically intractable seizures with drop attacks, infantile spasms, and/or bilaterally synchronized electroencephalographic discharges between August 2009 and April 2019. The timing of restart of competence in 5 ADL categories and surgical outcomes were recorded. RESULTS Patients (1) restarted speech at 2.2 ± 1.3 (mean ± 2 standard deviations; range 1-5) days, (2) restarted replying with their own name on request at 5.5 ± 8.6 (2-33) days, (3) restarted oral intake at 1.6 ± 1.7 (1-11) days, (5) discontinued intravenous feeding at 6.0 ± 3.0 (2-16) days, and (5) restarted ambulation or wheelchair movement at 5.8 ± 3.4 (2-10) days. Younger patients showed significantly (P < .0223) earlier recovery of ambulation or wheelchair movement, but no age difference was found in the other 4 ADL categories. Overall seizure freedom was achieved in 5 patients, excellent (>80%) seizure reduction in 11, good (50%-80%) seizure reduction in 5, and poor (<50%) seizure reduction in 20. CONCLUSION Early ADL recovery after 1-stage complete CC is favorable in both young and adult patients. These findings, with good surgical outcomes, will encourage more positive consideration of 1-stage complete CC in both pediatric and adult patients.
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Affiliation(s)
- Kazushi Ukishiro
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Shin-Ichiro Osawa
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masaki Iwasaki
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Yosuke Kakisaka
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazutaka Jin
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mitsugu Uematsu
- Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tetsuya Yamamoto
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Nobukazu Nakasato
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
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12
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Iwaki H, Sonoda M, Osawa SI, Silverstein BH, Mitsuhashi T, Ukishiro K, Takayama Y, Kambara T, Kakinuma K, Suzuki K, Tominaga T, Nakasato N, Iwasaki M, Asano E. Your verbal questions beginning with 'what' will rapidly deactivate the left prefrontal cortex of listeners. Sci Rep 2021; 11:5257. [PMID: 33664359 PMCID: PMC7933162 DOI: 10.1038/s41598-021-84610-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 02/15/2021] [Indexed: 12/31/2022] Open
Abstract
The left prefrontal cortex is essential for verbal communication. It remains uncertain at what timing, to what extent, and what type of phrase initiates left-hemispheric dominant prefrontal activation during comprehension of spoken sentences. We clarified this issue by measuring event-related high-gamma activity during a task to respond to three-phrase questions configured in different orders. Questions beginning with a wh-interrogative deactivated the left posterior prefrontal cortex right after the 1st phrase offset and the anterior prefrontal cortex after the 2nd phrase offset. Left prefrontal high-gamma activity augmented subsequently and maximized around the 3rd phrase offset. Conversely, questions starting with a concrete phrase deactivated the right orbitofrontal region and then activated the left posterior prefrontal cortex after the 1st phrase offset. Regardless of sentence types, high-gamma activity emerged earlier, by one phrase, in the left posterior prefrontal than anterior prefrontal region. Sentences beginning with a wh-interrogative may initially deactivate the left prefrontal cortex to prioritize the bottom-up processing of upcoming auditory information. A concrete phrase may obliterate the inhibitory function of the right orbitofrontal region and facilitate top-down lexical prediction by the left prefrontal cortex. The left anterior prefrontal regions may be recruited for semantic integration of multiple concrete phrases.
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Affiliation(s)
- Hirotaka Iwaki
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, MI, 48201, USA.,Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, 9808575, Japan
| | - Masaki Sonoda
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, MI, 48201, USA.,Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Kanagawa, 2360004, Japan
| | - Shin-Ichiro Osawa
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, 9808575, Japan.
| | - Brian H Silverstein
- Translational Neuroscience Program, Wayne State University, Detroit, MI, 48201, USA
| | - Takumi Mitsuhashi
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, MI, 48201, USA.,Department of Neurosurgery, School of Medicine, Juntendo University, Tokyo, 1138421, Japan
| | - Kazushi Ukishiro
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, 9808575, Japan.,Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Kanagawa, 2360004, Japan
| | - Yutaro Takayama
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, 9808575, Japan.,Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Kanagawa, 2360004, Japan.,Department of Neurosurgery, National Center of Neurology and Psychiatry, National Center Hospital, Tokyo, 1878551, Japan
| | - Toshimune Kambara
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, MI, 48201, USA.,Department of Psychology, Hiroshima University, Hiroshima, 7398524, Japan
| | - Kazuo Kakinuma
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, 9808575, Japan
| | - Kyoko Suzuki
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, 9808575, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, 9808575, Japan
| | - Nobukazu Nakasato
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, 9808575, Japan
| | - Masaki Iwasaki
- Department of Neurosurgery, National Center of Neurology and Psychiatry, National Center Hospital, Tokyo, 1878551, Japan.
| | - Eishi Asano
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, MI, 48201, USA. .,Department of Neurology, Children's Hospital of Michigan, Wayne State University, Detroit, MI, 48201, USA.
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