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Review article
Language tasks used for the presurgical assessment of epileptic patients with MEG
Mona Pirmoradi, Renée Béland, Dang K Nguyen, Benoit A Bacon, Maryse Lassonde
New noninvasive diagnostic techniques are being developed to reduce the risks associated with more invasive techniques. The aim of this paper is to review the different protocols for lateralizing and/or localizing language functions using magnetoencephalography (MEG), a noninvasive technique. The reviewed studies include control and patient populations using various protocols which employ different expressive and receptive language tasks. The overall findings reveal high concordance between MEG and the intracarotid amobarbital test (IAT). Moreover, MEG allows intrahemispheric localization of receptive and expressive language functions. However, the different language tasks used with MEG, whether receptive or expressive, appear to activate the left temporal more than frontal areas. The best task to assess language comprehension in both adults and children appears to be a word recognition task. A verbal fluency task could be used to test language production in children and a verb generation task in adults.
Original article
Lateralized ictal dystonia of upper and lower limbs in patients with temporal lobe epilepsy
Robert Kuba, Ivana Tyrlíková, Milan Brázdil, Ivan Rektor
(76 males, 66 females) with temporal lobe epilepsy, aged from 19 to 58 years with an average age of 33.1 ± 8.7 years. Overall, 454 seizures were analysed. The seizure onset zone was mesial in 112 patients (78.8%), and “non-mesial” in 30 patients (21.2%).ResultsIctal dystonia was present in 68 of the 142 patients (47.9%), and in 186 of 454 total seizures (40.9%). Upper limb dystonia was present in 94 sizures (50.5%) of 32 patients; hemidystonia in 84 seizures (45.2%) of 30 patients; and lower limb dystonia in eight seizures (4.3%) of six patients. For all cases, all types of ictal dystonia were contralateral to the seizure onset zone. Ictal dystonia was significantly more frequent in patients with a mesial seizure onset zone than in “non-mesial” patients (58.1% vs 7.7%; p < 0.001). Within the mesial group, ictal dystonia was significantly more frequent in patients with hippocampal sclerosis than in those patients with other lesions (66.1% vs 41.1%; p = 0.023).ConclusionIctal dystonia in temporal lobe epilepsy is a reliable lateralizing ictal sign. During almost half of the seizures studied, ictal dystonia was present in the form of hemidystonia, and isolated involvement of the lower limbs also occured. Combined data obtained from both noninvasive and invasive EEG showed that ictal dystonia tended to occur more often in mesial onset temporal lobe epilepsy, especially when hippocampal sclerosis was the epileptogenic lesion.
Mosaicism of a missense SCN1A mutation and Dravet syndrome in a Roma/Gypsy family
Dimitar N Azmanov, Sashka Zhelyazkova, Petya S Dimova, Melania Radionova, Veneta Bojinova, Laura Florez, Shelagh J Smith, Ivailo Tournev, Assen Jablensky, John Mulley, Ingrid Scheffer, Luba Kalaydjieva, Josemir W Sander
plus (GEFS+). While most Dravet syndrome cases are caused by de novo mutations, 5% inherit a mutation from a mildly affected or symptom-free parent. Parental mosaicism has been identified, with documented cases involving truncating mutations or gene rearrangements. We describe a Roma/Gypsy family, where a missense mutation in SCN1A, p.D194N, is transmitted from a mosaic GEFS+ father to a child with Dravet syndrome. Mosaicism may be more common than assumed and should be considered regardless of the nature of the mutation.
Influence of personality on sexual quality of life in epilepsy
Daniela Mölleken, Hertha Richter-Appelt, Stefan Stodieck, Thomas Bengner
epilepsy. SQOL was determined using the Derogatis Interview for Sexual Function - Self Report Inventory (DISF-SR) and personality was studied using the NEO five-factor inventory (NEO-FFI). Lower extraversion and female sex were factors associated with decreased SQOL, accounting for 22% of SQOL variance. Our results suggest that particularly introverted women with epilepsy may have an elevated risk of decreased SQOL.
Clinical commentary
Ictal whistling: a rare automatism during temporal lobe seizures
Seetharam Raghavendra, Seyed Mirsattari, Richard S McLachlan
Both had temporal lobe epilepsy with resolution of seizures after a temporal lobectomy. Ictal whistling appears to localize to the temporal lobe but may not be useful for lateralization. [Published with video sequences]
Nocturnal groaning (catathrenia) and epilepsy
Jan Zinke, Sven Rupprecht, Matthias Schwab, Georg Hagemann
of his seizure semiology. Video monitoring and polysomnography revealed episodes of nocturnal groaning. Escalation of antiepileptic treatment was avoided. [Published with video sequences]
Absence seizures with myoclonic features in a juvenile Chihuahua dog
Roberto Poma, Ayako Ochi, Miguel A Cortez
two seconds, multiple times per day before treatment. Ictal EEG showed generalised bilaterally synchronous 4 Hz spike-and-wave complexes during the “absence-like” event, along with rhythmically correlated head and nose twitching. We present video documentation of such attacks and discuss their similarities to human epilepsy with myoclonic absences. [Published with video sequences]
A seizure response dog: video recording of reacting behaviour during repetitive prolonged seizures
Lidia Di Vito, Ilaria Naldi, Barbara Mostacci, Laura Licchetta, Francesca Bisulli, Paolo Tinuper
seizures. We describe the case of a dog, not previously trained for assistance work, showing complex seizure response behaviour. This is the first release of a home video recording of a dog reacting to its owner's seizure. [Published with video sequences]
Levetiracetam-induced seizure aggravation associated with continuous spikes and waves during slow sleep in children with refrac
Roberto H Caraballo, Ricardo Cersósimo, Cecilia De los Santos
and waves during slow sleep, induced by levetiracetam. For both patients levetiracetam was discontinued, and there was significant improvement of this particular electroclinical picture.
Improvement of myoclonic epilepsy in Down syndrome treated with levetiracetam
Masoud Sangani, Asim Shahid, Shahram Amina, Mohamad Koubeissi
aged 52 and 44 years. Continuous video-EEG recording showed generalised spike and slow wave complexes as an ictal correlate of the myoclonic jerks in both patients. Low dose levetiracetam resulted in rapid, sustained seizure freedom in both patients with no reported adverse events. As for other myoclonic epilepsies, levetiracetam appears to be effective for the treatment of LOMEDS, and may be considered as a first line agent for this disorder.
Malignant autosomal dominant frontal lobe epilepsy with repeated episodes of status epilepticus: successful treatment with vaga
Mar Carreño, Dionisio Garcia-Alvarez, Iratxe Maestro, Santiago Fernández, Antonio Donaire, Teresa Boget, Jordi Rumià, Luis Pintor, Xavier Setoain
during sleep. Up to a third of patients may have refractory seizures, with repeated episodes of status epilepticus, intellectual disability of variable degree and psychiatric disturbances. We report a patient with ADNFLE, refractory seizures and repeated episodes of life-threatening convulsive status epilepticus who underwent prolonged video-EEG monitoring and was implanted with a vagal nerve stimulator. At 3.5 years of follow-up, a decrease of more than 80% in seizure frequency was achieved, episodes of status were completely controlled and he displayed improved mood and alertness. Vagal nerve stimulation may be considered as therapy for patients with refractory epilepsies of genetic cause, as well as repeated status epilepticus.
Epilepsy surgery for refractory epilepsy due to encephalocele: a case report and review of the literature
Howard J Faulkner, David R Sandeman, Seth Love, Marcus J Likeman, Desnomd A Nunez, Samden D Lhatoo
between meningoencephaloceles and epileptic seizures is well reported in the literature. We report a patient with refractory right frontal lobe epilepsy caused by a right nasal meningoencephalocele who was rendered seizure free by endoscopic nasal excision and skull base repair, obviating the need for resective epilepsy surgery. Epilepsy patterns associated with encephalocele and their management are reviewed.
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