Abstract
The seizure onset zone (SOZ) and propagation pathways in supplementary motor area (SMA) seizures are difficult to identify because of the short duration and swift propagations of this seizure type. Herein, we studied ictal cerebral blood flow changes, seizure electrical activities, and clinical signs employing simultaneous near-infrared spectroscopy (NIRS) and electrocorticography (ECoG) recordings in a brain tumor patient with SMA seizures. Increased cerebral blood flow was observed from the SOZ in the ipsilateral SMA and spread to the ipsilateral premotor cortex, ipsilateral sensorimotor cortex, and also the contralateral hemisphere. These propagation patterns were concordant with ictal ECoG seizure activities and clinical signs. Removal of the SOZ and surrounding areas, where the higher blood flow and higher frequency oscillations had been identified, achieved a good outcome for this patient. Our ictal NIRS-ECoG technique is robust and useful for detecting the SOZ and seizure propagations.
Highlights
Supplementary motor area (SMA) seizures are characterized by sudden, brief tonic posturing of the extremities, vocalization, and initially preserved consciousness.[1]
Near-infrared spectroscopy (NIRS), which measures realtime hemodynamic changes considered to be linked to underlying neural activities,[6,7] has recently been used to monitor rapid cortical hemodynamic changes in patients with epilepsy.[8,9]
We focused on ictal high-frequency oscillations (HFOs) in electrocorticography (ECoG), which are reportedly specific for detecting the seizure onset zone (SOZ) and allow visualization of dynamic ictal changes.[11]
Summary
Supplementary motor area (SMA) seizures are characterized by sudden, brief tonic posturing of the extremities, vocalization, and initially preserved consciousness.[1]. Previous studies used ictal single-photon emission computed tomography (SPECT) to investigate localization of the SOZ and ictal cortical propagation patterns in patients with SMA seizures,[3,4,5] it is not possible with SPECT to evaluate cortical hemodynamic changes for the entire time period from the preictal phase to the postictal phase. Our recent studies have demonstrated that simultaneous NIRS and electroencephalographic (EEG) analysis provides useful information about neural networks.[10] We focused on ictal high-frequency oscillations (HFOs) in electrocorticography (ECoG), which are reportedly specific for detecting the SOZ and allow visualization of dynamic ictal changes.[11] This is the first report, to our knowledge, describing successfully obtaining simultaneous
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