Abstract
PurposeTo elucidate the localization of ictal EEG activity, and correlate it to semiological features in self-limited epilepsy with centrotemporal spikes (formerly called “benign epilepsy with centrotemporal spikes”). MethodsWe have performed ictal electric source imaging, and we analysed electroclinical correlations in three patients with self-limited epilepsy with centrotemporal spikes. ResultsThe source of the evolving rhythmic ictal activity (9.7-13.5Hz) localized to the operculo-insular area. The rhythmic EEG activity was time-locked to the contralateral focal motor seizure manifestation: facial rhythmic myoclonic jerks, with the same frequency as the analysed ictal rhythm. In all three patients, the seizures had fluctuating course with pauses of clinical and electrographic seizure activity, ranging from 0.4 to 7s. ConclusionSource imaging of ictal EEG activity in patients with self-limited epilepsy with centrotemporal spikes showed activation of the operculo-insular area, time-locked to the contralateral focal myoclonic jerks. Fragmented seizure dynamics, with fluctuating course, previously described as a hallmark in patients with psychogenic non-epileptic seizures, can occur in rolandic seizures.
Highlights
Self-limited epilepsy with centrotemporal spikes [1] is the most common syndrome of idiopathic focal epilepsy in children [2]
Previous studies using electromagnetic source imaging have predominantly analysed the location of the interictal epileptiform discharges in self-limited epilepsy with centrotemporal spikes [8]
It has long been posited that the irritative zone might not be necessarily identical with the area that generates the seizures, and the source imaging of ictal activity should be obtained whenever possible
Summary
Self-limited epilepsy with centrotemporal spikes [1] (formerly called “benign epilepsy with centrotemporal spikes” or “idiopatic/ benign rolandic epilepsy of childhood”) is the most common syndrome of idiopathic focal epilepsy in children [2]. Since seizure frequency is usually low, there are scarce reports on the ictal EEG pattern in this syndrome; most of the papers are case reports or small case series. The largest number of patients was reported by Capovilla and co-workers [3]. They retrospectively collected 30 patients with ictal recordings, and they identified four types of ictal patterns, the most common being the low-voltage fast activity. The precise anatomic location of the ictal activity, and the temporal correlation between the ictal EEG and the semiological manifestation have not been systematically addressed yet
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