Temporal Seizures Research Articles

Non-lesional mesial temporal lobe epilepsy requires bilateral invasive evaluation

Mesial temporal lobe epilepsy (MTLE) usually responds well to surgical treatment, although in non-lesional cases up to 50% of patients experience seizure relapse. The possibility of bilateral independent seizure onset should be considered as a reason for epilepsy surgery failure. In a cohort of 177 patients who underwent invasive presurgical evaluation with stereo-tactically placed electrodes in two level four epilepsy centers, 29 had non-lesional MTLE. Invasive evaluation results are described. Among 29 patients with non-lesional MRI and mesial temporal lobe seizure onset recorded during stereo-EEG (SEEG) evaluation, four patients with unilateral preimplantation hypothesis had independent bilateral mesial temporal seizures on SEEG despite of unilateral non-invasive evaluation data. Three of these patients were treated with bitemporal responsive neurostimulator system (RNS). Independent bilateral mesial temporal seizures have been confirmed on RNS ECoG (electrocorticography). The fourth patient underwent right anterior temporal lobectomy. We propose that patients with non-lesional mesial temporal lobe epilepsy would benefit from bilateral invasive evaluation of mesial temporal structures to predict those patients who would be at most risk for surgical failure. Neurostimulaiton could be an initial treatment option for patients with independent bitemporal seizure onset.

Epilepsy Seizures in Spontaneously Hypertensive Rats After Acoustic Stimulation: Role of Renin-Angiotensin System.

Hypertension is a common comorbidity observed in individuals with epilepsy. Growing evidence suggests that lower blood pressure is associated with reduced frequency and severity of seizures. In this study, we sought to investigate whether the renin–angiotensin system (RAS), which is a critical regulator of blood pressure, is involved in the pathogenesis of audiogenic epilepsy-related seizures in a hypertensive rat model. Spontaneously hypertensive rats (SHRs) were given RAS inhibitors, angiotensin-converting enzyme (ACE) inhibitor or angiotensin II type I receptor (AT1R) antagonist, for 7 days prior to inducing epileptic seizures by acoustic stimulation. After the pretreatment phase, blood pressure (BP) of SHRs normalized as expected, and there was no difference in systolic and diastolic BP between the pretreated SHRs and normotensive rat group (Wistar). Next, treated and untreated SHRs (a high BP control) were individually subjected to acoustic stimuli twice a day for 2 weeks. The severity of tonic–clonic seizures and the severity of temporal lobe epilepsy seizures (product of forebrain recruitment) were evaluated by the mesencephalic severity index (Rossetti et al. scale) and the limbic index (Racine’s scale), respectively. Seizures were observed in both untreated (a high BP control) SHRs and in SHRs treated with AT1R antagonist and ACE inhibitor. There was no statistical difference in the mesencephalic severity and limbic index between these groups. Our results demonstrate that SHRs present seizure susceptibility with acoustic stimulation. Moreover, although RAS inhibitors effectively reduce blood pressure in SHR, they do not prevent developing epileptic seizures upon acoustic stimulation in SHR. In conclusion, our study shows that RAS is an unlikely link between hypertension and susceptibility to epileptic seizures induced by acoustic stimulation in SHRs, which is in contrast with the anticonvulsant effect of losartan in other animal models of epilepsy.

Epilepsy in early onset Alzheimer’s disease

AbstractBackgroundEpilepsy seems to be an important comorbidity in patients with Alzheimer’s disease (AD), especially in young onset AD (<65 years old). At this time epileptic seizures are still underestimated in this population. However, seizures may interact with AD evolution with possible acceleration of cognitive decline and early institutionalization. Seizures may also be a marker of a more aggressive subtype of AD.This study aims to determine the prevalence of the epileptic comorbidity in patients with early onset AD. Secondly, it will investigate the temporal relationship between AD and epilepsy and extract specific characteristics of AD patients at higher risk of epilepsy.MethodAll patients diagnosed as early‐onset Alzheimer disease between 2013 and 2019, with abnormal CSF biomarkers for Alzheimer disease, and followed at the University Hospital of Nancy (AD regional center) were selected. Patients with cortical focal lesion or old history of epilepsy were excluded. The usual clinical follow‐up was extended with a prolonged EEG and a specific consultation with an epilepsy expert. Based on this dedicated interrogation and EEG results, patients were then classified as epileptic or non‐epileptic. We collected demographic data and information on epilepsy and AD disorders.ResultAmong the 22 included patients, 10 were classified as epileptic with a prevalence of 45%. Considering seizure types, patients presented generalized seizures (n=4), typical temporal seizures (n=4), myoclonus (n=1) and extratemporal seizures (n=1). EEG recordings were not useful in our population. Epileptic patients presented a more severe cognitive decline than patients without seizures (MMSE 8.4+/‐6.9 versus MMSE non epileptic 20.9 +/‐ 5.45). 100% of patients with a MMSE <10 had epileptic comorbidity. In our population, epilepsy never occurred before AD diagnosis.ConclusionEpilepsy appears to be a frequent comorbidity in early onset AD patients, with a prevalence of 45% in our study. This comorbidity seems to be a marker for severe AD. The role of the epileptic disorder in the acceleration of cognitive decline as the positive impact of antiepileptic drugs still need to be determined.

Conversational analysis of consciousness during seizures

ObjectiveThe objectives of the study were to 1) investigate how patients with epilepsy describe the subjective, conscious experience of having a seizure and 2) determine whether certain themes and descriptions correspond to specific types of epilepsy. MethodsWe interviewed thirteen patients with electroencephalographically confirmed epilepsy about their subjective experience of having a seizure and used conversational analysis (CA) to analyze the language they used to describe this experience. ResultsSeven patients had focal to bilateral tonic–clonic seizures (FBTCS), 7 had focal impaired awareness seizures (FIAS), 1 had focal aware seizures (FAS), and one had generalized onset tonic–clonic (GTC) seizures. Three had multiple types of seizures. Focal seizure origin was frontal in 2 patients, right hemisphere in 1, parieto-occipital in 1, and temporal in 8. Focal to bilateral tonic–clonic and GTC seizures were most frequently associated with descriptions of a total loss of consciousness (n = 8), whereas FIAS were most frequently associated with a perceived loss of consciousness but able to describe some aspects of being unconscious (n = 5). Temporal seizures most frequently accompanied reports of memory loss/impairment (n = 4). Ten patients provided specific descriptions of the transition between the interictal and ictal state or auras. Descriptions consciousness and unconsciousness ranged significantly, resembling a continuum rather than corresponding to distinct levels. ConclusionThe subjective experience of consciousness for patients with epilepsy may differ by seizure type and origin. These may reflect different involvement of brain regions involved in producing consciousness and arousal. Conversational analysis and narrative approaches can significantly aid clinicians in the diagnosis and management of epilepsy.

Thalamus and focal to bilateral seizures: A multiscale cognitive imaging study.

ObjectiveTo investigate the functional correlates of recurrent secondarily generalized seizures in temporal lobe epilepsy (TLE) using task-based fMRI as a framework to test for epilepsy-specific network rearrangements. Because the thalamus modulates propagation of temporal lobe onset seizures and promotes cortical synchronization during cognition, we hypothesized that occurrence of secondarily generalized seizures, i.e., focal to bilateral tonic-clonic seizures (FBTCS), would relate to thalamic dysfunction, altered connectivity, and whole-brain network centrality.MethodsFBTCS occur in a third of patients with TLE and are a major determinant of disease severity. In this cross-sectional study, we analyzed 113 patients with drug-resistant TLE (55 left/58 right), who performed a verbal fluency fMRI task that elicited robust thalamic activation. Thirty-three patients (29%) had experienced at least one FBTCS in the year preceding the investigation. We compared patients with TLE-FBTCS to those without FBTCS via a multiscale approach, entailing analysis of statistical parametric mapping (SPM) 12–derived measures of activation, task-modulated thalamic functional connectivity (psychophysiologic interaction), and graph-theoretical metrics of centrality.ResultsIndividuals with TLE-FBTCS had less task-related activation of bilateral thalamus, with left-sided emphasis, and left hippocampus than those without FBTCS. In TLE-FBTCS, we also found greater task-related thalamotemporal and thalamomotor connectivity, and higher thalamic degree and betweenness centrality. Receiver operating characteristic curves, based on a combined thalamic functional marker, accurately discriminated individuals with and without FBTCS.ConclusionsIn TLE-FBTCS, impaired task-related thalamic recruitment coexists with enhanced thalamotemporal connectivity and whole-brain thalamic network embedding. Altered thalamic functional profiles are proposed as imaging biomarkers of active secondary generalization.

Atypical duration of epileptic and psychogenic nonepileptic events

ObjectivesWe aimed to estimate the frequency of epileptic seizures (ES) and psychogenic nonepileptic seizures (PNES) with atypical duration in our epilepsy monitoring unit (EMU), in order to raise awareness of atypical durations of both types of events. Materials & methodsWe retrospectively reviewed all consecutive video-electroencephalogram (vEEG) recordings in our medical center's EMU from January 2013 to December 2017 and identified patients with seizures with atypical duration. Short PNES were defined as those lasting fewer than 2 min and long ES as those lasting for more than 5 min. ResultsThe files of 830 adult (age >16 years) patients were reviewed, of whom 26 patients (3.1%, mean age: 33.3 ± 9.8 years, 12 females) were diagnosed as having an unusual seizure duration. Among 432 patients with ES during monitoring, fourteen patients [3.2% (95% confidence interval (CI): 1.5%–5.0%), mean age: 33.0 ± 12.2, 5 females [had long ES durations (exceeding 5 min). In 64% of patients with long ES, the events were provoked by antiepileptic drug (AED) withdrawal during vEEG, 62% had focal lesion on brain imaging, and 64% had a frontotemporal or a temporal seizure focus. Among 223 patients diagnosed with PNES, 12 patients [5.4% (95% CI: 2.2%–8.6%), mean age: 33.6 ± 6.6, 7 females] had short PNES durations (less than 2 min) and demonstrated motor (9/12, 75%), altered responsiveness (6/12, 50%), and vocalization (5/12, 42%) as the most prominent clinical features. ConclusionsThe data from our case files highlight two main considerations in the diagnosis of paroxysmal events: prolonged event can be due to ES, while short events can be psychogenic.

Ictal Asystole in Drug-Resistant Focal Epilepsy: Two Decades of Experience from an Epilepsy Monitoring Unit.

Background: Ictal asystole (IA) is a rare event observed in people with epilepsy (PwE). Clinical and IA video-electroencephalographic findings may be helpful in screening for high-risk subjects. Methods: From all PwE undergoing video-EEG for presurgical evaluation between 2000 and 2019, we retrospectively selected those with at least one IA (R–R interval of ≥3 s during a seizure). Results: IA was detected in eight out of 1088 (0.73%) subjects (mean age: 30 years; mean epilepsy duration: 9.6 years). Four out of them had a history of atonic falls. No patients had cardiac risk factors or cardiovascular diseases. Seizure onset was temporal (n = 5), temporo-parietal (n = 1) or frontal (n = 2), left-sided and right-sided in five and two patients, respectively. In one case a bilateral temporal independent seizure onset was recorded. IA was recorded in 11 out of 18 seizures. Mean IA duration was 13 s while mean IA latency from seizure onset was 26.7 s. Symptoms related to IA were observed in all seizures. Conclusion: IA is a rare and self-limiting event often observed during video-EG in patients with a history of atonic loss of consciousness and/or tardive falls in the course of a typical seizure.

Quantitative analysis of hyperkinetic seizures and correlation with seizure onset zone.

Hyperkinetic epileptic seizures (HKS) are difficult to characterize and localize according to semiologic features. We propose a multicriteria scale to help visual analysis and report results of cerebral localization. We assessed seizures from 37 patients with HKS, explored with stereoelectroencephalography during presurgical evaluation. We used a multicriteria scale (hyperkinetic seizure scale [HSS]) with 10 semiologic features, scored independently by two neurologists. The item scores were used to group seizures using the k-means method. Semiologic features were correlated with the seizure onset zone (SOZ) localization (temporal, prefrontal dorsolateral, prefrontal ventromesial, parietal, insular). Fifty-five seizures were analyzed, and each item of the HSS was compared between the two examiners with good interrater agreement (85.3%). Dystonia, integrated behavior, and bilateral or unilateral hyperkinetic movements were statistically significant according to localization. Three clusters were identified according to the HSS and correlated with different patterns of anatomic localization of SOZ. Cluster 1 was characterized clinically by asymmetric hyperkinetic movements associated with marked dystonia and vocalization. It mainly included parietal seizures. Cluster 2 was characterized by bilateral and symmetrical stereotyped hyperkinetic movements without dystonia. It represented half of temporal seizures and one-third of prefrontal seizures (dorsolateral). Cluster 3 was characterized by seizures with strong emotionality and vocalization with bilateral and symmetrical hyperkinetic movements and integrated behavior. It involved half of temporal seizures and a majority of prefrontal (ventromesial) seizures. We propose a first attempt to quantify clinical patterns of HKS. The HSS may help to predict SOZ localization according to three main groups of hyperkinetic seizures.

A description of verbal and gestural communication during postictal aphasia

Patients suffering from drug-resistant temporal lobe epilepsy show substantial language deficits (i.e., anomia) during their seizures and in the postictal period (postictal aphasia). Verbal impairments observed during the postictal period may be studied to help localizing the epileptogenic zone. These explorations have been essentially based on simple tasks focused on speech, thus disregarding the multimodal nature of verbal communication, particularly the fact that, when speakers want to communicate, they often produce gestures of various kinds. Here, we propose an innovative procedure for testing postictal language and communication abilities, including the assessment of co-speech gestures. We provide a preliminary description of the changes induced on communication during postictal aphasia.We studied 21 seizures that induced postictal aphasia from 12 patients with drug-refractory epilepsy, including left temporal and left frontal seizures. The experimental task required patients to memorize a highly detailed picture and, briefly after, to describe what they had seen, thus eliciting a communicative meaningful monologue. This allowed comparing verbal communication in postictal and interictal conditions within the same individuals. Co-speech gestures were coded according to two categories: “Rhythmic” gestures, thought to be produced in support of speech building, and “illustrative” gestures, thought to be produced to complement the speech content.When postictal and interictal conditions were compared, there was decreased speech flow along with an increase of rhythmic gesture production at the expense of illustrative gesture production. The communication patterns did not differ significantly after temporal and frontal seizures, yet they were illustrated separately, owing to the clinical importance of the distinction, along with considerations of interindividual variability.A contrast between rhythmic and illustrative gestures production is congruent with previous literature in which rhythmic gestures have been linked to lexical retrieval processes. If confirmed in further studies, such evidence for a facilitative role of co-speech gestures in language difficulties could be put to use in the context of multimodal language therapies.

Correlation between influencing factors of cognitive dysfunction and event-related potentials in patients with temporal lobe epilepsy

Objective To explore the influencing factors of cognitive dysfunction in patients with temporal lobe epilepsy using event-related potential detection methods and to evaluate the correlation between them. Methods Sixty patients with temporal lobe epilepsy were enrolled according to the inclusion and exclusion criteria.Clinical data (including age of onset, duration of disease, type of seizure, frequency of episodes and anti-epileptic drugs) were collected.The determination of event-related potentials was improved for all patients enrolled.The latency of the N1, P2, N2, and P3 waves and the amplitude of the P3 wave are comprehensively analyzed. Results Patients with temporal lobe epilepsy: the average latency of N1, P2, N2 and P3 and the average amplitude of P3 wave were (108.47±24.58) ms, (181.70±29.63) ms, (255.63±32.66) ms, (367.03±40.43) ms and (6.45± 5.84)μV, respectively.ERPs (latency of P3 wave) of the age of onset ≤14 years old and the age of onset >14 years old group were statistically significant (P 5 years group and disease course≤5 years group were statistically significant (P 4 times/month group and≤4 times/month group were statistically significant (P<0.05); ERPs (latency of N2 wave) of combination group and monotherapy group was statistically significant (P<0.05). The course of the temporal lobe epilepsy and medicine therapy of combination were impact factors of the latency of N2 wave (P<0.05). Temporal seizure frequency, age of onset and course of disease were impact factors of P3 wave (P<0.05). Conclusion Age of onset, the course of the temporal lobe epilepsy, the type of seizures, the frequency of seizures and the anti-epileptic drugs are important influencing factors of cognitive dysfunction in patients.In event-related potentials, they have different effects on different stages of cognition. Key words: Temporal lobe epilepsy; Cognitive function; Event-related potentials; Influencing factors

Ictal High-Frequency Oscillation for Lateralizing Patients With Suspected Bitemporal Epilepsy Using Wavelet Transform and Granger Causality Analysis.

Identifying lateralization of bilateral temporal lobe epilepsy (TLE) is a challenging issue; scalp electroencephalography (EEG) and routine band electrocorticography (ECoG) fail to reveal the epileptogenic focus for further temporal lobectomy treatment. High-frequency oscillations (HFOs) can be utilized as a biomarker for lateralizing the onset zone in suspected bitemporal epilepsy. Except subjective vision detect the HFOs, objective verification should be performed to raise the accuracy. In the present research, we prospectively studied 10 patients with refractory temporal seizures and who underwent ECoG with wide-band frequency amplifiers (2,048 Hz); all patients had a class I outcome after temporal resection. Pre- and ictal HFOs will be analyzed by wavelet transform (WT) and Granger causality (GC) to objectively verify lateralization of the seizure onset zone (SOZ). WT analysis showed ictal HFOs in 10 patients mainly covered from 80 to 115 Hz (average, 92.59 ± 10.23 Hz), and there was distinct bandpass boundary between pre-ictal HFOs and ictal HFOs. GC analysis showed five patients (2, 4, 5, 6, and 7), no matter the pre-ictal or ictal state, had the highest GC degree in SOZ itself. The remaining patients (1, 3, 8, 9, and 10) had the highest GC degree in SOZ with its adjacent regions in the pre-ictal and ictal stages. GC analysis further confirmed the result of the WT and suggested HFOs are initiated and propagated in the local brain region mainly, afterward, transmitting to adjacent brain regions. These results indicated that the combination of WT and GC analyses significantly contributes to accurate lateralization in patients with suspected bitemporal epilepsy.

Association between serum apolipoprotein E and cognitive functions in Egyptian patients with temporal lobe epilepsy.

Memory, cognition and visuospatial aspects of temporal lobe epilepsy (TLE) have not been fully analyzed yet. From among the huge growing population of circulating apoproteins analyzed in TLE, apolipoprotein E (APOE) was discovered; however, its role in TLE has not been fully elucidated yet. This study was designed to investigate the relation between the serum level of APOE and cognition in TLE patients. Sixty-five subjects (35 TLE patients and 30 healthy matched controls) were included. Evaluation of cognitive functions was done using Addenbrooke's Cognitive Examination Revised (ACE-R) scale. Serum APOE level was measured by ELISA. The mean total score, memory and visuospatial scores of ACE-R were significantly lower in TLE patients compared to healthy subjects. The mean total score and memory score of ACE-R were significantly lower in seizures originating from mesial temporal lobe (MTL) and left temporal lobe seizures. Serum APOE levels were significantly higher in TLE patients compared to healthy subjects. Serum APOE levels significantly negatively correlated with total score, memory, and visuospatial ability scores of ACE-R. Serum APOE was significantly higher in MTL seizures compared to lateral lobe seizures and in left temporal lobe seizures compared to right temporal seizures. Memory and visuospatial aspects were significantly affected in TLE patients. So, the serum APOE level can possibly contribute to cognitive dysfunction in such patients.

P17-T Hippocampal sclerosis (HS) with frontal lobe seizure semiology. Case presentation

Introduction 54-year-old lady with drug resistant epilepsy. Seizure onset aged 10. No history of febrile convulsions. Head injury aged 4. Medication; Lamotrigine, Topiramate and Levetiracetam. Seizure Description: Onset (20–30 s) comprised butterfly feeling in stomach associated with deja-vu and abnormal taste/smell/warm feeling. Majority progress to un-coordinated kicking or thrashing movements of 4 limbs. Cluster around menstruation/ovulation. Method-results Telemetry workups: 2003: Three seizure with frontal lobe semiology. Electrographic onset clearly localises activity to left hemisphere. Discordant with MRI (right HS). Patient did not progress to surgical investigations. 2011: One ‘Hyper-motor’ seizure preceded by vocalisation. EEG showed left temporal rhythmic delta. 2012: Epileptic seizures captured with left temporal EEG changes. 2017: temporal onset seizures. Lack of robust electrographic lateralisation. Imaging Results 2017: PET: Bilateral temporal hypo-metabolism. MRI: Right HS. Stereotactic –EEG(SEEG): 2017: Bilateral hippocampal and right frontal lobe insertion. SEEG findings in keeping with right mesial temporal onset. Frontal semiology 28 s following electrographic onset. First clinical symptoms were of deja-vu. Schedule Surgery: Trans-Sylvian selective right amygdalo-hippocampectomy performed June 2018. Patient reports a single possible seizure (non habitual) since then and is pleased with the surgical outcomes. Conclusion Initial telemetry suggested the patients seizures were probable frontal in lobe origin. We propose this was due to the rapid propagation of hippocampal seizure to the orbitofrontal, insula,and premotor cortex resulting in a ‘hyper-motor’ seizure. Demonstrates the importance of multimodal evaluation and imaging, robust semiological description and the value of SEEG in lateralisation of seizure onset.

P07-T Presurgical investigation of sexual behaviour of an epileptic patient

Introduction Periventricular nodular heterotopy is frequently associated with drug resistant, mainly temporal lobe epilepsy. Patients and methods We report a young female patient with frequent focal seizures with sexual behaviour. MRI revealed right hemispherial multiplex periventricular nodular heterotopy most of them arround amygdala-hippocampus and the occipital horn of the lateral ventricle. Based on the noninvasive diagnostic steps, depth electordes were implanted with robot assisted stereotactic surgical procedure. Results During SEEG monitoring beside identifing posterior temporal seizure onset zone, the sympotmatic amygdalar involvement was also recognized with typical behavioral pattern on video-EEG. Discussion: Based on the seizure semiology, the stereo-EEG results, neuroradiologic and neuopsychologic findigs intraoperative electrocorticography guided righ temporal lobe resection was performed. One year after the operation, the patient is seizure free and her quality of life improved. Conclusion Multimodal preoperative diagnostic approach including both invasive and non-invasive methods should lead to succesful outcome in therapy resistant epilepsy with multifocal cortical developmental malformations. Besides therapeutic aspects, SEEG offers unique opportunity in understanding complex neuro-pathophysiological mechanisms.

Preoperative MRI findings and prediction of diagnostic utility of foramen ovale electrodes.

Foramen ovale electrodes (FOEs) are a minimally invasive method to localize mesial temporal seizures in cases in which noninvasive methods are inconclusive. The objective of this study was to identify factors predicting the ability of FOEs to yield a diagnosis in order to determine optimal candidates for this procedure. All cases of diagnostic investigations performed with FOEs at the authors' institution between 2005 and 2017 were reviewed. FOE investigation was defined as diagnostic if it led to a treatment decision. Demographic and clinical variables for diagnostic and nondiagnostic investigations were compared using a Wilcoxon rank-sum test for continuous variables and Fisher's exact test for categorical variables. Ninety-three patients underwent investigations performed with FOEs during the study period and were included in the study. FOE investigation was diagnostic in 75.3% of cases. Of patients who underwent anterior temporal lobectomy following diagnostic FOE evaluation, 75.9% were Engel class I at last follow-up (average 40.1 months). When the diagnostic and nondiagnostic FOE groups were compared, patients who had diagnostic investigations were more likely to be male (57.1% male vs 26.1% in the nondiagnostic group, p = 0.015). They were also more likely to have temporal lesions on preoperative MRI (p = 0.018). FOEs are a useful, minimally invasive diagnostic modality resulting in a treatment decision in 75% of cases. Male patients and patients with temporal lesions on MRI may be most likely to benefit from FOE investigation.

Lateralized RNS detections and continuous glucose monitoring: pilot data of biomarker influence on risk of seizure

Background: We study a patient with bitemporal epilepsy and type 1 diabetes mellitus with both continuous glucose monitoring (CGM) and responsive neurostimulation (RNS) devices. CGM surveys tissue glucose with every 5-minute reads. RNS records long seizure events and hourly detection/stimulation counts (DSC). In this patient, we previously showed time-dependent variances in glucose dependent on side of temporal seizure onsets, specifically lower relative glucose and earlier morning onsets for right-sided seizures vs. left onset events. In this study, we investigate RNS evident DSC with correlation to tissue glucose.

Complex sexual behaviors during sleep as a manifestation of epilepsy: a case series.

Complex sexual behavior during sleep (CSBS) is a well described clinical entity in nonrapid eye movement (NREM) sleep parasomnias (i.e. sexsomnia). We report a retrospective case series of CSBS as clinical manifestation of epileptic seizures and compare them with the semiology of sexsomnia. Video-electroencephalopraphy (EEG)-monitoring data of patients with epileptic and nonepileptic paroxysmal events from one tertiary epilepsy center between 2013 and 2016 were retrospectively reviewed. Clinical features and presurgical, electroclinical, and follow-up data are presented and then discussed in the context of other published cases. From 4,629 patients, 6 patients had CSBS. EEG, single photon emission computed tomography (SPECT), magnetic resonance imaging (MRI), and histopathology confirmed an epileptic origin in four female patients, with temporal or frontal seizures. Two male patients had sexsomnia. None of the epilepsy patients had parasomnias. Clinical criteria to differentiate epileptic from parasomnic CSBS were: events also occurred out of wakefulness; current presence of additional nonsexual manifestations of epilepsy; sexual behavior only as part of a broad spectrum of emotional and motor automatisms; stereotyped behavior pattern without modulability by bystanders; unarousability during the event; no completion of sexual intercourse. The accuracy of the clinical diagnosis was improved by the development of an algorithm comparing patients' fulfillment of the criteria of epilepsy versus parasomnia. In our cohort, CSBS was a rare ictal phenomenon in temporal or frontal seizures. Symptomatological similiarities with sexsomnia might be explained by the same phylogenetically primitive "central pattern generator" manifesting in ictal CSBS by activation and in sexsomnia by disinhibition. Ictal CSBS should be considered in the differential diagnosis of sexsomnia.

Memory in children with epilepsy: Utility of the WRAML-2 in generalized and focal epilepsy syndromes

The material-specific model for memory impairment predicts that verbal memory deficits are seen with left temporal seizures, and visual memory deficits are seen with right temporal seizures (Henkin et al., 2005). In pediatric epilepsy, seizure pathology has not always yielded the expected material-specific memory profiles. This study used the Wide Range Assessment of Memory and Learning—Second Edition (WRAML-2) to assess memory functioning among pediatric patients with epilepsy. The WRAML-2 was administered to 180 youth with epilepsy during their neuropsychological evaluations. Memory and recognition scores correlated significantly with epilepsy severity variables. There were no significant differences in verbal and visual memory and recognition index scores among patients with generalized epilepsy or among those with lateralized or localized electroencephalography (EEG) patterns and lesions on imaging. However, clinically meaningful verbal versus visual discrepancy scores were significantly related to lateralized abnormalities on EEG and magnetic resonance imaging (MRI) results. Most patients with right hemisphere pathology showed the expected material-specific visual memory deficits, while fewer than 15% of the left hemisphere cases showed the expected verbal memory deficits. Over one-third of those with identified left-sided pathology showed clinically significant deficits in visual memory. Findings are incongruent with the material-specific memory model and reflect the fact that early developmental neurological insults can lead to functional reorganization/crowding effects in children with left hemisphere epilepsy. On exploratory analyses, there were no significant differences in discrepancy scores among participants with left, right, and bilateral languages on Wada and functional MRI (fMRI). However, those with right and bilateral language dominance were more likely to show discrepancies that were incongruent with the material-specific model.

Running-down phenomenon captured with chronic electrocorticography.

SummaryThe running‐down phenomenon refers to 2 analogous but distinct entities that may be seen after epilepsy surgery. The first is clinical, and denotes a progressive diminution in seizures after epilepsy surgery in which the epileptogenic zone could not be completely removed (Modern Problems of Psychopharmacology 1970;4:306, Brain 1996:989). The second is electrographic, and refers to a progressive deactivation of a secondary seizure focus after removal of the primary epileptogenic zone. This progressive decrease in epileptiform activity may represent a reversal of secondary epileptogenesis, where a primary epileptogenic zone is postulated to activate epileptiform discharges at a second site and may become independent.3 The electrographic running‐down phenomenon has been reported in only limited numbers of patients, using serial postoperative routine scalp electroencephalography (EEG) (Arch Neurol 1985;42:318). We present what is, to our knowledge, the most detailed demonstration of the electrographic running‐down phenomenon in humans, made possible by chronic electrocorticography (ECoG). Our patient's left temporal seizure focus overlapped with language areas, limiting the resection to a portion of the epileptogenic zone, followed by implantation of a direct brain‐responsive neurostimulator (RNS System, NeuroPace Inc.) to treat residual epileptogenic tissue. Despite the limited extent of the resection, the patient remains seizure‐free more than 2 years after surgery, with the RNS System recording ECoG without delivering stimulation. We reviewed the chronic recordings with automated spike detection and inspection of electrographic episodes marked by the neurostimulator. These recordings demonstrate progressive diminution in spiking and rhythmic discharges, consistent with an electrographic running‐down phenomenon.

Ictal Asystole in Temporal Lobe Epilepsy: A Possible Cause of Sudden Unexplained Death - A Case Report

ABSTRACTWe report a case of a 47-year-old woman who presented with a 3-year history of paroxysmal events after suffering traumatic brain injury in a motor vehicle accident. She had not previously been diagnosed with epilepsy. On video-EEG monitoring, she was found to have a right temporal seizure associated with ictal asystole lasting for 18 seconds. Our case raises the possibility that undiagnosed ictal asystole could be a potential cause of sudden unexplained death.