ObjectiveTo investigate the lateralization of ictal scalp EEG in different times in focal epilepsy.Methods356 surface ictal EEG of 41 patients were reviewed retrospectively in focal epilepsy arising from the mesial frontal, lateralfrontal, mesialtemporal, neocorticaltemporal, insular lobes and posterior cortex from July, 2010 to at, 2016. Each ictal scalp EEG was subdivided into ten epoches (E1-E10), then the lateralization of every epoch was analyzed. Ten epochs EEG were merged into three timesas E1-E3, E4-E6 and E7-E10. The ratio of lateralization, mislateralization and non-lateralization of each timeEEG were studied. Ictal onset zone (IOZ) were precise localized by intracranial EEG. The results of epileptogenic zone corresponded with surgical outcomes as seizure free or decreased.Results62% seizures were lateralized by surface ictal EEG in all epilepsies. Lateralized ictal scalp EEG were seen in nearly 80% of seizures in all times in temporal lobe epilepsy (TLE). The highest lateralization of 89% occurred inE4-E6 andfalse lateralization up to 30% in E1-E3 in mesial temporal lobe epilepsy (MTLE), whereas 95% lateralized seizures emerged in E1-E3 in neocortical temporal lobe epilepsy (NTLE). Apparent non-lateralization in all times were higher than lateralization in frontal lobe epilepsy (FLE), especially in mesial frontal lobe epilepsy (MFLE). Lateralization in E1-E3 was only 24% higher than other times. In addition, False lateralization never occurred in all times in lateral frontal lobe epilepsy (LFLE). There were maximum of 83%lateralized seizures in E1-E3 in LFLE and 93% in E1-E3 in posterior cortex epilepsy (PCE). Seizures arising from insular lobe epilepsy (ILE) tendedto predict less lateralization in all times.ConclusionsIctal scalp EEG of E1-E3 are valuable in the lateralization in all epilepsies particularly in LFLE, NTLE and PCE. Lateralized E4-E6 and E7-10 are very useful in MTLE.
ObjectiveTo make a better understanding of potassium channel-complex autoimmune antibodies associated limbic encephalitis, we studied in details with patients of this autoimmune disease accompanying without tumors. MethodsDiagnosis of 3 patients were confirmed by antibody detection in serum or CSF. All the clinical data, including history, CSF data, cranial MRI, EEG, pelvic ultrasound and treatment strategy, were carefully gathered. Two to eleven months follow-up were carried out. Results3 female adult patients showed common initial manifestation of seizures, and changes of consciousness, mental disorder and cognitive impairment. Hyponatremia was found in one LGI1-Ab+ patient. Cranial MRI showed unilateral or bilateral signal changes with limbic system. Changes of CSF and EEG were nonspecific. All 3 patients became recovery in different levels after two to eleven months. ConclusionsPotassium channel-complex antibodies associated encephalitis may be a common type of limbic encephalitis in adults without tumors. Seizures may be the first sign of the disease. Hyponatremia is one of characteristics of LGI1-Ab+ patient. Patients may have a fairly good short outcome.
ObjectiveTo investigate characteristics of motor semiology of epileptic seizure originated from dorsolateral frontal lobe. MethodsRetrospectively analysis the clinical profiles of patients who were diagnosed dorsolateral frontal lobe epilepsy (FLE) based on stereoelectroencephalography (SEEG) and underwent respective surgeries subsequently. Component of motor semiology in a seizure can be divided into elementary motor (EM, include tonic, versive, clonic, and myoclonic seizures) and complex motor (CM, include automotor, hypermotor, and so on). A Talairach coordinate system was constructed in the sagittal series of MRI images in each case. From the cross point of VAC and the Sylvian Fissure, a line was drawn antero-superiorly, which made an angle of 60° with the AC-PC line, then the frontal lobe could be divided into anterior and posterior portion. The epileptogenic zone, which was defined as ictal onset and early spreading zone in SEEG, was classified into three types, according to the positional relationship of the responding electrodes contacts and the "60° line": the anterior, posterior, and intermediate FLE. The correlation of the components of motor semiology in seizures and the location of the epileptogenic zone was analyzed. ResultsFive cases (26.3%) were verified as anterior FLE, among which there were 2 of EM, one of CM, and 2 of EM+CM. In 7 cases (36.8%) of intermediate FLE, there were one of EM, none of CM, and 6 of EM+CM. In the rest 7 cases of posterior FLE, there were 6 of EM, none of CM, and one of EM+CM. Compared with the cases that the epileptogenic zone involved anterior portion, the posterior FLE is more likely to present EM seizures (85.7%), and less likely to show CM components (P < 0.05). And Compared with the anterior FLE and posterior FLE, the intermediate FLE is more likely to present EM+CM seizures (85.7%)(P < 0.05). ConclusionThe motor seizure semiology of dorsolateral FLE has significant correlation with the localization of the epileptogenic zone. Posterior FLE mainly present a pure elementary motor seizure, and once the epileptogenic zone involved anteriorly beyond the "60° line", the component of complex motor seizure would be seen. Intermediate FLE, as its specialty of transboundary, is more likely to show "comprised semiology" of EM and CM. Construction of the "60° line" with AC-PC coordinate system in the MRI images may play an useful role in semiology analysis in presurgical evaluation of FLE.
ObjectiveTo study the clinical characteristics of patients onset epilepsy Dentatorubral-pallidoluysian atropy (DRPLA) in Epilepsy Center of Guangdong 999 Brain Hospital and improve understanding of the disease. MethodsCollected five patients from August 2014 to August 2016 in Guangdong 999 Brain Hospital, whom diagnosed through genetic testing of DRPLA, analysed their disease course, family history, video-EEG, brain MRI and treatment data. ResultsDRPLA performed as neurodegenerative diseases, and epilepsy population mainly performed as progressive myoclonic epilepsy (Progressive myoclonus epilepsy, PME). ConclusionDRPLA is autosomal dominant neurodegenerative disease. In patients with cerebellar atrophy, neurological regression, ataxia, drug refractory epilepsy, it is recommended routinely to detect ATN1 gene, so that timely diagnosis and genetic counseling.
ObjectiveTo analyse the seizure semeiology of MRI negative insular epilepsy.MethodsA case of patient with insular epilepsy who presented in Epileptic Center, Guangdong 999 Brain Hospital was collected. Related literatures were thoroughly reviewed.ResultsThe patient was diagnosised as insular epilepsy by SEEG and postoperative pathology reported focal cortical dysplasia Ib.ConclusionsThe insula lobe is a part of the limbic system, and the seizure semeiology in insular epilepsy is varied. Seizure semeiology analysis is particularly important in the evaluation of presurgical especially in a MRI negative case. In this paper, we summarized the semeiology characteristics of various parts of insula lobe, and provided some references for the diagnosis and treatment of insular epilepsy.
ObjectiveTo clarify the characteristic of secondary cerebral amyloidoma which is relapsing in one year after seven years gamma knife radiosurgery and review relevant literature.MethodsTo analyze the clinical manifestation, preoperative and postoperative MRI imaging, inter-ictal and ictal electroencephalogram (EEG) and histopathological evaluation.ResultsThe patient suffered from epilepsy (mainly autonomic seizure and global tonic-clonic seizure) at the age of 22 and took a gamma knife radiosurgery for right medial temporal epilepsy as the refractory seizures occurred at the age of 36. In her 43 and 44 years’ old, she suddenly found left hemiplegia and mental retardation, the MRI showed right frontal and parietal space-occupying lesion and relapsed after the partial excision respectively, the inter-ictal and ictal EEG displayed persistent slow wave in the right hemisphere and spike wave located in the right posterior temporal and central-parietal, after the surgery, we found amyloid in the histopathological evaluation.ConclusionOne of the delayed complications of gamma knife radiosurgery is secondary cerebral amyloidoma, and partial excision may induced relapsing easily.
Objective To investigate the task group’s effectiveness in language evaluation based on the task group's functional Magnetic resonance (fMRI) results’ agreement with the fixation side of the Wada language area. MethodsWe collected 90 patients with intractable epilepsy of 90 patients from December 13, 2018 to January 3, 2020 from the Epilepsy Center of Guangdong 999 Brain Hospital. We used two simple fMRI tasks. Among them, 25 patients completed the Wada experimental examination, and 8 patients completed the electrode implantation and subsequent preoperative language area mapping. Adopt block experimental design, ABBA style presentation, and use AFNI software to process fMRI data, lateralization index calculation, and multiple regression analysis. ResultsfMRI results from 90 patients showed that the results from both the sentence-completion task and the image-naming task were more stable than those from either task. The results were then compared with the results of the “gold standard” Wada test in 25 patients with fMRI-located language dominance in the hemisphere. The results showed that the accuracy of the single task was between 70% and 80%, but the accuracy of the combined results of the two tasks was 93.3%. Conclusions Compared with the results of a single task, the results of multiple fMRI tasks are more stable in the judgment of activation range and language dominance hemisphere. fMRI and Wada language area siding accuracy 93.3%, fMRI task siding valid and replicable.
ObjectiveTo investigate the application of stereoelectroencephalography (SEEG) in the refractory epilepsy related to periventricular nodular heterotopia (PNH). MethodsTen patients with drug-resistant epilepsy related to PNHs from Guangdong Sanjiu Brain Hospital and the First Affiliated Hospital of Jinan University from April 2017 to February 2021 were studied. Electrodes were implanted based on non-invasive preoperative evaluation. Then long-term monitoring of SEEG was carried out. The patterns of epileptogenic zone (EZ) were divided into four categories based on the ictal SEEG: A. only the nodules started; B. nodules and cortex synchronous initiation; C. the cortex initiation with early spreading to nodules; D. only cortex initiation. All patients underwent SEEG-guided radiofrequency thermocoagulation (RFTC), with a follow-up of at least 12 months. ResultsAll cases were multiple nodules. Four cases were unilateral and six bilateral. Eight cases were distributed in posterior pattern, and one in anterior pattern and one in diffused pattern, respectively. Seven patients had only PNH (pure PNH) and three patients were associated with other overlying cortex malformations (PNH plus). The EZ patterns of all cases were confirmed by the ictal SEEG: six patients were in pure type A, two patients were in pure type B, one patient in type A+B and one in type A+B+C, respectively. In eight patients SEEG-guided RF-TC was targeted only to PNHs; and in two patients RFTC was directed to both heterotopias and related cortical regions. The mean follow up was (33.4±14.0) months (12 ~ 58 months). Eight patients (in pure type A or type A included) were seizure free. Two patients were effective. None of the patients had significant postoperative complications or sequelae. ConclusionThe epileptic network of Epilepsy associated with nodular heterotopia may be individualized. Not all nodules are always epileptogenic, the role of each nodule in the epileptic network may be different. And multiple epileptic patterns may occur simultaneously in the same patient. SEEG can provide individualized diagnosis and treatment, be helpful to prognosis.
ObjectiveThe study aimed to investigate the clinical characteristics of epilepsy patients with DEPDC5 mutation, and to improve the understanding of familial hereditary focal epilepsy.MethodsThree families with familial hereditary focal epilepsy were enrolled in this study from September 2014 to September 2017 at the Sanjiu Brain Hospital of Guangdong Province. Epilepsy-related gene in peripheral blood was detected by the second generation sequencing. The medical history, family history, magnetic resonance imaging, electroencephalo-groph, treatment programs and other data were collected and aralyzed.ResultsThere were 8 patients in the three families, seizures of whom originate mostly from the frontal or temporal lobe. Cognitive function and other system function was basically normal fron patients treated with antiepilepsy drugs.ConclusionsThe mutations of DEPDC5 gene are common in familial hereditary focal epilepsy, which leads to the main clinical symptom of complex partial seizure. Antiepilepsy drug therapy is effective to most patients. However, to those drug resistant patients, prognosis can improved by surgical treatment.