Epileptic Disorders最新文献

We performed a systematic review of the ictal semiology of temporo-frontal seizures with the aim to summarize the state-of-the-art anatomo-clinical correlations in the field, and help guide the interpretation of ictal semiology within the framework of presurgical evaluation. We conducted the systematic review and meta-analysis, and reported its results according to the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. We searched electronic databases (Scopus, PUBMED, Web of Science, and EMBASE) using relevant keywords related to temporal, frontal and sublobar structures, semiology, and electroencephalography/stereoelectroencephalography exploration. The risk of bias was evaluated using the QUADAS2. We included articles in English, reporting the seizure semiology of patients with temporal lobe epilepsy with temporal-frontal involvement and patients with frontal lobe epilepsy and fronto-temporal network involved. We performed hierarchical cluster analysis to determine signs and symptoms associated with the temporo-frontal epileptogenic network for all patients and for each subgroup (frontal/temporal seizure onset). Fisher exact test was performed to evaluate the difference in seizure freedom and clinical sign/symptom occurrence in patients that underwent unilobar versus bilobar resection. Meta-analysis on the prevalence of temporo-frontal/fronto-temporal involvement applying a random-effect model was used. We included 40 articles and we extracted data from 109 patients. The meta-analysis showed the total prevalence of temporo-frontal/fronto-temporal network involvement was 19.75%, CI 12.02-27.47, high heterogeneity (82.71%). For the whole group and subgroups, the main cluster of clinical manifestations is emotional, autonomic, cognitive, grimace, hyperkinetic (association coefficient higher than .6). Elementary motor semiology is significantly associated with multilobar resection (p = .022 whole group and p = .0012 fronto-temporal subgroup). Fifty-eight patients were seizure-free after surgery. There was no significant difference between seizure freedom in uni versus bilobar resections (p = .28). Seizures involving temporo-frontal/fronto-temporal network usually manifest with a cluster of signs and symptoms: emotional, autonomic, grimace, cognitive and hyperkinetic behavior. Based on semiology, one cannot distinguish between fronto-temporal and temporo-frontal cases at individual patient level. In those patients undergoing a surgical procedure, elementary motor seizure semiology is significantly associated with multilobar resection.

Objective: To investigate the frequency of epileptiform discharges associated with self-limited focal epilepsy (EDSelFEC) in children who have undergone a hemispherotomy and to evaluate whether patients with coexistence of EDSelFEC and structural hemispheric epilepsies differ from patients without coexistence of EDSelFEC and whether there are differences between the two groups with regard to preoperative management and postoperative outcome.

Methods: Data on 131 children who underwent a hemispherotomy between January 1999 and January 2015 were retrieved from the Epilepsy center's epilepsy surgery database. Children with EDSelFEC were compared with children without EDSelFEC with respect to epileptogenic hemispheric pathology, family history, age at epilepsy onset, timing of surgery, lesion laterality, preoperative cognitive function, response to sodium channel blocker antiepileptic medication, and surgical outcome. Parental consent was obtained.

Results: EDSelFECs were present in the EEG in 27 (21%) of the 131 cases. None of the patients had seizures associated with EDSelFECs. The percentages of EDSelFECs varied between pathology groups: vascular lesions: 38%, focal cortical dysplasia: 16%, polymicrogyria: 5%, Rasmussen encephalitis: 10%, hemimegalencephaly: 8%, mild malformation of cortical development with oligodendroglial hyperplasia:20%, other pathologies: 22%. EDSelFEC in the vascular group were significantly correlated with MRI changes showing white matter damage in addition to cortical damage (p =.02). 82.1% of EDSelFEC were located multifocal versus 4.8% multifocality in EDs other than EDSelFEC. EDSelFEC were significantly more often exacerbated by sodium channel blockers than EDs caused by structural (cortical) lesions. No differences were found between EDSelFEC+ and EDSelFEC- patients with respect to other variables studied.

Significance: A significant number of children with hemispheric epileptogenic lesions, particularly children with pre-/perinatal vascular lesions, hemiplegia, and white matter lesions in addition to cortical lesions, presented with coexisting EDSelFEC.