Case 15: Non-lesional Temporal Epilepsy

Just as ‘no man is an island’, despite its misleading name, the insula is not an island. Sitting deeply within the cerebrum, the insular cortex and its connections play an important role in both normal brain function and seizure generation. Stimulating specific areas of the insula can produce somatosensory, viscerosensory, somatomotor and visceroautonomic symptoms, as well as effects on speech processing and pain. Insular onset seizures are rare, but may mimic both temporal and extra-temporal epilepsy and if not recognised, may lead to failure of epilepsy surgery. We therefore highlight the semiology of insular epilepsy by discussing three cases with different auras. Insular onset seizures can broadly be divided into three main types both anatomically and according to seizure semiology:1. Seizures originating in the antero-inferior insula present with laryngeal constriction, along with visceral and gustatory auras (similar to those originating in medial temporal structures).2. Antero-superior onset seizures can have a silent onset, but tend to propagate rapidly to motor areas causing focal motor or hypermotor seizures.3. Seizures originating in the posterior insula present with contralateral sensory symptoms.

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Parameters of autonomic regulation in patients with focal frontal and temporal epilepsy

I P Pavlov Russian Medical Biological Herald ◽

10.23888/pavlovj202129145-53 ◽

2021 ◽

Vol 29 (1) ◽

pp. 45-53

Author(s):

Julia I. Medvedeva ◽

Roman A. Zorin ◽

Vladimir A. Zhadnov ◽

Michael M. Lapkin

Keyword(s):

Regression Analysis ◽

Temporal Lobe Epilepsy ◽

Evoked Potentials ◽

Temporal Lobe ◽

Focal Epilepsy ◽

Autonomic Regulation ◽

Control Group ◽

Temporal Epilepsy ◽

Logit Regression ◽

Autonomic Support

Aim. This study aimed to investigate the mechanisms of autonomic regulation and autonomic support in focal frontal and temporal lobe epilepsy. Materials and Methods. Thirty-six individuals were examined (19 men and 17 women; mean age 33.71.4 years) in the control group (without history of epileptic seizures) and 68 patients (32 men and 36 women, 34.11.5 years) with focal epilepsy (36 patients with frontal lobe epilepsy, of which 32 had temporal lobe epilepsy). Physiological parameters of heart rate variability and of skin sympathetic evoked potentials were evaluated. Results. Predomination of sympathetic influences in both groups of patients was found. According to the analysis of skin sympathetic evoked potentials, a high activity of the suprasegmental autonomic centers was determined in patients with epilepsy. Based on the results of the correlation analysis, the initial state in patients with temporal lobe epilepsy was characterized by greater intrasystemic tension that reflects the high level of physiological costs. The logit regression analysis model makes it possible to distribute patients with focal epilepsy into groups with different disease courses on the basis of the parameters of the autonomic support of the activity. Conclusion. In patients with focal epilepsy, predomination of sympathetic influences was observed, as well as greater activity of the suprasegmental centers of the autonomic regulation. Intrasystemic ratios of autonomic regulation parameters demonstrate an increase in the intrasystemic tension and a limitation of functional reserves in patients with temporal lobe epilepsy. A complex of parameters of autonomic support allows, based on the logit regression analysis, to distribute patients into groups with different courses of focal epilepsy.

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Elevated IL-6 and IL-1β are associated with temporal lobe epilepsy: A study in Chinese patients

European Journal of Inflammation ◽

10.1177/2058739218778934 ◽

2018 ◽

Vol 16 ◽

pp. 205873921877893 ◽

Cited By ~ 1

Author(s):

Li Xia ◽

Song-Qing Pan ◽

Qiu-Min Zhang ◽

Qin Zhou ◽

Lu Xia ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Chinese Patients ◽

Enzyme Linked Immunosorbent Assay ◽

Healthy Controls ◽

Temporal Epilepsy ◽

Tnf Α ◽

Plasma Cytokines ◽

Proinflammatory Molecules ◽

Positive Correlations

Activation of proinflammatory cytokines in seizures has been well characterized. However, role of cytokines in epilepsy and association with different clinical phenotype has not been well investigated. Reports on possible link between proinflammatory molecules and epilepsy are very limited. In this study, we performed a hospital-based case control study to investigate the association of plasma cytokines and their expression with different clinical categories of epilepsy. Patients admitted to Neurology Department of Renmin Hospital were enrolled in this study after clinical investigations. In all, 92 patients with temporal lobe epilepsy (TLE) and 45 with extra-temporal lobe epilepsy (XTLE) were included in this study. Furthermore, we included 86 healthy controls from the similar geographical population. Plasma levels of interleukin (IL)-6, tumor necrosis factor (TNF)-α, and IL-1β were quantified by enzyme-linked immunosorbent assay (ELISA). All plasma cytokines were elevated in TLE and XTLE compared to healthy controls ( P < 0.0001). Furthermore, IL-6 and IL-1β were significantly higher in TLE when compared to extra-temporal epilepsy. Incidentally, no difference in mean plasma TNF-α levels was noticed among TLE and XTLE. Positive correlations were observed between all plasma proinflammatory molecules (TNF-α, IL-6, and IL-1β) investigated in this study. Epilepsy patients displayed higher proinflammatory molecules, namely, IL-6, IL-1β, and TNF-α. Plasma IL-6 and IL-1β can be use as biomarkers for differentiation of TLE from XTLE.

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Influence of Lithium Carbonate on Patients with Temporal Epilepsy

Canadian Psychiatric Association Journal ◽

10.1177/070674377301800116 ◽

1973 ◽

Vol 18 (1) ◽

pp. 77-78 ◽

Cited By ~ 15

Author(s):

A. Jus ◽

A. Villeneuve ◽

J. Gautier ◽

A. Pires ◽

J.M. Côté ◽

...

Keyword(s):

Lithium Carbonate ◽

Temporal Epilepsy

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Partial cortico-hippocampectomy in cats, as therapy for refractory temporal epilepsy: A descriptive cadaveric study

PLoS ONE ◽

10.1371/journal.pone.0244892 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0244892

Author(s):

Jessica Zilli ◽

Monika Kressin ◽

Anne Schänzer ◽

Marian Kampschulte ◽

Martin J. Schmidt

Keyword(s):

Temporal Lobe ◽

Tissue Injury ◽

Histopathological Examination ◽

Hippocampal Sclerosis ◽

Intraoperative Complications ◽

Temporal Cortex ◽

Cadaveric Study ◽

Vascular Lesions ◽

Temporal Epilepsy ◽

The Brain

Cats, similar to humans, are known to be affected by hippocampal sclerosis (HS), potentially causing antiepileptic drug (AED) resistance. HS can occur as a consequence of chronic seizure activity, trauma, inflammation, or even as a primary disease. In humans, temporal lobe resection is the standardized therapy in patients with refractory temporal lobe epilepsy (TLE). The majority of TLE patients are seizure free after surgery. Therefore, the purpose of this prospective cadaveric study is to establish a surgical technique for hippocampal resection in cats as a treatment for AED resistant seizures. Ten cats of different head morphology were examined. Pre-surgical magnetic resonance imaging (MRI) and computed tomography (CT) studies of the animals’ head were carried out to complete 3D reconstruction of the head, brain, and hippocampus. The resected hippocampal specimens and the brains were histologically examined for tissue injury adjacent to the hippocampus. The feasibility of the procedure, as well as the usability of the removed specimen for histopathological examination, was assessed. Moreover, a micro-CT (mCT) examination of the brain of two additional cats was performed in order to assess temporal vasculature as a reason for possible intraoperative complications. In all cats but one, the resection of the temporal cortex and the hippocampus were successful without any evidence of traumatic or vascular lesions in the surrounding neurovascular structures. In one cat, the presence of mechanical damage (a fissure) of the thalamic surface was evident in the histopathologic examination of the brain post-resection. All hippocampal fields and the dentate gyrus were identified in the majority of the cats via histological examination. The study describes a new surgical approach (partial temporal cortico-hippocampectomy) offering a potential treatment for cats with clinical and diagnostic evidence of temporal epilepsy which do not respond adequately to the medical therapy.

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The Paramedian Supracerebellar- Transtentorial Selective Amygdalohippocampectomy for Mediobasal Temporal Epilepsy

Operative Neurosurgery ◽

10.1093/ons/opx173 ◽

2017 ◽

Vol 14 (4) ◽

pp. 462-462 ◽

Cited By ~ 3

Author(s):

Mehmet Volkan Harput ◽

Uğur Türe

Keyword(s):

Temporal Epilepsy ◽

Selective Amygdalohippocampectomy

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Perampanel in adults with mesial temporal epilepsy: A single center post marketing study

Journal of the Neurological Sciences ◽

10.1016/j.jns.2017.08.3758 ◽

2017 ◽

Vol 381 ◽

pp. 550-551

Author(s):

C.Y. Lin ◽

T. Wu ◽

S.N. Lim

Keyword(s):

Single Center ◽

Temporal Epilepsy ◽

Post Marketing

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European trends in epilepsy surgery

Neurology ◽

10.1212/wnl.0000000000005776 ◽

2018 ◽

Vol 91 (2) ◽

pp. e96-e106 ◽

Cited By ~ 37

Author(s):

Maxime O. Baud ◽

Thomas Perneger ◽

Attila Rácz ◽

Max C. Pensel ◽

Christian Elger ◽

...

Keyword(s):

Epilepsy Surgery ◽

Disease Duration ◽

Focal Epilepsy ◽

Seizure Freedom ◽

Early Referral ◽

Temporal Epilepsy ◽

Included Patient ◽

Class 1 ◽

Postsurgical Outcomes ◽

Over Time

ObjectiveResective surgery is effective in treating drug-resistant focal epilepsy, but it remains unclear whether improved diagnostics influence postsurgical outcomes. Here, we compared practice and outcomes over 2 periods 15 years apart.MethodsSixteen European centers retrospectively identified 2 cohorts of children and adults who underwent epilepsy surgery in the period of 1997 to 1998 (n = 562) or 2012 to 2013 (n = 736). Data collected included patient (sex, age) and disease (duration, localization and diagnosis) characteristics, type of surgery, histopathology, Engel postsurgical outcome, and complications, as well as imaging and electrophysiologic tests performed for each case. Postsurgical outcome predictors were included in a multivariate logistic regression to assess the strength of date of surgery as an independent predictor.ResultsOver time, the number of operated cases per center increased from a median of 31 to 50 per 2-year period (p = 0.02). Mean disease duration at surgery decreased by 5.2 years (p < 0.001). Overall seizure freedom (Engel class 1) increased from 66.7% to 70.9% (adjusted p = 0.04), despite an increase in complex surgeries (extratemporal and/or MRI negative). Surgeries performed during the later period were 1.34 times (adjusted odds ratio; 95% confidence interval 1.02–1.77) more likely to yield a favorable outcome (Engel class I) than earlier surgeries, and improvement was more marked in extratemporal and MRI-negative temporal epilepsy. The rate of persistent neurologic complications remained stable (4.6%–5.3%, p = 0.7).ConclusionImprovements in European epilepsy surgery over time are modest but significant, including higher surgical volume, shorter disease duration, and improved postsurgical seizure outcomes. Early referral for evaluation is required to continue on this encouraging trend.

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