Prolonged postictal hemianopsia after a focal extraoccipital onset seizure

2021 ◽  
Vol 14 (1) ◽  
pp. e239021
Author(s):  
Vibhangini S Wasade ◽  
Jennifer L Logan
Keyword(s):  
Epileptiform Activity ◽  
Diagnostic Evaluation ◽  
Onset Seizure ◽  
Seizure Onset ◽  
Seizure Termination ◽  
Seizure Onset Zone ◽  
History Of ◽  
Epilepsy Monitoring

We report a case of a prolonged postictal hemianopsia occurring after a focal extraoccipital seizure. A 55-year-old man with a history of neurosyphilis, treated with penicillin, presented to our epilepsy monitoring unit (EMU) for diagnostic evaluation of his spells occurring for 2 years. The spell semiology was stereotypical, described as oral and manual automatisms, speech difficulty and unresponsiveness. During the EMU stay, after his typical seizure was recorded, he experienced right hemianopsia lasting for 2 hours. Electrographically, the ictal pattern was prominent over the left temporal derivation and propagated to the left occipital derivation as the seizure progressed. Interictal epileptiform activity was over the left temporal derivations. We support the view that postictal phenomenon may represent merely a seizure termination zone and not be necessarily localising to the seizure onset zone. Furthermore, prolonged isolated postictal symptom of hemianopsia could also be noted in rare situations.

scholarly journals Interictal epileptiform activity outside the seizure onset zone impacts cognition

Brain ◽  
2017 ◽  
Vol 140 (8) ◽  
pp. 2157-2168 ◽  
Author(s):  
Hoameng Ung ◽  
Christian Cazares ◽  
Ameya Nanivadekar ◽  
Lohith Kini ◽  
Joost Wagenaar ◽  
...  
Keyword(s):  
Epileptiform Activity ◽  
Seizure Onset ◽  
Seizure Onset Zone

scholarly journals Clinical Validation of the Champagne Algorithm for Epilepsy Spike Localization

2021 ◽  
Vol 15 ◽  
Author(s):  
Chang Cai ◽  
Jessie Chen ◽  
Anne M. Findlay ◽  
Danielle Mizuiri ◽  
Kensuke Sekihara ◽  
...  
Keyword(s):  
Refractory Epilepsy ◽  
Focal Epilepsy ◽  
Epileptiform Activity ◽  
Consecutive Series ◽  
Source Reconstruction ◽  
Seizure Onset ◽  
Current Dipole ◽  
Seizure Onset Zone ◽  
Complementary Techniques ◽  
Epilepsy Localization

Magnetoencephalography (MEG) is increasingly used for presurgical planning in people with medically refractory focal epilepsy. Localization of interictal epileptiform activity, a surrogate for the seizure onset zone whose removal may prevent seizures, is challenging and depends on the use of multiple complementary techniques. Accurate and reliable localization of epileptiform activity from spontaneous MEG data has been an elusive goal. One approach toward this goal is to use a novel Bayesian inference algorithm—the Champagne algorithm with noise learning—which has shown tremendous success in source reconstruction, especially for focal brain sources. In this study, we localized sources of manually identified MEG spikes using the Champagne algorithm in a cohort of 16 patients with medically refractory epilepsy collected in two consecutive series. To evaluate the reliability of this approach, we compared the performance to equivalent current dipole (ECD) modeling, a conventional source localization technique that is commonly used in clinical practice. Results suggest that Champagne may be a robust, automated, alternative to manual parametric dipole fitting methods for localization of interictal MEG spikes, in addition to its previously described clinical and research applications.

scholarly journals The seizure onset zone drives state-dependent epileptiform activity in susceptible brain regions

2019 ◽  
Vol 130 (9) ◽  
pp. 1628-1641 ◽  
Author(s):  
Joshua M. Diamond ◽  
Julio I. Chapeton ◽  
William H. Theodore ◽  
Sara K. Inati ◽  
Kareem A. Zaghloul
Keyword(s):  
Epileptiform Activity ◽  
Brain Regions ◽  
Seizure Onset ◽  
State Dependent ◽  
Seizure Onset Zone

scholarly journals The Insula: A Stimulating Island of the Brain

2021 ◽  
Vol 11 (11) ◽  
pp. 1533
Author(s):  
Inès Rachidi ◽  
Lorella Minotti ◽  
Guillaume Martin ◽  
Dominique Hoffmann ◽  
Julien Bastin ◽  
...  
Keyword(s):  
Anterior Insula ◽  
Homologous Region ◽  
Seizure Onset ◽  
Functional Brain Mapping ◽  
Axonal Conduction ◽  
Seizure Onset Zone ◽  
Clinical Responses ◽  
History Of ◽  
Posterior Insula ◽  
The Brain

Direct cortical stimulation (DCS) in epilepsy surgery patients has a long history of functional brain mapping and seizure triggering. Here, we review its findings when applied to the insula in order to map the insular functions, evaluate its local and distant connections, and trigger seizures. Clinical responses to insular DCS are frequent and diverse, showing a partial segregation with spatial overlap, including a posterior somatosensory, auditory, and vestibular part, a central olfactory-gustatory region, and an anterior visceral and cognitive-emotional portion. The study of cortico-cortical evoked potentials (CCEPs) has shown that the anterior (resp. posterior) insula has a higher connectivity rate with itself than with the posterior (resp. anterior) insula, and that both the anterior and posterior insula are closely connected, notably between the homologous insular subdivisions. All insular gyri show extensive and complex ipsilateral and contralateral extra-insular connections, more anteriorly for the anterior insula and more posteriorly for the posterior insula. As a rule, CCEPs propagate first and with a higher probability around the insular DCS site, then to the homologous region, and later to more distal regions with fast cortico-cortical axonal conduction delays. Seizures elicited by insular DCS have rarely been specifically studied, but their rate does not seem to differ from those of other DCS studies. They are mainly provoked from the insular seizure onset zone but can also be triggered by stimulating intra- and extra-insular early propagation zones. Overall, in line with the neuroimaging studies, insular DCS studies converge on the view that the insula is a multimodal functional hub with a fast propagation of information, whose organization helps understand where insular seizures start and how they propagate.

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

2020 ◽  
Vol 10 (7) ◽  
pp. 443
Author(s):  
Sara Casciato ◽  
Pier Paolo Quarato ◽  
Addolorata Mascia ◽  
Alfredo D’Aniello ◽  
Vincenzo Esposito ◽  
...  
Keyword(s):  
Focal Epilepsy ◽  
Rare Event ◽  
Cardiac Risk ◽  
Loss Of Consciousness ◽  
Drug Resistant ◽  
Seizure Onset ◽  
Presurgical Evaluation ◽  
History Of ◽  
Epilepsy Monitoring ◽  
Video Eeg

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.

scholarly journals Dynamic Training of a Novelty Classifier Algorithm for Real-Time Early Seizure Onset Detection

2021 ◽  
Author(s):  
Daniel Ehrens ◽  
Mackenzie C. Cervenka ◽  
Gregory K. Bergey ◽  
Christophe C. Jouny
Keyword(s):  
Real Time ◽  
High Performance ◽  
Epileptiform Activity ◽  
Support Vector ◽  
List Type ◽  
Onset Detection ◽  
Seizure Onset ◽  
Intracranial Eeg ◽  
Early Seizure ◽  
Epilepsy Monitoring

AbstractThe objective of this study was to develop an adaptive framework for seizure detection in real-time that is practical to use in the Epilepsy Monitoring Unit (EMU) as a warning signal, and whose output helps characterize epileptiform activity. Our framework uses a one-class Support Vector Machine (SVM) that is being trained dynamically according to past activity in all available channels. This is done to evaluate the novelty of the current instance according to previous activity. Our algorithm was tested on intracranial EEG from human epilepsy patients that are admitted to the EMU for presurgical evaluation. In this study, we compared multiple configurations for using a one-class SVM to assess if there is significance over specific neural features or electrode locations. Our results show our algorithm is capable of running in real-time and achieving a high performance for early seizure-onset detection with a low false-positive rate and robustness to different types of seizure-onset patterns as well as to the number of channels used. This algorithm offers a solution to warning systems in the EMU as well as a tool for seizure characterization during post-hoc analysis of intracranial EEG data for surgical resection of the epileptogenic network.HighlightsThis study proposes a dynamic training algorithm that efficiently detects sudden novel changes in intracranial electroencephalographic activity, creating a reliable seizure onset detection algorithm that does not need prior training.The algorithm described has the capability to be implemented in real-time, independently of the number of channels that are being analyzed.The presented detector shows high performance and reliability to be easily implemented in the Epilepsy Monitoring Unit to quickly alert clinical staff of seizure events.

scholarly journals Depth Electrode Guided Anterior Insulectomy: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Mauricio Mandel ◽  
Layton Lamsam ◽  
Pue Farooque ◽  
Dennis Spencer ◽  
Eyiyemisi Damisah
Keyword(s):  
Right Hemisphere ◽  
Preoperative Evaluation ◽  
Epileptiform Activity ◽  
Neurological Deficits ◽  
Depth Electrodes ◽  
Depth Electrode ◽  
Patient Reported ◽  
Frontal Operculum ◽  
History Of ◽  
Electroencephalogram Eeg

Abstract The insula is well established as an epileptogenic area.1 Insular epilepsy surgery demands precise anatomic knowledge2-4 and tailored removal of the epileptic zone with careful neuromonitoring.5 We present an operative video illustrating an intracranial electroencephalogram (EEG) depth electrode guided anterior insulectomy.  We report a 17-yr-old right-handed woman with a 4-yr history of medically refractory epilepsy. The patient reported daily nocturnal ictal vocalization preceded by an indescribable feeling. Preoperative evaluation was suggestive of a right frontal-temporal onset, but the noninvasive results were discordant. She underwent a combined intracranial EEG study with a frontal-parietal grid, with strips and depth electrodes covering the entire right hemisphere. Epileptiform activity was observed in contact 6 of the anterior insula electrode. The patient consented to the procedure and to the publication of her images.  A right anterior insulectomy was performed. First, a portion of the frontal operculum was resected and neuronavigation was used for the initial insula localization. However, due to unreliable neuronavigation (ie, brain shift), the medial and anterior borders of the insular resection were guided by the depth electrode reference. The patient was discharged 3 d after surgery with no neurological deficits and remains seizure free.  We demonstrate that depth electrode guided insular surgery is a safe and precise technique, leading to an optimal outcome.

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