Temporal neocortical origin of pilomotor seizures in association with an infiltrating glioma: a case confirmed by intracranial electroencephalography monitoring

Patients with seizures occasionally present with autonomic symptoms. Pilomotor seizures are uncommon and usually accompanied by other manifestations of complex partial seizures of limbic origin. Activation of the central autonomic network appears to be necessary for the development of ictal goose bumps. Pilomotor seizures have been reported to originate in the temporal lobe and other medial limbic structures. Ictal piloerection can arise due to a variety of brain pathologies. Isolated pilomotor seizures are very rare. The authors present the first case in which intracranial electroencephalography monitoring was used to confirm pilomotor seizures of temporal neocortical origin in association with an infiltrating tumor.

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Practice parameter: Temporal lobe and localized neocortical resections for epilepsy

Neurology ◽

10.1212/01.wnl.0000055086.35806.2d ◽

2003 ◽

Vol 60 (4) ◽

pp. 538-547 ◽

Cited By ~ 513

Author(s):

J. Engel ◽

S. Wiebe ◽

J. French ◽

M. Sperling ◽

P. Williamson ◽

...

Keyword(s):

Temporal Lobe ◽

Controlled Trial ◽

Mesial Temporal Lobe Epilepsy ◽

Class I ◽

Partial Seizures ◽

Complex Partial Seizures ◽

Single Class ◽

Intention To Treat ◽

Epileptic Syndromes ◽

Class Iv

Objectives/Methods: To examine evidence for effectiveness of anteromesial temporal lobe and localized neocortical resections for disabling complex partial seizures by systematic review and analysis of the literature since 1990.Results: One intention-to-treat Class I randomized, controlled trial of surgery for mesial temporal lobe epilepsy found that 58% of patients randomized to be evaluated for surgical therapy (64% of those who received surgery) were free of disabling seizures and 10 to 15% were unimproved at the end of 1 year, compared with 8% free of disabling seizures in the group randomized to continued medical therapy. There was a significant improvement in quantitative quality-of-life scores and a trend toward better social function at the end of 1 year for patients in the surgical group, no surgical mortality, and infrequent morbidity. Twenty-four Class IV series of temporal lobe resections yielded essentially identical results. There are similar Class IV results for localized neocortical resections; no Class I or II studies are available.Conclusions: A single Class I study and 24 Class IV studies indicate that the benefits of anteromesial temporal lobe resection for disabling complex partial seizures is greater than continued treatment with antiepileptic drugs, and the risks are at least comparable. For patients who are compromised by such seizures, referral to an epilepsy surgery center should be strongly considered. Further studies are needed to determine if neocortical seizures benefit from surgery, and whether early surgical intervention should be the treatment of choice for certain surgically remediable epileptic syndromes.

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Home Videorecording of "Spells" in Children

PEDIATRICS ◽

10.1542/peds.76.4.612 ◽

1985 ◽

Vol 76 (4) ◽

pp. 612-613

Author(s):

ROBERT C. WOODY

Keyword(s):

Hospital Admission ◽

Seizure Activity ◽

Tonic Activity ◽

Partial Seizures ◽

High Quality ◽

Complex Partial Seizures ◽

Permanent Record ◽

First Case ◽

The Family ◽

At Home

The increasing availability of videorecording cameras and cassette recorders now permits the visual documentation of medical events in children at home by parents. On two occasions recently, we asked families to videorecord their children's presumed seizure activity at home. In the first case, a 10-month-old white boy had frequent "spells" which by history appeared to be complex partial seizures. Routine awake and asleep EEG tracings were normal, and the family resisted hospital admission for financial reasons. Anticonvulsant medications were prescribed, and the family suggested that they borrow their parent's videocassette recorder to document their son's spells at home. Their videorecordings produced a high quality, permanent record of definite complex partial symptom activity clearly revealing eye deviation, nystagmus, and associated head and arm tonic activity.

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Extent of Mesiobasal Resection Determines Outcome after Temporal Lobectomy for Intractable Complex Partial Seizures

Neurosurgery ◽

10.1227/00006123-199107000-00009 ◽

1991 ◽

Vol 29 (1) ◽

pp. 55-61 ◽

Cited By ~ 72

Author(s):

Mohamed H. Nayel ◽

Issam A. Awad ◽

Hans Luders

Keyword(s):

Temporal Lobe ◽

Seizure Frequency ◽

Compartment Model ◽

Extent Of Resection ◽

Temporal Lobectomy ◽

Seizure Outcome ◽

Partial Seizures ◽

Complex Partial Seizures ◽

Lateral Structures

Abstract The extent of resection was assessed in 94 patients who underwent temporal lobectomy for medically intractable complex partial seizures originating from a unilateral seizure focus in the anteromesial temporal lobe. Postoperative magnetic resonance imaging in the coronal plane was used to quantify the extent of resection of lateral and mesiobasal structures according to a 20-compartment model of the temporal lobe. Successful seizure outcome (≥90% reduction in seizure frequency) was accomplished in 83% of the patients (all followed up for more than 1 year; mean duration of follow-up, 25.2 months) and correlated significantly (P<0.05) with the extent of mesiobasal resection, regardless of the extent of resection of lateral structures. Successful seizure outcome was accomplished in 81% of the patients with no structural lesions, and also correlated significantly (P<0.05) with the extent of mesiobasal resection regardless of the extent of lateral resection. A successful seizure outcome was accomplished in 90% of the 21 patients with structural lesions documented by neuroimaging studies. Two patients who underwent extensive lobectomy without resection of the structural lesion had no reduction in seizure frequency postoperatively. We conclude that the most important factor in determining the outcome of temporal lobectomy in patients with unilateral anteromesial temporal lobe epileptogenicity is the extent of resection of structures in the mesiobasal temporal lobe. In patients with structural lesions, lesion resection may be an added contributor to successful seizure outcome. (Neurosurgery 29:55-61, 1991)

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A Case with Temporal Lobe Epilepsy Producing Abundant Paraphasias Following Complex Partial Seizures. Depth EEG Study.

Journal of the Japan Epilepsy Society ◽

10.3805/jjes.12.237 ◽

1994 ◽

Vol 12 (3) ◽

pp. 237-242

Author(s):

Kousuke Kanemoto ◽

Itsuo Kawai

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Partial Seizures ◽

Complex Partial Seizures

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Neocortical Temporal Lobe Epilepsy

Epilepsy Research and Treatment ◽

10.1155/2012/103160 ◽

2012 ◽

Vol 2012 ◽

pp. 1-15 ◽

Cited By ~ 3

Author(s):

Eduard Bercovici ◽

Balagobal Santosh Kumar ◽

Seyed M. Mirsattari

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Mesial Temporal Lobe Epilepsy ◽

Functional Brain Imaging ◽

Disease Entity ◽

Partial Seizures ◽

Complex Partial Seizures ◽

Reciprocal Connections ◽

Mesial Temporal Lobe ◽

Poor Outcomes

Complex partial seizures (CPSs) can present with various semiologies, while mesial temporal lobe epilepsy (mTLE) is a well-recognized cause of CPS, neocortical temporal lobe epilepsy (nTLE) albeit being less common is increasingly recognized as separate disease entity. Differentiating the two remains a challenge for epileptologists as many symptoms overlap due to reciprocal connections between the neocortical and the mesial temporal regions. Various studies have attempted to correctly localize the seizure focus in nTLE as patients with this disorder may benefit from surgery. While earlier work predicted poor outcomes in this population, recent work challenges those ideas yielding good outcomes in part due to better localization using improved anatomical and functional techniques. This paper provides a comprehensive review of the diagnostic workup, particularly the application of recent advances in electroencephalography and functional brain imaging, in neocortical temporal lobe epilepsy.

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