Case Report: Ictal Central Apnea as First and Overlooked Symptom in Temporal Lobe Seizures

Ictal respiratory changes have been mainly described following generalized tonic-clonic seizures and recently considered to be a biomarker to assess the risk of sudden unexplained death in epilepsy (SUDEP). Nonetheless, modification of respiratory pattern can be related also to focal seizures, especially arising from the temporal lobe. Changes in cardiac function such as tachycardia or bradycardia could be often associated. We report a short case series of four patients with temporal lobe epilepsy admitted to our Epilepsy Monitoring Unit (EMU) presenting with an ictal central apnea as the first clinical manifestation of their seizures. None of these patients was aware of the occurrence of respiratory arrest. Age at onset ranged from 15 to 29 years. One patient had seizures with prolonged central apnea accompanied by a significant decrease in oxygen saturation. Neuroimaging in two patients showed alterations of mesial temporal lobe structures, including the amygdala. Recent neurophysiological studies supported the existence of a cortical network involving the limbic system that modulates downstream brainstem respiratory centers. Monitoring for respiratory changes and oxygen saturation in focal seizures is warranted for their potential value in identifying the epileptogenic zone and for a better understanding of ictal respiratory changes that could potentially define a subgroup of patients with high risk of seizure-related autonomic changes.

Download Full-text

Electrical Stimulation-Induced Seizures and Breathing Dysfunction: A Systematic Review of New Insights Into the Epileptogenic and Symptomatogenic Zones

Frontiers in Human Neuroscience ◽

10.3389/fnhum.2020.617061 ◽

2021 ◽

Vol 14 ◽

Author(s):

Manuela Ochoa-Urrea ◽

Mojtaba Dayyani ◽

Behnam Sadeghirad ◽

Nitin Tandon ◽

Nuria Lacuey ◽

...

Keyword(s):

Electrical Stimulation ◽

Temporal Lobe ◽

Epilepsy Surgery ◽

Meta Analysis ◽

Favorable Outcome ◽

Current Evidence ◽

Reference List ◽

Epileptogenic Zone ◽

Central Apnea ◽

Mesial Temporal Lobe

Objective: Electrical stimulation (ES) potentially delineates epileptogenic cortex through induction of typical seizures. Although frequently employed, its value for epilepsy surgery remains controversial. Similarly, ES is used to identify symptomatogenic zones, but with greater success and a long-standing evidence base. Recent work points to new seizure symptoms such as ictal central apnea (ICA) that may enhance presurgical hypotheses. The aims of this review are 2-fold: to determine the value of ES-induced seizures (ESIS) in epilepsy surgery and to analyze current evidence on ICA as a new surrogate of symptomatogenic cortex.Methods: Three databases were searched for ESIS. Investigators independently selected studies according to pre-specified criteria. Studies reporting postoperative outcome in patients with ESIS were included in a meta-analysis. For ES-induced apnea, a thorough search was performed and reference list searching was employed.Results: Of 6,314 articles identified for ESIS, 25 were considered eligible to be reviewed in full text. Fourteen studies were included in the qualitative synthesis (1,069 patients); six studies were included in the meta-analysis (530 patients). The meta-analysis showed that favorable outcome is associated with ESIS prior to surgery (OR: 2.02; 95% CI: 1.332–3.08). In addition, the overall estimation of the occurrence of favorable outcome among cases with ESIS is 68.13% (95% CI: 56.62–78.7). On the other hand, recent studies have shown that stimulation of exclusively mesial temporal lobe structures elicits central apnea and represents symptomatogenic anatomic substrates of ICA. This is in variance with traditional teaching that mesial temporal ES is non-symptomatogenic.Conclusions: ES is a tool highly likely to aid in the delineation of the epileptogenic zone, since ESIS is associated with favorable postoperative outcomes (Engel I). There is an urgent need for prospective evaluation of this technique, including effective stimulation parameters and surgical outcomes, that will provide knowledge base for practice. In addition, ES-induced apnea studies suggest that ICA, especially when it is the first or only clinical sign, is an important semiological feature in localizing the symptomatogenic zone to mesial temporal lobe structures, which must be considered in SEEG explorations where this is planned, and in surgical resection strategies.

Download Full-text

Seizure Freedom in Temporal Plus Epilepsy Surgery Following Stereo-Electroencephalography

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2020.26 ◽

2020 ◽

Vol 47 (3) ◽

pp. 374-381

Author(s):

Juan S. Bottan ◽

Ana Suller Marti ◽

Andrew G. Parrent ◽

Keith W. MacDougall ◽

Richard S. McLachlan ◽

...

Keyword(s):

Temporal Lobe ◽

Epilepsy Surgery ◽

Right Hemisphere ◽

Case Series ◽

Temporal Lobectomy ◽

Seizure Freedom ◽

Epileptogenic Zone ◽

Small Case Series ◽

Adjacent Structures

ABSTRACT:Background:“Temporal plus” epilepsy (TPE) is a term that is used when the epileptogenic zone (EZ) extends beyond the boundaries of the temporal lobe. Stereotactic electroencephalography (SEEG) has been essential to identify additional EZs in adjacent structures that might be part of the temporal lobe/limbic network.Objective:We present a small case series of temporal plus cases successfully identified by SEEG who were seizure-free after resective surgery.Methods:We conducted a retrospective analysis of 156 patients who underwent SEEG in 5 years. Six cases had TPE and underwent anterior temporal lobectomy (ATL) with additional extra-temporal resections.Results:Five cases had a focus on the right hemisphere and one on the left. Three cases were non-lesional and three were lesional. Mean follow-up time since surgery was 2.9 years (SD ± 1.8). Three patients had subdural electrodes investigation prior or in addition to SEEG. All patients underwent standard ATL and additional extra-temporal resections during the same procedure or at a later date. All patients were seizure-free at their last follow-up appointment (Engel Ia = 3; Engel Ib = 2; Engel Ic = 1). Pathology was nonspecific/gliosis for all six cases.Conclusion:TPE might explain some of the failures in temporal lobe epilepsy surgery. We present a small case series of six patients in whom SEEG successfully identified this phenomenon and surgery proved effective.

Download Full-text

Synaptic Reshaping and Neuronal Outcomes in the Temporal Lobe Epilepsy

International Journal of Molecular Sciences ◽

10.3390/ijms22083860 ◽

2021 ◽

Vol 22 (8) ◽

pp. 3860

Author(s):

Elisa Ren ◽

Giulia Curia

Keyword(s):

Animal Models ◽

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Current Knowledge ◽

Focal Epilepsy ◽

Ex Vivo ◽

Hippocampal Sclerosis ◽

Control Group ◽

Epileptogenic Zone ◽

Epileptiform Discharges

Temporal lobe epilepsy (TLE) is one of the most common types of focal epilepsy, characterized by recurrent spontaneous seizures originating in the temporal lobe(s), with mesial TLE (mTLE) as the worst form of TLE, often associated with hippocampal sclerosis. Abnormal epileptiform discharges are the result, among others, of altered cell-to-cell communication in both chemical and electrical transmissions. Current knowledge about the neurobiology of TLE in human patients emerges from pathological studies of biopsy specimens isolated from the epileptogenic zone or, in a few more recent investigations, from living subjects using positron emission tomography (PET). To overcome limitations related to the use of human tissue, animal models are of great help as they allow the selection of homogeneous samples still presenting a more various scenario of the epileptic syndrome, the presence of a comparable control group, and the availability of a greater amount of tissue for in vitro/ex vivo investigations. This review provides an overview of the structural and functional alterations of synaptic connections in the brain of TLE/mTLE patients and animal models.

Download Full-text

Oxygen saturation improved with nitrate-based nutritional formula in patients with COVID-19

Journal of International Medical Research ◽

10.1177/03000605211012380 ◽

2021 ◽

Vol 49 (4) ◽

pp. 030006052110123

Author(s):

Sergej M. Ostojic ◽

Aleksandra Milovancev ◽

Patrik Drid ◽

Alexandros Nikolaidis

Keyword(s):

Oxygen Saturation ◽

Patient Reported Outcomes ◽

Case Series ◽

Potassium Nitrate ◽

Open Label ◽

Patient Reported ◽

Baseline Values ◽

Study Participants ◽

To Receive ◽

Test Result

In this open-label case series trial, we evaluated the effects of a nitrate-based nutritional formula on oxygen saturation (SpO2) and patient-reported outcomes in individuals with coronavirus disease 2019 (COVID-19). Five adult patients (three men and two women, age 39.6 ± 6.9 years) with a positive COVID-19 test result, breathing difficulties, and SpO2 ≤95%, who were free from other pulmonary and cardiovascular conditions, were recruited for this study. Participants were assigned to receive a multi-component nutritional formula (containing 1200 mg of potassium nitrate, 200 mg of magnesium, 50 mg of zinc, and 1000 mg of citric acid) every 4 hours during the 48-hour monitoring period. In all participants, SpO2 improved immediately after administration of the nutritional formula, from 1 to 7 percentage points (mean increase 3.6 ± 2.7 points; 95% confidence interval 0.3 to 7.0). SpO2 remained above baseline values throughout the monitoring interval, with values persisting over threshold values (>92%) for all patients and at each time point during the 48 hours. No patients reported any side effects of the intervention. These promising and rather unexpected results call for immediate, well-sampled, mechanistic randomized controlled trials to validate our findings.

Download Full-text

Localization of epileptogenic zone in temporal lobe epilepsy by ictal scalp EEG

Seizure ◽

10.1053/seiz.2001.0603 ◽

2002 ◽

Vol 11 (3) ◽

pp. 163-168 ◽

Cited By ~ 14

Author(s):

Yuzo Sakai ◽

Hiromi Nagano ◽

Ayumi Sakata ◽

Sachiko Kinoshita ◽

Naotaka Hamasaki ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Epileptogenic Zone ◽

Scalp Eeg

Download Full-text

Inadvertent administration of drug residue causing respiratory arrest: case series

European Journal of Anaesthesiology ◽

10.1097/eja.0b013e328338409c ◽

2010 ◽

Vol 27 (9) ◽

pp. 846-848

Author(s):

Sabrina Hoesni ◽

Karen Tan ◽

Suzanne Crowe

Keyword(s):

Case Series ◽

Respiratory Arrest ◽

Drug Residue

Download Full-text

Surgical treatment of bilateral temporal lobe pharmacoresistant epilepsy

Vestnik nevrologii, psihiatrii i nejrohirurgii (Bulletin of Neurology, Psychiatry and Neurosurgery) ◽

10.33920/med-01-2008-06 ◽

2020 ◽

pp. 60-82

Author(s):

Igor Sergeevich Trifonov ◽

Mikhail Vladimirovich Sinkin ◽

Elena Vladimirovna Grigoryeva ◽

Rashid Abdurakhmanovich Navruzov

Keyword(s):

Surgical Treatment ◽

Temporal Lobe ◽

Clinical Picture ◽

Clinical Manifestations ◽

Epileptogenic Zone ◽

Pharmacoresistant Epilepsy ◽

Modern Methods ◽

Selection For ◽

Selection Of Patients ◽

Selection Of

Surgical treatment of bilateral temporal lobe pharmacoresistant epilepsy is associated with some difficulties: particularly, the lack of stereotypical clinical picture in the same patient and controversial data on modern methods of diagnostics — all these statements make identifying epileptogenic zone more difficult and lack of clear criteria for the selection of patients for surgical treatment. In this review, issues of aetiology, pathogenesis, clinical manifestations and criteria for the selection for surgical treatment suggested by different authors are presented.

Download Full-text

QT INTERVAL IN TEMPORAL LOBE EPILEPSY VERSUS NON TEMPORAL LOBE EPILEPSY

QJM ◽

10.1093/qjmed/hcab102.018 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Ahmed A Gaber ◽

Yousry A Abdelhamed ◽

Mona M Wahid Eldin ◽

Islam M Bastawy ◽

Maram S Nasef

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Qt Interval ◽

Case Series ◽

Electrode Placement ◽

Interval Prolongation ◽

Temporal Epilepsy ◽

Qt Interval Prolongation ◽

Significant Prolongation ◽

Significant Difference

Abstract Introduction Background SUDEP is leading cause of mortality in patients with chronic refractory epilepsy. Despite several epidemiological studies, case series , monitored and witnessed SUDEP the exact mechanism is not proposed Objective This work was carried out to assess QT interval prolongation in epilepsy and whether there’s a difference in QT interval prolongation between temporal epilepsy and non-temporal epilepsy. Patients and methods This study was conducted on 100 patients, 50 aged and sex matched healthy controls who underwent a prolonged (6 to 24 hours) 22 channel computerized EEG monitor with 10-20 system electrode placement and 12 lead electrocardiogram (25 millisecond speed). QT, QTd and QTc using Bazzet’s formulae were calculated. Results The results showed statistically significant difference prolongation of QT interval in epilepsy particularly temporal lobe epilepsy. Conclusion Significant prolongation of QT interval in epilepsy patients (11% suffered pathological prolonged QT). Marked prolongation of QTc and QTd in temporal lobe epilepsy over non temporal group.

Download Full-text

TP3-5 Structural connectivity driven stereoelectroencephalography (SEEG) electrode targeting in suspected pseudotemporal and temporal plus epilepsy

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2019-abn.60 ◽

2019 ◽

Vol 90 (3) ◽

pp. e19.1-e19

Author(s):

M Della Costanza ◽

VN Vakharia ◽

K Li ◽

M Mancini ◽

SB Vos ◽

...

Keyword(s):

Temporal Lobe ◽

Structural Connectivity ◽

Posterior Part ◽

Middle Part ◽

Fusiform Gyrus ◽

Angular Gyrus ◽

Computer Assisted ◽

Epileptogenic Zone ◽

Whole Brain ◽

Lingual Gyrus

ObjectivesOne third of patients with drug resistant focal mesial temporal lobe epilepsy (MTLE) fail to achieve long-term seizure freedom following temporal lobe resections. Reasons for failure may include ictal onset outside the temporal lobe (TL), termed ‘pseudotemporal lobe epilepsy’ (pTLE), with propagation from strongly connected neighboring areas or temporal plus (TL+) epilepsy, when the epileptogenic zone primarily involves the temporal lobe and also extends to neighboring regions. In such cases the perisylvian and orbito-frontal (OF) cortices, cingulum and temporo-parieto-occipital junction may be implicated. Stereoelectroencephalography (SEEG) is a procedure in which electrodes are stereotactically placed within predefined brain regions to delineate the SOZ and allows evaluation of deep anatomical structures adjacent to the TL. SEEG electrode contacts sample from a core radius of 3–5 mm. It is unclear which sub-regions of target structures should be preferentially implanted to optimally detect the network involved in seizure onset and rapid propagation. Using normalized average group templates of structural connectivity from patients with hippocampal sclerosis (HS), we determine the greatest connectivity to critical sub-regions and based upon this propose optimal locations for SEEG targeting.DesignObservational cross-sectional study.SubjectsTwelve patients with HS (6 right) that had undergone SEEG and pre-operative diffusion imaging were identified from a prospectively maintained database.MethodsWhole brain connectomes with 10 million tracts were generated using cortical seed regions derived from whole brain GIF parcellations. Normalized group templates were generated separately for right and left HS patients. Orbitofrontal cortex (OF), insula (INS), cingulum (Cing) and temporo-parietal-occipital junction (supramarginal gyrus, angular gyrus, precuneus, fusiform gyrus and lingual gyrus) were segmented into surgically targetable subregions. All subregions had similar volumes. Connectivity of the amygdalohippocampal complex (AHC) was defined based on the number of streamlines terminating in the subregions of interest.ResultsLeft HS showed preferential connections to the ipsilateral: posterior part of lateral OF cortex, posterior short gyrus of anterior INS, posterior part of the posterior Cing, middle part of lingual gyrus, posterior part of precuneus and middle part of fusiform gyrus. Right HS showed preferential connections to the ipsilateral: posterior part of the lateral OF cortex, anterior long gyrus of posterior INS, posterior part of posterior Cing, anterior part of lingual gyrus and posterior part of precuneus.ConclusionsUsing whole brain connectomes we determine surgically feasible targets in sub-regions based on greatest connectivity to the AHC. We propose that SEEG targeting utilizing computer-assisted planning may improve the understanding of the overall network connectivity in order to enhance the diagnostic utility of the SEEG implantation. SEEG electrode placement within structures associated with pTLE and TL +may aid in delineating the SOZ if the correct sub-regions are targeted. This should be evaluated prospectively.

Download Full-text

Respiratory Dysfunction in Becker Muscular Dystrophy Patients: A Case Series and Autopsy Report

Journal of Neuromuscular Diseases ◽

10.3233/jnd-190438 ◽

2020 ◽

Vol 7 (4) ◽

pp. 425-431

Author(s):

Madoka Mori-Yoshimura ◽

Yasushi Oya ◽

Hirohumi Komaki ◽

Kazuhiko Segawa ◽

Narihiro Minami ◽

...

Keyword(s):

Muscular Dystrophy ◽

Respiratory Function ◽

Age At Onset ◽

Case Series ◽

Respiratory Muscles ◽

Patient Characteristics ◽

Becker Muscular Dystrophy ◽

Source Population ◽

Respiratory Dysfunction ◽

Ambulant Patient

Background: Few studies have examined respiratory dysfunction in patients with Becker muscular dystrophy (BMD). Objective: This study aimed to examine the characteristics of respiratory dysfunction in patients with BMD. Methods: The present retrospective study assessed respiratory parameters of adult BMD patients using medical records and compared these parameters with various patient characteristics to identify correlations. BMD patients aged 17 years and older who had been diagnosed genetically and/or pathologically were included in the analysis. Results: Of the source population of 133 patients, respiratory function was assessed in 85. Two of these patients had no symptoms, and eight had died. Mean % forced vital capacity (% FVC) was 94.2+/–21.7% (median, 96.1%; range, 5.1–134.1%). In 16 (19%) of the 85 patients, % FVC was <80%. Of these, seven were non-ambulant. Age, ambulation, and cardiac function did not significantly differ between patients with or without respiratory dysfunction, whereas age at onset was significantly lower in patients with respiratory dysfunction (7.7+/–4.7 years vs. 14.4+/–11.9 years; p = 0.001). One non-ambulant patient was a continuous NPPV user, and one patient had been recommended NPPV use but refused. Autopsy of one patient revealed that the diaphragm and intercostal muscles were less affected than proximal skeletal muscles. Conclusion: BMD patients are at risk of developing respiratory dysfunction due to dystrophic changes in respiratory muscles. Respiratory function should be carefully and periodically monitored in these patients.

Download Full-text