Focal fast rhythmic epileptiform discharges on scalp EEG in a patient with cortical dysplasia
|
|
- Kellie Reeves
- 5 years ago
- Views:
Transcription
1 Seizure 2002; 11: doi: /seiz , available online at on CASE REPORT Focal fast rhythmic epileptiform discharges on scalp EEG in a patient with cortical dysplasia ABRAHAM KURUVILLA & ROLAND FLINK Department of Clinical Neurophysiology, Centre for Neuroscience, Uppsala University Hospital, S Uppsala, Sweden Correspondence to: Abraham Kuruvilla, MD, Department of Clinical Neurophysiology, Centre for Neuroscience, Uppsala University Hospital, S Uppsala, Sweden. akuruvilla@doctor4u.com A distinctive scalp electroencephalographic (EEG) pattern of focal fast rhythmic epileptiform discharges (FREDs) in a 23- year-old man with symptomatic localization related epilepsy is presented. Magnetic resonance imaging (MRI) of the brain revealed cortical dysplasia over the right temporal region where the peculiar EEG abnormality was detected. We suggest that this characteristic EEG pattern may be predictive of focal cortical dysplasia (FCD). A brief review of the rhythmic EEG abnormalities in FCDs is also presented. c 2002 BEA Trading Ltd. Published by Elsevier Science Ltd. All rights reserved. Key words: cortical dysplasia; epilepsy; intractable epilepsy; EEG; focal fast rhythmic epileptiform discharges; FREDs. INTRODUCTION Cortical dysplasia (CD) has been increasingly recognized as a cause of medically refractory epilepsy. Focal cortical dysplasias (FCDs), heterogenous disorders of cortical development and organization with varying subtypes, are highly epileptogenic and the mechanisms responsible for their intrinsic epileptogenicity or cellular hyperexcitability is still not completely elucidated 1 5. A variety of electroencephalographic (EEG) abnormalities have been reported by different authors. The EEG could be normal even when the cortical dysplasia is extensive 6. Available surgical data suggests that the dysplastic cortex should be removed completely for achieving freedom from seizures. However, the prognosis remains poor as FCD is difficult to delineate by imaging. The main predictors of a favourable outcome were complete removal of the dysplastic cortex and the epileptogenic zone. These results underscore the importance of neurophysiological data in accurately evaluating the extent of FCD 7. We report a characteristic EEG pattern consisting of intense, focal fast rhythmic epileptiform discharges (FREDs) which correlated well with the magnetic resonance imaging (MRI) lesion site in a patient with epilepsy and FCD. CASE REPORT A 23-year-old male presented with his first epileptic seizure at the age of 17 years. He was born full term to a non-consanguinous parentage and there was no family history of epilepsy. There was no history of febrile convulsions in childhood and he had been completely healthy until the debut of epilepsy. His first seizure was described as a generalized tonic clonic type and the EEG reportedly showed focal sharp waves on the right temporal area, also appearing in clusters with a duration of about 10 seconds during drowsiness. A computerized tomography (CT) scan of the brain was unremarkable. The patient was started on carbamazepine (CBZ) and he remained seizure-free. Four years later he started to complain of episodes of dizziness without any clinical seizure and at the age of 22 years, he started to have epileptic seizures of /02/$22.00/0 c 2002 BEA Trading Ltd. Published by Elsevier Science Ltd. All rights reserved.
2 Focal fast rhythmic epileptiform discharges on scalp EEG in a patient with cortical dysplasia 331 complex partial nature, described as short attacks of staring and oral automatisms without any secondary generalization. He was continued on CBZ and only had seizures provoked by physical exercise. heterotopic grey matter and closed-lip schizencephaly on the right temporal area, lateral to the trigone, extending to the parietal region (Fig. 2(a) and (b)). For the moment our patient has a satisfactory seizure control on an optimal dose of CBZ but in case of increased seizure frequency, he will be offered a preoperative evaluation. DISCUSSION Fig. 1(a): The scalp/sphenoidal EEG showing polyspike and wave complexes and delta waves on the right mid-temporal area. (Note the phase reversal at T4 electrode.) He was referred to the epilepsy group at the University hospital in Uppsala for a diagnostic evaluation due to changed seizure pattern. General physical examination did not reveal any neurocutaneous marker. A detailed neurological examination was unremarkable. He was monitored for 6 hours in a closed circuit video-eeg (VEEG) monitoring system with scalp and sphenoidal electrodes. EEG showed interictal epileptiform discharges consisting of spike/polyspike and wave complexes (Fig. 1(a)) and a moderate degree of slow wave abnormality on the right mid-temporal area. In addition, a distinctive pattern consisting of a spike and wave onset followed by fast rhythmic spikes at Hz was noted intermittently on the right temporal area (Fig. 1(b)) lasting for 4 6 seconds. These rhythms, which we call focal fast rhythmic epileptiform discharges (FREDs), were at times preceded by a short period of electrodecrement or desynchronization lasting for seconds (Fig. 1(c)). EEG abnormalities (Fig. 1(a), (b) and (c)) were seen in wakefulness and sleep and no clinical seizure was recorded during this monitoring. A magnetic resonance imaging (MRI) of the brain showed a focal cortical dysplasia consisting of Intense epileptogenicity of FCD lesions has always been a curiosity among electroencephalographers. This report highlights a distinct EEG pattern consisting of focal fast rhythmic epileptiform discharges (FREDs). The EEG findings revealed a spike and wave onset, at times with a short period of electrodecrement or desynchronization lasting for seconds, followed by a pattern with trains of rhythmic spikes at Hz, of 4 6 seconds in duration, clearly localized to the right temporal area. The MRI of the brain revealed findings consistent with cortical dysplasia concordant with the site of EEG abnormality, pointing to a well-defined epileptogenic zone. In a report consisting of three epileptic patients over a period of 9 years, Brodtkorb et al. 8 described a peculiar pattern of continuous, fast, interictal spiking which was distinctively localized on scalp EEG. These patients showed three different types of malformations of cortical development, namely hemimegalencephaly, a subcortical heterotopion and a FCD, respectively, in the MRI. The epileptiform abnormality described by these authors was continuous spikes, whereas, our patient had subclinical electrographic seizure-like bursts lasting for only 4 6 seconds. In addition, the epileptiform discharges described by these authors were of slower frequency (upto 8 Hz) when compared to our patient who had a faster frequency (12 14 Hz). In an elaborate study comprising a group of 34 patients with CD and intractable epilepsy, Gambardella et al. 1 observed rhythmic epileptiform discharges (REDs) in 15 (44%) patients and 12 (80%) of these 15 patients had continuous epileptiform discharges (CEDs) on electrocorticogram (ECoG). These patients were compared with another group comprising 40 patients who had non-dysplastic structural lesions of the brain and none of this latter group showed REDs in their EEGs. Hence, Gambardella et al. concluded that REDs and CEDs are highly specific and sensitive indicators of FCDs. The rhythmic epileptiform spikes observed on the scalp EEGs by these investigators were of two main types: (1) trains of rhythmic spikes or sharp waves at 4 10 Hz lasting for 1 4 seconds (8/15 or 60%); and (2) slower quasi-continuous rhythmic spikes at
3 332 A. Kuruvilla and R. Flink Fig. 1(b): This scalp/sphenoidal EEG illustrates the characteristic surface electrographic pattern consisting of spike/polyspike and wave onset followed by fast rhythmic epileptiform discharges (FREDs) at Hz on the right temporal area. (This pattern was never associated with clinical symptoms during this VEEG recording.) Fig. 1(c): The scalp/sphenoidal EEG showing FREDs preceded by a brief period of focal attenuation of background EEG on the right temporal area. Note the characteristic electrodecrement or desynchronization after the polyspike and wave onset. (This pattern was never associated with clinical symptoms during this VEEG recording.)
4 Focal fast rhythmic epileptiform discharges on scalp EEG in a patient with cortical dysplasia Hz lasting more than 10 seconds (7/15 or 40%). The EEG abnormality observed in our patient is slightly different in that the rhythmic discharges consisted of a faster rhythm at Hz preceded by a spike and wave onset and at times a transient electrodecremental state or desynchronization. In addition, the aforementioned authors found that out of the 10 patients with focal or lobar REDs, only two (20%) coincided with the distribution of interictal spiking, thereby showing that interictal sharp waves and spikes were more widespread than REDs. In our patient the interictal spikes and spike wave complexes were always concordant with the FREDs. Kuzniecky et al. 9 investigated the use of ictal singlephoton emission computed tomography (SPECT) in two children with intractable epilepsy and found that ictal scalp EEGs failed to localize the epileptic focus and the interictal EEG data demonstrated widespread lateralized abnormalities. Although large areas of epileptogenesis was evident by scalp and subdural EEG studies, resection of the abnormal areas shown by SPECT was carried out. These authors concluded that ictal SPECT provides functional evidence for localized epileptogenesis in FCDs. The EEG findings in our patient are different from Kuzniecky et al. s observation in that our tracing showed a very discrete, localized abnormality concordant with MRI findings. In children with extensive CD, two distinctive EEG abnormalities have been described by Quirk et al. 6 An EEG with very high amplitude rhythmic activity was found to have high specificity but low sensitivity (50% cases) for severe CD. These authors concluded that abnormal fast activity was not specific and was seen with very diverse pathologies. They added that EEG features of the majority of cases with localized CD were very variable. The abnormally fast rhythmic activity seen in our patient is unique and distinctive in that it coincided with the site of FCD lesion seen in MRI. The cellular mechanisms responsible for the trains of desynchronization or electrodecrement and fast rhythm seen on the scalp EEG of our patient appear to be complex. In a study comprising 15 CD patients, Mathern et al. 2 evaluated the electrophysiological and morphological mechanisms responsible for cellular hyperexcitability by sampling neocortical most and least epileptogenic areas based on neuroimaging and ECoG. The authors concluded that the abnormalities varied from hyperexcitability to hypoexcitability. Perhaps, these varying thresholds of excitation in these abnormal-appearing cells may be responsible for the electrodecremental, as well as fast, rhythms seen in our patient. It is known that cortical dysplastic tissue has a higher intrinsic ability to generate ictal-like discharges 3, 10. These epileptiform discharges depend Fig. 2: (a) T1W/Inversion recovery MRI scan in axial plane (Philips Gyroscan ACS-NT 1.5 T/TR 2500/TE 14/TI 300) showing cortical heterotopia and closed-lip schizencephaly on the right temporal-parietal region. (b) Note the closed-lip schizencephaly in the right trigone where there is frank communication between grey matter and ventricle (grey matter seen as a nipple like projection in to the ventricle). on excitatory amino acid receptor-mediated mechanisms 10. Experimental studies have shown that dysplastic cortical lesions have recurrent excitation and decreased inhibitory activity, compared with adjacent non-dysplastic cortex 11. Such dysfunction at the level of neuronal circuits may be responsible for the abnormal synchronization leading to prolonged trains of epileptic activity 1. Given that ours is a single case report, it is difficult to derive any statistical conclusion concerning the sensitivity or specificity of this EEG pattern. However, we believe that prolonged, focal FREDs on surface EEG may be predictive of FCD and, as such, may be considered as a clue for
5 334 A. Kuruvilla and R. Flink undertaking further studies with MRI for structural localization of the lesion. ACKNOWLEDGEMENTS Special thanks to Ms Lena Eriksson of the Department of Clinical Neurophysiology for her valuable help in preparing the EEG figures. REFERENCES 1. Gambardella, A., Palmini, A., Andermann, F. et al. Usefulness of focal rhythmic discharges on scalp EEG of patients with focal cortical and intractable epilepsy. Electroencephalography and Clinical Neurophysiology 1996; 98: Mathern, G. W., Cepeda, C., Hurst, R. S., Flores-Hernandez, J., Mendoza, D. and Levine, M. S. Neurons recorded from pediatric epilepsy surgery patients with cortical dysplasia. Epilepsia 2000; 41 (Suppl. 6): S162 S Mattia, D., Avoli, M. and Olivier, A. Seizure-like discharges recorded in human dysplastic neocortex maintained in vitro. Neurology 1995; 45: Palmini, A., Gambardella, A., Andermann, F. et al. Operative strategies for patients with cortical dysplastic lesions and intractable epilepsy. Epilepsia 1994; 35 (Suppl. 6): S57 S Raymond, A. A., Fish, D. R., Sisodiya, S. M., Alsanjari, N., Stevens, J. M. and Shorvon, S. D. Abnormalities of gyration, heterotopias, tuberous sclerosis, focal cortical dysplasia, microdysgenesis, dysembryoplastic neuroepithelial tumour and dysgenesis of the archicortex in epilepsy. Clinical, EEG and neuroimaging features in 100 adult patients. Brain 1995; 118: Quirk, J. A., Kendall, B., Kingsley, D. P., Boyd, S. G. and Pitt, M. C. EEG features of cortical dysplasia in children. Neuropediatrics 1993; 24: Chassoux, F., Devaux, B., Landre, E. et al. Stereoelectroencephalography in focal cortical dysplasia: a 3D approach to delineating the dysplastic cortex. Brain 2000; 123: Brodtkorb, E., Anderson, K., Henriksen, O., Myhr, G. and Skullerud, K. Focal, continuous spikes suggest cortical developmental abnormalities. Clinical, MRI and neuropathological correlates. Acta Neurologica Scantinavica 1998; 98: Kuzniecky, R., Mountz, J. M., Wheatley, G. and Morawetz, R. Ictal single-photon emission computed tomography demonstrates localized epileptogenesis in cortical dysplasia. Annals of Neurology 1993; 34: Avoli, M., Bernasconi, A., Mattia, D., Olivier, A. and Hwa, G. G. Epileptiform discharges in the human dysplastic neocortex: in vitro physiology and pharmacology. Annals of Neurology 1999; 46: Ferrer, I., Pineda, M. and Tallada, M. Abnormal local-circuit neurons in epilepsia partialis continua associated with focal cortical dysplasia. Acta Neuropathology (Berlin) 1992; 83:
What is the Relationship Between Arachnoid Cysts and Seizure Foci?
Epilepsin, 38( 10):1098-1102, 1997 Lippincott-Raven Publishers, Philadelphia 0 International League Against Epilepsy What is the Relationship Between Arachnoid Cysts and Seizure Foci? Santiago Arroyo and
More informationCase reports functional imaging in epilepsy
Seizure 2001; 10: 157 161 doi:10.1053/seiz.2001.0552, available online at http://www.idealibrary.com on Case reports functional imaging in epilepsy MARK P. RICHARDSON Medical Research Council Fellow, Institute
More informationInterictal High Frequency Oscillations as Neurophysiologic Biomarkers of Epileptogenicity
Interictal High Frequency Oscillations as Neurophysiologic Biomarkers of Epileptogenicity December 10, 2013 Joyce Y. Wu, MD Associate Professor Division of Pediatric Neurology David Geffen School of Medicine
More informationEpilepsy: diagnosis and treatment. Sergiusz Jóźwiak Klinika Neurologii Dziecięcej WUM
Epilepsy: diagnosis and treatment Sergiusz Jóźwiak Klinika Neurologii Dziecięcej WUM Definition: the clinical manifestation of an excessive excitation of a population of cortical neurons Neurotransmitters:
More informationHamartomas and epilepsy: clinical and imaging characteristics
Seizure 2003; 12: 307 311 doi:10.1016/s1059 1311(02)00272-8 Hamartomas and epilepsy: clinical and imaging characteristics B. DIEHL, R. PRAYSON, I. NAJM & P. RUGGIERI Departments of Neurology, Pathology
More informationEEG workshop. Epileptiform abnormalities. Definitions. Dr. Suthida Yenjun
EEG workshop Epileptiform abnormalities Paroxysmal EEG activities ( focal or generalized) are often termed epileptiform activities EEG hallmark of epilepsy Dr. Suthida Yenjun Epileptiform abnormalities
More informationEpilepsy & Behavior Case Reports
Epilepsy & Behavior Case Reports 1 (2013) 45 49 Contents lists available at ScienceDirect Epilepsy & Behavior Case Reports journal homepage: www.elsevier.com/locate/ebcr Case Report Partial disconnection
More informationCommon Ictal Patterns in Patients with Documented Epileptic Seizures
THE ICTAL IRAQI PATTERNS POSTGRADUATE IN EPILEPTIC MEDICAL JOURNAL PATIENTS Common Ictal Patterns in Documented Epileptic Seizures Ghaieb Bashar ALJandeel, Gonzalo Alarcon ABSTRACT: BACKGROUND: The ictal
More informationRelevance of Residual Histologic and Electrocorticographic Abnormalities for Surgical Outcome in Frontal Lobe Epilepsy
Relevance of Residual Histologic and Electrocorticographic Abnormalities for Surgical Outcome in Frontal Lobe Epilepsy C.H. Ferrier G. Alarcón J. Engelsman C.D. Binnie M. Koutroumanidis C.E. Polkey I.
More informationEpileptic Disord 2003; 5 (Suppl 2): S 85 S 90. in adult patients
Abnormalities of cortical development and epilepsy Epileptic Disord 2003; 5 (Suppl 2): S 85 S 90 Malformation of cortical development in adult patients Paolo Tinuper, Giuseppe d Orsi, Francesca Bisulli,
More information*Pathophysiology of. Epilepsy
*Pathophysiology of Epilepsy *Objectives * At the end of this lecture the students should be able to:- 1.Define Epilepsy 2.Etio-pathology of Epilepsy 3.Types of Epilepsy 4.Role of Genetic in Epilepsy 5.Clinical
More informationIntracranial Studies Of Human Epilepsy In A Surgical Setting
Intracranial Studies Of Human Epilepsy In A Surgical Setting Department of Neurology David Geffen School of Medicine at UCLA Presentation Goals Epilepsy and seizures Basics of the electroencephalogram
More informationEarly seizure propagation from the occipital lobe to medial temporal structures and its surgical implication
Original article Epileptic Disord 2008; 10 (4): 260-5 Early seizure propagation from the occipital lobe to medial temporal structures and its surgical implication Naotaka Usui, Tadahiro Mihara, Koichi
More informationFocal epilepsy recruiting a generalised network of juvenile myoclonic epilepsy: a case report
Clinical commentary Epileptic Disord 2014; 16 (3): 370-4 Focal epilepsy recruiting a generalised network of juvenile myoclonic epilepsy: a case report Myo Khaing 1,2, Kheng-Seang Lim 1, Chong-Tin Tan 1
More informationThe Requirement for Ictal EEG Recordings Prior to Temporal Lobe Epilepsy Surgery
Page 1 of 7 Archives of Neurology Issue: Volume 58(4), April 2001, pp 678-680 Copyright: Copyright 2001 by the American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply
More informationTemporal lobe dysembryoplastic neuroepithelial tumour: significance of discordant interictal spikes
Original article Epileptic Disord 2004; 6: 10-14 Temporal lobe dysembryoplastic neuroepithelial tumour: significance of discordant interictal spikes Angelo Labate 1, Regula S. Briellmann 1,6, Anthony S.
More informationEEG in Epileptic Syndrome
EEG in Epileptic Syndrome Surachai Likasitwattanakul, M.D. Division of Neurology, Department of Pediatrics Faculty of Medicine, Siriraj Hospital Mahidol University Epileptic syndrome Electroclinical syndrome
More informationApproximately 70% of childhood SURGICAL TREATMENTS FOR PEDIATRIC EPILEPSY PROCEEDINGS. Ronald P. Lesser, MD KEY POINTS
ASIM May p153-158 5/14/01 9:19 AM Page 153 SURGICAL TREATMENTS FOR PEDIATRIC EPILEPSY Ronald P. Lesser, MD KEY POINTS Most children with epilepsy refractory to drugs can improve with surgery Temporal lobe
More informationPRESURGICAL EVALUATION. ISLAND OF COS Hippocrates: On the Sacred Disease. Disclosure Research-Educational Grants. Patients with seizure disorders
PRESURGICAL EVALUATION Patients with seizure disorders Gregory D. Cascino, MD Mayo Clinic Disclosure Research-Educational Grants Mayo Foundation Neuro Pace, Inc. American Epilepsy Society American Academy
More informationCase report. Epileptic Disord 2005; 7 (1): 37-41
Case report Epileptic Disord 2005; 7 (1): 37-41 Periodic lateralized epileptiform discharges (PLEDs) as the sole electrographic correlate of a complex partial seizure Gagandeep Singh, Mary-Anne Wright,
More informationVagus nerve stimulation for refractory epilepsy
Seizure 2001; 10: 456 460 doi:10.1053/seiz.2001.0628, available online at http://www.idealibrary.com on CASE REPORT Vagus nerve stimulation for refractory epilepsy PAUL BOON, KRISTL VONCK, JACQUES DE REUCK
More informationThere are several types of epilepsy. Each of them have different causes, symptoms and treatment.
1 EPILEPSY Epilepsy is a group of neurological diseases where the nerve cell activity in the brain is disrupted, causing seizures of unusual sensations, behavior and sometimes loss of consciousness. Epileptic
More informationThe secrets of conventional EEG
The secrets of conventional EEG The spike/sharp wave activity o Electro-clinical characteristics of Spike/Sharp wave The polymorphic delta activity o Electro-clinical characteristics of Polymorphic delta
More informationThe EEG in focal epilepsy. Bassel Abou-Khalil, M.D. Vanderbilt University Medical Center
The EEG in focal epilepsy Bassel Abou-Khalil, M.D. Vanderbilt University Medical Center I have no financial relationships to disclose that are relative to the content of my presentation Learning Objectives
More informationInvasive Evaluation for Epilepsy Surgery Lesional Cases NO DISCLOSURES. Mr. Johnson. Seizures at 29 Years of Age. Dileep Nair, MD Juan Bulacio, MD
Invasive Evaluation for Epilepsy Surgery Lesional Cases NO DISCLOSURES Dileep Nair, MD Juan Bulacio, MD Mr. Johnson Seizures at 29 Years of Age Onset of seizures at 16 years of age bed wetting episodes
More informationObjectives. Amanda Diamond, MD
Amanda Diamond, MD Objectives Recognize symptoms suggestive of seizure and what those clinical symptoms represent Understand classification of epilepsy and why this is important Identify the appropriate
More informationEarly detection of abnormalities in partial epilepsy
104 Institute of Child Health and Hospital for Sick Children, London, Neurosciences Unit J H Cross G D Jackson B G R Neville F J Kirkham Radiology and Physics Unit A Connelly D G Gadian Department of Clinical
More informationEEG in Medical Practice
EEG in Medical Practice Dr. Md. Mahmudur Rahman Siddiqui MBBS, FCPS, FACP, FCCP Associate Professor, Dept. of Medicine Anwer Khan Modern Medical College What is the EEG? The brain normally produces tiny
More informationROLE OF EEG IN EPILEPTIC SYNDROMES ASSOCIATED WITH MYOCLONUS
Version 18 A Monthly Publication presented by Professor Yasser Metwally February 2010 ROLE OF EEG IN EPILEPTIC SYNDROMES ASSOCIATED WITH MYOCLONUS EEG is an essential component in the evaluation of epilepsy.
More informationDavid Dredge, MD MGH Child Neurology CME Course September 9, 2017
David Dredge, MD MGH Child Neurology CME Course September 9, 2017 } 25-40,000 children experience their first nonfebrile seizure each year } AAN/CNS guidelines developed in early 2000s and subsequently
More informationEMG, EEG, and Neurophysiology in Clinical Practice
Mayo School of Continuous Professional Development EMG, EEG, and Neurophysiology in Clinical Practice Matthew T. Hoerth, M.D. Ritz-Carlton, Amelia Island, Florida January 29-February 4, 2017 2016 MFMER
More informationDiagnosing Complicated Epilepsy: Mapping of the Epileptic Circuitry. Michael R. Sperling, M.D. Thomas Jefferson University Philadelphia, PA
Diagnosing Complicated Epilepsy: Mapping of the Epileptic Circuitry Michael R. Sperling, M.D. Thomas Jefferson University Philadelphia, PA Overview Definition of epileptic circuitry Methods of mapping
More informationIdiopathic epilepsy syndromes
1 Idiopathic epilepsy syndromes PANISRA SUDACHAN, M.D. Pe diatric Neuro lo gis t Pediatric Neurology Department Pras at Neuro lo gic al Institute Epilepsy course 20 August 2016 Classification 2 1964 1970
More informationSeizure Localization in Patients with Multiple Tubers: Presurgical Evaluation in Tuberous Sclerosis
Seizure Localization in Patients with Multiple Tubers: Presurgical Evaluation in Tuberous Sclerosis Case Report Journal of Epilepsy Research pissn 2233-6249 / eissn 2233-6257 Pamela Song, MD 1, Eun Yeon
More informationOverview: Idiopathic Generalized Epilepsies
Epilepsia, 44(Suppl. 2):2 6, 2003 Blackwell Publishing, Inc. 2003 International League Against Epilepsy Overview: Idiopathic Generalized Epilepsies Richard H. Mattson Department of Neurology, Yale University
More informationMultimodal Imaging in Extratemporal Epilepsy Surgery
Open Access Case Report DOI: 10.7759/cureus.2338 Multimodal Imaging in Extratemporal Epilepsy Surgery Christian Vollmar 1, Aurelia Peraud 2, Soheyl Noachtar 1 1. Epilepsy Center, Dept. of Neurology, University
More informationPresurgical Evaluation before Epilepsy Surgery
Presurgical Evaluation before Epilepsy Surgery Epilepsy Course for Neurology Resident 2015 Kanjana Unnwongse- Wehner, MD Prasat Neurological Epilepsy Center Facts About Epilepsy & Surgery Localization-related
More informationEPILEPSY SURGERY EVALUATION IN ADULTS WITH SCALP VIDEO-EEG MONITORING. Meriem Bensalem-Owen, MD University of Kentucky
EPILEPSY SURGERY EVALUATION IN ADULTS WITH SCALP VIDEO-EEG MONITORING Meriem Bensalem-Owen, MD University of Kentucky DISCLOSURES Received grants for sponsored research as investigator from: UCB Eisai
More informationClassification of Seizures. Generalized Epilepsies. Classification of Seizures. Classification of Seizures. Bassel F. Shneker
Classification of Seizures Generalized Epilepsies Bassel F. Shneker Traditionally divided into grand mal and petit mal seizures ILAE classification of epileptic seizures in 1981 based on clinical observation
More informationUpdate in Pediatric Epilepsy
Update in Pediatric Epilepsy Cherie Herren, MD Assistant Professor OUHSC, Department of Neurology September 20, 2018 Disclosures None Objectives 1. Identify common pediatric epilepsy syndromes 2. Describe
More informationIntroduction to EEG del Campo. Introduction to EEG. J.C. Martin del Campo, MD, FRCP University Health Network Toronto, Canada
Introduction to EEG J.C. Martin, MD, FRCP University Health Network Toronto, Canada What is EEG? A graphic representation of the difference in voltage between two different cerebral locations plotted over
More informationICD-9 to ICD-10 Conversion of Epilepsy
ICD-9-CM 345.00 Generalized nonconvulsive epilepsy, without mention of ICD-10-CM G40.A01 Absence epileptic syndrome, not intractable, with status G40.A09 Absence epileptic syndrome, not intractable, without
More informationEpilepsy, a common chronic neurological disorder, is a
10 SUPPLEMENT TO Journal of the association of physicians of india august 2013 VOL. 61 Epilepsy: Diagnostic Evaluation JMK Murthy* Epilepsy, a common chronic neurological disorder, is a potentially treatable
More informationA reappraisal of secondary bilateral synchrony
Neurology Asia 2007; 12 : 29 35 A reappraisal of secondary bilateral synchrony Liri JIN MD, PhD Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing,
More informationSurgical outcome of cortical dysplasias presenting with chronic intractable epilepsy: A 10-year experience
Original Article Surgical outcome of cortical dysplasias presenting with chronic intractable epilepsy: A 10-year experience Manjari Tripathi 1, Mahendra S. Singh, M. V. Padma 1, Shailesh Gaikwad 2, C.
More informationCoexistence of focal and idiopathic generalized epilepsy in the same patient population
Seizure (2006) 15, 28 34 www.elsevier.com/locate/yseiz Coexistence of focal and idiopathic generalized epilepsy in the same patient population Lara E. Jeha a, *, Harold H. Morris b, Richard C. Burgess
More informationEpilepsy. Hyunmi Choi, M.D., M.S. Columbia Comprehensive Epilepsy Center The Neurological Institute. Seizure
Epilepsy Hyunmi Choi, M.D., M.S. Columbia Comprehensive Epilepsy Center The Neurological Institute Seizure Symptom Transient event Paroxysmal Temporary physiologic dysfunction Caused by self-limited, abnormal,
More informationBrain Structure and Epilepsy: The Impact of Modern Imaging
Commentary Brain Structure and Epilepsy: The Impact of Modern Imaging Frederick Andermann, Professor of Neurology and Paediatrics, Department of Neurology and Neurosurgery, McGill University, Montreal,
More informationClassification of Epilepsy: What s new? A/Professor Annie Bye
Classification of Epilepsy: What s new? A/Professor Annie Bye The following material on the new epilepsy classification is based on the following 3 papers: Scheffer et al. ILAE classification of the epilepsies:
More informationSuccessful Treatment of Mesial Temporal Lobe Epilepsy with Bilateral Hippocampal Atrophy and False Temporal Scalp Ictal Onset: A case report
Hiroshima J. Med. Sci. Vol. 61, No. 2, 37~41, June, 2012 HIJM 61 7 37 Successful Treatment of Mesial Temporal Lobe Epilepsy with Bilateral Hippocampal Atrophy and False Temporal Scalp Ictal Onset: A case
More informationIntracranial video-eeg and surgery for focal atonic seizures
Clinical commentary with video sequences Epileptic Disord 2013; 15 (1): 62-6 Intracranial video-eeg and surgery for focal atonic seizures Martín Donadío, Gabriela Ugarnes, Mónica Segalovich, Naomi rakaki,
More informationGrey matter heterotopia: what EEG-fMRI can tell us about epileptogenicity of neuronal migration disorders
doi:10.1093/brain/awh710 Brain (2006), 129, 366 374 Grey matter heterotopia: what EEG-fMRI can tell us about epileptogenicity of neuronal migration disorders Eliane Kobayashi, Andrew P. Bagshaw, Christophe
More informationTrue Epileptiform Patterns (and some others)
True Epileptiform Patterns (and some others) a) What is epileptiform b) Some possible surprises c) Classification of generalized epileptiform patterns An epileptiform pattern Interpretative term based
More informationTaylor-type focal cortical dysplasia: is the epilepsy always resistant to medical treatment?
Case report Epileptic Disord 2006; 8 (4): 289-93 Taylor-type focal cortical dysplasia: is the epilepsy always resistant to medical treatment? Ennio Del Giudice 1, Maria Cristina Bianchi 2, Michela Tosetti
More informationEEG spikes resembling cardiac M-shaped waves in the EKG: the cerebral M pattern
ANNALS OF CLINICAL NEUROPHYSIOLOGY CASE REPORT Ann Clin Neurophysiol 2017;19:58-63 EEG spikes resembling cardiac M-shaped waves in the EKG: the cerebral M pattern A.Bruce Janati 1, Naif S. ALGhasab 2,
More informationElectroencephalography. Role of EEG in NCSE. Continuous EEG in ICU 25/05/59. EEG pattern in status epilepticus
EEG: ICU monitoring & 2 interesting cases Electroencephalography Techniques Paper EEG digital video electroencephalography Dr. Pasiri Sithinamsuwan PMK Hospital Routine EEG long term monitoring Continuous
More informationBenefit of Simultaneous Recording of EEG and MEG in Dipole Localization
Epilepsia, 43(8):924 928, 2002 Blackwell Publishing, Inc. International League Against Epilepsy Benefit of Simultaneous Recording of EEG and MEG in Dipole Localization *Harumi Yoshinaga, *Tomoyuki Nakahori,
More informationSeizure Semiology and Neuroimaging Findings in Patients with Midline Spikes
Epilepsia, 42(12):1563 1568, 2001 Blackwell Science, Inc. International League Against Epilepsy Seizure Semiology and Neuroimaging Findings in Patients with Midline Spikes *Ekrem Kutluay, *Erasmo A. Passaro,
More informationTypical childhood absence seizures are associated with thalamic activation
Original article Epileptic Disord 005; 7 (): 373-7 Typical childhood absence seizures are associated with thalamic activation A. Labate 1, R.S. Briellmann 1,, D.F. Abbott 1,, A.B. Waites 1,, Graeme D.
More informationAdult-Onset Neurologic Dysfunction Associated with Cortical Malformations
AJNR Am J Neuroradiol 20:1037 1043, June/July 1999 Adult-Onset Neurologic Dysfunction Associated with Cortical Malformations Woo Ho Cho, David Seidenwurm, and A. James Barkovich BACKGROUND AND PURPOSE:
More informationElectro-clinical manifestations of the epilepsy associated to the different anatomical variants of hypothalamic hamartomas
Electro-clinical manifestations of the epilepsy associated to the different anatomical variants of hypothalamic hamartomas Alberto JR Leal Hospital Fernando Fonseca, Dep. Neurology Lisbon. Abstract Objective
More informationSpike frequency is dependent on epilepsy duration and seizure frequency in temporal lobe epilepsy
Original article Epileptic Disord 2005; 7 (4): 355-9 Spike frequency is dependent on epilepsy duration and seizure frequency in temporal lobe epilepsy Jozsef Janszky 1,2,3, M. Hoppe 1, Z. Clemens 3, I.
More informationAccepted Manuscript. Editorial. Responsive neurostimulation for epilepsy: more than stimulation. Jayant N. Acharya
Accepted Manuscript Editorial Responsive neurostimulation for epilepsy: more than stimulation Jayant N. Acharya PII: S2467-981X(18)30022-2 DOI: https://doi.org/10.1016/j.cnp.2018.06.002 Reference: CNP
More informationEarly-onset symptomatic focal epilepsy: a dilemma in the timing of surgery
Anatomo-electro-clinical correlations Epileptic Disord 2008; 10 (4): 356-61 Anatomo-electro-clinical correlations: the Great Ormond Street Hospital, UK Case Report - Case 05-2008 Early-onset symptomatic
More informationAsian Epilepsy Academy (ASEPA) & ASEAN Neurological Association (ASNA) EEG Certification Examination
Asian Epilepsy Academy (ASEPA) & ASEAN Neurological Association (ASNA) EEG Certification Examination EEG Certification Examination Aims To set and improve the standard of practice of Electroencephalography
More informationRole of magnetic resonance imaging for preoperative evaluation of patients with refractory epilepsy
ACF Hui JMK Lam YL Chan KM Au-Yeung KS Wong R Kay WS Poon Key words: Epilepsy; Magnetic resonance imaging; Surgery "# Hong Kong Med J 2003;9:20-4 The Chinese University of Hong Kong, Prince of Wales Hospital,
More informationAsian Epilepsy Academy (ASEPA) EEG Certification Examination
Asian Epilepsy Academy (ASEPA) EEG Certification Examination EEG Certification Examination Aims To set and improve the standard of practice of Electroencephalography (EEG) in the Asian Oceanian region
More informationNon epileptiform abnormality J U LY 2 7,
Non epileptiform abnormality S U D A J I R A S A K U L D E J, M D. C H U L A L O N G KO R N C O M P R E H E N S I V E E P I L E P S Y C E N T E R J U LY 2 7, 2 0 1 6 Outline Slow pattern Focal slowing
More informationNeurophysiology & EEG
Neurophysiology & EEG PG4 Core Curriculum Ian A. Cook, M.D. Associate Director, Laboratory of Brain, Behavior, & Pharmacology UCLA Department of Psychiatry & Biobehavioral Sciences Semel Institute for
More informationSEIZURE OUTCOME AFTER EPILEPSY SURGERY
SEIZURE OUTCOME AFTER EPILEPSY SURGERY Prakash Kotagal, M.D. Head, Pediatric Epilepsy Cleveland Clinic Epilepsy Center LEFT TEMPORAL LOBE ASTROCYTOMA SEIZURE OUTCOME 1 YEAR AFTER EPILEPSY SURGERY IN ADULTS
More information2007 UCB Pharma SA. All rights reserved. GLOSSARY OF TERMS
2007 UCB Pharma SA. All rights reserved. GLOSSARY OF TERMS Absence Seizure A type of generalised seizure usually seen in children, characterised by transient impairment or loss of consciousness usually
More informationPaediatric Epilepsy Update N o r e e n Te a h a n canp C o l e t t e H u r l e y C N S E p i l e p s y
Paediatric Epilepsy Update 2018 N o r e e n Te a h a n canp C o l e t t e H u r l e y C N S E p i l e p s y Epilepsy Service CUH ~550 children New diagnosis-education, support, clinic follow up Epilepsy
More informationEpilepsy in children with cerebral palsy
Seizure 2003; 12: 110 114 doi:10.1016/s1059 1311(02)00255-8 Epilepsy in children with cerebral palsy A.K. GURURAJ, L. SZTRIHA, A. BENER,A.DAWODU & V. EAPEN Departments of Paediatrics, Community Medicine
More informationA study of 72 children with eyelid myoclonia precipitated by eye closure in Yogyakarta
Neurol J Southeast Asia 2003; 8 : 15 23 A study of 72 children with eyelid myoclonia precipitated by eye closure in Yogyakarta Harsono MD Department of Neurology, Faculty of Medicine, Gadjah Mada University,
More informationBeyond the Basics in EEG Interpretation: Throughout the Life Stages
Beyond the Basics in EEG Interpretation: Throughout the Life Stages Steve S. Chung, MD, FAAN Chairman, Neuroscience Institute Director, Epilepsy Program Banner University Medical Center University of Arizona
More informationHow do we evaluate patients before epilepsy surgery?
How do we evaluate patients before epilepsy surgery? Yotin Chinvarun, MD Chaiyos Khongkhatithum, MD How do we evaluate patients before epilepsy surgery? Chaiyos Khongkhatithum, MD Division of Neurology
More informationThe relevance of somatosensory auras in refractory temporal lobe epilepsies
BRIEF COMMUNICATION The relevance of somatosensory auras in refractory temporal lobe epilepsies Ghazala Perven, Ruta Yardi, Juan Bulacio, Imad Najm, William Bingaman, Jorge Gonzalez-Martinez, and Lara
More informationSurgical outcome in patients with epilepsy and dual pathology
Brain (1999), 122, 799 805 Surgical outcome in patients with epilepsy and dual pathology L. M. Li, 1 F. Cendes, 1 F. Andermann, 1 C. Watson, 2 D. R. Fish, 3 M. J. Cook, 4 F. Dubeau, 1 J. S. Duncan, 3 S.
More informationImaging and EEG in Post-traumatic Epilepsy
Imaging and EEG in Post-traumatic Epilepsy Michael R. Sperling, M.D. Thomas Jefferson University Philadelphia, PA American Epilepsy Society Annual Meeting Disclosure Name Upsher-Smith Sunovion, Eisai,
More informationCircadian rhythm of interictal epileptiform discharges and changes of spindles in patients with temporal lobe epilepsy.
Biomedical Research 2018; 29 (6): 1263-1267 ISSN 0970-938X www.biomedres.info Circadian rhythm of interictal epileptiform discharges and changes of spindles in patients with temporal lobe epilepsy. Yun-Li
More informationSubject: Magnetoencephalography/Magnetic Source Imaging
01-95805-16 Original Effective Date: 09/01/01 Reviewed: 07/26/18 Revised: 08/15/18 Subject: Magnetoencephalography/Magnetic Source Imaging THIS MEDICAL COVERAGE GUIDELINE IS NOT AN AUTHORIZATION, CERTIFICATION,
More informationMRI-negative frontal lobe epilepsy with ipsilateral akinesia and reflex activation
Anatomo-electro-clinical correlations with video sequences Epileptic Disord 2008; 10 (4): 349-55 Anatomo-electro-clinical correlations: the Miami Children s Hospital, USA Case Report - Case 04-2008 MRI-negative
More informationSo-called cryptogenic partial seizures resulting from a subtle cortical dysgenesis due to a doublecortin gene mutation
Seizure 2002; 11: 273 277 doi:10.1053/seiz.2001.0607, available online at http://www.idealibrary.com on So-called cryptogenic partial seizures resulting from a subtle cortical dysgenesis due to a doublecortin
More informationEpilepsy and Brain Tumor. Apasri Lusawat M.D. Pediatric Neurology Prasat Neurological Institute
Epilepsy and Brain Tumor Apasri Lusawat M.D. Pediatric Neurology Prasat Neurological Institute Outline Overview Pathogenesis : Tumor-> epilepsy Etiology of Epilepsy, age EPILEPSY AND BRAIN TUMORS CNS neoplasms
More informationACTH therapy for generalized seizures other than spasms
Seizure (2006) 15, 469 475 www.elsevier.com/locate/yseiz ACTH therapy for generalized seizures other than spasms Akihisa Okumura a,b, *, Takeshi Tsuji b, Toru Kato b, Jun Natsume b, Tamiko Negoro b, Kazuyoshi
More informationTransient Attenuation of Visual Evoked Potentials during Focal Status Epilepticus in a Patient with Occipital Lobe Epilepsy
131 Transient Attenuation of Visual Evoked Potentials during Focal Status Epilepticus in a Patient with Occipital Lobe Epilepsy Meng-Han Tsai 1, Shih-Pin Hsu 2, Chi-Ren Huang 1, Chen-Sheng Chang 2, Yao-Chung
More informationDiagnosing Epilepsy in Children and Adolescents
2019 Annual Epilepsy Pediatric Patient Care Conference Diagnosing Epilepsy in Children and Adolescents Korwyn Williams, MD, PhD Staff Epileptologist, BNI at PCH Clinical Assistant Professor, Department
More informationReview Article Electroencephalography in Mesial Temporal Lobe Epilepsy: A Review
Epilepsy Research and Treatment Volume 2012, Article ID 637430, 17 pages doi:10.1155/2012/637430 Review Article Electroencephalography in Mesial Temporal Lobe Epilepsy: A Review Manouchehr Javidan1, 2,
More informationPediatrics. Convulsive Disorders in Childhood
Pediatrics Convulsive Disorders in Childhood Definition Convulsion o A sudden, violent, irregular movement of a limb or of the body o Caused by involuntary contraction of muscles and associated especially
More informationThe Changing Surgical Landscape in Kids
The Changing Surgical Landscape in Kids December 7, 2013 Howard L. Weiner, MD NYU Langone Medical Center American Epilepsy Society Annual Meeting Disclosure none American Epilepsy Society 2013 Annual Meeting
More informationCandidates for Epilepsy Surgery. Presurgical Evaluation. Presurgical Evaluation. Presurgical Evaluation. Presurgical Evaluation 8/27/2017
PresurgicalEpilepsy Eval: A multidisciplinary approach to intractable epilepsy Tayard Desudchit MD Faculty Of Medicine Chulalongkorn U. Candidates for Epilepsy Surgery Persistent seizures despite appropriate
More informationUsing Multi-electrode Array Recordings to detect unrecognized electrical events in epilepsy
Using Multi-electrode Array Recordings to detect unrecognized electrical events in epilepsy December 1, 2012 Catherine Schevon, MD, PhD Columbia University New York, NY American Epilepsy Society Annual
More informationChronic PLEDs with transitional rhythmic discharges (PLEDs-plus) in remote stroke
Original article Epileptic Disord 2007; 9 (2): 164-9 Chronic PLEDs with transitional rhythmic discharges (PLEDs-plus) in remote stroke José F. Téllez-Zenteno 1, Sylaja N. Pillai 2, Michael D. Hill 2, Neelan
More informationBenign infantile focal epilepsy with midline spikes and waves during sleep: a new epileptic syndrome or a variant of benign focal epilepsy?
riginal article Epileptic Disord 2010; 12 (3): 205-11 Benign infantile focal epilepsy with midline spikes and waves during sleep: a new epileptic syndrome or a variant of benign focal epilepsy? Santiago
More informationEEG IN FOCAL ENCEPHALOPATHIES: CEREBROVASCULAR DISEASE, NEOPLASMS, AND INFECTIONS
246 Figure 8.7: FIRDA. The patient has a history of nonspecific cognitive decline and multiple small WM changes on imaging. oligodendrocytic tumors of the cerebral hemispheres (11,12). Electroencephalogram
More informationPractical 3 Nervous System Physiology 2 nd year English Module. Dept. of Physiology, Carol Davila University of Medicine and Pharmacy
Electroencephalography l h (EEG) Practical 3 Nervous System Physiology 2 nd year English Module Dept. of Physiology, Carol Davila University of Medicine and Pharmacy What is EEG EEG noninvasively records
More informationClinical Policy: Digital EEG Spike Analysis
Clinical Policy: Reference Number: CP.MP.105 Last Review Date: 01/18 Coding Implications Revision Log See Important Reminder at the end of this policy for important regulatory and legal information. Description
More informationScalp EEG Findings in Temporal Lobe Epilepsy
Scalp EEG Findings in Temporal Lobe Epilepsy Seyed M Mirsattari M.D., Ph.D., F.R.C.P.(C) Assistant Professor Depts. of CNS, Medical Biophysics, Medical Imaging, and Psychology University of Western Ontario
More informationHigh Resolution Ictal SPECT: Enhanced Epileptic Source Targeting?
High Resolution Ictal SPECT: Enhanced Epileptic Source Targeting? Marvin A Rossi MD, PhD RUSH Epilepsy Center Research Lab http://www.synapticom.net Chicago, IL USA Medically-Refractory Epilepsy 500,000-800,000
More informationImaging of Pediatric Epilepsy MRI. Epilepsy: Nonacute Situation
Imaging of Pediatric Epilepsy Epilepsy: Nonacute Situation MR is the study of choice Tailor MR study to suspected epileptogenic zone Temporal lobe Extratemporal A. James Barkovich, MD University of California
More information