Perisylvian vulnerability to postencephalitic epilepsy |
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| Affiliation: | 1. Department of Neurology, KG Hospital & Post Graduate Medical Institute, Coimbatore, Tamil Nadu, India;2. Department of Radiology, KG Hospital & Post Graduate Medical Institute, Coimbatore, Tamil Nadu, India;3. Department of Nuclear Medicine, Kovai Medical Centre and Hospital, Coimbatore, Tamil Nadu, India;1. Concord Repatriation General Hospital, Hospital Road, Concord, New South Wales 2139, Australia;2. Addenbrooke''s Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom;3. The University of Sydney, Camperdown, NSW, Australia 2006;1. Epilepsia Helsinki, HUS Medical Imaging Center, Clinical Neurophysiology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland;2. Aix Marseille Univ, APHM, INSERM, INS, Inst Neurosci Syst, Timone Hospital, Epileptology Department, Marseille, France;3. Aix Marseille Univ, APHM, INSERM, INS, Inst Neurosci Syst, Timone Hospital, Pediatric Neurosurgery Department, Marseille, France;4. Aix Marseille Univ, APHM, INSERM, INS, Inst Neurosci Syst, Timone Hospital, Functional and Stereotactic Neurosurgery Department, Marseille, France;5. Epilepsia Helsinki, Department of Pediatric Neurology, Helsinki University Hospital, Helsinki, Finland;6. APHM, Timone Hospital, Pediatric Neurology Department, Marseille, France;1. Brno Epilepsy Center, First Department of Neurology, St. Anne''s University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic;2. Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic;3. Brno Epilepsy Center, Department of Neurosurgery, St. Anne''s University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic;4. First Department of Pathological Anatomy, St. Anne''s University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic;5. Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic;6. Department of Radiology, St. Anne''s University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic |
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| Abstract: | ObjectivePostencephalitic epilepsy is often resistant to antiseizure medications, leading to evaluation for epilepsy surgery. Characterizing its localization carries implications for optimal surgical approach. We aimed to determine whether a prior history of encephalitis is associated with specific epileptogenic networks among patients with drug resistant epilepsy undergoing stereotactic EEG (SEEG).MethodsWe conducted a retrospective cohort study of drug resistant epilepsy, with and without a prior history of encephalitis. We analyzed SEEG recordings to identify patterns of seizure onset and organization. Seventeen patients with a history of encephalitis (of infectious etiology in two subjects) were identified from a database of patients undergoing SEEG and were compared to seventeen drug-resistant epilepsy controls without a history of encephalitis matched for confounding variables including pre-implantation hypotheses, epilepsy duration, age, and sex.ResultsIndependent bilateral seizures were noted in 65% of the postencephalitic epilepsy cohort. We identified four SEEG-ictal patterns in patients with a prior history of encephalitis: (1) anteromesial temporal onset (24%), (2) anteromesial temporal onset with early spread to the perisylvian region (29%), (3) perisylvian (59%) and (4) synchronized anteromesial temporal and perisylvian (29%) onsets. Patterns 3 and 4, with perisylvian involvement at onset, were unique to the encephalitis group (p = 0.0003 and 0.04 respectively) and exhibited a “patchwork” organization. None of the encephalitis patients vs 5/7 matched controls had Engel I outcome (p = 0.0048).ConclusionsPostencephalitic epilepsies involve anteromesial temporal and perisylvian networks, often in a bilateral independent manner. Unique ictal patterns involving the perisylvian regions was identified in the encephalitis group, but not in the matched control group. Significance: These findings may reflect a selective vulnerability of the perisylvian regions to epilepsy resulting from encephalitis, significantly mitigating the chances of success with SEEG-guided temporal resections. |
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| Keywords: | Epilepsy SEEG Encephalitis |
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