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Insular epilepsy

Phillip L Pearl, Annapurna Poduri, Sanjay P Prabhu, Chellamani Harini, Richard Goldstein, Richard M Atkinson, Dawna Armstrong, Hannah Kinney
The histopathology, "white matter spongiosis," defined by electron microscopy (EM) as "intramyelinic edema," has been associated with vigabatrin therapy in various animal models, but its role or significance in clinical studies is unknown. We conducted a neuropathological examination on a 27-month-old boy with bilateral polymicrogyria and epilepsy after sudden unexpected death in epilepsy (SUDEP). The patient was initiated on vigabatrin at 4 months of age, which controlled infantile spasms, and was continued as maintenance therapy...
February 23, 2018: Epilepsia
Lin Jiang, Tijiang Zhang, Fajin Lv, Shiguang Li, Heng Liu, Zhiwei Zhang, Tianyou Luo
Benign childhood epilepsy with centrotemporal spikes (BECTS) is associated with cognitive and language problems. According to recent studies, disruptions in brain structure and function in children with BECTS are beyond a Rolandic focus, suggesting atypical cortical development. However, previous studies utilizing surface-based metrics (e.g., cortical gyrification) and their structural covariance networks at high resolution in children with BECTS are limited. Twenty-six children with BECTS (15 males/11 females; 10...
2018: Frontiers in Neurology
Chengtian Zhao, Yuping Wang
Previous studies have reported that the insular cortex is involved in recognition memory, but it remains unclear which subarea of the insular cortex serves this function. To address this question, we examined 14 drug-resistant focal epilepsy patients implanted with stereotactic electrodes in the insular cortex. All participants performed a delayed match-to-sample task. Event-related potentials and spectrograms from each insular subarea were analyzed when the participants were exposed to identical (match condition) and different (mismatch condition) stimuli...
February 20, 2018: Neuroreport
Sophie Adler, Seok-Jun Hong, Min Liu, Torsten Baldeweg, J Helen Cross, Andrea Bernasconi, Boris C Bernhardt, Neda Bernasconi
OBJECTIVE: In drug-resistant temporal lobe epilepsy (TLE), relative to the large number of whole-brain morphological studies, neocortical T2 changes have not been systematically investigated. The aim of this study was to assess the anatomical principles that govern the distribution of neocortical T2-weighted fluid-attenuated inversion recovery (FLAIR) signal intensity and uncover its topographic principles. METHODS: Using a surface-based sampling scheme, we mapped neocortical FLAIR intensity of 61 TLE patients relative to 38 healthy controls imaged at 3 T...
January 31, 2018: Epilepsia
Yang Zhang, Wenjing Zhou, Siyu Wang, Qin Zhou, Haixiang Wang, Bingqing Zhang, Juan Huang, Bo Hong, Xiaoqin Wang
Previous studies have shown insular activations involving sensory, motor, and affective processing. However, the functional roles of subdivisions within the human insula are still not well understood. In the present study, we used intracranial electroencephalography and electrical cortical stimulation to investigate the causal roles of subdivisions of the insula in auditory emotion perception in epilepsy patients implanted with depth electrodes in this brain region. The posterior and the anterior subdivisions of the human insula, identified based on structural and functional analyses, showed distinct response properties to auditory emotional stimuli...
January 12, 2018: Cerebral Cortex
Raheel Ahmed, Hiroshi Otsubo, Carter Snead, Elizabeth Donner, Elysa Widjaja, Ayako Ochi, James M Drake, James T Rutka
INTRODUCTION: The diagnosis and surgical management of pediatric patients with insular epilepsy is challenging due to variable and indistinct seizure semiology arising within the insular cortex. In addition, surgical approaches are associated with potential morbidity given the regional neurosurgical and vascular anatomy. Our institutional experience in evaluation and surgical management of insular epilepsy patients is presented. Diagnostic evaluation, surgical treatment and seizures outcomes are highlighted...
December 20, 2017: Epilepsy Research
Charlotte De Maeseneire, Riem El Tahry, Susana Ferrao Santos
Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disorder of the central nervous system that typically manifests predominantly as a psychiatric disorder. However, other manifestations such as epileptic seizures, abnormal movements, and memory or language complications are not unusual. Here, we report the case of a young man who presented with a new-onset epilepsy, with ictal semiology suggestive of insular involvement; this hypothesis was supported by a PET-CT study. Anti-NMDAR antibodies were found in the CSF, confirming the diagnosis of anti-NMDAR encephalitis...
December 20, 2017: Epileptic Disorders: International Epilepsy Journal with Videotape
Luke D Tomycz, Andrew T Hale, Ali S Haider, Dave F Clarke, Mark R Lee
BACKGROUND: It has been increasingly recognized that the insular cortex plays an important role in frontotemporal-parietal epilepsy in children. The insula, however, cannot be properly interrogated with conventional subdural grids, and its anatomy makes it difficult to implicate the insula with semiology or noninvasive modalities. Frame-based, stereotactic placement of insular depth electrodes for direct extraoperative monitoring is a relatively low-risk maneuver that allows for conclusive interrogation of this region, and, in select cases, can easily be replaced with a laser applicator for minimally invasive treatment via thermoablation...
December 13, 2017: Operative Neurosurgery (Hagerstown, Md.)
Nuria Lacuey, Johnson P Hampson, Wanchat Theeranaew, Bilal Zonjy, Ajay Vithala, Norma J Hupp, Kenneth A Loparo, Jonathan P Miller, Samden D Lhatoo
Importance: A better understanding of the role of cortical structures in blood pressure control may help us understand cardiovascular collapse that may lead to sudden unexpected death in epilepsy (SUDEP). Objective: To identify cortical control sites for human blood pressure regulation. Design, Setting, and Participants: Patients with intractable epilepsy undergoing intracranial electrode implantation as a prelude to epilepsy surgery in the Epilepsy Monitoring Unit at University Hospitals Cleveland Medical Center were potential candidates for this study...
February 1, 2018: JAMA Neurology
Silvia Colnaghi, Giorgio Beltrami, Guy Poloni, Anna Pichiecchio, Stefano Bastianello, Carlo Andrea Galimberti, Maurizio Versino
Objective: Mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) may involve extrahippocampal areas of structural damage and dysfunction. The accuracy of medium-term spatial memory can be tested by memory-guided saccades (MGS) to evaluate a functional impairment of the parahippocampal cortex (PHC), while voxel-based morphometry (VBM) analysis can be used to detect a structural damage of the latter region. Methods: MGS with 3- and 30-s memorization delays were compared between 7 patients affected by right MTLE-HS (r-MTLE-HS), 6 patients affected by left MTLE-HS, and 13 healthy controls...
2017: Frontiers in Neurology
Anne Laure Salado, Laurent Koessler, Gabriel De Mijolla, Emmanuelle Schmitt, Jean-Pierre Vignal, Thierry Civit, Louise Tyvaert, Jacques Jonas, Louis Georges Maillard, Sophie Colnat- Coulbois
BACKGROUND: The exploration of the insula in pre-surgical evaluation of epilepsy is considered to be associated with a high vascular risk resulting in an incomplete exploration of the insular cortex. OBJECTIVE: To report a retrospective observational study of insular exploration using stereoelectroencephalography (sEEG) with transopercular and parasagittal oblique intracerebral electrodes from January 2008 to January 2016. The first purpose of this study was to evaluate the surgical risks of insular cortex sEEG exploration...
May 9, 2017: Operative Neurosurgery (Hagerstown, Md.)
Shao-Ping Zhang, Man Zhang, Hong Tao, Yan Luo, Tao He, Chun-Hui Wang, Xiao-Cheng Li, Ling Chen, Lin-Na Zhang, Tao Sun, Qi-Kuan Hu
Potassium channels can be affected by epileptic seizures and serve a crucial role in the pathophysiology of epilepsy. Dimethylation of histone 3 lysine 9 (H3K9me2) and its enzyme euchromatic histone‑lysine N‑methyltransferase 2 (G9a) are the major epigenetic modulators and are associated with gene silencing. Insight into whether H3K9me2 and G9a can respond to epileptic seizures and regulate expression of genes encoding potassium channels is the main purpose of the present study. A total of 16 subtypes of potassium channel genes in pilocarpine‑modelled epileptic rats were screened by reverse transcription‑quantitative polymerase chain reaction, and it was determined that the expression ATP‑sensitive inward rectifier potassium channel 10 (Kcnj10) increased in hippocampus and insular cortex, while the expression of most of the other subtypes decreased...
January 2018: Molecular Medicine Reports
Jacob J Johnson, Macauley S Breault, Pierre Sacre, Matthew S D Kerr, Mathew Johnson, Juan Bulacio, Jorge Gonzalez-Martinez, Sridevi V Sarma, John T Gale
Neural prostheses have generally relied on signals from cortical motor regions to control reaching movements of a robotic arm. However, little work has been done in exploring the involvement of nonmotor cortical and associative regions during motor tasks. In this study, we identify regions which may encode direction during planning and movement of a center-out motor task. Local field potentials were collected using stereoelectroencephalography (SEEG) from nine epilepsy patients implanted with multiple depth electrodes for clinical purposes...
July 2017: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
Giulia Liberati, Anne Klöcker, Maxime Algoet, Dounia Mulders, Marta Maia Safronova, Susana Ferrao Santos, José-Géraldo Ribeiro Vaz, Christian Raftopoulos, André Mouraux
Transient nociceptive stimuli elicit robust phase-locked local field potentials (LFPs) in the human insula. However, these responses are not preferential for nociception, as they are also elicited by transient non-nociceptive vibrotactile, auditory, and visual stimuli. Here, we investigated whether another feature of insular activity, namely gamma-band oscillations (GBOs), is preferentially observed in response to nociceptive stimuli. Although nociception-evoked GBOs have never been explored in the insula, previous scalp electroencephalography and magnetoencephalography studies suggest that nociceptive stimuli elicit GBOs in other areas such as the primary somatosensory and prefrontal cortices, and that this activity could be closely related to pain perception...
September 25, 2017: Cerebral Cortex
M Scott Perry, David J Donahue, Saleem I Malik, Cynthia G Keator, Angel Hernandez, Rohit K Reddy, Freedom F Perkins, Mark R Lee, Dave F Clarke
OBJECTIVE Seizure onset within the insula is increasingly recognized as a cause of intractable epilepsy. Surgery within the insula is difficult, with considerable risks, given the rich vascular supply and location near critical cortex. MRI-guided laser interstitial thermal therapy (LiTT) provides an attractive treatment option for insular epilepsy, allowing direct ablation of abnormal tissue while sparing nearby normal cortex. Herein, the authors describe their experience using this technique in a large cohort of children undergoing treatment of intractable localization-related epilepsy of insular onset...
December 2017: Journal of Neurosurgery. Pediatrics
Jørgen Alving, Martin Fabricius, Ivana Rosenzweig, Sándor Beniczky
PURPOSE: To elucidate the localization of ictal EEG activity, and correlate it to semiological features in self-limited epilepsy with centrotemporal spikes (formerly called "benign epilepsy with centrotemporal spikes"). METHODS: We have performed ictal electric source imaging, and we analysed electroclinical correlations in three patients with self-limited epilepsy with centrotemporal spikes. RESULTS: The source of the evolving rhythmic ictal activity (9...
November 2017: Seizure: the Journal of the British Epilepsy Association
Xinxin Yan, Qing Yu, Yuting Gao, Liting Li, Danhua Yu, Ying Chen, Xiaojuan Yao, Weidong Yang, Zhijuan Chen, Jianzhong Yin, Yang An, Ke Tan
OBJECTIVE: The purpose of this study was to investigate the relationship between alterations of functional brain network and cognition in patients with benign epilepsy with centrotemporal spikes (BECTS) as a function of spike-wave index (SWI) during slow wave sleep. METHODS: Resting-state functional magnetic resonance imaging (RS-fMRI) data and Intelligence Quotient (IQ) were collected from two groups of patients with BECTS, including a SWI<50% group (5 cases) and a SWI≥50% group (7 cases)...
September 4, 2017: Epilepsy & Behavior: E&B
Jonathan Roth, Sari Nagar, Shlomi Constantini, Itzhak Fried
INTRODUCTION: Hemispherotomies are an extreme treatment for epilepsy. As opposed to focal resections, in hemispherotomies the entire hemisphere is disconnected from the remaining nervous system, including functional regions and fibers. Despite this, hemispherotomy is recommended for certain indications, with good epilepsy and functional outcomes. AIMS: To summarize the experience of hemispherotomy performed at a tertiary national center. METHODS: A retrospective study was conducted including all patients operated on between 2001 and 2014...
August 2017: Harefuah
Laure Mazzola, Jean-Pierre Royet, Hélène Catenoix, Alexandra Montavont, Jean Isnard, François Mauguière
OBJECTIVE: Despite numerous studies suggesting the role of insular cortex in the processing of gustatory and olfactory inputs, the exact location of olfactogustatory representation in the insula remains controversial. Here we provide a functional mapping of olfactory-gustatory responses to stimulation of the human insular cortex. METHODS: We reviewed 651 electrical stimulations of the insula that were performed in 221 patients, using stereotactically implanted depth electrodes, during the presurgical evaluation of drug-refractory epilepsy...
September 2017: Annals of Neurology
Carolina Ciumas, Agathe Laurent, Mani Saignavongs, Faustine Ilski, Julitta de Bellescize, Eleni Panagiotakaki, Karine Ostrowsky-Coste, Alexis Arzimanoglou, Vania Herbillon, Danielle Ibarrola, Philippe Ryvlin
OBJECTIVE: We hypothesized that children with benign childhood epilepsy with centrotemporal spikes (BCECTS) might have altered social cognitive skills and underlying neural networks. METHODS: We studied 13 patients with BCECTS and 11 age-matched controls using event-related functional magnetic resonance imaging (fMRI) with an emotional discrimination task consisting of viewing happy, fearful, scrambled, and neutral faces. Behavioral performance measured during the task was correlated with clinical variables and behavioral ratings...
October 2017: Epilepsia
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