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P108: Long-term clinical and EEG consequences of idiopathic partial epilepsies
Abstracts of Poster Presentations / Clinical Neurophysiology 125, Supplement 1 (2014) S1–S339
Alzheimer’s disease. Memory impairment is fairly common symptom of epilepsy and it seems interesting to study the fronto-parietal coherence in epilepsy. Patients and methods: We examined 34 people with partial epilepsy, the mean age was 32.9 years, and 17 healthy control groop, the mean age was 30.5 years. For EEG recording, we used the 19-channel EEG (10-20%) and mathematical processing package “Neuron-Spectrum” (Russia). Recording took place in a resting state, was used for the analysis of the record for 20 seconds without artifacts. Estimation of the spectral coherence of the theta rhythm was conducted in the following leads: F3-P3, F4-P4, F3-F4, P3-P4. Subjects performed a test for short-term memory “Digit Span”. Results: Memory deficits were found in 58% (20) of patients, in the control group of memory impairment has not been. Fronto-parietal coherence in patients with memory decline differed significantly (p=0.001) from healthy and patients without memory impairment. Fronto-parietal coherence level in the group with memory impairment decreased depending on the amount of digits in the test (p=0.005). Conclusion: We assume that the fronto-parietal scalp EEG coherence may play a role in the assessment of cognitive impairment in patients with epilepsy.
S77
ated by ECoG with a 4×5 grid over the lateral temporal cortex and an 8-electrode mesial strip. Total Spiking Activity (TSA), defined as the mean spikes/min for all mesial channels, was computed before and after lateral cortectomy (LC). Based on the TSA after LC, a tailored anterior medial temporal resection (AMTR) was carried out. Results: At the last follow-up (19.1±1.4 months), patients were characterized as Engel’s class I: 84%, II: 8%, or III: 8%. During LC, TSA recorded from the mesial strip did not change in 14 patients, increased in 3 patients and decreased in 8 patients. In 20% of patients, the mesial activity completely disappeared following the LC, and mesial structures were spared. All of these patients were Engel’s class IA. The TSA in the mesial strip during the basal recording was located in the occipital region (80%) and did not change after LC.
P107 Electrocorticographic evidence and surgical implications of different pathophysiologic subtypes of temporal lobe epilepsy O. Garnes-Camarena 1 , L. Vega-Zelaya 1 , C. Torres 2 , G. Ortega 2 , M. Navas 2 , R.G. Sola 2 , J. Pastor 1 1 La Princesa Hospital, Clinical Neurophysiology, Madrid, Spain; 2 La Princesa Hospital, Neurosurgery, Madrid, Spain Question: Mesial temporal lobe epilepsy (MTLE) might have a focal or a network pathophysilogy. We hypothesize that changes in the interictal spiking activity during electrocorticography (ECoG) reflect changes occurring in the epileptic network. The elimination of mesial interictal spikes is tightly linked with the epileptogenic zone (EZ) resection. Methods: 25 patients diagnosed with MTLE were intraoperatively evalu-
Figure 2
Conclusions: Our results strongly suggest the existence of pathophysiologic differences within subtypes of MTLE. The identification of these subtypes is fundamental for an individualized surgical approach.
P108 Long-term clinical and EEG consequences of idiopathic partial epilepsies N. Doertcan 1 , B. Tekin Gueveli 2 , A. Dervent 3 Fatih Sultan Mehmet Research and Training Hospital, Neurology, Istanbul, Turkey; 2 Bakirkoy Research and Training Hospital for Psychiatry, Neurology, Neurosurgery, Neurology, istanbul, Turkey; 3 Private office, Neurology, Istanbul, Turkey 1
Figure 1
This study includes 61 consecutive patients followed by ourselves in a private office. All patients were diagnosed as having idiopathic partial epilepsy (IPE) and followed by for 3–18 years, mean 8 yearsAccording to syndromic classification of epilepsies and epileptic syndromes, patients were gathered into diagnostic groups as 1: Benign Rolandic Epilepsy (BRE), 2: Panayiotopoulos Syndrome (PS), 3: Childhood Epilepsy with Occipital Paroxsyms (Gastaut-type), 4: Atypical Benign Partial Epilepsy (ABPE) and 5: Cases with intermediate characteristics.
S78
Abstracts of Poster Presentations / Clinical Neurophysiology 125, Supplement 1 (2014) S1–S339
Main parameters evaluated in the study were age at onset of epilepsy, seizure characteristics as type, frequency, duration, relation with sleepwake cycle, patient and family history for paroxysmal disorders and clinical course of the seizures. Distribution of interictal spike-wave in the EEGs were analyzed and their localizations were questioned in relation to age of the patient at the time of recording. Number of patients with typical BRE was 17, PS 9, Childhood Epilepsy with Occipital Paroxsyms (Gastaut-type) 8 and ABPE 1. Remaining patients exhibited either characteristics common for more than one syndrome, or, some features within the borderlines of IPEs. Ratio of patients with idiopathic epilepsy in at least one family member was % 38 and with parental consanguinity was % 8 Spike distribution in the EEGs was not only related to the syndromic characteristics of the patients but also to the age at the EEG recording. Results are discussed in view of the related literature.
P111 Dacrystic status epilepticus: a case report M. Vicente Rasoamalala 1 , E. Lainez 1 , V. Thonon 1 , M. Raspall 2 Hospital Vall d’Hebron, Clinical Neurophysiolgy, Barcelona, Spain; 2 Hospital Vall d’Hebron, Pediatric Neuology, Barcelona, Spain
1
Question: To describe the clinical and electrographic features of a patient who presented a status epilepticus of persistent crying. Methods: Twelve year-old girl who was admitted in our hospital for headache, nausea, left upper limb paresis and dysarthria without fever that progressively evolved to a mental state alteration with persistent unmotivated crying. She received a cord blood transplantation for the treatment of a chronic myeloid leukemia six months ago. Cerebrospinal fluid analysis was negative for the most frequent viral and bacterial infectious agents. Cranial MRI revealed only a decreased diameter of M2-M3 segments of right median cerebral artery. Serial EEG recordings were performed. Results: EEG initially showed a focal slow activity in right fronto-temporal regions. 24 hours after we found profuse interictal epileptiform activity localized in temporal and frontal left hemisphere regions and in frontal right hemisphere region with a slowed background activity. A consecutive EEG performed 2 days after showed bifrontal rhythmic 2.5 Hz delta waves preceded by sharp waves that disappeared with the administration of endovenous midazolam bolus (5 mg); after that it persisted some interictal abnormalities in the recording; mental state improved and crying was no more present. An antiepileptic treatment was instaured (levetiracetam and lacosamide) producing a resolution of clinical manifestations and a normalisation of EEG recordings. Conclusion: Dacrystic seizures are a very infrequent ictal manifestation. They usually have a focal origin, mostly in fronto-temporal non-dominant hemisphere regions. We present a unique case of dacrystic status epilepticus without an elucidated etiology.
P112 Perspectives of neurosurgical treatment of epilepsy patients in resource poor countries – study in Georgia S. Kasradze 1,2 , G. Lomidze 1,2 1 Georgian Sleep research and Sleep medicine society, Clinical Neurophysiology, Tbilisi, Georgia; 2 Institute of Neurology and Neuropsychology, Tbilisi, Georgia Question: Focal brain abnormalities are major risk factors for pharmacoresistant epilepsy (PRE) andsurgical treatment of these patients is the most effective way. In resource limited countries epilepsy surgery is not largely accessible because of restricted availability of intracranial EEG monitoring and functional brain imaging, that leads to complete stagnation of development of epilepsy surgery. However, not all patients require further diagnostic procedures, if there is unequivocal concordance in seizure semiology, localization of brain lesion on MRI and epielptiform activity on EEG. Aim: To estimatethe rate ofconcordancebetween seizure semiology, EEG andMRIdatain people with PRE. Methods: Patients with uncontrolled seizures were recruited at Institute of Neurology and Neuropsychology, admitted between 2009-2012 years. All of them were clinically reexamined, underwent standard 20-minute interictal EEG and a high-resolution MRI (3T) according to epilepsy protocol. Pharmacoresistance was defined according to Kwan, et al. 2010. Epileptiform EEG abnormalities were defined as focal epileptiform discharges: spikes, spike-wave complexes, and sharp waves.
Results: 82 persons were investigated (mean age 26 years, SD 12). Fifty five (67%) were female. MRI revealed: mesial sclerosis - 15 case (18%), focal cortical dysplasia (FCD) - 5, tuberous sclerosis - 2 and brain tumour 3 cases. No lesion was found in 24 (29%) cases. In remaining 38 patients various brain abnormalities were detected. Localization of possibly epileptogenic lesions on MRI was in concordance with seizure semiology and EEG findings in 15 (18%) cases (mesial sclerosis - 11, FCD - 2, polymicrogiria 1, hypothalamic hamartoma - 1). In 22 (27%) cases ambiguous data were obtained. In remaining 21 (26%) people multifocal or diffuse abnormalities were detected that were irrelevant for epilepsy surgery. Conclusion: According to our study, in up to one-fifth of patients could be considered as good candidates for epilepsy surgery without needs of further high technological pre-operative assessment procedures. However, most patients in our cohort require more deep investigations for proper localisation of epileptogenic focus. Acknowledgement: The study was funded from Shota Rustaveli National Science Foundation grant.
P113 Correlation of neuropsychological and electrophysiological findings in patients with epilepsy T. Gagoshidze 1,2 , S. Kasradze 1 1 Institute of Neurology and Neuropsychology, Neuropsychology, Tbilisi, Georgia; 2 Iv. Javakhishvilis Tbilisi State University, Psychology, Tbilisi, Georgia Question: The goal of the study was to investigate the correlations of neuropsychological and electrophysiological data in adult patients admitted at Epilepsy Centre for diagnosis of epilepsy. Methods: Standard EEG and Neuropsychological findings of persons with age range of 18-79 years, admitted at the Epilepsy Centre (01.01.2011– 31.12.2012) of the Institute of Neurology and Neuropsychology (INN) for diagnosis of epilepsy were analyzed. Brief Neuropsychological Test for adults was compiled from A. Luria’s neuropsychological tests and A. Benton Visual Memory Retention Test. Luria’s syndrome analysis approach was used for neuropsychological conclusion and probable localization of brain dysfunction. EEG criteria for identification of prevalent localization of pathological area were mainly sharp waves, pick-waves, poly-pick waves and pick and slow waves. Statistical procedures for categorical data, non-parametric statistics: phi correlation, Pearson χ2 coefficient were used. Results: After multidisciplinary investigations of 585 people, 255 male/320 female, 101 persons were diagnosed as having non-epileptic seizures, 113 – with Generalized Epilepsy, 371 – with Focal Epilepsy. From total group 548 (93.7%) had pathological indicators on EEG and out of them the normal neuropsychological functioning has only 55 (10%); in remaining 37 persons with normal EEG normal neuropsychological functioning were reviled in 22 cases (61%). Comparing Generalized, Focal and non-epilepsy seizures, there was a moderate to severe neuropsychological dysfunction in the group of focal epilepsies and no or mild dysfunction in persons with non-epileptic seizures (χ2 =77.395, p<0.005). High concordance revealed between EEG and Neuropsychological data in case of frontal, frontal-temporal, frontal-temporal-parietal localizations (PC=0.693, p<0.024, Cramer’s V=0.231, p<0.05, CC=0.569, p<0.05). No compatibility was in cases of occipital localization. Conclusions: There is a high correlation of EEG and neuropsychological findings especially in frontal and fronto-temporal epilepsies. Neuropsychological assessment could easily capture temporal lobes dysfunction in combination with other brain regions, then pure temporal area’s dysfunction. Failure in occipital localization coincidence can be explained by the weakness of neuropsychological test in identification of occipital lobes dysfunction.
P117 Quantitative EEG alterations in alcohol-dependent patients with epileptic seizures – pilot study M. Nowakowska-Kotas, E. Kowalczyk, M. Waliszewska-Prosół, A. Pokryszko-Dragan Wroclaw Medical University, Department of Neurology, Wroclaw, Poland Question: The aim of study was to analyze features of quantitative electroencephalography (qEEG) in alcohol- dependent subjects with epileptic seizures. Methods: The study comprised 24 alcohol-dependent patients (19 men, 5
Alzheimer’s disease. Memory impairment is fairly common symptom of epilepsy and it seems interesting to study the fronto-parietal coherence in epilepsy. Patients and methods: We examined 34 people with partial epilepsy, the mean age was 32.9 years, and 17 healthy control groop, the mean age was 30.5 years. For EEG recording, we used the 19-channel EEG (10-20%) and mathematical processing package “Neuron-Spectrum” (Russia). Recording took place in a resting state, was used for the analysis of the record for 20 seconds without artifacts. Estimation of the spectral coherence of the theta rhythm was conducted in the following leads: F3-P3, F4-P4, F3-F4, P3-P4. Subjects performed a test for short-term memory “Digit Span”. Results: Memory deficits were found in 58% (20) of patients, in the control group of memory impairment has not been. Fronto-parietal coherence in patients with memory decline differed significantly (p=0.001) from healthy and patients without memory impairment. Fronto-parietal coherence level in the group with memory impairment decreased depending on the amount of digits in the test (p=0.005). Conclusion: We assume that the fronto-parietal scalp EEG coherence may play a role in the assessment of cognitive impairment in patients with epilepsy.
S77
ated by ECoG with a 4×5 grid over the lateral temporal cortex and an 8-electrode mesial strip. Total Spiking Activity (TSA), defined as the mean spikes/min for all mesial channels, was computed before and after lateral cortectomy (LC). Based on the TSA after LC, a tailored anterior medial temporal resection (AMTR) was carried out. Results: At the last follow-up (19.1±1.4 months), patients were characterized as Engel’s class I: 84%, II: 8%, or III: 8%. During LC, TSA recorded from the mesial strip did not change in 14 patients, increased in 3 patients and decreased in 8 patients. In 20% of patients, the mesial activity completely disappeared following the LC, and mesial structures were spared. All of these patients were Engel’s class IA. The TSA in the mesial strip during the basal recording was located in the occipital region (80%) and did not change after LC.
P107 Electrocorticographic evidence and surgical implications of different pathophysiologic subtypes of temporal lobe epilepsy O. Garnes-Camarena 1 , L. Vega-Zelaya 1 , C. Torres 2 , G. Ortega 2 , M. Navas 2 , R.G. Sola 2 , J. Pastor 1 1 La Princesa Hospital, Clinical Neurophysiology, Madrid, Spain; 2 La Princesa Hospital, Neurosurgery, Madrid, Spain Question: Mesial temporal lobe epilepsy (MTLE) might have a focal or a network pathophysilogy. We hypothesize that changes in the interictal spiking activity during electrocorticography (ECoG) reflect changes occurring in the epileptic network. The elimination of mesial interictal spikes is tightly linked with the epileptogenic zone (EZ) resection. Methods: 25 patients diagnosed with MTLE were intraoperatively evalu-
Figure 2
Conclusions: Our results strongly suggest the existence of pathophysiologic differences within subtypes of MTLE. The identification of these subtypes is fundamental for an individualized surgical approach.
P108 Long-term clinical and EEG consequences of idiopathic partial epilepsies N. Doertcan 1 , B. Tekin Gueveli 2 , A. Dervent 3 Fatih Sultan Mehmet Research and Training Hospital, Neurology, Istanbul, Turkey; 2 Bakirkoy Research and Training Hospital for Psychiatry, Neurology, Neurosurgery, Neurology, istanbul, Turkey; 3 Private office, Neurology, Istanbul, Turkey 1
Figure 1
This study includes 61 consecutive patients followed by ourselves in a private office. All patients were diagnosed as having idiopathic partial epilepsy (IPE) and followed by for 3–18 years, mean 8 yearsAccording to syndromic classification of epilepsies and epileptic syndromes, patients were gathered into diagnostic groups as 1: Benign Rolandic Epilepsy (BRE), 2: Panayiotopoulos Syndrome (PS), 3: Childhood Epilepsy with Occipital Paroxsyms (Gastaut-type), 4: Atypical Benign Partial Epilepsy (ABPE) and 5: Cases with intermediate characteristics.
S78
Abstracts of Poster Presentations / Clinical Neurophysiology 125, Supplement 1 (2014) S1–S339
Main parameters evaluated in the study were age at onset of epilepsy, seizure characteristics as type, frequency, duration, relation with sleepwake cycle, patient and family history for paroxysmal disorders and clinical course of the seizures. Distribution of interictal spike-wave in the EEGs were analyzed and their localizations were questioned in relation to age of the patient at the time of recording. Number of patients with typical BRE was 17, PS 9, Childhood Epilepsy with Occipital Paroxsyms (Gastaut-type) 8 and ABPE 1. Remaining patients exhibited either characteristics common for more than one syndrome, or, some features within the borderlines of IPEs. Ratio of patients with idiopathic epilepsy in at least one family member was % 38 and with parental consanguinity was % 8 Spike distribution in the EEGs was not only related to the syndromic characteristics of the patients but also to the age at the EEG recording. Results are discussed in view of the related literature.
P111 Dacrystic status epilepticus: a case report M. Vicente Rasoamalala 1 , E. Lainez 1 , V. Thonon 1 , M. Raspall 2 Hospital Vall d’Hebron, Clinical Neurophysiolgy, Barcelona, Spain; 2 Hospital Vall d’Hebron, Pediatric Neuology, Barcelona, Spain
1
Question: To describe the clinical and electrographic features of a patient who presented a status epilepticus of persistent crying. Methods: Twelve year-old girl who was admitted in our hospital for headache, nausea, left upper limb paresis and dysarthria without fever that progressively evolved to a mental state alteration with persistent unmotivated crying. She received a cord blood transplantation for the treatment of a chronic myeloid leukemia six months ago. Cerebrospinal fluid analysis was negative for the most frequent viral and bacterial infectious agents. Cranial MRI revealed only a decreased diameter of M2-M3 segments of right median cerebral artery. Serial EEG recordings were performed. Results: EEG initially showed a focal slow activity in right fronto-temporal regions. 24 hours after we found profuse interictal epileptiform activity localized in temporal and frontal left hemisphere regions and in frontal right hemisphere region with a slowed background activity. A consecutive EEG performed 2 days after showed bifrontal rhythmic 2.5 Hz delta waves preceded by sharp waves that disappeared with the administration of endovenous midazolam bolus (5 mg); after that it persisted some interictal abnormalities in the recording; mental state improved and crying was no more present. An antiepileptic treatment was instaured (levetiracetam and lacosamide) producing a resolution of clinical manifestations and a normalisation of EEG recordings. Conclusion: Dacrystic seizures are a very infrequent ictal manifestation. They usually have a focal origin, mostly in fronto-temporal non-dominant hemisphere regions. We present a unique case of dacrystic status epilepticus without an elucidated etiology.
P112 Perspectives of neurosurgical treatment of epilepsy patients in resource poor countries – study in Georgia S. Kasradze 1,2 , G. Lomidze 1,2 1 Georgian Sleep research and Sleep medicine society, Clinical Neurophysiology, Tbilisi, Georgia; 2 Institute of Neurology and Neuropsychology, Tbilisi, Georgia Question: Focal brain abnormalities are major risk factors for pharmacoresistant epilepsy (PRE) andsurgical treatment of these patients is the most effective way. In resource limited countries epilepsy surgery is not largely accessible because of restricted availability of intracranial EEG monitoring and functional brain imaging, that leads to complete stagnation of development of epilepsy surgery. However, not all patients require further diagnostic procedures, if there is unequivocal concordance in seizure semiology, localization of brain lesion on MRI and epielptiform activity on EEG. Aim: To estimatethe rate ofconcordancebetween seizure semiology, EEG andMRIdatain people with PRE. Methods: Patients with uncontrolled seizures were recruited at Institute of Neurology and Neuropsychology, admitted between 2009-2012 years. All of them were clinically reexamined, underwent standard 20-minute interictal EEG and a high-resolution MRI (3T) according to epilepsy protocol. Pharmacoresistance was defined according to Kwan, et al. 2010. Epileptiform EEG abnormalities were defined as focal epileptiform discharges: spikes, spike-wave complexes, and sharp waves.
Results: 82 persons were investigated (mean age 26 years, SD 12). Fifty five (67%) were female. MRI revealed: mesial sclerosis - 15 case (18%), focal cortical dysplasia (FCD) - 5, tuberous sclerosis - 2 and brain tumour 3 cases. No lesion was found in 24 (29%) cases. In remaining 38 patients various brain abnormalities were detected. Localization of possibly epileptogenic lesions on MRI was in concordance with seizure semiology and EEG findings in 15 (18%) cases (mesial sclerosis - 11, FCD - 2, polymicrogiria 1, hypothalamic hamartoma - 1). In 22 (27%) cases ambiguous data were obtained. In remaining 21 (26%) people multifocal or diffuse abnormalities were detected that were irrelevant for epilepsy surgery. Conclusion: According to our study, in up to one-fifth of patients could be considered as good candidates for epilepsy surgery without needs of further high technological pre-operative assessment procedures. However, most patients in our cohort require more deep investigations for proper localisation of epileptogenic focus. Acknowledgement: The study was funded from Shota Rustaveli National Science Foundation grant.
P113 Correlation of neuropsychological and electrophysiological findings in patients with epilepsy T. Gagoshidze 1,2 , S. Kasradze 1 1 Institute of Neurology and Neuropsychology, Neuropsychology, Tbilisi, Georgia; 2 Iv. Javakhishvilis Tbilisi State University, Psychology, Tbilisi, Georgia Question: The goal of the study was to investigate the correlations of neuropsychological and electrophysiological data in adult patients admitted at Epilepsy Centre for diagnosis of epilepsy. Methods: Standard EEG and Neuropsychological findings of persons with age range of 18-79 years, admitted at the Epilepsy Centre (01.01.2011– 31.12.2012) of the Institute of Neurology and Neuropsychology (INN) for diagnosis of epilepsy were analyzed. Brief Neuropsychological Test for adults was compiled from A. Luria’s neuropsychological tests and A. Benton Visual Memory Retention Test. Luria’s syndrome analysis approach was used for neuropsychological conclusion and probable localization of brain dysfunction. EEG criteria for identification of prevalent localization of pathological area were mainly sharp waves, pick-waves, poly-pick waves and pick and slow waves. Statistical procedures for categorical data, non-parametric statistics: phi correlation, Pearson χ2 coefficient were used. Results: After multidisciplinary investigations of 585 people, 255 male/320 female, 101 persons were diagnosed as having non-epileptic seizures, 113 – with Generalized Epilepsy, 371 – with Focal Epilepsy. From total group 548 (93.7%) had pathological indicators on EEG and out of them the normal neuropsychological functioning has only 55 (10%); in remaining 37 persons with normal EEG normal neuropsychological functioning were reviled in 22 cases (61%). Comparing Generalized, Focal and non-epilepsy seizures, there was a moderate to severe neuropsychological dysfunction in the group of focal epilepsies and no or mild dysfunction in persons with non-epileptic seizures (χ2 =77.395, p<0.005). High concordance revealed between EEG and Neuropsychological data in case of frontal, frontal-temporal, frontal-temporal-parietal localizations (PC=0.693, p<0.024, Cramer’s V=0.231, p<0.05, CC=0.569, p<0.05). No compatibility was in cases of occipital localization. Conclusions: There is a high correlation of EEG and neuropsychological findings especially in frontal and fronto-temporal epilepsies. Neuropsychological assessment could easily capture temporal lobes dysfunction in combination with other brain regions, then pure temporal area’s dysfunction. Failure in occipital localization coincidence can be explained by the weakness of neuropsychological test in identification of occipital lobes dysfunction.
P117 Quantitative EEG alterations in alcohol-dependent patients with epileptic seizures – pilot study M. Nowakowska-Kotas, E. Kowalczyk, M. Waliszewska-Prosół, A. Pokryszko-Dragan Wroclaw Medical University, Department of Neurology, Wroclaw, Poland Question: The aim of study was to analyze features of quantitative electroencephalography (qEEG) in alcohol- dependent subjects with epileptic seizures. Methods: The study comprised 24 alcohol-dependent patients (19 men, 5