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Ictal semiology of epileptic seizures with insulo-opercular genesis
OBJECTIVE: Epileptic seizures with insular genesis are often difficult to distinguish from those originating in the temporal lobe due to their complex and variable semiology. Here, we analyzed differentiating characteristics in the clinical spectrum of insulo-opercular seizures. METHODS: Ictal semio...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9120119/ https://www.ncbi.nlm.nih.gov/pubmed/34812940 http://dx.doi.org/10.1007/s00415-021-10911-0 |
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author | Martinez-Lizana, Eva Brandt, Armin Foit, Niels A. Urbach, Horst Schulze-Bonhage, Andreas |
author_facet | Martinez-Lizana, Eva Brandt, Armin Foit, Niels A. Urbach, Horst Schulze-Bonhage, Andreas |
author_sort | Martinez-Lizana, Eva |
collection | PubMed |
description | OBJECTIVE: Epileptic seizures with insular genesis are often difficult to distinguish from those originating in the temporal lobe due to their complex and variable semiology. Here, we analyzed differentiating characteristics in the clinical spectrum of insulo-opercular seizures. METHODS: Ictal semiology in patients with a diagnosis of insulo-opercular epilepsy (IOE) based on imaging of epileptogenic lesions or electrophysiological evidence of an insulo-opercular seizure origin was retrospectively analyzed and compared to age-matched controls with mesial temporal lobe epilepsy (MTE). RESULTS: Forty-six IOE and 46 matched MTE patients were included. The most prominent ictal features in IOE were focal motor phenomena in 80.4% of these patients. Somatosensory sensations, version, tonic and clonic features, when present, were more frequent contralateral to the SOZ in MTE patients, while they occurred about equally often ipsilateral and contralateral to the SOZ in IOE patients. Ipsilateral manual automatisms were significantly more frequent in MTE patients than in IOE (p = 0.010). Multivariate analysis correctly identified IOE in 78.3% and MTE in 84.8% using five semiologic features (Chi-square = 53.79 with 5 degrees of freedom, p < 0.0001). A subanalysis comparing patients with purely insular lesions with MTE patients using only the earliest ictal signs showed that somatosensory sensations are significantly more frequent in insular epilepsy (p = 0.010), while automatisms were significantly more frequent in MTE patients (p = 0.06). SIGNIFICANCE: Our study represents the first in-depth analysis of ictal semiology in IOE compared to MTE. Use of these differentiating characteristics can serve for a correct syndrome classification and to steer appropriate diagnostic and local therapeutic procedures. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00415-021-10911-0. |
format | Online Article Text |
id | pubmed-9120119 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-91201192022-05-21 Ictal semiology of epileptic seizures with insulo-opercular genesis Martinez-Lizana, Eva Brandt, Armin Foit, Niels A. Urbach, Horst Schulze-Bonhage, Andreas J Neurol Original Communication OBJECTIVE: Epileptic seizures with insular genesis are often difficult to distinguish from those originating in the temporal lobe due to their complex and variable semiology. Here, we analyzed differentiating characteristics in the clinical spectrum of insulo-opercular seizures. METHODS: Ictal semiology in patients with a diagnosis of insulo-opercular epilepsy (IOE) based on imaging of epileptogenic lesions or electrophysiological evidence of an insulo-opercular seizure origin was retrospectively analyzed and compared to age-matched controls with mesial temporal lobe epilepsy (MTE). RESULTS: Forty-six IOE and 46 matched MTE patients were included. The most prominent ictal features in IOE were focal motor phenomena in 80.4% of these patients. Somatosensory sensations, version, tonic and clonic features, when present, were more frequent contralateral to the SOZ in MTE patients, while they occurred about equally often ipsilateral and contralateral to the SOZ in IOE patients. Ipsilateral manual automatisms were significantly more frequent in MTE patients than in IOE (p = 0.010). Multivariate analysis correctly identified IOE in 78.3% and MTE in 84.8% using five semiologic features (Chi-square = 53.79 with 5 degrees of freedom, p < 0.0001). A subanalysis comparing patients with purely insular lesions with MTE patients using only the earliest ictal signs showed that somatosensory sensations are significantly more frequent in insular epilepsy (p = 0.010), while automatisms were significantly more frequent in MTE patients (p = 0.06). SIGNIFICANCE: Our study represents the first in-depth analysis of ictal semiology in IOE compared to MTE. Use of these differentiating characteristics can serve for a correct syndrome classification and to steer appropriate diagnostic and local therapeutic procedures. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00415-021-10911-0. Springer Berlin Heidelberg 2021-11-23 2022 /pmc/articles/PMC9120119/ /pubmed/34812940 http://dx.doi.org/10.1007/s00415-021-10911-0 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Original Communication Martinez-Lizana, Eva Brandt, Armin Foit, Niels A. Urbach, Horst Schulze-Bonhage, Andreas Ictal semiology of epileptic seizures with insulo-opercular genesis |
title | Ictal semiology of epileptic seizures with insulo-opercular genesis |
title_full | Ictal semiology of epileptic seizures with insulo-opercular genesis |
title_fullStr | Ictal semiology of epileptic seizures with insulo-opercular genesis |
title_full_unstemmed | Ictal semiology of epileptic seizures with insulo-opercular genesis |
title_short | Ictal semiology of epileptic seizures with insulo-opercular genesis |
title_sort | ictal semiology of epileptic seizures with insulo-opercular genesis |
topic | Original Communication |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9120119/ https://www.ncbi.nlm.nih.gov/pubmed/34812940 http://dx.doi.org/10.1007/s00415-021-10911-0 |
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