Seizure-associated aphasia has good lateralizing but poor localizing significance.

OBJECTIVE: To investigate the occurrence of ictal and postictal aphasia in different focal epilepsy syndromes. METHODS: We retrospectively analyzed the video-electroencephalographic monitoring data of 1,118 patients with focal epilepsy for seizure-associated aphasia (SAA). Statistical analysis included chi-square analysis and Fisher's exact test. RESULTS: We identified 102 of 1,118 patients (9.1%) in whom ictal or postictal aphasia (SAA) was part of their recorded seizures (n = 59 of 102; 57.8%) or who reported aphasia by history (n = 43; 42.2% only reported aphasia by history). Postictal aphasia was present in 18 patients (30.5%). Six of the 59 patients had both ictal and postictal aphasia (10.2%). SAA occurred either with left hemisphere seizure onset or with seizures spreading from the right to the left hemisphere. SAA was most common in patients with parieto-occipital epilepsy (10.9%; five of 46 patients), followed by patients with temporal (6.7%; 28 of 420 patients), focal (not further localized; 4.8%; 22 of 462 patients), and frontal epilepsy (2.1%; four of 190 patients; p = 0.04). SAA was more common in parieto-occipital epilepsy than in frontal epilepsy (p = 0.02). In contrast, there was no significant difference in SAA between temporal and parieto-occipital epilepsy (p = 0.36). SIGNIFICANCE: SAA has a high lateralizing but limited localizing value, as it often reflects spread of epileptic activity into speech-harboring brain regions.

PET imaging in extratemporal epilepsy requires consideration of electroclinical findings.

OBJECTIVE: The study aimed to assess the relevance of interictal temporal glucose hypometabolism in patients with extratemporal epilepsy (ETE) by analyzing its association with a seizure semiology suggestive for temporal seizure involvement and the presence of temporal interictal epileptiform discharges (IEDs). METHODS: We retrospectively reviewed the database of our epilepsy monitoring unit for patients with ETE, in whom long-term EEG-video-monitoring and [(18)F] fluorodeoxyglucose positron emission tomography (FDG-PET) had been performed. The localization of IEDs and the glucose hypometabolism were compared. RESULTS: Almost half (46%) of the 63 ETE patients had IEDs localized in the temporal lobe. Most patients (87.5%; 7/8) with temporal IEDs and an ipsitemporal hypometabolism showed seizure semiology suggestive of temporal or limbic system involvement in contrast to only 31.0% (9/29, p=0.01) in patients without temporal IEDs nor temporal hypometabolism. Those patients also showed an ictal seizure pattern spread into the ipsitemporal lobe, compared with 75.9% (22/29, n.s.) in patients without temporal IEDs nor temporal hypometabolism. Both, extratemporal (ipsilateral in 82.1%; 23/28 patients) and temporal (ipsilateral in 78.6%; 11/14 patients) hypometabolism significantly (p<0.05) lateralized to the epileptogenic hemisphere. CONCLUSION: The common temporal glucose hypometabolism in ETE patients reflects a remote epileptic dysfunction arising from extratemporal epileptogenic zones. Thus, interpretation of interictal FDG-PET results requires consideration of EEG results and seizure semiology to avoid false localization particularly in non-lesional epilepsy.

NeuroKinect: A Novel Low-Cost 3Dvideo-EEG System for Epileptic Seizure Motion Quantification.

Epilepsy is a common neurological disorder which affects 0.5-1% of the world population. Its diagnosis relies both on Electroencephalogram (EEG) findings and characteristic seizure-induced body movements--called seizure semiology. Thus, synchronous EEG and (2D)video recording systems (known as Video-EEG) are the most accurate tools for epilepsy diagnosis. Despite the establishment of several quantitative methods for EEG analysis, seizure semiology is still analyzed by visual inspection, based on epileptologists' subjective interpretation of the movements of interest (MOIs) that occur during recorded seizures. In this contribution, we present NeuroKinect, a low-cost, easy to setup and operate solution for a novel 3Dvideo-EEG system. It is based on a RGB-D sensor (Microsoft Kinect camera) and performs 24/7 monitoring of an Epilepsy Monitoring Unit (EMU) bed. It does not require the attachment of any reflectors or sensors to the patient's body and has a very low maintenance load. To evaluate its performance and usability, we mounted a state-of-the-art 6-camera motion-capture system and our low-cost solution over the same EMU bed. A comparative study of seizure-simulated MOIs showed an average correlation of the resulting 3D motion trajectories of 84.2%. Then, we used our system on the routine of an EMU and collected 9 different seizures where we could perform 3D kinematic analysis of 42 MOIs arising from the temporal (TLE) (n = 19) and extratemporal (ETE) brain regions (n = 23). The obtained results showed that movement displacement and movement extent discriminated both seizure MOI groups with statistically significant levels (mean = 0.15 m vs. 0.44 m, p<0.001; mean = 0.068 m(3) vs. 0.14 m(3), p<0.05, respectively). Furthermore, TLE MOIs were significantly shorter than ETE (mean = 23 seconds vs 35 seconds, p<0.01) and presented higher jerking levels (mean = 345 ms(-3) vs 172 ms(-3), p<0.05). Our newly implemented 3D approach is faster by 87.5% in extracting body motion trajectories when compared to a 2D frame by frame tracking procedure. We conclude that this new approach provides a more comfortable (both for patients and clinical professionals), simpler, faster and lower-cost procedure than previous approaches, therefore providing a reliable tool to quantitatively analyze MOI patterns of epileptic seizures in the routine of EMUs around the world. We hope this study encourages other EMUs to adopt similar approaches so that more quantitative information is used to improve epilepsy diagnosis.

A novel portable, low-cost kinect-based system for motion analysis in neurological diseases.

Many neurological diseases, such as Parkinson's disease and epilepsy, can significantly impair the motor function of the patients, often leading to a dramatic loss of their quality of life. Human motion analysis is regarded as fundamental towards an early diagnosis and enhanced follow-up in this type of diseases. In this contribution, we present NeuroKinect, a novel system designed for motion analysis in neurological diseases. This system includes an RGB-D camera (Microsoft Kinect) and two integrated software applications, KiT (KinecTracker) and KiMA (Kinect Motion Analyzer). The applications enable the preview, acquisition, review and management of data provided by the sensor, which are then used for motion analysis of relevant events. NeuroKinect is a portable, low-cost and markerless solution that is suitable for use in the clinical environment. Furthermore, it is able to provide quantitative support to the clinical assessment of different neurological diseases with movement impairments, as demonstrated by its usage in two different clinical routine scenarios: gait analysis in Parkinson's disease and seizure semiology analysis in epilepsy.

Seizure semiology identifies patients with bilateral temporal lobe epilepsy.

OBJECTIVE: Laterality in temporal lobe epilepsy is usually defined by EEG and imaging results. We investigated whether the analysis of seizure semiology including lateralizing seizure phenomena identifies bilateral independent temporal lobe seizure onset. METHODS: We investigated the seizure semiology in 17 patients in whom invasive EEG-video-monitoring documented bilateral temporal seizure onset. The results were compared to 20 left and 20 right consecutive temporal lobe epilepsy (TLE) patients who were seizure free after anterior temporal lobe resection. The seizure semiology was analyzed using the semiological seizure classification with particular emphasis on the sequence of seizure phenomena over time and lateralizing seizure phenomena. Statistical analysis included chi-square test or Fisher's exact test. RESULTS: Bitemporal lobe epilepsy patients had more frequently different seizure semiology (100% vs. 40%; p<0.001) and significantly more often lateralizing seizure phenomena pointing to bilateral seizure onset compared to patients with unilateral TLE (67% vs. 11%; p<0.001). The sensitivity of identical vs. different seizure semiology for the identification of bilateral TLE was high (100%) with a specificity of 60%. Lateralizing seizure phenomena had a low sensitivity (59%) but a high specificity (89%). The combination of lateralizing seizure phenomena and different seizure semiology showed a high specificity (94%) but a low sensitivity (59%). SIGNIFICANCE: The analysis of seizure semiology including lateralizing seizure phenomena adds important clinical information to identify patients with bilateral TLE.

Eye movements differ between ictal ipsilateral and contralateral head turning.

PURPOSE: This study evaluated the relation of head and eye movements during ictal ipsilateral and contralateral head turning in patients with focal epilepsies with regard to lateralization of the epileptogenic zone. METHODS: We reviewed our database and identified patients with ictal head turning ipsilateral and contralateral to the seizure onset as defined by ictal EEG. Twenty-seven seizures of 19 consecutive patients with ipsilateral and 40 seizures of 32 patients with contralateral head turning were investigated. Twenty-four patients had temporal lobe epilepsy (TLE), and 27 patients had extratemporal or multifocal epilepsy. KEY FINDINGS: Eye movement in the same direction preceded contralateral head turning in 90% (36 of 40 seizures) of the seizures, but this was the case in only 33% (9 of 27 seizures) of the ipsilateral ictal head turning. In contrary, head turning preceded the eye movements in 67% (18 of 27 seizures) of the ipsilateral ictal head turning and in only 10% of the contralateral head turning (p < 0.001). The results were similar in TLE and FLE. SIGNIFICANCE: The sequence of head and eye movements is different in ictal ipsilateral and contralateral head turning movements which likely reflects different spread patterns of epileptic activity associated with activation of different generators. The analysis of eye movements adds to the lateralization of ictal head movements.

Syncope: there is more than haemodynamic failure.

Convulsive syncopes may be particularly difficult to differentiate from epileptic seizures. Recurrent syncopes are caused by autonomic or non-autonomic failure. In this report, we present a 22-year-old woman who was misdiagnosed as epileptic and whose first symptoms during neurocardiogenic syncope occurred prior to asystole. The patient sensed her aura and reached for the alarm button 2 s before a cardiac asystole was documented in the ECG. We conclude that so far unspecified autonomic mechanisms play a significant role in our patient leading to the symptoms of dizziness and nausea heralding her attacks prior to the occurrence of asystole.