Seizure semiology, localization, and the 2017 ILAE seizure classification.

In the study of epilepsy, the term semiology is used to comprise the clinical characteristics of a seizure, both subjective symptoms and objective phenomena. It is produced by activation of the symptomagenic zone, and an accurate and comprehensive understanding of the localizing value of seizure semiology is crucial for presurgical evaluation and planning. Myriad publications in epilepsy journals detail correlations between various semiological features and activation of specific cortical regions. Traditionally these studies involved scalp EEG recorded in epilepsy monitoring units. The increasing use of invasive monitoring, and specifically the use of depth electrodes and stereo-electroencephalography, has advanced our understanding of the characteristics of seizures arising from ictal foci deep to the scalp, including the cingulate, insula and operculum. However, the distinction between seizure onset and symptomogenic zones is not always clear. In 2017 the International League Against Epilepsy (ILAE) published an operational classification of seizure types based heavily on seizure semiology. The current paper provides an updated review of the current body of knowledge relating to seizure semiology, incorporating both scalp EEG studies and more recent stereo-electroencephalography discoveries in the framework of the 2017 ILAE classification.

Muscle-Nerve-Muscle Grafting for Facial Reanimation in Rats.

OBJECTIVE: Facial paralysis is a devastating condition leaving patients with a myriad of aesthetic and functional consequences. Muscle-nerve-muscle (MNM) neurotization is a reinnervation technique that involves implanting an autogenous nerve graft as a conduit between an innervated "donor" muscle and a denervated "recipient" muscle. We investigated the use of MNM reinnervation, alone or in combination with electrical stimulation (ES) and testosterone propionate (TP) in comparison to nerve reanastomosis (RE), on functional recovery following rat facial nerve injury. METHODS: Thirty-one male, Sprague-Dawley rats were assigned to groups: no graft (control), MNM grafting alone (MNM), MNM grafting with ES and TP (MNM+ES+TP), or RE. Harvested right facial nerve branches were used as the MNM graft. Functional recovery was assessed by behavioral observations and electromyographic recordings. RESULTS: The MNM grafting improved muscle tone and vibrissae movement. The ES+TP treatment further enhanced muscle tone as well as reduced recovery time for coordinated movement in a manner that is comparable to those of RE. Electromyographic recordings demonstrated electrical conductance across all MNM grafts. CONCLUSION: These data have important implications for patients with unilateral paralysis from facial or laryngeal nerve injury, particularly those who are not candidates for nerve reanastomosis.