Electroclinical features of insulo‐opercular epilepsy: an SEEG and PET study
Abstract Objective To report clinical experience with presurgical evaluation in patients with insulo‐opercular epilepsy. Quantitative analysis on PET imaging and stereoelectroencephalography (SEEG) signals was used to summarize their electroclinical features. Methods Twenty‐two patients with focal e...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2019-07-01
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| Series: | Annals of Clinical and Translational Neurology |
| Online Access: | https://doi.org/10.1002/acn3.789 |
| _version_ | 1818938938634534912 |
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| author | Xiu Wang Wenhan Hu Aileen McGonigal Chao Zhang Lin Sang Baotian Zhao Tao Sun Feng Wang Jian‐guo Zhang Xiaoqiu Shao Kai Zhang |
| author_facet | Xiu Wang Wenhan Hu Aileen McGonigal Chao Zhang Lin Sang Baotian Zhao Tao Sun Feng Wang Jian‐guo Zhang Xiaoqiu Shao Kai Zhang |
| author_sort | Xiu Wang |
| collection | DOAJ |
| description | Abstract Objective To report clinical experience with presurgical evaluation in patients with insulo‐opercular epilepsy. Quantitative analysis on PET imaging and stereoelectroencephalography (SEEG) signals was used to summarize their electroclinical features. Methods Twenty‐two patients with focal epilepsy arising from the insular and/or opercular cortex according to SEEG were retrospectively analyzed. Presurgical noninvasive data were analyzed in detail. Interictal PET data of patients were then statistically compared with those of healthy controls to identify the interictal hypometabolic network. The epileptogenicity index (EI) of ictal SEEG signal was computed to identify areas of spread at the beginning of seizure onset. Results Focal tonic seizures of the face and/or neck (16/22, 73%) were the most prevalent early objective signs. Epileptic discharges in the interictal and ictal scalp‐EEG mostly showed an ipsilateral perisylvian distribution. Statistical analysis of interictal PET showed significant hypometabolism in the insular lobe, central operculum, supplementary motor area, middle cingulate cortex, bilateral caudate nuclei, and putamen. According to the EI analysis, insulo‐opercular epilepsy could be classified as insulo‐opercular epilepsy (50%), opercular epilepsy (41%), and insular cortex epilepsy (9%). Significance Clinical diagnosis of insulo‐opercular epilepsy is challenging because of its complex seizure semiology and nonlocalizing discharges on scalp‐EEG. A common hypometabolic network involving the insulo‐opercular cortex, mesial frontal cortex and subcortical nuclei may be involved in the organization of the insulo‐opercular epilepsy network. Furthermore, quantified SEEG analysis suggested that pure insular epilepsy is rare, and the close connection between insular and opercular cortex necessitates SEEG implantation to define the epileptogenic zone. |
| first_indexed | 2024-12-20T06:15:48Z |
| format | Article |
| id | doaj.art-14eadf18f85446ad91ce3bca44915d29 |
| institution | Directory Open Access Journal |
| issn | 2328-9503 |
| language | English |
| last_indexed | 2024-12-20T06:15:48Z |
| publishDate | 2019-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Annals of Clinical and Translational Neurology |
| spelling | doaj.art-14eadf18f85446ad91ce3bca44915d292022-12-21T19:50:33ZengWileyAnnals of Clinical and Translational Neurology2328-95032019-07-01671165117710.1002/acn3.789Electroclinical features of insulo‐opercular epilepsy: an SEEG and PET studyXiu Wang0Wenhan Hu1Aileen McGonigal2Chao Zhang3Lin Sang4Baotian Zhao5Tao Sun6Feng Wang7Jian‐guo Zhang8Xiaoqiu Shao9Kai Zhang10Department of Neurosurgery Beijing Tian Tan Hospital Capital Medical University Beijing ChinaBeijing Key Laboratory of Neurostimulation Beijing ChinaINSERM UMR 1106 Institut de Neurosciences des Systèmes Marseille FranceDepartment of Neurosurgery Beijing Tian Tan Hospital Capital Medical University Beijing ChinaEpilepsy Center Medical Alliance of Beijing Tian Tan Hospital Peking University First Hospital Fengtai Hospital Beijing ChinaDepartment of Neurosurgery Beijing Tian Tan Hospital Capital Medical University Beijing ChinaDepartment of Neurosurgery General Hospital of Ningxia Medical University Yinchuan ChinaDepartment of Neurosurgery General Hospital of Ningxia Medical University Yinchuan ChinaDepartment of Neurosurgery Beijing Tian Tan Hospital Capital Medical University Beijing ChinaDepartment of Neurology Beijing Tian Tan Hospital Capital Medical University Beijing ChinaDepartment of Neurosurgery Beijing Tian Tan Hospital Capital Medical University Beijing ChinaAbstract Objective To report clinical experience with presurgical evaluation in patients with insulo‐opercular epilepsy. Quantitative analysis on PET imaging and stereoelectroencephalography (SEEG) signals was used to summarize their electroclinical features. Methods Twenty‐two patients with focal epilepsy arising from the insular and/or opercular cortex according to SEEG were retrospectively analyzed. Presurgical noninvasive data were analyzed in detail. Interictal PET data of patients were then statistically compared with those of healthy controls to identify the interictal hypometabolic network. The epileptogenicity index (EI) of ictal SEEG signal was computed to identify areas of spread at the beginning of seizure onset. Results Focal tonic seizures of the face and/or neck (16/22, 73%) were the most prevalent early objective signs. Epileptic discharges in the interictal and ictal scalp‐EEG mostly showed an ipsilateral perisylvian distribution. Statistical analysis of interictal PET showed significant hypometabolism in the insular lobe, central operculum, supplementary motor area, middle cingulate cortex, bilateral caudate nuclei, and putamen. According to the EI analysis, insulo‐opercular epilepsy could be classified as insulo‐opercular epilepsy (50%), opercular epilepsy (41%), and insular cortex epilepsy (9%). Significance Clinical diagnosis of insulo‐opercular epilepsy is challenging because of its complex seizure semiology and nonlocalizing discharges on scalp‐EEG. A common hypometabolic network involving the insulo‐opercular cortex, mesial frontal cortex and subcortical nuclei may be involved in the organization of the insulo‐opercular epilepsy network. Furthermore, quantified SEEG analysis suggested that pure insular epilepsy is rare, and the close connection between insular and opercular cortex necessitates SEEG implantation to define the epileptogenic zone.https://doi.org/10.1002/acn3.789 |
| spellingShingle | Xiu Wang Wenhan Hu Aileen McGonigal Chao Zhang Lin Sang Baotian Zhao Tao Sun Feng Wang Jian‐guo Zhang Xiaoqiu Shao Kai Zhang Electroclinical features of insulo‐opercular epilepsy: an SEEG and PET study Annals of Clinical and Translational Neurology |
| title | Electroclinical features of insulo‐opercular epilepsy: an SEEG and PET study |
| title_full | Electroclinical features of insulo‐opercular epilepsy: an SEEG and PET study |
| title_fullStr | Electroclinical features of insulo‐opercular epilepsy: an SEEG and PET study |
| title_full_unstemmed | Electroclinical features of insulo‐opercular epilepsy: an SEEG and PET study |
| title_short | Electroclinical features of insulo‐opercular epilepsy: an SEEG and PET study |
| title_sort | electroclinical features of insulo opercular epilepsy an seeg and pet study |
| url | https://doi.org/10.1002/acn3.789 |
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