Search

Abstract Epilepsy surgery in genetic drug‐resistant epilepsy is a debated subject as more histological and molecular data are available. We retrospectively collected data from focal drug‐resistant epilepsy patients that underwent stereoelectroencephalography (SEEG) invasive recordings. Patients with nonlesional brain imaging or in whom a first epilepsy surgery failed to control seizures were selected. We computed and displayed the intracranial ictal onset activity pattern on structural imaging. Patients underwent epilepsy gene panel testing, next generation sequencing—NGS. Of 113 patients, 13 underwent genetic testing, and in 6 patients, a mechanistic target of rapamycin pathway gene germline mutation (mTOR) was identified. Brain imaging was nonlesional except for one patient in whom two abnormalities suggestive of focal cortical dysplasia (FCD) were found. Patients underwent tailored brain surgery based on SEEG data, tissue analysis revealed FCD and postsurgical outcome was favorable. Our findings are similar to previous case series suggesting that epilepsy surgery can be a treatment option in patients with mTOR pathway mutation. In patients with mTOR pathway mutation, the postsurgical outcome is favorable if complete resection of the epileptogenic zone is performed. Electrophysiological seizure onset patterns in FCDs associated with mTOR pathway mutations display low‐voltage fast activity as previously described.

Objectives. Transient ischemic attacks (TIAs) can present with a large variety of clinical features that impose an extensive differential diagnosis. We report this case due to its particularities of clinical presentation and diagnosis algorithm. Material and methods. A 72-year old male patient presented to our Neurology Department for recurrent episodes of numbness felt in the right upper limb. The initial patient history deemed the episodes as consistent with simple focal seizures. The cerebral computed tomography scan showed no recent lesions. Furthermore, video-electroencephalography was performed, but revealed no abnormalities. A second, more thorough anamnesis revealed that paresthesia was also present in the left part of the upper and lower lips and that the numbness episodes were being accompanied by blurred vision, loss of balance and difficulties coordinating his right upper limb. Results. The time-of-flight magnetic resonance angiography revealed dolichoectasia of the left vertebral and basilar arteries. Furthermore, the basilar artery grooved and displaced the pons with respect to the midline. The angio-computed tomography scan of the supra-aortic trunks showed multiple stenoses located in the V4 segment of both vertebral arteries, in the intracavernous segment of the right internal carotid artery and in the proximal segment (90%) and the middle third part (80%) of the basilar artery. The patient was diagnosed with vertebrobasilar TIAs and started treatment with Clopidogrel with no recurrence of the TIAs. Conclusions. This case was chosen to be presented in order to highlight another facet of the clinical polymorphism exhibited by transient ischemic attacks.

Objectives. The carotid-cavernous fistula (CCF) represents an abnormal communication developed between the internal and/or the external carotid artery (ICA, ECA) or their branches and the cavernous sinus (CS). We report this case in order to highlight the course and an alternative to treatment of a CCF. Material and methods. A 47-year-old male patient with medical history of subarachnoid hemorrhage and cranio-facial comminuted fractures due to a motorcycle accident-induced cranio-facial traumatism (4 months prior to admission) was referred to our clinic for further investigation regarding a potential CCF. Results. The cerebral digital subtraction angiography showed a direct CCF type A. The Neurology and Interventional Radiology team opted for endovascular stent-grafting of the right ICA. Conclusions. This case is presented in order to highlight that angioplasty with stent-graft is a safe and effective procedure in selected cases of CCF.

Abstract The postictal state, an abnormal cerebral condition following a seizure until the return to the interictal baseline, is frequently overlooked, despite often exceeding ictal duration and significantly impacting patients' lives. This study analyzes stereo‐EEG (SEEG) signal dynamics using permutation entropy to quantify recovery time (postictal alteration time – PAT) in focal epilepsy and its clinical correlations. The average PAT was 4.5 min, extending up to an hour and was highest in temporal epilepsy and hippocampal sclerosis. Correlating with age at seizure onset and at SEEG, PAT provides a solution for operationally defining the postictal state and guiding interventions.

Musicogenic epilepsy is a rare form of reflex epilepsy in which seizures are provoked by music. Different musicogenic stimuli have been identified: pleasant/unpleasant music or specific musical patterns. Several etiologies have been uncovered, such as focal cortical dysplasia, autoimmune encephalitis, tumors, or unspecific gliosis. In this article, we report two patients with musicogenic seizures. The first patient was diagnosed with structural temporal lobe epilepsy. Her seizures were elicited by music that she liked. Interictal and ictal video-electroencephalography (video-EEG) and signal analysis using independent component analysis revealed the right temporal lobe seizure onset extending over the neocortical regions. The patient underwent right temporal lobectomy (including the amygdala, the head, and the body of the hippocampus) and faced an Engel IA outcome 3 years post-surgery. The second patient was diagnosed with autoimmune temporal lobe epilepsy (GAD-65 antibodies). Her seizures were triggered by contemporary hit radio songs without any personal emotional significance. Interictal and ictal video-electroencephalography (video-EEG) and independent component analysis highlighted the left temporal lobe seizure onset extending over the neocortical regions. Intravenous immunoglobulin therapy was initiated, and the patient became seizure-free at 1 year. In conclusion, musicogenic seizures may be elicited by various auditory stimuli, the presence or absence of an emotional component offering an additional clue for the underlying network pathophysiology. Furthermore, in such cases, the use of independent component analysis of the scalp EEG signals proves useful in revealing the location of the seizure generator, and our findings point toward the temporal lobe, both mesial and neocortical regions.