Search

In 1880, Jules Cotard described a set of delusions in the form of negations that later became his eponymous syndrome. Cotard's syndrome is an uncommon condition characterised by the presence of nihilistic delusions in which the person thinks that "they are dead or that the world no longer exists". This document describes two cases in which a broad and enriching semiology is evidenced from a descriptive point of view, which allows us to review them together with Cotard's syndrome in the light of modern psychiatry. The first case corresponds to a depressive disorder and the other occurs in the context of a non-affective psychotic disorder. A review of the literature is presented from what Cotard described until the current psychiatric classifications.

Longstanding epilepsy can lead to modulation of cortical networks over time and unexpected seizure onset zones. Frontal lobe seizures, in particular, can have diverse semiologies and evolution patterns. We present a male patient with drug-resistant epilepsy secondary to severe traumatic brain injury who underwent bilateral stereo electroencephalography (SEEG) for surgical planning. SEEG localized an ictal circular head roll to the right anterior prefrontal region. This was followed by spread to the left orbitofrontal region and later the left amygdala and hippocampus, at which point a different semiology with behavioral arrest, lip smacking and oral automatisms began. This case, in which an ictal circular head roll was localized to the anterior prefrontal region, demonstrates the complexity of broad seizure networks that develop over time, leading to remote seizure spread.

Background Arachnoid web (AW) is a rare but probably underestimated cause of spinal cord injury that is complex to diagnose due to subtle MRI findings and similarities to other better-known diseases such as arachnoid cyst (AC) or transdural spinal cord herniation (TSCH). Increased recognition of AW is mandatory since delay in diagnosis can lead to potentially serious neurological sequelae. Case presentations We report two additional cases of AW for didactic purposes, with special emphasis on the distinctive MRI and intraoperative findings. Both patients presented with progressively worsening neurological symptoms, including proprioceptive ataxia, motor weakness, numbness and neuropathic pain. The diagnosis of AW was suspected on the basis of specific MRI criteria, especially the so-called “scalpel sign”. Formal confirmation of the diagnosis was obtained in two patients that were managed surgically. Postoperative follow-up demonstrated significant functional recovery. Discussion There is a need for better recognition of AW by the medical community. Careful analysis of MRI semiology is crucial for the distinction between AW, AC and TSCH. Prompt and accurate diagnosis is mandatory to conserve functional prognosis, since appropriate surgical treatment with AW resection is curative, halting or even resolving the neurological symptoms.

In addition to the legs, restless legs syndrome (RLS) affects various other parts of the body, including the arms, abdomen, face, head-neck, oral cavity, genital area and bladder. RLS is also associated with several comorbid conditions, including irritable bowel syndrome (IBS). We are reporting two cases of RLS who also had IBS, fulfilling the Rome IV criteria. The administration of levodopa and dopamine agonists provided a complete improvement in both IBS and RLS. Review of the literature suggest that the clinical semiology and clinical pattern of IBS (urge to defaecate, abdominal pain, abdominal distension, bloating, disturbed sleep and circadian rhythm) simulate the semiology and pattern of RLS. Similarities are also noted in the associated comorbid conditions, effective drugs and proposed hypotheses for both clinical syndromes. We hypothesise that RLS may affect intestine, and IBS-like symptoms in a subset of patients with RLS may be the part of RLS symptoms complex.

About 25% of patients with intracranial meningioma display seizures at the time of initial presentation. Hence, identification of risk factors for preoperative seizures is crucial during perioperative care of meningioma patients.Associations of preoperative seizures with clinical, radiological and histological variables were analyzed in 945 patients (689 females, 73% and 256 males, 27%; median age: 58 years) who underwent surgery for primary diagnosed intracranial meningioma.Preoperative seizures were found in 189 patients (20%). In univariate analyses, male gender (OR: 1.91, 95%CI 1.37-2.68; p.001), grade II/III histology (OR: 2.24, 95%CI 1.46-3.46; p.001), brain invasion (OR: 2.59, 95%CI 1.45-4.63; p=001), non-skull base tumor location (OR: 3.07, 95%CI 2.13-4.41; p.001), heterogeneous contrast-enhancement (OR: 1.60, 95%CI 1.04-2.46; p=.031), intratumoral calcifications (OR: 1.91, 95%CI 1.17-3.10; p=.009), an irregular shape (OR: 2.07, 95%CI 1.32-3.26; p=.002) as well as tumor (OR: 1.01 per ccm, 95%CI 1.00-1.02; p=.001) and edema volumes (OR: 1.01 per ccm, 95%CI 1.00-1.01; p.001) were correlated with seizures. Semiology was not related to any of the analyzed variables (p.05, each). No associations were found between seizures and histological subtype of 832 grade I meningiomas (p=.391). In multivariate analyses, only non-skull base tumor location (OR: 3.12, 95%CI 1.74-5.59; p.001) and a rising peritumoral edema volume (OR: 1.01 per ccm, 95%CI 1.00-1.01; p.001) were identified as independent predictors for preoperative seizures.Several mostly radiological variables were identified as risk factors for epilepsy. However, multivariate analyses confirmed only peritumoral edema and non-skull base tumor location as independent predictors for preoperative seizures. None of the variables predicts semiology.

A 47-year-old woman with history of seizure disorder (semiology of seizure unknown), not well controlled with antiepileptic drugs since last 30 years presented with 1-year history of intermittent throbbing headache. On the day prior to admission, she experienced worst headache, followed by loss of consciousness. On regaining consciousness, she had neck pain without any focal neurological deficit, but examination was marked by positive meningeal signs. She had history of oral ulceration, photosensitivity and small joints pain for which no medical consultancy was sought until. Following relevant investigations, this case came out to be moyamoya angiopathy secondary to underlying systemic lupus erythematosus. She was put on immunosuppressive and immunomodulator as per recommendations. Among neurological symptoms, headache improved dramatically without any further seizure recurrence till the 6 months of follow-up.

Forestier Syndrome is a rheumatological disease of unknown origin, which consist in calcification of different areas of the body, predominantly at the level of the anterior common vertebral ligament, where osteophytes capable of producing varied symptoms of variable intensity are formed. Normally asymptomatic, although, when it affects the cervical spine, the most common symptom is dysphagia. A case of Forestier syndrome is presented who consulted for dysphagia in the Head and Neck Surgery Unit of the Otolaryngology Service of the Institute of Social Prevision, Asuncion, Paraguay. The semiology allowed to observe a submucosal bulge in the posterior wall of the oropharynx of 1,5 cm in diameter, which could be evaluated and confirmed by tomography. Due to the low intensity of the symptoms and little impact on the general state, it was decided to carry out a conservative treatment with good results, after two years of clinical follow-up. In these cases, surgery occupies a secondary place, either before the failure of this conservative behavior or the progression of the symptoms.

International audience; Archaeological excavations carried out in the 1990s in the former rural parish of Rigny (Indre-et-Loire, France) uncovered 1738 graves. Among the individuals discovered, a female adult presents a series of cranial deformities characteristic of an extremely rare pathology, til then unknown in the archaeological record: the Treacher-Collins syndrome. It induces facial dysmorphism and is generally associated with hearing loss or even conductive deafness of the patient due to malformations of the hearing system.The retrospectif diagnosis of this individual was based on macroscopic analysis and computed tomography (CTscan). The use of 3D imaging made it possible to explore the impact of the pathology on the individual's hearing.In addition to the functional implications, the negative impacts of facial dysmorphic disorders in the social sphere are well known in today's societies while they are poorly documented for the medieval period.During this period, diet was an important social marker. The analysis of the individual affected by this syndrome’s diet, compared to those of other members of the Rigny village community, provide an opportunity to discuss the social significance of disability in a rural context in the Middle Ages. In this perspective, the isotopic ratios of carbon and nitrogen in this individual's bone collagen were compared to those of forty-seven other individuals found on the site.Archaeological, paleopathological and biochemical information are relevant to better characterize the functional repercussions of this syndrome on the Rigny individual and also to discuss the integration of this individual into this medieval village community.

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 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.

Sleep-related hypermotor epilepsy (SHE) is a group of clinical syndromes with heterogeneous etiologies. SHE is difficult to diagnose and treat in the early stages due to its diverse clinical manifestations and difficulties in differentiating from non-epileptic events, which seriously affect patients’ quality of life and social behavior. The overall prognosis for SHE is unsatisfactory, but different etiologies affect patients’ prognoses. Surgical treatment is an effective method for carefully selected patients with refractory SHE; nevertheless, preoperative assessment remains challenging because of the low sensitivity of noninvasive scalp electroencephalogram and imaging to detect abnormalities. However, through a careful analysis of semiology, the clinician can deduce the potential epileptogenic zone. This paper summarizes the research status of the background, etiology, electro-clinical features, diagnostic criteria, prognosis, and treatment of SHE to provide a more in-depth understanding of its pathophysiological mechanism, improve the accuracy in the diagnosis of this group of syndromes, and further explore more targeted therapy plans.

Clinical seizure signs continue to be of central importance to guide diagnosis, classification, treatment and prognosis. Some basic principles guide history-taking and observation in clinical epileptology. The information contained within subjective seizure descriptions can be framed within standardized vocabulary and a classification of ictal signs, seizure types, and the integrated framework of epilepsy syndromes. As illustrative examples, we discuss the historical origins and current research context of Dravet syndrome and Janz syndrome, two genetic epilepsy syndromes. In candidates for epilepsy surgery, ictal signs aid us in identifying the symptomatogenic zone and hence delineating the ictal onset zone. Here, historical reports from Victor Horsley and Hughlings Jackson provide valuable perspective on clinical reasoning. Lastly, the information contained within clinical signs and syndromes presents an indispensable data source in future efforts of large-scale genotype-phenotype correlations and machine learning methods.

В течение долгого времени идеограммы и графемы неолитического периода интересовали преимущественно археологов, этнологов, культурологов и историков религии. Однако с развитием и упрочением дисциплинарных позиций археоастрономии они все больше становились предметом внимания историков астрономии. Несомненная ориентированность памятников эпохи бронзы по значимым солнечным и лунным направлениям, связанным с азимутами восхода и / или захода этих светил в экстремальные моменты солнечных и лунных циклов, убедительно свидетельствует о том, что представители бронзового века были неплохими астрономами. А это, в свою очередь, означает, что для полноценного понимания оставленной ими символики (если она действительно являлась таковой) нужно обладать компетенцией астронома, хорошо знакомого с основами хотя бы сферической астрономии. Эпоха бронзы в фазе ее наивысшего развития прекрасно ориентировалась по сторонам горизонта, имела представление о тропическом годе как о цикле повторений положений Солнца относительно горизонта, знала о солнцестояниях и равноденствиях, различала азимуты самой высокой и самой низкой Луны, возвела монументальную архитектуру для регулярных наблюдений за Солнцем и Луной и даже изобрела первое, идеографическое, письмо, хотя и не повсеместно. Очень сложно представить, чтобы столь насыщенная система представлений и действий родилась разом, без эволюционного накопления деталей этого довольно сложного знания и цепочек ярких прозрений, подготовивших итоговое открытие, материализовавшееся в каменных и письменных памятниках бронзового века. Указанное обстоятельство вынуждает нас с максимальной пристальностью всматриваться в символику эпох, предшествовавших бронзовому веку, а именно – в символику неолита и энеолита. Не сохранила ли она в себе каких-то следов формализации первичных астрономических наблюдений, результаты которых были усвоены, усовершенствованы и широко использованы представителями бронзового века? В данном исследовании предпринимается попытка, использовав систему значений неолитических знаков Ариэля Голана и гипотезу стадиального называния знаков зодиака Александра Гурштейна, выявить в комплексе неолитических символов, графем и идеограмм знаки, предположительно употреблявшиеся для обозначения астрономических значений. В ходе семиологического анализа неолитических идеограмм выявлены категории символов и знаков, сложно поддающихся интерпретации с точки зрения данных археологии и этнографии, но имеющих очевидные признаки корреляций с ритмами смены сезонов тропического года. Это так называемые знаки «двух солнц», «Ф-образные знаки» и «четырехчастно-парные символы». Анализ их вероятной семантики позволяет предположить, что появлению концепта «протозодиака» могло предшествовать более простое бинарное членение года, маркируемое оппозицией зимнего и летнего солнцестояний. В связи с этим внесены уточнения в гипотезу Гурштейна, касающиеся семантики и символической значимости первого зодиакального квартета. For a long time, ideograms and graphemes of the Neolithic period were primarily the particular archaeological, ethnological, cultural, and theological interest. However, as archaeoastronomy consolidated its disciplinary positions, they were increasingly becoming a matter of attention for historians of astronomy. Indisputable alignments of archaeological remains toward the points of midsummer and midwinter risings and settings of the sun shows conclusively that people of the Bronze Age were expected to have a still greater knowledge of astronomy. The broad truth of the cyclical movements of the points of rising and setting and their correlation with the cycle of growth in nature was certainly known from very early times. That, in turn, means that the thorough understanding of the oldest symbolism to have come down to us – if it, in fact, was so – is only possible when a researcher is familiar at least with spherical astronomy. At their highest stage of development the Bronze Age people certainly knew the cardinal points of the horizon; they were aware of the tropical year as a cycle of repetition of the position of the sun against the horizon; they knew about solstices and equinoxes; some of them distinguished between azimuth positions of the highest and the lowest moon; they built monumental architecture for regular observations of the sun and the moon, and even invented writing, though not everywhere. It would be hard to imagine that such a complicated system of ideas and actions was created all at once, without an evolutionary accumulation of that rather complex knowledge and a concatenation of insights which came together to make the final discovery embodied in stone monuments of the Bronze Age. The given circumstance forces us to look closely into ideograms of the pre-Bronze Ages, namely the Neolithic and the Aeneolithic ones. Is it possible to find there some traces of formalization of primary astronomical observations which could be assimilated, developed, and widely adopted by representatives of the Bronze Age? This study attempts to identify among the corpus of Neolithic symbols, graphemes, and ideograms those of them that could be supposedly used as denotations for astronomical meanings. The article uses the system of Neolithic meanings developed by Ariel Golan as the reference body. The astronomical part of the study is based on the gradualist concept of the Western Zodiac by Alexander Gurshtein. In the course of a semiological analysis of Neolithic ideograms, categories of symbols and signs have been identified that are difficult to interpret from the point of view of archaeological and ethnographic data. However, they show clear signs of correlation with the rhythms of the seasons. Among these are, for instance: the so-called sign of ‘two suns,’ ‘f-shaped’ signs, and ‘four-part-binary symbols.’ Analysis of their probable semantics suggests that ‘protozodiac’ concept could have been preceded by a simpler binary division of the year indicated by opposition between the winter and summer solstices. In this regard, clarifications, concerning semantics and symbolic meanings of the first zodiacal quartet are included in the hypothesis by Gurshtein.

Fire death investigations attempt to determine whether a subject was alive or dead before the fire started. Therefore, it is essential to assess if the bone damage is traumatic or the result of exposure to heat. This observational study aims to expose the specific CT semiology of thermal bone lesions to allow the forensic radiologist to identify and distinguish them from traumatic lesions that would have preceded death. We retrospectively reviewed the CT findings of 25 bodies with thermal bone lesions for which a postmortem computed tomography (PMCT) was performed prior to an autopsy. Imaging findings were correlated to the autopsy data to identify the specific features of thermal bone lesions. Specific signs of thermal injuries to bone were identified on PMCT on all deceased cases. Thermal damages predominated in areas directly exposed to flames (rib cage, distal extremities) with less soft tissue coverage (“soft tissue shielding”). The mottled appearance of bone marrow was a constant sign of burned bones. Heat fractures such as trans-diploic fractures of flat bones and beveled (“flute-mouthpiece”) fractures of extremities seemed specifically related to thermal mechanism. In addition, we provided a better description of superficial cortical fissures of flat bones (“ancient Chinese porcelain”) and observed a “stair step” fracture of a long bone until now undescribed in radiological literature. Thermal bone lesions have specific CT findings, different on several points from traumatic injuries. Their knowledge is essential for radiologists and forensic physicians to provide an accurate report of injury and conclusions.

No texto propõe-se analisar aspectos da obra de Paul Ricoeur em sua inserção no chamado círculo hermenêutico, especialmente, pela questão dos símbolos, da finitude e culpabilidade, entre outros princípios filosóficos e éticos. Em suas obras evidenciam-se temas como a plurivocidade dos símbolos e suas possibilidades interpretativas em bases de conflito, sempre de perspectiva ontológica e crítica em face à psicanálise, linguística e semiologia, realçando a profundidade dialógica de seu pensamento.

Introduction: Despite the best possible pharmacotherapy, 30% of persons with epilepsy will remain drug resistant. Drug resistant Epilepsy (DRE) has many different presentations and causes; hence evaluation may help to understand and manage appropriately. Aim: To study a cohort of adult patients with refractory focal epilepsy, focusing on clinical semiology, risk factors, imaging and video EEG findings. Materials and Methods: This is a prospective observational study done in adult neurology department of tertiary care hospital, from 2013 to 2016. The primary inclusion criteria were patients with drug refractory focal seizure (as per ILAE definition 2010), with age more than 12 years. Detailed clinical data, long term EEG monitoring, MRI and minimum follow up of 6 months were collected. Results: Of 120 patients of DRE, 72% were in the age group of 12-30 yrs. Febrile seizure (26%) and head injury (17%) were the most significant antecedent history. Focal seizures with dyscognitive features were present in 87%. 16 patients had abnormal neurological examination. The most common radiological finding was mesial temporal sclerosis and gliosis. After complete evaluations, 30% of the patients were found to have pseudo-resistance. The evaluation led to modification of treatment in more than three-fourth of the patients. Summary: Early age of onset, history of febrile seizures, past history of head injury, focal dyscognitive type of seizures and structural lesion on imaging are common factors in patients with DRE. Pseudo- resistance due to wrong diagnosis and inadequate AEDs were responsible for one third of cases. Keywords: Drug­resistant epilepsy (DRE), Focal dyscognitive seizures, mesial temporal sclerosis (MTS), Long­term EEG monitoring (LTEM), Pseudo­resistance

The fashionable disavowal of structural semiology as logocentric is easily countered by a review of the important innovations of second-generation semiology, spearheaded by Jacques Derrida, Roland Barthes, and Jacques Lacan. The scope of Saussurean semiology is hampered only by its reliance upon alphabetic language and presence grounded in the voice; the assertion that semiology is a part of linguistics, rather than the reverse, does not reject the existence of nonlinguistic meaning; wordplay and textual experimentation are no mere stylistic ornamentation, but are on the contrary the key strategy of second-generation semiology for exposing the limitations of language. All three of these writers rely upon the glossematics of Louis Hjelmslev for the articulation of the concrete, non-logocentric object of general linguistics — his stratification of the Saussurean sign provides the centerpiece for the synthetic theoretical model introduced here.

Objectives The primary objective of this study was to investigate the prevalence of epileptic seizures and of presumed idiopathic epilepsy (PIE, describing epilepsy of unknown origin) in a cohort of British Shorthair (BSH) cats in Sweden. The secondary objective was to describe epileptic seizure characteristics and outcome for cats with PIE. Methods Owners of BSH cats born between 2006 and 2016 and registered with SVERAK (the Swedish Cat Clubs’ National Association) were invited to reply to a questionnaire about their cat’s general health. Owners who indicated that their cat had experienced epileptic seizures were invited to participate in an in-depth telephone interview about the epileptic seizures. The clinical characteristics of epileptic seizures in BSH cats were determined from the results of the interview. Results In this population comprising 1645 BSH cats (representing 28% of registered BSHs), the prevalence of epileptic seizures was 0.9% and for PIE it was 0.7%. BSH cats with PIE presented with infrequent but consistent epileptic seizures. Twenty-seven percent of BSH cats with epileptic seizures had cluster seizures but none presented with status epilepticus. None of the BSH cats was treated with antiepileptic drugs, and none of the owners reported epileptic seizure remission in their cat. Conclusions and relevance The prevalence of PIE in this population of BSH cats was 0.7%. The prevalence of epileptic seizures was 0.9%. In general, PIE in the BSH cat displayed a relatively benign phenotype where progression of epileptic seizures was uncommon.

The semiology of epileptic seizures reflects activation, or dysfunction, of areas of brain (often termed the symptomatogenic zone) as a seizure begins and evolves. Specific semiologies in focal epilepsies provide an insight into the location of the seizure onset zone, which is particularly important for presurgical epilepsy assessment. The correct diagnosis of paroxysmal events also depends on the clinician being familiar with the spectrum of semiologies. Here, we summarise the current literature on localisation in focal epilepsies using illustrative cases and discussing possible pitfalls in localisation.

Focal seizure semiology is often inadequately studied, specifically in preschool children. Among drug-resistant epilepsies amenable to surgery, temporal lobe seizure semiology has been widely described in this age group. Nevertheless, a systematic anatomo-electroclinical study has never been performed. We retrospectively reviewed the charts of patients younger than six years old at the time of video-EEG recording who were operated on for temporal lobe epilepsy in our centre between 2010 and 2016. In order to describe the electroclinical semiology and establish anatomo-clinical correlations, we reviewed all the recorded seizures on scalp and invasive video-EEG and analysed pre- and postsurgical clinical data, MRI scans, and surgical and pathological data. We classified patients into the following four anatomical groups: mesio-temporal, temporal lateral, polar, and mesio-lateral, and for each group we selected video-EEG samples for educational purposes. Twenty-eight patients fulfilled the selection criteria. Twenty-three patients (82%) were explored with invasive electrodes that consisted of foramen ovale electrodes in 11 (39%) and stereoelectroencephalography in 12 (43%). The majority of the 53% of patients with mesio-temporal epilepsies had specific ictal semiology, as described in adults. The others had subtle seizures or seizures limited to apnoea. The other groups also had some features comparable to adults, although no child reported the classic auras of lateral epilepsies. In total, 11% had infantile spasms (IS); post-ictal examination provided lateralization signs in 28%. With a mean post-surgical follow-up duration of 5.5 years, 89% of the patients were classified as Engel Class I. Preschool children were shown to have non-specific seizures, notably subtle events or IS. However, careful video-EEG analysis can provide arguments for localizing the epileptogenic zone within the temporal lobe in most cases. Seizures with apnoea are characteristic of mesial temporal onset in patients with long-term epilepsy-associated tumours.

International audience; The clinical expression of seizures represents the main symptomatic burden of epilepsy. Neural mechanisms of semiological production in epilepsy, especially for complex behaviors, remain poorly known. In a framework of epilepsy as a network rather than a focal disorder, we can think of semiology as being dynamically produced by a set of interconnected structures, in which specific rhythmic interactions, and not just anatomical localization, are likely to play an important part in clinical expression. This requires a paradigm shift in how we think about seizure organization, including from a presurgical evaluation perspective. Semiology is a key data source, albeit with significant methodological challenges for its use in research, including observer bias and choice of semiologic categories. Better understanding of semiologic categorization and pathophysiological correlates is relevant to seizure classification systems. Advances in knowledge of neural mechanisms as well as anatomic correlates of different semiological patterns could help improve knowledge of epilepsy networks and potentially contribute to therapeutic innovations.

Aims Anti‐leucine‐rich glioma‐inactivated 1 (LGI1) autoimmune encephalitis (AE) is characterized by complex manifestations of seizures. Here, we report a new seizure semiology, attempt to classify the disease by semiology type, and explore the metabolic pattern of each group. Methods Anti‐LGI1 AE patients were retrospectively screened between May 2014 and September 2019 in our tertiary epilepsy center. All enrolled patients had seizures during long‐range video electroencephalogram (EEG) recordings, and all patients (except one) underwent [18F] fluoro‐2‐deoxyglucose (FDG) positron emission tomography (PET) scans. Voxel‐based metabolic analysis and z‐distribution analysis were carried out to determine the metabolic pattern. Results Thirty‐three patients were enrolled. According to the patients’ seizure semiology, we divided the patients into four groups: focal impaired awareness seizures (FIAS, n = 17), faciobrachial dystonic seizures (FBDS)‐only (n = 6), FBDS‐plus (n = 8), and focal aware motor seizures (FAMS) (n = 2). No significant differences were found in the clinical manifestations or accessory tests except for the onset age (FIAS, Dozens of clinical and subclinical seizures were detected in the long‐range video EEG recording of an anti‐LGI1 encephalitis patient with focal aware motor seizures (A). Furthermore, FDG‐PET scans showed a wide range of abnormal metabolic pattern of this patient and patients with other seizure semiologies, which is not limited to the temporal regions and basal ganglia and far beyond our previous interpretation (B).

Tumour-associated epilepsy accounts for a quarter of paediatric patients undergoing epilepsy surgery with the vast majority achieving long-term seizure and drug freedom. We report the case of an eight-year-old patient who presented with developmental delay and overgrowth, followed by temporal lobe seizures that were attributed to a mesio-temporal brain tumour, and who was eventually treated with epilepsy surgery. Histopathology revealed a diffuse astrocytoma but its gross total resection surprisingly failed to control the temporal lobe seizures. Genetic testing identified a de novo pathogenic variant in the NSD1 gene, thus establishing the diagnosis of Sotos syndrome. Sotos syndrome is a rare overgrowth syndrome with an increased incidence of malignancy, including the very rare occurrence of brain tumours. Seizures are frequent in patients with Sotos syndrome, often occurring with temporal lobe semiology and ictal EEG patterns in the absence of a brain lesion, and usually responding to anti-seizure medication. Our case highlights Sotos syndrome as a rare but important pitfall in the presurgical workup of temporal lobe epilepsy that should be considered particularly in MRI-negative cases but also in the presence of a focal lesion that does not fully explain the clinical picture. Most importantly, our observations underline the value of thorough presurgical diagnostics including genetic testing, even in apparently straightforward cases of lesional epilepsy, to rule out an underlying genetic aetiology that may not be treated by surgery. Finally, our findings emphasize the need to re-evaluate our less successful epilepsy surgery cases and offer informed counselling and prognostication.

We aimed to describe the phenotypic spectrum of seizures in Sotos syndrome, a genetic condition involving overgrowth, macrocephaly, dysmorphic features, and learning disability, in which 60%‐90% have NSD1 pathogenic variants. Patients were recruited from clinics and referral from support groups. Those with seizures and a clinical diagnosis of Sotos syndrome were included. Phenotyping data were collected via structured clinical interview and chart review. Forty‐nine patients were included. Twenty had NSD1 testing results available; of these, 15 (75%) had NSD1 pathogenic variants. Seizure onset age ranged from 3 months to 12 years. Staring spells (absence or focal impaired awareness seizure) were the most frequently reported semiology (33/49; 67%), followed by febrile seizures (25/49; 51%) and afebrile bilateral tonic‐clonic seizures (25/49; 51%). Most patients (33/49; 67%) had multiple seizure types. The majority (33/49; 67%) had seizures controlled on a single antiseizure medication or no medication. Nine (18%) had drug‐resistant epilepsy. Epilepsy syndromes included febrile seizures plus, Lennox‐Gastaut syndrome, childhood absence epilepsy, and generalized tonic‐clonic seizures alone. The seizure phenotype in Sotos syndrome most commonly involves staring spells, afebrile tonic‐clonic seizures or febrile convulsions; however, other seizure types may occur. Seizures are typically well‐controlled with medication, but drug‐resistant epilepsy occurs in a minority.

Status epilepticus (SE) is a neurological and medical emergency, defined as a condition resulting either from the failure of the mechanisms responsible of seizure self-limitation or from the initiation of mechanisms which lead to atypically prolonged seizures. Further than death, SE can have long-term consequences, including neuronal injury, depending on the type, cause and duration of seizures with severe associated disabilities. In Europe, SE shows an incidence rate ranging about 9 to 40/100,000/y. In adults, mortality of patients with SE is ~30%, and even higher (up to 40%) in refractory status epilepticus. To date, etiology, duration, presence of comorbidity, level of consciousness, semiology and age are the main clinical predictors of SE outcome.

Background and purpose Status epilepticus (SE) is a heterogeneous condition and considerable variability exists in its etiology, semiology, electroencephalographic correlates, and response to treatment. The aim of the present study was to explore whether distinct phenotypes may be identified within SE with prominent motor symptoms. Methods Consecutive episodes of SE with prominent motor symptoms in patients aged ≥14 years were included. Etiology of SE was defined as symptomatic (acute, remote, progressive) or unknown. Electroencephalogram (EEG) recordings were searched for lateralized periodic discharges (LPDs), generalized sharply and/or triphasic periodic potentials (GPDs), and spontaneous burst suppression (BS). According to treatment response, SE was classified into responsive, refractory and super‐refractory. Average linkage hierarchical cluster analysis was performed with Pearson's correlation as a similarity measure. Results A total of 240 episodes of SE were identified. Three major clusters were found. The first cluster linked focal motor SE evolving into non‐convulsive SE (NCSE), presence of LPDs/GPDs on EEG, unknown etiology and treatment refractoriness. The second cluster linked convulsive and myoclonic SE evolving into NCSE, presence of spontaneous BS on EEG, progressive symptomatic etiology and super‐refractoriness. The third cluster linked convulsive and myoclonic SE not evolving into other semiologies, absence of LPDs/GPDs/spontaneous BS on EEG, acute symptomatic etiology and treatment responsiveness. Conclusions Distinct electroclinical phenotypes characterized by different response to pharmacological intervention can be identified within the heterogeneity of SE with prominent motor phenomena., The study explored whether distinct phenotypes may be identified within status epilepticus (SE) with prominent motor symptoms. Average linkage hierarchical cluster analysis was performed. Three major electro‐clinical phenotypes were identified. The first cluster associated focal motor SE evolving into non‐convulsive SE (NCSE), presence of LPDs/GPDs on EEG, unknown etiology and treatment refractoriness. The second cluster linked convulsive and myoclonic SE evolving into NCSE, presence of spontaneous BS on EEG, progressive symptomatic etiology and super‐refractoriness. The third cluster gathered convulsive and myoclonic SE not evolving into other semiologies, absence of LPDs/GPDs/spontaneous BS on EEG, acute symptomatic etiology and treatment responsiveness.

Introdução: na grade curricular da formação acadêmica em enfermagem é instituída a disciplina de semiologia e semiotécnica; onde a semiologia representa uma análise crítica e científica das sintomatologias relatadas pelo paciente, como também dos achados por toda equipe, enquanto a semiotécnica é compreendida como a execução de procedimentos técnicos estudados na teoria. Objetivo: relatar as experiências de acadêmicas de enfermagem acerca do ensino em semiologia e semiotécnica e suas contribuições na formação do profissional de enfermagem. Metodologia: trata-se de um estudo descritivo, observacional, do tipo relato de experiência, realizado por 4 acadêmicas matriculadas no período noturno do curso de enfermagem de um Centro Universitário particular, localizado na cidade de Maceió, estado de Alagoas. Resultados: as aulas, nesta instituição, são lecionadas em sala e também em laboratório de enfermagem, a disciplina acontece durante o 4º período, seguindo grade curricular padronizada, e tem como carga horária o total de 300 horas. Conclusões: durante o período observacional na instituição de ensino onde desenvolveu-se este estudo, foi possível identificar que a disciplina de semiologia e semiotécnica para os estudantes de enfermagm é capaz de contribuir na propagação da enfermagem de uma maneira vasta, indo desde o conhecimento da área assistencial até o papel social do enfermeiro; a realização de atividades com bonecos contribui de forma positiva no processo de aprendizagem, entretanto, apenas ela não é suficiente para sanar a insegurança nos momentos de contato direto com o paciente, visto que o ser humano possui sentimentos e reaçoes diversas.

Tabes dorsalis, a late neurological complication of syphilis, is nowadays almost extinct. The path to understanding this disease and its pathophysiology was long and winding, spanning multiple centuries. The 19th century was a crucial period for understanding it. In the first third of the century, German and French physicians defined the semiology of tabes dorsalis, renamed in France "ataxie locomotrice progressive [progressive locomotor ataxia]." Nevertheless, the multiplicity of ancient and recent terms and the description of sometimes unclear nosological concepts (tabes nervosa, tabes spasmodic, nervo-tabes, etc.) were a hindrance to understanding it. Tabes dorsalis was a fertile ground for the description of many clinical signs that have become classics in medicine. No real treatment was available and various unusual therapies were performed. For a long time, the etiology of this disease remained unknown. The link between syphilis and tabes dorsalis was slowly established in the second part of the 19th century from epidemiologic observations. We present an overview of the concept of tabes dorsalis in the medical context of the 19th century and discuss the medical observations of some famous patients suffering from the disease such as Edouard Manet (1832-1883) and Alphonse Daudet (1840-1897).

Background: Facioscapulohumeral dystrophy (FSHD) is a rare hereditary disease with a prevalence of 2.03–6.8 per 100,000 individuals. FSHD is the third most common type of muscular dystrophy after the Duchene muscular dystrophy and myotonic dystrophy. To the best of our knowledge, the current case report is the first to report probable FSHD case mainly diagnosed using clinico-pathological evidence from sub-Saharan Africa (SSA). Case Report: A 22-year-old right-handed male college student presented with progressive proximal muscular weakness associated with wasting. The weakness started from the bilateral facial muscles and progressively involved proximal upper and lower limbs muscles associated with scapular winging, waddling gait, and bilateral foot drops. His bulbar, sensory, autonomic, and cognitive systems were spared. Muscles EMG showed myopathic patterns and normal serum CK. Muscle biopsy from affected muscles showed variation in fiber size with groups of angular fibers, preserved fibers, and hypertrophic fibers with marked fibrosis and adipose tissue replacement with no apparent inflammation and necrosis which is consistent with pathological features of muscular dystrophy. Considering the clinical semiology, physical findings, EMG findings, and pathological findings diagnosis of FSHD of scapuloperoneal variant was made. The patient was managed with analgesics, nutritional advice, and ankle prosthesis for foot drops. Currently, the patient is in a similar condition with modest improvement in his musculoskeletal pain complaints. Conclusion: This case highlights the fact that a careful clinical evaluation with thorough utilization of diagnostic investigations available at our disposal may support the diagnosis of FSHD in resource-limited areas where the necessary genetic tests were not available. Keywords: facioscapulohumeral muscular dystrophy, dystrophy, clinico-pathology, sub-Saharan Africa

Objective To develop and validate a model to predict seizure freedom in children undergoing cerebral hemispheric surgery for the treatment of drug-resistant epilepsy. Methods We analyzed 1267 hemispheric surgeries performed in pediatric participants across 32 centers and 12 countries to identify predictors of seizure freedom at 3 months after surgery. A multivariate logistic regression model was developed based on 70% of the dataset (training set) and validated on 30% of the dataset (validation set). Missing data were handled using multiple imputation techniques. Results Overall, 817 of 1237 (66%) hemispheric surgeries led to seizure freedom (median follow-up = 24 months), and 1050 of 1237 (85%) were seizure-free at 12 months after surgery. A simple regression model containing age at seizure onset, presence of generalized seizure semiology, presence of contralateral 18-fluoro-2-deoxyglucose-positron emission tomography hypometabolism, etiologic substrate, and previous nonhemispheric resective surgery is predictive of seizure freedom (area under the curve = .72). A Hemispheric Surgery Outcome Prediction Scale (HOPS) score was devised that can be used to predict seizure freedom. Significance Children most likely to benefit from hemispheric surgery can be selected and counseled through the implementation of a scale derived from a multiple regression model. Importantly, children who are unlikely to experience seizure control can be spared from the complications and deficits associated with this surgery. The HOPS score is likely to help physicians in clinical decision-making.

Purpose Accurate characterization and quantification of seizure types are critical for optimal pharmacotherapy in epilepsy patients. Technological advances have made it possible to continuously monitor physiological signals within or outside the hospital setting. This study tested the utility of single-channel surface-electromyography (sEMG) for characterization of motor epileptic seizure semiology. Methods Seventy-one subjects were prospectively enrolled where vEEG and sEMG were simultaneously recorded. Three epileptologists independently identified and classified seizure events with upper-extremity (UE) motor activity by reviewing vEEG, serving as a clinical standard. Surface EMG recorded during the events identified by the clinical standard were evaluated using automated classification methods and expert review by a second group of three independent epileptologists (blinded to the vEEG data). Surface EMG classification categories included: tonic-clonic (TC), tonic only, clonic only, or other motor seizures. Both automated and expert review of sEMG was compared to the clinical standard. Results Twenty subjects experienced 47 motor seizures. Automated sEMG event classification methods accurately classified 72 % (95 % CI [0.57, 0.84]) of events (15/18 TC seizures, 5/9 tonic seizures, 1/3 clonic seizures, and 13/17 other seizures). Three independent reviewers’ majority-rule analysis of sEMG correctly classified 81 % (95 % CI [0.67, 0.91]) of events (16/18 TC seizures, 8/9 tonic seizures, 1/3 clonic seizures, and 13/17 other manifestations). Conclusions Continuous monitoring of sEMG data provides an objective measure to evaluate motor seizure activity. Using sEMG from a wearable monitor recorded from the biceps, automated and expert review may be used to characterize the semiology of events with UE motor activity, particularly TC and tonic seizures.

Introducción: Tradicionalmente se ha recurrido al examen clínico-neurológico y a los estudios por imágenes para identificar lesiones de la columna cervical en pacientes con politraumatismos. En diferentes centros de trauma, la evaluación inicial de estos pacientes incluye un examen clínico-neurológico más radiografías obligatorias, independientemente de una semiología normal, en un paciente despierto y consciente. Esto se debe a la creencia de que el examen clínico es insuficiente para detectar estas lesiones. Materiales y Métodos: Se trata de un estudio transversal y observacional para determinar la sensibilidad y la especificidad de la evaluación clínica para el diagnóstico de lesiones de la columna cervical comparadas con las de los estudios por imágenes, en un período de 22 meses, en un Servicio de Urgencias. Resultados: Durante este período, se asistió a 127 pacientes. El examen físico neurológico fue normal en 101 pacientes, ninguno tenía una lesión constatada en las radiografías o las imágenes tomográficas. Veintiséis pacientes refirieron dolor a la palpación de las apófisis espinosas; en 6 de ellos, se constató una lesión de la columna cervical con la tomografía. La sensibilidad del examen físico fue del 100% y la especificidad, del 83%. La tasa de falsos positivos fue del 17% y no se registró ningún falso negativo. Conclusiones: Los datos de este estudio demuestran que la mayoría de los estudios por imágenes, radiografías o tomografías computarizadas podrían disminuirse, sin perder la sensibilidad del diagnóstico de lesiones de la columna cervical, reduciendo así los costos de la atención.Nivel de Evidencia: IV

Background Psychogenic non-epileptic seizure (PNES) has long been the counterpart of epileptic seizure (ES). Despite ample of evidence differentiating the two, PNES mistakenly diagnosed as ES was still common, resulting in unnecessary exposure to long-term antiepileptic medications and reduced patient’s and caregiver’s quality of life, not to mention the burgeoning financial costs. Objectives In this review, we aimed to elucidate various differences between PNES and epileptic seizure with respect to baseline characteristics, seizure semiology, EEG pattern, and other key hallmark features. Methods An unstructured search was carried out in PubMed, MEDLINE, and EMBASE using keywords pertinent to PNES and ES differentiation. Relevant information was subsequently summarized herein. Results PNES differs significantly with ES in terms of baseline characteristics, prodromal symptoms, seizure semiology, presence of pseudosleep, and other hallmark features (for instance provoking seizure with suggestion). The combined approach, if applied appropriately, can yield high diagnostic yield. Conclusions PNES can be clearly differentiated from ES via careful adherence to a set of valid clinical cues. The summarized clinical hallmarks is highly useful to prevent unnecessary ES diagnosis and treatment with AEDs.

The study attempts to characterize the clinical, demographic, risk factors, electroencephalographical, and neuroimaging features of hot-water epilepsy (HWE) in children. This is a hospital-based observational study in the pediatric neurology clinic and who met the clinical definition of hot-water epilepsy were studied from January 2017 to October 2018. Clinical history, demographic data, and examination findings were recorded in a pre-structured proforma. Electroencephalography (EEG) and neuroimaging were carried out. A total of 68 children with male to female ratio of 2.4:1 were studied. The most common age of onset of seizures was between 1 and 5 y. Focal seizures with impaired awareness were the most common semiology (48.5%). Abnormal EEG was detected in 13.2% and abnormal neuroimaging in 4.4% which consisted of incidental abnormalities. Nonreflex seizures occurred in 35.3% of the children with HWE and the risk factors associated with this were not statistically significant. Clobazam before taking bath helped to achieve seizure control in 85.7% of the children. Hot-water epilepsy should be suspected in children who develop seizures following a hot-water bath. The most common age of onset is 1–5 y. EEG and neuroimaging are normal in the majority of cases. Nonreflex seizures occurred in 35.3% of the children.

A male patient with a de novo mutation in the YWHAG gene and mild phenotype is presented. He had normal delivery and normal development, with normal speech and social milestones. At the age of 9 months, myoclonic seizures started, with generalized epileptiform discharges. The child responded well to levetiracetam monotherapy with complete seizure resolution. Levetiracetam was stopped and he remained seizure-free for 10 months. His development was appropriate for age according to psychological evaluation and he attended a regular kindergarten. At the age of approximately 4 years, the seizures reappeared with different semiology of staring with eye blinking. Electroencephalogram (EEG) showed multifocal spikes. Brain magnetic resonance imaging did not reveal any structural abnormality. Genetic analysis revealed a de novo likely pathogenic missense variant in the YWHAG gene (c.619G>A p.Glu207Lys). We compared our case to the other cases published in the literature. Our case is unique in its seizure semiology and evolution of EEG. Moreover, in contrast to our case, the majority of cases described in the literature have dysmorphism and intellectual disability or autistic spectrum disorder. This report emphasizes the phenotypic heterogeneity of YWHAG mutation as is the case in other developmental encephalopathies.

Ictal vomiting is a rare condition easily misdiagnosed as a common disease. We report two children presenting with retching and vomiting as the main ictal manifestation. Patient 1 was a four-year-old girl with a history of daily nocturnal vomiting for two months, first interpreted as a functional disorder, then as a viral infection. She presented with vomiting accompanied by focal right-sided hemifacial clonic jerking, occurring multiple times per day. Video-EEG demonstrated ictal discharges associated with the retching and vomiting, over a normal background, and occasional interictal focal spikes. MRI was normal. PET demonstrated left-sided opercular hypometabolism. Patient 2 was a girl with a history of focal epilepsy, secondary to a right central dysembryoplastic tumour, first resected with subsequent seizure freedom at the age of three years. At five years of age, she presented with recurrent episodes of retching and vomiting initially diagnosed as migraine. Video-EEG showed ictal discharges, clinically correlating with retching, vomiting and clonic facial jerking, with normal interictal activity. Brain MRI showed a progression of the tumour. A second resection resulted in seizure freedom. Ictal vomiting often goes undiagnosed, especially in children, causing treatment delays. An ictal origin should be considered, particularly when the episodes are recurrent and stereotyped. [Published with video sequences].

Epilepsy is the most common form of chronic neurologic disease. Here, we review the available randomized controlled trials (RCTs) that examined the efficacy of resective epilepsy surgery in select patients suffering from medically intractable epilepsy (defined as persistent epilepsy despite two or more antiepileptic drugs [AEDs]). Three RCTs (two adult RCTs and one pediatric RCT) consistently supported the efficacy of resective surgery as treatment for epilepsy with semiology localized to the mesial temporal lobe. In these studies, 58–100% of the patients who underwent resective surgery achieved seizure freedom, in comparison to 0–13% of medically treated patients. In another RCT, the likelihood of seizure freedom after resective surgery was independent of the surgical approach (transSylvian [64%] versus subtemporal [62%]). Two other RCTs demonstrated that hippocampal resection is essential to optimize seizure control. But, no significant gain in seizure control was achieved beyond removing 2.5 cm of the hippocampus. Across RCTs, minor complications (deficit lasting 3 months) ranged 2–5% and 5–11% respectively. However, nonincapacitating superior subquadrantic visual-field defects (not typically considered a minor or major complication) were noted in up to 55% of the surgical cohort. The available RCTs provide compelling support for resective surgery as a treatment for mesial temporal lobe epilepsy and offer insights toward optimal surgical strategy.

Eating epilepsy is rare and comprises reflex seizures induced by food intake presenting with broad clinical manifestations. Despite this heterogeneity, a unique focal impaired awareness seizure semiology localizing to specific brain regions has been noted. Here, we present a case with video-EEG depicting this characteristic clinical presentation and its informative electrographic correlate. [Published with video sequence].

Objective To describe the semiology of pain and its associated features in patients with coronavirus disease 2019 (COVID‐19) and headache presenting to the emergency department who do not require urgent services. Background Headache is one of the most frequent neurological symptoms reported in case series, epidemiological studies, and meta‐analyses of COVID‐19, with a prevalence ranging from 8 to 71.1%. Studies addressing the semiology of these headaches are lacking. Methods We conducted a cross‐sectional study in the emergency department of a tertiary hospital. Patients classified according to the Manchester Triage System as standard and non‐urgent and those fulfilling the criteria for probable or confirmed COVID‐19 according to World Health Organization guidelines who presented with headache were included. A standardized questionnaire was used for data collection. Results Of the 145 confirmed and probable COVID‐19 patients, 99 (68.3%) reported headache. A total of 54/99 (54.5%) were classified with probable COVID‐19 and 45/99 (45.5%) with confirmed COVID‐19. The mean age (44.7 ± 11.8 vs 40.4 ± 10.7, P = .061), sex distribution (35/54 [64.8%] vs 28/45 [62.2%] female, P = .768), and headache comorbidity (19/54 [35.2%] vs 17/45 [37.8%], P = .789) were similar between the probable and confirmed COVID‐19 groups, along with other medical comorbidities and laboratory data. Patients with confirmed COVID‐19 showed a higher incidence of anosmia (21/54 [38.9%] vs 28/45 [62.2%], P = .021) and pneumonia (10/54 [18.5%] vs 18/45 [40%], P = .018), headache at onset (32/54 [59.3%] vs 39/45 [86.7%], P = .002), and hospital admission (0/54 [0%] vs 2/45 [11.1%], P = .017). In most cases, the headache appeared simultaneously with other COVID‐19 symptoms (57/99, 57.6%). It was bilateral (86/99, 86.9%), frontal or holocranial (34/99, 34.3% each) in location and intense (60/99, 60.6%, reported a visual analog scale [VAS] score ≥7). A total of 39/99 (39.4%) identified triggers, most commonly fever. The most frequent aggravating factors were physical activity (45/99, 45.5%) and coughing (43/99, 43.4%). Patients showed a propensity toward prostration (41/99, 41.4%), photophobia (29/99, 29.3%), and phonophobia (27/99, 27.3%). Partial (53/99, 53.5%) or total (26/99, 26.3%) responses to first‐step analgesics were reported. A total of 25/99 (25.3%) patients had a prior history of migraine, presenting with headache different from the usual in 23/25 (92.0%) patients. Individuals with migraine were more likely to have earlier (headache at onset of the respiratory symptoms in 24/25 [96.0%] vs 57/74 [77.0%], P = .023 [95% CI: 0.067, 0.313]), longer (>24 hours of pain in 20/25 [80%] vs 25/74 [33.8%], P

The recurring failure to accurately account for local realities, by semiology built on the universalist model of evidence-based medicine has made it necessary to theorize culture-bound syndrome. The case of Mrs. S. illustrates how, despite multiple hospitalizations and management, a first symptomatology of psychotic appearance has eclipsed, for years, a recurrent depressive disorder. These diagnostic errors involve people because of their non-Western origins, and lead to an overdiagnostic of schizophrenia. It seems urgent to us to promote awareness of this social inequity of health by sensitizing French psychiatric interns to cross-cultural issues.

Objectives. Establishment of a link between the nature of damage to the neocortex and the functional manifestations of this damage is important for understanding the mechanisms of development of acute convulsions and their sequelae. Analysis of immediate convulsions in patients with traumatic brain injury (TBI) in practice is extremely difficult but can be performed in animal models. Study aims. To compare damage to functional areas in the neocortex with the semiology of immediate convulsive seizures and behavioral impairments in the acute period after TBI. Materials and methods. Studies were carried out using 48 Wistar rats. TBI was modeled by application of lateral hydrodynamic blows to the area of the right sensorimotor cortex. Video recordings were made at the moment of trauma and for 5 min into the post-trauma period, which provided for studies of the semiology of convulsive seizures. This was followed by use of a series of tests assessing the animals’ behavior. Results and conclusions. This study is the first to use the “unfolded maps” approach for detailed analysis of damage to the functional zones of the neocortex in the acute period of TBI. The focus of damage in the cortex increased over 3–7 days and was complex in shape, far removed from the limits of the area of direct action. Blows induced immediate convulsions, whose variability could not be explained only by the involvement of defined areas of the neocortex, along with behavioral impairments which could be the manifestations of developing necrosis largely in the sensory areas of the neocortex.

The authors report the case of a 22-year-old female patient who presented with two distinct relapses of multiple sclerosis. The first was a lesion in the dorsal paramedian pontine area to the left, and the second, not visible in the MRI but presumably affecting the right medial longitudinal fasciculus, in the pons. In both cases, the semiology was unquestionable and compatible to the proposed areas of demyelination, with the patient fully recovering her eye movements after pulses of methylprednisolone.