Semiology of epileptic seizures with insular genesis

Medientyp: E-Book

Titel: Semiology of epileptic seizures with insular genesis

Beteiligte: Martinez Lizana, Eva [Verfasser]; Schulze-Bonhage, Andreas [Akademischer Betreuer]; Schulze-Bonhage, Andreas [Sonstige]; Tebartz van Elst, Ludger [Sonstige]

Körperschaft: Klinik für Neurochirurgie, Abteilung Epileptologie - Epilepsiezentrum ; Albert-Ludwigs-Universität Freiburg, Medizinische Fakultät

Erschienen: Freiburg: Universität, 2022

Umfang: Online-Ressource

Sprache: Englisch

DOI: 10.6094/UNIFR/225512

Identifikator:

Schlagwörter: Searches and seizures ; Epilepsie ; (local)doctoralThesis

Entstehung:

Hochschulschrift: Dissertation, Universität Freiburg, 2022

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Beschreibung: Abstract: The insular cortex is located deep in the Sylvian fissure, hidden by the frontal, temporal and parietal operculum. These anatomic constrains limit its evaluation using scalp electroencephalography. Ontogenetically and architecturally, the insular cortex is composed of different areas with a multitude of different functions and connectivities. Epileptic seizures with insular genesis are often difficult to distinguish from those found in temporal lobe epilepsy due to their complex and variable semiology. Here, we analyzed differentiating characteristics in the clinical spectrum of insular seizures. In the present study, the seizure semiology of patients with a diagnosis of insular epilepsy was retrospectively analyzed. The diagnosis was stablished based on imaging of epileptogenic lesions or electrophysiological evidence of an insular seizure origin. The seizure semiology in patients with insular epilepsy was compared to age-matched controls with mesial temporal lobe epilepsy. Forty-six patients with insular epilepsy and forty-six patients with mesial temporal lobe epilepsy were included. The most prominent ictal features in insular epilepsy 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 seizure onset zone (SOZ) in patients with mesial temporal lobe epilepsy, while they occurred about equally often ipsilateral as contralateral to the SOZ in patients with insular epilepsy. Ipsilateral manual automatisms were significantly more frequent in patients with mesial temporal lobe epilepsy than in patients with insular epilepsy (p=0.010). A Multivariate analysis correctly identified insular epilepsy in 87% and mesial temporal lobe epilepsy in 83% of the patients using 6 semiologic features (Chi square=64.1, p<0.0001). Two major symptom clusters in patients with insular epilepsy were identified: Cluster 1 comprised subjective feelings (including fear, olfactory, gustatory, auditory, déjà-vu, somatosensory, cephalic or epigastric sensations), language disturbances (including ictal speech and aphasia) and hyperkinetic features while cluster 2 comprised behavior arrest, automatisms, autonomic and focal motor features. The detected differentiating features are relevant for the correct localization of seizure generators in the framework of presurgical evaluation and epilepsy surgery

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