John Libbey Eurotext

Motor and emotional facial features in parietal lobe seizures: an ictal functional connectivity study using SEEG Ahead of print

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Authors
1 Epilepsy Monitoring Unit, Emergency University Hospital Bucharest,
2 Physics Department, University of Bucharest,
3 Neurology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
* Correspondence: Ioana Mindruta Epilepsy Monitoring Unit, Emergency University Hospital Bucharest, Splaiul Independentei 169, Bucharest 050098, Romania Andrei Barborica Physics Department, University of Bucharest, P.O. Box MG-11, Bucuresti, Magurele, RO 077125, Romania.
* * Authors contributed equally

Objectives

Parietal lobe epilepsy is one of the rarest types and patients with this form of epilepsy report multiple subjective symptoms during ictal manifestation. Specific facial coupling of emotion and motor symptoms may take various forms, such as pouting and disgust or smiling. We aimed to highlight brain structures and the network involved during ictal grimacing in parietal lobe seizures.

Methods

In this study, we report two patients with drug-resistant epilepsy, with seizure onset located in the inferior parietal lobule and a semiology characterized by ictal grimacing. Patients were explored with intracranial electrodes using the stereo-electroencephalographic method. Time-frequency and functional connectivity (a non-linear regression method based on the h2 correlation coefficient) signal analyses were performed time-locked to ictal grimace. For both patients, using spectral analysis, we were able to confirm that the bipolar channels, localized at the level of the inferior parietal lobule, were involved in the seizure onset zone, exhibiting a high frequency discharge.

Results

The first patient presented with ictal pouting and disgust and the second with smiling/laughter. Connectivity analysis highlighted two different networks responsible for seizure semiology, consisting of grimacing with different emotional expression. The inferior parietal lobule, connected mainly to the anterior insula, dorsal-lateral prefrontal cortex and frontal operculum were responsible for the typical grimace associated with disgust. Furthermore, the inferior parietal lobule, basal temporal structures, superior temporal gyrus, orbitofrontal cortex and temporal pole were involved in smiling and laughter.

Significance

It is of great significance for epileptologists to know that the same seizure onset zone in the inferior parietal lobule can generate contrasting facial expressions, smiling/laughter and pouting/disgust, by engaging different epileptogenic networks; the temporo-basal-orbitofrontal and insulo-opercular networks, respectively.