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Epileptic Disorders

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Somatomotor or somatosensory facial manifestations in patients with temporobasal epilepsies Volume 24, issue 3, June 2022

Figure 1.

Patient 1. (A) Preoperative MRI (coronal view; T2 weighted sequences). (B, C) Scalp EEG (10-20 system with supplementary temporo-basal electrodes; longitudinal montage; amplitude: 150 mV/cm, low-pass filter: 70 Hz, high-pass filter: 0.530 Hz). (B) Seizure onset with electrical onset showing left temporal rhythmic activity from temporal anterior and basal electrodes (1) and decrease in heart frequency (2). (C) Seizure continuation with opening of the eyes 19 seconds after the electrical onset (3), right facial contraction (4) and left temporal delta activity (5).

Figure 1.

(D) Electrode implantation (left panel: lateral view; right panel: insular view; lower panel: hippocampal view). (E-H) SEEG recording (amplitude: 400 μV/cm, low-pass filter: 120 Hz, high-pass filter: 0.530 Hz). MTG: middletemporal gyrus; STG: superior temporal gyrus; GR: gyrusrectus; AC: anterior cingulate. (E, F) Type 1 seizure. (E) Onset showing beta activity from the contacts exploring the lesion (Lp7-Lp8) (star) followed by a fast discharge at the same contacts (diamond) with propagation in the shape of a spike discharge from the temporal electrodes. The patient does not provide any warning, does not answer immediately during the discharge and describes having a brief non-specific sensation after the seizure. (F) Seizure continuation and end (continued).

Figure 1

Figure 1. (G, H) Type 2 seizure. (G) Electrical onset (star) showing beta activity from the contacts exploring the lesion. In the following seconds, the discharge slows down with propagation to the amygdala and hippocampus. (H) Seizure continuation, 14 seconds after the electrical onset, corresponding to clinical onset (eyes open and slowing of heart rate) (1) and facial contraction (17 seconds after electrical onset) (2). Immediately after the clinical onset, the ictal discharge speeds up from the contacts exploring the lesion (star) with a simultaneous fast discharge on the insula and frontal operculum (arrows). (I) Post-operative MRI (continued).

Figure 2.

Patient 2. (A) Preoperative MRI (upper panel: coronal view, T2-weighted sequences; lower panel: axial view, FLAIR sequences). (B, C) Scalp EEG (10-20 system with supplementary temporo-basal electrodes; longitudinal montage; amplitude: 100 mV/cm, low-pass filter: 70 Hz, high-pass filter: 0.530 Hz). (B) Seizure onset during sleep corresponding to awakening (clinical onset) (1) and right fronto-temporal delta activity (electrical onset), starting five seconds after the clinical onset (2). (C) Seizure continuation with facial contraction occurring 11 seconds after clinical onset (3).

Figure 2.

D) Electrode implantation. Left panels: implantation in the right hemisphere showing lateral view (upper), insular view (middle) and hippocampal view (lower). Right panels: implantation in the left hemisphere showing lateral view (upper), insular view (middle) and hippocampal view (lower). (E, F) SEEG recording (amplitude: 750 mV/cm, low-pass filter: 120 Hz, high-pass filter: 0.530 Hz). TP: temporal pole; STS: superior temporal sulcus; STG: superior temporalgyrus; MTG: middletemporalgyrus; LOC: lateraloccipitalcortex; PCG: post-central gyrus; tab: left temporo-basal area; lIOA: left insulo-opercular area. (E) Seizure onset showing electricalonsetwithafastdischargefromtheelectrodesexploringthelesion(OI 1-2)(1) withfastpropagationon the temporal pole, fast discharge on the insula (arrow) at clinical onset (6 seconds after the electrical onset) (2), with movement, tachycardia and facial contraction (7 seconds after the electrical onset) (3). Note the rhythmic activity from the opercular electrodes and the theta activity from OG1 facing the lesion on the left (continued).

Figure 2.

(F) Seizure continuation and end. The patient shows head and trunk deviation to the left and hypertonia of the right side of the body. The discharge has spread out and predominates from the electrodes exploring not only the lesion, the temporal pole and the amygdalo-hippocampal complex, but also the insula and the central operculum explored by OP. (G) Postoperative MRI (T1-weighted sequences). Left panel: sagittal view; right panel: coronal view (continued).

Figure 3.

Comparison of seizure dynamics between the lesion (channel OI1-OI2) and posterior superior insula (channel OP1-OP2) in Patient 2. (A) Time series of a seizure onset showing the first 10 seconds. (B) SEEG power in time-frequency domain, z-scored over the baseline and averaged across the seizures. Ictal changes are stronger in the lesion and propagate to the insula after around three seconds. (C) Group propagation map of high-gamma (80-180 Hz) power indicating the onset, in seconds, of significant ictal changes of power. The pattern of propagation is relatively complex.

Figure 4.

Patient 3. (A, B) Scalp EEG of a seizure occurring during hyperventilation (10-20 system; longitudinal montage; amplitude: 70 mV/cm, low-pass filter: 70 Hz, high-pass filter: 0.530 Hz). The patient was asked to refrain from warning and remain with eyes closed which he was able to do, except for occasional eyelid movements, and he described a heat sensation on the right part of the face and right upper limb as well as fear after the end of the discharge. (A) Electrical onset showing theta activity on the temporal anterior region (1). (B) Seizure continuation showing theta activity from suprasylvian electrodes (C4 P4), 10 seconds after the electrical onset (2). (C) Seizure continuation showing fronto-centro-parietal propagation (2).

Figure 4.

(D) Preoperative MRI (FLAIR sequences) (upper left panel: coronal view; lower panel: sagittal view) and postoperative MRI (T1-weighted sequence) (right panel: coronal view) (continued).