Self-control of epileptic seizures by nonpharmacological strategies

Despite the unpredictability of epileptic seizures, many patients report that they can anticipate seizure occurrence. Using certain alert symptoms (i.e., auras, prodromes, precipitant factors), patients can adopt behaviors to avoid injury during and after the seizure or may implement spontaneous cognitive and emotional strategies to try to control the seizure itself. From the patient's view point, potential means of enhancing seizure prediction and developing seizure control supports are seen as very important issues, especially when the epilepsy is drug-resistant. In this review, we first describe how some patients anticipate their seizures and whether this is effective in terms of seizure prediction. Secondly, we examine how these anticipatory elements might help patients to prevent or control their seizures and how the patient's neuropsychological profile, specifically parameters of perceived self-control (PSC) and locus of control (LOC), might impact these strategies and quality of life (QOL). Thirdly, we review the external supports that can help patients to better predict seizures. Finally, we look at nonpharmacological means of increasing perceived self-control and achieving potential reduction of seizure frequency (i.e., stress-based and arousal-based strategies). In the past few years, various approaches for detection and control of seizures have gained greater interest, but more research is needed to confirm a positive effect on seizure frequency as well as on QOL

Epilepsie du sujet âgé (à propos de 80 cas)

AIX-MARSEILLE2-BU Méd/Odontol. (130552103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Rôle du cortex pré-frontal dans l'expression de la peur critique

AIX-MARSEILLE2-BU Méd/Odontol. (130552103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Organisation anatomo-fonctionnelle du langage dans l'épilepsie temporale

Quels sont les corrélats anatomo-fonctionnels sous tendant la compréhension et la production de la parole ? De la perception des indices acoustico-phonétiques à l accès au sens des mots, quel est le degré de latéralisation des réseaux mis en jeu dans le traitement du langage ? Nous avons tenté de répondre à ces questions au travers du modèle pathologique de l épilepsie temporale. En effet, dans le cadre du bilan pré-chirurgical de cette pathologie, l implantation d électrodes intracérébrales (SEEG) permet, lors de la cartographie fonctionnelle, l enregistrement in vivo de l activité corticale lors de processus linguistiques particuliers. Par ailleurs, l épilepsie temporale en raison de la potentielle désorganisation (critique et/ou inter-critique) de certaines structures impliquées dans la perception et/ou la production du langage, s avère être un modèle pathologique intéressant. Dans un premier travail, nous avons corrélé le traitement temporel d indices acousticophonétiques et la latéralisation hémisphérique pour le langage. A partir d enregistrements de surface, nous avons localisé les générateurs responsables de cette activité au niveau du cortex auditif gauche lorsque les sujets avaient une spécialisation hémisphérique gauche pour le langage. Puis nous avons mis en évidence, grâce à des enregistrements intracérébraux, le traitement parallèle de l information verbale au niveau de l hémisphère dominant pour le langage lors de tâches comportant un monitoring de mots ou pseudo-mots. Les processus lexico-sémantiques mettent en jeu préférentiellement la voie ventrale (temporale), les processus phonologiques mettent en jeu la voie dorsale. La région frontale inférieure semble contribuer à ces deux processus. Nous avons précisé le rôle de la région temporale et basale postérieure gauche dans l accès lexical. L anomie observée chez les patients dont l épilepsie concernait l hémisphère dominant pour le langage serait liée au dysfonctionnement de cette région. Notre dernière étude a confirmé le rôle clef de la région temporo-basale gauche dans l accès lexical ainsi que sa participation multi-modalitaire au traitement d un matériel verbal. L ensemble de ces travaux suggèrent (1) l existence d un traitement parallèle des informations lexico-sémantiques du langage parlé après un traitement spécifique des indices acousticophonétiques par le cortex auditif de l hémisphère dominant pour le langage (2) la participation de la région basale et postérieure temporale à l accès lexical dans la production, comme dans la perception de la parole.AIX-MARSEILLE2-BU Méd/Odontol. (130552103) / SudocSudocFranceF

MTL-P300 as a marker of the epileptogenic zone and hippocampal functionality in the presurgical evaluation of temporal lobe epilepsy: a systematic review

Abstract Background In the past twenty years, there has been an increasing interest among neuroscientists and physicians in mapping the cortical areas involved in the epileptogenic zone (EZ) through event-related potentials (ERPs) that enable the evaluation of the functional preservation of these areas. The present review is an update on publications on this topic. Objective To investigate the accuracy of the cognitive evoked of the medial temporal lobe P300 (MTL-P300) potential in detecting the EZ in temporal lobe epilepsy (TLE). Methods The systematic review of articles on the PubMed, Embase and Lilacs databases was conducted between February and December 2020. Articles published in English from 1985 to December 2020 were included. Additional studies were identified by searching the references of the selected studies and review articles. The studies were included for the following reasons: in-depth intracranial electroencephalography (iEEG) analysis of hippocampal activity; investigations of patients with TLE; and correlations between regarding the ERP results obtained in the temporal regions (MTL-P300) and the EZ. Results In the three studies analyzed, the authors were able to define the laterality of the EZ during the preoperative investigation through the MTL-P300 results. The sensitivity of this method was of ∼ 70% to 80%, and the specificity between 70% and 94.7%. One of the limitations of the present review was the low number of studies. Conclusion There is evidence that the reduced amplitude of the MTL-P300 has high specificity in identifying the EZ, and this is a good marker for diagnosis in unilateral TLE. The low sensitivity and negative likelihood ratios negative that a normal MTL-P300 response does not exclude the epileptogenicity of the hippocampus

High frequency gamma activity in the left hippocampus predicts visual object naming performance

International audienceAccess to an object's name requires the retrieval of an arbitrary association between it's identity and a word-label. The hippocampus is essential in retrieving arbitrary associations, and thus could be involved in retrieving the link between an object and its name. To test this hypothesis we recorded the iEEG signal from epileptic patients, directly implanted in the hippocampus, while they performed a picture naming task. High-frequency broadband gamma (50-150 Hz) responses were computed as an index of population-level spiking activity. Our results show, for the first time, single-trial hippocampal dynamics between visual confrontation and naming. Remarkably, the latency of the hippocampal response predicts naming latency, while inefficient hippocampal activation is associated with ``tip-of-the-tongue'' states (a failure to retrieve the name of a recognized object) suggesting that the hippocampus is an active component of the naming network and that its dynamics are closely related to efficient word production. (C) 2014 Elsevier Inc. All rights reserved

Accelerated long‐term forgetting in focal epilepsy: Do interictal spikes during sleep matter?

International audienc

Brain regions underlying word finding difficulties in temporal lobe epilepsy

International audienceWord finding difficulties are often reported by epileptic patients with seizures originating from the language dominant cerebral hemisphere, for example, in temporal lobe epilepsy. Evidence regarding the brain regions underlying this deficit comes from studies of peri-operative electro-cortical stimulation, as well as post-surgical performance. This evidence has highlighted a role for the anterior part of the dominant temporal lobe in oral word production. These conclusions contrast with findings from activation studies involving healthy speakers or acute ischaemic stroke patients, where the region most directly related to word retrieval appears to be the posterior part of the left temporal lobe. To clarify the neural basis of word retrieval in temporal lobe epilepsy, we tested forty-three drug-resistant temporal lobe epilepsy patients (28 left, 15 right). Comprehensive neuropsychological and language assessments were performed. Single spoken word production was elicited with picture or definition stimuli. Detailed analysis allowed the distinction of impaired word retrieval from other possible causes of naming failure. Finally, the neural substrate of the deficit was assessed by correlating word retrieval performance and resting-state brain metabolism in 18 fluoro-2-deoxy-d-glucose-Positron Emission Tomography. Naming difficulties often resulted from genuine word retrieval failures (anomic states), both in picture and in definition tasks. Left temporal lobe epilepsy patients showed considerably worse performance than right temporal lobe epilepsy patients. Performance was poorer in the definition than in the picture task. Across patients and the left temporal lobe epilepsy subgroup, frequency of anomic state was negatively correlated with resting-state brain metabolism in left posterior and basal temporal regions (Brodmanns area 20-37-39). These results show the involvement of posterior temporal regions, within a larger antero-posterior-basal temporal network, in the specific process of word retrieval in temporal lobe epilepsy. A tentative explanation for these findings is that epilepsy induces functional deafferentation between anterior temporal structures devoted to semantic processing and neocortical posterior temporal structures devoted to lexical processing

Accelerated long‐term forgetting in focal epilepsy: Do interictal spikes during sleep matter?

International audienc

Reading epilepsy from the dominant temporo-occipital region

Décomptée en 2009International audienceReading epilepsy is a rare form of epilepsy, classified among idiopathic, age- and localisation-related (partial) epilepsies as a reflex epilepsy syndrome. Seizures usually consist of myoclonic jerks restricted to the jaw. However, distinct ictal features including visual symptoms and paroxysmal a- or dyslexia are described in some patients. The anatomical substrate of ictogenesis in reading epilepsy remains poorly understood. We report here the case of a primary reading epilepsy for which ictal semiology was characterized by visual symptoms and dyslexia, investigated by MRI, interictal high-resolution EEG and PET, ictal video-EEG and SPECT. Brain MRI was normal. Interictal high resolution EEG was performed with 64 scalp channels, a realistic head model and different algorithms to solve the inverse problem. Interictal source localizations highlighted the left occipito-temporal junction. Interictal PET demonstrated bilateral occipito-temporal hypometabolism with left-sided predominance. Ictal EEG showed a rhythmic discharge in left temporo-parieto-occipital junction channels, with left occipito-temporal predominance. MRI fusion of the co-registered subtraction between ictal and interictal SPECT individualized relative hyperperfusion affecting (a) the left occipito-parietal junction area (b) the left lateral middle and inferior temporal gyri and (c) the left inferior frontal area. Besides reading-induced myoclonic jerks of the jaw, a second variant of reading epilepsy exists with clearly partial seizures manifested by visual symptoms and a- or dyslexia. These seizures originate from the occipito-temporal region of the dominant hemisphere, corresponding to the posterior part of the neural network that underlies the function of reading