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The underlying mechanism for the production of oroalimentary automatisms in medial temporal seizures is based on temporal-insulo-opercular theta coherence leading to a synchronous state generating rhythmic patterned outputs from the cortical masticatory area.

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Demonstrating cerebral blood flow changes during seizures, ictal-interictal single photon emission computed tomography (SPECT) with co-registration to MRI (SISCOM) reflects brain activation and its pathways of spread. To investigate subcortical ictal hyperperfusion patterns during focal seizures, we retrospectively reviewed SISCOM analysis of patients who became seizure-free after cortical resection. Our aim was to evaluate the relationship between epileptogenic zones and subcortical hyperperfusion. Method: 67 patients were identified as having SISCOM evaluation and having remained seizure-free for at least one year after surgical resection. SISCOM analysis was blindly reviewed for localization of basal ganglia (BG), thalamic (TN) and cerebellar (CH) hyperperfusion based on three different thresholds. Subcortical activation and epilepsy characteristics were then compared between patients. For a given region of interest and threshold, the sensitivity, specificity and positive and negative predictive value for correct lateralization of the epilepsy side was calculated. Results: Depending on the threshold used, BG hyperperfusion was found in 37.3-73.9% of patients, TN hyperperfusion in 31.3-68.1% and CH hyperperfusion in 13.5-29%. For a threshold of 1.5, the best predictive positive value for correct lateralization of the epilepsy side was obtained with BG/CH coactivation (89%). For a threshold of 2.0 and 2.5, it was obtained with BG/TN coactivation (88%) and BG activation (82%), respectively. Conclusion: Subcortical SISCOM hyperperfusion could offer additional clues in terms of lateralization.

Epilepsy is a common disorder but diagnosis remains largely clinical. Although MRI and EEG significantly aid the diagnosis of epilepsy, these techniques may also be misleading and indicate abnormalities not related to phenomenology. Consequences of erroneous diagnosis of epilepsy may lead to aggressive and escalating pharmacotherapy with potentially serious side effects. Metabolic disorders, which may mimic epilepsy, should always be considered as they are potentially curable and may be fatal if untreated. We report a case of an insulinoma, misdiagnosed as temporal lobe epilepsy. We highlight the risks associated with misinterpretation of neuroimaging and EEG and outline an approach to differentiate between symptoms of insulinoma or neuroglycopenia and temporal epileptic seizures.

BackgroundTuberous sclerosis complex (TSC) is a rare autosomal dominant genetic disorder. Due to the various manifestations of TSC and their potential complications, a multidisciplinary care approach is recommended by consensus guidelines.ObjectivesOur study aimed to give a complete description of our TSC adult cohort and to evaluate the multidisciplinary and interdisciplinary management model.MethodsData on each adult patient diagnosed with TSC, including disease manifestations, interventions and outcomes, were collected at baseline and updated annually. A multidisciplinary TSC approach with all the recommended explorations was carried out annually.Results90 patients were enrolled in Centre Hospitalier Universitaire de Bordeaux, between January 2000 and September 2018. Median age of patients at inclusion was 37 years (range, 27–47) and 20 years old at diagnosis of TSC. Regarding the occurrence of TSC manifestations, 97% of the patients had cutaneous lesions, 89% had neurological manifestations, 83% had renal manifestations and 100% had dental lesions with pits. More than half the patients had sclerotic bone lesions (68%), TSC-associated neuropsychiatric disorders (64%) and lymphangioleiomyomatosis (59%). A TSC multidisciplinary approach was developed including a global follow-up and an evaluation of TSC targeting organs, according to the recommendations. A satisfaction survey revealed global and entire satisfaction of patients with TSC.ConclusionWe obtained an accurate description of a cohort of adult patients with TSC. Our multidisciplinary approach model allowed us to provide optimal management of patients with TSC with a high level of patient satisfaction.