Secondary bilateral synchrony associated to a parasagittal tumor case report

Cukiert, Arthur; Gronich, Gary; Marino, Raul

doi:10.1590/s0004-282x1991000300018

Cited by 6 publications

(4 citation statements)

References 13 publications

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“…PALAVRAS-CHAVE: lobo frontal, epilepsia, cirurgia, eletrodos subdurais. Secondary bilateral synchrony (SBS) can be generated from unilateral parasagittal and mesiofrontal epileptic foci 1 . This phenomenon has been well documented in both animal and human models 2 .…”

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Secondary bilateral synchrony due to fronto-mesial lesions: an invasive recording study

Cukiert

Forster

Buratini

et al. 1999

Arq. Neuro-Psiquiatr.

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-Frontal lobe epilepsies may present difficulties in focus localization in the pre-operative work-up for epilepsy surgery. This is specially true in patients with normal MRIs. We report on a 16 years-old girl that started with seizures by the age of 8 years. They were brief nocturnal episodes with automatisms such as bicycling and boxing. Seizure frequency ranged from 4-10 per night. Scalp EEG showed few right frontal convexity spiking and intense secondary bilateral syncrhony (SBS). High resolution MRI directed to the frontal lobes was normal. Ictal SPECT suggested a right fronto-lateral focus. Ictal video-EEG showed no focal onset. She was submitted to invasive recordings after subdural plates implantation. Electrodes covered all the frontal convexity and mesial surface bilaterally. Ictal recordings disclosed stereotyped seizures starting from the right mesial frontal. Using a high-resolution tool to measure intra and interhemispheric latencies, the timing and direction of seizure spread from the right fronto-mesial region were studied. Motor strip mapping was performed by means of electrical stimulation. She was submitted to a right frontal lobe resection, 1.5 cm ahead of the motor strip and has been seizure free since surgery (8 months). Pathological examination found a 4 mm area of cortical dysplasia. Invasive studies are needed to allow adequate localization in patients with non-localizatory non-invasive work-up and may lead to excellent results in relation to seizures after surgery.KEY WORDS: frontal lobe epilepsy, surgery, sub-dural electrodes. Sincronia bilateral secundária devido a lesões mesiais: estudo com registros invasivosRESUMO -Podem ocorrer dificuldades na localização de focos nas epilepsias frontais, principalmente nos pacientes que possuem ressonância magnética (RM) normal. Relatamos o caso de uma paciente de 16 anos de idade que começou a apresentar crises convulsivas aos 8 anos. As crises eram breves episódios noturnos que incluíam automatismos tais como pedalar e boxear. A frequência das crises era 4-10 por noite. O eletrencefálograma (EEG) mostrou raras descargas na convexidade frontal direita e intensa sincronia bilateral secundária não localizatória. A RM foi normal e o SPECT ictal sugeriu um foco frontal lateral direito. Realizou-se implante com eletrodos subdurais cobrindo a convexidade frontal e a superfície mesial bilateralmente. Registros ictais mostraram o início das crises na superfície fronto-mesial direita. As latências intra e inter-hemisféricas foram medidas com aparelhagem de alta resolução. O mapeamento da área motora foi realizado através de estimulação elétrica. A paciente foi submetida a ressecção frontal 1,5 cm anterior à área motora. Está sem crises desde a cirurgia há 8 meses. O estudo anátomo-patológico mostrou uma área de 4 mm de displasia cortical. Estudos invasivos são necessários para permitir a localização adequada para o tratamento cirúrgico das epilepsias em pacientes com focos frontais e RM normais. A despeito da maior complexidade, os resultados qua...

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confidence: 99%

Secondary bilateral synchrony due to fronto-mesial lesions: an invasive recording study

Cukiert

Forster

Buratini

et al. 1999

Arq. Neuro-Psiquiatr.

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“…It can pose significant lateralization/localization problems and often necessitates invasive evaluations (table 1). It is well described in frontal lobe epilepsies, especially in the mesial region and is a frequent lateralization conundrum (Marcus and Watson, 1968;Musgrave and Gloor, 1980;Cukiert et al, 1991;Cukiert et al, 1999;Lacruz et al, 2007;Umeoka et al, 2010;Iwasaki et al, 2011). Extensive connectivity between homotopic regions of both frontal lobes is a likely explanation (Lacruz et al, 2007;Iwasaki et al, 2011).…”

Section: Discussionmentioning

confidence: 99%

“…The anatomical location of the cingulate gyrus (CG), medial and distant from the cerebral surface, makes localization of the ictal onset zone difficult. The phenomenon of secondary bilateral synchrony (SBS) increases the lateralization difficulty (Cukiert et al, 1991;Iwasaki et al, 2011). Extensive connectivity demonstrated between homotopic cingulate and mesial frontal regions across the corpus callosum in mammals (Marcus and Watson, 1968;Musgrave and Gloor, 1980;Umeoka et al, 2010;Iwasaki et al, 2011) may provide the basis for the lateralization difficulties encountered in humans.…”

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Lesion‐negative anterior cingulate epilepsy

Lacuey

Davila

Zonjy

et al. 2015

Epileptic Disorders

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MRI‐negative anterior cingulate epilepsy is a rare entity. Herein, we describe a case of MRI and functional imaging‐negative intractable frontal lobe epilepsy in which, initially, secondary bilateral synchrony of surface and intracranial EEG and non‐lateralizing semiology rendered identification of the epileptogenic zone difficult. A staged bilateral stereotactic EEG exploration revealed a very focal, putative ictal onset zone in the right anterior cingulate gyrus, as evidenced by interictal and ictal high‐frequency oscillations (at 250 Hz) and induction of seizures from the same electrode contacts by 50‐Hz low‐intensity cortical stimulation. This was subsequently confirmed by ILAE class 1 outcome following resection of the ictal onset and irritative zones. Histopathological examination revealed focal cortical dysplasia type 1b (ILAE Commission, 2011) as the cause of epilepsy. The importance of anatomo‐electro‐clinical correlation is illustrated in this case in which semiological and electrophysiological features pointed to the anatomical localization of a challenging, MRI‐negative epilepsy. [Published with video sequence]

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“…For example, patients with a clear-cut MRI visible lesion, coherent focal PET hypometabolism, and consistent electro-clinical data, would not require SEEG monitoring. Here, we selected only those patients for whom the definition of EZ was particularly challenging with noninvasive investigations alone because of the deep location of the cingulate gyrus and the frequent propensity for bilateral spread of EEG abnormalities 7,53,54 or because inconsistency of anatomo-electro-clinical correlations.…”

Section: Overview Of Ce Literature and Final Remarks In Light Of Our ...mentioning

confidence: 99%

Stereo-electroencephalography (SEEG)-Guided Surgery in Epilepsy With Cingulate Gyrus Involvement: Electrode Implantation Strategies and Postoperative Seizure Outcome

d’Orio

Revay²,

Bevacqua

et al. 2023

Journal of Clinical Neurophysiology

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Surgical treatment of cingulate gyrus epilepsy is associated with good results on seizures despite its rarity and challenging aspects. Invasive EEG monitoring is often mandatory to assess the epileptogenic zone in these patients. To date, only small surgical series have been published, and a consensus about management of these complex cases did not emerge. The authors retrospectively analyzed a large surgical series of patients in whom at least part of the cingulate gyrus was confirmed as included in the epileptogenic zone by means of stereo-electroencephalography and was thus resected. One hundred twenty-seven patients were selected. Stereoelectroencephalography-guided implantation of intracerebral electrodes was performed in the right hemisphere in 62 patients (48.8%) and in the left hemisphere in 44 patients (34.7%), whereas 21 patients (16.5%) underwent bilateral implantations. The median number of implanted electrodes per patient was 13 (interquartile range 12-15). The median number of electrodes targeting the cingulate gyrus was 4 (interquartile range 3-5). The cingulate gyrus was explored bilaterally in 19 patients (15%). Complication rate was 0.8%. A favorable outcome (Engel class I) was obtained in 54.3% of patients, with a median follow-up of 60 months. The chance to obtain seizure freedom increased in cases in whom histologic diagnosis was type-IIb focal cortical dysplasia or tumor (mostly ganglioglioma or dysembryoplastic neuroepithelial tumor) and with male gender. Higher seizure frequency predicted better outcome with a trend toward significance. Our findings suggest that stereo-electroencephalography is a safe and effective methodology in achieving seizure freedom in complex cases of epilepsy with cingulate gyrus involvement.

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Secondary bilateral synchrony associated to a parasagittal tumor case report

Cited by 6 publications

References 13 publications

Secondary bilateral synchrony due to fronto-mesial lesions: an invasive recording study

Secondary bilateral synchrony due to fronto-mesial lesions: an invasive recording study

Lesion‐negative anterior cingulate epilepsy

Stereo-electroencephalography (SEEG)-Guided Surgery in Epilepsy With Cingulate Gyrus Involvement: Electrode Implantation Strategies and Postoperative Seizure Outcome

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