Clinical features of sleep‐related hypermotor epilepsy in relation to the seizure‐onset zone: A review of 135 surgically treated cases

Gibbs, Steve A.; Proserpio, Paola; Francione, Stefano; Mai, Roberto; Cardinale, Francesco; Sartori, Ivana; Castana, Laura; Plazzi, Giuseppe; Tinuper, Paolo; Cossu, Massimo; Russo, Giorgio Lo; Tassi, Laura; Nobili, Lino

doi:10.1111/epi.14690

Cited by 55 publications

(54 citation statements)

References 41 publications

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“…Nonintegrated gestural motor behaviors including hyperkinetic movements without emotional content have been reported in seizures arising from premotor and lateral prefrontal regions 26 and the temporal lobe, 32 and also from operculo‐insular and parietal lobes 33 . This is proposed to reflect seizure spread to mesial frontal lobes including SMAs and cingulate gyrus 24,34 .…”

Section: Discussionmentioning

confidence: 99%

Semiologic subgroups of insulo‐opercular seizures based on connectional architecture atlas

et al. 2020

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Objective: Insulo-opercular seizures are characterized by diverse semiology, related to the insula's multiple functional roles and extensive connectivity. We aimed to identify semiologic subgroups and correlate these with insulo-opercular subregions based on connectional architecture. Methods: We retrospectively collected a large series of 37 patients with insuloopercular seizures explored by stereoelectroencephalography (SEEG) from three epilepsy centers. A new human brain atlas (Brainnetome Atlas, BNA) based on both anatomic and functional connections was employed to segment insulo-opercular cortex. Semiology and SEEG changes were carefully reviewed and quantified. Principal component analysis and cluster analysis were used to correlate semiologic characteristics with insulo-opercular subregions. Results: Four main semiologic subgroups were identified, organized along an anteroventral to posterodorsal axis based on BNA. Group 1 was characterized by epigastric sensation and/or integrated gestural motor behaviors with or without feelings of fear or rage, involving the anteroventral insular regions and mesial temporal lobes. Group 2 was characterized by auditory sensations and symmetric proximal/axial tonic signs involving the posteroventral temporal operculum. The characteristics of group 3 were orofacial and laryngeal signs, involving the intermediate insulo-opercular regions.The features of group 4 were somatosensory signs followed by nonintegrated gestural motor behaviors and/or asymmetric tonic signs involving the posterodorsal insuloopercular regions with propagation to the mesial frontal lobes. Thus anteroventral seizure organizations predominantly showed limbic system semiology, whereas more posterodorsal regions were associated with semiology involving mainly the sensorimotor system. Subjective symptoms proved to be particularly discriminating factors. Significance: Insulo-opercular seizures can be categorized in terms of clinical semiology and correlate with connectional architecture subregions along an anteroventral-posterodorsal axis in line with the cytoarchitectonic gradient rather than the gyral anatomy [Corrections added on May 13, 2020, after first online publication: Affiliations of authors "Xiu Wang" and "Xiao Wang" were changed from 5 and 6 to 4 and 5.] | 985 WANG et Al.

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Section: Discussionmentioning

confidence: 99%

Semiologic subgroups of insulo‐opercular seizures based on connectional architecture atlas

et al. 2020

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“…Characterizing the electroclinical pattern of hyperkinetic seizures and predicting the seizure onset zone (SOZ) is difficult. Previous studies have compared semiologic features that could allow differentiation of frontal seizures from temporal seizures, 9,10 between different frontal seizures, 11 or between frontal and extrafrontal seizures 12 …”

Section: Introductionmentioning

confidence: 99%

Quantitative analysis of hyperkinetic seizures and correlation with seizure onset zone

et al. 2020

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Objective: Hyperkinetic epileptic seizures (HKS) are difficult to characterize and localize according to semiologic features. We propose a multicriteria scale to help visual analysis and report results of cerebral localization. Methods: We assessed seizures from 37 patients with HKS, explored with stereoelectroencephalography during presurgical evaluation. We used a multicriteria scale (hyperkinetic seizure scale [HSS]) with 10 semiologic features, scored independently by two neurologists. The item scores were used to group seizures using the k-means method. Semiologic features were correlated with the seizure onset zone (SOZ) localization (temporal, prefrontal dorsolateral, prefrontal ventromesial, parietal, insular). Results: Fifty-five seizures were analyzed, and each item of the HSS was compared between the two examiners with good interrater agreement (85.3%). Dystonia, integrated behavior, and bilateral or unilateral hyperkinetic movements were statistically significant according to localization. Three clusters were identified according to the HSS and correlated with different patterns of anatomic localization of SOZ. Cluster 1 was characterized clinically by asymmetric hyperkinetic movements associated with marked dystonia and vocalization. It mainly included parietal seizures. Cluster 2 was characterized by bilateral and symmetrical stereotyped hyperkinetic movements without dystonia. It represented half of temporal seizures and one-third of prefrontal seizures (dorsolateral). Cluster 3 was characterized by seizures with strong emotionality and vocalization with bilateral and symmetrical hyperkinetic movements and integrated behavior. It involved half of temporal seizures and a majority of prefrontal (ventromesial) seizures. Significance: We propose a first attempt to quantify clinical patterns of HKS. The HSS may help to predict SOZ localization according to three main groups of hyperkinetic seizures. K E Y W O R D S classification, focal seizures, hyperkinetic seizures, SEEG 1020 |

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“…Sleep-related hypermotor epilepsy (SHE), previously named nocturnal frontal lobe epilepsy (NFLE), is a focal epilepsy characterized by a wide spectrum of seizures occurring predominantly during sleep. 1 The diagnosis relies principally on the clinical history and video-electroencephalography (EEG) documentation of seizures. 2 SHE includes hyperkinetic seizures (Video S1) associated with possible asymmetric-tonic attacks, dystonic postures, 1,2 seizures with paroxysmal arousals (SPAs) (Video S2), and epileptic nocturnal wandering.…”

Section: Introductionmentioning

confidence: 99%

Seizures with paroxysmal arousals in sleep‐related hypermotor epilepsy (SHE): Dissecting epilepsy from NREM parasomnias

et al. 2020

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Objective: Sleep-related hypermotor epilepsy (SHE) is a focal epilepsy characterized by seizures occurring mostly during sleep, ranging from brief seizures with paroxysmal arousals (SPAs) to hyperkinetic seizures and ambulatory behaviors. SPAs are brief and stereotypic seizures representing the beginning of a major seizure. Distinguishing SPAs from disorders of arousal (DOAs) and their briefest episodes called simple arousal movements (SAMs) is difficult. We performed a characterization of SPAs and SAMs to identify video-polysomnographic (VPSG) features that can contribute to the diagnosis of SHE or DOA. Methods: Fifteen SHE, 30 DOA adult patients, and 15 healthy subjects underwent full-night VPSG. Two neurologist experts in sleep disorders and epilepsy classified all the sleep-related movements and episodes recorded. For each SPAs and SAMs, sleep stage at onset, duration, limb involvement, progression, and semiology have been identified. Results: A total of 121 SPAs were recorded, emerging mostly during stage 1-2 nonrapid eye movement (NREM) sleep (median duration: 5 seconds). At the beginning, the SPAs motor pattern was hyperkinetic in 78 cases (64%), involving more than three non-contiguous or all body parts. The standard was a constant progression of movements during SPAs without any motor arrests. In DOA patients a total of 140 SAMs were recorded (median duration: 12 seconds) mostly emerging during stage 3 NREM sleep. In SAMs, we did not observe any tonic/dystonic or hypermotor patterns or stereotypy; motor arrest was present over the course of about half of the episodes. In comparison with both DOA and healthy subjects, SHE patients showed a higher number of sleep-related movements per night and a reduction of sleep efficiency. Significance: SPAs and SAMs present different semiological and clinical features. Their recognition could be useful to drive the diagnosis when major episodes are not recorded during VPSG in patients with a clear clinical history of SHE or DOA.

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Clinical features of sleep‐related hypermotor epilepsy in relation to the seizure‐onset zone: A review of 135 surgically treated cases

Cited by 55 publications

References 41 publications

Semiologic subgroups of insulo‐opercular seizures based on connectional architecture atlas

Semiologic subgroups of insulo‐opercular seizures based on connectional architecture atlas

Quantitative analysis of hyperkinetic seizures and correlation with seizure onset zone

Seizures with paroxysmal arousals in sleep‐related hypermotor epilepsy (SHE): Dissecting epilepsy from NREM parasomnias

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