Secondarily generalized seizures in temporal lobe epilepsy

Bóné, Beáta; Fogarasi, András; Schulz, Reinhard; Gyimesi, Csilla; Kalmár, Zsuzsa; Kovács, Norbert; Ebner, Alois; Janszky, József

doi:10.1111/j.1528-1167.2012.03435.x

Cited by 43 publications

(48 citation statements)

References 36 publications

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“…Bone et al [67] reported a positive association between the presence of hippocampal sclerosis and SGS, which is in agreement with the high proportion of patients with SGS in our series. Nevertheless, SGSs are not uniform entities [68], and the pathophysiology of secondary generalization is still poorly understood.…”

Section: Discussionsupporting

confidence: 93%

Neurotrophin receptors expression in mesial temporal lobe epilepsy with and without psychiatric comorbidities and their relation with seizure type and surgical outcome

Kandratavicius

Hallak

Carlotti

et al. 2014

Acta Neuropathologica Communications

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Epilepsy and psychiatric comorbidities are frequently associated, but their common biological substrate is unknown. We have previously reported altered structural elements and neurotrophins (NTs) expression in mesial temporal lobe epilepsy (MTLE) patients with psychiatric comorbidities. NTs receptors can regulate neurotransmission and promote neuroplasticity, being important candidates in the regulation and manifestation of psychopatological states and seizure-related events. MTLE hippocampi of subjects without psychiatric history, MTLE + major depression, MTLE + interictal psychosis derived from epilepsy surgery, and control necropsies were investigated for p75 NTR , TrkB, TrkA, and TrkC immunohistochemistry. Increased expression of p75 NTR , decreased TrkA, unaltered TrkC, and complex alterations involving TrkB expression were seen in MTLE groups. Increased TrkB expression in patients without complete seizure remission and in those with secondarily generalized seizures was seen. Decreased p75 NTR expression associated with interictal psychosis, and increased TrkB in those with psychosis or major depression was also reported, although their p75 NTR /TrkB ratios were lower than in MTLE without psychiatric comorbidities. Our results provide evidence of alterations in expression of NTs receptors in the epileptogenic hippocampus that are differentially modulated in presence of psychiatric comorbidities. As already explored in animal models, even in chronic human MTLE increased TrkB expression, among other NT receptors alterations, may play a major role in seizure type, frequency and surgery outcome.

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Section: Discussionsupporting

confidence: 93%

Neurotrophin receptors expression in mesial temporal lobe epilepsy with and without psychiatric comorbidities and their relation with seizure type and surgical outcome

Kandratavicius

Hallak

Carlotti

et al. 2014

Acta Neuropathologica Communications

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“…In addition, the presence of early responsiveness, known to be a strong negative predictor for SGTCS in TLE, was systematically tested by asking a question (“what is your name?”) and giving a command (“point to the window!”). Spontaneous signs of awareness of the onset of seizure (e.g., pushing the alarm button to alert the nurse) were also considered as preserved early responsiveness.…”

Section: Methodsmentioning

confidence: 96%

Recurrent secondary generalization in frontal lobe epilepsy: Predictors and a potential link to surgical outcome?

2015

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SUMMARYObjective: Frontal lobe epilepsy (FLE) frequently leads to secondary generalized tonic-clonic seizures (SGTCS). However, little is known about the clinical, electrophysiologic, and radiologic correlates of SGTCS and whether these could influence diagnosis and treatment. Methods: A cohort of 48 patients with confirmed FLE was retrospectively identified and dichotomized into a group with and a group without SGTCS defined by history (≥1/year) or video-electroencephalography (vEEG). Demographics, seizure semiology, vEEG, neuroimaging data, and estimated seizure-onset zone were tabulated, and their association with the occurrence of SGTCS was evaluated with use of a chi-square test. Independent predictors of SGTCS were confirmed using a stepwise multivariate analysis. Similarly, these predictors as well as a history of SGTCS were tested as multivariate predictors of the postoperative International League Against Epilepsy (ILAE) score in the surgical subgroup (n = 25). Results: We identified three independent predictors of a history of SGTCS in FLE, including loss of responsiveness at seizure onset (corrected p = 0.04), a semiology involving early elementary motor signs (corrected p = 0.01), and multifocal spikes on EEG (corrected p = 0.02). A seizure-free outcome occurred in 57% of surgical cases and was more likely in the group without SGTCS (100%, p = 0.001). When considering only SGTCS occurring during video-EEG monitoring, the association with semiology and surgical outcome vanished, but the association with preserved awareness and a multifocal EEG persisted. Significance: A history of SGTCS is related to a specific ictal semiology and interictal EEG, and may have a role in surgical risk stratification.

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“…Moreover, the separate age corrected analysis yielded similar results as the initial analysis. Also, a study by Bone et al (Bone et al, 2012) showed that in patients with SGTCS, age had an effect on video-EEG features rather than on imaging results. Therefore, we argue for the exclusion of an age effect.…”

Section: Limitationsmentioning

confidence: 99%

Multimodal MRI Reveals Secondarily Generalized Seizure Related Abnormalities at 1.5 T: Preliminary Findings

Jansen¹,

Vlooswijk²,

Reijs³

et al. 2015

JMED

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Patients with chronic epilepsy, who have suffered a high number of secondarily generalized tonicclonic seizures (SGTCS) frequently show cognitive comorbidity. It is yet unclear whether a higher number of SGTCS is associated with tissue changes in the brain. We have investigated in patients with chronic epilepsy whether a high number of SGTCS accumulated over life is associated with microstructural changes in brain tissue. Sixteen patients with localization-related epilepsy with SGTCS underwent a multimodal quantitative Magnetic Resonance (MR) examination at 1.5 T, comprising T2 relaxometry, and diffusion weighted imaging to study microstructural changes in the temporal and frontal lobes. Fourteen healthy volunteers were also included to assess the effect of age. Patients with more than 20 SGTCS (n=8) showed a significantly lower IQ (-20%, p<0.05) compared to those with less than 20 SGTCS (n=8). Furthermore, regional combined multimodal analysis revealed that significant quantitative MRI changes, related to the number of SGTCS, were present in the frontal lobe but not in the temporal lobe. Moreover, the left and right frontal lobe generally displayed lower T2 relaxation times, smaller pericortical cerebrospinal fluid fraction and lower apparent diffusion coefficients, in the patients with more than 20 SGTCS. These findings suggest that SGTCS are associated with substantial changes in microstructural brain tissue characteristics within the frontal lobes. These frontal changes possibly explain the cognitive problems which are often observed in patients with many SGTCS. This knowledge may help in the development of treatment aimed at preventing decline in cognitive abilities.

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Secondarily generalized seizures in temporal lobe epilepsy

Cited by 43 publications

References 36 publications

Neurotrophin receptors expression in mesial temporal lobe epilepsy with and without psychiatric comorbidities and their relation with seizure type and surgical outcome

Neurotrophin receptors expression in mesial temporal lobe epilepsy with and without psychiatric comorbidities and their relation with seizure type and surgical outcome

Recurrent secondary generalization in frontal lobe epilepsy: Predictors and a potential link to surgical outcome?

Multimodal MRI Reveals Secondarily Generalized Seizure Related Abnormalities at 1.5 T: Preliminary Findings

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