Electroclinical characteristics of MRI negative focal epilepsy:  A video-EEG study

Aleksandar J. Ristić; Aleksandra  Arsić; Goran  Trajković; Ivana  Berisavac; Bojana Kisić

doi:10.2298/VSP180511152R

Aleksandar J. Ristić University of Belgrade, Faculty of Medicine, Clinical Center of Serbia, Clinic of Neurology , Belgrade, Serbia
Aleksandra Arsić Institute of Occupational Health Care „Serbian Railways“, Service of Laboratory Diagnostics -Biohemical and Hematology Laboratory, Novi Sad, Serbia
Goran Trajković University of Belgrade, Faculty of Medicine, Clinical Center of Serbia, Institute of Medical Statistics and Informatics, Belgrade, Serbia
Ivana Berisavac University of Belgrade, Faculty of Medicine, Clinical Center of Serbia, Clinic of Neurology, Belgrade, Serbia
Bojana Kisić University of Priština, Faculty of Medicine, Institute of Biochemistry, Kosovska Mitrovica, Serbia

DOI: https://doi.org/10.2298/VSP180511152R

Keywords: brain, diagnosis, electroencephalography, epilepsies, partial, hippocampus, magnetic resonance imaging

Abstract

Background/Aim. Epileptogenic lesions carry intrinsic epileptogenicity or epileptogenic potential in their close vicinity. One third of patients with focal epilepsy have no epileptogenic lesions magnetic resonance imaging [MRI(-)]. The aim of this study was to determine the epileptogenic zone investigating electrical and clinical properties of MRI- patients. Methods. In 180 patients with focal epilepsy we analyzed 1,712 seizures for interictal and ictal electroencephalography (EEG) and seizure semiology. If multiple seizures occurred we took the best seen on video as an example, with secondary generalized tonic-clonic seizures (GTCS) if it occurred. Brain MRI was focused to investigate the zone of ictal EEG onset. Electroclinical properties of the MRI- patients were compared to lesion positive patients [MRI(+)]. Results. A single epileptogenic lesion was identified in 68.89% [hippocampal sclerosis (HS) in 58, focal cortical dysplasia (FCD) in 28 and other pathologies in 38 patients]. MRI(-) patients had significantly less interictal epileptiform abnormalities, and presented more often (p < 0.001) with secondary GTCS as the only seizure. Eye opening, hypermotor seizure, bilateral asymmetric clonic seizure, vocalization, and contralateral body turning occurred more frequently in the MRI- group compared to the MRI+ one. MRI- patients share some semiological features with FCD as opposed to HS patients. Conclusion. MRI- epilepsy patients frequently present with electroclinical features seen in frontal lobe epilepsy or in epilepsy associated with FCD.

References

Bien CG, Szinay M, Wagner J, Clusmann H, Becker AJ, Urbach H. Characteristics and surgical outcomes of patients with re-fractory magnetic resonance imaging-negative epilepsies. Arch Neurol 2009; 66(12): 1491‒9.

Berg AT, Vickrey BG, Langfitt JT, Sperling MR, Walczak TS, Shinnar S, et al. The multicenter study of epilepsy surgery: re-cruitment and selection for surgery. Epilepsia 2003; 44(11): 1425‒33.

McGonigal A, Bartolomei F, Régis J, Guye M, Gavaret M, Trébu-chon-Da Fonseca A, et al. Stereoelectroencephalography in pre-surgical assessment of MRI-negative epilepsy. Brain 2007; 130(Pt 12): 3169‒83.

Kotagal P, Lüders HO, Williams G, Nichols TR, McPherson J. Psychomotor seizures of temporal lobe onset: analysis of symptom clusters and sequences. Epilepsy Res 1995; 20(1): 49‒67.

Kotagal P, Arunkumar G, Hammel J, Mascha E. Complex partial seizures of frontal lobe onset statistical analysis of ictal semi-ology. Seizure 2003; 12(5): 268‒81.

Theodore WH, Porter RJ, Albert P, Kelley K, Bromfield E, Devinsky O, et al. The secondarily generalized tonic-clonic seizure: a videotape analysis. Neurology 1994; 44(8): 1403‒7.

Salanova V, Morris HH 3rd, Van Ness PC, Lüders H, Dinner D, Wyllie E. Comparison of scalp electroencephalogram with subdural electrocorticogram recordings and functional map-ping in frontal lobe epilepsy. Arch Neurol 1993; 50(3): 294‒9.

Lee SK, Lee SY, Kim KK, Hong KS, Lee DS, Chung CK. Surgical outcome and prognostic factors of cryptogenic neocortical epilepsy. Ann Neurol 2005; 58(4): 525‒32.

Scott CA, Fish DR, Smith SJ, Free SL, Stevens JM, Thompson PJ, et al. Presurgical evaluation of patients with epilepsy and normal MRI: role of scalp video-EEG telemetry. J Neurol Neurosurg Psychiatry 1999; 66(1): 69‒71.

Rasmussen T. Characteristics of a pure culture of frontal lobe epilepsy. Epilepsia 1983; 24(4): 482‒93.

Laskowitz DT, Sperling MR, French JA, O'Connor MJ. The syn-drome of frontal lobe epilepsy: characteristics and surgical management. Neurology 1995; 45(4): 780‒7.

Harvey AS, Hopkins IJ, Bowe JM, Cook DJ, Shield LK, Berkovic SF. Frontal lobe epilepsy: clinical seizure characteristics and localization with ictal 99mTc-HMPAO SPECT. Neurology 1993; 43(10): 1966‒80.

Lee JJ, Lee SK, Lee SY, Park KI, Kim DW, Lee DS, et al. Fron-tallobe epilepsy: clinical characteristics, surgical outcomes and diagnostic modalities. Seizure 2008; 17(6): 514‒23.

Blumenfeld H, Westerveld M, Ostroff RB, Vanderhill SD, Freeman J, Necochea A, et al. Selective frontal, parietal, and temporal networks in generalized seizures. Neuroimage 2003; 19(4): 1556‒66.

Stüve O, Dodrill CB, Holmes MD, Miller JW. The absence of in-terictal spikes with documented seizures suggests extratem-poral epilepsy. Epilepsia 2001; 42(6): 778‒81.

Manford M, Fish DR, Shorvon SD. An analysis of clinical seizure patterns and their localizing value in frontal and temporal lobe epilepsies. Brain 1996; 119( Pt 1): 17‒40.

Wong CH, Mohamed A, Larcos G, McCredie R, Somerville E, Bleasel A. Brain activation patterns of versive, hypermotor, and bilateral asymmetric tonic seizures. Epilepsia 2010; 51(10): 2131‒9.

Janszky J, Fogarasi A, Jokeit H, Ebner A. Are ictal vocalisations related to the lateralisation of frontal lobe epilepsy? J Neurol Neurosurg Psychiatry 2000; 69(2): 244‒7.

Urbach H, Hattingen J, von Oertzen J, Luyken C, Clusmann H, Kral T, et al. MR imaging in the presurgical workup of patients with drug-resistant epilepsy. AJNR Am J Neuroradiol 2004; 25(6): 919‒26.

Henkel A, Noachtar S, Pfänder M, Lüders HO. The localizing value of the abdominal aura and its evolution: a study in focal epilepsies. Neurology 2002; 58(2): 271‒6.

Kotagal P, Lüders H, Morris HH, Dinner DS, Wyllie E, Godoy J, et al. Dystonic posturing in complex partial seizures of tem-poral lobe onset: a new lateralizing sign. Neurology 1989; 39(2 Pt 1): 196‒201.