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Hippocampal seizure-onset laterality can change over long timescales: A same-patient observation over 500 days.

Smart O, Rolston JD, Epstein CM, Gross RE - Epilepsy Behav Case Rep (2013)

Bottom Line: This study describes seizure laterality and localization changes over 500 consecutive days in a patient with bilateral temporal lobe epilepsy (BTLE) and implanted NeuroPace RNS™ System.During a continuous two-year time period, the RNS™ device stored 54 hippocampal electrocorticography (ECoG) seizures, which we analyzed to determine their distribution and time variance across hippocampi.This case suggests that hippocampal seizures dynamically progress over extensive timescales.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Emory University School of Medicine, Woodruff Memorial Research Building, 101 Woodruff Circle, Room 6329, Atlanta, GA 30322, USA.

ABSTRACT
This study describes seizure laterality and localization changes over 500 consecutive days in a patient with bilateral temporal lobe epilepsy (BTLE) and implanted NeuroPace RNS™ System. During a continuous two-year time period, the RNS™ device stored 54 hippocampal electrocorticography (ECoG) seizures, which we analyzed to determine their distribution and time variance across hippocampi. We report nonrandom long-term seizure laterality and localization variations, especially in the first 200 days postimplant, despite equivalent total seizure counts in both hippocampi. This case suggests that hippocampal seizures dynamically progress over extensive timescales.

No MeSH data available.


Related in: MedlinePlus

Intraoperative (A–E) and extraoperative (F–G) recordings from both hippocampi. (A) Left and (B) right hippocampal action potentials (APs). (C) Left side with interictal spikes and (D) right side without interictal spikes. (E) Left interictal spikes (red) coincided with multiunit AP bursts (black). (F) The 1st and (G) 54th ECoG seizures with L1 and R1 SOZs, respectively (arrow). The RNS™ delivers therapy upon seizure detection (vertical line).
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f0010: Intraoperative (A–E) and extraoperative (F–G) recordings from both hippocampi. (A) Left and (B) right hippocampal action potentials (APs). (C) Left side with interictal spikes and (D) right side without interictal spikes. (E) Left interictal spikes (red) coincided with multiunit AP bursts (black). (F) The 1st and (G) 54th ECoG seizures with L1 and R1 SOZs, respectively (arrow). The RNS™ delivers therapy upon seizure detection (vertical line).

Mentions: A track per DBS lead (NeuroPace, Mountain View, CA) targeted each anterior hippocampus using the microTargeting WayPoint Planner 2.0 software (FHC, Inc., Bowdoin, ME). Occipital lead entry points were chosen to avoid the ventricles, prominent veins, and arteries as visualized by the preoperative coregistered volumetric MRI and CT scans. On each side, a recording (Figs. 2A–E) was performed before implanting one four-electrode DBS lead, which was then connected to the pulse generator embedded in the right side of the skull (Fig. 1A).


Hippocampal seizure-onset laterality can change over long timescales: A same-patient observation over 500 days.

Smart O, Rolston JD, Epstein CM, Gross RE - Epilepsy Behav Case Rep (2013)

Intraoperative (A–E) and extraoperative (F–G) recordings from both hippocampi. (A) Left and (B) right hippocampal action potentials (APs). (C) Left side with interictal spikes and (D) right side without interictal spikes. (E) Left interictal spikes (red) coincided with multiunit AP bursts (black). (F) The 1st and (G) 54th ECoG seizures with L1 and R1 SOZs, respectively (arrow). The RNS™ delivers therapy upon seizure detection (vertical line).
© Copyright Policy - CC BY-NC-SA
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4150592&req=5

f0010: Intraoperative (A–E) and extraoperative (F–G) recordings from both hippocampi. (A) Left and (B) right hippocampal action potentials (APs). (C) Left side with interictal spikes and (D) right side without interictal spikes. (E) Left interictal spikes (red) coincided with multiunit AP bursts (black). (F) The 1st and (G) 54th ECoG seizures with L1 and R1 SOZs, respectively (arrow). The RNS™ delivers therapy upon seizure detection (vertical line).
Mentions: A track per DBS lead (NeuroPace, Mountain View, CA) targeted each anterior hippocampus using the microTargeting WayPoint Planner 2.0 software (FHC, Inc., Bowdoin, ME). Occipital lead entry points were chosen to avoid the ventricles, prominent veins, and arteries as visualized by the preoperative coregistered volumetric MRI and CT scans. On each side, a recording (Figs. 2A–E) was performed before implanting one four-electrode DBS lead, which was then connected to the pulse generator embedded in the right side of the skull (Fig. 1A).

Bottom Line: This study describes seizure laterality and localization changes over 500 consecutive days in a patient with bilateral temporal lobe epilepsy (BTLE) and implanted NeuroPace RNS™ System.During a continuous two-year time period, the RNS™ device stored 54 hippocampal electrocorticography (ECoG) seizures, which we analyzed to determine their distribution and time variance across hippocampi.This case suggests that hippocampal seizures dynamically progress over extensive timescales.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Emory University School of Medicine, Woodruff Memorial Research Building, 101 Woodruff Circle, Room 6329, Atlanta, GA 30322, USA.

ABSTRACT
This study describes seizure laterality and localization changes over 500 consecutive days in a patient with bilateral temporal lobe epilepsy (BTLE) and implanted NeuroPace RNS™ System. During a continuous two-year time period, the RNS™ device stored 54 hippocampal electrocorticography (ECoG) seizures, which we analyzed to determine their distribution and time variance across hippocampi. We report nonrandom long-term seizure laterality and localization variations, especially in the first 200 days postimplant, despite equivalent total seizure counts in both hippocampi. This case suggests that hippocampal seizures dynamically progress over extensive timescales.

No MeSH data available.


Related in: MedlinePlus