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EEG-fMRI findings in late seizure recurrence following temporal lobectomy: A possible contribution of area tempestas.

Garganis K, Kokkinos V, Zountsas B - Epilepsy Behav Case Rep (2013)

Bottom Line: Late seizure relapses following temporal lobectomy for drug-resistant temporal lobe epilepsy occur in 18-30% of operated-on cases, and recent evidence suggests that a significant proportion of them are due to maturation and activation of proepileptic tissue having defied initial resection and located at the vicinity of or at a short distance from its borders, usually over the posterior medial, basal temporal-occipital, and lateral temporal regions.This case report of a patient with late seizure relapse, three years following an initially successful right temporal lobectomy for ipsilateral medial temporal sclerosis, is the first one in the literature to demonstrate interictal EEG-fMRI evidence of significant BOLD signal changes over the inferior, basal and lateral temporal and temporooccipital cortices posterior to the resection margin, plus a significant BOLD signal change over the ipsilateral basal frontal region, closely corresponding to the piriform cortex/area tempestas.Our case study provides further functional imaging evidence in support of maturation/activation of proepileptic tissue located at the vicinity of the initial temporal lobe resection in cases of late seizure relapses and suggests, in addition, a possible role for the piriform cortex/area tempestas in the relapsing process.

View Article: PubMed Central - PubMed

Affiliation: Epilepsy Center of Thessaloniki, "St. Luke's" Hospital, Panorama, Thessaloniki, Greece.

ABSTRACT
Late seizure relapses following temporal lobectomy for drug-resistant temporal lobe epilepsy occur in 18-30% of operated-on cases, and recent evidence suggests that a significant proportion of them are due to maturation and activation of proepileptic tissue having defied initial resection and located at the vicinity of or at a short distance from its borders, usually over the posterior medial, basal temporal-occipital, and lateral temporal regions. Experimental studies in animals and functional imaging studies in humans suggest that the area tempestas, a particular region of the basal-frontal piriform cortex, is critical for kindling and initiation and propagation of seizure activity arising from different cortical foci, especially limbic ones. This case report of a patient with late seizure relapse, three years following an initially successful right temporal lobectomy for ipsilateral medial temporal sclerosis, is the first one in the literature to demonstrate interictal EEG-fMRI evidence of significant BOLD signal changes over the inferior, basal and lateral temporal and temporooccipital cortices posterior to the resection margin, plus a significant BOLD signal change over the ipsilateral basal frontal region, closely corresponding to the piriform cortex/area tempestas. Our case study provides further functional imaging evidence in support of maturation/activation of proepileptic tissue located at the vicinity of the initial temporal lobe resection in cases of late seizure relapses and suggests, in addition, a possible role for the piriform cortex/area tempestas in the relapsing process.

No MeSH data available.


Related in: MedlinePlus

EEG–fMRI results of our patient showing discharge-correlated BOLD changes in: A) the right AT (z = 4.04, BOLD+) and the ipsilateral posterior lateral temporal neocortex (z = 3.82, BOLD+); B) the right anterior inferior temporal gyrus (z = 4.77, BOLD−), opposite to the posterior resection border; C) the right posterior inferior temporal gyrus (z = 6.81, BOLD−); and D) the right mesiobasal occipital region (z = 6.07, BOLD−).
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f0010: EEG–fMRI results of our patient showing discharge-correlated BOLD changes in: A) the right AT (z = 4.04, BOLD+) and the ipsilateral posterior lateral temporal neocortex (z = 3.82, BOLD+); B) the right anterior inferior temporal gyrus (z = 4.77, BOLD−), opposite to the posterior resection border; C) the right posterior inferior temporal gyrus (z = 6.81, BOLD−); and D) the right mesiobasal occipital region (z = 6.07, BOLD−).

Mentions: decreased BOLD signal clusters over the right inferior/basal temporal (close to the lateral resection borders), inferior lateral temporooccipital, and posterior mesial/basal occipital regions (at a distance from the posterior resection margin) (Fig. 2B, C, and D, respectively);


EEG-fMRI findings in late seizure recurrence following temporal lobectomy: A possible contribution of area tempestas.

Garganis K, Kokkinos V, Zountsas B - Epilepsy Behav Case Rep (2013)

EEG–fMRI results of our patient showing discharge-correlated BOLD changes in: A) the right AT (z = 4.04, BOLD+) and the ipsilateral posterior lateral temporal neocortex (z = 3.82, BOLD+); B) the right anterior inferior temporal gyrus (z = 4.77, BOLD−), opposite to the posterior resection border; C) the right posterior inferior temporal gyrus (z = 6.81, BOLD−); and D) the right mesiobasal occipital region (z = 6.07, BOLD−).
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4150631&req=5

f0010: EEG–fMRI results of our patient showing discharge-correlated BOLD changes in: A) the right AT (z = 4.04, BOLD+) and the ipsilateral posterior lateral temporal neocortex (z = 3.82, BOLD+); B) the right anterior inferior temporal gyrus (z = 4.77, BOLD−), opposite to the posterior resection border; C) the right posterior inferior temporal gyrus (z = 6.81, BOLD−); and D) the right mesiobasal occipital region (z = 6.07, BOLD−).
Mentions: decreased BOLD signal clusters over the right inferior/basal temporal (close to the lateral resection borders), inferior lateral temporooccipital, and posterior mesial/basal occipital regions (at a distance from the posterior resection margin) (Fig. 2B, C, and D, respectively);

Bottom Line: Late seizure relapses following temporal lobectomy for drug-resistant temporal lobe epilepsy occur in 18-30% of operated-on cases, and recent evidence suggests that a significant proportion of them are due to maturation and activation of proepileptic tissue having defied initial resection and located at the vicinity of or at a short distance from its borders, usually over the posterior medial, basal temporal-occipital, and lateral temporal regions.This case report of a patient with late seizure relapse, three years following an initially successful right temporal lobectomy for ipsilateral medial temporal sclerosis, is the first one in the literature to demonstrate interictal EEG-fMRI evidence of significant BOLD signal changes over the inferior, basal and lateral temporal and temporooccipital cortices posterior to the resection margin, plus a significant BOLD signal change over the ipsilateral basal frontal region, closely corresponding to the piriform cortex/area tempestas.Our case study provides further functional imaging evidence in support of maturation/activation of proepileptic tissue located at the vicinity of the initial temporal lobe resection in cases of late seizure relapses and suggests, in addition, a possible role for the piriform cortex/area tempestas in the relapsing process.

View Article: PubMed Central - PubMed

Affiliation: Epilepsy Center of Thessaloniki, "St. Luke's" Hospital, Panorama, Thessaloniki, Greece.

ABSTRACT
Late seizure relapses following temporal lobectomy for drug-resistant temporal lobe epilepsy occur in 18-30% of operated-on cases, and recent evidence suggests that a significant proportion of them are due to maturation and activation of proepileptic tissue having defied initial resection and located at the vicinity of or at a short distance from its borders, usually over the posterior medial, basal temporal-occipital, and lateral temporal regions. Experimental studies in animals and functional imaging studies in humans suggest that the area tempestas, a particular region of the basal-frontal piriform cortex, is critical for kindling and initiation and propagation of seizure activity arising from different cortical foci, especially limbic ones. This case report of a patient with late seizure relapse, three years following an initially successful right temporal lobectomy for ipsilateral medial temporal sclerosis, is the first one in the literature to demonstrate interictal EEG-fMRI evidence of significant BOLD signal changes over the inferior, basal and lateral temporal and temporooccipital cortices posterior to the resection margin, plus a significant BOLD signal change over the ipsilateral basal frontal region, closely corresponding to the piriform cortex/area tempestas. Our case study provides further functional imaging evidence in support of maturation/activation of proepileptic tissue located at the vicinity of the initial temporal lobe resection in cases of late seizure relapses and suggests, in addition, a possible role for the piriform cortex/area tempestas in the relapsing process.

No MeSH data available.


Related in: MedlinePlus