Interictal and Ictal MEG in presurgical evaluation for epilepsy surgery

Although presurgical evaluation of patients with pharamacoresistent focal epilepsies provides essential information for successful epilepsy surgery,there is still a need for further improvement.Developments of noninvasive electrophysiological recording and analysis techniques offer additional information based on interictal and ictal epileptic activities.In this review,we provide an overview on the application of ictal magnetoencephalography(MEG).The results of a literature research for published interictal/ictal MEG findings and experiences with own cases are demonstrated and discussed.Ictal MEG may provide added value in comparison to interictal recordings.The results may be more focal and closer to the invasively determined seizure onset zone.In some patients without clear interictal findings,ictal MEG could provide correct localization.Novel recording and analysis techniques facilitate ictal recordings.However,extended recording durations,movement and artifacts still represent practical limitations.Ictal MEG may provide added value regarding the localization of the seizure onset zone but depends on the selection of patients and the application of optimal analysis techniques.

The Relationship between Aggressiveness and Gender in Patients with Temporal Lobe Epilepsy

Purpose: To examine the impact of gender and social gender on the level and typology of interictal aggressiveness in patients with temporal lobe epilepsy. Material and Methods: 40 adult patients with Temporal Lobe Epilepsy (TLE) and 86 healthy individuals were included. The qualitative and quantitative aggressiveness assess- ment was made with Buss-Durkee Hostility Inventory. The gender role behavior was measured with Bem Sex Role Inventory. Results: Patients with TLE didn’t differ from healthy subjects on the total scores of motor and attitudinal hostility components, but scored higher on subscales “resentment” and “guilt”. The comparative gender analysis showed there were no phenomenological differences in people with TLE. Assault dominated in healthy male subjects, resentment—in healthy female subjects. The prevalence of feminine social gender type was significantly higher in people with TLE in comparison to healthy people (55% vs. 26%, p 0.01). In patients with TLE, the number of masculine traits positively correlated with indirect hostility subscale and attitudinal hostility component scores. In healthy subjects, the masculine traits positively correlated with assault.

Clinical Characteristics of Headache in Egyptian Patients with Idiopathic Epilepsy

Purpose: Headache and epilepsy are common neurological disorders and their relationship is still incompletely known. The purpose of our work was to estimate the most common types of primary headache syndromes and its relation to seizure timing in epileptic patients in Upper Egypt. Patients & Methods: In a cross-sectional study, we evaluated headaches in 100 consecutive patients with idiopathic epilepsy attending the neurology outpatient clinic and the epilepsy clinic at Sohag university hospital by complete medical history, physical and neurologic examination EEG and CT brain. Results: Of our study population, 78% of patients with epilepsy reported headaches. Migraine occurred in 70.6% of patients with headache followed by tension-type headache in 25.58% of patients and other types of headaches occurred in 2.56% of patients. There were 8 patients (10.1%) had a pre-ictal headache, 52 patients (66.5%) had a postictal headache and 39 patients (50%) had an interictal headache. In our study, we found that the occurrence of headache being linked to the female sex, lower mean age, lower mean age at the onset of epilepsy, focal epilepsy, longer duration of epilepsy, high frequency of seizures and the use of polytherapy of antiepileptics. Conclusion: Headache especially migraine is an important comorbidity of epilepsy and should receive more attention especially in female patients, patients with younger age, lower mean age at epilepsy onset, longer duration of the disease, patients on polytherapy, patients with higher frequency of seizures and patients with focal epilepsy.

Expert consensus on clinical applications of high-frequency oscillations in epilepsy

Studies in animal models of epilepsy and pre-surgical patients have unanimously found a strong correlation between high-frequency oscillations(HFOs,>80 Hz)and the epileptogenic zone,suggesting that HFOs can be a potential biomarker of epileptogenicity and epileptogenesis.This consensus includes the definition and standard detection techniques of HFOs,the localizing value of pathological HFOs for epileptic foci,and different ways to distinguish physiological from epileptic HFOs.The latest clinical applications of HFOs in epilepsy and the related findings are also discussed.HFOs will advance our understanding of the pathophysiology of epilepsy.