Magnetoencephalography localizing spike sources of atypical benign partial epilepsy

Hideaki Shiraishi; Kazuhiro Haginoya; Eiji Nakagawa; Shinji Saitoh; Yutaka Kaneko; Nobukazu Nakasato; Derrick Chan; Hiroshi Otsubo

doi:10.1016/j.braindev.2012.12.011

Magnetoencephalography localizing spike sources of atypical benign partial epilepsy

Brain Dev. 2014 Jan;36(1):21-7. doi: 10.1016/j.braindev.2012.12.011. Epub 2013 Feb 4.

Authors

Hideaki Shiraishi¹, Kazuhiro Haginoya², Eiji Nakagawa³, Shinji Saitoh¹, Yutaka Kaneko⁴, Nobukazu Nakasato⁵, Derrick Chan⁶, Hiroshi Otsubo⁷

Affiliations

¹ Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.
² Department of Pediatrics, Tohoku University School of Medicine, Sendai, Miyagi, Japan.
³ Department of Neurology, National Hospital for Mental, Nervous and Muscular Disorders, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan.
⁴ Department of Neurosurgery, National Hospital for Mental, Nervous and Muscular Disorders, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan.
⁵ Department of Epileptology, Tohoku University School of Medicine, Sendai, Miyagi, Japan.
⁶ Division of Neurology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Neurology Service, Department of Pediatric Medicine, KK Women's and Children's Hospital, Singapore.
⁷ Division of Neurology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. Electronic address: [email protected].

PMID: 23384398
DOI: 10.1016/j.braindev.2012.12.011

Abstract

Rationale: Atypical benign partial epilepsy (ABPE) is characterized by centro-temporal electroencephalography (EEG) spikes, continuous spike and waves during sleep (CSWS), and multiple seizure types including epileptic negative myoclonus (ENM), but not tonic seizures. This study evaluated the localization of magnetoencephalography (MEG) spike sources (MEGSSs) to investigate the clinical features and mechanism underlying ABPE.

Methods: We retrospectively analyzed seizure profiles, scalp video EEG (VEEG) and MEG in ABPE patients.

Results: Eighteen ABPE patients were identified (nine girls and nine boys). Seizure onset ranged from 1.3 to 8.8years (median, 2.9years). Initial seizures consisted of focal motor seizures (15 patients) and absences/atypical absences (3). Seventeen patients had multiple seizure types including drop attacks (16), focal motor seizures (16), ENM (14), absences/atypical absences (11) and focal myoclonic seizures (10). VEEG showed centro-temporal spikes and CSWS in all patients. Magnetic resonance imaging (MRI) was reported as normal in all patients. MEGSSs were localized over the following regions: both Rolandic and sylvian (8), peri-sylvian (5), peri-Rolandic (4), parieto-occipital (1), bilateral (10) and unilateral (8). All patients were on more than two antiepileptic medications. ENM and absences/atypical absences were controlled in 14 patients treated with adjunctive ethosuximide.

Conclusion: MEG localized the source of centro-temporal spikes and CSWS in the Rolandic-sylvian regions. Centro-temporal spikes, Rolandic-sylvian spike sources and focal motor seizures are evidence that ABPE presents with Rolandic-sylvian onset seizures. ABPE is therefore a unique, age-related and localization-related epilepsy with a Rolandic-sylvian epileptic focus plus possible thalamo-cortical epileptic networks in the developing brain of children.

Keywords: Atypical absence; Centro-temporal spike; Continuous spike and waves during sleep; Epileptic negative myoclonus; Focal seizure; Secondary bilateral synchrony.

MeSH terms

Adolescent
Anticonvulsants / therapeutic use
Brain / physiopathology*
Brain Mapping
Brain Waves / drug effects
Brain Waves / physiology*
Child
Child, Preschool
Cognition Disorders / etiology
Electroencephalography
Epilepsies, Partial / complications*
Epilepsies, Partial / drug therapy
Epilepsies, Partial / pathology
Ethosuximide / therapeutic use
Female
Humans
Infant
Magnetic Resonance Imaging
Magnetoencephalography*
Male
Retrospective Studies

Substances

Anticonvulsants
Ethosuximide