Quantitative analysis of hyperkinetic seizures and correlation with seizure onset zone

Abstract

Objective: Hyperkinetic epileptic seizures (HKS) are difficult to characterize and localize according to semiologic features. We propose a multicriteria scale to help visual analysis and report results of cerebral localization. Methods: We assessed seizures from 37 patients with HKS, explored with stereoelectroencephalography during presurgical evaluation. We used a multicriteria scale (hyperkinetic seizure scale [HSS]) with 10 semiologic features, scored independently by two neurologists. The item scores were used to group seizures using the k-means method. Semiologic features were correlated with the seizure onset zone (SOZ) localization (temporal, prefrontal dorsolateral, prefrontal ventromesial, parietal, insular). Results: Fifty-five seizures were analyzed, and each item of the HSS was compared between the two examiners with good interrater agreement (85.3%). Dystonia, integrated behavior, and bilateral or unilateral hyperkinetic movements were statistically significant according to localization. Three clusters were identified according to the HSS and correlated with different patterns of anatomic localization of SOZ. Cluster 1 was characterized clinically by asymmetric hyperkinetic movements associated with marked dystonia and vocalization. It mainly included parietal seizures. Cluster 2 was characterized by bilateral and symmetrical stereotyped hyperkinetic movements without dystonia. It represented half of temporal seizures and one-third of prefrontal seizures (dorsolateral). Cluster 3 was characterized by seizures with strong emotionality and vocalization with bilateral and symmetrical hyperkinetic movements and integrated behavior. It involved half of temporal seizures and a majority of prefrontal (ventromesial) seizures. Significance: We propose a first attempt to quantify clinical patterns of HKS. The HSS may help to predict SOZ localization according to three main groups of hyperkinetic seizures. K E Y W O R D S classification, focal seizures, hyperkinetic seizures, SEEG 1020 |

Sleep-Related Hypermotor Epilepsy: Etiology, Electro-Clinical Features, and Therapeutic Strategies

“…96,97 Readings from subdural electrodes in a hypermotor patient with a temporal pole lesion confirmed that the low-voltage fast activity at the seizure's onset began in the inferolateral anterior temporal lobe, and the patient developed hypermobility symptoms when a slow-wave rhythm appeared in the OFC, indicating that hypermotor seizures associated with temporal pole lesions are caused by the spread of discharges to the frontal lobes. 91,94 The SEEG data also confirmed that the temporal pole and OFC are the most important in the HMS epileptogenic network of temporal lobe origin and that the amygdala is also involved. 97 As previously mentioned, the diminished correlation between these emotional network structures in the temporal pole and the OFC results in emotion-related release signs.…”

“…5 The correlation between semiology pattern typing and the SOZ of both Gibbs 5 and Rheims 52 methods follows the same rule: from the rostral to the caudal side of the frontal lobe, the hypermotor symptoms range from complex to simple, from relatively coordinated to uncoordinated or unnatural hypermotor movements (often manifested as asymmetrical hypermotor movements with dystonia), with more emotional responses on the ventral side of the medial prefrontal lobe. 90,91 The OFC, dorsolateral prefrontal cortex, amygdala, and ACC are key structures primarily involved in the emotional regulation circuit, and abnormalities in one of these interconnected structures or their interconnections can alter emotional regulation and increase impulsive aggression and violent tendencies. 92 Using a computational model of EEG activity and nonlinear correlation analysis, the correlations between certain specific structures of the emotional network (eg, the amygdala, OFC, ACC, and temporal pole) were found to be significantly reduced in patients with frontal lobe epilepsy during the ictal phase compared to those during the background phase; in particular, the correlation between the OFC and amygdala was the most pronounced, thus leading to inhibition dissolution of negative emotions and corresponding agitated behaviors.…”

“…In addition to the postcentral gyrus, the parietal cortex includes the superior parietal lobule, inferior parietal lobule, and parietal operculum. 103 In previous studies, the main clinical features of parietal SHE included asymmetric "hypermotor" events and dystonia 91 and were associated with an SOZ in the inferior parietal lobule, parietal operculum, or posterior cingulate cortex (PCC). 91,104,105 Bartolomei et al analyzed 17 patients with epilepsy in the posterior parietal cortex (including the superior parietal lobule, inferior parietal lobule, and parietal operculum), 105 of whom four patients with EZs located in the parietal operculum or inferior parietal lobule exhibited hypermotor movements and dystonic or tonic posture, tending to fit the HMS type 2 or SP1 and SP2 (Figure 2).…”

On seizure semiology

“…72 Regions of primary and unimodal cortex have sparse connectivity between them, in contrast to multimodal and transmodal regions of cortex, which are densely connected to allow binding of distributed information. 72 Following on from this distinction between unimodal and multimodal cortex, a spatial hierarchy of semiology with regard to cortical involvement of seizure organization could be posited, in which more elementary signs with highly specific relation to cortical localization are likely to involve unimodal cortex; whereas more complex signs or constellations of signs, which are relatively non-specific for individual cortical regions (eg, hyperkinetic motor behavior 73 ) or which may depend on widespread cortical involvement (eg, altered consciousness 66,71 ) would be related to dynamic effects involving higher-level, multi-modal or transmodal cortex and their cortical and subcortical connections.…”

A Multi-Stream Approach for Seizure Classification with Knowledge Distillation

“…Both ES and PNES were selected according to presence of hyperkinetic motor behavior [5], which involve large amplitude, often explosive whole body movements. Due to the clinical challenges of localizing hyperkinetic ES seizures, and the challenges of discriminating between ES and PNES, this type of semiology is of great interest to neurologists [12,19,36]. The duration of the seizures ranged from 15 seconds to 180 seconds.…”