Functional brain mapping of ictal activity in gelastic epilepsy associated with hypothalamic hamartoma: A case report

Summary Hypothalamic hamartomas (HHs) have been demonstrated as the cause of gelastic epilepsy, both by intracranial electrodes and functional imaging. The neocortex becomes secondarily involved, through poorly characterized propagation pathways. The detailed dynamics of seizure spread have not yet...

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Bibliographic Details
Published in:Epilepsia (Copenhagen) 2009-06, Vol.50 (6), p.1624-1631
Main Authors: Leal, Alberto J.R., Monteiro, José P., Secca, Mário Forjaz, Jordão, Constança
Format: Article
Language:English
Subjects:
Anticonvulsants. Antiepileptics. Antiparkinson agents
Biological and medical sciences
BOLD
Brain - blood supply
Brain - pathology
Brain Mapping
Child, Preschool
EEG‐fMRI
Electroencephalography - methods
Epilepsies, Partial - complications
Epilepsies, Partial - pathology
Epilepsy
Functional mapping
Hamartoma - complications
Hamartoma - pathology
Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy
Humans
Hypothalamic Diseases - complications
Hypothalamic Diseases - pathology
Hypothalamic hamartoma
Image Processing, Computer-Assisted - methods
Magnetic Resonance Imaging - methods
Male
Medical sciences
Nervous system (semeiology, syndromes)
Neurology
Neuropharmacology
Oxygen - blood
Pharmacology. Drug treatments
Seizure
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Summary:Summary Hypothalamic hamartomas (HHs) have been demonstrated as the cause of gelastic epilepsy, both by intracranial electrodes and functional imaging. The neocortex becomes secondarily involved, through poorly characterized propagation pathways. The detailed dynamics of seizure spread have not yet been demonstrated, owing to the limited spatial–temporal resolution of available functional mapping. We studied a patient with epilepsy associated with HH and gelastic epilepsy. Simultaneous electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) of several seizure events were obtained, with blood oxygen level dependent (BOLD) activation of the hamartoma, and left hemisphere hypothalamus, hippocampus, parietal–occipital area, cingulate gyrus, and dorsal–lateral frontal area. Integration of regional BOLD kinetics and EEG power dynamics strongly suggests propagation of the epileptic activity from the HH through the left fornix to the temporal lobe, and later through the cingulate fasciculus to the left frontal lobe. The EEG/fMRI method has the spatial–temporal resolution to study the dynamics of seizure activity, with detailed demonstration of origin and propagation pathways.
ISSN:0013-9580
1528-1167
DOI:10.1111/j.1528-1167.2008.01810.x