Frontal lobe seizures: From clinical semiology to localization
Francesca Bonini
INSERM UMR 1106, Institut de Neurosciences des Systèmes, Marseille, France
Faculty of Medicine, Aix-Marseille University, Marseille, France
These authors equally contributed to this study.Search for more papers by this authorAileen McGonigal
INSERM UMR 1106, Institut de Neurosciences des Systèmes, Marseille, France
Faculty of Medicine, Aix-Marseille University, Marseille, France
Clinical Neurophysiology Department, Timone Hospital, Assistance Publique des Hôpitaux de Marseille, Marseille, France
These authors equally contributed to this study.Search for more papers by this authorAgnès Trébuchon
INSERM UMR 1106, Institut de Neurosciences des Systèmes, Marseille, France
Faculty of Medicine, Aix-Marseille University, Marseille, France
Clinical Neurophysiology Department, Timone Hospital, Assistance Publique des Hôpitaux de Marseille, Marseille, France
Search for more papers by this authorMartine Gavaret
INSERM UMR 1106, Institut de Neurosciences des Systèmes, Marseille, France
Faculty of Medicine, Aix-Marseille University, Marseille, France
Clinical Neurophysiology Department, Timone Hospital, Assistance Publique des Hôpitaux de Marseille, Marseille, France
Search for more papers by this authorFabrice Bartolomei
INSERM UMR 1106, Institut de Neurosciences des Systèmes, Marseille, France
Faculty of Medicine, Aix-Marseille University, Marseille, France
Clinical Neurophysiology Department, Timone Hospital, Assistance Publique des Hôpitaux de Marseille, Marseille, France
Search for more papers by this authorBernard Giusiano
INSERM UMR 1106, Institut de Neurosciences des Systèmes, Marseille, France
Faculty of Medicine, Aix-Marseille University, Marseille, France
Division of Public Health, Assistance Publique des Hôpitaux de Marseille, Marseille, France
Search for more papers by this authorCorresponding Author
Patrick Chauvel
INSERM UMR 1106, Institut de Neurosciences des Systèmes, Marseille, France
Faculty of Medicine, Aix-Marseille University, Marseille, France
Clinical Neurophysiology Department, Timone Hospital, Assistance Publique des Hôpitaux de Marseille, Marseille, France
Address correspondence to Patrick Chauvel, Faculty of Medicine, UMR 1106 INSERM, Institut de Neurosciences des Systèmes, Aix-Marseille University, 27 Bd Jean Moulin, Marseille Cedex 05 13385, France. E-mail: [email protected]Search for more papers by this authorFrancesca Bonini
INSERM UMR 1106, Institut de Neurosciences des Systèmes, Marseille, France
Faculty of Medicine, Aix-Marseille University, Marseille, France
These authors equally contributed to this study.Search for more papers by this authorAileen McGonigal
INSERM UMR 1106, Institut de Neurosciences des Systèmes, Marseille, France
Faculty of Medicine, Aix-Marseille University, Marseille, France
Clinical Neurophysiology Department, Timone Hospital, Assistance Publique des Hôpitaux de Marseille, Marseille, France
These authors equally contributed to this study.Search for more papers by this authorAgnès Trébuchon
INSERM UMR 1106, Institut de Neurosciences des Systèmes, Marseille, France
Faculty of Medicine, Aix-Marseille University, Marseille, France
Clinical Neurophysiology Department, Timone Hospital, Assistance Publique des Hôpitaux de Marseille, Marseille, France
Search for more papers by this authorMartine Gavaret
INSERM UMR 1106, Institut de Neurosciences des Systèmes, Marseille, France
Faculty of Medicine, Aix-Marseille University, Marseille, France
Clinical Neurophysiology Department, Timone Hospital, Assistance Publique des Hôpitaux de Marseille, Marseille, France
Search for more papers by this authorFabrice Bartolomei
INSERM UMR 1106, Institut de Neurosciences des Systèmes, Marseille, France
Faculty of Medicine, Aix-Marseille University, Marseille, France
Clinical Neurophysiology Department, Timone Hospital, Assistance Publique des Hôpitaux de Marseille, Marseille, France
Search for more papers by this authorBernard Giusiano
INSERM UMR 1106, Institut de Neurosciences des Systèmes, Marseille, France
Faculty of Medicine, Aix-Marseille University, Marseille, France
Division of Public Health, Assistance Publique des Hôpitaux de Marseille, Marseille, France
Search for more papers by this authorCorresponding Author
Patrick Chauvel
INSERM UMR 1106, Institut de Neurosciences des Systèmes, Marseille, France
Faculty of Medicine, Aix-Marseille University, Marseille, France
Clinical Neurophysiology Department, Timone Hospital, Assistance Publique des Hôpitaux de Marseille, Marseille, France
Address correspondence to Patrick Chauvel, Faculty of Medicine, UMR 1106 INSERM, Institut de Neurosciences des Systèmes, Aix-Marseille University, 27 Bd Jean Moulin, Marseille Cedex 05 13385, France. E-mail: [email protected]Search for more papers by this authorSummary
Objective
Frontal lobe seizures are difficult to characterize according to semiologic and electrical features. We wished to establish whether different semiologic subgroups can be identified and whether these relate to anatomic organization.
Methods
We assessed all seizures from 54 patients with frontal lobe epilepsy that were explored with stereoelectroencephalography (SEEG) during presurgical evaluation. Semiologic features and concomitant intracerebral EEG changes were documented and quantified. These variables were examined using Principal Component Analysis and Cluster Analysis, and semiologic features correlated with anatomic localization.
Results
Four main groups of patients were identified according to semiologic features, and correlated with specific patterns of anatomic seizure localization. Group 1 was characterized clinically by elementary motor signs and involved precentral and premotor regions. Group 2 was characterized by a combination of elementary motor signs and nonintegrated gestural motor behavior, and involved both premotor and prefrontal regions. Group 3 was characterized by integrated gestural motor behavior with distal stereotypies and involved anterior lateral and medial prefrontal regions. Group 4 was characterized by seizures with fearful behavior and involved the paralimbic system (ventromedial prefrontal cortex ± anterior temporal structures). The groups were organized along a rostrocaudal axis, representing bands within a spectrum rather than rigid categories. The more anterior the seizure organization, the more likely was the occurrence of integrated behavior during seizures. Distal stereotypies were associated with the most anterior prefrontal localizations, whereas proximal stereotypies occurred in more posterior prefrontal regions.
Significance
Meaningful categorization of frontal seizures in terms of semiology is possible and correlates with anatomic organization along a rostrocaudal axis, in keeping with current hypotheses of frontal lobe hierarchical organization. The proposed electroclinical categorization offers pointers as to the likely zone of organization of networks underlying semiologic production, thus aiding presurgical localization. Furthermore, analysis of ictal motor behavior in prefrontal seizures, including stereotypies, leads to deciphering the cortico-subcortical networks that produce such behaviors.
Supporting Information
| Filename | Description |
|---|---|
| epi12490-sup-0001-TableS1.docWord document, 57.5 KB | Table S1. First three components issued from PCA performed on score ranks accounting for 44.36% of variance. |
| epi12490-sup-0002-FigS1.tifimage/tif, 373.7 KB | Figure S1. Patients' position in PCA space colored as a function of resulting clusters: the first two components are represented in Figure 1A and the first three components are represented in Figure 1B. |
| epi12490-sup-0003-FigS2.tifimage/tif, 101.3 KB | Figure S2. Hierarchical classification of patients based on PCA-resulting space distinguishes four homogeneous groups. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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