title: Cortical involvement in focal epilepsies with epileptic spasms.
abstract: The pathophysiological mechanisms of epileptic spasms are still poorly understood. The role of subcortical structures has been suggested on the basis of non-localized EEG features and from experimental data. The description of asymmetric spasms associated with lateralized EEG patterns has challenged this view and raises the possibility of a cortical origin. This study investigated the cortical organization of partial seizures associated with epileptic spasms in children undergoing intracerebral EEG recordings for presurgical evaluation. Eleven children with drug resistant epileptic spasms and for whom depth electrode recordings were performed were retrospectively studied. In all children several features suggested a focal origin. Cortical involvement was studied using the "Epileptogenicity Index" (EI). A focal origin was finally demonstrated in 10/11 patients. Seven patients demonstrated pre-ictal changes in the seizure onset zone area. EI analysis showed maximal values in the temporal (n=5), parietal (n=1) or frontal (n=5) cortices. EEG changes were also observed in the premotor cortex during spasms in patients with frontal or parietal seizures and in 3/5 patients with temporal lobe seizures. Good surgical outcome (class I or II) was obtained in 7/10 patients. Seizures associated with epileptic spasms may originate from various cortical regions. Premotor/motor cortices are probably involved in determining ictal clinical changes.
authors.affiliation: Hôpital Henri Gastaut, Marseille, France; Service de Pédiatrie, Clocheville Hospital, CHRU Tours F-37000, France.
authors.forename: Sabine
authors.initials: S
authors.lastname: de la Vaissière
authors.affiliation: Service de Neuropédiatrie, Assistance Publique des Hôpitaux de Marseille, Marseille F-13005, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Milh
authors.affiliation: Service de Neurochirurgie Pédiatrique, Assistance Publique des Hôpitaux de Marseille, Marseille F-13005, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Scavarda
authors.affiliation: Service de Neurochirurgie fonctionnelle et Stéréotaxie, Assistance Publique des Hôpitaux de Marseille, Marseille F-13005, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Carron
authors.affiliation: Hôpital Henri Gastaut, Marseille, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Lépine
authors.affiliation: Service de Neurophysiologie Clinique, Assistance Publique des Hôpitaux de Marseille, Marseille F-13005, France.
authors.forename: Agnes
authors.initials: A
authors.lastname: Trébuchon
authors.affiliation: Service de Neurophysiologie Clinique, Assistance Publique des Hôpitaux de Marseille, Marseille F-13005, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Gavaret
authors.affiliation: Service de Neurophysiologie Clinique, Assistance Publique des Hôpitaux de Marseille, Marseille F-13005, France.
authors.forename: Russell
authors.initials: R
authors.lastname: Hewett
authors.affiliation: Hôpital Henri Gastaut, Marseille, France.
authors.forename: Virginie
authors.initials: V
authors.lastname: Laguitton
authors.affiliation: Hôpital Henri Gastaut, Marseille, France.
authors.forename: Géraldine
authors.initials: G
authors.lastname: Daquin
authors.affiliation: Hôpital Henri Gastaut, Marseille, France; Service de Neuropédiatrie, Assistance Publique des Hôpitaux de Marseille, Marseille F-13005, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Villeneuve
authors.affiliation: Hôpital Henri Gastaut, Marseille, France; Service de Neurophysiologie Clinique, Assistance Publique des Hôpitaux de Marseille, Marseille F-13005, France. Electronic address: fabrice.bartolomei@ap-hm.fr.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Bartolomei
mesh_terms: D000293:Adolescent; D001931:Brain Mapping; D058256:Brain Waves / Q000502:physiology; D002540:Cerebral Cortex / Q000473:pathology*; D002648:Child; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000150:complications*; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies; D013035:Spasm / Q000150:complications*
keywords: Epileptic spasms; Epileptic surgery; Epileptogenicity index; Intracerebral EEG; Supplementary motor area