Asymmetrical generalized paroxysmal fast activities in children with intractable localization-related epilepsy

Mahmoud Mohammadi; Tohru Okanishi; Kazuo Okanari; Shiro Baba; Hironobu Sumiyoshi; Satoru Sakuma; Ayako Ochi; Elysa Widjaja; Cristina Y. Go; O. Carter Snead; Hiroshi Otsubo

doi:10.1016/j.braindev.2014.03.006

Asymmetrical generalized paroxysmal fast activities in children with intractable localization-related epilepsy

Mahmoud Mohammadi, Tohru Okanishi, Kazuo Okanari, Shiro Baba, Hironobu Sumiyoshi, Satoru Sakuma, Ayako Ochi, Elysa Widjaja, Cristina Y. Go, O. Carter Snead, Hiroshi Otsubo^*

^*Corresponding author for this work

Radiology

Research output: Contribution to journal › Article › peer-review

15 Scopus citations

Abstract

Background: Generalized paroxysmal fast activity (GPFA) consists of burst of generalized rhythmic discharges; 100-200. μV; 1-9. s; 8-26. Hz; with frontal predominance; appearing during NREM sleep. GPFA was originally described as an electrographic feature of Lennox-Gastaut Syndrome (LGS). We analyzed GPFA on scalp video EEG (VEEG) in children to evaluate that GPFA presents in patients with intractable localization-related epilepsy. Methods: We collected cases with GPFA with intractable localization-related epilepsy who underwent scalp VEEG, MRI, and magnetoencephalography (MEG) prior to intracranial video EEG (IVEEG) and surgical resection. We collected 50 epochs of GPFA per patient during the first night during scalp VEEG. We analyzed amplitude, duration and frequency of GPFA over the bilateral frontal region between surgical resection side with grid placement and non-resection side. Results: We identified 14 (14%) patients with GPFA on scalp VEEG. The mean amplitude ranged from 145 to 589. μV (mean 293. μV). The mean duration ranged from 1.18 to 2.31. s (mean 1.6. s). The mean frequencies ranged from 9.3 to 14.7. Hz (mean 11.1. Hz). The amplitude (307. ±. 156. μV) and duration (1.62. ±. 0.8. s) of GPFAs in all the patients over the resection side were significantly higher than those (279. ±. 141. μV, 1.58. ±. 0.8. s) of the non-resection side (. p<. 0.001). All nine patients who showed significant duration differences between two hemispheres (. p<. 0.05) had longer duration of GPFA over the resection side. Eight of 12 patients who showed significant amplitude differences between two hemispheres (. p<. 0.05) had higher amplitude of GPFA over the resection side. Four of six patients who showed significant frequency differences between two hemispheres (. p<. 0.05) had higher frequency of GPFA over the resection side. Nine (64%) patients became seizure free after surgical resection including multilobar resections in eight patients. Conclusions: GPFA can exist in localization-related epilepsy with secondary bilateral synchrony. Although EEG shows GPFA on scalp VEEG, the precise localization of the epileptogenic zone using IVEEG could achieve the successful surgical resection.

Original language	English (US)
Pages (from-to)	59-65
Number of pages	7
Journal	Brain and Development
Volume	37
Issue number	1
DOIs	https://doi.org/10.1016/j.braindev.2014.03.006
State	Published - Jan 1 2015

Funding

We thank Dr. Mahdi Razzaghi from Bloomsburg University (PA, USA), for his invaluable assistance in statistical tests selection. Drs. Tohru Okanishi and Satoru Sakuma were supported by Ontario Brain Institute (OBI).

Keywords

Amplitude
Asymmetry
Children
Cortico-thalamic epileptic network
Duration
Epilepsy surgery
Epileptogenic hemisphere
Generalized paroxysmal fast activity (GPFA)
Intracranial video EEG
Localization-related epilepsy

ASJC Scopus subject areas

Clinical Neurology
Developmental Neuroscience
Pediatrics, Perinatology, and Child Health

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10.1016/j.braindev.2014.03.006

Cite this

@article{8c60dc3c935742fea522883f04c49a3d,

title = "Asymmetrical generalized paroxysmal fast activities in children with intractable localization-related epilepsy",

abstract = "Background: Generalized paroxysmal fast activity (GPFA) consists of burst of generalized rhythmic discharges; 100-200. μV; 1-9. s; 8-26. Hz; with frontal predominance; appearing during NREM sleep. GPFA was originally described as an electrographic feature of Lennox-Gastaut Syndrome (LGS). We analyzed GPFA on scalp video EEG (VEEG) in children to evaluate that GPFA presents in patients with intractable localization-related epilepsy. Methods: We collected cases with GPFA with intractable localization-related epilepsy who underwent scalp VEEG, MRI, and magnetoencephalography (MEG) prior to intracranial video EEG (IVEEG) and surgical resection. We collected 50 epochs of GPFA per patient during the first night during scalp VEEG. We analyzed amplitude, duration and frequency of GPFA over the bilateral frontal region between surgical resection side with grid placement and non-resection side. Results: We identified 14 (14%) patients with GPFA on scalp VEEG. The mean amplitude ranged from 145 to 589. μV (mean 293. μV). The mean duration ranged from 1.18 to 2.31. s (mean 1.6. s). The mean frequencies ranged from 9.3 to 14.7. Hz (mean 11.1. Hz). The amplitude (307. ±. 156. μV) and duration (1.62. ±. 0.8. s) of GPFAs in all the patients over the resection side were significantly higher than those (279. ±. 141. μV, 1.58. ±. 0.8. s) of the non-resection side (. p<. 0.001). All nine patients who showed significant duration differences between two hemispheres (. p<. 0.05) had longer duration of GPFA over the resection side. Eight of 12 patients who showed significant amplitude differences between two hemispheres (. p<. 0.05) had higher amplitude of GPFA over the resection side. Four of six patients who showed significant frequency differences between two hemispheres (. p<. 0.05) had higher frequency of GPFA over the resection side. Nine (64%) patients became seizure free after surgical resection including multilobar resections in eight patients. Conclusions: GPFA can exist in localization-related epilepsy with secondary bilateral synchrony. Although EEG shows GPFA on scalp VEEG, the precise localization of the epileptogenic zone using IVEEG could achieve the successful surgical resection.",

keywords = "Amplitude, Asymmetry, Children, Cortico-thalamic epileptic network, Duration, Epilepsy surgery, Epileptogenic hemisphere, Generalized paroxysmal fast activity (GPFA), Intracranial video EEG, Localization-related epilepsy",

author = "Mahmoud Mohammadi and Tohru Okanishi and Kazuo Okanari and Shiro Baba and Hironobu Sumiyoshi and Satoru Sakuma and Ayako Ochi and Elysa Widjaja and Go, {Cristina Y.} and Snead, {O. Carter} and Hiroshi Otsubo",

note = "Funding Information: We thank Dr. Mahdi Razzaghi from Bloomsburg University (PA, USA), for his invaluable assistance in statistical tests selection. Drs. Tohru Okanishi and Satoru Sakuma were supported by Ontario Brain Institute (OBI). Publisher Copyright: {\textcopyright} 2014 The Japanese Society of Child Neurology.",

year = "2015",

month = jan,

day = "1",

doi = "10.1016/j.braindev.2014.03.006",

language = "English (US)",

volume = "37",

pages = "59--65",

journal = "Brain and Development",

issn = "0387-7604",

publisher = "Elsevier",

number = "1",

}

TY - JOUR

T1 - Asymmetrical generalized paroxysmal fast activities in children with intractable localization-related epilepsy

AU - Mohammadi, Mahmoud

AU - Okanishi, Tohru

AU - Okanari, Kazuo

AU - Baba, Shiro

AU - Sumiyoshi, Hironobu

AU - Sakuma, Satoru

AU - Ochi, Ayako

AU - Widjaja, Elysa

AU - Go, Cristina Y.

AU - Snead, O. Carter

AU - Otsubo, Hiroshi

N1 - Funding Information: We thank Dr. Mahdi Razzaghi from Bloomsburg University (PA, USA), for his invaluable assistance in statistical tests selection. Drs. Tohru Okanishi and Satoru Sakuma were supported by Ontario Brain Institute (OBI). Publisher Copyright: © 2014 The Japanese Society of Child Neurology.

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Background: Generalized paroxysmal fast activity (GPFA) consists of burst of generalized rhythmic discharges; 100-200. μV; 1-9. s; 8-26. Hz; with frontal predominance; appearing during NREM sleep. GPFA was originally described as an electrographic feature of Lennox-Gastaut Syndrome (LGS). We analyzed GPFA on scalp video EEG (VEEG) in children to evaluate that GPFA presents in patients with intractable localization-related epilepsy. Methods: We collected cases with GPFA with intractable localization-related epilepsy who underwent scalp VEEG, MRI, and magnetoencephalography (MEG) prior to intracranial video EEG (IVEEG) and surgical resection. We collected 50 epochs of GPFA per patient during the first night during scalp VEEG. We analyzed amplitude, duration and frequency of GPFA over the bilateral frontal region between surgical resection side with grid placement and non-resection side. Results: We identified 14 (14%) patients with GPFA on scalp VEEG. The mean amplitude ranged from 145 to 589. μV (mean 293. μV). The mean duration ranged from 1.18 to 2.31. s (mean 1.6. s). The mean frequencies ranged from 9.3 to 14.7. Hz (mean 11.1. Hz). The amplitude (307. ±. 156. μV) and duration (1.62. ±. 0.8. s) of GPFAs in all the patients over the resection side were significantly higher than those (279. ±. 141. μV, 1.58. ±. 0.8. s) of the non-resection side (. p<. 0.001). All nine patients who showed significant duration differences between two hemispheres (. p<. 0.05) had longer duration of GPFA over the resection side. Eight of 12 patients who showed significant amplitude differences between two hemispheres (. p<. 0.05) had higher amplitude of GPFA over the resection side. Four of six patients who showed significant frequency differences between two hemispheres (. p<. 0.05) had higher frequency of GPFA over the resection side. Nine (64%) patients became seizure free after surgical resection including multilobar resections in eight patients. Conclusions: GPFA can exist in localization-related epilepsy with secondary bilateral synchrony. Although EEG shows GPFA on scalp VEEG, the precise localization of the epileptogenic zone using IVEEG could achieve the successful surgical resection.

AB - Background: Generalized paroxysmal fast activity (GPFA) consists of burst of generalized rhythmic discharges; 100-200. μV; 1-9. s; 8-26. Hz; with frontal predominance; appearing during NREM sleep. GPFA was originally described as an electrographic feature of Lennox-Gastaut Syndrome (LGS). We analyzed GPFA on scalp video EEG (VEEG) in children to evaluate that GPFA presents in patients with intractable localization-related epilepsy. Methods: We collected cases with GPFA with intractable localization-related epilepsy who underwent scalp VEEG, MRI, and magnetoencephalography (MEG) prior to intracranial video EEG (IVEEG) and surgical resection. We collected 50 epochs of GPFA per patient during the first night during scalp VEEG. We analyzed amplitude, duration and frequency of GPFA over the bilateral frontal region between surgical resection side with grid placement and non-resection side. Results: We identified 14 (14%) patients with GPFA on scalp VEEG. The mean amplitude ranged from 145 to 589. μV (mean 293. μV). The mean duration ranged from 1.18 to 2.31. s (mean 1.6. s). The mean frequencies ranged from 9.3 to 14.7. Hz (mean 11.1. Hz). The amplitude (307. ±. 156. μV) and duration (1.62. ±. 0.8. s) of GPFAs in all the patients over the resection side were significantly higher than those (279. ±. 141. μV, 1.58. ±. 0.8. s) of the non-resection side (. p<. 0.001). All nine patients who showed significant duration differences between two hemispheres (. p<. 0.05) had longer duration of GPFA over the resection side. Eight of 12 patients who showed significant amplitude differences between two hemispheres (. p<. 0.05) had higher amplitude of GPFA over the resection side. Four of six patients who showed significant frequency differences between two hemispheres (. p<. 0.05) had higher frequency of GPFA over the resection side. Nine (64%) patients became seizure free after surgical resection including multilobar resections in eight patients. Conclusions: GPFA can exist in localization-related epilepsy with secondary bilateral synchrony. Although EEG shows GPFA on scalp VEEG, the precise localization of the epileptogenic zone using IVEEG could achieve the successful surgical resection.

KW - Amplitude

KW - Asymmetry

KW - Children

KW - Cortico-thalamic epileptic network

KW - Duration

KW - Epilepsy surgery

KW - Epileptogenic hemisphere

KW - Generalized paroxysmal fast activity (GPFA)

KW - Intracranial video EEG

KW - Localization-related epilepsy

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DO - 10.1016/j.braindev.2014.03.006

M3 - Article

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SN - 0387-7604

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JO - Brain and Development

JF - Brain and Development

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ER -

Asymmetrical generalized paroxysmal fast activities in children with intractable localization-related epilepsy

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Keywords

ASJC Scopus subject areas

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