UNIVERSITY OF BUCHAREST
FACULTY OF PHYSICS

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2024-11-23 18:26
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Conference: Bucharest University Faculty of Physics 2016 Meeting


Section: Biophysics; Medical Physics


Title:
Successful Epilepsy Surgery in Startle Epilepsy


Authors:
Ana GHEORGHIU (CIUREA) (1,2,3) Jean CIUREA (3), Alin RĂȘINA (3), Ioan OPRIS (4), Radu MUTIHAC(1)


Affiliation:
1. University of Bucharest, Faculty of Physics, Magurele, Romania

2. Neurology Department, Neurology and Neurovascular Diseases National Institute, Bucharest, Romania

3. Neurosurgery Department, Bagdasar-Arseni Hospital Bucharest

4. University of Miami, Miami Project to Cure Paralysis, USA.




E-mail
anagheorghiu88@gmail.com


Keywords:
Intractable epilepsy, startle syndrome, SEEG investigation, epileptogenic network


Abstract:
Startle epilepsy is a rare type of epilepsy in which the trigger is often a sudden and unexpected stimulus. The involvement of anatomical regions (like the rolandic sensory-motor area or supplementary motor area-SMA) is usually correlated with this type of epilepsy. Case report This is a case report of a 33 years old male, with intractable epilepsy, categorized as a startle syndrome. In our case the patient did not have a visible lesion on MRI and the seizure semiology did not indicate a clear lateralization. We performed presurgical evaluation using depth electrodes and we found a large epileptogenic network including a large number of anatomical regions. A good outcome was obtained after tailored frontal mesial resection, using accurate SEEG investigation. Histopathological analysis revealed a type I focal cortical dysplasia. One year after surgery the patient was seizure-free. Discussions and conclusions In this case a large epileptogenic network was involved. The patient had a very good outcome after surgery. Postoperative seizure freedom and positive histopathological result confirms that we explored and removed the right structures.


References:

1. Fernández S., Donaire A. et al. Functional neuroimaging in startle epilepsy: Involvement of a mesial frontoparietal network, Epilepsia, 52(9):1725–1732, 2011doi: 10.1111/j.1528-1167.2011.03172.x

2. Job A.-S., De Palma L.,Principe A. et al. The pivotal role of the supplementary motor area in startle epilepsy as demonstrated by SEEG epileptogenicity maps. Epilepsia, 55(8):e85-e88, 2014 doi: 10.1111/epi.12659

3.Manford MRA, Shorvon SD. Startle provoked epileptic seizures: features in 19 patients. J Neurol Neurosurg Psychiatry 1996; 61: 151-156

4. Szucs A., Rasonyi G., Orbay P. et al. Are proprioceptive-induced reflex seizures epileptically-enhanced stretch reflex manifestations?. Epileptic Disord 2012; 14 (2): 149-54

5. Klinkenberg S., Ubbink S., Vles J. et al. Noninvasive treatment alternative for intractable startle epilepsy.Epilepsy & Behavior Case Reports 2 (2014) 49–53

Acknowledgement:
Ana Gheorghiu (Ciurea) was supported by the strategic grant POSDRU/159/1.5/S/133652, “Integrated system to improve the quality of doctoral and postdoctoral research in Romania and promotion of the role of science in society” cofinanced by the European Social Found within the Sectorial Operational Program Human Resources Development 2007–2011.