From the Guidelines
The seizure likely localizes to the insula, with possible involvement of the temporal lobe, and the primary areas to sample with stereoelectroencephalography (sEEG) should include the insula, mesial and lateral temporal lobe, anterior cingulate cortex, and amygdala. These symptoms (dysphagia, nausea, and flushing) strongly suggest activation of the autonomic nervous system during the seizure, as discussed in the context of epilepsy diagnosis and management 1. The insula, in particular, is known to play a significant role in processing visceral sensations and regulating autonomic functions, which is crucial for understanding the seizure onset and propagation.
Key Considerations for sEEG Electrode Placement
- The insula is the most crucial target due to its role in interoception and autonomic regulation.
- The temporal lobe, especially its mesial structures, can also contribute to autonomic symptoms in seizures.
- Connected regions that might be involved in the seizure network should be covered to provide a comprehensive sampling.
- Individual patient anatomy and any additional clinical or imaging data should be taken into account when finalizing the sEEG sampling strategy.
Importance of Multidisciplinary Approach
Consultation with a multidisciplinary epilepsy team is recommended for optimal electrode placement and interpretation of results, as emphasized in the guidelines for the appropriate use of PET and SPECT for patients with epilepsy 1. This approach ensures that all aspects of the patient's condition are considered, leading to more effective treatment planning and improved outcomes.
Recent Guidelines and Recommendations
Recent studies and guidelines, such as those published in the European Journal of Nuclear Medicine and Molecular Imaging 1, highlight the importance of molecular neuroimaging in the presurgical management of epilepsy patients. These guidelines provide valuable insights into the role of PET and SPECT in localizing the seizure onset zone and predicting postsurgical seizure outcome, which is essential for informing sEEG electrode placement and surgical planning.
From the Research
Seizure Localization
The symptoms presented, including dysphagia, nausea, and flushing, can be associated with seizures originating from various brain regions.
- Dysphagia has been reported in patients with temporal lobe epilepsy 2.
- Nausea and vomiting are considered localizing signs in patients with partial seizures of temporal origin 3.
- Flushing can be a part of ictal vegetative symptoms, which can be helpful in localizing and lateralizing seizure onset in partial epilepsies, especially those originating in the temporal lobe 4.
Potential Areas to Sample with Stereoelectroencephalography (sEEG)
Based on the symptoms presented, potential areas to sample with sEEG include:
- Temporal lobe, particularly the mesial temporal structures 4, 3, 5
- Parietal lobe, as ictal vomiting has been associated with parietal lobe involvement 3
- Insula, as it is involved in autonomic functions and can be a potential source of seizures with autonomic symptoms 5
Localizing Value of Symptoms
The localizing value of the symptoms presented can be estimated based on the probabilistic landscape of seizure semiology localizing values 5.