Neural networks underlying parietal lobe seizures: a quantified study from intracerebral recordings

In this study we have quantified the "epileptogenicity" of several brain regions in seizures originating in the posterior parietal cortex in 17 patients investigated by intracerebral recordings using stereotactic EEG (SEEG). Epileptogenicity of brain structures was quantified according to the "epileptogenicity index" (EI), a way to quantify rapid discharges at seizure onset. Seven patients had maximal epileptogenicity in the superior parietal lobule-BA area 7 (Gr1), 2 patients in the superior parietal lobule-area 5 (Gr2), 4 patients in inferior parietal lobule (Gr3) and 4 in the opercular region (Gr4). A large majority of patients (15/17 (88%)) reported to have at least one aura during the course of their disease. Somato-sensory manifestations were reported in the four groups. Vestibular disturbance was observed mainly in seizures from the superior parietal lobule (Gr1 and 2). Ipsilateral version was the most frequent objective manifestation (64%). Hyperkinetic behaviour (motor agitation) was found to be frequent, observed in 4/17 cases (23%) and observed in seizures from inferior parietal regions. In conclusion, the electrophysiological organization and the clinical manifestations of PLS are various and complex. The subjective manifestations are frequent and often suggestive, therefore must be actively sought.