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Generation and On-Demand Initiation of Acute Ictal Activity in Rodent and Human Tissue
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Localization value of ictal turning prone.

Amir M Arain1, Azaz Umar2, Pawan Rawal2

  • 1Department of Neurology, University of Utah, Salt Lake City, UT 84132.

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Ictal turning prone (ITP) can occur with various epilepsy zones, not just frontal lobes. The direction of ITP may vary, limiting its consistent localizing value in epilepsy diagnosis.

Keywords:
Complex partial seizuresEpilepsyEpilepsy surgeryFrontal lobe epilepsyGyratory seizuresHypermotor seizuresIctal turning proneSeizuresTemporal lobectomy

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Area of Science:

  • Neurology
  • Epileptology
  • Clinical Neurophysiology

Background:

  • Ictal semiology, including body turning, aids in identifying the epileptogenic zone.
  • Ictal turning prone (ITP), defined as body turning of 90° or more, is often associated with frontal lobe epilepsies.

Purpose of the Study:

  • To evaluate the localizing and lateralizing value of ITP in a general patient population undergoing long-term video-electroencephalography (EEG) monitoring.
  • To determine if ITP is specific to frontal lobe seizures or if it can indicate other epileptogenic zones.

Main Methods:

  • Retrospective review of adult patients with habitual seizures exhibiting ITP from an epilepsy monitoring unit database.
  • Inclusion of 16 patients with continuous video-EEG monitoring (scalp and, in some, intracranial EEG).
  • Analysis focused on focal impaired awareness seizures without evolution to bilateral tonic-clonic activity.

Main Results:

  • Sixteen patients with ITP were identified, with mean age 32.5 years.
  • ITP occurred in focal impaired awareness seizures in all patients.
  • Ictal onset zones included temporal (left/right), frontal convexity (left/right), and medial frontal (left/right).
  • ITP direction was uni-directional in 12 patients and varied in 4.
  • Five of nine surgically treated patients achieved Engel class I outcome.

Conclusions:

  • Ictal turning prone (ITP) lacks consistent single localizing or lateralizing value.
  • ITP can be associated with diverse epileptogenic zones, including temporal, lateral frontal, and medial frontal regions.
  • The direction of ITP can be inconsistent, even within the same patient with a single epileptogenic zone.