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Insulo‐opercular cortex generates oroalimentary automatisms in temporal seizures
Author(s) -
Aupy Jerome,
Noviawaty Ika,
Krishnan Balu,
Suwankpakdee Piradee,
Bulacio Juan,
GonzalezMartinez Jorge,
Najm Imad,
Chauvel Patrick
Publication year - 2018
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/epi.14011
Subject(s) - stereoelectroencephalography , ictal , temporal lobe , epilepsy , neuroscience , psychology , automatism (medicine) , cortex (anatomy) , electroencephalography , medicine
Summary Objective Oroalimentary automatisms ( OAA s) resembling normal alimentary behavior are stereotyped complex movements that may occur during epileptic seizures. They are considered common clinical signs in temporal lobe seizures, but their anatomofunctional mechanisms are not established. We took the opportunity of presurgical intracerebral recordings to study the relations between the occurrence of OAA s and temporal/spatial features of ictal activities. Methods We retrospectively reviewed patients with medically intractable medial temporal lobe epilepsy who underwent stereoelectroencephalography ( SEEG ) at Cleveland Clinic between 2009 and 2016. Patients presenting oroalimentary automatisms during seizures, with intracerebral electrodes spanning temporal and extratemporal areas, were selected. SEEG ‐clinical correlations with latency measurements were done. Coherence analyses were performed on regions of interest as defined by the areas involved at the onset of oroalimentary automatisms. Results Fifteen patients (115 seizures) were analyzed. Sixty‐nine seizures exhibited overt oroalimentary automatisms. Only insulo‐opercular cortex ictal involvement was consistently related to the occurrence of OAA s, with a linear correlation between OAA onset and ictal oscillatory activity onset in the insulo‐opercular cortex. SEEG signal processing showed an increase in theta coherence preceding oroalimentary automatism onset between mediobasal‐temporal structures and insulo‐opercular cortex, as well as between the 2 insulo‐opercular regions. Significance The underlying mechanism for the production of oroalimentary automatisms in medial temporal seizures is based on temporal‐insulo‐opercular theta coherence leading to a synchronous state generating rhythmic patterned outputs from the cortical masticatory area.