Neurology · 12 h ago
Cingulate and insulo-opercular regions common in MRI-negative sleep-related hypermotor epilepsy
A retrospective multimodal presurgical study of 17 patients with sleep-related hypermotor epilepsy found cingulate or insulo-opercular involvement in 11 of 16 patients with an assigned localization. MRI–PET fusion provided regionally informative findings in 16 of 17, although the study was small and descriptive.
- Cingulate or insulo-opercular involvement in 11 of 16 localized cases
- All 17 patients were MRI-negative
- MRI–PET fusion was informative in 16 patients
Sleep-related hypermotor epilepsy (SHE) is often associated with frontal lobe onset, but seizures may arise from other regions. Researchers retrospectively assessed multimodal presurgical data from 17 patients with clinically diagnosed SHE, including video-EEG monitoring and high-resolution MRI. PET, magnetoencephalography, stereo-EEG (SEEG) and surgical findings were incorporated where available to assign the best-supported anatomical localization.
A localization was assigned in 16 patients. Cingulate or insulo-opercular regions were involved in 11 of these 16 (68.8%); the other five were localized to different frontal regions. In a sensitivity analysis of 10 patients with SEEG-defined and/or surgically supported localizations, six had cingulate or insulo-opercular involvement. All patients were MRI-negative, while MRI–PET fusion provided regionally informative findings in 16 of 17. Regionally informative ictal scalp EEG patterns were seen in eight patients, with interpretation often limited by rapid seizure propagation, movement artifacts or delayed EEG onset. Five of seven resected specimens showed histopathological findings related to focal cortical dysplasia.
The findings highlight the potential value of combining electroclinical, imaging and invasive data when localizing seizures in MRI-negative SHE. However, this small, retrospective cohort describes localization patterns and does not establish that a particular workup improves surgical outcomes or applies to all patients with SHE.
In practice
For patients with MRI-negative sleep-related hypermotor epilepsy undergoing presurgical assessment, this cohort suggests that seizure localization may involve cingulate or insulo-opercular regions, not only other frontal areas. MRI–PET fusion provided regionally informative findings in most patients, and the investigators used a multimodal framework that included invasive and surgical evidence where available. These results support considering integrated localization data in this setting, but the retrospective cohort included only 17 patients and does not show that this approach improves surgical outcomes or warrants a change to standard practice.
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Epilepsia: Frequent involvement of cingulate and insulo‐opercular regions in sleep‐related hypermotor epilepsy: A multimodal presurgical study ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.