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Background and ObjectivesIt remains unknown to what extent ictal scalp EEG can accurately predict the localization of the intracerebral seizure onset in presurgical evaluation of drug-resistant epilepsies. In this study, we aimed to define homogeneous ictal scalp EEG profiles (based on their first ictal abnormality) and assess their localizing value using simultaneously recorded scalp EEG and stereo-EEG.MethodsWe retrospectively included consecutive patients with drug-resistant focal epilepsy who had simultaneous stereo-EEG and scalp EEG recordings of at least 1 seizure in the epileptology unit in Nancy, France. We analyzed 1 seizure per patient and used hierarchical cluster analysis to group similar seizure profiles on scalp EEG and then performed a descriptive analysis of their intracerebral correlates.ResultsWe enrolled 129 patients in this study. The hierarchical cluster analysis showed 6 profiles on scalp EEG first modification. None were specific to a single intracerebral localization. The “normal EEG” and “blurred EEG” clusters (early muscle artifacts) comprised only 5 patients each and corresponded to no preferential intracerebral localization. The “temporal discharge” cluster (n = 46) was characterized by theta or delta discharges on ipsilateral anterior temporal scalp electrodes and corresponded to a preferential mesial temporal intracerebral localization. The “posterior discharge” cluster (n = 42) was characterized by posterior ipsilateral or contralateral rhythmic alpha discharges or slow waves on scalp and corresponded to a preferential temporal localization. However, this profile was the statistically most frequent scalp EEG correlate of occipital and parietal seizures. The “diffuse suppression” cluster (n = 9) was characterized by a bilateral and diffuse background activity suppression on scalp and corresponded to mesial, and particularly insulo-opercular, localization. Finally, the “frontal discharge” cluster (n = 22) was characterized by bilateral frontal rhythmic fast activity or preictal spike on scalp and corresponded to preferential ventrodorsal frontal intracerebral localizations.DiscussionThe hierarchical cluster analysis identified 6 seizure profiles regarding the first abnormality on scalp EEG. None of them were specific of a single intracerebral localization. Nevertheless, the strong relationships between the “temporal,” “frontal,” “diffuse suppression,” and “posterior” profiles and intracerebral discharge localizations may contribute to hierarchize hypotheses derived from ictal scalp EEG analysis regarding intracerebral seizure onset.

International audience; Interictal electrical source imaging (ESI) encompasses a risk of false localization due to complex relationships between irritative and epileptogenic networks. This study aimed to compare the localizing value of ESI derived from ictal and inter-ictal EEG discharges and to evaluate the localizing value of ESI according to three different subgroups: MRI lesion, presumed etiology and morphology of ictal EEG pattern. We prospectively analyzed 54 of 78 enrolled patients undergoing pre-surgical investigation for refractory epilepsy. Ictal and inter-ictal ESI results were interpreted blinded to- and subse-quently compared with stereoelectroencephalography as a reference method. Anatomical concordance was assessed at a sub-lobar level. Sensitivity and specificity of ictal, inter-ictal and ictal plus inter-ictal ESI were calculated and compared according to the different subgroups. Inter-ictal and ictal ESI sensitivity (84% and 75% respectively) and specificity (38% and 50% respectively) were not statistically different. Regarding the sensitivity, ictal ESI was never higher than inter-ictal ESI. Regarding the specificity, ictal ESI was higher than inter-ictal ESI in malformations of cortical development (MCD) (60% vs. 43%) and in MRI positive patients (49% vs. 30%). Within the ictal ESI analysis, we showed a higher specificity for ictal spikes (59%) and rhythmic discharges > 13 Hz (50%) than rhythmic discharges < 13 Hz (37%) and (ii) for MCD (60%) than in other etiologies (29%). This prospective study demonstrates the relevance of a combined interpretation of distinct inter-ictal and ictal analysis. Inter-ictal analysis gave the highest sensitivity. Ictal analysis gave the highest specificity especially in patients with MCD or a lesion on MRI.

Objective Fear of having a seizure called anticipatory anxiety of epileptic seizure (AAS), constitutes a daily life burden but has been rarely studied. Our aim was to assess the prevalence and the determining factors of AAS in patients with drug-resistant focal epilepsy, a dimension that has not been thoroughly investigated before. Methods We conducted an observational, prospective study enrolling patients with drug-resistant focal epilepsy. The psychiatric assessment aimed to evaluate psychiatric comorbidities, trauma history, and quality of life using hetero-evaluation and self-assessment tools. Dimensions of anxiety specifically related to epilepsy (peri-and-inter-ictal) were explored as exhaustively as possible. Results AAS was found in 53 % of the 87 patients. We compared the two groups of patients: with or without AAS. Patients with AAS had a significantly shorter duration of epilepsy (p = 0.04). There was no difference between groups with respect to psychiatric disorders, except for cannabis dependence, more frequent in patients with AAS (p = 0.02). Compared to patients without AAS, those with AAS presented more subjective ictal anxiety (p = 0.0003) and postictal anxiety (p = 0.02), were more likely to avoid outdoor social situations due to seizure fear (p = 0.001), and had a poorer quality of life (QOLIE emotional well-being; p = 0.03). Additionally, they had experienced more traumatic events in their lifetime (p = 0.005) and reported more frequently a feeling of being unsafe during their seizures (p = 0.00002). Significance AAS is a specific dimension of anxiety, possibly linked to trauma history. AAS is strongly linked to subjective ictal anxiety but not to the objective severity of seizures or frequency.

OBJECTIVEIn drug-resistant temporal lobe epilepsy (TLE) patients, the authors evaluated early and late outcomes for decline in visual object naming after dominant temporal lobe resection (TLR) according to the resection status of the basal temporal language area (BTLA) identified by cortical stimulation during stereoelectroencephalography (SEEG).METHODSTwenty patients who underwent SEEG for drug-resistant TLE met the inclusion criteria. During language mapping, a site was considered positive when stimulation of two contiguous contacts elicited at least one naming impairment during two remote sessions. After TLR ipsilateral to their BTLA, patients were classified as BTLA+ when at least one positive language site was resected and as BTLA− when all positive language sites were preserved. Outcomes in naming and verbal fluency tests were assessed using pre- and postoperative (means of 7 and 25 months after surgery) scores at the group level and reliable change indices (RCIs) for clinically meaningful changes at the individual level.RESULTSBTLA+ patients (n = 7) had significantly worse naming scores than BTLA− patients (n = 13) within 1 year after surgery but not at the long-term evaluation. No difference in verbal fluency tests was observed. When RCIs were used, 5 of 18 patients (28%) had naming decline within 1 year postoperatively (corresponding to 57% of BTLA+ and 9% of BTLA− patients). A significant correlation was found between BTLA resection and naming decline.CONCLUSIONSBTLA resection is associated with a specific and early naming decline. Even if this decline is transient, naming scores in BTLA+ patients tend to remain lower compared to their baseline. SEEG mapping helps to predict postoperative language outcome after dominant TLR.

International audience; Objective: To evaluate the incidence of short-term recurrence (

International audience; Stereoelectroencephalography (SEEG) was designed and developed in the 1960s in France by J. Talairach and J. Bancaud. It is an invasive method of exploration for drug-resistant focal epilepsies, offering the advantage of a tridimensional and temporally precise study of the epileptic discharge. It allows anatomo-electrical correlations and tailored surgeries. Whereas this method has been used for decades by experts in a limited number of European centers, the last ten years have seen increasing worldwide spread of its use. Moreover in current practice, SEEG is not only a diagnostic tool but also offers a therapeutic option, i.e., thermocoagulation. In order to propose formal guidelines for best clinical practice in SEEG, a working party was formed, composed of experts from every French centre with a large SEEG experience (those performing more than 10 SEEG per year over at least a 5 year period). This group formulated recommendations, which were graded by all participants according to established methodology. The first part of this article summarizes these within the following topics: indications and limits of SEEG; planning and management of SEEG; surgical technique; electrophysiological technical procedures; interpretation of SEEG recordings; and SEEG-guided radio frequency thermocoagulation. In the second part, those different aspects are discussed in more detail by subgroups of experts, based on existing literature and their own experience. The aim of this work is to present a consensual French approach to SEEG, which could be used as a basic document for centers using this method, particularly those who are beginning SEEG practice. These guidelines are supported by the French Clinical Neurophysiology Society and the French chapter of the International League Against Epilepsy.

International audience; Medical international guidelines recommend regular psychiatric consultations for patients with epilepsy, in order to detect comorbidities. However, there is a lack of guidance about PNES that constitute both a differential diagnosis and a comorbidity of epilepsy. While waiting for the ideal collaboration between neurologists and psychiatrists, we develop a pragmatic approach. Wrong diagnosis between epilepsy and Psychogenic nonepileptic seizures (PNES) is frequent and may lead to iatrogenic consequences for patients. To limit the risk of misdiagnosis, psychiatrists and neurologists should collaborate and be more trained about epilepsy, PNES, and their comorbidities. We illustrate the aim of this collaboration through the case of a patient, initially diagnosed with epilepsy, then with PNES only and finally with comorbid epilepsy and PNES. The correct final diagnosis would not have been performed without the collaboration of psychiatrists and neurologists, trained in "Epi-Psy" approach.

Objectives To describe the hippocampal stereo-electroencephalogram during sleep according to sleep stages (including N2 sleep) and cycles, together with the hippocampal spindles. Methods All patients with drug-resistant focal epilepsy undergoing intra-hippocampal implantation between August 2012 and June 2013 at Nancy University Hospital were screened. Six patients with explored hippocampus devoid of pathological features were analyzed. During one night, we identified continuous periods of successive N2, N3 and REM sleep for two full cycles. We performed a spectral analysis of the hippocampal signal for each labeled sleep period. Results N2, N3 and REM sleeps were individualized according to their spectral powers, for each frequency band and sleep cycle. Hippocampal spindles showed dynamic intrinsic properties, the 11.5–16 Hz frequency band being mainly dominant, whereas the 9–11.5 Hz frequency band heightening during the beginning and the end of the transient. For N3 and REM sleep stages, the power of the hippocampal signal was significantly decreased between the first and the second sleep cycle. Conclusion Distinct N2 sleep, fast spindles and homeostatic profile are all common properties shared by hippocampus and cortex during sleep. Significance The close functional link between hippocampus and cortex may have various sleep-related substrates.

Présentation Poster. Abstract published in Neurophysiologie Clinique 49(3):196-197, June 2019; International audience; Contexte: Les épilepsies focales structurelles pharmacorésistantes avec crises pariétales représentent seulement 5 % des séries chirurgicales et moins de 10 % dans notre série de patients explorés en SEEG à Nancy. Ce sont des épilepsies de diagnostic difficile du fait de leur rareté et d’une symptomatologie riche témoignant d’une implication extrapariétale. Le diagnostic localisateur des crises peut donc être retardé voire conduire à une localisation erronée de la zone épileptogène.Objectifs: À partir des corrélations anatomo-électrocliniques en SEEG, déterminer les signes critiques associés à la décharge critique pariétale initiale et à la propagation pariétale et extrapariétale.Méthodes: Étude de deux patients implantés en SEEG présentant une épilepsie pariétale pharmacorésistante. Analyse de l’activité paroxystique enregistrée et de la clinique lors de la crise enregistrée en simultanée en vidéo.Résultats: La première patiente présente une symptomatologie sensitive unilatérale associée à une décharge limitée au cortex post-central. Le second patient présente une activité motrice dystonique et hyperkinétique concomitante d’une décharge pariétale avec une propagation lente intrapariétale (26 s) puis secondairement une propagation extrapariétale asymétrique (frontal ipsilatéral), contrairement aux crises frontales qui se caractérisent par une propagation bilatérale rapide.Conclusion: Ces deux observations permettent de mettre évidence un pattern électroclinique orientant vers le lobe pariétal aussi bien au niveau des signes que de la dynamique. Ces conclusions sont à confirmer sur une série de patient plus importante.

International audience; Psychiatric comorbidities are 2 to 3 times more frequent in patients with epilepsy than in the general population. This study aimed to prospectively assess the following: (i) the prevalence of specific and nonspecific interictal psychiatric comorbidities in a population of patients with drug-resistant focal epilepsy and (ii) the influence of epilepsy lateralization and localization on these psychiatric comorbidities.In this prospective monocentric study, we collected demographic data, characteristics of the epilepsy, interictal psychiatric comorbidities, mood, anxiety, and alexithymia dimensions. We used criteria from Diagnostic and Statistical Manual of Mental Disorders IV ( DSM IV) (Mini International Mental Interview (MINI)), diagnosis criteria for specific comorbidities, and validated mood and anxiety scales (general and specific for epilepsy).Among the 87 enrolled patients (39 males, 48 females), 52.9% had at least one psychiatric comorbidity. The most common comorbidity was anxiety disorder (28.7% according to the MINI, and 38.4% screening by the Generalized Anxiety Disorder 7 (GAD 7)). Mood disorders were the second most frequent psychiatric comorbidity: 21.8% of our patients had interictal dysphoric disorders (IDDs), 16.1% presented major depressive disorders according to the MINI, and 17.2% screening by the Neurological Disorders Depression Inventory for Epilepsy (NDDIE).Patients with temporal lobe epilepsy had a higher prevalence of psychiatric comorbidities than patients with extratemporal lobe epilepsy (p = 0.002), which is probably related to a higher rate of anxiety disorders in this subgroup (p = 0.012). Prevalence of psychiatric disorders prior to epilepsy in patients was higher in right- than in left-sided epilepsy (p = 0.042). No difference was found according to limbic involvement at seizure onset.Overall, this article highlighted a very high proportion of anxiety disorders in these patients with drug-resistant focal epilepsy and the necessity to systematically detect them and thus lead to a specific treatment.

International audience; Study Objectives: Confusional arousals (CA) are characterized by the association of behavioral awakening with persistent slow-wave electroencephalographic (EEG) activity during non-rapid eye movement (NREM) sleep—suggesting that sensorimotor areas are “awake” while non-sensorimotor areas are still “asleep.” In the present work, we aimed to study the precise temporo-spatial dynamics of EEG changes in cortical areas during CA using intracerebral recordings.Methods: Nineteen episodes of CA were selected in five drug-resistant epileptic patients suffering incidentally from arousal disorders. Spectral power of EEG signal recorded in 30 non-lesioned, non-epileptogenic cortical areas and thalamus was compared between CA and baseline slow-wave sleep.Results: Clear sequential modifications in EEG activity were observed in almost all studied areas. In the last few seconds before behavior onset, an increase in delta activity occurred predominantly in frontal regions. Behavioral arousal was associated with an increase of signal power in the whole studied frequency band in the frontal lobes, cingulate cortex, insular cortex, and precuneus. Afterwards, a diffuse cessation of very low frequencies (

We report the case of a patient (MB, young female human subject) who systematically experiences confusion between perceived facial identities when electrically stimulated inside the lateral section of the right fusiform gyrus. In the presence of a face stimulus (an experimenter or a photograph), intracerebral electrical stimulation in this region generates a perceptual hallucination of an individual facial part integrated within the whole perceived face, i.e. facial palinopsia. In the presence of a distracting stimulus (visual scene or object picture), the patient also experiences an individual face percept superimposed on the non-face stimulus. The stimulation site evoking this category-selective transient palinopsia is localized in a region showing highly selective responses to faces both with functional magnetic resonance imaging (“Fusiform Face Area”, “FFA”) and intracerebral electrophysiological recordings during fast periodic visual stimulation (FPVS). Importantly, the largest electrophysiological response to fast periodic changes of facial identity is also found at this location. Altogether, these observations suggest that a local face-selective region of the right lateral fusiform gyrus suffices to generate a vivid percept of an individual face, supporting the active role of this region in individual face representation.

International audience; Stereoelectroencephalography (SEEG) aims to define the epileptogenic zone (EZ), to study its relationship with functional areas and the causal lesion and to evaluate the possibility of surgical therapy. Planning of exploration is based on the validity of the hypotheses developed from electroclinical and imaging correlations. Further investigations can refine the implantation plan (e.g. fluorodeoxyglucose positron emission tomography [FDG-PET], single photon emission computerized tomography [SPECT], magnetoencephalography [MEG] and high resolution electroencephalography [EEG-HR]). The scheme is individualized according to the features of each clinical case, but a general approach can be systematized according to the regions involved (temporal versus extra-temporal), the existence of a lesion, its type and extent. It takes account of the hemispheric dominance for language if this can be determined. In "temporal plus" epilepsies, perisylvian and insular regions are among the key structures to investigate in addition to mesial and neocortical temporal areas. In frontal lobe epilepsies, determining the functional and anatomical organization of seizures (anterior versus posterior, mesial versus dorsolateral) allows better targeting of the implantation. Posterior epilepsies tend to have a complex organization leading to multilobar and often bilateral explorations. In lesional cases, it may be useful to implant one or several intralesional electrode(s), except in cases of vascular lesions or cyst. The strategy of implantation can be modified if thermocoagulations are considered. The management of SEEG implies continuous monitoring in a dedicated environment to determine the EZ with optimal safety conditions. This methodology includes spontaneous seizure recordings, low and high frequency stimulations and, if possible, sleep recording. SEEG is applicable in children, even the very young. Specific training of medical and paramedical teams is required.

a b s t r a c t Purpose: To investigate cognition, particularly anterograde and remote memory, in patients suffering from unilateral drug-responsive mesial temporal lobe epilepsy (mTLE) patients and to compare their performance with that observed in drug-resistant mTLE patients. Methods: Sixteen drug-responsive mTLE patients, with only infrequent seizures in their lifetime, were matched for demographic and clinical variables to 18 patients suffering from drug-resistant unilateral mTLE. A comprehensive neuropsychological examination, including baseline, anterograde memory tasks, and a large range of remote memory tests was carried out. Results: Patients with drug-responsive epilepsy obtained average scores on every anterograde memory test. Although in general, they obtained lower scores than the healthy controls on remote memory tests, the differences failed to reach significance. Moreover, the drug-responsive group performed significantly better than the drug-resistant group on anterograde recall tests and an episodic autobiographical memory test. Performance was not significantly different between the patient groups in personal semantics or memory for public events. Conclusion: Our results show that a mild clinical course of mTLE with no cognitive deficits can occur notwithstanding hippocampal sclerosis. The differences in cognitive function between the two groups are likely due to distinct pathophysiology of the underlying cause of epilepsy. Drug-resistant seizures and cognitive deficits may be the consequence of a more severe underlying cerebral process. Better understanding of the variety of pathogenesis of mTLE could help to answer this open question.

National audience; Peu d’études ont décrit l’aspect des potentiels évoqués somesthésiques (PES) enregistrés en intracérébral chez l’homme. Ces données en corrélation avec les potentiels évoqués observés en surface ont permis de mieux comprendre le siège des différents générateurs correspondants aux PES et les contraintes liées à l’orientation des électrodes. Notre objectif était, à partir des aspects décrits dans la littérature, d’évaluer la pertinence des PES dans la définition anatomo-fonctionnelle du cortex sensitif, moteur et prémoteur au cours du bilan préchirurgical d’une épilepsie. Nous avons enregistré les PES du nerf médian (gauche ou droit ?) par 4 électrodes implantées dans le cortex controlatéral sensitif primaire, moteur primaire et prémoteur chez une patiente souffrant d’une épilepsie frontale explorée en SEEG dans le cadre d’un bilan préchirurgical. L’étude des réponses corticales N20, P24, N30 sur les différents contacts ainsi que la réactivité de la réponse N30 lors de l’exécution de mouvements actifs, nous ont permis de localiser avec précision les cortex somesthésiques primaires, moteur primaire et prémoteur chez cette patiente. Ces hypothèses anatomo-fonctionnelles ont été parfaitement confirmées par les résultats des stimulations directes corticales. En conclusion, les PES peuvent être un complément valide du bilan classique intracrânien pour la cartographie fonctionnelle du cortex sensorimoteur. Plus d’études sont nécessaires afin d’évaluer leur sensibilité et spécificité, et notamment une confrontation avec les données d’IRM fonctionnelle.

International audience; While object naming is traditionally considered asa left hemisphere function, neuroimaging studies have reported activations related to naming in the ventral temporal cortex (VTC) bilaterally. Our aim was to use intracerebral electrical stimulation to specifically compare left and right VTC in naming. In twenty-three epileptic patients tested for visual object naming during stimulation, the proportion of naming impairments was significantly higher in the left than in the right VTC (31.3% vs 13.6%). The highest proportions of positive naming sites were found in the left fusiform gyrus and occipito-temporal sulcus (47.5% and 31.8%). For 17 positive left naming sites, an additional semantic picture matching was carried out, always successfully performed. Our results showed the enhanced role of the left compared to the right VTC in naming and suggest that it may be involved in lexical retrieval rather than in semantic processing.

International audience; Purpose: Seizure frequency, although considered as an important factor in memory impairment in mesial temporal epilepsy (mTLE), is mostly confounded with other clinical variables, making it unclear to what extent recurrent seizures actually interfere with memory. The present study focuses on the influence of seizure frequency, studied as a main variable, on anterograde and remote memory.Methods: Seventy-one patients with unilateral mTLE were divided into two subgroups, as a function of their seizure frequency (monthly versus weekly seizures). Other seizure-related variables were controlled, namely, lateralisation and type of lesion, age at onset, years of ongoing seizures, etiologic factors, and number of AED. A comprehensive neuropsychological examination, including anterograde memory (verbal and non verbal recognition memory and free recall) tasks together with a large range of tests exploring different domains of remote memory, was carried out.Results: Despite similar results on IQ, executive functions and attention, the low seizure-frequency group performed significantly better than the high seizure-frequency group on anterograde memory tests. Loss of autobiographical episodes and public-events memory, concomitant with spared personal semantic knowledge, was observed in both patient groups compared with healthy subjects. A worsening effect of high seizure frequency was recorded for autobiographical incidents and news-events memory, but unexpectedly, not for memory for famous people.Conclusion: The study of seizure frequency as the main variable leads us to suggest that high seizure frequency, itself, potentiates the effects of mesial temporal lobe damage on episodic memory deficits.

International audience; OBJECTIVE:Despite its well-known effectiveness, the cost-effectiveness of epilepsy surgery has never been demonstrated in France. We compared cost-effectiveness between resective surgery and medical therapy in a controlled cohort of adult patients with partial intractable epilepsy.METHODS:A prospective cohort of adult patients with surgically remediable and medically intractable partial epilepsy was followed over 5 years in the 15 French centers. Effectiveness was defined as 1 year without a seizure, based on the International League Against Epilepsy (ILAE) classification. Clinical outcomes and direct costs were compared between surgical and medical groups. Long-term direct costs and effectiveness were extrapolated over the patients' lifetimes with a Monte-Carlo simulation using a Markov model, and an incremental cost-effectiveness ratio (ICER) was computed. Indirect costs were also evaluated.RESULTS:Among the 289 enrolled surgery candidates, 207 were operable-119 in the surgical group and 88 in the medical group-65 were not operable and not analyzed here, 7 were finally not eligible, and 10 were not followed. The proportion of patients completely seizure-free during the last 12 months (ILAE class 1) was 69.0% in the operated group and 12.3% in the medical group during the second year (p < 0.001), and it was respectively 76.8% and 21% during the fifth year (p < 0.001). Direct costs became significantly lower in the surgical group the third year after surgery, as a result of less antiepileptic drug use. The value of the discounted ICER was 10,406 (95% confidence interval [CI] 10,182-10,634) at 2 years and 2,630 (CI 95% 2,549-2,713) at 5 years. Surgery became cost-effective between 9 and 10 years after surgery, and even earlier if indirect costs were taken into account as well.SIGNIFICANCE:Our study suggests that in addition to being safe and effective, resective surgery of epilepsy is cost-effective in the medium term. It should therefore be considered earlier in the development of epilepsy.

The adherence to medication in drug-resistant focal epilepsy (RFE) remains largely unknown. The present work aimed to assess the frequency of recent adherence to antiepileptic drugs (AEDs) in patients with RFE. This prospective observational study screened all patients with RFE, admitted to the Nancy University Hospital between April 2006 and September 2008, for a 5-day hospitalization without AED tapering. The adherence to AEDs was assessed by measuring serum drug levels on day 1 (reflecting the recent "at home" adherence) and day 5 (reflecting the individual reference concentration when drug ingestion was supervised). A patient was considered nonadherent if at least one of their serum drug levels was different between days 1 and 5. The day-1 value was considered different from day 5 when it was at least 30% lower (underdosed) or 30% higher (overdosed). Nonadherent patients were classified as under-consumers in the case of one or more underdosed day-1 values, over-consumers in the case of one or more overdosed day-1 values, or undefined if they exhibited both underdosed and overdosed day-1 values. Forty-four of the 48 screened patients were included. Eighteen (40.9%) of 44 patients were nonadherent. Among them, 12 (66.7%) were over-consumers, 4 (22.2%) were under-consumers, and 2 (11.1%) were undefined nonadherents. The study indicates that recent adherence to antiepileptic medication in this group of patients with RFE is poor. Overconsumption is the most frequent form of nonadherence in this population and should be specifically assessed to prevent its possible consequences in terms of AEDs dose-dependent adverse events.

Objectifs Les eveils dissocies sont caracterises par un eveil comportemental et des ondes lentes a l’electroencephalogramme, qui ont fait suggerer un eveil cortical des regions sensorimotrices et la persistance de sommeil profond dans les autres aires corticales. A partir de l’enregistrement d’eveils dissocies avec des electrodes intracerebrales profondes, nous avons etudie la modification de l’activite electrique de differentes zones cerebrales au cours de ces episodes. Methodes Nous avons inclus 19 eveils dissocies survenus chez 5 sujets epileptiques explores en SEEG a Lille, Lyon et Nancy. Nous avons effectue une analyse temps frequence de l’activite electrique dans les differentes regions corticales que nous avons comparee a l’activite electrique du sommeil lent profond. Resultats L’activite corticale se modifiait dans toutes les regions corticales, traduisant un eveil cortical generalise. Dans les secondes precedant l’eveil, une augmentation de l’activite delta etait observee dans les regions frontales (notamment l’aire motrice supplementaire, le gyrus cingulaire et le cortex operculaire), suivie d’un blocage des activites de basse frequence traduisant un eveil cortical, d’une activite rapide dans les regions sensorimotrices, et d’une synchronisation autour d’une frequence de 1,5 hz au sein d’un large reseau incluant le cortex cingulaire, et le cortex lateral, frontal, parietal et temporal. Cette activite delta hypersynchrone etait maximale dans la region orbito-frontale laterale et dans l’opercule frontal. Conclusion Durant les eveils confusionnels, l’ensemble des regions corticales modifient leur activite, avec une activite d’eveil des regions sensorimotrices et une activite anormale hypersynchrone au sein du gyrus cingulaire et des regions laterales corticales, et notamment des regions impliquees dans le mode par defaut.

Objectif Les eveils dissocies sont caracterises par un eveil comportemental et des ondes lentes a l’electroencephalogramme, qui ont fait suggerer un eveil cortical des regions sensorimotrices et la persistance de sommeil profond dans les autres aires corticales. Notre objectif etait de preciser la modification de l’activite des zones cerebrales impliquees dans les eveils dissocies a partir d’enregistrements intracerebraux chez l’Homme. Methodes Nous avons inclus 20 eveils dissocies survenus chez 5 sujets epileptiques explorees en SEEG. Nous avons etudie la modification de l’activite electrique des differentes regions corticales explorees par une analyse temps-frequence. Resultats L’activite corticale se modifiait dans toutes les regions explorees. Dans les secondes precedant l’eveil, une augmentation de l’activite delta etait observe dans les regions frontales, suivie d’un blocage des activites de basse frequence, d’une activite rapide dans les regions sensorimotrices, et d’une synchronisation autour d’une frequence de 1,5 hz au sein d’un large reseau incluant le cortex cingulaire, et le cortex lateral, frontal, parietal et temporal. Conclusion Durant les eveils confusionnels, l’ensemble des regions corticales modifient leur activite, traduisant un eveil cortical generalise, avec une activite d’eveil des regions sensorimotrices et une activite anormale hypersynchrone au sein du gyrus cingulaire et des regions laterales corticales, et notamment des regions impliquees dans le mode par defaut.

Introduction La chirurgie curative de l’epilepsie s’adresse aux patients ayant une epilepsie partielle pharmaco-resistante et invalidante. Il existe depuis 10 ans une collaboration entre les hopitaux de Reims et Nancy pour cette chirurgie. Objectifs Notre objectif est d’evaluer l’efficacite de la chirurgie curative de l’epilepsie et le devenir socioprofessionnel des patients epileptiques adultes suivis a Reims et ensuite operes a Nancy. Patients et methodes Nous avons realise une etude retrospective a partir des dossiers medicaux des patients. La plupart sont actuellement revus regulierement en consultations. Nous avons complete les informations et recupere les donnees plus recentes en appelant par telephone les patients. Resultats Nous avons inclus 24 patients qui ont beneficie d’une chirurgie curative de l’epilepsie au CHU de Nancy, entre 2003 et 2012. Parmi ces patients, tous avaient une epilepsie d’origine temporale sauf 4 (frontale). Apres un recul moyen de 5,79 ans, 11 patients (47,8 % IC95 [27,4 ; 68,2]) avaient un score d’Engel 1a (libre de toutes crises) et 18 (78,3 % IC95 [61,5 ; 95,1]) avaient un score d’Engel 1 (libre de crises invalidantes). Discussion Les patients prenaient en moyenne 1,04 traitement antiepileptique de moins apres l’intervention. Ils etaient 80 % a travailler apres la chirurgie contre 65,22 % avant la chirurgie. Treize patients (56,52 %) etaient en couple avant la chirurgie, ce nombre restait stable. Douze patients (57,14 %) conduisaient apres la chirurgie contre 5 (21,74 %) avant la chirurgie. Conclusion La chirurgie curative de l’epilepsie est efficace sur la frequence des crises et peut ameliorer les patients d’un point de vue socioprofessionnel particulierement si cette chirurgie est precoce.

International audience; This prospective study investigated and compared psychiatric features of 25 consecutive patients with psychogenic nonepileptic seizures (PNES) on the basis of presence of reported trauma. The "trauma" group comprised 19 patients (76%) and the "no-trauma" group comprised 6 patients (34%). We compared history of PNES, psychiatric comorbidity, alexithymia, and symptoms of dissociation. The study clearly characterized two distinct profiles of patients with PNES on the basis of trauma history. Patients with trauma had at least one psychiatric comorbidity or antecedent (vs 0% in the no-trauma group NT, P < 0.001) and a higher median score of dissociation (P < 0.001). Patients without trauma had more frequent "frustration situations" as a factor triggering PNES and subsequent sick leaves as perpetuating factors (P = 0.001). Trauma antecedents correlated with a high rate of psychiatric comorbidity and a strong dissociative mechanism. Patients without trauma had no psychiatric comorbidity and a weaker dissociative mechanism.

Resume Introduction Plusieurs travaux ont montre qu’une resection au niveau du lobe temporal (RT), pratiquee dans le cas d’une epilepsie du lobe temporal median (ELT) pharmaco-resistante, peut se traduire par un declin des performances en memoire anterograde ou memoire du passe. Cependant, la plupart de ces travaux n’ont pas utilise de criteres d’inclusion stricts pour constituer des groupes de patients homogenes. Dans la presente etude, nous avons evalue l’impact d’une RT sur les performances mnesiques en realisant un suivi neuropsychologique longitudinal de patients atteints d’ELT, patients selectionnes selon des criteres demographiques et cliniques restreints. Methode Trente patients atteints d’ELT unilaterale (17 droites et 13 gauches) ont ete evalues a 4 tests de memoire anterograde et a six tests de memoire du passe, trois mois avant la RT, ainsi que cinq mois et 12 mois apres l’operation. Resultats Suite a la RT, les performances en memoire anterograde sont ameliorees un an apres l’operation. Seuls les patients operes dans l’hemisphere droit ameliorent leur memoire autobiographique. Conclusions Une amelioration postoperatoire des capacites mnesiques a ete observee des lors que les patients presentaient des caracteristiques cliniques specifiques.

International audience; Establishing an early diagnosis of Lafora disease (LD) is often challenging. We describe two cases of LD presenting as myoclonus and tonic–clonic seizures, initially suggesting idiopathic generalized epilepsy. The subsequent course of the disease was characterized by drug-resistant myoclonic epilepsy, cognitive decline, and visual symptoms, which oriented the diagnosis toward progressive myoclonic epilepsy and, more specifically, LD. Early in the evolution in the first case, and before histopathologic and genetic confirmation of LD in both cases, [18]Fluorodeoxyglucose positron emission tomography (FDG-PET) revealed posterior hypometabolism, consistent with the well-known posterior impairment in this disease. This suggests that FDG-PET could help to differentiate LD in early stages from other progressive myoclonic epilepsies, but confirmation is required by a longitudinal study of FDG-PET in progressive myoclonic epilepsy.

Résumé publié dans Médecine du Sommeil, 15(1):45, March 2018; International audience; Objectif : Décrire le sommeil dans l’hippocampe humain, en déterminant par stéréo-électroencéphalographie le profil spectral du signal électrique au cours des stades et des cycles du sommeil.Méthodes : Tous les patients avec une épilepsie focale réfractaire ayant bénéficié d’une implantation d’électrodes intra-hippocampiques au centre hospitalier universitaire de Nancy entre août 2012 et juin 2013 ont été considérés pour analyse du sommeil. Six patients avec des hippocampes explorés dépourvus de caractère pathologique ont été analysés. Durant une nuit, nous avons identifié sur l’électroencéphalogramme de surface synchronisé des périodes continues de sommeil N2, N3 et REM pour deux cycles complets de sommeil. Pour chacune de ces périodes, nous avons réalisé une analyse spectrale du signal hippocampique correspondant.Résultats : Les stades N2, N3 et REM étaient clairement individualisables selon le profil de la puissance spectrale du signal hippocampique, tout en tenant compte des cycles du sommeil. Pour les stades N3 et REM seulement, la puissance du signal hippocampique était significativement diminuée entre le premier et le second cycle du sommeil.Conclusion : À l’instar du cortex, l’hippocampe humain présente une activité électrique variable selon les stades et les cycles de sommeil. Ce constat pose la question de l’effet du sommeil sur les fonctions cognitives dépendantes de l’hippocampe, en particulier la consolidation mnésique.

International audience; According to neuropsychological evidence, a distributed network of regions of the ventral visual pathway - from the lateral occipital cortex to the temporal pole - supports face recognition. However, functional magnetic resonance imaging (fMRI) studies have generally confined ventral face-selective areas to the posterior section of the occipito-temporal cortex, i.e., the inferior occipital gyrus occipital face area (OFA) and the posterior and middle fusiform gyrus fusiform face area (FFA). There is recent evidence that intracranial electrical stimulation of these areas in the right hemisphere elicits face matching and recognition impairments (i.e., prosopagnosia) as well as perceptual face distortions. Here we report a case of transient inability to recognize faces following electrical stimulation of the right anterior fusiform gyrus, in a region located anteriorly to the FFA. There was no perceptual face distortion reported during stimulation. Although no fMRI face-selective responses were found in this region due to a severe signal drop-out as in previous studies, intracerebral face-selective event-related potentials and gamma range electrophysiological responses were found at the critical site of stimulation. These results point to a causal role in face recognition of the right anterior fusiform gyrus and more generally of face-selective areas located beyond the "core" face-processing network in the right ventral temporal cortex. It also illustrates the diagnostic value of intracerebral electrophysiological recordings and stimulation in understanding the neural basis of face recognition and visual recognition in general.

Unfortunately, the captions of Figs. 5 and 6 are swapped in the original publication of the article. The authors would like to correct the error with this erratum. The corrected captions should read: Fig. 5 Hierarchical clustering dendrogram of averaged ISS. All M ISS networks were classified in a same cluster (in red) whereas M?NC and NC ISS networks were classified together in another cluster (in blue). Two outliers were observed in network 13, patient 6, (M?NC network) and in network 21, patient 7 (NC network) Fig. 6 Topographic consistency test (TCT), applied time-instant by time-instant to the EEG recordings, for the three different spike networks in patient 5. In the upper graphs, the dark line shows the global field power (GFP) computed for all EEG signals (n = 14) and for all observations (n = 368, 84, 64), the grey lines show the GFP of randomly shuffled EEG signals obtained with 500 randomization runs. In the lower graphs, the dark line shows the obtained p-value, the dotted line shows the threshold of a false discovery rate (FDR) of 5%. Around t0, the GFP of real data is increasing and the p-value is under the threshold indicating the presence of a consistent topography

Using results from cortical stimulations, as well as the symptoms of spontaneous epileptic seizures recorded by stereoelectroencephalography we re-studied the phenomenon of the dreamy state, as described by Jackson (Jackson JH. Selected writings of John Hughlins Jackson. Vol 1. On epilepsy and epileptiform convulsions. Taylor J, editor. London: Hodder and Stoughton; 1931). A total of 15 sensations of déjà vécu, 35 visual hallucinations consisting of the image of a scene and 5 'feelings of strangeness' occurred. These were recorded during 40 stimulations in 16 subjects, and 15 seizures in 5 subjects. Forty-five per cent of dreamy states were evoked by stimulation of the amygdala, 37.5% by the hippocampus and 17.5% by the para-hippocampal gyrus. During both spontaneous and provoked dreamy state, the electrical discharge was localized within mesial temporal lobe structures, without involvement of the temporal neocortex. Early spread of the discharge to the temporal neocortex appeared to prevent the occurrence of the dreamy state. Semiological analysis showed a clinical continuity between déjà vécu and visual hallucinations, the latter often consisting of a personal memory that was 'relived' by the subject; such memories could be recent, distant or from childhood. With one exception, the particular memory evoked differed from one seizure to another, but were always drawn from the same period of the subject's life. Given the role of the amygdala and hippocampus in autobiographic memory, their pathological activation during seizures may trigger memory recall. This study of the dreamy state is in keeping with other evidence demonstrating the constant and central role of the amygdala and hippocampus (right as much as left) in the recall of recent and distant memories. It demonstrates the existence of large neural networks that produce recall of memories via activation of the hippocampus, amygdala and rhinal cortex.

Summary: Purpose: The present study aims at characterizing remote memory in patients with temporal lobe epilepsy (TLE); it also considers the impact of its most important variables (lateralization of the lesion, duration of epilepsy, age at onset, and seizure frequency) on remote memory. Methods: We examined the performance of 38 patients with unilateral TLE (19 right TLE and 19 left TLE) and 35 healthy subjects on six remote memory tasks. Memory for personal events was assessed by using the Autobiographical Memory Interview and the Modified Crovitz Test. Memory for public events was evaluated by means of photographs of famous faces and famous scenes, questions about famous events, and the Dead/Alive Test. Results: Both right-TLE and left-TLE groups had impaired memory for autobiographic episodes and public events relative to normal subjects. In contrast, personal semantic memory was preserved. In addition, an effect of laterality was recorded, with right-TLE patients obtaining significantly better scores than leftTLE patients on every test. Duration of epilepsy, age at onset, and seizure frequency did not influence performance on remote memory measures. Conclusions: The comprehensive neuropsychological study of 38 TLE patients showed that this neurologic condition affects remote memory systems differently. We discuss the different factors that could account for this pattern of performance on the bases of both functional brain organization and memory theories. Key Words: Temporal lobe epilepsy—Autobiographic memory—Public-events memory—Seizure variables. The initial report (1) of memory deficits in the famous patient H.M. described a massive anterograde and only a brief retrograde amnesia after bilateral mesial temporal lobe surgery. In part from these observations, the mesial temporal lobe (MTL) had been strongly related to learning capacities, and almost all research has focused on anterograde memory deficits in patients with temporal lobe epilepsy (TLE). Interestingly, further evaluations of H.M.’s retrograde memory, carried out decades later, revealed a retrograde amnesia involving ≤11 years before surgery (2), with severely impaired autobiographic memory and relatively preserved public-events memory (3). In general, little attention had been directed toward deficits in the recall of remote memory in patients with epilepsy. Remote memory encompasses autobiographic memory and memory for public events; the former is a complex concept that implies different kinds of knowledge pertaining to oneself. Episodic autobiographic memories

Summary: Purpose: The International League Against Epilepsy (ILAE) classification distinguishes medial and neocortical temporal lobe epilepsies. Among other criteria, this classification relies on the identification of two different electroclinical patterns, those of medial (limbic) and lateral (neocortical) temporal lobe seizures, depending on the structure initially involved in the seizure activity. Recent electrophysiologic studies have now identified seizures in which medial and neocortical structures are both involved at seizure onset. The purpose of the study was therefore to study the correlations of ictal semiology with the spatiotemporal pattern of discharge in temporal lobe seizures. Methods: The 187 stereoelectroencephalography-recorded seizures from 55 patients were analyzed. Patients were classified into three groups according to electrophysiologic findings: medial (M; seizure onset limited to medial structures, n = 24), lateral (L; seizure onset limited to lateral structures, n = 13), and medial-lateral (ML; seizure onset involving both medial and lateral structures, n = 18). Clinical findings were compared between groups. Results: Initial epigastric sensation, initial fear, delayed oroalimentary and elementary upper limb automatisms, delayed loss of contact, long seizure duration, and absent or rare secondary generalizations were associated with M seizures. Initial auditory illusion or hallucination, initial loss of contact, shorter duration of seizures, and more frequent generalizations were associated with L seizures. Initial epigastric sensation, initial loss of contact, early oroalimentary and verbal automatisms, and long duration of seizures were associated with ML seizures. Conclusions: Although the syndrome of mesial temporal epilepsy is now relatively well defined, our findings support the idea that the organization of temporal lobe seizures may be complex and that different patterns exist. We demonstrate three distinct patterns, characterized by both semiologic and electrophysiologic features. This distinction may help to define better the epileptogenic zone and the subsequent surgical procedure.