Papers by Aileen McGonigal
Neurosurgery Clinics of North America, 2020
KEY POINTS
Seizure semiology represents the dynamic clinical expression of seizures and is an i... more KEY POINTS
Seizure semiology represents the dynamic clinical expression of seizures and is an important data
source providing clues to cerebral organization.
Seizure semiology is produced through interactions between seizure onset and propagation within
physiologic and pathologic brain networks.
Semiology can be described in spatial and temporal terms, and depends on both spatial and temporal
characteristics of cerebral electrical activity.
Stereoelectroencephalography studies of electroclinical correlations, including with quantified
signal analysis, have helped elucidate several semiological patterns.
Future research could help improve pattern recognition of complex semiological patterns, possibly
using deep learning methods in a multiscale, multimodal modelization framework.
Neurophysiologie Clinique/Clinical Neurophysiology, 2020
Objectives.-Rhythmic, stereotyped movements occur in some epileptic seizures. We aimed to documen... more Objectives.-Rhythmic, stereotyped movements occur in some epileptic seizures. We aimed to document time-evolving frequencies of antero-posterior rocking occurring during prefrontal seizures, using a quantitative video analysis. Methods.-Six seizures from 3 patients with prefrontal epilepsy yet different sublobar local-izations were analyzed using a deep learning-based head-tracking method. Results.-Mean rocking frequency varied between patients and seizures (0.37-1.0 Hz). Coefficient of variation of frequency was low (≤ 12%). Discussion.-Regularity of body rocking movements suggests a mechanism involving intrinsic oscillatory generators. Since localization of seizure onset varied within prefrontal cortex across patients, altered dynamics converging on a ''final common pathway'' of seizure propagation involving cortico-subcortical circuits is hypothesized.
Epilepsia, 2014
Frontal lobe seizures are difficult to characterize according to semiologic and electrical featur... more Frontal lobe seizures are difficult to characterize according to semiologic and electrical features. We wished to establish whether different semiologic subgroups can be identified and whether these relate to anatomic organization. We assessed all seizures from 54 patients with frontal lobe epilepsy that were explored with stereoelectroencephalography (SEEG) during presurgical evaluation. Semiologic features and concomitant intracerebral EEG changes were documented and quantified. These variables were examined using Principal Component Analysis and Cluster Analysis, and semiologic features correlated with anatomic localization. Four main groups of patients were identified according to semiologic features, and correlated with specific patterns of anatomic seizure localization. Group 1 was characterized clinically by elementary motor signs and involved precentral and premotor regions. Group 2 was characterized by a combination of elementary motor signs and nonintegrated gestural motor behavior, and involved both premotor and prefrontal regions. Group 3 was characterized by integrated gestural motor behavior with distal stereotypies and involved anterior lateral and medial prefrontal regions. Group 4 was characterized by seizures with fearful behavior and involved the paralimbic system (ventromedial prefrontal cortex ± anterior temporal structures). The groups were organized along a rostrocaudal axis, representing bands within a spectrum rather than rigid categories. The more anterior the seizure organization, the more likely was the occurrence of integrated behavior during seizures. Distal stereotypies were associated with the most anterior prefrontal localizations, whereas proximal stereotypies occurred in more posterior prefrontal regions. Meaningful categorization of frontal seizures in terms of semiology is possible and correlates with anatomic organization along a rostrocaudal axis, in keeping with current hypotheses of frontal lobe hierarchical organization. The proposed electroclinical categorization offers pointers as to the likely zone of organization of networks underlying semiologic production, thus aiding presurgical localization. Furthermore, analysis of ictal motor behavior in prefrontal seizures, including stereotypies, leads to deciphering the cortico-subcortical networks that produce such behaviors.
Epilepsy & Behavior, 2014
Semiology, the manifestation of epilepsy, is dependent upon electrical activity produced by epile... more Semiology, the manifestation of epilepsy, is dependent upon electrical activity produced by epileptic seizures that are organized within existing neural pathways. Clinical signs evolve as the epileptic discharge spreads in both time and space. Studying the relation between these, of which the temporal component is at least as important as the spatial one, is possible using anatomo-electro-clinical correlations of stereoelectroencephalography (SEEG) data. The period of semiology production occurs with variable time lag after seizure onset and signs then emerge more or less rapidly depending on seizure type (temporal seizures generally propagating more slowly and frontal seizures more quickly). The subset of structures involved in semiological production, the "early spread network", is tightly linked to those constituting the epileptogenic zone. The level of complexity of semiological features varies according to the degree of involvement of the primary or associative cortex, with the former having a direct relation to peripheral sensory and motor systems with production of hallucinations (visual and auditory) or elementary sensorimotor signs. Depending on propagation pattern, these signs can occur in a "march" fashion as described by Jackson. On the other hand, seizures involving the associative cortex, having a less direct relation with the peripheral nervous system, and necessarily involving more widely distributed networks manifest with altered cognitive and/or behavioral signs whose neural substrate involves a network of cortical structures, as has been observed for normal cognitive processes. Other than the anatomical localization of these structures, the frequency of the discharge is a crucial determinant of semiological effect since a fast (gamma) discharge will tend to deactivate normal function, whereas a slower theta discharge can mimic physiological function. In terms of interaction between structures, the degree of synchronization plays a key role in clinical expression, as evidenced, for example, by studies of ictal fear-related behavior (decorrelation of activity between structures inducing "release" phenomena) and of déjà vu (increased synchronization). Studies of functional coupling within networks underlying complex ictal behavior indicate that the clinical semiology of a given seizure depends upon neither the anatomical origin of ictal discharge nor the target areas of its propagation alone but on the dynamic interaction between these. Careful mapping of the ictal network in its full spread offers essential information as to the localization of seizure onset, by deducing that a given network configuration could only be generated by a given area or group of areas.
Brain, 2007
According to most existing literature, the absence of an MRI lesion is generally associated with ... more According to most existing literature, the absence of an MRI lesion is generally associated with poorer prognosis in resective epilepsy surgery. Delineation of the epileptogenic zone (EZ) by intracranial recording is usually required but is perceived to be more difficult in 'MRI negative' cases. Most previous studies have used subdural recording and there is relatively less published data on stereoelectroencephalography (SEEG). The objective of this study was to report the experience of our group in using SEEG in presurgical evaluation, comparing its effectiveness in normal and lesional MRI cases. One hundred consecutive patients undergoing SEEG for presurgical assessment were studied. Forty-three patients out of one hundred (43%) had normal MRI and 57 (57%) had lesional MRI. Successful localization was achieved with no difference between these two groups, in 41/43 (95%) normal MRI and in 55/57 (96%) lesional MRI cases (P = 1.00). Surgery was proposed in 84/100 patients and contraindicated in 16/100 with no significant difference between lesional and MRI-negative groups (P > 0.05). At 1 year follow-up, 11/20 (55%) of those having undergone cortectomy in the MRI-negative group and 21/40 (53%) in the lesional MRI group were entirely seizure free (P > 0.05) and these proportions were maintained at 2 years follow-up. Significant improvement in seizure control (ILAE outcome groups 1-4) was achieved in >90% cases with no difference between groups (P > 0.05). Of MRI-negative cases that underwent surgery, 10/23 (43%) had focal cortical dysplasia. This series showed that SEEG was equally effective in the presurgical evaluation of MRI-negative and lesional epilepsies.
Movement Disorders, 2013
The definition of stereotypies traditionally does not include &am... more The definition of stereotypies traditionally does not include "epileptic automatisms." However repetitive, sometimes rhythmic behaviors can occur during frontal lobe seizures in a reproducible pattern for a given patient. Thus, the concept of a frontostriatal "motor loop" could be relevant to repetitive ictal behaviors. We describe 17 patients with frontal lobe epilepsy who presented with motor and/or verbal stereotypies and who were explored using depth electrodes (stereoelectroencephalography [SEEG]) in the context of epilepsy presurgical evaluation. Motor patterns were typically reproducible between seizures for a given patient. Distal motor stereotypies were associated with anterior prefrontal localization, and proximal stereotypies were associated with posterior prefrontal localization. "Stereotypy" is a useful term to describe ictal repetitive behaviors produced by prefrontal seizure discharge. The expression of distal and proximal stereotypies follows a rostrocaudal gradient within the frontal lobes. Exploration of the cortical compartment of frontostriatal networks in epileptic patients offers a unique opportunity to study the mechanisms of stereotypies in vivo.
Epilepsy Research, 2013
Classification of seizures arising from the cortical motor system classically distinguishes betwe... more Classification of seizures arising from the cortical motor system classically distinguishes between primary motor seizures and supplementary motor area (SMA) seizures. With the aim of better characterizing the underlying networks of motor seizures, we quantitatively studied the "epileptogenicity" of brain structures in 28 patients investigated by intracerebral recordings (stereoelectroencephalography, SEEG). Epileptogenicity of various motor regions (rolandic, SMA, pre-SMA, cingulate motor area (CMA), lateral area 6) as well as prefrontal and parietal areas, was calculated according to the "epileptogenicity index" (EI), a technique that allows mathematical quantification of rapid discharges at seizure onset. According to the maximal value of EI five groups of patients were identified: precentral, premotor/precentral, mesial premotor, lateral premotor and mesio-lateral premotor groups. Most patients disclosed a complex pattern of motor/premotor involvement, while pure mesial premotor seizures ("SMA seizures") were rare. A positive correlation between the number of structures exhibiting high EI and epilepsy duration was found, as well as a relationship between high EI values in rolandic cortex and poorer surgical outcome. Seizures arising from the motor system appear to be organized in complex electrophysiological patterns that often involve both lateral and mesial aspects of premotor areas together with precentral cortex.
Epilepsia, 2012
We aimed at determining the lateralizing and localizing values of ''hemiballic-like'' ictal movem... more We aimed at determining the lateralizing and localizing values of ''hemiballic-like'' ictal movements observed in some partial seizures. Among 20 patients disclosing ictal hyperkinetic features and explored by stereotactic-EEG (SEEG), this sign was observed in four patients. In these cases, hemiballic movement was ipsilateral to the ictal-onset zone and was associated with contralateral ictal dystonia. Noninvasive and subsequent invasive recording revealed seizure origin in the inferior parietal lobule or the parietal operculum in three patients and in the inferior prefrontal cortex in one.
Epilepsy Research, 2009
Purpose: Hyperkinetic seizures are most often considered to originate from prefrontal cortex. Rec... more Purpose: Hyperkinetic seizures are most often considered to originate from prefrontal cortex. Recently however, it has been suggested that hyperkinetic seizures can be found in patients with temporal lobe seizures. The objective of this study was to determine the features of temporal epilepsy with hyperkinetic seizures and the functional anatomy of involved brain networks. Methods: We retrospectively identified patients investigated by depth electrodes (SEEG) in whom hyperkinetic manifestations were proved to be linked to initial temporal lobe involvement. Seizure organisation was determined according to the ''Epileptogenicity Index'' (EI), a new way to quantify rapid discharges at seizure onset. Results: We found 7 patients among 130 SEEG investigations that fulfilled the inclusion criteria. Most of the patients presented with hyperkinetic occurring (or predominating) during sleep. SEEG signal analysis demonstrated a common temporo-frontal network in which the temporal pole played a central role. Major involvement of the orbito-frontal cortex and to a lesser extent the cingulate gyrus was also a particular feature of these seizures. Discussion: Seizures originating in the temporal lobe must be recognized as an important cause of hyperkinetic seizures. The temporal pole and its connexions with medio-basal prefrontal cortex represent the main structures involved in epileptogenic networks.
Epilepsy Research, 2012
This study aims to contribute to the identification of selective brain regions involved in hyperk... more This study aims to contribute to the identification of selective brain regions involved in hyperkinetic behaviors.
Epileptic disorders : international epilepsy journal with videotape, 2008
We report the case of a young boy presenting with pre-frontal seizures including singing automati... more We report the case of a young boy presenting with pre-frontal seizures including singing automatisms. There was no visible lesion on MRI, but following localisation using stereoelectroencephalography (SEEG), surgery revealed an underlying dysplastic lesion.
Supplements to Clinical Neurophysiology, 2004
... Aileen McGonigal is supported by a Fellowship from the European Federation of Neurological Sc... more ... Aileen McGonigal is supported by a Fellowship from the European Federation of Neurological Sciences and by the Glasgow Neuroscience Foundation ... Diekmann, V.,Becker, w., Jurgens, R, Grozinger, B., Kleiser, B., Richter, HPand WolJinsky, KH Localisation of epileptic foci 407 ...
Journal of Clinical Neurophysiology, 2006
The objective of this study was to determine the validity of interictal spike (IIS) source locali... more The objective of this study was to determine the validity of interictal spike (IIS) source localization in frontal lobe epilepsies (FLE) using stereoelectroencephalography as a validating method. Ten patients with drug-resistant FLE were studied with high-resolution EEG and stereoelectroencephalography. Sixty-four scalp channels, a realistic head model, and different algorithms were used. For each patient, the intracerebral interictal distribution was studied and classified into one of three groups: lateral, medial, and mixed (latero-medio-basal). Surface IIS were abundant or subcontinuous for 8 of 10 FLE patients. In lateral and medial groups, intracerebral interictal activities were accurately localized. In the mixed group, source localizations designated a part of the intracerebral interictal distribution. A high degree of source localization accuracy is obtained in FLE. False-positive results were never obtained, but the extent of interictal activity could be underestimated by source localization results. Geometrical and cytoarchitectonic characteristics of the generator appear crucial to explain why medial frontal IIS (anterior para-cingulate gyrus and anterior cingulate gyrus) may be localizable whereas only the lateral orbitofrontal IIS seems to be localizable.
2008 19th International Conference on Pattern Recognition, 2008
This paper addresses the recovering of 3D pose and animation of the human face in a monocular sin... more This paper addresses the recovering of 3D pose and animation of the human face in a monocular single image under uncontrolled imaging conditions. Our goal is to fit a 3D animated model in a face image with possibly large variations of head pose and facial expressions. Our data were acquired from filmed epileptic seizures of patients undergoing investigation in the videotelemetry unit, La Timone hospital, Marseille, France 1 .
Brain, 2006
Using results from cortical stimulations, as well as the symptoms of spontaneous epileptic seizur... more 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 dé jà vé cu, 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 dé jà vé cu 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.
Using results from cortical stimulations, as well as the symptoms of spontaneous epileptic seizur... more 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 dejav ecu,
Epilepsia, 2004
The International League Against Epilepsy (ILAE) classification distinguishes medial and neocorti... more 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. 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. 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. 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.
Brain, 2006
The EEG activity of the thalamus and temporal lobe structures (hippocampus, entorhinal cortex and... more The EEG activity of the thalamus and temporal lobe structures (hippocampus, entorhinal cortex and neocortex) was obtained using intracerebral recordings (stereoelectroencephalography, SEEG) performed in patients with TLE seizures undergoing pre-surgical evaluation. Synchrony was studied using a statistical measure of SEEG signal interdependencies (non-linear correlation). The results demonstrated an overall increase of synchrony between the thalamus and temporal lobe structures during seizures. Moreover, although there was great inter-individual variability, we found that values from seizure onset period were significantly higher than values from the background period (P = 0.001). Values at the end of seizure were significantly higher than values from the seizure onset (P < 0.0001). Several indices were also defined in order to correlate some clinical features to the degree of coupling between cortical structures and the thalamus. In patients with mesial TLE seizures, a correlation was found between the degree of thalamocortical synchrony and the presence of an early loss of consciousness but not with other clinical parameters. In addition, surgical prognosis seemed better in patients with low values of thalamocortical couplings at the seizure onset. This report demonstrates that the thalamus and remote cortical structures synchronize their activity during TLE seizures and suggest that the extension of the epileptogenic network to the thalamus is a potential important factor determining surgical prognosis.
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Papers by Aileen McGonigal
Seizure semiology represents the dynamic clinical expression of seizures and is an important data
source providing clues to cerebral organization.
Seizure semiology is produced through interactions between seizure onset and propagation within
physiologic and pathologic brain networks.
Semiology can be described in spatial and temporal terms, and depends on both spatial and temporal
characteristics of cerebral electrical activity.
Stereoelectroencephalography studies of electroclinical correlations, including with quantified
signal analysis, have helped elucidate several semiological patterns.
Future research could help improve pattern recognition of complex semiological patterns, possibly
using deep learning methods in a multiscale, multimodal modelization framework.
Seizure semiology represents the dynamic clinical expression of seizures and is an important data
source providing clues to cerebral organization.
Seizure semiology is produced through interactions between seizure onset and propagation within
physiologic and pathologic brain networks.
Semiology can be described in spatial and temporal terms, and depends on both spatial and temporal
characteristics of cerebral electrical activity.
Stereoelectroencephalography studies of electroclinical correlations, including with quantified
signal analysis, have helped elucidate several semiological patterns.
Future research could help improve pattern recognition of complex semiological patterns, possibly
using deep learning methods in a multiscale, multimodal modelization framework.