Clinical Features of Automatism and Correlation with the Seizure Onset Zones: A Cluster Analysis of 74 Surgically Treated Cases
Abstract number :
3.192
Submission category :
4. Clinical Epilepsy / 4A. Classification and Syndromes
Year :
2021
Submission ID :
1825524
Source :
www.aesnet.org
Presentation date :
12/1/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:43 AM
Authors :
Bo-wen Yang, MD, PhD - Beijing Tiantan Hospital, Capital Medical university, China; Jia-jie Mo, PhD – Beijing Tiantan Hospital, Capital Medical University, China; Chao Zhang, PhD – Beijing Tiantan Hospital, Capital Medical University, China; Xiu Wang, PhD – Beijing Tiantan Hospital, Capital Medical University, China; Lin Sang, PhD – Beijing Fengtai Hospital; Xiao-qiu Shao, PhD – Beijing Tiantan Hospital, Capital Medical University, China; jian-guo Zhang, PhD – Beijing Tiantan Hospital, Capital Medical University, China; Kai Zhang, PhD – Beijing Tiantan Hospital, Capital Medical University, China; Wen-Han Hu, PhD – Beijing Tiantan Hospital, Capital Medical University, China
Rationale: Localizing seizure onset zone (SOZ) according to semiologic features of automatism is challenging. We aimed to identify semiologic patterns that correlate to the anatomic origin of seizures with automatism.
Methods: We assessed a total of 204 seizures from 74 patients with either oral or manual automatism. The location of the SOZ was determined using presurgical anatomo-electroclinical data (including stereo-EEG if performed), postsurgical brain MRI, and postoperative outcome (Engel's classification). Patients were divided into four subgroups according to the location of the SOZ: frontal, neocortical temporal, posterior, and mesial temporal cortex. Eleven clinical features were combined into a multi-criteria scale, based on which the k-means analysis was then performed. Subsequently, the patterns of the semiologic clusters were correlated with the SOZ localizations.
Results: The clinical features were compared between the two examiners with a good inter-rater agreement (82.3%). Four semiologic patterns were identified (Figure 1). Cluster 1 was characterized by frequent aura, post-ictal confusion with a short delay of automatism, and correlated significantly with mesial temporal lobe epilepsy (p = .017). Cluster 2 was characterized by remarkable hyperkinetic movement with a moderate version. Cluster 3 included one-third of patients with frontal lobe epilepsy and was characterized by strong emotionality. Cluster 4 was characterized by strong contralateral dystonia with prominently short delay of automatism, and correlated significantly with neocortical temporal lobe epilepsy (p = .011). Besides, the SOZ localization of the four semiologic clusters were illustrated on the schematic plot (Figure 2).
Conclusions: In this study, the cluster analysis illustrated four clinical patterns of automatism characterized by various clinical features. Moreover, several correlations between semiology and SOZ localization were found. In terms of the clinical application, the accompanying symptoms of the four patterns could provide essential information in SOZ localization for focal seizures with automatism.
Funding: Please list any funding that was received in support of this abstract.: This work was supported by the National Natural Science Foundation of China (82071457, 81771399, 81701276), the Beijing Municipal Science & Technology Commission (Z171100001017069), and Capital’s Funds for Health Improvement and Research (2020-2-1076).
Clinical Epilepsy