Authors :
Presenting Author: Julio Moreno, MD – Uniepilepsias
Andrea Osorio Restrepo, MD – Uniepilepsias; Marco Venegas, MD – Uniepilepsias; Angelica Uscategui-Daccarett, MD – Associated Profesor, Pediatrics, Uniepilepsias / Universidad Nacional de Colombia; Friedrich Dueñas garcia, MD – Resident, Bogota, Uniepilepsias; Cesar Buitrago, MD – UNIEPILEPSIAS
Rationale:
This study aims to describe the symptomatogenic and epileptogenic zone in a group of patients with drug-resistant epilepsy who presented the ictal pouting sign (“Chapeau de gendarme”) as part of the seizure and underwent surgical resection and remained seizure-free after surgery during a minimum follow up of one year.
Methods:
We retrospectively reviewed 563 medical records of patients with drug resistant epilepsy who underwent to surgical management at our epilepsy center in Bogota, Colombia between 2013 and 2022. We identified 16 patients who presented ictal pouting. Seizure semiology, neuroimaging, video electroencephalography recording and stereoelectroencephalography data (when it was performed), histopathologic founding and follow up after surgery were analyzed.
Results:
A total of 16 patients with ictal pouting were found (seven women and nine men), mean age: 23 years (range 10-51 years). Engel's class I outcome was obtained in eight patients (11 to 37 months follow-up, mean:17.2 months). The epileptogenic zone was observed in frontal areas (3), mesial temporal (2), posterior quadrant (2) and temporal pole (1).
Conclusions:
Prior reports have documented that ictal pouting has a good localizing value in frontal lobe epilepsies, especially anterior cingulate cortex. However, in this review we found that ictal pouting can be part of networks with extrafrontal ictal onset.
References:
1 Lu H, Zhang W, Long Q, Zhang C, Shang L, Liu S, Sun W. A semiological marker of emotional insulo-cingulate network activation in epileptic human brain. Epilepsy Behav. 2021 Jul;120:107970.
2 Souirti Z, Landré E, Mellerio C, Devaux B, Chassoux F. Neural network underlying ictal pouting ("chapeau de gendarme") in frontal lobe epilepsy. Epilepsy Behav. 2014 Aug;37:249-57.
3 Wiwchar LD, Hader W, Pauranik A, Joseph JT, Appendino JP. Focal seizures associated with the chapeau de gendarme sign or ictal pouting of insular origin. Epilepsy Behav Rep. 2019 Nov 15;12:100347.
Funding: None