Alisali Mohammad, Joshi Stuti, Ganne Chaitanya, Vashin Vladimir, Pati Sandipan
Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, TX, USA.
Epilepsy Behav Rep. 2024 Nov 19;28:100729. doi: 10.1016/j.ebr.2024.100729. eCollection 2024.
Hypnopompic seizures, characterized by arousal from sleep as the primary clinical manifestation, are a rare and challenging seizure type. Their exact localization has been elusive, often requiring stereotactic EEG (SEEG) for accurate identification. We present the case of a 23-year-old male with drug-resistant focal epilepsy, in whom hypnopompic seizures were localized to the mesial orbitofrontal cortex, with rapid recruitment of the middle temporal gyrus, fusiform gyrus, rostral cingulate, and amygdala. SEEG captured multiple seizures, with arousal occurring 4-5 s after EEG onset, followed by ictal central apnea. The patient underwent resection of the right orbitofrontal and mesial temporal lobe regions and has remained seizure-free for over seven months. This case provides new insights into the neuroanatomical origins of seizure-induced arousal, identifying the mesial orbitofrontal cortex as a potential site for hypnopompic seizures. The findings underscore the critical role of SEEG in accurately localizing seizure foci in complex epilepsy cases, enabling targeted surgical interventions. Additionally, we discuss the orbitofrontal cortex's role as a site for extra-thalamic arousal pathways, offering new perspectives on the mechanisms underlying hypnopompic seizures.
睡眠觉醒期癫痫发作以从睡眠中觉醒为主要临床表现，是一种罕见且具有挑战性的癫痫发作类型。其确切定位一直难以捉摸，通常需要立体定向脑电图（SEEG）来准确识别。我们报告一例23岁耐药性局灶性癫痫男性患者，其睡眠觉醒期癫痫发作定位于眶额内侧皮质，同时颞中回、梭状回、扣带回前部和杏仁核迅速被激活。SEEG记录到多次癫痫发作，脑电图发作开始4 - 5秒后出现觉醒，随后出现发作性中枢性呼吸暂停。该患者接受了右侧眶额叶和颞叶内侧区域切除术，术后已无癫痫发作超过7个月。本病例为癫痫发作引起觉醒的神经解剖学起源提供了新见解，确定眶额内侧皮质是睡眠觉醒期癫痫发作的一个潜在部位。这些发现强调了SEEG在复杂癫痫病例中准确确定癫痫病灶的关键作用，从而实现有针对性的手术干预。此外，我们讨论了眶额皮质作为丘脑外觉醒通路部位的作用，为睡眠觉醒期癫痫发作的潜在机制提供了新的视角。
