TY - JOUR
T1 - The involvement of the piriform cortex in non-lesional temporal lobe epilepsy
T2 - an uncommon component of the epileptogenic network
AU - Pedersen, Nigel P.
AU - Raghu, Ashley
AU - Shivamurthy, Veeresh Kumar N.
AU - Chern, Joshua J.
AU - Gross, Robert E.
AU - Willie, Jon T.
AU - Dingledine, Raymond J.
AU - Kheder, Ammar
N1 - Publisher Copyright:
© 2024 The Author(s).
PY - 2024
Y1 - 2024
N2 - The piriform cortex is recognized as highly epileptogenic in rodents, yet its electrophysiological role in human epilepsy remains understudied. Recent surgical outcomes have suggested potential benefits in resecting the piriform cortex for cases of medial temporal lobe epilepsy. However, little is known about its electrophysiological activity in human epilepsy. This case-series study aimed to explore the electrophysiological role of the piriform cortex within the epileptogenic network among patients with suspected temporal lobe epilepsy. Participants were recruited from Emory University Hospital or Children's Healthcare of Atlanta, with non-lesional frontotemporal or temporal lobe hypotheses, undergoing stereoelectroencephalographic studies. Specifically, focus was placed on patients with one or more electrode contacts in the piriform cortex. Primary objectives included determining piriform cortex involvement within the electrophysiologically defined epileptogenic network and assessing the effects of electrical stimulation. Twenty-two patients were included in the study. Notably, only one patient exhibited piriform cortex involvement at seizure onset, associated with an olfactory aura. Two patients showed early piriform cortex involvement, while others displayed late or no involvement. Electrical stimulation of the piriform cortex induced after-discharges in three patients and replicated a habitual seizure in one. These findings present a contrast to surgical outcome studies, suggesting that the piriform cortex may not typically play a significant role in the epileptogenic network among patients with non-lesional temporal lobe epilepsy.
AB - The piriform cortex is recognized as highly epileptogenic in rodents, yet its electrophysiological role in human epilepsy remains understudied. Recent surgical outcomes have suggested potential benefits in resecting the piriform cortex for cases of medial temporal lobe epilepsy. However, little is known about its electrophysiological activity in human epilepsy. This case-series study aimed to explore the electrophysiological role of the piriform cortex within the epileptogenic network among patients with suspected temporal lobe epilepsy. Participants were recruited from Emory University Hospital or Children's Healthcare of Atlanta, with non-lesional frontotemporal or temporal lobe hypotheses, undergoing stereoelectroencephalographic studies. Specifically, focus was placed on patients with one or more electrode contacts in the piriform cortex. Primary objectives included determining piriform cortex involvement within the electrophysiologically defined epileptogenic network and assessing the effects of electrical stimulation. Twenty-two patients were included in the study. Notably, only one patient exhibited piriform cortex involvement at seizure onset, associated with an olfactory aura. Two patients showed early piriform cortex involvement, while others displayed late or no involvement. Electrical stimulation of the piriform cortex induced after-discharges in three patients and replicated a habitual seizure in one. These findings present a contrast to surgical outcome studies, suggesting that the piriform cortex may not typically play a significant role in the epileptogenic network among patients with non-lesional temporal lobe epilepsy.
KW - olfactory aura
KW - piriform cortex
KW - SEEG
KW - stereo-electroencephalography
KW - temporal lobe epilepsy
UR - http://www.scopus.com/inward/record.url?scp=85199301414&partnerID=8YFLogxK
U2 - 10.1093/braincomms/fcae179
DO - 10.1093/braincomms/fcae179
M3 - Article
C2 - 39015765
AN - SCOPUS:85199301414
SN - 2632-1297
VL - 6
JO - Brain Communications
JF - Brain Communications
IS - 4
M1 - fcae179
ER -