PMC:6610377 / 7230-11280 JSONTXT

{"project":"MyTest","denotations":[{"id":"30838920-28520631-28639267","span":{"begin":825,"end":827},"obj":"28520631"},{"id":"30838920-21883183-28639268","span":{"begin":828,"end":831},"obj":"21883183"},{"id":"30838920-28419327-28639269","span":{"begin":1453,"end":1456},"obj":"28419327"},{"id":"30838920-23811976-28639270","span":{"begin":1554,"end":1558},"obj":"23811976"},{"id":"30838920-28318128-28639271","span":{"begin":1930,"end":1933},"obj":"28318128"},{"id":"30838920-22118838-28639272","span":{"begin":2330,"end":2333},"obj":"22118838"},{"id":"30838920-24117237-28639273","span":{"begin":2355,"end":2358},"obj":"24117237"},{"id":"30838920-27472665-28639274","span":{"begin":3189,"end":3192},"obj":"27472665"},{"id":"30838920-28954895-28639275","span":{"begin":3473,"end":3477},"obj":"28954895"},{"id":"30838920-28644201-28639276","span":{"begin":3699,"end":3702},"obj":"28644201"},{"id":"30838920-25623524-28639277","span":{"begin":3831,"end":3834},"obj":"25623524"},{"id":"30838920-26096837-28639278","span":{"begin":3864,"end":3867},"obj":"26096837"}],"namespaces":[{"prefix":"_base","uri":"https://www.uniprot.org/uniprot/testbase"},{"prefix":"UniProtKB","uri":"https://www.uniprot.org/uniprot/"},{"prefix":"uniprot","uri":"https://www.uniprot.org/uniprotkb/"}],"text":"Noninvasive Investigation of Operculo-Insular Epilepsy\nDang Khoa Nguyen, MD, PhD\nThe heterogeneous clinical manifestations of insular seizures highlight the need for confirmation with noninvasive diagnostic tests.\n\nVideo EEG\nMost auras in insular seizures cannot be appreciated on video, but certain clinical signs (eg, expression of pain, hand movement to the throat, long latency between electrical onset, and hypermotor manifestations) suggest an insular focus. On scalp EEG, because the insula is a deep structure, insular spikes are seen only if they project to the surface. Interictal epileptiform discharges are regularly found over frontopolar and frontotemporal regions with anterior operculo-insular foci, and over the midtemporal region extending to frontotemporal regions and/or central leads with posterior foci.15,16 During seizures, various nonspecific patterns can be seen when the discharge reaches surface electrodes. Interictal and ictal discharges generally allow lateralization of the epileptic focus.\n\nMagnetic Resonance Imaging\nClinical diagnosis of insular epilepsy is greatly facilitated by the identification of an insular epileptogenic lesion, although nonlesional cases are frequent. Among 25 patients who underwent nontumoral epilepsy surgery involving operculo-insular resection, presurgical magnetic resonance imaging (MRI) of the operculo-insular area was normal or revealed questionable nonspecific findings in 18 (72%).17 Malformations of cortical development were commonly associated with medication resistant seizures.18\n\nMagnetic Resonance Spectroscopy\nMagnetic resonance spectroscopy (MRS) of the insula may be difficult compared with other regions due to its curved/pyramidal shape and the presence of cerebrospinal fluid in the Sylvian fissure. The value of proton MRS in identifying patients with insular epilepsy was assessed in 12 nonlesional cases with confirmed operculo-insular focus.19 Voxels were positioned to include bilateral anterior and posterior insular regions. Metabolite concentrations and ratios did not differ from those of noninsular epileptic patients and healthy controls, and asymmetry indices fared poorly in lateralizing the focus.\n\nMagnetoencephalography\nMagnetoencephalography (MEG) is one of the most useful tests to identify potential operculo-insular patients.20 Mohamed and colleagues21 reviewed MEG data of 14 patients with refractory insular seizures and identified the following 3 main patterns of spike sources: 7 (50%) had an anterior operculo-insular cluster, 2 (14%) had a posterior operculo-insular cluster, and 4 (29%) showed a diffuse perisylvian distribution. No spikes were detected in the remaining patients. Spike sources showed uniform orientation perpendicular to the Sylvian fissure. Nine patients underwent insular epilepsy surgery with favorable surgical outcome.\n\nSingle-Photon Computed Tomography and Positron Emission Tomography\nSingle-photon computed tomography (SPECT) can identify an operculo-insular epileptic focus. In a retrospective study of 17 patients with confirmed operculo-insular epilepsy, ictal SPECT correctly identified the focus in 65% and provided misleading information in 18%.22 Secondary activations in areas connected to the insula were common, but generally less intense. By contrast, interictal positron emission tomography (PET) yielded more equivocal findings, as it correctly identified the operculo-insular focus in 47% cases and was misleading in 24%.23\n\nGenetic Testing\nGenetic defects have been reported in operculo-insular epilepsy cases, including mutations in the CHRNB2 and CHRNA4 genes in 2 patients with sleep-related hypermotor seizures (functional testing under way).24 A subtle insular focal cortical dysplasia was reported in a patient with familial focal epilepsy associated with DEPDC5 mutation.25 Finally, Nguyen and colleagues26 described an epileptogenic network involving the temporo-insular region in a family with reflex bathing epilepsy associated with a Q555X mutation of synapsin 1 on chromosome Xp11-q21."}

{"project":"0_colil","denotations":[{"id":"30838920-28520631-1118","span":{"begin":825,"end":827},"obj":"28520631"},{"id":"30838920-21883183-1119","span":{"begin":828,"end":830},"obj":"21883183"},{"id":"30838920-28419327-1120","span":{"begin":1453,"end":1455},"obj":"28419327"},{"id":"30838920-23811976-1121","span":{"begin":1554,"end":1556},"obj":"23811976"},{"id":"30838920-28318128-1122","span":{"begin":1930,"end":1932},"obj":"28318128"},{"id":"30838920-22118838-1123","span":{"begin":2330,"end":2332},"obj":"22118838"},{"id":"30838920-24117237-1124","span":{"begin":2355,"end":2357},"obj":"24117237"},{"id":"30838920-27472665-1125","span":{"begin":3189,"end":3191},"obj":"27472665"},{"id":"30838920-28954895-1126","span":{"begin":3473,"end":3475},"obj":"28954895"},{"id":"30838920-28644201-1127","span":{"begin":3699,"end":3701},"obj":"28644201"},{"id":"30838920-25623524-1128","span":{"begin":3831,"end":3833},"obj":"25623524"},{"id":"30838920-26096837-1129","span":{"begin":3864,"end":3866},"obj":"26096837"}],"text":"Noninvasive Investigation of Operculo-Insular Epilepsy\nDang Khoa Nguyen, MD, PhD\nThe heterogeneous clinical manifestations of insular seizures highlight the need for confirmation with noninvasive diagnostic tests.\n\nVideo EEG\nMost auras in insular seizures cannot be appreciated on video, but certain clinical signs (eg, expression of pain, hand movement to the throat, long latency between electrical onset, and hypermotor manifestations) suggest an insular focus. On scalp EEG, because the insula is a deep structure, insular spikes are seen only if they project to the surface. Interictal epileptiform discharges are regularly found over frontopolar and frontotemporal regions with anterior operculo-insular foci, and over the midtemporal region extending to frontotemporal regions and/or central leads with posterior foci.15,16 During seizures, various nonspecific patterns can be seen when the discharge reaches surface electrodes. Interictal and ictal discharges generally allow lateralization of the epileptic focus.\n\nMagnetic Resonance Imaging\nClinical diagnosis of insular epilepsy is greatly facilitated by the identification of an insular epileptogenic lesion, although nonlesional cases are frequent. Among 25 patients who underwent nontumoral epilepsy surgery involving operculo-insular resection, presurgical magnetic resonance imaging (MRI) of the operculo-insular area was normal or revealed questionable nonspecific findings in 18 (72%).17 Malformations of cortical development were commonly associated with medication resistant seizures.18\n\nMagnetic Resonance Spectroscopy\nMagnetic resonance spectroscopy (MRS) of the insula may be difficult compared with other regions due to its curved/pyramidal shape and the presence of cerebrospinal fluid in the Sylvian fissure. The value of proton MRS in identifying patients with insular epilepsy was assessed in 12 nonlesional cases with confirmed operculo-insular focus.19 Voxels were positioned to include bilateral anterior and posterior insular regions. Metabolite concentrations and ratios did not differ from those of noninsular epileptic patients and healthy controls, and asymmetry indices fared poorly in lateralizing the focus.\n\nMagnetoencephalography\nMagnetoencephalography (MEG) is one of the most useful tests to identify potential operculo-insular patients.20 Mohamed and colleagues21 reviewed MEG data of 14 patients with refractory insular seizures and identified the following 3 main patterns of spike sources: 7 (50%) had an anterior operculo-insular cluster, 2 (14%) had a posterior operculo-insular cluster, and 4 (29%) showed a diffuse perisylvian distribution. No spikes were detected in the remaining patients. Spike sources showed uniform orientation perpendicular to the Sylvian fissure. Nine patients underwent insular epilepsy surgery with favorable surgical outcome.\n\nSingle-Photon Computed Tomography and Positron Emission Tomography\nSingle-photon computed tomography (SPECT) can identify an operculo-insular epileptic focus. In a retrospective study of 17 patients with confirmed operculo-insular epilepsy, ictal SPECT correctly identified the focus in 65% and provided misleading information in 18%.22 Secondary activations in areas connected to the insula were common, but generally less intense. By contrast, interictal positron emission tomography (PET) yielded more equivocal findings, as it correctly identified the operculo-insular focus in 47% cases and was misleading in 24%.23\n\nGenetic Testing\nGenetic defects have been reported in operculo-insular epilepsy cases, including mutations in the CHRNB2 and CHRNA4 genes in 2 patients with sleep-related hypermotor seizures (functional testing under way).24 A subtle insular focal cortical dysplasia was reported in a patient with familial focal epilepsy associated with DEPDC5 mutation.25 Finally, Nguyen and colleagues26 described an epileptogenic network involving the temporo-insular region in a family with reflex bathing epilepsy associated with a Q555X mutation of synapsin 1 on chromosome Xp11-q21."}

{"project":"2_test","denotations":[{"id":"30838920-28520631-28639267","span":{"begin":825,"end":827},"obj":"28520631"},{"id":"30838920-21883183-28639268","span":{"begin":828,"end":830},"obj":"21883183"},{"id":"30838920-28419327-28639269","span":{"begin":1453,"end":1455},"obj":"28419327"},{"id":"30838920-23811976-28639270","span":{"begin":1554,"end":1556},"obj":"23811976"},{"id":"30838920-28318128-28639271","span":{"begin":1930,"end":1932},"obj":"28318128"},{"id":"30838920-22118838-28639272","span":{"begin":2330,"end":2332},"obj":"22118838"},{"id":"30838920-24117237-28639273","span":{"begin":2355,"end":2357},"obj":"24117237"},{"id":"30838920-27472665-28639274","span":{"begin":3189,"end":3191},"obj":"27472665"},{"id":"30838920-28954895-28639275","span":{"begin":3473,"end":3475},"obj":"28954895"},{"id":"30838920-28644201-28639276","span":{"begin":3699,"end":3701},"obj":"28644201"},{"id":"30838920-25623524-28639277","span":{"begin":3831,"end":3833},"obj":"25623524"},{"id":"30838920-26096837-28639278","span":{"begin":3864,"end":3866},"obj":"26096837"}],"text":"Noninvasive Investigation of Operculo-Insular Epilepsy\nDang Khoa Nguyen, MD, PhD\nThe heterogeneous clinical manifestations of insular seizures highlight the need for confirmation with noninvasive diagnostic tests.\n\nVideo EEG\nMost auras in insular seizures cannot be appreciated on video, but certain clinical signs (eg, expression of pain, hand movement to the throat, long latency between electrical onset, and hypermotor manifestations) suggest an insular focus. On scalp EEG, because the insula is a deep structure, insular spikes are seen only if they project to the surface. Interictal epileptiform discharges are regularly found over frontopolar and frontotemporal regions with anterior operculo-insular foci, and over the midtemporal region extending to frontotemporal regions and/or central leads with posterior foci.15,16 During seizures, various nonspecific patterns can be seen when the discharge reaches surface electrodes. Interictal and ictal discharges generally allow lateralization of the epileptic focus.\n\nMagnetic Resonance Imaging\nClinical diagnosis of insular epilepsy is greatly facilitated by the identification of an insular epileptogenic lesion, although nonlesional cases are frequent. Among 25 patients who underwent nontumoral epilepsy surgery involving operculo-insular resection, presurgical magnetic resonance imaging (MRI) of the operculo-insular area was normal or revealed questionable nonspecific findings in 18 (72%).17 Malformations of cortical development were commonly associated with medication resistant seizures.18\n\nMagnetic Resonance Spectroscopy\nMagnetic resonance spectroscopy (MRS) of the insula may be difficult compared with other regions due to its curved/pyramidal shape and the presence of cerebrospinal fluid in the Sylvian fissure. The value of proton MRS in identifying patients with insular epilepsy was assessed in 12 nonlesional cases with confirmed operculo-insular focus.19 Voxels were positioned to include bilateral anterior and posterior insular regions. Metabolite concentrations and ratios did not differ from those of noninsular epileptic patients and healthy controls, and asymmetry indices fared poorly in lateralizing the focus.\n\nMagnetoencephalography\nMagnetoencephalography (MEG) is one of the most useful tests to identify potential operculo-insular patients.20 Mohamed and colleagues21 reviewed MEG data of 14 patients with refractory insular seizures and identified the following 3 main patterns of spike sources: 7 (50%) had an anterior operculo-insular cluster, 2 (14%) had a posterior operculo-insular cluster, and 4 (29%) showed a diffuse perisylvian distribution. No spikes were detected in the remaining patients. Spike sources showed uniform orientation perpendicular to the Sylvian fissure. Nine patients underwent insular epilepsy surgery with favorable surgical outcome.\n\nSingle-Photon Computed Tomography and Positron Emission Tomography\nSingle-photon computed tomography (SPECT) can identify an operculo-insular epileptic focus. In a retrospective study of 17 patients with confirmed operculo-insular epilepsy, ictal SPECT correctly identified the focus in 65% and provided misleading information in 18%.22 Secondary activations in areas connected to the insula were common, but generally less intense. By contrast, interictal positron emission tomography (PET) yielded more equivocal findings, as it correctly identified the operculo-insular focus in 47% cases and was misleading in 24%.23\n\nGenetic Testing\nGenetic defects have been reported in operculo-insular epilepsy cases, including mutations in the CHRNB2 and CHRNA4 genes in 2 patients with sleep-related hypermotor seizures (functional testing under way).24 A subtle insular focal cortical dysplasia was reported in a patient with familial focal epilepsy associated with DEPDC5 mutation.25 Finally, Nguyen and colleagues26 described an epileptogenic network involving the temporo-insular region in a family with reflex bathing epilepsy associated with a Q555X mutation of synapsin 1 on chromosome Xp11-q21."}

{"project":"testtesttest","denotations":[{"id":"T73","span":{"begin":207,"end":212},"obj":"Body_part"},{"id":"T74","span":{"begin":340,"end":344},"obj":"Body_part"},{"id":"T75","span":{"begin":361,"end":367},"obj":"Body_part"},{"id":"T76","span":{"begin":468,"end":473},"obj":"Body_part"},{"id":"T77","span":{"begin":491,"end":497},"obj":"Body_part"},{"id":"T78","span":{"begin":571,"end":578},"obj":"Body_part"},{"id":"T79","span":{"begin":810,"end":819},"obj":"Body_part"},{"id":"T80","span":{"begin":916,"end":923},"obj":"Body_part"},{"id":"T81","span":{"begin":1635,"end":1641},"obj":"Body_part"},{"id":"T82","span":{"begin":1741,"end":1760},"obj":"Body_part"},{"id":"T83","span":{"begin":1768,"end":1783},"obj":"Body_part"},{"id":"T84","span":{"begin":1990,"end":1999},"obj":"Body_part"},{"id":"T85","span":{"begin":2000,"end":2015},"obj":"Body_part"},{"id":"T86","span":{"begin":2276,"end":2281},"obj":"Body_part"},{"id":"T87","span":{"begin":2551,"end":2560},"obj":"Body_part"},{"id":"T88","span":{"begin":2755,"end":2770},"obj":"Body_part"},{"id":"T89","span":{"begin":3240,"end":3246},"obj":"Body_part"},{"id":"T90","span":{"begin":3924,"end":3938},"obj":"Body_part"},{"id":"T91","span":{"begin":4030,"end":4040},"obj":"Body_part"}],"attributes":[{"id":"A73","pred":"uberon_id","subj":"T73","obj":"http://purl.obolibrary.org/obo/UBERON_0000473"},{"id":"A74","pred":"uberon_id","subj":"T74","obj":"http://purl.obolibrary.org/obo/UBERON_0002398"},{"id":"A75","pred":"uberon_id","subj":"T75","obj":"http://purl.obolibrary.org/obo/UBERON_0000341"},{"id":"A76","pred":"uberon_id","subj":"T76","obj":"http://purl.obolibrary.org/obo/UBERON_0000403"},{"id":"A77","pred":"uberon_id","subj":"T77","obj":"http://purl.obolibrary.org/obo/UBERON_0002022"},{"id":"A78","pred":"uberon_id","subj":"T78","obj":"http://purl.obolibrary.org/obo/UBERON_0002416"},{"id":"A79","pred":"uberon_id","subj":"T79","obj":"http://purl.obolibrary.org/obo/UBERON_0001353"},{"id":"A80","pred":"uberon_id","subj":"T80","obj":"http://purl.obolibrary.org/obo/UBERON_0002416"},{"id":"A81","pred":"uberon_id","subj":"T81","obj":"http://purl.obolibrary.org/obo/UBERON_0002022"},{"id":"A82","pred":"uberon_id","subj":"T82","obj":"http://purl.obolibrary.org/obo/UBERON_0001359"},{"id":"A83","pred":"uberon_id","subj":"T83","obj":"http://purl.obolibrary.org/obo/UBERON_0002721"},{"id":"A84","pred":"uberon_id","subj":"T84","obj":"http://purl.obolibrary.org/obo/UBERON_0001353"},{"id":"A85","pred":"uberon_id","subj":"T85","obj":"http://purl.obolibrary.org/obo/UBERON_0002022"},{"id":"A86","pred":"uberon_id","subj":"T86","obj":"http://purl.obolibrary.org/obo/UBERON_0000473"},{"id":"A87","pred":"uberon_id","subj":"T87","obj":"http://purl.obolibrary.org/obo/UBERON_0001353"},{"id":"A88","pred":"uberon_id","subj":"T88","obj":"http://purl.obolibrary.org/obo/UBERON_0002721"},{"id":"A89","pred":"uberon_id","subj":"T89","obj":"http://purl.obolibrary.org/obo/UBERON_0002022"},{"id":"A90","pred":"uberon_id","subj":"T90","obj":"http://purl.obolibrary.org/obo/UBERON_0002022"},{"id":"A91","pred":"uberon_id","subj":"T91","obj":"http://purl.obolibrary.org/obo/GO_0005694"}],"text":"Noninvasive Investigation of Operculo-Insular Epilepsy\nDang Khoa Nguyen, MD, PhD\nThe heterogeneous clinical manifestations of insular seizures highlight the need for confirmation with noninvasive diagnostic tests.\n\nVideo EEG\nMost auras in insular seizures cannot be appreciated on video, but certain clinical signs (eg, expression of pain, hand movement to the throat, long latency between electrical onset, and hypermotor manifestations) suggest an insular focus. On scalp EEG, because the insula is a deep structure, insular spikes are seen only if they project to the surface. Interictal epileptiform discharges are regularly found over frontopolar and frontotemporal regions with anterior operculo-insular foci, and over the midtemporal region extending to frontotemporal regions and/or central leads with posterior foci.15,16 During seizures, various nonspecific patterns can be seen when the discharge reaches surface electrodes. Interictal and ictal discharges generally allow lateralization of the epileptic focus.\n\nMagnetic Resonance Imaging\nClinical diagnosis of insular epilepsy is greatly facilitated by the identification of an insular epileptogenic lesion, although nonlesional cases are frequent. Among 25 patients who underwent nontumoral epilepsy surgery involving operculo-insular resection, presurgical magnetic resonance imaging (MRI) of the operculo-insular area was normal or revealed questionable nonspecific findings in 18 (72%).17 Malformations of cortical development were commonly associated with medication resistant seizures.18\n\nMagnetic Resonance Spectroscopy\nMagnetic resonance spectroscopy (MRS) of the insula may be difficult compared with other regions due to its curved/pyramidal shape and the presence of cerebrospinal fluid in the Sylvian fissure. The value of proton MRS in identifying patients with insular epilepsy was assessed in 12 nonlesional cases with confirmed operculo-insular focus.19 Voxels were positioned to include bilateral anterior and posterior insular regions. Metabolite concentrations and ratios did not differ from those of noninsular epileptic patients and healthy controls, and asymmetry indices fared poorly in lateralizing the focus.\n\nMagnetoencephalography\nMagnetoencephalography (MEG) is one of the most useful tests to identify potential operculo-insular patients.20 Mohamed and colleagues21 reviewed MEG data of 14 patients with refractory insular seizures and identified the following 3 main patterns of spike sources: 7 (50%) had an anterior operculo-insular cluster, 2 (14%) had a posterior operculo-insular cluster, and 4 (29%) showed a diffuse perisylvian distribution. No spikes were detected in the remaining patients. Spike sources showed uniform orientation perpendicular to the Sylvian fissure. Nine patients underwent insular epilepsy surgery with favorable surgical outcome.\n\nSingle-Photon Computed Tomography and Positron Emission Tomography\nSingle-photon computed tomography (SPECT) can identify an operculo-insular epileptic focus. In a retrospective study of 17 patients with confirmed operculo-insular epilepsy, ictal SPECT correctly identified the focus in 65% and provided misleading information in 18%.22 Secondary activations in areas connected to the insula were common, but generally less intense. By contrast, interictal positron emission tomography (PET) yielded more equivocal findings, as it correctly identified the operculo-insular focus in 47% cases and was misleading in 24%.23\n\nGenetic Testing\nGenetic defects have been reported in operculo-insular epilepsy cases, including mutations in the CHRNB2 and CHRNA4 genes in 2 patients with sleep-related hypermotor seizures (functional testing under way).24 A subtle insular focal cortical dysplasia was reported in a patient with familial focal epilepsy associated with DEPDC5 mutation.25 Finally, Nguyen and colleagues26 described an epileptogenic network involving the temporo-insular region in a family with reflex bathing epilepsy associated with a Q555X mutation of synapsin 1 on chromosome Xp11-q21."}