Background: Temporal lobe epilepsy (TLE) has been redefined as a disorder associated with network-level dysfunction not limited to the epileptic zone. As such, as resting state (rs) fMRI has been used to evaluate the implicated resting state networks (RSN) and their ensuing functional impairments. However, few studies have analyzed patients with (TLE-HS) and without (TLE-nonHS) hippocampal sclerosis independently. Whereas TLE-HS often warrants surgical intervention, drug-resistant TLE-nonHS might pose challenges for diagnosis and treatment decisions. Methods: This study aimed to investigate functional connectivity changes (FC) of RSNs beyond the hippocampus using rs-fMRI. Rs-fMRI data was acquired from 16 TLE-HS and nine TLE-nonHS, along with 25 healthy controls (HC). RSNs were established using a data-driven independent component analysis approach, in order to determine significant connections between HC and patient groups ipsilateral and contralateral to the seizure focus. Results: When comparing TLE-HS to HC, FC changes were found for the dorsal-attentional (DAN), visual, fronto-parietal (FPN), sensorimotor and default-mode networks (DMN). Alterations in the DAN, DMN and FPN were found when comparing TLE-nonHS to HC. Conclusions: This study demonstrated widespread network reorganization across TLE subtypes. These FC patterns hold promise as a prognostic biomarker, and may be used to define subsequent function and dysfunction in this patient population.

Background: In Canada, approximately 300,000 women with epilepsy (WWE) are of childbearing potential. Given the unique aspects of providing care for WWE, our objective was to gather demographic and practice characteristics of health care professionals providing care for WWE to identify potential gaps. Methods: We developed a questionnaire to understand the demographic and practice characteristics of professionals providing care for WWE. We invited all French and English practitioners (physicians, physician assistants and nurse practitioners), recruited through the Canadian League Against Epilepsy (CLAE), Canadian Neurological Sciences Federation (CNSF) and Canadian Epilepsy nursing Group (CENG), to complete our online questionnaire. Results: Preliminary data show 43% were between 32-40 years of age and 76% were medical doctors. Sixty-three percent had been in practice for less than 20 years; 81% considered themselves epilepsy specialists and 66% devoted their practice entirely to epilepsy patients and 78% practiced exclusively in academic centers. Conclusions: Our data shows providers involved in the care of women with epilepsy in Canada are predominantly academic experts in epilepsy. Potential gaps in care include mid-late career physicians, non-specialized health care practitioners, and community-based practices, as less likely to provide care for WWE. This snapshot may provide future insights to the unmet needs of WWE Canada.

Background: The electroencephalography (EEG) pattern extreme delta brush (EDB) is felt to be highly specific for anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. This study aimed to characterize EEG findings in anti-NMDAR encephalitis patients looking for the proportion of abnormal EEGs, presence of EDB, and to relate EDB to clinical outcomes (Glasgow Outcomes Scale (GOS) at 6 months, need for ICU admission, and death). Methods: This retrospective single centre study included anti-NMDAR encephalitis patients who had ≥1 EEGs obtained from 2014-2021. EEGs were retrospectively analyzed by 2 reviewers. Clinical outcomes of interest were extracted through hospital and clinic chart review. Results: Twenty-one patients with anti-NMDAR encephalitis were included. Sixty-four EEGs were analyzed. Four EEGs (6.3%) were within normal limits. Focal or generalized slowing (without EDB) was seen on 44 EEGs (68.8%). EDB was seen on 16 EEGs (25.0%) in 9 of 21 patients. The presence of EDB was significantly associated with need for ICU admission (p=0.02), poorer outcome at 6 months as per the GOS (p=0.002), and with death (p=0.02) Conclusions: The presence of EDB on EEG in anti-NMDAR encephalitis patients is associated with increased need for ICU admission, risk of death, and worse functional outcomes at 6 months.

Background: Cortical electrical stimulation (CES) may produce different motor responses according to the brain area stimulated. In this study, we describe a new motor response characterized by finger movements such as a person playing piano, which we named the Piano Player Hand (PPH) sign. Methods: We retrospectively reviewed the CES results of 252 patients with drug-resistant epilepsy who underwent SEEG between January 2005 and December 2019 at the Grenoble-Alpes University Hospital. The patients’ characteristics, SEEG findings and CES parameters were extracted to find common clinical and anatomical features. Results: The PPH sign was identified 20 times from 12 patients, with stimulation of either the supplementary motor area (SMA), anterior cingulate gyrus (ACG), pre-SMA, middle frontal gyrus and anterior insula. It was obtained with high frequency stimulation, with intensity ranging from 0,7 to 3mA and mostly contralateral to the stimulation side (19/20). It was part of the ictal semiology of five patients. An afterdischarge was observed in five of the relevant CES. Conclusions: The PPH sign is a novel clinical sign, obtained mainly, but not exclusively, with CES of a small vicinity encompassing the SMA, pre-SMA and ACG. The PPH sign, when occurring ictally, may point to the premotor mesial frontal surface of the brain.