The precuneus is located on the posteromedial side of the parietal lobe and has extensive cortical and subcortical connections. Functional imaging studies have shown that the precuneus has four subregions with different functional connectivity patterns: the anterior sensorimotor area, the central cognitive area, the posterior visual area, and the ventral limbic area. The precuneus plays a core role in a series of highly integrated tasks, including visual-spatial processing, sensorimotor functions, episodic memory, self-processing, and consciousness. Its importance in complex cognitive functions is related to the three brain networks it participates in: the default mode network (DMN) core, the DMN episodic memory subnetwork, and the para-cingulate network. Vestibular reactions, visual symptoms, and body image disturbances are the main non-motor symptoms of precuneus epilepsy, while postural tonic and hypermotor are the main motor symptoms of its seizures. The differences in clinical features may be related to the specific location of the epileptogenic zone in the precuneus and the diffusion pattern of epileptic seizures. Precuneus epilepsy is mostly drug-resistant epilepsy, and the value of scalp EEG localization is limited, so surgical treatment is an effective option.
ObjectiveTo explore the clinical characteristics, neuroimaging, diagnosis and treatment process of inpatients with Juvenile Myoclonic Epilepsy (JME).Methods83 inpatients with JME in the Epilepsy Center of Lanzhou University Second Hospital from January 2016 to August 2020 were analyzed retrospectively. Their clinical features, seizure types, inducing factors, MRI and EEG, first consultation hospital, reason for visit and drug treatment were summarized.ResultsAmong the 83 patients, there were 43 males and 40 females, with an average age of (18±5.6) years. 21 patients had family history of epilepsy or history of febrile convulsion. the average age of onset was 11.5 years old, which was earlier than those without family history and history of febrile convulsion (P<0.05). The results of cranial nuclear magnetic resonance examination were abnormal in 14 patients, including hippocampal sclerosis and local small cysts. The first symptom of 62.7% JME patients is myoclonic seizures, followed by tonic-clonic seizures, sleep deprivation was the most common inducing factor, and tonic-clonic seizures was the most common cause of treatment in JME patients, accounting for 78.3%. 80.7% of patients choose local primary hospitals for their first consultation, and there was a non-standard use of ASMs in treatment, and the seizure free rate of epilepsy after ASMs treatment was 6%, which was lower than that in provincial hospitals (P<0.05). 88% of JME inpatients can effectively control their seizures through monotherapy, among which valproic acid is the most commonly used monotherapy and combination therapy. The new oral ASMs lamotrigine and levetiracetam tablets were mostly used in female patients.ConclusionA family history of epilepsy and history of febrile convulsion may be associated with an earlier age of onset in patients with JME. Neuroimaging abnormalities can be found in a small number of patients with JME, including hippocampal sclerosis and local small cysts. Tonic-clonic seizures is the main treatment cause of JME patients, and most of them are first diagnosed in local hospitals, but the seizure free rate of epilepsy in local hospitals after ASMs treatment is low, so the training of epilepsy related knowledge for doctors in primary hospitals is helpful to the diagnosis of clinical JME and improve its control rate.