Semiology of Seizures Involving the OFC: A Narrative Review About a Silent Epilepsy
Bibliographic record
Abstract
SUMMARY: The orbitofrontal cortex (OFC) is a highly interconnected region, cytoarchitectonically diverse. Seizures involving the OFC present significant diagnostic challenges because of their variable semiological features, which often overlap with those typically attributed to frontal and temporal epilepsies. Moreover, OFC seizures semiology is shaped by the epileptogenic zone network (EZN), involving either ictal propagation or reconfiguration of functional networks. We systematically reviewed 87 patients presenting seizures involving the OFC to analyze semiological profiles using the latest International League Against Epilepsy classification. We found that seizures with EZN restricted to the OFC displayed sparse semiology, including hyperkinetic behaviors, verbal automatisms, and frequent sleep association, while extended EZN seizures exhibited richer semiological profiles, varying according to EZN distribution. Temporal involvement correlated with more auras, oro-alimentary automatisms, and occurred more often with sleep, while frontal and insular participation involved hyperkinetic behaviors with more mimic and gestural automatisms. Semiological profiles of the OFC-restricted EZN seizures are concordant with propagation patterns that align with the functional connectivity of the OFC: lateral OFC seizures tend to propagate to the lateral and mesial frontal lobe while medial OFC seizures propagated to temporal lobe, either medial or polar. Despite population-level observations, semiological profiles alone seem insufficient for delimitation of extension or distribution of EZN. According to seizure semiology, "frontal" like profiles appear more frequent (∼2/3 of patients) while "temporal" like profiles were more associated with an extended EZN. These findings underscore the importance of comprehensive presurgical evaluations, to delineate EZN extension and distribution in seizures involving the OFC.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.024 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.009 | 0.004 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.003 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".