Biomedical subjects

F Boesebeck

Publications and source records attributed to F Boesebeck.

3 recordsLinked to original sources

PubMed2006

[Suggestion for a new, patient-oriented epilepsy classification].

The recent proposal by the ILAE Task Force for Epilepsy Classification is a multiaxial, syndrome-oriented approach. Epilepsy syndromes--at least as defined by the ILAE Task Force--group patients according to multiple, usually poorly defined parameters. As a result, these syndromes frequently show significant overlap and may change with patient age. We propose a five-dimensional and patient-oriented approach to epilepsy classification. This approach shifts away from syndrome orientation, using independent criteria in each of the five dimensions similarly to the diagnostic process in general neurology. The main dimensions of this new classification consist of (1) localizing the epileptogenic zone, (2) semiology of the seizure, (3) etiology, (4) seizure frequency, and (5) related medical conditions. These dimensions characterize all information necessary for patient management, are independent parameters, and include information more pertinent than the ILAE axes with regard to patient management. All cases can be classified according to this five-dimensional system, even at initial encounter when no detailed test results are available. Information from clinical tests such as MRI and EEG are translated into the best possible working hypothesis at the time of classification, allowing increased precision of the classification as additional information becomes available.

Epilepsy↗

PubMed2004

Cognitive changes after epilepsy surgery in the posterior cortex.

OBJECTIVE: The relationship between the posterior cortex and cognitive functions is still a relatively open field. There are no studies on populations in which functions of posterior structures were examined by a standardised neuropsychological examination before and after posterior resections. Changes in cognitive performance are regularly observed after epilepsy surgery in the temporal lobe. However, information about neuropsychological impairments after resections in the posterior cortex is poor, owing to the relatively low proportion of cortical resections in this area. METHODS: We retrospectively studied changes in cognition in the neuropsychological data of 28 patients prior to and 6 months after posterior cortical resections. RESULTS: Cognition significantly showed differences in performance intelligence quotient compared with verbal intelligence quotient. Post-operative verbal intelligence consistently increased, whereas performance intelligence decreased. There was no effect regarding the lesion side, continuation of seizures, or reduction of visual field after surgery. Epilepsy surgery in this area did not lead to significant differences in general intelligence after surgery. CONCLUSION: Functions of posterior areas could be described by standardised neuropsychological measures. Posterior regions contribute to explicit attentional and visuoconstructional abilities. Epilepsy surgery in the posterior cortex bears no risk for substantial decline in general cognition although some discrete impairment in performance intelligence may occur.

Adolescent↗

PubMed2002

Lateralizing semiology predicts the seizure outcome after epilepsy surgery in the posterior cortex.

Compared with temporal or frontal resections, epilepsy surgery in the posterior cortex is rarely performed, and the literature concerning clinical predictors for the postoperative seizure outcome in this particular subgroup is sparse. The data of 42 patients with lesional focal epilepsies of the parieto-occipital lobe and the occipital border of the temporal lobe were evaluated retrospectively and related to the seizure outcome 2 years after epilepsy surgery. The investigated parameters included ictal semiology, pre- and postoperative EEG and neuroimaging, histological findings and demographic data. Postoperatively, seizure-free outcome was seen in: (i) 69% of patients with lateralizing auras, but only in 28% of patients without lateralizing auras (P = 0.01); and (ii) 57% of the patients with lateralizing seizures, but only in 17% of patients without lateralizing ictal semiology (P = 0.02). None of the patients with neither lateralizing auras nor lateralizing seizures achieved freedom from seizures (P < 0.01). The proportion of lateralizing seizures (P < 0.01) and auras (P = 0.02) in the total number of recorded seizures and auras was significantly related to the probability of a favourable surgical outcome. No patient with clinical lateralizing signs to the non-lesional hemisphere but 58% without such "false" lateralization achieved freedom from seizures (P = 0.02). The following parameters also proved to be predictive for a favourable seizure outcome: (i) tumoural aetiology; and (ii) absence of epileptiform discharges in the postoperative EEG. The presence and frequency of ictal semiology lateralizing to the lesional hemisphere and the absence of lateralizing signs to the non-lesional hemisphere are highly predictive of a favourable outcome after surgical treatment of epilepsy in the posterior cortex.

Adolescent↗