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Biomedical subjects

J Talairach

Publications and source records attributed to J Talairach.

At least 19 recordsLinked to original sources
PubMed1992

Surgical therapy for frontal epilepsies.

We have described our 25 years experience concerning 100 patients operated on for frontal epilepsy. Results show that 55% of patients are practically cured of their seizures and that 76% benefited from cortectomy (reduction of more than 75% of seizures). These results are the worst in the total series of St. Anne. Reasons for success and especially failure were analyzed in detail: 1. SEEG methods gave good indications along three dimensions of the limits and borders of the cortical excision. 2. When clinical semiology and organization of ictal discharges give evidence for rapid bilateral discharge, with involvement of axial musculature and generalized tonic-clonic manifestations, experience shows that it is necessary to combine cortectomy with a section of the adjacent cortico-subcortical fibers of the corona radiata, as if propagation of ictal discharges were impeded if not interrupted by sectioning such fibers and the primary site were incapable of expressing itself clinically. 3. If the characteristics of seizures suggest the quasisimultaneous involvement of the two frontal lobes and the existence of bilateral multifocal epilepsy, we suggest that a systematized anterior callosotomy might lead to useful results. 4. Finally, we propose general criteria for indications and contraindications for surgery.

Adolescent↗
PubMed1991

[Introduction to the clinical study of postrolandic epileptic seizures].

We reviewed, in 145 epilectics studied with SEEG, 800 clinical and electrographic seizures originating from the post-rolandic areas (590 spontaneous Sz and 260 induced by stimulation). The intra-cranial electrodes were implanted using a technique described by Talairach et al. (1974). Seizure onsets were recorded in the centro-parietal region (64 patients) in the parietal and in the occipital region. Additionally in 15 patients, mixed Sz onset were recorded. One hundred and eight (108) patients underwent surgical removal of their epileptic focus. (69 on the right, 39 on left.) 65% were cured (Sz free or occas Sz, f/up 3 years). The main ictal cal features are discussed. Emphasis is placed on the role of the operculo-insular cortex in the functional organization in man, based on Sz arising from the supra-temporal (fronto-pariental) cortex. The study of the pattern of onset and spread of seizures originating in the post-rolandic areas and of their clinical correlates allow a topographic differential diagnosis.

Diagnosis, Differential↗
PubMed1990

Methodology of "in vivo" anatomical study and stereo-electroencephalographic exploration in brain surgery for epilepsy.

Stereotactic implantation of deep SEEG electrodes performed as a prelude to surgery in some patients with drug-resistant focal epilepsy requires previous "in vivo" identification and localization of the cortical and subcortical structures to be explored, visualized "semi-directly" "or directly" by neuroradiological imaging techniques. Stereoscopic stereotactic teleangiography is a safety factor in transcutaneous electrode implantation and biopsies, but it also localizes the cortical sulci in a "semi-direct" manner by identifying vascular segments deeply buried in this sulci, which constitute their lamina vascularis. Although RMI greatly contributes to the study of the pallium, visualizing fragments of sulci and gyri does not necessarily mean that these structures can be identified with certainty, notably on the convexity of the brain. To solve this problem, RMI sections are enlarged by a photographic process, then combined with the images obtained from neuroradiological stereotaxis by means of anatomical landmarks that are common to both types of documents, using the bicommissural reference systems, bicallosal l/nl or vascular segments. This enables the angiographic laminae vascularis, which define the sulci in a "semi-direct" manner, to be used a kind of "Ariadne's clew" to identify cortical structures on RMI sections. In percutaneous stereotactic electrode implantation, the choice of the trajectories results from a compromise between the need to reach the desired anatomical structures, identified and localized within the stereotactic space, and the necessity to avoid the blood vessels displayed by stereoangiography. In some cases, the accuracy of anatomical definition can be verified during the SEEG study and/or by the evoked potential technique. Once the electrodes have been removed, their traces can be identified in a control RMI examination which constitutes a further verification.

Brain↗
PubMed1988

Hemispheric lateralization of motor and speech functions after early brain lesion: study of 73 epileptic patients with intracarotid amytal test.

This study reports results of a bilateral intracarotid amytal test in 73 epileptic patients with medically intractable focal seizures. No right-handers but 50% of left-handers have a right dominance for speech in this particular population. Lateralization of cerebral speech functions, as well as manual preference, are dependent on the neurological disease and can shift conjointly or independently. We study the relationships of those shifts to different variables related to the cerebral pathology: age at onset and lateralization of epilepsy, extensive brain damage, neurological deficit.

Adolescent↗
PubMed1987

[Value of bifocal stereotaxic destruction in case of dyskinesia in patients with a motor deficit of cerebral origin].

Authors report a study concerning 12 dyskinetic patients with cerebral palsy. The clinical pre-operative examination shows that many signs and symptoms are associated: volitional and postural dyskinesia, athetosis and dystonia, pyramidal deficit and spasticity. Talairach's stereotactic methodology has been used for bifocal (VPL thalamic nucleus and internal pallidum) Yttrium 90 implantation. After stereotactic bifocal lesions, involuntary movements have been reduced in 45.5% of cases and have disappeared in 27% of cases. Impairment of previous motor deficit has been observed in 3% of cases; volitional and postural dyskinesia seems to be the most curable symptomatology. Clinical results in athetoid involuntary movements and dystonia are less rewarding. Because of important anatomical modifications often observed cerebral palsy patients, the authors stress the interest of individual acute neurophysiological study and discuss about the stereotactic targets and the modalities of destruction. They insist upon the necessity of rigorous selection of indications based on acute clinical examination in the perspective of improvement of global functional capacities.

Adolescent↗
PubMed1985

[Electro-clinical semiology of subintrant temporal lobe seizures].

The authors recorded 10 to 67 TLS (mean 29) in 10 patients (5 M, 5 F; 9 to 41 years, mean 23) during 'acute' (4-6 hours) stereo-EEG exploration. At the onset of seizures, we observed: subjective manifestations (often epigastric), autonomic symptoms, and oro-alimentary 'automatisms'. Affective, unpleasant, manifestations occurred in only 2 patients. The discharges may only affect the Ammon's horn, but they never involve only the amygdala. There is a strong relationship between the duration of the discharge, the number of cerebral structures (temporal and, later, extratemporal) involved in the discharge, and the clinical symptomatology. Somatomotor lateralized manifestations, and gestural 'automatisms' only occur when the discharges spread to extratemporal cerebral structures. The secondary generalizations are very rare and are also linked to a large extratemporal spread of the discharge.

Adolescent↗
PubMed1984

Somatomotor manifestations in temporal lobe seizures.

Some authors include somatomotor manifestations (SMM) among the clinical features of temporal lobe seizures in man; however, data are limited and conflicting. This study describes 101 seizures recorded during stereo-EEG explorations in 50 patients, selected on the basis of the demonstration of onset in temporal lobe structures (stereo-EEG) and the presence of lateralized SMM and/or secondary generalization (SG). SMM and SG were present in about 20% of our population of patients with temporal seizures explored with stereo-EEG, and were only rarely observed during the first 10 s (early SMM) of the seizures (less than 10%). Seizures characterized by early SMM were generally induced by electrical stimulation or chemical activation and only exceptionally spontaneous. In all cases the ictal electrical discharge also involved at an early stage extratemporal structures such as the rolandic operculum, the parietal lobe, or contralateral temporal structures. In most cases (greater than 90%) SMM represented a late (greater than 10 s) event in the ictal symptomatology. The face and the upper limb were by far the most frequently involved segments. Thirty-eight percent of seizures ended up in SG. The associated ictal symptomatology was rather poor and differed from our previous findings in temporal lobe seizures: oroalimentary automatisms were relatively rare, whereas an impairment of consciousness was observed in more than 50% of seizures. The critical electrical discharge had a long duration and always involved extratemporal structures in one or both hemispheres. The involvement of the central region could be demonstrated in all patients with deep electrodes in that region. In conclusion, SMM are not characteristic of temporal lobe seizures, and their presence indicates spreading of the critical discharge beyond the temporal lobe.

Adolescent↗
PubMed1982

Prevalence of psychosis in epilepsy as a function of the laterality of the epileptogenic lesion.

Retrospective analysis of the psychiatric diagnoses in a group of patients surgically relieved of medically intractable epilepsy tested the hypothesis that patients with left-sided temporal lobe epileptogenic lesions are at greater risk for the development of a so-called schizophrenic-like psychosis than are those with right-sided temporal lobe epileptogenic lesions. The data confirmed the hypothesis and also demonstrated an increased prevalence of sinistrals in the psychotic group. Thus, epilepsy involving the dominant hemisphere at the inception of the seizure disorder is the significant risk factors. The data also indicated that a psychosis is unlikely to develop in patients with other (nontemporal) forms of focal epilepsy. On the basis of these data and data from other studies, the prevalence of psychosis in patients with poorly controlled temporal lobe epilepsy was estimated to be approximately 10% to 15%.

Adult↗
PubMed1982

[Cerebral concentrations of anticonvulsants in patients with epilepsy of tumoral origin (author's transl)].

(1) The concentrations of various anticonvulsants (PB, PHT, CBZ, VPA) were measured in brain specimens from 7 patients who had undergone neurosurgery for a therapy resistant epilepsy of tumoral origin (astrocytoma) in 6 cases, glioblastoma in 1 case). (2) Great interindividual variability of the mean brain/plasma concentration ratios was observed for PB in 5 patients (range: 0.4-1.0). A mean brain/plasma ratio of 1.0 was recorded for PHT and CBZ (one patient each). (3) In the different tissue specimens (7-14) from the same patient AED concentrations varied greatly, even in neighboring areas. (4) Intraindividual variations were more marked in the present group of patients than in previously studied non-tumoral epileptics. (5) No correlation was found between the localization of the lesions and the variations in AED concentrations. (6) Brain AED concentration appeared to be higher in the few samples of non-tumoral tissue and lower in the 'epileptogenic' areas as defined by stereo-EEG seconding. (7) On the basis of these data, the hypothesis can be formulated that the therapy resistance of these patients may be at least partly explained by the presence of low AED concentration (even in presence of 'therapeutic' AED plasma levels) in the epileptogenic areas.

Adolescent↗
PubMed1982

[Motor and postural manifestations of temporal lobe epilepsy seizure].

This study reports on 73 epileptic seizures (in 36 patients) originating in the temporal lobe (stereo-EEG) presenting motor or postural signs. Motor symptoms occur rarely in the early phase of seizures (less than 10% of our series) and they are exceptional during spontaneous seizures. The critical electrical discharge always affects extra-temporal structures such as the rolandic operculum, the cingulate gyrus, etc. The occurrence of motor symptoms during the late phase of seizures is associated with a long duration of the critical discharge and, again, with the involvement of extra-temporal structures. The characteristics of the associated clinical signs (e.g., frequent loss of contact with the environment, relatively rare oroalimentary automatic activities), together with the high frequency of secondary 'generalizations' are consistent with the stereo-EEG findings and indicate that these seizures also affect extra-temporal regions.

Adolescent↗
PubMed1982

[Continuous partial epilepsy: syndrome and disease].

Twenty three patients are described with a Kojewnikow syndrome in order to identify possible etiological factors. According to their history, clinical and E.E.G. features, patients could be classified into two groups; 1) Eleven patients corresponded to the classical description of the Kojewnikow syndrome: variable age at onset of the disease, rare somatomotor seizures, delay of onset of myoclonic jerks often of long duration, myoclonus limited to a small region, normal neurological examination, stable hemiplegia, normal results of psychometric tests, localised E.E.G. alterations. In most of these patients the etiology of the disorder was known, and the symptoms could be related to a localised lesion of the central cortex; 2) the second group (11 patients) presented with completely different characteristics: early onset of fits (age: 2 to 10 years), presence of other seizure types, short delay of onset of myoclonic jerks, high frequency of seizures, localization of myoclonus over large parts of the body, progressive evolution of a motor syndrome, associated neurological signs and disorders of sleep and behavior, progressive mental deterioration, characteristic E.E.G. pattern with long subclinical paroxysms of slow spikes (sharp waves) with variable localization, diffuse cerebral lesions of unknown etiology were found. Only one patient could not be allocated to either group. Several circumstantial data suggest that patients of the second group may suffer from a slow virus infection. Should this hypothesis be confirmed, a reconsideration of the Kojewnikow syndrome from the etiological standpoint would be of great theoretical and practical interest.

Adolescent↗
PubMed1980

Application of stereotactic concepts to the surgery of epilepsy.

For the authors, the essential feature of stereotaxis is the three-dimensional representation of the entire brain, including the central gray nuclei as well as the cerebral cortex. Stereotactic neurosurgery, which in this conception might be called "global", associates data from indirect localization (basic reference lines, proportional grid) to direct individual localization (performed by bidirectional, orthogonal teleradiography, with stereoscopy). The obtained high precision radiographic documents allow to establish the three coordinates (X, Y, Z). This method, also used in localization of tumours and interstitial irradiation of tumours, led to the definition of a special methodology for epilepsy surgery (threefold correlation of the clinical seizure patterns, electrical anomalies and the concerned anatomical structures). The stereotactic implantation of several acute and chronic electrodes (stereo-EEG) gives a 3-dimensional definition of the epileptogenic area and of its propagation pathways. These data, as well as the individual anatomy of the patient's brain are represented by the neurosurgeon on a surgical diagram. The transfer of these data to the surgical field is facilitated by the accuracy of the diagram. A double postoperative control is made (photographs--teleangiography). The described methodology increases the precision of open surgery. It is also used to localize and to remove "incipient" lesions evidenced by the CT scan (accurate anatomical localization--vascularization). In the opinion of the authors, the use of a common stereotactic geometry applied to the collection of paraclinical data will lead in the future to an increased precision of surgery and hence, to a better respect of the brain and of its function.

Adolescent↗