The authors describe a 7-year-old boy with severe epilepsy cured by means of two-stage hemispherectomy. Epileptic seizures occurred in the left extremities and recurred several tens of times daily despite intensive pharmacological treatment. EEG investigations demonstrated seizure activity in the right motor-parietal-temporal area. Stereotaxic destruction of Forel's field and thalamus on the right side gave only brief improvement lasting several days. In view of this the frontal, temporal and a part of the parietal lobe were removed according to electrocorticographic investigations. During 6 months after the operation epileptic attacks were absent, than they recurred with increasing frequency. After 10 months full hemispherectomy was done. The child tolerated the operation very well, and control examination after 2 years showed disappearance of epileptic attacks and considerable compensation of motor power loss and sensory disturbances in the left extremities. The authors believe that hemispherectomy carried out in two stages at an interval of several months is better tolerated by the patients and makes possible better compensation of functional disturbances than classic hemispherectomy. In the discussion the authors stress the importance of extrapyramidal pathways for compensation of motor disturbances.

Child↗

PubMedDate not supplied

[Relationship between blood serum luminal and diphenylhydantoin level and the results of treatment and other clinical data in drug-resistant epilepsy].

The authors report a statistical analysis of the levels of phenobarbital (PH) and diphenylhydantoin (DPH) in a group of 100 patients with different types of epilepsy mostly resistant to pharmacological treatment. The mean values of PH and DPH were compared with the types of epilepsy, duration of the disease, additional treatment, EEG changes and therapeutic results. The following conclusions have been reached: a) therapeutic ranges of the PH and DPH levels in this group of patients were greater than those reported by others. b) no significant correlation is found between the levels of these drugs and the type of epilepsy, disease duration and EEG changes, with the exception of a positive correlation with PH level. c) Clonazepam, diazepam and mysodin raised the serum PH level in the serum, while only amizepine raised the DPH level. d) higher levels of PH and DPH were found in patients with poor therapeutic results.

Adolescent↗