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Biomedical subjects

M R Sperling

Publications and source records attributed to M R Sperling.

At least 19 recordsLinked to original sources
PubMed1992

Cardiac rhythm during temporal lobe seizures.

We studied the neuroanatomic correlates of ictal tachycardia in 27 seizures from five patients with unilateral temporal lobe epilepsy being evaluated with bilateral temporal lobe depth electrodes and orbitofrontal subdural electrodes. There were 11 complex partial seizures, three simple partial seizures, and 13 subclinical seizures. For all seizures, heart rate (HR) increased in a graded fashion as new cortical regions anywhere in the brain were recruited into the seizure. HR plateaued at the new level despite EEG frequency changes until the next region became involved. Increases in HR did not correlate with increased duration of seizures but rather with volume of brain involved. Restricted amygdaloid seizure activity was generally insufficient to alter HR. We conclude that the amygdala has a limited role in modulating HR during seizures, and ictal tachycardia depends principally on the volume of cerebral structures recruited into a seizure.

Adult↗
PubMed1992

A noninvasive protocol for anterior temporal lobectomy.

We report the results of a protocol for choosing candidates for temporal lobectomy using a standard battery of objective tests without intracranial electrodes. We assigned each test a level of importance, and an algorithm was used to determine whether temporal lobectomy could be performed. Fifty-one patients (total pool, 103 patients) met protocol requirements and had an anterior temporal lobectomy with a mean follow-up of 39.4 months (range, 21 to 64 months), most remaining on anticonvulsant therapy. Eighty percent are seizure free, 12% have less than 3 seizures per year or only nocturnal seizures, and 8% have greater than 80% reduction in seizure frequency. One-third of patients who failed protocol criteria did not have temporal lobe seizures when studied with intracranial electrodes. We analyzed and modified the algorithm after comparing these patients with others who were poor candidates for temporal lobectomy. We conclude that this protocol is effective and recommend using such an objective algorithm.

Action Potentials↗
PubMed1991

Acute effect of anterior temporal lobectomy on musical processing.

Patients with intractable epilepsy treated by anterior temporal lobectomy (Right, RT, n = 12; Left, LT, n = 9) and healthy controls (n = 12) with no musical training were prospectively evaluated with a standardized battery, including the Musical Aptitude Profile and the Seashore Tonal Memory Test. Before surgery, patients performed below controls (P less than 0.001), but there were no differences between RT and LT patients. After resection (2 weeks), RT patients showed a differential decline on tasks measuring perception of meter (P = 0.005) and tempo (P = 0.008) but not tonal processes. LT, and controls studied at the same time interval, showed no decline. The results support the role of the right hemisphere in specific aspects of musical processing.

Adult↗
PubMed1991

Epileptic palatal myoclonus.

Palatal myoclonus (PM) is usually caused by lesions of the brainstem. We report a case of PM of focal cortical origin in a patient with epilepsia partialis continua. The PM sometimes occurred in isolation, and at other times was accompanied by unilateral face, neck, and arm twitching. This was documented by both EEG and SPECT.

Adolescent↗
PubMed1990

Auras and subclinical seizures: characteristics and prognostic significance.

The characteristics and prognostic significance of subclinical seizures and independent auras were studied in 40 patients with partial epilepsy who had long-term electroencephalographic (EEG) monitoring with intracranial electrodes. Focal, restricted subclinical seizures were noted in 23 patients, and 11 patients experienced auras that were accompanied by ictal EEG discharges. Auras and subclinical seizures usually were identical in EEG appearance, but were distributed differently among patients. The subclinical seizures and auras usually had the same origin as complex partial seizures, but did not always reliably indicate complex partial seizure origin. Subclinical seizures and auras were of favorable prognostic significance for patients undergoing temporal lobectomy. A majority (greater than 80%) of individuals with subclinical seizures and auras were free of complex partial seizures after surgery, whereas a minority (29%) of patients without subclinical seizures and auras became free of complex partial seizures.

Brain↗
PubMed1990

Acute naming deficits following dominant temporal lobectomy: prediction by age at 1st risk for seizures.

Age at 1st risk for seizures may predict anomia following dominant anterior temporal lobectomy. We assessed confrontation naming before and 2 to 3 weeks after surgery in 45 right-handed patients grouped by side of focus and presence or absence of early (less than or equal to 5 years) risk factors. After left lobectomy, 6 of 10 (60%) patients with no early risks demonstrated significant decline (greater than or equal to 25%) in naming, but none of the patients with early risks showed this decline. After right lobectomy, there was no change. Cerebral representation of naming may be atypical in patients with early risks.

Aging↗
PubMed1989

Comparison of depth and subdural electrodes in recording temporal lobe seizures.

Intracranial EEG recording is often required to identify an area of the brain for resective surgery for intractable epilepsy. We simultaneously compared bilaterally placed depth and limited subdural electrode EEG to determine the most effective method of recording seizures from the temporal lobes. Localized complex partial seizures usually appeared earlier in hippocampal depth electrodes and spread later to subdural recording sites. In 3 patients, hippocampal recordings showed localized seizure origin but subdural recording was nonlocalizing due to rapid bilateral seizure propagation. In 1 patient with nonlocalized seizures presumably of extratemporal origin, subdural electrodes incorrectly lateralized seizure origin to a temporal lobe. Auras and subclinical seizures detected by depth electrode recording were often not evident with subdural electrodes. We conclude that EEG recording with hippocampal depth electrodes correctly identifies and lateralizes temporal lobe seizures more often than with limited subdural electrodes.

Adolescent↗
PubMed1989

Memory during subclinical hippocampal seizures.

We performed neuropsychological testing in 2 patients during subclinical hippocampal seizures recorded with depth electrodes. Neither subject showed impairment of consciousness, orientation, motor skills, or verbal fluency. The rapidity of recall of a well-learned word list was impaired in 1 subject during ictal fast spiking in the left hippocampus. Subclinical seizure activity may be responsible for a portion of the memory deficits found in patients with epilepsy.

Adult↗
PubMed1988

Neurosurgical treatment of intractable epilepsy.

Many patients with epilepsy are refractory to anticonvulsant therapy. For some, surgery is a means to control their seizures. Temporal lobectomy, the most common neurosurgical approach to intractable epilepsy, has resulted in improvement or cure in as many as 90% of treated individuals. To determine patients suitable for surgery, presurgical selection and evaluation criteria have been devised. With epilepsy surgery becoming more widely utilized and more centers appearing in the United States, there is a growing need for neuroscience nurses to know about recent developments. This overview of surgery for epilepsy includes the presurgical evaluation process through the postoperative phase presented from a nursing perspective.

Brain↗
PubMed1986

The effect of limbic and extralimbic electrical stimulations upon prolactin secretion in humans.

The effect that extra-hypothalamic regions of the brain have upon prolactin secretion in humans was evaluated by performing electrical stimulations. Thirty-nine stimulations were performed, 22 to basolateral amygdala, 12 to hippocampus and 5 to orbitofrontal, supplementary motor and cingulate cortex. Only two stimulations causing high-frequency widespread limbic afterdischarges were followed by significant prolactin elevation. Four low-frequency afterdischarges involving amygdala and anterior hippocampus, one amygdala stimulus-dependent discharge and 19 amygdala, 8 hippocampal and 5 frontal sub-afterdischarge threshold stimulations had no prolactin elevation. These results fail to replicate earlier studies. We suggest that there is no evidence that the amygdala regulates serum prolactin within physiologic ranges, but that the regulation of prolactin may depend primarily upon other sub-cortical structures.

Amygdala↗
PubMed1986

Magnetic resonance imaging in intractable partial epilepsy: correlative studies.

A study was performed evaluating magnetic resonance imaging (MRI) in 35 patients with intractable complex partial seizures in whom computed tomographic (CT) scans showed no focal abnormalities. These results were correlated with positron emission tomography evaluation (PET), the electroencephalographic ictal onset, and findings during pathological examination. Seven patients had structural lesions that were epileptogenic, detected by MRI; the lesions were tuberous sclerosis, astrocytomas, or hamartomas. Three of these 7 patients underwent PET scanning, which was normal in all. Of 18 patients with mesial temporal sclerosis, 10 were shown by PET to have temporal lobe hypometabolism, though all 18 had normal MRI findings. The results indicate that MRI contributes information to that provided by CT and PET, by detecting nonsclerotic epileptogenic lesions of the temporal lobe.

Astrocytoma↗
PubMed1986

Prolactin in partial epilepsy: an indicator of limbic seizures.

A study was performed to evaluate changes in serum prolactin levels after simple and complex partial seizures, and to identify which specific anatomical structures must be involved in seizures for postictal elevation of prolactin levels to occur. Seventy-eight seizures were studied in patients with electrodes implanted bilaterally into amygdala, hippocampus, hippocampal gyrus, and frontal sites. All 38 complex partial seizures had bilateral limbic ictal discharges, and each was followed by a significant increase in prolactin concentration (mean peak, 50.8 ng/ml; range, 16.0 to 150.0 ng/ml). Eight of 10 simple partial seizures with unilateral high-frequency regional limbic discharges were followed by prolactin elevation (mean peak, 28.2 ng/ml; range, 13.4 to 44 ng/ml). Thirty simple partial seizures with other ictal limbic discharges or without limbic discharges were not followed by an elevated prolactin level. The data indicate that serum prolactin levels always rise after complex partial seizures involving the temporal lobes, and rise after certain simple partial seizures involving limbic structures. Thus, measurement of the prolactin level can help identify which simple partial seizures involve mesial temporal lobe structures. Limbic structures serve to trigger prolactin release, which may depend upon spread of the seizure to subcortical structures.

Electroencephalography↗
PubMed1986

Focal burst-suppression induced by thiopental.

Five patients were subjected to a thiopental fast activation test, recording with implanted depth electrodes in two patients and at electrocorticography in 3 patients. A burst-suppression pattern was seen focally in each patient, while adjacent regions in that hemisphere and in the contralateral hemisphere had continuous activity. Although detected in depth electrodes, this pattern was not seen with simultaneous scalp electrode recording. This focal pattern correlated with the presence of a pathological abnormality on histologic examination in all patients. It is postulated that the appearance of a focal burst-suppression pattern during a thiopental fast activation test implies the presence of underlying structural abnormality.

Adult↗
PubMed1986

Visual versus computer evaluation of thiopental-induced EEG changes in temporal lobe epilepsy.

Thiopental-induced EEG beta activity was analyzed both visually and by computer in 33 patients with complex partial epilepsy. Studies were done in 16 patients with depth electrodes in limbic structures and 17 patients with scalp and sphenoidal electrodes. The percentage of drug-induced change in beta activity was quantified by computer using spectral analysis. The statistical significance of asymmetries between homologous sites in the amount of change was determined. The spatial distribution of significant asymmetries was used for localization and compared with the results of independent visual analysis of the thiopental EEG. Concordance between computer and visual evaluation occurred in 10 of 17 scalp/sphenoidal and 10 of 16 depth electrode tests. The accuracy of visual and computer localization was determined by comparing them with locus of itcal EEG onset, interictal spikes, and positron emission tomography. In scalp/sphenoidal studies, computer analysis indicating asymmetry appeared more likely to correlate with independent clinical criteria than visual analysis. In depth studies the reverse appeared to be true. Scalp/sphenoidal tests yielded positive results in 25-30% of patients whereas depth electrode tests were positive in 50-70% of patients. The results indicate that computer analysis of surface thiopental tests is an accurate and useful supplement to visual evaluation of these tests.

Brain↗