Biomedical subjects

M R Sperling

Publications and source records attributed to M R Sperling.

85 records · Page 5Linked to original sources

PubMed1985

Electroencephalographic recording from the temporal lobes: a comparison of ear, anterior temporal, and nasopharyngeal electrodes.

A prospective study was performed to evaluate the usefulness of ear, anterior temporal, and nasopharyngeal electrodes for recognizing temporal lobe epileptic electroencephalographic (EEG) foci. One hundred and three EEGs were performed on patients suspected of having epilepsy who had a previous normal record. Nasopharyngeal electrodes were simultaneously compared with ear and anterior temporal electrodes to determine their relative abilities to detect pathological epileptiform transients from the temporal region. Epileptic discharges were detected in 22% of the recordings. Pathological discharges seen in nasopharyngeal electrode derivations invariably were seen in ear and anterior temporal electrode derivations using carefully designed montages, and EEG diagnosis was not altered by use of nasopharyngeal electrodes. We conclude that EEG recording with ear and anterior temporal electrodes is sufficient to detect pathological temporal epileptiform transients, and that the use of nasopharyngeal electrodes as a routine procedure offers no added benefit.

Adolescent↗

PubMed1985

Syndrome of palatal myoclonus and progressive ataxia: two cases with magnetic resonance imaging.

Two patients are reported with palatal myoclonus, progressive ataxia, and dysarthria, unresponsive to treatment with trihexyphenidyl or L-5-hydroxytryptophan. MRI showed enlargement of the inferior olives in one patient, consistent with the pathology usually associated with palatal myoclonus. The syndrome of progressive ataxia and palatal myoclonus should be distinguished from other ataxias and degenerations that affect the brainstem and cerebellum. Pathology and specificity of site of the lesions are distinctive.

Adult↗

PubMed1984

Hypoglycemic activation of focal abnormalities in the EEG of patients considered for temporal lobectomy.

EEGs were recorded in 22 patients with medically refractory complex partial epilepsy undergoing presurgical evaluation and 11 age-matched controls while subjected to moderate levels of hypoglycemia to determine if changes activated were predictive of underlying pathology. Five patients had fasting EEGs showing focal abnormalities not seen in the non-fasting state. With hypoglycemia, EEG tracings in normal individuals showed diffuse background slowing, whereas 7 of 22 patients developed focal temporal changes, including focal spike and focal slow wave activation. The development of focal changes correlated well with clinical data concerning underlying focal pathology; focal abnormalities were not evoked in patients with multifocal disease. Hypoglycemic activation of the EEG may be a useful technique for predicting the presence of pathology in patients considered for anterior temporal lobectomy.

Adult↗

PubMed1984

Nocardia brain stem abscess: diagnosis and response to medical therapy.

A patient with a rapidly progressive brain stem syndrome is reported. CT scan showed a ring enhancing lesion in the pons and CSF examination showed elevated protein and pleocytosis. A pulmonary abscess containing Nocardia was found and antimicrobial therapy produced progressive reduction in size of the pontine lesion and clinical improvement without surgical drainage. This is the first documented diagnosis and survival of a medically treated patient with a brain stem abscess of presumed Nocardia etiology.

Brain Abscess↗

PubMedDate not supplied

Mesial temporal spikes: a simultaneous comparison of sphenoidal, nasopharyngeal, and ear electrodes.

A prospective study was performed to compare the relative ability of sphenoidal (SP), nasopharyngeal (NP), and ear electrodes for detecting mesial temporal lobe epileptiform discharges. Forty-four EEGs were performed on patients with complex partial seizures, simultaneously recording from NP, SP, and ear electrodes. Spikes were noted in SP derivations in 25 records, in ear derivations in 23 records, and in NP derivations in 20 records. A total of 875 spikes were counted, SP showing 99%, NP 57%, and ear 54% of discharges, with greatest amplitudes generally seen in SP derivations. The Mann-Whitney rank sum test showed SP electrodes superior to both NP and ear electrodes (p less than 0.0001) and no significant differences between NP and ear electrodes. We conclude that SP electrodes are superior to both NP and ear electrodes in detecting mesial temporal spikes.

Brain↗

PubMedDate not supplied

Lack of effect of naloxone on prolactin and seizures in electroconvulsive therapy.

Both opiate agonist and antagonist injection have been reported to modulate prolactin secretion, alter brain excitability and produce seizures, and modify the postictal state. We studied the effects of administration of high-dose naloxone, an opiate antagonist, on postictal prolactin levels, seizure duration, and postictal behavior, using patients undergoing electroconvulsive therapy (ECT) as a seizure model. Seven patients had 8 mg naloxone injected prior to one ECT treatment and saline injected prior to another treatment, with the order of injection randomized. Before ECT and 15 min after ECT, prolactin levels were drawn, and no blunting of the expected postictal prolactin elevation by naloxone injection was observed. We found no evidence that endogenous opiates trigger prolactin secretion during seizures. Seizure duration was also similar in saline and naloxone groups, and naloxone did not reverse postictal depression, as has been reported in an animal model.

Electroconvulsive Therapy↗

PubMedDate not supplied

Prognostic significance of independent auras in temporal lobe seizures.

We performed a retrospective study of auras that occurred independently of complex partial seizures in patients undergoing continuous EEG monitoring with stereotactically implanted depth electrodes placed in mesiotemporal structures. Forty of 54 patients had a history of independent auras, and 32 of these individuals had independent auras while being monitored. Two hundred ninety-two independent auras were recorded, and EEG characteristics and subjective symptoms were analyzed with regard to surgical outcome. Most patients had ictal EEG changes with all or some of their auras. Four patients had nonlocalized or multifocal complex partial seizures despite the presence of well-localized auras, indicating that if intracranial ictal recording is used as a gold standard for localization, complex partial seizures must be recorded. Presence or absence of EEG change with auras did not affect prognosis nor did variability of ictal EEG pattern, spatial extent of initial field potential, aura duration, or character of symptoms correlate with prognosis or postoperative persistence of auras.

Electroencephalography↗

PubMedDate not supplied

Relief of seizures from a predominantly posterior temporal tumor with anterior temporal lobectomy.

We report the relief of intractable complex partial seizures in a patient with a posteromesial temporal lobe hamartoma after anterior temporal lobectomy, despite minimal tumor removal. We suggest that the key to successful treatment is the mainly medial, or limbic, location of the tumor, which apparently requires anterior limbic structures for full clinical expression of seizures. We conclude that excision anterior to a posterior temporal lesion can result in seizure relief and that a medial tumor location may be important for successful treatment.

Adult↗

PubMedDate not supplied

Speech during partial seizures: intracranial EEG correlates.

Vocalization during a seizure may help predict the location of seizure onset or identify structures ultimately involved in the seizure. Spontaneous vocalization during seizures was studied retrospectively in 22 patients with refractory complex partial seizures evaluated with bilateral intracranial electrodes. Of 22 patients, 12 vocalized during seizures. Seizures were as likely to originate from language-dominant (6/12) as from language-nondominant mesial temporal cortex (6/12). Fluent speech frequently occurred as seizure activity was recorded from language-dominant temporal lobe neocortex (6/12 seizures). Of the patients with well-localized seizure onsets who did not speak (6/10), seizures arose from both language-dominant and -nondominant mesial temporal cortex. We conclude that the presence or absence of vocalizations during a seizure does not reliably indicate the anatomic regions in which the seizure begins or spreads.

Adult↗

PubMedDate not supplied

Magnetic resonance imaging in localization of EEG depth electrodes for seizure monitoring.

Preoperative evaluation of patients with medically refractory complex partial seizures requires intensive EEG monitoring. Part of this process may include insertion of depth electrodes into temporal lobe structures. Although many imaging methods have been used for stereotactic placement of the electrodes, only computed tomography (CT) has been used to verify position after implantation. We studied 30 patients in whom magnetic resonance imaging (MRI) was used to visualize the position of stainless-steel electrodes stereotactically implanted in the temporal lobes. The procedure is noninvasive, does not utilize radiation, and has the additional advantages of multiplanar capability, increased soft tissue contrast, and lack of bony artifacts commonly associated with CT.

Electrodes, Implanted↗

PubMedDate not supplied

Absence seizures and carbamazepine in adults.

Carbamazepine (CBZ) therapy was associated with development of absence seizures in 4 adults with generalized epilepsy. Two patients had new appearance of absence seizures and 2 patients had recrudescence of remote absence seizures. The seizures abated after discontinuation of CBZ therapy or addition of ethosuximide (ESM) in 1 patient intolerant of valproate (VPA).

Adult↗

PubMedDate not supplied

Subcortical metabolic alterations in partial epilepsy.

The function of subcortical nuclei in partial epilepsy was investigated using positron emission tomography (PET) to measure metabolism in the basal ganglia and thalamus. Sixteen patients undergoing surgical evaluation were studied with 18F-fluorodeoxyglucose (FDG) interictally and had intensive extracranial and intracranial electrophysiologic evaluations. Eight patients had left temporal lobe seizure foci, six had right temporal lobe foci, and two had right posterotemporal or parietal foci. The PET data were analyzed visually and quantitatively, using a multivariate analysis of variance on the quantitative data. Hypometabolism of subcortical nuclei was present ipsilateral to the cortical seizure focus. Cortical hypometabolism was noted focally in the temporal lobe in patients with left temporal lobe seizure foci, whereas patients with right temporal lobe seizure foci had diffuse hemispheric hypometabolism. We postulate that the subcortical hypometabolism is secondary to decreased efferent activity from temporal lobe structures, in particular amygdala and hippocampus, to subcortical nuclei. Diminished subcortical activity may then lead to defective regulation of cortical excitability in the temporal lobe, increasing the likelihood of seizure development and spread.

Adult↗

PubMedDate not supplied

Olfactory dysfunction in schizophrenia and temporal lobe epilepsy.

BACKGROUND: Schizophrenia and mesial temporal lobe epilepsy (TLE) represent two common brain disorders that share dysfunction of temporo-limbic neural substrates. OBJECTIVE: We evaluated whether patients with schizophrenia exhibited olfactory performance more similar to right or left temporal lobe epilepsy patients. METHODS: Odor identification ability and detection threshold sensitivity were measured in 40 patients with schizophrenia, 14 patients with right- and 18 patients with left-temporal lobe epilepsy (TLE) patients, and 25 healthy controls. Odor identification was assessed with the University of Pennsylvania Smell Identification Test (UPSIT) and odor detection threshold sensitivity with a single-staircase procedure using the stimulant phenyl ethyl alcohol (PEA). RESULTS: Relative to controls, only patients with schizophrenia and right TLE exhibited significant impairment in UPSIT performance. Left TLE patients and controls performed comparably on the UPSIT. Detection threshold sensitivity to PEA did not differ significantly among the four groups. CONCLUSIONS: These data suggest a greater reliance of olfactory processing on right hemisphere structures and are also consistent with recent neuroimaging studies that have implicated aberrant processing of olfactory information in right hemispheric brain regions in schizophrenia.

Adult↗