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Biomedical subjects

Mary E Bertrand

Publications and source records attributed to Mary E Bertrand.

5 recordsLinked to original sources
PubMed2006

Composite SISCOM perfusion patterns in right and left temporal seizures.

OBJECTIVE: To compare composite subtraction ictal single-photon emission computed tomography coregistered to magnetic resonance imaging (also known as SISCOM) patterns between right and left medial temporal-onset seizures to document neuroanatomical involvement in perfusion patterns. DESIGN: A retrospective comparative survey. SETTING: Epilepsy monitoring unit in a tertiary care referral center. PARTICIPANTS: Subjects with temporal lobe epilepsy (TLE) who underwent ictal single-photon emission computed tomography studies. MAIN OUTCOME MEASURES: Comparison of ictal perfusion pattern changes in subjects with right and left temporal seizures. RESULTS: Composite subtraction ictal single-photon emission computed tomography coregistered to magnetic resonance images showed similar regions of hyperperfusion change in the ipsilateral anteromedial temporal-corpus striatum-insula region in both groups. In the midbrain reticular formation, there was a significant difference in hyperperfusion between the left and right TLE groups. In addition, the right, but not the left, TLE group shows contralateral hypoperfusion of the temporoparietal junction. CONCLUSIONS: While anteromedial temporal-corpus striatum-insula perfusion patterns are similar, there are brainstem and hemispheric perfusion pattern differences in right and left TLE seizures, confirming pathophysiological differences between the groups. These findings help define neuronal network involvement in TLE seizures, and may explain the differences in clinical symptoms of right and left TLE seizures.

Adult↗
PubMed2005

Quantitative analysis of cerebral blood flow patterns in mesial temporal lobe epilepsy using composite SISCOM.

UNLABELLED: Our objective was to demonstrate common patterns of ictal cerebral blood flow changes in a group of patients with mesial temporal lobe epilepsy (MTLE) using the technique of composite subtraction ictal SPECT coregistered to MRI (SISCOM). METHODS: We retrospectively reviewed the video electroencephalography recordings, SPECT studies, and MR images of 32 MTLE patients and of a subgroup of 11 patients with pathologically verified mesial temporal sclerosis (MTS). Composite SISCOM studies were performed as previously described. The patients were grouped for analysis into those with right seizure onset and those with left seizure onset. The images of the right and left MTS subgroups were combined for analysis by rotating right MTS images to show changes on the left side. The SPECT subtractions were segmented to show regions of hyperperfusion at 1 SD above the mean. A rainbow color map was applied to the final composite SISCOM images to assist in the interpretation of results. Binomial probability was calculated to demonstrate the level of significance of perfusion changes. RESULTS: All patients demonstrated typical seizure semiology of MTLE. Seventeen patients had left MTLE and 15 patients had right MTLE. The levels of significance were set at 6 of 17 (P = 0.042) for the left MTLE group, 6 of 15 (P = 0.022) for the right MTLE group, and 5 of 11 (P = 0.021) for the MTS subgroup. Results among all groups were similar. The most-contiguous area of hyperperfusion was the anterior temporal area extending to include the insular cortex and basal ganglia, lateralizing to the side of seizure onset. CONCLUSION: Composite SISCOM studies in patients with well-localized MTLE most commonly show a region of hyperperfusion in the anterior temporal region, which often also involves the basal ganglia and insula, likely representing the primary regions of seizure propagation. Identifying this pattern of hyperperfusion as typical for mesial temporal onset seizures should assist in clinical interpretation and localization of ictal SPECT studies.

Adolescent↗
PubMed2004

MRI-based high-dimensional hippocampal mapping in mesial temporal lobe epilepsy.

MRI-based evaluation of the hippocampus is important in the assessment and treatment of patients with mesial temporal lobe epilepsy (MTLE). Using MRI-based large-deformation high-dimensional mapping (HDM-LD), which allows structural evaluation of regions of the hippocampus, we document the HDM-LD-defined pattern of hippocampal deformation in MTLE patients compared with matched controls. In 30 subjects with MTLE and confirmed medial temporal lobe sclerosis (MTS), we performed measurements of intracranial area, brain parenchymal volume and deformation-based hippocampal segmentations, and then grouped patients into right and left MTS groups (resulting in 15 subjects in each group). Using HDM-LD techniques, we compared the right and left MTS groups with a group of 15 matched controls. Analysis included both the MTS and contralateral hippocampi, and covariance for changes in brain parenchymal volume. Final results were interpreted using a segmentation showing normal hippocampal surface subfield anatomy. Comparing the MTS groups with controls, after covarying with brain parenchymal volume, the MTS hippocampi showed significant volume loss (P < 0.0001), contralateral hippocampi showed no significant volume loss. HDM-LD techniques showed significant shape changes, with marked inward deviation in the Sommer sector of the MTS hippocampi. In the contralateral hippocampi, the inferior surface of the hippocampal body showed inward deformation in the medial aspect of the subiculum, with minimal involvement of the Sommer sector. HDM-LD shows involvement of subregions of the hippocampus which are consistent with MTS histopathology. Contralateral hippocampi show different HDM-LD changes, suggesting that the underlying disease process in the contralateral hippocampi is different from MTS.

Adult↗
PubMed2003

Continuous or emergent EEG: can bedside caregivers recognize epileptiform discharges?

OBJECTIVE: When emergent or continuous EEG monitoring is carried out to detect subclinical seizures, expert interpretation of the results is usually not immediately available. We assessed the ability to recognize epileptiform discharges among various nonexpert bedside caregivers. A second objective was to determine whether such skill improves with a simple educational intervention. DESIGN AND SETTING: A prospective cohort study with an educational intervention in a university-based tertiary medical center. PARTICIPANTS: All 125 neurology and neurosurgery residents, intensive care fellows, critical care and neurological floor nurses, and EEG technicians were offered participation. Of these, 50 completed the study and provided 2,398 EEG responses. INTERVENTIONS: A computer-based PowerPoint lecture designed to teach recognition of epileptiform discharges. MEASUREMENTS AND RESULTS: (a) Average number of correct responses in identifying epileptiform discharges in a computer-based pre-test consisting of 24 EEG questions. (b) Impact of the educational intervention as measured by change in the mean average score in a similar post-test. The rate of correct responses by group ranged from 46% for medical critical care nurses to 94% for EEG technicians. Overall mean correct response rate was 14.72 (61%) for the pre-test, and increased to 16.06 (67%) in for post-test (p=0.002). CONCLUSIONS: Recognition of epileptiform discharges by bedside caregivers is disturbingly low. A simple educational intervention only modestly improved such ability. Therefore we should not rely on nontrained personnel to interpret emergent or continuous recordings. EEG technicians are an exception, and their skill could be utilized during emergent studies.

Cohort Studies↗