Biomedical subjects

R Mireles

Publications and source records attributed to R Mireles.

4 recordsLinked to original sources

PubMed1986

Magnetic resonance imaging, electroencephalogram, and selected neuropsychological testing in staged corpus callosotomy.

A 21-year-old man with medically intractable secondarily generalized atonic seizures underwent a corpus callosotomy on Nov 5, 1981. Though improved, the falling seizures persisted. In January 1984, magnetic resonance imaging (MRI) documented that the anterior quarter of the corpus callosum remained intact. In March, the patient underwent a completion of the callosotomy, at which time the MRI findings were corroborated. Since the second surgery, a further improvement in seizure control has been observed. Use of MRI can document both noninvasively and in vivo the extent of corpus callosotomy. The implications of selected neurophysiologic and neuropsychological findings are also discussed.

Adult↗

PubMedDate not supplied

Ictus emeticus and the insular cortex.

A 30-year-old man had a long history of seizures that began with feelings of tightness in his throat and fear, followed by projectile vomiting and head and eye deviation to the left. These episodes were not completely controlled by antiepileptic medications. Video EEG monitoring confirmed his clinical description. Corticography was performed before and after temporal lobectomy and revealed residual spikes in the unresectable tissue of the insula. Three years postoperatively he has had no seizures with vomiting but has occasional 'auras' of throat tightening and fear. The case suggests that the insula may be a trigger area for emesis but requires anterior-mesial temporal cortex for completion.

Adult↗

PubMedDate not supplied

Valproate and clonazepam comedication in patients with intractable epilepsy.

The efficacy and the potential risk of inducing convulsive or nonconvulsive status epilepticus with the combination of valproate (VPA) and clonazepam (CZP), with or without other anticonvulsant drugs, in 55 patients with intractable epilepsy was evaluated. The patients were treated with VPA and CZP concomitantly for from 3 to 72 months (mean 21.7 months). Trough VPA serum levels ranged from 26 to 96 micrograms/ml). Trough CZP serum levels ranged from 5 to 63 ng/ml (mean 22.6 ng/ml). The treatment seizure frequency was compared with baseline values before combination treatment. Seizure improvement was obtained in 7 of 8 patients with absence seizures, 8 of 9 patients with myoclonic seizures, 19 of 39 patients with complex partial seizures, 3 of 14 patients with primary generalized tonic-clonic seizures, 8 of 23 patients with secondarily generalized tonic-clonic seizures, and 3 of 14 patients with atonic seizures. No single case of status epilepticus or exacerbation of seizures of any type was seen.

Adolescent↗

PubMedDate not supplied

Value of intraoperative EEG changes during corpus callosotomy in predicting surgical results.

The intraoperative transformation of generalized epileptiform discharges (GED) to lateralized epileptiform activity during the course of corpus callosum sectioning for intractable epilepsy in 37 patients was correlated with percentage of decrease in atonic-tonic seizures with "drops" at mean follow-up of 26 months (range 12-86 months). Twenty-seven (73%) patients had intraoperative interictal discharges, and 21 (78%) showed varying degrees of lateralization of GED during corpus callosum sectioning (two thirds to total). All patients experienced > 80% reduction in atonic-tonic seizures with drops. The group (n = 7) with largest decrease in GED had the greatest decrease in seizures (95.5%). Six patients without change in GED had 88% decrease in seizures, as did 14 patients (85-86%) with mild or moderate decreases in GED, but there was no statistically significant correlation between decrease in GED and seizure frequency after operation. Thus, although lateralization of GED after corpus callosum sectioning was evident in 78% of patients with GED, the degree of lateralization of GED did not correlate with degree of reduction of tonic-atonic seizures. Therefore, intraoperative surface EEG monitoring does not appear to be helpful at this time as a guide to extent of callosotomy.

Adolescent↗