New drugs: which should be included in the formulary? Epilepsy: all new drugs should be included.
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Anticonvulsants↗
Biomedical subjects
S J Pierre-Louis
Publications and source records attributed to S J Pierre-Louis.
Direct intraoperative recordings from the hippocampal formation: relation with quantitative volumetric MRI.
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Adolescent↗
Deficits in delayed memory following cerebral malaria: a case study.
Cerebral malaria is a common disease, but there have not been any reports or investigations of long-term neurological or neuropsychological outcome. We present a case in which severe deficits in delayed memory and naming ability are observed 10 years after the patient contracted cerebral malaria. Neuropsychological testing and medical imaging are both consistent with temporal lobe/hippocampal dysfunction, which corroborates earlier animal research that cerebral malaria is particularly likely to lead to interrupted blood circulation in this area.
Adult↗
Tailored anterior temporal lobectomy. Relation between extent of resection of mesial structures and postsurgical seizure outcome.
OBJECTIVE: The purpose of this study was to assess the relationship between the extent of resection of mesial temporal structures and postsurgical seizure outcome in a group of patients who had undergone a tailored anterior temporal lobectomy. METHODS: Twenty-four patients with unilateral interictal and ictal foci restricted to anterior/mesial temporal regions underwent resection of mesial and temporal lateral structures, the extent of which was tailored by intraoperative electrocorticographic findings and functional mapping of eloquent cortex. The extent of resection was determined with postoperative magnetic resonance imaging scans, using a semiquantitative method, based on a 20-compartment model of the temporal lobe. The magnetic resonance imaging scans were rated by three investigators blinded to seizure outcome. Follow-up period ranged between 18 months and 5 years. RESULTS: Amygdala and hippocampus were spared in six patients; nine patients had a partial to total resection of amygdala, eight patients had a resection of amygdala and the anterior third of the hippocampus, and one patient underwent resection of amygdala and anterior two thirds of hippocampus. Twenty-one of the 24 patients were seizure free (Engel's class I) and three had rare seizures (Engel's class II). Among these three patients, one had a resection of amygdala; one had resection of amygdala and anterior third of hippocampus; while in the third patient, mesial structures were spared. CONCLUSION: These data suggest that in patients with an anterotemporal seizure focus, the sparing or limited resection of amygdala and/or hippocampus is not necessarily associated with a poor seizure outcome, as had been previously suggested, provided that the decision not to resect is based on the absence of epileptiform activity during intraoperative electrocorticography or during recordings with depth electrodes.
Adolescent↗
Significance of unilateral ear extinction on the dichotic listening test.
The association between unilateral ear extinction on the dichotic listening test and the lateralization of epileptogenic foci was examined in a sample of 49 seizure patients undergoing preoperative evaluation for epilepsy surgery. Results from patients who were left hemisphere dominant for speech indicated that right ear impairment was always predictive of a unilateral left hemisphere focus, but left ear extinction was associated with unilateral lesions of either hemisphere. In this patient sample, dichotic listening performance reflected an interaction of both lateralized foci and hemispheric preference of language processing. Implications concerning clinical use of the dichotic listening test are discussed.
Adolescent↗
Landau-Kleffner syndrome. Treatment with subpial intracortical transection.
Landau-Kleffner syndrome (LKS) is an acquired epileptic aphasia occurring in childhood and associated with a generally poor prognosis for recovery of speech. It is thought to be the result of an epileptogenic lesion arising in speech cortex during a critical period of development. Utilizing a new surgical technique designed to eliminate the capacity of cortical tissue to generate seizures while preserving the normal cortical physiological function, we have treated 14 children with aphasia, seizures and a severely abnormal EEG by multiple subpial transection of the epileptogenic cortex. Seven of the 14 patients (50%) have recovered age-appropriate speech, are in regular classes in school and no longer require speech therapy. Four of the 14 (29%) have shown marked improvement, are speaking and understanding verbal instruction but are still receiving speech therapy. Thus, 11 of the 14 (79%), none of whom had used language to communicate for at least 2 years, are now speaking--a rate of sustained improvement considered unusual in this disorder. This study documents the value of a treatment modality not previously used in LKS. Success depends on selection of cases having severe epileptogenic abnormality that can be demonstrated to be unilateral in origin despite a bilateral electrographic manifestation.
Adolescent↗
Neurologic complications of critical medical illnesses.
OBJECTIVES: To identify the neurologic complications of critical medical illnesses, and to assess their effect on mortality rates and on medical ICU and hospital lengths of stay. DESIGN: Prospective clinical evaluation of all medical ICU admissions for 2 yrs. SETTING: A 14-bed, general medical intensive and coronary care unit in a large university hospital. PATIENTS: Patients (n = 1,850) admitted to the hospital, of whom 92 were admitted for primarily neurologic problems. Of the remaining 1,758 patients, 217 (12.3%) experienced a neurologic complication. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patients developing a neurologic complication while in the medical ICU demonstrated an increased risk of inhospital mortality when compared with patients who did not suffer such problems (45.7% vs. 26.6%; p < .00001). Patients with neurologic complications experienced 2.5-fold longer medical ICU stay times (p < .001) and almost two-fold longer hospital stay times (p < .001). Metabolic encephalopathy, seizures, hypoxic-ischemic encephalopathy, and stroke were the most common complications. Sepsis was the most frequent cause of encephalopathy, and cerebrovascular lesions were the most common cause of seizures. Formal neurologic consultations were requested in only 36% of these patients. CONCLUSIONS: Neurologic complications are associated with increased mortality rates and longer medical ICU and hospital lengths of stay. These conditions are probably underrecognized at present. ICUs have the potential to serve as environments for neurologic teaching and research.
Bacterial Infections↗
Epileptiform activity in chronically isolated cerebral cortex in humans.
The ability of neuronally isolated human cerebral cortex to sustain epileptiform rhythms over long time intervals is unknown. We report here two patients after functional hemispherectomy for infantile hemiplegia and infantile meningoencephalitis. Both patients had intractable seizures. EEG performed early and up to 3 years after surgery showed persistent epileptiform activity in the isolated frontal cortex in both cases. This indicates that human isolated cortex retains its epileptogenic potential for years, independently of subcortical influences. Previous related animal and human studies are briefly reviewed.
Cerebral Cortex↗