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Biomedical subjects

S Pacia

Publications and source records attributed to S Pacia.

6 recordsLinked to original sources
PubMed1997

Significance of spikes recorded on intraoperative electrocorticography in patients with brain tumor and epilepsy.

PURPOSE: Patients with medically intractable epilepsy due to brain tumors may undergo resective surgery for treatment of both the tumor and the epilepsy. In this instance, the extent of surgical resection is sometimes guided by spikes recorded on intraoperative electrocorticography (ECoG). Whether spikes recorded by electrocorticography imply active epileptogenicity has not been addressed adequately. METHODS: We performed preresection and postresection electrocorticography on 36 patients with brain tumor and seizures. There were 31 low-grade gliomas, 4 high grade gliomas, and 1 dysembryonic neuroepithelial tumor. Patients had resection of the tumor to normal tissue margins only. No additional surgery was performed, based on electrocorticography findings. Patients were divided into 2 groups: Group I (no seizures or rare seizures after resection) and Group II (recurrent seizures). Recorded spikes were analyzed for spike distribution and spike discharge rate. RESULTS: On preresection ECoG, 85% of patients in Group I and 88% of patients in Group II had spikes. In Group I, 70% of patients had spikes over the tumor bed, and 63% of patients had spikes in the surrounding tissue. In Group II, 55% of patients had spikes over the tumor bed and 89% of patients had spikes in the surrounding tissue. Spike distribution and discharge rate did not correlate with outcome. On postresection ECoG, 60% of patients in Group I and 67% of patients in Group II had residual spikes. In Group I, 46% of patients had spikes along the margin of resection and 26% of patients had extramarginal spikes. In Group II, 50% had spikes along the margin of resection and 67% of patients had extramarginal spikes. CONCLUSIONS: The difference in spike distribution in the extramarginal area between the 2 groups was not statistically significant, but showed a trend toward a relationship between postresection spikes and seizure recurrence.

Brain Neoplasms↗
PubMed1997

Dissociation in epilepsy and conversion nonepileptic seizures.

PURPOSE: We examined the dimensionality of the item content of the Dissociative Experiences Scale (DES) in relation to the clinical diagnosis of conversion nonepileptic seizures (C-NES) versus complex partial epilepsy (CPE). METHODS: The DES was administered to a sex- and age-matched sample of 132 patients with C-NES and 169 with CPE and was factor analyzed with principal components analysis (PCA) with varimax rotation. RESULTS: The mean total DES score was 15.1 in the C-NES group and 12.7 in the CPE group (p = 0.079). The factors obtained by PCA differentiated the CPE and C-NES groups more strongly than did the total DES score. The factor accounting for the most variance, interpreted as "depersonalization-derealization," was significantly greater in C-NES than CPE (p = 0.005). An "absorption-imaginative involvement" factor, which included some of the clinical features of posttraumatic stress disorder was elevated only in subjects reporting histories of childhood abuse (p = 0.001) regardless of the diagnosis of CPE or C-NES. An "amnestic" factor appearing to represent memory problems related to neurologic impairment showed a trend toward elevation in CPE (p = 0.056) and may have confounded the CPE versus C-NES distinction using total DES scores. CONCLUSIONS: The DES has separate underlying dimensions that appear to relate distinctively to depersonalization and derealization, childhood trauma, and neurologic impairment. The heterogeneous item content of the DES is a potential confound that should be appreciated when this instrument is used to study dissociation in neuropsychiatric populations.

Adult↗
PubMed1997

Bradycardia and asystole induced by partial seizures: a case report and literature review.

Bradyarrhythmias associated with partial seizures are uncommon, with most reported patients having temporal lobe seizure foci on scalp EEG recordings. We report a patient with bradycardia and sinus arrest during a complex partial seizure documented during bilateral subdural EEG and EEG and simultaneous video and EEG recordings. The seizure began in the left temporal lobe and spread to the right temporal region, with bradycardia occurring 55 seconds after ictal onset and asystole after 60 seconds.

Adult↗
PubMed1995

Significance of spikes recorded on electrocorticography in nonlesional medial temporal lobe epilepsy.

Whether spikes recorded by intraoperative electrocorticography imply active epileptogenicity has not been adequately addressed. We performed preresection and postresection electrocorticography on 47 patients with nonlesional medial temporal lobe epilepsy who were undergoing surgery for the treatment of medically refractory epilepsy. A standard anteromedial temporal lobectomy was performed on all patients, with no additional resection, regardless of electrocorticographic findings. Patients were divided into two groups: Group I (no seizures or rare seizures) and Group II (recurrent seizures). Recorded spikes were analyzed for distribution and spike discharge rate. On preresection electrocorticography, 83% of Group I and 82% of Group II had spikes in the anterior temporal lobe. The spike discharge rate was equally distributed between high frequency and low frequency for both groups (not significant). Although spikes localized to the posterior temporal neocortex were seen more in Group II (64%) than Group I (39%), this was not a significant difference (p > 0.1). Most of these patients had a low-frequency spike discharge rate. On postresection electrocorticography, 80% of Group I and 75% of Group II had residual spikes. The majority of these had a low-frequency spike discharge rate and were localized to the margin of resection. We found no correlation between residual spikes on preresection and postresection electrocorticography and outcome. These findings do not support the role of intraoperative electrocorticography in guiding mesial temporal lobe resection.

Adolescent↗
PubMed1993

Epilepsy surgery.

Epilepsy surgery is assuming greater importance in treating patients with partial epilepsy whose seizures are uncontrolled with antiepileptic drugs. Many good candidates for surgical treatment are not presented with the option of surgery. The evaluation for epilepsy surgery is extensive and includes several stages of noninvasive and invasive testing. As more sophisticated noninvasive tests develop, fewer patients require invasive monitoring studies such as depth or subdural electrodes. The principal forms of surgical treatment include focal resection, corpus callosotomy, and hemispherectomy. Temporal lobectomy remains the most common and effective form of epilepsy surgery. Frontiers of epilepsy surgery include resective surgery for intractable infantile spasms and multiple subpial transections for patients whose seizure foci are in sensory, motor, or languages cortex. Additional studies are needed to define the safety and efficacy of these new procedures.

Animals↗