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T Tottori

Publications and source records attributed to T Tottori.

33 records · Page 2Linked to original sources
PubMed1990

Surgical treatment of epilepsy in the comprehensive care program: advantages and considerations.

To properly establish the surgical treatment of epilepsy in the comprehensive care program, we planned a surgical strategy mainly for a temporal lobe epilepsy and have performed 60 temporal lobectomies. The surgical candidates were selected from 142 patients who met the initial criteria, and passed the initial evaluation for surgical intervention. Forty-five patients had long-term intracranial EEG recording, and circumscribed organic lesions were disclosed in 27 patients by neuroimaging techniques. The outcome of 23 patients who were followed for 2 years postoperatively was complete freedom from complex partial seizures in 17 patients (74%) and an increase in full employment from 2 to 10 patients. Despite the possible surgical complications, including detrimental effects on the higher cerebral functions, it is essential that the surgical treatment of epilepsy should be established as a part of the comprehensive care program. Our experiences and analyses of the state of the art in surgical intervention also suggest that surgical indications for more intractable patients whose social adjustment is less hopeful should be established and the surgical care system for these patients should also be planned. Furthermore, some patients may be free from recurrent seizures postoperatively, but still have difficulties in social rehabilitation. The problems for such patients remain unsolved.

Adult↗
PubMed1990

Subtypes of temporal lobe epilepsies: a clinical point of view.

We studied 40 patients with temporal lobe epilepsies who had long-term intracranial EEG recordings and temporal lobectomies. They were divided into 3 groups on the basis of the anatomical site of seizure origin. An electrode implantation technique combined intracerebral depth electrodes with subdural strip electrodes. The seizures were of amygdalo-hippocampal origin in 18 patients, lateral temporal in 13 patients, and temporo-basal in 9 patients. The clinical and EEG features were reviewed retrospectively with regard to 3 factors in each patient: localization of interictal spikes in the scalp-recorded EEG, signal symptoms (auras), and presumed etiologies. Epilepsy with amygdalo-hippocampal and lateral temporal seizures was found to be distinguishable by the electroclinical features. It seems practical to classify these 2 subtypes of temporal lobe epilepsies as in the 1989 Classification of Epilepsies and Epileptic Syndromes. Temporal lobe epilepsies thus defined can be regarded as epileptic syndromes rather than a cluster of seizure manifestations.

Adolescent↗
PubMed1990

Feasibility of subclassification of temporal lobe epilepsy (1989): an etiological overview.

Temporal lobe epilepsy with amygdalohippocampal seizures may have episodes of severe convulsions in childhood more frequently and the onset age is significantly lower compared to epilepsy with lateral temporal seizures. To the contrary, tumorous lesions are found more frequently in epilepsy with lateral temporal seizures. In view of the presumed known etiologies in relation to the localization of epileptogenic foci, the Classification of Epileptic Syndrome (1989), subdividing temporal lobe epilepsies into 2 groups, was found to be useful.

Adult↗
PubMed1989

Focal CT abnormality and epileptogenic focus.

In 31 patients with temporal lobe epilepsy, the precise site of epileptogenic focus was determined by means of a depth EEG recording as one of the presurgical evaluations. In 13 patients, a CT scan revealed focal lesions; 7 in the left temporal lobe and 6 in the right temporal lobe. In 5 of the 7 patients and in 5 of the 6 patients the epileptogenic foci were determined in the temporal lobe on the side of a CT lesion. However, in 2 of the patients with a CT lesion in the left temporal lobe, independent epileptogenic foci were found in both the temporal lobes, and in the other patient with a CT lesion in the right temporal lobe, they were found in the right frontal and left temporal lobes. Thus, the CT lesions agreed in lateralization and focality with the epileptogenic foci in 10 of the 13 patients (77%), but they disagreed in 3 (23%). A CT lesion disclosed in the temporal lobe does not necessarily indicate the side and/or site where the epileptogenic focus may be localized. Although exceptions may be made, spatial disagreement was exemplified between the CT lesion and epileptogenic focus. Therefore, extreme caution has to be taken on the side and/or site of the epileptogenic focus when functional surgical indication is to be made.

Adolescent↗
PubMed1989

MRI lesion and epileptogenic focus in temporal lobe epilepsy.

The spatial relationship between a circumscribed lesion in the temporal lobe detected by MRI and an epileptogenic focus identified by ictal depth EEG along with a correlation of the MRI lesion with neuropathological findings were investigated in patients with medically intractable temporal lobe epilepsy but without any focal lesion on CT. Four parameters (an areal ratio of the temporal lobe against the hemisphere, area and calculated T1, T2 values of the hippocampus) were used to determine the abnormal MRI side. An agreement was reached in 67-72% of 18 patients between the abnormal values of the hippocampal area and of calculated T1, T2 and the side of the epileptogenic focus. In 14 of 17 patients, typical hippocampal sclerosis was demonstrated in resected tissue in accordance with the MRI lesions (atrophy and/or prolonged T2 of hippocampus). These results imply: 1) MRI abnormality thus defined may, if not all, indicate the side of the epileptogenic focus, and 2) also the presence of hippocampal sclerosis. It was emphasized that the MRI lesion would be a usable instrument to explore the causal relationship of hippocampal sclerosis to a generation of epileptogenic lesions as well as for presurgical evaluation.

Adolescent↗
PubMed1989

Emotional facial expressions at the onset of temporal lobe seizures: observations on scalp and intracranial EEG recordings.

The initial facial expressions of 195 complex partial seizures of 98 patients with temporal lobe epilepsy were reviewed in relation to the laterality and focality of electroencephalographic (EEG) seizure origin. A neutral expression was observed most often (71) followed in frequency by expressions of disgust (13), happiness (7) and sadness (7). There was no expression of anger, surprise and fear. No correlation was found between the type of facial expression and the side of seizure origin. However, among 27 patients examined by means of intracranial EEG recordings, it was evident that a disgust expression occurred with oro-alimentary automatisms at the beginning of mesial temporal lobe seizures, whereas a happy one occurred without oro-alimentary automatisms at the beginning of lateral temporal lobe seizures. Although the facial expressions were not always related to the concurrent ictal emotion, it appeared that the majority of the patients with the disgust expression had autonomic features, while those of the happy/sad expression had psychic/sensory ones. It was concluded that (1) a disgust expression occurs as an indirect consequence of "crude sensation," while a happy/sad expression occurs as a direct consequence of "elaborate mental state" (Jackson) and (2) facial expressions must be reviewed in relation to focality rather than laterality in temporal lobe seizures.

Adolescent↗
PubMed1989

A correlative study between hippocampal atrophy quantified by tomo-pneumoencephalography and epileptogenic focus in temporal lobe epilepsy.

It appeared certain that we can quantify the rate of hippocampal atrophy by utilizing the sagittal cuts in tomo-pneumoencephalography. This is a reliable method to infer the side of the epileptogenic focus in temporal lobe epilepsy since a close correlation was disclosed between the side with more atrophic features of the hippocampus and that of the epileptogenic focus explored by depth EEG, in particular, in the mesial temporal focus group. On the other hand, it seems to be plausible that the hippocampal atrophy could be secondarily induced by epileptic discharges in the lateral temporal group. Namely, controversies dealing with the casual relationship of hippocampal atrophy should be discussed based on the epileptogenic focus localization in temporal lobe epilepsy.

Amygdala↗