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Results for “Temporal Lobe Resection”

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PubMed1996

Functional MRI localization of language in a 9-year-old child.

BACKGROUND: Localizing critical brain functions such as language in children is difficult and generally requires invasive techniques. Recently sensory, motor and language functions in adults have been mapped to specific brain locations using functional imaging techniques. Of these techniques, functional MRI (fMRI) is the least invasive and has the highest spatial and temporal resolution. Its use in adults is well documented but application to children has not been as well described. In the present study lateralization and localization of language was evaluated with fMRI prior to epilepsy surgery in a nine-year-old male with complex partial seizures, attentional difficulty and decreased verbal proficiency. METHODS: Two language paradigms well studied in adults (read, verb generation) and two additional language paradigms (antonym generation, latter fluency) were studied using whole brain fMRI after stimulus items and timing were adjusted to achieve the desired performance level during imaging. The patient was also conditioned to the magnet environment prior to imaging. RESULTS: Word reading and letter fluency tasks produced lateralized and localized activation similar to that seen in adults. The patient had no language deficits following an anterior 2/3 dominant temporal lobe resection. CONCLUSIONS: With modifications of protocols such as those detailed in this report, this non-invasive method for localizing language function is feasible for the presurgical evaluation of children as well being applicable for a variety of developmental language issues.

Brain↗

PubMed2003

Mortality in a population-based cohort of epilepsy surgery patients.

PURPOSE: To investigate mortality and especially the incidence of sudden unexpected death in epilepsy (SUDEP) in a population-based cohort of epilepsy surgery patients. METHODS: All patients who underwent epilepsy surgery treatment between January 1990 and December 1998 (surgery patients) or whose presurgical evaluation started, although not leading to an operation, during the same period (nonsurgery patients) were identified through the Swedish National Epilepsy register. All subjects were followed up through the Cause of Death Register until December 1998. Standardized mortality ratios (SMRs) for all causes of death and incidence of SUDEP were calculated. RESULTS: During the study period, 651 surgical operations were carried out on 596 patients (316 male). Of those, 14 patients died (six in SUDEP), rendering a total SMR of 4.9 [95% confidence interval (CI), 2.7-8.3]. SUDEP incidence was 2.4 per 1,000 person years. No major differences were found in SMRs or SUDEP rates between subgroups when stratifying for type of operation and for seizure outcome 2 years after surgery. SMR and SUDEP rates were higher in right-sided temporal lobe resections for gliosis than in left-sided, but the number of deaths was small. Among 212 nonsurgery patients, five died (four in SUDEP). The SMR for all causes was 7.9 (2.6-18.4), and SUDEP incidence, 6.3 per 1,000 person years. CONCLUSIONS: In this large and strictly population-based cohort, SMR for all causes and SUDEP incidence among surgery patients were similar to those of other studies. No differences in overall mortality emerged by seizure outcome, but none of the SUDEP cases was seizure free at the time of death. Four of five deaths in the nonsurgery group occurred during the surgery evaluation period. Mortality appeared to be lower for surgery than for nonsurgery patients, and the interpretation of this finding is discussed.

Adult↗

PubMed1998

Handedness, footedness, and language laterality: evidence from Wada testing.

A total of 37 candidates for temporal lobe resection for epilepsy completed the Lateral Dominance Examination, a self-report instrument that measures hand and foot preference. Questionnaire results were compared with speech dominance, which had been determined by Intracarotid Sodium Amytal Procedure. Footedness was as good as handedness as a predictor of language laterality.

Journal Article↗

PubMed2000

B7 expression and antigen presentation by human brain endothelial cells: requirement for proinflammatory cytokines.

Interaction between systemic immune cells with cells of the blood-brain barrier is a central step in development of CNS-directed immune responses. Endothelial cells are the first cells of the blood-brain barrier encountered by migrating lymphocytes. To investigate the antigen-presenting capacity of human adult brain endothelial cells (HBECs), we used HBECs derived from surgically resected temporal lobe tissue, cocultured with allogeneic peripheral blood derived CD4+ T lymphocytes. HBECs in response to IFN-gamma, but not under basal culture conditions, expressed HLA-DR, B7.1 and B7.2 antigens. Despite such up-regulation, these IFN-gamma-treated HBECs, in contrast to human microglia and PB monocytes, did not sustain allogeneic CD4+ cell proliferation, supported only low levels of IL-2 and IFN-gamma production, and did not stimulate IL-2 receptor expression. CD4+ T cell proliferation and increased IL-2 receptor expression could be obtained by addition of IL-2. Our data suggests that, although HBECs cannot alone support T cell proliferation and cytokine production, HBECs acting in concert with cytokines derived from a proinflammatory environment could support such a response.

Adult↗

PubMed1994

Glial cell nuclear hypertrophy in complex partial seizures.

The white matter of resected temporal lobes from patients with intractable complex partial seizures shows increased cellularity which appears to be related to glia and neurons. This study, using quantitative methods, defines an increase in glial cell numbers and a significant increase in glial nuclear size within a defined area of white matter in the lateral temporal lobe. Evaluation was made on specimens from ten patients with complex partial seizures compared with two patients with non-epileptic brain lesions and five autopsy patients with no neurologic disease. The importance of recognizing these alterations in glia and the possible relevance to the pathoetiology of epilepsy are discussed.

Adolescent↗

PubMed1996

Distribution of heterotopic neurons in normal hemispheric white matter: a morphometric analysis.

One of the frequent abnormalities described in the context of surgically resected temporal lobe (TL) specimens is the presence of heterotopic neurons within white matter (WM). We have attempted to morphometrically define the distribution of the heterotopic neurons in normal subjects, comparing the incidence of heterotopic neurons in TL WM with that in occipital (OL) and frontal lobe (FL) sections. Using a a combination of routine and special stains combined with immunohistochemical confirmation 20 adult autopsy cases were examined. WM from TL, FL, and Ol sections was outlined and the area measured by image analysis. Using defined criteria, heterotopic neurons within these areas were counted. Results confirm our hypothesis that normal adult TL WM contains a significantly higher population of residual/heterotopic neurons than OL and FL WM groups. It is felt that these neurons represent interstitial remnants of the subplate which have failed to undergo programmed cell death. The significance of these findings with regard to assessment of similar findings in temporal lobectomy specimens is addressed. A second intriguing association of this TL WM heterotopia concerns its possible relationship to the more frequent occurrence of ¿malformative neoplasms¿ with neuronal elements (such as ganglioglioma and dysembryoplastic neuroepithelial tumor) in the temporal lobe.

Adult↗

PubMedDate not supplied

Intact implicit memory for novel patterns in Alzheimer's disease.

Repetition priming is a kind of implicit memory (learning without awareness) that does not depend on the medial temporal-lobe system. For example, the amnesic patient H.M., who underwent bilateral medial temporal-lobe resection, shows intact priming with novel patterns, suggesting that perceptual priming with nonverbal material does not depend on areas critical for explicit memory. A logical candidate for the neural substrate that supports this kind of priming is the peristriate cortex, an area that is relatively spared in Alzheimer's disease (AD). We therefore predicted that AD subjects would be unimpaired on pattern priming. Subjects copied each of six target figures onto dot patterns. After performing a 3-min distractor task, they were given the same dot patterns (without lines) and asked to draw the first figure that came to mind by connecting the dots with straight lines. Subsequently, in a test of recognition (explicit) memory, subjects viewed each of the six patterns of dots that they had copied previously and were asked to indicate which of four possible completions corresponded to the figure that they had copied 3 min earlier. The AD and control groups achieved comparable priming scores, but AD subjects were significantly impaired in recognizing the patterns explicitly. Our finding of intact pattern priming in AD provides, for the first time, evidence that pattern priming depends on the peristriate cortex.

Aged↗

PubMed2006

Astrocytoma with pilomyxoid features presenting in an adult.

Pilomyxoid histology is presently considered to occur in pediatric brain tumors. We report an astrocytoma with pilomyxoid features presenting in an adult and discuss its relationship to both the established childhood pilomyxoid astrocytoma (PMA) and recently reported tanycytoma. A 28-year-old man with medically intractable seizures presented for surgical evaluation. MRI revealed a discrete lesion in the right amygdala/uncus region. The patient elected for craniotomy with stereotactic temporal lobe resection and excision of the lesion. Postoperatively, the patient has done well. At 30-month follow up, he is seizure free and without evidence of tumor recurrence. We report an astrocytoma with pilomyxoid features presenting in an adult, illustrating that while this histological pattern is most commonly seen in children, it may also affect older individuals. Recognition of this enigmatic pattern in adult gliomas expands the currently accepted epidemiology for this lesion.

Adult↗

PubMedDate not supplied

Vigabatrin (gamma-vinyl-GABA): neuropathologic evaluation in five patients.

We performed neuropathologic examination of cerebral cortex specimens from 4 patients who underwent epilepsy surgery and the brain of 1 patient who died suddenly. All had severe epilepsy and had received gamma-vinyl-GABA (GVG, vigabatrin) for 3-5.5 years. Neither the surgically resected temporal lobe specimens nor the frontal and temporal lobes autopsy specimens showed abnormal white matter vacuolation.

Adult↗

PubMed1994

Psychiatric morbidity after surgery for epilepsy: short-term follow up of patients undergoing amygdalohippocampectomy.

The aim was to assess the occurrence and type of psychiatric disorders of patients with medically intractable epilepsy in relation to surgical treatment, with special reference to amygdalohippocampectomy (AHE). The design was a retrospective psychiatric interview study, including Present State Examination (PSE) and diagnostic classification according to the International Classification of Diseases--8th revision (ICD-8) and ICD-10. Forty seven (94% of total) patients operated on between 1987 and mid-1991 in the Danish epilepsy surgery programme were studied. The main group of interest included 37 patients treated by AHE. The presence of psychiatric disorders before and after operation was assessed by PSE (including the Catego classification) and by ordinary clinical procedures, making use of all available information (hospital case notes and presurgical psychiatric assessments independent of the study). Four patients in the AHE group developed depressive disorders of various durations and severity after operation (in three (8%) patients these occurred de novo). One other patient with AHE with a presumed personality disorder who underwent AHE developed a severe depression, as did one patient after a lesionectomy. No patients developed new paranoid hallucinatory psychoses. No association was found between presence of psychiatric disorders and neither right sided cerebral dominance nor histopathological findings. In conclusion, the postoperative psychiatric morbidity in this sample of patients treated with AHE is of the same magnitude as described in recent series of patients undergoing temporal lobe resection for medically intractable epilepsy. Likewise, affective disorders (depressive conditions) constitute the most prominent psychiatric problem after surgery for epilepsy.

Adolescent↗

PubMed1994

Role of surgery in the therapy of epilepsy.

A brief overview is given on the concepts and methods of presurgical evaluation, as well as on the principles and techniques of surgical treatment of epilepsies. Lesion-oriented surgery is differentiated from epilepsy-oriented lesional surgery and from surgery for epilepsy sensu stricto. The rationale for 'curative' and 'palliative' interventions is discussed. Selective amygdalohippocampectomy, anterior temporal lobe resection, extratemporal topectomies, subtotal functional hemispherectomies, stereotactic interventions, anterior corpus callosum section and multiple subpial transection are briefly described. Results of a survey done on the occasion of the 2nd International Palm Desert Conference on the 'Surgical Treatment of the Epilepsies' are summarized.

Brain Mapping↗

PubMed2000

Neuregulins and erbB receptor expression in adult human oligodendrocytes.

We have previously reported that neonatal rat oligodendrocytes (OLGs) express and secrete neuregulins (NRGs) (Raabe et al., 1997). This laboratory has also shown that NRGs stimulate the differentiation of neonatal rat OLGs and that these cells express the erbB receptors for NRGs (Raabe et al., 1997). In this study, we have characterized NRG expression in adult human OLG cultures isolated from the temporal lobe resection of intractable epilepsy patients. Using immunocytochemistry and Western blotting, we find that adult human OLGs contain both the alpha and beta isoforms of NRGs. In addition, Western blots show that the adult human OLGs secrete both isoforms as N-glycosylated molecules. These cells also express all four erbB receptor subtypes, and possibly an activated erbB receptor. The observation that these cells synthesize and secrete their own NRGs, and possibly express a tyrosine-phosphorylated erbB receptor, is consistent with autocrine and/or paracrine signaling. Amplification of this signaling may provide a useful mechanism to stimulate differentiation of adult human OLGs in demyelinating disease.

Adult↗

PubMed1992

Pre-oligodendrocytes from adult human CNS.

CNS remyelination and functional recovery often occur after experimental demyelination in adult rodents. This has been attributed to the ability of mature oligodendrocytes and/or their precursor cells to divide and regenerate in response to signals in demyelinating lesions. To determine whether oligodendrocyte precursor cells exist in the adult human CNS, we have cultured white matter from patients undergoing partial temporal lobe resection for intractable epilepsy. These cultures contained a population of process-bearing cells that expressed antigens recognized by the O4 monoclonal antibody, but these cells did not express galactocerebroside (a marker for oligodendrocytes), glial fibrillary acidic protein (a marker for astrocytes), or vimentin. Selective elimination of O4-positive (O4+) cells by complement-mediated lysis resulted in inhibition of oligodendrocyte development in vitro. Since O4+ cells have an antigenic phenotype reminiscent of the rat adult oligodendrocyte-type 2 astrocyte progenitor and appear to develop into oligodendrocytes rather than type 2 astrocytes with time in culture, we call them "pre-oligodendrocytes." Neither pre-oligodendrocytes nor oligodendrocytes incorporated 3H-thymidine in response to rat astrocyte-conditioned medium, platelet-derived growth factor, insulin-like growth factor (IGF-1), or basic fibroblast growth factor (bFGF). However, IGF-1 increased the relative abundance of oligodendrocytes to pre-oligodendrocytes, while bFGF had the opposite effect. Cells with the antigenic phenotype of pre-oligodendrocytes were also identified in tissue prints of adult human white matter. We propose that, in human demyelinating diseases such as multiple sclerosis, pre-oligodendrocytes may divide and/or migrate in response to signals present in demyelinated lesions and thus facilitate remyelination.

Adult↗

PubMed2006

[Indications and outcomes of epilepsy surgery in children].

INTRODUCTION: One in every four children who suffer epilepsy will continue to seize despite all the current arsenal of anticonvulsant medications. Epilepsy surgery can be an effective treatment for many cases of pharmaco-resistant epilepsy. AIM: To review some of the most recent data regarding indication and results for epilepsy surgery in children. DEVELOPMENT: New analysis of neurophysiological data such as magnetoencephalography, dipole analysis and high frequency oscillations, plus functional neuroimaging and higher resolution MRI, have improved the prompt referral of potential candidates for surgery. An adequate selection of the surgical candidates will be fundamental in obtaining positive outcomes. Children, just like adults, can achieve seizure freedom or more than 90% seizure reduction in 85% of the cases of temporal lobe resections. Extratemporal epilepsy surgery is more challenging, and presents frequently in epilepsy surgery centres specialized in pediatric care. CONCLUSION: It is not mandatory for a patient to have an structural lesion evident on MRI in order to be considered a candidate for epilepsy surgery. In many cases a partial reduction of seizure activity can significantly improve the patient's and family's quality of life, and can have a sinergistic effect with other therapies which were no effective before surgery.

Child↗

PubMed1984

Complex partial seizures.

Complex partial seizures, the most common of the adult seizure types, originate in the temporal lobe or limbic system. They include spells with emotional content, cognitive defects, hallucinations and automatisms. Video recordings, EEG telemetry and positron emission tomography have provided a better understanding of the electrophysiology of these seizures. Computed tomography reveals lesions in 50 to 70 percent of the patients. Seizures that are intractable to medical therapy can be treated by temporal lobe resection, with benefits in at least 70 percent of patients.

Anticonvulsants↗

PubMed1995

[Psychiatric morbidity in connection with surgical treatment of epilepsy. A short-term follow-up of patients with amygdalohippocampectomy].

The aim of the study was to examine the occurrence of psychiatric disorders in epilepsy patients who had received surgical treatment, especially amygdalohippocampectomy (AHE), for the relief of medically intractable seizures. Forty-seven subjects, treated during the period 1987-1991 in the Danish epilepsy surgery programme (EPIKIR), entered a retrospective interview study. Of these, 37 had undergone AHE. Preoperative psychiatric morbidity was assessed through interview and available case notes, including a routine psychiatric interview. Postoperative psychiatric morbidity was assessed by the use of the Present State Examination. A total of six subjects (five AHE subjects) developed depressive disorders of various duration and severity after operation. In three subjects this occurred "de novo". No paranoid-hallucinatory psychoses developed within the follow-up period (a minimum of one year), and the presence of psychiatric disorders could not be associated with either lateralization of cerebral dominance of histopathological findings. Thus, depression appears to be the most frequent psychiatric problem following epilepsy surgery. Although the present study mainly deals with AHE, this finding is in accordance with the results of recent findings concerning anterior temporal lobe resection.

Adolescent↗

PubMed1993

Surgery for intractable seizures in infancy and early childhood.

Epilepsy surgery is becoming an increasingly used therapy for infants and young children with severe, medically intractable seizures. As in older children and adults, the presurgical evaluations of possible candidates typically consist of a detailed history, neurologic and neuropsychologic examination, and anatomic and functional neuroimaging. The "gold standard" test, however, is the recording of ictal events using simultaneous EEG and video monitoring. While temporal lobe resection is the most commonly performed surgery in older children and adults, nontemporal lobe resections, corpus callosotomies, and hemispherectomies are more commonly performed in younger children. Antiepileptic drugs remain the mainstay of treatment of children with epilepsy. However, the clinician should consider surgery early in the course of the catastrophic seizure disorders of childhood: infantile spasms, Sturge-Weber syndrome, and Rasmussen's encephalitis.

Brain↗

PubMed1997

[Presurgical diagnosis of epilepsy and surgical epilepsy treatment].

20% of patients with focal epilepsy suffer from medically refractory seizures. Many of these patients can be cured by a surgical intervention removing the brain area where the seizures are originating (epileptogenic zone). 6000 patients in Austria would benefit from epilepsy surgery with an additional 150-200 new patients appearing each year. Potential candidates have to undergo an extensive presurgical work-up. During the non-invasive Phase I each patient is evaluated with an intensive video-EEG monitoring with scalp-EEG, a high resolution MRI, a SPECT and/or PET, a neuropsychological evaluation and a Wada-test. If the epileptogenic zone cannot be localized adequately with these methods, invasive electrophysiological techniques (epidural Peg-electrodes, Foramen-ovale electrodes, depth electrodes, subdural strip and grid electrodes) have to be applied. Operative strategies for temporal lobe epilepsies include antero-mesial temporal lobe resections and selective amygdala-hippocampectomies. Extratemporal epilepsies are treated by cortical resections guided by structural and electrophysiological parameters. The new technique of multiple subpial transections facilitates treatment of seizures originating in essential brain regions. Catastrophic epilepsies of early childhood often are caused by extensive pathologies affecting one hemisphere and can be treated successfully by large multilobar resections or hemispherectomies. Epilepsy surgery renders 70-80% of patients seizure free and thus can be regarded as an effective and safe treatment option for patients with medically refractory focal epilepsies.

Brain Diseases↗