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PubMed1990

Prevalence of the Fuld profile in temporal lobe epilepsy.

A pattern of performance on the WAIS-R presumably related to temporal lobe abnormalities associated with Alzheimer's Disease was examined in patients with focal temporal lobe EEG abnormalities to determine if the profile was related to other forms of temporal lobe disease. Among 120 patients with unilateral or bilateral temporal lobe EEG abnormalities, only 4(3%) demonstrated the profile. The presence of the profile was unrelated to laterality of EEG abnormality. These findings were discussed in regard to previous studies and the utility of the so-called Fuld profile.

Adult↗
PubMed1992

MRI-guided stereotactic placement of depth electrodes in temporal lobe epilepsy.

Electrodes placed stereotactically in mesial temporal lobe structures may be useful for determining laterality, and extent of the epileptogenic zone in temporal lobe epilepsy. We present and compare our experience with the use of two stereotactic arcs, the Brown-Roberts-Wells (BRW) and Cosman-Roberts-Wells (CRW) for magnetic resonance imaging guided placement of multicontact electrodes in the amygdala, anterior and posterior hippocampus. Out of 101 electrodes, 28 were placed in 6 and 17 patients using the BRW and CRW arcs, respectively. The target-centered design of the CRW arc eliminated the need for trajectory calculations, used uniform 'depth' measurements, and allowed greater operative flexibility and a shortened operating time. The use of depth electrode recording allowed 14 of the 23 patients to be selected for temporal lobectomy.

Brain↗
PubMed1994

Rapidly progressing atrophy of medial temporal lobe in Alzheimer's disease.

The symptoms of Alzheimer's disease are associated with pathological change and loss of neurons in the medial temporal lobe. By yearly temporal-lobe-oriented computed tomograms the average rate of atrophy of the medial temporal lobe was 15.1% per year (95% CI 10.0, 20.2) in 20 patients with histopathologically, confirmed Alzheimer's disease and 1.5% (0.2, 2.8) in 47 healthy ageing controls. Such excessive atrophy presumably reflects the vulnerability of the medial temporal lobe to a catastrophic event, probably a pathological cascade process. Thus, Alzheimer's disease may not be due simply to an acceleration of normal ageing but, rather, is the consequence of a true disease process.

Aged↗
PubMed1979

Sexual disturbances in temporal lobe epilepsy:a controlled study.

Seventy cases each of temporal lobe epilepsy and grand mal epilepsy were studied for their sexual functioning. The two groups were similar as regards age, sex, duration of illness, frequency of seizures and menstrual and marital history. A significantly greater number of temporal lobe epileptics were found to be hyposexual. They had a global loss of performance and interest in the sexual sphere and showed no concern over it. One case in the group of temporal lobe eiplepsy, as against none in the other group, was hypersexual. There were no cases of sexual deviations in either of the groups. The findings of the study are discussed in the light of the relevant literature.

Adolescent↗
PubMed2002

Long term outcome of temporal lobe epilepsy surgery: analyses of 140 consecutive patients.

OBJECTIVE: To analyse the long term results of temporal lobe epilepsy surgery in a national epilepsy surgery centre for adults, and to evaluate preoperative factors predicting a good postoperative outcome on long term follow up. METHODS: Longitudinal follow up of 140 consecutive adult patients operated on for drug resistant temporal lobe epilepsy. RESULTS: 46% of patients with unilateral temporal lobe epilepsy became seizure-free, 10% had only postoperative auras, and 15% had rare seizures on follow up for (mean (SD)) 5.4 (2.6) years, range 0.25 to 10.5 years. The best outcome was after introduction of a standardised magnetic resonance (MR) imaging protocol (1993-99): in unilateral temporal lobe epilepsy, 52% of patients became seizure-free, 7% had only postoperative auras, and 17% had rare seizures (median follow up 3.8 years, range 0.25 to 6.5 years); in palliative cases (incomplete removal of focus), a reduction in seizures of at least 80% was achieved in 71% of cases (median follow up 3.1 years, range 1.1 to 6.8 years). Most seizure relapses (86%) occurred within one year of the operation, and outcome at one year did not differ from the long term outcome. Unilateral hippocampal atrophy with or without temporal cortical atrophy on qualitative MR imaging (p < 0.001, odds ratio (OR) 5.2, 95% confidence interval (CI) 2.0 to 13.7), other unitemporal structural lesions on qualitative MR imaging (p < or = 0.001, OR 6.9, 95% CI 2.2 to 21.5), onset of epilepsy before the age of five years (p < 0.05, OR 2.9, 95% CI 1.2 to 7.2), and focal seizures with ictal impairment of consciousness and focal ictal EEG as a predominant seizure type (p < 0.05, OR 3.4, 95% CI 1.2 to 9.1) predicted Engel I-II outcome. Hippocampal volume reduction of at least 1 SD from the mean of controls on the side of the seizure onset (p < 0.05, OR 3.1, 95% CI 1.1 to 9.2) also predicted Engel I-II outcome. CONCLUSIONS: Outcome at one year postoperatively is highly predictive of long term outcome after temporal lobe epilepsy surgery. Unitemporal MR imaging abnormalities, early onset of epilepsy, and seizure type predominance are factors associated with good postoperative outcome.

Adult↗
PubMed1986

Reproductive endocrine disorders in men with partial seizures of temporal lobe origin.

Twenty consecutive men with partial seizures of temporal lobe origin were evaluated for sexual or reproductive dysfunction. Eleven (55%) had diminished sexual interest or reduced potency. Nine of them had reproductive endocrine disorders, with features of hypogonadotropic hypogonadism in five, hyperprolactinemia in two, and hypergonadotropic hypogonadism in two. Among these nine were cases in which the reproductive endocrine abnormalities could not readily be attributed to antiseizure medication use. Other possible interpretations are as follows: epileptic discharges in medial temporal lobe structures may disrupt hypothalamic regulation of pituitary secretion, hypogonadism may promote the development of epileptic discharges, and temporal lobe epilepsy and associated reproductive endocrine disorders may represent the parallel effects of prenatal factors common to the development of both the brain and the reproductive system.

Adult↗
PubMed1976

Differences between patients with temporal lobe seizures and those with other forms of epileptic attacks.

Seventy-eight patients with temporal lobe type seizures were precisely matched for age, sex, and Wechsler I.Q. levels with patients suffering from other seizure types. Statistically significant differences were established between the groups in regard to treatment response, etiologies, and behavioral variables. Further analysis of the data showed that the behavioral problems of the temporal lobe patients were present only in that group that suffered from more than one seizure type. That temporal lobe epilepsy group having only one seizure type differed from the controls with one seizure type in regard to etiological factors; they actually showed better performance on certain subscales of the WAIS, as well as better employment records. The clinical impression of the temporal lobe epilepsy patient usually presenting more difficulties than other patients with epilepsy results from the fact that the temporal lobe patients have, in the overwhelming majority of instances, more than one seizure type.

Adolescent↗
PubMed2000

Glutamate and gamma-aminobutyric acid content and release of synaptosomes from temporal lobe epilepsy patients.

During surgical intervention in medically refractory temporal lobe epilepsy (TLE) patients, diagnosed with either mesial temporal lobe sclerosis (MTS)- or tumor (T)-associated TLE, biopsies were taken from the anterior temporal neocortex and the hippocampal region. Synaptosomes, isolated from these biopsies were used to study intrasynaptosomal Ca(2+) levels ([Ca(2+)](i)), and glutamate and gamma-aminobutyric acid (GABA) contents and release. All synaptosomal preparations demonstrated a basal [Ca(2+)](i) of about 200 nM, except neocortical synaptosomes from MTS-associated TLE patients (420 nM). K(+)-induced depolarization resulted in a robust increase of the basal [Ca(2+)](i) in all preparations. Neocortical synaptosomes from TLE patients contained 22.9 +/- 3.0 nmol glutamate and 4.6 +/- 0.5 nmol GABA per milligram synaptosomal protein, whereas rat cortical synaptosomes contained twice as much glutamate and four times as much GABA. Hippocampal synaptosomes from MTS-associated TLE patients, unlike those from T-associated TLE patients, contained about 70% less glutamate and 55% less GABA than neocortical synaptosomes. Expressed as percentage of total synaptosomal content, synaptosomes from MTS-associated TLE patients exhibited an increased basal and a reduced K(+)-induced glutamate and GABA release compared to rat cortical synaptosomes. In MTS-associated TLE patients, only GABA release from neocortical synaptosomes was partially Ca(2+)-dependent. Control experiments in rat synaptosomes demonstrated that at least part of the reduction in K(+)-induced release can be ascribed to resection-induced hypoxia in biopsies. Thus, synaptosomes from MTS-associated TLE patients exhibit a significant K(+)-induced increase in [Ca(2+)](i), but the consequent release of glutamate and GABA is severely impaired. Our data show that at least part of the differences in glutamate and GABA content and release between human biopsy material and fresh rat tissue is due to the resection time.

Animals↗
PubMed1997

Normalization of neuronal metabolic dysfunction after surgery for temporal lobe epilepsy. Evidence from proton MR spectroscopic imaging.

Surgery is a safe and effective treatment for patients with temporal lobe epilepsy (TLE) who do not respond adequately to anticonvulsant medication and in whom the seizure generator can be identified and safely removed. Proton MR spectroscopic imaging (MRSI) can image and quantify neuronal damage in patients with TLE based on reduced signals from N-acetylaspartate (NAA), a compound localized exclusively in neurons. We performed proton MRSI in patients with TLE before and after surgical treatment to determine whether NAA or other resonance intensities changed in the temporal lobes of patients with TLE after surgery, and whether these changes correlated with surgical outcome. N-acetylaspartate resonance intensity relative to creatine (NAA/Cr) was abnormally low preoperatively in at least one temporal lobe in all 14 patients examined. It was low ipsilaterally in the patients who became seizure free and bilaterally in those who did not. Postoperatively, it increased to the normal range on the side of surgery in all patients who became seizure free. In the one patient who became seizure free and who had low NAA/Cr in both temporal lobes before surgery, NAA/Cr values in the contralateral, unoperated temporal lobe also increased to the normal range. In contrast, NAA relative intensity ratios did not change in those patients who continued to have seizures after surgery. The creatine resonance intensity (Cr) in the temporal lobes was high, relative to the brainstem, in seven patients preoperatively. After surgery, the Cr remained high in two patients, both of whom continued to have seizures. We conclude that NAA (and Cr) abnormalities in TLE do not result solely from neuronal loss and gliosis but can be reversible after postsurgical control of seizures. This implies that the NAA and Cr abnormalities in patients with TLE, at least in part, are dynamic markers of both local and remote physiologic dysfunction associated with ongoing seizures.

Adolescent↗
PubMed1999

Haloperidol improves membrane phospholipid abnormalities in temporal lobes of schizophrenic patients.

Using 31P magnetic resonance spectroscopy, we examined changes in the levels of phosphorus metabolites in the temporal lobes of 13 schizophrenic patients before and 12 weeks after initiating haloperidol treatment. Spectra were obtained from a volume of interest positioned in each temporal lobe. Findings were compared with those in 13 age- and gender-matched healthy subjects. Prior to treatment the patients showed higher levels of phosphodiesters (PDE) in both temporal lobes than healthy subjects. Haloperidol administration significantly reduced the excess of PDE in the left temporal lobe, although the PDE concentration remained somewhat higher bilaterally than in controls. Treatment was associated with a decline in the total symptom score according to the Brief Psychiatric Rating Scale and the score for positive symptoms showed a relatively high correlation with reduction in PDE level in the left temporal lobe. These preliminary results suggest that haloperidol may partially normalize disturbed metabolism or abnormalities in components of membrane phospholipids in the left temporal lobe of untreated schizophrenic patients, paralleling symptom alleviation.

Adolescent↗
PubMed2001

Typical and atypical perfusion patterns in periictal SPECT of patients with unilateral temporal lobe epilepsy.

PURPOSE: To characterize perfusion patterns of periictal single-photon emission tomography (SPECT) in patients with unilateral temporal lobe epilepsy (TLE) and to determine their relationship to the epileptogenic zone (EZ). METHODS: We studied periictal SPECT scans of 53 patients after anterior mesial temporal lobectomy who had good seizure outcome after surgery. Ictal SPECT scans were performed during video-EEG monitoring. Typical SPECT patterns consisted of ipsilateral ictal hyperperfusion or ipsilateral postictal hypoperfusion. Atypical ictal patterns included normal scans, bilateral temporal hyperperfusion, or contralateral patterns. These perfusion patterns were retrospectively analyzed searching for concordance rate with the EZ. RESULTS: We obtained 51 ictal and two early postictal scans. In the typical group, 40 (75.4%) patients had ipsilateral ictal temporal lobe hyperperfusion, and one (1.9%) patient had ipsilateral postictal temporal lobe hypoperfusion. Twelve (22.7%) patients exhibited atypical perfusion patterns: seven (13.2%) patients had bitemporal ictal hyperperfusion (four cases showed asymmetric temporal lobe changes), four (7.6%) patients had contralateral hyperperfusion, and one (1.9%) patient had a normal SPECT scan. All four patients with bitemporal asymmetric hyperperfusions showed greater perfusion lateralized to the side of the EZ. Three of the four patients who had contralateral hyperperfusion also had a complex postictal-like pattern in the ipsilateral temporal lobe consisting of anteromesial hyperperfusion with adjacent lateral hypoperfusion. CONCLUSIONS: This study analyzed typical and atypical perfusion patterns in unilateral TLE, and suggested that not only typical, but also some atypical perfusion patterns may contribute to the lateralization of EZ.

Adolescent↗
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↗
PubMed2003

[Age dynamics of temporal lobe epilepsy in children].

To study clinical features of temporal lobe epilepsy in children of different age, to trace disease development and to define risk factors for its occurrence and adverse course, 88 patients aged 3-14 years were examined. The study confirmed that temporal lobe epilepsy has its characteristic clinical features in children of different age. In children under 7 years of age, motor and autonomic paroxysms prevail accompanied in older children with psychomotor and psychosensory fits. With age the latter become more complicated. In children under 10 years of age psychomotor seizures prevail and in those older 10 years sensory and psychosensory ones predominate. Children over 10 years were characterized by polymorphic seizures or combinations of several kinds of seizures. The seizures can transform into either generalized or focal ones. In our study, the course of temporal lobe epilepsy was rather favorable. Seizures number reduced by more than a half in 82% of the cases. Adverse disease course was mainly detected in children with perinatal complications in their anamnesis and "spike-wave" complexes in EEG as well as in those suffering from psychomotor and psychosensory seizures.

Adolescent↗
PubMedDate not supplied

Contralateral temporal hypometabolism on positron emission tomography in temporal lobe epilepsy.

INTRODUCTION: No detailed case studies report lateralised hypometabolism on positron emission tomography (PET) contralateral to the epileptogenic focus in temporal lobe epilepsy (TLE). MATERIAL AND METHODS: We performed 18F fluorodeoxyglucose (FDG) PET in two intractable TLE patients. RESULTS: One had right temporal interictal spikes on electroencephalography (EEG) and a right medial temporal lobe lesion on magnetic resonance imaging (MRI). FDG-PET showed decreased uptake in the left temporal lobe. Right temporal ictal onset, with bilateral interictal epileptiform activity, occurred on intracranial EEG. He is seizure free after right temporal lobectomy and ganglioglioma resection. The second had right temporal lobe interictal and ictal EEG activity. MRI demonstrated right anteriomedial temporal increased T2 signal. Neuropsychology revealed bilateral cognitive dysfunction. FDG-PET showed left anterior temporal and lateral frontal hypometabolism. He is seizure free after right temporal lobectomy. CONCLUSION: These findings suggest that regional uptake asymmetry on FDG-PET may be give misleading lateralising information in TLE.

Adult↗
PubMed1999

Anterior temporal abnormality in temporal lobe epilepsy: a quantitative MRI and histopathologic study.

OBJECTIVE: To examine the nature and frequency of anterior temporal lobe (AT) abnormalities that occur in intractable temporal lobe epilepsy (TLE). METHODS: We reviewed the MR scans and clinical histories of 50 consecutive patients with intractable TLE. Histopathology was available in 42 surgically treated cases. RESULTS: MRI demonstrated loss of the gray-white matter differentiation and decreased T1- and increased T2-weighted signal in the ipsilateral AT in 58% of the 50 patients. This appearance was observed in 64% of the 36 patients with hippocampal sclerosis (HS) but was also seen in patients without HS. These changes were associated with temporal lobe atrophy, a higher hippocampal T2 relaxation time, and a history of febrile convulsions. Pathologic examination showed that the MRI appearances were not caused by dysplasia, degenerative abnormalities, or inflammatory change. Histologic quantitation showed increased glial cell nuclei counts in the intractable TLE cases compared with controls. There was no difference in glial cell numbers between cases with AT abnormality and those without this appearance. Presence or absence of changes was not predictive of preoperative neuropsychology, postoperative change in neuropsychology, or seizure outcome after surgery. CONCLUSIONS: These frequently seen ipsilateral changes are not caused by gliosis and may reflect a nonspecific increase in water content in the temporal lobe. This may be due to myelin abnormalities or some other as yet unidentified pathologic factor.

Adolescent↗
PubMed1981

Frequency of hypergraphia in temporal lobe epilepsy: an index of interictal behaviour syndrome.

Frequency and degree of hypergraphia were studied in order to assess interictal behaviour change in temporal lobe epilepsy. Patients with temporal lobe epilepsy tended to reply more frequently to a standard questionnaire, and wrote extensively (mean: 1301 words) as compared to others (mean: 106 words). The incidence of temporal lobe epilepsy was 73% in patients exhibiting hypergraphia compared to 17% in patients without this trait. These findings suggest that hypergraphia may be a quantitative index of behaviour change in temporal lobe epilepsy.

Electroencephalography↗
PubMed1992

[Foramen ovale electrodes in the study of temporal lobe epilepsy].

Corticograms of the mesial structures of the temporal lobe may be obtained with the recently developed foramen ovale electrodes. Since their installation is easy and of low risk, they will probably displace other invasive techniques routinely used up to the moment for the localization and lateralization of epileptic foci originated in the temporal lobe. For the first time in our country, we have used this technique in 7 patients with medically intractable complex partial epilepsy. In all the patients, the study allowed to clear doubts about the laterality of the start of ictal activity and to define irritative foci not found with conventional continuous superficial electroencephalographic recordings. The procedure was uneventful and the implanted electrodes were optimally tolerated. Foramen ovale electrodes are an effective diagnostic method for temporal lobe epilepsies and their features are specially appropriate for our milieu.

Adolescent↗