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Damage to the amygdalo-hippocampal projection in temporal lobe epilepsy: a tract-tracing study in chronic epileptic rats.

Both the amygdala and hippocampus are damaged in drug-resistant temporal lobe epilepsy (TLE), suggesting that amygdalo-hippocampal interconnectivity is compromised in TLE. Therefore, we examined one of the major projections from the amygdala to the hippocampus, the projection from the amygdala to the CA1 subfield of the hippocampus/subiculum border region, and assessed whether it is preserved in rats with spontaneous seizures. Male Wistar rats were injected with kainic acid (9 mg/kg, i.p.) to induce chronic epilepsy. The occurrence of spontaneous seizures was monitored 5 or 15 weeks later by video-recording the rats for up to 5 days. Saline-injected animals served as controls. Thereafter, the retrograde tracer Fluoro-gold was injected into the border region of the temporal CA1/subiculum. Rats were perfused for histology 1-2 weeks later and sections were immunohistochemically processed to detect Fluoro-gold-positive cells. Comparison of the labeling in control and epileptic tissue indicated that a large cluster of retrogradely labeled cells in the parvicellular division of the basal nucleus was well preserved in epilepsy, even when the neuronal damage in the amygdala was substantial. Another large cluster of retrogradely labeled cells in the lateral division of the amygdalo-hippocampal area, the posterior cortical nucleus (part of the vomeronasal amygdala), and the periamygdaloid cortex (part of the olfactory amygdala), however, had disappeared in epileptic brain in parallel to severe neuronal loss in these nuclei. These data demonstrate that a projection from the parvicellular division of the basal nucleus to the temporal CA1/subiculum region is resistant to status epilepticus-induced neuronal damage and provides a candidate pathway by which seizure activity can spread and propagate from the amygdala to the hippocampal formation.

Amygdala↗

Clinical applications of MR spectroscopy in epilepsy.

1H and 31P spectroscopy detects relevant metabolite changes in patients with TLE. Numerous studies confirm reduction in NAA and in the ratio of PCr/Pi. In his 1999 review, Kuzniecky concluded that proton MRS, using single-voxel or chemical shift imaging, lateralizes temporal lobe epilepsy in 65% to 96% of cases, with bilateral changes seen in 35% to 45% of cases, whereas phosphorus MRS shows a lateralizing PCr/Pi ratio in 65% to 75% of the TLE patients. There are indications that these changes are reversible with seizure treatment. Improvements in MRS technology, such as the ability to calculate absolute concentrations, to account for differences be-tween gray and white matter and to achieve better spectral resolution by use of a higher magnetic field strength, will now allow more extensive use of this technique for patients with epilepsy.

Amino Acids↗

Overexpression of NPY and Y2 receptors in epileptic brain tissue: an endogenous neuroprotective mechanism in temporal lobe epilepsy?

Recurrent epileptic seizures in the rat enhance the expression of neuropeptide Y (NPY) and its mRNA in various brain areas including the hippocampus, cerebral cortex and the amygdala. In the hippocampus, the most prominent expression of NPY is observed in mossy fibers and in GABAergic interneurons. At the same time, expression of Y2 receptors is also increased whereas Y1 receptors are reduced. Similar changes in Y1 and Y2 receptors were observed in the hippocampus of patients with temporal lobe epilepsy (TLE). In contrast to the rat, NPY expression is not enhanced in mossy fibers in TLE. In the same tissue, surviving NPY interneurons show marked axonal sprouting into areas innervated by mossy fibers (dentate hilus, stratum lucidum, inner molecular layer of the dentate gyrus). Stimulation of presynaptic Y2 receptors inhibits glutamate release, and exert an anticonvulsant action in experimental models. Y1 receptors mediate a weak excitatory component of NPY action. These findings suggest that changes in the NPY system induced by seizures represent an endogenous adaptive mechanism aimed at counteracting hyperexcitability underlying epileptic activity. This concept is strongly supported by evidence that genetically modified rats overexpressing the NPY gene are less susceptible to seizures while deletion of NPY or Y2 receptor genes results in increased susceptibility to seizures.

Animals↗

Can I treat this small larynx lesion with radiation alone? Update on the radiation management of early (T1 and T2) glottic cancer.

This article endeavors to explain the advantages and disadvantages of radiotherapy (RT) versus transoral laser excision (TLE)and to suggest when each modality may be employed for optimal treatment of patients with this heterogeneous group of tumors. It compares RT and TLE using the criteria of cure and local control rates, posttreatment voice quality, side effects and morbidity, cost,convenience, and salvage potential.

Glottis↗

Postoperative routine EEG correlates with long-term seizure outcome after epilepsy surgery.

We investigated the correlation of interictal epileptiform discharges (IED) in routine EEG 6 and 24 months after epilepsy surgery with regard to long-term seizure outcome. In 148 patients (74% temporal lobe epilepsy (TLE), 26% extratemporal epilepsy) EEG results (IED present or absent) were correlated with the postoperative outcome using the Engel classification 6 and 24 months after resection (PO6m and PO2y, respectively). Self-evaluation was conducted 3 and 5 years after resection (PO3y and PO5y, respectively). Ninety-one patients (62%) were seizure-free 5 years after resection; 88% of them showed no IED in PO6m. Twenty-eight patients (19%) displayed IED in routine EEG 6 months after resection; 61% of them had recurrent seizures at PO5y, whereas of 120 patients without IED only 33% had recurrent seizures at PO5y; p=0.01. Absence of IED in PO6m and PO2y correlated with good outcome: 71% without IED remained seizure-free, whereas only 25% with IED at PO6m and PO2y remained seizure-free; p=0.001. Seizure-free patients (Engel 1) and patients with less favourable outcome (Engel 3-4) at PO6m and PO2y rarely changed categories of outcome during the following years (p<0.001). Half of the patients with favourable seizure reduction (Engel 2) changed to seizure-free (Engel 1) or to a worse outcome category (Engel 3-4). Postoperative routine EEG is a good prognostic instrument for the prediction of long-term seizure outcome, especially for TLE. It predicts the running up and down of fits in patients with rare seizures (Engel 2).

Adolescent↗

Resection extent versus postoperative outcomes of seizure and memory in mesial temporal lobe epilepsy.

OBJECTIVES: To investigate the effects of the resection of hippocampus and temporal neocortex on postsurgical seizure and memory outcomes in mesial temporal lobe epilepsy (mTLE) patients. METHODS: Sixty-eight mTLE patients underwent pre- and postsurgical brain magnetic resonance imaging (MRI). The patients were divided into seizure-free group (SF, N=54) and non-seizure-free group (NSF, N=14). The resection length of hippocampus was determined by the difference between presurgical and postsurgical hippocampus lengths in MRIs. The lengths of resected temporal gyri were measured on three-dimensional MRI reconstruction. Among SF group, 37 patients performed pre- and postsurgical neuropsychological tests. The postsurgical memory decline (PMD) was calculated by subtracting postsurgical memory score from presurgical one in verbal and visual memory tests. RESULTS: The resection length of hippocampus in SF was significantly longer than in NSF (32.7 +/- 7.7 mm versus 25.1 +/- 7.3 mm, t-test, p=0.002), regardless of intersubject difference in the extent of hippocampal sclerosis (logistic regression, p=0.003) while the resection lengths of the lateral temporal gyri were not different between SF and NSF. Overall postsurgical change of verbal or visual memory was not significant. However, regression analysis showed a significant correlation between the resection length of inferior or basal temporal gyrus and verbal PMD (p<0.001) in left TLE patients with seizure-free outcome. CONCLUSION: More resection of hippocampus may predict a better postsurgical seizure-free outcome. The larger resection of inferior or basal temporal gyrus seems to be related to a postsurgical verbal memory decline in left TLE patients.

Adolescent↗

Attention, memory, and behavioral adjustment in children with frontal lobe epilepsy.

To explore whether attention, memory, and behavior would be more affected in children with frontal lobe epilepsy than in children with other types of epilepsy, we compared 16 children with frontal lobe epilepsy (FLE), 8 with temporal lobe epilepsy (TLE), and 8 with generalized absence (GEA) seizures on the Performance Speed (PS) and Freedom of Distraction (FD) indices of the WISC-III, the Continuous Performance Test (CPT), the California Verbal Learning Test (CVLT), and Rey-Osterrieth Complex Figure (ROCF). Parents completed Achenbach's Child Behavior Check List. Children with FLE scored significantly lower than the other two groups on the PS and CPT. On the CVLT they made more intrusion errors and were more prone to interference. Furthermore, they had more difficulties copying and recalling the ROCF. Behavior profiles revealed greater attention problems in this group. This may put children with FLE at greater risk of developing school problems than children with TLE and GEA.

Adaptation, Psychological↗

The localizing value of auditory event-related potentials (P300) in patients with medically intractable temporal lobe epilepsy.

The localizing value of postictal versus interictal event-related potentials (ERPs) was studied in patients with medically intractable TLE admitted for long-term video EEG monitoring. Ten patients with partial seizures and secondary generalization underwent preictal (upon hospital admission), postictal (</=6h after seizure), and interictal (7-48h after seizure) ERP recordings of an auditory oddball paradigm. Preictal ERPs were compared to postictal and interictal recordings. Intraclass correlations, transformed into z scores, were utilized to analyze amplitude differences between electrodes placed on the hemisphere ipsilateral versus contralateral to the epileptogenic focus. The results showed that in 9 out of 10 patients the ERP amplitude was reduced in postictal compared to preictal recordings for electrodes placed ipsilateral to the epileptogenic focus (P<0.0001). However, there was no difference in amplitude between ipsilateral and contralateral electrodes in preictal and interictal recordings. These findings suggest that postictal ERPs are of localizing value in patients with TLE while interictal ERPs are not.

Acoustic Stimulation↗

Mesial temporal lobe epilepsy and hippocampal sclerosis: cognitive function assessment in Hispanic patients.

PURPOSE: The goal of this study was to assess the cognitive function status in patients with mesial temporal lobe epilepsy and hippocampal sclerosis (TLE+HS) to determine their cognitive function profile and to correlate material-specific memory deficits with HS laterality diagnosed by MRI. METHODS: Seventy-one patients were assessed with a neuropsychological protocol that includes IQ, attention, handedness, verbal memory, visual memory, language, and the executive function. chi(2) and correlation tests were used. RESULTS: Memory impairment was found in 46 patients (66%): patients without any memory deficit (n=25), patients with verbal memory deficit (n=21), patients with visual memory deficit (n=17), patients with deficit for both types of memory (n=8). Correlation between MRI lesion and memory was 66%. Language was impaired in 33 patients (46%). Eighteen patients (25%) had a deficit of the executive function. CONCLUSIONS: Patients with TLE+HS presented with a deficit in material-specific episodic memory correlating in large proportion with HS lateralization. We also found language and executive function impairments.

Adult↗

Excessive masturbation after epilepsy surgery.

Sexual behavior changes as well as depression, anxiety, and organic mood/personality disorders have been reported in temporal lobe epilepsy (TLE) patients before and after epilepsy surgery. The authors describe a 14-year-old girl with symptoms of excessive masturbation in inappropriate places, social withdrawal, irritability, aggressive behavior, and crying spells after selective amygdalohippocampectomy for medically intractable TLE with hippocampal sclerosis. Since the family members felt extremely embarrassed, they were upset and angry with the patient which, in turn, increased her depressive symptoms. Both her excessive masturbation behavior and depressive symptoms remitted within 2 months of psychoeducative intervention and treatment with citalopram 20mg/day. Excessive masturbation is proposed to be related to the psychosocial changes due to seizure-free status after surgery as well as other possible mechanisms such as Kluver-Bucy syndrome features and neurophysiologic changes associated with the cessation of epileptic discharges. This case demonstrates that psychiatric problems and sexual changes encountered after epilepsy surgery are possibly multifactorial and in adolescence hypersexuality may be manifested as excessive masturbation behavior.

Adolescent↗

Memory relationships between MRI volumes and resting PET metabolism of medial temporal lobe structures.

Prior studies of temporal lobe epilepsy (TLE) patients showed that MRI volumes and resting PET scan measures of temporal lobe structures were related to memory. Weintrob and colleagues [Ann. Neurol. 2002;51:442-7] reported that PET glucose uptake in the left perirhinal cortex predicted verbal paired associate (PA) learning, whereas MRI volume of the left hippocampus did not. We investigated whether MRI volumes could account for memory functioning if both PET and volumes were from the same region in 18 TLE patients. Volumes and glucose uptake of the hippocampus and parahippocampal gyrus (PHG) were compared with WMS-III performance. Significant correlations were observed between hippocampal volumes and PA and Logical Memory (LM) Percent Retention, but not between memory and PHG volumes or any PET measures. Multiple regression revealed that hippocampal volumes, but not PHG volumes or PET, significantly predicted PA and LM retention scores. These findings suggest that hippocampal volumes provide unique information regarding memory.

Adolescent↗

Temporal lobe ictal behavioral patterns in hippocampal sclerosis and other structural abnormalities.

Ictal behavioral characteristics may provide clues in determining the nature of the epileptic focus. We defined ictal behavioral characteristics in patients with intractable temporal lobe epilepsy (TLE) who underwent anterior temporal lobectomy (ATL) and lived seizure-free for 2 years of follow-up. Video/EEG data on 282 seizures observed in 48 patients who suffered from TLE and underwent ATL were analyzed. All patients were seizure-free after surgery. We divided the patients into two groups on the basis of the pathological examination. Two hundred and two seizures in 35 patients with hippocampal sclerosis (Group 1) and eighty seizures in 13 patients with other pathological findings, such as tumors, cavernoma, and hamartoma (Group 2), were analyzed. Ictal behavior characteristics were evaluated for each of the seizures recorded in the two groups. Behavioral arrest, bilateral hand automatisms, oral and leg automatisms, and ictal aggression were significantly more frequent in Group 2 (P<0.05), whereas contralateral dystonia of the upper extremity (P<0.05), ipsilateral hand automatisms (P<0.05), ipsilateral hand automatisms in the presence of contralateral dystonia of the upper extremity (P<0.001), contralateral forced head deviation (P<0.05), and secondary generalization (P<0.05) were more significant in Group 1. There was no significant difference in vocalization and ipsilateral nonforced head deviation between the two groups (P>0.05). The number of seizures observed during ictal speech, crying, and postictal nose wiping was not large enough, so differences could not be analyzed. It was concluded that although ictal behavioral characteristics differed between the two groups, certain behavioral patterns may be helpful in differentiating between hippocampal sclerosis and other pathology.

Adolescent↗

Psychiatric morbidity, quality of life, and disability in mesial temporal lobe epilepsy patients before and after anterior temporal lobectomy.

Considerable interest has been focused on the psychiatric complications of medically refractory temporal lobe epilepsy (TLE) before and after epilepsy surgery. The aim of the present study was to evaluate the psychiatric status, quality of life, and level of disability in medically refractory mesial temporal lobe epilepsy (MTLE) patients, a homogenous subgroup of patients with TLE, before and after anterior temporal lobectomy (ATL). The study population consisted of 22 patients with medically refractory MTLE who were candidates for ATL. Patients were examined before surgery as well as in the third and sixth months of the postoperative period. Psychiatric diagnosis was determined by using SCID-I. To rate the severity of psychiatric disorders, BPRS, HDRS, and HARS were employed on each visit. WHO-DAS-II and WHOQOL-BREF were used to determine the level of disability and quality of life. Preoperatively, six patients had a psychiatric diagnosis. Three months after surgery, six of the patients had psychiatric diagnoses. Five of these six patients had not been previously diagnosed. There was no significant difference between preoperative and postoperative follow-up evaluations in terms of HDRS, HARS, and BPRS ratings. With respect to the total scores and domains of WHO-DAS-II, the change in pre- and postoperative evaluations was statistically significant only for the social life attendance domain. There was no significant difference in the mean scores on the WHOQOL-BREF domains or on the first question about general evaluation of quality of life. For the second question on the level of satisfaction with health, the difference between the three ratings was statistically significant. Preoperative and postoperative rates of psychiatric disorders in our sample were low. While social phobia was frequently seen preoperatively, the postoperative period was spearheaded by major depressive disorder. The decrease in disability in attendance to social life and improvement in the quality of health were in concordance with the literature, indicating the positive results of surgical treatment of epilepsy on quality of life. This study suggests that surgical intervention might be one of the causes of postoperative psychiatric disorders in patients with MTLE.

Adolescent↗

Cerebellar atrophy in temporal lobe epilepsy.

PURPOSE: The goal of this work was to determine the presence and degree of cerebellar atrophy in chronic temporal lobe epilepsy, its clinical seizure correlates, and its association with general cortical atrophy. METHODS: Study participants were 78 persons with temporal lobe epilepsy and 63 age- and gender-matched healthy controls. All subjects underwent high-resolution MRI with manual tracing of the cerebellum. Clinical seizure features and history were obtained by structured interview and review of medical records. RESULTS: The epilepsy group exhibited significant abnormality in cerebellar volume, with mean reductions ranging from 4 to 6.6% depending on adjustments. Significantly more individual subjects with epilepsy exhibited cerebellar atrophy compared with controls across all operational definitions or thresholds of abnormality including z < or = -2.0 (13% TLE, 3.4% controls) and z < or = 1.5 (22% TLE, 3.4% controls). Clinical seizure features reflecting both neurodevelopmental (history of initial precipitating injuries) and severity of course (longer duration, increased number of lifetime generalized tonic-clonic seizures) factors were associated with cerebellar atrophy. Atrophy of the cerebellum could be observed independent of more general (cerebral) atrophic processes. CONCLUSIONS: The presence of cerebellar atrophy is a reflection of the extratemporal abnormalities that can be observed in localization-related temporal lobe epilepsy, which may be due, at least in part, to factors associated with epilepsy chronicity.

Adult↗

New facets of the neuropathology and molecular profile of human temporal lobe epilepsy.

This review summarizes the salient features of the anatomical and molecular neuropathology of the hippocampus from patients with intractable temporal lobe epilepsy (TLE). It argues that sclerotic hippocampus is essential for seizure expression and that sclerosis is not a consequence of seizures, but is related to the epileptogenicity of the seizure focus. While neurons in sclerotic hippocampus may contribute to hippocampal hyperexcitability, this role is perhaps less important than that of the astrocytes. The astrocytes in sclerotic hippocampus may directly influence excitability through altered water homeostasis and K+ buffering by redistribution of AQP4 transporters on their plasma membrane. It is proposed that they contribute to a high extracellular glutamate level through reduced glutamine synthetase, and activation through pro-inflammatory factors that release chemokines and cytokines, which enhance calcium-dependent glutamate release. Such a focal pool of glutamate may diffuse to surrounding neuron-rich areas to generate seizure activity in TLE.

Animals↗

The decay of memory between delayed and long-term recall in patients with temporal lobe epilepsy.

OBJECTIVES: Impairment of long-term recall may worsen everyday functioning of patients with epilepsy even if the standard short-term or delayed recall tests do not show significant abnormalities. We evaluated prospectively the decay of memory between delayed and long-term recall in patients with temporal lobe epilepsy (TLE) and controls with the aim of identifying the determinants of long-term memory impairment. METHODS: Seventy patients with TLE and 59 controls underwent neuropsychological assessment of verbal and nonverbal memory, attention, and executive functions at visit 1. Long-term verbal and nonverbal memory was tested with the same word list, verbal logical story, and Rey-Osterrieth complex figure test 4 weeks later at visit 2. The decay in memory was estimated as information recalled at visit 2 as a percentage of the delayed recall at visit 1. RESULTS: Frequent seizures (> or = 4 per month) during the study period were related to poor long-term recall, even for those patients who did relatively well on delayed recall tests. On all long-term memory tests, patients with complex partial and/or secondary generalized seizures did significantly worse than patients with simple partial seizures. The presence of interictal generalized or focal temporal epileptiform activity was associated with more accelerated forgetting of the word list and complex figure. Multiple regression analysis confirmed that number of complex partial seizures, age of patient, and abnormal interictal EEG are significant predictors of accelerated forgetting. CONCLUSIONS: Uncontrolled seizures, especially with ictal impairment of consciousness, can be a significant factor in the accelerated decay of memory, although subclinical interictal epileptiform EEG activity may also be relevant.

Adolescent↗

Language dominance in mesial temporal lobe epilepsy: a functional transcranial Doppler sonography study of brain plasticity.

Functional transcranial Doppler sonography was used to study hemispheric language dominance (HLD) in 24 right-handed patients with left temporal lobe epilepsy (TLE) and a structural lesion in the left temporal lobe and in 69 healthy controls. Twenty-five percent of the patients and 4% of controls showed atypical (right or bilateral) HLD. Degree of HLD was not correlated with age, Full Scale IQ, Verbal IQ, spike frequency, seizure frequency, age at seizure onset, or duration of TLE. Atypical HLD appears to be lesion-induced, independent of epilepsy characteristics.

Adolescent↗

Activation of neurotensin receptors and purinoceptors in human colonic adenocarcinoma cells detected with the microphysiometer.

Activation of endogenous neurotensin (NT) receptors and P2-purinoceptors expressed by human colonic adenocarcinoma HT-29 cells increased extracellular acidification rates that were detected in the microphysiometer. NT (pGlu-Leu-Tyr-Glu-Asn-Lys-Pro-Arg-Arg-Pro-Tyr-Ile-Leu), NT[8-13] (Arg-Arg-Pro-Tyr-Ile-Leu), NT[9-13] (Arg-Pro-Tyr-Ile-Leu), and NT1 (N alpha methyl-Arg-Lys-Pro-Trp-Tle-Leu [Tle = tert-leucine]) were full agonists, whereas XL 775 (N-[N-[2-[3-[[6-amino-1-oxo-2-[[(phenylmethoxy)carbonyl]-amino]hex yl]amino]phenyl]-3-(4-hydroxyphenyl)-1-oxo-2-propenyl]-L-isoleucyl]-L-le ucine) was a partial agonist for activating NT receptors expressed by HT-29 cells. Desensitization induced by NT was rapid and monophasic with 85% of the initial response lost by a 30-s exposure. Once initiated, the rate and extent of desensitization were similar for different concentrations of a given agonist, for agonists of different potencies, and for agonists of different efficacies, which suggests that desensitization may be independent of receptor occupancy or agonist efficacy. Resensitization was a much slower process, requiring 60 min before the full agonist response to NT was recovered. ATP, via P2-purinoceptors, also activated cellular acidification rates in a concentration-dependent manner. ATP induced a biphasic desensitization of purinoceptors with a loss of ca. 50% of the initial stimulation detectable between 30 and 90 s of exposure to the agonist. Desensitization of NT receptors did not influence the activation of P2-purinoceptors by ATP, suggesting there was no heterologous desensitization between the two types of receptors. Superfusion with NT receptor agonists for 15 min at concentrations that did not elicit changes in extracellular acidification rates blocked, in a concentration-dependent manner, the agonist response induced by 100 nM NT. This may reflect sequestration of the receptor. These results suggest that the high agonist affinity state of NT receptors may modulate receptor sequestration, whereas activation of the low agonist affinity state may be linked to cellular metabolism. Comparison of our results with published data found differences as well as similarities of NT responses among three lines of HT-29 cells.

Adenosine Triphosphate↗