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PubMed1995

Ictal ECG changes in temporal lobe epilepsy.

Changes in cardiac rhythm may occur during epileptic seizures and this has been suggested as a possible mechanism for sudden unexpected death amongst patients with chronic epilepsy (SUDEP). We have studied ECG changes during 61 complex partial seizures of temporal lobe origin in 20 patients. Tachycardia was observed in 24/61 (39%) and bradycardia in 3/61 (5%). The mean and median tachycardia rate was 139 and 140 beats/min (range 120-180). The longest R-R interval observed was 9 seconds. No difference was found in regard to the lateralisation of seizures and cardiac arrhytmia. One of the patients with bradycardia was fitted with a demand cardiac pacemaker, which appeared to decrease the number of his falls. In conclusion, ictal cardiac changes which may be seen in temporal lobe epilepsy (TLE) are sinus tachycardia and occasionally sinus bradycardia. Patients presenting vague complains suggestive of either TLE or cardiac dysrhythmia, simultaneous monitoring with EEG/ECG is required, and if the episodes are frequent, video-EEG should be considered. Further studies on this subject are warranted as this may shed some light on possible mechanisms for SUDEP.

Adolescent↗

PubMed2001

Late onset temporal lobe epilepsy with MRI evidence of mesial temporal sclerosis following acute neurocysticercosis: case report.

UNLABELLED: The objective of this case report is to describe magnetic resonance imaging (MRI) evidence of mesial temporal sclerosis (MTS) in a patient with new onset temporal lobe epilepsy (TLE) and acute neurocysticercosis with multiple cysts. A 56 years old man with new onset headache, Simple Partial Seizures and Complex Partial Seizures underwent CT scan and lumbar puncture as diagnose proceeding. Multiple cysts and meningitis were identified, with a positive immunology for cysticercosis. Seizures were recorded over the left temporal region in a routine EEG. Treatment with albendazole was performed for 21 days, with clinical improvement and seizure remission after 4 months. An MRI scan 11 months after treatment, showed complete resolution of those cystic lesions and a left hippocampal atrophy (HA) with hyperintense T2 signal. The presence of HA and hyperintense T2 signal in this patient has not, to date, been associated with a poor seizure control. CONCLUSIONS: This patient presented with MRI evidence of left MTS after new onset partial seizures of left temporal lobe origin. Although we did not have a previous MRI scan, it is likely that this hippocampal abnormality was due to the acute inflammatory response to cysticercosis associated to repeated partial seizures. This suggests that acute neurocysticercosis associated with repeated seizures may cause MTS and late onset TLE.

Acute Disease↗

PubMed2006

Interictal electroencephalographic findings in children and adults with temporal lobe tumors.

OBJECTIVE: To characterize clinical and interictal electroencephalographic aspects of children and adults with temporal lobe epilepsy (TLE) due to tumoral lesions. METHOD: We performed a retrospective analysis of the clinical and interictal electroencephalographic aspects of 16 children (64 exams) and 12 adults (78 exams) with lesions in the temporal lobe. RESULTS: The most frequent etiologies were gangliogliomas, DNETs, followed by astrocytomas. Auras occurred in both groups, the most common being epigastric sensation. Other findings such as myoclonias, behavioral arrest and vomiting were more frequent in children. Temporal epileptiform and nonepileptiform activities, mostly unilateral, were found in both groups. Extratemporal epileptiform activities (frontal, parietal, central, occipital and generalized) were also found equally in both groups. CONCLUSION: Our data show that children and adults with TLE due to expansive lesions present with similar EEG findings.

Adult↗

PubMed1978

Contact angle and surface tension in studies of lung surfactant.

The contact angle (theta) was determined in combination with surface tension measured in a Langmuiur-Willhelmy surface tension balance. Correction of the surface tension by the contact angle factor (1/cos theta) was tried on the monolayer curve of dipalmitoyl phosphatidyl choline (DPPC) and total lipid extracts from the bovine lung surfactant material (TLE). The contact angle was observed with an optical apparatus called a Contangulometer and pictures taken discontinuously, and was determined by drawing tangents at the peak of a junction between the water mensicus and a glass plate. The contact angle was about 15 degrees, and had a narrow range of variation until the surface tension became very low, less than 5 dynes/cm, and then the contact angle jumped to almost 90 degrees both in DPPC and in TLE. It is concluded that the directly recorded surface tension curve underestimates the value by about 3-4% and that when the surface tension becomes very low, less than 5 dynes/cm, the value is no longer valid because the contact angle becomes nearly 90 degrees.

Methods↗

PubMed2006

Drug-resistant temporal lobe epilepsy due to cavernous malformations.

OBJECT: Supratentorial cavernous angiomas may be associated with drug-resistant focal epilepsy. Surgical removal of the malformation may result in seizure control in a number of patients, although in most studies a long history and high frequency of attacks have been recognized as indicators of unfavorable seizure outcome. In the literature, there are no clear indications regarding the optimal diagnostic presurgical workup and the surgical strategy for this particular subgroup of patients with symptomatic epilepsy. In this paper the authors focus on the preoperative workup and the surgical management of the disease in eight consecutive patients undergoing surgery for drug-resistant temporal lobe epilepsy (TLE) due to cavernous malformations (CMs), and the relevant literature on this issue is also reviewed. METHODS: Preoperatively, all patients were assessed using a noninvasive protocol aimed at localizing the epileptogenic zone on the basis of anatomical, electrical, and clinical criteria. The presurgical assessment yielded an indication for lesionectomy in two cases, lesionectomy plus anteromesial temporal lobectomy in four cases, and lesionectomy plus extended temporal lobectomy in two cases. At follow-up examinations, seizure, neuropsychological, and psychiatric outcomes were all evaluated. Seven patients were categorized in Engel Class IA (seizure free), and one was categorized in Engel Class IB (occasional auras only). No adverse effects on neuropsychological or psychosocial functioning were observed. CONCLUSIONS: Epilepsy surgery can be performed with excellent results in patients with intractable TLE caused by CMs. Noninvasive presurgical evaluation of these patients may enable a tailored approach, providing complete seizure relief in most cases.

Adult↗

PubMed1995

Quantified patterns of mossy fiber sprouting and neuron densities in hippocampal and lesional seizures.

Quantified hippocampal mossy fiber synaptic reorganization and neuron losses were measured to determine the pathological features associated with epileptogenic fascia dentata. Twenty-five patients with temporal lobe epilepsy (TLE) were classified as having either mesial temporal sclerosis (MTS; 16 patients), with seizure genesis in the hippocampus, or temporal mass lesions (nine patients), with seizures that were probably extrahippocampal. Neo-Timm's histochemistry identified mossy fiber sprouting, and aberrant fascia dentata puncta densities were objectively measured by light microscopic analysis on an image-analysis computer. neuron densities determined cell losses and the two seizure groups were compared to control specimens obtained from autopsies. Results showed significantly greater fascia dentata mossy fiber puncta densities and neuron losses in TLE patients compared to autopsy specimens (p < 0.026). Furthermore, there were significant differences between the two seizure groups: 1) mossy fiber puncta densities in the inner molecular layer were significantly greater in MTS compared to lesions (p < 0.02), and 2) mossy fiber puncta densities were greater in the inner molecular layer than in the stratum granulosum in 14 of 16 MTS patients (88%) compared to four of nine patients with lesions (44%, p < 0.01). Neuron densities were significantly different comparing MTS, lesion and control groups for stratum granulosum (p = 0.0001) and Ammon's horn (p = 0.0001), with each group significantly different (p < 0.05) compared to another. All patients were either seizure-free or significantly improved 1 year or more after en bloc temporal lobectomy. There were no significant correlations between fascia dentata mossy fiber puncta densities and counts of hilar neurons, CA4 pyramids, granule cells, or years of seizures. This indicates that inner molecular layer mossy fiber puncta densities and neuron losses are greater in patients with MTS than in those with lesions, and mossy fiber sprouting probably contributes to the pathophysiology of hippocampal seizures. Furthermore, these data show that some patients with extrahippocampal lesions have mossy fiber sprouting similar to MTS patients, suggesting that hippocampi in lesion patients may be capable of epileptogenesis from synaptic reorganization.

Adult↗

PubMed1995

Unilateral hippocampal mossy fiber sprouting and bilateral asymmetric neuron loss with episodic postictal psychosis.

Rarely are both sides of the hippocampus available for pathological study in a patient with intractable temporal lobe epilepsy (TLE). The authors report a patient with TLE investigated with bilateral depth electrodes who had an episode of postictal psychosis. The patient died 4 weeks after temporal lobectomy of unknown reasons, despite complete postmortem examination and clinical evidence of postsurgery seizure control. Pathological examination of surgical and autopsy hippocampal specimens found bilateral asymmetric neuron losses. However, only the resected epileptogenic hippocampus showed the profile of neuron loss typical of mesial temporal sclerosis (MTS) and abnormal mossy fiber synaptic reorganization. Quantitative depth electroencephalographic (EEG) analysis of the postictal psychotic event showed that it was not associated with a cluster of seizures, increased postictal depth EEG spike activity, or insufficient antiepileptic medication. These results support the hypothesis that ipsilateral hippocampal epileptogenesis is associated with MTS and mossy fiber sprouting. The results also suggest that the etiology of postictal psychosis in this patient was initiated by an ictal event and the behavior apparently depended on seizure propagation outside the hippocampus. The relevance of these two findings to the literature is discussed.

Adult↗

PubMed2005

Long-term outcome after surgical treatment of temporal lobe epilepsy in children.

OBJECT: Surgery is an accepted treatment for carefully selected patients with focal epilepsy. In the present study, the authors assessed clinical and surgery-related data obtained in a large series of children suffering from intractable temporal lobe epilepsy (TLE). METHODS: Etiological, pathological, and clinical features of possible prognostic significance were studied in 109 children who underwent surgery for TLE at the Montreal Neurological Institute and Hospital and the Montreal Children's Hospital between 1985 and 2000. The mean age of patients at seizure onset was 5.5 years and the duration of epilepsy ranged from 0.1 to 17.6 years. Preoperative magnetic resonance imaging revealed mesial sclerosis in 51 patients, a mass lesion in 45, and no visible abnormalities in 12. In six patients invasive monitoring was required. Cortical amygdalohippocampectomy was performed in 72% of patients, whereas 20% underwent transcortical selective amygdalohippocampectomy. In 23 patients a second surgical intervention was necessary. Low-grade tumors were found in 35% and mesial sclerosis was confirmed on pathological evaluation in 45%. Outcome was excellent (seizure free or > 90% reduction) in 94 patients (86%). The patients were followed prospectively for a median of 10.9 years (range 5-20.2 years). There were no permanent neurological complications and no deaths. CONCLUSIONS: Successful postsurgical outcomes, especially in patients treated for mesial temporal lobe sclerosis and lesion-related epilepsies, can be obtained in pediatric patients suffering minimal complications. Unfavorable outcomes are most likely to occur when epileptiform discharges are bitemporal or multifocal in distribution and in cases involving incomplete resection of mesiotemporal structures.

Adolescent↗

PubMed1992

Dissociations among memory measures in memory-impaired subjects: evidence for a processing account of memory.

Deficits in conceptual transfer on both implicit and explicit memory tests were obtained for memory-impaired temporal lobe epileptic (TLE) subjects in three studies. In Experiment 1, in which a generate-read paradigm was employed, memory-impaired TLEs failed to show normal generation effects on conceptually driven tests of semantic cued recall and general knowledge questions, although their data-driven memory as measured by word-fragment completion and graphemic cued recall tasks was normal. In Experiment 2, memory-impaired patients having left temporal lobe seizure foci were tested on these four tasks and compared with nonimpaired TLEs having right temporal foci. The left TLEs showed deficits on conceptually driven tasks and normal memory for data-driven tests. These findings were extended in Experiment 3, in which left TLE patients failed to show any benefit from blocked study, as compared with random study, on category production and semantic cued-recall tests, although right TLEs and normal controls showed blocking effects on both tasks. These findings may be accommodated by a processing framework of memory in which memory-impaired patients are characterized as having deficits in conceptual, but not in data-driven, processing capabilities.

Adult↗

PubMed1999

[New methods for evaluation of memory in temporal lobe epilepsy: a functional imaging approach].

Temporal lobe epilepsy (TLE) is usually associated with a specific impairment of memory functions. A reliable assessment of memory function seems therefore a crucial element of the presurgical evaluation for surgery epilepsy, especially for temporal lobectomy. To date, intracarotid amobarbital testing remains the gold standard to evaluate memory before planning surgery in patients with refractory TLE. Functional imaging, either positron emission tomography or functional MRI, holds great promise as a powerful tool in memory evaluation. Preliminary studies, essentially in healthy volunteers, have shown promising results. In the future, functional imaging, combined with other techniques, will certainly contribute to the clinical presurgical evaluation of patients with epilepsy.

Epilepsy, Temporal Lobe↗

PubMed2000

Effect of anticonvulsants on nocturnal sleep in epilepsy.

Our objective was to determine, in three separate studies, the effects of controlled-release carbamazepine (CBZ-CR), lamotrigine (LTG), and gabapentin (GBP) on nocturnal sleep in epilepsy. Antiepileptic drugs (AEDs) control seizures and also modify hypnic structure. Despite widespread clinical use, their effects on sleep are not well known. PSG was performed in all three studies as follows: CBZ-CR: at baseline, after initial administration of CBZ-CR 400 mg, and after 1 month of CBZ-CR treatment (400 mg BID) in a sample of seven temporal lobe epileptic (TLE) patients. Results were compared with those of nine healthy volunteers; LTG: at baseline, after 3 months of stable treatment with LTG (300 mg/day); GBP: at baseline, after 3 months of stable treatment with GBP (1800 mg/day). Significant findings are as follows for each study. The acute administration of CBZ-CR increased number of stage shifts, reduced REM sleep, and increased REM sleep fragmentation. In the TLE group, these effects were almost completely reversed after chronic treatment. LTG increased REM sleep, reduced number of entries into REM sleep, decreased number of phase shifts, and decreased percentage of slow-wave sleep. GBP increased REM sleep percentage, increased mean duration of REM periods, reduced number of awakenings, and reduced stage 1 sleep percentage. We conclude that CBZ-CR disrupts REM sleep, but only during acute administration. LTG and GBP improve sleep stability while reducing seizures.

Acetates↗

PubMed2000

Structure and function of the Groucho gene family and encoded transcriptional corepressor proteins from human, mouse, rat, Xenopus, Drosophila and nematode.

A gene family of the Groucho, TLE, ESG and AES proteins has been characterized from Drosophila, nematode, Xenopus, mouse, rat and human, and their structural relationships have been analyzed. The genomic organization of nematode ESG, human and mouse AES genes has been determined, and the expression of ESG and AES genes from Xenopus and human has been analyzed. The Groucho, TLE and ESG proteins all share a similar structure, consisting of a conserved amino-terminal domain, a variable middle region, and highly conserved carboxyl-terminal WD-40 repeats. The Drosophila Groucho transcriptional corepressor protein has been shown to interact with the DNA-binding bHLH domain of Enhancer of split, Hairy and Deadpan proteins, which proteins are involved in neurogenesis, segmentation and sex-determination, respectively. Human TLE1 protein has been demonstrated to interact with mammalian AML1 protein, which regulates hematopoiesis and osteoblast differentiation. The AES proteins from human, mouse, rat and Xenopus exhibit strong similarity to the amino-terminal domain of Groucho proteins; however, the biological function remains to be elucidated.

Amino Acid Sequence↗

PubMed1999

Psychosocial functioning in chronic epilepsy: relation to hippocampal volume and histopathological findings.

MRI volumetric measurements of the ipsi- and contralateral hippocampal volume (HV) were performed in a group of 37 patients with lesional and non-lesional temporal (TLE), and extratemporal lobe (ETLE) lobe epilepsy. Twenty-six patients underwent surgery and the resected tissues subjected to histopathological examination. Psychosocial scores were calculated on the basis of employment, partnership/family status and presence of a positive psychiatric history. Poorest values were obtained for the group with right lesional and non-lesional TLE (RTLE, p < 0.001). In this group, significant positive correlations between psychosocial functioning and the left hippocampal volume or age of onset were observed. We found that the left hippocampal volume in RTLE was smaller with increasing epilepsy duration. We conclude that patients with RTLE represent a particular group with regard to the structural and psychosocial consequences of chronic epilepsy. With regard to histopathological analysis, no particular type of lesion was identified as the major determinant of the results described above.

Adult↗

PubMed2002

Jerky, a protein deficient in a mouse epilepsy model, is associated with translationally inactive mRNA in neurons.

Temporal lobe epilepsy (TLE) is a common seizure disorder, but the underlying molecular mechanisms are unknown. We reported previously that inactivation of the jerky gene in mice causes recurrent limbic seizures highly similar to TLE. Electrophysiological studies showed abnormal firing in hippocampal neurons in these mice, but it is not known how a deficiency in the Jerky protein leads to neuronal hyperexcitability. Here we show that Jerky is a brain-specific protein with a high expression level in neurons. Jerky binds mRNAs with high affinity, and it is a component of messenger ribonucleoprotein complexes in vivo. However, Jerky is not associated with ribosomes and actively translating mRNAs. These data suggest that Jerky may regulate mRNA use in neurons, and its deficiency could lead to perturbations in the regulated use of preexisting mRNAs.

Animals↗

PubMed2002

Tumid lupus erythematosus.

Tumid lupus erythematosus (TLE) is a variant of cutaneous lupus erythematosus. Most patients who present with these skin lesions are young women. The condition clinically resembles polymorphous light eruption, systemic lupus erythematosus (SLE), reticulated erythematous mucinosis, or gyrate erythema. Histopathologically, the lesions resemble classic lupus erythematosus because of their superficial and deep lymphohistiocytic inflammatory infiltrates and dermal mucin. However, unlike classic lupus erythematosus, there is little or no epidermal or dermo-epidermal involvement. Antinuclear antibody test results are usually negative. We describe 4 cases of TLE and discuss the differential diagnosis.

Adult↗

PubMedDate not supplied

[In vivo and in vitro neurophysiological features of epilepsy].

INTRODUCTION: Some electrophysiological aspects of the interictal activity in temporal lobe epilepsy (TLE) are under debate. However, surgery is often guided by both, pre and intra operative recordings of interictal activity. Some of these studies include intraoperative electrocorticography (ECoG) that guide tailored resection. OBJECTIVE: To analyze several aspects of interictal activity recorded by ECoG and to explore its electrophysiological basis in vitro. PATIENTS AND METHODS: ECoGs from thirteen patients suffering drug resistant TLE were analyzed. Both linear and non linear methods were introduced to explore the ECoG signals. In two cases, neocortical tissue was also electrophysiologically studied in vitro. RESULTS: Interictal ECoG activity showed a mesial origin, a cortical origin or a mixed mesial/temporal origin. Both in cortical and mesial/cortical origin, cortical interictal ECoG signals are characterized by spatiotemporal clusters of activity. In vitro study of cortical tissue from these clusters showed alterations in the synaptic control of excitability. CONCLUSION: Our results suggest an electrophysiological basis of interictal activity. Combination of linear and non linear methods is a very useful tool to explore on line the interictal ECoG activity during surgery.

6-Cyano-7-nitroquinoxaline-2,3-dione↗

PubMed2002

Memory for famous people in patients with unilateral temporal lobe epilepsy and excisions.

Memory for famous individuals was assessed by the use of a recognition test in which participants first made familiarity judgments, followed by forced-choice decisions to specific probes for identity. Patients with temporal lobe epilepsy (TLE) or excisions, 12 left hemisphere and 12 right hemisphere, and 18 control participants identified famous figures across 3 decades (1970s-1990s). Only patients with right TLE were impaired at familiarity judgments of faces; this deficit was evident only for the most recent decades. Both groups of patients, however, were impaired at naming famous faces and at providing semantic information about famous people. These findings suggest the integrity of temporal structures in both hemispheres is critical for retrieval of detailed semantic information about famous individuals.

Adult↗

PubMed2002

Epilepsy and neuroprotection: an illustrated review.

Multiple types of insults, such as status epilepticus, hypoxia and trauma, may alter the central nervous system. Strategies to protect the brain against insults remain a very difficult and challenging problem. Damage to the central nervous system can be modulated via excessive excitatory and reduced inhibitory neurotransmission. In addition, increased sodium and calcium loading through impaired voltage-sensitive channels, as well as alterations in the acid-base balance can contribute to both excitotoxic and apoptotic cell death. Epilepsy treatment has always been related to neuroprotection, since it aims to reduce the duration or totally suppress seizures. Although the debate on the capacity of simple seizures to induce neuronal injury is still ongoing, no doubt persists on the disastrous effects of prolonged episodes of status. The next step would be to prevent epilepsy. Several animal models have been used to study the various aspects of the epileptogenic process. In humans, one of the most compelling examples of a series of epileptogenic events is temporal lobe epilepsy (TLE). Temporal lobe epilepsy is often attributed to prolonged febrile convulsions in childhood resulting in mesial temporal sclerosis. However, the relationship between TLE, seizures in childhood and hippocampal sclerosis may not be apparent as initially believed. Furthermore, it is well recognized that in a number of patients there is a delay from a specific insult to the onset of seizures. This "latent period" could be an opportunity for effective intervention, provided that the underlying mechanisms are understood and that appropriate means for a beneficial modification of the disease process become available. The present review discusses the various steps of temporal lobe epilepsy and provides illustrations of the various mechanisms implicated in neuronal death. Data from animal models is also presented and illustrated with video sequences. Finally, on the basis of what is known on mechanisms of action of available antiepileptic drugs, some suggestions are put forward. Basic science and research are guided by clinical queries and from ongoing dialogue. The present illustrated review deals with only a small part of the important amount of work related to epilepsy and neuroprotection. As such it is necessarily schematic or even simplistic. The review is designed to inform clinicians about the basic issues related to the subject, thus allowing them to follow the ongoing debate and participate with pertinent questions. (Published with video sequences).

Animals↗