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PubMed2000

[Surgical treatment of clinical syndromes of intractable epilepsy in developmental age].

According to a longterm cathamnestic investigation in a series of 2400 patients 80% had favorably responded to medication, 60% are seizure free and in 20% there was significant improvement. In further 20% any therapy has had failed. 200 children have been operated upon because of epilepsy resistant to pharmacological treatment. In 80 classical methods (hemispherectomies, lobectomies topectomies and disconnective techniques) have been performed. In further 120 cases nosologically verified symptomatic epilepsy associated with the leading symptom of untreatable fits due to aetiological lesions as neoplasms, scars, angiomas, cysts lesionectomies extended by focectomies have been performed.

Adolescent↗
PubMed2000

[Surgical treatment of symptomatic surgery in children using classical techniques versus extended lesion surgery and focal lesion surgery].

In a series of 2400 children 80% had favourablly responded to medication, 60% are seizure-free and in 20% there was significant improvement in further 20% any medication has failed. 200 children have been operated upon because of epilepsy resistant to pharmacological treatment., in 80 = 3% classical methods of removal of the epileptogenic substrate (lobectomies, hemisphereectomies, topectomies and disconnective techniques) have been applied. In 120 cases verified symptomatic epilepsy associated with the leading symptom of untreatable attacks due to aetiological lesions as benign neoplasms, scars, angiomas, cysts lesionectomies extended by focectomies have been performed (with a seizure result of 77.6%). The pathological substrate of the epileptic excitation area has been localized and tailored by repeated diagnostic associated bioelectrical and neuroradiological procedures (EEG, BEAM, SPECT, NMR) Since at least many years after the operation nearly 2/3 of the patients remain seizure-free our methods have proven themselves as a useful and noninvasive tool for the focus localization. The plasticity of the developing brain has resulted in a very impressively favourable outcome particularly in the seizure-free children as far as it concerns the intellectual level and social validation. On neurological testing there was no deterioration. On psychological and neurolinguistic exploration there was an evident improvement of gnostic orientation and quality of life; speech functions are fairly good for current and fluent communication.

Child↗
PubMedDate not supplied

[Surgical treatment of spasmodic torticollis. Physiopathological considerations and follow-up of 20 cases (author's transl)].

The standard surgical procedures on either peripheral or central nervous system in the treatment of primary spasmodic torticollis are: myotomy, neurotomy, cervical rhizotomy, cortical topectomy, prefrontal lobotomy and a variety of stereotaxic nucleotomies and tractotomies (globus pallidus, thalamus, subthalamus, midbrain). These procedures are briefly reviewed. Some newly proposed operations are than discussed (Svien's labyrinthine suppression and Mazar's interruption of cortico-capsular head-turning pathways). The former surgical intervention is based on physiological and experimental evidence than an altered influence of the reticular substance of the midbrain on the "central" vestibular circuits may be relevant in the genesis of primary spasmodic torticollis. The results are reported of 20 personal cases treated with various surgical procedures with a maximum follow-up of 14.4 years (mean = 6.7 years). It is concluded that at present the most effective and reliable treatment is bilateral anterior rhizotomy of C1-C3 combined with unilateral or bilateral neurotomy (or spinal rhizotomy) of the 11th cranial nerve. The results were rated clinically as useful in 66.6% of the 15 patients treated with this procedure.

Adolescent↗
PubMed1953

What's new in cerebral palsy.

Among new researches bearing on cerebral palsy are the growth of brain cells in tissue cultures for experimentation; the use of polysaccharides to prevent the formation of a glial barrier to nerve growth after injury; observation of changes in reactions of neurons at various stages of development; the finding of hypernatremia and hyperchloremia in lesions of the frontal lobe and the thalamus; stimulation of cerebral blood flow by injection of sodium bicarbonate and retardation with ammonium chloride; and studies of serial sections of brains of palsied children who died. Study of development in the early months of life has made possible the detection of significant abnormalities in behavior early in life. Loss of hearing may be tested in very young children by measuring minute variations in electrical resistance of the skin upon auditory stimulation of the sympathetic nervous system. Conditions which have been described as having been confused with cerebral palsy are dislocation of a cervical vertebra, hereditary spastic paraplegia, transverse myelopathy, injury to the spinal cord or cauda equina by anomalous growths of the spine, and also encephalitis and meningitis. Sedation has proved a valuable adjunct to electroencephalographic study of cerebral palsy. Better criteria for abnormality in the young child should be determined and the application of them more clearly standardized. Simple exercises are useful for early training of palsied children to stimulate development. "Crossed laterality"-the dominant eye being contralateral to the preferred hand-has been counteracted by special training with great success in eliminating emotional and behavior problems and accelerating development.Recent studies indicate that only 50 per cent of cerebral palsy patients have normal or better intelligence. Subluxation of the hip joint, a common deformity associated with cerebral palsy, can sometimes be corrected by operation if detected at an early stage. Radical ablation of epileptogenic foci in the cortex is also being done in young patients if drug control of seizures fails. Frontal topectomy, cingulate gyrectomy or prefrontal labotomy may be advisable in cases in which proper response to drug therapy is not obtained. Improvement in behavior as well as control of seizures may follow the use of Benzedrine,(R) Dexedrine,(R) Dilantin(R) sodium, Mebaral(R) and phenobarbital. Alcohol, paraldehyde and chloral hydrate have been effective as relaxants.

Cerebral Palsy↗
PubMed1979

[Psychoses with painful manifestations].

Apart from pain related to nociception and pain due to sensory deafferentation, some patients complain repeatedly of some visceral, abdominal or peripheric type of pain, urging surgeons to perform iterative operations in spite of the lack of anatomical background: these patients often labelled as cenestopaths, can be included in the group of severe obsessional neurosis, pain being the main or unique obsessional symptom. Alike other compulsive symptoms of obsessional neurosis, prefrontal lobotomy, topectomy and best of all, prefrontal cryocorticectomy provide an excellent control of pain with little or no side effects.

Humans↗
PubMed1984

[Destruction of apical dendritic layers in penicillin-induced cortical epileptic focus].

It has been generally accepted that topectomy is a choice of treatment for patients who have an intractable cortical epileptic focus. However, the surgery is not indicated in the cases whose focus is functionally involved in the vital cortical regions. We have experienced a case of intractable traumatic cortical epilepsy, in which the patient underwent cortical surface coagulation on his motor cortex during the dissection of his wide-spread durocortical adhesion. Subsequently, his epileptic attacks have been abolished completely for over 7 years without motor deficit. It is the purpose of this work to confirm experimentally that destruction of apical dendrites on the epileptic focus may prevent occurrence of abnormal spike epileptic discharges without vital neuronal deficit. Fifty dogs were used in this study. In normal dogs, the antidromic cortical response, after stimulation of the internal capsule, showed three predominant negative waves axonal (the first), cortical neuronal (the second) and apical dendritic potentials (the third) by surface recordings. Upon creation of the penicillin-induced cortical epileptic focus, spike discharges appeared on the corticogram, and the third wave of the antidromic cortical response shifted from negative to positive. Selected destruction of the dendrites, in the first and the second cortical layers, in the area of the epileptic focus brought about disappearance of the third wave, to isopotentially, and a marked inhibition or complete disappearance of spikes on the corticograms. The possibility exists, as been suggested by our experiment, to clinically apply this method as a treatment for intractable cortical epilepsy with foci in the functionally vital regions, although there are yet many problems to be solved.

Animals↗
PubMed1980

The surgical control of acute epileptic foci in the cat's cerebral cortex.

Topectomy is the treatment of choice for patients suffering from intractable focal epilepsy not responding to pharmacological treatment. A disadvantage of this method is the neurological deficit produced by excision of functional neurons. For this reason the excision of epileptic foci in vital cortical regions is avoided. Thus patients suffering from intractable focal epilepsy in the motor area do not, as yet, have a satisfactory medical or surgical solution to their problem. The purpose of this work is to suggest a different surgical approach on the basis of new data regarding vertical neural connections in the cortex that are vital to the maintenance of the epileptic foci. This possibility has been investigated so far only in acute animal experiments with the intention of applying this method next in chronic animal experiments and then, if successful, in human beings.

Animals↗
PubMed1996

Epilepsy surgery.

Surgical therapy of epilepsy, although still underutilized, is presently well accepted and performed world-wide with increasing frequency. In the last decade the following changes have been noticed: non-invasive pre-surgical evaluation is increasingly carried out in close collaboration with referring centres so that often no (or only a very short) hospitalization is necessary in highly specialized epilepsy centres for this purpose. Stereoelectro-encephalography (SEEG) is used less often in invasive evaluation while the subdural strip and grid electrode-techniques are used more often. There is a general trend for a more flexible and collaborative multidisciplinary and multi-method approach utilizing the whole spectrum of modern diagnostic facilities in a more patient-oriented and therefore more cost-effective way. The main objective of the pre-surgical evaluation is to determine the onset area of the patient's spontaneous habitual seizures. The primary epileptogenic zone is not necessarily synonymous with the so-called lesional zone, although in the great majority of patients they are related. In a small percentage of candidates for epilepsy surgery additional special examinations are necessary to prevent and/or predict the degree of post-operative deficits. At present selective Amytal tests are often used but these invasive procedures might be replaced in the future by functional PET and functional MR studies. Surgery in patients with epilepsy can be categorized into: (i) lesion-oriented surgery (lesionectomy sensu stricto), (ii) epilepsy-oriented lesional surgery, (iii) surgery for epilepsy sensu stricto. Surgery is performed with a 'curative (= causal)' or a 'palliative' intention. Furthermore surgery can be categorized into standardized epilepsy surgery (such as anterior temporal lobe resection, selective amygdalohippeocampectomy, anterior callosotomy); and individually tailored surgical interventions. It is obvious that also so-called standardized operations are tailored to some degree, usually based on pre-operative findings as well as on intraoperative corticography and/or other intra-operative neurophysiological tests (functional mapping). Individually tailored operations comprise smaller topectomies and larger resections. Surgery for temporal lobe epilepsy still prevails. For mesial temporal lobe epilepsy more selective operations, such as the selective amygdalohippocampectomy, are increasingly performed. Today the majority of patients suffering from this syndrome can be evaluated non-invasively (or 'semi-invasively' with the foramen ovale electrode technique) in combination with MRI (including volumetry of the hippocampus) and PET or SPECT. In general one has the impression that extratemporal resections without a lesion are performed less often. But, if a morphological abnormality is present, pre-surgical evaluation (using grids), and surgery making use of 'functional mapping' are increasingly offered from more and more centres. Anterior callosal sections and functional hemispherectomies have also witnessed a renaissance. The most important standardized operations are reviewed.

Amygdala↗