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PubMed2003

Epileptiform synchronization in the human dysplastic cortex.

Taylor's focal cortical dysplasia corresponds to a localized disruption of the normal cortical lamination with an excess of large, aberrant cells. Sustained epileptic discharges originate from the dysplastic neocortex and this tissue retains sufficient connectivity for expressing seizure abnormalities. In this brief review, we summarize the findings obtained by analyzing surgically-resected human tissue with focal cortical dysplasia that was maintained in vitro in a brain slice preparation. These data have been compared with those obtained from human cortex with normal structural organization; such tissue was available from patients undergoing surgery for a variety of neurological disorders, most often for mesial temporal lobe epilepsy. These studies have shown that: (i). slices obtained from focal cortical dysplastic tissue have an intrinsic ability to generate ictal-like epileptiform events when challenged with the convulsant drug 4-aminopyridine; (ii). 4-aminopyridine-induced ictal discharges are not seen in neocortical slices obtained from neocortical samples with no or minimal structural lesion; (iii). these ictal discharges are caused by the activation of excitatory amino acid receptors, and in particular those of the N-methyl-D aspartate type; (iv). focal cortical dysplastic tissue also generates synchronous potentials that are mainly contributed by GABA(A) receptor-mediated conductances.

4-Aminopyridine↗

PubMed1992

[A case of intracerebral epidermoid associated with aspergillosis].

A case of intracerebral epidermoid associated with aspergillosis, which spread from the middle ear to the left temporal lobe, is reported. A 58-year-old woman was admitted on 6 June 1988, complaining of left temporalgia and motor aphasia. She had suffered from lt. chronic otitis media with cholesteatoma and had undergone a radical operation 11 years previously. CT scan revealed low density area with a mass effect in lt. temporal lobe. Bone image coronal CT scan revealed destruction of the roof of the pyramidal bone had resulted in communication between abscess cavity and external auditory meatus. On MRI scan lt. temporal lobe showed low signal intensity on T1WI, and high signal intensity on T2WI. In spite of strong antibiotic chemotherapy, mass effect on CT scan showed no sign of improvement. We performed total removal of the abscess on 15 July 1987. A number of characteristic aspergillus hyphae were recognized in the resected cyst. As the cyst wall consisted of keratinising squamous epithelium intermingled with granulation tissue, we had a diagnosis of epidermoid cyst. The diagnosis of epidermoid associated with aspergillosis was difficult. CT findings of epidermoid in general, show homogeneous low density without enhancement, but, in our case, CT scan showed heterogeneous low density area with capsular high dense. MRI of epidermoid usually shows a low signal intensity on T1WI, but our case showed iso-low signal intensity on T1WI. In spite of a poor prognosis of aspergillosis of the CNS, our patient has recovered well due to receiving prompt surgical treatment.

Aspergillosis↗

PubMed1989

[Clinical analysis of reoperation in cases of complex partial seizures].

Of a series of 526 cases of surgically treated refractory epilepsy, 387 cases were patients with complex partial seizures. Among 118 cases who had no improvement by the first operation, to prevent partial seizures, 20 patients underwent reoperation. Of the 20 patients, 12 (60%) were men. The mean age at the first operation was 21.7 years. A retrospective analysis of clinical findings, successive EEG findings, psychological studies, surgical findings and surgical treatment of these patients were made. Following the first operation, complex partial seizures reappeared within a mean period of 5.5 months. And the mean period from the first operation to the reoperation was 4.9 years. Following reoperations, 6 patients (30%) became seizure-free, 3 patients (15%) had a remarkable reduction of seizures and 7 patients (35%) had worthwhile improvement. But 4 patients (20%) had no improvement. Histopathological study of the resected hippocampus revealed gliosis in 16 patients (80%). The indication for and procedures of reoperation were discussed.

Adolescent↗

PubMed2004

[Place of surgery in the treatment of adult temporal lobe epilepsy].

Surgery for temporal lobe epilepsy has made significant progress during the past twenty years: in addition to traditional factors (frequency of partial seizures and relative resistance to medical treatment), the possibilities offered by MRI in a large number of cases to detect the responsible lesion (hippocampal sclerosis in the majority of cases) has led to an increase in the use of surgical methods. Furthermore, other examinations (EEG-video, SPECT Depth-electrode recording) now permit precise localization of the epileptic focus. Surgical techniques have likewise been considerably modified: in parallel to classical temporal lobectomy, new surgical methods offer more restricted resection of the lateral cortex. The results are, on the whole, quite satisfactory, as three-quarters of patients can be considered cured or greatly improved. The length of post-operative follow-up does not seem to influence the quality of the results, as observed by the end of the second year.

Electroencephalography↗

PubMed2002

The role of radiation in the treatment of advanced juvenile angiofibroma.

OBJECTIVES/HYPOTHESIS: To demonstrate the efficacy of external beam radiation therapy as a primary treatment modality for the management of patients with advanced juvenile nasopharyngeal angiofibroma (JNA). STUDY DESIGN: Retrospective chart review. METHODS: The medical records of 130 patients with the diagnosis of JNA seen at UCLA Medical Center over a 41-year period (1960-2000) were retrospectively reviewed. RESULTS: One hundred thirty cases of JNA have been seen at UCLA Medical Center from 1960 to 2000. One hundred two were treated with surgical resection, 1 refused therapy, and the remaining 27 received radiation (3000-5500 cGy) as their primary mode of treatment. Fifteen percent (4 of 27) of the irradiated patients developed recurrent tumor 2 to 5 years later. Long-term complications occurred in 4 patients (15%) and consisted of growth retardation, panhypopituitarism, temporal lobe necrosis, cataracts, and radiation keratopathy. CONCLUSIONS: External beam radiation therapy represents an effective mode of treatment for patients with advanced JNA. Although the latency period may be long, we think the likelihood of potentially fatal complications developing at the radiation dosages we recommend is less than the risk of significant morbidity and mortality associated with surgical intervention in these cases.

Angiofibroma↗

PubMedDate not supplied

Magnetic resonance imaging of intractable complex partial seizures: pathologic and electroencephalographic correlation.

Prior studies indicate variable usefulness of magnetic resonance imaging (MRI) in the evaluation of patients with complex partial seizures (CPS), but sensitivities as low as 12% have been reported. We analyzed the MRI examinations of 20 patients with medically refractory CPS who later underwent resection of the seizure focus proven by electroencephalography (EEG). MRI studies were correlated with surgical pathology in all patients. Eleven of the 20 CPS patients had mesial temporal sclerosis (MTS). Seven of the 11 (64%) exhibited an MRI abnormality at the site of the EEG-demonstrated histopathologic focus. MRI abnormalities included temporal lobe hypoplasia or atrophy (four patients), and increased signal intensity on long repetition time (TR) sequences (three patients). Four patients had no MRI abnormalities corresponding to the histopathologic focus. Nine of the 20 CPS patients had other abnormalities responsible for the seizures, including astrocytoma, cryptic vascular malformation, hamartoma, polymicrogyria, tuberous sclerosis (forme fruste), arachnoid cyst, and congenital hemiatrophy. No patient had normal MRI studies. Our single most useful MRI sequence was the coronal long TR/dual echo sequence, using cardiac gating and first-order gradient moment nulling to diminish flow-related artifacts that could hinder evaluation of medial temporal lobe structures.

Electroencephalography↗

PubMed2004

Successful management of post-tumor resection middle cerebral artery thrombosis with stent-assisted angioplasty and thrombolytic therapy: case report.

OBJECTIVE AND IMPORTANCE: To describe successful endoluminal revascularization of an acute M1 occlusion 4 days after craniotomy and tumor resection. CLINICAL PRESENTATION: A 16-year-old right-handed girl presented with a 1-month history of daily headaches. The neurological examination was normal. Magnetic resonance imaging and computed tomography demonstrated a mass consistent with an epidermoid tumor compressing the left upper pons, left cerebral peduncle, and mesial left temporal lobe. INTERVENTION: A combination of low-dose antiplatelet agents administered intra-arterially and stent-assisted angioplasty was used. Successful endoluminal revascularization was achieved. Acute complications such as intracranial stent-thrombosis and/or intracranial hemorrhage were successfully avoided. CONCLUSION: In the acute postoperative period, most current chemical thrombolytic protocols are contraindicated because of the prohibitive risk of iatrogenic intracranial hemorrhage. With an understanding of the pharmacokinetics of the currently available antiplatelet drugs, combined chemical and mechanical thrombolysis may be used in the acute postoperative setting for endoluminal recanalization.

Adolescent↗

PubMed2004

[Adenoid cystic carcinoma with striking intracranial extension: a case report].

We report a case of intracranial adenoid cystic carcinoma in the middle cranial fossa. A 40-year-old woman had noticed a tumor in the left external auditory canal 8 years previously. It was totally resected at that time. Histologically, the tumor was diagnosed as an adenoid cystic carcinoma. Recently the patient presented with loss of consciousness, suffering from mild recent-memory disturbance. Neurological examination revealed no other abnormalities. Magnetic resonance imaging (MRI) demonstrated an enhanced solid mass with a multicystic component in the left temporal lobe. She underwent subtotal removal of the tumor. It was well-demarcated, and was confirmed to be adhesive to the dura matter of the middle cranial fossa. Histology of the tumor was the same as it was 8 years ago. She was discharged from our hospital without neurological deficits. Two months after surgery, gamma knife radiosurgery was performed against the residual tumor.

Adult↗

PubMed2003

Preoperative construction of an extracranial arterial shunt for resection of an aortic arch aneurysm with occluded left carotid artery.

A 68-year-old man with aortic arch aneurysm was referred to our department. Preoperative carotid echography and magnetic resonance angiography revealed occlusion of the left internal carotid artery. Single-photon emission computed tomography scanning indicated that cerebral blood flow was decreased and reactivity to acetazolamide was reduced in the left temporal lobe. A successful superficial temporal artery-middle cerebral artery anastomosis was first made by neurosurgeons. A postoperative single-photon emission computed tomography scan showed that cerebral blood flow and reactivity to acetazolamide were remarkably improved. Two months after the anastomosis, the aortic arch aneurysm was successfully repaired.

Acetazolamide↗

PubMed2005

Lateralized ictal immobility of the upper limb in patients with temporal lobe epilepsy.

The primary aim of this study was to establish the incidence and the lateralizing value of 'lateralized ictal immobility of the upper limb' (LIL) in patients suffering from temporal lobe epilepsy (TLE), and to describe the connection between LIL and other clinical ictal signs. We retrospectively reviewed video records of 87 patients with TLE. We reviewed a total of 276 focal epileptic seizures with or without secondary generalization. We studied the incidence of LIL, its lateralizing value, and its relationship to other ictal clinical signs. Of the 87 patients, 49 had undergone a successful resective surgery at least 1 year prior to the study. LIL is a late sign in the course of partial seizure. It occurred in 25 of our 87 patients (28.7%), and in 47 of 276 seizures (17.1%). In all of the evaluated seizures, LIL occurred contralateral to the side of seizure onset (P < 0.001). LIL was always associated with ipsilateral upper limb automatisms, and in 63.1% of the occurrences, it was immediately followed by ictal dystonia. LIL is a more accurate term to describe what has previously been called 'ictal paresis' in the literature. Due to the inability to execute proper testing during a partial seizure, it is better to use the term LIL when making a visual analysis of a seizure. LIL is a more suitable term to describe the studied ictal sign. It is a relatively frequent sign in patients with TLE. LIL has an excellent lateralizing value for the contralateral hemisphere. It is a negative motor sign, and its genesis is probably associated with the epileptic involvement of the contralateral frontal lobe.

Adolescent↗

PubMed1998

Surgical outcome in occipital lobe epilepsy: implications for pathophysiology.

Medically refractory occipital lobe epilepsies are increasingly treated with surgery, but outcome and its relationship to etiology, pathological substrate, occipital lobe location, surgical approach, and electroclinical features have not been systematically investigated in a substantial group of patients. Thirty-five patients who underwent surgery for intractable occipital lobe seizures were retrospectively evaluated. Outcome and occipital lobe location were analyzed with respect to surgical procedure, pathology, clinical seizure characteristics, seizure onset and termination locations, and localization of interictal spikes. Most patients had developmental abnormalities (14) or tumors (13, all gliomas). Developmental abnormalities consisted of focal cortical dysplasia (5), heterotopia (2), hamartoma (3), cortical duplication (1), polymicrogyria (1), Sturge-Weber syndrome (1), and tuberous sclerosis (1). There was 1 patient with a vascular abnormality, 1 with chronic inflammatory changes, 4 with gliosis, 1 with cerebral ossification, and 1 with normal pathology. Developmental abnormalities had significantly worse outcome (45% excellent/good) than tumors (85% excellent/good). In the developmental group, low-grade focal cortical dysplasias had better outcome than heterotopia and hamartoma regardless of type of surgical procedure. Pathological groups did not significantly differ with respect to location within the occipital lobe (overall medial [50%] or lateral [38%]); clinical seizure characteristics referable to specific lobe (occipital [14%], temporal [34%], frontal [23%], more than one type [29%]); electroencephalographic localization (to occipital [17%], temporal [27%], or other/multifocal locations [56%]); or intracranial ictal onset or termination location. Electroclinical variables were also unrelated to the occipital lobe location of abnormality. Surgical outcome was not predicted by surgical approach (lesion excision with margins or lobectomy). The main pathological substrates of uncontrolled occipital lobe epilepsy are gliomas and developmental abnormalities. Whereas resection of occipital lobe tumors associated with chronic epilepsy produces nearly uniform seizure control, outcome after resection of occipital lobe developmental abnormalities is less uniform.

Adolescent↗

PubMed1997

Dipole modelling and intracranial EEG recording: correlation between dipole and ictal onset zone.

This study includes 11 patients (3 males, 8 females) with mean age of 29 years (range: 15-42 years) who underwent a presurgical evaluation for refractory complex partial seizures (CPS). In all patients, neuroimaging (1.5 T optimum-MR) demonstrated intracranial structural abnormalities (space-occupying: n = 2; atrophic: n = 8; dysplastic: n = 1) and video-EEG monitoring showed CPS, because of discrepancies in the non-invasive examinations, all underwent additional intracranial EEG monitoring. After tailored resective procedures, all but one patient became seizure free. Mean follow-up was 30 months (range: 12-52 months). Results of intracranial EEG recording were compared with spatiotemporal dipole mapping of interictal and ictal epileptic discharges. Interictal dipole modelling revealed two distinct dipole patterns. Patients with lesions located in the medial temporal lobe uniformly presented a combined dipole that consisted of a radial and a tangential component with a high degree of elevation relative to the axial plane. Patients with extrahippocampal lesions had a less stable dipole with a predominant radial component. Dipole modelling of early ictal discharges revealed a striking correspondence with the interictal findings in individual patients. Elevation of ictal dipoles was always congruent with localisation based on intracranial EEG recordings. Interictal and ictal dipole mapping of medial temporal lobe sources may limit the number of surgical candidates for refractory CPS that need intracranial EEG recording. Whether ictal dipole modelling can be equally useful in extratemporal epilepsy remains to be proven.

Adolescent↗

PubMed1978

Complex partial status epilepticus: case report and proposal for diagnostic criteria.

A child had complex partial status epilepticus after resection of a craniopharyngioma. The status epilepticus was manifested by confusion and documented electroencephalographically by continuous focal seizure patterns in the right temporal region. Complex partial status epilepticus is an electroclinical syndrome of prolonged or repetitive complex partial seizures (with continuous interictal confusion) accompanied by electroencephalographic seizure patterns, which are either focal (usually temporal lobe) or secondarily generalized from a focal pacemaker.

Child, Preschool↗

PubMed2001

Psychiatric disorders before and after surgery for epilepsy.

PURPOSE: To examine the frequency of psychiatric disorders before and after surgery for epilepsy and the postoperative changes. METHODS: We examined the psychiatric status of 226 patients aged 18 years or older and with IQ >50 who underwent focal resection surgery after age 15 years at our center and were followed up for >2 years after surgery. RESULTS: Seventy-eight (34.5%) patients had psychiatric disorders before and/or after surgery, comprising 36 patients with psychosis, 15 with affective disorders, and 27 with neurotic/behavioral disorders. All but four of these patients had temporal lobe epilepsy. Of the 61 patients who had psychiatric disorders before surgery, 22 patients were free of psychiatric symptoms after surgery (eight with psychosis, 13 with neurotic/behavior disorders, one with affective disorders), and 39 patients continued having psychiatric symptoms after surgery (22 with psychosis, 12 with neurotic/behavior disorders, five with affective disorders). Nine patients had a transient affective disorder that appeared 1-2 months after surgery and disappeared within 1-2 months. In eight patients, chronic psychiatric symptoms manifested after surgery (psychosis in six cases, neurotic/behavior disorders in two), one of whom exhibited postictal psychosis after drug noncompliance. Psychosis that disappeared after surgery was often seizure related. The patients with aggravated psychiatric conditions after surgery had a lower age at epilepsy onset and at surgery, and exhibited deviated personality traits even before surgery. CONCLUSIONS: One third of the surgical patients had psychiatric disorders before and/or after surgery. Preexisting psychiatric problems disappeared after surgery in one third of the patients, but persisted after surgery in the remaining patients, with aggravation in a few. Transient affective disorders appeared in some patients immediately after surgery, and chronic psychiatric disorders appeared after surgery in a minority of patients. The patients having aggravated psychiatric conditions after surgery tended to be young and to have deviated personality traits. The social situation of the patients having psychiatric disorders after surgery was not good.

Adolescent↗

PubMed2005

Changes in verbal and nonverbal memory following anterior temporal lobe surgery for refractory seizures: effects of sex and laterality.

We studied the effects on verbal and nonverbal memory of anterior temporal lobe (ATL) surgery for epilepsy in 91 patients (46 men, 45 women), all of whom had left-hemisphere dominance for speech. Patients were divided into four groups according to sex and laterality of the excision. The memory tasks were administered shortly before surgery, 6 months postoperatively, and at a 2-year follow-up. Test scores were submitted to repeated-measures analyses of variance. We found that men treated with left temporal resection declined significantly in long-delay verbal memory after surgery, whereas no clear pre- to postoperative sex differences were found with respect to other verbal memory scores. Only the results on long-delay verbal memory confirm previous findings, showing a greater vulnerability of verbal memory to left ATL surgery in men than in women. Women with left temporal excisions obtained particularly poor scores on a long-delay nonverbal memory test preoperatively, but improved their performance on this test significantly after surgery. The seemingly gradual improvement during the 2-year follow-up suggests a plastic process.

Adult↗

PubMed1992

Temporal lobectomy for complex partial seizures that began in childhood.

Forty-six consecutive patients who underwent surgery for intractable temporal lobe seizures originating in childhood are reported; invasive preoperative monitoring (e.g., depth electrodes and subdural arrays) was not used in the selection process. Our results, with respect to the control of seizures and improvement in behavior, are comparable to those of series in which invasive monitoring was used in the selection process. Eighty-five percent of the 46 patients (96% of the 28 operated after the introduction of long-term electroencephalographic monitoring) became either seizure free or experienced near total control of their seizures. Our results indicate that many patients can be selected successfully for temporal resection without exposure to the risk and expense of invasive presurgical procedures. A long duration of epilepsy prior to surgery in patients with neoplasia portended a less satisfactory outcome. Our results strengthen the argument for early operation in children with intractable epilepsy.

Adaptation, Psychological↗

PubMed1979

Psychoses in drug-resistant temporal lobe epilepsy.

In the survey of 74 Danish patients with temporal lobe epilepsy who underwent temporal lobectomy, a total of 20 patients were psychotic. Nine of these became psychotic during the follow-up period, six of them after cessation of their epileptic seizures. There were 13 schizophrenia-like psychoses, six paranoid delusional and depressive psychoses, and one childhood psychosis. Operation was on the right side in 39 and on the left side in 35 patients. When the various psychotic groups were compared with each other or with the nonpsychotic patients, the side of operation was not found to be statistically important. The patients with psychoses were older at operation and showed a higher rate of focal lesions in the resected specimens. Although more psychotic patients were bright or normally gifted, and had achieved a higher standard of schooling than nonpsychotic patients, their social status after operation was inferior. Surgery had no effect on psychosis present preoperatively nor on its possible postoperative onset. The diagnosis of psychosis was not considered to be contraindication to temporal lobectomy.

Age Factors↗

PubMed1991

Tailoring of cortical excisions for frontal lobe epilepsy.

Follow-up data of 2 to 49 years' duration are presented on 257 patients with cortical excisions for non-tumoral frontal lobe epilepsy. Twenty-six percent have become and remained seizure free. Another 30% have had a marked reduction of seizure tendency. Thus a total of 56% have had a long term complete or marked reduction of seizure tendency after the cortical resection. The cortical resections were classified into 5 regional categories. Forty-seven percent of patients with anterior frontal resections were in the seizure free category, as were 35% of patients with excisions limited to the convexity cortex and 32% of patients with maximal or near maximal frontal lobectomy. Only 18% of patients with frontal parasaggital excisions were in the seizure free category, and 10% of the patients who had excision of frontal cortex plus limited excision of adjacent central and/or temporal cortex.

Adolescent↗