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PubMed1986

Surgical options for uncontrolled epilepsy.

Surgical management of refractory epilepsy has undergone many modifications since it was instituted for the treatment of post-traumatic seizures many decades ago. Localization of onset of all seizures to a single resectable area of brain by various noninvasive and invasive recording methods is a complicated and controversial area, but guidelines are available. Success is correlated with accurate location and complete resection of the focus. When this is accomplished, resective surgery for epilepsy can provide cure or over 95 per cent reduction in seizure frequency in 60 to 90 per cent of patients undergoing these procedures. Although most often applied to temporal lobe foci, resections may be done in any cerebral lobe in the dominant or nondominant hemisphere with appropriate modifications of the evaluation and surgical procedure. When patients have unlocalizable or unresectable foci, depending on their exact pattern of seizures, electrical abnormalities, and neurologic status, other procedures may be used for surgical control of seizures. These include hemispherectomy, corpus callosum section, or stereotaxic procedures. The risks of all evaluation and surgical approaches are well balanced by the benefits obtained in a large proportion of patients.

Cerebral Decortication↗
PubMed2002

Age-related changes of the nitric oxide system in the rat brain.

This work examines the age-related changes of the NO pathway in the central nervous system (CNS), analyzing nitric oxide synthase (NOS) isoform expression, the level of nitrotyrosine-modified proteins, and the NOS activity in the cerebral cortex, decorticated brain (basal ganglia, thalamus, hypothalamus, tegtum and tegmentum) and cerebellum of young, adult and aged rats. Our data demonstrate that the different NOS isoforms are not uniformly expressed across the CNS. In this sense, the nNOS and eNOS isoenzymes are expressed mainly in the cerebellum and decorticated brain, respectively, while the iNOS isoenzyme shows the highest level in cerebellum. Concerning age, in the cerebral cortex nNOS significantly increased its expression only in adult animals; meanwhile, in the cerebellum the eNOS expression decreased whereas iNOS increased in adult and aged rats. No age-related changes in any isoform were found in decorticated brain. NOS activity, determined by nitrate plus nitrite quantification, registered the highest levels in the cerebellum, where the significant increase detected with aging was probably related to iNOS activity. The number of nitrotyrosine-modified immunoreactive bands differed among regions; thus, the highest number was detected in the decorticated brain while the cerebellum showed the least number of bands. Finally, bulk protein nitration increased in cerebral cortex only in adult animal. No changes were found in the decorticated brain, and the decrease detected in the cerebellum of aged animals was not significant. According to these results, the NO pathway is differently modified with age in the three CNS regions analyzed.

Aging↗