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Brain SPECT imaging in temporal lobe epilepsy.

Temporal lobe epilepsy is diagnosed by clinical symptoms and signs and by localization of an epileptogenic focus. A brain SPECT study of two patients with temporal lobe epilepsy, using 99mTc-HMPAO, was used to demonstrate a perfusion abnormality in the temporal lobe, while brain CT and MRI were non-contributory. The electroencephalogram, though abnormal, did not localize the diseased area. The potential role of the SPECT study in diagnosis and localization of temporal lobe epilepsy is discussed.

Adult

Gamma-aminobutyric acid uptake is decreased in the hippocampus in a genetic model of human temporal lobe epilepsy.

Temporal lobe epilepsy (TLE) is one of the most commonly occurring and most intractable forms of seizure disorders in humans. The fundamental mechanisms underlying the pathogenesis of the disorder have, however, not yet been elucidated. El is an inbred mouse strain with genetic predisposition to epileptic seizures. The El mouse epilepsy shares its main features with TLE in humans and is considered to be an excellent model of the latter. We report a marked decrease in the uptake of gamma-aminobutyric acid (GABA) in the hippocampus of El mice. The data favor the involvement of GABA and the hippocampus in the mechanisms of TLE and suggest a genetic basis for the altered GABA uptake. This is the first report suggesting the possibility of a hereditary defect of a neurotransmitter function in TLE.

Animals

Self-report of memory function in patients with temporal lobe epilepsy and temporal lobectomy.

Thirty-one surgical candidates with a unilateral temporal lobe seizure focus, 72 temporal lobectomy patients, 63 non-epileptic controls and their relatives, respectively, filled in the Memory Observation Questionnaire. The two patient groups rated their current memory similarly, but significantly worse than controls rated their own memory. Memory status was judged to be improved approximately three years after a temporal lobectomy. The relatives' ratings agreed with those of the patients. Thus patients who underwent surgical resection for relief of temporal lobe epilepsy did not report further subjective deterioration in memory compared to pre-operative cases. Laterality of excision did not affect self-report of general memory function. Nevertheless, a brief Verbal memory subscale yielded the expected material specific pattern after unilateral temporal lobectomy.

Adult

Altered distribution of excitatory amino acid receptors in temporal lobe epilepsy.

In temporal lobe epilepsy, excitatory amino acid receptors in the hippocampus and temporal lobe may contribute to both increased excitability and vulnerability to excitotoxic damage. We used receptor autoradiography to examine the density of N-methyl-D-aspartate (NMDA) and kainic acid (KA) receptors in the hippocampus and parahippocampal gyrus obtained from five patients who had undergone anterior temporal lobectomy for the treatment of intractable seizures and from six control individuals, in which the hippocampus was obtained postmortem. Within the hippocampal formation, loss of [3H]KA and NMDA-sensitive L-[3H]glutamate binding was apparent in the sclerotic regions CA3, hilus, and CA1. In the subiculum and molecular layer of the denate gyrus, binding densities were maintained or even increased in some of the epileptic patients. A two-fold increase in L-[3H]glutamate binding, along with an increase in [3H]KA binding, was observed in the parahippocampal gyrus obtained from the epileptic patients. The results suggest that the vulnerability of the hippocampus in temporal lobe epilepsy may result, at least in part, from the presence of aberrant excitatory circuits in the parahippocampal gyrus.

Adult

Outcome of surgery in 40 children with temporal-lobe epilepsy.

Temporal-lobe epilepsy commonly has its origins in childhood, particularly when the lesion involved is mesial temporal (Ammon's horn) Sclerosis. Evidence suggests that this lesion is probably a common cause of chronic epilepsy in adults and that often it is probably the result of a severe febrile convulsion in infancy. 40 children, fifteen years of age and younger, who had an anterior temporal lobectomy were followed up for one to twenty-four years. The findings confirm those already established in adults, that the best results of surgery, not only in seizure relief but also in behaviour, are obtained when mesial temporal sclerosis is the lesion found at operation, and also indicate that a severe febrile convulsion in infancy is often the chief provocative factor in the development of epilepsy.

Adaptation, Psychological

MRI in the presurgical evaluation of patients with frontal lobe epilepsy and children with temporal lobe epilepsy: pathologic correlation and prognostic importance.

We performed magnetic resonance imaging (MRI) using a high-field strength magnet (1.5 T) in two series of 53 patients with intractable partial epilepsy of frontal lobe or temporal lobe origin who subsequently received ablative surgery for their seizure disorder. In the first series of patients the pathologic correlation and prognostic importance of an MRI-identified lesion in the frontal lobe were assessed. Twenty-five percent of the patients with negative MRI studies and 67% of patients with neuroimaging abnormalities restricted to the frontal lobe, were seizure-free at a minimum duration of follow-up of 1 year. None of the patients with a multilobar MRI-detected abnormality was seizure-free postoperatively. In the second study the sensitivity and specificity of MRI-based hippocampal volumetry was determined in pediatric patients with partial epilepsy of temporal lobe origin unrelated to foreign-tissue pathology. Hippocampal formation atrophy in the epileptic temporal lobe was identified in 63% of patients. The sensitivity and specificity of hippocampal volumetry was 100% in patients with mesial temporal sclerosis. The presence of an MRI-detected epileptogenic lesion in the frontal lobe and hippocampal formation atrophy in the temporal lobe may correlate with the underlying pathology and affect the identification of potential candidates for epilepsy surgery.

Adolescent

Endocrine abnormalities in human temporal lobe epilepsy.

Patients with temporal lobe epilepsy secrete ACTH at higher rates and in greater amounts than normal subjects. Temporal lobectomy restores ACTH secretion to normal amounts and rates. The ACTH secretion in temporal lobe epilepsy is independent of anticonvulsant drug effect and seizure frequency. Electrical stimulation of medial temporal lobe structures in patients with temporal lobe epilepsy affected ACTH secretion in a manner consistent with the hypothesis that ACTH secretion is regulated by tonic inhibition. A defect in the excitatory and/or inhibitory components of this regulatory process appears to exist in temporal lobe epilepsy.

Adrenocorticotropic Hormone

The measurement of emotional concepts in patients with temporal lobe epilepsy.

Eleven temporal lobe epileptics, implanted with depth electrodes, 21 post-lobectomy epileptics, and 24 orthopedic controls were given a semantic differential test, which measured responses along 4 scales (evaluative, potency, activity, and danger) of 18 emotional and 1 non-emotional concepts. Results showed that post-lobectomy females thought of themselves as more dangerous than did orthopedic control females. Both post-lobectomy and implantation patients found the anger-hostility and fear-anxiety concepts less bad, potent, active, and dangerous than did the orthopedic controls. The post-lobectomy and implantation patients found the concept "sexual intercourse" and other non-sexual love-related concepts to be worse and more dangerous, but less potent and active than did the orthopedic controls.

Adolescent

Reproductive function in temporal lobe epilepsy: the effect of temporal lobectomy.

We have examined sexual and reproductive changes in 25 patients (11 men and 14 women; mean follow-up 13 years) with temporal lobe epilepsy who underwent temporal lobectomy. Five men and two women had sexual dysfunction preoperatively, in particular, decreased libido. This improved after temporal lobectomy in three of these patients. One woman developed a partial Klüver-Bucy syndrome. Reproductive dysfunction was present in one man (oligospermia) and in ten women (four had the onset of seizures either at pregnancy or menarche; four had increased frequency of seizures during menarche or pregnancy, and two had amenorrhea). The man fathered two children post-operatively, and an appreciable improvement in both the seizure activity and the reproductive dysfunction was noted in the majority of the women.

Adolescent

Clinical aspects of temporal lobe epilepsy--a review.

Temporal lobe epilepsy appears to be of increasing concern to psychiatrists, pediatricians and lawyers as an explanation for some aspects of behavior. There is a high incidence of structural abnormality associated with temporal lobe epilepsy, the most common being mesial temporal sclerosis. Depth electrode studies have shown that the most common focus for the clinical seizure is in the hippocampus or hippocampal gyrus. The first line of treatment continues to be attempt at control with anticonvulsant agents. Surgical treatment can be offered, in many instances, when drug therapy has failed.

Age Factors

Autonomic responsiveness to affective visual stimulation in temporal lobe epilepsy.

Patients with temporal lobe epilepsy (TLE) have been posited by some to manifest a syndrome of interictal personality and behavioral change. Furthermore, this syndrome has been attributed to an underlying mechanism--enhanced affective responsiveness. The purpose of this investigation was to determine whether patients with TLE manifest increased emotional responsiveness relative to appropriate controls. Patients with TLE (n = 23) were compared with non-TLE (n = 7) and healthy controls (n = 16) as to their autonomic nervous system responsiveness to an emotionally stressing film. No differences were found among the groups. These results are related to the larger literature concerning epilepsy and psychopathology.

Adult

Hyperprolactinemia and temporal lobe epilepsy in a woman: concomitant and persistent prolactin suppression and temporal lobe epilepsy relief.

It has been reported that hyperprolactinemia may be associated with increased temporal lobe activity. Coexisting hyperprolactinemia (97.5 +/- 3.2 ng/ml) related to a pituitary tumefaction (8 mm) and Temporal Lobe Epilepsy (TLE), were observed in a 37-year-old woman. Carbamazepin (CBZ) therapy induced a marked improvement in TLE symptoms and EEG recordings, but did not influence hyperprolactinemia and related symptoms. Long-lasting (27 months) normoprolactinemia (19.4 +/- 0.6 ng/ml) and TLE relief were achieved on a dopamine (DA) agonist medication, e.g. pergolide mesylate, 25-50 micrograms/day given over 8 months, and persisted as long as 27 months after drug withdrawal. Posttreatment CT scans showed progressive shrinkage of the pituitary tumor (2 mm) associated with an empty-sella. It is proposed that, whenever TLE and hyperprolactinemia coexist, therapy with a DA agonist such as pergolide mesylate, resulting in normoprolactinemia, may be beneficial in TLE control.

Adult

The radiologic investigation of temporal lobe epilepsy. Value of high resolution CT with temporal orientated sections.

The value of high resolution computed tomography of the temporal lobes using temporal lobe orientated sections and intrathecal contrast is described. The results of this technique are correlated with the pathologic findings in 13 patients subsequently proven to have temporal lobe gliomas. These patients all presented with drug resistant temporal lobe epilepsy and underwent temporal lobectomy. This technique was successful in detecting the tumours in 11 of 13 patients. The average size of the tumours was just over 2 cm. The importance of detecting these small tumours is emphasised because of the profound effect this has on management.

Brain