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[The inscisural porencephaly of the temporal lobe and the "temporal lobe agenesis syndrome" (author's transl)].

Clinical, radiological and pathomorphological investigations on five cases offering the patterns of the so-called temporal lobe agenesis syndrome (Robinson) have shown that this is not always originally malformative, but may be due to vascular processes in the sense of porencephalic defects, with all their pathomorphological features. We think that compression of the vein of Rosenthal by inscisural hippocampal herniation is the most probable aetiological mechanism. Earle, Baldwin and Penfield also described large temporal defects in connexion with their impressive demonstration of the inscisural herniation of the hippocampal gyrus at birth. We propose to use the name of--inscisural porencephaly--for this state.

Adolescent

Temporal lobe epilepsy and neuropathology. Histological findings in resected temporal lobes correlated to surgical results and clinical aspects.

Neuropathological findings were studied in 74 patients with drug-resistant temporal lobe epilepsy who underwent unilateral temporal lobe resection in 1960-1969 in Denmark. In 60 per cent of the patients a well-defined neuropathological abnormality was revealed (i.e. 13 cases of focal lesions, including four small tumours, 21 cases of gliosis, and 10 cases of perivascular infiltration), in 23 per cent the findings were either questionably abnormal or without structural abnormality, while in the last 18 per cent sequelae of a previous operation dominated the histology. The general trend was for the postoperative clinical outcome to be better, the more specific and circumscribed the histological abnormality. There was no correlation between the neuropathological findings and the preoperative types of seizures. Postoperative recurrence of seizures was more often observed in patients with gliosis than in those with other histological diagnoses. A positive correlation existed between a history of cerebral infection and the presence of perivascular lymphocytic and histiocytic infiltration, and gliosis was a frequent finding in patients with epilepsy of unknown aetiology. No other significant correlation was found between the neuropathological abnormalities and the clinical, hereditary, aetiological, and social aspects.

Adolescent

Temporal lobe epilepsy. Follow-up investigation of 74 temporal lobe resected patients.

This survey covers 74 patients with temporal lobe epilepsy, resistant to medication, who underwent unilateral temporal lobectomy during the years 1960-1969 at Rigshospitalet, Copenhagen. Preoperatively all patients were socially incapacitated. In all patients a unilateral or predominantly unilateral temporal EEG focus was found. No tumour or gross vascular malformation had been recognized before or during operation. At follow-up 45 patients were free from seizures. A further 15 had obtained a reduction in their seizure frequencies by at least 75%, while the remaining 10 survivors, only obtained a slight improvement or remained unchanged. There were four deaths. The operation also favourably influenced the psychiatric status, which was found closely related to relief from seizures. Prognostically favourable factors were: i) preoperative presence of a single type of seizure, ii) duration of epilepsy of less than four years, iii) operation in or before early adulthood, iv) an anterior temporal or sphenoidal electrode focus, or both, on the EEG. The prognostically unfavourable factors regarding complete relief from seizures were: i) preoperative presence of grand mal, ii) age at onset of epilepsy or of the first grand mal seizure between 5 and 19 years of age, iii) preoperative duration of epilepsy of over ten years and of grand mal of over one year. Prognostically unfavourable factors regarding psychiatric normalization were: i) preoperative presence of psychosis, ii) ictal-affective attacks or automatisms of a complex nature, iii) impairment of intellectual functions. The eventual neuropathological conclusion was that the more specific and circumscribed the histological abnormality the better the final outcome. The social rehabilitation was found to be significantly improved by operation at an early age.

Adolescent

Temporal lobe epilepsy and neuro-ophthalmology. Ophthalmological findings in 74 temporal lobe resected patients.

A survey is presented of the ophthalmological findings in 74 patients with drug-resistant temporal lobe epilepsy, who underwent unilateral anterior temporal lobectomy 1960-1969 at Rigshospitalet, Copenhagen. At follow-up, 1970-1971, one to ten years following the operation, 81% of the patients had no or only few seizures. Preoperatively 11% of the patients suffered from strabismus as compared to an expected frequency of 5%, but this trend just falls short of statistical significance. The visual acuity remained unchanged in all patients following the operation. Preoperatively a visual field defect was observed in 2 patients. At follow-up 51 patients had homonymous hemianopias, in 38 of them this was limited to the upper quadrants, and in 13 patients also included the lower quandrants, but was characterized as a total homonymous hemianopia in only 6 patients. The presence and extent of the visual field defects were correlated to surgical results, age at onset of epilepsy, age at operation, preoperative duration of epilepsy, presence of grand mal, preoperative complications, and neuropathological findings, but without observing any statistically significant conclusions. On the other hand, the extent of the postoperative visual field defect was significantly influenced by the side of the operation, with more and larger defects following right-sided lobectomies. In the 51 patients with postoperative hemianopias, this defect was either unobserved by the patient or regarded as a considerably less important handicap than the frequent and socially invalidating preoperative seizures...

Adolescent

Mental aspects of temporal lobe epilepsy. Follow-up of 74 patients after resection of a temporal lobe.

Psychiatric disorders were investigated in 74 patients with drug-resistant temporal lobe epilepsy (complex partial epilepsy). In all cases unilateral anterior temporal lobectomy had been performed during the period 1960-69. At follow-up in 1970-71, 45 patients were free from seizures, and in a further group of 15 patients seizure frequency had been substantially reduced. There were four postoperative deaths. Six patients were psychiatrically normal and had no history of any such disorder. Behavioural disturbances were observed in 55 patients. Before operation 11 patients displayed schizophrenia-like psychoses, and nine others became psychotic during follow-up. Fourteen patients attempted suicide on one or more occasions. Half the patients had diminished sexual drive. Improvement in psychiatric status was clearly correlated with relief from seizures and, in those cases with only a few or no seizures after operation, led directly to social rehabilitation. The presence or absence of a psychiatric disorder was not useful as a criterion for or against surgery.

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

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

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

Facial asymmetry in patients with temporal lobe epilepsy. A clinical sign useful in the lateralization of temporal epileptogenic foci.

While a clinical history is frequently sufficient for a localizing diagnosis of temporal lobe epilepsy, lateralization of the epileptogenic abnormality often is impossible on clinical grounds alone. Since we have noted facial asymmetry in such patients, 50 individuals with temporal lobe epilepsy were studied. In patients with unilateral foci, we found contralateral lower facial weakness of mild to severe degree in 73 percent while 13 percent had ipsilateral weakness, and in 13 percent the face was symmetrical. The facial weakness usually was more striking on emotional movement. In the group of patients with bitemporal independent discharges, 61 percent had some asymmetry, often facial weakness on the side opposite the major focus. Of 25 control individuals, only one third had a facial asymmetry and this was slight. Facial asymmetry in temporal lobe epilepsy is a useful though not an absolute clinical lateralizing sign. It is a factor to be considered in addition to other clinical, radiologic, neuropsychologic, and electroencephalographic findings in the evaluation of patients with temporal lobe seizures.

Epilepsy, Temporal Lobe

Quantitative analysis of interictal behavior in temporal lobe epilepsy.

Patients with unilateral temporal epileptic foci were contrasted with normal subjects and patients with neuromuscular disorders in the evaluation of specific psychosocial aspects of behavior. Eighteen traits were assessed in equivalent questionnaires completed by both subjects and observers. The epileptic patients self-reported a distinctive profile of humorless sobriety, dependence, and obsessionalism; raters discriminated temporal lobe epileptics on the basis of circumstantiality, philosophical interests, and anger. The right temporal epileptic displayed emotional tendencies in contrast to ideational traits of left temporal epileptic. Right temporal epileptics exhibited "denial," while left temporal epileptics demonstrated a "catastrophic" overemphasis of dissocial behavior. The results support the hypotheses that sensory-affective associations are established within the temporal lobes, and that, in man, there exists a hemispheric asymmetry in the expression of affect.

Adolescent

Temporal lobe epilepsy and aggression.

Research on temporal lobe epilepsy (TLE) and aggression is reviewed in order to learn why it has not contributed more to our understanding of the neural basis of aggression. The research problem can be resolved into two questions: Are temporal lobe epileptics more aggressive? What inferences can be drawn about the factors underlying aggression in TLE? Difficulties in finding suitable operational definitions for TLE and for aggression have, to date, received insufficient attention. In published studies, sample bias and lack of regard for the validity and reliability of behavioral assessments prevent our deciding whether an association exists between interictal aggressive behavior and TLE. Even if this association were demonstrated, one could not draw direct neurobehavioral inferences from it, since a variety of social and psychological, as well as neurophysiological variables could contribute to the association. These would have to be controlled. Methodological refinements could lead to more satisfactory answers to the first question, but the second is considerably more difficult. Some sources of complexity and apparent contradictions in the experimental literature on the neurology of aggression are discussed. They consist of technical problems, the complexity of the neural substrate of aggression and the influence of environmental cues and learning. The combined use of electrophysiological and interview techniques has yielded some interesting results with TLE patients.

Age Factors

Psychiatric aspects of temporal lobe epilepsy.

This study is an attempt to investigate cases of temporal lobe epilepsy, the starting point being a large number of psychiatric patients. The data presented in this study suggest that a certain number of schizophrenic-like psychoses are produced by temporal seizural activity. There is some evidence that if there is a centrencephalic seizure at the beginning of such a psychotic state, the patient's behavior will have confusional characteristics (perhaps a postictal centrencephalic state). Some findings suggest that the side localization of the temporal lobe focus affects the feature of the psychotic state. None of the nine patients with periodic psychoses had schizoid or paranoid premorbid personality. As to the interictal behavioral disorders of epileptics, we have noticed that two patients with hysteroepilepsy and two with compensation neurosis had dominant temporal lobe focus. Of 10 cases with behavior disorders, all had grand mal or petit mal epilepsy, and none had a temporal lobe focus. Although this study is not based on sufficient data, it may provide working hypotheses for further research.

Bipolar Disorder

Sexual disturbances in temporal lobe epilepsy:a controlled study.

Seventy cases each of temporal lobe epilepsy and grand mal epilepsy were studied for their sexual functioning. The two groups were similar as regards age, sex, duration of illness, frequency of seizures and menstrual and marital history. A significantly greater number of temporal lobe epileptics were found to be hyposexual. They had a global loss of performance and interest in the sexual sphere and showed no concern over it. One case in the group of temporal lobe eiplepsy, as against none in the other group, was hypersexual. There were no cases of sexual deviations in either of the groups. The findings of the study are discussed in the light of the relevant literature.

Adolescent

Differences between patients with temporal lobe seizures and those with other forms of epileptic attacks.

Seventy-eight patients with temporal lobe type seizures were precisely matched for age, sex, and Wechsler I.Q. levels with patients suffering from other seizure types. Statistically significant differences were established between the groups in regard to treatment response, etiologies, and behavioral variables. Further analysis of the data showed that the behavioral problems of the temporal lobe patients were present only in that group that suffered from more than one seizure type. That temporal lobe epilepsy group having only one seizure type differed from the controls with one seizure type in regard to etiological factors; they actually showed better performance on certain subscales of the WAIS, as well as better employment records. The clinical impression of the temporal lobe epilepsy patient usually presenting more difficulties than other patients with epilepsy results from the fact that the temporal lobe patients have, in the overwhelming majority of instances, more than one seizure type.

Adolescent

Temporal lobe aggression in rats.

Although reports of aggressive behavior in temporal lobe epileptics are common, it has proven difficult in clinical settings to gain the experimental control necessary to systematically investigate temporal lobe aggression or even to provide unequivocal evidence of its existence. Increases in aggressive behavior were observed in rats with experimentally induced epileptic foci in temporal lobe structures but not in control rats or those with foci in the caudate.

Aggression

'Agenesis' of the temporal lobe. A case report with autopsy findings.

The temporal lobe agenesis syndrome is a rare congenital abnormality. In previous case reports, this syndrome has been described in association with arachnoid cysts or abnormal collections of CSF. An autopsy performed in the case of our 25-year-old patient revealed agenesis of frontal and temporal lobes without an anatomic cyst. During life the patient had no neurologic abnormalities that could be related to the lesion.

Adult

The orienting reflex in cats with experimental temporal lobe epilepsy.

Aluminum-induced temporal lobe epilepsy in 24 cats showed marked interictal intensification of somatic and EEG components of the orienting reaction and increase in their resistance to habituation. The greatest disturbances of the orienting response were noted in cases of bitemporal foci, of foci situated in the allocortex (hippocampus and amygdala) and of foci inducing generalized or generalized and partial seizures.

Animals