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Lu D, Tan J, Xu H. Ventriculoperitoneal shunt for giant porencephaly: a case report and literature review. Front Surg 2024; 11:1389050. [PMID: 38708364 PMCID: PMC11066292 DOI: 10.3389/fsurg.2024.1389050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/08/2024] [Indexed: 05/07/2024] Open
Abstract
Porencephaly (POR) is an exceedingly rare neurological disorder characterized by the presence of solitary or multiple regressive cerebrospinal fluid (CSF) cavities within the brain parenchyma. Currently, there is a limited understanding of the pathogenesis and treatment options for this condition, and clinical presentations can vary significantly. However, imaging plays a crucial role in diagnosis and determining the optimal treatment strategy, necessitating individualized comprehensive treatment upon detection. We reported a 25-year-old male case with persistent head pain that did not resolve with rest. Magnetic resonance imaging (MRI) confirmed the giant POR, and we finally performed a ventriculoperitoneal shunt, and the symptoms of intracranial hypertension were relieved after surgery.
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Affiliation(s)
| | | | - Haitong Xu
- Department of Neurosurgery, Guangdong Sanjiu Brain Hospital, Guangzhou, China
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Ghatan S, McGoldrick P, Palmese C, La Vega-Talbott M, Kang H, Kokoszka MA, Goodman RR, Wolf SM. Surgical management of medically refractory epilepsy due to early childhood stroke. J Neurosurg Pediatr 2014; 14:58-67. [PMID: 24866497 DOI: 10.3171/2014.3.peds13440] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
UNLABELLED OBJECT.: The risk of developing epilepsy after perinatal stroke, hypoxic/ischemic injury, and intracerebral hemorrhage is significant, and seizures may become medically refractory in approximately 25% of these patients. Surgical management can be difficult due to multilobar or bilateral cortical injury, nonfocal or poorly lateralizing video electroencephalography (EEG) findings, and limited functional reserve. In this study the authors describe the surgical approaches, seizure outcomes, and complications in patients with epilepsy due to vascular etiologies in the perinatal period and early infancy. METHODS The records were analyzed of 19 consecutive children and adults with medically refractory epilepsy and evidence of perinatal arterial branch occlusions, hypoxic/ischemic insult, or hemorrhagic strokes, who underwent surgery at the Comprehensive Epilepsy Center of Beth Israel Medical Center and St. Luke's-Roosevelt Hospital Center. Preoperative findings including MRI, video EEG, functional MRI, and neuropsychological testing were analyzed. The majority of patients underwent staged operations with invasive mapping, and all patients had either extra- or intraoperative functional mapping. RESULTS In 7 patients with large porencephalic cysts due to major arterial branch occlusions, periinsular functional hemispherotomy was performed in 4 children, and in 3 patients, multilobar resections/disconnections were performed, with 1 patient undergoing additional resections 3 years after initial surgery due to recurrence of seizures. All of these patients have been seizure free (Engel Class IA) after a mean 4.5-year follow-up (range 15-77 months). Another 8 patients had intervascular border-zone ischemic infarcts and encephalomalacia, and in this cohort 2 hemispherotomies, 5 multilobar resections/disconnections, and 1 focal cortical resection were performed. Seven of these patients remain seizure free (Engel Class IA) after a mean 4.5-year follow-up (range 9-94 months), and 1 patient suffered a single seizure after 2.5 years of seizure freedom (Engel Class IB, 33-month follow-up). In the final 4 patients with vascular malformation-associated hemorrhagic or ischemic infarction in the perinatal period, a hemispherotomy was performed in 1 case, multilobar resections in 2 cases, and in 1 patient a partial temporal lobectomy was performed, followed 6 months later by a complete temporal and occipital lobectomy due to ongoing seizures. All of these patients have had seizure freedom (Engel Class IA) with a mean follow-up of 4.5 years (range 10-80 months). Complications included transient monoparesis or hemiparesis in 3 patients, transient mutism in 1 patient, infection in 1 patient, and a single case of permanent distal lower-extremity weakness. Transient mood disorders (depression and anxiety) were observed in 2 patients and required medical/therapeutic intervention. CONCLUSIONS Epilepsy surgery is effective in controlling medically intractable seizures after perinatal vascular insults. Seizure foci tend to be widespread and rarely limited to the area of injury identified through neuroimaging, with invasive monitoring directing multilobar resections in many cases. Long-term functional outcomes have been good in these patients, with significant improvements in independence, quality of life, cognitive development, and motor skills, despite transient postoperative monoparesis or hemiparesis and occasional mood disorders.
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Affiliation(s)
- Saadi Ghatan
- Department of Neurosurgery, St. Luke's/Roosevelt Hospital Center and Beth Israel Medical Center, New York; and
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Bulacio JC, González-Martínez JA. Candidatos a cirugía de la epilepsia: quiénes y cómo. REVISTA MÉDICA CLÍNICA LAS CONDES 2013. [DOI: 10.1016/s0716-8640(13)70256-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
The spectrum of focal epileptogenic lesions and their clinical manifestations in children differ substantially from those seen in adults. In adults, mesial temporal sclerosis is the common lesion in surgical series; but in children, MTS is uncommon, and when it does occur, it exists frequently as dual pathology. The most common lesions in pediatric epilepsy surgery candidates are malformations of cortical development, developmental tumors, or encephalomalacia from infarction, hypoxia, trauma, or infection. Careful analysis of the lesion characteristics on brain MRI is sufficiently predictive of pathology in most cases. Histopathological evaluation remains the gold standard for diagnosis of mass lesions. The electroclinical phenotype of epilepsy in adults is largely determined by the anatomical location of the lesion and its connectivity. In children, in addition to the location of the lesion, the age at onset of the lesion and the age at onset of epilepsy have a major impact on the electroclinical phenotype. Children with congenital or early acquired lesions may manifest with generalized features on EEG and seizure semiology. Experience from various centers has demonstrated that a subset of these children benefit from epilepsy surgery despite a generalized epilepsy phenotype. All children with medically refractory epilepsy and a focal lesion should undergo evaluation for potential epilepsy surgery irrespective of the EEG findings and seizure semiology.
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Affiliation(s)
- Ahsan N V Moosa
- Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
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Matsubara T, Ayuzawa S, Aoki T, Fujiomto A, Osuka S, Matsumura A. The patient had a normal magnetic resonance imaging and temporal lobe epilepsy secondary to a porencephalic cyst but showed structural lesions (hippocampal sclerosis). EPILEPSY & BEHAVIOR CASE REPORTS 2013; 1:153-6. [PMID: 25667851 PMCID: PMC4150633 DOI: 10.1016/j.ebcr.2013.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 08/30/2013] [Accepted: 08/30/2013] [Indexed: 11/27/2022]
Abstract
Patients with a porencephalic cyst frequently develop intractable temporal lobe epilepsy (TLE). We report a surgically-treated male patient with intractable mesial TLE (mTLE) secondary to a porencephalic cyst. Although magnetic resonance imaging showed no hippocampal abnormalities, long-term video-electrocorticography revealed seizure onset discharges in the hippocampus. Temporal lobectomy brought an end to the patient's seizures. Hippocampal sclerosis was histopathologically confirmed (dual pathology). Careful evaluation of hippocampal epileptogenicity is required, and temporal lobectomy, which is less invasive than hemispherectomy, can be a treatment of choice for patients with mTLE secondary to a porencephalic cyst.
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Affiliation(s)
| | - Satoshi Ayuzawa
- Department of Neurosurgery, Tsukuba University Hospital, Japan ; Department of Neurosurgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Japan
| | - Tsukasa Aoki
- Department of Neurosurgery, Ryugasaki Saiseikai Hospital, Japan
| | - Ayataka Fujiomto
- Department of Neurosurgery, Seirei Hamamatsu General Hospital, Japan
| | - Satoru Osuka
- Department of Neurosurgery, Tsukuba University Hospital, Japan
| | - Akira Matsumura
- Department of Neurosurgery, Tsukuba University Hospital, Japan ; Department of Neurosurgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Japan
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Albéri L, Chi Z, Kadam SD, Mulholland JD, Dawson VL, Gaiano N, Comi AM. Neonatal stroke in mice causes long-term changes in neuronal Notch-2 expression that may contribute to prolonged injury. Stroke 2010; 41:S64-71. [PMID: 20876509 DOI: 10.1161/strokeaha.110.595298] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE Notch receptors (1-4) are membrane proteins that, on ligand stilumation, release their cytoplasmic domains to serve as transcription factors. Notch-2 promotes proliferation both during development and cancer, but its role in response to ischemic injury is less well understood. The purpose of this study was to understand whether Notch-2 is induced after neonatal stroke and to investigate its functional relevance. METHODS P12 CD1 mice were subjected to permanent unilateral (right-sided) double ligation of the common carotid artery. RESULTS Neonatal ischemia induces a progressive brain injury with prolonged apoptosis and Notch-2 up-regulation. Notch-2 expression was induced shortly after injury in hippocampal areas with elevated c-fos activation and increased cell death. Long-term induction of Notch-2 also occurred in CA1 and CA3 in and around areas of cell death, and had a distinct pattern of expression as compared to Notch-1. In vitro oxygen glucose deprivation treatment showed a similar increase in Notch-2 in apoptotic cells. In vitro gain of function experiments, using an active form of Notch-2, show that Notch-2 induction is neurotoxic to a comparable extent as oxygen glucose deprivation treatment. CONCLUSIONS These results suggest that Notch-2 up-regulation after neonatal ischemia is detrimental to neuronal survival.
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Affiliation(s)
- Lavinia Albéri
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Kadam S, Smith-Hicks C, Smith DR, Worley P, Comi AM. Functional integration of new neurons into hippocampal networks and poststroke comorbidities following neonatal stroke in mice. Epilepsy Behav 2010; 18:344-57. [PMID: 20708575 PMCID: PMC2923452 DOI: 10.1016/j.yebeh.2010.05.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Revised: 05/05/2010] [Accepted: 05/07/2010] [Indexed: 12/22/2022]
Abstract
Stroke in the developing brain is an important cause of chronic neurological morbidities including neurobehavioral dysfunction and epilepsy. Here, we describe a mouse model of neonatal stroke resulting from unilateral carotid ligation that results in acute seizures, long-term hyperactivity, spontaneous lateralized circling behavior, impaired cognitive function, and epilepsy. Exploration-dependent induction of the immediate early gene Arc (activity-regulated cytoskeleton associated protein) in hippocampal neurons was examined in the general population of neurons versus neurons that were generated approximately 1 week after the ischemic insult and labeled with bromodeoxyuridine. Although Arc was inducible in a network-specific manner after severe neonatal stroke, it was impaired, not only in the ipsilateral injured but also in the contralateral uninjured hippocampi when examined 6 months after the neonatal stroke. Severity of both the stroke injury and the acquired poststroke epilepsy negatively correlated with Arc induction and new neuron integration into functional circuits in the injured hippocampi.
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Affiliation(s)
- S.D. Kadam
- Department of Neurology and Developmental Medicine, Kennedy Krieger Research Institute, Johns Hopkins University School of Medicine; Baltimore, MD-21205,Department of Neurology, Johns Hopkins University School of Medicine; Baltimore, MD-21205
| | - C.L. Smith-Hicks
- Department of Neurology, Johns Hopkins University School of Medicine; Baltimore, MD-21205
| | - D. R. Smith
- Neurogenetics and Behavior Center, Department of Psychological and Brain Sciences, Johns Hopkins University, Baltimore, MD 21218
| | - P.F. Worley
- Department of Neuroscience, Johns Hopkins University School of Medicine; Baltimore, MD-21205,Department of Neurology, Johns Hopkins University School of Medicine; Baltimore, MD-21205
| | - A. M. Comi
- Department of Neurology and Developmental Medicine, Kennedy Krieger Research Institute, Johns Hopkins University School of Medicine; Baltimore, MD-21205,Department of Neurology, Johns Hopkins University School of Medicine; Baltimore, MD-21205,Department of Pediatrics, Johns Hopkins University School of Medicine; Baltimore, MD-21205
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Yoshinaga H, Kobayashi K, Hoshida T, Kinugasa K, Ohtuska Y. Magnetoencephalogram in a postoperative case with a large skull defect. Pediatr Neurol 2008; 39:48-51. [PMID: 18555173 DOI: 10.1016/j.pediatrneurol.2008.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2007] [Revised: 01/30/2008] [Accepted: 03/10/2008] [Indexed: 10/22/2022]
Abstract
We present a patient in whom magnetoencephalograms were successfully performed in presurgical and postsurgical evaluations. A 12-year-old boy with congenital porencephaly was admitted with refractory adversive seizures and frontal absence seizures. Ictal magnetoencephalographic dipoles with frontal absence seizures were located in the left frontal lobe, anterior to the porencephalic cyst, and concordant with the same area detected by intraoperative electrocorticography. A partial cortical excision was performed, and the patient's cranial bone flap was removed because of an epidural abscess. The frontal absences then disappeared. The magnetoencephalogram revealed that secondary bilateral synchrony of focal discharges from the lesion may have caused the generalized seizures in this patient. Because of residual partial seizures, second and third magnetoencephalograms were performed, and we detected residual spike dipoles clustering in the area posterior to the cavity of cortical excision and anterior to the porencephalic cyst. Another excision of the area between the cavity and frontal edge of the cyst was performed, and seizure frequency diminished dramatically. In this case, despite the failure of dipole estimation by electroencephalogram in the context of a large bone defect, the magnetoencephalogram was useful in detecting the residual epileptogenic zone after failed epilepsy surgery.
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Affiliation(s)
- Harumi Yoshinaga
- Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
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Morrison CE, Nakhutina L. Neuropsychological features of lesion-related epilepsy in adults: an overview. Neuropsychol Rev 2007; 17:385-403. [PMID: 17952606 DOI: 10.1007/s11065-007-9044-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2007] [Accepted: 10/03/2007] [Indexed: 11/26/2022]
Abstract
Lesional epilepsy is thought to be a direct consequence of focal brain lesions of dysgenetic, neoplastic, vascular, or traumatic origin. It has been estimated that at least half of all epilepsies are the result of such lesions. The current discussion includes an overview of the cognitive and behavioral presentations in adults with epilepsy secondary to focal pathology. The neuropsychological presentation in this population is influenced by many factors, including the location and nature of the underlying lesion, seizure characteristics, the effects of treatment, and patient variables. Few studies attempt to disentangle the specific contributions of these variables to cognitive performance. However, where available studies examining the separable effects of seizure-related variables on cognitive functioning in individuals with lesional epilepsy are also reviewed. This overview includes a discussion of focal malformations of cortical and vascular development and select foreign tissue and acquired lesions.
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Affiliation(s)
- Chris E Morrison
- Department of Neurology, Comprehensive Epilepsy Center, New York University Medical Center, 403 E 34th St., 4th Floor, New York, NY, 10016, USA.
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Iida K, Otsubo H, Arita K, Andermann F, Olivier A. Cortical resection with electrocorticography for intractable porencephaly-related partial epilepsy. Epilepsia 2005; 46:76-83. [PMID: 15660771 DOI: 10.1111/j.0013-9580.2005.28704.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE We evaluated the results of cortical resection of epileptogenic tissue for treatment of intractable porencephaly-related epilepsy. METHODS We examined clinical features, electrophysiological data, surgical findings, and seizure outcomes after cortical resection in eight patients with intractable epilepsy related to porencephalic cysts. RESULTS All eight patients had hemiparesis. Five retained motor function in the hemiparetic extremities; six retained visual fields. All had partial seizures, six with secondary generalization. Seven patients had simple and three had complex partial seizures (CPSs); two also had drop attacks. Four patients had multiple seizure types. Long-term scalp video-EEG (LVEEG) localized interictal epileptic abnormalities that anatomically corresponded to the cyst location in three patients. LVEEG recorded ictal-onset zones in five; these anatomically corresponded to the cyst location in three of the five. EEG recorded generalized seizures in two patients, hemispheric in one, and multifocal in two. Intraoperative electrocorticography (ECoG) revealed interictal epileptic areas extending beyond the margins of the cyst in seven patients. We resected ECoG-localized interictal epileptic areas completely in five patients and partially in two. Cortical resection was based on seizure semiology and LVEEG in one patient whose ECoG showed no epileptiform discharges. After a minimum follow-up of 1 year, six patients had excellent seizure outcome (Engel class I), and two had a >90% seizure reduction (Engel class III) without complications. CONCLUSIONS Cortical resection guided by ECoG allows preservation of motor function and visual field and provides an effective surgical procedure for treatment of intractable epilepsy secondary to porencephaly.
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Affiliation(s)
- Koji Iida
- Department of Neurology and Neurosurgery, The Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec
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Van Paesschen W. Qualitative and quantitative imaging of the hippocampus in mesial temporal lobe epilepsy with hippocampal sclerosis. Neuroimaging Clin N Am 2004; 14:373-400, vii. [PMID: 15324854 DOI: 10.1016/j.nic.2004.04.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
MR imaging allows the in vivo detection of hippocampal sclerosis (HS) and has been instrumental in the delineation of the syndrome of mesial temporal lobe epilepsy with HS (mTLE-HS). MR features of HS include hippocampal atrophy with an increased T2 signal. Quantitative MR imaging accurately reflects the degree of hippocampal damage.Ictal single photon emission computed tomography (SPECT) in mTLE-HS shows typical perfusion patterns of ipsilateral temporal lobe hyperperfusion, and ipsilateral frontoparietal and contralateral cerebellar hypoperfusion. Interictal 18fluoro-2-deoxyglucose positron emission tomography (PET) shows multiregional hypometabolism, involving predominantly the ipsilateral temporal lobe. 11C-flumazenil PET shows hippocampal decreases in central benzodiazepine receptor density. Future strategies to study the etiology and pathogenesis of HS should include longitudinal MR imaging studies,MR studies in families with epilepsy and febrile seizures, stratification for genetic background, coregistration with SPECT and PET, partial volume correction and statistical parametric mapping analysis of SPECT and PET images.
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Affiliation(s)
- Wim Van Paesschen
- Department of Neurology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, 49 Herestraat, 3000 Leuven, Belgium.
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Abstract
Intraoperative electrocorticography (ECoG) has been traditionally used in the surgical management of medically refractory partial epilepsies to identify the location and limits of the epileptogenic area, to guide the extent of resection, and to assess its completeness. Although in clinical use for many years, the basic questions regarding indications and limitations of this method has remained unanswered. ECoG plays a major role in tailored temporal lobectomies, whereas, it serves no practical purpose in standard resection of medial temporal lobe epilepsy (TLE) with magnetic resonance imaging (MRI) evidence of mesial temporal sclerosis (MTS). Residual hippocampal spikes, unaltered by resection, correlate with a greater proportion of seizure recurrence. Intraoperative hippocampal ECoG can allow sparing of functionally important hippocampus, thus minimising postoperative memory decline. ECoG eminently aids removal of developmental malformations of brain, and most importantly, the excision of highly epileptogenic cortical dysplasias (CDs) for deciding the extent of resection for best seizure control. The ECoG can be a valuable tool during multiple subpial transections (MST).
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Affiliation(s)
- Abraham Kuruvilla
- Department of Clinical Neurophysiology, Centre for Neuroscience, Uppsala University Hospital, SE-751 85, Uppsala, Sweden.
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Teixeira RA, Li LM, Santos SLM, Zanardi VA, Honorato DC, Guerreiro CAM, Cendes F. Early development destructive brain lesions and their relationship to epilepsy and hippocampal damage. Brain Dev 2003; 25:560-70. [PMID: 14580670 DOI: 10.1016/s0387-7604(03)00065-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Fifty-one consecutive adult patients with epilepsy and early development destructive brain lesions were divided into three main groups according to the topographic distribution of the lesion on magnetic resonance imaging: hemispheric (H) (n=9); main arterial territory (AT) (n=25) and arterial borderzone (Bdz) (n=17). Eight (89%) patients from group H presented status epilepticus in the first 5 years of life, five of them associated with fever. Seventeen of the 25 patients from group AT (76%) had an obvious hemiparesis observed early in life. In addition, major prenatal events were significantly more common in the group AT compared with the other two groups. Among patients from group Bdz, prenatal or postnatal events were not identified, except for one patient. Conversely, nine patients from group Bdz (60%) showed a history of perinatal complications. Hippocampal atrophy (HA) was determined by visual analysis in 74.5% of all patients and by volumetry in 92%. The frequency of HA was comparable among groups, but patients from group H presented the most severe atrophy and more frequent hyperintense T2 hippocampal signal. In conclusion, these three groups of patients with early destructive lesions and epilepsy (H, AT and Bdz), appear to have distinct pathogenic mechanisms. Our data show that there is a striking association of HA with different patterns of neocortical destructive lesions of early development. This association seems to be related to a common and synchronic pathogenic mechanism. The recognition of the pattern and degree of HA among these patients with intractable seizures may influence the surgical rationale.
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Affiliation(s)
- Ricardo A Teixeira
- Department of Neurology, University of Campinas (UNICAMP), Campinas, SP, CEP 13083-970, Brazil
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Carreño José V, Serrano Castro PJ. [Partial epilepsy refractory to medical treatment and occipital porencephalic lesion]. Rev Clin Esp 2001; 201:345-6. [PMID: 11490915 DOI: 10.1016/s0014-2565(01)70842-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Teixeira RA, Leone AA, Honorato DC, Damasceno BP, Guerreiro CA, Cendes F. Congenital destructive hemispheric lesions and epilepsy: clinical features and relevance of associated hippocampal atrophy. ARQUIVOS DE NEURO-PSIQUIATRIA 2000; 58:990-1001. [PMID: 11105063 DOI: 10.1590/s0004-282x2000000600003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We studied the clinical, EEG and MRI findings in 19 patients with epilepsy secondary to congenital destructive hemispheric insults. Patients were divided in two groups: 10 with cystic lesions (group 1), and 9 with atrophic lesions (group 2). Seizure and EEG features, as well as developmental sequelae were similar between the two groups, except for the finding that patients of group 2 more commonly presented seizures with more than one semiological type. MRI showed hyperintense T2 signal extending beyond the lesion in almost all patients of both groups, and it was more diffuse in group 2. Associated hippocampal atrophy (HA) was observed in 70% of group 1 patients and 77.7% of group 2, and it was not correlated with duration of epilepsy or seizure frequency. There was a good concordance between HA and electroclinical localization. The high prevalence of associated HA in both groups suggests a common pathogenesis with the more obvious lesion. Our findings indicate that in some of these patients with extensive destructive lesions, there may be a more circumscribed epileptogenic area, particularly in those with cystic lesions and HA, leading to a potential rationale for effective surgical treatment.
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Affiliation(s)
- R A Teixeira
- Departamento de Neurologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, 13083-970, Brasil
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Jing H, Takigawa M. Comparison of human ictal, interictal and normal non-linear component analyses. Clin Neurophysiol 2000; 111:1282-92. [PMID: 10880804 DOI: 10.1016/s1388-2457(00)00305-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The non-linear properties of EEG and filtered rhythms obtained from healthy subjects and epileptic patients with complex partial seizures were analyzed to investigate whether EEG in different neurological states can be generated by the mechanism that integrates several non-linear dynamic systems. METHODS The control EEG (from 26 healthy subjects), interictal EEG and ictal EEG (from 25 patients) were digitally filtered into delta (0.5-4 Hz), theta (4-8 Hz), alpha (8-13 Hz), beta (13-30 Hz) and gamma (30-40 Hz) components. The correlation dimension was calculated on each original signal and corresponding surrogate data. A new method was developed to accelerate the calculation of the correlation integral. Function P(m,r) was defined to visualize the meaning of the correlation dimension. The point critical to the estimation was determined by the P(m,r) function. RESULTS The EEG in the control subjects and patients showed significantly lower correlation dimensions than the surrogate data. The delta, alpha, beta and gamma components from the control EEG exhibited similar complexity to the surrogate data, while only the alpha component from the interictal EEG presented the same dimension as the surrogate data. The correlation dimensions of the theta and alpha components remained the same when the neurological state changed from interictal EEG to ictal EEG. The complexity of the beta component was higher than the complexity of other components in both control subjects and patients. The correlation dimension of EEG was significantly correlated to the complexity of delta, theta, beta and gamma components. CONCLUSIONS Our results suggest that EEG and filtered components in different neurological states demonstrate varied dynamic properties. The characteristics of neuronal networks can be differentiated by the dynamics of filtered components. Separating EEG into different dynamic systems may facilitate understanding of the mechanisms involved in the human EEG.
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Affiliation(s)
- H Jing
- Department of Neuropsychiatry, Faculty of Medicine, Kagoshima University, 8-35-1 Sakuragaoka, 890-8520, Kagoshima City, Japan
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Kuzniecky R, Hugg J, Hetherington H, Martin R, Faught E, Morawetz R, Gilliam F. Predictive value of 1H MRSI for outcome in temporal lobectomy. Neurology 1999; 53:694-8. [PMID: 10489028 DOI: 10.1212/wnl.53.4.694] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the predictive value of 1H MRSI for outcome in patients with mesial temporal lobe epilepsy (MTLE). BACKGROUND 1H MRSI has been shown to be highly sensitive in the lateralization of temporal lob epilepsy. METHODS The authors analyzed the relationship between the 1H MRSI findings and surgical outcome in 40 consecutive patients who underwent temporal lobe surgery for MTLE. Outcome at a mean of 24 months (range 18 to 40 months) was classified as seizure free or not seizure free. RESULTS At follow-up, 78% of patients were seizure free. Correlations showed no predictive value for the creatine/N-acetylated compound (Cr/NA) ratio of the operated temporal lobe and outcome. However, a relationship was found between surgical failure and the Cr/NA ratio of the nonoperated temporal lobe and with a Cr/NA ratio in the nonoperated lobe above 1.21 in patients with bilateral abnormalities (p < 0.01). CONCLUSIONS Preoperative elevations in the Cr/NA ratio in the nonoperated temporal lobe or the presence of higher metabolic ratios contralateral to the proposed surgery are associated with surgical failure. The predictive value of 1H MRSI absolute metabolite concentrations for outcome in MTLE requires further investigation.
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Affiliation(s)
- R Kuzniecky
- Department of Neurology, UAB Epilepsy Center, University of Alabama at Birmingham, USA
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Abstract
The objective of this review is a summary of the clinical and electrographic findings in those forms of epilepsy to which the term 'extratemporal' (ExT) can be applied. They form a group that differs in many ways from the better known temporal lobe epilepsies. Seizure foci are difficult to localize by clinical semiology alone but modern imaging now often allows a precise definition of the epileptogenic area. The most common causes of ExT epilepsy are tumors and cortical dysgenesis. The concept of 'dual pathology' implies the coexistence of two or more distinct lesions, typically mesial temporal sclerosis and cortical dysplasia. Electroencephalography (EEG) and electrocorticography (ECoG) are valuable tests in the definition of the epileptogenic area beyond the structural lesion, and surgical removal must be guided by the nature of the lesion and the extent of the epileptogenic zone.
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Affiliation(s)
- R L Kutsy
- University of Washington/Harborview Medical Center, Seattle 98104, USA.
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Holmes GL, Sarkisian M, Ben-Ari Y, Liu Z, Chevassus-Au-Louis N. Consequences of cortical dysplasia during development in rats. Epilepsia 1999; 40:537-44. [PMID: 10386521 DOI: 10.1111/j.1528-1157.1999.tb05554.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To determine whether focal cortical dysplasia alters excitability in regions distant to the region of the dysplasia. METHODS We studied the physiological consequences of cortical dysplasia induced by either one or three freeze lesions at birth. Seizure susceptibility was assessed at age 35 days by amygdala kindling. c-fos immunostaining was performed after kainic acid-induced seizures at 10, 20, or 30 days to evaluate the patterns of neuronal activation. RESULTS Freeze lesions consistently produced uniform regions of dysplasia. No significant differences in seizure susceptibility, as measured by afterdischarge threshold and kindling rate, were seen between controls and rats receiving either one or three freeze lesions. c-fos activation after kainic acid injection was not observed in the region of the dysplasia. However, rats with freeze lesions at age 30 days demonstrated asymmetric c-fos staining with greater staining in CA1 ipsilateral, than contralateral, to the lesion. CONCLUSIONS Focal cortical dysplasia results in enhancement of c-fos activation in regions outside the borders of the dysplasia. However, as indicated by kindling rate, the functional consequences of these alterations do not appear to be robust.
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Affiliation(s)
- G L Holmes
- Department of Neurology, Harvard Medical School, Children's Hospital, Boston, Massachusetts 02115, USA
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Millichap JG. Congenital Porencephaly and Hippocampal Sclerosis. Pediatr Neurol Briefs 1997. [DOI: 10.15844/pedneurbriefs-11-12-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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