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Lőrincz K, Bóné B, Karádi K, Kis-Jakab G, Tóth N, Halász L, Erőss L, Balás I, Faludi B, Jordán Z, Chadaide Z, Gyimesi C, Fabó D, Janszky J. Effects of anterior thalamic nucleus DBS on interictal heart rate variability in patients with refractory epilepsy. Clin Neurophysiol 2023; 147:17-30. [PMID: 36630886 DOI: 10.1016/j.clinph.2022.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 11/02/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Heart rate variability (HRV) changes were investigated by several studies after resective epilepsy surgery/vagus nerve stimulation. We examined anterior thalamic nucleus (ANT)-deep brain stimulation (DBS) effects on HRV parameters. METHODS We retrospectively analyzed 30 drug-resistant epilepsy patients' medical record data and collected electrocardiographic epochs recorded during video- electroencephalography monitoring sessions while awake and during N1- or N2-stage sleep pre-DBS implantation surgery, post-surgery but pre-stimulation, and after stimulation began. RESULTS The mean square root of the mean squared differences between successive RR intervals and RR interval standard deviation values differed significantly (p < 0.05) among time-points, showing increased HRV post-surgery. High (0.15-0.4 Hz) and very low frequency (<0.04 Hz) increased, while low frequency (0.04-0.15 Hz) and the LF/HF ratio while awake decreased, suggesting improved autonomic regulation post-surgery. Change of effect size was larger in patients where both activated contacts were located in the ANT than in those where only one or none of the contacts hit the ANT. CONCLUSIONS In patients with drug-resistant epilepsy, ANT-DBS might positively influence autonomic regulation, as reflected by increased HRV. SIGNIFICANCE To gain a more comprehensive outcome estimation after DBS implantation, we suggest including HRV measures with seizure count in the post-surgery follow-up protocol.
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Affiliation(s)
- Katalin Lőrincz
- Department of Neurology, Medical School, University of Pecs, Ret u. 2, H-7623 Pecs, Hungary; Department of Neurosurgery, University Hospital Tübingen, Eberhard Karls University, Hoppe-Seyler str. 3, 72076 Tübingen, Germany.
| | - Beáta Bóné
- Department of Neurology, Medical School, University of Pecs, Ret u. 2, H-7623 Pecs, Hungary
| | - Kázmér Karádi
- Department of Behavioral Sciences, Medical School, University of Pecs, Szigeti u.12, H-7624 Pecs, Hungary
| | - Greta Kis-Jakab
- Department of Neurology, Medical School, University of Pecs, Ret u. 2, H-7623 Pecs, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Ret u. 2., H-7623 Pecs, Hungary
| | - Natália Tóth
- Department of Neurology, Medical School, University of Pecs, Ret u. 2, H-7623 Pecs, Hungary
| | - László Halász
- Department of Functional Neurosurgery, National Institute of Neurosciences, Amerikai ut 57, H-1345 Budapest, Hungary
| | - Loránd Erőss
- Department of Functional Neurosurgery, National Institute of Neurosciences, Amerikai ut 57, H-1345 Budapest, Hungary
| | - István Balás
- Department of Neurosurgery, Medical School, University of Pecs, Ret u. 2, H-7623 Pecs, Hungary
| | - Béla Faludi
- Department of Neurology, Medical School, University of Pecs, Ret u. 2, H-7623 Pecs, Hungary
| | - Zsófia Jordán
- Department of Neurology, National Institute of Neurosciences, Amerikai ut 57., H-1345 Budapest, Hungary
| | - Zoltan Chadaide
- University of Szeged Albert Szentgyörgyi Medical School, Tisza Lajos krt.109, 6725 Szeged, Hungary
| | - Csilla Gyimesi
- Department of Neurology, Medical School, University of Pecs, Ret u. 2, H-7623 Pecs, Hungary
| | - Dániel Fabó
- Department of Neurology, National Institute of Neurosciences, Amerikai ut 57., H-1345 Budapest, Hungary
| | - József Janszky
- Department of Neurology, Medical School, University of Pecs, Ret u. 2, H-7623 Pecs, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Ret u. 2., H-7623 Pecs, Hungary
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2
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Sóki N, Richter Z, Karádi K, Lőrincz K, Horváth R, Gyimesi C, Szekeres-Paraczky C, Horváth Z, Janszky J, Dóczi T, Seress L, Ábrahám H. Investigation of synapses in the cortical white matter in human temporal lobe epilepsy. Brain Res 2022; 1779:147787. [PMID: 35041843 DOI: 10.1016/j.brainres.2022.147787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/27/2021] [Accepted: 01/10/2022] [Indexed: 11/02/2022]
Abstract
Temporal lobe epilepsy (TLE) is one of the most common focal pharmacotherapy-resistant epilepsy in adults. Previous studies have shown significantly higher numbers of neurons in the neocortical white matter in TLE patients than in controls. The aim of this work was to investigate whether white matter neurons are part of the neuronal circuitry. Therefore, we studied the distribution and density of synapses in surgically resected neocortical tissue of pharmacotherapy-resistant TLE patients. Neocortical white matter of temporal lobe from non-epileptic patients were used as controls. Synapses and neurons were visualized with immunohistochemistry using antibodies against synaptophysin and NeuN, respectively. The presence of synaptophysin in presynaptic terminals was verified by electron microscopy. Quantification of immunostaining was performed and the data of the patients' cognitive tests as well as clinical records were compared to the density of neurons and synapses. Synaptophysin density in the white matter of TLE patients was significantly higher than in controls. In TLE, a significant correlation was found between synaptophysin immunodensity and density of white matter neurons. Neuronal as well as synaptophysin density significantly correlated with scores of verbal memory of TLE patients. Neurosurgical outcome of TLE patients did not significantly correlate with histological data, although, higher neuronal and synaptophysin densities were observed in patients with favorable post-surgical outcome. Our results suggest that white matter neurons in TLE patients receive substantial synaptic input and indicate that white matter neurons may be integrated in epileptic neuronal networks responsible for the development or maintenance of seizures.
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Affiliation(s)
- Noémi Sóki
- Department of Medical Biology and Central Electron Microscopic Laboratory, University of Pécs Medical School Szigeti u. 12. Pécs, 7643, Hungary; Neuromorphology and Cellular Neurobiology Research Group, Center for Neuroscience, University of Pécs Ifjúság u. 20. Pécs, 7624, Hungary
| | - Zsófia Richter
- Department of Medical Biology and Central Electron Microscopic Laboratory, University of Pécs Medical School Szigeti u. 12. Pécs, 7643, Hungary
| | - Kázmér Karádi
- Department of Behavioral Sciences, University of Pécs Medical School Szigeti u. 12. Pécs, 7624, Hungary
| | - Katalin Lőrincz
- Department of Neurology, University of Pécs Medical School Rét u. 2. Pécs, 7623, Hungary
| | - Réka Horváth
- Department of Neurology, University of Pécs Medical School Rét u. 2. Pécs, 7623, Hungary
| | - Csilla Gyimesi
- Department of Neurology, University of Pécs Medical School Rét u. 2. Pécs, 7623, Hungary
| | - Cecília Szekeres-Paraczky
- Human Brain Research Laboratory, Institute of Experimental Medicine, ELKH Szigony u. 43. Budapest, 1083, Hungary
| | - Zsolt Horváth
- Department of Neurosurgery, University of Pécs Medical School Rét u. 2. Pécs, 7623, Hungary
| | - József Janszky
- Department of Neurology, University of Pécs Medical School Rét u. 2. Pécs, 7623, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Center for Neuroscience, University of Pécs Ifjúság u 20. Pécs, 7624, Hungary
| | - Tamás Dóczi
- Department of Neurosurgery, University of Pécs Medical School Rét u. 2. Pécs, 7623, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Center for Neuroscience, University of Pécs Ifjúság u 20. Pécs, 7624, Hungary
| | - László Seress
- Department of Medical Biology and Central Electron Microscopic Laboratory, University of Pécs Medical School Szigeti u. 12. Pécs, 7643, Hungary; Neuromorphology and Cellular Neurobiology Research Group, Center for Neuroscience, University of Pécs Ifjúság u. 20. Pécs, 7624, Hungary
| | - Hajnalka Ábrahám
- Department of Medical Biology and Central Electron Microscopic Laboratory, University of Pécs Medical School Szigeti u. 12. Pécs, 7643, Hungary; Neuromorphology and Cellular Neurobiology Research Group, Center for Neuroscience, University of Pécs Ifjúság u. 20. Pécs, 7624, Hungary.
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3
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Tóth M, Barsi P, Tóth Z, Borbély K, Lückl J, Emri M, Repa I, Janszky J, Dóczi T, Horváth Z, Halász P, Juhos V, Gyimesi C, Bóné B, Kuperczkó D, Horváth R, Nagy F, Kelemen A, Jordán Z, Újvári Á, Hagiwara K, Isnard J, Pál E, Fekésházy A, Fabó D, Vajda Z. The role of hybrid FDG-PET/MRI on decision-making in presurgical evaluation of drug-resistant epilepsy. BMC Neurol 2021; 21:363. [PMID: 34537017 PMCID: PMC8449490 DOI: 10.1186/s12883-021-02352-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 08/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background When MRI fails to detect a potentially epileptogenic lesion, the chance of a favorable outcome after epilepsy surgery becomes significantly lower (from 60 to 90% to 20–65%). Hybrid FDG-PET/MRI may provide additional information for identifying the epileptogenic zone. We aimed to investigate the possible effect of the introduction of hybrid FDG-PET/MRI into the algorithm of the decision-making in both lesional and non-lesional drug-resistant epileptic patients. Methods In a prospective study of patients suffering from drug-resistant focal epilepsy, 30 nonlesional and 30 lesional cases with discordant presurgical results were evaluated using hybrid FDG-PET/MRI. Results The hybrid imaging revealed morphological lesion in 18 patients and glucose hypometabolism in 29 patients within the nonlesional group. In the MRI positive group, 4 patients were found to be nonlesional, and in 9 patients at least one more epileptogenic lesion was discovered, while in another 17 cases the original lesion was confirmed by means of hybrid FDG-PET/MRI. As to the therapeutic decision-making, these results helped to indicate resective surgery instead of intracranial EEG (iEEG) monitoring in 2 cases, to avoid any further invasive diagnostic procedures in 7 patients, and to refer 21 patients for iEEG in the nonlesional group. Hybrid FDG-PET/MRI has also significantly changed the original therapeutic plans in the lesional group. Prior to the hybrid imaging, a resective surgery was considered in 3 patients, and iEEG was planned in 27 patients. However, 3 patients became eligible for resective surgery, 6 patients proved to be inoperable instead of iEEG, and 18 cases remained candidates for iEEG due to the hybrid FDG-PET/MRI. Two patients remained candidates for resective surgery and one patient became not eligible for any further invasive intervention. Conclusions The results of hybrid FDG-PET/MRI significantly altered the original plans in 19 of 60 cases. The introduction of hybrid FDG-PET/MRI into the presurgical evaluation process had a potential modifying effect on clinical decision-making. Trial registration Trial registry: Scientific Research Ethics Committee of the Medical Research Council of Hungary. Trial registration number: 008899/2016/OTIG. Date of registration: 08 February 2016.
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Affiliation(s)
- Márton Tóth
- Department of Neurology, Medical School, University of Pécs, Rét u. 2, Pécs, H-7623, Hungary.
| | - Péter Barsi
- Department of Medical Imaging, Semmelweis University, Balassa út 6, Budapest, H-1083, Hungary
| | - Zoltán Tóth
- Dr. József Baka Diagnostic, Radiation oncology, Research and Teaching Center, Somogy County Moritz Kaposi Teaching Hospital, Guba Sándor u. 40, Kaposvár, H-7400, Hungary.,MEDICOPUS Healthcare Provider and Public Nonprofit Ltd., Somogy County Moritz Kaposi Teaching Hospital, Guba Sándor u. 40, Kaposvár, H-7400, Hungary
| | - Katalin Borbély
- PET/CT Ambulance, National Institute of Oncology, Ráth György u.7-9, Budapest, H-1122, Hungary
| | - János Lückl
- Dr. József Baka Diagnostic, Radiation oncology, Research and Teaching Center, Somogy County Moritz Kaposi Teaching Hospital, Guba Sándor u. 40, Kaposvár, H-7400, Hungary
| | - Miklós Emri
- MEDICOPUS Healthcare Provider and Public Nonprofit Ltd., Somogy County Moritz Kaposi Teaching Hospital, Guba Sándor u. 40, Kaposvár, H-7400, Hungary.,Division of Nuclear Medicine and Translational Imaging, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, H-4032, Hungary
| | - Imre Repa
- Dr. József Baka Diagnostic, Radiation oncology, Research and Teaching Center, Somogy County Moritz Kaposi Teaching Hospital, Guba Sándor u. 40, Kaposvár, H-7400, Hungary
| | - József Janszky
- Department of Neurology, Medical School, University of Pécs, Rét u. 2, Pécs, H-7623, Hungary.,MTA-PTE Clinical Neuroscience MRI Research Group, Ifjúság u. 20, Pécs, H-7624, Hungary
| | - Tamás Dóczi
- MTA-PTE Clinical Neuroscience MRI Research Group, Ifjúság u. 20, Pécs, H-7624, Hungary.,Department of Neurosurgery, Medical School, University of Pécs, Rét u. 2, Pécs, H-7623, Hungary
| | - Zsolt Horváth
- Department of Neurosurgery, Medical School, University of Pécs, Rét u. 2, Pécs, H-7623, Hungary
| | - Péter Halász
- National Institute of Clinical Neurosciences, Amerikai út 57, Budapest, H-1145, Hungary
| | - Vera Juhos
- Epihope Non-Profit Kft, Szilágyi Erzsébet fasor 17-21, Budapest, 1026, Hungary
| | - Csilla Gyimesi
- Department of Neurology, Medical School, University of Pécs, Rét u. 2, Pécs, H-7623, Hungary
| | - Beáta Bóné
- Department of Neurology, Medical School, University of Pécs, Rét u. 2, Pécs, H-7623, Hungary
| | - Diána Kuperczkó
- Department of Neurology, Medical School, University of Pécs, Rét u. 2, Pécs, H-7623, Hungary
| | - Réka Horváth
- Department of Neurology, Medical School, University of Pécs, Rét u. 2, Pécs, H-7623, Hungary
| | - Ferenc Nagy
- Department of Neurology, Somogy County Moritz Kaposi Teaching Hospital, Sándor u. 40, Guba, H-7400, Hungary
| | - Anna Kelemen
- National Institute of Clinical Neurosciences, Amerikai út 57, Budapest, H-1145, Hungary
| | - Zsófia Jordán
- National Institute of Clinical Neurosciences, Amerikai út 57, Budapest, H-1145, Hungary
| | - Ákos Újvári
- National Institute of Clinical Neurosciences, Amerikai út 57, Budapest, H-1145, Hungary
| | - Koichi Hagiwara
- Epilepsy and Sleep Center, Fukuoka Sanno Hospital, 3-6-45, Momochihama, Sawara-ku, Fukuoka, 814-0001, Japan
| | - Jean Isnard
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Hospital for Neurology and Neurosurgery Pierre Wertheimer, 59 Boulevard Pinel, 69500, Lyon, France
| | - Endre Pál
- Department of Neurology, Medical School, University of Pécs, Rét u. 2, Pécs, H-7623, Hungary
| | - Attila Fekésházy
- Dr. József Baka Diagnostic, Radiation oncology, Research and Teaching Center, Somogy County Moritz Kaposi Teaching Hospital, Guba Sándor u. 40, Kaposvár, H-7400, Hungary.,MEDICOPUS Healthcare Provider and Public Nonprofit Ltd., Somogy County Moritz Kaposi Teaching Hospital, Guba Sándor u. 40, Kaposvár, H-7400, Hungary
| | - Dániel Fabó
- National Institute of Clinical Neurosciences, Amerikai út 57, Budapest, H-1145, Hungary
| | - Zsolt Vajda
- Dr. József Baka Diagnostic, Radiation oncology, Research and Teaching Center, Somogy County Moritz Kaposi Teaching Hospital, Guba Sándor u. 40, Kaposvár, H-7400, Hungary.,Department of Neurosurgery, Medical School, University of Pécs, Rét u. 2, Pécs, H-7623, Hungary
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4
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Ábrahám H, Molnár JE, Sóki N, Gyimesi C, Horváth Z, Janszky J, Dóczi T, Seress L. Etiology-related Degree of Sprouting of Parvalbumin-immunoreactive Axons in the Human Dentate Gyrus in Temporal Lobe Epilepsy. Neuroscience 2020; 448:55-70. [PMID: 32931846 DOI: 10.1016/j.neuroscience.2020.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/22/2020] [Accepted: 09/05/2020] [Indexed: 11/16/2022]
Abstract
In the present study, we examined parvalbumin-immunoreactive cells and axons in the dentate gyrus of surgically resected tissues of therapy-resistant temporal lobe epilepsy (TLE) patients with different etiologies. Based on MRI results, five groups of patients were formed: (1) hippocampal sclerosis (HS), (2) malformation of cortical development, (3) malformation of cortical development + HS, (4) tumor-induced TLE, (5) patients with negative MRI result. Four control samples were also included in the study. Parvalbumin-immunoreactive cells were observed mostly in subgranular location in the dentate hilus in controls, in tumor-induced TLE, in malformation of cortical development and in MR-negative cases. In patients with HS, significant decrease in the number of hilar parvalbumin-immunoreactive cells and large numbers of ectopic parvalbumin-containing neurons were detected in the dentate gyrus' molecular layer. The ratio of ectopic/normally-located cells was significantly higher in HS than in other TLE groups. In patients with HS, robust sprouting of parvalbumin-immunoreactive axons were frequently visible in the molecular layer. The extent of sprouting was significantly higher in TLE patients with HS than in other groups. Strong sprouting of parvalbumin-immunoreactive axons were frequently observed in patients who had childhood febrile seizure. Significant correlation was found between the level of sprouting of axons and the ratio of ectopic/normally-located parvalbumin-containing cells. Electron microscopy demonstrated that sprouted parvalbumin-immunoreactive axons terminate on proximal and distal dendritic shafts as well as on dendritic spines of granule cells. Our results indicate alteration of target profile of parvalbumin-immunoreactive neurons in HS that contributes to the known synaptic remodeling in TLE.
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Affiliation(s)
- Hajnalka Ábrahám
- Department of Medical Biology and Central Electron Microscopic Laboratory, University of Pécs Medical School, Szigeti u 12., Pécs 7624, Hungary.
| | - Judit E Molnár
- Department of Medical Biology and Central Electron Microscopic Laboratory, University of Pécs Medical School, Szigeti u 12., Pécs 7624, Hungary
| | - Noémi Sóki
- Department of Medical Biology and Central Electron Microscopic Laboratory, University of Pécs Medical School, Szigeti u 12., Pécs 7624, Hungary
| | - Csilla Gyimesi
- Department of Neurology, University of Pécs Medical School, Rét u. 2., Pécs 7623, Hungary
| | - Zsolt Horváth
- Department of Neurosurgery, University of Pécs Medical School, Rét u. 2., Pécs 7623, Hungary
| | - József Janszky
- Department of Neurology, University of Pécs Medical School, Rét u. 2., Pécs 7623, Hungary
| | - Tamás Dóczi
- Department of Neurosurgery, University of Pécs Medical School, Rét u. 2., Pécs 7623, Hungary
| | - László Seress
- Department of Medical Biology and Central Electron Microscopic Laboratory, University of Pécs Medical School, Szigeti u 12., Pécs 7624, Hungary
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5
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Lőrincz KN, Bóné B, Tóth M, Horváth R, Kovács N, Komoly S, Karádi K, Barsi P, Ábrahám H, Seress L, Horváth Z, Dóczi T, Janszky J, Gyimesi C. [Postoperative outcome of surgical interventions for epilepsy between 2005 and 2016 at the Epilepsy Center of Pécs]. Orv Hetil 2019; 160:270-278. [PMID: 30741003 DOI: 10.1556/650.2019.31321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Epilepsy as a chronic, severe neurologic disease significantly influences the quality of life of the epileptic patients. In candidates well selected for surgery, the seizure freedom is realistically achievable, and the quality of life can be further improved with complex individual rehabilitation. AIM We aimed to evaluate the postoperative outcome of patients who underwent epilepsy surgery between 2005 and 2016 at the Epilepsy Center at Pécs. METHOD We evaluated seizure status at regular follow-up visits after surgery and the quality of life using questionnaires focusing on employment and social status. RESULTS 76% of the 72 patients who underwent surgical resection for epilepsy were free from disabling seizures , and 10% had rare disabling seizures (almost seizure-free), 7% experienced worthwhile improvement and 7% had no worthwhile improvement. Comparing the employment status of patients free from disabling seizures to patients not free from disabling seizures, we found that the employment status is significantly influenced by seizure freedom (p<0.01, Fisher's exact test). While 67% of seizure-free patients were employed, only 19% of patients not free from disabling seizures were hired. CONCLUSION Our results resemble the international tendencies and success rate, proving epilepsy surgery as an available, valid and effective treatment in well selected patients. Orv Hetil. 2019; 160(7): 270-278.
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Affiliation(s)
- Katalin Nóra Lőrincz
- Neurológiai Klinika, Pécsi Tudományegyetem, Általános Orvostudományi Kar Pécs, Rét u. 2., 7623
| | - Beáta Bóné
- Neurológiai Klinika, Pécsi Tudományegyetem, Általános Orvostudományi Kar Pécs, Rét u. 2., 7623
| | - Márton Tóth
- Neurológiai Klinika, Pécsi Tudományegyetem, Általános Orvostudományi Kar Pécs, Rét u. 2., 7623
| | - Réka Horváth
- Neurológiai Klinika, Pécsi Tudományegyetem, Általános Orvostudományi Kar Pécs, Rét u. 2., 7623
| | - Norbert Kovács
- Neurológiai Klinika, Pécsi Tudományegyetem, Általános Orvostudományi Kar Pécs, Rét u. 2., 7623.,Klinikai Idegtudományi Képalkotó Kutatócsoport, PTE-MTA Pécs
| | - Sámuel Komoly
- Neurológiai Klinika, Pécsi Tudományegyetem, Általános Orvostudományi Kar Pécs, Rét u. 2., 7623.,Klinikai Idegtudományi Képalkotó Kutatócsoport, PTE-MTA Pécs
| | - Kázmér Karádi
- Magatartástudományi Intézet, Pécsi Tudományegyetem, Általános Orvostudományi Kar Pécs
| | - Péter Barsi
- MR Kutatóközpont, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest.,Pécsi Diagnosztikai Központ Pécs
| | - Hajnalka Ábrahám
- Orvosi Biológiai Intézet és Központi Elektronmikroszkópos Laboratórium, Pécsi Tudományegyetem, Általános Orvostudományi Kar Pécs
| | - László Seress
- Orvosi Biológiai Intézet és Központi Elektronmikroszkópos Laboratórium, Pécsi Tudományegyetem, Általános Orvostudományi Kar Pécs
| | - Zsolt Horváth
- Idegsebészeti Klinika, Pécsi Tudományegyetem, Általános Orvostudományi Kar Pécs
| | - Tamás Dóczi
- Idegsebészeti Klinika, Pécsi Tudományegyetem, Általános Orvostudományi Kar Pécs.,Pécsi Diagnosztikai Központ Pécs.,Klinikai Idegtudományi Képalkotó Kutatócsoport, PTE-MTA Pécs
| | - József Janszky
- Neurológiai Klinika, Pécsi Tudományegyetem, Általános Orvostudományi Kar Pécs, Rét u. 2., 7623.,Klinikai Idegtudományi Képalkotó Kutatócsoport, PTE-MTA Pécs
| | - Csilla Gyimesi
- Neurológiai Klinika, Pécsi Tudományegyetem, Általános Orvostudományi Kar Pécs, Rét u. 2., 7623
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6
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Tényi D, Gyimesi C, Kupó P, Horváth R, Bóné B, Barsi P, Kovács N, Simor T, Siegler Z, Környei L, Fogarasi A, Janszky J. Ictal asystole: A systematic review. Epilepsia 2016; 58:356-362. [DOI: 10.1111/epi.13644] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Dalma Tényi
- Department of Neurology; University of Pécs; Pécs Hungary
| | - Csilla Gyimesi
- Department of Neurology; University of Pécs; Pécs Hungary
| | - Péter Kupó
- Heart Institute; University of Pécs; Pécs Hungary
| | - Réka Horváth
- Department of Neurology; University of Pécs; Pécs Hungary
| | - Beáta Bóné
- Department of Neurology; University of Pécs; Pécs Hungary
| | - Péter Barsi
- MR Research Center; Semmelweis University; Budapest Hungary
| | - Norbert Kovács
- Department of Neurology; University of Pécs; Pécs Hungary
- PTE-MTA Clinical Neuroscience MR Research Group; Budapest Hungary
| | - Tamás Simor
- Heart Institute; University of Pécs; Pécs Hungary
| | - Zsuzsa Siegler
- Epilepsy Center; Bethesda Children's Hospital; Budapest Hungary
| | - László Környei
- Gottsegen György Hungarian Institute of Cardiology; Budapest Hungary
| | - András Fogarasi
- Epilepsy Center; Bethesda Children's Hospital; Budapest Hungary
| | - József Janszky
- Department of Neurology; University of Pécs; Pécs Hungary
- PTE-MTA Clinical Neuroscience MR Research Group; Budapest Hungary
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Tényi D, Gyimesi C, Kovács N, Tényi T, Janszky J. The possible role of the insula in the epilepsy and the gambling disorder of Fyodor Dostoyevsky. J Behav Addict 2016; 5:542-7. [PMID: 27558486 PMCID: PMC5264423 DOI: 10.1556/2006.5.2016.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 05/22/2016] [Accepted: 08/03/2016] [Indexed: 11/19/2022] Open
Abstract
Background The retrospective diagnosis of Fyodor Mikhailovich Dostoyevsky's (1821-1881) neurological and psychiatric disease proves to be particularly interesting. Recent neurobiological data suggest a solution to the questions regarding the writer's retrospective diagnosis, claiming the insular cortex to be the origin of the rare ecstatic seizures. Regarding Dostoyevsky's pathological gambling, this hypothesis is consistent with another finding from recent neuroscience, namely that the malfunction of the insula could be an important underlying pathology in gambling disorder. Case study Literary and scientific overview (1928-2015) on the subjects of Dostoyevsky's epilepsy and gambling disorder. Discussion and conclusion Taking Dostoyevsky's neurological (ecstatic seizures) and psychiatric (pathological gambling) disease and the crossroads into consideration, these two disciplines make regarding the underlying pathology, we would like to suggest a speculative theory that these two disorders have a common insular pathomechanism, namely, the malfunctioning of the risk prediction-risk prediction error coding system. Furthermore, based on Dostoyevsky's case, regarding gambling disorder in general, we would like to hypothesize that the three common gambling-related cognitive distortions (near-miss effect, gambler's fallacy, and the illusion of control) can be all attributed to the impairment of the anterior insular risk prediction-risk prediction error coding system.
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Affiliation(s)
- Dalma Tényi
- Department of Neurology, Faculty of Medicine, University of Pécs, Pécs, Hungary
| | - Csilla Gyimesi
- Department of Neurology, Faculty of Medicine, University of Pécs, Pécs, Hungary
| | - Norbert Kovács
- Department of Neurology, Faculty of Medicine, University of Pécs, Pécs, Hungary
| | - Tamás Tényi
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Pécs, Pécs, Hungary
| | - József Janszky
- Department of Neurology, Faculty of Medicine, University of Pécs, Pécs, Hungary
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Nagy SA, Horváth R, Perlaki G, Orsi G, Barsi P, John F, Horváth A, Kovács N, Bogner P, Ábrahám H, Bóné B, Gyimesi C, Dóczi T, Janszky J. Age at onset and seizure frequency affect white matter diffusion coefficient in patients with mesial temporal lobe epilepsy. Epilepsy Behav 2016; 61:14-20. [PMID: 27232377 DOI: 10.1016/j.yebeh.2016.04.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 04/05/2016] [Accepted: 04/06/2016] [Indexed: 02/01/2023]
Abstract
In mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS), structural abnormalities are present not only in the hippocampus but also in the white matter with ipsilateral predominance. Although the timing of epilepsy onset is commonly associated with clinical and semiological dissimilarities, limited data exist regarding white matter diffusion changes with respect to age at epilepsy onset. The aim of this study was to investigate diffusion changes in the white matter of patients with unilateral MTLE-HS with respect to clinical parameters and to compare them with an age- and sex-matched healthy control group. Apparent diffusion coefficients (ADCs) were derived using monoexponential approaches from 22 (11 early and 11 late age at onset) patients with unilateral MTLE-HS and 22 age- and sex-matched control subjects after acquiring diffusion-weighted images on a 3T MRI system. Data were analyzed using two-tailed t-tests and multiple linear regression models. In the group with early onset MTLE-HS, ADC was significantly elevated in the ipsilateral hemispheric (p=0.04) and temporal lobe white matter (p=0.01) compared with that in controls. These differences were not detectable in late onset MTLE-HS patients. Apparent diffusion coefficient of the group with early onset MTLE-HS was negatively related to age at epilepsy onset in the ipsilateral hemispheric white matter (p=0.03) and the uncinate fasciculus (p=0.03), while in patients with late onset MTLE-HS, ADC was no longer dependent on age at epilepsy onset itself but rather on the seizure frequency in the ipsilateral uncinate fasciculus (p=0.03). Such diffusivity pattern has been associated with chronic white matter degeneration, reflecting myelin loss and higher extracellular volume which are more pronounced in the frontotemporal regions and also depend on clinical features. In the group with early onset MTLE-HS, the timing of epilepsy seems to be the major cause of white matter abnormalities while in late onset disease, it has a secondary role in provoking diffusion changes.
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Affiliation(s)
- Szilvia A Nagy
- Pécs Diagnostics Center, H-7623 Pécs, Rét Street 2., Hungary; MTA-PTE, Neurobiology of Stress Research Group, H-7624 Pécs, Ifjúság Street 20., Hungary.
| | - Réka Horváth
- Department of Neurology, University of Pécs, H-7623 Pécs, Rét Street 2., Hungary.
| | - Gábor Perlaki
- Pécs Diagnostics Center, H-7623 Pécs, Rét Street 2., Hungary; MTA-PTE, Clinical Neuroscience MR Research Group, H-7623 Pécs, Rét Street 2., Hungary.
| | - Gergely Orsi
- Pécs Diagnostics Center, H-7623 Pécs, Rét Street 2., Hungary; MTA-PTE, Clinical Neuroscience MR Research Group, H-7623 Pécs, Rét Street 2., Hungary.
| | - Péter Barsi
- MR Research Centre, Semmelweis University, H-1083 Budapest, Balassa Street 6., Hungary.
| | - Flóra John
- Department of Neurology, University of Pécs, H-7623 Pécs, Rét Street 2., Hungary.
| | - Andrea Horváth
- Pécs Diagnostics Center, H-7623 Pécs, Rét Street 2., Hungary; Department of Neurosurgery, University of Pécs, H-7623 Pécs, Rét Street 2., Hungary.
| | - Norbert Kovács
- Department of Neurology, University of Pécs, H-7623 Pécs, Rét Street 2., Hungary; MTA-PTE, Clinical Neuroscience MR Research Group, H-7623 Pécs, Rét Street 2., Hungary.
| | - Péter Bogner
- Department of Radiology, University of Pécs, H-7624 Pécs, Ifjúság Street 13., Hungary.
| | - Hajnalka Ábrahám
- Department of Medical Biology, University of Pécs, H-7624 Pécs, Szigeti Street 12., Hungary; Central Electron Microscopic Laboratory, University of Pécs, H-7624 Pécs, Honvéd Street 1., Hungary.
| | - Beáta Bóné
- Department of Neurology, University of Pécs, H-7623 Pécs, Rét Street 2., Hungary.
| | - Csilla Gyimesi
- Department of Neurology, University of Pécs, H-7623 Pécs, Rét Street 2., Hungary.
| | - Tamás Dóczi
- Pécs Diagnostics Center, H-7623 Pécs, Rét Street 2., Hungary; MTA-PTE, Clinical Neuroscience MR Research Group, H-7623 Pécs, Rét Street 2., Hungary; Department of Neurosurgery, University of Pécs, H-7623 Pécs, Rét Street 2., Hungary.
| | - József Janszky
- Department of Neurology, University of Pécs, H-7623 Pécs, Rét Street 2., Hungary; MTA-PTE, Clinical Neuroscience MR Research Group, H-7623 Pécs, Rét Street 2., Hungary.
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Tényi D, Gyimesi C, Horváth R, Kovács N, Ábrahám H, Darnai G, Fogarasi A, Büki A, Janszky J. Concussive convulsions: A YouTube video analysis. Epilepsia 2016; 57:1310-6. [DOI: 10.1111/epi.13432] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Dalma Tényi
- Department of Neurology; University of Pécs; Pécs Hungary
| | - Csilla Gyimesi
- Department of Neurology; University of Pécs; Pécs Hungary
| | - Réka Horváth
- Department of Neurology; University of Pécs; Pécs Hungary
| | - Norbert Kovács
- Department of Neurology; University of Pécs; Pécs Hungary
- PTE-MTA Clinical Neuroscience MR Research Group; Pécs Hungary
| | | | - Gergely Darnai
- Department of Neurology; University of Pécs; Pécs Hungary
| | - András Fogarasi
- Epilepsy Center; Bethesda Children's Hospital; Budapest Hungary
| | - András Büki
- Department of Neurosurgery; University of Pécs; Pécs Hungary
| | - József Janszky
- Department of Neurology; University of Pécs; Pécs Hungary
- PTE-MTA Clinical Neuroscience MR Research Group; Pécs Hungary
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Tényi D, Rajna P, Janszky J, Horváth Z, Tényi T, Gyimesi C. [Dostoyevsky's epilepsy in the light of recent neurobiological data]. Ideggyogy Sz 2014; 67:52-55. [PMID: 24654447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND PURPOSE Since the 1960s several theories have developed on the epilepsy of Fyodor Mikhailovich Dostoyevsky. Probably the most exciting and still actual question might be the subject of the "ecstatic aura", he described in his novels based on his own experiences. During this extremely rare seizure onset the patients experience a strong sense of happiness, harmony and wholeness. The symptomatogenic zone of ecstatic seizures were considered to be of temporal lobe origin for a long time. Lately though this theory seems to be questioned based on the results of SPECT and deep brain EEG monitoring techniques in addition to the enrichment of our knowledge concerning the function of the insular cortex. METHODS Literary and scientific overview on the subject of Dostoyevsky's epilepsy, with special concern to his ecstatic seizures. RESULTS AND CONCLUSION According to new electrophysiology and imaging techniques ecstatic seizures--including the seizure onset of Dostoyevsky--could rather be connected to the insular cortex.
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Gyimesi C, Bóné B, Tóth M, Horváth R, Komoly S, Janszky J. [Antiepileptic drugs in treatment of epilepsy and follow up of their efficacy]. Ideggyogy Sz 2013; 66:76-88. [PMID: 23750423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Epilepsy is one of the most common neurological diseases usually demanding long term treatment. The prime goal of therapy is to achieve seizure freedom with avoidance of side effects. Precise diagnosis is fundamental selecting the proper antiepileptic drug(s). In addition of wide-spectrum antiepileptics, selective syndrome-specific antiepileptic drugs are available. Pharmacological features of the new antiepileptics allow more personalized clinical use. Aim of this paper is to provide a comprehensive pragmatic review of therapeutic possibilities and recommendations currently accessible in Hungary.
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Affiliation(s)
- Csilla Gyimesi
- Pécsi Tudományegyetem, Klinikai Központ, Neurológiai Klinika, Pécs.
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Fogarasi A, Loddenkemper T, Mellado C, Tuxhorn I, Evers G, Sarco D, Burgess RC, Halász P, Barsis P, Gyorsok Z, Gyimesi C, Kóbor J, Siegler Z, Janszky J, Jakus R, Rásonyi G, Ebner A, Woermann FG, Sahin M. Sturge-Weber syndrome: clinical and radiological correlates in 86 patients. Ideggyogy Sz 2013; 66:53-57. [PMID: 23607230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUNDS AND PURPOSE To correlate the extent of the leptomeningeal angiomatosis with clinical features in Sturge-Weber syndrome (SWS). METHODS The study group consisted of 86 consecutive patients aged two months to 56 (mean 7.9 +/- 10.3) years with SWS and epilepsy. Clinical and MRI data were analyzed. RESULTS Based on the extent of leptomeningeal angiomatosis, patients were divided into two subgroups: 43 patients had hemispheric angiomatosis and atrophy, whereas, another 43 had focal involvement. Nine of the 43 hemispherial patients (10%) showed bilateral involvement: all of these bilateral cases demonstrated dominance in a single side with hemispheric leptomeningeal angiomatosis and contralateral focal extension. Hemispheric and focal subgroups were clinically different. Patients with hemispheric SWS were younger at the age of epilepsy onset (p < 0.001) and age at MRI examination (p < 0.05). Neither gender, lateralization, duration of epilepsy, appearance of secondarily generalized seizures, nor seizure frequency revealed a significant difference between subgroups. CONCLUSION Bilateral involvement is frequent and occurs in cases with a hemisperic involvement on one side. The age of epilepsy onset is related to the extent of leptomeningeal angiomatosis. Patients with hemispheric form of SWS presented with earlier age of seizure onset. Focal pial angiomatoses do not tend to progress (a longer duration is not associated with more frequent hemispheric involvement). Other variables including seizure frequency and secondary generalized tonic-clonic seizures are not associated with the extent of angiomatosis.
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Affiliation(s)
- András Fogarasi
- Epilepsy Center, Bethesda Children's Hospital, Budapest, Hungary.
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Karádi K, Janszky J, Gyimesi C, Horváth Z, Lucza T, Dóczi T, Kállai J, Abrahám H. Correlation between calbindin expression in granule cells of the resected hippocampal dentate gyrus and verbal memory in temporal lobe epilepsy. Epilepsy Behav 2012; 25:110-9. [PMID: 22796338 DOI: 10.1016/j.yebeh.2012.06.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 06/05/2012] [Accepted: 06/07/2012] [Indexed: 01/06/2023]
Abstract
Calbindin expression of granule cells of the dentate gyrus is decreased in temporal lobe epilepsy (TLE) regardless of its etiology. In this study, we examined the relation between reduction of calbindin immunoreactivity and the verbal and visuo-spatial memory function of patients with TLE of different etiologies. Significant linear correlation was shown between calbindin expression and short-term and long-term percent retention and retroactive interference in auditory verbal learning test (AVLT) of patients including those with hippocampal sclerosis. In addition, we found significant linear regression between calbindin expression and short-term and long-term percent retention of AVLT in patients whose epilepsy was caused by malformation of cortical development or tumor and when no hippocampal sclerosis and substantial neuronal loss were detected. Together with the role of calbindin in memory established in previous studies on calbindin knock-out mice, our results suggest that reduction of calbindin expression may contribute to memory impairments of patients with TLE, particularly, when neuronal loss is not significant.
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Affiliation(s)
- Kázmér Karádi
- Department of Behavioral Sciences, Faculty of Medicine, University of Pécs, Szigeti u. 12., Pécs 7624, Hungary
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Bone B, Fogarasi A, Schulz R, Gyimesi C, Kalmar Z, Kovacs N, Ebner A, Janszky J. Secondarily generalized seizures in temporal lobe epilepsy. Epilepsia 2012; 53:817-24. [DOI: 10.1111/j.1528-1167.2012.03435.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abrahám H, Richter Z, Gyimesi C, Horváth Z, Janszky J, Dóczi T, Seress L. Degree and pattern of calbindin immunoreactivity in granule cells of the dentate gyrus differ in mesial temporal sclerosis, cortical malformation- and tumor-related epilepsies. Brain Res 2011; 1399:66-78. [PMID: 21621747 DOI: 10.1016/j.brainres.2011.05.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 05/04/2011] [Accepted: 05/04/2011] [Indexed: 11/17/2022]
Abstract
A loss of calbindin immunoreactivity in granule cells of the hippocampal dentate gyrus is a characteristic feature of temporal lobe epilepsy with hippocampal sclerosis. Whether decreased calbindin expression is unique to the hippocampal sclerosis associated with cryptogenic temporal lobe epilepsy, or also occurs in tumor- or malformation-related epilepsy, is unknown. We show that calbindin immunoreactivity in granule cells has been decreased in epilepsy regardless of its etiology. In cases of cortical malformations or hippocampal sclerosis, calbindin immunoreactivity was undetectable in most granule cells. In tumor-related resections, in patients who had a long history of epileptic seizures, calbindin was detected only in one-third of granule cells. Regardless of etiology, calbindin expression correlated with age of onset and with duration of the epilepsy. In contrast to tumor-induced epilepsy, where calbindin-immunoreactive granule cells were equally distributed in the granule cell layer, in hippocampal sclerosis and malformation-related epilepsy, two-thirds of calbindin-immunoreactive granule cells were located in the outer half and only one-third in the inner half of the layer. Developmentally, granule cells at the border of the molecular layer are ontogenetically the oldest, and those at the border of the hilus are the youngest. The reduction of calbindin immunoreactivity in ontogenetically younger granule cells highlights the deleterious effect of early occurring epilepsy and initial early precipitating injury, including febrile seizures that may substantially affect developing immature granule cells, but less the earlier born matured ones.
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Affiliation(s)
- Hajnalka Abrahám
- Central Electron Microscopic Laboratory, Faculty of Medicine, University of Pécs, Szigeti u 12., Pécs, 7624, Hungary.
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Elsharkawy AE, Pannek H, Woermann FG, Gyimesi C, Hartmann S, Aengenendt J, Ogutu T, Hoppe M, Schulz R, Pietilä TA, Ebner A. Apical temporal lobe resection; "tailored" hippocampus-sparing resection based on presurgical evaluation data. Acta Neurochir (Wien) 2011; 153:231-8. [PMID: 20640459 DOI: 10.1007/s00701-010-0734-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2009] [Accepted: 06/24/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND It is the aim of epilepsy surgery in patients with lesional epilepsy for the surgeon to not only remove the lesion itself, but also the epileptogenic zone. Here, we report our experience with a modified temporal resection technique confined to the apical temporal lobe, i.e., sparing the hippocampal formation in patients with epileptogenic lesions in the anterior part of the temporal lobe. This apical temporal lobe resection (aTLR) includes tailored lesionectomy, amygdalectomy, and resection of the mesial structures only in the apex of the temporal lobe. This paper presents our surgical technical details and the outcome of aTLR. METHODS Between 2001 and 2008, aTLR was performed in 61 patients. All patients underwent comprehensive presurgical evaluation including video-EEG monitoring, magnetic resonance imaging (MRI), and neuropsychological testing. All patients had a lesion in the apex of the temporal lobe and a normal hippocampus as seen in MRI, as well as intact memory functions in neuropsychological examination. There were 33 males (54.1%) and 28 females (45.9%). The mean age in years at epilepsy onset was 20.2 ± 13.4, the mean age at epilepsy surgery was 32.1 ± 11.9, the mean preoperative epilepsy duration was 11.8 ± 8.8 years and the mean duration of follow-up was 2.1 ± 1.3 years (range 0.5-6 years). RESULTS Fifty-four (88.5%) of 61 patients were in Engel Class 1 at 6 months, 38 (80.9%) of 47 at 2 years and nine (81.8%) of 11 at the 5 year follow-up. Histopathological examination showed tumors in 31 patients, FCD in ten patients, amygdala sclerosis in seven patients, cavernomas in six patients, unspecific reactions in eight patients, and gliosis in one patient. Surgical complications occurred in four patients: one had a permanent and three had transient complications which could be successfully treated. Fifty (82%) resections were considered to be complete resections as evaluated by serial postoperative MRI, seven patients (11.5%) had incomplete resection of the preoperative MRI lesion and in four patients (6.6%) it remained unclear. Fifteen patients (29.4%) were withdrawn from antiepileptic drugs for more than 2 years without relapse. Postoperative neuropsychological examination revealed worsening of memory performance in two patients (3.2%) and improved or no changes in the rest of the patients. CONCLUSIONS Apical temporal resection sparing the mesial temporal structures is an effective procedure with good long-term seizure outcome in patients with refractory epilepsy due to lesions confined to the apex of the temporal lobe.
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Gyimesi C, Pannek H, Woermann FG, Elsharkawy AE, Tomka-Hoffmeister M, Hortsmann S, Aengenendt J, Horvath RA, Schulz R, Hoppe M, Janszky J, Ebner A. Absolute spike frequency and etiology predict the surgical outcome in epilepsy due to amygdala lesions. Epilepsy Res 2010; 92:177-82. [DOI: 10.1016/j.eplepsyres.2010.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Revised: 09/11/2010] [Accepted: 09/13/2010] [Indexed: 10/18/2022]
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Janszky J, Kovacs N, Gyimesi C, Fogarasi A, Doczi T, Wiebe S. Epilepsy surgery, antiepileptic drug trials, and the role of evidence. Epilepsia 2010; 51:1004-9. [DOI: 10.1111/j.1528-1167.2010.02566.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Toth V, Hejjel L, Fogarasi A, Gyimesi C, Orsi G, Szucs A, Kovacs N, Komoly S, Ebner A, Janszky J. Periictal heart rate variability analysis suggests long-term postictal autonomic disturbance in epilepsy. Eur J Neurol 2010; 17:780-7. [DOI: 10.1111/j.1468-1331.2009.02939.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Elsharkawy AE, Pannek H, Schulz R, Hoppe M, Pahs G, Gyimesi C, Nayel M, Issa A, Ebner A. Outcome of extratemporal epilepsy surgery experience of a single center. Neurosurgery 2009; 63:516-25; discussion 525-6. [PMID: 18812963 DOI: 10.1227/01.neu.0000324732.36396.e9] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Our aim was to determine the surgical outcome in adult patients with intractable extratemporal epilepsy and follow it over time. METHODS We retrospectively studied the operative outcome in 218 consecutive adult patients with extratemporal lesions who underwent resective surgical treatment for intractable partial epilepsy in the Bethel Epilepsy Center, Bielefeld, Germany, between 1991 and 2005. Patients were divided into three groups according to the 5-year period in which the surgical procedure took place. RESULTS Group I (1991-1995) consisted of 64 patients. The postoperative Engel Class I outcome was 50% at 6 months, 44.4% at 2 years, and 45.2% at 5 years. Group II (1996-2000) included 91 patients. Engel Class I outcome was 57.1% at 6 months, 53.8% at 2 years, and 53.5% at 5 years. In Group III (2001-2005), there were 63 patients. Engel Class I outcome was 65.1% at 6 months, 61.3% at 2 years, and 60.6% at 5 years. Short duration of epilepsy, surgery before 30 years of age, pathological findings of neoplasm, and well-circumscribed lesions on the preoperative magnetic resonance imaging scan were good prognostic factors. Poor prognostic factors were one or more of the following: psychic aura, generalized tonic-clonic seizure, versive seizure, history of previous surgery, and focal cortical dysplasia. On multivariate analysis, only the presence of well-circumscribed lesions on preoperative magnetic resonance imaging predicted a positive outcome (P = 0.001). CONCLUSION Our results indicate that extratemporal epilepsy surgery at the Bethel Epilepsy Center has become more effective in the treatment of extratemporal epilepsy patients over the years, ensuring continuous improvement in outcome. This improvement can be attributed mainly to more restrictive patient selection.
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Affiliation(s)
- Alaa E Elsharkawy
- Department of Presurgical Evaluation, Bethel Epilepsy Center, Bielefeld, Germany.
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Horváth R, Kalmár Z, Fehér N, Fogarasi A, Gyimesi C, Janszky J. [Brain lateralization and seizure semiology: ictal clinical lateralizing signs]. Ideggyogy Sz 2008; 61:231-237. [PMID: 18763478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Clinical lateralizing signs are the phenomena which can unequivocally refer to the hemispheric onset of epileptic seizures. They can improve the localization of epileptogenic zone during presurgical evaluation, moreover, their presence can predict a success of surgical treatment. Primary sensory phenomena such as visual aura in one half of the field of vision or unilateral ictal somatosensory sensation always appear on the contralateral to the focus. Periictal unilateral headache, although it is an infrequent symptom, is usually an ipsilateral sign. Primary motor phenomena like epileptic clonic, tonic movements, the version of head ubiquitously appear contralateral to the epileptogenic zone. Very useful lateralization sign is the ictal hand-dystonia which lateralizes to the contralateral hemisphere in nearly 100%. The last clonus of the secondarily generalized tonic-clonic seizure lateralizes to the ipsilateral hemisphere in 85%. The fast component of ictal nystagmus appears in nearly 100% on the contralateral side of the epileptic focus. Vegetative symptoms during seizures arising from temporal lobe such as spitting, nausea, vomiting, urinary urge are typical for seizures originating from non-dominant (right) hemisphere. Ictal pallor and cold shivers are dominant hemispheric lateralization signs. Postictal unilateral nose wiping refers to the ipsilateral hemispheric focus compared to the wiping hand. Ictal or postictal aphasia refers to seizure arising from dominant hemisphere. Intelligable speech during complex partial seizures appears in non-dominant seizures. Automatism with preserved consciousness refers to the seizures of non-dominant temporal lobe.
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Affiliation(s)
- Réka Horváth
- Pécsi Tudományegyetem, Neurológiai Klinika, Pécs
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Tóth V, Hejjel L, Kalmár Z, Fogarasi A, Auer T, Gyimesi C, Szucs A, Janszky J. [Effect of epileptic seizures on the heart rate]. Ideggyogy Sz 2008; 61:155-161. [PMID: 18567390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Sudden death appears in 8-17% of epilepsy patients non-responding to antiepileptic therapy. Some studies suggest that the most common cause of death is seizure-related cardiac arrhythmia. AIM OF STUDY To analyze the alteration of the heart rate six hours before and after the seizures. METHODS Eighteen patients suffering from focal epilepsy were examined before epilepsy surgery. Video-EEG-ECG was carried out for 2-10 days, and 32 seizures were registered. Analysis of the heart rate was based on the 5-minute-long epochs of the ECGs taken at the 5-10-15-30th minutes and at the 1-3-6th hours before and after seizures. RESULTS The heart rate increases (from an average of 69 beats/min to 92 beats/min, p<0.001) immediately after seizures, though significantly higher heart rate was observed 3 hours after seizures. There were no patients with severe peri-ictal bradycardia. In one of our patients, ectopic cardiac rhythm occurred after a generalized tonic-clonic seizure. CONCLUSIONS We can conclude that the sympathetic activity increases while the parasympathetic activity decreases after seizures. The observed alterations lasted for a long time and predict fatal arrhythmias. These suggest that sudden death in epilepsy can be induced by cardiac arrhythmias connected with epileptic seizures.
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Affiliation(s)
- Vanda Tóth
- Pécsi Tudományegyetem, Neurológiai Klinika, Pécs
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Elsharkawy AE, Behne F, Oppel F, Pannek H, Schulz R, Hoppe M, Pahs G, Gyimesi C, Nayel M, Issa A, Ebner A. Long-term outcome of extratemporal epilepsy surgery among 154 adult patients. J Neurosurg 2008; 108:676-86. [DOI: 10.3171/jns/2008/108/4/0676] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The goal of this study was to evaluate the long-term outcome of patients who underwent extratemporal epilepsy surgery and to assess preoperative prognostic factors associated with seizure outcome.
Methods
This retrospective study included 154 consecutive adult patients who underwent epilepsy surgery at Bethel Epilepsy Centre, Bielefeld, Germany between 1991 and 2001. Seizure outcome was categorized based on the modified Engel classification. Survival statistics were calculated using Kaplan–Meier curves, life tables, and Cox regression models to evaluate the risk factors associated with outcomes.
Results
Sixty-one patients (39.6%) underwent frontal resections, 68 (44.1%) had posterior cortex resections, 15 (9.7%) multilobar resections, 6 (3.9%) parietal resections, and 4 (2.6%) occipital resections. The probability of an Engel Class I outcome for the overall patient group was 55.8% (95% confidence interval [CI] 52–58% at 0.5 years), 54.5% (95% CI 50–58%) at 1 year, and 51.1% (95% CI 48–54%) at 14 years. If a patient was in Class I at 2 years postoperatively, the probability of remaining in Class I for 14 years postoperatively was 88% (95% CI 78–98%). Factors predictive of poor long-term outcome after surgery were previous surgery (p = 0.04), tonic–clonic seizures (p = 0.02), and the presence of an auditory aura (p = 0.03). Factors predictive of good long-term outcome were surgery within 5 years after onset (p = 0.015) and preoperative invasive monitoring (p = 0.002).
Conclusions
Extratemporal epilepsy surgery is effective according to findings on long-term follow-up. The outcome at the first 2-year follow-up visit is a reliable predictor of long-term Engel Class I postoperative outcome.
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Affiliation(s)
- Alaa Eldin Elsharkawy
- 1Department of Presurgical Evaluation and
- 3Neurosurgical Department, Cairo University, Cairo, Egypt
| | - Friedrich Behne
- 2Neurosurgical Department, Bethel Epilepsy Centre, Bielefeld, Germany; and
| | - Falk Oppel
- 2Neurosurgical Department, Bethel Epilepsy Centre, Bielefeld, Germany; and
| | - Heinz Pannek
- 2Neurosurgical Department, Bethel Epilepsy Centre, Bielefeld, Germany; and
| | | | | | | | | | - Mohamed Nayel
- 3Neurosurgical Department, Cairo University, Cairo, Egypt
| | - Ahmed Issa
- 3Neurosurgical Department, Cairo University, Cairo, Egypt
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Janszky J, Fogarasi A, Toth V, Magalova V, Gyimesi C, Kovacs N, Schulz R, Ebner A. Peri-ictal vegetative symptoms in temporal lobe epilepsy. Epilepsy Behav 2007; 11:125-9. [PMID: 17584534 DOI: 10.1016/j.yebeh.2007.04.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2007] [Revised: 04/14/2007] [Accepted: 04/17/2007] [Indexed: 12/16/2022]
Abstract
We investigated peri-ictal vegetative symptoms (PIVS) in 141 patients with adult temporal lobe epilepsy (TLE) and assessed frequency, gender effect, and lateralizing value of peri-ictal autonomic signs. We recorded abdominal auras in 62%, goosebumps in 3%, hypersalivation in 12%, spitting in 1%, cold shivering in 3%, urinary urge in 3%, water drinking in 7%, postictal nose wiping (PNW) in 44%, and postictal coughing in 16%. At least one vegetative sign appeared in 86% of the patients. The presence of PIVS did not have a significant lateralizing value. PNW occurred in 52% of women and in 33% of men, whereas any PIVS was present in 93% of women and 77% of men. In summary, contradictory to previous studies, the presence of PIVS has no lateralizing value, which may be linked to a low frequency of occurrence of PIVS. PIVS, especially PNW, occurred more frequently in women, supporting the gender differences in epilepsy.
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Affiliation(s)
- J Janszky
- Epilepsy Center Bethel, Bielefeld, Germany.
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Gyimesi C, Fogarasi A, Kovács N, Toth V, Magalova V, Schulz R, Ebner A, Janszky J. Patients' ability to react before complex partial seizures. Epilepsy Behav 2007; 10:183-6. [PMID: 17088108 DOI: 10.1016/j.yebeh.2006.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Revised: 10/01/2006] [Accepted: 10/06/2006] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of the study described here was to investigate the pathophysiology of patients' ability to react during the conscious (aura) phase of complex partial seizures (CPS) originating from the temporal lobe. METHODS We reviewed video recordings of CPS experienced by 130 adult patients who had undergone epilepsy surgery for intractable medial temporal lobe epilepsy. All patients were instructed to push the alarm button when they felt an aura. We defined the preictal reactivity as the ability to push the alarm button before the complex partial (unconscious) phase of seizures. RESULTS Seventy-seven patients (59%) pushed the alarm button before seizures. Patients with preictal reactivity were significantly younger, more often had lateralized EEG seizure patterns, and had a better postoperative outcome. Patients who did not push the alarm button had secondarily generalized seizures more often. CONCLUSIONS Ability to react before CPS is associated with a circumscribed region involved at seizure onset and spread, and with a seizure-free postoperative outcome.
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Affiliation(s)
- C Gyimesi
- Epilepsy Center Bethel, Bielefeld, Germany
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Janszky J, Fogarasi A, Magalova V, Gyimesi C, Kovács N, Schulz R, Ebner A. Unilateral hand automatisms in temporal lobe epilepsy. Seizure 2006; 15:393-6. [PMID: 16757187 DOI: 10.1016/j.seizure.2006.05.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2006] [Revised: 03/28/2006] [Accepted: 05/03/2006] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To analyse the lateralising value of unilateral manual automatism (UMA), its relation to contralateral dystonia and the hand by which the UMA was performed. METHODS In this retrospective study, we reviewed video recordings of 141 patients (mean age 34.1+/-10) who had consecutively undergone presurgical evaluations with ictal video-EEG recordings and high-resolution MRI, had had epilepsy surgery due to intractable medial temporal lobe epilepsy with complex partial seizures due to unilateral medial temporal lobe lesions. The video recordings were prospectively reviewed by one of the authors blinded to patient's clinical data except the diagnosis of medial temporal lobe epilepsy. Altogether 310 archived seizures were analysed. RESULTS Hand automatisms occurred in 86.5% of patients. UMA occurred in 53% of patients. If UMA was accompanied by contralateral hand dystonia, it had a high lateralising value to the ipsilateral epileptic focus (EF), it was ipsilateral in 85% of patients. Conversely, if UMA occurred without contralateral dystonia, it had only a limited lateralising value because it was ipsilateral to the EF in only 63% of patients. However, we found that left-sided UMA without dystonia had a high lateralising value to the left hemisphere (ipsilateral to the EF in 82%), while right-sided UMA without dystonia has practically no lateralising value. CONCLUSIONS UMA with contralateral dystonia has a high lateralising value to the ipsilateral hemisphere. Left-sided UMA without contralateral dystonia has a lateralising value to the left hemisphere. Right-sided UMA without contralateral dystonia has no lateralising value.
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Affiliation(s)
- J Janszky
- Epilepsy Center Bethel, Bielefeld, Germany.
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Kondakor I, Toth M, Wackermann J, Gyimesi C, Czopf J, Clemens B. Distribution of Spatial Complexity of EEG in Idiopathic Generalized Epilepsy and Its Change After Chronic Valproate Therapy. Brain Topogr 2005; 18:115-23. [PMID: 16341579 DOI: 10.1007/s10548-005-0280-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2005] [Indexed: 10/25/2022]
Abstract
The objective of this study was to investigate the global and regional spatial synchrony of the EEG background activity, and to assess the effect of chronic valproate therapy on spatial synchrony. 15 idiopathic generalized epilepsy (IGE) patients were examined and compared to 16 normal controls. Resting EEG with 19 channels was investigated before and during chronic administration of valproate (VPA). Omega, a single-valued measure of spatial covariance complexity, was calculated to assess the degree of spatial synchrony of EEG. Furthermore, a new parameter was defined to characterize the distribution of spatial synchrony (Antero-Posterior Complexity Ratio, APCR). Global Omega complexity was significantly lower in IGE compared to controls, while regional complexity showed significant differences only in the anterior region: the IGE group showed lower complexity. APCR was significantly lower in IGE. VPA therapy (1) lowered the global complexity, (2) increased regional complexity in the anterior region, but decreased it in the posterior region, and (3) increased APCR. In IGE lower complexity, i.e. enhanced spatial synchrony, was found, especially in the anterior cortical area. VPA modified the distribution of spatial synchrony in IGE patients towards that of normal controls, although the effect is not identical with full normalization of cortical bioelectric activity. Whether the observed change of spatial synchrony distribution may reflect the normalizing effect of valproate on the brain state is worth further investigation.
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Affiliation(s)
- Istvan Kondakor
- Department of Neurology, Medical Center, University of Pécs, H-7623, Pécs, Rét utca 2, Hungary.
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Janszky J, Hoppe M, Clemens Z, Janszky I, Gyimesi C, Schulz R, Ebner A. Spike frequency is dependent on epilepsy duration and seizure frequency in temporal lobe epilepsy. Epileptic Disord 2005; 7:355-9. [PMID: 16338679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2005] [Accepted: 08/20/2005] [Indexed: 05/05/2023]
Abstract
OBJECTIVES We wanted to investigate factors that are associated with frequency of interictal epileptiform discharges by investigating 303 patients with temporal lobe epilepsy (TLE). METHODS We included all patients who consecutively underwent the adult presurgical evaluation program at our center and who had intractable, medial TLE with complex partial seizures due to unilateral medial temporal lobe lesions. The interictal EEG samples were automatically recorded and stored on computer. The location and frequency of interictal epileptiform discharges were assessed by visual analysis of interictal EEG samples of 2-minute duration every hour. RESULTS There were 303 patients (aged 16-63) who met the inclusion criteria. The median interictal epileptiform discharge frequency was 15 IED/h, the median seizure frequency was 4 seizures/month. According to univariate analyses, we found that age at monitoring, epilepsy duration, and higher seizure frequency were associated with higher interictal epileptiform discharge frequency. In the logistic regression analysis, we found that higher seizure frequency (p < 0.001) and longer epilepsy duration (p = 0.007) were independently associated with higher spike frequency, while the age at monitoring was not. CONCLUSIONS Seizure frequency and epilepsy duration (years of patient's life with seizure activity) were independently associated with IED frequency, suggesting that IED are modulated by seizures.
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