ABSTRACT
Objective To evaluate the effect of vagus nerve stimulation (VNS)on post－encephalitic intrac-table epilepsy and the improvement of postoperative cognitive function and quality of life.Methods The patients with post－encephalitic epilepsy in Sanbo Brain Hospital,Capital Medical University from January 2008 to December 2016 were selected.A single center and retrospective study method was used to evaluate the cognitive function,social function of preoperative and postoperative and postoperative seizure classification.The follow－up time points included preopera-tive,posto-perative in 6 months,1 year after operation and postoperative annual review.Results A total of 43 patients were followed up,including 19 females and 24 males,with an average age of (9.37 ± 4.18)years old.The time of fol-low－up was (43.90 ± 33.04)months.According to Engel classification:GradeⅠ3 cases (7.0%),gradeⅡ3 ca-ses (7. 0%),grade Ⅲ14 cases (32.6%),grade Ⅳ21 cases (48.8%).According to McHugh classification:GradeⅠ8 cases (18.6%),grade Ⅱ12 cases (28%),gradeⅢ11 cases (25.5%),gradeⅣ6 cases (14.0%),gradeⅤ4 cases (9.3%).Speech improvement of postoperative:significant improvement in 3 cases (7.0%),slightly improved in 17 cases (39.6%);interpersonal communication improvement of postoperative:significantly increased 7 cases (16. 4%), slightly improved 16 cases(37.2%);learning/working ability improvement of postoperative:significantly improved 6 cases (14. 0%),slightly increased 14 cases(32. 6%).The postoperative VIQ (6.21 ±5.02)scores,PIQ (7.28 ±6.10)scores,FIQ (2.93 ±3.74)scores and MQ were (4.81 ± 2.98)scores higher than preoperative.Conclusions VNS can effectively im-prove the seizures of post－encephalitic epilepsy as well as the children's quality of life,cognition and social function.
ABSTRACT
The epileptic eye and head movements during epileptic seizures may be much more complicated thanpeople originally understood, which can be ipsilateral or contralateral to the electroencephalographyfocus. Here, we describe a male patient with drug resistant focal seizures associated with a directionalseparation between head and eye movement before evolving into generalized tonic-clonic seizure.His contralateral head leading turning showed forced, sustained, and unnatural features companiedby ipsilateral eye staring. Stereoeletroencephalography monitoring was performed, and 4 habitualseizures were recorded over 5 days. Three seizures showed left head leading turning and generalizedtonic-clonic seizure, and only one showed dizziness and ringing in the ears. All the seizures showedthat the ictal onset contacts were located in the posterior inferior temporal sulcus which borders onthe anterolateral part of medial superior temporal area. The patient underwent a resection includingtemporooccipital region, and the histopathology showed focal cortical dysplasia type Ic. He has beenseizure free for two years after operation. The scores of the intelligence and memory quotient improvedhalf year after operation.
ABSTRACT
<p><b>BACKGROUND</b>Bipolar electro-coagulation has a reported efficacy in treating epilepsy involving functional cortex by pure electro-coagulation or combination with resection. However, the mechanisms of bipolar electro-coagulation are not completely known. We studied the acute cortical blood flow and histological changes after bipolar electro-coagulation in 24 patients with intractable temporal lobe epilepsy.</p><p><b>METHODS</b>Twenty-four patients were consecutively enrolled, and divided into three groups according to the date of admission. The regional cortical blood flow (rCBF), electrocorticography, the depth of cortex damage, and acute histological changes (H and E staining, neuronal staining and neurofilament (NF) staining) were analyzed before and after the operation. The t-test analysis was used to compare the rCBF before and after the operation.</p><p><b>RESULTS</b>The rCBF after coagulation was significantly reduced (P < 0.05). The spikes were significantly reduced after electro-coagulation. For the temporal cortex, the depth of cortical damage with output power of 2-9 W after electro-coagulation was 0.34 ± 0.03, 0.48 ± 0.06, 0.69 ± 0.06, 0.84 ± 0.09, 0.98 ± 0.08, 1.10 ± 0.11, 1.11 ± 0.09, and 1.22 ± 0.11 mm, respectively. Coagulation with output power of 4-5 W completely damaged the neurons and NF protein in the molecular layer, external granular layer, and external pyramidal layer.</p><p><b>CONCLUSIONS</b>The electro-coagulation not only destroyed the neurons and NF protein, but also reduced the rCBF. We concluded that the injuries caused by electro-coagulation would prevent horizontal synchronization and spread of epileptic discharges, and partially destroy the epileptic focus.</p>