Evaluation of memory in persons with mesial temporal lobe sclerosis: A combined fMRI and VBM study

Persons with drug refractory TLE have the option of being managed by surgery. They may develop memoryimpairment with specific etiology of mesial temporal sclerosis and anterior temporal lobe resection (ATLR).The study evaluated the semantic verbal memory outcomes in pre- and post-surgery temporal lobe epilepsy(TLE) patients using functional MRI and voxel morphometric methods. Twenty consecutive persons withdrug-resistant epilepsy (DRE) and 20 healthy controls were recruited after obtaining the institute ethicsapproval. The fMRI scans were performed on a 1.5 T MR Scanner using standardized semantic verbal memorytasks using a native Hindi paradigm, before and after an anterior temporal lobectomy (in cases). A task-basedfunctional connectivity (FC) was estimated using a conn toolbox. Data analysis was carried out using thestatistical parametric imaging (SPM12) and CAT12 toolbox. Post-surgery TLE group showed increased robustFC in the right middle and posterior temporal regions as compared to pre-surgery session. A significantreduction in grey matter volume was observed in the left temporal lobe post-operatively as compared to presurgery and healthy control groups. In the post-surgery TLE group, neuropsychological scores were reduced inspecific PGI domains such as visuospatial, working memory, and executive functioning. Our results may helpin understanding of memory reorganization in TLE post-operatively.

Clinical and immunological responses of zidovudine lamivudine-nevirapine versus tenofovir lamivudine-efavirenz antiretroviral treatment among HIV-1 infected adults: Gandhi Hospital, Telangana, India

Background: HAART (Highly active antiretroviral therapy) is the cornerstone of management of patients with HIV infection. Antiretroviral therapy was started in the year 1986 with the first drug Zidovudine (ZDV). Later on, other antiretroviral drugs (NRTIs, NNRTIs and Pls) were introduced. Dual and mono therapies were used initially but the problem of resistance emerged. Currently, 3 or more ARV drugs are recommended globally for the treatment of people with HIV infection.Methods: A cross-sectional descriptive study conducted at a tertiary care Hospital over 200 patients, two commonly used medications are ZLN (Zidovudine+Lamivudine+Nevirapine) and TLE (Tenofovir+Lamivudine+Efavirenz ). The factors considered to affect the clinical and immunologic outcomes in both groups were assessed using baseline CD4 count, WHO clinical staging, presence of chronic diarrhea, anemia, and baseline weight, occurrence of TB, and switching of ART regimen.Results: A total of 200 patients were included in the study. ART documents of 100 patients are on Zidovudine+Lamivudine+Nevirapine) and 100 patients are on TLE (Tenofovir+Lamivudine+Efavirenz) regimen. Out of 200 patients, 97 were males and 103 were females. Maximum number of subjects were in the age of 15-45 years (82.5%) followed by 45 and above (17.5%). Mean age was 34.5±2.5 (years) with range 15 to 65 years. The baseline CD4 count of the patients, 94 were <350 and 6 were ≥350 on ZLN, in case of TLE 82 were <350 and 18 were ≥350. CD4 count after 6 months in 200 patients as follows, 60 were <350 and 40 were ≥350 in case of TLE 53 were <350 and 47 were ≥350.Conclusions: This research finding concluded that there is no critical difference between the two medications in regards to serious adverse events but did find that TDF is superior to AZT in terms of immunologic response and adherence and more frequent emergence of resistance.

Comparative evaluation of adherence to antiretroviral therapy

Background: While treating patients with HIV infection it is important to achieve more than 95% compliance to ART (Antiretroviral Therapy) in order to suppress viral replication.Methods: This was a retrospective, observational, record based study of HIV positive patients undergoing treatment with ZLN (zidovudine 300 mg, lamivudine 150 mg, nevirapine 200 mg) and TLE ( tenofovir 300 mg, lamivudine 150 mg, efavirenz 600 mg) regimens. The treatment charts of the patients fulfilling inclusion and exclusion criteria were reviewed.Results: Analysis of adherence showed that there were 12 patients out of 150 on ZLN regimen and 31 patients out of 150 on TLE regimen were nonadherent to the respective treatments.Conclusions: In this observational study patients on ZLN regimen were showing greater compliance than TLE regimen.

A pharmacovigilance study of antiretroviral therapy in HIV positive out patients at a tertiary care teaching hospital

Background: Anti-Retroviral Therapy regimen (ART) is the only treatment option for treating the HIV positive patients for improving the immune system by increasing the CD4 cells. But eventually these medications lead to development of some Adverse Drug Reactions (ADRs) in seropositive patients under treatment.Methods: A prospective observational study was conducted for 6 months from March to August 2018 at ART Centre, Sri Venkateswara Ramnarayan Ruya Government General Hospital (SVRRGGH), Tirupati.Results: Out of 216 ADRs identified, majority where identified in females (54.35%). Most common regimen caused ADR was tenofovir+ lamivudine+ efavirenz (TLE) (55.55%). Data were analysed using the chi-square test were P-value was found to be 0.0024. Majority of ADRs were found in patients of age group between 31-35years was found to be 45 (20.83%) followed by age group between 41-45years was found to be 40 (18.51%). Most of the ADRs were related to central nervous system (27.31%) followed by metabolic disorders (26.38%), hematologic system (23.14%), gastrointestinal system (12.96%), dermatologic system (9.25%), renal system (0.46%) and musculoskeletal system (0.46%). On evaluation of WHO-UMC causality of ADRs, majority were found to be possible (78.7%). The Hartwig and Siegel’s severity assessment scale showed that most of the ADRs were mild (64.42%). The Schumock and Thornton preventability scale showed that 50.92% patients ADRs were probably preventable.Conclusions: As most of the ADRs were observed in patients receiving TLE regimen. So, patients receiving TLE regimen need intensive monitoring. Doctors, nurses, pharmacist must focus on early detection and prevention of ADRs, based on their severity.

Clinicopathologic and Prognostic Significance of Transducin-Like Enhancer of Split 1 Protein Expression in Invasive Breast Cancer / 한국유방암학회지

PURPOSE: Transducin-like enhancer of split 1 (TLE1) is a member of the TLE family of transcriptional co-repressors that control the transcription of a wide range of genes. We investigated the prognostic significance of TLE1 protein expression in breast cancers by using immunohistochemistry and explored the relationship of TLE1 with clinicopathological parameters. METHODS: Immunohistochemistry was performed on 456 cases of breast cancer tiled on tissue microarrays. The relationship between TLE1 expression in normal breast specimens and ductal carcinoma in situ (DCIS) was also analyzed. RESULTS: TLE1 was highly expressed in 57 of 456 (12.5%) carcinoma samples. TLE1 was more frequently expressed in DCIS and invasive breast cancers than in normal breast tissue (p=0.002). High expression of TLE1 significantly correlated with negative lymph node (LN) metastasis (p=0.007), high histologic grade (p<0.001), estrogen receptor negativity (p<0.001), progesterone receptor negativity (p<0.001), human epidermal growth factor receptor 2 (HER2) positivity (p<0.001), and high Ki-67 proliferation index (p<0.001). Based on intrinsic subtypes, high TLE1 expression was strongly associated with HER2+ and triple-negative breast cancers (TNBC) (p<0.001). Survival analysis demonstrated no significant association between TLE1 expression and disease-free survival (DFS) (p=0.167) or overall survival (OS) (p=0.286). In subgroup analyses, no correlation was found between TLE1 expression and DFS or OS according to LN status or intrinsic subtype. CONCLUSION: High TLE1 expression is significantly associated with the HER2+ and TNBC subtypes. This is the first study documenting immunohistochemical expression of TLE1 in invasive breast cancer and its association with clinicopathological parameters, prognosis, and intrinsic subtype.

Prognostic and Clinicopathological Significance of Transducer-Like Enhancer of Split 1 Expression in Gastric Cancer

PURPOSE: Transducer-like enhancer of split 1 (TLE1) is a member of the Groucho/TLE family of transcriptional co-repressors that regulate the transcriptional activity of numerous genes. TLE1 is involved in the tumorigenesis of various tumors. We investigated the prognostic significance of TLE1 expression and its association with clinicopathological parameters in gastric cancer (GC) patients. MATERIALS AND METHODS: Immunohistochemical analysis of six tissue microarrays was performed to examine TLE1 expression using 291 surgically resected GC specimens from the Soonchunhyang University Cheonan Hospital between July 2006 and December 2009. RESULTS: In the non-neoplastic gastric mucosa, TLE1 expression was negative. In GC, 121 patients (41.6%) were positive for TLE1. The expression of TLE1 was significantly associated with male gender (P=0.021), less frequent lymphatic (P=0.017) or perineural invasion (P=0.029), intestinal type according to the Lauren classification (P=0.024), good histologic grade (P<0.001), early pathologic T-stage (P=0.012), and early American Joint Committee on Cancer stage (P=0.022). In the Kaplan-Meier analysis, the TLE1 expression was significantly associated with longer disease-free (P=0.022) and overall (P=0.001) survival rates. CONCLUSIONS: We suggested that TLE1 expression is a good prognostic indicator in GCs.

Immunohistochemical validation of TLE1, a novel marker, for synovial sarcomas.

Background & objectives: Logistic and financial constraints limit application of several available immunohistochemical (IHC) markers and molecular analysis in every case of synovial sarcoma, diagnosed in our settings. Recently, TLE1 has been recognized as a robust IHC marker for diagnosing a synovial sarcoma. Here, we present IHC features of synovial sarcomas, including TLE1 expression in these cases and in some other tumours. Methods: Conventional sections from 42 synovial sarcomas (30 retrospective & 12 prospectively diagnosed) were subjected to TLE1 IHC staining, including 21 tumours confirmed with molecular testing. TLE1 immunostaining was graded from 0, 1+, 2+, 3+, with 2+ or 3+ grades interpreted as positive staining. Results: Of the 42 tumours, 26 (61.9%) were of monophasic spindle cell type, 13 biphasic type (30.9%), two (4.7%) calcifying type and remaining one (2.3%) was a poorly differentiated synovial sarcoma. On immunohistochemistry (IHC), tumours were positive for epithelial membrane antigen (EMA) (26/34, 76.4%), cytokeratin (CK)7 (6/10, 60%), CK/MNF116 (6/21, 28.6%), B cell lymphoma 2 (BCL2) (36/37, 97.3%), cluster of differentiation molecule 99 (MIC2) (23/31, 74.1%) and transducin-like enhancer of split 1 (TLE1) (40/42, 95.2%), while negative for CD34 in all 21 tumours, wherever performed. TLE1 was also positive in tumour controls, including schwannomas (5/5, 100%), neurofibromas (2/2, 100%), malignant peripheral nerve sheath tumors (2/12, 17%) and Ewing sarcomas (4/10, 40%). TLE1 sensitivity for diagnosis of synovial sarcomas was 95.2 per cent. Its overall specificity was 63.7 per cent, whereas with regards to tumors forming its closest differential diagnoses, its specificity was 72 per cent. Interpretation & conclusions: Although molecular confirmation is the diagnostic gold standard for synovial sarcoma, TLE1, in view of its high sensitivity may be a useful marker within the optimal IHC panel comprising EMA, BCL2, MIC2, CD34 and CK7, especially on small biopsy samples, for substantiating a diagnosis of synovial sarcoma. Awareness of TLE1 expression in other tumours and its correct interpretation are necessary.

The attentional networks in patients with temporal lobe epilepsy / 中国神经精神疾病杂志

Objective To investigate the attentional network in patients with temporal lobe epilepsy(TLE) and the disease-related factors. Methods Fity-four patients with TLE and 40 controls were enrolled in our hospital from January 2007 to December 2008.The computerized ANT software was used for evaluating the attentional network efficiency and the clinical date of the patients with TLE were recorded. Logistic regression was used to identify the risk factors of attentional network efficiency. Results The mean reaction time(TLE:688.2±138.1 ms;Control:625.1±100.1 ms, t=2.06, P <0.05)and executive control network efficiency (TLE:155.7±57.0 ms;Control:108.0±33.8 ms, t=4.62, P <0.01) of the TLE group were lower than the healthy control group. The efficiency of alerting network and orienting network between the two groups were no significant difference. Logistic regression analysis showed that the positive epileptiform activity was an independent risk factor of the attentional impairment(95% CI : 1.03～42.33, OR =6.603, P =0.043). Conclusions The ANT demonstrate that patients with TLE may accompany with attentional executive control network efficiency impairment. Epileptiform discharge may cause attentional executive network efficiency impairment.

Quality of life and the self-perception impact of epilepsy in three different epilepsy types

PURPOSE: This study aimed to evaluate the quality of life (QOL) and verify the domains of greater impact in patients with focal and generalized epilepsies. METHODS: The sample, composed by 57 subjects from Hospital São Paulo da Universidade Federal de São Paulo, was divided into 3 groups, temporal lobe epilepsies (TLE), extra-temporal epilepsies (Extra-TLE) and idiopathic generalized epilepsy (IGE). They answered a preliminary self-reported questionnaire to identify the perception of the most impaired aspects in their lives. The QOL was evaluated through the validated Brazilian version of the Quality of Life Epilepsy Inventory 31 (QOLIE-31). The correlation of the QOLIE-31 domains with epilepsy duration and seizure frequency was defined by dispersion graphics and also Pearson’s and Spearman’s correlation. RESULTS: The most frequently identified impact of epilepsy was related to interpersonal, familial and social relationships mentioned by 13 (22.81 percent) patients. The seizure frequency per patient in Extra-TLE group was significantly greater (p = 0.007) than in the other groups. The Cognition Functioning scores were lower for the Extra-TLE group (38.4) when compared with TLE (52.6) and IGE (62.6) (p = 0.01). The correlation between epilepsy duration and QOLIE-31 domains did not demonstrate statistical significance; however, seizure frequency was correlated with Seizures Worry (p = 0.0463, alpha = 0.05) and Medication Effects (p = 0.0476, alpha = 0.05) domains. CONCLUSIONS: 1) Interpersonal, familial, and social relationships were the dimension which most impacted daily life; 2) Cognition domain in Extra-TLE group showed the worst scores; 3) QOL scores were similar in the three groups for the majority of the QOLIE-31 domains; 4) The seizure frequency in the Extra-TLE group was significantly greater; 5) Seizure frequency was associated with worse QOLIE-31 scores in the domains Seizure Worry and Medication Effects.

OBJETIVO: Este estudo teve como objetivo avaliar a qualidade de vida (QV) em três diferentes grupos de epilepsia e verificar a esfera percebida como de maior impacto na vida diária. METODOLOGIA: A amostra foi composta por 57 pacientes com epilepsias focais e generalizadas do Hospital São Paulo, Universidade Federal de São Paulo, divididos em três grupos, epilepsias do lobo temporal (ELT), extratemporais (Extra-ELT) e generalizadas idiopáticas (EGI). Os pacientes responderam a um questionário preliminar para identificar a percepção sobre os aspectos mais comprometidos em suas vidas. A QV foi avaliada por meio da versão brasileira do Quality of Life in Epilepsy Inventory 31 (QOLIE-31). A correlação dos domínios do QOLIE-31 com a duração da epilepsia e freqüência de crises foi definida pela inspeção dos gráficos de dispersão e pela correlação de Pearson e de Spearman. Foram considerados significantes os valores de p < 0,05. RESULTADOS: Dificuldades nas relações interpessoais, familiares e sociais foram apontadas como a esfera de maior impacto relacionado à epilepsia, citada por 13 (22,81 por cento) pacientes. O QOLIE-31 mostrou resultado semelhante nos três diferentes tipos de epilepsia, com exceção do domínio Funcionamento Cognitivo. Os escores deste domínio foram significativamente menores (p = 0,01) no grupo com Extra-ELT (38,4) do que nos grupos ELT (52,6) e EGI (62,6). A duração da epilepsia não influenciou na QOL nesta amostra, porém foi observada uma correlação estatística significante entre a freqüência de crises e os domínios Efeitos da Medicação (p = 0,0476, alfa = 0,05) e Preocupação com Crises (p = 0,0463, alfa = 0,05). A freqüência de crises mostrou ainda uma diferença estatisticamente significante (p = 0.007) no grupo com Extra-ELT, que apresentou mais crises/paciente, quando comparado aos demais grupos. CONCLUSÕES: Os pacientes identificaram as relações interpessoais, familiares e sociais como sendo a área mais afetada pela...

Isolation and Purification of Thrombin-like Enzyme from the Venom of Agkistrodon halys Pallas / 中国药房

OBJECTIVE:To study a simple method for the isolation and purification of thrombin-like enzyme (TLE) from the venom of Agkistrodon halys Pallas. METHODS:DEAE-Sephadex A-25 vs. Sephadex G-25 chromatography in the isolation and purification of TLE from the venom of Agkistrodon halys Pallas was analyzed. RESULTS:TLE was isolated from the venom of Agkistrodon halys Pallas. SDS-PAGE electrophoresis appeared as a strap with its molecular weight at about 35.5 kDa, meeting electrophoresis purity standard. Physical-chemical character assay showed that the TLE has hemostasia activity in vitro with its specific activity at about 12.57IU?mg-1, while the arginine esterase activity was about 137.65IU?mg-1 measured by BAEE method. PMSF and EDTA were used in the inhibition experiment on this enzyme, and the enzyme was proved to be serine protease other than metalloproteinase. CONCLUSION:The methods can be used for the isolation and purification of thrombin-like enzyme (TLE) from the venom of Agkistrodon halys Pallas.

Intracranial Ictal EEG Patterns Predicting the Surgical Outcome and the Yield of Intracranial Electrodes in Patients with Temporal Lobectomy

BACKGROUND: Analysis of intracranial ictal patterns may help to predict surgical outcomes. We investigated intracranial EEG patterns to correlate with surgical outcomes and compared the yield of 'subdural electrodes alone (SE)' versus 'combined depth and subdural electrodes (CDSE)' for ictal lateralization in temporal lobe epilepsy (TLE). METHODS: We reviewed a total of 95 seizures recorded by bilateral temporal depth and subdural electrodes in 25 TLE patients who underwent surgery. We classified surgical outcomes as 'seizure-free' or 'not-seizure-free'. Each seizure was analyzed based on the presence or absence of peri-ictal discharges, ictal distribution, waveform patterns, onset frequency and involved number of electrodes, and interhemispheric propagation time (IHPT). The accuracy of lateralizing seizure foci by CDSE was compared to that by SE. RESULTS: 20 patients (80.0%) were 'seizure-free' and 5 (20.0%) were 'not-seizure-free'. The presence of peri-ictal discharges (p<0.001), distribution of depth only or depth and medial electrodes (p<0.001) and higher onset frequency (p=0.021) were associated with 'seizure-free' outcomes. Ictal onset pattern with fast spike trains was common in 'seizure-free', whereas pattern with rhythmic activity was common in 'not-seizure-free' (p=0.005). SE correctly lateralized in 18 of 20 patients, and incorrectly lateralized in the remaining 2 patients, but CDSE correctly lateralized in all 20 patients. CONCLUSIONS: Some intracranial ictal patterns were significantly correlated with good surgical outcomes. These findings suggest that the analysis of ictal EEG patterns help to predict surgical outcomes. CDSE is more accurate for the lateralization of seizure foci compared to SE.

Effects of Trifoliumpratense Leguminosae extract on mouse allogenetic skin transplantation / 中华中医药杂志

Objective: To observe the effect of Trifoliumpratense Leguminosae extract (TLE) on mouse allogenetic skin transplantation. Methods: Recipient BALB/c was divided into physiologic saline (PS) group and TLE group, full-thickness skins were transplanted through back to back method from donor C57BL/6. The allogenetic transplanted skin growth condition was observed. The proliferation of lymphocytes of recipient mice in vitro were detected by CFDA-SE stain and mixed lymphocyte reaction respectively. Results: The allogenetic transplanted skin injected with TLE 25g/kg per day by vena caudalis growed better than that in PS group. The proliferation of lymphocyte in TLE group was smaller than that in PS group. Conclusion: TLE maybe participate in the regulation of mouse immune system and induce its tolerance to the allogenetic transplanted skin.

Dipole Source Localization and Low Resolution Electromagnetic Tomography(LORETA) of Interictal Spikes in Mesial and Lateral Temporal Lobe Epilepsy / 대한간질학회지

PURPOSE: To investigate the usefulness of dipole source localization (DSL) and low resolution electromagnetic tomography (LORETA) in localizing epileptic focus, we performed DSL and LORETA of interictal spikes in patients with mesial and lateral temporal lobe epilepsy (TLE). METHOD: We analyzed representative interictal spikes in 17 patients with TLE (9:mesial TLE; 8:lateral TLE). We used ASA3 (Advanced Neuro Technology, Netherlands) for DSL, voltage topography (VT) and LORETA of interictal spikes. RESULT: Most interictal spikes for analysis have their maximum amplitudes at electrode F7, 8 or T7, 8 except one patient with lateral TLE (P7). In mesial TLE, VT showed a maximum negative electrical field in ipsilateral fronto-temporal region. DSL showed dipole sources in ipsilateral anterior mesial temporal lobe (33.3%, 3/9), temporal pole (44.5%, 4/9), orbitofrontal (11.1%, 1/9) and anterior inferior frontal (11.1%, 1/9) regions. LORETA showed maximum current density in ipsilateral fronto-temporal or anterior-mid temporal areas with lateral temporal maximum. In lateral TLE, dipole sources were in ipsilateral temporal pole (62.5%, 5/8), thalamus (12.5%, 1/8) and in posterosuperior temporal area (2/8, 25%). VT of spikes at F7 or F8 showed similar results as those of mesial TLE while that of spikes at T7, T8 and P7 had a tendency of electrical fields more extending to the mid- and posterior temporal regions. LORETA showed more diffuse current distribution in whole temporal lobe (anterior to posterior) with lateral temporal maximum. CONCLUSION: The patterns of DSL and LORETA were somewhat helpful to differentiate mesial from lateral TLE. LORETA usually showed more diffuse activity beyond the epileptic focus.

A case of Tumid Lupus Erythematosus / 대한피부과학회지

Tumid lupus erythematosus (TLE) is a variant of cutaneous lupus erythematosus. Most patients who present with these skin lesions are young women. The condition clinically resembles polymorphous light eruption, reticulated erythematous mucinosis, or gyrate erythema. Histopathologically, the lesions resemble classic lupus erythematosus because of their superficial and deep lymphohistiocytic inflammatory infiltrates and dermal mucin. However, unlike classic lupus erythematosus, there is little or no epidermal or dermo-epidermal involvement. Antinuclear antibody test results are usually negative. We report a case of TLE and discuss the differential diagnosis.

Combined Bilateral Depth and Subdural Electrode Investigation in Temporal Lobe Epilepsy

BACKGROUND: Depth and subdural electroencephalographic (EEG) recordings are often required to identify an area of the brain for epileptic surgery. We simultaneously compared bilaterally placed depth and subdural electrode EEGs to determine the site of seizure origins from the temporal lobes. METHODS: We included nine consecutive patients with medically refractory temporal lobe epilepsy, whose noninvasive evaluations such as magnetic resonance imaging, scalp and sphenoidal EEG, and other tests had not proved consistent lateralization. All patients had bilateral temporal depth electrodes, anterior and lateral temporal subdural strip electrodes. Thirty-eight clinical seizures and 3 subclinical seizures were evaluated. RESULTS: Seven out of 9 patients (78%) had unitemporal seizures, one patient had bilateral seizures, and the other had lateral temporal seizures in an invasive study. Ictal onset was localized by depth electrodes in 8 patients, and subdural strip electrodes in one. In ictal recordings, the ictal rhythms never spread to the contralateral neocortex before the ipsilateral neocortex. Most of the ictal rhythms began focally with periodic spikes or fast activities in the depth electrode, then spread to the ipsilateral strip electrode after 14 to 90 seconds (mean : 35.2 seconds). If ictal rhythms propagated to the contralateral side, it took 14 to 140 seconds (mean : 64.2 seconds). Subdural strip electrodes were less sensitive than depth electrodes in the detection of seizure onset and subclinical seizures, but were accurate when lateralized. CONCLUSIONS: We conclude that EEG recordings with depth and subdural strip electrodes correctly identify and lateralize temporal lobe seizures more often than subdural electrodes alone.

Relationship of Longitudinal Extent of Hippocampal Sclerosis to Clinical Characteristics, Hippocampal Neuronal Cell Loss and Dynorphin-Immunoreactivity Patterns in Intractable Temporal Lobe Epilepsy with Hippocampal Sclerosis / 대한간질학회지

PURPOSE: In mesial temporal lobe epilepsy (TLE). Hippocampl sclerosis (HS) is a pathologic substrate and characterized by significant neuronal loss and band-like synaptic reorganization in dentate inner molecular layer (DGIML) og sclerotic hippocampus with either Timm`s staining or Dynorphin (Dyn)-immunohistochemical staining methods. Hippocampus has neuronal synaptic circuitries of both intralamellar and translamellar patterns, from which we may hypothesize that longitudinal extent of HS represents variable pathophysiologic implications of neuronal injury, ictogenesis and epileptogenesis in mesial TLE. We tested the hypothesis. METHODS: Eleven mesial TLE patients with HS on MRI were recruited from epilepsy surgery registry. Resected hippocampal slices were stained with Dyn immunohistochemical method. We classified them into cases with partial HS and thoes with extensive HS according to longitudinal HS extent,. Between the two groups, clinical characteristics of seizures or epilepaies, Hippocampal neuronal density and neuronal loss. and Dynimmunoreactivity (IR) patterns were compared and analyzed. Dyn-IR pattern was classified as presence or absence of DGIML band and of CA3-IR. RESULTS: Nine cases showed extensive HS whereas two were classified as partial HS. There appeared no significant differences in clinical characteristics, neuronal density, neuronal loss and Dyn-IR patterns between those with extensive and partial HS. CONCLUSION: In this study, we could not prove the hypothesis that difference in HS extend on MRI may represent distinctive variabliity in severity of hippocampal neuronal injury and in ictiogenetic or epileptogenetic pathophysiology.

THREE SUBTYPES OF TEMPORAL LOBE EPILEPSY: Clinical and Electrophysiological Characteristics of Medial, Anterior neocortical, and posterior lateral TLE

BACKGROUND: The clinical differentiation of hippocampal and neocortical temporal lobe epilepsy has practical value. And there seems no report concerning the clinical difference between anterior and posterior neocortical TLE. This study aims to determine whether there are important clinico-electrical differences between patients with hippocampal sclerosis(medTLE; MTLE) and those with anterior lateral temporal epileptogenic zone(anterior lateral TLE; ALTLE) and posterior lateral temporal one(posterior lateral TLE; PLTLE). METHODS: The case histories, interictal EEG, ictal semiology, ictal EEG, and memory lateralization in Wada test were compared statistically in the three groups (30 MTLE, 16 ALTLE, and 11 PLTLE). Lateral TLE(LTLE) was diagnosed when the radiologic studies showed discrete lesions lateral to collateral sulcus or the results of invasive study confirmed massive epileptogenic zones in the lateral temporal lobe. Whether the epileptogenic zone was located on the anterior or posterior to the line across the interpeduncular fossa of the midbrain made the differentiation between ALTLE and PLTLE. RESULTS: A history of febrile convulsion was more common in MTLE patients(p<0.001). An aura with auditory or visual components was unique in ALTLE and PLTLE. Oroalimentary and hand automatisms occurred more frequently in MTLE, while secondary GTCS and version were more frequent in PLTLE(p<0.01). Onset of secondary GTCS and version occurred later in seizures of MTLE(p<0.05). Memory lateralization in Wada test was highly possible in MTLE and PLTLE(p<0.01). Irritative zone was located on the posterior temporal electrode in 4 of 11 patients with PLTLE. Ictal onset with rhythmic beta activity was not observed in MTLE. CONCLUSION: There are a number of clinico-electrical differences among MTLE, ALTLE, and PLTLE.