Religiosity and spirituality in patients with epilepsy / Religiosidade e espiritualidade em pacientes com epilepsia

ABSTRACT Religiosity and spirituality (R/S) are widely regarded as important allies against illness and suffering in general. Findings in temporal lobe epilepsy (TLE) suggest the temporal lobe as the anatomical-functional basis of religious experiences. Both R/S are relevant in patients with epilepsy (PWE) since epilepsy can lead to psychosocial issues for a significant portion of patients and their families. Objective: To investigate R/S in PWE, as well as the impact of different epileptic syndromes on patients' R/S. Methods: One hundred PWE and 50 healthy volunteers matched for age, sex and educational level were submitted to an interview, as well as three previously validated questionnaires: Index of Core Spiritual Experience (INSPIRIT-R), Hospital Anxiety and Depression Scale (HADS), and the Quality of Life in Epilepsy Inventory (QOLIE-31). Results: PWE's and control's mean ages were 35.9 ± 12.4 vs. 36.3 ± 18.1 years, mean schooling was 8.9 ± 3.7 vs. 10.1 ± 4.2 years. The mean age of epilepsy onset was 14.5 ± 12.1 and monthly frequency of seizures was 5.9 ± 12.6. INSPIRIT-R's scores were not statistically significantly different between patients and controls (3.0 ± 0.8 vs. 3.0 ± 0.8); however, INSPIRIT-R's scores were significantly higher in TLE patients when compared with other epilepsy syndromes (3.2 ± 0.7 vs. 2.8 ± 0.9; p = 0.04). Conclusion: Temporal lobe epilepsy patients have higher levels of R/S.

Resumo Religiosidade e espiritualidade (R/E) são geralmente consideradas importantes aliadas no enfrentamento de doenças e sofrimento. Estudos na epilepsia do lobo temporal (ELT) sugerem que o lobo temporal é a base anatômico-funcional de experiências religiosas. Além disso, R/E têm impacto na vida de pacientes com epilepsia (PCE), uma vez que a epilepsia frequentemente está associada a distúrbios psicossociais em pacientes e seus familiares. Objetivo: Investigar R/E em PCE, bem como o impacto de diferentes síndromes epilépticas na R/E dos pacientes. Método: Cem PCE e 50 voluntários saudáveis pareados por idade, sexo e nível educacional foram submetidos a uma entrevista, bem como três questionários previamente validados: Index of Core Spiritual Experience (INSPIRIT-R), Hospital Anxiety and Depression Scale (HADS), e Quality of Life in Epilepsy Inventory (QOLIE-31). Resultados: As médias de idade de PCE e controles foram de 35,9 ± 12,4 vs. 36,3 ± 18,1 anos, com escolaridade média de 8,9 ± 3,7 vs. 10,1 ± 4,2 anos. A idade média do início da epilepsia foi de 14,5 ± 12,1 e a frequência de crises mensais foi de 5,9 ± 12,6. Os escores do INSPIRIT-R não foram estatisticamente diferentes entre os pacientes e controles (3,0 ± 0,8 vs. 3,0 ± 0,8); entretanto, os escores do INSPIRIT-R foram significativamente maiores em pacientes com ELT quando comparados com outras síndromes epilépticas (3,2 ± 0,7 vs. 2,8 ± 0,9; p = 0,04). Conclusão: Pacientes com epilepsia do lobo temporal possuem níveis mais altos de religiosidade e espiritualidade.

Alteraciones en las ejecuciones viso-perceptuales en pacientes con síndromes electro-clínicos de epilepsias del lóbulo temporal y frontal / Visuoperceptual performances impairments in patients with electro-clinical syndromes of temporal lobe and frontal lobe epilepsies

RESUMEN INTRODUCCIÓN: Según el modelo de actividad modular encapsulada del foco epiléptico (FE), las epilepsias del lóbulo temporal (ELI) y del frontal (ELF) se asocian con alteraciones cognitivas de memoria, atención, lenguaje y función ejecutiva. Por eso la mayoría de los protocolos neuropsicológicos se centran en la evaluación de estas funciones. Las habilidades viso-perceptuales se evaluarían en los pacientes con epilepsias del cuadrante posterior (ECP). OBJETIVO: Establecer las alteraciones viso-perceptuales en pacientes adultos con síndrome electro-clínico compatible con ELT y ELF de Medellín, Colombia, al compararse con un grupo de personas sin epilepsia. Pacientes y métodos: la muestra estuvo conformada por 19 pacientes, 10 (52,6 %) mujeres, edad de 43,0±12,3 (IC 95 %:37,1-48,9) años, con síndromes electro-clínicos por video-telemetría compatibles con ELT o ELF, con capacidad intelectual total estimada 107,2±14,1 (IC95 %:100,3-114,0). Se compararon con 16 personas sin epilepsia, 9(56,2 %) mujeres, edad 41,8±12,7 (IC95 %:35,1-48,6) y capacidad intelectual de 117±17,5 (IC95 %:108,6-127,2). Se les aplicó un protocolo para evaluación de procesos viso-perceptuales. RESULTADOS: Los pacientes presentaron un rendimiento significativamente inferior (p<0,05) en discriminación de figura-fondo, orientación viso-espacial de líneas y en el reconocimiento diferido de la memoria visual de puntos. Estas dificultades fueron mayores en los pacientes con ELF. CONCLUSIONES: Se observan alteraciones en ejecuciones viso-perceptuales y de almacenamiento de memoria visual más severas en pacientes con ELF. Esto apoya el modelo de redes complejas (no modulares y no encapsuladas), tanto para la actividad epiléptica como para la cognitiva. Por esto, los procesos viso-perceptuales deben ser evaluados en los pacientes con síndromes de ELT o ELF.

SUMMARY INTRODUCTION: According to modular encapsulated activity model of the epileptic focus (EF), Temporal lobe epilepsies (TLE) and Frontal lobe epilepsies (FLE) are associated to memory, attention, language and executive function impairments. For this reason most of the neuropsychological protocols are focused in the assessment of these functions. Visuoperceptual skills only would be assessed in patients with posterior quadrant epilepsies (PQE). OBJECTIVE: To establish visuoperceptual impairment in a sample of electro-clinical syndromes compatibles with TLE and FLE from Medellín-Colombia, compared with a group of healthy people without epilepsy. Patients and methods: sample was constituted by 19 patients, 10 women (52,6%), aged 43,0±12,3 (CI95%:37,1-48,9), with electro-clinical syndromes compatible with TLE or FLE, median estimated IQ 107,2±14,1 (CI95%:100,3-114,0). They were compared with 16 healthy people without epilepsy, 9(56,2%) women, median age 41,8±12,7 (CI95%:35,1-48,6) and 117±17,5 (IC95%:108,6-127,2). A visuoperceptual protocol was administered to both groups. RESULTS: Patients presented significant lower (p<0,05) on figure-background discrimination, visuospatial line orientations, and delayed recall by recognition of dots visual memory. These impairments were significant worst in FLE patients. CONCLUSIONS: TLE and FLE patients have visuoperceptual and delayed visual memory store impairments, which were significant worst in FLE patients. These findings support the complex network (non-modular and non-encapsulated) model to explain EF and cognitive functioning in patient with TLE and FLE. Visuoper-ceptual processes should be always assessed in these patients.

Comorbilidad psiquiátrica en niños con epilepsia benigna de la infancia / Psychiatric comorbidity in children with benign childhood epilepsy

La epilepsia es una enfermedad crónica que en ocasiones puede afectar el funcionamiento emocional, cognitivo y lingüístico del niño e impactar en su funcionamiento intra-psíquico e interpersonal incluyendo a su familia y al medio académico y social. Si bien en el ámbito internacional se han realizado numerosos estudios que han podido demostrar que muchos niños con epilepsia ven afectadas sus funciones mentales, sus emociones y conducta, muy pocas investigaciones se propusieron explorar la relación existente entre psicopatología y tipo de epilepsia. Es frecuente que la epilepsia se acompañe de síntomas y cuadros psicológicos y psiquiátricos, causados ya sea por los efectos neurofisiológicos de la misma enfermedad, como consecuencia de las condiciones de vida que la enfermedad impone, por las características constitucionales de los sujetos, por la dinámica que se establece en el plano familiar y también como efectos adversos de la medicación. El predominio de problemas del comportamiento en niños con epilepsia se muestra dos veces superior al considerado en niños con enfermedades crónicas que no implican el SNC y cuatro veces superior al de niños sanos. Estudios más recientes señalan la presencia de disturbios del comportamiento en 21-32% de niños con epilepsia usando la lista de comprobación del comportamiento del niño, en 23-26% con el inventario de la depresión del niño, en el 48% con la escala de Rutter. Es objetivo de esta investigación, determinar la distribución de los trastornos mentales asociados a epilepsia benigna de la infancia en un grupo de pacientes de entre 6 y 13 años y comparar esta distribución con la de un grupo de niños de entre 6 y 13 años de la población escolar general (AU)

Epilepsy is a chronic disease that may affect emotional, cognitive, and linguistic, as well as inter-psychic and intrapersonal functioning including the family and academic and social environments. Although numerous international studies have been conducted showing that in children with epilepsy cognitive function, emotions, and behavior are often impaired, few investigations have proposed to assess the correlation between psychopathology and type of epilepsy. Epilepsy is commonly associated with psychological and psychiatric features caused either by the neurophysiological effects of the disease or by the conditions of life related to the disease, due to constitutional characteristics of the patients, family dynamics, and adverse effects of the antiepileptic drugs. Predominance of behavioral difficulties of children with epilepsy are two-fold higher than in children with other chronic diseases not involving the CNS and four-fold higher than in healthy children. More recent studies have found the presence of behavioral disturbances in 21-32% of children with epilepsy using a checklist of child behavior, with the Child Depression Inventory in 23-26% and the Rutter Scale in 48%. The aim of this study was to determine the distribution of mental disorders associated with benign childhood epilepsy in a group of patients between 6 and 13 years of age compared with that in a group of children between 6 and 13 years of age from the general school-age population (AU)

The role of central cholinergic system in epilepsy / 浙江大学学报·医学版

Epilepsy is a chronic neurological disorder, which is not only related to the imbalance between excitatory glutamic neurons and inhibitory GABAergic neurons, but also related to abnormal central cholinergic regulation. This article summarizes the scientific background and experimental data about cholinergic dysfunction in epilepsy from both cellular and network levels, further discusses the exact role of cholinergic system in epilepsy. In the cellular level, several types of epilepsy are believed to be associated with aberrant metabotropic muscarinic receptors in several different brain areas, while the mutations of ionotropic nicotinic receptors have been reported to result in a specific type of epilepsy-autosomal dominant nocturnal frontal lobe epilepsy. In the network level, cholinergic projection neurons as well as their interaction with other neurons may regulate the development of epilepsy, especially the cholinergic circuit from basal forebrain to hippocampus, while cholinergic local interneurons have not been reported to be associated with epilepsy. With the development of optogenetics and other techniques, dissect and regulate cholinergic related epilepsy circuit has become a hotspot of epilepsy research.

Tuberous sclerosis complex with refractory epilepsy: a clinicopathologic study of 14 cases / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the clinicopathologic features of tuberous sclerosis complex (TSC).</p><p><b>METHODS</b>The clinicopathologic data of the patients diagnosed as TSC with refractory epilepsy and resection of epileptic focus were retrospectively analyzed.</p><p><b>RESULTS</b>Fourteen cases were included, the mean age was (15.8±12.9) years, with a male predominance (male to female ratio=10:4). Frontal lobe was the most common (13/14) site of involvement. MRI showed multiple patchy long T1 and long T2 signals. CT images showed multiple subependymal high density calcified nodules in nine cases. Histology showed mild to severe disruption of the cortical lamination, cortical and subcortical tubers with giant cells and/or dysmorphic neurons. The giant cells showed strong immunoreactivity for vimentin and nestin, while the dysmorphic neurons partially expressed MAP2 and NF. Vimentin also stained strongly the "reactive" astrocytes. Thirteen cases had follow-up information: Engel class I in six cases, Engel class II in six cases, and Engel class III in one case.</p><p><b>CONCLUSIONS</b>Diagnosis of TSC relies on combined pathologic, clinical and neuroradiological features. Immunohistochemical staining can be helpful. Resection of epileptic focus is an effective method to treat refractory epilepsy in TSC.</p>

Semiología de la crisis epiléptica: un reto clínico / Semiology of epileptic seizures: A clinical challenge

La epilepsia es una afección cerebral crónica caracterizada por crisis recurrentes, autolimitadas y de etiología diversa cuyas manifestaciones clínicas incluyen una variada gama de signos y síntomas en relación con las zonas corticales estimuladas, considerando y diferenciando adecuadamente la zona epileptogénica al igual que la sintomatogénica en el contexto claro del arte de la interpretación semiológica que reúne un adecuado conocimiento de las funciones corticales y el reconocimiento respectivo de lateralizadores y localizadores del foco epileptogénico, para determinar adecuadamente el tipo de epilepsia o síndrome epiléptico. El objetivo de este artículo es plantear de forma clara y concisa los hallazgos en la presentación clínica de las principales formas de epilepsia o síndromes epilépticos en relación con la función cortical por lóbulos, lo que nos permitirá una mayor introspección y habilidad en la práctica clínica en el diagnóstico rápido y oportuno. El diagnóstico de epilepsia depende de un número amplio de factores, particularmente detallados y precisos en la historia de las crisis o semiología.

Epilepsy is a chronic brain disorder characterised by recurrent seizures that are self-limited and of diverse aetiology, in which the clinical manifestations include a wide range of signs and symptoms in relation to the cortical areas stimulated. Semiology consider and properly differentiates the epileptogenic and the symptomatogenic zone in the clear context of the art of semiological interpretation that combines adequate knowledge of cortical functions and the corresponding recognition of lateraliser and localiser signs of the seizure focus, in order to properly determine the type of epilepsy or epileptic syndrome. The aim of this article is to present clear and concise findings in the clinical presentation of the main forms of epilepsy and epileptic syndromes in relation to the function of the cortical lobes, which allow us greater introspection and skill in clinical practice in the rapid and timely diagnosis. The diagnosis depends upon a number of factors, particularly the detailed and accurate recording of the history of the seizure, or semiology.

Therapeutic effect of levetiracetam add-on treatment for frontal lobe epilepsy in 105 children / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the changes in 24-hour video electroencephalogram (EEG) and epileptic attacks after levetiracetam add-on therapy in children with frontal lobe epilepsy and epileptiform discharges.</p><p><b>METHODS</b>A prospective study was carried out in 105 children with the frontal lobe epilepsy who received long-term treatment with 1 or 2 types of antiepileptic drug but still with epileptiform discharges in ECG. Levetiracetam add-on therapy was administered at the initial daily dose of 20 mg/kg (given in 2 doses) for 2 weeks followed by an increase of the dose to 30 mg/kg with a maintenance dose of 30-40 mg/kg. The changes in seizure attacks and 24-hour video-EEG monitoring after a 6-month therapy were observed.</p><p><b>RESULTS</b>Levetiracetam add-on therapy reduced epileptiform discharges in 55 children (52.3%) and resulted in significant changes in EEG (P<0.05). Of the 77 children with clinical seizures, complete seizure control was achieved in 12 cases after the therapy, and the seizure attacks were reduced in 28 cases, showing a total response rate of 51.9%; the reduction in seizure attacks was positively correlated with EEG improvement (P<0.001).</p><p><b>CONCLUSION</b>Levetiracetam add-on therapy can decrease epileptiform discharges in EEG and reduce clinical seizure attacks in children with frontal lobe epilepsy with only mild adverse reactions.</p>

Emerging Surgical Strategies of Intractable Frontal Lobe Epilepsy with Cortical Dysplasia in Terms of Extent of Resection

OBJECTIVE: Cortical dysplasia (CD) is one of the common causes of epilepsy surgery. However, surgical outcome still remains poor, especially with frontal lobe epilepsy (FLE), despite the advancement of neuroimaging techniques and expansion of surgical indications. The aim of this study was to focus on surgical strategies in terms of extent of resection to improve surgical outcome in the cases of FLE with CD. METHODS: A total of 11 patients of FLE were selected among 67 patients who were proven pathologically as CD, out of a total of 726 epilepsy surgery series since 1992. This study categorized surgical groups into three according to the extent of resection : 1) focal corticectomy, 2) regional corticectomy, and 3) partial functional lobectomy, based on the preoperative evaluation, in particular, ictal scalp EEG onset and/or intracranial recordings, and the lesions in high-resolution MRI. Surgical outcome was assessed following Engel's classification system. RESULTS: Focal corticectomy was performed in 5 patients and regional corticectomy in another set of 5 patients. Only 1 patient underwent partial functional lobectomy. Types I and II CD were detected with the same frequency (45.45% each) and postoperative outcome was fully satisfactory (91%). CONCLUSION: The strategy of epilepsy surgery is to focus on the different characteristics of each individual, considering the extent of real resection, which is based on the focal ictal onset consistent with neuroimaging, especially in the practical point of view of neurosurgery.

Clinical features and mutation analysis of CHRNA4 gene for families and sporadic cases affected with autosomal dominant nocturnal frontal lobe epilepsy / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To investigate mutations of CHRNA4 gene in Chinese patients with autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE).</p><p><b>METHODS</b>Two hundred and fifty-seven patients (including 215 sporadic and 42 familial cases) were analyzed. Mutational screening was performed by sequencing all of the 6 exons of the CHRNA4 gene including the donor and acceptor splice sites.</p><p><b>RESULTS</b>The results have excluded the involvement of any known mutations of the CHRNA4 gene. A novel synonymous mutation c.570C>T(D190D) and 6 single nucleotide polymorphisms (SNPs) of the CHRNA4 gene were detected in 6 sporadic cases, including c.639T/C, c.678T/C, c.1209G/T, c.1227T/C, c.1659G/A, and c.1629C/T. The SNP D190D was hererozygous and absent in 200 healthy controls.</p><p><b>CONCLUSION</b>This results suggested that mutations of the CHRNA4 gene may be rare in southern Chinese population with ADNFLE. The synonymous mutation D190D has not been reported previously. Its impact on the pathogenesis of ADNFLE warrant further study.</p>

Epileptic Nystagmus and Vertigo Associated with Bilateral Temporal and Frontal Lobe Epilepsy

Epileptic nystagmus is defined as a quick, repetitive jerky movement of the eyeball associated with seizure activity. In cases of epileptic nystagmus associated with ictal discharge from multiple brain areas, localization of the exact epileptogenic zone could be extremely difficult. In a nine-year-old patient with epileptic nystagmus and vertigo associated with bilateral temporal and frontal lobe epilepsy, we could infer the epileptic focus by interpreting the patient's clinical picture, characteristics of nystagmus, and findings of electroencephalography.

Mutational analysis of CHRNB2 and CHRNA2 genes in southern Chinese population with autosomal dominant nocturnal frontal lobe epilepsy / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To investigate the gene mutations of CHRNB2 and CHRNA2 in Chinese population with autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE).</p><p><b>METHODS</b>One hundred and six Han nationality patients (74 sporadic and 32 familial) were recruited and studied. Mutational screening was performed by sequencing all the 6 coding exons of the CHRNB2 gene and exons 6 and 7 of the CHRNA2 gene including the donor and acceptor splice sites.</p><p><b>RESULTS</b>The results excluded the involvement of all known published mutations of the CHRNB2 and CHRNA2 genes. However, a novel synonymous mutation c.483C>T (H161H) and a single nucleotide polymorphism (c.1407C>G) of CHRNB2 gene were detected in two ADNFLE sporadic patients respectively. The nucleotide variation H161H was heterozygous and absent in 200 healthy control samples. The mutation was also found in the proband's unaffected mother.</p><p><b>CONCLUSION</b>Our study suggests that the mutations of CHRNB2 and CHRNA2 genes may be rare in Chinese ADNFLE population. The novel synonymous mutation of H161H has not been reported previously and its impact on the pathogenesis of ADNFLE needs to be further studied.</p>

Successful Desensitization of Oxcarbazepine: First Case in Pediatric Patient / 대한소아신경학회지

Aromatic antiepileptic drugs (AEDs), such as diphenylhydantoin, phenobarbital, or carbamazepine (CBZ), are frequently associated with hypersensitivity reactions. This may restrict treatment options considerably due to cross reactivity with other aromatic AEDs. Desensitization can be very helpful for patients who show cross sensitivity with other AEDs. We report a case an 8-year-old patient who had cross sensitivity to oxcarbazepine (OXC) and CBZ and successfully managed by desensitization to OXC. The patient presented with intractable frontal lobe epilepsy. He had become seizure free with OXC; however OXC had to be discontinued due to whole body rash. CBZ also caused a hypersensitivity reaction. Therefore, OXC desensitization was attempted; he then had very subtle seizures during sleep with a frequency of 5 to 6 episodes per month on the 18th month of desensitization. Desensitization can be considered in a patient with limited treatment options due to hypersensitivity to aromatic AEDs.

Usefulness of video-EEG monitoring in paroxysmal nonepileptic events of children and adolescents / 소아과

PURPOSE: In addition to epileptic seizures (ES), a variety of physiologic, organic and psychogenic disorders can manifest as paroxysmal behavioral events. Paroxysmal nonepileptic events (PNEs) are quite encountered in infants, young children, and adolescents. In a substantial proportion of cases, a careful history and examination will elucidate their nature. However, in other cases, it is necessary to differentiate PNEs from ES by video-electroencephalographic (EEG) monitoring. We report our experiences with PNEs in a group of children and adolescents who underwent video-EEG monitoring. METHODS: From September, 2004 to June, 2006, one hundred thirty patients were monitored in the Pediatric Epilepsy Monitoring Units of Korea University Guro and Ansan hospitals. Their hospital charts were reviewed and video records of these events were analyzed. We observed all patients after video- EEG monitoring for more than 3 months. RESULTS: Typical spells occurred during monitoring in 33 patients, not associated with a seizure pattern on EEG recordings. Two patients were diagnosed as frontal lobe epilepsy on basis of typical semiology and clinical characteristics, so 31 patients were documented to have PNEs finally. The mean age of patients was 7.2+/-5.8 years. The male to female ratio was 15 (48.4%) to 16 (51.6%). Among 31 patients, fifteen patients had associated disorders such as epilepsy, developmental delay, cerebral palsy, gastric ulcer, attention deficit hyperactivity disorder or depressive disorder. Somatoform disorder and factitious disorder was frequently seen in children more than 5 years old (P0.05). CONCLUSION: Our study suggests that video-EEG monitoring is an important diagnostic tool in the evaluation of paroxysmal behavioral events. With correct diagnosis of the PNEs, several unnecessary treatment could be avoided.

Epilepsia do lobo frontal na infância: aspectos psicológicos e neuropsicológicos / Frontal lobe epipsy in childhood: psychological and neuropsychological aspects

Objetivos: Revisar os aspectos psicológicos neuropsicológicos da epilepsia do lobo frontal na infância. Fonte de Dados: Revisão de literatura, utilizando principalmente, artigos de jornais indexados no Scielo e Mdline. Síntese de Dados: Crises epiléticas do lobo frontal na infância, aspectos neuropsicológicos e psicológicos da epilepsia do lobo frontal e suas repercusões são abordados e discutidos. Conclusões: Na criança, a epilepsia do lobo forntal pode gerar distúrbios psicológicos e neuropsicológicos, como déficits em funções executivas (cognição, planejamento, linguagem, memória a atenção), alterações compotamentais (controle de impulsos e agressividade), manifestações de crises epilépticas comportamentais e piora da qualidade de vida. Suas alterações podem ser confudidas com doenças psiquiátricas, reforçando a importância do diagnóstico diferencial e da avaliação neuropsicológica.

value of seizure semiology in lateralizing and localizing partially originating seizures

Diagnosis epilepsy depends heavily on a detailed, and accurate description of the abnormal transient neurological manifestations. Observing the seizures yields important semiologic features that characterize epilepsy. Video-EEG monitoring allows the identification of important lateralizing [left versus right], and localizing [involved brain region] semiologic features. This information is vital for identifying the seizure origin for possible surgical interventions. The aim of this review is to present a summary of important semiologic characteristics of various seizures that are important for accurate seizure lateralization and localization. This would most likely help during reviewing video-EEG recorded seizures of intractable patients for possible epilepsy surgery. Semiologic features of partial and secondarily generalized seizures can be grouped into one of 4 categories including; automatism, speech, motor, and autonomic features. These features will be discussed in detail in this review. However, seizure semiology should be correlated with EEG and MRI findings. Accurate identification of the seizure origin is more likely if focal EEG onset and MRI findings were concordant with the clinical semiology

Surgical Treatment of Intractable Frontal Lobe Epilepsy / 대한간질학회지

PURPOSE: Frontal lobe epilepsy is difficult to be managed with medical or surgical treatment. So the authors analyzed and reviewed the clinical results of the frontal lobe epilepsy patients who underwent surgical treatment. METHODS: From 1996 to 2004, Thirty-nine patients were treated surgically. The authors reviewed retrospectively the radiological, clinical and pathological data of the patients. The surgical outcome was classified using Engel's classification. RESULTS: The mean follow-up period is 70.5 (+/-29.7) months. The preoperative MR image was normal in 19 cases and abnormal in 20 cases. There were 11 encephalomalacias, 4 cortical dysplasias and 5 brain tumors. The postoperative pathological finding was normal in 5 cases and abnormal finding in 34. There were 20 cortical dysplasias, 4 encephalomalacias, 3 gliosises, 2 fibrous scars, 2 cavernous malformations, 1 dysembryoplastic neuroepithelial tumor, 1 paragonimiasis and 1 venous thrombosis. The postoperative surgical outcomes were as follows: Class I, 41%; Class II, 25.6%; Class III, 20.5%; Class IV, 12.8%. CONCLUSIONS: The surgical outcomes of frontal lobe epilepsy have improved, compared with previous series. The pathological abnormality was observed in large portion of the frontal lobe epilepsy patients.

Temporal lobe epilepsy in childhood: review article

The authors present a review article on temporal lobe epilepsy in childhood. We performed a search in the literature. The main etiologies of temporal lobe epilepsy in childhood are developental tumors and focal cortical displasia, besides temporal medial sclerosis. The clinical features may be variable particularly in children younger than six years of age. Epilepsy may present with generalized seizures. Electroencephalographic findings are also variable and show a functional dysfunction of several brain areas besides temporal lobes, especially frontal lobes. Recent advances demonstrate that temporal lobe epilepsy in childhood present with great etiologic, clinical and electroencephalographic diversity

Menstrual cycle worsening of epileptic seizures in women with symptomatic focal epilepsy

INTRODUCTION: Hormonal fluctuation is responsible for worsening of epileptic seizures during the menstrual cycle. OBJECTIVE: To identify irregularities in the menstrual cycles of women with mesial temporal lobe epilepsy (MTLE) and extratemporal focal epilepsy (ETFE) and correlate the frequency of seizures during the menstrual cycles. METHOD: We evaluated prospectively women in the menacme with MTLE and ETFE. Calendars were provided for these patients, and they were asked to mark their seizure frequency according to the menses. Calendars were reviewed in each routine medical appointment. RESULTS: Thirty-nine patients with MTLE and 14 with ETFE were evaluated. We registered 211 cycles in the patients with MTLE and 49 in those with ETFE. Irregular menstrual cycles were found in 28 (28/39, 71.7%) patients with MTLE and 6 (6/14, 42.8%) with ETFE (p=0.052). Premenstrual seizure worsening was observed in 46 (21.8%) patients with MTLE and 9 (18.3%) with ETFE (p=0.596). Menstrual worsening was observed in 47 (22.2%) patients with MTLE and 15 (30.6%) with ETFE (p=0.217). Ovulatory worsening was observed in 36 (17%) patients with MTLE and 13 (26.5%) with ETFE (p=0,126). Catamenial worsening was observed in 58 (27.4%) of the patients with MTLE and in 17 (34.7%) of the patients with ETFE (p=0.315). CONCLUSION: There was no difference between the group of patients with MTLE and ETFE regarding the frequency of irregular cycles and seizure worsening during the premenstrual, menstrual, catamenial or ovulatory periods.

INTRODUÇÃO: Admite-se que a flutuação hormonal seja a responsável para a piora de crises epilépticas no período catamenial. OBJETIVO: Identificar irregularidades nos ciclos menstruais de mulheres com epilepsia de lobo temporal mesial (ELTM) e epilepsia focal extratemporal (EFET); e relacionar a frequencia de crises durante o ciclo menstrual. MÉTODO: Avaliamos mulheres na menacme, que apresentem quadro clínico laboratorial compatível com ELTM e EFET. Foram fornecidos calendários para estas pacientes e instruídas para preenchimento correto da menstruação e das crises epilépticas e serão revistos em cada consulta médica rotineira. RESULTADOS: Foram avaliadas 39 pacientes com ELTM e 14 com EFET. Registramos 211 ciclos nas pacientes com ELTM e 49 nas com EFET. Ciclos menstruais irregulares foram apresentados por 28 (71,7%) pacientes com ELTM e 14 (42,8%) com EFEP (p=0,052). Piora pré-menstrual foi observada em 46 (21,8%) pacientes com ELTM e 9 (18,3%) com EFET (p=0,596). Piora menstrual foi observada em 47 (22,2%) pacientes com ELTM e 15 (30,6%) com EFET (p=0,217). Piora ovulatória foi observada em 36 (17%) pacientes com ELTM e 13 (26,5%) com EFET (p=0,126). Piora catamenial foi observada em 58 (27,4%) das pacientes com ELTM e em 17 (34,7%) das pacientes com EFET (p=0,315). CONCLUSÃO: Não houve diferença entre os grupos de pacientes com ELTM e EFET quanto à freqüência de ciclos irregulares e piora das crises nos períodos pré-menstrual, menstrual, catamenial ou ovulatório.

Effect of Long-term Deep Brain Stimulation of the Subthalamic Nucleus for Frontal Lobe Epilepsy: Subtraction SPECT Analysis

BACKGROUND: Experimental data and case reports of intractable epilepsy patients treated with deep brain stimulation (DBS) on the subthalamic nucleus (STN) suggest the considerable anticonvulsant effect. However, no satisfactory mechanisms of action have yet been elucidated. We investigated DBS's therapeutic mechanism from the cerebral perfusion changes as measured by subtracting the SPECT images. METHODS: Two patients who had previous resection on their right frontal cortices were selected for DBS of the STN. The cerebral blood flow (rCBF) changes between two SPECT images (pre-insertion and post-operatively after at least 6 months) were analyzed by SPECT subtraction with the volumetric MRI coregistration method using Analyze 5.0 software. RESULTS: After chronic STN DBS [18 months (case 1) and 6 months (case 2)], they both experienced markedly reduced seizure frequencies (86.7% reduction in patient 1, 88.6% in patient 2). In patient 1, the increased rCBF was observed in the right frontal areas (dorsolateral and inferior frontal area). Unexpectedly, there was definite hyperperfusion on the right superior and inferior temporal areas as well as rCBF increase on the right superior frontal area (SMA) in patient 2. CONCLUSIONS: We demonstrate that the cerebral perfusion increase at the irritative zones of epilepsy patients is associated with the favorable seizure reduction after STN DBS in two cases of frontal lobe epilepsy. Although its exact mechanism remains unknown, our preliminary data suggests the clinical relevance to assessing the post-procedural outcome as well as the characteristics of perfusion patterns in other epilepsy syndromes.

Forntal Lobe Epilepsy Presenting with Blinking and Leg Jerking

Eye blinking is a rare semiology in frontal lobe epilepsy. However, eye blinking with leg jerking as a manifestation of simple partial seizure has not been reported. We report a patient with frontal oligodendroglioma who showed simple partial seizure presenting with eye blinking and leg jerking.