[Prognostic factors in temporal lobe epilepsy surgery]. / Factores pronósticos en la cirugía de la epilepsia del lóbulo temporal.

INTRODUCTION: Temporal lobe epilepsy surgery represents the majority of surgical interventions in patients with refractory epilepsy. In consequence, knowledge of prognostic factors in this type of epilepsy surgery is of major importance. The objective of this study is to study series of prognostic factors in a group of patients who underwent temporal lobe epilepsy surgery and to correlate Engel's Classification of Postoperative Outcome, now used in most epilepsy centers, and the Proposal for New Classification in regards to Epileptic Seizures Following Epilepsy Surgery of the International League Against Epilepsy (ILAE). METHODS: We analyzed 41 consecutive patients who underwent temporal lobe epilepsy surgery in the Epilepsy Surgery Program of the Epilepsy Unit in the Fundación Jiménez Díaz. The following prognostic factors were analyzed: age at surgery, time since the first seizure (excluding febrile seizures), risk factors for the development of epilepsy, presence of simple partial seizures, presurgical complex partial seizure frequency, findings in brain magnetic resonance imaging, interictal and ictal electroencephalogram, neuropsychological assessment, Wada test and neuropathological study of the surgical specimen. Two outcome classifications were used: Engel's classification of postoperative outcome and the proposal for a new classification of outcome in regards to epileptic seizures following epilepsy surgery of the ILAE. Statistical analysis was performed using non-parametric tests. RESULTS: The presence of temporal unilateral interictal epileptiform activity and the presence of less than 20 seizures complex partial seizures per month before surgery were associated with a better prognosis using both classifications. The electronencephalographic unilateral temporal ictal onset recording was associated with a better prognosis using Engel's classification but not ILAE's outcome classification. The presence of febrile seizures was associated with a better prognosis in regards to ILAE's outcome classification but not in regards to Engel's classification. The remaining factors were not associated with outcome. CONCLUSIONS: The following factors were associated with a good prognosis: presence of unilateral temporal interictal epileptiform activity, presurgery seizure frequency below 20 complex partial seizures per month, unilateral temporal ictal onset, and presence of febrile seizures. A good correlation was found between both outcome classifications in regards to most of the analyzed prognostic factors.

Long-term intracerebral infusion of fibroblast growth factors restores motility and enhances F-DOPA uptake in parkinsonian monkeys.

Fibroblast growth factors (FGFs) are important for dopamine neurons in health and disease. Acidic (aFGF) and basic (bFGF) fibroblast growth factors increase the survival and growth of dopamine cells. Nigrostriatal dopamine neurons, the target cells for degeneration in Parkinson's disease, display receptors for basic fibroblast growth factor and these receptors are decreased in the brain of parkinsonian patients. We have investigated the effects of long-term intrastriatal infusion of FGFs in hemiparkinsonian monkeys. All animals were lesioned with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), 0.4mgkg(-1), into the left internal carotid artery. The monkeys that had persistent asymmetric akinesia and contralateral rotation induced by apomorphine, were selected for chronic, unilateral, intracerebral infusion of neurotrophic factors or vehicle into the striatum ipsilateral to the lesion. Two animals received intrastriatal aFGF or bFGF, 2mugweek(-1), for 6 months. The controls received intrastriatal saline or intraventricular epidermal growth factor (EGF). F-DOPA positron emission tomography scans were performed in each animal before and after the intracerebral infusion of neurotrophic factors. We measured the tyrosine hydroxylase (TH) immunoreactive neurons in the substantia nigra and terminals in the striatum and evaluated the pathological complications related to the treatment or the delivery system. All four animals had, after the lesion with MPTP, a transient but incomplete recovery of akinesia. This period of spontaneous improvement was followed by a progressive deterioration of motor behaviour during the following months. The monkeys treated with FGFs, however, recovered quickly and persistently during the intracerebral infusion. F-DOPA uptake, prior to the intracerebral infusion, was greatly reduced in the lesioned striatum. The post-infusion F-DOPA scans revealed a 60% reduction respect to baseline in the lesioned striatum of the saline and EGF-infused animals. In the animals infused with FGFs, the post-infusion F-DOPA uptake increased more than 400% in the lesioned (and infused) striatum and around 200-300% in the contralateral side, with respect to the pre-infusion scan. The number of TH-positive cells in the substantia nigra correlated well with the uptake of F-DOPA in the post-infusion scan. No severe side-effects were present. Intrastriatal infusion of FGFs restores motor behaviour and increases F-DOPA striatal uptake in hemiparkinsonian monkeys.