Primary cultures of human caudate nucleus.

It is possible to grow functional primary dissociated cultures and explants from stereotactic biopsies of human parkinsonian caudate nuclei. Two major classes of cells were identified on morphological grounds. The culture cells appear to be stimulated by an unidentified soluble factor(s) obtained from human fetal neuronal cells in vitro. Culture of primary neuronal and glial cells from human adult cerebral nuclei seems to be a useful tool for several research purposes and in particular for studying both trophic factor action and target effects on afferent neurons for prospective human brain grafting.

[Interruption of antiepileptic therapy in seizure-free patients following surgery to remove the epileptogenic lesion]. / Interruzione della terapia antiepilettica nei pazienti liberi da crisi dopo intervento per la rimozione della lesione epilettogena.

This paper presents a series of 20 epileptic patients operated on at our Institute, with a clinical, EEG and drug plasma level follow-up, for periods from 48 to 60 months. Following surgery a group of 12 patients were seizure-free in a 3 year period of follow-up, and anticonvulsant medication was gradually withdrawn. While in 8 of these patients drug interruption uneventful, in 4 cases drug withdrawal caused the seizure to reappear. These 4 patients became seizure-free again, following a reintroduction of pharmacological therapy, which appeared to be effective also at low doses. Another group of 8 patients continued to have seizure also after surgery. Following quantitative and qualitative adjustments of their anticonvulsant medication, 5 patients became again seizure-free, while 3 continued to have seizures. Our experience suggests that in patients in whom the epileptogenic lesions have been surgically removed, anticonvulsant therapy can be safely withdrawn and removed after a seizure-free period of 3 years. Reappearance of seizures after drug withdrawal has a good prognosis, since a simple readjustment of medical therapy is usually effective in preventing further seizures to occur.

Head-holder interfacing computed tomography with Talairach stereotactic frame.

A device is described which allows employ of CT data in conjunction to the Talairach frame for biopsy and other fine localization procedures. A series of new accessory parts allows reversible exact placement of the patient head in the same relative position to the reference system both in the stereotactic frame and the CT machine. No modification has been introduced in the standard Talairach head-holder, preserving its features of simplicity and versatility without need for introduction of new stereotactic methodologies or new computer programs.

CT-scan and EEG findings in professional pugilists: early detection of cerebral atrophy in young boxers.

In order to evaluate the possibility of early detection of minimal cerebral damages in the professional boxers, ten young pugilists were submitted to complete neurological examination, EEG recording and CT-scan. Neuroradiological data, electrical patterns and neurological aspects were examined in connection with sporting career of each boxer. Neurological examination was normal in all cases. EEG patterns were considered normal in 3 cases, borderline in 4 cases and pathological in 3 cases. CT-scan was considered normal in 4 cases, borderline in 4 and pathological (showing signs of cerebral atrophy) in 2 cases. A good correlation was found between CT-scan pictures, EEG patterns and sporting career of the boxers: the pugilistis who suffered knockouts had pathological and/or borderline CT-scan and EEGs, while the pugilists who did not experience knockouts during their career showed a normal CT-scan and EEG, independently of the years of activity and number of matches.

Differences between the concentrations of antiepileptic drugs in normal and pathological human brain.

The concentrations of antiepileptic drugs in histologically normal and pathological brain tissues were investigated in 6 patients submitted to surgery. No significant difference for phenobarbital and phenytoin was found between normal and scar tissue, whereas there was a trend to concentration in tumour tissue (meningioma and glioma) of phenobarbital, phenytoin and carbamazepine. Alteration in the vascular supply and pathological changes at cellular and subcellular levels could be responsible for the differences in the distribution of the drugs. The possible clinical relevance of the preferential concentration of the drugs in tumour tissue is discussed.

Antiepileptic drug distribution in cerebral cortex, ammon's horn, and amygdala in man.

Significant correlations in the concentrations of phenobarbital, phenytoin, and carbamazepine in the brain, plasma, and cerebrospinal fluid were found in 12 surgically treated epileptic patients. These findings confirm the clinical reliability of monitoring anticonvulsant drug plasma levels as part of the routine management of epilepsy. Phenobarbital, phenytoin, and carbamazepine are uniformly distributed in the gray and white matter in different brain areas (except for a higher concentration of phenobarbital in the rhinencephalic structures in comparison with the corresponding temporal neocortex) and in normal and scar tissue. In these 12 patients, all of whom were medically resistant, molar cortex concentration of phenobarbital and phenytoin was at "therapeutic" levels or even higher. These data suggest that in therapy-resistant patients, despite cerebral drug concentrations of the same therapeutic level as, or higher than, those present in medically controlled patients, anticonvulsant drugs are pharmacologically ineffective.

Stereo-EEG and surgery in partial epilepsy with temporo-parieto-occipital foci.

Six cases of partial epilepsy operated on for lesions at the temporo-parieto-occipital junction are presented. Three cases had signs of enlargement of one lateral ventricle at the temporo-parieto-occipital carrefour, three had a lateral homonymous hemianopsia and all showed lateralizing interictal EEG abnormalities. The manifold features of the seizures could not be related to the involvement of one or more definite cortical areas. Since clinical, radiological, scalp EEG investigations provided no sufficient data to map the epileptogenic lesion to be excised, stereo-EEG studies with chronic depth electrodes were performed. Besides permitting the exact delimitation of the epileptogenic lesion, depth EEG gave the clue for interpreting physiopathological mechanisms underlying the electroclinical seizures in each case.

Late results of stereotactic radiofrequency lesions in epilepsy.

Thirty-five patients with partial complex seizures and two patients with generalized epilepsy were treated by stereotactic radiofrequency lesions. Follow-up from 2 to 13 years was available in 30 patients. The stereotactic targets in patients with partial complex seizures were: a) Amygdala; b) Ammon's horns; c) parahippocampal gyrus; d) Fornix. Depending on scalp EEG and depth electrode studies, each patient had one or more target coagulated, unilaterally or bilaterally. In the 2 cases of generalized epilepsy, bilateral Forel field lesions were performed. Late surgical results are discussed in relation to the depth EEG studies and the number and site of stereotactic lesions.

Interictal acute psychoses in temporal lobe epilepsy during withdrawal of anticonvulsant therapy.

Acute interictal psychotic attacks during withdrawal of medication are described in two patients with temporal lobe epilepsy submitted to depth EEG study with a view to surgical treatment. The patients were on chronic treatment with clonazepam associated in one with phenobarbitone and in the other with phenobarbitone plus carbamazepine. Our observations suggest that the acute withdrawal of clonazepam, the plasma levels of which were monitored may play a part in producing psychotic attacks characterised by dysphoric manifestations, irritability, aggressiveness, anxiety, and hallucinations. These symptoms could be interpreted as a withdrawal syndrome.

Long-term prognosis of early epilepsy in juvenile head-injured patients (preliminary results).

The authors present the results of a long-term follow up of 52 juvenile head-injured patients who showed early epileptic seizures. The purpose of this study is to stress the role of long-term prognosis in the early seizures and to determine in which cases a treatment preventing late seizures is eligible. They consider long-term prognosis as to be favourable. Late epilepsy occurred in 15.3% of the cases and responded favourably to anticonvulsive therapy. They suggest prophylaptic treatment in those patients who had loss of consciousness immediately after trauma, recurring seizures, coma and/or surgery.

Indications of anticonvulsant plasma levels monitoring in medical and surgical treatment of epilepsy.

The results of long-term (19-21 months) intensive anticonvulsant plasma levels monitoring in two patients with partial complex epilepsy resistant to therapy are reported. In the first case the qualitative and quantitative therapeutic adjustment based on the monitoring data caused the disappearance of the seizures. In the second case, in which a right mid-temporal calcification (abscess) was demonstrated by CT-scan, the attacks were not controlled by different drugs. The patient became seizure-free after a right temporal lobectomy. The importance of long-term anticonvulsant plasma levels monitoring in partial complex epilepsies unresponsive to pharmacological therapy is discussed in detail in view of possible surgical treatment.

Chronic depth electrodes study of one case of bitemporal epilepsy due to glial tumour. Some physiopathological considerations.

The authors describe a seventeen-years-old girl suffering from partial seizures with complex symptomatology. The neuroradiological studies demonstrated a slow-growing glial tumour seated deeply in the right temporo-occipital region. Scalp EEG demonstrated a bilateral asynchronous temporal focus without definite lateralization. Chronic depth electrodes recording allowed identification of a primary epileptogenic area in the right rhinencephalic structures. Radiofrequency lesions performed in the right amygdala and anterior third of right Ammon's horn abolished the seizures at ten months follow up.