ABSTRACT
PURPOSE: This study was performed with the purpose of analysing the relationship between epileptological and surgical variables and post-operative memory performance, following surgery for refractory mesial temporal lobe epilepsy (MTLE) due to hippocampal sclerosis (HS). METHODS: Logical memory (LM) and visual memory (VM) scores for immediate and late follow-up of 201 patients operated for MTLE/HS were reviewed. Scores were standardized with a control group of 54 healthy individuals matched for age and education. The Reliable Change Index (RCI) was calculated to verify individual memory changes for late LM and VM scores. A multiple linear regression analysis was carried out with the RCI, using LM and VM scores as well as the clinical variables. RESULTS: A total of 112 (56%) patients had right HS. The RCI of the right HS group demonstrated that 6 (7%) patients showed improvement while 5 (6%) patients showed decreased scores in late LM; for late VM, 7 (8%) patients presented improvement, and 2 (3%) patients showed poorer scores. RCI of the left HS group showed that 3 (3%) individuals showed improved scores, while scores of 5 (4%) patients worsened for late LM; for late VM, 3 (3%) patients presented higher scores and 6 (5%) showed lower scores. Left HS and advanced age at onset of the first epileptic seizure were predictors of late LM loss (p<.05). CONCLUSION: Left MTLE/HS and seizure onset at advanced ages were predictive factors for the worsening of late LM. We observed poorer baseline LM function in the left HS group and improvement of LM in some patients who had resection of the right MTL. Patients in the right HS group showed a higher percentage of reliable post-operative improvement for both VM and LM scores.
Subject(s)
Epilepsy, Temporal Lobe , Hippocampus , Memory Disorders , Sclerosis , Humans , Epilepsy, Temporal Lobe/surgery , Hippocampus/pathology , Hippocampus/surgery , Female , Male , Adult , Memory Disorders/etiology , Middle Aged , Neuropsychological Tests , Young Adult , Hippocampal SclerosisABSTRACT
BACKGROUND: Patients with hypothalamic hamartomas (HH) often have severe refractory epilepsy, incapacitating behavioral abnormalities, and cognitive decline. Attempts to control the seizure disorder by resection of apparently epileptogenic mesial temporal or other cortical structures have failed consistently. OBJECTIVE: To report a series of 13 patients in whom the hamartoma itself was resected. METHODS: All patients underwent preoperative evaluation between ages 2 and 33 years and had subtotal or complete resection of the hamartoma. Follow-up ranged from 1 to 5.5 years (mean: 2.8 y). RESULTS: Preoperatively, all patients had variable combinations of gelastic, complex partial, and generalized seizures. Eight had drop attacks. In addition, all had marked behavior abnormalities and cognitive impairment. Postoperatively, two patients are completely seizure-free and 11 are either seizure-free or have achieved a greater than 90% reduction of drop attacks and generalized tonic-clonic seizures. However, minor gelastic, complex partial, and atypical absence seizures have persisted in 11 patients, although at significantly reduced rates. In addition, there has been a dramatic improvement in behavior and cognition. Three patients had an anterior thalamic and one a capsular infarct, which left only minimal long-term deficits. Exact location of the lesion in relation to the interpeduncular fossa and the walls of the third ventricle correlated with extent of excision, seizure control, and complication rate. CONCLUSION: Resection can alleviate both the seizures and the behavioral and cognitive abnormalities of hypothalamic hamartomas, but complications are frequent.
Subject(s)
Epilepsy/etiology , Hamartoma/complications , Hamartoma/surgery , Hypothalamic Neoplasms/complications , Hypothalamic Neoplasms/surgery , Adolescent , Adult , Brain/diagnostic imaging , Brain/pathology , Brain/surgery , Child , Child, Preschool , Cognition Disorders/etiology , Electroencephalography , Epilepsy/therapy , Female , Follow-Up Studies , Hamartoma/diagnosis , Humans , Hypothalamic Neoplasms/diagnosis , Lamotrigine , Magnetic Resonance Imaging , Male , Neurosurgical Procedures/adverse effects , Paresis/etiology , Recovery of Function , Remission Induction , Tomography, Emission-Computed , Treatment Outcome , Triazines/therapeutic useABSTRACT
Lesöes displásicas corticais (LDC) estäo frequentemente associadas a epilepsias de difícil controle. Nós descrevemos os correlatos eletrográficos deste alto grau de epileptogenicidade, caracterizado por descargas epileptógenas rítmicas, contínuas ou quase-contínuas, registradas diretamente das LDC durante eletrocorticografia trans-operatória. Esta atividade ictal ou descargas epileptogênicas contínuas (AI/DEC) manifestava-se por um de três padröes: (a) crises eletrográficas repetidas; (b) surtos de polipontas recorrentes; ou (c) espículas rítmicas contínuas ou quase-contínuas. Um ou mais destes padröes estava presente em 23 de 34 pacientes (67 por cento ) com epilepsia partial de difícil controle associada a LDC. Esta AI/DEC era geralmente mais localizada, assim contrastando com a atividade interictal ao eletrocorticograma, que era mais difusa. Nós concluimos que LDC säo altamente e intrinsicamente epileptogênicas e discutimos mecanismos possivelmente relacionados a esta epileptogenicidade intrínsica
Subject(s)
Infant , Child, Preschool , Child , Adolescent , Adult , Humans , Male , Female , Cerebral Cortex/injuries , Electroencephalography , Epilepsies, Partial , SeizuresABSTRACT
Bovine and equine growth hormones were chemically modified with tetranitromethane, at pH 7.4 during 5 h and at pH 8.0 in the presence of 8 M urea during 1 h. a) Both hormones have very similar but not identical reactivities. b) The nitration of the reactive tyrosines and tryptophan residues at pH 7.4 produces no detectable changes in their immunological or somatotrophic activities. C) The nitration of all tyrosine residues in both hormones gives rise to a complete loss of somatographic activity with no alteration of the immunological activity.
