Memory changes in patients with hippocampal sclerosis submitted to surgery to treat mesial temporal lobe epilepsy.

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.

Freeze shoe sampler for the collection of hyporheic zone sediments and porewater.

The Starr and Ingleton (1992) drive point piston sampler (DPPS) design was modified by fitting it with a Murphy and Herkelrath (1996) type sample-freezing drive shoe (SFDS), which uses liquid carbon dioxide as a cryogen. Liquid carbon dioxide was used to freeze sediments in the lower 0.1 m of the core and the drive-point piston sealed the core at the top preserving the reductive-oxidation (redox) sensitive sediments from the atmosphere and maintaining natural stratigraphy. The use of nitrogen gas to provide positive pressure on the gas system blocked the ingress of water which froze on contact with the cryogen thus blocking the gas lines with ice. With this adaptation to the gas system cores could be collected at greater depths beneath the static water level. This tool was used to collect intact saturated sediment cores from the hyporheic zone of the tidally influenced Fraser River in Vancouver, British Columbia, Canada where steep geochemical and microbial gradients develop within the interface between discharging anaerobic groundwater and recharging aerobic river water. In total, 25 cores driven through a 1.5 m sampling interval were collected from the river bed with a mean core recovery of 75%. The ability to deploy this method from a fishing vessel makes the tool more cost effective than traditional marine-based drilling operations which often use barges, tug boats, and drilling rigs.

Impacto de la cirugía de la epilepsia infantil en el rendimiento intelectual / Impact of pediatric epilepsy surgery on intellectual efficiency

Introducción. La cirugía de la epilepsia podría ser una opción terapéutica muy prometedora para el control de las crisis en pacientes con crisis refractarias que no responden a la medicación. Otro factor importante a favor de la opción quirúrgica son los resultados cognitivos. Objetivo. Investigar la correlación entre los resultados tanto de las crisis como cognitivos tras la cirugía para tratar la epilepsiaen una población pediátrica.Pacientes y métodos. Se evaluó de manera retrospectiva a un total de 59 pacientes pediátricos antes y al menos seis meses después de la cirugía mediante la tercera edición de la escala de inteligencia para niños de Wechsler (escala global, escala verbal y escala manipulativa). Se dividió a los pacientes en dos grupos en función de la presencia o ausencia de la mejoría del control de las crisis tras la cirugía. Los datos que se recogían de cada niño incluían: tipo de epilepsia, etiología, edad de comienzo de la epilepsia, duración de la epilepsia y frecuencia de las crisis.Resultados. Al comparar los datos mediante un análisis multivariado de la varianza se observaron diferencias significativas en las escalas global, verbal y manipulativa preoperatorias (p = 0,01) con unos resultados mejores en el grupo con reducción de las crisis que en el grupo sin reducción de las crisis. El grupo con mejoría de las crisis consiguió una mejoría significativa en la escala manipulativa (p = 0,01) y el grupo sin mejoría de las crisis obtuvo un empeoramiento significativoen la escala verbal (p = 0,01).Conclusiones. Nuestros resultados sugieren que el éxito de la cirugía para el tratamiento de la epilepsia en la infancia cuando se logra un control de las crisis podría conllevar también una mejoría en la escala manipulativa, mientras que lapersistencia de las crisis podría empeorar la escala verbal (AU)

Introduction. Epilepsy surgery may be a promising alternative therapy for seizure control in patients with refractory seizures, resistant to medication. Cognitive outcome is another important factor in favor of the surgical decision. Aim. To investigate the correlation between seizure outcome and cognitive outcome after epilepsy surgery in a pediatric population. Patients and methods. A total of 59 pediatric patients were retrospectively assessed with the WISC-III (Full Scale, Verbal Scale and Performance Scale) before and, at least, 6 months after surgery. Patients were divided into two groups according whether or not improvement of seizure control after surgery. Data collected for each child included: epileptic syndrome, etiology, age at epilepsy onset, duration of epilepsy and seizure frequency. Results. Comparison using a MANOVA test revealed significant differences across pre-operative Full Scale, Verbal Scale and Performance Scale (p = 0.01) with seizure reduction group performing better than no seizure reduction group. Seizureimprovement group achieved significant Performance Scale improvement (p = 0.01) and no seizure improvement groupshowed significant Verbal Scale worsened after surgery (p = 0.01).Conclusions. Our results suggest that the success of the epilepsy surgery in childhood when the seizure control is achieved may also provide an improvement in the Performance Scale whereas the seizure maintenance may worsen the Verbal Scale (AU)

[Comparative analysis of occupational therapy benefits in spastic patients with hands involvement before and after botulinum toxin infiltration]. / Analisis comparativo de los beneficios de la ergoterapia en pacientes espasticos con afectacion de las manos antes y despues de la infiltracion de toxina botulinica.

INTRODUCTION: Spasticity is the most difficult motor disorder to be treated after an encephalic vascular accident or stroke, which interferes in the patient's selective motor functioning. AIM: To compare the involvement type of the extrinsic muscles, the functionality degree of the hand and functional independence of patients with spastic hemiplegia due to stroke after botulinum toxin A (BTA) infiltration. They were divided into a group receiving occupational therapy treatment (group I), and other who has not received it (group II). PATIENTS AND METHODS: Longitudinal study with 20 spastic hemiplegic outpatients due to stroke, both sexes, with average age of 53.1 +/- 15.3 years-old who have been attending in the botulinum toxin service. They have received BTA infiltration in the muscles responsible for the hand functional movements, and they were evaluated before and after 3-months infiltration. To collect data, these instruments were used: anamnesis questionnaire of occupational therapy, the Classification of involvement types of extrinsic muscle, according to adapted Zancolli, the adapted Hausen's Functional Classification, the Functional Independence Measure Scale, the Rivermead's Scale of Activity of Daily Life and the Barthel Index. RESULTS: In the classification, according to adapted Zancolli, group I presented higher improvement of involvement than group II. Statistical significance (p < 0.05) was observed in group I according to the other evaluations, except in the Barthel Index. CONCLUSION: Both effectiveness and importance of occupational therapy were observed in the rehabilitation of patients with spastic hemiplegia due to stroke after infiltration of BTA providing them greater abilities and functional independence in their daily life activities.

Physical activity and dementia risk in the elderly: findings from a prospective Italian study.

OBJECTIVE: To examine the effect of physical activity on risk of developing Alzheimer disease (AD) and vascular dementia (VaD) in the elderly. METHODS: Data are from a prospective population-based cohort of 749 Italian subjects aged 65 and older who, in 1999/2000, were cognitively normal at an extensive assessment for clinically overt and preclinical dementia and, in 2003/2004, underwent follow-up for incident dementia. Baseline physical activity was measured as energy expenditure on activities of different intensity (walking, stair climbing, moderate activities, vigorous activities, and total physical activity). RESULTS: Over 3.9 +/- 0.7 years of follow-up there were 86 incident dementia cases (54 AD, 27 VaD). After adjustment for sociodemographic and genetic confounders, VaD risk was significantly lower for the upper tertiles of walking (hazard ratio [HR] 0.27, 95% CI 0.12 to 0.63), moderate (HR 0.29, 95% CI 0.12 to 0.66), and total physical activity (HR 0.24, 95% 0.11 to 0.56) compared to the corresponding lowest tertile. The association persisted after accounting for vascular risk factors and overall health status. After adjustment for sociodemographic and genetic confounders, AD risk was not associated with measures of physical activity and results did not change after further adjustment for vascular risk factors and overall health and functional status. CONCLUSIONS: In this cohort, physical activity is associated with a lower risk of vascular dementia but not of Alzheimer disease. Further research is needed about the biologic mechanisms operating between physical activity and cognition.

[Prevalence of hand dysfunction in cerebral palsy following Botulinum toxin therapy]. / Prevalencia de la disfuncion de la mano en la paralisis cerebral tras la toxina botulinica.

AIM: To examine the level of dependence, the functional class, the most frequent type of compromise and the proprioception of the hand in spastic cerebral palsy following the application of botulinum toxin, as well as to determine the sociodemographic characteristics of the individuals involved. PATIENTS AND METHODS: We conducted a cross-sectional study of 21 spastic patients with extrinsic muscle involvement, of both sexes and a mean age of 15.4 +/- 5.6 years, who attended the neuro-rehabilitation outpatients department and were treated with botulinum toxin in the muscles responsible for the functional movements in the hand; they were evaluated after a mean period of 2.1 years. Patients were subjected to procedures such as a semi-structured interview, the FIM (Functional Independence Measurement) scale, Hausen's functional characterisation, Zancolli classification and a proprioception test. RESULTS: There was a predominance of females (57% of patients) and of a basic level of schooling. On the FIM scale, 38% of the patients presented modified independence, without help; 23.8% belonged to Hausen grade 3 (grasping and holding an object steady with the help of the other hand). On the Zancolli classification, 54% belonged to type III (the fingers can only be extended if the fist is bent more than 70 masculine); perception of movement is absent (76.2%) and the sense of position of the movement is altered (54.2%). CONCLUSIONS: Findings confirmed the existence of a high rate of modified independence, grade 3 (Hausen), together with type III involvement (Zancolli) and alterations affecting proprioception. Data from the study show the importance of occupational therapy as part of the care received by patients with cerebral palsy following the administration of botulinum toxin type A.

Prevalencia de la disfunción de la mano en la parálisis cerebral tras la toxina botulínica / Prevalence of hand dysfunction in cerebral palsy following botulinum toxin therapy

Investigar el nivel de dependencia, el grado funcional, el tipo más frecuente de afectación y la propiocepciónde la mano en la parálisis cerebral espástica después de la aplicación de toxina botulínica, así como las características sociodemográficas de los individuos. Pacientes y métodos. Estudio transversal con 21 pacientes espásticos con afectaciónde la musculatura extrínseca, de ambos sexos, con una media de edad de 15,4 ± 5,6 años, que frecuentaban el ambulatorio de neurorrehabilitación y a quienes se les administró toxina botulínica en músculos responsables de los movimientos funcionales de la mano, evaluados tras un período medio de 2,1 años. Se sometió a los pacientes a procedimientos como: entrevista semiestructurada,escala FIM (Functional Independence Measurement), grado funcional de Hausen, clasificación de Zancolli ytest de propiocepción. Resultados. Predominio del sexo femenino (57% de los pacientes) y con nivel de estudios básicos. En la escala FIM, un 38% de los pacientes presentaba una independencia modificada, sin ayuda; un 23,8% pertenecía al grado 3 de Hausen (agarrar y estabilizar un objeto con ayuda de la otra mano). En la clasificación de Zancolli, el 54% formaba partedel tipo III (la extensión de los dedos sólo es posible con el puño flexionado más de 70 º); percepción del movimiento ausente (76,2%) y sentido de la posición del movimiento alterado (54,2%). Conclusión. Se verifica la existencia de un alto índice de independencia modificada, de grado 3 (Hausen), así como del tipo III de afectación (Zancolli) y alteraciones en la propiocepción. Los datos del estudio muestran la relevancia de la terapia ocupacional en la atención de los pacientes con parálisis cerebral después de la administración de toxina botulínica A

Aim. To examine the level of dependence, the functional class, the most frequent type of compromise and the proprioception of the hand in spastic cerebral palsy following the application of botulinum toxin, as well as to determine the sociodemographic characteristics of the individuals involved. Patients and methods. We conducted a cross-sectional study of 21 spastic patients with extrinsic muscle involvement, of both sexes and a mean age of 15.4 ± 5.6 years, who attended the neurorehabilitation outpatients department and were treated with botulinum toxin in the muscles responsible for the functional movements in the hand; they were evaluated after a mean period of 2.1 years. Patients were subjected to procedures such as a semi-structured interview, the FIM (Functional Independence Measurement) scale, Hausen’s functional characterisation,Zancolli classification and a proprioception test. Results. There was a predominance of females (57% of patients) and of a basic level of schooling. On the FIM scale, 38% of the patients presented modified independence, without help; 23.8% belongedto Hausen grade 3 (grasping and holding an object steady with the help of the other hand). On the Zancolli classification, 54% belonged to type III (the fingers can only be extended if the fist is bent more than 70º); perception of movement is absent (76.2%) and the sense of position of the movement is altered (54.2%). Conclusions. Findings confirmed the existence of a highrate of modified independence, grade 3 (Hausen), together with type III involvement (Zancolli) and alterations affecting proprioception. Data from the study show the importance of occupational therapy as part of the care received by patients withcerebral palsy following the administration of botulinum toxin type A

Calcified cysticercotic lesions and intractable epilepsy: a cross sectional study of 512 patients.

BACKGROUND: Neurocysticercosis is a major cause of epilepsy in developing countries and is endemic in Brazil. To test the hypothesis that the aetiological profile of patients with intractable epilepsy in Brazil includes neurocysticercosis, we conducted a cross sectional study investigating the aetiology of intractable epilepsy. METHODS: A total of 512 patients evaluated at the outpatient clinic for intractable epilepsy at the Ribeirão Preto School of Medicine were included in the survey. Medical intractability was determined on the basis of seizure incidence and severity, and response to appropriate epilepsy management. Neuroimaging included brain CT with non-contrasted and contrasted phases and high resolution MRI. Patients were divided into neurocysticercosis and non-neurocysticercosis groups according to previous diagnostic criteria. RESULTS: The most common epileptogenic lesions were mesial temporal sclerosis (MTS; 56.0%), malformations of cortical development (12.1%), and brain tumours (9.9%). Neuroimaging was normal in 8.7% of patients. Calcifications were found in 27% of patients and were significantly more common in patients with MTS than in those without MTS (p<0.001). Isolated neurocysticercosis was found in only eight patients (1.56%). CONCLUSIONS: These data suggest that neurocysticercosis is an uncommon cause of intractable epilepsy, even in an endemic region such as Brazil, and that it may only represent a coexistent pathology. However, an analysis of our findings reveals that neurocysticercosis was more common in patients with MTS. This finding could suggest either that there is a cause-effect relationship between MTS and neurocysticercosis, or that MTS and neurocysticercosis co-vary with a missing variable, such as socio-economic status.

Serum and cerebrospinal fluid S100B concentrations in patients with neurocysticercosis.

The clinical manifestations of neurocysticercosis (NC) are varied and depend on the number and location of cysts, as well as on the host immune response. Symptoms usually occur in NC when cysticerci enter a degenerative course associated with an inflammatory response. The expression of brain damage markers may be expected to increase during this phase. S100B is a calcium-binding protein produced and released predominantly by astrocytes that has been used as a marker of reactive gliosis and astrocytic death in many pathological conditions. The aim of the present study was to investigate the levels of S100B in patients in different phases of NC evolution. Cerebrospinal fluid and serum S100B concentrations were measured in 25 patients with NC: 14 patients with degenerative cysts (D), 8 patients with viable cysts (V) and 3 patients with inactive cysts. All NC patients, except 1, had five or less cysts. In most of them, symptoms had been present for at least 1 month before sample collection. Samples from 8 normal controls (C) were also assayed. The albumin quotient was used to estimate the blood-brain barrier permeability. There were no significant differences in serum (P = 0.5) or cerebrospinal fluid (P = 0.91) S100B levels among the V, D, and C groups. These findings suggest that parenchymal changes associated with a relatively small number of degenerating cysts probably have a negligible impact on glial tissue.

Serum and cerebrospinal fluid S100B concentrations in patients with neurocysticercosis

The clinical manifestations of neurocysticercosis (NC) are varied and depend on the number and location of cysts, as well as on the host immune response. Symptoms usually occur in NC when cysticerci enter a degenerative course associated with an inflammatory response. The expression of brain damage markers may be expected to increase during this phase. S100B is a calcium-binding protein produced and released predominantly by astrocytes that has been used as a marker of reactive gliosis and astrocytic death in many pathological conditions. The aim of the present study was to investigate the levels of S100B in patients in different phases of NC evolution. Cerebrospinal fluid and serum S100B concentrations were measured in 25 patients with NC: 14 patients with degenerative cysts (D), 8 patients with viable cysts (V) and 3 patients with inactive cysts. All NC patients, except 1, had five or less cysts. In most of them, symptoms had been present for at least 1 month before sample collection. Samples from 8 normal controls (C) were also assayed. The albumin quotient was used to estimate the blood-brain barrier permeability. There were no significant differences in serum (P = 0.5) or cerebrospinal fluid (P = 0.91) S100B levels among the V, D, and C groups. These findings suggest that parenchymal changes associated with a relatively small number of degenerating cysts probably have a negligible impact on glial tissue.

Suppression of obsessive-compulsive symptoms after epilepsy surgery.

We report two male patients with medically intractable epilepsy and obsessive-compulsive disorder (OCD) symptoms. Both patients experienced remission of obsessive-compulsive symptoms after surgical treatment of epilepsy. Although the surgeries targeted different brain regions, the two patients had in common unilateral anterior cingulate cortex ablation. On the basis of these observations, we discuss the pathophysiology of OCD symptoms, emphasizing the role of corticosubcortical pathways in their genesis. Our data suggest that surgeries that affect neural loops associated with obsessive-compulsive symptoms can lead to an improvement of OCD; however, the structures responsible for this effect cannot be conclusively determined.

Cognitive performance of patients with mesial temporal lobe epilepsy and incidental calcified neurocysticercosis.

OBJECTIVES: Although chronic calcified neurocysticercosis (NCC) has been considered a major cause of symptomatic epilepsy in developing countries, it can also be an incidental pathological finding in epileptic patients from endemic regions. The mechanisms of brain plasticity occurring in patients with NCC during and after the inflammatory process related to the parasite infection, death, degeneration, and calcification within the host brain might be an independent factor for cognitive impairment in patients with NCC and epilepsy. In order to assess this possibility cognitive performance of patients with mesial temporal lobe epilepsy related to hippocampal sclerosis (MTLE-HS) with and without NCC was investigated through structured neuropsychological testing. METHODS: Cognitive performance of long term MTLE-HS patients with (HS-NCC group, n = 32) and without NCC (HS only, n = 48) was compared. Imbalances between the two groups with respect to clinical, demographic, neuroimaging, and electrophysiological variables were adjusted by linear multiple regression analysis and Bonferroni correction for multiple tests. RESULTS AND CONCLUSIONS: There were no cognitive performance differences between HS-NCC and HS only patients, leading to the conclusion that chronic calcified NCC per se does not aggravate the cognitive performance of patients with long term MTLE-HS.

Incidence and etiology of dementia in a large elderly Italian population.

OBJECTIVE: To estimate age- and sex-specific incidence of dementia, Alzheimer disease (AD), and vascular dementia (VaD) in the Conselice Study of Brain Aging, an Italian prospective population-based study, and to assess whether poor education is a risk factor for dementia. METHODS: In 1999 to 2000, the baseline study identified a dementia-free cohort of 937 subjects aged 65 years and older who were reexamined in 2003 to 2004 using a two-phase procedure. RESULTS: Information was obtained for 91% of the subjects at risk; 115 incident cases of dementia were identified. Incidence rates per 1,000 person-years were 37.8 (95% CI = 30.0 to 47.7) for dementia, 23.8 (95% CI = 17.3 to 31.7) for AD, and 11.0 (95% CI = 7.2 to 16.9) for VaD. This translates into more than 400,000 new cases of dementia expected per year in Italy. Increasing age was an independent risk factor for both AD and VaD. Poor education was an independent risk factor for AD but not VaD. Sex did not affect dementia risk. CONCLUSIONS: In this Italian population-based cohort, incidence of dementia increased with age, and Alzheimer disease (AD) was the most frequent type of dementia. Poor education was associated with a higher risk of AD. Our incidence rates are higher than previously reported in Italy, and provide new estimates for projection of future burden of disease in Italy.

Cortical malformations are associated with a rare polymorphism of cellular prion protein.

Studies in animals lacking the cellular prion protein (PrP(c)) gene (Prnp) showed higher neuronal excitability in vitro and increased sensitivity to seizures in vivo. The authors previously reported a rare polymorphism at codon 171 (Asn-->Ser) of human Prnp to be associated with mesial temporal lobe epilepsy related to hippocampal sclerosis. They demonstrated that the same variant allele is also associated with symptomatic epilepsies related to different forms of malformations of cortical development.

Common polymorphisms in methylenetetrahydrofolate reductase (MTHFR): relationships with plasma homocysteine concentrations and cognitive status in elderly northern italian subjects.

Hyperhomocysteinemia may be a risk factor for cognitive impairment. Methylenetetrahydrofolate reductase (MTHFR) is a key enzyme in homocysteine (Hcy) metabolism. Both the MTHFR 677C-->T and the 1298A-->C polymorphisms are associated with mild hyperhomocysteinemia, particularly in conditions of low folate status. The prevalence of these MTHFR polymorphisms and their relationships with plasma total Hcy (tHcy), serum folate and cognitive function was evaluated in 194 elderly Italian individuals: 122 healthy controls (73.8 +/- 7.1 years of age), 24 cognitively- impaired- not-demented individuals (78.6 +/- 9.3 years), and 48 subjects with Alzheimer dementia (AD = 26), vascular dementia (VD =22; 85.5 +/- 7.0 years). Twenty-one percent of all subjects were homozygous for 677C-->T and 7 % for 1298A-->C polymorphism. No significant relationship was found betweenMTHFR polymorphisms and age, cognitive status and type of dementia. Plasma tHcy did not differ significantly by MTHFR genotypes, but, subjects of all genotypes with low serum folate (<12 nmole/l) had higher plasma tHcy (p < 0.001), than subjects with high serum folate (>= 12 nmole/l). The study suggests that 677C-->T and 1298A-->C polymorphisms are common in the Northern Italian population, but do not significantly affect plasma tHcy levels of elderly individuals, even under conditions of low folate status. The lack of association of age and cognitive function with MTHFR genotypes argues against a negative selection for these polymorphisms.

Homocysteine and cognitive performance in healthy elderly subjects.

Hyperhomocysteinemia is a risk factor for dementia but only scanty data exist about its relationship to specific cognitive abilities during normal aging. We recruited 62 healthy and cognitively normal subjects of age 65-91 years from the Conselice Study of brain aging. The following neuropsychological tests were applied (i) The mental deterioration battery(MDB) consisting of 7 parts: the Rey's 15 words immediate and delayed recall, word fluency, sentence construction, Raven's progressive matrices '47, immediate visual memory, freehand copying of drawings and copying drawings with landmarks. (ii) The Prose memory test. (iii) The Corsi block-tapping task. (iv) The mini mental state examination(MMSE) scores. We measured plasma total homocysteine (tHcy), serum folate, vitamin B12 and plasma vitamin B6. Multivariate-adjusted linear regression analysis showed statistically significant negative association of plasma tHcy with scores at MMSE (b= -0.01 2,p < 0.001) and word fluency (b = -0.009, p = 0.021). A non-significant trend towards a negative association was also found for sentence construction (b = -0.006, p = 0.076). One can conclude that in healthy elderly subjects, increased plasma tHcy is correlated to poorer performance at a specific measure of language abilities being compromised in both vascular and Alzheimer's dementia. The study suggests that plasma tHcy could be an early marker of cognitive impairment.