Failure of standard magnetic resonance imaging in patients with refractory temporal lobe epilepsy.

OBJECTIVE: To compare the sensitivity of standard magnetic resonance imaging (MRI) scans done outside an epilepsy center with that of special protocol MRI scans done at an epilepsy center in delineating relevant lesions of the temporal lobe. SUBJECTS: Eighty-four consecutive patients who had temporal lobe resections for refractory temporal lobe epilepsy between January 1, 1993, and February 1, 1996. DESIGN: The reports of findings on standard MRI scans done outside an epilepsy center were compared with the findings of special protocol MRI scans done with 1.5-mm T1-weighted coronal and 3-mm T2-weighted coronal images (no gaps) on a 1.5-T system. Both sets of MRI findings were compared with findings on histologic examination of the resected tissue. RESULTS: Of the 84 patients, 51 had standard MRI scans done outside an epilepsy center; of these, there were 34 patients with normal results, 10 with tumors, 2 with vascular malformations, 2 with hippocampal atrophy, 2 with unclassified abnormalities, and 1 with cortical malformation. In 32 of the 34 patients with normal results of an MRI scan done outside an epilepsy center, abnormalities were found on our special protocol MRI scans. These included hippocampal atrophy in 27 patients, tumors in 2, and cortical malformations in 1. Additionally, all 17 of the abnormalities detected on the standard MRI scans done outside the epilepsy center were identified on our special protocol MRI scans. Important pathologic abnormalities of the temporal lobe were identified in 16 (35%) of the 46 patients with standard MRI scans done outside an epilepsy center and in 44 (96%) with our special protocol MRI scans. In the 29 patients for whom adequate surgical specimens were available and results of standard MRI scans were normal, our special protocol MRI scans showed the abnormality in 27 (93%). CONCLUSIONS: Conventional neuroimaging studies are inadequate for diagnosing hippocampal sclerosis although they fairly readily detect low-grade tumors and vascular malformations. Magnetic resonance imaging scans for the evaluation of patients with refractory temporal lobe epilepsy should be done with a special temporal lobe protocol and read by physicians experienced with the findings in hippocampal sclerosis. Health care dollars are wasted on neuroimaging done for refractory temporal lobe epilepsy outside epilepsy centers.

Epidemiology and classification of brain tumors.

Several studies suggest that the incidence of brain tumors is rising, an increase that cannot be accounted for by improved diagnostic abilities. Brain tumors can be subdivided according to their histology and location. When approached from this standpoint, survival statistics and treatment options can vary greatly. Understanding the pathology and classification of tumors assists in understanding treatment approaches and provides a knowledge base for education of patients and families.

Stabilizing seizure disorders.

Scientific understanding of seizures and epilepsy is rapidly evolving. Recent advances in diagnosis, classification, and medical and surgical treatment have significantly altered our approach to patients with these conditions.

Ticlopidine hydrochloride: its current use in cerebrovascular disease.

It is estimated that half a million Americans will suffer strokes this year (National Stroke Association, 1989). The physical, emotional, and financial impacts of such an event are enormous. While stroke treatment methods have improved and rehabilitation programs have expanded, a substantial number of stroke patients are left with major disabilities. The only way to intervene is to focus on stroke prevention through the identification and modification of risk factors. One such intervention involves antiplatelet therapy, which has been found to reduce the risk of initial thrombotic stroke and the potential for recurrent stroke. Nurses caring for stroke patients need to know about this type of therapy, because continuity of pharmacological treatment, patient compliance, and education are essential for adequate stroke prevention.

Psychosocial components in stroke. Implications for adaptation.

Relatively little is known about poststroke psychosocial adjustments when compared to the wealth of data present regarding functional recovery. Recent studies have shown depression to exist in a large portion of the stroke population. Varying degrees of depression may be associated with lesion location, functional capacity, and personal and social support. Identification of depression in stroke patients and the implications for care interventions are in their infancy. Beginning efforts at assessing coping strategies and personal resources are indicating some correlation between how people cope and their ability to manage stressful illness situations such as stroke. At present, there is no conclusive evidence that any intervention can improve emotional and social well-being. Efforts are being pursued to treat stroke depressive disorders. These efforts, combined with the initiation of stroke support groups, ongoing community follow-up, and psychosocial treatment approaches, may improve the quality of life of stroke victims.

Reliability of the activities of daily living scale and its use in telephone interview.

Activities of daily living (ADL), a popular outcome assessment tool for studies of disabled populations, was evaluated for use in multicentered studies. The interobserver reliability of a modified Barthel Index of the ADL was evaluated on 18 stroke patients. Reliabilities between administrators of the ADL and between observers of the ADL administrations were r = .99 for total scores and r greater than .90 for most of the individual component items. The validity of ADL evaluation based on telephone interviews was demonstrated relative to ADL scores obtained on 72 patients in a direct test of their performance capabilities. The correlations between the performance-based ADL and the interview-based ADL were r greater than .97 for the total score and r greater than .85 for most of the individual items. The modified Barthel Index of the ADL is a reliable measure for assessing stable stroke patients, supporting its use in multicenter studies. In addition, the high validity observed in the telephone interview supports its use in longitudinal studies and large surveys where direct performance evaluation is not feasible or too costly.