Clinical significance of isolated hippocampal volume asymmetry in childhood epilepsy.

This study defines the clinical characteristics and evolution of 16 epileptic children with hippocampal asymmetry (HA) without sclerosis on MRI. The association of a positive family history of epilepsy (11/16), low incidence of febrile seizures (2/16), and benign prognosis (seizure control in monotherapy in 11/16, mean follow-up = 4.3 years, range 1 to 10) suggest a different clinical presentation than patients with mesial temporal sclerosis. Genetic studies of these mostly French Canadian families should help confirm the existence of a distinct syndrome.

The pathological basis of temporal lobe epilepsy in childhood.

OBJECTIVE: To characterize the pathologic findings of temporal lobe epilepsy (TLE) in children undergoing temporal lobectomy for refractory seizures and to correlate these findings with clinical presentation. METHODS: The authors reviewed the charts of all children who underwent anterior temporal lobectomy for refractory TLE from 1979 through 1999. A new neuropathologic analysis was performed blinded to clinical features and outcome. RESULTS: Twenty-two children met inclusion criteria. Mean age at onset of epilepsy was 3 years, 7 months (range 1 month to 10 years). Mean age at surgery was 10 years, 11 months (range 1 to 18 years). All patients had complex partial seizures, 48% with secondary generalization. Most had daily seizures. Auras were reported in 45% of patients. Post-resection follow-up averaged 5 years, 2 months (range 2 to 19 years). Seizure-free status was achieved in 41% of patients, and 14% had residual auras only. The most frequent neuropathologic abnormalities were cortical dysplasia (CD) of the temporal neocortex (14 of 22) and mesial temporal sclerosis (MTS) (12 of the 15 children with available hippocampal tissue). These two findings coexisted in seven children. MTS was associated with extra-hippocampal pathology in 8 of 12 (67%) of the cases. CONCLUSIONS: MTS occurs frequently in association with CD in this population of children. The high incidence of dual pathology could explain the early age of seizure onset and high seizure frequency rate observed. TLE in childhood may constitute a different entity than in adults, from both the clinical and neuropathologic perspectives.

Autoantibodies in childhood post-varicella acute cerebellar ataxia.

BACKGROUND: Anti-Purkinje cell antibodies have been reported in cerebellar ataxia following Epstein-Barr virus (EBV) infection. We investigated autoantibody responses, including anti-Purkinje cell antibodies, and the clinical course in eight children who developed post-varicella ataxia, five of their siblings with uncomplicated varicella, one child with post-EBV ataxia, two children with acute disseminated encephalomyelitis (ADEM) and one with neuroblastoma associated ataxia, and in age and gender matched controls. METHODS: Autoantibodies were tested by indirect immunofluorescence (IIF) on cryopreserved cerebrum and cerebellum sections. Other autoantibodies were measured by conventional IIF protocols using HEp-2 cells as a substrate. Antibodies to myelin associated glycoprotein (MAG), asialo-GM1, beta2 glycoprotein 1, cardiolipin and myelin basic protein (MBP) were measured by ELISA. RESULTS: Three of eight children with acute post-varicella ataxia, one child with post-EBV ataxia, one child with ADEM and one child with uncomplicated varicella, had high titer autoantibodies (>1/160) that reacted with cerebrum and cerebellar tissue. This reactivity was not seen in one child with ADEM, in one with neuroblastoma and ataxia, in the remainder of the children with uncomplicated varicella or age and gender matched controls. Autoantibodies were not seen in CSF from two children with post-varicella ataxia. The punctate staining seen on cerebrum and cerebellum sections co-localized with rabbit antibodies to the centrosome protein pericentrin. All patients with strong reactivity with cerebrum and cerebellar tissue by IIF had elevated levels of anti-MAG that was not confirmed by absorption assay. No reactivity was seen with asialo-GM1, MBP, beta2 glycoprotein 1 or cardiolipin. None of the sera had autoantibodies directed against endosomes, the Golgi complex, or the paraneoplastic autoantigens Hu and Yo. CONCLUSION: Some children with post-viral ataxia develop antibodies that have strong reactivity with cerebral and cerebellar tissue. Some of the antigenic reactivity co-localized with the centrosome protein pericentrin.

Epidermal nevi and localized cranial defects.

We report on a girl with a congenital pigmented hairy nevus of the scalp, epidermal nevi of the right temple, and localized cranial defects. We have not found other reported cases of giant pigmented hairy nevus of the scalp occurring with absence of underlying cranial bone. We speculate that the localized cranial defects are undergrowth anomalies representative of a paracrinopathy from the overlying nevus or simultaneous bone/skin dysplasia, the former having been resorbed. In the absence of a familial history of epidermal nevi and/or seizures, our patient represents a sporadic case, perhaps a somatic mutation.

Myopathy of the Proteus syndrome: hypothesis of muscular dysgenesis.

The Proteus syndrome is a congenital disorder of growth regulation affecting tissues of mesodermal and ectodermal origin. It is expressed as hemihypertrophy, hemimegalencephaly, muscular overgrowth, verrucous epidermal nevi, haemangiomas and bony dysplasias. Muscle biopsies were examined at 7 and 10 yr of age from a girl with this disease. Several cytoarchitectural alterations of myofibres, proliferation of sarcolemmal nuclei, and other myopathic changes were demonstrated in regions adjacent to other with normal myofibres; the boundaries did not correspond to fascicular margins. A perinuclear and subsarcolemmal distribution of excessive desmin was also found. It is suggested that this myopathy represents a new category of neuromuscular disease, "muscular dysgenesis", due to faulty paracrine growth factors.

Somatosensory cortical neurons with an identifiable electrophysiological signature.

In both cats and rats, neurons with a distinctively narrow action potential were recognized as a small subset of all neurons isolated in the somatosensory cortex. These cells were characterized by generally having a spontaneous activity, some evidence of an afferent input, a sensitivity to glutamate but a relative resistance to depolarization block induced by glutamate and a marked insensitivity to acetylcholine. Two were filled with horseradish peroxidase (HRP) and recovered. Although others have suggested that such neurons are interneurons, following reconstruction it was apparent that the two cells filled with HRP were pyramidal cells. These observations suggest that there may be more than one class of cortical neurons with thin spikes.

Morphological and electrophysiological characteristics of somatosensory thalamocortical axons studied with intra-axonal staining and recording in the cat.

The intracortical arborizations of thalamocortical fibers arising from the ventroposterolateral (VPL) nucleus in the cat were studied following intra-axonal injections of horseradish peroxidase (HRP). The axons were impaled 1.5 to 3 mm below the surface of the cortex, identified electrophysiologically by stimulating the VPL nucleus and functionally by stimulating the somatic receptive field with natural stimuli. Many of the results obtained in a previous study using similar techniques (Landry and Deschênes 1981) were confirmed by the present experiments. Fibers activated by cutaneous stimulation arborized either in area 3b or 1 but some did send branches to both areas. Also, the intracortical arborization of a rapidly adapting cutaneous afferent fiber in area 2 is described. The size and tangential extent of the fiber in area 2 are similar to those arborizing in other areas of the primary somatosensory cortex and consist of multiple patches separated by uninvaded gaps. One fiber activated by stimulation of deep tissue receptors gave rise to two bushes that arborized along a rostrocaudal axis exclusively in area 3b. Terminal boutons and varicosities were found mostly in layers VI, IV, the bottom third of III and the upper portion of V, but some fibers did send a few collateral branches to layer II and the bottom part of layer I. The results suggest that in the forebrain representation, the same modality and submodality can be recorded in more that one cytoarchitectonic area but that areas 3b, 1 and 2 should not be considered as a single functionally homogeneous area. Counts of terminals suggest that a single fiber arborizing in area 1 makes as many as 3 times the number of synapses made in area 2 or 3b. Since fibers appear to be modality and submodality specific, if convergence of modality, submodality and/or body areas occur in the cortex, then this must be preferentially, but not exclusively, done by thalamic fibers of different functions which arborize in the same cytoarchitectonic area and synapse upon a shared postsynaptic target. In the same experiments intra-axonal recordings revealed the presence of two hyperpolarizing after potentials elicited by a preceding action potential. The first after potential was associated with a decrease in excitability of the fiber and an increase in membrane resistance.(ABSTRACT TRUNCATED AT 400 WORDS)

Interhemispheric reciprocal interaction between ventroposterolateral thalamic nuclei involving cortical relay neurons.

Extracellular and intracellular recordings were performed in the somatosensory cortex of cats anesthetized with sodium pentobarbital. Commissural neurons identified antidromically from the corpus callosum (CC) were activated synaptically at latencies compatible with a monosynaptic delay following stimulation of the thalamic ventroposterolateral (VPL) nucleus. Corticothalamic cells identified antidromically from the VPL nucleus were synaptically driven at latencies compatible with either a mono- or disynaptic delay following CC stimulation. We propose that an interhemispheric reciprocal interaction exists between VPL nuclei via cortical relay cells involving commissural and corticothalamic neurons.