[Characteristics of clinical presentation, diagnosis, and surgical treatment of temporal partial epilepsy].

Results of surgical treatment of 55 patients with pharmacologically resistant temporal epilepsy (age 16-43 years) admitted to Polenov Neurosurgical Institute (Saint-Petersburg, Russia) were assessed. EEG-monitoring as the part of examination protocol discovered stable focus of paroxysmal activity in frontotemporal area in 30 patients (54.5%). It is shown that the evaluated multifocal type is characterized by specific clinical, neurophysiological and neuroradiological features. Results of complex examination substantiated appropriateness of distinguishing of this type and possibility of its relevant and timely evaluation for optimization of surgical treatment. Semeiology of paroxysmal clinical symptoms, being in direct correlation with data obtained by EEG-monitoring which indicated frontotemporal localization of epileptogenic focus, shows the dynamics of pathological process in the late stages of temporal epileptogenesis. Discovered clinical and neurophysiological features determined optimal tactics of surgical management of frontotemporal type of partial epilepsy - open surgical resection of the anterior 2/3 of temporal lobe combined with subpial resection of frontal cortex with addition subpial cortical transsections with continuous intraoperative electrophysiological monitoring.

[Clinical and neurophysiologic aspects of surgical treatment of pharmacoresistant forms of epilepsy]. / Kliniko-neirofiziologicheskie aspekty khirurgicheskogo lecheniia farmakorezistentnoi épilepsii.

Surgical treatment of pharmacoresistant forms of epilepsy under neurophysiological monitoring is a key problem studied in A.L. Polenov Russian Neurosurgical Institute (Saint-Petersburg). A summary of long-term studies and main stages of surgical treatment development are presented. The indications and contra-indications, along with basic neurophysiologic strategic and tactic arguments of open and stereotaxic treatment of focal and generalized epilepsy based on neurophysiologic model which determines a role of epileptic focus, epileptic and inhibiting brain systems in spreading and arresting of seizure discharge at each disease stage are formulated. A program of clinico-neurophysiologic monitoring of temporal epilepsy in pre- and intraoperative periods is considered.

[The use of millimeter waves in neurosurgery under electrophysiological control]. / Ispol'zovanie millimetrovykh voln v neirokhirurgii pod élektrofiziologicheskim kontrolem.

Patients with organic CNS lesions including epileptic syndrome can be treated using indirect influence of millimetric waves upon major brain regulatory systems via specific peripheral receptor fields under control of adequate bioelectric criteria. 42 brain-affected patients were studied. The above method used as a part of combined surgical treatment resulted in stable functional restoration and normalization of bioelectric brain activity.

[Stereotaxic amygdalotomy in the treatment of children with epilepsy]. / Stereotaksicheskaia amigdalotomiia v lechenii detei, bol'nykh épilepsiei.

Seventy four children with generalized and partial epileptic seizures were treated stereotactically. Local destruction of the amygdaloid complex was performed in 50 patients. It was combined with thalamotomy in 20 patients, and with campotomy in 4 patients. All cases were monitored intraoperatively by neurophysiologic techniques (e.g. EEG etc.). The follow up ranges from 1 to 17 years. When assessing the outcome, several factors were taken into consideration. Among those were the etiology, the stage of the disease, type of stereotactic procedure, and lateralization. Generally, positive results were obtained in 70% of cases.

[Neurophysiological analysis of the central mechanisms of glossalgia]. / Neirofiziologicheskii analiz tsentral'nykh mekhanizmov glossalgii.

Bioelectrical activity of the brain was studied in 20 patients with glossalgia characterized by a most severe clinical symptomatology. Neurophysiological analysis has shown a marked imbalance of the leading neuromediator cerebral systems, namely, deficiency of ascending activating reticular effects, tense functioning of syncronizing systems, and involvement into the chain of impaired relationships of the limbic-reticular complex and inhibitory systems of the brain. It has been established that general disorganization of the activity of the cerebral mechanisms is attended by impaired control of ascending afferentation. As a result, any type of chronic stimulation of the peripheral receptors is no longer blocked when entering the central nervous system and manifests in a clinically marked syndrome of glossalgia. On the basis of clinico-physiological correlations the authors draw a conclusion that the syndrome of glossalgia should be considered as one of the links in the chain of chronic emotional stress manifestations.

[Clinico-electrophysiologic analysis of the results of surgical treatment of focal epilepsy in children]. / Kliniko-élektrofiziologicheskii analiz rezul'tatov khirurgicheskogo lecheniia fokal'noi épilepsii in children.

The authors analyzed the electroclinical data obtained in the surgical treatment by the open method of 104 children and adolescents with focal and multifocal epilepsy. The indications were frequent epileptic seizures, resistance to drug therapy, clear-cut clinical and electrophysiological correlations with regard to the localization of the epileptic focus. If nonoperative treatment has no effect, it is not advisable to delay surgical intervention by more than 1--2 years. Dynamic EEG examination under conditions of natural sleep, deprivation of sleep or dark adaptation yields complete objective information on the principal focus. The used system of diagnostic and operative intervention ensured favourable outcomes in 88% of the children with focal epilepsy.

[Topography of the optic thalamus, caudate and lenticular nuclei of the human brain in frontal section (an anatomical-statistical study applied to stereotaxis)]. / Topografiia zritel'nogo bugra, khvostatogo i chechevitseobraznogo iader mozga cheloveka na frontal'nom sreze (anatomo-statisticheskoe issledovanie primenitel'no k stereotaksisu)

Topographic coordinates of the thalamus, caudate and lentiform nuclei of the human brain in relation to the medial-sagittal plane and inferior-medial part of the corpus callosum were studied in 70 preparations. The parameters under study are characterized by mean values of the variants and square deviations. Detailed tables of these values are given which may be employed in stereotaxical calculations for all coordinates, for men and women separately, for the right and left hemispheres, brachy- and mesencephaly. Statistically reliable differences of coordinates found for 3 of 13 parameters studied were not regular. The necessity to identify the above subgroups in topometrical investigations of the human brain is under doubt.

Stereoelectrosubcorticography in epilepsy, the focus and epileptogenic system.

According to the conceptual electrophysiological model for epilepsy worked out by the authors earlier (1968-1971) the development of the disease has the following stages: "epileptic" neurone epileptogenic focus epileptogenic system epileptic brain. The mechanisms of the II and III stages are analysed in the given paper. The critical volume of the neuronal population capable of functioning as a triggering focus is shown to be 10(3)-10(5) cells (Microsystem). On the II stage the control is achieved by the lateral inhibition. Further on epileptogenic macrosystems and subsystems of discharge reverberation (vertical and horizontal) are formed with complex hierarchy on a reciprocal principle. A morpho-functional organization of pathological systems in petit mal, grand mal, uni- and bitemporal epilepsy was found during ictal and interictal periods. Inhibitory systems (low pontine and caudate) and reciprocal inhibition during the III stage were found to act as controls.