Transsylvian amygdalohippocampectomy for mesial temporal lobe epilepsy: Comparison of three different approaches.

OBJECTIVE: This study's objective was to compare the transinsular (TI-AH), transuncus (TU-AH), and temporopolar (TP-AH) amygdalohippocampectomy approaches regarding seizure control, temporal stem (TS) damage, and neurocognitive decline. METHODS: We included 114 consecutive patients with unilateral hippocampal sclerosis (HS) who underwent TI-AH, TU-AH, or TP-AH between 2002 and 2017. We evaluated seizure control using Engel classification. We used diffusion tensor imaging and postoperative Humphrey perimetry to assess the damage of the TS. We also performed pre- and postoperative memory performance and intelligence quotient (IQ). RESULTS: There were no significant differences in the proportion of patients free of disabling seizures (Engel IA+IB) among the three surgical approaches in the survival analysis. However, more patients were free of disabling seizures (Engel IA+IB) at 2 years of postsurgical follow-up with TP-AH (69.5%) and TI-AH (76.7%) as compared to the TU-AH (43.5%) approach (p = .03). The number of fibers of the inferior fronto-occipital fasciculus postoperatively was reduced in the TI-AH group compared with the TU-AH and TP-AH groups (p = .001). The rate of visual field defects was significantly higher with TI-AH (14/19, 74%) in comparison to the TU-AH (5/15, 33%) and TP-AH (13/40, 32.5%) approaches (p = .008). Finally, there was a significant postoperative decline in verbal memory in left-sided surgeries (p = .019) and delayed recall for both sides (p < .001) regardless of the surgical approach. However, TP-AH was the only group that showed a significant improvement in visual memory (p < .001) and IQ (p < .001) for both right- and left-sided surgeries. SIGNIFICANCE: The TP-AH group had better short-term seizure control than TU-AH, a lower rate of visual field defects than TI-AH, and improved visual memory and IQ compared to the other groups. Our findings suggest that TP-AH is a better surgical approach for temporal lobe epilepsy with HS than TI-AH and TU-AH.

Parahippocampectomy as a New Surgical Approach to Mesial Temporal Lobe Epilepsy Caused By Hippocampal Sclerosis: A Pilot Randomized Comparative Clinical Trial.

BACKGROUND AND OBJECTIVE: The parahippocampal gyrus plays an important role in the epileptogenic pathways of mesial temporal lobe epilepsy caused by hippocampal sclerosis (mTLE-HS); its resection could prevent epileptic seizures with fewer complications. This study evaluates the initial efficacy and safety of anterior temporal lobectomy (ATL), selective amygdalohipppocampectomy (SAH), and parahippocampectomy (PHC) surgical approaches in mTLE-HS. METHODS: A randomized comparative pilot clinical trial (2008-2011) was performed that included patients with mTLE-HS who underwent ATL, trans-T3 SAH, and trans-T3 PHC. Their sociodemographic characteristics, visual field profiles, verbal and visual memory profiles, and Engel scale outcome at baseline and at 1 and 5 years are described, using descriptive statistics along with parametric and nonparametric tests. RESULTS: Forty-three patients with a mean age of 35.2 years (18-56 years), 65% female, were analyzed: 14 underwent PHC, 14 ATL, and 15 SAH. The following percentages refer to those patients who were seizure free (Engel class IA) at 1-year and 5-year follow-up, respectively: 42.9% PHC, 71.4% ATL, and 60% SAH (P = 0.304); 28.6% PHC, 50% ATL, and 53.3% SAH (P = 0.353). Postoperative visual field deficits were 0% PHC, 85.7% ATL, and 46.7% SAH (P = 0.001). Verbal and/or visual memory worsening were present in 21.3% PHC, 42.8% ATL, and 33.4% SAH (P = 0.488) and preoperative and postoperative visual memory scores were significantly different in the SAH group only (P = 0.046). CONCLUSIONS: PHC, ALT, and SAH show a preliminary similar efficacy in short-term seizure-free rates in patients with mTLE-HS. However, PHC efficacy in the long-term decreases compared with the other surgical techniques. PHC does not produce postoperative visual field deficits.

Emotion Reactivity and Cerebrovascular Burden in Late-Life GAD: A Neuroimaging Study.

OBJECTIVE: Generalized anxiety disorder (GAD) in older adults is associated with persistent deficits in emotion reactivity (ER) and regulation, yet the neural basis of these deficits has not been explored. This study focuses on the neural basis of ER deficits in late-life GAD and the association with cerebrovascular burden. METHODS: Twenty elderly nonanxious participants and 17 late-life GAD participants were included. The faces-shapes functional magnetic resonance imaging task was used to assess ER; the Hamilton Anxiety Rating Scale and the Penn State Worry Questionnaire to measure global anxiety and worry, respectively; linear regression models to examine the association between ER and global anxiety severity and between ER and worry severity; and mediation analysis to explore the effect of ER on the relationship between global anxiety/worry severity and cerebrovascular burden. RESULTS: A positive association was found between ER and global anxiety in the left parahippocampus, left and right precuneus, and right superior occipital gyrus. A negative association was found between ER and worry severity in the left and right precuneus. The association between cerebrovascular burden and anxiety/worry severity was indirectly mediated by increased ER in limbic and paralimbic areas and by decreased ER in prefrontal regulatory regions. CONCLUSION: These results indicate that ER is associated with different neural activation patterns for worry and global anxiety and that ER-related functional connectivity indirectly mediates the relationship between cerebrovascular burden and late-life GAD. This latter result supports a yet-unexplored cerebrovascular pathway involved in the pathophysiology of late-life anxiety.

Microsurgical Approaches to the Ambient Cistern Region: An Anatomic and Qualitative Study.

OBJECTIVE: We used microscopy to conduct qualitative and quantitative analysis of 4 surgical approaches commonly used in the surgery of the ambient cistern: infratentorial supracerebellar (SC), occipital interhemispheric, subtemporal (ST), and transchoroidal (TC). In addition, we performed a parahippocampal gyrus resection in the ST context. METHODS: Each approach was performed in 3 cadaveric heads (6 sides). After the microscopic anatomic dissection, the parahippocampal gyrus was resected through an ST approach. The qualitative analysis was based on anatomic observation and the quantitative analysis was based on the linear exposure of vascular structures and the area of exposure of the ambient cistern region. RESULTS: The ST approach provided good exposure of the inferior portion of the cistern and of the proximal segments of the posterior cerebral artery. After the resection of the parahippocampal gyrus, the area of exposure improved in all components, especially the superior area. A TC approach provided the best exposure of the superior area compared with the other approaches. The posterolateral approaches (SC/occipital interhemispheric) to the ambient cistern region provided similar exposure of anatomic structures. There was a significant difference (P < 0.05) in linear exposure of the posterior cerebral artery when comparing the ST/TC and ST/SC approaches. CONCLUSIONS: This study has demonstrated that surgical approaches expose dissimilarly the different regions of the ambient cistern and an approach should be selected based on the specific need of anatomic exposure.

How acute total sleep loss affects the attending brain: a meta-analysis of neuroimaging studies.

STUDY OBJECTIVES: Attention is a cognitive domain that can be severely affected by sleep deprivation. Previous neuroimaging studies have used different attention paradigms and reported both increased and reduced brain activation after sleep deprivation. However, due to large variability in sleep deprivation protocols, task paradigms, experimental designs, characteristics of subject populations, and imaging techniques, there is no consensus regarding the effects of sleep loss on the attending brain. The aim of this meta-analysis was to identify brain activations that are commonly altered by acute total sleep deprivation across different attention tasks. DESIGN: Coordinate-based meta-analysis of neuroimaging studies of performance on attention tasks during experimental sleep deprivation. METHODS: The current version of the activation likelihood estimation (ALE) approach was used for meta-analysis. The authors searched published articles and identified 11 sleep deprivation neuroimaging studies using different attention tasks with a total of 185 participants, equaling 81 foci for ALE analysis. RESULTS: The meta-analysis revealed significantly reduced brain activation in multiple regions following sleep deprivation compared to rested wakefulness, including bilateral intraparietal sulcus, bilateral insula, right prefrontal cortex, medial frontal cortex, and right parahippocampal gyrus. Increased activation was found only in bilateral thalamus after sleep deprivation compared to rested wakefulness. CONCLUSION: Acute total sleep deprivation decreases brain activation in the fronto-parietal attention network (prefrontal cortex and intraparietal sulcus) and in the salience network (insula and medial frontal cortex). Increased thalamic activation after sleep deprivation may reflect a complex interaction between the de-arousing effects of sleep loss and the arousing effects of task performance on thalamic activity.

Transport along the dendritic endoplasmic reticulum mediates the trafficking of GABAB receptors.

In neurons, secretory organelles within the cell body are complemented by the dendritic endoplasmic reticulum (ER) and Golgi outposts (GOPs), whose role in neurotransmitter receptor trafficking is poorly understood. γ-aminobutyric acid (GABA) type B metabotropic receptors (GABABRs) regulate the efficacy of synaptic transmission throughout the brain. Their plasma membrane availability is controlled by mechanisms involving an ER retention motif and assembly-dependent ER export. Thus, they constitute an ideal molecular model to study ER trafficking, but the extent to which the dendritic ER participates in GABABR biosynthesis has not been thoroughly explored. Here, we show that GABAB1 localizes preferentially to the ER in dendrites and moves long distances within this compartment. Not only diffusion but also microtubule and dynein-dependent mechanisms control dendritic ER transport. GABABRs insert throughout the somatodendritic plasma membrane but dendritic post-ER carriers containing GABABRs do not fuse selectively with GOPs. This study furthers our understanding of the spatial selectivity of neurotransmitter receptors for dendritic organelles.

The very preterm brain in young adulthood: the neural correlates of verbal paired associate learning.

OBJECTIVE: To determine whether preterm birth influences functional neuronal development in adulthood. STUDY DESIGN: We evaluated adults born very preterm (VPT; < 33 weeks of gestation) using a verbal paired-associate learning task within a functional magnetic resonance imaging paradigm. Hippocampi and parahippocampal gyri gray matter volumes were also quantified. RESULTS: Despite similar task performance compared with control participants, VPT adults showed increased brain activation in the left parahippocampal and precentral gyri during Encoding, and in the precentral gyrus during Recall. Very preterm participants also had decreased gray matter volume in the left and right hippocampi yet increased gray matter in the left parahippocampal gyrus. In VPT participants alone, activation in the left parahippocampal gyrus during Encoding (VPT>control participants) was positively associated with gray matter volume in the left parahippocampal gyrus, with VPT participants with the youngest gestational age (eg, born 28 weeks or less) having both increased gray matter and functional activation in this region. These results may reflect the process of neural reorganization after early brain injury. CONCLUSION: Preterm birth leads to functional neuronal differences in adulthood, which are meditated by both structural variations in task-specific regions, and gestational age.

Neurodegeneration and prolonged immediate early gene expression throughout cortical areas of the rat brain following acute administration of dizocilpine.

N-methyl-d-aspartate receptor antagonist drugs (NMDA-A), such as dizocilpine (MK801), induce long-lasting behavioral disturbances reminiscent to psychotic disorders in humans. To identify cortical structures affected by NMDA-A, we used a single dose of MK801 (10 mg/kg) that caused low and high neurodegeneration in intact and orchiectomized male rats, respectively. Degenerating somas (neuronal death) and axonal/synaptic endings (terminal degeneration) were depicted by a silver technique, and functionally affected cortical neuronal subpopulations by Egr-1, c-Fos, and FosB/DeltaFosB-immunolabeling. In intact males, MK801 triggered a c-Fos induction that remained high for more than 24 h in selected layers of the retrosplenial, somatosensory and entorhinal cortices. MK801-induced neurodegeneration reached its peak at 72 h. Degenerating somas were restricted to layer IV of the granular subdivision of the retrosplenial cortex, and were accompanied by suppression of Egr-1 immunolabeling. Terminal degeneration extended to selected layers of the retrosplenial, somatosensory and parahippocampal cortices, which are target areas of retrosplenial cortex. Induction of FosB/DeltaFosB by MK801 also extended to the same cortical layers affected by terminal degeneration, likely reflecting the damage of synaptic connectivity. In orchiectomized males, the neurodegenerative and functional effects of MK801 were exacerbated. Degenerative somas in layer IV of the retrosplenial cortex significantly increased, with a parallel enhancement of terminal degeneration and FosB/DeltaFosB-expression in the mentioned cortical structures, but no additional areas were affected. These observations reveal that synaptic dysfunction/degeneration in the retrosplenial, somatosensory and parahippocampal cortices might underlie the long-lasting impairments induced by NMDA-A.

Correlação entre memória e volume de estruturas cerebrais em idosos deprimidos: um estudo de morfometria baseada no voxel / Correlation between memory and volume of brain structures in depressed elderly: a study using voxel-based morphometry

Déficits cognitivos e alterações cerebrais estruturais são comumente encontrados em idosos deprimidos. Este estudo teve como objetivos comparar o volume de regiões de interesse, hipocampo e giro para-hipocampal, de idosos com transtornos depressivos e sem transtornos depressivos utilizando a técnica de morfometria baseada no voxel, investigando se há correlação entre o volume dessas regiões e os escores dos testes cognitivos. Neste estudo, as diferenças clínicas, demográficas e de volume de substância cerebral total foram avaliadas por meio de exames de ressonância magnética estrutural em 48 idosos com transtornos depressivos e 31 controles. Os dados contínuos dos grupos de indivíduos foram comparados pelo teste t de Student ou pelo teste de Mann-Whitney, e a análise das freqüências de categorias foi feita utilizando-se o teste exato de Fisher ou o teste do qui quadrado com correção de continuidade. A comparação dos escores nos testes cognitivos dos dois grupos foi feita por meio da análise de covariância, pois os grupos eram diferentes quanto à escolaridade. A correlação entre o volume de cada estrutura e os escores nos testes cognitivos, para cada grupo estudado, foi feita utilizando-se o programa "Statistical Parametric Mapping" e o coeficiente de correlação de Pearson. Pacientes e controles eram similares quanto ao volume cerebral total e quanto às regiões de interesse, mas os pacientes apresentaram desempenho inferior em testes de avaliação da memória, das funções executivas e da velocidade de processamento. No grupo de idosos com transtornos depressivos, foi verificada correlação entre teste de memória episódica verbal e volume do hipocampo esquerdo (p = 0,023) e giro para-hipocampal direito (p = 0,044) e esquerdo (p = 0,007). Nesse grupo, também foi verificada correlação entre giro para-hipocampal esquerdo, teste de memória episódica visual (p = 0,039) e evocação tardia em teste de aprendizagem visuo-verbal (p = 0,040)...

Cognitive deficits and structural brain alterations are usually found in depressed elderly. The objective of this study was to compare the volume of the regions of interest, hippocampus and parahippocampal gyrus, of elderly with and without depressive disorders using the voxel-based morphometry technique, investigating whether there is a correlation between the volume of these regions and the scores on these cognitive tests. In this study, the clinical and demographic differences, as well as the difference in the volume of the total brain matter were assessed using structural magnetic resonance imaging in 48 elderly people with depressive disorders and 31 controls. The continuous data of the groups of subjects were compared using the Student's t test or the Mann-Whitney test; and the analysis of category frequency was performed using the Fisher's Exact Test or the Chi-square test with Continuity Correction. The comparison of the scores on the cognitive tests of both groups was carried out using the Analysis of Covariance, since the groups were different in terms of level of education. The correlation between the volume of each structure and the scores on the cognitive tests for each group studied was made using the Statistical Parametric Mapping program and Pearson's Correlation Coefficient. Patients and controls were similar regarding the total brain volume and also with respect to the regions of interest; however, the patients presented lower performance on the tests that assessed memory, executive functions and processing speed. In the group of elderly subjects with depressive disorder, there was a correlation between the verbal episodic memory test and the volume of the left hippocampus (p = 0.023); right (p = 0.044) and left (p = 0.007) parahippocampal gyrus...

Opioid receptor binding in parahippocampus of patients with temporal lobe epilepsy: its association with the antiepileptic effects of subacute electrical stimulation.

Opioid receptor binding was evaluated in parahippocampal cortex (PHC) obtained from patients with intractable mesial temporal lobe epilepsy (MTLE) with and without subacute high frequency electrical stimulation (HFS) in this brain area. Mu, delta and nociceptin receptor binding was determined by autoradiography in PHC of five patients (ESAE group) with MTLE history of 14.8 +/- 2.5 years and seizure frequency of 11 +/- 2.9 per month, two of them (40%) with mesial sclerosis. This group demonstrated antiepileptic effects following subacute HFS (130 Hz, 450 micros, 200-400 microA), applied continuously during 16-20 days in PHC. Values were compared with those obtained from patients with severe MTLE (history of 21.7 +/- 2.8 years and seizure frequency of 28.2 +/- 14 per month) in whom electrical stimulation did not induce antiepileptic effects (ESWAE group, n = 4), patients with MTLE in whom no electrical stimulation was applied (MTLE group, n = 4) and autopsy material acquired from subjects without epilepsy (n = 4 obtained from three subjects). Enhanced 3H-DAMGO (MTLE, 755%; ESAE, 375%; ESWAE, 693%), 3H-DPDPE (MTLE, 242%; ESAE, 80%; ESWAE, 346%) and 3H-nociceptin (MTLE, 424%; ESAE, 217%; ESWAE, 451%) binding was detected in the PHC of all epileptic groups. However, tissue obtained from ESAE group demonstrated lower opioid receptor binding (3H-DAMGO, 44.5%, p < 0.05; 3H-DPDPE, 47%, p < 0.05; 3H-nociceptin, 39.3%, p < 0.5) when compared with MTLE group. The present results indicate that a high effectiveness to the antiepileptic effects induced by HFS is associated with reduced opioid peptide binding.

c-Fos expression related to sexual satiety in the male rat forebrain.

The long term inhibition of masculine sexual behavior after repeated ejaculations is known as sexual satiety. To investigate the brain areas that may regulate sexual satiety, c-Fos expression was studied in different groups of sexually experienced male rats: controls not allowed to copulate, males allowed two or four ejaculations and animals allowed to reach sexual satiety. Interestingly, males that ejaculated two or four times had similar c-Fos densities in all the evaluated brain regions, except for the suprachiasmatic nucleus. Similarly, sexually satiated males had analogous c-Fos densities in all the evaluated brain areas independently of the number of ejaculations required to reach satiety. Sexual activity (evidenced in males that ejaculated two or four times) increased c-Fos levels in the anteromedial bed nucleus of the stria terminalis, claustrum, entorhinal cortex, medial preoptic area, nucleus accumbens core, suprachiasmatic nucleus and supraoptic nucleus; however, sexual satiety did not modify c-Fos expression in these regions. Sexually satiated males had increased c-Fos densities in the ventrolateral septum and the anterodorsal and posteroventral medial amygdala, compared with animals allowed to copulate but that did not reach sexual satiety, and decreased c-Fos density in the piriform cortex. These results suggest that the network that underlies sexual satiety is different from that which regulates copulation.

[Neuroanatomical basis of behavior: history and recent contributions]. / As bases neuroanatômicas do comportamento: histórico e contribuições recentes.

Considering the most recent contributions, the limbic cortical areas, originally known as the greater limbic lobe, besides the cingulated and the parahippocampal gyri also includes the insula and the posterior orbital cortex. In contrast to the nonlimbic cortical areas that project to the basal ganglia (particularly over the dorsal aspects of the striatum, constituted by the caudate nucleus and by the putamen), the limbic cortical areas are characterized by projecting to the hypothalamus and also to the ventral striatum (particularly to the nucleus accumbens). Once all the striatum projects to the globus pallidus which projects to the thalamus and then to the cortex, generating cortical-subcortical reentrant circuits, while the dorsal striatum and pallidum related cortico-subcortical loops are involved with motor activities, the ventral cortical-striatal-pallidal system is particularly related with behavior functions. The extended amygdala (central medial amygdala, stria terminalis or dorsal component, ventral component, and bed nucleus of stria terminalis) receives inputs primarily from the limbic cortical areas, is particularly modulated by the prefrontal cortex, and receives also direct connections from the thalamus that enables the amygdala to generate nonspecific and quick responses through its projections to the hypothalamus and to the brainstem. The ventral striatal-pallidal and the extended amygdala are then two basal forebrain macro-anatomical systems, that together with the basal nucleus of Meynert and with the septal-diagonal band system, constitute the main structures that are particularly connected with the limbic cortical areas, and that altogether project to the hypothalamus and to the brainstem which give rise to the autonomic, endocrine and somatosensory components of the emotional experiences, and that regulate the basic activities of drinking, eating, and related to the sexual behavior.

As bases neuroanatômicas do comportamento: histórico e contribuições recentes / Neuroanatomical basis of behavior: history and recent contributions

Tendo em vista as mais recentes contribuições, as áreas corticais límbicas - originalmente denominadas em conjunto de grande lobo límbico -, além dos giros do cíngulo e parahipocampal, são constituídas pelas regiões mais posteriores do córtex fronto-orbitário e pelo córtex insular. Em contraposição ao restante do córtex cerebral, que se projeta sobre os gânglios da base (particularmente sobre as porções mais dorsais e mais extensas do striatum, constituídas fundamentalmente pelo núcleo caudado e pelo putame), as áreas corticais límbicas se caracterizam por se projetarem principalmente sobre o hipotálamo e também sobre a porção mais ventral do striatum (principalmente sobre o núcleo accumbens). Uma vez que todo o striatum se projeta para o globo pálido - e este para o tálamo, que se projeta para o córtex cerebral, constituindo-se, assim, circuitos córtico-subcorticais reentrantes -, tem-se que, enquanto as alças relacionadas com o striatum e o pallidum dorsais são responsáveis por atividades e rotinas motoras, as alças relacionadas com o striatum e o pallidum ventrais caracterizam circuitos córtico-subcorticais reentrantes e segregados que se relacionam particularmente com funções comportamentais. A amígdala estendida (amígdala centromedial, componente dorsal ou estria terminal, componente ventral e núcleo da estria terminal), por sua vez, também recebe aferências de todas as áreas corticais límbicas, é particularmente modulada pelas áreas corticais pré-frontais e, ao invés de se projetar sobre o striatum, projeta-se diretamente sobre o hipotálamo e o tronco encefálico. Ao receber também conexões diretas do tálamo, a amígdala estendida pode ainda desencadear respostas principalmente autonômicas, de forma inespecífica, porém rápida, através da ativação de centros do tronco encefálico. Os sistemas macro-anatômicos fronto-basais, estriatal-palidal ventral e amígdala estendida, em conjunto com o núcleo basal de Meynert e com o sistema septo-banda...

Considering the most recent contributions, the limbic cortical areas, originally known as the greater limbic lobe, besides the cingulated and the parahippocampal gyri also includes the insula and the posterior orbital cortex. In contrast to the nonlimbic cortical areas that project to the basal ganglia (particularly over the dorsal aspects of the striatum, constituted by the caudate nucleus and by the putamen), the limbic cortical areas are characterized by projecting to the hypothalamus and also to the ventral striatum (particularly to the nucleus accumbens). Once all the striatum projects to the globus pallidus which projects to the thalamus and then to the cortex, generating cortical-subcortical reentrant circuits, while the dorsal striatum and pallidum related cortico-subcortical loops are involved with motor activities, the ventral cortical-striatal-pallidal system is particularly related with behavior functions. The extended amygdala (central medial amygdala, stria terminalis or dorsal component, ventral component, and bed nucleus of stria terminalis) receives inputs primarily from the limbic cortical areas, is particularly modulated by the prefrontal cortex, and receives also direct connections from the thalamus that enables the amygdala to generate nonspecific and quick responses through its projections to the hypothalamus and to the brainstem. The ventral striatal-pallidal and the extended amygdala are then two basal forebrain macro-anatomical systems, that together with the basal nucleus of Meynert and with the septal-diagonal band system, constitute the main structures that are particularly connected with the limbic cortical areas, and that altogether project to the hypothalamus and to the brainstem which give rise to the autonomic, endocrine and somatosensory components of the emotional experiences, and that regulate the basic activities of drinking, eating, and related to the sexual behavior.

Volumetric evidence of bilateral damage in unilateral mesial temporal lobe epilepsy.

PURPOSE: We sought to analyze the contralateral volumes of the temporal pole, posterior segment of the temporal lobe, amygdala, hippocampus, and parahippocampal gyrus in patients with temporal lobe epilepsy (TLE) due to histologically proven mesial temporal lobe sclerosis (MTLS), seizure free for >or=4 years of postsurgical follow-up. METHODS: Forty-six (23 male) TLE patients, operated on between 1996 and 2001, with histopathologic diagnosis of MTLS, and a postsurgical follow-up of >or=4 years, had their temporal lobe structures manually segmented, measured, and compared with those of 23 normal volunteers, paired as groups for sex, age, and handedness. RESULTS: The mean volumes of the contralateral temporal pole, hippocampus, and parahippocampal gyrus in TLE patients were significantly lower than those in controls. CONCLUSIONS: MRI volumetric data show that the damage in TLE due to MTS may be more widespread and bilateral, even in patients with unilateral TLE by clinical and neurophysiological criteria. Our results are relevant to the discussion of epileptogenic mechanisms in TLE.

Association between major depressive symptoms in heart failure and impaired regional cerebral blood flow in the medial temporal region: a study using 99m Tc-HMPAO single photon emission computerized tomography (SPECT).

BACKGROUND AND PURPOSE: Depressive symptoms are frequently associated with heart failure (HF), but the brain mechanisms underlying such association are unclear. We hypothesized that the presence of major depressive disorder (MDD) emerging after the onset of HF would be associated with regional cerebral blood flow (rCBF) abnormalities in medial temporal regions previously implicated in primary MDD, namely the hippocampus and parahippocampal gyrus. METHOD: Using 99mTc-SPECT, we measured rCBF in 17 elderly MDD-HF patients, 17 non-depressed HF patients, and 18 healthy controls, matched for demographic variables. Group differences were investigated with Statistical Parametric Mapping. RESULTS: Significant rCBF reductions in MDD-HF patients relative to both non-depressed HF patients and healthy controls were detected in the left anterior parahippocampal gyrus and hippocampus (ANOVA, p=0.008 corrected for multiple comparisons) and the right posterior hippocampus and parahippocampal gyrus (p=0.005 corrected). In the overall HF group, there was a negative correlation between the severity of depressive symptoms and rCBF in the right posterior hippocampal/parahippocampal region (p=0.045 corrected). CONCLUSIONS: These findings are consistent with the notion that the medial temporal region is vulnerable to brain perfusion deficits associated with HF, and provide evidence that such functional deficits may be specifically implicated in the pathophysiology of MDD associated with HF.

Evaluation of GABA system and cell damage in parahippocampus of patients with temporal lobe epilepsy showing antiepileptic effects after subacute electrical stimulation.

PURPOSE: The gamma-aminobutyric acid (GABA) system and neuronal loss were evaluated in the parahippocampal cortex (PHC) of patients with intractable mesial temporal lobe epilepsy (MTLE) who received subacute electrical stimulation and showed antiepileptic effects. METHODS: GABA tissue content, GABA(A) and benzodiazepine (BZD) receptor levels, as well as neuronal density were determined in PHC of five patients (ESAE group) with an MTLE history of 14.8 +/- 2.5 years and seizure frequency of 11 +/- 2.9 per month, two (40%) of them with mesial sclerosis. This group demonstrated antiepileptic effects after subacute electrical stimulation (130 Hz, 450 micros, 200-400 microA), applied continuously during 16 to 20 days in PHC. Values were compared with those obtained from patients with severe MTLE (history of 21.7 +/- 2.8 years and seizure frequency of 28.2 +/- 14 per month) in whom electrical stimulation did not induce antiepileptic effects (ESWAE group, n = 4), patients with MTLE in whom no electrical stimulation was applied (MTLE group, n = 4), and autopsy material acquired from subjects without epilepsy (n = 4 obtained from three subjects). RESULTS: The ESAE group demonstrated high GABA tissue levels (219%), as well as a significantly higher cell count (58.5%) when compared with the MTLE group. The ESWAE group showed enhanced BZD-receptor levels (38%), whereas their values for GABA tissue levels and GABA(A) receptor were similar to those obtained from the MTLE group. CONCLUSIONS: It is suggested that subacute electrical stimulation of PHC is more effective in patients with less severe epilepsy, an effect associated with a high GABA tissue content and a low rate of cell loss.

Analysis of parahippocampal gyrus in 115 patients with hippocampal sclerosis.

PURPOSE: Analysis of the parahippocampal gyrus (PHG) involvement in 115 patients with hippocampal sclerosis (HS) by MR imaging. The simultaneous occurrence of ipsilateral fornix (F) and mamillary body (MB) volume loss was checked also. These findings were correlated with the side of hippocampal involvement, the sex, patient s age, and the symptoms onset. METHOD: The MR images of 115 patients with HS were studied retrospectively. All the examinations were performed on 1.5 T units (SIGNA, GE, Milwaukee, WI) and included high resolution coronal T2-weighted images (3 mm thickness, 0.6 mm gap). RESULTS: The patient's age ranged between 3.5 and 80 years (mean 34.1); 62 (53.9%) were female and 53 (46.1%) were male. There were HS on the left side in 53 (46.0%), on the right side in 51 (44.3%), and bilateral in 11 (9.7%). In 43 (37.3%) cases there were ipsilateral PHG volume loss and signal hyper intensity on T2-weighted imaging. In 29 (25.2%) cases there were ipsilateral fornix volume loss and in 10 (34.5%) of this there were also ipsilateral MB changes. In abnormal PHG, 23 (53.4%) were on the left side, 17 (39.5%) were on the right side, and 3 (7.1%) were bilateral. There were fornix changes in 15 (34.8%) cases and MB volume loss in 5 (11.6%) cases. Pertinent clinical data were obtained in only 18 (41.8%) of the PHG lesion cases and 11 (61.1%) of these patients had epileptic attacks for more than 20 years before the examination. CONCLUSION: PHG involvement must be investigated in patients with HS and we suggest that the term mesial temporal sclerosis should be used only if there are also changes at this anatomical site.

Analysis of parahippocampal gyrus in 115 patients with hippocampal sclerosis

PURPOSE: Analysis of the parahippocampal gyrus (PHG) involvement in 115 patients with hippocampal sclerosis (HS) by MR imaging. The simultaneous occurrence of ipsilateral fornix (F) and mamillary body (MB) volume loss was checked also. These findings were correlated with the side of hippocampal involvement, the sex, patient s age, and the symptoms onset. METHOD: The MR images of 115 patients with HS were studied retrospectively. All the examinations were performed on 1.5 T units (SIGNA, GE, Milwaukee, WI) and included high resolution coronal T2-weighted images (3 mm thickness, 0.6 mm gap). RESULTS: The patient's age ranged between 3.5 and 80 years (mean 34.1); 62 (53.9 percent) were female and 53 (46.1 percent) were male. There were HS on the left side in 53 (46.0 percent), on the right side in 51 (44.3 percent), and bilateral in 11 (9.7 percent). In 43 (37.3 percent) cases there were ipsilateral PHG volume loss and signal hyper intensity on T2-weighted imaging. In 29 (25.2 percent) cases there were ipsilateral fornix volume loss and in 10 (34.5 percent) of this there were also ipsilateral MB changes. In abnormal PHG, 23 (53.4 percent) were on the left side, 17 (39.5 percent) were on the right side, and 3 (7.1 percent) were bilateral. There were fornix changes in 15 (34.8 percent) cases and MB volume loss in 5 (11.6 percent) cases. Pertinent clinical data were obtained in only 18 (41.8 percent) of the PHG lesion cases and 11 (61.1 percent) of these patients had epileptic attacks for more than 20 years before the examination. CONCLUSION: PHG involvement must be investigated in patients with HS and we suggest that the term mesial temporal sclerosis should be used only if there are also changes at this anatomical site