1/10. Estimation of topiramate in subdural cerebrospinal fluid, subcutaneous extracellular fluid, and plasma: a single case microdialysis study.PURPOSE: To estimate topiramate (TPM) concentrations in subdural cerebrospinal fluid (CSF), subcutaneous extracellular fluid (ECF), and plasma and to study the correlation of TPM concentrations in these three different compartments. methods: In this single case study of a patient with drug-resistant partial epilepsy undergoing presurgical evaluation with subdural EEG monitoring, we used microdialysis to estimate concentrations of unbound TPM in CSF of the subdural space and ECF of abdominal subcutaneous tissue. blood samples were drawn for estimation of TPM concentrations in plasma. RESULTS: The correlation between unbound TPM concentrations in subdural CSF and abdominal subcutaneous ECF was good. The mean ratio of ECF/CSF TPM concentration was 0.93 (SD /-0.03) and the correlation coefficient was 0.98. The mean ratio of ECF/total plasma TPM was 0.75 (SD /-0.06), and the correlation coefficient was 0.99. The mean ratio of CSF/total plasma TPM was 0.81 (SD /-0.06), and the correlation coefficient was 0.97. CONCLUSIONS: Assuming a protein binding of TPM of approximately 13%. it is concluded that, based on nine microdialysis samples from a single subject, TPM levels in the CSF at the cortical surface are approximately the same as the unbound plasma levels. Additional patients should be studied to confirm the results.- - - - - - - - - - ranking = 1keywords = drug-resistant (Clic here for more details about this article) |
2/10. homocystinuria with transverse sinus thrombosis.A case of cerebral venous thrombosis caused by undiagnosed homocystinuria is reported. The pitfalls regarding the diagnosis of a potentially medically treatable condition are discussed. Cerebral venous thrombosis in children has a variable type of onset and a multiplicity of causes. This type of pathology, although not frequent, is more common than previously thought. Among the different etiologies, undiagnosed homocystinuria is not routinely considered. We report a case of venous thrombosis of the left transverse cerebral sinus in a girl with drug-resistant partial epilepsy and homocystinuria. This diagnosis was considered and confirmed after the appearance of acute cerebral symptoms caused by venous thrombosis.- - - - - - - - - - ranking = 1keywords = drug-resistant (Clic here for more details about this article) |
3/10. Small hypothalamic hamartomas and gelastic seizures.PURPOSE: To describe the clinical history of patients with gelastic seizures (GSs) related to small-size hypothalamic hamartomas (HHs), and to show some of these unusual seizures. MATERIAL AND methods: patients with GSs and the MRI finding of HH < 1 cm diameter. Ictal EEG or video EEG are required. RESULTS: Three patients, among 6 with GSs and HH, had a small sessile HH. None of them had a history of precocious puberty, nor any relevant cognitive defects. All patients suffered from other seizure types, in addition to GSs. GSs were drug-resistant in all cases. CONCLUSION: since small, not easily recognizable HHs may be present in patients with GSs, a careful MRI study of the hypothalamic, infundibular and mammillary bodys areas is mandatory in these cases [published with videosequences].- - - - - - - - - - ranking = 1keywords = drug-resistant (Clic here for more details about this article) |
4/10. Coeliac disease, unilateral occipital calcifications, and drug-resistant epilepsy: successful lesionectomy.PURPOSE: To draw attention to the triad of coeliac disease (CD), occipital calcifications, and drug-resistant epilepsy, with focus on the outcome of epilepsy surgery. methods: We describe a male patient who despite a diagnosis of CD from the age of 9 did not comply with the gluten-free diet. At the age of 11 he developed simple and complex partial seizures with visual symptoms, anxiety, and ambulatory automatisms. His epilepsy appeared to be drug resistant, and after having tried nine antiepileptic drugs (AEDs), alone or in combinations, he underwent a presurgical evaluation at the age of 30. Interictal standard electroencephalograms (EEGs) disclosed frequent biparieto-occipital epileptiform discharges. Computed tomography showed cortical-subcortical punctate calcifications in the right parieto-occipital region, where his seizures seemed to start, according to ictal EEG registrations from intracranial strip electrodes. RESULTS: At the age of 31 he underwent epilepsy surgery. A 5 x 6 cm large area of the right parieto-occipital region was resected, including the area with calcifications. Except for a few short-lasting episodes of anxiety (simple partial seizures?) he has now been seizure-free for 12 years. AEDs were withdrawn 5 years ago. Postoperatively he was left with an upper left-sided quadrant anopsia, which is not bothering him. CONCLUSIONS: In patients with CD, unilateral occipital calcifications, and drug-resistant epilepsy, epilepsy surgery should be considered, as a lesionectomy might be very successful.- - - - - - - - - - ranking = 6keywords = drug-resistant (Clic here for more details about this article) |
5/10. Gelastic seizures due to right temporal cortical dysplasia.Gelastic seizures are an uncommon seizure type. They are most frequently observed in patients with hypothalamic hamartoma. Their association with other types of cerebral lesions is rare. Depending on the location of the lesion, gelastic seizures may or may not be accompanied by a subjective feeling of mirth. The pathophysiological mechanisms of this type of seizure are still undefined, and little is known about which pathways promote laughter and its emotional content, mirth. We present a young man with drug-resistant, gelastic seizures due to focal cortical dysplasia of the right inferior temporal gyrus. The lesion was evident on cranial MRI. Interictal EEG displayed a right temporal focus, whereas ictal EEG was not informative. Ictal loss of consciousness precluded reporting of any possible emotional experience. The patient underwent surgical resection of the lesion and has been seizure-free with anti-epileptic medication for two years. Although various anatomical regions may elicit laughter, in view of the current literature it seems that the anterior cingulate region is involved in the motor aspects of laughter, while the basal temporal cortex is involved in the processing of mirth. The fact that the present case exhibited gelastic seizures stresses once more the importance of the baso-lateral temporal cortex in the genesis of this type of seizures.[Published with video sequences].- - - - - - - - - - ranking = 1keywords = drug-resistant (Clic here for more details about this article) |
6/10. Transient athetosis induced by tiagabine.movement disorders have been reported with use of different antiepileptic drugs (AEDs). We report a 32-year-old woman, affected by a symptomatic focal drug-resistant epilepsy and a mild hemiparesis, with acute athetoid movements, transiently linked to increasing tiagabine (TGB) therapy. To our knowledge, no other cases of acute athetosis related to TGB have been reported to date. However, we cannot rule out the possibility that involuntary movements were induced by an interaction between TGB and concomitant AEDs, in particular phenobarbital (PB), possibly by increasing GABAergic transmission. We hypothesize that the presence of a static encephalopathy may have influenced the kind of extrapyramidal side effect induced by TGB in our patient, leading to athetosis.- - - - - - - - - - ranking = 1keywords = drug-resistant (Clic here for more details about this article) |
7/10. Focal resection for malignant partial seizures in infancy.There is little experience with excisional surgery for drug-resistant partial seizures in very young patients. We describe our experience with 5 infants under 1 year of age with malignant partial seizures and deteriorating developmental status. All were experiencing frequent daily seizures that did not respond to 1st-line antiepileptic medications at high therapeutic serum levels and considerable medication toxicity. Three infants had complete resection of epileptic tissue (frontal corticectomy and prefrontal lobectomy) and are seizure-free. Two underwent partial resection (lateral temporal lobectomy, frontal corticectomy with anterior callosotomy) and have experienced a significant reduction in seizure frequency. Surgery did not result in any significant neurologic deficit or lead to compromise of developmental status. From these data, we tentatively conclude that excisional surgery can be performed safely in selected infants with medically uncontrolled malignant partial seizures and may significantly improve long-term seizure status. Referral to a tertiary center specializing in early childhood epilepsy surgical evaluation may be considered in these circumstances.- - - - - - - - - - ranking = 1keywords = drug-resistant (Clic here for more details about this article) |
8/10. Focal epilepsy with mesial temporal sclerosis after acute meningitis.Following acute meningitis associated with severe convulsions in childhood, two patients had chronic, drug-resistant, temporal lobe epilepsy. This disorder was preceded by an entirely natural development, in one case extending for nine years and in the other case for eight years. Each patient was treated with right anterior temporal lobectomy. Classic mesial temporal sclerosis (Ammon's horn sclerosis) was found in both patients. Relief of the epilepsy was associated with remission of the concomitant social and psychiatric handicaps. At least ten years of follow-up are required in the evaluation of the treatment of early brain infections. Chronic focal epilepsy after childhood meningitis with febrile convulsions merits neurosurgical consideration.- - - - - - - - - - ranking = 1keywords = drug-resistant (Clic here for more details about this article) |
9/10. magnetoencephalography (MEG) in epilepsy surgery.Whole-scalp MEG has proved to be a suitable tool for preoperative evaluation of patients suffering from drug-resistant focal epilepsy. MEG recordings are non-invasive and safe for the subject, and no demanding preparations of the patient are needed before measurement. The MEG recordings may reveal several epileptic foci, and the order of activation can be resolved in millisecond scale. In addition, epileptic cortex can be localized with respect to important functional areas, such as sensorimotor or visual cortices, and these areas can be visualized in a same brain reconstruction. This helps in patient selection and planning of the operation. Moreover, prior MEG localization of epileptic foci and functionally important areas aids in placing the intracranial electrodes to right places, when needed.- - - - - - - - - - ranking = 1keywords = drug-resistant (Clic here for more details about this article) |
10/10. Neuropsychological study during video-EEG recording of successive partial seizures of right temporo-central origin.A 15-year-old, right-handed boy underwent video-EEG study as a first step in presurgical evaluation for a severe drug-resistant right temporo-central epilepsy. He was monitored while performing neuropsychological tests over a 67-minute period during which 23 brief seizures were recorded. Despite his right-handedness, both inter-ictal and ictal verbal performances were impaired. Analysis of the relationships between the characteristics of the EEG and the neuropsychological results revealed that a worsening in cognitive performances correlated with an increase in inter-ictal abnormalities, particularly when subclinical paroxysms were present; that the cognitive tasks executed peri-ictally were correctly performed in almost 50% of the cases; and that the error rate was higher when a task was presented during or immediately after a seizure rather than before its onset. A Wada test, performed on the basis of the cognitive results, demonstrated right hemisphere dominance for language. Our observations underline the importance of neuropsychological testing in presurgical procedures, and suggest that it should be performed peri-ictally whenever possible.- - - - - - - - - - ranking = 1keywords = drug-resistant (Clic here for more details about this article) |
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