Cases reported "Epilepsies, Partial"

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1/11. Periictal diffusion-weighted imaging in a case of lesional epilepsy.

    PURPOSE: diffusion-weighted MR imaging (DWI) has been used for the early diagnosis of acute ischemic lesions in humans and in animal models of focal status epilepticus. We hypothesized that DWI may be a sensitive, noninvasive tool for the localization of the epileptogenic area during the periictal period. methods: A periictal DWI study was performed on a 35-year-old patient during focal status epilepticus with repetitive prolonged focal motor seizures originating from a lesion in the right frontal lobe. DWI results were analyzed visually and by calculating apparent diffusion coefficient (ADC) maps. RESULTS: On DWI, a single area of signal increase (decrease in ADC) was found in the region of focal electrocorticographic seizures that was mapped intraoperatively. CONCLUSIONS: Ictal/postictal DWI may be a useful technique for seizure localization in patients with lesional epilepsy.
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2/11. EEG and evoked potential recording from the subthalamic nucleus for deep brain stimulation of intractable epilepsy.

    OBJECTIVES: The substantia nigra in the animal model has been implicated in the control of epilepsy. The substantia nigra pars reticulata (SNpr) receives afferents from the subthalamic nucleus (STN), which thus may have an effect on the control of epilepsy. There is evidence in the animal model of a direct connection from the cortex to the STN. High-frequency STN stimulation is being used in experimental trial for the management of intractable epilepsy. Our primary objective in this study was to determine if there was epileptiform activity recorded from the STN in association with scalp recorded epileptiform activity to support the presence of a pathway from the cortex to the STN in humans as described in animals that may be important for the management of epilepsy. This article describes the interictal and ictal electroencephalographic (EEG) findings as well as evoked potential recordings from the STN in these patients with intractable epilepsy. methods: Four patients (3 males) ranging from 19 to 45 years with intractable focal epilepsy refractory to anti-epileptic drugs were studied. Two patients failed vagal nerve stimulation and one patient had previous epilepsy surgery. Depth electrodes were implanted stereotactically in the STN bilaterally. A comparative analysis of the interictal and ictal activities recorded from the scalp and STN electrodes was performed. median nerve somatosensory evoked potentials (SEPs) and auditory evoked potentials (AEPs) were also recorded. RESULTS: Interictal sharp waves recorded in the scalp EEG were always negative in polarity. These sharp waves were always associated with sharp waves recorded at the ipsilateral STN electrode contacts that were always positive in polarity. In addition repetitive spikes were recorded independently at the left or right STN electrode contacts, with no reflection at the scalp. These spikes were extremely stereotyped, of high amplitude and short duration, and were positive or negative in polarity. Focal scalp EEG seizures were also recorded at the ipsilateral STN electrodes. In 3 patients SEPs were recorded from the contralateral STN electrodes corresponding to the P14/N18 far-field complex. In two patients AEPs were recorded, and wave V (near-field) and wave VII (far-field) from the contralateral STN electrodes. CONCLUSIONS: This study demonstrates that scalp recorded epileptiform activity is reflected at the ipsilateral STN either following or preceding the scalp sharp waves. The STN sharp waves are most probably an expression of the direct cortico-STN glutamatergic pathways that have been demonstrated previously in animals. This pathway in man may be important with regard to a possible mechanism for the treatment of epilepsy with STN stimulation.
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keywords = animal
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3/11. Focal cooling suppresses spontaneous epileptiform activity without changing the cortical motor threshold.

    PURPOSE: Focal cerebral cooling has been shown to reduce epileptiform activity in animals. There are, however, few reports of this phenomenon in humans. methods: Electrocorticography was performed before resection of a right frontal tumor in a patient with partial seizures. Cold saline was applied to the interictal spike focus, and its effect on the epileptiform discharges was observed. RESULTS: Application of cold saline to the spike focus resulted in a transient, complete cessation of spiking. This effect was reproduced with a second application of cold saline. The motor threshold for electrical stimulation remained unchanged during the application of saline. CONCLUSIONS: In this patient with tumor-related epilepsy, focal cooling of the cortex reproducibly abolished interictal epileptiform discharges without changing the motor threshold to electrical stimulation.
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4/11. Recurrent seizure activity after epidural morphine in a post-partum woman.

    PURPOSE: We report on a primiparous woman who suffered recurrent seizure activity after repeated small doses of epidural morphine to highlight the neuroexcitation potential of neuraxial opioids in the epileptic patient. CLINICAL FEATURES: Seizure activities as a complication of opioid administration have been reported in laboratory animals and humans. We report the case of a 30-yr-old primiparous woman with a history of epilepsy under carbamazepine treatment, who had epidural anesthesia for elective cesarean section at 38 weeks gestation. Postoperatively, 1.5 mg of morphine were administered epidurally for pain control. Three hours later the patient suffered from clonic movements of the right arm without loss of consciousness. One day later, she again received 1 mg of epidural morphine twice at a 12-hr interval and similar seizure episodes recurred eight hours after each dose. A relation between the administration of morphine and seizure activity was suspected and the use of opioids for pain control was stopped. The patient was discharged on the fifth postoperative day and, more than one year after the last episode, she remains free of any seizure activity. CONCLUSION: Our report indicates that even a remote history of epilepsy carries a pro-convulsant potential in the peripartum period, even following the administration of small doses of epidural morphine.
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5/11. Magnetic stimulation in the treatment of partial seizures.

    We have recently demonstrated that Magnetoencephalographic (MEG) brain measurements in patients with seizure disorders show significant MEG activity often in the absence of conventional EEG abnormalities. We localized foci of seizure activity using the mapping technique characterized by the ISO-Spectral Amplitude (ISO-SA) on the scalp distribution of specified spectral components or frequency bands of the emitted MEG Fourier power spectrum. In addition, using an electronic device, we utilized the above recorded activity to emit back the same intensity and frequency of magnetic field to the presumed epileptic foci. Using this method we were able, over the past two years, successfully to attenuate seizure activity in a cohort of over 100 patients with various forms of epilepsy. We now present in more detail three randomly selected patients with partial seizures in whom application of an external artificial magnetic field of low intensity produced a substantial attenuation of seizure frequency during an observation period extending from 10 to 14 months. All patients had previously obtained only partial response to conventional anticonvulsant therapy. Attenuation in seizure frequency was associated with normalization of the MEG activity. These cases demonstrate that artificial magnetic treatment may be a valuable adjunctive procedure in the management of partial seizures. The possible mechanisms underlying the anticonvulsant properties of magnetic stimulation at both cellular and systemic levels are discussed. Specifically, since the pineal gland has been shown to be a magnetosensitive organ which forms part of a combined compass-solar clock system, and since it exerts an inhibitory action on seizure activity in both experimental animals and humans, we discuss the potential pivotal role of the pineal gland in the long term anticonvulsant effects of external artificial magnetic stimulation.
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keywords = animal
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6/11. A TIA-like syndrome associated with mycoplasma pneumoniae infection.

    A transient expressive aphasia associated with focal slowing in the electroencephalogram, is described in a patient with documented Mycoplasma infection. The hypothesis that ischemia is a mechanism for the transient clinical findings is considered in relation to animal studies.
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7/11. More intense focal seizure types after callosal section: the role of inhibition.

    corpus callosum section reduces the incidence of generalized seizures associated with loss of consciousness. Minimal data are available, however, regarding the types of seizures that may be present following surgery. Five of 17 patients in our clinic who underwent partial or complete corpus callosum section developed more intense and sometimes newly patterned (but not necessarily more frequent) focal seizures postoperatively. These patients were not predictably different from the other 12 in terms of age at onset of seizures or at surgery, cause of seizures, extent of callosum sectioned, radiographically demonstrable structural lesions, or the types of preoperative seizures. All 5 patients, however, had bilateral independent frontal electroencephalographic foci. No patients without these electroencephalographic findings developed more intense focal seizures after surgery. The findings are consistent with the results of experimental animal studies and argue for a suppressive influence of the contralateral hemisphere on some types of seizures.
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8/11. seizures in thyrotoxicosis.

    Over a period of 2 years we have observed 3 thyrotoxic patients who presented with a convulsive encephalopathy. These patients had no history of seizures before and experienced no further seizures after subsidence of the thyroid dysfunction. During the convulsive period, electroencephalograms of 2 patients showed evidence of cerebral hyperexcitability, but in both cases it returned to normal once the thyroid disorder was corrected. We believe that thyrotoxic seizures are not rare. These seizures can be focal as well as generalized and can constitute the presenting symptoms of the disease. Absence of other laboratory abnormalities such as serum electrolytes, or osmolality changes, or hypoglycemia in all patients who reportedly suffered from thyrotoxic seizures, and the data obtained from animal studies, suggest that human thyrotoxic seizures result mainly from the direct effect of thyroid hormones over the cerebral tissue.
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keywords = animal
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9/11. Simple formed hallucinations confined to the area of a specific visual field defect.

    Thirteen patients with transient or permanent homonymous visual field defects experienced formed hallucinations localized to the affected part of the visual field. The lesion was occipital in 8 instances (infarction 7, porencephalic cyst 1), parietooccipital in 3 (infarction 2, angioma 1) and probably parietal in 2 (epilepsy 1, encephalitis 1). The disorder involved the right hemisphere in 9 cases, the left hemisphere in 3 cases and both hemispheres sequentially in one patient. hallucinations were accompanied by palinopsia in 2 cases, metamorphopsia in one case and constriction of one pupil in another case. This particular type of hallucination is considered as an irritative phenomenon of the visual association cortex which can be symptomatic of a parieto-occipital lesion and does not necessarily implicate the temporal lobes. Distinctive features about the visions were that they consisted of people, animals or objects. There was no auditory accompaniment and any action that took place was stereotyped and did not tell a story. In most cases, the hallucinations were not clearly related to any visual memory. It is suggested that the visual association cortex amy be responsible for the organization of visual percepts into broad categories of which people, animals and objects are representative. The occurrence of such hallucinations with a visual field defect suggests that the cells of the association cortex are more likely to discharge spontaneously once they are deprived of their normal afferent inflow from the calcarine cortex.
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ranking = 2
keywords = animal
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10/11. Coupling of cortical and thalamic ictal activity in human partial epilepsy: demonstration by functional magnetic resonance imaging.

    PURPOSE: To localize metabolic coupling between a cortical seizure focus and other brain regions by using functional magnetic resonance imaging (fMRI) data of ictal events obtained in a patient with frequent partial seizures involving his right face. methods: Cross-correlation analysis was used to examine time-dependent alterations in regional signal intensity that correlated with signal-intensity changes from a well-characterized cortical seizure focus in a patient with frequent partial seizures. RESULTS: Signal changes in the left ventrolateral thalamus showed a high degree of temporal correlation with signal changes in the left frontal cortical seizure focus, demonstrating close corticothalamic coupling of metabolism. CONCLUSIONS: A significant role for thalamocortical interactions in the pathophysiology of epilepsy has been suggested by studies in animal models and human patients. This finding provides further support for the integral involvement of the thalamus in human focal epilepsy and underscores the potential for identifying neuronal networks by using cross-correlation analysis of fMRI data.
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