ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1994.tb02499.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1994.tb02500.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Summary:We analyzed retrospectively the clinical and EEG data in 13 patients with simple partial seizures (SPS). All EEGs were recorded with surface electrodes with the standard 10–20 system and additional closely spaced scalp and subfrontotemporal skin electrodes. Seventy‐seven seizures were recorded. We detected electrographic correlates with SPS in 10 of 13 patients (77%) and in 47 of 77 seizures (61%). The most common ictal correlatrd relates were rhythmic theta waves or spikes. Of the SPS with EEG changes, 58% were motor, 14% were sensory, and 28% were psychic seizures. Use of additional electrodes and recording channels may account for the higher incidence of EEG changes in this study than has been reported previously in the literat

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1994.tb02501.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Summary:Experimental studies suggest important interactions between hippocampus and entorhinal cerebral cortex in generation of temporal lobe seizure activity. We studied electrical expression of spontaneous temporallobe ictal activity in hippocampus and entorhinal cortex in 9 medically refractory epileptic patients who had intracranial depth and subdural electrodes implanted during surgical evaluation. All 9 patients subsequently under‐went anteromedial temporal lobectomy with hippocam‐pectomy, all had>50% decrease in neuronal cell density in hippocampal CA1 and CA3, and all had good to excellent seizure outcome after operation. Two to 10 spontaneous seizures were analyzed per patient (total 41 seizures). Nine patients had variable onset of seizure activity recorded in hippocampus, entorhinal cortex, or both simultaneously. Low‐voltage fast activity was observed in either location and varied among seizures in an individual patient. Periodic preictal spikes, when present, were often synchronous in both locations, but were noted independently only in hippocampus. Our data suggest that preictal spikes and low‐voltage fast seizure discharges have anatomically distinct origins, and that some syndromes of medial temporal lobe epilepsy involve interactions between entorhinal and hippocampal regions that act together to produce and propagate the seizures in such p

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1994.tb02502.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Summary:We used a computerized image‐analysis system to perform a quantitative analysis of rapid Golgiimpregnated pyramidal neurons of the third cortical layer of histologically normal cerebral cortex surgically removed from patients with partial epilepsy. Various parameters of 51 neurons from 9 patients and 29 neurons from 5 age‐matched controls were compared. Dendritic spine density decreased progressively with increasing duration of seizures, and dendritic swellings were most numerous in epilepsy cases of uncertain etiology and in patients with seizures of longer standing. Neurons from seizure cases showed fewer dendritic branching points and fewer proximal dendritic branches than those from controls, suggesting a simplified dendritic architecture. These findings indicate that neurons in cortex distant from the primary site of epileptogenic activity may be undergoing subtle, progressive degeneration, which may explain the propensity of chronic epilepsy patients to have increased seizure activity and interictal behavioral and cognitive aberrati

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1994.tb02503.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Summary:Ictal behavioral characteristics may reflect seizure spread patterns and provide a clue to seizure onset location, between or within specific cerebral lobes. Sequential symptomatology might therefore distinguish patients with hippocampal sclerosis from patients with temporal lobe tumors. To determine ictal behavioral differences in patients of these groups, we analyzed 145 seizures of 33 patients with hippocampal sclerosis (group I) and 79 seizures of 22 patients with temporal lobe tumors (group 11). First appearance of a variety of ictal behavioral characteristics was determined in three phases (first 5 s, 5–60 s, and from 60 s to mental clearing) for patients in both groups. Ipsilateral hand automatisms were significantly more frequent in the first 60 s in group I (p<0.005). Onset of contralateral head turning was observed in the first 5 s only in group Il (p<0.05). First appearance of leg automatisms in group I and of oral automatisms in group Il were very rare in phase 2 (p<0.01, p<0.005). Time of onset of other ictal behavioral characteristics and duration of seizures were not statistically different between the two groups. Ictal behavioral characteristics varied among and within patients and patient groups, but certain behavioral characteristics were helpful in differentiating these two groups of temporal lobe epilepsy (TLE) patient

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1994.tb02504.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Summary:Cognitive testing was repeated at intervals ranging from 1 to 8 years in 47 adult patients with temporal lobe epilepsy (TLE). Each patient underwent standardized batteries, including the Wechsler Adult Intelligence Scale, Revised (WAIS‐R), and Wechsler Memory Scale (WMS). Both surgically treated and nonsurgical patients were examined. The nonsurgical group underwent serial testing for clinical indications, usually for complaints of memory dysfunction. Longitudinal testing could not verify any mean deterioration of intellect or memory in this group; variance over time was similar to test‐retest norms in healthy controls. WAIS‐R scores before and after resection in the surgical group were similar to our serial WAIS‐R data in nonsurgical patients. When we divided surgical patients according to side of epileptogenesis, we noted the expected differences in verbal and visual memory. Right‐sided surgery patients improved significantly in Full‐scale IQ (FSIQ) and tended to improve in logical memory on postoperative testing. Patients undergoing left resections had no retest improvement and tended to show decrease in several measures of verbal memory. Our findings should stimulate continued investigation into the natural history of lateralized memory and intellectual function in epilepsy, particularly to clarify longterm cognitive outcome in nonsurgic

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1994.tb02505.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Summary:We interviewed 1,558 adults with idiopathic1 cryptogenic epilepsy ascertained from voluntary organizations and 316 of their siblings without epilepsy to determine their personal history of marriage and pregnancy. We examined the effects of seizure type, age at onset, and family history of epilepsy on the sex‐specific likelihood of pregnancy in individuals with idiopathic/cryptogenic epilepsy as compared with their same‐sex siblings. Overall, men with idiopathic/cryptogenic epilepsy were only 36% as likely as male unaffected siblings ever to have fathered a pregnancy. In men, the reduced likelihood of fathering a pregnancy was associated with partial‐onset seizures, early age at onset (<20 years), and a negative family history of epilepsy, and the effects of these epilepsy characteristics appeared to be mediated through reduced marriage rates. Among men with epilepsy who had ever been married, reproductive disadvantage was confined to those with early‐onset (<10 years) partial epilepsy. Overall, women with idiopathiclcryptogenic epilepsy were only 37% as likely ever to have had a pregnancy as female unaffected siblings; this effect was not strongly influenced by seizure type, age at onset, or family history of epilepsy. In women who had ever been married, unlike in men, reduced likelihood of pregnancy persisted, regardless of seizure type, age at onset, or family history of e

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1994.tb02506.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Summary:We report a mixed handed (L>R) patient with exclusive right cerebral language representation who de–veloped a permanent anterograde amnestic syndrome after right anterotemporal lobectomy. Preoperative neuropsychological performance consisted of impaired verbal memory and normal nonverbal memory. Wada memory performance was asymmetrical for objects presented soon after amobarbital injection in conjunction with no memory asymmetry for items presented later in the Wada evaluation. Preand postoperative magnetic resonance imaging (MRI) scans showed no structural lesions; however, postoperative MRI hippocampal volume measurements suggested decreased hippocampal volume for the nonresected temporal lobe. These results confirm the risk of anterograde amnesia after unilateral temporal lobectomy and demonstrate that baseline neuropsychological testing may falsely literalize material‐specific memory functions in patients with atypical cerebral language domina

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1994.tb02507.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Summary:To explore the risk factors and circumstances for burns in a population of persons with epilepsy, we surveyed 244 University of Colorado Health Sciences Center Seizure Clinic patients. Twenty‐five had at least one seizure‐related burn requiring medical attention (12 were hospitalized), 21 reported burns requiring medical attention not related to seizure activity, and 199 reported no burns. All patients with seizure‐related burns had alteration of consciousness during most seizures. Statistical models with logistic regression indicated that a useful model for assessing risk of seizure‐related burns in this population of patients could be constructed using three significant variables: lifetime total number of seizures experienced by the patient, the presence of interictal neurologic impairment, and gender. The remainder of the variables studied (percentage of seizures that occurred nocturnally, percentage of seizures preceded by a simple partial seizure (SPS) warning, self‐care status, number of seizures in adult life, seizure type, patient age, age of onset of seizure disorder, and presence of burns not associated with seizure) were either not significantly correlated with seizure‐related burns or did not significantly improve the success of the statistical model in light of the other variables studied. Most injuries occurred in the home during activities that might have been avoided. They included 10 burns incurred while cooking, 5 incurred while showering (with a plumbing system that permitted exposure to scalding water), and 3 caused by exposed room heaters. A subset of epileptic patients are at increased risk for burns and should minimize situations in which they ca

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1994.tb02508.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY