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Pediatric epilepsy surgery: the widening spectrum of surgical candidacy
M.l Duchowny
is particularly evident at pediatric centers where seizure presentations are diverse and often extremely severe. Many present as severe electroclinical syndromes with adverse prognoses that are well studied [1, 2]. Thus, without definitive intervention, the long-term outlook for affected patients is poor, and provides justification for seeking innovative and radical solutions.
Articles originaux
Effects of valproate, vigabatrin and tiagabine on GABA uptake into human astrocytes cultured from fœtal and adult brain tissue
C. M. Fraser, G. J. Sills, E. Butler, G. G. Thompson, K. Lindsay, R. Duncan, A. Howatson, M. J. Brodie
inhibitory neurotransmitter g-aminobutyric acid (GABA). This information has, however, been gleaned from studies employing experimental systems derived from animal tissues. We have conducted preliminary studies of the effects of VPA, VGB and TGB on the transport of GABA into primary cultures of human astrocytes, derived from both adult and foetal tissues. Astrocytes were prepared from cerebral cortical tissue obtained from patients undergoing surgery for intractable epilepsy, and from spontaneously aborted foetuses (16-24 weeks gestation). The cells were isolated via a series of enzymatic digestions, grown under standard culture conditions for around 21 days and then assayed for GABA uptake activity. VPA (1,000 mM), VGB (100 mM) and TGB (200 nM) all significantly (p < 0.05) reduced the uptake of GABA into primary cultures of human adult astrocytes following a one hour exposure. VPA (1,000 mM) and VGB (100 mM) similarly reduced GABA uptake into astrocytes derived from human foetal tissue, while TGB (200 and 500 nM) was without effect. The results of these preliminary studies suggest that VPA and VGB reduce GABA transport into both adult- and foetally-derived human astrocytes, whereas TGB appears active only in cells cultured from adult brain. Delayed development of the GAT-1 transporter in foetal tissue could explain this observation.
Efficacy of lamotrigine in idiopathic generalized epilepsy syndromes: a video-EEG-controlled, open study
C. A. Gericke, F. Picard, A. de Saint-Martin, S. Strumia,C. Marescaux, E. Hirsch
HASH(0xae0b1c0)
Reading epilepsy in a patient with previous idiopathic focal epilepsy with centrotemporal spikes
M. P. Valenti, P. Tinuper, A. Cerullo, R. Carcangiu, C. Marini
male who suffered since the age of 8 from nocturnal partial motor seizures. Clinical features were typical of BECT. We reviewed the EEG recorded at that time which showed centro-temporal spike and waves. He was seizure-free from the age of 12 to the age of 17 when seizures evoked only by reading appeared. No other stimuli provoked seizures. Neurological and neuroradiological (CT and MR) investigations were normal. Baseline video-polygraphic EEG recordings were normal while reading aloud provoked myoclonic jerks in the facial muscles related to bilateral spike and wave discharges. Therapy with carbamazepine and valproic acid strongly reduced seizure frequency. Conclusion: Recent papers have debated the difficulties in classifying RE among the generalized or focal syndromes. Literature reports describe an association with RE and juvenile myoclonic epilepsy, supporting the hypothesis of an idiopathic generalized form. We report the first documented case with a clear-cut idiopathic localization-related epilepsy evolving to a primary reading epilepsy.
Somatosensory evoked potentials and eeg findings in siblings of juvenile myoclonic epilepsy patients
D. Atakli, A. Soysal, T. Atay, H. Altintas, B. Arpaci, S. Baybas
evaluated the EEG findings and SEP in asymptomatic siblings of JME patients.
Methods: We analysed the EEG and SEP findings of 37 JME patients and 48 asymptomatic siblings of 27 patients and compared the results with healthy volunteers.
Results: Of 13 asymptomatic siblings with EEG abnormalities (27.1%), 5 had 4-6 Hz spike/polyspike and wave paroxysms (10.4%), 5 had slow wave paroxysms (10.4%), and the remaining 3 patients exhibited focal spike and wave activity during hyperventilation (6.25%). No significant difference was found between JME patients, asymptomatic siblings and control groups with respect to N20 latencies. N20/P25 amplitudes were significantly higher in both JME group and asymptomatic siblings than those of control cases. HASEP were observed in 8 out of 37 JME patients (21.6%), 10 out of 48 healthy siblings (20.8%) and none of the control cases. The consanguinity rate was higher in parents of patients who had at least one asymptomatic sibling with EEG and/or SEP abnormalities (68.7%) than in those of patients who had siblings with no EEG and SEP abnormalities (9.9%). We suggest that the high rate of SEP and EEG changes among offspring of consanguineous marriages might reflect the genetic heterogeneity of the disease.
Psychosocial functioning in chronic epilepsy: relation to hippocampal volume and histopathological findings
M. Seeck, F. Lazeyras, K. Murphy, A. Naimi, G.P. Pizzolatto, N. de Tribolet, J. Delavelle, J.-G. Villemure, T. Landis
lobe (ETLE) lobe epilepsy. Twenty-six patients underwent surgery and the resected tissues subjected to histopathological examination. Psychosocial scores were calculated on the basis of employment, partnership/family status and presence of a positive psychiatric history. Poorest values were obtained for the group with right lesional and non-lesional TLE (RTLE, p < 0.001). In this group, significant positive correlations between psychosocial functioning and the left hippocampal volume or age of onset were observed. We found that the left hippocampal volume in RTLE was smaller with increasing epilepsy duration. We conclude that patients with RTLE represent a particular group with regard to the structural and psychosocial consequences of chronic epilepsy. With regard to histopathological analysis, no particular type of lesion was identified as the major determinant of the results described above.
Paroxysmal non-kinesigenic dyskinesia: pathophysiological investigations
C. T. Lombroso, A. Fischman
dyskinesia (PNKD), an invasive video-electrographic study demonstrated that his PNKD did not originate from the cortex, while a discharge was registered from the caudate nuclei. An 18FDG PET scan failed to show metabolic anomalies. A 18FDOPA and a 11C raclopride PET scans revealed a marked reduction in the density of presynaptic dopa decarboxylase activity in the striatum, together with an increased density of postsynaptic dopamine D2 receptors. These findings may suggest a chronic upregulation of postsynaptic dopa receptors, either because of an increase in their numbers or changes in their affinity. It remains unknown if these are secondary to reduced dopamine synthesis or altered release, or if the changes in striatal dopamine receptor binding are a primary or a compensatory mechanism.
Brèves
Ipsilateral blinking: a rare lateralizing seizure phenomenon in temporal lobe epilepsy
A. Henkel, P.A. Winkler, S. Noachtar
[4] occur contralateral to the seizure onset zone. Conversely, unilateral blinking has been described as a rare ipsilateral ictal phenomenon [5]. We reviewed the database of our epilepsy monitoring unit for ictal unilateral blinking and identified two patients. We report on these two patients, both of whom had temporal lobe epilepsy.
Spect findings in reflex seizures induced by movement in non-ketotic hyperglycemia
R. Suárez-Moro, J. Salas-Puig, M. Amorín, C. Róiz, CH. Lahoz
Ictal SPECT in extratemporal partial seizures shows focal cortical hyperperfusion. Ipsilateral basal ganglia and contralateral cerebellar hyperperfusion can also be seen [3]. Our aim was to study the interictal and ictal SPECT findings in reflex partial seizures induced by movement in an elderly patient with NKH.
