- Neuromodulation Advances for Seizure Control
Epilepsy surgery has had an impressive development over the years, becoming a first option for many patients who have refractory seizures.
- Memory for facial expressions in patients with temporal lobe epilepsy: Preliminary findings
La Epilepsia del Lóbulo Temporal (ELT) está asociada a problemas emocionales y de memoria. La mayoría de los estudios previos han examinado a pacientes después de que haya habido una extirpación quirúrgica de las estructuras afectadas (hipocampo y amígdala), por lo que continúa sin estar claro qué déficits son atribuibles a la propia enfermedad y cuáles son consecuencia de la cirugía.
- Mu Opioid Receptor mRNA Expression, Binding, and Functional Coupling to G-Proteins in Human Epileptic Hippocampus
Mu opioid receptors (MOR) are known to be involved in seizure activity. The main goal of the present study was to characterize the MOR mRNA expression, binding, as well as G protein activation mediated by these receptors in epileptic hippocampus of patients with pharmacoresistant mesial temporal lobe epilepsy (TLE). In contrast with autopsy samples, hippocampus obtained from patients with mesial TLE demonstrated enhanced MOR mRNA expression (116%).
- Estudio con tractografía y campimetría del defecto visual en pacientes con epilepsia mesial del lóbulo temporal, postoperados de lobectomía temporal anterior
El asa de Meyer representa el campo visual superior contralateral, evitar el daño a esta estructura es esencial para preservar esta función del campo visual. La tractografía ofrece el único método no invasivo para la medición del curso de la fibras de sustancia blanca in vivo. Objetivo. Describir imagenológica y campimétricamente la visión en los pacientes sometidos a lobectomía temporal para tratamiento de la epilepsia refractaria. Material y métodos. Se realizó un estudio descriptivo, prospectivo y longitudinal en cinco pacientes con diagnóstico de epilepsia del lóbulo temporal de difícil control, sometidos a lobectomía temporal. En todos los casos se presentó déficit clínico del cuadrante visual superior contralateral a la lobectomía. Resultados. En todos los pacientes fue evidente la lesión del asa de Meyer visualizada en el estudio de tractografía posoperatorio. Se observaron diferencias en el grado de déficit visual, lo que indica variaciones anatómicas en el trayecto del asa de Meyer o en la cantidad y localización del tejido resecado.
- Centromedian Thalamic Stimulation for Epilepsy
Sudden onset of generalized seizures that includes loss of consciousness, involvement of global motor activity, and diffuse electroencephalographic (EEG) discharges suggests that convulsive activity is propagated through structures with widespread anatomical and physiological connections. The participation of a neural system with these characteristics in the genesis and propagation of epileptic attacks was proposed some time ago on the basis of clinical observations.
- Stimulation of the Hippocampus and the Seizure Focus
Neuromodulation has been used as an alternative nonlesional surgical procedure for patients with intractable epilepsy. Several targets for such modulation have been proposed. Cerebellar, entromedian thalamic, vagal nerve, anterior nucleus of the thalamus and subthalamic nucleus stimulation have all shown variable degrees of efficacy in decreasing either primary or secondary generalized seizures.
- Epilepsy Mechanism, Models and translational persperctives
- Migraña y epilepsia AMN
La migraña y la epilepsia son trastornos paroxísticos muy frecuentes en la consulta neurológica. Ambos representan distintas familias de alteraciones neurológicas que tiene una constelación de síntomas típicos. La migraña se caracteriza por ataques de dolor asociados, mientras que la epilepsia se determina por recurrentes de síntomas neurológicos positivos (crisis epilépticas) que pueden progresar a arresto conductual o convulsiones
- Memory for facial expressions in patients with temporal lobe epilepsy: Preliminary findings
Abstract: Temporal Lobe Epilepsy (TLE) is associated with memory and emotional impairments. However, the majority of previous studies examined patients after the affected structures (hippocampus and amygdala) were surgically removed, so it remains unclear to what extent these deficits are associated with the illness itself or are a consequence of the surgery. Thus, the objective of this study was to compare recognition memory for facial emotional expressions in pre- and post-surgery TLE patients, and its relationship to neuropsychological and clinical variables. We observed higher memory accuracy in pre-surgical patients than in those who had undergone surgery. Moreover, there was a significant positive correlation between the task and the executive
functions and memory subtests of the neuropsychological battery, as well as a negative correlation with illness duration. These preliminary results suggest a possible effect of the surgical resection on memory, and highlight the importance of an early intervention for reducing cognitive decline.
- Developments in Neurostimulation Therapy for Epilepsy
Abstract: Neuromodulating neural tissue instead of performing lesions is a current trend in neurosurgery. In the case of epilepsy, stimulation of the nervous system is under investigation, and the field is growing at a fast pace. The purpose of this article is to review the various targets that have been studied in the search for a way to control refractory seizures. Consideration is made of why each target is chosen, patient selection, results, and adverse effects. Cerebellar stimulation was the first proposed method; vagus nerve stimulation is currently the most widely used due to its easy technique, but the results on seizure reduction are modest. Other targets were chosen with the idea of interfering with seizure propagation-this is the case with thalamic stimulation. Currently, studies are being performed stimulating the epileptic focus. Although there are still many controversies regarding which is the best target and stimulating parameters, all authors agree that neuromodulation reduces seizures and has the advantage of being reversible and safe.
- Neuromodulation Advances for Seizure Control
Epilepsy surgery has had an impressive development over the years, becoming a first option for many patients who have refractory seizures. The results of conventional surgery are Fig. 1. Patients that are rejected from conventional epilepsy surgery This flow diagram shows the usual route a patient follows to undergo a surgical procedure. In red are shown those patients who are rejected from surgery. Almost all patients who have none lesional MRI (magnetic resonance imaging) are almost always rejected (dropouts) since the diagnostic procedure is complicated and the outcome is not very reassuring. Patients who have lesions are sometimes rejected too. This is due to an involvement of primary functions with high risk of postsurgical neurologic deficit.
- Mu Opioid Receptor mRNA Expression, Binding, and Functional Coupling to G-Proteins in Human Epileptic Hippocampus
ABSTRACT: Mu opioid receptors (MOR) are known to be involved in seizure activity. The main goal of the present study was to characterize the MOR mRNA expression, binding, as well as G protein activation mediated by these receptors in epileptic hippocampus of patients with pharmacoresistant mesial temporal lobe epilepsy (TLE). In contrast with autopsy samples, hippocampus obtained from patients with mesial TLE demonstrated enhanced MOR mRNA expression (116%). Saturation binding experiments revealed significantly higher (60%) Bmax values for the mesial TLE group, whereas the Kd values were not statistically different. Although mesial TLE group demonstrated high levels of basal binding for the G proteins (136%), DAMGO-stimulated [35S]GTPcS binding did not demonstrate significant alterations. In conclusion, our present data provide strong evidence that the epileptic hippocampus of patients with pharmacoresistant mesial TLE presents significant alterations in MOR. Such changes may represent adaptive mechanisms to compensate for other as yet unknown alterations. VVC 2010 Wiley-Liss, Inc.
We report two cases of chronic therapeutic stimulation of epileptic foci localized in motor areas. Case 1 is an adolescent with supplementary motor area seizures whose intracranial recordings showed a right SMA focus. Case 2 is a female teenager with primary motor seizures originating in the right motor cortex in the hand area as shown by her intracranial recordings and cortical mapping. Both had apparently normal MRI. Chronic stimulation of the epileptic focus decreased the number of seizures more than 90% the seizure number while preserving motor function. None of the patients had side effects. Neuromodulation is proposed as a safe, efficient surgical alternative for motor seizure control.
- Neuromodulation of Epileptic Foci in Patients with Non-Lesional Refractory Motor Epilepsy
We report two cases of chronic therapeutic stimulation of epileptic foci localized in motor areas. Case 1 is an adolescent with supplementary motor area seizures whose intracranial recordings showed a right SMA focus. Case 2 is a female teenager with primary motor seizures originating in the right motor cortex in the hand area as shown by her intracranial recordings and cortical mapping. Both had apparently normal MRI. Chronic stimulation of the epileptic focus decreased the number of seizures more than 90% the seizure number while preserving motor function. None of the patients had side effects. Neuromodulation is proposed as a safe, efficient surgical alternative for motor seizure control.
- Developments in Neurostimulation Therapy for Epilepsy
- Treatment of the child with a first unprovoked seizure
Abstract—The Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society develop practice parameters as strategies for patient management based on analysis of evidence regarding risks and benefits. This parameter reviews published literature relevant to the decision to begin treatment after a child or adolescent experiences a first unprovoked seizure and presents evidence-based practice recommendations.
- The Neurodiagnostic Evaluation of the Child With a First Simple Febrile Seizure
Abstract- The American Academy of Pediatrics and its Provisional Committee on Quality Improvement, in collaboration with experts from the Section on Neurology, general pediatricians, consultants in the fields of neurology and epilepsy, and research methodologists, developed this practice parameter. This parameter provides recommendations for the neurodiagnostic evaluation of a child with a first simple febrile seizure. These recommendations derive from both a thorough review of the literature and expert consensus.
- Evaluating a first nonfebrile seizure in children
Abstract—Objective: The Quality Standards Subcommittee of the American Academy of Neurology develops practice parameters as strategies for patient management based on analysis of evidence. For this practice parameter, the authors reviewed available evidence on evaluation of the first nonfebrile seizure in children in order to make practice recommendations based on this available evidence.
- Efficacy and tolerability of the new antiepileptic drugs I: Treatment of new onset epilepsy
Abstract—Objective: To assess the evidence demonstrating efficacy, tolerability, and safety of seven new antiepileptic drugs (AEDs) (gabapentin, lamotrigine, topiramate, tiagabine, oxcarbazepine, levetiracetam, and zonisamide—reviewed in the order in which these agents received approval by the US Food and Drug Administration) in the treatment of children and adults with newly diagnosed partial and generalized epilepsies.
- Efficacy and tolerability of the new antiepileptic drugs II: Treatment of refractory epilepsy
Abstract—Objective: To assess the evidence demonstrating efficacy, tolerability, and safety of seven new antiepileptic drugs (AEDs) (gabapentin, lamotrigine, topiramate, tiagabine, oxcarbazepine, levetiracetam, and zonisamide) in the treatment of children and adults with refractory partial and generalized epilepsies.
- Management issues for women with epilepsy - Focus on pregnancy
Abstract- Objective: To reassess the evidence for management issues related to the care of women with epilepsy (WWE) during pregnancy, including the risk of pregnancy complications or other medical problems during pregnancy in WWE compared to other women, change in seizure frequency, the risk of status epilepticus, and the rate of remaining seizure-free during pregnancy.
- Management issues for women with epilepsy- Teratogenesis and perinatal outcomes
Abstract- Objective: To reassess the evidence for management issues related to the care of women with epilepsy (WWE) during pregnancy.
- Management issues for women with epilepsy ? Vitamin K, folic acid, blood levels, and breastfeeding
Abstract- Objective: To reassess the evidence for management issues related to the care of women with epilepsy (WWE) during pregnancy, including preconceptional folic acid use, prenatal vitamin K use, risk of hemorrhagic disease of the newborn, clinical implications of placental and breast milk transfer of antiepileptic drugs (AEDs), risks of breastfeeding, and change in AED levels during pregnancy.
- Management issues for women with epilepsy ? Obstetrical complications and change in seizure frequency
Abstract- Objective: To reassess the evidence for management issues related to the care of women with epilepsy (WWE) during pregnancy, including the risk of pregnancy complications or other medical problems during pregnancy in WWE compared to other women, change in seizure frequency, the risk of status epilepticus, and the rate of remaining seizure-free during pregnancy.
