Hamartomas and epilepsy: clinical and imaging characteristics.

Purpose: Cerebral hamartomas are lesions marked by a disorganized arrangement of mature neural elements and represent a rare cause of medically intractable focal epilepsy. We present the clinical presentation and imaging findings of this rare entity.

Methods: History and neurophysiological studies of 14 patients with pathologically confirmed hamartomas who had surgery for intractable focal epilepsy were reviewed.

Neocortical temporal FDG-PET hypometabolism correlates with temporal lobe atrophy in hippocampal sclerosis associated with microscopic cortical dysplasia.

Purpose: Medically intractable temporal lobe epilepsy (TLE) due to hippocampal sclerosis (HS), with or without cortical dysplasia (CD), is associated with atrophy of the hippocampal formation and regional fluorodeoxyglucose positron-emission tomography (FDG-PET) hypometabolism. The relation between areas of functional and structural abnormalities is not well understood. We investigate the relation between FDG-PET metabolism and temporal lobe (TL) and hippocampal atrophy in patients with histologically proven isolated HS and HS associated with CD.

Interictal EEG, hippocampal atrophy, and cell densities in hippocampal sclerosis and hippocampal sclerosis associated with microscopic cortical dysplasia.

The EEG characteristics of isolated hippocampal sclerosis (HS) and HS associated with other types of temporal lobe pathology are not well defined. The pathologic substrate may be an important variable in determining seizure-free outcome. The objective of this study was to define the distribution of epileptiform discharges in patients with HS and HS associated with microscopic dysplasia, and to examine their relationship with hippocampal atrophy and cell loss.

Fluid-attenuated inversion recovery: correlations of hippocampal cell densities with signal abnormalities.

Background: Hippocampal sclerosis (HS) is characterized by hippocampal atrophy and increased signal on T2-weighted images and on fluid-attenuated inversion recovery (FLAIR) images.

Objective: To quantitate cell loss and compare it with signal abnormalities on FLAIR images.

Methods: Thirty-one patients with temporal lobe resection, pathologically proven HS, and Engel class I and II outcome were included: 20 with HS only and 11 with HS associated with pathologically proven cortical dysplasia (dual pathology).

Disturbed benzodiazepine receptor function at the onset of temporal lobe epilepsy--lomanzenil-binding in de-novo TLE.

Purpose: Epileptogenic foci exhibit disturbed function at the level of the benzodiazepine receptor. The aim of our study was to investigate the incidence of focal reductions of temporal benzodiazepine receptor binding (BRB) as assessed by scintigraphy with 123I-iomazenil in patients with denovo temporal lobe epilepsy (TLE).

Methods: Forty adult patients (age: 34+/-12 years) with cryptogenic denovo TLE underwent scintigraphy with 123I-iomazenil.

Temporal hypometabolism at the onset of cryptogenic temporal lobe epilepsy.

Most patients with intractable temporal lobe epilepsy (TLE) exhibit temporal glucose hypometabolism. The reasons for the development of this abnormality are as yet unclear. The current notion is that an initial injury causes seizures, which in turn give rise to hypometabolism.

Postictal diffusion-weighted imaging for the localization of focal epileptic areas in temporal lobe epilepsy.

Purpose: Diffusion-weighted MR imaging (DWI) is a novel technique to delineate focal areas of cytotoxic edema of various etiologies. We hypothesized that DWI may also detect the epileptogenic region and adjacent areas during the ictal and early postictal periods in patients with temporal lobe epilepsy (TLE).

Methods: We studied patients with intractable TLE (n = 9), due to hippocampal sclerosis (HS, n = 7), left mesial temporal lobe tumor (n = 1), and of unknown etiology (n = 1).

Temporal lobe epilepsy: when are invasive recordings needed?

Temporal lobe epilepsy (TLE) is the most common type of medically intractable partial epilepsy amenable to surgery. In the majority of cases, the underlying pathology in temporal lobe epilepsy is mesial temporal sclerosis (MTS). Whereas historically invasive recordings were required for most epilepsy surgeries, indications have dramatically changed since the introduction of high-resolution MRI, which uncovers structural lesions in a high percentage of cases.

Evidence of cingulate motor representation in humans.

A 44-year-old man with a right frontal lobe tumor and intractable seizures underwent subdural grid evaluation before resection. The electrode locations were identified on a three-dimensional surface-reconstructed image of the brain after subdural grid placement. Electrical stimulation of electrodes placed over the right cingulate gyrus revealed evidence of tonic posturing of the left forearm and wrist and tonic extension of the left leg.

5'-hydroxycotinine-N-oxide, a new nicotine metabolite isolated from rat urine.

1. 5'-Hydroxycotinine-N-oxide, 5-(3-pyridyl-N-oxide)-5-hydroxy-1-methyl-pyrrolidone-2, was identified as a new in vivo metabolite of nicotine. 2.

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.

Cerebral hemodynamic response to generalized spike-wave discharges.

Purpose: Data in the literature concerning metabolic demand during generalized spike-wave activity (gSW) are conflicting. We investigated instantaneous changes in cerebral blood flow velocities (CBFV) in both middle cerebral arteries (MCAs) by transcranial Doppler sonography (TCD) during gSW paroxysms recorded by scalp EEG.

Methods: In 13 patients, CBFVs in both MCAs were averaged, time-locked to the occurrence of the gSW; respiratory rate (RR) and end-expiratory pco2 were measured in one patient.

PET and SPECT in medically non-refractory complex partial seizures. Temporal asymmetries of glucose consumption, benzodiazepine receptor density, and blood flow.

Aim: In contrast to medically refractory complex partial seizures (CPS), only limited knowledge exists on cerebral perfusion and metabolism in medically non-refractory CPS. The aim of this study was to investigate the frequency of temporal asymmetries in regional cerebral glucose consumption (rCMRGlc), regional cerebral blood flow (rCBF), and regional cerebral benzodiazepine receptor density (BRD) in this group of patients.

Methods: The study included 49 patients with medically non-refractory cryptogenic CPS (age: 36.

Worsening seizures after surgery for focal epilepsy due to emergence of primary generalized epilepsy.

Our patient underwent right anteromesial temporal resection at 17 years of age for intractable complex partial seizures due to hippocampal sclerosis, and then developed juvenile myoclonic epilepsy after a change in medication. Postoperative seizures ceased after a change to valproate monotherapy. Our patient reminds us to remain aware that generalized and focal epilepsy may coexist as an unusual cause for surgical failure.

The photic driving EEG response and photoreactive cerebral blood flow in the posterior cerebral artery in controls and in patients with epilepsy.

Objectives: Instantaneous changes in blood flow velocities during visual stimulation can be assessed by transcranial Doppler sonography (TCD).

Methods: We investigated the possible relationship between the characteristics of photic driving in the EEG elicited by repetitive intermittent photic stimulation and the photoreactive flow changes in the posterior and middle cerebral artery (PCA, MCA) of 25 normal controls and 25 patients with focal epilepsy. Cerebral blood flow velocities (CBFV) of the right PCA (P2 segment) and the left middle cerebral artery (MCA) were measured using a 2 Hz transcranial Doppler device.

NMR spectroscopy in pharmacy.

Since drugs in clinical use are mostly synthetic or natural products, NMR spectroscopy has been mainly used for the elucidation and confirmation of structures. For the last decade, NMR methods have been introduced to quantitative analysis in order to determine the impurity profile of a drug, to characteristic the composition of drug products, and to investigate metabolites of drugs in body fluids. For pharmaceutical technologists, solid state measurements can provide information about polymorphism of drug powders, conformation of drugs in tablets etc.

[Routine electroencephalogram in follow-up of patients with HIV infections of different stages. A long-term study].

Electroencephalography (EEG) is a well-tolerated non-invasive method and is therefore well suited for repetitive examinations. We performed serial EEG's on 117 HIV patients without any clinical signs of secondary neuromanifestation in order to document electroencephalographic changes in the course of HIV infection. Clinical signs of HIV-associated encephalopathy presented 18 patients at the first examination and 23 at reexamination.

Measurement of temporal asymmetries of glucose consumption using linear profiles: reproducibility and comparison with visual analysis.

Aim: One approach to regionally analyze temporal glucose consumption consists in drawing linear profiles over the maximal values measured in the temporal cortical ribbon. The aim of our study was to test the reproducibility of this method and to compare its diagnostic performance to that of visual analysis in patients with complex partial seizures (CPS).

Methods: Regional cerebral glucose consumption (rCMRGIc) was measured interictally in 25 CPS patients and 10 controls using F-18-deoxyglucose and the positron emission tomography (PET) camera ECAT EXACT 47.

Spontaneous oscillations in cerebral blood flow velocities in middle cerebral arteries in control subjects and patients with epilepsy.

Background And Purpose: Cardiac arrhythmias mediated by the sympathetic nervous system have been implicated in sudden, unexplained deaths in patients with epilepsy. Cerebral blood flow velocities (CBFV) as measured by transcranial Doppler are characterized by slow spontaneous oscillations in part attributed to changes in sympathetic activity (M waves, 3 to 9 cycles per minute) and to discharges of monoaminergic neurons in the brain stem (B waves, 0.5 to 2 cycles per minute).

Membrane lipids of Rhodopseudomonas viridis.

In search of the precyanobacterial origin of the typical thylakoid lipids found in cyanobacteria and chloroplasts, we analyzed the polar lipids of the anaerobic phototrophic bacterium Rhodopseudomonas viridis. Glycolipids (monogalactosyl-, digalactosyl- and glucuronosyl diacylglycerol), phospholipids (phosphatidyl choline, -ethanolamine, -glycerol and cardiolipin) and an ornithine lipid were isolated and identified by NMR (1H, 13C, 31P) and mass spectrometry. Positional distribution and pairing of fatty acids in molecular species show small, but significant differences between glyco- and phospholipids.

Persistent unihemispheric perceptual impairments in humans following focal seizures.

Perception has been linked to a highly coordinated activation of cortical regions whose functional organization and performance is subject to plastic changes. We tested whether chronic repetitive disturbances of the brain by focal epileptic activity have a long-standing detrimental effect on the perceptual performance in the affected hemisphere. Nine patients were examined who had a history of complex partial seizures but no structural cerebral damage on magnetic resonance imaging and no evidence of ongoing epileptic activity on scalp electroencephalography and who had clinically been without seizures for at least 3 days.

Reduced GABAA receptor density contralateral to a potentially epileptogenic MRI abnormality in a patient with complex partial seizures.

Imaging cerebral GABAA receptor density (GRD) with single-photon emission tomography (SPET) and iodine-123 iomazenil is highly accurate in lateralizing epileptogenic foci in patients with complex partial seizures of temporal origin. Limited knowledge exists on how iomazenil SPET compares with magnetic resonance imaging (MRI) in this regard. We present a patient with complex partial seizures in whom MRI had identified an arachnoid cyst anterior to the tip of the left temporal lobe.

Developing a patient classification system for the pediatric rehabilitation setting.

Patient classification systems can be valuable tools for identifying trends in acuity and for justifying budgeted nursing care hours. A valid and reliable patient classification system can greatly facilitate the delivery of cost-effective, high-quality care. However, the more highly specialized the institutional population, the more difficult it becomes to use a standardized system.

A credentialing program for nursing staff caring for pediatric patients with an ilizarov apparatus.

The purpose of this article is to provide an overview of an educational program that was implemented at a postacute pediatric rehabilitation facility to prepare the nursing staff to provide quality care for patients undergoing limb lengthening. Patients undergoing limb lengthening and limb reconstruction by the Ilizarov orthopedic method wear a highly complex external fixation device that has numerous variations. As such, it is a type of apparatus that pediatric rehabilitation nurses are unaccustomed to dealing with in the clinical arena.