Magnetic source imaging versus intracranial electroencephalogram in epilepsy surgery: a prospective study.

Objective: Noninvasive brain imaging tests can potentially supplement or even replace the use of intracranial electroencephalogram (ICEEG), an invasive, costly procedure used in presurgical epilepsy evaluation. This study prospectively examined the agreement between magnetic source imaging (MSI) and ICEEG localization in epilepsy surgery candidates.

Methods: Patients completing video monitoring with scalp EEG who had intractable partial epilepsy based on ictal electro-clinico-anatomical features were screened.

Racial disparities in the use of surgical treatment for intractable temporal lobe epilepsy.

Objective: To compare the use of surgical treatment for epilepsy among different ethnic and racial groups with surgically remediable temporal lobe epilepsy (TLE).

Methods: The authors used multiple logistic regression analysis to model the use of anterior temporal lobectomy in a cross-sectional study of video-EEG monitoring discharge data among residents of Alabama and surrounding states discharged from the University of Alabama at Birmingham Hospital between July 1998 and January 2003 with a primary diagnosis of TLE.

Results: Of 432 patients diagnosed with TLE, 130 had evidence of mesial temporal sclerosis on MRI studies.

Eclampsia, hippocampal sclerosis, and temporal lobe epilepsy: accident or association?

Background: Up to 30% of patients with temporal lobe epilepsy (TLE) have no identifiable risk factors.

Objective: S: To report nine patients with TLE who had a history of eclampsia as the only risk factor for epilepsy and to investigate whether this possible association existed in a larger cohort of women with surgically treated TLE.

Methods: The clinical data, video-EEG, neuroimaging, and neuropathology of 195 consecutive women undergoing anterior temporal lobectomy (ATL) were reviewed.

Confirmatory factor analysis of the california verbal learning test in patients with epilepsy: relationship to clinical and neuropathological markers of temporal lobe epilepsy.

Latent constructs involved in California Verbal Learning Test (D. C. Delis, J.

Significance of fornix atrophy in temporal lobe epilepsy surgery outcome.

Background: Previous magnetic resonance imaging (MRI) studies have shown concurrent fornix atrophy in a large proportion of patients with hippocampal atrophy. The contribution of the fornix as an independent preoperative determinant of surgical outcome is unknown.

Objective: To evaluate the contribution of the fornix as a determinant of surgical outcome in patients with preoperatively determined temporal lobe epilepsy.

Temporal lobectomy in congenital porencephaly associated with hippocampal sclerosis.

Background: Clinical and neuroimaging features of patients with epilepsy and coexisting extratemporal porencephaly and hippocampal sclerosis have been previously described.

Objective: To present the clinical characteristics and surgical outcome of 6 patients with intractable epilepsy and coexisting extratemporal porencephaly and hippocampal sclerosis.

Patients And Methods: Twenty-four patients with porencephaly and epilepsy were studied.

Gender, Memory, and Hippocampal Volumes: Relationships in Temporal Lobe Epilepsy.

Previous research has suggested bilateral hippocampal support for verbal memory in women with early left-hemisphere injury and that women experience better verbal memory outcome following anterior temporal lobectomy (ATL). The present study investigated two issues: (1) Do women have better verbal memory outcome following ATL compared with men? (2) Are verbal memory abilities differentially supported by the right and left hippocampus in males and females? Verbal memory performance [Wechsler Memory Scale: Logical Memory (LM) savings score] was assessed in 70 patients who underwent ATL. MRI volumetric measurements of the left and right hippocampus were performed.

Risk to verbal memory following anterior temporal lobectomy in patients with severe left-sided hippocampal sclerosis.

Background: Previous investigations indicate low risk for memory loss following anterior temporal lobectomy (ATL) in patients with severe hippocampal sclerosis (HS) compared with patients with mild HS. However, these conclusions have been established primarily with group-level analyses.

Objective: To investigate individual base rate risk for verbal memory loss following ATL in patients who have pathologically verified mild, moderate, or severe HS.

Magnetic resonance spectroscopic imaging in temporal lobe epilepsy: neuronal dysfunction or cell loss?

Background: Magnetic resonance spectroscopy (MRS) has demonstrated consistent metabolic abnormalities in temporal lobe epilepsy. The reason for decreases in N-acetylated compounds are thought to be related to neuronal hippocampal cell loss as observed in hippocampal sclerosis. However, mounting evidence suggest that the N-acetylated compound decreases may be functional and reversible.

Bilateral hippocampal atrophy: consequences to verbal memory following temporal lobectomy.

Background: Bilateral hippocampal damage is a risk factor for memory decline after anterior temporal lobectomy (ATL).

Objective: To investigate verbal memory outcome in patients with temporal lobe epilepsy (TLE) with either unilateral or bilateral hippocampal atrophy as measured by MRI.

Methods: The authors selected 60 patients with TLE who had undergone ATL (left = 31, right = 29).

Wisconsin Card Sorting performance in patients with temporal lobe epilepsy: clinical and neuroanatomical correlates.

Purpose: A sizable proportion of patients with temporal lobe epilepsy (TLE) display impairments on tests of executive function. Previous studies have suggested several factors that may explain such performance, including the presence of hippocampal sclerosis, electrophysiological disruption to extratemporal regions, and early age of seizure onset. However, no clear determinants have been found that consistently explain such executive dysfunction.

Occipitoparietal epilepsy, hippocampal atrophy, and congenital developmental abnormalities.

Purpose: Diagnostic uncertainty may arise in patients with occipitoparietal epilepsy when there is neuroimaging evidence of a posterior quadrant lesion and coexistent hippocampal abnormalities ("dual pathology"). It is not known whether hippocampal atrophy (HA) in these patients results from seizure propagation to temporolimbic structures or whether it is part of the pathological process underlying the occipitoparietal epilepsy. Clarification of this issue may have a significant bearing on the management of these patients.

Investigation of executive function change following anterior temporal lobectomy: selective normalization of verbal fluency.

The nociferous cortex hypothesis predicts that electrophysiological normalization to distal extratemporal brain regions following anterior temporal lobectomy (ATL) will result in improvements in executive functioning. The present study examined the effects of seizure laterality and seizure control on executive function change. The authors administered the Wisconsin Card Sorting Test (WCST), Trails B, and the Controlled Oral Word Association Test to 174 temporal lobe epilepsy patients who underwent ATL.

Predictive value of MRI-identified mesial temporal sclerosis for surgical outcome in temporal lobe epilepsy: an intent-to-treat analysis.

Purpose: Magnetic resonance imaging (MRI) accurately identifies mesial temporal sclerosis (MTS), but prediction of successful surgical outcome ranges from 62% to 96% in published studies. Prior investigations only used patients who had received anterior temporal lobectomy (ATL), potentially overestimating the predictive value of MRI-identified MTS (MRI-MTS).

Methods: The authors performed an intent-to-treat analysis of 90 consecutive patients assessed for possible ATL, including 13 who did not undergo ATL because of inconclusive intracranial ictal EEG.

Subjective versus objective memory change after temporal lobe epilepsy surgery.

Objective: To examine subjective versus objective memory change after anterior temporal lobectomy (ATL).

Methods: A prospective, controlled study. Controls included 39 unoperated patients with intractable temporal lobe epilepsy (TLE) who were administered a series of cognitive and health-related quality of life measures at baseline and at 12-month follow-up intervals.

Cognitive consequences of coexisting temporal lobe developmental malformations and hippocampal sclerosis.

Objective: To characterize patterns of cognitive functioning in a well-defined group of patients with MRI-identified coexisting left temporal lobe developmental malformations (TLDM) and mesial temporal sclerosis (MTS), and to examine neuropsychological outcome in this dual-pathology group following epilepsy surgery.

Methods: Cognitive functioning in patients with left TLDM and MTS (n = 15) was compared with patients with isolated left MTS (n = 40). TLDM and MTS were identified by high-quality MRI protocol.

Predictive value of 1H MRSI for outcome in temporal lobectomy.

Objective: To investigate the predictive value of 1H MRSI for outcome in patients with mesial temporal lobe epilepsy (MTLE).

Background: 1H MRSI has been shown to be highly sensitive in the lateralization of temporal lob epilepsy.

Methods: The authors analyzed the relationship between the 1H MRSI findings and surgical outcome in 40 consecutive patients who underwent temporal lobe surgery for MTLE.

Patient-oriented outcome assessment after temporal lobectomy for refractory epilepsy.

Objective: To determine patient-oriented outcome after anterior temporal lobectomy (ATL) for refractory epilepsy.

Background: Health-related quality of life (HRQOL) is an important component of the assessment of outcome from epilepsy surgery, but prior controlled studies of the effect of surgery on HRQOL are inconclusive. Direct assessment of the effect of surgery on patient concerns of living with epilepsy has not been reported.

IL-4 and IL-10 are both required for the induction of oral tolerance.

Protection from the development of experimental autoimmune uveitis (EAU) can be induced by feeding mice interphotoreceptor retinoid binding protein before uveitogenic challenge with the same protein. Two different regimens are equally effective in inducing protective tolerance, although they seem to do so through different mechanisms: one involving regulatory cytokines (IL-4, IL-10, and TGF-beta), and the other with minimal involvement of cytokines. Here we studied the importance of IL-4 and IL-10 for the development of oral tolerance using mice genetically engineered to lack either one or both of these cytokines.

CD40-deficient mice infected with the defective murine leukemia virus LP-BM5def do not develop murine AIDS but produce IgE and IgG1 in vivo.

CD40-deficient mice, when inoculated with the LP-BM5def murine retorvirus, become infected and show virus expression similar to wild-type mice. However, unlike the wild-type mice, CD40-deficient mice do not develop symptoms of immunodeficiency, lymphoproliferative disease and the typical histological changes in the lymphoid tissue. These results show that the CD40-CD40 ligand (CD40L) interaction in vivo is essential for anergy induction and the subsequent development of immunodeficiency and pathologic expansion of lymphocytes.

Temporal lobe developmental malformations and hippocampal sclerosis: epilepsy surgical outcome.

Background: Temporal lobe developmental malformations coexist with mesial temporal sclerosis in the form of dual pathology with a high frequency of bilateral amygdala or hippocampal abnormalities.

Objective: The aim of this study was to correlate and compare the MRI findings and the surgical outcome in patients with temporal lobe developmental malformations (n = 20) and isolated mesial temporal sclerosis (n = 36).

Methods: MRI-based normalized volumetry of the amygdala and hippocampal formation in patients with unilateral temporal lobe developmental malformations and isolated mesial temporal sclerosis who underwent temporal lobe resections was performed.

Rasmussen's encephalitis with concomitant cortical dysplasia: the role of GluR3.

The role of the glutamate receptor GluR3 in Rasmussen's encephalitis is actively under investigation. Autoimmune processes with this receptor as the target are currently theorized. We provide an additional case of pathologically proved Rasmussen's encephalitis (with concomitant cortical dysplasia) in the presence of antibodies against the GluR3 receptor.

Amygdala atrophy and seizure outcome after temporal lobe epilepsy surgery.

Surgical outcome in hippocampal atrophy (n = 44) and amygdalohippocampal atrophy (n = 14) were compared. Hippocampal atrophy had better seizure-free outcome than amygdalohippocampal atrophy (80% versus 50%, p = 0.043).

Individual memory change after anterior temporal lobectomy: a base rate analysis using regression-based outcome methodology.

Purpose: To characterize patterns of base rate change on measures of verbal and visual memory after anterior temporal lobectomy (ATL) using a newly developed regression-based outcome methodology that accounts for effects of practice and regression towards the mean, and to comment on the predictive utility of baseline memory measures on postoperative memory outcome.

Methods: Memory change was operationalized using regression-based change norms in a group of left (n = 53) and right (n = 48) ATL patients. All patients were administered tests of episodic verbal (prose recall, list learning) and visual (figure reproduction) memory, and semantic memory before and after ATL.