A new strategy for treating drug-resistant focal aware seizures: thalamic specific nuclei deep brain stimulation. Illustrative case.

Background: Focal aware seizures (FASs) are relatively common and frequently pharmaco-resistant. If the seizure onset zone (SOZ) is in eloquent cortical areas, making resective surgery risky and inadvisable, deep brain stimulation (DBS) of the anterior nucleus of the thalamus, which is efficacious in less than half of the cases, has been the main alternative. New targets should be searched to address this deficiency.

Bilateral Globus Pallidus Externus Deep Brain Stimulation for the Treatment of Refractory Tourette Syndrome: An Open Clinical Trial.

Objectives: We have previously proposed that Tourette syndrome (TS) is the clinical expression of the hyperactivity of globus pallidus externus (GPe) and various cortical areas. This study was designed to test this hypothesis by verifying the efficacy and safety of bilateral GPe deep brain stimulation (DBS) for treating refractory TS.

Materials And Methods: In this open clinical trial, 13 patients were operated on.

Ventral intermediate nucleus deep brain stimulation for treatment-resistant focal aware motor seizures: illustrative case.

Background: Resection of the seizure onset zone (SOZ) is considered the gold standard for treating refractory focal aware seizures (FASs). When resective surgery is unadvisable, deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT; ANT-DBS) has been the procedure of choice. However, less than half of patients with FASs respond to ANT-DBS.

The impact of subcaudate tractotomy on delusions and hallucinations in psychotic patients.

Background: Delusions and hallucinations, hallmarks of the psychotic disorders, usually do not respond to surgical intervention. For many years, the surgical technique of choice for the treatment of refractory aggressiveness in psychotic patients in our Service was amygdalotomy in isolation or associated with anterior cingulotomy. No improvement of hallucinations and delusions was noticed in any of these patients.

Wastewater disinfection: long-term laboratory and full-scale studies on performic acid in comparison with peracetic acid and chlorine.

Chemical disinfection of municipal wastewater to preserve the microbiological quality of discharges has traditionally relied on chlorine, and more recently on peracetic acid (PAA). A more recent option is performic acid (PFA). This work uses laboratory and full-scale studies over a span of 15 years and five wastewater treatment plants (WWTPs) in Italy, to compare the efficacy of these three disinfectants and identify the differences among peracids in a context where both can be an alternative to chlorine.

Genetic polymorphisms of the 5HT receptors are not related with depression in temporal lobe epilepsy caused by hippocampal sclerosis.

Background: Temporal lobe epilepsy caused by hippocampal sclerosis (TLE-HS) is the most frequent form of drug-resistant epilepsy in adults. Mood disorders are the most frequent psychiatric comorbidities observed in these patients. Common pathophysiological mechanisms of epilepsy and psychiatric comorbidities include abnormalities in the serotonin pathway.

Earwax as an alternative specimen for forensic analysis.

In this work, we presented, for the first time, earwax as an alternative forensic specimen for detecting 12 neuropsychotic drugs employing liquid chromatography-tandem mass spectrometry in positive and negative ion modes after straightforward extraction with methanol. The method was validated and standard curves were established by external calibration with correlation coefficients >0.99.

Evaluation of cytotoxicity, genotoxicity, and apoptosis of wastewater before and after disinfection with performic acid.

Disinfection with performic acid (PFA) represents an emerging technology in wastewater treatment. Many recent studies indicate its effectiveness and suitability as a disinfectant for different applications; several have demonstrated its reliability as an alternative to chlorine for disinfecting secondary effluents from urban wastewater treatment plants (WWTPs). Some disinfection technologies, in relation to their oxidative power, lead to the formation of disinfection by-products (DBPs), some of which are of concern for their toxic and carcinogenic potential.

Vagus nerve stimulator in patients with epilepsy: indications and recommendations for use.

Epilepsy comprises a set of neurologic and systemic disorders characterized by recurrent spontaneous seizures, and is the most frequent chronic neurologic disorder. In patients with medically refractory epilepsy, therapeutic options are limited to ablative brain surgery, trials of experimental antiepileptic drugs, or palliative surgery. Vagal nerve stimulation is an available palliative procedure of which the mechanism of action is not understood, but with established efficacy for medically refractory epilepsy and low incidence of side-effects.

Striatal somatotopy and motor responses evoked by acute electrical stimulation of the posterior striatum in rats.

Introduction/objectives: Previous experiments suggest that the striatal sensorimotor territory in rats is located in its dorsolateral region, along the rostrocaudal axis, unlike what has been observed in primates. In the present study, electrical stimulation was performed to investigate the degree of participation of the posterior striatum in its motor territory, its somatotopic organization, and the motor responses evoked by stimulation.

Methods: Twenty-five rats were submitted to stereotactic stimulation of the posterior striatum under general anesthesia, receiving consecutively four different current intensities.

Possible mechanisms involved in subthalamotomy-induced dyskinesia in patients with Parkinson's disease.

Background/aims: Operation-induced dyskinesia (OID) occurs in approximately 10% of patients submitted to subthalamotomy. The goal of the authors was to determine the possible causes of this feared complication.

Methods: The 54 patients who underwent unilateral subthalamotomy were divided into two groups: the OID group (OIDG), composed of 6 patients who developed dyskinesia following the operation, and the control group (CG), consisting of 48 patients who did not present this complication.

A new disinfection system for wastewater treatment: performic acid full-scale trial evaluations.

To evaluate the efficiency and effect of a new disinfection technology in wastewater treatment, batch and full-scale experiments were performed between winter 2005 and summer 2011. The system, developed by Kemira Oyj, produces a disinfection solution containing performic acid (PFA) by mixing hydrogen peroxide and formic acid. A preliminary study in batch reactors established the suitability for wastewater disinfection; three subsequent full-scale plant experiments conducted at two municipal wastewater treatment plants (120,000 and 32,000 equivalent inhabitants) discharging in sensitive areas demonstrated its effectiveness and reliability in this application field.

[Central pontine and extra-pontine myelinosis in alcoholic patient with Shoshin beriberi].

The central pontine myelinosis is classically related with rapid correction of chronic hyponatremia. Recently, important additional factors have been described in the pathogenesis of this condition. We report the case of a 43-year-old alcoholic malnourished man, with acute renal failure with dialytic treatment, and output failure Shoshin beriberi.

Mutagenicity and disinfection by-products in surface drinking water disinfected with peracetic acid.

The aims of this research were to study the influence of peracetic acid (PAA) on the formation of mutagens in surface waters used for human consumption and to assess its potential application for the disinfection of drinking water. The results obtained using PAA were compared to those found with sodium hypochlorite (NaClO) and chlorine dioxide (ClO2). The Ames test, root anaphase aberration assay, and root/micronuclei assay in Allium cepa and Tradescantia/micronuclei test were used to evaluate the mutagenicity of disinfected samples.

Effects of ethanol on human visual evoked potentials.

Studies of the effect of ethanol on human visual evoked potentials are rare and usually involve chronic alcoholic patients. The effect of acute ethanol ingestion has seldom been investigated. We have studied the effect of acute alcoholic poisoning on pattern-reversal visual evoked potentials (PR-VEP) and flash light visual evoked potentials (F-VEP) in 20 normal volunteers.

Alfentanil-induced activation: a promising tool in the presurgical evaluation of temporal lobe epilepsy patients.

Pharmacologic activation of epileptic foci has been used experimentally with the hope that it may accelerate the presurgical evaluation of patients with medically intractable epilepsy. In this article, we will review the existing literature on these activating tests giving emphasis on the opioid analogs, and particularly alfentanil. Alfentanil is an opioid analog with rapid anesthetic effect, which has been known to trigger epileptiform discharges in epilepsy patients.

Corpus callosotomy in treatment of medically resistant epilepsy: preliminary results in a pediatric population.

We report the results of 34 patients who underwent corpus callosotomy between 1986 and 1989 with 28-65 months of postoperative follow-up (mean 42 months). Thirty-two patients had mental retardation and 26 had significant behavioral problems. Thirteen patients had total section, 8 had subtotal section with preservation of the posterior half of the splenium, and 13 had section of the anterior two thirds of the callosum.

[Interhemispheric disconnection syndrome following total callosotomy associated to anterior commissurotomy for the treatment of intractable epilepsy: a case report].

The authors provide a brief review of the indication criteria of callosotomy for the treatment of medically intractable seizures. They report a surgical case with the classical picture of disconnection (split brain) syndrome, following a two-staged complete callosotomy plus anterior commissurotomy. The disconnection syndrome was more severe on the first 5 days post-operatively, improving quickly after the 11th day; there was almost complete functional recovery and a great reduction in seizure frequency.

Functional microsurgical partial callosotomy in patients with secondary generalized epilepsies. II. Mesial surface electrocorticography.

Eight patients with secondary generalized epilepsy not alleviated by medical treatment underwent partial callosotomy. During the surgical procedure, they had mesial surface ECoG recordings taken from both frontal and parietal lobes, using large flat multilead platinum electrodes, and simultaneously recordings from a number of scalp positions, using needle electrodes. In all cases studied, this approach demonstrated one or, more commonly, several focal areas of epileptiform activity discharging independently over the mesial aspects of one or both hemispheres.

Functional microsurgical partial callosotomy in patients with secondary generalized epilepsies. I. Disruption of bilateral synchrony of spike and wave discharges.

Fourteen patients with secondary generalized epilepsy suffering from multiform seizures (MS) not amenable to medication were submitted to partial section of the corpus callosum. In all patients, there was a partial disruption of the previous generalized bilateral synchronous epileptiform discharges (GBSD). The electroencephalographic findings after callosal section are discussed with respect to their implications in furthering our understanding of the mechanisms subserving the organization of GBSD.

On the dose equivalence of flurazepam and triazolam.

Flurazepam (30 mg), triazolam (0.5 mg) and placebo were given in the morning to 6 normal volunteers in a double-blind crossover study. Subjects were evaluated by a large battery of psychophysiological tests before and 1 and 5 hours after drug administration.

Anterior zygomatic electrodes: a special electrode for the study of temporal lobe epilepsy.

The position of a surface electrode over the anterior zygomatic arch is described. Epileptiform activity recorded at this position is compared with that recorded by sphenoidal electrodes in 21 cases of temporal lobe epilepsy. In 100% of the cases abnormalities were detected with both electrodes, although in 11% of the cases the findings could not be definitely described as epileptiform in the anterior zygomatic electrodes.

Anterior callosotomy as a substitute for hemispherectomy.

Two patients with epilepsy and large hemispheric lesions underwent section of the frontal fibres of the corpus callosum for the treatment of seizures refractory to medical treatment. A severely retarded girl of 18 had encephalotrigeminal angiomatosis (Sturge-Weber syndrome) with multiple daily absences, tonic-clonic, myoclonic, atonic and adversive seizures since infancy. All types of fits--with the exception of adversive seizures and rare tonic-clonic fits--disappeared after anterior callosotomy.

Anterior callosotomy in epileptics with multiform seizures and bilateral synchronous spike and wave EEG pattern.

Cerebral commissurotomy is a well established procedure in the treatment of epileptics refractory to drug therapy. Breeching of the ventricles in complete commissurotomy carries a certain morbidity. This has led others to perform operations in which the entire corpus callosum or only its anterior portion with or without the anterior commissure were sectioned.