Surgical therapy for frontal epilepsies.

We have described our 25 years experience concerning 100 patients operated on for frontal epilepsy. Results show that 55% of patients are practically cured of their seizures and that 76% benefited from cortectomy (reduction of more than 75% of seizures). These results are the worst in the total series of St.

[Introduction to the clinical study of postrolandic epileptic seizures].

We reviewed, in 145 epilectics studied with SEEG, 800 clinical and electrographic seizures originating from the post-rolandic areas (590 spontaneous Sz and 260 induced by stimulation). The intra-cranial electrodes were implanted using a technique described by Talairach et al. (1974).

Methodology of "in vivo" anatomical study and stereo-electroencephalographic exploration in brain surgery for epilepsy.

Stereotactic implantation of deep SEEG electrodes performed as a prelude to surgery in some patients with drug-resistant focal epilepsy requires previous "in vivo" identification and localization of the cortical and subcortical structures to be explored, visualized "semi-directly" "or directly" by neuroradiological imaging techniques. Stereoscopic stereotactic teleangiography is a safety factor in transcutaneous electrode implantation and biopsies, but it also localizes the cortical sulci in a "semi-direct" manner by identifying vascular segments deeply buried in this sulci, which constitute their lamina vascularis. Although RMI greatly contributes to the study of the pallium, visualizing fragments of sulci and gyri does not necessarily mean that these structures can be identified with certainty, notably on the convexity of the brain.

Hemispheric lateralization of motor and speech functions after early brain lesion: study of 73 epileptic patients with intracarotid amytal test.

This study reports results of a bilateral intracarotid amytal test in 73 epileptic patients with medically intractable focal seizures. No right-handers but 50% of left-handers have a right dominance for speech in this particular population. Lateralization of cerebral speech functions, as well as manual preference, are dependent on the neurological disease and can shift conjointly or independently.

[Value of bifocal stereotaxic destruction in case of dyskinesia in patients with a motor deficit of cerebral origin].

Authors report a study concerning 12 dyskinetic patients with cerebral palsy. The clinical pre-operative examination shows that many signs and symptoms are associated: volitional and postural dyskinesia, athetosis and dystonia, pyramidal deficit and spasticity. Talairach's stereotactic methodology has been used for bifocal (VPL thalamic nucleus and internal pallidum) Yttrium 90 implantation.

[Electro-clinical semiology of subintrant temporal lobe seizures].

The authors recorded 10 to 67 TLS (mean 29) in 10 patients (5 M, 5 F; 9 to 41 years, mean 23) during 'acute' (4-6 hours) stereo-EEG exploration. At the onset of seizures, we observed: subjective manifestations (often epigastric), autonomic symptoms, and oro-alimentary 'automatisms'. Affective, unpleasant, manifestations occurred in only 2 patients.

Somatomotor manifestations in temporal lobe seizures.

Some authors include somatomotor manifestations (SMM) among the clinical features of temporal lobe seizures in man; however, data are limited and conflicting. This study describes 101 seizures recorded during stereo-EEG explorations in 50 patients, selected on the basis of the demonstration of onset in temporal lobe structures (stereo-EEG) and the presence of lateralized SMM and/or secondary generalization (SG). SMM and SG were present in about 20% of our population of patients with temporal seizures explored with stereo-EEG, and were only rarely observed during the first 10 s (early SMM) of the seizures (less than 10%).

Prevalence of psychosis in epilepsy as a function of the laterality of the epileptogenic lesion.

Retrospective analysis of the psychiatric diagnoses in a group of patients surgically relieved of medically intractable epilepsy tested the hypothesis that patients with left-sided temporal lobe epileptogenic lesions are at greater risk for the development of a so-called schizophrenic-like psychosis than are those with right-sided temporal lobe epileptogenic lesions. The data confirmed the hypothesis and also demonstrated an increased prevalence of sinistrals in the psychotic group. Thus, epilepsy involving the dominant hemisphere at the inception of the seizure disorder is the significant risk factors.

[Motor and postural manifestations of temporal lobe epilepsy seizure].

This study reports on 73 epileptic seizures (in 36 patients) originating in the temporal lobe (stereo-EEG) presenting motor or postural signs. Motor symptoms occur rarely in the early phase of seizures (less than 10% of our series) and they are exceptional during spontaneous seizures. The critical electrical discharge always affects extra-temporal structures such as the rolandic operculum, the cingulate gyrus, etc.

[Cerebral concentrations of anticonvulsants in patients with epilepsy of tumoral origin (author's transl)].

(1) The concentrations of various anticonvulsants (PB, PHT, CBZ, VPA) were measured in brain specimens from 7 patients who had undergone neurosurgery for a therapy resistant epilepsy of tumoral origin (astrocytoma) in 6 cases, glioblastoma in 1 case). (2) Great interindividual variability of the mean brain/plasma concentration ratios was observed for PB in 5 patients (range: 0.4-1.

[Continuous partial epilepsy: syndrome and disease].

Twenty three patients are described with a Kojewnikow syndrome in order to identify possible etiological factors. According to their history, clinical and E.E.

[Genital and sexual manifestations occurring in the course of partial seizures in man (author's transl)].

The literature only rarely mention the genital and sexual manifestations occurring in the course of partial seizures in man. The authors presently describe 42 seizures of this type recorded with E.E.

Application of stereotactic concepts to the surgery of epilepsy.

For the authors, the essential feature of stereotaxis is the three-dimensional representation of the entire brain, including the central gray nuclei as well as the cerebral cortex. Stereotactic neurosurgery, which in this conception might be called "global", associates data from indirect localization (basic reference lines, proportional grid) to direct individual localization (performed by bidirectional, orthogonal teleradiography, with stereoscopy). The obtained high precision radiographic documents allow to establish the three coordinates (X, Y, Z).

[Role of the amygdala in the occurence of oro-alimentary signs of during epileptic seizures in man (author's transl)].

The authors study the role of amygdala dysfunction in cases of oro-alimentary signs occuring in seizures recorded during a series of stereo-electroencephalographic investigations (S.E.E.

[Contribution to anatomical and clinical studies of avoidance phenomena (author's transl)].

The authors report 5 cases of avoiding phenomenon of the hand from parietal lesions. Four of these patients were operated for intractable epilepsy, from a parietal cortectomy that implicated a certain amount of white matter. The avoiding phenomena observed are analyzed as elementary motor perturbations rather than a disturbance of motor comportment.

Distribution of beta2-microglobulin in cerebrospinal fluid and in cystic fluid of brain tumors. A preliminary study.

The concentrations of immuno-reactive beta2-microglobulin (beta2m) were measured in the cerebrospinal fluid (CSF) and the cystic fluid (CF) of Central Nervous System (CNS) tumours (gliomas, n = 5; craniopharyngiomas, n = 5) and in the culture medium of established cell lines derived from CNS tumors. These data are compared with plasma and CSF values of beta2m in normal subjects (n = 15) and in a group of peripheral solid tumors (metastatic breast carcinomas, n = 9). In the control group the absence of correlation between plasma and CSF values, suggests an independant production of beta2m in the two compartments considered.

[Auditory response at the posterior part of the first temporal convolution (author's transl)].

Among the epileptic patients investigated by the stereotactic E. E. G.

Clinical consequences of corticectomies involving the supplementary motor area in man.

Three patients with well-mapped, circumscribed ablations of the medial part of the frontal lobe are reported. A specific clinical evolution in 3 stages was observed: (1) post-operatively there was global akinesia, more prominent contralaterally, with an arrest of speech; (2) recovery occurred suddenly but even then there was severe reduction of spontaneous motor activity contralaterally, an emotional type facial palsy and a reduction of spontaneous speech; (3) long after the operation the only sequela was disturbance of the alternating movements of the hands. The anatomical basis of these disorders appears to be a lesion of the supplementary motor area (SMA).