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Objective To illustrate the semiological characteristics of the three sub-types within the broad bilateral asymmetric tonic seizures (BATS),summarize their predictive values on lateralization and localization of seizure onset zone (SOZ),and analyze the difference between BATS and asymmetrical tonic limb posturing (ATLP).Methods A retrospective review of 385 patients who underwent stereotactic electrode implantation in the Sanbo Brain Hospital,Capital Medical University from September 2011 to May 2018 was performed.As long as there was a clinical epileptic seizure in the presence of BATS or ATLP,the patients were classified into the corresponding groups.Postoperative prognosis was assessed using Engel's grading criteria for a follow-up of no less than six months.Seizure descriptions were based on the classification of epileptic seizures introduced by Lüiders,which used arrows to connect the symptoms in chronological order.Results There was no statistically significant difference between the classic BATS and bilateral proximal tonic seizure in terms of whether it could be an independent seizure,as the onset and end of the seizure,with version and generalized tonic-clonic seizure (P＞0.05).Compared with the ATLP,except for whether it could be an independent seizure (P=1.000) and onset before versive seizure (P=0.068),the BATS showed significantly different semiological features (P＜0.05).The classic BATS and secondary motor area epilepsy had a 100.0％ predictive accuracy on the lateralization of SOZ.In the patients with broad BATS,the SOZ distribution was more extensive,but it was rare in the orbitofrontal gyrus,frontal pole and mesial temporal lobe.Compared with the bilateral proximal tonic seizures from the other regions,those originated from supplementary somatosensory motor area and its adjacent areas were rare and showed no statistically significant difference (0/8 vs 40.0％ (18/45),x2=3.226,P=0.072) but a low trend.The predictive value of BATS on lateralization of SOZ was higher than that of ATLP (84.9％ (45/53) vs 57.1％ (24/42),x2=9.086,P=0.003),and BATS was less originated from temporal lobe than ATLP (3.8％ (2/53) vs 23.8％ (10/42),x2=8.523,P=0.004).Conclusion Different from ATLP,the broad BATS are characterized by tonic proximal upper limb posturing,and have a higher predictive value on lateralization and localization of SOZ.
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Objective To evaluate the effect of vagus nerve stimulation (VNS)on post－encephalitic intrac-table epilepsy and the improvement of postoperative cognitive function and quality of life.Methods The patients with post－encephalitic epilepsy in Sanbo Brain Hospital,Capital Medical University from January 2008 to December 2016 were selected.A single center and retrospective study method was used to evaluate the cognitive function,social function of preoperative and postoperative and postoperative seizure classification.The follow－up time points included preopera-tive,posto-perative in 6 months,1 year after operation and postoperative annual review.Results A total of 43 patients were followed up,including 19 females and 24 males,with an average age of (9.37 ± 4.18)years old.The time of fol-low－up was (43.90 ± 33.04)months.According to Engel classification:GradeⅠ3 cases (7.0%),gradeⅡ3 ca-ses (7. 0%),grade Ⅲ14 cases (32.6%),grade Ⅳ21 cases (48.8%).According to McHugh classification:GradeⅠ8 cases (18.6%),grade Ⅱ12 cases (28%),gradeⅢ11 cases (25.5%),gradeⅣ6 cases (14.0%),gradeⅤ4 cases (9.3%).Speech improvement of postoperative:significant improvement in 3 cases (7.0%),slightly improved in 17 cases (39.6%);interpersonal communication improvement of postoperative:significantly increased 7 cases (16. 4%), slightly improved 16 cases(37.2%);learning/working ability improvement of postoperative:significantly improved 6 cases (14. 0%),slightly increased 14 cases(32. 6%).The postoperative VIQ (6.21 ±5.02)scores,PIQ (7.28 ±6.10)scores,FIQ (2.93 ±3.74)scores and MQ were (4.81 ± 2.98)scores higher than preoperative.Conclusions VNS can effectively im-prove the seizures of post－encephalitic epilepsy as well as the children's quality of life,cognition and social function.
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Inhibitory GABAergic interneurons are fundamental elements of cortical circuits and play critical roles in shaping network activity. Dysfunction of interneurons can lead to various brain disorders, including epilepsy, schizophrenia, and anxiety. Based on the electrophysiological properties, cell morphology, and molecular identity, interneurons could be classified into various subgroups. In this study, we investigated the density and laminar distribution of different interneuron types and the co-expression of molecular markers in epileptic human cortex. We found that parvalbumin (PV) and somatostatin (SST) neurons were distributed in all cortical layers except layer I, while tyrosine hydroxylase (TH) and neuropeptide Y (NPY) were abundant in the deep layers and white matter. Cholecystokinin (CCK) neurons showed a high density in layers IV and VI. Neurons with these markers constituted ~7.2% (PV), 2.6% (SST), 0.5% (TH), 0.5% (NPY), and 4.4% (CCK) of the gray-matter neuron population. Double- and triple-labeling revealed that NPY neurons were also SST-immunoreactive (97.7%), and TH neurons were more likely to express SST (34.2%) than PV (14.6%). A subpopulation of CCK neurons (28.0%) also expressed PV, but none contained SST. Together, these results revealed the density and distribution patterns of different interneuron populations and the overlap between molecular markers in epileptic human cortex.
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Adolescent , Adult , Child , Female , Humans , Male , Middle Aged , Young Adult , Brain Chemistry , Genetics , Physiology , Cerebral Cortex , Metabolism , Pathology , Cholecystokinin , Metabolism , Epilepsy , Pathology , Gene Expression Regulation , Physiology , Interneurons , Metabolism , Neuropeptide Y , Metabolism , Parvalbumins , Metabolism , Phosphopyruvate Hydratase , Metabolism , Somatostatin , Metabolism , Tyrosine 3-Monooxygenase , MetabolismABSTRACT
Objective@#To investigate the clinicopathologic characteristics of intractable epilepsy.@*Methods@#Based on the classification criteria proposed by the International League Against Epilepsy (ILAE), a retrospective analysis of the pathological characteristics was done in 822 patients who underwent epilepsy surgery in Sanbo Brain Hospital, Capital Medical University, from June 2008 to December 2012.@*Results@#The mean age of epilepsy onset was 9.9 years, mean duration of epilepsy was 11.9 years. Complex partial seizures were the main presenting features. Histopathological study showed 33 cases (4.01%) with mild forms of cortical malformations, 690 cases (83.94%) with focal cortical dysplasia (FCD) and 99 cases with others (including 39 pure hippocampal sclerosis, 20 cystosclerosis, 19 Sturge-Weber syndrome, 8 tuberous sclerosis complex, 6 without significant pathological changes, 5 gyral malformations and 2 hamartoma). Among the 690 FCD cases, 106 were FCD typeⅠ, 91 were FCD typeⅡ and 493 were FCDⅢ(Ⅲa: 160, Ⅲb: 106, Ⅲc: 26 and Ⅲd: 201).@*Conclusions@#FCDⅢd is the most common histopathological subtype causing intractable epilepsy, mainly due to focal hypoxia/ischemia in the perinatal period, which results in scarring of local brain tissue; this is followed by other isolated forms of FCD (FCDⅠand FCDⅡ), and then FCD Ⅲa and FCD Ⅲb. The reason to distinguish isolated forms of FCD (types Ⅰ and Ⅱ) from FCD Ⅲ and to subclassify FCD Ⅲ is to allow better definition of cortical dyslamination. Therefore, the pathogenic factors of intractable epilepsy can be grouped in greater details, and facilitate the diagnosis and potential curative treatment of intractable epilepsy.
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Objective: To assess the surgical techniques and surgical outcomes of temporoparietooccipital and parietooccipital disconnection. Methods: The authors conducted a retrospective review of clinical, neuropsychological, EEG, imaging data in 16 patients with intractable epilepsy who underwent temporoparietooccipital and parietooccipital disconnection between April 2008 and October 2011. Of the 16 cases, 12 were males and 4 were females. The age of seizure onset was from 0.1 to 27 years (average 6.6) and disease duration of 0.1 to 18 years (average 7.5). The surgery was performed between the age of 3 and 37 years (average 14.1). Nine patients underwent temporoparietooccipital disconnection, 5 patients parietooccipital disconnection and 2 patient parietooccipital disconnection and temporal lobotomy. Results: After a mean follow-up of 1.6 years (range 0.5–3.9 years), 13 patients (81%) were seizure free, 1 patient had Engel Class II seizure outcome and 2 patient had Engel class III outcome. Two patients exhibited severe brain swelling and one patients had second resective operation with good recovery. None of the patients developed new motor defi cits postoperatively and there was no mortality. Conclusion: Temporoparietooccipital and parietooccipital is a safety and effective epilepsy surgery procedure for patients with epileptic zone localization to the posterior quadrant on one side. The results of surgical disconnection for posterior quadrantic epilepsy have yielded excellent seizure outcomes in 81% of the patients, with no mortality or major morbidity.
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@#Objective To analyze the blood flow velocities in middle cerebral artery with Rasmussen encephalitis. Methods8 patients with Rasmussen encephalitis were detected bilateral middle cerebral artery in both period of onset and intermission during simple partial seizures with Transcranial Doppler. ResultsThe mean velocity variance between focus side and non-focus side was minimums among the 3 indexes observed. The mean velocity of MCA displayed uneven increase during seizures. ConclusionThe mean velocity was the most stable index for judging.
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@#ObjectiveTo discuss clinical significance of changes in cerebral blood flow velocities with Rasmussen encephalitis. Methods8 cases diagnosed as Rasmussen encephalitis were measured the blood flow velocities in middle cerebral artery (MCA) with transcranial Doppler in ictal and interictal seizures. ResultsIctal mean flow velocity in the ipsilateral MCA to the epileptogenic foci increased 14.02%～48.14% to interictal one, while it was -0.74%～22.63% in the contralateral MCA. ConclusionAn increased flow velocity has been found in the ipsilateral MCA to the epileptogenic foci during seizure in Rasmussen encephalitis patients.
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The earliest activities related to epilepsy surgery in China ma�� � y be tra�ce��d to the 19���50s an�� �� d 60s��. A�ter a lull during the cultural revolution, there was resurgence of epilepsy surgery from the 1980s, and rapid development from 2000. It is estimated that app�roximately 150- ���200 p hysi�cians �currentl�� � y pra�cti�ce epilepsy surgery in the country.�� In year 2��� 005, there were a total of 2,��500 �cases of e�pile�ps��y o�perate��d in whole of �China, close to half in Beijing, Tian�jin, �Shanghai, �Chongqing an��d Guang�zhou, an�� a �uarter in Beijing. There are three Chinese epilepsy surgery journals, 5 monographs on epilepsy surgery, and “��Epilepsy surgery” edite�� ��� ��� �� ��� ��� d by HO Luders has also �been translate��d into �Chinese��.
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There is rapid growth of pediatric surgery service in China in the recent years. A survey by the China Association �A gainst �Epi�lepsy underta�ken in �June ����� 2006���� on the ma�jor cities in different parts of the country showed a dramatic increase particularly in years 2004 and 2006. Surgery for temporal lobe epilepsy accounts for half of the operation. Surgery has an important role in the treatment of drug resistant pediatric epilepsy. With large population and vast geographical spread, it is important to further develop pediatric epilepsy surgery service in China
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Objective To explore the expression of Tau protein in brains of the intractable epilepsy patients and discuss its function in the pathogenesis. Methods Immunohistochemistry was adapted to test the expression of Tau protein and the mossy fiber sprouting in the hippocampus and cortex of temporal lobe from 48 intractable epilepsy patients and age-mached 48 cases of controls. Results The expression of phosphorylated Tau protein in the CA_3 areas (0.0450?0.0115) and the molecular layers of dentate gyrus (0.0463?0.0120) in intractable epilepsy patients was increased, accompanied by the hippocampus mossy fiber sprouting (3.18?0.35). No difference on the expression of total Tau protein was observed between the intractable epilepsy patients and the controls. Conclusion The present findings demonstrate that the strengthening of phosphorylated Tau protein might play an important role for the synaptic reorganization of the hippocampus. Thus, the changes of phosphorylated Tau protein could improve clinical prognosis in the intractable epilepsy patients.
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Objective To investigate expression of extracelluar signal regulated protein kinase(ERK)and phosphorylation ERK(p-ERK)in the temporal lobe from patients with DR-TLE so as to explore the possible roles of ERK in the pathogenesis of DR-TLE.Methods Expression of ERK was detected with Western blot and immunohistochemistry in 32 patients with DR-TLE(24 temporal lobe,8 hippocampi),as compared with 12 controls(9 temporal lobe,3 hippocampi).Results ERK and p-ERK expression in DR-TLE was significantly higher(0.2266?0.0613,0.2097?0.0183 and 0.1924?0.0054,respectively)than those of controls(0.1840?0.0023,0.1974?0.0056 and 0.1825?0.0063,respectively,all P
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<p><b>OBJECTIVE</b>To observe the clinical effects of lesionectomies combined with bipolar coagulation of the surrounding cortex (BCSC) on symptomatic epilepsy.</p><p><b>METHODS</b>The effectiveness of lesionectomies combined with BCSC (71 patients) and of lesionectomies alone (78 patients) were compared in follow-up surveys conducted 2 - 5 years (average of 37 months) post-operation.</p><p><b>RESULTS</b>Treatment in the BCSC group was significantly more effective than in the lesionectomy group (P < 0.01). Meanwhile, patients in the BCSC group suffered no permanent post-operative complications.</p><p><b>CONCLUSION</b>Lesionectomy combined with BCSC is a new, effective and safe treatment for symptomatic epilepsy.</p>
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Adolescent , Adult , Child , Female , Humans , Male , Middle Aged , Cerebral Cortex , General Surgery , Electrocoagulation , Methods , Epilepsy , General Surgery , Treatment OutcomeABSTRACT
Objective To determine the ultrastructural localization of MDR1 and GFAP in the surgically resected brain tissues from intractable epilepsy patients. Methods Expression of MDR1 and GFAP in brain tissues was examined by using PAG immunolabeling technique for electron microscopy. Results The MDR1 and GFAP labeled by gold particles were only detected at some reactive astrocytes. The positive gold particles were mainly located in the astrocytic cytoplasm and their membrane, but not in the nucleus.Conclusion The expression of MDR1 and GFAP in the brain of patients with clinically intractable epilepsy were mainly located at the cytoplasm and membrane of certain reactive astrocytics.;
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Objective:To study the expression of ULBP2 protein in the brain tissues of patients with drug-refractory epilepsy and its clinical significance.Methods:Gene-chip,immunofluorescence and Western blot were used to test expression of ULBP2 in the surgically removed brain tissue of patients with drug-refractory epilepsy from the brain bank of our department(n=42),and the results were compared with that of normal controls (n=12).Results:The relative increasing expression of ULBP2-gene in the brain of patients with drug-refractory epilepsy,and ULBP2 protein expression was significantly increased in temporal lobe cortex of patients with drug-refractory epilepsy as compared with the same regions of the controls specimens.Conclusion:The results indicate that the overexpression of ULBP2 may be involved in the pathophysiology of drug-refractory epilepsy.
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Objective To investigate the expression of cyclin dependent kinases 5(CDK5)in the temporal lobes of the epilepsy patients and to explore the possible roles of CDK5 in the pathogenesis of refractory epilepsy.Methods The brain tissues of intractable epilepsy(IE)were studied by fluorescence quantative polymerase chain reaction(FQ-PCR)for CDK5 mRNA,while immunohistochemistry and Western blot were used to study the protein expression.Nonepileptogenic control brain tissues were used for comparison.Results FQ-PCR analysis showed that the expression of CDK5 mRNA in epilepsy patients was significant higher than those in the control group.And immunohistochemistry showed that the protein mainly existed in the neuron and glial.At the 35000 relative molecular mass,Western blot could been seen that there is a limpid strap.The optical density of CDK5 in IE(temporal lobe 1.4293?0.1839,hippocampus 2.0733?0.4738)was significantly higher than that in the control(temporal lobe 0.9680?0.4147, hippocampus 1.4030?0.6160,P