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. Risk factors for TLE, age at epilepsy onset, and occurrence of pregnancy were identified in each patient. RESULTS: Twenty-six women had no identifiable risk factors or seizures following a pregnancy. Nine of the 26 women had a history of eclampsia. The median age at the time of eclampsia was 16 years, and the latent period between the occurrence of eclampsia and onset of epilepsy ranged from 1 month to 2 years. The clinical, EEG, MRI, and neuropathologic findings were typical of hippocampal sclerosis (HS) and other than age at onset were no different from those of noneclampsia ATL patients. At mean follow-up of 57 months, seven patients were seizure-free and the other two markedly improved. CONCLUSION: Eclampsia may be a risk factor for TLE and HS.

Supplementary sensorimotor area epilepsy. Seizure localization, cortical propagation and subcortical activation pathways using ictal SPECT.

We studied clinical signs, EEGs and ictal cerebral blood flow by single-photon emission computed tomography (SPECT) in eight patients with intractable supplementary sensorimotor area (SSMA) seizures. SPECT scans were performed after injection of the regional cerebral blood flow tracer [99mTc]HMPAO (hexametylpropylene amine oxime) early in the ictal phase (2-5 s after seizure onset). Ictal SPECT demonstrated unilateral predominance of hyper-perfusion of the SSMA in all patients, concordant with either lateralizing clinical signs, lateralization of ictal scalp EEG or with the site of ictal onset of seizures, obtained from intracranial electrodes. Two distinctive cortical blood-flow propagation patterns were identified in SSMA seizures. The type I pattern consisted of primary involvement of the ipsilateral SSMA and dorsal premotor and motor cortex. The type II pattern consisted of bilateral but asymmetric mesial frontal propagation. Ictal contraversive head and eye movements were associated with a type I propagation pattern (P < 0.03). Activation of subcortical structures led to variable hyper-perfusion of the basal ganglia and thalamus. Contralateral cerebellar hyperperfusion was observed in all cases. We conclude that ictal SPECT is a useful method for seizure localization in patients with SSMA epilepsy. The observed heterogeneity of clinical features in SSMA epilepsy correlates with propagation to, and activation of, specific cortical structures, and is consistent with known anatomical interconnections between the SSMA, ipsilateral cortical and transcallosal cortical structures.

[Thrombolysis in acute occlusion of cerebral blood vessels]. / Thrombolyse beim akuten Verschluss zerebraler Gefässe.

Thrombolysis may achieve recanalization in cases of occlusion of the cerebral vessels. If therapy is initiated in good time, development of cerebral infarction may be at least partially prevented. Thrombolytic treatment was performed in 14 patients at the Wagner-Jauregg Hospital within a period of one year. Urokinase was given locally, while rtPA was applied locally and/or systemically. 4 patients had an occlusion of the internal carotid artery, 6 an occlusion of the middle cerebral artery, and 4 an occlusion of the basilar artery. Complete recanalization was achieved in 6 patients, partial recanalization in 4, and no recanalization in 4. The neurological outcome of the cases with complete recanalization was good with the exception of one patients who died. Partial recanalization resulted in a fair outcome in 2 patients, while the other 2 died. 3 out of the 4 patients in whom no recanalization was achieved died. Our findings show that this form of therapy may considerably improve the natural history of the disease, provided recanalization is achieved in good time. They encourage us to continue this form of therapy and to work at improving the therapeutic criteria.