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1.
Tomoyuki AkiyamaMakoto Osada Masahide IsowaCristina Y. Go Ayako OchiIrene M. Elliott Mari AkiyamaO. Carter Snead III James T. RutkaJames M. Drake Hiroshi Otsubo 《Clinical neurophysiology》2012,123(1):93-99
Objective
We determined whether kurtosis analysis of intracranial electroencephalogram (EEG) can estimate the localization of the epileptogenic zone.Methods
We analyzed 29 pediatric epilepsy patients who underwent intracranial EEG before focal resective surgery. We localized the brain regions with high kurtosis, the seizure onset zone (SOZ) and the regions with high-rate, high-amplitude and long-duration interictal paroxysms ?20 Hz. We tested correlations between the surgical resection of those regions and post-surgical seizure outcome, and correlations between kurtosis and the rate/amplitude/duration of interictal paroxysms.Results
The resection of the regions with high kurtosis correlated with 1-year post-surgical seizure outcome (p = 0.028) but not with 2-year outcome. Kurtosis showed more significant correlation with 1-year seizure outcome than the SOZ and the rate/amplitude/duration of interictal paroxysms. Kurtosis showed positive, independent correlations with the amplitude and duration of interictal paroxysms (p < 0.0001) but not with the rate (p = 0.4).Conclusions
The regions with high kurtosis provide more reliable information to predict seizure outcome than the SOZ and the regions with high-rate/amplitude and long-duration interictal paroxysms. Kurtosis reflects combined effects of the amplitude and duration of the interictal paroxysms.Significance
High kurtosis suggests the regions with acquired ictogenicity within the irritative zone. 相似文献2.
Jounhong Ryan Cho Eun Yeon Joo Dae Lim Koo Seung Chyul Hong Seung Bong Hong 《JOURNAL OF CLINICAL NEUROLOGY》2012,8(1):22-34
Background and Purpose
There is growing interest in high-frequency oscillations (HFO) as electrophysiological biomarkers of the epileptic brain. We evaluated the clinical utility of interictal HFO events, especially their occurrence rates, by comparing the spatial distribution with a clinically determined epileptogenic zone by using subdural macroelectrodes.Methods
We obtained intracranial electroencephalogram data with a high temporal resolution (2000 Hz sampling rate, 0.05-500 Hz band-pass filter) from seven patients with medically refractory epilepsy. Three epochs of 5-minute, artifact-free data were selected randomly from the interictal period. HFO candidates were first detected by an automated algorithm and subsequently screened to discard false detections. Validated events were further categorized as fast ripple (FR) and ripple (R) according to their spectral profiles. The occurrence rate of HFOs was calculated for each electrode contact. An HFO events distribution map (EDM) was constructed for each patient to allow visualization of the spatial distribution of their HFO events.Results
The subdural macroelectrodes were capable of detecting both R and FR events from the epileptic neocortex. The occurrence rate of HFO events, both FR and R, was significantly higher in the seizure onset zone (SOZ) than in other brain regions. Patient-specific HFO EDMs can facilitate the identification of the location of HFO-generating tissue, and comparison with findings from ictal recordings can provide additional useful information regarding the epileptogenic zone.Conclusions
The distribution of interictal HFOs was reasonably consistent with the SOZ. The detection of HFO events and construction of spatial distribution maps appears to be useful for the presurgical mapping of the epileptogenic zone. 相似文献3.
Martin Pail Josef Halámek Pavel Daniel Robert Kuba Ivana Tyrlíková Jan Chrastina Pavel Jurák Ivan Rektor Milan Brázdil 《Clinical neurophysiology》2013,124(10):1935-1942
Objective
We compared the possible contribution (in the detection of seizure onset zone – SOZ) of simple visual assessment of intracerebrally recorded high-frequency oscillations (HFO) with standard automated detection.Methods
We analyzed stereo-EEG (SEEG) recordings from 20 patients with medically intractable partial seizures (10 temporal/10 extratemporal). Independently using simple visual assessment and automated detection of HFO, we identified the depth electrode contacts with maximum occurrences of ripples (R) and fast ripples (FR). The SOZ was determined by independent visual identification in standard SEEG recordings, and the congruence of results from visual versus automated HFO detection was compared.Results
Automated detection of HFO correctly identified the SOZ in 14 (R)/10 (FR) out of 20 subjects; a simple visual assessment of SEEG recordings in the appropriate frequency ranges correctly identified the SOZ in 13 (R)/9 (FR) subjects.Conclusions
Simple visual assessment of SEEG traces and standard automated detection of HFO seem to contribute comparably to the identification of the SOZ in patients with focal epilepsies. When using macroelectrodes in neocortical extratemporal epilepsies, the SOZ might be better determined by the ripple range.Significance
Standard automated detection of HFO enables the evaluation of HFO characteristics in whole data. This detection allows general purpose and objective evaluation, without any bias from the neurophysiologist’s experiences and practice. 相似文献4.
Martin Pail Pavel Řehulka Jan Cimbálník Irena Doležalová Jan Chrastina Milan Brázdil 《Clinical neurophysiology》2017,128(1):106-114
Objective
The purpose of the presented study is to determine whether there are frequency-independent high-frequency oscillation (HFO) parameters which may differ in epileptic and non-epileptic regions.Methods
We studied 31 consecutive patients with medically intractable focal (temporal and extratemporal) epilepsies who were examined by either intracerebral or subdural electrodes. Automated detection was used to detect HFO. The characteristics (rate, amplitude, and duration) of HFO were statistically compared within three groups: the seizure onset zone (SOZ), the irritative zone (IZ), and areas outside the IZ and SOZ (nonSOZ/nonIZ).Results
In all patients, fast ripples (FR) and ripples (R) were significantly more frequent and shorter in the SOZ than in the nonSOZ/nonIZ region. In the group of patients with favorable surgical outcomes, the relative amplitude of FR was higher in the SOZ than in the IZ and nonIZ/nonSOZ regions; in patients with poor outcomes, the results were reversed. The relative amplitude of R was significantly higher in the SOZ, with no difference between patients with poor and favorable surgical outcomes.Conclusions
FR are more frequent, shorter, and have higher relative amplitudes in the SOZ area than in other regions. The study suggests a worse prognosis in patients with higher amplitudes of FR outside the SOZ.Significance
Various HFO parameters, especially of FR, differ in epileptic and non-epileptic regions. The amplitude and duration may be as important as the frequency band and rate of HFO in marking the seizure onset region or the epileptogenic area and may provide additional information on epileptogenicity. 相似文献5.
Purpose: High‐frequency oscillations (HFOs) known as ripples (80–250 Hz) and fast ripples (250–500 Hz) can be recorded from macroelectrodes inserted in patients with intractable focal epilepsy. They are most likely linked to epileptogenesis and have been found in the seizure onset zone (SOZ) of human ictal and interictal recordings. HFOs occur frequently at the time of interictal spikes, but were also found independently. This study analyses the relationship between spikes and HFOs and the occurrence of HFOs in nonspiking channels. Methods: Intracerebral EEGs of 10 patients with intractable focal epilepsy were studied using macroelectrodes. Rates of HFOs within and outside spikes, the overlap between events, event durations, and the percentage of spikes carrying HFOs were calculated and compared according to anatomical localization, spiking activity, and relationship to the SOZ. Results: HFOs were found in all patients, significantly more within mesial temporal lobe structures than in neocortex. HFOs could be seen in spiking as well as nonspiking channels in all structures. Rates and durations of HFOs were significantly higher in the SOZ than outside. It was possible to establish a rate of HFOs to identify the SOZ with better sensitivity and specificity than with the rate of spikes. Discussion: HFOs occurred to a large extent independently of spikes. They are most frequent in mesial temporal structures. They are prominent in the SOZ and provide additional information on epileptogenicity independently of spikes. It was possible to identify the SOZ with a high specificity by looking at only 10 min of HFO activity. 相似文献
6.
Shuang Wang Norman K. So Bo Jin Irene Z. Wang Juan C. Bulacio Rei Enatsu Shenyi Dai Zhong Chen Jorge Gonzalez-Martinez Imad M. Najm 《Clinical neurophysiology》2017,128(6):945-951
Objective
This study aimed to identify the subtype of interictal ripples that help delineate the epileptogenic zone in neocortical epilepsy.Methods
Totally 25 patients with focal neocortical epilepsy who had invasive electroencephalography (EEG) evaluation and subsequent surgery were included. They were followed up for at least 2 years. Interictal ripples (80–250 Hz) and fast ripples (250–500 Hz) during slow-wave sleep were identified. Neocortical ripples were defined as type I ripples when they were superimposed on epileptiform discharges, and as type II ripples when they occurred independently. Resection ratio was calculated to present the extent to which the cortical area showing an interictal event or the seizure onset zone (SOZ) was completely removed.Results
Fast ripples and types I and II ripples were found in 8, 19, and 21 patients, respectively. Only the higher resection ratio of interictal fast or type I ripples was correlated to the Engel 1a surgical outcome.Conclusions
Type I ripples could assist in localizing the epileptogenic zone in neocortical epilepsy.Significance
Type I and fast ripples both may be pathological high-frequency oscillations. 相似文献7.
Background
In order to test the possible effect of Oxytocin (OT) on Ghrelin-stimulated GH, PRL, ACTH and cortisol, ten healthy normal men were studied.Methods
Tests: Ghrelin (0.2 μg/kg body weight (BW)) as an iv bolus; Ghrelin plus OT (2 IU as bolus plus 0.07 IU/min administered for 90 min).Results
The administration of OT did not change GH, PRL, ACTH and cortisol release induced by Ghrelin.Conclusions
The data suggests that in humans OT did not modulate the GH, PRL, ACTH and cortisol response to Ghrelin. 相似文献8.
Cristian Donos Ioana Mîndruţă Mihai Dragoş Malîia Alin Raşină Jean Ciurea Andrei Barborica 《Clinical neurophysiology》2017,128(6):1043-1052
Objective
To perform a side-by-side comparison of two epileptogenicity biomarkers, high frequency oscillations (HFOs) and delayed responses (DRs), as a result of single-pulse electrical stimulation.Methods
We have recorded stimulation-evoked HFOs and DRs in 16 epileptic patients undergoing presurgical evaluation using the stereoelectroencephalographic method. To evaluate converging and complementary information provided by the biomarkers, we analyzed them individually and for logical “and”/“or” combinations between them. 3D maps of the biomarkers’ distributions by recording location (inbound maps) and by stimulation location (outbound maps) were created to analyze their relationship with the epileptogenic structures.Results
HFOs occur less frequently than DRs, by 18.7%, when counting by recording contacts, and more frequently, by 7.4%, when counting by stimulation contacts. 40.6% of the contacts exhibiting HFOs also exhibit DRs, and 44.1% of the contacts exhibiting DRs also exhibit HFOs. When combining biomarkers, there was a tradeoff between increased seizure onset zone (SOZ) sensitivity, from 21.3% to 73%, and decreased specificity, from 87.2% to 34.3%.Conclusions
There is a moderate similarity in the information provided by the DRs and HFOs.Significance
The biomarkers complement each other, but there is a tradeoff between different metrics for SOZ localization. 相似文献9.
Pan Gong Jiao Xue Ping Qian Haipo Yang Xiaoyan Liu Lixin Cai Kaigui Bian Zhixian Yang 《Brain & development》2018,40(4):299-310
Objective
To investigate high-frequency oscillations (HFOs) in epileptic encephalopathy with continuous spike-and-wave during sleep (CSWS) with different etiologies.Methods
Twenty-one CSWS patients treated with methylprednisolone were divided into structural group and genetic/unknown group. Comparisons were made between the two etiological groups: selected clinical variables including gender, age parameters, seizure frequencies and antiepileptic drugs; distribution of HFOs in pre-methylprednisolone electroencephalography (EEG) and percentage changes of HFOs and spikes after methylprednisolone treatment.Results
There were 7 patients (33%) in structural group and 14 patients (68%) in genetic/unknown group. No significant difference was found between the two groups regarding selected clinical variables. HFOs were found in 12 patients in pre-methylprednisolone EEG. The distribution of HFOs was focal and accordant with lesions in 5 of structural group, and it was also focal but in different brain regions in 7 of genetic/unknown group. The percentage reduction of total HFOs and spikes was 81% (158/195) and 19% (1956/10,037) in structural group, while 98% (315/323) and 55% (6658/12,258) in genetic/unknown group after methylprednisolone treatment.Conclusion
The etiologies had no distinct correlation with some clinical characteristics in CSWS. HFOs recorded on scalp EEG might not only be used as makers of seizure-onset zone (SOZ), but also have association with functional disruption of brain networks. Both HFOs and spikes reduced more in genetic/unknown patients than that in structural patients after methylprednisolone treatment and HFOs were more sensitive to treatment than spikes. 相似文献10.
Teresa Biermann Rita Asemann Carmel McAuliffe Armin Strbel Jochen Keller Wolfgang Sperling Stefan Bleich Johannes Kornhuber Udo Reulbach 《Comprehensive psychiatry》2009,50(6):573-577
Objective
The hypothesis of a lunar influence on human abnormal behavior is still widespread, although research has led to conflicting findings. Therefore, a population-based study to assess the influence of lunar phases on violent crimes was conducted.Methods
The study included all serious crimes of battery (aggravated assaults) committed in Middle Franconia (Bavaria, Germany) between 1999 and 2005 (n = 23?142). Data were analyzed regarding lunar phase, sex, and place of crime scene (outdoor vs indoor).Results
No significant associations between full, absent, and the moon's interphases and serious crimes of battery could be detected. Furthermore, a Fourier analysis was conducted that failed to produce an association between violence and the moon's phases.Discussion
Several possible explanations for the presented results are discussed including biological and social mechanisms.Conclusions
The present study fails to find a significant association between lunar phases and crimes of battery. 相似文献11.
High-frequency oscillations (HFOs), termed ripples (80-200 Hz) and fast ripples (250-600 Hz), are recorded in the EEG of epileptic patients and in animal epilepsy models; HFOs are thought to reflect pathological activity and seizure onset zones. Here, we analyzed the temporal and spatial evolution of interictal spikes with and without HFOs in the rat pilocarpine model of temporal lobe epilepsy. Depth electrode recordings from dentate gyrus (DG), CA3 region, subiculum and entorhinal cortex (EC), were obtained from rats between the 4th and 15th day after a status epilepticus (SE) induced by i.p. injection of pilocarpine. The first seizure occurred 6.1 ± 2.5 days after SE (n = 7 rats). Five of 7 animals exhibited interictal spikes that co-occurred with fast ripples accounting for 4.9 ± 4.6% of all analyzed interictal spikes (n = 12,886) while all rats showed interictal spikes co-occurring with ripples, accounting for 14.3 ± 3.4% of all events. Increased rates of interictal spikes without HFOs in the EC predicted upcoming seizures on the following day, while rates of interictal spikes with fast ripples in CA3 reflected periods of high seizure occurrence. Finally, interictal spikes co-occurring with ripples did not show any specific relation to seizure occurrence. Our findings identify different temporal and spatial developmental patterns for the rates of interictal spikes with or without HFOs in relation with seizure occurrence. These distinct categories of interictal spikes point at dynamic processes that should bring neuronal networks close to seizure generation. 相似文献
12.
Purpose : To investigate the effect of sleep stage on the properties of high-frequency oscillations (HFOs) recorded from depth macroelectrodes in patients with focal epilepsy.
Methods : Ten-minute epochs of wakefulness (W), stage 1–2 non-REM (N1-N2), stage 3 non-REM (N3) and REM sleep (R) were identified from stereo-electroencephalography (SEEG) data recorded at 2 kHz in nine patients. Rates of spikes, ripples (>80 Hz), and fast ripples (>250 Hz) were calculated, as were HFO durations, degree of spike–HFO overlap, HFO rates inside and outside of spikes, and inside and outside of the seizure-onset zone (SOZ).
Results : Ripples were observed in nine patients and fast ripples in eight. Spike rate was highest in N1-N2 in 5 of 9 patients, and in N3 in 4 of 9 patients, whereas ripple rate was highest in N1-N2 in 4 of 9 patients, in N3 in 4 of 9 patients, and in W in 1 of 9 patients. Fast ripple rate was highest in N1-N2 in 4 of 8 patients, and in N3 in 4 of 8 patients. HFO properties changed significantly with sleep stage, although the absolute effects were small. The difference in HFO rates inside and outside of the SOZ was highly significant (p < 0.000001) in all stages except for R and, for fast ripples, only marginally significant (p = 0.018) in W.
Conclusions : Rates of HFOs recorded from depth macroelectrodes are highest in non-REM sleep. HFO properties were similar in stages N1-N2 and N3, suggesting that accurate sleep staging is not necessary. The spatial specificity of HFO, particularly fast ripples, was affected by sleep stage, suggesting that recordings excluding REM sleep and wakefulness provide a more reliable indicator of the SOZ. 相似文献
Methods : Ten-minute epochs of wakefulness (W), stage 1–2 non-REM (N1-N2), stage 3 non-REM (N3) and REM sleep (R) were identified from stereo-electroencephalography (SEEG) data recorded at 2 kHz in nine patients. Rates of spikes, ripples (>80 Hz), and fast ripples (>250 Hz) were calculated, as were HFO durations, degree of spike–HFO overlap, HFO rates inside and outside of spikes, and inside and outside of the seizure-onset zone (SOZ).
Results : Ripples were observed in nine patients and fast ripples in eight. Spike rate was highest in N1-N2 in 5 of 9 patients, and in N3 in 4 of 9 patients, whereas ripple rate was highest in N1-N2 in 4 of 9 patients, in N3 in 4 of 9 patients, and in W in 1 of 9 patients. Fast ripple rate was highest in N1-N2 in 4 of 8 patients, and in N3 in 4 of 8 patients. HFO properties changed significantly with sleep stage, although the absolute effects were small. The difference in HFO rates inside and outside of the SOZ was highly significant (p < 0.000001) in all stages except for R and, for fast ripples, only marginally significant (p = 0.018) in W.
Conclusions : Rates of HFOs recorded from depth macroelectrodes are highest in non-REM sleep. HFO properties were similar in stages N1-N2 and N3, suggesting that accurate sleep staging is not necessary. The spatial specificity of HFO, particularly fast ripples, was affected by sleep stage, suggesting that recordings excluding REM sleep and wakefulness provide a more reliable indicator of the SOZ. 相似文献
13.
Purpose
Corpus callosotomy (CC) is a palliative surgical procedure to control atonic, tonic, or generalized tonic-clonic seizure in Lennox-Gastaut syndrome (LGS). Here, we report patients with LGS who underwent resective surgery, following CC better delineating the presumed seizure foci localized in one hemisphere.Methods
We retrospectively reviewed seven patients with LGS who underwent CC and subsequent cortical resection. The median follow-up duration after lobectomy was 20 months (range, 15-54 months) and three patients had follow-up periods over 24 months. The findings of video electroencephalography (EEG) monitoring, structural and functional neuroimagings were compared between pre- and post-CC.Results
Four patients had Engel class I and one patient had Engel class II outcomes following cortical resection; post-CC, compared to pre-CC, showed better localized ictal/interictal epileptiform discharges in the unilateral frontal area in two patients, in the unilateral parieto-temporo-occipital areas in one patient and in the unilateral fronto-temporal areas in the remaining two patients. Two patients had Engel Class III outcome following cortical resection; post-CC EEG continued to show multifocal epileptiform discharges but predominantly arising from a unilateral frontal area. Following CC, positron emission tomography showed localized glucose hypometabolism of which location was concordant with post-CC EEG abnormalities in all patient. Similarly, ictal/interictal single photon emission computed tomography also showed localized abnormalities concordant with post-CC EEG abnormalities in five of the six patients. Pathological assessment revealed cortical dysplasia in six patients, whereas no pathological abnormality was found in the remaining patient, who obtained Engel Class I outcome following cortical resection.Conclusion
CC could change EEG findings, glucose metabolisms and cerebral blood flows, and it is sometimes helpful in delineating the primary seizure focus in patients with LGS. 相似文献14.
Rassi A Veras AB dos Reis M Pastore DL Bruno LM Bruno RV de Ávila MA Nardi AE 《Comprehensive psychiatry》2010,51(6):599-2498
Objective
To investigate the prevalence of psychiatric disorders among women in ambulatory treatment for polycystic ovary syndrome (PCOS) and to correlate its clinical and demographic aspects with mental disorders.Methodology
Seventy-two patients in ambulatory treatment at the Endocrinal and Gynaecological Institute of the Federal University of Rio de Janeiro were evaluated using Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition criteria by means of MINI (Mini International Neuropsychiatric Interview, version 4.4). Polycystic ovary syndrome was confirmed according to the ultrasonographic criteria of Adams and by clinical parameters.Results
Forty-one patients (57%) presented at least one psychiatric diagnosis. Among them, the prevalence of mood disorder reached 78%. The most prevalent diagnostics were major depression (26.4%) and bipolar disorder (11.1%).Conclusion
A high prevalence of mental disorders was observed, especially major depression and bipolar disorder. The data obtained regarding the relationship between PCOS and mood disorders in a Brazilian sample is in accordance with recent research findings in the same area. 相似文献15.
E. RodriguesA. Wenzel M.P. RibeiroL.C. Quarantini A. Miranda-ScippaE.P. de Sena I.R. de Oliveira 《European psychiatry》2011,26(7):452-456
Background
Several studies have found a reduction in hippocampal volume in borderline personality disorder (BPD) patients.Methods
In order to investigate the degree to which comorbid posttraumatic stress disorder (PTSD) could account for reduction in hippocampal volume in these patients, we conducted a systematic review and meta-analysis of studies that compared hippocampal volume in BPD patients with and without PTSD relative to healthy controls.Results
Seven articles, involving 124 patients and 147 controls, were included. We found a statistically significant reduction for the left and right hippocampus. Data from the four studies that discriminated BPD patients with and without PTSD indicate that hippocampal volumes were reduced bilaterally in BPD patients with PTSD, relative to healthy controls, but that results were mixed for BPD patients without PTSD, relative to healthy controls.Conclusions
Results from this meta-analysis suggest that hippocampal volumes are reduced in patients with BPD, relative to healthy controls, but particularly in cases in which patients are diagnosed with comorbid PTSD. 相似文献16.
Shoichi Shimamoto Zachary J. Waldman Iren Orosz Inkyung Song Anatol Bragin Itzhak Fried Jerome Engel Richard Staba Ashwini Sharan Chengyuan Wu Michael R. Sperling Shennan A. Weiss 《Clinical neurophysiology》2018,129(1):296-307
Objective
To develop and validate a detector that identifies ripple (80–200?Hz) events in intracranial EEG (iEEG) recordings in a referential montage and utilizes independent component analysis (ICA) to eliminate or reduce high-frequency artifact contamination. Also, investigate the correspondence of detected ripples and the seizure onset zone (SOZ).Methods
iEEG recordings from 16 patients were first band-pass filtered (80–600?Hz) and Infomax ICA was next applied to derive the first independent component (IC1). IC1 was subsequently pruned, and an artifact index was derived to reduce the identification of high-frequency events introduced by the reference electrode signal. A Hilbert detector identified ripple events in the processed iEEG recordings using amplitude and duration criteria. The identified ripple events were further classified and characterized as true or false ripple on spikes, or ripples on oscillations by utilizing a topographical analysis to their time-frequency plot, and confirmed by visual inspection.Results
The signal to noise ratio was improved by pruning IC1. The precision of the detector for ripple events was 91.27?±?4.3%, and the sensitivity of the detector was 79.4?±?3.0% (N?=?16 patients, 5842 ripple events). The sensitivity and precision of the detector was equivalent in iEEG recordings obtained during sleep or intra-operatively. Across all the patients, true ripple on spike rates and also the rates of false ripple on spikes, that were generated due to filter ringing, classified the seizure onset zone (SOZ) with an area under the receiver operating curve (AUROC) of >76%. The magnitude and spectral content of true ripple on spikes generated in the SOZ was distinct as compared with the ripples generated in the NSOZ (p?<?.001).Conclusions
Utilizing ICA to analyze iEEG recordings in referential montage provides many benefits to the study of high-frequency oscillations. The ripple rates and properties defined using this approach may accurately delineate the seizure onset zone.Significance
Strategies to improve the spatial resolution of intracranial EEG and reduce artifact can help improve the clinical utility of HFO biomarkers. 相似文献17.
Cohen-Gadol AA 《Clinical neurology and neurosurgery》2011,113(10):844-853
Background
Microvascular decompression (MVD) surgery for trigeminal neuralgia and hemifacial spasm offers a relatively low-risk opportunity to treat cranial nerve hyperactivity-compression syndromes, which are associated with severe, disabling facial pain and spasm. Although a number of publications have described the technique in detail, combining the technical nuances from different schools of thought or neurosurgical training in an effort to increase the safety and efficacy of this procedure would be beneficial to the surgeon.Methods
The nuances of technique and operative findings from performing this procedure for the last 100 cases have been reviewed and combined. The author has reflected on his experience performing microvascular decompression operation.Findings
The specifics of operating room set-up, positioning, craniotomy, and intradural microsurgical methods are provided, including managing postoperative care and complications.Conclusion
In the presence of alternative methods of therapy, microvascular decompression operations should be performed with low risk to the patient. There is a learning curve involved with this operation and the surgeon should remain always critical of his/her performance and aspire for a “perfect” result. 相似文献18.
Evelien E. Geertsema Maryse A. van ’t Klooster Nicole E.C. van Klink Frans S.S. Leijten Peter C. van Rijen Gerhard H. Visser Stiliyan N. Kalitzin Maeike Zijlmans 《Clinical neurophysiology》2017,128(1):153-164
Objective
We aimed to test the potential of auto-regressive model residual modulation (ARRm), an artefact-insensitive method based on non-harmonicity of the high-frequency signal, to identify epileptogenic tissue during surgery.Methods
Intra-operative electrocorticography (ECoG) of 54 patients with refractory focal epilepsy were recorded pre- and post-resection at 2048 Hz. The ARRm was calculated in one-minute epochs in which high-frequency oscillations (HFOs; fast ripples, 250–500 Hz; ripples, 80–250 Hz) and spikes were marked. We investigated the pre-resection fraction of HFOs and spikes explained by the ARRm (h2-index). A general ARRm threshold was set and used to compare the ARRm to surgical outcome in post-resection ECoG (Pearson X2).Results
ARRm was associated strongest with the number of fast ripples in pre-resection ECoG (h2 = 0.80, P < 0.01), but also with ripples and spikes. An ARRm threshold of 0.47 yielded high specificity (95%) with 52% sensitivity for channels with fast ripples. ARRm values >0.47 were associated with poor outcome at channel and patient level (both P < 0.01) in post-resection ECoG.Conclusions
The ARRm algorithm might enable intra-operative delineation of epileptogenic tissue.Significance
ARRm is the first unsupervised real-time analysis that could provide an intra-operative, ‘on demand’ interpretation per electrode about the need to remove underlying tissue to optimize the chance of seizure freedom. 相似文献19.
Gaud S Sauvée M Muresan M Gospodaru N Foscolo S Debouverie M 《Revue neurologique》2011,167(11):833-836
Introduction
Neurosyphilis has become uncommun in the developed countries.Observation
We report a case of neurosyphilis with limbic presentation, left mesiotemporal lesions on MRI and severe anterograde amnesia.Discussion
Pathogeneses of MRI findings are unknown. We suggest the implication of arteritis wich affects small vessels, parenchymatous and excitotoxic lesions. The absence of mesiotemporal lesion in immunodeficient patients, the limbic systematization of pathology underlines the involvement of probably auto-immune process. Neurosyphilis should always be considered in the differential diagnosis of limbic encephalitis in order to initiate treatment and to prevent cognitives sequelaes. At last, partial status epilepticus should be diagnosed and excitotoxicity lesions prevents with antiepileptic treatment. 相似文献20.
Yoichiro TakeiYoko Komada Kazuyoshi NambaTaeko Sasai Masaki NakamuraTatsuki Sugiura Kenichi Hayashida Yuichi Inoue 《Clinical neurophysiology》2012,123(1):137-141