颞叶癫痫的MRI与临床分析

目的：探讨颞叶癫痫的MRI表现、临床特征及治疗。方法：利用MRI辅以EEG诊断并定位32例颞叶癫痫（TLE），抗癫痫药(AED)正规治疗2年控制不良并外科手术治疗。结果：32例TLE患全部海马萎缩，2例双侧；高信号26例。诊断海马硬化26例。24例手术病理结果证实与MRI结果相符。手术后加药物治疗，效果满意15例，显7例，良好2例。结论：海马萎缩与信号增高是硬化常见MRI表现，有诊断价值。MRI有助于TLE定位诊断。手术加药物是治疗顽固性TLE之重要方法。     

Corticofugal modulation of the information processing in the auditory thalamus of the cat

Summary Single unit activity of 355 cells was recorded in the auditory thalamus of anesthetized cats before, during, and after the inactivation by cooling of the ipsilateral primary auditory cortex (AI). Most of the units (n = 288) showed similar functional characteristics of firing before and after the cryogenic blockade of AI. The spontaneous firing rate remained unchanged by cooling in 20% of the units and decreased in the majority of them (60%). In some regions, i.e. dorsal division of the medial geniculate body (MGB), lateral part of the posterior group of the thalamus, and auditory sector of the reticular nucleus of the thalamus, the maximum firing rate evoked by white noise bursts was generally affected by cooling in the same direction and to the same extent as the spontaneous activity. Units in the ventral division of MGB showed a characteristic increase of signal-to-noise ratio during cortical cooling. The corticofugal modulation led to the appearance or disappearance of the best frequency of tuning in 51 units and changed it by more than 0.5 octave in 34 units. The bandwidths of different response patterns to pure tones stimulation were used to define a set of functional properties. During cryogenic blockade of AI, two cortically modulated sub-populations of units were usually distinguished that exhibited changes for a given functional property. The complexity and diversity of the effects of cortical inactivation suggest that the corticothalamic projection may be the support for selective operations such as an adaptive filtering of the incoming acoustic signal at the thalamic level adjusted as a function of cortical activity.     

Ictal and enduring interictal disturbances in emotional behaviour in an animal model of temporal lobe epilepsy

Unilateral microinjections of kainic acid (4.7 nmol) were made into the dorsal hippocampus of 17 unanaesthetized freely moving cats. These injections provoked an acute period of intense seizure activity (first 48–72 h) which in 10 cats was followed by a chronic period of recurrent spontaneous complex partial seizures persisting for as long as the cats were studied (up to 4 months). During the chronic epileptic period 8 of these 10 cats demonstrated both ictal and interictal emotional behaviour disturbances. The ictal events included behaviour similar to a ‘defensive rage’ reaction. Interictally, each of the cats demonstrated an emotional lability. That is, although they behaved in a normal manner if handled affectionately, any mild provocation triggered an explosive defensive rage reaction. As well, the thresholds for electrical brain stimulation induced defensive rage were lowered. That the interictal emotional behaviour disturbances were related to the presence of an active epileptogenic process was suggested by the finding that during periods when no spontaneous seizures were observed for several days, the cats reverted to a less emotionally reactive state and the thresholds for stimulation-induced defense reactions returned to baseline. The results indicate that epileptogenic lesions of the temporal lobe alone can induce an enduring disturbance of emotional behaviour. They support the view that emotional disturbances in patients with epilepsy may sometimes result from pathophysiological mechanisms related to the epileptogenic process, and further suggest that such emotional disturbances might be reversed or prevented if the epileptic seizures could be controlled.     

A study of the interrupted REM episode

Brief interruptions of REM sleep are considered to be part of the REM episode. The maximum allowable duration of such an interruption, which is used to define the end of the REM episode, is currently a matter of debate. Making measurements on individual REM cycles, inter-REM interval analysis was carried out to determine whether the generally adopted 15 minute empirical rule for this maximum needs to be extended to 25 minutes as suggested by several including Kobayashi et al. Our results show that there is no reason to alter the 15 minute rule and that measurements which do not take into account the time-of-night effect may be misleading. The proportion of interrupted REM episodes observed in our population of healthy adults is high. We have therefore also examined in some detail the phenomenology of the temporal evolution of the structure and content of the interrupted REM episodes. Both showed a definite change over the night: the interruptions in the earlier episodes tend to return the system to slow wave sleep while those in the later episodes tend to return it to wake. It is hypothesized that these interruptions reflect a measure of REM sleep pressure and its interaction with both slow wave sleep and wake pressures.     

砧骨发育不良的CT检查

目的 :探讨砧骨多层螺旋CT多平面重组 (multi planarreformation ,MPR)技术和各种类型砧骨发育不良的CT特征。方法 :对 5 0例无耳症状、体征的志愿者行平行枕眶线扫描 ,应用轴位图像行以下多方位的MPR :①冠状位 ;②矢状位 ;③砧骨长轴位层面 ;④砧骨、锤骨同层显示层面。比较轴位和前三种位置整体显示砧骨形态的能力。在砧骨长轴位图像上测量砧骨的长度。异常组 ,砧骨发育异常 5 4例 86耳 ,2 7例行听骨链重建术。全部病例经电测听检查均表现有不同程度的传导性耳聋。结果 :正常组轴位、冠状位、矢状位均未能显示砧骨长轴位整体形态 ,砧骨长轴位MPR图像均直观显示了砧骨长轴整体形态。锤骨与砧骨长轴在同一层面显示 13例 ,2 2耳 ,在不同层面分别显示 37例 ,78耳。在砧骨长轴位MPR图像上 ,测量砧骨的长度为 6 .8mm± 0 .5mm。异常组 5 4例 ,砧骨长脚缺如 2 5例 ;砧骨长脚被软组织取代 9例 ,砧骨与镫骨之间的“L”型夹角消失 2 0例 ,其中 ,砧骨长脚与鼓室壁粘连 2例。结论 :利用MPR技术可得到与砧骨长轴层面平行的重组图像 ,可较完整的显示砧骨的大小、形态 ,准确评价砧骨的各种畸形和病变 ,为制定治疗方案提供科学依据。     

Scalp and Limbic P3 Event-Related Potentials in the Assessment of Patients with Temporal Lobe Epilepsy

Auditory oddball scalp and limbic P3s were recorded from 18 patients with unilateral temporal lobe epilepsy (TLE) prior to seizure surgery. Limbic P3s were unilaterally absent ipsilateral to the seizure focus and were present in the nonepileptogenic temporal lobe in all 18 cases studied. Scalp P3s, recorded from C3 and C4, on the other hand, were elicited bilaterally and there was no significant difference in amplitude or latency between the epileptogenic and nonepileptogenic sides. These data concur with studies of scalp P3 performed following surgery and suggest that the assessment of the contribution of limbic P3 to scalp P3 may be masked by volume conduction effects and other generators of P3. We conclude that the P3 recorded from central scalp sites, unlike its limbic counterpart, offers little clinical information in the presurgical assessment of patients with TLE.     

Temporal Lobe Epilepsy in Children: Electroclinical Study of 77 Cases

Summary:  Purpose: Temporal lobe epilepsy (TLE) is probably more difficult to recognize in children than in adults. In fact, ictal symptoms in children are less stereotyped and less obvious, and the neuropathological substrate is more heterogeneous than in adults. The aim of this study is to examine the relationships between etiology, age at onset and electroclinical findings in 77 children with TLE, 32 of whom were surgically treated.
Methods: Electroclinical study including video-EEG recording of seizures in 77 children with TLE. The investigation focused on the first five initial ictal symptoms.
Results: Age at onset was less than 3 years in 39 cases, between 3 and 6 years in 17 cases and older than 6 years in 21 cases. Auras also occurred in younger children but were more common after the age of 6 years. A peculiar initial ictal semiology consisted in staring with arrest, lip cyanosis, and very slight oral automatisms. In some cases, EEG recordings documented seizures starting independently on both temporal lobes. Based on electroclinical and neuroradiological features, we recognized three subgroups: symptomatic TLE due to cortical malformations or nonevolutive tumors, TLE with mesial temporal sclerosis, and cryptogenic TLE.
Conclusions: A correct electroclinical and neuroradiological approach allows in several cases early recognition of TLE even when onset is earlier than the age of 6 years. A correct definition of the localization relies primarily on video-EEG recording of the seizures, possibly repeated during follow up in cases lacking obvious neuroradiological correlation.     

Unsupervised fuzzy clustering analysis supports behavioral cutoff criteria in an animal model of posttraumatic stress disorder.

BACKGROUND: Unsupervised fuzzy clustering (UFC) analysis is a mathematical technique that groups together objects in the multidimensional feature space according to a specified similarity measurement, thereby yielding clusters of similar data points that can be represented by a set of prototypes or centroids. METHODS: Since clinical studies of mental disorders distinguish between affected and unaffected individuals, we designed an inclusion/exclusion criteria (cutoff behavioral criteria [CBC]) approach for animal behavioral studies. The effect of classifying the study population into clearly affected versus clearly unaffected individuals according to behaviors on two behavioral paradigms was statistically significant. RESULTS: Here the raw data from previous studies were subjected to UFC algorithms as a means of objectively testing the validity of the concept of the CBC for our experimental model. The first UFC algorithm yielded two clearly discrete clusters, found to consist almost exclusively of the exposed animals in the one and unexposed animals in the other. The second algorithm yielded three clusters corresponding to animals designated as clearly affected, partially affected, and clearly unaffected. The algorithm for physiological data in addition to behavioral data failed to elicit discrete clusters. CONCLUSIONS: The UFC analysis yielded data that support the conceptual contention of the CBC and lends additional validity to our previous behavioral studies.     

一侧混合性颞叶癫痫的联合微创手术治疗

目的 探讨一侧混合性颞叶癫痫联合微创手术治疗的方法.方法 16例顽固性颞叶癫痫患者,经临床症状、长程视频脑电监测(V-EEG)、头颅CT、MRI、磁共振波谱(MRS)、正电子发射断层显像-计算机断层显像(PET-CT)、脑磁图(MEG)和术中皮层脑电(ECoG)以及深部脑电(DEEG)检查,发现在一侧颞叶海马和颞叶新皮层中存在着各自独立的致痫灶,诊断为一侧混合性颞叶癫痫,分别给予立体定向杏仁核海马毁损(SAHT)和多处软膜下横切术(MST)联合治疗.结果 随访6～32个月,按照Engel的疗效判断标准:Ⅰ级7例,Ⅱ级4例,Ⅲ级4例,Ⅳ1例.术后未发生永久性并发症.结论 采用联合微创手术方法治疗一侧混合性颞叶癫痫,是安全有效的.