Primary Generalized Epilepsy and Temporal Lobe Epilepsy: A Psychological Study Using Rorschach Tests

Abstract: Rorschach tests were performed on patients with primary generalized epilepsy (PGE) and on patients with temporal lobe epilepsy (TLE) combined with generalized tonic-clonic convulsions. Each group consisted of 20 cases and the two groups were matched as closely as possible. Patients with PGE were found to be characterized by variable responses, sensitivity, extroversion and undifferentiated tendencies. Patients with TLE are practical but inefficient and constricted in character. Cases not on medication displayed the same character types. On the basis of the above findings, speculation is made concerning the features of neurotic or psychotic PGE patients.     

颞叶癫Xian术前综合定位诊断

目的:研究术前对颞叶癫癎不同定位手段的综合应用。方法:采用ＥＥＧ、ＰＥＴ、ＭＲＩ、ＭＲＳ对２４例顽固性颞叶癫癎患者进行术前定位。结果:结合ＥＥＧ,ＭＲＩ,ＭＲＳ,ＰＥＴ对８３%,７９%,８５%病例作出定位;ＥＥＧ结合ＭＲＩ与ＭＲＳ,可对９２%病例作出定位;ＥＥＧ结合ＭＲＩ,ＭＲＳ,ＰＥＴ,可对９６%的病例作出定位。结论:结合ＥＥＧ,综合采用ＭＲＩ,ＭＲＳ,ＰＥＴ等手段可提高对颞叶癫癎术前定位的准确率。     

Quantification of Hippocampal Signal Intensity in Patients with Mesial Temporal Lobe Epilepsy

BACKGROUND: Refractory mesial temporal lobe epilepsy (MTLE) is frequently associated with hippocampal atrophy (HA) and an abnormal hippocampal signal (Hsig) on magnetic resonance imaging (MRI). OBJECTIVE: To quantify Hsig on MRI using a simplified technique. METHODS: The authors included 15 patients with refractory MTLE who underwent surgery and had preoperative MRI with hippocampal volumetry. Hsig was quantified on preoperative coronal T1-weighted and T2-weighted MRI using the NIH-Image program. Hsig was determined for the head, tail, and entire hippocampal extension. Abnormal Hsig was defined when values were above (for T2) or below (for T1) 2 standard deviations from the mean of normal control group. RESULTS: The lateralization of abnormal Hsig values was concordant with electroencephalograms and HA in all patients. There was a significant difference in ipsilateral T2 Hsig between patients and controls (P < .0001), but not for contralateral T2 Hsig. T1 Hsig showed bilateral abnormalities more frequently, whereas T2 Hsig could lateralize better hippocampal abnormalities. Overall, there were no differences when comparing T2 Hsig for the entire hippocampus, head, or tail only. However, there were some individual differences. T2 Hsig abnormalities involved the entire hippocampus in most patients but were restricted to the head in one patient and to the tail in another. CONCLUSIONS: This simplified method for the quantification of Hsig using NHI-Image is an efficient method for the identification and quantification of hippocampal abnormalities in patients with MTLE. The assessment of the entire extension of the hippocampal formation may provide important additional data, compared to T2 relaxometry maps limited to one segment of the hippocampus.     

Ictal Speech Manifestations in Temporal Lobe Epilepsy: A Video-EEG Study

Summary: To evaluate ictal speech manifestations in complex partial seizures (CPS), we reviewed videotapes of 68 consecutive patients who underwent anterior temporal lobectomy (ATL) for treatment of intractable epilepsy in Taiwan. In all, 261 CPS were collected from their video-EEG (VEEG) recordings. Cerebral speech dominance was determined by intracarotid injection of sodium amobarbital (Wada test) in all cases. Ictal speech manifestations, classified as verbalization or vocalization, occurred in 32 patients (47.1%) with 96 seizures (36.8%). Ictal verbalization occurred in 10 patients (14.7%). Ictal vocalization was observed in 28 patients (41.2%); including 6 patients who also had ictal verbalization. Thirty-six patients (52.9%) had no seizure with ictal speech manifestations. Ictal verbalization had significant lateralization value: 90% of patients with this manifestation had seizure focus in the nondominant temporal lobe (p = 0.049). Seizures of patients with ictal vocalization were not more likely to arise from either temporal lobe. We also observed bilingual patients who exclusively spoke in their mother tongue (Taiwanese) rather than the acquired language (Mandarin) in 72.2% of seizures with verbalization. This finding is significant and contrary to a commonly held notion that the acquired language is used in seizures associated with speech behaviors.     

Temporal Lobe Epilepsy with Ecstatic Seizures (So-Called Dostoevsky Epilepsy)

Summary: The present report documents for the first time the polygraphic pattern of an ecstatic seizure and confirms that this kind of seizure may be an expression of a temporal lobe epilepsy.     

Nondominant Temporal Lobe Epilepsy with Depressive Reaction

Abstract: A 56-year-old woman was admitted to our hospital because of insomnia and psychomotor retardation. This is her second admission. She was diagnosed as having depression and began to receive antidepressants. Her conditions got better after the treatment but the depressive state occurred again after she stopped taking those drugs. As EEG showed some spike discharges at the nondominant temporal lobe area, she was given anticonvulsants this time. Her depressive state improved rapidly by taking anticonvulsants instead of the antidepressants. The spike discharges at the nondominant temporal lobe area disappeared when the clinical symptoms improved.     

Recent Advances of PET in Temporal Lobe Epilepsy

Abstract: Recent advancement of PET studies in patients with temporal lobe epilepsy was reviewed. Changes of receptor plasticity are also examined in the experimental model of temporal lobe epilepsy in rats with unilateral injection of Kainic acid into the basolateral portion of the amygdala. The characteristic changes of receptor function in the specific topographical areas in both hippocampi with and without any morphological changes in these rats were observed. We plan to investigate these changes of receptor plasticity by PET with ¹¹C-labeled ligands in patients with temporal lobe epilepsy in the near future to obtain a better understanding of the mechanisms of temporal lobe epilepsy.     

Cognitive Outcomes in Patients with Chronic Temporal Lobe Epilepsy

Summary:  Cognitive impairment is frequent in temporal lobe epilepsy (TLE). In particular, specific deficits in temporal lobe related functions occur, but deficits in extratemporal lobe functions and global intelligence are also found. The degree and type of the impairment are first determined by structural damage and functionally dynamic factors. Most cognitive problems in TLE are already detectable at, or even before, the onset of the epilepsy. Accumulation of damage during the course of chronic epilepsy may add to this. This additional damage may be caused directly by severe seizures, head trauma, intoxication etc., or indirectly by interference of the epilepsy with mental development. Surgical treatment of TLE may also affect the cognitive outcome of patients with chronic TLE, with a risk of additional impairments on the one hand and functional recovery due to seizure control on the other hand. With regard to patient-associated factors, better baseline performance, younger age, cerebral plasticity, and good mental reserve capacities are associated with a better outcome. With regard to treatment-associated factors, prevention of additional brain dysfunction/damage and successful seizure control are important.     

Cognitive Impairments in Children with Nonidiopathic Temporal Lobe Epilepsy

Summary:  Ictal and interictal activities occurring in a mature brain can disorganize the neural network activity involved in one or various specific cognitive processes. In children, the situation might be more complex: the epileptic process occurs in a period when the cortex is still maturing and it may interfere with normal cerebral development. Although neural plasticity in children is greater than it is in adults, greater plasticity does not necessarily mean adaptive plasticity. Studies have shown that temporal lobe epilepsy in children is not systematically associated with global mental retardation. However, various difficulties in specific cognitive domains are more often found in children than in patients with adult-onset epilepsy. Language, memory, socioperceptive competence, and also executive functions, which can be impaired by the disruption of the temporofrontal circuit, are among such cognitive functions that need to be evaluated. Early detection of specific deficits is of primary importance for the implementation of appropriate remediation measures.     

Anterior Temporal Lobectomy and Medically Refractory Temporal Lobe Epilepsy of Childhood

The evaluation and outcome of 22 patients who had onset of complex partial seizures (CPS) of temporal lobe origin in childhood and subsequently underwent anterior temporal lobectomy are described. All patients showed improved seizure control; 81.8% had a reduction greater than or equal to 95% in seizure frequency. However, many patients had difficulty adjusting to a seizure-free life. Psychosocial, behavioral, and educational problems occurred more frequently in patients whose surgery was delayed until adult life. We conclude that attempts should be made early in the course of CPS of childhood to determine whether the seizures are truly intractable to medical management so that surgical intervention can be expedited.     

Chemosensory Event-Related Potentials in Patients with Temporal Lobe Epilepsy

Summary: We investigated chemosensory functions in patients with temporal lobe epilepsy (TLE) to discover whether olfactory and trigeminal stimuli applied either ipsilaterally or contralaterally to the epileptic focus are processed differently. Twenty-two patients were investigated, 12 of whom had epilepsy with a focus located in left temporal lobe (LTL). The remaining 10 patients had a right temporal lobe (RTL) focus. Input from the trigeminal system was examined by use of CO₂; input from the olfactory system was evaluated with vanillin and hydrogen sulfide as stimuli. Chemosensory function was assessed by evaluation of chemosensory event-related potentials (CSERP) and the patients' verbal reports in an odor identification test. In both groups of patients, prolonged CSERP latencies were noted after stimulation of the left nostril with CO₂ as compared with stimulation of the right nostril. In contrast, a different pattern emerged for olfactory stimuli. After right-sided olfactory stimulation, latencies were prolonged in patients with right-sided epileptical foci. Similarly, when the left nostril was stimulated in patients with a left-sided focus, CSERP latencies were prolonged. Thus, neocortical processing of olfactory, but not trigeminally mediated information evidently is affected by functional lesions of the temporal lobe. After olfactory stimulation in patients with a right-sided focus, the distribution of amplitudes was different from normal. Moreover, analyses showed nonoverlapping 95% confidence intervals (CI) for latency N1 when vanillin was applied to the right nostril. These results indicate that RTL may play a different role in processing of olfactory information as compared with LTL.     

Indication for Anterior Temporal Lobectomy in Patients with Temporal Lobe Epilepsy and Psychopathology

Summary: The chronicity and severity of epilepsy, as well as the presence of temporal lobe foci, appear to correlate with psychopathology. A high prevalence of psychopathology has been reported among patients who are candidates for anterior temporal lobectomy (ATL). A review of the literature indicates that episodic psychosis may diminish when patients become free of seizures after surgery and that chronic psychosis neither improves nor worsens after ATL. If this is the case, patients with episodic psychosis may benefit from ATL. Patients with chronic psychosis may benefit if they become free from seizures after the operation, even if the psychosis persists. Case reports of maladjustment to seizure-free life after surgery, and de novo psychopathology, underline the importance of preop-erative psychiatric evaluation and postoperative psychiatric intervention in patients undergoing epilepsy surgery. Although there is a need for each epilepsy center to state its policy with regard to patients with psychopathology who undergo epilepsy surgery, it would be unwise to make a decision on whether to reject a patient simply on the grounds of psychosis. A detailed psychiatric evaluation of each individual patient is required.     

Temporal Lobe Epilepsy Surgery with Limited Resources: Results and Economic Considerations

Summary: This study evaluates the surgical outcome of patients with medically refractory temporal lobe epilepsy (TLE) who underwent anterior temporal lobe lobectomy (ATL) based on data derived from noninvasive studies and assesses the economic costs entailed at a newly created epilepsy program in Chile. Seventeen ATL candidates underwent a presurgical evaluation. This included outpatient brain MRI and neuropsychological testing and inpatient scalp/sphenoidal prolonged video-EEG monitoring. There were 10 females and 7 males, with a mean age of 23.8 years and a mean duration of seizure disorder of 12 years. Patients with congruent data localizing the seizure focus to one anterotemporal region underwent ATL. Seven patients underwent a left-side ATL and 10 patients a right-side ATL. The histopathological findings showed a lowgrade tumor in six patients, hippocampal sclerosis in five, neuronal migration disorder in four, and cavernous angiomas in two patients. The mean follow-up period was 29·1 months. Seizure outcome was assessed with Engel's classification: class I, no seizures or only auras; class II, rare seizures; class III, >90% seizure reduction; class IV, <90% seizure reduction. Fifteen patients are now in class I, one patient in class II, and one in class IV. The total cost, including evaluation and surgery, was equivalent to US$ 5,020. Thus, well-selected TLE patients can derive maximal benefit from ATL after a noninvasive presurgical evaluation. This finding is of great significance for the creation of epilepsy surgery programs in developing countries.     

Neuropsychological Effect of Temporal Lobe Resection in Preadolescent Children with Epilepsy

Summary: Purpose : Numerous studies have demonstrated changes in cognitive, memory, and language functioning in adults and adolescents after temporal lobectomy, yet little information is available regarding neuropsychological outcome in preadolescent children.
Methods : We studied pre-and postoperative neuropsychological test results from 14 children who underwent temporal lobe resection for intractable epilepsy at age 7–12 years (mean 9.4 years).
Results : Thirteen patients (93%) had no seizures or less than one seizure a year at follow-up 23-48 months (mean 34 months) after operation. Postoperative neuropsychological testing was performed 6–9 months (mean 7 months) after surgery in 13 patients and 36 months after the first operation in 1 patient who underwent two-stage resection of a tumor. Verbal, Performance, and Full Scale IQ were initially in the low-average range, with no significant change across the pre-and postoperative evaluations. Immediate verbal memory performance decreased significantly in children who initially performed above the median preoperatively and tended to decrease in children who had left rather than right temporal lobe resection. Significant postoperative decreases in delayed memory scores were independent of preoperative ability or side of resection.
Conclusions : Our small study suggests vulnerability to postoperative decline in immediate verbal memory scores in preadolescent children who have higher baseline immediate memory function or undergo left rather than right temporal lobe resection, similar to that observed in adolescents in adults. The entire group exhibited a statistically significant decrease in delayed verbal memory. Study of larger series of patients will be important to clarify further the short-and long-term risks and benefits of temporal lobe resection in childhood.