Sprachdiagnostik bei Patienten mit unilateraler Temporallappenepilepsie

Background

Deficits in visual confrontation naming ability constitute a typical deficit in patients with left temporal lobe epilepsy.

Patients and methods

Naming function was assessed in 106 patients with temporal lobe epilepsy (left: 58, right: 48) and left hemispheric language representation and in 74 healthy volunteers.

Results

Focus localization was improved with application of the Boston Naming Test. Patients with left and right temporal lobe epilepsy showed significantly worse naming performance compared to controls (p<0.01). Naming performance of patients with left temporal lobe epilepsy was significantly worse compared to patients with right temporal lobe epilepsy (p<0.01). Regression analysis revealed focus localization and verbal intelligence as the most important predictors for naming performance. Naming deficit ≥17.5% was specifically found in patients with left temporal lobe epilepsy and verbal intelligence level lower than average.

Conclusion

Our results suggest that the left temporal lobe plays a specific role for controlling speech-related processing of visually perceived objects. Therefore, dysnomia in left temporal lobe epilepsy reflects a deficit in the accurate semantic and/or phonological interpretation of visual information.     

Plastische Veränderungen von Neuropeptiden bei Patienten mit Temporallappenepilepsie

Neuropeptides are stored together with the classical neurotransmitter in large dense core vesicles from where they are released upon stimulation. In animal models, neuropeptides have been shown to influence neuronal excitability. For example, an anticonvulsive action was found for neuropeptide Y (NPY), galanin, dynorphin and somatostatin. By contrast, substance P was found to have a proconvulsive action. We investigated the expression of NPY, dynorphin, secretoneurin and chromogranin B in hippocampi from patients with intractable temporal lobe epilepsy (TLE) (n=29; mean age=34.5 years; mean duration of epilepsy=21.4 years) and post mortem controls (n=21; mean age=57.7 years; mean post mortem delay=17.2 hours). In situ hybridization for dynorphin showed a marked increase of mRNA expression in granule cells of the dentate gyrus. For NPY, we found increased mRNA expression in hilar interneurons. Immunohistochemical staining showed a sprouting of neuropeptide-containing axons. Antibodies for dynorphin, secretoneurin and chromogranin B labeled mossy fiber terminals in the inner molecular layer of the denate gyrus of patients with, but not without, hippocampal sclerosis. NPY- and secretoneurin-containing interneurons revealed a dense plexus of fibers in the molecular layer and the hilus of the dentate gyrus as well as in stratum lucidum, the terminal field of mossy fibers. Radioligand binding to the NPY Y2 receptor, which mediates anticonvulsive actions of NPY, was increased in the hippocampus of TLE patients. In summary, our data show a marked reorganization of hippocampal circuits and an upregulation of the expression of dynorphin, NPY and the Y2 receptor in the epileptic hippocampus. These changes may contribute to endogenous anticonvulsive mechanisms in TLE patients.     

Chirurgie der Temporallappenepilepsie

Clinical Epileptology - Die chirurgische Therapie der therapierefraktären Temporallappenepilepsie ist der medikamentösen weitaus überlegen, und es kann bei 60–80% der Patienten...     

Langzeit-Prognose von Patienten mit juvenilem Insult

Zusammenfassung Bei 57 von 70 Patienten, die vor dem 40. Lebensjahr erstmals zerebrale Durchblutungsstörungen auf ischämischer Basis erlitten hatten, wurde der weitere Verlauf über durchschnittlich 84 Monate verfolgt. Innerhalb von 48 Monaten nach dem initialen Ereignis kam es bei 22 von 51 Patienten (43,1%) mit Spontanverlauf zu weiteren Manifestationen (Rezidivquote fur Patienten mit transitorischischämischen Attacken 78,6%, für Patienten mit prolongierten reversiblen Defekten 33,3%, für Patienten mit kompletten Schlaganfällen 28,6%), wobei 31,5% aller Patienten schon innerhalb des ersten Jahres neuerliche zerebrale Durchblutungsstörungen erlitten, die meisten sogar innerhalb der ersten wenigen Monate.Trotz der wesentlich höheren Rezidivrate waren Patienten mit initialen passageren zerebralen Durchblutungsstörungen am Ende des Beobachtungszeitraums (BZR) in sozialer Hinsicht weniger beeinträchtigt als Patienten mit kompletten Schlaganfällen als Erstmanifestation. 78,4% aller Patienten waren am Ende des BZR voll arbeitsfähig.Bei 72,2% der patienten mit neuerlichen zerebralen Durchblutungsstörungen war das Herdgeschehen einem anderen als dem urspriinglich betroffenen Gefäßgebiet zuzuordnen.Patienten mit arterieller Hypertonic im BZR halten eine etwas ungünstigere Langzeitprognose, während Nikotinkonsum wie auch relatives Körpergewicht auf den Schweregrad der sozialen Beeinträchtigung keinen Einfluß hatte.Trotz der eher günstigen Langzeitprognose weisen unsere Ergebnisse — besonders im Hinblick auf die hohe Rezidivquote innerhalb der ersten Monate nach der initialen Attacke — auf die Notwendigkeit einer unverzüglichen umfassenden diagnostischen Abklärung und Einleitung einer individuellen Therapie bei Patienten mit juvenilem Insult hin.     

Integrierte Versorgung von Patienten mit Epilepsie

In Germany, social legislation [§ 140 Sozialgesetzbuch (SGB) V] defines the fundamental provision of interdisciplinary healthcare for individual clinical profiles. For epilepsy, a corresponding model of integrated care has been developed building on the existing care structure. In addition, it should regulate the participation of the care providers. In this paper, a model for the treatment and documentation of epilepsy patients in general practice is introduced and discussed. The present model provides a basis for negotiation with health insurance companies. However, the readiness of the insurance companies to make contracts is currently rather conservative.     

Tiermodelle der mesialen Temporallappenepilepsie

Clinical Epileptology - Tiermodelle sind in der experimentellen Epilepsieforschung noch immer unverzichtbar, um Beschränkungen in klinischer Forschung zu umgehen. Modelle der mesialen...     

Therapeutisches Management bei Patienten mit tumorassoziierter Epilepsie

Epileptic seizures are common in patients with brain tumors. They occur in up to 60?C80% of patients and depend on entity, malignancy, location, and progression of the brain tumor. Treatment is interdisciplinary and should, thus, be considered in the management of anticonvulsive therapy. Specific aspects arise with respect to interactions between antitumoral and anticonvulsive therapy, which influence the choice of medication. The aim of the present article is to provide an overview of current recommendations for anticonvulsive treatment in brain tumor patients. In addition to the current evidence concerning the individual anticonvulsive drugs, several multimodal therapy principles in the interdisciplinary treatment of brain tumor patients are highlighted.     

Zur Korrelation klinisch-apparativer Differenzialdiagnosen mit neuropathologischen Diagnosen bei Patienten mit Aids

BACKGROUND: During the course of HIV infection, the majority of patients develop opportunistic cerebral neuro-manifestations. If conventional diagnostic tools are not sufficient, a stereotactic biopsy is often necessary. PATIENTS AND METHODS: In order to evaluate the correctness of the clinical diagnosis of cerebral neuro-manifestations in HIV-infected patients, we compared the results of cerebral biopsy or autopsy with the previous clinical diagnosis. A total of 19 biopsies and 49 autopsies could be analyzed. RESULTS: Except for HIV-associated encephalopathy, we detected a very high conformity between the clinical and the neuropathological diagnoses. We obtained the best sensitivity for progressive multifocal leukoencephalopathy (PML), whereas for cerebral toxoplasmosis the worst sensitivity and specificity was identified. CONCLUSION: We conclude that the diagnosis of PML can be made on clinical grounds alone, whereas the diagnosis of cerebral toxoplasmosis and lymphoma often requires a biopsy, which should be performed early.