Gelastic seizures due to right temporal cortical dysplasia.

Gelastic seizures are an uncommon seizure type. They are most frequently observed in patients with hypothalamic hamartoma. Their association with other types of cerebral lesions is rare. Depending on the location of the lesion, gelastic seizures may or may not be accompanied by a subjective feeling of mirth. The pathophysiological mechanisms of this type of seizure are still undefined, and little is known about which pathways promote laughter and its emotional content, mirth. We present a young man with drug-resistant, gelastic seizures due to focal cortical dysplasia of the right inferior temporal gyrus. The lesion was evident on cranial MRI. Interictal EEG displayed a right temporal focus, whereas ictal EEG was not informative. Ictal loss of consciousness precluded reporting of any possible emotional experience. The patient underwent surgical resection of the lesion and has been seizure-free with anti-epileptic medication for two years. Although various anatomical regions may elicit laughter, in view of the current literature it seems that the anterior cingulate region is involved in the motor aspects of laughter, while the basal temporal cortex is involved in the processing of mirth. The fact that the present case exhibited gelastic seizures stresses once more the importance of the baso-lateral temporal cortex in the genesis of this type of seizures.[Published with video sequences].     

Time distribution of seizures during long-term video-EEG monitoring.

The purpose of this study was to investigate the duration of monitoring, number of seizures recorded, and date and time of occurrence of seizures in different patient groups during video-EEG monitoring (VEEGM). Patients with partial or psychogenic seizures who were admitted to our VEEGM unit between September 1996 and March 2002 were retrospectively evaluated. Duration of monitoring, date and time of occurrence of seizures were identified in each patient. For practical reasons, a day was divided into 3 equal time periods (period 1: 08-16; period II: 16-24 and period III: 24-08 hrs), and the period in which the seizure occurred was noted. Patients were classified in 5 groups: 1-temporal; 2-frontal; 3-parieto-occipital; 4-psychogenic and 5-unclassified. Duration of monitoring, the number of seizures recorded and time distribution of seizures were identified in each group and compared statistically. We evaluated 746 seizures in 209 patients. Seizures were more likely to occur in periods I and III in groups 1 (p = 0.004) and 5 (p < 0.001). In group 4 they were more likely to occur in periods I and II (p < 0.001). Duration of monitoring was not statistically different between the groups. However, the number of seizures recorded varied significantly (p = 0.006). Patients in group 5 had the greatest number of seizures and were followed by groups 2, 4, 3 and 1, respectively. Groups also differed according to date of seizure occurrence (p < 0.001). We conclude that the number of seizures recorded and time distribution of seizures during VEEGM are influenced by the lobe of onset of seizures.     

Mu-opioid receptor binding measured by [11C]carfentanil positron emission tomography is related to craving and mood in alcohol dependence.

BACKGROUND: The endogenous opioid system has been linked to alcohol dependence through animal and human studies. We investigated the relationship between alcohol craving and brain mu opioid receptors (mu-OR) in alcohol-dependent subjects. METHODS: Regional brain mu-OR binding potential (BP) was measured using [(11)C]carfentanil positron emission tomography in eight male alcohol-dependent subjects undergoing alcohol withdrawal and eight matched control subjects. Self-reported alcohol craving, withdrawal, and mood were measured. RESULTS: Lower mu-OR BP was associated with higher craving in the right dorsal lateral prefrontal cortex, the right anterior frontal cortex, and right parietal cortex. In these regions, alcoholics showed lower mean mu-OR BP compared with control subjects. Mu-OR BP in four other brain regions also correlated with craving, but there were no group differences in receptor binding potential. Mu-OR BP also correlated with depressive symptoms in five brain regions, three of which were identified in the craving analyses. CONCLUSIONS: Results show a strong functional relationship between alcohol craving, mood, and mu-OR binding in specific brain regions of recently abstinent, alcohol-dependent men.     

Acute Liver Failure following Sleeve Gastrectomy with Jejuno-Ileal Bypass

IntroductionLaparoscopic sleeve gastrectomy (LSG) is one of the most commonly performed bariatric surgery in recent years, and some modifications have emerged to improve its efficacy. Melissas has described SG plus jejuno-ileal bypass (JIB), which has reported good results in a few studies. We performed this procedure in 21 cases and in one case, we observed acute liver failure (ALF) that has not been reported before.Case presentationA 38-year-old female (BMI: 56.1 kg/m²) underwent laparoscopic SG plus JIB. There was no sign of diarrhea, malnutrition or liver failure for eight months and her BMI was 43.0 kg/m². At the 9th month, she was hospitalized for abdominal pain, jaundice and ALF. The patient was treated by plasmapheresis and molecular absorptive recirculation system. She was planned to undergo liver transplantation but died of multiorgan failure on the 40th day of hospitalization.ConclusionALF can be observed following SG plus JIB. JIB reversal before compromising liver functions should be taken into consideration.     

Non-malignant thoracic pathologies of the women of reproductive age. Can we suggest to collect them under the same heading?

The reproductive age covers approximately 1/3 of a woman's life and have many hormone-related problems causing many admissions to gynecology clinics. Beside these pathologies, there are also some respiratory system related diseases making women to admit pulmonology clinics. In this article, we want to focus attention of gynecologists, chest physicians, thoracic surgeons and primary care physicians to these pathologies which could be collected under the same heading "Non-malignant thoracic pathologies of the women of reproductive age".     

Unilateral lid retraction with contralateral oculomotor paresis

A patient is presented with acute onset of partial oculomotor paresis on one side and upper eyelid retraction on the other due to a vascular insult. An electromyographic study revealed frontalis muscle overactivity on the side of lid retraction which has never been documented before, indicating that not only was the supramotor control over the central caudal nucleus affected as previously proposed, but the inhibition of the frontalis muscle motoneurons was also disrupted. Based on these data, a premotoneuronal system is proposed that controls upper eyelid movements by affecting the frontalis muscle and orbicularis oculi muscle motoneurons in addition to the central caudal nucleus.     

Clinical Assessment of Topiramate Therapy in Patients With Migrainous Vertigo

( Headache 2010;50:77-84)
Objective.— To assess the efficacy of topiramate in reducing both the frequency and the severity of vertigo and headache attacks in patients with migrainous vertigo and to compare 50 and 100 mg/day doses of the drug.
Methods.— Thirty patients diagnosed as definite migrainous vertigo were recruited in the study. Vertigo and headache frequency was determined as the monthly number of attacks whereas severity was determined by visual analog scales measured in millimeters from 0 to 100. Patients were randomized to either 50 or 100 mg/day topiramate for 6 months. Vertigo and headache frequency and severity were evaluated at the end of the study period.
Results.— Number of mothly vertigo attacks decreased significantly in the overall group after treatment (median from 5.5 to 1; P  < .01). The same was true for monthly headache attacks (median from 4 to 1; P  < .01). A statically significant improvement in vertigo severity was noted (median from 80 to 20 mm; P  < .01). Headache severity showed significant improvement as well (median from 60 to 30 mm; P  < .01). No statistically significant difference between high- and low-dose groups was present regarding efficacy ( P  > .05). Four patients in the high-dose group discontinued treatment at the end of the first month because of adverse effects.
Conclusions.— In the overall group, topiramate was found to be effective in reducing the frequency and the severity of vertigo and headache attacks. Both doses of the drug were equally efficacious. The 50 mg/day dose seems to be appropriate as higher adverse effects were noted when 100 mg/day was used.