Clinical differences in patients with unilateral hippocampal sclerosis and unitemporal or bitemporal epileptiform discharges

PURPOSE: To investigate factors determining the presence of bilateral interictal epileptiform discharges (IEDs) in temporal lobe epilepsy (TLE) with unilateral hippocampal sclerosis (HS). METHODS: We analysed data of 243 TLE patients with unilateral HS who had long-term video-EEG. Eighty-one patients (33%) had bitemporal IEDs. RESULTS: We categorised patients into a unilateral group (UG), a bilateral group (BG) according to presence of bitemporal IEDs. We found no difference between UG and BG regarding epilepsy duration, secondarily generalised seizures, and history of febrile seizures. Mean seizure frequency was significantly higher in the BG (UG: 7.7+/-14.7 seizures/month; BG: 13+/-35 seizures/month, P=0.01). We found a significant correlation between late epilepsy onset and the presence of bitemporal IEDs. The mean age at epilepsy onset in UG was 10.1+/-7.9 years, while in BG it was 13+/-9.2 years (P=0.02). CONCLUSIONS: The traditional concept of the evolution of mirror focus cannot apply for humans because the duration of epilepsy does not influence the evolution of bitemporal IEDs. Other factors, i.e. age at onset and seizure frequency may play a role in this process. The association between the higher seizure frequency and mirror foci indicates that the development of mirror focus depends on seizures and not on a progressive 'interictal' epileptogenesis.     

Strong relationship between NT‐proXNP levels and cardiac output following cardiac surgery in neonates and infants

Background: NT‐proXNP, a new natriuretic peptide analyte, incorporates information about the concentrations of both N‐terminal pro‐atrial and pro‐brain natriuretic peptides (NT‐proANP, NT‐proBNP). We aimed to investigate whether NT‐proXNP is a reliable indicator of the cardiac index (CI) and the hemodynamic state in neonates and infants undergoing an open heart surgery. Methods: We enrolled 26 children under the age of 1 year into this prospective study. All patients underwent an elective cardiac operation with cardiopulmonary bypass (CPB) to achieve complete biventricular repair. Peri‐operative hemodynamic parameters were assessed by transpulmonary thermodilution and natriuretic peptide levels were recorded. Results: The NT‐proXNP level correlated significantly with the simultaneously measured NT‐proANP level (r=0.60, P<0.001), but more strongly with the NT‐proBNP level (r=0.89, P<0.001) and the arithmetic sum of both (r=0.88, P<0.001). NT‐proXNP had a strong correlation with CI (r=?0.85, P<0.001), the stroke volume index (r=?0.80, P<0.001) and the global ejection fraction (r=?0.67, P<0.009) throughout the post‐operative period. Conventionally measured parameters such as heart rate, mean arterial pressure and pulse‐pressure product exhibited weaker correlations with CI than NT‐proXNP. Among laboratory values, creatinine levels correlated significantly with CI (r=?0.77, P<0.001) and NT‐proXNP (r=0.76, P<0.001) during the post‐operative period. A post‐operative NT‐proXNP level of 3079 pmol/l was diagnostic for CI <3 l/min/m² with 89% sensitivity and 90% specificity (area under the curve: 0.91 ± 0.05). Conclusion: NT‐proXNP is a good marker of cardiac output following pediatric cardiac surgery and might be a useful tool in the recognition of a low output state.