Stereotactic cortical resection in non-lesional extra-temporal partial epilepsy

The presentation and treatment of a patient with extra-temporal non-lesional partial epilepsy is discussed herein. His clinical semiology was consistent with supplementary motor area seizures; however, MR imaging did not demonstrate a lesion. A region of stable cortical glucose hypermetabolism in the left frontal region was noted with 2-fluoro-2-deoxy-D-glucose (FDG)-PET. This was consistent with the frequent interictal discharges evident over the left fronto-temporal region and the stereotypic high amplitude ictal discharges arising with highest amplitude from the left frontal region. Epileptiform activity evident on an intracranial 64-point subdural recording grid placed over the left dorsolateral frontal cortex confirmed a distribution concordant with FDG-PET findings. The subsequent resection was guided by the PET and EEG findings rather than structural MR imaging, and a limited cortical resection led to an immediate and substantial reduction in seizure frequency.     

Association of TNF-alpha -308 G/A and IL-4 -589 C/T gene promoter polymorphisms with asthma susceptibility in the south of Iran.

BACKGROUND: Both tumor necrosis factor alpha (TNF-alpha) and interleukin (IL) 4 have been implicated in the pathogenesis of asthma. Furthermore, a G/A substitution at position -308 of the TNF-alpha gene promoter and a C/T substitution at position -589 of the IL-4 gene promoter have been associated with increased production of TNF-alpha and IL-4, respectively. OBJECTIVE: The aim of the present study was to analyze the association between TNF-alpha-308 G/A and IL-4-589 C/T polymorphisms and susceptibility to asthma in a group of patients from southern Iran. METHODS: We analyzed the frequency of TNF-alpha -308 G/A and IL-4-589 C/T polymorphisms in a total of 203 asthmatic patients compared to 113 nonasthmatic control subjects. RESULTS: An association was observed between the TNF-alpha -308 G/A polymorphism and susceptibility to asthma in patients with a ratio between forced expiratory volume in 1 second and forced vital capacity of less than 75% compared with normal subjects; however, the association did not achieve statistical significance (P = .054). The IL-4-589 C/T polymorphism was associated with asthma susceptibility (P = .02). In addition, the association between this polymorphism and asthma severity approached statistical significance (P = .07). CONCLUSION: These results provide further evidence for a role of TNF-alpha-308 G/A and IL-4-589 C/T polymorphisms in susceptibility to and severity of asthma. Further studies involving a larger number of patients may help to confirm our observations.     

Treatment of overactive bladder (OBA) with anti-cholinergic drugs and the risk of glaucoma.

Overactive bladder (OAB) and glaucoma are prevalent and frequently co-exist, particularly in the elderly. Anti-cholinergic drugs are the cornerstone of medical management of OAB. There is a great deal of confusion about the safety of use of the anti-cholinergic medication regarding the risk of glaucoma. This review examines the pharmacological relationship of anti-cholinergic medications used to treat OAB and the various types of glaucoma.     

Mechanistic insight into the dermal delivery from nanoparticle-coated submicron O/W emulsions

The influence of silica nanoparticle coating of negatively and positively charged submicron emulsion oil droplets on the dermal delivery of a lipophilic fluorescent probe, acridine orange 10-nonyl bromide (AONB) using an ex vivo porcine skin model is reported. The skin retention and depth of the penetration of AONB significantly increased (p ≤ 0.05) up to a skin depth of ～265 µm by nanoparticle coating of negative lecithin-stabilised emulsion oil droplets especially when nanoparticles were added from the water phase. The extent and depth of penetration of AONB incorporated into positively charged silica-coated oleylamine-stabilised emulsions significantly increased up to the upper dermis (～290 µm) with more pronounced effect by nanoparticle incorporation from the water phase of the control oleylamine emulsion. The permeation of AONB through full-thickness porcine skin was negligible (<0.12% of the topically applied dose). The skin penetration profile of AONB was well correlated to the more facilitated transport of the electrostatically bond silica–AONB complex compared to free AONB as one of the potential mechanisms of the improved delivery. The skin permeation of silica nanoparticles was negligible (<1 µg mL^?1 after a 6-h exposure time) which demonstrated the potential of nanoparticle-coated emulsions for topical targeting. © 2009 Wiley-Liss, Inc. and the American Pharmacists Association J Pharm Sci 99:890–904, 2010     

Efficacy of surgical treatment of de novo, adult-onset, cryptogenic, refractory focal status epilepticus

BACKGROUND: There have been few published reports of successful surgical treatment of focal status epilepticus. Surgical intervention is considered a last resort after medical strategies have been exhausted. OBJECTIVE: To report a case of an adult who was initially seen with de novo, medically refractory, cryptogenic focal status epilepticus and underwent resection of an electrographically defined portion of the left middle frontal gyrus with multiple subpial transections of the adjacent cortex resulting in termination of the electroclinical seizure activity. DESIGN: Report of a case of successful surgical treatment of cryptogenic focal status epilepticus. INTERVENTION: After an initial 35 days of oral antiepileptic drug therapy and subsequent 16 days of continuous electroencephalography-guided intravenous antiepileptic drug therapy in an intensive care unit setting, and after extensive preoperative and intraoperative characterization of the epileptogenic zone, a tailored resection of the left middle frontal gyrus with multiple subpial transections of the surrounding cortex was performed. RESULTS: The restricted surgical resection and multiple subpial transections terminated the seizure activity. Neuropathological examination of the resected tissue revealed moderate inflammatory changes and a few abnormally located neurons without any definitive evidence of dysplasia, which was suspected preoperatively. CONCLUSIONS: We suggest that focal cortical resection may be an appropriate intervention in medically refractory focal status epilepticus even when an overt structural etiology is not evident preoperatively and should be considered as an option at the onset of intractability.     

Consistent linear and non-linear responses to invasive electrical brain stimulation across individuals and primate species with implanted electrodes

BackgroundElectrical neuromodulation via implanted electrodes is used in treating numerous neurological disorders, yet our knowledge of how different brain regions respond to varying stimulation parameters is sparse.Objective/HypothesisWe hypothesized that the neural response to electrical stimulation is both region-specific and non-linearly related to amplitude and frequency.MethodsWe examined evoked neural responses following 400 ms trains of 10–400 Hz electrical stimulation ranging from 0.1 to 10 mA. We stimulated electrodes implanted in cingulate cortex (dorsal anterior cingulate and rostral anterior cingulate) and subcortical regions (nucleus accumbens, amygdala) of non-human primates (NHP, N = 4) and patients with intractable epilepsy (N = 15) being monitored via intracranial electrodes. Recordings were performed in prefrontal, subcortical, and temporal lobe locations.ResultsIn subcortical regions as well as dorsal and rostral anterior cingulate cortex, response waveforms depended non-linearly on frequency (Pearson's linear correlation r < 0.39), but linearly on current (r > 0.58). These relationships between location, and input-output characteristics were similar in homologous brain regions with average Pearson's linear correlation values r > 0.75 between species and linear correlation values between participants r > 0.75 across frequency and current values per brain region. Evoked waveforms could be described by three main principal components (PCs) which allowed us to successfully predict response waveforms across individuals and across frequencies using PC strengths as functions of current and frequency using brain region specific regression models.ConclusionsThese results provide a framework for creation of an atlas of input-output relationships which could be used in the principled selection of stimulation parameters per brain region.     

Clinical profile of gastric cancer in Khuzestan, southwest of Iran

AIM: To analyze the characteristics of epidemiological, clinical and survival patterns among patients with carcinoma of the stomach. METHODS: We retrospectively studied the characteristics of 186 gastric adenocarcinoma patients at Ahwaz Jundishapur University Hospitals (AJSUH) from September 1, 1996 to September 1, 2002. All the patients had histopathologicallyconfirmed malignancy. Demographic variables, family history of gastric cancer (GC), clinicopathologic characteristics and treatment-related variables were analyzed. Univariate analysis was performed with the log-rank test and multivariate analysis with Cox regression. P < 0.05 was considered statistically significant. RESULTS: Male to female ratio was 2.6:1. The mean age was 60.6 years and 14% of the patients were younger than 40 years. Adenocarcinoma, gastric lymphoma, and gastric metastasis were found in 94.5%, 2.3%, and 3% patients, respectively. There was an average of 6-mo delay between the initial symptoms and the diagnosis. Among adenocarcinoma groups, intestinal type was the commonest (55.9%) and the distal third was the most common localization (88.4%). One hundred and thirty-four patients (72.1%) were males. Thirty-one patients (17%) had a family history of GC. Surgery was performed in 90% of patients (non-curative). CONCLUSION: The epidemiological features of GC in south Iran mimic those in high-risk areas. There is a higher frequency of GC in young patients at our institution. Patients are detected and treated after a relatively long delay. Most patients present in advanced stages, which favors a poor overall survival. Family history of GC has a significant problem in our area. Studying the etiology of this cancer in south Iran and earlier diagnosis and subsequent better cares are recommended.