Functional Magnetic Resonance Imaging in Partial Epilepsy

Summary: Functional magnetic resonance imaging (FMRI) detects signal changes in brain that accompany regional changes in neuronal activity. In normal human brain, FMRI shows changes in signal in the postcentral gyrus or superior temporal gyrus that correlate with voluntary motor activity or language processing, respectively. The model used to explain the changes in signal linked temporally with cerebral activity is a reduction in cerebral capillary deoxyhemoglobin concentration due to the increased blood flow that accompanies neuronal activity in the cerebrum. FMRI has been used in normal subjects but not extensively in patients. To determine the feasibility of using FMRI to map cerebral functions in patients with partial epilepsy syndromes, we performed a pilot study, using FMRI to identify signal changes in motor and language areas in response to tasks that activate those areas. Signal changes in epilepsy patients approximated those observed in volunteers. We conclude that FMRI can be developed as a method for functional cerebral mapping in partial epilepsies.     

Bilateral loss of vision in bright light

We describe four patients with episodic bilateral vision impairment related exclusively to light exposure. Each had angiographically documented bilateral high-grade stenosis or occlusion of the internal carotid arteries. This phenomenon appears to be related to bilateral simultaneous retinal ischemia delaying regeneration of visual pigments in the pigment epithelial layer. It must be distinguished from bilateral occipital lobe ischemia caused by vertebrobasilar system disease.     

Waterloo Vision and Mobility Study: Normal gait characteristics during dark and light adaptation in individuals with age-related maculopathy

The purpose of this study was to evaluate the gait responses of individuals with low vision compared to those of normal-visioned individuals when their vision is challenged by extreme levels of light. Twenty subjects with age-related maculopathy (ARM) and 20 subjects with normal vision first walked along a flat, unobstructed path immediately after the ambient light level was changed from low (5 lux) to high (2500 lux). The procedure was repeated after the light was reduced from the high to the low level. Muscle activity, temporal and kinematic variables, and ground reaction forces were used to detect gait characteristics because of ambient light level changes. Data suggested that ARM subjects walked slower and with more caution than normal subjects but that these differences were not related to ambient light level. Head angle, an estimate of gaze direction, was lower for ARM subjects during high light, but the gaze direction for both groups was low during low light. Among these ARM subjects, extreme levels of ambient light did not affect gait; subjects made adaptations that were reasonable to encourage safe ambulation, despite the direction of light change. Normal-visioned individuals in this study experienced more difficulty in low light than high light situations.     

Cancer of the oral cavity and Mohs surgery

Malignant tumors of the oral cavity make up approximately 4% of all cancers occurring in men and 2% in women. In spite of this relatively small incidence, the functional and cosmetic disabilities resulting from this disease produce a profound impact on those stricken. Although the oral cavity is one of the most accessible areas to inspection and palpation, most patients developing oral cavity cancer present with advanced disease. Regional metastases are present in approximately 30% of these patients. A number of therapeutic modalities are available for management of cancer of the oral cavity. The most important include surgical excision, radiation therapy, chemotherapy, or a combination of two or more of these modalities. Surgery and radiotherapy are equally successful in controlling smaller tumors, but advanced tumors are best treated with a combination of surgery and irradiation with or without the addition of chemotherapy. Although combined therapy continues to become more common, it has had little impact on survival rates. Most patients dying of oral cavity cancer die of local regional disease. It is this group of patients that will benefit from newer surgical approaches that can provide an opportunity to increase control of local disease. We believe that an interdisciplinary approach combining the skills of the head and neck oncologic surgeon and the Mohs surgeon may provide a more effective method of controlling oral cancer, while at the same time lessening the functional and cosmetic deformities that frequently result following surgical treatment of this disease. Complete microscopic analysis of all surgical margins (as opposed to random analysis of isolated margins) theoretically should ensure better local control of cancers involving the oral cavity.     

Reversal of the sexually dimorphic distribution of serotonin-immunoreactive fibers in the medial preoptic nucleus by treatment with perinatal androgen

A small, discrete nucleus at the rostral end of the third ventricle, the anteroventral periventricular nucleus (AVPv), has been reported to be involved in the control of gonadotropin release. Since monoaminergic neurotransmitter systems have also been implicated in this function we used an indirect immunohistochemical approach to examine the distribution of 3 monoaminergic neurotransmitter systems in this nucleus. Sections through the AVPv of both colchicine and non-colchicine-treated adult male and female Sprague-Dawley rats were processed for immunohistofluorescence with antisera directed against tyrosine hydroxylase (TH), dopamine beta-hydroxylase (DBH), or serotonin (5-HT), and were subsequently counterstained with the fluorescent Nissl stain ethidium bromide. The distributions of TH-, DBH- and 5-HT-immunoreactive neural elements within the AVPv were evaluated and a comparison was made between males and females. In both sexes, few 5-HT-stained fibers were seen within the borders of the AVPv, in contrast to the relatively high 5-HT-stained fiber density of the surrounding region. A dramatic sexual dimorphism was found in the distribution of TH-immunoreactive fibers and cell bodies. Compared to males, the AVPv in the female contained 3-4 times as many TH-stained perikarya, and a 2- to 3-fold greater density of TH-stained fibers. A low to moderate density of DBH-immunoreactive fibers, and no DBH-stained cell bodies, were seen in the nucleus. A clear sex difference was not found in the density of DBH-stained fibers in the AVPv, indicating that the sexual dimorphism in TH-immunoreactive neural elements in this nucleus is due to a greater density of dopaminergic fibers and a greater number of dopaminergic cell bodies in the female. These results suggest that dopamine may participate in the control of gonadotropin secretion at the level of the AVPv.