Ictal Single-Photon Emission Computed Tomography Imaging in Extra Temporal Lobe Epilepsy Using Statistical Parametric Mapping

PURPOSE: To examine the application of statistical parametric mapping (SPM) to analyze ictal single-photon emission computed tomography (SPECT) scans in surgical candidates with extratemporal lobe epilepsy. METHODS: The authors selected patients who underwent successful ictal SPECT acquisition in the process of surgical treatment of intractable partial epilepsy. Thirteen patients were identified who met inclusion criteria for confident seizure localization from either intracranial electroencephalogram recordings or epilepsy surgery outcome. In these cases, ictal scans were registered to an in-house-developed normal SPECT atlas composed of 14 spatially normalized brains of normal subjects. SPM96 was used to test on a voxel-by-voxel basis for statistically significant increases in blood flow associated with each patient's ictal scan. The results were then mapped back onto the patient's magnetic resonance image (MRI) for final interpretation. Statistical parametric mapping (SPM) analysis of ictal SPECT scans was compared to both conventional visual interpretation and the analysis of subtraction ictal SPECT co-registered to MRI (SISCOM). RESULTS: Ten of 13 patient scans showed localizing focal ictal increases in regional cerebral blood flow, all of which were concordant with ultimate epilepsy localization. Of the 3 cases not localized with SPM, 1 was localized by conventional visual interpretation and another, not localized by visual interpretation, was correctly localized with SISCOM. Two cases not localized by SISCOM were localized by both visual and SPM analysis. CONCLUSIONS: This work provides supportive evidence for proof of principle that SPM can be used to provide objective, accurate analysis of ictal SPECT scans in patients with extratemporal lobe epilepsy.     

Following Catastrophic Epilepsy Patients from Childhood to Adulthood

Summary:  As patients with catastrophic epilepsies move from childhood to adulthood, evolving and innovative therapeutic regimens are often required. However, the goal of providing the best quality of life while minimizing both seizures and side effects remains the same. Clinicians can develop appropriate care plans by being aware of patients' changing needs. Clinical symptoms of the catastrophic epilepsies may change over time; by understanding the natural history of a patient's condition, clinicians can help ease the transition from childhood to adulthood. Additionally, as children with catastrophic epilepsies become adults, medical issues (e.g., medication side effects, tolerance, and dependence) and nonmedical issues (e.g., guardian/caretaker issue, group home applications, and respite care options) must be considered when developing strategies for patient care. Regular assessment of patients, the development of emergency plans, and maintenance of consistency in the delivery of care are also important issues to consider. Finally, a multidisciplinary care plan that incorporates resources from health-care practitioners, social service professionals, and community agencies can be valuable in optimizing treatment for patients with catastrophic epilepsies.     

托吡酯对慢性癫(癎)大鼠海马碱性成纤维细胞生长因子表达的影响

目的研究托吡酯（TPM）对慢性癫痫大鼠海马碱性成纤维细胞生长因子（bFGF）表达的影响。方法制作戊四氮（PTZ）慢性癫痫点燃大鼠模型，分为PTZ组、TPM组及正常对照组，每组又以5d、10d、15d3个时间点各分为3小组。免疫组化法观察各组海马CAl、CA3区及齿状回bFGF表达，HE染色观察病理形态学改变。结果（1）行为学观察：PTZ组和TPM组在癫痫发作上无明显差别。（2）bFGF表达：①各组齿状回区bFGF表达：PTZ组和TPM组各时点表达不断增高，与正常对照组比较差异有统计学意义（均P〈0．01），尤以10d及15d时增高更明显，与5d时比较差异有统计学意义（均P〈0．05）。②各组CAl区bFGF表达：PTZ组各时点均有明显表达，且随时间延长而表达不断增高，各时点比较差异有统计学意义（均P〈0．01），与正常对照组比较差异有统计学意义（均P〈0．01）；TPM组在5d时与正常对照组比较差异有统计学意义（P〈0．01），而10d、15d时逐渐下降，接近正常对照组水平。③各组CA3区bFGF表达：5d时3组比较差异无统计学意义。但PTZ组和TPM组在10d时与正常对照组比较差异有统计学意义（P〈0．01），PTZ组在15d时和TPM组及正常对照组比较差异有统计学意义（均P〈0．01）。（3）病理形态学改变：PTZ组和TPM组的海马CAl、CA3区尤其是CAl区可见较多神经元发生变性和坏死，PTZ组更显著。结论PTZ点燃过程中海马bF-GF表达增高，尤其在CAl区，且随时间延长有表达不断增高的趋势。TPM可能通过减少海马神经元损伤而明显下调海马CAl、CA3区bFGF的表达。     

Simple Partial Status Epilepticus Localized by Single-Photon Emission Computed Tomography Subtraction in Chronic Cerebral Paragonimiasis

A patient with chronic cerebral paragonimiasis began to have new motor seizures of the right face manifested by clonic contractions that occurred several hundred times a day, consistent with simple partial status epilepticus. Ictal electroencephalogram discharges started from the left frontal region and then spread to the left hemisphere with left frontal maximum. But clinical seizures were limited to the right face. The frequent partial seizures were controlled by the intravenous infusion of phenytoin. Brain magnetic resonance imaging showed multiple conglomerated round nodules with encephalomalacia in the left temporal and occipital lobes. Applying the technique of ictal-interictal single-photo emission computed tomography subtraction, the authors were able to localize the focal ictal-hyperperfusion on left precentral cortex adjacent to the lesions that correspond to the anatomical distribution of left face motor area.     

Phosphorylation of brain (Na+,K+)-ATPase alpha catalytic subunits in normal and epileptic cerebral cortex: I. The audiogenic mice and the cat with a freeze lesion.

Partially purified (Na+,K+)-ATPase (E.C. 3.6.1.3.) was investigated in the epileptic cortex of audiogenic DBA/2 mice and in the primary and secondary foci of cats with acute or chronic freeze lesions. No differences in specific activities measured at 3 mM K+ were observed between epileptic and control cortex, except an increase of enzymic activities in the primary focus of acutely lesioned cats. The (Na+,K+)-ATPase catalytic subunits were resolved by SDS-gel electrophoresis and their phosphorylation levels were measured in presence of K+ ions and phenytoin. K+ was more effective in inducing maximal dephosphorylation of (Na+,K+)-ATPase in C57/BL, with identical affinity in the two strains. Phenytoin decreased the net phosphorylation level of (Na+,K+)-ATPase by about 50% in C57/BL mice, but only by 20% in DBA/2 mice. Both K+ and phenytoin dephosphorylating influences were decreased in primary and secondary foci of acutely lesioned cats. Those changes were limited to the alpha(-) subunit. In chronic cats, the dephosphorylating step of the (Na+,K+)-ATPase catalytic subunit recovered a normal affinity to K+, but its sensitivity to phenytoin remained decreased. Those differences in K+ and phenytoin influences on brain (Na+,K+)-ATPases between control and epileptic cortex might be responsible for the ictal transformation and seizure spread. In cats, the alteration of the alpha(-) isoform could mainly affect the glial cells.     

视频脑电图诊断儿童癫痫128例

目的 分析视频脑电图（Video-EEG)在小儿癫痫诊断，分类中的应用价值及癫痫发作期的EEG特点。临床诊断的癫痫患儿128（男94，女34）例，1mo-14岁，平均年龄5．4岁，应用伟思VEEG1161B型视频脑电图仪，对患儿进行至少4－6h包括清醒与睡眠期的临床和EEG监测。监测中对各种状态及事件进行标记，结束后将EEG信号与临床录象资料同步回放并逐秒分析。结果 128例癫痫患儿中有54例（42．2％）进一步确定了癫痫综合征的诊断，其中儿童良性癫痫伴中央－颞区棘波25例，儿童失神癫痫3例，少年肌阵挛癫痫1例，额叶癫痫5例，West综合征13例，Lennox-Gastaut综合征7例，有49例（38．3％）可明确其发作类型，其中强直或（和）阵挛发作10例，部分性发作33例，肌阵挛发作5例，失张力发作1例，另外有25例（19．5）尚无法分类。结论 视频脑电图 是诊断癫痫及明确癫分类的可靠检查方法。     

大鼠马桑内酯急性局灶型癫痫大脑运动皮质的形态计量研究

用微量马桑内酯注入Ｗｉｓｔａｒ大鼠左侧前肢运动皮质，造成急性局灶型癫痫。用光镜、电镜和体视学方法研究其运动皮质第Ｖ层结构的改变。结果显示：癫痫大鼠运动皮质灶区、灶旁区的神经细胞数和胶质细胞数均分别比对照大鼠灶区和灶旁区显著减少；灶区神经毡中突触性终末数，显著减少；突触性终末的面积分数明显减少，而树突的面积分数无变化；神经胶质突起的面积分数增加。     

原发全身性癫痫遗传流行病学研究

本文报道１００例原发全身性癫痫家系的遗传流行病学研究结果。先证者一级亲属患病率为６．８６％，二级亲属为１．０３％；分别是对照组一级亲属的１３．８３倍和２．０８倍。原发全身性癫痫的遗传度为：一级亲属０．７５２１±０．０６７８，二级亲属０．３５９２±０．０７４６；加权平均０．５７４３±０．０５０２。说明遗传因素起重要作用。发病年龄影响因素分析表明：原发全身性癫痫有一定年龄依从性。ＥＥＧ家系分析显示，该型癫痫一级亲属癫痫样放电明显高于对照组一级亲属，提示癫痫样放电的遗传倾向。     

颅内神经节细胞胶质瘤(附8例报告)

目的探讨颅内神经节细胞胶质瘤的临床特征及治疗效果。方法回顾性分析8例颅内神经节细胞胶质瘤的临床资料。结果平均发病年龄27岁,肿瘤位于大脑半球6例,脑干2例。临床表现主要为癫,影像学检查无特异性表现。显微手术全切5例,大部切除3例,放、化疗4例。随访3个月～5年,7例症状明显缓解,1例复发。结论神经节细胞胶质瘤呈相对良性过程,癫为其主要临床表现,治疗上应手术全切;对有术后残留或间变者可给予放、化疗,预后相对良好。