Identifying homologous anatomical landmarks on reconstructed magnetic resonance images of the human cerebral cortical surface

Guided by a review of the anatomical literature, 36 sulci on the human cerebral cortical surface were designated as homologous. These sulci were assessed for visibility on 3-dimensional images reconstructed from magnetic resonance imaging scans of the brains of 20 normal volunteers by 2 independent observers. Those sulci that were found to be reproducibly identifiable were used to define 24 landmarks around the cortical surface. The interobserver and intraobserver variabilities of measurement of the 24 landmarks were calculated. These reliably reproducible landmarks can be used for detailed morphometric analysis, and may prove helpful in the analysis of suspected cerebral cortical structured abnormalities in patients with such conditions as epilepsy.     

妊娠合并癫痫16例临床分析

目的探讨妊娠合并癫痫临床处理。方法回顾性分析16例妊娠合并癫痫孕妇服抗癫痫药情况、癫痫发作频率变化及妊娠结局。结果妊娠合并癫痫发生率0.078%,原发性4例,继发性12例。全身性癫痫发作13例（2例癫痫持续状态）,局部癫痫发作3例。孕期发作频率增加者5例,无变化者6例。孕期新发现单次发作5例。孕期未用抗癫痫药物（AEDs）3例,间断用药1例,连续用药7例,均为单一AEDs治疗。顺产4例,剖宫产10例,人工流产2例。新生儿出生无窒息,平均出生体重2852g,无新生儿出生缺陷,无新生儿死亡。母亲亦无产科并发症发生。2例人工流产孕妇癫痫持续状态、吸入性肺炎死亡,1例智力低下孕妇产后卡马西平中毒昏迷,抢救成功。结论妊娠可诱发并使癫痫发作频率增加。孕期用AEDs可控制癫痫发作。应采用单一AEDs治疗,且应按时监测血浆中AED及叶酸水平。     

颞叶癫痫的临床特点与脑电图分析

目的：分析颞叶癫痫患的临床特点及脑电图定位的意义。方法：回顾分析92例颞叶癫痫患的脑电图。结果：左颞有癫痫样波42例，右颞有癫痫样波29例，双颞有癫痫样波21例，临床表现与癫痫样波发放部位有关，癫痫波的传导主要有容积传导和神经传导方式。结论：结合患临床表现与脑电图癫痫样波起始部位分析有助于致痫灶的定位。     

动态脑电图对癫痫诊断和鉴别诊断的意义

对临床诊断癫痫的５３例和可疑癫痫的１１７例行２４ｈ动态脑电图（ＡＥＥＧ）监测。结果ＡＥＥＧ阳性率（３２．９％）明显高于常规ＥＥＧ（２０％），ＡＥＥＧ痫样放电率在癫痫组为５４．７％（２９／５３），可疑癫痫组为１５．４％（１８／１１７）。后者中有临床发作者６３例，检出痫样放电１０例，睡眠期出现痫样放电占８９．４％（４２／４７）。本文对痫样放电出现与临床发作间的关系以及癫痫诊断和鉴别诊断进行了讨论。     

常染色体显性遗传性枕叶癫癎临床与脑电图1家系6例报告

目的：报道常染色体显性遗传性枕叶癫痫一家系6例。方法：对先证者进行详尽的临床、脑电图(EEG)、录像脑电图(Video—EEG)、头MRA观察。结果：此家系祖孙三代6例，男性女性均有发病，患者大多为8～15岁起病，主要症状为发作性视幻觉、偏身麻木、头痛、呕吐。先证者EEG、Video—EEG、头颅MRA未见异常，家系中继发全面性强直阵挛发作患者EEG见枕颞区异常放电。结论：该家系患者的临床表现、EEG均符合枕叶癫痫诊断，并排除了颅内占位性及血管性病变。该家系符合常染色体显性遗传规律。     

Psychomotor impairment and anticonvulsant therapy in adult epileptic patients

Summary Using a battery of simple tests, psychomotor performance was assessed in 11 healthy subjects, 14 untreated epileptic patients and 66 epileptics on chronic anticonvulsant medication. Significant differences were found between controls and untreated patients for choice reaction time, card sorting and Simple Simon memory game. Treated patients performed less well than both untreated epileptics and controls in choice reaction time (p<0.05; p<0.001), card sorting (p<0.01; p<0.001), Simple Simon (p<0.05; p<0.001) and finger tapping (p<0.05; p<0.001). Patients with centrencephalic epilepsy were slower than those with discrete focal EEG abnormalities in reaction time and card sorting. Patients receiving treatment with carbamazepine, phenytoin or sodium valproate alone all performed similarly to each other and to those patients taking anticonvulsant polypharmacy. Monotherapy patients with potentially toxic plasma anticonvulsant concentrations did no worse than those within or below the therapeutic range. Both the disease and its treatment reduce psychomotor performance. All major anticonvulsants appear to cause a similar degree of impairment across a wide range of concentrations. The effect of chronic anticonvulsant medication on quality of life should not be neglected in the pursuit of perfect seizure control.     

Partial epilepsy in neurologically normal children: clinical syndromes and prognosis

A clinical and electroencephalographic study of 107 neurologically normal children with partial seizures was undertaken to verify the existence and determine the frequency of epileptic syndromes reported in selected populations. Sixty-three children had simple partial seizures, 39 had complex partial seizures, and 5 children were unclassifiable. The syndrome of benign partial epilepsy of children with rolandic spikes (BPEC, 38 cases) was clearly identified and its uniformly benign final prognosis was confirmed even if some of these children had at times severe or poorly controlled seizures. Among the children with simple partial seizures outside the BPEC (25 cases) and complex partial seizures (39 cases), no homogeneous clinical or electroclinical subgroup could be found. Two children with benign partial epilepsy and myoclonic-astatic seizures ("atypical benign partial epilepsy of childhood") and one child with "benign epilepsy with occipital spike-waves" were identified. 74% of children with epilepsy with complex partial seizures (ECP) had a 1-year seizure-free interval, and many children with epilepsy with simple partial seizures outside the BPEC group (ESP) had no more than two seizures. A benign course is thus not limited to the BPEC but is difficult to predict. Prospective studies are necessary to confirm the existence of well-defined benign syndromes among the idiopathic partial epilepsies of childhood, which appear quite rare outside the BPEC.     

Early prognosis of epilepsy. Effects of treatment in the first follow-up year

A multicenter prospective investigation was conducted in 17 teaching and general hospital in Italy to assess the efficacy of the care delivered to previously untreated patients with epilepsy. 175 cases were included and allocated to monotherapy. Only 112 cases completed the first year of follow-up. Of these, 59 (52.7%) were completely controlled and 53 (47.3%) had one or more seizure relapses. Controlied and uncontrolled patients were compared with respect to the main variables believed to influence non-responsiveness to standard therapy. The proportion of cases with relapses was significantly associated with the number of seizures reported before treatment was started. Selected seizure patterns (absences, myoclonic seizures) and prolonged disease duration were also reported more frequently among patients with recurrences. The implications of these findings are discussed with respect to drug response and prognosis of epilepsy.

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Sommario Il presente studio consiste in una indagine prospettica multicentrica condotta in 17 centri ospedalieri italiani sulla efficacia del trattamento e sulla prognosi della malattia in pazienti con epilessia alla prima diagnosi. Dei 175 casi ammessi allo studio, 112 hanno completato il primo anno di osservazione. Di questi, 59 (52,7%) risultavano completamente controllati e 53 (47,3%) avevano presentato una o più crisi durante il follow-up. Le principali variabili ritenute responsabili di una insoddisfacente risposta al trattamento vennero quindi esaminate nei due gruppi. Il rischio di recidiva di crisi risultava significativamente correlato al numero di crisi presentate prima del trattamento. Inoltre, i pazienti con crisi nel follow-up presentavano una maggior durata di malattia o specifici tipi di crisi (assenze, crisi miocloniche). Il significato di tali dati è discusso in riferimento alle modalità di trattamento e agli altri fattori implicati nella prognosi dell'epilessia.

     

Rolandic paroxysmal epilepsy: a long term study in 150 children

150 children with Rolandic paroxysmal epilepsy (RPE) aged 3 to 12 years were followed up clinically and by EEG for 16 years. Antiepileptic drugs were administered initially for 2 years and then suspended for 6–12 months. Treatment was resumed in the 29 patients who had seizures during the drug-free interval and was maintained for a further 5 years.80.6% of all patients were in clinical remission after the 2-year treatment period. Some patients had seizures while on drugs, others during the drug-free interval. Seizure frequency declined with age. No seizures occured after the age of 14 or in the 8 years following final discontinuation of drug therapy. The need for prolonged drug treatment is therefore questioned.

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Sommario 150 bambini affetti da Epilessia a Parossismi Rolandici, di età compresa tra i 3 e i 12 anni, sono stati tenuti sotto controllo clinico ed elettroencefalografico per un periodo di sedici anni.È stato effettuato un trattamento con farmaci antiepilettici per 2 anni. Dopo 6/12 mesi di wash-out farmacologico, in 29 pazienti che hanno manifestato crisi, la terapia farmacologica è stata ripristinata e mantenuta per 5 anni.Dopo i primi due anni di terapia, si è avuta una remissione clinica nell'80.6% dei casi. Alcuni pazienti hanno manifestato crisi durante l'assunzione della terapia, altri durante il periodo di wash-out. In ogni caso l'incidenza delle crisi diminuisce con il crescere dell'età dei pazienti. Al di sopra dei 14 anni non sono state registrate crisi, e l'osservazione durante gli otto anni successivi alla sospensione definitiva della terapia farmacologica non ha rivelato la comparsa di alcuna crisi.Viene quindi discussa la necessità di un trattamento farmacologico prolungato in corso di Epilessia a Parossismi Rolandici.