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Epilepsia Mar 2016Epilepsy surgery is an effective treatment in many patients with drug-resistant focal epilepsies. An early decision for surgical therapy is facilitated by a magnetic...
International recommendation for a comprehensive neuropathologic workup of epilepsy surgery brain tissue: A consensus Task Force report from the ILAE Commission on Diagnostic Methods.
Epilepsy surgery is an effective treatment in many patients with drug-resistant focal epilepsies. An early decision for surgical therapy is facilitated by a magnetic resonance imaging (MRI)-visible brain lesion congruent with the electrophysiologically abnormal brain region. Recent advances in the pathologic diagnosis and classification of epileptogenic brain lesions are helpful for clinical correlation, outcome stratification, and patient management. However, application of international consensus classification systems to common epileptic pathologies (e.g., focal cortical dysplasia [FCD] and hippocampal sclerosis [HS]) necessitates standardized protocols for neuropathologic workup of epilepsy surgery specimens. To this end, the Task Force of Neuropathology from the International League Against Epilepsy (ILAE) Commission on Diagnostic Methods developed a consensus standard operational procedure for tissue inspection, distribution, and processing. The aims are to provide a systematic framework for histopathologic workup, meeting minimal standards and maximizing current and future opportunities for morphofunctional correlations and molecular studies for both clinical care and research. Whenever feasible, anatomically intact surgical specimens are desirable to enable systematic analysis in selective hippocampectomies, temporal lobe resections, and lesional or nonlesional neocortical samples. Correct orientation of sample and the sample's relation to neurophysiologically aberrant sites requires good communication between pathology and neurosurgical teams. Systematic tissue sampling of 5-mm slabs along a defined anatomic axis and application of a limited immunohistochemical panel will ensure a reliable differential diagnosis of main pathologies encountered in epilepsy surgery.
Topics: Advisory Committees; Brain; Consensus; Epilepsy; Hemispherectomy; Hippocampus; Humans; Internationality; Malformations of Cortical Development; Practice Guidelines as Topic; Psychosurgery; Research Report; Stereotaxic Techniques; Temporal Lobe
PubMed: 26839983
DOI: 10.1111/epi.13319 -
Arquivos de Neuro-psiquiatria Oct 2015Egas Moniz is credited with the discovery in 1927 of radioarteriography, for which he was, on three occasions, nominated for the Nobel Prize, and in all three denied the...
Egas Moniz is credited with the discovery in 1927 of radioarteriography, for which he was, on three occasions, nominated for the Nobel Prize, and in all three denied the award. In 1949 he was awarded the Nobel Prize for Medicine for having designed leucotomy, a brain surgery to treat some forms of severe metal disorders. He was also an successful politician and accomplished statesman.
Topics: Angiography; History, 19th Century; History, 20th Century; Nobel Prize; Portugal; Psychosurgery
PubMed: 26465405
DOI: 10.1590/0004-282X20150138 -
Epilepsy & Behavior : E&B Oct 2015Atonic seizures are debilitating and poorly controlled with antiepileptic medications. Two surgical options are primarily used to treat medically refractory atonic... (Review)
Review
Atonic seizures are debilitating and poorly controlled with antiepileptic medications. Two surgical options are primarily used to treat medically refractory atonic seizures: corpus callosotomy (CC) and vagus nerve stimulation (VNS). However, given the uncertainty regarding relative efficacy and surgical complications, the best approach for affected patients is unclear. The PubMed database was queried for all articles describing the treatment of atonic seizures and drop attacks with either corpus callosotomy or VNS. Rates of seizure freedom, >50% reduction in seizure frequency, and complications were compared across the two patient groups. Patients were significantly more likely to achieve a >50% reduction in seizure frequency with CC versus VNS (85.6% versus 57.6%; RR: 1.5; 95% CI: 1.1-2.1). Adverse events were more common with VNS, though typically mild (e.g., 22% hoarseness and voice changes), compared with CC, where the most common complication was the disconnection syndrome (13.2%). Both CC and VNS are well tolerated for the treatment of refractory atonic seizures. Existing studies suggest that CC is potentially more effective than VNS in reducing seizure frequency, though a direct study comparing these techniques is required before a definitive conclusion can be reached.
Topics: Corpus Callosum; Epilepsy, Generalized; Humans; Psychosurgery; Syncope; Vagus Nerve Stimulation
PubMed: 26247311
DOI: 10.1016/j.yebeh.2015.06.001 -
BMJ Case Reports Aug 2015
Topics: Aged; Female; Frontal Lobe; Humans; Psychosurgery; Tomography, X-Ray Computed
PubMed: 26240096
DOI: 10.1136/bcr-2014-208767 -
Neurosurgery Nov 2015The ventral intermediate nucleus of the thalamus is a primary target of deep brain stimulation (DBS) in patients with essential tremor. Despite reliable control of...
BACKGROUND AND IMPORTANCE
The ventral intermediate nucleus of the thalamus is a primary target of deep brain stimulation (DBS) in patients with essential tremor. Despite reliable control of contralateral tremor, there is sometimes a need for lead revision in cases of infection, hardware malfunction, or failure to relieve symptoms. Here, we present the case of a patient undergoing revision after ventral intermediate nucleus (Vim) DBS failed to control his tremor. During the electrode removal, the distal portion of the lead was found to be tightly adherent to tissue within the deep brain. Partial removal of the electrode in turn caused weakness, paresthesias, and tremor control similar to the effects produced by thalamotomy or thalamic injury.
CLINICAL PRESENTATION
A 48-year-old man with essential tremor had bilateral Vim DBS leads implanted 10 years earlier but had poor control of his tremor and ultimately opted for surgical revision with lead placement in the zona incerta. During attempted removal of his right lead, the patient became somnolent with contralateral weakness and paresthesias. The procedure was aborted, and postoperative neuroimaging was immediately obtained, showing no signs of stroke or hemorrhage. The patient had almost complete control of his left arm tremor postoperatively, and his weakness soon resolved.
CONCLUSION
To the best of our knowledge, this is the first reported case of cerebral injury after DBS revision and offers insights into the mechanism of high-frequency electric stimulation compared with lesions. That is, although high-frequency stimulation failed to control this patient's tremor, thalamotomy-like injury was completely effective.
Topics: Deep Brain Stimulation; Device Removal; Electrodes; Essential Tremor; Humans; Male; Middle Aged; Prostheses and Implants; Psychosurgery; Reoperation; Ventral Thalamic Nuclei
PubMed: 26200771
DOI: 10.1227/NEU.0000000000000906 -
Comptes Rendus Biologies 2015At the Paris Colloquium held forty years ago, and which this paper celebrates, the issue of psychosurgery had not been tackled yet. At that time psychosurgery was...
At the Paris Colloquium held forty years ago, and which this paper celebrates, the issue of psychosurgery had not been tackled yet. At that time psychosurgery was tainted by the controversial history of lobotomy and leucotomy. Supporters of psychosurgery at the time of the Colloquium were preparing their fourth International Conference, which was held in Madrid the following year. This represented a key characteristic of the collective, institutional and symbolic action of psychosurgery practitioners. At the end of the seventies, their strategy changed as noted below. Furthermore, we focus on the special importance of the results presented and commented on by psychosurgery supporters, including its conception and classification throughout the rhetoric historically involved (its supposed ventriloquism, its persuasive strength). Based on this view, we suggest a critical reflection encompassing old and new psychosurgery, while questioning the value of new rhetorical devices for the assessment and presentation of psychosurgery results after the surge of Deep Brain Stimulation.
Topics: Deep Brain Stimulation; History, 20th Century; History, 21st Century; Humans; Mental Disorders; Psychosurgery
PubMed: 26149524
DOI: 10.1016/j.crvi.2015.06.004 -
Medical History Jul 2015Neuropathologists constituted a small field in post-war England, perched between neurology, psychiatry, neurosurgery and pathology, but recognised as a discrete field of...
Neuropathologists constituted a small field in post-war England, perched between neurology, psychiatry, neurosurgery and pathology, but recognised as a discrete field of expertise. Despite this recognition, the success of the neighbouring fields of neurosurgery, psychosurgery and neurobiology, and the consultant status granted to pathologists in the National Health Service, neuropathologists struggled to stabilise their field. A discourse of skills, acquired and acquirable, became central to their attempts to situate the field in relation to surgeons' handicraft, physicians' diagnostic acumen and the technologies of the biological sciences.
Topics: Clinical Competence; England; History, 20th Century; Humans; Neuroanatomy; Neurosurgery; Pathology; State Medicine; Surgeons
PubMed: 26090736
DOI: 10.1017/mdh.2015.27 -
Current Behavioral Neuroscience Reports Jun 2015The limbic system is a network of interconnected brain regions regulating emotion, memory, and behavior. Pathology of the limbic system can manifest as psychiatric...
The limbic system is a network of interconnected brain regions regulating emotion, memory, and behavior. Pathology of the limbic system can manifest as psychiatric disease, including obsessive-compulsive disorder and major depressive disorder. For patients with these disorders who have not responded to standard pharmacological and cognitive behavioral therapy, ablative surgery is a neurosurgical treatment option. The major ablative limbic system procedures currently used are anterior capsulotomy, dorsal anterior cingulotomy, subcaudate tractotomy, and limbic leucotomy. In this review, we include a brief history of ablative limbic system surgery leading up to its current form. Mechanistic justification for these procedures is considered in a discussion of the pathophysiology of psychiatric disease. We then discuss therapeutic efficacy as demonstrated by recent trials. Finally, we consider future directions, including the search for predictors of treatment response, the development of more precise targeting methods, and the use of advances in neuroimaging to track treatment response.
PubMed: 31745448
DOI: 10.1007/s40473-015-0038-1 -
Neuropsychiatric Disease and Treatment 2015
PubMed: 25897232
DOI: 10.2147/NDT.S74875 -
Annals of General Psychiatry 2015Dromokaition Psychiatric Hospital opened its doors in 1887, following the donation made by Zorzis Dromokaitis from the island of Chios. Private donations and all forms...
Dromokaition Psychiatric Hospital opened its doors in 1887, following the donation made by Zorzis Dromokaitis from the island of Chios. Private donations and all forms of charities had contributed to a large extent in the establishment of hospitals across Greece, during the late 19th and the early 20th century. Dromokaition was one of them but it was also unique, as it was the first psychiatric hospital in Athens, admitting patients from every part of the country. This paper aimed at highlighting the long service of the institution through the different historical periods the country went through. We present the chronicle of its foundation, the development of its inner structure, and the medical and organizational influences which it received, along the way. The therapeutic methods used during the first decades of its operation reflected the corresponding European standards of the time. As a model institution from its foundation, it followed closely the prevailing European guidelines, throughout its historical path, either as an independent institution or as an integrated one within the National Health Service.
PubMed: 25694790
DOI: 10.1186/s12991-015-0047-1