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Annals of Neurology May 2015There are competing explanations for persistent postoperative seizures after temporal lobe surgery. One is that 1 or more particular subtypes of mesial temporal lobe...
OBJECTIVE
There are competing explanations for persistent postoperative seizures after temporal lobe surgery. One is that 1 or more particular subtypes of mesial temporal lobe epilepsy (mTLE) exist that are particularly resistant to surgery. We sought to identify a common brain structural and connectivity alteration in patients with persistent postoperative seizures using preoperative quantitative magnetic resonance imaging and diffusion tensor imaging (DTI).
METHODS
We performed a series of studies in 87 patients with mTLE (47 subsequently rendered seizure free, 40 who continued to experience postoperative seizures) and 80 healthy controls. We investigated the relationship between imaging variables and postoperative seizure outcome. All patients had unilateral temporal lobe seizure onset, had ipsilateral hippocampal sclerosis as the only brain lesion, and underwent amygdalohippocampectomy.
RESULTS
Quantitative imaging factors found not to be significantly associated with persistent seizures were volumes of ipsilateral and contralateral mesial temporal lobe structures, generalized brain atrophy, and extent of resection. There were nonsignificant trends for larger amygdala and entorhinal resections to be associated with improved outcome. However, patients with persistent seizures had significant atrophy of bilateral dorsomedial and pulvinar thalamic regions, and significant alterations of DTI-derived thalamotemporal probabilistic paths bilaterally relative to those patients rendered seizure free and controls, even when corrected for extent of mesial temporal lobe resection.
INTERPRETATION
Patients with bihemispheric alterations of thalamotemporal structural networks may represent a subtype of mTLE that is resistant to temporal lobe surgery. Increasingly sensitive multimodal imaging techniques should endeavor to transform these group-based findings to individualize prediction of patient outcomes.
Topics: Adult; Epilepsy, Temporal Lobe; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Postoperative Period; Seizures; Temporal Lobe; Thalamus; Treatment Outcome
PubMed: 25627477
DOI: 10.1002/ana.24376 -
Epilepsia 2008Interest in temporal lobe seizure pathways has a long history based initially on the human condition of temporal lobe epilepsy (TLE). This interest in TLE has extended... (Review)
Review
Interest in temporal lobe seizure pathways has a long history based initially on the human condition of temporal lobe epilepsy (TLE). This interest in TLE has extended more recently into explorations of experimental models. In this review, the network structures in the temporal lobe that are recruited in animal models during various forms of limbic seizures and status epilepticus are described. Common to all of the various models is recruitment of the parahippocampal cortices, including the piriform, perirhinal, and entorhinal areas. This cortical involvement is seen in in vitro and in vivo electrophysiological recordings throughout the network, in trans-synaptic neuroplastic changes in associated network structures manifest at the molecular level, in network energy utilization visualized by 14C2-deoxyglucose uptake, and finally, in the behavioral consequences of network lesions. The conclusions of the animal models reviewed here are very similar to those described for the human condition presented recently in the 2006 Lennox lecture by Warren Blume, and addressed 53 years ago in the quadrennial meeting of the ILAE in 1953 by Henri Gastaut.
Topics: Amygdala; Animals; Autoradiography; Carbon Radioisotopes; Cats; Deoxyglucose; Disease Models, Animal; Dogs; Electroencephalography; Entorhinal Cortex; Epilepsy, Temporal Lobe; Functional Laterality; Humans; Kindling, Neurologic; Limbic System; Neural Pathways; Neuronal Plasticity; Parahippocampal Gyrus; Rats; Temporal Lobe
PubMed: 18304253
DOI: 10.1111/j.1528-1167.2008.01507.x -
Magnetic Resonance Imaging 1995Forty-nine consecutive patients undergoing anteromedial temporal lobe resection for medically intractable temporal lobe seizures, and averaging 2 yr (range 6 mo to 4 yr)...
Forty-nine consecutive patients undergoing anteromedial temporal lobe resection for medically intractable temporal lobe seizures, and averaging 2 yr (range 6 mo to 4 yr) postoperative follow-up, were selected for a retrospective study. This study correlated magnetic resonance imaging (MRI) derived hippocampal volumetrics, preoperative demographics, postoperative seizure control, and tissue analysis, including hippocampal CA (cornu ammonis) field neuronal, and glial cell counts, and immunohistochemistry (IHC) evidence for dentate sprouting and reorganization. These measures were compared in hippocampi with or without an adjacent presumptive epileptogenic temporal lobe mass. Mesial temporal sclerosis (MTS) was defined as > 50% neuronal cell loss averaged across all CA fields with NPY (neuropeptide-y) and somatostatin reorganization. These patients may or may not include granule cell sprouting as determined by dynorphin staining. Patients were divided into two groups based on CA field neuronal cell counts, one averaging > 50% cell loss and one averaging < 50% cell loss. For the MTS group (N = 38), 89% had significant volumetric atrophy of the ipsilateral hippocampus, 74% had dentate reorganization, and complete seizure control was seen in 76% of these patients. In one subgroup of the < 50% cell loss group, patients with medial temporal lobe epilepsy caused by a mass in the medial temporal lobe (mass group) (N = 6), 33% demonstrated significant volumetric atrophy of the hippocampus ipsilateral to the mass, 0% had dentate sprouting, and seizures were completely controlled in 67%. For the second subgroup of the < 50% cell loss group, patients without mass lesions (N = 5) who were classified as the paradoxical medial temporal lobe epilepsy group (paradoxical group), 20% had ipsilateral hippocampal atrophy, 0% had dentate reorganization, and complete seizure control was seen in 60% of these patients. In conclusion, for the MTS group, hippocampal atrophy proven by MRI volumetrics was highly predictive of significant neuronal cell loss and an excellent indicator of success. However, in patients who had a foreign mass, hippocampal atrophy was not necessarily indicative of significant neuronal cell loss and MRI volumetrics was not a factor in the determination of a successful outcome. Furthermore, patients without mass lesions who have normal volumetrics but demonstrate hippocampal disease through invasive electrode monitoring, are likely to have paradoxical medial temporal lobe epilepsy, seizures beginning at a later age, and a lower, but not insignificant, success rate than the classical mesial temporal sclerosis group.
Topics: Adolescent; Adult; Epilepsy, Temporal Lobe; Female; Hippocampus; Humans; Image Processing, Computer-Assisted; Magnetic Resonance Imaging; Male; Middle Aged; Neuroglia; Neurons; Psychosurgery; Temporal Lobe
PubMed: 8750318
DOI: 10.1016/0730-725x(95)02014-k -
Molecular Imaging and Radionuclide... Aug 2013The aim of this study is to investigate the presence of pyramidal lobe in thyroid scintigraphy and to compare the presence of pyramidal lobe in different thyroid...
OBJECTIVE
The aim of this study is to investigate the presence of pyramidal lobe in thyroid scintigraphy and to compare the presence of pyramidal lobe in different thyroid pathologies between genders.
METHODS
Images of 866 patients (663 female, 203 male) with ages ranging from 8 to 85 were evaluated retrospectively. Presence of pyramidal lobe and its location were established in images. Patients were divided into groups in terms of gender, presence of nodular/diffuse goiter, thyroid function test results and rate of the presence of pyramidal lobe and whether a significant difference existed between the groups were calculated.
RESULTS
Of the 866 patients, 156 (18%) had pyramidal lobe observed in scintigraphy. Hundred and 26 (81%) of patients observed to have pyramidal lobe were female and 30 (19%) were male. Pyramidal lob stemmed from the left lobe in 76 (48%) patients, right lobe in 61 (40%) patients, and isthmus in 19 (12%) patients. Pyramidal lobe visualization rate was 18% for euthyroidism and hyperthyroidism, it was found as 15% for hypothyroidism. The rate of pyramidal lobe visualization was 13% in nodular goiter patients, 43% in diffuse goiter patients, and 20% in patients whose scintigraphy showed normal thyroid glands. In the statistical evaluation, rate of pyramidal lobe visualization in diffuse goiter patients was found to be significantly higher compared to other patients (p<0.001).
CONCLUSION
Preoperative imaging of pyramidal lobe especially in patients requiring total thyroidectomy would decrease relapses that may occur later and thus facilitate the treatment and monitoring of patients.
CONFLICT OF INTEREST
None declared.
PubMed: 24003394
DOI: 10.4274/Mirt.09719 -
International Journal of Cancer Medicine 2023Non-small cell lung cancer can spread into lobe specific stations and non-lobe-specific mediastinal lymph nodes. We evaluated frequency and features of non-lobe specific...
OBJECTIVES
Non-small cell lung cancer can spread into lobe specific stations and non-lobe-specific mediastinal lymph nodes. We evaluated frequency and features of non-lobe specific nodal metastases, focusing especially on the prognostic value of only non-lobe specific N2-metastases after lobectomy.
METHODS
We performed a retrospective review of 550 patients with non-small cell lung cancer with clinical N0, undergoing lobectomy and systematic or lobe specific node dissection. We evaluated disease free and overall survival rates using Kaplan-Meier method and significance was tested by log-rank test.
RESULT
Occult N2 disease was detected in 68 patients (8.1%), 26 of them (38.2%) had metastases in non-lobe specific stations. Comparing patients with lobe and non-lobe specific lymph node metastases, 3-years DFS rate was 44.4% 20.0% (p-value = 0.009), while 3-years OS rate was 87.3% . 26.7% (p-value <0.001). Among patients with non-lobe specific metastases 16 of them (61.5%) had only non-lobe specific metastases, the remaining 10 patients (38.5%) had metastatic lymph node at the same time in non-lobe specific station but also in lobe-specific stations. Comparing post-operative survival between patients with only non-lobe specific metastases and synchronous lobe and non-lobe specific metastases, 3-years DFS rate was 12.5% 41.3% respectively (p-value = 0.03), and 3-years OS rate was 12.5% vs 76.7% (p-value = 0.002).
CONCLUSION
In patients with occult N2 disease, the finding of a metastatic lymph node in a non-lobe specific station relates with significant lower survival rate. The subset of patients who presented only non-lobe specific node metastases showed a significant lower survival rate compared to the remaining occult N2.
PubMed: 36790951
DOI: No ID Found -
Medicine Jul 2020Investigating the effect of post-labeling delay (PLD) on regional cerebral blood flow (CBF) in adults and optimizing the PLD for arterial spin-labeling (ASL) magnetic... (Clinical Trial)
Clinical Trial
BACKGROUND
Investigating the effect of post-labeling delay (PLD) on regional cerebral blood flow (CBF) in adults and optimizing the PLD for arterial spin-labeling (ASL) magnetic resonance (MR) imaging are important.
METHODS
Pseudo-continuous ASL imaging with a three PLDs protocol was performed in 90 healthy adult volunteers from January 2018 to February 2019. Healthy subjects were divided into youth group (mean age, 30.63 years; age range, 20-44 years), middle-aged group (mean age, 52.16 years; age range 45-59 years) and elderly group (mean age, 66.07 years; age range, 60-77 years). After preprocessing, analyses of variance (ANOVA) and volume-of-interest (VOI) were conducted to compare the CBF in each brain region. According to the trends of CBF changing with PLD and the results of ANOVA, we optimized the PLD for ASL imaging in different brain regions and age groups.
RESULTS
The CBF values of 87 VOIs [global gray matter (global GM) and other 86 VOIs] for each subject were obtained. Young people had less statistically significant VOIs than middle-aged and elderly people [Numbers of VOIs which had statistical significance (P < .05) in the analysis of ANOVA: 42 (youth group), 79 (middle-aged group), and 71 (elderly group)]. In youth group, the deep GM, occipital lobe and temporal lobe were more affected by PLDs than limbic system, frontal lobe and parietal lobe [VOIs with statistical significance (P < .05)/total VOIs: 8/8 (deep GM) > 8/12 (occipital lobe) > (8/14) (temporal lobe) > 5/12 (limbic system) > 11/28 (frontal lobe) > (2/12) parietal lobe]. In middle-aged group, the limbic system, deep GM and temporal lobe were more affected by PLDs than parietal lobe, frontal lobe and occipital lobe [VOIs with statistical significance (P < 0.05)/total VOIs: 12/12 (limbic system) = 8/8 (deep GM) > (13/14) (temporal lobe) > (11/12) parietal lobe > 25/28 (frontal lobe) > 9/12 (occipital lobe)]. In elderly group, the temporal lobe, parietal lobe, and frontal lobe were more affected by PLDs than occipital lobe, limbic system, and deep GM [VOIs with statistical significance (P < .05)/total VOIs: 14/14 (temporal lobe) > 12/12 (parietal lobe) > 22/28 (frontal lobe) > 9/12 (occipital lobe) > 8/12 (limbic system) > 5/8 (deep GM)]. The optimal PLD for most VOIs in youth group was 1525 ms. However, for middle-aged and elderly group, the optimal PLD for most VOIs was 2525 ms.
CONCLUSION
Young people are less affected by PLDs than middle-aged and elderly people. The middle-aged people are most affected by PLDs. In addition, the spatial distributions of PLD effect were different among the three age groups. Optimizing the PLD for ASL imaging according to age and brain regions can obtain more accurate and reliable CBF values.
Topics: Adult; Age Factors; Aged; Cerebrovascular Circulation; Female; Healthy Volunteers; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Prospective Studies; Young Adult
PubMed: 32629629
DOI: 10.1097/MD.0000000000020463 -
Epilepsia Jan 2012Surgical resection of the hippocampus is the most successful treatment for medication-refractory medial temporal lobe epilepsy (MTLE) due to hippocampal sclerosis.... (Review)
Review
Surgical resection of the hippocampus is the most successful treatment for medication-refractory medial temporal lobe epilepsy (MTLE) due to hippocampal sclerosis. Unfortunately, at least one of four operated patients continue to have disabling seizures after surgery, and there is no existing method to predict individual surgical outcome. Prior to surgery, patients who become seizure free appear identical to those who continue to have seizures after surgery. Interestingly, newly converging presurgical data from magnetic resonance imaging (MRI) and intracranial electroencephalography (EEG) suggest that the entorhinal and perirhinal cortices may play an important role in seizure generation. These areas are not consistently resected with surgery and it is possible that they continue to generate seizures after surgery in some patients. Therefore, subtypes of MTLE patients can be considered according to the degree of extrahippocampal damage and epileptogenicity of the medial temporal cortex. The identification of these subtypes has the potential to drastically improve surgical results via optimized presurgical planning. In this review, we discuss the current data that suggests neural network damage in MTLE, focusing on the medial temporal cortex. We explore how this evidence may be applied to presurgical planning and suggest approaches for future investigation.
Topics: Anterior Temporal Lobectomy; Electroencephalography; Epilepsy, Temporal Lobe; Humans; Magnetic Resonance Imaging; Nerve Net; Temporal Lobe; Treatment Outcome
PubMed: 22050314
DOI: 10.1111/j.1528-1167.2011.03298.x -
Epilepsia 2000The chronicity and severity of epilepsy, as well as the presence of temporal lobe toci, appear to correlate with psychopathology. A high prevalence of psychopathology... (Review)
Review
The chronicity and severity of epilepsy, as well as the presence of temporal lobe toci, appear to correlate with psychopathology. A high prevalence of psychopathology has been reported among patients who are candidates for anterior temporal lobectomy (ATL). A review of the literature indicates that episodic psychosis may diminish when patients become free of seizures after surgery and that chronic psychosis neither improves notr worsens after ATL. If this is the case, patients with episodic psychosis may benefit from ATL. Patients with chronic psychosis may benefit if they become free from seizures after the operation, even if the psychosis persists. Case reports of maladjustment to seizure-free life after surgery, and de novo psychopathology, underline the importance of preoperative psychiatric evaluation and postoperative psychiatric intervention in patients undergoing epilepsy surgery. Although there is a need for each epilepsy center to state its policy with regard to patients with psychopathology who undergo epilepsy surgery, it would be unwise to make a decision on whether to reject a patient simply on the grounds of psychosis. A detailed psychiatric evaluation of each individual patient is required.
Topics: Chronic Disease; Clinical Protocols; Comorbidity; Epilepsy, Temporal Lobe; Follow-Up Studies; Humans; Mental Disorders; Patient Selection; Practice Guidelines as Topic; Prevalence; Prognosis; Psychiatry; Severity of Illness Index; Temporal Lobe; Treatment Outcome
PubMed: 11156510
DOI: 10.1111/j.1528-1157.2000.tb02219.x -
Seizure Feb 2017
Topics: Adult; Anticonvulsants; Brain; Carbamazepine; Drug Overdose; Drug Resistant Epilepsy; Electroencephalography; Epilepsy, Temporal Lobe; Humans; Male; Nystagmus, Pathologic; Oxcarbazepine
PubMed: 27984806
DOI: 10.1016/j.seizure.2016.11.027 -
Philosophical Transactions of the Royal... Apr 2005The visual system is constantly challenged to organize the retinal pattern of stimulation into coherent percepts. This task is achieved by the cortical visual system,... (Review)
Review
The visual system is constantly challenged to organize the retinal pattern of stimulation into coherent percepts. This task is achieved by the cortical visual system, which is composed by topographically organized analytic areas and by synthetic areas of the temporal lobe that have more holistic processing. Additional visual areas of the parietal lobe are related to motion perception and visuomotor control. V1 and V2 represent the entire visual field. MT represents only the binocular field, and V4 only the central 30 degrees-40 degrees. The parietal areas represent more of the periphery. For any eccentricity, the receptive field grows at each step of processing, more at anterior areas in the temporal lobe. Minimal point image size increases towards the temporal lobe, but remains fairly constant toward the parietal lobe. Patterns of projection show asymmetries. Central V2 and V4 project mainly to the temporal lobe, while peripherals V2 (more than 30 degrees) and V4 (more than 10 degrees) also project to the parietal lobe. Visual information that arrives at V1 projects to V2, MT and PO, which then project to other areas. Local lateral propagation and recursive loops corroborate to perceptual completion and filling in. Priority connections to temporal, parietal and parieto-temporal cortices help construct crude early representations of objects, trajectories and movements.
Topics: Animals; Brain Mapping; Electron Transport Complex IV; Haplorhini; Immunohistochemistry; Models, Anatomic; Parietal Lobe; Temporal Lobe; Visual Cortex; Visual Perception
PubMed: 15937009
DOI: 10.1098/rstb.2005.1629