Temporal Lobe Epilepsy
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The Effect of Temporal Lobectomy Upon Two Cases of an Unusual Form of Mental Deficiency by D
J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.17.4.267 on 1 November 1954. Downloaded from J. Neurol. Neurosurg. Psychiat., 1954, 17, 267. THE EFFECT OF TEMPORAL LOBECTOMY UPON TWO CASES OF AN UNUSUAL FORM OF MENTAL DEFICIENCY BY D. W. LIDDELL and D. W. C. NORTHFIELD From Runwtvell Hospital, Wickford, Essex In 1898, when giving the final particulars and the Case Histories necropsy findings of a case of epilepsy which fully Case l.-M. G., aged 18 years, was referred to exemplified dreamy states and automatisms, Hugh- Runwell Hospital from the Royal Eastern Counties lings Jackson (1931a) wrote that there were post- Hospital because of bouts of violent uncontrollable epileptic actions " of a kind which in a man fully behaviour and repeated attempts to abscond. He was himself would be criminal ". But another 25 years the seventh child of healthy working-class parents. were to elapse before Penfield began his studies on There is no family history of epilepsy. His birth was brain-scars (Penfield and Erickson, 1941) which were normal and he was breast fed for nine months. He guest. Protected by copyright. eventually to secure for surgery a began to walk and talk at about 14 months. As a child place in the be was placid but active, easily managed, and there were treatment of epilepsy. At first the operations were no difficulties in toilet training. restricted to those patients resistant to medical At the age of 7 years he fell out of a tree and was treatment in whom there was conclusive evidence of momentarily unconscious. -
Case Study: Right Temporal Lobe Epilepsy
Case Study: Right temporal lobe epilepsy Group Members • Rudolf Cymorr Kirby P. Martinez • Yet dalen • Rachel Joy Alcalde • Siriwimon Luanglue • Mary Antonette Pineda • Khayay Hlaing • Luch Bunrattana • Keo Sereymonica • Sikanal Chum • Pyone Khant khant • Men Puthik • Chheun Chhorvy Advisers: Sudasawan Jiamsakul Janyarak Supat 2 Overview of Epilepsy 3 Overview of Epilepsy 4 Risk Factor of Epilepsy 5 Goal of Epilepsy Care 6 Case of Patient X Patient Information & Hx • Sex: Female (single) • Age: 22 years old • Date of admission: 15 June 2017 • Chief Complaint: Jerking movement of all 4 limbs • Past Diagnosis: Temporal lobe epilepsy • No allergies, family history & Operation Complete Vaccination. (+) Developmental Delay Now she can take care herself. Income: Helps in family store (can do basic calculation) History Workup Admission Operation ICU Female Surgery D/C 7 • Sex: Female Case of Patient X • Age: 22 years old • CC: Jerking movement of all 4 limbs History Past Present History Workup Admission Operation ICU Female Surgery D/C 8 • Sex: Female Case of Patient X • Age: 22 years old • CC: Jerking movement of all 4 limbs Past Present (11 mos) (+) high fever. Prescribed AED for 2-3 Treatment at Songkranakarin Hosp. mos. After AED stops, no further episode Prescribe AED but still with 4-5 ep/mos 21 yrs 6 yrs Present PTA PTA (15 y/o) (+) jerking movement (15 y/o) (+) aura as jerking Now 2-3 ep/ mos both arms and legs with LOC movement at chin & headache Last attack 2 mos for 5 mins. Drowsy after attack ago thus consult with no memory of attack 15-17 episode/ mos History Workup Admission Operation ICU Female Surgery D/C 9 • Sex: Female Case of Patient X • Age: 22 years old • CC: Jerking movement of all 4 limbs Past Present 2 months prior to admission, she had jerking movement both arms and legs, blinking both eyes, corner of the mouth twitch, and drool. -
Status Epilepticus: Pathophysiology, Epidemiology, and Outcomes
Arch Dis Child 1998;79:73–77 73 CURRENT TOPIC Arch Dis Child: first published as 10.1136/adc.79.1.73 on 1 July 1998. Downloaded from Status epilepticus: pathophysiology, epidemiology, and outcomes Rod C Scott, Robert A H Surtees, Brian G R Neville Convulsive status epilepticus (CSE) is the most consciousness being regained between the sei- common neurological medical emergency and zures. This gives the impression that status epi- continues to be associated with significant lepticus is always convulsive and is a single morbidity and mortality. Our approach to the entity. There are, however, as many types of epilepsies in childhood has been clarified by the status epilepticus as there are types of seizures, broad separation into benign and malignant and this definition is now probably outdated. syndromes. The factors that suggest a poorer To show that status epilepticus is a complex outcome in terms of seizures, cognition, and disorder, Shorvon has proposed the following behaviour include the presence of multiple sei- definition. Status epilepticus is a disorder in zure types, an additional, particularly cognitive which epileptic activity persists for 30 minutes disability, the presence of identifiable cerebral or more, causing a wide spectrum of clinical pathology, a high rate of seizures, an early age symptoms, and with a highly variable patho- of onset, poor response to antiepileptic drugs, physiological, anatomical, and aetiological and the occurrence of CSE.1 basis.2 CSE needs diVerent definitions for Convulsive status epilepticus is not a syn- diVerent purposes. Many seizures that last for drome in the same sense as febrile convulsions, five minutes will continue for at least 20 benign rolandic epilepsy, and infantile poly- minutes, and so treatment is required for most morphic epilepsy. -
Status Epilepticus: Initial Management
DATE: July 2018 TEXAS CHILDREN’S HOSPITAL EVIDENCE-BASED OUTCOMES CENTER Initial Management of Status Epilepticus Evidence-Based Guideline Definition: Status Epilepticus (SE) is a disease process Diagnostic Evaluation resulting in prolonged seizures of longer than 5 minutes. (1) The NOTE: Central nervous system (CNS) infection should be cause of SE can stem from the malfunction of the response to excluded. terminate a seizure or from the commencement of the mechanisms that result in prolonged seizures. (2) If SE History: Assess for continues for longer than 30 minutes, there can be permanent Seizure onset neurological damage, including neuronal death, neuronal Known seizure disorder injury, and alteration of neuronal networks. (2,3) Ingestion Fever (e.g., signs of serious infection) Epidemiology: Convulsive status epilepticus (CSE) is the Medications (4) most common neurological emergency seen in childhood. It o Received prior to presentation (e.g., type, dose, is also among the top five reasons for admission to the PICU at dosage, route) Texas Children’s Hospital and is the third most common o Current anticonvulsant medications reason for transport calls. SE is a medical emergency and is o Use of psychopharmacologic medications associated with an overall mortality rate of 8% in children and Toxic/Subtherapeutic anticonvulsant levels (4,5) o 30% in adults. Among children, the overall incidence of SE Nonadherence and/or recent change (4-6) o is approximately 1 to 6 per 10,000/year. The incidence Vagus Nerve Stimulation (VNS) appears to be higher in children under 1 year of age with over Metabolic abnormalities 50% of cases occurring in children under 3 years. -
Is It a Convulsion Or Dopamine Deficiency? a Case of Epilepsy in Dihydropteridine Reductase Deficiency
Letter to the editor pISSN 2635-909X • eISSN 2635-9103 Ann Child Neurol 2020;28(2):72-74 https://doi.org/10.26815/acn.2019.00304 Is It a Convulsion or Dopamine Deficiency? A Case of Epilepsy in Dihydropteridine Reductase Deficiency Jisu Ryoo, MD, Eun Sook Suh, MD, Jeongho Lee, MD Department of Pediatrics, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea Received: December 20, 2019 Dihydropteridine reductase (DHPR) deficiency A 15-year-old man was admitted to Soon- Revised: February 13, 2020 Accepted: March 2, 2020 is a severe form of hyperphenylalaninemia due chunhyang University Seoul Hospital. At the age to impaired renewal of a substance known as tet- of 3 months, he experienced the first seizure, Corresponding author: rahydrobiopterin (BH4), caused by mutations in characterized by brief psychomotor arrest and Jeongho Lee, MD the quinoid dihydropteridine reductase (QDPR) right hand tremor. He had no family history of Department of Pediatrics, gene [1]. If little or no BH4 is available to facili- seizures or genetic disorders. Brain magnetic res- Soonchunhyang University Seoul tate processing phenylalanine (Phe), this amino onance imaging (MRI) and EEG showed nor- Hospital, Soonchunhyang University College of Medicine, 59 acid can accumulate in the blood and other tis- mal results. The seizures were not controlled by Daesagwan- ro, Yongsan-gu, Seoul sues, and the levels of neurotransmitters (dopa- antiepileptic drugs, including topiramate, val- 04401, Korea mine, serotonin) and the folate in cerebrospinal proate, and lamotrigine; therefore, he discontin- Tel: +82-2-709-9341 fluid also decrease [1]. Symptoms such as mental ued the medication. -
The Value of Seizure Semiology in Lateralizing and Localizing Partially Originating Seizures
Review Article The value of seizure semiology in lateralizing and localizing partially originating seizures Mohammed M. Jan, MBChB, FRCP(C). observations help in lateralizing (left versus right) and ABSTRACT localizing (involved brain region) the seizure onset. Therefore, this information is vital not only for seizure Diagnosing epilepsy depends heavily on a detailed, and accurate description of the abnormal transient classification, but more so for identification of surgical neurological manifestations. Observing the candidates. The EEG and neuroimaging, particularly seizures yields important semiologic features that MRI, are needed to identify focal physiological and characterize epilepsy. Video-EEG monitoring allows pathological brain abnormalities.3-5 The development of the identification of important lateralizing (left video-EEG monitoring has allowed careful correlation of versus right), and localizing (involved brain region) semiologic features with simultaneous EEG recordings.6 semiologic features. This information is vital for As a result, clinical semiology gained greater reliability identifying the seizure origin for possible surgical in diagnosing specific seizure types and localizing their interventions. The aim of this review is to present a onset.7 The aim of this review is to present a summary summary of important semiologic characteristics of various seizures that are important for accurate seizure of important semiologic characteristics of various lateralization and localization. This would most seizures that are needed for accurate lateralization likely help during reviewing video-EEG recorded and localization. This would most likely help during seizures of intractable patients for possible epilepsy reviewing video-EEG recorded seizures of intractable surgery. Semiologic features of partial and secondarily patients for possible epilepsy surgery. generalized seizures can be grouped into one of 4 History taking. -
Long-Term Results of Vagal Nerve Stimulation for Adults with Medication-Resistant
View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector Seizure 22 (2013) 9–13 Contents lists available at SciVerse ScienceDirect Seizure jou rnal homepage: www.elsevier.com/locate/yseiz Long-term results of vagal nerve stimulation for adults with medication-resistant epilepsy who have been on unchanged antiepileptic medication a a, b a c a Eduardo Garcı´a-Navarrete , Cristina V. Torres *, Isabel Gallego , Marta Navas , Jesu´ s Pastor , R.G. Sola a Division of Neurosurgery, Department of Surgery, University Hospital La Princesa, Universidad Auto´noma, Madrid, Spain b Division of Neurosurgery, Hospital Nin˜o Jesu´s, Madrid, Spain c Department of Physiology, University Hospital La Princesa, Madrid, Spain A R T I C L E I N F O A B S T R A C T Article history: Purpose: Several studies suggest that vagal nerve stimulation (VNS) is an effective treatment for Received 15 July 2012 medication-resistant epileptic patients, although patients’ medication was usually modified during the Received in revised form 10 September 2012 assessment period. The purpose of this prospective study was to evaluate the long-term effects of VNS, at Accepted 14 September 2012 18 months of follow-up, on epileptic patients who have been on unchanged antiepileptic medication. Methods: Forty-three patients underwent a complete epilepsy preoperative evaluation protocol, and Keywords: were selected for VNS implantation. After surgery, patients were evaluated on a monthly basis, Vagus nerve increasing stimulation 0.25 mA at each visit, up to 2.5 mA. Medication was unchanged for at least 18 Epilepsy months since the stimulation was started. -
God and the Limbic System from Phantoms in the Brain, by V.S
Imagine you had a machine, a helmet of sorts that you could ... http://www.historyhaven.com/TOK/God and the Limbic Syst... God and the Limbic System From Phantoms in the Brain, by V.S. Ramachandran Imagine you had a machine, a helmet of sorts that you could simply put on your head and stimulate any small region of your brain without causing permanent damage. What would you use the device for? This is not science fiction. Such a device, called a transcranial magnetic stimulator, already exists and is relatively easy to construct. When applied to the scalp, it shoots a rapidly fluctuating and extremely powerful magnetic field onto a small patch of brain tissue, thereby activating it and providing hints about its function. For example, if you were to stimulate certain parts of your motor cortex, different muscles would contract. Your finger might twitch or you'd feel a sudden involuntary, puppetlike shrugging of one shoulder. So, if you had access to this device, what part of your brain would you stimulate? If you happened to be familiar with reports from the early days of neurosurgery about the septum-a cluster of cells located near the front of the thalamus in the middle of your brain-you might be tempted to apply the magnet there. Patients "zapped" in this region claim to experience intense pleasure, "like a thousand orgasms rolled into one." If you were blind from birth and the visual areas in your brain had not degenerated, you might stimulate bits of your own visual cortex to find out what people mean by color or "seeing." Or, given the well-known clinical observation that the left frontal lobe seems to be involved in feeling "good," maybe you'd want to stimulate a region over your left eye to see whether you could induce a natural high. -
Myths and Truths About Pediatric Psychogenic Nonepileptic Seizures
Clin Exp Pediatr Vol. 64, No. 6, 251–259, 2021 Review article CEP https://doi.org/10.3345/cep.2020.00892 Myths and truths about pediatric psychogenic nonepileptic seizures Jung Sook Yeom, MD, PhD1,2,3, Heather Bernard, LCSW4, Sookyong Koh, MD, PhD3,4 1Department of Pediatrics, Gyeongsang National University Hospital, 2Gyeongsang Institute of Health Science, Gyeongsang National University College of Medicine, Jinju, Korea; 3Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA; 4Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA, USA Psychogenic nonepileptic seizures (PNES) is a neuropsychiatric • PNES are a manifestation of psychological and emotional condition that causes a transient alteration of consciousness and distress. loss of self-control. PNES, which occur in vulnerable individuals • Treatment for PNES does not begin with the psychological who often have experienced trauma and are precipitated intervention but starts with the diagnosis and how the dia- gnosis is delivered. by overwhelming circumstances, are a body’s expression of • A multifactorial biopsychosocial process and a neurobiological a distressed mind, a cry for help. PNES are misunderstood, review are both essential components when treating PNES mistreated, under-recognized, and underdiagnosed. The mind- body dichotomy, an artificial divide between physical and mental health and brain disorders into neurology and psychi- atry, contributes to undue delays in the diagnosis and treat ment Introduction of PNES. One of the major barriers in the effective dia gnosis and treatment of PNES is the dissonance caused by different illness Psychogenic nonepileptic seizures (PNES) are paroxysmal perceptions between patients and providers. While patients attacks that may resemble epileptic seizures but are not caused are bewildered by their experiences of disabling attacks beyond by abnormal brain electrical discharges. -
Epilepsy Syndromes E9 (1)
EPILEPSY SYNDROMES E9 (1) Epilepsy Syndromes Last updated: September 9, 2021 CLASSIFICATION .......................................................................................................................................... 2 LOCALIZATION-RELATED (FOCAL) EPILEPSY SYNDROMES ........................................................................ 3 TEMPORAL LOBE EPILEPSY (TLE) ............................................................................................................... 3 Epidemiology ......................................................................................................................................... 3 Etiology, Pathology ................................................................................................................................ 3 Clinical Features ..................................................................................................................................... 7 Diagnosis ................................................................................................................................................ 8 Treatment ............................................................................................................................................. 15 EXTRATEMPORAL NEOCORTICAL EPILEPSY ............................................................................................... 16 Etiology ................................................................................................................................................ 16 -
Surgical Alternatives for Epilepsy (SAFE) Offers Counseling, Choices for Patients by R
UNIVERSITY of PITTSBURGH NEUROSURGERY NEWS Surgical alternatives for epilepsy (SAFE) offers counseling, choices for patients by R. Mark Richardson, MD, PhD Myths Facts pilepsy is often called the most common • There are always ‘serious complications’ from Epilepsy surgery is relatively safe: serious neurological disorder because at epilepsy surgery. Eany given time 1% of the world’s popula- • the rate of permanent neurologic deficits is tion has active epilepsy. The only potential about 3% cure for a patient’s epilepsy is the surgical • the rate of cognitive deficits is about 6%, removal of the seizure focus, if it can be although half of these resolve in two months identified. Chances for seizure freedom can be as high as 90% in some cases of seizures • complications are well below the danger of that originate in the temporal lobe. continued seizures. In 2003, the American Association of Neurology (AAN) recognized that the ben- • All approved anti-seizure medications should • Some forms of temporal lobe epilepsy are fail, or progressive and seizure outcome is better when efits of temporal lobe resection for disabling surgical intervention is early. seizures is greater than continued treatment • a vagal nerve stimulator (VNS) should be at- with antiepileptic drugs, and issued a practice tempted and fail, before surgery is considered. • Early surgery helps to avoid the adverse conse- parameter recommending that patients with quences of continued seizures (increased risk of temporal lobe epilepsy be referred to a surgi- death, physical injuries, cognitive problems and cal epilepsy center. In addition, patients with lower quality of life. extra-temporal epilepsy who are experiencing • Resection surgery should be considered before difficult seizures or troubling medication side vagal nerve stimulator placement. -
Handbook of EEG INTERPRETATION This Page Intentionally Left Blank Handbook of EEG INTERPRETATION
Handbook of EEG INTERPRETATION This page intentionally left blank Handbook of EEG INTERPRETATION William O. Tatum, IV, DO Section Chief, Department of Neurology, Tampa General Hospital Clinical Professor, Department of Neurology, University of South Florida Tampa, Florida Aatif M. Husain, MD Associate Professor, Department of Medicine (Neurology), Duke University Medical Center Director, Neurodiagnostic Center, Veterans Affairs Medical Center Durham, North Carolina Selim R. Benbadis, MD Director, Comprehensive Epilepsy Program, Tampa General Hospital Professor, Departments of Neurology and Neurosurgery, University of South Florida Tampa, Florida Peter W. Kaplan, MB, FRCP Director, Epilepsy and EEG, Johns Hopkins Bayview Medical Center Professor, Department of Neurology, Johns Hopkins University School of Medicine Baltimore, Maryland Acquisitions Editor: R. Craig Percy Developmental Editor: Richard Johnson Cover Designer: Steve Pisano Indexer: Joann Woy Compositor: Patricia Wallenburg Printer: Victor Graphics Visit our website at www.demosmedpub.com © 2008 Demos Medical Publishing, LLC. All rights reserved. This book is pro- tected by copyright. No part of it may be reproduced, stored in a retrieval sys- tem, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher. Library of Congress Cataloging-in-Publication Data Handbook of EEG interpretation / William O. Tatum IV ... [et al.]. p. ; cm. Includes bibliographical references and index. ISBN-13: 978-1-933864-11-2 (pbk. : alk. paper) ISBN-10: 1-933864-11-7 (pbk. : alk. paper) 1. Electroencephalography—Handbooks, manuals, etc. I. Tatum, William O. [DNLM: 1. Electroencephalography—methods—Handbooks. WL 39 H23657 2007] RC386.6.E43H36 2007 616.8'047547—dc22 2007022376 Medicine is an ever-changing science undergoing continual development.