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Biomedical subjects

C E Polkey

Publications and source records attributed to C E Polkey.

At least 55 records · Page 3Linked to original sources
PubMed1999

Comparison of sphenoidal, foramen ovale and anterior temporal placements for detecting interictal epileptiform discharges in presurgical assessment for temporal lobe epilepsy.

OBJECTIVES: Some authors have recently stressed that the position of the tip of the sphenoidal electrode plays a crucial role in its efficacy to detect mesio-basal spikes. We have tested this hypothesis by comparing the sensitivity of a contact of a foramen ovale bundle located at the foramen ovale (CFO) with scalp electrodes in detecting interictal epileptiform discharges. We have also compared deep and superficial foramen ovale contacts in the same bundle in order to establish whether deeper contacts can detect epileptiform discharges not seen at the foramen ovale or on the scalp. METHODS: The sensitivity for detecting epileptiform discharges of simultaneous intracranial and scalp EEG recordings from 20 patients under telemetric presurgical assessment for temporal lobe epilepsy were compared. RESULTS: Out of 2280 epileptiform discharges evaluated, about 70% were seen only at the deep foramen ovale contacts. Out of the 722 discharges recorded by CFO and/or scalp electrodes, 698 were seen at the CFO and 690 at the scalp anterior temporal electrode. Only on 29 occasions (4.15%) were discharges recorded at the CFO and not at the anterior temporal electrode. On 21 occasions (3.04%) CFO failed to detect discharges seen at the anterior temporal electrode. CONCLUSIONS: Our findings confirm previous results suggesting that sphenoidal electrodes, however accurately positioned, offer no significant increase in detection sensitivity compared with anterior temporal scalp electrodes. In addition, these results confirm that a large proportion of discharges seen at the deepest foramen ovale contacts are not seen either on the scalp nor at the superficial foramen ovale contacts.

Brain↗
PubMed1999

Histological heterogeneity of dysembryoplastic neuroepithelial tumour: identification and differential diagnosis in a series of 74 cases.

AIMS: In a retrospective study of resected specimens from 416 patients being treated for long-standing epilepsy, 74 cases of dysembryoplastic neuroepithelial tumour (DNT) were encountered that were all characteristically composed of small round oligodendroglia-like cells (OLC), astrocytes and mature neurones in varying proportions. The architectural patterns, histological, immunohistochemical and ultrastructural features and results of cell proliferation studies and postoperative follow-up are described to facilitate the identification of DNT and to differentiate it from other intrinsic neoplasms that commonly present with seizures. METHODS AND RESULTS: The tumours presented with early onset of seizures, at a median age of 7 years, without the signs of raised intracranial pressure. A majority of the lesions were located in the temporal lobe (n = 59), with fewer cases in the frontal (n = 8), parietal (n = 6) and occipital lobes (n = 1), and ranged in size from 10 to 70 mm; 33 were cystic. Histologically three types could be distinguished, multinodular, solitary nodular and diffuse. The first type (37.8%) had the features of a typical DNT with multinodular architecture and mixed cellular composition. The second type (33.8%) consisted of a solitary nodule, while the third (28.4%) was a diffuse tumour, both composed of a similar mixture of cells as the multinodular DNT. The lesions were seen in the neocortex and white matter and tumours in the temporal lobe often involved the amygdala and hippocampus. The presence of myxoid matrix, microcystic change, calcification and leptomeningeal involvement were common. Dysplastic neurones at the periphery of the tumour and abnormalities in cortical lamination in the adjacent neocortex were found in about one-third of the resections. Rare mitotic figures were encountered in eight of the tumours and necrosis was found in two. Immunocytochemistry for glial fibrillary acidic protein (GFAP) and neuronal markers neuron-specific enolase, synaptophysin and neurofilament (RT 97) assists in establishing the diagnosis, highlighting the astrocytic and neuronal components, and the OLC, by the absence of expression of GFAP. Electron microscopy showed that in some cases OLC show neuronal differentiation. Although the proliferating cell nuclear antigen labelling index varied between 0 and 45.5%, 20 of the 51 tumours stained failed to express the antigen, in keeping with the indolent nature of this neoplasm. The response to surgery was excellent; none of the tumours have recurred, and the control of seizures remained good. CONCLUSIONS: Despite some histological heterogeneity, the clinical and pathological features and indolent biological behaviour indicate that these tumours constitute a single distinct entity. The spectrum of morphological appearances of DNT is broader than has been previously reported, the recognition of which is needed to avoid unnecessary neoadjuvant therapy.

Adolescent↗
PubMed1999

Effect of propofol on the electrocorticogram in epileptic patients undergoing cortical resection.

We have compared the effect of clinical doses of propofol with thiopental on epileptiform activity in the electrocorticograms (ECoG) of 20 epileptic patients undergoing temporal lobe resection. After baseline ECoG had been obtained, with inspired concentrations of 0.5-1% isoflurane and 70% nitrous oxide to provide background anaesthesia, subjects were allocated randomly to receive boluses of either thiopental 25 mg or propofol 20 mg i.v. every 30 s to a maximum of 5 mg kg-1 or until burst suppression was seen. The ECoG was recorded throughout administration and for 10 min thereafter. After return of baseline ECoG tracings, the alternate agent was administered. The amount of epileptiform activity was recorded on an ordinal rating scale, an increase being indicated by either a rise of at least one category on the scale or discharges occurring at a minimum of one new site. Activation occurred more frequently with thiopental but the difference was not significant. This study suggests that propofol has no greater proconvulsive effect than thiopental, a drug commonly used in managing status epilepticus.

Adolescent↗
PubMed1999

Differential spatial memory impairment after right temporal lobectomy demonstrated using temporal titration.

In this study a temporal titration method to explore the extent to which spatial memory is differentially impaired following right temporal lobectomy was employed. The spatial and non-spatial memory of 19 left and 19 right temporal lobectomy (TL) patients was compared with that of 16 normal controls. The subjects studied an array of 16 toy objects and were subsequently tested for object recall, object recognition and memory for the location of the objects. By systematically varying the retention intervals for each group, it was possible to match all three groups on object recall at sub-ceiling levels. When memory for the position of the objects was assessed at equivalent delays, the right TL group revealed disrupted spatial memory, compared with both left TL and control groups (P < 0.05). MRI was used to quantify the extent of temporal lobe resection in the two groups and a significant correlation between hippocampal removal and both recall of spatial location and object name recall in the right TL group only was shown. These data support the notion of a selective (but not exclusive) spatial memory impairment associated with right temporal lobe damage that is related to the integrity of the hippocampal functioning.

Adult↗
PubMed1999

Prognostic factors in presurgical assessment of frontal lobe epilepsy.

OBJECTIVES: To determine predictors for surgical outcome in the presurgical assessment of frontal lobe epilepsy. METHODS: Thirty seven patients were operated on for frontal lobe epilepsy between 1975 and 1996. Their medical records were reviewed for ictal semiology, age at onset, duration of the epilepsy, age at operation, preoperative interictal and ictal encephalographic findings, and abnormalities on neuroimaging and neuropsychological testing. In addition, type of resection and pathology were compared with surgical outcome. RESULTS: Univariate statistical analysis showed that the presence of a focal abnormality on neuroimaging was associated with favourable outcome. The presence of the following ictal findings was associated with poor outcome: autonomic manifestations, eye deviation, head version contralateral to the operated side, and bilateral or multifocal ictal onset. Fifteen patients had secondarily generalised interictal discharges and, interestingly, their presence was not associated with poor outcome. Multivariate logistic regression showed that the presence of a focal abnormality on neuroimaging was significantly associated with a favourable outcome while contralateral head version was the only variable significantly associated with poor surgical outcome. CONCLUSIONS: A focal abnormality on neuroimaging was the only variable which was significantly associated with a favourable surgical outcome, whereas contralateral head version was the most significant predictor for a poor outcome. The presence of generalised discharges before surgery was not associated with poor outcome.

Adolescent↗
PubMed1999

Generation of scalp discharges in temporal lobe epilepsy as suggested by intraoperative electrocorticographic recordings.

OBJECTIVES: To study the variability, topography, polarity, duration, and incidence of interictal epileptiform discharges (EDs) in the scalp EEG and electrocorticogram (ECoG) from 16 patients with temporal lobe epilepsy who underwent surgical treatment. METHODS: Preoperative scalp EEGs during quinalbarbitone induced sleep were compared with preresection ECoGs obtained under general anaesthesia. The analysis was based on the initial ECoG record obtained before activation by intravenous thiopentone, and the EEG during stages I and II of sleep. RESULTS: On the scalp, 15 patients had a single discharge pattern, spikes were predominantly negative, EDs were of largest amplitude at the anterior temporal electrode in 13 patients and mean discharge incidence was 4.0 (SD 4.2) discharges/min. In ECoG recordings, nine patients had two independent ECoG patterns, the polarity of spikes was negative, positive-negative, or positive, the site of maximal amplitude varied greatly between subjects, discharge incidence was 7.3 (SD 3.9) discharges/min. There was no relation between the topography of the largest spikes on the scalp and in the ECoG. In 14 patients, scalp spikes showed statistically significant longer duration on the scalp than in the ECoG. In seven patients who had frequent widespread ECoG discharges, averaging spikes across ECoG channels generated spiky patterns of duration similar to that of scalp spikes. CONCLUSION: It seems that, in temporal lobe epilepsy, scalp discharges originate from widespread ECoG discharges and tend to produce a stereotyped pattern on the scalp with largest amplitudes at the anterior temporal electrodes. This is probably due to local anatomical peculiarities in the brain coverings, such as skull discontinuities, rather than to the location of neuronal generators within the temporal lobe. Due to spatiotemporal averaging, widespread cortical discharges which become asynchronous during propagation appear with increased duration and blunted waveform in the EEG, whereas sharply localised phenomena such as positive focal spikes are not recorded from the scalp.

Adolescent↗
PubMed1999

Interictal 18FDG PET findings in temporal lobe epilepsy with déjà vu.

The authors studied the functional anatomy of the déjà vu (DV) experience in nonlesional temporal lobe epilepsy (TLE), using interictal fluorine-18 fluorodeoxyglucose PET in 14 patients with and 17 patients without DV. Several clinical conditions, such as age at PET study, side of ictal onset zone, and dominance for language, were no different between the two groups. The patients with DV showed significant relative reductions in glucose metabolism in the mesial temporal structures and the parietal cortex. The findings demonstrate that ictal DV is of no lateralizing value. They further suggest that temporal lobe dysfunction is necessary but not sufficient for the generation of DV. Extensive association cortical areas may be involved as part of the network that integrates this distinct experience.

Adult↗
PubMed1999

Vagal nerve stimulation in epileptic encephalopathies.

OBJECTIVE: To study the effect of vagal nerve stimulation (VNS) in children with epileptic encephalopathies. METHODS AND MATERIALS: All children receiving VNS during a 2-year period at our center were studied prospectively for changes in seizure frequency, electroencephalogram (EEG), adaptive behavior, quality of life, and where appropriate, verbal/nonverbal performance. Assessments were made before and for at least 1 year after implant. RESULTS: Sixteen children were studied. One device was removed because of infection. Of the remaining 15 children, 4 had a >50% reduction and 2 had a >50% increase in seizure frequency at 1 year after implant. Median reduction in seizure frequency was 17%. There was no trend toward improvement of the EEG or adaptive behavior. Quality of life was unchanged in most areas, except in perceived treatment side effects and general behavior that were improved. In 6 children undergoing further assessment, there was a significant improvement in verbal performance; this did not correlate with reduction in seizure frequency. CONCLUSION: VNS did not significantly improve seizure frequency, severity, adaptive behavior, or the EEG during the first year of treatment for the group as a whole, although 4 children (27%) had a worthwhile reduction in seizure frequency. There were significant improvements in perceived treatment side effects and general behavior.

Adolescent↗
PubMed1998

Recognition memory and memory for order in script-based stories following frontal lobe excisions.

Memory for stories was investigated in 25 patients with frontal lobe excisions and 25 control subjects. The subjects were presented with three different story types that either conformed to a well-known script, contained the same elements as a script but in a randomised order, or described a novel event. Subjects were asked to perform a test of recognition memory and memory for order on words presented in each story. The frontal lobe patients were unimpaired on the recognition memory test for salient words taken from each story. However, an impairment was observed in the frontal patients when they were asked to order the words taken from the novel story only. This deficit was no longer seen when the subjects were required to order sentences describing the key events in the story. These findings help to elucidate the role of the frontal lobes in memory for order information.

Adult↗
PubMed1998

Selective spatial memory impairment after right unilateral temporal lobectomy.

Deficits in performance of both spatial and visual tasks are common following tissue loss in the right temporal lobe. Since spatial and visual attributes are frequently confounded in experimental tasks, we have studied patients following unilateral temporal lobectomy, in an attempt to determine which aspect mediates the observed deficits. Spatial and visual memory performance was compared in normal controls (n = 16), left temporal (LTL; n = 19) and right temporal (RTL; n = 19) lobectomy patients, by presentation of eight abstract designs in a spatial array for subsequent recall and recognition of the designs (visual memory) and recall of their spatial position (spatial memory). By varying the retention intervals for each group, all three groups were matched on both recall and recognition of the designs at sub-ceiling levels. In contrast, recall of the position of the designs (spatial memory), tested at equivalent delays to those of the visual memory tests, revealed a deficit in the RTL patients compared to both controls and LTL patients (p < 0.05). Magnetic resonance imaging (MRI) was used to quantify the extent of resection of the hippocampus and parahippocampal regions in the two patient groups and showed a significant correlation between hippocampal and parahippocampal removal and spatial memory in the RTL group only. These data support the notion of a disproportionately large involvement of the right hippocampus and adjacent regions in spatial memory.

Adult↗
PubMed1998

Independent recovery of memory and language functioning during the Intracarotid Sodium Amytal Test.

Memory and language recovery during the Intracarotid Sodium Amytal Test (IAP) was investigated in 49 left-hemisphere-dominant patients with unilateral temporal epileptic seizure foci. Memory was assessed by presenting items (words, objects, and faces) immediately after injection, and testing for recognition memory 10 min after motoric recovery. To assess language the patients responded verbally to the same items during memory presentation. Memory for the individual items was found to be independent of their presentation order and language functioning was impaired only with the dominant-hemisphere injection, recovering during the presentation of the memory items. These results suggest that the encoding of material remains at a constant level throughout the initial active phase of the IAP, whereas language functioning recovers independently.

Adult↗
PubMed1998

Dissociating executive mechanisms of task control following frontal lobe damage and Parkinson's disease.

Twelve patients with focal damage of the frontal cortex and 12 patients with mild, medicated, early stage Parkinson's disease switched between letter- and digit=naming tasks on every second trial of a task-switching paradigm. Compared with age- and IQ-matched control performance, patients with left-sided, but not right-sided, frontal damage exhibited markedly increased time costs associated with these predictable switches only when there was a general incidence of interference or 'crosstalk' between the tasks, and particularly so when the available task cues were relatively weak and arbitrary. The same patients also showed evidence of an increased sensitivity to the facilitatory and inhibitory effects of previous processing, when required to switch between tasks. Both groups of patients (with left- or right-sided frontal damage) exhibited slow, disorganized performance early in practice. In contrast to these frontal effects, the Parkinson's disease patients showed little indication of larger time costs of task switches but they did show progressive increases in the error costs, while age- and IQ-matched control subjects showed reductions. We propose that while both left and right frontal cortical areas are involved in the organization of cognitive and motor processes in situations involving novel task demands, only the left frontal cortex is involved in the dynamic reconfiguring between already-established task-sets, and specifically, that it is the site of an executive mechanism responsible for the modulation of exogenous task-set activity. Finally, dopaminergic transmission, along the nigrostriatal pathway, may be implicated in sustaining various cognitive and motor processes over prolonged periods, including the operation of those executive control mechanisms that accomplish reconfiguring between task-sets.

Adult↗
PubMed1998

Clinical value of "ictal" FDG-positron emission tomography and the routine use of simultaneous scalp EEG studies in patients with intractable partial epilepsies.

PURPOSE: EEG is widely used during positron emission tomography (PET) to confirm the interictal state of the patient and assist in scan interpretation when a seizure occurs. Ictal scans usually reflect mixed interictal-ictal-postictal metabolic activity as seizures are brief in comparison to the 30-min uptake period of the tracer. We wished to determine whether routine EEG is justified and if seizures commonly affect the diagnostic information of the PET scan. METHODS: We examined the PET scans of 6 of 236 outpatients with intractable epilepsy with clinical and electrical evidence of a seizure during tracer uptake. We performed semi-quantitative analysis in 2 patients who had "ictal" and control interictal scans. RESULTS: Patients with single seizures lasting 23 s to 4 min [four complex partial seizures (CPS) and one absence seizure (AS)] had focal hypometabolism concordant with results of other investigations. One patient with complex partial status had irregular cortical uptake and focal hypometabolism, but the site of the ictal focus could not be confirmed. CONCLUSIONS: In this group of patients, seizures occurred infrequently during tracer uptake. The interpretation of the PET scan when single seizures occurred did not appear to be influenced by the continuous scalp EEG (CSEEG) recordings. The value of routine CSEEG in outpatients treated with medication should be reappraised, with potential cost savings. In rare circumstances in which a true ictal study occurs (complex partial status, epilepsia partialis continua, and repetitive CPS), PET scanning may be inconclusive and repeat interictal scanning should be pursued.

Adolescent↗