Corpus callosotomy for intractable generalized epilepsy.
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Cognition Disorders↗
Biomedical subjects
E Wyllie
Publications and source records attributed to E Wyllie.
Subdural electrodes in the evaluation for epilepsy surgery in children and adults.
To evaluate the utility and safety of chronic extraoperative subdural EEG and functional localization studies in children compared to adults, we studied 61 patients each of whom had similar evaluations for epilepsy surgery, regardless of age. The 23 children and adolescents (3 to 18 years old) and the 38 adults (20 to 41 years old) each had several days and nights of extraoperative EEG from scalp and chronically-implanted subdural electrodes, and the same percentage of children and adults also had functional localization studies including cortical electrical stimulation. The methods and results of these studies and of the subsequent resections did not differ between the two groups, and they both had similar rate of complications and similar incidence of good outcome. The subdural technique was as effective and well-tolerated in children and adolescents as in adults. Other invasive EEG techniques have not yet been systematically compared between children and adults, but the subdural technique, at least, appears to be suitable for patients over a wide age range.
Adolescent↗
Localization of cortical function: new information from extraoperative monitoring of patients with epilepsy.
Intraoperative cortical stimulation for evaluation of cortical function has been used extensively to define the extent of cortical excisions for surgical treatment of epilepsy. With chronic implantation of subdural electrodes, extraoperative cortical stimulation becomes possible, and these favorable testing conditions permit more precise mapping of the cortex. This assists the surgeon in planning details of the surgical removal and also provides additional data about the function of the human cortex. Four aspects in which detailed extraoperative studies have provided information complementing the pioneer studies of Foerster, Penfield, and others will be discussed here: (1) Frontal eye field: In the human, this is always an integral part of the motor strip (most probably located in Brodman's area 4 and/or 6) and elicits only conjugate eye movements to the contralateral side with a variable upward component. (2) Negative motor area: Stimulation of the inferior frontal gyrus immediately in front of the face area and of the supplementary motor area of the dominant and nondominant hemisphere produces "inhibition" of voluntary fine movements. (3) The movement related potentials (bereitschaftpotential, negative slope, and motor potential) are strictly localized to the portion of the sensorimotor strip where the movement is represented. Lower amplitude bereitschaftpotentials can also be detected in the homotopic ipsilateral sensorimotor cortex and in the supplementary motor cortex. (4) Three language areas can be distinguished by electrical stimulation: Broca's, Wernicke's, and the basal temporal language area. Electrical stimulation in all these areas produces a similar deficit, but Broca's area tends to overlap with the inferior frontal negative motor area. This may explain the predominant motor deficit of Broca's aphasia.
Brain Mapping↗
Ictus emeticus: an electroclinical analysis.
We report 31 episodes of ictal vomiting in nine patients, documented by simultaneous video and EEG recordings. In four patients, chronically implanted subdural electrode arrays recorded the event. Only one patient showed "projectile" vomiting. Amnesia for the episode occurred in eight of the nine patients. Interictal epileptiform abnormalities were maximal in the right temporal region in seven patients and bitemporal in two. Ictal epileptiform abnormalities were lateralized to the right hemisphere and involved temporal lobe structures in all patients. Three of four patients recorded with subdural electrode arrays were seizure-free following right temporal lobectomy, and the fourth continues to have ictus emeticus at a reduced rate. The consistent right hemisphere lateralization of seizures in this series corroborates with earlier reports documenting right-sided lateralization in four of five previous cases. Two features that help delineate paroxysmal vomiting as an ictal event are (1) patient unawareness of vomiting and (2) its association with other ictal phenomena.
Adolescent↗
Supplementary motor seizures: clinical and electroencephalographic findings.
The clinical and EEG features of 11 patients with seizures arising in the supplementary motor area (SMA) were reviewed. All patients underwent prolonged EEG with simultaneous video recording. Three patients had recordings and electrical stimulation of the SMA using subdural electrode arrays. All patients had preservation of consciousness during the seizure unless it became secondarily generalized. Tonic posturing of the extremities was present in all patients, and in seven it was present bilaterally. Adversive movements were not seen unless the seizure became secondarily generalized. Interictal and/or ictal abnormalities were present at or adjacent to the midline in ten patients. Seizures arising from the supplementary motor region are clinically distinct, and the diagnosis can almost always be verified with prolonged EEG/video recording.
Adolescent↗
Increased seizure frequency with generic primidone.
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Adolescent↗
Electrophysiologic pathologic correlations in patients with complex partial seizures.
We studied interictal activity and site of ictal onset in 26 patients with complex partial seizures of temporal lobe origin. All patients had prolonged electrocorticographic recordings from subdural electrode arrays placed both over the convexity and beneath the temporal lobe. We found a significant correlation between the epileptogenic focus and the type of pathologic lesion found at time of surgery. Macroscopic lesions strongly tended to have an epileptogenic focus on the lateral surface of the temporal lobe; patients with only microscopic abnormalities tended to have an epileptogenic focus in the mesial/basal region of the temporal lobe.
Brain Mapping↗
Complex partial seizures of childhood onset. A five-year follow-up study.
Few detailed studies have examined the long-term outcome of complex partial seizures (CPS) in children and adolescents. Previous studies have selected patients on clinical criteria only or have included those with benign focal epileptiform discharges of childhood, nonepileptiform sharp transients, and generalized epileptiform discharges. We have followed up 29 patients with clinically and electroencephalographically defined CPS of childhood onset for five years or more. Twelve patients are seizure free, eight of them after having epilepsy surgery. Of the remaining, eight patients have intractable seizures. Only one patient was able to discontinue anticonvulsant therapy after epilepsy surgery. No patient had spontaneous remission of seizures without anticonvulsant medications. School difficulties, behavior problems, and unemployment were seen in half the group. We believe CPS in this age group are difficult to control and need aggressive management. In selected patients, epilepsy surgery offers a good chance of seizure control and improvement of educational, social, and vocational potential.
Adolescent↗
Extraoperative cortical functional localization in patients with epilepsy.
Functional localization prior to cortical resections for intractable seizures has usually been performed in the operating room in awake patients. Chronically placed subdural electrodes offer the possibility of performing such testing outside of the operating room and without the unavoidable stresses and time limitations of the surgical setting. The use of the technique is reviewed.
Electrodes, Implanted↗
The source of 'paradoxical lateralization' of cortical evoked potentials to posterior tibial nerve stimulation.
We report the potentials elicited by posterior tibial nerve stimulation and recorded simultaneously from the scalp and from electrodes within the interhemispheric fissure. The primary cortical potential was recorded from cortex contralateral but from scalp ipsilateral to the stimulated nerve. The scalp recordings thus demonstrated "paradoxical lateralization" as reported previously, and the similar morphology of the scalp and contralateral cortical recordings confirm that this "paradoxical lateralization" is most likely the result of a horizontal dipole located within the interhemispheric fissure.
Adolescent↗
Clinical outcome after complete or partial cortical resection for intractable epilepsy.
This is the first epilepsy surgery series to analyze the definition of "completeness" of resection, based solely on results of chronic scalp and subdural EEG recording. When patients had complete removal of all cortical areas with ictal and interictal epileptiform discharges, the clinical outcome was usually good. When areas with epileptiform discharges were left behind, good outcome was significantly less frequent. This correlation between complete resection and good outcome was independent of the presence or absence of CT-detected structural lesions or sharp waves on post-resection electrocorticography. These results support completeness of resection, defined by prolonged extraoperative EEG, as an important factor in seizure surgery.
Adolescent↗
The mechanism of nitrazepam-induced drooling and aspiration.
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Child↗
Mental deterioration in epilepsy.
A variety of factors could potentially influence the occurrence of mental deterioration in epilepsy, including seizure type, age of seizure onset, seizure duration, and seizure severity. The available literature suggests that measures of severity are more predictive of progressive decreases in intellectual functioning. There is also evidence suggesting that seizure severity and cognitive deterioration might both be the result of underlying pathophysiologic abnormalities in some cases. In the majority of patients with epilepsy, however, with relatively less severe disease, there is little evidence for cognitive deterioration. Total seizure number also has an inverse correlation with level of psychosocial functioning in some studies, whereas others have found that patients with emotional difficulties have fewer seizures. In the case of emotional deterioration, the impact of interpersonal relationships and other environmental factors upon psychosocial outcome seems clear, and the evidence for specific pathophysiologic explanations for emotional deterioration, less convincing.
Adult↗
The lateralizing significance of versive head and eye movements during epileptic seizures.
We studied 37 patients who had head and eye turning during 74 spontaneous epileptic seizures. Videotapes and EEGs were analyzed independently. Turning movements were classified without knowledge of EEG or clinical data as either versive (unquestionably forced and involuntary, resulting in sustained unnatural positioning) or nonversive (mild, unsustained, wandering, or seemingly voluntary). Videotape observations were then correlated with the EEG location of seizure onset. Contralateral versive head and eye movements occurred during 61 seizures in 27 patients, but ipsilateral versive movements did not occur. Nonversive lateral head and eye movements occurred ipsilaterally and contralaterally with equal frequency and were nonlocalizing, but versive movement was a reliable lateralizing sign.
Adolescent↗
Ipsilateral forced head and eye turning at the end of the generalized tonic-clonic phase of versive seizures.
We studied 61 spontaneous seizures in 27 epileptic patients with simultaneous EEG and video recording. Each seizure had an initial forced turning (versive) head and eye movement contralateral to the EEG location of seizure onset. Twelve of the 27 secondarily generalized versive seizures also had ipsilateral head and eye version at the end of the generalized convulsion. Initial contraversion and late ipsiversion both appeared to result from ictal activation of frontal contraversive areas in the hemisphere that, at the time, was predominantly involved in the seizure discharge. During initial contraversion, ictal activation was predominant in the hemisphere of seizure onset; during late ipsiversion, in the hemisphere involved by secondary generalization. Late version, unlike initial version, is frequently ipsilateral and cannot be assumed to indicate seizure onset in the contralateral hemisphere.
Adolescent↗
Postictal serum creatine kinase in the diagnosis of seizure disorders.
We prospectively correlated daily serum creatine kinase (CK) levels with the occurrence of different types of epileptic and nonepileptic seizures documented by video EEG recording in 22 hospitalized patients. Prolonged postictal CK elevations, 8.0 to 19.2 times baseline, were seen following six (15%) of 41 generalized tonoclonic seizures. No CK elevations were seen following 147 complex partial, focal motor, absence, and tonic seizures or 55 psychogenic seizures, 89% of which involved vigorous muscular activity. Six of 12 patients with generalized tonoclonic seizures had postictal CK elevations compared with none of six patients with psychogenic seizures and none of 15 patients with complex partial, focal motor, absence, and tonic seizures. Thus, postictal CK determination can serve as an adjunctive test for differentiation between psychogenic and epileptic generalized tonoclonic seizures.
Adolescent↗
Pancreatitis associated with valproic acid therapy.
Four patients had pancreatitis associated with valproic acid therapy. Three patients received valproic acid at usual doses, and all were free of other symptoms of toxic reactions, with serum levels of valproic acid in the usual therapeutic range. Two patients underwent exploratory laparotomy prior to diagnosis. Complications included pseudocyst, pericardial effusion, laparotomy wound infection, and coagulopathy. All patients recovered with discontinuation of valproic acid therapy and enteral feeding and administration of intravenous fluids. After recovery, a valproic acid regimen was restarted uneventfully (in one patient). All were asymptomatic with normal serum amylase levels after five to 14 months. Pancreatitis is a serious complication of valproic acid therapy that must be considered in any patient receiving valproic acid who experiences severe abdominal pain and vomiting.
Abdomen↗
Serum prolactin levels after epileptic seizures.
We prospectively studied serum prolactin (PRL) elevation after different types of documented seizures in 17 patients. Marked PRL elevations above normal and above three times baseline were seen at 15 or 30 minutes after 20 of 25 (80%) generalized tonic-clonic, 13 of 30 (43%) complex partial, and 1 of 10 (10%) simple partial seizures. Although marked postictal PRL elevation is a sensitive indicator of recent epileptic seizures, a normal 15- or 30-minute postictal PRL level does not exclude an epileptic seizure.
Adolescent↗