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M R Trenerry

Publications and source records attributed to M R Trenerry.

34 records · Page 2Linked to original sources
PubMed1995

Depth electrode studies in temporal lobe epilepsy: relation to quantitative magnetic resonance imaging and operative outcome.

We performed a retrospective study of 30 patients with presumed intractable temporal lobe epilepsy (TLE) who underwent chronic intracranial EEG monitoring (CIEM). Multicontact depth electrodes were stereotactically implanted through the medial occipital lobe into amygdala and hippocampus. All patients had previously undergone extracranial ictal EEG monitoring that proved inadequate to localize the epileptogenic zone. No morbidity was associated with CIEM in the 30 patients. Twenty-five patients were shown to have exclusively or predominantly unilateral temporal lobe seizures, and 5 patients had bitemporal seizures without unilateral predominance; 24 patients subsequently underwent an anterotemporal lobe cortical resection. Twenty-one patients have been followed a minimum of 1 year postoperatively. Nine patients (43%) had a class I outcome (seizure-free, auras only, or provoked seizures), 3 patients (14%) had a class II outcome (> or = 95% seizure reduction), 4 patients (19%) had a class III outcome (> or = 50% seizure reduction); and 5 patients (24%) had a class IV outcome (< 50% seizure reduction or no change). A prolonged interhemispheric propagation time (p < 0.01) and magnetic resonance imaging (MRI)-identified hippocampal atrophy (p < 0.01) correlated with a favorable surgical outcome. Results of this study may prove useful in counseling patients who undergo CIEM before temporal lobe surgery.

Adolescent↗
PubMed1995

Electrocorticography and temporal lobe epilepsy: relationship to quantitative MRI and operative outcome.

We investigated the relationship between electrocorticography (ECoG), quantitative magnetic resonance imaging (MRI), and surgical outcome in 165 patients with intractable nonlesional temporal lobe epilepsy (NLTLE). A standard mesial temporal resection was performed in all patients. Patients with an operative follow-up < 1 year were excluded from the study. The extent of the lateral temporal neocortex resection (LCR) was guided by ECoG and the side of surgery. The extent of the LCR was not predictive of seizure outcome in patients with or without hippocampal formation atrophy (p > 0.5). Patients undergoing a right anterior temporal lobectomy had a larger LCR (p < 0.0001), but the side of surgery was not of predictive value in determining seizure outcome (p > 0.1). The topography of the acute intracranial spikes did not correlate with operative outcome (p > 0.5) and was independent of hippocampal volumetric studies (p > 0.5). The postexcision ECoG was also shown not to be of prognostic importance (p > 0.5). Our results indicates that the extent of the lateral temporal cortical resection and the ECoG findings are not important determinants of surgical outcome in patients with NLTLE.

Adolescent↗
PubMed1995

Bilaterally symmetric hippocampi and surgical outcome.

This study investigates the relationship between hippocampal volume and seizure control following temporal lobectomy in patients with volumetrically symmetric hippocampi. Forty-six patients who underwent temporal lobectomy for nonlesional temporal-lobe-onset seizures, and in whom the volumes of the two hippocampi were roughly equal (ie, the difference of the right minus the left hippocampal volume fell between -0.1 and 0.3 cm3), were included. We graded postoperative seizure control on a four-point scale according to criteria defined by Engel. We found no relationship between the hippocampal sum (sum of the right plus left hippocampal volumes normalized for cranial size) and operative outcome. A satisfactory operative outcome is possible in patients with bilaterally symmetric mesial temporal sclerosis by MRI criteria.

Adult↗
PubMed1995

Intracarotid amobarbital procedure. The Wada test.

Wada testing has been a standard part of temporal lobectomy evaluation since the early 1960s. Although the procedure was initially used to lateralize language function, it was soon modified to assess risk for postoperative amnesia. The use of the procedure has now evolved to include prediction of degrees of memory decline. This use has been criticized, but more recent research has better described important parameters of the procedure and supported its validity. The Wada test is effective in lateralizing seizure onset, predicting postoperative seizure control, and predicting degree of verbal memory decline following left temporal lobectomy. The validity of Wada test data has also been supported by correlations between Wada memory performance and hippocampal pyramidal cell loss or MR imaging determined hippocampal volumes. It remains to be seen, however, if Wada memory performance and data from other sources such as MR imaging, ictal SPECT, positron emission tomography, or functional MR imaging are redundant or independently contribute to patient diagnosis and management.

Amobarbital↗
PubMed1994

Intractable nonlesional epilepsy of temporal lobe origin: lateralization by interictal SPECT versus MRI.

We performed a retrospective study of 53 consecutive "nonlesional" temporal lobectomy patients to assess the relative utility of MRI versus interictal single-photon emission computed tomography (SPECT) in this patient population. We compared the seizure lateralizing properties of MRI and SPECT using multiple blinded expert reviewers for both SPECT and MRI with a test-retest reviewer paradigm and measurements of hippocampal volume from MRI. The criterion standard for seizure lateralization was satisfactory postoperative seizure control (n = 43). The rate of correct seizure lateralization was significantly greater for MRI than for SPECT (p < or = 0.01), and the rate of incorrect lateralization was significantly less for MRI than for SPECT. The most accurate MRI measure was hippocampal volume measurements, which correctly lateralized the seizures in 86.0% of cases. The correct lateralization rate for SPECT was 45.4%. The MRI and SPECT studies tended to be noncomplementary with respect to seizure lateralization, and SPECT was likely to give an incorrect or indeterminate result in patients who were not lateralized by MRI. Concordant MRI-EEG lateralization was a strong predictor of satisfactory postoperative seizure control, while no relationship between postoperative seizure control and SPECT findings was present.

Adult↗
PubMed1993

Operative strategy in patients with MRI-identified dual pathology and temporal lobe epilepsy.

We performed a prospective study using preoperative magnetic resonance imaging to identify hippocampal formation atrophy in 15 consecutive patients with intractable partial epilepsy who had undergone a stereotactic resection of an extrahippocampal temporal lobe foreign-tissue lesion. A stereotactic lesionectomy was performed in all patients, i.e., only the imaging-defined lesion itself was resected. Hippocampal formation atrophy was identified in three of the 15 patients. Neuroimaging-detected hippocampal formation atrophy has been shown to be a reliable marker of moderate to severe mesial temporal sclerosis. All patients with hippocampal formation atrophy had an unfavorable operative outcome. Pathological examination of the hippocampus in one patient with neuroimaging-identified hippocampal formation atrophy who subsequently received an anterior temporal lobectomy revealed mesial temporal sclerosis. Nine of the 12 patients without hippocampal formation atrophy experienced a significant reduction in seizure tendency after lesionectomy. The surgically excised hippocampus in one patient without hippocampal formation atrophy who later underwent a temporal lobectomy showed no significant neuronal loss. Results of this study have modified the surgical approach taken at this institution in patients with temporal lobe lesional epilepsy. Patients with magnetic resonance imaging-defined dual pathology now undergo a temporal lobectomy which includes resection of the hippocampus and the foreign-tissue lesion.

Adolescent↗
PubMed1993

Quantitative MRI hippocampal volumes: association with onset and duration of epilepsy, and febrile convulsions in temporal lobectomy patients.

The relationships between preoperatively acquired MRI-based hippocampal volumes (HV), seizure disorder onset and duration, and early childhood febrile convulsions were investigated retrospectively with data from 72 left and 56 right temporal lobectomy patients. Patients with lesional pathology and heterotopic abnormalities were excluded. Age at development of spontaneous seizures unprovoked by an acute illness defined age of seizure disorder onset. Age of onset was subtracted from age at neurosurgery to determine duration. MRI variables included in this study were the right and left HV divided by total intracranial volume (RAHV, LAHV), and the right-left hippocampal difference (DHF). Partial correlations were used to better isolate relationships with onset of recurrent seizures corrected for age at surgery, and age at neurosurgery corrected for age of recurrent seizure onset. Partial correlations between age at neurosurgery and volume were not significant in either group. LAHV (r = 0.42, P < 0.0003) and DHF (r = -0.49, P < 0.0001) were correlated with age of onset in the left lobectomy group. Correlations in the right lobectomy group were not significant. The presence of a febrile convulsion was associated with smaller LAHV (F(1,70) = 10.54, P < 0.002) and larger DHF (F(1,70) = 11.36, P < 0.002) in left temporal lobectomy patients. The presence of a febrile convulsion in the right temporal group was associated with a slightly smaller DHF (F(1,56) = 5.90, P < 0.02), and slightly smaller RAHV (F(1,56) = 4.49, P < 0.04). These data suggest that hippocampal atrophy remains stable over the duration of temporal lobe onset seizure disorders, and is associated with early onset of recurrent seizures in left temporal patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

MRI hippocampal volumes and memory function before and after temporal lobectomy.

We investigated the relationship between preoperative MRI hippocampal volumes and clinical neuropsychological memory test data obtained before and after temporal lobectomy and amygdalohippocampectomy for intractable epilepsy in 44 left (LTL) and 36 right (RTL) temporal lobectomy patients. In LTL patients, the difference (right minus left hippocampal volume) between hippocampal volumes (DHF) was significantly (p < 0.001) correlated (r = 0.61) with postoperative verbal memory change as measured by a delayed memory percent retention score from the Wechsler Memory Scale-Revised, Logical Memory subtest. DHF was also positively associated with postoperative memory for abstract geometric designs in LTL patients (r = 0.49, p < 0.005). Resection of a relatively nonatrophic left hippocampus was associated with poorer verbal and visual memory outcome. In RTL patients, larger right adjusted (for total intracranial volume) hippocampal volume was associated with decline in visual-spatial learning, but not memory, following surgery. MRI hippocampal volume data appear to provide meaningful information in evaluating the risk for memory impairment following temporal lobectomy.

Adult↗
PubMed1992

MRI in the presurgical evaluation of patients with frontal lobe epilepsy and children with temporal lobe epilepsy: pathologic correlation and prognostic importance.

We performed magnetic resonance imaging (MRI) using a high-field strength magnet (1.5 T) in two series of 53 patients with intractable partial epilepsy of frontal lobe or temporal lobe origin who subsequently received ablative surgery for their seizure disorder. In the first series of patients the pathologic correlation and prognostic importance of an MRI-identified lesion in the frontal lobe were assessed. Twenty-five percent of the patients with negative MRI studies and 67% of patients with neuroimaging abnormalities restricted to the frontal lobe, were seizure-free at a minimum duration of follow-up of 1 year. None of the patients with a multilobar MRI-detected abnormality was seizure-free postoperatively. In the second study the sensitivity and specificity of MRI-based hippocampal volumetry was determined in pediatric patients with partial epilepsy of temporal lobe origin unrelated to foreign-tissue pathology. Hippocampal formation atrophy in the epileptic temporal lobe was identified in 63% of patients. The sensitivity and specificity of hippocampal volumetry was 100% in patients with mesial temporal sclerosis. The presence of an MRI-detected epileptogenic lesion in the frontal lobe and hippocampal formation atrophy in the temporal lobe may correlate with the underlying pathology and affect the identification of potential candidates for epilepsy surgery.

Adolescent↗
PubMed1991

The treatable dementia of Sjögren's syndrome.

Progressive dementia developed during a 15-month period in a 56-year-old woman with serologically and clinically documented primary Sjögren's syndrome. Findings from magnetic resonance imaging and angiography were normal, but a brain biopsy disclosed perivascular lymphocytic inflammation in leptomeningeal and parenchymal vessels. Treatment with high-dose corticosteroids produced rapid and nearly complete resolution of the dementia.

Alzheimer Disease↗
PubMed1990

The utility of the MAPI in the assessment of depression.

The relationships between the Millon Adolescent Personality Inventory (MAPI; Millon, Green, & Meagher, 1982) and depression, as assessed by the Multiscore Depression Inventory (MDI; Berndt, 1968) were examined. Elevations on the MDI subscales were positively related to elevations on MAPI personality style Scale 2 (Inhibited) and Scale 8 (Sensitive) and on six of the eight MAPI expressed concerns scales. MAPI personality style Scale 4 (Sociable) and Scale 5 (Confident) were negatively correlated with the MDI. MAPI code types containing either Scale 2 or 8 were associated with a high MDI full-scale score. The subjects who received a MAPI computer-generated diagnosis of borderline personality disorder also had elevated MDI full-scale scores. The findings of this study appear consistent with the existing body of MAPI research, and the data suggest that the MAPI personality style scales may have both state and trait qualities.

Adjustment Disorders↗
PubMed1990

MAPI code types in an inpatient crisis-unit sample.

Limited data is available concerning the use of the Millon Adolescent Personality Inventory (MAPI; Millon, Green, & Meagher, 1982) and high-point code combinations of its personality style scales. Our study reports on the frequency of high-point codes in an inpatient crisis-unit sample. Data analyses comparing personality style codes using MAPI expressed concerns scale elevations and Rorschach data are reported. Results comparing the personality style codes and expressed concerns scales were consistent with the findings of Millon et al. (1982). Analyses comparing Rorschach and MAPI data revealed only the presence or absence of vista responses as having any appreciable relationship to MAPI codes or personality scales.

Adaptation, Psychological↗
PubMed1988

California Verbal Learning Test (CVLT) performance in severely head-injured and neurologically normal adult males.

California Verbal Learning Test (CVLT) performance was compared for 33 head-injured and 33 neurologically normal adult males. On learning trials, head-injured persons recalled fewer items than controls in general, though the percent of improvement between trials did not differ for these groups. Head-injured patients also demonstrated more intrusions and used semantic groupings less than did normal controls during learning trials. On delayed recall trials, head-injured persons remembered a smaller percentage of items they had learned earlier than did controls. Semantic cues aided recall for head-injured but not normal persons. Head-injured persons were less able to discriminate list from nonlist items during the recognition trial. Results indicated both retrieval and storage (i.e., encoding or retention) deficits for the head-injured group. The CVLT is a useful instrument for defining memory deficits in a head-injured population.

Adult↗
PubMedDate not supplied

Long-term follow-up of stereotactic lesionectomy in partial epilepsy: predictive factors and electroencephalographic results.

We performed an extended follow-up study assessing the efficacy of stereotactic lesionectomy in 23 patients with foreign-tissue lesions and intractable partial epilepsy. Sixteen lesions involved functional or eloquent cortex as determined by anatomic localization. By definition, the surgical objective in these patients was excision of the lesion, and not the surrounding cerebral cortex. The mean duration of follow-up was 48.5 months (range 26-69 months). Seventeen patients (74%) had a significant reduction in seizures (greater than or equal to 90%) after lesionectomy. Thirteen patients (56%) had a class I operative outcome (seizure-free, single seizure episode, or auras only). Five of these patients were successfully discontinued from antiepileptic drug (AED) therapy. Patients with temporal lobe lesions were statistically less likely to be rendered seizure-free (p less than 0.05). Age at operation, duration of epilepsy, and underlying pathology were not significant predictors of seizure outcome. The anatomic distribution of extracranial EEG recorded epileptiform activity did not appear to be an important determinant of outcome. The absence of interictal epileptiform activity in the 3-month postoperative EEG correlated with a significant reduction in seizures. Long-term follow-up indicates that lesionectomy may be effective in select patients with medically refractory partial seizure disorders.

Adolescent↗
PubMedDate not supplied

Extratemporal cortical resections and lesionectomies for partial epilepsy: complications of surgical treatment.

Fifty patients with medically refractory extratemporal seizures underwent epilepsy surgery at our institution between 1988 and 1992. Twenty-nine patients (group I) had an extratemporal (mainly frontal lobe) corticectomy, and 21 patients (group II) had an epileptogenic lesion extirpated without resection of the epileptic brain tissue. Comprehensive neurologic evaluation was performed preoperatively, soon after operation, and approximately 3 months postoperatively to assess operative outcome. Magnetic resonance imaging (MRI) in group I patients usually showed no abnormality or a large destructive lesion. Neuroimaging showed a foreign tissue lesion in most group II patients. Thirteen of the 29 patients who underwent corticectomy had at least one adverse event (AE) potentially related to operation at the time of initial assessment. Four of the 13 patients required a surgical procedure to treat the operative complication, but only 1 of the 13 patients had a persistent neurologic deficit at follow-up examination. Three of the 21 patients who received lesionectomy had acute and persistent neurologic morbidity. Patients undergoing cortical resection remained intubated longer postoperatively (p < 0.005), and required longer hospitalization after operation (p < 0.001) and in the intensive care unit (p < 0.001) as compared with the lesionectomy group. Results of this study may prove useful in counseling patients regarding neurologic outcome after extratemporal surgery.

Adolescent↗