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4-17-07 Expression of P-glycoprotein and related proteins in brain of patients with refractory temporal lobe epilepsy (TLE)
S234
Epilepsy
These processes are closely connected and cause development of ED. The determination of the types of ED, the prevailing of character or intellectual mnestic disturbances, degree of personality changes make the choice of psychotherapeutic methods or medicine possible.
M. Bhaskara
Rao, S. Dinesh
Nayak,
Sanjeev
Comprehensive Epilepsy Program, Sree ChiWa Tirunal lnsfitute Sciences and Technology; Trivandrum, Kerala, South India
Gustav0 Sevlever, Ramon Leiguarda,
V. Thomas.
1 Olfactory bed. Side test to identify temporo. Orbitofrontal dysfunction
I. Savic1,2, Y.S. Bookheimer3, I. Fried4, J. Engel Jr.‘. ‘Dept. of Neurology, 3 Div. of Brain Mapping, 4 Dept. of Neurosurgery UCLA, USA, 2 Dept. of Neuroscience Karolinska Institute, Stockholm, Sweden
1 Follow up of seizures - 500 patients over a period of two to ten years
R. Sethuraman, MB. Pranesh, S. Dinesh Nayak, R. Sambasivam, P. Rajendran, V. Rajmohan, R. Murali. Depr of Neurosciences, KG Hospital PGIMS, Coimbatore, India
of pseudo
&
500 patients with seizures were studied clinically and were investigated appropriately. Follow up done revealed that about 20 per cent of the patients were non-compliant towards drug treatment and also regarding the other advice given. However recurrence of fits did occur in roughly one third of the patients and inspite of the recurrence these patients came regularly. The paper would
Ana Lia Taratuto,
Departmen& of Neurologicas Raul
Objective: Overexpression of the multiple drug resistant gene MDRl) in tissue from patients with refractory epilepsy has recently been reported (Tishler et al, Epilepsia 1995; 36:1-6). P-glycoprotein accounts for drug resistance on patients with tumors, partially by acting as an efflux pump which results in low intracellular levels of chemotherapeutic agents. Other compounds had been related to chemoresistance, although by different mechanisms. We assessed the immunoexpression of P-glycoprotein, glutathion S transferase IT, Metalothionein and bcl/2 in 12 patients with non-lesional medically intractable TLE, who proved on pathology to have mesial temporal sclerosis (MTS) and spared lateral neocortex. Methods: Temporal lobe specimens from 12 consecutive patients were studied. lnmunohistochemistly was performed for the analysis of P-glycoprotein, metalothionein, glutathion S transferase P and bcV2. Determinations were made on all patients at both, mesial temporal lobe structures and lateral neocortex. Results: We detected P-glycoprotein and metalothionein on 9 samples, limited to the region of MTS but not lateral neocortex. Gluthation and bcV2 were negative. lmmunostaining was evident in both neuronal and glial components. Conclusions: 1) We found expression of P-glycoprotein and metalothionein in human tissue limited to the epileptogenic region in 9 of 12 patients. 2) Our findings might explain, at least in part, the underlying mechanisms related to drug-resistant epilepsy.
4-17-08
Introduction: Olfactory memory and discrimination are processed by the antero - mesial temporal cortex and the orbitofrontal cortex. Both functions may therefore be impaired in limbic epilepsy. Method: 29 patients with mesial temporal lobe (MTL) seizures, 1 with neowrtical seizures (NS), and 10 controls were evaluated for olfactory (discrimination (D) and memory (M). The olfactory processing was tested before assessment of the diagnosis, and during an interictal period. The test were performed in a same-different paradigm with 10 seconds and 6 minutes between presentations of the odors, using the University of Pennsylvania Scratch and Sniff Test. The results were related to region glucose metabolism measured with [‘sF]FDG PET scans. Results: Patients with MTLseizures differed from controls and patients with NS by an impaired D ipsilaterally to the epileptogenic region and by a higher total number of errors (including both tests), (p < 0.05). The combined M and D test showed a sensitivity of 85% and a specificity of 90% to correctly identify MTL dysfunction. A correct lateralization was achieved in 23 MTL patients. Correlative PET studies with 18-F FDG showed that MTL-patients whose D was more impaired than M different from those with more impaired M, by having a significant hypometabolism not only in the lateral temporal lobe, but also in the anterior fraction of the epileptogenic temporal lobe (p = 0.007), and in the ipsilateral orbitofrontal cortex (p = 0.02). The majority of patients with impaired D had mesial temporal sclerosis, whereas those with impared M had other types of pathology. Conclusion: Tests of olfactory function are useful in the differentiation between patients with neocortical and MTL seizures. Olfactory M and D can be dissociated, suggesting that these functions are mediated by different structures. Among patients with MTL those with mesial temporal sclerosis seem to have more widespread limbic dysfunction and more frequent impairement of D.
( 4-17-06
Carlos D’Giano, Albert0 Lazarowski, Hugo Pomata, Adrian L. Rabinowicz.
Neurology and Pathology, lnstituto de lnvestigaciones Carrea-Fleni, Buenos Aires, Argentina
for Medical
Very little information regarding the practice and outcome of anterior temporal lobectomy (ATL) for intractable temporal lobe epilepsy (TLE) is available from developing countries. Intracranial EEG recording to localize the epilep togenic focus escalates the cost of epilepsy surgery. Through a prospective standardized non-invasive presurgical protocol utilizing scalp EEG, MRI, neuropsychological tests and video-EEG, we selected patients with a concordant unilateral temporal epileptogenic focus for ATL with amygdalohippocampectomy. We assessed the post-ATL outcome using a composite scoring system to quantify the seizure (seizure score, Surgical Treatment of the Epilepsies, 2nd ed. New York: Raven Press, 1993: 609-621), psychologic, psychiatric, occupational and quality of life outcomes. 41 patients (22 men, 19 women) with g mean age i5.7 i4-45) years, and a mean duration of epilepsy 17.i (3.5-39) years underwent ATL (29 right, 12 left) between March 199!&June i996. ?he average cost per patient-for presur&al evaluation and surgery was INR 17,600 (USD 500). Three-month and l-year post-ATL assessment revealed a remarkable improvement in outcome scores; 26 (63.4%) patients achieved a seizure score O-2. Utilizing noninvasive evaluation, patients with intractable TLE can be selected for cost-effective surgical treatment to provide good seizure control and improved quality of life.
( 4-17-05
as well as the low incidence
14-l 7-07 I Expression Of P-glycoprotein and related proteins in brain of patients with refractory temporal lobe epilepsy (TLE)
14-l 7-04 1 Successful epilepsy surgery without invasive EEG recording: Experience from South India K. Radhakrishnan,
highlight the causes of recurrence seizures on organic seizures.
Vigabatrin in the treatment of epileptic in children
R. Slapal, A. Zouhar,
Medical Faculty
H. MiSurcov&
of Masaryk
Universib
Department of Children’s Bmo, Czech Republic
syndromes Neurolog)!
The authors evaluated the effect of vigabatrin (Sabril) in 69 children of all age groups with various, mostly pharmacoresistant, epileptic syndromes (partial with or without secondary generalisation, West and Lennox-Gastaut). In the EEG records a focal epileptic activity was significantly predominant. Vigabatrin was administered in the average daily dose of 50 mg/kg, predominantly in the adjuvant way, however in 13 children (18.8%) the drug was given as initial monotherapy. The total daily dose usually did not exceed 2.0 g. The authors found a very good clinical effect in 23 children (33.3%), out of this number in 17 patients a complete compensation was achieved. In further 29 patients (42.1%) the effect was good and only in 17 cases (24.6%) vigabatrin was without more apparent effect. In 4 cases the worsening of the disease was observed. In 5 children with tuberous sclerosis vigabatrin had a positive response in all patients, out of this number the effect in 3 children was very good. Side-effects manifested predominantly by behavioural disturbances were seen in 5 children (7.3%) only.
I 4-17-09
1 Using wavelet transform method to remove muscular artifacts and characterize EEG signals from epileptic tonic-clonic seizure
‘, A. Figliola’ , R. Quian Quiroga *, O.A. Rosso ‘. ’ lnstiruto de Calculo, Facultad de Ciencias Exactas y Naturales, U.B.A., Argentina, ‘Institute of Physiology, Medical University of Luebeck, Germany
S. Blanc0
The noisy signals obtained during a tonic-clonic epileptic seizure, are usually neglected for visual inspection by the physicians because the muscle activity obscures the record, totally. Some information about the underlying brain activity and dynamical parameters can be obtained without filtering the signal using Wavelet Transforms and derivated methods. These methods satisfy that the frequency elimination does not modify the remanent ones. Wavelet Transform provides a time-scale description, and lead us to decompose any signal into frequency bands. From the wavelet coefficients, we could evaluate the Information Cost Function (ICF) of the EEG series, that is essentially an entropy function, and it give us an measure of the order/disorder of the system in time. As a better precision in the frequency domain is often necessary, a natural idea is to combine wavelet analysis with local Fourier analysis using a appropriate strategy. This can be solved using wavelet packets, which are a collection of modulated wave-forms.
Epilepsy
These processes are closely connected and cause development of ED. The determination of the types of ED, the prevailing of character or intellectual mnestic disturbances, degree of personality changes make the choice of psychotherapeutic methods or medicine possible.
M. Bhaskara
Rao, S. Dinesh
Nayak,
Sanjeev
Comprehensive Epilepsy Program, Sree ChiWa Tirunal lnsfitute Sciences and Technology; Trivandrum, Kerala, South India
Gustav0 Sevlever, Ramon Leiguarda,
V. Thomas.
1 Olfactory bed. Side test to identify temporo. Orbitofrontal dysfunction
I. Savic1,2, Y.S. Bookheimer3, I. Fried4, J. Engel Jr.‘. ‘Dept. of Neurology, 3 Div. of Brain Mapping, 4 Dept. of Neurosurgery UCLA, USA, 2 Dept. of Neuroscience Karolinska Institute, Stockholm, Sweden
1 Follow up of seizures - 500 patients over a period of two to ten years
R. Sethuraman, MB. Pranesh, S. Dinesh Nayak, R. Sambasivam, P. Rajendran, V. Rajmohan, R. Murali. Depr of Neurosciences, KG Hospital PGIMS, Coimbatore, India
of pseudo
&
500 patients with seizures were studied clinically and were investigated appropriately. Follow up done revealed that about 20 per cent of the patients were non-compliant towards drug treatment and also regarding the other advice given. However recurrence of fits did occur in roughly one third of the patients and inspite of the recurrence these patients came regularly. The paper would
Ana Lia Taratuto,
Departmen& of Neurologicas Raul
Objective: Overexpression of the multiple drug resistant gene MDRl) in tissue from patients with refractory epilepsy has recently been reported (Tishler et al, Epilepsia 1995; 36:1-6). P-glycoprotein accounts for drug resistance on patients with tumors, partially by acting as an efflux pump which results in low intracellular levels of chemotherapeutic agents. Other compounds had been related to chemoresistance, although by different mechanisms. We assessed the immunoexpression of P-glycoprotein, glutathion S transferase IT, Metalothionein and bcl/2 in 12 patients with non-lesional medically intractable TLE, who proved on pathology to have mesial temporal sclerosis (MTS) and spared lateral neocortex. Methods: Temporal lobe specimens from 12 consecutive patients were studied. lnmunohistochemistly was performed for the analysis of P-glycoprotein, metalothionein, glutathion S transferase P and bcV2. Determinations were made on all patients at both, mesial temporal lobe structures and lateral neocortex. Results: We detected P-glycoprotein and metalothionein on 9 samples, limited to the region of MTS but not lateral neocortex. Gluthation and bcV2 were negative. lmmunostaining was evident in both neuronal and glial components. Conclusions: 1) We found expression of P-glycoprotein and metalothionein in human tissue limited to the epileptogenic region in 9 of 12 patients. 2) Our findings might explain, at least in part, the underlying mechanisms related to drug-resistant epilepsy.
4-17-08
Introduction: Olfactory memory and discrimination are processed by the antero - mesial temporal cortex and the orbitofrontal cortex. Both functions may therefore be impaired in limbic epilepsy. Method: 29 patients with mesial temporal lobe (MTL) seizures, 1 with neowrtical seizures (NS), and 10 controls were evaluated for olfactory (discrimination (D) and memory (M). The olfactory processing was tested before assessment of the diagnosis, and during an interictal period. The test were performed in a same-different paradigm with 10 seconds and 6 minutes between presentations of the odors, using the University of Pennsylvania Scratch and Sniff Test. The results were related to region glucose metabolism measured with [‘sF]FDG PET scans. Results: Patients with MTLseizures differed from controls and patients with NS by an impaired D ipsilaterally to the epileptogenic region and by a higher total number of errors (including both tests), (p < 0.05). The combined M and D test showed a sensitivity of 85% and a specificity of 90% to correctly identify MTL dysfunction. A correct lateralization was achieved in 23 MTL patients. Correlative PET studies with 18-F FDG showed that MTL-patients whose D was more impaired than M different from those with more impaired M, by having a significant hypometabolism not only in the lateral temporal lobe, but also in the anterior fraction of the epileptogenic temporal lobe (p = 0.007), and in the ipsilateral orbitofrontal cortex (p = 0.02). The majority of patients with impaired D had mesial temporal sclerosis, whereas those with impared M had other types of pathology. Conclusion: Tests of olfactory function are useful in the differentiation between patients with neocortical and MTL seizures. Olfactory M and D can be dissociated, suggesting that these functions are mediated by different structures. Among patients with MTL those with mesial temporal sclerosis seem to have more widespread limbic dysfunction and more frequent impairement of D.
( 4-17-06
Carlos D’Giano, Albert0 Lazarowski, Hugo Pomata, Adrian L. Rabinowicz.
Neurology and Pathology, lnstituto de lnvestigaciones Carrea-Fleni, Buenos Aires, Argentina
for Medical
Very little information regarding the practice and outcome of anterior temporal lobectomy (ATL) for intractable temporal lobe epilepsy (TLE) is available from developing countries. Intracranial EEG recording to localize the epilep togenic focus escalates the cost of epilepsy surgery. Through a prospective standardized non-invasive presurgical protocol utilizing scalp EEG, MRI, neuropsychological tests and video-EEG, we selected patients with a concordant unilateral temporal epileptogenic focus for ATL with amygdalohippocampectomy. We assessed the post-ATL outcome using a composite scoring system to quantify the seizure (seizure score, Surgical Treatment of the Epilepsies, 2nd ed. New York: Raven Press, 1993: 609-621), psychologic, psychiatric, occupational and quality of life outcomes. 41 patients (22 men, 19 women) with g mean age i5.7 i4-45) years, and a mean duration of epilepsy 17.i (3.5-39) years underwent ATL (29 right, 12 left) between March 199!&June i996. ?he average cost per patient-for presur&al evaluation and surgery was INR 17,600 (USD 500). Three-month and l-year post-ATL assessment revealed a remarkable improvement in outcome scores; 26 (63.4%) patients achieved a seizure score O-2. Utilizing noninvasive evaluation, patients with intractable TLE can be selected for cost-effective surgical treatment to provide good seizure control and improved quality of life.
( 4-17-05
as well as the low incidence
14-l 7-07 I Expression Of P-glycoprotein and related proteins in brain of patients with refractory temporal lobe epilepsy (TLE)
14-l 7-04 1 Successful epilepsy surgery without invasive EEG recording: Experience from South India K. Radhakrishnan,
highlight the causes of recurrence seizures on organic seizures.
Vigabatrin in the treatment of epileptic in children
R. Slapal, A. Zouhar,
Medical Faculty
H. MiSurcov&
of Masaryk
Universib
Department of Children’s Bmo, Czech Republic
syndromes Neurolog)!
The authors evaluated the effect of vigabatrin (Sabril) in 69 children of all age groups with various, mostly pharmacoresistant, epileptic syndromes (partial with or without secondary generalisation, West and Lennox-Gastaut). In the EEG records a focal epileptic activity was significantly predominant. Vigabatrin was administered in the average daily dose of 50 mg/kg, predominantly in the adjuvant way, however in 13 children (18.8%) the drug was given as initial monotherapy. The total daily dose usually did not exceed 2.0 g. The authors found a very good clinical effect in 23 children (33.3%), out of this number in 17 patients a complete compensation was achieved. In further 29 patients (42.1%) the effect was good and only in 17 cases (24.6%) vigabatrin was without more apparent effect. In 4 cases the worsening of the disease was observed. In 5 children with tuberous sclerosis vigabatrin had a positive response in all patients, out of this number the effect in 3 children was very good. Side-effects manifested predominantly by behavioural disturbances were seen in 5 children (7.3%) only.
I 4-17-09
1 Using wavelet transform method to remove muscular artifacts and characterize EEG signals from epileptic tonic-clonic seizure
‘, A. Figliola’ , R. Quian Quiroga *, O.A. Rosso ‘. ’ lnstiruto de Calculo, Facultad de Ciencias Exactas y Naturales, U.B.A., Argentina, ‘Institute of Physiology, Medical University of Luebeck, Germany
S. Blanc0
The noisy signals obtained during a tonic-clonic epileptic seizure, are usually neglected for visual inspection by the physicians because the muscle activity obscures the record, totally. Some information about the underlying brain activity and dynamical parameters can be obtained without filtering the signal using Wavelet Transforms and derivated methods. These methods satisfy that the frequency elimination does not modify the remanent ones. Wavelet Transform provides a time-scale description, and lead us to decompose any signal into frequency bands. From the wavelet coefficients, we could evaluate the Information Cost Function (ICF) of the EEG series, that is essentially an entropy function, and it give us an measure of the order/disorder of the system in time. As a better precision in the frequency domain is often necessary, a natural idea is to combine wavelet analysis with local Fourier analysis using a appropriate strategy. This can be solved using wavelet packets, which are a collection of modulated wave-forms.