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Query: UMLS:C0014547 (focal epilepsy)
 1,627 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Patients with refractory focal epilepsy are thoroughly evaluated to identify an area of cortex that, if removed or disconnected, will lead to seizure freedom. Clinical semiology, neuroimaging, and scalp electroencephalogram provide an approximation of this area, whereas intracranial recording may permit a more precise localization and investigation of a selected cortical area. Intraoperative electrocorticography delineates the irritative zone, and subdural electrode implantation also permits cortical stimulation of eloquent areas. Intraoperative electrocorticography rarely captures spontaneous seizures and may be influenced by the effect of anesthetic drugs, and the correlation between complete resection of the irritative zone and postsurgical seizure outcome is unclear. Extraoperative monitoring is often superior to intraoperative electrocorticography but may also be associated with more risk of adverse events. Further development of ultrahigh-density electrode arrays is providing novel insights into the role of microseizures and high-frequency oscillations on ictogenesis and epileptogenesis.
J Clin Neurophysiol 2013 Dec
PMID:Electrocorticography for seizure foci mapping in epilepsy surgery. 2430 Sep 81

Intraoperative neurophysiologic monitoring endeavors to preserve the integrity of the nervous system at a time of potential risk. The examination of language function in the operative setting is a unique task that requires a detailed and systematic approach to be carried out efficiently and reliably in this dynamic environment. In this review, we detail the technique used to identify eloquent language cortex during awake craniotomy. This technique requires a coordinated effort to testing, which is reliant on preoperative assessment and structured approach to functional cortical mapping by the surgical, anesthetic, and neurophysiology teams. Despite the intricate nature of this modality of testing, the accurate identification of language areas facilitates neurosurgeries for tumor and focal epilepsy syndromes in the dominant cerebral hemisphere, which depend on maximal margins of resection for best outcomes.
J Clin Neurophysiol 2013 Dec
PMID:Intraoperative functional cortical mapping of language. 2430 Sep 83

Focal epilepsy with ictal abdominal pain is an unusual partial epilepsy characterized by paroxysmal episodes of abdominal or visceral pain, disturbance of awareness and electroencephalographic abnormalities. We describe a new case of ictal abdominal pain in which gastrointestinal complaints were the only manifestation of seizures and review the previously described pediatric patients. In our patient clinical findings, ictal EEG abnormalities, and a good response to antiepileptic drugs allowed us to make a diagnosis of focal epilepsy with ictal abdominal pain. This is a rare epileptic phenomenon that should be suspected in patients with unexplained paroxysmal abdominal pain and migraine-like symptoms. We suggest that, after the exclusion of more common etiologies, focal epilepsy with ictal abdominal pain should be considered in patients with paroxysmal abdominal pain and ictal EEG abnormalities.
Ital J Pediatr 2013 Dec 09
PMID:Focal epilepsy with ictal abdominal pain: a case report. 2432 31

Functional imaging studies complement structural magnetic resonance imaging (MRI) in the assessment of patients with brain tumor-associated focal epilepsy. (11)C-Methionine (MET) and (18) F-fluoro-ethyl-L-tyrosine (FET) are amino acid analogues that highlight metabolically active areas in positron emission tomography (PET). Ictal single photon emission computed tomography (SPECT) can provide information about perilesional areas of seizure onset and early propagation. Functional MRI (fMRI) and diffusion tensor imaging (DTI) allow noninvasive identification of potentially eloquent motor, sensory, and language cortical areas and pathways with an accuracy of 10-15 mm compared to electrocortical stimulation (ECS). Repetitive navigated transcranial magnetic stimulation (TMS) allows even more precise noninvasive delineation of primary motor cortex. Information from functional imaging studies helps in the planning of brain tumor biopsies, resections, and the planning of intracranial video-electroencephalography (EEG) studies.
Epilepsia 2013 Dec
PMID:The role of functional imaging in the tumor patient. 2432 72

The goal of the present study was to evaluate the clinical characteristics and postoperative seizure outcome of epileptogenic tumors associated with focal cortical dysplasias (FCDs) compared to both solitary FCD type I and solitary tumors. Particular attention is given to FCD type IIIb (tumors associated with FCD type I), which have been recently classified as a separate entity. We retrospectively reviewed the clinical charts of 1,109 patients who were operated on for drug-resistant focal epilepsy, including 492 patients with a histologic diagnosis of solitary FCD I and II (83 and 157 cases, respectively), solitary tumors (179 cases), and FCD-associated tumors (73 cases, 58 of which met the criteria of FCD IIIb of the new International League Against Epilepsy [ILAE] classification). The different subgroups were evaluated for clinical characteristics and postoperative surgical outcome. Clinical variables and postoperative seizure outcome of patients with coexisting tumor and FCDs (FCD IIIb and tumor associated FCD II) were similar to those of patients with a solitary tumor and differed significantly from patients with solitary FCDs. Nevertheless, tumors associated with FCDs are characterized by a striking male predominance and a higher seizure frequency as compared to solitary tumors. Patients with drug-resistant focal epilepsy secondary to a solitary tumor or with a tumor-associated FCD have similar basic clinical presentation and postoperative seizure outcome. Nevertheless, the epileptogenic contribution of the associated FCDs can be crucial, and it needs to be adequately assessed. The impact of FCD on tumor-related epilepsy deserves future research in order to optimize the surgical strategies aimed at seizure relief.
Epilepsia 2013 Dec
PMID:Epilepsy surgery of focal cortical dysplasia-associated tumors. 2432 84

Focal cortical dysplasia (FCD) is frequently associated with focal epilepsy, and a broad spectrum of histopathology is included in the diagnosis of FCD. In 2011, an International League Against Epilepsy (ILAE) task force proposed an international consensus for a classification system to better characterise specific clinicopathological FCD entities. The clinical characteristics of patients with FCD should be confirmed according to the new ILAE classification. We retrospectively analysed 92 patients who had undergone surgical treatment for temporal lobe epilepsy and received a pathological diagnosis of FCD. The pathological sections were re-examined and diagnosed according to the 2011 ILAE classification. The clinical data from patients with different FCD subtypes were evaluated, including a detailed history regarding spontaneous abortions, trauma, ischaemic injury, encephalitis, and febrile seizures at an early age. The age of epilepsy onset, duration of epilepsy, age at surgery, seizure frequency, history of febrile seizures, and seizure type, particularly whether the seizures were secondarily generalised tonic-clonic seizures, were recorded. Clinical differences were found in the patients with temporal lobe FCD. The associated FCD subtypes have unique clinical characteristics, including a later age of epilepsy onset and a shorter duration of epilepsy, especially in FCD Type IIIc; and a high susceptibility to febrile seizures was observed in FCD Type IIIa.
J Clin Neurosci 2014 Dec
PMID:Clinical characteristics of 92 patients with temporal lobe focal cortical dysplasia identified by pathological examination. 2506 46

The prevalence of focal cortical dysplasia (FCD) in pediatric patients with focal epilepsy is not exactly known because authors of publications in which the etiologies of epilepsies are listed, but which are not dealing specifically with epilepsy surgery issues, tend to lump together the many kinds of malformations of cortical development (MCD), of which FCDs, because of their relative frequency, are the most relevant subtypes. Out of 561 patients with MCD (children and adults) operated at centers in Europe who do feed data into the "European Epilepsy Brain Bank," 426 (76 %) had FCD.
Childs Nerv Syst 2014 Dec
PMID:Electro-clinical-pathological correlations in focal cortical dysplasia (FCD) at young ages. 2525 73

Benign focal epilepsy in childhood with centro-temporal spikes (BECTS) is one of the most common forms of idiopathic epilepsy, with onset from age 3 to 14 years. Although the prognosis for children with BECTS is excellent, some studies have revealed neuropsychological deficits in many domains, including language. Auditory event-related potentials (AERPs) reflect activation of different neuronal populations and are suggested to contribute to the evaluation of auditory discrimination (N1), attention allocation and phonological categorization (N2), and echoic memory (mismatch negativity--MMN). The scarce existing literature about this theme motivated the present study, which aims to investigate and document the existing AERP changes in a group of children with BECTS. AERPs were recorded, during the day, to pure and vocal tones and in a conventional auditory oddball paradigm in five children with BECTS (aged 8-12; mean=10 years; male=5) and in six gender and age-matched controls. Results revealed high amplitude of AERPs for the group of children with BECTS with a slight latency delay more pronounced in fronto-central electrodes. Children with BECTS may have abnormal central auditory processing, reflected by electrophysiological measures such as AERPs. In advance, AERPs seem a good tool to detect and reliably reveal cortical excitability in children with typical BECTS.
Epilepsy Res 2014 Dec
PMID:Auditory event-related potentials in children with benign epilepsy with centro-temporal spikes. 2530 62

Focal malformations of cortical development (FMCDs) account for the majority of drug-resistant pediatric epilepsy. Postzygotic somatic mutations activating the phosphatidylinositol-4,5-bisphosphate-3-kinase (PI3K)-protein kinase B (AKT)-mammalian target of rapamycin (mTOR) pathway are found in a wide range of brain diseases, including FMCDs. It remains unclear how a mutation in a small fraction of cells disrupts the architecture of the entire hemisphere. Within human FMCD-affected brain, we found that cells showing activation of the PI3K-AKT-mTOR pathway were enriched for the AKT3(E17K) mutation. Introducing the FMCD-causing mutation into mouse brain resulted in electrographic seizures and impaired hemispheric architecture. Mutation-expressing neural progenitors showed misexpression of reelin, which led to a non-cell autonomous migration defect in neighboring cells, due at least in part to derepression of reelin transcription in a manner dependent on the forkhead box (FOX) transcription factor FOXG1. Treatments aimed at either blocking downstream AKT signaling or inactivating reelin restored migration. These findings suggest a central AKT-FOXG1-reelin signaling pathway in FMCD and support pathway inhibitors as potential treatments or therapies for some forms of focal epilepsy.
Nat Med 2015 Dec
PMID:An AKT3-FOXG1-reelin network underlies defective migration in human focal malformations of cortical development. 2652 71

Vomiting is uncommon in patients with epilepsy and has been reported in both idiopathic and symptomatic epilepsies. It is presumed to originate in the anterior part of the temporal lobe or insula. To date, 44 cases of nonidiopathic focal epilepsy and seizures associated with ictal vomiting have been reported. Of the 44 cases, eight were studied using invasive exploration (3 stereo-EEG/5 subdural grids). Here, we report a 4-year-and-7-month-old patient with a history of febrile convulsion in the second year of life and who developed episodes of vomiting and complex partial seizures at 3 years of age. Scalp EEG showed no electrical modification during vomiting while the complex partial seizure displayed a clear right temporal origin. Brain MR showed hippocampal volume reduction with mild diffuse blurring of the temporal lobe. Stereoelectroencephalography study confirmed the mesiotemporal origin of the seizures and showed that the episodes of vomiting were strictly related to an ictal discharge originating in the mesial temporal structures without insular diffusion. The patient is now seizure-free (18 months) after removal of the right anterior and mesial temporal structures. In all the reported patients, seizures seemed to start in mesial temporal structures. The grid subgroup is more homogeneous, and the most prominent characteristic (4/5) is the involvement of both mesial and lateral temporal structures at the time of vomiting. In the S-EEG group, there is evidence of involvement of either the anterior temporal structures alone (2/3) or both insular cortices (1/3). Our case confirms that vomiting could occur when the ictal discharge is limited to the anterior temporal structure without insular involvement. Regarding the pathophysiology of vomiting, the role of subcortical structures such as the dorsal vagal complex and the central pattern generators (CPG) located in the reticular area is well established. Vomiting as an epileptic phenomenon seems to be related to the involvement of temporal structures, mainly mesial structures (amygdala) and with an uncertain role of the insula. An intriguing hypothesis is that the ictal discharge in mesial structures determines seizure manifestation that could be explained not only by tonic activation of the cortex, but also by 'release' (reduction of inhibition?) of the CPG responsible for involuntary motor behaviors.
Epilepsy Behav 2015 Dec
PMID:Ictal vomiting as a sign of temporal lobe epilepsy confirmed by stereo-EEG and surgical outcome. 2655 13


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