BMC Geriatrics (http://www. biomedcentral.com/bmcgeriatr) is an open access journal published by BioMed Central Ltd. The journal publishes original peer-reviewed research on all aspects of the health and healthcare of older people, including the effects of healthcare systems and policies. BMC Geriatrics (ISSN 1471-2318) is indexed/tracked/covered by PubMed, MEDLINE, CAS, EMBASE, Scopus and Google Scholar
Objective: Behavioral changes in patientswithepilepsy can range from depression, anxiety to psychosis and personality traits. We evaluated the frequency of psychiatric disorders (PD) in a homogenous series ofpatientswith refractory temporallobeepilepsy (TLE) related to mesial temporal sclerosis (MTS) aiming at determining the frequency of PD and possible correlations to clinical variables and to laterality of MTS. Methods: Data from 106 refractory TLE patients were reviewed. Psychiatric evaluation was based on DSM-IV criteria. Statistical analysis was performed through the chi-square (χ²), Student’s t test and Fisher’s exact test. P value considered significant was < 0.05. Results: PD were found in 65 patients (61.3%). Among them, mood disorders were the most frequent (32 patients; 30%), followed by interictal (15 patients; 14%) and postictal (10 patients; 9.4%) psychosis. Postictal and interictal psychosis were significantly associated with left side MTS (p < 0.05), while PD in general and mood disorders were not associated to any side. Conclusion: There was a high prevalence of PD in patientswith refractory TLE associated to MTS. The most common were mood and psychotic disorders. Psychosis was significantly associated to left side. These findings are concordant with data in literature, confirming the existence of anatomic alterations, and also a possible left laterality effect in the mesial temporallobe structures in patientswith epileptic psychosis. Key words: temporallobeepilepsy, mesial temporal sclerosis, psychiatric disorders.
Connectome creation from the acquired data is summarised in Fig 6, while Fig 7 shows nodes and connections imaged in pseudo-3D space averaged over all subjects, and indicates how this is then used to generate simulations of activity for each node. Firstly FreeSurfer  was used to obtain surface meshes of gray and white matter boundries from the MRI data, and to parcellate the brain into regions of interest (ROI) based on the Desikan atlas [97, 98]. There were 82 ROI included, spanning cortical and subcortical regions (subcortical regions included the Nucleus accumbens, Amygdala, Caudate, Hippocampus, Pallidum, Putamen and the Thal- amus). Streamline tractography was obtained from DTI images using the Fiber Assignment by Continuous Tracking (FACT) algorithm  through the Diffusion toolkit along with Track- Vis . First we performed eddy-correction of the image by applying an affine transform of each diffusion volume to the b0 volume and rotating b-vectors using FSL toolbox (FSL, http:// www.fmrib.ox.ac.uk/fsl/). After the diffusion tensor and its eigenvector was estimated for every voxel, we applied a deterministic tractography algorithm  initiating a single streamline from the center of each voxel. Tracking was stopped when the angle change was too large (35 degree of angle threshold) or when tracking reached a voxelwith a fractional anisotropy value of less than 0.2 . For further details see .
We did not find volume differences in the parieto-insular vestibular cortex (PIVC), located in the parietal operculum (OP2). This area is considered to be the best candidate for a primary vestibular cortex, though clearly it is not a unimodal area [50,51]. The vestibular system has a widespread cortical representation, however and stimulation of multiple brain regions can trig- ger feelings of motion. Perceptions of non-spinning self-motion such as linear translation and oscillating motion (e.g. rocking and swaying) can be elicited by electrically stimulating the ACC and functionally connected areas like the precuneus and the frontal operculum [52,53]. In contrast, perceptions of rotation or tilting are more likely to be elicited by stimulating the posterior temporallobe . Therefore, our finding of altered volume in the pgACC and fron- tal opercular area (IFG) is more consistent with direct stimulation studies that elicit sensations of rocking motion rather than rotational vertigo. This may help explain why chronic rocking dizziness specifically is often associated with anxiety and affective disorders [4,5]. This was our rationale for using the HADS scores to regress out specific brain volume trends associated with high mood or anxiety scores.
Employment information was registered for each patient before and three years after surgery. The patients were classified in three groups: (A) those who had an active work based on monthly income (formal or no-formal employment); (B) those unemployed, receiving ill-health benefits or retired, individuals who were identified as inactive; and (C) others who were students, housewives or subjects that have never worked.
A retrospective observational investigation was conduct- ed with data collected from all patients treated in the epilepsy clinic of the Faculdade de Medicina de Sao Jose do Rio Preto (FAMERP, a Brazilian tertiary referral epilepsy center) with di- agnoses oftemporallobeepilepsy associated with hippocam- pal sclerosis (TLE-HS) from January 2000 to March 2013. he clinical data were retrospectively obtained from the patient records and iles. For all patientswith a diagnosis of TLE-HS based on magnetic resonance imaging (MRI), the following data were collected: sex, age at surgery, handedness, type and number of antiepileptic drugs (AEDs) used, and formal neu- ropsychological evaluation results. NCC was evaluated with brain computed tomography (CT). he present study was ap- proved by the ethical committee of our institution.
None of the 20 patientswith TLE had chronic ob- structive pulmonary disease. Anthropometrics and clinical characteristics of the patientswithepilepsy in the study are shown in the Table. The mean age of the patients was 41±12.3 years and the mean du- ration ofepilepsy was 20±9 years. All patients were treated with AEDs, using at least one medication at the time of the study. Carbamazepine (80%) was the most commonly used AED, followed by cloba- zam (10%). Almost all patients presented with con- trolled seizures. Pulmonary function ofpatientswithepilepsy showed no significant alterations in respi- ratory tests: FVC (4.09±1.24), FEV1 (3.33±1.03) and FEV1/FVC (0.81±0.05). No association between sei- zure frequency, AED and altered pulmonary func- tion was found.
A multivariate logistic regression model was performed (sensivity 78.8%; specificity 71.2%; positive predictive value 73.2%; negative predictive value 68.1%; area under the curve 0.768) to identify possible clinical and socio- demographic risk factors associated to a non-favorable seizure outcome. The presence of any pre-surgical PD was associated to a worse surgical outcome (OR=3.53; p=0.002) at initial model.However, when psychiatric diagnoses were analyzed separately, onlymajor depressive disorderpersisted as statistically significant (OR=5.11; p=0.004), while other PD together (except depression) were not significant (OR=1.62; p=0.34).The presence of post-surgical PD wasnot associated with a worse seizure outcome (OR=1.50; p=0.35), as well as others clinical
Introdução: Um dos objetivos da avaliação pré-cirúrgica de pacientes com epilepsia do lobo temporal é detectar pacientes com mau prognóstico cirúrgico para o controle das crises epilépticas. Teoricamente, tes- tes neuropsicológicos poderiam ser empregados com tal finalidade. Objetivo: Avaliar se testes de memória verbal e visual podem ser utilizados como preditores isolados de resultado cirúrgico do controle de crises em pacientes com epilepsia do lobo temporal mesial associada a esclerose hipocampal refratária ao tratamento farmacológico. Métodos: Em um estudo de coorte retrospectivo, usando como end-point o controle de cri- ses epilépticas, nós avaliamos 187 pacientes, correlacionando aspectos clínicos, avaliação cognitiva, dados de neuroimagem, dados demográficos e achados eletrofisiológicos com o resultado do controle de crises após a lobectomia nesses pacientes. Resultados: Um prognóstico desfavorável no período pós-operatório foi ob- servado apenas em associação com baixos escores de reprodução visual (memória visual). Contudo, após uma correção de Bonferroni, necessária para reduzir a chance de erro tipo I, esse resultado mostrou-se espú- rio. Conclusão: Nós concluímos que os testes neuropsicológicos de memória verbal e visual, tais como utili- zados na avaliação pré-cirúrgica de rotina dos nossos pacientes com epilepsia do lobo temporal, não são bons preditores isolados de resultado cirúrgico.
and increased signal intensity on T2-weighted and/or FLAIR images, without other MRI lesions except minor white mat- ter changes on T2 or FLAIR sequences, also supported the diagnosis of MTS. All patients presented with medically re- fractory epilepsy and were in the process of surgical evalu- ation. All patients underwent prolonged video-EEG moni- toring with recording of at least one epileptic seizure and had electrographic onset in the temporallobe. Patientswith other neurological or active psychiatric disease, previous or current ethanol abuse and comorbidity with nonepileptic psychogenic seizures were excluded. Healthy controls, ful- illing the other inclusion and exclusion criteria served as a control group.
Objective: To analyze retrospectively a series ofpatientswithtemporallobeepilepsy (TLE) and mesial temporal sclerosis (MTS), and the association of patterns of hippocampal sclerosis with clinical data and surgical prognosis. Method: Sixty-six patientswith medically refrac- tory TLE with unilateral MTS after anterior temporal lobectomy were included. Quantitative neuropathological evaluation was performed on NeuN-stained hippocampal sections. Patient’s clinical data and surgical outcome were reviewed. Results: Occurrence of initial precipitating insult (IPI), as well as better postoperative seizure control (i.e. Engel class 1), were associated with classical and severe patterns of hippocam- pal sclerosis (MTS type 1a and 1b, respectively). Conclusion: Quantitative evaluation of hippocampal neuronal loss patterns predicts surgical outcome in patientswith TLE-MTS.
Patient 1. A six year-old girl has had recurrent abdo- minal pain since 4 year- old, which she sometimes des- cribed as “my belly is dreaming”. The duration of the epi- sodes ranged from seconds to few minutes and crying and a “facies” of fear followed the pain. The frequency was initially once a day and progressively increased to six a day. Some of them were followed by awareness distur- bance and occasionally a tonic-clonic seizure. After a nega-
Objectives: Patientswithtemporallobeepilepsy (TLE) and unilateral severe hippocampal sclerosis (HS) may have contralateral temporal scalp ictal onset. This has recently been called “burned-out hippocampus”, which is believed to be a rare entity. In this study we report four patientswith unilateral hippocampal sclerosis and contralateral ictal onset registered by scalp electrodes. We discuss the importance of such cases in pre- surgical evaluation ofpatientswith TLE, as well as possible strategies used for evaluation of these particular cases. Patients and methods: We reviewed charts from all patientswith TLE submitted to pre-surgical evaluation, which included high resolution MRI and prolonged video-electroencephalogram (video-EEG) monitoring with scalp and sphenoidal electrodes, during a three-year period (2002-2004). We looked for patients who only had seizures that were clearly contralateral in location to the atrophic hippocampus. Results: Four patients fulfilled the criteria above. Two of these patients had semi-invasive video-EEG monitoring with foramen ovale (FO) electrodes, which revealed seizures originating from the temporallobewith the atrophic hippocampus, hence confirming false lateralization in the scalp-sphenoidal EEG. These patients were submitted to surgical treatment and had favorable prognosis after surgery. Conclusions: Burned- out hippocampus syndrome may not be as rare as it was previously believed. Further studies will be necessary before one can affirm that patientswith unilateral HS and scalp ictal EEG showing contralateral ictal onset may be operated without confirmation of the epileptogenic zone by invasive monitoring. In these patients, semi-invasive monitoring with FO electrodes might be an interesting alternative.
were due to confounding bias related to imbalances in the demographic and clinical variables, a multiple linear regres- sion was done. For this analysis, we included the variables showing the association with the SSS with a p < 0.20 level of significance. Considering the clinical and biological plausi- bility of an association between sleepiness and low cognitive performance, to avoid a type II error, a p < 0.05 was consid- ered significant for our analysis. Because we were unable to test the degree of difference between the mean score (and SD) of the cognitive test scores in the analyzed groups that could be considered clinically meaningful for our patients, the dif- ference was chosen based arbitrarily on our previous study 23 .
Neuromyelitis optica (NMO) is an inflammatory, demyelinating disease of the central nervous system (CNS) characterized by the association of a serious acute or subacute myelitis and unilateral or bilateral optic neuritis. NMO patients usually have a worse clin- ical presentation and more deficits after each bout, being distinct from patientswith multiple sclerosis (MS) by the symptomatic stereotypy, although fulfill- ing the McDonald´s criteria for MS. Neuropatholog- ic studies demonstrated an association among demy- elinating lesions in NMO and peri-vascular deposits of immunoglobulin, local activation of complement cascade and eosinophilic infiltration. Humoral mark- ers would be therefore implicated in the pathogen- esis of NMO.
MARV, a 48 years-old female started having simple partial autonomic and complex partial seizures by the age of 40. Autonomic seizures were characterized by an ascending epigastric sensation and was followed by complex partial seizures with right arm automatisms and left arm paresis. Seizure’s frequency was of 3-4 per month. There were 2 tonic-clonic generalized seizures over the last 3 months but these were sporadic. Pre-operative EEG investigation including zygomatic electrodes showed a clear right anterior temporallobe focus. Neuropsychological testing disclosed a non-dominant fronto- temporal dysfunction. MRI showed an anterior insular cavernoma (Fig 1, left). Cerebral angiography was normal.
Introduction: Epilepsy is a disorder that results in abnormal activity in a group of neurons that may have significant impact on the normal cognitive processes and behavior. Temporallobeepilepsy (TLE) is the most frequent form of partial epilepsy in adults, and hippocampal sclerosis (HS) the most common neuropathologic finding in patientswith medically refractory TLE. Patientswith TLE often present cognitive difficulties that may be determined by the effects of epileptic discharges and side of the lesion. And its consequence is that patients have poor effects on quality of life (QOL). Purpose: We report the relationship between neuropsychological assessment and QOL under the hypotheses that patientswith worst results in neuropsychological assessment have poorer QOL assessed by the QOLIE-31. Results: Regarding seizure frequency, 23 (46%) had had 1-5, 20 (40%) 6-10 and 7 (14%) more than 10 seizures/month. In relation to seizure types, 5 (10%) had had auras, 37 (74%) complex partial seizures and 8 (16%) partial evolving to generalized tonic-clonic seizures (GTCS). Neuropsychological evaluation had a positive correlation with QOLIE-31 domains. QOL evaluations had the worst scores in QOLIE-31 were in Cognitive Function (45.0) and Social Function (46.0). The best was Overall QOL (62.0). Conclusion: People withepilepsy have great impact on their QOL not only because of daily seizures but because of the impact seizures cause in their cognitive functions. TLE is an example of how refractory epilepsy can exterminate any possibilities of work, study and live in a society that discriminates someone withepilepsy who also presents cognitive decline.
All patients underwent corticoamygdalohippocam- pectomy. In this surgical technique 2-3 cm of the left and 4-5 cm of the right neocortex are ressected; most of the amygdala is aspirated, leaving 20% of amygdalian tissue close to the internal capsule, while 2-3 cm of hippocampus is also removed. As for the surgery outcomes all four patients had good results. Patients 1 and 2, in a short follow-up (< 1 year), did not report any auras or seizures whatsoever. Patient 3 now reports focal somatosensory symptoms restricted to the right hand and patient 4 seldom refers auras.
Cento e vinte pacientes, avaliados no Centro de Cirurgia de Epilepsia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, e estudados conforme o protocolo pré-cirúrgico padrão da instituição (ver abaixo) foram avaliados com a volumetria das estruturas do lobo temporal, de 1999 a 2001.Todos os pacientes eram adultos, acima de 18 anos de idade, sendo este um dos critérios de inclusão. Destes, 70 pacientes foram operados e 69 apresentavam seguimento pós-operatório superior a seis meses e disponibilidade dos dados clínicos e de imagem para análise, sendo incluídos neste estudo. Todos apresentavam suspeita clínica e neurofisiológica de epilepsia do lobo temporal mesial, uni ou bilateral, intratável farmacologicamente e a volumetria foi realizada sem conhecimento prévio da lateralização ou localização dos achados neurofisiológicos, clínicos ou de imagem.