Objective: To identify clinical factors contributing to the lateralization of mesiotemporal memory functions in epilepsy by using memory- activated fMRI. Methods: Sixty patients aged 16 to 63 years with mesial tempora...Objective: To identify clinical factors contributing to the lateralization of mesiotemporal memory functions in epilepsy by using memory- activated fMRI. Methods: Sixty patients aged 16 to 63 years with mesial temporal lobe epilepsy (MTLE)and 20 patients aged 16 to 60 years with extratemporal epilepsy (ETE) due to circumscribed epileptogenic lesions who cnsecutively underwent presurgical evaluation including continuous video- EEG monitoring and structural MRI examinations were examined. During memory fMRI, the activation condition consisted of retrieval from long- term memory induced by selfpaced performance of an imaginative walk through the patient’ s hometown. On the basis of a previous study, memory lateralization was defined as typical if larger fMRI activation was in the mesiotemporal structures contralateral to the epileptic focus. Results: There were 45 patients with MTLE who had typical memory lateralization (75% ), whereas only 9 patients (45% ) with ETE exhibited typical memory lateralization (p = 0.013). In MTLE patients, bilateral independent epileptiform discharges occurred more often in the atypical group than in patients with typical memory lateralization (p = 0.015). Conclusions: The fMRI lateralization of mesiotemporal visuospatial memory functions in patients with mesiotemporal lobe epilepsy (MTLE) is asymmetric: The larger activation usually appears contralateral to the side of the epileptogenic region. These findings occur more often in MTLE; in patients with extratemporal epilepsy, such type of asymmetry is not characteristic. In MTLE patients with bilateral independent epileptiform discharges, this type of asymmetry is also less frequent.展开更多
Objectives: To identify predictive factors for the seizure-free outcome of va gus nerve stimulation (VNS). Methods: All 47 patients who had undergone VNS impl antation at one centre and had at least one year of follow...Objectives: To identify predictive factors for the seizure-free outcome of va gus nerve stimulation (VNS). Methods: All 47 patients who had undergone VNS impl antation at one centre and had at least one year of followup were studied. They underwent complete presurgical evaluation including detailed clinical history,ma gnetic resonance imaging, and long term video-EEG with ictal and interictal rec ordings. After implantation, adjustment of stimulation parameters and concomitan t antiepileptic drugs were at the discretion of the treating physician. Results: Mean (SD) age of the patients was 22.7 (11.6) years (range 7 to53). Six patients (13%) became seizure-free after the VNS implantation.Only two variables showe d a significant association with the seizure-free outcome: absence of bilateral interictal epileptiform discharges (IED) and presence of malformation of cortic al development (MCD). Epilepsy duration showed a non-significant trend towards a negative association with outcome.By logistic regression analysis, only absenc e of bilateral IED correlated independently with successful VNS treatment(p < 0. 01, odds ratio = 29.2 (95%confidence interval, 2.4 to 353)). Bilateral IED (ind ependent or bilateral synchronous)was found in one of six seizure-free patients and in 33 of 41non-seizure-free patients. When bilateral IED were absent, the sensitivity for seizure-free outcome was 0.83 (0.44 to 0.97),and the specifici ty was 0.80 (0.66 to 0.90). Conclusions: Bilateral IED was independently associa ted with the outcome of VNS. These results are preliminary because they were based on a small patient population. They may facilitate prospective VNS studi es enrolling larger numbers of patients to confirm the results.展开更多
文摘Objective: To identify clinical factors contributing to the lateralization of mesiotemporal memory functions in epilepsy by using memory- activated fMRI. Methods: Sixty patients aged 16 to 63 years with mesial temporal lobe epilepsy (MTLE)and 20 patients aged 16 to 60 years with extratemporal epilepsy (ETE) due to circumscribed epileptogenic lesions who cnsecutively underwent presurgical evaluation including continuous video- EEG monitoring and structural MRI examinations were examined. During memory fMRI, the activation condition consisted of retrieval from long- term memory induced by selfpaced performance of an imaginative walk through the patient’ s hometown. On the basis of a previous study, memory lateralization was defined as typical if larger fMRI activation was in the mesiotemporal structures contralateral to the epileptic focus. Results: There were 45 patients with MTLE who had typical memory lateralization (75% ), whereas only 9 patients (45% ) with ETE exhibited typical memory lateralization (p = 0.013). In MTLE patients, bilateral independent epileptiform discharges occurred more often in the atypical group than in patients with typical memory lateralization (p = 0.015). Conclusions: The fMRI lateralization of mesiotemporal visuospatial memory functions in patients with mesiotemporal lobe epilepsy (MTLE) is asymmetric: The larger activation usually appears contralateral to the side of the epileptogenic region. These findings occur more often in MTLE; in patients with extratemporal epilepsy, such type of asymmetry is not characteristic. In MTLE patients with bilateral independent epileptiform discharges, this type of asymmetry is also less frequent.
文摘Objectives: To identify predictive factors for the seizure-free outcome of va gus nerve stimulation (VNS). Methods: All 47 patients who had undergone VNS impl antation at one centre and had at least one year of followup were studied. They underwent complete presurgical evaluation including detailed clinical history,ma gnetic resonance imaging, and long term video-EEG with ictal and interictal rec ordings. After implantation, adjustment of stimulation parameters and concomitan t antiepileptic drugs were at the discretion of the treating physician. Results: Mean (SD) age of the patients was 22.7 (11.6) years (range 7 to53). Six patients (13%) became seizure-free after the VNS implantation.Only two variables showe d a significant association with the seizure-free outcome: absence of bilateral interictal epileptiform discharges (IED) and presence of malformation of cortic al development (MCD). Epilepsy duration showed a non-significant trend towards a negative association with outcome.By logistic regression analysis, only absenc e of bilateral IED correlated independently with successful VNS treatment(p < 0. 01, odds ratio = 29.2 (95%confidence interval, 2.4 to 353)). Bilateral IED (ind ependent or bilateral synchronous)was found in one of six seizure-free patients and in 33 of 41non-seizure-free patients. When bilateral IED were absent, the sensitivity for seizure-free outcome was 0.83 (0.44 to 0.97),and the specifici ty was 0.80 (0.66 to 0.90). Conclusions: Bilateral IED was independently associa ted with the outcome of VNS. These results are preliminary because they were based on a small patient population. They may facilitate prospective VNS studi es enrolling larger numbers of patients to confirm the results.
