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7 results

  • 5 - What Are Common Epilepsy Imaging Findings in New Onset and Chronic Epilepsy Care?

  • Patrick Landazuri, University of Kansas Medical Centre, Nuria Lacuey Lecumberri, University of Texas Health Science Center, Houston, Laura Vilella Bertran, University of Texas Health Science Center, Houston, Mark Farrenburg, University of Kansas Medical Centre, Samden Lhatoo, University of Texas Health Science Center, Houston
  • Book:
    Seizure and Epilepsy Care
    Published online:
    28 January 2023
    Print publication:
    09 February 2023, pp 79-101

  • Summary

    The use of imaging in epilepsy care is a powerful tool to show a patient why they have epilepsy. You can use it to correlate your semiology history with an imaging finding. Magnetic resonance imaging (MRI) is the most widely used modality for epilepsy care. Ordering an epilepsy protocol MRI on a 3 Tesla (3T) machine increases the likelihood of finding an epilepsy’s etiology. Common findings include stroke, tumor (i.e., ganglioglioma), hippocampal sclerosis, encephalocele, cortical dysplasia, heterotopia, polymicrogyria, or cavernoma. For MRI-negative epilepsy, additional tests to identify the epileptogenic region include PET (positron emission tomography) and SPECT (single photon emission computed tomography). Functional MRI (fMRI) can delineate brain areas critical for specific functions.Lastly, the use of CT (computed tomography) is limited to identification of acute findings like hemorrhage and tumors in new onset seizures.

  • Chapter 2 - Anatomic and Histological Changes of the Aging Brain

  • Edited by Kenneth M. Heilman, University of Florida, Stephen E. Nadeau, University of Florida
  • Book:
    Cognitive Changes and the Aging Brain
    Published online:
    30 November 2019
    Print publication:
    05 December 2019, pp 5-15

  • Summary

    This chapter discusses the age-related microscopic changes affecting neurons and glia emphasizing the alterations seen in cognitively intact individuals, although some changes also occur in neurodegenerative diseases. Also reviewed are common histopathological correlates of white matter changes and small vessel cerebrovascular changes. One age-associated vascular lesion, brain arteriolosclerosis, was recently shown to be related to “hippocampal sclerosis of aging.” The two disease entities are now collectively called “cerebral age-related TDP43 and sclerosis.” Finally, amyloid accumulation without tau or other neuropathologies, termed “pathological aging,” is discussed with a review of current described conditions occurring during aging, e.g., “primary age-related tauopathy” and “aging-related tau astrogliopathy.”

  • Executive Dysfunction and Depression in Pediatric Temporal Lobe Epilepsy: The Contribution of Hippocampal Sclerosis and Psychosocial Factors

  • William A. Schraegle, Nancy L. Nussbaum, Jeffrey B. Titus
  • Journal:
    Journal of the International Neuropsychological Society / Volume 24 / Issue 6 / July 2018
    Published online by Cambridge University Press:
    25 March 2018, pp. 606-616
    • Article
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  • Objectives: Temporal lobe epilepsy (TLE) has been identified as a risk factor for increased depression features in children and adolescents; however, less is known regarding specific neurocognitive predictors of depression in this population above and beyond seizure-specific and sociodemographic factors. Methods: The study included 62 patients with TLE (64% male) aged 8 to 16 years (M=12.62; SD=2.26) who underwent comprehensive neuropsychological evaluation. Results: Correlation analyses revealed significant association between patient depression and WCST Total Perseverations, BRIEF Behavioral Regulation Index (BRI) and family stress. Perseverative errors on the WCST and the BRI were found to significantly predict depression features in youth with TLE. Patient performance on WCST was also found to fully mediate the significant relationship between hippocampal sclerosis (HS) and depression in pediatric TLE. Finally, logistic regression indicated HS in the presence of TLE was associated with a four-fold risk of clinically significant depression ratings. Conclusions: The current findings offer strong support for the relationship between executive function (EF) and depression in pediatric TLE. Also, as HS is not modifiable, these findings suggest EF intervention may be a potential modality for improving health-related quality of life (HRQOL) in youth with TLE. (JINS, 2018, 24, 606–616)

  • Interictal psychosis following temporal lobe surgery: dentate gyrus pathology

  • M. Thom, M. Kensche, J. Maynard, J. Liu, C. Reeves, J. Goc, D. Marsdon, D. Fluegel, J. Foong
  • Journal:
    Psychological Medicine / Volume 44 / Issue 14 / October 2014
    Published online by Cambridge University Press:
    08 April 2014, pp. 3037-3049
  • Background

    De novo interictal psychosis, albeit uncommon, can develop in patients following temporal lobe surgery for epilepsy. Pathological alterations of the dentate gyrus, including cytoarchitectural changes, immaturity and axonal reorganization that occur in epilepsy, may also underpin co-morbid psychiatric disorders. Our aim was to study candidate pathways that may be associated with the development of interictal psychosis post-operatively in patients with hippocampal sclerosis (HS).

    Method

    A total of 11 patients with HS who developed interictal psychosis (HS-P) post-operatively were compared with a matched surgical HS group without psychosis (HS-NP). Resected tissues were investigated for the extent of granule cell dispersion, mossy fibre sprouting and calbindin expression in the granule cells. We quantified doublecortin, mini-chromosome maintenance protein 2 (MCM2) and reelin-expressing neuronal populations in the dentate gyrus as well as the distribution of cannabinoid type 1 receptor (CBR1).

    Results

    The patterns of neuronal loss and gliosis were similar in both groups. HS-P patients demonstrated less mossy fibre sprouting and granule cell dispersion (p < 0.01) and more frequent reduction in calbindin expression in granule cells. There were no group differences in the densities of immature MCM2, doublecortin and reelin-positive cells. CBR1 labelling was significantly lower in Cornu ammonis area CA4 relative to other subfields (p < 0.01); although reduced staining in all hippocampal regions was noted in HS-P compared with HS-NP patients, the differences were not statistically significant.

    Conclusions

    The alterations in dentate gyrus pathology found in HS-P patients could indicate underlying differences in the cellular response to seizures. These mechanisms may predispose to the development of psychosis in epilepsy and warrant further investigation.

  • Chapter 71 - Neurocysticercosis

  • from Section 3 - Symptomatic epilepsy
  • Edited by Simon D. Shorvon, Frederick Andermann, Renzo Guerrini
  • Book:
    The Causes of Epilepsy
    Published online:
    05 March 2012
    Print publication:
    14 April 2011, pp 495-500

  • Summary

    Hippocampal sclerosis (HS) has been recognized as the most commonly encountered pathological substrate of mesial temporal lobe epilepsy (MTLE). The pathological condition was initially described by early neuropathologists based on postmortem material. Studies in familial MTLE are also important for better understanding of the pathogenesis of HS. HS identified by magnetic resonance imaging (MRI) has been associated with poor medical control of seizures. Neurologic examination is usually normal except for facial asymmetry and memory deficits, which are material-specific for the side of ictal onset. Interictal electroencephalogram (EEG) findings in patients with MTLE typically include unilateral or bilaterally independent mesial temporal spikes, best seen with basal derivations. Treatment should start with a first-line antiepileptic drug (AED) in monotherapy, the dose of which is increased until seizure freedom or the occurrence of side effects such as tiredness, dizziness, diploplia, or gait disturbance.

  • Chapter 80 - Other vascular disorders

  • from Section 3 - Symptomatic epilepsy
  • Edited by Simon D. Shorvon, Frederick Andermann, Renzo Guerrini
  • Book:
    The Causes of Epilepsy
    Published online:
    05 March 2012
    Print publication:
    14 April 2011, pp 565-572

  • Summary

    This chapter provides an overview of biological and psychosocial issues that may be associated with seizure recurrence after epilepsy surgery. It reviews seizure recurrence without introducing the variable constituted by antiepileptic drugs (AED) tapering or discontinuation. Unilateral mesial temporal lobe epilepsy due to hippocampal sclerosis (MTLE/HS) is the prototype of a surgically remediable epilepsy syndrome, in which the chances for medical control are reduced whereas the chances for surgical remediation are elevated. The chapter discusses what could be seen as de novo epilepsy after epilepsy surgery and is subdivided into two independent parts: postoperative seizures possibly related to surgically inflicted cortical damage, and postoperative seizures possibly associated with disinhibition of a potential epileptogenic zone (EZ). Stopping AEDs would be the closest construct for the cure of epilepsy. There is evidence that at least in some pathologies epilepsy may be a release phenomenon following initial resection for epilepsy.

  • Dementia associated with epilepsy

  • Paulo Caramelli, Luiz Henrique Martins Castro
  • Journal:
    International Psychogeriatrics / Volume 17 / Issue s1 / September 2005
    Published online by Cambridge University Press:
    08 September 2005, pp. S195-S206

  • In this review, we explore the relationship between epilepsy and cognition and between epilepsy and dementia. Chronic epilepsy, particularly mesial temporal lobe epilepsy (MTLE) with hippocampal sclerosis, may be associated with impaired cognition, which can be secondary to uncontrolled seizures, to adverse effects of antiepileptic drugs (AEDs) or to the underlying biological abnormality. The choice of an adequate AED with an appropriate dose regimen may lead to a favorable outcome. This feature is especially relevant in elderly patients with dementia and associated epilepsy, a vulnerable population in which the diagnosis of seizures can be difficult and for whom treatment guidelines are not yet available. Based on available information and on data derived from studies with other populations, recommendations for the management of these patients are presented.