China ; Epilepsy ; pathology ; Humans ; Prognosis

Astrocytes ; metabolism ; pathology ; Epilepsy ; pathology ; Humans

Post traumatic epilepsy （PTE） refers to the epileptic seizures after traumatic brain injury. Organic damage can be found by imaging examination, and abnormal electroencephalogram can be detected via electroencephalogram examination which has the similar location of the brain injury. PTE has the characteristics of low incidence, absence of case reports, and easy to exaggerate the state of illness, which add difficulties to the forensic identification. This paper reviews the status of epidemiology, pathogenesis, clinical treatment and forensic identification for PTE.
Brain Injuries, Traumatic/physiopathology* ; Electroencephalography ; Epilepsy ; Epilepsy, Post-Traumatic/pathology* ; Forensic Pathology ; Humans ; Incidence

PURPOSE: Memory complaints are common in patients with epilepsy, particularly temporal lobe epilepsy. Many factors may adversely affect memory function in epilepsy, including seizures themselves, pathology causing the epilepsy and antiepileptic medication. The Wechsler Memory Scale (WMS) is used widely for test of memory. The aim of this study is to evaluate memory in patients with temporal lobe epilepsy using the WMS and to analyze memory impairment with respect to various factors. METHODS: Twenty four epileptic patients with temporal lobe epilepsy were evaluated with the WMS. Memory impairment was analyzed with respect to age at seizure onset, epilepsy duration, and antiepileptic medication. RESULTS: Memory test using the WMS showed significant differences between epileptic patients and controls for general information, mental control, associate learning, digit span and logical memory subtests. There was no correlation between memory quotient and age at seizure onset, epilepsy duration, or antiepileptic medication. CONCLUSIONS: Patients with temporal lobe epilepsy have a memory impairment though none of the factors to impair memory function in epileptic patients could be identified.
Epilepsy ; Epilepsy, Temporal Lobe* ; Humans ; Learning ; Logic ; Memory* ; Pathology ; Seizures ; Temporal Lobe*

OBJECTIVE: The aim of this study is to compare the frequency of postoperative epilepsies of patients with chronic as opposed to recent onset epilepsy due to glial tumors in the frontal or temporal lobe with the hypothesis that patients with chronic epilepsy do worse. METHODS: We compared the clinical and diagnostic characteristics of the patients(n=73) who had seizures preoperatively to those of the patients(n=153) who did not. Among those who have had seizures preoperatively, we compared those(n=32, chronic seizure group) who had seizures a year or more prior to surgery to those(n=41, acute seizure group) who had seizures within a year prior to surgery. RESULTS: Among the various factors, the frequency of benign pathology and favorable neurological state were higher in seizure group than in non-seizure group(p<0.05). Complex partial seizure and low-grade tumors were frequent in chronic seizure group, whereas simple partial seizure and high-grade tumors were frequent in acute seizure group. Seizure-free rate was significantly higher in acute seizure group than in chronic one(p<0.05). Also, the difference of seizure control rate between surgical strategies were statistically significant(p<0.05). CONCLUSION: This study indicates that preoperative seizure durations and frequencies have a close relationship with the frequency of postoperative epilepsy of glial tumors. A longer lapse may allow the formation of epileptogenic foci, leading to chronic epilepsy, and eventually having a negative effect on the prognosis of the patients. Factors including histopathological characteristics of the tumor, its location, seizure duration/frequency, and semiology should be taken account of deciding on surgical strategies.
Brain Neoplasms ; Epilepsy* ; Glioma ; Humans ; Pathology ; Prognosis ; Seizures ; Temporal Lobe

OBJECTIVETo review the recent development of functional MRI application in epilepsy.

DATA SOURCESBoth Chinese and English language literatures were researched using MEDLINE/CD ROM (1996 - 2005) and the Chinese Biomedical Literature Disk (1996 - 2005).

STUDY SELECTIONPublished articles about functional MRI application and epilepsy were selected.

DATA EXTRACTIONData were mainly extracted from 38 articles which are listed in the reference section of this review.

RESULTSfMRI can be used to localize seizure foci through detecting these cerebral hemodynamic changes produced by epileptiform discharges. EEG-triggered fMRI, which has higher spatial and temporal resolution, helps to detect the spatiotemporal pattern of spike origin and propagation, and define localization of the epileptogenic focus. fMRI is also useful in language and memory cognitive function assessment and presurgical assessment of refractory epilepsy. Atypically distributed cognitive function areas can be detected by fMRI, because of cortical language and memory areas reorganization during long-term epileptic activity in patients with epilepsy.

CONCLUSIONSfMRI technique plays a very important role in cognitive function and presurgical assessment of patients with epilepsy. It is meaningful for understanding pathogenesis of epilepsy.

In 2011, the International League against Epilepsy (ILAE) proposed a first international consensus of the classification of focal cortical dysplasia (FCD). This FCD classification had been widely used in worldwide. In this review paper, the authors would like to give helpful comments for better understanding of the current FCD classification. Especially, the basic concepts of FCD type I, such as “radial”, “tangential” and “microcolumn” will be discussed with figures. In addition, the limitations, genetic progress and prospect of FCD will be suggested.
Classification ; Consensus ; Embryology ; Epilepsy ; Humans ; Malformations of Cortical Development ; Pathology

OBJECTIVES: To analyze the case, scene and forensic pathological characteristics of sudden unexpected death in epilepsy (SUDEP), to provide a practical basis for forensic identification. METHODS: A total of 9 autopsy cases of SUDEP were collected. The basic information of the cases, the scene characteristics, the forensic pathological changes, the common drugs and antiepileptic drug test results, and pericardial fluid biochemical test results were analyzed. RESULTS: All of the 9 cases were male epilepsy patients died during sleep at night, the age of death was (37.1±8.6) years, and the course of epilepsy was (21.3±5.6) years. Six corpses were in prone position and three in left lateral position. The hemorrhage of the sternocleidomastoid muscle, sternal thyroid muscle and sternohyoid muscle were found with 8 cases, 5 cases and 4 cases, respectively, all of them were unilateral. Six cases had bilateral hemorrhage of pectoralis minor muscle. Brain edema, phagocytosis of frontotemporal neurons and gliosis, cardiac fibers bend in wavy patterns and eosinophilic staining enhancement, pulmonary edema, pulmonary congestion, alveolar hemorrhage, pulmonary small bronchiole wall shrinking, tubular proteinuria and pancreatic parenchymal hemorrhage were the common histopathological changes. The biochemical test results of pericardial fluid indicated that there were myocardial ischemic damage. CONCLUSIONS Young male, early onset, long course of disease, sleep in the prone position, poor drug compliance or combination, epileptic seizure may be the risk factors of SUDEP. Cardiac dysfunction and respiratory depression might be the main death mechanism of SUDEP.
Humans ; Male ; Adult ; Middle Aged ; Female ; Sudden Unexpected Death in Epilepsy ; Death, Sudden/pathology* ; Epilepsy/complications* ; Forensic Medicine ; Forensic Pathology

Focal cortical dysplasia (FCD) is one of the most common causes of drug-resistant epilepsy. Dysmorphic neurons are the major histopathological feature of type II FCD, but their role in seizure genesis in FCD is unclear. Here we performed whole-cell patch-clamp recording and morphological reconstruction of cortical principal neurons in postsurgical brain tissue from drug-resistant epilepsy patients. Quantitative analyses revealed distinct morphological and electrophysiological characteristics of the upper layer dysmorphic neurons in type II FCD, including an enlarged soma, aberrant dendritic arbors, increased current injection for rheobase action potential firing, and reduced action potential firing frequency. Intriguingly, the upper layer dysmorphic neurons received decreased glutamatergic and increased GABAergic synaptic inputs that were coupled with upregulation of the Na⁺-K⁺-Cl^- cotransporter. In addition, we found a depolarizing shift of the GABA reversal potential in the CamKII-cre::PTEN^flox/flox mouse model of drug-resistant epilepsy, suggesting that enhanced GABAergic inputs might depolarize dysmorphic neurons. Thus, imbalance of synaptic excitation and inhibition of dysmorphic neurons may contribute to seizure genesis in type II FCD.
Animals ; Drug Resistant Epilepsy/surgery* ; Epilepsy/pathology* ; Malformations of Cortical Development/pathology* ; Malformations of Cortical Development, Group I ; Mice ; Neurons/pathology* ; Seizures/pathology*

PURPOSE: To compare the diagnostic value of electroencephalography (EEG), MRI and PET studies and surgical outcome in patients with medically refractory temporal lobe epilepsy due to hippocampal sclerosis (HS) versus temporal lobe lesions (TLL). METHODS: Records of 122 consecutive patients who underwent surgery for epilepsy from January 1993 to April 2000 were retrieved from the MGH Epilepsy Surgery Database. Fifty eight patients with temporal lobe epilepsy due to pathologically proven HS or TLL were identified and presurgical interictal and ictal EEG, MRI, and 2-[(18)F]fluoro-2-deoxy-D-glucose (FDG)-PET data and surgical outcome were reviewed. Patients with dual or normal pathology were excluded. Pathologically proven HS was present in 32 patients, and 26 patients has temporal lobe lesions (cortical dysplasia in 6 patients, vascular malformation in 6, gliomas in 5, DNET in 4, heterotopia in 1, other pathologies in 4). Comparisons of the diagnostic value of EEG, MRI and FDG-PET studies were performed in 43 patients who were seizure-free after epilepsy surgery. Among 43 patients, HS was in 24 patients and TLL in 19. RESULTS: The occurrence of abnormal interictal and ictal EEG, MRI and FDG-PET findings in the side of operation was not significantly different between patients with HS and with TLL respectively. There was no significant difference in at least one year follow-up surgical outcome between the two groups. CONCLUSIONS: Diagnostic value of presurgical interictal and ictal EEG, MRI and FDG-PET findings, and surgical outcome were not different in patients with mesial versus neocortical temporal lobe epilepsies.
Electroencephalography* ; Epilepsy ; Epilepsy, Temporal Lobe* ; Follow-Up Studies ; Glioma ; Humans ; Magnetic Resonance Imaging ; Neuroimaging* ; Pathology ; Sclerosis ; Temporal Lobe* ; Vascular Malformations