There is rapid growth of pediatric surgery service in China in the recent years. A survey by the China Association �A gainst �Epi�lepsy underta�ken in �June ����� 2006���� on the ma�jor cities in different parts of the country showed a dramatic increase particularly in years 2004 and 2006. Surgery for temporal lobe epilepsy accounts for half of the operation. Surgery has an important role in the treatment of drug resistant pediatric epilepsy. With large population and vast geographical spread, it is important to further develop pediatric epilepsy surgery service in China

The earliest activities related to epilepsy surgery in China ma�� � y be tra�ce��d to the 19���50s an�� �� d 60s��. A�ter a lull during the cultural revolution, there was resurgence of epilepsy surgery from the 1980s, and rapid development from 2000. It is estimated that app�roximately 150- ���200 p hysi�cians �currentl�� � y pra�cti�ce epilepsy surgery in the country.�� In year 2��� 005, there were a total of 2,��500 �cases of e�pile�ps��y o�perate��d in whole of �China, close to half in Beijing, Tian�jin, �Shanghai, �Chongqing an��d Guang�zhou, an�� a �uarter in Beijing. There are three Chinese epilepsy surgery journals, 5 monographs on epilepsy surgery, and “��Epilepsy surgery” edite�� ��� ��� �� ��� ��� d by HO Luders has also �been translate��d into �Chinese��.

Objective To determine the ultrastructural localization of MDR1 and GFAP in the surgically resected brain tissues from intractable epilepsy patients. Methods Expression of MDR1 and GFAP in brain tissues was examined by using PAG immunolabeling technique for electron microscopy. Results The MDR1 and GFAP labeled by gold particles were only detected at some reactive astrocytes. The positive gold particles were mainly located in the astrocytic cytoplasm and their membrane, but not in the nucleus.Conclusion The expression of MDR1 and GFAP in the brain of patients with clinically intractable epilepsy were mainly located at the cytoplasm and membrane of certain reactive astrocytics.;

Objective: To assess the surgical techniques and surgical outcomes of temporoparietooccipital and parietooccipital disconnection. Methods: The authors conducted a retrospective review of clinical, neuropsychological, EEG, imaging data in 16 patients with intractable epilepsy who underwent temporoparietooccipital and parietooccipital disconnection between April 2008 and October 2011. Of the 16 cases, 12 were males and 4 were females. The age of seizure onset was from 0.1 to 27 years (average 6.6) and disease duration of 0.1 to 18 years (average 7.5). The surgery was performed between the age of 3 and 37 years (average 14.1). Nine patients underwent temporoparietooccipital disconnection, 5 patients parietooccipital disconnection and 2 patient parietooccipital disconnection and temporal lobotomy. Results: After a mean follow-up of 1.6 years (range 0.5–3.9 years), 13 patients (81%) were seizure free, 1 patient had Engel Class II seizure outcome and 2 patient had Engel class III outcome. Two patients exhibited severe brain swelling and one patients had second resective operation with good recovery. None of the patients developed new motor defi cits postoperatively and there was no mortality. Conclusion: Temporoparietooccipital and parietooccipital is a safety and effective epilepsy surgery procedure for patients with epileptic zone localization to the posterior quadrant on one side. The results of surgical disconnection for posterior quadrantic epilepsy have yielded excellent seizure outcomes in 81% of the patients, with no mortality or major morbidity.

Objective To analyze the blood flow velocities in middle cerebral artery with Rasmussen encephalitis. Methods8 patients with Rasmussen encephalitis were detected bilateral middle cerebral artery in both period of onset and intermission during simple partial seizures with Transcranial Doppler. ResultsThe mean velocity variance between focus side and non-focus side was minimums among the 3 indexes observed. The mean velocity of MCA displayed uneven increase during seizures. ConclusionThe mean velocity was the most stable index for judging.

ObjectiveTo discuss clinical significance of changes in cerebral blood flow velocities with Rasmussen encephalitis. Methods8 cases diagnosed as Rasmussen encephalitis were measured the blood flow velocities in middle cerebral artery (MCA) with transcranial Doppler in ictal and interictal seizures. ResultsIctal mean flow velocity in the ipsilateral MCA to the epileptogenic foci increased 14.02%～48.14% to interictal one, while it was -0.74%～22.63% in the contralateral MCA. ConclusionAn increased flow velocity has been found in the ipsilateral MCA to the epileptogenic foci during seizure in Rasmussen encephalitis patients.

OBJECTIVETo observe the clinical effects of lesionectomies combined with bipolar coagulation of the surrounding cortex (BCSC) on symptomatic epilepsy.

METHODSThe effectiveness of lesionectomies combined with BCSC (71 patients) and of lesionectomies alone (78 patients) were compared in follow-up surveys conducted 2 - 5 years (average of 37 months) post-operation.

RESULTSTreatment in the BCSC group was significantly more effective than in the lesionectomy group (P < 0.01). Meanwhile, patients in the BCSC group suffered no permanent post-operative complications.

CONCLUSIONLesionectomy combined with BCSC is a new, effective and safe treatment for symptomatic epilepsy.

Adolescent ; Adult ; Cerebral Cortex ; surgery ; Child ; Electrocoagulation ; methods ; Epilepsy ; surgery ; Female ; Humans ; Male ; Middle Aged ; Treatment Outcome

Objective To explore the expression of Tau protein in brains of the intractable epilepsy patients and discuss its function in the pathogenesis. Methods Immunohistochemistry was adapted to test the expression of Tau protein and the mossy fiber sprouting in the hippocampus and cortex of temporal lobe from 48 intractable epilepsy patients and age-mached 48 cases of controls. Results The expression of phosphorylated Tau protein in the CA_3 areas (0.0450?0.0115) and the molecular layers of dentate gyrus (0.0463?0.0120) in intractable epilepsy patients was increased, accompanied by the hippocampus mossy fiber sprouting (3.18?0.35). No difference on the expression of total Tau protein was observed between the intractable epilepsy patients and the controls. Conclusion The present findings demonstrate that the strengthening of phosphorylated Tau protein might play an important role for the synaptic reorganization of the hippocampus. Thus, the changes of phosphorylated Tau protein could improve clinical prognosis in the intractable epilepsy patients.

Objective:To study the expression of ULBP2 protein in the brain tissues of patients with drug-refractory epilepsy and its clinical significance.Methods:Gene-chip,immunofluorescence and Western blot were used to test expression of ULBP2 in the surgically removed brain tissue of patients with drug-refractory epilepsy from the brain bank of our department(n=42),and the results were compared with that of normal controls (n=12).Results:The relative increasing expression of ULBP2-gene in the brain of patients with drug-refractory epilepsy,and ULBP2 protein expression was significantly increased in temporal lobe cortex of patients with drug-refractory epilepsy as compared with the same regions of the controls specimens.Conclusion:The results indicate that the overexpression of ULBP2 may be involved in the pathophysiology of drug-refractory epilepsy.

Objective To illustrate the semiological characteristics of the three sub-types within the broad bilateral asymmetric tonic seizures (BATS),summarize their predictive values on lateralization and localization of seizure onset zone (SOZ),and analyze the difference between BATS and asymmetrical tonic limb posturing (ATLP).Methods A retrospective review of 385 patients who underwent stereotactic electrode implantation in the Sanbo Brain Hospital,Capital Medical University from September 2011 to May 2018 was performed.As long as there was a clinical epileptic seizure in the presence of BATS or ATLP,the patients were classified into the corresponding groups.Postoperative prognosis was assessed using Engel's grading criteria for a follow-up of no less than six months.Seizure descriptions were based on the classification of epileptic seizures introduced by Lüiders,which used arrows to connect the symptoms in chronological order.Results There was no statistically significant difference between the classic BATS and bilateral proximal tonic seizure in terms of whether it could be an independent seizure,as the onset and end of the seizure,with version and generalized tonic-clonic seizure (P＞0.05).Compared with the ATLP,except for whether it could be an independent seizure (P=1.000) and onset before versive seizure (P=0.068),the BATS showed significantly different semiological features (P＜0.05).The classic BATS and secondary motor area epilepsy had a 100.0％ predictive accuracy on the lateralization of SOZ.In the patients with broad BATS,the SOZ distribution was more extensive,but it was rare in the orbitofrontal gyrus,frontal pole and mesial temporal lobe.Compared with the bilateral proximal tonic seizures from the other regions,those originated from supplementary somatosensory motor area and its adjacent areas were rare and showed no statistically significant difference (0/8 vs 40.0％ (18/45),x2=3.226,P=0.072) but a low trend.The predictive value of BATS on lateralization of SOZ was higher than that of ATLP (84.9％ (45/53) vs 57.1％ (24/42),x2=9.086,P=0.003),and BATS was less originated from temporal lobe than ATLP (3.8％ (2/53) vs 23.8％ (10/42),x2=8.523,P=0.004).Conclusion Different from ATLP,the broad BATS are characterized by tonic proximal upper limb posturing,and have a higher predictive value on lateralization and localization of SOZ.