PURPOSE: To develop a fast and robust seizure anticipation program and test its usefulness in seizure prediction and localization of epileptic focus. METHODS: The video-EEG monitoring was performed in 20 epilepsy patients. The NPISI (Nonlinear Periodicity of Inter-Spike Intervals) of each channel and averaged NPISI of all channels were calculated in pre-ictal and ictal periods of 21 epileptic seizures. Seizure prediction times of NPISI in each channel and all channels were determined. RESULTS: There were eight mesial TLE, twelve neocortical epilepsies. The significantly reduced NPISI prior to seizure onset was observed in 20 seizures (95.2%) by NPISI of single EEG channel and in 14 seizures (66.7%) by the averaged NPISI of all channels. Time of seizure anticipation was 17.3+/-7.3 min by single channel NPISI and 14.0+/-6.0 min by all channel NPISI prior to the seizure onset. The earliest NPISI reduction was detected at electrodes concordant to the seizure focus in 6/20 (30.0%) seizures, electrodes adjacent to the focus in 5/20 (25.5%), mirror electrodes contralateral to the seizure focus in 4/20 (20.0%), and irrelevant electrodes to the focus in 5/20 (25.5%). CONCLUSIONS: This study demonstrated that the reduction of NPISI could predict epileptic seizures long before clinical seizure onset. Although the earliest NPISI reduction was observed at or near to epileptic focus in most cases, pre-ictal changes of NPISI occurred far beyond the epileptic focus. These findings suggest that pre-ictal NPISI reduction may reflect a widespread facilitation of brain before the seizure onset.
Brain ; Electrodes ; Electroencephalography ; Epilepsy* ; Humans ; Periodicity* ; Seizures

Neuroimaging of the brain is useful diagnostic evaluation of patients with hepatic encephalopathy msofar as it is able to exclude other causes of abno rmal mental status. Recently, changes of basal ganglia on MRI characteriwd by increased signal mtensity on Tl-weighted images were reported m patients with liver cirrhosis. Signal abnormality involves mainly the globus pallidus and seems to be specific for patients with chronic liver disease. Its pathogenesis and significance are obscure, and no pathological reports have been made. We experienced 3 cases of Chronic acquired hepatic failure whose MRI showed increased signal in-tensity in the basal ganglia on Tl-weighted imaging. Our findings su-ggest that basal ganglia signal abnormality could arise as a marker of brain impairment related to deposition of an unidentified paramagnetic substance or altered intracellular water relaxation.
Basal Ganglia ; Brain ; Globus Pallidus ; Hepatic Encephalopathy ; Humans ; Liver Cirrhosis ; Liver Diseases ; Liver Failure* ; Magnetic Resonance Imaging ; Neuroimaging ; Relaxation

PURPOSE: To investigate the various ictal perfusion patterns and find the relationships between clinical factors and different perfusion patterns. MATERIALS AND METHODS: lnterictal and ictal SPECT and SPECT subtraction were performed in 61 patients with partial epilepsy. Bath positive images showing ictal hypoperfusion and negative images revealing ictal hypoperfusion were obtained by SPECT subtraction. The ictal perfusion patterns of subtracted SPECT were classified into focal hypoperfusion, hypoperfusion-plus, combined hypoperfusion-hypoperfusion, and focal hypoperfusion only. RESULTS: The concordance rates with epileptic focus were 91.8% in combined analysis of ictal hypoperfusion and hypoperfusion images of subtracted SPECT, 85.2% in hypoperfusion images only of subtracted SPECT, and 68.9% in conventional ictal SPECT analysis. Ictal hypoperfusion occurred less frequently in temporal lobe epilepsy (TLE) than extratemporal lobe epilepsy. Mesial temporal hypoperfusion alone was seen only in mesial TLE while lateral temporal hypoperfusion alone was observed only in neocortical TLE. Hippocampal sclerosis had much lower incidence of ictal hypoperfusion than any other pathology. Some patients showed ictal hypoperfusion at epileptic focus with ictal hypoperfusion in the neighboring brain regions where ictal discharges propagated. CONCLUSION: Hypoperfusion as well as hypoperfusion in ictal SPECT should be considered for localizing epileptic focus. Although the mechanisrn of ictal hypopertusion could be an intra-ictal early exhaustion of seizure focus or a steal phenomenon by the propagation of ictal discharges to adjacent brain areas, further study is needed to elucidate it.
Baths ; Brain ; Epilepsies, Partial* ; Epilepsy ; Epilepsy, Temporal Lobe ; Humans ; Incidence ; Pathology ; Perfusion* ; Sclerosis ; Seizures ; Tomography, Emission-Computed, Single-Photon*

PURPOSE: The detection of epileptogenic lesion plays an important role in the management of patients with partial epilepsy. Although the development of MRI improved the examination of cerebral hemispheres greatly, many patients with neocortical temporal lobe epilepsy (TLE) or extratemporal lobe epilepsy (extra-TLE) still show no lesion in conventional two-dimensional (2D) images. To increase the yield of MRI in those patients, we performed three-dimensional (3D) surface-projection rendering (SPR) of the cerebral hemispheres. METHODS: Conventional 2D MRI (T1, T2, FLAIR, thin slice SPGR) and 3D SPR were performed in 24 patients with neocortical TLE and extra-TLE, and 20 normal subjects. Sulcogyral patterns were evaluated blindly to clinical information. The locations of the epileptogenic zone, ictal onset zone (IOZ) and irritative zone (IRZ) were determined by intracranial EEG monitoring and epilepsy surgery. RESULTS: The 2D MRI identified epileptogenic lesions in five of the 10 neocortical TLE (50%) and five of the 14 extra-TLE (35.7%). 3D SPR revealed abnormal sulcogyral patterns in 9 of the 10 neocortical TLE (90%) and 9 of the 14 extra-TLE (64.3%). Cortical deformation zones with sulcogyral anomalies included the whole area of IOZ in 10 (55.5%) and IRZ in 6 (33.3%), overlapped with IOZ in 7 (38.9%) and IRZ in 11 (61.1%), were connected to IOZ in 1 (5.6%) and IRZ in 1 (5.6%). CONCLUSION: 3D SPR of volumetric MRI data can detect epileptogenic structural lesions of neocortical epilepsy that are not visible in the conventional 2D images.
Brain* ; Cerebrum ; Electroencephalography ; Epilepsies, Partial ; Epilepsy* ; Epilepsy, Temporal Lobe ; Humans ; Magnetic Resonance Imaging*

A 37-year-old woman was admitted to our hospital with altered mentality. The patient was diagnosed an internal carotid artery (ICA) dorsal wall aneurysm leading to acute subdural hemorrhage (SDH) without occurring subarachnoid hemorrhage and/or internal parenchymal hemorrhage. An aneurysmal neck clipping and hematoma evacuation were performed at once. A pure SDH by ruptured aneurysm is unusual, but it is important to consider it if a SDH patient has no other medical history.
Adult ; Aneurysm* ; Aneurysm, Ruptured ; Carotid Artery, Internal* ; Female ; Hematoma ; Hematoma, Subdural* ; Hemorrhage ; Humans ; Intracranial Aneurysm ; Neck ; Rupture* ; Subarachnoid Hemorrhage

BACKGROUND: The interpretation of Wada memory test is various in different epilepsy centers. Four types of Wada memory score (WMS) were defined by four different criteria to determine the best WMS in predicting postsurgical memory outcome. METHODS: Twenty temporal lobe epilepsy patients underwent Wada test before surgery and pre- and post-operative neuropsychological tests. WMS was obtained by four ways; including 1) total stimulating items, 2) items presented between one and two minutes after amobarbital injection, 3) items presented before ipsilateral EEG slowing decreased to 50%, 4) items presented until EEG slowing disappeared. Wada memory asymmetry index (WAI) was determined by [(WMS of normal side ? WMS of epileptic side)/their mean]. Logical and visual memory tests were performed before and after operation. Neuropsychological asymmetry index (NPAI) was defined as [(postsurgical score ? Presurgical score)/their mean]. Spearman correlation coefficients were obtained between WAIs and NPAIs. RESULTS: WAIs obtained by method 2) and 3) showed relatively good correlation with NPAIs. Visual memory outcome was correlated with WMS better than logical memory both in non-dominant and dominant hemisphere epilepsy groups. The lateralizing value of memory dominance in non-dominant hemisphere epilepsy group was greater than that of dominant group. CONCLUSIONS: Early presented stimuli during Wada test had a better predictive value of postoperative memory outcome.
Amobarbital ; Electroencephalography ; Epilepsy ; Epilepsy, Temporal Lobe ; Humans ; Logic ; Memory* ; Neuropsychological Tests