Cortical dysplasia is a cause of intractable epilepsy and a candidate for surgical resection to control epileptic attacks. The neuronal cytomegaly and balloon cell change are the diagnostic hallmarks of cortical dysplasia. Little research has been performed about the normal-sized dysplastic neuron which has complex arborizing dendrites and lacks in its polarity. The aim of this study was to define the histopathologic characteristics of the neurons in cortical dysplasia. Twelve cases of cortical dysplasia who underwent partial lobectomy for intractable seizures were selected and immunohistochemical staining for NF-M/H, MAP2, tau, and ubiquitin was performed. The perikarya and dendrite of dysplastic neurons were more intensely labeled with antibodies for the high and medium molecular weight neurofilament proteins (NF-M/H) than normal neurons. Immunoreactivity with the MAP2 antibody expressed mainly within the somatodendritic regions was present in the dysplastic or normal neurons without any significant difference in intensity. The complex arborizing dendrites of dysplastic neurons were easily identified due to pronounced immunoreactivity within the somatodendritic regions. Immunoreactivity with the primary antibody against tau and ubiquitin was present in the normal-looking neurons as well as the dysplastic neurons. This study suggests that the dysplastic neurons in cortical dysplasia are accompanied by changes of cytoskeletal neurofilaments, and the immunohistochemical stains for NF-M/H, MAP2, tau, and ubiquigin are useful to detect them.
Antibodies ; Coloring Agents ; Dendrites ; Epilepsy ; Malformations of Cortical Development* ; Molecular Weight ; Neurofilament Proteins ; Neurons ; Seizures ; Ubiquitin

Kainic acid(KA) is an excitotoxic analogue of glutamate which is now widely used in the studies of epilepsy. Electroencephalographic, behavioral and pathologic observation were done for 2 months after microinjection of kainic acid(Kainic acid group;0.4 microgram, 0.8 microgram, 1.2 microgram, 1.6 microgram, 2.0 microgram, 3.0 microgram) and phosphate buffer solution(Control group) into the left basolateral amygdala(AMG) in 30 Spaque-Doley rats. The control group showed no change in EEG and behavior during the observation period and pathologic findings were normal. One of four rats which 1.2 microgram of KA was injected, four of six rats of 1.6 microgram, all six rats of 2.0 microgram, one of four rats of 3.0 microgram developed acute complex partial seizure and multiple epileptic spikes with high amplitude in EEG. One of four rats of 1.2 microgram, one of six rats of 1.6 microgram, three of six rats of 2.0 microgram, showed spontaneous limbic seizure 14~21days after kainic acid injection. Among those which developed spontaneous limbic seizure, two rats demonstrated spontaneous secondarily generalized seizure 30~60days after kainic acid injection. Pathological examination revealed focal necrosis with perifocal gliosis at the tip of the cannula in the left amygdala. Neuronal cell loss was observed in the CA3 portion of pyramidal cell layer of the hippocampus on the injected side of KA, which developed spontaneous secondarily generalized seizure. But the cellular architecture was normal in the contralateral hippocampus. This is regarded as a good medel of spontaneous generalized complex partial seizure, which is similar to that of temporal lobe epilepsy in human.
Amygdala* ; Animals ; Catheters ; Electroencephalography ; Epilepsy ; Epilepsy, Temporal Lobe ; Gliosis ; Glutamic Acid ; Hippocampus ; Humans ; Kainic Acid* ; Microinjections* ; Necrosis ; Neurons ; Pyramidal Cells ; Rats* ; Seizures*

PURPOSE: We wanted to investigate the efficacy of percutaneous radiofrequency (RF) neurotomy of the medial branch for the management of chronic low back pain due to lumbar zygapophysial joint dysfunction. MATERIALS AND METHODS: Thirteen patients who had unremitting chronic low back pain for more than 6 months and whose VAS scores were over 7 were selected on the basis of double comparative nerve blocks. The patients consist of three males and 10 females, and their nean age was 67 years. Sensory stimulation was performed to detect the "pathologic branches" that were responsible for pain generation. RF neurotomy was performed using a lesion generator at 80 C for 90 seconds. The postoperative outcome was classified, depending on the degree of pain reduction, as excellent (> or = 75%), good (50-75%), and poor (<50%). Follow-up evaluation was performed at 6 weeks, 3 months and 6 months after surgery. RESULTS: The mean number of medial branches was 6.2. Eleven patients had bilateral disease and two had unilateral disease. Sensory stimulation was positive in all patients with a mean amplitude of 4.5V (range: 0.15-6 V). The L5 dorsal ramus was the most frequently involved segment, and this was followed by L4, L3 and L2. The number of lesionings for each medial branch was 3.7. The surgical outcome was graded as excellent (53%), good (23%), and poor (24%) after 6 months of follow-up. Transient backaches were noticed in two patients; however, complications were not observed. Recurrences were not demonstrated during the follow-up period CONCLUSION: We conclude that RF neurotomy of the medial branches is an efficient method to substantially alleviate the chronic low back pain caused by zygapophysial joint dysfunction.
Arthralgia* ; Back Pain ; Female ; Follow-Up Studies ; Humans ; Joints* ; Low Back Pain ; Male ; Nerve Block ; Recurrence ; Spine

A selective posterior rhizotomy(SPR) was done for reducing spasticity in 18 patients with cerebral palsy. Based on a standard techniques developed by Fasano(Lumbar SPR) and Heimberger(Cervical SPR), we dissected L1-S1 dorsal rootlets through T12, L1 laminectomy in 10 patients and C5-C8 dorsal rootlets through C5-C7 laminectomy in 8 patients. All the rootlets from each root were electrically stimulated with bipolar electrodes(1 sec, 1-50 mV). The muscle responses were observed visually and recorded by intraoperative 8-channel electromyography. The rootlets showing abnormal motor responses visually and electromyopraphically were divided and cut. The Patients were accessed preoperatively and postoperatively in terms of clinical, functional, electrophysiological evaluations. Reduction of spasticity was observed in 9 patients in Lumbar SPR, and 5 patients cervical SPR. Recurrence was seen in 3 patients in Lumbar SPR, and 3 patients in cervical SPR. It was noticed that the reasons for the bad outcomes was due to improper division and selection of the rootlets which should be cut. These results was shown that SPR could be effective for treating spasticity in the patients of cerebral palsy and more selective section of the rootlets based on neurophysiologic monitoring during operation might maximize its effectiveness on SPR in the treatment of spasticity.
Cerebral Palsy* ; Electromyography ; Humans ; Laminectomy ; Muscle Spasticity* ; Neurophysiological Monitoring ; Recurrence

PURPOSE: Although occipital lobe epilepsy may be operable, localization of the epileptogenic zone can be difficult and there is a high risk of postoperative visual loss. METHODS: Thirteen patients with intractable occipital lobe epilepsy underwent resective surgery. Preoperatively, all underwent video-EEG monitoring using extracranial electrodes and MRI; Nine had PET scans; In ten, who were cortically stimulated with subdural grid electrodes, invasive recordings were made. Foramen ovale electrodes had been previously used in two, and bitemporal depth electrodes in one; Nitemporal and occipital electrodes had been used in one, and a unilateral temporal depth electrode in one. Nine underwent partial occipital resection, which had spared the nonepileptogenic primary visual cortex, and two underwent a total unilateral occipital lobectomy: A temporal lobectomy was performed in two. RESULTS: Twelve patients experienced visual aura prior to complex partial seizure, and five had quadrantanopsia. In no patient was noninvasive monitoring reliable in localizing the epileptogenic zone, and in eleven patients, this was localized by invasive recordings. Electrocortical stimulation with subdural grid electrodes evoked simple and complex visual phenomena in nine patients, reproduced the same auras in four, induced a typical seizure in two, and provided language mapping in five. Histopathologic findings revealed cortical dysplasia in five; Tuberous sclerosis was combined in one, hamartoma and ganglioglioma, each in two, and infarction and nonspecific change in the occipital lobe each in one, neuronal loss in the hippocampus and neuronal heterotopia in mesial temporal structures were reported in two patients who underwent temporal lobectomy. Ten were seizure-free during follow-up between six and 46(mean 22.3) months. Seizures recurred in two and were unchanged in one. Only two patients with preoperative quadrantanopsia developed homonymous hemianopsia. CONCLUSION: This study suggests that in the surgical treatment of the occipital lobe epilepsy, the use of intracranial EEG and functional mapping with subdural grid electrodes, can achieve a good outcome, including the preservation of vision.
Electrodes ; Electroencephalography ; Epilepsies, Partial* ; Epilepsy ; Follow-Up Studies ; Foramen Ovale ; Ganglioglioma ; Hamartoma ; Hemianopsia ; Hippocampus ; Humans ; Infarction ; Magnetic Resonance Imaging ; Malformations of Cortical Development ; Neurons ; Occipital Lobe* ; Positron-Emission Tomography ; Seizures ; Tuberous Sclerosis ; Visual Cortex ; Visual Fields

No abstract available.
Orbit

PURPOSE: Epilepsy surgery has become increasingly available in children with medically intractable epilepsy including temporal lobe epilepsy(TLE). TLE in children, however, has many different clinical and electrophysiologic characteristics which make presurgical evaluation difficult. The aim of this study is to evaluate the electroencephalographic(EEG) features which might be one of the predictors of postsurgical seizure outcomes in TLE. METHODS: Standard EEG, video-EEG, subdural or depth EEG were investigated in 12 children who underwent anterior temporal lobectomy, and their seizure semiology, MRI, and pathologic findings were also reviewed. Postsurgical seizure outcomes were divided into favorable(class I, II) and unfavorable(class III, IV) groups by using the Engel's classification. RESULTS: Half of the patients showed favorable outcomes, whose pathologic findings revealed hippocampal sclerosis or gliosis. Such pathologic findings were not demonstrated in MRI. Interictal epileptiform discharges were concordant with the location of the ictal onset in only 2 cases of the favorable outcomes. For the other 4 cases in the favorable group, focal ictal onset patterns were clearly evident in video-EEG monitorings or invasive EEG studies. Six cases in the unfavorable group showed unlocalized or multifocal interictal or ictal discharges -extratemporal, bitemporal or generalized epileptic activities- even in the invasive EEG studies. Five of them revealed cortical dysplasia in the pathology. CONCLUSION: The postsurgical seizure outcomes of hippocampal sclerosis or gliosis were more favorable than those of cortical dysplasia. Invasive EEG recordings should be considered for the localization of epileptic foci in the presurgical evaluation of children with intractable TLE.
Anterior Temporal Lobectomy ; Child* ; Classification ; Electroencephalography ; Epilepsy ; Gliosis ; Humans ; Magnetic Resonance Imaging ; Malformations of Cortical Development ; Pathology ; Sclerosis ; Seizures ; Temporal Lobe*

An AVM located in or adjacent to the sylvian fissure is one of the most difficult to remove because it is surrounded by critical structures such as the basal ganglia and internal capsule and it involves the middle cerebral artery. We have operated on 6 cases of arteriovenous malformation(AVM) in and around the sylvian fissure. We describe the characteristic features of these AVMs from the anatomical and surgical points of view. The surgical results were satisfactory in 5 cases, and 1 patients died.
Arteriovenous Malformations ; Basal Ganglia ; Humans ; Internal Capsule ; Middle Cerebral Artery

Fifty six patients with unstable thoracolumbar bursting fractures were treated using variable internal fixation devices such as the Kaneda Anterior Fixation System(Kaneda device), the Z-Plate-ATL(TM) Anterior Fixation System(Z-Plate ATL(TM) device), the Harrington device, Cotrel-Ducousset(CD) or Compact Contrel Dubousset(CCD) device or Steffee Transpedicular System with or without decompression. Such internal fixation devices were grouped into anterior and posterior internal fixation devices and compared with each other in the aspect of the degree of neurological improvement, the changes of the vertebral height and the kyphotic angle, the duration of admission, and postoperative complications. In conclusion, the anterior internal fixation device appears to be of more benefit in the management of patients with unstable thoracolumbar bursting fracture.
Decompression ; Humans ; Internal Fixators ; Postoperative Complications

OBJECTIVE: Congenital bilateral perisylvian syndrome (CBPS) has been defined as a characteristic malformative perisylvian polymicrogyria (PMG) in patients with clinical symptoms of pseudobulbar palsy and epileptic seizures. For the present study, we investigate clinicopathologic features of CBPS associated with timing of lesion formation. METHODS: Clinicopathologic features of CBPS from 6 patients with surgical resection of the cerebral lesions due to medically intractable seizures were studied. RESULTS: Seizure onset ranged from 1 to 10years (average 6.7years) of age, and average duration of seizure was 23years. All had complex partial seizures, and two patients had additional tonic clonic seizures. Magnetic resonance (MR) images showed polymicrogyria, atropic gyri with gliosis. In the histopathologic examination, the cortical lesions revealed features of ulegyria ; atrophic and sclerotic gyri, laminar loss of neurons, extensive lobular gliosis throughout the gray and white matter, neuronoglial nodule formation, and many amyloid bodies. Unlayered or four-layered PMG was not identified. CONCLUSION: Above data suggest that CBPS might be caused by ulegyria resulting from developmental cortical defect during early fetal stage or acquired hypoxic/ischemic injury in prenatal or postnatal life.
Amyloid ; Epilepsy ; Gliosis ; Humans ; Malformations of Cortical Development ; Neuronal Migration Disorders ; Neurons ; Pseudobulbar Palsy ; Seizures