A. D. Rothner

Dystonic posturing in complex partial seizures of temporal lobe onset: A new lateralizing sign

We observed unilateral dystonic posturing of an arm or leg in 41 complex partial seizures (CPS) from 18 patients. In all cases this was contralateral to the ictal discharge. Unilateral automatisms occurred in 39 of 41 seizures on the side opposite the dystonic limb. Version occurred in 11 of the 41 CPS to the same side as the dystonic posturing and always followed the posturing. Subdural recordings of seven seizures showed ictal onset from the mesial basal temporal lobe. At the onset of dystonic posturing, maximum ictal activity was in the basal temporal lobe with minimal involvement of the cerebral convexity. Unilateral dystonic posturing occurs frequently in CPS of temporal lobe onset and is a lateralizing sign with a high degree of specificity. It probably reflects spread of the ictal discharge to basal ganglia structures.

Clinical outcome after complete or partial cortical resection for intractable epilepsy

This is the first epilepsy surgery series to analyze the definition of “completeness” of resection, based solely on results of chronic scalp and subdural EEG recording. When patients had complete removal of all cortical areas with ictal and interictal epileptiform discharges, the clinical outcome was usually good. When areas with epileptiform discharges were left behind, good outcome was significantly less frequent. This correlation between complete resection and good outcome was independent of the presence or absence of CT-detected structural lesions or sharp waves on post-resection electrocorticography. These results support completeness of resection, defined by prolonged extraoperative EEG, as an important factor in seizure surgery.

Gilles de la Tourette's syndrome Effects of stimulant drugs

We reviewed the medication histories in 200 children with Gilles de la Tourettes syndrome to investigate how frequently CNS stimulants may unmask a latent syndrome or worsen existing tics. Forty-eight patients had received stimulant drugs. Nine were treated before the onset of tics, but only four were still receiving stimulants when tics began. In 39 patients with preexisting tics, stimulants increased tics in 11, caused no change in 26, and decreased tics in 2. Behavior improved in 22 patients. Thirteen of these 22 had no increase in tics when stimulants were used. Cautious trials of stimulant therapy may benefit some patients with this syndrome.

Quantitative Analysis of Seizure Frequency 1 Week and 6, 12, and 24 Months After Surgery of Epilepsy

Summary: We made quantitative analysis of seizure frequency 1 week and 6, 12, and 24 months after seizure surgery. Seizure recurrence was significantly higher when seizures occurred in the first postoperative week. Seizure recurrence increased progressively with longer follow‐ups, but the 6 month postoperative follow‐up period was an excellent index of long‐term outcome. In operative follow‐up studies, seizure frequency should be reported at fixed follow‐up periods, e.g., at 6 months and 1, 2, 5, and 10 years. Meaningful comparison of outcomes between different studies is possible only when reports include outcome at fixed postoperative follow‐up periods (as opposed to ranges of follow‐up periods).

Four dichotic speech tests before and after temporal lobectomy

Thirty patients were tested with four dichotic speech tests before and after temporal lobectomy for control of intractable seizures. Ipsilateral ear scores improved on all tests postoperatively; these improved scores reached statistical significance for the Staggered Spondaic Word Test and for consonant-vowel syllables. This result, combined with a nonsignificant decrease for contralateral ear scores, produced postoperative increase in the ipsilateral minus contralateral ear difference scores, similar to previous literature. Preoperative tests for a larger group of patients showed significantly poorer performance than for normal subjects, for all four tests. Total correct scores, used as a measure of overall auditory processing capacity, were impaired for these patients, but unchanged or slightly improved after surgery.