F. Marossero

Interictal acute psychoses in temporal lobe epilepsy during withdrawal of anticonvulsant therapy.

Acute interictal psychotic attacks during withdrawal of medication are described in two patients with temporal lobe epilepsy submitted to depth EEG study with a view to surgical treatment. The patients were on chronic treatment with clonazepam associated in one with phenobarbitone and in the other with phenobarbitone plus carbamazepine. Our observations suggest that the acute withdrawal of clonazepam, the plasma levels of which were monitored may play a part in producing psychotic attacks characterised by dysphoric manifestations, irritability, aggressiveness, anxiety, and hallucinations. These symptoms could be interpreted as a withdrawal syndrome.

Late results of stereotactic radiofrequency lesions in epilepsy.

Thirty-five patients with partial complex seizures and two patients with generalized epilepsy were treated by stereotactic radiofrequency lesions. Follow-up from 2 to 13 years was available in 30 patients. The stereotactic targets in patients with partial complex seizures were: a) Amygdala; b) Ammons horns; c) parahippocampal gyrus; d) Fornix. Depending on scalp EEG and depth electrode studies, each patient had one or more target coagulated, unilaterally or bilaterally. In the 2 cases of generalized epilepsy, bilateral Forel field lesions were performed. Late surgical results are discussed in relation to the depth EEG studies and the number and site of stereotactic lesions.

Primary cultures of human caudate nucleus

It is possible to grow functional primary dissociated cultures and explants from stereotactic biopsies of human parkinsonian caudate nuclei. Two major classes of cells were identified on morphological grounds. The culture cells appear to be stimulated by an unidentified soluble factor(s) obtained from human fetal neuronal cells in vitro. Culture of primary neuronal and glial cells from human adult cerebral nuclei seems to be a useful tool for several research purposes and in particular for studying both trophic factor action and target effects on afferent neurons for prospective human brain grafting.

Differences between the concentrations of antiepileptic drugs in normal and pathological human brain

SummaryThe concentrations of antiepileptic drugs in histologically normal and pathological brain tissues were investigated in 6 patients submitted to surgery. No significant difference for phenobarbital and phenytoin was found between normal and scar tissue, whereas there was a trend to concentration in tumour tissue (meningioma and glioma) of phenobarbital, phenytoin and carbamazepine. Alteration in the vascular supply and pathological changes at cellular and subcellular levels could be responsible for the differences in the distribution of the drugs. The possible clinical relevance of the preferential concentration of the drugs in tumour tissue is discussed.

Chronic depth electrodes study of one case of bitemporal epilepsy due to glial tumour. Some physiopathological considerations.

SummaryThe authors describe a seventeen-years-old girl suffering from partial seizures with complex symptomatology. The neuroradiological studies demonstrated a slow-growing glial tumour seated deeply in the right temporo-occipital region. Scalp EEG demonstrated a bilateral asynchronous temporal focus without definite lateralization. Chronic depth electrodes recording allowed identification of a primary epileptogenic area in the right rhinencephalic structures. Radiofrequency lesions performed in the right amygdala and anterior third of right Ammons horn abolished the seizures at ten months follow up.

Stereo-EEG and Surgery in Partial Epilepsy with Temporo-Parieto-Occipital Foci

Six cases of partial epilepsy operated on for lesions at the temporo-parieto-occipital junction are presented. Three cases had signs of enlargement of one lateral ventricle at the temporo-parieto-occipital carrefour, three had a lateral homonymous hemianopsia and all showed lateralizing interictal EEG abnormalities. The manifold features of the seizures could not be related to the involvement of one or more definite cortical areas. Since clinical, radiological, scalp EEG investigations provided no sufficient data to map the epileptogenic lesion to be excised, stereo-EEG studies with chronic depth electrodes were performed. Besides permitting the exact delimitation of the epileptogenic lesion, depth EEG gave the clue for interpreting physiopathological mechanisms underlying the electroclinical seizures in each case.

Multifocal Epilepsy: Surgical Treatment after Stereo-EEG Study

The term “multifocal epilepsy” has not been clearly defined. “Multifocal epilepsy” includes all cases of partial epilepsy with multiple independent electrical foci, either unilateral or bilateral (Marossero et al. 1975).

Depth-EEG in Stereotactic Biopsy

This paper presents the results of the use of depth electrode mapping of EEG signals in and around the lesions to be biopsied in 40 patients. The correlation between histological findings and depth-EEG patterns are discussed. Special emphasis is placed on cases with hypodense CT lesions which were usually large and confined to one or more cerebral lobes, did not enhance with contrast media, were angiographically silent, and manifested clinically with occasional epileptic fits.