Jorge G. Burneo

Effect of epilepsy magnetic source imaging on intracranial electrode placement

Intracranial electroencephalography (ICEEG) with chronically implanted electrodes is a costly invasive diagnostic procedure that remains necessary for a large proportion of patients who undergo evaluation for epilepsy surgery. This study was designed to evaluate whether magnetic source imaging (MSI), a noninvasive test based on magnetoencephalography source localization, can supplement ICEEG by affecting electrode placement to improve sampling of the seizure onset zone(s).

A prospective study of the incidence of the purple glove syndrome.

Summary: u2002Purpose: Phenytoin (PHT) has been widely used intravenously for the treatment of seizures since 1956, and for many years, it has been considered first‐line therapy for status epilepticus. It is routinely administered intravenously in emergency departments and hospitals for patients who have had isolated seizures and for many patients undergoing neurosurgical procedures who are unable to receive oral medication. Adverse reactions from PHT have been widely studied for years, but in the past decade, new adverse reactions have been identified. One of these adverse reactions is the purple glove syndrome (PGS), characterized by edema, discoloration, and pain distal to the site of i.v. administration of PHT. Because there have been no prospective reports of the incidence of PGS, the objective of the study was to report the incidence of this syndrome.

Adult‐onset Neuronal Ceroid Lipofuscinosis (Kufs Disease) with Autosomal Dominant Inheritance in Alabama

∗Jorge G. Burneo, †Thomas Arnold, ‡Cheryl A. Palmer, ∗Ruben I. Kuzniecky, §Shin J. Oh, and ∗Edward Faught ∗UAB Epilepsy Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama; †Department of Neurology, Semmes-Murphy Clinic, Memphis, Tennessee; ‡Department of Pathology, and §Division of Neuromuscular Diseases, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama

Magnitude of the placebo effect in randomized trials of antiepileptic agents

Placebo-controlled randomized trials ideally produce unbiased estimates of the treatment effect after accounting for nonpharmacological effects (regression to the mean, Hawthorne, and placebo effects). Recognizing that the magnitude of these effects may help understand why investigators need to control for them, we sought to measure this magnitude. We reviewed published meta-analyses of randomized, placebo-controlled add-on trials of antiepileptic medications versus placebo, included in the Cochrane Library. In randomized trials of antiepileptic agents for epilepsy, 9.3-16.6% of patients in the placebo arm had a >50% reduction in seizure frequency. This effect represents 20-50% of the effect observed with active agents. Because patients with epilepsy in the placebo arm of randomized trials experience a large clinical benefit due to nonpharmacological effects, randomized controlled trials are necessary to gauge the true magnitude of the treatment effect of new antiepileptic agents.

Chronic temporal lobe epilepsy: spatial extent and degree of metabolic dysfunction studied with magnetic resonance spectroscopy (MRS)

INTRODUCTIONnProton magnetic resonance spectroscopy ((1)H MRS) has been proposed as a lateralizing method for the presurgical evaluation of patients with medically intractable temporal lobe epilepsy (TLE). Studies have shown correlations between temporal lobe (TL) NAA and seizure frequency, and TL NAA/Cr and the duration of epilepsy in patients with TLE. This latter finding may suggest that progressive neuronal dysfunction may occur in both temporal lobes in patients with TLE, even when the seizures originate in only one temporal lobe. We analyzed our data in an attempt to find a possible correlation between extension of neuronal dysfunction based on NAA measures and duration of epilepsy.nnnMETHODSnWe studied 45 consecutive patients with the diagnosis of TLE, who were referred for presurgical evaluation. Duration of epilepsy was defined as the interval between the age of seizure onset and the time of the MRS examination. All studies were performed in the inter-ictal state, prior to intracranial monitoring or resection. We performed two-tailed Pearson correlation analysis between ipsilateral NAA/Cr and extension of the abnormality (voxels involved) and the duration of the seizure disorder in years.nnnRESULTSnThe average duration of epilepsy in this group was 20 years. No significant correlation was found between duration of epilepsy and mean hippocampal NAA/Cr (r=-.131, p=.390); nor was a correlation found between duration of epilepsy in years or the extent of metabolic lesion (voxels involved) (r=-.264, p=.079).nnnCONCLUSIONSnHippocampal NAA/Cr does not correlate with duration of epilepsy in TLE. Our findings suggest that cross-sectional group measures of hippocampal neuronal function do not suggest damage progression.

Ictal Single-Photon Emission Computed Tomography Imaging in Extra Temporal Lobe Epilepsy Using Statistical Parametric Mapping

Purpose. To examine the application of statistical parametric mapping (SPM) to analyze ictal single‐photon emission computed tomography (SPECT) scans in surgical candidates with extratemporal lobe epilepsy. Methods. The authors selected patients who underwent successful ictal SPECT acquisition in the process of surgical treatment of intractable partial epilepsy. Thirteen patients were identified who met inclusion criteria for confident seizure localization from either intracranial electroencephalogram recordings or epilepsy surgery outcome. In these cases, ictal scans were registered to an in‐house‐developed normal SPECT atlas composed of 14 spatially normalized brains of normal subjects. SPM96 was used to test on a voxel‐by‐voxel basis for statistically significant increases in blood flow associated with each patients ictal scan. The results were then mapped back onto the patients magnetic resonance image (MRI) for final interpretation. Statistical parametric mapping (SPM) analysis of ictal SPECT scans was compared to both conventional visual interpretation and the analysis of subtraction ictal SPECT co‐registered to MRI (SISCOM). Results. Ten of 13 patient scans showed localizing focal ictal increases in regional cerebral blood flow, all of which were concordant with ultimate epilepsy localization. Of the 3 cases not localized with SPM, 1 was localized by conventional visual interpretation and another, not localized by visual interpretation, was correctly localized with SISCOM. Two cases not localized by SISCOM were localized by both visual and SPM analysis. Conclusions. This work provides supportive evidence for proof of principle that SPM can be used to provide objective, accurate analysis of ictal SPECT scans in patients with extratemporal lobe epilepsy.

Cerebral venous thrombosis due to protein S deficiency in pregnancy

patients with cerebral haemorrhage. Our case is distinct, since the protein S deficiency-induced CVT occurred in early pregnancy, not the usual prothrombotic period. Therefore, we suspected a clotting abnormality, for which low-molecular-weight heparin was well tolerated and effective. This form of heparin offers several advantages over continuous infusion heparin or oral warfarin. All three treatments reduce the size of a thrombus and prevent recurrent thromboembolic episodes, but lowmolecular-weight heparin does not cross the placenta and may avoid the teratogenic side-effects. The subcutaneous route of administration is far more convenient than continuous infusions of heparin.

Sonko-Nanay and epilepsy among the Incas.

The ancient American Inca culture was characterized by great cultural and organizational achievements. Medicine was also highly developed and epilepsy was a well-recognized disorder. Spanish chroniclers have given insightful accounts of the native point of view. Sonko-Nanay, a term that possibly refers to an epileptic event, is discussed in this article.

Neurocysticercosis: an unusual presentation of a rare disease.

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