Omkar N. Markand

Temporal Lobe Epilepsy Surgery: Outcome, Complications, and Late Mortality Rate in 215 Patients

Summary: u2002Purpose: We studied the surgical outcome, complications, and the late mortality rate in a large group of patients with medically refractory temporal lobe epilepsy (TLE).

Presenting the diagnosis of pseudoseizure.

Simultaneous video-EEG monitoring has allowed pseudoseizures to be effectively diagnosed. Discussing the results of the monitoring with the patient is the 1st step in treatment. We outline a protocol for presenting the diagnosis of pseudoseizure with the goal of conveying to the patient the importance of knowing the nonepileptic nature of the spells and the need for psychiatric follow-up. The protocol also allows elicitation of a sexual abuse history and the use of suggestion to aid in controlling the pseudoseizures.

Health‐Related Quality of Life Outcome in Medically Refractory Epilepsy Treated with Anterior Temporal Lobectomy

Summary: Purpose: A prospective study to investigate health‐related quality of life (HRQOL) outcome in patients with temporal lobe epilepsy treated with anterior temporal lobectomy (ATL).

Longitudinal follow-up in 145 patients with medically refractory temporal lobe epilepsy treated surgically between 1984 and 1995

Summary: Purpose: There are few studies of prolonged longitudinal follow‐up after temporal resections.

Electrophysiologic evaluation of diaphragm by transcutaneous phrenic nerve stimulation

Phrenic nerve function was evaluated by transcutaneous stimulation in the neck and recording the diaphragmatic potential from surface electrodes placed at the ipsilateral seventh intercostal space (7CS) and the xiphoid process (XP). Simultaneous recordings from 7CS and XP electrodes connected together (XP-7CS) and each connected to a remote reference (knee-7CS and knee-XP) disclosed that the 7CS electrode was always more active and showed electropositive activity, whereas the XP electrode, which was only minimally active, showed electronegative response. Out-of-phase summation of opposite polarity activity at the two electrodes resulted in a higher amplitude response in XP-7CS derivation. Phrenic nerve studies are useful in establishing phrenic nerve injury following cardiothoracic operation. They may also provide evidence of phrenic nerve or diaphragmatic involvement in demyelinative neuropathies, motor neuron disease, and muscular dystrophies.

Temporal lobe epilepsy: analysis of patients with dual pathology

Objectives – To determine the frequency and types of dual pathology in patients with temporal lobe epilepsy (TLE) and to analyze the clinical manifestations and surgical outcome.

Monitoring of multimodality evoked potentials during open heart surgery under hypothermia.

Multimodality evoked responses (ERs) were monitored in 16 adults who had cardiac surgery under cardiopulmonary bypass and moderate hypothermia (19-25 degrees C). Cooling affected all sensory ERs by progressively increasing the latencies of the major components. The effect was more profound on the later than on the earlier ER components. Visual evoked responses (VERs) were most inconsistent and always disappeared at temperatures below 25 degrees C. The later components of the long latency somatosensory evoked responses (SERs) also attenuated or disappeared rather early during hypothermia. On the other hand, short latency SERs were more resistant to the effects of hypothermia. They were always recordable at temperatures of 25 degrees C or above; and usually persisted even at temperatures between 20 and 25 degrees C. Brain-stem auditory evoked responses (BAERs) were consistently present at temperatures above 25 degrees C, wave V was recordable in majority between 20 and 25 degrees C. All sensory ERs disappeared with severe hypothermia (20 degrees C or less) except the components generated more peripherally such as N10 of the short latency SERs. We feel that BAERs and short latency SERs may serve as useful intraoperative monitors of brain function during hypothermia.

Temporal lobe epilepsy: analysis of failures and the role of reoperation.

Purpose – To analyze failures and reoperations in temporal lobe epilepsy (TLE), and compare these patients with those seizure‐free, and to determine any significant differences between the groups.

Postoperative Phrenic Nerve Palsy in Patients with Open-Heart Surgery

We prospectively studied patients undergoing open-heart surgical procedures to evaluate the role of phrenic nerve palsy in the causation of the high incidence of pulmonary complications reported in these patients. Although atelectasis, or infiltrates, or both developed in the left lower lobe of 98% of the patients (43 of 44) with or without similar changes on the right side, only 5 (11%) of the 44 patients had diaphragmatic dysfunction following operation. In 1, the left phrenic nerve became inexcitable; 2 had paresis of the left hemidiaphragm, and 2 had paresis of the right hemidiaphragm. Although damage to the phrenic nerve can occur during open-heart operations, a relatively low incidence of this complication does not support it as the major cause of postoperative pulmonary complications.

Single photon emission computed tomography (SPECT) brain imaging using N,N,N′‐trimethyl‐N′‐(2 hydroxy‐3‐methyl‐5–123Iiodobenzyl)‐1,3‐propanediamine 2 HCl (HIPDM) Intractable complex partial seizures

HIPDM-SPECT brain imaging was performed in four patients with intractable complex partial seizures (CPS). Three patients had an epileptogenic focus in one temporal lobe and underwent anterior temporal lobectomy. Interictal HIPDM-SPECT demonstrated decreased regional cerebral perfusion (rCP) in the epileptogenic area in only one patient, but ictal studies showed increased rCP in the epileptic foci of all three patients. In the fourth patient, interictal HIPDM-SPECT showed increased rCP in the area of epileptogenic focus; when antiepileptic medication was taken, rCP decreased. HIPDM-SPECT brain imaging is useful for localizing epileptogenic foci in CPS.