139 Epileptic Seizures and Ability to Work in Cavernous Angioma Located Within Eloquent Brain Areas

Abstract BACKGROUND The postoperative outcomes and the predictors of seizure control are poorly studied for supratentorial cavernous angiomas (CA) within or close to the eloquent brain area. OBJECTIVE To assess the predictors of preoperative seizure control, postoperative seizure control, and postoperative ability to work, and the safety of the surgery. METHODS Multicenter international retrospective cohort analysis of adult patients benefitting from a functional-based surgical resection with intraoperative functional brain mapping for a supratentorial CA within or close to eloquent brain areas. RESULTS A total of 109 patients (66.1% women; mean age 38.4 ± 12.5 yr), were studied. Age >38 yr (odds ratio [OR], 7.33; 95% confidence interval [CI], 1.53-35.19; P = .013) and time to surgery > 12 mo (OR, 18.21; 95% CI, 1.11-296.55; P = .042) are independent predictors of uncontrolled seizures at the time of surgery. Focal deficit (OR, 10.25; 95% CI, 3.16-33.28; P < .001) is an independent predictor of inability to work at the time of surgery. History of epileptic seizures at the time of surgery (OR, 7.61; 95% CI, 1.67-85.42; P = .003) and partial resection of the CA and/or of the hemosiderin rim (OR, 12.02; 95% CI, 3.01-48.13; P < .001) are independent predictors of uncontrolled seizures postoperatively. Inability to work at the time of surgery (OR, 19.54; 95% CI, 1.90-425.48; P = .050), Karnofsky Performance Status ≤ 70 (OR, 51.20; 95% CI, 1.20-2175.37; P = .039), uncontrolled seizures postoperatively (OR, 105.33; 95% CI, 4.32-2566.27; P = .004), and worsening of cognitive functions postoperatively (OR, 13.71; 95% CI, 1.06-176.66; P = .045) are independent predictors of inability to work postoperatively. CONCLUSION The functional-based resection using intraoperative functional brain mapping allows safe resection of CA and the peripheral hemosiderin rim located within or close to eloquent brain areas.

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Neuronal Hyperexcitability and Reduction of GABAA-Receptor Expression in the Surround of Cerebral Photothrombosis

Journal of Cerebral Blood Flow & Metabolism ◽

10.1097/00004647-199609000-00014 ◽

1996 ◽

Vol 16 (5) ◽

pp. 906-914 ◽

Cited By ~ 216

Author(s):

Klaus Schiene ◽

Claus Bruehl ◽

Karl Zilles ◽

Meishu Qu ◽

Georg Hagemann ◽

...

Keyword(s):

Gabaa Receptor ◽

Rose Bengal ◽

Sensorimotor Cortex ◽

Neuronal Excitability ◽

Epileptic Seizures ◽

Receptor Expression ◽

Aminobutyric Acid ◽

Brain Areas ◽

Series Of Experiments ◽

The Rose

Changes of neuronal excitability and γ-aminobutyric acid (GABAA)-receptor expression were studied in the surround of photothrombotic infarcts, which were produced in the sensorimotor cortex of the rat by using the rose bengal technique. In a first series of experiments, multiunit recordings were performed on anesthetized animals 2–3 mm lateral from the lesion. Mean discharge frequency was considerably higher in recordings from lesioned animals (>100 Hz in the first postlesional week) compared with control animals (mean, 15 Hz). These alterations were already present after 1 day but were most pronounced 3 to 7 days after lesion induction. Thereafter the hyperexcitability declined again, although it remained visible up to 4 months. In a second series of experiments, the GABAA-receptor expression was studied autoradiographically. This revealed a reduction of GABAA receptors in widespread brain areas ipsilateral to the lesion. The reduction was most pronounced in the first days after lesion induction and declined with longer intervals. It is concluded that cortical infarction due to photothrombosis leads to a long-lasting and widespread reduction of GABAA-receptor expression in the surround of the lesion, which is associated with an increased neuronal excitability. Such alterations may be responsible for epileptic seizures that can be observed in some patients after stroke and may contribute to neurologic deficits after stroke.

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Social Worker, Therapist for Systemic Therapy, 13 years’ experience, Germany

Non-Epileptic Seizures in Our Experience ◽

10.1093/med/9780190927752.003.0052 ◽

2020 ◽

pp. 147-148

Author(s):

Markus Reuber ◽

Gregg H. Rawlings ◽

Steven C. Schachter

Keyword(s):

Social Worker ◽

Systemic Therapy ◽

Epileptic Seizures ◽

Counseling Center ◽

Disabled People ◽

Ability To Work ◽

Pension Insurance ◽

The Social ◽

Epilepsy Center ◽

The Way

This chapter focuses on the experience of a social worker with patients with Non-Epileptic Seizures. It specifically considers one client who had been given the diagnosis of epilepsy after her first attack. In addition, she had become depressed, a second serious diagnosis. She was sent to the counseling center to learn how to cope with her disease and for the social worker to help her find work. However, the pension insurance and the epilepsy center came to different conclusions about the patient’s ability to work. The social worker then accompanied the patient to the job center, which brought the patient emotional relief. Several months later, the patient’s invalidity pension was granted. This cleared the way for her integration into a workshop for disabled people.

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Surgical resection of cavernous angioma located within eloquent brain areas: International survey of the practical management among 19 specialized centers

Seizure ◽

10.1016/j.seizure.2019.03.022 ◽

2019 ◽

Vol 69 ◽

pp. 31-40 ◽

Cited By ~ 6

Author(s):

Marc Zanello ◽

Bernhard Meyer ◽

Megan Still ◽

John R. Goodden ◽

Henry Colle ◽

...

Keyword(s):

Surgical Resection ◽

Cavernous Angioma ◽

International Survey ◽

Brain Areas ◽

Practical Management

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Electric Stimulation of Ear Reduces the Effect of Toll-Like Receptor 4 Signaling Pathway on Kainic Acid-Induced Epileptic Seizures in Rats

BioMed Research International ◽

10.1155/2018/5407256 ◽

2018 ◽

Vol 2018 ◽

pp. 1-11 ◽

Cited By ~ 6

Author(s):

En-Tzu Liao ◽

Yi-Wen Lin ◽

Chun-Ping Huang ◽

Nou-Ying Tang ◽

Ching-Liang Hsieh

Keyword(s):

Protein Kinase ◽

Signaling Pathway ◽

Kainic Acid ◽

Epileptic Seizure ◽

Electric Stimulation ◽

Epileptic Seizures ◽

Toll Like Receptor ◽

Toll Like Receptor 4 ◽

Brain Areas

Epilepsy is a common clinical syndrome with recurrent neuronal discharges in the temporal lobe, cerebral cortex, and hippocampus. Clinical antiepileptic medicines are often ineffective or of little benefit in 30% of epileptic patients and usually cause severe side effects. Emerging evidence indicates the crucial role of inflammatory mediators in epilepsy. The current study investigates the role of toll-like receptor 4 (TLR4) and its underlying mechanisms in kainic acid- (KA-) induced epileptic seizures in rats. Experimental KA injection successfully initiated an epileptic seizure accompanied by increased expression of TLR4 in the prefrontal cortex, hippocampus, and somatosensory cortex. In addition, calcium-sensitive phosphorylated Ca2+/calmodulin-dependent protein kinase II (pCaMKIIα) increased after the initiation of the epileptic seizure. Furthermore, downstream-phosphorylated signal-regulated kinase (ERK), c-Jun NH2-terminal protein kinase (JNK), and p38 kinase simultaneously increased in these brain areas. Moreover, the transcriptional factor phosphorylated nuclear factor-κB (pNF-κB) increased, suggesting that nucleus transcription was affected. Furthermore, the aforementioned molecules decreased by an electric stimulation (ES) of either 2 Hz or 15 Hz of the ear in the three brain areas. Accordingly, we suggest that ES of the ear can successfully control epileptic seizures by regulating the TLR4 signaling pathway and has a therapeutic benefit in reducing epileptic seizures.

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