Fentanyl-induced electrocorticographic seizures in patients with complex partial epilepsy

1992 ◽  
Vol 77 (2) ◽  
pp. 201-208 ◽  
Author(s):  
René Tempelhoff ◽  
Paul A. Modica ◽  
Kerry L. Bernardo ◽  
Isaac Edwards
Keyword(s):  
Temporal Lobe ◽  
Seizure Activity ◽  
Epileptiform Activity ◽  
Temporal Lobectomy ◽  
Electrode Arrays ◽  
Complex Partial Seizures ◽  
Content Type ◽  
Temporal Lobe Seizures ◽  
Eeg Recordings ◽  
The Right

✓ Although electrical seizure activity in response to opioids such as fentanyl has been well described in animals, scalp electroencephalographic (EEG) recordings have failed to demonstrate epileptiform activity following narcotic administration in humans. The purpose of this study was to determine whether fentanyl is capable of evoking electrical seizure activity in patients with complex partial (temporal lobe) seizures. Nine patients were studied in whom recording electrode arrays had been placed in the bitemporal epidural space several days earlier to determine which temporal lobe gave rise to their seizures. The symptomatic temporal lobe was localized by correlating clinical and electrical seizure activity obtained during continuous simultaneous videotape and epidural EEG monitoring. In each patient, clinical seizures and electrical seizure activity were consistently demonstrated to arise unilaterally from one temporal lobe (four on the right, five on the left). During fentanyl induction of anesthesia in preparation for secondary craniotomy for anterior temporal lobectomy, eight of the nine patients exhibited electrical seizure activity at fentanyl doses ranging from 17.7 to 35.71 µg · kg−1 (mean 25.75 µg · kg−1). More importantly, four of these eight seizures occurred initially in the “healthy” temporal lobe contralateral to the surgically resected lobe from which the clinical seizures had been shown to arise. These findings indicate that, in patients with complex partial seizures, moderate doses of fentanyl can evoke electrical seizure activity. The results of this study could have important implications for neurosurgical centers where electrocorticography is used during surgery for the purpose of determining the extent of the resection.

Surgical management of epilepsy using epidural recordings to localize the seizure focus

1984 ◽  
Vol 60 (3) ◽  
pp. 457-466 ◽  
Author(s):  
Sidney Goldring ◽  
Erik M. Gregorie
Keyword(s):  
Temporal Lobe ◽  
Focal Epilepsy ◽  
Temporal Lobectomy ◽  
Epileptogenic Focus ◽  
Electrode Arrays ◽  
Content Type ◽  
Seizure Focus ◽  
Depth Electrodes ◽  
Sensory Evoked ◽  
Fine Print

✓ One hundred patients with focal epilepsy (44 were children) were evaluated with extraoperative electrocorticography via epidural electrode arrays. Localization of the epileptogenic focus was derived predominantly from recordings made during spontaneously occurring seizures. All resection procedures were carried out under general anesthesia. During anesthesia, the recording of sensory evoked responses made it possible to readily identify the sensorimotor region. Of the 100 patients, 72 underwent resection of an epileptogenic focus, and 33 of these were children. Those who did not have a resection either exhibited a diffuse seizure focus, failed to show an electrical seizure discharge in association with the clinical seizure, failed to have a seizure during the period of monitoring, or failed to exhibit conclusive changes for identifying a focus in the interictal record. Fifty-seven patients (29 children and 28 adults) who had a resection have been followed for between 1 and 12 years. Eighteen (62%) of the 29 children and 18 (64%) of the 28 adults enjoyed a good result. Twenty of the 100 patients reported here had temporal lobe epilepsy. They were candidates for recordings with depth electrodes to identify their focus, but they were evaluated instead with epidural recordings; the method is described. In 15 of them, a unilateral focus was identified and they underwent an anterior temporal lobectomy. Pathological changes were found in every case and, in 11 patients, the epidural recordings distinguished between a medial and a lateral focus. Ten of these patients have been followed for 9 months to 3½ years, and seven have had a good result. The observations suggest that epidural electrodes may be used in lieu of depth electrodes for identifying the symptomatic temporal lobe.

Temporal-lobe seizures with additional foci treated by resection

1975 ◽  
Vol 43 (5) ◽  
pp. 596-607 ◽  
Author(s):  
John M. Van Buren ◽  
Cosimo Ajmone Marsan ◽  
Naomi Mutsuga
Keyword(s):  
Temporal Lobe ◽  
Epileptiform Activity ◽  
Epileptic Activity ◽  
Temporal Lobectomy ◽  
Seizure Type ◽  
Content Type ◽  
Implanted Electrodes ◽  
Number Of Patients ◽  
Fine Print

✓ The authors describe the use of temporal lobectomy following careful and repeated electroencephalogram (EEG) evaluation (with implanted electrodes in otherwise unresolvable cases) in the epileptic group characterized by automatisms (psychomotor seizures) with temporal epileptiform activity complicated by EEG foci in the opposite temporal lobe or by extratemporal activity. They found that this can render a significant number of patients (between 25% and 50%) either seizure-free or with significant and useful reduction in their seizure frequency. The cure and improvement rates of cases followed up after temporal resection with or without prior study with implanted electrodes were approximately equal. However, the implanted electrodes permitted surgical treatment of certain cases which would have been rejected on the basis of evidence derived from the scalp recordings alone. Of 28 of these 34 patients with persisting EEG epileptiform activity in the postoperative period, only one had such activity in a different location in a follow-up period of 6 years. No evidence of spreading epileptic activity or appearance of “mirror foci” was seen during a follow-up period averaging 8.2 years. Seizure remission up to 15 years with eventual recurrence of the original seizure type may occur following surgical therapy. Follow-up studies of surgical epileptic treatment of less than 3 to 5 years are of doubtful value.

scholarly journals Transient Hemifacial Sensory Loss with Xerophthalmia following Temporal Lobectomy

2000 ◽  
Vol 27 (3) ◽  
pp. 251-253 ◽  
Author(s):  
Ajith J. Thomas ◽  
Kost Elisevich ◽  
Brien Smith
Keyword(s):  
Temporal Lobe ◽  
Clinical Presentation ◽  
Nasal Congestion ◽  
Temporal Lobectomy ◽  
Sensory Loss ◽  
Partial Seizures ◽  
Complex Partial Seizures ◽  
Cavernous Malformations ◽  
Greater Superficial Petrosal Nerve ◽  
The Right

Objective and importance:The occurrence of a unilateral sensory loss in the second trigeminal distribution and the inability to tear following an ipsilateral temporal lobectomy has not been noted despite a number of reports of cranial nerve compromise under similar situations.Clinical presentation:A 48-year-old woman experienced complex partial seizures over three years attributable to the presence of cavernous malformations of the right temporal lobe.Intervention:An anterior temporal extrahippocampal resection was performed. The surgery was marked by the need for electrocoagulation of the dural base of the temporal lobe where numerous bleeding points were encountered. Postoperatively, the patient experienced an ipsilateral maxillary division sensory loss, absence of tearing, and diminished nasal congestion for an eight-month period until resolution.Conclusion:Injury of the fibers of the maxillary division of the trigeminal nerve and the adjacent greater superficial petrosal nerve appears to be the cause. No prior account of such an occurrence has been published.

Epileptiform activity extinguished by amygdala infusion of the neurotoxin ibotenate in a rat model of temporal lobe epilepsy

2002 ◽  
Vol 97 (2) ◽  
pp. 450-454 ◽  
Author(s):  
John R. Pace ◽  
Russell R. Lonser ◽  
R. Duncan Kirkby ◽  
Neal Jeffries ◽  
Michael A. Rogawski ◽  
...  
Keyword(s):  
Amino Acid ◽  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Rat Model ◽  
Seizure Activity ◽  
Excitatory Amino Acid ◽  
Epileptiform Activity ◽  
Recurrent Seizure ◽  
Content Type ◽  
Fine Print

Object. The long-term antiseizure effects of local convection-enhanced infusion of the excitotoxin ibotenate were examined in a rat model of temporal lobe epilepsy. Methods. A single injection of kainate, an epileptogenic excitatory amino acid, into the left amygdala elicited chronic spontaneous recurrent seizure activity for at least 36 days after the injection. Two weeks after the injection, infusion of ibotenate, a nonepileptogenic excitatory amino acid that is an axon-sparing neuronal cell toxin, into the left amygdala and piriform lobe induced immediate and permanent extinction of electrical and behavioral seizure activity. Conclusions. Lesioning of an epileptic focus by convective distribution of ibotenate can produce an enduring suppression of seizure activity, indicating a chemical neurosurgical approach for epilepsy therapy.

Intractable epilepsy following radiosurgery for arteriovenous malformation

2001 ◽  
Vol 95 (5) ◽  
pp. 888-892 ◽  
Author(s):  
Aatif M. Husain ◽  
Melissa Mendez ◽  
Allan H. Friedman
Keyword(s):  
Intractable Epilepsy ◽  
Temporal Lobectomy ◽  
Mesial Temporal Sclerosis ◽  
Complex Partial Seizures ◽  
Content Type ◽  
Posterior Quadrant ◽  
Original Size ◽  
One Year ◽  
The Right ◽  
Fine Print

✓ Radiosurgery is often used to treat arteriovenous malformations (AVMs) located in deep brain locations. Most of these procedures are successful not only in obliterating the AVM but also in decreasing the frequency and severity of associated seizures. Although radiosurgery is occasionally associated with the development of easy-to-control seizures immediately postoperatively, there have been no reports of intractable epilepsy developing after radiosurgery. In this report, however, a case is presented in which a patient underwent gamma knife surgery (GKS) for an AVM, after which intractable epilepsy and mesial temporal sclerosis (MTS) gradually developed. A 37-year-old right-handed woman underwent GKS for a right mesial parietotemporooccipital AVM. One year later, the AVM had reduced in size, but the patient began to experience complex partial seizures (CPSs). These CPSs initially occurred at a frequency of one per month, but 6 months later they were occurring every other week. She also started having secondarily generalized tonic—clonic seizures (GTCSs) once per month. Over the next year the frequency of her seizures gradually increased to several CPSs per day and two to three GTCSs per week, despite treatment with various combinations of antiepileptic drugs. By this time her AVM had decreased to one half of its original size. Video-electroencephalography monitoring demonstrated that both the CPSs and GTCSs were arising from the right posterior quadrant. Magnetic resonance imaging revealed not only the presence of the right-sided AVM, but also right-sided MTS. The patient underwent surgical resection of the AVM and right temporal lobectomy. She has been free from seizure for longer than 1 year. Radiosurgery may be associated with intractable epilepsy and MTS.

Asymmetry of Neuronal Activity During Extracellular Microelectrode Recording from Left and Right Human Temporal Lobe Neocortex During Rhyming and Line-Matching

2000 ◽  
Vol 12 (5) ◽  
pp. 803-812 ◽  
Author(s):  
Theodore H. Schwartz ◽  
Michael M. Haglund ◽  
Ettore Lettich ◽  
George A. Ojemann
Keyword(s):  
Temporal Lobe ◽  
Neuronal Activity ◽  
Right Hemisphere ◽  
Cerebral Dominance ◽  
Firing Frequency ◽  
Hemispheric Lateralization ◽  
Temporal Lobectomy ◽  
Complex Partial Seizures ◽  
Match To Sample ◽  
The Right

Recordings of neuronal activity in humans have identified few correlates of the known hemispheric asymmetries of functional lateralization. Here, we examine single-unit activity recorded from both hemispheres during two delayed match-to-sample tasks that show strong hemispheric lateralization based on lesion effects; a line-matching (LM) task related to the right hemisphere, and a rhyming (RHY) task related to the left. Nineteen neuronal populations were recorded with extracellular microelectrodes from the left temporal neocortex of 11 awake patients, and 18 from the right in 9 patients during anterior temporal lobectomy for complex partial seizures under local anesthesia. All subjects were left hemisphere dominant for language. Twelve (32%) populations exhibited statistically significant changes in activity at p < .05. Although changes in firing frequency were recorded from both hemispheres during both tasks, the RHY task elicited changes in activity several hundred milliseconds earlier on the left side than on the right. The LM task, on the other hand, induced changes earlier on the right side than on the left. Both hemispheres contained units active during verbal responses regardless of which behavior elicited the response. Our results indicate that cerebral dominance is reflected in earlier neuronal activity in the anterior temporal lobe during tasks lateralized to that hemisphere.

Preserved musical abilities following right temporal lobectomy

1996 ◽  
Vol 85 (6) ◽  
pp. 1000-1004 ◽  
Author(s):  
Atsushi Koike ◽  
Hiroyuki Shimizu ◽  
Ichiro Suzuki ◽  
Buichi Ishijima ◽  
Morihiro Sugishita
Keyword(s):  
Standard Deviation ◽  
Temporal Lobe ◽  
Intractable Epilepsy ◽  
Sylvian Fissure ◽  
Temporal Lobectomy ◽  
Content Type ◽  
Before And After ◽  
The Right ◽  
Lines Of Evidence ◽  
Fine Print

✓ It has been widely accepted that the right temporal lobe plays a major role in the processing of music. One of the main lines of evidence was derived from Milner's study, published in 1962, which reported that right temporal lobectomy led to a decline in patient scores on four of the six subtests (Tonal Memory, Timbre, Loudness, and Time subtests) of the Seashore Measures of Musical Talents. That finding had led some surgeons and patients to hesitate in choosing right temporal lobectomy as a treatment for intractable epilepsy. The authors examined performance on the Seashore Measures before and after operations in 20 patients with right temporal lobectomy and nine patients with left temporal lobectomy. No disturbances in the Seashore Measures were detected after temporal lobectomy on either side. The extent of these temporal lobectomies was smaller than that of the temporal lobectomies in Milner's study, as measured along the sylvian fissure (1.5–4 cm; mean 2.7 cm, standard deviation (SD) 0.92 cm) and the base of the temporal lobe (3.5–5.5 cm; mean 4.7 cm, SD 0.63 cm). These findings indicate that the region resected on right temporal lobectomy in the present study is not essential for basic musical processing.

Malignant astrocytoma following radiotherapy of a craniopharyngioma

1978 ◽  
Vol 48 (4) ◽  
pp. 622-627 ◽  
Author(s):  
Richard L. Sogg ◽  
Sarah S. Donaldson ◽  
Craig H. Yorke
Keyword(s):  
Experimental Evidence ◽  
Temporal Lobe ◽  
Malignant Astrocytoma ◽  
Content Type ◽  
Suprasellar Region ◽  
The Right ◽  
Fine Print

✓ A 9-year-old schoolgirl received 6007 rads to the suprasellar region for craniopharyngioma. Five years later, a malignant astrocytoma developed in the right temporal lobe. We cite clinical and experimental evidence to support our suspicion that the glioma may have been induced by radiation.

Regional brain tissue pressure gradients created by expanding extradural temporal mass lesion

1997 ◽  
Vol 86 (3) ◽  
pp. 505-510 ◽  
Author(s):  
Christopher E. Wolfla ◽  
Thomas G. Luerssen ◽  
Robin M. Bowman
Keyword(s):  
Intracranial Pressure ◽  
Frontal Lobe ◽  
Brain Tissue ◽  
Temporal Lobe ◽  
Mass Lesion ◽  
Pressure Monitor ◽  
Tissue Pressure ◽  
Content Type ◽  
Regional Brain ◽  
The Right

✓ A porcine model of regional intracranial pressure was used to compare regional brain tissue pressure (RBTP) changes during expansion of an extradural temporal mass lesion. Measurements of RBTP were obtained by placing fiberoptic intraparenchymal pressure monitors in the right and left frontal lobes (RF and LF), right and left temporal lobes (RT and LT), midbrain (MB), and cerebellum (CB). During expansion of the right temporal mass, significant RBTP gradients developed in a reproducible pattern: RT > LF = LT > RF > MB > CB. These gradients appeared early, widened as the volume of the mass increased, and persisted for the entire duration of the experiment. The study indicates that RBTP gradients develop in the presence of an extradural temporal mass lesion. The highest RBTP was recorded in the ipsilateral temporal lobe, whereas the next highest was recorded in the contralateral frontal lobe. The RBTP that was measured in either frontal lobe underestimated the temporal RBTP. These results indicated that if a frontal intraparenchymal pressure monitor is used in a patient with temporal lobe pathology, the monitor should be placed on the contralateral side and a lower threshold for therapy of increased intracranial pressure should be adopted. Furthermore, this study provides further evidence that reliance on a single frontal intraparenchymal pressure monitor may not detect all areas of elevated RBTP.

scholarly journals Electroencephalographic Features of Temporal Lobe Epilepsy

2010 ◽  
Vol 37 (4) ◽  
pp. 439-448 ◽  
Author(s):  
Mohammed M. Jan ◽  
Mark Sadler ◽  
Susan R. Rahey
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Surgical Management ◽  
Temporal Lobe ◽  
Seizure Onset ◽  
Resective Surgery ◽  
Accurate Localization ◽  
Epileptiform Discharges ◽  
Ictal Eeg ◽  
Temporal Lobe Seizures ◽  
Eeg Recordings

Electroencephalography (EEG) is an important tool for diagnosing, lateralizing and localizing temporal lobe seizures. In this paper, we review the EEG characteristics of temporal lobe epilepsy (TLE). Several “non-standard” electrodes may be needed to further evaluate the EEG localization, Ictal EEG recording is a major component of preoperative protocols for surgical consideration. Various ictal rhythms have been described including background attenuation, start-stop-start phenomenon, irregular 2-5 Hz lateralized activity, and 5-10 Hz sinusoidal waves or repetitive epileptiform discharges. The postictal EEG can also provide valuable lateralizing information. Postictal delta can be lateralized in 60% of patients with TLE and is concordant with the side of seizure onset in most patients. When patients are being considered for resective surgery, invasive EEG recordings may be needed. Accurate localization of the seizure onset in these patients is required for successful surgical management.

Sign in / Sign up

Export Citation Format

Share Document