PSYCHIATRIC ASPECTS OF PSYCHOMOTOR EPILEPSY

Psychomotor or temporal lobe epilepsy is a frequently missed diagnosis. It is often confused with grand mal and petit mal epilepsy. At times it is the first symptom of an organic neurological disease. It is often masked as a psychiatric disorder or is associated with a mental illness without clinically detectable seizures.These psychic manifestations simulate all of the neuroses and major psychiatric states. Excitement states with amnesia may lead to violent antisocial behavior. All these manifestations may be aggravated by alcohol.Thalamic epilepsy shows itself in similar psychiatric manifestations and accounts for behavior disorder in children more than temporal lobe epilepsy. Atypical seizures with vegetative or emotional aura and a characteristic electroencephalogram differentiate it from temporal lobe epilepsy.Proper understanding of the varied manifestations, with positive electroencephalographic findings, leads to the correct diagnosis in most cases. All patients with unusual or atypical personality or psychiatric-like states should have careful electroencephalographic examination. Anticonvulsant therapy and other psychiatric treatment procedures can relieve most cases. Surgical therapy sometimes is necessary.     

Effect of EEG Biofeedback on Cognitive Flexibility in Children with Attention Deficit Hyperactivity Disorder With and Without Epilepsy

Attention deficit hyperactivity disorder (ADHD) is one of the most common developmental disorders in school-aged children. Symptoms consistent with ADHD have been observed in 8–77 % of children with epilepsy. Researchers have been motivated to search for alternative forms of treatment because 30 % of patients with ADHD cannot be treated by psychostimulants. Several studies support the use of a multimodal treatment approach that includes neurofeedback (NF) for the long-term management of ADHD. These studies have shown that NF provides a sustained effect, even without concurrent treatment with stimulants. We aimed to assess cognitive flexibility in ADHD children with and without temporal lobe epilepsy (TLE), and to evaluate the effects of NF on cognitive flexibility in these groups of children. We prospectively evaluated 69 patients with ADHD aged 9–12 years. The control group was 26 ADHD children without TLE who received no treatment. The first experimental group comprised 18 children with ADHD. The second experimental group comprised 25 age-matched ADHD children with TLE. This group was further divided in two subgroups. One subgroup comprised those with mesial temporal lobe epilepsy (16 patients, 9 with hippocampal sclerosis and 7 with hippocampal atrophy), and the other with lateral temporal lobe epilepsy (9 patients, 5 with temporal lobe dysplasia, 3 with temporal lobe cysts, and 1 with a temporal lobe cavernoma). We treated their ADHD by conducting 30 sessions of EEG NF. Reaction time and error rates on the Trail Making Test Part B were compared before and after treatment, and significant differences were found for all groups of patients except those who had mesial temporal lobe epilepsy with hippocampal atrophy. Our results demonstrate that in most cases, NF can be considered an alternative treatment option for ADHD children even if they have TLE. Additional studies are needed to confirm our results.     

Endocrine abnormalities in human temporal lobe epilepsy

Patients with temporal lobe epilepsy secrete ACTH at higher rates and in greater amounts than normal subjects. Temporal lobectomy restores ACTH secretion to normal amounts and rates. The ACTH secretion in temporal lobe epilepsy is independent of anticonvulsant drug effect and seizure frequency. Electrical stimulation of medial temporal lobe structures in patients with temporal lobe epilepsy affected ACTH secretion in a manner consistent with the hypothesis that ACTH secretion is regulated by tonic inhibition. A defect in the excitatory and/or inhibitory components of this regulatory process appears to exist in temporal lobe epilepsy.     

SCN9A基因多态与颞叶癫痫相关性

目的:探讨SCN9A基因多态与颞叶癫痫相关性。方法:搜集179例癫痫患者及正常对照组236例血样,提取全基因组DNA。聚合酶链反应-限制性片段长度多态(PCR-RFLP)、测序法检测四个标签SNPs多态性,比较两组各位点基因型和等位基因频率的差异。结果:SCN9A基因rs12620053和rs7588632位点多态在癫痫组与对照组间存在显著差异(P0.05),而rs2893013和rs4465779位点多态在癫痫组与对照组间无显著差异(P0.05)。结论:SCN9A基因rs12620053和rs7588632位点多态与癫痫易感性相关,而位点rs2893013和rs4465779与癫痫易感性无关。     

MicroRNA-134/CREB/pCREB通路在癫痫中的表达及意义

目的探讨miR-134、CREB、pCREB在癫痫大鼠海马及难治性癫痫患者颞叶脑组织中的表达及意义。方法难治性癫痫患者及非癫痫对照组颞叶组织、氯化锂-匹罗卡品癫痫大鼠及空白对照组海马组织中,应用实时荧光定量PCR技术检测microRNA-134（miR-134）的表达,用Western blot方法检测CREB及p CREB的表达,用免疫组织化学方法检测人脑颞叶皮质及大鼠海马区CREB、p CREB的表达。结果与对照组相比miR-134表达在难治性癫痫患者中明显降低（P〈0.05）,在癫痫模型组中点燃后3、7、14、60 d明显降低（P〈0.05）,1 d与30 d表达降低较对照组差异无显著性（P〉0.05）;癫痫模型组CREB在3、7、14、60 d时间点明显升高（P〈0.05）、pCREB各时间点表达均高于空白对照组（P〈0.05）。结论难治性癫痫患者颞叶皮质及癫痫动物海马中miR-134表达下降,CREB、pCREB表达升高,提示其可能在癫痫发生发展机制中起重要作用。     

Wnt/β‐catenin signalling pathway mediated aberrant hippocampal neurogenesis in kainic acid‐induced epilepsy

Temporal lobe epilepsy is a chronic disorder of nerve system, mainly characterized by hippocampal sclerosis with massive neuronal loss and severe gliosis. Aberrant neurogenesis has been shown in the epileptogenesis process of temporal lobe epilepsy. However, the molecular mechanisms underlying aberrant neurogenesis remain unclear. The roles of Wnt signalling cascade have been well established in neurogenesis during multiple aspects. Here, we used kainic acid‐induced rat epilepsy model to investigate whether Wnt/β‐catenin signalling pathway is involved in the aberrant neurogenesis in temporal lobe epilepsy. Immunostaining and western blotting results showed that the expression levels of β‐catenin, Wnt3a, and cyclin D1, the key regulators in Wnt signalling pathway, were up‐regulated during acute epilepsy induced by the injection of kainic acids, indicating that Wnt signalling pathway was activated in kainic acid‐induced temporal lobe epilepsy. Moreover, BrdU labelling results showed that blockade of the Wnt signalling by knocking down β‐catenin attenuated aberrant neurogenesis induced by kainic acids injection. Altogether, Wnt/β‐catenin signalling pathway mediated hippocampal neurogenesis during epilepsy, which might provide new strategies for clinical treatment of temporal lobe epilepsy. Temporal lobe epilepsy is a chronic disorder of nerve system, mainly characterized by hippocampal sclerosis. Aberrant neurogenesis has been shown to involve in the epileptogenesis process of temporal lobe epilepsy. In the present study, we discovered that Wnt3a/β‐catenin signalling pathway serves as a link between aberrant neurogenesis and underlying remodelling in the hippocampus, leading to temporal lobe epilepsy, which might provide new strategies for clinical treatment of temporal lobe epilepsy.     

Temporal Lobe Epilepsy: A Clinical Study of 47 Cases

Clinical features of 47 cases of temporal lobe epilepsy are analyzed and treatment of this disorder is outlined. Twenty-four per cent of all cases of epilepsy seen by one of the authors over a two-year period were of this type. Fifteen of these 47 patients had a history of birth injury. Care must be taken to distinguish the symptoms of temporal lobe epilepsy from those of acute anxiety or hysteria and to differentiate the short-lived temporal lobe attack from centrencephalic petit mal.Interictal personality disturbances were identified in 11 of 24 persons with temporal lobe epilepsy, four of 35 with focal epilepsy from all other areas, and one of 17 with centrencephalic epilepsy. Personality deviations most frequently encountered were irritability, aggressiveness, bouts of depression, paranoid tendencies and exhibitionism. Medical or surgical treatment often improves the personality abnormalities concomitantly with control of seizures.     

Gelsolin in Cerebrospinal Fluid as a Potential Biomarker of Epilepsy

Gelsolin is an actin regulatory protein that generally distributed in a wide variety of body tissues, especially the brain tissues and cerebrospinal fluid. In this study we found that lumbar CSF-gelsolin concentrations markedly decreased in epileptic patients by enzyme linked immunosorbent assay. In order to help judge the result, we determined gelsolin expression in temporal lobe tissues of patients with temporal lobe epilepsy using double-label immunofluorescence to location and using western blot to quantitation. Then we observed that gelsolin was co-expressed with microtubule-associated protein-2 in axons and cytoplasms of neurons and gelsolin protein level was also down-regulated in temporal lobe tissues of epileptic patients. Our findings suggested that CSF-gelsolin level might reflect the alteration of gelsolin in brain tissue of epileptic patients and CSF-gelsolin seems to be a potential biomarker for epilepsy.     

GABAergic modulation of the oscillatory activity in the medial septal area during epilepsy

On brain slices from healthy guinea pigs and animals with a model of chronic temporal lobe epilepsy, a comparative study of GABAergic modulation of oscillatory activity of neurons in the medial septal area was carried out. Under the action of GABA, burst activity persisted only in pacemakers in both groups of preparations. In epilepsy, the effectiveness of GABA action on the rhythmic neurons sharply increased. In the control group, GABA significantly reduced bursts frequency in cells preserving their oscillatory activity, whereas in slices from the epileptic brain burst frequency increased under the action of GABA. Blockade of GABAergic receptors led to a disruption of tonic GABAergic intraseptal influences and to a significant decrease in the effectiveness of blockers in epilepsy. The study was the first to demonstrate a dysfunction of the septal GABAergic system in temporal lobe epilepsy, which is a possible cause of a sharp change in the oscillatory properties of septal neurons. These findings contribute to elucidation of the mechanisms of temporal lobe epilepsy.     

Laboratory animal models of temporal lobe epilepsy

Temporal lobe epilepsy is a common human disease that is difficult to treat. The pathogenesis of temporal lobe epilepsy, which holds many unresolved questions, and opportunities for creating more effective treatments and preventative strategies are reviewed herein. Laboratory animal models are essential to meet these challenges. How models are created, how they compare with each other and with the disease in human patients, and how they advance our understanding of temporal lobe epilepsy are described.     

不同术式对颞叶癫痫患者术后认知功能、记忆能力以及生活质量的影响

目的:探讨不同术式对颞叶癫痫患者术后认知功能、记忆能力以及生活质量的影响。方法:选取2014年2月～2018年4月期间我院收治的103例颞叶癫痫患者为研究对象,根据随机数字表法将患者分为单侧前颞叶切除术(ATL)组(n=51,给予ATL治疗)和选择性海马杏仁核切除术(SAH)组(n=52,给予SAH治疗),比较两组患者的手术疗效、术后认知功能、记忆能力、生活质量以及并发症。结果:两组术后6个月临床总有效率比较差异无统计学意义(P0.05)。两组患者术后6个月生活质量量表各项评分均较术前升高(P0.05)。两组患者术后6个月总智商(FIQ)、语言智商(VIQ)评分均较术前升高,且SAH组高于ATL组(P0.05)。两组术后6个月优势半球侧记忆商数(MQ)评分降低,非优势半球侧MQ评分升高(P0.05);SAH组术后6个月非优势半球侧MQ评分高于ATL组(P0.05)。两组患者术后并发症发生率比较无统计学差异(P0.05)。结论:颞叶癫痫患者采用ATL、SAH术式治疗,可获得相似的治疗效果,安全性均较好,但SAH术式在保护患者的认知功能及记忆能力方面更优。     

癫痫与海马结构的改变

癫痫作为一种严重危害人类健康的常见病、多发病，其致病机理至今尚未阐明。30—60％的患者药物治疗无效，称“难治性癫痫”。随着现代医学的发展，外科手术的开展对于癫痫患者治疗也没有满意的效果。这就对于我们探求癫痫患者病灶的起源有了更深层次的要求。大量动物实验表明，海马作为中枢神经系统的重要结构不仅同学习、记忆、情绪等密切相关，还同癫痫的发生发展有着重要的联系。本文就大脑可塑性与癫痫的关系进行综述。     

Mitochondrial dysfunction in neurological disorders with epileptic phenotypes

A broad variety of mutations of the mitochondrial DNA or nuclear genes that lead to the impairment of mitochondrial respiratory chain or mitochondrial ATP synthesis have been associated with epileptic phenotypes. Additionally, evidence for an impaired mitochondrial function in seizure focus of patients with temporal lobe epilepsy and Ammon’s horn sclerosis, as well as, animal models of temporal lobe epilepsy has been accumulated. This implies a direct pathogenic role of mitochondrial dysfunction in the process of epileptogenesis and seizure generation in certain forms of epilepsy.     

Estimation by humans of signals simulating different sound movement directions and specificity of the perception of these signals by patients with temporal epilepsy

The perception of moving sound stimuli that imitate directional sound source movement was studied in healthy subjects and in patients with temporal lobe lesions, as well as in a group of patients with simultaneous lesions of the temporal cortex and hippocampus. Under the conditions of dichotic stimulation of patients with the rightor left-side foci of convulsive activity, the nature and length of the trajectories of the emerging subjective sound images (SSI) were estimated depending on the direction of movement and interaural time difference (700, 400, 200 μs). The audiograms of all patients did not differ from those of healthy subjects, suggesting that the auditory sensitivity of patients remained unimpaired. However, in the patients, the trajectories were shorter than the trajectories in healthy subjects at all the values of the initial time delay and at all the directions of SSI movements. In patients with the cortical temporal epilepsy, changes of the subjective sound field were the most significant in the case of the right-side localization of foci of the convulsive activity. In patients with simultaneous lesions of the temporal cortex and hippocampus, the averaged trajectories of SSI movement differed significantly from those in the group of healthy subjects (p < 0.01) and in patients with a relatively isolated lesion of the temporal cortex (p < 0.05); these trajectories were independent of the initial delay. The mediobasal structures of the temporal lobe that are involved in the epileptic process proved to play a significant role in the perception and estimation of the moving sound stimuli, although they do not belong to the auditory system proper. The possible mechanisms underlying disorders in patients with temporal epilepsy are discussed.     

The use of gamma-linolenic acid and linoleic acid to differentiate between temporal lobe epilepsy and schizophrenia

Three long-stay, hospitalised schizophrenics who had failed to respond adequately to conventional drug therapy were treated with gamma-linolenic acid and linoleic acid in the form of evening primrose oil. They became substantially worse and electroencephalographic features of temporal lobe epilepsy became apparent. In all three the clinical state dramatically improved when carbamazepine, the conventional therapy for temporal lobe epilepsy was introduced. It can be extremely difficult to distinguish on clinical grounds between schizophrenia and temporal lobe epilepsy, and electroencephalographic studies do not always reveal an abnormality in the temporal lobe syndrome, unless additional procedure such as sphenoidal electroencephalography is undertaken. A trial of therapy with gamma-linolenic acid may prove of considerable value in distinguishing between these two states, so allowing specific therapy to be introduced.     

基于ReHo方法的颞叶癫痫功能磁共振成像研究

癫痫是一种以神经活动同步性异常增高为特征的中枢神经系统疾病。作者利用基于局域一致性(regional homogeneity,ReHo)分析方法的功能磁共振成像技术对内侧颞叶癫痫(medial temporal lobe epilepsy,mTLE)进行了研究。观察颞叶癫痫病人相比正常对照组局域一致性的改变情况。结果表明:在静息状态下,病人大脑的局域一致性在某些脑区较正常人高,主要集中在海马、丘脑、顶叶;另外在某些脑区的局域一致性较正常人低,主要集中在小脑后叶。提示该方法可检出癫痫活动造成的局部脑组织血氧水平信号同步性的改变,进而达到对癫痫活动的定位检测。     

Proton magnetic resonance spectroscopy in patients with solitary and sporadic temporal lobe epileptic seizures

Proton magnetic resonance spectroscopy (¹H MRS) is an optional diagnostic method for potential epilepsy surgery candidates. The aim of this study was to determine the credibility of ¹H MRS examination in a group of patients suffering from solitary and sporadic epileptic seizures generated in temporal lobe. We recorded a 100% sensitivity of ¹H MRS in a group of ten patients in terms of detection of a pathological process in the temporal lobe. ¹H MRS also enabled determination of lateralization of the pathological process in three patients with bilateral epileptiform abnormalities on electroencephalography. Based on these results we suggest new perspectives on ¹H MRS as a part of standard diagnostic algorithm for solitary and sporadic temporal lobe epileptic seizures, particularly in cases with normal electroencephalography and magnetic resonance imaging findings.     

A Mesiotemporal Lobe Epilepsy Mouse Model

Among the different forms of epilepsies, mesiotemporal lobe epilepsy (MTLE) is one of the most common and represents the main pharmaco-resistant form of epilepsy. There is therefore an urgent need to better understand this form of epilepsy to develop better anti-epileptic drugs. Many rodent models are mimicking some aspects of the human temporal lobe epilepsy but only few are addressing most of the human mesiotemporal lobe epilepsy. In this article, we describe the main characteristics of a mouse of model of mesial temporal lobe epilepsy. This model is generated by a single injection of kainic acid into the dorsal hippocampus which reproduces most of the morphological and electrophysiological features of human MTLE in a mouse. This model may help to better understand mesial temporal lobe epilepsy and the development of new therapeutic drugs.     

Recognition memory: what are the roles of the perirhinal cortex and hippocampus?

The hallmark of medial temporal lobe amnesia is a loss of episodic memory such that patients fail to remember new events that are set in an autobiographical context (an episode). A further symptom is a loss of recognition memory. The relationship between these two features has recently become contentious. Here, we focus on the central issue in this dispute--the relative contributions of the hippocampus and the perirhinal cortex to recognition memory. A resolution is vital not only for uncovering the neural substrates of these key aspects of memory, but also for understanding the processes disrupted in medial temporal lobe amnesia and the validity of animal models of this syndrome.