Surgical Management of Epilepsy

Therapy with anticonvulsant drugs reduces the frequency and severity of seizures in many but not all epileptic patients. Unfortunately, in a significant number control remains poor even when maximal doses of multiple anticonvulsant drugs are given. Some of these patients are candidates for surgical treatment of epilepsy. The operative management of convulsive disorders is a well-established technique and is available in some centers. In selected cases, such operations are both safe and effective, with good longterm improvement or complete control in 76 percent of patients. We have summarized the 24-year experience with surgical operation for epilepsy at the University of Washington Medical Center.     

The origin of protein and fatty yolk in Rana pipiens. III. Intramitochondrial and primary vesicular yolk formation in frog oocytes.

The precise origin of the primary yolk precursor complex or primary vesicular yolk is obscure but in its earliest recognizable stage it is a typical multivesicular body which first acquires a moderately electron-dark matrix. Following this, an extremely electron-dark amorphous material, the yolk protein, appears within the precursor. This yolk protein increases in amount as the yolk vesicle grows and by the time the precursors are about 1 micrometer in diameter this protein is partly to almost completely crystalline. Yolk originating within mitochondrial cristae unlike that in the yolk precursor complexes is crystalline from its earliest appearance. Intracristae mitochondrial yolk crystals have a spacing of 70--85 A. Their molecular organization appears in some sections as electron-dark lamellae and in others as light cylinders surrounded by an electron-dark matrix.     

Thermophilic methanogenesis in a hot-spring algal-bacterial mat (71 to 30 degrees C).

Algal-bacterial mats which grow in the effluent channels of alkaline hot springs provided an environment suitable for studying natural thermophilic methane producing bacteria. Methane was rapidly produced in cores taken from the meat and appeared to be an end product of decomposition of the algal-bacterial organic matter. Formaldehyde prevented production of methane. Initial methanogenic rate was lower and methanogenesis became exponential when samples were permitted to cool before laboratory incubation. Methanogenesis occurred and methanogenic bacteria were present over a range of 68 to 30 degrees C, with optimum methanogenesis near 45 degrees C. The temperature distribution of methanogenesis in the mat is discussed relative to published results on standing crop, primary production, and decomposition in the thermal gradient. The depth distribution of methanogenesis was similar to that of freshwater sediments, with a zone of intense methanogenesis near the mat surface. Methanogenesis in deeper mat layers was very low or undetectable despite large numbers of viable methanogenic bacteria and could not be stimulated by addition of anoxic source water, sulfide, or a macronutrient solution.     

Relationship of chin spot size to dominance in the black-chinned mouthbrooding cichlid fish (Sarotherodon melanotheron)

Aggressive interactions of male Sarotherodon melanotheron were studied to determine the communicative value of chin spot size in relation to dominance. In addition, the effects of residency and size on the aggressiveness of this fish were determined. Two-factor analysis of variance was used for frequencies of each modal action pattern for residency and size. Results show that residency played a major role in the outcome of an aggressive interaction, whereas size had little effect. Dominance of each experimental fish was calculated using Barlow & Ballin's (1976) dominance index. A chin spot ratio was obtained by dividing the chin spot area by the total surface area of the individual fish. Simple linear regression was conducted to determine if dominance and chin spot size were correlated and a positive linear relationship was found to exist between the two variables.     

Asymmetries in oriented-line detection indicate two orthogonal filters in early vision.

Visual detection of a line target differing in orientation from a background of lines may be achieved speedily and effortlessly. Such performance is assumed to occur early in vision and to involve filter mechanisms acting in parallel over the visual field. This study establishes orientational limits on this performance and analytically derives some generic properties of the underlying filters. It was found that, in brief displays, target orientation detection thresholds increased approximately linearly with background orientation, from minima at 0 degree (vertical) and 90 degrees, whereas background orientation detection thresholds decreased approximately linearly with target orientation, from maxima at 0 degree and 90 degrees. Target and background threshold functions were exactly antisymmetric. These data are shown to indicate a model of early line processing dominated by two classes of orientation-sensitive filter with axes close to the vertical and horizontal and orientation-tuning half-widths each of approximately 30 degrees at half-height.     

Effect of phrenic afferent stimulation on pattern of respiratory muscle activation.

Ventilation and electromyogram (EMG) activities of the right hemidiaphragm, parasternal intercostal, triangularis sterni, transversus abdominis, genioglossus, and alae nasi muscles were measured before and during central stimulation of the left thoracic phrenic nerve in 10 alpha-chloralose anesthetized vagotomized dogs. Pressure in the carotid sinuses was fixed to maintain baroreflex activity constant. The nerve was stimulated for 1 min with a frequency of 40 Hz and stimulus duration of 1 ms at voltages of 5, 10, 20, and 30 times twitch threshold (TT). At five times TT, no change in ventilation or EMG activity occurred. At 10 times TT, neither tidal volume nor breathing frequency increased sufficiently to reach statistical significance, although the change in their product (minute ventilation) was significant (P less than 0.05). At 20 and 30 times TT, increases in both breathing frequency and tidal volume were significant. At these stimulus intensities, the increases in ventilation were accompanied by approximately equal increases in the activity of the diaphragm, parasternal, and alae nasi muscles. The increase in genioglossus activity was much greater than that of the other inspiratory muscles. Phrenic nerve stimulation also elicited inhomogeneous activation of the expiratory muscles. The transversus abdominis activity increased significantly at intensities from 10 to 30 times TT, whereas the activity of the triangularis sterni remained unchanged. The high stimulation intensities required suggest that the activation of afferent fiber groups III and IV is involved in the response. We conclude that thin-fiber phrenic afferent activation exerts a nonuniform effect on the upper airway, rib cage, and abdominal muscles and may play a role in the control of respiratory muscle recruitment.     

Tolerance and upregulation of acetylcholine receptors follow chronic infusion of d-tubocurarine.

The hypothesis that chronic competitive antagonism of nicotinic acetylcholine receptors (nAChR), even in the absence of immobilization or paralysis, induces proliferation of the receptor and tolerance to the competitive antagonist was tested. Chronic antagonism of the nAChR was achieved in rats by an infusion of d-tubocurarine (dTC) via subcutaneously placed osmotic pumps. After 2 wk of dTC or saline, the neuromuscular pharmacodynamics and nAChR number were examined. No differences in weight gain or mobility were observed between groups. Chronic dTC infusion at 2 wk resulted in a baseline concentration of 0.41 +/- 0.07 (SE) micrograms/ml, which, if achieved acutely, would cause a depression of the twitch tension to 60% of control twitch height. Moreover the experimental group was able to develop a baseline twitch tension of 50 g, similar to that of controls. Despite the baseline dTC concentration in the experimental group, the effective doses of dTC for twitch depression were similar to those of controls. The plasma dTC concentration required for steady-state twitch inhibition was significantly (P less than 0.05) higher in the experimental group (0.83 +/- 0.04 vs. 0.50 +/- 0.15 micrograms/ml) as were the extrajunctional nAChR (19.76 +/- 1.77 vs. 13.37 +/- 1.82 fmol/mg protein). The diaphragmatic nAChR were unaltered. This study confirms that chronic doses of dTC cause tolerance to its effects and proliferation of nAChR even in the absence of immobilization. The absence of nAChR changes in the diaphragm may be due to the higher margin of safety of the diaphragm for muscle relaxants than for peripheral muscles. Intensive Care Unit patients receiving chronic infusions of dTC to facilitate mechanical ventilation will require increased doses with time.     

Management of traumatic intracranial haematoma.

Deciding which head-injured patients should be transferred to a neurosurgical unit can be difficult. Traditional criteria emphasise the development of deteriorating responsiveness but lead to delayed diagnosis and to avoidable mortality and morbidity. To discover if a more liberal admission policy improved results a study was conducted analysing data collected prospectively from 683 patients who had a traumatic intracranial haematoma evacuated in the Glasgow neurosurgical unit between 1974 and 1980. In the first four years, before the change in policy, mortality was 38% but decreased to 29% afterwards. This reflected a reduction in the proportion of patients who talked after injury but who deteriorated into coma before operation--that is, 31% before the change in policy, 16% afterwards. If the potential benefits of CT scanning in the management of head injuries are to be realised patients must be scanned sooner than in the past. This will usually mean that more patients should go to a neurosurgical unit and that simple criteria for transfer should be established.