Patients with refractory focal epilepsy and normal MRI findings will be included into the study, examined using electrophysiological and neuroimaging techniques and subsequently operated. Potential of individual noninvasive techniques to localize epileptogenic zone will be evaluated by correlation with invasive monitoring and postoperative MRI results. Yield of individual diagnostic methods will be improved. Exact etiopathogenesis of the illness will be established by detailed histologic and immunohistochemical analysis of the resected brain tissue. Etiopathogentical subgroups of patients will be identified. By correlation with neuropathological findings, we will evaluate the potency of individual diagnostic techiques to predict etiology preoperativelyand to early identify subgroups of patients. This may influence the choice of therapeutic approaches.

Do studie budou zařazeni pacienti s farmakorezistentní fokální epilepsií a normálním nálezem na MRI mozku vyšetření pomocí elektrofyziologických a funkčně zobrazovacích vyšetřeni a následně odoperovaní. Lokalizační přínos jednotlivých neinvazivních testůzhodnotíme korelací s výsledkem invazivní monitorace a s pooperačním MRI nálezem. Pokusíme se zvýšit výtěžnost jednotlivých vyšetření. Podrobná histologická a imunohistochemická analýza resekované mozkové tkáně určí etiopatogenezi onemocnění. Zaměříme se na identifikaci jednotlivých etiopatogenetických podskupin pacientů. Korelací s neuropatologickými nálezy zjistíme schopnost jednotlivých diagnostických testů predikovat strukturální povahu epilepsie a časně identifikovat jednotlivé podskupiny pacientů, což ovlivní volbu terapeutického postupu.

• MeSH
• antikonvulziva MeSH
• diagnostické techniky neurologické MeSH
• elektroencefalografie MeSH
• epilepsie chirurgie   MeSH
• léková rezistence MeSH
• magnetická rezonanční spektroskopie MeSH
• magnetická rezonanční tomografie MeSH
• malformace mozkové kůry MeSH
• nemoci nervového systému diagnóza   patofyziologie   MeSH
• pozitronová emisní tomografie MeSH

• Konspekt
• Patologie. Klinická medicína
• NLK Obory
• neurologie
• farmacie a farmakologie
• radiologie, nukleární medicína a zobrazovací metody
• NLK Publikační typ
• závěrečné zprávy o řešení grantu IGA MZ ČR

Focal cortical dysplasias (FCDs) represent a prominent cause of pharmacologically intractable epilepsy. In FCD, the decrease of parvalbumin immunoreactive (PV+) inhibitory interneurons has been repeatedly documented. Here, we wanted to show whether another interneuronal population, the calretinin immunoreactive (CR+) neurons, exhibits any change in human FCD. We also investigated samples of morphologically normal temporal neocortex resected together with sclerotic hippocampus (nHSTN), where decrease of PV+ interneurons was previously documented as well. Brain tissue from 24 patients surgically treated for pharmacoresistant epilepsy was examined. Calretinin immunoreactivity was qualitatively evaluated and the density of CR+ neuronal profiles was quantified. As a control, post-mortem acquired neocortical samples of nine patients without any brain affecting disease were used. CR+ neurons were located predominantly in superficial cortical layers both in controls and pathological samples. Similarly, the morphology of CR+ neurons was unaffected in pathological samples. The overall density of CR+ neurons was significantly decreased in FCD type I (to approximately 70% of control values) and even more in FCD type II (to approximately 50% of controls). In nHSTN, no change compared to controls was found in CR+ neuronal density. Our results may contribute to the better understanding of the role of individual interneuronal populations in epileptogenesis.

• MeSH
• dítě MeSH
• dospělí MeSH
• elektroencefalografie MeSH
• epilepsie metabolismus   patologie   MeSH
• fluorodeoxyglukosa F18 diagnostické užití   MeSH
• hipokampus metabolismus   patologie   MeSH
• interneurony metabolismus   MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• malformace mozkové kůry patologie   MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mozková kůra metabolismus   patologie   MeSH
• parvalbuminy metabolismus   MeSH
• pozitronová emisní tomografie MeSH
• předškolní dítě MeSH
• S100 kalcium vázající protein G metabolismus   MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

The aim of the study was to analyze the lateralizing value of proton magnetic resonance spectroscopy ((1)H MRS) in histopathologically different subgroups of mesial temporal lobe epilepsies (MTLE) and to correlate results with clinical, MRI and seizure outcome data. A group of 35 patients who underwent resective epilepsy surgery was retrospectively studied. Hippocampal (1)H MR spectra were evaluated. Metabolite concentrations were obtained using LCModel and NAA/Cr, NAA/Cho, NAA/(Cr+Cho), Cho/Cr ratios and coefficients of asymmetry were calculated. MRI correctly lateralized 89% of subjects and (1)H MRS 83%. MRI together with (1)H MRS correctly lateralized 100% of patients. Nineteen subjects had "classical" hippocampal sclerosis (HS), whereas the remaining 16 patients had "mild" HS. Nineteen patients had histopathologically proven malformation of cortical development (MCD) in the temporal pole; 16 subjects had only HS. No difference in (1)H MRS findings was found between patients in different histopathological subgroups of MTLE. Our results support the hypothesis that (1)H MRS abnormalities do not directly reflect histopathological changes in MTLE patients. Subjects with non-lateralized (1)H MRS abnormalities did not have a worse postoperative seizure outcome. We found no significant impact of contralateral (1)H MRS abnormality on post-surgical seizure outcome.

• MeSH
• dospělí MeSH
• elektroencefalografie metody   MeSH
• epilepsie temporálního laloku diagnóza   chirurgie   patologie   MeSH
• hipokampus patologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční spektroskopie metody   MeSH
• magnetická rezonanční tomografie metody   MeSH
• mladiství MeSH
• reprodukovatelnost výsledků MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH

• Publikační typ
• abstrakty MeSH

BACKGROUND: Focal cortical dysplasia (FCD) is recognized as the major cause of focal intractable epilepsy in childhood. Various factors influencing postsurgical seizure outcome in pediatric patients with FCD have been reported. OBJECTIVE: To analyze different variables in relation to seizure outcome in order to identify prognostic factors for selection of pediatric patients with FCD for epilepsy surgery. METHODS: A cohort of 149 patients with histologically confirmed mild malformations of cortical development or FCD with at least 2 years of postoperative follow-up was retrospectively studied; 113 subjects had at least 5 years of postoperative follow-up. Twenty-eight clinical, EEG, MRI, neuropsychological, surgical, and histopathologic parameters were evaluated. RESULTS: The only significant predictor of surgical success was completeness of surgical resection, defined as complete removal of the structural MRI lesion (if present) and the cortical region exhibiting prominent ictal and interictal abnormalities on intracranial EEG. Unfavorable surgical outcomes are mostly caused by overlap of dysplastic and eloquent cortical regions. There were nonsignificant trends toward better outcomes in patients with normal intelligence, after hemispherectomy and with FCD type II. Other factors such as age at seizure onset, duration of epilepsy, seizure frequency, associated pathologies including hippocampal sclerosis, extent of EEG and MRI abnormalities, as well as extent and localization of resections did not influence outcome. Twenty-five percent of patients changed Engel's class of seizure outcome after the second postoperative year. CONCLUSIONS: The ability to define and fully excise the entire region of dysplastic cortex is the most powerful variable influencing outcome in pediatric patients with focal cortical dysplasia.

• MeSH
• dítě MeSH
• dospělí MeSH
• elektroencefalografie MeSH
• hemisferektomie normy   MeSH
• hipokampus patologie   MeSH
• inteligence MeSH
• kohortové studie MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• malformace mozkové kůry diagnóza   chirurgie   komplikace   psychologie   MeSH
• mladiství MeSH
• mladý dospělý MeSH
• následné studie MeSH
• retrospektivní studie MeSH
• skleróza MeSH
• výsledek terapie MeSH
• záchvaty diagnóza   etiologie   patofyziologie   MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH

PURPOSE: Cortical dysplasia (FCD) is a frequent cause of epilepsy in childhood. Two major pathological variants are distinguished, FCD type I and II. The aim of the study was to characterize differences between FCD type I and II with respect to imaging and EEG findings, clinical and neuropsychological presentations, and surgical outcome. METHODS: Forty children with refractory epilepsy and histopathologically confirmed FCD were retrospectively analyzed. FCD type I was identified in 24 and FCD type II in 16 patients. RESULTS: Characteristic MRI abnormalities in FCD type I included subtle white matter signal changes and regional reduction of the white matter volume. Typical MRI findings in FCD type II were increased cortical thickness, transmantle sign, gray-white matter junction blurring, fluid-attenuated inversion recovery (FLAIR) and proton density (PD) gray matter signal changes as well as T1w, and PD white matter signal changes. Continuous EEG slowing was significantly more common in patients with FCD type I. Children with FCD type I presented with lower levels of intelligence and were suffering more often from maladaptive behavior and behavioral disorders. Surgical outcome was significantly worse in the FCD type I group (seizure freedom was achieved in 21% FCD type I patients and in 75% FCD type II subjects, p < 0.001). CONCLUSIONS: Clinically important differences were found in children with distinct histopathological subtypes of FCD. Due to prominent neuropsychological deficits and worse seizure outcome, treatment strategies in FCD type I are more challenging than previously reported and these children should be recognized and specifically addressed within the incoherent group of patients with malformative brain disorders.

• MeSH
• atrofie patologie   MeSH
• dítě MeSH
• elektroencefalografie MeSH
• financování organizované MeSH
• fluorodeoxyglukosa F18 diagnostické užití   MeSH
• gliový fibrilární kyselý protein metabolismus   MeSH
• hipokampus patologie   MeSH
• imunohistochemie MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• malformace mozkové kůry epidemiologie   metabolismus   patologie   MeSH
• monoklonální protilátky metabolismus   MeSH
• pooperační péče MeSH
• předoperační péče MeSH
• radiofarmaka diagnostické užití   MeSH
• retrospektivní studie MeSH
• věk při počátku nemoci MeSH
• výsledek terapie MeSH
• záchvaty epidemiologie   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH

High-frequency activity has been described as having a role in the initiation of epileptic seizures. The case of a patient with refractory bitemporal epilepsy is presented. Extraoperative monitoring with depth and subdural electrodes revealed an ictal pattern with a build-up of high-frequency (> 80 Hz) activity originating in the cortex, with spread to both hippocampi. This observation was only revealed with the use of high-pass filtering, and represented crucial information that significantly influenced the decision about the side, localization and extent of resection. Removal of the cortex generating high-frequency activity, led to cessation of seizures in this patient. Current knowledge about the role of high-frequency activity and the case presented here support the importance of recording with equipment capable of detecting fast activity during the presurgical invasive monitoring. An active search for a high-frequency seizure onset zone in patients with structurally-unaffected hippocampi may improve the outcome beyond that possible with conventional bandwidth, invasive EEG recordings.

• MeSH
• elektroencefalografie MeSH
• epilepsie temporálního laloku chirurgie   patofyziologie   patologie   MeSH
• hipokampus patofyziologie   patologie   MeSH
• implantované elektrody MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• mozková kůra patofyziologie   patologie   MeSH
• neurochirurgické výkony MeSH
• pozitronová emisní tomografie MeSH
• spánkový lalok chirurgie   patofyziologie   patologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH
• práce podpořená grantem MeSH

The introduction to the application of (1)H MR spectroscopy for clinical and research studies of mesial temporal and extratemporal epilepsies is done. The techniques of single voxel and spectroscopic imaging are discussed and the analysis of (1)H MR spectra together with basic metabolic descriptions is presented.

• MeSH
• antikonvulziva terapeutické užití   MeSH
• elektroencefalografie MeSH
• epilepsie diagnóza   metabolismus   terapie   MeSH
• fantomy radiodiagnostické MeSH
• lidé MeSH
• magnetická rezonanční spektroskopie metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH

OBJECTIVE: Focal cortical dysplasia (FCD) is the most frequent pathological finding in pediatric epilepsy surgery patients. Several histopathological types of FCD are distinguished. The aim of the study was to define distinctive features of FCD subtypes. METHODS: We retrospectively reviewed clinical, electroencephalographic, magnetic resonance imaging, neuropsychological, and surgical variables, and seizure outcome data in 200 children. Cortical malformations were histopathologically confirmed in all patients, including mild malformation of cortical development type II (mMCD) in 36, FCD type Ia in 55, FCD type Ib in 39, FCD type IIa in 35, and FCD type IIb in 35 subjects. RESULTS: Perinatal risk factors were more frequent in mMCD/FCD type I than FCD type II. Children with FCD type IIb had more localized ictal electroencephalographic patterns and magnetic resonance imaging changes. Increased cortical thickness, abnormal gyral/sulcal patterns, gray/white matter junction blurring, and gray matter signal abnormality in fluid-attenuated inversion recovery and T2-weighted sequences occurred more often in FCD type II, were infrequent in FCD type I, and rare in mMCD. Lobar hypoplasia/atrophy was common in FCD type I. Hippocampal sclerosis was most frequent in FCD type I. Neuropsychological testing demonstrated no significant differences between the groups. There was a trend toward better surgical outcomes in FCD type II compared with FCD type I patients. INTERPRETATION: Different histopathological types of mMCD/FCD have distinct clinical and imaging characteristics. The ability to predict the subtype before surgery could influence surgical planning. Invasive electroencephalographic study should be considered when mMCD/FCD type I is expected based on noninvasive tests.

• MeSH
• atrofie etiologie   patofyziologie   patologie   MeSH
• biopsie MeSH
• dítě MeSH
• dospělí MeSH
• elektroencefalografie MeSH
• epilepsie etiologie   patofyziologie   patologie   MeSH
• financování organizované MeSH
• hipokampus patofyziologie   patologie   MeSH
• kojenec MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• malformace mozkové kůry komplikace   parazitologie   patologie   MeSH
• mladiství MeSH
• mozková kůra patofyziologie   patologie   MeSH
• prediktivní hodnota testů MeSH
• předoperační péče MeSH
• předškolní dítě MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH

We report on a case of frontal lobe epilepsy in an eight-year-old girl. Seizure semiology and EEG indicated an epileptogenic zone localized in the mesial frontal structures, without clear-cut lateralization. MRI showed a lesion in the right cingulate gyrus, initially regarded as a hamartoma. Ictal SPECT did not have a localization value. MR spectroscopy revealed two metabolic abnormalities: one in the area of the MRI lesion and a second contra-laterally. Invasive monitoring using subdural electrodes covering the convexity and mesial part of the right frontal lobe including mesial strips with bilateral contacts was used. The invasive monitoring failed to localize ictal onset in the right hemisphere; however, electric stimulation induced seizures from electrodes facing the left supplementary sensorimotor area ("through" the falx cerebri). We re-implanted the electrodes over the left frontal lobe and the second invasive monitoring clearly localized the ictal onset zone in the left supplementary sensorimotor area, which was subsequently resected. Histopathology found MRI-negative focal cortical dysplasia. The contralateral lesion was reassessed as nonspecific enlargement of perivascular spaces. The patient has been seizure-free for more than two years.[Published with video sequences].

• MeSH
• cingulární gyrus patologie   MeSH
• dítě MeSH
• elektroencefalografie MeSH
• epilepsie čelního laloku chirurgie   patologie   MeSH
• financování organizované MeSH
• implantované elektrody MeSH
• lidé MeSH
• magnetická rezonanční spektroskopie MeSH
• magnetická rezonanční tomografie MeSH
• motorické korové centrum patologie   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH