ObjectiveTo explore the clinical features and surgical treatment effects of the temporal lobe epilepsy with hippocampal sclerosis.MethodsForty two patients diagnosed as temporal lobe epilepsy with hippocampal sclerosis and underwent protemporal lobectomy in Wuhan Brain Hospital from Jan. 2012 to Dec. 2018 were collected, which included 30 males and 12 females, with the age between 9 to 60 years. Their disease duration ranged from 3 to 10 years. The clinical manifestations showed complex partial seizure in 18 cases, partial-secondary –generalized seizure in 4 cases, and generalized tonic-clonic seizure in 20 cases. Based on their results of clinical manifestations, combined with MRI and VEEG results, all the patients underwent anterior temporal lobectomy (including the most parts of the hippocampus and amydala).ResultsThe postoperative pathology confirmed the diagnosis of hippocampal sclerosis. The follow-up of more than 1 year showed seizure-free in 38 cases, and significant improvement in 4 cases.ConclusionsTo the patients of temporal lobe epilepsy with hippocampal sclerosis, anterior temporal lobectomy should be performed (including the most parts of the hippocampus and amydala) if the VEEG monitoring results show that there are epileptic discharges in the ipsilateral temporal lobe. And the postoperative curative result is satisfactory.
Objective To analyze the EEG characteristics and clinical significance of subclinical epilepsy from frontotemporal lobe.Methods A collection of patients with epilepsy who had subclinical seizures monitored by 24-hour video EEG from January 2020 to January 2021 in the Neurology Department of General Hospital of Tianjin Medical University General Hospital, and analyzed the duration of seizures and the number of seizures on the EEG.The characteristics and clinical significance of onset time (sleep period/waking period), interictal discharge, and number of leads involved in seizures.Results A total of 18 patients were enrolled, and 280 clinical seizures (11/18) and 34 clinical seizures (9/18) were captured. Among them, 2 patients had both subclinical seizures and clinical seizures. Frontal lobe origin, 235 subclinical seizures and 15 clinical seizures; temporal lobe origin, 26 subclinical seizures and 19 clinical seizures; frontotemporal lobe origin, subclinical seizures 19 times, no clinical seizures were captured. In the subclinical seizure group (11/18), there were 163 sleep episodes (58.2%) and 117 (41.8%) during waking phase; in the clinical seizure group (9/18), 16 episodes during sleep (47.1%) , 18 seizures (52.9%) in the awake period. Among the leads involved in seizures, <6 leads, 270 subclinical seizures, and no clinical seizures; ≥6 leads, subclinical seizures 10 times, and 34 clinical seizures. In the total duration of seizures: the clinical seizure group was (27.43±17.73) s, with a median value of 30s; the subclinical seizure group was (20.10±15.68) s, with a median value of 13 s. In the analysis of Spearman related factors, the subclinical seizure group was positively correlated with the sleep period (P=0.000), and negatively correlated with the normal nuclear magnetic field (P=0.004).Conclusion The epilepsy originated from the frontotemporal lobe has the characteristics of short clinical seizures, fewer leads involved, more likely to occur during sleep, and subclinical seizures that are more likely to occur when the MRI is abnormal. Therefore, strengthening the monitoring of long-term video EEG for patients with epilepsy and attaching importance to the interpretation of EEG during sleep will help to detect the subclinical seizures of patients and further improve the management of patients with epilepsy.
Objective To identify the most consistent and replicable characteristics of altered spontaneous brain activity in mesial temporal lobe epilepsy patients with unilateral hippocampal sclerosis (MTLE-HS). Methods A systematic literature search was performed in PubMed, Embase, The Cochrane Library, China National Knowledge Infrastructure, Wanfang, and CQVIP databases, to identify eligible whole-brain resting state functional magnetic resonance imaging studies that had measured differences in amplitude of low-frequency fluctuations or fractional amplitude of low-frequency fluctuations between patients with MTLE-HS and healthy controls from January 2000 to January 2019. After literature screening and data extraction, Anisotropic Effect-Size Signed Differential Mapping software was used for voxel based pooled meta-analysis. Results Nine datasets from six studies were finally included, which contained 207 MTLE-HS patients and 239 healthy controls. The results demonstrated that, compared with the healthy controls, the MTLE-HS patients showed increased spontaneous brain activity in right hippocampus and parahippocampal gyrus, right superior temporal gyrus, left cingulate gyrus, right fusiform gyrus, and right inferior temporal gyrus; while decreased spontaneous brain activity in left superior frontal gyrus, right angular gyrus, right middle frontal gyrus, left inferior parietal lobule, left precuneus, and right cerebellum (P<0.005, cluster extent≥10). Conclusion The current meta-analysis demonstrates that patients with MTLE-HS show increased spontaneous brain activity in lateral and mesial temporal regions and decreased spontaneous brain activity in default mode network, which preliminarily clarifies the characteristics of altered spontaneous brain activity in patients with MTLE-HS.
Objective To discuss the correlation between glutamate receptor 5 (GLUR5) and the pathogenesis of intractable temporal lobe epilepsy (ITLE), through detecting the GLUR5 expression in human with ITLE and Coriaria lactone-induced rhesus monkey temporal lobe epilepsy model. Methods Fifty-four patients with ITLE treated in West China Hospital between January 2007 and December 2015 were regarded as clinical case group in this study. The other 43 patients who underwent temporal lobe removal decompression surgery in the same time period due to trauma, tumor or large area cerebral hemorrhage complicated with cerebral hernia were designated as the clinical control group. Quantitive polymerase chain reaction (PCR) and Western blot methods were used to detect mRNA and protein levels of GLUR5. Western blot was also used to detect the GLUR5 protein level in the hippocampus and temporal lobe tissues of Coriaria lactone-induced rhesus monkey epilepsy model, and the result was compared with that of animal controls. Results Quantitive PCR results showed that the expression ratio (R value) of GLUR5 in the temporal lobe of the clinical case group to the clinical control group was 0.262, without significant difference (P>0.05), while theR value in the hippocampus was 4.896, with a significant difference (P<0.05). The amplification curve showed that the GLUR5 level in the hippocampus of the clinical case group was higher than that of the clinical control group, but the GLUR5 mRNA level in the temporal lobe tissue was not significantly changed. GLUR5 PCR amplified product electrophoresis showed that the amplified fragment was 161 bp. Western blot analysis showed that the GLUR5/actin value of the temporal lobe tissue in the clinical case group was 2.172±0.063, while the value in the clinical control group was 2.142±0.060, and the difference was not statistically significant (P>0.05). The GLUR5/actin value of the hippocampus in the clinial case group was 2.548±0.509, while it was 1.584±0.415 in the clinial control group, and the difference was statistically significant (P<0.05). The GLUR5/actin value of the hippocampus of the rhesus monkey model of epilepsy was 1.007±0.034, and it was 1.001±0.032 in the animal control group, and the difference was not statistically significant (P>0.05). The GLUR5/actin value of the temporal lobe tissue in the animal experimental group of rhesus model of epilepsy was 0.763±0.026, and it was 0.742±0.034 in the animal control group, and the difference was not statistically significant (P>0.05). The target protein bands showed that GLUR5 protein expression in the temporal lobe tissue and hippocampus of the rhesus model of epilepsy and animal controls was not significantly different (P>0.05). Conclusions GLUR5 participates in the pathogenesis of human ITLE by acting on the hippocampus. The expression of GLUR5 in human ITLE is abnormal, but the expression of GLUR5 is not changed in the rhesus model of epilepsy. The abnormal expression of GLUR5 may play a role in the pathogenesis of ITLE.