ObjectiveTo analyze the causes of unrelieved epilepsy thoroughly in children with isolated focal cortical dysplasia (FCD) based on MRI.MethodsRetrospective analysis of MRI and clinical data of 21 children with isolated FCD during July 2014 to January 2018, which confirmed by pathology and unrelieved thoroughly after operation performed, the pathological types and MRI signs were analyzed, as well as the frequency of different MRI signs in FCD of each pathological type. Analyzed the possible factors of surgical failure.ResultsAmong the 21 cases, there were 15 males and 6 females, with an average age of (5.7±0.3) years and an average course of disease of (3.4±0.5) years.MRI signs of this part of the children were mainly manifested by blurred focal gray matter boundaries, abnormal cortical structure changes (thickening and/or thinning), transmantle signs (abnormal cone signals extending from subcortical white matter to the ventricle) and abnormal gray matter signals, which were similar to MRI signs of FCD with satisfactory postoperative epilepsy control. 17 cases (80.9%) appeared epileptic discharge after operation in the EEG monitoring area 2 weeks to 6 months, FCD type I and type Ⅱ accounted for 35.3%, 64.7% respectively. During intraoperative EEG monitoring, no epileptiform discharge was observed in the transmantle sign region in 6 cases, and the region was retained, and only the surrounding abnormal discharge cortex was removed, complete removal of the tansmantle sign and surrounding abnormal discharge area was performed in 2 cases, and different degrees of epileptic epilepsy were observed in both methods.ConclusionMRI signs of isolated FCD with unrelieved epilepsy after operation were nonspecific, there were still epilepsy of varying degrees after all epileptogenic lesions have been removed, the cause may be related to potential epileptic factors.
Objective To study the clinical results of focal debridement and primary internal fixation with CD rod in treatment of multisegmental spinaltuberculosis.Methods From July 1999 to November 2002, 16 patients with multisegmental spinal tuberculosis were given focal debridement and primary internal fixation with CD rod trans sick vertebra. There were 9 males and 7 females, aging from 21 to 59 years. The course of disease was 2 to 11 months. The locations of lesion were T 6T 11 in 11 patients and T 10 -L2 in 5 patients.The involved vertebral bodies were 3 segments in 13 patients, 4 or more than 4 segments in 3 patients. There were 5 cases of Pott’s paralysis (according to Frankel classification system: 3 cases of degree C, 2 cases of degree D) and 4 cases of kyphosis and 2 cases of collapse. Focal debridement and internal fixation was performed in 1 or 2 incisions according to concrete conditions. Results All patients were followed up 11 months (6 months-3years), spinal tuberculosis was completely cured and the grafted bones were fused in all 16 patients. All patients obtainedprimary healing of the incision. Postoperative complication met with cerebrospinal fluid leakage in 1 case. After 6 months, 5 cases of paraplegia recovered. The kyphosis was corrected partly. No loose and dislocation of the nails and rods was found. Conclusion Focal debridement and primary internal fixation with CD rod can stabilize involved spinal segments, prevent and correct local deformity,and improve its curative ratio and fused ratio of grafted bone.
ObjectiveTo explore the clinical features and sum up the laws of the hepatic focal nodular hyperplasia (FNH) in its diagnosis and treatment. MethodsFNH was an uncommon benign hepatic tumor that often posed diagnostic dilemmas. We analyzed retrospectively the clinical, imaging of ultrasound, imaging of computed tomography (CT) and magnetic resonance images (MRI), and pathological materials of 21 patients with FNH proven by the pathological diagnosis during 5 years from April 1996 through April 2001 in two hospitals. ResultsThe diagnosis of FNH remained a challenge for clinicians and surgeons. Rate of correct diagnosis of FNH was low preoperatively (19.0%). The lesions of FNH were seen in males and females (m/f: 14/7). Only three female patients (3/7) had the history of taking oral contraceptive. Patients with FNH were largely young and middle age persons (81.0% under 50 years), discovered by accident (57.1%), without infection of the hepatitis B virus (95.2%) and with normal liver functions (100%) and serum AFP levels (100%). Color Doppler ultrasound showed blood vessels passing through the lesion (80.0%) and there was abundant in blood (66.7%). CT scan showed that the lesion had transient immediate enhancement in 60.0% of patients and had homogeneous signal in 60.0% after bolus injection. MR imaging demonstrated early vigorous enhancement (64.3%), homogenous signal (57.1%) and having central scar (35.7%) in the lesion. The demonstration of a central scar in the lesion was very helpful for the diagnosis of FNH. MRI was more helpful for the diagnosis of FNH using liver specific contrast agents: superparamagnetic iron oxide（SPIO）. All patients underwent focus resection (18 cases) or segmentectomy (2 cases), except one having no treatment. ConclusionFNH shows some typical clinical and imaging features. We could increase the rate of correct diagnosis by comprehensively analyzing the clinical and imaging materials. It is very important and necessary to determine a definite diagnosis of FNH, hepatic adenoma (HA) and primary liver cancer (PLC) preoperatively, because the HA and PLC must be surgically resected, FNH can only be followed up.
Cenobamate is one of the latest antiseizure medications (ASMs) developed for the treatment of focal onset seizures in adult patients. Cenobamate is characterized by a peculiar pharmacology. The mechanisms responsible for its anti-seizure activity include enhancement of the inactivated state of voltage-gated sodium channels with blockade of the persistent sodium current and positive allosteric modulation of GABAa receptors at a non-benzodiazepine binding site. Studies showed that cenobamate appears to be an effective treatment for focal epilepsy, showing reductions in seizure frequency, increased responder rates, and high rates of seizure freedom, and is well tolerated and safe. This article reviews the mechanism, pharmacokinetic characteristics, clinical efficacy, and safety of cenobamate as a novel anti-seizure drug
ObjectiveTo summarize the clinical phenotype, electrophysiological characteristics, imaging characteristics, surgical treatment and prognosis of Rasmussen encephalitis (RE), so as to deepen the understanding of the disease. MethodsThe clinical data of patients with RE who underwent surgical therapy from October 2014 to October 2019 at Children's Epilepsy Center in Peking University First Hospital were retrospectively reviewed. Demographic characteristics, seizure forms, electroencephalogram (EEG), cranial nuclear magnetic resonance (MRI), operative methods as well as surgical outcomes evaluated by Engel classification during follow-up of the subjects were collected and analyzed. ResultsTotally 21 pediatric patients were enrolled, including 8 males and 13 females. The age at onset was (5.0±2.0) years old, the age at the time of surgery was (6.9±2.7) years old, and the disease duration at the time of surgery was (1.7±1.3) years. Twenty (20/21, 95.2%) patients had focal motor seizures, and 10 (10/21, 47.6%) patients had 2 or 3 forms of focal motor seizures. Fifteen patients (15/21, 71.4%) had epilepsia partialis continua (EPC), which occurred (0.7±0.6) years after the onset. All patients had hemiplegia, which appeared at (0.9±0.6) years after the onset. All patients showed a slow rhythm at their affected hemispheres during the EEG monitoring and 4 of them also showed slow rhythm at the contralateral hemispheres as the disease progressed. All patients had epileptiform discharges at the involved hemisphere, and 6 patients also had independent epileptiform discharges on the contralateral side. All 21 patients underwent hemispheric disconnection. The duration of follow-up was 2 to 7 years, and all patients achieved Engel class I after the surgery. The neurological dysfunction recovered to varying degrees during the postoperative period. ConclusionRE mostly occurs around the school age. Focal motor seizures are the main manifestations and the most common onset symptoms. With the progress of the disease, the condition of patients worsened gradually. The EEG of patients was mainly characterized by broad slow wave and spike wave in the affected hemisphere. Some patients can also have bilateral involvement, which was obviously asymmetrical. Through surgical treatment, the patients all achieved good results in terms of seizures and development.
To evaluate the appl ication value of internal fixation of spinal column by posterior approach and extraperitioneal bilateral focal debridement for the treatment of tuberculosis of lumbosacral vertebral body. Methods From March 2000 to February 2005, 16 cases of spinal tuberculosis in L3-S1 were treated with internal fixation of spinal column by posterior approach and extraperitioneal bilateral focal debridement. Sixteen cases included 11 males and 5 females, and the age was 21-56 years. The locations of spinal tuberculosis were L3 in 4 cases, L4 in 6, L5 in 4, and S1 in 2. The course of disease averaged 13 monthes (range 6 monthes to 6 years). The ESR of all cases was greater than 20 mm/h (average40 mm/h); WBC was normal in 14 cases, and a l ittle high in 2 cases. The X-ray picture showed narrow intervertebral space in 5 cases, compressed body of vertebra in 7 cases, and destroyed 2 consecutive vertebra and its sclerotin was condupl icate in 1 case. All cases were abscess in major psoas muscle. The CT showed destruction of bone, abscess-formation and dead bone in body of vertebra of 16 cases. The abscess were found in vertebral canal in 5 cases and dura mater of spinal cord and spinal nerve root crushed in 2 cases. The MRI showed destruction of bone, abscess-formation and hibateral abscess in major psoas muscle in 11 cases. The abscess were found in vertebral canal and dura mater of spinal cord and spinal nerve root crushed in 6 cases. The therapy of pasid was treated after operation in all the cases. Results Incision healed by first intention in 16 cases; and disruption of wound occurred and heal ing was achieved after symptomatic treatment in 1 case. Sixteen cases were followed up 2-5 years (29 months on average). Among all the cases, anaesthesia in double thigh was found in 3 cases, adynamia of dorsiflexion in foot in 1 case, gatism in 1 case; after 2 weeks the symptoms were vanished. Indirect hernia of fold inguen were found in 1 case after 2 years, and the patient refused operation for age and was no longer followed up. Fuzzy, exsic and acerb in eyes were foundin 6 cases, hearing disturbance were found in 2 cases, and symptoms were vanished after medication adjustment. Low-grade fever and lumbar myalgia were found in 1 case and cured after staying in bed and medication adjustment. All ESR were normal, synostosis of lumbosacral vertebral body was found in 13 cases, kyphosis in 1 case. Conclusion Internal fixation of spinal column by posterior approach and extraperitioneal bilateral focal debridement is safe and available way for the treatment of tuberculosis of lumbosacral vertebral body, it can save the times of operation, shorten period and enhance effect of treatment.
Approximately 70 million people worldwide suffer from epilepsy, with about 9 million in China. About one-third of patients demonstrating resistance to traditional antiseizure medications (ASMs), Focal Cortical Stimulation (FCS) emerges as a novel neuromodulation therapy based on neural stimulation, showing potential in treating drug-resistant focal epilepsy. FCS reduces seizure frequency by diminishing abnormal excitability in cortical areas. Compared to traditional surgery, it carries lower risks and is particularly suited for patients whose epileptogenic foci are difficult to surgically localize. Its adjustability provides physicians with treatment flexibility, allowing them to tailor therapy based on patient conditions. Recent studies highlight the practical clinical application of FCS, underscoring its advantages in reducing the frequency of drug-resistant epilepsy seizures. The article concludes by exploring the future prospects of FCS, emphasizing the need for research in long-term efficacy assessment and patient adaptability, thus demonstrating its significant potential and direction for development in the field of epilepsy treatment.
Objective To review the examination techniques and the current research progress of the magnetic resonance diffusion weighted-imaging (DWI) used in liver. Methods The recent and relevant literatures about the principles and the current study situation of liver DWI were scrutinized and analyzed retrospectively. In addition, the existing problems of liver DWI were discussed. Results DWI could demonstrate the normal and abnormal structure and function through measuring the diffusion motions of water molecule in the liver. With the improving technology and better understanding of diffusion dynamics, DWI has been used for the diagnosis and differential diagnosis for hepatic diseases. Conclusion DWI as a non-invasive examine method, may provide valuable functional information for clinical diagnosis and treatment.
ObjectiveTo explore the microscopic character and clinical pathological feature of focal cortical dysplasia (FCD).Methods51 cases were collected from January 2015 to September 2018 in the 988th Hospital of the Joint Logistics Support Force of the People’s Libereation Army. Pathology with FCD of their diseased brain tissue was classified according to the classification standard by the International Anti-Epilepsy Union (ILAE) in 2011. Epileptic seizure characteristics were analysed in different types.ResultsFCD I was 23 cases (45.1%). FCD II was 11 (21.6%). FCD III was 17 (33.3%). Ia was the most common type (23.5%, 12/51). Neurons were arranged into microcolumnar structures in Ia. NF expression in immunohistochemistry was characteristic. It was close to the neuron like line or waterfall. The second type was Ⅲa (15.7%, 8/51). Hippocampal sclerosis was given priority to CA4 area pyramidal cells to reduce or disappear. Three types all happened in bilateral cerebral hemisphere. There was no statistical difference. Temporal lobe was significantly more than frontal lobe. More than 50% of the cases occurredepilepsy before the age of 18. The main manifestation was partial onset seizures and secondary body stiffness clonus. The onset age and history of epilepsy in patients with FCD Ⅲ were earlier than those in the other two types. On image the positive rate of I type was 78.3% and that of Ⅱ and Ⅲ was both 100%.ConclusionFCD is a common pathological feature of epilepsy patients. Carefully pathologic examination is the premise of accurate classification of each subtype. Ⅲ type is different from Ⅰ and Ⅱ type in epileptic seizures.
ObjectiveThrough neuropsychological assessment, explore the factors that may cause cognitive impairment in patients with focal epilepsy.MethodsCollected 53 epilepsy patients in outpatients and inpatients of Tianjin Medical University General Hospital from March 2016 to January 2020, including 25 males and 28 females, with an average age of (23.58±13.24) years old, and the course of disease (6.49±7.39), all met the 2017 ILEA diagnostic criteria for focal epilepsy, and there was no history of progressive brain disease or brain surgery. Carry out relevant cognitive assessments for the enrolled patients, use SPSS statistical software to conduct Spearman correlation analysis on the cognitive functions of the study subjects, and further analyze the related factors of cognition through Logistic regression analysis to clarify the factors related to cognition whether it may be a risk factor for cognitive impairment in patients with focal epilepsy.Results Spearman correlation analysis showed that the FIQ of patients with focal epilepsy was related to education level, age of onset, seizure pattern, total number of seizures, AEDs and EEG interval discharge side (P<0.05). Binary Logistic regression analysis shows that among all cognitive-related factors, only the number of AEDs (P=0.003) and EEG interval discharge (P=0.013) are the risk of cognitive impairment in patients with focal epilepsy factor.ConclusionIn the clinical treatment of epilepsy, seizures should be actively controlled, but the types of drugs should be minimized. When there are more than 3 kinds of drugs, surgical treatment or other non-surgical treatments can be considered. At the same time, the EEG should be reviewed regularly to understand the changes in epileptiform discharges between episodes.