ObjectiveTo investigate the status and prognosis effect of surgical operation for Temporal lobe epilepsy.MethodsRetrospective analyses were performed on 24 patients with intractable temporal lobe epilepsy who were treated by surgery in Zibo Changguo Hospital and had complete clinical and follow-up data, during the period from April 2011 to June 2014. Among them, 14 were male and 10 were female, 16 to 44 years old, the average age was (24.40±6.26) years old, and the average course of disease was (12.50±8.42) years old. The clinical characteristics and prognosis of the patients were analyzed.ResultsAll 24 patients had hippocampal sclerosis and underwent "anterior temporal lobe and medial temporal structural resection". Patients were followed up for 5~7 years, the postoperative epileptic seizure of the patient reached grade Engel Ⅰ in 20 cases (83.3%), grade Engel Ⅱ in 2 cases (8.3%) and grade Engel Ⅳ in 2 cases (8.3%).ConclusionHippocampal sclerosis and cortical dysplasia were common in 24 patients, and the operation controlling intractable epilepsy was better. In order to improve the prognosis of patients, surgical treatment should be carried out as soon as possible.
In the treatment of drug-refractory epilepsy in children, surgical treatment has a good clinical effect. However, for children whose surgical site is difficult to determine and who cannot undergo resectional surgery, neuromodulation techniques are one of the treatments that can be considered. At present, new neuromodulation technologies in children mainly include transcutaneous vagus nerve stimulation (transcutaneous auricular vagus nerve stimulation, ta-VNS), deep brain stimulation (deep brain stimulation, DBS), reactive nerve stimulation (responsive neurostimulation, RNS), transcranial magnetic stimulation (transcranial magnetic stimulation, TMS), transcranial direct current stimulation (transcranial direct current stimulation, TDCS) and transcranial alternating current stimulation (transcranial alternating current stimulation, TACS). This article briefly discussed the clinical efficacy and safety of various currently available neuromodulation technologies, so as to provide a reference for the rational selection and application of neuromodulation technologies, and improve the clinical efficacy and quality of life of children with drug-refractory epilepsy.
Objective The purpose of this study was to explore the expressions of EPO-R, JAK2 and STAT-5 in the human brain with refractory epilepsy and the role in neural apotosis. Methods Collecting the brain tissue of 24 patients with intractable epilepsy (as experimental group) who were hospitalized and underwent surgery in the Epilepsy Center of the First Hospital Jilin University between March 2010 to July 2011 and 6 cases of accidental or unnatural death immediately following autopsy (as control group) as required by law during the same term. Immunohistochemical was performed to observe the expression of EPO-R, JAK2 and STAT-5 in brain tissue and statistical analysis was performed. Results ① EPO-R, JAK2 and STAT-5 were expressed in both experimental and control groups. In experimental group, the positive-cell number were 41.05±2.40, 50.21±2.50 and 60.18±2.84 under light microscope (400×). While in control group, the positive-cell number were 23.00±0.49, 27.00±0.88 and 25.93±0.33. There were significant differences between the 2 groups (P<0.001). ② There were the pathologic and ultrastructural changes in the human brain with refractory epilepsy. Under the optical microscope, we can observe that the distribution of neurons was uneven and immature neurons were visible. We can see that the nuclei were vacuolar, less cytoplasm, dark staining, hyalomitome acidophilic body, and the neurons became triangular due to degeneration. The proliferation and hyperemia appeared in small vascular and glial cells. Under the transmission electron microscope we observed degeneration and necrosis of the nerve cells, nuclear karyopyknosis, nucleolis dyssymmetry and karyolemma breakage and even dissolution. The mitochondria and astrocytes were swelling. We also saw that part of the mitochondrial cristae was abnormal. Conclusion ① We found neuronal apotosis in the human brain with refractory epilepsy. ② The expression of EPO-R, JAK2 and STAT-5 in intractable epilepsy was significantly increased in neurons and glial cells compared with the control group. The high expression of EPO-R, JAK2 and STAT-5 is unrelated with course and frequency of epileptic seizures. ③ The pathway of EPO-R/JAK2/STAT-5 may be involved in the pathophysiological processes of neural protective effect of endogenous EPO against brain injury induced by epileptic seizures.
ObjectiveTo investigate the clinical effect of Electro-Cortico-Graphy (ECOG) monitoring on refractory epilepsy caused by double pathology. MethodsA retrospective analysis was performed on 10 patients with refractory epilepsy who underwent surgical treatment in Hunan Brain Hospital from January 2020 to December 2021. The diagnosis of postoperative disease was dual pathology of medial temporal lobe sclerosis (MTS) and focal cortical dysplasia (FCD), and the effect of oral drugs was poor. All patients underwent full preoperative evaluation to determine the scope of excision of epileptogenic lesions. Cortical electrodes were used to monitor the location and scope of epileptic discharge during the operation. Epileptogenic lesions were excised, cortical heat cautery was performed, and then cortical EEG monitoring was performed to adjust the excision strategy. The patients were followed up for 24 to 48 months, and the prognosis was assessed according to the Engel scale. ResultsAmong the 10 patients, 1 patient had acute subdural hemorrhage after surgery, 1 patient had speech and naming disorders, but all of them were recovered at discharge. The other patients had no neurological defects such as intracranial infection, hemiplegia, aphasia, etc. Engel grade I was observed in 9 cases (90%) and Engel grade III was observed in 1 case (10%). ConclusionCortical electrode monitoring is safe and effective for refractory epilepsy caused by double pathological signs.
Objective To introduce experiences in the application of island myocutaneous flap for refractory wound in cervicothoracic region. Methods From August 1994 to December 2004, 98 cases of refractory wound in cervicothoracic region were treated; there 42 males and 56 females, aging 2168 years.The course of disease was 3 hours to 13 months. The locations were anterior pectorial region(29 cases), cervical part (28 cases), nuchal region (18 cases), subaxillary and axillary region (15 cases), and thoracic wall (8 cases). The defect area ranged from 6 cm×4 cm to 20 cm×15 cm. According to location, peculiarity and etiological factor of wound, various island myocutaneous flaps were selected: 28 pectoralis major island myocutaneous flaps,34 latissimus dorsi island myocutaneous flaps, 19 trapizius island myocutaneousflaps and 17 rectus abdominis island myocutaneous flap. The sizes of the dissected flap ranged from 8 cm×6 cm to 35 cm×15 cm. Results Of 98 patients, the woundhealed by first intention and the flap survived completely in 92 and the flap necrosed partially in 6. The good function and cosmetic results were obtained without severe complication. Eightythree cases were followed up from 2 weeks to 5 years. The flap obtained satisfactory appearance, good function and cosmetic results. Conclusion Repairing refractory wound in cerviconuchal region may selectpectoralis major island myocutaneous flap, latissimus dorsi island myocutaneousflap, and trapizius island myocutaneous flap; repairing refractory wound on thoracic region may select latissimus dorsi island myocutaneous flap and rectus abdominis island myocutaneous flap. According to specific condition of wound, using suitable island myocutaneous flap for refractory wound in cervicothoracic region may obtain satisfactory functional and cosmetic results.
ObjectiveTo investigate the effect of medical counseling games on ketogenic diet therapy for drug-resistant epilepsy children. MethodsA total of 98 children with drug-resistant epilepsy admitted to the neurology ward of Shenzhen Children's Hospital from January 2023 to June 2024 who were treated with ketogenic diet for the first time were selected as the study objects by random number table method, and were divided into observation group (n=49) and control group (n=49). The control group received the traditional multidisciplinary team health education mode, while the observation group received the ketogenic diet treatment based on the multidisciplinary team health education mode and participated in the customized medical counseling games intervention. The time of children reaching ketosis, the knowledge level of ketogenic diet caregivers and the retention rate of children on ketogenic diet were compared between the two groups. ResultsThe time of ketosis in observation group was earlier than that in control group (P<0.05). The knowledge level of the main caregivers of ketogenic diet and the retention rate of children with ketogenic diet at 3 months and 6 months in observation group were higher than those in control group (P<0.05). ConclusionThe use of medical counseling games in the ketogenic diet for medically refractory epilepsy is an effective therapeutic strategy that facilitates the early attainment of ketosis in children with medically refractory epilepsy, improves the knowledge of caregivers on the ketogenic diet, improves retention of children on the ketogenic diet, and serves to optimize the effectiveness of clinical outcomes, which may contribute to the quality of life of children with medically refractory epilepsy.
Objective To observe the efficacy and safety of subretinal injection of Aflibercept for the treatment of refractory or recurrent polypoidal choroidal vasculopathy (PCV). MethodsA prospective clinical research. From January to June 2022, 18 patients of 18 eyes with PCV diagnosed in The Affiliated Eye Hospital of Nanchang University were included in the study. All patients underwent best corrected visual acuity (BCVA), indocyanine green angiography and optical coherence tomography (OCT). The BCVA examination was performed using the international standard visual acuity chart, which was converted to logarithm of the minimum angle of resolution (logMAR) visual acuity during statistics. The large choroidal vessel thickness (LVCT), central retinal thickness (CRT), sub-foveal choroidal thickness (SFCT) and retinal pigment epithelium detachment (PED) height were measured by enhanced depth imaging technique of OCT. The choroidal vascular index (CVI) was calculated. There were 18 patients of 18 eyes, 11 males of 11 eyes and 7 females of 7 eyes. The age was (64.22±3.86) years old. The disease duration was (5.22±1.80) years. The patient had received intravitreal injection of anti-vascular endothelial growth factor (VEGF) drugs for (7.72±1.36) times. The logMAR BCVA of the affected eyes was 1.28±0.25. The SFCT, CRT, LVCT, PED height were (436.56±9.80), (432.44±44.29), (283.78±27.10), (342.44±50.18) μm, respectively, and CVI was 0.65±0.01. All eyes were treated with a single subretinal injection of 40 mg/ml Aflibercept 0.05 ml (including Aflibercept 2.0 mg). According to the results of OCT and BCVA after treatment, the lesions were divided into active type and static type. The active lesions were treated with intravitreal injection of Aflibercept at the same dose as before. Quiescent lesions were followed up. Examinations were performed 1-3, 6, 9 and 12 months after treatment using the same equipment and methods before treatment. The BCVA, LVCT, CRT, SFCT, PED height, CVI, interretinal or subretinal fluid, lesion regression rate, injection times, and complications during and after treatment were observed. The BCVA, SFCT, CRT, LVCT, PED height and CVI before and after treatment were compared by repeated measures analysis of variance. ResultsEighteen eyes received subretinal and/or intravitreal injection of Aflibercept (1.61±0.85) times (1-4 times). At the last follow-up, the polypoid lesions regressed in 4 eyes and PED disappeared in 1 eye. Compared with before treatment, BCVA (F=50.298) gradually increased, CRT (F=25.220), PED height (F=144.16), SFCT (F=69.77), LVCT (F=136.69), CVI (F=72.70) gradually decreased after treatment. The differences were statistically significant (P＜0.001). Macular hole occurred in 1 eye after treatment, and the hole closed spontaneously 3 months after treatment. No serious complications such as retinal tear, retinal detachment, endophthalmitis and vitreous hemorrhage occurred during and after treatment. ConclusionSubretinal injection of Aflibercept is safe and effective in the treatment of refractory PCV.
Background To summarize the genetic characteristics of GATOR1 complex gene mutations and the surgical prognosis of patients with refractory epilepsy. Methods A retrospective analysis was conducted on 16 patients with GATOR1 complex gene mutations who presented with mainly refractory epilepsy and underwent surgical treatment at the Epilepsy Center of Tsinghua University Yuquan Hospital from May 2019 to August 2024. The follow-up period ranged from 0.5 to 4.0 years. The genetic characteristics, clinical data, treatment, and prognosis of the patients were analyzed. Results Among the 16 patients, 9 were male and 7 were female, with an onset age ranging from 0.6 to 9.4 years, and seizure frequency ranging from once a day to dozens of times a day. Twelve patients (75.0%) had no seizures after surgery, and three of them had completely stopped taking medication. EEG were focal or multifocal, and all clinical seizures were monitored. Two patients had negative MRI. Among the 16 patients, there were 8 with DEPDC5 gene mutations, 5 with NPRL3 gene mutations, and 3 with NPRL2 gene mutations. Conclusions Patients with refractory epilepsy related to GATOR1 complex gene mutations are good surgical candidates, with a high rate of no seizures after surgery. For confirmed patients, surgical treatment should be considered.