The present book is the fruit of a workshop, designed as a discussion forum, with the participation of experts from all over the world, to extensively review clinical, neurophysiological and fundamental research available data in order to generate new axes for research, clinical practice and care. The first section traces back to the definitions and concepts underlying the terms “generalized seizures and epilepsies”. Section II reviews human and animal data suggesting that the brainstem network plays an important role for tonic seizures generation. The third and fourth sections analyze recent knowledge on cortico-thalamic and basal ganglia networks in absence and myoclonic seizures, both in animal models and in humans. The fifth section compares the phenomenology of “Primary versus Secondary Tonico-clonic seizures”, including animal data, clinical expression in humans and genetics. Section VI goes back to the discussion “Cortical” versus “Centrencephalic” theories. The last two chapters thoroughly review the clinical applications of current knowledge, in terms of pharmacological approach and clinical care.
This report of the proceedings of the Colloquium on Occipital Seizures and Epilepsies in Children held in Milan in March 1992 covers topics such as: ontogenesis, structures and function of the occipital lobe; occipital epilepsy in children; and structures and functions of the occipital lobe.
Rasmussen encephalitis (RE) is a rare, inflammatory, and possibly immuno-mediated disease that typically affects one hemisphere. The two cardinal symptoms are progressive neurological deficits and intractable seizures, often in the form of epilepsia partialis continua and recurring epileptic status. Distinctive MRI features include progressive unilateral focal cortical atrophy and gray or white matter high-signal changes with basal ganglion involvement. Histopathology is characterized by brain inflammation dominated by T cells, microglial activation, and microglial nodules, followed by neuronal loss and astrogliosis. The diagnosis of RE, which may be particularly challenging in the initial stages, is based on clinical and laboratory findings. The diagnosis requires the exclusion of other causes of epilepsia partialis continua, and other cerebral focal inflammatory diseases. The treatment of RE is often demanding: antiepileptic drugs are of limited effect, whereas the surgical exclusion of the affected hemisphere offers a very high chance of seizure freedom but at the price of irreversible neurological deficits. By contrast, long-term immunotherapy may delay hemispheric tissue loss and neurological deficits, but has a lesser effect on total seizure burden. Given that the severity of symptoms varies among different patients and phases, the therapeutic strategy, including medical and surgical options, must be tailored to the need of each patient.
Pain is a subject of significant scientific and clinical interest. This has resulted both from realistic rodent models, and the publication of imaging, psychological and pharmacological studies in humans. Investigators studying rodents refer to anatomical and physiological studies in non-human primates to make their results relevant to humans. Psychophysical and pharmacological studies in humans are interpreted in terms of anatomical and physiological studies in animals; primarily evidence from rodents and cats. There are significant differences in pain mechanisms between these species and primates. Over 20 years of imaging studies have demonstrated the activation of human cortical and subcortical structures in response to painful stimuli. Interpretation of these results relies upon an understanding of the anatomy and physiology of these structures in primates. Jones, Lenz, Casey and Willis review the anatomy and physiology of nociception in monkeys and humans, and provide a firm basis for interpreting studies in humans.
This report of the proceedings of the Colloquium on Occipital Seizures and Epilepsies in Children held in Milan in March 1992 covers topics such as: ontogenesis, structures and function of the occipital lobe; occipital epilepsy in children; and structures and functions of the occipital lobe.
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