Epilepsy surgery has become a treatment option for children with medically intractable epilepsy [1][2][3][4][5][6] . Accurate localization and removal of the epileptogenic zone is crucial in order to achieve seizure control. most centers like ours reserve intracranial recording for complex cases, such as those with potential multiple foci or dual pathology, or to resolve discordant data in which surface electroencephalogram (EEG) and magnetic resonance imaging (mRi) do not provide enough information to correctly recognize the ictal onset zone.the goal of the surgery is to accurately identify and remove the epileptogenic zone while minimizing new functional deficits from surgery. our main objective though remains the attainment of complete seizure freedom without harm to the patient.intracranial recording includes epidural pegs, subdural grid placement, and depth electrode insertion. in the past, like most pediatric epilepsy centers we have implanted large subdural grids in patients with epilepsy in order to further map the ABSTRACT: Background: the surgical removal of the epileptogenic zone in medically intractable seizures depends on accurate localization to minimize the neurological sequelae and prevent future seizures. to date, few studies have demonstrated the use of depth electrodes in a pediatric epilepsy population. Here, we report our study of pediatric epilepsy patients at our epilepsy center who were successfully operated for medically intractable seizures following the use of intracranial depth electrodes. in addition, we detail three individuals with distinct clinical scenarios in which depth electrodes were helpful and describe our technical approach to implantation and surgery. Methods: We retrospectively reviewed 18 pediatric epilepsy patients requiring depth electrode studies who presented at the University of Alberta Comprehensive Epilepsy Program between 1999 and 2010 with medically intractable epilepsy. Patients underwent cortical resection following depth electrode placement according to the Comprehensive Epilepsy Program surgical protocols after failure of surface electroencephalogram and magnetic resonance imaging to localize ictal onset zone. Result: the ictal onset zone was successfully identified in all 18 patients. treatment of all surgical patients resulted in successful seizure freedom (Engel class i ) without neurological complications. Conclusion: intracranial depth electrode use is safe and able to provide sufficient information for the identification of the epileptogenic zone in pediatric epilepsy patients previously not considered for epilepsy surgery.RÉSUMÉ: Électrodes profondes dans la chirurgie de l'épilepsie en pédiatrie. Contexte : l'ablation chirurgicale de la zone épileptogène chez les patients atteints de crises d'épilepsie réfractaires au traitement médical dépend d'une localisation précise du foyer épileptogène afin de minimiser les séquelles neurologiques et de prévenir les crises. À ce jour, peu d'études ont démontré l'utilité d'électrodes profondes chez une populatio...
Aim. This case report provides insight into the function of the anterior prefrontal cortex (aPFC), specifically Brodmann Area 10 (BA10), and its interconnectivity. Method. We present a 10‐year‐old patient with lesional epilepsy and ictal onset, localised to BA10 in the aPFC. Results. Thirty‐four seizures were recorded. All seizures involved a demonstration of elation with laughter that was associated with a variety of different patterns of complex motor behaviour that included performing specific celebratory movements and acting out a Michael Jackson dance move. Electrographically, the seizures were all stereotyped and arose from the right frontal region, followed by a distinct left temporal ictal rhythm that corresponded with the onset of the behaviours. The lesion in the right aPFC was identified as a mixed lesion with both dysembryoplastic neuroepithelial tumour cells and type II cortical dysplasia. Conclusion. The electrographic analysis and unique seizure semiology suggest a connection between the aPFC and the contralateral temporal lobe. This neural pathway appears to be involved in the activation of previously formed procedural memories, creating an intensely positive emotional experience.
Hydrocephaly is the defective absorption of cerebrospinal fluid (CSF) into the blood stream. This work is an experimental and computational fluid dynamic modelling study to determine the permeability of the diploë as a potential receptor for CSF. Human calvariae were studied by micro-CT to measure their porosity, the area of flow and develop model geometry. Pressure-flow measurements were conducted on specimens to determine their permeability in the physiological and transverse flow directions to compare with numerical results. The overall porosity and permeability of the calvaria were spatially variable. Results suggest an order of magnitude increase in permeability for a 14% increase in overall porosity based on a small number of samples. Numerical results fell within the experimental infusion tests results. Due to the difficulty and ethical considerations in obtaining adolescent skull samples to perform large-scale testing, the developed model will be invaluable.
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