Even after the complete removal of temporal-lobe-mass lesions, a high frequency of residual spikes was obtained from the hippocampus. Effective surgical seizure control was achieved by carrying out additional procedures on the affected hippocampus. To detect seizure foci surrounding the lesion, especially over the hippocampus, intraoperative electrocorticogram monitoring was shown to be an effective technique.
These findings confirmed that callosotomy is the treatment of choice for disabling generalized seizures, especially for drop attacks. Total section is far more effective than partial section in terms of control of drop attacks and prevention of seizure relapse. However, new types of seizure could occur after callosotomy. When newly developed postural seizures were very severe, patients may fall due to sudden torsion of body, but the entire process of falling was not as sudden as that observed during previous drop attacks.
Background: CD4+CD25+ regulatory T (Treg) cells can control the allergic response to allergen, airway eosinophilia and airway hypersensitivity. We speculated that chronic inflammation persisting in asthma airways is dependent on abnormalities of these Treg cells. There are differences in the pathology of asthma in adults and children, and the airways of pediatric asthma are considered to be more naive than those of adults. Therefore, we analyzed the functionality of Treg cells in pediatric asthma and the relationship between Treg function and asthma symptoms. Methods: The anergic state, which is one of the defining properties of Treg, was analyzed by measuring intracellular Ca2+ influx following T cell receptor (TCR) stimulation. FOXP3-positive cells and FOXP3 mRNA expression were measured by flow analysis and real-time PCR with the SYBR method, respectively. Results: CD45RO+ cells make up approximately 99% of CD4+CD25high T cells and 89% of CD4+CD25low T cells in human adult blood. The proportion of CD45RO+ cells in CD4+CD25+ (high + low) T cells from pediatric asthma was much smaller (about 56%). Interestingly, our data indicated that CD45RO+ Treg cells from pediatric asthma aberrantly increased intracellular Ca2+ concentrations following TCR activation compared with pediatric nonasthma controls. Conclusion: These impaired CD45RO+ Treg cell functions were correlated with asthma symptoms. The correlation was observed in the group with a highly expressed atopic phenotype and longer duration of asthma. We suggest that chronic inflammation in pediatric asthma airways may be the result of impaired regulatory functions of CD45RO+ Treg cells.
A 15-year-old boy presented with a dermoid cyst in the left temporal lobe manifesting as complex partial seizures. Magnetic resonance imaging demonstrated a tumor with mixed signal intensity in the left anterior temporal subdural area, but no evidence of rupture. Intraoperatively, the tumor was located mainly in the deep sylvian fissure, adjacent to the amygdala, and had compressed the hippocampus. Intraoperative electrocorticography (ECoG) showed sporadic interictal spikes in both the adjacent areas of the tumor and over the anterior segment of the hippocampus. Total removal of the tumor and gliotic area of the surrounding tissue including the amygdala was performed. The hippocampal epileptic region was treated by transection of the pyramidal layer to preserve verbal memory function. Histological examination showed the dermoid tumor was closely attached to the brain parenchyma. The complex partial seizures ceased completely after surgery. Intraoperative recording of ECoG from the hippocampus and other limbic structures was very important to determine the epileptogenic area even if the tumor did not directly invade the hippocampus.
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