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Michael R Sperling - One of the best experts on this subject based on the ideXlab platform.
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postsurgical outcome in patients with auditory Auras and drug resistant epilepsy
Epilepsy & Behavior, 2017Co-Authors: Ali A Asadipooya, Maromi Nei, Ashwini Sharan, Dale Wyeth, Michael R SperlingAbstract:Abstract Objectives We investigated the clinical features associated with olfactory Auras in patients with drug-resistant epilepsy and also hypothesized that this type of aura may predict worse postsurgical outcome in patients with drug-resistant temporal lobe epilepsy (TLE). Methods In this retrospective analysis, data from all patients with drug-resistant epilepsy who underwent epilepsy surgery were reviewed. Patients were prospectively registered in a database from 1986 through 2016. We assessed outcome in the first 5 years after surgery to produce a Kaplan–Meier estimate of seizure recurrence. Post-surgical outcome was classified into two groups; 1) seizure-free, with or without Auras; or 2) relapse of complex partial or secondarily generalized seizures. We also investigated the clinical features of patients with TLE and olfactory Auras compared with those without olfactory Auras. Results We studied 1186 patients. Thirty-seven patients (3.1%) reported olfactory Auras with their seizures. Thirty-two patients had temporal lobe surgery. Intracranial video-EEG recording was performed in four patients. Three patients with lateral temporal neocortical seizures reported olfactory Auras with their seizures; two of them were seizure-free after surgery. There were no significant clinical differences between patients with TLE and olfactory Auras compared with those without. Seizure outcome after surgery was not significantly different between these two groups (p = 0.3; Cox–Mantel test). Conclusion The rarity of olfactory Auras makes it difficult to propose new diagnostic and treatment strategies. A multicenter approach, which can enroll more patients, is needed to devise better therapies for patients with drug-resistant epilepsy and this symptom.
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Auras in patients with temporal lobe epilepsy and mesial temporal sclerosis
Journal of the Neurological Sciences, 2016Co-Authors: Ali A Asadipooya, Maromi Nei, Ashwini Sharan, Michael R SperlingAbstract:We investigated Auras in patients with drug-resistant temporal lobe epilepsy (TLE) and mesial temporal sclerosis (MTS). We also investigated the clinical differences between patients with MTS and abdominal Auras and those with MTS and non-mesial temporal Auras. All patients with drug-resistant TLE and unilateral MTS who underwent epilepsy surgery at Jefferson Comprehensive Epilepsy Center from 1986 through 2014 were evaluated. Patients with good postoperative seizure outcome were investigated. One hundred forty-nine patients (71 males and 78 females) were studied. Thirty-one patients (20.8%) reported no Auras, while 29 patients (19.5%) reported abdominal aura, and 30 patients (20.1%) reported non-mesial temporal Auras; 16 patients (10.7%) had sensory Auras, 11 patients (7.4%) had auditory Auras, and five patients (3.4%) reported visual Auras. A history of preoperative tonic-clonic seizures was strongly associated with non-mesial temporal Auras (odds ratio 3.8; 95% CI: 1.15-12.98; p=0.02). About one-fifth of patients who had MTS in their MRI and responded well to surgery reported Auras that are historically associated with non-mesial temporal structures. However, the presence of presumed non-mesial temporal Auras in a patient with MTS may herald a more widespread epileptogenic zone.
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Postoperative Auras and the risk of recurrent seizures
Epilepsy Research, 2008Co-Authors: Thenappan Chandrasekar, Ashwini Sharan, Michael R SperlingAbstract:Summary Purpose Little is known about the prognostic significance of persistent Auras following temporal lobe surgery in determining the recurrence of complex partial seizures (CPS) or generalized tonic–clonic seizures (GTCS). Methods In a retrospective analysis of temporal lobectomy patients who had preoperative Auras associated with CPS or GTCS and who were seizure-free following surgery, the predictive value of Auras was assessed at 3 months and 2 years following surgery. Medication use, in relation to the presence of Auras, was also assessed. Results Three hundred and forty-seven patients were seizure-free for 3 months following surgery (247 aura-free, 101 with persistent Auras). KM analysis yielded no difference in outcome (p = 0.65) and current outcome class was also similar (p = 0.99). Patients with persistent Auras were somewhat more likely to be on medication at the time of recurrence (p = 0.06) and at last follow-up (p = 0.09). 224 patients were seizure-free for 2 years following surgery (163 aura-free, 61 with persistent Auras). KM analysis yielded no difference in outcome (p = 0.86) and current outcome class was also similar (p = 0.35). Patients with persistent Auras were more likely to be on medication at the time of recurrence (p Conclusions Auras were not associated with increased risk of recurrence, although increased rates of AED use were seen in these patients. However, any medication effect appears to be quite small, so we consider it reasonable to advise cessation of AEDs in patients with persistent Auras who are otherwise seizure-free.
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Postoperative Auras and the risk of recurrent seizures.
Epilepsy research, 2008Co-Authors: Thenappan Chandrasekar, Ashwini D Sharan, Michael R SperlingAbstract:Little is known about the prognostic significance of persistent Auras following temporal lobe surgery in determining the recurrence of complex partial seizures (CPS) or generalized tonic-clonic seizures (GTCS). In a retrospective analysis of temporal lobectomy patients who had preoperative Auras associated with CPS or GTCS and who were seizure-free following surgery, the predictive value of Auras was assessed at 3 months and 2 years following surgery. Medication use, in relation to the presence of Auras, was also assessed. Three hundred and forty-seven patients were seizure-free for 3 months following surgery (247 aura-free, 101 with persistent Auras). KM analysis yielded no difference in outcome (p=0.65) and current outcome class was also similar (p=0.99). Patients with persistent Auras were somewhat more likely to be on medication at the time of recurrence (p=0.06) and at last follow-up (p=0.09). 224 patients were seizure-free for 2 years following surgery (163 aura-free, 61 with persistent Auras). KM analysis yielded no difference in outcome (p=0.86) and current outcome class was also similar (p=0.35). Patients with persistent Auras were more likely to be on medication at the time of recurrence (p<0.001) and at last contact (p<0.01). Auras were not associated with increased risk of recurrence, although increased rates of AED use were seen in these patients. However, any medication effect appears to be quite small, so we consider it reasonable to advise cessation of AEDs in patients with persistent Auras who are otherwise seizure-free.
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association of fear Auras with mood and anxiety disorders after temporal lobectomy
Epilepsia, 2001Co-Authors: Christian G Kohler, Michael J Oconnor, Melissa A Carran, Warren B Bilker, Michael R SperlingAbstract:Summary: Purpose: Epilepsy has been associated with increased occurrence of behavioral disorders. Auras reflect abnormal stimulation of brain areas in close proximity to regions from which clinical seizures originate. The purpose of our study was to investigate whether fear Auras are associated with a higher rate of mood and anxiety disorders before and 1 year after temporal lobectomy. Methods: Twenty-two patients with fear Auras were compared with matched groups with other Auras and no Auras. Neurologic and neuropsychological evaluations before, 1–2 months after, and 1 year after temporal lobectomy were reviewed for mood and anxiety disorders and psychotropic medication treatment. A logistic regression model examined effects of patient group and psychiatric status on postoperative psychiatric status. Results: The majority of patients in the three groups experienced mood and anxiety disorders before surgery. Mood and anxiety disorders declined in the control, but not in the fear aura group after surgery. Presence of Auras at 1 year after surgery was not related to psychiatric outcome. Postoperative mood and anxiety disorders were more common in patients with persistence of seizures and in those in the fear group who were seizure free. The minority of patients in all groups underwent psychotropic treatment before surgery, but the majority with fear Auras underwent treatment after surgery. Conclusions: Postoperative mood and anxiety disorders were more common in fear aura patients after temporal lobectomy, in particular, if seizure free. Possible mechanisms include the role of the amygdala in fear conditioning, the concepts of forced normalization, and kindling.
M. J. Coleman - One of the best experts on this subject based on the ideXlab platform.
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‘Costen's syndrome’—correlation or coincidence: a review of 45 patients with temporomandibular joint dysfunction, otalgia and other aural symptoms
Clinical Otolaryngology, 2009Co-Authors: G. B. Brookes, M. J. ColemanAbstract:Costen's syndrome—correlation or coincidence. A review of 45 patients with temporomandibular joint dysfunction, otalgia and other aural symptoms Forty-five patients with temporomandibular joint dysfunction, and otalgia together with other aural symptoms (deafness, tinnitus, pressure/blockage and vertigo) were evaluated clinically and audiometrically. The theoretical mechanisms by which aural symptoms may be produced as a result of temporomandibular joint dysfunction are outlined and discussed in the light of the patients under review. The wide diversity in the incidence of additional aural symptoms apart from otalgia reported in the literature is noted, together with the general lack of full objective audiometric assessment. In 37 patients the aural symptoms were directly attributable to other coincidental otolaryngologies] pathology. Details of the remaining 8 cases are presented. The other aural symptoms of 4 of these patients were also probably accounted for by other coincidental otolaryngologic!] pathology. It may be significant that 2 of the other patients were suffering from concurrent psychiatric disorders. Thus in this series at least 91% of the patients were considered to have other aural symptoms coincidental to temporomandibular joint dysfunction. This is compatible with the relatively common occurrence of both temporomandibular joint dysfunction and aural symptoms in the general population. This study leads us to believe that there is no direct aetiological basis to link temporomandibular joint dysfunction and other aural symptems apart from otalgia.
Miguel J A Lainez - One of the best experts on this subject based on the ideXlab platform.
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Preventing Disturbing Migraine Aura With Lamotrigine: An Open Study
Headache, 2004Co-Authors: Julio Pascual, Carlos Roig, Rogelio Leira, Ana B. Caminero, Valentín Mateos, Carlos García-moncó, Miguel J A LainezAbstract:Lamotrigine has been suggested as possibly effective for preventing migraine aura. To describe our experience with a series of patients with disturbing migraine aura treated with lamotrigine. The members of the Headache Group of the Spanish Society of Neurology were sent an ad hoc questionnaire to collect patients treated with lamotrigine due to disturbing migraine aura. The main outcome parameter ("response") was a >50% reduction in the mean frequency of migraine Auras at 3 to 6 months of treatment. A total of 47 patients had been treated with lamotrigine due to severe migraine aura. Three could not complete the protocol as a result of developing skin rashes. Thirty (68%) patients responded. These were 21 females and 9 males whose ages ranged from 19 to 71 years. Eight suffered from migraine with "prolonged" aura, 8 typical aura with migraine headache (but had frequent episodes including speech symptoms), 6 basilar-type migraine, 6 typical aura without headache, and 2 hemiplegic migraine. Fifteen had been previously treated, without response, with other preventatives. The mean monthly frequency of migraine Auras in these 30 patients changed from 4.2 (range: 1 to 15) to 0.7 (range: 0 to 6). Response was considered as excellent (>75% reduction) in 21 cases (70% of responders). Auras reappeared in 2 months in 9 out of 13 patients where lamotrigine was stopped, and ceased as soon as this drug was reintroduced. Lamotrigine should be considered in clinical practice for the preventive treatment of selected patients with disturbing migraine Auras. Lamotrigine seems worthy of a controlled trial as prophylaxis of migraine aura.
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Preventing disturbing migraine aura with lamotrigine: an open study.
Headache, 2004Co-Authors: Julio Pascual, Verónica Mateos, Caminero, Carlos García‐moncó, Carlos Roig, Rogelio Leira, Miguel J A LainezAbstract:Background.—Lamotrigine has been suggested as possibly effective for preventing migraine aura. Objective.—To describe our experience with a series of patients with disturbing migraine aura treated with lamotrigine. Methods.—The members of the Headache Group of the Spanish Society of Neurology were sent an ad hoc questionnaire to collect patients treated with lamotrigine due to disturbing migraine aura. The main outcome parameter (“response”) was a >50% reduction in the mean frequency of migraine Auras at 3 to 6 months of treatment. Results.—A total of 47 patients had been treated with lamotrigine due to severe migraine aura. Three could not complete the protocol as a result of developing skin rashes. Thirty (68%) patients responded. These were 21 females and 9 males whose ages ranged from 19 to 71 years. Eight suffered from migraine with “prolonged” aura, 8 typical aura with migraine headache (but had frequent episodes including speech symptoms), 6 basilar-type migraine, 6 typical aura without headache, and 2 hemiplegic migraine. Fifteen had been previously treated, without response, with other preventatives. The mean monthly frequency of migraine Auras in these 30 patients changed from 4.2 (range: 1 to 15) to 0.7 (range: 0 to 6). Response was considered as excellent (>75% reduction) in 21 cases (70% of responders). Auras reappeared in 2 months in 9 out of 13 patients where lamotrigine was stopped, and ceased as soon as this drug was reintroduced. Conclusions.—Lamotrigine should be considered in clinical practice for the preventive treatment of selected patients with disturbing migraine Auras. Lamotrigine seems worthy of a controlled trial as prophylaxis of migraine aura.
Elza Marcia Targas Yacubian - One of the best experts on this subject based on the ideXlab platform.
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Auras in temporal lobe epilepsy with hippocampal sclerosis relation to seizure focus laterality and post surgical outcome
Epilepsy & Behavior, 2012Co-Authors: Taissa Ferrarimarinho, Luis Otavio Sales Ferreira Caboclo, Murilo Martinez Marinho, Ricardo Silva Centeno, Rafael Scarpa Da Costa Neves, Maria Teresa Castilho Garcia Santana, Fernanda S Brito, Henrique Carrete, Elza Marcia Targas YacubianAbstract:We examined the relationship between presence and frequency of different types of Auras and side of lesion and post surgical outcomes in 205 patients with medically intractable mesial temporal lobe epilepsy (MTLE) with unilateral hippocampal sclerosis (HS). With respect to the number of Auras, multiple Auras were not associated with side of lesion (p=0.551). The side of HS was not associated with the type of Auras reported. One hundred fifty-seven patients were operated. The occurrence of multiple Auras was not associated with post-surgical outcome (p=0.740). The presence of extratemporal Auras was significantly higher in patients with poor outcome. In conclusion, this study suggests that the presence of extratemporal Auras in patients with MTLE-HS possibly reflects extratemporal epileptogenicity in these patients, who otherwise showed features suggestive of TLE. Therefore, TLE-HS patients undergoing pre-surgical evaluation and presenting clinical symptoms suggestive of extratemporal involvement should be more extensively evaluated to avoid incomplete resection of the epileptogenic zone.
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Auras and clinical features in temporal lobe epilepsy a new approach on the basis of voxel based morphometry
Epilepsy Research, 2010Co-Authors: Maria Teresa Castilho Garcia Santana, Luis Otavio Sales Ferreira Caboclo, Ricardo Silva Centeno, Henrique Carrete, Andrea Parolin Jackowski, Henrique Hattori Da Silva, Rodrigo A Bressan, Elza Marcia Targas YacubianAbstract:Summary MRI investigations in patients with temporal lobe epilepsy (TLE) with mesial temporal sclerosis (MTS) have demonstrated structural abnormalities extending beyond ipsilateral hippocampus which may be studied through voxel-based morphometry (VBM). We investigated brain morphology related to clinical features in patients with refractory TLE with MTS using VBM. One hundred patients with unilateral TLE with MTS (59 left) and 30 controls were enrolled. VBM5 was employed to analyze (1) hemispheric damage, (2) influence of initial precipitating injury (IPI): 23 patients with febrile seizures and 19 with status epilepticus, and (3) types of Auras classified as: mesial, including psychic Auras (19 patients); anterior mesio-lateral, as autonomic symptoms, specially epigastric Auras (27 patients) and neocortical, which included auditory, vertiginous, somatosensory and visual Auras (16 patients). (1) Left TLE patients presented more widespread gray matter volume (GMV) reductions affecting ipsilateral hippocampus, temporal neocortex, insula and also left uncus, precentral gyrus, thalamus, parietal lobule, cuneus and bilateral cingulum. (2) Febrile seizures group presented ipsilateral GMV reductions in hippocampus, neocortical temporal, frontal and occipital cortices, insula and cingulum. Status epilepticus group presented more widespread GMV reductions involving temporal and extratemporal lobes. (3) Patients with mesial Auras showed significant ipsilateral GMV reductions in hippocampus and amygdala, particularly right TLE group, who presented greater extension of GMV reduction in the entorhinal cortex. Significant reductions in hippocampus, amygdala and insula were seen in patients with anterior mesio-lateral Auras. This study evaluated a large number of TLE–MTS patients showing structural damage extending beyond hippocampus, and different types of IPI associated with the extension of brain damage. Subtypes of Auras are related to different clusters of areas of GMV reductions in VBM. For the first time, we have demonstrated GMV reductions anatomically correspondent to psychic (mesial areas) and autonomic Auras (mesial and insular areas) reproducing previous cortical stimulation studies.
G. B. Brookes - One of the best experts on this subject based on the ideXlab platform.
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‘Costen's syndrome’—correlation or coincidence: a review of 45 patients with temporomandibular joint dysfunction, otalgia and other aural symptoms
Clinical Otolaryngology, 2009Co-Authors: G. B. Brookes, M. J. ColemanAbstract:Costen's syndrome—correlation or coincidence. A review of 45 patients with temporomandibular joint dysfunction, otalgia and other aural symptoms Forty-five patients with temporomandibular joint dysfunction, and otalgia together with other aural symptoms (deafness, tinnitus, pressure/blockage and vertigo) were evaluated clinically and audiometrically. The theoretical mechanisms by which aural symptoms may be produced as a result of temporomandibular joint dysfunction are outlined and discussed in the light of the patients under review. The wide diversity in the incidence of additional aural symptoms apart from otalgia reported in the literature is noted, together with the general lack of full objective audiometric assessment. In 37 patients the aural symptoms were directly attributable to other coincidental otolaryngologies] pathology. Details of the remaining 8 cases are presented. The other aural symptoms of 4 of these patients were also probably accounted for by other coincidental otolaryngologic!] pathology. It may be significant that 2 of the other patients were suffering from concurrent psychiatric disorders. Thus in this series at least 91% of the patients were considered to have other aural symptoms coincidental to temporomandibular joint dysfunction. This is compatible with the relatively common occurrence of both temporomandibular joint dysfunction and aural symptoms in the general population. This study leads us to believe that there is no direct aetiological basis to link temporomandibular joint dysfunction and other aural symptems apart from otalgia.
