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W ostatnich latach opublikowano wiele rekomendacji oraz standar dow diagnostyki i leczenia chor ych z padaczką. Mimo roznic pomiedzy pr zedstawionymi zaleceniami podstawowe zasady dotyczące stosowani a lekow przeciwpadaczkowych są dokladnie określone. W Polsce w ostatnich kilku latach zasady refundacji istotnie sie zmienily. Wprowadzone zmiany umozliwiają wybor terapii zgodnie z dostepną wiedzą wynikającą z pr zeprowadzonych badan klinicznych oraz doświadczenia nagro madzonego z praktyki klinicznej. Podstawowe znaczenie dla uzyskania pozytywnego efektu stosowanej terapii ma prawidlowo przeprowadzona diagnostyka. Wlaściwe rozpoznanie odpowiedniego typu napadow padaczkowych lub określonego zespolu padaczkowego warunkuje skutecznośc terapii. W niniejszym artykule przedstawiono aktualne zalecenia dotyczące diagnozowania i leczenia padaczki zarowno n a etapie wstepnym, jak i u osob z podejr zeniem padaczki lekoopornej. Dokonano rowniez adaptacji rekomendacji miedzynarodowych do warunkow systemu opieki medycznej funkcjonującego w Polsce. Na podstawie dostepnych danych naukowych oraz uwarunkowan refundacyjnych obowiązujących w Polsce na rok 2020 Sekcja Padaczki Polskiego Towarzystwa Neurologicznego opracowala niniejsze rekomendacje.

Patients undergoing presurgical evaluation for resective epilepsy surgery require the localization of the epileptogenic zone. The detection and analysis of interictal and ictal epileptiform spikes are of major importance for identifying this area. The “irritative zone” of the cortex with interictal spikes is usually revealed intraoperatively during acute electrocorticography (ECoG). Since ECoG recordings cannot be completely visually reviewed in a reasonable amount of time, computer algorithms for the automatic detection of seizures and spikes were developed. We proposed the spike detection algorithm based on the definition of the physical properties of the sought spikes (duration and amplitude). The parameters are easily interpreted by neurophysiologists. The detection sensitivity was 93%, and the precision was 99%. In addition, based on the number of spikes detected on individual electrodes, it is possible to draw the “frequency of spike occurrence” map. The algorithm proved to be so effective in analyzing ECoG records, as it is allowed to be used in practice.

Objectives: The resection of an epileptic focus provides a chance for seizure outcome regression, which markedly influences the level of patients' quality of life. One of its dimensions is the satisfaction with one's sexual life. Patients with epilepsy usually report low sexual satisfaction due to commonly diagnosed disturbances of sexual functions characterized by a multifactorial etiology. The aim of the study was to assess the level of satisfaction with their sexual life in patients after the surgical resection of an epileptic focus. Patients and methods: The study group included 63 patients who had undergone the surgical resection of an epileptic focus in a neurosurgical ward. The study was conducted with the present authors' own tool consisting of three parts. Result: The patients assessed their sexual life as moderately satisfactory (the average score was 4 out of a 7-grade scale). 38% of the respondents reported a complete withdrawal from sexual life, sporadic sexual activity or masturbatory behavior (instead of interactive behavior). This type of behavior correlates with the reduction in sexual satisfaction. Higher satisfaction is associated with initiating new behavior which is adequate to the patient's health status, more frequent sexual contacts or no changes between behavior before and after the surgery. Moreover, the removal of an epileptic focus reduced the fear of a possible seizure during intercourse. Conclusion: Based on the findings it may be assumed that the sexual satisfaction of patients with epilepsy after the resection of an epileptogenic focus is markedly affected by psychological factors, which should be considered in the therapeutic process. Keywords: Epilepsy, Sexual satisfaction, Epileptic focus resection, Quality of life

Dysfunction in the understanding of social signals has been reported in persons with epilepsy, which may partially explain lower levels of life satisfaction in this patient population. Extensive assessment is necessary, particularly when the mesial temporal lobe, responsible for emotion processing, is affected. The authors examined multiple levels of social perception in patients with mesial temporal lobe epilepsy (MTLE), including judgments of point-light motion displays of human communicative interactions (Communicative Interactions Database-5 Alternative Forced Choice format) and theory-of-mind processes evaluated using geometric shapes (Frith-Happé animations [FHA]). This case-control study included MTLE patients with anterior temporal lobectomies (ATL+) (N=19), MTLE patients without lobectomies (ATL-) (N=21), and healthy controls (HCs) (N=20). Both groups of MTLE patients were less efficient in recognizing goal-directed and mentalizing interactions of FHA compared with HC subjects. The ATL+ group attributed emotions to FHA less accurately than HC subjects. Both the ATL- and ATL+ groups classified individual point-light animations more often as communicative than the HC group. ATL+ patients were also less efficient in interpreting point-light animations in terms of individual actions than the HC group. The number of years of epilepsy duration was inversely correlated with recognition of FHA interactions. The mean number of seizures was inversely correlated with the interaction identification in point-light stimuli. Patients with MTLE, irrespective of surgical treatment, present impaired social perception in domains assessed with abstract moving shapes or nonabstract biological motion. This impairment may be the basis of problems faced by patients reporting difficulties in understanding the intentions and feelings of other individuals.

Introduction Epilepsy is one of the most common neurological disorders. Seizures that occur during attacks may lead to head injuries. It is crucial to establish proper prophylactic management against trauma occurrence, as nowadays prevention is not sufficient. Aim Assessment of the frequency of head and intraoral trauma during epileptic seizures and to evaluate factors that may predispose to injuries. Material and Methods The questionnaire was carried out among 106 patients with epilepsy. Survey conducted questions regarding development of the disease and occurrence of orodental and head trauma. Results were statistically analyzed with the chi-square test (p Results 52.4% of subjects admitted the occurrence of oral trauma during epileptic seizures. The most common were lips, tongue or cheeks injuries. 18% patients suffered from tooth crack and 17% from tooth fracture. 50% of respondents suffered from head trauma during seizures: 41% patients reported bruises, 39% burns, 37% wounds, 10% nose fractures, 7% eye socket trauma and 3% skull crack. 14.1% of respondents experienced dentist refusal to undertake treatment, while 4% of patients had epileptic attack during dental procedures. Conclusions Dental trauma is common result of epileptic seizures. It is necessary to implement prophylactic management to prevent hard and soft tissues injuries, for example by using custom-made mouthguards. Moreover, specially designed dental programs for this group of patients should be provided.

This article presents a comprehensive system for automatic heart rate (HR) detection. The system is robust and resistant to disturbances (noise, interferences, artifacts) occurring mainly during epileptic seizures. ECG signal filtration (IIR) and normalization due to skewness and standard deviation were used as preprocessing steps. A key element of the system is a reference QRS complex pattern calculated individually for each ECG recording. Next, a cross-correlation of the reference QRS pattern with short, normalized ECG windows is calculated and the maxima of the correlation are found (R-wave locations). Determination of the RR intervals makes possible calculation of heart rate changes and also heart rate variability (HRV). The algorithm was tested using a simulation in which a noise of an amplitude several times higher than ECG standard deviation levels was added. The proposed algorithm is characterized by high QRS detection accuracy, and high sensitivity and specificity. The algorithm proved to be useful in clinical practice, where it was used to automatically determine HR for ECG signals recorded before and during 58 focal seizures in 56 adult patients with intractable temporal lobe epilepsy.

The article presents a system for detection of epileptic seizures with the use of automatic ECoG signal analysis. Features in the form of signal energy in nine different signal subbands were used. Next algorithms of feature selection (SFS, SBS) and classification (LDA, QDA) were performed. The developed algorithm was tested on signals taken from the ECoG database, containing signals recorded during epileptic seizures and without seizures. The proposed method is characterized by relatively low computational complexity and satisfactory accuracy of classification - up to 98%.

Epilepsy is a common neurological disorder. About one-third of epileptic patients demonstrate multidrug resistance (MDR) phenotype and develop drug-resistant epilepsy (DRE). Single nucleotide polymorphism (SNP) C3435T (rs1045642), identified in the MDR1 gene, is associated with an increased intestinal expression of P-glycoprotein (P-gp) which affects the levels of anti-epileptic drugs in plasma. The reported study was designed to explore associations between the MDR1-C3435T gene SNP and the risk of DRE in the Polish population. The C3435T polymorphism of MDR1 gene was investigated by the PCR-RFLP technique in 74 patients with DRE and 70 age- and sex-matched non-DRE controls. Blood samples were obtained from patients with drug-resistant epilepsy, treated at the Department of Neurological Surgery, Medical University in Warsaw between the years 2011 and 2012. Odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated for each genotype and allele. Genotype distribution of C3435T polymorphism of MDR1 gene was compared between the DRE patients and controls with significant differences (p

Objective. Temporal lobe tumours, especially low-grade gliomas and glioneuronal tumours, are common causes of seizures in patients referred for epilepsy surgery. We here present our experience of surgical treatment of patients with intractable chronic epilepsy associated with temporal lobe tumours, focusing on the long-term surgical outcomes and the features associated with better seizure control. Methods. In this study, we retrospectively analysed 44 consecutive patients from a total of 182 with refractory temporal lobe epilepsy presenting with long-term intractable epilepsy due to a temporal lobe tumour who were surgically treated at our institution between 2005 and 2015 with post-surgical follow-up of at least two years. All patients underwent a standard pre-surgical evaluation that included: history and physical examination with a description of the seizure semiology, serial scalp EEG recording, brain MR imaging, and a detailed neuropsychological evaluation. Our surgical strategy comprised tumour resection, and combined mesial temporal and neocortical resection in most cases. Results. No patient died during surgery or the postoperative course. Seven patients had postoperative complications, of whom two had permanent hemiparesis due to ischaemic stroke. At the final follow-up, a favourable seizure outcome (Engel Class I) was found in 37 patients (84%), including 31 (70.5%) in Engel Class IA (excellent result). Two (4.5%) patients presented with an Engel Class II outcome (unfavourable outcome). Five patients (11.5%) were in Engel Classes III or IV (surgical failure). We found that complete resection of the hippocampus along with tumour and temporal pole removal was strongly associated with seizure freedom (p = 0.015). Pathological diagnosis was also a significant prognostic indicator of tumour-related seizure freedom. Patients with a diagnosis of a glioneuronal tumour benefited from more seizure freedom after resection compared to those who had a low-grade glioma (p = 0.024). Conclusion. The most appropriate management of tumour-related chronic temporal lobe epilepsy in adults appears to be tai-lored temporal lobe resection including tumour and hippocampal complex removal. Surgical treatment of tumoural temporal lobe epilepsy demonstrates excellent results in terms of seizure improvement, especially in patients with glioneuronal tumours.

Localization of the epileptogenic zone (EZ) is very important for patients undergoing presurgical evaluation for resective epilepsy surgery. The detection of epileptiform spikes is of major importance for identifying the epileptogenic zone. The zone of cortex with interictal spikes is usually revealed intraoperatively, during acute electrocorticography (ECoG). The ECoG recordings cannot be completely visually reviewed, by a specialist, in a reasonable amount of time. So, computer algorithms for the automatic detection of spikes are very desirable. The article contains a proposal of spike detection algorithm, based on three ECoG signal parameters: signal energy, entropy and fractal dimension. The sensitivity of spike detection was 0.83, the specificity was 0.98 and the precision – 0.91.

The presurgical evaluation patients for resective epilepsy surgery require localization of the epileptogenic cortical zone (EZ). The detection and analysis of interictal and ictal epileptiform spikes is of major importance for identifying this area. The “irritative zone” of cortex with interictal spikes are usually revealed intraoperatively during acute electrocorticogram (ECoG). Since ECoG recordings cannot be completely visually reviewed in a reasonable amount of time, computer algorithms for automatic detection of seizures and spikes were developed. In this article we present a method of spike detection in ECoG signal using lagged phase space (LPS). Vectors in lagged phased space are treated as features. For spike detection we used expectation-maximization (EM) clustering algorithm. In this way we obtained quite high detection accuracy 96.4%.

The aim of this study was to analyse the frequency of genotypes and alleles of single-nucleotide polymorphism (SNP)-G2677T/A (rs2032582) of MDR1 gene and to investigate the significance this genetic variation exerts on drug-resistant epilepsy (DRE) in the Polish adult population. The study comprised 340 patients treated for DRE and 240 patients treated for drug-responsive epilepsy. Three hundred and sixty disease-free individuals were used as controls. Genomic DNA was isolated, and the SNP G2677T/A of MDR1 was determined by High-Resolution Melter technique. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for each genotype and allele. In this paper, we have demonstrated that A allele of SNP G2677T/A of MDR1 may reduce the risk of DRE (OR 0.44; 95% CI 0.33-0.58, p 0.0001), whereas allele G itself may be a risk factor for this disease. No differences were found in the distribution of the genotypes and alleles in the studied groups, depending on sex as well as on concomitant diseases (p 0.05). G2677T/A polymorphism of MDR1 may play a significant role in the development of DRE in the Polish patients.

Purpose The aim of the study was to examine if gaze and emotional expression, both highly self-relevant social signals, affect the recollection accuracy of perceived faces in patients with mesial temporal lobe epilepsy (MTLE). Methods Forty patients with MTLE (twenty-one without surgery and nineteen after anterior temporal lobectomy) as well as twenty healthy controls (HC) took part in the study. We used a set of 64 facial stimuli: 32 neutral and 32 emotional displays (16 fearful; 16 angry) from well-established affective stimuli databases. Half of the faces in each condition had eyes directed straight and half — away from the observer. Participants performed a gender identification task, and then, after a 45-minute delay were asked to identify the previously seen stimuli, presented among a new set of photos. Results Increased automatic learning of angry and fearful compared to neutral expressions was found in HC. There was no emotional enhancement of memory in MTLE but an increased learning for faces with averted than direct gaze. Conclusion Our results expand on previous research by demonstrating that emotion expression and gaze direction can affect memory of faces. The study supports the hypothesis that healthy individuals and patients with temporal lobe abnormalities present different patterns of emotional gazes processing. The potential consequences of altered emotional gaze processing and social cognition impairments need to be further investigated to improve the quality of life of patients with MTLE.

The aim of the study was to assess the differences in health-related quality of life in groups of men and women suffering with drug-resistant epilepsy and to determine which factors influence quality of life.The examined group consisted of 64 subjects with drug-resistant epilepsy - 31 men and 33 women. The mean duration of epilepsy was 17.56±8.92 and 19±9.56years, respectively. The following diagnostic tools were used: QOLIE-31-P, Wechsler Adult Intelligence Scale - Revised (WAIS-R (PL)), and Hamilton Rating Scale for Depression (HRSD).Scores in QOLIE-31-P did not differ significantly between groups of men and women with drug-resistant epilepsy; however, a more detailed analysis revealed certain disparities. Multiple regression analyses indicated that some distinct factors were associated with quality of life in each sex. In the group of women, there were no significant predictors of their quality of life. Among the group of men, depression intensity was the only statistically significant QoL predictor, explaining 16% of the variance (adjusted R(2)=0.16, F(6, 24)=19.7, p0.01). Moreover, patients with depression had lowered scores in the Emotional Well-Being and Energy/Fatigue subscales, regardless of the sex.The study revealed that, despite similar scores in QOLIE-31-P, specific factors may differentially affect the quality of life of men and women with drug-resistant epilepsy in Poland. Nevertheless, replication of these results with a larger number of participants is needed for a more definitive conclusion.

The paper presents the study concerning the application of a single-class support vector machine (SVM) and directed transfer function method for the localization of the region of the brain containing the epileptic focus on the basis of EEG registration. The results of the performed numerical experiments for the localization of the seizure focus in the brain will be demonstrated on the examples of EEG for few patients.

PurposeThe electric stimulation of the vagus nerve is used to obtain therapeutic results in epilepsy, depression and Alzheimer diseases. The purpose of this paper is to show numerical model of stimulation, focusing on the mathematical approach to modeling a phenomenon of neural cells activation and its propagation in the nerve.Design/methodology/approachThe paper presents a model based on the bidomain theory. It uses two continuous, averaged domains which depict the intra‐ and extra‐cellular domains and are connected with the membrane ionic currents. The numerical model uses 3D cylindrical model approximating the anatomical shape of the neck. The simulator is based on a time domain finite element method.FindingsThe presented approach allows to model the discrete behaviour of the membrane potential in the macroscopic, realistic model of the nerve. The validation of the parameters with the velocity of activation propagations suggests the strong disscussion on physical interpretation to the bidomain theory parameters. To obtain realistic results the parameters needed to be unrealistic.Originality/valueThe paper presents the combination of bidomain model of neural tissue with the time domain finite element method along with the atributes of bidomain model for realistic modeling of the process of propagtion of activation.

PurposeThe purpose of this paper is to develop the new method of estimation of the short‐term largest Lyapunov exponent of electroencephalogram (EEG) waveforms for the detection and prediction of the epileptic seizure.Design/methodology/approachThe paper proposed the modifications concerned with the way of selection of the segments of EEG waveforms taking part in estimation of Lyapunov exponent, as well as determination of the distances between two time series. The proposed method is based on Kolmogorov‐Smirnov test of similarity of two vectors. Through the application of this test more accurate and less parameterized approach to the estimation of the short‐term largest Lyapunov exponent of EEG waveforms has been obtained.FindingsThe results of performed experiments have shown that in most cases our modified method has outperformed the classical procedure, leading to more stable results, closer to the neurologist indications. The analysis of the data has proved that the change of the largest Lyapunov exponent provides a lot of information regarding the epileptic seizure. The minimum value of Lyapunov exponent indicates fairly well the seizure moment. The Tindex applied for few different electrode sites can provide good advanced prediction of the incoming epileptic seizure.Practical implicationsAfter additional experiments this method may find practical application for supporting the medical diagnosis of the epilepsy.Originality/valueThe proposed modification of the estimation of the short‐term largest Lyapunov exponent of the EEG waveforms eliminates some arbitrarily chosen parameters tuned by the user and leads to more accurate estimate. Such estimation results are better suited for the characterization of the epileptic activity.

The Procedure for SPECT and BEAM Images Adjustment Visualisation of EEG Electrodes in SPECT Images Preliminary results of research to devise a method allowing spatial alignment of BEAM maps obtained from EEG examinations with SPECT data are presented. The main concept of the method presented lies in simultaneous recording of multi-channel EEGs during SPECT examination, and also in visualizing location of EEG electrodes on SPECT images that provide spatial three dimensional coordinates assignment. The proposed methodology of simultaneous SPECT and EEG examinations could be a significant complement to results of epileptic focus localisation obtained with the ISAS method used for the last few years. The ISAS method allows localisation of focuses with 80% confidence, but it requires carrying out MRI examinations for alignment of compared anatomical structures on two SPECT images. Complementing these results with a BEAM map analysis would improve significantly the effectiveness of the examinations. This work presents results of experiments carried out on the Jaszczak phantom.

Focal cortical dysplasia (FCD) is a developmental brain disorder characterized by localized abnormalities of cortical layering and neuronal morphology. It is associated with pharmacologically intractable forms of epilepsy in both children and adults. The mechanisms that underlie FCD-associated seizures and lead to the progression of the disease are unclear. Matrix metalloproteinases (MMPs) are enzymes that are able to influence neuronal function through extracellular proteolysis in various normal and pathological conditions. The results of experiments that have used rodent models showed that extracellular MMP-9 can play an important role in epileptogenesis. However, no studies have shown that MMP-9 is involved in the pathogenesis of human epilepsy. The aim of the present study was to determine whether MMP-9 plays a role in intractable epilepsy. Using an unbiased antibody microarray approach, we found that up regulation of MMP-9 is prominent and consistent in FCD tissue derived from epilepsy surgery, regardless of the patient's age. Additionally, an up regulation of MMP-1, -2, -8, -10, and -13 was found but was either less pronounced or limited only to adult cases. In the dysplastic cortex, immunohistochemistry revealed that the highest MMP-9 immuno reactivity occurred in the cytoplasm of abnormal neurons and balloon cells. The neuronal over expression of MMP-9 also occurred in sclerotic hippocampi that were excised together with the dysplastic cortex, but sclerotic hippocampi were free of dysplastic features. In both locations, MMP-9 was also found in reactive astrocytes, albeit to a lesser extent. At the subcellular level, increased MMP-9 immunoreactivity was prominently upregulated at synapses. Thus, although upregulation of the enzyme in FCD is not causally linked to the developmental malformation, it may be a result of ongoing abnormal synaptic plasticity. The present findings support the hypothesis of the pathogenic role of MMP-9 in human epilepsy and may stimulate discussions about whether MMPs could be novel therapeutic targets for intractable epilepsy.

Lipidization is observed only occasionally in primary neuroectodermal tumors of the central nervous system. It may reflect lipomatous transformation of tumor cells into xanthomatous and/or adipocyte-like cells. We report a unique case of mixed glioneuronal tumor with marked lipomatous changes in a young patient with intractable epilepsy. MRI revealed a well-circumscribed lesion in the right temporal lobe. Histopathological findings showed the pleomorphic tumor with numerous cells containing large lipid droplets, resembling mature adipocytes, that were arranged in clusters or scattered within the neoplastic tissue. The tumor was composed of both glial and neuronal elements. Some tumor cells displayed features intermediate between glial and neuronal cells. The reticulin fibers were limited to blood vessels. Mitotic figures, vascular proliferation, and necrosis were absent, and MIB-1 labeling index was less than 1%. Diffuse immunoreactivity for GFAP and S100-protein was observed. In some heavily lipidized cells, the lipid droplets were surrounded by a cytoplasmic rim of GFAP immunoreactivity. Numerous cells exhibited immunostaining for NSE and synaptophysin. This is the first documented case of glioneuronal tumor with extensive lipomatous transformation, which might be considered as a heavily lipidized unclassified pleomorphic glioneuronal tumor or a variant of lipoganglioglioma with marked pleomorphism and severe lipidization.

The paper presents the application of a single-class Support Vector Machine (SVM) for localization of the focus region at the epileptic seizure on the basis of EEG registration. The diagnostic features used in recognition are derived from the directed transfer function description, determined for different ranges of EEG signals. The results of the performed numerical experiments for the localization of the seizure focus in the brain have been confirmed by the real surgery of the brain for few patients.

An isolated, well-differentiated ectopic cerebellum arising outside the posterior fossa is extremely rare. We present a unique case of ectopic cerebellum in 25-year-old woman with hypertelorism, skull deformation, and a longstanding history of epileptic seizures. Magnetic resonance imaging revealed a mass lesion at the base of the frontal lobes with no apparent connections to the adjacent brain structures. Total resection of the lesion was performed. On gross inspection, its surface resembled cerebellar cortex with densely packed folia. Histologically, the cerebellar cortex was composed of well-differentiated external molecular, Purkinje cell, and internal granular cell layers. The deeper part of white matter displayed the features of neuroglial, hamartomatouslike abnormalities. There were numerous neuronal and/or glial heterotopias ranging from single dysplastic neurons to well-circumscribed clusters of neuronal and/or glial cells surrounded by neuropil. Some large neurons looked like mature ganglion cells, Purkinje cells, or dentate neurons. Large irregular islands of heterotopic tissue displaying well-differentiated cerebellar cortex could also be seen. Other parts of the ectopic cerebellum revealed loosening of tissue with dispersed glioneuronal elements. The ectopic brain tissue may arise from disturbed migration of primitive pluripotent stem cells during embryogenesis. The presented case of cerebellar ectopia associated with skull congenital malformations exhibited multiple dysontogenetic abnormalities. To our knowledge, this is the first report of totally isolated, well-differentiated ectopic cerebellum in the anterior cranial fossa accompanied by skull deformation and epilepsy.

The paper presents the application of the largest short-term Laypunov exponents for the characterization of the epileptic activity on the basis of the observed EEG waveforms. The proposed by authors modified method of Lyapunov exponent estimation for detection and prediction of the seizure on the basis of EEG waveform is presented and discussed. The results of the performed numerical experiments for the recognition of the seizure activity of the brain are demonstrated.

The aim of the study was to assess the function of the central motor pathway in young patients with diabetes mellitus type 1 by use of transcranial and paravertebral magnetic stimulation.MEPs were recorded in 68 young patients (25+/-5.69 years), with diabetes mellitus type 1, from muscles: abductor digiti minimi and abductor hallucis (AH). Central motor conduction time (CMCT) was calculated by subtracting cortical latency (CL) after transcranial stimulation from the motor nerve conduction time (MNCT) after paravertebral stimulation. The obtained results were compared with normative data from the group of 36 healthy volunteers, matched for age and height. Statistical comparison of CMCT between diabetic and control groups was performed.There were no significant differences between the diabetics and control means of CMCT. Also, we were unable to elicit the MEPs cortically from AH muscle in 19 (27.9%) of diabetic patients and only in 3 (8.3%) controls.CMCT is normal in patients below 40 years of age, in whom the MEPs after transcranial stimulation can be elicited. Lack of MEPs in lower limb muscles following transcranial stimulation in almost 30% of patients in the presence of MEPs in upper limbs may indirectly suggest the dysfunction of central motor conduction in those cases.

Changes over time in evoked potentials of various modality (VEP, SSEP and BAEP) were analyzed in 3 patients, submitted to chronic Vagus Nerve Stimulation (VNS) due to drug resistant epilepsy. The aim of a study was to establish which cerebral structures are most prone to change their baseline electrophysiological status in consequence of chronic VNS. Evoked potentials were examined before the Vagus Nerve Stimulator implantation and at arbitrarily defined follow-ups several months after the implantation. Preliminary results obtained in a small group of 3 patients suggest a possible prolongation of the central conduction time in the examined modalities of evoked potentials due to the VNS treatment. A hypothetical mechanism of antiepileptic VNS action might be related to the permanent stimulation of brainstem and cortical structures that limit seizures propagation through hyperpolarisation both at the cortical level and in subcortical structures.

Vagus nerve stimulation (VNS) is an alternative non-destructive surgical treatment for patients with medically intractable epilepsy. Neither the rationale nor proper indications for this treatment modality have been fully established yet.To assess the long-term efficacy of chronic VNS.A series of 6 patients with drug-resistant epilepsy, subjected to VNS therapy. (4 females, 2 males, mean age 35.5 years, 3 patients with focal epilepsy, 3 with non-focal epilepsy, mean history of seizures 10 years, seizures frequency 10-400/per month).An open-label prospective study with a 4-year follow-up.At a 4-year follow-up one patient (with non-focal epilepsy) was seizure-free, with only rare episodes of aura (Engel Ia), while in another one (with bitemporal epilepsy) seizures frequency remained unchanged with VNS (Engel IVb). In the remaining 4 cases (one with bitemporal, one with parietal, and two with non-focal epilepsy) the mean overall reduction in seizures frequency as compared to the baseline was 60% (Engel IIIa). VNS resulted in a reduction of seizures by 90% in a patient with a history of an unsuccessful anterior callosotomy.1. VNS was found to reduce both the frequency of seizures (an overall 60% reduction in seizures frequency) and the duration of post-seizure consciousness disturbances in focal and non-focal epilepsies, but seizures-free state could be obtained in only one out of six patients. 2. A previous unsuccessful callosotomy did not prevent a good anticonvulsant effect in one patient. 3. The anticonvulsant effect of VNS was cumulative over time during the first 3 years postoperatively, then it tended to reach a plateau. 4. The best clinical outcome was positively correlated with the currents 1.5-2.0 mA. No significant correlation was noted for the current adjustments at the level of 2.0-3.5 mA. 5. Since no difference between the two stimulation patterns tested (30 s stimulation + 5 min break vs. 14 s + 3 min) was found as regards the anticonvulsant action of VNS, the latter pattern was subsequently used as the one more sparing the battery.

The paper presents the method of predicting the epileptic seizure on the basis of EEG waveform analysis. The Support Vector Machine and the largest Lyapunov exponent characterization of EEG segments are employed to predict the incoming seizure. The results of numerical experiments will be presented and discussed.

Background: Epilepsy resistant to pharmacological treatment still remains one of the main problems in contemporary epileptology. The problem most frequently concerns patients with focal epilepsy, with the seizure focus possible to localize. In case of drug-resistant epilepsy, both morphological imaging methods (MR) and manual measurementa or volumetry are used. Also functional studies, such as MRS (magnetic resonance spectroscopy), fMRI (functional magnetic resonance), SPECT (single photon emission tomography) and PET (positron emission tomography) are performed. Material/Methods: The study presents application of own computer program based on the method of segmentation of the cerebrospinal fluid (CSF) and the brain tissue. The program calculates automatically the brain-fluin index in the hippocampal region. The material comprises the brain-fluin index results calculated with the presented program in comparison with the method of manual delineation in a group of 50 patients with drug-resistant temporal lobe epilepsy. The program is easy to use, it reads the MR data recorded in DICOM installed on a PC. Results: The brain-fluin index result (expressed as a decimal fraction) is calculated on the basis of 4 consecutive layers examined by MR (evaluating hippocampal structures) performed using SE sequence, and T2-weighted imaging in the frontal plane perpendicular to the long axis of the temporal lobes. The results obtained in epilepsy patients were compared with 24 control subjects. Conclusions: Detailed analysis of the obtained data allowed to conclude that precise hippocampal volume assessment can be obtained by combination of both methods, i.e. manual delineation and automatic calculation of brain-fluin index taking into consideration the total volume of cerebral structures.