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OBJECTIVE: Completeness as a predictor of seizure freedom is broadly accepted in epilepsy surgery. We focused on the requirements for a complete hemispherotomy and hypothesized that the disconnection of the insula contributes to a favorable postoperative seizure outcome. We analyzed surgical and non-surgical predictors influencing long-term seizure outcome before and after a modification of our hemispherotomy technique.; METHODS: We retrospectively studied surgical procedures, electro-clinical parameters, MRI results, and follow-up data in all children who had undergone hemispherotomy between 2001 and 2018 at our institution. We used logistic regression models to analyze the influence of different factors on seizure outcome.; RESULTS: 152 patients were eligible for seizure outcome analysis only. Of these, 140 cases had complete follow-up data for ≥24 months and provide the basis for the following results. The median age at surgery was 4.3years (range 0.3-17.9years). Complete disconnection (including the insular tissue) was achieved in 63.6% (89/140). At two-year follow-up, seizure freedom (Engel class IA) was observed in 34.8% (8/23) with incomplete insular disconnection while this was achieved in 88.8% (79/89) with complete surgical disconnection (p

Transient global amnesia (TGA) is defined by an acute memory disturbance of unclear aetiology for a period of less than 24 h. Observed psychological, neuroanatomical and hormonal differences between the sexes in episodic memory suggest sex-specific differences in memory disorders such as TGA. The aim of this study was to determine sex-specific differences in cardiovascular risk profiles, recurrences and magnetic resonance imaging (MRI). In total, 372 hospitalised TGA patients between 01/2011 and 10/2021 were retrospectively analysed. Comparisons were made between female and male TGA patients and compared to 216 patients with acute stroke. In our sample, women were overrepresented (61.8%), especially compared to the general population in the 65–74 age category (χ2 = 10.6, p < 0.02). On admission, female TGA patients had significantly higher systolic blood pressure values and a higher degree of cerebral microangiopathy compared to male TGA patients, whereas acute stroke patients did not. No sex-specific differences were observed with respect to recurrences or hippocampal DWI lesions. Our data demonstrate sex-specific differences in TGA. The higher blood pressure on admission and different degree of cerebral microangiopathy in female TGA patients supports the theory of blood pressure dysregulation as a disease trigger. Distinct precipitating events in female and male patients could lead to differences in the severity and duration of blood pressure abnormalities, possibly explaining the higher incidence in female patients.

OBJECTIVE: Focal cortical dysplasias (FCDs) are a common cause of drug-resistant focal epilepsy but frequently remain undetected by conventional magnetic resonance imaging (MRI) assessment. The visual detection can be facilitated by morphometric analysis of T1-weighted images, for example, using the Morphometric Analysis Program (v2018; MAP18), which was introduced in 2005, independently validated for its clinical benefits, and successfully integrated in standard presurgical workflows of numerous epilepsy centers worldwide. Here we aimed to develop an artificial neural network (ANN) classifier for robust automated detection of FCDs based on these morphometric maps and probe its generalization performance in a large, independent data set. METHODS: In this retrospective study, we created a feed-forward ANN for FCD detection based on the morphometric output maps of MAP18. The ANN was trained and cross-validated on 113 patients (62 female, mean age ± SD =29.5 ± 13.6 years) with manually segmented FCDs and 362 healthy controls (161 female, mean age ± SD =30.2 ± 9.6 years) acquired on 13 different scanners. In addition, we validated the performance of the trained ANN on an independent, unseen data set of 60 FCD patients (28 female, mean age ± SD =30 ± 15.26 years) and 70 healthy controls (42 females, mean age ± SD = 40.0 ± 12.54 years). RESULTS: In the cross-validation, the ANN achieved a sensitivity of 87.4% at a specificity of 85.4% on the training data set. On the independent validation data set, our method still reached a sensitivity of 81.0% at a comparably high specificity of 84.3%. SIGNIFICANCE: Our method shows a robust automated detection of FCDs and performance generalizability, largely independent of scanning site or MR-sequence parameters. Taken together with the minimal input requirements of a standard T1 image, our approach constitutes a clinically viable and useful tool in the presurgical diagnostic routine for drug-resistant focal epilepsy. ispartof: EPILEPSIA vol:62 issue:4 pages:1005-1021 ispartof: location:United States status: published

Typische MRT-Veranderungen bei limbischer Enzephalitis (LE) sind FLAIR- bzw. T2-Hyperintensitaten und Volumenzunahmen (Schwellungen) in temporomesialen Strukturen (insbesondere der Amygdala), die sich im Verlauf dynamisch darstellen konnen (bilateral oder seitenwechselnd, zu- bzw. abnehmend). Die Rolle der Bildgebung ist es, den klinischen Verdacht auf eine LE zu verstarken, noch bevor der Antikorperstatus bekannt ist. Dabei geht es auch darum, wesentliche Differenzialdiagnosen (periiktale MRT-Veranderungen, Herpes-simplex-Virus-Enzephalitis oder Tumoren) fruh unwahrscheinlich zu machen. Zwar unterscheidet die Bildgebung nicht zwischen limbischen Autoimmunenzephalitiden (meist mit Antikorpern gegen Antigene auf neuralen Oberflachen, z. B. Anti-LGI1-Enzephalitis) und autoimmun-assoziierten Epilepsien bei LE (oft mit Antikorpern gegen intrazellulare neurale Antigene, z. B. bei LE mit GAD-Antikorpern). Die MRT ist aber in der Lage, Verlaufe zu dokumentieren, seien es rucklaufige temporomesiale Veranderungen (z. B. nach erfolgreicher Therapie) oder die Entwicklung einer Hippocampussklerose.

Wir berichten uber 2 Patientinnen mit differenzialdiagnostisch schwieriger Konstellation. In beiden Fallen wurden durch den EEG-Befund bzw. anamnestische Details „falsche Fahrten“ gelegt. Implikationen fur die Praxis werden diskutiert.

Objective Some patients with genetic generalized epilepsy (GGE) may present with ambiguous and atypical findings and even focal brain abnormalities. Correct diagnosis may therefore be difficult. Methods We retrospectively collected six patients investigated on the epilepsy monitoring unit with MRI abnormalities mimicking focal cortical dysplasia (FCD‐like) or heterotopias, but with semiology and EEG features of GGE. We compared them to four additional patients with GGE and nonmigratory abnormalities. Results All six patients presented with frontal MRI lesions: radial (“transmantle,” n = 4), cortical‐subcortical (n = 1), and periventricular heterotopia (n = 1). Five had positive family histories. Semiologic lateralizing signs compatible with the lesion were seen in four. Five patients had 3/s spike‐wave complexes, with an asymmetric appearance in three. Regional EEG changes matched with the side of the abnormality in three patients. Invasive EEG (n = 2) or postoperative outcomes (n = 3) argued against an ictogenic role of the MRI abnormalities. Histology showed mild malformation of cortical development, but no focal cortical dysplasia. The six patients were finally diagnosed with juvenile myoclonic epilepsy (n = 2), juvenile absence epilepsy (n = 2), or GGE not further specified (nfs, n = 2). Compared to these patients, the other four (final diagnoses: childhood absence epilepsy, n = 1; perioral myoclonia with absences, n = 1; and GGE nfs, n = 2) had no lateralizing EEG findings. Significance Patients with GGE may have coincidental MRI abnormalities. These cases are challenging as frontal epilepsy and GGE can present with similar semiologies. GGE with coincidental FCD‐like lesions/heterotopias is in particular difficult to diagnose as patients have more lateralizing features (in semiology and EEG) than those with tumors. A detailed noninvasive presurgical evaluation may be justified. We point out red flags that may help to distinguish GGE from frontal epilepsy, even in the presence of brain abnormalities: 3/s spike waves (even if asymmetric), changing lateralizing signs at different times, and a positive family history hinting at GGE.

Background: Emotion dysfunction is a key symptom in patients with borderline personality disorder (BPD) and is considered a consequence of dysfunctional emotion regulation (e.g., reduced emotion acceptance). In the present functional MRI (fMRI) study, we investigated the neural correlates of habitual emotion acceptance in individuals with BPD.; Methods: Female patients with BPD and female healthy controls passively viewed negative and neutral movie clips of faces during fMRI. We assessed emotion acceptance using the Emotion Acceptance Questionnaire (EAQ). To examine brain activation associated with habitual emotional acceptance of negative stimuli, the EAQ score was included as a regressor of interest in brain data analyses of activation intensity during negative compared with neutral movies.; Results: We included 20 women with BPD and 20 heatlhy controls in our analysis. Compared with healthy controls, patients with BPD showed significantly more activation in frontostriatal brain regions (i.e., left superior frontal gyrus, right caudate) as well as in the left precuneus, left precentral gyrus, left posterior cingulate cortex and left hippocampus when confronted with negative (v. neutral) stimuli. Patients with BPD reported decreased emotion acceptance compared with healthy controls, and habitual emotion acceptance was inversely associated with activation of striatal areas (i.e., left putamen, left caudate) in patients with BPD.; Limitations: Causal conclusions are not possible. Comorbid diagnoses were not excluded, and only female participants were investigated. Stimuli were not rated immediately and may not be generalizable to all negative emotions. We cannot make any statements about other emotion-regulation strategies that may have been applied here.; Conclusion: Data indicate that striatal hyperactivation during the processing of negative stimuli in women with BPD is related to their decreased disposition to accept unpleasant emotional states. Thus, individuals with BPD may benefit from therapy approaches that focus on emotion acceptance in order to normalize emotional reactions. © 2019 Joule Inc. or its licensors

Mit dem Nachweis einer epileptogenen Lasion leistet die MRT ihren Beitrag zum besonderen Ziel der Epilepsietherapie bei Kindern: eine von Anfallen ungestorte (fruh)kindliche Entwicklung. Malformationen kortikaler Entwicklung und hemispharale Pathologien kommen bei Kindern mit pharmakoresistenter Epilepsie haufiger vor. Bis zum 24. Lebensmonat verandert die Hirnreifung/Myelinisierung die Kontraste in MRT-Untersuchungen, was den Lasionsnachweis storen kann.

Subkortikal oder subependymal gelegene, periventrikulare nodulare Heterotopien sind ein morphologisches Korrelat pharmakoresistenter Epilepsien, das einer epilepsiechirurgischen Resektion in aller Regel nicht zuganglich ist. Die stereotaktische Thermoablation stellt in dieser Situation eine effektive Behandlungsmoglichkeit mit geringem Risiko interventionsassoziierter Defizite dar. Vorausgehen muss eine bildgebende und elektrophysiologische Diagnostik einschlieslich Ableitung mit Tiefenelektroden, um die Epileptogenizitat der Heterotopie zu belegen. Wir stellen die Behandlung eines Kindes und eines Erwachsenen mit dieser Vorgehensweise bei Nachbeobachtung von mehr als 5 Jahren dar und diskutieren sie auf Basis der Literatur zur Epileptogenizitat von Heterotopien und ihrer Behandlung mittels epilepsiechirurgischer oder thermoablativer Verfahren.

Antibodies against adenylate kinase 5 (AK5) have been described in patients with non-paraneoplastic limbic encephalitis, mainly in men around 70 years of age. Routine testing with specific cell-based assays is not yet available. Three patients with episodic anterograde memory problems and depression had extensive limbic lesions and developed severe atrophy, mainly of the medial temporal lobes. The antibodies were identified in serum and CSF based on the typical staining pattern of AK5 antibodies on a tissue-based assay (here, unfixed mouse brain). Subsequently, they were confirmed by a research laboratory through a cell-based assay.

Juvenile myoclonic epilepsy (JME) has been classified as a syndrome of idiopathic generalized epilepsy and is characterized by specific types of seizures, showing a lack of pathology using magnetic resonance imaging (MRI) and computed tomography scanning. However, JME is associated with a particular personality profile, and behavioral and neuropsychological studies have suggested the possible involvement of frontal lobe dysfunction. The development of highly sensitive neuroimaging techniques has provided a means of elucidating the underlying mechanisms of JME. Positron emission tomography demonstrated metabolic and neurotransmitter changes in the dorsolateral prefrontal cortex reflecting the particular cognitive and behavioral profile of JME patients. (1)H-magnetic resonance spectroscopy has shown evidence of thalamic dysfunction, which appears to be progressive. Such techniques provide evidence of multi-focal disease mechanisms, suggesting that JME is a frontal lobe variant of a multi-regional, thalamocortical 'network' epilepsy, rather than a generalized epilepsy syndrome. Quantitative MRI revealed significant abnormalities of cortical gray matter in medial frontal areas close to the supplementary motor area and diffusion abnormalities with increased functional coupling between the motor and prefrontal cognitive systems. This altered structural connectivity of the supplementary motor area provides an explanatory framework for the particular imaging findings, seizure type, and seizure-provoking mechanisms in JME.

Moderne bildgebende Verfahren bieten neue Moglichkeiten, die Pathomechanismen idopathisch generalisierter Epilepsien (IGE) zu ergrunden. Dieser Beitrag fasst aktuelle Studien mit strukturellen und funktionellen MRT-, MR-Spektroskopie und PET-Untersuchungen zusammen und verdeutlicht sie exemplarisch an einigen Studien. In den meisten Studien werden strukturelle und/oder funktionelle Veranderungen des Thalamus und frontaler Kortexegionen berichtet. Zusatzlich werden syndromspezifische Unterschiede beschrieben. Die Befunde lassen eine zugrunde liegende thalamofrontokortikale Netzwerkstorung bei IGE vermuten und sprechen gegen die traditionelle syndromatische Trennung in fokale und generalisierte Epilepsien.

Positive autoscopic phenomena - autoscopy, heautoscopy and out-of-body experience - may occur in a variety of diseases and also in physiological conditions. They are a rare but probably underreported phenomenon in focal epilepsies. Here, we investigate whether ictal lateralized autoscopic phenomena give lateralizing information about the underlying epileptic focus. We present the cases of seven patients from our center who experienced ictal lateralized autoscopic phenomena and analyzed their focus lateralization and localization of the underlying brain lesion. In addition, we reviewed seven cases published in German and English language literature. In the total group of 14 patients with ictal lateralized autoscopic phenomena, 12 (85.7%) of them had a well-defined epileptic focus contralateral to the side of the autoscopic appearance. Therefore, the data point to an association between ictal lateralized autoscopy and contralateral epileptic focus. (C) 2012 Elsevier Inc. All rights reserved.

There are contradictory results on lateralisation and localisation of rhythm processing. Our aim was to test whether there is a hemispheric dissociation of metric and non-metric rhythm processing. We created a non-metric rhythm stimulus without a sense of metre and we measured brain activities during passive rhythm perception. A total of 11 healthy, right-handed, native female Hungarian speakers aged 21.3 ± 1.1 were investigated by functional magnetic resonance imaging (fMRI) using a 3T MR scanner. The experimental acoustic stimulus consisted of comprehensive sentences transformed to Morse code, which represent a non-metric rhythm with irregular perceptual accent structure. Activations were found in the right hemisphere, in the posterior parts of the right-sided superior and middle temporal gyri and temporal pole as well as in the orbital part of the right inferior frontal gyrus. Additional activation appeared in the left-sided superior temporal region. Our study suggests that non-metric rhythm with irregular perceptual accents structure is confined to the right hemisphere. Furthermore, a right-lateralised fronto-temporal network extracts the continuously altering temporal structure of the non-metric rhythm.

We analysed the association of presurgical language fMRI activations and postsurgical verbal memory changes in 16 left-sided mesial temporal lobe epilepsy patients with initially intact memory. Patients with severe verbal memory decline after surgery (n=9) had stronger presurgical fMRI activations within the left posterior temporal lobe, compared to those with no decline (n=7). Language fMRI activation may predict verbal memory outcome, even in patients with a high risk of postsurgical memory deterioration. (C) 2010 Elsevier B.V. All rights reserved.

The postictal state is defined as manifestation of seizure-induced reversible alterations in neuronal function, but not structure. Following a seizure, it is common to experience feelings of exhaustion, both mental and physical, that can last a day or two. There are three major hypotheses regarding what cellular and molecular mechanisms could cause the observed postictal symptoms: neurotransmitter depletion or changes in receptor concentration, active inhibition, and cerebral blood flow changes. Here, we describe the contributions of functional neuroimaging studies to the understanding of postictal symptoms.

Introduction The localization of the seizure onset zone, being mandatory prior to epilepsy surgery, frequently requires the use of invasive depth electrodes. The interpretation of the electrophysiological recordings then critically depends on the visualization of the electrode positions in 3D MRI scans of these patients. We developed a fully automated software pipeline to segment the depth electrode contacts and to achieve a separation into distinct electrodes. The pipeline uses pre- and post-implantation cranial computerized tomography as well as post-implantation 3D MRI. It consists of standard pre-processing routines for co-registering and masking of images and a custom-made image analysis procedure. Prior spatial information about the implanted electrodes is not required. Methods In a first step, both the pre-implantation CT (preOP-CT) and the post-implantation CT (OP-CT) were co-registered to a post-implantation 3D MRI. Then masks of brain and skull bone were extracted from the preOP-CT, and an automated search for intensity clusters was performed in the brain masked OP-CT. The detected clusters were finally separated into electrode contacts. The only requirements for this method were a voxel size of 1 × 1 × 1 mm or better for the OP-CT and an equidistant spacing of the contacts of all implanted electrodes. Results The method was tested in 28 patients with pharmacoresistant focal epilepsy (161 electrodes and 1608 contacts altogether). A comparison between automatic segmentation and visual identification of the electrode contacts showed that 1597 contacts (99.3%) were correctly detected. Only 9 contacts, which were all located within or outside the skull bone, remained undetected. In 2 patients, one single contact was falsely detected and had to be corrected manually. The pre-processing routines (co-registration and masking) took about 30 min per patient. The image analysis procedure (cluster search and electrode separation) took less than 30 s per patient. Conclusions The implemented method is, to the best of our knowledge, the first fully automated procedure for the segmentation of intracerebral depth electrode contacts with subsequent separation of the detected contacts into distinct electrodes, which can be directly superimposed on 3D MRI. The method does not require any a priori information about the implanted electrodes and is able to identify the loci of depth electrode contacts in a fast and reliable manner.

Introduction. Although emotional dysregulation is a core problem in borderline personality disorder (BPD), few neuropsychological studies have evaluated the impact of emotion. The present study aimed at the comprehensive investigation of verbal memory functions with and without emotionally relevant interference in BPD. BPD patients were expected to perform as well as healthy subjects in standard memory tasks but to show fewer capacities to control for emotionally negative interference. Methods. 47 patients with BPD and 70 healthy control subjects participated. An experimental task assessed verbal memory with respect to standard and emotionally relevant and neutral interference learning conditions. Applied standard tests covered working memory, delayed memory, and word fluency. Results. Memory performances of BPD patients were impaired when negatively valenced interference was conducted but normal in all other conditions. These results remained stable after controlling for comorbid major depression and posttraumatic stress disorder. Discussion. The present findings suggest no general impairment of verbal memory functions in BPD but control and inhibition of interference by emotionally significant material seem to be disturbed.

The contribution of the Wada test (intracarotid amytal procedure, IAP) to predicting postoperative memory outcome in left temporal lobe epilepsy (LTLE) is becoming increasingly controversial when preoperative neuropsychological evaluation and MRI findings are available. We retrospectively analyzed 59 patients with LTLE who underwent en bloc temporal lobe resection. All patients had valid bilateral IAP test results, complete pre- and postoperative neuropsychological evaluation, and MRI grading on a 5-point scale integrating T 2 signal increase and degree of atrophy. Thirty percent of patients showed postoperative memory decline. Multiple regression analysis revealed that significant predictors of decline [F(2.56)=22.71, P

Hippocampal sclerosis in adults and focal cortical dysplasia in children with epilepsy are frequent lesions, but they are overlooked on standard MRI. Errors in the interpretation of MRI in epilepsy can be attributed mainly to poor technique and perceptual misses, but incomplete knowledge and poor judgment are also possible sources. This review covers what to expect in structural MRI of an adult patient with mesial temporal lobe epilepsy (TLE) and how to find hippocampal sclerosis (HS). It also covers the clinical MRI-based detection of focal cortical dysplasia (FCD) in extratemporal lobe epilepsy, mainly in children. In a stepwise approach, first, a typical epilepsy MRI protocol at 1.5 T includes axial and coronal fluid-attenuated inversion recovery (FLAIR) imaging, T2- and T2∗-weighted images, and a T1-weighted, three-dimensional volume acquisition. Advanced MR techniques (quantitation, new contrasts like diffusion, MR spectroscopy, high-contrast high-resolution imaging on high-field MR scanners ⩾ 3 T) are used to increase the method’s sensitivity to detect a lesion in an individual patient. Exploiting increased sensitivity, we can avoid false-positive results in the light of a clinical hypothesis, possibly isolating a localized brain area by seizure semiology and EEG prior to MR reading.

Objective: Emotional dysregulation is a key feature of borderline personality disorder (BPD) with altered inhibitory functions having suggested as being crucial. The anterior cingulate cortex and further prefrontal brain regions are crucial for response inhibition. The regulation of emotions is ensured via inhibitory control over the amygdala. The present study aimed to investigate neural correlates of response inhibition in BPD by using an emotional Stroop paradigm extending the task to word stimuli which were related to stressful life events. Methods: Twenty BPD patients and 20 healthy controls underwent functional magnetic resonance imaging (fMRI) while performing the individual emotional Stroop task. A block design was used with the following word type conditions: neutral words, general negative words, and individual negative words. The individual negative words were recruited from a prior interview conducted with each participant. Results: While BPD patients had overall slower reaction times in the Stroop task compared to healthy controls, there was no increased slowing with emotional interference. Controls exhibited significant fMRI blood oxygenation level-dependent signal increases in the anterior cingulate cortex as welt as in frontal cortex contrasting generally negative vs. neutral and individual negative vs. neutral conditions, respectively. BPD patients did not show equivalent signal changes. Conclusions: These results provide further evidence for a dysfunctional network of brain areas in BPD, including the ACC and frontal brain regions. These areas are crucial for the regulation of stress and emotions, the core problems of BPD patients. (C) 2008 Elsevier Ltd. All rights reserved.

PURPOSE: To characterize the spatial relationship between activations related to language-induced seizure activity, language processing, and motor control in patients with reading epilepsy. METHODS: We recorded and simultaneously monitored several physiological parameters [voice-recording, electromyography (EMG), electrocardiography (ECG), electroencephalography (EEG)] during blood oxygen level-dependent (BOLD) functional magnetic resonance imaging (fMRI) in nine patients with reading epilepsy. Individually tailored language paradigms were used to induce and record habitual seizures inside the MRI scanner. Voxel-based morphometry (VBM) was used for structural brain analysis. Reading-induced seizures occurred in six out of nine patients. RESULTS: One patient experienced abundant orofacial reflex myocloni during silent reading in association with bilateral frontal or generalized epileptiform discharges. In a further five patients, symptoms were only elicited while reading aloud with self-indicated events. Consistent activation patterns in response to reading-induced myoclonic seizures were observed within left motor and premotor areas in five of these six patients, in the left striatum (n = 4), in mesiotemporal/limbic areas (n = 4), in Brodmann area 47 (n = 3), and thalamus (n = 2). These BOLD activations were overlapping or adjacent to areas physiologically activated during language and facial motor tasks. No subtle structural abnormalities common to all patients were identified using VBM, but one patient had a left temporal ischemic lesion. DISCUSSION: Based on the findings, we hypothesize that reflex seizures occur in reading epilepsy when a critical mass of neurons are activated through a provoking stimulus within corticoreticular and corticocortical circuitry subserving normal functions.

Alcohol addiction is typically associated with intense alcohol craving triggered by internal or environmental cues linked with past alcohol use. We used functional magnetic resonance imaging (fMRI) to record cerebral correlates of craving in an alcoholic patient. Craving was evoked by highly individual cues associated with past alcohol use and was assessed before (T1) and after an 8-month period of psychotherapy (T2). To control for effects of life event memories related to non alcoholic cravings, the patient provided two events from periods of his life when he experienced caffeine craving. We detected activation of the superior temporal lobe during recall of a highly alcohol craving situation (T1 minus T2), whereas we did not observe any activation during coffee craving recall when pre und post activations were compared. These results indicate that the superior temporal lobe may be involved when alcohol craving is initiated by individual verbal cues. Further studies using individual cues are needed to explore the neural correlates of alcohol craving.

Human behavior strongly relies on the visual storage of events. Unfortunately, the sense of sight is susceptible to numerous distortions and misidentifications. Our study investigated the possibility of applying neuroimaging methods for verification of eyewitness reports. We developed a film paradigm and investigated three related picture sets in a recognition task using functional magnetic resonance imaging (fMRI). For each picture subjects were instructed to make a known-unknown decision. Behavioral results showed false recognitions for nearly half of the presented stimuli. The fMRI results revealed distinct activations for correct and false recognitions. The orbito-frontal cortex could be distinguished as a key region for processing imagined and distorted information resulting in correct rejection of unknown material. Otherwise, false recognitions of unknown material highlighted surprising activation within the posterior cingulate gyrus indicating the subjects' strain to match unknown information to that known. The results are discussed in terms of current false memory research.

Recent functional neuroimaging and lesion studies demonstrate the involvement of the orbitofrontal/ventromedial prefrontal cortex as a key structure in decision making processes. This region seems to be particularly crucial when contingencies between options and consequences are unknown but have to be learned by the use of feedback following previous decisions (decision making under ambiguity). However, little is known about the neural correlates of decision making under risk conditions in which information about probabilities and potential outcomes is given. In the present study, we used functional magnetic resonance imaging to measure blood-oxygenation-level-dependent (BOLD) responses in 12 subjects during a decision making task. This task provided explicit information about probabilities and associated potential incentives. The responses were compared to BOLD signals in a control condition without information about incentives. In contrast to previous decision making studies, we completely removed the outcome phase following a decision to exclude the potential influence of feedback previously received on current decisions. The results indicate that the integration of information about probabilities and incentives leads to activations within the dorsolateral prefrontal cortex, the posterior parietal lobe, the anterior cingulate and the right lingual gyrus. We assume that this pattern of activation is due to the involvement of executive functions, conflict detection mechanisms and arithmetic operations during the deliberation phase of decisional processes that are based on explicit information.

Electrical stimulation of the human epileptic brain is used mainly for identification of eloquent cortical regions such as motor and speech areas. Other stimulation responses include the patient's epileptic auras and seizures. In addition, experiential phenomena may be elicited. Here we describe the reproducible initiation of a structured complex visual hallucination on stimulation of the left lateral occipital cortex (superior part of Brodmann area 19, close to the angular gyrus of the parietal lobe). Our findings illustrate that stimulation of the left temporo-parieto-occipital junction may activate networks of visual perception (color, pattern, movement, rotation, shape, and memory) independent of the cortical hierarchy from elementary to complex information.

Eine wichtige Voraussetzung fur die erfolgreiche epilepsiechirurgische Behandlung ist der Nachweis kongruenter Befunde der praoperativen Abklarung. Anfallsfreiheit wird in der Regel nur dann erwartet, wenn es gelingt, eine als epileptogen definierte Lasion komplett zu entfernen. In diesem Fallbericht wird der unerwartet gute postoperative Verlauf nach inkompletter Resektion einer ausgedehnten kortikalen Entwicklungsstorung beschrieben.

Summary: Purpose: By using speech-activated functional MRI (fMRI), we investigated whether the frequency of left-sided interictal epileptic activity (IED: spikes or sharp waves on the EEG) is associated with atypical speech lateralization. Methods: We investigated 28 patients (13 men, aged 17–59 years) with left-sided mesial temporal lobe epilepsy (MTLE) and 11 patients with right-sided MTLE as a control population. Only patients with unilateral hippocampal sclerosis with unilateral IED were included. For fMRI of individual patients, we contrasted images sampled during covert word generation with a low-level rest condition. With SPM99, an individual comparison for the contrast “word generation versus resting inactivity” was conducted. To characterize speech lateralization in individual patients, we calculated asymmetry indexes (AIs): the difference between activated left-sided and right-sided voxels was divided by all activated voxels. Analyzing long-term EEG, the first 2 min of each hour were evaluated for the frequency of IED. Univariate associations with AIs were assessed by Pearson's correlation and by t test. When testing the independent associations, multivariate linear regression was performed. Results: The AIs in patients with left-sided MTLE were 0.40 ± 0.53 on average (range, −0.83 to +1.0), whereas in right-sided MTLE, they were 0.78 ± 0.15 (p = 0.029). For the further investigations, we included left-sided MTLE patients only. The median frequency of IED was six per hour (range, 0–240). Higher IED frequency was correlated with left-right shift of lateralization of speech fMRI activity (p = 0.002). Conclusions: Higher left-sided spike frequency in MTLE was associated with a left–right shift of speech representation, suggesting that chronic frequent interictal activity may induce a reorganization of speech lateralization.

Background. Patients with borderline personality disorder (BPD) frequently report unresolved life events but it is still poorly understood, how these experiences are represented in the brain. Using functional magnetic resonance imaging (fMRI), the present study aimed at investigating the neural correlates of the recall of unresolved life events in patients with BPD and healthy controls.Method. Twenty female BPD patients and 21 healthy control subjects underwent fMRI. During measurement subjects recalled unresolved and resolved negative life events. Individual cue words were used to stimulate autobiographical memory. After scanning, subjects rated their emotional states during the recall of both types of memories.Results. When contrasting unresolved and resolved life events, patients showed significant bilateral activation of frontotemporal areas including the insula, amygdala, and the anterior cingulate cortex, the left posterior cingulate cortex, right occipital cortex, the bilateral cerebellum and the midbrain. In healthy subjects, no differential brain activation was related to these conditions. The 2×2 factorial analysis (ΔBPD−Δcontrols) revealed similar results with bilateral activation of the frontal cortex including parts of the insula and of the orbitofrontal cortex, temporal activation including the amygdala, activation of the right occipital cortex, and parts of the cerebellum. Patients but not controls reported higher levels of anxiety and helplessness during the unresolved versus resolved memory condition.Conclusions. The activation of both, the amygdala and prefrontal areas, might reflect an increased effortful but insufficient attempt to control intensive emotions during the recall of unresolved life events in patients with BPD.

Summary: Purpose: We used short-echo-time proton magnetic resonance spectroscopy imaging (MRSI) to study metabolite concentration variation through the temporal lobe in patients with temporal lobe epilepsy (TLE) with and without abnormal MRI. Methods: MRSI was performed at TE = 30 ms to study 10 control subjects, 10 patients with TLE and unilateral hippocampal sclerosis, and 10 patients with TLE and unremarkable MRI (MRI negative). We measured the concentrations of N-acetyl aspartate +N-acetyl aspartyl-glutamate (NAAt), creatine (Cr), choline (Cho), glutamate + glutamine (Glx), and myoinositol, in the anterior, middle, and posterior medial temporal lobe (MTL), and in the posterior lateral temporal lobe. Segmented volumetric T1-weighted MRIs gave the tissue composition of each MRSI voxel. Normal ranges were defined as the control mean ± 3 SD. Results: In the hippocampal sclerosis group, seven of 10 had abnormally low NAAt in the ipsilateral anterior MTL. In the MRI-negative group, four of 10 had low NAAt in the middle MTL voxel ipsilateral to seizure onset. Metabolite ratios were less sensitive to abnormality than was the NAAt concentration. Group analysis showed low NAAt, Cr, and Cho in the anterior MTL in hippocampal sclerosis. Glx was elevated in the anterior voxel contralateral to seizure onset in the MRI-negative group. Metabolite concentrations were influenced by voxel position and tissue composition. Conclusions: (a) Low NAAt, Cr, and Cho were features of the anterior sclerotic hippocampus, whereas low NAAt was observed in the MRI-negative group in the middle MTL region. The posterior temporal lobe regions were not associated with significant metabolite abnormality; (b) The two patient groups demonstrated different metabolite profiles across the temporal lobe, with elevated Glx a feature of the MRI-negative group; and (c) Voxel tissue composition and position influenced obtained metabolite concentrations.

Psychosis of epilepsy (POE) has been recognized as a severe complication of chronic intractable epilepsy for more than a century. Most of the clinical symptoms of POE are reminiscent of schizophrenia. Nevertheless, there is general agreement that the phenomenology of POE differs from classical schizophrenia. The temporal lobe hypothesis of schizophrenia put forward in the 1960s notes that episodes with paranoid psychoses are more prevalent in temporal lobe epilepsy (TLE). However, the aetiology and pathogenesis of POE are poorly understood. One of the strongest biological findings in schizophrenia is volume loss of temporal lobe structures and the hippocampus in particular. In order to test the hypothesis that atrophy of the hippocampus and the amygdala is found in patients with TLE and POE, we performed a retrospective study of all patients with TLE who were admitted to the assessment unit of the Chalfont Centre for Epilepsy from 1995 until 1999. Twenty-six (2.6%) of these 1008 patients fulfilled inclusion criteria and were compared with 24 patients with TLE without psychopathology and 20 healthy volunteers. All patients underwent extensive MRI investigations, including volumetric data sets and quantitative T(2 )relaxometry. We found that patients with TLE and POE differed from patients with TLE alone and healthy volunteers in that the total brain volumes were significantly smaller. While there were no differences in hippocampal volumes between the three study groups, there was a significant 16-18% enlargement of the amygdala on both sides in patients with POE. Our findings support the notion that POE is a distinct nosologic entity differing from schizophrenia not only in clinical details but also in neurobiological aspects. The finding of amygdala enlargement agrees with the observation of an association between dysphoric disorders of epilepsy and POE described nearly 100 years ago.

MRI is an important diagnostic tool in patients with epilepsy, but patient motion during long scans may result in image artefacts. We studied the utility of an ultra-fast MR sequence in patients with epilepsy. Ultra-fast low-angle rapid acquisition and relaxation enhancement (UFLARE) images were acquired for 100 consecutive patients and nine control subjects. Scans were compared with routine T2-weighted spin echo images for signal-to-noise ratio, contrast, and conspicuity, followed by a blind review of lesion detectability. UFLARE scans were also acquired for 15 patients who moved during conventional scans. All UFLARE scans had lower signal-to-noise ratios and lower contrast than the T2-weighted images. Compared with T1- and T2-weighted, PD and FLAIR images, 86% of hippocampal sclerosis (HS), 92% of large but only 24% of small white-matter lesions were detected on the blind review of the UFLARE images. Reduced motion artefacts were seen on the UFLARE images in all 15 patients who moved during the conventional scans, and in three patients UFLARE was the only sequence we were able to obtain. Despite the lower lesion detectability for smaller lesions, the use of an ultra-fast MRI sequence such as UFLARE may be very useful in patients who are not able to co-operate during conventional MRI examinations, if a general anaesthetic is to be avoided.

Recurrent episodes with interictal affective aggression are a rare but well-recognized problem in patients with temporal lobe epilepsy. They are referred to as episodic dyscontrol or, more precisely, as intermittent explosive disorder (IED). The amygdala play a crucial role in the affective evaluation of multimodal sensory input and the neurobiological mediation of aggressive behaviour. With hippocampal sclerosis, in the context of mesial temporal lobe sclerosis, being the most common cause of temporal lobe epilepsy, we hypothesized that the amygdala might be affected by the same pathogenic process in aggressive patients. We investigated 50 patients with temporal lobe epilepsy: 25 with and 25 without a history of IED. Data from clinical, electrophysiological, neuropsychological and psychometric investigations were obtained, as well as MRI scans for the quantitative assessment of possible amygdala pathology. We found no evidence of a higher prevalence of amygdala sclerosis in the aggressive patients. Hippocampal sclerosis was significantly less common in patients with temporal lobe epilepsy and IED. However, a significant subgroup of patients (20%) with temporal lobe epilepsy and aggressive behaviour had severe amygdala atrophy in the context of a history of encephalitis. Another subgroup of aggressive patients (28%) had different left temporal lesions affecting either the amygdala or periamygdaloid structures. IED was associated with left-sided or bilateral EEG and MRI abnormalities, low IQ and high scores in depression and anxiety.