Search

Arousability and reactivity to sensory stimuli are essential features of sleep, discriminating it from coma and keeping the sleeper in contact with the environment. Arousals and oscillations during sleep serve the reversibility of sleep and carry an alarm function awakening the sleeper in danger. In this review, we will explore mechanisms and circuits involved in arousal intrusions within the sleep texture, focusing on the significance of these phenomena in two sleep-related conditions: NREM sleep parasomnias and sleep-related hypermotor epilepsy. Knowledges and gaps in the field are discussed.

Az epileptogenesis útjainak vizsgálata a rend­szerepilepszia-koncepció mentén. Irodalmi áttekintés és saját tapasztalatok alapján ismertetjük a deklaratív memóriarendszer, az alvás/ébredés és a perisylvian kommunikációs rendszer epilepsziás átalakulását, majd az epileptogenesis folyamatát bemutatjuk az agyi sérülések és a poszttraumás epilepszia modelljén is. Az ismertetett rendszer-epilepsziák kiala­kulásában közös lépések ismerhetők fel a plaszticitás és a NREM-alvás alatti szinaptikus homeosztázis felfoko­zó­dásában, ami egyben rávilágít az alvás döntő szerepére epilepsziában. Megkíséreljük körvonalazni a rend­szerepilepszia-koncepciót, és az egymással összefüggő plaszticitás – alvási szinaptikus homeosztázis „kisiklása” formájában rámutatunk az epileptogenesis lehetséges közös patomechanizmusára.

We review the literature on REM parasomnias, and their the underlying mechanisms. Several REM parasomnias are consistent with sleep dissociations, where certain elements of the REM sleep pattern emerge in an inadequate time (sleep paralysis, hypnagogic hallucinations and cataplexy) or are absent/partial in their normal REM sleep time (REM sleep without atonia, underlying REM sleep behavior disorder). The rest of REM parasomnias (sleep related painful erection, catathrenia) may have other still unclear mechanisms. REM parasomnias deserve attention, because in addition to disturbing sleep and causing injuries, they may shed light on REM sleep functions as well as the heterogeneous etiologies of parasomnias. One of them, REM sleep behavior disorder has special importance as a warning sign of evolving neurodegenerative conditions mainly synucleinopathies (some cases synucleinopathies themselves) and it is a model parasomnia revealing that parasomnias may have by autoimmune, iatrogenic and even psychosomatic etiologies.Áttekintjük a REM-parasomniák irodalmát, és röviden foglalkozunk a hátterükben álló mechanizmussal. A csoport tagjainak egy része alvásdisszociációnak felel meg, ahol a REM-alvás egyes elemei inadekvát fázisban (például alvási paralysis, hypnagog hallucinációk) jelennek meg, vagy fordítva, elmaradnak/töredékesek a REM-alvás alatt, amelynek egyébként fiziológiás részei (REM-alvás izomatónia nélkül, a REM-magatartászavar hátterében álló rendellenesség). A többi REM-parasomnia (alvásfüggő fájdalmas erectio, catathrenia) hátterében egyéb, egyelőre tisztázatlan me­chanizmus állhat. A REM-parasomniák alvászavart és sérüléseket okozhatnak, és tanulmányozásuk meg­vilá­gít­hatja a REM-alvás funkcióit és a parasomniák hátterében álló sokszínű etio­lógiát. A REM-magatartászavarnak különleges jelentősége van: neurodegeneratív betegségek, különösen synuclei­no­pathiák előjele (vagy kísérője) lehet, talán maga is az. Egyben modell-rendellenesség, ami autoimmun, iatrogén és pszichoszomatikus zavarok fel­tá­rását teheti lehetővé.

Összefoglaló. Bevezetés és célkitűzés: A terápiarezisztens fokális epilepsziák sebészeti kezelése elterjedten használt kezelési lehetőség. Célunk az epilepsziasebészet-hatékonyság változásának vizsgálata egy évtizednyi távlatból a budapesti centrumban. Módszerek: Az Országos Klinikai Idegtudományi Intézetben reszektív epilepsziasebészeti beavatkozásokon átesett fokális epilepsziás betegek adatai kerültek feldolgozásra. A vizsgált 10 év beteganyagát két periódusra osztottuk a műtét időpontja szerint (2006–2010 és 2011–2016). Vizsgálati szempontjaink: demográfiai adatok, az epilepszia kezdete és típusa, mágnesesrezonancia-lelet, preoperatív rohamfrekvencia, műtéttípus és szövettani lelet. Az epileptológiai kimenetelt az Engel-klasszifikáció alapján értékeltük. Eredmények: Epilepsziasebészeti beavatkozás 187 betegen történt, akik közül 137-nél került sor reszekciós műtétre. A betegek 65%-ában temporalis, 18%-ában frontalis, míg 7%-ában olyan multilobaris epilepszia igazolódott, mely a temporalis vagy a frontalis lebenyt érintette. Teljes rohammentességet (Engel I/A) az 1. évben 68%-ban, a 2. évben 64%-ban, míg az 5. évben 63%-ban mértünk. A két intervallum összehasonlításakor az 1 éves rohammentesség aránya 60%-ról (temporalis: 67%, extratemporalis: 50%) 73%-ra (temporalis: 79%, extratemporalis: 62%) javult a második periódusban. Az etiológia szempontjából a hippocampalis sclerosis aránya 28%-ról 14%-ra csökkent, a fokális corticalis dysplasiák aránya 22%-ról 31%-ra növekedett. Következtetés: A sebészeti kezelés fokális epilepsziák esetén – alapos előzetes kivizsgálást követően – általában biztonságos és a legnagyobb arányban sikeres beavatkozás. A legkedvezőbb kimenetel temporalis lokalizációban érhető el. A hatékonyság az évek során egyre javuló tendenciát mutatott az egyre nehezebb sebészeti esetek ellenére. Ez magyarázható a sebészeti technikák fejlődésével, illetve a jobb, műtét előtti elektrofiziológiai és képalkotó technikákkal, amelyek bevezetésével pontosabb lokalizáció adható. Orv Hetil. 2021; 162(6): 219–226. Summary. Introduction and objective: The surgical treatment of medically intractable focal epilepsies is a well established practice. Our aim was to examine the efficacy of epilepsy surgery within a decade long period in our centre in Budapest. Methods: Data of drug-resistant patients with resective epilepsy surgery in the National Institute of Clinical Neurosciences were evaluated. The examined 10-year period was divided based on the year of the operation in two parts (2006–2010 and 2011–2016). The following data were collected: demography, beginning and type of epilepsy, magnetic resonance, preoperative seizure frequency, type of surgery and histology. Epileptological outcome was based on modified Engel’s classification. Results: Out of 187 surgeries, we identified 137 patients with resective intervention: 65% temporal lobe, 18% frontal, and 7% multilobar epilepsy. Seizure-freedom (Engel I/A) was 68% in the first postoperative year, 64% in the second, and 63% in the fifth year. In the first period, 1-year seizure freedom was 60% (temporal: 67% extratemporal: 50%), while in the second period it was 73% (temporal 79%, extratemporal 62%). Hippocampal sclerosis ratio dropped from 28% to 14%, while focal cortical dysplasia ratio increased from 22% to 31%. Conclusion: Surgical treatment in focal epilepsy – after thorough presurgical evaluation – is generally safe and successful. The most favorable outcome is in temporal localization. The efficacy tended to improve over time despite of the more challenging cases. This can be explained with the development of surgical techniques and improvement of presurgical localization. Orv Hetil. 2021; 162(6): 219–226.

Harangozó Imre: Napkeleti kalászat... Válogatott tanulmányok, írások, naplók, fényképek. Tortoma Könyvkiadó, Barót 2020. 240 old.

A néprajztudomány által gyűjtögetésnek nevezett tevékenységgel összeszedett fűzvesszőkből font használati tárgyakat, különböző célra szolgáló kosarakat a hagyományos parasztcsaládban elsősorban a férfiak készítették. A 18. század végén, Erdélyből menekült székelyek által alapított Pusztina magyar lakossága kevés és gyönge minőségű földje miatt különösen rá volt utalva erre a sokak által háziiparként űzött mesterségre, vagyis inkább a cserekereskedelmére. Minél kevesebb földje volt valakinek, annál inkább rászorult a kosaraiért cserélt terményekre, főleg az étkezési és takarmányozási célokat szolgáló kukoricára. A vizek mellett nőtt füzesek vesszőit maguk gyűjtötték, hántolták, válogatták, szükség esetén hasították, használat előtt áztatták, majd speciális tudásukkal különböző célra szolgáló kosarakká fonták. Az értékesítés részben helyben, részben saját vagy bérelt lófogattal, távolabbra vasúttal történt. A kosárfonáshoz a legegyszerűbb szerszámokat, kést (újabban metszőollót), kovács készítette hántoló vasat, és maguk faragta vesszőhasítót használtak. A cserélő utakon egy kosárért rendszerint annyi csöves kukoricát kaptak, amennyi kétszer, vagy annyi szemest, ami másfélszer fért bele.

We aim to review the impact of COVID-19 pandemic on epilepsy and epilepsy-care. While the virus has no specific link with epilepsy, it may affect the nervous system both directly and indirectly, leading to seizures in several ways. The hyper-coagulable state occurring with the infection may cause strokes leading to seizures. The infection may first manifest in the form of disturbances of consciousness and behaviour, seizures, and even status epilepticus. The interactions of antiviral/antiepileptic drugs need to be taken into account during treatment. The hypercoagulable state induced by COVID-2 infection may cause stroke, which leads to seizures. The infection can occur also as an impaired consciousness of non-epileptic origin. Interactions of antiviral/antiepileptic drugs have also to be taken into account. The pandemic itself as well as quarantines and social distancing may cause anxiety and insomnia, challenge continuous antiepileptic supply;each one carrying the risk of seizing. Young epilepsy patients with learning disabilities and mental health issues are most vulnerable, justifying their hyper-protection. The danger of infection has highlighted the role of telemedicine. Internet-based video communication may ensure full care for chro nic patients. Those methods favour bes ted patients with higher education. Epilepsy does not increase directly the risk of infection, but its comorbidities may worsen the course of the disease. Brain lesions and hypoxia, stress, insomnia and fever joining the infection increase seizure susceptibility. Because the danger of infection ma de telemedicine an essential tool of pa - tient care, education and better computer supply for those in need is crucial. © 2021 Literatura Medica Publishing House. All rights reserved.

Perka Mihály: Gyökerek. A moldvai magyarokról. A csángók. Fordította, szerkesztette és az utószót írta Iancu Laura. Kariosz Kiadó. Bp. 2020. 584 old. és 17 kép

To examine the ways of epileptogenesis closely linked to the system epilepsies' concept.We follow the ways of epileptic transformation in the declarative memory-system, in the sleep/arousal twin-systems, in the perisylvian neuronal network and in postinjury epilepsy, which we consider a general model of the epileptic transformation.In the presented systems, epileptogenesis shares a similar mechanism in the form of augmentation and derailment of plasticity and sleep-related synaptic homeo-stasis. This highlights the central role of NREM sleep in those epilepsies.We try to characterize the concept of system epilepsies and suggest a shared mechanism of epileptogenesis.Az epileptogenesis útjainak vizsgálata a rend­szerepilepszia-koncepció mentén.Irodalmi áttekintés és saját tapasztalatok alapján ismertetjük a deklaratív memóriarendszer, az alvás/ébredés és a perisylvian kommunikációs rendszer epilepsziás átalakulását, majd az epileptogenesis folyamatát bemutatjuk az agyi sérülések és a poszttraumás epilepszia modelljén is.Az ismertetett rendszer-epilepsziák kiala­kulásában közös lépések ismerhetők fel a plaszticitás és a NREM-alvás alatti szinaptikus homeosztázis felfoko­zó­dásában, ami egyben rávilágít az alvás döntő szerepére epilepsziában.Megkíséreljük körvonalazni a rend­szerepilepszia-koncepciót, és az egymással összefüggő plaszticitás – alvási szinaptikus homeosztázis „kisiklása” formájában rámutatunk az epileptogenesis lehetséges közös patomechanizmusára.

The paper presents an advanced scheduling model and a multi-objective reactive solving method of flexible job shop manufacturing system. A scheduling approach is presented that can be able to manage alternative technological routes, limited available machines, unrelated processing times, sequence dependent setup times, in addition jobs with different due dates and priorities. An extended flexible job shop scheduling model is defined to solve the resource allocation problems and to create the fine schedule of the execution of operations. The paper describes the most important characteristics of the analysed problem and shows the main approach of the developed multi-objective reactive solving method.

We report on a peculiar way of chronic cognitive impairment associated with interictal epileptic activity during NREM sleep. We review three major groups of epilepsy: mesiotemporal epilepsy (MTLE) involving the epileptic derailment of the hippocampal declarative memory system; childhood developmental epileptic encephalopathies; and the spectrum disorders of the perisylvian communication network with the centrotemporal spike phenomenon, overarching child- and adulthood epilepsies, totaling up the majority of epilepsies in childhood. We outline high impact research-lines on the cognitive harm of epilepsy; causing specific or global cognitive decline through its interference with sleep plastic functions. We highlight the key role of interictal activity in the development of cognitive impairment and the fact that we are unarmed against this harm, antiepileptic pharmaco-therapy being ineffective against the interictal process marked by spikes and high frequency oscillations.

Obstructive sleep apnea is linked to cardiovascular disease, metabolic disorders and dementia. The precise nature of the association between respiratory events in obstructive sleep apnea, cortical or subcortical arousals, and cognitive, autonomic and oxidative stress consequences remains incompletely elucidated. Previous studies have aimed to understand the relationship between obstructive sleep apnea and arousal patterns, as defined by the cyclic alternating pattern, but results have been inconsistent, in part likely due to the presence of associated comorbidities. To better define this relationship, we analysed cyclic alternating patterns in patients with obstructive sleep apnea without any additional comorbidities. We identified 18 adult male, non-obese subjects with obstructive sleep apnea and no other comorbidities or medication history, who underwent whole-night electroencephalography and polysomnography. Cyclic alternating pattern analysis was performed and verified by certified somnologists. Pairwise linear regression analysis demonstrated an inverse relationship between obstructive sleep apnea severity and cyclic alternating pattern subtype A1, and a direct correlation with cyclic alternating pattern subtype A3. Cyclic alternating pattern subtypes A1 prevail in milder obstructive sleep apnea phenotype, whilst cyclic alternating pattern subtypes A2 and A3 overcome among moderate-to-severe obstructive sleep apnea patients. The milder obstructive sleep apnea group also presented higher sleep efficiency, and increased percentages of non-rapid eye movement stage 3 and rapid eye movement sleep, as well as longer cyclic alternating pattern sequences in N3, while severe obstructive sleep apnea patients spent more time in lighter sleep stages. These results imply/suggest a balance between cyclic alternating pattern's adaptive and maladaptive arousal processes in obstructive sleep apnea of differing severities. In milder obstructive sleep apnea (apnea-hypopnea index < 20), sleep continuity may be reinforced by cyclic alternating pattern subtype A1, whereas in more severe obstructive sleep apnea, decompensation of these sleep-stabilizing mechanisms may occur and more intrusive cyclic alternating pattern fluctuations disrupt sleep circuitry.

BACKGROUND AND PURPOSE: Some epilepsy syndromes (sleep-related epilepsies, SREs) have a strong link with sleep. Comorbid sleep disorders are common in patients with SRE and can exert a negative impact on seizure control and quality of life. Our purpose was to define the standard procedures for the diagnostic pathway of patients with possible SRE (scenario 1) and the general management of patients with SRE and comorbidity with sleep disorders (scenario 2).METHODS: The project was conducted under the auspices of the European Academy of Neurology, the European Sleep Research Society and the International League Against Epilepsy Europe. The framework entailed the following phases: conception of the clinical scenarios; literature review; statements regarding the standard procedures. For the literature search a stepwise approach starting from systematic reviews to primary studies was applied. Published studies were identified from the National Library of Medicine's MEDLINE database and Cochrane Library.RESULTS: Scenario 1: Despite a low quality of evidence, recommendations on anamnestic evaluation and tools for capturing the event at home or in the laboratory are provided for specific SREs. Scenario 2: Early diagnosis and treatment of sleep disorders (especially respiratory disorders) in patients with SRE are likely to be beneficial for seizure control.CONCLUSIONS: Definitive procedures for evaluating patients with SRE are lacking. Advice is provided that could be of help for standardizing and improving the diagnostic approach of specific SREs. The importance of identifying and treating specific sleep disorders for the management and outcome of patients with SRE is underlined.

Összefoglaló. Bevezetés és célkitűzés: A terápiarezisztens fokális epilepsziák sebészeti kezelése elterjedten használt kezelési lehetőség. Célunk az epilepsziasebészet-hatékonyság változásának vizsgálata egy évtizednyi távlatból a budapesti centrumban. Módszerek: Az Országos Klinikai Idegtudományi Intézetben reszektív epilepsziasebészeti beavatkozásokon átesett fokális epilepsziás betegek adatai kerültek feldolgozásra. A vizsgált 10 év beteganyagát két periódusra osztottuk a műtét időpontja szerint (2006-2010 és 2011-2016). Vizsgálati szempontjaink: demográfiai adatok, az epilepszia kezdete és típusa, mágnesesrezonancia-lelet, preoperatív rohamfrekvencia, műtéttípus és szövettani lelet. Az epileptológiai kimenetelt az Engel-klasszifikáció alapján értékeltük. Eredmények: Epilepsziasebészeti beavatkozás 187 betegen történt, akik közül 137-nél került sor reszekciós műtétre. A betegek 65%-ában temporalis, 18%-ában frontalis, míg 7%-ában olyan multilobaris epilepszia igazolódott, mely a temporalis vagy a frontalis lebenyt érintette. Teljes rohammentességet (Engel I/A) az 1. évben 68%-ban, a 2. évben 64%-ban, míg az 5. évben 63%-ban mértünk. A két intervallum összehasonlításakor az 1 éves rohammentesség aránya 60%-ról (temporalis: 67%, extratemporalis: 50%) 73%-ra (temporalis: 79%, extratemporalis: 62%) javult a második periódusban. Az etiológia szempontjából a hippocampalis sclerosis aránya 28%-ról 14%-ra csökkent, a fokális corticalis dysplasiák aránya 22%-ról 31%-ra növekedett. Következtetés: A sebészeti kezelés fokális epilepsziák esetén - alapos előzetes kivizsgálást követően - általában biztonságos és a legnagyobb arányban sikeres beavatkozás. A legkedvezőbb kimenetel temporalis lokalizációban érhető el. A hatékonyság az évek során egyre javuló tendenciát mutatott az egyre nehezebb sebészeti esetek ellenére. Ez magyarázható a sebészeti technikák fejlődésével, illetve a jobb, műtét előtti elektrofiziológiai és képalkotó technikákkal, amelyek bevezetésével pontosabb lokalizáció adható. Orv Hetil. 2021; 162(6): 219-226.The surgical treatment of medically intractable focal epilepsies is a well established practice. Our aim was to examine the efficacy of epilepsy surgery within a decade long period in our centre in Budapest.Data of drug-resistant patients with resective epilepsy surgery in the National Institute of Clinical Neurosciences were evaluated. The examined 10-year period was divided based on the year of the operation in two parts (2006-2010 and 2011-2016). The following data were collected: demography, beginning and type of epilepsy, magnetic resonance, preoperative seizure frequency, type of surgery and histology. Epileptological outcome was based on modified Engel's classification.Out of 187 surgeries, we identified 137 patients with resective intervention: 65% temporal lobe, 18% frontal, and 7% multilobar epilepsy. Seizure-freedom (Engel I/A) was 68% in the first postoperative year, 64% in the second, and 63% in the fifth year. In the first period, 1-year seizure freedom was 60% (temporal: 67% extratemporal: 50%), while in the second period it was 73% (temporal 79%, extratemporal 62%). Hippocampal sclerosis ratio dropped from 28% to 14%, while focal cortical dysplasia ratio increased from 22% to 31%.Surgical treatment in focal epilepsy - after thorough presurgical evaluation - is generally safe and successful. The most favorable outcome is in temporal localization. The efficacy tended to improve over time despite of the more challenging cases. This can be explained with the development of surgical techniques and improvement of presurgical localization. Orv Hetil. 2021; 162(6): 219-226.

The aim of this review is to summarize and discuss the strong bond between NREM sleep and epilepsy underlain by the shared link and effect on brain plasticity. Beyond the seizure occurrence rate, sleep relatedness may manifest in the enhancement of interictal epileptic discharges (spikes and pathological ripples). The number of the discharges as well as their propagation increase during NREM sleep, unmasking the epileptic network that is hidden during wakefulness. The interictal epileptic discharges associate with different sleep constituents (sleep slow waves, spindling and high frequency oscillations); known to play essential role in memory and learning. We highlight three major groups of epilepsies, in which sleep-related plastic functions suffer an epileptic derailment. In absence epilepsy mainly involving the thalamo-cortical system, sleep spindles transform to generalized spike-wave activity. In mesio-temporal epilepsy affecting the hippocampal declarative memory system, the sharp wave ripples derail to dysfunctional epileptic oscillations (spikes and pathological ripples). Idiopathic childhood epilepsies affecting the perisylvian network may progress to catastrophic status electricus during NREM sleep. In these major epilepsies, NREM sleep has a pivotal role in the development and course of the disorder. Epilepsy is born in-, and exhibits its pathological properties during NREM sleep. Interictal discharges are important causative agents in this process.

Aims - Overview of the new data about the strong link of sleep and epilepsy and conjoining cognitive impairment. Methods - Search for relevant references and summary of our own research activity on the topic. Results - Strong interrealtionship exists between epilepsy and plastic brain functions (memory processing and synaptic homeostasis) and the working modes of NREM sleep. In the most frequent childhood and adult epilepsy networks responsible for plastic functions can be derailed to an epileptic level of excitability, and suffer a transitory or permanent epileptic transformation. Exampling on the three big epilepsies: absence epilepsy; medial temporal lobe epilepsy; and childhood idiopathic focal age dependent epilepsy spectrum we demonstrate the most important features of this epileptic transformation. The association of cognitive impairment to certain sleep dependent epilepsies gains explanation by the epilepsy caused interference with slow wave decline (ICFE) and memory consolidation (MTLE) during NREM sleep. This paper serves also to introduce the concept of sleep dependent system epilepsies. Conclusions - We provide evidences about shared mechanisms among sleep related epilepsies being the derailment of sleep plastic funcions toward exaggerated excitability determined by the inherent possibilities of the signal transduction properties.

Slow waves recorded with EEG in NREM sleep are indicative of the strength and spatial extent of synchronized firing in neuronal assemblies of the cerebral cortex. Slow waves often appear in the A1 part of the cyclic alternating patterns (CAP), which correlate with a number of behavioral and biological parameters, but their physiological significance is not adequately known. We automatically detected slow waves from the scalp recordings of 37 healthy patients, visually identified CAP A1 events and compared slow waves during CAP A1 with those during NCAP. For each slow wave, we computed the amplitude, slopes, frequency, synchronization (synchronization likelihood) between specific cortical areas, as well as the location of origin and scalp propagation of individual waves. CAP A1 slow waves were characterized by greater spatial extent and amplitude, steeper slopes and greater cortical synchronization, but a similar prominence in frontal areas and similar propagation patterns to other areas on the scalp. Our results indicate that CAP A1 represents a period of highly synchronous neuronal firing over large areas of the cortical mantle. This feature may contribute to the role CAP A1 plays in both normal synaptic homeostasis and in the generation of epileptiform phenomena in epileptic patients.

Frontotemporal dementia (FTD) is a frequent cause of cognitive decline. While epilepsy is an important comorbidity of Alzheimer's disease, we lack studies on its presence in FTD. We report on an FTD patient with transient, short-term changes of behavior and cognitive performance suggesting non-convulsive epilepsy. Video-EEG recording with foramen ovale (FO) electrodes revealed mesio-temporal epileptiform potentials, undetectable by scalp leads. We also found beta spindles in the FO electrodes, not described in the literature. We conclude that video-EEG monitoring with FO electrodes might usefully complement the assessment of dementia-associated epilepsy opening new perspectives in dementia-research.

Accumulating evidence suggests that epileptic seizures originating from the temporal lobe (TL) occur in cats. Typically, affected animals have clinically focal seizures with orofacial automatisms including salivation, facial twitching, lip smacking, chewing, licking, and swallowing. Motor arrest and autonomic and behavioral signs also may occur. Many affected cats have magnetic resonance imaging (MRI) changes within the hippocampus or histopathologically confirmed hippocampal sclerosis or necrosis. From the 1950s to the 1980s, cats frequently were used as animal models for neurophysiological experiments and electrophysiological studies, from which important basic knowledge about epilepsy originated, but which has been rarely cited in clinical veterinary studies. These studies were reviewed. Experimental research on cats showed the widespread anatomical connections among TL structures. The ictal clinical signs originating from the hippocampus, amygdala, or lateral temporal cortex are similar, because of their dense interconnections. The ictal signs can be divided into autonomic, somatic, and behavioral. For research purposes, a 6-stage system was established, reflecting the usual sequential progression from focal to generalized seizure: attention response (1), arrest (2), salivation, licking (3), facial twitching (4), head turning or nodding (5), and generalized clonic convulsions (6). Knowledge of this data may help in recognizing low-stage (stage 1 or stage 2) epileptic seizures in clinical practice. Early experimental research data are in accordance with recent clinical observations regarding ictal clinical signs of TL epileptic seizures in cats. Furthermore, the research data supports the idea that TL epilepsy represents a unique clinical entity with a specific seizure type and origin in cats.

Aims - Overview of the new data about the strong link of sleep and epilepsy and conjoining cognitive impairment. Methods - Search for relevant references and summary of our own research activity on the topic. Results - Strong interrealtionship exists between epilepsy and plastic brain functions (memory processing and synaptic homeostasis) and the working modes of NREM sleep. In the most frequent childhood and adult epilepsy networks responsible for plastic functions can be derailed to an epileptic level of excitability, and suffer a transitory or permanent epileptic transformation. Exampling on the three big epilepsies: absence epilepsy; medial temporal lobe epilepsy; and childhood idiopathic focal age dependent epilepsy spectrum we demonstrate the most important features of this epileptic transformation. The association of cognitive impairment to certain sleep dependent epilepsies gains explanation by the epilepsy caused interference with slow wave decline (ICFE) and memory consolidation (MTLE) during NREM sleep. This paper serves also to introduce the concept of sleep dependent system epilepsies. Conclusions - We provide evidences about shared mechanisms among sleep related epilepsies being the derailment of sleep plastic funcions toward exaggerated excitability determined by the inherent possibilities of the signal transduction properties.Célkitűzés - Az alvás- és epilepsziakutatás újabb eredményeinek áttekintése az alvás és az epilepszia szoros kapcsolatának és az egyes epilepsziákhoz társuló kognitív zavarok jobb megértése érdekében. Módszer - Újabb irodalmi adatok áttekintése és saját kutatások összefoglalása. Eredmények - Szoros összefüggés mutatható ki az epilepszia és a plasztikus agyi funkciók (memória, szinaptikus homeosztázis) között, ugyanakkor a plasztikus funkciók és a NREM-alvás munkamódjai között is. A leggyakoribb gyermek- és felnőttkori epilepsziák patomechanizmusában egyre jobban feltárhatók azok a vonások, melyek arra utalnak, hogy az agy fejlődésének korai és serdüléskori flexibilis szakaszaiban azok a hálózatok, melyek a NREM-alvásban a leginkább plasztikus sajátságokkal rendelkeznek, túlgerjeszt­hetők, így átmeneti, vagy tartós epilepsziás transzformáción esnek át. Három nagy epilepsziás formakör: az absence epilepszia; a medialis temporalis epilepszia és az idio­pa­thiás fokális életkorfüggő gyermekkori epilepsziák példáján mutatjuk be az epilepsziás átalakulás jellemző vonásait. A plasztikus funkciók és az epilepszia összefonódása magya­rá­zattal szolgál egyes, epilepsziákhoz társuló kognitív zavarformák megértéséhez is. Egyúttal bevezetést adunk az alvás­függő rendszer-epilepsziák fogalomkörébe. Konklúzió - Az epilepsziák közös mechanizmusra vezet­hetők vissza. Ez valószínűsíthetően a NREM-alvással kap­cso­lódó agyi plaszticitás kisiklása az epilepsziás excitabili­tás irányába. Az agyi jelátviteli folyamatok természetében adott inherens lehetőségek határozzák meg az epilepsziás tüneteket, az egyes kórformák kimenetelét és a kognitív működések károsodását is.

SummaryIntroduction.Medial temporal lobe epilepsy (MTLE) is the most frequent form of epilepsy in adulthood. It is classified as local/regional epilepsy. However, there is increasing evidence of the involvement of both temporal lobes and this provides abundant arguments to question this view, and consider MTLE as one of the typical bilateral system epilepsies.Aim.To provide a contemporary review of medial temporal lobe epilepsy, discussing the bilateral aspects, with reference to epilepsy surgery.Methods.A literature review and a resume of the author’s own experiences with MTLE patients.Results.Recent electrophysiological and neuroimaging data provide convincing data supporting that MTLE is a bilateral disease. The uni-and bilateral features form a continuum and the participation rate of the two temporal lobes determine course and surgical perspective of the individual patient.Conclusions.The contradictory data of invasive presurgical evaluations of MTLE patients suggest that there need to identify further indicatory markers of bilaterality and thus change the presurgical evaluation from the non-invasive towards the invasive ways. The mechanisms of the interrelationship between the two temporal lobes in MTLE warrants further research.

We aimed to integrate new data about K-complex (KC) physiology and relate KC to other low-frequency waves observed in slow wave sleep. KC can be considered a 'prototype' of reactive sleep slow waves. Similarly to slow waves, KCs feature up- and down-states, they are subject to homeostatic regulation but they are also associated with sensory activation. As a part of the continuum of reactive sleep slow waves, the study of the KC may offer a better understanding of how slow waves are activated by the sensory system. KCs appear to have a special place among sleep slow waves and in the newly established framework of input-related NREM sleep regulation. It is a key element highlighting how the brain may choose to maintain sleep in response to a sensory input when facing the question "to wake or not to wake".

Aim We aim to study the mechanism of reflex seizure triggering in close link with the system-epilepsy concept. Method We use data and theories presented in the literature and scrutinize a few illustrative cases. Conclusions The prerequisite of seizure triggering is an epilepsy-prone brain network. When it is activated, it may produce seizures manifesting the function(s) of the same system. Beyond classical reflex seizures triggered by sensory-motor stimuli, we extend the reflex-epilepsy concept to seizures induced by the normal activation of epilepsy-prone systems e.g. praxis-induced seizures and those of sleep/wake system epilepsies elicited by falling asleep (absences) or arousals from NREM sleep (seizures of genetic frontal lobe epilepsy). We suggest that normal functioning of epilepsy-prone systems may trigger seizures in epilepsies in general.

We overview here the new data about the epileptic spectrum disorders within the frame of perisylvian epileptic network since our first trial to synthetize knowledge about this system epilepsy (Halasz et al., 2005). We found evidences for a continual features relating together syndromes constituting this spectrum disorder in several fields: in sharing genetic origin, in common perisylvian human communication circuitry, in NREM sleep related potentiation of interictal epileptiform discharges of the centro-temporal spike phenomenon and in the discharge related cognitive impairment, reflecting functional deficits in human communication abilities. The transformation of a part of the children to develop into a malignant course with different degree of residual cognitive loss, through compromising sleep plastic functions, by the epileptic discharges during sleep, beside pure genetic origin, is still under research. Both factual data and new conceptual approaches helps understand better the developmental childhood epilepsies.

SUMMARY Introduction. The seizure propagation phenomenon by inducing remote symptoms brings several difficulties in finding the seizure onset and delineating the epileptic network which should be taken into consideration in epilepsy surgery. By demonstrating a difficult (MRI negative) epilepsy surgery case explored with invasive presurgical evaluation we highlight the importance to recognise the secondary sensory area and to explore the the parieto-opercular-insular-medial frontal network in certain cases. A further conclusion is the consideration of the redistributory role of the insula as a special structure in the cerebral connectome, having a role in epileptic network organisation. Aims. To support the role of the insula in the organisation of an opercular – medial frontal epileptic network and to confirm Penfield’s the “second somatic sensory leg area” by way of a case report. We try to give an up to date exploration of our patient’s remote epileptic seizures by way of a connectome. Methods. The epileptic disorder was studied with intensive video EEG monitoring and two times 3T MRI. Interictal FDG (fluorodeoxyglucose) PET was also undertaken. Beside the scalp EEG and computerized frequency analysis, the evaluation was performed by invasive EEG with 2 grids and 2 strips and an insular deep electrode in addition. Electrical cortical stimulation and cortical mapping were also undertaken. Results. The video-EEG study revealed the complex seizure semiology. The left sided global somatosesensory aura in the leg, followed supplementary motor area manifestations represented a remote seizure. The seizure onset zone and the symptomatogenic zone were localised by the invasive electrophysiology. With the insular deep electrode we succeeded to explore the propagation of ictal activity to the insula and later to frontal medial surface. The PET, the negative 3T MRI results and the postprocessing morphometry confirmed the lesional origin and localised the epileptogenic area to the second somato-sensory field where a dysgenesis was located. Conclusions. By preoperative invasive video-EEG evaluation, the second somato-sensory leg area was delineated as the seizure onset zone. The resection of this area by IIb type cortical dysgenesis, resulted in a complete relief of the seizures. The invasive video-EEG revealed the peculiar role of the insula in the propagation of the epileptic seizure from the second sensory leg area to the ipsilateral fronto-medial supplemetary motor area. Our results, confirm, that the insula has a relay or node function on the parietal opercular-fronto-medial epileptic network. The connectome of the insula is a further additive of the scale-free features of the remote epileptic networks.