Increased expression of matrix metalloproteinase-9 in patients with temporal lobe epilepsy

Aim: The molecular mechanism of epileptogenesis in temporal lobe epilepsy is still unclear. Experimental studies have suggested that matrix metalloproteinases have important roles in this process, but human studies are limited. The aim of this study was to assess the expression of MMP-9, MMP-2 and their tissue inhibitors (TIMP-1 and TIMP-2) in patients with temporal lobe epilepsy with hippocampal sclerosis (TLE-HS). Material and Methods: The tissue samples from temporal neocortex and hippocampus were obtained from patients with temporal lobe epilepsy with hippocampal sclerosis who had undergone anterior temporal lobectomy for recurrent medically resistant seizures. Immunohistochemical methods were used to determine the expression of MMP-9, MMP-2 and their tissue inhibitors. Tissue samples were also analyzed with transmission electron microscopy. Results: The immunoreactivity for MMP-9 both in hippocampal and temporal neocortical neurons was stronger than that of MMP-2. Additionally, there was a mild reaction for its tissue inhibitor TIMP-1 as with TIMP-2. The TEM analysis of the hippocampus revealed that there was apparent ultra-structural damage on the pericarya and neuropil of some neurons. There was obvious damage in the mitochondria and the nuclear membrane. Conclusion: The preliminary results of this study revealed that MMP-9 may have a role in patients with drug resistant TLE-HS

Parkinson hastalarında subtalamik çekirdek derin beyin stimülasyonunun fiziksel, emosyonel, kognitif fonksiyon ve günlük yaşam aktiviteleri üzerine etkisi

Aim: To describe effectiveness of deep brain stimulation of subthalamic nucleus (DBS STN) on physical, emotional, cognitive functions and daily activities in Parkinson's patients. Material and Methods: Ten patients (51.20 ±10.20 yr.) were assessed three times. The Time Up and Go Test, 12 m Walking Test and Chair Stand Test were used to assess mobility and balance. Purdeu Pegboard and hand writing tests were used to evaluate hand function. The Hospital Anxiety and Depression Scale (HAD) was used to detect depressive symptoms and anxiety score. The Unified Parkinson\'s Disease Rating Scale (UPDRS) and Hoehn &Yahr Scale were also used. The Schwab and England Test was used to evaluate the daily activities (ADL). Results: The results showed that all the patients' mobility and balance ability improved after surgery (p<0.05). Depressive symptoms/anxiety scores were found to be lower than before surgery (p<0.05). There were differences in terms of ADL and UPDRS scores after surgery (p<0.05). At six month after surgery; depressive symptoms decreased by 78%. ADL and UPDRS motor and total scores improved by 190%, 72%, and 78% respectively. Conclusion: STN DBS is an effective treatment to improve physical functioning, emotional status and daily activities in Parkinson's patients. However, it did not show any positive effect on cognitive function

Posttraumatic isolated infarction in the territory of Heubner's and lenticulostriate arteries: case report.

A 12 year old male had a secondarily generalized epileptic seizure and a subsequent right hemiparesis with fasciobrachial predominance after a closed head injury. His seizures responded to antiepileptic drug therapy immediately. Computerized tomographic scanning and magnetic resonance imaging showed an acute infarct of the head of the left caudate nucleus, indicating the isolated occlusion of the left recurrent artery of Heubner and lateral lenticulostriate arteries. Pathologies leading to vasculitis and embolism were also looked for, but no finding of associated systemic disease could be disclosed. We present this case since posttraumatic infarction in the territory of the deep perforators such as recurrent artery of Heubner and lateral lenticulostriate arteries are exceptionally rare conditions especially in this age group

A case report of surgically treated drug resistant epilepsy associated with subependymal nodular heterotopia

Subependymal nodular heterotopia (SNH) is a cortical development malformation that is commonly associated with medically resistant epilepsy. Cases of SNH are challenging to treat surgically because there are typically multiple nodules, which may be involved in epileptogenesis. Moreover, dual pathology may exist in these patients. Here, we present a case with unilateral subependymal heterotopic nodules associated with ipsilateral hippocampal atrophy. Invasive and non-invasive work-ups revealed that the hippocampus was the actual ictal onset zone and that the SNH was not involved. An anterior temporal lobectomy was carried out, and postoperative seizure outcome was class Ia at the end of 2 years. The case demonstrates that SNH may not play a major role in patients with dual pathology. However, direct electroencephalography (EEG) recording from areas of SNH and other possible epileptogenic regions is indispensable in defining the ictal onset zone and avoiding poor surgical outcomes. (C) 2011 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved

Is spinal instrumentation a risk factor for late-onset infection in cases of distant infection or surgery?

As a cause of revision spinal surgery, spinal epidural abscess after instrumentation-assisted fusion is rare in neurosurgical practice. Postoperative infections are frequently seen in the time period soon after surgery. The authors report on the case of a 45-year-old woman who had undergone posterior instrumentation-augmented fusion for L4-5 degenerative spondylolisthesis. Ten months after the operation she presented to the neurosurgery clinic with complaints of severe low-back pain and radicular right lower-extremity pain. She had undergone laparoscopic surgery for acute cholecystitis 1 month prior to readmission. Radiological study revealed a spinal epidural abscess in communication with a right psoas abscess at L4-5. The abscess was drained percutaneously with the aid of C-arm fluoroscopic guidance, and a 6-week course of parenteral antibiotic therapy was administered. Retrograde lymphatic bacterial translocation, hematopoietic spread, and the suitable characteristics in the host may facilitate the development of infection around the implant. Thus, distant surgery and infection may be a risk factor in cases in which spinal instrumentation is placed. In such cases a prolonged antibiotic therapy for distant infection after surgery is recommended

History of spinal disorders and Cerrahiyetül Haniye (imperial surgery): A review of a Turkish treatise written by Şerefeddin Sabuncuoǧlu in the 15th century. Historical vignette

The history of the spinal surgery represent an important aspect of spine-related sciences. The development of the treatment strategies of spine-related disorders has predominantly been recorded in the Western literature. In this paper, a Turkish physician, Şerefeddin Sabuncuoǧlu (1385-1468), and this treatise, Cerrahiyetül Haniye (Imperial Surgery), are presented. Three sections of this book regarding spinal disorders (spinal dislocations, sciatica, and back pain) are reviewed. The techniques describe were used by Sabuncuoǧlu in the 1400s. In conclusion, the languages and illustrations of this treatise are unique. Compared with current approaches, there are no major differences in the principles of treating spinal traumas despite the passage of almost 500 years

Trigeminal neuralgia and vascular compression in patients with trigeminal schwannomas

OBJECTIVE: Trigeminal neuralgia (TN) is often associated with neurovascular compression. However, intracranial tumors are occasionally observed, particularly when symptoms are atypical. We describe three patients with Type-1 TN and trigeminal schwannoma diagnosed by magnetic resonance imaging, with concomitant arterial compression of the trigeminal nerve. CLINICAL PRESENTATION: All three patients had Type-1 TN with spontaneous onset, paroxysm-triggered pain, and response to antiepileptic medication. Contrast-enhanced T1-weighted magnetic resonance imaging scans demonstrated an ipsilateral enhancing perineural mass consistent with a schwannoma. Two of the three patients had previously undergone gamma knife radiosurgery without improvement. Subsequent high-resolution magnetic resonance imaging in all three patients revealed obvious compression of the trigeminal nerve by an arterial structure. INTERVENTION: Two patients underwent retrosigmoid craniectomy followed by microvascular decompression and remain pain-free. One patient elected not to pursue surgical intervention. CONCLUSION: Although intracranial tumors are occasionally observed in patients with TN, neurovascular compression must still be considered as an etiology, especially if typical TN symptoms are reported