A kortikális hálózatok szerepe a gyermek- és felnőttkori temporális lebeny epilepszia szemiológiai sajátosságaiban = The role of cortical networks in seizure semiology of childhood and adulthood temporal lobe epilepsy

Kutatásom során a temporális lebeny epilepszia karakterisztikájának számos életkorfüggő sajátosságát tártam fel. Igazoltam, hogy a hippocampalis sclerosis, illetve a motoros rohamkomponens, a lateralizációs jelek, az automatizmusok, és a szekunder generalizáció gyakorisága életkorfüggő jelenségek; míg az aura, illetve az emocionáis és autonóm tünetek megjelenése az agyi hálózatok érésétől független ebben, a leggyakoribb fokális epilepszia típusban. Néhány új roham-lateralizációs és lokalizációs jelenséget is leírtam: pl. a preiktális magatartás megváltozást, az iktális mosolyt, iktális elsápadást, a pozitív emocionális jeleket, iktális hyperoralitást és a posztiktális beszéd automatizmust. Számos ismert lateralizációs jel (iktális vízivás, manuális automatizmus, köhögés, hányás) jelentőségét pedig pontosítottam életkorfüggőségük, illetve a kezesség szempontjából. Az MR és EEG adatok kiterjedése szempontjából rámutattam arra, hogy fiatal életkorban a rohamszemiológia csak finom részleteiben függ a rohamindító zónától, ami a kortikális agyi hálózatok kiterjedt bevonódását igazolja az érésben lévő agy esetén. A műtéti prognózis, az iktális agyi hálózatok kiterjedése, illetve a hisztopatológiai adatok közötti szignifikáns összefüggéseket is sikerült igazolnom. A kapott eredményeket nagyszámú (21 közlemény és 22 előadás), és azok klinikai kutatási jellegéhez képest magas impakt faktorú folyóiratokban sikerült megismertetni (összesített impakt faktor 41,69). | During the study, we uncovered many age-dependent characteristics of temporal lobe epilepsy axes. Hippocampal sclerosis as well as the frequency of seizure motor components, lateralizing signs, automatisms, and secondarily generalization showed age-dependency, while the frequency of aura, emotional signs, and autonomic symptoms were independent of the cortical networks? maturity. We described some new localizing and lateralizing signs. Preictal behavioral change, ictal smile, ictal pallor, positive emotional signs, ictal hyperorality, and postictal speech automatism had localizing and/or lateralizing value. Some earlier described lateralizing signs (e.g. peri-ictal water drinking, manual automatisms, ictal vomiting, and postictal coughing) were also reviewed and reconsidered according to special factors (age and handedness). Assessing the extension and localization of MR lesion and ictal EEG, we could show that localization of the seizure onset zone in young children has only subtle influence on seizure semiology, supporting the fast end extensive ictal involvement of different cortical networks in the developing brain. Our study showed also significant correlations between cortical network involvement, histopathological data and the prognosis of epilepsy surgery. Our results are available in a large number of publications (21 papers, 22 oral presentations) with a high cumulative impact factor (41.69)

Modelling climate effects on Hungarian winter wheat and maize yields

Hungarian cereal production is situated in the zone of Europe which is most vulnerable to the effects of changes in climatic conditions. The objectives of this paper are to present the calibration and validation of the 4M crop simulation model using farm-level observed representative values, and to estimate the potential yields of winter wheat and maize production for the next three decades. Analysing the differences between the estimated and observed yields, we identified as key influencing factors the heterogeneity of technologies and of land quality. A trend of slightly decreasing yields is projected for the next three decades for both cereals. The precise impact of environmental change on crop yields will depend on which climate scenario occurs

A detailed semiologic analysis of childhood psychogenic nonepileptic seizures

Purpose: Psychogenic nonepileptic seizure (PNES) is an important differential diagnostic problem in patients with or without epilepsy. There are many studies that have analyzed PNES in adults; currently, however, there is no systematic assessment of purely childhood PNES semiology. Our study based on a large pediatric video-electroencephalography (EEG) monitoring (VEM) cohort, provides a detailed analysis of childhood PNES and assesses the usability of the current classification system described in adults. Methods: Medical and video-EEG records of 568 consecutive children (younger than 18 years) who underwent video-EEG monitoring (VEM) at our hospital were reviewed. Aura, type of movement, anatomic distribution, synchrony, symmetry, eye movement, responsiveness, vocalization, hyperventilation, vegetative and emotional signs, presence of eyewitness, and duration of the event were recorded among children with the diagnosis of PNES. We also compared our data with those of earlier adult studies. Key Findings: Seventy-five archived PNES of 27 children (21 girls; age 8-18 years) were reanalyzed. Nine children (33%) had the diagnosis of epilepsy currently or in the past. Mean age at the time of PNES onset was 11.6 (standard deviation 3.2) years. Mean duration of PNES was longer (269 s) compared to seizures of the epileptic group (83 s; p = 0.002). Eyewitnesses (mostly parents) were present in 89% of cases. Eighty percent of PNES had an abrupt start, with 68% also ending abruptly. In only 15% of events were the patients eyes closed at the beginning of the attack. Patients were unresponsive in 34%. The most frequent motor sign was tremor (25%) with the upper, rather than lower limbs more frequently involved. Pelvic thrusting was seen in only two attacks. Emotional-mostly negative-signs were observed during 32 PNES (43%). Based on Seneviratne et al.'s classification, 18 events (24%) were classified as rhythmic motor PNES, only half the frequency of that previously described in adults. No hypermotor PNES was found. The frequency of complex motor PNES (13%) and mixed PNES (4%) showed similar frequency in children as in adults. Dialeptic PNES was found more frequently among younger children. All PNES belonged to the same semiologic type in 23 patients (85%). Significance: Because homogeneity of PNES within a patient was high in the pediatric population, we found it useful to classify PNES into different semiologic categories. Dialeptic PNES seems to be more frequent among younger children. Tremor is the most frequent motor sign and usually accompanied by preserved responsiveness in childhood. Negative emotion is commonly seen in pediatric PNES, but pelvic thrusting is a rare phenomenon. We, therefore, suggest a modification of the present classification system in which PNES with motor activity is divided into minor and major motor PNES, and the latter group is subdivided into synchron rhythmic motor and asynchron motor PNES. We believe that our study, a detailed analysis on the semiology and classification of purely childhood PNES might assist the early and precise diagnosis of nonepileptic paroxysmal events

A neokortikális és hippocampális epilepsziák komplex elektrofiziológiai rétegelvezetéses és szövettani vizsgálata emberben = Complex laminar electrophysiological and histological examination of the human neocortical and hippocampal epilepsies

Az OITI és a MTA PKI együttműködésében részletesen kidolgoztuk az intraoperatív és krónikus multielektróda beültetés technikai feltételeit és a vizsgálatok forgatókönyvét. Létrehoztunk egy kombinált multielektródás és konvencionális klinikai grid-sztrip elektródos elvezető rendszert, mely segítségével az operáció alatt, illetve krónikusan tudunk elvezetni intrahippokampális, intrakortikális, valamint szubdurális potenciálokat. Kimutattuk a szubikulumban generált különféle epilepsziás kisülések és a laterális temporális kéreg aktivitásának kapcsolatait, kimutattuk továbbá az alvásban és epilepsziában fontos K-komplexum generátorainak kérgi eredetét. Vizsgáltuk az alvási oszcilláció és az epilepsziás események kapcsolatát, kimutattuk, hogy epilepsziás emberben a felszínhez közeli kérgi rétegek igen erős szinaptikus és tüzelési aktivitást mutatnak az alvási oszcilláció aktív fázisában. Kimutattuk továbbá, hogy az aktív fázis csoportosítja az epilepsziás kisüléseket. A kérgi elektromos ingerlés hatását vizsgálva epilepsziás betegeken megállapítottuk, hogy a rövid elektromos ingerek inaktiválják a kérget, amit későbbiekben terápiás céllal lehet hasznosítani. | In collaboration with the OITI and MTA PKI we have worked out in details the intraoperative and chronic multielectrode implantation technique and the schedule of the investigation. We have established a combined system composed of the conventional clinical grid and strip based electrophysiology apparatus and the novel investigational multielectrode system to measure intrahippocampal, intracortical and subdural potentials chronically and intraoperatively. We have shown the relationship of the subicular and lateral temporal lobe epileptic discharges, we have also shown the cortical origin of the K-complex, an important brain wave in sleep and epilepsy. We have investigated the slow sleep oscillation and its relationship to epilepsy. The slow waves were originated in the superficial layers of the cortex and the epileptiform discharges were grouped by the up-states of the slow oscillation. Investigating the effect of electrical stimulation, we have shown that brief current pulses can inactivate the cortex, which effect can also be exploited in the therapy of epilepsy

Increased resting-state EEG functional connectivity in benign childhood epilepsy with centro-temporal spikes

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Increased resting-state EEG functional connectivity in benign childhood epilepsy with centro-temporal spikes

AbstractPurposeTo explore intrahemispheric, cortico-cortical EEG functional connectivity (EEGfC) in benign childhood epilepsy with rolandic spikes (BECTS).Methods21-channel EEG was recorded in 17 non-medicated BECTS children and 19 healthy controls. 180s of spike- and artifact-free activity was selected for EEGfC analysis. Correlation of Low Resolution Electromagnetic Tomography- (LORETA-) defined current source density time series were computed between two cortical areas (region of interest, ROI). Analyses were based on broad-band EEGfC results. Groups were compared by statistical parametric network (SPN) method. Statistically significant differences between group EEGfC values were emphasized at p<0.05 corrected for multiple comparison by local false discovery rate (FDR).Results(1) Bilaterally increased beta EEGfC occurred in the BECTS group as compared to the controls. Greatest beta abnormality emerged between frontal and frontal, as well as frontal and temporal ROIs. (2) Locally increased EEGfC emerged in all frequency bands in the right parietal area.ConclusionsAreas of increased EEGfC topographically correspond to cortical areas that, based on relevant literature, are related to speech and attention deficit in BECTS children

Tapasztalatok a levetiracetamkezeléssel gyermekkori epilepsziákban = Experience with levetiracetam in childhood epilepsy

OBJECTIVE: To evaluate the efficacy and tolerability of levetiracetam in children with drug resistant epilepsy from a retrospective study. METHODS: We report the result of a study of 85 pediatric patients (mean 10.5 years, range: 1-24) with refractory generalized and focal epilepsy, who received levetiracetam as add-on treatment. The average duration of epilepsy was eight years, and the patient were treated with mean of 6.0 antiepileptic drugs before levetiracetam was introduced. RESULTS: Ten patients (12%) became seizure-free, three (3%) responded with seizure reduction of more than 90%, 32 (38%) responded with seizure reduction of more than 50% following introduction of levetiracetam. No response to levetiracetam was reported in 34% (n: 29). Positive psychotropic effect was observed in 26 patient (30%). Mild to moderate side effects were reported in 11 patients (13%), consisting most frequently general behavioral changes, aggression, sleep disturbances, but they ceased after decreasing the dose of levetiracetam. Mental retardation was associated with poor response and associated with more side effects. CONCLUSION: Levetiracetam is a well tolerated new antiepileptic drug that may effectively improve seizures control as an add-on drug in resistant epilepsy in childhood with good tolerability

A Dravet-szindróma klinikai és genetikai diagnosztikájáról húsz esetünk kapcsán = Clinical and genetic diagnosis of Dravet syndrome: report of 20 cases

OBJECTIVE AND BACKGROUND: Severe myoclonic epilepsy in infancy (SMEI; Dravet's syndrome) is a malignant epilepsy syndrome characterized by prolonged febrile hemiconvulsions or generalized seizures starting in the first year of life. Later on myoclonic, atypical absence, and complex partial seizures appear. When one of these seizure forms is lacking the syndrome of borderline SMEI (SMEB) is defined. Psychomotor delay resulting in mental retardation is observed during the second year of life. In most patients a de novo sodium channel alpha-1 subunit (SCN1A) mutation can be identified. By reviewing the clinical, laboratory, and neuroimaging data of our SMEI patients diagnosed between 2000 and 2008, we would like to share our experiences in this rare but challenging syndrome. Our results will facilitate the earlier and better diagnosis of Hungarian children with SMEI. PATIENTS AND METHODS: Clinical, EEG, MRI and DNA mutation data of 20 SMEI patients treated in the Bethesda Children's Hospital (Budapest) were reviewed. RESULTS: The first seizure appeared at age 6.3+/-3.0 months. At least one of the first two seizures were complex febrile seizures in 19/20 and unilateral seizures in 12/20 children. All children except for one showed hemiconvulsions at least once; all children had seizures lasting longer than 15 minutes. Eight of twenty patients had SMEB. DNA diagnostics identified an SCN1A mutation in 17 patients (6 missense, 4 nonsense, 4 frameshift, 2 splice site, 1 deletion) while 3 children had no mutation. CONCLUSION: Early diagnosis of SMEI is important for the avoiding unnecessary examinations and false therapies as well as for genetic counselling. Typical symptoms of SMEI are early and prolonged febrile hemiconvulsions with neurological symptoms, mental retardation and secondary seizure types later on. The presence of an SCN1A mutation supports the diagnosis. We propose the availability of molecular diagnostics and stiripentol therapy for SMEI children in Hungar

Common Man, Society and Religion in the 16th century/Gemeiner Mann, Gesellschaft und Religion im 16. Jahrhundert

Der zweisprachige Sammelband vereinigt zum Teil bahnbrechende Ergebnisse einer interdisziplinären Forschungstagung, deren Beiträge sozial-, wirtschafts-, kultur- und kirchengeschichtliche Aspekte der Frühneuzeit im Karpatenbogen aufgreifen. Basierend auf vielfach erstmals ausgewerteten Quellen bearbeiten die Beiträge aktuelle Fragestellungen und Forschungshorizonte zur Interdependenz von sozialen, ökonomischen, kulturellen und religiösen Phänomenen im Karpatenbogen der Frühen Neuzeit, in dem die Osmanen der international dominante politische Faktor wurden. Transformationsprozesse wurden angestoßen durch Bevölkerungs- und Militärbewegungen, ökonomische, politische und religiös-mentale Umwälzungen, die zwischen opportunistischer Anpassung und rebellierendem Widerstand oszillierten und entsprechende politische Maßnahmen und Gegenreaktionen hervorriefen. Dabei wird die bislang geltende Forschungsmeinung zur Toleranzgeschichte Siebenbürgens in Frage gestellt und völlig neu bewertet