L’histoire épique de la chirurgie de l’épilepsie

At present day, the mainstay of epilepsy treatments is antiepileptics, surgery is only considered for intractable epilepsy. Many epileptic syndromes are remediable by surgery after the failure of antiepileptics. These epileptic syndromes are generally focal and pharmacoresistant and involves mesial temporal sclerosis, neocortical temporal lobe epilepsy, premotor and central lobe epilepsy, mesial frontal epilepsy, basi-frontal lobe epilepsy, parieto-occipital lobe epilepsy, insular epilepsy, cingulate epilepsy, hypothalamic hamartomas, Rasmussen syndrome, and Landau–Kleffner syndrome. However, not only focal pharmacoresistant Epilepsy can be remediable by surgery. The Lennox–Gastaut syndrome is an example of generalised epilepsy that can benefit from palliative surgery (callosotomy, vagal nerve stimulation or radiosurgery). However, if epilepsy surgery has proved certain effectiveness, many surgical techniques were developed during the epilepsy history with unequal efficacy. The concept of epilepsy aetiology has remained for centuries dominated by supernatural views, considering seizure attacks as a religious or a superstitious concept. The “middle ages” in epilepsy surgery has unfortunately persisted until the twentieth century, based on wrong theories and illusory wisdom of curing epilepsy by numerous surgical procedures that gave no chance of any kind of improvement. Running parallel with these wrong theories, there were many bright spirits for more than 3000 years who gave considerable advances in the fields of medical and surgical treatment of epilepsy surgery.De nos jours, la pierre angulaire du traitement de l’épilepsie reste le traitement médical. La chirurgie n’est indiquée qu’en cas d’épilepsie pharmacorésistante. Plusieurs syndromes épileptiques sont traités chirurgicalement après l’échec des antiepileptiques. Ces syndromes épileptiques sont généralement focaux et pharmacorésistants à l’instar de la sclérose mésiotemporale, de l’épilepsie basifrontale, mésiofrontale, pariétale, insulaire ou cingulaire, des hammartomes hypothalamiques, du syndrome de Rasmussen et du syndrome de Landau-Kleffner. En revanche, Le synddrome de Lennox-Gastaut est un exemple de l’épilepsie généralisée qui peut tirer bénéfice d’une chirurgie palliative telle que la callosotomie, la stimulation du nerf vague ou la radiochirurgie. Si actuellement l’efficacité de la chirurgie de l’épilepsie est reconnue, plusieurs techniques chirurgicales développées au cours de l’histoire n’ont pas connu le même succès. Le concept même d’étiologie de l’épilepsie a été dominé par le caractère surnaturel considérant la crise d’épilepsie comme un phénomène religieux ou superstitieux. Le «moyen âge» de la chirurgie de l’épilepsie a malencontreusement persisté jusqu’au vingtième siècle basé sur des théories fallacieuses et de faux espoirs n’ayant amené aucune amélioration. Parallèlement à ces faux pas de la chirurgie, plusieurs grands esprits de la science ont apporté durant trois millénaires des avancées considérables dans le traitement médical et chirurgical de l’épilepsie

Les kystes dermoïdes de la fosse cerebrale postereure

Matériel et Méthode 3 enfants âgés de 18 mois à 8 ans ont été colligés au service entre 2005 et 2010. Résultas 3 patients ont présenté un syndrome d’hypertension intracrânienne, dont un patient a présenté une méningite récidivante. Tous avaient un sinus dermique. L’IRM a été réalisée dans tous les cas. Tous ont bénéficié d’une exérèse chirurgicale totale et d’une dérivation du LCR par ventriculo-cisternostomie première en urgence dans un cas et par dérivation ventriculo-péritonéale en post-opératoire dans deux cas. L’évolution était satisfaisante sans récidive avec un recul moyen de 3 ans. Conclusion Dans notre série, le KD de la fosse cérébrale postérieure est toujours associé à un sinus dermique et à une hydrocéphalie. La prise en charge repose sur l’exérèse chirurgicale et sur la dérivation du liquide cérébro-spinal.Mots clés : kyste dermoïde, sinus dermique, fosse cérébrale postérieure, chirurgie, résonance magnétiqu

Hémangiopéricytome de l’angle ponto-cérébelleux: cas clinique et revue de la littérature

Les hémangiopéricytomes primitifs du système nerveux central sont rares et représentent moins de 1% des tumeurs intracraniennes. La localisation au niveau de l'angle ponto-cerebelleux est très rare, pouvant simuler un neurinome de l'acoustique ou un méningiome. Le diagnostic de certitude est basé sur l'étude histologique et immunohistochimique. Notre but est d'illustrer avec une revue de la littérature les aspects clinicoradiologiques, anatomopathologiques et la prise en charge thérapeutique de ce type de lésion

Nocardia brain abscess - case report and literature review

Background and purposeNocardia species is an aerobic soil-saprophyte bacterium, responsible for rare opportunistic infections, mainly reported in immunocompromised patients. Nocardia brain abscess accounts for 1 to 2% of cerebral abscess. Abscesses are mainly located in the brain stem. Prognosis is poor.Methods The authors report one biloculated cerebral abscess case located in the left cerebellar and occipital lobes. We describe clinical, radiological and bacteriological findings and management; we also a review literature on Nocardia cerebral abscess.Case report A 56 year old man who was immunosuppressed, presented with headache and cerebellar syndrome. Head Computerised Tomography showed an irregularly enhancing cystic lesion in the left cerebellar and occipital lobes. He underwent posterior fossa cranitomy and chemotherapy that included high doses of Sulfamethoxazole-Trimethoprim and cefotaxime as microbateriologic examination revealed norcardia asteroids. He was eventually discharged home.Conclusion Nocardiasis is a rare cause of cerebral abcess in Morocco. Effective management includes early surgery and treatment with appropriate antibiotics

Who Watches the Watchmen? An Appraisal of Benchmarks for Multiple Sequence Alignment

Multiple sequence alignment (MSA) is a fundamental and ubiquitous technique in bioinformatics used to infer related residues among biological sequences. Thus alignment accuracy is crucial to a vast range of analyses, often in ways difficult to assess in those analyses. To compare the performance of different aligners and help detect systematic errors in alignments, a number of benchmarking strategies have been pursued. Here we present an overview of the main strategies--based on simulation, consistency, protein structure, and phylogeny--and discuss their different advantages and associated risks. We outline a set of desirable characteristics for effective benchmarking, and evaluate each strategy in light of them. We conclude that there is currently no universally applicable means of benchmarking MSA, and that developers and users of alignment tools should base their choice of benchmark depending on the context of application--with a keen awareness of the assumptions underlying each benchmarking strategy.Comment: Revie

Une cause rare d’exophtalmie

Une enfant de 3 ans, issue d’un mariage non consanguin, deuxième d’une fratrie de 3, et sans antécédents pathologiques particuliers. Le début de la symptomatologie remonte à un mois par la constatation par la maman d’une exophtalmie de l’œil gauche qui augmentait rapidement de volume sans autres signes associés. A l’examen clinique, on notait la présence d’une importante exophtalmie de l’œil gauche avec bombement du cavum sans déficits neurologiques, le fond d’œil a objectivé une atrophie optique temporale. Une tomodensitométrie orbitaire a objectivé un processus énorme intra-orbitaire iso dense infiltrant la base du crâne, le sinus caverneux, le sinus sphénoïdal gauche  avec extension vers le cavum sur une étendue de 40 mm

Robust sequence alignment using evolutionary rates coupled with an amino acid substitution matrix

BACKGROUND: Selective pressures at the DNA level shape genes into profiles consisting of patterns of rapidly evolving sites and sites withstanding change. These profiles remain detectable even when protein sequences become extensively diverged. A common task in molecular biology is to infer functional, structural or evolutionary relationships by querying a database using an algorithm. However, problems arise when sequence similarity is low. This study presents an algorithm that uses the evolutionary rate at codon sites, the dN/dS (ω) parameter, coupled to a substitution matrix as an alignment metric for detecting distantly related proteins. The algorithm, called BLOSUM-FIRE couples a newer and improved version of the original FIRE (Functional Inference using Rates of Evolution) algorithm with an amino acid substitution matrix in a dynamic scoring function. The enigmatic hepatitis B virus X protein was used as a test case for BLOSUM-FIRE and its associated database EvoDB. RESULTS: The evolutionary rate based approach was coupled with a conventional BLOSUM substitution matrix. The two approaches are combined in a dynamic scoring function, which uses the selective pressure to score aligned residues. The dynamic scoring function is based on a coupled additive approach that scores aligned sites based on the level of conservation inferred from the ω values. Evaluation of the accuracy of this new implementation, BLOSUM-FIRE, using MAFFT alignment as reference alignments has shown that it is more accurate than its predecessor FIRE. Comparison of the alignment quality with widely used algorithms (MUSCLE, T-COFFEE, and CLUSTAL Omega) revealed that the BLOSUM-FIRE algorithm performs as well as conventional algorithms. Its main strength lies in that it provides greater potential for aligning divergent sequences and addresses the problem of low specificity inherent in the original FIRE algorithm. The utility of this algorithm is demonstrated using the Hepatitis B virus X (HBx) protein, a protein of unknown function, as a test case. CONCLUSION: This study describes the utility of an evolutionary rate based approach coupled to the BLOSUM62 amino acid substitution matrix in inferring protein domain function. We demonstrate that such an approach is robust and performs as well as an array of conventional algorithms.This item is part of the UA Faculty Publications collection. For more information this item or other items in the UA Campus Repository, contact the University of Arizona Libraries at [email protected]

A Tragical Paediatric Case History of Intraorbital and Intracranial Epithelioid Hemangioendothelioma

Epithelioid hemangioendothelioma (EHE) is a rare tumor of intermediate malignancy. We report a case of intracranial and intraorbitar EHE. A 3-year-old girl presented with a 3-month history of progressive left exophthalmia. Neuroradiologic imaging (CT scan and MRI) showed an intraorbitar process with an intense enhancement extending to temporal fossa, ethmoidal bone, nasal fossa, maxillary sinus, and cavernous sinus. The angiogram was normal. The tumor was operated through subfrontal approach but only a partial resection was performed. The histological diagnosis was epithelioid hemangioendothelioma. The patient was neurologically intact 2 months after surgery without exophtalmia. However 4 months after surgery he displayed a fall of the right eye vision with intense headache. Control CT scan showed persistence of important tumoral residue. Epithelioid hemangioendothelioma is a hemorrhagic tumor. Total removal must be possible. Otherwise, we recommend a complementary chemoradiotherapy and close followup. We propose this interesting case history of a tragical evolution of EHE in contradiction with what has already been reported