Phase Lag Analyses on Ictal Scalp Electroencephalography May Predict Outcomes of Corpus Callosotomy for Epileptic Spasms

Objective: We aimed to clarify the patterns of ictal power and phase lag among bilateral hemispheres on scalp electroencephalography (EEG) recorded pre-operatively during epileptic spasms (ESs) and the correlation with the outcomes following corpus callosotomy.Methods: We enrolled 17 patients who underwent corpus callosotomy for ESs before 20 years of age. After corpus callosotomy, seven patients did not experience further ESs (favorable outcome group), and the remaining 10 patients had ongoing ESs (unfavorable outcome group). We used pre-operative scalp EEG data from monopolar montages using the average reference. The relative power spectrum (PS), ictal power laterality (IPL) among the hemispheres, and phase lag, calculated by the cross-power spectrum (CPS) among symmetrical electrodes (i.e., F3 and F4), were analyzed in the EEG data of ESs from 143 pre-operative scalp video-EEG records. Analyses were conducted separately in each frequency band from the delta, theta, alpha, beta, and gamma range. We compared the means of those data in each patient between favorable and unfavorable outcome groups.Results: Among all frequency bands, no significant differences were seen in the individual mean relative PSs in the favorable and unfavorable outcome group. Although the mean IPLs in each patient tended to be high in the unfavorable outcome group, no significant differences were found. The mean CPSs in the delta, theta, and gamma frequency bands were significantly higher in the unfavorable than in the favorable outcome group. Using the Youden index, the optimal cutoff points of those mean CPS values for unfavorable outcomes were 64.00 in the delta band (sensitivity: 100%, specificity: 80%), 74.20 in the theta band (100, 80%), and 82.05 in the gamma band (100, 80%). Subanalyses indicated that those CPS differences originated from pairs of symmetrical electrodes in the bilateral frontal and temporal areas.Significance: Ictal power and laterality of the ictal power in each frequency band were not associated with the outcomes of CC; however, the phase lags seen in the delta, theta, and gamma frequency bands were larger in the unfavorable than in the favorable outcome group. The phase lags may predict outcomes of CC for ESs on pre-surgical scalp-ictal EEGs

Resective Surgery for Double Epileptic Foci Overlapping Anterior and Posterior Language Areas: A Case of Epilepsy With Tuberous Sclerosis Complex

Tuberous sclerosis complex is a genetic systematic disorder characterized by hamartomas in multiple organs. Cortical tubers, the hamartomas in the cerebrum, cause multifocal refractory seizures. In certain cases, epileptic foci potentially involve language areas, and hence, extra- and intraoperative cortical mapping can help identify anterior and posterior areas, thus avoiding postsurgical language impairment. We report on a 21-year-old female with tuberous sclerosis complex experiencing refractory partial seizures due to two epileptic foci in the left hemisphere overlapping anterior and posterior language areas. To completely evaluate both language areas, we performed stepwise resections beginning from the anterior to the posterior epileptic focus. Although the patient presented with expressive aphasia following anterior resection, it was possible to conduct language tests during every resection. Postoperatively, she presented with expressive aphasia, comprehension deficits, left-right disorientations, and arithmetic deficits. The language dysfunctions almost disappeared at 5 weeks after the surgery and were completely resolved at 6 months after surgery. At postoperative 9 months, she was free from seizures

A case of posterior quadrant disconnection for post-subdural empyema epilepsy -focal cortical dysplasia might be the underlying cause of refractory epilepsy-

Introduction: Intracranial subdural empyema (ISDE) can cause drug-resistant epilepsy. We attempted to cure post-ISDE refractory epilepsy by operative surgery and assessed the neuropathological findings. Patient and method: A 23-year-old right-handed man with refractory epilepsy had ISDE on the right temporal and occipital areas at 14 years old. He underwent ISDE drainage operation at the time. A week after the infection, he developed epileptic seizure, which consisted of epigastric sensation, followed by loss of awareness with gelastic seizure. This type of seizure occurred around five times a day. He underwent right posterior disconnection and the temporal lobe was submitted to histopathological examination. Result: The patient has remained seizure-free for more than 3 months. Histopathological diagnosis showed focal cortical dysplasia (FCD) type IB. Conclusion: We cured post-ISDE refractory epilepsy by posterior quadrant disconnection. Epileptogenicity of FCD might be triggered by ISDE. Keywords: Subdural empyema, Focal cortical dysplasia, Posterior quadrant disconnection, Refractory epileps

Visceral pleural invasion is an invasive and aggressive indicator of non-small cell lung cancer

ObjectiveAlthough visceral pleural invasion by non-small cell lung cancer is considered a poor-prognostic factor, further information is lacking, especially in relation to other clinicopathologic prognostic factors. We assessed the relationship between visceral pleural invasion and other clinicopathologic characteristics and evaluated its significance as a prognostic factor.MethodsWe reviewed 1074 patients with surgically resected T1/2 non-small cell lung cancer for their clinicopathologic characteristics and prognoses. The patients were divided into 2 groups according to visceral pleural invasion status (visceral pleural invasion group and non-visceral pleural invasion group). Both groups were compared with regard to age, sex, histology, tumor size, tumor differentiation, lymph node involvement, lymphatic invasion, vascular invasion, scar grade, nuclear atypia, mitotic index, serum carcinoembryonic antigen level, and survival. Univariate and multivariate analyses were conducted.ResultsVisceral pleural invasion was identified in 288 (26.8%) of the resected specimens. Survival was 76.0% at 5 years and 53.2% at 10 years in the non-visceral pleural invasion group and was 49.8% at 5 years and 37.0% at 10 years in the visceral pleural invasion group. The difference between groups was highly significant (P < .0001). Visceral pleural invasion was also significantly associated with a higher frequency of lymph node involvement. However, regardless of N status (N0 or N1/2), there was a significant difference in survival when the visceral pleura was invaded. Visceral pleural invasion was observed significantly more frequently in tumors with factors indicative of tumor aggressiveness/invasiveness: moderate/poor differentiation, lymphatic invasion, vascular invasion, high scar grade, high nuclear atypia grade, high mitotic index, and high serum carcinoembryonic antigen level. By multivariate analysis, visceral pleural invasion proved to be a significant independent predictor of poor prognosis in non-small-cell lung cancer patients with or without lymph node involvement.ConclusionsVisceral pleural invasion is a significant poor-prognostic factor, regardless of N status. Our analyses indicated that visceral pleural invasion is an independent indicator of non-small cell lung cancer invasiveness and aggressiveness

中学校保健分野の発展的学習内容構成についての試み : 「身体の内的環境」に関するひとつの構成 <第2部 教科研究>

我が校では,過去3期9年間にわたり文部科学省研究開発学校の指定を受け,中学校・高等学校を通して学ぶ教科横断的な新教科「現代への視座」の創設に,全ての教科で取り組んできた。保健体育科は理科・家庭科と共に,中学校2年生での「環境」について担当した。そこでは,「自然環境(外的環境)」と「体内環境(内的環境)」の二つのテーマのもと,複眼的見方や探求の方法,科学的思考力,読解力,判断力,まとめ方や表現力等の獲得を目指し,一定の成果を上げることができた。この稿においては,その成果を中学校保健分野の発展的学習内容へ還元し,思考力・判断力など現在の学習指導要領が求めている資質や能力が育成されるような授業構成を試み,基礎的・基本的な知識の暗記や再現にとどまらず,知識を活用する学習活動によって,保健学習が活性化する授業の在り方を検討した