[DIAGNOSIS AND TREATMENT OF A GIRL SUFFERING FROM DRUG RESISTANT EPILEPSY WITH AN INNOVATIVE MINIMALLY INVASIVE APPROACH]

INTRODUCTION

About one percent (over 81,000 patients) of the Israeli population suffer from epilepsy. The main treatment for this condition is medication, but about a third of the patients suffer from drug-resistant epilepsy (DRE). Each year about 5,000 new patients are diagnosed with epilepsy, of whom 3,000 are children. For these patients, an evaluation in designated centers is required in order to diagnose possible foci and propose neurosurgical treatment alternatives.

BACKGROUND

A model for diagnosis and treatment of the epileptic network in a minimally invasive approach is presented through the description of a case study. Phase I: includes diagnosis of the semiology, neuropsychological assessment, video EEG recording and performing a PET-MRI-FMRI-EEG synchronized examination. Phase II: involves stereo-electroencephalography (SEEG) minimally invasive diagnosis to target the epileptic area and accurately map adjacent functional areas and assessment of cortical redundancy. Phase III: includes radiofrequency ablation of the foci without any further surgery. This procedure is performed under clinical monitoring (the patient is awake during treatment) and continuous EEG monitoring.

CONCLUSIONS

This case study demonstrates the multi-dimensional model performed by a multidisciplinary team, combining innovative technologies. This model is essential for the precision of the diagnosis and treatment methods of focal epilepsy and allows preservation of function based, among other factors, on the identification of cortical redundancy.

DISCUSSION

The preoperative assessment identified focal epilepsy adjacent to the motor area dominating the right hand. A combined PET-FMRI-MRI-EEG examination enabled detecting redundancy of motor functions beyond the epileptic focus. Based on this information, a targeted implantation of depth electrodes (SEEG) was performed, the epileptic foci were identified and targeted ablations were performed during clinical monitoring and continuous EEG. This resulted in the cessation of seizures in parallel with the disappearance of the pathological signal in the EEG, all while preserving the patient's hand function.

FIRDA, refractory epilepsy, and SEEG guided RF: a case report

OBJECTIVES

We will demonstrate that FIRDA (frontal intermittent rhythmic delta activity) - otherwise related to systemic disorders and encephalopathy - has a role as an epileptic biomarker of deep seated midline SOZ. Its abolishment following SEEG guided radiofrequency of such SOZ correlates with clinical improvement, suggests its role as a non-invasive biomarker of otherwise inaccessible SOZs.

METHODS

We report the case of AK who was admitted with "psychiatric and gastrointestinal complaints". AK's complaints were further associated with FIRDA during VEEG. His previous refractoriness to AEDs, the clinico-electroencephalographic correlation, MRI showing bilateral hippocampal atrophy (more to the left) and severe memory deficits prompted us to suggest a left temporo-mesial SOZ, for which SEEG was done. Dual SEEG and scalp electrodes was used primarily for diagnostic purpose but taking into account an option for a therapeutic action by RF ablation.

RESULTS

The dual array demonstrated a clear association between left hippocampal high voltage spikes and HFO's on SEEG recordings with FIRDA on concomitant scalp EEG parallel to behavioral changes, as suspected on our preliminary hypothesis. A further RF ablation eliminated the epileptiform activity (Spikes, HFO's and FIRDA) followed by clinical improvement.

SIGNIFICANCE

This is the first report showing the clinical significance of FIRDA associated with behavioral changes as a marker for latent refractory mesial epilepsy. SEEG exploration has the potential to uncover deep sources which are manifested as FIRDA on scalp EEG. These abnormalities and clinical symptoms can be eliminated by RF ablation.

From chromosomal alterations to target genes for therapy: integrating cytogenetic and functional genomic views of the breast cancer genome

A vast number of recurrent chromosomal alterations have been implicated in cancer development and progression. However, most of the genes involved in recurrent chromosomal alterations in solid tumors remain unknown, despite the recent substantial progress in genomic research and availability of high-throughput technologies. For example, it is now possible to quickly identify large numbers of differentially expressed genes in cancer specimens using cDNA microarrays. Integration of this "functional genomic view" of the cancer genome with the "cytogenetic view" could lead to the identification of genes playing a critical role in cancer development and progression. In this review, we illustrate how the combination of three different microarray technologies, cDNA, CGH, and tissue microarrays, makes it possible to directly identify genes involved in chromosomal rearrangements in cell line model systems and then rapidly explore their significance as potential diagnostic and therapeutic targets in human primary breast cancer progression.

Acute appendicitis in early childhood

1728 appendectomies were performed in our institution between the years 1973 and 1978, only 18 of them below the age of 5 years. Acute appendicitis in this age is characterized by a very low incidence (1%); an overwhelming male predominance (8:1), a short history, and a rapid progress of the disease. In 72% perforation of appendix and peritonitis were present at operation. The triad of fever, abdominal pains and vomiting was present in all cases. A high leucocyte count was noted in all cases except one. All patients were operated upon within 16 h of admission. No mortality, a low morbidity and a short hospital stay were recorded.

Electromagnetic field scattering by a triangular aperture

The multiple Laplace transform has been applied to analysis and computation of scattering by a double triangular aperture. Results are obtained which match far-field intensity distributions observed in experiments. Arbitrary polarization components, as well as in-phase and quadrature-phase components, may be determined, in the transform domain, as a continuous function of distance from near to far-field for any orientation, aperture, and transformable waveform. Numerical results are obtained by application of numerical multiple inversions of the fully transformed solution.