By F. Riordian. Manhattan College.
Following the hybridization reaction purchase toradol 10mg menstrual pain treatment natural, the membrane is washed and regions of hybridization are identified by Embryo Cloning autoradiography order 10 mg toradol with visa pain treatment for trigeminal neuralgia. The detection of mutant gene that causes diseases like cystic aim of this is not to create a cloned human being buy genuine toradol on line pain treatment and wellness center seattle, rather fibrosis purchase toradol online now chest pain treatment guidelines. Stem cells are extracted in the blastocyst stage Northern blotting of development, which can practically generate any type Northern blotting is similar to southern blotting except of cells in the human body. Western blotting Tissue Cloning Western blotting is used for identification of specific pro This technique is called tissue culture, in which cells are teins. The known mutagens are Xrays, ultra Cloning means production of many identical copies of a violet light, certain chemicals, etc. Generally, there are four types of cloning: Gene of mutations: Point mutation and frameshift mutation. Gene clon Frame-shift Mutations ing is used widely in genetic engineering for sequencing In this mutation, base pairs are either deleted or inserted genomes and in gene therapy. The However, translation continues and proteins formed have Broad methodology: many altered amino acid sequence. The technique of reproductive cloning uses the prin Mutation results in diseases such as sickle cell disease, ciple of somatic cell nuclear transfer, in which genetic phenylketonuria, cystic fibrosis, etc. Chromosomal translocation: In this, a part of chro mosome is translocated to other chromosome. For Genetic screening is detecting the genetic variations in a example, an area of chromosome 8 in patients with human being. It is used for diagnosing diseases at various Burkitt’s lymphoma is translocated to either of the stages and for various purposes such as prenatal diagno chromosome 2, 14 and 22. Missense mutation: In this, amino acid sequence of protooncogene changes that helps the protein to con Prenatal Diagnosis vert into oncogene. Gene amplification: Amplification of some of the in the fetal stage and therefore has preventive values. This genes to become oncogene has been implicated in the is performed by chorionic villus sampling, amniocentesis genesis of lung, breast, stomach and colon cancer. Defective P53 Gene Diagnosis of Carrier States Normally, stimulation of P53 gene results in formation of A group of people carry and transmit the disease without P53 protein. The identification of such carrier people for many physiological functions that prevent malignancy. Genetic Basis of Cancer Telomerase Some cancers such as cancer of colon and female breast, Telomerase recognizes telomere in cell divisions. Cancer Genes Tumor Suppressor Gene These are also called anti-oncogenes that prevent genesis There are genes that predispose to cancer and genes of cancer. Gene Therapy Oncogenes Hereditary disorders occur due to transmission of defec Cancer causing genes are called oncogenes. Gene therapy aims at providing the correct more than 100 oncogenes have been described so far. Many factors stimulate with a normal gene conversion of protooncogenes to oncogenes. Normally, caspases are present in the therapy as changes in these cells cannot be inherited. Cells are isolated with the defective gene from the Internal stimuli: Mitochondria release cytochrome patient and grown in culture. Grown cells are transfected with a remedial gene cons caspase 9, which induces apoptosis. External stimuli: External stimuli are various ligands It is successfully tried in cystic fibrosis of the lung and that bind with cell surface to activate apoptosis. In cancer, gene therapy is very useful, in which oncogenic gene is inactivated by introducing a gene like tumor suppressor gene. Apoptosis is a (a) Usually it is triggered by absence of stimuli that are nor Greek word meaning ‘falling off ’ or ‘dropping off ’, first mally required for normal cell survival such as absence described 1972. Death of neurons in central nervous system during Once apoptosis is initiated, certain intracellular proteins brain development and synapse formation is an exam provide signal for the final programmed cell death, which ple of apoptosis. During fetal development, degeneration of many tis teins include the following: sues like web in the fingers is other example. Another things: the identification of components of the binding protein present in the cytosol is the proapop cell death control and effector mechanisms, and the linkage of abnormalities in cell totic proteaseactivating factor (apzaf1), which is a death to human disease, in particular cancer. Horvitz and John E Sulston for their work (Nobel Prize, 2002, for pioneering research (b) Other apoptotic regulator proteins: Other regulator identifying genes that control apoptosis. Physiologic involution of cells in hormonedependent tissues such as endometrial shedding in menstrual cycles, regression of lactating breast after cessation of breastfeeding. Tumor cell death on exposure to chemotherapeutic Apoptosis occurs in following major steps (Flowchart agents. Cell death induced by viral infections as occurs in viral contact with the target cell, is activated. For (b) Ceramide generation: Hydrolysis of sphingomyelin example, prostatic atrophy after orchiectomy. Changes in apoptosis confuses with the changes in necro (e) Formation of apoptotic bodies: Apoptotic bodies are sis. In apoptosis, there is Physiologic and Pathologic Processes condensation of nuclear chromatin and cell fragments into Apoptosis is a biologic phenomenon, which has both phy apoptotic bodies that are phagocytosed by macrophages siologic and pathologic processes. Chapter 5: Physiology of Genetics and Apoptosis 39 the characteristic changes in apoptosis include the fol lowing: 1. The cytoplasm becomes intensely eosinophilic containing condensed or fragmented nuclear chromatin material. Cell membrane convolutes with formation of mem branebound spherical structures called apoptotic bodies that contain compacted organelles. A glycoprotein molecule called thrombospondin and a phosphoprotein called phosphatidylserine appear on the outer surface of apoptotic bodies, which facilitate recognition by macrophages for phagocytosis. In necrosis, cyto and effector mechanisms and the linkage of abnormali plasm is homogenously eosinophilic, and nuclear changes are ties in cell death to human disease, in particular cancers, pyknosis, karyolysis and karyorrhexis. In apoptosis, there is con densation of nuclear chromatin and cell fragments into apopto has unraveled the research for preventing the cell death. Inflammatory Understanding the concept of apoptosis has promising response around apoptosis is absent. It deals with the understanding of the concept of gene and gene therapy in treat ment of genetic disorders. Discovery of cancer genes (oncogenes) and genes preventing cancers has changed the concept and modality of treatment of malignancies. Understanding the concept of apoptosis has promising role in regenerative medicine. Name common ion channels in the membrane; and name different types of carrier proteins with examples. Classify transport processes and list the differences between passive and active transport mechanisms. Describe the mechanism, factors affecting and physiological application with example of each transport process, especially of diffusion and osmosis. Describe the mechanism and importance of endocytosis, exocytosis and transcytosis. Fluid and electrolytes on either side of the cell membrane through water channels formed by integral proteins, pass through the membrane by various means due to and by combination with carrier molecules in the cell the presence of different channels and carrier molecules. Transport of specific substances, like drugs, chemicals and hormones also influence cell functions. Proteins that constitute channels are selectively perme- Passage of substances through the membrane can be able. They are tubular structures that connect the exte- broadly divided into two categories: rior with the interior of cells. Direct passage without involvement of carrier mole depends on molecular size, shape and charge. Hence, lipid- soluble substances, such as gases, fatty acids, alcohol, Types of Protein Channels ketone bodies, aldehydes and many small-uncharged Broadly, they are of two types: ion channels and water molecules pass through the membrane easily. Passage through channels or carrier proteins: Though Ion Channels water passes easily through the membrane, water- soluble substances, such as electrolytes, glucose and Ion channels are integral proteins that span the entire amino acids do not penetrate membrane readily. Normally, they are formed by There are two major means through which these sub- several polypeptide subunits. There are 13 types of aquaporins (for details, refer to ‘Water reabsorption from kidney’ in ‘Renal Physiology’). Gating of Ion Channels Some of the ion channels remain always open, and, there- fore, they are referred to as nongated channels. Ion channels are provided with gate on either side of the channel, and opening or closure of the gate regulates the movement of various ions through them. Note the presence of selectivity There are three general mechanisms of gating: vol- filter and the gate. Along the length of the integral protein, an aqueous pore is present, around which the polypeptide sub- Change in the membrane potential beyond a certain units are arranged. Ions pass through the aqueous threshold value opens or closes the gate of the ion chan- pore from one side of the membrane to the other. Thus, ions cross the membrane without entering For example, ion channels in excitable tissues, such as through the lipid bilayer of the membrane. They are also present in pace- channel that opens in response to a specific stimulus maker tissues in the heart and other organs. It is proposed that alteration in membrane potential induces movement of some charged amino acids in 4. However, there is a selectivity filter that permits speci- helical segment of the channel protein that causes a fic ions to pass through the channel. Therefore, ion conformational change of the channel protein, which channels are often selective. For Na channels, the gate is located on the outer end Sodium Channels of the channel (Fig.
The hypoechoic joint effusion appears dark buy toradol master card pacific pain treatment center san francisco, and the bone margin of the phalanx appears as a white line buy cheap toradol 10 mg ayurvedic treatment for shingles pain. Diagnostic value of high-resolution B-mode and Doppler sonography for imaging of hand and finger joints in rheumatoid arthritis buy 10mg toradol amex interventional spine and pain treatment center nj. This image corresponds to grade 3 in the conventional power Doppler grading (vessel dots over more than half the synovial area) purchase toradol 10 mg otc a better life pain treatment center. Monitoring anti-interleukin 6 receptor antibody treatment for rheumatoid arthritis by quantitative magnetic resonance imaging of the hand and power Doppler ultrasonography of the finger. A: In this partial-thickness tear, the thickened ligament (solid arrowheads) is characterized by interstitial hypoechoic defects (open arrowheads). Axial ultrasound image (A) of the left hand showing a large homogenous soft tissue mass, which is 554 isoechoic to subcutaeneous fat and lacks vascularity on color Doppler (B). The mass is noted on either side of second and third common flexor tendon sheaths (arrows in B). Transverse image through the distal end of the index (I) and middle finger (M) metacarpals. The middle finger extensor hood is intact with the extensor tendon seen (arrowhead). On the index finger the extensor hood is torn and the extensor tendon has subluxed to the ulnar side (arrow). Ganglion cyst associated with the flexor digitorum superficialis/profundus tendon sheath. A: Longitudinal view of the flexor tendons (T) overlying the metacarpal-phalangeal joint demonstrates a small cyst (C) overlying the flexor tendons. B: Transverse view at the same level demonstrates the tendons (T) and the overlying cyst (C). A: Transverse gray-scale view of the hand overlying the third and fourth metacarpals. A hypoechoic soft tissue mass (cursors) is seen in the tissues superficial to the metacarpals. B: Color Doppler view of the same area demonstrates intense hypervascularity of this mass. The clinical findings and the sonographic appearance are both consistent with a hemangioma. C: the clinical findings and the sonographic appearance are both consistent with a hemangioma. Axial sonogram of the volar hand shows hemorrhagic (curved arrow) and solid (straight arrow) components of the tumor. Flexor tenosynovitis with heterogeneous synovial hypertrophy (arrowheads) at the level of the metacarpophalangeal joint. A: Transverse view of the extensor tendons demonstrates fluid (F) distending the extensor tendon sheath. B: Longitudinal view of an extensor tendon (T) in a different patient demonstrating fluid (F) distending the tendon sheath and thickening of the tendon sheath (arrows). C: Transverse color Doppler view of the extensor tendons demonstrates hypervascularity of the synovial tissue associated with these tendons. At the base of the flexor tendon complex, the ulnar (1) and radial (2) sesamoids appear as bright echogenic structures. A closer look at the radial sesamoid reveals an irregular cortical break (arrow) in its midsubstance splitting the ossicle into two parts (2a and 2b). Longitudinal view of the metacarpal-phalangeal joint of the third digit demonstrates two highly echogenic, minimally shadowing, glass foreign bodies overlying the flexor tendons to the finger. A: Transverse view of the palm demonstrates a vertically oriented foreign body (arrows), in this case a splinter. B: Similar power Doppler view demonstrates intense hypervascularity associated with the inflammatory response adjacent to the foreign body. It is important for the clinician to recognize that each imaging modality has its advantages and disadvantages and one should not rely solely on the finding of a single imaging study if the clinical 557 impression does not match (Fig. If a foreign body is identified, ultrasound-guided removal is a reasonable next step (Fig. Under constant ultrasound guidance the skin is incised together with the underlying fascia if necessary. Innervation of the metacarpophalangeal and interphalangeal joints: a microanatomic and histologic study of the nerve endings. Technique for intra-articular injection of the metacarpophalangeal joint of the fingers. Hyperextension is limited by the volar and collateral ligaments, which along with a dense joint capsule and surrounding tendons, help strengthen the interphalangeal joints and protect against subluxation (Fig. Hyperextension on the interphalangeal joints is limited by the volar and collateral ligaments, which along with a dense joint capsule and surrounding tendons, help strengthen the interphalangeal joints and protect against subluxation. The primary function of the interphalangeal joints of the fingers is to aid in the gripping and pinching functions of the hand. The articular cartilage of the interphalangeal joints of the fingers is susceptible to damage, which left untreated, will result in arthritis with its associated pain and functional disability. Osteoarthritis is the most common cause of arthritis in the interphalangeal joints (Fig. Less common causes of arthritis-induced pain of the interphalangeal joints of the fingers include the collagen vascular diseases (especially rheumatoid arthritis), infection, psoriatic arthritis, post-traumatic arthritis, villonodular synovitis, and Lyme disease (Figs. Acute infectious arthritis of the interphalangeal joints of the fingers joint is best treated with early diagnosis, with culture and sensitivity of the synovial fluid and prompt initiation of antibiotic therapy. The collagen vascular diseases generally manifest as a polyarthropathy rather than a monoarthropathy limited to the interphalangeal joints of the fingers. A: Conventional radiography shows no central or marginal erosions in the fourth proximal interphalangeal joint (enlarged image). Coronal (B) and axial (C) T1- weighted magnetic resonance images show an erosion at the insertion site of the collateral ligament (arrows). Ultrasound images of the second proximal interphalangeal joints of rheumatoid arthritis patients with different synovitis volumes. Images are taken from the dorsal side; the left side of the image is the proximal side of the hand and the right side is the distal side. Images are graded semiquantitatively with regard to the effusion and synovitis volumes, as follows: (A) 0, none; (B) 1, little; (C) 2, moderate; and (D) 3, high. Doppler ultrasonography and dynamic magnetic resonance imaging for assessment of synovitis in the hand and wrist of patients with rheumatoid arthritis. The characteristic deformity of the interphalangeal joints known as sausage finger caused by psoriatic arthritis. Patients with pain in the interphalangeal joints of the fingers secondary to arthritis, gout, synovitis, and collagen vascular disease–related joint pain complain of pain that is localized to the head of the metacarpals. Activity, including grasping and pinching motions, makes the pain worse, with rest and heat providing some relief. Sleep disturbance is common with awakening when patients roll over onto the affected hand. Some patients complain of a 561 grating, catching, or popping sensation with range of motion of the joints, and crepitus may be appreciated on physical examination. Swelling of the joints commonly occurs with enlargement of the distal interphalangeal joints (called Heberden nodes) and enlargement of the proximal interphalangeal joints (called Bouchard nodes) (Fig. Herberden nodes (blue arrow) and Bouchard nodes (white arrows) are characteristic findings of osteoarthritis of the interphalangeal joints. Plain radiographs are indicated in all patients who present with pain in the interphalangeal joints of the fingers (Fig. Based on the patient’s clinical presentation, additional testing may be indicated, including complete blood cell count, sedimentation rate, and antinuclear antibody testing. Plain radiograph of osteoarthritis of the hands with marked proximal interphalangeal joint involvement (Bouchard nodes) as well as distal interphalangeal joint involvement (Heberden nodes). High-resolution ultrasound in the diagnosis of upper limb disorders: a tertiary referral centre experience. With the patient in the above position, the dorsal surface of the affected interphalangeal joint is identified by palpation. A high- frequency small linear ultrasound transducer is placed in a longitudinal position over the dorsal surface of the affected interphalangeal joint and an ultrasound survey scan is taken (Figs. The hypoechoic joint space is identified between the head of the metacarpal and the base of the proximal phalanges. When the joint space is identified, the intra-articular space is evaluated for erosions, effusion, osteophytes, crystal deposition, and joint mice (Figs. Correct longitudinal position for ultrasound transducer for ultrasound evaluation of the interphalangeal joints of the fingers. Longitudinal ultrasound image demonstrating degenerative joint changes of the proximal interphalangeal joint. Different imaging modalities demonstrate findings of erosive osteoarthritis in a 62-year-old woman. B: the corresponding axial ultrasound view showing cortical bone defects (arrows) and joint effusion (asterisk). C: Longitudinal ultrasound image of the third distal interphalangeal joint showing a bone cortex defect (arrow) and joint effusion (asterisk). D: Longitudinal ultrasound image of the fourth interphalangeal joint showing joint effusion (asterisk), synovial hyperproliferation (arrowheads) and a bony protrusion (arrow). G: the corresponding coronal T2-magnetic resonance image nicely shows the joint effusion as an area with high signal intensity between the middle and distal phalanx (white signal in the joint). Single asterisk indicates gray-scale synovitis, and double asterisk shows intracapsular and extracapsular power Doppler signals.
Psychiatric aspects of patients with hypotha- with hypothalamic hamartoma and catastrophic epilepsy purchase toradol now back pain treatment for dogs. Intrinsic epileptogenesis of hypothalamic tients with hypothalamic hamartoma and refractory epilepsy buy generic toradol 10 mg line pain medication for dogs at home. Precocious puberty due to a hypothalamic ic hamartomas: infrequent epilepsy and normal cognition in patients presenting hamartoma buy toradol 10 mg otc st. john-clark pain treatment center in clearwater florida. Surgical treatment of intractable seizures Acad Child Adolesc Psychiatry 2001; 40: 696–703 buy toradol 10mg free shipping treatment guidelines for pain management. Gamma knife surgery for epilepsy related Cambridge University Press, 2011: 449–458. Orbitozygomatic resection for hypotha- lamic hamartomas, with control of seizures, in children with gelastic epilepsy. Epilepsy related to hypothalamic hamarto- doscopic surgery and stereotactic radiosurgery: a case report. Minim Invasive mas: surgical management with special reference to gamma knife surgery. Outcome and predictors of in- hamartomas causing medically refractory gelastic epilepsy. Childs Nerv Syst2006; terstitial radiosurgery in the treatment of gelastic epilepsy. Lef vagal nerve stimulation in six patients otactic radiosurgery in patients with epilepsy due to hypothalamic hamartoma. Subsidence of seizure induced by stereotactic associated with hypothalamic hamartomas. Electrical stimulation of the anterior nucleus of thalamic hamartomas in patients with medically intractable epilepsy and preco- thalamus for treatment of refractory epilepsy. The use of radiosurgery to treat intractable cordings of the mammillary body in epilepsy patients. Gamma knife surgery for epilepsy related to lamic tract for the treatment of resistant seizures associated with hypothalamic hypothalamic hamartoma. Deep brain stimulation for the treatment of surgery for hypothalamic hamartomas accompanied by medically intractable drug-refractory epilepsy in a patient with a hypothalamic hamartoma: case report. Gamma knife radiosurgery for re- report of two cases surviving surgical removal of the tumour. Stereotactic radiofrequency ablation for ses- crosurgery: a novel strategy to approach complex ventricular lesions. A certain proportion of patients who undergo eval- produced an epileptic focus with aluminium gel lesions in the lef uation for possible surgical resection are found to have an epilepto- precentral motor cortex, which resulted in the development of focal genic zone originating in, or overlapping with, eloquent cortex. Using a small wire, he disconnected the horizontal patients traditionally have been denied surgery because resection of fbres at 5-mm intervals throughout the epileptogenic zone. This pro- primary speech, motor, sensory or visual cortex would result in unac- cedure, the frst subpial transection for epilepsy, stopped the seizures, ceptable defcits. The purpose of this technique is confrm that what he had transected was motor cortex, 1 year lat- to disrupt the intracortical horizontal fbre system while preserving er Morrell surgically removed the transected area, resulting in the the columnar organization of the cortex (i. With this experimental evidence, Morrell and put and output systems and vascular supply) . The transection of colleagues moved forward into the treatment of intractable human horizontal fbres is aimed at preventing the propagation of epileptic neocortical epilepsy arising in or overlapping eloquent cortex. The pres- ervation of the columnar organization of the cortex prevents or min- Planning for multiple subpial transection imizes the disruption of the functional state of the transected cortex. Multiple subpial transection is indicated in any patient in whom the ep- The development of this technique was derived from three sets of ileptic zone arises from or overlaps with eloquent cortex. The procedure experiments, each unrelated to the others or to the feld of epilepsy is performed afer a detailed presurgical evaluation, which includes surgery. The frst set of experiments by Asanuma and Hunsperger closed-circuit video electroencephalographic recording of habitual sei- , Hubel and Wiesel  and Mountcastle  demonstrated that zures using scalp and intracranial electrodes, mainly subdural grids. In the vertically oriented micro- and macrocolumns (with their ver- addition, detailed functional mapping to identify eloquent cortex by tically oriented input, output and vascular supply) are the organi- electrical cortical stimulation and evoked potentials is performed. The functional role ropsychological testing and functional neuroimaging studies all assist of the intracortical horizontal fbre system is yet to be frmly estab- in defning the baseline function and risks of the procedure. However, this system is composed of fbres responsible for encephalography studies have also been very useful in the evaluation of recurrent inhibition and excitation underlying neuronal plasticity. It allows more accurate identifcation gical disruption of the horizontal fbre system in the visual cortex of the source of the dipole, especially its depth within a sulcus [12,13]. In the third set of experiments, Tarp with resection of non-eloquent cortex, depending on the extent to related the importance of the horizontal fbre system as a ‘critical which the epileptogenic zone involves eloquent cortex. Epileptic activity in the form of typically patients with dominant temporal mesial or neocortical ep- spikes or sharp waves requires a synchronous neuronal activation ilepsy, dominant frontal lobe epilepsy, or primary sensory, motor or of a contiguous cortical surface of at least 12 to 25 mm2[7,8]. In patients undergoing resection/transec- found that epileptic foci would synchronize their activity if the dis- tion, resection of non-eloquent cortex is performed to within 1. We recognize that this pa- between the foci would desynchronize the epileptic activity. However, the microgyral patterns of in- Afer the frst transection is completed, bleeding from the pial dividual gyri may be considerably variable. Tese cortical variations opening is controlled with small pieces of Gelfoam and a cotton- must be taken into account in a procedure where transections are oid. The 4-mm tip is then placed up against the cortex next to the being made perpendicular to the long axis of a gyrus. Tus, careful transection so as to select the next transection site 5 mm from the inspection of each gyrus prior to the procedure is important. This is repeated until the identifed epileptogenic zone is tran- matter is, on average, 5 mm thick over the crown of a gyrus; howev- sected. Over a few minutes, the lines take on a striped appearance er, the depth of each sulcus is variable. Minimal bleeding Tese points are critical in subpial transection procedures be- is encountered if the transections are done properly. The transected area perpendicular to the long axis of the gyrus while preserving the displays a signifcant attenuation of the background activity with overlying pia with its blood vessels and the underlying white matter elimination of the spikes. Favourable outcomes using alternative instruments and meth- ods of transection have been described by neurosurgeons [15,16]. Operative procedure Patients are given preoperative antibiotics and ofen steroids and are positioned so that the surgical site is at the highest point in the Outcome operative feld. However, Anaesthesia is accomplished with intravenous methohexital and as has been reported by other centres, there is a late reoccurrence local anaesthesia. Re- tion hook is introduced into the grey matter layer and advanced to duction in seizures by 50% or more was seen in 79% of patients. If the 4-mm tip is excellent outcome (greater than 95% reduction in seizure frequen- introduced just below the pia, it should remain in the grey matter cy) in 87% of patients who had generalized seizures and 68% of layer, leaving the white matter undisturbed. Ten to 44 months postsurgery three pa- tients remained seizure free and the remaining four had only rare seizures. During this pro- cedure, longitudinal hippocampal circuits are cut and disrupted by transection of the pyramidal cortical layer while the transverse lam- inar confguration of the hippocampus, which serves memory func- tion, is preserved. Similar fndings have been described in mouse models of mesial temporal lobe epilepsy where a selective transec- tion of the dentate gyrus and hilus signifcantly reduced the occur- rence of paroxysmal epileptic discharges and abolished the spread (d) over the longitudinal axis of the hippocampus, suggesting that lon- gitudinal projections are critical for the generation and spread of Figure 72. Of the 21 patients, 17 were as to select the next transection site 5 mm from the frst. Fourteen patients (82%) became sei- until the identifed epileptogenic zone is transected. Eight patients underwent procedure is to abolish synchronized epileptic activity and preserve the a full postoperative battery of neuropsychological testing of verbal functional status of the transected cortex by sectioning the intracortical memory. Verbal memory was completely spared in seven, with one horizontal fbres at 5-mm intervals while preserving the columnar patient having a transient worsening that cleared over 6 months organization of the cortex. The authors were encouraged with the above results; however, a longer follow-up and greater numbers of patients are required be- fore transection of hippocampus is confrmed to be efcacious and sparing of verbal memory function. This usually included afected cortex extending 5–7 cm from the Multiple subpial transection 919 temporal tip. The postoperative results were excellent with Multiple subpial transection with cortical resection has been used 94. Repeat neuropsy- in patients with multifocal multilobar epilepsy, clinical seizures and chological testing at 3–6 months postoperatively was available in developmental regression. Verbal memory improved in seven of nine improvement in language, social and behavioural function with a patients and in the remainder it remained stable. Good The patients who underwent right-sided surgery showed improve- success rates, even in groups of patients with catastrophic types of ment in verbal memory only, while the patients who underwent epilepsy, have been reported, without signifcant cognitive or func- lef-sided surgery had no signifcant memory change in relation to tional decline . In a series of sev- patients with non-lesional dominant mesial temporal lobe epilepsy. The mortality of this condition is high and achieving seizure and immunotherapy is used to control seizures and behaviour- control to prevent further neurological and systemic damage is im- al changes, but the cognitive defcits associated with the disease perative. All intractable infantile spasm with some improvement in seizures and had continuous spike and wave in slow-wave sleep from a unilat- developmental delay . The variability of reported short and long-term out- ment of language coming within the frst 6 months postoperatively. The main one is probably the experience of tive improvement on receptive and expressive tasks, which further the neurophysiology and neurosurgical team performing the pro- improved as they were followed over a longer period of time afer cedure. The frequency of disconnection over the transected area result in better postoper- of seizures and behavioural disorders signifcantly improved in ative seizure outcome. This might be related to the duration of epilepsy prior seems to result in better outcome. Finally, the diversity and limitations of recent hospital series describes similar trends. Ten children ages 5 the design of the reported studies also plays an important role in 920 Chapter 72 Table 72. Tese included foot tapping test showed a much broader and bilateral cortical activation drop in 2%, language defcit in 2% and a parietal sensory loss in 1%.