Faculty Bibliography

The review of previous research and the studies undertaken at our center suggest an important role for mapping of nonlinguistic cognitive functions with cortical stimulation. Such mapping is usually restricted to language functions, which is understandable given the importance of language to daily activities and the reports of postoperative declines in naming. However, memory functions are also critical to adaptive daily living, and these studies show that memory may be effectively addressed through mapping procedures. Both Ojemann's studies and those at our center suggest an important role for much of the temporal convexity in memory processing, and we believe that postoperative memory declines can be minimized with mapping of the temporal lobe prior to resection. Patients presenting with unique abilities that may be susceptible to postoperative declines can also be effectively mapped with stimulation studies tailored to their unique abilities. We encourage the expansion of mapping paradigms beyond just the language domain and believe that such studies will both improve the quality of our patients' functioning and further our knowledge of brain-behavior relationships

Identified 37 patients (aged 11-57 yrs) with juvenile myoclonic epilepsy (JME) out of 740 consecutive epilepsy patients. Only 3 were initially diagnosed with JME. Factors leading to misdiagnosis included warnings (auras) suggesting partial seizures before generalized tonic-clonic seizures (GTCS), confusion between absence and complex partial seizures, failure of patients to spontaneously report or for physicians to obtain a history of myoclonic jerks, and failure to report myoclonic jerks to medical personnel despite specific questioning. Psychiatric disorders were common: depression occurred in 9 Ss and panic disorder in 7 Ss. Following diagnosis, 86% of Ss were seizure-free on antiepileptic drugs. To improve diagnostic sensitivity, Ss with epilepsy should be routinely questioned about the occurrence of myoclonic seizures, and JME should not be excluded because patients report nonspecific warnings before GTCS.

In 5 cases suffering from intractable seizures and ictal onset in exquisite (primary somatosensory or language related) cortex, surgical therapy has been done consisting wholly or in part of multiple subpial transections. In two cases with involvement of the primary somatosensory cortex, good seizure control without detectable neurological deficit was achieved. In the other three cases with involvement of the language cortex, deficits were minimal and cleared with time. Patients became seizure-free