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A limited cortical resection including the rolandic fissure and the pre- and postcentral cortical regions was carried out in a patient suffering from epilepsia partialis continua resistant to antiepileptic drugs. The histological examination revealed several foci of very large neurons distributed with no laminar organization in the depth of the rolandic fissure and in the crown of the primary motor and primary somatosensory areas; these lesions were consistent with focal cortical dysplasia. In addition, decreased numbers of neurons, astrocytosis and proliferation of capillaries, compatible with chronic tissue necrosis, were found in the inferior regions of the banks of the rolandic fissure. Subpopulations of local-circuit neurons were examined with parvalbumin, calbindin D-28k and somatostatin immunocytochemistry. Focal areas of cortical dysplasia contained abnormal immunoreactive neurons. Huge parvalbumin-immunoreactive cells were distributed at random and resembled axo-axonic (chandelier) and basket neurons. Abnormal calbindin D-28k-immunoreactive cells were reminiscent of double-bouquet neurons and multipolar cells. Very large somatostatin-immunoreactive cells were seldom observed in the dysplastic foci. On the other hand, areas of tissue necrosis displayed massive reduction of immunoreactive cells and fibers. Abnormalities in the morphology and distribution of local-circuit (inhibitory) neurons observed here for the first time in focal cortical dysplasia may have a pivotal role in the appearance and prolongation of electrical discharges and continuous motor signs in human focal epilepsy.

SummaryThis paper evaluates the use of metoclopramide (MaxoIon) in emptying human stomach contents into the duodenum and beyond. A method of quantitative assessment of content by barium swallow radiography is used in the study, and the method is recommended as a diagnostic manoeuvre in patients presenting for emergency surgery in whom the stomach content is in doubt.Oral metoclopramide was found effective in emptying stomachs challenged by water load, and the intravenous route has been found effective in emptying semisolid contents in emergency clinical situations. A radiographic scan of the resting stomach was made on patients waiting for routine surgery who had received a variety of common premedication; it was shown that significant residues occur.We believe that metoclopramide deserves further investigation in order to exploit its potential in reducing the hazard of regurgitation and vomiting in patients requiring emergency anaesthesia and surgery.

Invasive versus non‐invasive epileptogenic zone definition was analyzed in a series of 89 patients operated on for drug‐resistant epilepsy. In the group of 69 cortical resections, 26% needed invasive recordings, 13.5% when foreign‐tissue lesions had been detected by MRI and 32% when were absent. In this last group temporal resections had invasive EEG recordings in 23.5% versus 54.5% when the epileptogenic zone was extratemporal. In a group of 43 temporal resections with more than one year follow‐up MRI has detected some abnormality in 84%. Excluding focal lesions, MRI detected hippocampal/temporal lobe atrophy in 66% of the cases in agreement with other noninvasive tests and in 4% contralateral to the epileptogenic zone located by subdural strips. The outcome analysis showed that 85% of the patients with MRI‐EEG agreement were seizure free in contrast to only 43% when MRI was non‐lateralizing. Future studies has to be oriented to better understand the epileptic process of patients without MRI abnormalities.

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