Summary:Purpose: Epilepsy is a relatively frequent disease in children, with considerable impact on cognitive and social life. Successful epilepsy surgery depends on unambiguous focus identification and requires a comprehensive presurgical workup, including several neuroimaging techniques [magnetic resonance imaging, positron emission tomography (PET), and single-photon emission computed tomography (SPECT)]. These may be difficult to apply in younger or developmentally delayed children or both, requiring sedation, and hence, a significant workforce. Modern electric source imaging (ESI) provides accurate epileptic source-localization information in most patients, with minimal patient discomfort or need for cooperation. The purpose of the present study was to determine the usefulness of ESI in pediatric EEG recordings performed with routine electrode arrays.Methods: Preoperative EEGs recorded from 19 to 29 scalp electrodes were reviewed, and interictal epileptiform activity was analyzed by using a linear source-imaging procedure (depthweighted minimum norm) in combination with statistical parametric mapping.Results: In 27 (90%) of 30 patients, the ESI correctly localized the epileptogenic region. These numbers compare favorably with the results from other imaging techniques in the same patients (PET, 82%; ictal SPECT, 70%). In extratemporal epilepsy, ESI was correct in all cases, and in temporal lobe epilepsy, in 10 of 13 cases. In two temporal lobe patients showing less-accurate ESI results, 128-electrode data could be analyzed, and in both cases, the 128-electrode ESI was correct.Conclusions: ESI with standard clinical EEG recordings provides excellent localizing information in pediatric patients, in particular in extratemporal lobe epilepsy. The lower yield in temporal lobe epilepsy seems to be due to undersampling of basal temporal areas with routine scalp recordings. Key Words: Epilepsy-Pediatric-EEG-Source imaging.The indication for early surgical intervention in children with refractory epilepsy should be actively investigated for two reasons: (a) to avoid the deleterious effect of epileptic seizures and antiepileptic medication on cognitive, intellectual, and social development (1,2); and (b) to increase the chances of postoperative functional reorganization due to the expected higher degree of brain plasticity in children (3-5). The surgical outcome is similar to that in adults (6-8) (i.e., between 60 and 80% of patients with temporal lobe epilepsy are postoperatively seizure free) (8-10). However, in extratemporal epilepsy, which is more frequent in pediatric patients, the outcome is still somewhat less favorable compared with surgical treatment of temporal lobe seizures. Overall, 50-75% benefit from surgical treatment, and evidence converges that the outcome deAccepted January 15, 2006. Address correspondence and reprint requests to Dr. G. Lantz at Functional Brain Mapping Laboratory, Department of Neurology, University Hospital, 24 Rue Micheli-du-Crest, CH-1211 Genève 14, Switzerland. E-mail Goran.Lant...

BackgroundPregnancy is associated with reduced activity of multiple sclerosis (MS). However, the biological mechanisms underlying this pregnancy-related decrease in disease activity are poorly understood.MethodologyWe conducted a genome-wide transcription analysis in peripheral blood mononuclear cells (PBMCs) from 12 women (7 MS patients and 5 healthy controls) followed during their pregnancy. Samples were obtained before, during (i.e. at the third, sixth, and ninth month of gestation) and after pregnancy. A validation of the expression profiles has been conducted by using the same samples and an independent group of 25 MS patients and 11 healthy controls. Finally, considering the total group of 32 MS patients, we compared expression profiles of patients relapsing during pregnancy (n = 6) with those of relapse-free patients (n = 26).Principal FindingsResults showed an altered expression of 347 transcripts in non-pregnant MS patients with respect to non-pregnant healthy controls. Complementary changes in expression, occurring during pregnancy, reverted the previous imbalance particularly for seven inflammation-related transcripts, i.e. SOCS2, TNFAIP3, NR4A2, CXCR4, POLR2J, FAM49B, and STAG3L1. Longitudinal analysis showed that the overall deregulation of gene expression reverted to “normal” already within the third month of gestation, while in the post-partum gene expressions rebounded to pre-pregnancy levels. Six (18.7%) of the 32 MS patients had a relapse during pregnancy, mostly in the first trimester. The latter showed delayed expression profiles when compared to relapse-free patients: in these patients expression imbalance was reverted later in the pregnancy, i.e. at sixth month.ConclusionsSpecific changes in expression during pregnancy were associated with a decrease in disease activity assessed by occurrence of relapses during pregnancy. Findings might help in understanding the pathogenesis of MS and may provide basis for the development of novel therapeutic strategies.

Urinary disorders are uncommon in the initial phases of multiple sclerosis, but increase in frequency as the disease progresses, with a negative impact on quality of life. The goal of this study was to propose a protocol for the diagnosis and treatment of urinary disorders in multiple sclerosis, based on data from the scientific literature and the experience of Italian clinical centres. In particular, the following clinical aspects were considered: what to do with patients with asymptomatic multiple sclerosis; what to do with symptomatic patients; how and when to perform a second-level diagnostic evaluation; and how to treat urinary disorders. A diagnostic-therapeutic algorithm is proposed, that can be applied in Italian clinical centres.

Summary:The cerebral representation of laughter is dissociated. The emotional aspects seem to be processed in the temporal lobe; whereas the motor features apparently rely on the frontal cortex. In a few prior studies of patients in whom laughter was elicited by electrical stimulation (ES), it always was associated with mirth. We report a patient in whom ES in the right cingulate gyrus elicited smile and laughter, but no mirth. At low voltages, smiling was seen first contralaterally and became bilateral with increasing currents. Our observation supports the concept of the motor representation of laughter in the mesial frontal cortex. Key Words: Epilepsy-Laughter-Cingulate gyrus-Corticography-Electrical stimulation.Study of the neurobiologic bases of laughter has interested researchers for centuries, because laughter is an essential part of our daily behavior, and it contributes significantly to our well-being (1). It has been postulated that laughter includes two components: the mirth or merriment and the motor aspect. The feeling of mirth seems to be related to temporal and frontal neocortical functions, whereas the sequential movements (diaphragm, larynx/pharynx, facial musculature) associated with laughter depend on the limbic system and brainstem (2). The evidence for this hypothesis comes mainly from patients with various cerebral insults, such as extensive structural lesions from stroke or brain tumor, or epileptic seizures. Electrical stimulation (ES) provides an important source of information, allowing the determination of the relation between the irritated zone and the behavioral effect. A few reports exist in patients with epilepsy (2-5) and with movement disorders (6-8), in whom ES provoked laughter. In all cases, the laughter was associated with a feeling of mirth. Here we report of a patient in whom ES in the right cingulate gyrus provoked a smile and laughter, but without associated mirth. CASE REPORTThis 21-year-old, developmentally delayed, righthanded man had predominantly nocturnal intractable seizures with onset at age 13 years. Most commonly, the patient's seizures were preceded by acoustic auras of incomprehensible voices, followed by loss of contact and sometimes manual automatisms. His neurologic examination was normal. Ictal EEG recordings suggested left temporoparietal onset. Interictally, only rare left and right frontocentral sharp waves were noted. Highresolution magnetic resonance imaging (MRI) did not reveal any focal abnormalities. The fluorodeoxyglucosepositron emission tomography (FDG-PET) examination showed a diffuse left hemispheric hypometabolism, however, with predominance in the left temporoparietal region and to a lesser degree in the left frontoorbital cortex. An ictal 99m Tc-ECD single-photon emission computed tomography (SPECT) indicated maximal hyperperfusion in the left lateral posterior temporal cortex. The interictal neuropsychological examinations revealed difficulties in verbal memory tasks and executive functions, indicating left frontotemporal impairment in the...