No abstract

Significant correlations in the concentrations of phenobarbital, phenytoin, and carbamazepine in the brain, plasma, and cerebrospinal fluid were found in 12 surgically treated epileptic patients. These findings confirm the clinical reliability of monitoring anticonvulsant drug plasma levels as part of the routine management of epilepsy. Phenobarbital, phenytoin, and carbamazepine are uniformly distributed in the gray and white matter in different brain areas (except for a higher concentration of phenobarbital in the rhinencephalic structures in comparison with the corresponding temporal neocortex) and in normal and scar tissue. In these 12 patients, all of whom were medically resistant, molar cortex concentration of phenobarbital and phenytoin was at "therapeutic" levels or even higher. These data suggest that in therapy-resistant patients, despite cerebral drug concentrations of the same therapeutic level as, or higher than, those present in medically controlled patients, anticonvulsant drugs are pharmacologically ineffective.

No abstract

The concentrations of antiepileptic drugs in histologically normal and pathological brain tissues were investigated in 6 patients submitted to surgery. No significant difference for phenobarbital and phenytoin was found between normal and scar tissue, whereas there was a trend to concentration in tumour tissue (meningioma and glioma) of phenobarbital, phenytoin and carbamazepine. Alteration in the vascular supply and pathological changes at cellular and subcellular levels could be responsible for the differences in the distribution of the drugs. The possible clinical relevance of the preferential concentration of the drugs in tumour tissue is discussed.

With 11 FiguresAmeli (1952) first showed the importance of vertebral angiogr~phy for visuMising the vaseul~risation of ~n intr~ventricular meningiom~ by the posterior ehoroidM arteries.The usefulness of e~rotid ~ngiography for diagnosing intraventricular meningiomas was pointed out by Guidetti andAlvisi (1952, 1954), who drew attention to the inerease in calibre of the anterior choroid~l artery which supplied the tumour. In the years that followed Migliavacca (1953, 1955), Aral~i (1954), Wall (1954), Cecotto andFrugoni (1955) and FaZk (1956) adduced ~ large body of evidence to support the diagnostic value of this angiographic pattern. Falk (1956) stated that thickening and lengthening of the anterior choroidM artery may also be found in gliomas growing partly in the ventricle. In the same year SjSgren (1956) described an ~nterior choroid~l artery contributing to the blood supply of a temporM glioma developing mainly in the ventricle. in this case the step-like deformity of the anterior part of the artery, frequently found in intraventricular meningiomas, was also visible. Later on, Lade~heim (1963)--of the school of Olivecrona--contributed an important case-series. The literature that followed this author's monograph was collected by Delandsheer (1965) in a congress report, in which he recognised the importance of changes in the ~nterior choroidal artery, but pointed out that it w~s impossible to differentiate between a meningioma and ~ p~pilloma of the trigone, and he went on to emphasise the importance of vertebral angiogr~phy in cases in which carotid angiography reveals only changes indicating a temporo-parietal space-occupying lesion. Of the most recent Italian contributions we would mention: Signore~li (1960), Smaltino et al. (1961), Davini and Baratta (1963), Moretlo and P~uchino (1965).Another feature, less characteristic but still very important for the diagnosis of intraventricular meningioma and one to which several authors (Ladenheim 1963, De~andsheer 1965 have drawn attention, is the downward displacement of the vein of Galen and of the internal