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Objective-To investigate the eVect of radiosurgery for symptomatic epilepsy associated with cerebral arteriovenous malformations (AVMs). Methods-Thirty five patients with unruptured epileptogenic AVMs were studied with a mean follow up of 43.0 months. The duration of epilepsy before radiosurgery ranged from 2 months to 21 years (mean 2.8 years). Fifteen patients showed partial seizures; eight of these had associated secondary generalisation. The remaining 20 patients showed only generalised seizures without preceding focal seizures. Results-At the final follow up examination, 28 patients remained seizure free, whereas seizures continued in seven. Variables significantly associated with continuity of seizures after radiosurgery were the number of seizures before therapy (p<0.01) and duration of epilepsy (p<0.05). According to Engel's classification, the 10 patients with intractable seizures before treatment included five with grade I, four with grade III, and one with grade IV. The frequency of seizures began to decrease several months after radiosurgery; much shorter than the time required for morphological change in the AVMs.Conclusions-Radiosurgery seems to be beneficial for seizure control in patients with unruptured epileptogenic AVM. (J Neurol Neurosurg Psychiatry 1998;65:648-655) Keywords: arteriovenous malformation; symptomatic epilepsy; gamma knife; radiosurgery Various therapeutic alternatives are currently available for eliminating the risk of bleeding from cerebral arteriovenous malformations (AVMs), and the reported treatment results have been favourable in terms of overall morbidity and mortality. However, the prognosis of epilepsy associated with cerebral AVMs has received little attention. Controversy exists on the surgical treatment of AVMs associated with epilepsy, and seizure outcome after AVM radiosurgery has not been documented in detail.In this study, we analysed the characteristics and frequency of seizures in 35 patients with epileptogenic unruptured AVMs after gamma knife radiosurgery. A retrospective survey of 22 additional patients with unruptured nonepileptogenic AVMs was also done to assess the development of seizures after the procedure. Here we report the early eVect of focused irradiation on seizures associated with AVMs and discuss the various factors that influence the prognosis. Patients and methods PATIENT POPULATIONBetween June 1990 and December 1995, 315 patients with angiographically demonstrable cerebral arteriovenous malformations (AVMs) underwent radiosurgical treatment at our institution. The initial manifestation at diagnosis was haemorrhage in 228 (72.4%), seizure in 42 (13.3%), headache in 15 (4.8%), progressive or stable neurological deficits in 10 (3.2%), and other clinical symptoms in three (1.0%). In the remaining 17 patients (5.4%), AVM was an incidental finding (table 1).From 42 patients who had epilepsy as a diagnostic symptom, we excluded five who underwent surgical resection or had a bleeding episode before radiosurgery, one whose AVM bled during t...

We have generated mutant mice for epidermal-type fatty acid binding protein by the gene targeting technique and examined the phenotype in detail. Despite a lack in the expression of epidermal-type fatty acid binding protein mRNA and its protein in the skin and other tissues of the mutant mice, the animals appeared normal in gross and histologic examination. Northern blot analysis of other fatty acid binding proteins revealed a distinct elevated gene expression of heart-type fatty acid binding protein in the skin of the homozygous mice. In analyses of the skin, no differences were observed in contents of major fatty acids, electron microscopic appearance as well as inflammatory responses in ear skin between the mutant and wild-type mice. Basal transepidermal water loss of homozygous mice was lower than that of the wild mice. When acetone was applied to the skin for disruption of the water permeability barrier, recovery in transepidermal water loss was delayed, although maximum transepidermal water loss upon acetone treatment was similar between homozygous and wild-type mice in terms of size and time course. The molecular mechanism by which epidermal-type fatty acid binding protein contributes to the water barrier function of the skin remains to be elucidated.

Radiosurgical treatment of intractable epilepsy has emerged as a noninvasive alternative to resection. Although gamma knife surgery (GKS) reportedly is effective when the radiation dose is sufficient to cause a destructive reaction in the targeted medial temporal lobe, the optimal target area and dose distribution are largely unknown. Some investigators have suggested that focused irradiation from a nondestructive dose is also effective. In this article the authors report two cases of medial temporal lobe epilepsy in which the patients underwent GKS performed using a 50% marginal dose of 18 Gy covering the amygdala. hippocampal head and body, and parahippocampal gyrus. In both cases this procedure failed to control seizures. Both patients became seizure free after undergoing anterior temporal lobectomy 30 and 16 months, respectively, after radiosurgery.

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