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Objective: Hippocampal sclerosis (HS) is the most frequent histopathological finding after hippocampal resection in patients suffering from drug-resistant mesial temporal lobe epilepsy (MTLE). However, in a number of cases the histopathological specimen reveals astrogliosis (AG) instead of HS. There[for full text, please go to the a.m. URL], 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS)

Drawing inferences from past experiences enables adaptive behavior in future situations. Inference has been shown to depend on hippocampal processes. Usually, inference is considered a deliberate and effortful mental act which happens during retrieval, and requires the focus of our awareness. Recent fMRI studies hint at the possibility that some forms of hippocampus-dependent inference can also occur during encoding and possibly also outside of awareness. Here, we sought to further explore the feasibility of hippocampal implicit inference, and specifically address the temporal evolution of implicit inference using intracranial EEG. Presurgical epilepsy patients with hippocampal depth electrodes viewed a sequence of word pairs, and judged the semantic fit between two words in each pair. Some of the word pairs entailed a common word (e.g.,‘winter - red’, ‘red - cat’) such that an indirect relation was established in following word pairs (e.g, ‘winter - cat’). The behavioral results suggested that drawing inference implicitly from past experience is feasible because indirect relations seemed to foster ‘fit’ judgments while the absence of indirect relations fostered 'do not fit' judgments, even though the participants were unaware of the indirect relations. A event-related potential (ERP) difference emerging 400 ms post-stimulus was evident in the hippocampus during encoding, suggesting that indirect relations were already established automatically during encoding of the overlapping word pairs. Further ERP differences emerged later post-stimulus (1500 ms), were modulated by the participants' responses and were evident during encoding and test. Furthermore, response-locked ERP effects were evident at test. These ERP effects could hence be a correlate of the interaction of implicit memory with decision-making. Together, the data map out a time-course in which the hippocampus automatically integrates memories from discrete but related episodes to implicitly influence future decision making.

Drawing inferences from past experiences enables adaptive behavior in future situations. Inference has been shown to depend on hippocampal processes. Usually, inference is considered a deliberate and effortful mental act which happens during retrieval, and requires the focus of our awareness. Recent fMRI studies hint at the possibility that some forms of hippocampus-dependent inference can also occur during encoding and possibly also outside of awareness. Here, we sought to further explore the feasibility of hippocampal implicit inference, and specifically address the temporal evolution of implicit inference using intracranial EEG. Presurgical epilepsy patients with hippocampal depth electrodes viewed a sequence of word pairs, and judged the semantic fit between two words in each pair. Some of the word pairs entailed a common word (e.g., 'winter-red,' 'red-cat') such that an indirect relation was established in following word pairs (e.g., 'winter-cat'). The behavioral results suggested that drawing inference implicitly from past experience is feasible because indirect relations seemed to foster 'fit' judgments while the absence of indirect relations fostered 'do not fit' judgments, even though the participants were unaware of the indirect relations. A event-related potential (ERP) difference emerging 400 ms post-stimulus was evident in the hippocampus during encoding, suggesting that indirect relations were already established automatically during encoding of the overlapping word pairs. Further ERP differences emerged later post-stimulus (1,500 ms), were modulated by the participants' responses and were evident during encoding and test. Furthermore, response-locked ERP effects were evident at test. These ERP effects could hence be a correlate of the interaction of implicit memory with decision-making. Together, the data map out a time-course in which the hippocampus automatically integrates memories from discrete but related episodes to implicitly influence future decision making.

Population-based studies of material-specific cognitive functions yield evidence of sex differences: women are superior on verbal tasks whereas men are superior on figural and visuo-spatial tasks. Although there is still no direct evidence, these sex differences have been assumed to be related to a different cerebral organisation of language and nonlanguage functions, i.e. language in women is suggested to be more bilaterally organised than in men. We investigated this issue with respect to verbal/nonverbal memory functions in 42 men and 43 women with left temporal lobe epilepsies who all underwent intracarotid amobarbital testing for language dominance. The results indicate that atypical language dominance is not significantly more frequent in women than in men (44% vs 33%). Atypical dominance was related to an onset of epilepsy before puberty and appeared to be a consequence of the left hemisphere pathology rather than being naturally predisposed. Furthermore, women indeed showed the expected advantage with respect to verbal memory, and men showed an advantage in figural memory. With consideration of language dominance, however, the sex difference in verbal memory was observed particularly with atypical dominance, whereas the sex difference in figural memory was observed with left dominance.

In patients with pharmacorefractory epilepsy, preoperative epilepsy evaluation and subsequent epilepsy surgery lead to a significant improvement of seizure control, proportion of seizure-free patients, quality of life and social participation. The aims of preoperative epilepsy evaluation are to define the chance of complete seizure freedom and the likelihood of inducing new neurological deficits in a given patient. As epilepsy surgery is an elective procedure quality standards are particularly high. As detailed in the first edition of these practice guidelines, quality control relates to seven different domains: (1) establishing centres with a sufficient number of sufficiently and specifically trained personnel, (2) minimum technical standards and equipment, (3) continuing medical education of employees, (4) surveillance by trained personnel during the video electroencephalography (EEG) monitoring (VEM), (5) systematic acquisition of clinical and outcome data, (6) the minimum number of preoperative evaluations and epilepsy surgery procedures and (7) cooperation of epilepsy centres. In the first edition of these practice guidelines published in 2000 it was defined which standards were desirable and that their implementation should be aimed for. These standards related especially to the certification required for different groups of medical doctors involved and to the minimum numbers of procedures required. In the subsequent decade quite a number of colleagues have been certified by the trinational Working Group (Arbeitsgemeinschaft, AG) for Presurgical Epilepsy Diagnosis and Operative Epilepsy Treatment (http://www.ag-epilepsiechirurgie.de) and therefore, on 8 May 2013 the executive board of the AG decided to now make these standards obligatory.

It is unknown whether brain affection in myotonic dystrophy type 1 (DM1) and 2 (DM2) is due to neurodevelopmental defects, neurodegeneration or both. Longitudinal imaging studies are missing to date. We performed a longitudinal study to compare changes in cognitive functioning and brain morphology including 16 DM1 (m/f: 6/10, age at baseline 42.48 ± 6.46 years/y, disease duration/DD 13.4 ± 7.5 y), 16 DM2 patients (m/f: 9/7, age 48.49 ± 8.36 y, DD 11.4 ± 9.1 y), and 17 healthy controls (m/f: 9/8, age 50.54 ± 9.78 y). At baseline and 5.45 ± 0.41 y follow-up all subjects underwent neurological and neuropsychological (NP) examinations and 3T-brain magnetic resonance imaging using the identical hard- and software. Diffusion tensor imaging (DTI, Tract Based Spatial Statistics) was conducted to analyse white matter (WM) affection with respect to fractional anisotropy (FA), axial, radial, and mean diffusivity. We used 2-sample t-tests (TT) for group comparisons between patients and controls, and paired t-tests (PT) for longitudinal analyses within each group (p < 0.05, corrected for multiple comparisons). DTI group comparisons (TT) showed almost identical FA reduction patterns at baseline and follow-up. In DM1 compared to controls, FA was reduced along the corpus callosum (CC), association (AF), and projection fibres. In DM2, we found mild affection of CC and forceps minor, and minor additional changes at follow-up. At follow-up, the number of voxels showing FA reduction was particularly increased in DM1 indicating progressive WM disintegrity. Analysing longitudinal differences within each group (PT), we found significant FA changes only in DM1 affecting frontal and posterior AF. These findings were accompanied by a decline in motor tasks in DM1, and a mild deterioration of NP performance in DM1 more than DM2 over time. Our data indicate a mild -however significant-progress of WM affection predominantly in DM1 which might point towards a neurodegenerative component of WM changes.

Introduction: The majority of psychiatric patients suffer from sexual dysfunction. Although sexual impairment is a major cause for non-compliance in psychiatric patients, it remains under-diagnosed by the attending physician. Therefore, the aim of the following study was to examine sexual behaviour and sexual dysfunction in a large sample of psychiatric patients. Methods: Male psychiatric inpatients received a questionnaire for sexuality ("Sexualitatsfrage-bogen fur Manner", SFM) examining various aspects of sexual behaviour (e.g., value of sexuality, sexual dysfunction). Questionnaires from 351 patients were analysed. Additionally, 55 male healthy controls and 52 male patients with epilepsy were recruited. Results: Psychiatric patients demonstrated more severe sexual dysfunction in the acute phase of their illness as well as in the premorbid time period compared with healthy controls. Patients with epilepsy showed only mild current sexual dysfunction (in the acute phase of the illness), with the exception of persisting erectile dysfunction. When comparing the two groups of patients, the psychiatric patients reported more current sexual impairments. Discussion: Sexual dysfunction is not limited to the acute phase of psychiatric illnesses. Hence, treatment and follow-up must be geared towards such aspects of the quality of life while focussing on coping strategies.

Patients with Alzheimer's disease (AD) showing a selective impairment of episodic and semantic memory have recently been classified as affected by focal temporal lobe dysfunction (FTLD) and considered as a distinct subgroup of patients affected by a particular form of AD. The aim was to compare the cerebral perfusion of patients with AD with FTLD and patients with AD with the more typical profile of diffuse cognitive impairment (dAD).Ten patients with AD with FTLD, 14 patients with AD with dAD, and 12 normal controls were studied. All the 24 patients with AD underwent a complete neuropsychological assessment. SPECT examination with [(99m)Tc]-HMPAO, using a four head brain dedicated tomograph, was performed in patients and controls. Tracer uptake was quantified in 27 regions of interest (ROIs), including lateral and mesial temporal areas. Mean counts in the 27 ROIs of controls, patients with FTLD and those with dAD were compared using an ANOVA for repeated measures with Bonferroni's correction. A logistic regression analysis, followed by a receiver operating characteristic (ROC) analysis, was also applied to select SPECT patterns which significantly differentiated patients with FTLD and those with dAD.Two scintigraphic patterns of abnormalities, shaping a double dissociation between the FTLD and dAD groups, emerged: a bilateral mesial temporal hypoperfusion, characteristic of FTLD and a posterior parietal (and temporal parietal) hypoperfusion characteristic of patients with dAD.These scintigraphic findings provide further support to the hypothesis that FTLD is not a mere stage but a distinct anatomoclinical form of AD. The combination of neuropsychological tests and [(99m)Tc]-HMPAO SPECT may be very useful in identifying patients with FTLD from the wider group of patients with dAD. This issue is particularly worthwhile, as there is increasing evidence that patients with FTLD have a slower rate of cognitive decline.