A Ebner

University of Pécs, Fuenfkirchen, Baranya county, Hungary

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Publications (186)558.73 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Our aim is to investigate seizure outcome and prognostic factors after pure frontal lobe epilepsy (FLE) surgery. We retrospectively studied the operative outcome in 97 consecutive adult patients who underwent resective surgery for intractable partial epilepsy between 1991 and 2005. Based on Kaplan-Meier, the probability of an Engel Class I outcome was found to be 54.6% (95% CI 44-64) at 6 months, 49.5% (95% CI 39.3-59.6) at 2 years, 47% (CI 34-59) at 5 years and 41.9% (CI 23.5-60.3) at 10 years. If the patient was seizure free at 2-year follow-up, the probability of remaining seizure free up to 10 years was 86% (95% CI 76-98). For 13.6% of the patients a running down of seizures could be shown. Factors predictive of poor long-term outcome were incomplete resection, using of subdural grids, IED in follow-up EEG, tonic seizures and an unspecific aura or a postoperative aura. Factors predictive of good long-term outcome were the presence of a well-circumscribed lesion in preoperative MRI, ipsilateral IED in preoperative EEG, surgery before age of 30 and short epilepsy duration prior to surgery. In the multivariate analysis, preoperative well-circumscribed lesion in MRI predicts seizure remission whereas persistent postoperative auras predict seizure relapse. FLE surgery should depend on restrictive patient selection to assure favorable outcome.
    Epilepsy Research 07/2008; 81(2-3):97-106. · 2.24 Impact Factor
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    ABSTRACT: The goal of this study was to evaluate the long-term outcome of patients who underwent extratemporal epilepsy surgery and to assess preoperative prognostic factors associated with seizure outcome. This retrospective study included 154 consecutive adult patients who underwent epilepsy surgery at Bethel Epilepsy Centre, Bielefeld, Germany between 1991 and 2001. Seizure outcome was categorized based on the modified Engel classification. Survival statistics were calculated using Kaplan-Meier curves, life tables, and Cox regression models to evaluate the risk factors associated with outcomes. Sixty-one patients (39.6%) underwent frontal resections, 68 (44.1%) had posterior cortex resections, 15 (9.7%) multilobar resections, 6 (3.9%) parietal resections, and 4 (2.6%) occipital resections. The probability of an Engel Class I outcome for the overall patient group was 55.8% (95% confidence interval [CI] 52-58% at 0.5 years), 54.5% (95% CI 50-58%) at 1 year, and 51.1% (95% CI 48-54%) at 14 years. If a patient was in Class I at 2 years postoperatively, the probability of remaining in Class I for 14 years postoperatively was 88% (95% CI 78-98%). Factors predictive of poor long-term outcome after surgery were previous surgery (p = 0.04), tonic-clonic seizures (p = 0.02), and the presence of an auditory aura (p = 0.03). Factors predictive of good long-term outcome were surgery within 5 years after onset (p = 0.015) and preoperative invasive monitoring (p = 0.002). Extratemporal epilepsy surgery is effective according to findings on long-term follow-up. The outcome at the first 2-year follow-up visit is a reliable predictor of long-term Engel Class I postoperative outcome.
    Journal of Neurosurgery 05/2008; 108(4):676-86. · 3.15 Impact Factor
  • Source
    Klinische Neurophysiologie - KLIN NEUROPHYSIOL. 01/2008; 39(01).
  • Aktuelle Neurologie - AKTUEL NEUROL. 01/2008; 35.
  • Aktuelle Neurologie - AKTUEL NEUROL. 01/2008; 35.
  • Aktuelle Neurologie - AKTUEL NEUROL. 01/2008; 35.
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    ABSTRACT: Electrical stimulation of the human epileptic brain is used mainly for identification of eloquent cortical regions such as motor and speech areas. Other stimulation responses include the patient's epileptic auras and seizures. In addition, experiential phenomena may be elicited. Here we describe the reproducible initiation of a structured complex visual hallucination on stimulation of the left lateral occipital cortex (superior part of Brodmann area 19, close to the angular gyrus of the parietal lobe). Our findings illustrate that stimulation of the left temporo-parieto-occipital junction may activate networks of visual perception (color, pattern, movement, rotation, shape, and memory) independent of the cortical hierarchy from elementary to complex information.
    Epilepsy & Behavior 09/2007; 11(1):147-51. · 1.84 Impact Factor
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    ABSTRACT: We investigated peri-ictal vegetative symptoms (PIVS) in 141 patients with adult temporal lobe epilepsy (TLE) and assessed frequency, gender effect, and lateralizing value of peri-ictal autonomic signs. We recorded abdominal auras in 62%, goosebumps in 3%, hypersalivation in 12%, spitting in 1%, cold shivering in 3%, urinary urge in 3%, water drinking in 7%, postictal nose wiping (PNW) in 44%, and postictal coughing in 16%. At least one vegetative sign appeared in 86% of the patients. The presence of PIVS did not have a significant lateralizing value. PNW occurred in 52% of women and in 33% of men, whereas any PIVS was present in 93% of women and 77% of men. In summary, contradictory to previous studies, the presence of PIVS has no lateralizing value, which may be linked to a low frequency of occurrence of PIVS. PIVS, especially PNW, occurred more frequently in women, supporting the gender differences in epilepsy.
    Epilepsy & Behavior 09/2007; 11(1):125-9. · 1.84 Impact Factor
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    ABSTRACT: To examine the predictive value of demographic data for the seizure outcome after extratemporal epilepsy surgery. Eightyone patients who underwent resective extratemporal epilepsy surgery were retrospectively studied concerning (a) age at surgery, (b) onset of epilepsy, (c) duration of epilepsy, (d) number of seizures at the time of presurgical evaluation, (d) number of presurgically tested antiepileptic substances and (f) number of seizure types. The data were correlated to the postoperative seizure outcome after two years. 33 patients (40.7%) were seizure free two years after surgery. Univariate and multivariate analysis revealed that both tumor etiology and low presurgical seizure frequency were independently associated with seizure freedom after epilepsy surgery. The recurrence rate in patients with one or more seizures per day was more than two-fold if compared with patients with fewer seizures. The remaining demographic factors did not show a significant association with seizure outcome in our 81 patients. Fewer than daily seizures prior to surgery and a tumoral etiology independently increase the likelihood of remaining seizure free two years after extratemporal epilepsy surgery.
    Journal of Neurology 09/2007; 254(8):996-9. · 3.58 Impact Factor
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    ABSTRACT: Eine wichtige Voraussetzung für die erfolgreiche epilepsiechirurgische Behandlung ist der Nachweis kongruenter Befunde der präoperativen Abklärung. Anfallsfreiheit wird in der Regel nur dann erwartet, wenn es gelingt, eine als epileptogen definierte Läsion komplett zu entfernen. In diesem Fallbericht wird der unerwartet gute postoperative Verlauf nach inkompletter Resektion einer ausgedehnten kortikalen Entwicklungsstörung beschrieben. Concordant findings during the presurgical work-up are important prerequisites for successful epilepsy surgery. Seizure freedom is usually expected only if the epileptogenic lesion is completely removed. We report a patient who became seizure-free although a huge cortical malformation was only partially removed.
    Zeitschrift für Epileptologie 04/2007; 20(2):84-88.
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    ABSTRACT: We assessed cognitive functions before and 3 months after interstitial radiotherapy in 14 patients with gelastic seizures caused by hypothalamic hamartoma. Cognitive functioning was assessed before temporary implantation of (125)I-seed and 3 months after seed explantation. Performance was compared with that of a selected control group of conservatively treated patients with symptomatic focal epilepsy tested before add-on treatment with a new antiepileptic drug and after reaching steady state. No short-term negative side effects of the interstitial radiosurgery could be observed for the domains of attention and executive functions and verbal and figural memory performance. Cognitive development of the patients treated with seeds was comparable to that of the control group at both assessments. Thus, the stereotactic implantation of (125)I-seeds in this patient group with gelastic seizures caused by hypothalamic hamartoma provides a well-tolerated minimally invasive method in the treatment of this severe epileptic syndrome without negative cognitive side effects.
    Epilepsy & Behavior 04/2007; 10(2):328-32. · 1.84 Impact Factor
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    ABSTRACT: The purpose of the study described here was to investigate the pathophysiology of patients' ability to react during the conscious (aura) phase of complex partial seizures (CPS) originating from the temporal lobe. We reviewed video recordings of CPS experienced by 130 adult patients who had undergone epilepsy surgery for intractable medial temporal lobe epilepsy. All patients were instructed to push the alarm button when they felt an aura. We defined the preictal reactivity as the ability to push the alarm button before the complex partial (unconscious) phase of seizures. Seventy-seven patients (59%) pushed the alarm button before seizures. Patients with preictal reactivity were significantly younger, more often had lateralized EEG seizure patterns, and had a better postoperative outcome. Patients who did not push the alarm button had secondarily generalized seizures more often. Ability to react before CPS is associated with a circumscribed region involved at seizure onset and spread, and with a seizure-free postoperative outcome.
    Epilepsy & Behavior 03/2007; 10(1):183-6. · 1.84 Impact Factor
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    ABSTRACT: To quantitatively evaluate the lateralizing significance of ictal head movements of patients with temporal lobe epilepsy (TLE). We investigated EEG-video recorded seizures of patients with TLE, in which the camera position was perpendicular to the head facing the camera in an upright position and bilateral head movement was recorded. Thirty-eight seizures (31 patients) with head movement in both directions were investigated. Ipsilateral and contralateral head movements were defined according to ictal EEG. Head movements were quantified by selecting the movement of the nose in relation to a defined point on the thorax (25/s) in a defined plane facing the camera. The duration of the head version was determined independently of the camera angle. The angle, duration, and angular speed of the head movements were computed and inter and intrasubject analyses were performed (Wilcoxon rank sum). Ipsilateral movement always preceded contralateral movement. The positive predictive value was 100% for movement in both directions. The duration of contralateral head version was significantly longer than ipsilateral head movement (6.4 +/- 4.1 s vs. 3.9 +/- 3.1 s, p<0.001). The angular speed of both movements was similar (15.5 +/- 12.1 deg/s vs. 17.3 +/- 13.0 deg/s). The quantitative analysis shows the importance of sequence in the seizure's evolution and duration, but not angular speed for correct lateralization of versive head movement. This quantitative method shows the high lateralizing value of ictal lateral head movements in TLE.
    Epilepsia 03/2007; 48(3):524-30. · 3.91 Impact Factor
  • Aktuelle Neurologie - AKTUEL NEUROL. 01/2007; 34.
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    ABSTRACT: Since its development in the early 20th century by Berger, clinical EEG based on scalp electrodes has played a crucial role in the diagnosis and treatment of epilepsy. Until today EEG is the simplest, safest and most inexpensive diagnostic tool to directly register the basic pathophysiologic cerebral mechanisms of epileptic disorders. Specificity and sensitivity of the interictal epileptiform potentials (IED) like spikes, sharp waves and spike-wave complexes is about 90%, so that interictal occurrence of IED in surface EEG is strongly supportive of the diagnosis of epilepsy, and recording an ictal pattern proves the epileptic nature of an attack almost with certainty. Special procedures like hyperventilation, intermittent photic stimulation, prolonged or repeated recordings and sleep recordings can be performed to increase sensitivity and specificity. Also, certain patterns resembling epileptiform potentials -the so called benign variants- should be familiar to the EEG reader. With these restraints, occurrence, shape, localization, and evolution of epileptiform activity in surface EEG is irreplaceable in the diagnosis of epilepsy, and in the classification of the epileptic syndrome.
    Das Neurophysiologie-Labor 01/2007; 29(2):79-93.
  • Klinische Neurophysiologie - KLIN NEUROPHYSIOL. 01/2007; 38(2):97-100.
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    ABSTRACT: To analyse the lateralising value of unilateral manual automatism (UMA), its relation to contralateral dystonia and the hand by which the UMA was performed. In this retrospective study, we reviewed video recordings of 141 patients (mean age 34.1+/-10) who had consecutively undergone presurgical evaluations with ictal video-EEG recordings and high-resolution MRI, had had epilepsy surgery due to intractable medial temporal lobe epilepsy with complex partial seizures due to unilateral medial temporal lobe lesions. The video recordings were prospectively reviewed by one of the authors blinded to patient's clinical data except the diagnosis of medial temporal lobe epilepsy. Altogether 310 archived seizures were analysed. Hand automatisms occurred in 86.5% of patients. UMA occurred in 53% of patients. If UMA was accompanied by contralateral hand dystonia, it had a high lateralising value to the ipsilateral epileptic focus (EF), it was ipsilateral in 85% of patients. Conversely, if UMA occurred without contralateral dystonia, it had only a limited lateralising value because it was ipsilateral to the EF in only 63% of patients. However, we found that left-sided UMA without dystonia had a high lateralising value to the left hemisphere (ipsilateral to the EF in 82%), while right-sided UMA without dystonia has practically no lateralising value. UMA with contralateral dystonia has a high lateralising value to the ipsilateral hemisphere. Left-sided UMA without contralateral dystonia has a lateralising value to the left hemisphere. Right-sided UMA without contralateral dystonia has no lateralising value.
    Seizure 10/2006; 15(6):393-6. · 2.00 Impact Factor
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    ABSTRACT: The recent proposal by the ILAE Task Force for Epilepsy Classification is a multiaxial, syndrome-oriented approach. Epilepsy syndromes--at least as defined by the ILAE Task Force--group patients according to multiple, usually poorly defined parameters. As a result, these syndromes frequently show significant overlap and may change with patient age. We propose a five-dimensional and patient-oriented approach to epilepsy classification. This approach shifts away from syndrome orientation, using independent criteria in each of the five dimensions similarly to the diagnostic process in general neurology. The main dimensions of this new classification consist of (1) localizing the epileptogenic zone, (2) semiology of the seizure, (3) etiology, (4) seizure frequency, and (5) related medical conditions. These dimensions characterize all information necessary for patient management, are independent parameters, and include information more pertinent than the ILAE axes with regard to patient management. All cases can be classified according to this five-dimensional system, even at initial encounter when no detailed test results are available. Information from clinical tests such as MRI and EEG are translated into the best possible working hypothesis at the time of classification, allowing increased precision of the classification as additional information becomes available.
    Der Nervenarzt 09/2006; 77(8):961-9. · 0.80 Impact Factor
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    ABSTRACT: Der krzlich erschienene Vorschlag der ILAE-Taskforce zur Epilepsieklassifikation ist ein multiaxialer, syndromorientierter Ansatz. Hierbei werden die Patienten unterschiedlichen und oftmals unzureichend definierten Kriterien zugeordnet. Die resultierenden Syndrome haben hufig keine tiologische oder pathophysiologische Relevanz, berlappen und wechseln je nach Alter des Patienten. Wir schlagen einen 5-dimensionalen, patientenorientierten Ansatz zur Klassifikation der Epilepsien vor. Dieser Ansatz wendet sich von der Orientierung an Syndromen ab und basiert stattdessen auf dem methodologischen Ansatz der allgemeinen Neurologie, in dem einerseits das klinische Bild des einzelnen Patienten im Mittelpunkt steht und andererseits in jeder Dimension voneinander unabhngige und mglichst operationalisierbare Kriterien angewandt und schlielich zusammengefhrt werden. Die Dimension dieser Klassifikation sind: (1) Lokalisation der epileptogenen Zone, (2) Semiologie der epileptischen Anflle, (3) tiologie, (4) Anfallshufigkeit und (5) sonstige relevante medizinische Faktoren. Diese Dimensionen enthalten alle fr das Management eines Patienten notwendige Information und sind voneinander unabhngige Parameter. Alle Patienten knnen selbst beim initialen Patientenkontakt sinnvoll in das System eingeordnet werden, auch wenn noch keine apparativen Untersuchungen durchgefhrt wurden. Die Information aller Untersuchungen (z. B. MRT, EEG) fliet zum jeweiligen Zeitpunkt der Klassifikation in die Zuordnung des Patienten ein und erlaubt mit jeder neu verfgbaren Information eine Zunahme der Przision und Validitt der Klassifikation.The recent proposal by the ILAE Task Force for Epilepsy Classification is a multiaxial, syndrome-oriented approach. Epilepsy syndromes – at least as defined by the ILAE Task Force – group patients according to multiple, usually poorly defined parameters. As a result, these syndromes frequently show significant overlap and may change with patient age. We propose a five-dimensional and patient-oriented approach to epilepsy classification. This approach shifts away from syndrome orientation, using independent criteria in each of the five dimensions similarly to the diagnostic process in general neurology. The main dimensions of this new classification consist of (1) localizing the epileptogenic zone, (2) semiology of the seizure, (3) etiology, (4) seizure frequency, and (5) related medical conditions. These dimensions characterize all information necessary for patient management, are independent parameters, and include information more pertinent than the ILAE axes with regard to patient management. All cases can be classified according to this five-dimensional system, even at initial encounter when no detailed test results are available. Information from clinical tests such as MRI and EEG are translated into the best possible working hypothesis at the time of classification, allowing increased precision of the classification as additional information becomes available.
    Der Nervenarzt 07/2006; 77(8):961-969. · 0.80 Impact Factor
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    ABSTRACT: We report the induction of laughter and smiling by cortical electrical stimulation of the frontal lobe of two patients: an 18-month-old boy with a left frontal cortical lesion extending to the vertex and the central gyrus, and a 35-year-old woman with a lesion in the right supplementary sensorimotor area (SSMA). The subjects underwent presurgical epilepsy evaluation with subdural grid electrodes to determine surgical candidacy. Stimulation of the prefrontal area reproducibly induced laughter. The adult patient reported absence of emotional content. Slowing of speech occurred under stimulation of electrodes in the upper and posterior vicinity. In this patient laughter was elicited in the anterior part of the SSMA. In the child, this response was induced by stimulation of the lateral prefrontal cortex near the midline. We conclude that the anterior portion of the SSMA/lateral premotor cortex is involved in generating the motor pattern of laughter.
    Epilepsy & Behavior 07/2006; 8(4):773-5. · 1.84 Impact Factor

Publication Stats

3k Citations
558.73 Total Impact Points

Institutions

  • 2005–2012
    • University of Pécs
      • Neurosurgery Clinic
      Fuenfkirchen, Baranya county, Hungary
    • Semmelweis University
      Budapeŝto, Budapest, Hungary
    • Friedrich-Alexander Universität Erlangen-Nürnberg
      • Department of Neurology
      Erlangen, Bavaria, Germany
  • 2004–2012
    • Evangelic Hospital Bielefeld
      Bielefeld, North Rhine-Westphalia, Germany
    • The University of Georgia (Tbilisi)
      Tbilsi, T'bilisi, Georgia
    • Universität Regensburg
      • Lehrstuhl für Neurologie
      Regensburg, Bavaria, Germany
  • 2011
    • Otto-von-Guericke-Universität Magdeburg
      • Clinic for Stereotactic Neurosurgery
      Magdeburg, Saxony-Anhalt, Germany
  • 2010
    • Birjand University of Medical Sciences
      Birdjand, Khorāsān-e Jonūbī, Iran
    • Bielefeld University
      • Physiologische Psychologie
      Bielefeld, North Rhine-Westphalia, Germany
  • 2000–2006
    • University of Münster
      • • Department of Neurology
      • • Institute of Zoophysiology (Hospital)
      Münster, North Rhine-Westphalia, Germany
    • Philipps University of Marburg
      Marburg, Hesse, Germany
  • 2002–2005
    • Swiss Epilepsy Centre in Zurich
      Zürich, Zurich, Switzerland
  • 2003–2004
    • Országos Idegsebészeti Tudományos Intézet
      Budapeŝto, Budapest, Hungary
  • 2002–2004
    • Universitätsklinikum Düsseldorf
      Düsseldorf, North Rhine-Westphalia, Germany
  • 1996–2000
    • Heinrich-Heine-Universität Düsseldorf
      • Neurologische Klinik
      Düsseldorf, North Rhine-Westphalia, Germany
  • 1998
    • Ludwig-Maximilian-University of Munich
      • Department of Urology
      München, Bavaria, Germany