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Congress of Cervical Pathology and Colposcopy (Rome, May 13,

REFERENCES 1990). J Exp Clin Cancer Res 1990; 9 (suppl): 73 (FC) (abstr).
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Br Med J 1989; 299: 855. outpatient treatment under local anaesthesia. Presentation to annual
2. Campion MJ, Singer A, Mitchell MS. Complacency in diagnosis of meeting of British Society of Colposcopy and Cytology (Sheffield,
cervical cancer. Br Med J 1987; 294: 1337-40. March 29-31, 1990).
3. Fox M. Cervical smears: new terminology and new demands. Br Med J 11. Phipps JH, Gunasekara PC, Lewis BV. Occult cervical carcinoma
1987; 294: 1307-08. revealed by large loop diathermy. Lancet 1989; ii: 453.
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region. Br Med J 1989; 299: 899-901. large loop diathermy. Lancet 1989; ii: 807.
5. Prendiville WJ, Davies WAR, Davies JO, Shepherd AM. Medical 13. McIndoe GAJ, Smith JR, Tidy JA, Yahya A, Mason WP, Anderson
dilatation of the non-pregnant cervix. The effect of ethinyl oestradiol on MC. Occult cervical carcinoma revealed by large loop diathermy.
the visibility of the transformation zone. Br J Obstet Gynaecol 1986; 93: Lancet 1989; ii: 807
508-11. 14. Byrne PF, Sant Cassia LJ. Occult cervical carcinoma revealed by large
6. Carrier R. Practical colposcopy, 2nd ed. Paris: Laboratoire Cartier, 1984. loop diathermy. Lancet 1989; ii: 807.
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transformation zone (LLETZ): a new method of management for the cervix. Lancet 1989; ii: 1160.
women with cervical intra-epithelial neoplasia. Br J Obstet Gynaecol 16. Bellina JM, Wright VC, Varos JI, Ripello MA, Hohenschutz U. Carbon
1989; 96: 1054-60. monoxide laser management of cervical intraepithelial neoplasia. Am J
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presented at 7th World Congress of Cervical Pathology and Gynecol 1989; 162: 60-68.

EPILEPSY OCTET

Anatomy, physiology, and pathology of epilepsy


B. S. MELDRUM

Anatomy lobe. Intracortical spread is mainly via anatomica


connections (horizontal fibres in layer VI are important2). I
An epileptic seizure is the result of a sudden excessive the hippocampus contiguous spread via extracellular ioni
discharge of cells in part of the brain. Since the clinical changes and local current flow may be substantial. Th
components of the seizure are determined by the site of
Jacksonian march is associated with a strictly localise
origin and the pattern of spread of the abnormal discharge, seizure propagating at a speed of mm/s.2 An "inhibitor
the task of defining the anatomical basis of epilepsy is closely
surround" due to activation of intrinsic GABAergic neuron
related to that of differentiating the various clinical
may limit local cortical (and homotopic) spread of seizur
syndromes of epilepsy. The main clinical differentiation is
into focal or partial epilepsies (called localisation-related by activity.
Activation of basal ganglia, thalamic, and brainste
the Commission on Classification and Terminology of the
nuclei accompanies some clinical signs of focal seizur
International League Against Epilepsy) and generalised
activity. The transition from clonic to tonic activity ma
epilepsies (see S. Shorvon, this series). However, this reflect a change in the pattern of cortical discharge, but whe
differentiation is not absolute: in many patients seizures
seizure activity becomes more generalised it reflects
have a focal or regional origin (as judged from clinical signs
and from electroencephalographic [EEG] records) but sequence of events in the brainstem.
progress to generalised seizures (secondarily generalised
seizures) associated with bilaterally synchronous EEG Complex-partial (psychomotor, temporal lobe, limbic)
seizures
discharges.! It is therefore reasonable to ask whether all
seizures might have a focal origin, with very rapid Typical complex partial seizures usually originate in on
generalisation giving rise to so-called generalised seizures. mesial temporal lobe but may start in other limbic structure
or in cortical areas that project to limbic areas (includin
Focal cortical seizures and simple partial seizures frontal and occipital cortex). Depth electrode studies b
Wieser3have contributed to the differentiation of severa
The character of these seizures is entirely determined by
their site of origin, and patients may present with motor, types of complex partial seizures in terms of the origin an
somatosensory, special sensory, autonomic, or psychic
spread of electrical discharges-eg, hippocampal o
symptoms. Focal motor seizures commonly originate in or
near the primary motor cortex but may involve the ADDRESS Department of Neurology, Institute of Psychiatr
secondary motor area on the medial aspect of the frontal London SE5 8AF, UK (Prof B. S Meldrum, MB)