This chapter presents a brief review of the enzymes, transporters, and cofactor producers of the urea cycle. Seizures have long been associated with urea cycle disorders (UCDs), thought to be caused by high levels of ammonia. Furthermore, the brain damage obtained during metabolic crisis has been thought to damage critical structures, leading to epilepsy after the conclusion of the crisis. The first and most critical step of successful treatment of UCDs is recognition. Neurologic monitoring is an essential part of the emergency management of UCDs. The neurological abnormalities observed in patients with urea cycle defects are vast. Controlling ammonia levels by dialysis and complementary medication are needed. EEG monitoring should be initiated early, as this may be very useful for clinical management and indication of untreated metabolic crises. Furthermore, aggressive treatment of clinical and subclinical seizure activity may be helpful in optimizing outcomes for these patients.

Progress in neuroscience over the past several decades has led to a greater understanding of how the brain functions as a child or adult learns. This chapter focuses on disorders of the brain as applied to school settings. It explores learning disabilities (LD) as they pertain to practice in schools, as well as policy and research implications, and ethical and legal issues. Social workers must understand how the brain develops during various developmental ages and how this affects the learning of individuals. Research by the National Institutes of Mental Health (NIMH) have detected that the causes of LD are diverse and complex. New brain cells and neural networks continue to be produced for a year or so after the child is born. Electroencephalogram (EEG) can provide accurate timing information but provides little impression of where in the brain a particular activity is occurring.

Neurocognitive testing (NCT) and quantitative electroencephalography (qEEG) are brain assessment procedures that are used to investigate relationships between cortical functioning and context-specific outcome measures to arrive at clinical diagnoses or better informed patient and client evaluations. Research is ongoing to test the premise that NCT and qEEG can serve as reliable criterion-referenced measures for athletes profile primary higher order (AP PHO) constellations, heart rate variability (HRV) responding and eventually macro- and micro-performance outcome. Low/high ratio (L/H) was associated with numerous conceptually relevant NCT tests, including motor tapping variability, motor tapping, and switching of attention completion time. This chapter reviews the results from pilot research encompassing over 50 athletes from the sports of baseball, tennis, and ice hockey prior to presenting a case study of an ex-world class professional tennis player who underwent NCT and qEEG as part of the American Board of Sport Psychology-Carlstedt Protocol (ABSP-CP) pre-intervention evaluation process.

Epilepsy surgery is a cost-effective treatment for drug-resistant focal epilepsy, as it improves quality of life, cognition and behavior in children and adults and, in certain cases, leads to epilepsy cure. The field now faces new challenges in industrialized, resource-rich settings, where cases have become more complex, evidenced by growing rates of extratemporal surgery and intracranial monitoring. An increase in the complexity of cases has translated into an increase in the use of stereoelectroencephalography (SEEG). SEEG was first developed by Bancaud and Tailarach in the late 1950s, before the MRI era. High-resolution MRI aids in detecting the epileptogenic lesion and may inform postoperative prognosis. MRI-negative refractory focal epilepsy has become an increasingly common and challenging indication for invasive EEG studies. This chapter addresses the concepts of MRI-positive and MRI-negative intractable epilepsy in the context of SEEG, illustrated by challenging cases.

Stereoelectroencephalography (SEEG) has become an increasingly important technique in epilepsy surgery. Multiple methods exist for the implantation of SEEG electrodes. This chapter summarizes the technique of using a stereotactic frame for this purpose, as well as discusses the major stereotactic frame systems used and their relative advantages and disadvantages. The localization and targeting of intracerebral structures has been a project that has engaged neurosurgeons since the earliest origins of the specialty. The unique nature of the brain makes minimization of disruption to surrounding tissue and definition of the safest trajectory an imperative for reducing neurologic deficits caused by surgical procedures. While newer technologies, such as robotic assistance, have emerged, stereotactic frames continue to be a familiar, accurate, and efficient method of placing SEEG electrodes. As with any technique, a proper understanding of the technical nuances and limitation is important for minimization of complications.

Posterior cortex epilepsies are a group of epilepsies arising from the occipital, parietal, or posterior temporal cortices, or from any combination of these topographies. Parietal lobe epilepsy (PLE) is considered the great imitator among focal epilepsies because of the prominent connectivity underlying the parietal cortex leading to highly variable seizure semiology and nonspecific scalp electroencephalography (EEG) findings. Additional testing, such as magnetoencephalography (MEG) and invasive EEG, are usually required—especially in nonlesional cases. Because of its rich connectivity, coupled with particular anatomical features shared by posterior cortices, scalp EEG is generally unhelpful or misleading in this subset of patients. As a result, diagnosing posterior cortex epilepsies is significantly challenging. Additional diagnostic workup with MEG, nuclear medicine studies, and invasive EEG monitoring is often required. This chapter seeks to review each posterior cortex epilepsy subtype as well as discusses two cases in order to highlight important key concepts.

Surgical resection in frontal lobe epilepsy (FLE) is considered less successful than in temporal lobe epilepsy (TLE), with positive seizure outcome situated at around 50% in more recent studies, although great variability exists depending on series. Such variability concerns also prognostic factors, such as the absence of a visible lesion on MRI which is often reported within negative outcome predictors, namely in series without systematic use of stereoelectroencephalography (SEEG). The first challenge of SEEG in FLE is being able to formulate appropriate hypotheses about the likely sublobar organization of seizures. The next challenge is to perform adequate sampling of the presumed epileptogenic zone (EZ) within the large volume of the lobe. This chapter briefly reviews some anatomo-functional aspects, then focuses on different types of FLSs according to a sublobar organization, with illustrative cases to describe clinical and SEEG features and to provide some practical tips about implantation strategies.

The main goal of curative epilepsy surgery is the arrest of the epileptic activity by the complete resection (or complete disconnection) of the cortical or subcortical areas responsible for the primary organization of the epileptogenic activity. As successful resective epilepsy surgery relies on accurate preoperative localization of the epileptogenic zone (EZ), a presurgical evaluation is fundamental to obtain the widest and most accurate spectrum of information from clinical, anatomical, and neurophysiological aspects. This chapter describes stereoelectroencephalography (SEEG) as a method of extraoperative brain exploration for medically refractory epilepsy. It outlines resective epilepsy surgery guided by SEEG and compares SEEG-guided resections in lesional and nonlesional scenarios. The main clinical challenge for the near future remains in the further refinement of specific selection criteria for the different methods of invasive monitoring, with the ultimate goal of comparing and validating the results (long-term seizure-free outcome) obtained from different methods of invasive monitoring.

Intracranial recordings, whether obtained with Stereo electroencephalography (SEEG), subdural grid (SDG), or SDG with depth electrodes, aid in identifying the epileptogenic zone and allow for delineation of appropriate surgical boundaries in patients with medically refractory epilepsy. Fundamentally, SEEG is different from SDG in that SEEG allows for three-dimensional cortical sampling whereas SDGs provide a two-dimensional neurophysiologic view. Beyond this, SEEG offers multiple benefits over SDG implantations. In appropriately selected patients, SEEG allows for delineation of the epileptogenic zone while avoiding the need for a craniotomy. In addition, SEEG provides recording from deep cortical structures and within cortical sulci. SEEG offers an opportunity for evaluating multiple potential regions, including bihemispheric areas. Given the benefits of SEEG with minimal risk associated with the procedure, SEEG should be considered in patients with medically refractory focal epilepsy and a potentially resectable epileptogenic zone.