bluuebunny/crossref_metadata_2025 huggingface dataset:
Catatonia Mimicking Nonconvulsive Status Epilepticus
Authors: Louis Elan D. , Master Norman L.
Published: August 2005

Summary: Nonconvulsive status epilepticus (NCSE) and catatonia share many clinical features and distinguishing between them on the basis of the physical examination may be difficult and even impossible. Although several reports have been made of NCSE simulating catatonia, there are no published cases of catatonia mimicking NCSE. We report a 24‐year‐old woman whose initial examination was notable for a fixed stare, no response to voice or command, gaze preference, tonic head posturing, constant stereotypic chewing movements, profuse foamy salivation, and a dramatic response to the parenteral administration of benzodiazepines (BZDs). She was initially misdiagnosed as having NCSE. EEG, however, was normal. We believe this is the first published report of catatonia simulating NCSE. The EEG may be more useful than the clinical examination in distinguishing NCSE from catatonia.
The Institute of Epileptology of King's College, University of London
Authors: Reynolds Edward H.
Published: August 2005

Summary: The Institute of Epileptology of King's College, London has arisen from need and from opportunity. The need is due to the relative neglect nationally and internationally of the most common serious brain disorder with important physical, psychological, and social complications. The relative neglect is reflected in services, research, charitable donations, public profile, and stigma and in a serious lack of professional education. The opportunity arose because of the existence in several medical institutions at Denmark Hill, London, of a group of medical and related colleagues with a special interest covering almost every aspect of this multidisciplinary disorder who agreed to combine their expertise in this initiative. The idea was born and developed in 1991–1992 and was supported by all the parent institutions: The Maudsley and King's College Hospitals, St Piers Lingfield, The Institute of Psychiatry, King's College School of Medicine and Dentistry, and the School of Life, Basic Medical and Health Sciences, all under the umbrella of King's College, University of London. Further stimulus and help came from a group of dedicated supporters in private and public life. There are three strands to this initiative: (a) a charity, The Fund for Epilepsy; (b) the clinical Centre for Epilepsy, which was formally opened at the Maudsley Hospital in July 1994; and (c) the academic Institute of Epileptology for research and teaching, which was launched on November 15, 1994.
Melatonin Response in Active Epilepsy
Authors: Schapel Graham J. , Beran Roy G. , Kennaway David L. , McLoughney Julie , Matthews Colin D.
Published: August 2005

Summary: Urinary excretion of 6‐sulfatoxymelatonin (aMT.6S), the hepatic metabolite of melatonin, was measured for three consecutive 8‐h intervals, beginning at 0600 h, in 30 patients with untreated active epilepsy and in 19 healthy subjects. Excretion of aMT.6S in a 24‐h period in patients with active epilepsy was 77.3 ± 55 nmol (median 68.0, range 8.7–280 nmol), significantly higher (p < 0.05) than that of healthy subjects (49.1 ± 14 nmol, median 49.0, range 19.7–68.0 nmol). Sequential 8‐h urinary aMT.6S excretion rates in patients with active epilepsy were 2.45 ± 2.8 nmol/h (0600–1400 h), 0.83 ± 0.5 nmol (1400–2200 h) and 6.38 ± 5.0 nmol/h (2200–0600 h) as compared with 1.43 ± 0.8, 1.10 ± 0.8 and 3.81 ± 1.3 nmol/h, respectively, in healthy subjects. Analysis of variance (ANOVA) indicated that the difference in total output resulted from greater nocturnal excretion (F= 5.58, p = 0.018). Melatonin production in untreated patients with active epilepsy is increased and has a circadian pattern with a phase difference as compared with that of normal subjects.
Change in Neurotrophins and Their Receptor mRNAs in the Rat Forebrain After Status Epilepticus Induced by Pilocarpine
Authors: Mudò Giuseppa , Jiang Xing H. , Timmusk Tõnis , Bindoni Mauro , Belluardo Natale
Published: August 2005

We studied the effects of status epilepticus (SE) induced by lithium chloride/pilocarpine treatment on gene expression of neurotrophins of the nerve growth factor (NGF) family and of their high‐affinity receptors of the tyrosine protein kinase (trk) family in the forebrain. Using in situ hybridization (ISH), we demonstrated an early (3 h after treatment) increase in brain‐derived neurotrophic factor (BDNF) and trkB mRNA expression in the dentate gyrus, amygdala, and piriform cortex, as well as widespread increases in the cerebral cortex. NGF mRNA, but not the mRNA of its receptor trkA, was increased in the dentate gyrus. In contrast, 12 h after treatment, neurotrophin‐3 (NT‐3) decreased, and its receptor trkC mRNA increased. There was no change in NT‐4 mRNA levels. All changes were blocked by pretreatment with scopolamine, a muscarinic antagonist. The noncompetitive N‐methyl‐aspartate (NMDA) antagonist ketamine blocked NGF, BDNF, and trkB mRNA increases in the hippocampus and cerebral cortex, but not in the amygdala and piriform cortex. In contrast, ketamine did not affect NT‐3 and trkC changes. These results provide a complete description of changes in mRNA levels of neurotrophins and their receptors in the forebrain after SE and supply additional data supporting the view that neurotrophin gene expression is related to abnormal neuronal activity.
Relation of Cocaine Use to Seizures and Epilepsy
Authors: Koppel Barbara S. , Samkoff Lawrence , Daras Michael
Published: August 2005

Summary: Purpose: Cocaine can provoke seizures, exacerbate a preexisting seizure disorder, or cause an ischemic or hemorrhagic stroke that leads to seizures. To determine the importance of cocaine use in patients with and without epilepsy, we studied these relations and other risk factors for seizures and the mode of cocaine use.

Methods: We reviewed all charts of emergency department visits and hospitalizations of patients with discharge diagnoses simultaneously listing seizures, epilepsy, and cocaine use during a 24‐month period. Data collected included patient age, sex, route of cocaine use, seizure description and duration of epilepsy, provocative factors, results of electroencephalography and computed tomography, treatment, and outcome.

Results: Of 67, 668 adult emergency department visits and 25, 768 adult admissions, 1, 900 were cocaine related, and 58 of these also had seizures or epilepsy. Seizure occurrences were approximately equally distributed among groups with idiopathic epilepsy, remote symptomatic localization‐related epilepsy, cerebrovascular disease, and acute symptomatic seizures due to cocaine use alone. Less frequently, seizures were cryptogenic or symptomatic of metabolic abnormalities.

Conclusions: Cocaine use can reduce seizure threshold in patients with underlying epilepsy as a direct toxic effect or indirectly by contributing to poor compliance with antiepileptic drug treatment, poor diet, or poor sleep habits. In 12 of the 58 patients, cocaine appeared to be the only provocative factor. This may be a less significant risk factor for epilepsy than either alcohol or head trauma.
Comparative Effects of Valproate and the New Experimental Anticonvulsant Drug α‐Ethyl‐α‐Methyl‐Thiobutyrolactone on Selected Metabolite Levels in the Plasma, Livers, and Brains of Infant Mice
Authors: Thurston Jean Holowach , Haulart Richard E.
Published: August 2005

Summary: The newly discovered anticonvulsant drug, α‐ethyl‐α‐methylthiobutyrolactone (α‐EMTBL), is as effective as valproate (VPA) in blocking seizures induced by convulsant compounds and maximal electric shock in adult mice. Other data have suggested that α‐EMTBL might be less toxic than VPA and longer acting. We compared the effects of a single therapeutic dose of the two drugs on levels of key metabolites in the blood, liver, and brain of normal suckling infant mice. Unlike VPA, α‐EMTBL had no adverse effects on selected aspects of liver carbohydrate, fat (ketogenesis), coenzyme A (CoA), carnitine, or amino acid metabolism. In contrast to VPA, α‐EMTBL did not alter concentrations of neurotransmitter amino acids in brain. Coupled with the impressive anticonvulsant activity of α‐EMTBL in adult mice and its lack of acute hepatotoxicity in infant mice, our findings support further study of α‐EMTBL as a potential adjunct to the relatively limited armamentarium of effective anti‐epileptic drugs (AEDs) for clinical use.
Brain Single Photon Emission Computed Tomography Imaging in Landau‐Kleffner Syndrome
Authors: Guerreiro M. M. , Camargo E. E. , Kato M. , Netto J. R. Menezes , Silva E. A. , Scotoni A. E. , Silveira D. C. , Guerreiro C. A. M.
Published: August 2005

Summary: Five right–handed children with Landau‐Kleffner syndrome (LKS) who had disease onset between the ages of 3 and 9 years were studied with EEG and single‐photon emission computed tomography (SPECT) before and, in four cases, after 6 months of corticosteroid treatment. EEG findings included both focal and generalized spikes as well as spike‐wave discharges with bilateral temporal predominance. These increased markedly during sleep in 1 child, and continuous spike‐and‐wave complexes appeared during slow‐wave sleep in another patient. Neuropsychological testing demonstrated verbal auditory agnosia. Magnetic resonance imaging (MRI) was performed in 4 children and was normal. Brain SPECT imaging demonstrated abnormal perfusion in the left temporal lobe in all patients. The response to corticosteroid therapy was mixed. Our findings reinforce the concept that LKS is a functional disease affecting the language‐dominant brain areas. We conclude that SPECT imaging may be of diagnostic assistance in the evaluation of this syndrome of unknown etiology.
Early Clinical and EEG Features of Infantile Spasms in Down Syndrome
Authors: Silva M. L. , Cieuta C. , Guerrini R. , Plouin P. , Livet M. O. , Dulac O.
Published: August 2005

Summary: The combination of West syndrome (WS) and Down syndrome appears not to be coincidental. Fourteen patients free of cardiac malformation or history of perinatal hypoxia were referred and investigated before they had received any treatment and were followed to the mean age of 4.5 years (range 19 months to 14 years). Spasms had onset at the mean age of 8 months (range 4–18 months) in cluster and were symmetrical. Hypsarrhythmia was symmetrical and, after intravenous diazepam (4 patients, 0.5 mg/kg) it disappeared, without any remaining focus. Recorded spasms during a cluster were “independent,” with recurrence of hypsarrhythmia between successive spasms, and thus had the ictal and interictal EEG characteristics of idiopathic WS. Seven patients exhibited other types of seizures after WS, consisting of myoclonic jerks, atonic, tonic‐clonic or absence seizures, which proved quite easy to control with valproate and/or ethosuximide.
Benzodiazepine Antagonists Reduce Epileptiform Discharges in Rat Hippocampal Slices
Authors: Polc Petar , Jahromi Shokrollah S. , Facciponte Giovanni , Pelletier Marc R. , Zhang Liang , Carlen Peter L.
Published: August 2005

Summary: Purpose: The antiepileptic effects of benzodiaze‐pine‐receptor (BZR) agonists have been well documented. Surprisingly, an antiepileptic effect for the BZR antagonist, fluma‐zenil, has also been described, the mechanism of which is unknown. We investigated the effects of nanomolar concentrations of flumazenil and a structurally dissimilar BZR antagonist, propyl‐β‐carboline‐3‐carboxylate (β‐CCP), on normal synaptic responses and epileptiform discharges induced by a variety of methods in the CA1 region of rat hippocampal slices.

Methods: Extracellular field potentials were recorded from stratum pyramidale of the CA1 region. Orthodromic stimulation was delivered by a bipolar electrode placed in the stratum radiatum at the border of the CA2/KA3 regions. Drugs were bath applied, and epileptiform discharges were quantified by using the Coastline Bursting Index, which calculates the total length of the discharge waveform of evoked multiple population spikes. For statistical comparisons, we calculated the Coastline Bursting Index for the average of five traces at the end of the control period (20 min), drug application (20 min), and washout (20–40 min).

Results: Flumazenil was without effect on normal synaptic responses; however, flumazenil reduced epileptiform discharges evoked in the presence of high [K+]0, leu‐enkephalin, the BZR inverse agonist, methyl‐6,7‐dimethoxy‐4‐ethyl‐β‐carboline‐3‐carboxylate (DMCM), or after a cold‐shock procedure. β‐CCP exhibited an action similar to that observed for flumazenil, suggesting that the antiepileptic effect is due to properties common to BZR antagonists.

Conclusions: We suggest that the antiepileptic effect we observed for flumazenil and (β‐CCP is mediated at the BZR and might be due to competition with endogenous BZR inverse agonists released preferentially during epileptiform activity.
Nocturnal Penile Tumescence and Rigidity Evaluation in Men with Epilepsy
Authors: Guldner Gregory T. , Morrell Martha J.
Published: August 2005

Summary: Purpose: Men with epilepsy appear to have an approximately fivefold increase in risk of erectile dysfunction (ED). We attempted to determine whether ED in men with epilepsy was due to a physiological basis and whether erectile function could be adequately evaluated with an ambulatory nocturnal penile tumescence and rigidity monitor.

Methods: The physiologic integrity of the sexual response in men with epilepsy and ED was assessed with an ambulatory nocturnal penile tumescence and rigidity monitor (NPTR). Six men with localization‐related epilepsy of temporal lobe origin (TLE) and ED, 2 men with TLE and normal sexual function, and 1 man with nonepileptic seizures (NES) and ED underwent evaluation of nocturnal erections for at least 2 nights.

Results: Five of 6 men with TLE and complaints of ED had abnormal ambulatory NPTR evaluations. All others had normal ambulatory NPTR. All abnormal evaluations showed reduced levels of rigidity, often with normal levels of tumescence.

Conclusions: Previous studies have shown this abnormal ambulatory NPTR pattern to be associated with neurogenic rather than vasogenic ED. Therefore, epilepsy‐related ED may have a substantial neurophysiologic component.
Validation of the Wechsler Memory Scale‐Revised in a Sample of People with Intractable Temporal Lobe Epilepsy
Authors: Moore Pascale M. , Baker Gus A.
Published: August 2005

Summary: Purpose: The Wechsler Memory Scale‐Revised (WMS‐R) is used routinely for presurgical assessment of memory for patients considering elective resection of the temporal lobe and/or hippocampus for the relief of intractable temporal lobe epilepsy (TLE). We investigated the validity of the WMS‐R in a population of people with TLE.

Methods: The sample consisted of 138 patients with a diagnosis of TLE in which the epileptogenic focus was clearly and exclusively lateralized to either the right or left hemisphere. They underwent a complete neuropsychological examination as a routine part of their investigation for epilepsy surgery. Psychometric scores included in this study were: Wechsler Adult Intelligence Scale‐Revised (WAIS‐R) I.Q. scores, National Adult Reading Test Revised (NART‐R) predicted‐I.Q. scores, and WMS‐R Memory Index and subtest scores.

Results: Multiple univariate analyses were performed. The group with left temporal focus had significantly lower Verbal Memory Index, Logical memory (both immediate and delayed), and Digit Span scores. Visual/Verbal discrepancy scores incorrectly identified most patients with right temporal focus. Analyses of a total group of people with epilepsy (i.e., mixed temporal, frontal, occipital and unknown foci) as compared with the normative sample indicated that the patient group scored significantly lower across all memory index scores and most memory subtests.

Conclusions: Our results confirm that the WMS‐R is capable of lateralizing to left hemispheric impairment but is more problematic in the assessment of right hemispheric impairment. The Visual/Verbal Memory Index discrepancy has questionable validity. People with epilepsy performed less well on the WMS‐R than did the normative sample. The need for reliable and valid nonverbal tests of memory is therefore warranted.
Bilateral Hippocampal Volume Loss in Patients with a History of Encephalitis or Meningitis
Authors: Free S. L. , Li L. M. , Fish D. R. , Shorvon S. D. , Stevens J. M.
Published: August 2005

Volumetric analysis of high‐quality magnetic resonance imaging (MRI) scans identifies asymmetric hippocampal atrophy in most patients with temporal lobe epilepsy. However, bilateral hippocampal atrophy can be missed by unnormalized volume measures. We considered two patient groups with temporal lobe epilepsy, one with a history of febrile convulsions (FC, n = 14) and one with a history of encephalitis or meningitis (E/M, n = 12), to compare the prevalence of bilateral volume loss between the groups. A volume normalization process defines a normal range of hippocampal volumes in control subjects (n = 32). Normalized volumes indicated that 11 of 14 subjects with a history of FC had unilateral hippocampal atrophy and 9 of 12 subjects with a history of E/M had bilateral hippocampal atrophy as compared with the controls. Visual assessments of unilateral hippocampal atrophy (n = 17) correlated well with measured unilateral volume loss (n = 14), but visual assessment of bilateral hippocampal atrophy (n = 3) correlated poorly with measured bilateral volume loss (n = 12). Mean age at seizure onset was lower in the FC group (7 years) than in the E/M group (13 years), but other clinical features were similar between the two groups. Hippocampal volume normalization is necessary to detect bilateral volume loss, which is common in patients with a history of encephalitis or meningitis.
Felbamate‐Induced Headache
Authors: Ettinger Alan B. , Jandorf Lina , Berdia Ajay , Andriola Mary R. , Krupp Lauren B. , Weisbrot Deborah M.
Published: August 2005

We prospectively investigated drug‐induced headaches (HA) among 60 epileptic patients receiving felbamate (FBM). Twenty patients (33%) experienced HA. HA was pounding in 11 (55%), steady in 9 (45%), moderate or severe in 19 (95%), occurred at least once a week in all patients, and was relieved by nonnarcotic analgesics in 14 (70%). Mean duration on FBM before HA onset was 19 days. HA occurred with higher FBM doses and was relieved in 8 of 13 patients (62%) with FBM dose reduction. FBM was discontinued in most cases because of risks of anemia or hepatitis; not because of HA. Other side effects included insomnia (25%), gastrointestinal symptoms (27%), and agitation or restlessness (23%). HA is a common dose‐related complication of FBM, occurs early after initiation of FBM treatment, and is relieved by dose reduction.
Competitive NMDA‐Receptor Antagonists, LY 235959 and LY 233053, Enhance the Protective Efficacy of Various Antiepileptic Drugs Against Maximal Electroshock‐Induced Seizures in Mice
Authors: Borowicz Kinga K. , Gasior Maciej , Kleinrok Zdzislaw , Czuczwar Stanislaw J.
Published: August 2005

Purpose: The objective of this study was to evaluate an interaction of two competitive N‐methyl‐D‐aspartate (NMDA)‐receptor antagonists, LY 235959 [(‐)‐3R,4aS,6R,8aR‐6‐(phosphonomethyl)‐decahydroiso‐quinoline‐3‐carboxylic acid; 50.5 mgikg] or LY 233053 [cis‐(±)‐4–[(2H‐tetrazol‐5–yl) methyl] piperidine‐2‐carboxylic acid; 5 mg/kg] with carbamazepine, diphenylhydantoin, phenobarbital, or valproate magnesium against maximal electroshock‐induced convulsions in mice.

Methods: Electroconvulsions were produced by means of an alternating current (ear‐clip electrodes, 0.2‐s stimulus duration, tonic hindlimb extension taken as the end point) delivered by a Hugo‐Sachs stimulator (Type 221, Freiburg, FRG). Adverse effects were evaluated in the chimney test (motor performance) and passive‐avoidance task (long‐term memory). Plasma levels of antiepileptic drugs were measured by immunofluorescence.

Results: Both LY 235959 and LY 233053 (=0.5 and 5 mg/kg, respectively) did not influence the electroconvul sive threshold but potentiated the anticonvulsant action of all antiepileptics studied. The combined treatment of LY 233053 (5 mg/kg) with carbamazepine, diphenylhydan‐toin, or phenobarbital (providing a 50% protection against maximal electroshock) resulted in the impairment of long‐term memory. No adverse effects were observed with combinations of LY 235959 with these antiepileptics. The combined treatment of valproate with either LY 235959 or LY 233053 was superior to valproate alone, as regards motor impairment, but not the impairment of long‐term memory. Neither NMDA‐receptor antagonist elevated the total plasma levels of antiepileptic drugs studied.

Conclusions: It may be concluded that NMDA‐receptor blockade leads to the enhanced anticonvulsive action of conventional antiepileptics against maximal electroshock‐induced seizures. A pharmacokinetic interaction does not seem probable.
Systematic Testing of Medical Intractability for Carbamazepine, Phenytoin, and Phenobarbital or Primidone in Monotherapy for Patients Considered for Epilepsy Surgery
Authors: Hermanns Guido , Noachtar Soheyl , Tuxhorn Ingrid , Holthausen Hans , Ebner Alois , Wolf Peter
Published: August 2005

Summary: Purpose: To assess medical intractability in patients considered for restrictive epilepsy surgery.

Methods: Seventy‐four patients received single drug treatment with carbamazepine (CBZ), phenytoin (PHT), and either phenobarbital (PB) or primidone (PRM). Medical intractability was established if seizure control was not obtained despite maximum tolerable doses of the drug. In all, 120 single drug treatments were administered with the drugs that has not been administered at maximal doses in monotherapy before the study.

Results: Complete seizure control was not achieved in any patient. However, 7 patients (9.5%) had significant seizure reduction of at least 80%. In 4 patients, only the third antiepileptic drug (AED) proved effective.

Conclusion: The poor result of AED monotherapy in our patients may be attributed to the patients’long‐standing chronic epilepsies and high seizure frequencies. Our findings suggest that despite the failure of one or two major AEDs in controlling seizures completely, further single drug treatment may still improve the quality of life in some patients who are candidates for epilepsy surgery.
Electrocerebral Recovery During the Intracarotid Amobarbital Procedure: Influence of Interval Between Injections
Authors: Selwa Linda M. , Buchtel Henry A. , Henry Thomas R.
Published: August 2005

Summary: Purpose and Methods: During the intracarotid amobarbital procedure (IAP) at the University of Michigan, continuous scalp EEG monitoring guides the timing for presentation of memory items and postinjection testing. Most of our patients have undergone bilateral injections. The interval between injections varied from 22 to 60 min, depending on the test and recovery time, as well as the time to catheterize the second side. After noting a trend toward prolonged electro‐graphic recovery following the second injection, we tested our clinical impression that recovery of the second hemisphere may be influenced by (a) the time between injections and (b) which hemisphere is injected first (epileptogenic or nonepileptogenic).

To study these questions, we analyzed EEG recovery data from 48 consecutive IAPs. Approximately half the patients had the epileptogenic side injected first.

Results: We found that (a) electrographic recovery after the second injection is prolonged if the interval between bilateral injections is less than 40 minutes and (b) electrographic recovery is more rapid after injection of the epileptogenic hemisphere.

Conclusions: We now recommend waiting at least 45 min between injections. The pathophysiology of more prolonged amobarbital effect on the nonepileptogenic hemisphere than on the epileptogenic hemisphere remains unclear.
Scalp‐Recorded, Ictal Focal DC Shift in a Patient with Tonic Seizure
Authors: Ikeda Akio , Yazawa Shogo , Kunieda Takeham , Araki Kasumi , Aoki Tomokazu , Hattori Hamo , Taki Waro , Shibasaki Hiroshi
Published: August 2005

Summary: Purpose: We recorded focal ictal DC shifts from scalp electrodes in a 9–year‐old boy with intractable, clinically generalized tonic seizures. The patient had a high intensity signal abnormality of the left temporal cortex with thickening of the gyri on T2–weighted MRI.

Methods: Scalp digital EEGs were recorded using electrodes made of silver/silver chloride. The low frequency filter (LFF) was set at 0.016 Hz. Recorded seizures were subsequently analyzed with LFF settings of 1.0, 0.016 and 0.03 Hz.

Results: All recorded seizures initially showed diffuse, low voltage, high frequency activity (electrodecremental pattern) followed 10–20 s later by quasirhythmic activity over the left frontotemporal region. In two seizures, LFF of 0.016–0.03 Hz revealed a slow negative shift over the left frontotemporal area simultaneously with onset of the bilateral electrodecremental pattern. However, in the other seizures, this initial slow negative shift was obscured by artifacts. Subsequent electrocorticography (ECoG) delineated frequent epileptiform discharges in the left temporal as well as frontal cortex.

Conclusions: Scalp‐recorded ictal DC shifts may help identify focal epileptogenic brain area in patients with clinically generalized seizures although the technique is vulnerable to artifact.
“Periodic” Seizures
Authors: Blume Warren T. , Wiebe Samuel
Published: August 2005

Summary: Purpose: To describe regularly recurring ictal phenomena as recorded in a single patient whose seizure disorder related to a left temporal cavernous angioma.

Methods: Seizures were recorded by left temporal subdural strip electrodes which were bilaterally placed because of ambiguous seizure origin and right temporal memory dysfunction at Wada testing. Seizure length, interseizure intervals, and interseizure onset intervals were visually assessed. The coefficient of variation was used as an estimate of variability in seizure periodicity.

Results: Mean seizure durations varied from 68 to 95 s; coefficients of variation varied from 0.08 to 0.18, values similar to other periodic biological phenomena. Mean daily seizure intervals varied from 96 to 152 s with coefficients of variation ranging from 0.12 to 0.35. Interseizure onset intervals had smaller coefficients of variation (0.03–0.20). Manifestations of these simple partial seizures included a rising epigastric sensation and nausea.

Conclusions: Previously described periodic EEG phenomena are interictal events or appear with peripheral events of similar cadence. Therefore, we remain unaware of any documentation of periodic ictal electrographic events. The restricted propagation and duration of these recorded seizures may have simplified their pathophysiology allowing a stereotyped involvement of excitatory and inhibitory mechanisms producing the periodicity.
Paranoid‐Hallucinatory State in Patients with Epilepsy: Historical Perspective in Japan
Authors: Onuma Teiichi
Published: August 2005

Summary: The major literature on psychosis in patients with epilepsy in Japan is reviewed. A well‐documented case report of postictal psychosis appeared as early as 1908; since then, psychiatrists have been taking an active role in the field of epileptology. Personal observation of a large number of similar cases indicates that most paranoid psychoses in epilepsy are different from schizophrenia in terms of seizure occurrence, time course, and psychiatric symptomatology and may be classified as (a) postictal psychosis, (b) episodic psychosis, (c) chronic schizophrenialike psychosis, (d) psychosis with generalized EEG seizure discharges, and (e) a combination of epilepsy and schizophrenia.
Frontal Lobe Epilepsy of Childhood Onset
Authors: Aso Kosaburo , Watanabe Kazuyoshi , Negoro Tamiko , Nakashima Sachie
Published: August 2005

Summary: We retrospectively studied long‐term clinical profiles of 38 patients with cryptogenic or symptomatic frontal lobe epilepsy (FLE) of childhood onset. More patients in our patient population had FLE than temporal lobe epilepsy (TLE). Etiology of symptomatic FLE included tuberous sclerosis, cortical dysplasia, intracranial hemorrhage, perinatal asphyxia, and hemiconvulsion‐hemiplegia‐epilepsy syndrome. In 6 patients, magnetic resonance imaging (MN) showed no abnormality, but positron emission tomography (PET) with [18F]fluorodeoxyglucose (FDG) showed glucose hypometabolism in the frontal lobe. The seizures were characterized by postural seizures, focal tonic or clonic seizures, complex gestural automatism, eye deviation, and adversive seizures. Seizure prognosis was poor. Only 13 patients (35%) became seizure‐free for 2 years. Poor prognostic factors for seizures included intelligence deficits, seizure clustering, and aura.
Epilepsy in Peroxisomal Diseases
Authors: Takahashi Yukitoshi , Suzuki Yasuyuki , Kumazaki Kaori , Tanabe Yuzo , Akaboshi Shinjiro , Miura Kiyokuni , Shimozawa Nobuyuki , Kondo Naomi , Nishiguchi Toshihiro , Terada Kihei , Orii Tadao
Published: August 2005

Summary: Purpose: To clarify the electroclinical manifestation of epileptic seizures and the evolution of epilepsy in patients with peroxisomal diseases.

Methods: Retrospective review of the medical records and EEGs of 14 patients with peroxisomal diseases: seven with Zellweger syndrome (ZS), two with neonatal adrenoleuko‐dystrophy (NALD), two with acyl‐CoA oxidase deficiency (AOXD), two with bifunctional enzyme deficiency (BFED), and one with rhizomelic chondrodysplasia punctata (RCDP). The diagnoses were made by biochemical analysis and pathological examinations in our laboratory.

Results: Patients manifested serious neurologic deficits in the neonatal period or in early or late infancy. Patients with ZS or AOXD had partial motor seizures originating in the arms or legs or corners of the mouth. Their seizures did not culminate in generalized tonic‐clonic seizures and were easily controlled by antiepileptic drugs (AEDs). Interictal EEGs of the patients with ZS showed infrequent bilateral independent multifocal spikes, predominantly in the frontal motor cortex and its surrounding regions. The EEGs of patients with AOXD showed interictal fast theta activity, predominantly in the frontocentral regions. Patients with BFED also had partial motor seizures in early infancy, but the seizures were intractable, evolving in one case to myoclonic seizures. Interictal EEGs of patients with BFED showed bilateral independent multifocal spikes that evolved to bilateral diffuse high‐voltage slow waves in one case and to a hypsarythmic pattern in another case as the disease progressed. Patients with NALD had intractable tonic seizures or epileptic spasms. Interictal EEGs showed high‐voltage slow waves and bilateral independent multifocal spikes, evolving in one patient to a flat pattern. The patient with RCDP, whose interictal EEGs showed frequent multifocal independent spikes, did not have epileptic seizures.

Conclusions: The age of epilepsy onset or the duration of survival is related to the types of seizures occurring in patients with peroxisomal diseases. Neonates or young infants usually have partial motor seizures (facial twitching or clonic convulsions of the arms or legs) of various multifocal origins. Older infants may have generalized seizures at the onset of the disease or evolutionally. Seizure intractability is usually less severe in patients with ZS or AOXD than in patients with NALD or BFED. There is no relation between the electroclinical characteristics of epilepsy and the genetic complementation groups in peroxisomal diseases.
Does Physical Exercise Influence the Occurrence of Epileptiform EEG Discharges in Children?
Authors: Nakken Karl O. , Løyning Alvhild , Løyning Tone , Gløersen Gunvor , Larsson Pål G.
Published: August 2005

Summary: Purpose: To determine if, and how, epileptiform EEG discharges in children were influenced by physical exercise.

Methods: Twenty‐six children with intractable partial and generalized epilepsy exercised during video‐telemetry recording, aiming at exhaustion after ∼10 min.

Results: During the exercise, epileptiform discharges decreased in 20 of 26 children (17 children had at least 25% reduction) and showed a rebound increase after the exercise (17 of 26 children) compared to baseline conditions. This exercise‐induced reduction in epileptiform discharges reached statistical significance only in the 16 patients with localization‐related epilepsy. Five patients showed an atypical EEG response to exercise with either unchanged or increased epileptiform activity while exercising. As compared to the other patients, these 5 children had experienced frequent clinical seizures during or immediately after exercise in their leisure time.

Conclusions: In the majority of the tested children, epileptiform EEG discharges decreased during exercise. “Exercise‐EEG” may be a helpful diagnostic tool to identify patients who are disposed to have exercise‐induced seizures.
No Effect of Long‐Term Vigabatrin Treatment on Central Nervous System Conduction in Patients with Refractory Epilepsy: Results of a Multicenter Study of Somatosensory and Visual Evoked Potentials
Authors: Mauguière F. , Chauvel P. , Dewailly J. , Dousse N. ,   the PMS Study Multicenter Group
Published: August 2005

Summary: Purpose: In dogs, vigabatrin (VGB) has been associated with intramyelinic edema producing delayed central conduction in somatosensory and visual evoked potentials (SEP, VEP). No such effects have been reported in humans. We assessed whether abnormalities of central conduction could be detected prospectively in patients with epilepsy treated with VGB as long‐term add‐on medication.

Methods: Two hundred one patients with refractory partial epilepsy were enrolled and monitored for as long as 2 years. VGB was added to the treatment at an average dose of 2–3g/ day. Conduction in somatosensory and visual pathways was assessed by median nerve SEP and pattern VEP recordings performed at inclusion and once every 6 months. The upper limit and test‐retest variability of EP latencies were evaluated at time of enrollment in the patient group. Prolonged N13‐N20 or P14‐N20 SEP intervals and P100 VEP latency >2.5 SD above the baseline mean, observed on repeated runs in the same session and exceeding the test‐retest variability at enrollment were considered to indicate central conduction slowing.

Results: One hundred nine patients completed the 2‐year study period, and 92 discontinued VGB, of whom 37 were monitored with regard to EP until the end of the study. No consistent change in SEP or VEP was observed in the entire group during VGB treatment. The number of occasional EP values outside the baseline range in patients treated with VGB similar to that in patients whose VGB treatment had been discontinued.

Conclusions: We detected no evidence of changes in SEP and VEP attributable to altered neuronal conduction in the CNS during long‐term VGB treatment.
Incidence of Epilepsy in Rural Central Ethiopia
Authors: Tekle‐Haimanot Redda , Forsgren Lars , Ekstedt Jan
Published: August 2005

Summary: Purpose: To study the incidence of epilepsy in a rural area of Ethiopia.

Methods: A community‐based study was performed in a random sample of villages with 61,686 inhabitants in a rural area of central Ethiopia. In a door‐to‐door survey, all inhabitants in the study area were interviewed about seizures. A standardized protocol was used. All new cases with epilepsy that had occurred since a previous study was made 3.5 years earlier were included. Fifty‐three of the subjects were investigated with EEG.

Results: One‐hundred thirty‐nine incident cases were identified, corresponding to an annual incidence of 64 in 100,000 inhabitants [95% confidence interval (CI) 44–84]. The corresponding rate for males was 72 (CI 42–102); for females, it was 57 (CI 31–84). The highest age‐specific incidence occurred in the youngest age groups (0–9 years); the next highest was in the group aged 10–19 years. Generalized convulsive seizures occurred in 69%, partial seizures occurred in 20%, and unclassifiable seizures occurred in 11%. Seizures occurred daily in 10% and weekly in another 14%; 33% had monthly seizures. Twenty‐two percent had a family history of epilepsy. A history of head trauma was ascertained in 5.7% and was the most common possible etiologic factor identified. Thirteen percent were treated with antiepileptic drugs (AEDs).

Conclusions: The incidence of epilepsy in Ethiopia is high. A high incidence in combination with a prevalence of epilepsy in the study area comparable to that in the rest of the world may be explained by a high degree of spontaneous remission of epilepsy and/or a high mortality due to epilepsy. Despite health education on epilepsy given to the community, a minority of subjects were treated with AEDs, which may reflect the inadequacies of the health services and transportation difficulties faced by the patients.
Volumetric Magnetic Resonance Imaging Evidence of Bilateral Hippocampal Atrophy in Mesial Temporal Lobe Epilepsy
Authors: Quigg Mark , Bertram Edward H. , Jackson Theodore , Laws Edward
Published: August 2005

Summary: Purpose: We measured absolute volumes and volume differences of hippocampi in patients with mesial temporal lobe epilepsy (MTLE) using volumetric magnetic resonance imaging (MRI) to determine the extent of bilateral atrophy in MTLE and to relate hippocampal volumes (HV) to outcome of temporal lobectomy.

Methods: HV and hippocampal differences (HD) were measured in 40 patients with MTLE determined by pathology of hippocampal sclerosis (HS) and compared with those of age‐matched controls. Results were matched with surgical outcome.

Results: Hippocampi contralateral to lobectomy (right hippocampi 2.96 ± 0.49 cm3, left 3.14 ± 0.51 cm3) were significantly smaller than those of controls (right hippocampi 3.73 ± 0.52 cm3, left 3.60 ± 0.51 cm3 but were significantly larger than hippocampi ipsilateral to lobectomy (right hippocampi 2.63 ± 0.61 cm3, 2.18 cm3) as compared across groups by analysis of variance (ANOVA: F= 27.2, p < 0. 0001). The smaller hippocampus was ipsilatera1 to lobectomy in 39 of 40 cases. Seven of 40 MTLE patients (18%) had bilateral atrophy, defined by volumes of each hippocampi 2 SD lower than control means. Surgical outcome was independent of hippocampal asymmetry and bilateral atrophy measured by chi‐square and Fisher's exact tests.

Conclusions: We determined that most patients with MTLE have some degree of bilateral, asymmetric hippocampal pathology. However, asymmetry and bilateral atrophy have no clear relation to surgical outcome.
Asymmetries in the Effect of Side of Seizure Onset on Recognition Memory Following Intracarotid Amobarbital Injection
Authors: Breier J. I. , Thomas A. B. , Plenger P. M. , Wheless J. W. , Brookshire B. L. , Papanicolaou A. , Willmore L. J.
Published: August 2005

Summary: Purpose: To assess inter hemispheric differences in recognition memory for objects during the intracarotid amobarbital sodium procedure (IAP).

Methods: The recognition memory for real objects of patients with either right (RTLE, n = 28) or left (LTLE; n = 22) temporal lobe epilepsy was assessed at baseline, and after left and right intracarotid amobarbital sodium injection.

Results: There were no differences between groups on baseline performance. Performance following injection ipsilateral to the side of seizure focus was relatively lower for the LTLE as compared with the RTLE group, but this difference did not reach statistical significance. However, performance following injection contralateral to the side of seizure focus was significantly lower for the RTLE as compared with the LTLE group. Within‐group differences in performance after ipsilateral as compared with contralateral injection were significant for the RTLE but not the LTLE group. The difference in inter hemispheric asymmetry in IAP memory performance between RTLE and LTLE groups was reflected in decreased ability to classify LTLE patients as compared with RTLE patients about side of seizure onset, using a clinically applicable decision rule.

Conclusions: Recognition memory during the IAP for real objects, simultaneously named and presented visually during encoding, is mediated effectively by both the left and right hemisphere when there is no seizure focus present. However, memory appears to be more vulnerable to the presence of a seizure focus in the right as compared with the left hemisphere.
A Double‐Blind, Placebo‐Controlled Study on the Effect of Vigabatrin on In Vivo Parameters of Hepatic Microsomal Enzyme Induction and on the Kinetics of Steroid Oral Contraceptives in Healthy Female Volunteers
Authors: Bartoli A. , Gatti G. , Cipolla G. , Barzaghi N. , Veliz G. , Fattore C. , Mumford J. , Perucca E.
Published: August 2005

Summary: Purpose: This study was conducted to determine whether vigabatrin affects in vivo indices of hepatic microsomal enzyme activity and the pharmacokinetics of steroid oral contraceptives in healthy subjects.

Methods: Under double‐blind conditions, 13 female healthy volunteers received, in random order and with a washout interval of ≤= 4 weeks, two oral 4‐week treatments with vigabatrin (VGB) (maintenance dosage, 3,000 mg daily) and placebo, respectively. The clearance and half‐life of antipyrine (a broad marker of drug oxidation capacity), the urinary excretion of 6‐β‐hydroxycortisol (a selective marker of cytochrome CYP3A‐mediated oxidation), and the activity of serum γ‐glutamyltransferase (a nonspecific index of microsomal enzyme activity) were determined after 3 weeks of each treatment. The single‐dose kinetics of a combined oral contraceptive containing 30 μg ethinyl estradiol and 150 μg levonorgestrel were also determined after 3 weeks of treatment by specific radioimmunologic assays.

Results: VGB treatment had no influence on antipyrine clearance (28 ± 5.6 vs. 30 ± 4.5 ml/h/kg on placebo), antipyrine half‐life (15.5 ± 3.5 vs. 14.1 ± 2.1 h), urinary 6–β‐hydroxycortisol excretion (488 ± 164 vs. 470 ± 228 nmol/day), 6‐β‐hydroxycortisol‐to‐cortisol concentration ratio (6.8 ± 3.1 vs. 6.1 ± 3.1) and serum γ‐glutamyltransferase activity (12 ± 3 vs. 11 ± 3 IUIL). No difference in pharmacokinetic parameters between VGB and placebo sessions were found for ethinyl estradiol (half‐life, 12.5 ± 3.2 vs. 13.9 ± 3.2 h; AUC, 874 ± 301 vs. 939 ± 272 ng/L/h) and levonorgestrel (half‐life, 17.7 ± 5.2 vs. 23.1 ± 9.8 h; AUC, 27.5 ± 9.6 vs. 30.0 ± 12.0 μg/L/h). Two subjects, however, showed a 50 and a 39% reduction in ethinyl estradiol AUC during VGB treatment.

Conclusions: At therapeutic dosages, VGB did not modify in vivo indices of hepatic microsomal enzyme activity and did not interfere significantly with the CYP3A‐mediated metabolism of ethinyl estradiol and levonorgestrel. Based on these data, VGB is unlikely to affect consistently the efficacy of steroid oral contraceptives or interact pharmacokinetically with drugs that are eliminated mainly by oxidative pathways, particularly those involving cytochrome CYP3A.
Semiology of Temporal Lobe Seizures: Value in Lateralizing the Seizure Focus
Authors: Marks William J. , Laxer Kenneth D.
Published: August 2005

Summary: Purpose: To determine the lateralizing value of the clinical manifestations of seizures in patients with temporal lobe epilepsy (TLE), we made a retrospective videotape analysis of complex partial seizures (CPS) in 55 patients who underwent temporal lobectomy and were seizure‐free postopera‐tively for >2 years.

Methods: Blinded to clinical details, we reviewed videotapes from video‐EEG telemetry monitoring with attention paid to seizure semiology.

Results: Useful lateralizing features included unilateral clonic activity (with the seizure focus contralateral in all patients), unilateral dystonic or tonic posturing (with the seizure focus contralateral in 90 and 86%, respectively), unilateral automatisms (with the seizure focus ipsilateral in 80%), and ictal speech preservation (with the seizure focus contralateral to the language‐dominant hemisphere in 80%). Versive head rotation occurring ≤10 s before seizures secondarily generalized consistently predicted a contralateral focus. Seizure manifestations less predictive but suggestive of lateralization included ictal speech arrest and postictal speech status, with predictive values of 67%. Seizure manifestations not providing reliable lateralizing information included eye deviation, type of aura, and versive head movements occurring at times other than immediately before seizures secondarily generalized.

Conclusions: In TLE, several clinical seizure manifestations are useful in lateralizing the seizure focus, although some provide no reliable information. Therefore, ictal semiology can assist in the evaluation of patients for seizure surgery, providing additional information in the lateralization of TLE.
Vagus Nerve Stimulation in 16 Children with Refractory Epilepsy
Authors: Lundgren J. , Åmark P. , Blennow G. , Strömblad L. G. , Wallstedt L.
Published: August 2005

Summary: Purpose: Vagus nerve stimulation (VNS) has been reported to produce >90% reduction in the number of seizures in children with intractable epilepsy. These encouraging results need confirmation.

Methods: Sixteen children, 10 boys and 6 girls aged 4‐19 years, were treated with VNS (Cyberonics, Webster, TX, U.S.A.) for 12‐24 months. Seizure frequency, seizure severity, changes in quality of life (QOL: visual analogue scale), and side effects were recorded. Eight children had partial and 8 had generalized seizures; 4 of the latter had Lennox‐Gastaut syndrome (LGS).

Results: During the tenth to twelfth month of VNS, 6 of 16 children experienced ≥50% reduction in seizure frequency. One girl became seizure‐free. Seizure severity showed an average decrease in the score from 15 to 11. After 10 months of treatment, QOL was estimated to have improved ≥50% in 6 of 16 children. Reduction in seizure frequency, decreased seizure severity, and reported improvement in QOL did not entirely coincide. Six children experienced hoarseness, 1 had neck pain, 2 had hypersalivation, 2 experienced tiredness, 2 had aspiration episodes during liquid intake, and 6 had electrical transmission problems; in 4 the problem has been surgically corrected. Five stimulators were turned off due to lack of efficacy.

Conclusions: Six of 16 children with refractory epilepsy treated with VNS improved, with a reduction not only in seizure frequency but also in seizure severity and in QOL.
Morbidity of Nonfebrile Status Epilepticus in Rochester, Minnesota, 1965–1984
Authors: Cascino Gregory D. , Hesdorffer Dale , Logroscino Giancarlo , Hauser W. Allen
Published: August 2005

Summary: Purpose: To analyze the nonfatal adverse events (AE) associated with a first episode of status epilepticus (SE).

Methods: We performed a population‐based retrospective cohort study to determine the morbidity of SE. Participants included 184 residents of Rochester, Minnesota who experienced nonfebrile SE between 1965 and 1984.

Results: The etiology of SE was acute symptomatic in 100 patients and unprovoked in 84 patients. The most common seizure‐types were continuous partial (n = 56, 30%), generalized convulsive (n = 52, 28%). and generalized with focal features (n = 32, 17%). Morbidity related to SE was noted in 5 of the 146 patients (3.4%) surviving 30 days. The AE included hemiparesis (n = 3), encephalopathy (n = 2), mental retardation (n = l), and aphasia (n = 1). All patients with morbidity had an acute symptomatic (n = 4) or remote symptomatic (n = 1) etiology. Thirty‐four patients (18.5%) had a second episode of SE.

Conclusions: Based on this retrospective study, significant morbidity related to SE is uncommon and is associated with the underlying etiology.