bluuebunny/crossref_metadata_2025 huggingface dataset:
On the Structure of Ictal Events in Vitro
Authors: Traub Roger D. , Borck Cornelius , Colling Simon B. , Jefferys John G. R.
Published: August 2005

Summary: Purpose: To analyze the cellular and network mechanisms of sustained seizures, we reviewed the literature and present new data on in vitro epileptiform events. We considered single and recurring synchronized population bursts occurring on a time scale from tens of milliseconds to I min.

Methods: We used intracellular and field potential recordings, together with computer network simulations, derived from three types of experimental epileptogenesis: γ‐aminobutyric‐acidA, (GABAA) blockade, low extracellular [Mg2+]0, and 4‐aminopyridine (4‐AP).

Results: In all three models, sustained depolarizing synaptic currents developed, either through N‐methyl‐D‐aspartate (NMDA) receptors, depolarizing GABAA, receptors, or both. Ectopic action potentials (APs), probably originating in axonal structures, occurred in 4‐AP and (as shown by other researchers) after tetanic stimulation; ectopic APs, occurring at sufficient frequency. should also depolarize dendrites, by synaptic excitation, enough to trigger bursts.

Conclusions: Ictal‐like events appear to arise from two basic mechanisms. The first mechanism consists of sustained dendritic depolarization driving a series of dendritic bursts. The second mechanism consists of an increase in axonal and presynaptic terminal excitability driving a series of bursts analogous to interictal spikes.
Eyelid Myoclonia with Absences in Adults: A Clinical and Video‐EEG Study
Authors: Giannakodimos Stylianos , Panayiotopoulos Chrysostomos P.
Published: August 2005

Summary: We report clinical and video‐EEG findings in 11 adults with the syndrome of eyelid myoclonia with absences (EMA). Prevalence was 2.7% among all epilepsies and 12.9% among idiopathic generalized epilepsies (IGE) with typical absences. All patients with EMA were women, with a mean age of 30.9 years and a mean age of 7.8 years at reported onset of eyelid myoclonia. The characteristic seizures, studied with video‐EEG in 10 patients, began with and were mainly manifested by eyelid myoclonia, either alone if brief ( 2 s) or with associated mild impairment of consciousness if longer. The ictal EEG was characterized by polyspike and slow waves at 3‐6 Hz. Ictal clinical and EEG manifestations occurred mainly after eye closure and were inhibited by total darkness. All patients were photosensitive, but photosensitivity decreased with age; nonpatient had self‐induced seizures. Infrequent generalized tonic‐clonic seizures (GTCS) occurred in all but the youngest patient; they were usually infrequent and were precipitated mainly by flickering lights, sleep deprivation, fatigue, and menstruation. Mild myoclonic jerks of the upper limbs occurred in 6 patients. Eyelid myoclonia was resistant to medication and persisted despite control of other seizures.
Comparison of Antiepileptic Drugs on Cognitive Function in Newly Diagnosed Epileptic Children: A Psychometric and Neurophysiological Study
Authors: Chen Yung‐Jung , Kang Wun‐Ming , So Warren Chin‐Min
Published: August 2005

Summary: Using a randomized parallel group study design, we compared the cognitive effects of carbamazepine (CBZ), phenobarbital (PB), and valproate (VPA) in children with epilepsy. Seventy‐three children with newly diagnosed epilepsy were tested with the Wechsler Intelligence Scale for Children‐Revised (WISC‐R), Bender‐Gestalt test, and auditory event‐related potentials (P300) before and 6 and 12 months after antiepileptic drug (AED) treatment. There were no significant differences in WISC‐R IQs and Bender‐Gestalt scores for children in any group at any of the three sessions. P300 latencies were increased in the children receiving PB but not in children receiving CBZ and VPA. P300 amplitudes were significantly reduced in treated children in all three groups, but amplitudes were not significantly different among the three groups. These findings suggest that PB may affect cognitive function of epileptic children and that the P300 may be a sensitive additional procedure that can be used to assess the cognitive effect of AEDs.
Sudden Unexplained Death Among Subjects with Refractory Epilepsy
Authors: Derby Laura E. , Tennis Patricia , Jick Hershel
Published: August 2005

Summary: Purpose: To address concerns about possible increases in rates of sudden unexplained death (SUD) after use of new anticonvulsants, more information on the rate of SUD among subjects with refractory epilepsy is needed to provide a comparison.

Methods: We conducted a study to estimate the incidence of SUD among subjects younger than 50 years with refractory epilepsy, by using information from the General Practice Research Database (GPRD) in the United Kingdom. For the purposes of this study, subjects receiving two or more anticonvulsant drugs concurrently were considered to have refractory epilepsy. Potential cases of SUD were identified from the computer records, and clinical records for these subjects were reviewed by two specialists in SUD in epilepsy.

Results: Fifteen subjects (eight male, seven female) of the 4,150 subjects with refractory epilepsy were considered to have definite/probable or possible SUD.

Conclusions: The overall incidence rate of SUD in the population was 2.2 per 1,000 person‐years (95% CI, 1.3–3.6). The rate for subjects with highly probable SUD was 1.5 per 1,000 person‐years (95% CI, 0.8–2.7).
Functional Neuroimaging with Positron Emission Tomography
Authors: Henry Thomas R.
Published: August 2005

Summary: Epilepsy research using positron emission tomography (PET) has provided considerable new information about ictal and interictal dysfunctions in human epilepsy. Neuroreceptor mapping with PET ligands has revealed altered central benzodiazepine receptor and opiate receptor densities in partial epilepsies interictally, and regional increases in endogenous opioid peptide concentrations during absence seizures. Imaging of perfusion and glucose metabolism during cognitive processing has shown interictal abnormalities of regional activation in partial and generalized epilepsies. The diagnostically robust patterns of interictal glucose hypometabolism are not adequately explained by macrostructural and microstructural alterations in temporal lobe epilepsy. Current investigations of the pathophysiology of interictal hypometabolism must address ultrastructural and neurochemical factors. Clinical PET in pre‐surgical evaluation of medically refractory epilepsies remains an active area of research, but remarkably little antiepileptic drug research has exploited PET techniques.
Concurrent Illnesses in Adults with Childhood‐Onset Epilepsy: A Population‐Based 35‐Year Follow‐Up Study
Authors: Jalava Merja , Sillanpää Matti
Published: August 2005

Summary: Purpose: To ascertain the occurrence of concurrent illnesses in adults with epilepsy since childhood.

Method: After a mean follow‐up of 35 years of a prospective, population‐based long‐term followed patient cohort with epilepsy since childhood, comorbidity was examined in 176 surviving (100 of them with epilepsy only) and 44 dead patients and in random and employee controls.

Results: Somatic comorbidity varied from 84 to 95% in patients and from 67 to 74% in controls. No significantly increased risk of somatic diseases could be shown. Psychosomatic disorders were associated in 46‐74% of patients and in 42‐75% of controls, and psychiatric disorders were associated in 11‐23% of patients and in 7% of controls. As compared with random controls, patients with epilepsy had only a 4.0‐ to 4.2‐fold risk of psychiatric disorders or of combinations of somatic, psychosomatic, and/or psychiatric disorders. Patients received psychotropic drugs 8.6 times more frequently than employee controls. The risk for psychiatric and psychsomatic disorders was higher than expected in patients with childhood‐onset epilepsy, regardless of whether or not they were still receiving antiepileptic drugs (AEDs).

Conclusion: Epilepsy per se, but not AEDs, has an apparent association with the occurrence of psychiatric and psychosomatic disorders. Risk for somatic comorbidity is not increased.
The Functional Organization of the Interictal Spike Complex in Benign Rolandic Epilepsy
Authors: Baumgartner Christoph , Graf Martin , Doppelbauer Andreas , Serles Wolfgang , Lindinger Gerald , Olbrich Achim , Bacher Johanna , Pataraia Ekaterina , Almer Gabriele , Lischka Andreas
Published: August 2005

Summary: Purpose: We studied the functional organization of the interictal epileptic spike complex in patients with benign rolandic epilepsy of childhood (BREC).

Methods: We recorded interictal epileptiform spikes and somatosensory evoked potentials after median nerve stimulation, providing a biologic marker for the location of the central sulcus in 12 patients with BREC. We used multiple dipole modeling to assess the number, the three‐dimensional intracerebral location, and the time activity of the underlying neuronal sources.

Results: Although the interictal spike complex could be modeled by a single tangential dipolar source in seven patients (group 1), in the remaining five patients, two sources—a radial and a tangential dipole—were necessary adequately to explain the interictal spikes (group 2). The tangential source was located deeper than the radial source and was characterized by a frontal positivity and a centroparietal negativity with a phase reversal across the central sulcus, suggesting that the interictal spikes originated in the anterior wall of the central sulcus. The radial source showed a single electronegativity over the ipsilateral central region, which would be compatible with involvement of the top of either the pre‐ or postcentral gyrus. Both sources showed biphasic time patterns with an average latency difference of 30 ms.

Conclusions: Our results indicate that in some patients with typical BREC, the interictal epileptiform spike complex is generated by multiple, simultaneously active neuronal populations within the central region and that epileptiform activity is propagated between these two adjacent cortical areas.
Evaluation of Carbamazepine and Carbamazepine‐Epoxide Protein Binding in Patients Undergoing Epilepsy Surgery
Authors: Gidal Barry E. , Spencer Nancy W. , Maly Melissa M. , Pitterle Michael E.
Published: August 2005

Carbamazepine (CBZ) serum concentrations increase after epilepsy surgery. A possible mechanism may be acute changes in protein binding, specifically those involving the acute phase reactant α1‐acid glycoprotein (AAG). We prospectively evaluated 16 adults (11 receiving CBZ) with epilepsy (mean age 30 ± 8.9 years, 8 women and 8 men) undergoing temporal lobe resections and characterized AAG, albumin, CBZ, and CBZ‐epoxide (CBZ‐E) free fractions over time. AAG, ALB, CBZ, and CBZ‐E free fractions were determined before surgery (baseline) and on postoperative days 1–5, 14, and 30. AAG was measured with a radial immunodiffusion assay method, CBZ and CBZ‐E serum concentrations were determined by high‐performance liquid chromatography (HPLC). Free fractions of CBZ and CBZ‐E were calculated as the ratio of unbound (determined after ultracentrifugation) to total serum drug concentrations. Statistical analysis included analysis of variance (ANOVA) and Student's t test for paired data when appropriate, with significance assigned at p < 0.05. All data are mean ± SD. AAG concentrations increased significantly from baseline (61.9 ± 21.3 mg/dl), peaking at postoperative day 3 (116.8 ± 20.6 mg/dl) and decreasing to baseline levels between days 14 and 30. CBZ serum concentrations were significantly increased in the immediate postoperative period (day 3), but albumin concentrations and CBZ and CBZ‐E free fractions did not differ significantly between baseline and the postoperative time points. Temporal lobe resection results in an acute phase reaction which is manifested in part by significant changes in AAG. Although CBZ and CBZ‐E total serum concentrations increased significantly in the immediate postoperative period, epilepsy surgery did not appear to result in significant overall changes in drug binding to plasma proteins.
Hippocampal Cell Distributions in Temporal Lobe Epilepsy: A Comparison Between Patients With and Without an Early Risk Factor
Authors: O'Connor William M. , Masukawa Leona , Freese Andrew , Sperling Michael R. , French Jacqueline A. , O'Connor Michael J.
Published: August 2005

Summary: Neuronal cell distributions were measured for anterior and posterior locations in the hippocampi of epilepsy patients who were seizure‐free after temporal lobectomy. Patients were divided into two groups, those with an early risk factor, defined as a neurologic insult occurring in the first 4 years of life, and those with no early risk factor. Early‐risk patients had lower hilar cell densities, lower granule cell densities, and fewer granule cells per millimeter, a measure related to total granule cell number, than no early risk patients. Moreover, each risk group had different anteroposterior density gradients for granule cells and hilar cells. These differences in cell distribution may arise from different patterns of cell loss or cell migration in the dentate gyrus during development. In the early‐risk group, there was also a distinction between patients with a history of febrile convulsions without CNS infection and patients with a history of meningitis or encephalitis. These two subgroups had similar numbers of granule cells. However, the meningitis/encephalitis subgroup exhibited a wider granule cell layer, suggesting that the granule cell layer was more dispersed. Our results support the hypothesis of a predominantly anterior hippocampal insult in temporal lobe epilepsy (TLE). In nonepileptic hippocampus, the ratio of putatively excitatory granule neurons to putatively inhibitory hilar neurons is highest in the anterior hippocampus. This ratio may explain in part why the anterior hippocampus is more prone to cell loss and seizures.
Relation Between Intracarotid Amobarbital Memory Asymmetry Scores and Hippocampal Sclerosis in Patients Undergoing Anterior Temporal Lobe Resections
Authors: Davies Keith G. , Hermann Bruce P. , Foley Kevin T.
Published: August 2005

Summary: The intracarotid amobarbital procedure (IAP) is used to evaluate memory function preoperatively in candidates for anterior temporal lobe resections (ATL). We examined IAP memory asymmetry scores in 30 patients undergoing ATL (17 R, 13 L), as a function of the presence (HS+) or absence (HS−) of hippocampal sclerosis. Ictal onset zones were determined by extraoperative recording with subdural strip electrodes in all but 3 patients in whom magnetic resonance imaging (MRI) scan showed HS. MRI scans were otherwise normal. All patients were left hemisphere dominant for language except 1, in whom language was represented bilaterally. IAP memory testing involved presentation of eight subjects during anesthesia of each hemisphere, followed by recognition testing after patients recovered from amobarbital effects. A score of 1 was given for each correctly recognized object, and 0.5 was deducted for each false‐positive identification. There were 16 foils. A total asymmetry score was calculated, which was positive if there was agreement between the direction of the symmetry and side of operation and negative if reversed. The mean asymmetry score for HS‐ (n = 8) was 0.9; that for HS+ (n = 22) was 4.1 (p < 0.01). IAP memory performance provided lateralizing information (asymmetry score 2 + or −2) in 73% of cases; among these, the lateralization was correct in 91%. Our data indicate that IAP memory asymmetry predicts both laterality of ictal onset and the presence of HS.
Concentration‐Effect and Concentration‐Toxicity Relations with Lamotrigine: A Prospective Study
Authors: Kilpatrick E. S. , Forrest G. , Brodie Martin J.
Published: August 2005

Summary: This prospective study was designed to ascertain whether measurement of lamotrigine (LTG) concentrations in the epilepsy clinic could be used to predict the onset of complete seizure control or the emergence of adverse effects. LTG was initiated in doses of 25 or 50 mg daily in 69 patients with newly diagnosed or poorly controlled epilepsy and was increased monthly in 50–mg increments until the patient became seizure‐free for at least 6 months or developed adverse effects that abated after a reduction in dosage. LTG and other antiepileptic drug (AED) concentrations were measured at each clinic visit but were not supplied to the investigator examining the patients. Overall, 19 patients either withdrew due to lack of efficacy or defaulted from the clinic. Of the remaining 50 patients, 32 (19 monotherapy, 13 polytherapy) became seizure‐free at widely varying daily LTG doses (median 200 mg, range 25–850 mg) and concentrations (median 3.8 mg/L, range 1.4–18.7 mg/L). Likewise, the 18 patients (5 monotherapy, 13 polytherapy) who experienced intolerable side effects showed substantial variations in daily LTG doses (median 300 mg, range 100–900 mg) and concentrations (median 4.0 mg/L, range 0.4–18.5 mg/L). No useful concentration‐effect or concentration‐toxicity relation with LTG could be demonstrated in this study; therefore, we believe that routine therapeutic drug monitoring with this new AED is not currently indicated.
Routine EEG and Temporal Lobe Epilepsy: Relation to Long‐Term EEG Monitoring, Quantitative MRI, and Operative Outcome
Authors: Cascino Gregory D. , Trenerry Max R. , So Elson L. , Sharbrough Frank W. , Shin Cheolsu , Lagerlund Terrence D. , Zupanc Mary L. , Jack Clifford R.
Published: August 2005

Summary: Purpose: To investigate the relation among routine EEG, long‐term EEG monitoring (LTM), quantitative magnetic resonance imaging (MRI), and surgical outcome in temporal lobe epilepsy (TLE).

Methods: We evaluated 159 patients with intractable TLE who underwent an anterior temporal lobectomy between 1988 and 1993. The epileptogenic temporal lobe was determined by ictal LTM. A single awake‐sleep outpatient EEG with standard activating procedures was performed before LTM. EEGs were analyzed by a blinded investigator.

Results: MRI scans showed unilateral medial temporal atrophy (109 patients) or symmetrical hippocampal volumes (50 patients). The surgically excised epileptogenic brain tissue revealed mesial temporal sclerosis, gliosis, or no histopathologic alteration. Routine EEG revealed temporal lobe epileptiform discharges in 123 patients. Routine EEG findings correlated with the temporal lobe of seizure origin (p < 0.0001) and the results of MRI volumetric studies (p < 0.0001). Interictal epileptiform discharges were seen only during LTM in 24 patients. Routine EEG was disconcordant with interictal LTM in another 20 patients. MRI‐identifed unilateral medial temporal lobe atrophy was a strong predictor of operative success (p < 0.0001). There was no significant relation between the routine EEG findings and operative outcome (p > 0.20).

Conclusions: Results of this study modified our approach in patients with TLE. Interictal epileptiform discharges localized to one temporal lobe on serial routine EEGs or during LTM may be adequate to identify the epileptogenic zone in patients with MRI‐identified unilateral medial temporal lobe atrophy.
Paroxysmal Staring and Masticatory Automatisms During Postural Hypotension in a Patient with Multiple System Atrophy
Authors: Iani Cesare , Attanasio Antonio , Manfredi Mario
Published: August 2005

Summary: Purpose: We studied a 51‐year‐old man with multiple system atrophy and autonomic insufficiency. He had repeated episodes of loss of contact, staring, and masticatory automatisms.

Methods: Blood pressure during these events documented a systolic pressure of 60 mm Hg. Cardiovascular reflex tests provided evidence of autonomic failure. Head computed tomography (CT) revealed moderate, diffuse cortical and cerebellar atrophy.

Results: These events were strictly related to blood pressure decreases and could be reproduced consistently by having the patient sit up after a meal. Ictal polygraphic recordings showed EEG changes consistent with anoxia, preceded by sudden hypotension with fixed heart rate.

Conclusions: Cerebral anoxia during a syncopal attack may therefore precipitate transient, sudden neurologic dysfunction that closely mimics complex partial seizures. Masticatory automatisms may represent a release phenomenon resulting from inactivation of neocortical structures by cerebral anoxia or reticular disconnection.
Partial Epileptic Seizures of Different Origin Variably Affect Cardiac Rhythm
Authors: Galimberti Carlo Andrea , Marchioni Enrico , Barzizza Franco , Manni Raffaele , Sartori Ivana , Tartara Amelia
Published: August 2005

Summary: Purpose: The present study was aimed at evaluating electrocardiographic (ECG) changes associated with partial epileptic seizures without seizure activity secondarily generalized.

Methods: We assessed heart rate (HR) changes occurring during 100 partial epileptic seizures, as recorded by ambulatory EEG‐ECG in 50 outpatients. Consecutive R‐R intervals were measured for the 30 s immediately preceding the onset and for the first 10‐s period of discharge. In addition, HR was sampled at 10‐s intervals during EEG paroxysmal discharge and for 1 min after the end of discharge.

Results: The highest and lowest respective HR peaks achieved during these seizures were 186 and 44 beats/min. Analysis of the R‐R intervals during the first 10‐s period of EEG discharge showed a significant early HR increase in 49% of the seizures; the corresponding figure for an early HR reduction was 25.5%. Eighty percent of the seizures showing an early HR decrease were of temporal lobe origin. No severe cardiac arrhythmias were noted during the seizures.

Conclusions: Our data suggest that an early HR decrease is more probable in temporal lobe seizures than in seizures of other origin. An accurate HR measurement, focused on discharge onset, may provide both a reliable way of evaluating the possible effect of partial seizures on HR and valuable information about the cerebral sites involved in the control of cardiac rhythm.
Double‐Blind, Placebo‐Controlled Trial of Topiramate (600 mg Daily) for the Treatment of Refractory Partial Epilepsy
Authors: Tassinari C. A. , Michelucci R. , Chauvel P. , Chodkiewicz J. , Shorvon S. , Henriksen O. , Dam M. , Reife R. , Pledger G. , Karim R.
Published: August 2005

Summary: Purpose: We wished to evaluate adjunctive therapy for partial‐onset seizures with topiramate (TPM) for efficacy and safety in a double‐blind, placebo‐controlled, randomized, parallel‐group study.

Methods: Sixty outpatients with epilepsy (47 men and 13 women, mean age 32.9 years) were studied. All had a documented history of partial‐onset seizures with or without secondarily generalized seizures. After an 8‐week baseline during which patients had at least one seizure per week, 30 patients each were randomized to TPM 300 mg twice daily (b.i.d.) or placebo for 12 weeks.

Results: TPM was significantly superior to placebo, as indicated by all efficacy assessments: greater median percent reduction from baseline in the average monthly seizure rate (46 vs. ‐12%, p = 0.004); greater number of treatment responders (patients with 50% reduction in seizure rate) (47 vs. 10%, p = 0.001), and better investigator (p = 0.002) and patient (p = 0.010) global assessments of treatment. Among TPM‐treated patients, the most commonly reported adverse events (AE) were headache, somnolence, fatigue, dizziness, and abnormal thinking. Most AE were mild or moderate in severity.

Conclusions: The results of the present trial indicate that TPM 600 mgiday is effective in the treatment of refractory partial‐onset seizures with or without secondarily generalized seizures.
Steady‐State Pharmacokinetics of Topiramate and Carbamazepine in Patients with Epilepsy During Monotherapy and Concomitant Therapy
Authors: Sachdeo Rajesh C. , Sachdeo S. K. , Walker S. A. , Kramer L. D. , Nayak R. K. , Doose D. R.
Published: August 2005

Summary: Purpose: We studied the steady‐state pharmacokinetic profile of topiramate (TPM) as a function of dose and the effects of comedication with carbamazepine (CBZ).

Methods: We enrolled 12 patients with partial epilepsy receiving chronic stable doses of CBZ 300–800 mg every 8 h. In a 6‐week period, TPM was added and doses were increased at ‐2‐week intervals from 100 to 200 to 400 mg every 12 h and stabilized at the highest tolerated dose to as high as 400 mg every 12 h. CBZ was tapered in the next 4 weeks when possible, and TPM was maintained as monotherapy at the highest stabilized dose for 2 more weeks. Plasma and urine samples were collected before TPM dosing, after each TPM dose increase, and during TPM monotherapy.

Results: Dose‐normalized results (n = 10) for TPM area under the curve from 0 to 12 h (AUC(0–12)), Cmin(0), and Cavg indicated that TPM exhibits linear plasma pharmacokinetics over the dose range of 100‐ to 400‐mg every 12 h when administered with CBZ. Mean TPM AUC(0–12)) Cmax, Cmin(0), and Cavg values were ‐40% lower during CBZ treatment as compared with those during TPM monotherapy (n = 3). TPM oral and nonrenal clearance rates were approximately two‐ to threefold higher, whereas TPM renal clearance was unchanged during concomitant CBZ treatment (n = 3). There were no significant changes in total and unbound CBZ and CBZ‐epoxide (CBZ‐E) pharmacokinetics during TPM administration (n = 10). TPM pharmacokinetics during concomitant CBZ treatment were significantly different from those during TPM monotherapy, suggesting that metabolic clearance of TPM increases when CBZ is coadministered.

Conclusions: When CBZ is reduced or discontinued, TPM doses may need to be lowered to maintain equivalent plasma concentrations. Adjusting the CBZ dose for pharmacokinetic reasons when TPM is administered as adjunctive treatment does not appear to be necessary.
Prevalence, Classification, and Severity of Epilepsy and Epileptic Syndromes in Children
Authors: Eriksson K. J. , Koivikko M. J.
Published: August 2005

Summary:Purpose:To determine the point prevalence of active childhood epilepsy in a defined area and evaluate the usefulness of ILAE classification of seizures, and epilepsies/syndromes with special interest in severe epilepsies.

Methods:By using the latest ILAE International Classification of Epileptic Seizures (ICES, 1981) and Epilepsies and Epileptic Syndromes (ICE, 1989), we determined the age‐ and sex‐specific prevalence rates of epilepsy, type of seizures, epilepsies, and recognizable epileptic syndromes, as well as the proportion of severe cases in each seizure/epilepsy/syndrome category in all children 0–15 years of age from a geographically defined area in Finland. All medical records, neurophysiological recordings and available clinical data were reviewed retrospectively.

Results:Point prevalence of active epilepsy on December 12, 1992 was 3.94 per 1,000. According to ICESDCE, we were able to classify 96% of seizures and 90% of epilepsies and syndromes. Generalized seizure and epilepsy/syndrome types were more prevalent in children 0–6 years of age and partial/ localization‐related in children 6–15 years of age. Epilepsy was intractable in 17% of all cases and correlated significantly with symptomatic etiology and early onset of epilepsy, as well as with additional neuroimpairments.

Conclusions:A considerable number of cases fell into the nonspecific categories of ICE, which limits the value of present epilepsy/syndrome classification in terms of prognosis, prediction, and indication for special investigations in individual cases. A number of intractable cases was relatively low, indicating good prognosis in many childhood epilepsies, especially when additional neuroimpairments are absent.
Prevalence and Descriptive Epidemiology of Lennox‐Gastaut Syndrome Among Atlanta Children
Authors: Trevathan Edwin , Murphy Catherine C. , Yeargin‐Allsopp Marshalyn
Published: August 2005

Summary: Purpose: To determine the prevalence and descriptive epidemiology of Lennox‐Gastaut Syndrome (LGS) among metropolitan Atlanta children.

Methods: We conducted a population‐based study of LGS as part of the Metropolitan Atlanta Developmental Disabilities Study (MADDS) using a multiple‐source surveillance system for epilepsy and developmental disabilities. Children were defined as having LGS if they had onset of multiple seizure types before age 11 years, with at least one seizure type resulting in falls, and an EEG demonstrating slow spike‐wave complexes (<2.5 Hz). Mental retardation (MR) was not used as a diagnostic criterion.

Results: The lifetime prevalence of LGS at age 10 years was 26/1,000. Ninety‐one percent of those with LGS had MR (IQ <= 70), and 39% had a history of infantile spasms (IS). A comparison of children with LGS and those with multiple seizure types without slow spike‐wave complexes demonstrated that those with LGS were more likely to have MR, history of IS, and multiple disabilities (MR, cerebral palsy, blindness, hearing impairment). Seventeen percent of all children in Atlanta with profound MR (IQ < 20) had LGS.

Conclusions: LGS accounts for only 4% of all childhood epilepsy, yet is a significant contributor to childhood morbidity.
Pre‐ and Postoperative Socioeconomic Development of 151 Patients with Focal Epilepsies
Authors: Lendt Michael , Helmstaedter Christoph , Elger Christian Erich
Published: August 2005

Summary: Purpose: We evaluated retrospectively the socio‐economic development of epilepsy patients after temporal or extratemporal epilepsy surgery and analyzed the relationship to clinical and neuropsychological data.

Methods: 151 patients (from ages 11–65 years; mean postoperative followup: 3 years) replied to a structured questionnaire, which referred to objective data of the patient's educational and vocational development. Neuropsychological data were obtained from pre‐ and postoperative (1–year follow‐up) examinations.

Results: The preoperative development data indicated that patients exposed to epilepsy at any delopmental stage had a higher prevalence of educational/vocational difficulties as compared with patients with a later onset of epilespy. Postopera‐tively, the integration of the formerly unemployed improved and the unemployment rate decreased from 33 to 16%. Out of those patients who had been schooled or who were employed, 79%‐91% made progress in development, or were at least able to keep their status. Only 2 of 14 patients, who had been retired early because of their epilepsy, returned to employment. In general, a deterioration of the socioeconomic status was significantly related to insufficient seizure control. A reemploy‐ment of patients who were formerly unemployed depended mainly on age and neuropsychological outcome.

Conclusions: Our results suggest that early and successful surgical intervention improves or at least maintains the socio‐economic situation, especially the employment status.
ILAE Neuroimaging Commission Recommendations for Neuroimaging of Patients with Epilepsy ILAE Neuroimaging Commission
Authors:   ILAE Neuroimaging Commission
Published: August 2005

These guidelines are intended to apply to patients with a clear diagnosis of epilepsy. They have been specifically formulated for the management of newly diagnosed patients and those with chronic epilepsy who have not been fully evaluated, and are not designed for the full investigation of patients for possible surgical treatment. Therefore, these recommendations are dedicated to computed tomography (CT) and magnetic resonance imaging (MRI) but not to functional imaging techniques.
Evolution of Epilepsy and EEG Findings in Angelman Syndrome
Authors: Laan Laura A. E. M. , Renier Willy O. , Arts Willem Frans M. , Buntinx Inge M. , Burgt Ineke J. A. M. v.d. , Stroink Hans , Beuten Joke , Zwinderman Koos H. , van Dijk J. Gert , Brouwer Oebele F.
Published: August 2005

Summary: Purpose: To evaluate the evolution of epileptic seizures and EEG features in a large group of patients with Angelman syndrome (AS).

Methods: Thirty‐six patients with AS with a proven chromosome 15qll–13 deletion were retrospectively analyzed with regard to their epilepsy and EEG findings by examination of patient files and EEGs. All EEGs were reviewed by one of the authors. A logistic regression model, with a follow‐up from 1 to 39 years (mean, 15 years), was used for statistical analysis.

Results: Epileptic seizures had occurred in 30 (83%) patients. In 43% of them, the initial symptoms of epilepsy were febrile convulsions in infancy. In childhood, epilepsy could start with almost any type of seizure. Atypical absences and myoclonic seizures prevailed in adulthood. Epileptic seizures were present in 92% of the adult patients. The most typical EEG findings were rhythmic triphasic delta waves of high amplitude with a maximum over the frontal regions, identified in 99 (66%) of 150 EEGs, and continuously or intermittently, in 30 (83%) of 36 patients with AS. In 47% it was present even before a clinical diagnosis of AS was considered. High‐amplitude rhythmic 4–6/s slow activity, seen in 44 (29%) of 150 EEGs, was not present after the age of 12 years.

Conclusions: In contrast to previous reports suggesting a decreasing frequency of epileptic seizures with age, we found that 92% of the adult patients with AS continued to have epileptic seizures. The most typical EEG finding in AS, in both children and adults, was the presence of frontal triphasic delta waves. In mentally retarded patients, this EEG pattern should point the physician in the direction of AS.
Musicogenic Epilepsy: Review of the Literature and Case Report with Ictal Single Photon Emission Computed Tomography
Authors: Wieser Heinz Gregor , Hungerböhler Hansjörg , Siegel Adrian M. , Buck Alfred
Published: August 2005

Summary: Purpose: We report a case of musicogenic epilepsy with ictal single photon emission computed tomography (SPECT) study and discuss the findings of this patient in the context of 76 cases with musicogenic epilepsy described in the literature and seven other cases followed in Zurich.

Methods: We analyzed the 83 patients according to the precipitating musical factors, type of epilepsy, presumed localization of seizure onset, and demographic data.

Results: Fourteen of 83 patients (17%) had seizures triggered exclusively by music. At time of examination, music was the only known precipitating stimulus in 65 of 83 patients (78%). Various characteristics of the musical stimulus were significant, e.g., musical category, familiarity, and instruments.

Conclusions: Musicogenic epilepsy is a particular form of epilepsy with a strong correlation to the temporal lobe and a right‐sided preponderance. A high musical standard might predispose for musicogenic epilepsy. Moreover, the majority of cases do not fall into the category of a strictly defined “reflex epilepsy”, but appear to depend on the indermediary of a certain emotional reaction mediated through limbic mesial temporal lobe structures.
Patient‐Validated Content of Epilepsy‐Specific Quality‐of‐Life Measurement
Authors: Gilliam Frank , Kuzniecky Ruben , Faught Edward , Black Lorie , Carpenter Gordon , Schrodt Rita
Published: August 2005

Summary: Purpose: To study the effects of epilepsy from the patients’perspective and assist determination of content validity of health‐related quality‐of‐life (HRQOL) measures.

Methods: We asked 81 consecutive patients with moderately severe epilepsy to list in order of importance their concerns of living with recurrent seizures. To minimize investigator bias, patients completed the procedure in a private setting without staff involvement.

Results: Twenty‐four distinct domains were generated by the patients. Concerns about driving (64%), independence (54%), employment (51%), social embarrassment (36%), medication dependence (33%), mood/stress (32%), and safety (31%) each were listed by >30% of patients. Driving was listed as the most important concern by 28% of patients, followed by employment (21%), independence (9%), safety (6%), antiepileptic‐drug side effects (5%), seizure unpredictability (5%), and seizure aversion (5%).

Conclusions: The effect of epilepsy on HRQOL is not vague or obscure from the patients’perspective but is defined by a limited number of domains. Independence is an important concern that may not be evaluated adequately by currently available HRQOL instruments.
Effect of Topiramate on the Pharmacokinetics of an Oral Contraceptive Containing Norethindrone and Ethinyl Estradiol in Patients with Epilepsy
Authors: Rosenfeld William E. , Doose Dennis R. , Walker Sally A. , Nayak R. K.
Published: August 2005

Summary: Purpose: Because enzyme‐inducing antiepileptic drugs (AEDs) can affect pharmacokinetics of oral contraceptives and thereby cause contraceptive failure, the potential effect of topiramate, a new AED, on the pharmacokinetics of the combination oral contraceptive norethindrone/ethinyl estradiol was evaluated.

Methods: Twelve women receiving stable valproic acid (VPA) monotherapy for epilepsy received a combination norethindrone 1.0 mg/ethinyl estradiol 35‐μg tablet daily for 21 days followed by seven daily doses of inert tablets for four 28‐day cycles. After a baseline cycle (cycle 1), topiramate 100, 200f and 400 mg every 12 h was administered in cycles 2 through 4, respectively. Serial blood samples were obtained on day 20 of each cycle and were analyzed for norethindrone, ethinyl estradiol, and progesterone by using validated radioimmunoassay methods.

Results: Compared with cycle 1, none of the norethindrone pharmacokinetic parameters changed significantly in the presence of topiramate, 100–400 mg every 12 h. Individual patient serum progesterone concentrations measured during each cycle were at or close to the limit of quantification with no apparent differences among cycles. However, mean area under the concentration‐versus‐time curve over the 24‐h period (AUC0–24) values for ethinyl estradiol were 18–30% lower in cycles 2 through 4 compared with cycle 1 (p 0.05 for all pairs), whereas mean oral serum clearance (CL/F) values were 14.7–33.0% higher (p 0.05 for cycles 2 and 4 vs. cycle 1). Mean time of peak concentration (Tmax values determined during topiramate therapy were not significantly different from those at baseline.

Conclusions: When prescribing an oral contraceptive for patients receiving topiramate, clinicians should consider initial therapy with an agent containing 235 μg of ethinyl estradiol.
Alteration of Cardiac Function in Patients with Temporal Lobe Epilepsy: Different Roles of EEG‐ECG Monitoring and Spectral Analysis of RR Variability
Authors: Massetani Roberto , Strata Giancarlo , Galli Renato , Gori Sara , Gneri Carlo , Limbruno Ugo , Di Santo Domenica , Mariani Mario , Murri Luigi
Published: August 2005

Summary: Purpose: Because several reports have described the relation between epilepsy and cardiac arrhythmias and suggest that changes in autonomic neural control of the heart could be involved in the pathogenesis of sudden unexplained death in patients with epilepsy, the aim of this study was to evaluate cardiac function in patients with temporal lobe epilepsy.

Methods: Sixty‐five patients with epilepsy were evaluated by simultaneous ambulatory 24‐h EEG‐ECG monitoring, and in 30 of these, power spectral analysis of relative‐risk (RR) variability also was carried out, both in the supine position and in a passive tilt position at 60°. The power spectrum of RR variability, the two major spectral components detectable at low frequency (LF) and at high frequency (HF), respectively, and the LF/HF ratio were calculated.

Results: By EEG‐ECG monitoring, we recorded six partial seizures, and in four cases, discharges were associated with sinus tachycardia. However, interictally the occurrence of ventricular and supraventricular arrhythmias was not different from that in normal subjects. The spectral analysis of RR variability, on the other hand, demonstrated in patients with epilepsy a significant decrease in the total RR variability and in both of its components (LF and HF) in the supine position, and of the LF/HF ratio in orthostatic position.

Conclusions: These findings suggest that the spectral analysis of RR variability may detect disorders of autonomic cardiac control in patients with epilepsy, even in the absence of abnormal findings during ECG monitoring. This alteration, which is more severe in cases with right EEG focus, could play a role in the pathogenesis of cardiac arrhythmias.
Reproductive Activity and Offspring Health of Young Adults with Childhood‐Onset Epilepsy: A Controlled Study
Authors: Jalava Merja , Sillanpää Matti
Published: August 2005

Summary: Purpose: To study reproductive activity and offspring health in a prospective follow‐up setting.

Methods: After a 35‐year follow‐up of a population‐based patient cohort with childhood‐onset “epilepsy only”, 100 (56.8%) of 176 surviving patients were shown to have “epilepsy only”, i.e., recurrent unprovoked seizures with no associated neuroimpairment. Their reproductivity and offspring health were compared with those of matched controls.

Results: The marriage rate and fertility of patients with “epilepsy only” were significantly reduced as compared with those of matched controls. Continuation of antiepileptic drug (AED) treatment was significantly associated with reduced reproduction, whereas occurrence of seizures during the previous 5 years was not. The incidence of epilepsy was nine times greater among the children of patients than among those of controls. No higher risks were observed in pregnancy or delivery in patients, nor were increased rates of birth defects in their offspring than in those of contols. Exposure to AEDs during pregnancy did not increase these risks.

Conclusions: Patients with “epilepsy only” since childhood have fewer marriages and fewer children than expected. However, when they marry, their pregnancies and deliveries are unremarkable and their children do not have increased congenital health problems. Obviously, etiologies causative of both epilepsy and associated neurological impairments are more harmful to the course of pregnancy and delivery and offspring health than are those resulting in “epilepsy only”.
Early Discontinuation of Treatment in Children with Uncomplicated Epilepsy: A Prospective Study with a Model for Prediction of Outcome
Authors: Braathen Gunnar , Melander Hans
Published: August 2005

Summary: Purpose: The main purpose of the present study was to identify predictor variables with significant influence on seizure outcome after discontinuation of treatment in children with uncomplicated epilepsy and to analyze whether these variables, included in a prognostic model could identify children in whom 1‐year treatment would be sufficient.

Methods: Before initiation of treatment in children aged 2–16 years with uncomplicated epilepsy, the duration of treatment was randomized to 1 year (group I) or 3 years (group II). At the end of the allotted period, treatment was discontinued in 161 children who had been seizure free during the previous 6 months. The mean follow‐up period after treatment was 5.8 years. Twenty‐three predictor variables were analyzed by survival methods regarding their influences on the outcome.

Results: At the latest follow‐up check, 60 children (37%) had relapsed. The following predictor variables were selected by multiple regression analysis and constituted a model with a simple scoring system: age at seizure onset; seizure type; generalized, irregular spike‐wave activity on EEG after 1 year of treatment; and persistent 3‐Hz spike‐wave activity after 6 months of treatment in children with absence epilepsy. In group I, the remission rate was 73% in children with high prognostic scores, 10% in children with low scores, and 40% in those with intermediate scores (log‐rank test, p = 0.0001).

Conclusions: After 1 year of treatment, our prognostic model identified children in whom treatment could be withdrawn at that time. Our model should be easily applicable in clinical practices and may be of clinical importance in determining the duration of treatment in children with uncomplicated epilepsy.
The Diagnostic Yield of a Second EEG After Partial Sleep Deprivation: A Prospective Study in Children with Newly Diagnosed Seizures
Authors: Carpay J. A. , de Weerd A. W. , Schimsheimer R. J. , Stroink H. , Brouwer O. F. , Peters A. C. B. , van Donselaar C. A. , Geerts A. T. , Arts W. F. M.
Published: August 2005

Summary: Purpose: To assess the diagnostic yield of a repeated EEG (REPEEG) after partial sleep deprivation (SD) in children and adolescents with one or more seizures who previously had had a standard EEG (STDEEG) without epileptiform abnormalities (EAs). In the literature, 32–75% of such REPEEGs after SD were reported to show EA.

Methods: In a prospective, multicentred study, we selected children aged 1 month to 16 years with one or more idiopathic or remote symptomatic newly diagnosed seizures. A REPEEG was recorded in children without EAs in their STDEEG.

Results: Of 552 children and adolescents who entered the study, 243 (44%) had a STDEEG without EAs. In 177 (73% of eligible children), REPEEGs were recorded after SD. We found EAs in 61 (34.5%) REPEEGs and new nonepileptiform abnormalities in five (1%). In 552 children in the total cohort, the REPEEG thus added 11% with EAs to the 56% with EAs in the STDEEG. Of REPEEGs, 81% included sleep compared with 20% of STDEEGs. In about half the REPEEGs, EAs occurred during sleep only. One child had tonic‐clonic seizures probably related to the SD.

Conclusions: One third of REPEEGs yielded new diagnostic information. Partial, age‐dependent SD was highly effective in inducing sleep, which is important because in many cases EAs were found only during EEG recording in sleep. The procedure was safe and convenient.
Neuronal Generators of Visual Evoked Potentials in Humans: Visual Processing in the Human Cortex
Authors: Arroyo Santiago , Lesser Ronald P. , Poon Wai‐Tat , Robert W. , Webber S. , Gordon Barry
Published: August 2005

Summary: Purpose: We wished to define the localization of cortical generators of visual (pattern) evoked potentials (VEP) and the temporal sequence of activation in the occipital region.

Methods: In 4 candidates for epilepsy surgery, a large array of subdural electrodes was placed over occipital areas. Checkerboard pattern reversal stimuli were generated and the epileptogenic focus was localized and functionally mapped. Magnetic resonance imaging did not show any occipital lesions in any of the 4 patients.

Results: The area first activated was the lingual gyrus in the mesial occipital lobe (negative potential peaks at ∼70 ms), followed by an area superior to the calcarine fissure (negative peaks at ∼80 ms). Later (starting at ∼90 ms), there were positive potentials over the occipital pole and lingual gyrus, followed by potentials at the lateral occipital lobe.

Conclusions: These data support the idea that VEP are generated in the mesial and lateral occipital cortex by different circumscribed neuronal generators with different latencies of activation. The scalp‐recorded N1 and P1 potential peaks most likely derive from the progressive activation of neuronal masses in different regions of the occipital lobe.