bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors Distinguishing Families of Patients with Psychogenic Seizures from Families of Patients with Epilepsy
Authors: Wood Beatrice L. , McDaniel Susan , Burchfiel Kendra , Erba† Giuseppe
Published: August 2005

Summary: Purpose: Psychogenic seizures (PS) (emotionally based nonelectrical seizures) have been explained by psychodynamics and trauma. However, the family health literature suggests that somatization, of which psychogenic seizures are a form, may run in families and be determined by family patterns of response to distress. This study compared families of patients with PS and those of patients with epilepsy on variables of distress (anxiety and depression) and somatization.

Methods: Eighteen patients (9 with PS and 9 with epilepsy) matched for age and education, and their families answered the Health Status Questionnaire (HSQ), the Weinberger Adjustment Inventory (WAI), the Family Emotional Involvement and Criticism Scale (FEICS), Barsky's Somatization Symptom Inventory (SS), and the Dissociation Experience Scale (DES). Family members' scores were averaged to obtain “family scores.”

Results: Patients with PS and those with epilepsy did not differ in any of the measures. However, families of patients with PS reported more health problems, distress, and criticism than did families of patients with epilepsy (p < 0.05). Families of patients with PS had increased criticism and somatic problem scores comparable to those of both types of patients.

Conclusions: Although epilepsy causes patients physical and emotional problems, their families are relatively healthy. In contrast, families of patients with PS are more troubled and may unwittingly contribute to PS through family distress, criticism, and tendencies to somatize.
The Demand for Hospital Services for Patients with Epilepsy
Authors: Currie Craig J. , Morgan Christopher LI. , Peters John R. , Kerr Michael
Published: August 2005

Summary: Purpose: To describe the patterns of inpatient and outpatient hospital care for patients with epilepsy in our health district.

Methods: Routine hospital data for the health district of South Glamorgan (population 408,000) underwent record linkage to identify those records relating to the same patients and to flag those records for patients with epilepsy. This data was analyzed to determine inpatient and outpatient activity by specialty and compared with the nonepileptic population.

Results: We identified 2,267 patients representing a prevalence of 0.56%. The average age was 46 years in both male and female patients. This group, which constituted 1.5% of the hospital population, was responsible for 2.8% of all admissions but, because of increased length of stay, utilized 7.3% of all bed days. The total cost of care for this group lies between these two extreme values and is dependent on case seventy. The patterns of associated diagnoses differed considerably in three arbitrary age groups (0–18, 19–55, >55 years).

Conclusions: This study quantifies for the first time the level of demand that this subpopulation places on the service as a whole, and begins to illustrate that there may be evidence for cost containment by, for example, a reduction in multiple admissions. The demand for inpatient services is greater than we would have predicted.
Fixation‐Off (Scoto) Sensitivity Combined with Photosensitivity
Authors: Agathonikou A. , Koutroumanidis M. , Panayiotopoulos C. P.
Published: August 2005

Summary: A 16‐year‐old boy of normal intelligence had brief absence and myoclonic jerks since age 7 years. Video‐EEG documented the unexpected combination of fixation‐off sensitivity (scotosensitivity) with photosensitivity.
Phenytoin Blocks the Reversal of a Classically Conditioned Discriminative Eyeblink Response in Rabbits
Authors: Churchill James D. , Voss Steven E. , Miller Daniel P. , Steinmetz Joseph E. , Garraghty Preston E.
Published: August 2005

Summary: Purpose: Cognitive deficits associated with chronic treatment with phenytoin (PHT) have been reported. PHT blocks transfer from a signaled appetitive bar press to an active avoidance response in rats. We investigated the effects of PHT and the prodrug fosphenytoin in rabbits required to learn a discrimination and reversal of a classical eyeblink conditioning paradigm.

Methods: Before drug treatment was started, rabbits were trained to produce a discriminated eyeblink response. PHT (n = 7) was administered centrally or the prodrug fosphenytoin (n = 2) was given systemically. Control animals were similarly treated centrally with either saline (n = 3) or no drug treatment (n = 13). Rabbits were then challenged with a stimulus reversal while being maintained on the respective drug.

Results: On the first day of reversal training, control animals typically displayed high response rates to both tones, followed by a reduction in responsiveness to the new conditioned stimulus (CS‐) in the ensuing days. In contrast, PHT‐treated animals failed to suppress responsiveness to the new CS‐.

Conclusions: The response patterns observed are similar to those observed in rabbits with hippocampal ablations, leading us to suggest that the adverse effects of phenytoin may be due to actions in the hippocampus.
Neuronal Complexity Loss in Interictal EEG Recorded with Foramen Ovale Electrodes Predicts Side of Primary Epileptogenic Area in Temporal Lobe Epilepsy: A Replication Study
Authors: Weber B. , Lehnertz K. , Elger C. E. , Wieser H. G.
Published: August 2005

Summary: Purpose: To investigate whether a correct lateralization of the primary epileptogenic area by means of neuronal complexity loss analysis can be obtained from interictal EEG recordings using semi‐invasive foramen ovale electrodes. In a previous study with recordings from intrahippocampal depth and subdural strip electrodes it was shown that the dynamics of the primary epileptogenic area can be characterized by an increased loss of neuronal complexity in patients with unilateral temporal lobe epilepsy (TLE).

Methods: Neuronal complexity loss analysis was applied. This analysis method is derived from the theory of nonlinear dynamics and provides a topological diagnosis even in cases where no actual seizure activity can be recorded. We examined interictal EEG recorded intracranially from multipolar foramen ovale electrodes in 19 patients with unilateral TLE undergoing presurgical evaluation.

Results: The primary epileptogenic area was correctly lateralized in 16 of the 19 investigated patients. The misclassification of the side of seizure onset in three patients might be attributed to the larger distance between the foramen ovale electrodes and the mesial temporal structures as compared to intrahippocampal depth electrodes.

Conclusions: Our results confirm the previous findings and provide further evidence for the usefulness of nonlinear time‐series analysis for the characterization of the spatiotemporal dynamics of the primary epileptogenic area in mesial temporal lobe epilepsy.
Cortical Excitability in Patients After Loading Doses of Lamotrigine: A Study with Magnetic Brain Stimulation
Authors: Manganotti P. , Bongiovanni L. G. , Zanette G. , Turazzini M. , Fiaschi A.
Published: August 2005

Summary: Purpose: Transcranial magnetic stimulation (TMS) of the brain allows the pharmacologic effects of anti‐convulsant drugs (AEDs) on the excitability of motor cortico‐spinal pathways to be evaluated in patients with epilepsy and normal subjects. However, no study has yet documented the changes in motor excitability in patients treated with lamotrigine (LTG). We aimed to study the effects of loading doses of LTG on TMS recordings in patients with epilepsy at the beginning of their treatment.

Methods: We investigated single‐pulse TMS in six patients with complex partial seizures. The TMS recordings were performed in five sessions before and during 5 weeks of treatment. Motor threshold, motor‐evoked potential (MEP) amplitude, cortical silent period, and peripheral conduction velocity were used as parameters of evaluation. LTG was started with a dosage of 25 mg/day until a daily maintenance dosage of 200 mg/day was reached.

Results: The motor threshold activation of thenar muscles was significantly increased by LTG after 2 weeks of treatment and was increased in a parallel way to the loading dose of the drug at week 3 and 5 of treatment. The MEP size recorded from the thenar muscles did not show significant changes at high‐ or low‐intensity stimulation. The cortical silent period remained unchanged at low‐ and high‐intensity stimulation. The absolute latency of MEPs after cortical and cervical stimulation was unchanged, as was the central motor conduction time.

Conclusions: Our study documents that loading doses of LTG, administered as monotherapy, progressively increases patients' motor thresholds over short periods.
Extremely Acute Phenytoin‐Induced Peripheral Neuropathy
Authors: Yoshikawa Hideto , Abe Tokinari , Oda Yoshihiko
Published: August 2005

Summary: Purpose: Peripheral neuropathy is a rare adverse effect associated with phenytoin (PHT), and it usually occurs after the prolonged use of PHT. Acute PHT‐induced peripheral neuropathy is extremely rare.

Methods: An 18‐year‐old girl was admitted for the control of epilepsy. Just a few hours after the administration of PHT, she complained of distal lower‐extremity paresthesia in a stocking distribution and motor weakness: the Achilles tendon reflex was absent.

Results: Electrophysiological studies revealed slightly reduced sensory‐conduction velocity and mild prolongation of distal latency in the lower extremities. After the discontinuation of PHT, these symptoms disappeared gradually, and sensory‐conduction velocity and distal latency became normal.

Conclusions: Although it has been reported that peripheral neuropathy occurred after treatment with PHT for a week, there has been no report of a patient such as ours, who developed peripheral neuropathy just a few hours after the initial administration of PHT. The underlying mechanism remains unknown; however, we should pay attention to such extremely acute peripheral neuropathy when using PHT.
Pharmacokinetics of Fosphenytoin in Patients with Hepatic or Renal Disease
Authors: Aweeka Francesca T. , Gottwald Mildred D. , Gambertoglio John G. , Wright Teresa L. , Boyer Thomas D. , Pollock Alan S. , Eldon Michael A. , Kugler Alan R. , Alldredge Brian K.
Published: August 2005

Summary: Purpose: The pharmacokinetic behavior of fosphenytoin (FOS), the water‐soluble prodrug of phenytoin (PHT), has been characterized in normal subjects. This is the first study of the effect of hepatic or renal disease on the rate and extent of conversion of FOS to PHT.

Methods: A single dose of fosphenytoin (250 mg over a period of 30 min) was administered to subjects with hepatic cirrhosis (n = 4), renal disease requiring maintenance hemodialysis (n = 4), and healthy controls (n = 4). Serial plasma concentrations were measured, and pharmacokinetic parameters were calculated.

Results: The mean time to reach the peak plasma FOS concentration was similar for each of the three groups. However, the mean time to achieve peak plasma concentrations of PHT tended to occur earlier in the hepatic or renal disease groups than in healthy subjects. The half‐life of FOS was 4.5, 9.2, and 9.5 min for the three groups, respectively. There was a trend toward increased FOS clearance and earlier peak PHT concentration in subjects with hepatic or renal disease. This finding is consistent with decreased binding of FOS to plasma proteins and increased fraction of unbound FOS resulting from decreased plasma protein concentrations associated with these disease states. The conversion of FOS to PHT was equally efficient in subjects with hepatic or renal disease and healthy subjects.

Conclusions: Although the differences in pharmacokinetic parameters between the three groups were not statistically significant, these data suggest the need for close clinical monitoring during FOS administration to patients with hepatic or renal disease. To minimize the incidence of adverse effects in this patient population, FOS may need to be administered at lower doses or infused more slowly.
Analysis of Temporal Lobe Resections in MR Images
Authors: Moran Nicholas F. , Lemieux Louis , Maudgil David , Kitchen Neil D. , Fish David R. , Shorvon Simon D.
Published: August 2005

Summary: Purpose: The nature of the resection in surgery for intractable medial temporal lobe epilepsy is likely to be a principal factor determining seizure and neuropsychological outcome. However, there is no universally accepted system for describing the characteristics of individual resections to allow comparison between patients and patient groups treated at different institutions. We therefore developed a technique of volumetric analysis of temporal lobe resections.

Methods: With comparison of coregistered pre‐ and postoperative, volumetric magnetic resonance imaging (MRI) scans in 10 subjects, the volumes of six temporal lobe substructures were determined by manual delineation in the pre‐ and postoperative images for each case, allowing the extent of resection to be determined.

Results: The substructures and their extent of resection were measured with acceptable repeatability in each case.

Conclusions: We developed a reliable method for the quantitative description of temporal lobe resections. This will be of application in determining the relation between the anatomic nature of the resection in intractable epilepsy and the seizure and neuropsychological outcome.
Value of Inpatient Diagnostic CCTV‐EEG Monitoring in the Elderly
Authors: Drury Ivo , Selwa Linda M. , Schuh Lori A. , Kapur Jaideep , Varma Navin , Beydoun Ahmad , Henry Thomas R.
Published: August 2005

Summary: Purpose: To examine the outcome of inpatient diagnostic closed circuit TV‐EEG (CCTV‐EEG) monitoring in a consecutive series of elderly patients admitted to an adult epilepsy‐monitoring unit (EMU) over a continuous 6‐year period.

Methods: Retrospective review of all admissions to a university hospital adult EMU. Those older than 60 years were identified. Patients who were monitored for status epilepticus were excluded. Data on duration of events, frequency of events, physical examination, medications, preadmission EEG, brain imaging, length of stay, and interictal and ictal EEG were obtained.

Results: Of the 18 patients admitted for monitoring only, mean age was 69.5 years (range, 60–90 years). Mean length of stay was 4.3 days (range, 2–9 days). Five patients had complex partial seizures recorded. Three patients, all treated with antiepileptic drugs (AEDs), had no spells recorded, and no additional diagnostic information was gained from the admission. The other 10 patients, eight of whom had been treated with AEDs, were symptomatic during their admission, leading to a variety of neurologic but not epileptic, psychiatric, or other medical disorders, and allowing tapering of AEDs.

Conclusions: In elderly patients with suspected epilepsy, CCTV‐EEG is a very useful diagnostic tool. In this series of 18, 10 patients were diagnosed with potentially treatable medical illnesses not responsive to AEDs.
Coadministration of Phenytoin and Felbamate: Evidence of Additional Phenytoin Dose‐Reduction Requirements Based on Pharmacokinetics and Tolerability with Increasing Doses of Felbamate
Authors: Sachdeo R. , Wagner M. L. , Sachdeo S. , Shumaker R. C. , Lyness W. H. , Rosenberg A. , Ward D. , Perhach J. L.
Published: August 2005

Summary: Purpose: This open‐label study investigated the pharmacokinetic interaction of phenytoin (PHT) and felbamate (FBM).

Methods: Ten subjects with epilepsy receiving PHT monotherapy were administered increasing doses of FBM (1,200, 1,800, 2,400–3,600 mg/day) at 2‐week intervals. PHT doses were reduced by 20% on an individual basis when evidence of clinically significant intolerance was present. With intolerance, the PHT dose was reduced before the next incremental FBM dose. Blood samples were analyzed for FBM, PHT, and PHT metabolite 5‐(4‐hydroxyphenyl)‐5‐phenylhydantoin (HPPH).

Results: Total PHT plasma concentrations increased with coadministered FBM. PHT Cmax increased from 15.9 μg/ml at baseline to 20.9 μg/ml after 1,200 mg/day FBM and to 26.8 μg/ml after 1,800 mg/day FBM. Four subjects required a 20% PHT dose reduction after 1,800 mg/day FBM and six after the administration of 2,400 mg/day FBM. All subjects required further 20% PHT reductions before 3,600 mg/day FBM. FBM Cmax and AUCτ were reduced, and apparent clearance increased compared with data from FBM monotherapy.

Conclusions: With the initiation of FBM therapy in subjects receiving PHT, the PHT dosage should be reduced by 20%. Further PHT dose reductions are likely to be necessary if the FBM dose is increased. The requirements for reductions in dose might be predicted by clinical signs of PHT intolerance.
GABA Uptake Blocker NNC‐711 Exhibits Marked Anticonvulsant Action in Two Cortical Epileptic Models in Immature Rats
Authors: Bernášková K. , Šlamberová R. , Mareš P.
Published: August 2005

Summary: Purpose: To study the anticonvulsant action of a γ‐aminobutyric acid (GABA) uptake inhibitor NNC‐711 in two models of cortical epileptogenesis in immature rats.

Methods: Twelve‐, 18‐, and 25‐day‐old rat pups with implanted electrodes were used in this study. Epileptogenic foci were elicited by a local application of bicuculline methiodide (BMI) on the sensorimotor cortical region by means of an implanted cannula, and cortical epileptic afterdischarges (ADs) were induced by low‐frequency stimulation (8 Hz) of the same cortical area. Epileptogenic foci were formed after pretreatment with NNC‐711 (1 or 10 mg/kg, i.p.), and epileptic ADs were elicited in the second experimental series. Then NNC‐711 was administered in the same doses, and stimulation was repeated.

Results: NNC‐711 did not block the formation of epileptogenic foci, but it significantly suppressed the spontaneous transition of interictal focal into ictal activity in all age groups. The intensity of movements accompanying stimulation of the sensorimotor cortex was less under the influence of NNC‐711 in the 18‐ and 25‐day‐old rats. The duration of cortical ADs was shortened in all age groups, but transient abolition of ADs was observed only after the higher dose in the 25‐day‐old rats. In addition, the intensity of clonic seizures appearing during ADs decreased, and the transition of ADs into another type due to an involvement of limbic structures failed to appear in the 18‐ and 25‐day‐old rats.

Conclusions: Primary epileptogenesis in the cerebral cortex was hardly influenced by NNC‐711, but the spread of epileptic activity was markedly suppressed. This effect was better expressed in the 18‐ and 25‐day‐old animals than in the youngest group.
Malformations in Offspring of Women with Epilepsy: A Prospective Study
Authors: Canger R. , Battino D. , Canevini M. P. , Fumarola C. , Guidolin L. , Vignoli A. , Mamoli D. , Palmieri C. , Molteni F. , Granata T. , Hassibi P. , Zamperini P. , Pardi G. , Avanzini G.
Published: August 2005

Summary: Purpose: The incidence of malformations among infants of mothers with epilepsy treated with antiepileptic drugs (AEDs) during pregnancy is higher than that found in the general population. The aim of this study was to contribute to providing a definition of the rate of congenital anomalies in the offspring of mothers with epilepsy and to detect possible risk factors.

Methods: Since 1977, 517 pregnancies were followed up at the San Paolo Hospital in Milan by a team of epileptologists and obstetricians. The patients received monthly obstetric and neurologic examinations, and the blood levels of AEDs were tested monthly. During pregnancy the patients underwent ultrasound investigations to evaluate fetal morphology and development. At the time of delivery, the infants were submitted to a standardized examination by a pediatrician, and a more detailed clinical examination was performed on day 5. Malformations were classified as (a) genetic and chromosomic, (b) severe and mild malformations, and (c) deformities.

Results: The overall rate of malformations was 9.7%: of these, 5.3% were structurally severe, 2.2% were mild, 0.4% were chromosomic‐genetic, and 1.8% were deformities. No malformation was detected in the 25 untreated patients.

Conclusions: The risks of teratogenicity have been regarded as multifactorial, involving such factors as genetic predisposition, although most prospective studies show that AED‐related factors are the primary risk factors for an increased incidence of congenital malformations.
Antidepressant Drugs and Seizure Susceptibility: From In Vitro Data to Clinical Practice
Authors: Pisani Francesco , Spina Edoardo , Oteri Giancarla
Published: August 2005

The use of antidepressant drugs (ADs) in patients with epilepsy still raises uncertainties because of the widespread conviction that this class of drugs facilitates seizures. A detailed knowledge of this issue in its various aspects may help in optimal management of patients suffering concurrently from epilepsy and depression. This article reviews the available data in vitro in animals and humans concerning the known potential of various ADs to induce epileptic seizures. Emphasis has been placed on those variables that may generate confusion in interpreting the results of the various studies. Most ADs at therapeutic dosages exhibit in nonepileptic patients a seizure risk close to that reported for the first spontaneous seizure in the general population (i.e., <0.1%). In patients taking high AD doses, seizure incidence rises markedly and may reach values up to 40%. With a patient history of epilepsy and/or concomitant drugs that act on neuronal excitability, low or therapeutic AD doses may be sufficient to trigger seizures. Experimental data are in partial conflict with human data on the relative potential seizure risk of the various ADs. Therefore, a reliable scale for assigning a relative value to an individual AD or to single AD classes cannot be made. It appears fair to say that maprotiline and amoxapine exhibit the greatest seizure risk, whereas trazodone, fluoxetine, and fluvoxamine exhibit the least. Some ADs may also display antiepileptic effects, especially in low doses, in experimental models of epilepsy and in humans, but the mechanism of this action is largely unknown. The available data suggest that ADs may display both convulsant and anticonvulsant effects and that the most important factor in determining the direction of a given compound in terms of excitation/inhibition is drug dosage. It is probable that drugs that increase serotonergic transmission are less convulsant or, even, more anticonvulsant than others. Because of mutual pharmacokinetic interactions between antiepileptic drugs and ADs, with consequent marked changes in plasma concentrations, it remains to be established whether or not plasma AD levels that are effective against depression also facilitate seizures. Finally, exploring the mechanisms through which ADs modulate neuronal excitability might open new possibilities in antiepileptic drug development.
The Effect of Video‐Game Software in Video‐Game Epilepsy
Authors: Ricci Stefano , Vigevano Federico
Published: August 2005

Purpose: The individual role of video‐game (VG) programs in VG activation is still unclear. Strict relations between VG seizures and photo‐ and pattern sensitivity suggest that programs per se may have a role in seizure activation.

Methods: We tested a series of 12 commercially available VG programs in 30 subjects aged 7–28 years; test protocol comprised intermittent photic stimulation (IPS), pattern stimulation, and a game session with 12 programs, each played for 5 min, delivered from a 50‐Hz screen.

Results: Activation was observed in 17 subjects; marked differences were observed between different games: two programs activated 13 subjects; one program did not provoke activation. High variability between scenes makes it impossible to define mean brightness for the whole program. Activation correlated with “steady maximal brightness” (SMB) within a program; SMB is defined as the brightness in lux of the brightest scene steadily present in a program. SMB varied between 6 and 305 lux in tested programs. Difference in activation between different games was statistically significant (p < 0.001). Pattern sensitivity is strictly correlated with the probability of VG activation (p < 0.001).

Conclusions: Our study demonstrates a strong variation in activation between different game programs and a strict relation between VG activation and pattern sensitivity. Programs with SMB >100 lux should be regarded as potentially dangerous; programs with SMB <50 lux may be considered relatively safe.
Video‐Game Epilepsy: A European Study
Authors: Trenité D. G. A. Kasteleijn‐Nolst , da Silva A. Martins , Ricci S. , Binnie C. D. , Rubboli G. , Tassinari C. A. , Segers J. P.
Published: August 2005

With the introduction of Nintendo video‐games on a large scale, reports of children having seizures while playing suggested a possible specific, provocative factor. Although 50% of the photosensitive patients are also sensitive to a 50‐Hz television, nonphotosensitive patients with a history of videogame seizures were described as well. The question arises whether this is a mere coincidence, provoked by fatigue and stress, is related to the reaction to the television screen itself, or depends on the movement and color of the pictures of this specific game.

A European study was performed in four countries and five sites. All patients were selected because of a history of television, video‐ or computer‐game seizures, with a history of sunlight‐, discotheque‐, or black and white pattern‐evoked seizures, or were already known to be sensitive to intermittent photic stimulation. A total of 387 patients were investigated; 220 (75%) were female and 214 (55%) of those were <18 years of age.

After a routine examination, intermittent photic, pattern, and television stimulation were performed in a standardized way. The patients were investigated with Super Mario World and a standard relatively nonprovocative TV program, both on a 50‐and 100‐Hz television. Regardless of the distance, Super Mario World proved to be more provocative than the standard program (Wilcoxon, p < 0.05). Eighty‐five percent showed epileptiform discharges evoked by intermittent photic stimulation. Forty‐five percent of patients were 50‐Hz television sensitive and 26% were 100‐Hz television sensitive. Pattern sensitivity was found in 28% of patients.

The patients, referred because of a television, video‐ or computer‐game seizure, were significantly more sensitive to pattern and to the 50‐Hz television (chi square, p < 0.001). More patients are sensitive when playing Super Mario, compared with the standard program (Wilcoxon, p = 0.001) and more sensitive with playing versus viewing (p = 0.016).

Of the patients who were referred because of seizures in front of the television, or evoked by a video‐ or computer game, 14% proved not to be photosensitive. Although no difference in age or use of medication was found, twice as many men were found in this nonphotosensitive group.
Photic Stimulation: Standardization of Screening Methods
Authors: Trenité D. G. A.Kasteleijn‐Nolst , Binnie C. D. , Harding G. F. A. , Wilkins A.
Published: August 2005

Purpose: Differences in methodology of intermittent photic stimulation within and between countries in Europe make collaborative research and interpretation of results difficult.

Method: Experts in the field of photic stimulation from European countries have given an overview of methods used in routine photic stimulation. A consensus meeting was organized in May 1996 in the Netherlands.

Results: Methodology, including specification of a photo stimulator, procedure of photic stimulation, and interpretation of EEG results, has been defined according to available scientific and clinical knowledge.

Conclusions: Consensus was reached in setting up a safe, quick, simple and reliable method to determine whether or not patients are photosensitive. A specification of an international standard for intermittent photic stimulation in the routine EEG examination is given with the purpose of improving patient care and facilitating collaborative research.
Monostars: An Aid to Choosing an Antiepileptic Drug as Monotherapy
Authors: Brodie Martin J.
Published: August 2005

This article describes a flexible, dynamic system for comparing antiepileptic drugs (AEDs) as monotherapy, taking into account the needs of the patient and the characteristics of the treatment. Because differences in efficacy between AEDs cannot readily be demonstrated in regulatory clinical trials, safety is of paramount importance. Each drug has been judged across 11 criteria. These include knowledge of mechanism of action, suitable pharmacokinetics, drug interactions, delineated range of efficacy, ease of titration, idiosyncratic reactions, sedative burden, neuropsychiatric profile, teratogenic potential, and the likelihood of producing long‐term side effects. The final consideration relates to how “comfortable” the doctor is with prescribing the drug as monotherapy. Scores of ‐1 (drawback), 0 (neutral/unknown), or +1 (advantage) have been allocated under each category, depending on current knowledge and clinical experience. The sum of the individual scores determines the awarding of “stars.” In addition, the positive and negative features of each AED, when used as monotherapy, are highlighted. A range of established and new AEDs has been examined using the “monostars” method, including phenobarbital, phenytoin, carbamazepine, sodium valproate, lamotrigine, gabapentin, oxcarbazepine, and vigabatrin. Scores can be adjusted as new information comes to light. Other agents can be added when suitable monotherapy data become available. This analysis supports the contention that choice of treatment in newly diagnosed epilepsy should take into consideration the patient's age, sex, general health, coexisting disabilities, concomitant medication, and life style. Seizure type, syndrome, and the AED's pharmacology, efficacy, and safety profile should also be considered. Because dosing is often modest, cost should rarely be the overriding factor in choosing a drug for a patient with newly diagnosed epilepsy in the developed world. With these criteria, some of the newer AEDs have potentially more to offer the patient as monotherapy than do the established agents.
Marital Status After Epilepsy Surgery
Authors: Carran Melissa A. , Kohler Christian G. , O'Connor Michael J. , Cloud Blaine , Sperling Michael R.
Published: August 2005

Summary: Purpose: To characterize features influencing marital status in a group of patients with refractory epilepsy before and after epilepsy surgery and to assess the effect of seizure control on marital status after epilepsy surgery.

Methods: We analyzed marital status in 430 epilepsy surgery patients and in a subset with temporal lobe epilepsy. Marital status was assessed in relation to gender and age of epilepsy onset and compared with marital rates for the U.S. population. Patients who had 4 years of postsurgical follow‐up were examined for change in marital status after surgery. Those patients who changed marital status were then evaluated for change in employment.

Results: Marital rates were lower than expected in men. Men with onset of epilepsy by age 11 years were less likely to be married than men whose seizures began after age 11 or women whose seizures began at any age. Men and women with temporal lobe epilepsy had higher marriage rates than those with extratemporal lobe epilepsy. More than 4 years after epilepsy surgery (n = 190), patients who had no recurrent seizures were more likely to change marital status (28 of 124, 23%), than those who had recurrent seizures (five of 66, 8%). Seizure‐free women were more likely to divorce (n = 9) than were seizurefree men (n = 1). Most men who married were employed (77%), whereas women who divorced were usually unemployed (67%).

Conclusions: The age at which seizures begin influences later marital status in men, who have reduced marriage rates. The abolition of seizures by epilepsy surgery creates new opportunities for changing social relationships. Location of the epileptic focus may influence psychosocial function.
Visual and Quantitative Ictal EEG Predictors of Outcome After Temporal Lobectomy
Authors: Assaf Bassam A. , Ebersole John S.
Published: August 2005

Summary: Purpose: We investigated whether visual and quantitative ictal EEG analysis could predict surgical outcome after anteromesial temporal lobectomy (AMTL) in which mesial structures, basal, and temporal tip cortex were resected.

Methods: We retrospectively reviewed 282 presurgical scalp‐recorded ictal EEGs (21‐ to 27‐channel) from 75 patients who underwent AMTL. We examined the pattern of seizure onset (frequency, distribution, and evolution) and estimated the principal underlying cerebral generators by using a multiple fixed dipole model that decomposes temporal lobe activity into four sublobar sources (Focus 1.1). We correlated findings with a 2‐year postoperative outcome.

Results: Sixteen patients had seizures with a well‐lateralized, regular 5 to 9‐Hz rhythm at onset, that most often had a temporal or subtemporal distribution. All patients became seizure free after surgery. In 51 patients, seizure onset was remarkable for lateralized slow rhythms (>5 Hz), which sometimes appeared as periodic discharges, were often irregular and stable only for short periods (>5 s), and had a widespread lateral temporal distribution. Among these a favorable surgical outcome was encountered in patients with seizures having prominent anterior‐tip sources (16 of 17 seizure free), whereas those with dominant lateral or oblique sources had a less favorable outcome (three of 14 and 13 of 18, respectively). Irregular, nonlateralized slowing characterized seizure onsets in eight patients. Three patients became seizure free after surgery.

Conclusions: Both visual and quantitative sublobar source analysis of scalp ictal EEG can predict surgical outcome in most cases after AMTL and complement non‐invasive presurgical evaluation.
Cross‐Cultural Adaptation and Use of the Epilepsy Psychosocial Effects Scale: Comparison Between the Psychosocial Effects of Chronic Epilepsy in Sweden and the United Kingdom
Authors: Chaplin John E. , Malmgren Kristina
Published: August 2005

Summary: Purpose: To establish Swedish weightings for the Epilepsy Psycho‐Social Effects Scale (EPSES) and examine differences between Sweden and the U.K. in attitudes toward chronic epilepsy.

Methods: After translation and back‐translation of the EPSES into Swedish, weightings were established through a paired comparison study in which 24 epilepsy professionals participated. The EPSES was then given to a hospital‐based sample of 57 patients with chronic epilepsy and the results compared with a British sample matched for age, sex, and frequency of seizures.

Results: In the professional judgments of the EPSES statements, there were statistically significant differences in only four of 42 statements. Attitudes to employment, to medication, and to fear of seizures were considered more serious in the U.K., whereas social isolation was considered more a problem in Sweden. Patient attitudes to chronic epilepsy were found to be largely similar in the U.K. and Sweden; however, attitudes to employment, to the future, and to fear of seizures were significantly more a problem for patients in the U.K.

Conclusions: The results indicate a great similarity in the interpretation of problems as measured by the EPSES in the U.K. and in Sweden. The differences in attitudes found are discussed in relation to economic and legislative differences between the two countries. Social as well as cultural differences should be taken into account when using standardized questionnaires. It is suggested that culturally specific weightings should be calculated and that these should be reevaluated at regular intervals.
Lack of Association Between Juvenile Myoclonic Epilepsy and HLA‐DR13
Authors: Hellard Stéphanie Le , Neidhart Elisabeth , Thomas Pierre , Feingold Josué , Malafosse Alain , Tafti Mehdi
Published: August 2005

Summary: Purpose: We sought to replicate and extend a previously reported positive association between juvenile myoclonic epilepsy and HLA‐DR13.

Methods: Ninety‐three subjects with juvenile myoclonic epilepsy and 93 normal blood donors, entirely of white origin with their families mostly of French extraction, underwent DNA‐based HLA‐DR13 and DQB6 typing.

Results: None of the investigated alleles or combination of alleles (DRB1*1301‐DQB1*0603 or DRB1*1302‐DQB1*0604) showed a significant difference between patients and controls.

Conclusions: Unlike previously reported positive association, in this population, there is no evidence that susceptibility to juvenile myoclonic epilepsy is associated with HLA‐DR13.
Sleep Problems and Daytime Behavior in Childhood Idiopathic Epilepsy
Authors: Cortesi Flavia , Giannotti Flavia , Ottaviano Salvatore
Published: August 2005

Summary: Purpose: To evaluate the presence of sleep problems and their association with behavioral and adjustment problems in children with idiopathic epilepsy.

Methods: A parental questionnaire was used to assess sleep problems in 89 children with idiopathic epilepsy for comparisons with 49 siblings and 321 healthy control children, equally distributed for age and sex. Sleep problems were clustered into five factors: parasomnias, parent/child interaction during the night, sleep fragmentation, daytime drowsiness, and bedtime difficulties. Daytime behavior and psychological adjustment were assessed by means of the Child Behavior Checklist. Maternal distress and disturbance was evaluated by the Malaise Inventory. The better to identify factors associated with sleep problems in the children with epilepsy, multiple regression analysis was performed.

Results: Children with epilepsy showed significantly more sleep problems than did both siblings and healthy controls. Within the epileptic group, children with current seizures complained more of sleep problems than did the seizure‐free children. Moreover, children with epilepsy showed more behavioral problems and maladjustment. Age, paroxysmal activity density, duration of illness, seizure frequency, and behavioral problems were significantly associated with sleep problems in the epileptic group.

Conclusions: The results of this study in a highly selected sample pointed out the presence of sleep problems, and adjustment and behavioral problems in children with idiopathic epilepsy. The presence of epilepsy, although benign, in childhood is associated with adaptive problems of the child. From this point of view, the alteration of some sleep habits may be a sign of emotional maladjustment. Although parents failed to perceive them as a problem, our findings indicate that attention to sleep and behavioral problems is important in clinical management of children with idiopathic epilepsy.
Comparison of Status Epilepticus with Prolonged Seizure Episodes Lasting from 10 to 29 Minutes
Authors: DeLorenzo R. J. , Garnett L. K. , Towne A. R. , Waterhouse E. J. , Boggs J. G. , Morton L. , Choudhry M. Afzal , Barnes T. , Ko D.
Published: August 2005

Summary: Purpose: Status epilepticus (SE) is a major medical and a neurologic emergency associated with significant morbidity and mortality. The current definition of SE is continuous seizure activity or intermittent seizure activity without regaining consciousness, lasting ≥30 min. Epilepsy monitoring unit data indicate that many seizures self‐terminate within minutes. Thus consideration was recently given to include seizure episodes lasting ≥10 min in the definition of SE. Because no large studies have been conducted on seizures lasting 10–29 min, this study was initiated to compare cases of SE and 10 to 29‐min seizure episodes seen within the same period.

Methods: Patients seen at the Medical College of Virginia Hospitals of Virginia Commonwealth University over the same 2‐year period were studied. Two hundred twenty‐six prospective SE cases (91 children and 135 adults) and 81 retrospective 10‐ to 29‐min seizure episodes (31 children and 50 adults) were compared. A standardized data‐entry‐form system was compiled on each patient and was used to evaluate the data collected.

Results: The 10‐ to 29‐min seizure patients and the SE cases had similar demographic characteristics, such as sex, race, and age, and also had similar etiologies. The majority (93%) of SE cases required anticonvulsant (AED) treatment to control and stop seizure activity. In the 10‐ to 29‐min group, 43% stopped seizing spontaneously, and the remainder (57%) required AED treatment to stop seizure activity. The mortality for the SE patients was 19% compared with 2.6% for 10‐ to 29‐min group (p <0.001). In the 10‐ to 29‐min group that stopped seizing spontaneously, the mortality was 0. In the 10‐ to 29‐min patients that required AED treatment, the mortality was 4.4%.

Conclusions: The results demonstrate that a significant number of patients experience seizure activity lasting from 10‐ to 29‐min. Approximately half of these seizure events stopped spontaneously and did not require AED treatment. The other half of the patients responded quickly to medications and stopped seizing before the 30‐min definition for SE. The overall mortality of this group was significantly lower than that of the patients with SE. The results demonstrate that further studies on the 10‐ to 29‐min seizure group are needed to differentiate seizures that will stop spontaneously and those that will only stop with AED treatment. Because almost half of the prolonged seizures stopped spontaneously, further studies are needed before including prolonged seizure activity in the definition of SE.
Effects of Menopause on Seizures in Women with Epilepsy
Authors: Abbasi Fariha , Krumholz Allan , Kittner Steven J. , Langenberg Patricia
Published: August 2005

Summary: Purpose: Although important associations between epilepsy and women's hormonal phases are described, the relation of menopause to epilepsy has received little attention.

Methods: By using a structured interview, we studied menopausal women with epilepsy seen at the University of Maryland Epilepsy Center over a 1‐year period from 1994 to 1995. We analyzed the characteristics and temporal relation of the seizures to menopause and compared the frequency and severity of the seizures with those in a similar group of premenopausal women.

Results: We identified 61 menopausal women (46 who were postmenopausal and 15 perimenopausal) and compared them with 46 premenopausal women. No statistically significant differences were noted in either the frequency or the severity of seizures comparing all menopausal or only postmenopausal with premenopausal women. However, 12 (20%) of the 61 menopausal women noted that their seizures first began during or after menopause, with eight having no proven cause for their seizures. Many individual women described changes in their seizures with menopause. Among the 61 menopausal women, 49 had established epilepsy before the onset of menopause, and 20 (41%) reported worsening of their seizures with menopause, 13 (27%) noted improvement, and 16 (33%) described no changes. These observations were similar for peri‐ and post‐menopausal women. Of the 15 menopausal women taking hormone replacement therapy, the six taking progestin were significantly less likely to report worsening of their seizures.

Conclusions: These findings support the view that hormonal influences are important in women with seizures. Although, in aggregate, menopausal (combined perimenopausal and post‐menopausal) and postmenopausal women's seizures were similar in frequency and severity to those of other women, menopause was associated with changes in seizures for some women. Moreover, menopause may be a previously unrecognized factor for some new‐onset seizures. The relations between menopause and epilepsy deserve to be more fully investigated.
Mortality Risk in an Adult Cohort with a Newly Diagnosed Unprovoked Epileptic Seizure: A Population‐Based Study
Authors: Lindsten Hans , Nyström Lennart , Forsgren Lars
Published: August 2005

Summary: Purpose: We sought to investigate mortality risk in an adult cohort with newly diagnosed unprovoked epileptic seizures.

Methods: One hundred seven patients who were at least 17 years old and had newly diagnosed unprovoked epileptic seizures were prospectively identified during a period of 20 months between 1985 and 1987. Patients were followed until the date of death or the end of 1996. The standard mortality ratio (SMR) was analyzed in the whole cohort and in the portion of the cohort with recurrent seizures at inclusion. The influences on the SMR of time since diagnosis, sex, age at diagnosis, seizure cause, seizure type, and cause of death were also investigated.

Results: The SMR was significantly increased (SMR, 2.5; 95% confidence interval [CI], 1.2–3.2). This significantly increased risk was found during the first 2 years after diagnosis (year 1: SMR, 7.3; 95% CI, 4.4–12.1; year 2: SMR, 3.6; 95% CI, 1.6–8.1) and at years 9–11 (SMR, 5.4; 95% CI, 2.7–11.2). The increased mortality risk was most pronounced when the seizures occurred before the age of 60 years. Mortality risk was elevated among patients with remote symptomatic epilepsy (SMR, 3.3; 95% CI, 2.4–4.5) but not idiopathic epilepsy.

Conclusions: There is increased mortality risk in an adult cohort with newly diagnosed unprovoked epileptic seizures. This increase is found in symptomatic patients, young patients, and during the first 2 years after the diagnosis.
Frontal Nonconvulsive Status Epilepticus Associated with High‐Dose Tiagabine Therapy in a Child with Familial Bilateral Perisylvian Polymicrogyria
Authors: Piccinelli P. , Borgatti R. , Perucca E. , Tofani A. , Donati G. , Balottin U.
Published: August 2005

Summary: Purpose: Antiepileptic drugs are known to exacerbate absence and myoclonic seizures, especially in patients with idiopathic generalized epilepsies. Exacerbation of nonconvulsive generalized seizures in patients with partial epilepsy is less common. Recently, however, a number of cases of putative generalized nonconvulsive status epilepticus (NCSE) or NCSE without further specification have been reported in patients with chronic partial epilepsy treated with the γ‐aminobutyric acid reuptake inhibitor tiagabine. Although complex partial status epilepticus during tiagabine therapy has also been reported, possible precipitation of NCSE specifically associated with frontal lobe discharges does not appear to have been recognized. In this communication, we describe the case of a boy with familial bilateral perisylvian polymicrogyria who developed frontal NCSE after being stabilized on high‐dose tiagabine

Methods: A 12‐year‐old boy with familial bilateral perisylvian polymicrogyria, mental retardation, and refractory partial seizures was administered tiagabine in addition to sodium valproate. The tiagabine dosage was increased gradually up to 10 mg t.i.d. (1 mg/kg per day), resulting in complete seizure control.

Results: After 1 week on maintenance treatment, seizures were completely controlled, but the child developed hypoactivity, decreased reactivity, and affective detachment. An EEG recording revealed subcontinuous sharp‐wave discharges with irregular runs of atypical spike‐wave complexes over the anterior regions of both hemispheres, consistent with a diagnosis of frontal NCSE. A reduction in tiagabine dosage to 15 mg/day led to complete regression of the behavioral and affective changes and to disappearance of the subcontinuous EEG discharges.

Conclusions: Although tiagabine‐induced NCSE has been described previously, particularly in patients with preexisting spike‐wave abnormalities, this is the first report that identifies its potential role in the precipitation of frontal NCSE.