bluuebunny/crossref_metadata_2025 huggingface dataset:
Carbamazepine Versus Phenobarbital for Partial Onset Seizures in Children
Authors: Mitchell Wendy G. , Chavez John M.
Published: November 2007

Summary: Thirty‐nine children were treated with either phenobarbital (PB) or carbamazepine (CBZJ for newly diagnosed partial onset seizures. Drug selection was randomized in 33 subjects. Parents and the psychologist evaluating the child were blind to drug identity. Psychometric and behavioral evaluations were done at intake and at 6‐ and 12‐month follow‐ups. There were no significant differences between drugs in effect on behavior or cognitive function. CBZ caused more systemic problems. There was a trend toward better seizure control with CBZ, but this was not statistically significant. Although individual children in each group had changes in behavior or cognitive status, neither group changed significantly, in either acute or chronic follow‐up.

En 39 nin̄os diagnosticados de ataques parciales de reciente aparición se ha utilizado el fenobarbital (PHE) o la carbamace‐pina (CBZ). La selección de la droga se realizó de modo rando‐mizado en 33 sujetos. Los padres y los psicologós que valoraban a los nin̄os no conocían la identidad de la medicación. La valo‐ración de los estudios psicométricos y de comportamientó se realizo al iniciar la medicación, a los 6 y a los 12 meses. No se encontraron diferencias significativas entre ambas drogas en sus efectos sobre el comportamiento o sobre las funciones cogni‐tivas. La CBZ causó más problemas sistémicos. Se observó una tendencia hacia un mejor control de los ataques con la CBZ pero sin significado estadístico. A pesar de que algunos nin̄os en cada grupo mostraron cambios individuales en el comportamiento o en el status cognitive ningún grupo cambió de modo significative durante el período agudo o en el seguimiento crónico.

39 Kinder mit frisch diagnostizierten fokal beginnenden Anfällen wurden entweder mit Carbamazepin oder Phenobarbital behandelt. Bei 33 Kindern wurde die Medikamentenwahl rando‐misiert. Eltern und auswertende Psychologen kannten die Medi‐kamentenidentität nicht. Psychometrische und Verhaltensunter‐suchungen wurden durchgeführt bei Beginn, sowie 6 und 12 Monate später. Bezüglich Verhalten und kognitiver Funktionen boten die Medikamente keine signifikanten Unterschiede. CBZ verursachte mehr systemische Nebenwirkungen. Es konnte nur ein Trend bezüglich besserer Anfalisminderung bei CBZ festges‐tellt werden, jedoch ohne statistische Signifikanz. Obwohl in beiden Gruppen individuell Kinder Veränderungen im Verhalten und in den kognitiven Functionen zeigten, änderte sich keine Gruppe signifikant, weder akut noch im Längsschnitt.
High‐Dose Phenytoin in the Treatment of Refractory Epilepsy
Authors: Cobos Jorge Eslava
Published: November 2007

Summary: Refractory, long‐standing, high‐frequency epilepsy was successfully managed with high‐dose phenytoin treatment. Side effects were observed in only three patients and were easily corrected. Most of the patients had partial seizures, but many also had a myoclonic component. Emphasis was placed on monotherapy whenever possible. Results, interpretation of serum levels, and toxic reactions to phenytoin are discussed.

Nous avons pu traiter avec succès des épilepsies réfractaires, anciennes, à crises fréquentes, au moyen de fortes doses de phénytoïne. Des effets secondaires n'ont été observes que chez trois patients, et ont pu être aisément corrigés. La plupart des patients présentaient une épilepsie partielle, mais beaucoup ď;entre eux présentaient également une composante myoclonique. Une monothérapie fut maintenue autant que possible. Les résultats, ľinterprétation des taux sériques et les manifestations de toxicité sont discutés.

Varios pacientes con epilepsia refractaria prolongada, de alta frecuencia ictal, fueron tratados con éxito con fenitoína a altas dosis. Se observaron efectos colaterales solamente en tres pacientes y fueron corregidos con facilidad. La mayoría de los pacientes sufrian crisis parciales pero algunos tenían un componente mioclónico agregado. Se intentó llevar el tratamiento en monoterapia en la medida de lo posible. Se discuten los resultados, interpretación de los niveles séricos y reacciones tóxicas.

Therapieresistente, lange bestehende Epilepsien mit hoher Anfallsfrequenz wurden erfolgreich mit einer Phenytoin‐Hoch‐dosis‐Therapie behandelt. Nur bei drei Patienten wurden Nebenwirkungen beobachtet, die leicht zu beheben waren. Die meisten der Patienten hatten Partial‐Anfälle, aber viele boten auch myoklonische Elemente. Wenn irgendwie möglich wurde eine Monotherapie versucht. Ergebnisse, Interpretation derSerumspiegel und toxische Reaktionen von Phenytoin werden diskutiert.
Homovanillic Acid and Prolactin in Plasma and CSF of Medicated Epileptic Patients
Authors: Kalfakis N. , Markianos M.
Published: November 2007

Summary: Homovanillic acid (HVA), the main dopamine metabolite, and prolactin (PRL) were estimated in plasma and cerebrospinal fluid (CSF) of 11 male epileptic patients treated with antiepileptic drugs and of 14 neurologic controls. A trend toward higher concentrations in plasma and lower concentrations in CSF in the patient group as compared with controls was observed for both parameters. The plasma to CSF ratios of HVA and PRL levels were significantly higher in the patient group. This shift may be due to an influence of the drugs on the blood‐brain barrier (BBB) permeability. The PRL levels in the CSF correlated negatively to the HVA levels in CSF in the patient group only.

Ľacide homovanillique (HVA), principal métabolite de la dopamine, et la prolactine (PRL) ont été dosés dans le plasma et dans le LCR chez 11 patients épileptiques traites et chez 14 patients neurologiques temoins. Pour ces deux variables, nous avons noté une tendance àľélévation des concentrations plas‐matiques et àľabaissement des concentrations dans le LCR par comparaison aux témoins. Le rapport plasma/LCR des taux de HVA et de PRL était significativement plus élevé chez les élevé chez Is épileptiques. Cette élévation peut être la conséquence ď;une modification de la perméabilité de la barrière hemato‐encéphalique due aux médicaments. Les taux de PRL dans LCR étaient inversement corrélés à ceux de HVA dans le LCR chez les patients épileptiques seulement.

En 11 enfermos epilépticos varones tratados con antiepilépticos y en 14 enfermos neurológicos seleccionados como controles, se han determinado los niveles en plasma y en líquido cefalorraquídeo del ácido homovanílico (HVA), el metabolito principal de la dopamina, y de la prolactina (PRL). Para ambos parámetros se observó una tendencia hacia una concentración más elevada en plasma y más baja en el líquido cefalorraquídeo en el grupo de pacientes compareándolo con el grupo control. La relación plasma/líquido cefalorraquídeo del HVA y de la PRL fue significativamente más elevada en el grupo de enfermos. Esta modificación puede ser debida a la influencia de las medicaciones sobre la permeabilidad de la barrera hematoencefálica. Los niveles de PRL en el liquido cefalorraquídeo mostraron una correlación negativa con respecto a los niveles en el líquido cefalorraquideo del HVA, sólo en el grupo de enfermos.

HVS, Hauptmetabolit von Dopamin und Prolactin (PRL) wurde im Plasma und Liquor bei 11 männlichen, unter Antiepileptika stehenden Anfallskranken bestimmt, sowie bei 14 Kontrollpersonen mit anderen neurologischen Erkrankungen. Verglichen mit den Kontrollen wurde bei den Patienten für beide Substanzen ein Trend zu höheren Konzentrationen im Plasma und niedrigeren im Liquor beobachtet. Das Plasma‐Liquor‐Verhältnis von HVS und PRL lag in der Patientengruppe signifikant höher. Diese Verschiebung könnte durch eine Beeinflussung der Blut‐Hirn‐Schranke durch die Medikamente bedingt sein. Die Liquor‐PRL‐Spiegel korrelierten in der Patientengruppe negativ mit den Liquor‐HVS‐Spiegeln.
Infarction After Surgery for Focal Epilepsy: Manipulation Hemiplegia Revisited
Authors: Helgason Cathy M. , Bergen Donna , Bleck Thomas P. , Morrell Frank , Whisler Walter
Published: November 2007

Summary: The success of surgery for seizure focus resection depends on postoperative reduction or disappearance in number of seizures, improvement in psychosocial functioning, and low morbidity and mortality. Permanent neurologic sequelae are most often not discussed in this context. Deficits more than a superior quadrantanopsia are not expected after temporal lobectomy. Four cases of ischemic stroke after seizure focus resection, each distant from the site of tissue removal, are reported. These are the first such radiologically documented reports of “manipulation hemiplegia.” The permanent neurologic deficits are not attributed to resected tissue or edema.

Le succès de l'exérèse chirurgicale d'un foyer épileptique se traduit par la réduction post‐opératoire de la fréquencie–ou par la disparition – des crises, une amélioration de l'insertion psycho‐sociale, avec parallèlement faible morbidité et mortalité. II est rare de discuter, dans ce contexte, de séquelles neurolo‐giques permanentes. Après lobectomie temporale. une quadra‐nopsie supérieure constitue le seul déficit attendu. Nous avons observé 4 cas d'infarctus cérébral ischémique après résection d'un foyer épileptogène, 1'infarctus siégeant dans chaque cas à distance du champ de l'exérèse. Ces observations constituent les premiers cas documentes sur le plan radiologique d'hémiplégie post chirurgicale dans ce contexte. Le déficit neurolo‐gique permanent ne peut être rattaché ni à la résection paren‐chymateuse, ni à un oedème.

El éxito de la cirugía para la resección de un foco epiléptico depende de la reductión o desaparición del número de ataques en el periodo postoperatorio, la mejoría de la función sicosocial y la baja morbilidad y mortalidad. En general, las secuelas neu‐rológicas permanentes no son analizadas en este tema. Déficits que superan una cuandrantonopsia superior no se tienen en cuenta después de una lobectomía temporal. Se presentan cuatro casos de infarto isquémico después de la reseccíon de focos epilépticos y alejados del lugar del tejido extraido. Estos casos constituyen el primer informe radiológico documentado de “hemiplegía postmanipulación.” Los defectos neurológicos permanentes no son atribuidos al tejido resecado o al edema.
Benign Occipital Epilepsy: A Family Study
Authors: Kuzniecky Ruben , Rosenblatt Bernard
Published: November 2007

Summary: Benign occipital epilepsy is a newly recognized form of partial epilepsy in children. It is characterized by motor seizures preceded in some cases by visual symptoms and a relatively benign course. We present three siblings with this condition and a fourth with the EEG abnormalities. A family study including 25 relatives demonstrated a typical EEG abnormality in 26% of relatives. These EEG changes were more evident in younger members. These findings suggest an autosomal dominant pattern for the EEG abnormalities with age‐dependent expression and variable penetrance of the seizure disorder.

L'épilepsie occipitale bénigne est une forme d'épilepsie par‐tielle de l'enfant récemment individualisée. Elle se caractérise par des crises motrices précédées dans certains cas par des symptômes visuels, et par une évolution relativement bénigne. Nous présentons 3 patients d'une même fratrie atteints de cette forme d'épilepsie, et un 4ème présentant les anomalies EEG. Une étude familiale, qui a porte sur 25 parents de ces sujets, a mis en evidence une anomalie EEG typique chez 26% des parents. Ces anomalies EEG étaient plus évidentes chez les parents les plus jeunes. Nos données suggèrent un mode de transmission autosomique dominant pour les anomalies EEG, avec expression âge‐dépendante, ainsi qu'une pénétrance varíable pour la maladie.
Feline Agenesis of the Corpus Callosum
Authors: Hiyoshi Toshio , Wada Juhn A.
Published: November 2007

Summary: The unusual pattern of seizure development and developed seizure in a cat kindled at the ventral hippocampus is discussed in the light of agenesis of the corpus callosum (CC). In this animal, not only the CC but also the hippocampal commissure was completely absent and the dorsal portion of the septal area was separated in the midline. There was no other morphological anomaly except for slightly enlarged lateral ventricles. No behavioral or physical peculiarities were noted. The unusual profile of kindling in this animal was characterized by (a) very rapid kindling at the primary site, (b) the lateralized nature of the kindled primary site convulsion preceded by repetitive and violent contralateral axial rotation, and (c) the complete absence of positive transfer effect expected at the contralateral nomotopic secondary site. These features are strikingly reminiscent of the pattern of amygdaloid kindling in forebrain‐bisected cats. These observations add strength to our hypothesis that the CC (and possibly the hippocampal commissure) is the major anatomic substratum for convulsive generalization and the transhemispheric positive transfer effect in feline limbic kindling.

Les modalités inhabituelles de l'installation des crises et des crises installées chez un chat qui avait subi un embrasement au niveau de 1'hippocampe ventral sont discutées en fonction d'une agénésie du corps calleux (CC) découverte à l'autopsie. Chez cet animal, il manquait non seulement le CC, mais aussi la commissure hippocampique, et la portion dorsale de la région septale était séparée au niveau de la ligne médiane. II n'y avait pas d'autre anomalie morphologique, en dehors d'une discréte augmentation de volume des ventricules latéraux. On n'avait pas noté d'anomalies physiques ou comportementales. L'évolution inhabituelle de I'embrasement chez cet animal était caractérisé par: (1) un embrasement très rapide au niveau du site primaire, (2) la nature latéralisée de la convulsion par embrasement au niveau du site primaire, laquelle avait été précédée de rotations axiales répétées et violentes vers le côté opposé, et (3) par [‘absence totale de I’ effet de transfert positif attendu au niveau du site homologue contralateral. Ces caractéristiques rappellent l'évolution de l'embrasement amygdalien chez les chats com‐missurectomisés. Ces constatations renforcent notre hypothèse, selon laquelle le CC (et peut‐être la commissure hippocampique) constitue le substratum anatomique principal de la généralisation convulsive et du transfert interhémisphérique positif dans I'embrasement limbique chez le chat.
Computed Tomography in Adult‐Onset Epileptic Seizures in a City Hospital Population
Authors: Daras Michael , TAichman Alan J. , Strobos Robert J.
Published: November 2007

Summary: Computed tomography (CT) was performed on 155 patients from a city hospital population who developed seizures after age 20. CT was normal in 58 (37.4%) and abnormal in 97 patients (62.6%). A focal abnormality was seen in 71 patients (45.8%). Lesions potentially correctable by surgery were found in 24 patients (15.4%). As expected, the occurrence of abnormal CTs was higher (73%) in patients with partial seizures. Although CT is undeniably useful in evaluating the cause of seizures, no demonstrable lesion was found in a relatively large number of patients (37.4%).

Une scanographie cérébrale (CT) a été pratiquée chez 155 patients d'un hôpital de ville qui présentaient une épilepsie ayant débuté après l'âge de 20 ans. La CT s'est révélée normale chez 58 patients (37.4%) et anormale ches 97 patients (62.6%). Une anomalie focale a été constatée chez 71 patients, soit 45.8%. Des lesions susceptibles d'être sanctionées par la chirurgie ont été constatée chez 24 patients, soit 15.4%. Comme il élait prévisible, la fréquence des anomalies focales était plus élévée (73%) chez les patients présentant des crises partielles. Bien que la CT soit indéniablement utile dans le bilan étiologique des crises, nous retenons qu'elle n'a pas permis de démontrer l'existence d'une leasion dans une proportion relativement élévée des patients (37.4%).

Se ha practicado una tomografia computarizada (CT) en 155 enfermos de una población perteneciente a un hospital civil que desarrolló ataqués despuls de los 20 años de edad. La CT fue normal en 58 casos (37.4%) y anormal en 97 enfermos (62.6%) se observó una anormalidad focal en 71 pacientes (45.8%) lesiones que podían ser corregidas mediante cirugía se encontraron en 24 pacientes (15.4%). Como era anticipable, la frecuencia de CTs anormales fue más elevada (73%) enfermos con ataques par‐dales. Aunque el CT es, sin duda, útil en la evaluación de la causa de los ataques, no se ha demostrado lesiones en un nfl‐mero relativamente altos de pacientes (37.4%).
The Exact Ictal and Interictal Duration of Electroencephalographic Neonatal Seizures
Authors: Clancy Robert R. , Legido Agustin
Published: November 2007

Summary: The temporal behavior of neonatal seizures caused by diverse acute encephalopathies in 42 patients with 487 seizures was studied. All 487 seizures were confirmed by typical ictal electroencephalogram (EEG) patterns. Neonatal seizures are relatively brief events, which usually last about 2 min. They are recurrent and are separated by interictal recovery periods of variable duration, on the average, about 8 min. Solitary prolonged seizures are rare and do not represent the usual behavior of neonatal seizures.

L'évolution dans le temps de crises néonatales secondaires à diverses encéphalopathies aiguës a étéétudiée chez 42 patients ayant présenté un total de 487 crises. Les 487 crises ont toutes été confirmées par un aspect EEG critique typique. Les crises néonatales sont des phénomènes relativement brefs qui durent en général environ 2 minutes. Elles réridivent et sont séparées par des périodes intercritiques de récuperation de durée variable, en moyenne autour de 8 minutes. Les crises isolées et prolongeés sont rares et ne représented pas l'évolution habituelle des crises néonatales.

Se ha estudiado el comportamiento temporal de los ataque neonatales causados por diversas encefalopatías agudas en 42 pacientes que habían padecido 487 ataques. Cada uno de los 487 ataques fue confirmado mediante patrones típicos ictales en el EEG. Los ataques neonatales son, generalmente, aconteci‐mientos relativamente cortos que habitualmente duran alrededor de 2 minutos, son recurrentes y estan separados por perïodos de recuperacidn interictal de duración variable con un promedio de 8 minutos. Ataques prolongados solitarios son raros y no repre‐sentan el comportamiento habitual de los ataques neonatales.

Der zeitliche Verlauf von NeugeborenenAnfällen bei verschie‐denen akuten Encephalopathien bei 42 Patienten mit 487 An‐fallen wurde untersucht: Alle Anfälle waren von einem typis‐chen EEG‐Muster begleitet. NeugeborenenAnfälle sind relativ kurze Ereignisse mit einer Dauer bis zu 2 Minuten. Sie treten wiederholt auf und sind durch interiktuale Erholungsperioden unterschiedlicher Dauer–im Mittel 8 Minuten–getrennt. Ein‐zelne, lang dauernde Anfälle sind selten und entsprechen nicht den normalen NeugeborenenAnfällen.
Inferior Collicular Interactions with Limbic Seizure Activity
Authors: McCown Thomas J. , Greenwood Robert S. , Breese George R.
Published: November 2007

Summary: : Because under certain conditions, seizure activity electrically elicited from layers III and IV of the inferior collicular cortex can spread into forebrain regions, potential inferior collicular interactions with the amygdala were studied. Following acute electrical initiation of seizure activity from the inferior colliculus, no changes in amygdala EEG activity were noted. Following repetitive stimulation of the inferior colliculus, however, postictal spiking activity was noted in the amygdala, similar to interictal spiking reported for amygdala kindling, but this abnormal EEG activity did not coincide with any observable behavioral change. Conversely, the course of amygdala kindling in animals previously stimulated in the inferior colliculus progressed quite differently in comparison to control animals. Those animals repetitively stimulated in the inferior colliculus required a significantly greater number of amygdala kindling stimulations to reach class 5 seizure activity than did animals that received no inferior collicular stimulation and, unlike the controls, the chronic inferior collicular stimulation group usually regressed to class 2 or 3 seizure activity after the first class 5 seizure. Furthermore, the chronic inferior collicular stimulation group all exhibited wet‐dog shakes during the amygdaloid kindling stimulation, whereas at no time did controls exhibit wet‐dog shake behaviors. Finally, the seizure generalization from the inferior colliculus appears to be mediated by a mechanism distinct from the acute seizure activity, because a dose of diazepam (0.4 mg/kg), or carbamazepine (10 mg/kg), which had no effect on the wild running seizure, blocked behaviors indicative of seizure generalization. The significance of these results to epilepsy is discussed.
The Early Phase of Cryogenic Lesions: An Experimental Model of Seizures Updated
Authors: Loiseau H. , Averet N. , Arrigoni E. , Cohadon F.
Published: November 2007

Summary: : Following cryogenic lesions in 64 rabbits, epileptic activity and gray matter edema were correlatively investigated during the initial phase (23 h). Indexes were developed to allow a quantitative assessment of epileptic activity. The indexes demonstrated that the early phase of cryogenic epilepsy is a very rapid phenomenon during the first 4 h postlesion. Epileptic activity precedes brain edema, and in individual animals, there is a significant positive correlation between the total amount of epileptic activity and the total amount of edema. The relationship between epileptic activity and brain edema are most likely interrelated at the level of pathophysiological mechanisms and several mechanisms can be postulated.
Risk Factors for Epilepsy: Case‐Control Study in Nigerians
Authors: Ogunniyi A. , Osuntokun B. O. , Bademosi O. , Adeuja A. O. G. , Schoenberg Bruce S.
Published: November 2007

Summary: : In a case‐control study we compared 155 Nigerians affected by epilepsy, with an equal number of controls matched for age and sex, with the aim of identifying risk factors of epilepsy. Febrile convulsions and head trauma (with odds ratios of 11.0 and 13.0, respectively) were significant risk factors (p < 0.01). Childhood immunizations were found associated with a decreased risk of epilepsy. None of the following factors was significantly associated with epilepsy: hemoglobinopathy, venereal disease, use of psychotropic drugs or alcohol, and cerebrovascular disease. Preventive measures for the risk factors identified are suggested as ways of reducing the burden of epilepsy in Nigeria.
Reading Epilepsy
Authors: Mesri J. C. , Pagano M. A.
Published: November 2007

Summary: This is a report of a 21‐year‐old woman with reading epilepsy. Clinical and electroencephalographic (EEG) observations are presented while the patient (a) read a news magazine in Spanish, (b) read a magazine in English, (c) read an announcement repetitively, (d) viewed comic strips without legends, (e) made a mathematical calculation. Only reading in Spanish produced clinical and EEG paroxysms. This case report supports the “communication” hypothesis as opposed to hypotheses that emphasize propioceptive and other “lower order” stimuli in evoking seizures while reading.
Predisposing and Causative Factors in Childhood Epilepsy
Authors: Nelson Karin B. , Ellenberg Jonas H.
Published: November 2007

Summary: We review information from large studies of defined populations, examining the role of known factors and especially of prenatal and perinatal factors in contributing to nonfebrile seizure disorders of early childhood. We depend especially, but not exclusively, on the recently completed analyses from the Collaborative Perinatal Project of the National Institute of Neurological and Communicative Disorders and Stroke, the NCPP. About 4% of children in the NCPP who had at least one non‐febrile nonsymptomatic seizure by the age of 7 years had a previous seizure during acute neurologic illness, such as meningitis or during the acute illness after trauma. Many such seizures should potentially be preventable. Of children with seizures, 10% had had a neonatal seizure and 13% had had a febrile seizure. Among the hundreds of prenatal and perinatal factors explored as predictors of childhood seizure disorders, the principal predictors identified were congenital malformations of the fetus, cerebral and noncerebral; family history of certain neurologic disorders; and neonatal seizures. In agreement with the British National Child Development Study, labor and delivery factors in the NCPP appeared to contribute very little to childhood seizure disorders. Maldevelopment, rather than damage at birth to an initially intact nervous system, appeared to be the more common mechanism. Most seizure disorders of early childhood remained unexplained by the large set of prenatal and perinatal characteristics examined.
Etiologic and Preventive Aspects of Epilepsy in the Child–Bridging the Gap Between Laboratory and Clinic
Authors: Lombroso Cesare T. , Burchfiel James L.
Published: November 2007

Summary:Four broad categories of basic phenomena are pertinent to developing ways to prevent epilepsy. These include mechanisms of epileptogenesis, ictal initiation and temporary entrainment by the seizure discharge of normally functioning brain, seizure propagation, and control mechanisms that function both to restrain the cascade of epileptic events culminating in a seizure and to arrest the epileptic event and restore the interictal state. In newborns and children, hypoxia‐ischemia is a major factor leading to epileptogenesis, and several schemes are proposed to classify, quantify, and prevent hypoxic‐ischemic encephalopathy. Control mechanisms must be better understood in order to develop prophylactic recommendations for epilepsy, and an experimental model of “kindling antagonism” may increase our understanding of these. Programs of prevention of seizures in children will evolve only if basic researchers and clinicians work productively together to develop an adequate understanding of factors important in epileptogenesis and antiepileptogenic control mechanisms.
Special Pharmacokinetic Considerations in Children
Authors: Dodson W. Edwin
Published: November 2007

Summary: Pediatric patients have greater degrees of pharmacokinetic variability and unpredictability than adults. This variability results from the effects of pharmacogenetics, age and growth, prior and current comedication, and disease. Newborns with seizures have the least predictable dosage requirements, and their needs change as drug‐eliminating mechanisms mature in the neonatal period. Infants have the highest relative capacities to eliminate antiepileptics of any age group and require the largest relative doses. In addition to age‐related trends, children demonstrate the same drug‐specific, pharmacokinetic phenomena that adults do, including nonlinear phenytoin elimination, nonlinear valproate binding, and autoinduction of carbamazepine. Intercurrent illness and drug interactions further modify the age‐related pharmacokinetic patterns in children and make dosage requirements even more unpredictable. Recent studies have shown that febrile illness can affect drug elimination, sometimes decreasing drug levels by 50% or more. Intermittent treatment with benzodiazepines administered either orally or rectally can be an important adjunct and help minimize this type of problem for children with marginally controlled epilepsy. Intermittent benzodiazepines are also helpful for children who have febrile seizures and who need only occasional antiepileptic protection.
Cognitive Dysfunction Associated with Antiepileptic Drug Therapy
Authors: Vining Eileen P.G.
Published: November 2007

Summary: Epilepsy is frequently associated with cognitive dysfunction. However, the reasons for this correlation are unclear. Possible influential factors include patient age; duration, frequency, etiology, and type of seizures; hereditary factors; psychosocial issues; and antiepileptic drug (AED) therapy. Whereas many of these factors are beyond the physician's control, AED therapy is one element that can be addressed in treatment decisions by recognizing the potential cognitive effects of particular AEDs. For example, phenobarbital impairs memory and concentration; phenytoin affects attention, problem solving ability, and performance of visuomotor tasks. In contrast, carbamazepine may affect concentration, while valproate would appear to have minimal effects on cognition. Moreover, cognitive effects of AEDs are amplified with coadministration of multiple anticonvulsants (polytherapy). A review of studies on the cognitive effects of monotherapy with AEDs, as opposed to those of polytherapy, provides evidence that drug‐related cognitive dysfunction can be reversed if patients are switched to a simpler therapeutic regimen. Future research should be directed toward developing reliable measures for assessing and monitoring cognition, and understanding the particular cognitive side effects of each AED. Physicians also need to revise their opinions about which side effects are “tolerable” for epileptic patients.
Pharmacology of Antiepileptic Drugs
Authors: Ferrendelli James A.
Published: November 2007

Summary: Several different types of chemical compounds are useful as antiepileptic drugs. Their mechanisms of action, as well as their physical structures, differ. Compounds such as carbamazepine, phenytoin, and probably valproate act by modifying ionic conductances, particularly sodium and calcium, in excitable membranes, thus limiting sustained high‐frequency neuronal discharges. In contrast, barbiturates and benzodiazepines tend to affect 7‐aminobutyric acid (GABA) mediation of the chloride channel opening. Knowledge of drug mechanisms is important for choosing the proper drug for various seizure types. In addition, an understanding of antiepileptic drug pharamcokinetics, nonther‐apeutic effects, and interactions is essential for optimal therapy. The lack of uniform pharmacokinetics among patients and among different formulations of a drug can make it difficult to arrive at uniform criteria for both seizure control and determinations of toxicity. Both pharmacokinetic and pharmacodynamic interactions can occur between antiepileptic medications and other drugs. Three major types of side effects with anticonvulsants can be identified: dose‐related alterations of neurologic function, idiosyncratic reactions, and nonidiosyncratic direct actions on other organ systems. These effects often compromise treatment.
Anticonvulsant Drugs and Cognitive Function: A Review of the Literature
Authors: Trimble Michael R.
Published: November 2007

Summary: Alterations of cognitive function are separate from disturbances of behavior seen in association with epilepsy. The nature of the cognitive disability may to a certain extent depend on the seizure type. Partial seizures, mainly derived from a temporal lobe focus, impair memory tasks, while generalized seizures seem to have more effect on attentional abilities. A number of studies, reviewed in this paper, suggest that anticonvulsant drugs further impair cognitive function. Maximal impairments are seen in patients receiving polytherapy: rationalization of polytherapy improves cognitive abilities. Studies in children and adults have allowed differentiation of the effects of various commonly used antiepileptic agents. Maximal cognitive deficits are seen with. phenytoin, while phenobarbital and sodium valproate induce moderate disturbances, and carbamazepine seems relatively free from such toxicity. Further research is needed on the interrelationship between types of seizure disorders, types of anticonvulsant medications, and cognitive function.
Carbamazepine Side Effects in Children and Adults
Authors: Pellock John M.
Published: November 2007

Summary: Most of the side effects associated with carbamazepine (Tegretol®, USP, Geigy Pharmaceuticals) therapy are mild, transient, and reversible with an adjustment in dosage or rate of dosage increase. Direct reports to Geigy Pharmaceuticals for the period 1975 to 1986 totaled 371 hematologic, 396 dermatologic, and 156 hepatic and pancreatic occurrences out of more than 4 million patients treated. These include 27 cases of aplastic anemia and 10 of agranulocytosis. In a study of the incidence of side effects in 220 children below the age of 16 years who were receiving carbamazepine, drowsiness, loss of coordination, and vertigo were the most commonly observed side effects and were almost always transient and dose related. The findings of this study are comparable with those of other series assessing carbam‐azepine‐associated adverse reactions in children and adults. Overall, 30 to 50% of children and adults were reportedly free of side effects in these studies. Recommendations for carbamazepine therapy include education of patients and parents in the nature and likelihood of possible serious adverse reactions and routine monitoring to detect laboratory abnormalities.
Juvenile Myoclonic Epilepsy: A Study in Saudi Arabia
Authors: Obeid T. , Panayiotopoulos C. P.
Published: November 2007

Summary: We studied 50 patients in Saudi Arabia with juvenile myoclonic epilepsy (JME). There was a high positive family history of epilepsy (48.7%) and a high prevalence (10.7%) of other forms of epilepsy. JME was unrecognized at the time of referral for all patients. Age at onset varied from 6 to 28 years with an average of 15.5 years. Treatment was effective with valproate or with clonazepam; 42 patients were seizure‐free for a minimum of 6 months of follow‐up. EEG abnormalities were recorded in 37 patients; photoconvulsive responses were elicited in 15 patients but only 1 was clinically photosensitive.

Hemos estudiado 50 pacientes de Arabia Saudita con epilepsyía mioclónica juvenil. Se encontró una importante historia familiar positiva de epilepsyía (48.7%) y una alta prevalencia (10.7%) de otras formas de epilepsyía. La epilepsyía mioclónica juvenil había pasado desapercibida hasta el momento de referir a todos los enfermos para su estudio. La edad de comienzo variaba entre 6 y 28 años con un promedio de 15.5 años. El tratamiento fue eficaz con Valproato y Clonazepam; 42 pacientes permanecieron libres de ataques durante un mínimo de 6 meses de sequimiento. Las anormalidades electroencefÁlograTicas se registraron en 37 pacientes; respuestas fotoconvulsivas fueron apreciadas en 15 enfermos pero solamente uno era clínicamente fotosensible.
Acquired Aphasia with Epilepsy–Landau‐Kleffner Syndrome
Authors: Sawhney I. M. S. , Suresh N. , Dhand U. K. , Chopra J. S.
Published: November 2007

Summary: Landau‐Kleffner syndrome is characterized by long‐lasting acquired aphasia associated with seizures and EEG abnormalities. Three new cases of this rare syndrome are reported from India.

Le syndrome de Landau‐Kleffner se caractérise par une aphasie acquise de longue durée et des crises et anomalies EEG. Les auteurs décrivent trois nouveaux cas de ce syndrome rare, rencontrés en Inde.

El síndrome de Landau‐Kleffner se caracteriza por una afasia adquirida de larga duración, asociada a ataques y a anomalías en el EEG. Tres casos nuevos de este raro síndrome se publican desde la India.

Das LKS wird charakterisiert durch eine lang anhaltende er‐worbene Aphasie, die mit AnfaUllen und pathologischem EEG einhergeht. Über 3 neue Falle dieses seltenen Syndroms in In‐dien wird berichtet.
Increased Concentration of Prostaglandin E‐2 in Cerebrospinal Fluid of Children with Febrile Convulsions
Authors: Loscher Wolfgang , Siemes Hartmut
Published: November 2007

Summary: Concentrations of prostaglandins (PGs) in the central nervous system are known to increase during and after experimentally induced seizures. In the present study, concentrations of PGE‐2 were determined by radioimmunoassay in lumbar cerebrospinal fluid (CSF) of 17 children shortly after a febrile convulsion. PGE‐2 data of these children were compared with those determined in afebrile children and febrile children without convulsions. Duration of storage of CSF samples at ‐ 30oC prior to analysis had no influence on PGE‐2 levels. Compared with afebrile patients, PGE‐2 levels were significantly higher after febrile convulsions. Significantly elevated concentrations of PGE‐2 were also found in febrile children without seizures, although the mean PGE‐2 level in these patients was somewhat lower than that determined after a febrile convulsion. When body temperature of the patients was compared with their CSF PGE‐2 levels, a significant positive correlation was determined between both variables. It is therefore not clear if the increased concentrations of PGE‐2 in CSF of patients with febrile convulsions are, at least in part, to be related to increased PG synthesis and release during and after the seizure or are solely to be related to the febrile state of the children.

Die Prostaglandin‐Konzentration im zentralen Nervensystem steigt nach experimentell induzierten Anfällen an. In dieser Un‐tersuchung wurde RGE‐2 im Liquor mit einem Radioimmunoassay bei 17 Kindern kurz nach einem Fieberkrampf bestimmt. Die PGE‐2‐Ergebnisse bei diesen Kindern wurden mit denen von afebrilen Kindern und von febrilen Kindern ohne Anfälle vergli‐chen. Die Lagerung der Liquorproben bei ‐30oC. bis zur Analyse beeinflusste nicht die PGE‐2‐Spiegel. Im Vergleich mit afebrilen Patienten waren die PGE‐2‐Spiegel nach Fieberkrämpfen signifikant erhöht. Desgleichen wurden signifikant erhöhte PGE‐2‐Konzentrationen bei Kindern ohne Anfälle gefunden, die je‐doch im Mittel etwas niedriger waren als nach einem Fieberkrampf. Die PGE‐2‐Spiegel korrelierten signifikant positiv mit der Körpertemperatur der Patienten. Es ist somit nicht klar, ob die erhöhten Konzentrationen von PGE‐2 im Liquor von Patienten mit Fieberkrämpfen zumindest teilweise einer erhöhten PG‐Synthese und Freisetzung während oder nach einem Anfall oder alleine dem fieberhaften Zustand der Kinder zugeschrieben werden kann.
Penetration of Valproate and its Active Metabolites into Cerebrospinal Fluid of Children with Epilepsy
Authors: Löscher Wolfgang , Nau Heinz , Siemes Hartmut
Published: November 2007

Summary: Levels of the antiepileptic drug valproate (VPA) and five of its active metabolites (2‐en‐VPA, 3‐keto‐VPA, and 3‐,4‐, and 5‐hydroxy‐VPA) were determined by gas chromatography‐mass spectrometry in cerebrospinal fluid (CSF) of 15 epileptic children undergoing chronic treatment with VPA. In eight of these children, total and free drug and metabolite concentrations in plasma were also measured. All VPA metabolites present in plasma could also be detected in CSF, although concentrations were substantially'lower than those of the parent compound. CSF concentrations of VPA and most of its metabolites were positively correlated with total and free concentrations in plasma. However, concentrations in CSF were always significantly lower than free plasma concentrations, which may be explained by asymmetric transport at the blood‐CSF barrier. The data on low CSF levels of VPA metabolites do not exclude the possibility that accumulation of active metabolite(s) may occur in certain brain areas during chronic treatment of epileptic patients with VPA.
Deep Prepiriform Cortex Lesion and Development of Amygdala Kindling
Authors: Ludvig Nandor , Moshe Solomon L.
Published: November 2007

Summary: The effects of a unilateral thermocoagulating lesion of the deep prepiriform cortex on the development of amygdala kindling were studied in adult rats. The lesion did not alter the local excitability of the ipsilateral amygdala. Furthermore, the number of stimulations required to produce generalized seizures did not significantly differ between lesioned and control animals. The results suggest that the deep prepiriform cortex may not be important in the development of amygdala kindling.

Les effets ďune thermocoagulation lésionnelle unilatérale au niveau du cortex prépiriforme profond sur le développement ďun embrasement amygdalien ont étéétudiés chez lé rat adulte. Les lésions n'ont pas modifiéľexcitabilité locale de ľamygdale homolatérale. De plus, le nombre de stimulations nécessaires àľobtention de crises généralisées n'était pas significativement différent chez les animaux lésés et chez les animaux contrôles. Ces résultats suggèrent que le cortex prépiriforme profond ne semble pas jouer un rôle important dans le développement de ľembrasement amygdalien.

Los efectos de una lesión unilateral por termocoagulación de la corteza prepiriforme profunda sobre el desarrollo de un condicionamiento de la amigdala (kindling) han sido estudiados en ratas adultas. La Iesión no alteró la excitabilidad local de la amigdala ipsilateral. Además el número de estimulaciones requeridas para producir ataques generalizados no fue significativamente diferente entre los animales lesionados y los control. Estos resultados sugieren que la corteza profunda prepiriforme no parece ser importante en el desarrollo del condicionamiento de la amigdala (kindling).

Bei erwachsenen Ratten wurden die Auswirkungen von einer unilateralen Thermokoagulation des tiefen präpiriformen Kortex auf die Entwicklung des Amygdala‐Kindlings untersucht. Die Läsion änderte nicht die lokale Erregbarkeit des ispsilateralen Mandelkerns. Die Zahl von Stimulationen, die zur Erzeugung generalisierter Anfälle benötigt wurden, unterschied sich nicht signifikant zwischen den experimentellen Tieren und Kontrollen. Die Ergebnisse legen die Vermutung nahe, daβ der tiefe präpiriforme Kortex keine Rolle bei der Entwicklung des Amygdala‐Kindlings spielt.
Increased Valproate Serum Concentrations Upon Carbamazepine Cessation
Authors: Jann Michael W. , Fidone George S. , Israel Marc K. , Bonadero Peter
Published: November 2007

Summary: Valproate (VPA) serum concentrations (Cp) were followed in six epileptic mentally retarded patients when carbamazepine (CBZ) was discontinued. VPA Cp significantly increased when CBZ was discontinued. A new plateau of VPA Cp was achieved 4 weeks post‐CBZ discontinuation. This time factor is analogous to the autoinduction property of CBZ. Careful VPA Cp monitoring is recommended when CBZ or other enzyme inducing agents are discontinued.

Les taux sériques de valproate (VPA) ont été surveilles chez 6 patients épileptiques présentant un retard mental au décours de ľinterruption d'un traitement par carbamazépine (CBZ). Les taux sériques de VPA se sont significativement élévés apres interruption de la CBZ. Un nouveau plateau de concentration sérique du VPA a été observe 4 semaines aprés retrait de la CBZ. Ce facteur temps est à rapprocher des protriétes auto‐inductrices de la CBZ. Une surveillance soigneuse des taux sériques de VPA doit être effectuée lors de ľarrêt d'un traitment concommittant par la CBZ ou une autre molécule à activité inductrice enzyma‐tique.

En seis epilépticos con retraso mental en los que se interrumpió el tratamiento con carbamazepina (CBZ) se han seguido las concentraciones séricas (Cp) de Valproate (VPA). La Cp de VPA se incrementó significativamente al cesar la CBZ. Se al‐canzó un nuevo “planteau” de Cp de VPA a las 4 semanas de su interrupción. Este factor temporal es análogo a la propiedad de auto‐reducción de la CBZ. Se recomienda una monitorización cuidadosa cuando la CBZ u otros agentes de inducción enzi‐mática se interrumpen.

Die Valproat‐Serum‐Spiegel wurden bei 6 epileptischen, mental retardierten Patienten laufend untersucht nach Absetzen von Carbamazepin. VPA stieg signifikant an. Ein neues Plateau hatte sich 4 Wochen nach Carbamazepinentzug wieder eingestellt. Sorgfältige VPA‐Überwachung ist zu empfehlen, wenn Carba‐pazepin oder andere enzyminduzierende Substanzen abgestzt werden.
Fatal Aplastic Anemia in a Patient Treated with Carbamazepine
Authors: Franceschi Massimo , Ciboddo Gianfranco , Truci Giulio , Borri Anna , Canal Nicola
Published: November 2007

Summary: : A case of fatal aplastic anemia due to carbamazepine treatment in an epileptic woman is reported. Despite concerns of fatal bone marrow toxicity due to carbamazepine, this is only the fourth documented and published report. Carbamazepine is a safe drug, but physicians and patients should be aware of the exceedingly rare but potentially fatal side effects, better prevented by clinical than by laboratory monitoring.

Les auteurs rapportent un cas d'aeamie aplasique fatale secondare à un traitement par carbamazépine chez une patiente epileptique. En dépit des inquiétudes suscitées par la notion d'une toxicity médullaire potentiellement fatale ltée à la carbamazépine, ce cas n'est que la quatrième observation documented ée publicée. La carbamazépine est un médicament non dangereux, mais médecins et patients devraient étre avertis de ľexistence d'effets secondaires extrémement rares mais potentiellement fa‐tals, qui sont mieux prévenus par la surveillance clinique que par la surveillance biologique.

Se publica un caso fatal de anemia aplástica debido a un trat‐amiento concarbamazepina en una mujer epiléptica. A pesar de la preocupación de toxicidad fatal de la médula osea debido a la carbamazepina ésta constituye soalamente el cuarto caso docu‐mentado y publicado. La carbamazepina es una medicacioan segura pero potencialmente puede mostrar efectos colaterales fa‐tales que se evitan mejor siguiendo una observación clínica que mediante monitorización de laboratorio.

Es wird ein Fall einer aplastischen Anämie mit tödlichem Aus‐gang aufgrund einer Carbamazepin‐Behandlung bei einer epilep‐tischen Patientin benchtet. Obwohl Bedenken bezüglich einer tödlichen Knochenmarktoxizität durch Carbamazepin bestehen, ist dies erst der vierte dokumentierte und publizierte Fall‐Report. Carbamazepin ist ein sicheres Medikament, jedoch sol‐len Ärzte und Patienten sich der sehr seltenen, aber potentiell tödlichen Nebenwirkungen bewußt sein, die besser durch klini‐sche Beobachtung als labortechnische Maßnahmen verhutet werden können.
Paroxysmal Aphasias
Authors: Ardila Alfredo , Lopez Maria Victoria
Published: November 2007

Summary: Forty cases of paroxysmal aphasia were found in a sample of 4,000 patients with epilepsy. Twenty‐five had structural brain damage demonstrated by CT scan. Except for two cases, the epileptic focus was located in the left hemisphere. Two patients had a paroxysmal alexia associated with the aphasic disorder. Though preliminary, our data suggest a correlation of dysphasic components with posterior lesions and phonatory components with anterior lesions.

40 cas d'aphasie paroxystique ont été trouves parmi 4,000 patients épileptiques. 25 patients présentaient une lesion cérébrale prouvée par la tomodensitométrie. Sauf dans 2 cas, le foyer éileptique se trouvait dans ľhémisphere gauche. 2 patients présentaient une alexie paroxystique associée a ľaphasie. Nos con‐statations, bien que preliminaires, suggerent qu'il existe une correlation entre les composantes dysphasiques et les lesions post^rieures, et les componsantes phonatoires et les lesions an‐t^rieures.

Se hallaron 40 casos de afasias paroxisticas en una muestra de 4.000 pacientes con epilepsia. Entre ellos, 25 presentaben un dafio estructural mostrado escanograficamente. Exceptuando dos casos, los demas pacientes presentaban un dano hemisfer‐ico izquierdo; dos de los pacientes presentaban una alexia par‐oxistica. Se analizan los diferentes tipos de alteraciones paroxisticas del lenguaje. Aunque nuestra informacidn es preliminar, sugiere la existencia de una correlacion de los componenetes disfasicos con posibles lesiones posteriores y del componente fonatorio con lesiones anteriores.