bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of a self‐directed learning package on emergency nurses’ knowledge of assessment of oxygenation and use of supplemental oxygen
Authors: Considine Julie , Botti Mari , Thomas Shane
Published: August 2005

Abstract  Emergency nurses frequently and independently make decisions regarding supplemental oxygen. The importance of these decisions for patients is highlighted by the well documented association between respiratory dysfunction and adverse events. This study aimed to: (i) examine the effect of educational preparation on emergency nurses’ knowledge of assessment of oxygenation, and the use of supplemental oxygen; (ii) explore the impact of existing knowledge on decisions related to the implementation of supplemental oxygen; and (iii) explore nurses’ characteristics that were associated with effectiveness of the educational preparation. A pretest/post‐test, controlled, quasi‐experimental design was used in this study. Educational preparation was effective in increasing emergency nurses’ knowledge. Baseline level of knowledge was predictive of reports of independent decisions regarding the implementation of oxygen. There was a significant positive relationship between postgraduate qualification in emergency nursing and the effect of education, and significant negative relationships between effect of education and baseline level of knowledge and daily decisions to implement supplemental oxygen.
How effective is email communication for patients requiring elective surgery?
Authors: Ketteridge Geraldine , Delbridge Hilary , Delbridge Leigh
Published: August 2005

Background:  Patients increasingly use the Internet for communication as well as to obtain information, but there are few published reports on either the utilization or effectiveness of email as a means of communication between patient and surgeon. The aim of the present study is to examine the effectiveness of email communication by patients prior to undergoing elective surgery.

Methods:  This is a retrospective cohort study of 306 patients undergoing thyroid or parathyroid surgery at a tertiary referral centre who had been provided with an information sheet promoting email communication compared to 352 patients in a control group who had not been provided with the same information.

Results:  In the study group 50 of 306 patients (16%) utilized email communication. There was a statistically significant difference (P = 0.0004) in the age distribution between those who did (mean: 46.2, 95% confidence interval (CI): 42.0−50.4) and those who did not (mean: 54.6, 95%CI: 52.7−56.4) utilize emails, with the email users representing a younger population. In the control group, only 10 of 352 (3%) used email, a significantly lower percentage (P = 0.0001) than in the study group. A total of 101 emails were sent by 50 patients in the study group. Of these, the majority did so only once (n = 28−56%), with one patient sending seven separate emails. Most emails sent focused on only one issue, but some patients raised multiple issues with the most being seven issues in a single email.

Conclusions:  Despite concerns about potential medicolegal issues and other disadvantages, routine email communication between physician and patient provides an effective means of communication for patients undergoing elective surgery.
Colon perforation in an adolescent after short‐term diclofenac intake
Authors: Schiffmann L. , Kahrau S. , Berger G. , Buhr H. J.
Published: August 2005

Chronic intake of non‐steroidal anti‐inflammatory drugs (NSAIDs) has been reported to cause side‐effects distal to the duodenum. These include strictures, diaphragm‐like lesions and perforations of the small and large intestines. This is the first case report on colon perforation occurring in an adolescent (16‐year‐old girl) after short‐term diclofenac intake.
Randomized, prospective comparison of postoperative pain in low‐ versus high‐pressure pneumoperitoneum
Authors: Koc Mahmut , Ertan Tamer , Tez Mesut , Kocpinar M. Ali , Kilic Mehmet , Gocmen Erdal , Aslar A. Kessaf
Published: August 2005

Background:  Reduced postoperative pain after laparoscopic cholecystectomy (LC) compared to open cholecystectomy (OC) may be able to be further optimized. To reduce pain, focus should be directed on the effects of individual components of pain.

Methods:  A double‐blind, randomized, controlled trial was carried out in a tertiary care hospital. Fifty‐three elective patients with symptomatic gallstones were enrolled into the study. Patients were randomized to low‐ or high‐pressure pneumoperitoneum groups. In all patients, gas pressure was set to 15 mmHg during placement of ports. Later on, in the low‐pressure group, the rest of the procedure was performed at 10 mmHg pressure. At 6 and 24 h postoperatively, a short‐form McGill Questionnaire (MPQ) was obtained from all patients. Patients were then asked to complete a 10‐cm visual analogue scale (VAS) for abdominal pain.

Results:  Pain scores were generally low for both groups. Statistical comparisons of mean cumulative McGill score and VAS abdominal pain scores in both groups did not reach statistical significance at 6 and 24 h after operation.

Conclusion:  There was no correlation between high‐ and low‐pressure laparoscopy and postoperative pain after LC. Peritoneal stretching may be more responsible for shoulder pain but has less effect on intensity of abdominal pain or incisional pain. On the basis of these negative findings, routine use of low‐pressure pneumoperitoneum for alleviation of postoperative pain following LC is not recommended.
Meningiomas and the Polynesian population
Authors: Olson Sarah , Law Andrew
Published: August 2005

Background:  In Auckland Hospital, New Zealand there has been a perception for many years that the incidence of meningiomas was higher in Polynesians. It was also suspected these occurred at a younger age in Polynesians and were more likely to be multiple. The purpose of the present study was to confirm whether the Polynesian population does have a higher incidence of meningioma, review at what age they presented with meningioma and compare the outcome of treatment with Caucasians.

Methods:  A retrospective review was performed of 302 patients who had had a cranial meningioma excised in the 10 years between 1991 and 2001 at Auckland hospital. Age, sex, ethnicity, number of tumours, type, size, comorbidities, time to presentation and outcome at discharge and follow‐up were recorded.

Results:  Polynesians had a significantly higher incidence of meningiomas (P < 0.0001). In particular Polynesian women were significantly over represented. (P < 0.05). Polynesians were more likely to have two or more tumours (P < 0.02) and they presented at a significantly younger age (P < 0.0001). The tumours were also larger. (P = 0.0006). Despite this Polynesians did not have a worse outcome at discharge or at follow up (P > 0.1) nor did they have a higher incidence of comorbidites, perhaps reflected by their younger age.

Conclusions:  There is a higher incidence of meningiomas in the Polynesian population, particularly young Polynesian women. The tumours are more likely to be multiple and larger in Polynesians. The present study confirms a predisposition to meningioma in New Zealand Polynesians and should lead to further investigation into whether this is genetic (likely chromosome 22) or hormonal possibly mediated by insulin‐like growth factor‐1.
Undergraduate experience of surgical teaching and its influence and its influence on career choice
Authors: Ek Edmund W. , Ek Eugene T. , Mackay Sean D.
Published: August 2005

Background:  The purpose of this survey was to determine the views of final year medical students in Melbourne regarding both undergraduate surgical teaching and the students’ career aspirations.

Methods:  A structured questionnaire was given to all final year medical students at Monash and Melbourne Universities in 2003. The questions dealt with the factors influencing graduating medical students, including theatre experience, encouragement/support from surgeons, presence of mentors, lifestyle factors and gender issues.

Results:  The response rate was 61.2% (251/410). Of these, 50.6% were male, 32.3% declared an interest in surgical training with the remainder either uncertain (24%) or uninterested (44%). Male students were more likely to be interested in surgery. General surgery was the most popular field (69%), followed by plastic surgery (37%) and orthopaedic surgery (35%). Of respondents, 78% reported positive influences towards pursuing a surgical career during their undergraduate years, while 63% reported a negative experience. A total of 67% believed that the current curriculum is adequate and 43% that there is enough support/encouragement towards a surgical career. Only 44% of respondents reported that surgeons are approachable. Lifestyle and family factors were the most important career influence. In particular, 57% of female respondents felt discouraged from pursuing a surgical career and 99% of these women reported lifestyle/family factors as the main source of discouragement, with a further 72% identifying a lack of female role models.

Conclusions:  This survey highlights important issues in current undergraduate perception of surgical teaching and higher training. Issues that may encourage or discourage a graduating student to pursue a surgical career are identified.
Information, understanding and the benign order of everyday life in genetic counselling
Authors: Lehtinen Esa
Published: August 2005

Genetic counselling as a medical encounter is characterised by the centrality of the provision of information. Much of the counselling session is filled by information delivery about the symptoms, the prognosis and the transmission of the disease, the risks involved and the possibilities for genetic testing. The present paper is a study of how information is delivered in actual genetic counselling sessions. The data consist of 10 video‐recorded sessions from a genetics clinic in Finland, and the methodology is based on conversation analysis. The paper focuses on the doctor's talk in a specific interactional context, the slot after a candidate understanding by a client. The analysis shows that the doctors have two basic orientations: they work towards securing correct understanding and they display being attuned to what the information means to the clients, particularly to whether it is positive or negative to them. The latter orientation is related to what has been called ‘the benign order of everyday life’ (Maynard 2003). The findings in the paper offer a possibility for a discussion about the principles and practices of genetic counselling.
Do occupation and work conditions really matter? A longitudinal analysis of psychological distress experiences among Canadian workers
Authors: Marchand Alain , Demers Andrée , Durand Pierre
Published: August 2005

This study analyses the relationship between occupation, work conditions and the experience of psychological distress within a model encompassing the stress promoted by constraints‐resources embedded in macrosocial structures (occupational structure), structures of daily life (workplace, family, social networks outside the workplace) and agent personality (demography, physical health, psychological traits, life habits, stressful childhood events). Longitudinal data were derived from Statistics Canada's National Population Health Survey and comprised 6,359 workers nested in 471 occupations, followed four times between 1994–1995 and 2000–2001. Discrete time survival multilevel regressions were conducted on first and repeated episodes of psychological distress. Results showed that 42.9 per cent of workers had reported one episode of psychological distress and 18.7 per cent had done so more than once. Data supported the model and challenged the results of previous studies. The individual's position in the occupational structure plays a limited role when the structures of daily life and agent personality are accounted for. In the workplace, job insecurity and social support are important determinants, but greater decision authority increases the risk of psychological distress. Workplace constraints‐resources are not moderated either by the other structures of daily life or by agent personality.
Rule of law, democracy, openness, and income
Authors: Rigobon Roberto , Rodrik Dani
Published: August 2005

We estimate the interrelationships among economic institutions, political institutions, openness, and income levels, using identification through heteroskedasticity (IH). We split our cross‐national dataset into two sub‐samples: (i) colonies versus non‐colonies; and (ii) continents aligned on an East–West versus those aligned on a North–South axis. We exploit the difference in the structural variances in these two sub‐samples to gain identification. We find that democracy and the rule of law are both good for economic performance, but the latter has a much stronger impact on incomes. Openness (trade/GDP) has a negative impact on income levels and democracy, but a positive effect on rule of law. Higher income produces greater openness and better institutions, but these effects are not very strong. Rule of law and democracy tend to be mutually reinforcing.
Institutions matter, but which ones?
Authors: Bardhan Pranab
Published: August 2005

The purpose of this paper is to go beyond the narrow focus of the current institutional economics literature in development on the institutions protecting individual property rights, and to look at the economic effects of some other aspects of institutional quality on the development process (like democratic participation rights and institutions to address coordination failures). Another purpose is to suggest an alternative instrumental variable in quantifying the effects of property rights institutions. Finally, we speculate how, on account of distributive conflicts, institutions that have an adverse effect on economic performance often tend to persist for long periods of time in many poor countries.
Economic development and the decline of rural and urban community‐based networks*
Authors: Munshi Kaivan , Rosenzweig Mark
Published: August 2005

This paper studies how traditional networks in rural and urban India have responded to economic development. In rural areas, the impact of the Green Revolution on within‐network inequality has resulted in defection by the wealthiest members of caste‐based social insurance networks. In Bombay, the most able members of the caste‐based labour market networks are exiting from the traditional occupations to participate in new occupations in which individual rather than group ability is rewarded. In both cases, the weakest members of the community are left in networks that now have lowered capacity to provide services.
A retrospective study in the use of botulinum toxin type‐A in a UK multidisciplinary cosmetic practice
Authors: Bowler Patrick J
Published: August 2005

Background  Botulinum toxin type‐A is established as safe and effective and is widely used for cosmetic indications; however, little data exist on patient satisfaction following treatment.

Aims  To correlate patient satisfaction with dose levels in the treatment of hyperfunctional facial lines.

Patients/methods  Retrospective data were collected on 300 patients treated with Botox® for facial lines. Patients completed a subjective assessment of satisfaction with their treatment, and details of dose and treatment area were recorded.

Results  Eighty‐five percent of patients rated their satisfaction with treatment as ≥ 8 (on a 10‐point scale), with higher scores seen at higher dosages. The highest mean score was seen in the 51–75 U dose group. Satisfaction was highest in patients who had three facial areas treated vs. those who had one or two areas treated. No safety issues were raised.

Conclusions  The results show a high level of satisfaction with botulinum toxin type‐A treatment, with most patients achieving a desired “natural” look. Future studies should be carried out to standardize ways of achieving optimum patient satisfaction to maximize the link between physical appearance and psychological well‐being.
Removal of amateur blue‐black tattoos in Arabic women of skin type (III–IV) with Q‐switched alexandrite laser
Authors: Bukhari Iqbal A
Published: August 2005

Background and Objectives  Tattoos in Arabic society used to have a cosmetic importance on the face of females. These were usually amateur tattoos done by non‐professional women in the tribe. Because Islam as a religion prohibited its practice and its application, people became concerned about removing the old tattoos by any means. Nowadays, laser is considered an effective method of tattoo removal. Here, we report our experience in the removal of tattoos in Arabic women of skin type III–IV using the Q‐switched alexandrite laser.

Study Design/Materials and Methods  Twenty female subjects aged 35–50 years from similar racial and ethnic background with amateur tattoos were treated using the Q‐switched alexandrite laser. Fluence threshold was determined and a spot test was made. Q‐switched alexandrite laser with a fluence range 4.0–7.5 J/cm2 (mean 6.05) was used at 6–12‐week intervals. Total treatment numbers ranged from three to six sessions (mean 4.15) with single‐pulse technique application.

Results  More than 95% lightening was achieved in five patients after three to six sessions at fluence range of 6–7.5 J/cm2 and > 75% lightening in 10 subjects after three to six sessions of treatment at fluence range of 4–7.5 J/cm2. Pinpoint bleeding was observed in one case but no pigmentary alteration or scarring was seen.

Conclusion  Tattoo pigment removal by Q‐switched alexandrite laser is an effective method in skin type (III–IV) with minimal side effects, which gives high patient satisfaction.
Medium‐depth and deep chemical peels
Authors: Camacho Francisco M
Published: August 2005

Chemical peeling, also known as chemoexfoliation or dermapeeling, is performed to improve the skin's appearance as it reduces the wrinkles caused by aging and the features of photoaged skin. Although the best results are obtained with deep peels, the medium‐depth peels allow to obtain excellent results without the dangerous side effects of deep peels.

Medium‐depth peelings are performed with trichloroacetic acid (TCA) at 35–50% alone or at 35% in combination with Jessner's solution, 70% glycolic acid, and solid CO2. TCA must be applied with a cotton‐tipped applicator or saturated gauze pads with smooth strokes. After application, a dry gauze pad must be used to blot the excess TCA from the skin. Postoperative care of 35% TCA peeling consists of cleansing during the following days.

Habitually, medium‐depth peelings with TCA alone or in combination have no complications. Sometimes, as a consequence of the patient's type of skin, the practitioner's lack of experience or other circumstances, complications such as hyper‐ or hypopigmentation, erythema, hypertrophiyc and keloid scars, infections, and milia may occur.

Deep peeling with phenol has two modalities: unoccluded and occluded Baker's formula phenol. Unoccluded phenol peels is similar to the medium‐depth peeling with Jessner's solution + TCA at 35%, but it has the disadvantage that it may produce cardiac and renal complications. This kind of peeling must be applied more slowly, and it is specific for the eyelids in full‐face deep peeling. Afterpeel care is the same as that of medium‐depth peeling.

Complications of deep peelings can be cardiac arrhythmias, hypertrophic scars, infections, prolonged erythema, pigmentary changes, cutaneous atrophy, and exceptionally toxic shock syndrome.
Psychological aspects of hair disease
Authors: Grimalt Ramon
Published: August 2005

Balding men are viewed as less desirable in a physical, personal, and social sense. Given the stereotype, it is not surprising that some men with androgenetic alopecia (AGA) appear to have a lower self‐image, depression resulting in increased introversion, and increased feelings of unattractiveness.

Ours is a culture that places a premium on physical appearance. In this context, appearance‐altering conditions can be psychosocially insidious, especially conditions such as AGA with an uncertain course and a negative social meaning.

To date, little or no data have been available regarding the psychosocial and quality‐of‐life aspects of AGA in a representative sample of community men. It is unknown whether AGA is a causal factor in the development of low self‐esteem, depression, introversion, and feeling of unattractiveness, or whether there are underlying problems in certain patients prior to hair loss. Longitudinal studies will be important to investigate the temporal relationships between the degree of hair loss and psychosocial variables associated with AGA.

A patient with male pattern baldness will be better treated and consequently more satisfied (better quality of life) if he receives effective anti‐alopecia agents and simultaneously is evaluated and treated, if needed, for his psychological disorder.
Community‐Based Study of Mortality in Children with Epilepsy
Authors: Harvey A. Simon , Nolan Terry , Carlin John B.
Published: August 2005

Summary: Summary: We used the records of a statewide pediatric mortality surveillance system to determine mortality rates and causes of death in children with epilepsy. Of the 1,095 children aged 1–14 years who died in the state of Victoria during the study period 1985–1989,93 had a history of epilepsy. Six children (6%) had primary epilepsy, and 87 (94%) had secondary epilepsy. Death was (a) directly attributable to epilepsy in 20 (22%), including 11 with sudden unexplained death, (b) not directly attributable to epilepsy in 59 (63%), and (c) of undetermined cause in 14 (15%). No classifiable death occurred as a direct result of status epilepticus. The average annual mortality rates for children with epilepsy were (a) death from all causes, 30.6 in 10,000 [95% confidence interval (CI) 19.7, 47.51, and (b) death attributable to epilepsy, 6.6 in 10,000 (95% CI 3.7, 11.8). Relative to the all‐cause mortality rate in children without epilepsy, the all‐cause mortality rate ratios were (a) all children with epilepsy, 13.2 (95% CI 8.5, 20.7); (b) primary epilepsy, 1.1 (95% CI 0.5, 2.6); and (c) secondary epilepsy, 49.7 (95% CI 31.7, 77.9). The mortality rate ratios for secondary epilepsy relative to primary epilepsy were (a) death from all causes, 43.5 (95% CI 19.0, 99.5); and (b) death attributable to epilepsy, 9.0 (95% CI 3.3, 24.8). Epilepsy appeared on the death certificate of only 11 of 20 (55%) children whose deaths were attributable to epilepsy. We conclude that (a) there was an increased risk of death during childhood in children with epilepsy; (b) the risk of death was greatest for children with secondary epilepsy; (c) potentially preventable, epilepsy‐related deaths occurred in children with primary epilepsy; (d) sudden unexplained death accounted for at least 12% of deaths; and (e) death certification was deficient with respect to recording of epilepsy.
Patterns of Seizures Observed in Association with Neurofibromatosis 1
Authors: Korf Bruce R. , Carrazana Enrique , Holmes Gregory L.
Published: August 2005

Summary: Clinical features of seizures occurring in a neurofibromatosis clinic population were examined in a retrospective study. Twenty‐two individuals in a population of 359 persons with neurofibromatos 1 (NF1) had had one or more seizures. Age at first seizure ranged from 4 days to <20 years. Patients were classified into five groups on the basis of medical history, seizure type, and EEG findings. Two patients had seizures in the first 3 months of life: 1 was born prematurely and had perinatal encephalopathy, and the other developed infantile spasms (IS) and had extensive growth of a plexiform neurofibroma. Two males had seizures in association with aqueductal stenosis. Six individuals had one or more generalized seizures with fever, and 3 had primary generalized epilepsy. Nine patients had complex partial seizures (CPS), which varied in clinical manifestations and response to antiepileptic drugs (AEDs). In none of the individuals with seizures in this study was a structural lesion in the brain visible by neuroimaging. Seizures appear to be relatively uncommon in individuals with NF1, and when they occur have a natural history similar to that of seizures in the general population.
Aicardi Syndrome: A Longitudinal Clinical and Electroencephalographic Study
Authors: Ohtsuka Yoko , Oka Eiji , Terasaki Tomoyuki , Ohtahara Shunsuke
Published: August 2005

Summary:We report clinical and EEC follow‐up of 6 children with Aicardi syndrome. Age at seizure onset was <3 months in 5 patients and 4 months in 1 patient. All patients had spasms, and these continued at time of follow‐up in 5 patients. Five patients had seizures other than spasms which disappeared during early infancy. Bilateral independent bursts (BIBs) characteristic of Aicardi syndrome were noted in 4 patients. In 1, BIBs showed suppression‐burst patterns. BIBs converted to hypsarrhythmia or multifocal spikes with a tendency to BIBs during sleep. BIBs disappeared completely during both waking and sleeping states between the ages of 3 years 1 month and 4 years 9 months. After BIB disappearance, the EEG of 1 patient showed diffuse slow spike‐and‐wave complexes most of which appeared asynchronously. At onset, 1 patient had early‐infantile epileptic encephalopathy with suppression‐burst which evolved initially into West syndrome (WS) and then Lennox‐Gastaut syndrome (LGS). The other 3 children also had WS.
Benign Partial Epilepsy with Secondarily Generalized Seizures in Infancy
Authors: Watanabe Kazuyoshi , Negoro Tamiko , Aso Kousaburo
Published: August 2005

Summary: Seven infants with benign idiopathic partial epilepsy presented with apparently generalized tonic‐clonic seizures (GTCs) which proved to be partial seizures evolving to secondarily generalized seizures. All were easily controlled with phenobarbital (PB) or carbamazepine (CBZ), and remained seizure‐free >3 years even after discontinuation of medication, and had a normal developmental outcome. The initial seizure manifestation consisting of motion arrest, staring or blank eyes, or crying associated with focal paroxysmal discharges was followed by GTCs in accordance with generalization of paroxysmal discharges. Four infants had a family history of benign type of childhood convulsions. The term “benign partial epilepsy in infancy” is proposed to combine this syndrome with the previously described benign infantile epilepsy with complex partial seizures.
Progressive Unilateral Encephalopathy of Childhood (Rasmussen's Syndrome): A Reappraisal
Authors: Vining Eileen P. G. , Freeman John M. , Brandt Jason , Carson Benjamin S. , Uematsu Sumio
Published: August 2005

Summary: Twelve children with Rasmussen's encephalitis underwent hemispherectomy and have been followed for an average of 9.15 years. Our decision‐making process leads to early, rather than late operation. Because hemiplegia is inevitable with or without operation, earlier operation may allow such children to resume a more normal life. We postulate that earlier operation may prevent some of the intellectual decline that accompanies the continued seizures and their treatment. In view of the variable pathologic findings and lack of evidence of a viral etiology, we suggest either use of the term “progressive unilateral encephalopathy of childhood” or “Rasmussen's syndrome” in recognition of its heritage.
Twenty‐Four‐Hour Ambulatory EEG Monitoring in Infantile Spasms
Authors: Plouin Perrine , Dulac Olivier , Jalin Claude , Chiron Catherine
Published: August 2005

Summary: Twenty‐four‐hour ambulatory EEG (AEEG) recordings were performed in 74 infants with West Syndrome (WS) who had not received corticosteroids before the recording. EEG analysis was performed visually for interictal background activity as well as for ictal events: spasms (isolated or in clusters) and other seizures either generalized or partial. Six hundred fifty‐four seizures were recorded in 67 patients. Partial seizures (PS) were noted in 31 infants (51% of symptomatic WS cases, 33% of cryptogenic WS cases). In 14 patients, PS were immediately followed by a cluster of spasms consisting of a single ictal event. Patients with PS had an asymmetrical interictal background activity in 85% of cases, with no return to hypsarrhythmia between spasms in a given cluster. AEEG is a reliable method to detect and analyze ictal events in infants with WS. In this population, patients with unfavorable outcome of both epilepsy and psychomotor development have PS. Therefore, the existence of PS may contribute to etiologic diagnosis and prognostic evaluation.
West Syndrome Due to Perinatal Insults
Authors: Cusmai Raffaella , Ricci Stefano , Pinard Jean Marc , Plouin Perrine , Fariello Giuseppe , Dulac Olivier
Published: August 2005

Summary: Clinical, neuroradiological data and outcome of epilepsy of 32 patients with symptomatic infantile spasms caused by perinatal insults are reported. Neuroradiological investigations showed focal as well as diffuse cerebral lesions. Fifteen children had a porencephalic lesion, 12 had periventricular leukomalacia and five had diffuse bilateral cerebral atrophy, associated with status marmoratus in one child and bilateral ulegyria in another. Eight patients (25%) had epilepsy following West syndrome. In the group of 15 children with porencephalic cysts, the lesion was always unilateral, but topography and extension varied. Eight children had circumscribed cysts involving the rolandic or parieto‐occipital regions, and the outcome of epilepsy was favorable. Seven patients had large lesions involving the frontal lobe, associated with unilateral hemispheric atrophy in four cases. These four children had an unfavorable epilepsy outcome. In the 12 patients with periventricular leukomalacia, all premature, eleven had no seizure relapse after the spasms; one of these children had epilepsy. In the five full‐term patients with bilateral and diffuse cerebral lesions, three children had epilepsy at the last observation. In children with leukomalacia and in patients with localized porencephalic lesions the outcome of epilepsy appears to be better than in patients with diffuse cerebral lesions or in children with extensive porencephalic cysts, particularly those involving the frontal lobe.
Treatment of Infantile Spasms with High‐Dosage Vitamin B6
Authors: Pietz J. , Benninger C. , Schäfer H. , Sontheimer D. , Mittermaier G. , Rating D.
Published: August 2005

Summary: High‐dose vitamin B6 (pyridoxine‐HCl, 300 mg/kg/day orally) was introduced as the initial treatment of recently manifested infantile spasms in 17 children (13 symptomatic cases with identified brain lesion and 4 cryptogenic cases). 5 of 17 children (2 cryptogenic, 2 with severe pre/perinatal brain damage and one with Sturge‐Weber syndrome) were classified as responders to high‐dose vitamin B6. In all 5 cases the response to vitamin B6occurred within the first 2 weeks of treatment and within 4 weeks all patients were free of seizures. Two patients’ developed other seizures (partial seizures, etiologically unclear blinking attacks), but no relapse of infantile spasms was observed among the five responders to vitamin B6. No serious adverse reactions were noted. Side effects were mainly gastrointestinal symptoms, which were reversible after reduction of the dosage. Considering the life‐threatening side effects of treatment with ACTH/corticosteroids or valproate, a controlled clinical trial with high‐dose vitamin B6 would appear justified to either prove or disprove efficacy.
Surgery for Intractable Infantile Spasms: Neuroimaging Perspectives
Authors: Chugani Harry T. , Shewmon D. Alan , Shields W. Donald , Sankar Raman , Comair Youssef , Vinters Harry V. , Peacock Warwick J.
Published: August 2005

Summary: Twenty‐three infants and children underwent cortical resection (n= 15) or hemispherectomy (n =8) for intractable infantile spasms. Infantile spasms were present at the time of surgery in 17 of the 23 patients; in six, spasms had evolved to other seizure types during surgical evaluation. Children with a remote history of infantile spasms were excluded from this study. Focal or hemispheric lesions were identified by magnetic resonance imaging in seven children; an additional two showed focal atrophy without a discrete lesion. Positron emission tomography (PET) showed lateralized or localized abnormalities of cerebral glucose utilization in all patients; in 14, PET was the only neuroimaging modality to identify the epileptogenic cortex. When this occurred, neuropathological examination of resected brain tissue typically showed malformative and dysplastic cortical lesions. Focal interictal and/or ictal electrographic abnormalities were present in all patients, and corresponded well with localization from neuroimaging. None of the patients were subjected to chronic invasive electrographic monitoring with intracranial electrodes. At follow‐up (range 4–67 months; mean 28.3 months), 15 children were seizure‐free, three had 90% seizure control, one had 75% seizure control, and four failed to benefit from surgery with respect to seizure frequency.
Epilepsy Education in Medical Schools: Report of the American Epilepsy Society Committee on Medical Student Education
Authors: Devinsky Orrin , Lowenstein Daniel , Bromfield Edward , Duchowny Michael , Smith Dennis B.
Published: August 2005

The education of medical students about epilepsy is often fragmentary and incomplete. Basic information regarding the classification of epileptic seizures, epilepsy syndromes, first aid for seizures, and practical use of antiepileptic drugs (AEDs) may not be covered in medical school curricula. In this report we describe reasons why the study of epilepsy provides a relatively unique opportunity to integrate concepts related to basic neuroscience and clinical neurology. Furthermore, we present a curricular framework that may prove useful for the education of medical students about epilepsy.
Concordance of Clinical Forms of Epilepsy in Families with Several Affected Members
Authors:   Italian League Against Epilepsy Genetic Collaborative Group
Published: August 2005

Evidence for genetic heterogeneity in epilepsy is strong. We evaluated the concordance of clinical forms in the same family in a series of families with several cases of idiopathic epilepsy, collected as part of the Study on the Genetics of Epilepsy of the Italian League against Epilepsy (LICE). The studied families had at least three members affected by an idiopathic form of epilepsy in one or more generations. Seventy‐four families (with a total of 296 affected members) have been analyzed; two families had cases with benign neonatal familial convulsions (BNFC); in 25% of the remaining families all members were affected by the same clinical form, 13.9% had a prevalent clinical form with only one affected member with a different seizure type, 36.1% had two clinical forms, and 25% had three forms of epilepsy in the same family. There are no clinical differences in the form of epilepsy between the families concordant for one clinical form and families with two or three clinical forms of idiopathic epilepsies. The distribution of the clinical form in the affected relatives in our families showed the higher concordance with the proband in febrile convulsions (FC, 70.8%) and in epilepsy with generalized tonic‐clonic seizures (EGTC, 63.0%). FC and EGTC were highly diffused in the affected relatives in the families with other forms of idiopathic epilepsy, above all in the more distantly related affected family members. In our families we observed a rare association between childhood absence epilepsy (CAE) and juvenile myoclonic epilepsy (JME). In every idiopathic form of epilepsy, there was a high concordance for the seizure phenotype in first‐degree affected relatives, whereas in more distantly related family members concordance was less evident and there was a tendency toward a different phenotypic expression.
Ictal 99mTc‐HMPAO Single Photon Emission Computed Tomography in Children with Temporal Lobe Epilepsy
Authors: Harvey A. Simon , Bowe Judith M. , Hopkins Ian J. , Shield Lloyd K. , Cook David J. , Berkovic Samuel F.
Published: August 2005

Seventeen ictal 99mTc‐HMPAO single photon emission computed tomography (SPECT) studies were performed in 15 children with temporal lobe epilepsy (TLE) aged 7–14 years (mean 10.3 years). Ictal SPECT was informative in 16 of 17 (94%) studies in 14 of 15 (93%) children, showing unilateral temporal lobe hyperperfu sion. In all 16 informative ictal SPECT studies, lateral‐ization was concordant with ictal EEC, magnetic resonance imaging (MRI), and pathology. In 4 children, ictat SPECT provided additional localizing information that was not apparent from concurrent ictal EEC recording. Blinded interpretation of ictal SPECT studies by two independent investigators showed correct lateralization of the epileptic focus in every child. Results of visual analysis of ictal SPECT images were corroborated by quantitative analysis. Although interictal SPECT studies showed a degree of temporal lobe hypoperfusion in all children, in 9 of 15 hypoperfusion was either minimal, bilateral, contralateral, or associated with extratemporal hypoperfusion. In children with TLE, ictal SPECT provides reliable lateralizing information to corroborate or supplement that obtained from surface EEG and MRI.
Partial Seizures Presenting as Life‐Threatening Apnea
Authors: Singh Balbir , Al Shahwan Saad A. , Al Deeb Saleh M.
Published: August 2005

Apneic episodes, quite common in newborns, are considered rare after age 1 month, when gastroesophageal reflux, cardiac arrhythmias, idiopathic central apnea, and seizures become included in differential diagnosis. Determining the cause of apnea is important as treatment differs significantly and can be harmful; Caffeine given for presumed idiopathic central apnea is reported to have precipitated seizures in 2 patients with apneic seizures. Two cases of partial seizures presenting as apnea in infants were studied. Interictal EEC was normal in 1 and showed focal spikes in the other. Video EEG monitoring (16 channel) showed focalictal discharge originating from temporal areas clearly preceding onset of apnea in both patients. Because therapeutic options are sometimes diametrically opposite and interictal EEGs are particularly unreliable for diagnosis, we recommend video‐EEG monitoring if there is any doubt about the diagnosis before starting treatment in patients with apneic episodes.
Corpus Callosotomy for Intractable Epilepsy: Seizure Outcome and Prognostic Factors
Authors: Reutens D. C. , Bye A. M. , Hopkins I. J. , Banks A. , Somerville E. , Walsh J. , Bleasel A. , Ouvrier R. , MacKenzie R. A. , Manson J. I. , Bladin P. F. , Berkovic S. F.
Published: August 2005

We reviewed the outcome of corpus callosal section in 64 adult and pediatric patients to identify factors associated with a good outcome: 48% of patients had a favorable outcome for overall seizure frequency. Improvement was noted in several seizure types and was most likely for drop attacks, particularly in the setting of a unilateral focal cerebral lesion or a true generalized epilepsy of Lennox‐Gastaut type. Poor outcomes for drop attacks were more likely if there was associated severe intellectual handicap or bilateral independent spikes on interictal EEG. Complex partial seizures (CPS), most commonly of frontal lobe origin, also responded favorably. The complications of callosal section were usually mild and transient. New focal seizures occurred in only 2 patients and were not as frequent or disabling as preoperative seizure types. A worthwhile improvement in seizure outcome was achieved by completion of the callosotomy in 6 of 10 patients with unsatisfactory results from anterior callosotomy.
Corpus Callostomy in Treatment of Medically Resistant Epilepsy: Preliminary Results in a Pediatric Population
Authors: Cendes Fernando , Ragazzo Paulo C. , da Costa Valter , Martins Luis F.
Published: August 2005

We report the results of 34 patients who underwent corpus callosotomy between 1986 and 1989 with 28–65 months of postoperative follow‐up (mean 42 months). Thirty‐two patients had mental retardation and 26 had significant behavioral problems. Thirteen patients had total section, 8 had subtotal section with preservation of the posterior half of the splenium, and 13 had section of the anterior two thirds of the callosum. Satisfactory seizure control was achieved in 25 patients (73.5%.) Atonic seizures, followed by tonic seizures, generalized tonic‐clonic seizures (GTCs), and atypical absence seizures were most improved. Myoclonic and complex partial seizures (CPS) did not improve significantly. No deterioration in seizure status was observed postoperatively. Two patients developed previously unobserved simple seizures and CPS postoperatively, but they were not as disabling as the preoperative seizures. Among the patients with behavioral problems, 81% had significant decrease in aggressiveness, hyperactivity, and/or attention deficit. Patients who underwent total section had interhemispheric disconnection symptoms that improved progressively and did not interfere with daily life. Decreased speech output, dysarthria, and gait dyspraxia occurred after total callosal section and persisted in 5 of the 13 patients. Patients who underwent anterior two thirds or subtotal sections did not have such symptoms. Early postoperative complications consisted of aseptic ventriculitis (5), subdural hematoma (1), and wound infection (4) and resolved without sequelae.
Suppression of Interictal Spikes and Seizures by Stimulation of the Vagus Nerve
Authors: McLachlan Richard S.
Published: August 2005

The effects of electrical stimulation of the vagus nerve, a proposed treatment for patients with intractable epilepsy, on focal interictal spikes produced by penicillin and EEG secondarily generalized seizures induced by pentylenetetrazol were assessed in rats. Interictal spike frequency was reduced by 33% during 20 s of stimulation (p < 0.001) and remained low for ≤3 min. Amplitude of residual spikes was also decreased. Cardiac and respiratory rates were suppressed. Cooling the nerve proximal to the point of stimulation abolished the EEG and respiratory effects. A similar reduction in spike frequency of 39% was obtained by heating the animals' tail (p < 0.01). Vagal stimulation at onset of seizures reduced mean seizure duration from 30.2 ± 15.7 s without stimulation to 5.0 ± 1.8 s (p < 0.01). Only the EEG equivalent of the clonic phase of the seizure was affected. These findings suggest that vagus nerve stimulation can be a potent but nonspecific method to reduce cortical epileptiform activity, probably through an indirect effect mediated by the reticular activating system.
Motor and Sensory Impairments in Children with Intractable Epilepsy
Authors: Beckung Eva , Uvebrant Paul
Published: August 2005

During a 3‐year period (1988–1991), 72 children with severe intractable epilepsy were studied. A standardized protocol for assessment of motor and sensory function was designed for school age children. Function was quantified on a 4‐point scale on 47 items, including gross motor function, balance, coordination, strength, range of motion (ROM), velocity, fine motor function, sensation, perception, and neurologic tests. Classification of handicaps according to World Health Organization (WHO) definitions was performed. Videotape documentation completed the assessment. Evaluation of treatment services showed that provision of rehabilitation services had been insufficient and provided only for children with additional major movement disorders, mainly cerebral palsy (CP) cases. To minimize the handicap in children with severe epilepsy, it is essential to clarify the total sensorimotor impairment pattern, including balance, co‐ordination, and perceptual capacity. Impairments in these functions are, as shown in this study, frequent and exist independent of major disabilities such as mental retardation or cerebral palsy. When several neuroimpairments were identified, a multiplicative rather than an additive effect on the total handicap was evident.
Remission of Seizures and Predictors of Intractability in Long‐Term Follow‐Up
Authors: Sillanpää Matti
Published: August 2005

In an incidence cohort, remission and relapse rates and determinants were studied in 178 patients followed long‐term. A comparative study of predictive factors was performed in 40 patients with histories of antiepileptic (AED)‐drug‐refractory epileptic seizures in the last 10 years of follow‐up and compared with the other 138 cohort subjects. The two groups were cross‐tabulated with 353 variables of family history, obstetric, developmental and seizure histories, and current medical and social status. Multivariate analyses were applied for control of confounding. Defined or probable remote symptomatic etiology of seizures, abnormal neurologic development/ status, high initial seizure frequency, occurrence of status epilepticus, and poor short‐term effects of AED therapy were significantly associated with long‐term AED refractoriness. On logistic regression analyses, poor short‐term outcome of AED therapy [odds ratio (OR) 3.6; 95% confidence interval (CI) 1.2–10.4], occurrence of status epilepticus (OR 11.4; 95% CI 3.2–41.0), high initial seizure frequency (OR 4.6; 95% CI 1.1–19.3), and remote symptomatic seizure etiology (OR 2.9; 95% CI 1.1–8.2) remained the only independent predictors of seizure intractability. These factors enable early assessment of need for epilepsy surgery.
Language Before and After Temporal Lobectomy: Specificity of Acute Changes and Relation to Early Risk Factors
Authors: Saykin Andrew J. , Stafiniak Paul , Robinson Lindsey J. , Flannery Kathleen A. , Gur Ruben C. , O'Connor Michael J. , Sperling Michael R.
Published: August 2005

Summary:We evaluated language functions in 154 patients with left hemisphere speech dominance undergoing anterior temporal lobectomy (ATL). Measures of phonemic and semantic fluency, confrontation naming, repetition, comprehension, and reading were administered before and 3 weeks postoperatively. Patients were grouped by focus (left, LT; right, RT) and presence of early risk factors for development of seizures (ER, early risk, 5 years; NER, no early risk): (LT‐ER, n = 45; RT‐ER, n = 49; LT‐NER, n = 27; RT‐NER, n = 33). Preoperatively, the LT group showed a selective naming deficit as compared with the RT group. Postoperatively only the LTNER group showed significant overall decline in language. For this group, the change was attributable to a selective decline in naming as compared with other functions. These data indicate that there is a specific risk to naming after dominant ATL for adult temporal lobe epilepsy (TLE) patients with a left hemisphere focus and the absence of an early risk factor for the development of seizures.