bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk Factors for Idiopathic Generalized Seizures: A Population‐Based Case Control Study in Copparo, Italy
Authors: Monetti Vincenza Cinzia , Granieri E. , Casetta I. , Tola M. R. , Paolino E. , Malagù S. , Govoni V. , Quatrale R.
Published: August 2005

Summary: We examined the etiopathogenetic role of pre‐ perinatal risk factors in the history of epileptic patients, identified in a previous descriptive study performed in Copparo, Italy. A community‐based case control study of a group of epileptic patients with idiopathic generalized seizures was performed. The population consisted of 55 patients aged <35 years as of December 31, 1988, residing in Copparo. Symptomatic patients were not included in the present study. The control sample consisted of 165 randomly selected healthy individuals, matched with patients for sex, age, and residence in the study area. The interview for detection of history of presumed risk factors was based on the Protocol of the Italian League Against Epilepsy. Obstetric, neurologic, and neonatal hospital charts were also reviewed. A family history of epilepsy, febrile seizures, and other perinatal factors (such as continual physical stress during pregnancy, maternal age <35 years, and birth order <3) were significantly more common in patients as compared with controls. Our data support the hypothesis of genetic propensity for generalized and febrile seizures, which may represent early expression of a low seizure threshold that subsequently de‐ velops into epilepsy.
Depth Electrode Studies in Temporal Lobe Epilepsy: Relation to Quantitative Magnetic Resonance Imaging and Operative Outcome
Authors: Cascino Gregory D. , Trenerry Max R. , Sharbrough Frank W. , So Elson L. , Marsh W. Richard , Strelow Dan C.
Published: August 2005

Summary: We performed a retrospective study of 30 patients with presumed intractable temporal lobe epilepsy (TLE) who underwent chronic intracranial EEG monitoring (CIEM). Multicontact depth electrodes were stereotactically implanted through the medial occipital lobe into amygdala and hippocampus. All patients had previously undergone extracranial ictal EEG monitoring that proved inadequate to localize the epileptogenic zone. No morbidity as associated with CIEM in the 30 patients. Twenty‐five patients were shown to have exclusively or predominantly unilateral temporal lobe seizures, and 5 patients had bitemporal seizures without unilateral predominance; 24 patients subsequently underwent an anterotemporal lobe cortical resection. Twenty‐one patients have been followed a minimum of 1 year postoperatively. Nine patients (43%) had a class I outcome (seizure‐free, auras only, or provoked seizures), 3 patients (14%) had a class I1 outcome (≥95% seizure reduction), 4 patients (19%) had a class III outcome (≥50% seizure reduction); and 5 patients (24%) had a class IV outcome (<50% seizure reduction or no change). A prolonged interhemispheric propagation time (p <0.01) and magnetic resonance imaging (MR1)‐identified hippocampal atrophy (p <0.01) correlated with a favorable surgical outcome. Results of this study may prove useful in counseling patients who undergo CIEM before temporal lobe surgery.
Paroxysmal Microarousals in Amygdala‐Kindled Kittens: Could They Be Subclinical Seizures?
Authors: Shouse M. N. , Langer J. , King A. , Alcalde O. , Bier M. , Szymusiak R. , Wada Y.
Published: August 2005

Summary: Amygdala–kindled kittens exhibit frequent epileptiform EEG transients, often in conjunction with phasic arousal events of sleep [k–complexes, pontogeniculo–occipital (PGO) waves, and/or sleep spindles]. In this study, paroxysmal microarousals occurred throughout the sleep–wake cycle after kindling, but were most frequent during seizure–prone states of slow–wave sleep (SWS) and the transition into rapid–eye–movement sleep (REM). Their incidence correlated with interictal sleep fragmentation as well as onset of spontaneous convulsions. Results could reflect transsynaptic kindling effects on brainstem and forebrain arousal mechanisms with which amygdala is reciprocally connected. Increased discharge rates of neural generators for normal EEG and behavioral arousal could disrupt sleep at some times and recruit epileptic neurons in the kindled focus to precipitate seizures at others. Alternatively, epileptiform EEG paroxysms were accompanied by subtle behavioral stereotypes (a head nod, limb elevation, eye twitch, lip smack, or a combination of these). Behavioral correlates were elements of partial kindled seizures, suggesting that paroxysmal microarousals may be subclinical seizures. Whether or not the microarousals are true seizures, our findings may link ictal onset and interictal sleep disorders to a subclinical paroxysmal arousal disorder and suggest a common epileptic mechanism.
Self‐Induced Photogenic Seizures in a Child with Severe Myoclonic Epilepsy in Infancy: Optical Investigations and Treatments
Authors: Takahashi Yukitoshi , Shigematsu Hideo , Fujiwara Tateki , Yagi Kazuichi , Seino Masakazu
Published: August 2005

Summary: In a 2‐year‐old patient with severe myoclonic epilepsy in infancy, we studied self‐induced photogenic seizures using optical filters and blue‐tinted contact lenses. The patient induced absences and/or myoclonic jerks by two kinds of behaviors: flickering hand movement (FHM) and forced eye closure (FEC). The placebo inhibitory effect on FHM by a blank goggle frame indicated that acquisition of learning affected the frequency of FHMs per se. Optical studies suggested that the degree of absorption from ∼600–700 nm might determine the inhibitory effect of filters on FHM. Investigations using contact lenses showed that blue‐tinted lenses gradually reduced photosensitivity and inhibited FHMs.
Sudden Death in Epilepsy: A Study of Incidence in a Young Cohort with Epilepsy and Learning Difficulty
Authors: Nashef L. , Fish D. R. , Garner S. , Sander J. W. A. S. , Shorvon S. D.
Published: August 2005

Summary: Sudden death, often seizure related, may occur in patients with epilepsy. Population‐based incidence is probably on the order of 1:1,000/year. The incidence is much higher in selected groups, however. We wished to establish the incidence of sudden unexpected death (SUD) in a young cohort with severe epilepsy and learning difficulties. The study cohort included 310 pupils with epilepsy enrolled at a special residential school between April 1970 and April 1993. The follow‐up period totaling 4,135 person‐years included a period of residence at the school as well as time after leaving. Age and sex standardized overall mortality ratio was 15.9 [95% confidence interval (CI) 10.6–23.0], with 20 of 28 deaths considered epilepsy related. An incidence of sudden death cases of 1:295/year was noted. All 14 sudden deaths occurred when the pupils were not under the close supervision of the school and most were unwitnessed, which has implications for prevention.
4p‐ Syndrome: A Chromosomal Disorder Associated with a Particular EEG Pattern
Authors: Sgrò Vincenzo , Riva Enrica , Canevini Maria Paola , Colamaria Vito , Rottoli Amilcare , Minotti Lorella , Canger Raffaele , Bernardina Bernardo Dalla
Published: August 2005

Summary: We report an electroclinical and cytogeneticstudy of 4 patients with Wolf‐Hirschhorn syndrome (WHS). In all cases, we observed a stereotyped EEG and clinical picture characterized by generalized or unilateral myoclonic seizures followed later by brief atypical absences. Electrographically, these were accompanied by a sequence of centroparietal or parietotemporal sharp waves; high‐voltage wave with a superimposed spike becoming unusual spike‐wave complexes, often elicited byeye closure; bursts of diffuse spikes and waves; and frequent jerks. This electroclinical pattern is very similar to the one described in Angelman syndrome (AS) in which a defect in GABAA receptor function has been suggested. Moreover, the genes encoding the GABAA receptor subunit have been mapped to the p12–pl3 bands of chromosome 4. Even though the deletion in these cases does not encompass the 4p12–p13 region, we suggest that the electroclinical picture common to WHS and AS might represent a characteristic type of epilepsy linked to a common genetic abnormality.
Cerebral Neurocytoma: An Unusual Cause of Refractory Epilepsy. Case Report and Review of the Literature
Authors: Rabinowicz Adrian L. , Abrey Lauren E. , Hinton David R. , Couldwell William T.
Published: August 2005

Summary: We report a patient with medically refractory complex partial seizures (CPS) caused by a cerebral neurocytoma located near the amygdala. Neurocytoma represents an important addition to the differential diagnosis and, in particular, must be differentiated from oligoden‐droglioma and dysembryoplastic neuroepithelial tumor. Accurate pathological differentiation has therapeutic and prognostic implications.
Distribution of Unsaturated Metabolites of Valproate in Human and Rat Brain‐Pharmacologic Relevance?
Authors: Adkison Kimberly D.K. , Ojemann George A. , Rapport Richard L. , Dills Russell L. , Shen Danny D.
Published: August 2005

Summary: The concentrations of valproate (VPA) and six of its pharmacologically active, unsaturated metabolites (E‐δ2‐VPA, Z‐δ3‐VPA, E‐δ3‐VPA, E, E‐δ2, 3.‐VPA, δ4‐VPA, and E‐δ2, 4‐VPA) were measured in serum and cortical brain samples from 24 patients undergoing epilepsy surgery. Collectively, the six metabolites were present at concentrations ≤13% of VPA brain concentrations. Because the six unsaturated metabolites were present at such low brain concentrations, we concluded that these metabolites probably did not contribute significantly to the anticonvulsant effect of VPA. Results from a parallel pharmacodynamic study in rats in which VPA was administered three times daily for 8 weeks supported this conclusion. Only three unsaturated metabolites (E‐δ2‐VPA, δ3‐VPA, E, E‐A2, 3‐VPA)were detected in rat brain. No correlation was observed between the time course of anticonvulsant effect [as measured by the timed intravenous pentylenetetrazol (PTZ) test] and the time course of VPA or metabolite concentrations in rat brain. Despite the structural similarity of VPA and its metabolites, striking differences were observed in their serum protein binding and blood‐brain distribution properties. In the human brain, VPA and δ4‐VPA exhibited brain‐to‐free serum concentration ratios that were less than unity. In contrast, compounds with the double bond at the 2‐or 3‐position had brain: free concentration ratios that were much higher than unity. The structure‐distribution relationship observed with VPA and its unsaturated metabolites suggested that these branched‐chain fatty acids differ in their asymmetric transport across the blood‐brain barrier (BBB).
Thyroid and Myocardial Function After Replacement of Carbamazepine by Oxcarbazepine
Authors: Isojärvi Jouko I. T. , Airaksinen K. E. Juhani , Mustonen Juha N. , Pakarinen Arto J. , Rautio Arja , Pelkonen Olavi , Myllylä Vilho V.
Published: August 2005

Summary: We determined changes in serum concentrations of thyroid hormones during carbamazepine (CBZ) therapy during a 5‐year prospective follow‐up study of 20 patients with newly diagnosed epilepsy. In addition, we evaluated the effects of replacing CBZ with oxcarbazepine (OCBZ) in 12 male patients with epilepsy in a 6‐month prospective follow‐up study. Circulating thyroxine and free thyroxine levels decreased after 2‐month CBZ treatment and remained at a low level during the 5‐year follow‐up. There were no associated changes in serum thyrotropin (TSH) concentrations. When CBZ was replaced by OCBZ, the function of the liver's P450 enzyme system normalized, as shown by an increase in antipyrineT1/2, and a decrease in antipyrineCL. Serum total and free thyroxine levels increased, and thereafter serum TSH levels decreased. Indexes of diastolic heart function improved concomitantly, which may reflect subclinical hypothyroidism at the cellular level during CBZ treatment. We conclude that normal thyroid function can be restored in patients with epilepsy by replacing CBZ with OCBZ.
Bilateral Hippocampal Atrophy in Medial Temporal Lobe Epilepsy
Authors: King David , Spencer Susan S. , McCarthy Gregory , Luby Marie , Spencer Dennis D.
Published: August 2005

Summary: Quantitative evidence of hippocampal atrophy has been correlated with site of seizure onset, hippocampal neuronal loss, and seizure relief after resection. Most studies have quantified hippocampal atrophy using ratios or differences between right and left hippocampal values. However, bilateral hippocampal atrophy may remain undetected by these techniques. To assess the frequency and implications of bilateral hippocampal atrophy, we studied absolute hippocampal volumes in 53 temporal lobectomy patients who had undergone intracranial electroencephalogram recordings preoperatively. Coronal images were constructed perpendicular to the longitudinal axis of the hippocampus. Atrophy was defined as >2 SD below control values in the volume of the posterior. 5 cm of the hippocampus. Five of 53 patients (9%)had bilateral hippocampal atrophy; four of these cases were undetected by ratios. Surgery was performed on the side of ictal onset in all five patients; four have been seizure‐free for >2 years. These results suggest that (a) mesial temporal sclerosis can be present bilaterally and may go undetected by hippocampal ratio or difference measures; (b) ab‐solute hippocampal volume values as well as ratios are needed to detect all patients with bilateral hippocampal atrophy; and (c) temporal lobectomy is not contraindicated in patients with bilateral hippocampal atrophy, but success depends on electroencephalographic documentation of the side of predominant ictal onset.
Epilepsy and Society
Authors: de Boer Hanneke M.
Published: August 2005

Summary: Epilepsy and the epileptic do not exist; epilepsies and people with epilepsy do. Together with many other groups of people, they make up society, and the attitudes of all these people determine to a great degree the quality of life (QOL) of persons with epilepsy. The various attitudes of different target groups in society, those of the general public, of governments, of physicians, and those of people with epilepsy themselves differ. There is room for improvement, although much has been achieved both in the approach to epilepsy and in societal attitudes and actions. However, even in this day and age, epilepsy and society are two inseparable factors. Living with epilepsy in any society should mean living a full life, with no more than absolutely necessary restrictions, with everyone else and like everyone else. The attitude of society can cause more pain than the seizures, but society can also prevent such pain.
Epilepsy, Learning, and Behavior in Childhood
Authors: Besag Frank M. C.
Published: August 2005

Summary: Several major issues exist with regard to epilepsy and learning in childhood. A small subgroup of children have a decreasing I.Q. In addition, a high proportion of children with epilepsy, possibly one half, have some schooling difficulties. Learning problems may be a consequence of the epilepsy or a result of associated factors. It is important to distinguish between the slowing of acquisition of skills and actual loss of skills; the practical implications for the child and family are very different in these two situations. In the very small proportion of children in whom actual loss of skills occurs, it is essential to seek a cause, because a cause can usually be identified and may require specific management. The importance of distinguishing between state‐dependent, potentially reversible intellectual impairment and permanent impairment cannot be overemphasized. State‐dependent intellectual impairment, e.g., arising from ongoing nonconvulsive status epilepticus (NCSE) or antiepileptic drug (AED) toxicity, must be identified and every effort made to eliminate it. Studies at St Piers Lingfield have shed light on these issues although the answers to many of the questions remain incomplete. Educational difficulty is among the factors that may affect behavior. However, there are many other causes for behavioral disturbance in the child with epilepsy. A specific framework for assessing the child with epilepsy and behavioral disturbance allows the cause or causes of the behavioral disturbance to be identified and managed in a rational way.
Memory Tests Distinguish Between Patients with Focal Temporal and Extratemporal Lobe Epilepsy
Authors: Breier J. I. , Plenger P. M. , Wheless J. W. , Thomas A. B. , Brookshire B. L. , Curtis V. L. , Papanicolaou A. , Willmore L. J. , Clifton G. L.
Published: August 2005

We examined the ability of preoperative memory performance to distinguish between patients who had been diagnosed as having left (LTLE, n = 31), right (RTLE, n = 37), and extra‐(ETLE, n = 17) temporal lobe focal epilepsy. All patients eventually underwent surgical resections. Analyses indicated that the ETLE group performed better than the RTLE group on nonverbal memory measures and better than the LTLE group on verbal memory measures. Discriminant function analyses indicated that use of a combination of measures that assess different aspects of memory were of significant value in distinguishing between patients with focal TLE and ETLE. This approach, as compared the use of single measures, improved classification rates of all three groups. The best single predictor of group membership, an index of verbal learning, yielded a 47% overall correct classification rate, with sensitivities ranging from 25 to 59%, and performed at worse than chance levels in classifying RTLE patients. A multivariate approach, which included an index of verbal and nonverbal learning, incidental nonverbal memory, and consolidation of organized and rote verbal material, yielded a 65% correct classification rate, with sensitivities ranging from 57 to 75%. This compares favorably with other noninvasive techniques for lateralizing epileptogenic lesions.
Assessment of Drowsiness in Epilepsy Patients Receiving Chronic Antiepileptic Drug Therapy
Authors: Salinsky M. C. , Oken B. S. , Binder L. M.
Published: August 2005

Drowsiness is a common complaint among patients with epilepsy taking antiepileptic drugs (AEDs) and may be of particular importance because of the potential effects on cognitive abilities. We used a novel EEG‐based measure (the Awake Maintenance Task, AMT) to determine objectively whether patients on chronic, stable AED therapy had impaired ability to maintain wakefulness. Thirty patients receiving AEDs [carbamazepine (CBZ), phenytoin (PHT), phenobarbital (PB), valproate (VPA)] were compared to 35 healthy controls, 12 seizure patients not taking AEDs, and 16 patients with multiple sclerosis. A structured EEG recording was conducted under controlled conditions, and subjects were tested to determine their ability to maintain wakefulness during a 6‐min unstimulated trial. Testing also included Digit Symbol, auditory reaction time, and subjective measures of fatigue or sleepiness [Profile of Mood States (POMS), Stanford Sleepiness Scale (SSS)]. Patients receiving AEDs had a mean total drowsiness score of 101 s compared with ≤ 12 s for each of the three control groups (p < 0.001). One third of the AED‐treated patients had >120 s of drowsiness, in contrast to only 1 of 63 controls (p < 0.001). Among patients receiving AEDs, objective EEG drowsiness did not correlate with AED levels or performance measures. Untreated seizure patients had significantly greater complaints of lack of vigor despite a near absence of objective drowsiness on the AMT. These results suggest that epilepsy patients receiving chronic AED therapy have impaired ability to maintain wakefulness. Patient self‐reports of AED‐related sleepiness may not accurately represent this problem.
Properties of a Delayed Rectifier Potassium Current in Dentate Granule Cells Isolated from the Hippocampus of Patients with Chronic Temporal Lobe Epilepsy
Authors: Beck H. , Blümcke I. , Kral T. , Clusmann H. , Schramm J. , Wiestler O. D. , Heinemann U. , Elger C. E.
Published: August 2005

Summary: Purpose: Properties of potassium outward currents were investigated in human hippocampal dentate gyrus granule cells from 11 hippocampal specimens obtained from patients with temporal lobe epilepsy (TLE) during resective surgery.

Methods: Dentate granule cells were isolated enzymatically and outward currents analyzed by using the whole‐cell configuration of the patch‐clamp method. Hippocampal specimens were classified neuropathologically with respect to severe segmental cell loss, gliosis, and axonal sprouting (Ammon's horn sclerosis, AHS), or the presence of a focal lesion in the adjacent temporal lobe.

Results: A delayed rectifier outward current (I), but not an A‐type potassium current (Ik) or inwardly rectifying potassium currents, was observed in all cells. The average current density of Ik, the time‐dependent decay of Ik, and the resting membrane characteristics were not significantly different between patients with and without AHS. The voltage of half‐maximal activation V1/2(act) was 5·4 ± 1·8 mV in AHS compared with −2·9 ± 1·8 mV in lesion‐associated epilepsy (NS). In contrast, V1/2(inact) was shifted in a hyperpolarizing direction in AHS (−67·7 ± 0·6 mV) compared with that in hippocampi not showing AHS (−47·7 ± 2·6 mV; p = 0·0017).

Conclusions: The altered steady‐state voltage‐dependence of Ik, may result in abnormal excitability of dentate granule cells in AHS and exert a marked influence on input‐output properties of the dentate gyrus.
Incidence of Epilepsy in Childhood and Adolescence: A Population‐Based Study in Nova Scotia from 1977 to 1985
Authors: Camfield Carol S. , Camfield Peter R. , Gordon Kevin , Wirrell Elaine , Dooley Joseph M.
Published: August 2005

Summary: Data from a regional EEG laboratory allowed us to identify almost all children in Nova Scotia (population 850,000) with one or more unprovoked, afebrile seizures from 1977 through 1985. We then reviewed hospital and pediatric neurology physician charts to limit cases to those with two or more definite afebrile seizures between the ages of 1 month and 16 years. In all, 693 children developed epilepsy: typical childhood absence seizures (AS) (97), either generalized tonic‐clonic (GTCs) or partial seizures either secondarily generalized or not (511), and other generalized seizure types, including infantile spasms (IS) as well as myoclonic, akinetic, tonic, and atypical AS (85). The incidence of epilepsy was 118 in 100,000 for children aged < 1 year, 48 in 100,000 for those aged 1–5 years, 43 in 100,000 for those aged 6–10 years, and 21 in 100,000 for those aged 11–15 years. The incidence for each year of age between 1 and 10 years was remarkably constant (mean 46 in 100,000 ± 7 SD). Comparison of the incidence rates showed significant differences for those aged <1 year as compared with all others, and for those aged >10 years as compared with those aged 1–10 years. We conclude that the incidence of epilepsy is highest in the first year of life, plateaus in early childhood, and decreases markedly after age 10 years. The overall incidence of epilepsy in childhood is lower than that reported in previous studies.
Ictal Speech Manifestations in Temporal Lobe Epilepsy: A Video‐EEG Study
Authors: Yen Der‐Jen , Su Ming‐Shung , Yiu Chun‐Hing , Shih Yang‐Hsin , Kwan Shang‐Yeong , Tsai Ching‐Piao , Lin Yung‐Yang
Published: August 2005

Summary: To evaluate ictal speech manifestations in complex partial seizures (CPS), we reviewed videotapes of 68 consecutive patients who underwent anterior temporal lobectomy (ATL) for treatment of intractable epilepsy in Taiwan. In all, 261 CPS were collected from their video‐EEG (VEEG) recordings. Cerebral speech dominance was determined by intracarotid injection of sodium amobarbital (Wada test) in all cases. Ictal speech manifestations, classified as verbalization or vocalization, occurred in 32 patients (47.1%) with 96 seizures (36.8%). Ictal verbalization occurred in 10 patients (14.7%). Ictal vocalization was observed in 28 patients (41.2%); including 6 patients who also had ictal verbalization. Thirty‐six patients (52.9%) had no seizure with ictal speech manifestations. Ictal verbalization had significant lateralization value: 90% of patients with this manifestation had seizure focus in the nondominant temporal lobe (p = 0.049). Seizures of patients with ictal vocalization were not more likely to arise from either temporal lobe. We also observed bilingual patients who exclusively spoke in their mother tongue (Taiwanese) rather than the acquired language (Mandarin) in 72.2% of seizures with verbalization. This finding is significant and contrary to a commonly held notion that the acquired language is used in seizures associated with speech behaviors.
Quality of Life and Life Satisfaction in Families After a Child Has Undergone Corpus Callosotomy
Authors: Yang Tsui‐Fen , Wong Tai‐Tong , Kwan Shang‐Yeong , Chang Kai‐Ping , Lee Ying‐Chiao , Hsu Tao‐Chang
Published: August 2005

: Epilepsy is a chronic neurological condition which can have a detrimental effect on patients’quality of life (QOL). We evaluated the overall satisfaction with QOL and changes in QOL in 25 families with children who had undergone corpus callosotomy for severe epilepsy. The mean age of seizure onset was 3.4 years, and the mean period from seizure onset to operation was 5.2 years. Mean follow‐up was 19.3 months. Twenty of 22 patients had various degrees of mental retardation. Mean reduction in severity of seizure activity was 64%. Nineteen of 25 (76%) parents were satisfied with the surgical result. Eighteen of 25 parents (72%) described a good level of satisfaction with their families QOL after callosotomy. Reduction in severity of seizure activity was significantly correlated with how successful families considered the surgery to be and how satisfied they were with their QOL (r= 0.72 and 0.77, respectively). Life domains showing one greatest improvement after callosotomy included level of self‐care, family life, and school performance. Improvements in level of self‐care, family life, and school performance were associated with higher levels of life satisfaction (r= 0.69, 0.60, and 0.59, respectively). Hyperactivity, attention span, and social skills improved significantly in 11 patients after surgery. Callosotomy did not improve mental performance. We conclude that improved seizure control after callosotomy is also associated with improved QOL.
Preoperative Valproate Administration Does Not Increase Blood Loss During Temporal Lobectomy
Authors: Ward Mariann M. , Barbaro Nicholas M. , Laxer Kenneth D. , Rampil Ira J.
Published: August 2005

Summary: Surgical treatment is increasingly used for patients with medically refractory seizures. Valproate (VPA) is an effective, widely used anticonvulsant in this patient population, but believed by some researchers to increase surgical bleeding because of quantitative thrombocytopenia and functional defects in platelet aggregation. Because we have observed no clinical evidence that perioperative administration of VPA increases blood loss or complications related to postoperative bleeding in patients undergoing temporal lobectomy at our institution, we sought to test this hypothesis. We made a retrospective review of the medical records of all patients who underwent epilepsy surgery at the University of California, San Francisco Medical Center, from September 1986 through January 1993. Patients who had a temporal lobectomy and whose medical records documented preoperative platelet counts and pre‐ and postoperative hematocrit and hemoglobin values were included. We excluded patients who had cranial surgery before temporal lobectomy and those with intracranial neoplasms or vascular malformations. Patients were divided into two groups: those who received VPA in the immediate preoperative period and those who had not received VPA recently. We compared the estimated surgical blood loss and the estimated change in red blood cell (RBC) volume between groups by unpaired t tests. The charts of 87 consecutive patients qualified for inclusion in the study. Patients in the VPA group had relative (but not absolute) thrombocytopenia preoperatively (235 ± 64 vs. 277 ± 69 k in the No‐VPA group). There were no differences in the estimated blood loss, RBC volume, or in the incidence of postoperative transfusion. VPA apparently does not increase complications of hemostasis during therapeutic surgical resections for epilepsy. Therefore, we do not recommend routinely discontinuing VPA before craniotomy.
Sphenoidal Electrode Insertion Using Topical Anesthesia
Authors: Bazil Carl W. , Walczak Thaddeus S.
Published: August 2005

Summary: Sphenoidal electrodes are frequently used in epilepsy centers, but insertion can be painful. We used a topical anesthetic cream on patients (2.5% lidocaine, 2.5% prilocaine) before inserting electrodes and had patients rate their discomfort on an analogue pain scale. As a comparison, the same patients rated the pain caused by inserting a heparin lock. There was no significant difference between the pain of sphenoidal electrode insertion with use of topical anesthesia and that of heparin lock insertion. We suggest that when a topical anesthetic is used, the discomfort of inserting sphenoidal electrodes is minimal and comparable to that of inserting a heparin lock.
Postictal Alteration of Sodium Content and Apparent Diffusion Coefficient in Epileptic Rat Brain Induced by Kainic Acid
Authors: Wang Yang , Majors Anthony , Najm Imad , Xue Min , Comair Youssef , Modic Michael , Ng Thian C.
Published: August 2005

Summary: Purpose: We studied temporal changes of brain sodium and apparent diffusion coefficient (ADC) in a temporal lobe epilepsy (TLE) rat model using kainic acid (KA).

Methods: In situ three‐dimensional 23Na magnetic resonance imaging (MRI) and proton diffusion‐weighted imaging (DWI) were used. KA at a dose of 10 mg/kg body weight and 12 adult Sprague Dawley rats weighing 228–318 g (268 ± 25 g) were used.

Results: Twenty‐four hours after KA injection, magnetic resonance (MR) visible sodium levels increased in both the pyriform cortex (+90%) and amygdala (+68%) and increased insignificantly in the hippocampus (+18%) and caudate‐putamen (12%). The ADC in the pyriform cortex showed a −9% decrease at 5 h postictally, reaching −30% at 24 h, whereas in the amygdala decreases were −8 and −26% respectively. A significant decrease in ADC (−7%) in the hippocampus was also observed 24 h postically. Seven days later, sodium increases persisted, whereas ADC returned to normal level.

Conclusions: The increase in MR visible sodium, associated with the decrease in ADC is consistent with the hypothesis that sequential seizures caused an increase in sodium influx and perturbation of membrane ion homeostasis, which eventually evolved into an irreversible phase of cellular edema, with increased MR visible intracellular sodium and decreased ADC. Return of ADC to near‐control level and persistent high sodium level at 7 days may be explained by the increase in extracellular space and tissue necrosis.
Seizures in Lung Transplant Recipients
Authors: Vaughn Bradley V. , Ali I. I. , Olivier K. N. , Lackner R. P. , Robertson K. R. , Messenheimer J. A. , Paradowski TL. J. , Egan T. M.
Published: August 2005

Summary: Purpose: We wished to assess organ transplant recipients, who incur a significant risk for seizures.

Method: We reviewed 85 lung transplants performed in 81 patients at the University of North Carolina hospitals between 1991 and 1994. All patients were reviewed for age, reason for transplant, detailed description of seizures, neurological examination, medications, and laboratory results, including cyclosporine level, EEG, and brain imaging.

Results: Eighteen of 81 (22%) patients experienced seizures. Patients aged <25 years had the greatest risk of seizures and 15 of the 18 patients had cystic fibrosis. Sixteen of the 18 (89%) patients, by history, had partial‐onset seizures. Eleven of the 18 (61%) patients had seizures ≤10 days after initiation of intravenous methylprednisolone for allograft rejection. Two patients had seizures associated with sustained hypertension; 1 of these patients was simultaneously being treated for rejection. Four patients had strokes (1 before transplant) and seizures. Two patients were receiving imipenem. Magnetic resonance imaging (MRI) of the brain demonstrated areas of increased T, signal in 8 of 9 patients.

Conclusions: Our findings demonstrate multiple etiologies for seizures in our transplant recipients. However, we believe that patients, especially those aged <25 years, being treated with intravenous methylprednisolone for rejection may be at increased risk of seizures. We hypothesize that the focal loss of blood‐brain barrier (BBB) may play a significant role in the development of partial seizures in lung transplant recipients.
Long‐Term Antiepileptic Effects of Chronic Intake of CNK‐602A, a Thyrotropin‐Releasing Hormone Analogue, on Spontaneously Epileptic Rats
Authors: Momiyama Toshihiko , Ishihara Kumatoshi , Kimura Kazuo , Todo Naoyuki , Fujita Yasuhiko , Serikawa Tadao , Sasa Masashi
Published: August 2005

Summary: Spontaneously epileptic rats (SER), which represent a double mutation (zi/zi, tm/tm), spontaneously exhibit both tonic and absence‐like seizures. We examined the long‐term effects of a thyrotropin‐releasing hormone (TRH) analogue, CNK‐602A, acute administration of which was effective in inhibiting both types of seizures in SER, to determine if this agent could be used to treat epilepsy for long periods. Food pellets containing 0.001% CNK‐602A were given ad libitum to SER from age 7 weeks. CNK–602A significantly inhibited tonic convulsions and prolonged survival. There were no alterations in body weight or plasma levels of triiodotyronine (T3) and thyroxine (T4). These findings indicate that chronic intake of CNK‐602A in a dose that does not affect plasma levels of T3 and T4 inhibits tonic convulsions in SER and suggest that this drug may be an effective treatment for convulsive seizures in patients with epilepsy.
Myoclonic Alcoholic Epilepsy
Authors: Bartolomei Fabrice , Azulay Jean‐Philippe , Barrié Maryline , Gastaut Jean‐Louis
Published: August 2005

We describe 2 patients with chronic alcoholism who over a period of several years developed epilepsy associated with a cerebellar syndrome and action myoclonus. The clinical picture suggested progressive myoclonic epilepsy, but subsequent investigations did not confirm this diagnosis. Myoclonus worsened during abstinence and was relieved during indulgence. We believe that this special clinical syndrome should be recognized as a complication of chronic alcoholism.
Families Are Content to Discontinue Antiepileptic Drugs at Different Risks Than Their Physicians
Authors: Gordon Kevin , MacSween Judith , Dooley Joseph , Camfield Carol , Camfield Peter , Smith Bruce
Published: August 2005

Summary: Purpose: To define the risk of seizure recurrence (RSR) that families and physicians would accept before discontinuing antiepileptic drugs (AEDs) for children with controlled epilepsy.

Methods: A questionnaire was completed by families of 76 children with epilepsy ≥ 3 months seizure‐free and by their attending epilepsy specialist (n = 4).

Results: Forty‐two percent of families were unwilling to discontinue AEDs with an RSR of 25%. In contrast, 20% were willing to accept a > 75% RSR. Several factors differentiated the risk acceptable to families: previous seizure frequency (risk adverse with intermediate frequency), multiple seizure types (risk taking), grade or grades repeated in school (risk adverse), and the family's strategy of playing lotteries. Although families and physi‐cians were prepared to accept similar median RSR (35 and 40%, respectively), individual answers did not correlate (r2= ‐0.07). Physicians were unable to predict the families response (r2= 0.09).

Conclusions: Our current practice is to discontinue AEDs after 2 years of seizure‐free results in seizure recurrence of 30–40%. This risk may seem excessive to more than half of families, whereas other families will risk stopping AEDs at higher risks of recurrence. Physicians are poor judges of the degree of risk that is acceptable to a particular family, which may account in part for the anxiety manifested by families at AED discontinuation.
Objective Measure of Treatment Outcome in Epilepsy
Authors: Eslava‐Cobos Jorge
Published: August 2005

Summary: Treatment outcome in epilepsy is too often a vague, ill‐defined subjective measure. Based on a proposal of Shoffer and Temkin (1987) of “time to kth seizure” as a measure of seizure frequency, we devised the formula: % improvement = 100 ‐ [time to X seizure (i*) * 100]/ [time to X seizure (f*)]. This formula provides an objective measure of treatment outcome and should prove useful in clinical settings and research. We offer examples of practical applications of the formula.
Chronic Malnutrition Caused by a Corn‐Based Diet Lowers the Threshold for Pentylenetetrazol‐Induced Seizures in Rats
Authors: Palencia Guadalupe , Calvillo Minerva , Sotelo Julio
Published: August 2005

The incidence of epilepsy is high in developing countries where malnutrition is prevalent. Although malnutrition is not a direct cause of seizures, chronic malnutrition may predispose the brain to seizures. In large undernourished human groups from Latin America, the most common sources of food are corn and corn derivatives. We used a rat model of chornic malnutrition, in which corn tortillas were the only solid food intake, to study the possible influence of malnutrition at late stages of brain development on the dynamics of experimental seizures induced by pentylenetetrazole (PTZ). The threshold and does of PTZ required to produce seizures were greatly reduced in malnourished rats. The model of malnutrition used in the study imitates a form of malnutrition common among large numbers of humans. Our results suggest that chronic malnutrition early in life induces changes that lower the seizure threshold and leave the brain more susceptible to seizures. Whether this observation relates to the high incidence of epilepsy in underdeveloped countries remains to be determined.
Influence of D‐Cycloserine on the Anticonvulsant Activity of Phenytoin and Carbamazepine Against Electroconvulsions in Mice
Authors: WlazA Piotr , RolinAski Zbigniew , Czuczwar Stanislaw J.
Published: August 2005

Summary: Purpose: D‐Cycloserine (DCS) is a high‐efficacy partial agonist at the strychnine‐insensitive glycine modulatory site within the N‐methyl+‐aspartate (NMDA)‐receptor/ionophore complex. Previous studies demonstrated that DCS exhibits anticonvulsant activity in a variety of experimental epilepsy models. In this study, we determined the influence of DCS in subprotective doses on the anticonvulsant action of phenytoin (PHT) and carbamazepine (CBZ) in mice.

Methods: Two electroconvulsive tests were used, i.e., determination of seizure threshold and maximal electro‐shock seizures. Antiepileptic drug‐induced motor and long‐term memory deficits were quantified by using the chimney test and the passive‐avoidance test, respectively. In addition, plasma levels of PHT and CBZ were measured by fluorescence polarization immunoassay to exclude any pharmacokinetic interactions.

Results: DCS, when used alone in doses of 80 and 160 mg/kg, significantly increased the threshold for electro‐convulsive seizures. DCS in a wide range of doses (1.25–40 mg/kg) was combined with either PHT or CBZ and tested in electroconvulsive tests. DCS, at doses of 2.5 and 10 mg/kg, was the most effective in potentiating the threshold‐increasing action of PHT; higher doses of DCS (20 and 40 mg/kg) were required to achieve a similar effect of CBZ. In maximal electroshock‐induced seizures, DCS (10 mg/kg) augmented the protective action of PHT, but was ineffective at a dose of 40 mg/kg with CBZ. DCS did not potentiate the neurotoxicity produced by PHT and CBZ in the chimney test. Both PHT and CBZ induced impairments of long‐term memory; PHT‐induced memory adverse effects were counteracted by DCS (10 mg/kg). There was no such effect on CBZ‐induced memory impairment, and a worsening influence was observed. Any pharmacokinetic interactions were excluded by measuring total and free plasma levels of both antiepileptic drugs.

Conclusion: Our results suggest that combining DCS with PHT and CBZ may be beneficial in treating epileptic seizures.
Surgical Neuropathology of Intractable Epilepsy
Authors: Arai Nobutaka , Oda Masaya
Published: August 2005

Summary: Pathological examination of surgical specimens from patients with intractable epilepsy has been performed more frequently as neurosurgical procedures have been increasingly applied to the control of pharmacoresistant intractable epilepsy. The pathological lesions are classified as (a) hippocampal sclerosis of various degree with or without extrahippo‐campal dual pathology, (b) glioneuronal malformative lesions (including focal cortical dysplasia, hemimegalencephaly, tuberous sclerosis, microdysgenesis) with or without coexistence of tumor or tumor‐like lesions, (c) vascular lesions [including areriovenous malformations (AVM) and hemangiomal, (d) tumors alone, (e) chronic inflammatory or infectious lesions, (f) ulegyric lesions (including traumatic, ischemic, or undetermined episodes) with or without siderotic changes, (g) gliosis or astrocytic proliferation alone, (h) concomitant calcified lesions, and (i) unspecified lesions. We discuss recent factors with regard to this classification.
Interictal 99Tcm HMPAO SPECT and 1H MRS in Children with Temporal Lobe Epilepsy
Authors: Cross J. H. , Gordon I. , Connelly A. , Jackson G. D. , Johnson C. L. , Neville B. G. R. , Gadian D. G.
Published: August 2005

Summary: Purpose: To understand the pathological basis of focal hypoperfusion seen on interictal 99Tcm hexamethylpropyleneamine oxime (HMPAO) single‐photon‐emission computed tomography (SPECT) in intractable temporal lobe epilepsy, and to determine why the technique may be misleading in the localization and lateralization of the seizure focus in some cases.

Methods: Interictal 99Tcm HMPAO SPECT and proton magnetic resonance spectroscopy (1H MRS) of the mesial temporal regions were performed in 14 children with intractable temporal lobe epilepsy not caused by a foreign tissue lesion.

Results: Hypoperfusion of one temporal lobe ipsilateral to the seizure focus was demonstrated in 10 (71%) of the children; 1H MRS correctly lateralised in eight of these 10. No asymmetry of perfusion of the anterior temporal regions was seen in the remaining four children; on 1H MRS, three of these were bilaterally abnormal but nonlateralising. Repeated SPECT and 1H MRS in three children demonstrated changes over time, the findings from the two techniques being consistent with each other on both the initial and the repeated scans.

Conclusions: Abnormalities demonstrated by 1H MRS correlate well with those seen on interictal SPECT and can help to understand the pathologic basis of these SPECT abnormalities. Furthermore, the presence of bilateral damage can result in an absence of perfusion asymmetry on interictal SPECT.
Seizure Severity in Children with Epilepsy: A Parent‐Completed Scale Compared with Clinical Data
Authors: Carpay J. A. , Vermuelen J. , Stroink H. , Brouwer O. F. , Peters A. C. B. , Aldenkamp A. P. , van Donselaar C. A. , Arts W. F. M.
Published: August 2005

Summary: Purpose: We wished to compare a parent‐completed scale quantifying seizure severity (SS) in children with various seizure types with the clinicians' impression of SS and other clinical data.

Methods: The parents of 117 children with recurrent seizures completed a 13‐item, subjective scale (The Hague Seizure Severity Scale, HASS). Eight treating neurologists quantified SS on a 10‐point Visual Analog Scale (VAS) and supplied other clinical data.

Results: Both the HASS and the VAS assessments of SS showed considerable variation within one seizure type. Significant differences were noted between groups with (a) absences and simple partial seizures (SPS), (b) complex partial seizures (CPS), and (c) generalized tonic‐clonic seizures (GTCS). The correlation coefficient between the neurologists' and the parents' scores was 0.45 but did not exceed 0.26 after stratification for seizure type. The parents' score was not substantially influenced by various other clinical variables. The neurologists' score was correlated with resistance to treatment and presence of mental retardation.

Conclusions: The SS ratings of the parents and the neurologists were not substantially correlated. The consideration that parents, as eyewitnesses to the seizures, are probably better judges of SS than clinicians may favor the use of a parent‐completed scale to quantify SS. The HASS is a valid and reliable measure of parent‐perceived SS that can be useful as an outcome measure in childhood epilepsy.
Widespread Functional Deficits in Perception‐Related Networks Demonstrated by PET in a Case with Simple Visual Seizures
Authors: Mielke R. , Weber‐Luxenburger G. , Kessler J. , Szelies B. , Heiss W.‐D.
Published: August 2005

Summary: Purpose: To study benzodiazepine receptor (BZR) density and functional deficits in occipital lobe epilepsy.

Methods: A 39‐year‐old man who had simple partial visual seizures after neurosurgical transtentorial extirpation of a pine‐aloma was studied by EEG, magnetic resonance imaging (MRI), and positron emission tomography (PET) of [18F]2‐fluoro‐2‐deoxy‐D‐glucose (FDG) at rest and during visual activation task and [11C]flumazenil (FMZ).

Results: Electroencephalographic recordings were nonspecific, and MRI did not reveal any morphologic anomaly in the occipital lobe. Flumazenil‐PET demonstrated a small epileptogenic region in the right visual association cortex and FDG‐PET showed hypometabolism in a corresponding location and thalamic diaschisis. Stimulation of occipital metabolism by a continuous visual recognition task improved significantly the contrast between the dysfunctional zone and its surround.

Conclusions: As BZR deficits are restricted to a small region, widespread hypometabolism in networks involved in visual information processing indicates an extensive functional deactivation by the epileptogenic focus.
IgA and IgG2 Deficiency Associated with Zonisamide Therapy: A Case Report
Authors: Maeoka Yukinori , Hara Toshiro , Dejima Sunao , Takeshita Kenzo
Published: August 2005

Summary: Purpose: To report a previously undescribed adverse effect, IgA/IgG subclass deficiency associated with zonisamide (ZNS) therapy.

Methods: Serum IgA and IgG subclass levels were determined by the turbidimetric immunoassay and enzyme‐linked immunosorbent assay, respectively, in a 2–year‐old boy with postmeningitis sequelae who was treated by ZNS.

Results: Four months after initiation of ZNS, combined deficiency of IgA and IgG2 was noted. After cessation of ZNS, serum IgA level was promptly increased. IgG2 level was gradually increased, but remained subnormal after 7 months.

Conclusions: This case documents, for the first time, the action of ZNS on IgG immune system as well as IgA system. If patients with ZNS therapy showed IgA deficiency and recurrent infections, it is preferable to check serum IgG subclass concentrations as well.