bluuebunny/crossref_metadata_2025 huggingface dataset:
Continuous Unilateral Epileptiform Discharge and Language Delay: Effect of Functional Hemispherectomy on Language Acquisition
Authors: Rosenblatt Bernard , Vernet Olivier , Montes Jose L. , Andermann Frederick , Schwartz Sybil , Taylor Laughlin B. , Villemure Jean‐Guy , Farmer Jean‐Pierre
Published: August 2005

Summary: Purpose: To assess the efficacy of functional hemispherectomy in promoting language acquisition in a child with severe language delay and continuous left hemispheric epileptiform discharge in the absence of clinical seizures. We report a 6‐month‐old girl who initially presented with a right hemiparesis secondary to a lesion of probable prenatal origin in the distribution of the left middle cerebral artery. Weeks later, she developed infantile spasms. At 1.5 years of age, because of intractable seizures, the patient had fenestration of the left porencephalic cyst and anterior temporal lobectomy. The seizures ceased; however, language development remained limited to 35 words at 3.5 years of age. The EEG showed almost continuous epileptiform activity over the left hemisphere with no independent epileptiform potentials contralaterally. She underwent a functional left hemispherectomy.

Methods: Imaging, electroencephalographic investigation, pre‐ and postoperative psychological and speech assessment were carried out.

Results: Considerable language, speech, and behavior improvement was noted within 2 months of surgery.

Conclusions: Interictal epileptiform discharges can interfere with the development of contralateral hemispheric function in the absence of clinical seizures. Early functional hemispherectomy may have a role in promoting optimal language development in appropriately selected patients. Although the primary indication for functional hemispherectomy is to control intractable seizures, a secondary proposed indication is to reduce functional impairment of the other hemisphere by electrical interference.
Effects of Tiagabine Monotherapy on Abilities, Adjustment, and Mood
Authors: Dodrill Carl B. , Arnett John L. , Shu Vincent , Pixton Glenn C. , Lenz Gregory T. , Sommerville Kenneth W.
Published: August 2005

Summary: Purpose: We evaluated the dose‐related impacts of tiagabine (TGB) on cognition and mood in a monotherapy study.

Methods: Patients were 123 adults with uncontrolled partial seizures, each treated with a single currently available antiepileptic drug (AED) for management of clinical epilepsy. They completed a battery of neuropsychological tests during an 8 week prospective baseline period and once again at the end of the 12‐week fixed‐dose period (or earlier if they dropped out of the study). Sixty‐six patients were randomized to 6 mg/day TGB and 57 were randomized to 36 mg/day TGB.

Results: Few changes in either abilities or adjustment and mood were noted when all patients were considered as a single group. However, analysis of both dose and attainment of TGB monotherapy showed that patients receiving TGB monotherapy did best, improving particularly in the areas of adjustment and mood with low‐dose TGB and in the area of abilities with high‐dose TGB. Patients who did not attain monotherapy showed no change except that the high‐dose group did not perform as well on measures of mood and adjustment. Baseline AED and changes in seizure control did not affect the results.

Conclusions: Patients attainment of TGB monotherapy was associated with their achievement of positive changes of varying degree on psychological tests. Failure to attain TGB monotherapy was associated with no changes on the tests except in patients receiving high‐dose TGB where it appeared that some alterations in mood might have been avoided if a slower titration schedule had been used.
Predicting Outcome of Anterior Temporal Lobectomy Using Simulated Neural Networks
Authors: Grigsby Jim , Kramer Ronald E. , Schneiders Jay L. , Gates John R. , Brewster Smith W.
Published: August 2005

Summary: Purpose: Anterior temporal lobectomy (ATL) is an important option for treatment of medically refractory seizures. Patient selection is not always clear‐cut, and there is inherent morbidity and mortality associated with the invasive and expensive surgical protocols. To determine whether patient selection might be facilitated by application of artifical intelligence, we developed a model that predicted seizure outcome after ATL, using a simulated neural network (SNN).

Methods: Predictions of the model were compared with predictions derived from conventional discriminant function analysis. Neural networks and discriminant functions were devised that would predict the occurrence of both Class 1 out‐comes (totally seizure‐free), and Class 1 or Class 2 outcomes (nearly or totally seizure‐free), using data from 87 patients from three surgical centers. The SNNs and discriminant functions were developed using data from a randomly selected subsample of 65 patients, and both models were cross‐validated, using the remaining 22 patients.

Results: The discriminant functions showed overall predictive accuracy of 78.5% and 72.7%, while the neural networks demonstrated overall accuracy of 81.8 and 95.4%.

Conclusions: Simulated neural networks show promise as adjuncts to decision‐making in the selection of epilepsy surgery patients.
Startle Epilepsy with Infantile Hemiplegia: Report of Two Cases Improved by Surgery
Authors: Oguni Hirokazu , Hayashi Kitami , Usui Norihisa , Osawa Makiko , Shimizu Hiroyuki
Published: August 2005

Summary: Purpose: To study the effectiveness of surgical therapy on 2 patients with startle epilepsy with infantile brain damage (SEIBD), a rare but distinctive epileptic syndrome characterized by motor seizures resistant to antiepileptic drugs (AEDs).

Methods: The patients with SEIBD both had hemiplegia, due to gross contralateral hemispheric lesions, and suffered from tonic postural seizures, frequently provoked by sudden unexpected somatosensory stimuli on the paretic side of the body. These attacks occasionally caused the patients to drop to the floor, and mild‐to‐moderate injuries had been sustained; they were resistant to all currently available AEDs. Consequently, these daily drop attacks severely restricted the patients' social lives and school participation. Both patients underwent corpus callosotomy and resection of epileptogenic premotor and supplementary motor lesions. One patient also underwent additional multiple subpial transections of the primary sensorimotor area.

Results: Seizures, as well as quality of life, improved dramatically in both patients after surgery.

Conclusions: Startle epilepsy with infantile hemiplegia is distinct epileptic syndrome characterized by structural brain damage restricted primarily to one hemisphere, large ipsilateral epileptogenic lesions involving the perisensorimotor area, refractory startle‐provoked drop attacks, and a good response to epilepsy surgery.
Influence of an Evacuation in February 1995 in The Netherlands on the Seizure Frequency in Patients with Epilepsy: A Controlled Study
Authors: Swinkels W. A. M. , Engelsman M. , Kasteleijn‐Nolst Trenité D. G. A. , Baal M. G. , De Haan G. J. , Oosting J.
Published: August 2005

Summary: Purpose: Stress is often noted by patients to be a precipitating factor in causing seizures. No precise data are, however, available. In 1995 for 250,000 inhabitants in the Netherlands, a serious life event occurred within a period of seven days. An extreme high water level in the province of Gelderland, with the possibility of a flood, made the government decide to evacuate people and their livestock. This retrospective study investigated the influence of this forced evacuation on the seizure frequency of patients with epilepsy, compared with patients of the same age and type of epilepsy living outside the evacuation area at the time of the threatening flood.

Methods: Information regarding epilepsy syndrome, seizure type, and frequency was derived from seizure diaries and medical histories of 30 evacuated patients and 30 matched control patients.

Results: Of the 30 evacuees, eight showed an increase and one a decrease in seizure frequency during or shortly after the evacuation period, compared with one and zero control patients, respectively. These results proved to be statistically significant (p < 0.05).

Conclusions: Our data support the hypothesis that there is a relation, albeit small, between a stressful life event and seizure frequency.
Electrophysiologic Analysis of the Actions of Valproate on Pyramidal Neurons in the Rat Hippocampal Slice
Authors: Albus H. , Williamson R.
Published: August 2005

Summary: Purpose: Studies in invertebrates and cultured mammalian neurons suggested that valproate (VPA) mediates its main antiepileptic effect by slowing the recovery from inactivation of voltage‐dependent sodium channels. This predicts an effect on the refractory period of the action potential and, consequently, on the bursting behavior of neurons.

Methods: We investigated this prediction using intracellular and extracellular recording techniques in hippocampal slices prepared from adult rats. The refractory period (RFP) and the ratio of the slopes (SR) of a pair of action potentials were used as indices of the recovery from inactivation of sodium channels. They were measured by injecting a series of paired depolarizing current pulses into CAI pyramidal neurons.

Results: No significant changes were observed in the RFP or SR measured during a I‐h recording period when VPA was bath‐applied (1 mM), or when it was present in the recording electrode (10–50 mM). Lowering the temperature from 34.5°C to 26.4°C resulted in an increase of the RFP by 100% and a decrease of the SR by 40%. However, VPA did not affect any of the measured action potential parameters at this lower temperature. VPA was also without effect on the presynaptic fiber volley of axons recorded extracellularly in the stratum radiatum. The antidromic population spike was unaffected by VPA (2 mM), whereas phenytoin (50 μM) clearly affected this spike in the same slices. The absence of effect of VPA on each of the measured parameters could not be attributed to poor penetration through the slice because bath‐applied VPA reduced the frequency of extracellularly recorded spontaneous interictal bursts, induced by bicuculline and elevated K+, within 10 min.

Conclusions: These findings suggest that at least in the hippocampal slice the drug's principal antiepileptic effect cannot be explained by its action on voltage‐dependent sodium channels.
MRS Metabolic Markers of Seizures and Seizure‐Induced Neuronal Damage
Authors: Najm I. M. , Wang Y. , Shedid D. , Lüders H. O. , Ng T. C. , Comair Y. G.
Published: August 2005

Summary: Purpose: Proton magnetic resonance spectroscopy (MRS) was used to identify specific in situ metabolic markers for seizures and seizure‐induced neuronal damage. Kainic acid (KA)‐induced seizures lead to histopathologic changes in rat brain. The protective effect of cycloheximide treatment against neuronal damage caused by KA‐induced seizures was studied, using in situ proton MRS imaging technique.

Methods: Rats were pretreated with placebo or cycloheximide 1 h before KA injection. Rat brains (n = 25) were scanned at the level of the hippocampus before, during, and 24 h after seizures. Spectra were recorded and the relative ratios of N‐acetylaspartate (NAA), choline (cho), and lactate (Lac) to creatine (Cr) were calculated and compared between groups.

Results: A significant increase in Lac ratios was observed in KA‐treated rats during and 24 h after seizure onset and this increase was prevented by cycloheximide pretreatment. NAA ratios were significantly higher during the ictal phase following KA treatment and this effect was not affected by cycloheximide pretreatment. Nissl staining confirmed previously reported prevention of KA‐induced neuronal loss in CA1 and CA areas of the hippocampus by cycloheximide pretreatment.

Conclusions: Our results suggest that in situ Lac increase is a marker of seizure‐induced neuronal damage, whereas N‐acetylaspartate (NAA) changes during and after status epilepticus may be a reflection of neuronal activity and damage, respectively.
Contribution of Neuropsychological Data to the Prediction of Temporal Lobe Epilepsy Surgery Outcome
Authors: Sawrie Stephen M. , Martin Roy C. , Gilliam Frank G. , Roth David L. , Faught Edward , Kuzniecky Ruben
Published: August 2005

Summary: Purpose: We empirically examined the contribution of neuropsychological data to the prediction of postoperative seizure control relative to base rate information in an existing series of patients undergoing anterior temporal lobectomy (ATL).

Methods: A discriminant function predicting surgery outcome (seizure‐free vs. non‐seizure‐free) was computed separately for samples of patients with left (n = 79) and right (n = 62) temporal lobectomy (LATL, RATL). Predictor variables included 14 measures tapping five neurocognitive domains. The predicted base rates were compared with the actual base rates in the two samples. Finally, overall predictive accuracy was examined in optimal versus suboptimal ATL patients.

Results: The base rate of seizure freedom in the LATL group was 74.70%; that in the RATL group was 66.10%. The predictive function for the LATL group achieved a hit rate of 80.00% and a positive predictive power of 92.1 1%. The function for the RATL group achieved a hit rate of 83.33% and a positive predictive power (PPP) of 89.66%. The overall predictive accuracy for the optimal group was only 55%, but that in the suboptimal group was 72%.

Conclusions: Neuropsychological data used in a multivariate statistical fashion may be able to offer an incremental increase in the prediction of postoperative seizure freedom relative to existing base rates of surgery success in patients with ATL epilepsy. The use of neuropsychological data may be of greatest predictive value in a population of ATL candidates with suboptimal findings with a lower base rate of postoperative seizure freedom, but may actually reduce predictive accuracy in a group of ATL candidates from an optimal population with an already high base rate of surgical success.
Naming Decline After Left Anterior Temporal Lobectomy Correlates with Pathological Status of Resected Hippocampus
Authors: Davies Keith G. , Bell Brian D. , Bush Andrew J. , Hermann Bruce P. , Curtis Dohan F. , Jaap Amy S.
Published: August 2005

Summary:Purpose:To evaluate the determinants of postoperative change in visual confrontation naming ability and the differential sensitivity of two common tests of confrontation naming.

Methods:In a group of 99 patients undergoing lobectomy of the left, language‐dominant anterior temporal lobe, we examined naming ability using two measures: the 60 item Boston Naming Test (BNT), and the Visual Naming (VN) subtest of the Multilingual Aphasia Examination (MAE). ATL entailed resection of lateral temporal lobe followed by microsurgical complete removal of hippocampus. Language mapping was not performed. The status of the resected hippocampus was graded on a scale 0–4 of hippocampal sclerosis (HS). A dichotomous grouping HS‐ (grades 0 and 1, n = 34) and HS+ (grades 3 and 4, n = 61) was effected. Age at surgery, age of epilepsy onset, sex, extent of lateral temporal resection, Full‐Scale IQ (FSIQ), and preoperative naming scores were also examined as potential predictors of pre‐ versus postoperative naming change.

Results:Preoperative BNT and VN scores were significantly worse for HS+ than for HS‐ (BNT, p c 0.05; VN, p = 0.001). Postoperatively, BNT and VN scores significantly declined for HS‐ as compared with HS+ patients (p c 0.001). For individual risk, the 90th centile of reliable change index (RCI) was used. By this criterion, of the total sample, 39% evidenced decline on the BNT and 17% evidenced decline on the VN. Logistic regression analysis with backward elimination showed HS to be the only predictor of decline in BNT and HS and sex to be the only predictors of VN decline. Males were more at risk than females. Age, age at onset, extent of lateral resection, preoperative scores, and FSIQ were not predictors. Using age at onset as a proxy for HS+/HS‐ we calculated probabilities for naming decline for given onset age.

Conclusions:Both preoperative and postoperative change in naming ability are associated with the pathological status of the hippocampus. The potential interpretations and implications of these findings are discussed.
Nonconvulsive Status Epilepticus in Two Patients Receiving Tiagabine Treatment
Authors: Eckardt Karin M. , Steinhoff Bernhard J.
Published: August 2005

Summary: In the course of an open study on the add‐on treatment of tiagabine (TGB) in patients with localization‐related epilepsy syndromes, 2 of 9 patients developed nonconvulsive status epilepticus (NCSE) with electroclinical features consistent with those of atypical absence seizures. One patient had never had atypical absence seizures before. In both cases, immediate discontinuation of TGB was followed by complete and sustained electroclinical remission; we suggest a possible causative role of TGB. This observation may be consistent with a paradoxical effect of TGB in selected cases. Possible risk factors and a pathophysiological hypothesis are discussed.
Visual and Automatic Investigation of Epileptiform Spikes in Intracranial EEG Recordings
Authors: Dümpelmann M. , Elger C. E.
Published: August 2005

Summary: Purpose: Performance of automatic spike‐detection algorithms and interrater reliability of human EEG reviewers were investigated previously by using scalp EEG recordings. However, it is not known, whether the findings of these studies hold for intracranial recordings. To address this question, we analyzed spike detection in intracranial recordings by two human reviewers and three automatic systems covering major lines in the development of automatic spike‐detection systems.

Methods: Intracranial recordings from subdural and intrahippocampal depth electrode contacts in seven patients were analyzed by two reviewers and three spike‐detection systems: (a) The rule‐based system by Gotman, (b) a two‐stage system consisting of a linear predictor and a second rule‐based stage, and (c) a system using wavelet coefficients of the intracranial EEG data.

Results: Agreement between the two human reviewers with respect to spike identification was <50%. The automatic systems achieved agreements of 24% (Gotman), 26% (wavelet detector), and 32% (two‐stage system) with the individual human reviewers. In spite of the small proportion of agreements, the same anatomic regions were identified by human and automatic EEG analysis as generators for the majority of spikes.

Conclusions: The poor agreement between the human EEG reviewers suggests that the definition of spikes and spike‐like episodes in intracranial electrodes is far from unequivocal. Nevertheless, localizing information is highly consistent by either visual or automatic spike detection, independent of the algorithm used for automatic spike detection.
Prediction of Postoperative Seizure Control by Hippocampal Event‐Related Potentials
Authors: Grunwald Thomas , Lehnertz Klaus , Pezer Nico , Kurthen Martin , Van Roost Dirk , Schramm Johannes , Elger Christian E.
Published: August 2005

Summary: Purpose: In spite of unequivocal results of the presurgical evaluation, between 10 and 30% of patients with medial temporal lobe epilepsy (MTLE) do not become seizure free by temporal lobe surgery. Because event‐related potentials (ERPs) recorded within the hippocampal formation have been shown to be sensitive to the epileptogenic process, we examined whether ERPs can help to improve the prediction of postoperative seizure control.

Methods: We recorded ERPs to words from bilateral intrahippocampal electrodes by using a visual word‐recognition paradigm in 70 patients with unilateral hippocampal pathology and related these measurements to seizure outcome after temporal lobe surgery.

Results: Words elicited N400 potentials, which were reduced in amplitude on repetition on the side contralateral to hippocampal sclerosis. This contralateral repetition effect, however, was significantly diminished in the group of patients who experienced seizure recurrence after the operation. Contralateral repetition effects thus permitted correct prediction of postoperative seizure control in 94% of all patients.

Conclusions: Recording ERPs to words within the medial temporal lobes can improve the prediction of postoperative seizure control. Reduced repetition effects contralateral to the side of hippocampal sclerosis may indicate bilateral epileptogenicity.
An Evaluation of the Impact of Health Worker and Patient Education on the Care and Compliance of Patients with Epilepsy in Zimbabwe
Authors: Adamolekun B. , Mielke J. K. , Ball D. E.
Published: August 2005

Summary: Purpose: The use of primary health care personnel to identify cases of epilepsy and initiate simple treatment protocols has been advocated as a solution to the numeric inadequacy and uneven distribution of medical manpower available for the management of epilepsy in developing countries. This study sought to evaluate the effectiveness of primary health care nurses in the diagnosis and management of epilepsy, as well as the impact of patient‐information pamphlets on drug compliance and clinic attendance of patients with epilepsy.

Methods: Primary health care workers from 24 clinics in the Zvimba district in Zimbabwe attended a workshop to improving their knowledge in the diagnosis and management of generalized tonic‐clonic seizures. Half of these clinics (experimental group) subsequently received patient‐information pamphlets for distribution to patients and relatives, whereas the other half (control group) did not. Frequency of clinic attendance, mean seizure frequencies, and mean serum levels of phenobarbitone were compared at baseline and at 6 months after intervention in patients within each group, and at 6 months after intervention between both groups.

Results: Community health worker education led to a 74% increase in patient recruitment as well as a marked improvement in patient drug compliance over the 6‐month study period. The use of patient‐information pamphlets led to a marked reduction in patient default from clinic follow‐up, but did not appear to influence drug compliance or seizure frequency.

Conclusions: The benefits of these simple and inexpensive interventions make a strong case for their widespread implementation for improved epilepsy care not only in Zimbabwe, but also in other developing countries.
Ictal Bradycardia in a Patient with a Hypothalamic Hamartoma: A Stereo‐EEG Study
Authors: Kahane Philippe , Di Leo Matilde , Hoffmann Dominique , Munari Claudio
Published: August 2005

Summary: Little is known about bradycardia and cardiac asystole which occur during partial epileptic seizures, especially whether they relate to ictal involvement of well‐defined cortical areas. Several reports based on simultaneous electro‐cardiographic and intracranial depth electroencephalographic monitoring have shown that either the fronto‐orbital cortex or the amygdalohippocampal complex could be responsible for such cardiac variations.

We performed stereo‐EEG recordings in a patient with refractory localization‐related epilepsy associated with a hypo‐thalamic hamartoma. We found that other cortical areas, such as the frontocentral region and the temporal neocortex, can contribute to the genesis of ictal bradyarrhythmia. Second, the lesion per se, although located within the hypothalamus, is not involved with this phenomenon.
Risk Factors for a First Febrile Convulsion in Children: A Population Study in Southern Taiwan
Authors: Huang Chao‐Ching , Wang Shan‐Tair , Chang Ying‐Chao , Huang Mei‐Chih , Chi Yun‐Chan , Tsai Jing‐Jane
Published: August 2005

Summary: Purpose: To identify risk factors for a first febrile convulsion among 3‐year‐old children by a matched case‐control population study.

Methods: All 11,714 neonatal survivors born in Tainan City between October 1989 and September 1991 were enrolled. At age 3, 10,460 children were available for telephone survey for febrile convulsions, and were confirmed by home visit interviews. Those without history of seizure were randomly matched to each febrile convulsion case by age, gender, and residence district.

Results: Two hundred fifty six children had febrile convulsions, and 218 of them and their matched controls were available for analysis. The febrile convulsion cases had significantly more febrile episodes (four or more) per year (33.0 vs. 22.5%; p = 0.021), and cases had a higher percentage of developmental delay (3.7 vs. 0.4%; p = 0.046) and a higher percentage of febrile convulsions in their siblings (12 vs. 0.4%; p = 0.011) than controls. The other sociodemographic, environmental, and biologic variables showed no differences between cases and controls. Step‐wise logistic regression showed a highly significant independent association between febrile convulsions and history of febrile convulsions in the siblings, and a moderate one between febrile convulsions and the number of febrile episodes per year.

Conclusions: The presence of febrile convulsions in the siblings and the number of fever episodes per year were the independent and significant predictors of febrile convulsion for an individual case in our population‐based sample.
Agreement and Correctness in Adjusting Antiepileptic Drug Treatment: A Need for Rational Drug Treatment?
Authors: Smeets R. , Meinardi H. , Talmon J. , Hasman A.
Published: August 2005

Summary: Purpose: To study interobserver variation in treatment decisions in a first follow‐up contact after initiation of antiepileptic drug (AED) treatment. The results should aid us in the assessment of whether decision support can be of value in this situation.

Methods: Data from patient records were used to construct 270 different test cases containing information about the course of the disease after initiation of drug treatment. The cases were presented to five neurologists from different general hospitals who previously agreed about the diagnosis and the initial treatment for these cases. They were asked to write a prescription for each test case.

Results: All five neurologists agreed on a treatment decision in 21.9% of the 265 cases available for analysis. Each neurologist made a decision different from the decisions taken by all other neurologists in 14.0–19.6% of the cases. Kappa values for agreement among individual neurologists as well as for agreement between an individual and the group of his peers were low. In 82.6% of the cases, a majority of the neurologists agreed on a treatment decision. Comparing the decisions of individual neurologists with the majority decision reference (219 cases) showed a significant difference in correctness (range, 67.1–82.6%) among the neurologists.

Conclusions: The fact that a majority decision could be reached in a considerable number of cases, as well as the variability in adjustment of an initiated drug treatment, leads us to the conclusion that decision support can contribute to a rational adjustment of drug treatment.
EPIMART: Prospective Incidence Study of Epileptic Seizures in Newly Referred Patients in a French Carribean Island (Martinique)
Authors: Jallon Perre , Smadja Didier , Cabre Philippe , Le Mab Guillaume , Bazin Marcel ,   EPIMART
Published: August 2005

Summary: Purpose: To identify, in the population living in the island of Martinique, persons who had their first epileptic seizure or first came to medical attention because of an epileptic seizure.

Methods: Between May 1, 1994, and April 30, 1995, we collected all suspected cases of provoked and unprovoked epileptic seizures admitted to the hospitals or addressed to the private neurologists or pediatricians of the island.

Results: Three hundred nine cases were collected. Rate of initial diagnosis of provoked and nonprovoked seizures (standardized to the U.S. population): 77.7/100,000, with a bimodal distribution of the cases with age (86 in 0‐ to 10‐year age group and 203 in patients older than 60 years). Sixty‐three cases were classified as provoked seizures (incidence, 16.4/100,000). Alcohol consumption, stroke, and cranial trauma were the most frequent causes (30.1, 20.6, and 18.7%, respectively). Two hundred forty‐six cases were classified as unprovoked seizures (incidence, 64.1): seizures with a stable condition, 74 cases (I, 19.3); seizures with an evolutive condition, 17 cases (I, 4.5); seizures of unknown etiology, 155 cases (I, 40.4). These figures must be considered as the minimal rate.

Conclusions: The global incidence rate of newly referred persons with a diagnosis of epileptic seizures in this study is clearly higher than those observed in industrialized countries but lower than those in developing countries. The major risk factors are represented by alcohol consumption, followed by stroke, cranial trauma, and infectious diseases.
Childhood Secondary (Symptomatic) Epilepsy, Seizure Control, and Intellectual Handicap in a Nontropical Region of South Africa
Authors: Leary P. M. , Riordan G. , Schlegel B. , Morris S.
Published: August 2005

Summary: Purpose: To determine the prevalence of secondary (symptomatic) epilepsy and to ascertain levels of seizure control and intellectual function in a clinic population of children drawn from a poor community in a temperate region of South Africa.

Methods: Detailed review of the records of every child with recurrent seizures who attended a special epilepsy outpatient clinic during 1995.

Results: A total of 1,017 children was studied. In 432 (43%), there was historic, clinical, and radiologic evidence to suggest that epilepsy was symptomatic of underlying brain damage or defect. Acceptable seizure control was maintained with a single standard anticonvulsant drug (AED) in 65% of cases. In the 6 months preceding the study, 37% of the subjects had remained seizure free. Forty‐seven percent of the study population were considered to be of subnormal intelligence.

Conclusions: In a children's hospital outpatient population in the Western Cape region of South Africa, the prevalence of secondary epilepsy is higher than is found in developed countries. There is need within the community for preventive measures aimed at reducing the prevalence of perinatal insults, meningitis, tuberculosis, neurocysticercosis, and cerebral trauma.
Benign Childhood Epilepsy with Centrotemporal Spikes and Hippocampal Atrophy
Authors: Gelisse Philippe , Genton Pierre , Raybaud Charles , Thiry Annick , Pincemaille Olivier
Published: August 2005

Summary: A boy without significant family or personal history had three consecutive nocturnal seizures at 1‐month intervals at age 10 years, all simple focal seizures with motor and sensory symptoms, the last with secondary generalization. Waking and napping EEG showed focal sharp changes typical of benign epilepsy with centrotemporal spikes (BECTS). A magnetic resonance imaging documented a marked right hippocampal atrophy (HA). After valproic acid (VPA) therapy, there were no more seizures, and there were fewer EEG changes. An EEG performed in the younger, fully asymptomatic 8‐year‐old sister documented unilateral right focal sharp waves. This case shows that HA, as well as other central nervous system lesions, can be found fortuitously in patients with BECTS.
Behavioral, Psychotic, and Anxiety Disorders in Epilepsy: Etiology, Clinical Features, and Therapeutic Implications
Authors: Torta Riccardo , Keller Roberto
Published: August 2005

This chapter deals with some aspects of psychiatric disturbances in people with epilepsy. Because depression and its treatment are extensively described later in this issue, they are not discussed here. The same pertains to forced normalization.
Incidence of Epileptic Syndromes in Rochester, Minnesota: 1980–1984
Authors: Zarrelli Michele M. , Beghi Ettore , Rocca Walter A. , Hauser W. Allen
Published: August 2005

Summary: Purpose: To determine the incidence and the distribution of epileptic syndromes in a well‐defined population.

Methods: By using the records‐linkage system of the Rochester Epidemiology Project, we screened all the residents of Rochester, Minnesota, who received a diagnosis of seizures, convulsions, or epilepsy from 1980 through 1984. One hundred fifty‐seven residents with incident epilepsy (recurrent unprovoked seizures) were classified by using the International League Against Epilepsy (ILAE) Classification of the Epilepsies and Epileptic Syndromes. Residents with special syndromes were excluded. With a pretested algorithm, patients were classified at three levels of specification: major syndromic groups (e.g., localization‐related syndromes), syndromic subgroups (e.g., idiopathic epilepsy with age‐related onset), and whenever possible, individual syndromes.

Results: All but one patient were classified into major syndromic groups and subgroups. The annual age‐adjusted incidence per 100,000 population was 52.3 cases (34.9 for localization‐related epilepsies; 7.7 for generalized epilepsies; 9.7 for undetermined epilepsies). Incidence was 0.2 for idiopathic, 17.2 for cryptogenic, 17.5 for symptomatic localization‐related epilepsies, 3.7 for idiopathic, 1.7 for symptomatic or cryptogenic (age‐related), and 2.3 for symptomatic (non age‐related) generalized epilepsies.

Conclusions: With the exception of idiopathic epilepsies, the incidence of the major syndromic categories in our study was higher than that provided by previous population‐based studies.
Hippocampal Asymmetries and White Matter Abnormalities on MRI in Benign Childhood Epilepsy with Centrotemporal Spikes
Authors: Lundberg Staffan , Eeg‐Olofsson Orvar , Raininko Raili , Eeg‐Olofsson Karin Edebol
Published: August 2005

Summary: Purpose: To look for brain abnormalities by using magnetic resonance imaging (MRI) in patients with benign childhood epilepsy with centrotemporal spikes (BCECTS), which is the most common epilepsy syndrome in children.

Methods: Eighteen children, aged 6–12 years, with typical BCECTS were examined with MRI, six of them twice.

Results: Some hippocampal abnormality was found in six (33%) of the children, all with the syndrome's typical electroencephalogram (EEG) pattern ipsilaterally. Hippocampal size asymmetry was found in five (28%) children (right side < left in two and left < right in three), and high signal intensities on T2‐weighted images were found in three (17%). Two children also had other abnormalities; one had a heterotopic nodule near the contralateral frontal horn, and one had an Arnold‐Chiari malformation. The hippocampal asymmetry remained unchanged in three of the children who were reexamined after 2 years. High signal intensities on T2‐weighted images were seen beneath the cortex‐white matter junction in the frontal and temporal lobes of five (28%) children, one of whom also had a hippocampal asymmetry. MRIs were normal in eight (44%) children.

Conclusion: For the first time, hippocampal asymmetries and white‐matter abnormalities have been detectable on the MRIs of children with typical BCECTS. The etiology of the former is unclear, whereas the latter may be a result of a maturational delay involving a defective myelination. Long‐term follow‐up studies are needed to evaluate the relation between these findings and the clinical course of BCECTS.
Autosomal Dominant Nocturnal Frontal Lobe Epilepsy: An Electroclinical Study of a Norwegian Family with Ten Affected Members
Authors: Nakken Karl Otto , Magnusson Andres , Steinlein Ortrud K.
Published: August 2005

Summary: Purpose: The aim of the study was to describe in detail the electroclinical findings associated with a mutation in the acetylcholine receptor in a Norwegian family with autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE). Furthermore, we compared the clinical features associated with this mutation with those of an Australian family with a different mutation at the same locus, as well as with those of eight Italian families with ADNFLE and without a verified mutation in this gene.

Methods: We obtained medical records from all of the 10 known affected members of the Norwegian family. A personal interview and a clinical neurologic examination were carried out in six of them. Interictal and ictal scalp EEG recordings were obtained in eight and three, respectively, computed tomography/magnetic resonance imaging (CT/MRI) in five, and blood samples for genetic analysis in seven individuals. The clinical features after an insertion of a leucine residue in the α4 subunit of the neuronal nicotinic acetylcholine receptor are examined. Furthermore, the clinical features that accompany this insertion and the clinical features associated with a missense mutation (Ser248Phe) in the same gene were compared.

Results: All the affected individuals had a seizure semiology consistent with frontal lobe seizures. Their seizures started in childhood (mean age, 8 years) and were often misinterpreted as benign nocturnal parasomnias, nocturnal paroxysmal dystonia, or a psychiatric disorder. The affected family members were of normal intellect and showed no abnormalities at neurologic and neuroradiologic examinations. Interictal scalp EEG registrations were mostly normal, ictal scalp EEG registrations in three individuals revealed left frontal low‐voltage epileptiform discharges in two, and only shallow arousal preceding the attack in one. Although the seizure susceptibility varied among the affected individuals, the epilepsy course was mostly benign.

Conclusions: Patients with ADNFLE, either with the 776ins3 mutation or the Ser248Phe mutation, and those without any recognized mutation in the acetylcholine receptor, have strikingly homogeneous phenotypes, and it seems difficult to separate them on clinical grounds.
Violence and Epilepsy: A Close Relation Between Violence and Postictal Psychosis
Authors: Kanemoto Kousuke , Kawasaki Jun , Mori Etsuko
Published: August 2005

Summary: Purpose: We investigated the incidence of well‐directed violent behavior and suicide attempts in patients with temporal lobe epilepsy, with special attention to postictal psychosis.

Methods: We compared 57 episodes of postictal psychosis with 62 episodes of acute interictal (or alternative) psychosis and with 134 complex partial seizures. All patients were matched for age and for age at onset of seizures.

Results: The incidence of well‐directed violent behavior against human beings was significantly higher (23%) during postictal psychotic episodes than during acute interictal episodes (5%) and postictal confusion (1%). Suicide attempts were also more frequent during postictal psychosis (7%) than during either acute interictal psychosis (2%) or postictal confusion (0%).

Conclusions: Our study showed that well‐directed violent and self‐destructive behavior was not a feature of epileptic psychosis in general but a specific hallmark of postictal psychosis.
Spitting Automatism in Complex Partial Seizures: A Nondominant Temporal Localizing Sign?
Authors: Voss Nicholas F. , Davies Keith G. , Boop Frederick A. , Montouris Georgia D. , Hermann Bruce P.
Published: August 2005

Summary: Purpose: Spitting as an ictal automatism has been rarely reported. We aimed to establish its potential lateralizing and localizing significance.

Methods: Review of patients undergoing surgery for intractable epilepsy at two comprehensive epilepsy centers.

Results: Five patients were found who had spitting as a stereotyped automatism of their complex partial seizures. All had evidence of right temporal ictal onset and underwent resective surgery. Two had tumors; one, a cavernous angioma; one, hippocampal gliosis, and one, hippocampal sclerosis. We found no instances of ictal spitting in patients with left hemisphere onset.

Conclusions: Spitting as an automatism in complex partial seizures, although uncommon, may be a localizing sign to the nondominant temporal lobe.
Combined Measurements of Hippocampal N‐Acetyl‐Aspartate and T2 Relaxation Time in the Evaluation of Mesial Temporal Lobe Epilepsy: Correlation with Clinical Severity and Memory Performances
Authors: Namer I. J. , Bolo N. R. , Sellal F. , Nguyen V. H. , Nedelec J. F. , Hirsch E. , Marescaux C.
Published: August 2005

Summary: Purpose: In this study we tried to find a correlation between the clinical severity and memory performances, by comparing proton magnetic resonance (MR) spectroscopy and T2 relaxation time measurements in the hippocampi, in a homogeneous group of 27 patients with unilateral mesial temporal lobe epilepsy with ipsilateral hippocampal sclerosis on MR imaging, with a view to answer the following questions: (a) how sensitive is this approach for the assessment of the apparently normal contralateral hippocampus, (b) do the results relate to the clinical severity, and (c) does it allow evaluation of the degree of hippocampal dysfunction.

Methods: Volume‐selective proton MR spectroscopy of the head of both hippocampi was performed at 3 T, by using the PRESS sequence, with an echo time of 135 ms, to estimate NAA/(Cho + Cr) ratios. The relaxation times were measured at 0.28 T, by using a conventional Carr‐Purcell‐Meiboom‐Gill sequence, with a repetition time of 2,000 ms, an echo time of 15 ms, and 48 echoes.

Results: The combination of NAA/(Cho + Cr) ratio and T2 relaxation time values was allowed to classify contralateral hippocampus abnormalities in two groups: first, decreased NAA/(Cho + Cr) ratio with strongly increased T2 relaxation time values corresponding to abnormalities observed in sclerotic ipsilateral hippocampi; and second, decreased NAA/(Cho + Cr) ratio with normal or slightly increased T2 relaxation time values. Whereas the NAA/(Cho + Cr) ratio or T2 relaxation time value alone was not correlated with memory performances, their association shows that left hippocampal injury evaluated both by NAA and T2 relaxation time measurements was clearly correlated with verbal memory scores, and right hippocampal injury, with visual memory scores. On the other hand, the maximal seizure frequency reported by the patients was correlated with ipsilateral NAA/(Cho + Cr) ratio and T2 relaxation time values but not with contralateral results.

Conclusions: We showed that the combination of NAA and T2 relaxation time measurements can be used to examine the degree of ipsi‐ and contralateral hippocampal dysfunction or injuries and their relations with memory performances in the presurgical evaluation of patients.
Low Insulin‐Like Growth Factor (IGF‐1) in the Cerebrospinal Fluid of Children with Progressive Encephalopathy, Hypsarrhythmia, and Optic Atrophy (PEHO) Syndrome and Cerebellar Degeneration
Authors: Riikonen Raili , Somer Mirja , Turpeinen Ursula
Published: August 2005

Summary: Purpose: In patients with progressive encephalopathy, hypsarrhythmia, and optic atrophy (PEHO) syndrome, the pathophysiology underlying early progressive cerebellar and brainstem degeneration and severe epilepsy is unknown. Because insulin‐like growth factor (IGF)‐1 has been shown significantly to promote survival of cerebellar neurons, we wanted to see if the IGF system played a role in the pathogenesis of cerebellar atrophy.

Methods: We used a sensitive enzyme immunoassay kit for measuring cerebrospinal fluid (CSF) IGF‐1 and insulin‐like growth‐binding protein (IGFBP)‐3 in four groups of patients: PEHO syndrome patients (eight), PEHO‐like patients (seven), age‐matched controls (31), and patients with other types of cerebellar atrophy (11).

Results: Patients with PEHO syndrome and those with other progressive, degenerative cerebellar diseases had lower levels of CSF IGF‐1 than the controls with other neurologic diseases. The CSF IGF‐1 also allowed us to differentiate the “true” PEHO patients from the “PEHO‐like” patients (those with similar clinical symptoms but without the typical neuroophthal‐mologic or neuroradiologic findings). The concentrations of IGFBP‐3 did not significantly differ in any of the patient or control groups studied.

Conclusions: CSF IGF‐1 levels might be used as a marker of the degeneration of neurons in specific areas.
Profile of Antiepileptic Pharmacotherapy in a Tertiary Referral Center in South India: A Pharmacoepidemiologic and Pharmacoeconomic Study
Authors: Radhakrishnan K. , Nayak S. Dinesh , Kumar S. Pradeep , Sarma P. Sankara
Published: August 2005

Summary: Purpose: To study the current pharmacotherapy practices of epilepsy and its economics in a developing country by correlating the epidemiology and economics of antiepileptic drug (AED) treatment in general epilepsy care and comprehensive epilepsy care.

Methods: We compared the AED‐use profiles, efficacy, and tolerability at entry and at last follow‐up for 972 patients seen at a comprehensive epilepsy care program in South India from 1993 to 1995. The relative cost was expressed as the average percentage of the per capita gross national product (GNP/capita) each individual spent for AED treatment.

Results: At entry, 562 (57.8%) subjects were receiving poly‐therapy; at last follow‐up, 743 (76.4%) patients were receiving monotherapy, an increase of 34.3% in the use of monotherapy. One or more adverse drug reactions were reported by 28.6% of patients at entry and by 19.8% at last follow‐up. The proportion of patients who were seizure free increased from 29.0 to 44.8%. Carbamazepine (CBZ) was the most frequently used AED, followed by diphenylhydantoin (DPH), valproate (VPA), and phenobarbitone (PB). The relative cost (% GNP/capita) for standard AEDs were as follows: PB, 4.4%; DPH, 7.1%; CBZ, 16.8%; and VPA, 29.5%. The average annual cost of AED treatment per patient in U.S. dollars was $64.32 at entry and $47.73 at last follow‐up. Reduction in polytherapy resulted in the net annual saving of $16,128 ($16.59 per patient, or 5.4% GNP/capita).

Conclusions: The more frequent use of relatively expensive drugs like CBZ and VPA and the use of polytherapy—still quite prevalent in developing countries—has escalated the cost of AED therapy. Although in recent years AEDs have become more available in developing regions, primary and secondary care physicians have not been adequately educated about the current trends in the pharmacotherapy of epilepsy.
Referral Patterns of Family Physicians May Allow Population‐Based Incidence Studies of Childhood Epilepsy
Authors: Speechley Kathy Nixon , Levin Simon D. , Wiebe Samuel , Blume Warren T.
Published: August 2005

Summary: Purpose: To evaluate the burden of illness of childhood epilepsy on patient, care giver, and society, representative incidence cohorts must be followed longitudinally. Case ascertainment through pediatricians and neurologists would be a valid method if family physicians refered all new cases of childhood epilepsy. The study objective was to determine whether family physicians' physicians patterns in Southwestern Ontario make it possible to conduct a population‐based incidence study of childhood epilepsy by sampling only from specialists' specialists.

Methods: Of the 1,718 family physicians practicing in South‐western Ontario, a systematic sample participated in a mailed survey. Case simulations describing seven types of childhood seizures were presented to physicians with instructions to respond as to whether they would investigate/manage without referral; refer to a specialist only if problems occurred; or refer to a specialist always.

Results: Of 214 family physicians, 185 (86.4%) returned completed surveys; 86% would not refer a child with a febrile seizure. Referral to a specialist would be made always by 93% of family physicians for patients with status epilepticus, 95% for worsening partial epilepsy, 82% for a first, brief, generalized clonic seizure, 80% for absence epilepsy, and 99% for neonatal seizures. Only 50% of family physicians would always refer a neurodevelopmentally abnormal child with generalized clonic epilepsy, but a further 37% would refer if problems occurred.

Conclusions: It is feasible to recruit a representative population‐based cohort of recently diagnosed patients for epide‐miologic studies of childhood epilepsy by surveying pediatricians and neurologists. These survey results could be used to adjust estimates of incidence obtained through specialists' specialists for the bias in case ascertainment that may result from this practical method.