bluuebunny/crossref_metadata_2025 huggingface dataset:
Optimal Size of Prostheses for Functioning of the Aortic Prosthetic Valve in Aortic and Mitral Valve Replacement with Annular Enlargement through Manouguian's Technique
Authors: Maekawa Atsuo , Watanabe Takashi , Usui Akihiko , Ohara Yasuhisa , Takagi Yasushi , Masumoto Hiroshi , Yano Takashi , Usui Masato , Narita Yuji , Takemura Haruki , Mizutani Shinichi , Ueda Yuichi
Published: March 2003

Abstract: There is not yet agreement about the optimal size of the prostheses in aortic and mitral valve replacement with Manouguian's technique. In this technique, the aortic prosthetic valve can be pushed upon the mitral prosthesis which may cause dysfunction of the aortic prosthetic valve. The aim of this study was to clarify the size of the prostheses needed to avoid dysfunction of the aortic prosthetic valve. Three patients underwent aortic and mitral valve replacement through this procedure. Two of them had active aortic and mitral valve endocarditis. Aortomitral continuity involved with abscesses could be approached and completely excised using this technique. All patients survived the operation, but 1 of them suffered aortic mechanical valve dysfunction for the reason stated. Anatomical analysis of the geometrical relation of the 2 prosthetic valves suggests that the mitral annulus should be enlarged less than 25 mm to avoid dysfunction of the aortic prosthetic valve.
Chordal‐Sparing Mitral Valve Replacement Using Artificial Chordae Tendineae for Rheumatic Mitral Stenosis: Experience of the “Oblique” Method
Authors: Soga Yoshiharu , Nishimura Kazunobu , Ikeda Tadashi , Nishina Takeshi , Ueyama Koji , Nakamura Tomohiro , Miwa Senri , Koyama Tadaaki , Komeda Masashi
Published: March 2003

Abstract: Chordal‐sparing mitral valve replacement (CSMVR) has been proven to be beneficial for postoperative left ventricular (LV) function. In patients with mitral stenosis, however, diseased chordae tendineae (CT) often have to be replaced using artificial CT to achieve CSMVR. Previously, we reported that resusupension of artificial CT in an oblique direction enhances systolic LV function. Among 40 consecutive patients with mitral valve replacement (MVR), 17 (4 men and 13 women; mean age 66.5 years) with rheumatic mitral stenosis underwent CSMVR with oblique resuspension. Echocardiography was done before the operation, early (mean 25 days) after the operation, and at a late stage (mean 14 months). There was no mortality or major morbidity. LV ejection fraction late after the operation (68 ± 8%) was better than that in the early period (61 ± 8%, p < 0.01), and comparable to the preoperative level (65 ± 9%). The oblique method may help to improve the results of MVR.
Assessing the Calf Pulmonary Function During a Long‐Term Biventricular Assist Device Study with a Centrifugal Blood Pump
Authors: Nonaka Kenji , Linneweber Joerg , Ichikawa Seiji , Kawahito Shinji , Motomura Tadashi , Ishitoya Hiroshi , Oestmann Daniel , Glueck Julia , Nosé Yukihiko
Published: March 2003

Abstract: Pulmonary congestion due to inappropriate pump flow management is one major problem necessary to avoid during long‐term biventricular assist device (BVAD) implantation. Our objective was to assess the effects of pulmonary arterial flow rate and flow rates of both (right and left) bypass pumps. Six healthy calves, which had been implanted with a BVAD system, were selected for this retrospective study. Pulmonary artery flows, both pump flow rates, oxygen saturation of the arterial blood, and pulmonary arterial pressures were assessed as parameters of pulmonary function as was routine clinical evaluation of respiratory rate and character and chest auscultation. The average pulmonary artery flow rate (PAF), systolic pressure of pulmonary artery (sPAP), and oxygen saturation were 148.8 ml/kg per min, 35.1 mm Hg, and 95.3%, respectively. Pulmonary dysfunction occurred in one case, in which the mean PAF, sPAP, and oxygen saturation were 169 ml/kg per min, 66.1 mm Hg, and 90.9%, respectively. The ratio for the right/left pump flow rate (R/L ratio) for the case having pulmonary dysfunction was 1.57 even though the ratio for the other cases was less than 1. Maintaining an R/L ratio less than 1 and/or PAF less than 160 ml/kg per min and PAP less than 50 mm Hg is recommended as the initial conditions to target to avoid pulmonary dysfunction during a BVAD implantation with a beating heart condition.
Implementing Ethics in the Professions: Toward Ecological Integrity
Authors: Soskolne Colin L. , Sieswerda Lee E.
Published: March 2003

ABSTRACT

Ethics guidelines for professionals in the risk sciences are relatively recent. The need for accountability is recognized by many professionals, and has led to the development of ethics guidelines, anchored in organization‐specific mission statements or sets of core values. Almost none of the professions’ existing codes reflect on broader social consequences such as concern for ecological integrity. The importance of this consideration was recently noted in The Toronto Resolution where ensuring ecological integrity was directly linked to professional conduct. Guidelines are useful and necessary for professional development and day‐to‐day functioning, but alone they are insufficient to ensure that professionals learn about ethics and how to apply the guidelines while simultaneously recognizing the broader social consequences of their professional pursuits. In the interests both of professional accountability, as well as concern for the seamless web upon which all life‐support systems depend, each profession needs an ethics infrastructure. This paper provides a comprehensive organizational infrastructure, comprising a seven‐step program—focusing more on process than on content—for the integration of ethics into professional life. A framework for action is developed, integrating several operationalizable process steps. Difficulties in raising professional awareness and introducing an ethics infrastructure are discussed in the context of epidemiology. Professional organization and consensus on core values are seen as laying the foundation for an ethics program. To implement a program, codifying professional conduct in the form of ethics guidelines, establishing consistent procedures and review processes, and establishing ethics education and training, are essential. Furthermore, introducing incentives to encourage ethical conduct, an ethics consultation service, and ongoing oversight and commitment, are critical components for success. Its process goals would include ongoing review, education, dissemination, and adherence to the professions’ core values, into which concern for issues beyond the narrow confines of professional pursuits would be integrated.
Applications of Ecosystem Health for the Sustainability of Managed Systems in Costa Rica
Authors: Aguilar Bernardo J.
Published: March 2003

ABSTRACT A growing body of literature explores the links between the social and ecological dimensions of sustainability. However, much remains to be researched, especially concerning managed ecosystems. Costa Rica has approximately 25% of its area under some conservation regime; many of these protected areas, especially in and near urban areas, are under private ownership and management. Among these is the regime of the protected zones (PZ) that seeks to protect watershed resources. The achievement of conservation objectives in these areas will not only depend on ecological conditions but also on social and economic ones. This framework provides a good field in which to explore the interrelations between sustainability and ecosystem health. This study summarizes the work I participated in the last three years at the Center for Sustainable Development Studies in Costa Rica. We developed a holistic ecosystem health indicator (HEHI) for managed ecosystems. This indicator was tested several times in seven PZs in the east, south, and west sections of the central valley of Costa Rica. The evaluation tool includes measurements of productivity, organization, and resilience of the ecosystems. These were combined with social indicators and resource use patterns from the communities surrounding the PZs studied. The use of this indicator and the conclusions of this project could justify the use of an integral approach to address conservation problems in developing nations. The creation and management of these protected areas should be the result of a combined effort between community organizations and government agencies dealing with land distribution, zoning, and public health, among others.
Understanding the Interrelationships Between Botanical, Human, and Veterinary Epidemiology: The Ys and Rs of It All
Authors: Nutter Forrest W.
Published: March 2003

ABSTRACT Epidemiology is concerned with disease dynamics within host populations. The botanical (plant disease), human (medical), and veterinary fields of epidemiology all have a common lineage in that all three disciplines share ecology as a common parent, yet all three fields have also evolved from a practical need to better manage diseases in their respective host populations. The analysis of botanical, human, and veterinary epidemics shares six common steps: 1) Defining disease problems in quantitative terms (attainable production or attainable population health minus the current production or population health management level presently being achieved); 2) Quantifying state and rate variables of pathosystem components (pathosystem analysis) to determine the effect of host, pathogen, and vector populations on the rate of pathogen spread (r), and the source and strength of inoculum reservoirs (y0); 3) Identifying the most effective management strategy(ies) (i.e., reduce y0, r, and/or t) to achieve effective control; 4) Developing and then quantifying the impacts of specific and integrated management tactics on disease dynamics as a means to evaluate a proposed disease management strategy or strategies; 5) Integrating management tactics into management programs and reevaluating the epidemiologic impacts of whole disease management programs on pathosystem dynamics, and finally; 6) Assessing the economic and environmental risks versus the actual benefits achieved by implementing integrated disease management programs. Although the botanical, human, and veterinary fields of epidemiology share many common concepts, the terminology used to express these concepts within the different disciplines has evolved different dialects (operational definitions) as well as different approaches to solve epidemiologic questions. By improving communication among epidemiologists who work mostly within their own disciplines (botanical, medical, and veterinary branches of epidemiology), we can better understand not only our own pathosystems, but we can vastly improve our understanding of disease dynamics at the ecosystem and global scales as well.
Spatial Analysis of Land‐Use Changes as Knowledge Tools in Support of European Spatial Policies and Ecosystem Health
Authors: Smits Paul C. , Annoni Alessandro
Published: March 2003

ABSTRACT Cost‐effective decision making calls for appropriate methods for the modeling, forecasting, and presentation of problem‐specific information. This paper discusses the systematic use of remote‐sensing derived information to assess the impact of past policies and to support the definition of sustainable European spatial policies through an example of landscape change analysis. A case study of landscape changes along parts of the European coastline between the mid‐70s and early‐90s is reported, providing an integrated assessment addressing possible causes and effects related to natural and labor resources. The impact of human activities on changes in the natural landscape is discussed both from a qualitative and a quantitative viewpoint.
Entrapment: Global Ecological and/or Local Demographic? Reflections Upon Reading the BMJ's Six Billion Day Special Issue
Authors: Butler Colin
Published: March 2003

ABSTRACT Global human population recently passed six billion. To mark this, the BMJ (formerly the British Medical Journal) published a special edition that was both controversial and innovative. It had 12 complimentary essays, written by leading demographers, epidemiologists, and public health workers. A key issue highlighted was a debate between the nondemographer Maurice King and many demographers, regarding the concept of “demographic entrapment.” King and his supporters argue that the limited reserve carrying capacity of Rwanda was a major factor in that country's devastating civil war, a consequence of which was the release of spare carrying capacity. In contrast to this body of opinion, the key importance of population pressure as a factor in Rwanda's war is denied, not only by demographers but most other analysts of Rwanda.

A second major issue highlighted in the journal was that of overconsumption, particularly of natural capital. The importance of this was partially recognized by the demographic papers, but none exhibited the sense of urgency concerning this conveyed in the two relevant papers written by epidemiologists and public health workers.

This article discusses relevant sections of the 12 papers with regard to demographic entrapment and overconsumption. In addition, several other examples of demographic entrapment, both historic and contemporary, are suggested and described.

Finally, the suggestion by King that the whole world may be demographically entrapped is refined by consideration of ongoing global environmental changes, both anthropogenic and natural, which are likely to reduce future global carrying capacity. While such changes are, themselves, unlikely to cause global under‐nutrition, the negative political and economic consequences of increased regional scarcity, consequent to approaching or passing local carrying capacities, are likely to exacerbate the risk of regional conflict. These areas of conflict could widen, and be aggravated by an increased frequency of natural disasters, predicted by some computerized climate change models. At the worst case, “civilization failure” or “barbarianization” could result. The complex pathway to this, substantially caused by adverse global environmental change, is called global “ecological entrapment.”
Early and Transient Side Effects of Repetitive Intravenous Dihydroergotamine
Authors: Queiroz Luiz P. , Weeks Randall E. , Rapoport Alan M. , Sheftell Fred D. , Baskin Steven M. , Siegel Sheryl E.
Published: March 2003

Side effects associated with administration of repetitive intravenous dihydroergotamine (DHE) were prospectively studied in 72 patients with chronic daily headache who ware hospitalized in a dedicated inpatient headache treatment program. All patients received 11 consecutive doses of DHE, starting with 0.25 mg and increasing by 0.25 mg up to a maximum dose of 1.25 mg, depending on side effects and/or headache relief. The adverse events were recorded after each dose administered.

The great majority of patients (91.6%) reported at least one side effect. The most common were: nausea (72.2%), increase in previous headache (47.2%), lightheadedness (33.3%), “new” headache (27.8%), and leg cramps (23.6%). The overall number of side effect complaints did not increase proportionally with the strength of the dose of DHE administered. These complaints declined from the earlier to the later doses of DHE, except for leg cramps, which were more common with the later doses.

Side effects determined the strength of subsequent doses of DHE in only 18.1% of patients. Only four patients had to have a decrease in dosage and none required termination of DHE due to side effects.

Although repetitive intravenous DHE causes frequent side effects, they are usually mild and transient and decrease with subsequent doses, even at higher doses.
Vasospasm‐lnduced Myocardial Infarction With Sumatriptan
Authors: Mueller Loretta , Gallagher R. Michael , Ciervo Carmen A.
Published: March 2003

Sumatriptan, a 5‐hydroxytryptamine1 (5‐HT1) receptor agonist is an effective abortive agent for migraine headaches. A common side effect in 3% to 7.9% of patients is chest pain. Although most cases of chest pain are not thought to be of cardiac origin, its mechanism is not entirely understood. Rare examples of electrocardiogram changes consistent with transient ischemia have been reported. Isolated instances of angina, arrhythmia, myocardial infarction, and death have been temporally associated with sumatriptan administration. In most cases, it is unclear whether underlying cardiovascular disease existed or contributed to this adverse event. We report the history of a 56‐year‐old female patient with migraine who experienced myocardial infarction shortly after using sumatriptan, despite having had a normal cardiovascular evaluation. As she had a normal cardiac catheterization after the event, we find it probable that sumatriptan induced coronary vasospasm and myocardial infarction.
Circumstances of Onset of Chronic Headache in Patients Attending a Specialty Practice
Authors: Karpouzis Katerina M. , Spierings Egilius L.H.
Published: March 2003

In a data base of 1013 patients with chronic headache, 44.1% reported the onset of headaches before the age of 20 (preadult‐onset headache) and 55.9% at or after that age (adult‐onset headache). Circumstances of headache onset were mentioned significantly more frequently in the latter than in the former group (8.5% versus 38.2%, P<.001). The 10 most common circumstances of headache onset in adult‐onset chronic headache, accounting for 87.9% of all circumstances mentioned, are further discussed. The 3 most common factors, accounting for 58.4% of all circumstances, were head, neck, or back injury; stress; and pregnancy. Illnesses, influenzalike and otherwise, and estrogen administration for birth control or hormone replacement shared the fourth place. It is concluded that in the etiology of chronic headache, other than genetic factors should be considered as well.
Intranasal Lidocaine to Prevent Headache Following Migraine Aura
Authors: Maizels Morris
Published: March 2003

Objective.—To report the consistent effect of intranasal lidocaine 4% on preventing headache following aura in one individual.

Background.—A treatment that could prevent the headache which follows an aura would be an important advance in the treatment of migraine. No migraine abortive treatment has been shown to have such an effect.

Methods.–A 15‐year‐old adolescent boy with a history of recurrent headache since aged 2, fulfilling the criteria for migraine with aura, was seen in consultation. Intranasal lidocaine 4% was used during the aura phase to prevent the headaches.

Results.—Before using intranasal lidocaine, the patient invariably experienced a migraine following a typical visual aura. The episodes occurred approximately weekly, with a stable pattern for several years. When given during the aura, intranasal lidocaine prevented the headache following the aura, and remained successful on all but two occasions over 1 ½ years of use (approximately 75 episodes). Them was no effect on the duration of the aura itself.

Conclusions.–Intranasal lidocaine consistently prevented the development of headache symptoms following aura in this individual. Such an effect suggests a role for the sphenopalatine ganglion in the development of migraine pain.
Ophthalmoplegic Migraine With Unusual Features
Authors: O'Halloran H.S. , Lee W.B. , Baker R.S. , Pearson P.A.
Published: March 2003

We report the details of a patient with an unusual form of ophthalmoplegic migraine resulting in permanent vertical misalignment of the affected eye. The presentation, history, and ophthalmologic examination are reported as well as disease course and follow‐up complications. We review the literature on ophthalmoplegic migraine with discussion regarding typical presentation, methods of diagnosis, and other diseases which may cause diagnostic confusion. In light of current case reports on ophthalmoplegic migraine, this is the first documented example with a permanent deficit.
Permeation of Sumatriptan Through Human Vaginal and Buccal Mucosa
Authors: Van Der Bijl P. , Penkler L. , Van Eyk A.D.
Published: March 2003

Continued interest in the various routes by which sumatriptan may be administered prompted us to investigate its passage through buccal mucosa. Because human buccal mucosa is scarce, we proposed using the relatively abundant vaginal mucosa, which has been shown to have comparable diffusion rates for a number of widely varying molecules, as a model of buccal mucosa. In addition, by comparing these two tissues with respect to their permeability to sumatriptan, the human vaginal/buccal mucosa model could be further evaluated. Clinically healthy human vaginal and buccal mucosa specimens were used in the permeability studies. Permeability to sumatriptan was determined using a continuous flow‐through diffusion system in the presence and absence of permeation enhancers. No statistically significant differences in permeability could be demonstrated for both mucosae toward sumatriptan. Flux values obtained in the absence and presence of glycodeoxycholate and lauric acid (1:1 molar ratio) to sumatriptan of buccal and vaginal mucosa, respectively, were not significantly different. The results obtained further support the hypothesis of the vaginal/buccal mucosal in vitro permeability model and suggest that this model may be used in conjunction with various absorption enhancers. Further studies on the buccal route of absorption of sumatriptan are thus warranted.
Stabbing Headache as the Presenting Manifestation of Intracranial Meningioma: A Report of Two Patients
Authors: Mascellino Ann Marie , Lay Christine L. , Newman Lawrence C.
Published: March 2003

Stabbing headache may occur as a primary headache disorder, may accompany other primary headaches, or, in rare instances, may be associated with secondary headache syndromes. We report two patients with intracranial meningioma in whom stabbing headache was the heralding symptom. Headache remitted promptly following surgical resection. These cases stress the importance of excluding underlying pathology in patients presenting with new‐onset stabbing headache.
Character of Headache in Kimmerle Anomaly
Authors: Split Wojciech , Sawrasewicz‐Rybak Magorzata
Published: March 2003

The Kimmerle anomaly may be associated with a variety of neurological symptoms. We sought to determine the prevalence and character of these symptoms in a large cohort of afflicted patients.
Relationships Among Hippocampal Volumetry, Proton Magnetic Resonance Spectroscopy, and Verbal Memory in Temporal Lobe Epilepsy
Authors: Sawrie Stephen M. , Martin Roy C. , Knowlton Robert , Faught Ed , Gilliam Frank , Kuzniecky Ruben
Published: March 2003

Summary:  Purpose: To examine the relationship between hippocampal volumes, 1H magnetic resonance spectroscopy (MRS)‐identified hippocampal metabolic function, and verbal memory in patients with unilateral mesial temporal lobe epilepsy (MTLE).

Methods: Hippocampal volumes, 1H MRS‐derived hippocampal creatine to N‐acetylaspartate (Cr/NAA), and verbal memory assessment were obtained preoperatively in 22 patients (six right, 16 left) with EEG‐defined unilateral MTLE.

Results: Left hippocampal volume correlated significantly with left hippocampal Cr/NAA (r = −0.549, p < 0.01), whereas right volume correlated significantly with right Cr/NAA (r = −0.478, p < 0.05). Verbal memory correlated significantly with left hippocampal Cr/NAA (r = −0.594, p < 0.01), but not with left hippocampal volume or right hippocampal measures.

Conclusions: Hippocampal volumes and 1H MRS‐derived metabolite ratios are statistically related, but share only a small percentage of variance, suggesting separate but related pathophysiologic processes. Left hippocampal Cr/NAA appears to be more sensitive to verbal memory function than volumes.
Prolonged Vigabatrin Treatment Modifies Developmental Changes of GABAA‐Receptor Binding in Young Children with Epilepsy
Authors: Juhász Csaba , Muzik Otto , Chugani Diane C. , Shen Chengang , Janisse James , Chugani Harry T.
Published: March 2003

Summary:  Purpose: To determine whether prolonged treatment with vigabatrin (VGB), an antiepileptic drug (AED) that acts by elevating brain γ‐aminobutyric acid (GABA) levels, interferes with age‐related changes of in vivo GABAA‐receptor binding in children with epilepsy.

Methods: Using [11C]flumazenil (FMZ)–positron emission tomography (PET) imaging, 15 children (aged 1–8 years) with medically intractable epilepsy were studied. Seven of these children were treated with VGB (1,000–2,500 mg/day) for ≥3 months before the FMZ‐PET study. The remaining eight patients were medicated with other drugs that are known not to act directly on the GABAergic system. Absolute quantification of PET data was performed by using the volume of distribution (VD) of FMZ in brain tissue representing FMZ ligand binding.

Results: After controlling for age, hemispheric FMZ VD values were significantly lower in children treated with VGB as compared with the non‐VGB group (p = 0.012). Regional FMZ VD values of the VGB‐treated patients were significantly lower in all cortical regions and the cerebellum, whereas the difference was not significant in the thalamus and basal ganglia. No significant drug effect or drug‐by‐region interaction could be determined when the patients were separated according to treatment with carbamazepine (p = 0.97) or valproate (p = 0.55).

Conclusions: VGB induces a decrease in GABAA‐receptor binding in the cortex and cerebellum of the developing epileptic brain. A similar effect of other drugs and substances of abuse targeting the GABAergic system may be hypothesized. Because of the important role of the GABAergic system in developmental plasticity, the reversibility and functional consequences of this age‐specific drug effect should be further studied.
Melatonin Effect on Seizures in Children with Severe Neurologic Deficit Disorders
Authors: Peled Nir , Shorer Zamir , Peled Eli , Pillar Giora
Published: March 2003

Summary:  Purpose: Recently, melatonin has been associated with antiepileptic activity, most probably because of its antioxidant activity as a free radical scavenger. This study aimed to expand the clinical experience with melatonin as an antiepileptic drug (AED) in humans.

Methods: Six children (aged 2–15 years), with severe intractable seizures, were treated with 3 mg of oral melatonin 30 min before bedtime, in addition to their previous AED treatment for 3 months. A diary of clinical seizure activity (time of day, duration, and type) was kept by parents for a month before and during treatment. Five patients underwent a baseline polysomnography, and three also were monitored during melatonin treatment.

Results: With the exception of the parents of one child, all reported a significant clinical improvement in seizure activity during treatment, particularly during the night. Sleep studies showed a decrease in epileptic activity in two of the three patients who were monitored during treatment, and a change of sleep efficiency from 84.2% to 89.7% (NS). Improvement in daytime behavior and in communication abilities was reported by parents, although it was not objectively measured.

Conclusions: This clinical observation adds to the growing data showing the antiepileptic effect of melatonin. However, owing to the paucity of well‐controlled studies, using melatonin as an AED should be limited to this specific group of patients with intractable seizures.
Monotherapy versus Polytherapy for Epilepsy: A Multicenter Double‐Blind Randomized Study
Authors: Deckers Charles L. P. , Hekster Yechiel A. , Keyser Antoine , Van Lier Henk J. J. , Meinardi Harry , Renier Willy O.
Published: March 2003

Summary:  Purpose: Monotherapy has been the gold standard in epilepsy treatment for the last 20 years, partly because of the reputation for increased toxicity of polytherapy. However, monotherapy and polytherapy have not been compared in a double‐blind clinical trial. Open trials that compared the two treatments were not optimally designed and compared the two at unequal drug loads (i.e., at nonequivalent dosages). We report on a double‐blind clinical trial in which a combination of carbamazepine (CBZ) and valproate (VPA) was compared with CBZ monotherapy. Patients started with equal drug loads, and neurotoxicity was the primary outcome measure.

Methods: The 130 adult patients with untreated generalized tonic–clonic and/or partial seizures were randomized to equal drug loads of either monotherapy (400 mg CBZ per day) or polytherapy (200 mg CBZ plus 300 mg VPA per day). Outcome was measured by seizure counts, clinimetric epilepsy scales, and neuropsychological tests at baseline, at 2 and 12 months, and irregularly between 2 and 12 months.

Results: No statistical differences were found between the two treatments in the reduction of seizure frequencies, in overall neurotoxicity, or in overall systemic toxicity. The frequencies and clinimetric scores of certain adverse effects did differ (e.g., more monotherapy patients remained sedated, and more polytherapy patients gained weight). Fewer polytherapy patients withdrew because of adverse effects (14 vs. 22%), although this did not reach statistical significance (p = 0.15). Neuropsychological assessment did not show significant differences.

Conclusions: No differences were found in overall neurotoxicity between monotherapy and polytherapy.
Utility of the Scalp‐Recorded Ictal EEG in Childhood Epilepsy
Authors: Yoshinaga Harumi , Hattori Junri , Ohta Hodaka , Asano Takashi , Ogino Tatsuya , Kobayashi Katsuhiro , Oka Eiji
Published: March 2003

Summary:  Purpose: To evaluate the usefulness of the scalp‐recorded ictal EEGs in diagnosing childhood epilepsy.

Methods: We analyzed the ictal EEGs of 259 seizures in 183 patients who visited the department of child neurology, Okayama University Medical School, during the past 6 years.

Results: We divided all seizures into the following four categories, according to the diagnostic usefulness of ictal EEGs in determining the seizure type: 1. (a) Ictal EEGs confirmed the diagnosis of the seizure type based on seizure symptoms (101 seizures); (b) Ictal EEGs aided in the classification of the seizure type based on the seizure symptoms (101 seizures); (c) Ictal EEGs corrected errors in the classification (37 seizures); and (d) Ictal EEGs revealed previously unreported/undocumented seizure type (20 seizures). 2. Of the 37 misdiagnosed seizures (group C), 11 were nonepileptic seizures misdiagnosed as epileptic seizures, eight were complex partial seizures (CPS) misdiagnosed as the other seizure types, and 10 were other seizure types misdiagnosed as CPSs. 3. Of the 20 previously unreported/undocumented seizures (group D), nine were myoclonic seizures, five were absence seizures, five were CPS, and one was tonic spasms. 4. Seventy‐two patients had CPS. Among them, 11 patients showed no epileptic spikes in their interictal EEG recordings. Therefore, ictal recordings confirmed the diagnosis of epilepsy.

Conclusions: Ictal EEG recording is a very useful diagnostic tool not only for determining seizure types, but also for uncovering the existence of the unsuspected seizure types. It supplies the physician with useful information for the classification and the treatment of epilepsy. In particular, ictal EEGs are useful in diagnosing patients with CPS.
On the Use of Tranquillisers in Epilepsy
Authors: Trimble Michael R.
Published: March 2003

Summary: In this article, the use of benzodiazepines (BZDs) in epilepsy is reviewed. In particular, it concentrates on the use of oral BZDs, and, following a brief discussion as to their value in psychiatric disorders generally, their more specific use in epilepsy is then noted. The main oral drugs are the 1,4BZDs and 1,5‐BZDs. The latter is represented only by clobazam (CLB), and the advantages of the 1,5‐BZDs over the 1,4‐BZDs are reviewed. It is concluded that CLB has a significant value in a number of situations. It is a first‐line add‐on therapy when standard medications have failed. It is useful in patients that have catamenial seizures, clusters of seizures, and also in the prevention of postictal syndromes. It is used in childhood epilepsy, and is also helpful in the management of febrile seizures.
The Localizing Yield of Sphenoidal and Anterior Temporal Electrodes in Ictal Recordings: A Comparison Study
Authors: Kanner Andres M. , Parra Jaime , Gil‐Nagel Antonio , Soto Arnoldo , Leurgans Sue , Iriarte Jorge , DeToledo‐Morrell Leyla , Palac Susan
Published: March 2003

Summary:  Purpose: To compare the localizing yield of sphenoidal electrodes placed under fluoroscopic guidance (SEs) and anterior temporal electrodes (ATEs) in ictal recordings from a group of patients with seizure disorders of anterior temporal origin.

Methods: We compared ictal recordings of 156 seizures obtained with SEs and ATEs from 40 consecutive patients with seizures of anterior temporal origin. Four electroencephalographers reviewed ictal recordings independently and blind to the patients' identity, presurgical data, and inclusion of ATEs or SEs. Outcome variables included (a) number of correctly localized seizures with SE and ATE recordings by at least three raters; (b) number of ictal foci in which all seizures were localized only with SEs; and (c) number of seizures in which SEs identified the ictal onset ≥5 s earlier than ATEs.

Results: Interrater agreement among the four raters was significantly greater with SE than with ATE recordings (p < 0.0001). The number of seizures correctly localized was significantly greater with SEs (n = 144) than with ATEs (n = 99; p < 0.0001). All the seizures [n = 36 (23%)] originating from 14 ictal foci (29%) in 11 patients (27.5%) were localized only with SEs. Finally, the ictal onset was detected at SEs ≥5 s earlier than at ATEs in 67 (43%) seizures originating from 33 (69%) foci in 30 (75%) patients.

Conclusions: SEs improve interrater agreement in the localization of seizures of anterior temporal origin, and in about one fourth of patients, SEs add ictal data not identified by ATEs.
Superiority of HMPAO Ictal SPECT to ECD Ictal SPECT in Localizing the Epileptogenic Zone
Authors: Lee Dong Soo , Lee Sang Kun , Kim Yu Kyeong , Lee Jae Sung , Cheon Gi Jeong , Kang Keon Wook , Kim Eun Sil , Chung June‐Key , Lee Myung Chul
Published: March 2003

Summary:  Purpose: We examined diagnostic performances of Tc‐99m hexamethylpropylene amine oxime (HMPAO) and Tc‐99m electron capture detection (ECD) ictal single‐photon emission computed tomography (SPECT) to localize the epileptogenic zones in mesial temporal lobe epilepsy (TLE) and neocortical epilepsy (NE).

Methods: Epileptogenic zones were identified by invasive EEG or surgical outcome. Ictal SPECT was performed with stabilized Tc‐99m HMPAO (TLE, 17; NE, 23) and with Tc‐99m ECD (TLE, 7; NE, 7). Single‐blind visual interpretation was used to localize the epileptogenic zones. Asymmetric index was calculated. Subtraction ictal SPECT was coregistered to a magnetic resonance imaging (MRI) template.

Results: In TLE, the sensitivity of Tc‐99m HMPAO SPECT was 82% (14 of 17) and that of Tc‐99m ECD SPECT was 71% (five of seven). The asymmetric index (AI; 25 ± 10) of Tc‐99m HMPAO SPECT was larger (p = 0.05) than the AI (13 ± 13) of Tc‐99m ECD SPECT in patients with TLE. In NE, the sensitivity of Tc‐99m HMPAO SPECT was 70% (16 of 23), but that of Tc‐99m ECD SPECT was 29% (two of seven). The AI (15 ± 10) of Tc‐99m HMPAO SPECT was significantly larger (p = 0.02) than the AI (4.8 ± 6) of Tc‐99m ECD SPECT in patients with NE. Subtraction ictal SPECT coregistered to MRI supported the visual assessment.

Conclusions: We concluded that the sensitivity of Tc‐99m ECD ictal SPECT is similar to that of Tc‐99m HMPAO ictal SPECT in TLE; however, ictal hyperperfusion was higher with the Tc‐99m HMPAO SPECT. In patients with NE, Tc‐99m HMPAO ictal SPECT also was superior to Tc‐99m ECD ictal SPECT in sensitivity and degree of hyperperfusion.
Epilepsy Patients Treated with Antiepileptic Drug Therapy Exhibit Compromised Ocular Perfusion Characteristics
Authors: Hilton Emma J. Roff , Hosking Sarah L. , Betts Tim
Published: March 2003

Summary:  Purpose: Reduced cerebral blood flow and decreased cerebral glucose metabolism have been identified in patients with epilepsy treated with antiepileptic drug (AED) therapy. The purpose of this study was to determine whether ocular haemodynamics are similarly reduced in patients with epilepsy treated with AEDs.

Methods: Scanning laser Doppler flowmetry was used to measure retinal capillary microvascular flow, volume, and velocity in the temporal neuroretinal rim of 14 patients diagnosed with epilepsy (mean age, 42.0 ± 0.9 years). These values were compared with those of an age‐ and gender‐matched normal subject group (n = 14; mean age, 41.7 ± 0.3 years). Student's unpaired two‐tailed t tests were used to compare ocular blood‐flow parameters between the epilepsy and normal subject groups (p < 0.05; Bonferroni corrected).

Results: A significant reduction in retinal blood volume (p = 0.001), flow (p = 0.003), and velocity (p = 0.001) was observed in the epilepsy group (13.52 ± 3.75 AU, 219.14 ± 76.61 AU, and 0.77 ± 0.269 AU, respectively) compared with the normal subject group (19.02 ± 5.11 AU, 344.03 ± 93.03 AU, and 1.17 ± 0.301 AU, respectively). Overall, the percentage mean difference between the epilepsy and normal groups was 36.31% for flow, 28.92% for volume, and 34.19% for velocity.

Conclusions: Patients with epilepsy exhibit reduced neuroretinal capillary blood flow, volume, and velocity compared with normal subjects. A reduction in ocular perfusion may have implications for visual function in people with epilepsy.
Cardiovascular Regulation through Hypothalamic GABAA Receptors in a Genetic Absence Epilepsy Model in Rat
Authors: Aker Rezzan Gülhan , Onat Filiz Yılmaz
Published: March 2003

Summary:  Purpose: γ‐Aminobutyric acid (GABA) plays a vital role in both central cardiovascular homeostasis and pathogenesis of epilepsy. Epilepsy affects autonomic nervous system functions. In this study, we aimed to clarify the role of GABAA receptors in hypothalamic cardiovascular regulation in a genetically determined animal model of absence epilepsy.

Methods: Nonepileptic Wistar rats and genetic absence epilepsy rats from Strasbourg (GAERS) were instrumented with a guide cannula for drug injection and extradural electrodes for EEG recording. After a recovery period, iliac arterial catheters were inserted for direct measurement of mean arterial pressure and heart rate. Bicuculline, a GABAA‐receptor antagonist, was injected into the dorsomedial (DMH) or posterior (PH) hypothalamic nuclei of nonepileptic control rats or GAERS. Blood pressure, heart rate, and EEG recordings were performed in conscious unrestrained animals.

Results: Bicuculline injections into the hypothalamus produced increases in blood pressure and heart rate of both control rats and GAERS. The DMH group of GAERS showed a twofold increase in the blood pressure and the heart rate compared with those of control rats. Pressor responses to bicuculline, when microinjected into the PH, were similar in the nonepileptic animals and GAERS. Conversely, the amplitude of tachycardic responses to the administration of bicuculline into the PH was significantly higher in GAERS compared with those of control rats.

Conclusions: The bicuculline‐induced increases in blood pressure and heart rate were more prominent when given in the DMH of GAERS. These results indicate an increased GABAA receptor–mediated cardiovascular response through the DMH in conscious rats with absence epilepsy.
The Effect of Age on Rate of Functional Recovery after Intracarotid Amobarbital Injection
Authors: Segal Jessica B. , Moo Lauren R. , Hart John
Published: March 2003

Summary:  Purpose: The duration of the drug effect during the intracarotid amobarbital procedure (IAP) is an important factor when considering the prioritization of behavioral testing during the IAP. Previous studies of thiopental, a barbiturate similar to sodium amobarbital, found that age and gender significantly affect the dose required to induce anesthesia, such that younger patients require higher dosage.

Methods: A total of 55 patients who underwent the IAP procedure at Johns Hopkins Hospital were included in the study (110 hemispheric injections). The patient group included 30 female and 25 male patients, ranging in age from 11 to 50 years. To determine if a higher dose of sodium amobarbital was needed for younger patients during the IAP, we analyzed the time to return to preinjection EEG baseline status and time to return to 5/5 strength as a function of patient age and gender.

Results: We found that younger patients (11–20 years old) returned to preinjection baseline EEG status and full (5/5) strength faster than older patients. No gender difference was found.

Conclusions: The sodium amobarbital effect during IAP dissipates faster in young patients. Consideration of this difference in rate of recovery in 11‐to 20‐year‐old patients has important clinical implications in terms of prioritizing behavioral testing.
The Neurodevelopmental Impact of Childhood‐onset Temporal Lobe Epilepsy on Brain Structure and Function
Authors: Hermann Bruce , Seidenberg Michael , Bell Brian , Rutecki Paul , Sheth Raj , Ruggles Kevin , Wendt Gary , O'Leary Daniel , Magnotta Vincent
Published: March 2003

Summary:  Purpose: To characterize the neurodevelopmental correlates of childhood‐onset temporal lobe epilepsy on brain structure and cognition compared with late‐onset chronic temporal lobe epilepsy and healthy controls.

Methods: Healthy controls (n = 62) and patients with early (n = 37) versus late (n = 16) age at onset of temporal lobe epilepsy were compared with high‐resolution quantitative magnetic resonance imaging (MRI) volumetrics and comprehensive neuropsychological assessment.

Results: Patients with childhood‐onset temporal lobe epilepsy (mean onset age, 7.8 years) exhibited widespread compromise in neuropsychological performance and substantial reduction in brain tissue volumes extending to extratemporal regions compared with healthy controls and late‐onset temporal lobe epilepsy patients (mean onset age, 23.3 years). Most evident was reduced total white‐matter volume among the childhood‐onset patients. Reduction in brain tissue volume, especially total white‐matter volume, was associated with significantly poorer cognitive status, attesting to the clinical significance of the volumetric abnormalities.

Conclusions: Childhood‐onset temporal lobe epilepsy appears to be associated with an adverse neurodevelopmental impact on brain structure and cognition that appears generalized in nature and especially evident in white‐matter tissue volume.
A Short‐echo‐time Proton Magnetic Resonance Spectroscopic Imaging Study of Temporal Lobe Epilepsy
Authors: Simister Robert J. , Woermann Friedrich G. , McLean Mary A. , Bartlett Philippa A. , Barker Gareth J. , Duncan John S.
Published: March 2003

Summary:  Purpose: We used short‐echo‐time proton magnetic resonance spectroscopy imaging (MRSI) to study metabolite concentration variation through the temporal lobe in patients with temporal lobe epilepsy (TLE) with and without abnormal MRI.

Methods: MRSI was performed at TE = 30 ms to study 10 control subjects, 10 patients with TLE and unilateral hippocampal sclerosis, and 10 patients with TLE and unremarkable MRI (MRI negative). We measured the concentrations of N‐acetyl aspartate +N‐acetyl aspartyl‐glutamate (NAAt), creatine (Cr), choline (Cho), glutamate + glutamine (Glx), and myoinositol, in the anterior, middle, and posterior medial temporal lobe (MTL), and in the posterior lateral temporal lobe. Segmented volumetric T1‐weighted MRIs gave the tissue composition of each MRSI voxel. Normal ranges were defined as the control mean ± 3 SD.

Results: In the hippocampal sclerosis group, seven of 10 had abnormally low NAAt in the ipsilateral anterior MTL. In the MRI‐negative group, four of 10 had low NAAt in the middle MTL voxel ipsilateral to seizure onset. Metabolite ratios were less sensitive to abnormality than was the NAAt concentration. Group analysis showed low NAAt, Cr, and Cho in the anterior MTL in hippocampal sclerosis. Glx was elevated in the anterior voxel contralateral to seizure onset in the MRI‐negative group. Metabolite concentrations were influenced by voxel position and tissue composition.

Conclusions: (a) Low NAAt, Cr, and Cho were features of the anterior sclerotic hippocampus, whereas low NAAt was observed in the MRI‐negative group in the middle MTL region. The posterior temporal lobe regions were not associated with significant metabolite abnormality; (b) The two patient groups demonstrated different metabolite profiles across the temporal lobe, with elevated Glx a feature of the MRI‐negative group; and (c) Voxel tissue composition and position influenced obtained metabolite concentrations.
Socioeconomic Prognosis after a Newly Diagnosed Unprovoked Epileptic Seizure in Adults: A Population‐based Case–Control Study
Authors: Lindsten Hans , Stenlund Hans , Edlund Curt , Forsgren Lars
Published: March 2003

Summary:   Purpose: To investigate the socioeconomic prognosis after a newly diagnosed unprovoked epileptic seizure in adults.

Methods: Sixty‐three patients 17 years or older with a newly diagnosed unprovoked epileptic seizure from 1985 through 1987 and 107 sex‐ and age‐ matched controls were followed up for 10 years to 1996. Studied variables were income, source of income, sickness periods, incapacity rate, diagnosis‐specific incapacity rate, vocational status, and education.

Results: Relative growth of income was similar between patients and controls during follow‐up. Patients had lower income than did controls 2 years before seizure onset and during the entire follow‐up. This was related to higher morbidity among patients, as measured by sickness periods and incapacity rate. Employment rates did not evolve negatively among patients after seizure onset and were close to employment rates of controls during follow‐up time. There was no difference between patients and controls regarding education.

Conclusions: After a newly diagnosed unprovoked epileptic seizure in adults, no negative development regarding employment and education occurs. Income development is positive unless refractory seizures evolve. However, income is lower among patients with epilepsy than among controls, and this difference can be related to overall morbidity.
Gabapentin Increases the Hyperpolarization‐activated Cation Current Ih in Rat CA1 Pyramidal Cells
Authors: Surges Rainer , Freiman Thomas M. , Feuerstein Thomas J.
Published: March 2003

Summary:  Purpose: Gabapentin (GBP) is a commonly used drug in the treatment of partial seizures, but its mode of action is still unclear. The genesis of seizures in temporal lobe epilepsy is thought to be crucially influenced by intrinsic membrane properties. Because the Ih substantially contributes to the intrinsic membrane properties of neurons, the effects of GBP on the Ih were investigated in CA1 pyramidal cells of rat hippocampus.

Methods: CA1 pyramidal cells in hippocampal slices were examined by using the whole‐cell patch‐clamp technique.

Results: GBP increased the Ih amplitude in a concentration‐dependent manner mainly by increasing the conductance, without significant changes in the activation properties or in the time course of Ih. The effects ranged from ∼20% at 50 μM, ∼25% at 75 μM, to ∼35% at 100 μM GBP (at –110 mV). In the presence of intracellular cyclic adenosine monophosphate (cAMP), the effects of GBP on Ih were similar to those obtained in the absence of cAMP.

Conclusions: These results suggest that GBP increases the Ih through a cAMP‐independent mechanism. Because the applied GBP concentrations were in a clinically relevant range, the observed effect may contribute to the anticonvulsant action of GBP in partial seizures and may represent a new concept of how this anticonvulsant drug works.