bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Seizures on Brain Phenobarbital Concentration in Newborn Piglets
Authors: Monin P. , Clozel M. , Morselli P. L. , Dubruc C. , Vert P.
Published: November 2007

Summary: Phenobarbital (PB) brain and blood concentrations were measured together with brain and blood pH in newborn piglets before and at the end of seizure activity induced by pentylenetetrazol or bicuculline. Seizures induced a significant elevation of arterial blood pressure and profound changes in the blood gases and in the acid‐base balance, with a marked reduction in brain tissue pH. Despite an intense brain acidosis, however, and a significant rise in blood/brain [H +] gradient, phenobarbital brain concentrations were not reduced during seizures but, on the contrary, were increased in 7 of 11 piglets. These data suggest that contrary to the pH partition hypothesis, brain uptake of PB is concomitantly increased during seizures and brain acidosis.

La concentration cerebrale et sanguine de phenobarbital (PB) ainsi que le pH cerebral et sanguin ont été mesures chez le co‐chon nouveau‐ne avant et juste apres une activite critique in‐duite par le pentylene‐tetrazole ou la bicuculline. Les crises ont entraine une elevation significative de la pression arterielle et des modifications importantes des gaz du sang et de ľequilibre acido‐basique, avec diminution nette du pH tissulaire cerebral. Cependant, malgre une intense acidose cerebrale et une augmentation significative du gradient [H +] hemato‐encephalique, les concentrations de phenobarbital n'ont pas été diminuees pendant les crises, avec aucontraire, chez 7animaux sur 11, une augmentation. Ces resultats suggerent que, en opposition avec la theorie de la partition liee au pH, la captation cerebrale de PB augmente parallelement a I'acidose cerebrale contemporaine des crises.

Se han medido las concentraciones de fenobarbital en cerebro y en sangre y el pH cerebral y de la sangre en cerdos recién nacidos, antes y al final de la actividad epiléptica inducida por el pentilen‐tetrazol o la bicuculina. Los ataques produjeron una elevación significativa de la presión arterial y profundos cambios en los gases sanguíneos y en el balance ácido‐base, con una reducción importante en el pH tisular cerebral. Sin embargo, a pesar de la intensa acidosis cerebral y de la importante elevación del gradiente sangre/cerebro (H +), las concentraciones cere‐brales de fenobarbital no se redujeron durante los ataques pero, al contrario, en siete de los once animales, estaban incremen‐tadas. Esta información sugiere que, contrariamente a la hipótesis de partición del pH, la captación cerebral del fenobarbital se eleva concomitantemente durante la acidosis cerebral que se presenta en los ataques.
Effectiveness of Multiple EEGs in Supporting the Diagnosis of Epilepsy: An Operational Curve
Authors: Salinsky Martin , Kanter Roy , Dasheiff Richard M.
Published: November 2007

Summary: Interictal epileptiform activity (IIEA) on EEG may be useful in the diagnosis and characterization of epilepsy. A single scalp EEG may fail to detect this abnormality, which is then discovered on repeat recordings. Since many people with epilepsy have persistently normal EEGs, a practical question arises concerning the yield of multiple EEGs. To determine the probability of finding IIEA with serial EEGs (the operational curve), we reviewed data from 1,201 EEGs on 429 adult patients, most with definite epilepsy presenting in adulthood. The diagnosis was made either clinically or with the support of the EEG. In 50% of our patients with IIEA, the abnormality is present on the first record, in 84% by the third EEG, and in 92% by the fourth. There is relatively little yield to serial EEGs beyond this point.

Lactivité EEG paroxystique intercritique est utile au diag‐ nostic et à la caractérisation des épilepsies. Un EEG de surface unique peut ne pas détecter les anomalies, qui seront objectivéer par la répétition des enregistrernents. Cornme beaucoup de pa‐ tients épileptiques ont des EEG norrnaux de façon répétitive, il se pose le problème trés pratique de la rentabilité de la répétition des EEG. Afin d'évaleur la probabilité de découverte d'activités paroxystiques intercritiques par répétition des enregistrements (courbe de détection), nous avons repris les résultats de 1201 traces pratiqués chez 429 patients adultes, la plupart avec une épilepsie certaine. Le diagnostic a été porté cliniquement ou avec l'aide de l'EEG. Chez 50% des patients avec paroxysrnes intercritiques, l'anomalie a été constatée dès le premier enregistrernent, chez 84% sur les 3 premiers tracés, chez 92% sur ies 4 premiers tracés. Les enregistrernents successifs au‐delà du 4érne n'augrnentent que très peu ces chiffres.

La actividad epileptiforme interictal (IIEA) en el EEG puede ser de utilidad en el diagnóstico y caracterización de la epilepsía. Un trazado único a través del cuero cabelludo, puede ser in‐ eficaz en la detección de ésta anornalía, la cual es posteriorrnente descubierta en trazado subsiguientes. Puesto que muchos en‐ fermos con epilepsía tienen EEGs norrnales de rnodo persis‐ tente, resulta importante el preguntarse el alcanze de múltiples EEGs. Para determinar la probabilidad de encontrar IIEA en EEGs sucesivos (la curva operacional), hernos revisado la infor‐ mación de 1.201 EEGs en 429 adultos con epilepsía que persistía en la edad adulta. El diagnóstico fue hecho clínicamente, o con el apoyo del EEG. En el 50% de 10s pacientes con IIEA, la anor‐ rnalidad se presentó en el primer trazado, 84% en el tercer EEG y 92% en el cuarto. Asi pues, parece que no existe ninguna ven‐ taja en repetir EEGs seriados despues de repetir el cuarto.
Epileptic Seizures Evoked by Card Games, Draughts, and Similar Games
Authors: Senanayake Nimal
Published: November 2007

Summary: Three Asian patients, since adolescence, had myoclonic jerks and tonic‐clonic seizures during card games, draughts, and a local game “punchi.” Interictal EEG showed generalized bisynchronous atypical 3‐Hz spike and wave discharges. Test procedures evoked EEG dysrhythmia and clinical seizures in two patients. These patients and previously reported cases have the seizure disorder juvenile myoclonic epilepsy (impulsive petit mal), which seems particularly sensitive to provocation by cognitive functions, especially decision making. Myoclonic epilepsy is considered resistant to antiepileptic drugs other than clonazepam and valproate, but two of our patients responded well to clobazam.
Epilepsia Partialis Continua in Sjögren's Syndrome
Authors: Bansal S. K. , Sawhney I. M. S. , Chopra J. S.
Published: November 2007

Summary: Epilepsia partialis continua with Sjogren's syndrome is reported. The patient had extensive involvement of the nervous system with left middle cerebral artery occlusive stroke, mononeuritis multiplex, right partial sensory motor seizures and epilepsia partialis continua involving the right big toe and foot. The EEG showed nonspecific bilateral theta slowing. The epilepsia partialis continua did not respond to antiepileptic drugs.

Nous rapportons l'association d'une épilepsie partielle continue avec un syndrome de Sjögren. Le sujet présentait une at‐teinte neurologique importante avec infarctus sylvien gauche, multinévrite, crises partielles sensitivomotrices droites, et épilepsie partielle continue (EPC) touchant le gros orteil et le pied droits. L'électroencéphalogramme a mis en évidence un ralen‐tissement théta non spécifique bilatéral. L'EPC s'est montrée résistante aux médications antiépileptiques.

Se describe un caso de epilepsía partialis continua con un síndrome de Sjögren. El paciente tenía una amplia afectación del sistema nervioso con un infarto isquémico en el territorio de la arteria cerebral media del lado izquierdo, ataques sensitivo‐mo‐tores partialis en ei /ado derecho, mononeuritis multiple y epilepsia partialis contínua que afectaba al pie y al dedo gordo del lado derecho. El EEG mostró una actividad theta bilateral ine‐specífica. La epilepsía partialis continua no mejoro con medica‐ciones antiepilépticas.

Über einen Fall von EPC bei Sjögren‐Syndrom wird berichtet. Der Patient bot eine massive ZNS‐Beteiligung mit A. media In‐farkt links, Mononeuritis multiplex, rechtsseitigen sensomotor‐ischen Partialanfällen und eine EPC im Bereich des rechten FuBes und der Großzehe. Das EEG zeigte eine unspezifische bilaterale Theta‐Verlangsamung. Die EPC lieSz sich nicht durch antiepileptische Medikation beeinflussen.
Observations on the Effect of Morphine on Thalamocortical Excitability in the Cat
Authors: Nowack William J. , Johnson Richard N. , Hanna George R.
Published: November 2007

Summary: The acute effects of morphine on the thalamocortical augmenting response in the cat were evaluated. The thalamocortical augmenting response was elicited by delivering pairs of pulses to the ventrolateral thalamus and recording from ipsilateral sensorimotor cortex. A biphasic, dose‐related, naloxone‐attenuable effect on the augmenting response elicited by pulse pairs was observed. Although the clinical significance of those morphine‐induced changes is currently uncertain, they can be correlated with the convulsant and anticonvulsant effects of different doses of morphine.

Nous avons étudie les effets de la morphine administrée en aigu sur la réponse facilitatrice thalamocorticale du chat. La ré‐ponse facilitatrice thalamocorticale a été obtenue par administration de décharges par paires au niveau du thalamus ventrolatéral avec enregistrement au niveau du cortex sensorimoteur homolateral. Nous avons observé un effet biphasique, dose‐dependant, diminué par la naloxone, sur la réponse facilitatrice provoquée par les paires de décharges. Bien que la signification clinique de ces modifications induites par la morphine reste hy‐pothétique, nos constatations peuvent être rapprochées des effets convulsivants et anticonvulsivants de diffdréntes doses de morphine.

Se han estudiado los efectos agudos de la morfina sobre el incremento de la respuesta tálamo‐cortical en el gato. Esta re‐spuesta se determinó mediante la administración de pares de pulsos al núcleo ventrolateral del tálamo y registrándola desde la corteza sensitivo‐motora homolateral. Se ha observado un efecto bifásico y atenuador, dósis‐dependiente, de la naloxona sobre el aumento de la respuesta producida por los pares de pulsos. A pesar de que el significado clinico de estos cambios inducidos por la morfina es, por el momento, incierto es posible establecer una correlación con los efectos convulsivos y anticonvulsives de dósis diferentes de morfina.

Die akute Wirkung von Morphin auf die thalamokortikale Verstärkerantwort bei der Katze wurde ausgewertet. Die thalamokortikale Verstärkerantwort wurde durch Stimuluspaare des ventrolateralen Thalamus ausgelöst und vom ipsilateralen sowie motorischen Kortex abgeleitet. Eine biphasische. Dosis‐korrelierte und durch Naloxon abzuschwächende Wirkung der Verstärkerantwort durch Stimuluspaare wurde beobachtet. Obwohl die klinische Signifikanz dieser Morphin‐induzierten Veränder‐ungen zur Zeit nicht klar ist, kann sie mit den konvulsiven und antikonvulsiven Wirkungen veschiedener Morphindosen korre‐liert werden.
Epilepsy in Adolescence: Implications for the Development of Personality
Authors: Viberg M. , Blennow G. , Polski B.
Published: November 2007

Summary: Sixteen adolescent children with onset of epilepsy between the ages of 1 and 12 years and 16 control children were investigated by interview, self‐esteem scales, and the Thematic Apperception Test (TAT). Children with epilepsy had a significantly larger discrepancy between the self‐image and the ideal self‐image than did the control children. TAT indicated the body and self‐image is poorer, the unknown and the risk of acting out more threatening, the sex identity less stable, and the defense not as adaptive as the control group. Persons suffering from epilepsy are often stigmatized. One explanation could be the influence of epilepsy on the development during adolscence of the basic trust of their bodies and of themselves.

16 adolescents épileptiques, dont la maladie avait commené entre les âges de 1 et de 12 ans et 16 adolescents teamoins ont fait 1'objet d'un entretien et d'une évaluation par échelles d'auto‐ap‐préciation et par test d'apperception thématique (TAT). Par rapport aux témoins, les adolescents épileptiques présentaient un hiatus significativement plus important entre l'image qu'ils per‐cevaient d'eux‐mfimes et leur image idéale. Le TAT a montré que l'image du corps et l'auto‐évaluation est inférieure, l'in‐connu et le risque de l'activité exterieure plus menacants, l'identite sexuelle plus instable et les réactions de défense moins adaptées que dans le groupe témoin. Les sujets épileptiques sont souvent stigmatisés. Une des explications de cette constatation pourrait résider dans l'influence qu'exerce l'épilepsie sur le d6‐veloppement de la confiance dans le corps et dans la personalité

Se han investigado 16 adolescentes en los que la epilepsía co‐menzó entre los 1 y los 12 años y 16 niños control mediante una entrevista y escalas de apreciación‐propia y el Test de Aprecia‐ción Temática (TAT). Los adolescentes con epilepsía tenian una discrepancia significativamente más amplia entre su imagen‐propia y la imagen‐propia ideal de los adolescentes control. El TAT indicó que la imagen corporal y la imagen‐propia es más pobre, lo desconocido y el riesgo de mostrarse a los demas más amenazante, la identificatión sexual menos estable y la capa‐cidad de defenderse not an adaptativa como en el grupo control. Las personas que sufren epilepsías estdn frecuentemente estig‐matizadas. Una explicación para este dato podría consistir en la influencia de la epilepsía en el desarrollo, durante la adole‐scencia, de la confianza básica en su cuerpo y en ellos mismos.
Motor Cortical Kindling in Cats: A Comparison of Adult Cats and Kittens
Authors: Fukushima Junko , Kohsaka Shinobu , Fukushima Kikuro , Kato Masamichi
Published: November 2007

Summary: We compared the establishment of motor cortex kindling by daily electrical stimulation in adult cats and in 4‐week‐old kittens. All the adult cats and kittens examined reached a stable state of kindled seizures. There was no significant difference in after discharge (AD) thresholds, the course of clinical seizure development, or the number of stimuli required for the establishment of kindling between adult cats and kittens. During the development of the kindling stage, AD frequency increased in both adult cats and kittens, although AD duration did not show a clear change.

Nous avons comparé l'installation d'un embrasement cortical par stimulation électrique quotidienne chez le chat adulte et chez le chaton de 14 semaines. Tous les chats adultes et tous les chatons ont atteint un état stable d'embrasement critique. Nous n'avons pas observé de différence significative entre chats adultes et chatons dans les seuils de post‐décharge, dans l'évolution de l'installation des crises cliniques et dans le nombre de stimulations nécessaires à l'obtention d'un embrasement. Pendant l'installation de l'état d'embrasement, la fréquence des post‐décharges a augmenté chez les chats adultes comme chez les chatons, bien que la duree des post‐décharges ne se soit pas modifiée de façon évidente.

Hemos comparado la estabilización del “kindling” de la cor‐teza motora mediante estimulación eléctrica diaria en gatos adultos y en gatos de 4 semanas de edad. Todos los gatos adultos y los gatos jóvenes examinados alcanzaron un estado de estabilización de los ataques “kindled” (condicionados). No se obser‐varon diferencias significativas en los umbrales de la post‐de‐scarga (AD) en el curso del desarrollo de los ataques clinicos o en el número de los estímulos necesarios para logra el “kindling”, entre los gatos adultos y los jóvenes. Durante el desarrollo del estado de “kindling” la frecuencia de las AD aumentó en ambos animales a pesar de que la duracion de las AD no mostro ningún cambio.

Wir verglichen die Entwicklung vom Kindling des motoris‐chen Kortex bei täglicher elektrischer Stimulation bei ausge‐wachsenen Katzen und bei 4‐Wochen alten Katzenjungen. Alle untersuchten erwachsenen und jungen Katzen erreichten einen stabilen Zustand von Kindling‐Anfällen. Ein signifikanter Un‐terschied in der Nachentladungsschwelle (AD), klinischer An‐fallsentwicklung oder benötigter Stimuli bis zum Erreichen des Kindling konnte zwischen Katzen und Jungen nicht festgestellt werden. Während der Entwicklung des Kindling‐Stadiums stieg die AD‐Frequenz sowohl bei Katzen als auch bei Jungen an, ob‐wohl die AD‐Dauer keine klare Veränderung zeigte.
Differential Effects of Phenobarbital and Pentobarbital on Stimulus Train‐Induced Bursting in the Hippocampal Slice
Authors: Swartzwelder H. Scott , Wilson Wilkie A.
Published: November 2007

Summary: :Stimulus train‐induced bursting (STIB) in the hippocampal slice is an in vitro model of epileptiform activity that is analogous to kindling and requires no manipulation of the neurochemical or ionic environment. The bursts recorded from slices after STIB closely resemble the discharges observed in vivo after kindling and may provide a convenient and accessible model for studies of the electrophysiological underpinnings of epileptiform bursting in local neural circuits. One critical element in the validation of this model is the responsiveness of STIB to traditional sedatives and anticonvulsants. In this study we assessed the effects of the barbiturates phenobarbital and pentobarbital on both spontaneous and stimulus‐triggered bursts after STIB. Concentration‐response studies indicated that both drugs had inhibitory effects on stimulus‐triggered bursting, although at significantly different concentrations. The rate of spontaneous bursting, however, was not significantly affected by phenobarbital at any of the concentrations tested, whereas pentobarbital reduced the frequency of spontaneous bursting in a concentration‐dependent manner. These results indicate that STIB is responsive to the barbiturates tested, although the drugs have differential potencies depending on the type of bursting measured. These effects may be the result of differential potencies of these drugs on y‐amino‐butyric acid‐mediated inhibition within local hippocampal circuits, as well as different effects on the bio‐physical characteristics of pacemaker cells within these circuits.
An Assessment of Current Views on Epilepsy
Authors: Rodin E.
Published: November 2007

Summary: : The current neurologic literature tends to equate the term “epilepsy” with “epileptic seizures” and regards the condition mainly as a symptom of several different neurologic disorders. This has led to the creation of a great variety of “epilepsies” and a proposal to establish an International Classification of Epilepsies and Epileptic Syndromes. The assumptions underlying the proposed classification were reviewed, and it was pointed out that in spite of the differences in manifestations and etiologies there may be an underlying commonality. The suggestion is made that epilepsy may be viewed as a process that can express itself in various degrees of intensity, and a definition is proposed that takes into account not only the ictal but also the interictal phenomena. The implications for future research directed toward the solution of the epilepsy problem are discussed.
Intradose and Circadian Variation in Circulating Carbamazepine and Its Epoxide in Epileptic Patients: A Consequence of Autoinduction of Metabolism
Authors: Macphee Graeme J. A. , Butler Elaine , Brodie Martin J.
Published: November 2007

Summary: : Total and free carbamazepine (CBZ), and CBZ 10,11 epoxide (CBZ‐E) concentrations were measured over 24 h in 19 patients receiving CBZ 400 mg b.i.d. either as monotherapy (n = 13) or combined with another anticonvulsant (n = 6). Differences in CBZ and CBZ‐E disposition between day and night dosing were minor. Mean plasma CBZ concentrations were higher and CBZ‐E/CBZ ratios were lower in the monotherapy patients. Variations in total and free plasma CBZ levels were comparable in the monotherapy and polypharmacy groups. Peak free and total CBZ concentrations coincided at 4 h postdose. Free CBZ levels correlated significantly with total in each patient. The extent of variation in total plasma CBZ concentration during 24 h correlated significantly with antipyrine clearance in the monotherapy group. Circadian rhythms are unlikely to influence CBZ disposition to a clinically relevant extent. Measurement of peak and trough CBZ concentrations should improve the value of therapeutic drug monitoring. The diurnal variation in CBZ concentration appears related to the degree of autoinduction of metabolism and is substantial enough to warrant the development of a slow‐release preparation of the drug.
HIPDM Single Photon Emission Computed Tomography Brain Imaging in Partial Onset Secondarily Generalized Tonic‐Clonic Seizures
Authors: Lee B. I. , Markand O. N. , Wellman H. N. , Siddiqui A. R. , Mock B. , Krepshaw J. , Kung Hank
Published: November 2007

Summary: HIPDM‐Single photon emission computed tomography brain imaging was performed during interictal and ictal stages in three patients with complex partial seizures and secondarily generalized tonic‐clonic seizures. In all three patients, interictal studies demonstrated decreased regional cerebral perfusion (rCP) and ictal studies showed increased rCP in the epileptogenic region. The demonstration of focal hyperperfusion by SPECT performed during secondarily generalized tonic‐clonic seizures suggests that rCP in the epileptic focus remains higher than in other cerebral regions during immediate postictal stages, even in secondarily generalized seizures.
An Overview of Pediatric Seizure Disorders and Epileptic Syndromes
Authors: Tharp Barry R.
Published: November 2007

Summary: Seizures are common in infants and children and must be differentiated from a wide variety of other neurological and nonneurological disorders which include episodic disturbances of behavior. If the diagnosis is clear, then one must decide if the seizure is an isolated event and unlikely to recur (as are many afebrile generalized convulsive seizures in early childhood), a symptom of underlying cerebral pathology, or part of an epileptic syndrome. The latter may be a potentially lethal neurodegenerative disease or a benign epilepsy with excellent outcome. This review will discuss the various aspects of epilepsy in the pediatric age group, emphasize the benign nature of most seizures in children (including many forms of partial, or focal, seizures), and present an overview of the more serious epileptic syndromes. The myoclonic epilepsies will be used as a model to illustrate the wide scope of epileptic phenomena in infants and children.
Genetic Considerations in Childhood Epilepsy
Authors: Bird Thomas D.
Published: November 2007

Summary: This report reviews various lines of evidence demonstrating important genetic influences in the epilepsies, with special emphasis on childhood epilepsy. Five pertinent topics are discussed: (a) examples of dominant, recessive, and X‐linked single‐gene disorders known to be associated with epilepsy, (b) examples of gross chromosomal aberrations associated with epilepsy, (c) discussion of multifactorial and polygenic inheritance and issues of genetic heterogeneity with specific reference to idiopathic generalized epilepsy, febrile seizures, and infantile spasms, (d) brief review of experimental clues to possible pathogenetic mechanisms underlying genetic forms of epilepsy, and (e) an overview of strategies for applying genetic linkage analysis to hereditary epileptic disorders.
Hepatic Considerations in the Use of Antiepileptic Drugs
Authors: Dreifuss Fritz E. , Langer Dennis H.
Published: November 2007

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well‐defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.
Efficacy and Safety of Antiepileptic Drugs: A Review of Controlled Trials
Authors: Treiman David M.
Published: November 2007

Summary: Twenty randomized, double‐blind, controlled clinical trials of antiepileptic drugs (AEDs) in mostly adult patients with mostly partial onset and/or generalized tonic‐clonic seizures have been reported, with a total of 1,336 patients. None of these studies has demonstrated significant differences in antiepileptic efficacy between available antiepileptic drugs, but the results show that there are considerable individual differences between patients' responses to the same drug. While side effects are common with all of the antiepileptic drugs currently available, these are usually mild and reversible. Although some toxic effects may occur more frequently with certain drugs, there is sufficient overlap between the effects of various antiepileptic drugs that most side effects cannot be attributed with certainty to any one drug. Since side effects are generally dose‐related, they can frequently be avoided or minimized by careful dosage titration and individualization of therapy.
How to Initiate and Maintain Carbamazepine Therapy in Children and Adults
Authors: Porter Roger J.
Published: November 2007

Summary: Appropriate use of carbamazepine for the treatment of epilepsy is based on correct identification of the patient's seizure type. Carbamazepine is effective against partial seizures and against generalized tonic‐clonic seizures. Therapy should begin gradually, with initial doses increased slowly over 1 or 2 weeks, as tolerated. Side effects include fatigue, dizziness, ataxia, double vision, nausea, and vomiting. Most practitioners agree that, because of carbamazepine's relatively short half‐life, the total dosage should be administered in at least two divided doses. This avoids too high a peak blood level that would occur with a single dose. Carbamazepine therapy is associated with the development of two hematologic conditions. Leukopenia, which may be transient or persistent, requires careful monitoring but is not cause for immediate discontinuation of therapy. Aplastic anemia occurs rarely but is potentially fatal, and therefore diligent monitoring of hematologic function is indicated. Aplastic anemia is an idiosyncratic, non‐dose‐related side effect that is most likely to occur within the first 3 or 4 months of initiating therapy. Once seizures are controlled, plasma levels of carbamazepine should be measured to establish optimum levels for individual patients being treated with this drug.
Polytherapy, Monotherapy, and Carbamazepine
Authors: Reynolds E. H.
Published: November 2007

Summary: Despite the widespread and traditional use of polytherapy in the treatment of epilepsy, there is little evidence of its advantages over monotherapy. Among other undesirable effects, it can produce subtle cognitive and behavioral changes and sometimes even exacerbate the epilepsy. Recent studies provide evidence that in many patients seizures can be controlled by carefully monitored monotherapy: Approximately 75% of newly diagnosed, previously untreated epileptic patients will enter a 2‐year remission with this form of treatment. The theory has even been advanced that early control of seizures may help prevent the evolution of drug‐resistant, chronic epilepsy. In some patients with chronic epilepsy, multiple‐drug therapy can be reduced to single‐drug treatment, usually with an improvement in cognitive function and without increase in seizures. Trials conducted to date have shown no evidence of superiority of any one major antiepileptic drug over another in control of a particular seizure type. The choice of antiepileptic drug for monotherapy may therefore be influenced by differences in toxic effects associated with individual agents. On the basis of clinical and psychometric evidence, carbamazepine has been shown to cause fewer adverse effects than other antiepileptic drugs on cognitive function, mood, and behavior.
Chronic Focal Encephalitis (Rasmussen Syndrome): Six Cases
Authors: Piatt J. H. , Hwang P. A. , Armstrong D. C. , Becker L. E. , Hoffman H. J.
Published: November 2007

Summary: Six of 81 (7.4%) patients with medically intractable epilepsy treated by selective cortical excision at The Hospital for Sick Children, Toronto, Canada, since 1974 were found to have inflammatory changes in the excised specimens of cerebral cortex. The clinical and histopath‐ological findings in these cases resemble the chronic encephalitic syndrome described by Rasmussen. We confirm the unsatisfactory seizure control and the guarded neurological and intellectual prognosis that has been associated with Rasmussen syndrome.

Parmi 81 patients présentant une épilepsie résistante au trait‐ement médical et opérés par excision corticale sélective à l'Hôpital des Enfants Malades de Toronto, Canada, depuis 1974, des altérations inflammatoires ont été constatées sur les pieAces d'exérése corticale chez 6 sujets (7.4%). Les constatations cliniques et histopathologiques évoquent le syndrome d'encéphalite focale décrit par Rasmussen. Nous confirmons le pronostic péjoratif du syndrome de Rasmussen sur le plan des crises et sur le plan neurologique et intellectuel.

En seis de 81 pacientes (7.4%) con epilepsyía resistente a toda terapéutica médica y tratados posteriormente mediante la exciseón selectiva cortical en el Hospital de Niños Enfermos de Toronto, Canada desde 1974, se encontraron cambios inflamatorios en las muestras de corteza cerebral extraidas. En estos casos los hallazgos clínicos e histopatológicos son semejantes al síndrome de encefalitis crónica descrito por Rasmussen. Nosostros, en este estudio, confirmamos la dificultad en el control de los ataques y el pronóstico reservado del proceso neurológico y del desarrollo intelectual que se han asociado con el síndrome de Rasmussen.
Immunoreactive Leucine‐Enkephalin Content in Brains of Epileptic E1 Mice
Authors: Ochi Junko , Ito Masatoshi , Okuno Takehiko , Mikawa Haruki
Published: November 2007

Summary: The immunoreactive leucine‐enkephalin (IR Leu‐E) content in the brains of epileptic E1 mice was determined. E1 mice are mutants from the dd strain of mice and are susceptible to convulsions. Seizures were elicited in E1 mice by repeated postural stimulations. As controls, ddY strain (nonconvulsive) mice and nonstimulated E1 mice (which had not developed convulsions) were used. IR Leu‐E content was measured by radioimmunoassay. Before the convulsion, the IR Leu‐E content in the striatum of E1 mice was 60% of the content in the controls. In the hypothalamus, IR Leu‐E levels were increased by 85% 45 min after a convulsion. IR Leu‐E was also increased in the striatum (176% of preconvulsive state), cortex (121%), medulla oblongata + pons (132%), hypothalamus (180%), and midbrain (159%) 48 h after a convulsion.

Nous avons measuré les taux de leucine‐enképhaline immunoréactive (IR Leu‐E) dans le cerveau de souris épileptiques El. Les souris E1 sont des mutantes de la souche dd et sont prédisposées aux convulsions. Les crises ont été provoquées par des stimulations posturales répétées. Nous avons utilisé comme témoins des souris de souche ddY (non‐épileptiques) et des souris E1 non stimulus (qui ne présentaient pas de convulsions). Les taux de IR Leu‐E ont été mésurés par radio‐immunologie. Avant la convulsion, les taux de IR Leu‐E mesurés au niveau du striatum chez les souris E1 était à environ 60% des taux observés chez les témoins. Au niveau de l'hypothalamus, les taux de IR Leu‐E ont augmenté de 85% 45 minutes aprés une convulsion. Les taux de IR Leu‐E ont aussi été trouvés augmentés dans le striatum (176%), dans le cortex (121%). dans le bulbe et la pro‐tuvérance (132%), dans l'hypothalamus (180%) et dans le mésencéphale (159%) 48 heures aprés une convulsion.

Der immunreaktive Leukin‐Enkephalin (IR Leu‐E)‐Gehalt im Gehirn von epileptischen El‐Mausen wurde bestimmt. El‐Mäuse sind anfallsempfindliche Mutanten eines dd‐Mäuse‐stammes. Die Anfälle wurden durch wiederholte Körperste‐lungs‐Stimulation ausgelöst. Als Kontrolltiere diente ein ddY‐Mäusestamm (nicht konvulsiv) sowie nicht stimulierte El‐Mäuse, die bislang keine Anfälle entwickelt hatten. Der IR Leu‐E‐Gehalt wurde durch einen Radioimmunoassay bestimmt. Vor den Anfällen betrug der IR Leu‐E‐Gehalt des Striatums bei El‐Mäusen ungefähr 60% des Gehaltes der Kontrolltiere. Im Hypothalamus war der IR Leu‐E‐Gehalt 45 Minuten nach den Anfällen urn 85% erhoht. IR Leu‐E war 48 Stunden nach den Anfällen auch im Striatum urn 176%, im Kortex urn 121%, in der Medulla oblongata und Ponsbereich urn 132%. im Hypothalamus urn 180% und im Mittelhirnbereich um 159% erhöht gefunden worden.
Neurological Morbidity of Severe Epilepsy
Authors: Janz Dieter
Published: November 2007

Summary:: The “severity” of a disease is a relative expression and its definition will vary depending on the perspective of the observer. The patient's subjective perception of the disease, the way it is regarded socially by the community, and the doctor's objective assessment rarely coincide. In fact, they are frequently diametrically opposed. As far as the patient's personal perception of epilepsy is concerned, there has apparently been no satisfactory attempt thus far at a systematic grading of the subjective handicap, despite the growth of interest in psychological matters and the self‐help movement. Similarly, social ability or disability cannot be adequately assessed on the basis of medical criteria such as frequency and type of seizures. We present a grading system which will serve as an example of an appropriate method of assessing social abilities, and which will permit the patient's occupational potential to be estimated in relation to the risk of accidents resulting from seizures. From the medical point of view, the impairment of a patient's abilities due to epilepsy is a function of the patient's responsiveness to treatment. We present a critical review of the factors which have an effect on the therapeutic prognosis: the causes of epilepsy, underlying structural lesions, the incidence of convulsive status epilepticus, various types of attacks, and the different epileptic syndromes. Taking two examples–epilepsy presenting in the form of absence and epilepsy with complex focal seizures–we show that ultimately the “severity of epilepsy” can only be defined from the medical standpoint on the basis of several factors whose value is of a predictive nature.
Adjunctive Therapy in Resistant Epilepsy
Authors: Callaghan Noel , Goggin Tim
Published: November 2007

Summary: : It is now established that the overall prognosis for epilepsy is good and that remission will occur in at least 75% of patients following adequate treatment with monotherapy. Patients who fail to respond to monotherapy, who are not suitable for surgery, and who continue to have frequent seizures may have to be considered for an alternative drug regimen. A review of the literature indicates that complete seizure control with adjunctive treatment is rare, but improved seizure control can be obtained in up to 40% of patients. In a study of clobazam as adjunctive treatment, 60% (N = 20) of our patients responded to treatment initially and 33% maintained an improvement over an 18‐month period. In 31 patients who failed to respond to carbamazepine as monotherapy, primidone (N = 16) or valproate (N = 15) were prescribed as adjunctive treatment. One patient obtained complete freedom from seizures and 14 (45%) had a > 50% reduction in seizure frequency. Suggested indications for the use of additive treatment in epilepsy are discussed.
Carbamazepine Therapy and LongTerm Prognosis in Epilepsy of Childhood
Authors: Okuno Takehiko , Ito Masatoshi , Nakano Shozo , Hattori Haruo , Fujii Tatsuya , Go Toshin , Mikawa Haruki
Published: November 2007

Summary: Sixty‐seven of 90 patients (74% who had been treated with carbamazepine (CBZ) alone were seizure‐free for > 3 years. The EEG of the patients given CBZ monotherapy was more often normal in those without neurologic abnormalities other than mental retardation or a genetic predisposition. The prognosis of patients with partial seizures secondarily generalized was poorer than that of the other patients. Patients without mental retardation more often had monotherapy CBZ. The lowest blood level of CBZ for maintenance was considered to be 4 μg/ml, although the therapeutic blood level was between 6 and 12 μ.g/ml. Most of the side effects were mild.

67 patients parmi 90 enfants (soit 74%) qui avaient été traités par carbamazépine (CBZ) en monothérapie n'ont plus présenté de crises pendant au moins 3 ans. L'EEG de patients traités par CBZ en monothérapie était souvent normal chez ceux qui ne présentaient pas d'anomalies neurologiques en dehors d'un retard mental ou d'une predisposition genetique. Le pronostic était plus mauvais chez les patients présentant des crises partielles secondairement généralisées que chez les autres. Les patients sans retard mental avaient plus souvent que les autres une monotherapie par CBZ. Le seuil inferieur efficace du taux sanguin de CBZ a été estiméà 4 mg/1, bien que le taux thérapeutique se soit situé entre 6 et 12 mg/1. La plupart des effets secondares ont été peu importants.

Sesenta y siété de 90 pacientes (74%) que habian sido tratados con carbamazepina (CBZ) como medicación única, permanecieron libres de ataques durante más de 3 años. El EEG de los pacientes que recibfan monoterapia con CBZ fue mis frecuent‐emente normal que el de los enfermos sin anomalfas neurológicas, aparte de retraso mental o predisposición genética. El pronóstico de los pacientes con ataques parciales con generalización secundaria fue peor que en otros pacientes. Los enfermos sin retraso mental recibieron monoterapia con CBZ más frecuente‐mente. Se consideró que los niveles en sangre de CBZ más bajos de mantenimiento fueron de 4 μg/ml a pesar de que el nivel terapéutico se consideraba entre 6 y 12 μ.g/ml. Los síntomas colaterales fueron, en su mayor parte, de poca importancia.
Genetics of the Partial Epilepsies: A Review
Authors: Ottman Ruth
Published: November 2007

Summary: The research literature is consistent in reporting somewhat less familial aggregation in partial than in generalized epilepsy. However, relatives of patients with partial seizures do appear to have higher seizure risks than relatives of controls, suggesting that genetic factors are important in at least some partial epilepsies. Complex partial epilepsy appears to be only slightly less familial than other types of epilepsy. Relatives of patients with focal EEG abnormalities generally have been found to have lower risk of both EEG abnormalities and epilepsy than relatives of patients with generalized abnormalities. For focal temporocentral abnormalities, however, there is evidence of an important influence of genetic factors.

La littérature rapporte de façon concordante un caractère familial moins prononcé dans les épilepsies partielles que dans les epilepsies généralisées. Cependant. les parents de patients présentant des crises partielles présentent bien des risques supérieurs pour épilepsie que les parents de sujets contrôles: ceci suggère que les facteurs généiques jouent un rôle important dans au moins une partie des épilepsies partielles. Les épilepsies partielles complexes semblent avoir un caractère familial à peine moins prononcé que autres types épilepsies. Chez les parents de sujets présentant des anomalies EEG focales, on a constaté en général que le risque de présenter à la fois des anomalies EEG focales et une épilepsie était moindre que chez les parents de sujets présentant une épilepsie généralisée. En ce qui concerne les anomalies focales centro‐temporales, il y a cependant des preuves une influence importante de facteurs génétiques.

En la literatura se insiste de modo persistente que existe una agregación familiar menos importante en las epilepsías parciales que en la epilepsia generalizada. Sin embargo, se ha observado que familiares de enfermos con ataques parciales tienen un riesgo más elevado de ataques que los familiares de los controles, lo que sugiere la importancia de factores genéticos en, al menos, algunas formas de epilepsías parciales. La epilepsía parcial compleja parece ser algo menos familiar que otros tipos de epilepsía. Los familiares de enfermos con anormalidades focales del EEG. generalmente tienen un riesgo menor de tener anomalías en el EEG o de sufrir epilepsia que los familiares de aquellos casos con anomalías generalizadas. Sin embargo, en aquellos casos de anomalías centro‐temporales, existe importante eviden‐cia de posibles influencias de factores genéticos.
Magnetic Resonance Imaging as a Sensitive and Specific Predictor of Neoplasms Removed for Intractable Epilepsy
Authors: Bergen Donna , Bleck Thomas , Ramsey Ruth , Clasen Raymond , Ristanovic Ruzica , Smith Michael , Whisler Walter W.
Published: November 2007

Summary: Twenty‐three patients had magnetic resonance imaging (MRI) and computed tomography (CT) of the head prior to surgery for medically intractable epilepsy. Eleven patients had neoplasms, mostly astrocytomas. Six of the 11 tumors were seen on CT. In five of the six cases, the MRI showed a focal area of increased signal on T2‐weighted images. All 11 tumors were detected by MRI. None of the non‐neoplastic lesions produced an abnormal T2‐weighted signal area on MRI. Only one of the non‐neoplastic lesions was seen on both CT and on MRI. MRI allowed clear discrimination between tumors and non‐neoplastic lesions in patients coming to surgery for intractable epilepsy.

23 patients ont bénlificié une imagerie par résonnance mag‐néique (IRM) et une scannographie (TDM) cérébrales avant traitement éhirurgical une épilepsie rebelle. 11 patients prése‐ntaient une néoplasie, le plus souvent un astrocytome. La TDM a permis de mettre en évidence la tumeur chez 6 patients sur 11. IRM mit en evidence la tumeur dans 10 cas sur 11, avec un aspect augmentation focale du signal en T2. Aucune des lésions non néoplasiques n'a produit image pathologique en T2 à examen par IRM. Une seule tumeur a été visible à la fois en TDM et en IRM. IRM a permis de séparer clairement les tumeurs et les lésions non néoplasiques chez les patients hospitalisés pour chirurgie une épilepsie rebelle.

Antes de practicar cirugía en 23 enfermos con epilepsyía intrat‐able médicamente se practiceó una Resonancia Magnética (MRI) y una Tomograffa Computarizada (CT). Once enfermos tertían neoplasias, la mayor parte astrocitomas. Los tumores fueron visualizados mediante la CT en 6 de 11 casos. En 5 de estos 6 casos, la MRI mostró un área focal de incremento de señal en las imágenes T2. Todos los 11 tumores fueron detectados mediante la MRI. Ninguna de las lesiones no‐neoplásicas produjeron señates anormales en T2 mediante la MRI. Solamente un tumor se vio en ambas técnicas, la CT y la MRI. La MRI permitió aclarar la discriminación entre tumores y lesiones no‐neoplásicas en pa‐cientes que se programan para cirguía de la epilepsyía m4eAdicamente incurable.

Bei 23 Patienten mit medicamentös nicht behandelbarer Epi‐lepsie wurden vor dem (Epilepsie) chircurgischen Eingriff NMR und CAT durchgeführt. 11 Patienten zeigten Neoplasmen, meist Astrozytome, die im CT nur 6 mal erschienen. 11 mal stellte das NMR den Tumor las fokales Signal bei T2‐Gewichtung dar, bis auf eine Ausnahme. Keine der nicht‐neoplastischen Laesionen erzeugte eine abnorme T2‐Gewichtung im NMR. Nur eine Lae‐sion wurde sowohl im CT als auch im NMR gesehen. Das NMR erlaubt somit eine klare Unterscheidung zwischen Tumor und nicht‐neoplastischen Laesionen bei Patienten, die zur EpUepsie‐Chirugie kommen.
Valproate Competes with Palmitate for Binding to Serum Albumin
Authors: Vorum Henrik , Andersen Signe , Brodersen Rolf
Published: November 2007

Summary: Addition of sodium valproate (VPA) to a buffered solution of human serum albumin (HSA) or to serum reduces binding affinity for palmitate. A maximal pharmacologic VPA concentration, 700 μM added to a 300‐μM albumin solution, reduces the reserve albumin concentration for binding of palmitate by a factor of 0.64. One possible site model explaining these findings may be that VPA competes strongly with one among three palmitate molecules, bound to albumin with high affinity, and induces a weaker displacement of a second palmitate.

addition du valproate de sodium (VPA) à une solution tampon de sérum‐albumine humaine ou au sérum réduit les affinityé's de liaison du palmitate. Une concentration maximale du VPA pharmacologique, 700 μM, ajoutée à une solution albumine de 300 μM réduit la réserve de concentration albumine un fac‐teur de 0.64. Le VPA possiblement est en forte compétition avec une des trois molécules de palmitate, liée a albumine par une grande affinityé, et entraine un défacement plus faible une deuxième molécule palmitate.

Adición de valproato de sodio (VPA) a una solución tampón de suero albúmina humano, o a suero, reduce la afinidad de com‐binación de palmitato. Una concentracidn farmacológica maxima de VPA, de 700 μM, adicionada a una solucidn de albumina de 300 μM, reduce la reserva de la concentraci6n de albumina en cuanto a combinación de palmitato con un factor de 0.64. A base de un site modelo, VPA puede compite fuertemente con una de tres moléculas de palmitato, combinadas a albumina con gran afinidad, e induce un desplazamiento más débil de la siguiente molécula de palmitato.

Beimischung von Sodium Valproat (VPA) zu einer pufferten Lösung von humaner Serumalbumin, oder zu Serum, reduziert die Bindungsaffinität für Palmitat. Eine maximale, pharmakolo‐gische VPA‐Konzentration, 700 μM, einer 300 μM Albumin‐Lösung beigemischt, reduziert die Reservealbumin‐Konzentration für Bindung der Palmitat mit einem Faktor von 0.64. In einem Site Modell VPA kann in starkem Grad mit einem von drei Palmitat‐Molekülen, zu Albumin mit hoher Affinität gebunden, konkurrieren und kann eine schwachere Verdrängung eines zweiten Palmitat‐Molekül verursachen.