bluuebunny/crossref_metadata_2025 huggingface dataset:
Chronic Semichronic Limbic Epilepsy Produced by Microinjection of Tetanus Toxin in Cat Hippocampus
Authors: Darcey Terrance M. , Williamson Peter D.
Published: August 2005

Summary: We describe an animal preparation in which a semichronic or chronic limbic epileptiform syndrome can be produced reliably by unilateral microinjection of tetanus toxin in cat ventral hippocampus. Injections were given at 1‐week intervals until abnormal EEG activity was observed. After two to five injections, the animals abruptly began to exhibit intermittent spikes and subclinical discharges that soon gave way to spontaneous and recurrent behavioral seizures which gradually increased in frequency, duration, and severity in the next 12 48h. Anticonvulsant therapy (phenobarbital, PB) was required within the first 3 days of the syndrome, since life‐ threatening generalized tonic‐clonic seizures (GTCS) and status epilepticus would develop if the animal were left untreated. If severe seizures were prevented by antiepileptic drugs (AEDs) there was complete remission of the syndrome and repeat injection was necessary to reinitiate seizures. Animals that experienced severe seizures or that were reinjected after remission developed a chronic seizure syndrome and could be maintained with AEDs for long times (> 1 year) without significant debilitation. Although early spikes and subclinical discharges were typically focal to ipsilateral limbic sites, initial seizures appeared explosively in the form of a high‐amplitude, high‐frequency discharge, which often had an apparently bilateral limbic onset. On the other hand, chronic seizures had much more gradual onset and spread, often consisting of periodic sharp waves or low‐amplitude sinusoidal discharge that was more clearly focal to ipsilateral limbic sites. Throughout the syndrome, ictal behavioral manifestations were highly stereotyped and very comparable to those described by other investigators in studies of clinical and experimental limbic epilepsy. All animals exhibited signs of independent contralateral involvement during the syndrome, ranging from independent contralateral spikes to subclinical discharges with a clear contralateral onset. None of the animals exhibited structural lesions on histologic examination at the level of light microscopy.
Seizures Induced by the Cocaine Metabolite Benzoylecgonine in Rats
Authors: Konkol Richard J. , Erickson Brian A. , Doerr Julie K. , Hoffman Raymond G. , Madden Jane A.
Published: August 2005

Summary:The half‐life (t1/2) of cocaine is relatively short, but some of the consequences of its use, such as seizures and strokes, can occur hours after exposure. This led us to hypothesize that a metabolite of cocaine may be responsible for some of those delayed sequelae. We evaluated the potential of the major metabolite of cocaine, benzoylecgonine (BE), to cause seizures. Two separate equimolar doses (0.2 and 0.4 μmol) of either cocaine or BE were injected ventricularly in unanesthetized juvenile rats. Treated rats were then evaluated for incidence, latency, and seizure pattern or for locomotor activity in animals without seizures. BE‐Induced seizures occurred more frequently and had significantly longer latencies than those induced by equimolar amounts of cocaine. Whereas cocaine‐induced seizures were best characterized as brief, generalized, and tonic and resulted in death, those induced by BE were prolonged, often multiple and mixed in type, and rarely resulted in death. Electrical recordings from the hippocampus showed a rhythmic progression in EEG frequency and voltage with clinical seizure expression. BE‐Injected rats that did not have seizures had significantly more locomotor activity than cocaine‐injected animals without seizures. The finding that cocaineand BE‐induced seizures differ in several respects suggests more than one mechanism for cocaine‐induced seizures and emphasizes the importance of a cocaine metabolite, BE.
Changes in the Strength of Recurrent Inhibition in Cobalt‐Induced Epilepsy
Authors: Kawakami Yoriko , Koyama Ikuko
Published: August 2005

Summary: Changes in the strength of recurrent inhibition in the feline cortex in cobalt (CoCl2)‐induced epilepsy were observed. The strength of inhibition was analyzed in terms of paired‐pulse depression of the amplitude of somatosensory evoked potentials (SEPs) elicited by stimulation of the ventral posterolateral (VPL) thalamic nucleus. An enhancement in recurrent inhibition was observed shortly after CoCl2 application. The size of the amplitude of cortical evoked potentials (EPs) elicited by VPL stimulation increased simultaneously. The reduction of inhibition that appeared later was associated with after discharges (ADS) evoked by VPL stimulation. These ADS frequently extended to epileptic discharges. These results suggest that the reduction in recurrent inhibition induced by CoCl2 application plays an important role in the spread of seizure activity.
Epilepsy in Schizencephaly: Abnormal Cortical Organization Studied by Somatosensory Evoked Potentials
Authors: Vossler David G. , Wilkus Robert J. , Pilcher Webster H. , Farwell Jacqueline R.
Published: August 2005

Summary: Median nerve short‐latency somatosensory evoked potentials (MN‐SSEP) are recorded from the scalp to assess parietal lobe function and from the cortex to identify primary sensory and motor areas before epilepsy surgery. Nevertheless, the origins of many of the MN‐SSEP waveforms and the reliability of this technique for localizing the central sulcus are not definitively known. We studied a child with a unilateral, closed, right parietal schizencephalic cleft and frequent simple partial seizures before the child underwent cortical resection. The sensory examination, neuroimaging, and electrical brain stimulation findings indicated a normal thalamus and an abnormal parietal lobe. Scalp‐recorded MN‐SSEPs showed intact widespread N18 potentials bilaterally, but absent right, although normal left parietal N20 and P27 waveforms. Cortically recorded MN‐SSEPs could not localize the central sulcus owing to an absence of the expected negative potential over the right postcentral gyrus and the presence of waves with abnormal latencies over the precentral cortex. These findings suggest that: (a) the N18 potential probably originates at or below the level of the thalamus, (b) the N20 and P27 peaks are most likely generated by parietal cortex or white matter, and (c) cortically recorded MN‐SSEPs can fail to localize the central sulcus before epilepsy surgery when congenital anomalies exist in the parietal lobe.
Spike Morphology in Childhood Focal Epilepsy: Relationship to Syndromic Classification
Authors: Frost James D. , Hrachovy Richard A. , Glaze Daniel G.
Published: August 2005

Summary: The waveform morphology of interictal spike activity associated with uncontrolled childhood focal epilepsy was quantified in 40 patients by a computer‐based technique. The findings were then analyzed with respect to epileptic syndromes. Samples of spike activity from each patient were characterized by determination of average amplitude (A), duration (D), and sharpness (S). A single morphologic index, the composite spike parameter (CSP), was also derived from the basic spike parameters (CSP = A × D/S). The spikes of patients in the benign focal epilepsy category differed from those of patients in other syndromic categories (symptomatic, cryptogenic, and Landau‐Kleffner). Specifically, they were higher in amplitude, longer in duration, less sharp, and had a higher CSP value. The pretreatment spike parameters did not differ significantly in patients who responded favorably to initial antiepileptic drug (AED) therapy as compared with those whose seizures were harder to control. The findings suggest that quantitative assessment of interictal spike morphology may help develop a more objective basis for classifying patients according to epileptic syndrome.
Fluoxetine, a Selective Serotonin‐Uptake Inhibitor, Enhances the Anticonvulsant Effects of Phenytoin, Carbamazepine, and Ameltolide (LY 201116)
Authors: Leander J. David
Published: August 2005

Summary: Dose‐response curves for the prototypical anticonvulsants phenytoin (PHT) and carbamazepine (CBZ), and a novel anticonvulsant, Ameltolide (LY201116), were determined with and without pretreatment with the selective serotonin‐uptake inhibitor fluoxetine by maximal electroshock seizure (MES) test in mice. Fluoxetine (2.5, 5, and 10 mg/kg intraperitoneally, i.p.) produced a dose‐related decrease in the ED50, values for the anticonvulsants (i.p. administration) to protect against MES‐induced tonic‐extensor seizures. Fluoxetine (10 mg/kg i.p.) also decreased the intravenous (i.v.) ED50 doses of the three anticonvulsants by a factor of ∼2. These data suggest that fluoxetine, through its selective inhibition of serotonergic reuptake, may have beneficial advantages as compared with common antidepressant drugs in treatment of depressed patients with epilepsy and may also enhance the seizure control of prototypical anticonvulsants in treatment of epilepsy.
Age‐Dependent Changes in Long‐Term Seizure Susceptibility and Behavior After Hypoxia in Rats
Authors: Jensen F. E. , Holmes G. L. , Lombroso C. T. , Blume H. K. , Firkusny I. R.
Published: August 2005

Summary: We showed that hypoxia is acutely epileptogenic in immature but not in adult rats. In the present study, we evaluated whether hypoxia results in an in‐crease in long‐term seizure susceptibility to flurothyl and whether this is associated with impaired performance on behavioral tests. We also determined whether these long‐term outcomes are dependent on age at time of O2, deprivation. Long Evans hooded rats were rendered hypoxic on either postnatal day (P)5, P10, or P60. Sixty to 75 days after hypoxia, rats were tested for performance in water maze, open field, and handling tests and for seizure susceptibility to flurothyl. Hypoxia at P10 significantly in‐creased seizure susceptibility to fluorothyl, whereas hypoxia at P5 and P60 induced no long‐term changes in seizure threshold. At P10, greater seizure severity during hypoxia and more prolonged exposure to hypoxia significantly increased long‐term seizure susceptibility. This long‐term change in seizure susceptibility appeared to be dissociated from any long‐term neurobehavioral consequences, because only animals rendered hypoxic as adults (P60) had impaired behavioral performance. The results suggest that hypoxia‐induced seizures can alter long‐term seizure susceptibility and that this long‐term effect is dependent on age and on severity of seizure activity at the time of previous hypoxia.
Seizures in a Fetal Lamb After Cocaine Exposure: A Case Report
Authors: Peters Aemil J. M. , Abrams Robert M. , Burchfield David J. , Gilmore Robin L.
Published: August 2005

Summary: We report the chance observation of two generalized seizures in a fetal lamb that received cocaine. Cocaine was infused intravenously into a 138‐day‐old fetus while electrocortical (ECoG), electroocular (EOG), and neck electromyographic (EMG) activity were recorded. Fetal rapid eye movement (REM) and nonrapid eye movement (NREM) sleep were disrupted during the cocaine exposure and returned to a normal pattern after infusions were stopped. Seventy‐two hours later, however, we recorded generalized seizures with ECoG spike and spike wave activity.
Pre‐ and Postoperative Auditory Event‐Related Potentials in Temporal Lobe Epilepsy
Authors: Mervaala Esa , Nousiainen Unto , Kinnunen Jukka , Vapalahti Matti , Riekkinen Paavo
Published: August 2005

Summary: We studied auditory event‐related potentials (ERPs) in 11 surgically treated patients with intractable temporal lobe epilepsy (TLE) pre‐ and postoperatively. ERPs through sphenoidal electrodes (Sp1‐T3, Sp2‐T4) provided clinically relevant and correctly lateralizing electrophysiologic evidence of temporal lobe dysfunction in 9 of 11 patients, confirmed by EEGs, electrocorticograms, neuroradiologic, and neuropsychological results, and clinical follow‐up. Lateralizing asymmetries were noted in P300 amplitude, but latencies were prolonged bilaterally. Sphenoidal ERPs might serve as a new functional indicator of temporal lobe dysfunction in patients evaluated for epilepsy surgery.
Prolonged Ictal Amnesia with Transient Focal Abnormalities on Magnetic Resonance Imaging
Authors: Lee B. I. , Lee B. C. , Hwang Y. M. , Sohn Y. H. , Jung J. W. , Park S. C. , Han M. H.
Published: August 2005

Summary: A previously healthy woman had a prolonged amnestic state caused by complex partial status epilepticus with bilateral mesiotemporal lobe involvement confirmed by EEG with nasopharyngeal electrodes. A magnetic resonance imaging (MRI) scan obtained shortly after recovery from the amnesia showed reversible focal abnormalities consisting of increased signal intensity on T2‐weighted scan in the mesiotemporal lobe.
Adult Postanoxic “Erratic“ Status Epilepticus
Authors: Bortone E. , Bettoni G. , Giorgi C. , Murgese A. , Stocchetti M. , Mancia D.
Published: August 2005

Summary: A 66‐year‐old woman with posttraumatic anoxic coma after diffuse cerebral fat embolism had continuous alternating‐side myoclonic jerks. Usually, this kind of myoclonic status epilepticus (SE) occurs in newborn infants. We postulate the unusual combination of diffuse cerebral anoxia plus commissural fiber damage as a possible explanation.
Validation of a Questionnaire for Clinical Seizure Diagnosis
Authors: Reutens David C. , Howell R. Anne , Gebert Kylie E. , Berkovic Samuel F.
Published: August 2005

Summary: A detailed questionnaire has been devised for diagnosis of seizure type. It is suitable for administration by trained interviewers, either directly or by telephone. A comparison of physician‐based and questionnaire‐based diagnoses showed almost perfect agreement in classification of patients into those with seizures of either generalized or focal origin. Substantial to almost‐perfect agreement was reached in diagnosis of patients with most individual seizure types. Disagreement in differentiation between simple and complex partial seizures (CPS) probably reflects the limitations of the clinical method rather than of the questionnaire itself. The questionnaire should be of value in large‐scaled clinical and epidemiologic studies.
Facial Asymmetry in Partial Epilepsies
Authors: Tinuper Paolo , Plazzi Giuseppe , Provini Federica , Cerullo Angelina , Leonardi Marco , Agati Raffaele , Righini Andrea , Montagna Pasquale
Published: August 2005

Summary: Fifty‐six consecutive epileptic patients with partial seizures (30 temporal, 26 extratemporal) and facial asymmetry were studied. Facial asymmetry was compared with EEG, radiologic, and other clinical findings. Thirty patients had a lesional epilepsy whereas 26 were considered cryptogenic. In lesional epilepsies, 60% of patients had EEG foci ipsilateral to the smaller hemiface and only 20% had EEG foci contralaterally. In the cryptogenic group, the EEG focus was ipsilateral in 50% and contralateral to the facial smallness in 46%. No differences were noted between temporal and extratemporal epilepsies. Early acquired cerebral lesions may modify development of the hemisphere involved, leading to a small ipsilateral hemiface and seizures originating from the same side.
Determinants of IQ Profile in Children Generalized Epilepsy
Authors: Singhi Pratibha D. , Bansal Usha , Singhi Sunit , Pershad Dwarka
Published: August 2005

Summary: To determine the IQ profile of children with epilepsy and the influence of various epilepsy‐related variables on IQ scores, we studied 50 children with idiopathic generalized epilepsy of > 1‐year duration, 25 of their siblings, and 30 healthy controls. IQ assessments were made with Malin's Indian modification of the Wechsler Intelligence Scale for Children. The mean ± SD IQ scores of children with epilepsy (85.6 k 12) and their siblings (93.2 ± 11) were significantly lower than those of the controls (101.6 ± 9). The IQ scores of the children with epilepsy were also significantly lower than those of their siblings (p < 0.05). The IQ scores showed a significant correlation with socioeconomic status (SES) score (r= 0.33), a history of status epilepticus (r= ‐0.38), duration of seizure disorder (r= ‐0.31), and total number of seizures (r= ‐0.31). On multiple regression analysis, status epilepticus emerged as the most significant variable, accounting for 14% variance, followed by SES score (9% variance), duration of seizure disorder (6% variance), and sex of the child (5% variance). Genetic or environmental factors that probably lead to cognitive deficit in children with epilepsy and their siblings require further study.
Efficacy of the Ketogenic Diet for Intractable Seizure Disorders: Review of 58 Cases
Authors: Kinsman Stephen L. , Vining Eileen P. G. , Quaskey Shirley A. , Mellits David , Freeman John M.
Published: August 2005

Summary: The ketogenic diet was developed in the 1920s as a treatment for intractable childhood seizures when few antiepileptic drugs (AEDs) were available. There are still children whose seizures are refractory even to modern therapy, but use of the ketogenic diet appears to be waning. At Johns Hopkins, we continue to believe that the diet is very effective and well accepted by patients and families. To reevaluate our opinion of the efficacy and acceptability of this form of therapy in patients cared for in the 1980s with the newer AEDs, we analyzed the records of 58 consecutive patients who had been started on the diet. Before using the diet, 80% of the patients had multiple seizure types and 88% were treated with multiple AEDs; these children were among our most intractable patients. Despite this, seizure control improved in 67% of patients with the ketogenic diet, and actuarial analysis indicated that 75% of these improved patients continued the diet for at least 18 months. Sixty‐four percent had AEDs reduced, 36% became more alert, and 23% had improved behavior. The improvement in these patients with intractable seizures and the length of time that families maintained the regimen indicate that the ketogenic diet continues to have a very useful therapeutic role in selected patients and their families.
Possible Association of Juvenile Myoclonic Epilepsy with HLA‐DRw6
Authors: Durner Martha , Janz Dieter , Zingsem Juergen , Greenberg David A.
Published: August 2005

Summary: Juvenile myoclonic epilepsy (JME) is a clearly defined subform of idiopathic generalized epilepsy with a high aggregation of epilepsy in family members. With the HLA‐system used as a genetic marker, a linkage between JME and the HLA region was demonstrated. Linkage with the HLA region suggests that JME may be associated with an HLA‐antigen. An association could indicate that the gene lies in the HLA region and is in linkage disequilibrium with one of the HLA‐antigens. Eightyeight unrelated patients with JME were typed for the HLA‐A and HLA‐B locus, 77 were typed for the HLA‐C locus, and 76 were typed for the DR locus. The antigen frequency was compared with those of healthy blood donors. The highest difference was noted in the frequency of DRw6 (39.5% in patients vs. 22.1% in controls). This weak association is open to question because DRw6 is known to split into DRwl3 and DRw14.
Neonatal Hyperekplexia: A Case Report
Authors: Pascotto A. , Coppola G.
Published: August 2005

Summary: We report the case of a baby with transient generalized stiffness noticeable from the first days of life, hyperreflexia, massive jerks in response to sudden tactile and acoustic stimuli, and long‐lasting myoclonic jerks closely resembling epileptic seizures. The father and paternal grandfather both had hyperekplexia. At age 3 years, the child had normal psychomotor development and persistent abnormal startle response to unexpected sounds or touch.
Late‐Onset Epilepsy and Diffuse Cryptogenous Cerebral Atrophy
Authors: Regesta Giovanni , Tanganelli Paolo
Published: August 2005

Summary: Diffuse cerebral atrophy (CA), a frequent computed tomography (CT) finding in late‐onset epilepsy, is sometimes of unknown origin or cryptogenous (CCA). From a series of 228 patients with late‐onset epilepsy with diffuse CA, we excluded patients with a presumed etiology. The remaining 73 (36.8%) patients were studied for a mean of 7.2 years; 15.1% had a family history of epilepsy. CCA was cortical in 50.7%, subcortical in 6.8%, and corticosubcortical in 42.5%. Seizures, generalized in 71.2%, and focal in 28.8% were generally of low occurrence with good therapeutic response. Background EEG activity was normal in most patients. During follow‐up, the clinical and EEG features remained unchanged. In a control series of 92 nonepileptic subjects with diffuse CA, CCA was noted in only 4 (4.3%). No variation in grade or distribution of CCA was noted in repeated CT scans of the two groups, except in 2 epileptic patients. Psychometric tests demonstrated no cognitive impairment during evolution. The results appear to confirm the hypothesis that late‐onset epilepsy associated with CCA constitutes a syndrome that is related to the characteristics of the atrophy.
Gyratory Epilepsy in a Patient with a Thalamic Neoplasm
Authors: Leiguarda Ramón , Nogués Martin , Berthier Marcelo
Published: August 2005

Summary: A patient with a right thalamic oligodendroglioma developed seizures characterized by circling behavior, speech arrest, and secondarily generalized seizures. Gyratory epilepsy is relatively uncommon and may either represent a benign form of primary generalized epilepsy or occur secondary to a focal cortical lesion. Thalamic stimulation has been shown experimentally to induce circling movements, but no other clinical cases with a thalamic lesion have been described.
Nonconvulsive Status Epilepticus in Adults: Thirty‐Two Consecutive Patients from a General Hospital Population
Authors: Tomson Torbjörn , Lindbom Ulla , Nilsson Bengt Y.
Published: August 2005

Summary: We studied all adult patients who between 1984 and 1989 were initially diagnosed at our hospital as having nonconvulsive status epilepticus. Thirty‐two patients fulfilled the criteria, which included ictal EEG recordings. The annual incidence was 1.5 in 100,000 inhabitants. The median age at onset of status was 51 years. Ten patients had status as their first epileptic manifestation, but most patients had a previous history of epilepsy. Median duration of epilepsy at onset of status was 4 years. Fourteen patients had focal ictal seizure activity on EEG and thus met the criteria for complex partial status. Eighteen patients had generalized seizure activity on EEG, but only 6 of these had a history of absence epilepsy or juvenile myoclonic epilepsy. None had Lennox‐Gastaut syndrome. The clinical features of status in the remaining 12 patients were in some respects similar to those of the patients with complex partial status. We hypothesize that the EEG seizure activity in these patients may have been generalized from an initial focus.
Placebo‐Controlled Pilot Study of Centromedian Thalamic Stimulation in Treatment of Intractable Seizures
Authors: Fisher Robert S. , Uematsu Sumio , Krauss Gregory L. , Cysyk Barbara J. , McPherson Robert , Lesser Ronald P. , Gordon Barry , Schwerdt Pamela , Rise Mark
Published: August 2005

Summary: Stimulation of centromedian (CM) thalamic nuclei has been proposed as a treatment for seizures. We implanted programmable subcutaneous (s.c.) stimulators into CM bilaterally in 7 patients with intractable epilepsy to test feasibility and safety. Stimulation was on or off in 3‐month blocks, with a 3‐month washout period in a double‐blind, cross‐over protocol. Stimuli were delivered as 9O‐μs pulses at 65 pulses/s, 1 min of each 5 min for 2 h/day, with voltage set to half the sensory threshold. Stimulation was safe and well‐tolerated, with a mean reduction of tonic‐clonic seizure frequency of 30% with respect to baseline when stimulator was on versus a decrease of 8% when the stimulator was off. There was no improvement in total number of generalized seizures with stimulation, and treatment differences were not statistically significant. Stimulation at low intensity did not alter the EEG acutely, but high‐intensity stimulation induced slow waves or 2–3 Hz spike‐waves with ipsilateral frontal maximum. In an open‐label follow‐up segment with stimulator trains continuing for 24 h/day, 3 of 6 patients reported at least a 50% decrease in seizure frequency. There were no side effects. This pilot project demonstrated the feasibility of controlled study of thalamic stimulation in epilepsy, but further study will be needed to demonstrate efficacy.
Psychosocial Difficulties and Outcome After Temporal Lobectomy
Authors: Bladin Peter F.
Published: August 2005

Summary: One hundred fifteen consecutive patients in the Austin Hospital Comprehensive Epilepsy Program (Melbourne, Australia) were surveyed to document the psychosocial and rehabilitation difficulties after temporal lobectomy. During the follow‐up period (mean 4 years) 3 patients died, 5 patients were lost to follow‐up, and 107 patients with family and friends were interviewed. Eighty‐four patients (78%) had been seizure‐free for the year preceding the interview; 13 others had seizure reduction >75%. Success in ablation or reduction in seizures correlated with the amount of postoperative gain, but in this series, analysis of work and dependency out‐come did not emphasize areas of success. Although improvement in work and financial status, interpersonal relations and sexuality were all recorded, successful patients deemed that most advance had been made in the areas of newly acquired independence, enhanced career potential, and social freedom. Significant postoperative anxiety, especially after left temporal lobectomy, was noted, possibly explained by benzodiazepine antiepileptic drug (AED) discontinuation. Although 1 patient committed suicide, neither depression nor psychosis was common in the rehabilitation period, in contrast to results in previous series. Significant sociodomestic problems emerged from this survey, however: 35% of patients considered successes reported postoperative problems stemming from the necessity to restructure family dynamics; in 6%, this resulted in divorce. Moreover, 20% of patients and relatives reported significant behavioral problems in coping with the seizure‐free lifestyle. Finally, the problems of the worsened situation after surgical failure indicated the counterproductive potential of ineffective lobectomy. These results indicate the necessity for a pre‐operative counseling program to prevent these problems.
Antiepileptic Drug Treatment After Temporal Lobe Epilepsy Surgery: A Randomized Study Comparing Carbamazepine and Polytherapy
Authors: Kuzniecky Ruben , Rubin Zeava K. , Faught Edward , Morawetz Richard
Published: August 2005

Summary: Temporal lobectomy is an effective treatment in selected patients with medically intractable temporal lobe epilepsy (TLE). Postoperative antiepileptic drug (AED) treatment guidelines have not been established, and patients are often treated with polytherapy postoperatively. We prospectively randomized 40 patients under‐going temporal lobectomy to monotherapy with carbamazepine (CBZ, 20) or to continuation of their presurgical polytherapy (20) to assess the efficacy and safety of each regimen during the first year after operation. No significant differences between groups were noted with respect to seizure recurrence rate and type or time of recurrence. Patients in the polytherapy group had a 30% incidence of drug‐related side effects as compared with only 10% in the CBZ group. These results suggest that after temporal lobectomy for intractable epilepsy, patients can be safely treated with CBZ monotherapy and that treatment with multiple AEDs is not necessary.
Circuit Mechanisms of Seizures in the Pilocarpine Model of Chronic Epilepsy: Cell Loss and Mossy Fiber Sprouting
Authors: Mello Luiz E. A. M. , Cavalheiro Esper A. , Tan Aiko M. , Kupfer William R. , Pretorius James K. , Babb Thomas L. , Finch David M.
Published: August 2005

We used the pilocarpine model of chronic spontaneous recurrent seizures to evaluate the time course of supragranular dentate sprouting and to assess the relation between several changes that occur in epilep tic tissue with different behavioral manifestations of this experimental model of temporal lobe epilepsy. Pilo carpine‐induced status epilepticus (SE) invariably led to cell loss in the hilus of the dentate gyrus (DG) and to spontaneous recurrent seizures. Cell loss was often also noted in the DG and in hippocampal subfields CA1 and CA3. The seizures began to appear at a mean of 15 days after SE induction (silent period), recurred at variable frequencies for each animal, and lasted for as long as the animals were allowed to survive (325 days). The granule cell layer of the DG was dispersed in epileptic animals, and neo‐Timm stains showed supra‐and intragranular mossy fiber sprouting. Supragranular mossy fiber sprout ing and dentate granule cell dispersion began to appear early after SE (as early as 4 and 9 days, respectively) and reached a plateau by 100 days. Animals with a greater degree of cell loss in hippocampal field CAS showed later onset of chronic epilepsy (r= 0.83, p < 0.0005), suggest ing that CA3 represents one of the routes for seizure spread. These results demonstrate that the pilocarpine model of chronic seizures replicates several of the fea tures of human temporal lobe epilepsy (hippocampal cell loss, suprar and intragranular mossy fiber sprouting, den tate granule cell dispersion, spontaneous recurrent sei zures) and that it may be a useful model for studying this human condition. The results also suggest that even though a certain amount of cell loss in specific areas may be essential for chronic seizures to occur, excessive cell loss may hinder epileptogenesis.
Convulsions Induced by Methyl β‐Carboline‐3‐Carboxylate in Mice: Effects of Preceding Saline Injections
Authors: Martin Benoît , Venault Patrice , Chapouthier Georges
Published: August 2005

The convulsant effects of a high (5 mg/kg intraperitoneally, i.p.) dose of benzodiazepine (BZD) receptor ligand methyl β‐carboline‐3‐carboxylate (β‐CCM), whether or not preceded by administration of two lower doses of β‐CCM (0.5 and 1 mg/kg i.p.) or of saline were studied in nine inbred mouse strains. In five of the strains (A/J, BALB/cBy, C3H/HeJ, CBA/H, and DBA/2J), neither saline nor preceding injections of β‐CCM had any effect on subsequent reactivity to the subsequent convulsant dose. In the other 4 strains, such injections induced either tolerance (CPB‐K, NZB), or sensitization (C57BL/6J, XLII), whatever the compound subsequently administered (β‐CCM or saline). In these strains, the data rule out any tolerance or sensitization effect due to β‐CCM, but suggest that such effects could be due to injection itself.
Effect of Anticysticercal Treatment on the Prognosis of Epilepsy in Neurocysticercosis: A Pilot Trial
Authors: Medina Marco T. , Genton Pierre , Montoya María C. , Córdova Sergio , Dravet Charlotte , Sotelo Julio
Published: August 2005

Epilepsy secondary to active or inactive neurocysticercosis (NCC) is a major public health problem in Latin American countries. In an open‐label pilot trial, we evaluated and followed (mean = 13 months) 16 patients with epilepsy resulting from active NCC which was treated with anticisticercal (ACC) drugs. These patients were aged 12–68 years with confirmed active NCC and seizures not controlled by adequate antiepileptic drug (AED) therapy. Patients were treated with albendazole or praziquantel (ALB and PZQ, ACC drugs) and AED monotherapy. The number of NCC cysts was markedly reduced by ACC therapy. Thirteen patients remained seizure‐free and 2 had only one seizure during follow‐up. Our data suggest a positive effect of ACC treatment on the prognosis of epilepsy caused by active NCC, but a prospective, double‐blind, controlled study with long‐term follow‐up must be performed to determine whether ACC therapy improves long‐term seizure control.
Predictivity of Plasma Prolactin Levels in Differentiating Epilepsy from Pseudoseizures: A Prospective Study
Authors: Anzola Gian Paolo
Published: August 2005

The predictivity of raised plasma prolactin (PRL) concentrations in differentiating seizure from syncopal attack was prospectively assessed in all patients consecutively admitted to the Clinica Neurologica of Brescia, Italy in a 12‐month period who fulfilled the criteria for either a seizure or syncopal attack. Postictal plasma prolactin concentration (P1) was assessed as soon as possible after the event. Three further assessments were performed: P2 was sampled 1 h after P1, P3, and P4 were sampled in the morning for the next 2 days. Patients who had had a seizure showed significantly increased P1 concentrations, when P1 was sampled within 60 min of the attack. In seizure patients assessed >1 h after the event, P1 was not significantly different from either P2, P3, or P4. In patients who had had a syncopal attack, PRL concentration never increased. In patients assessed ≤60 min after the seizure, cutoff criterion of P1 exceeding by + 3 SD the mean calculated on P2, P3, and P4 yielded a positive predictive value of 89% and a negative predictive value of 61%. These findings confirm that plasma prolactin concentration is highly predictive of true epilepsy but barely predictive of pseudoseizures.
Reduced Bioavailability of Moisture‐Exposed Carbamazepine Resulting in Status Epilepticus
Authors: Bell William L. , Crawford Isaac L. , Shiu Gerald K.
Published: August 2005

A 28‐year‐old man with seizures well controlled with carbamazepine (CBZ) and valproate (VPA) developed generalized convulsive status epilepticus three days after his CBZ tablets became wet during a rainstorm while he was camping out. He continued the CBZ but avoided ingesting obviously disintegrating tablets. The VPA was not exposed to excessive moisture. Previous random CBZ blood levels had been in the range of 9–13 μg/ml; at the time of admission to the emergency room the level had decreased to 3.8 μg/ml. The VPA level did not change significantly from baseline. The moistureexposed CBZ tablets were of expected weight but were swollen and enlarged. Analysis of these tablets by USP paddle method 2 demonstrated a mean dissolution of 16% at 60 min as compared with >80% for fresh CBZ tablets. After final dissolution of the moisture‐exposed CBZ tablets, normal quantities of active drug were noted. We propose that poor dissolution of moisture‐exposed CBZ tablets results in reduced bioavailability. We urge caution in the packaging and storage of CBZ to avoid exposure to moisture.
Effects of Carbamazepine on Auditory Brainstem Response, Middle‐Latency Response, and Slow Cortical Potential in Epileptic Patients
Authors: Japaridze G. , Kvernadze D. , Geladze T. , Kevanishvili Z.
Published: August 2005

Auditory brainstem responses, middle‐latency responses, and slow cortical potentials (ABRs, MLRs, SCPs) were recorded in 21 epileptic patients before and during treatment with carbamazepine (CBZ). The peaklatencies, interpeak intervals, and amplitudes were estimated and evaluated statistically. CBZ monotherapy resulted in prolongation of peak latencies of ABR waves I, III, and V as well as of interpeak intervals I–III and I–V. A significant increase in the peak‐latencies of MLR components Na, Pa, and Nb and of interpeak intervals V–Pa and Na‐Nb was also observed along with the systematic NaPa amplitude reduction. CBZ also prolonged the peaklatencies of SCP components P1 and N1. Based on the obtained results, we suggest that CBZ exerts suppressive influences both on modally specific (lemniscal) and modally nonspecific (extralemniscal) auditory structures.
Carbamazepine Effects on Preoptic GABA Release and Pituitary Luteinizing Hormone Secretion in Rats
Authors: Wolf Rainer , Strehle Franz , Emrich Hinderk M.
Published: August 2005

In vivo effects of carbamazepine (CBZ) on the neuroendocrine preopticopituitary feedback system were studied by local application of CBZ through a push—pull cannula into the preoptic area and measurement of local effects on γ‐aminobutyric acid (GABA) and distant effects on a subsequent biologic response: luteinizing hormone (LH). Perfusion with 8 and 12 μg CBZ/ml cerebro‐spinal fluid caused a reduction in preoptic GABA release and concomitant suppression of plasma LH levels. These results suggest a GABA component to the mechanism(s) of action of CBZ: (a) CBZ reduces extracellular available GABA concentration, and (b) owing to the known inhibitory role of preoptic GABA in pituitary LH secretion, an increase of postsynaptic GABAergic transmission by CBZ itself could be inferred.
Phenytoin and/or Stiripentol in Pregnancy: Infant Monkey Hyperexcitability
Authors: Phillips Nona K. , Lockard Joan S.
Published: August 2005

A monkey (Macaca fascicularis) model was used to assess infant hyperexcitability after prenatal exposure to phenytoin (PHT, n = 4), stiripentol (STP, n = 5), or PHT + STP (n = 4). Adult female monkeys were equipped with tether systems and stomach catheters so that drug administration could start 1 month before mating and could be continued throughout gestation. During pregnancy, PHT and STP plasma levels were maintained between 4–12 and 4–10 μg/ml respectively (for both monotherapy and polytherapy). Infants were separated from mothers at birth and transferred to the University of Washington's (Seattle) Infant Primate Research Laboratory (IPRL) for postnatal care and testing. Data on a hyperexcitability scale were obtained during cognitive testing for visual and cross‐modal recognition memory in 13 infant monkeys when they were between 2 weeks and 3 months of age. The data indicated that infants prenatally exposed to PHT, whether alone or in combination with STP, were at increased risk for hyperexcitability (screeching, refusing to attend to stimuli, lack of visual orientation). This was not true of infants prenatally exposed to STP monotherapy (drug group differences, p < 0.05).
Seizures with Onset in the Sensorimotor Face Area: Clinical Patterns and Results of Surgical Treatment in 20 Patients
Authors: Lehman Richard , Andermann Frederick , Olivier André , Tandon Prakash N. , Quesney Luis F. , Rasmussen Theodore B.
Published: August 2005

Summary: It is not generally appreciated that intractable seizures involving the face area are amenable to surgical treatment. Twenty patients with onset of sensorimotor seizures in the face area of the pre‐ and postcentral gyri have been studied and surgically treated since 1948. Seizures started in the face, tongue, or throat, followed by diverse patterns depending on spread of seizure activity. Two patients had epilepsia partialis continua; 6 had either tonic or atonic drop attacks. All patients had pre‐ and postcentral face area resections, 12 in the dominant hemisphere. In addition, 3 had more extensive postcentral removal, 7 had temporal lobe, and 4 had small separate or contiguous frontal or parietal resection. Because the seizures were not sufficiently reduced by the first operation, 6 required reoperation; 4 of these patients had residual epileptiform activity on electrocorticogram (ECoG) after the first resection. Three patients had new neurologic signs that did not return to the preoperative level, but in 2 of them the deficit related mainly to higher resection in the central area. All but 2 of these 20 patients had at least moderate seizure reduction. Corticectomy can be performed for treatment of seizures arising in the lower central area and usually does not lead to significant permanent neurologic deficit.
Prognostic Significance of Ictal and Interictal Epileptiform Activity in Temporal Lobe Epilepsy
Authors: Hufnagel Andreas , Elger Christian E. , Pels Hendrik , Zentner Joseph , Wolf Helmut K. , Schramm Johannes , Wiestler Otmar D.
Published: August 2005

Summary: Long‐term electrocorticograms (ECoG), recorded by chronically implanted subdural electrodes during preoperative evaluation of 59 patients with temporal lobe epilepsy (TLE) were analyzed retrospectively to assess the prognostic relevance of distribution of interictal epileptiform potentials (IEP) and seizure origin (SO) and to investigate factors affecting their lateralization. Subsequent to preoperative evaluation, a standardized two thirds anterotemporal lobectomy including subtotal hippocampectomy had been performed in all patients. The following results were obtained: (a) Only patients with 100% lateralization of SO and IEP had excellent seizure outcome (= 89% seizure‐free); (b) patients with bitemporal SO were unlikely to benefit from surgical treatment (=12.5% seizure‐free); (c) 40–56% patients with unilateral temporal SO and bitemporal IEP, became seizure‐free irrespective of the degree of lateralization of IEP; and (d) multidimensional analysis of variance showed that lateralization of SO, presence of a magnetic resonance imaging (MRI)‐detectable lesion, presence of hippocampal sclerosis, presence of febrile seizures and seizures at age ≥6 years are the five most important variables indicating abolition of seizures. Combined analysis of ECoG‐recorded SO and IEP allows prediction of postoperative seizure control within close boundaries.
Functional Magnetic Resonance Imaging in Partial Epilepsy
Authors: Morris George Lee , Mueller W. M. , Yetkin F. Z. , Haughton V. M. , Hammeke T. A. , Swanson S. , Rao S. M. , Jesmanowicz A. , Estkowski L. D. , Bandettini P. A. , Wong E. C. , Hyde J. S.
Published: August 2005

Summary: Functional magnetic resonance imaging (FMRI) detects signal changes in brain that accompany regional changes in neuronal activity. In normal human brain, FMRI shows changes in signal in the postcentral gyrus or superior temporal gyrus that correlate with voluntary motor activity or language processing, respectively. The model used to explain the changes in signal linked temporally with cerebral activity is a reduction in cerebral capillary deoxyhemoglobin concentration due to the increased blood flow that accompanies neuronal activity in the cerebrum. FMRI has been used in normal subjects but not extensively in patients. To determine the feasibility of using FMRI to map cerebral functions in patients with partial epilepsy syndromes, we performed a pilot study, using FMRI to identify signal changes in motor and language areas in response to tasks that activate those areas. Signal changes in epilepsy patients approximated those observed in volunteers. We conclude that FMRI can be developed as a method for functional cerebral mapping in partial epilepsies.
Video Material and Epilepsy
Authors: Harding G. F. A. , Jeavons P. M. , Edson A. S.
Published: August 2005

Summary: Nine patients who had epileptic attacks while playing computer games were studied in the laboratory. Patients had an EEG recorded as well as their response to intermittent photic stimulation (IPS) at flash rates of 1–60 fps. In addition, pattern sensitivity was assessed in all patients by a gratings pattern. Only 2 patients had no previous history of convulsions, and only 2 had a normal basic EEG. All but 1 were sensitive to IPS, and all but 1 were pattern sensitive. Most patients were male, but although this appears to conflict with previously published literature results regarding the sex ratio in photosensitivity, it was due to the male predominance of video game usage. We compared our results with those reported in the literature. Diagnosing video game epilepsy requires performing an EEG with IPS and pattern stimulation. We propose a standard method of testing.
Cost of Epilepsy in the United States: A Model Based on Incidence and Prognosis
Authors: Begley Charles E. , Annegers John F. , Lairson David R. , Reynolds Thomas F. , Hauser W. Allen
Published: August 2005

Summary: A model of the clinical course of epilepsy from onset until remission or death has been developed for six prognostic groups, including survival, use and cost of medical care, and time lost from work and housekeeping. The model has been used to generate preliminary estimates of the lifetime cost of epilepsy for a cohort of persons diagnosed in 1990 in the United States. The distribution of incident cases among prognostic groups is derived from epidemiologic studies of prognosis in epilepsy. Direct cost is estimated by multiplying nationally representative unit costs by the expected type and frequency of medical care use. The latter were derived by an expert panel, based on inferences from existing literature and on their own clinical experiences. Indirect cost is estimated based on lost earnings associated with projections of restricted activity days, excess unemployment, and excess mortality. Total lifetime cost in 1990 dollars of all persons with epilepsy onset in 1990 was estimated at $3.0 billion, with indirect cost accounting for 62% of the total. Cost per patient ranged from $4,272 for persons with remission after initial diagnosis and treatment to $138,602 for persons with intractable and frequent seizures. Antiepileptic drug (AED) treatment is the most costly category of service. Different assumptions about the amount and type of drug administration cause major changes in overall cost estimates.
Physical Exercise in Women with Intractable Epilepsy
Authors: Eriksen Hege R. , Ellertsen Bjørn , Grønningsæter Hilde , Nakken Karl Otto , Løyning Yngve , Ursin Holger
Published: August 2005

Summary: Fifteen women with pharmacologically intractable epilepsy were given physical exercise (aerobic dancing with strength training and stretching) for 60 min, twice weekly, for 15 weeks. Seizure frequency was recorded by the patients for 3–7 months before the intervention, during the intervention period, and for 3 months after the intervention. Medication and other known seizure‐influencing factors were kept as constant as possible. Self‐reported seizure frequency was significantly reduced during the intervention period. The exercise also led to reduced level‐of subjective health complaints, such as muscle pains, sleep problems, and fatigue. The exercise reduced plasma cholesterol ratio and increased maximum O2 uptake. Because most of the patients were unable to continue the exercise on their own after the intervention period, the exercise effects were not maintained during the follow‐up period. The patients were not unwilling to continue the exercise, but it was not sufficient to offer them the possibility of continuing similar types of exercise. We believe that 15 weeks is too short a time to establish a life‐style change and that continued physical exercise for these patients requires a well‐organized and supportive program, requiring experienced and dedicated instructors.
Washington Psychosocial Seizure Inventory: A Multiinstitutional Study in Japan
Authors: Hosokawa Kiyoshi , Kugoh Toshiaki , Mino Susumu
Published: August 2005

Summary: No reports of the Washington Psychosocial Seizure Inventory (WPSI) have yet been presented from Asian countries in detail. We performed a multiinstitutional study of this test in 652 Japanese subjects. The mean value of the Lie Scale was high, and only one third of our subjects were under the limit of the original criterion; this has been the biggest obstacle to use of the validity scales of this test in Japan. The profile form of the clinical scales was very similar to those reported from other countries. According to the relation between clinical characteristics and the WPSI scales, seizure frequency showed the strongest influence. In a comparison of whole subjects, mean scores of the clinical scales in Japan remained at an intermediate value or lower. This result was obviously distorted by the high score of the Lie Scale. When comparison was restricted to cases with valid Lie Scale scores, the values of five clinical scales showed high levels. Therefore, Japanese patients among developed countries apparently showed relatively severe levels of problems. We conclude that the WPSI could be a useful examination in Japan to determine reliably the various psychosocial problems of epileptic persons, but use of the Lie Scale according to the original criterion is not practical. Modifications of the limitation may be needed.