bluuebunny/crossref_metadata_2025 huggingface dataset:
Electrophysiologic Studies of Cervical Vagus Nerve Stimulation in Humans: II. Evoked Potentials
Authors: Hammond Edward J. , Uthman Basim M. , Reid Steven A. , Wilder B. J.
Published: August 2005

Summary: Evidence from studies of experimental animals indicates that electrical stimulation of the vagus nerve not only can alter the EEG but evokes activity in specific brain areas. We report effects of electrical stimulation of the vagus nerve in 9 patients with medically intractable seizures as part of a clinical trial of chronic vagal stimulation for control of epilepsy. The left vagus nerve in the neck was stimulated with a programmable implanted stimulator. Effects of stimulus amplitude, duration, and rate were studied. Noncephalic reference recording of the vagus nerve evoked potential showed some unusual properties: a scalp negative component occurred with a latency of 12 ms, very high amplitude (60 μV), and widespread scalp distribution. Field distribution studies indicated that this potential was myogenic in origin and generated in the region of the stimulating electrodes in the neck area. Chemically induced muscle paralysis confirmed this observation. Bipolar scalp recording showed several small‐amplitude topographically distinct potentials occurring in 30 ms. No effect, either acute or chronic, could be detected on pattern‐reversal evoked potentials, auditory brainstem evoked potentials, auditory 40‐Hz potentials, or cognitive evoked potentials.
Factors in Children That Predict Performance on the Intracarotid Amobarbital Procedure
Authors: Williams Jane , Rausch Rebecca
Published: August 2005

Summary: The intracarotid amobarbital procedure (IAP) is frequently used to determine hemispheric language dominance and memory competence in individuals with intractable epilepsy before surgical intervention. The present study focused on outcome results concerning use of this technique in children. The IAP was an effective tool in determining their hemispheric language dominance. Seven characteristics, including age, gender, dose level of sodium amobarbital, Full‐scale I.Q., hemispheric side of injection (left or right), language dominance of hemisphere injected, and order of injection (first or second) were examined as possible factors predictive of memory performance on the IAP. Results suggest that after injection of the hemisphere suspected of containing the primary seizure origin, children aged < 13 years who had the left language‐dominant hemisphere injected were significantly less likely to pass IAP memory tasks than were older children or younger children who had the nondominant hemisphere injected. These findings suggest that the IAP is a reliable indicator of hemispheric memory competence in children aged > 13 years or younger children whose suspected seizure focus is located in the nondominant language hemisphere.
Experience with the International League Against Epilepsy Classifications of Epileptic Seizures (1981) and Epilepsies and Epileptic Syndrome (1989) in Epileptic Children in a Developing Country
Authors: Shah K. N. , Rajadhyaksha S. B. , Shah V. S. , Shah N. S. , Desai V. G.
Published: August 2005

Summary: Four hundred eighty‐three epileptic children attending the Pediatric Epilepsy Clinic at Bai Jerbai Wadia Hospital for Children, Bombay, India were classified according to the International League Against Epilepsy (ILAE) classification of epileptic seizures (1981) and epilepsies and epileptic syndromes (1989). The predominant seizures were partial (53.6), generalized (40.3%), and unclassifiable (6%). In epilepsies and epileptic syndromes, 55.3% were partial, 27% were generalized, 13.5% were undetermined, and 4.1% were special syndromes. Although our results were similar in many respects to those of other reported series, some differences were observed in the incidence of partial and generalized seizures, and partial and generalized epileptic syndromes and their subgroups, such as idiopathic, symptomatic, and cryptogenic partial syndromes, idiopathic generalized syndromes, and symptomatic specific syndromes. These differences are probably due to different age limits, methods of case ascertainment and inclusion criteria, different genetic and environmental factors, variable interpretation of clinical and EEG features, and lack of facilities for investigation in developing countries. Despite various limitations, we were able to classify most cases; the ILAE classification can be used in developing countries so that comparison can be made with other studies.
Psychosocial Outcomes of Antiepileptic Drug Discontinuation
Authors: Jacoby Ann , Johnson Anthony , Chadwick David ,   on Behalf of the Medical Research Council Antiepileptic Drug Withdrawal Study Group
Published: August 2005

Summary: The MRC Antiepileptic Drug Withdrawal Study compared seizure control and the risk of relapse resulting from policies of slow discontinuation and routine maintenance of antiepileptic drug (AED) treatment in patients seizure‐free for 2 years. Because the decision to discontinue AEDs can have important psychosocial as well as medical consequences, we also sought to examine the psychosocial outcomes of the alternative policies Questionnaires were sent to eligible adults 2 years after their randomization. The response rate was 85%. There was little evidence of substantial effects of treatment policy on psychosocial outcomes, but seizure recurrence since randomization was associated with increased distress on several measures. However, receiving AEDs to control seizures was also associated with increased distress. Among patients for whom the risk of relapse after discontinuation appears low, the psychosocial benefits of discontinuation may be considerable.
Carbamazepine (CBZ) Controlled Release Compared with Conventional CBZ: A Controlled Study of Attention and Vigilance in Children with Epilepsy
Authors: Pieters M. S. M. , Jennekens‐Schinkel A. , Stijnen Th. , Edelbroek P. M. , Brouwer O. F. , Liauw L. , Heyer A. , Lanser J. B. K. , Peters A. C. B.
Published: August 2005

Summary: To compare the effects on attention and vigilance of conventional carbamazepine (CBZ) and CBZ controlled release (CBZ‐CR), 15 schoolchildren with epilepsy and normal intelligence receiving CBZ were switched to CBZ‐CR. Psychological examination was performed on the day before (day A) and 1 month after substitution (day B). Measurements of attention and vigilance were repeated throughout the day at 2‐h intervals. Both on days A and B, CBZ plasma levels were monitored during a 12‐h period. Fifteen matched healthy controls were submitted to identical test programs, allowing comparisons within subjects as well as between patients and control children. Variability of performance over sessions was neither increased nor decreased with CBZ‐CR. Consistent differences over sessions did not exist between patients and controls with either drug. No relation was noted between reaction time and CBZ plasma level. The pharmacologic data confirm results of earlier studies in children. We noted a reduction in intradose fluctuations of CBZ level with CBZ‐CR as compared with conventional CBZ. The neuropsychological results do not show a difference between the drugs. Neither were differences noted with respect to antiepileptic efficacy and side effects. At the end of the study, all but one of the children (and their parents) opted to receive CBZ‐CR for ease of dosage administration and overall satisfaction.
Monaural Audiogenic Seizures: Evidence for Control by Parallel Processes
Authors: Reid Howard M. , Collins Robert L.
Published: August 2005

Summary: SJL/J mice were binaurally sensitized and monaurally tested for susceptibility to sound‐induced seizure. Most control subjects exhibited the expected biphasic pattern of running. In mice in the experimental groups, the acoustic stimulation was interrupted for <20 s at the conclusion of the initial burst of running. During this quiet period, the side of the blocked ear was reversed for some mice. These mice had an independent biphasic seizure when acoustic stimulation was reintroduced, indicating that the biphasic seizure progression characteristic of monaural testing is the result of a lateralized process. We conclude that the locus of this process is probably at the level of the inferior colliculus (IC).
Ontogeny of Feline Temporal Lobe Epilepsy, II: Stability of Spontaneous Sleep Epilepsy in Amygdala‐Kindled Kittens
Authors: Shouse Margaret N. , Dittes Paul , Langer James , Nienhuis Robert
Published: August 2005

Summary: We previously described a model of spontaneous “sleep epilepsy” in kindled kittens with temporal lobe epilepsy (TLE). We now describe the postkindling course of this model from preadolescence to maturity and suggest pathophysiologic mechanisms. Spontaneous epilepsy, particularly generalized tonic‐clonic convulsions (GTCs), developed 1h to 4 months after amygdala kindling and persisted to adulthood. At first, GTCs were detected only in sleep; later, convulsions also occurred during wakefulness. Two factors were consistently associated with the sequential onset of sleep and waking GTCs: seizure clusters and anatomic seizure localization. (1) Seizure clusters. Cats with infrequent or unclustered GTCs continued to exhibit “sleep epilepsy,” defined by convulsions occurring exclusively during sleep. In contrast, cats with frequent seizure clusters developed recurrent or terminal convulsive status in conjunction with GTCs during waking and sleep. Severe seizure manifestations therefore appeared to contribute to the dissociation of convulsions from the sleep‐wake cycle. (2) Anatomical seizure localization. Focal seizure origin appeared to differentiate sleep from waking GTCs. Onset during sleep was first recorded in the kindled amygdala, whereas onset during waking was initially detected outside the temporal lobe. Findings thus suggest secondary “kindling” of multifocal epilepsy. Secondary epileptogenesis is consistent with “transsynaptic” kindling effects. This phenomenon is defined in mature animals by rapid secondary site kindling (transfer) and subtle morphologic changes distal to the stimulating electrode. Transfer may be accentuated by youth, because kittens developed spontaneous seizure foci in previously unstimulated tissue. Moreover, multifocal interactions and diffuse cell loss were implicated as possible mechanisms. Collectively, the findings indicate complications with early onset TLE in kindled cats. Onset during youth can have an unfavorable prognosis, reflected by recurrent status epilepticus and multifocal epilepsy with convulsions distributed throughout the sleep‐wake cycle.
Sleep Microstructure and EEG Epileptiform Activity in Patients with Juvenile Myoclonic Epilepsy
Authors: Gigli G. L. , Calia E. , Marciani M. G. , Mazza S. , Mennuni G. , Diomedi M. , Terzano M. G. , Janz D.
Published: August 2005

Summary: Clinical and EEG manifestations of juvenile myoclonic epilepsy (JME) occur in a strict relationship to the sleep‐wake cycle, particularly to transition phases (awakening, falling asleep, afternoon relaxation after work). JME manifestations are deactivated during sleep. Because arousal fluctuations during NREM sleep may be controlled by the same neurophysiologic mechanisms regulating awakening, we studied the relationship between the cyclic alternating pattern (CAP) and JME manifestations. All‐night polysomnographic recordings of 10 JME patients were analyzed for variations of epileptiform EEG abnormalities in relation to sleep stages and to different microstructural variables (NCAP, CAP, phases A and B). CAP rates (ratio between total CAP duration and total NREM sleep duration) were also calculated. Average CAP rate was 46.70%, significantly higher than that (23%) of an age‐matched control group. Macrostructural analysis showed only a trend toward a slight predominance of EEG epileptiform activity during slow wave sleep but no significant correlation between spiking rates and sleep stages. Microstructural analysis confirmed the CAP modulation of EEG epileptiform activity, with maximum appearance of epileptiform abnormalities during phase A CAP (normalized spiking rate = 4.00 ± 0.98) and strong inhibition during phase B (0.06 ± 00.6). Intermediate values were noted during NCAP (0.54 ± 0.27). No correlation was noted between spiking rates during NREM sleep and CAP rates, possibly indicating that in JME patients the increased CAP rate may be partially independent of epileptiform EEG activity. Our data suggest that in JME patients CAP may be a neurophysiologic oscillator organizing expression of the epileptiform discharges independent of the tendency of the individual patient to produce epileptiform EEG discharges.
Visuomotor Coordination During Focal and Generalized EEG Discharges
Authors: Opp J. , Wenzel D. , Brandl U.
Published: August 2005

Summary: A new computer‐based method for continuous gauging of momentary, visuomotor coordination under simultaneous EEG control proved both effective and suitable for children. Thirty‐eight patients (age 4–17 years) who had different types of hyper synchronous activity were examined: None of the patients with focal discharges showed significant impairment in the test performance. Slight losses were evident in <3‐s generalized, irregular spike‐wave paroxysms. Deterioration was particularly evident in the bilateral synchronous 3‐Hz spike‐wave series, which lasted >3 s.
Temporal Neocorticectomy in Management of Intractable Epilepsy: Long‐Term Outcome and Predictive Factors
Authors: Keogan M. , McMackin D. , Peng S. , Phillips J. , Burke T. , Murphy S. , Farrell M. , Staunton H.
Published: August 2005

Summary: We report the results of a long‐term follow‐up study of 50 patients who underwent removal of temporal neocortex with preservation of deeper limbic structures as surgical therapy for intractable temporal lobe epilepsy. The follow‐up period ranged from 3 to 15 years. Preoperative EEG investigations were based on interictal discharges alone. Three factors were predictive of a good outcome: (a) A clear unilateral anterior‐midtemporal focus (p < 0.01), (b) stereotypical onset of temporal lobe seizure (p < 0.005), and (c) greater volume of tissue removed at operation (p < 0.05). Overall results showed that 62% of patients experienced an outcome of “cure” or “almost cure,” as classified according to a modified version of Crandall's criteria (Crandall's I and II). Those who experienced a significant reduction in seizures but who continued to have intractable epilepsy (Crandall's III) were not considered to have had a good result. Overall outcome compares favorably with other that of centers using different surgical approaches and indicates that neocorticectomy is a suitable procedure in a highly selected population even when limited resources are available.
Anatomic Correlates of Interhippocampal Seizure Propagation Time
Authors: Spencer Susan S. , Marks David , Katz Amiram , Kim Jung , Spencer Dennis D.
Published: August 2005

Summary: The relation between interhippocampal seizure propagation time (IHSPT) and anatomic alterations in the human epileptic hippocampus may provide insight into the pathophysiology of temporal lobe epilepsy (TLE). Using depth electrode recordings, we measured the time required for spontaneous seizures with onset in one hippocampus to become manifest in the contralateral hippocampus in 50 patients who underwent resection of the temporal lobe of seizure origin. Cell densities in individual hippocampal subfields were determined and correlated with mean IHSPT for each patient. Mean IHSPT was significantly and inversely correlated with cell counts in CA4 only (r =−0.38, p < 0.01, Pearson's product correlation; r =−0.52, p < 0.001, Spearman's rank order correlation). In 5 patients with bilateral independent hippocampal seizure onset who had temporal lobectomy and a diagnosis of mesial temporal sclerosis, mean IHSPT was consistently longer from the sclerotic temporal lobe than to it. These observations suggest that anatomic changes associated with chronic epilepsy alter propagation patterns. Because CA4 is believed to modulate the output of dentate granule cells and also has commissural connections to the contralateral homotopic area, the association of decreased CA4 cells with prolongation of IHSPT suggests that the observed anatomic alterations may actively (through increased inhibition) or passively (through decreased recruitment) interfere with various routes of seizure propagation.
Magnetic Resonance Imaging in Localization of EEG Depth Electrodes for Seizure Monitoring
Authors: Brooks Michael L. , O'Connor Michael J. , Sperling Michael R. , Mayer David P.
Published: August 2005

Summary: Preoperative evaluation of patients with medically refractory complex partial seizures requires intensive EEG monitoring. Part of this process may include insertion of depth electrodes into temporal lobe structures. Although many imaging methods have been used for stereotactic placement of the electrodes, only computed tomography (CT) has been used to verify position after implantation. We studied 30 patients in whom magnetic resonance imaging (MRI) was used to visualize the position of stainless‐steel electrodes stereotactically implanted in the temporal lobes. The procedure is noninvasive, does not utilize radiation, and has the additional advantages of multiplanar capability, increased soft tissue contrast, and lack of bony artifacts commonly associated with CT.
Role of the Fastigial Nucleus in Generalized Seizures as Demonstrated by GABA Agonist Microinjections
Authors: Miller John W. , Gray Beverly C. , Turner Glenna M.
Published: August 2005

The cerebellum is electrically and metaboli cally active during seizures. Numerous studies have also shown that cerebellar electrical stimulation and lesions of the cerebellar cortex or nuclei influence seizure thresh old, but there are significant contradictions, with different effects observed even in investigations using the same species and similar seizure types and experimental ma nipulations. Discrete intracerebral microinjection of neu roactive agents has been used to characterize the way in which other brain regions control seizures, but has not been applied to the cerebellar systems. This approach has advantages because effects are restricted to specific re ceptors and spare passing axons; experimental variables also can be simply specified and reproduced. We used this method to characterize the role of the cerebellar nu clei in seizures and to determine if observed effects could be reproduced with different agents at different doses. Effects of bilateral control microinjections in the fastigial (medial) cerebellar nucleus were compared with different doses of the GABAA agonist piperidine‐4‐sulfonic acid and the GABAB agonist (−)baclofen (Bf). Soon after in jection, the animals were ataxic. After 4 min, seizures were induced by timed continuous intravenous (i.v.) bicu culline (BIC) infusion. Both GABA agonists produced significant reductions in myoclonic, clonic, and tonic sei zure thresholds. Injections just dorsal or anterior to this nucleus and bilateral dentate (lateral) nucleus injections had little effect on seizures. These results demonstrate that the cerebellar system does control seizures, but does not provide support for the early concept that cerebellar stimulation and systemic phenytoin block seizures through inhibition of cerebellar nuclei secondary to Pur kinje cell activation.
Phosphate Energy Metabolism During Domoic Acid‐Induced Seizures
Authors: Sutherland Garnette R. , Ross Brian D. , Lesiuk Howard , Peeling James , Pillay Neelan , Pinsky Carl
Published: August 2005

The effect of domoic acid‐induced seizure activity on energy metabolism and on brain pH in mice was studied by continuous EEC recording and in vivo 31P nuclear magnetic resonance (NMR) spectroscopy. Mice were divided into ventilated (n = 6) and nonventilated (n = 7) groups. Baseline EEG was 0.1‐mV amplitude with frequence of >30‐Hz and of 4–5 Hz. After intraperitoneal (i.p.) administration of domoic acid (6 mg/kg), electro graphic spikes appeared at increasing frequency, pro gressing to high‐amplitude (0.1‐0.8 mV) continuous sei zure activity (status epilepticus). In ventilated mice, the [31P]NMR spectra showed that high‐energy phosphate levels and tissue pH did not change after domoic acid administration or during the intervals of spiking or status epilepticus. Nonventilated mice showed periods of EEG suppression accompanied by decreases in the levels of high‐energy phosphate metabolites and in pH, corresponding to episodic respiratory suppression during the spiking interval. In all animals, status epilepticus was fol lowed by a marked decrease in EEG amplitude that pro gressed rapidly to isoelectric silence. [31P]NMR spectra obtained after this were indicative of total energy failure and tissue acidosis. In a separate group of ventilated mice (n = 4), domoic acid‐induced status epilepticus was ac companied initially by an increase in mean arterial blood pressure (MAP) that slowly returned to baseline level. Isoelectric silence was accompanied by a decrease in MAP to 75 ± 8 mm Hg. These experiments suggest that domoic acid‐induced seizures are not accompanied by an increase in substrate demand that exceeds supply.
Knowledge, Attitude, and Practice Toward Epilepsy Among Rural Tanzanian Residents
Authors: Rwiza H. T. , Matuja W. B. P. , Kilonzo G. P. , Haule J. , Mbena P. , Mwang'ombola R. , Jilek‐Aall L.
Published: August 2005

Before a health education program can be established, one must first know what the target population believes and does with respect to the disease in question. Therefore, we performed a study among Tanzanian rural inhabitants to identify their knowledge, attitude, and practice (KAP) toward epilepsy: 3,256 heads of households (mean age 40.2 years, range 15–90 years; M/F ratio 1:1) were interviewed. Of the respondents, 32.9% said they had never seen a seizure; 67.7% said they did not know the cause of epilepsy; 33.3% mentioned various causes including heredity, witchcraft, infection of the spinal cord, hernia; 40.6% believed epilepsy was infectious through physical contact, flatus, breath, excretions, sharing food; 36.8% believed epilepsy could not be cured and 17.1% believed it could not even be controlled; 45.3% believed epilepsy could be treated by traditional healers, and only 50.8% believed hospital drugs were of any use; and 62.7% of the respondents would not allow an epileptic child to go to school for various reasons, including mental subnormality (54.0%), fear of the child falling while alone (65.9%), and fear that the epileptic child would infect other children (11.2%). Concerning what is to be done when a seizure occurs, 33.5% of the respondents would keep away and not touch the person; 16.5% would take some potentially harmful measure such as forcing a mouth gag or forcing a drink such as water (1 even mentioned urine); 5.2% would take unnecessary measures such as rushing the patient to a hospital. Only 35.7% of respondents would perform at least some of the currently recommended first‐aid measures. Therefore, there is a need for health education on epilepsy in Tanzania, and these results are forming the base for design and execution of a health education and a primary health care program in epilepsy control.
Prevalence of Epilepsy in Kelibia, Tunisia
Authors: Attia‐Romdhane N. , Mrabet A. , Hamida M. Ben
Published: August 2005

A door‐to‐door survey was made in Kelibia, Tunisia to determine the prevalence of major neurologic disorders, including epilepsy. The survey was made according to a World Health Organization (WHO) protocol (1981). All individuals responding positively to the screening tool were examined by a neurologic team using well‐defined diagnostic criteria. One hundred forty‐one individuals, alive on prevalence day (July 1, 1985), were identified as having active epilepsy, giving a crude prevalence ratio of 4.04 per 1,000 and an age‐adjusted (on WHO population) prevalence ratio of 3.64 per 1,000. Prevalence ratios increase with age (in children and young adults with the highest prevalence ratio at ∼20 years) and decrease after 40 years. The most frequently identified type was generalized convulsive seizures (93%). The most frequently associated conditions were cerebral palsy and mental retardation.
Prototype Antiepileptic Drug Clinical Development Plan
Authors: Kramer Lynn D. , Pledger Gordon W. , Kamin Marc
Published: August 2005

Antiepileptic drug (AED) development has been generally difficult owing to many factors: regulatory requirements for demonstration of efficacy and safety, subject availability, traditional trial designs, and physicians' beliefs about epilepsy and its treatment. The U.S. Food and Drug Administration (FDA) regulations require a new drug to be shown safe and effective for its intended use before it can be marketed. The unambiguous proof required is a formidable hurdle for AED development. We report a recent clinical development plan highlighting innovations in clinical trial design that have addressed these requirements, discuss alternative endpoints, and compare the results of various trial designs at various stages of development. This model clinical development plan includes trials relevant to all three clinically relevant contexts in which an AED might be used: as an adjunct to an existing regimen, as a substitution for much of an existing AED regimen, and as monotherapy.
Profile of Anticonvulsant Activity and Minimal Toxicity of Methyl 4‐[(p‐Chlorophenyl)amino]‐6‐Methyl‐2‐Oxo‐Cyclohex‐3‐En‐l‐Oate and Some Prototype Antiepileptic Drugs in Mice and Rats
Authors: Mulzac Dianna , Scott Kenneth R.
Published: August 2005

The anticonvulsant and toxic properties of methyl 4‐[(p‐chlorophenyl)amino]‐6‐methyl‐2‐oxo‐cyclohex‐3‐en‐l‐oate (ADD 196022), were compared with those of phenytoin (PHT), carbamazepine (CBZ), and valproate (VPA). These compounds were evaluated in mice and rats using well‐standardized anticonvulsant testing procedures. Results indicate that ADD 196022 is a very potent anticonvulsant in the maximal electroshock seizure (MES) model. The compound was effective in nontoxic doses after intraperitoneal (i.p.) administration in mice and oral administration in rats. In mice, i.p. administration of ADD 196022 resulted in an ED50 value of 26.2 mg/kg as compared with a value of 6.48 mg/kg for PHT in the same assay. ADD 196022 was more potent that PHT in the oral rat model, having an ED50 value of 5.79 mg/kg as compared to 23.2 mg/kg for PHT. ADD 196022 was ineffective in nontoxic doses against all other seizure models evaluated and thus has a pharmacologic profile similar to that of PHT.
Birth Order, Sibship Size, and Risk of Epilepsy
Authors: Garza‐Chapa Raul , Ottman Ruth
Published: August 2005

Summary: We examined the relation between epilepsy and birth order, using data on 1,950 probands with epilepsy and 4,636 of their full siblings without epilepsy from the Epilepsy Family Study of Columbia University. The proportion of first‐born individuals appeared to be higher among probands with epilepsy than among their unaffected siblings, but this relation disappeared after we controlled for the confounding effect of sibship size. With sibship size controlled, the proportion of first‐born individuals was similar to that in unaffected siblings for probands with idiopathickryptogenic epilepsy, generalized and partial onset seizures, and all ages at onset of epilepsy. Probands with remote symptomatic epilepsy had higher birth orders than their unaffected siblings, even after we controlled for sibship size.
Relationship of Carbamazepine Reduction Rate to Seizure Frequency During Inpatient Telemetry
Authors: Malow Beth A. , Lynch Bryan , Blaxton Teresa A. , Mikati Mohamed A.
Published: August 2005

Summary: To establish guidelines for medication reduction during inpatient telemetry, the records of 18 children and young adults with refractory partial seizures undergoing carbamazepine (CBZ) reductions during continuous video/EEG telemetry were reviewed. Six patients were receiving CBZ monotherapy, and 12 patients were treated with an additional antiepileptic drug (AED) maintained at baseline dosage during CBZ taper. Despite relatively rapid mean reductions in dosage of 44% by day 2 of taper, no patients experienced frequent repetitive seizures or status epilepticus (SE). Seizure rate during the entire CBZ reduction period correlated significantly with rate of drug reduction. Linear regression analysis showed drug reduction rate to be a good predictor of seizure rate. Fourteen patients experienced at least three seizures during CBZ taper. On the average, the third seizure occurred on day 5 of taper at a percentage of dose seduction of 79%. In 8 patients, CBZ concentrations were measured both before taper and ≤24 h after the third seizure. For these patients, seizure rate also correlated significantly with reduction in CBZ level. We conclude that manipulation of CBZ dose reduction rate is important in maximizing seizure frequency during telemetry and, in our patients, a relatively rapid rate of dose reduction was safe and effective in promoting seizure recordings.
Postoperative EEG and Electrocorticography: Relation to Clinical Outcome in Patients with Temporal Lobe Surgery
Authors: Tuunainen A. , Nousiainen U. , Mervaala E. , Pilke A. , Vapalahti M. , Leinonen E. , Paljärvi L. , Riekkinen P.
Published: August 2005

Summary: To evaluate the role of different EEG methods with respect to postoperative clinical follow‐up, 32 non‐lesionary epilepsy patients who had undergone temporal lobectomy were studied preoperatively and at 2‐week, 3‐month, and 1‐year postoperative follow‐up. Routine, sleep, and sphenoidal EEG recordings as well as intraoperative electrocorticography (ECoG) were made for all patients. At 1‐year follow‐up, the EEGs with sphenoidal electrodes and with sleep deprivation procedure provided important prognostic information; the appearance of seizures was associated with the presence of interictal epileptiform abnormalities in EEG. In the postresection ECoG, however, epileptiform abnormalities were not associated with clinical outcome or with postoperative epileptiform EEG at 1 year. Routine EEG reliably reflects clinical outcome after temporal lobectomy; with sphenoidal electrodes as well as with sleep deprivation procedure, the diagnostic yield can be further improved.
Degree of Hippocampal Neuron Loss Determines Severity of Verbal Memory Decrease After Left Anteromesiotemporal Lobectomy
Authors: Sass Kimberlee J. , Westerveld Michael , Buchanan Cathleen P. , Spencer Susan S. , Kim Jung H. , Spencer Dennis D.
Published: August 2005

Summary: Fifty‐eight left speech dominant adults with medically refractory epilepsy originating from the temporal lobe (28 left, 30 right) were examined using the verbal Selective Reminding Test before and after anteromesiotemporal lobectomy. After neuron density in the excised hippocampal tissue was established, a median split procedure was performed to distinguish patients with severe neuron loss (13 left, 16 right) from those with only mild or moderate neuron loss (15 left, 14 right). The memory of patients with severe left hippocampal neuron loss did not decrease significantly postoperatively. Patients with mild or moderate left hippocampal neuron loss experienced significant verbal memory decrease postoperatively. The magnitude of the verbal memory decrease was not related to recurrence of seizures after operation. Patients undergoing right anteromesiotemporal lobectomy exhibited significant improvements in verbal memory, regardless of the condition of the excised hippocampal tissue. The degree of hippocampal neuron loss determines to a great extent the severity of the verbal memory decrease that follows dominant anteromesiotemporal lobectomy.
Hyperventilation Activation on EEG Recording in Childhood
Authors: Yamatani Miwa , Konishi Tohru , Murakami Miyako , Okuda Tadayuki
Published: August 2005

Summary: In 66 children with no neurologic symptoms, we analyzed EEG slowing quantitatively during standardized hyperventilation (HV) activation. [respiration rate (RR) of 30/min, threefold increase of VE, and 4‐min duration]. Changes in cerebral blood flow (CBF) and velocity were also monitored in right common carotid artery by Doppler ultrasonic method. Decreases in PCO, and CBF were the fundamental factors producing EEG slowing during HV. The degree of EEG slowing was greater in younger children and well proportional to age with such standardized HV. The decrease in CBF was much greater in younger children at the beginning of HV and may be related to the significant EEG slowing. EEG slowing was not related to the degree of decrease in CBF. The age difference in EEG response to HV in children and adults may be due to the differences in the decrease in the CBF volume and sensitivity of the CNS to the change in CBF.
Liver Enzyme Induction and Serum Lipid Levels After Replacement of Carbamazepine with Oxcarbazepine
Authors: Isojärvi Jouko I. T. , Pakarinen Arto J. , Rautio Arja , Pelkonen Olavi , Myllylä Vilho V.
Published: August 2005

Summary: We evaluated liver P450 enzyme system induction and serum lipid levels in a prospective follow–up study in 12 male patients with epilepsy after replacing carbamazepine (CBZ) medication with oxcarbazepine (OCBZ). Antipyrine1 1/2 increased and antipyrineCL decreased 2 months after the medication was changed, reflecting normalization of liver P450 enzyme system function. Furthermore, serum total cholesterol levels decreased, but serum concentrations of high‐density lipoprotein (HDL)‐cholesterol and triglycerides (TG) were unchanged. OCBZ may be the preferable antiepileptic drug (AED) with regard to the effects of the medication on lipid metabolism.
Management and Attitudes of Epilepsy by a Group of Sydney General Practitioners
Authors: Frith John F. , Harris Mark F. , Beran Roy G.
Published: August 2005

Summary: Previous surveys of general practitioners (GPs) have shown stereotypic attitudes and management of persons with epilepsy (PWE). We mailed a questionnaire to 107 GPs in the Sydney and Illawarra regions of Australia to evaluate changes in knowledge and management of epilepsy and attitudes of GPs toward PWE as compared with results of a similar study made 10 years previously. Most GPs referred patients with epilepsy to a neurologist for initial management in preference to initiating investigation and treatment themselves. GPs were very satisfied with their sharing of care with neurologists, but indicated their high level of dissatisfaction with other health care therapists because of impractical advice and lack of empathy. The GPs' objectives of continuing management were mainly to prevent seizures, monitor of medication and its effects, and reduce the impact of patients' epilepsy on their daily life. Although many GPs believed that PWE were more likely to have emotional and relationship problems, most also believed that such persons contribute equally to society and can have normal quality of life (QOL). Although the GPs prefer to use a neurologist for initial management of PWE, they see themselves as having a role in continuing care and providing psychosocial support. The stereotyped perceptions of GPs indicated in the previous study have improved, although in some respects they remain negative. This study offers an audit of the outcome of a decade of educational promotion regarding epilepsy.
Physical Exercise, Stressful Life Experience, and Depression in Adults with Epilepsy
Authors: Roth David L. , Goode Kathryn T. , Williams Valerie L. , Faught Edward
Published: August 2005

Summary: Adults with epilepsy completed self‐report measures of exercise participation, barriers to exercise, stressful life experience, depression, and general psycho‐social adjustment (n=133) as part of routine outpatient visits. Descriptive statistics showed lower levels of depression among patients who exercised regularly. Structural equation analyses confirmed the fit of a path model that included significant direct effects of exercise and stressful life experience on depression. These effects were independent of each other, and independent of the influence of other predictor variables, such as seizure frequency, age, and gender. Stressful life experience also had a direct unique effect on seizure frequency in the multivariate models. These results suggest that problems with depression, which are common in adults with epilepsy, are significantly lower among those who exercise regularly and avoid stressful life change.
Nerve Fiber Size–Related Block of Action Currents by Phenytoin in Mammalian Nerve
Authors: Van den Berg R. J. , Versluys C. A. A. , de Vos A. , Voskuyl R. A.
Published: August 2005

Summary: We investigated nerve fiber size‐related actions of phenytoin (PHT) by applying the anticonvulsant on 2‐mm‐long stretches of desheathed whole nerves, excised from rat sural nerve. Compound action potentials (APs) were elicited by voltage pulses of increasing amplitude and recorded as monophasic action currents of the Aαβ‐type along the surface of the nerve. The area under the action current Q at supramaximal stimulation was reduced by 11 and 30% in solutions containing 10 and 100 μM PHT, respectively, similar to the reduction in peak action current. However, a greater reduction in Q induced by PHT was observed with smaller stimuli at both concentrations. This stimulus‐dependent reduction was believed to originate from selective inhibition of the thicker nerve fibers. Using a mathematical model, we separated Q into contributions Qα of the α‐fibers and Qβ of the β‐fibers. In solutions containing 10 μM PHT, Qα, was reduced by 15% maximally, whereas Qβ was not affected. Both fiber types were reduced ≤30% in the presence of 100 μM PHT, whereas the relations between Qβ and Qβ, respectively, and stimulus voltage shifted along the voltage axis for 0.3 V, suggesting that the larger fibers in the Aαβ‐groups were more inhibited by PHT than the smaller ones. Abolition of the early phases of the compound action currents by PHT also indicated loss mainly of faster conducting nerve fibers. We conclude that primarily the larger fibers in the Aαβ populations were inhibited by the anticonvulsant, strongly suggesting a differential mode of action by PHT on myelinated nerve fibers.
Ontogeny of Feline Temporal Lobe Epilepsy. III: Spontaneous Sleep and Arousal Disorders in Amygdala‐Kindled Kittens
Authors: Shouse Margaret N. , Langer James V. , Alcalde Oscar G. , Szymusiak Ronald S.
Published: August 2005

Summary: We report the ontogeny and persistence of sleep and arousal disorders in amygdala‐kindled kittens. We also identify procedural differences that may explain discrepancies in the literature on postkindling sleep disorders. The study population consisted of 12 preadolescent kittens kindled between 2.5 and 6.5 months of age, 8 of which were followed to adulthood (≥1 year), and 8 unkindled implanted control animals. Sleep and seizure patterns were monitored on 12‐24‐h polygraphic or split‐screen video recordings of EEG and behavioral activity. Kindled kittens displayed spontaneous seizure and interictal sleep anomalies that persisted to adulthood, as follows. As compared with neurosurgical controls, kindled kittens exhibited slow‐wave sleep (SWS) and REM sleep insomnia at least 1 year after kindling and 1–5 months after convulsions, regardless of postictal recording delay. Sleep and arousal defects in kindled kittens were similar to but more pronounced than those in kindled adult cats, possibly because kittens spontaneously became epileptic. Detection of postkindling SWS insomnia could be masked by brief scoring epochs (less than the preferred 1‐min epoch for cats); recurrent behavioral arousals after kindling frequently aborted 1‐min SWS epochs but often did not interrupt 30‐s SWS epochs (based on 1‐min vs. 30‐s minimum duration scoring criteria). Detection of postkindling REM sleep insomnia could be masked in kittens with alternating patterns of REM loss and REM rebound; all these kittens showed periodic bouts of REM onset from waking after kindling. Different data collection and analysis procedures influence detection of sleep and arousal disorders in amygdala‐kindled cats when replication of findings is attempted. We conclude that these differences explain some controversies regarding the nature and prevalence of sleep disturbances in the kindling literature in temporal lobe epilepsy (TLE).
Electrical Stimulation of the Mammillary Nuclei Increases Seizure Threshold to Pentylenetetrazol in Rats
Authors: Mirski Marek A. , Fisher Robert S.
Published: August 2005

Summary: High‐frequency electrical stimulation of mammillary nuclei (MN) of rat posterior hypothalamus resulted in a significant increase in seizure threshold induced by pentylenetetrazol (PTZ). The anticonvulsant effect was frequency and intensity specific. Stimulation at 100 Hz (1–5V, 30–200 μA) afforded protection against EEG and behavioral manifestations of PTZ seizures. Stimulation of either low frequency (5 Hz), high intensities (8–20 V, 300–800 μA), or outside the histologically verified MN target region did not increase seizure threshold. In some instances, high‐intensity stimulation of MN alone elicited spike‐wave epileptiform EEG activity accompanied by either arrest of behavior or myoclonic seizures. In animals with ongoing seizure activity, electrical stimulation of MN disrupted the high‐voltage synchronous wave forms on cortical EEG. These data support the concept that electrical perturbation of MN in hypothalamus may functionally inhibit generalization of paroxysmal activity required for expression of the EEG and, in particular, the behavioral component of PTZ seizures. These studies provide additional insight into forebrain‐brainstem interactions mediating generalized seizure expression.
Intractable Complex Partial Seizures Associated with Posterior Cerebral Artery Giant Aneurysm: A Case Report
Authors: Yacubian Elza M. T. , Rosemberg Sérgio , da Silva Helga C. A. , Jorge Carmen L. , de Oliveira Evandro , de Assis Luís Marques
Published: August 2005

Summary: Giant aneurysms have rarely been reported in association with intractable complex partial seizures (CPS). We report a 30‐year‐old man with intractable CPS since age 18 years. Seizure onset was electrically localized to right temporal lobe. Preoperative neuroimaging studies showed a partially thrombosed giant aneurysm of the right posterior cerebral artery. Selective arnygdalo‐ hippocampectomy and occlusion of the posterior cerebral artery did not cause deficits. The patient has been seizure‐free for 15 months after operation. We review the relevant literature on aneurysms as a cause of epilepsy.
Reversible Amnesia Associated with a Left Temporal Hematoma in a Case of Right Temporal Complex Partial Seizures
Authors: Cantrell Deborah T. Combs , Levin Harvey S. , Capruso Daniel X. , Eisenberg Howard M.
Published: August 2005

Summary: We report the case of a 44‐year‐old woman with complex partial seizures (CPS) of right frontotemporal origin who developed generalized amnesia after undergoing intracranial electrode implantation complicated by left hippocampal hemorrhage. Serial memory testing disclosed recovery from the amnesic disorder, while repeated magnetic resonance imaging (MRI) showed resolution of her left hippocampal hemorrhage in a 2‐month period. A second intracarotid amytal procedure confirmed the capability of her left temporal region to support memory. Consequently, aright orbitofrontotemporal lobectomy was performed without complication.
Outcomes After Seizure Recurrence in People with Well‐Controlled Epilepsy and the Factors That Influence It
Authors: Chadwick David , Taylor Joan , Johnson Tony
Published: August 2005

Summary: Purpose: To determine the risk of further seizures and probability of further remission after a first seizure recurrence in patients in remission of their epilepsy, and to examine the prognostic factors influencing this risk.

Methods: Continued follow‐up of a cohort of 409 patients with a recurrence of seizures after randomization to the Medical Research Council (MRC) Antiepileptic Drug Withdrawal Study.

Results: By 3 years after a seizure, 95% of patients have experienced a further 1‐year remission of their epilepsy and by 5 years 90% of patients have experienced a further 2‐year remission. The most important factors contributing to the risk of further seizures after a first seizure after randomization were the previous seizure‐free interval, having partial seizures at recurrence, and having previously experienced seizures while receiving treatment. There was no evidence that the group of patients who had discontinued or reduced treatment before the occurrence of their first seizure after randomization had a different outcome from those patients who continued treatment.

Conclusion: Our results provide no evidence that discontinuation of antiepileptic drugs (AEDs) modifies the long‐term prognosis of a person's epilepsy, although it does increase the risk of seizures in the 1‐ to 2‐year period after discontinuation.
Partial Seizures in West Syndrome
Authors: Ohtsuka Yoko , Murashima Itsuko , Asano Takashi , Oka Eiji , Ohtahara Shunsuke
Published: August 2005

Summary: Purpose: To study the occurrence of partial seizures (PS) and elucidate the characteristics of patients with West syndrome (WS) with PS.

Methods: We investigated the electroclinical and radiologic features in 92 children with WS who were older than 3 years at follow‐up.

Results: Thirty‐six (39.1%) children had PS at some time during the course of the disease. They had a significantly high incidence of asymmetric spasms, hemiparesis, and asymmetric hypsarrhythmia. Their seizure prognosis was significantly less favorable. PS appeared only before spasms (group A, six children), concomitant with spasms (group B, 18 children), and only after spasms ceased (group C, 12 children). Five children in group B had PS after spasms stopped. PS in group A and during the period of active spasms in group B showed high seizure frequency and variability of both seizures and EEG manifestations. The PS and EEG epileptiform discharges were mainly in parietal‐posterior temporal‐occipital, and central regions. Late PSs in group B and PSs in group C were characterized by stereotyped manifestations and relatively low seizure frequency. These PSs originated mostly from frontal regions.

Conclusions: In some children with WS, cortical lesions can induce both PS and spasms in series, whereas in others, both types of seizures occur with abnormally increased excitability throughout the cortex rather than as the result of a single cortical lesion. These findings suggest caution in interpreting focal discharges, which may fluctuate and are not necessarily indicative of a surgically accessible lesion. When the discharges are stable and correlate with an equally stable clinical pattern, the likelihood of an underlying cortical lesion is greater.