bluuebunny/crossref_metadata_2025 huggingface dataset:
Kindling Induces Transient Changes in Neuronal Expression of Somatostatin, Neuropeptide Y, and Calbindin in Adult Rat Hippocampus and Fascia Dentata
Authors: Tønder Niels , Kragh Jørn , Finsen Bente R. , Bolwig Tom G. , Zimmer Jens
Published: August 2005

Summary: Fully hippocampus‐kindled rats were examined 1 day and 1 month after the last stimulation for changes in somatostatin (SS)‐, neuropeptide Y (NPY)‐, and calbindin (CaBP)‐immunoreactivity (ir) and SS‐ and NPY‐mRNA in situ hybridization (ISH). One day after the last stimulation, there was marked, bilateral increase in SS‐ and NPY‐ir in the outer part of the dentate molecular layer. The cell bodies of dentate hilar SS‐ and NPY‐containing neurons, known to project to this area, also appeared to display increased immunoreactivity as well as an increased ISH signal for SS and NPY mRNA. Bilateral de novo expression of NPY‐ir in dentate mossy fiber projection to dentate hilus and CA3 was also evident, but we noted no corresponding NPY‐mRNA signal in the parent cell bodies, the dentate granule cells. After 1 month, the levels of NPY‐ir and ISH signal appeared essentially normal. In contrast, the levels of SS apparently were decreased, although not yet normal. CaBP‐ir was markedly and selectively reduced in dentate granule cell bodies, dendrites, and mossy fibers 1 day after the last stimulation, but after I month CaBP‐ir appeared essentially normal. Because kindling, once established, is a permanent phenomenon, the observed transient changes in SS, NPY, and CaBP in specific hippocampal terminal fields and neuronal populations cannot be associated specifically with kindling. Rather, they relate to the repeated high‐frequency stimulations and may serve as protective measures against deleterious effects of such stimulations.
Magnetic Resonance Imaging Evidence of Hippocampal Sclerosis in Progression: A Case Report
Authors: Nohria Virinder , Lee Namsoo , Tien Robert D. , Heinz E. Ralph , Smith Jean S. , DeLong G. Robert , Skeen Mark B. , Resnick Trevor J. , Crain Barbara , Lewis Darrell V.
Published: August 2005

Summary: A 32‐month‐old child presented in status epilepticus (SE) involving the left side of the body. Fast spin‐echo magnetic resonance imaging (FSE‐MRI) with hippocampal volumetry performed ≤24 h after the seizure showed increased T2 signal of the right hippocampus, but no atrophy. Complex partial seizures (CPS) appeared at age 33 months, and three more episodes of SE occurred between 33 and 37 months of age. Follow‐up FSE‐MRI at 34 and at 45 months of age demonstrated progressive hippocampal atrophy with resolution of the increased T2 signal. Her CPS became intractable and, at age 51 months, she underwent right temporal lobectomy. In the ensuing 5 months, she has had only one major motor seizure. This case demonstrates that acute increased hippocampal T2 signal intensity can occur soon after SE and hippocampal sclerosis (HS) may become evident within months in the setting of recurrent early childhood SE. This observation may support the hypothesis that early childhood SE can lead to HS. Furthermore, this case suggests that years of temporal lobe CPS may not be necessary for development of HS.
GABA‐Mediated Synchronous Potentials and Seizure Generation
Authors: Avoli Massimo
Published: August 2005

Summary: This article summarizes findings related to a synchronous, GABA‐mediated potential that may contribute to the initiation and spread of epileptiform discharges within the brain. This phenomenon is observed in cortical structures such as the hippocampus, the entorhinal cortex, and the neocortex during application of low concentrations of 4‐amimopyridine and is characterized at the intracellular level by a long‐lasting membrane depolarization. The synchronous, GABA‐mediated potential continues to occur after blockade of excitatory synaptic transmission and relays on the synchronous firing of inhibitory interneurons and consequent activation of postsynaptic (mainly type A) GABA receptors leading to a transient elevation of [K+]o.

Studies performed in young rat hippocampus indicate that the synchronous, GABA‐mediated potential may play a role in initiating ictal discharges under normal conditions (i.e., when excitatory amino acid receptors are operant). Moreover, a similar phenomenon may also occur in adult rat entorhinal cortex. These findings therefore indicate a novel role that is played by GABAA receptors in limbic structures. The ability of this synchronous GABA‐mediated potential to propagate in the absence of excitatory synaptic transmission may also be relevant for the propagation of synchronous activity outside conventional neuronal‐synapse dependent pathways. This condition may occur in brain structures with neuronal loss and consequent disruption of normal excitatory synaptic connections such as mesial limbic structures of temporal lobe epilepsy patients with Ammon's horn sclerosis.
ILAE Classification of Epilepsies: Its Applicability and Practical Value of Different Diagnostic Categories
Authors:   Osservatorio Regionale per L'Epilessia (OREp), Lombardy
Published: August 2005

Summary: Purpose: The study was aimed at verifying the applicability of the ILAE classification and the appropriateness of the different diagnostic categories in a large series of patients with epilepsy observed by epilepsy centers.

Methods: Data concerning 10,342 patients observed by a network of 14 epilepsy centers in the Lombardy region between June 1990 and June 1994 were collected by using a simple standard form and stored in a PC database.

Results: The diagnosis of epilepsy was assessed in 8,570 patients; the remaining 1,772 cases were excluded from the analysis as being affected by nonepileptic ictal events or by isolated or situation‐related seizures, including febrile and neonatal convulsions. A definite syndromic diagnosis, according to the ILAE Classification criteria, was made in 7,332 (85.5%) of 8,570 cases. Atypical features were found in 995 (11.6%) cases, who were therefore classified as uncertain; 198 (2.3%) cases remained unclassified; and in the remaining 45 patients, the diagnosis was not properly codified. The seizure‐control profile was found to be highly related to the syndromic diagnosis. The highest percentage of drug‐resistant cases was found among patients with generalized symptomatic or cryptogenic syndromes (32.3%) and among cases with partial symptomatic epilepsy (19.8%), whereas virtually no drug‐resistant cases were found among patients with idiopathic epilepsies.

Conclusions: The ILAE classification was found satisfactory in the large majority of cases observed at tertiary centers; however, the appropriateness of its various items in identifying homogeneous subpopulations was uneven, being maximal for those syndromes defined by highly consistent electroclinical pictures. An early identification of the characteristic pictures of distinct epileptic syndromes appears to be a valuable prerequisite for diagnostic and therapeutic approaches.
Quality of Life in Children with Epilepsy
Authors: Hanai Toshio
Published: August 2005

Summary: To study quality of life in school children with epilepsy, we surveyed families of 443 elementary and junior high school children with epilepsy, as well as their school teachers. Approximately 80% responded. Seizures were controlled in 70% of the children. Of the children with epilepsy, 27% received education for disturbed children. Main family concerns were the future of their child, seizures, and school performance. Main concerns of the children were medication and seizures. The majority of both families and teachers agreed that children should participate in all physical education and school events based on individual considerations. Many teachers expressed the opinion that correct information about epilepsy and close communication between teachers and physicians are necessary. To establish comprehensive medical care that satisfies the needs of children with epilepsy and their families, further training of medical specialists in epilepsy, establishment of more hospitals specializing in epilepsy, and enhancement of the network among relevant organizations are needed. For children with intractable epilepsy, special considerations include associated handicaps and antiepileptic drug side effects.
Recommendation of Early Surgery from the Viewpoint of Daily Quality of Life
Authors: Mihara Tadahiro , Inoue Yushi , Matsuda Kazumi , Tottori Takayasu , Otsubo Toshiaki , Watanabe Yutaka , Hiyoshi Toshio , Kubota Yuko , Yagi Kazuichi , Seino Masakazu
Published: August 2005

Summary: We surveyed pre‐ and postoperative levels of satisfaction with a range of the daily quality‐of‐life (QOL) domains in 132 sets of epilepsy surgery patients and their families. All patients underwent resective surgery for temporal lobe epilepsy and were monitored for >2 years. Patient and family assessments showed patients’ overall QOL markedly improves after surgery, depending on freedom from seizures. However, factors such as social contacts, family relations, or financial status improved little. Some families and patients were not satisfied with the postsurgical status, despite freedom from seizures. Patients who had surgery at a later age were not so satisfied with their postsurgical status as were patients who had surgery at a younger age, particularly on the QOL domains of role activities, memory function, leisure activities, or emotional well‐being. This lower satisfaction level in older patients likely results from a variety of problems affecting patients during the long‐lasting epileptic process; social handicaps, psychologic conflicts, and deterioration of cognitive/behavioral functions. Based on each case, we recommend that investigations start at an early stage of the illness, so that surgical intervention may be considered as early as possible.
Sudden Unexplained Death in Epilepsy: Observations from a Large Clinical Development Program
Authors: Leestma Jan E. , Annegers John F. , Brodie Martin J. , Brown Stephen , Schraeder Paul , Siscovick David , Wannamaker Braxton B. , Tennis Patricia S. , Cierpial Mark A. , Earl Nancy L.
Published: August 2005

Summary: Purpose: The present study was conducted to determine the rate of sudden unexplained death in epilepsy (SUDEP) in a well‐defined cohort of patients included in the lamotrigine (LTG) clinical development database.

Methods: A panel of scientists experienced in the area of SUDEP was assembled and provided with case summaries on all deaths (n = 45) reported during the initial clinical development of LTG. The panel developed a set of criteria for classifying cases as SUDEP (definite or highly probable), possible SUDEP, or non‐SUDEP. This classification algorithm was then applied to the LTG cases, and SUDEP rates were calculated using patient‐years of exposure as the denominator.

Results: At the time of the study, 4,700 patients (5,747 patient‐years of exposure) were included in the worldwide LTG clinical trials database. In this cohort, 45 deaths were reported. Eighteen were judged by the panel to be SUDEP, 6 were defined as possible SUDEP, 20 were judged to be due to other causes (non‐SUDEP), and 1 lacked sufficient data from which to make a classification. The overall SUDEP rate (definite/highly probable SUDEP and possible SUDEP combined) was calculated to be 3.5 in 1,000 patient‐years of exposure to LTG.

Conclusions: The rate of SUDEP in this cohort of patients was comparable to the rate that would be expected in young adults with severe epilepsy (the subgroup of patients believed to be at highest risk of SUDEP). The data suggest that the rate of SUDEP in the LTG clinical development program is a function of the clinical trial population and is unrelated to drug treatment.
Functional Anatomy of Spontaneous Seizures in a Rat Model of Limbic Epilepsy
Authors: Bertram Edward H.
Published: August 2005

Summary: Purpose: The substrate of seizure initiation in partial epilepsy is not well understood. Although many studies imply a focus that is will localized to a single structure, some information suggests that seizures arise regionally with simultaneous or near‐simultaneous onset at several separate sites. To determine the physiological pattern of seizure onset, recordings were made of spontaneous seizures from multiple limbic structures in a rat model of limbic epilepsy.

Methods: Seventeen rats with chronic spontaneous limbic seizures that occurred after an episode of electrical hippocampal stimulation‐induced status epilepticus (SE) underwent chronic recording of seizures with a minimum of four electrodes placed bilaterally in the midventral hippocampus and either the amygdala or piriform cortex. As many as 15 of the first recorded spontaneous seizures (mean of 12 seizures, range 2–15) was evaluated for each animal with regard to pattern of seizure onset (focal hippocampal, focal nonhippocampal, or diffuse). The results were evaluated for number of seizure patterns displayed by each animal and the potential change in the pattern of onset with successive seizures (from the first to the fifteenth).

Results: In all, 210 seizures were evaluated, beginning 1 week after SE and with monitoring lasting ≥18 weeks (mean recording duration 6 weeks) to record a maximum of 15 seizures for each animal. Overall, 54% of the seizures were of diffuse onset, 25% were of nonhippocampal onset, and 21% were of hippocampal onset. Eight of the 17 (47%) animals had seizures with all three patterns of onset. Evaluation of the evolution of the pattern of onset from the first to the fifteenth seizure recorded for the animals showed a clear tendency for the later seizures to have diffuse onsets (regression analysis r = 0.737, p < 0.002). Qualitative histologic analysis demonstrated neuronal loss in the recorded regions.

Conclusions: These findings indicate that the epileptogenic zone is broad in this model of limbic “focal” epilepsy and suggest that the substrate for seizure generation is distributed over several structures.
Intravenous Carbamazepine: Comparison of Different Parenteral Formulations in a Mouse Model of Convulsive Status Epilepticus
Authors: Löscher Wolfgang , Hönack Dagmar
Published: August 2005

Summary: Purpose: A drawback of carbamazepine (CBZ), a major antiepileptic drug (AED) with clinical efficacy against partial and generalized convulsive seizures, is its isolubility in aqueous vehicles, which is generally considered a contraindication to parenteral administration in epileptic patients. However, CBZ can be dissolved in glycofurol, a solvent used clinically as a vehicle for parenteral preparations of drugs such as diazepam (DZP) and phenytoin (PHT). Furthermore, aqueous CBZ solutions can be prepared by complexing CBZ with 2–hy‐droxypropyl‐β‐cyclodextrin (HPPCD), an inert β‐cyclodextrin derivative believed to have acceptable tolerability for human use. Such solutions of CBZ have been proposed to be suitable for intravenous administration in treatment of convulsive (grand mal) status epilepticus (CSE).

Methods: A series of five generalized tonic‐clonic seizures (GTCS) in 30 min was induced by repeated transauricular electrical stimulation in mice. In this model of convulsive (grand mal) SE, the anticonvulsant potency of intravenous CBZ dissolved in aqueous dilutions of either HPβCD or glycofurol was evaluated.

Results: In both solutions, CBZ rapidly suppressed seizures after intravenous bolus injection. Potent anticonvulsant activity was obtained as early as 30 s after injection, and peak effects were observed at ∼3 min. ED50 for blockade of GTCS throughout the 30–min period of repeated electrical stimulation was ∼7 mg/kg, similar to the potency of DZP in this model. Whereas the HPβCD/CBZ solutions were tolerated by the animals, with no pronounced behavioral or motor adverse effects, the glycofurol/CBZ solutions induced marked sedation and motor impairment, indicating interactions between drug and solvent. Determination of CBZ in plasma and brain demonstrated that the rapid onset of anticonvulsant action after intravenous bolus injection was related to rapid drug penetration into brain tissue.

Conclusions: An intravenous formulation of CBZ achieved through complexing with HPβCD might be suitable for parenteral use in acute clinical conditions such as SE, particularly because CBZ has the advantage of being almost free of respiratory or cardiovascular adverse effects.
Ictal Laughter Associated with Paroxysmal Hypothalamopituitary Dysfunction
Authors: Arroyo Santiago , Santamaría Joan , Sanmartí Francesc , Lomeña Francisco , Catafau Ana , Casamitjana Roser , Setoain Javier , Tolosa Eduardo
Published: August 2005

Summary: Purpose: Seizures with ictal laughter (also termed gelastic seizures) have been associated with hypothalamic hamartomas and precocious puberty. It is not known, however, where in the brain such seizures originate. We describe a child with gelastic seizures and a hypothalamic lesion (probably a hamartoma) in whom two dysfunctional phenomena were observed.

Results: First, there was a hyperperfusion in the hypothalamopituitary areas shown by ictal [99m]Tc hexamethyl‐propyleneamine oxime (HM‐PAO) single photon‐emission computed tomography (SPECT). Second, there was an ictal pulse of gonadotropins, 17β‐estradiol, and growth hormone well above the normal limits in one of the seizures.

Conclusion: These findings suggest that gelastic seizures associated with hypothalamic hamartomas are generated in the hypothalamus or in its neighboring regions and that these seizures may cause paroxysmal dysfunction of the hypothalamo‐pitutary axis.
Complex Partial Seizure Provocation by Vasovagal Syncope: Video‐EEG and Intracranial Electrode Documentation
Authors: Bergey Gregory K. , Krumholz Allan , Fleming C. Pam
Published: August 2005

Summary: Vasovagal syncope precipitating an epileptic seizure has only rarely been described. A patient with known intractable complex partial seizures being evaluated for a left anterior temporal lobectomy experienced a typical seizure with mesial temporal onset precipitated by an observed vasovagal episode. This is the first report of a partial epileptic seizure precipitated by vasovagal syncope and the first example of an epileptic seizure induced by syncope in an adult. Video and intracranial depth electrode and subdural grid recordings documented the event.
Cysticercosis and Epilepsy: A Critical Review
Authors: Carpio Arturo , Escobar Alfonso , Hauser W. Allen
Published: August 2005

Summary: Neurocysticercosis (NC) remains a major public health problem in developing and some developed countries. Currently, the best procedures for diagnosing NC are neuroimaging studies. Immunoserologic assays, such as enzyme‐linked immunoelectrotransfer blot assay (EITB) or enzyme‐linked immunosorbent assay (ELISA), detect antibodies against Taenia solium, or cysticercus. Consequently, they are useful in identifying a population at risk of contact with the parasite but do not necessarily indicate a systemic active infection. Most seropositive individuals are asymptomatic. No data from prospective studies concern the proportion of these individuals that will develop seizures or other neurologic symptoms. There is a discrepancy between the results of serologic assays and neuroimaging studies: >50% of those individuals with NC diagnosed by computed tomography (CT) scan test EITB negative.

Pathophysiologic classification of NC into active, transitional, and inactive forms permits a good correlation between clinical manifestations and neuroimaging procedures and facilitates medical and surgical management and research. The most frequent clinical manifestations of NC are seizures. We assume that NC is the main cause of symptomatic epilepsy in developing countries; however, no case‐control or cohort studies demonstrate this association. Most patients with NC with seizures have a good prognosis; nevertheless, further studies analyzing factors related to recurrence of seizures and possibilities of discontinuation of antiepileptic medications (AEDs) are needed.

Regarding treatment of NC with antihelminthic drugs, no controlled clinical trials exist that establish specific indications, definitive doses, and duration of treatment. The most effective approach to taeniasis/cysticercosis infection is prevention. This should be a primary public health focus for developing countries.

We critically review the available information regarding the epidemiology and diagnosis of human cysticercosis, the physiopathology and imaging correlation of the parasite in the central nervous system (CNS) of the host, the relation between seizures or epilepsy and NC, and the issues surrounding the treatment and prognosis of NC, including the use of antihelminthic therapy.
Glucose Utilization During Interictal Intervals in an Epilepsy Model Induced by Pilocarpine: A Qualitative Study
Authors: Scorza F. A. , Sanabria E. R. G. , Calderazzo L. , Cavalheiro E. A.
Published: August 2005

Summary: Purpose: Interictal intervals in pilocarpineinduced chronic epilepsy are characterized by apparent normal electrographic activity and longer sleep periods or drowsiness or both. Sparse information exists concerning the neural network activity during these seizure‐free intervals. In our research, a [14C]2‐deoxy‐D‐glucose (2DG) autoradiographic technique was used to investigate interictal changes in the metabolism of the epileptic rat brain.

Methods: Epileptic rats were monitored by video‐EEG for ‐120 days, with [14C]2DG injected after a seizure‐free interval of ≥24 h.

Results: Autoradiographic analysis revealed an increase in glucose utilization by several brain regions; the most consistent increase was found in the lateral posterior thalamic nucleus and pretectal region.

Conclusions: These findings suggest that the lateral posterior thalamic nucleus and the pretectal region may be involved in cerebral circuits inhibiting epileptic activity during interictal intervals.
Does Short‐Term Antiepileptic Drug Treatment in Children Result in Cognitive or Behavioral Changes?
Authors: Williams Jane , Bates Stephen , Griebel May L. , Lange Bernadette , Mancias Pedro , Pihoker Catherine M. , Dykman Roscoe
Published: August 2005

Summary: Purpose: To determine possible cognitive and behavioral effects of antiepileptic drug (AED) therapy by assessing children with newly diagnosed epilepsy before and after initiation of treatment. A comparison group of children with diabetes mellitus (DM) was included to control for the effects of practice, maturation, and chronic illness.

Methods: Baseline neuropsychological assessments were completed for children with epilepsy (n = 37) and children with DM (n = 26) recruited through outpatient clinics at a regional children's hospital. Children were reevaluated 6 months from baseline testing. At follow‐up, children with epilepsy had therapeutic AED levels and controlled seizures. Statistical analysis included a between‐group repeated measures ANCOVA with pretest scores serving as the covariate.

Results: Significant differences between groups were not found for any cognitive or behavioral factors, including attention (p < 0.24), immediate memory (p < 0.24), delayed memory (p < 0.10), complex motor speed (p < 0.19), or behavior problems (p < 0.89).

Conclusions: Changes in performance on cognitive and behavioral measures were not different for children treated with AEDs and controls. Although adverse effects may be associated with prolonged treatment, results would not suggest adverse effects from AED monotherapy during the first 6 months of therapy.
Antiepileptic Drug‐Related Cognitive Complaints in Seizure‐Free Children with Epilepsy Before and After Drug Discontinuation
Authors: Aldenkamp A. P. , Alpherts W. C. J. , Sandstedt P. , Blennow G. , Elmqvist D. , Heijbel J. , Nilsson H. L. , Tonnby B. , Wåhlander L. , Wosse¶ E.
Published: August 2005

Summary: The cognitive complaints reported by children and their parents, as subjectively associated with antiepileptic drug (AED) treatment, were evaluated in seizure‐free children before and after drug discontinuation. The aim of the design was to isolate the cognitive side effects of AEDs from other factors, such as the effect of seizures. Our inventory explored the following areas: “alertness,”“concentration,”“activation/ tiredness,”“memory,”“drowsiness,”“depression,”“aggressiveness,” and “hyperactivity,” using a 5‐point Likert scaling procedure. One hundred two eligible patients were selected, each matched with a healthy control and assessed when still on antiepileptic medication. All children were seizure free for at least 1 year. The medication was then discontinued gradually over a 3‐month period. Four months after the children were completely medication free, a second assessment was carried out, but only in the 83 children who remained seizure free and in their matched controls.

The results of the reports made by the children themselves did not show differences with the matched controls, and only showed improvement after drug discontinuation for complaints about “tiredness.” Parents of the children with epilepsy reported significant improvement in all areas related to “alertness and activation” after discontinuation of the drugs.

The finding that only a limited number of children have cognitive complaints, both when still on AEDs and after discontinuation, may be in line with the reports that the major factor contributing to quality of life is whether patients are seizure free or still have seizures. All patients in this study were seizure free for a period >1 year, which may have caused the favorable pattern of response in our patient group.
Neuropsychological Outcomes in Randomized Controlled Trials of Antiepileptic Drugs: A Systematic Review of Methodology and Reporting Standards
Authors: Cochrane Haydee C. , Marson Anthony G. , Baker Gus A. , Chadwick David W.
Published: August 2005

Summary: Purpose: To systematically review the methodology and use of neuropsychological tests in randomized controlled trials (RCTs) of antiepileptic drugs (AEDs) in patients with epilepsy.

Methods: Trial reports were found by searching Medline 1966–1996 and searching through journals by hand. Inclusion and exclusion criteria were applied, and methodological and neuropsychological test data was extracted by using a pro‐forma.

Results: 43 reports met our inclusion criteria, representing 40 RCTs, as three RCTs had generated two reports. Twenty‐two were actively controlled, and 18 were placebo‐controlled studies. Reporting of basic methods such as randomization method was poor. There has been no uniform approach to the use of neuropsychological tests, and a total of 87 has been used. The Stroop Colour Word Test and the Finger Tapping Test were most commonly used, at 13 times each, but were not used or reported in a uniform manner.

Conclusions: Poor reporting of methods and the use of a plethora of neuropsychological tests create great difficulties for anyone wishing to make sense of currently available data. If we are better to understand the neuropsychological effects of AEDs, a more rational approach is needed, for which recommendations are made.
Ictal Oroalimentary Automatisms with Preserved Consciousness: Implications for the Pathophysiology of Automatisms and Relevance to the International Classification of Seizures
Authors: Alarcon G. , Elwes R. D. C. , Polkey C. E. , Binnie C. D.
Published: August 2005

Summary: A patient showing seizures presenting ictal automatisms with preserved consciousness is reported. A 30‐year‐old, right‐handed man with normal development and without family history of epilepsy was referred for surgical treatment of epilepsy. At 15 he began to have seizures, starting with an epigastric aura, occasionally developing automatisms (lip‐smacking, chewing), sometimes followed by tonicxAonic convulsions. At the time of referral, he averaged six convulsive seizures per year and one nonconvulsive per week. His sleep EEG showed sharpened slow activity over the right anterior quadrant magnetic resonance imaging (MRI) showed a benign lesion in the mesial aspect of the right occipital lobe. Simultaneous video monitoring and intracranial EEG with subdural strips recording from the right temporal and occipital lobes was undertaken. During one seizure, he had pronounced oroalimentary automatisms while holding a conversation with a technician, answering her questions, and explaining details of his seizures. Memory of this event was preserved. At seizure onset, spike activity was seen at the mesial occipital strips. At mid‐seizure, high‐voltage sharpened delta was seen throughout the right hemisphere. Left‐sided scalp electrodes remained relatively uninvolved. The lesion, a dysembryoplastic neuroepithelial tumour was removed. Surgery was followed by abolition of seizures described. Because it is agreed that complex partial seizures require impaired consciousness, a history of automatisms with retained consciousness usually suggests nonepileptic attacks. This case suggests that automatisms in epileptic seizures can take place with minimal loss of consciousness, particularly if there is widespread but unilateral involvement. The need for a revision of the International Classification is suggested.
Bicuculline‐Induced Rhythmic EEG Episodes: Gender Differences and the Effects of Ethosuximide and Baclofen Treatment
Authors: Matějovská Iveta , Velis̃ková Jana , Velis̃ek Libor
Published: August 2005

Summary: Purpose: There are gender differences in the expression of seizures. We tested rhythmic EEG episodes induced by low doses of bicuculline in rats for gender differences. To verify the validity of these discharges as a model of absence seizures in both male and female rats, we tested the antiabsence drug ethosuximide (ESM) and a γ‐aminobutyric acid (GABAB)‐receptor agonist, baclofen, which may exacerbate absence seizures.

Methods: Adult rats of both sexes were used. Under general anesthesia, EEG electrodes were implanted over frontal and occipital cortex, and some females were ovariectomized. After recovery, male, intact female rats, and female rats ovariectomized and ovariectomized rats with estradiol replacement were compared for occurrence of rhythmic EEG episodes (∼6 cycles/ s) induced by 2.5 mgkg of bicucullin?, s.c. Because of gender differences in sensitivity to bicuculline, further pharmacologic effects of ESM (125 and 250 mgkg, i.p.) and baclofen (2 mgkg, i.p.) were tested separately in male (3.0 mgkg of bicuculline), and female (2.5 mgkg of bicuculline) rats.

Results: After the identical dose of bicuculline, s.c., male and female rats differed in the incidence of rhythmic episodes and in the latency to onset of the first as well as the generalized episode. Female rats with natural or exogenous estrogens (but not ovariectomized rats) developed EEG episodes more often than did males, and this effect could be attributed to the presence of estrogens. ESM pretreatment suppressed the episodes, whereas baclofen enhanced their occurrence, as well as the total duration of episodes without gender‐specific differences.

Conclusions: The study demonstrates gender differences (related probably to the presence of circulating estrogens) in the susceptibility of rats to develop rhythmic EEG episodes induced by threshold doses of bicuculline. This activity has some features of an acute absence seizure model.
Comparison of Combined Versus Subdural or Intracerebral Electrodes Alone in Presurgical Focus Localization
Authors: Brekelmans G. J. F. , van Emde Boas W. , Velis D. N. , Lopes da Silva F. H. , van Rijen P. C. , van Veelen C. W. M.
Published: August 2005

Summary: purpose: The yield of subdural versus intracerebra1 electrodes for ictal localization remains a point of controversy. We assessed the relative sensitivity of these two types of electrodes per case.

Methods: Eighty‐three intracranial recordings obtained from 82 patients were retrospectively reviewed to establish which type of electrode performed best in which patients and which seizure types.

Results: Sixty (73%) of 82 patients had temporal lobe seizure onsets, eight frontal, nine widespread or multifoca/multilobar or both, whereas in five, seizure onset was not localized. Exclusive use of intracerebral electrodes would have been sufficient for accurate localization of the seizure—‐onset zone in all 35 patients with strictly mesial temporal seizure onsets. In only 20 (57%) of these 35 patients, the same decision would have been reached with exclusive use of subdural electrodes. In wide‐spread neocortical and mesial temporal seizures (n = 25). yield of both electrode types was at about the same level, but neither was sufficient to identify the zone of ictal onset on its own. In frontal or multilobar seizures (n = 22), yield of subdural electrodes was slightly better then that of the intracerebral electrodes, but was not sufficient in all cases.

Conclusions: This study indicates that, depending on the characteristics of the seizure disorder, exclusive use of either intracerebral or subdural electrodes may easily result in erroneous diagnosis because of insufficient sampling of the brain. These findings are in contrast with other studies emphasizing the high yield of reliable EEG findings in evaluations with a single type of electrode and corroborate the results of one of our previous studies.
The Effects of Genetic Polymorphisms of CYP2C9 and CYP2C 19 on Phenytoin Metabolism in Japanese Adult Patients with Epilepsy: Studies in Stereoselective Hydroxylation and Population Pharmacokinetics
Authors: Mamiya Kohsuke , Ieiri Ichiro , Shimamoto Junta , Yukawa Eiji , Imai Jun , Ninomiya Hideaki , Yamada Hiroaki , Otsubo Kenji , Higuchi Shun , Tashiro Nobutada
Published: August 2005

Summary: Purpose: The aim of this study was to clarify the effects of genetic polymorphisms of cytochrome P450 (CYP) 2C9 and 2C19 on the metabolism of phenytoin (PHT). In addition, a population pharmacokinetic analysis was performed.

Methods: The genotype of CYP2C9 (Arg144/Cys, Ile359/Leu) and CYP2C19 (*1, *2 or *3) in 134 Japanese adult patients with epilepsy treated with PHT were determined, and their serum concentrations of 5‐(4‐hydroxyphenyl)‐5‐phenylhydantoin (p‐HPPH) enantiomers, being major metabolites of PHT, were measured. A population pharmacokinetic analysis (NONMEM analysis) was performed to evaluate whether genetic polymorphism of CYP2C9/19 affects the clinical use of PHT by using the 336 dose‐serum concentration data.

Results: The mean maximal elimination rate (Vmax) was 42% lower in the heterozygote for Leu359 allele in CYP2C9, and the mean Michaelis‐Menten constants (K,) in the heterozygous extensive metabolizers and the poor metabolizers of CYP2C19 were 22 and 54%, respectively, higher than those without the mutations in CYP2C9/19 genes. (R)‐ and (5′)‐p‐HPPHPHT ratios were lower in patients with mutations in CYP2C9 or CYP2C19 gene than those in patients without mutations.

Conclusions: Although the hydroxylation capacity of PHT was impaired with mutations of CYP2C9/19, the impairment was greater for CYP2C9. In view of the clinical use of PHT, two important conclusions were derived from this population study. First, the serum PHT concentration in patients with the Leu359 allele in CYP2C9 would increase dramatically even at lower daily doses. Second, the patients with CYP2C19 mutations should be treated carefully at higher daily doses of PHT.
A Pilot Study of Topiramate in the Treatment of Infantile Spasms
Authors: Glauser Tracy A. , Clark Peggy O. , Strawsburg Richard
Published: August 2005

Summary: Purpose: West syndrome is a rare epileptic syndrome associated with infantile spasms, a specific abnormal electroencephalographic pattern (termed hypsarrhythmia). and mental retardation. Management of this disorder is difficult because current treatment regimens, including many anticonvulsants and hormones, are often ineffective. Topiramate (TPM) is a new antiepileptic drug that may be effective in pediatric epilepsies. We conducted a pilot study to test the effects of rapid TPM dosing in patients with refractory infantile spasms.

Methods: Eleven children with refractory infantile spasms were given an initial dose of 25 mg TPM per day in addition to their current therapy. Dosage was increased by 25 mg every 2–3 days until spasms were controlled, the maximal tolerated dose was reached, or the maximal dose of 24 mg/kg/day was achieved. Efficacy was primarily assessed by video EEG and secondarily by parental count of spasm frequency.

Results: Five (45%) subjects became spasm free during the study, with absence of infantile spasms and hypsarrhythmia (either classic or modified) proven by video EEG. Nine subjects, including the five spasm free, achieved a spasm reduction of 250%. Spasm frequency decreased from 25.6 f 19.3 to 6.9 r 5.9 spasmdday. Sixty‐four percent of the subjects were able to achieve TPM monotherapy.

Conclusions: Results in this cohort of 11 patients with refractory disease show TPM to be a promising new agent for the treatment of infantile spasms.
Photosensitive Seizures Provoked While Viewing “Pocket Monsters,” a Made‐for‐Televison Animation Program in Japan
Authors: Ishida Shigenobu , Yamashita Yushiro , Matsuishi Toyojiro , Ohshima Masachika , Ohshima Hiroharu , Kato Hirohisa , Maeda Hisao
Published: August 2005

Summary: Purpose: To describe the recent epidemic of photosensitive seizure that occurred in relation to an episode of the television animation program “Pocket Monsters,” we report four patients who experienced seizures while watching the episode in question. We also report some technical aspects of the program episode.

Methods: We investigated the clinical symptoms of the four patients and performed routine EEGs with intermittent photic stimulation (IPS). If IPS provoked no photoparoxysmal response (PPR) during the routine EEG examination, a second EEG was performed with the photic stimulator placed 10 cm from the patient's eyes. In addition, we reviewed the “Pocket Monsters” episode, focusing our attention on the visual techniques used with reference to the Independent Television Commission (ITC) guidelines.

Results: One patient who had myoclonic jerks before the convulsion in question was diagnosed as having juvenile myoclonic epilepsy, and the diagnosis of another patient was pure photosensitive epilepsy. The remaining two patients had their first seizures, which could be occasional seizures, and we therefore could not reach a diagnosis of epilepsy. In our four patients, only one showed PPR on the routine EEG. Two patients revealed PPR on the second EEG, and the remaining patient showed no PPR. Rapid changes in color are believed to be responsible for the photosensitive seizures because all four patients had seizures at around 1850, when seconds of deep red and bright blue flashes, alternating at a frequency of 12 Hz, were shown.

Conclusions: Regulations for technical aspects of children's programming, including the use of colors, are urgently needed in Japan to prevent a repeated incident. In addition, the IPS procedure needs to be standardized, especially for patients who are suspected to have photosensitivity.
ILAE‐Defined Epilepsy Syndromes in Children: Correlation with Quantitative MRI
Authors: Lawson John A. , Nguyen William , Bleasel Andrew F. , Pereira John K. , Vogrin Simon , Cook Mark J. , Bye Ann M. E.
Published: August 2005

Summary: Purpose: The role of quantitative magnetic resonance imaging (MRI) in evaluation of childhood epilepsy remains poorly defined, with minimal published data. Previous work from our center questioned the specificity of hippocampal asymmetry (HA) in an outpatient group whose epilepsy was defined by using clinical and interictal data only. By using childhood volunteer controls and defining epilepsy syndromes using video‐EEG monitoring, we readdressed the utility of HA in differentiating mesial temporal lobe epilepsy (Mtle) from other partial and generalized epileptic syndromes in children.

Methods: Seventy children were enrolled; entry criteria were age younger than 18 years with predominant seizure type recorded on video‐EEG telemetry with volumetric MRI in all cases. Thirty healthy child volunteers had volumetric MRI. Epilepsy syndrome classification was according to ILAE.

Results: Control data revealed symmetric hippocampi, mean smallernarger ratio of 0.96 (0.95–0.97,95% CI) with no gender or rightneft predominance. Overall 23% of patients had significant HA. Mean hippocampal ratio for Mtle was 0.78 (95% CI, 0.70–0.86), significantly lower than controls and from all other epilepsy syndromes. HA was highly specific (85%) to the syndrome of MTLE. Other potential epileptogenic lesions were found in 27 (39%) patients, lowest yield in frontal and mesial temporal syndromes. Dual pathology was present in 10% of patients. There was no significant association between HA and risk factors.

Conclusions: In this study, we found that HA in children with a well‐defined epilepsy syndrome is highly sensitive and specific for MTLE. Whether this will correlate with surgical outcome, as in adults, is the subject of ongoing study.
Ictal Smile
Authors: Molinuevo Jose L. , Arroyo Santiago
Published: August 2005

Summary: Purpose: Smiling is sometimes manifested during partial seizures. Its value for localizing the epileptogenic focus is not known. We analyzed smiling as an ictal manifestation possibly useful for seizure localization.

Methods: We reviewed patients referred to the video‐EEG monitoring unit who presented a smile as part of their critical symptoms. Ictal smile was defined as an accordant expression accompanied by other characteristic epileptic symptoms and ictal EEG activity.

Results: Five of 86 patients experienced partial seizures with an ictal smile. We observed smiling during parietal (two patients) and temporal lobe (three patients) seizures. The right hemisphere appeared to be involved with greater frequency.

Conclusions: Ictal smile is an uncommon manifestation of partial seizures involving temporal or parietal lobes, localized mainly on the right hemisphere.
Multiracial Recruitment in the Field of Family Therapy: An Innovative Training Program for People of Color
Authors: Kaplan Laurie , Small Sippio
Published: August 2005

This article describes the creation of a training program designed to increase the number of family therapists of color in the family therapy field. In 1992, a partnership between New York City schools of social work, community agencies, and the Ackerman Institute for the Family created the Diversity and Social Work Training Program. Elements critical to the program's success were recruitment strategies, mentorships, partnerships with outside organizations, provision of a long‐term institutional commitment, biracial collaborations, and institutional change. This article describes the design, structure, and process of this program's evolution and its impact 12 years later.
Systemic Training for Healthcare Professionals: The Chicago Center for Family Health Approach
Authors: Rolland John S. , Walsh Froma
Published: August 2005

There has been increasing interest in family‐centered, collaborative, biopsychosocial models of care by health and mental health professionals and consumers. This trend has led to growing demand and development of specialized training in family systems approaches to health care. This article describes the Families, Illness, and Collaborative Healthcare programs developed at the University of Chicago affiliate, the Chicago Center for Family Health. The program philosophy is guided by the following principles: a systems orientation focused on the family, a Family Systems Illness Model, a family resilience framework, a family‐centered collaborative model of health care, and a social justice and advocacy orientation. Specific training components that implement these principles are described, including intensive certificate and fellowships; workshops, conferences, and institutes; and consultation and training services for community‐based organizations. Discussion includes professional networking opportunities, funding challenges, and policy recommendations.
It Was the Best of Times, It Was the Worst of Times: Doctoral Students' Experiences of Family Therapy Research Training Through Alternative Forms of Data Representation
Authors: Piercy Fred P. , McWey Lenore M. , Tice Susan , James Ebony Joy , Morris Matt , Arthur Kristin
Published: August 2005

In this study, we interviewed 14 doctoral students from 10 COAMFTE‐accredited doctoral programs to learn more about how they experienced their research training and what they might suggest to strengthen the research culture in their training programs. We solicited somewhat unconventional data—metaphors, poetry, free associations, critical experiences—to (a) tap into our participants' underlying thought processes, (b) capture the multifaceted nature of their doctoral research training, and (c) represent the richness of our participants' subjective experiences. The themes we identified reflect both positive and negative research training experiences and suggest several ways that family therapy program faculty might improve their programs' research training and culture.
Excessive Bacterial Decomposition of H2O2 During Enhanced Biodegradation
Authors: Spain J. C. , Milligan J. D. , Downey D. C. , Slaughter J. K.
Published: August 2005

Enhanced aerobic biodegradation of hydrocarbons in the subsurface requires large quantities of oxygen to be distributed throughout the contaminated zone. Although hydrogen peroxide is a commonly used source of oxygen, its uncontrolled decomposition can result in wasteful off‐ gassing. Our results indicate that bacterial catalase is responsible for rapid decomposition of hydrogen peroxide at a jet fuel spill site undergoing enhanced biodegradation. Catalase positive bacteria found in infiltration galleries have dramatically decreased the useful oxygen supplied to the subsurface.
Mapping Recharge Areas Using a Ground‐Water Flow Model – A Case Study
Authors: Stoertz Mary W. , Bradbury Kenneth R.
Published: August 2005

We have developed a method to calculate ground‐ water recharge rates using the mass‐balance equation, water‐ table elevation data, estimates of hydraulic conductivity, and aquifer thickness data, and have applied this method to produce a map of the recharge and discharge patterns for a ground‐water basin in central Wisconsin. This recharge mapping method is simplified using a modified computer program, the USGS Modular Groundwater Flow Model (McDonald and Harbaugh, 1984). The modeled recharge pattern compares favorably with a recharge map based on field observations. Because recharge rates are extremely sensitive to hydraulic conductivity, the magnitudes of the calculated rates are less reliable than the patterns of recharge and discharge areas. However, introducing stream discharge data constrains the model to produce net recharge rates averaged over the basin which agree with estimates of the basin yield. Because the method is insensitive to the position of lateral boundaries, it can be used to map recharge over areas within basins that are not physically bounded. Recharge maps made with this method can be used to design ground‐water monitoring networks and as frameworks for interpreting geochemical or potentiometric data.