bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparing the Cognitive Effects of Phenytoin and Carbamazepine in Long‐Term Monotherapy: A Two‐Year Follow‐Up
Authors: Pulliainen Veijo , Jokelainen Matti
Published: August 2005

Summary: We compared the cognitive effects of randomly prescribed phenytoin (PHT) and carbamazepine (CBZ) therapy on newly diagnosed patients with epilepsy in a 2–year parallel group follow‐up study. Fifteen patients were receiving PHT and 16 were receiving CBZ. Neuropsychological assessements were conducted before the treatment and after 6 and 24 months of steady‐state drug therapy. Differential effects of PHT and CBZ during follow‐up were observed in 3 of 32 measurements. PHT appeared to have negative effects on visually guided motor speed of both hands. In addition, the performance of the PHT group as compared with the CBZ group developed less positively in one visual memory task. The development of mood, as measured by Profile of Mood States (POMS), was quite similar in both drug groups; Tension, Depression, and Bewilderment decreased and Vigor increased during the follow‐up. The results suggest that the long‐term effects of PHT as compared with thoseof CBZ on cognition are few and restricted mainly to some visually guided motor functions. The effects of PHT on cerebellar function as a possible mechanism for these changes is discussed.
Prognosis and Treatment of eizures in Children with Acute Lymphoblastic Leukemia
Authors: Maytal J. , Grossman R. , Yusuf F. H. , Shende A. C. , Karayalycin G. , Lanzkowsky P. , Schaul N. , Eviatar L.
Published: August 2005

Summary: We reviewed the records of 127 consecutive pediatric patients with acute lymphoblastic leukemia (ALL) to determine the incidence, timing, etiologies, and recurrence rate of seizures in this population. Patients with ALL and seizures were identified retrospectively by review of the records of all pediatric ALL patients who were diagnosed and treated during the years 1983 through March 1993 in a large tertiary‐care hospital. Seventeen patients (13%) developed one or more seizures. In 16 patients, seizures occurred during antileukemic treatment, and in almost all of them seizures were related to intrathecal methotrexate (IT MTX) or subcutaneous L‐asparaginase treatment. One patient who developed a seizure while not receiving chemotherapy had a history of cerebral infarctions. In 8 patients, 47%), the initial seizure episode was associated with a cerebral lesion. One or more seizures recurred in 6 patients. Four of these patients had an isolated recurrence, in 3 patients %ge;3 months and in 1 patient >6 months after the initial event. Two patients (12%) with static encephalopathy and neurological deficits developed a chronic seizure disorder. There is a significant risk of acute symptomatic seizures in pediatric ALL patients. Most seizures in these patients occur during the acute treatment phase and are most frequently related to side effects of chemotherapy. The longterm recurrence risk is low; recurrence occurs most often in patients with evidence of cerebral structural lesions and neurological deficits. Long‐term antiepileptic drug (AED) therapy should be restricted to such patients.
Search for the Structures Initiating Seizures Triggered by Intraventricular Injection of the μ opioid Agonist Dermorphin in Rats
Authors: Gioanni Yves , Greco Béatrice , Prevost Janine
Published: August 2005

Summary: Free‐moving rats received intraventricular (i.c.v.) or intravenous (i.v.) injections of the μ opioid agonist dermorphin (DRM). The EEG activity of the cortex and of several structures near the injected lateral ventricle was recorded. The intravenous injections of DRM did not induce epileptiform activity. The intracerebroventricular injections of DRM triggered several types of electrical seizures and interictal spikes. With the aim of determining which structure gave rise to the epileptiform discharges, we compared the time relationships of epileptiform phenomena occurring in different structures. Epileptiform discharges, at once generalized, appeared first in the CA3 area of the ventral hippocampus, with involvement of the CA1 area of ventral hippocampus, the entorhinal cortex and the amygdala following immediately. We conclude that, after intracerebroventricular in‐jection of a p opiate agonist, epileptiform activity originates in the CA3 area of the ventral hippocampus.
Magnetic Resonance Imaging and Spectroscopy Findings After Focal Status Epilepticus
Authors: Fazekas Franz , Kapeller Peter , Schmidt Reinhold , Stollberger Rudolf , Varosanec Stefan , Offenbacher Hans , Fazekas Gudrun , Lechner Helmut
Published: August 2005

Summary: The etiology of cerebral abnormalities after focal status epilepticus (SE) is unknown. Possible causes include hypoxia and the excessive release of excitatory amino acids. Magnetic resonance imaging (MRI) of a 21–year‐old patient with “cryptogenic” continuous motor seizures showed swelling and signal hyperintensity of the contralateral panetotemporal cortex, the thalamus, and the ipsilateral cerebellum on T2‐weighted images. These regions are connected by glutamatergic pathways. Proton magnetic resonance spectroscopy (MRS) of the cortical lesion yielded a signal peak at the resonance frequency of 2.29 ppm, suggesting a focal increase of glutamate or its degradation product glutamine. At 3–month follow‐up, structural alterations had disappeared, but the N‐acetylaspartatelcholine ratio was still reduced in the previously abnormal area. These findings are the first to demonstrate the contribution of MRS to pathophysiologic studies of focal SE in humans and, in combination with the pattern of imaging abnormalities, support a major role of glutamate for seizure‐related brain damage.
Neurotransmission in Epilepsy
Authors: Meldrum Brian S.
Published: August 2005

Summary: Some evidence indicates that in some types of focal epilepsy the enhanced excitability is due in part to impaired γ‐aminobutyric acid (GABA)ergic inhibitory feedback. One form that this can take is impaired excitatory input to GABAergic interneurons. Enhanced excitatory receptor sensitivity, most characteristically involving N‐methyl‐D‐aspartate (NMDA) receptors, has been identified in kindled rodents and in focal epilepsy in humans. Drugs that enhance GABA‐mediated inhibition are anticonvulsant in many syndromes of generalized and focal epilepsy. Mechanisms through which this occurs include direct interaction with the GABAhenzodiazepine (BZD) receptor (BZDs, barbiturates, chlormethiazole), inhibition of GABA‐transaminase (vigabatrin, VGB) and blocking GABA uptake (tiagabine, TGB). Glutamate receptor antagonists (both NMDA and non‐NMDA antagonists) are potent anticonvulsants in many animal models of epilepsy. Whether pure glutamate receptor antagonists will have a clinical role as antiepileptic drugs (AEDs) remains to be established.
Chemosensory Event‐Related Potentials in Patients with Temporal Lobe Epilepsy
Authors: Hummel T. , Pauli E. , Schüler P. , Kettenmann B. , Stefan H. , Kobal G.
Published: August 2005

Summary: We investigated chemosensory functions in patients with temporal lobe epilepsy (TLE) to discover whether olfactory and trigeminal stimuli applied either ipsilaterally or contralaterally to the epileptic focus are processed differently. Twenty‐two patients were investigated, 12 of whom had epilepsy with a focus located in left temporal lobe (LTL). The remaining 10 patients had a right temporal lobe (RTL) focus. Input from the trigeminal system was examined by use of CO2; input from the olfactory system was evaluated with vanillin and hydrogen sulfide as stimuli. Chemosensory function was assessed by evaluation of chemosensory event‐related potentials (CSERP) and the patients’ verbal reports in an odor identification test. In both groups of patients, prolonged CSERP latencies were noted after stimulation of the left nostril with CO2 as compared with stimulation of the right nostril. In contrast, a different pattern emerged for olfactory stimuli. After right‐sided olfactory stimulation, latencies were prolonged in patients with right‐sided epileptical foci. Similarly, when the left nostril was stimulated in patients with a left‐sided focus, CSERP latencies were prolonged. Thus, neocortical processing of olfactory, but not trigeminally mediated information evidently is affected by functional lesions of the temporal lobe. After olfactory stimulation in patients with a right‐sided focus, the distribution of amplitudes was different from normal. Moreover, analyses showed nonoverlapping 95% confidence intervals (CI) for latency N1 when vanillin was applied to the right nostril. These results indicate that RTL may play a different role in processing of olfactory information as compared with LTL.
Chemical Kindling: Implications for Antiepileptic Drugs‐Sensitive and Resistant Epilepsy Models
Authors: Shandra Alexei A. , Mazarati Andrey M. , Godlevsky Leonid S. , Vastyanov Rooslan S.
Published: August 2005

The efficacy of phenobarbital (PB) and phe‐nytoin (PHT) was evaluated against the convulsions in chemically (picrotoxin, PTX) kindled rats. Two protocols were used: assessment of seizures immediately after the completion of the kindling procedure and after the 2–week postkindling PTX‐free period, as compared with acute PTX seizures. Kindled convulsions were more sensitive than acute PTX seizures to the antiepileptic action of PB and PHT. On the other hand, the “postkindling state” was characterized by the enhancement of the seventy of the convulsions in comparison with both kindled and acute PTX seizures and dramatic increase in the resistance to the action of antiepileptic drugs (AEDs). It is concluded that the two paradigms—kindling proper and “postkindling”—could be applied as models for AED‐sensitive and AED‐resistant animal epilepsy models correspondingly.
Lamotrigine High‐Dose Tolerability and Safety in Patients with Epilepsy: A Double‐Blind, Placebo‐Controlled, Eleven‐Week Study
Authors: Matsuo Fumisuke , Gay Patricia , Madsen Jack , Tolman Keith G. , Rollins Douglas E. , Risner Marcus E. , Lai Allen A.
Published: August 2005

Summary: Purpose: This study was undertaken to evaluate the dose tolerability and safety of a chronic ascending twice‐daily (b.i.d.) dosage regimen of 700 mg/day larnotrigine (LTG) and to include determination of the LTG pharmacokinetic profile at doses 500 mg/day in patients receiving concomitant enzyme‐inducing antiepileptic drugs (AEDs).

Methods: Twelve adult male epileptic patients treated with enzyme‐inducing AEDs received 700 mg/day (b.i.d.) oral LTG (n = 8) or placebo (controls, n = 4). For 3 weeks, as outpatients they had their LTG dosage increased from 100 to 400 mg/day. Then, in a clinical research study unit, patients received regimens of 500, 600, and 700 mg/day for 1 week each. Controls received matching placebo in the same sequence. At study end, dosages were tapered in 2 weeks. Follow‐up evaluations were made 7 days later.

Results: Five LTG patients tolerated 700 mg/day for 1 week. LTG was reduced to 600 mg/day in a patient with mild diplopia and to 500 mg/day in a patient with mild oscillopsia and diplopia. One patient discontinued 300‐mg/day therapy with a moderately intense diffuse papular skin rash, attributed to LTG. Headache, drowsiness, faintness, and diplopia, the common adverse events (AEs), were mild to moderate in intensity and occurred in 50–75% of patients in both groups (except for diplopia, occurring only with LTG). Concomitant AED plasma concentrations were not markedly changed by LTG. LTG pharmacokinetics were linear over the range of 500–700 mg/day.

Conclusions: LTG doses 700 mg/day can be tolerated in patients receiving concomitant enzyme‐inducing AEDs.
Seizure Occurrence During Long‐Term Monitoring
Authors: Swick Cynthia T. , Bouthillier Alain , Spencer Susan S.
Published: August 2005

Summary: Purpose: Intensive long‐term monitoring (LTM) for patients with refractory seizures is common and expensive. Methods to decrease the length of stay would improve patient experience and reduce cost. Therefore, we prospectively analyzed seizure occurrence in 36 patients who had LTM.

Methods: Antiepileptic drug (AED) levels and reduction were monitored and seizures were related to these changes. Patients were divided into temporal and extratemporal groups.

Results: Twenty patients had partial seizures of temporal lobe origin. The temporal lobe partial seizures occurred between LTM days 1 and 16. All but 4 of the patients required reduction or discontinuation of a least one AED and had subtherapeutic levels of the tapered medications. In 16 patients with extratemporal partial seizures, seizures occurred between LTM days 1 and 8. Six of these patients required reduction of at least one AED, and 5 of the 6 had subtherapeutic levels of that medication. These differences between length of monitoring monitoring and AED reduction in temporal and extratemporal patients were statistically significant. The groups did not differ significantly with respect to number or identity of tapered or nontapered medications or levels of nontapered medications. Reported seizure frequency at home was significantly related to number of seizures recorded in the temporal group only. The only significant predictor of secondarily generalized seizure activity during monitoring was a history of such activity occurring at home.

Conclusions: We conclude that patients with extratemporal partial seizures need little reduction of AED for seizures to be captured in a minimal time period. Patients with temporal lobe seizures, however, required drastic reduction of AEDs to allow capture of seizures in a long time period.
Leisure Time Activity and Physical Fitness in Patients with Epilepsy
Authors: Steinhoff Bernhard J. , Neusiiss Karin , Thegeder Harald , Reimers Carl D.
Published: August 2005

Summary: Purpose: To assess social and physical activity by means of a controlled study based on a questionnaire and standardized clinical tests of physical fitness.

Methods: In this controlled study, we assessed several issues of social and physical activity in 136 patients with epilepsy and 145 controls by using a questionnaire. In addition, we investigated physical fitness based on physical parameters such as body mass index and body composition and standardized tests of aerobic and muscle strength endurance and physical flexibility in 35 adult patients and 36 healthy controls.

Results: Leisure time habits both at home and outside the home were mainly similar except for visits of friends, which were significantly reduced in patients. Although the general attitude toward sports and physical activity was positive in both groups, and although controls judged sports to be dangerous significantly more often (p = 0.007), controls participated in regular sports significantly more frequently (p = 0.005). The clinical study demonstrated a lack of physical fitness, as suggested by the questionnaire data. Statistical analysis demonstrated significant differences of aerobic endurance (p < 0·001), muscle strength endurance (p < 0.001), and physical flexibility (p < 0.001) in favor of the control subjects. The body mass index was significantly higher in patients (p = 0.03), whereas the body composition revealed a higher body fat ratio only in female patients (p − 0.04).

Conclusions: We conclude that patients with epilepsy suffer from a considerable lack of physical fitness that might have an important impact on their general health and quality of life. In addition to overprotection and reduced mobility, the questionnaire revealed insufficient knowledge among health professionals and sport instructors as a major factor contributing to these results.
Qualitative MRI Segmentation in Mesial Temporal Sclerosis: Clinical Correlations
Authors: Kuzniecky Ruben I. , Burgard Sheila , Bilir Erhan , Morawetz Richard , Gilliam Frank , Faught Edward , Black Lorie , Palmer Cheryl
Published: August 2005

Summary: Magnetic resonance imaging (MRI) is reliable and sensitive in the detection of mesial temporal atrophy in patients with temporal lobe epilepsy. We investigated the MRI patterns of atrophy in 47 patients with histologically confirmed hippocampal sclerosis and correlated the imaging findings to the clinical features and surgical outcome. One hundred percent of patients had hippocampal body atrophy, 70% had hippocampal tail atrophy, 23% had amygdala atrophy, and 10% had focal hippocampal body atrophy without other segmental involvement. Correlative analysis of the segmented MRI findings with other clinical variables, including a previous history of childhood febrile convulsions, showed no significant associations except for younger age of seizure onset associated with hippocampal tail atrophy (p < 0.03). No associations between surgical outcome and the patterns of mesial temporal atrophy were detected. Our results demonstrate that variable patterns of atrophy exist in mesial temporal atrophy, but invariably atrophy involves the hippocampal body segment. Segmental MRI analysis in mesial temporal atrophy provides added useful diagnostic information.
Quantitative Comparison of Language Deficits Produced by Extraoperative Electrical Stimulation of Broca's, Wernicke's, and Basal Temporal Language Areas
Authors: Schäffler Leonard , Lüders Hans O. , Beck Gerald J.
Published: August 2005

Summary: Subdural electrodes were implanted over the language‐dominant left lateral convexity in 45 patients undergoing evaluation for epilepsy surgery. In 29 patients, additional electrodes were placed over the left basal temporal cortex. We identified language areas by using intermittent electrical stimuli applied while patients read aloud. Aphasia was classified as expressive or receptive based on additional testing performed when electrical stimulation elicited reading arrest in the absence of direct excitatory or inhibitory motor effects. Using correlated logistic regression, we noted no statistically significant differences among Broca's, and Wernicke's areas and the basal temporal language area (BTLA) regarding the frequency with which electrical stimulation interfered with language. Speech production deficits, however, occurred significantly more frequently in Broca's than in Wernicke's area (p = 0.012). In contrast, language comprehension deficits occurred with equal frequency when Broca's and Wernicke's areas were stimulated. These results suggest that both Broca's and Wernicke's areas play important roles in language comprehension and that the primarily expressive aphasia of patients with lesions of Broca's area results mainly from the predominant participation of Broca's area in language production.
Neuroticism in Temporal Lobe Epilepsy: Assessment and Implications for Pre‐ and Postoperative Psychosocial Adjustment and Health‐Related Quality of Life
Authors: Rose Kristopher J. , Derry Paul A. , McLachlan Richard S.
Published: August 2005

Summary: We assessed 77 candidates for epilepsy surgery to determine the association among neuroticism (a dimension of personality characterized by chronic negative emotions and behaviors), psychosocial adjustment as measured by the Washington Psychosocial Seizure Inventory (WPSI), and health‐related quality of life (HRQOL) as measured by the Epilepsy Surgery Inventory 55 (ESI‐55). Minnesota Multiphasic Personality Inventory 2 (MMPI‐2) Neuroticism scale scores were significantly correlated with many domains of patient‐perceived psychosocial adjustment and HRQOL regardless of frequency or type of seizures. We then followed 45 of the patients who subsequently underwent epilepsy surgery to determine the influence of neuroticism on postoperative functioning. Two‐way analysis of variance (ANOVA) indicated that patients with high preoperative neuroticism had significantly poorer postoperative psychosocial adjustment and HRQOL scores than patients who had low or moderate preoperative neuroticism scores. These results support the validity of the MMPI‐2 as a useful measure of neuroticism. Preoperative neuroticism has an important influence on postoperative psychosocial adjustment and HRQOL that is independent of postoperative seizure outcome. Understanding the influence of personality variables, such as neuroticism, on psychosocial functioning both before and after epilepsy surgery is essential in managing intractable seizures.
Gabapentin Associated with Aggressive Behavior in Pediatric Patients with Seizures
Authors: Tallian Kimberly B. , Nahata Milap C. , Lo Warren , Tsao Chang‐Yong
Published: August 2005

Gabapentin (GBP) is a new antiepileptic drug (AED) approved for adjunctive treatment of complex partial seizures with or without seizures secondarily generalization in adults. We report 2 children who received GBP for intractable seizures and who developed intolerable aggressive behavior requiring dose reduction or drug discontinuation. Behavioral changes should be recognized as a possible side effect of GBP, especially in mentally retarded children.
The National Hospital Seizure Severity Scale: A Further Development of the Chalfont Seizure Severity Scale
Authors: O'Donoghue M. F. , Duncan J. S. , Sander J. W. A. S.
Published: August 2005

Summary: Seizure severity scales have recently been identified as an important additional outcome measure in trials of new antiepileptic drugs (AEDs). The National Hospital Seizure Severity Scale (NHS3) is presented as a refined version of the Chalfont Seizure Severity Scale. The principal advantages of the new version are that it is quicker and simpler to apply, the limits of reliability are now clearly defined, and construct validity for the scale is available. The scale is administered by a health professional during an interview with a patient and a witness to the seizures. It contains seven seizure‐related factors and generates a score from 1 to 27. An intraclass correlation coefficient of 0.90 was obtained during interobserver and test‐retest reliability assessment, suggesting that the scale is sufficiently reliable for group studies. Scores for an individual patient should be interpreted with caution in light of the limits of agreement obtained. Validation experiments indicate that NHS3 measures seizure severity in a manner compatible with the subjective impression of people with epilepsy. We suggest that the NHS3 is a valid, easily applicable measure of seizure severity that is acceptably reliable for use in trials of novel AEDs.
Epilepsy Surgery in Infants
Authors: Wyllie Elaine , Comair Youssef G. , Kotagal Prakash , Raja Shanker , Ruggieri Paul
Published: August 2005

Purpose: We report 12 infants who had frontal (n = 3), temporal (n = 2), or temporoparieto‐occipital (n = 2) resection or functional hemispherectomies (n = 5) at age 2.5–29 (mean 15.3) months for catastrophic epilepsy due to focal cortical dysplasia (n = 5), Sturge‐Weber syndrome (n = 3), ganglioglioma (n = 3), or hemimegalencephaly (n = 1). Seizures began at 1 day to 14 months (mean, 4.0 months) after birth, occurred frequently (often many times per day, and were refractory to antiepileptic drugs. Patients were evaluated for surgery at 2.5–24 (mean 12.4) months of age. Seven patients had hemiparesis and eight had slowed cognitive development. Seizures were characterized by arrest or marked reduction of behavioral motor activity with unclear level of consciousness (n = 4, with temporal or temporoparietal EEG seizures), focal clonic activity (n = 3, with perirolandic EEG seizures), generalized tonic stiffening (n = 3, with temporoparieto‐occipital, parietal, or frontal EEG seizures), or infantile spasms and hypsarrhythmia (n = 2, with a frontal tumor or temporoparieto‐occipital cortical dysplasia).

Methods: Magnetic resonance imaging (MRI) revealed the epileptogenic lesion in all but two patients, both with cortical dysplasia localized by interictal positron‐emission tomography (PET) and other clinical or EEG features and confirmed on histopathologic examination of resected tissue.

Results: At follow‐up 4‐86 (mean 32) months after surgery, six patients were seizure free (Engel outcome class I), three had rare seizures with none in at least the previous 6 months (Engel class II), and two had worthwhile improvement (Engel class III). Except for the severely developmentally delayed infant with hemimegalencephaly, several patients had marked “catch‐up” developmental progress after class I, 11, or III outcome. Postoperative complications included subdural hematoma over the contralateral hemisphere (one patient) and entrapment and enlargement of the ipsilateral temporal horn (one patient) after hemispherectomy, both corrected uneventfully with a second surgical procedure. One patient died of unexplained causes several hours after frontal lobectomy. No patients had new neurologic deficits after surgery, and one patient had resolution of progressive fluctuating hemiparesis after resection of temporoparieto‐occipital cortical dysplasia.

Conclusions: Our results agree with previous reports that epilepsy surgery can provide relief from catastrophic epilepsy in carefully selected infants.
Effect of Seizures on Cerebral Blood Flow Measured with 15–H2O and Positron Emission Tomography
Authors: Theodore W. H. , Balish M. , Leiderman D. , Bromfield E. , Sato S. , Herscovitch P.
Published: August 2005

Summary: To study quantitative alterations in regional cerebral blood flow (rCBF) accompanying seizures, and to assess the utility of ictal activation PET scanning as a noninvasive clinical tool for localization of epileptogenic foci, we used pentylenetetrazole (F'TZ) to induce seizures during 15O‐water positron emission tomography (PET) CBF measurement in 15 patients with uncontrolled complex partial seizures (CPS) who had been referred for surgical evaluation. Continuous EEG monitoring was performed during the PET scans. After baseline scans were obtained, each patient was injected with 150–300 mg PTZ. Two patients had generalized tonic‐clonic seizures (GTCs). CBF increases were asymmetrical. Two patients (in 1 the seizure occurred spontaneously, without PTZ injection) who had CPS had bitemporal 70–80% increases in CBF. Thalamic CBF increased during both CPS and GTCS. Five patients had an increase in focal EEG in‐terictal abnormality, accompanied by focal flow decreases in 3. PTZ injection not accompanied by clinical seizures did not increase CBF. Partial seizures may be associated with bilateral increases in CBF, and subcortical gray regions are involved in ictal activation.
Association of Combined MRI, Interictal EEG, and Ictal EEG Results with Outcome and Pathology After Temporal Lobectomy
Authors: Gilliam F. , Bowling S. , Bilir E. , Thomas J. , Faught E. , Morawetz R. , Palmer C. , Hugg J. , Kuzniecky R.
Published: August 2005

Summary: Purpose: Magnetic resonance imaging, interictal scalp EEG, and ictal scalp EEG each have been shown to localize the primaly epileptic region in most patients with mesial‐basal temporal lobe epilepsy (MBTLE), but the association of surgical outcome and pathology with each combination of these test results is not known.

Methods: We reviewed the MRI, interictal scalp EEG, and ictal scalp EEG results of 90 consecutive patients with MBTLE. Twelve patients were excluded from the analysis because inconclusive bitemporal intracranial EEG results precluded anterior temporal lobectomy (ATL); none had concordant MRI and interictal scalp EEG results. We compared all combinations of presurgical MRI, interictal EEG, and ictal EEG results to seizure outcome and tissue pathology in the 78 patients who underwent an ATL.

Results: Forty‐eight (61%) patients had concordant lateral‐ized MRI and interictal EEG temporal lobe abnormalities, with no discordant ictal EEG results; 77% of these patients were seizure‐free after ATL. Concordance of MRI and interictal EEG abnormalities correlated with seizure cessation (p < 0.05), compared to all combinations with discordant or nonlateralizing MRI and interictal EEG results. Mesial temporal sclerosis (MTS) was confirmed pathologically in about 80% of both groups (p = 0.5). Outcome in patients with concordant MRI and ictal EEG with nonlateralizing interictal EEG was significantly worse than combinations with concordant MRI and interictal EEG (p < 0.02).

Conclusions: Compared to other combinations of test results, concordance of MRI and interictal EEG is most closely associated with surgical outcome in MBTLE. However, most selected patients have pathologic confirmation of MTS regardless of test results or outcome. This information may be useful for planning the presurgical evaluation of patients with medically intractable MBTLE.
Analysis of Seizure Manifestations of ‘Pure’ Frontal Lobe Origin
Authors: Mihara Tadahiro , Tottori Takayasu , Matsuda Kazumi , Otsubo Toshiaki , Inoue Yushi , Yagi Kazuichi , Seino Masakazu
Published: August 2005

Summary: With the intention of subclassifying frontal lobe epilepsies based on ictal semiology, we scrutinized the seizure manifestations in 18 patients with “pure” frontal lobe epilepsy who underwent corticectomy restricted to the frontal lobe after undergoing invasive long‐term EEG/video monitoring and achieved excellent seizure outcome. All patients had well‐localized lesions. By combining principal seizure manifestations unequivocally appearing during the ictal events, we were able to subdivide the patients into the following three groups: group 1, supplementary motor seizures with tonic posturing and other relevant symptoms with consciousness retained; group 2, focal motor seizures with elementary clonic and/or tonic symptoms with consciousness also retained; and group 3, psychomotor seizures with various automatisms usually accompanying impairment of consciousness. In addition, localization of the epileptogenic lesions enabled us to conclude that in both the focal motor seizure group and the supplementary motor seizure group the epileptogenic zones were restricted to the posterior third of the frontal lobe generating somatomotor manifestations, whereas in the psychomotor seizure group the epileptogenic zones were largely in the anterior two thirds of the frontal lobe, where there may be no neuronal substratum primarily generating seizure manifestations. The electroclinical progress of psychomotor automatisms in 3 patients is presented in relation to seizure spread.
Quality of Life of People with Epilepsy: A European Study
Authors: Baker Gus A. , Jacoby Ann , Buck Deborah , Stalgis Carlos , Monnet Dominique
Published: August 2005

Summary: Purpose: To study the impact of epilepsy and its treatment on people with epilepsy in Europe. We therefore aimed to collect data from as many countries as possible.

Methods: Clinical and demographic details and information about psychosocial functioning was collected using self‐completed questionnaires mailed to members of epilepsy support groups.

Results: Quality of life data was collected from >5,000 patients living in 15 countries in Europe. Over a third of all respondents had frequent seizures, and a fifth believed that their seizures were not well enough controlled by antiepileptic medication. Reported levels of side effects from medication were high. A significant number of respondents reported changing their medication because of side effects or poor control. Respondents reported that epilepsy and its treatment had a significant impact on a number of different aspects of their daily lives. Half of all respondents felt stigmatised by their epilepsy. There were significant differences by seizure type and frequency in the way respondents scored on measures of the perceived impact of their condition, the stigma associated with it and their health status as measured by a generic scale, the SF36.

Conclusions: This study confirms the findings of previous smaller‐scale studies that reducing side effects and achieving better control of seizures are key to improving the quality of life of people with epilepsy, as is reducing the stigma and handicap associated with it.
Multiple Kainic Acid Seizures in the Immature and Adult Brain: Ictal Manifestations and Long–Term Effects on Learning and Memory
Authors: Sarkisian Matthew R. , Tandon Pushpa , Liu Zhao , Yang Yili , Hori Ariyuki , Holmes Gregory L. , Stafstrom Carl E.
Published: August 2005

Summary: Purpose: While there is increasing evidence that the adverse effects of prolonged seizures are less pronounced in the immature than in the mature brain, there have been few investigations of the long‐term effects of recurrent seizures during development. This study examined the effects of multiple administrations of the convulsant kainic acid (KA) on seizure characteristics and spatial learning as a function of brain development.

Method: To determine the long‐term effects of serial KA seizures during ontogeny, saline or convulsant doses of KA were given intraperitoneally 4 times, at 2‐day intervals. Immature rats were given KA on P20, P22, P24 and P26; adult rats got KA on P60, P62, P64 and P66. Ictal characteristics and EEGs were recorded. To examine the effects of multiple KA seizures on the retention of spatial learning, water maze testing was performed before (immature group: from P16–19, adult group: from P56–P59) and after (immature: from P60–P63, adult: from P1OO–Pl03) KA injections. Finally, histology was performed to compare KA‐induced damage at each age.

Results: In immature animals, serial KA administration resulted in seizures with a progressively longer onset latency anddecreased severity. In contrast, KA serially administered to adult rats caused severe seizures after each of the 4 injections. In immature rats, epileptiform EEG changes were most prominent after the first KA injection, whereas in adults, prolonged paroxysmal EEG patterns were seen after all 4 KA injections. Before KA, both rat pups and adults acquired place learning in the water maze. One month after the final KA injection, there was no deficit in spatial learning retention in the immature group, whereas the adult group had profound impairment compared to age‐matched, saline‐injected controls. Histology revealed no lesions in immature rats treated multiple times with KA but profound cell loss in hippocampal fields CA4, CA3 and CAI in rats treated serially with KA as adults.

Conclusions: Previous studies have shown that a single KA injection causes prolonged status epilepticus (which persists for several hours), leading to severe histologic and behavioral sequelae in adult rats but not in pups. Our study extends those findings, demonstrating that immature rats are spared the cognitive and pathological sequelae of multiple injections of convulsant doses of KA as well.
Intracranial EEG Substrates of Scalp Ictal Patterns from Temporal Lobe Foci
Authors: Pacia Steven V. , Ebersole John S.
Published: August 2005

Summary: Purpose: To determine the intracranial EEG features responsible for producing the various ictal scalp rhythms, which we previously identified in a new EEG classification for temporal lobe seizures.

Methods: In 24 patients, we analyzed simultaneous intracranial and surface ictal EEG recordings (64 total channels) obtained from a combination of intracerebral depth, subd‐ural strip, and scalp electrodes.

Results: Four of four patients with Type 1 scalp seizure patterns had mesial temporal seizure onsets. However, discharges confined to the hippocampus produced no scalp EEG rhythms. The regular 5‐ to 9‐Hz subtemporal and temporal EEG pattern of Type 1a seizures required the synchronous recruitment of adjacent inferolateral temporal neocortex. Seizure discharges confined to the mesiobasal temporal cortex produced a vertex dominant rhythm (Type 1c) due to the net vertical orientation of dipolar sources located there. Ten of 13 patients with Type 2 seizures had inferolateral or lateral, temporal neocortical seizure onsets. Initial cerebral ictal activity was typically a focal or regional, low voltage, fast rhythm (20–40 Hz) that was often associated with widespread background flattening. Only an attenuation of normal rhythms was reflected in scalp electrodes. Irregular 2‐ to 4‐Hz cortical ictal rhythms that commonly followed resulted in a comparably slow and irregular scalp EEG pattern (Type 2a). Type 2C seizures showed regional, periodic, 1– to 4‐Hz sharp waves following intracranial seizure onset. Seven patients had Type 3 scalp seizures, which were characterized by diffuse slowing or attenuation of background scalp EEG activity. This resulted when seizure activity was confined to the hippocampus, when there was rapid seizure propagation to the contralateral temporal lobe, or when cortical ictal activity failed to achieve widespread synchrony.

Conclusions: Type 1, 2, and 3 scalp EEG patterns of temporal lobe seizures are not a reflection of cortical activity at seizure onset. Differences in the subsequent development, propagation, and synchrony of cortical ictal discharges produce the characteristic scalp EEG rhythms.
Persistence of Photosensitivity
Authors: Harding G. F. A. , Edson A. , Jeavons P. M.
Published: August 2005

Summary: Purpose: One hundred patients with photosensitive epilepsy were investigated as part of an ongoing follow‐up study. Average duration of follow‐up was 14 years; mean age at follow‐up was 27 years.

Methods: All patients were EEG investigated using a standard technique of intermittent photic stimulation (IPS). The presence of a photoparoxysmal response (PPR) or a degraded PPR indicated the presence of photosensitivity.

Results: Seventy‐seven patients became seizure free. Of the untreated patients, photosensitivity disappeared in 14 patients but was present in 32 patients. Of the patients who were treated, 31 showed evidence of PPRs or degraded PPRs, but 23 patients no longer showed evidence of photosensitivity. Thirty‐two mothers had 67 children during the follow‐up period. Thirteen have so far proved to be sensitive to IPS in the laboratory and four have also had photosensitive seizures induced in the outside environment. Nine of the children have been found not to be photosensitive nor have they had seizures.

Conclusions: This study suggests that photosensitivity persists in at least two thirds of patients with photosensitive epilepsy and that valproate is effective in controlling this photosensitivity.
Resection of Frontal Encephalomalacias for Intractable Epilepsy: Outcome and Prognostic Factors
Authors: Kazemi N. J. , So Elson L. , Mosewich R. K. , O'Brien T. J. , Cascino G. D. , Trenerry M. R. , Sharbrough F. W.
Published: August 2005

Summary: Purpose: Because focal encephalomalacia is an important cause of medically intractable partial epilepsy and few studies have evaluated the efficacy and the safety of resecting focal encephalomalacias to improve seizure control, we studied a cohort of 17 consecutive patients who underwent resection of encephalomalacias in the frontal lobes as a treatment of their intractable epilepsy.

Methods: We evaluated several factors for their value in predicting postsurgical seizure control. Pre‐ and postsurgical magnetic resonance imaging (MRI) scans were reviewed independently by 2 blinded investigators.

Results: At a median of 3 years of follow‐up (range 0.6–7.5 years), 12 patients (70%) were seizure‐free or had only rare seizures. The presence of a focal fast frequency discharge (focal ictal β pattern) at the beginning of seizures on scalp EEG was predictive of seizure‐free outcome (p = 0.017), even among patients who had complete resection of their encephalomalacias (p = 0.016). There was no significant differences in outcome with regard to age at the time of the injury that caused encephalomalacia, interval between injury and onset of seizures, duration of presurgical seizure history, presurgical seizure frequency, age at surgery, or the completeness of encephalomalacia resection. The analysis regarding completeness of encephalomalacia resection almost reached significance, suggesting that it may also be an important predictive factor (p = 0.051).

Conclusions: We conclude that surgery is a very effective treatment for intractable frontal lobe epilepsy (FLE) secondary to encephalomalacias. Patients are more likely to become seizure‐free if they have a focal ictal β discharge on their scalp EEG. Complete resection of the encephalomalacia should be attempted, since our results suggest that this may be a favorable predictive factor. Moreover, the operative strategy for our patients entailed, whenever possible, complete resection of the encephalomalacias and of the adjacent electrophysiologically abnormal tissues.
“Cavernous Sinus EEG”: A New Method for the Preoperative Evaluation of Temporal Lobe Epilepsy
Authors: Mikuni Nobuhiro , Ikeda Akio , Murao Kenichi , Terada Kiyohito , Nakahara Ichiro , Taki Waro , Kikuchi Haruhiko , Shibasaki Hiroshi
Published: August 2005

Summary: Purpose: In presurgical evaluation of temporal lobe epilepsy (TLE), invasive methods are necessary if results of various noninvasive methods are not sufficiently convergent enough to identify the epileptogenic area accurately. To detect the epileptiform discharges originating specifically from the mesial temporal lobe, we applied the cavernous sinus catheterization technique.

Methods: We placed Seeker Lite‐10 guide wire electrodes into bilateral cavernous sinus through the internal jugular veins to record EEG (cavernous sinus EEG) in 6 patients with intractable TLE. Scalp EEG was simultaneously recorded in all 6 and electrocorticogram (ECoG) was also recorded in 4.

Results: The cavernous sinus EEG demonstrated clear epileptiform discharges, sometimes even when they were absent on the simultaneously recorded scalp EEG. The epileptiform discharges recorded from the cavernous sinus electrodes were specifically associated with those in the mesial temporal region.on ECoG. Ictal EEG pattern originating from mesial temporal lobe was also clearly documented on the cavernous sinus EEG.

Conclusions: This new, semi‐invasive method of identifying epileptogenic areas can detect the epileptiform discharges specifically arising from the mesial temporal lobe; it is as useful as or complements the invasive techniques such as foramen ovale or depth recording.
Rasmussen's Syndrome: Longitudinal EEG Study from the First Seizure to Epilepsia Partialis Continua
Authors: Capovilla G. , Paladin F. , Bernardina B. Dalla
Published: August 2005

Summary: Purpose: The aim of our work was to describe the initial electroencephalographic characteristics of Rasmussen's syndrome (RS).

Methods: We performed repeated EEG recordings in an 11–year 5–month‐old girl affected by RS, as demonstrated through the progressive evolution of the illness. All EEGs were carried out in polygraphy and videorecordered, both in waking and in sleep.

Results: In our opinion, our patient's EEG picture is absolutely unusual in childhood partial epilepsy form without any neuroradiologic perturbation. Delta focal activity persistence in such a clinical context should be considered an RS sign, among the possible causes.

Conclusioits: We are not aware of any early‐stage RS EEG description. We think that the initial RS EEG picture is so unusual as to suggest such pathology. We hope that analogous reports can confirm our belief.
Effect of Complete and Partial Bilateral Lesions of the Deep Cerebellar Nuclei on Amygdaloid Kindling in Rats
Authors: Min Jason K. , Valentine Pamela A. , Teskey G. Campbell
Published: August 2005

Summary: Purpose: The roles of the deep cerebellar nuclei in epileptogenesis and seizure expression are not well defined. To determine their properties, we examined the effects of lesions to the dentate, fastigial, and interpositus nuclei in adult rats that were electrically kindled in the amygdaloid complex. Changes in afterdischarge duration (ADD) as well as the expression and progression of behavioral seizures to fully generalized tonic‐clonic convulsions (stage 5) were assessed.

Methods: Fifty rats first underwent bilateral electrolytic lesions of either the dentate, fastigial, or interpositus nuclei. After a 7–day recovery period, they were kindled daily until they manifested two stage 5 convulsions. Careful histological examination was used to determine lesion extent.

Results: When the dentate or fastigial nucleus was completely destroyed on the side contralateral to the stimulated amygdala, fewer stimulations were required to produce stage 5 seizures and latencies to the expression of forelimb clonus were shorter, as were ADD. On the other hand, when the dentate or fastigial neucleus was only partly obliterated on the contralateral side, more stimulations were required to produce stage 5 seizures and ADD was longer. Neither complete nor partial lesions of the interpositus nuclei had any effect on the number of stimulations to reach a stage 5 seizure, latency to the expression of clonus, or ADD.

Conclusions: Our findings suggest that the dentate and fastigial nuclei, but not the interpositus nuclei, may normally retard epileptogenesis and inhibit clonic behaviors, but paradoxically may facilitate ADD.
Epilepsy Surgery in the First Three Years of Life
Authors: Duchowny M. , Jayakar P. , Resnick T. , Harvey A. S. , Alvarez L. , Dean P. , Gilman J. , Yaylali I. , Morrison G. , Prats A. , Altman N. , Birchansky S. , Bruce J.
Published: August 2005

Summary: Purpose: Partial seizures in early postnatal life may be catastrophic and associated with poor long‐term outcome. Epilepsy surgery can alleviate partial seizures in older children and adults, but there is little experience with surgical therapy in infancy apart from hemispheric epilepsy syndromes.

Methods: We analyzed the results of cortical resection to treat medically refractory partial epilepsy in 31 children (16 boys, 15 girls) aged <3 years (mean, 18.3 months). Subjects were included only if seizure relief was the primary indication for surgery.

Results: Follow‐up of at least 1 year (mean, 4.6 years) in 26 patients revealed that 16 were seizure‐free, 4 had >90% seizure reduction, and 6 had <90% reduction. There was no significant difference in seizure outcome between hemispherectomy/multilobar resections and lobar resections or temporal versus extratemporal resection. Seizure outcome was independent of the amount of cortex removed in nonlesional patients. Only the presence of a discrete lesion on preoperative neuroimaging correlated with a favorable outcome. Family perceptions of accelerated development in seizure‐free patients were not confirmed on developmental assessment.

Conclusions: We conclude that cortical resection often benefits very young children with catastrophic partial seizures, but does not guarantee enhanced neurological development. The location and extent of the excised cortex may not be critical as long as the entire epileptogenic region and tesion are removed.
Intractable Epilepsy in a Population‐Based Series of Mentally Retarded Children
Authors: Steffenburg Ulf , Hedström Anders , Lindroth Anne , Wiklund Lars‐Martin , Hagberg Gudrun , Kyllerman Mårten
Published: August 2005

Summary: Purpose: The characteristics of intractable epilepsy were analyzed in a population‐based study of active epilepsy in mentally retarded children aged 6–13 years.

Methods: Diagnostic registers, EEG laboratory registers, and registers for the Education of the Subnormal were searched. Medical files were scrutinized. Clinical examinations and interviews with parents and caregivers or both were performed. EEG recordings, computed tomography (CT) and magnetic resonance imaging (MRI) of the CNS were reevaluated.

Results: Forty‐five percent (44 of 98) of the children with mental retardation (MR) and active epilepsy had intractable seizures, defined as one or more seizures every day or week. The median age at onset was 0.8 years, as compared with 3.0 years for those with controlled epilepsy. Predictive factors for frequent seizures were the number of seizure types, severe MR, status epilepticus (SE) and tonic seizures. Epileptiform EEG activity was present in 91%, and focal activity in 65%. Brain lesions were detected on CT and MRI in 70%, with generalized lesions in 60%. Concurrent focal epileptiform activity and focal brain lesions on CTIMRI were detected in 26%. The percentages and prevalence rates for infantile spasms (IS) and Lennox‐Gastaut syndrome (LGS) were 18% (0.25 in 1,000) and 7% (0.06 in 1,000), respectively. One of 8 children with IS had had previous neonatal seizures, 3 had SE and 1 later developed LGS.

Conclusions: Children with MR and intractable epilepsy have a high frequency of severe MR and additional major neuroimpairments. EEG recordings frequently showed focal changes despite generalized lesions in neuroradiology.