bluuebunny/crossref_metadata_2025 huggingface dataset:
Postictal Nosewiping Lateralizes and Localizes to the Ipsilateral Temporal Lobe
Authors: Hirsch Lawrence J. , Lain Aurelio H. , Walczak Thaddeus S.
Published: August 2005

Summary: Purpose: We observed many patients with temporal lobe epilepsy (TLE) wiping their nose postictally, usually with the hand ipsilateral to their seizure focus. We wished to determine if this had lateralizing or localizing significance.

Methods: We retrospectively studied 87 patients: 47 with unilateral TLE defined by successful surgical outcome [30 with medial TLE (MTLE) and 17 with neocortical TLE (neoTLE)]; and 40 with extratemporal epilepsy (ExTLE). Videotapes of 319 complex partial seizures (CPS) without generalization were reviewed by 1 neurologist, blinded to patient identity, who recorded each episode of nosewiping and the hand with which it was performed.

Results: With regard to localizing potential, postictal nosewiping (PINW) was significantly more common in patients with unilateral TLE than in those with ExTLE. In the TLE group, PINW within 60 s of electrographic seizure offset occurred in 60% of patients (28 of 47) and 43% of seizures (74 of 171). In the ExTLE group, PINW was noted in 33% of patients (13 of 40; p < O.05 as compared with TLE) and 15% of seizures (22 of 148; p < O.001). Similar results were obtained with PINW within 30 s of seizure offset. Although PINW was more frequent in MTLE than in neoTLE (67% of patients vs. 47%), this finding did not reach significance. With regard to lateralizing potential, in the TLE group, unilateral PINW (performed with a single hand only) within 60 s of seizure offset was observed in 53% of patients (25 of 47) and was performed with the hand ipsilateral to the seizure focus in 92% (23 of 25). Thirteen patients (9 with TLE) wiped their nose more than once with the same hand in a single seizure within 60 s of offset in 18 seizures; this was done with the hand ipsilateral to the seizure focus in all 18 instances (predictive value = 100%).

Conclusions: PINW is more common in unilateral TLE, particularly MTLE, than in ExTLE. PINW performed exclusively with one hand occurs in ∼50% of patients with TLE and is highly predictive (92%) of seizure onset ipsilateral to the hand used, especially when it occurs repetitively. We hypothesize that ictal activation of the central autonomic nervous system, particularly the amygdala, results in ictal nasal secretions and causes nosewiping as the patient regains awareness postictally. The ipsilateral hand is used due to contralateral neglect or weakness.
Carbamazepine Effects on Na+ Currents in Human Dentate Granule Cells from Epileptogenic Tissue
Authors: Reckziegel G. , Beck H. , Schramm J. , Urban B. W. , Elger C. E.
Published: August 2005

Summary: Purpose: Carbamazepine (CBZ) is a well‐established drug in the therapy of temporal lobe epilepsy (TLE). The anticonvulsant action of CBZ has been explained mainly by use‐dependent effects on voltage‐dependent Na+ channels in various nonhuman cell types. However, it is unclear whether Na+ currents in neurons within the focal epileptogenic area of patients with medically intractable TLE show similar characteristics.

Methods: Therefore we used the whole‐cell patch‐clamp technique to investigate the effects of CBZ on voltage‐dependent Na+ currents in 23 acutely isolated dentate granule cells (DGCs) from the resected hippocampus of eight patients with medically intractable TLE.

Results: As in findings in animal preparations, CBZ significantly reduced the amplitude of the Na+ current and significantly shifted the current‐voltage dependence of the steady‐state inactivation in the hyperpolarizing direction. In contrast, the rapid component of the recovery from inactivation of the Na+ currents was not affected by CBZ. In addition, the reduction of the Na+ current amplitude observed during repetitive stimulation with depolarizing pulses was not significantly altered by CBZ.

Conclusions: In summary, CBZ strongly affects the voltage‐dependent steady‐state inactivation, with no effects on the removal of inactivation in Na+ currents of human DGCs. In spite of the lack of suitable control material, the CBZ insensitivity of the removal of inactivation may be an interesting concept to explain the medically intractable TLE in these patients.
Epilepsy Awareness Among School Teachers in Thailand
Authors: Kankirawatana Pongkiat
Published: August 2005

Summary: Purpose: Epilepsy is one of the most common neurologic disorders of childhood. However, in Thailand, as well as in most of other developing countries, little attention has been paid to improve the public knowledge regarding epilepsy. Currently public attitude toward epilepsy is rather negative, full of prejudices and bias. Children with epilepsy in Thailand still find themselves confronted with social barriers that prevent them from academic achievements, in addition to the limitation that the disease itself has already placed on them. To delineate the magnitude and scope of this problem, we performed a small pilot study to assess the knowledge, attitude, and practice of epilepsy in the schoolteachers in Thailand whose major impact on the children is manifested by attitudes and learning.

Methods: The study was conducted by sending simple self‐administered questionnaires to 360 schools all over Thailand. The questionnaires contained 14 questions relating to epilepsy awareness, attitudes, and first‐aid management of seizures.

Results: We found that 38% of respondents had not heard of or read about epilepsy, and 46.6% believed that epilepsy is a chronic incurable disease. Fifteen percent of the respondents preferred to place all children with epilepsy in a special classroom. Furthermore, half of the respondents who had experience with first‐aid management of seizures used improper and potentially harmful measures.

Conclusions: Besides the proper management of epilepsy, a general public education campaign for epilepsy and the need to address and correct the existing biases are necessary to improve the quality of life of children with epilepsy in Thailand.
Differential Neuronal and Glial Relations with Parameters of Ictal Discharge in Mesial Temporal Lobe Epilepsy
Authors: Spencer Susan S. , Kim Jung , DeLanerolle Nihal , Spencer Dennis D.
Published: August 2005

Summary: Purpose: EEG recordings of spontaneous seizures should provide clues to epilepsy pathogenesis and pathology. We examined onset, propagation, and termination characteristics of spontaneous seizures recorded by intracranial EEG in temporal lobe (TL) epilepsy in relation to neuronal, glial, and synaptic changes in the same tissue.

Methods: All of our patients with intracranial EEG recordings of spontaneous TL seizure onset, subsequent TL resection, and quantitative pathologic analysis of resected tissue were included. Seizure parameters were mean time to initial propagation, mean total electrical duration, uniformity of seizure‐onset distribution and location, and percentage of seizures with spiking onset per patient. Tissue was analyzed for glial and neuronal density in hippocampal fields and presence of sprouting. Outcome was classified as seizure free or not.

Results: All seizures with onset in resected TL in 62 patients were analyzed. The percentage of each patient's seizures with spike onsets was significantly correlated with glial density in CA3 (p < 0.01). Initial propagation time was significantly and inversely correlated with neuronal density in CA4 (p < 0.02). Electrical seizure duration was significantly correlated with glial density in CA2 and CA3 (p < 0.02). Neuronal and glial density were significantly (and inversely) related to one another only in CA1 (p < 0.001). Outcome was most significantly related to uniform hippocampal seizure onset. Presence or absence of sprouting was not significantly related to outcome or any EEG measure.

Conclusions: These results suggest both glia and neurons exert independent influences on the expression of ictal discharges in seizures of medial TL onset. Glial density influenced interictal‐ictal transition, whereas neuronal density influenced seizure propagation. These findings may have implications for pathogenesis.
Prospective Population‐Based Study of Intermittent and Continuous Convulsive Status Epilepticus in Richmond, Virginia
Authors: Waterhouse Elizabeth J. , Garnett Linda K. , Towne Alan R. , Morton Lawrence D. , Barnes Thomas , Ko Daijin , DeLorenzo Robert J.
Published: August 2005

Summary: Purpose: Previous work suggested that there is a lower mortality for convulsive status epilepticus (SE) with intermittent seizures (intermittent SE) as opposed to SE with continuous seizure activity (continuous SE). A plausible hypothesis to explain this difference is that the shorter ictal time in intermittent SE is responsible for the lower mortality in this group. This study investigates the relative contributions of total ictal time and SE duration to the differing mortalities of intermittent and continuous SE.

Methods: Six hundred forty‐five cases of prospectively identified convulsive SE were examined. Nonparametric statistical methods were used to compare continuous SE and intermittent SE variables. Multivariate logistic regression analyses were used to determine which factors were most highly associated with mortality. Intermittent SE cases were analyzed to evaluate the relative contributions of ictal time versus SE duration to mortality.

Results: Intermittent SE had a significantly lower mortality than continuous SE (19.6 vs. 31.4%; p < 0.001) in adults but not in children. Intermittent and continuous SE durations did not significantly differ in adult cases but did differ in pediatric cases. Ictal time was significantly shorter than SE duration for intermittent SE in both adults and children. After adjusting for age, etiology, and SE duration, SE type (continuous SE vs. intermittent SE) was shown to have an independent effect on mortality in adults. The relative risk of mortality for continuous SE was 1.79 times that of intermittent SE (p = 0.04). After controlling for SE duration, ictal time did not significantly affect mortality in adults.

Conclusions: Intermittent and continuous convulsive SE were common in both pediatric and adult populations. Intermittent SE had a significantly lower mortality than did continuous SE. This difference in mortality was not completely explained by differences in SE duration, total ictal time, etiology, or age. Further research is needed to identify the factor(s) contributing to the significant difference in mortality between intermittent SE and continuous SE.
Induction of Ethinylestradiol and Levonorgestrel Metabolism by Oxcarbazepine in Healthy Women
Authors: Fattore C. , Cipolla G. , Gatti G. , Limido G. L. , Sturm Y. , Bernasconi C. , Perucca E.
Published: August 2005

Summary: Purpose: To evaluate the effect of oxcarbazepine (OCBZ) on the pharmacokinetic profile of steroid oral contraceptives.

Methods: Twenty‐two healthy women aged 18–44 years were recruited, and 16 of them completed the study. By using a randomized double‐blind crossover design, each woman was studied in two different menstrual cycles, during which placebo or OCBZ (maintenance dosage, 1,200 mg/day) was given in randomized sequence for 26 consecutive days with a washout of at least one cycle in between. A steroid oral contraceptive containing 50 μg ethinylestradiol (EE) and 250 μg levonorgestrel (LN) was taken for the first 21 days of each cycle. Plasma concentrations of EE and LN were measured by gas chromatography‐mass spectrometry in samples collected at regular intervals on days 21–23 of each cycle.

Results: Compared with placebo, areas under the plasma concentration curves (AUC0–24h, geometric means) decreased by 47% for both EE (from 1,677 to 886 pg.h/ml; p < 0.01) and LN (from 137 to 73 ng.h/ml; p < 0.01), during OCBZ treatment. Peak plasma EE concentrations decreased from 180 pg/ml during the placebo cycle to 117 pg/ml during the OCBZ cycle (p < 0.01), whereas peak plasma LN concentrations decreased from 10.2 to 7.7 ng/ml (p < 0.01). The half‐lives of EE and LN also decreased from 13.6 to 7.9 h (p < 0.01) and from 28.8 to 15.8 h, respectively (p < 0.01).

Conclusions: OCBZ reduces plasma concentrations of the estrogen and progestagen components of steroid oral contraceptives, presumably by stimulating their CYP3A‐mediated metabolism in the liver or gastrointestinal tract or both. Because this may lead to a decreased efficacy of the contraceptive pill, women treated with OCBZ should receive preferentially a high‐dosage contraceptive and should be monitored for signs of reduced hormonal cover.
The Effect of Tetanus Toxin‐Induced Limbic Epilepsy on the Exploratory Response to Novelty in the Rat
Authors: Mellanby J. , Johansen‐Berg H. , Leyland R. , Milward A. J.
Published: August 2005

Summary: Purpose: To investigate the exploratory response to novelty in rats that have recovered from experimental limbic epilepsy.

Methods: Epilepsy was induced in 12 male rats by injecting a minute amount of tetanus toxin into the ventral hippocampus (and buffer vehicle was injected into 12 controls). Eight weeks after the injection, when the animals appeared behaviourally normal (and previous work would indicate that their electroencephalograms also would have returned to normal), they were tested on the playground maze. In this, their exploratory response to a novel object introduced in the context of seven familiar objects is measured. Simultaneously, their locomotion and investigation of familiar objects is measured.

Results: Whereas the control animals showed a significant response to the novel object on both test days, in the toxin‐injected rats the novelty response was not present. There was no difference between the groups on the locomotion measure, but the toxin rats explored the familiar as well as the novel objects less.

Conclusions: The exploratory response to a novel object was abolished in the previously epileptic rats.
Posttraumatic Epilepsy Risk Factors: One‐Year Prospective Study After Head Injury
Authors: Angeleri F. , Majkowski J. , Cacchiò G. , Sobieszek A. , D'Acunto S. , Gesuita R. , Bachleda A. , Polonara G. , Królicki L. , Signorino M. , Salvolini U.
Published: August 2005

Summary:Purpose:Prospective evaluation of risk factors for posttraumatic epilepsy (PTE) by using clinical, EEG, and brain computed tomography (CT) data in four assessments from the head injury (HI) acute phase to 1 year later; and evaluation of the possible epileptogenic role of hemosiderin as shown by brain magnetic resonance imaging (MRI).

Methods:Risk factors for PTE were evaluated by using Kaplan‐Meier curves, log‐rank test, and the Cox model in 137 consecutively enrolled adult inpatients. Percentage differences of patients with brain hyperintense and/or hemosiderin areas shown by MRI 1 year after HI were statistically evaluated by univariate tests considering two subgroups [e.g., patients with (PTE) and without (WLS) late seizures].

Results:The PTE subgroup included 18 patients with at least two seizures between the second and twelfth months. Kaplan‐Meier curves demonstrated that Glasgow Coma Scale low score, early seizures, and single brain CT lesions are PTE risk factors, as is the development of an EEG focus 1 month after HI. No significant percentage difference was found between PTE and WLS patients with hemosiderin spots shown by MRI 1 year after HI.

Conclusions:the Cox model indicates that, for HI patients with early seizures and brain CT single temporal or frontal lesions in the acute phase, the PTE risk is 8.58 and 3.43 times higher, respectively, than for those without. An EEG focus 1 month after HI is a risk factor 3.49 times higher than for patients without such EEG changes. One year after HI, a higher percentage of PTE than WLS patients had cortical MRI hyper‐intense areas including hemosiderin.
Focal Status Epilepticus: Clinical Features and Significance of Different EEG Patterns
Authors: Drislane Frank W. , Blum Andrew S. , Schomer Donald L.
Published: August 2005

Summary: Purpose: Focal status epilepticus is typically diagnosed by the observation of continuous jerking motor activity, but many other manifestations have been described. EEG evidence of focal status may take several forms, and their interpretation is controversial. We detailed the clinical spectrum of focal status in patients diagnosed by both clinical deficit and EEG criteria and contrasted clinical manifestations in patients with different EEG patterns.

Methods: Patients were diagnosed with a neurologic deficit and discrete recurrent focal electrographic seizures or rapid, continuous focal epileptiform discharges on EEG. Clinical findings were determined by chart review.

Results: Of 41 patients with focal status, acute vascular disease was the cause in 21; 10 of 41 had exacerbations of prior epilepsy. A variety of clinical seizure types occurred, both before and after the EEG diagnosis, but the diagnosis was not expected in 28 patients before the EEG. Three had no obvious clinical seizures. Focal motor seizures and an abnormal mental status were the most common manifestations at the time of the EEG. With antiepileptic drugs, almost all had control of clinical seizures, and most improved in mental status. Patients with rapid continuous focal epileptiform discharges were nearly identical in presentation, likelihood of diagnosis, subsequent seizures, response to medication, and outcome to those with discrete seizures on EEG.

Conclusions: Focal status epilepticus may be seen with a wide variety of clinical seizure types or without obvious clinical seizures. The diagnosis is often delayed or missed and should be considered after strokes or clinical seizures when patients do not stabilize or improve as expected. The diagnosis should be made equally whether patients have discrete electrographic seizures or continuous rapid focal epileptiform discharges on the EEG, and the same response to medications and outcome should be anticipated for the two groups.
Forced Normalization: Clinical and Therapeutic Relevance
Authors: Krishnamoorthy E. S. , Trimble M. R.
Published: August 2005

The phenomenon of forced normalization and its clinical counterpart, alternative psychoses, is discussed. The historical origins are briefly noted before the clinical presentation, and some associated clinical findings are given. The main part of the article is devoted to the literature on chemical and electrical kindling, in an attempt to provide some heuristic model to understand the antithetical relationship between seizures and behavior disorders. We conclude that the use of the kindling model may provide further insights into these phenomena, particularly taking into account such key neurotransmitters as glutamate, dopamine, and GABA.
Photosensitive and Nonphotosensitive Electronic Screen Game‐Induced Seizures
Authors: Inoue Yushi , Fukao Kenjiro , Araki Takehisa , Yamamoto Shinobu , Kubota Hidemoto , Watanabe Yutaka
Published: August 2005

Purpose: To disclose possible epileptologic differences between photosensitive and nonphotosensitive patients with seizures induced by electronic screen games (ESGs).

Methods: In patients with ESG‐induced seizures who showed photo‐ and pattern sensitivity, magnetoencephalography (MEG) and EEG were performed simultaneously during ESG play, and equivalent current dipoles (ECDs) of the MEG spikes were estimated. In patients without ESG‐induced seizures, who were surgical candidates, the intracranial EEG was analyzed for changes in epileptiform spike frequency.

Results: Fifteen of 29 patients were photo‐ or pattern sensitive, and they had a posterior predominance of ECDs of the MEG spikes. In contrast, nonphotosensitive patients had an anterior predominance of ECDs. Other seizure‐precipitating factors in the nonphotosensitive patients included hand manipulation or spatial processing. In patients without a history of ESG‐induced seizures who underwent intracranial EEG monitoring for surgical evaluation, ESG playing induced changes in spike frequency in the supplementary motor area, perisylvian region, and medial temporal lobe.

Conclusions: In photosensitive patients, interictal MEG spikes arise predominantly from the posterior region of the brain. In nonphotosensitive patients, epileptiform spikes tend to originate in the anterior part of the brain. Thus factors involving functions of the anterior part of the brain other than photo‐ or pattern sensitivity may play a role in the induction of seizures during ESG play. Furthermore, the changes in spike frequency in specific brain areas may correspond to their involvement in praxic activity and emotional changes during ESG play. A chance occurrence of seizures during ESG play also was observed.
Clinical Experience with New Antiepileptic Drugs: Antiepileptic Drugs in Europe
Authors: Loiseau Pierre Jean‐Marie
Published: August 2005

The use of antiepileptic drugs (AEDs), singly and in combination, has been marked by variation among European countries and by a slow progress toward a standard of care that is still far from uniform. Phenobarbital, phenytoin, trimethadione, and primidone, given in various combinations, were the predominant agents used in the first half of this century. Prescribing habits differed among the Latin countries, the United Kingdom, and Scandinavia, based on local trends, divergent teaching philosophies of medical schools, and the medical specialty of the prescribing physician. The advent of carbamazepine and valproate, in the early 1960s, changed European prescribing habits. Despite early fears regarding bone marrow toxicity, carbamazepine was found to be superior for treatment of complex partial seizures. Valproate, when the proper therapeutic dosage was belatedly realized, was seen as a superior treatment for generalized and partial epilepsies. Both agents are now considered first‐line treatments for these seizure types. The role of the benzodiazepines as adjunctive anticonvulsant therapy remains controversial because of concerns about neurotoxicity and patient tolerance. The number of AEDs marketed in Europe has grown dramatically in the past decade, with agents such as felbamate, gabapentin, lamotrigine, and tiagabine having been approved as either adjunctive or sole therapy. However, not all new agents are available in each European country, and some variation in prescribing persists.
Environmental Risk Factors for Multifactorial Epilepsy in EL Mice
Authors: Todorova Mariana T. , Burwell Timothy J. , Seyfried Thomas N.
Published: August 2005

Summary:Purpose:The epileptic EL mouse has been studied extensively as a model of multifactorial epilepsy. Although EL mice have a seizure occasionally during routine handling associated with cage changing, most studies have used vigorous tossing or shaking procedures for seizure induction. A new seizure testing procedure was developed that involved gentle handling and simulated situations associated with emotional stress in rodents. This new testing procedure was used to identify and characterize several environmental risk factors that influence seizure predisposition in EL mice.

Methods:Ten adult EL mice were monitored for 7 days under 24‐h light/dark video surveillance to assess the frequency of spontaneous seizures. The development of handling‐induced seizures also was studied in EL mice, in nonepileptic ABP and DDY mice, and in reciprocal ABP × EL F1hybrids from ages 30–180 days.

Results:Seizure induction was necessary in EL mice, as spontaneous clinical seizures were not observed. Handling‐induced seizure susceptibility was strongly age and gender dependent in naive EL mice (not previously handled) and peaked ‐90 days, with males significantly more susceptible than females. No seizures were induced by handling in the nonepileptic mouse strains (ABP and DDY) over the testing period. Handling and seizures at young ages in EL and EL × ABP F1hybrid mice significantly enhanced their seizure susceptibility when they were tested again 1 month later. A significant “Gowers effect” was seen also in EL mice. Furthermore, susceptibility was higher in ABP × EL F1hybrids than in their reciprocal EL × ABP F1hybrids at 90–150 days.

Conclusions:Seizure susceptibility in EL mice was significantly influenced by a number of environmental factors including age, gender, maternal/paternal effects, prior handling, and seizure history. The emotional stress/fear response is the likely trigger for seizure induction in EL mice. An early life experience stress‐diathesis model, similar to that proposed for major depression in humans, was applicable to the development of seizure susceptibility in EL mice. The new seizure test will be useful for defining gene‐environment interactions and in identifying susceptibility genes for multifactorial epilepsy.
Lamotrigine Concentrations in Human Serum, Brain Tissue, and Tumor Tissue
Authors: Meyer Frank P. , Banditt Peter , Schubert Adrian , Schöche Jochen
Published: August 2005

Summary: Purpose: Although lamotrigine (LTG) has been used for years as an antiepilepic drug (AED), there are no data on penetration into the brain with the exception of a single case report. It was our aim to determine the LTG content in the brain and the tumor tissue and to bring the same into relation to the serum concentration and protein binding in neurosurgically operated patients.

Methods: Neurosurgical intervention was performed on 11 patients with brain tumors. Tumor tissue was removed, and LTG kinetics was carried out for 12 h. LTG was determined by means of (HPLC) and the protein binding by means of ultra‐filtration.

Results: At the time of the section of the tumor, the LTG concentrations in the serum were an average of 3.7 μg/ml (range, 1.1–9.8); in the brain, an average of 6.8 μg/g (range, 1.0–14.9); and in the tumor, an average of 4.4 μg/g (range, 2.0–8.3). Brain/serum and tumor/serum ratios of 2.8 and 1.9, respectively, result from these data. The protein binding was on average 68% (range, 46–96).

Conclusions: LTG is a lipophile AED with a moderate protein binding that penetrates brain tissue well and can be proven even in the tumor tissue.
Benign Familial Neonatal Convulsions Followed by Benign Epilepsy with Centrotemporal Spikes in Two Siblings
Authors: Maihara Toshiro , Tsuji Masahiro , Higuchi Yoshihisa , Hattori Haruo
Published: August 2005

Summary: Purpose: To report on sibling cases with benign familial neonatal convulsions (BFNC) followed by benign epilepsy with centrotemporal spikes (BECT).

Methods: Case histories and EEGs were obtained for the two siblings with neonatal and subsequent epileptic seizures in one pedigree with BFNC.

Results: The family included six affected cases of BFNC in two generations: the proband, the proband's mother and two sisters, and the proband's maternal uncle and his daughter. The proband developed a generalized tonic convulsion 2 days after birth with no apparent cause and normal interictal EEG, and experienced a total of 18 episodes of tonic or clonic seizures or both by age 9 months. In the follow‐up course, an EEG recording showed rolandic discharges at 2 years, and a sylvian seizure occurred at 4 years during sleep. On carbamazepine therapy, the last seizure was recorded at 9 years after a total of 11 episodes of sylvian seizures, with normal EEGs after 12 years. The proband's sister experienced nine episodes of brief tonic seizures between 7 and 9 days after birth, and also developed eight episodes of sylvian seizures from 4 to 7 years, with rolandic discharges on EEG until age 9 years. All of the family members had normal psychomotor development, with no neurologic sequelae.

Conclusions: This report of BFNC followed by BECT in sibling cases is significant in view of the genetic analysis and the classification of epilepsies and epileptic syndromes.
Stereotactic Amygdalohippocampotomy for the Treatment of Medial Temporal Lobe Epilepsy
Authors: Parrent Andrew G. , Blume Warren T.
Published: August 2005

Summary: Purpose: This study was carried out to assess the safety and efficacy of stereotactic ablation of the amygdala and hippocampus for the treatment of medial temporal lobe epilepsy.

Methods: Twenty‐two stereotactic amygdalohippocampotomies were performed in 19 patients with unilateral temporal lobe seizures by using magnetic resonance imaging (MRI) localization for target planning and radiofrequency techniques for lesion production. Seizure frequency was assessed at 3‐monthly follow‐up visits. Two lesion groups were defined. In group I, four to 11 (mean, 6.4) discrete lesions were made, encompassing the amygdala and anterior 13–21 mm (mean, 16.8 mm) of the hippocampus. In group II, a large number of confluent lesions were made (mean, 26.0; range, 12–54) encompassing the amygdala and anterior 15–34 mm (mean, 21.5 mm) of the hippocampus. MRI scanning was carried out 24 h and 6–9 months after surgery.

Results: In five group I patients, one (20%) experienced a favorable seizure outcome. Of 15 group II patients, one of whom had previously undergone limited lesioning and was also analyzed as part of group I, nine (60%) experienced a favorable seizure outcome, with two seizure free. MRI scans at 6‐ to 9‐months’follow‐up disclosed discrete areas of atrophy in the amygdala and hippocampus, interspersed with preserved brain in the group I patients. More uniform and complete destruction of amygdala and hippocampus was evident in group II patients. All lesions were confined to the amygdala and hippocampus, sparing the parahippocampal gyrus (PHG).

Conclusions: The extensive amygdalohippocampal ablation in group II patients improved seizure outcome compared with more limited ablation in group I, but these results were not so good as those from temporal lobectomy in a similar patient group. When considered together with the results of selective amygdalohippocampectomy, and temporal resections that spare hippocampus or amygdala (all producing similar outcomes, and all involving resection of the entorhinal cortex), this study suggests a pivotal role of the entorhinal cortex in temporal epileptogenesis.
Two Visual Mechanisms of Photosensitivity
Authors: Harding G. F. A. , Fylan F.
Published: August 2005

Summary: Purpose: Photosensitive epilepsy is the most common of the “reflex” epilepsies. Precipitated by television viewing, flickering light, or specific visual patterns, it is the cause of seizures in 10% of young people with epilepsy. Photosensitivity is associated with two types of EEG abnormalities: photoparoxysmal responses (PPRs) and occipital spikes (OSs). It is unclear whether these abnormalities are mediated by different mechanisms, and furthermore, the clinical significance of OS is unknown.

Methods: By using our previously established population of patients with photosensitive epilepsy, all showing EEG abnormalities on intermittent photic stimulation or pattern stimulation, we examined the effects of pattern contrast, spatial and counterphase temporal frequency, and colour on these abnormalities.

Results: PPRs and not OSs show linear contrast dependency and are elicited by stationary stimuli and by non‐colour‐opponent isoluminant stimuli.

Conclusions: PPRs and OSs are generated independently by the parvocellular and magnocellular visual systems, respectively. The results add support to the hypothesis that only PPRs and not OSs are clinically significant.
Multimodal MR Imaging: Functional, Diffusion Tensor, and Chemical Shift Imaging in a Patient with Localization‐Related Epilepsy
Authors: Krakow K. , Wieshmann U. C. , Woermann F. G. , Symms M. R. , McLean M. A. , Lemieux L. , Allen P. J. , Barker G. J. , Fish D. R. , Duncan J. S.
Published: August 2005

Summary: Purpose: To demonstrate the integration of complementary functional and structural data acquired with magnetic resonance imaging (MRI) in a patient with localization‐related epilepsy.

Methods: We studied a patient with partial and secondarily generalized seizures and a hemiparesis due to a malformation of cortical development (MCD) in the right hemisphere by using EEG‐triggered functional MRI (fMRI), diffusion tensor imaging (DTI), and chemical shift imaging (CSI).

Results: fMRI revealed significant changes in regional blood oxygenation associated with interictal epileptiform discharges within the MCD. DTI showed a heterogeneous microstructure of the MCD with reduced fractional anisotropy, a high mean diffusivity, and displacement of myelinated tracts. CSI demonstrated low N‐acetyl aspartate (NAA) concentrations in parts of the MCD.

Conclusions: The applied MR methods described functional, microstructural, and biochemical characteristics of the epileptogenic tissue that cannot be obtained with other noninvasive means and thus improve the understanding of the pathophysiology of epilepsy.
Is Schizophrenia a Risk Factor for Epilepsy or Acute Symptomatic Seizures?
Authors: Gelisse RPhilippe , Samuelian Jean‐Claude , Genton Pierre
Published: August 2005

Summary: Purpose: The precise prevalence of epilepsies and seizures in patients with schizophrenia remains unclear.

Methods: To assess the prevalence of epilepsy and of acute symptomatic seizures in schizophrenics, we conducted a survey in a urban sector of Marseilles that includes 56,910 inhabitants, among whom 1,154 had been treated for psychiatric disorders, including 460 for schizophrenia or paranoid disorder (PD) (DSM III‐R 295 and 297.1, respectively; mean age, 41.9 years; range, 17–79 years; 215 men and 245 women).

Results: All 460 patients were receiving long‐term neuroleptic drug therapy, and 397 had been hospitalized at least once in the past year, whereas 63 were followed up as outpatients only. Seizures were present in the history of 12 patients: five had various forms of chronic epilepsy (four men, one woman; DSM III‐R 295.1, one case; 295.3, two cases; 295.9, two cases), and three of these experienced seizures only after the onset of their psychiatric condition; five had acute symptomatic seizures (four men, one woman; 295.1, two cases; 295.3, 295.9, and 297.1, one case), and two had only pseudoepileptic events (both 295.3).

Conclusions: This survey shows that the prevalence of epilepsy and acute symptomatic seizures is comparatively low in patients with schizophrenia or PD (10.8% each, respectively), and that the prevalence of a history of seizures (21.7% in this study) is not particularly increased in this middle‐aged population. In contrast to childhood‐onset autistic disorders, schizophrenia or PD are not major risk factors for epilepsy or acute symptomatic epileptic seizures.
Electrical Stimulation of the Contralateral Mesial Temporal Structure Induces an Ipsilateral Seizure Pattern in Mesial Temporal Lobe Epilepsy
Authors: Inoue Yushi , Mihara Tadahiro , Tottori Takayasu , Seino Masakazu
Published: August 2005

Summary: Purpose: We examined the mode of seizure development induced by electrical stimulation in patients with mesial temporal lobe epilepsy.

Methods: Of 25 patients undergoing intracranial EEG evaluation and electrical stimulation ipsilateral to the presumed site of habitual seizure origin, 17 patients had additional stimulation studies on the contralateral temporal lobe.

Results: Fourteen of the 25 patients had seizures induced with ipsilateral stimulation, and two of the 17 patients had seizures with contralateral stimulation. Seizures induced by ipsilateral stimulation started in the ipsilateral temporal lobe, whereas those induced by contralateral stimulation originated from the ipsilateral temporal lobe structure and were identical to the habitual seizures.

Conclusions: Electrical stimulation of the temporal lobe structure opposite the site of habitual seizure origin is said to induce a seizure rarely. However, according to our preliminary results, if contralateral stimulation elicits a habitual seizure in the ipsilateral temporal lobe, it might be considered additional confirmatory evidence of seizure lateralization.
Effect of Theophylline and Trimethobenzamide When Given During Kainate‐Induced Status Epilepticus: An Improved Histopathologic Rat Model of Human Hippocampal Sclerosis
Authors: Katzir Hilli , Mendoza Delia , Mathern Gary W.
Published: August 2005

Summary: Purpose: The most common pathology in temporal lobe epilepsy (TLE) is hippocampal sclerosis. It is controversial whether status epilepticus (SE) or prolonged seizures plus secondary cerebral injuries are pathogenic mechanisms of hippocampal sclerosis. This study addressed this question in rat models of TLE.

Methods: Hippocampal neuron densities and supragranular mossy fiber sprouting were determined in adult rats subjected to systemic kainate‐induced SE (KA‐only) and KA‐induced SE followed 75 minutes later by theophylline (KA/Theo) or trimethobenzamide (KA/Tri). These drugs probably decrease seizure‐induced cerebral hyperemia or hypertension.

Results: Compared with controls and KA‐only rats, KA/Tri and KA/Theo rats showed decreased CA3b and CA1 neuron densities (i.e., greater Sommer's sector injury). In addition, KA/Tri rats showed that increased trimethobenzamide dosages were associated with decreased hilar, CA3c, CA3b, CA1, and subiculum neuron densities. There were no significant differences in supragranular mossy fiber sprouting between KA‐only, KA/Tri, and KA/Theo rats.

Conclusions: Pharmacologic manipulations during KA‐induced SE are associated with differences in hippocampal pathology, especially in Sommer's sector, and the final pattern of damage and axon sprouting shows histopathologic similarities to that in patients with hippocampal sclerosis. Our findings support the hypothesis that secondary physiologic insults during SE that are likely to decrease seizure‐induced cerebral hyperemia and hypertension may generate greater hippocampal neuronal injury compared with SE alone, and this may be a pathogenic mechanism of human hippocampal sclerosis in patients with TLE.
Use of Cavernous Sinus EEG in the Detection of Seizure Onset and Spread in Mesial Temporal Lobe Epilepsy
Authors: Kunieda Takeharu , Ikeda Akio , Mikuni Nobuhiro , Ohara Shinji , Sadato Akiyo , Taki Waro , Hashimoto Nobuo , Shibasaki Hiroshi
Published: August 2005

Summary: Purpose: The study goal was to evaluate the clinical usefulness of intravenous EEG recording by placing wire electrodes in the cavernous sinus (CS) and the superior petrosal sinus (SPS) in patients with intractable temporal lobe epilepsy (TLE), with special emphasis on the ictal recording.

Methods: We placed Seeker Lite‐ 10 guide wire as electrodes in the bilateral CS, SPS, or both to simultaneously record both ictal and interictal EEGs with the scalp EEG in five patients with TLE. In addition, in one patient, we averaged interictal scalp and intravascular EEG time‐locked to the epileptiform discharge recorded from the CS/SPS‐EEG to further delineate the relationship of the spikes between scalp and intravenous recording.

Results: In four of five patients, clinically useful recording was obtained to determine ictal focus. We recorded habitual seizures in three patients, and the detailed characteristics of ictal epileptiform discharges were shown. The averaged waveform of interictal epileptiform discharges clarified the spike distribution in the scalp EEGs, which was otherwise undetectable in the single trace. All of the patients completed the intravenous EEG monitoring without any neurological or psychological problems.

Conclusions: The CS/SPS‐EEG is a relatively noninvasive method that is useful for the detection of ictal focus and its spreading pattern and thus for the selection of surgical candidate among patients with intractable TLE. Although the number of seizures detected during the short monitoring period may be limited, due to the advantages of its safety and simplicity, it is worth trying for potential surgical candidates before more invasive examinations are applied. A further study with a larger number of patients is needed to estimate its practical risk.
Cortical Dysplasia with Ossification
Authors: Maehara Taketoshi , Arai Nobutaka , Shimizu Hiroyuki , Yagishita Akira , Oda Masaya
Published: August 2005

Summary: We present the first case of cortical dysplasia with extensive intracerebral ossification. An eight‐year‐old epilepsy patient with a calcified lesion was successfully treated by surgical intervention. Pathological examination revealed a number of bizarre dysplastic cells in the whole lesion, which consisted of an epileptogenic cerebral cortex and a nonepileptogenic hamartomatous lesion with adipose tissue, vascular tissue, calcification, and ossification. The patient was diagnosed as having cortical dysplasia with ossification. Our findings support the notion that cortical dysplasia has a multipotentiality of cellular differentiation, including various hamartomatous tissues. We suggest that cortical dysplasia should be considered as a potential cause for epileptogenicity of a hamartomatous lesion even when magnetic resonance imaging (MRI) fails to disclose cortical dysplasia.
Spindles‐Inducing Mechanism Modulates Sleep Activation of Interictal Epileptiform Discharges in the Landau—Kleffner Syndrome
Authors: Nobili L. , Baglietto M. G. , Beelke M. , De Carli F. , De Negri E. , Tortorelli S. , Ferrillo F.
Published: August 2005

Summary: Purpose: Landau–Kleffner syndrome (LKS) is characterized by a marked increase of interictal epileptiform discharges (IEDs) during sleep. During nonrapid eye movement (NREM) sleep, neuronal membrane potential oscillations lead to the appearance of spindles and delta waves in the surface EEG and might develop into paroxysmal synchronization. Spectral analysis allows the quantitative description of the dynamics of delta (slow‐wave activity, SWA, 0.5‐4.5 Hz) and sigma activity (SA, 12.0–16.0 Hz) and can be used to assess the relation between SA, SWA, and IEDs during sleep.

Methods: We performed six overnight continuous EEG‐polysomnographic studies in three patients with LKS. The temporal series of SWA and SA were obtained from a spike‐free derivation lead. The IEDs count was performed on the most active lead. Relations between sigma and SWA and time series of lEDs were tested by means of correlation techniques after data normalization.

Results: Our results revealed a significantly higher correlation between IEDs and SA with respect to SWA in all the subjects, in total sleep time. The same analysis limited to NREM sleep highlights the better correlation between SA and IEDs.

Conclusions: Our data suggest that neural mechanisms involved in the generation of sleep spindles facilitate IEDs production in LKS.
Frequency of Bitemporal Independent Interictal Epileptiform Discharges in Temporal Lobe Epilepsy
Authors: Ergene Erhan , Shih Jerry J. , Blum David E. , So Norman K.
Published: August 2005

Summary: Purpose: Bitemporal interictal epileptiform discharges (IEDs) occur in ≤42% of scalp EEGs in patients with temporal lobe epilepsy (TLE) studied with routine EEGs or partial analysis of long‐term recordings.

Methods: Twenty‐eight patients with TLE demonstrating exclusively unilateral temporal IEDs on routine EEGs underwent 24‐h continuous recording. The entire record was visually in‐spected for epileptiform discharges. We used continuous EEG to assess the significance of long‐term recording in detecting bilateral IEDs.

Results: Twenty‐two patients had left temporal IEDs; 21 had right temporal IEDs. Seventeen (61%) patients had IEDs originating from both the right and left temporal lobes. The probability of detecting bilateral independent IEDs was correlated with the duration of continuous EEG recording. There was no correlation between the number of lEDs originating from one side and the probability of detecting independent IEDs on the other side. The frequencies of IEDs were not correlated with the length of time since onset of epilepsy.

Conclusions: The findings suggest that when long‐term recordings are performed, the incidence of bilateral discharges in TLE is higher than previously reported in the literature and supports the view that TLE is commonly a bilateral disease.
Independent Occurrence of the CHRNA4 Ser248Phe Mutation in a Norwegian Family with Nocturnal Frontal Lobe Epilepsy
Authors: Steinlein Ortrud K. , Stoodt Jens , Mulley John , Berkovic Sam , Scheffer Ingrid E. , Brodtkorb Eylert
Published: August 2005

Summary: Purpose: To describe the clinical features of a family from Northern Norway in which autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE) is associated with a Ser248Phe amino acid exchange in the second transmembrane domain of the neuronal nicotinic acetylcholine receptor α4 subunit (CHRNA4). We also tested for evidence of a de novo mutation or founder effect by comparing haplotypes with the original Australian family where the Ser248Phe mutation was first described.

Methods: Clinical details were obtained from 19 family members. Personal interviews and genetic analysis were carried out in 17. Parts of the coding region of CHRNA4 were sequenced, and two known polymorphisms (bp555/FokI, bp594/CfoI) were typed by restriction analysis.

Results: Eleven individuals had ADNFLE. The haplotypes of the mutation‐carrying alleles of affected individuals from the Northern Norwegian and the Australian ADNFLE family are different. The phenotypic expressions are remarkably similar.

Conclusions: The Ser248Phe mutation occurred independently in both families. Given the rarity of the disease, this suggests that not only the position of a mutation in the coding sequence but also the type of an amino acid exchange is important for the etiology of ADNFLE. The phenotypic similarity of these two families with different genetic backgrounds suggests that the Ser248Phe mutation largely determines the phenotype, with relatively little influence of other background genes.
Drug‐Induced Changes in Cerebral Glucose Consumption in Bifrontal Epilepsy
Authors: Matheja Peter , Weckesser Matthias , Debus Otfried , Löttgen Jan , Schuierer Gerhard , Schober Otmar , Kurlemann Gerhard
Published: August 2005

Summary: Purpose: Positron emission tomography (PET) using 18F‐radiolabeled deoxyglucose (18F‐FDG) is a sensitive procedure for detection of epileptogenic foci. Although alterations in glucose consumption are not restricted to the area of seizure generation itself, the magnitude and extent of cerebral metabolic disturbances induced by epileptic discharges can be detected. Despite two decades of epilepsy research using 18F‐FDG‐PET, little is known about the metabolic changes during therapy of focal epilepsy. We report on a child with frontal epilepsy with severe glucose hypometabolism that was nearly completely normalized during drug therapy.

Methods: Interictal 18F‐FDG‐PET was performed at the onset of epilepsy and after optimized drug therapy in a 5‐year‐old boy with behavioral abnormalities and repetitive seizures of frontal origin with bifrontal interictal EEG slowing for 8 weeks. Both scans were anatomically matched; initial and intratherapeutic glucose metabolism were compared.

Results: In accordance with the epileptogenic focus as identified by EEG and ictal/interictal perfusion single‐photon emission tomography (SPECT), bifrontal hypometabolism was depicted by 18F‐FDG‐PET. Magnetic resonance imaging (MRI) was unremarkable. After dual‐drug therapy (valproate, carbamazepine), the boy became seizure free, and his initial behavioral deficits disappeared. A control PET study after 3 months of therapy showed restored glucose consumption; the frontal EEG slowing was normalized.

Conclusions: This case demonstrates that reduction of glucose metabolism in epileptogenic foci may be a result of reversible neuronal dysfunction that correlates with the electroclinical follow‐up.