bluuebunny/crossref_metadata_2025 huggingface dataset:
APRON: an agent‐based specification and procurement system for construction products
Authors: Obonyo Esther , Anumba Chimay , Thorpe Tony
Published: August 2005

Purpose

The successful implementation of an optimal online system for specification and procurement has been impeded by the existence of semi‐structured or non‐structured product information held in catalogues in various formats. Consequently, a significant amount of time is spent in gathering relevant information. Proposes introducing a successful optimal online specification and procurement system for construction products.

Design/methodology/approach

The design and specification of the prototype were based on the analysis of closely related agent‐based implementations in various domains.

Findings

In the development phase it emerged that agent infrastructure is still maturing, even when a stable development environment is finally available. This is consistent with the latest research in this area which places the highest value on internet agents within the context of the semantic web.

Originality/value

This research demonstrated how agent technology can be used alongside other paradigms such as web services and XML to make the specification and procurement of construction products more effective and more efficient.
Family Context and Spanish‐Language Use: A Study of Latino Children in the United States*
Authors: Arriagada Paula A.
Published: August 2005

Objective. This article seeks to explain why Latino children maintain some knowledge of their native language even though past research has consistently supported the view that non‐English‐language use rarely lasts past the third generation. I argue that family context, in addition to assimilation characteristics, plays an important role in determining their language situation.

Method. I use both logistic regression and tobit regression, as well as data from the 1988 National Education Longitudinal Study, to examine the use and proficiency of Spanish among Latino children.

Results. The results demonstrate that language and family context strongly influence Spanish usage and proficiency for Latino children, regardless of generational status.

Conclusions. These findings reveal a relationship between assimilation, family, and language that can have important implications for the future academic and economic success of Latino children.
The Long‐Term Effects of Spousal Care Giving on Survivors' Well‐Being in Widowhood*
Authors: Prokos Anastasia H. , Keene Jennifer Reid
Published: August 2005

Objective. Previous research suggests that bereavement and adjustment to widowhood are long term and should be studied as processes rather than as static outcomes. We analyze how spousal care giving affects survivors' depressive symptoms 18 and 48 months into widowhood.

Method. We use three waves of data from the Changing Lives of Older Couples (CLOC) Survey and estimate OLS regression equations to determine the long‐term effects of spousal care giving on widow(er)s' well‐being.

Results. At 18 months, more burdensome spousal care giving predicted higher levels of depressive symptoms, while greater caregiver stress predicted lower levels. Specific characteristics of the caregiving situation were no longer significant predictors of well‐being 48 months into widowhood, although care giving itself had an ameliorative effect on level of symptoms.

Conclusions. The results highlight the dynamic nature of bereavement and suggest that the effects of spousal care and characteristics of the care situation on depressive symptoms during widowhood are not linear over time. We discuss the implications of our findings for the conceptualization of the relationship between care giving and bereavement.
Not all statins interfere with clopidogrel during antiplatelet therapy
Authors: Mach F. , Senouf D. , Fontana P. , Boehlen F. , Reber G. , Daali Y. , De Moerloose P. , Sigwart U.
Published: August 2005

Background Clopidogrel and statins are frequently coadministered in patients with ischemic heart diseases. Recent reports suggested that clopidogrel's effectiveness in inhibiting adenosine diphosphate (ADP)‐induced platelets aggregation is attenuated by co‐administration of certain statins. The objective of the present study was to define which statin might interfere with the antiaggregation property of clopidogrel.

Methods We designed a pharmacokinetic study and tested ex vivo platelet function on 21 healthy volunteers who received clopidogrel and all currently commercially available statins: rosuvastatin [10 mg o.d.], simvastatin [20 mg o.d.], fluvastatin [80 mg o.d.], pravastatin [40 mg o.d.], and atorvastatin [20 mg o.d.]. Each statin was administered for 7 days followed by 1 week of wash‐out period with clopidogrel treatment alone. Detection of the statins in the plasma was performed on all blood samples, using HPLC analytical method.

Results All individuals, except one, were responders to clopidogrel with inhibition of ex vivo ADP induced platelet aggregation. All statins, except pravastatin, were detectable in the plasma at the end of each treatment period in all patients, and no statin was detectable after any of the wash‐out periods. Clopidogrel was significantly less efficient to prevent platelet aggregation when coadministrated with simvastatin or fluvastatin. No difference was observed in clopidogrel efficacy when coadministered with rosuvastatin, pravastatin or atorvastatin.

Conclusions This is the first study investigating clopidogrel‐statin interactions on ex vivo platelet function with all commercially available statins and which were administered to the same individuals. It demonstrates in healthy volunteers that at the doses used in this study, simvastatin and fluvastatin, but not atorvastatin, pravastatin or rosuvastatin interfere with the anti‐aggregation effect of clopidogrel.
What is the optimum methodology for the clinical measurement of resting anal sphincter pressure?
Authors: Prott G. , Hansen R. , Badcock C. , Kellow J. , Malcolm A.
Published: August 2005

Abstract  There are conflicting recommendations from consensus groups with regard to the assessment of resting anal sphincter pressure. Our aims were to evaluate and compare the performance of three recognized techniques for the clinical measurement of resting anal sphincter pressure.

Methods:  In each of 54 patients presenting for anorectal manometry, and suffering from constipation or fecal incontinence, three different techniques for assessment of resting anal pressure were undertaken, namely stationary, stationary pull‐through and slow pull‐through techniques. Resting anal sphincter pressures were compared between groups and between techniques.

Results:  Mean resting anal sphincter pressure was lower with stationary, compared with stationary pull‐through and slow pull‐through, techniques (P ≤ 0.002). Resting pressure was higher for constipation than incontinence regardless of technique used (P < 0.00001). The techniques were highly correlated with each other (P < 0.0001). The stationary pull‐through technique conferred a minor advantage in the discrimination between constipation and incontinence. The stationary technique required significantly less time for completion (P < 0.0001).

Conclusion:  Resting anal sphincter pressure varies according to the specific technique employed, yet each technique is valid. The stationary pull‐through technique confers a minor advantage in clinical discrimination of patients, but the stationary technique is more time‐efficient. Standardized anal sphincter testing should be established to enable inter‐laboratory comparisons.
Perceptual sensitivity and response bias during rectal distension in patients with irritable bowel syndrome1
Authors: Corsetti M. , Ogliari C. , Marino B. , Basilisco G.
Published: August 2005

Abstract  Patients with irritable bowel syndrome (IBS) report an increased frequency of sensations during rectal distension in comparison with healthy subjects. This alteration might be due to a psychological response bias leading patients to over report their sensations. The aim of this study was to measure perceptual sensitivity and response bias during rectal distension in healthy subjects and IBS patients using the sensory decision theory (SDT). Thirteen healthy subjects and 22 IBS patients underwent five rectal distensions up to 100 mL, five up to 200 mL and five sham distensions. They were asked to identify the distension by means of an electronic marker. Perceptual sensitivity and response bias were calculated according to the SDT. The patients identified a more 100 mL distensions than the healthy subjects (P = 0.02), whereas there was no difference in the number of identified 200 mL and sham distensions between the two groups. The perceptual sensitivity of IBS patients was significantly greater during 100 mL (P = 0.01), but not during 200 mL distensions. The response bias was not significantly different between the two groups. These data suggest that the increased frequency of sensations reported by IBS patients is not due to a psychological response bias.
Determinants of genital wart case detection rates among STD clinic attendees in Athens, Greece
Authors: Kyriakis Kyriakos P. , Hadjivassiliou Maria , Paparizos Vassilios A. , Riga Panagiota , Katsambas Andreas
Published: August 2005

Background and objective  To report significant sociodemographic and behavioral outpatient characteristics associated with the diagnosis of genital warts.

Methods  Cross‐sectional hospital‐based study (1990–96).

Results  Genital warts (n = 2988, 51.2%) represent the leading sexually transmitted disease (STD) among 5831 consecutive symptomatic Greek and foreign immigrant STD outpatients. In Greek heterosexuals a low rate of partner change was the main patient characteristic at diagnosis (median: one partner in the past 6 months). Lower detection rate and riskier behavior characterized immigrants. Although associated with risky behavior, homo/bisexual orientation in males and injecting drug use were not significantly associated with condyloma diagnosis in the context of STDs.

Conclusion  Broader health education and secondary prevention are needed to control this infection, whereas low‐risk behavior in Greek heterosexuals with condylomata facilitates further preventive interventions.
Birt–Hogg–Dubé Syndrome
Authors: Welsch Michael Jude , Krunic Aleksandar , Medenica Maria M.
Published: August 2005

Birt–Hogg–Dubé Syndrome is an autosomal dominant condition characterized by a triad of fibrofolliculomas, trichodiscomas, and acrochordons. Since the first description in 1977, many conditions have been described in association with its clinical triad. Recent epidemiological studies have shown a significant association between the occurrence of lesions in the fibrofolliculoma/trichodiscoma category with renal neoplasms and pneumothoracies. The BHD protein folliculin had recently been identified. The histological findings of the clinical lesions are distinctive. We report a patient with a history of melanoma who presented for routine surveillance. Facial lesions in the fibrofolliculoma/trichodiscoma category were identified. Diagnostic work‐up revealed concomitant multinodular goiter, pulmonary cyst, and renal mass. The patient later developed pneumothorax. Clinical manifestations, histological findings, associations, management, and a review of the Birt–Hogg–Dubé Syndrome are discussed.
Patients’ priorities concerning health research: the case of asthma and COPD research in the Netherlands
Authors: Francisca Caron‐Flinterman J. , Broerse Jacqueline E. W. , Teerling Julia , Bunders Joske F. G.
Published: August 2005

Background  Although patients are increasingly involved in agenda setting within specific fields of health research, they rarely participate in decision‐making on the entire breadth of health research, including biomedical research. This might be attributable to a widely held view that patients are incapable of adequate research prioritization due to a lack of relevant knowledge, a failure to look beyond their own individual problems or an inability to objectively consider long‐term targets.

Aims  By conducting transparent and structured consultations with asthma and chronic obstructive pulmonary disease (COPD) patients regarding their health research priorities, we aim to assess the ability of patients to prioritize research in a well‐argued way.

Methods  Patients were consulted through seven focus groups, a feedback meeting, and a questionnaire. The focus groups and the feedback meeting aimed to explore the entire breadth of patients’ problems experienced in relation to their diseases, while the questionnaire aimed to investigate patients’ prioritization of possible research targets focused on solving these problems.

Results  The focus groups produced a wide range of problems, including those related to health‐care organization, social environment, therapy and costs. In terms of research prioritization, patients focused primarily on biomedical issues, particularly aetiology, co‐morbidity and effective medication.

Conclusions  The consultation procedure successfully elicited patients’ research priorities including the underlying arguments. Our results indicate that asthma and COPD patients are capable of research prioritization in a well‐argued way and that they highly value biomedical research. Furthermore, as they prioritized some research topics that are not covered by current Dutch research programmes, we argue that patient participation can broaden research agenda setting.
Is atopy a protective or a risk factor for cancer? A review of epidemiological studies
Authors: Wang H. , Diepgen T. L.
Published: August 2005

Objective:  There is an ongoing debate whether there is a link between a history of atopy and cancer risk. The purpose of this paper is to review the published epidemiological studies on the association between atopy and the risk of cancers.

Methods:  Through an electronic search (January 1986–April 2004) with an additional review of cited references, we identified studies with quantitative data on the relation of atopy (irrespective of its definition or subtype) to cancer (different cancer sites).

Results:  The protective effect of atopy in colorectal cancer has been observed consistently in the case–control studies, but not in cohort studies. A consistent inverse association between self‐reported atopy and glioma risk has been shown, but there is absence of such an association for meningioma. In most studies, the risk of leukaemia, in particular childhood leukaemia, tends to be lower among people with a history of atopy. Studies, which looked at, the association between atopic diseases and risk of cancers of pancreatic, breast, lymphoma showed varying outcomes. Most studies on the atopy–pancreatic cancer relation suggested an inverse association. For lymphoma, most studies have shown no substantial association. Overall evidence indicates an increased risk of lung cancer among persons with a history of asthma.

Conclusion:  Despite the mixed results, the emerging picture from most of the currently available epidemiological data indicate that atopic disease is associated with a reduced risk for cancer. Further research should focus on a more carefully defined ‘atopy’ status and manifestation of different atopic diseases, to advance our understanding of the role that allergies might play in the risk of developing cancer.
Inverse association between Mycobacterium tuberculosis infection and atopic rhinitis in children
Authors: Obihara C. C. , Beyers N. , Gie R. P. , Potter P. C. , Marais B. J. , Lombard C. J. , Enarson D. A. , Kimpen J. L. L.
Published: August 2005

Background:  The association between Mycobacterium tuberculosis (MTB) infection and atopy remains controversial.

Aim:  To investigate the association between MTB infection and atopic rhinitis in children living in a high TB incidence area.

Methods:  In this cross‐sectional study 418 children aged 6–14 years from an established epidemiological research‐site in a poor urban community were invited to participate. They were assessed for allergic rhinitis (ISAAC questionnaire) and skin responses to tuberculin and eight environmental allergens. The presence of a BCG scar was documented, intestinal parasites and total and Ascaris lumbricoides‐specific IgE levels were measured. Atopic rhinitis was defined, using the new World Allergy Organization (WAO) definition, as reported allergic rhinitis and a positive skin prick test (SPT ≥3 mm) to any allergen.

Results:  Among the 337 children enrolled 10.4% had allergic rhinitis, 17.5% a positive SPT and 53% a positive tuberculin skin test (TST ≥10 mm). Children with a positive TST were significantly less likely to have recent atopic rhinitis (ORadjusted 0.06; 95% CI 0.007–0.5) than those with a negative TST. SPTs were significantly more common in children with negative TST who had recent allergic rhinitis (ORadj 34.0; 95% CI 7.6–152.6), but not in children with positive TST and recent allergic rhinitis (ORadj 0.6; 95% CI 0.07–5.2).

Conclusions:  MTB infection seems to reduce the prevalence of atopic rhinitis, and influences SPT reactivity in children with allergic rhinitis from a high TB incidence area.
Solid‐pseudopapillary tumours of the pancreas: 14 years experience
Authors: Sun Chuan‐Dong , Lee Woo‐Jung , Choi Jin‐Suob , Oh Jung‐Tak , Choi Seung‐Hoon
Published: August 2005

Background:  Solid‐pseudopapillary tumour of the pancreas (SPTP) is a low‐grade malignancy lesion that is distinct from other pancreatic tumours. Preoperative diagnosis is often inaccurate and treatment strategies remain controversial. The present study reviews the clinical features, diagnosis, treatment, and outcome of Asian patients with SPTP from a single institution.

Methods:  The medical records and images of patients who underwent surgery for SPTP between June 1990 and December 2003 were retrospectively reviewed. Study eligibility required that patients had undergone surgical resections and that the SPTP had been pathologically demonstrated.

Results:  Twenty‐eight patients with SPTP were identified. Eighteen patients (64.3%) reported the predominant symptom of ‘vague abdominal pain’, five patients (17.8%) had an apparent ‘abdominal mass’, and five patients (17.8%) without overt symptoms had masses that were discovered incidentally during screening. All patients underwent magnetic resonance (MR) imaging (n = 22) and/or computed tomography (n = 17), with a specificity of 90.9% and 76.4%, respectively. All masses were well‐circumscribed, except for a tumour in one patient (3.6%), which adhered to the stomach wall and metastasized to the liver. Two patients (7.1%) underwent enucleation, while 25 patients (89.3%) received curative resection. The patient with the liver metastases underwent distal pancreatectomy and splenectomy with partial hepatectomy. The mean follow up was 66.9 months. No mortality occurred during follow up but the patient with the liver metastasis had progressive deterioration.

Conclusion:  Symptoms of SPTP are indistinct and preoperative diagnosis is often inaccurate. Magnetic resonance imaging improves SPTP diagnosis. In general, the prognosis of well‐circumscribed SPTP is favourable after curative resection.
Randomized controlled trial of Gastrografin in adhesive small bowel obstruction
Authors: Burge Jonathan , Abbas Saleh M. , Roadley Graeme , Donald Jennifer , Connolly Andrew , Bissett Ian P. , Hill Andrew G.
Published: August 2005

Background:  Several previous studies have shown that Gastrografin can be utilized to triage patients with adhesive small bowel obstruction (ASBO) to an operative or a non‐operative course. Previous studies assessing the therapeutic effect of Gastrografin have been confounded by post‐administration radiology alerting the physician to the treatment group of the patient. Therefore the aim of the present paper was to test the hypothesis that Gastrografin hastens the non‐operative resolution of (ASBO).

Methods:  Patients, diagnosed with ASBO on clinical and radiological grounds, were randomized to receive Gastrografin or placebo in a double‐blinded fashion. Patients did not undergo further radiological investigation. If the patient required subsequent radiological intervention or surgical intervention they were excluded from the study. End‐points were passage of time to resolution of ASBO (flatus and bowel motion), length of hospital stay and complications.

Results:  Forty‐five patients with ASBO were randomized to receive either Gastrografin or placebo. Two patients were excluded due to protocol violations. Four patients in each group required surgery. Eighteen of the remaining patients received Gastrografin and 17 received placebo. Patients who received Gastrografin had complete resolution of their ASBO significantly earlier than placebo patients (12 vs 21 h, P = 0.009) and this translated into a median of a 1‐day saving in time in hospital (3 vs 4 days, P = 0.03).

Conclusions:  Gastrografin accelerates resolution of ASBO by a specific therapeutic effect.
Treatable Partial Epilepsy and Unilateral Opercular Neuronal Migration Disorder
Authors: Ambrosetto Giovanni
Published: August 2005

Summary: Five patients with treatable partial epilepsy and unilateral opercular neuronal migration disorder (NMD) are reported. Outcome was considered favorable when seizure control was prompt and complete with appropriate antiepileptic drug (AED) therapy, and when there was no relapse after AED discontinuation. Minor cortical sensorimotor defects were noted in 4 patients. All had normal mental status. No epileptic discharges were observed in the EEG of 4 patients, but rolandic spikes were observed in 1. The electroclinical and evolutive features suggested partial idiopathic epilepsy in 2 patients. Cases with focal neuronal migration disorders and favorable epilepsy outcome are probably more common than has been reported previously. The extent and location of the underlying microscopic lesions associated with the radiologically detectable cortical dysplasia may influence clinical outcome.
Genetic Predisposition to West Syndrome
Authors: Dulac Olivier , Feingold Josue , Plouin Perrine , Chiron Catherine , Pajot Nicole , Ponsot Gérard
Published: August 2005

Summary:To determine the recurrence risk of West syndrome (WS), we studied the familial antecedents of consecutively referred patients. Among siblings, there was an increased incidence of WS but not of febrile convulsions. Familial incidence of epilepsy was intermediate between the epileptic and nonepileptic control groups. When cases resulting from a genetically determined disease were excluded, incidence of epilepsy among siblings was similar to that in normal controls. Five of the 11 familial cases of WS were due to an identifiable cause: twin pregnancy, tuberous sclerosis, and recurrent maternal toxemia. In 4 of the remaining families, the clinical picture included spasms, erratic myoclonus, and postnatal microcephaly, suggestive of a previously unidentifiable progressive encephalopathy. Therefore, when identifiable familial diseases were excluded, the recurrence risk was <1%.
Callosotomy in West Syndrome Suggests a Cortical Origin of Hypsarrhythmia
Authors: Pinard J. M. , Delalande O. , Plouin P. , Dulac O.
Published: August 2005

Summary: Hypsarrhythmia and spasms of West syndrome have been postulated by some investigators to have a brainstem origin. Cortical involvement is also postulated because of the frequent association with cortical lesions. Cortical discharges have been proposed to stimulate subcortical structures (i.e., brainstem) and hypsarrhythmia is a secondarily generalized phenomenon produced by the brainstem. Two children with cryptogenic West syndrome refractory for several years to steroids and conventional antiepileptic drugs underwent total callosotomy. Hypsarrhythmia that was bilateral before operation became unilateral after the procedure and spasms became asymmetrical, suggesting that a corticocortical pathway through the corpus callosum is important in the generalization of hypsarrhythmia.
Social Adjustment in Young Adults with Absence Epilepsies
Authors: Olsson I. , Campenhausen G.
Published: August 2005

A long‐term follow‐up of 58 young adults, aged 18–27 years, with persisting absence epilepsies since childhood or early adolescence, was performed to assess psychosocial outcome and the patients' own concept of their epilepsy. They were well adjusted in the areas of family status and employment, but had more unqualified jobs as compared with a reference group. They were also inclined to lead very regular lives in a way that led to social isolation. At least one of the following factors was considered by 74% of the group to have been affected by their epilepsy, schooling, occupation, routines of daily life, relations with friends, leisure time activities, and housing, this was independent of whether or not they had achieved seizure control. In treating absence epilepsies, it is important that one considers psychosocial aspects, even if a medically satisfying result with seizure control is obtained.
Ictal HMPAO‐Single Photon Emission Computed Tomography Findings in Reading Epilepsy in a Japanese Boy
Authors: Miyamoto Akie , Takahashi Satoru , Tokumitsu Aya , Oki Junichi
Published: August 2005

Summary: Reading epilepsy is rare. We report a 14‐year‐old right‐handed Japanese boy who had had jaw jerking only while reading since age 12 years. The episodes occurred every time he read an English textbook and some‐times during prolonged reading of a Japanese textbook. The jaw jerking evolved to generalized tonic‐clonic seizures (GTCS) on only two occasions during prolonged reading aloud. Routine EEGs showed no abnormality. After a few minutes of reading, however, the EEG showed bilateral 2‐Hz, 150‐μ V spike‐wave complexes with left frontotemporal accentuation, accompanied by jaw jerking. Ictal single photon emission computed tomography (SPECT) with [99mTc]hexamethylpropylene amine oxime (HMPAO) showed focal hyperperfusion of the frontal lobes bilaterally and of the left temporal area. Interictal SPECT and magnetic resonance imaging (MRI) were normal. The combination of valproate (VPA) and clonazepam (CZP) almost eliminated his symptoms. Ictal SPECT is a useful technique for seizure localization in reading epilepsy.
Linear Intracerebral Calcification After Depth Electrode Implantation
Authors: Blatt Ilan , Johnson David W. , Dasheiff Richard M. , Vries John K.
Published: August 2005

Summary: We report linear calcifications along the trajectories of previously implanted depth electrodes in 2 patients. A 20‐year‐old man and a 38‐year‐old woman with medically intractable complex partial seizures (CPS), underwent bilateral frontal and mesiotemporal depth electrode implantation as part of their epilepsy surgery workup. Brain computed tomography (CT) at that time was normal (except for cerebrellar atrophy in one case). One patient had a left anterotemporal lobectomy (ATL), and the other declined operation. Subsequent CT scans showed linear calcifications 1–2 cm long in the occipital lobes (unilateral in 1 and bilateral in the other) that followed the trajectories of the temporal depth electrodes. This finding remained unchanged at latest followup (2–2.5 years), and no new pathology has appeared on subsequent scans. No abnormalities of calcium metabolism were detected. Review of all available CT scans of our patients with a history of previous depth electrode implantation showed no additional similar cases. We believe this is the first report of intracerebral calcifications after depth electrode implantation.
Migrating Partial Seizures in Infancy: A Malignant Disorder with Developmental Arrest
Authors: Coppola G. , Plouin P. , Chiron C. , Robain O. , Dulac O.
Published: August 2005

Summary: Fourteen infants of both sexes had a previously unreported epileptic condition characterized by nearly continuous multifocal seizures. The first seizures occurred at a mean age of 3 months, without antecedent risk factors. At 1 to 10 months, the seizures became very frequent. They were partial with variable clinical expression, and the EEG showed that the discharges randomly involved multiple independent sites, moving from one cortical area to another in consecutive seizures. Although their topography varied, the EEG ictal pattern of each seizure was very similar. It consisted of rhythmic alpha or theta activity which spread to involve an increasing area of the cortical surface. Patients regressed developmentally and became quadriplegic with severe axial hypotonia. Three patients died at age 7 months and at age 7 and 8 years, respectively. Seizures were controlled in only 2 patients, and only 3 children resumed psychomotor development. Extensive investigation failed to determine an etiology, and there was no familial recurrence. Neuropathological examination of the brain in two cases showed only severe hippocampal neuronal loss and accompanying gliosis.
Epileptic Spasms in Older Children: Persistence Beyond Infancy
Authors: Talwar Dinesh , Baldwin Marjorie A. , Hutzler Ron , Griesemer David A.
Published: August 2005

Summary Although infantile spasms (IS) constitute a well‐recognized epileptic syndrome, only recently did investigators propose that spasms be classified as a distinct seizure type, characterized by axial flexionlextension jerks in clusters. Five older children (aged 4.5–14.2 years) who underwent video‐EEG monitoring in 1992 in our epilepsy program for intractable mixed seizure disorder (cryptogenic 1, symptomatic 4) demonstrated flexor and extensor spasms in clusters. Seizure onset was from birth to 1.33 years. All 5 had spasms during infancy that continued as the children aged. Ictal EEG during spasms showed a brief high‐amplitude delta burst followed by diffuse background attenuation or diffuse background decrease with superimposed rhythmic beta or alpha activity. Multiple other seizure types were present. Interictal EEGs were markedly abnormal and demonstrated slowing, multifocal spikes, generalized slow spike‐wave, and polyspike‐wave. Two children with spasms were unsuccessfully treated with ACTH, and 3 underwent corpus callosotomy. We conclude that spasms occur in older children with intractable mixed seizure disorders and may persist beyond infancy.
Effects of MK‐801 and Phenytoin on Flurothyl‐Induced Seizures During Development
Authors: Velíšek Libor , Velíšková Jana , Ptachewich Yael , Shinnar Shlomo , Moshé Solomon L.
Published: August 2005

Summary We determined the effects of the N‐methyl‐Daspartate (NMDA) receptor blocker MK‐801 (0.05, 0.1, and 0.5 mg/kg intraperitoneally, i.p.) and phenytoin (PHT, 5, 10, and 20 mg/kg i.p.) on flurothyl‐induced clonic and tonic‐clonic seizures in 9‐, 1 5, 30‐, and 60‐day‐old male rats. Both agents had seizure‐, age‐, and dose‐specific effects. The highest dose of MK‐801 was anticonvulsant against clonic flurothyl‐induced seizures only in 9‐ and 60‐day‐old rats, but suppressed tonic‐clonic seizures in all ages. The lowest dose of MK‐801 (0.05 mg/kg) produced significant anticonvulsant effects only in 15 day old rats. PHT did not have any effect on clonic seizures throughout development. Both doses of PHT (10 and 20 mg/kg) were anticonvulsant against tonic‐clonic seizures in adult rats but not in any other age group. The results indicate that NMDA receptors play an important role in tonic‐clonic flurothyl‐induced seizures throughout development (especially in 15‐day‐old rats) and that the anticonvulsant effects of PHT may vary at different stages of brain development.
New Injectable Aqueous Carbamazepine Solution Through Complexing with 2‐Hydroxypropyl‐β‐Cyclodextrin: Tolerability and Pharmacokinetics After Intravenous Injection in Comparison to a Glycofurol‐Based Formulation
Authors: Löscher Wolfgang , Hönack Dagmar , Richter Angelika , Schulz Hans‐Ulrich , Schürer Michael , Düsing Raija , Brewster Marcus E.
Published: August 2005

Summary: The poor water solubility of the antiepileptic drug (AED) carbamazepine (CBZ) is generally considered an absolute contraindication to parenteral administration in epileptic patients. However, the water solubility of CBZ can be largely enhanced through formation of an inclusion complex with an amorphous cyclodextrin derivative, 2‐hydroxypropyl‐β‐cyclodextrin(HPβCD). We studied tolerability and pharmacokinetics of an aqueous CBZ:HPβCD solution after intravenous (i.v.) administration in dogs. For comparison, a conventional glycofurol‐based solution of CBZ was used. We also administered a commercial liquid formulation of CBZ orally Infusion of CBZ:HPβCD solutions or HPbCD “placebo” formulations i.v. was well tolerated by the animals. In contrast, infusion of CBZ: glycofurol solutions and glycofurol placebo solutions induced marked behavioral and cardio‐vascular adverse effects. Pharmacokinetic studies indicated that glycofurol inhibited CBZ metabolism by de‐creasing formation of the major CBZ metabolite CBZ‐10,11‐epoxide (CBZ‐E). With infusion of CBZ:HPβCD 10 ml/min for 12–15 min, resulting in a CBZ dose of CBZ 5 mg/kg body weight, peak CBZ plasma levels of −3.6 pgl μmCl were obtained. This relatively low peak concentration is primarily due to the rapid elimination of CBZ in dogs [half‐life (t/2) <1 h]. Comparison of peak plasma levels determined after p.0. administration of CBZ to dogs with peak CBZ levels previously determined after p.0. administration in humans indicated that about four times higher doses are needed in dogs to attain the same peak plasma levels as in humans. In view of previous experimental data showing rapid penetration of CBZ into brain, our results indicate that aqueous CBZ:HPPCD solutions might be ideally suited for parenteral use in acute clinical conditions such as status epilepticus (SE), particularly because CBZ is a drug with only minor respiratory or cardiovascular effects.
Reflex Myoclonic Epilepsy in Infancy: A New Age‐Dependent Idiopathic Epileptic Syndrome Related to Startle Reaction
Authors: Ricci Stefano , Cusmai Raffaella , Fusco Lucia , Vigevano Federico
Published: August 2005

Summary Benign myoclonic epilepsy of infancy (BMEI) is an idiopathic disorder characterized by spontaneous myoclonic attacks with onset in the first 2 years of life. We observed 6 neurologically normal infants (aged 6–21 months) with attacks that resembled those of BMEI but that occurred as reflex responses to unexpected auditory and tactile stimuli. Four infants also had rare spontaneous attacks. These reflex attacks consisted of isolated muscle jerks or clusters of up to eight symmetric limb jerks affecting mainly the arms. Five of the children had a family history of epilepsy or febrile convulsions. Myoclonic attacks disappeared in 614months. In 3 patients, the jerks stopped spontaneously; the others responded to valproate (VPA). Myoclonus could be elicited in wakefulness and in sleep. Ictal EEGs showed brief generalized spike‐or polyspike‐and‐wave discharges. Interictal EEGs were normal during wakefulness; during sleep, brief generalized discharges were evident. We propose that reflex myoclonic epilepsy of infancy (RMEI) is a new agedependent idiopathic generalized epileptic (IGE) syndrome, with an apparently good prognosis.
[11C]Flumazenil Positron Emission Tomography Visualizes Frontal Epileptogenic Regions
Authors: Savic Ivanka , Thorell Jan Olof , Roland Per
Published: August 2005

Summary: Presently available noninvasive methods correctly localize epileptogenic regions in only ε50% of patients with frontal lobe epilepsy (FLE). Earlier studies have shown that temporal lobe epileptogenic regions may be identified readily by positron emission tomography (PET) measurements of regional benzodiazepine (BZD) receptor binding. We tested the specific applicability of this method in patients with FLE. Six patients with frontal partial seizures and 7 healthy men were investigated with PET and the BZD receptor ligand [11C]flumazenil. All patients had magnetic resonance (MR) brain scans. The independent assessment of seizure–onset region was based on seizure semiology, intra– and extracranial EEG and, in 4 cases, also on [18F]fluorodeoxyglucose (FDG) PET. The epileptic focus/seizure‐generating region was correctly identified by [11C]flumazenil PET in all patients. This region was characterized by a significant reduction in BZD receptor density. The area with reduced BZD receptor density was better delimited than the corresponding hypometabolic region, which was observed in 50% of patients investigated with [18F]FDG–PET. MRI was normal in 5 patients. Visualization of BZD receptors with [11C]flumazenil PET appears to be a promising approach for noninvasive identification of frontal lobe epileptogenic regions.
Assessment and Selection of Candidates for Surgical Treatment of Epilepsy
Authors: Polkey Charles E. , Binnie Colin D.
Published: August 2005

Summary: A variety of surgical strategies are available to deal with intractable epilepsy. These are resective operations, consisting of the removal of a focus or a discrete lesion, gross removal of malfunctioning brain, and functional operations consisting of division of the pathways of propagation or of an epileptic neuronal aggregate. A method of assessment for surgery involves investigation managed in phases, with the patient either being refused surgery, offered surgery or proceeding to the next phase. The place of the common modalities of investigation, e.g., clinical data, brain imaging, neurophysiological investigation, and neuropsychological assessment have a role in this phased management.
Amygdala Kindling of Forebrain Seizures and the Occurrence of Brainstem Seizures in Genetically Epilepsy‐Prone Rats
Authors: Coffey Lori L. , Reith Maarten E. A. , Chen Nian‐Hang , Mishra Pravin K. , Jobe Phillip C.
Published: August 2005

Forebrain seizures were kindled in rats by daily electrical stimulation of the amygdala. Genetically epilepsy‐prone rats scoring 9 (GEPR‐9s) on the seizure severity scale during audiogenic seizure (AGS) screening (“brainstem seizure‐experienced”) required fewer stimulations to achieve fully kindled seizures (forelimb clonus with rearing and falling) than control rats. AGS‐naive GEPR‐9s required an intermediate number of stimulations, indicating a role for both genetic predisposition and previous acoustically evoked brainstem seizure experience. Other forebrain kindling indices such as afterdischarge thresholdlduration and seizure latencylduration also involved genetic as well as phenotypic (previous seizure experience) factors. In most GEPR‐9s in both groups, severe brainstem seizures occurred after forebrain stimulation. The occurrence of brainstem seizures had a random nature and was not related to the sequence of kindling‐dependent forebrain seizure progression. The lack of a difference in the occurrence of brainstem seizures between seizure‐experienced and AGS‐naïve GEPR‐9s suggest that genetic predisposition is the major factor in forebrain seizure‐induced activation of brainstem seizure circuitry. This brainstem seizure activity appears to model pertinent aspects of secondary generalization observed in human partial seizures.
Distribution of Felbamate in Brain
Authors: Cornford Eain M. , Truong Hoan‐Vu M. , Sofia R. Duane , Kucharczyk Norbert
Published: August 2005

Summary: We studied the distribution of felbamate (FBM) in rat brain using a brain imaging scanner to analyze thaw‐mount autoradiographs. After intravenous injection of [14C]FBM in rats, the autoradiographic distribution of isotope labeling patterns in brain was captured on x‐ray film. Densitometric differences on the x‐ray film were converted into color‐code variations representing the different concentrations of FBM in regions of the brain. We demonstrated that relatively uniform concentrations of FBM were detected throughout the brain. In all brain regions examined, there were no specifically high or low concentrations of FBM. We conclude that the FBM distributes uniformly.
Movement Disorders Associated with the Use of Gabapentin
Authors: Reeves Andrew L. , So Elson L. , Sharbrough Frank W. , Krahn Lois E.
Published: August 2005

Summary: Purpose: We report two cases of unusual movement disorders associated with the use of gabapentin (GBP) in patients being treated for epilepsy who were otherwise neuro‐logically intact.

Methods: We describe two cases of unusual movement disorders associated with the use of GBP.

Results: There were significant differences in the clinical findings between the two cases. In the first case, movements were very pronounced and the patient was in oculogyric crisis. Movements in the second case were quite subtle but nonetheless problematic for the patient. In each case, discontinuation of GBP led to rapid resolution of the movements, although a single dose of lorazepam was used in the first case.

Conclusions: Although formal electrophysiologic studies have not been performed, the movements associated with GBP use appear to be dystonic or myoclonic. Discontinuation of GBP led to rapid resolution of the movements. In severe cases, as in patients with oculogyric crisis, small doses of a benzodi‐azepine (BZD) appear to be efficacious and safe.
The Pilocarpine Model of Epilepsy in Mice
Authors: Cavalheiro E. A. , Santos N. F. , Priel M. R.
Published: August 2005

Summary: Purpose: To characterize the acute and chronic behavioral, electrographic and histologic effects of sustained seizures induced by pilocarpine in mice.

Methods: After status epilepticus, the surviving animals were continuously monitored for 24 h/day for 120 days. The brains were processed by using neo‐Timm and Nissl stains.

Results: The first spontaneous seizures occurred between 4 and 42 days after status epilepticus. The mean “seizure‐silent period” lasted for 14.4 ± 11.9 days. During the chronic phase, recurrent spontaneous seizures were observed 1–5 times per animal per week and were associated with sprouting in the supragranular layer of the dentate gyrus.

Conclusions: Structural brain damage promoted by pilocar‐pine‐induced status epilepticus may underlie or be associated with recurrent spontaneous seizures in mice.
Valproate Metabolites in High‐Dose Valproate Plus Phenytoin Therapy
Authors: Sugimoto Tateo , Muro Hideki , Woo Man , Nishida Naoki , Murakami Kiyotaka
Published: August 2005

Summary: Purpose: We wished to determine the relation between liver function, β‐, and ω‐, and ω‐1‐oxidation metabolites and 4‐en‐valproate (VPA).

Methods: We measured the serum levels of VPA and its metabolites in children and adolescent receiving high‐dose VPA plus phenytoin (PHT) therapy using gas chromatography‐mass spectrometry with selected ion monitoring (GC/MS/SIM).

Results: In high‐dose VPA plus PHT polytherapy, the total VPA serum concentration was distinctly low, the concentrations of total β ‐oxidation metabolites were decreased, the percentage values of VPA (percent of VPA) of total β ‐oxidation metabolites were increased, and the E‐2‐en‐VPM3‐keto‐VPA ratios were decreased, as compared with those in high‐dose VPA monotherapy. In high‐dose VPA plus PHT polytherapy, 4‐en‐VPA (μM) was decreased and the concentrations of (ω+ (ω ‐ 1)]‐oxidation metabolites (μ M) were decreased as compared with those in high‐dose VPA monotherapy. In high‐dose VPA plus PHT, serum glutamic‐oxaloacetic transarninase (GOT), glutarnic‐pyruvic transaminase (GPT) and lactic dehy‐drogenase (LDH) did not correlate significantly with the (β/ω+ (ω ‐ 1) metabolites ratio and 4‐en‐VPA levels, but serum GOT, GPT, and LDH were increased as compared with those in high‐dose VPA therapy. We were not able to establish a significant relation between the formation of metabolites of VPA metabolites and liver dysfunction in patients receiving high‐dose VPA and PHT concurrently.

Conclusions: Metabolic levels do not appear to be a reliable predictor of hepatotoxicity in children receiving pharrnacological antiepileptic drug (AED) therapy.
Double Pathology in Rasmussen's Encephalitis: Etiologic Considerations
Authors: Yacubian Elza M. T. , Rosemberg Sérgio , Marie Suely K. N. , Valerio Rosa M. F. , Jorge Carmen L. , Cukiert Arthur
Published: August 2005

In a 7‐year‐old girl with epilepsia partialis continua (EPC) involving the left face, arm, and leg for 1 year, serial neuroimaging studies showed progressive, brain atrophy. Because medical treatment was ineffective, she underwent a large fronto‐temporal surgical resection. Neuropathological examination showed loss of lamination and dysplastic neurons, gliosis, microglial nodules, and perivascular cuffing. Such “double pathology” (dysgenesia and a chronic inflammatory process) may have implications for the pathophysiology of Rasmussen's syndrome.
Valproate‐Induced Systemic Lupus Erythematosus in a Patient with Partial Trisomy of Chromosome 9 and Epilepsy
Authors: Gigli Gian Luigi , Scalise Anna , Pauri Flavia , Silvestri Giulia , Diomedi Marina , Placidi Fabio , Pomponi Maria Grazia , Masala Cesare
Published: August 2005

Summary: We report a mentally retarded 30–year‐old woman with partial trisomy of chromosome 9 (46,XX6,+der(6)t(6,9)pat) who has had epilepsy since age 11 months. She had been treated with various combinations of drugs. After 1 year of treatment with valproate (VPA) and ethosuximide (ESM), the patient developed arthral‐gias, muscle weakness, fatigue, and fever. Laboratory examination showed increased sedimentation rate, hyper‐gammaglobulinemia, and high titers of antinuclear antibodies (ANA). The possibility of VPA‐induced systemic lupus erythematosus (SLE) was considered. This diagnosis was supported by detection of antihistone antibodies and the HLA‐DR4 antigen. VPA dosage was tapered and discontinued, with accompanying resolution of clinical, immunological and hematological signs of SLE 6 weeks after VPA discontinuation. This is the fourth reported case of VPA‐induced SLE.
Tooth‐Brushing Epilepsy: A Report of a Case with Structural and Functional Imaging and Electrophysiology Demonstrating a Right Frontal Focus
Authors: O'Brien Terence J. , Hogan Robert E. , Sedal Leslie , Murrie Vanessa , Cook Mark J.
Published: August 2005

Summary: Patients with reflex epilepsies may provide insights into cerebral pathophysiology. We report a patient with an unusual form of reflex epilepsy in whom seizures are induced by tooth brushing. Magnetic resonance imaging (MRI) demonstrated a right posterior frontal low‐grade tumor predominantly involving the precentral gyrus. Video‐telemetry demonstrated right‐sided epileptiform activity during a typical induced complex partial seizure. An ictal single photon emission computed tomography (SPECT) scan showed an area of hyperfusion that corresponded to the MRI lesion on coregistration with a surface‐matching technique. A subsequent coregistered interictal SPECT scan demonstrated hypoperfusion in the same region. Ours is the first report to demonstrate a structural focus in this unusual form of reflex epilepsy. Possible mechanisms to explain the induction of the seizures are discussed.