bluuebunny/crossref_metadata_2025 huggingface dataset:
Regional “Rigidity” of Background EEG Activity in the Epileptogenic Zone
Authors: Wang Jijun , Wieser Heinz Gregor
Published: October 2005

Summary: Spectral analysis of interictal background EEG activity recorded through foramen ovale (FO) electrodes during monitoring (mean 5.8 days per patient) was studied in 10 medically refractory complex partial seizure (CPS) patients who were candidates for epilepsy surgery. Data of the spectral analysis was plotted as compressed spectral array (CSA) with spectral edge frequency (SEF) markers. For each patient, time‐varying fluctuations of the SEF markers were compared visually and by a computer‐assisted method between two symmetrical FO electrode EEG channels recording from both mesiobasotemporal lobes (MTL). The amount of asymmetrical variations of the SEF markers (“rigidity” phenomenon) was first determined visually and then quantified by the computer‐assisted method. These findings were correlated with the results of other clinical tests, including FO electrode‐recorded seizure onset (FO ict), positron emission tomography with [18F]fluorodeoxyglucose (FDG‐PET), and magnetic resonance imaging (MRI) to investigate whether the rigidity phenomenon could lateralize the primary epileptogenic zone. The rigid side had 80, 70, and 60% coincidence rates with the pathologic side indicated by FDG‐PET, FO ict, and MRI, respectively, in a single test. We conclude that the rigidity phenomenon of FO electrode‐recorded interictal background EEG activity is a valuable sign for lateralization of the primary epileptogenic zone in MTL epilepsy. The relative invariance of SEF may be caused by interictal deafferentation of epileptic neurons.
Effect of Anterior Callosotomy on Bilaterally Synchronous Spike and Wave and Other EEG Discharges
Authors: Oguni Hirokazu , Andermann Frederick , Gotman Jean , Olivier André
Published: October 2005

Summary: We analyzed pre‐ and postoperative interictal and ictal EEG patterns in relation to seizure outcome in 29 patients with intractable epilepsy who had undergone anterior callosotomy. Twenty‐two patients had generalized bilaterally synchronous sharp or spike and slow wave discharges (GSW) and 7 did not: Postoperatively, patients with preoperative GSW showed disruption of synchrony, increased amplitude asymmetry, and a decreased amount of GSW. No significant decrease was noted in the amount of total epileptic discharge after operation. There was a significant relation between seizure outcome and decrease in amount of GSW. The degree of disruption of synchrony, total amount of epileptic discharge, and pre‐ and postoperative EEG patterns were not good indicators of seizure outcome. Postoperative changes in lateralization of epileptic foci consisted either of increased lateralization, less lateralization but increased independent discharges in the previously nonpredominant hemisphere, or appearance of some lateralization. There appears to be a spectrum of GSW: Both sec‐ondary bilateral synchrony and secondarily generalized corticoreticular epileptic discharges are distributed along this spectrum.
Surgical Treatment of Intractable Seizures Due to Hypothalamic Hamartoma
Authors: Nishio Shunji , Morioka Takato , Fukui Masashi , Goto Yoshinobu
Published: October 2005

Summary: A 6.5‐year‐old boy developed seizures at age 2.8 years consisting of episodes of unconsciousness and laughing attacks. By age 6 years, multiple seizure types, including generalized tonic‐clonic (GTC), complex partial (CPS) and akinetic seizures, and drop attacks were occurring several times daily. EEG showed multifocal epileptic discharges. Antiepileptic drugs (AEDs) did not control the seizures. With progression of the epilepsy, cognitive deterioration developed. There were no manifestations of precocious puberty. Neuroimaging disclosed a suprasellar mass in continuity with the hypothalamus, and a diagnosis of hypothalamic hamartoma was made. After surgical resection of the hamartoma, the seizures were completely alleviated, and the epileptic EEG discharges disappeared. Improvement of mental function was also noted.
Prognostic Value of Qualitative Magnetic Resonance Imaging Hippocampal Abnormalities in Patients Undergoing Temporal Lobectomy for Medically Refractory Seizures
Authors: Garcia Paul A. , Laxer Kenneth D. , Barbaro Nicholas M. , Dillon William P.
Published: October 2005

Summary: In patients with temporal lobe epilepsy (TLE), high‐resolution, magnetic resonance imaging (MRI) frequently demonstrates hippocampal atrophy and increased hippocampal signal. To assess the prognostic value of these findings, we studied 51 patients evaluated prospectively by a radiologist blinded to other preoperative evaluations. Thirty‐one of 51 (61%) patients undergoing temporal lobectomy had visually apparent hippocampal atrophy o r increased hippocampal signal on MRI (25 ipsilateral 3 contralateral, and bilateral to the operated site). Patients with ipsilateral abnormalities became seizure‐free more frequently than patients with normal scans [24 of 25 (96%) vs. 10 of 20 (50%) p < 0.015]. Both ipsilateral hippocampal atrophy and ipsilateral increased hippocampal signal independently predicted a seizure‐free outcome. Qualitative MRI provides important prognostic information in patients undergoing temporal lobectomy.
Memory Complaints Before and After Temporal Lobectomy: Do They Predict Memory Performance or Lesion Laterality?
Authors: McGlone Jeannette
Published: October 2005

Summary: The relationships among self‐report of memory, actual memory performance on objective tasks, and lesion laterality were examined in this longitudinal study. Right‐handed adults (n = 47) with medically intractable seizures were assessed both preoperatively and 1 year after a left or right temporal lobectomy. Memory complaints remained stable or diminished postoperatively, whereas performance on material‐specific memory tasks declined. Regression analyses showed that dosage of medications, seizure frequency and self‐reported depression were predictive of postoperative memory complaints, although size of resection and age were not. Together, these data suggest that many patients have a positive though mistaken impression that their memory functions improved after temporal lobectomy, an impression influenced by their positive surgical outcomes. Memory complaints did not predict laterality of the lesion. Sex‐laterality interactions were evident for both subjective and objective memory measures.
Patient Satisfaction and Epilepsy Surgery
Authors: Guldvog B.
Published: October 2005

Summary: This study was designed to describe patients' experience with surgical treatment of epilepsy in terms of whether it was useful or had negative effects and to assess associations between experienced utility (satisfaction), experienced negative effects (dissatisfaction), and selected objective outcome measures. An evaluation of patients' satisfaction and dissatisfaction was conducted retrospectively by questionnaires for all patients surgically treated for epilepsy in Norway between 1949 and 1988. One hundred sixteen patients (74.3%) replied. Overall, 75% of the surgically treated patients reported that treatment had been useful, and 20% reported that the treatment had negative effects. The experience of satisfaction with treatment was strongly associated with a favorable seizure outcome, more severe underlying disease, improvements in working ability, being in regular work or education postoperatively, and not having disability pensions postoperatively. The experience of dissatisfaction with treatment was significantly associated with neurologic deficit and decreased working ability. There was overall agreement between subjectively reported satisfaction with treatment and success measured objectively. The experiences of useful effects and negative effects of the operation could not be represented by a single‐dimension scale. Seizure outcome played a more important role in terms of reported useful effects, and neurologic deficit played a more important role in reported negative effects. In both categories, effects on social, occupational, emotional, and behavioral aspects played an important role.
Interictal Aggression in Epilepsy: The Buss‐Durkee Hostility Inventory
Authors: Devinsky Orrin , Ronsaville Donna , Cox Christiane , Witt Ellen , Fedio Paul , Theodore William H.
Published: October 2005

Summary: Adult patients with left, right, or bilateral temporal lobe epilepsy or absence epilepsy, and normal controls completed the Buss‐Durkee Hostility Inventory (BDHI), a standardized questionnaire of aggressive tendencies. Patients with left temporal lobe seizure foci scores higher on the Suspición scale than did other patients or controls (p < 0.05). Factor analysis scale scores identified three factors: hostile feelings, covert aggression, and overt aggression. The groups differed on their pattern of factor scores (p < 0.01): patients with left temporal lobe epilepsy scored higher than other groups on hostile feelings, normal controls scored higher on Covert aggression, and bitemporal patients scores higher on Overt aggression. Patients with absence seizures did not differ from controls. Lateralization of the seizure focus in patients with temporal lobe epilepsy may alter expression of aggressive behavior.
Development of a Novel Scale to Assess Life Fulfilment as Part of the Further Refinement of a Quality‐of‐Life Model for Epilepsy
Authors: Baker G. A. , Jacoby A. , Smith D. F. , Dewey M. E. , Chadwick D. W.
Published: October 2005

Summary: We have been involved in developing a health‐related quality‐of‐life model for use as an outcome measure in epilepsy. As part of the further development of this model, we have developed a measure of life fulfilment. This scale is based on methods previously described by Krupinski in 1980. The value of Krupinski's approach is the opportunity for patients to weight the numerous aspects of their quality of life and assess the discrepancy between their actual and desired circumstances. The life fulfilment scale has been shown to be reliable (α= 0.7) and valid. The scale is currently being applied to several clinical studies in epilepsy. We believe that the scale provides a valuable contribution to our health‐related quality‐of‐life model.
Quality of Life of Epilepsy Surgery Patients as Compared with Outpatients with Hypertension, Diabetes, Heart Disease, and/or Depressive Symptoms
Authors: Vickrey Barbara G. , Hays Ron D. , Rausch Rebecca , Sutherling William W. , Engel Jerome , Brook Robert H.
Published: October 2005

Summary: Health‐related quality of life (HRQOL) of 166 adults who had previously undergone surgical treatment for intractable epilepsy was compared with that of outpatients with hypertension, diabetes, heart disease, andlor depressive symptoms. Eight self‐reported HRQOL domains were evaluated and compared by the RAND 36‐Item Health Survey 1.0: emotional well‐being, social function, role limitations due to emotional problems, energy/fatigue, pain, role limitations due to physical problems, physical function, and general health perceptions. A pictorial item on overall QOL was also administered, for a total of 9 HRQOL domains. With adjustment made for age, gender, education, and comorbid conditions, 55 completely seizure‐free patients scored higher (i.e., better health) than patients with hypertension in 6 of 9 domains, higher than diabetic patients in 8 of 9, higher than those with heart disease in all 9, and higher than those with depressive symptoms in all 9 (all p < 0.05). Sixty‐seven patients still having seizures with impaired consciousness scored worse than hypertensive patients in 5 domains, worse than diabetic patients in 3, and worse than heart disease patients in 2; for all 3 conditions, these domains included emotional well‐being and overall QOL (p < 0.05). These 67 patients, however, scored better than patients with depressive symptoms in all 9 domains, better than those with heart disease in 2, and better than those with diabetes in 1 (all p < 0.05). Forty‐four other patients had only simple partial seizures (SPS); their scores were comparable to those of diabetic and heart disease patients on mental and social health scales but were higher (“better”) than those of these patients on physical health scales. HRQOL among patients who have undergone “curative” epilepsy surgery is better than that of patients who have hypertension, diabetes, heart disease, or depressive symptoms. Patients who have continued seizures with altered consciousness are worse off in terms of emotional well‐being and overall QOL than all other patients, except for those with depressive symptoms.
Vagus Nerve Stimulation for Treatment of Partial Seizures: 1. A Controlled Study of Effect on Seizures
Authors: Ben‐Menachem E. , Mañon‐Espaillat R. , Ristanovic R. , Wilder B. J. , Stefan H. , Mirza W. , Tarver W. B. , Wernicke J. F. ,   First International Vagus Nerve Stimulation Study Group
Published: October 2005

Summary: Vagus nerve stimulation (VNS) was shown to reduce seizure frequency in refractory epilepsy patients in two pilot studies. Based on these results, a multicenter, prospectively randomized, parallel, double‐blind study of patients with refractory partial seizures was initiated. After a 12–week baseline period, identical vagus nerve stimulators were implanted and patients randomized to either a high or low 14–week VNS treatment paradigm. The primary objective was to demonstrate that high VNS (therapeutic parameters) was more effective in reducing partial seizure frequency than was low VNS (less or noneffective parameters). Patients continued receiving antiepileptic drugs (AEDs) with plasma concentrations held constant throughout the study. We report results of the first 67 patients to exit the 14‐week acute phase. After 14 weeks of VNS, 31 patients receiving high VNS experienced a mean seizure frequency percentage reduction of 30.9%, which was statistically significant as compared with the mean seizure frequency percentage reduction of 11.3% in 36 patients receiving low VNS (p = 0.029, t test; p = 0.036, Wilcoxon rank‐sum test). In addition to the significant intra group p‐values, mean seizure frequency percentage change reached statistical significance for high VNS (p < 0.001) but not low VNS (p = 0.072) as compared with baseline. Twelve of 31 (38.7%) patients receiving high VNS achieved at least 50% reduction in seizure frequency whereas 7 of 36 (19.4%) patients receiving low VNS experienced at least 50% reduction after 14 weeks. The implant procedure and VNS therapy were well tolerated. Our study confirmed the effectiveness of VNS as treatment for epilepsy patients with refractorypartial seizures.
Vagus Nerve Stimulation for Treatment of Partial Seizures: 2. Safety, Side Effects, and Tolerability
Authors: Ramsay R. E. , Uthman B. M. , Augustinsson L. E. , Upton A. R. M. , Naritoku D. , Willis J. , Treig T. , Barolat G. , Wernicke J. F. ,   First International Vagus Nerve Stimulation Study Group
Published: October 2005

Summary: Vagus nerve stimulation (VNS) significantly reduces the frequency of partial seizures in refractory epilepsy patients. We examined the serious adverse events, side effects, and tolerability as they relate to the surgical implant procedure and the stimulating device.We also reviewed potential drug interactions, device out‐put complications, and impact of the therapy on overallhealth status. We analyzed the first 67 patients to exit theacute phase of the EO3 VNS trial comparing high (therapeutic) VNS to low (less or noneffective) VNS. Datawere collected from case report forms used at each of thefour visits during the 12‐week baseline and at each of thefour visits during the 14‐week randomized phase of the trial. No significant complications were reported as a re‐sult of the implant procedure. Serious adverse events in‐cluded 1 patient who experienced direct current to thevagus nerve owing to generator malfunction resulting inleft vocal cord paralysis and withdrawal of the patientfrom the study. No clinically significant effects on vitalsigns, cardiac function, or gastric function were detected. Side effects associated with VNS in the high group werehoarseness (35.5%), coughing (13.9%), and throat pain(12.9%). In the low group, only hoarseness (13.9%) andthroat pain (13.9%) were associated with VNS. Theseeffects generally were not considered clinically significantand occurred primarily during the stimulation pulses. Nopatients discontinued VNS therapy during the acutephase because of side effects associated with normal stimulation. Except for the one instance of a short circuitin the system resulting in a direct current, stimulatingsystem complications were minor, limited to programming, unscheduled stimulation, and high lead impedance.Patients, investigators, and patient companions rated patients receiving high stimulation as more “improved” than those receiving low stimulation in regards to overallhealth status. Antiepileptic drug (AED) plasma concentrations were not affected by VNS. The implant procedure, stimulating system, and therapy proved safe andtolerable during the study. The high percentage (67 of 68)of patients completing the study reflects patient acceptance and tolerability of this mode of therapy.
Vagus Nerve Stimulation for Treatment of Partial Seizures: 3. Long‐Term Follow‐Up on First 67 Patients Exiting a Controlled Study
Authors: George R. , Salinsky M. , Kuzniecky R. , Rosenfeld W. , Bergen D. , Tarver W. B. , Wernicke J. F. ,   First International Vagus Nerve Stimulation Study Group
Published: October 2005

Summary: Vagus nerve stimulation (VNS) has demonstrated a significant anticonvulsant effect in preclinicalstudies, in pilot studies in humans, and in the acute phaseof a multicenter, double‐blinded, randomized study. After completion of a 14–week, blinded, randomized study, with 31 receiving high (therapeutic) VNS and 36 receiving low (less or noneffective) VNS, 67 patients elected tocontinue in an open extension phase. During the extension phase, all 67 patients received high VNS. Seizurefrequency during the 3‐month treatment blocks was compared with a 12–week baseline. For both groups, all periods of high VNS demonstrated a significant decrease inseizure frequency (p < 0.01 level) as compared with baseline. For the 16–18–month period of VNS, data wereavailable for 26 of the 31 patients randomized to highVNS. This group achieved a 52.0% mean seizure frequency percentage réduction as compared with baseline. For those converted from low to high VNS, data wereavailable for 24 of the 36 patients at the 16–18‐month timeperiod. This group reported a mean seizure frequency percentage reduction of 38.1% as compared with baseline. No significant change in the safetyhde effect profilewas reported during longterm followup. The previouslyreported side effects of hoarsenesslvoice change, coughing, and paresthesia (sensation in neck and jaw) continued to occur during VNS. These side effects were well tolerated. During the follow‐up period, 1 patient died of thrombotic thrombocytopenic purpura (TTP) and 5 patients discontinued treatment because of unsatisfactory efficacy.
Occipital Lobe Epilepsy: A Chronic Condition Related to Transient Occipital Lobe Involvement in Eclampsia
Authors: Plazzi Giuseppe , Tinuper Paolo , Cerullo Angelina , Provini Federica , Lugaresi Elio
Published: October 2005

Summary: Eleven hours and 6 days, respectively, after childbirth 2 women exhibited hypertension and paroxysmal visual disturbances followed by tonic‐clonic seizures and no other preeclamptic signs. Both developed partial epilepsy with occipital lobe seizures with no other neurologic defects. Neuroimaging showed no lesion during either the acute episode or 3–5 year follow‐up. Selective vulnerability of the occipital lobes during eclamptic hypertensive encephalopathy was the probable pathophysiologic mechanism. Aggressive antihypertensive treatment during the acute phase may have exacerbated the risk of permanent cerebral damage.
Anticonvulsant Activities of 4–Bromobenzaldehyde Semicarbazone
Authors: Dimmock J. R. , Baker G. B.
Published: October 2005

Summary:Some of the properties of 4–bromobenzalde‐hyde semicarbazone (compound IV), a prototype molecule of a new class of anticonvulsants, aryl semicarbazones, are described. Compound IV demonstrated activity in the maximal electroshock (MES) and subcutaneous pentylenetetrazol (scPTZ) tests in mice, with low neurotoxicity. When given orally to rats, it displayed high potency in the MES test and very low neurotoxicity, resulting in a high protective index (PI). Compound IV displayed no proconvulsant properties, and development of rapid tolerance was not noted. When administered intraperitoneally (i.p.) at doses of 100, 300, or 600 mg/kg to rats, compound IV had no effect on levels of γ‐aminobu‐tyric acid (GABA) or on GABA‐T activity in whole brain. When tested in vitro, compound IV had no effect on rat brain GABA‐T at a drug concentration of 100 μM. Although the activities of certain drug‐metabolizing enzymes were increased after oral administration of compound IV to rats, these effects were less prominent than those of phenytoin (PHT) and carbamazepine (CBZ). The principal mode of action of compound IV does not appear to be an interaction with the GABAAreceptor complex, and other mechanisms, involving excitatory amino acid neurotransmission, will have to be considered in future investigations of the anticonvulsant activity of this compound.
Comparative Bioavailability of a Generic Phenytoin and Dilantin
Authors: Rosenbaum David H. , Rowan A. James , Tuchman Linda , French Jacqueline A.
Published: October 2005

Summary: Generic substitution of antiepileptic drugs(AEDs) has been controversial, with many alleged in‐stances of biologic and therapeutic inequivalence re‐ported. The recall of a generic phenytoin (PHT) formula‐tion used in the Veterans Administration (VA) medicalsystem allowed us to evaluate the question of biologicequivalence systematically in a relatively large number ofpatients at the Bronx VA Medical Center. Serum PHTlevels were 22–31% lower during the period of genericintake as compared with levels in the same patients re‐ceiving Dilantin. Review of the literature showed onlyone other adequately documented report of potential clin‐ically significant inequivalence between a brand nameand generic AED. Despite the apparent infrequency ofgeneric inequivalence, several areas in which proceduresfor certification of therapeutic equivalence should be im‐proved were identified.
Viewpoint of a Driver with Epilepsy
Authors: Bornemann Michael T.
Published: October 2005

Summary: Persons with seizure disorders are a variedgroup, but the group is treated indiscriminately when U.S. state laws restrict driving privileges on the basis ofa seizure incident without regard for individual drivingrecord, level of personal responsibility, or the almost insignificant danger posed to ourselves and other motorists.From the viewpoint of a driver with epilepsy, seven characteristics encompass a model driver licensing law, whichwould (a) be a proportionate response to the problemaddressed; (b) be reasonable enough to ensure compliance; (c) empower the individual (as opposed to a medicaladvisory board exclusively) to participate in decisions;(d) consider each individual's circumstances; (e) be consistent with U.S. Public Law 95–602, the RehabilitationAct of 1973; (f) be based on performance rather than onmedical incident; and (8) preserve for society the benefitof every driver's fullest participation.
Driving and Epilepsy: A Historical Perspective and Review of Current Regulations
Authors: Krumholz Allan
Published: October 2005

Summary: Historically, persons with seizures or epilepsyhave been prohibited from driving automobiles or motorvehicles because of concern for public safety. Seizureshave a tendency to recur and pose risks of traffic accidents, property damage, and personal injury. In our modern world, however, driving an automobile is such aneconomic and social necessity that a conflict results between our need to protect public safety and our responsibility to provide reasonable opportunities to drive forpersons handicapped by seizures and epilepsy. Currently, there is a trend toward liberalization of driving standardsfor persons with epilepsy, but there is still considerablecontroversy regarding the specific driving restrictionsnecessary for persons with seizures, the way in whichsuch policies should be administered, and the role physicians should have in the process.
Epilepsy and Driving Regulations in Wisconsin
Authors: Hansotia Phiroze
Published: October 2005

Summary: Driving regulations in the state of wisconsin have evolved In 1987, changes in these regulations focuseed the problem on loss of consciouness and bodily control of drivers rather than on specific diagnostic entities such as epilepsy or diabetes mellitus. Current wisconsin law encompasses loss of consciousness or events affecting bodily control, nop matter what the cause. Current regulations balance individual needs with the of safety for society Neurologists are encouraged come involved to keep the process of regulation with the dynamic changes in medical care and in portaion techonology (e.g. air bags, roll bars, etc).
Development and Application of Medical Guidelines for Drivers in the State of Maine
Authors: Jozefowicz Thaddeus H.
Published: October 2005

Summary: In 1984, the Medical Advisory Board for thestate of Maine realized that uniform criteria with regard tophysical, emotional, and mental competence to operate amotor vehicle were nonexistent. This resulted in confusion and inevitable inequities. The burden of determiningone's ability to operate a motor vehicle safely was leftwith the individual physician, who often had to defend astand without adequate guidelines. In addition, the impaired driver was frequently not reported because of fearof liability and breach of confidentiality. Being aware ofthese deficiencies, the Medical Advisory Board (MAB)decided to develop a reasonable uniform standard to beapplied in the state. The first step was to draft nonliabilitylegislation. The second step was to draft Driver Impairment Profiles. Care has been taken to insure that functionally impaired drivers are granted driving privilegesconsistent with the fullest extent of their ability to operatea motor vehicle safely. The guidelines identify impairments that post unacceptable driving risks. Most important, the decision to allow operation of a motor vehicle isnow shifted to the Division of Motor Vehicles (DMV), with the physician supplying the pertinent medical infor‐mation on the reporting form.
Driving and Epilepsy: Changing the Law in Maryland
Authors: Kingham Lee Ann
Published: October 2005

Summary: The Epilepsy Association of Maryland, an affiliate of the Epilepsy Foundation of America (EFA), recognized that the Maryland state regulations and laws ondriving licensing restricted the rights of individuals withepilepsy. After identifying the problem, the Associationdetermined the needed changes and planned a legislativestrategy to accomplish the change. Once the change wasachieved, the Association planned and executed stepsnecessary for successful implementation of the change.
Entorhinal‐Hippocampal Interactions in Medial Temporal Lobe Epilepsy
Authors: Spencer Susan S. , Spencer Dennis D.
Published: October 2005

Summary: Experimental studies suggest important interactions between hippocampus and entorhinal cerebral cortex in generation of temporal lobe seizure activity. We studied electrical expression of spontaneous temporallobe ictal activity in hippocampus and entorhinal cortex in 9 medically refractory epileptic patients who had intracranial depth and subdural electrodes implanted during surgical evaluation. All 9 patients subsequently under‐went anteromedial temporal lobectomy with hippocam‐pectomy, all had >50% decrease in neuronal cell density in hippocampal CA1 and CA3, and all had good to excellent seizure outcome after operation. Two to 10 spontaneous seizures were analyzed per patient (total 41 seizures). Nine patients had variable onset of seizure activity recorded in hippocampus, entorhinal cortex, or both simultaneously. Low‐voltage fast activity was observed in either location and varied among seizures in an individual patient. Periodic preictal spikes, when present, were often synchronous in both locations, but were noted independently only in hippocampus. Our data suggest that preictal spikes and low‐voltage fast seizure discharges have anatomically distinct origins, and that some syndromes of medial temporal lobe epilepsy involve interactions between entorhinal and hippocampal regions that act together to produce and propagate the seizures in such patients.
Neocortical Dendritic Pathology in Human Partial Epilepsy: A Quantitative Golgi Study
Authors: Multani P. , Myers R. H. , Blume H. W. , Schomer D. L. , Sotrel A.
Published: October 2005

Summary: We used a computerized image‐analysis system to perform a quantitative analysis of rapid Golgiimpregnated pyramidal neurons of the third cortical layer of histologically normal cerebral cortex surgically removed from patients with partial epilepsy. Various parameters of 51 neurons from 9 patients and 29 neurons from 5 age‐matched controls were compared. Dendritic spine density decreased progressively with increasing duration of seizures, and dendritic swellings were most numerous in epilepsy cases of uncertain etiology and in patients with seizures of longer standing. Neurons from seizure cases showed fewer dendritic branching points and fewer proximal dendritic branches than those from controls, suggesting a simplified dendritic architecture. These findings indicate that neurons in cortex distant from the primary site of epileptogenic activity may be undergoing subtle, progressive degeneration, which may explain the propensity of chronic epilepsy patients to have increased seizure activity and interictal behavioral and cognitive aberrations.
Serial Cognitive Testing in Temporal Lobe Epilepsy: Longitudinal Changes with Medical and Surgical Therapies
Authors: Selwa Linda M. , Berent Stanley , Giordani Bruno , Henry Thomas R. , Buchtel Henry A. , Ross Donald A.
Published: October 2005

Summary: Cognitive testing was repeated at intervals ranging from 1 to 8 years in 47 adult patients with temporal lobe epilepsy (TLE). Each patient underwent standardized batteries, including the Wechsler Adult Intelligence Scale, Revised (WAIS‐R), and Wechsler Memory Scale (WMS). Both surgically treated and nonsurgical patients were examined. The nonsurgical group underwent serial testing for clinical indications, usually for complaints of memory dysfunction. Longitudinal testing could not verify any mean deterioration of intellect or memory in this group; variance over time was similar to test‐retest norms in healthy controls. WAIS‐R scores before and after resection in the surgical group were similar to our serial WAIS‐R data in nonsurgical patients. When we divided surgical patients according to side of epileptogenesis, we noted the expected differences in verbal and visual memory. Right‐sided surgery patients improved significantly in Full‐scale IQ (FSIQ) and tended to improve in logical memory on postoperative testing. Patients undergoing left resections had no retest improvement and tended to show decrease in several measures of verbal memory. Our findings should stimulate continued investigation into the natural history of lateralized memory and intellectual function in epilepsy, particularly to clarify longterm cognitive outcome in nonsurgical patients.
Amnesia After Unilateral Temporal Lobectomy: A Case Report
Authors: Loring David W. , Hermann Bruce P. , Meador Kimford J. , Lee Gregory P. , Gallagher Brian B. , King Don W. , Murro Anthony M. , Smith Joseph R. , Wyler Allen R.
Published: October 2005

Summary: We report a mixed handed (L>R) patient with exclusive right cerebral language representation who de–veloped a permanent anterograde amnestic syndrome after right anterotemporal lobectomy. Preoperative neuropsychological performance consisted of impaired verbal memory and normal nonverbal memory. Wada memory performance was asymmetrical for objects presented soon after amobarbital injection in conjunction with no memory asymmetry for items presented later in the Wada evaluation. Preand postoperative magnetic resonance imaging (MRI) scans showed no structural lesions; however, postoperative MRI hippocampal volume measurements suggested decreased hippocampal volume for the nonresected temporal lobe. These results confirm the risk of anterograde amnesia after unilateral temporal lobectomy and demonstrate that baseline neuropsychological testing may falsely literalize material‐specific memory functions in patients with atypical cerebral language dominance.
Risk Factors for Burns as a Consequence of Seizures in Persons with Epilepsy
Authors: Spitz Mark C. , Towbin John A. , Shantz Dianne , Adler Lawrence E.
Published: October 2005

Summary: To explore the risk factors and circumstances for burns in a population of persons with epilepsy, we surveyed 244 University of Colorado Health Sciences Center Seizure Clinic patients. Twenty‐five had at least one seizure‐related burn requiring medical attention (12 were hospitalized), 21 reported burns requiring medical attention not related to seizure activity, and 199 reported no burns. All patients with seizure‐related burns had alteration of consciousness during most seizures. Statistical models with logistic regression indicated that a useful model for assessing risk of seizure‐related burns in this population of patients could be constructed using three significant variables: lifetime total number of seizures experienced by the patient, the presence of interictal neurologic impairment, and gender. The remainder of the variables studied (percentage of seizures that occurred nocturnally, percentage of seizures preceded by a simple partial seizure (SPS) warning, self‐care status, number of seizures in adult life, seizure type, patient age, age of onset of seizure disorder, and presence of burns not associated with seizure) were either not significantly correlated with seizure‐related burns or did not significantly improve the success of the statistical model in light of the other variables studied. Most injuries occurred in the home during activities that might have been avoided. They included 10 burns incurred while cooking, 5 incurred while showering (with a plumbing system that permitted exposure to scalding water), and 3 caused by exposed room heaters. A subset of epileptic patients are at increased risk for burns and should minimize situations in which they can be burned.
Aura Phenomena and Psychopathology: A Pilot Investigation
Authors: Silberman Edward K. , Sussman Neil , Skillings Gerald , Callanan Mimi
Published: October 2005

Summary: We investigated a possible relation between aura phenomena and psychopathology in patients with seizure disorders. Twenty‐one patients with a variety of seizure types (90% with generalized seizures, 12% with complex partial seizures, CPS) were studied. Aura phenomena were evaluated with the Silberman‐Post Psychosensory Phenomena Scale; psychopathology was assessed with the Schedule for Affective Disorders and Schizophrenia‐Lifetime Version (SADS‐L), the Minnesota Multiple Personality Inventory (MMPI), and the Washington Psychosocial Seizure Inventory (WPSI). Psychosensory symptoms occurring in the absence of frank seizures, but not those occurring with seizures, were related to increased psychopathology (primarily mood and anxiety related) and greater time in psychiatric treatment. Psychosensory symptoms may reflect ongoing neurophysiologic dysfunction related to epilepsy and may therefore be a useful subject for further study.
Evaluation of the Hypothesis that Hippocampal Interictal Spikes are Caused by Long‐Term Potentiation
Authors: Leung Lai‐Wo Stan
Published: October 2005

Summary: Hippocampal spontaneous interictal spikes (SISs) occur in the EEG after repeated afterdischarges (ADS) induced by high‐frequency (200 Hz) stimulationtrains. Because SISs resemble population excitatory postsynaptic potentials (EPSPs), and SISs persist for several days like some types of hippocampal long‐term potentiation (LTP), LTP has been suggested as a mechanism for SISs. We specifically examined the hypothesis that SISs are caused by basal‐dendritic LTP in CAI. Rats were chronically implanted with bilateral electrodes in the hippocampal CA1 region. In the first experiment, 10–18 patterned primed burst (PB) stimulations were delivered hourly for 2–3 days to activate the commissural basal‐dendritic EPSP in CA1. Robust LTP of the basal‐dendritic CAI synapse was detected, typically saturating at 100% enhancement after five stimulations. However, few SISs were detected if ADS were not elicited. In the second experiment, repeated commissurally evoked ADS induced a high rate of SISs, together with LTP of the basal‐dendritic and apical‐dendritic EPSP in CA1, but the SIS rate was not necessarily related to the level of LTP. In the third experiment, an intraventricular dose (20 p.g) of an N‐methyb‐aspartate (NMDA) receptor antagonist 2‐amino‐5‐phosphonovalerate (APV) was used to block the basal‐dendritic LTP in CA1. The increase in SISs induced by a single AD was not blocked, however, suggesting that NMDA receptors were not critical in generation of SISs. In the fourth experiment, PBs (that induced LTP but no ADS) were able to increase the rate of SISs marginally when SISs were already present. In all, the experiments suggest that LTP at the basal dendrites of CA1 is not critical in generation of hippocampal SISs, although an increase in LTP may increase the rate of SISs marginally when SISs are already present.
Epidemiologic Features of Infantile Spasms in Iceland
Authors: LúǒAvígsson Pétur , Ólafsson Elias , Sigurǒardóttir Sólveig , Hauser W. Allen
Published: October 2005

Summary: We determined the average annual incidence of epilepsy characterized by infantile spasms (IS) in Iceland based on the 13 cases identified in a 10‐year interval (1981–1990). The cumulative incidence was 3 in 10,000 live births. Males were more frequently affected than females. All patients responded completely (10) or partially (3) to ACTH or steroid therapy. At follow‐up, all children with cryptogenic IS are seizure‐free and have developed normally intellectually. One of the children with cryptogenic IS has mild spastic diplegia. All children in the symptomatic group are mentally retarded, and 5 of 7 continue to have unprovoked seizures. We detected no evidence for familial aggregation, and the incidence of seizures or epilepsy did not appear to be increased in first‐degree relatives of cases. The proportion of cases with a favorable outcome was greater than that reported in most clinical series.
Visual Abnormalities and Occipital EEG Discharges: Risk Factors for West Syndrome
Authors: Iinuma Kazuie , Haginoya Kazuhiro , Nagai Mayumi , Kon Kimiya , Yagi Tsuneo , Saito Tatsuhiko
Published: October 2005

Summary: Seventeen infants (7 boys and 10 girls) with visual abnormalities (such as poor tracking and following and nystagmoid eye movement) and occipital slow activities with irregular polyspikes on EEG were studied. Two thirds of the children showed development of West syndrome with hypsarrhythmia on follow‐up EEG. In 1 child, hypsarrhythmia was evident on the follow‐up EEG, but no clinical seizures occurred. Because most of the children in our series developed West syndrome, patients with visual abnormalities associated with occipital EEG discharges in early infancy may be at high risk for West syndrome. Occipital abnormalities in early infancy may relate to the occurrence of West syndrome.
Benign Partial Epilepsy with Affective Symptoms: Hyperkinetic Behavior During Interictal Periods
Authors: Wakai Shuji , Yoto Yuko , Higashidate Yoshihito , Tachi Nobutada , Chiba Shunzo
Published: October 2005

Summary: We report a 4‐year‐old boy with benign partial epilepsy (BPE) with affective symptoms associated with hyperkinetic behavior during interictal periods. He had had hypermobility and restlessness since about age 3. At 4 years, 6 months, he developed episodes consisting of an expression of terror without complete loss of consciousness. Although we first suspected an acute psychic problem, the ictal EEG was abnormal. After carbamazepine (CBZ) therapy, the frequency of the attacks decreased dramatically and the hyperkinetic behavior gradually diminished.
Ictal Video‐EEG Analysis of Infantile Neuroaxonal Dystrophy
Authors: Wakai Shuji , Asanuma Hideomi , Hayasaka Hiroyuki , Kawamoto Yoshitaka , Sueoka Hirofumi , Ishikawa Yukitoshi , Minami Ryoji , Chiba Shunzo
Published: October 2005

Summary: A 4‐year‐old boy with infantile neuroaxonal dystrophy (INAD) showed gradual deterioration from age 9 months with seizure development at age∼36 months. Sural nerve biopsy performed at age 42 months confirmed INAD. The seizure, recorded by video‐EEG, consisted of a series of symmetrical tonic spasms of both upper extremities after a prodrome period of staring and akinesis. Each spasm had phonation, and episodic autonomic symptoms such as hypertension and flushing of the face occurred throughout the seizure. Ictal EEG with each tonic spasm, showed diffuse 1‐s, irregular sharp and highvoltage slow wave complexes followed by desynchronization.
Epileptiform EEG Discharges in Healthy Children: Prevalence, Emotional and Behavioral Correlates, and Genetic Influences
Authors: Okubo Yoshiro , Matsuura Masato , Asai Toshio , Asai Kunihiko , Kato Masaaki , Kojima Takuya , Toru Michio
Published: October 2005

Summary: Epileptiform discharges in 8 electrode waking EEGs at rest and during hyperventilation in 1,057 healthy children aged 6–12 years from an elementary school were studied: Epileptiform discharges, detected in 53 children (5.0%), consisted of centrotemporal spikes (37 cases), generalized spike ahd slow wave complexes (10 cases), occipital spikes (2 cases), frontal spikes (1 case), and a combination of multiple spike and slow wave complexes and focal spikes (2 cases). The occurrence of a positive past history of febrile convulsions was higher in children with epileptiform discharges (18.9%) than in those without epileptiform discharges (9.4%). Using the Rutter scales for teachers and parents, we compared the emotional and behavioral problems of children with epileptiform EEG discharges with those of children without epileptiform discharges. No statistically significant differences were noted, indicating that the emotional and behavioral problems existing are most probably coincidental and not directly related to the epileptiform discharges. A genetic basis for generalized epileptiform discharges was postulated because the occurrence of generalized discharges in siblings of probands with generalized discharges was higher (4 of 9, 44.4%) than the prevalence in all subjects. However, the occurrence of centrotemporat spikes in the siblings of probands with centrotemporal spikes was not higher (2/38, 5.3%) and an autosomaldominant genetic factor for centrotemporal spikes in waking EEGs of healthy children could not be confirmed.
Kindled Amygdaloid Seizures in Rats Cause Immediate and Transient Increase in Protein Kinase C Activity Followed by Transient Suppression of the Activity
Authors: Osonoe Kouichi , Ogata Shin‐ichi , Iwata Yasuhide , Mori Norio
Published: October 2005

Summary: Protein kinase C (PKC) activity in hippocampus and amygdala was measured during kindled seizures and 30 rnin, 3, 24, and 80 h, and 2 weeks after seizures in amygdaloid‐kindled rats. Shamperated rats not subjected to kindling were used as controls. During kindled seizures, membrane‐bound PKC activity in bilateral hippocampi was significantly increased, with a slight reduction in cytosolic PKC activity, but there was no change in either membrane‐bound or cytosolic PKC activity in bilateral amygdaIa. Thirty minutes after seizures, PKC activity in both fractions was significantly increased in bilateral hippocampi and amygdala. Three hours after seizures, PKC activity in both fractions was markedly decreased in bilateral hippocampi. In bilateral amygdala, a similar and significant decrease in membrane‐bound PKC activity was noted, with no marked change in the cytosolic fraction. Twenty–four hours after seizurs, a significant decrease in membrane–bound PKC activity in bilateral hippocampi and amygdala was again noted, although cytosolic PKC activity was unchanged. Fortyeight hours after the seizures, PKC activity in both fractions had returned to control levels. Two weeks after the last seizure, there was no significant change in PKC activity in either fraction in any region, except for a slightincrease in membrane–bound PKC activity in unilateral hippocampus contralateral to the kindled arnygdala. These results suggest that kindled amygdaloid seizures cause an immediate and transient increase in PKC activity in limbic structures, followed by suppression of enzyme activity, and that PKC in hippocampus responds to kindled seizures more readily and preferentially than it does in amygdala. Examination of the direct effect of kindled seizures on PKC activity is important for understanding of the relation between kindled phenomena and PKC in limbic structures.
Amygdaloid Kindling Elicits Persistent Changes in Pertussis Toxin‐Catalyzed ADP‐Ribosylation
Authors: Iwasa Hiroto , Hasegawa Shuji , Kikuchi Shuichi , Watanabe Kaori , Sato Toshio
Published: October 2005

Summary: We examined the changes in pertussis toxin (PTX)‐catalyzed ADP‐ribosylation in amygdaloid‐kindled rats to clarify the role of G proteins in the basic mechanisms of epilepsies. Autoradiographic analysis showed a remarkable increase in PTX‐catalyzed ADP‐ribosylation in 39–4 1‐kDa proteins in hippocampus and cerebral cortex of kindled animals. The 39‐to 41‐kDa proteins were shown to be a ‐subunits of Gi and Go by immunoblotting with specific anti‐Cia and anti‐Goa. The increase in ADP‐ribosylation of these proteins was observed on stimulated and unstimulated sides of brains 24 h after the last genralized seizure and persisted for at least 3–4 weeks. These results suggest that persistent alterations in signal transduction through Gi and Go might be related to acquisition of long‐lasting epileptogenesis.
Audiogenic Seizure Susceptibility in WSP and WSR Mice
Authors: Feller D. J. , Bassir J. M. , Crabbe J. C. , Le Fevre C. A.
Published: October 2005

Summary: Mice selectively bred for susceptibility (WSP, withdrawal seizure prone) and resistance (WSR, withdrawal seizure resistant) to ethanol (EtOH) withdrawal seizures were tested for susceptibility to audiogenic sei–zures (AGS). The seizure response of mice was studied at four ages: 17, 22, 28, and 71–78 days. WSR mice exhibited no response at any age, whereas WSP mice were sensitive on days 17, 22, and 28. The maximum number of WSP mice responding to audiogenic stimulation was observed on day 22. However, the frequency and severity of responses by WSP mice was less than that of DBA/2J mice tested under identical conditions (60 vs. 100% showing at least Some response). Overall, these data suggest that susceptibility to AGS and handling‐induced convul‐sions (HIC) during EtOH withdrawal may share some common genetic determinants and presumably some common neurochemical systems. Various treatments have been shown to enhance HIC more in WSP as compared with WSR mice. Acoustic stimulation did not induce AGS in adult mice, but the treatment significantly enhanced HIC in WSP but not WSR mice. These data strongly imply that some common neurochemical pathway may regulate susceptibility to HIC elicited by diverse treatments.