bluuebunny/crossref_metadata_2025 huggingface dataset:
Age‐Specific Effects of Baclofen on Pentylenetetrazol‐Induced Seizures in Developing Rats
Authors: Velíšková Jana , Velíšek Libor , Moshé Solomon L.
Published: August 2005

Summary: Purpose: To determine whether seizures have age‐specific features, we studied the role of γ‐aminobutyric acid, (GABAB) transmission in rats of various ages (9, 15, 30, and 60 postnatal days). Methods: We used a GABA, receptor agonist baclofen (2 or 5 mg/kg intraperitoneally, i.p.) and a GABAB receptor antagonist CGP 35348 (100 or 600 mg/kg i.p.) in the pentylenetetrazol (PTZ)‐induced model of clonic and tonic‐clonic seizures (100 mg/kg subcutaneously, s.c.).

Results: Whereas baclofen was anticonvulsant and CGP 35348 proconvulsant in most animals, there were distinct age‐related differences in the effectiveness of these drugs and the antagonist had some anticonvulsant activity in adults. Furthermore, the two drugs acting at GABAB receptors had a different profile of action in clonic seizures as compared with tonic‐clonic seizures.

Conclusions: The differences in the age‐specific action of the GABAB agonist and antagonist suggest that different GABAB receptor subsets may mediate the drug effects. The results indicate that putative antiepileptic drugs (AEDs) must be tested during development because it may not be possible to extrapolate age‐specific anticonvulsant effects from studies in adult animals.
Temporal Lobe Epilepsy Subtypes: Differential Patterns of Cerebral Perfusion on Ictal SPECT
Authors: Ho Susan S. , Berkovic Samuel F. , McKay W. John , Kalnins Renate M. , Bladin Peter F.
Published: August 2005

Summary: Purpose: We studied cerebral perfusion patterns in the various subtypes of TLE, as determined by pathology and good outcome after temporal lobectomy (as confirmation of temporal origin).

Methods: We studied clinical features and ictal technetium 99m hexamethyl‐propyleneamineoxime (99mTc‐HM‐PAO) single‐photon emission‐computed tomography (SPECT) in four subgroups of patients with intractable temporal lobe epilepsy (TLE) treated with surgery: hippocampal sclerosis (group 1, n = 10), foreign‐tissue lesion in mesial temporal lobe (group 2, n = 8), foreign‐tissue lesion in lateral temporal lobe (group 3, n = 7), and normal temporal lobe tissue with good surgical outcome (group 4, n = 5).

Results: No major clinical differences in auras, complex partial seizures or postictal states were identified among the groups. Ictal SPECT showed distinct patterns of cerebral perfusion in these subtypes of TLE. In groups 1 and 2, hyperperfusion was seen in the ipsilateral mesial and lateral temporal regions. In group 3, hyperperfusion was seen bilaterally in the temporal lobes with predominant changes in the region of the lesion. Hyperperfusion was restricted to the ipsilateral anteromesial temporal region in group 4. Ipsilateral temporal hyperperfusion in mesial onset seizures can be explained by known anatomic projections between mesial structures and ipsilateral temporal neocortex. Bilateral temporal hyperperfusion in lateral onset seizures can be explained by the presence of anterior commissural connections between lateral temporal neocortex and the contralateral amygdala.

Conclusions: We conclude that the perfusion patterns seen on ictal SPECT are helpful for subclassification of temporal lobe seizures, whereas clinical features are relatively unhelpful. These perfusion patterns provide an insight into preferential pathways of seizure propagation in the subtypes of TLE.
Quantitative MRI in Outpatient Childhood Epilepsy
Authors: Lawson John A. , Cook Mark J. , Bleasel Andrew F. , Nayanar Vimala , Morris Kevin F. , Bye Ann M. E.
Published: August 2005

Summary: Purpose: In adult studies, MRI volumetrics is a proven technique in presurgical assessment of epilepsy. Hippocampal volume loss is maximal in the syndrome of mesial temporal lobe epilepsy. We aimed (a) to validate this methodology in a pediatric outpatient epilepsy population (b) to determine the relationship of hippocampal asymmetry (HA) to epileptic syndromes and risk factors.

Methods: Two neurologists classified the epileptic syndrome in 79 pediatric outpatients, according to the International Classification of Epilepsies and Epileptic Syndromes (ILAE). Hippocampal volumetrics were performed in all patients. HA was defined according to adult control values.

Results: Inter‐rater variability on measurement of HA was very small (Correlation of test retest of 0.97 on 17 children <3 years old). The rate of HA was 44/79 (57%). In 21 patients, (27%) potentially epileptogenic lesions (other than HA) were identified (cerebral dysgenesis n = 11). HA was present in 9/15 (60%) of temporal lobe epilepsy and in 15/28 (54%) extratemporal onset epilepsy and 5/11 (46%) of generalized symptomatic epilepsy. Analysis confined to <13 years also showed HA was not specific for epileptic syndrome. There was no significant association of febrile convulsions (13%) with HA or temporal lobe epilepsy.

Conclusions: There is a high incidence of HA in childhood epilepsy. HA was not confined to clinically defined temporal lobe epilepsy. The poor correlation of epileptic syndrome to quantitative MRI findings may be due to the inadequacies of epilepsy classification in the younger child, with the clinical semiology providing misleading localizing information. Normative childhood data for hippocampal volumes and symmetry is needed.
Relations Between EEG Seizure Morphology, Interhemispheric Spread, and Mesial Temporal Atrophy in Bitemporal Epilepsy
Authors: Spanedda F. , Cendes F. , Gotman J.
Published: August 2005

Summary: Purpose: A strong relation exists between lateralization of seizure onset in temporal‐lobe epilepsy and atrophic mesial structures measured by volumetric magnetic resonance imaging (MRI). We examined whether this relation extended to subregions of the mesial temporal lobe and whether the trend for seizures to spread contralaterally could be related to the localization of atrophy.

Methods: We analyzed 362 seizures (with and without clinical signs) from 23 patients having bitemporal epilepsy in whom intracerebral electrodes were implanted for presurgical evaluation. Patients had measurements of hippocampal and amygdala volumes, including comparison with normal controls. We assessed on EEG the laterialization and localization of seizure onset and the trend to spread to the contralateral side (proportion of seizures that spread for each patient). We included all seizures, independent of the presence of clinical manifestations. These features were related to presence and localization of atrophy.

Results: Among the 19 patients with mesial atrophy, agreement between side of prevalent seizure onset and predominant atrophy was found in 10 (53%). From 99 seizures starting in a temporal lobe with atrophy limited to the hippocampus, 67% started simultaneously in amygdala and hippocampus, 20% in hippocampus, and 13% in amygdala. From 137 seizures starting in a temporal lobe with amygdala and hippocampal atrophy, 47% started in amygdala and hippocampus, 48% in hippocampus, and 5% in amygdala. The trend to spread was 45% to the most atrophic side and 62% to the normal or less atrophic side.

Conclusions: When examining amygdala and hippocampus in this group of patients with bitemporal epilepsy, regions of seizure onset did not correspond to regions of predominant atrophy. The likelihood that seizures spread contralaterally was not influenced by atrophy in the region targeted by the spread. Precise relation between mesial temporal atrophy and seizures remain to be elucidated.
Localization of Epileptic Auras Induced on Stimulation by Subdural Electrodes
Authors: Schulz R. , Lüders H. O. , Tuxhorn I. , Ebner A. , Holthausen H. , Hoppe M. , Noachtar S. , Pannek H. , May Th. , Wolf P.
Published: August 2005

Summary: Purpose: This study evaluates the localization of stimulation‐induced auras (SIA) and tries to determine whether the SIA can help to define the boundaries of resection in epilepsy surgery.

Methods: Using subdural grid electrodes, 31 patients with drug resistant focal epilepsy were examined in a retrospective and prospective study lasting 2 years.

Results: On stimulation by subdural electrodes, we elicited habitual auras in 16 patients (52%). The zone of SIA overlapped the epileptogenic lesion in 12 patients (75%), the EEG seizure onset zone in 12 patients (75%), and the irritative zone of interictal spikes in eight patients (50%). Postoperative results showed a significant correlation with the complete removal of the epileptogenic lesion (p c 0.001). Because the number of patients in the study was small, we could not find a significant correlation with the complete removal of the SIA zone, EEG seizure onset zone. and irritative zone.

Conclusions: Our study confirms previous analyses which indicate that complete resection of the epileptogenic lesion is essential to achieve a good outcome. Frequent overlap of the SIA zone with the epileptogenic lesion and the EEG seizure onset zone indicates proximity of the SIA with the epileptogenic zone. Nevertheless, this study does not support the concept that the SIA zone and the EEG seizure onset zone have additional value in defining the boundaries of resection in epilepsy surgery. Three case presentations suggest that SIA result from facilitated pathways between the stimulated cortex, the epileptogenic zone around the lesion, and the symptomatogenic zone. Functional reorganization in the vicinity of the cortical lesion cannot be ruled out but was not seen in our patients. Thus, SIA often do not reflect the normal function of the stimulated underlying cortex.
The Contribution of Tertiary Centers to the Quality of the Diagnosis and Treatment of Epilepsy
Authors:   Osservatorio Regionale per l'Epilessia (OREp), Lombardy
Published: August 2005

Summary: Purpose: A survey was made of a network of 14 epilepsy centers in Italy to assess whether integrated diagnosis and treatment monitoring led to a more precise syndromic classification of the patients and a better response to treatment.

Methods: Data on the diagnosis and treatment of epilepsy and the degree of seizure control were recorded in a register on 2 separate occasions, on June 30, 1990 (to), before starting the integrated activities, and on June 30, 1992 (tl), on completion of a 2–year follow‐up. Each patient's history was required to fit a specific category of the International Classification of the Epilepsies (ICE) (1). Response to treatment was classified as complete remission, occasional seizures, recurrent nonrefractory seizures, and drug‐resistant epilepsy. A total of 3,469 patients of the ages of 4–80 years were enrolled.

Results: At to, 44% of cases had localization‐related epilepsy, 31% generalized epilepsy, 9% undetermined epilepsy, 6% special syndromes, and 10% epileptic syndromes with atypical features. At tl, the percentages in each category were 51, 27, 7, 6, and 9%. The cases classified as “other” within each syndromic category at to were 11–23% and remained unchanged at tl. Patients with symptomatic localization‐related epilepsies were largely recoded as symptomatic or cryptogenic epilepsies. About one‐third of patients with symptomatic generalized epilepsy were recoded as localization‐related epilepsies. Nine percent of patients were classified as “uncertain” epilepsies at to, and the same proportion at t1. However, many “uncertain” diagnoses became “definite” and vice versa.

Conclusions: There was a slight increase in the proportion of patients achieving complete remission (from 13 to 28%) and untreated patients (from 10 to 17%). Nine percent of patients unresponsive to treatment at to had achieved remission at t1l Drug resistance was confirmed in 78% of cases and was mostly independent of the therapeutic decision. Ten percent of cases achieved remission with unchanged or simplified treatment schedules.
Short‐Term Mortality After a First Episode of Status Epilepticus
Authors: Logroscino Giancarlo , Hesdorffer Dale C. , Cascino Gregory , Annegers John F. , Hauser W. Allen
Published: August 2005

Summary: Purpose: Studies evaluating short‐term mortality among people who experience status epilepticus (SE) have produced conflicting results. Most studies are derived from clinical series with results affected by unspecified follow‐up period and select referral of cases. This study was planned to evaluate short‐term mortality after a first episode of SE.

Methods: We performed a population‐based retrospective cohort study to determine the short‐term mortality following a first episode of SE. Between January 1,1965 and December 31, 1984, we studied all first episodes of a febrile SE who received medical attention in Rochester, Minnesota. Cases were followed until death or end of the study (February 1996).

Results: Mortality within the first 30 days was 19% (38 deaths out of 201 incident SE). Thirty‐four deaths (89%) occurred among those with non febrile acute symptomatic SE, while 4 deaths (11%) occurred among those with unprovoked SE. Within the acute symptomatic group, after adjusting for age, there was a decreased risk of death in women (RR = 0.4; 95% CI: 0.2–0.9). No effect of duration or seizure type was shown after adjusting for other risk factors.

Conclusions: One out of 5 subjects with SE died within the first 30 days. Short‐term mortality is associated with the presence of an underlying acute etiology. Among acute symptomatic cases, women had a decreased risk of dying.
Lateralizing Value and Semiology of Ictal Limb Posturing and Version in Temporal Lobe and Extratemporal Epilepsy
Authors: Bleasel Andrew , Kotagal Prakash , Kankirawatana Pongkiat , Rybicki Lisa
Published: August 2005

Summary: Purpose: Unilateral dystonic limb posturing in partial seizures has been shown to be an accurate lateralizing sign indicating seizure onset in the contralateral hemisphere. However, its clinical utility may be reduced by confusion with other lateralized ictal motor phenomena. In this study, the ictal phenomena of dystonic limb posturing, tonic limb posturing, unilateral immobile limb, and version were distinguished and examined in patients with temporal and extratemporal seizures.

Methods: Partial seizures in 54 patients, successfully treated by surgery (34 temporal, 20 extratemporal; 14 frontal, 3 parietal, and 3 occipital), were analyzed blindly by 3 reviewers. Interobserver agreement was tested with kappa indexes and positive predictive value (PPV) was determined for each sign.

Results: In patients with temporal lobe epilepsy (TLE), dystonic posturing occurred in 35.3% (kappa 0.78, positive predictive value (PPV) for the sign being contralateral to seizure onset 92%); tonic limb posturing occurred in 17.7% (kappa 0.36, PPV 40%); unilateral immobile limb occurred in 11.8% (kappa 0.23, PPV 100%); and version occurred in 35.3% (kappa 0.77, PPV 100%). In patients with extratemporal epilepsy, dystonic posturing occurred in 20.0% (kappa 0.31, PPV 100%); tonic limb posturing occurred in 15.0% (kappa 0.08, PPV 67%); and version occurred in 40.0% (kappa 0.54, PPV 100%). The higher kappa indexes were significant for dystonic posturing (p < 0.001) and tonic limb posturing (p = 0.032) in TLE. Dystonic posturing (p = 0.034), tonic posturing (p = 0.07), and version (p = 0.0038) occurred earlier in extratemporal seizures than in temporal seizures.

Conclusions: Of the limb ictal motor phenomena, only dystonic posturing was accurate and had good interobserver agreement.
Occipital Lobe Developmental Malformations and Epilepsy: Clinical Spectrum, Treatment, and Outcome
Authors: Kuzniecky Ruben , Gilliam Frank , Morawetz Richard , Faught Edward , Palmer Cheryl , Black Lorie
Published: August 2005

Summary: Purpose: Cortical developmental malformations (CDM) are increasingly recognized in association with epilepsy. We describe 10 patients (age range 14–35 years) with symptomatic occipital lobe epilepsy and CDM.

Methods: Neurologic, neuroophthalmologic and electro‐physiologic studies were performed. Patients had MRI, SPECT, and in some cases intracranial EEG investigators.

Results: Mean age of seizure onset was 8 years. We noted strong correlations between the presence of visual auras, the scalp EEG pattern, and the subtype of underlying pathology. Magnetic resonance imaging (MRI) showed CDM in all patients, with polymicrogyria and focal dysplasia being the most frequent malformations. Despite the presence of occipital lobe structural malformations in all patients, visual field deficits were present in only 2. Those who underwent cortical resections were seizure–free or showed major improvement at a mean follow–up of 3.5 years.

Conclusions: Intracranial stimulation studies and the low frequency of pre‐ and postoperative deficits suggest that some degree of cortical visual reorganization may occur in patients with occipital lobe malformations. Occipital lobe CDM should be sought as a cause of symptomatic occipital lobe epilepsy even though they may become symptomatic after childhood.
Occurrence of Epilepsies in Family Members of Indian Probands with Different Epileptic Syndromes
Authors: Jain S. , Padma M. V. , Jyoti A. Puri , Maheshwari M. C.
Published: August 2005

Summary: Purpose: Large numbers of families with many members having seizures have been used to understand the role of hereditary factors in the pathogenesis of human epileptic syndromes. We aimed to establish a genetic database to form a hypothesis on the possible genetic contributions in different epileptic syndromes.

Methods: The occurrence and patterns of different epilepsies and epileptic syndromes in 1,219 Indian probands and their relatives were studied. The concordance of epilepsies between probands and relatives was also analyzed.

Results: Of probands, 231 (19% of 1219) had first– or second‐ degree relatives affected with seizures. Incidence of family history in probands with generalized epilepsies (GES) and syndrome of single, small, enhancing lesions (SSEL) was comparable and significantly higher than that in probands with localization‐related epilepsies (LRES). The ratio of affected first‐ to second‐degree relatives was close to 4:1. Generalized epilepsies were the commonest type of epileptic syndromes seen among all relatives. The proportion of sibs and second‐degree relatives with epileptic syndromes similar to probands was significantly greater in the GES group as compared with the concordant relatives of probands with LRES and SSEL.

Conclusions: A significant percentage of first‐ and second–degree relatives of probands with all types of epileptic syndromes have seizures. The risk of relatives being affected varied as a function of the relation with the proband. Concordance of epileptic syndromes between probands and relatives was related to the epileptic syndromes in probands. The syndrome of SSEL is probably a benign epileptic syndrome seen in Indians genetically predisposed to seizures. Hereditary factors may play an almost equal role in the predisposition of relatives to epilepsy in families of probands with different epileptic syndromes.
Subdural Recording of Bereitschaftspotential Is Useful for Functional Mapping of the Epileptogenic Motor Area:
Authors: Yazawa S. , Ikeda A. , Terada K. , Mima T. , Mikuni N. , Kunieda T. , Taki W. , Kimura J. , Shibasaki H.
Published: August 2005

Summary: A 26‐year‐old man with intractable focal motor seizure beginning with tonic contraction of the left orbicularis oculi muscle had prolonged EEG monitoring with subdural grid electrodes placed over the right perirolandic cortex. Electrical stimulation of the cortex with implanted subdural electrodes showed a relatively low threshold for afterdischarges (ADS) but could not disclose the motor area for the left upper face where or near where the epileptogenic area was expected to be present. Bereitschaftspotential recorded from the subdural electrodes in association with self‐paced voluntary blink (eyelid closing) disclosed the motor area specifically related to voluntary movements of the left upper face, which was most likely buried in the sulcus. This observation suggests that recording of Bereitschaftspotential from subdural electrodes is useful for mapping the motor cortex, especially in patients with focal motor seizure with low threshold for ADS to electric stimuli.
Poststroke Late Seizures and Their Role in Rehabilitation of Inpatients
Authors: Paolucci Stefano , Silvestri Giulia , Lubich Sergio , Pratesi Luca , Traballesi Marco , Gigli Gian Luigi
Published: August 2005

Summary: Purpose: This study was designed to (a) identify the prevalence of poststroke late seizures in a population of patients admitted to rehabilitation of neurologic sequelae of their first stroke, (b) recognize reliable prognostic factors associated with the occurrence of poststroke late seizures, and (c) evaluate the impact of seizures on the results of rehabilitation treatment.

Methods: In a prospective study of 306 consecutive patients admitted to a rehabilitation hospital for sequelae of their first stroke, we assessed the relation among 15 independent variables and the development of seizures by using multiple regression analysis (forward stepwise). In addition, we evaluated the impact of occurrence of poststroke seizures on both efficiency and effectiveness of rehabilitation and length of stay.

Results: Poststroke late seizures occurred in 46 (15.03%) patients, with a mean interval from stroke of 101.98 ± 37.96 days. In multiple regression analysis, putaminal and lobar hemorrhages showed a significant positive association with the development of seizures (p < 0.005), whereas high scores on the Canadian Neurological Scale (CNS) (indicating less severe strokes) and increasing age were negatively associated (p < 0.01 and p < 0.05, respectively). Patients with putaminal and lobar hemorrhages and patients with severe stroke (CNS score at admission, <7) were at significantly greater relative risk of seizures [relative risk (RR) = 1.99, 95% confidence interval (CI), 1.11–1.39; RR = 3.00, CI, 1.06–1.13; and RR = 2.41, CI, 1.01–1.27, respectively). No significant association was found between poststroke seizures and results of rehabilitation.

Conclusions: Poststroke late seizures occurred mainly in patients with putaminal and lobar hemorrhagic strokes but, if treated, did not affect rehabilitation therapy.
Early‐Onset Benign Occipital Seizure Susceptibility Syndrome
Authors: Ferrie C. D. , Beaumanoir A. , Guerrini R. , Kivity S. , Vigevano F. , Takaishi Y. , Watanabe K. , Mira L. , Capizzi G. , Costa P. , Valseriati D. , Grioni D. , Lerman P. , Ricci S. , Vigliano P. , Goumas‐Kartalas A. , Hashimoto K. , Robinson R. O. , Panayiotopoulos C. P.
Published: August 2005

Summary: Purpose: Childhood epilepsy with occipital paroxysms (CEOP) is characterised by ictal visual hallucinations and occipital epileptiform activity on interictal EEG. A variant has been described with nonvisual symptoms including tonic head and eye deviation, vomiting, and episodes of partial status epilepticus. We fully documented the electroclinical features of such patients to determine whether classification separate from CEOP is justified.

Methods: This was a multicentre study with participating investigators submitting details of patients with idiopathic occipital seizures characterised by ictal head or eye deviation and vomiting.

Results: One hundred thirteen patients were recruited. Seizures began in early childhood (mean, 4.6 years) and occurred infrequently (mean total seizures, 3); 30% of patients had only a single seizure. Two thirds of seizures were nocturnal. Ictal eye deviation occurred in 79%, vomiting in 70%, and head deviation in 35%. Seizures were predominantly complex partial in type. Partial status epilepticus occurred in 44% of patients. Seventy‐four percent of patients had occipital interictal EEG epileptiform activity, predominantly right sided, with fixation‐off sensitivity. Extraoccipital EEG abnormalities occurred in 35% of patients. Prognosis was excellent: the mean duration of active seizures was 1 year.

Conclusions: Although the two groups shared identical EEG features, the distinct clinical symptoms probably justify separate classification. Early‐onset benign occipital seizure syndrome (EBOSS) is suggested as an appropriate name for the variant group.
Comparison of the Steady‐State Pharmacokinetics of Topiramate and Valproate in Patients with Epilepsy During Monotherapy and Concomitant Therapy
Authors: Rosenfeld W. E. , Liao S. , Kramer L. D. , Anderson G. , Palmer M. , Levy René H. , Nayak R. K.
Published: August 2005

Summary: Purpose: The steady‐state pharmacokinetics of valproate (VPA) and topiramate (TPM) were compared during VPA monotherapy, concomitant VPA and TPM therapy, and TPM monotherapy to evaluate pharmacokinetic interactions.

Methods: After a 3‐week baseline period, 12 patients receiving VPA monotherapy (500 to 2,250 mg every 12 h) received TPM at three escalating doses (from 100 to 200 to 400 mg every 12 h), each for 2 weeks. Thereafter, the VPA dose was tapered by 25% weekly. Blood and urine samples were collected over 12‐h intervals during VPA monotherapy and at the end of each stage of TPM dose escalation and TPM monotherapy.

Results: All patients reached TPM monotherapy, and nine achieved satisfactory seizure control for 2 weeks without VPA. TPM plasma peak concentration (Cmax) and area under the concentration‐versus‐time curve during a 12–h dosing interval (AUC0–12) were slightly higher (17%; n = 8) during TPM monotherapy than during concomitant VPA therapy. TPM oral and renal clearances (n = 8) were 25.9 ± 4.6 and 11.6 ± 3.2 ml/min during TPM monotherapy and were 29.8 ± 4.2 and 12.4 ± 2.7 ml/min during VPA concomitant therapy. VPA AUC(0–12) decreased (11.3%; n = 10) with the addition of TPM 400 mg every 12 h. VPA oral clearance was 12.8 ± 4.1 ml/min during monotherapy and was 13.8 ± 4.0,14.1 ± 3.9, and 14.5 ± 5.2 ml/min during coadministration of TPM 100, 200, and 400 mg every 12 h, respectively. Cognitive dysfunction, observed in some patients receiving high doses of VPA with TPM, reversed or improved with VPA dose reduction and discontinuation. The lower‐than‐normal prestudy platelet count measured in one patient increased to normal levels when VPA was discontinued.

Conclusions: Because changes in TPM and VPA pharmacokinetics were small, it is unlikely that their concomitant use will have a significant impact on the clinical condition of the patient.
A Chance SPECT Study of Ictal Aphasia During Simple Partial Seizures
Authors: Sakai Keiko , Hidari Mitsuharu , Fukai Mitsuhiro , Okamura Takehiko , Asaba Hiroyuki , Sakai Toshiaki
Published: August 2005

Summary: We report obtaining an ictal single photon emission computed tomographic (SPECT) scan in a right‐handed 51‐year‐old man who had an astrocytoma in the left cerebral hemisphere and simple partial seizures characterized by aphasia. An epileptic seizure producing loss of speech and right‐sided facial twitching occurred by chance during a SPECT scan. During the attack, he was unable to speak, but auditory comprehension and writing were intact. Ictal SPECT showed an area of increased perfusion in the left frontal cortex, with the area of highest perfusion involving the left frontal operculum to the inferior part of the left precentral gyrus. Interictal SPECT showed hypoperfusion in the same area. These SPECT findings suggest that the frontal operculum of the dominant hemisphere is one of the regions that can give rise to epileptic aphasia.
Lamotrigine Reduces Voltage‐Gated Sodium Currents in Rat Central Neurons in Culture
Authors: Zona Cristina , Avoli Massirno
Published: August 2005

Summary: Purpose: To study the mechanism or mechanisms of action of lamotrigine (LTG) and, in particular, to establish its effects on the function of NA+ channels in mammalian central neurons.

Methods: Rat cerebellar granule cells in culture were subjected to the whole‐cell mode of voltage clamping under experimental conditions designed to study voltage‐gated Na+ currents.

Results: Extracellular application of LTG (10–500 μM, n = 21) decreased in a dose‐related manner a tetrodotoxin‐sensitive inward current that was elicited by depolarizing commands (from −80 to +20mV). The peak amplitude of this Na+‐mediated current was diminished by 38.8 ± 12.2% (mean ± SD, n = 6) during application of 100 μM LTG, and the dose‐response curve of this effect indicated an IC50 145 μM. The reduction in the inward currents produced by LTG was not associate with any signficant change in the current decay, whereas the voltage dependency of the steady‐state inactivation shifted toward more negative values (midpoint of the inactivation curve: –47.5 and –59.0 mV under control conditions and during application of 100 μM LTG, respectively, n = 4).

Conclusions: Our findings indicate that LTG reduces the amplitude of voltage‐gated Na+ inward current in rat cerebellar granule cells and induces a negative shift of the steady‐state inactivation curve. Both mechanisms may be instrumental in controlling the repetitive firing of action potentials (AP) that occurs in neuronal networks during seizure activity.
Incidence of First Epileptic Seizures in the Canton of Geneva, Switzerland
Authors: Jallon Pierre , Goumaz Michel , Haenggeli Charles , Morabia Alfredo
Published: August 2005

Summary: Purpose: We wished to determine the incidence of first provoked and nonprovoked epileptic seizures in the canton of Geneva, Switzerland.

Methods: Between June 1, 1990: and May 31, 1991, we collected all cases of suspected epileptic seizures referred to the two hospitals of the county of Geneva, Switzerland and to the private neurologists of the town. The diagnosis probability was based on clinical data from the patient chart and the EEG data. The classification of risk factors proposed by the International League Against Epilepsy (ILAE) Commission on Epidemiology and Prognosis was used.

Results: In all, 273 cases were collected. The age‐adjusted incidence rate (U.S. population as standard) is 69.4 in 100.000. We observed a bimodal distribution of the cases with age (71 in the group aged 0–10 years and 107.5 in those aged >60 years). Ninety‐seven cases were classified as having provoked seizures (incidence: 25.2 in 100,000). Alcohol consumption (29.8%) and cerebrovascular diseases were the most frequent causes (16.4%). One hundred seventy‐six cases were classified as having unprovoked seizures (incidence: 45.6 in 100,000) with the following distribution: seizures in relation with a stable cerebral condition, 69 cases (incidence: 17.9); seizures in relation with an evolutive cerebral condition, 27 cases (incidence: 7); and seizures of unknown etiology, 80 cases (incidence: 20.8).

Conclusions: The incidence rate of first epileptic seizures in the canton of Geneva is quite similar to that reported in a French study (Epilepsia 1990;31:391–394) in which the same methodology for case ascertainment was used. Our data clearly demonstrate that the classification of risk factors proposed by the ILAE Commission on Epidemiology and Prognosis is useful and particularly easy to use in epidemiological surveys.
Recognition and Classification of Seizures in Infants
Authors: Nordli Douglas R. , Bazil Carl W. , Scheuer Mark L. , Pedley Timothy A.
Published: August 2005

Summary: Purpose: We wished to assess the reliability of the International League Against Epilepsy (ILAE) seizure classification system applied to infantile seizures and to test a proposed new classification.

Methods: We first analyzed 39 seizures in 20 infants (aged 1–26 months) recorded with simultaneous closed‐circuit television and EEG (CCTV/EEG). EEGs and videotapes of all seizures were independently analyzed by two epileptologists blinded to clinical histories. Videotapes of each seizure were reviewed without simultaneous EEG (phase I), and printouts of ictal EEGs were assessed without behavioral correlates (phase II). The observers classified seizures according to ILAE criteria. Interrater agreement was assessed by the kappa statistic.

Results: Agreement on EEG features (phase II) was moderate (= 0.54) in identifying focal ictal onsets and substantial (= 0.79) in identifying generalized onsets. In contrast, analysis of videotapes showed substantial disagreement between observers in terms of classifying seizures as partial or generalized. Therefore, agreement between observers for partial was slight (= 0.14) and fair for generalized seizures (= 0.26). Similarly, conclusions of the observers as compared with those of a consensus panel were divergent for both partial (= 0.18) and generalized seizures (= 0.30). We therefore developed an alternative classification scheme and retested interrater agreement in a review of 50 seizures in 25 other infants. With this classification scheme, there was substantial agreement between observers (= 0.72).

Conclusions: With clinical observations and interictal EEGs, seizures in infants cannot be reliably classified by current ILAE criteria. In contrast, a proposed new classification scheme based solely on semiology showed substantial reliability.
Reappraisal of Polytherapy in Epilepsy: A Critical Review of Drug Load and Adverse Effects
Authors: Deckers C. L. P. , Hekster Y. A. , Keyser A. , Meinardi H. , Renier W. O.
Published: August 2005

Summary: Purpose: We reviewed the literature to determine whether an analysis of published data could clarify the relationship between antiepileptic drug (AED) polytherapy and adverse affects (AE). We highlight the problems encountered.

Methods: We made a Medline‐search for articles published between 1974 and 1994 reporting the number of AE and doses or serum levels of every AED, per patient or treatment group, and used the PDD/DDD ratio to calculate AED load per patient from doses or the OSL/AToxL ratio to do so from serum levels of individual drugs. The PDD/DDD is the sum of ratios of the actual prescribed daily doses divided by the published average therapeutic dose of each drug. The OSL/AToxL is the sum of each observed serum level divided by its average toxic level.

Results: We retrieved 118 trial reports. Most had to be excluded because of incomplete reporting of concomitant medication or AE. The data of the 15 articles selected for further analysis indicate a relationship between drug load and number of AE. We noted no relationship between the number of AEDs administered and AE. In add‐on studies, the difference in neurotoxicity between the active and placebo arm may be obscured if the relative increase in drug load is small, as exemplified by the study of McGuire et al. (35).

Conclusions: Articles reporting add‐on trials of new AEDs generally do not provide detailed information about the basic medication to which the new AED is added, which makes calculation of total drug load impossible. Furthermore, often only frequency of AE is reported, not severity or development of tolerance, making it difficult to judge the impact of AE. However, despite the paucity of available information, we present some evidence that toxicity in AED polytherapy may be related to total drug load, rather than to the number of drugs administered. Therefore, the present trend to reject polytherapy for fear of increased toxicity is not warranted, which removes one of the objections to initiating specific research to prove or disprove the value of AED combinations as long as the drug load is appropriate.
Age at Onset and Neuropsychological Function in Frontal Lobe Epilepsy
Authors: Upton Dominic , Thompson Pamela J.
Published: August 2005

Summary: Purpose: Previous studies into the cognitive consequences of frontal lobe epileptic dysfunction may have proved inconclusive, due to a factor not commonly accounted for: Damage or disturbance during different epochs of development may give rise to different levels of neuropsychological dysfunction. In this study, we investigated the influence of age at onset on cognitive performance in a group of subjects with frontal lobe epilepsy (FLE).

Methods: Seventy‐four subjects (42 with left, and 32 with right) FLE were classified into early (0–6 years), intermediate (7–11 years) or late onset (12 years) and their performance recorded on a battery of measures assessing both executive and motor skills.

Results: On the measures of executive functioning, no consistent pattern emerged, whereas on the measures of motor skill, the results suggested that a right‐sided early onset (i.e., 0–6 years) did not impair performance compared to a later lesion within the same hemisphere. Furthermore, this sparing of performance was not observed within the left hemisphere.

Conclusions: Overall, the results suggest that individuals with differing ages of epilepsy onset will be differentially impaired on certain cognitive tasks. Several tentative ramifications of these results are suggested.
The Effect of Television Frame Rate on EEG Abnormalities in Photosensitive and Pattern‐Sensitive Epilepsy
Authors: Fylan F. , Harding G. F. A.
Published: August 2005

Summary: Purpose: Seizures provoked by television viewing may be triggered by patterns in the television image or by flicker from the display itself. We examined the incidence of EEG abnormalities elicited by patterns displayed on television sets with two different frame rates to evaluate the likely contribution of photosensitive and pattern‐sensitive mechanisms to television‐ and video‐game epilepsy.

Methods: Televisions with frame rates of 50 and 100 Hz were used to present 35 patients who were photosensitive or pattern‐sensitive with grating patterns. These patterns comprised vertical square‐wave and sine‐wave gratings of 90% contrast, and the spatial frequency was varied between 0.25–7 cycles/degree. EEGs were analysed for laboratory sensitivity to patterned and unpatterned intermittent photic stimulation (IPS).

Results: Significantly fewer EEG abnormalities were elicited by patterns displayed on the 100 Hz frame‐rate television than on the 50‐Hz frame‐rate television. No abnormalities were observed in response to the blank screens of either television. Thirty‐three patients showed abnormalities in response to patterned IPS but only 15 in response to diffuse flash. Two patients showed no laboratory evidence of photosensitivity. Patients who were sensitive to patterned IPS at 50 Hz were significantly more likely to demonstrate abnormalities to patterns displayed on the 100‐Hz frame‐rate television than were patients who were not sensitive to 50‐Hz patterned IPS.

Conclusions: We suggest that for many patients, the combination of high‐contrast patterns and screen flicker may elicit the observed EEG abnormalities. For patients with sensitivity to screen flicker, the use of a high frame‐rate television may be beneficial in reducing the risk of seizures.
Epilepsy in Developing Countries
Authors: Jallon P.
Published: August 2005

Summary: On June 6th and 7th, 1996, an international workshop on specific aspects of epilepsy in the developing world was organized in Geneva by the chairman of the ILAE Commission of Epilepsy in Developing Countries, P. Jallon, involving members of the ILAE, the World Health Organization (WHO), and a network of people who work with epilepsy patients in developing countries. Those taking part included all the members of the ILAE Commission on Epilepsy in Developing Countries, the chairmen of the ILAE Commissions on Tropical Diseases, Epidemiology, Education, Economics, and Drugs, as well as the president, treasurer, and past president of the ILAE; and the president of the IBE, Hanneke de Boer. There were representatives from Eastern European countries (Russia, Slovenia, Turkey), South America (Brazil, Colombia, Uruguay, Ecuador, Venezuela), Africa (Ethiopia, Senegal, South Africa, Togo, Tunisia), and Asia (India, Indonesia, Pakistan, Sri Lanka, The Philippines and China). Representatives from WHO joined the meeting on the last day (Drs. L. Prilipko, A. Janca, and C. L. Bolis).

Three major topics were considered—epidemiology, medical assessment, and therapeutic aspects as well as some economic and social aspects of the disease. A second mission of this meeting was to work with WHO representatives to develop a program for action to care for people with epilepsy in these countries.
Relationship Between Seizure Frequency and Costs and Quality of Life of Outpatients with Partial Epilepsy in France, Germany, and the United Kingdom
Authors: van Hout Ben , Gagnon Dennis , Souetre Eric , Ried Sibylle , Remy Claude , Baker Gus , Genton Pierre , Vespignani HervéC , McNulty Pauline
Published: August 2005

Summary: Purpose: The relationship between seizure frequency and both health care costs and quality of life (QOL) was investigated in a retrospective, cross‐sectional, multicenter study in France, Germany, and the United Kingdom.

Methods: Three hundred outpatients with stable partial epilepsy were approximately evenly distributed among five seizure—frequency groups, ranging from seizure—free in the last 3 months (group 1) to daily seizures (group 5). Economic data, obtained through patient interviews and record abstraction, comprised direct medical costs, direct nonmedical costs, and indirect costs for the preceding 3 months. Total societal costs in the three countries were pooled and converted to United States dollar equivalents. QOL was assessed through a self—administered questionnaire, the Functional Status Questionnaire (FSQ).

Results: Mean total costs increased from $780 in group 1 to $2,171 in group 5 (p = 0.0001), with significant increases in each cost category as seizure frequency increased. Greater seizure frequency also significantly (p = 0.0270) correlated with lower employment rates, which ranged from 57% in group 1 to 30% in group 5. QOL declined as seizure frequency increased. Particularly affected were basic and intermediate activities of daily living (ADL), mental health, social activity, and feeling about health.

Conclusions: The study results show that higher seizure frequencies are associated with higher direct and indirect costs and with reduced QOL for patients with epilepsy.
Familial Unverricht‐Lundborg Disease: A Clinical, Neurophysiologic, and Genetic Study
Authors: Parmeggiani Antonia , Lehesjoki Anna‐Elina , Carelli Valerio , Posar Annio , Santi Andrea , Santucci Margherita , Gobbi Giuseppe , Pini Antonella , Rossi Paola Giovanardi
Published: August 2005

Summary: Purpose: Progressive myoclonus epilepsies (PMEs) are a clinically and etiologically heterogeneous group of disorders. The authors report clinical, neurophysi‐ological, and genetic findings of a family from Southern Italy with three members affected with PME.

Methods: All data about familial and personal antecedents, clinical history, neurologic examination, laboratory tests, neurophysiological findings, brain imaging studies, and DNA analysis were examined.

Results: All results were compatible with the features of Unverricht‐Lundborg disease and patients were homozygous for the “Finnish” ancestral haplotype.

Conclusions: Work is in progress to identify and characterize the common EPM1 mutation in the Finnish patients. Subsequently, it will be possible to verify the hypothesis on the existence of a common mutation in the Finnish patients and the Italian family under study, or even in other Mediterranean EPM1 families.
Multiple Subpial Transection for Control of Epileptic Seizures: Effectiveness and Safety
Authors: Hufnagel Andreas , Zentner Josef , Fernandez Guillen , Wolf Helmut K. , Schramm Johannes , Elger Christian E.
Published: August 2005

Summary: Purpose: To assess the efficacy and safety of multiple subpial transection (MST), a new technique in epilepsy surgery, alone and in combination with resection.

Methods: MST was performed in 22 patients with intractable epilepsy, 10 of whom were treated with a combination of a resection and MST in functionally important cortex, 6 of whom were treated with a combination of a resection and MST performed outside functionally important cortex, and 6 of whom were treated with MST alone.

Results: Of the 6 patients who received MST alone, none became seizure free and 4 showed > 50% reduction of all seizure types. In 2 patients, including 1 with Rasmussen's encephalitis, no change in seizure frequency or intensity occurred. Of the 16 patients in whom MST was combined with a resection, 9 (56%) became seizure free. Six of the remaining 7 patients showed > 95% reduction of all seizure types. Disappearance of epileptiform potentials in the postoperative EEG correlated significantly with complete relief from seizures. Subtle, permanent neurological deficits remained in 5 of 14 patients who received MST in functionally important brain areas.

Conclusions: Reduction of the seizure frequency was substantial in 4 of 6 patients who received MST alone, but complete seizure control was not observed. MST surrounding a lesionectomy may be a new surgical approach which would minimize the excised volume and improve seizure control.
Anticonvulsant Action of Gabapentin During Postnatal Development in Rats
Authors: Mareš Pavel , Haugvicova Renata
Published: August 2005

: Purpose: To study the anticonvulsant effects of gabapentin (GBP) in immature animals.

Methods: Motor seizures were induced by pentylenetetrazol in 7‐, 12‐, 18‐, 25‐day‐old, and adult rats. Animals pretreated with GBP (15, 30, or 60 mg/kg i.p.) were compared with controls. The incidence and latency of two types of seizures [minimal (i.e., clonic)] and generalized tonic‐clonic (GTCS) were recorded, and seizure severity was scored.

Results: GBP suppressed or at least restricted the tonic phase of GTCS at all the developmental stages studied. In addition, minimal seizures were suppressed in 18‐day‐old rats. Both effects exhibited a tendency to a U‐shaped dose‐response curve.

Conclusions: Anticonvulsant effects of GBP were demonstrated in immature and in adult rats.
Partial Cosegregation of Familial Hemiplegic Migraine and a Benign Familial Infantile Epileptic Syndrome
Authors: Terwindt G. M. , Ophoff R. A. , Lindhout D. , Haan J. , Halley D. J. J. , Sandkuijl L. A. , Brouwer O. F. , Frants R. R. , Ferrari M. D.
Published: August 2005

: Purpose: We studied a large Dutch‐Canadian family, in which two very rare hereditary paroxysmal neurologic disorders, familial hemiplegic migraine (FHM) and a “benign familial infantile epileptic syndrome” concur and partially cosegregate. FHM is a dominantly inherited subtype of migraine with attacks of hemiparesis, linked to chromosome 19p13 in 50% of the families tested. Recently mutations in a brain‐specific P/Q‐type Ca2+ channel α1 subunit gene (CACNLlA4) were identified in families with chromosome 19‐linked FHM. The infantile epileptic syndrome resembles to two other dominantly inherited benign epilepsies occurring in the first year of life, benign familial neonatal convulsions (BFNC), assigned to chromosomes 20q13.2 and 8q, and benign infantile familial convulsions (BIFC), as yet unlinked.

Methods: Linkage analysis was performed for the known locations of FHM and BFNC. The question whether the two conditions in this family can be caused by a single gene defect was addressed by additional linkage analysis.

Results: We excluded linkage of the infantile convulsions to markers on chromosome 20q13.2, Sq, or 19p13. This indicates the existence of a third locus for benign familial convulsions in the first year of life. Linkage of FHM to these markers was not formally excluded but seems very unlikely. Statistical analysis of whether, in this family, both conditions are caused by a single gene defect was inconclusive.

Conclusions: We describe a “benign familial infantile epileptic syndrome“ with attacks of FHM at a later age. Further genetic studies in this family may help to unravel the genetic basis of epilepsy or migraine or both.