bluuebunny/crossref_metadata_2025 huggingface dataset:
Kentuckians' Attitudes Toward Children with Epilepsy
Authors: Baumann Robert J. , Wilson John F. , Wiese H. Jean
Published: August 2005

Summary: We explored Kentuckians' attitudes toward children with epilepsy. Questions compared respondents' attitudes about children with epilepsy, asthma, hyperactivity, and AIDS. Random digit dialing led to 617 completed interviews. The key questions asked concerned (a) how a pupil with each illness would alter the classroom environment, and (b) how the condition would affect the child's quality of life (QOL) at age 21 years. Respondents used a 0–10 rating scale (0 = worst, 5 = normal, 10 = best). A dichotomous variable divided respondents into those who rated below and those who rated at or above the norm: 24% predicted a deterioration of the classroom environment with the addition of a pupil with epilepsy (similar to AIDS at 26%); 41% predicted a lessened QOL at age 21 years (a worse rating than either asthma or hyperactivity). We created summary indexes, using difference scores between epilepsy ratings and ratings for the other conditions: Relative Educational Distance (RED) and Relative Quality of Life Distance (RQLD) measures. On the RED index, rural and Appalachian respondents showed the greatest prejudice toward pupils with epilepsy. Conversely, we noted the greatest prejudice in RQLD among urban residents (the best educated group). Our data do not support contentions that prejudices against persons with epilepsy are disappearing.
Palatal Tremor of Cortical Origin Presenting as Epilepsia Partialis Continua
Authors: Noachtar Soheyl , Ebner Alois , Witte Otto W. , Seitz Rüdiger J.
Published: August 2005

Summary Palatal tremor (PT) is frequently caused by brainstem lesions. The inferior olive plays a major role in the pathophysiologic mechanisms involved. We report a case of PT of cortical origin presenting as epilepsia partialis continua. EEG showed continuous left frontocentral epileptiform discharges and both single photon emission computed tomography (SPECT) and positron emission tomography (PET) showed focal hypoperfusion and hypometabolism in the corresponding location.
Carbamazepine and Its Metabolites in Human Perfused Placenta and in Maternal and Cord Blood
Authors: Pienimäki P. , Hartikainen A.‐L. , Arvela P. , Partanen T. , Herva R. , Pelkonen O. , Vähäkangas K.
Published: August 2005

Summary: Placental transfer and metabolism of carbamazepine (CBZ) was studied in a dual recirculating placental cotyledon perfusion system and was also evaluated in 16 pairs of maternal venous and cord blood samples. Among the parameters studied as possible indicators of a successful perfusion, volume changes in perfusate divided the perfusions into two groups, whereas no significant differences between perfusions were noted in blood gas analysis or in antipyrine transfer. CBZ added into the maternal circulation crosses the placenta in the beginning quicker than antipyrine which is in agreement with the different lipid solubilities of these compounds. Because the transfer rates of antipyrine and CBZ were about the same, the mechanism of transfer of CBZ is probably similar to that of antipyrine (passive diffusion). No metabolites of CBZ could be detected in the perfusate by high‐performance liquid chromatography (HPLC) or gas chromatographyhass spectrometry. With the improved HPLC methodology for CBZ metabolites, six metabolites were detected in clinical samples, including 10‐hydroxy‐10, 11‐dihydro‐CBZ (10‐OH‐CBZ), which has been described earlier in only 1 uremic patient. Relative levels of metabolites showed significant individual differences. CBZ crosses perfused placenta rapidly, but this does not contribute to CBZ metabolites detected in maternal and fetal circulation.
Ictal Contralateral Paresis in Complex Partial Seizures
Authors: Oestreich Lisa J. , Berg Michel J. , Bachmann Diane L. , Burchfiel James , Erba Giuseppe
Published: August 2005

Summary: Certain behaviors that occur during a complex partial seizure (CPS) are useful in lateralizing the side of seizure onset. In 5 (5.3%) of 94 consecutive patients with partial epilepsy, we observed ictal unilateral arm and hand paresis during 27 of 34 CPS. In all these seizures, this behavior occurred contralateral to an epileptogenic temporal lobe, as determined by video‐EEG monitoring and surgical outcome. In 5 of the 27 seizures, an observer demonstrated that the paretic arm and hand were flaccid. None of these patients had postictal (Todd's) paralysis. In most of the seizures, the arm ipsilateral to seizure onset had simultaneous purposeful movements or automatisms, sometimes with awkward posturing. Ictal unilateral paresis is distinctly different from ictal dystonia or postictal paralysis and consistently lateralizes seizure onset to the contralateral temporal lobe. Recognition of this particular ictal behavior and comparison to other simultaneous behaviors can aid in the lateralization and possibly localization of the epileptogenic zone.
Hemimegalencephaly: Localized Proton Magnetic Resonance Spectroscopy In Vivo
Authors: Hanefeld F. , Kruse B. , Holzbach U. , Christen H. J. , Merboldt K. D. , Hänicke W. , Frahm J.
Published: August 2005

Summary: Two children with hemimegalencephaly were examined by magnetic resonance imaging (MRI) and localized proton MR spectroscopy (MRS). In both cases, structural changes in the enlarged hemisphere included pachy‐or polymicrogyria and gliosis of white matter. Associated metabolic disturbances included a dramatic reduction of glutamate and N‐acetylaspartate (NAA) in white matter. Less severe or no alterations were noted in cortical gray matter, basal ganglia, and cerebellum. The older child (13 years) showed increased myoinositol in both gray and white matter as well as markedly increased choline‐containing compounds in gray matter. Both children also had mildly decreased NAA levels in the white matter of the contralateral hemisphere. The spectroscopic findings indicate loss of vital neuroaxonal tissue and glial cell proliferation. Metabolic disturbances were more pronounced in the older child. The normal‐appearing hemisphere was mildly affected in both cases.
Effects of Pentobarbital on Entorhinal Tetanic Responses and the Progression of Afterdischarges During the Early Course of Amygdala Kindling in Rats
Authors: Hirayama Ken , Murata Ryosuke , Matsuura Shiushi
Published: August 2005

Summary: We investigated the relationship between the progress of afterdischarges (AD) and the development of facilitated entorhinal tetanic responses by amygdala kindling stimulations in conscious and pentobarbital (PB)‐treated rats. The entorhinal responses consisted of deep negative components and the following shallow positive components. The negative potential (mean±SE) reflecting excitatory synaptic activation in the test response evoked by a single stimulation (600 μA) before kindling stimulations was greater in PB‐treated rats (1.3 ± 0.21 mV, n = 6) than in conscious rats (0.5 ± 0.08 mV, n = 9).The positive potential reflecting inhibitory synaptic activation in the test response was also greater in PB‐treated rats (0.6 ±0.14 mV, n = 6) than in conscious rats (0.2 ±0.04 mV, n = 9).The magnitude of the tetanic response was estimated as the area between the excitatory negative potential and the baseline in the averaged tetanic response during each kindling stimulation (10 Hz, 100 pulses).The magnitude of the tetanic response was significantly enhanced in association with the prolongation of AD duration in the conscious rats. In the PB‐treated (50 mg/kg intraperitoneally, i.p.) rats, enhancement of tetanic response was very slight and the progress of AD duration was prevented. There was a linear correlation >(r= 0.9) between the magnitude of tetanic response and AD duration. These findings indicate that PB suppresses kindling‐induced enhancement of excitatory synaptic activation in tetanic responses and that this enhancement is intimately related to the development of AD.
Neuropharmacology of Progressive Myoclonus Epilepsy: Response to 5‐Hydroxy‐L‐Tryptophan
Authors: Pranzatelli M. R. , Tate E. , Huang Y. , Haas R.H. , Bodensteiner J. , Ashwal S. , Franz D.
Published: August 2005

Summary: Low concentrations of the serotonin metabolite 5‐hydroxyindoleacetic acid (5‐HIAA) in cerebrospinal fluid (CSF) of patients with progressive myoclonus epilepsy (PME) suggest hypofunctional serotonergic neurotransmission. To study this hypothesis, we enrolled 6 patients with PME [Unverricht‐Lundborg disease (U‐L), mitochondria1 encephalomyopathy, or Lafora disease] in a controlled, double‐blinded, dose‐ranging, cross‐over add‐on pilot clinical trial of 5‐hydroxy‐L‐tryptophan (L‐ 5‐HTP) plus carbidopa after 2 other patients had received open‐label L‐5‐HTP for compassionate use. Prestudy CSF 5‐HIAA concentrations were low (<20 ng/ml) in 6 patients regardless of the etiology of PME. One patient with U‐L disease showed clinical improvement and a fivefold increase in CSF 5‐HIAA, and 1 with Lafora disease showed a twofold increase in CSF 5‐HIAA without improvement. A patient with Lafora disease reported enough improvement in myoclonus‐evoked convulsions to continue chronic use of the drug. One patient with mitochondria1 encephalomyopathy developed status epilepticus during treatment with L‐5‐HTP.As a group, patients had no statistically significant changes in myoclonus evaluation scale scores, subjective and objective measures of ataxia, seizure frequency, antiepileptic drug (AED) levels, or routine blood tests. These data suggest a serotonergic abnormality regardless of the underlying etiology of PME, but one that seldom responds to acute treatment with L‐5‐HTP.
Prevalence of Epilepsy and Epileptic Seizures in 10‐Year‐Old Children: Results from the Metropolitan Atlanta Developmental Disabilities Study
Authors: Murphy Catherine C. , Trevathan Edvin , Yeargin‐Allsopp Marshalyn
Published: August 2005

Summary: With reported prevalence rates of 4–9 cases per 1,000 children, childhood epilepsy is a major public health concern. Reported prevalence rates vary, mainly because researchers often use different epilepsy definitions. In addition, total prevalence may be underestimated if incomplete case‐ascertainment methods are used. We used a multiple‐source case‐ascertainment method that included obtaining information from electro‐encephalogram laboratories to estimate the prevalence of epilepsy and to classify seizure types among 10–year‐old children. In the metropolitan Atlanta (GA, U.S.A.) area, we found a lifetime prevalence of childhood epilepsy of 6 per 1,000 (95% confidence interval, 5. 5–6. 5) 10‐year‐old children. However, using capture‐recapture analysis, this prevalence may be as high as 7. 7 per 1,000. Proportionately more boys than girls had epilepsy. The prevalence did not vary appreciably by race. Partial seizures, including secondarily generalized seizures, were the most common seizure type (58%). Of children with epilepsy, 35% had another developmental disability (mental retardation, cerebral palsy, visual impairment, or hearing impairment). An accurate estimate of the public health burden of childhood epilepsy and determination of possible risk factors for idiopathic epilepsy both depend on conducting complete community‐based case ascertainment and obtaining detailed clinical data.
Epilepsy and Education
Authors: Pedley Timothy A.
Published: August 2005

Summary: Epilepsy education continues to be an essential component of every epilepsy organization'smission. Ongoing educational programs are an essential part of epilepsy patient care. A few basic rules to ensure success are to: (a) identify needs by users, not providers; (b) target programs to the specific audience; (c) remember that people learn by different methods; (d) take advantage of teachable moments; (e) account for transcultural differences; and (f) modify programs based on systemative evaluation and feedback.
Concepts of Epilepsy
Authors: Engel Jerome
Published: August 2005

Summary: The word “epilepsy” refers to a group of disorders characterized by recurrent epileptic seizures. Differential diagnosis first requires distinction between epileptic seizures and the many systemic, neurologic, and psychiatric disorders associated with paroxysmal behaviors that might be mistaken for epilepsy. By definition, isolated epileptic seizures that occur as a natural reaction to a noxious insult are not sufficient evidence for a diagnosis of epilepsy. Many factors contribute to the appearance of an epileptic condition, including nonspecific predisposing factors that alter the threshold for epilepsy and specific epileptogenic disturbances that cause chronic epilepsy to become manifest in susceptible individuals, both of which can be either genetic or acquired. Endogenous or exogenous precipitating factors determine when specific ictal events occur. The many clinical expressions of epileptic seizures reflect the location and extent of the cerebral disturbance, as well as diverse fundamental mechanisms that involve alterations of excitatory and inhibitory influences, resulting in hyperexcitability, hypersynchronization, or both. The various forms of epilepsy and epileptic syndromes are defined by a constellation of signs and symptoms that include characteristic seizure types, other clinical features, and family history. Whereas treatment is largely based on seizure type, identification of a specific epileptic syndrome often provides additional insights into management and prognosis. An example of the usefulness of syndromic classification is the existence of surgically remediable syndromes that have a known poor prognosis with pharmacotherapy, but an excellent prognosis with surgical intervention. Research on underlying basic mechanisms of the epilepsies, particularly molecular genetics designed to identify specific biological defects in idiopathic epilepsies and invasive investigations carried out in the epilepsy surgery setting to elucidate the pathophysiology of symptomatic epilepsies, may reveal definitive substrates that will ultimately permit epileptic syndromes to be reclassified as diseases.
The Basis of Behavioral Treatments in Seizure Control
Authors: Fenwick Peter
Published: August 2005

Summary: Many adult patients have behavioral strategies that they use either to inhibit seizures or to stop spread of the seizures. Patients who have difficulties in coping with life stresses may also learn to respond to difficult situations by the voluntary generation of seizures. Therefore, any complete epilepsy program must consider the patient, the patient's behavior, and the relationship between seizures and behavior.
Use of Saliva in Home Monitoring of Carbamazepine Levels
Authors: Rosenthal Eldad , Hoffer Erica , Ben‐Aryeh Hanna , Badarni Salem , Benderly Abraham , Hemli Yeshayahu
Published: August 2005

Summary: Total carbamazepine (CBZ) levels in serum of 61 epileptic children were compared with saliva levels. Both resting and stimulated saliva was analyzed. The salivary levels were 38.6% of serum CBZ levels. A highly significant correlation was noted (r= 0.89, p < 0.001). Stimulation had no effect on saliva CBZ levels (r= 0.97). Salivary and serum CBZ levels were not affected by storing the samples for 7 days at room temperature. The data indicate that salivary CBZ may provide a reliable alter‐native monitoring method to Tegretol therapy, especially in children, in whom blood sampling is difficult. Further‐more, the samples may be collected at home and delivered to the laboratory by mail.
Development of Epileptic Activity in Embryos and Newly Hatched Chicks of the Fayoumi Mutant Chicken
Authors: Guy Nicolas T. M. , Fadlallah Noureddine , Naquet Robert , Batini Cesira
Published: August 2005

Summary: The homozygous Fayoumi strain of epileptic chickens (Fepi) is affected by generalized convulsions consistently induced by intermittent light stimulation (ILS) and by intense sound. Although interictal EEG recordings show continuous spikes and spike and wave activity, desynchronization and flattening (DF) of the EEG are observed during seizures. We have studied development of the epileptic phenotype in embryonic (E) and posthatching (P) Fepi. As compared with those of chicken embryos of a normal strain, no differences were observed in the EEG before embryonic day (E) 16. Clearly differentiated spikes and spike and waves appeared at E17 in Fepi. Metrazol‐induced EEG seizures were observed at E16 in normal embryos and at E17 in Fepi. The Fepi showed some characteristics: Spontaneous EEG seizure‐like discharges also appeared at E17 but decreased to‐ward hatching; visual or acoustic hyperexcitability developed at E20 together with evoked responses in normal chickens; desynchronization of the EEG, typical of the epileptic seizure of the adult, could be induced by ILS at E20, but ILS‐ or sound‐induced generalized motor seizures appeared at P1, a few hours after hatching. Results show that Fepi phenotype reaches full expression at P1, but the electric paroxysms are expressed earlier, paralleling synaptic maturation.
Partial Epilepsy of Long Duration: Changing Semiology with Age
Authors: Tinuper Paolo , Provini Federica , Marini Carla , Cerullo Angelina , Plazzi Giuseppe , Avoni Patrizia , Baruzzi Agostino
Published: August 2005

There are few data on changing patterns of localization‐related epileptic syndromes with time and particularly on changes in seizure semiology as patients age. We retrospectively reviewed 53 patients aged >60 years who had had partial epileptic seizures for a mean duration of 44 years. In 20 patients, seizures became progressively less elaborate and briefer with time. In 29 patients, seizures were unchanged. In four patients, seizures worsened, with the appearance of drop attacks, secondarily generalized seizures, increasing drug resistance, and mental deterioration. These latter 4 patients had cerebrovascular disease with multiple strokes.
Felbamate Levels in Patients with Epilepsy
Authors: Harden Cynthia L. , Trifiletti Rosario , Kutt Henn
Published: August 2005

The usefulness of felbamate (FBM) levels in managing epilepsy patients has not been determined. The purpose of the present study was to determine if FBM levels obtained at routine office visits correlated with side effects reported by patients. We determined FBM levels by high‐pressure liquid chromatography (HPLC) of 46 epilepsy patient plasma specimens (41 patients) and assessed medication toxicity and seizure frequency by a questionnaire. Thirty‐six patients were treated with other antiepileptic drugs (AEDs); concomitant AED levels not in ranges believed to cause toxicity. FBM levels ranged from 9 to 134 pg/ml, and were divided into three groups for analysis, resulting in low‐range (9–36 pg/ml), mid‐range (37–54 μg/ml), and high‐level (44–134 pg/ml) groups. Anorexia and complaints of severe side effects were reported significantly more often in the high‐level group as compared with the low‐ and midrange groups. Significantly more patients in the high‐level group (1043) reported decreased seizure frequency, as compared with 12 of 30 of patients in the low‐and midrange groups combined. FBM levels correlated linearly with doses overall, but most closely in FBM monotherapy patients.
Significance of Spikes at Temporal Lobe Electrocorticography
Authors: Kanazawa Osamu , Blume Warren T. , Girvin John P.
Published: August 2005

Summary: Among 87 consecutive patients operated on under local anesthesia, few aspects of pre‐ and posttemporal lobe resection electrocorticograms (ECoG) yielded prognostic data. Preresection spikes were most common in the hippocampus, followed in order of frequency by the anterior temporal convexity and the inferior temporal surface. Moderately frequent (>10 spikes/100 s) preresection spikes appeared beyond the subsequent resection line in the posterior temporal region in 16 of 87 (18%) and in orbital frontal cortex in 12 of 87 (14%). Although many hippocampus spikes portended a favorable outcome and rare spikes an unfavorable one, preresection spike quantity otherwise failed to distinguish outcome groups. Absolute quantity of postresection spikes and change from preresection quantity in any region did not correlate with outcome except for the insula, where relatively abundant spikes portended favorable outcomes. Postresection electrographic seizures were rare but occurred equally in all outcome groups. No significant change in spike incidence occurred between the first and last 10‐min epoch of the 30‐min postresection recording.
Partial Epileptic Seizure with Versive Movements Examined by [99mTc] HM‐PAO Brain Single Photon Emission Computed Tomography: An Early Postictal Case Study Analyzed by Computerized Brain Atlas Methods
Authors: Weder B. , Oettli R. , Maguire R. P. , Vonesch T.
Published: August 2005

Summary: The consecutive steps of a seizure with leftward versive movements of the head and eyes were analyzed after video monitoring and correlated with findings on single photon emission computed tomography (SPECT) using [99mTc] hexamethyl propylene amine oxime (HM‐PAO). Evaluation included reconstruction of subtraction images from the early postictal state, obtained immediately after the video‐monitored seizure, and the interictal baseline. Based on normalized perfusion indexes within voxels of Talairach space, we concluded that the primary epileptogenic focus was in the premotor cortex of the contralateral hemisphere. We then placed the functional data in an anatomic context by adapting a dedicated computerized brain atlas (CBA) to the patient's brain with the aid of magnetic resonance imaging (MRI) slices. By inverse transformation, the patient's data were aligned with the standard geometry of the brain atlas for comparison purposes with data from the literature. The validated activation field projected exactly onto the right precentral sulcus with the anterior border zone including the right frontal eye field.
Cryptogenic Partial Epilepsies with Anti‐GM1 Antibodies: A New Form of Immune‐Mediated Epilepsy?
Authors: Bartolomei Fabrice , Boucraut José , Barrié Maryline , Kok Jérome , Dravet Charlotte , Viallat Danièle , Bernard Dominique , Gastaut Jean‐Louis
Published: August 2005

Summary: Purpose: We wished to study immune system dysfunction which has been proposed as a potential cause of epilepsy. Epileptogenic action of antibodies directed against GM1 gangliosides was demonstrated in rats, but the potential role of anti‐GMI antibodies in human epilepsy has not yet been studied.

Methods: We investigated the presence of IgG or IgM anti‐GMI antibodies in the sera of 64 patients with various types of epileptic syndromes: idiopathic generalized epilepsy (ICE) (n = 6), symptomatic or cryptogenic generalized epilepsy (SCGE) (n = 7), symptomatic partial epilepsy (SPE) (n = 26), and cryptogenic partial epilepsy (CPE) (n = 25).

Results: Two patients had elevated titers of IgM anti‐ GMl antibodies, one patient had elevated titers of both IgM and IgG anti‐GM1 antibodies, and I patient had elevated titers of IgG anti‐GMI antibodies. All 4 patients had complex partial seizures (CPS) secondarily generalized, generalized, drug resistance, psychiatric disorders, and normal brain imaging. Anti‐GMI antibodies were never associated with ICE, SCGE, or SPE. We compared the reactivity of sera from these patients with the sera from 5 patients with motor neuropathies with conduction block (MNCB) against different gangliosides and concluded that epilepsy sera did not react with the Gal(β1‐3)GalNAc epitope. Two anti‐GM1‐positive patients were treated successfully with high‐dose intravenous immunoglobulins (IgIV).

Conclusions: Our findings suggest that detection of anti‐GM1 antibodies could allow identification of a subgroup of patients with partial epilepsy associated with an autoimmune response. If anti‐GM1 antibodies prove pathogenic, they could be an important prognostic factor for drug resistance and worsening of seizures.
Postictal Language Dysfunction in Patients with Right or Bilateral Hemispheric Language Localization
Authors: Privitera Michael , Kohler Christian , Cahill William , Yeh Hwa‐Shain
Published: August 2005

Summary: Purpose: As shown previously, when temporal lobe complex partial seizures (TLCPS) originate from the language dominant hemisphere, patients cannot read a test phrase correctly within 60 s of the end of the ictal discharge. We wished to assess whether postictal language testing results discordant with this pattern identified patients with non‐left (right hemisphere or mixed) language dominance.

Methods: Since 1988, all patients undergoing video/EEG monitoring at our institution have been given a test phrase to read aloud as soon as a seizure is detected. Inclusion criteria for this study were (a) postictal language testing within 60 s of seizure end for at least one TLCPS, (b) >90% seizure reduction after anterior temporal lobectomy with 2‐year minimum follow‐ follow‐ up, and (c) language localization by either intracarotid amobarbital test (IAT) or direct electrical stimulation of left hemisphere cortex.

Results: Two hundred twenty‐four seizures in 64 patients were analyzed. Discordant postictal language patterns were noted in 10 of 11 patients with IAT documented non‐left language dominance and in 15 of 53 with left dominance (p = 0.006; sensitivity 90.9%, specificity 71.7%).

Conclusions: Postictal language testing accurately identifies patients with non‐left language dominance and may be useful in selecting appropriate patients for IAT.
Influence of Epilepsy on Mortality in Mental Retardation: An Epidemiologic Study
Authors: Forsgren Lars , Edvinsson Sven‐Olov , Nyström Lennarth , Blomquist Hans Kson
Published: August 2005

Summary: Purpose: A cohort consisting of all persons with known mental retardation (MR) and living in a Swedish province on December 31, 1985, was followed for 7 years (1987–1992) to study the mortality pattern.

Methods: A file of the cohort was linked to the cause‐of‐death pattern of the general population in the study area.

Results: One hundred twenty‐four deaths (8.4%) occurred among the 1,478 persons with MR. Thirty deaths (10.1%) occurred among the 296 persons with epilepsy and MR. The standardized mortality ratio (SMR) in those with only MR was significantly increased as compared with that of the general population: 1.6 [95% confidence interval (CI) 1.3–2.01; MR and epilepsy, 5.0 (CI 3.3–7.5); and MR, epilepsy, and cerebral palsy (CP), 5.8 (CI 3.4–9.7). Mortality was increased both in patients with partial seizures without seizures secondarily generalized (SMR 3.7, CI 1.0–13.6) and in patients with seizures secondarily generalized (5.0, CI 2.3–11.0). The highest mortality occurred in patients who had seizures that were always generalized from the onset: 8.1 (CI 5.7–11.5). Mortality increased with increasing seizure frequency during the year preceding the prevalence date. In patients with epilepsy and MR, pneumonia was the most common cause of death and a seizure was the probable cause of death in 6.7%.

Conclusions: Epilepsy is associated with a significantly increased mortality in persons with MR. The increase is related to seizure type and seizure frequency. Death in persons with epilepsy and MR is seldom directly due to seizures. Other impairments associated with epilepsy and MR are important causes of death.
Infant Monkey Hyperexcitability After Prenatal Exposure to Antiepileptic Compounds
Authors: Phillips Nona K. , Lockard Joan S.
Published: August 2005

Summary: Purpose: A monkey (Macaca fascicularis) model was previously used to assess infant hyperexcitability after prenatal exposure to phenytoin (PHT), stir‐ipentol (STP) or PHT + STP. To explore this issue further, we studied additional monkey infants in those groups, as well as groups prenatally exposed to carba‐mazepine (CBZ) in monotherapy (n = 5) or CBZ + STP poly therapy (n = 10).

Methods: The drug‐exposed groups were compared with a group of control infants (n = 10) for whom procedures were matched except that there was no prenatal drug exposure. All adult female monkeys were equipped with tether systems and stomach catheters so that drug administration (or water for controls) could be initiated before they were mated and continued throughout pregnancy. During pregnancy, PHT, STP, and CBZ plasma levels were maintained between 4–12, 4–10, and 1–6 μg/ml, respectively (for both monotherapy and polytherapy). At birth, infants were separated from mothers and transferred to the University of Washington's (Seattle, WA, U.S.A.) Infant Primate Research Laboratory (IPRL) for postnatal care and follow‐up testing. During tests of recognition memory administered between 2 weeks and 3 months of age, infants were rated on a hyperexcitability scale.

Results: Previously reported data indicated that infants prenatally exposed to PHT, in monotherapy or polytherapy with STP, were at increased risk for hyperexcitability (screeching, refusing to attend to stimuli, lack of visual orientation). This was not the case for infants prenatally exposed to STP monotherapy.

Conclusions: Our results confirm previous findings and also demonstrate that infants prenatally exposed to CBZ or CBZ + STP, like controls, are not hyperexcitable during testing.
Schizencephaly: Neuroradiologic and Epileptologic Findings
Authors: Granata Tiziana , Battaglia Giorgio , D'Incerti Ludovico , Franceschetti Silvana , Spreafico Roberto , Battino Dina , Savoiardo Mario , Avanzini Giuliano
Published: August 2005

Summary: Purpose: Nine patients affected by schizencephaly were analyzed, and the epileptologic findings prospectively studied, to define the relations between the anatomic brain malformations and clinical outcome.

Methods: The schizencephaly was diagnosed by means of magnetic resonance imaging (eight cases) or computed tomography (one case). The clinical histories of all the patients were analyzed, and a psychometric evaluation was made. The electroclinical features and course of epilepsy in the six patients with epilepsy were prospectively followed up for a period ranging from 3 to 14 years.

Results: The patients were divided into those who were unilaterally (six) and those bilaterally (three) affected. The former were characterized by mild neurologic deficits and late–onset epilepsy; their epileptologic features were consistent in terms of age of onset, seizure semiology, the absence of secondary generalization, and resistance to antiepileptic treatment. The patients with bilateral schizencephaly associated with other brain malformations were characterized by severe neurologic deficits but were only rarely affected by epilepsy, which was always completely controlled by antiepileptic treatment.

Conclusions: Our data show that the extent of anatomic malformation is strictly related to the severity of motor and mental impairment but not to the presence or severity of epilepsy. The absence of prenatal risk factors for brain damage in our series, previously described familial cases of schizencephaly, and the recent report of mutations in homeobox gene EMX2 associated with cases of schizencephaly all indicate that genetic factors may play a key role in the pathogenesis of this brain malformation.
Transient Facial Palsy in Sphenoidal Electrode Placement
Authors: Iriarte Jorge , Parra Jaime , Kanner Andres M.
Published: August 2005

Summary: Purpose: Sphenoidal electrode (SE) insertion can cause pain, for which local anesthesia with lidocaine or intravenous administration of fentanyl has been advocated by different epilepsy treatment centers. Transient facial palsies have been observed after SE insertion. Their frequency of occurrence, distribution, and duration have not been well characterized, however. We hypothesized that this complication is due to the effect of local anesthesia on the peripheral branches of the seventh cranial nerve. To test this hypothesis, we compared the incidence and characteristics of facial palsy during SE insertions performed with either local anesthesia or after intravenous fentanyl administration.

Methods: We performed a retrospective study in two patient groups. Group A consisted of 25 patients aged 28 ± 8·2 years who underwent a prolonged video‐EEG (VEEG) monitoring study with SE after subcutaneous infusion of 1% lidocaine in the insertion area. Group B included 25 patients aged 30·1 ± 8·9 years whose SE were inserted after intravenous administration of 100‐200 μ fentanyl. Blood pressure (BP) was monitored every 3‐5 min throughout the procedure.

Results: Five patients (20%) from group A had a transient facial palsy; in 4, it was complete and in 1 it was partial; 1 patient had a bilateral facial palsy. Paresis lasted 1‐7 min (mean 3·2 min). In all patients, the recovery was complete. None of the patients in group B had complications (p = 0·025, Fisher's exact test).

Conclusions: Transient facial palsy is a relatively frequent complication of SE insertion when SE are placed under local anesthesia; patients should be forewarned of its possible occurrence.
Preliminary Report on Teratogenic Effects of Zonisamide in the Offspring of Treated Women with Epilepsy
Authors: Kondo Tsuyoshi , Kaneko Sunao , Amano Yoshiyuki , Egawa Isao
Published: August 2005

Summary: Purpose: We wished to assess the risk of terato‐genicity of zonisamide (ZNS) in humans.

Methods: Pregnant epileptic women treated with ZNS and their offspring were prospectively monitored from June 1989 to December 1994. The outcome of pregnancy and status of neonates were examined based on the same standardized protocol.

Results: Twenty‐six offspring exposed to ZNS with or without other antiepileptic drugs (AEDs) were studied. Malformations were detected in 2 offspring (7·7%) exposed to ZNS polypharmacy. Anencephaly was detected in one case at 16 weeks of gestation (case 1, artificial abortion), and atrial septa1 defect was detected in another case at 37 weeks of gestation (case 2, delivery by cesarean section). Serum concentrations of ZNS during the first trimester of pregnancy were 6·1 μg/ml in case 1 and 6·3μ/ml in case 2; in both cases, the levels were below the therapeutic concentration range of ZNS.

Conclusions: Teratogenic effects of ZNS were not clearly defined from these results since malformations were detected in two polypharmacy cases but not in four monopharmacy cases. The present data do not indicate that the risk of ZNS teratogenicity is greater than that of other conventional AEDs. However, such risk cannot be neglected even at therapeutic dosages or concentrations of ZNS, especially in patients receiving polypharmacy.
Bilateral Magnetic Resonance Imaging‐Determined Hippocampal Atrophy and Verbal Memory Before and After Temporal Lobectomy
Authors: Trenerry Max R. , Jack Clifford R. , Cascino G. D. , Sharbrough F. W. , So E. L.
Published: August 2005

Summary: We investigated pre‐ and postoperative verbal memory in temporal lobectomy patients who had volumetrically symmetric hippocampi. Pre‐ and postoperative verbal memory data based on the Logical Memory subtest of the Wechsler Memory Scale‐Revised (WMS‐R) were obtained from 15 left and 18 right temporal lobectomy patients. The difference between hippocampal volumes (R/L) was between ‐0.1 and 0.3 cm3, which is indeterminate for lateralizing hippocampal atrophy. Patients were divided into four groups based on side of operation and combined hippocampal volume expressed as a function of total intracranial volume (R + L volume/total intracranial volume). Patients with a combined hippocampal volume that was smaller than any combined hippocampal value of a normal control group were defined as bilaterally atrophic. Left temporal lobectomy patients demonstrated the expected decrease in verbal memory postoperatively regardless of whether the volumetrically symmetric hippocampi were nonatrophic or atrophic. Left temporal lobectomy patients with bilaterally atrophic hippocampi, however, had the poorest verbal memory before and after operation. Right temporal lobectomy patients tended to have improved verbal memory after operation whether or not the volumetrically symmetric hippocampi were atrophic. We conclude that side of operation is a more potent predictor of verbal memory outcome than is hippocampal atrophy when hippocampi are bilaterally symmetric and that left temporal lobectomy patients with bilateral atrophy may be at risk for greater functional deficits after operation.
Vigabatrin as Initial Therapy for Infantile Spasms: A European Retrospective Survey
Authors: Aicardi J. ,   Sabril IS Investigator and Peer Review Groups, Mumford J. P. , Dumas C. , Wood S.
Published: August 2005

Purpose: The efficacy and tolerability of vigabatrin (VGB) as an add‐on therapy in the treatment of infantile spasm (IS) prompted physicians to explore its use as the first drug in this seizure type.

Methods: Our retrospective study included 250 infants diagnosed with IS; the data obtained were subjected to peer‐group review. Of this infant population, 192 infants were considered to have classic IS and had received VGB as their first treatment for the spasms. There was a slight preponderance of boys (57%) in this population. Mean age of IS onset was 5.8 months; 60% had typical hypsarrhythmia.

Results: Initial suppression of spasms was obtained in 68% of infants with a median time to response of 4 days at an average VGB dose of 99 mg/kg/day. The best response was seen in those infants with tuberous sclerosis (96% response) and in those younger than 3 months at onset of spasms (90% response). Of these infants, 43 (22%) of 192 subsequently had other types of seizures, and a recurrence of infantile spasms occurred in 28 (21%) of 131 responders. At the end of this study, 96 of 192 infants who could be evaluated were seizure free with VGB monotherapy. Treatment appeared to be well tolerated, with only 33 (13%) infants with adverse events, of which the most common were somnolence (15 patients) and hyper‐kinesia (eight patients). In only two cases did adverse events require VGB withdrawal.

Conclusion: This study supports the opinion that VGB may be considered an initial treatment for IS regardless of cause.
Nonconvulsive Status Epilepticus in the Emergency Room
Authors: Kaplan Peter W.
Published: August 2005

Purpose: The study reviewed emergent cases of nonconvulsive status epilepticus (NCSE) to evaluate causes of diagnostic and management delay and examined frequent diagnostic features suggestive of NCSE.

Methods: In a retrospective study, we assessed the clinical presentation of 23 patients with one or more NCSE episodes, their medical history, EEG, and antiepileptic drug (AED) treatment. We also evaluated causes of diagnostic delay in patients referred to the emergency room (ER) in confusional states.

Results: There was considerable overlap in clinical features of patients with complex partial SE (CPSE) and generalized nonconvulsive SE (GNSE). Delays in seeking medical attention were common. Diagnosis was significantly delayed in 10 patients. Three cases illustrate the possible markedly different presentations of NCSE.

Conclusions: NCSE often goes unrecognized or is mistaken for behavioral or psychiatric disturbance. The pleo‐morphic clinical presentation of NCSE indicates that EEG and a therapeutic trial of AEDs afford the best diagnostic measures in acute waxing and waning confusional states associated with agitation, bizarre behavior, staring, increased tone, mutism, or subtle myoclonus.
Learned Helplessness, Attributional Style, and Depression in Epilepsy
Authors: Hermann Bruce P. , Trenerry Max R. , Colligan Robert C. ,   The Bozeman Epilepsy Surgery Consortium
Published: August 2005

Summary: Purpose: We wished to examine the relevance of the theory of learned helplessness in general, and attributional style in particular, to the understanding of depression among patients with epilepsy.

Methods: Patients with lateralized temporal lobe epilepsy (TLE) (right = 73, left = 70) were administered two self‐report depression inventories [Beck Depression Inventory (BDI), Center for Epidemiological Studies‐Depression scale (CES‐D)]. Depression scores were examined in relation to a key component of the revised theory of learned helplessness (attributional style) using the Optimism/Pessimism Scale.

Results: Attributional style was significantly associated with increased self‐reported depression and remained significant when the effects of several confounding variables were controlled [age, age at onset, laterality of TLE, sex, and method variance].

Conclusions: The results indicate that the concepts of learned helplessness in general, and attributional style in particular, are related to the genesis of depression in epilepsy. Because they are known to be related to depression in the general population, and because specific techniques for intervention and prevention are available, greater consideration of learned helplessness and attributional style in the genesis of depression in epilepsy may be worthwhile.
Pharmacokinetic Interactions Between Lamotrigine and Other Antiepileptic Drugs in Children with Intractable Epilepsy
Authors: Eriksson Ann‐Sofie , Hoppu Kalle , Nergårdh Arne , Boreus Lars
Published: August 2005

Summary: Purpose: We wished to determine the oral pharmacokinetics of lamotrigine LTG and to assess possible interactions with other AEDs in an unselected population of children. Concentration data in plasma and in CSF for lamotrigine as well as for the other AEDs are presented.

Methods: Thirty‐one children, children and young adults aged > 2 years with intractable generalized epilepsy despite adequate duration and dose of at least three conventional AEDs were studied.

Results: There was a linear relation between the dose administered and the maximal plasma concentration, indicating that saturation of absorption or elimination mechanisms did not occur in the dose range studied. The median elimination half‐life (t1/2) in patients receiving concomitant valproate (VPA) was 43.3 h; in patients receiving carbamazepine (CBZ) and/or phenobarbital (PB), it was 14.1 h; and in patients receiving both VPA and CBZI PB or other antiepileptic drugs (AEDs), it was 28.9 h. No clinically important changes in the plasma levels of CBZ, VPA, valproate, ethosuximide, or PB were observed in the follow‐up period (2–12 months). No dose adjustments of concomitant AEDs were necessary. The plasma concentration of clonazepam (CZP) was reduced when LTG was introduced.

Conclusions: The complex interaction between LTG and other AEDs in children with intractable epilepsy makes therapeutic drug monitoring (TDM) desirable.
Vigabatrin Versus ACTH as First‐Line Treatment for Infantile Spasms: A Randomized, Prospective Study
Authors: Vigevano Pederico , Cilio Maria Roberta
Published: August 2005

Summary: Purpose: To compare the efficacy and tolerability of vigabatrin (VGB) and adrenocorticotrophic hormone (ACTH) as first‐line therapy in infantile spasms.

Methods: Forty‐two infants (22 males, 20 females) aged 2–9 months with newly diagnosed infantile spasms, were included in the trial. Patients were randomized to receive VGB 100–150 mg/kg/day or Depot ACTH 10 IU/day. The alternative drug was given if spasms were not controlled within 20 days or in cases of intolerance to initial therapy. Twenty‐three patients (7 cryptogenic, 16 symptomatic) received VGB as first‐line therapy; 19 patients (8 cryptogenic, 11 symptomatic) received ACTH as the first drug.

Results: Cessation of spasms was observed in 11 (48%) of the patients randomized to VGB and in 14 (74%) of those randomized to ACTH. Response to VGB was observed within 1–14 days, but two‐thirds of patients (7/11) responded within 3 days. In the group treated with VGB, side effects such as drowsiness, hypotonia and irritability were observed in 13% of patients, compared with 37% in the group treated with ACTH. VGB was more effective than ACTH as treatment for cerebral malformations or tuberous sclerosis, whereas ACTH proved more effective in perinatal hypoxic/ischemic injury. The efficacy of the two drugs was similar in cryptogenic cases. Disappearance of interictal EEG abnormalities occurred sooner in patients randomized to ACTH than in those who received VGB as initial therapy. During the second phase, the alternative drug was given to the resistant patients. Spasms ceased in 2 of 5 patients treated with VGB and in 11 of 12 patients treated with ACTH. After 3 months, relapses of spasms were observed in 6 patients treated with ACTH and in 1 treated with VGB. VGB produced a therapeutic response in nearly half the patients receiving this drug.

Conclusions: Our data lend further support to the view that VGB may be considered a first‐choice drug in the treatment of IS.
Quantitative MRI of Mesial Temporal Structures in Temporal Lobe Epilepsy
Authors: Van Paesschen Wim
Published: August 2005

Summary: Hippocampal sclerosis (HS) is the most common pathology associated with intractable temporal lobe epilepsy (TLE). MRI features of HS include hippocampal atrophy and an increased T2 signal. Hippocampal volume loss can be quantified using MR‐based hippocampal volume measurement, and the hippocampal T2 relaxation time can be measured on a hippocampal T2 map. Visual assessment of high quality T2‐and thin sliced IR TI‐weighted images along the axes of the hippocampus allows reliable detection of unilateral diffuse HS, the most common variant of HS. A combination of quantitative hippocampal MRI techniques may be required to detect some variants of HS, such as bilateral HS, and to better define the range of normality. Examples of unusual findings are presented and clinical correlations are discussed. The combination of AT2 mapping and FLAIR is a sensitive method with which to detect small lesions which are not seen on standard MR images in the amygdalae of patients with intractable TLE. These MRI techniques will detect an abnormality in mesial temporal structures in ∼80% of patients with intractable TLE not associated with a foreign tissue lesion.
Epileptogenic Lesions Requiring Additional MRI Studies
Authors: Meiners Linda C.
Published: August 2005

Summary: MRI is the technique of choice in the evaluation of patients suffering from epilepsy. Due to its high contrast resolution and its possibility of multiplanar imaging small epileptogenic lesions can be visualized using appropriate parameter sequences. MRI characteristics and imaging sequences in nine pathologic entities are discussed.
Comparison of Psychotic States in Patients with Idiopathic Generalized Epilepsy and Temporal Lobe Epilepsy
Authors: Sengoku Akira , Toichi Motomi , Murai Toshiya
Published: August 2005

Summary: We compared the characteristics of psychotic symptoms and pathogeneses of psychotic states in patients with idiopathic generalized epilepsy (IGE) and temporal lobe epilepsy (TLE). Sixty‐seven patients with IGE and 105 patients with TLE who were treated in our psychiatric clinic between December 1991 and July 1996 were selected. The clinical characteristics of the psychotic states accompanying each type of epilepsy were investigated retrospectively. Psychotic states were ascertained in 19.4% of the patients with IGE and 15.2% of the patients with TLE. The psychotic states of the patients with TLE tended to be more chronic than those of the patients with IGE. The characteristic psychotic symptoms were perplexed behavior and other various psychotic symptoms in the IGE group and hallucinations, delusions, and bad temper in the TLE group. The correlation with seizures was more evident in the TLE group than in the IGE group, because the seizure frequencies before the onset of psychotic states were significantly higher in the TLE group. The relationship between epileptic discharges and psychotic state was significantly more distinct in the IGE group. However, 3 patients with TLE with episodic psychotic states were mentally improved after tem‐prod lobectomy, which suggested that deep midtemporal epileptic discharges might have been the cause of their psychotic states. The psychotic symptoms of the patients with IGE and those with TLE were clearly different, and the incessant epileptic discharges of the different cerebral regions might be a key factor in the psychotic states accompanying both types of epilepsy.