bluuebunny/crossref_metadata_2025 huggingface dataset:
Aminergic Tone Correlates of Migraine and Tension‐type Headache: A Study Using the Tridimensional Personality Questionnaire
Authors: Di Piero V. , Bruti G. , Venturi P. , Talamonti F. , Biondi M. , Di Legge S. , Lenzi G.L.
Published: March 2003

Background.—Aminergic neurotransmitter activity has been studied in many neuropsychiatric diseases by means of a self‐administered questionnaire proposed by Cloninger. Given that central aminergic modulation plays a major role in the pathophysiology of primary headaches, we investigated the personality dimensions related to aminergic neurotransmitter activity in patients with migraine and tension‐type headache.

Methods.—From a consecutive series of 230 patients, we selected those presenting with migraine and tension‐type headache according to the International Headache Society criteria. All patients were assessed by means of the Cloninger 100‐item self‐report Tridimensional Personality Questionnaire and a depression scale. The four dimensions of personality are novelty seeking (dopaminergic), harm avoidance (serotonergic), reward dependence (noradrenergic), and persistence (glutaminergic).

Results.—One hundred twenty‐one patients presenting with migraine and 42 with tension‐type headache were recruited. The results indicate significantly higher harm avoidance scores (P<.001) in both patients with migraine and those with tension‐type headache than in controls. Furthermore, patients with migraine had a significantly low score in the novelty seeking dimension (P<.001). When we compared only the two groups of patients with headache, we found that the persistence dimension alone was significantly higher in patients with migraine than in those with tension‐type headache (P<.05). No differences were observed either in the overall scores of the other personality dimensions or in the depression scale scores.

Conclusions.—The Tridimensional Personality Questionnaire results support a role of the serotonergic system in both migraine and tension‐type headache pathophysiology. A dysfunction of dopaminergic and glutaminergic tone seems to be a specific feature of migraine.
Recovery Cycle of the Blink Reflex and Exteroceptive Suppression of Temporalis Muscle Activity in Migraine and Tension‐type Headache
Authors: Aktekin Berrin , Yaltkaya Korkut , Ozkaynak Sibel , Oguz Yurttas
Published: March 2003

Brain stem interneuronal excitability can be assessed by recording the recovery cycle of the blink reflex and exteroceptive suppression of temporalis muscle activity. Abnormal endogenous pain control mechanisms due to disturbed brain stem interneuronal activity have been implicated in the pathogenesis of tension‐type headaches. The blink reflex, exteroceptive suppression of temporalis muscle activity, and the recovery curve of both the R2 component of the blink reflex and the ES2 component of the exteroceptive suppression of the temporalis muscle activity were studied in 20 patients with migraine without aura, 32 patients with tension‐type headache, and 20 normal controls. In our study, the blink reflex was elicited by stimulation of the supraorbital nerve; the exteroceptive suppression of the temporalis muscle activity was elicited by applying electrical shocks to the labial commissure, both on the lower and upper sides. The recovery cycle was established by delivering paired shocks at different interstimulus intervals. Comparisons were made between normal control subjects, patients with migraine without aura, and patients with tension‐type headache. The latency of R1, R2, and R2′, the amplitude and size of the R2 and R2′ components of the blink reflex, the latency and duration of the ES1 and ES2 components, and the recovery curve of the ES2 component of the temporalis muscle activity did not differ between groups. However, the recovery curve of the R2 component of the blink reflex diminished in patients with tension‐type headache compared with the other groups. Our findings indicate reduced excitability of the brain stem interneurons in patients with tension‐type headache.
Headache in Divers
Authors: Cheshire William P. , Ott Michael C.
Published: March 2003

The increasing popularity of scuba diving has added a new category to the differential diagnosis of headache. Headache in divers, while uncommon and generally benign, can occasionally signify serious consequences of hyperbaric exposure such as arterial gas embolism, decompression sickness, and otic or paranasal sinus barotrauma. Inadequate ventilation of compressed gases can lead to carbon dioxide accumulation, cerebral vasodilatation, and headache. Other types of headache encountered in divers include exertional headache, cold stimulus headache, migraine, tension‐type headache, acute traumatic headache, cervicogenic headache, carbon monoxide poisoning headache, and headache associated with envenomation. Correct diagnosis and appropriate treatment require a careful history and neurologic examination as well as an understanding of the unique physiologic stresses of the subaquatic environment.
Opiate Use to Control Bowel Motility May Induce Chronic Daily Headache in Patients With Migraine
Authors: Wilkinson S.M. , Becker W.J. , Heine J.A.
Published: March 2003

Objectives.—To investigate whether opiate overuse might cause chronic daily headache in those with migraine, we studied patients who were taking codeine (or other opiates) for control of bowel motility after colectomy for ulcerative colitis.

Background.—Analgesic overuse is considered by many to be one factor which can result in the transformation of migraine into a chronic daily headache pattern. Most of the evidence for this comes from patients with migraine who are taking increasing amounts of analgesia for headache. Many of these patients revert to an intermittent migraine pattern once the analgesics are stopped.

Methods.—Women who were 1 year postcolectomy for ulcerative colitis were identified in several colorectal surgery practices in Calgary. They were sent a questionnaire designed to determine if they had a history of migraine prior to surgery, if they currently had chronic daily headache, what medications they were taking to control bowel motility, and what medications they were taking for headache.

Results.—Twenty‐eight patients who met our inclusion criteria returned completed questionnaires. Eight of these exceeded the recommended limits for opiate use in patients with headache. Eight patients met diagnostic criteria for migraine. Two patients had chronic daily headache starting after surgery. Both used daily opiates beginning after their surgery, and both had a history of migraine. The other six patients who used opiates daily did not have a history of migraine and did not have chronic daily headache. All patients with migraine who used daily opiates to control bowel motility following surgery developed chronic daily headache after surgery.

Conclusions.—Patients with migraine who use daily opiates for any reason are at high risk of developing transformed migraine with chronic daily headache. This risk appears much lower in patients without a history of migraine who use opiates for nonpain indications.
Coping Style and Social Support in Men and Women Suffering From Cluster Headache or Migraine
Authors: Blomkvist Vanja , Hannerz Jan , Katz Lillemor , Theorell Töres
Published: March 2003

Objective.—To investigate similarities and differences between patients with cluster headache and patients with migraine.

Background.—Patients with migraine and patients with cluster headache are considered, by many clinical neurologists, to be different psychologically and socially.

Methods.—Twenty‐five age‐matched pairs of men and 24 age‐matched pairs of women with either migraine or episodic cluster headache (men aged 31 to 62 years; mean, 47 years; women aged 23 to 72 years; mean, 44 years) were compared with regard to coping profiles as reflected in two “coping wheels,” one for the present situation and one for the future. In addition, availability of attachment and social interaction was assessed by means of the ISSI (Interview Schedule for Social Interaction).

Results.—Women with cluster headache anticipated fewer activities for themselves than women with migraine, and findings were similar in the male pairs. The men with cluster headache also anticipated significantly fewer activities for themselves in the present and with others in the present and in the future than the men with migraine. There was no significant difference as to emotional loading between the two groups. A tendency to more optimistic anticipation was found in the women with cluster headache. There were highly significant differences between the two groups in the “future” wheel. The group with migraine expected more concrete activities and more activities with their families in the future, and they also described their present situation to involve more activities with others.

Conclusion.—Results from the present study differ from those from studies utilizing more conventional questionnaires. In particular, we found that patients with cluster headache have fewer close social contacts than patients with migraine.
Health Resource Utilization of the Emergency Department Headache “Repeater”
Authors: Maizels Morris
Published: March 2003

Objective.—To document the health resource utilization of patients who repeatedly use emergency department services for headache care.

Background.—Patients with headache who frequently use emergency department services may differ from patients with more typical, episodic migraine. Previous studies of health resource utilization have often failed to distinguish the high utilizer as a specific subset of the migraine population.

Design.—Retrospective review of urgent care/emergency department charts, clinic charts, and pharmacy rosters.

Patients and Methods.—Patients who made three or more visits for headache to an urgent care/emergency department (UC/ED) facility for headache over a 6‐month study period were identified and designated as “repeaters” for this study. Pharmacy profiles and appointment histories of 52 of the 54 repeaters whose records were available were reviewed for the 12 months prior to the study period.

Results.—Over the 6‐month study period, 518 patients visited the UC/ED 1004 times for primary headache complaints. Fifty‐four (10%) repeaters made 502 visits (50% of total visits; mean 9.3, range 3‐50). In the 12 months prior to the study period, 52 of these repeaters made 1832 visits to the UC/ED or clinic (mean 35.2, range 0‐178): 1458 (79.6%) were headache related, and 1271 (69.4%) of all visits were to the UC/ED. An estimated 12‐month cost for all visits was $183,760. Pharmacy rosters showed use of narcotics in 41 of the 52 patients (annual mean ± SD, 613 ± 670 tablets), benzodiazepines in 30 patients (500 ± 486 tablets), and butalbital products in 27 patients (395 ± 590 tablets). Mean daily use of all symptomatic medications combined was 3.9 ± 3.2 doses/day.

Conclusion.—Health resource utilization of emergency department headache repeaters is predominantly headache‐related acute care. Associated medication overuse is frequently present. Efforts to improve care for patients with headache will benefit from distinguishing the high utilizer as a subset of the migraine population.
Prevalence of Migraine Among Mexican Americans in San Diego, California: Survey 1
Authors: Molgaard Craig A. , Rothrock John , Stang Paul E. , Golbeck Amanda L.
Published: March 2003

Objective.—To determine the population‐based prevalence of migraine in a cross‐sectional random sample of Mexican Americans aged at least 45 years in San Diego County, California.

Background.—The prevalence of migraine has been assessed in various populations in the United States and Mexico, but no study of migraine prevalence in Mexican Americans has been reported in the literature to date.

Design/Methods.—Using an epidemiological cross‐sectional research design, the population‐based prevalence and associated descriptive epidemiology of self‐reported migraine was estimated in Mexican Americans aged at least 45 years in San Diego County, California from a random sample of size 657.

Results.—The lifetime migraine prevalence was 9.2% (95% confidence interval, 6.8 to 11.6) and current prevalence was 7.4% (95% confidence interval, 5.3 to 9.5). The prevalence of migraine was higher in women than in men, higher in low income groups than in high income groups, and decreased with increasing age. Prevalence among Mexican Americans born in Mexico was twice that of American‐born Mexican Americans.

Conclusions.—These population‐based data on migraine prevalence in Mexican Americans aged 45 and over contribute substantially to the understanding of this disease. A second study addressing migraine prevalence in Mexican Americans younger than 45 years in San Diego County will be reported.
Clinical Benefits of Early Triptan Therapy for Migraine
Authors: Pascual Julio
Published: March 2003

Although triptans have been proven effective for acute treatment of migraine, reserving them for moderate or severe pain may produce suboptimal pain relief and higher rates of recurrence. Recent evidence indicates that early intervention at the onset of pain improves outcomes. Post hoc analysis of a long‐term, open‐label European study of almotriptan 12.5 mg found that the percentage of attacks rendered pain‐free at 2 hours was significantly greater when patients treated mild pain (84%) than when the intervention occurred during moderate or severe pain (53%). A similar pattern emerged with respect to the consistency of pain relief, with a significant advantage for early intervention (88% versus 56%, respectively). A difference in favor of early intervention was also seen with respect to recurrence, need for rescue medication, and adverse events. The recurrence rate was significantly lower in patients treating mild pain (28%) than in those delaying treatment until the pain became moderate or severe (33%), which suggests that achieving pain freedom results in less recurrence. These results were generally replicated in post hoc analysis of a subgroup of patients from a randomized, placebo‐controlled trial (the Spectrum Study) of oral sumatriptan 50 mg in migraineurs. This analysis demonstrated that with early intervention, pain was less likely to intensify, fewer attacks required redosing, more attacks remained pain‐free 24 hours postdose, and normal function returned more quickly. In sum, early intervention with triptans can improve outcomes, avoiding much of the pain and disability associated with treating moderate or severe attacks.
American Headache Society Members' Assessment of Headache Diagnostic Criteria
Authors: Nash Justin M. , Lipchik Gay L. , Holroyd Kenneth A. , McCool Heidi , Stensland Michael
Published: March 2003

Objective.—We assessed the views of physicians interested in headache as to the diagnosis of the most commonly occurring and currently controversial headaches.

Background.—The International Headache Society (IHS) classification system has received wide professional endorsement and considerable empirical support, but in the United States, their adoption by clinicians may be proceeding more slowly. Questions remain, including what diagnostic criteria for migraine and tension‐type headache clinicians may continue to favor over those outlined by the IHS, to what extent is the “transformed migraine” diagnosis used in clinical practice, and how is analgesic rebound headache diagnosed with regard to the various quantitative measures of analgesic use.

Methods.—Members of the American Headache Society rated the importance of IHS and non‐IHS diagnostic criteria for migraine and tension‐type headache and for analgesic rebound headache. Respondents also described their use of the proposed transformed migraine diagnosis.

Results.—Two‐thirds (67.3%) of the respondents reported use of the IHS criteria or the IHS criteria in conjunction with clinical judgment. For migraine and tension‐type headache, IHS criteria were rated with high importance, but some respondents reported using additional non‐IHS diagnostic criteria and de‐emphasizing certain IHS criteria. For chronic headache, almost two‐thirds (63%) of respondents reported using the transformed migraine diagnosis. For analgesic rebound headache, respondents preferred to make the diagnosis based on medication consumption that is lower than amounts stipulated in the IHS classification system.

Conclusions.—There remains a number of physicians interested in headache who do not use the IHS classification system, who modify the IHS criteria in practice, and who use the “transformed migraine” diagnosis for patients with chronic daily headache.
Prolonged Cortical Electrical Depression and Diffuse Vasospasm Without Ischemia in a Case of Severe Hemiplegic Migraine During Pregnancy
Authors: Gonzalez‐Alegre Pedro , Tippin Jon
Published: March 2003

The pathophysiology of the neurological deficits in hemiplegic migraine remains unclear. Both neurogenic and vascular etiologies have been proposed to explain this phenomenon. We present the case of a patient with hemiplegic migraine in whom there was no diffusion weighted magnetic resonance imaging evidence of cerebral ischemia, despite persistent left hemiplegia and diffuse vasospasm on cerebral angiography, there was no diffusion weighted magnetic resonance imaging evidence of cerebral ischemia. In addition, hypoperfusional changes were seen diffusely, more so on the less symptomatic hemisphere, whereas depression of cortical electrical activity was seen for several days on the right side. These findings support the notion that although both neurogenic and vascular changes occur in hemiplegic migraine, the former seems to be a more likely explanation for the neurological deficits.
Familial Neck‐Tongue Syndrome
Authors: Lewis Donald W. , Frank L. Matthew , Toor S.
Published: March 2003

Neck‐tongue syndrome is an uncommon clinical entity characterized by brief attacks of intense unilateral stabbing pain in the upper neck or occipital region upon sudden rotation of the head, accompanied by ipsilateral numbness of the tongue. Eight patients, 5 teenagers and 3 adults, with neck‐tongue syndrome are presented. Each of the 5 adolescents had normal examinations and normal neuroimaging. The 3 adults were parents of the affected children and had experienced transient symptoms during their adolescence suggesting an autosomal dominant inheritance pattern.
Pharmacology of the Selective 5‐HT1B/1D Agonist Frovatriptan
Authors: Comer M.B. , Hons
Published: March 2003

Objective.—To determine the pharmacological profile of frovatriptan.

Background.—Frovatriptan is a new 5‐HT1B/1D agonist developed for the treatment of migraine.

Methods.—Pharmacological studies were performed using in vitro and in vivo techniques.

Results.—Radioligand‐binding studies showed that frovatriptan has a high affinity for 5‐HT1B and 5‐HT1D receptors, and moderate affinity for 5‐HT1A, 5‐HT1F, and 5‐HT7 receptors. In vitro, frovatriptan acts as a potent full agonist at human cloned 5‐HT1B and 5‐HT1D receptors, and as a moderately potent full agonist at 5‐HT7 receptors. Studies of frovatriptan in isolated human arteries demonstrated a lower threshold for constriction of cerebral than coronary vasculature and a bell‐shaped dose‐response curve was apparent in the coronary arteries. In anesthetized dogs, frovatriptan administration produced no measurable effect on cardiac function or on blood pressure. Frovatriptan had no effects on coronary blood flow following transient coronary artery occlusion, whereas sumatriptan produced a prolonged and significant decrease in coronary blood flow.

Conclusion.—The pharmacology of frovatriptan suggests that it should be an effective agent for the acute treatment of migraine, with a low potential for undesirable peripheral effects.
Incidence of Status Epilepticus in Adults in Germany: A Prospective, Population‐Based Study
Authors: Knake Susanne , Rosenow Felix , Vescovi Mathias , Oertel Wolfgang H. , Mueller Hans‐Helge , Wirbatz Angelika , Katsarou Niki , Hamer Hajo M. ,   for the Status Epilepticus Study Group Hessen (SESGH)
Published: March 2003

Summary:  Purpose: To determine the incidence and case‐fatality rate of status epilepticus (SE) in adults in Hessen, Germany, we performed a prospective, population‐based study from July 1997 through June 1999.

Methods: All adult patients residing within the zip‐code area 35 (area‐35) with SE were included. Area‐35 had 743.285 adult inhabitants, including 123.353 adult inhabitants of the primary service area of the University Hospital Marburg (PS‐area). Patients were reported by 16 hospitals in the area and were prospectively identified and carefully reviewed within 5 days by one of the authors. Based on the crude annual incidence of SE and a rate of underascertainment of 10% determined for the PS‐area, the corrected, age‐adjusted incidence of SE in area 35, more representative of the population of Germany, was calculated.

Results: The crude annual incidence in the PS‐area was 15.8/100,000 [95% confidence interval (CI), 11.2–21.6]. The calculated, corrected, age‐adjusted incidence of SE in area 35 was 17.1/100,000. It was higher for men compared with women (26.1 vs. 13.7) and for those aged 60 years and older (54.5 vs. 4.2/100,000, p < 0.0001). The etiology was mainly remote symptomatic due to cerebrovascular disease. Epilepsy was previously diagnosed in only 50% of the patients. The case‐fatality rate was 9.3%.

Conclusions: Based on our data, at least 14,000 patients would be affected by SE in Germany, associated with ∼1,300 deaths annually. The incidence of SE in Germany is similar to that found in the white United States population. Furthermore, this study confirms the higher incidence of SE in male patients and in the elderly population. This may be due to a higher incidence of cerebrovascular disease in these subpopulations.
A Pharmacoepidemiologic Study of Factors Influencing the Outcome of Treatment with Lamotrigine in Chronic Epilepsy
Authors: Wong Ian C. K. , Mawer George E. , Sander Josemir W. A. S. , Lhatoo Samden D.
Published: March 2003

Summary: Purpose:To identify prognostic factors for freedom from seizures and long‐term retention of treatment in patients receiving lamotrigine (LTG).

Methods:A multicenter, retrospective, case record study of 1,050 patients with chronic epilepsy was carried out. Logistic regression and Cox regression analyses were used to identify clinical features associated with freedom from seizures and retention of treatment, respectively. Long‐term retention rates of LTG therapy were estimated using Kaplan–Meier survival analysis.

Results:The 1,050 patients with chronic epilepsy were included in the study. Patients with generalized epilepsy (p = 0.01), who were not receiving carbamazepine (CBZ; p = 0.02) were more likely to become seizure‐free. Sixty percent of patients continued on LTG therapy >1 year and estimated retention at 8 years was 38%. Patients with generalized epilepsy (p = 0.002), patients receiving concurrent sodium valproate (VPA; p < 0.0001), those not previously exposed to gabapentin and vigabatrin (p < 0.0001), and those in whom the starting dose was lower (p < 0.0012), were more likely to remain on long‐term treatment with LTG. The relationships with exposure to other antiepileptic drugs remained significant in patients with focal and with generalized epilepsy when considered separately.

Conclusions:The best results from LTG treatment in terms of freedom from seizures and long‐term retention of treatment were obtained in patients with generalized epilepsy. Retention of treatment was enhanced by VPA not only in generalized but also in focal epilepsy. The importance of a low starting dose of LTG was again confirmed. The apparent negative effect of CBZ in patients taking LTG merits further investigation.
Vagus Nerve Stimulation: Analysis of Device Parameters in 154 Patients during the Long‐Term XE5 Study
Authors: DeGiorgio Christopher M. , Thompson Jaye , Lewis Paul , Arrambide Stacey , Naritoku Dean , Handforth Adrian , Labar Doug , Mullin Paul , Heck Christi ,   the VNS U.S. Study Group
Published: March 2003

Summary:  Purpose: To determine the effect of changes in device settings and duty cycle (on and off times) on the efficacy of vagus nerve stimulation (VNS) for refractory epilepsy. In the long‐term XE5 study of VNS for intractable epilepsy, the median reduction in seizure frequency improved significantly after 1 year of follow‐up. A central question is whether device changes improve efficacy. We analyzed the effects of device parameter changes on seizure frequency in 154 subjects who completed the study and who had complete data for analysis.

Methods: Retrospective analysis of device changes during the XE5 long‐term study of VNS. During the XE5 long‐term follow‐up study, the subject's device settings were modified within a Food and Drug Administration (FDA)‐approved range of output current, pulse duration, frequency, on time, and off time. Significant changes in device settings occurred after 3 months. We investigated the relationship between percentage reduction in seizures and changes in device parameters between the 3‐ and 12‐month visits. Within‐group comparisons were performed for those who continued on standard on/off cycle of 30 s on and 5 min off, and those with the most common off times of 3, 1.8, and <1.1 min.

Results: Output current, pulse duration, frequency, and off time changed significantly between the 3‐ and 12‐month long‐term follow‐ups. For the group as a whole, changes in device settings were not correlated with an improvement in efficacy. However, a significant improvement in efficacy occurred in a subgroup whose off time was reduced to ≤1.1 min. In this group, the median reduction in seizures improved from 21% before the change in off time, to 39% after the change in off time (Wilcoxon Signed‐Rank, p = 0.011). The responder rate (>50% reduction in seizures) also significantly improved from 19 to 35% (McNemar's test, p = 0.046).

Conclusions: The data from this retrospective analysis indicate that device changes were not the primary determinant of increased efficacy at 12 months of long‐term follow‐up. In general, patients who remained on the original settings of 30 s on and 5 min off continued to respond or improve in their response over the 1‐year period. However, some patients may benefit from reductions in off time (increases in duty cycle). In a subgroup initially resistant to VNS, a change in off time to ≤1.1 min off did result in significant improvements in efficacy.
Relevance of Residual Histologic and Electrocorticographic Abnormalities for Surgical Outcome in Frontal Lobe Epilepsy
Authors: Ferrier C. H. , Alarcon G. , Engelsman J. , Binnie C. D. , Koutroumanidis M. , Polkey C. E. , Janota I. , Dean A.
Published: March 2003

Summary:  Purpose: To estimate the significance of residual electrocorticographic and neuropathologic abnormalities on seizure control after surgery for frontal lobe epilepsy with the purpose of determining their relevance in deciding the extent of the surgical procedure.

Methods: The presence of epileptiform discharges in intraoperative electrocorticograms (ECoGs) and the nature and extent of neuropathologic abnormalities were reviewed for 35 patients who underwent frontal lobe resections for the treatment of epilepsy at our institution. The relations between surgical outcome and presence of the following features were studied: (a) presence of abnormal tissue at the limits of the resection; (b) presence of sporadic spikes and seizure patterns in the preresection ECoG; (c) their abolition in the postresection ECoG; and (d) the topography of residual discharges with respect to the margins of the resection.

Results: On neuropathologic examination, 18 patients showed focal cortical dysplasia (CD), and 17 showed other abnormalities (non‐CD). Ten CD patients and 11 non‐CD patients experienced a favourable outcome. Seizure patterns were significantly more common in patients with focal cortical dysplasia than in those without, with a sensitivity of 94% and a specificity of 75%. Abolition of seizure patterns was associated with a favourable surgical outcome (p = 0.031). Abolition of sporadic spikes or their presence in the postresection ECoG did not influence outcome. There was no clear relation between outcome and location of residual sporadic discharges. Seizure patterns persisted in the postresection ECoG in three CD patients, were located at the margins of the resection in all three, and these patients had a poor outcome. Incomplete removal of abnormal tissue was not associated with a poorer outcome in either patient group or in the complete sample.

Conclusions: Seizure patterns were significantly more common in patients with cortical dysplasia, and their abolition on postresection ECoG recordings was associated with a favourable surgical outcome. Persistence of sporadic ECoG spikes and incomplete removal of histologic abnormalities did not affect outcome significantly.
Adverse Event Monitoring in Lamotrigine Patients: A Pharmacoepidemiologic Study in the United Kingdom
Authors: Wong Ian C. K. , Mawer George E. , A .S. Sander Josemir W.
Published: March 2003

Summary:  Purpose: This postmarketing surveillance study of lamotrigine (LTG) was performed to provide complementary data to large‐scale Prescription–Event Monitoring study with a retrospective case records survey in five tertiary referral epilepsy centres in the United Kingdom.

Methods: Adverse events were recorded and compared with those of two other new antiepileptic drugs (AEDs), gabapentin (GBP) and vigabatrin (VGB). All deaths were followed up and standardised mortality ratios (SMRs) were calculated. Serious adverse events were assessed individually.

Results: A total of 2,701 patients was identified as being exposed to LTG and/or the comparators. It was necessary to exclude 1,326 patients because LTG and/or comparators had been commenced outside the study centres. The adverse events with LTG reported by this study were similar to those reported in the literature. Skin rash was the major adverse event. Life‐threatening hepatic failure, acute exacerbation of ulcerative colitis, disseminated intravascular coagulation, and renal failure were reported. No death could be directly attributed to the use of LTG. The SMR was slightly higher than that reported in the literature; this probably reflects severity of epilepsy in the study population.

Conclusions: The safety profile of LTG was similar to that in the large‐scale Prescription‐Event Monitoring study and generally acceptable. Life‐threatening adverse reactions were rare.
Familial Infantile Myoclonic Epilepsy: Clinical Features in a Large Kindred with Autosomal Recessive Inheritance
Authors: De Falco Fabrizio A. , Majello Luigi , Santangelo Roberto , Stabile Mariano , Bricarelli Franca Dagna , Zara Federico
Published: March 2003

Summary: Purpose:To describe the clinical features of a large kindred with familial infantile myoclonic epilepsy (FIME) with autosomal recessive inheritance, and to discuss the nosology of the early infantile myoclonic epilepsies (IMEs).

Methods:The family descends from the intermarriage of two couples of siblings. In a previous study, we mapped the genetic locus to chromosome 16p13.We analyzed results of family records and personal history, psychomotor development, neurologic examination, epilepsy features, and EEG recordings for each subject.

Results:FIME has a strong penetrance (eight affected of 14 subjects) and a homogeneous clinical picture. Like the benign form of infantile myoclonic epilepsy (BIME), FIME is a true idiopathic IME with unremarkable history, no neurologic or mental impairment, good response to treatment, and normal interictal EEG pattern. Conversely, onset with generalized epileptic seizures without fever (four patients) or with fever (one patient), frequency and duration of the myoclonic seizures, occurrence of generalized tonic–clonic seizures (GTCSs) in all patients and persistence of seizures into adulthood are characteristics of the severe infantile myoclonic epilepsy (SIME).

Conclusions:Clinical overlap probably exists among the myoclonic epilepsies of infancy. FIME differs from other forms of IME in its phenotypic features. The peculiar mode of inheritance is explained by the genetic background of the family. Genetic studies suggest linkage to chromosome 16 in familial cases of true IME.
Propofol and Midazolam in the Treatment of Refractory Status Epilepticus
Authors: Prasad Avinash , Worrall Bradford B. , Bertram Edward H. , Bleck Thomas P.
Published: March 2003

Summary:  Purpose: To explore outcome differences between propofol and midazolam (MDL) therapy for refractory status epilepticus (RSE).

Methods: Retrospective chart review of consecutive patients treated for RSE between 1995 and 1999.

Results: We found 14 patients treated primarily with propofol and six with MDL. Propofol and MDL therapy achieved 64 and 67% complete clinical seizure suppression, and 78 and 67% electrographic seizure suppression, respectively. Overall mortality, although not statistically significant, was higher with propofol (57%) than with MDL (17%) (p = 0.16). Subgroup mortality data in propofol and MDL patients based on APACHE II (Acute Physiology and Chronic Health Evaluation) score did not show statistically significant differences except for propofol‐treated patients with APACHE II score ≥20, who had a higher mortality (p = 0.05). Reclassifying the one patient treated with both agents to the MDL group eliminated this statistically significant difference (p = 0.22).

Conclusions: In our small sample of RSE patients, propofol and MDL did not differ in clinical and electrographic seizure control. Seizure control and overall survival rates, with the goal of electrographic seizure elimination or burst suppression rather than latter alone, were similar to previous reports. In RSE patients with APACHE II score ≥20, survival with MDL may be better than with propofol. A large multicenter, prospective, randomized comparison is needed to clarify these data. If comparable efficacy of these agents in seizure control is borne out, tolerance with regard to hemodynamic compromise, complications, and mortality may dictate the choice of RSE agents.
Transient Oromotor Deficits in Children with Benign Childhood Epilepsy with Central Temporal Spikes
Authors: Kramer Uri , Ben‐Zeev Bruria , Harel Shaul , Kivity Sarah
Published: March 2003

Summary:  Purpose: To describe transient oromotor deficits in benign childhood epilepsy with centrotemporal spikes (BCECTS), an idiopathic age‐specific epileptic syndrome with a benign course.

Methods: Five children with BCECTS and intermittent dysarthria and drooling not in the context of typical clinical seizures are presented.

Results: The periods of oromotor deficits correlated with increased seizure frequency in all children. Concomitant EEGs that were recorded during periods of dysarthria in four of the children revealed focal electrographic seizures. The reported children did not differ from other patients with BCECTS in any other respect.

Conclusions: Transient oromotor dysfunction is a rare ictal phenomenon that occurs in children with BCECTS with no other unique clinical features.
Is Amygdalohippocampectomy Really Selective in Medial Temporal Lobe Epilepsy? A Study Using Positron Emission Tomography with 18Fluorodeoxyglucose
Authors: Dupont Sophie , Croizé Anne‐Claire , Semah Franck , Hasboun Dominique , Samson Yves , Clémenceau Stéphane , Baulac Michel
Published: March 2003

Summary:  Purpose: Selective amygdalohippocampectomy (SAH) is a surgical technique effective for the treatment of medial temporal lobe epilepsy, which selectively removes the epileptogenic hippocampus and amygdala but spares the temporal neocortex. However, the benefit of SAH in terms of functional outcome is debated. In this study, we aimed to assess the metabolic consequences of SAH.

Methods: Volumetric magnetic resonance imaging (MRI) and fluorodeoxyglucose positron emission tomography (PET) studies were performed in nine patients with medial temporal lobe epilepsy associated with hippocampal sclerosis before and after SAH. Regions of interest were delineated on MRIs and then replaced on PET images using an automatic 3D image registration. We calculated absolute metabolic rates of glucose and normalized metabolic values in each region of interest.

Results: The comparison between preoperative and postoperative metabolic values showed a statistically significant worsening of the hypometabolism on the ipsilateral temporal pole on the superior and the hippocampal levels (p < 0.05 and 0.0045, respectively). A postoperative increase of the metabolic activity also was noted in the contralateral anterior hippocampus (p < 0.05) and the orbitofrontal cortex bilaterally (p < 0.002 and 0.001, respectively)

Conclusions: SAH functional benefit is controversial. SAH worsened significantly the hypometabolism of a temporal structure that was not surgically removed (i.e., the temporal pole), and it improved postoperatively the metabolic activity in the contralateral hippocampus and the orbitofrontal cortex. Whether this postoperative improvement is linked to the selectivity of the surgical procedure must be further clarified.
Silent Celiac Disease in Patients with Childhood Localization‐Related Epilepsies
Authors: Labate A. , Gambardella A. , Messina D. , Tammaro S. , Le Piane E. , Pirritano D. , Cosco C. , Doldo P. , Mazzei R. , Oliveri R. L. , Bosco D. , Zappia M. , Valentino P. , Aguglia U. , Quattrone A.
Published: March 2003

Summary:  Purpose: To evaluate how many patients with a clinical picture of idiopathic childhood localization‐related epilepsies may also have silent celiac disease (CD). This will help determine whether investigation for CD should be restricted to those patients with childhood partial epilepsy with occipital paroxysms (CPEO) or should be extended to all patients with childhood partial epilepsy (CPE) regardless of seizure type and electroencephalographic (EEG) paroxysms.

Methods: The study group consisted of 72 patients (31 girls and 41 boys; mean age, 12.6 ± 4.28 years; age at onset, 6.4 ± 3.7 years) who were observed consecutively over a 5‐year period and who received an initial diagnosis of idiopathic CPE. A diagnosis of CD was confirmed by using enzyme‐linked immunosorbent assay (ELISA) to assess the presence of antigliadin antibodies and the immunofluorescent undirected test to assess the presence of antiendomysium antibodies.

Results: Twenty‐five patients had CPEO, whereas the remaining 47 had CPE with centrotemporal spikes (CPEC). None of the patients with CPEC had positive antibody tests. Of the 25 patients with CPEO, two (8%) had antiendomysium immunoglobulin (Ig) A antibodies. In both of these patients, the jejunal biopsy showed atrophy of the villi and hyperplasia of the crypts, consistent with a diagnosis of CD. Brain computed tomography (CT) was normal in one of these patients and revealed occipital corticosubcortical calcifications in the other.

Conclusions: Our study indicates that CD screening should be performed routinely only in patients with CPEO.
An Epilepsy Questionnaire Study of Knowledge and Attitudes in Canadian College Students
Authors: Young G. Bryan , Derry Paul , Hutchinson Ingrid , John Verity , Matijevic Suzan , Parrent Lisa , Wiebe Samuel
Published: March 2003

Summary: Purpose:Controversy exists about the relation of societal knowledge and attitudes regarding epilepsy. We conducted a survey to examine knowledge and attitudes, to note gender and occupational influences, and to examine the effect of an informational brochure.

Methods:We administered a standardized questionnaire that noted demographics and examined knowledge and attitudes regarding epilepsy and persons with epilepsy, respectively, to a wide variety of Canadian college students. In a separate class we gave every other student a brochure regarding epilepsy and then administered the questionnaire to both the naïve and brochure‐exposed students.

Results:Knowledge was patchy and weakest for the approximate prevalence of epilepsy in the population, hereditary epilepsy and several other etiologies, recognition of nonconvulsive seizures as a type of epilepsy, and knowledge of antiepileptic drug–induced teratogenicity. In contrast, attitudes were more uniformly favorable. However, 11 and 14%, respectively, showed negative bias against persons with epilepsy having children and equal opportunity for occupational employment. Women were slightly but significantly more tolerant than men. The brochure‐exposed group showed better knowledge but equivalent attitudes compared with the naïve group.

Conclusions:Results compare favorably with surveys in other countries. Although knowledge was patchy, it could be easily improved on with an educational brochure. Attitudes were positive but show some discrepancies from knowledge and a gender effect.
Informative Value of Magnetic Resonance Imaging and EEG in the Prognosis of Infantile Spasms
Authors: Saltik Sema , Kocer Naci , Dervent Aysin
Published: March 2003

Summary:  Purpose: To investigate the informative value of EEG and cranial magnetic resonance imaging (cMRI) in the prognosis of infantile spasms (ISs); 86 patients with ISs were included in this study.

Methods: All cases had epileptic spasms, psychomotor retardation, and hypsarrhythmia in at least one of their EEGs. cMRIs and laboratory tests necessary for etiologic diagnosis were completed in all cases. Patients were followed up periodically both clinically and by video‐EEGs for >1 year. Clinical information was categorized on the basis of four spheres as epilepsy, psychosocial development, motor development, and overall clinical condition, with each category being evaluated under three levels of involvement as good, moderate, and severe, depending on selected parameters. A similar scale was applied for the EEG results and for the cMRI findings. Clinical parameters were correlated to EEG and cMRI results, by Spearman test. Other statistical tests used were Kruskal–Wallis χ2 and Mann–Whitney U analysis as multiple comparison by post hoc Bonferroni correction.

Results: A severe overall clinical course was observed in 64% of patients, whereas this incidence was 58% and 44% in the EEG follow‐up and cMRI parameters, respectively. In regard to prognosis, a significant correlation was determined between the clinical and the EEG course. This relation was the most prominent in psychosocial developmental parameters and least prominent in the motor development. cMRI findings, however, were correlated only with motor development.

Conclusions: cMRI and repeated EEG recordings, especially when assessed together, may provide complementary information regarding the prognosis in ISs.
Acute Pancreatitis Coincident with Valproate Use: A Critical Review
Authors: Pellock John M. , Wilder B. J. , Deaton Roger , Sommerville Kenneth W.
Published: March 2003

Summary:  Purpose: Acute pancreatitis has been associated with a number of medications, including valproate (VPA). Valproate‐coincident pancreatitis is uncommon and is usually associated with other risk factors; however, the United States Food and Drug Administration has issued a box warning for risk of acute pancreatitis with VPA products. We reviewed cases of pancreatitis in VPA‐treated patients from the clinical database of VPA/divalproex trials and compared the incidence of elevated amylase levels between VPA‐ and placebo‐treated patients.

Methods: Report rates of acute pancreatitis coincident with VPA use in 34 clinical trials were calculated. Incidence rates of amylase elevations above the normal range in three clinical placebo‐controlled migraine trials were compared between VPA‐ and placebo‐treated patients.

Results: Among 3,007 VPA‐treated patients in 34 clinical trials, two reports of pancreatitis were considered by investigators to be probably related to VPA. Both patients recovered. Similar rates of amylase elevations were observed in VPA‐ (5.9%) and placebo‐treated (6.1%) patients in the three migraine headache trials.

Conclusions: VPA‐coincident acute pancreatitis is uncommon and idiosyncratic. Checking amylase levels in the absence of other clinical signs and symptoms provides little value for predicting pancreatitis. Physicians should be guided by clinical symptoms of pancreatitis to identify cases.
Determining Reliable Cognitive Change after Epilepsy Surgery: Development of Reliable Change Indices and Standardized Regression‐based Change Norms for the WMS‐III and WAIS‐III
Authors: Martin Roy , Sawrie Stephen , Gilliam Frank , Mackey Melissa , Faught Edward , Knowlton Robert , Kuzniekcy Ruben
Published: March 2003

Summary:  Purpose: Reliable change indices (RCIs) and standardized regression‐based (SRB) change scores norms were established for the recently revised Wechsler Adult Intelligence Scale–III (WAIS‐III) and Wechsler Memory Scale–III (WMS‐III) in patients with complex partial seizures. Establishment of such standardized change scores can be useful in determining the effects of epilepsy surgery on cognitive functioning independent of test–retest artifacts including practice effects.

Methods: Forty‐two nonoperated‐on adult patients with complex partial seizures (primarily of temporal lobe onset) were administered the WMS‐III and WAIS‐III on two occasions (mean 7‐month interval). All patients were receiving stable antiepileptic drug (AED) treatment at both testings. RCI and SRB change scores were calculated. Confidence interval cutoff scores (90% and 80%) and standardized regression equations were calculated for each of the WAIS‐III and WMS‐III Primary Indices and individual subtests. Age, gender, education, test–retest interval, preoperative test performance, seizure onset, and seizure duration were predictor variables for the SRB equations.

Results: Test–retest reliabilities for the WAIS‐III and WMS‐III Primary Indices were within acceptable ranges, although considerable individual subtest variability was found. Preoperative performance was the single largest contributor to each of the predictive regression equations. Age, gender, education, seizure onset, and seizure duration contributed modest variance to several of the regression equations.

Conclusions: We calculated both RCI and SRB change score indices for the recently revised Wechsler instruments. These formulas help control for test–retest methodologic artifacts and provide a standardized method with which to examine both individual and group level cognitive change after epilepsy surgery.
Serum and CSF Glutamine Levels in Valproate‐related Hyperammonemic Encephalopathy
Authors: Vossler David G. , Wilensky Alan J. , Cawthon David F. , Kraemer Diana L. Abson , Ojemann Linda M. , Caylor Lisa M. , Morgan John D.
Published: March 2003

Summary:  Purpose: To investigate ammonia and glutamine levels in valproate (VPA)‐related hyperammonemic encephalopathy (VHE).

Methods: We reviewed the medical records and EEG recordings of seven adults diagnosed with VHE.

Results: Venous ammonia levels were elevated in five (71%) of the seven patients. Elevated serum or cerebrospinal fluid (CSF) glutamine levels were found in four (80%) of five cases tested, including two who had normal ammonia levels. Initial behavioral signs included violent outbursts in three patients, paranoid ideation severe enough to require restraint in two cases, and milder abnormalities in two instances. The severity of encephalopathy was not related to any particular serum VPA level. In four patients serum VPA levels did not exceed 100 μg/ml, and in one case, VHE developed after taking only one 250‐mg dose. Symptoms eventually cleared after reducing the dose of, or discontinuing, VPA. Liver‐function tests were normal. Each of six patients tested had EEG findings that supported the diagnosis of VHE and excluded nonconvulsive status epilepticus. The rate of normalization of one patient's serum glutamine level and the EEGs of two cases correlated better with the timing of their delayed clinical recovery than did the more rapid rate of decline of the serum ammonia levels.

Conclusions: Serum or CSF glutamine levels are initially elevated in a majority of patients with suspected VHE, sometimes in the absence of hyperammonemia. Glutamine levels may be useful adjunctive laboratory tests for the diagnosis of VHE.