bluuebunny/crossref_metadata_2025 huggingface dataset:
Ecological Ethics: Building a New Tool Kit for Ecologists and Biodiversity Managers
Authors: MINTEER BEN A. , COLLINS JAMES P.
Published: October 2005

Abstract:  Ecological research and biodiversity management often raise ethical questions in areas that include responsibilities and duties to the scientific community, public welfare, research animals, species, and ecosystems. Answering these questions is challenging because ecologists and biodiversity managers do not have the equivalent of bioethics, an established field with a support network focused mainly on biomedicine, to guide them in making decisions. Environmental ethics provides some insight into environmental values and the duties these may impose on humans. But for the most part those in the field have not considered many of the common responsibilities and obligations that ecologists and managers have to the scientific profession or to public welfare. There is a need to bring ethicists, scientists, and biodiversity managers together in a collaborative effort to study and inform the methods of ethical analysis and problem solving in ecological research and biodiversity management. We present a series of cases that illustrate the kinds of ethical questions faced by researchers and biodiversity managers in practice. We argue for the creation of an extensive case database and a pluralistic and integrated ethical framework, one that draws from the theoretical (normative), research, animal, and environmental ethics traditions. These tools form the foundations of a new area of inquiry and practical ethical problem solving, that we call “ecological ethics.”
Risk‐Based Viable Population Monitoring
Authors: STAPLES DAVID F. , TAPER MARK L. , SHEPARD BRADLEY B.
Published: October 2005

Abstract:  We describe risk‐based viable population monitoring, in which the monitoring indicator is a yearly prediction of the probability that, within a given timeframe, the population abundance will decline below a prespecified level. Common abundance‐based monitoring strategies usually have low power to detect declines in threatened and endangered species and are largely reactive to declines. Comparisons of the population's estimated risk of decline over time will help determine status in a more defensible manner than current monitoring methods. Monitoring risk is a more proactive approach; critical changes in the population's status are more likely to be demonstrated before a devastating decline than with abundance‐based monitoring methods. In this framework, recovery is defined not as a single evaluation of long‐term viability but as maintaining low risk of decline for the next several generations. Effects of errors in risk prediction techniques are mitigated through shorter prediction intervals, setting threshold abundances near current abundance, and explicitly incorporating uncertainty in risk estimates. Viable population monitoring also intrinsically adjusts monitoring effort relative to the population's true status and exhibits considerable robustness to model misspecification. We present simulations showing that risk predictions made with a simple exponential growth model can be effective monitoring indicators for population dynamics ranging from random walk to density dependence with stable, decreasing, or increasing equilibrium. In analyses of time‐series data for five species, risk‐based monitoring warned of future declines and demonstrated secure status more effectively than statistical tests for trend.
Metaphit‐Induced Audiogenic Seizure and Its Inhibition by MK‐801: Electroencephalographic and Behavioral Characterization
Authors: Šušić V. T. , Marković O. , Lipovac M. N.
Published: October 2005

Summary: Adult male Wistar rats were subjected to intense sound stimulation from an electric bell (100 dB and 12 KHz for 60 s) after a single intraperitoneal (i.p. 50 mg/kg) injection of metaphit [l‐(l‐/3 isothiocyanatophenyl‐cyclohexyl) piperidine]. EEG recordings demonstrated appearance of paroxysmal activity and spike‐wave complexes from cortical electrodes, with frequency and amplitude increasing with time. Metaphit‐induced audiogenic seizures in the rats were tested 24 h after metaphit administration. The seizures consisted of wild running followed by clonic and tonic convulsions, and the seizure pattern could be elicited at hourly intervals for the next 24 h in all tested animals. Forty‐eight hours after metaphit administration, susceptibility to sound stimulation began to decrease gradually. The first component of seizure response to disappear was tonic extension, followed by disappearance of clonic convulsion; the last component to disappear was running behavior. Each behavioral seizure response had a characteristic EEG correlate. After ∼50 h, no animal responded to sound stimulation. The noncompetitive antagonist of the N‐methyl‐D‐aspartate (NMDA) receptors, MK‐801 [5‐methyl‐10, ll‐dihydro‐5H‐dibenzo (a, d) cyclohepten‐5,10‐imine maleate] was evaluated as an anticonvulsant against metaphit‐induced audiogenic seizures in two experiments. In the first experiment, MK‐801 was administered in a single dose of 0.5 mg/kg i.p. 23.5 h after metaphit injection and 30 min before sound stimulation, which completely blocked both the EEG and the behavioral response to sound stimulation for 37 h. After that time, seizure susceptibility began to appear and within 7 h reached a maximum, at which time all animals responded with a complete pattern of a severe seizure. During the next 5 h, seizure susceptibility began to abate gradually and disappeared completely 76 h after metaphit administration. The EEG and behavioral responses did not differ from those elicited in animals treated with metaphit alone. In the second experiment, MK‐801 (0.5 mg/kg i.p.) administered 30 min before metaphit did not protect the animals from the effects of metaphit but significantly reduced the incidence of clonic‐tonic seizures. EEG signs of seizure susceptibility and progressive increase in epileptic discharges were not suppressed by MK‐801. Results suggest that MK‐801 is an anticonvulsant rather than an antiepileptic agent in the metaphit‐induced audiogenic seizure model.
Duration of Sodium Amytal Effect: Behavioral and EEG Measures
Authors: Bouwer M. S. , Jones‐Gotman M. , Gotman J.
Published: October 2005

Summary: In performance of an intracarotid sodium amytal test duration of action is a critical factor since measurements obtained after cessation of action are invalid. Duration of action is often monitored by measuring handstrength contralateral to injection or by visual inspection of amytal‐induced EEG slow waves ipsilateral to injection. We describe new objective methods of monitoring drug effect: quantified EEG and sensory discrimination. In a first study of patients with scalp electrodes, the two traditional and the two new measures were compared in 40 injections. Results indicated that the two EEG measures did not differ significantly and estimated a shorter drug effect than the two behavioral measures, which were also not significantly different. The two new measures had a smaller SD, indicating that they may be less erratic. In a second study of 14 patients, using intracerebral electrodes, we showed that slow waves in the frontocentral region lasted as long as the motor and sensory effects, but also that slow waves in the medial temporal region dissipated earlier than the motor and sensory deficits. Our results suggest that motor and sensory measures may overestimate the time in which valid testing can occur if hippocampal function is at issue.
Value of Intraoperative EEG Changes During Corpus Callosotomy in Predicting Surgical Results
Authors: Fiol M. E. , Gates J. R. , Mireles R. , Maxwell R. E. , Erickson D. M.
Published: October 2005

Summary: The intraoperative transformation of generalized epileptiform discharges (GED) to lateralized epileptiform activity during the course of corpus callosum sectioning for intractable epilepsy in 37 patients was correlated with percentage of decrease in atonic‐tonic seizures with “drops” at mean follow‐up of 26 months (range 12– 86 months). Twenty‐seven (73%) patients had intraoperative interictal discharges, and 21 (78%) showed varying degrees of lateralization of GED during corpus callosum sectioning (two thirds to total). All patients experienced >80% reduction in atonic‐tonic seizures with drops. The group (n = 7) with largest decrease in GED had the greatest decrease in seizures (95.5%). Six patients without change in GED had 88% decrease in seizures, as did 14 patients (85–86%) with mild or moderate decreases in GED, but there was no statistically significant correlation between decrease in GED and seizure frequency after operation. Thus, although lateralization of GED after corpus callosum sectioning was evident in 78% of patients with GED, the degree of lateralization of GED did not correlate with degree of reduction of tonic‐atonic seizures. Therefore, intraoperative surface EEG monitoring does not appear to be helpful at this time as a guide to extent of callosotomy.
Carnitine Disposition Before and During Valproate Therapy in Patients with Epilepsy
Authors: Riva Roberto , Albani Fiorenzo , Gobbi Giuseppe , Santucci Margherita , Baruzzi Agostino
Published: October 2005

Summary: Free and total carnitine and acylcarnitine in plasma and urine samples was measured in 22 epileptic patients before and after 15 and 45 days of valproate (VPA) therapy and in 16 healthy volunteers on a single occasion. Carnitine plasma concentration and renal excretion observed in epileptic patients before VPA therapy did not differ from control values. After VPA was started, free and total plasma concentration decreased significantly (p < 0.05) from 49 ± 17 to 35 ± 16 at 15 days and to 35 ± 13 nmol/ml at 45 days of therapy (free carnitine) and from 60 ± 18 to 50 ± 18 at 15 days and to 55 ± 14 nmol/ml at 45 days of therapy (total carnitine), whereas acylcarnitine increased significantly (p < 0.05) from 10 ± 8 to 14 ± 8 at 15 days and to 18 ± 16 nmol/ml at 45 days of therapy. Free carnitine urinary excretion decreased significantly (p < 0.05) from 200 ± 135 to 115 ± 76 and 118 ± 75 μmol/24 h, whereas acylcarnitine urinary excretion increased significantly (p < 0.05) from 78 ± 56 to 154 ± 98 and 155 ± 89 μmol/24 h after VPA therapy was started. As a consequence, acylcarnitine renal clearance increased significantly (+ 30%, p < 0.05) whereas free carnitine renal clearance did not change during VPA therapy. No difference was detected between 15 and 45 days of therapy. No patients experienced symptoms of VPA toxicity. Our results suggest that VPA in patients increases both formation and renal clearance of acylcarnitine.
Metaphit‐Induced Audiogenic Seizures in Mice: I. Pharmacologic Characterization
Authors: Debler E. A. , Lipovac M. N. , Lajtha A. , Zlokovic B. V. , Dunlop D. S. , Jacobson A. E. , Rice K. C. , de Costa B. , Reith M. E. A.
Published: October 2005

Summary: Metaphit [an analogue of phencyclidine (PCP) with an acylating isothiocyanate group] induced audiogenie clonic to clonic‐tonic seizures in mice exposed to audio stimulation 24 h after metaphit administration. The incidence of seizures was reduced by treatment 30 min before audio stimulation with specific PCP‐like compounds [5‐methyl‐10, ll‐dihydro‐5H‐dibenzo(a, d)cyclohepten‐5,10‐imine maleate (MK‐801), and PCP itself], competitive N‐methyl‐d‐aspartate antagonists 2‐amino‐5‐ phosphonopentanoic acid (AP‐5 and NPC‐12626), antiepileptic drugs [phenobarbital (PB), phenytoin (PHT)], and γ‐aminobutyric acid (GABA) agonists (muscimol and diazepam). In contrast, when given in conjunction with metaphit, most of these drugs were ineffective in protecting animals from audiogenic seizures 24 h later. Only compounds with long half‐lives (t½) such as MK‐801, PB, and PHT had a protective effect. High‐performance liquid chromatography (HPLC) determination of [3H]MK‐801 showed its long‐term presence in the brain after intraperitoneal (i.p.) administration of [3H]MK‐801. Audiogenic seizures observed 24 h after metaphit administration were potentiated by administration of the GABA antagonist picrotoxin 15 min before audio stimulation, and picrotoxin‐induced spontaneous seizures were enhanced by pretreatment (24 h earlier) with a dose of metaphit that in itself did not produce spontaneous seizures at the time of the picrotoxin test. Similar observations were made with N‐methyl d‐aspartic acid (NMDA) instead of picrotoxin. Thus, an interplay exists between excitatory glutaminergic and inhibitory GABAergic circuitries in the metaphit seizure model.
Electroencephalographic and Magnetic Resonance Correlations in Children with Intractable Seizures of Lennox‐Gastaut Syndrome and Epilepsia Partialis Continua
Authors: Velasco Ana Luisa , Boleaga Bernardo , Santos Noemí , Velasco Francisco , Velasco Marcos
Published: October 2005

Summary: A study was performed of EEG‐magnetic resonance imaging (MRI) abnormalities in 7 Lennox‐Gastaut syndrome (LGS) children and 3 epilepsia partialis continua (EPC) children with intractable generalized and partial motor seizures, respectively. In 4 children with LGS and 3 children with EPC, depth electrodes were implanted in the centromedian thalamic nuclei (CM) for seizure control. In all children with LGS, hyperdense, T2‐weighted MRI signals were observed at the mesencephalic level of the brainstem, whereas none of the 3 children with EPC had this finding. Patients with idiopathic LGS without cerebral hemisphere MRI abnormalities showed generalized bilateral and symmetrical spike‐wave EEG activity. Patients with symptomatic LGS with unilateral hemispheric MRI abnormalities demonstrated asymmetrical EEG activity with higher amplitude spike‐and‐wave over the normal hemisphere. Patients with EPC with unilateral hemispheric lesions had lateralized higher amplitude spike‐wave over the damaged hemisphere. These data suggest that abnormal mesencephalic MRIs are a sign of bad prognosis in patients with LGS but not with EPC. Maximal amplitude paroxysmal EEG activities may indicate the abnormal hemisphere in patients with EPC or the normal hemisphere in those with LGS.
Differential Diagnosis in Pseudoepileptic Seizures
Authors: özkara Cigdem , Dreifuss Fritz E.
Published: October 2005

Summary: With increasing use of intensive video‐EEG monitoring, publications concerning pseudoepileptic seizures have burgeoned, but without clarification concerning differing psychopathologic mechanisms and without distinction of different syndromic varieties. The frequent concurrence of pseudoepileptic and epileptic seizures has not been sufficiently recognized, and an undue reliance on clinical experience on the one hand and individual tests such as EEG on the other has proven equally misleading in this group of cases.
Vagus Nerve Stimulation Has No Effect on Awake EEG Rhythms in Humans
Authors: Salinsky Martin C. , Burchiel Kim J.
Published: October 2005

Summary: Vagus nerve stimulation (VNS) has been shown to have an anticonvulsant effect in several animal models, and clinical trials in patients were recently started. Experimental data have suggested that VNS may act by modulating EEG rhythmic activity. We studied the acute effects of VNS on EEG background rhythms in patients undergoing treatment for poorly controlled partial seizures. Six patients had recordings of satisfactory quality for quantitative EEG analysis. A significant effect of VNS on EEG total power, median frequency, or power in any of the conventional frequency bands, could not be demonstrated. Intraindividual analysis did not show a significant effect of VNS on total power for any patient, including those with apparent clinical response. We conclude that VNS at the parameters in current clinical use does not alter awake EEG background rhythms. The mechanism mediating acute antiepileptic effect remains unknown.
De Novo Absence Status Epilepticus as a Benzodiazepine Withdrawal Syndrome
Authors: Thomas Pierre , Lebrun Christine , Chatel Marcel
Published: October 2005

Summary: A 67‐year‐old woman with a history of psychotropic drug abuse developed confusion. EEG was consistent with absence status epilepticus (AS). Intravenous (i.v.) flumazenil 1 mg, a benzodiazepine antagonist with anticonvulsant properties, increased both confusion and paroxysmal activity. Complete resolution was obtained after diazepam was administered i.v., and the patient then admitted that she had abruptly discontinued long‐standing treatment with carpipramine, amitryptiline, bromazepam, and flunitrazepam. The aggravating effect of flumazenil indicates that benzodiazepine withdrawal was probably the elective triggering factor of this de novo absence status epilepticus.
Decreased Dopamine and Increased Norepinephrine Levels in the Spontaneously Epileptic Rat, a Double Mutant Rat
Authors: Hara M. , Sasa M. , Kawabata A. , Serikawa T. , Yamada T. , Yamada J. , Takaori S.
Published: October 2005

Summary: Dopamine (DA) and norepinephrine (NE) brain levels and turnover rate were examined in the spontaneously epileptic rat (SER: zi/zi, tm/tm), a double mutant rat obtained by mating tremor heterozygotes (tml +) with zitter homozygotes associated with epileptic seizures composed of spontaneously occurring tonic convulsion and absence‐like seizure. DA and NE levels were also determined in age‐matched male zitter, tremor and Kyo:Wistar rats. DA levels in caudate nucleus were significantly lower in adult age (10–12 weeks) SER, which showed epileptic seizures, and zitter rats than in adultKyo:Wistar and tremor rats. DA levels in other areas such as thalamus‐hypothalamus, midbrain, and ponsmedulla were not different among SER, zitter, tremor, and Kyo:Wistar rats at age 10–12 weeks. Except in cerebral cortex and hippocampus, there were no differences in brain DA levels between young seizure‐free SER (age 5 weeks) and young Kyo:Wistar rats. Furthermore, the turnover rate of DA was significantly lower in caudate nucleus of adult SER than of Kyo:Wistar rat, whereas in pons‐medulla there was no difference between the two strains. In contrast, NE levels in the thalamushypothalamus, midbrain, cerebellum and pons‐medulla were higher in SER and zitter rats at age 10–12 weeks than in age‐matched tremor and Kyo:Wistar rats. Higher NE levels were also observed in midbrain, cerebellum, and pons‐medulla of young SER as compared with young Kyo:Wistar rats. Turnover rates of NE were significantly lower in pons‐medulla and cerebellum of the adult SER than in those of Kyo:Wistar rat. In genetic studies using backcross mating of zitter and BN rats, decreased DA was also observed in caudate nucleus of backcrossed zitter rats as compared with BN, F1, and zitter wild‐type rats. Increased NE contents were observed in the thalamus‐hypothalamus, midbrain, and pons‐medulla of zitter rats as compared with other rats, although the increase was also observed in the thalamus‐hypothalamus and midbrain of zitter wild‐type rats. Results suggest that a decrease in DA in caudate nucleus and an increase in NE in midbrain and pons‐medulla are due to the homozygous zi gene, and together with previous findings, suggest that the decrease in DA, although probably not the only cause, facilitates appearance of tonic and absence‐like seizures by lowering the threshold triggering such seizures.
Incidence of Epilepsy and Unprovoked Seizures in Rochester, Minnesota: 1935–1984
Authors: Hauser W. Allen , Annegers John F. , Kurland Leonard T.
Published: October 2005

Summary: The incidence of epilepsy and of all unprovoked seizures was determined for residents of Rochester, Minnesota U.S.A. from 1935 through 1984. Ageadjusted incidence of epilepsy was 44 per 100,000 personyears. Incidence in males was significantly higher than in females and was high in the first year of life but highest in persons aged ≥75years. Sixty percent of new cases had epilepsy manifested by partial seizures, and two thirds had no clearly identified antecedent. Cerebrovascular disease was the most commonly identified antecedent, accounting for 11% of cases. Neurologic deficits from birth, mental retardation and/or cerebral palsy, observed in 8% of cases, was the next most frequently identified preexisting condition. The cumulative incidence of epilepsy through age 74 years was 3.1%. The age‐adjusted incidence of all unprovoked seizures was 61 per 100,000 person‐years. Age‐and gender‐specific incidence trends were similar to those of epilepsy, but a higher proportion of cases was of unknown etiology and was characterized by generalized onset seizures. The cumulative incidence of all unprovoked seizures was 4.1% through age 74 years. With time, the incidence of epilepsy and of unprovoked seizures decreased in children and increased in the elderly.
Lafora's Disease in South India: A Clinical, Electrophysiologic, and Pathologic Study
Authors: Acharya J. N. , Satishchandra P. , Asha T. , Shankar S. K.
Published: October 2005

Summary: Twenty‐one cases (12 males, 9 females) of Lafora's disease in 16 families were studied at the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India, from 1982 to 1990. Mean age of onset was 13.5 years (range 9.5–18 years). First symptom was generalized tonic‐clonic seizure (17), myoclonus (3), or dementia (1). All patients eventually developed the classical triad, except 1 who has had only myoclonus. Seven had occipital seizures. Other signs included behavioral changes (9), brisk tendon reflexes (11), cerebellar signs (8), and visual impairment (4). Patients from 14 of the 16 families (85%) were products of consanguineous marriage. More than 1 sibling was affected in 6 families. Scalp EEGs showed diffuse background slowing with epileptiform discharges in all and progressive slowing as the disease progressed in 3. Photosensitivity occurred in 4 of the 17 cases studied (23.5%). EEC abnormalities were documented in the presymptomatic stage in 2 cases 6 months and 6 years before clinical symptom onset. Visual evoked responses were abnormal in 4 of the 6 cases studied. Giant somatosensory evoked potentials (SSEP) were observed in all 8 cases studied. Lafora bodies were demonstrated in axillary skin in 14 of 17 (82.4%), in liver in 4 of 10 (40%), and in both brain biopsy specimens. In 2 cases, liver biopsy was positive while axillary skin biopsy was negative. In the brain, inclusions were evident in glial and capillary endothelial cells in addition to neurons. Although our cases were similar to those described earlier, the relative rarity of visual phenomena is emphasized. The clinical pattern was consistent with autosomal recessive inheritance. The high frequency of consanguinity in the South Indian population may be responsible for the many cases observed at our center.
Seizure Threshold in Juvenile Myoclonic Epilepsy with Graves Disease
Authors: Su Yu‐Hsien , Izumi Tatsuro , Kitsu Megumi , Fukuyama Yukio
Published: October 2005

Summary: Thyroxine lowers the seizure threshold in experimental animals and humans. We report juvenile myoclonic epilepsy (JME) in two female patients with Graves’ disease who had exophthalmos at age 11 (patient 1) and age 12 years (patient 2) but remained untreated until onset of seizures at ages 15 and 13 years, respectively. Seizures were not controlled well despite administration of antiepileptic drugs (AEDs) during the periods of excess serum thyroid hormones in Graves disease. When the serum levels of T3 were reduced to <220 ng/dl with antithyroid drug treatment, both clinical seizures and paroxysmal EEG abnormalities disappeared despite discontinuation of AEDs and sleep deprivation. JME was noted only during periods of excess thyroid hormone and low compliance with antithyroid drug treatment. The excessively high level of thyroid hormones may have been a factor in precipitating the onset of JME.
Epilepsy with Bilateral Occipital Calcifications: Sturge‐Weber Variant or a Different Encephalopathy?
Authors: Tiacci Camillo , D'Alessandro Patrizia , Cantisani Teresa Anna , Piccirilli Massimo , Signorini Enrico , Pelli Maria Antonietta , Cavalletti Maria Lucia , Castellucci Giuseppe , Palmeri Silvia , Battisti Carla , Federico Antonio
Published: October 2005

Summary: A series of cases of epilepsy with associated bilateral occipital calcifications (EBOC) without signs of phakomatosis and without any disorders known to produce cerebral calcifications have been reported. It is unclear whether EBOC is an incomplete variant of Sturge Weber disease (SWD) or if it is a different, as yet undefined encephalopathy. We describe four new cases of EBOC that are different clinically by age of onset, type, course, severity of epilepsy, and associated cognitive deficits but that are linked by similar neuroradiologic findings. Similar to cases described in the literature, there is convincing evidence in favor of the hypothesis that these cases belong to an encephalopathy different from SWD and frequently associated with celiac disease.
Case of Landau‐Kleffner Syndrome Secondary to Inflammatory Demyelinating Disease
Authors: Perniola T. , Margari L. , Buttiglione M. , Andreula C. , Simone I. L. , Santostasi R.
Published: October 2005

Summary: A 6‐year old girl developed acquired aphasia with epilepsy and a paroxysmal EEG (Landau‐Kleffner syndrome). Isoelectric CSF focusing showed oligoclonal IgG bands. Small lesions were visualized in periventricular left frontal white matter and right parietal lobe centrum semiovale with magnetic resonance imaging (MRI). After a week of ACTH therapy, the EEG paroxysmal activity disappeared; during the next few months, the language disorder improved. Further MRI examination showed a decrease in size and signal of the left frontal lesions, with localized white matter atrophy, dilatation of the subarachnoidal spaces, and disappearance of the right parietal lesion. The clinical and neuroradiologic features and the laboratory data suggest an acute disseminated encephalomyelitis.
Ictal EEG Changes with Corpus Callosum Section
Authors: Spencer Susan S. , Katz Amiram , Ebersole John , Novotny Edward , Mattson Richard
Published: October 2005

Summary: Corpus collosum section diminishes but does not completely abolish secondary bilaterally synchronous interictal EEG discharges, yet often causes cessation of generalized seizures. The effects of corpus callosum section on ictal EEG patterns have not been described. We contrasted ictal EEG patterns before and after anterior callosotomy in 18 patients and before and after total callosotomy in 10 patients. Bilaterally synchronous seizure onset was disrupted in 5 of 11 anterior section patients and 5 of 5 total section patients. Seven of 18 anterior section patients and 5 of 10 total section patients had more localized seizure onset after the procedure; localization to the frontal lobe was observed after anterior or total section, but only total section patients had newly demonstrated posterior locations of seizure onset. These data suggest that the mechanisms by which bilaterally synchronous interictal and ictal discharges are generated differ. Although brainstem or diencephalic structures may contribute to formation of interictal bilateral synchrony, the corpus callosum may be the only pathway used in producing apparent bilateral synchronous seizure onset in patients with secondarily generalized seizures.
Mirror Focus: Function of Seizure Frequency and Influence on Outcome After Surgery
Authors: Gilmore Robin , Morris Harold , Van Ness Paul C. , Gilmore‐Pollak Wendy , Estes Melinda
Published: October 2005

Summary: The concept of the mirror focus (MF) implies that an actively discharging epileptiform region may induce similar paroxysmal behavior in a homologous site. In a group of patients with complex partial seizures (CPS) we investigated whether occurrence of a MF was influenced by certain clinical factors and whether surgical out‐come was influenced by the presence of an MF. Factors studied included age at onset, duration, and total number of seizures. Patients had had CPS for >3 years and had pathologically proven temporal lobe neoplasms. Seizure frequency was estimated by the history‐taking physician. We estimated total seizure number by multiplying frequency by duration. Seven patients had MF, and 15 did not. Mean age at onset of seizures, duration of seizure disorder, and total seizure number did not vary statistically between the two groups of patients. All patients with an MF except 1 were seizure‐free at follow‐up. Ten of the 15 patients without MF were seizure‐free. Three patients who were not seizure‐free had had subtotal resection owing to tumor overlap with eloquent cortex. We conclude that an MF is not a contraindication to operation even when the preponderance of interictal spike activity is contralateral to the tumor or when seizures appear to arise from the MF on scalp EEG.
Juvenile Myoclonic Epilepsy: A 5‐Year Prospective Study
Authors: Panayiotopoulos C. P. , Obeid T. , Tahan A. R.
Published: October 2005

Summary: We made a long term prospective study of 66 patients with juvenile myoclonic epilepsy (JME). Prevalence was 10.2% among 672 patients with epilepsies. Sex distribution was equal. Sixty‐three were not diagnosed on referral; JME was not initially recognized in the epilepsy clinic in 22. Clinical typical absence seizures were reported in 33.3%, myoclonic jerks in 97% and generalized tonic‐clonic seizures (GTC) in 78.8% of the patients. Mean age (±SD) at onset was 10.5 ± 3.4 years (range 5–16 years) for absence seizures, 15 ± 3.5 years (range 8–26 years) for myoclonic jerks, and 16 ± 3.5 years (9–28) for GTC. Absence predated myoclonic jerks by 3.9 ± 2.3 years (range‐1–9 years) and GTC by 4.4 ± 2.7 years (range 1–8 years) in 14 (21.2%) patients who manifested all three types of seizure. Absence were never antedated by myoclonic jerks or GTC. Myoclonic jerks occurred on awakening in 87.5% of the patients. GTC occurred mainly on awakening, but other patients had nocturnal or diurnal GTC with no circadian distribution. Neurologic examination was normal for all patients except for tremor of the hands similar to essential tremor, noted in 35% of patients. Computed tomography (CT) brain scans were normal: 93% of patients had precipitating factors: sleep deprivation (89.5%), fatigue (73.7%), photosensitivity (36.8%; television and video games 8.8%), menstruation (24.1% of women), mental concentration (22.8%), and stress (12.3%). Incidence of JME among siblings (13 of 41 examined families) implies an autosomal recessive mode of inheritance for this Arab population. EEGs were frequently normal in treated patients. At least one abnormal EEG was recorded in 56 (84.9%) patients. Abnormalities consisted mainly of generalized discharges of spike/double spike and/or polyspike and slow wave. Frequent multiple spikes and discharge fragmentations varied from 0.5to 20‐s duration (mean 6.8 s). Twenty (30.3%) had focal abnormalities, and 18 (27.3%) had photoconvulsive discharges. Eighty‐eight percent of patients remained seizure‐free for 3 years of follow‐up. Effective treatment was achieved with valproate (VPA); control of myoclonic jerks was improved with clonazepam (CZP). CZP monotherapy did not consistently prevent GTC. Adding small doses of CZP with simultaneous reduction of VPA was the most effective and better tolerated form of medication, particularly in patients demonstrating an adverse reaction or requiring a large VPA dosage. VPA dosage was successfully reduced in 15 patients who were seizure‐free for >2 years and had infrequent seizures before treatment, but 9 of 11 patients relapsed after VPA discontinuation.
Clinical and EEG Asymmetries in Juvenile Myoclonic Epilepsy
Authors: Lancman Marcelo E. , Asconapé Jorge J. , Penry J. Kiffin
Published: October 2005

Summary: We reviewed records of 85 patients with juvenile myoclonic epilepsy (JME) for significant asymmetries in clinical seizures or the EEG. We noted asymmetries in 26 of 85 patients (30.6%). Only 2 patients had both clinical and EEG asymmetries; 12 had clinical asymmetries and 12 had EEG asymmetries exclusively. Analysis of patients with and without asymmetries showed no statistically significant differences in comparisons of sex, age at seizure onset, family history of epilepsy, seizure type, or response to treatment. The delay in diagnosis was greater in JME patients with asymmetries (9.5 years) than in JME patients with no asymmetries (7.5 years), but this difference was not statistically significant. Fourteen of the 26 patients with asymmetries (53.8%) were initially misdiagnosed as having partial seizures. Asymmetries in JME patients are not only common, but are also a frequent cause of misdiagnosis.
Stressful Life Events and with Seizure Frequency in Patients Epilepsy
Authors: Neugebauer Richard , Paik Myunghee , Hauser W. Allen , Nadel Edward , Leppik Ilo , Susser Mervyn
Published: October 2005

Summary: We tested whether unpleasant life events increased seizure occurrence in persons with epilepsy. Forty‐six subjects maintained daily diaries for 10–36 weeks in which they recorded seizures and life events. Mean age of subjects was 39 years; 78% were female; 83% had complex partial seizures (CPS). On the average, subjects reported 3.3 seizures a week. Analyses first were conducted within each subject and then in the sample overall. For each person, we tested whether seizure frequency increased within 24 h of the occurrence of unpleasant events, using Poisson regression analyses that adjusted for daily antiepileptic medication, sleep duration and quality, alcohol intake, menstrual status, and pleasant events. Rarity of events precluded analyses in 9 subjects. Events increased seizure frequency in 5 subjects (14%) (p < 0.05). Events decreased seizure frequency in 2 subjects (p < 0.05). When individual risk ratios were aggregated across subjects, unpleasant events were significantly associated with seizure increase only in men (RR = 1.67, 95% Confidence interval 1.09, 2.54). However, this finding must be interpreted with caution because of the limited number of men in the sample. In other aggregate analyses, events and seizures were not associated in subjects grouped by seizure type, age of seizure onset, current age, ethnicity, educational level, or marital status. Identification of factors that distinguish patients with and without event‐triggered seizures requires further study.
Lamotrigine in Treatment of 120 Children with Epilepsy
Authors: Schlumberger E. , Chavez F. , Palacios L. , Rey E. , Pajot N. , Dulac O.
Published: October 2005

Summary: One hundred twenty children aged 10 months to 16 years 9 months were included in three studies with lamotrigine (LTG): a single‐blind study (n = 60), a pharmacokinetic study (n = 23), and a compassionate group (n = 37). At 3 months, 11 patients had become seizure‐free and 34 had >50% decrease in seizure frequency. The best results involved absence epilepsy, Lennox‐Gastaut syndrome (LGS), and other symptomatic generalized epilepsy. Forty‐two patients were followed > 1 year, 22 for a mean of 2.2 years, and there was no significant increase in seizure frequency as compared with 3‐month follow‐up. Fourteen patients became seizure‐free for >6 months; all except 1 had generalized epilepsy. For 12 patients, treatment could be reduced to monotherapy, but for those with valproate (VPA) comedication LTG dosage had to be increased; 25% of patients with VPA monotherapy exhibited skin rash, appearing 3–18 days after starting LTG. For 4 patients, LTG could be reintroduced after VPA was withdrawn. Ten patients had ataxia and/or drowsiness and 2 had vomiting. For all other patients, tolerance was excellent.
EEG Abnormalities in Children with a First Unprovoked Seizure
Authors: Shinnar Shlomo , Kang Harriet , Berg Anne T. , Goldensohn Eli S. , Hauser W. Allen , Moshé Solomon L.
Published: October 2005

Summary: We examined EEG findings from an ongoing study of 347 children with a first unprovoked seizure. EEGs were available in 321 (93%), and 135 (42%) had an abnormal EEG. EEG abnormalities included focal spikes (n = 77), generalized spike and wave discharges (n = 28), slowing (n = 43), and nonspecific abnormalities (n = 7). Abnormal EEGs were more common in children with remote symptomatic seizures (60%) than in those with idiopathic seizures (38%) (p < 0.003), more common in partial seizures (56%) than in generalized seizures (35%) (p < 0.001), and more common in children age >3 years (52%) than in younger children (12%) (p < 0.001). Records including both awake and sleep tracings were available in 148 (46%) cases. For 122 (38%) only awake tracings and for 51 (16%) only sleep tracings were available. Fifty‐nine (40%) of the 148 patients with both an awake and asleep tracing had abnormal EEGs. Of 50 such EEGs with epileptiform abnormalities, 15 (30%) demonstrated the abnormality either only while awake (n = 8) or only while asleep (n = 7). Of 17 patients with EEG slowing, 8 showed slowing only in the awake tracing and 9 showed slowing in both the awake and asleep tracing. Children with even a single unprovoked seizure have a high incidence of EEG abnormalities. Obtaining a combined awake and sleep EEG significantly increases the yield of EEG abnormalities. In children with an idiopathic first seizure, EEG abnormalities are associated with an increased risk of seizure recurrence.
Intraictal Activation in the Neocortex: A Marker of the Epileptogenic Region
Authors: Jayakar P. , Duchowny M. , Alvarez L. , Resnick T.
Published: October 2005

Summary: During the course of a seizure, subdural recordings often show secondary areas which develop in‐dependent electrographic sequences that may outlast the primary seizure sequence. We reviewed the subdural data on 8 patients with intraictal secondarily activated foci (ISF). In 6 patients, ISFs were documented to be capable of generating independent seizures; ISF seizures occurred during the initial subdural monitoring period in 3, but became ictal generators only after excision of the primary focus in the other 3. Prominent interictal abnormalities were observed at the ISFs in 5 of 8 patients. The ISF in 1 patient correlated with the structural lesion on magnetic resonance imaging (MRI) scan. We believe that ISFs have significant epileptogenicity and should be re‐sected when possible.
Anatomic Distribution of Cortical Language Sites in the Basal Temporal Language Area in Patients with Left Temporal Lobe Epilepsy
Authors: Schäffler Leonard , Lüders Hans O. , Morris Harold H. , Wyllie Elaine
Published: October 2005

Summary: In evaluation for surgical treatment of intractable psychomotor seizures originating in the language‐dominant left mesiotemporal region, subdural grid electrodes were placed in 29 patients over the temporoparietal cortex and over the basotemporal region. In 13 patients, cortical stimulation of the basotemporal region showed interference with language processing. The most anterior border of the basotemporal language area began 1.1 cm posterior to the anterotemporal tip, and the most posterior margin of the language region was located 6.1 cm posteriorto the temporal tip. The most lateral and the most mesial border were located 1.4 and 5.9 cm, respectively, from the lateral edge of the temporal lobe. The region in which language disturbance could be elicited included the inferior temporal gyrus, the fusiform (lateral and medial occipitotemporal) gyrus, and the parahippocampal gyrus. The basotemporal area most consistently involved with language function was the fusiform gyrus (60% of affected electrodes), followed by the inferotem‐poral (30%), and the parahippocampal (10%) gyri.
Surgical Treatment for Partial Epilepsy Among Norwegian Adults
Authors: Guldvog B. , Løyning Y. , Hauglie‐Hanssen E. , Flood S. , Bjørnæs H.
Published: October 2005

Summary: We conducted a retrospective longitudinal self‐controlled study of 124 adult patients treated with resective surgery for medically uncontrolled partial epilepsy from 1949 to 1988. Approximately 65% of the patients experienced >95% reduction in seizure frequency, and 75% had worthwhile improvement of at least 75% seizure reduction. Significant reductions were noted in all major seizure types treatable with resective surgery; complex partial (CPS), simple partial (SPS), and secondarily generalized tonic‐clonic seizures (GTC) (all p < 0.05). Tissue pathology and region of resection did not provide significant information with respect to seizure outcome. EEG in the first postoperative year was an important predictor of long‐term seizure outcome (p = 0.03). One third of the temporal lobe resected patients had neurologic deficits as a consequence of the resection as compared with 14% of patients with frontal resections (p = 0.03). One third of the deficits among the temporal lobe resected patients were considerable, with possible social implications. Half of the patients with preoperative focal spike activity had a normal EEG postoperatively. One fifth of patients maintained their preoperative epileptic focus after the operation, and about one fifth displayed new foci. Approximately one fourth of the patients were free of medication for a median of 16 years postoperatively, and 60% of patients who were seizure‐free were still receiving medication. There was no operative mortality, but the late mortality, as expected, was higher than that of the general population. Two male patients (1.6%) committed suicide.
Surgical Treatment for Partial Children and Epilepsy Among Norwegian Adolescents
Authors: Guldvog B. , Løyning Y. , Hauglie‐Hanssen E. , Flood S. , Bjørnæs H.
Published: October 2005

Summary: We conducted a retrospective longitudinal self‐controlled study of 64 patients aged 4–19 years treated with resective surgery for partial epilepsy from 1952 to 1988. Approximately 60% of patients experienced >95% reduction in seizure frequency, and 70% hadworth while improvement of at least 75% reduction. Seizure relief was more frequent among patients who under‐went operation after 1978, and significant differences by time period of operation were noted for those with temporal lobe excisions and patients with normal tissue histology. The region of resection and the age at treatment did not provide significant information with respect toseizure outcome. Postresection electrocorticography(ECoG) and EEG of the first postoperative year predicted later seizure outcome. Small neurologic deficits weremore common among patients resected in the temporallobe than in patients resected in the frontal lobe. Half ofthe patients with preoperative unilateral focal activity anda third of those with bilateral focal activity had normal EEG postoperatively. One fourth had discontinued antiepileptic drug (AED) therapy. As expected, long‐termmortality was significantly higher than the mortality of the general population. Seven patients died during followup. Two male patients committed suicide.
Epilepsy and Driving: An International Perspective
Authors: Fisher Robert S. , Parsonage Maurice , Beaussart Marc , Bladin Peter , Masland Richard , Sonnen Arthur E. H. , Rémillard Guy ,   (Joint Commission on Drivers' Licensing of the International Bureau for Epilepsy and the International League Against Epilepsy)
Published: October 2005

Summary: Individuals with a history of seizures may be granted driving privileges if the risks of future seizure while driving are relatively low. Different nations have defined these risks in a wide variety of ways. Some countries, e.g., Japan, Greece, Brazil, India, and Russia, preclude driving after a single seizure. Other countries, suchas Canada and the United States, allow driving 3 months after certain types of seizures. A Joint Commission of the International Bureau for Epilepsy/International League Against Epilepsy has summarized regulations in several countries. From a consideration of med‐ical literature and existing practices, a series of proposedguidelines for driving and epilepsy is recommended. Ingeneral, these guidelines suggest use of a seizure‐free interval, generally 1–2 years but less in particular instances, to determine fitness to drive. Required physician reporting is discouraged, but physicians should report patientswhom they believe pose a danger to themselves and topublic safety. Individualized consideration should begiven to special circumstances that may modify a generaldriving prohibition. Education and information programsare necessary for medical and regulatory authorities to develop a rational approach to driving and epilepsyworldwide.
Consensus Statements, Sample Statutory Provisions, and Model Regulations Regarding Driver Licensing and Epilepsy
Authors:   American Academy of Neurology, American Epilepsy Society, and Epilepsy Foundation of America
Published: October 2005

RéSUMé:

Les representants de l'American Academy of Neurology, de l'American épilepsy Society et de l'épilepsy Foundation of America se sont reunies du 31 mai au 2 juin 1991, pour une conference de consensus sur les criteres appropries a l'attribution d'un permis de conduire chez les patients épileptiques. En utilisant des positions de consensus comme base de leur travail, ils ont mis au point des regulations types et des provisions stat‐utaires types, sur lesquelles ils se sont mis d'accord en mars 1992. Il y avait un consensus unanime, cependant, selon lequel des modifications évolutives de leur prise de position seraient vraisemblablement fondees sur l'experience et sur l'emergence de données nouvelles et plus précises. Les decisions d'autorisa‐tion de conduite devraient are faites par l'autorite gouvernementale appropriie plutôt que par le médecintraitant. Cette autorite gouvernementale devrait bénéficier d'une commission médicale consultative ou similaire, qui devrait inclure au moins un membre ayant une experience dans le traitement de l'épilepsie et des troubles episodiques de la conscience ou des fonctions motrices. Les médecins devraient bénéficier d'une immunite pour leur choix de signaler ou de ne pas signaler un patient a cette autorite. Aux Etats Unis, il y a eu un consensus selon lequel les statuts des differents états devraient etablir la structure du processus d'autorisation a la conduite, ainsi que les droits d'appel et donner au departement des vehicules a nioteur l'autorite, ainsi qu'une protection adequate contre les poursuites aux personnes impli‐quées dans ce processus. Des criteres médicaux pour le permis de conduire semblent devoir and préferentiellement etablis sous la forme de regulations ou de conseils medicaux, plutôt que d'étre fixts au niveau legidatif.
Electroencephalographic Changes During Simple Partial Seizures
Authors: Bare Mary A. , Burnstine Thomas H. , Fisher Robert S. , Lesser Ronald P.
Published: October 2005

Summary: We analyzed retrospectively the clinical and EEG data in 13 patients with simple partial seizures (SPS). All EEGs were recorded with surface electrodes with the standard 10–20 system and additional closely spaced scalp and subfrontotemporal skin electrodes. Seventy‐seven seizures were recorded. We detected electrographic correlates with SPS in 10 of 13 patients (77%) and in 47 of 77 seizures (61%). The most common ictal correlatrd relates were rhythmic theta waves or spikes. Of the SPS with EEG changes, 58% were motor, 14% were sensory, and 28% were psychic seizures. Use of additional electrodes and recording channels may account for the higher incidence of EEG changes in this study than has been reported previously in the literature.