bluuebunny/crossref_metadata_2025 huggingface dataset:
Development of the Quality of Life in Epilepsy Inventory
Authors: Devinsky Orrin , Vickrey Barbara G. , Cramer Joyce , Perrine Kenneth , Hermann Bruce , Meador Kimford , Hays Ron D.
Published: August 2005

Summary: We developed an instrument to measure health‐related quality of life (HRQOL) in epilepsy. A 99‐item inventory was constructed from the RAND 36‐Item Health Survey (generic core), with 9 additional generic items, 48 epilepsy‐targeted items, and 6 other items concerning attitudes toward epilepsy and self‐esteem. We administered the 99‐item inventory to 304 adults with epilepsy at 25 epilepsy centers. Patients and patient‐designated proxies completed the inventory and were retested 1–91 days later. A multitrait scaling analysis of these data led to retention of 86 items distributed in 17 multiitem scales (Cronbach's alpha ranged from 0.78 to 0.92). Factor analysis of the 17 multiitem scales yielded four underlying dimensions of health: an epilepsy‐targeted dimension, a cognitive factor, mental health, and physical health. Construct validity was supported by significant patient‐proxy correlations for all scales and correlations between neuropsychologic tests and self‐reported emotional and cognitive function (all p values < 0.05). There were significant negative correlations between the four factor scores derived from the HRQOL scales and neurotoxicity, systemic toxicity, and health care utilization (except for the correlation between mental health factor and health care utilization; all p values < 0.05). Patients who were seizure‐free in the preceding year reported better HRQOL for the overall score, three of the four factor scores, and 8 of the 17 scale scores than did patients with a high frequency of seizures. Relative validity analysis showed that the epilepsy‐targeted factor and three of its four component scales were more sensitive to categorization of patients by severity of seizure frequency and type than scales tapping physical health, mental health, or cognitive function. These cross‐sectional data support the reliability and validity of this measure of HRQOL in epilepsy. The addition of an epilepsy‐targeted supplement to the generic core improved the sensitivity to severity of epilepsy. The 86 items included in the field testing were supplemented by three additional items to form the Quality of Life in Epilepsy (QOLIE‐89) inventory.
Psychogenic Elaboration of Simple Partial Seizures
Authors: Kapur Jaideep , Pillai Ashok , Henry Thomas R.
Published: August 2005

Summary: Seizures that cause loss of consciousness (LOC) can be classified as epileptic or nonepileptic based on evaluation of ictal semiology and analysis of changes in EEG events, recorded with continuous scalp EEG and video monitoring. We report 3 patients who had hippocampal electrographic seizures documented with intracranial EEG recording with no accompanying scalp EEG change immediately preceding psychogenic unresponsiveness. Each patient also had complex partial seizures (CPS) originating in the hippocampus. Some individuals can have complex interactions of epileptic and nonepileptic seizures.
Wechsler Adult Intelligence Scale‐Revised in the Evaluation of Anterior Temporal Lobectomy Candidates
Authors: Hermann Bruce P. , Gold James , Pusakulich Robert , Wyler Allen R. , Randolph Christopher , Rankin Gene , Hoy Wayne
Published: August 2005

Summary: We wished to (a) determine the ability of the Wechsler Adult Intelligence Scale‐Revised (WAIS‐R) to discriminate between patients with epilepsy of left or right temporal lobe (LTLE, RTLE) origin and (b) examine the ability of Kaufman's (1990) WAIS‐R short forms to estimate actual Full‐Scale IQ (FSIQ). We administered the WAIS‐R to 215 nonretarded, left hemisphere dominant patients with invasively verified epilepsy of unilateral TL origin without lesions demonstrated by magnetic resonance imaging (MRI) (excluding mesial temporal sclerosis, MTS). LTLE (n = 106) and RTLE (n = 109) groups were compared on the WAIS‐R subtests and summary IQ scores, Verbal–Performance IQ (VIQ—PIQ) discrepancies of various magnitudes, and Verbal Comprehension (VC) and Perceptual Organization (PO) scores derived by factor analysis. The LTLE group scored significantly lower on the Vocabulary subtest, and none of the other indexes reliably distinguished LTLE from RTLE patients. The Kaufman 2, 3, and 4 subtest short forms were significant predictors of FSIQ, with the 4 subtest short form having the highest correlation and lowest error of estimate.
High‐Dose Tamoxifen in Treatment of Brain Tumors: Interaction with Antiepileptic Drugs
Authors: Rabinowicz Adrian L. , Hinton David R. , Dyck Peter , Couldwell William T.
Published: August 2005

Summary: The incidence of seizures related to primary brain tumors is 20–80%. High‐dose tamoxifen was recently reported as a novel treatment for patients with malignant gliomas who have failed standard therapies. Tamoxifen inhibits protein kinase C (PKC) in vitro and thus may regulate glioma cell growth by modulating intracellular signal transduction. We report a patient with a recurrent supratentorial pilocytic astrocytoma who had an untoward interaction between high‐dose tamoxifen therapy and phenytoin (PHT), drugs that share a common enzyme for metabolism, therefore emphasizing the need to monitor concomitant antiepileptic drug (AED) levels when high‐dose tamoxifen therapy is instituted.
Differential Impairments of Spatial Memory and Social Behavior in Two Models of Limbic Epilepsy
Authors: Letty Sandrine , Lerner‐Natoli Mireille , Rondouin Gérard
Published: August 2005

Summary: To explore memory impairments in temporal lobe epilepsy, we used two experimental models in the rats: (a) kainate‐induced status epilepticus (SE) resulting in excitotoxic damage and in later spontaneous seizures; and (b) amygdala kindling, known to induce no lesions (or only minor) and neuronal reorganization. Long‐term effects of these models on memory were investigated with a spatial learning task in a radial‐arm maze, and a social interaction test that implies degree of short‐term memory. An histological analysis was made to determine neuronal damage or loss caused by epileptic activity in brain regions that could be related to memory functions. Kainate‐induced epilepsy produced large memory deficits in animals tested 5 months after the injection. The rats showed severe lesions in amygdala and hippocampus and piriform and entorhinal cortex. Spatial memory was strongly diminished. The social memory test was severely impaired, probably due to the extent of amygdala injury, which is known to disturb social behavior. On the contrary, kindled rats showed no evident lesion in any brain region and displayed performances as good as those of controls in both tests. These experiments demonstrated that memory deficits appear to be related to the severity of neuronal damage in limbic areas, and the ability to develop seizures (permanence) is not solely responsible for these memory disturbances.
Spatial and Temporal Characteristics of Neonatal Seizures
Authors: Bye A. M. E. , Flanagan D.
Published: August 2005

Summary: Thirty‐two neonates (26 term and 6 premature) having seizures were prospectively recruited and studied. Using prolonged video/EEG monitoring, we quantified seizure variables (electrographic and clinical seizure durations, interictal periods and electrographic seizure spread) for all 1,420 seizures recorded. The effects of time and antiepileptic drug (AED) therapy were analyzed statistically. Seizures were generally frequent, with limited electrographic spread. However, some neonates had consistently longer interictal periods and 13% had mean interictal periods >60 min. Seizure variables were relatively stable over time, but they changed with AED therapy. There was a trend to decreased seizure duration, increased length of interictal periods, and decreased electrographic spread. Furthermore, there was evidence of reduced clinical features after sequential AED infusions. Seizures ceased during the monitoring period in 22 neonates. Eighty‐five percent of all seizures had no clinical manifestations. Among neonates with clear clinical correlates, clinical observations underestimated electrographic seizures in individual neonates by a mean of 54% (range 0–95%). Seizures generally had limited electrographic spread. Use of only four recording electrodes, characteristic of some portable EEG systems, underestimated seizures in 19 neonates, and missed all seizures in 2.
Seizures Involving the Supplementary Sensorimotor Area in Children: A Video‐EEG Analysis
Authors: Connolly Mary B. , Langill Lisa , Wong Peter K. H. , Farrell Kevin
Published: August 2005

Summary: Most reports of supplementary sensorimotor seizures have been of adults with medically refractory epilepsy. Typically, supplementary sensorimotor seizures have onset in childhood. We describe the electro‐clinical features in 12 children. Cases were selected from an EEG laboratory population in whom video‐EEG was performed routinely on all children. Supplementary sensorimotor seizures were diagnosed when there was bilateral tonic posturing of the upper or lower extremities, preserved consciousness, and lack of postictal confusion. Sensory auras were reported by 8 of 9 children aged >3 years who had daytime seizures. Speech arrest occurred in all patients in whom it could be assessed, and abnormal vocalization was observed in 7 children. Interictal EEGs were often normal (49% of recordings), and ictal EEG changes could be subtle. An etiology was demonstrated in only 2 children, and brain imaging studies were normal in the other 10 patients. Seizures were controlled with anti‐epileptic drugs (AEDs) in 6 of the 12 children. The clinical manifestations of supplementary sensorimotor seizures in children are similar to those reported in adults; misdiagnosis is common at all ages.
Monitoring Sodium Methohexital Distribution with [99mTc]HMPAO with Single Photon Emission Computed Tomography During Wada Test
Authors: Coubes Ph. , Baldy‐Moulinier M. , Zanca M. , Boire J. Y. , Child R. , Bourbotte G. , Frerebeau Ph.
Published: August 2005

Summary: Twenty‐five consecutive patients being considered for surgery for intractable epilepsy had intracarotid sodium methohexital procedures (ISM) as part of their evaluation. The lipophilic brain SPECT agent, [99mTc]hexamethylpropylene aminoxime (HMPAO), was administered intravenously during the procedure to determine the intracerebral distribution of methohexital. The validity of the ISM depends on consistent delivery of the anesthetizing agent to one hemisphere, including the mesial structures of the temporal lobe. To prevent post‐operative language and memory deficits, correct interpretation of the test results supposes a reliable knowledge of which regions of the brain have been anesthetized. Currently, no absolute criteria allow determination of the level and topographical extent of the anesthesia. We compared results of HMPAO‐SPECT with clinical and EEG video‐monitoring data and with results of digital subtraction angiography (DSA) performed during the test. In all patients, the effect of SM was ipsilateral cerebral hypo‐perfusion on SPECT and crossed cerebellar diaschisis. The distribution of HMPAO varied from patient to patient. The delivery of SM to mesial temporal lobe structures was not constant. Using nonparametric tests, we demonstrated a statistically significant relationship between hypoperfusion on SPECT and duration of hemiplegia but not with the duration of aphasia. Hypoperfusion on SPECT was also related to the onset and duration of drug‐induced delta activity on EEG. SPECT showed a statistically different distribution of SM in the brain from that predicted with DSA. We present our experience with HMPAO‐SPECT use for mapping the distribution of methohexital's effects during the ISM (Wada test). We confirm the results of previous studies that SPECT assessment may be an excellent way of determining the distribution of barbiturate during the examination. It in‐creases confidence in interpreting results of speech and memory testing by detecting either contralateral diffusion of the drug due to crossflow between hemispheres or in‐sufficient quantitative delivery to the homolateral hemisphere.
Epilepsy in Twentieth Century Literature
Authors: Paladin Anna Vanzan
Published: August 2005

Summary: Literature can be viewed as a mirror that reflects society's attitude toward epilepsy. This article examines how epilepsy is portrayed in selected twentieth century literary works. Although these works were written by intellectuals, they still offer an image of epilepsy as a phenomenon characterized by supernatural features.
Focal Intermittent Delta Activity in Patients with Mesiotemporal Atrophy: A Reliable Marker of the Epileptogenic Focus
Authors: Gambardella Antonio , Gotman Jean , Cendes Fernando , Andermann Frederick
Published: August 2005

Summary We attempted to determine the significance of background abnormalities and their relation with spikes and location of atrophy in 56 patients with temporal lobe epilepsy (TLE) and mesiotemporal atrophy (MTA) assessed by volumetric magnetic resonance imaging (MRI): 35 patients had unilateral (group I) and 21 had bilateral atrophy with lateralized predominance (group 11). Trains of delta waves over temporal regions were observed in >90% of patients. They lateralized with accuracy equal to that of the spikes to the site of atrophy (delta 92% or 29 of 32 patients in group I and 63% or 12 of 19 of group 11; spikes 85% or 28 of 33 of group I and 65% or 13 of 20 of group 11). Delta waves and spikes occurred together in >85% of cases. With respect to their location, a striking concordance was observed: delta activity almost always occurred ipsilateral with unilateral spiking (90% or 19 of 21 of patients with unilateral and 88% or 7 of 8 of patients with bilateral atrophy) and bilaterally independently with bilateral spiking (67% or 6 of 9 of patients in group I and 100% or 10 of 10 in group 11). Furthermore, spiking and delta activity were never in disagreement with respect to lateralization. In TLE related to MTA, delta transients are a reliable indicator of the epileptogenic focus and presumably reflect the epileptogenic process rather than the underlying structural pathology.
Language Function After Temporal Lobectomy Without Stimulation Mapping of Cortical Function
Authors: Davies Keith G. , Maxwell Robert E. , Beniak Thomas E. , Destafney Elizabeth , Fiol Miguel E.
Published: August 2005

Summary We studied 95 patients who underwent standard anterior temporal lobectomy (ATL) without stimulation mapping of language areas, using neuropsychological parameters of language function preoperatively and 1 year postoperatively [Boston Naming Test and Verbal Fluency, and the Information, Comprehension, Arithmetic, Similarities, Digit Span, and Vocabulary subtests of the Wechsler Adult Intelligence Scale (WAIS)]. Verbal IQ (VIQ), Performance IQ (PIQ), Full‐scale IQ (FSIQ), and Verbal Deviation Quotient were also evaluated, as were parameters of memory function. All patients had hemisphere dominance for language assessed by an intracarotid amytal test. Fifty‐three patients had a left dominant (LHDL) ATL with a mean extent of lateral resection of 4.8 cm, and 10 had a left ATL with right or mixed hemisphere dominance (RHDL, MDL). Thirty‐two patients had a right nondominant ATL. Seizure outcome was 57 and 59% seizure‐free for LHDH and right nondominant group, respectively, 1 year after operation. Comparison of preoperative scores showed the LHDL group to have significantly lower scores than the right nondominant group for several parameters of language function and memory. The group undergoing left dominant ATL showed no significant loss of language function postoperatively and actually showed gains in many parameters. Standard ATL without stimulation mapping of language areas and with conservative lateral resection is safe for long‐term language function. In addition, evidence shows preexisting language dysfunction in patients undergoing left dominant ATL.
Neuroprotective Effect of Ketamine Administered After Status Epilepticus Onset
Authors: Fujikawa Denson G.
Published: August 2005

Summary We investigated the neuroprotective effect of the noncompetitive N‐methyl‐d‐asparatate (NMDA) antagonist ketamine when administered after onset of lithium‐pilocarpine‐induced status epilepticus (SE). Seizures were induced in Wistar rats with lithium chloride (3 mEq/kg) and pilocarpine (PC) (30–60 mg/kg intraperitoneally, i.p.). Fifteen minutes after SE onset, either ketamine 100 mg/kg or normal saline was injected i.p., and 3 h after SE onset atropine, diazepam (DZP), and phenobarbital (PB) were administered i.p. to terminate the seizures. Twentyfour hours later, rats underwent brain perfusion‐fixation, with subsequent brain processing for light‐microscopic examination. Rats administered saline (n = 5) had neuronal damage in 24 of 25 brain regions examined. Rats administered ketamine (n = 7) had significant neuroprotection in 22 of 24 damaged regions. Ketamine reduced the amplitude of seizure discharges, and in 3 rats EEG seizur activity ceased in 30 min; none of these rats had neuronal damage. In the other 4 rats, EEG seizure discharges persisted >90 min; in these animals, 21 of 24 damaged regions were protected. In contrast, rats with 1‐h high‐dose PC‐induced SE (400 mg/kg i.p. without lithium chloride preadministration) had 14 damaged regions, of which 7 were significantly different from the undamaged regions of the ketamine subgroup with persistent electrographic seizures. Thus, ketamine is remarkably neuroprotective when administered after onset of SE, whether or not seizure discharges are eliminated.
Influence of Ethnic and Geographic Factors on the Classic Photoparoxysmal Response in the Electroencephalogram of Epilepsy Patients
Authors: de Graaf Andries S. , Lombard Carl J. , Claassen Darryl A.
Published: August 2005

Summary: The classic photoparoxysmal response (CPPR) on photic stimulation in the electroencephalogram (EEG) of 128 patients with chronic epilepsy, constituting three different ethnic groups, was investigated. All patients were referred for routine clinical EEG investigation. There was a significantly higher occurrence in whites (2.7%, 72 of 2,657) as compared with blacks (0.1%, 1 of 848) and subjects of “mixed race” (0.9%, 55 of 5,958). Interictal abnormalities and the range of responses were similar in the two main ethnic groups. There was no evidence of a seasonal association with CPPR. We conclude that genetic rather than environmental factors influence the CPPR.
Incidence of Acute Symptomatic Seizures in Rochester, Minnesota, 1935‐1984
Authors: Annegers J. F. , Hauser W. A. , Lee J. R‐J. , Rocca W. A.
Published: August 2005

Summary We determined the incidence of seizures due to acute CNS insults for residents of Rochester, Minnesota, U.S.A., from 1935 though 1984. The age‐adjusted incidence rates for 1955–1984, the period of most complete case ascertainment, was 39.0/100,000 person‐years (United States 1970 population as standard). The age‐adjusted incidence was considerably higher in men: 52.0 as compared with 29.5 in women. The 3.6% risk of experiencing an acute symptomatic seizure in an 80‐year lifespan approaches that of developing epilepsy. The major causes of acute symptomatic seizures were traumatic brain injury, cerebrovascular disease, drug withdrawal, and CNS infections. Each type of acute symptomatic seizure has age, gender, and time period patterns that reflect the occurrence of the underlying cause.
Risk Factors for a First Febrile Seizure: A Matched Case‐Control Study
Authors: Berg Anne T. , Shinnar Shlomo , Shapiro Eugene D. , Salomon Morton E. , Crain Ellen F. , Hauser W. Allen
Published: August 2005

Summary We conducted a matched casecontrol study to identify risk factors for first febrile seizures, with special emphasis on characteristics of the acute illness episode. Cases were identified through hospital emergency departments; controls were identified through outpatient clinics and emergency departments. Sixtynine children with first febrile seizures and no history of previous unprovoked seizures were matched for age (±6 months), site of routine pediatric care, and date of visit (±weeks) with 1 or 2 febrile controls who had no history of previous febrile or unprovoked seizures. Medical records for the index visit were reviewed, and parents were interviewed by telephone. Illness characteristics examined included height of temperature, type of underlying illness, contact with a physician during the illness but before the index visit, and use of acetaminophen or decongestants. Family history of febrile and of unprovoked seizures, sociodemographic characteristics, daycare use, and selected preand perinatal variables were also studied. On multivariable analysis, significant independent risk factors were height of temperature, history of febrile seizures in a firstor in a higher degree relative. Gastroenteritis as the underlying illness had a significant inverse (i.e., protective) association with febrile seizures. Maternal smoking during pregnancy was a marginally significant predictor of febrile seizures.
Ovulatory Function in Epilepsy
Authors: Cummings Lisa N. , Giudice Linda , Morrell Martha J.
Published: August 2005

Summary Women with epilepsy have lower fertility rates than women without epilepsy. We hypothesized that limbic dysfunction in temporal lobe epilepsy (TLE) alters the release of hypothalamic trophic hormones that secondarily affect release of the pituitary gonadotropins, causing ovulatory failure. We assessed ovulatory function over three consecutive menstrual cycles in 17 women with partial seizures arising from the temporal lobe (TLE), 7 women with primary generalized epilepsy (PGE), and 12 controls. We devised scores to reflect ovulatory function that were based on daily basal body tem perature and monthly serum progesterone levels. Seizure frequency, antiepileptic drugs (AEDs), and depressive symptomatology were also evaluated. Anovulation was more frequent in subjects with TLE (35.3%) than in subjects with PGE (0%) or in controls (8.3%). Anovulatory cycles tended to occur more frequently in subjects with TLE who were treated with polytherapy than in those receiving monotherapy, but this result was not statistically significant. Seizure frequency and symptoms of depression did not affect ovulatory function. Although AED polytherapy may increase the likelihood of anovulation, our results suggest a mechanism of infertility related to temporal lobe dysfunction.
Sex Hormones and Pituitary Function in Male Epileptic Patients with Altered or Normal Sexuality
Authors: Murialdo Giovanni , Galimberti Carlo Andrea , Fonzi Stefano , Manni Raffaele , Costelli Patrizia , Parodi Cristina , Solinas Gian Piero , Amoretti Guido , Tartara Amelia
Published: August 2005

Summary Male epileptic patients frequently complain of sexual dysfunction, particularly impotence and loss of libido. Epilepsy itself, antiepileptic drugs (AEDs), and psychosocial factors are believed to contribute to impaired sexuality. We studied luteinizing hormone (LH) ulsatile secretion, gonadotropin, and prolactin (PRL) esponses to LH‐releasing hormone (LHRH) and thyrotropin‐releasing hormone (TRH) in 37 adult male epileptic patients receiving AED monotherapy who were seizure‐free and had normal EEGs. Sexuality was assessed by psychological interview. Impotence was diagnosed in 8 patients (in 2 combined with loss of sexual desire). The occurrence of hyposexuality (‐20%) was independent of epilepsy syndrome or AED. No change in total testosterone (T) level was observed. Free T (ft)and dihydrotestosterone (DHT) levels were lower and sex hormone binding globulin (SHBG) levels were higher in epileptic subjects than in healthy controls, but a statistically significant difference was not observed between hypo‐ and normosexual patients. In impotent epileptic patients, estradiol (E2) levels were significantly increased as compared with those of patients with preserved sexuality and of healthy controls. The unbalanced relation between androgen and E2 levels was emphasized by decreased fT/E2, fT/E2, and DHT/E2 ratios obtained in hyposexual epileptic patients. In this group, LHRH induced blunted LH peaks. No changes were noted in LH pulsatility features. These findings of higher E2 levels and of decreased LH response to LHRH administration in some epileptic patients with impaired sexuality, may suggest they have subclinical hypogonadotropic hypogonadism.
Carbamazepine, Phenytoin, Sex Hormones, and Sexual Function in Men with Epilepsy
Authors: Isojarvi Jouko I. T. , Repo Marja , Pakarinen Arto J. , Lukkarinen Olavi , Myllylä Vilho V.
Published: August 2005

Summary We evaluated the effects of carbamazepine (CBZ) on serum androgen levels and sexual function prospectively for 5 years in 11 men with epilepsy and in 25 patients receiving either CBZ (14 patients) or phenytoin (PHT) (11) monotherapy for >5 years. Serum sex hormone binding globulin (SHBG) levels increased and free androgen index (FAI) decreased during CBZ treatment, and these changes correlated with duration of CBZ therapy. Similarly, serum SHBG levels increased and FA1 values decreased in patients receiving PHT for >5 years. CBZ and PHT increase serum SHBG levels, leading to decreased FAI. These drugrelated hormonal changes may be the primary cause of hyposexuality common in men with epilepsy.
Regional Distributions of Hippocampal Na+, K+‐ATPase, Cytochrome Oxidase, and Total Protein in Temporal Lobe Epilepsy
Authors: Brines Michael L. , Tabuteau Herriot , Sundaresan Sanjoy , Kim Jung , Spencer Dennis D. , de Lanerolle Nihal
Published: August 2005

Summary Na+, K+‐ATPase (the sodium pump) is a ubiquitous enzyme that consumes ATP to maintain an adequate neuronal transmembrane electrical potential necessary for brain function and to dissipate ionic transients. Reductions in sodium pump function augment the sensitivity of neurons to glutamate, increasing excitability and neuronal damage in vitro. Temporal lobe epilepsy (TLE) is one disease characterized by hyperexcitability and marked hippocampal neuronal losses that could depend in part, on impaired sodium pump capacity secondary to changes in sodium pump levels and/or insufficient ATP supply. To assess whether abnormalities in the sodium pump occur in this disease, we used [3H]ouabain to determine the density of Na+, K+‐ATPase for each anatomic region of hippocampus by in vitro autoradiography. Tissues were surgically obtained from epileptic patients with hippocampal sclerosis and compared with specimens from patients with seizures originating from temporal lobe tumors and autopsy controls. Changes in cellular population arising from neuronal losses or gliosis were assessed by protein densities derived from quantitative computerized densitometry of Coomassie‐stained tissue sections. We estimated regional differences in capacity for ATP generation by determining cytochrome c oxidase (CO) activity. Principal neurons of hippocampus exhibit high levels of sodium pump enzyme. Both epilepsy groups exhibited slight but significant increases in sodium pump densityhnit mass of protein in the dentate molecular layer, CA2, and subiculum as compared with autopsy controls. Greater hilar sodium pump density was also observed in sclerotic hippocampi. In contrast, CO activity was reduced in both epilepsy types throughout hippocampus. Results suggest that although sodium pump protein in surviving neurons appears to be upregulated in epilepsy, sodium pump capacity may be limited by the reduced levels of CO activity. Functional reduction in sodium pump capacity may be an important factor in hyperexcitability and neuronal death.
Changes in Learning and Memory, Acetylcholinesterase Activity and Monoamines in Brain After Chronic Carbamazepine Administration in Rats
Authors: Sudha S. , Lakshmana Madepalli K. , Pradhan N.
Published: August 2005

Summary Groups of adult male Wistar rats were administered carbamazepine (CBZ) in doses of 5, 10, 20, 40, or 80 mg/kg/day intraperitoneally (i.p.) for 21 days. The learning and memory of the rats were assessed by the T‐maze and passive avoidance tests. The CBZ plasma levels, the activity of acetylcholinesterase (AChE) in different brain regions, and the levels of monoamines in the hippocampus were also measured. None of the administered doses of CBZ impaired learning and memory. Rats with CBZ plasma levels of 2.5 and 4.5 μg/ml corresponding to the doses of 20 and 40 mg/kg, learned significantly better than controls. AChE activity was decreased in hippocampus and pyriform cortex (19%) in these groups. Simultaneously, an increase in the serotonin (5‐HT) (36%) and dopamine (137%) levels in the hippocampus was noted in the 20‐mg/kg CBZ group. 5–Hydroxyindole acetic acid (5‐HIAA) and homovanillic acid (HVA) levels were increased at 10‐, 20‐, and 40‐mg/kg CBZ doses. However, a dose of 80‐mg/kg caused no change in learning performance as compared with that of controls. Correspondingly, no changes were evident in the AChE activity or monoamine levels. We postulated that the decreased AChE activity caused by CBZ in the therapeutic range may lead to increased ACh levels in brain, thus producing improvement in learning and memory. The increased turnover of 5‐HT and dopamine (DA) in the hippocampus may play a role in long‐term potentiation and improvement in memory.
Visual Learning on a Selective Reminding Procedure and Delayed Recall in Patients with Temporal Lobe Epilepsy
Authors: Giovagnoli Anna Rita , Casazza Maria , Avanzini Guiliano
Published: August 2005

Summary: We administered a visual selective reminding procedure for the learning of designs to healthy controls and to left or right temporal lobe epilepsy (TLE) patients without demonstrable brain lesions. In comparison with the other groups, right TLE patients showed a deficit of learning characterized by an impairment in storing visual material and consistently retrieving it from long‐term memory. Patients with left TLE performed similarly to controls. These data are consistent with the hypothesis of right hippocampal involvement in the learning of nonverbal material. Delayed retrieval of learned material was similar in all the subject groups tested at long time intervals, suggesting the impairment of learning in patients with right TLE does not necessarily imply a subsequent deficit in the retrieval of stored information. This finding may agree with the opinion that distinct functional systems subserve learning and memory.
Absence Epilepsies
Authors: Loiseau Pierre , Duché Bernard , Pédespan Jean‐Michel
Published: August 2005

Summary: Individuals fulfilling diagnostic criteria for childhood absence epilepsy (CAE) and juvenile absence epilepsy (JAE) were selected from a large group of patients who were born between 1945 and 1973 and had presented with absence seizures (AS). Updated data allowed an analysis of 52 patients with CAE and of 62 patients with JAE aged ≥20 years. In CAE, complete control was achieved in 90% of patients (95%, AS only; 77%, AS + generalized tonic‐clonic seizures, GTCS). Only 16% of patients with an onset <9 years had developed GTCS. In JAE, complete control was achieved in 37% of patients (47%, AS; 37%, GTCS). These figures support the validity of the International Classification of Epilepsy (ICE). Stricter diagnostic criteria are discussed.
Gabapentin Toxicity in Children Manifesting as Behavioral Changes
Authors: Wolf Steven M. , Shinnar Shlomo , Kang Harriet , Gil Karen Ballaban , Moshé Solomon L.
Published: August 2005

Summary: Pediatric experience with gabapentin (GBP), a new antiepileptic drug (AED), is limited. We describe 3 learning disabled children, 1 aged 7 years and 2 aged 10 years, with intractable partial seizures who developed severe behavioral problems while receiving modest doses of GBP. The children became hyperactive and had explosive outbursts consisting of aggressive and oppositional behavior. The behavioral problems were sufficiently severe to require discontinuation of GBP despite moderately improved seizure control.
Case of Simple Partial Status Epilepticus in Occipital Lobe Epilepsy Misdiagnosed as Migraine: Clinical, Electrophysiological, and Magnetic Resonance Imaging Characteristics
Authors: Walker M. C. , Smith S. J. M. , Sisodiya S. M. , Shorvon S. D.
Published: August 2005

Summary: A 31–year‐old man had a unique form of occipital lobe epilepsy. Since age 13 years, he has had episodes of simple partial status epilepticus (SE) occurring twice a month. These typically consisted of elementary visual hallucinations of flashing lights obscuring his left visual field for a period of 2 days, associated with a severe frontal headache initially diagnosed as migraine. These episoaes of simple partial SE then evolved to a complex partial seizure (CPS) or secondarily eneralized seizure. There were unique EEG features, including: (a) the perception of a flash of light in the left visual field with a single sharpislow wave discharge over the right occipital lobe, (b) right occipital lobe epileptiform activity during the prolonged aura, and (c) an abnormal response to photic stimulation, with occipital lobe discharges during low rates of stimulation (3–5 Hz), time‐locked to the stimzlus. High‐resolution magnetic resonance imaging (MRI) with quantitative morphometry demonstrated that the right hemisphere and right caudate nucleus were smaller than those on the left. An abnormal gyral pattern was also noted over the right parietal region. Occasionally, distinguishing occipital lobe epilepsy from migraine may be difficult.
Propofol in Prehospital Treatment of Convulsive Status Epilepticus
Authors: Kuisma Markku , Roine Risto O.
Published: August 2005

Summary: We studied the safety and efficacy of intravenous propofol in the out–of–hospital treatment of convulsive status epilepticus (SE) in 8 patients (age 29–70 years), 4 of them with posttraumatic epilepsy. Four patients had no history of seizures. Convulsions ceased promptly after patients received a bolus of 100–200 mg propofol administered before hospital admission by staff of a mobile intensive care unit (ICU). The median duration of coma was 3 h 15 min (range 2–41 h), and the median duration of hospital treatment was 3 1/2 days (range 12 h to 23 days). Only 1 patient was admitted to the hospital's ICU. No adverse effects were observed except for a transient decrease in systolic blood pressure (SBP). Propofol may be a useful drug for the prehospital treatment of recurrent seizures not responding to intravenous diazepam (DZP).
Neonatal Caffeine Exposure and Seizure Susceptibility in Adult Rats
Authors: Guillet Ronnie , Dunham Lynn
Published: August 2005

Summary: Early developmental exposure to caffeine in rats results in changes in brain excitability that persist to adulthood. The mechanism of these alterations is un‐ known. To identify potential neurotransmitter systems involved, we exposed neonatal rats to caffeine and determined seizure thresholds for chemoconvulsants active at different CNS receptors in the adult animal. Rats were unhandled (NH) or received by gavage (0.05 m1/10 g) either vehicle (water) or caffeine (15–20 mg/kg/day) for postnatal days 2–6.At age 70–90 days, each rat was infused intravenously (i.v.) with picrotoxin (PIC), bicucul‐line (BIC) [convulsants acting at the γ‐aminobutyric acid/ benzodiazepine (GABA/BDZ) receptor], pentylenetetra‐zol [PTZ, possibly acting at both GABA/BDZ and N‐methyl‐D‐aspartate (NMDA) receptors], caffeine (acting at adenosine receptors), strychnine (STR, acting at glycine receptors), or kainic acid (KA, acting at the NMDA receptor).Seizure thresholds were analyzed as a function of neonatal treatment and sex. Thresholds for caffeine, PTZ, PIC, and KA were increased as a function of neonatal caffeine exposure (p = 0.01, 0.02, 0.02, and 0.005, respectively).The thresholds for BIC and STR were not altered. There were also gender differences in seizure susceptibility. Thresholds for seizures produced by BIC, caffeine, PIC, and STR were higher in females (p = 0.005, 0.0005, 0.0001, and 0.0001, respectively), but were not different for seizures caused by PTZ. These results suggest that early developmental exposure to caffeine affects later seizure susceptibility. Moreover, some of these effects are gender specific.
Seizures Induced by Homocysteine in Rats During Ontogenesis
Authors: Kubová H. , Folbergrová J. , Mareš P.
Published: August 2005

Summary: We studied the convulsant action of homocysteine in 211 immature and adult Wistar albino rats. Homocysteine elicited minimal, predominantly clonic, and major generalized tonic‐clonic seizures at six different developmental stages, from 7 days to adulthood. Nevertheless, some age‐dependent differences in the seizure pattern were apparent. Minimal seizures in immature rats lasted ≤20 min, thus representing an epileptic status, whereas in adult animals these seizures were much shorter, lasting only ≥40 s. In addition, flexion seizures were observed in 7‐and 12‐day‐old rats, only rarely in 15‐and 18‐day‐old animals, and never in the 25‐day‐old and adult rats. ECoG recordings demonstrated a nearly iso‐electric pattern during homocysteine‐induced seizures in 7‐and 12‐day‐old rat pups. In older rats, spikes or sharp waves were recorded, but precise electroclinical correlations were poor. The greater sensitivity of younger animals to kainic acid (KA) and N‐methyl‐D‐aspartate (NMDA), as reported previously, was not evident in the case of homocysteine‐induced seizures. This observation, together with a different behavioral pattern, suggests that homocysteine cannot be considered a simple agonist of the kainate or NMDA type of excitatory amino acid receptors. The exact mechanism of the convulsant action of homocysteine, both during development and in adulthood, remains to be clarified.
Kindling Increases the Sensitivity of Rats to Adverse Effects of Certain Antiepileptic Drugs
Authors: Hönack Dagmar , Löscher Wolfgang
Published: August 2005

Summary: Development of novel antiepileptic drugs (AEDs) requires determining the margin between the desired anticonvulsant effect and undesired adverse effects (AE) (therapeutic index).For this purpose, drug‐induced “minimal neurological deficits” (e.g., motor dysfunctions) are commonly quantified by simple tests, such as the rotarod test, in normal, i.e., nonepileptic animals. However, increasing evidence shows that chronic brain dysfunction associated with epilepsy may increase susceptibility to the AE of certain AEDs, e.g., N‐methyl‐D‐aspartate (NMDA) receptor antagonists. The increased. AE potential of such investigational drugs can be predicted by using kindled rats instead of normal rodents in preclinical drug evaluation studies. In the present experiments, we wished to determine whether kindled rats also exhibit an altered susceptibility to neurological adverse effects of standard AEDs, i.e., carbamazepine (CBZ), phenobarbital (PB), valproate (VPA), and diazepam (DZP). Abecarnil, a novel benzodiazepine (BZD) receptor agonist, was included in the study for comparison. All drugs were administered in diverse doses in kindled and nonkindled rats, and all behavioral alterations were scored in the cage and open field. Furthermore, the rotarod test was used to detect and quantify motor impairment induced by drug treatments. Kindled rats were more susceptible than nonkindled rats to motor impairment (ataxia and/or rotarod failures) induced by high doses of AEDs, although differences were noted between the drugs tested. VPA was the only drug that induced stereotyped behavior; it was much more potent in this respect in kindled than nonkindled rats. Abecarnil did not differ substantially in its AE in either subgroup of animals. Our data indicate that epileptogenesis induced by kindling renders the brain more susceptible to certain AE of AEDs. To avoid overestimation of the therapeutic index, models such as kindling should be used during preclinical evaluation of new AEDs.
Panic Attacks as Ictal Manifestations of Parietal Lobe Seizures
Authors: Alemayehu Shimellis , Bergey Gregory K. , Barry Elizabeth , Krumholz Allan , Wolf Aizik , Fleming Cynthia Pam , Frear Edward J.
Published: August 2005

Summary: Although most panic attacks appear to be primary psychiatric disturbances, some evidence suggests a biologic basis for panic disorder, possibly associated with temporal lobe dysfunction. Fear is a common affective change associated with some complex partial seizures (CPS) originating from the right temporal lobe. We describe a previously unreported association between panic attacks and seizures originating from the parietal lobe in 2 patients with right parietal lobe tumors. Intracranial monitoring documented correlations between the symptoms of fear and restricted regional parietal cortical discharges. Surgical resections of the lesions (one total, one subtotal) resulted in complete recovery or improvement.
MDR1 Gene Expression in Brain of Patients with Medically Intractable Epilepsy
Authors: Tishler David M. , Weinberg Kenneth I. , Hinton David R. , Barbaro Nicholas , Annett Geralyn M. , Raffel Corey
Published: August 2005

Summary: Why some patients with seizures are successfully treated with antiepileptic drugs (AEDs) and others prove medically intractable is not known. Inadequate intraparenchymal drug concentration is a possible mechanism of resistance to AEDs. The multiple drug resistance gene (MDRI) encodes P‐glycoprotein, an energy‐dependent efflux pump that exports planar hydrophobic molecules from the cell. If P‐glycoprotein is expressed in brain of some patients with intractable epilepsy and AEDs are exported by P‐glycoprotein, lower intraparenchymal drug concentrations could contribute to lack of drug response in such patients. Eleven of 19 brain specimens removed from patients during operation for intractable epilepsy had MDR1 mRNA levels > 10 times greater than those in normal brain, as determined by quantitative reverse transcriptase‐polymerase chain reaction (RT‐PCR) method. Immunohistochemistry for P‐glycoprotein from 14 of the patients showed increased staining in capillary endothelium in samples from epileptic patients as compared with staining in normal brain samples. In epileptic brain specimens with high MDR1 mRNA levels, expression of P‐glycoprotein in astrocytes also was identified. Last, steady‐state intracellular phenytoin (PHT) concentrations in MDR1 expressing neuroectodermal cells was one fourth that in MDR1‐negative cells. MDR1 expression is increased in brain of some patients with medically intractable epilepsy, suggesting that the patients’ lack of response to medication may be caused by inadequate accumulation of AED in brain.
Successful Epilepsy Surgery Without Intracranial EEG Recording: Criteria for Patient Selection
Authors: Thadani V. M. , Williamson P. D. , Berger R. , Spencer S. S. , Spencer D. D. , Novelly R. A. , Sass K. J. , Kim J. H. , Mattson R. H.
Published: August 2005

Summary: Twenty‐two patients with intractable complex partial seizures (CPS) were treated with temporal lobectomy. Eighteen of 22 (82%) are seizure‐free while receiving medication, with a mean follow‐up time of 4 years. In each case, the clinical seizure pattern, interictal and ictal scalp EEG, magnetic resonance imaging (MRI), neuropsychological testing, and results of the intracarotid amobarbital procedure (IAP) converged to indicate a localized abnormality. None of the patients in this series had mass lesions, vascular malformations, or cortical scars, but 18 of 22 had hippocampal atrophy on MRI and 20 had hippocampal sclerosis (HS) on pathologic examination. We believe it is possible, on the basis of the preoperative evaluation described, to identify a population of epileptic patients who will do very well postoperatively. Such patients do not require invasive EEG monitoring, and they represent ∼20% of the patients treated surgically in our epilepsy unit in the past several years.
Surgical Treatment of an Early Epileptic Encephalopathy with Suppression‐Bursts and Focal Cortical Dysplasia
Authors: Pedespan J. M. , Loiseau H. , Vital A. , Marchal C. , Fontan D. , Rougier A.
Published: August 2005

Summary: A case of early epileptic encephalopathy (EIEE) with suppression‐bursts or Ohtahara's syndrome, associated with focal cortical dysplasia is reported. Infantile spasms and brief tonic unilateral seizures began on the fifth day of life. Interictal EEG demonstrated an asymmetrical “suppression‐burst” pattern with no wake or sleep cycling. Seizures were refractory to all antiepileptic drug (AED) and steroid therapy. Magnetic resonance imaging (MRI) showed right frontotemporal cortical thickening. After three weeks of an ineffective medical treatment a preoperative evaluation with single photon emission computed tomography (SPECT) and electrocorticography (ECoG) was performed to characterize epileptogenic focus. Surgical resection of the precentral area was performed at age 1 month. Neuropathologic examinations confirmed diagnosis of focal cortical dysplasia by identifying cytoarchitectural disarray and ectopic neurons located deep in subcortical white matter. During follow‐up, 1‐year postoperative the child had a single febrile seizure. Neurologic examination showed minor developmental delay and slight left‐sided weak ness.
Occipital Paroxysmal Discharges Suppressed By Eye Opening: Variability in Clinical and Seizure Manifestations in Childhood
Authors: Maher John , Ronen Gabriel M. , Ogunyemi Abayomi O. , Goulden Keith J.
Published: August 2005

Summary: The EEG in childhood epilepsy with occipital paroxysms (CEOP) was termed “distinctive” by Gastaut (1985) and Talwar et al. (1992) and “characteristic” by Herranz Tanarro et al. (1984), which suggests that the EEG is specific and diagnostic for CEOP. However, this hypothesis has been challenged (Newton and Aicardi, 1983; Beaumanoir and Grandjean, 1987). To test this, we reviewed 5,291 EEG reports made in 51/2 years in the only tertiary pediatric center in Newfoundland and Labrador. We identified 31 children who had one or more EEGs with occipital spike/sharp waves showing suppression of discharges with eye opening and normal background activity. Six had CEOP, 17 had benign nocturnal childhood occipital epilepsy, 5 had symptomatic epilepsy, 3 had unusual complex partial seizures (CPS), 4 had only provoked seizures, and 2 had no definite seizures. Overlap between seizure types was common. The EEG criteria for CEOP are not very specific.
Lesion Localization in Periodic Lateralized Epileptiform Discharges: Gray or White Matter
Authors: Raroque Henry G. , Purdy Phillip
Published: August 2005

Summary: We analyzed the results of neuroimaging studies in patients with periodic lateralized epileptiform discharges (PLEDs) or bilateral independent periodic lateralized epileptiform discharges (BIPLEDs) for localization of lesions in gray or white matter to determine if “cortical isolation” is a critical mechanism in the pathogenesis of this phenomena. We assessed 32 patients who had undergone computed tomography (CT) exclusively and 8 patients who had undergone magnetic resonance imaging (MRI) with or without CT. The superior resolution necessary for adequate lesion localization allowed use of only the MRI scans from the 8 patients. Six patients had scans with cortical and subcortical gray and white matter lesions, and 1 patient had a cortical gray matter lesion only. One patient had an indeterminate scan. No patient had white matter lesions only. Our findings in patients with PLEDs and BIPLEDs correlate with postmortem data in patients with generalized periodic EEG patterns that show consistent localization of lesions in the gray matter. These findings do not support cortical isolation as the critical or sole mechanism in PLEDs or BIPLEDs.