bluuebunny/crossref_metadata_2025 huggingface dataset:
Characteristics of people providing family placements to adult persons with intellectual disabilities
Authors: McConkey Roy , McConaghie Jayne , Roberts Paul , King Diana
Published: August 2005

The success of family placement schemes depends largely on the recruitment of suitable people who are willing to offer placements in their own home yet little research has been undertaken of their characteristics and the reasons for their involvement. Thirty providers of family based placements to adult persons with intellectual disabilities were individually interviewed. All but one were female; two‐thirds were aged 50 plus and just over one‐third were in employment. The majority of providers have been recruited from the care sector and many had experience of people with intellectual disabilities. Most had come into the schemes because of their personal interest in this client group. No one came solely as a result of seeing an advertisement and only one person explicitly mentioned the financial reimbursement. Over half had been involved for 3 years and more. All felt they gained a great deal of satisfaction and enjoyment from their involvement but stressed the amount of commitment needed to become a provider. The placement providers overall were very satisfied with the way the schemes operated. The main complaint appeared to be in regard to the low payments. Proposals are made for the future development of family placement schemes particularly in the recruitment of providers.
Description and evaluation of a bereavement group for people with learning disabilities
Authors: Mappin Rachel , Hanlon Derek
Published: August 2005

The present study evaluates the effect of a bereavement group for six people with learning disabilities. There was a significant increase in knowledge of the more ‘concrete’ aspects of death and dying and in participants’ awareness of emotional, behavioural and physiological responses associated with grief, as measured by the Knowledge About Death and Understanding Emotions Questionnaires, respectively. There was a small, albeit nonsignificant, trend towards increased understanding of the components of the death concept, as measured by the Death Concept Questionnaire. The study's outcome and its implications are discussed.
Violence against pregnant women: prevalence and characteristics. A population‐based study in Nicaragua
Authors: Valladares Eliette , Peña Rodolfo , Persson Lars Åke , Högberg Ulf
Published: August 2005

Objective  This study aims to estimate the prevalence and characteristics of partner abuse during pregnancy as well as to investigate associated social factors in León, Nicaragua.

Design  Cross‐sectional community‐based study.

Setting  All pregnant women from 50 randomly selected geographical clusters out of 208 in the municipality of León, Nicaragua.

Sample  A total of 478 pregnant women were included; only one woman refused to participate.

Method  The domestic violence questionnaire from the WHO‐co‐ordinated Multi‐Country Study on Women's Health and Life Events was used with each participant being interviewed twice during pregnancy.

Main outcome measures  Prevalence and characteristics of partner violence during pregnancy.

Results  The prevalence of emotional, physical and sexual abuse during pregnancy was 32.4%, 13.4% and 6.7%, respectively. Seventeen percent reported experience of all three forms of violence. Two‐thirds of the victims reported repeated abuse. Half of the abused women had experienced punches and kicks directed towards the abdomen and 93% had been injured. Most women had not sought health care in relation to the abuse, but those who did were usually hospitalised. Factors such as women's age below 20 years, poor access to social resources and high levels of emotional distress were independently associated with violence during pregnancy.

Conclusion  Violence against pregnant women in Nicaragua is common and often repeated. Although these women have poor access to social resources and high levels of emotional distress, they are rarely assisted by the health services. Innovative strategies are needed to provide support and counselling.
Fecundity and pregnancy outcome in a cohort with sickle cell‐haemoglobin C disease followed from birth
Authors: Serjeant Graham R. , Hambleton Ian , Thame Minerva
Published: August 2005

Objective  To compare pregnancy outcome in sickle cell‐haemoglobin C (SC) disease with that in homozygous sickle cell (SS) disease and age‐matched controls with a normal haemoglobin (AA) genotype.

Design  A cohort study followed from birth.

Setting  Sickle Cell Clinic, University Hospital and other Jamaican hospitals.

Population  Ninety‐five pregnancies in 43 patients with SC disease, 94 pregnancies in 52 patients with SS disease and 157 pregnancies in 68 controls.

Methods  Systematic review of all pregnancies occurring in sample population. Kaplan–Meier analysis for interval to first pregnancy, and the t test, χ2 test or Fisher's exact test as appropriate; correction was made for multiple testing and multiple linear regression was used for analysis of determinants of birthweight.

Main outcome measures  Age at menarche, interval to first pregnancy, outcome of pregnancy, maternal complications and possible predictors of low birthweight.

Results  Menarche was marginally delayed in SC disease compared with AA controls (median age 13.7 vs 13.0 years, P= 0.02) but age at first pregnancy was similar (median age 22.5 vs 20.1 years, P= 0.32). Pregnancy outcome in SC disease did not differ from AA controls but compared with SS disease there were marginally fewer miscarriages, more live deliveries and greater birthweight. The prevalence of pregnancy‐induced hypertension, pre‐eclampsia, antepartum or postpartum haemorrhage in SC disease did not differ from AA controls but the prevalence of sickle‐related complications was similar to SS disease.

Conclusions  Contrary to some claims, pregnancy outcome in SC disease is generally benign compared with SS disease.
Why are women still aborting outside designated facilities in metropolitan South Africa?
Authors: Jewkes Rachel K. , Gumede Tebogo , Westaway Margaret S. , Dickson Kim , Brown Heather , Rees Helen
Published: August 2005

Objective  To explore why South African women still abort outside designated services where there is substantial legal service provision.

Design  Descriptive study.

Setting  Three hospitals in Gauteng Province in South Africa.

Sample  Forty‐six women attending hospital with incomplete abortion who had abortions induced outside of designated facilities.

Methods  An interviewer‐administered questionnaire with open and closed questions was completed. Induction status was determined from answers to a set of closed questions. Open‐ended questions explored the circumstances of induction.

Main focus of interviews  Methods of induction used, barriers to legal service use.

Results  Nearly two‐thirds of women (n= 38) had self‐induced or had consulted a traditional healer. A minority of these women (n= 11) indicated that they did this because they experienced barriers to legal service use. For others it was presented as a ‘natural’ response to a health problem (unwanted pregnancy). Several women (n= 10) were given misoprostol by a doctor, nurse, or pharmacist. Fifty‐four percent of the women had not used legal services because they did not know about the law, while 15% knew of their legal rights, but did not know of a legal facility. Others did know where to access legal services but feared rude staff (17%) or breaches of confidentiality (6.5%). Others (6.5%) had been unable to get a legal abortion early enough in pregnancy to comply with the law.

Conclusions  Lack of information on abortion rights under the Act and perceived poor quality of designated facilities were the most important barriers to access and should be addressed by policymakers and health service management. The willingness of women to self‐medicate and visit traditional healers in these circumstances may influence the overall ability of the new legislation to reduce abortion morbidity.
A randomised controlled trial of empowerment training for Chinese abused pregnant women in Hong Kong
Authors: Tiwari A. , Leung W.C. , Leung T.W. , Humphreys J. , Parker B. , Ho P.C.
Published: August 2005

Objective  To evaluate the effectiveness of an empowerment intervention in reducing intimate partner violence (IPV) and improving health status.

Design  Randomised controlled trial.

Setting  Antenatal clinic in a public hospital in Hong Kong.

Sample  One hundred and ten Chinese pregnant women with a history of abuse by their intimate partners.

Methods  Women were randomised to the experimental or control group. Experimental group women received empowerment training specially designed for Chinese abused pregnant women while the control group women received standard care for abused women. Data were collected at study entry and six weeks postnatal.

Main outcomes measures  IPV [on the Conflict Tactics Scale (CTS)], health‐related quality of life (SF‐36) and postnatal depression [Edinburgh Postnatal Depression Scale (EPDS)].

Results  Following the training, the experimental group had significantly higher physical functioning and had significantly improved role limitation due to physical problems and emotional problems. They also reported less psychological (but not sexual) abuse, minor (but not severe) physical violence and had significantly lower postnatal depression scores. However, they reported more bodily pain.

Conclusion  An empowerment intervention specially designed for Chinese abused pregnant women was effective in reducing IPV and improving the health status of the women.
SHORT COMMUNICATION: Mental health screening in women with genital tract fistulae
Authors: Goh Judith T.W. , Sloane Kate M. , Krause Hannah G. , Browning Andrew , Akhter Sayeba
Published: August 2005

There is little information regarding the mental health status of women with genital tract fistulae in developing countries. The aim of this prospective observational study was to screen women at Dhaka Medical College Hospital, Bangladesh (December 2003 to June 2004), and Addis Ababa Fistula Hospital, Ethiopia (June to July 2004), with genital tract fistula for mental health dysfunction. Women presenting to the above institutions were screened using the General Health Questionnaire (GHQ‐28) prior to fistula surgery. As the women were illiterate, the questionnaire was completed with the assistance of a medical officer, nurse or interpreter. The female staff members acted as controls. Sixty‐eight women with fistulae and 28 controls completed the GHQ‐28. Sixty‐six of the 68 women with fistulae screened positive to probable mental health dysfunction compared with 9 of the 28 controls. We conclude that women with genital tract fistula are at high risk of mental health dysfunction. If the high rates of positive screening are confirmed on psychiatric evaluation, then the management of women with genital tract fistulas must include routine psychological/psychiatric assessment and treatment.
REVIEW: Current strategies for the reduction of maternal mortality
Authors: Bullough Colin , Meda Nicolas , Makowiecka Krystyna , Ronsmans Carine , Achadi Endang L. , Hussein Julia
Published: August 2005

The purpose of this article is to review current strategies for the reduction of maternal mortality and the evidence pertinent to these strategies. Historical, contextual and current literature were examined to identify the evidence base upon which recommendations on current strategies to reduce maternal mortality are made. Current safe motherhood strategies are designed based mostly on low grade evidence which is historical and observational, as well as on experience and a process of deductive reasoning. Safe motherhood strategies are complex public health approaches which are different from single clinical interventions. The approach to evidence used for clinical decision making needs to be reconsidered to fit with the practicalities of research on the effectiveness of strategies at the population level. It is unlikely that any single strategy will be optimal for different situations. Strengthening of the knowledge base on the effectiveness of public health strategies to reduce maternal mortality is urgently required but will need concerted action and international commitment.
A randomised controlled trial of 6 and 12 hourly administration of vaginal misoprostol for second trimester pregnancy termination
Authors: Herabutya Yongyoth , Chanrachakul Boonsri , Punyavachira Piyaporn
Published: August 2005

Objective  To compare the effectiveness of vaginal misoprostol administered 6 or 12 hourly for second trimester pregnancy termination.

Design  A randomised controlled trial.

Setting  University teaching hospital.

Sample  Two hundred and seventy‐nine pregnant women at gestations between 14 and 26 weeks undergoing pregnancy termination.

Methods  Women were randomised to receive 600‐μg misoprostol tablets vaginally either every 6 hours or every 12 hours until abortion occurred.

Main outcome measures  Induction–abortion interval, success rate within 24 and 48 hours and adverse effects.

Results  There was no significant difference in the median induction to abortion interval 6 hours (16 hours) and 12 hours (16 hours; P= 0.80). The total dose of misoprostol was higher in the 6‐hour group (1800 vs 1200 μg). The cumulative abortion rates within 24 hours were 74% and 67% and within 48 hours 94% and 92%, in the 6‐ and 12‐hour groups, respectively. Fever was more common in the 6‐hour group (53%) versus the 12‐hour group (31%; P < 0.001). The incidence of nausea, vomiting, diarrhoea, severe bleeding and abdominal pain were similar.

Conclusions  Misoprostol (600 μg) administered at 12‐hour intervals was associated with fewer adverse effects and was as effective as a 6‐hour interval.
Prevalence of Epilepsy in Adults in Northern Sweden
Authors: Forsgren Lars
Published: August 2005

Summary: A multisource medical register review identified persons with active epilepsy in northern Sweden. Seven hundred thirteen persons aged ≥17 years with epilepsy were determined on the prevalence day, December 31, 1985. The overall prevalence was 553 in 100,000 (566 in 100,000 if adjusted to the 1980 U.S. population). The ratio of males to females was 1.1, with a male prevalence of 575 and a female prevalence of 530 in 100,000. Age‐specific prevalences varied between 530–644 in 100,000 except in persons aged ≥70 years, for whom the prevalence was 321 in 100,000. Partial seizures were most common, 333 in 100,000, of whom the majority (250 in 100,000) had seizures that occasionally were secondarily generalized. Mental retardation was the foremost coexistent disorder, noted in 23%. The mean yearly seizure frequency was higher in persons with mental retardation than in nonretarded persons. Seventeen percent had seizures during the last week, 57% during the last year, whereas 16% had ≥5 years' freedom from seizures. Most had onset of epilepsy before age 20 years. A presumed etiology was noted in 35%, more often in men than in women. Cerebrovascular disease was the most commonly identified presumed cause. Other nonepileptic diseases/disabilities were noted in 47%.
Public Attitudes Toward Epilepsy in Denmark
Authors: Jensen Rigmor , Dam Mogens
Published: August 2005

Summary: Social acceptance of persons with epilepsy very often constitutes a considerable problem for patients and their relatives. Nationwide opinion polls on the knowledge of and public attitude toward epilepsy have been taken in several countries, but never in Denmark. We report a Gallup survey of the general knowledge of and attitude toward epilepsy. A representative population of 1,500 persons aged ≥15 years was selected in a four‐state proportional sampling procedure. Ninety‐seven percent of respondents had heard or read about epilepsy, 60% of these knew a person with epilepsy, and 50% had seen an epileptic seizure. The attitudes toward social acceptance and employment of persons with epilepsy were generally favorable, but 7% had objections to social contact between their children and persons with epilepsy in the playground and at school and 7% had objections to equal employment. Familiarity with persons with epilepsy was correlated to questions about attitudes and general knowledge of epilepsy. Such knowledge and public attitude in Denmark are mainly positive, but we believe that a continuous information campaign about epilepsy is essential, especially among youth.
The Natural History of Untreated Epilepsy in a Rural Community in Africa
Authors: Watts Anne E.
Published: August 2005

Summary: The duration of epilepsy was evaluated in over 460 previously untreated patients who attended newly established epilepsy clinics in a rural area of Malawi. The mean duration at first attendance was 6.5 years. It was found that as the duration of active epilepsy increased, the number of patients having epilepsy of a given duration decreased. Possible explanations for this result, such as an increasing incidence of epilepsy or a high mortality rate, are considered, but thought to be unlikely. Since the distribution of patients with epilepsy of differing durations is similar to that described in a study carried out in Tonbridge, Kent, England, where the number of patients in remission was found to increase over time, it is postulated that the observed distribution also reflects remission, and that spontaneous remission of epilepsy is a frequent occurrence, independent of antiepileptic drug treatment.
EEG and Seizures in Children with Hemolytic–Uremic Syndrome
Authors: Dhuna A. , Pascual‐Leone A. , Talwar D. , Torres F.
Published: August 2005

Summary: The EEG results of 11 children, ages 1–15 years, who presented with hemolytic‐uremic syndrome complicated by seizures 3–10 days after the prodrome were studied. In four children who experienced generalized tonic‐clonic seizures, the EEGs demonstrated diffuse delta slowing with no focality. All recovered without neurological deficits or a residual seizure disorder. Of seven children who experienced partial seizures, six had structural lesions on cranial computed tomography and residual focal neurological deficits with epilepsy. The EEGs in two patients revealed focal spikes and slowing consistent with the lateralization of the partial seizures, in four it was characterized by atypical “burst suppression,” and in one showed epochs of high‐amplitude delta slowing alternating with generalized suppression. Although episodic and generalized burst suppression is usually regarded as a grave prognostic indicator, all four subjects recovered.
Lack of Pathologic Changes in Human Temporal Lobes After Transcranial Magnetic Stimulation
Authors: Gates John R. , Dhuna Anil , Pascual‐Leone Alvaro
Published: August 2005

Summary: Most animal studies have failed to demonstrate pathologic changes in the brain after transcranial magnetic stimulation (TMS). Nevertheless, vacuolar lesions in the cortex of rats after TMS have been reported. We report the first histopathologic studies of human brains after TMS in 2 patients with epilepsy who underwent temporal lobectomies. They had been involved in a study to determine the speech‐dominant hemisphere by TMS and had received ∼2,000 stimuli centered over the resected temporal lobe. Histologic study of the surgical specimens did not show any lesions attributable to TMS in these 2 patients.
Compulsive Somatosensory Self‐Stimulation Inducing Epileptic Seizures
Authors: Guerrini Renzo , Genton Pierre , Dravet Charlotte , Viallat Danielle , Bureau Michelle , Horton Elizabeth J. , Roger Joseph
Published: August 2005

Summary: Three children who had been diagnosed as having infantile spasms with major psychomotor retardation were referred for the persistence of series of spasm‐like seizures, which were resistant to antiepileptic drug treatment, beyond infancy. Serial seizures were elicited by a compulsive self‐stimulating behavior that was documented by long‐term video‐polygraphy. These behaviors implicated proprioceptive inputs: tapping on the chin in one case, flexion and external rotation of the leg with dislocation of the femur in one case, a particular posturing of the body followed by rhythmic shaking of the head in the last case. This clinical picture seems to constitute a particular type of outcome for infantile spasms and is particularly resistant to therapy.
Neurosurgical Treatment of Refractory Status Epilepticus
Authors: Gorman David G. , Shields W. Donald , Shewmon D. Alan , Chugani Harry T. , Finkel Richard , Comair Youssef G. , Peacock Warwick J.
Published: August 2005

Summary: Refractory status epilepticus (RSE) is defined as status epilepticus that continues despite aggressive treatment. A 9.8‐year‐old boy with a past history of daily left focal motor seizures was transferred to University of California at Los Angeles (UCLA) Hospital in pentobarbital coma after 4 days in RSE. The RSE was treated with very high doses of all appropriate antiepileptic drugs (AEDs), alone and in combination. The pentobarbital was titrated to burst suppression on EEG, but whenever pentobarbital was decreased, the seizures recurred. An ictal positron tomography scan of glucose metabolism demonstrated a right frontal area of hypermetabolism corresponding to an epileptic focus on EEG and magnetic resonance lesion. Eight days after the boy was admitted to UCLA, the right frontal focus was surgically removed, with immediate control of the status epilepticus. Whereas before onset of RSE, he had daily focal seizures, the boy has been seizure‐free postoperatively for > 1 year. Operative treatment should be considered in patients with RSE in whom a focus of seizure onset can be demonstrated and who are reasonably considered surgical candidates.
A Neuropharmacological Evaluation of Felbamate as a Novel Anticonvulsant
Authors: White H. Steve , Wolf Harold H. , Swinyard Ewart A. , Skeen Gwendolyn A. , Sofia R. Duane
Published: August 2005

Summary: Felbamate (2‐phenyl‐1,3‐propanediol dicarbamate, FBM) was subjected to a series of carefully selected in vivo and in vitro tests to provide additional insight into mechanism of action, margin of safety, and clinical potential. FBM was effective against intracere broventricular (i.c.v.) N‐methyl‐D‐aspartate (NMDA)‐induced clonus and i.c.v. NMDA‐ and quisqualic acid (quis)‐induced forelimb tonic extension in mice and ineffective against i.c.v. quis‐induced clonus in mice. FBM was also effective in preventing the expression of Stage 5 kindled seizures in corneal‐kindled rats. The calculated protective indices (rotorod median toxic dose divided by anticonvulsant median effective dose) ranged from 28 to 146 for those tests in which FBM displayed activity. With the in vitro tests, FBM did not significantly displace [3H]MK‐801 from its binding site. In contrast, FBM was effective in blocking sustained repetitive firing in mouse spinal cord neurons grown in tissue culture (median inhibitory concentration 67 μg/ml). This effect on repetitive firing suggests indirectly that FBM modulates sodium channel conductance. The results, when compared to similar data for phenytoin, carbamazepine, valproate, and ethosuximide, support the concept that FBM is a relatively nontoxic agent with a unique profile of anticonvulsant action, a broad margin of safety, and a clinical potential that includes at least generalized tonic‐clonic and complex partial seizures.
N‐Methyl‐d‐Aspartate Injection Into the Massa Intermedia Facilitates Development of Limbic Kindling in Rats
Authors: Hirayasu Y. , Wada J. A.
Published: August 2005

The effect on limbic kindling of N‐methyl‐D‐ aspartate (NMDA) injection into the midline thalamus of rats was investigated. Repeated injection of 25 nmol/0.5 pl NMDA (experimental group) into the massa intermedia (MI), particularly into the reuniens nucleus, caused tonic and/or clonic generalized convulsion associated with temporal limbic EEG seizure discharge. This did not occur after injection of phosphate‐buffered saline (PBS, control group). When the animals were subjected to sub‐sequent kindling at either the hippocampus (HP) or the amygdala (AM), only the experimental group showed a significant facilitation of kindling rate. The results suggest that an NMDA receptor in the reuniens nucleus participates in modulation of temporal limbic excitability and seizure development.
Prevalence and Incidence of Epilepsy in Ulanga, a Rural Tanzanian District: A Community‐Based Study
Authors: Rwiza H. T. , Kilonzo G. P. , Haule J. , Matuja W. B. P. , Mteza I. , Mbena P. , Kilima P. M. , Mwaluko G. , Mwang'ombola R. , Mwaijande F. , Rweyemamu G. , Matowo A. , Jilek‐Aall L. M.
Published: August 2005

Summary: A random cluster sample survey of approximately 18,000 people in 11 villages was performed in Ulanga, a Tanzanian district with a population of approximately 139,000 people. Well‐instructed fourth‐year medical students and neurologic and psychiatry nurses identified persons with epilepsy using a screening questionnaire and sent them to a neurologist for detailed evaluation. Identified were 207 subjects (88 male, 119 female) with epilepsy; of these, 185 (89.4%) (80 male, 105 female) had active epilepsy. The prevalence of active epilepsy was 10.2 in 1,000. Prevalence among villages varied, ranging from 5.1 to 37.1 in 1,000 (age‐adjusted 5.8‐37.0). In a 10‐year period (1979–1988) 122 subjects living in the 11 villages developed epilepsy, with an annual incidence of 73.3 in 100,000. Generalized tonic‐clonic seizures (GTCS) accounted for 58% and partial seizures accounted for 31.9%, whereas in 10.1% seizures were unclassifiable. Of the partial seizures, secondarily generalized seizures were the most common. Possible etiologic or associated factors were identifiable in only 25.3% of cases. Febrile convulsions were associated in 13.4 of cases. Other associated factors included unspecified encephalitis (4.7%), cerebral malaria (1.9%), birth injury (1.4%), and other (3%). In 38% of the cases, there was a positive family history of epilepsy.
Epilepsy in Angelman Syndrome Associated with Chromosome 15q Deletion
Authors: Matsumoto Akiko , Kumagai Toshiyuki , Miura Kiyokuni , Miyazaki Shuji , Hayakawa Chiemi , Yamanaka Tsutomu
Published: August 2005

Summary: We report eight sporadic cases of typical Angelman syndrome (AS) associated with chromosome 15q12 deletion. Age at first visit was 3–35 months (average 18 months), and follow‐up period was 4‐20 years (average 14.1 years). The characteristic features of epilepsy in AS are (a) seizure onset in early childhood (8 of 8); (b) evolution of seizure type with age (8 of 8); (c) EEG abnormality changes from high‐voltage slow bursts (HVS) in infancy to diffuse spike and waves in middle childhood (4 of 5); (d) atypical absence seizures (8 of 8), often occurring as atypical absence status (4 of 8); and (e) diminution of seizure discharges and clinical seizures after puberty (7 of 7). We believe that AS may frequently exist in the intractable epilepsies of childhood with severe mental retardation. We stress the importance of AS as one of the main etiologic background diseases of the intractable epilepsies with infantile onset such as West syndrome, Lennox‐Gastaut syndrome, and others.
Generalized Spike‐Waves, Multiple Loci, and Clinical Course in Children with EEG Features of Benign Epilepsy of Childhood with Centrotemporal Spikes
Authors: Beydoun Ahmad , Garofalo Elizabeth A. , Drury Ivo
Published: August 2005

Summary: In 41 patients with EEG features of benign epilepsy of childhood with centrotemporal spikes (BECCT), we noted associated generalized spike‐wave discharges (GSWD) in 14.6% and multiple independent sharp wave foci in 9.8%. The presence or absence of these EEG features was not predictive of the clinical course. The high incidence of GSWD in children with BECCT suggests a possible relation in the expression of these two EEG traits.
Bilateral Todd's Paralysis After Focal Seizures
Authors: Bergen Donna C. , Rayman Lea , Heydemann Peter
Published: August 2005

Summary: Transient postictal hemiparesis or monoparesis is not uncommon after partial (focal) seizures. We report 2 patients who complained of severe bilateral limb weakness after generalized tonic‐clonic seizures (GTCS) beginning focally. Bilateral Todd's paralysis was verified and documented in both patients. EEG and clinical evidence indicate the supplementary motor cortex as the most likely source of the seizures in both cases.
Correlates of Behavior Problems in Children with Epilepsy
Authors: Austin Joan K. , Risinger Michael W. , Beckett Laurel A.
Published: August 2005

Summary: We report results from the first part of an ongoing longitudinal study aimed at identifying the relative contributions of demographic, seizure, and family variables in the prediction of behavior problems in children with epilepsy. We studied 127 children with epilepsy aged 8–12 years and their mothers. Self‐report questionnaires, interviews, and medical records were data sources. Backward and forward stepwise elimination procedures using multiple regression indicated five variables that contributed significantly to prediction of behavior problems: female gender, family stress, family mastery, extended family social support, and seizure frequency. These factors accounted for 29% (p < 0.001) of the variation in behavioral problems. Findings suggest that family variables are important correlates of behavior problems and should be considered in clinical management of children with epilepsy.
Oxcarbazepine Does Not Affect the Anticoagulant Activity of Warfarin
Authors: Kramer G. , Tettenborn B. , Jensen P. Klosterskov , Menge G. P. , Stoll K. D.
Published: August 2005

Summary: The possible interaction of the antiepileptic drug oxcarbazepine (OCBZ) on the anticoagulant effect of warfarin was investigated in 10 healthy male volunteers. After reaching steady‐state conditions by repeated administration of warfarin, the prothrombin time (Quick value) was assessed before and after single (600 mg) and multiple dosing (450 mg twice daily in 1 week) of OCBZ. In 7 of the 10 volunteers with evaluable data, the prothrombin time was not significantly different (paired t test) from baseline either after single (p = 0.299) or repeated dosing (p = 0.333), indicating that OCBZ does not interact to any relevant extent with the hypothrombinemic effect of warfarin.
Possible Interaction Between Oxcarbazepine and an Oral Contraceptive
Authors: Jensen P. Klosterskov , Saano V. , Haring P. , Svenstrup B. , Menge G. P.
Published: August 2005

Summary: The effect of oxcarbazepine (OCBZ) on the kinetics of an oral contraceptive containing ethinyloestradiol (EE) and levonorgestrel (LNG) was investigated in 13 healthy female volunteers who had previously received the contraceptive for at least 3 months. After 15 days of the first study cycle, each subject received, in addition to the oral contraceptive, 300 mg OCBZ on day 16, 300 mg twice daily on day 17, and 300 mg three times daily from day 18 of the first cycle to day 18 of the next menstrual cycle. The area under the curve values for both EE and LNG decreased when OCBZ was given with the oral contraceptive (p = 0.006, analysis of variance). The results indicate that OCBZ, like most antiepileptic drugs (AEDs), decreases the bioavailability of EE and LNG, perhaps by affecting metabolism or protein binding.
Video‐EEG Analysis of Drop Seizures in Myoclonic Astatic Epilepsy of Early Childhood (Doose Syndrome)
Authors: Oguni Hirokazu , Fukuyama Yukio , Imaizumi Yuichi , Uehara Takashi
Published: August 2005

Summary: We studied 36 drop seizures in 5 patients with myoclonic astatic epilepsy of early childhood (MAEE) with simultaneous split‐screen video recording and polygraph. Sixteen were falling attacks and 20 were either less severe attacks exhibiting only deep head nodding or seizures equivalent to drop attacks in terms of ictal pattern but recorded in the supine position. All seizures except those that occurred in patients in the supine position showed sudden momentary head dropping or collapse of the whole body downward. Recovery to the preictal position was observed in 0.3–1 s. As a result of carefully repeated observations, the 36 seizures were classified as myoclonic flexor type in 9, myoclonic atonic type in 2, and atonic type, with and without transient preceding symptoms in the remaining 25. The MF seizure was characterized by sudden forward flexion of the head and trunk as well as both arms, which caused the patient to fall. In the myoclonic atonic seizure, patients showed brief myoclonic flexor spasms, immediately followed by atonic falling. The AT seizure showed abrupt atonic falling, with and without transient preceding facial expression change and/or twitching of extremities. The ictal EEGs of all 36 seizures exhibited generalized bilaterally synchronous single or multiple spike(s) and wave discharges. Atonic drop attacks appear to be a common cause of ictal epileptic falling in MAEE.
Ictal and Interictal Activity in Partial Epilepsy Recorded with Multichannel Magnetoelectroencephalography: Correlation of Electroencephalography/Electrocorticography, Magnetic Resonance Imaging, Single Photon Emission Computed Tomography, and Positron Emission Tomography Findings
Authors: Stefan H. , Schneider S. , Feistel H. , Pawlik G. , Schüler P. , Abraham‐Fuchs K. , Schlegel T. , Neubauer U. , Huk W. J.
Published: August 2005

Summary: Ictal and interictal epileptic activity was recorded for the first time by multichannel magnetoencephalography (MEG) in three patients with partial epilepsy. Pre‐ and intra‐operative localization of the epileptogenic region was compared. The interictal epileptic activity was localized at the same region of the temporal or frontal lobe as the ictal activity. Main zones of ictal activity were shown to evolve from the tissue at the centers of interictal activity. Pre‐ and intra‐operative electrocorticography (ECoG) as well as postoperative outcome confirmed localization in the temporal and frontal lobe. Results also correlated with findings from scalp EEG, interictal and ictal single photon emission computed tomography (SPECT), positron emission tomography (PET), and magnetic resonance imaging (MRI). Combined multichannel MEG/EEG recording permitted dipole localization of interictal and ictal activity.
Seizures During Cognitive Testing in Patients with Temporal Lobe Epilepsy: Possibility of Seizure Induction by Cognitive Activation
Authors: Helmstaedter C. , Hufnagel A. , Elger C. E.
Published: August 2005

Summary: In 18 of 185 patients under consideration for epilepsy surgery, 20 seizures were observed during neuropsychological evaluation. We wished to determine whether the task at seizure onset corresponded neuropsychologically to lateralization of the epileptic focus. The patients' characteristics and the circumstances of the seizures were as follows: Fourteen patients had right temporal lobe epilepsy (RTE) and four had left temporal lobe epilepsy (LTE). Although a wide range of cognitive functions had been tested, all but one seizure occurred during assessment of memory performance. In the RTE patients, 12 of 16 seizures occurred during visual memory testing. Two seizures were observed during a verbal memory task, and one seizure was observed during mental rotation. In two LTE patients, seizures were elicited during verbal memory testing. Two LTE patients with seizures during visual memory testing had speech dominance of the right hemisphere. This high correspondence between the eliciting performance and the focus localization suggests that cognitive performances ipsilateral to the epileptic focus may affect seizure threshold in focal epilepsies.
γ‐Vinyl GABA (Vigabatrin) in Epilepsy: Clinical, Neurochemical, and Neurophysiologic Monitoring in Epileptic Patients
Authors: Ylinen A. , Sivenius J. , Pitkänen A. , Halonen T. , Partanen J. , Mervaala E. , Mumford J. P. , Riekkinen P. J.
Published: August 2005

Summary: We report long‐term clinical, neurochemical, and electrophysiologic data of γ‐vinyl GABA (GVG, vigabatrin) in three groups of patients. GVG was started as add‐on therapy for 75 patients with refractory complex partial seizures (group A) and for 36 mentally handicapped patients with severe epilepsy (group B). The third group (C) consisted of 20 patients with carbamazepine (CBZ) monotherapy, in half of whom GVG monotherapy was substituted. After 3 months, 55% of patients in group A and 42% in group B were responders (reduction in seizure frequency >50%). After 6 (group A) and 3 years (group B) of follow‐up, 27 and 33% of the patients, respectively, still had good response to GVG. Neurochemical measurements showed a twofold increase in CSF GABA concentrations and minimal or no changes in other neurotransmitter‐related parameters. In group C, substitution of GVG as medication tended to normalize the lengthened latencies in somatosensory evoked potentials (SEPs) observed during CBZ treatment.
γ‐Vinyl GABA (Vigabatrin): Relationship Between Dosage, Plasma Concentrations, Platelet GABA‐Transaminase Inhibition, and Seizure Reduction in Epileptic Children
Authors: Arteaga Rosa , Herranz José L. , Valdizán Elsa M. , Armijo Juan A.
Published: August 2005

Summary: The relationship between vigabatrin γ‐vinyl GABA (GVG, vigabatrin) daily dosage or steady‐state plasma concentrations (CSS), platelet GABA‐transaminase (GABA‐T) inhibition, and seizure reduction were studied in 16 children with refractory epilepsy. After 2 months of observation and 1 month of single‐blind add‐on placebo, a fixed GVG dosage was added for 2 months. The dosage was then adjusted in two 2‐month periods each, based on the patient's clinical response. In the fixed‐dose period, GVG dosages of 56.8 mg/kg/day and CSS of 8.1 mg/L reduced GABA‐T activity from 13.9 to 5.1 pmol/min/mg protein (p < 0.001) and that of seizures from 51.4 to 22.3 seizures per month (p < 0.01). Seizure reduction was correlated with dosage (r= 0.83, p < 0.001), but not with CSS or with platelet GABA‐T inhibition. After the GVG dose‐adjustment periods, in which dosages of 84.4 mg/kg/day and CSS of 10.6 mg/L were reached, only a slight reduction was observed in both GABA‐T activity (from 5.1 to 4.9 pmol/min/mg protein) and seizures (from 22.3 to 18.1 seizures per month). In GVG‐responsive patients (excluding placebo‐sensitive and GVG‐resistant patients), a greater reduction of seizures was achieved (from 17.0 to 7.1 seizures per month, p < 0.05), which was not accompanied by greater inhibition of GABA‐T. GVG treatment in children should be started with a dosage of 50 mg/kg/day, increased to 75 or even 100 mg/kg/day when a partial response is observed. If seizures do not improve or if they become worse, the patient should be considered resistant and GVG should be discontinued.
Total Cholesterol, High‐Density Lipoprotein Cholesterol, and Triglycerides in Children Receiving Antiepileptic Drugs
Authors: Franzoni Emilio , Govoni Marina , D'Addato Sergio , Gualandi Stefano , Sangiorgi Zina , Descovich Gian Carlo , Salvioli Gian Paolo
Published: August 2005

Summary: The influence of antiepileptic drug (AED) therapy on total cholesterol (TC), high‐density lipoprotein (HDL) cholesterol, and triglycerides was studied in 208 epileptic children compared with 175 normal children. A significant increase in TC plasma levels was observed with carbamazepine (CBZ), phenobarbital (PB), and phenytoin (PHT). The patients receiving valproate (VPA) showed levels very similar to those of the control population. The results may be explainable by the different biotransformation pathway of these drugs. HDL cholesterol and triglycerides were not altered by any of the AEDs. We recommend monitoring TC level in patients receiving CBZ, PB, and PHT and prescription of diet treatment, at least during the time of AED treatment.
Electrochemistry of Anticonvulsants: Electron Transfer as a Possible Mode of Action
Authors: Ames James R. , Kovacic Peter , Kadaba Pankaja K. , Kiser Patrick F.
Published: August 2005

Summary: Reduction potentials were determined for various anticonvulsants, including progabide, SL 75.102, CGS 9896, pyridazines, zonisamide, 1,2,3‐triazoles, and copper complexes. The values generally were in the range of about 0.1 to 0.6 V for the protonated drugs and the metal complexes. Reduction potentials provide information on the feasibility of electron transfer (ET) in vivo. If the value is relatively positive (greater than about 0.6 V), the agent can act catalytically as an electron acceptor from an appropriate cellular donor. A concomitant favorable influence on abnormal neuronal processes associated with epilepsy could occur. We describe ET as a possible mode of action of anticonvulsants as well as some anti‐epileptic agents with no electrochemical data based on this hypothetical ET approach.
Blood‐Brain Barrier Penetration of Felbamate
Authors: Cornford Eain M. , Young Deborah , Paxton James W. , Sofia R. Duane
Published: August 2005

Summary: The brain uptake index (BUI) method of Oldondorf was used to examine blood‐brain barrier (BBB) drug transport in mice, rats, and rabbits; felbamate (FBM) extraction (E) in a single transcapillary passage was 5–20%, and drug uptake in rat brain was not concentration‐dependent. Like diazepam, FBM was retained in mouse brain. To ensure that radioactivity measurements reflected the disposition of parent drug and not some metabolite, extracts of mouse brain were prepared for further analysis. No FBM metabolites were detected in brain 5 min after administration: In silica gel thin‐layer chromatography (TLC), a single [14C]FBM peak was detected—Rf = 0.504 (70:30 acetone:hexane). Confirmatory high‐performance liquid chromatography (HPLC) separations [30% methanol, 1.3 ml/min, C18 column, ultraviolet (UV) detection 254 nm] indicated a single peak containing >93% of the radioactivity in the FBM fraction (12‐min retention time). In a single transit through the liver (a nonbarrier tissue with fenestrated capillaries), FBM E was 82%. The octanol: buffered saline partition coefficient of FBM was (log PFBM =) 0.54 2 0.01. Thus, lipid mediated BBB penetration of FBM is similar to that of phenytoin (PHT) and phenobarbital (PB). Plasma proteins do not affect FBM entry to the brain: neither human serum, nor bovine or human serum albumin (BSA, HSA), nor human a1 acid glycoprotein (orosomucoid) significantly modified BBB FBM extraction. Erythrocyte‐borne FBM may also dissociate and gain access to the brain in a single transcapillary passage. Differences between newborn and adult rabbit BBB FBM extraction and between different anesthetic agents are attributable to cerebral blood flow (CBF) rates. The permeability‐surface area products (PS = [CBF]. [E]) for FBM in rats, rabbits, and mice were 0.09, 0.16 and 0.30 ml/min/g, respectively. Preliminary autoradiographic analyses of frozen brain sections suggest that [14C]FBM distributes relatively uniformly throughout the brain and that minor variations apparently are a function of differing CBF rates.
Pharmacokinetics of Felbamate in Pediatric and Adult Beagle Dogs
Authors: Adusumalli V. E. , Gilchrist J. R. , Wichmann J. K. , Kucharczyk N. , Sofia R. D.
Published: August 2005

Summary: The relative bioavailability and pharmacokinetics of felbamate (FBM) after a single oral dose and after 10 once‐daily oral doses of 60 mg/kg were investigated in adult and pediatric dogs of both sexes. The pediatric and adult dogs were aged 4–6 weeks and 1–2 years, respectively. Analysis of variance (ANOVA) was performed on the bioavailability parameters among all groups and between the first and last doses. No sex‐related differences in bioavailability and pharmacokinetic parameters were observed. The bioavailability of FBM in pediatric dogs was significantly less as compared with that in adult dogs. Rapid overall elimination of the drug in pediatric dogs appears to be responsible for the lower bioavailability. The bioavailability of FBM after the last dose was also significantly lower than after the first dose for both age groups. No major differences in the rate constant of FBM absorption (ka) and volume of distribution at steady state (VSS) were observed between the two age groups. As with other clinically useful antiepileptic drugs (AEDs), higher doses of FBM may be required in pediatric populations to achieve optimum drug levels, assuming that age‐related changes in FBM disposition will also be confirmed in humans.
Influence of Audiogenic Seizures on Synaptic Facilitation in Mouse Hippocampal Slices Is Mediated by N‐Methyl‐d‐Aspartate Receptor
Authors: Wieraszko Andrzej , Seyfried Thomas N.
Published: August 2005

The influence of audiogenic seizures (AGS) on synaptic facilitation was studied in DBA/2J (D2) and C57BL/6J (B6) mice. AGS susceptibility is inherited in D2 mice, but can be acquired in AGS‐resistant B6 mice through acoustic priming. The experiments were per formed on hippocampal slices obtained from D2 and B6 mice both with and without seizures. Long‐term potenti ation (LTP) and low‐Mg2 +‐induced synaptic facilitation (LMISF) were evaluated after stimulation of Schaffer col laterals. The magnitude of LTP and LMISF was signifi cantly greater in slices obtained from mice with seizures than from mice without seizures in both strains. Seizure induced enhancement of LTP and LMISF was markedly reduced by the JV‐methyl‐D‐aspartate (NMDA) receptor antagonist AP‐5. The noncompetitive NMDA receptor antagonist MK 801 reduced the efficiency of priming in B6 mice and abolished AGS in D2 mice and primed B6 mice, the data suggest that audiogenic seizures can en hance synaptic facilitation through activation of the NMDA receptor.
Some Aspects of Prognosis in the Epilepsies: A Review
Authors: Sander J. W. A. S.
Published: August 2005

The traditional view that epilepsy is usually a chronic condition in which the prognosis is consistently poor has been challenged in the last 2 decades. Evidence from population‐based studies and from intervention studies in newly diagnosed patients has produced a wealth of information of a much better prognosis. It is now generally accepted that as many as 70–80% of people developing seizures for the first time will eventually achieve terminal remission, whereas the remaining 20–30% will continue to have recurrent seizures despite all treatment. Despite the high recurrence rate after a first epileptic seizure, remission usually occurs early and for most persons, epilepsy is a short‐lived condition. The exact role of antiepileptic drugs (AEDs) in this good outcome, however, remains open to debate, because the natural history of the untreated condition is largely unknown. In this article, factors that may influence the prognosis of the epilepsies, including the problems of diagnosis, are reviewed. Special emphasis is given to the issue of spontaneous remission and the question of prognosis of different epileptic syndromes.
Status Epilepticus Related to Alcohol Abuse
Authors: Alldredge Brian K. , Lowenstein Daniel H.
Published: August 2005

We reviewed the case records of 249 adult patients with generalized convulsive status epilepticus (SE) examined at San Francisco General Hospital between 1977 and 1989 and identified 27 patients (10.8%) in whom alcohol abuse was the only identifiable precipitating cause of SE. In 12 patients (44% of the study group), SE was the first presentation of alcohol‐related seizures. Seizures with focal features were observed in 11 patients (40.1%), but there was little correlation with localized computed tomography (CT) or EEG abnormalities. SE was controlled with phenytoin (PHT), with or without a benzodiazepine (BZD), in 18 patients (66.7%). Twentytwo patients (81.5%) were discharged with no new neurologic deficits, but time to recovery of baseline mental status was prolonged (>12 h) in 24 patients. With regard to alcohol abuse history, study patients did not differ from a comparison group with isolated alcohol withdrawal seizures. The results indicate that alcohol abuse is a common cause of SE and that SE may be the first presentation of alcohol‐related seizures. Furthermore, the outcome of patients with alcohol‐related SE compares favorably with that of patients with SE due to other causes, but recovery of these patients may be complicated by a prolonged postictal state.