bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychosis of Epilepsy, with Special Reference to Anterior Temporal Lobectomy
Authors: Matsuura Masato
Published: August 2005

Summary: The incidence of psychosis in patients with temporal lobe epilepsy before and after anterior temporal lobectomy, as well as that of de novo psychosis, is reviewed. Psychosis is defined as an acute confusional state, a chronic delusional state, or schizophrenialike psychosis. All three conditions have tended to decrease in recent years. In recent studies, the incidence of de novo psychosis is estimated to be ‐4%. Early onset of de novo psychosis with decreased or diminished seizures might be an alternative psychosis related to forced normalization. In contrast, late‐onset psychosis with seizure continuation might be related to synaptic changes due to aberrant reinnervation after temporal lobectomy. Right‐sided temporal lobectomy might have a provoking effect on psychosis. The role of the neuropsychiatrist is important in epilepsy surgery with regard to presurgical identification and postoperative support of patients who are vulnerable to psychosis.
Effective Temporal Lobectomy in Childhood Without Invasive EEG
Authors: Blume Warren T. , Girvin John P. , McLachlan Richard S. , Gilmore Barbara E.
Published: August 2005

Summary: Temporal lobectomy abolished complex partial seizures (CPSs) in 14 consecutive children (12 years or younger) whose presurgical evaluation included clinical analysis, scalp EEG, and neuroimaging. Seizures of 13 of 14 patients began with a simple partial component whose symptoms were suggestive of limbic system involvement. EEG recorded clinically typical seizures arising from the ultimately operated on temporal lobe in seven (50%) and never falsely lateralized seizure origin. Most active interictal spikes arose from the epileptogenic temporal lobe in 13 (93%) and never falsely lateralized epileptogenesis. Neuroimaging disclosed epileptogenic lesions in all: magnetic resonance imaging (MRI; 11 patients) and computed tomography (CT; three patients). Children may obtain relief from CPSs by temporal lobectomy without invasive electroencephalography.
Effect of Wada Memory Stimulus Type in Discriminating Lateralized Temporal Lobe Impairment
Authors: Loring David W. , Hermann Bruce P. , Perrine Ken , Plenger Patrick M. , Lee Gregory P. , Meador Kimford J.
Published: August 2005

Summary: Purpose: To examine the effects of memory stimulus type on Wada memory performance.

Method: Ninety‐six patients (left, 47; right, 49) from four epilepsy centers who were candidates for anterior temporal lobectomy (ATL) and who have subsequently undergone surgery were studied. Patients with atypical cerebral language lateralization or with evidence on magnetic resonance imaging (MRI) to suggest a lesion other than hippocampal sclerosis were excluded. Wada memory performance was obtained by using both real objects and line drawings as memory stimuli.

Results: Wada memory laterality scores with either real objects or line drawings as memory stimuli discriminated left from right‐ATL groups. However, objects were superior to line drawings in making this differentiation. Further, objects were superior to line drawings in individual patient classification of candidates for left ATL, with no difference in the classification rates using either objects or line drawings in candidates for right ATL.

Conclusions: Type of memory stimuli is an important factor affecting memory results during the Wada test.
Pharmacokinetics of Oxcarbazepine and Carbamazepine in Human Placenta
Authors: Pienimäki P. , Lampela E. , Hakkola J. , Arvela P. , Raunio H. , Vähäkangas K.
Published: August 2005

Summary: Purpose: To study the transfer and metabolism of oxcarbazepine (OCBZ) and 10‐hydroxy‐10,11‐dihydrocarbamazepine (10‐OH‐CBZ) and carbamazepine (CBZ) metabolism and its possible induction in human placenta.

Methods: A dual recirculating human placental perfusion system, blood sampling, high performance liquid chromatography (HPLC), reverse transcriptase‐polymerase chain reaction (RT‐PCR), and enzyme assays.

Results: OCBZ was metabolized into 10‐OH‐CBZ in five human placental cotyledons perfused for 2 h in a dual recirculating perfusion system. The same metabolite was found by HPLC in three sample pairs of maternal and cord blood taken during delivery from patients on OCBZ therapy. In all of the clinical samples, 10, 11‐trans‐dihydroxy‐10, 11‐dihydrocarbamazepine (l0, 11‐D) was also found, but not in the perfusions. In addition, 10‐OH‐CBZ was not metabolized in the placental perfusions. The transfer of OCBZ through the perfused placentas was quicker than the transfer of antipyrine, while the transfer of 10‐OH‐CBZ was slower. Both OCBZ and 10‐OH‐CBZ also accumulated in placental tissue. CBZ metabolism was studied in three perfusions using placentas from mothers on CBZ therapy. No metabolism could be detected in the perfused placentas, while metabolites were found in both maternal and cord blood of the same mothers. Another series of placentas of mothers on CBZ therapy did not differ significantly from the placenta of a healthy mother as to CYP activities or the level of CYP3A4 mRNA.

Conclusions: OCBZ is metabolized into 10‐OH‐CBZ to some extent in human placenta in vitro, suggesting that the placenta also participates in the metabolism of OCBZ in vivo. On the contrary, the placenta does not participate in the metabolism of CBZ. No induction of placental CBZ metabolism in vitro can be detected after maternal CBZ treatment during pregnancy.
Anticonvulsant Activity of Pyrid‐3‐yl‐Sulfonyl Ureas and Thioureas
Authors: Masereel B. , Lambert D. M. , Dogné J. M. , Poupaert J. H. , Delarge J.
Published: August 2005

Summary: The N‐[(4‐cycloheptylaminopyrid‐3–yl)sulfonyl]‐N′‐cycloheptyl urea, a neuroprotective agent, and 10 chemically related sulfonyl(thio)ureas were evaluated in the maximal electroshock seizure test in mice. This sulfonylurea, BM 27, and two stucturally related sulfonylthioureas, BM 11 and BM 34, emerged with a 50% effective dose (ED50) of 2.87, 1.72, and 1.19 mg/kg, respectively. Their anticonvulsant profiles were found to be similar to that of phenytoin: active in the maximal electroshock seizure (MES) test and inactive in chemically induced seizures (pentetrazole, strychnine, bicuculline, picrotoxine, N‐methyl‐D,L‐aspartic acid). These compounds exhibited a higher protective index and potency than those of phenytoin. Additional work remains necessary, however, to determine whether BM 27 is of clinical interest.
Epilepsy in Pakistan: Stigma and Psychosocial Problems. A Population‐Based Epidemiologic Study
Authors: Aziz Hasan , Akhtar Syed Wasim , Hasan K. Zaki
Published: August 2005

Summary: Purpose: To assess the stigmatization and psycho‐social problems of persons with epilepsy in Pakistan.

Methods: A population‐based, cross‐sectional epidemiologic study of 241 persons with epilepsy identified from an at‐risk population of 24,130 individuals (64.7% from urban and 35.3% from rural areas). Of these patients, 77% suffered from recurrent non‐febrile generalized convulsions. We evaluated degree of stigmatizations (i.e., avoidance by friends, neighbors, and others), and the effect of epilepsy on other psychosocial aspects (e.g., marriage), and also the relationships between gender and level of education of the patients, and stigmatization.

Results: Patients with epilepsy in Pakistan do not appear to be highly stigmatized, but their education and grades are affected by the disorder. They have difficulty performing activities of daily living and find it hard to make decisions about whether to marry or to have children. Women believed that they were more dangerous to others, received less help from their families, and, more frequently than men, encouraged others to avoid them. Women were also more likely than men to express the belief that people with epilepsy should not marry, but in fact, women more frequently married as compared men—a fact influenced by social and cultural pressures, including pressure from family, because it is nearly always the responsibility of the parents to arrange the marriage of a daughter. Influence of education indicates that people with epilepsy who have higher education, as compared with those with less education, had fewer children, were less often avoided by their classmates and neighbors, had fewer problems with plans for education, less frequently encouraged others to avoid them, were more frequently married, and believed that they were more dangerous to others. Most people believed that their conditions had a physical basis; only 3.1% attributed their epilepsy to supernatural causes.

Conclusions: Stigmatization regarding epilepsy has not been proven to be an important feature in the culture of Pakistan because none of the observations are statistically significant as per P‐value.
Sexual Function in Women with Epilepsy
Authors: Duncan Susan , Blacklaw Jackie , Beastall G. H. , Brodie M. J.
Published: August 2005

Summary: Purpose: To examine certain aspects of sexual behaviour and attitudes in a group of women with epilepsy using a validated questionnaire (Sexuality Experience Scales), and effects of antiepileptic drugs (AEDs) on sex hormone binding globulin (SHBG), total testosterone (TT), and free testosterone (FT).

Methods: One hundred ninety‐five women all attending a hospital‐based epilepsy clinic were recruited. One hundred fifty‐nine received AED therapy and 36 women did not. A control group of 48 women was also recruited. All women completed the first two Sexuality Experience Scales (SES 1 and SES 2), and those women in stable heterosexual relationships completed SES 3 and SES 4. At the same time blood was taken for TT and SHBG levels. FT was calculated using the method of Nanjee and Wheeler (22).

Results: Women receiving AED therapy achieved significantly higher SES 1 and SES 2 scores than the rest of the women, suggesting that they adhered to a stricter sexual morality and were less open to psychosexual stimulation than the rest of the women treated. Women in the treated group were less likely to have received further education than the controls, a factor that influences SES 1 and SES 2 scores. There were no significant differences between the three groups on SES 3 or SES 4, with the exception of the orgasmic adequacy (OE) scale of SES 3 where those women in the treated group attained a higher mean score than the controls, suggesting that they found orgasm less satisfying. Women receiving AEDs had significantly higher SHBG and TT than controls and untreated patients. There were no differences in FT between the groups. Those women receiving AEDs also exhibited the expected mid‐cycle rise in FT. There was no significant correlation between FT and the desired frequency of intercourse or enjoyment of it for the three groups.

Conclusions: Women in the treated group appeared to be more “moral” and less open to sexual approach, but those who had regular partners appeared to desire and enjoy intercourse as much as the control and untreated groups. This could be explained by differences in demographic characteristics of the study groups or be indicative of a bimodal distribution of sexual interest in these women. As FT was within physiological norms for each study group this cannot be cited as a cause for hyposexuality.
Altered Seizure Patterns After Temporal Lobectomy
Authors: Blume Warren T. , Girvin John P.
Published: August 2005

Summary: Purpose: We compared features of seizures occurring after temporal lobectomy with those of preoperative seizures in the same patients to determine whether aspects of postoperative partial seizures presage ultimate seizure control.

Methods: Seizure descriptions of 100 consecutive patients who underwent anterior temporal lobectomy (ATL) were obtained by our epileptologists before and after surgery. Follow‐up for seizure control for all patients was obtained for a median of 5.5 years.

Results: Twenty‐six of the 100 patients had at least one diurnal complex partial seizure (CPS) after lobectomy. The proportion of patients with an aura for their CPS decreased from 86% preoperatively to 58% postoperatively. Fifty–five percent had two or more aura features before surgery, as compared with 31% after lobectomy. Eleven of 18 (61%) with fewer than two postoperative aura features, as compared with 2 of 8 (25%) with two or more aura features ultimately had >90% seizure reduction postoperatively. Nineteen (95%) of 20 patients with only simple partial seizures (SPS) postoperatively ultimately obtained ≥90% reduction, and 7 (35%) of them became seizure‐free. Although generalized tonic‐clonic seizures (GTCS) decreased from 70% to 39% after lobectomy, 7 (23%) of 30 patients who had not had GTCS preoperatively had at least one after lobectomy, usually while receiving a lesser amount of antiepileptic drug (AED) therapy. Among the 27 patients with residual CPS, ultimate outcome was better among patients with removal of >6 cm as measured along the inferior temporal gyrus than among those with less extensive resections.

Conclusions; In addition to eliminating or reducing the frequency of temporal lobe seizures, lobectomy may simplify or eliminate the aura features of residual CPS. The number of CPS aura features correlated inversely with ultimate postoperative seizure reduction. Ultimate seizure control among patients with only SPS was better than that of patients with CPS postoperatively. First‐ever GTCS may occur when AED dosages are reduced after surgery.
The New Antiepileptic Drugs: A Systematic Review of Their Efficacy and Tolerability
Authors: Marson A. G. , Kadir Z. A. , Hutton J. L. , Chadwick D. W.
Published: August 2005

: Purpose: Gabapentin (GBP), lamotrigine (LTG), tiagabine (TGB), topiramate (TPM), vigabatrin (VGB), and zonisamide (ZNS) are all in use as “add‐on” treatment for patients with refractory epilepsy. There have been no comparative randomized controlled trials allowing an evidence‐based choice between these drugs. We report a series of meta‐analyses of randomized placebo‐controlled add‐on trials in which these drugs have been tested in patients with partial epilepsy. This work provides an estimate of each drug's efficacy and tolerability compared with placebo. These estimates are compared across drugs to give broad estimates of comparative efficacy and tolerability.

Methods: Trial reports were found by searching Medline, by searching through journals by hand, and by contacting the pharmaceutical industry. The outcomes chosen were the proportion of patients who (a) have a 350% reduction in seizure frequency (50% responders); (b) withdrew from the study (any reason); or (c) reported the following side effects: ataxia, dizziness, fatigue, nausea, or somnolence. Overall odds ratio (OR) with 95% confidence intervals (CIS; 50% responders) or 99% CIS; side effects) were calculated.

Results: Twenty‐nine trials were included, representing 4,091 randomized patients. The ORs for 50% response (95% CI) were GBP, 2.29 (1.53–3.43); LTG, 2.32 (1.47–3.68); TGB, 3.03 (2.01–4.58); TPM, 4.07 (2.87–5.78); VGB, 3.67 (2.44–5.51); and ZNS, 2.7 (1.36–4.47). ORs for discontinuation were GBP, 1.36 (0.75–2.49); LTG, 1.19 (0.79–1.79); TGB, 1.81 (1.21–2.70); TPM, 2.56 (1.64–4.00); VGB, 2.58 (126–5.27); and ZNS, 4.23 (1.71–10.49).

Conclusions: We have clear evidence that each of these drugs is better than placebo at preventing seizures. When results are compared across drugs, the confidence intervals overlap, and we have no conclusive evidence of differences in efficacy or tolerability. Despite this, the agent that appears most effective may be twice as effective as the agent that appears least effective, and the agent that appears most likely to cause discontinuation may be 4 times more likely to do so than the treatment that appears least likely to do so. Comparative randomized studies are needed further to evaluate these drugs.
Tolerability and Pharmacokinetics of Monotherapy Felbamate Doses of 1,200–6,000 mg/day in Subjects with Epilepsy
Authors: Sachdeo Rajesh , Narang‐Sachdeo Satinder K. , Shumaker R. C. , Perhach J. L. , Lyness W. H. , Rosenberg A.
Published: August 2005

: Purpose: Felbamate (FBM) pharmacokinetic parameters, safety and tolerability in the dose range of 1,200–6,000 mg/day were assessed in two open‐label studies with similar designs.

Methods: In study A, newly diagnosed subjects with epilepsy receiving FBM monotherapy at a starting dose of 1,200 mg/day (400 mg/three times daily, t.i.d.) and increased 1,200 mg/day, if tolerated, at 14‐day intervals to 3,600 mg/day were investigated. In study B, epilepsy subjects with prior FBM monotherapy exposure received ascending FBM doses in five consecutive 14‐day periods with a starting dose of 3,600 mg/day (1,200 mg t.i.d.) FBM. In each successive period, if FBM was well tolerated, the dose was increased by 600 mg/day to a maximum of 6,000 mg/day (2,000 mg t.i.d.).

Results: The pharmacokinetic parameter estimates maximum observed concentration (Cmax), area under the concentration–time curve (AUCτ) Ctrough, and Cav showed a linear dependence to dose above the 1,200–6,000 mg/day FBM dose range (F‐tests; p <0.0001) with apparent clearance (Cl/kg) and Tmax (time to Cmax) independent of dose. When AUCτ, Cmaxand Ctroughwere adjusted for dose, there were no significant differences between the dosing periods.

Conclusions: The data establish that plasma concentrations of FBM are linear with respect to dose to 6,000 mg/day. In addition, FBM was safely administered at these doses for periods as long as 14 days to epileptic subjects with prior exposure to FBM. FBM‐naive subjects appeared to report more adverse experiences (generally of mild to moderate severity) than did subjects with prior FBM exposure.
In Whom Does Status Epilepticus Occur: Age‐Related Differences in Children
Authors: Shinnar Shlomo , Pellock John M. , Moshé Solomon L. , Maytal Joseph , O'Dell Christine , Driscoll Susan M. , Alemany Marta , Newstein David , DeLorenzo Robert J.
Published: August 2005

: Purpose: Status epilepticus (SE) is an uncommon but potentially life‐threatening seizure. It is most common in children. Little is known about the differences within the pediatric age group in terms of the type of patient seen with SE.

Methods: We analyzed the records of 394 children aged 1 month to 16 years who were part of two large studies of pediatric SE conducted in Bronx, New York, and Richmond, Virginia. The 394 children had a mean age of 4.4 years and included 349 (89%) with an initial episode of SE.

Results: Status epilepticus was most common in younger children with > 40% of cases occurring in those younger than 2 years. The distribution of causes was highly age dependent. More than 80% of children younger than 2 years had SE of febrile or acute symptomatic origin, whereas cryptogenic and remote symptomatic causes were most common in older children (p <0.001). One hundred fifty‐eight (40%) of the cases were known to be previously neurologically abnormal, including 35 (21%) of 169 younger than age 2 years and 123 (55%) of 225 older than 2 years (p <0.001). One hundred seventy‐seven (45%) children had a history of seizures including 142 (41%) of the 349 children with a first episode of SE. A history of seizures was present in 34 (20%) of those younger than 2 years and 143 (64%) of those older than 2 years (p < 0.001). The effect of age remained significant even when the analysis was limited to those with SE of cryptogenic or remote symptomatic origin.

Conclusions: There is a strong effect of age on the frequency and etiology of SE, as well as on the type of child who has SE. In young children, SE occurs primarily in children who are neurologically normal and with no history of unprovoked seizures. In older children, SE occurs primarily in those who are known to have prior unprovoked seizures and who are often also neurologically abnormal.
De Novo Aphasic Status Epilepticus
Authors: Grimes David Andrew , Guberman Alan
Published: August 2005

: The literature contains only a handful of reports of patients with aphasia as the principal or only obvious manifestation of partial status epilepticus. Even fewer patients of this type have been well documented both clinically and by ictal EEG monitoring. We studied an otherwise healthy woman with abrupt onset of aphasia initially thought to be the result of an infarct of the left temporoparietal area. We were able to document partial status epilepticus involving the left temporoparieta1 area with EEG/video monitoring and showed rapid reversal of the aphasic disorder with antiepileptic drug (AED) treatment. The case is presented with a review of previous reports to underscore the importance of considering this diagnosis in patients with abrupt onset of aphasia.
Migraine with Visual Aura and Photosensitive Epileptic Seizures
Authors: Donnet Anne , Bartolomei F.
Published: August 2005

Summary: A relationship between epilepsy and migraine has long been postulated, but the nature of this interaction is still debated. We observed this association in a 23‐year old man with a history of migraine with visual aura who had seizures at age 15 years while watching television. Waking EEG was normal, but sleep recordings demonstrated posterior spike‐waves during sleep. During intermittent photic stimulation (IPS), a photoparoxysmal response occurred, maximum in occipital areas. Brain magnetic resonance imaging scan was normal. Seizures did not recur after 4‐year treatment with valproate. He is currently seizure‐free, but continues to have rare migraine with visual aura. The role of spreading depression or of a putative dopaminergic failure in occipital cortex is discussed.
Locus Coeruleus Lesions Suppress the Seizure‐Attenuating Effects of Vagus Nerve Stimulation
Authors: Krahl Scott E. , Clark Kevin B. , Smith Douglas C. , Browning Ronald A.
Published: August 2005

Summary: Purpose: Although vagus nerve stimulation (VNS) is now marketed throughout most of the world as a treatment for drug‐resistant epilepsy, the therapeutic mechanism of action of VNS‐induced seizure suppression has not yet been established. Elucidation of this mechanism is an important first step in the development of strategies to improve VNS efficacy. Because the locus coeruleus (LC) has been implicated in the antinociceptive effects of VNS, we chemically lesioned the LC in the present study to determine if it is a critical structure involved in the anticonvulsant mechanisms of VNS.

Methods: Rats were chronically depleted of norepinephrine (NE) by a bilateral infusion of 6‐hydroxydopamine (6‐OHDA) into the LC. Two weeks later, they were tested with maximal electroshock (MES) to assess VNS‐induced seizure suppression. In another experiment, the LC was acutely inactivated with lidocaine, and seizure suppression was tested in a similar fashion.

Results: VNS significantly reduced seizure severities of control rats. However, in animals with chronic or acute LC lesions, VNS‐induced seizure suppression was attenuated.

Conclusions: Our data indicate that the LC is involved in the circuitry necessary for the anticonvulsant effects of VNS. Seizure suppression by VNS may therefore depend on the release of NE, a neuromodulator that has anticonvulsant effects. These data suggest that noradrenergic agonists might enhance VNS‐induced seizure suppression.
Incidence of Psychogenic Seizures in Adults: A Population‐Based Study in Iceland
Authors: Sigurdardottir Katrin Ruth , Olafsson Elias
Published: August 2005

Summary: Purpose: We wished to determine the incidence of psychogenic nonepileptic (NES) seizures in a population‐based study.

Methods: Cases were identified through review of the results of all long‐term video‐EEG studies made in Iceland during the study period.

Results: The incidence of NES was 1.4 in 100,000 person‐years of observation. Age‐specific incidence was highest in the youngest age group (age 15–24 years) and decreased thereafter. A strong female preponderance was observed.

Conclusions: The incidence of NES is equal to almost 4% of that reported for epilepsy from Iceland for persons aged ≥15 years. For people aged 15–24 years, the incidence of NES is equal to −5% of the incidence of epilepsy. Half the patients also had epilepsy.
Clinical Value of “Ictal” FDG‐Positron Emission Tomography and the Routine Use of Simultaneous Scalp EEG Studies in Patients with Intractable Partial Epilepsies
Authors: Barrington Sally F. , Koutroumanidis Michael , Agathonikou Alexander , Marsden Paul K. , Binnie Colin D. , Polkey Charles E. , Maisey Michael N. , Panayiotopoulos Chrysostomos P.
Published: August 2005

Summary: Purpose: EEG is widely used during positron emission tomography (PET) to confirm the interictal state of the patient and assist in scan interpretation when a seizure occurs. Ictal scans usually reflect mixed interictal‐ictal‐postictal metabolic activity as seizures are brief in comparison to the 30‐min uptake period of the tracer. We wished to determine whether routine EEG is justified and if seizures commonly affect the diagnostic information of the PET scan.

Methods: We examined the PET scans of 6 of 236 outpatients with intractable epilepsy with clinical and electrical evidence of a seizure during tracer uptake. We performed semi‐quantitative analysis in 2 patients who had “ictal” and control interictal scans.

Results: Patients with single seizures lasting 23 s to 4 min [four complex partial seizures (CPS) and one absence seizure (AS)] had focal hypometabolism concordant with results of other investigations. One patient with complex partial status had irregular cortical uptake and focal hypometabolism, but the site of the ictal focus could not be confirmed.

Conclusions: In this group of patients, seizures occurred infrequently during tracer uptake. The interpretation of the PET scan when single seizures occurred did not appear to be influenced by the continuous scalp EEG (CSEEG) recordings. The value of routine CSEEG in outpatients treated with medication should be reappraised, with potential cost savings. In rare circumstances in which a true ictal study occurs (complex partial status, epilepsia partialis continua, and repetitive CPS), PET scanning may be inconclusive and repeat interictal scanning should be pursued.
Prediction of Verbal Memory Loss in Individuals After Anterior Temporal Lobectomy
Authors: Davies Keith G. , Bell Brian D. , Bush Andrew J. , Wyler Allen R.
Published: August 2005

Summary: Purpose: Decreased memory function represents the area of greatest neuropsychological morbidity after anterior temporal lobectomy (ATL), particularly for left ATL candidates. We wished to identify easily derived demographic and neuropsychological predictors of risk of pre‐to postoperative memory decline using only information available preoperatively.

Methods: We assessed decline in memory as measured by the California Verbal Learning Test (CVLT) by deriving multiple regression equations using the following measures as independent variables: age at onset, chronological age at time of surgery, sex, Full Scale IQ (FSIQ), level of education, and preoperative memory scores. In all, 203 patients (93 males, 110 females), undergoing ATL (107 left, 96 right) with preoperative and 6‐month postoperative testing, were examined.

Results: The combination of age, FSIQ, sex, side of surgery and preoperative score was highly predictive (p‐values <0.0001) of postoperative memory scores. Higher postoperative scores were associated with higher preoperative score, younger chronological age, higher FSIQ, female sex, and right side of resection. Reliable change index (RCI) values were used to estimate meaningful decline on the total score across five trials. Logistic regression analysis showed preoperative score and age to be predictors of RCI decline for left‐sided resections. Sensitivity of decline (≥90th centile RCI) prediction was 56%, and specificity was 95%. Validation in 30 patients from a separate population of patients undergoing left ATL produced similar figures.

Conclusions: The derived regression equations can accurately predict verbal memory decline on a list‐learning task in‐50% of individual patients undergoing ATL, and false‐positive prediction errors are very rare.
Histopathological Correlates of Epileptogenicity as Expressed by Electrocorticographic Spiking and Seizure Frequency
Authors: Rosenow Felix , Lüders Hans O. , Dinner Dudley S. , Prayson Richard A. , Mascha Edward , Wolgamuth Barbara R. , Comair Youssef G. , Bennett Gregory
Published: August 2005

Summary: Purpose: To study the correlation between histopathology and epileptogenicity, as measured by seizure frequency and electrocorticography (EcoG), in patients with cortical dysplasia (CD) as compared with control patients with gangliogliomas or gliomas.

Methods: The influence of the histopathological classification and the presence of balloon cells in CD on the frequency and extension of five predefined patterns of ECoG spiking, seizure frequency, age of seizure onset and 6‐month postoperative outcome were analyzed in 32 patients with focal epilepsy undergoing presurgical evaluation with chronically implanted subdural electrodes.

Results: Comparison of patients with CD, gangliogliomas, and gliomas showed that the seizure frequency was greatest in patients with CD and ECoG spiking and was most extensive in patients with gangliogliomas. The onset of epilepsy was earlier in patients with CD and with gangliogliomas. None of these differences was significant. However, in patients with CD, the presence of balloon cells was associated with significantly greater seizure frequency (p = 0.009), and a significantly greater number of electrodes recording continuous frequent spiking (p = 0.03). The presence of continuous very frequent spiking correlated with the duration of the epilepsy and the number of seizures recorded during monitoring. No significant correlation was detected between histopathology, seizure frequency, or ECoG activity and postoperative outcome, which was relatively favorable in patients with balloon cells.

Conclusions: CD refers to a variety of histopathological patterns associated with different epileptogenicity. In CD, increased clinical and ECoG epileptogenicity correlates with the presence of balloon cells. This finding confirms that balloon cells should be considered in the histopathological classification of CD. The predefined ECoG were not specific for any of the histopathologies investigated.
Effect of Renal Impairment on the Pharmacokinetics and Tolerability of Tiagabine
Authors: III Allen Cato , Gustavson Linda E. , Qian Jiang , El‐Shourbagy Tawakol , Kelly Edward A.
Published: August 2005

Summary: Purpose: We wished to determine the effect of renal impairment on the pharmacokinetics and tolerability of the new antiepileptic drug tiagabine (TGB).

Methods: We assessed TGB pharmacokinetics and tolerability in 25 subjects with various degrees of renal function (based on creatinine clearance, n = 4–6 per group) from healthy (group I) to requiring hemodialysis (group V) in a single and multiple dose (every 12h), one‐period (groups I‐IV) or a single dose, two‐period (group V) study (4‐mg oral doses of TGB · HCl). Blood samples were collected after the first dose (both periods for group V) and after the last dose on day 5 (groups I‐IV). TGB plasma concentrations and plasma protein binding were determined by high‐performance liquid chromatography (HPLC) and ultrafiltration, respectively.

Results: TGB was well tolerated by all study subjects. The pharmacokinetics of TGB were similar in all subjects; no pharmacokinetic parameter (based on either total or unbound concentrations) was statistically correlated with creatinine clearance. For total TGB in plasma, single‐dose mean values of the maximum plasma concentration, clearance, and half‐life (t1/2) ranged from 52 to 108 ng/ml, from 7.14 to 11.02 I/h, and from 6.4 to 8.4 h, respectively.

Conclusions: TGB pharmacokinetics and tolerability were independent of renal function; therefore, dosage adjustment is unnecessary for epilepsy patients with renal impairment.
Long‐Term Follow‐Up of Childhood Epilepsy Associated with Tuberous Sclerosis
Authors: Ohtsuka Yoko , Ohmori Iori , Oka Eiji
Published: August 2005

Summary: Purpose: To study the clinical and electroencephalographic (EEG) characteristics of patients whose epilepsy is associated with tuberous sclerosis, with special reference to their clinical course.

Methods: We investigated the electroclinical and radiologic features of 38 patients with epilepsy associated with tuberous sclerosis.

Results: Eleven patients showed only generalized epilepsy, and 10 showed only localization‐related epilepsy throughout their clinical course. Among the other 17 cases, the nature of the epilepsy changed between generalized and localization‐related epilepsies during the clinical course. A shift from generalized to localization‐related epilepsies was more common than the reverse. Seventeen had West syndrome (WS), three had Lennox‐Gastaut syndrome (LGS), and eight had epilepsies that evolved from WS to LGS. Tonic spasms, mostly in series, were seen in all 28 patients with generalized epilepsy. Eleven of the 28 patients had partial seizures and tonic spasms in the same period. Six of them showed “simultaneous seizures,” consisting of tonic spasms in series and a partial seizure. Partial seizures were the main seizure type in 27 patients with localization‐related epilepsy, but three of them also showed tonic spasms that included “simultaneous seizures.” Ictal EEGs revealed multiple active foci in the same period that could shift during the clinical course. Neither the location nor number of tubers was related to the clinical course. As for seizure outcome, 12 (32%) of 38 patients were free from seizures at follow‐up.

Conclusions: In epilepsies associated with tuberous sclerosis, there may be an interrelation between generalized and localization‐related epilepsies, as well as one between generalized and partial seizures.
Medial Temporal Objective Lobe Epilepsy: Videotape Analysis of Clinical Seizure Characteristics
Authors: Williamson Peter D. , Thadani Vijay M. , French Jacqueline A. , Darcey Terrance M. , Mattson Richard H. , Spencer Susan S. , Spencer† Dennis D.
Published: August 2005

Summary: Purpose: The syndrome of temporal lobe epilepsy has been described in great detail. Here we focus specifically on the clinical manifestations of seizures originating in the hippocampus and surrounding mesial temporal structures.

Methods: Seizure origin was confirmed in 67 cases by depth EEG recording and surgical cure after mesial temporal resection.

Results: Among nonlateralized manifestations, we commonly found oral automatisms, pupillary dilatation, impaired consciousness, and generalized rigidity. Appendicular automatisms were often ipsilateral to the seizure focus, whereas dystonia and postictal hemiparesis were usually contralateral. Head deviation, when it occurred early in the seizure, was an ipsilateral finding, but was contralateral to the seizure focus when it occurred late. Clear Ictal speech and quick recovery were found when seizures originated in the non‐language‐dominant hemisphere, but postictal aphasia and prolonged recovery time were characteristic of seizure origin in the language‐dominant hemisphere.

Conclusions: These signs help to define the mesial temporal lobe epilepsy (MTLE) syndrome and often provide information as to the side of seizure origin.
Patient Expectations of Temporal Lobe Surgery
Authors: Wilson Sarah J. , Saling Michael M. , Kincade Penny , Bladin Peter F.
Published: August 2005

Summary: Purpose: The purpose of this study was to examine expectations of postoperative quality of life expressed by patients undergoing anterior temporal lobectomy (ATL) for the control of intractable seizures. An important component of this study was an exploration of the relationship between preoperative expectations and perceived success of the operation.

Methods: Psychosocial functioning of 60 patients was assessed preand postoperatively, using a standardised, semistructured clinical interview. Preoperative assessment included a detailed examination of the patients' expectations of surgery, while postoperative assessment at 6 months examined the patients' perception of surgical success with respect to seizure outcome and postoperative psychosocial status.

Results: A range of expectations were expressed about postoperative outcome. These were classified into 11 posthoc categories. Patients who perceived the operation as a success tended to endorse ‘practical’ expectations (i.e., driving, employment, activities) preoperatively, rather than expectations of a psychologic or social nature (i.e., self‐change, relationships). These patients experienced fewer postoperative seizures and psychosocial difficulties. In contrast, a perceived lack of success was associated with greater emphasis on psychosocial expectations preoperatively. These patients experienced a greater number of perceived postoperative psychosocial difficulties, and more postoperative seizures.

Conclusions: Preoperative expectations of surgery formed an important baseline against which to assess postoperative outcome, and should constitute a routine part of assessment in studies of psychosocial outcome of ATL.
Aggressive Behaviour in Intellectually Challenged Patients with Epilepsy Treated with Lamotrigine
Authors: Beran Roy G. , Gibson Rebecca J.
Published: August 2005

Summary: Purpose: Lamotrigine (LTG) is a valuable addition to the medical management of epilepsy with wide spectrum of efficacy and good outcomes for quality of life. We report the emergence of a syndrome of aggressive behavior provoked by LTG in patients with epilepsy and intellectual challenge.

Methods: On recognition of a tendency to aggression in intellectually challenged patients whose epilepsy was treated with LTG, a survey was conducted of those from centers specializing in management of patients with intellectual disability who were treated with LTG. Responses to LTG were sought and patient's behavioral profiles were determined.

Results: Nineteen patients were identified (16 men, 3 women, aged 17–54 years). Five patients discontinued LTG due to unprovoked aggressive behavior subsequent to its use; 2 had aggressive behavior sufficient to justify discontinuation of LTG but required reintroduction to control the epilepsy; 1 required reduction in LTG dosage; 1 had aggression that responded to psychiatric intervention; and I had aggression unrelated to LTG. Four patients had behavioral problems other than aggression, 4 had no change in behavior, and the behavior of 1 was improved by LTG treatment.
Buccal Absorption of Midazolam: Pharmacokinetics and EEG Pharmacodynamics
Authors: Scott Rod C. , Besag Frank M. C. , Boyd Stewart G. , Berry David , Neville Brian G. R.
Published: August 2005

Summary: Purpose: To determine whether buccal/sublingual administration of midazolam (MDL) would lead to detectable venous concentrations and EEG changes in 10 healthy volunteers.

Methods: The study consisted of an open‐label and a double‐blind phases. Subjects held 10 mg MDL in 2 ml peppermint‐flavored fluid or peppermint‐flavored placebo in their mouth for 5 min and then spat it out. Cardiorespiratory and EEG monitoring was performed in all subjects.

Results: Venous MDL concentrations measured on 10 occasions from 5 to 600 min after administration showed a rapid increase for the first 20–30 min. However, changes in the 8‐to 30‐Hz frequencies identified by spectral analysis of the EEG showed changes in ≤5–10 min in test but not in control subjects—more rapid than were expected from the venous absorption data. There were no significant adverse effects.

Conclusions: Our data provide direct evidence of the speed of cerebral effect of a drug. Our results suggest that the buccal/sublingual route of administration should be tested in emergency treatment of seizures as an alternative to the rectal route, over which it has clear practical advantages.
Brain Hypometabolism in a Model of Chronic Focal Epilepsy in Rat Neocortex
Authors: Hagemann Georg , Bruehl Clam , Lutzenburg Michael , Witte Otto W.
Published: August 2005

Summary: Purpose: Metabolic mapping of the human brain has become a widely used method for identifying and localizing epileptic foci. A reduction of glucose consumption usually is found interictally in the area of the focus. By contrast, animal models of acute epilepsy show a hypermetabolism in the epileptic focus. Here we investigated how metabolism is altered in an animal model of chronic epilepsy caused by focal injection of tetanus toxin into rat neocortex.

Methods: A total of 27 male Wistar rats were anesthetized and injected into the motor or sensory cortex either with dissolved tetanus toxin or with the solvent only. Animals recovered for 7, 14, or 30 days and then were anesthetized again for quantitative 14C–deoxyglucose autoradiography. Data were analyzed with an imaging program, and regional cerebral glucose metabolism (rCMRGlc) was determined.

Results: Injection of tetanus toxin into the motor cortex caused a focal hypometabolism which was confined to the cytoarchitectonic boundaries of the injected area, whereas sensory cortex injection caused a more widespread hypometabolism in all sensory cortical and connected, areas. None of the animals displayed focal hypermetabolism and we observed no significant time–dependent alteration of brain metabolism.

Conclusions: Tetanus toxin injection into the cortex of the rat induces chronic epileptic activity accompanied by a focal hypometabolism. The data suggest that the spread of the metabolic alterations depends on the connectivity of the injected cortical area.
Psychiatric Outcome of Temporal Lobectomy for Epilepsy: Incidence and Treatment of Psychiatric Complications
Authors: Blumer Dietrich , Wakhlu Sidarth , Davies Keith , Hermann Bruce
Published: August 2005

Summary: Purpose: To determine the incidence of psychiatric disorders before and after surgical treatment for partial epilepsy and to document the effectiveness of their treatment.

Methods: Fifty consecutive patients treated surgically for focal epilepsy (44 temporal and six frontal) were evaluated by established neuropsychiatric methods before surgery and over a mean period of 2 years after surgery. The patients with interictal dysphoric disorders, with or without psychotic episodes, were treated with tricyclic antidepressant medication alone or combined with serotonin selective reuptake inhibitors and, if necessary, with the addition of risperidone.

Results: Before surgery, 25 (57%) of the 44 patients with temporal lobe epilepsy had dysphoric disorders. After surgery, 17 (39%) of the 44 patients experienced either de novo psychiatric complications (six psychotic episodes, six dysphoric disorders, and two depressive episodes) or exacerbation of preoperative dysphoric disorder (three patients). Eight previously intact patients of the 19 (42%) developed dysphoric disorders after surgery that were significantly related to recurrence of seizures. All psychiatric complications occurred in the first 2 months after surgery, except for the six patients intact before surgery, who had a recurrence of seizures. A significant predictor of ultimate excellent psychiatric outcome was complete absence of seizures after surgery. All postoperative psychiatric complications remitted on treatment with psychotropic medication in the compliant patients.

Conclusions: An exceptional psychiatric morbidity is associated with the months after temporal lobectomy. Possible pathogenetic mechanisms are discussed. Antidepressant drugs are very effective in treating the psychiatric disorders of chronic epilepsy; their use in conjunction with the surgical treatment of epilepsy appears to be crucial for the overall positive outcome of a significant number of patients.
Lamotrigine Hypersensitivity in Childhood Epilepsy
Authors: Iannetti Paola , Raucci Umberto , Zuccaro Piergiorgio , Pacifici Roberta
Published: August 2005

Summary: Purpose: To evaluate the effect of lamotrigine (LTG) on several humoral and cellular immune functions in children with epilepsy and the change in immunological status in patients with LTG‐induced rash.

Methods: Sixteen children with epilepsy of unknown origin or secondary to various etiologies undergoing treatment with LTG participated in the humoral and cellular immunological study. Of these, 2 patients developed a rash during LTG treatment and are described in detail.

Results: No modifications of humoral or cellular immunity (measured at 1 and 3 months) were noted in 14 of the 16 patients during this treatment. In the 2 children who manifested rash, basal immune function was normal. In both, immediately after the skin rash appeared, there was a high increase in the percentage of activated T‐helper lymphocytes (CDCDR) and activated T‐suppressor lymphocytes (CDS‐DR), a slight increase in percentage of B lymphocytes (CD19), and a greater increase in serum concentration of IgE. In 1 of the 2 patients, reevaluation of immunity 20 days after the rash appeared and after LTG suspension showed normal percentages of CDCDR, CDS‐DR, and CD19, whereas the serum concentration of IgE had decreased.

Conclusions: The observed immunological results indicate that LTG‐induced rash may be considered an immune‐mediated hypersensitivity reaction.
Semiological Seizure Classification*
Authors: Lüders H. , Acharya J. , Baumgartner C. , Benbadis S. , Bleasel A. , Burgess R. , Dinner D. S. , Ebner A. , Foldvary N. , Geller E. , Hamer H. , Holthausen H. , Kotagal P. , Morris H. , Meencke H. J. , Noachtar S. , Rosenow F. , Sakamoto A. , Steinhoff B. J. , Tuxhorn I. , Wyllie E.
Published: August 2005

Summary: We propose an epileptic seizure classification based exclusively on ictal semiology. In this semiological seizure classification (SSC), seizures are classified as follows:

a. Auras are ictal manifestations having sensory, psychosensory, and experiential symptoms.

b. Autonomic seizures are seizures in which the main ictal manifestations are objectively documented autonomic alterations.

c. “Dialeptic” seizures have as their main ictal manifestations an alteration of consciousness that is independent of ictal EEG manifestations. The new term “dialeptic” seizure has been coined to differentiate this concept from absence seizures (dialeptic seizures with a generalized ictal EEG) and complex partial seizures (dialeptic seizures with a focal ictal EEG).

d. Motor seizures are characterized mainly by motor symptoms and are subclassified as simple or complex. Simple motor seizures are characterized by simple, unnatural movements that can be elicited by electrical stimulation of the primary and supplementary motor area (myoclonic, tonic, clonic and tonic‐clonic, versive). Complex motor seizures are characterized by complex motor movements that resemble natural movements but that occur in an inappropriate setting (“automatisms”).

e. Special seizures include seizures characterized by “negative” features (atonic, astatic, hypomotor, akinetic, and aphasic seizures).

The SSC identifies in detail the somatotopic distribution of the ictal semiology as well as the seizure evolution. The advantages of a pure SSC, as opposed to the current classification of the International League Against Epilepsy (ILAE), which is actually a classification of electroclinical syndromes, are discussed.