bluuebunny/crossref_metadata_2025 huggingface dataset:
Epileptic Seizures in Alcoholism and Diagnostic Value of EEG After Sleep Deprivation
Authors: Deisenhammer Eberhard , Klingler Dieter , Trägner Hannelore
Published: November 2007

Summary:Alcoholism and epileptic seizures frequently coincide. Two groups can be distinguished clinically and by EEG. In one group (group I), seizures occur only during a period of alcohol withdrawal or partial withdrawal and can only be explained because of alcoholism in the history of the patient. In the other group (group II), seizures occur spontaneously, as well as during alcohol withdrawal, and epileptogenic factors (residual brain damage, former epileptic seizures, and a family history of seizures) probably play an important role in the manifestation of the seizures. Paroxysms or focal abnormalities are rarely seen in group I; in group II, EEG abnormalities are seen approximately as frequently as in other epileptic conditions. Both groups were examined to determine the extent of their EEG abnormalities after 24 h of sleep deprivation. Before and after sleep deprivation, only 4% of 52 chronic alcoholic patients without epileptogenic risk factors had EEG foci. Of the 52, 2% before sleep deprivation and 8% after sleep deprivation had generalized paroxysms. Of 128 chronic alcoholic patients with additional epileptogenic factors, 19% before sleep deprivation and 24% after sleep deprivation had EEG foci, and 17% before and 28% after sleep deprivation had generalized paroxysms. The pathogenesis of epileptic seizures in both groups and the therapeutic consequences are discussed.

Alkoholismus und epileptische Anfälle treten oft gemeinsam auf. Dabei konnen zwei Gruppen klinisch und elektroenzephalographisch unterschieden werden: bei einer Gruppe treten die Anfälle nur während des Alkoholentzugs (oder Teilentzugs) auf, epileptische Risikofaktoren fehlen. Bei der anderen Gruppe treten diese Anfälle spontan oder während des Alkoholentzugs auf und es finden sich epileptische Risikofaktoren (residuale Hirnschädigung, frühere epileptische Anfälle, Familienanamnesen mit epileptischen Anfällen), die möglicherweise eine wesentliche Rolle für die Manifestation der Anfälle spielen. In der ersten Gruppe finden sich nur selten generalisierte Paroxysmen oder fokale Abnorrnitäten, in der zweiten Gruppe finden sich EEG‐Abnormitäten etwa gleich häufig wie bei anderen Patienten mit epileptischen Anfällen. Beide Gruppen wurden bezüglich der EEG‐Aktivierung nach Schlafentzug untersucht. Bei 52 Patienten rnit chronischem Alkoholismus ohne epileptische Risikofaktoren fanden sich in 4% vor und/oder nach Schlafentzug Herde, in 2% vor und in 8% nach Schlafentzug generalisierte Paroxysmen. Bei 128 Patienten mit chronischem Alkoholismus und epileptogenen Faktoren fanden sich in 19% vor und in 24% nach Schlafentzug Herde und in 17% vor und in 28% nach Schlafentzug generalisierte Paroxysmen. Pathogenese der epileptischen Anfälle und therapeutische Konsequenzen werden diskutiert.
Phenytoin Metabolism in the Cat After Long‐Term Oral Administration
Authors: Hassell Thomas M. , Maguire James H. , Cooper Gaylord , Johnson Philip T.
Published: November 2007

Summary: The metabolism of sodium phenytoin (PHT) in the cat was studied by gas‐liquid chromatographic analyses of the drug and its metabolites extracted from plasma, urine, and feces during a 5‐month course of daily oral administration. Plasma PHT levels of 15–18 μg/ml were observed. Urine contained 5‐(4‐hydroxyphenyl)‐5‐phenylhydantoin, 5‐(3,4‐dihydroxy‐1,5‐cyclohexadien‐1‐yl)‐5‐phenylhydantoin, 1‐deoxy‐1‐(5,5‐diphenylhydantoin‐3‐yl)‐β‐d‐glucopyranuronate, and unmetabolized PHT. Large quantities of PHT (32–63% of the daily dose) were observed in feces. We suggest that gastrointestinal malabsorption, extensive N‐glucuronidation, and limited hydroxylation determine the fate of orally administered PHT in the cat. This is not the case in humans.

El metabolismo de la fenitoina sódica (PHT) en el gato ha sido estudiado mediante análisis por cromatografía de gas‐liquido de la droga y sus metabolitos extraidos del plasma, orina y heces durante un periodo de 5 meses de administración diaria oral. Se registraron niveles plasmáticos de PHT de 15 a 18 μg/ml. La orina contenía 5‐(4‐hidroxifenil)‐5‐fenilhidantoina; 5‐(3,4‐dihidroxi‐1'5‐ciclohexadien‐1‐yl)‐5‐fenilhidantoina; 1‐deoxi‐1–5‐(5,5‐difenilhidantoina‐3‐yl)‐B‐D‐glucopiranuronato; y PHT no metabolizada. Grandes cantidades de PHT (32 a 63% de las dosis diarias) aparecieron en las heces. Nosotros sugerimos que una malabsorción gastrointestinal, una importante N‐glucuronidación en el higado y una hidroxilación limitada, determinan el destino de la PHT administrada oralmente al gato. Este no es el caso en el hombre.

Der Stoffwechsel des Phenytoin‐Natriums (PHT) wurde bei der Katze mit gasflüssigkeischromatographischen Analysen des Medikaments und seiner Metaboliten im Plasma, im Urin und im Stuhl während einer 5 Monate langen täglichen oralen Verabreichung untersucht. Plasma PHT‐Spiegel von 15 bis 18 μg/ml wurden beobachtet. Der Urin enthielt 5‐(4‐Hydroxyphenyl)‐5‐Phenylhydantoin; 5‐(3, 4 Dihydroxy‐1,5‐Cyclohexadien‐1‐yl)‐5‐Phenylhydantoin; 1‐Deoxy‐1‐(5,5‐Diphenylhydantoin‐3‐yl)‐B‐D‐Glucopyranuronat und unmetabolisiertes PHT. Große Mengen von PHT (32–63% der täglichen Dosis) wurden im Stuhl beobachtet. Wir vermuten, daß gastrointestinale Malabsorption, extensive hepatische N‐Glucuronisierung und eine begrenzte Hydroxylierung das Schicksal des oral verabfolgten PHT bei der Katze bestimmen. Das trifft für den Menschen nicht zu.
Effects of SKF525A, Phenobarbital, Fasting, and Carnitine on the Anticonvulsant Activity and Neurotoxicity of Valproate in Mice
Authors: Ater Stewart B. , Swinyard Ewart A. , Tolman Keith G. , Madsen Jack A. , Matsuo Fumisuke
Published: November 2007

Summary:The anticonvulsant potency of valproate (VPA), as measured by the maximal electroshock seizure model in mice, was improved by pretreatment with the microsomal inhibitor SKF525A and by fasting, but was reduced by chronic phenobarbital pretreatment. Carnitine did not significantly alter the anticonvulsant properties of VPA. These findings suggest that the efficacy of VPA can be improved by factors that alter its metabolic pattern.

La potencia anticonvulsiva de valproato (VPA), medida medrante el modelo de ataques por máximo electroshock en ratones, mejoró con un tratamiento previo con el inhibidor microsomal SKF525A y con el ayuno. Por el contrario, se redujo con un tratamiento previo con fenobarbital. La carnitina no alteró significativamente las propiedades anticonvulsivas del VPA. Estos datos sugieren que la eficacia del VPA puede ser mejorada con factores que alteran su patrón metabólico.

Die antikonvulsive Stärke von Valproat (VPA) wird im maximalen Elektroschockmodell bei Mäusen gemessen. Sie wurde durch Vorbehandlung mit dem mikrosomalen Inhibitor SKF 525 A und durch Fasten verbessert, durch chronische Vorbehandlung mit Phenobarbital jedoch vermindert. Carnitin änderte die antikonvulsiven Fähigkeiten von VPA nicht signifikant. Diese Befunde weisen darauf hin, daß die Wirksamkeit des VPA durch Faktoren gesteigert werden kann, die ihren Metabolismus verändern.
Epileptic Nystagmus
Authors: Beun A. M. , Beintema D. J. , Binnie C. D. , Debets R. M. Chr. , Overweg J. , ten Ham M. W. Van Heycop
Published: November 2007

Summary: “Epileptic nystagmus” unaccompanied by other ictal phenomena is rare. We report four new cases confirmed by ictal EEG and video or cine recording in which nystagmus was a prominent and sometimes the only clinical manifestation of the seizures. The ictal EEG showed a parietal focus in three instances and generalized spike‐wave activity in one.

El “nistagmus epiléptico” sin acompañarse de otros fenómenos ictales, es raro. Nosotros presentamos 4 casos nuevos confirmados con EEG ictal y video o registro cinematográfico, en los que el nistagmus era prominente y, algunas veces, la única manifestación ch'nica de los ataques. El EEG ictal mostró un foco parietal en 3 occasiones y actividad generalizada de punta‐onda, en otras.

Der isoliert auftretende epileptische Nystagmus ohne andere iktale Phänomene ist selten. Wir berichten über 4 neue Fälle, die durch ein Anfalls‐EEG, Video‐ oder Filmaufnahmen dokumentiert worden sind, in denen der Nystagmus deutlich war und manchmal die einzige klinische Anfallsmanifestation bildete. Das iktale EEG zeigte in 3 Fällen einen parietalen Fokus und in einem weiteren generalisierte spike wave Aktivität.
Behavioral Effects of Anticonvulsant Prophylaxis: No Effect or Artifact?
Authors: Dikmen Sureyya , Temkin Nancy , Weiler Michael , Wyler Allen R.
Published: November 2007

Summary: We examined the effects that may be attributable to current use of anticonvulsants in patients with traumatic head injury. The performances of 15 head‐injured matched pairs were compared on a comprehensive battery of neuropsychological and psychosocial measures f year post injury. The members of both groups were placed on anticonvulsants, principally phenytoin, immediately after the head injury. The members of one of the groups were still taking the drug at 1 year; the others had discontinued prior to that time. Although the results provided no evidence for appreciable side effects of anticonvulsants on formal neuropsychological or psychosocial measures, some methodological issues need to be considered in the interpretation of results and future studies of drug side effects.

Se han examinado los efectos que pueden ser atribuídos al uso de anticonvulsivantes en enfermos con traumatismos craneales. Se compararon las funciones de 15 parejas de traumatismos craneales mediante una batería comprensiva de medidas neuropsi‐cológicas y psicosciales, al año del traumatismo. Los componentes de ambos grupos fueron tratados con anticonvulsivantes, principalmente fenitoína, inmediatamente después del traumatismo craneal. Los miembros de uno de los grupos estaban todavía tomando la medicación al cabo de un año mientras que los otros la habfan interrumpido con anterioridad. Aunque los resultados no han producido evidencia de efectos colaterales apre‐ciables de los anticonvulsivantes en las medidas neuropsicoló‐gicas o psicosociales, algunos asuntos metodológicos necesitan ser considerados en la interpretation de los resultados y en es‐tudios futuros de los efectos colaterales de la droga.

Wir untersuchten die Wirkungen, die dem Gebrauch von An‐tikonvulsiva bei Patienten mit Schädelhirntrauma zugeschreiben werden könnten. Die Ergebnisse von 15 Patienten mit Schädelhirntrauma und entsprechenden Kontrollen wurde anhand neu‐ropsychologischer und psychosozialer Testbatterien ein Jahr nach der Verletzung untersucht. Beide Gruppen standen unter Antikonvulsiva, überwiegend Phenytoin, das unmittelbar nach dem Schädelhirntrauma verabfolgt wurde. Angehörige einer Gruppe nahmem das Medikament noch nach 1 Jahr, während die anderen es schon vorher abgesetzt hatten. Die Ergebnisse erbrachten keine Hinweise einer eindeutigen Nebenwirkung der Antikonvulsiva auf die formale neuropsychologishe und psycho‐sozialen Maßstäbe; einige methodische Fragen müssen bei der Interpretation der Ergebnisse und den weiteren Untersuchungen von Nebeneffekten genauer berücksichtigt werden.
Epileptic Nystagmus Associated with Typical Absence Seizures
Authors: Watanabe Kazuyoshi , Negoro Tamiko , Matsumoto Akiko , Inokuma Kazuyo , Takaesu Etsuko , Maehara Mitsuo
Published: November 2007

Summary: A 10‐year‐old girl was reported who showed horizontal nystagmus in association with typical absence and 3‐cycles/s generalized, bisynchronous spike‐and‐wave discharges. In view of the general concept that epileptic nystagmus is a manifestation of partial seizures, the occurrence of such an association deserves documentation.

Les auteurs rapportent le cas ď une fillette de 10 ans qui présentait un nystagmus horizontal au cours ď absences typiques avec décharges de P.O. à 3 c/s, généralisées, bisynchrones. Etant donné que le nystagmus épileptique est considére comme un symptôme de crise épileptique partielle, la survenue ď une telle association mérite ďétra documentée.

Una chica de 10 años presentó un nistagmo horizontal asociado con ausencias típicas y descargas de punta y onda bisíncromas, generalizadas de 3 c/s. En base al concepto general de que el nistagmo epiléptico es una manifestación de crisis parciales, la aparición de tal asociación merece documentatión.

Bericht über ein 10 Jahre altes Mädchen mit horizontalem Nystagmus in Verbindung mit typischen Absencen und generalisierten, seitengleichen 3/s spike wave Entladungen. Im Hinblick auf die allgemeine Annahme, daß den epileptogener Nystagmus ein Ausdruck von Partialanfällen ist, bedarf das Vorkommen dieser Kombination der Dokumentation.
Psychologic Adaptation of Children to Epilepsy in a Parent
Authors: Lechtenberg Richard , Akner Lois
Published: November 2007

Summary: A prospective study of the children in 12 families examined the impact of and adjustments to epilepsy in one of the parents. Young children allowed to see the parent's seizures and the treatment for those seizures adapted to the threat of illness in a parent by becoming involved in the care and supervision of the affected adult. Parents concealing the neurologic disorder from their children faced the most anger and resentment when the children discovered the epilepsy. Uncompromising and consistent disclosure of the problem to the children, regardless of their ages, by the parents allowed the children to adjust to the epilepsy while maintaining trust in and concern for both parents.

En un estudio prospectivo de los niños en 12 familias se examinó el impacto de la epilepsyía de uno de lo padres y su adaptatión a la misma. Los niños jóvenes a los que se les permitió presenciar los ataques de uno de los padres y el tratamiento de estos ataques, se adaptaron a la amenaza de la enfermedad de uno de sus progenitores mediante una participateón directa en el cuidado y superviseón del adulto afecto. Los padres que ocultaron a sus hijos su trastorno neurológico se enfrentaron con mayor resentimiento cuando sus hijos descubrieron la epilepsia. La revelación consistente del problema a los niños, sea cualquiera su edad, permite que éstos se adapten a la epilepsyía a la vez que mantienen confianza en sus padres.

Eine prospektive Untersuchung von Kindern in 12 Familien beleuchtete die Bedeutung der Epilespie bei einem Eltemteil und die Anpassungsvorgänge an die Erkrankung durch das Kind. Junge Kinder, denen man erlaubte, den Anfall des Elternteils und auch die Behandlung einies solchen Anfalles mitzuerleben, adaptierten sich dadurch an die Krankheitsbedrohung, daß sie in die Pflege und Überwachung des betroffenen Erwachsenen einbezogen wurden. Patienten, die die neurologische Störung vor ihren Kindern verbargen, erlebtten deutlichen Zorn und Verdruß, wenn die Kinder von der epileptischen Krankheit erfuhren. Kompromisslose Enthüllung des Problems durch die Eltern ohne Rücksicht auf das Alter der Kinder, ermöglichte den Kindern, sich an die Epilepsie zu gewöhnen und gleichzeitig Vertrauen und Teilaahme beiden Eltern gegenüber zu erhalten.
Effects of Anticonvulsants on Hyperthermia‐Induced Seizures in the Rat Pup
Authors: Olson James E. , Scher Mark S. , Holtzman David
Published: November 2007

Summary: We studied the effects of phenobarbital (PB), valproic acid (VPA), and phenytoin (PHT) on the electroencephalograms and behaviorally defined seizure threshold temperatures in rat pups exposed to ambient hyperthermia on the fifth day of life. Animals injected with 10, 20, or 40 μg PB/g body weight (GBW) or 80, 150, or 300 μg VPA/GBW daily from the second day of life showed seizure temperature thresholds that were about 1.0oC higher than those of controls. Pups injected with PHT had thresholds that were equal to or lower than those in controls despite blood levels greater than 20 μg/ml. Preictal rhythmic sharp wave activity appeared in VPA‐injected animals at temperatures below the threshold temperature. All experimental animals showed electrographic epileptiform activity at the threshold temperatures. We conclude that this animal model shows similar anticonvulsant efficacies to those found in human febrile seizures. This model may be useful in determining the efficacy of potentially useful anticonvulsant drugs and their mechanisms of action.

Hemos estudiado los efectos del fenobarbital (PB), ácido valpróico (VPA) y fenitoina (PHT) sobre el electroencefalograma y los umbrales de temperaturas que producen ataques definidos por el comportamiento demostrado en cachorros de rata expuestos a hipertermia ambiental en el quinto día de vida. Los animates inyectados con 10, 20 y 40 μg de PB/gramo de peso corporal (GBW) u 80, 150 y 300 μ.g de VPA/GBW dirarios a partir del segundo día de vida mostraron umbrales de temperatura que producían ataques de aproximádamente 1.0oC más elevados que los controles. Los cachorros inyectados con PHT tenían umbrales iguales o más reducidos que los controles a pesar de que los niveles superaban los 20 μg/ml. En animales inyectados con VPA se registró una actividad pre‐ictal de ondas agudas con temperaturas más bajas que la temperatura umbral. Todos los animales experimentales mostraron actividad epileptiforme electrográfica con las temperaturas umbral. Concluimos que este modelo animal demuestra la eficacia de los anticonvulsivantes de modo semejante a las convulsiones febriles en humanos. Este modelo puede ser útil para determinar la eficacia de drogas potencialmente anticomiciales y sus mecanismos de acción.
Occipital Lobe Epilepsy with Scotosensitive Seizures: The Role of Central Vision
Authors: Lugaresi E. , Cirignotta F. , Montagna P.
Published: November 2007

Summary: In four cases of occipital lobe epilepsy, clinical seizures and EEG discharges were evoked by darkness and/or closed eyes. In all cases the inducing factor was represented by the abolition of central vision. The importance of central vision in the excitation‐inhibition process of the occipital EEG discharges is emphasized in light of the anatomophysiological organization of the visual system. Scotosensitive epilepsy and benign partial epilepsy of childhood with occipital spike‐waves may represent the same clinical entity.
Variability in Level‐Dose Ratio of Valproate: Monotherapy Versus Polytherapy
Authors: Levy Rene H.
Published: November 2007

One of the most useful pharmacokinetic parameters of a drug is the level‐dose ratio. This ratio originates from a relationship between the dosing rate (i.e., the daily dose) and the corresponding steady‐state plasma level. For most drugs that relationship is linear, indicating that changes in doses are associated with proportional changes in plasma levels. This proportionality between plasma level and dose is an expression of the fact that the clearance of the drug is constant. Valproic acid has been available in a number of countries for over a decade, and in spite of the large number of pharmacokinetic studies available in the literature, it is not possible, at the present time, to define a characteristic level‐dose ratio. This situation is a result of the fact that the clearance of valproate exhibits large interpatient variability. This article presents an analysis of the causes for the variability in valproate clearance. It is shown that when the determinants of valproate clearance are understood and taken into consideration, only a few factors are found to have a profound influence on it. Most important among these are age and polytherapy.
Controlled and Comparative Trials with Valproate: United States
Authors: Ramsay R. Eugene
Published: November 2007

Valproic acid (VPA) was released for general use in the United States in 1978. Since that time the use of VPA has steadily grown, and considerable literature on valproate from the United States has resulted. Despite this fact, however, very few studies that were either well controlled or compared the efficacy of VPA with that of another standard anticonvulsant drug have been published from this country.
Adverse Effects of Valproate
Authors: Schmidt Dieter
Published: November 2007

Any review on adverse effects alone without due reference to the therapeutic benefits of a valuable drug is in danger of exaggerating the side effects. Nevertheless, it is reasonable to expect that some of the signs and symptoms seen in patients with epilepsy may not be due to the epilepsy but rather to the adverse effects of antiepileptic drugs (Schmidt and Seldon, 1982). Awareness of the common and the less well‐known adverse effects will increase the safety of a drug, such as valproate, that is taken chronically by many patients worldwide. From a clinical perspective, any unwanted reaction may be seen as an adverse effect. Adverse effects can usually be classified in a small number of rather rare but sometimes fatal and mostly unpredictable drug‐induced diseases or in more frequent, mostly mild, dose‐related, and reversible side effects (Schmidt, 1983). The adverse effects of valproate are difficult to classify in that scheme, because dose dependency is rare and the mechanisms of most adverse reactions are not well understood. It may therefore be useful to start with an overview of the common adverse effects observed in therapeutic trials, followed by a review of the individual organ systems involved in the adverse effects of valproate, including rather rare drug‐induced diseases. The purpose of this review is to provide an overview of the adverse effects of valproate, except for its hepatotoxic and teratogenic actions, which will be covered by Prof. Jeavons (S50–55).
The Use and Impact of Positron Computed Tomography Scanning in Epilepsy
Authors: Mazziotta John C. , Engel Jerome
Published: November 2007

Summary: Through the effective combination of instrumentation, tracer kinetic principles, and radiopharmaceuticals, positron computed tomography (PET) allows for the analytic, noninvasive measurement of local tissue physiology in humans. A large number of studies have already been performed in patients with epilepsy using 18F‐fluorodeoxyglucose (FDG) to measure local cerebral glucose utilization. In patients with complex partial epilepsy who are candidates for surgery, hypometabolic zones have been seen consistently (70%) in the interictal state. These areas of hypometabolism have been related to electroencephalographic findings, surgical pathology, and clinical symptomatology. The complex anatomical and pathophysiological investigation of these hypometabolic zones is discussed. Ictal studies of patients with partial seizures have demonstrated a much more variable metabolic pattern which usually consists of hypermetabolism relative to baseline or interictal studies. Generalized epilepsy produced by electroconvulsive shock and petit mal epilepsy have been studied using FDG to estimate glucose metabolism. These studies demonstrated hypermetabolism in the ictal state, relative to interictal or postictal scans, but with a more generalized pattern than ictal studies of partial seizures. Methodological problems in the study of epilepsy with PET are discussed in detail. The investigation of interictal hypometabolism through animal models of epilepsy and quantitative autoradiography is described as a means to understand the human PET results. The impact and future direction of PET studies in epileptic populations will probably employ the use of behavioral, pharmacological, and electrophysiological maneuvers to provide more specific details about the fundamental pathophysiological mechanisms of specific aspects of epilepsy. These techniques may allow for a truly pathophysiological classification system for the common and unusual types of epilepsy, and through this classification system improve the therapeutic and prognostic clinical approach to patients
Dopaminergic Supersensitivity After Long‐Term Administration of Phenytoin in Rats
Authors: Lalonde Robert
Published: November 2007

Summary: Male albino rats (n = 10) were injected with phenytoin (PHT) every day for 20 consecutive days and were tested on days 21 and 28 for their response to 1 mg/kg apomorphine, a dopamine‐receptor agonist. Rats treated with PHT showed an increased responsiveness to apomorphine‐induced stereotypy on day 28, which is evidence for dopaminergic supersensitivity after long‐term treatment with the drug. In experiment 2, a supersensitivity response to apomorphine‐induced stereotypy was noted on day 14 after 10 days of PHT administration. In experiment 3, after 17 days of PHT administration, rats were also supersensitive to the climbing response induced by apomorphine. These results may explain, in part, the clinical findings of orofacial dyskinesias produced by PHT in epileptic patients.

On a injecté de la phénytoine (PHT) à des rats albinos mâles (n=10) tous les jours pendant 20 jours consécutifs, puis l'on a testé leur reaponse à 1 mg/kg d'apomorphine, agoniste des récepteurs dopamine, au 21ème et au 28ème jours. Chez le srates rats traités par le PHT la réactivité aux stéréotypies induites par l'apomorsensibilité dopaminergique, après un traitement de longue durée par cette frogue. Dans le deuxième expérimentation une hyper sensibilité dans la réponse aux stéréotypies induites par l'apomorphine était notée le 14ème jour après 10 jours d'administration de PHT. Dans la troisième expérimentation, au 17ème jourd'administration de PHT les rates étaient aussi hypersensibles à la réponse “grimpement” induite par l'apomorphine. ces résultats peuvent expliquer en partie les dyskinésies oro‐faciales que l'on observe sout PHT chez certains partients épileptiques.

Seha inyectado fenitoíno (PHT) diariamente durante 20 días consecutivos, a 10 ratat albino macho en las que se probó en los días 21 y 28 sus respuestas a 1 mg/kg de apomorfina, un agonista des receptor dopamínico. Se encontrjoA que las ratas tratadas con PHT mostraron una respusta incrementada de las estereotipias inducidas por la apomorfina enel día 28, aue se interpreta como evidenceia de una superexcitabilidad de las estereotipias inducidas por las apomorfina en el día, 14, después de 10 días de administraciÓn de PHT. las ratas también mostraron una supersensitividas al trepar inducido por la apomorfina. Estos resultados pueden explicar, en parte, sos hallazgos clíinicos de disquinesias orofacilaes producidas por la PHT en pacientes epilépticos.
Neuron Density in the Molecular Layer of the Frontal Cortex in Primary Generalized Epilepsy
Authors: Meencke H.‐J.
Published: November 2007

Summary: Developmental disturbance of the brain as a factor in the causation of epilepsies has been suspected for a long time. An increase of nerve cells in the stratum moleculare, which is qualitatively observed in primary generalized epilepsy, is thought to be an indicator for slight maldevelopment. In this morphometric study, the neuron density of layer I in the frontal lobe in primary generalized epilepsy is measured. Compared with age‐matched controls, the neuron density in primary generalized epilepsy is significantly increased. Thus, neuron density could be a significant index for the disturbance of regional maturation of the cortex.

Schon seit langer Zeit wird vermutet, dass Hirnentwicklungsstörungen ein ätiologischer Faktor für Epilepsien sein können. Diffuse Zu‐nahme von Nervenzellen im stratum moleculare, bei primär generalisierten Epilepsien besonders häufig beobachtet, wurde als Hin‐weis für eine leichte Fehlbildung angesehen. In dieser morphome‐trischen Untersuchung wurde die Nervenzelldichte im stratum moleculare des Frontalpols bei primär generalisierter Epilepsie bestimmt. Dabei zeigte sich, dass die Nervenzelldichte gegenüber altersgleichen Kontrollen signifikant höher ist. Dieser Befund kann ein wichtiger Hinweis auf eine regionale Entwicklungsstörung des Cortex sein.
Myocardial Infarction Complicating Status Epilepticus
Authors: Sechi GianPietro , Dessì‐Fulgheri Paolo , Glorioso Nicola , Volta Giorgio , Rosati Giulio
Published: November 2007

Il n'existe pas de documentation concernant l'infarctus du myocarde comme complication de l'état de mal épileptique (SE). Chez un homme âgé de 31 ans un infarctus myocardique infero‐latéral aigu s'est développé pendant des crises épileptiques répétées. Une étude angiocinématographique effectuée 6 mois plus tard a mis en évidence des artères coronales normales et un anévrysme apical dans le ventricule gauche. Les auteurs discutent les principaux mécanismes pathogéniques et le traitement possible.

No existe documentación acerca del infarto de miocardio como complicación del status epilepticus (SE). Un hombre de 31 años de edad desarrolló un infarto de miocardio agudo infero‐lateral durante ataques epilépticos repetitivos. Un estudio cineangiográfico realizado 6 meses más tarde reveló unas arterias coronarias normales y un aneurisma apical en el ventrículo izquierdo. Se discuten los mecanismos patogénicos más importantes que participan en esta complicación y también las posibilidad terapéuticas.

Es gibt keinen dokumentierten Myocard‐Infarkt als Komplikation eines Status epilepticus (SE). Ein 31 Jahre alter Mann entwickelte einen akuten infero‐lateralen Myocard‐Infarkt während repetetiver epileptischer Anfälle. Die Cineangiographie 6 Monate später zeigte normale Koronararterien und ein apikales Aneurysma des linken Ventrikels. Die hauptsächlichen pathogenetischen Mechanismen und ein therapeutischer Weg werden diskutiert.

Summary: No documentation is available for myocardial infarction complicating status epilepticus. A 31‐year‐old man developed an acute inferolateral myocardial infarction during repetitive epileptic seizures. A cineangiographic study performed 6 months later revealed normal coronary arteries and an apical aneurysm in the left‐ventricle. The main pathogenetic mechanisms involved and a therapeutic possibility are discussed.
Sleep and Epilepsy
Authors: Kellaway Peter
Published: November 2007

Summary: Epileptic mechanisms in the brain are subject to long‐duration, time‐ordered neuromodulatory processes controlled by endogenous oscillators which are responsible for appropriately phased modulation of various normal physiological processes, including the 24‐h sleep/wakefulness cycle and the ultradian 100‐min cycle of rapid eye movement/non‐rapid eye movement sleep. Both focal and generalized types of epileptiform activity in humans are subject to biorhythmic modulation, and the various modulation patterns observed are in accord with a model which explains these patterns as a consequence of the interaction of two endogenous modulatory processes: one with a period of about 24 h, the other with a period of about 100 min. Differences in the phase angle between the two cyclic processes, determined by time of sleep onset, explain the various modulatory patterns observed. The mechanisms involved in the genesis and elaboration of electrical epileptiform activity in animal models are examined in relation to known processes involved in the physiology of sleep, and compared with data derived from long‐term studies of the time distribution of epileptic events in humans. In infantile spasms, clinical seizure activity and the ictal and interictal EEG patterns in relationship to the phases of the sleep cycle, the significant defects in the quality and quantity of sleep in this disorder, and the changes that take place in all of these when seizures are abolished by effective treatment, suggest that pontine mechanisms responsible for the sleep cycle may be involved in the elaboration of infantile spasms and hypsarrhythmia.
Myoclonus: Relation to Epilepsy
Authors: Hallett Mark
Published: November 2007

Summary: Myoclonus can be divided into those types which are fragments of epilepsy and those which are non‐epileptic. Epileptic myoclonus is viewed as the effect of an isolated spike in neurons of the motor system. Cortical reflex myoclonus is a fragment of partial epilepsy and represents hyperactivity of a focal area of cerebral cortex. Reticular reflex myoclonus is a fragment of generalized epilepsy with hyperactivity of medullary brainstem reticular formation. Primary generalized epileptic myoclonus is a fragment of primary generalized epilepsy and may represent a generalized hyperactive response of cortex to subcortical input.
A Comparison of Phenytoin Dosing Methods in Private Practice Seizure Patients
Authors: Welty T. E. , Robinson F. C. , Mayer P. R.
Published: November 2007

Summary: In an attempt to evaluate the accuracy of phenytoin (PHT) pharmacokinetic dosage adjustments in a private practice setting, three single dose‐concentration pair methods and three multiple point PHT pharmacokinetic dosing methods were studied. Dose and concentration data from 28 patients seen in a private neurology practice were utilized for the study. From a comparison of these methods in private practice seizure patients, it appears that the Bayesian feedback method may be the most accurate in making routine PHT dosage adjustments, perhaps by minimizing the contribution of unknown variables within the Bayesian approach.

RESUME

Dans le but d'évaluer l'exactitude de l'adaptation de posologie pharmacocinétique de la PHT dans des conditions de pratique privée, 3 méthodes d'évaluation par paire de concentration en dose unique et 3 méthodes de dosages pharmacocinétiques de la PHT à détermination multiple ont étéétudiées. Les résultats des concentrations et des doses chez 28 patients vus en pratique privée neurologique ont été utilisés pour cette étude. La comparaison de ces méthodes chez des épileptiques suivis en pratique privée montre que celle du feed‐back Bayesien pourrait ětre la plus exacte pour l'adaptation de la posologie de la PHT en routine, peut‐ětre en minimisant la contribution de variables inconnues dans l'approche bayesienne.

Intentando evaluar la exactitud, de los ajustes farmacocinéticos de dosis de fenitoína (PHT) en un consultorio privado de neurología, se estudiaron 6 métodos farmacocinéticos de dosificación, 3 de los cuales requerían que se proveyera una sola dosis (par dosis sencilla‐concentración) y los 3 restantes requerían múltiples dosis (par dosis múltiple‐concentración). Se utilizaron para el estudio datos de dosis y concentración de 28 pacientes epilépticos. Si se comparan los métodos de dosificación en dichos pacientes, parece ser que el método Bayesiano sería el más exacto para hacer ajustes de rutina en la dosis de PHT quizás porque dicho método minimiza variables desconocidas y su posible contribución en el cálculo de la dosis final.

In einem Versuch, die Genauigkeit der Phenytoin (PHT) Pharmakokinetik entsprechend der Dosierung in einer privaten Praxis zu prüfen, wurden verschiedene Methoden (3 Einzeldosis‐ Konzentrationspaare und 3 PHT‐Profile) untersucht. Dosierungs‐ und Konzentrationsdaten lieferten 28 Patienten einer privaten neurologischen Praxis. Ein Vergleich dieser Methoden bei Patienten einer Privatpraxis lät vermuten, daß die feedback‐Methode nach Bayes die besten Ergebnisse für die routinemäige PHT‐Dosisoptimierung liefert. Das mag daran liegen, daß der Einflu unbekannter Variablen bei Anwendung dieser Methode minimiert wird.
Liposome‐Entrapped γ‐Aminobutyric Acid Inhibits Isoniazid‐Induced Epileptogenic Activity in Rats
Authors: Loeb Carlo , Besio Gabriella , Mainardi Paolo , Scotto Pierangelo , Benassi Enrico , Bo Gian Paolo , Sanchez A. Portera , Scheffner D.
Published: November 2007

Summary: Sprague—Dawley rats with interictal and ictal spike activity induced by intraperitoneally injected isoniazid (INH) were treated, 5 min before or 30 min later, with liposome‐entrapped γ‐aminobutyric acid (GABA) (LEG) or GABA or phosphatidylserine. Crossover injections were given in random sequence and INH alone was also injected in every animal as a control. LEG inhibited either seizures or interictal spikes in both groups. No decrease of epileptogenic activity was seen after GABA or phosphatidylserine treatment alone. It is suggested that LEG could contribute to the reconstitution of the GABA pool decreased by INH.

Vingt Sprague‐Dawley rats injectés avec Isoniazid (INH) et démontrant une activité ictal et interictal de pointes, ont été traités avec GABA associéà une preparation liposomal de Phosphatidylserine (LEG), ou GABA, ou PS. Le LEG démontre une activité inhibitrice soit sur l'activité de pointes interictales. soit sur l'activité de crise epileptique tandis que le GABA ou la PS n'ont aucune action. Cet observation suggére que le LEG peut contribuer à la reconstitution du pool de GABA. reduit par le INH.

Se ha utilizado el GABA (LEG), el GABA o la Fosfatidilserina unidos a liposomas. en el tratamiento de ratas Sprague‐Dowley con puntas interictales e ictales inducidas mediante la inyeccién intraperitoneal de Isoniazida (INH). Las inyecciones se administraron mediante téenica “crossover” en secuencia randomizada y la INH también se inyectó a cada animal como control. El LEG inhibió tanto los ataques como las puntas interictales en ambos grupos. No se observé un decremento de la aclividad epileptogénica después del GABA o después de la fosfatidilserina. administrados independientemente. Se sugiere que el LEG puede contribuir a la reconstitución del reducido acúmulo de GABA producido por la INH.

Sprague‐Dowley‐Ratten mit interiktaler und iktaler spike‐Aktivität als Folge i.p.‐injizierten Isoniazids (INH) wurden fünf Minulen vorher oder dreissig Minulen später mit in Liposomen verkapselter GABA (LEG) oder GABA oder Phosphatidylserin behandelt. Die unterschiedlichen Injektionen wurden in zufäl‐liger Folge verabreicht und INH alleine wurde ebenso als Kontrolle jedem Tier injiziert. LEG inhibierte in beiden Gruppen entweder Anfälle oder interiktale spikes. Eine Abnahme der epileptogenen Aktivitat fehlte nach GABA oder Phosphatidylserin alleine. Es wird vermutet, daß LEG einen Beitrag zum Wiederherstellen des GABA‐Pools leisten könnte, der durch INH vermindert ist.
Estrogen Alters the Acquisition of Seizures Kindled by Repeated Amygdala Stimulation or Pentylenetetrazol Administration in Ovariectomized Female Rats
Authors: Horn Anne C. , Buterbaugh Gary G.
Published: November 2007

Summary: Ovariectomized female rats received estradiol (E2) replacement by means of subcutaneous silastic capsules (10% E2 in cholesterol). E2‐replaced rats required fewer daily amygdala stimulations to develop fully kindled seizures as compared with ovariectomized rats implanted with cholesterol‐only capsules. Other rats were injected with pentylenetetrazol (PTZ), 40 mg/kg i.p., every 48 h. E2‐replaced rats showed a progressive increase in convulsive severity from minimal responses after the first injection to tonic convulsions after eight injections. Most rats without E2 replacement failed to progress past clonic convulsive responses after 22 injections. The results support a marked influence of E2 on seizure processes as demonstrated in two different models of seizure acquisition.

Des rates ovariectomisées ont reçu de l'estradiol (E2) de remplacement par l'intermédiaire de capsules en silastique sous‐cutanées (10% d'E2 dans du cholestérol). Chez les rates recevant E2 il fallait moins de stimulations quotidiennes de l'amygdale pour obtenir des crises complètes par embrasement que chez des rates ovariectomisées chez qui les capsules implantées contenaient seulement du cholestérol. Chez d'autres rates on a injecté du pentylenetetrazol (PTZ), 40 mg/kg intra‐péritonéal toutes les 48 H. Chez les rates recevant E2 on observait une augmentation progressive de la sévérité des convulsions, allant de réponses minimales après la première injection à des convulsions toniques après 8 injections. La plupart des rates sans E2 de substitution n'arrivaient pas à dépasser des réponses convulsives cloniques après 22 injections. Ces résultats sont en faveur de l'influence de l'estradiol sur les processus critiques, démontrée dans 2 modèles différents d'acquisition des crises.

En ratas hembras ovariectomizadas se restituyǒ el estradiol (E2) mediante capsulas silásticas subcutáneas (10% E2 de coles‐terol). Las ratas que tomaban E2 requirieron menos estimulaciones diarias de la aniígdala para desarrollar ataques completamente condicionados (kindled), comparándo las con las ratas ovariectomizadas en las que se habían implantado capsulas de colesterol. Otras ratas fueron inyectadas con pentilenetetrazol (PTZ), 40 mg/kg i.p., cada 48 horas. Las ratas que habían to‐mado E2 mostraron un incremento progresivo en la severidad convulsiva que osciló, de minimas respuestas tras la primera in‐yección, a convulsiones tónicas después de 8 inyecciones. La mayor parte de las ratas sin E2 no empeoró después de las respuestas convulsivas tras 22 inyecciones. Estos resultados indican que existe una marcada influencia del estradiol sobre los procesos convulsivos como queda demostrado en dos modelos diferentes de adquisiciǒn de ataques.
Double‐Blind, Placebo‐Controlled Study of Vigabatrin (Gamma‐Vinyl GABA) in Drug‐Resistant Epilepsy
Authors: Loiseau P. , Hardenberg J. P. , Pestre M. , Guyot M. , Schechter P. J. , Tell G. P.
Published: November 2007

Summary: Vigabatrin (GVG) (3 g/day) and placebo were compared as an add‐on to standard therapy in therapy‐resistant epileptic patients using a double‐blind crossover design with randomized treatment allocation. Twenty‐three patients entered the trial, with four dropping out due to either increased seizure frequency following the cross‐over from GVG to placebo (n = 1), intolerance to GVG therapy (n = 2), or poor seizure record (n = 1). Of the 19 patients who completed the study, 17 had partial seizures, eight of whom had secondary generalization and two who had primary generalized seizures. Compared with placebo, GVG was associated with a significant reduction in seizure frequency (p < 0.01), with 11 of 19 patients experiencing >50% reduction in weekly seizure occurrence, two showing a 25–50% reduction, four unchanged, and two showing an increase in seizures. Global efficacy ratings were greater in the GVG period for 15 patients (p < 0.05) compared with one in whom there was no period difference and two in whom ratings were higher in the placebo period. Fourteen of the 19 patients indicated a preference for the GVG period. Adverse effects observed during GVG treatment were generally mild and consisted of drowsiness, confusion, nausea, irritability, and constipation. No clinically significant alterations in laboratory test results were observed. No treatment‐related changes in plasma concentrations of concomitant antiepileptic drugs were noted. These results confirm the antiepileptic efficacy of oral GVG in refractory epileptics.
Efficacy of Second Line Antiepileptic Drugs in the Treatment of Patients with Medically Refractive Complex Partial Seizures
Authors: Dasheiff Richard M. , McNamara Delores , Dickinson LaVera
Published: November 2007

Summary: The efficacy of second‐line antiepileptic drugs (AEDs) was evaluated in the treatment of 66 patients with complex partial seizures who had previously failed first‐line AEDs. Methsuximide, valproate, or clorazepate had eliminated seizures in 11% of the patients at the end of the study. However, these good results deteriorated on longer follow‐up and were not expected to be permanent. It is recommended that suitable patients with partial epilepsy be referred for surgical evaluation after failing the first‐line AEDs, and that second‐line AEDs be reserved for nonsurgical candidates.

L'efficacité des médicaments antiépileptiques de seconde ligne (AEDs) a étéévaluée chez 66 patients ayant des crises partielles complexes qui avaient résisté aux AEDs de première ligne. Le methsuximide, le valproate ou le clonazepate avaient éliminé les crises chez 11% des malades à la fin de l'étude. Cependant ces bons résultats diminuaient avec le témps et il est probable qu'ils ne sont pas durables. 11 est recommandé d'envoyer les patients avec épilepsie partielle susceptible de bénéficier d'un traitement chirurgical chez les chirurgiens après l'échec des médicaments de première ligne et de réserver les médicaments de seconde ligne à ceux qui ne peuvent pas ětre candidats à un traitement chirurgical.

Se ha evaluado la eficacia de medicaciones antiepilépticas de segunda categoría (AEDs) en el tratamiento de 66 enfermos con ataques parciales complejos que no habían mejorado previamente con AEDs de primera categoría. La metosuximida, el valproato y el cloracepato habi'an eliminado los ataques en el 11% de los pacientes al finalizar el estudio. Sin embargo estos buenos resultados no fueron persistentes al no mantenerse durante un periodo de seguimiento más largo. Se recomienda que pacientes seleccionados y adecuados, con epilepsia parcial, sean referidos para una evaluación quirúrgica si han fallado en ellos los AEDs de primera categoría, reservando los AEDs para los candidatos no quirúrgicos.

Die Wirkung von Antiepileptika (AED) der zweiten Wahl wurde bei der Behandlung von 66 Patienten mit komplexen Partialanfällen geprüft, die sich als résistent gegenüber AED der ersten Wahl erwiesen. Methsuximid, Valproat oder Clorazepat hatten die Anfälle bei 11% der Patienten am Ende der Untersuchung eliminiert. Diese guten Ergebnisse verschlechterten sich jedoch bei längerer Beobachtung und dürfen nicht als endgültig angesehen werden. Es wird empfohlen, geeignete Patienten mit Partialepilepsie zur neurochirurgischen Begutachtung zu über‐weisen, wenn die Antiepileptika der ersten Wahl versagen sollten. Antiepileptika der zweiten Wahl sollten für nicht‐chirurgische Kandidaten reserviert bleiben.
Eating Seizures
Authors: Loiseau Pierre , Guyot Martine , Loiseau Hugues , Rougier Alain , Desbordes Patrice
Published: November 2007

Summary: An 18‐year old man had a cluster of three seizures in a few hours and then remained seizure‐free without medication: his mother has experienced seizures induced by movement. A 29‐year‐old man has had recurrent seizures for six years. In both cases, seizures were partial motor seizures induced by chewing. They are considered to be a particular variety of movement‐induced seizures triggered by proprioceptive afferents of muscular origin. This explanation does not account for the great majority of the 63 published cases of seizures precipitated by eating. Eating seizures represent a heterogeneous group of seizures with discrete electroclinical signs and mechanisms. The term “eating seizures” should be preferred to the term “eating epilepsy.”

Un adolescente de 18 años tuvo. en algunas horas. tres crisis que cesaron espontáneamente sin tratamiento. Su madré habia tenido crisis desencadenadas por el movimiento. Un hombre de 29 años tuvo crisis repetidas durante 6 años. En los dos casos se trataba de crisis motoras parciales desencadenadas por la masticación. Estas crisis se consideran como una variedad particular, provocadas por el movimiento y desencadenadas por aferencias proprioceptivas de origen muscular. Esta explicación no es válida para la mayonía de las 63 crisis provocadas por la alimentación publicadas en la literatura. Las crisis de la alimentación constituyen un conjunto heterogéneo con expresiones electro‐clínicas diversas y respondiendo a mecanismos diferentes. El término de crisis provocadas por la alimentación es preferible al de epilepsfa provocada por la alimentación.

Ein 18‐jähriger erlitt innerhalb weniger Stunden eine Serie von 3 Anfällen, die sich ohne Behandlung nichl wiederholten. Seine Mutter hatte früher bewegungsinduzierte Anfalle. Ein 29‐jähriger Mann hatte in einem Zeitraum von 6 Jahren wiederholt Anfälle. In beiden Fällen handelt es sich um motorische Herdanfälle. die durch Kauen ausgelöst werden. Dabei handelte es sich um eine spezielle, bewegungsinduzierte Anfallsart. die durch propriozeptive Erregungen muskulären Ursprungs hervorgerufen werden. Für den Großteil der publizierten, durch Nahrung‐saufnahme hervorgerutenen Anfalle trifft diese Erklarungjedoch nicht zu. Diese sind eine heterogene Gruppe mit unterschiedlichem elektroklinischem Korrelat. die durch verschiedene Mechanismen ausgelöst werden. Die Definition alimentär bedingte Anfälle soil den Epilepsien vorbehalten werden, die durch Nahrungsaufnahme ausgelöst werden.