bluuebunny/crossref_metadata_2025 huggingface dataset:
Approaches to make CDS/ISIS databases interoperable with OAI‐compliant digital libraries
Authors: Jayakanth F. , Maly K. , Zubair M. , Aswath L.
Published: August 2005

Purpose

To make CDS/ISIS databases OAI‐compliant.

Design/methodology/approach

One of the biggest obstacles for information dissemination to a user community is that many digital libraries or bibliographic databases use heterogeneous technologies that inhibit interoperability. The Open Archives Initiative (OAI) addresses interoperability by using a framework to facilitate the discovery of content stored in distributed archives or bibliographic databases through the use of the OAI Protocol for Metadata Harvesting (OAI‐PMH). Though the OAI‐PMH is becoming the de facto standard, many of the legacy databases or bibliographic systems, for various reasons, are not OAI‐compliant. CDS/ISIS is one such database system. In this paper, we discuss the static repository (SR) approach to make CDS/ISIS databases OAI‐compliant. The records from a CDS/ISIS database are exported onto a file and the exported records are then converted to the SR XML file format. The SR file is made OAI‐compliant either by ingesting it into the Kepler Archivelet or through the intermediation of a static repository gateway (SRG).

Findings

The SR is a simple approach for making bibliographic records contained in non‐OAI‐compliant systems, OAI‐compliant.

Research limitations/implications

The SR approach is meant for records, which are relatively static. If the OAI‐compliance is achieved through the SRG, then the number of records contained in a SR file should not exceed 5,000. However, if the SR file is ingested into the Kepler Archivelet, then there is no restriction on the number of records contained in a SR file.
Assessing the quality of disclosure on intangibles in the Spanish capital market
Authors: García‐Meca Emma , Martínez Isabel
Published: August 2005

Purpose

The purpose of this study is to analyse the quality of disclosure on intangibles in presentations to analysts held by firms listed in the Spanish capital market. Given that quantification of the information provides a more precise and convincing message than qualitative disclosure, the information is measured by two indices, which are focused on the specificity of the disclosure.

Design/methodology/approach

The reports of all presentations to financial analysts held by Spanish companies listed in the Madrid Stock Exchange are analysed during the year 2000 and 2001. The sample contains 257 reports.

Findings

Briefly, the study finds that there are differences in the quality of the information reported to financial analysts in Spain, and that several factors, such as firm size and the levels of profitability and leverage, highly influence it.

Practical implications

This study contributes to the literature by analysing the disclosure of the information on intangibles beyond the commonly used disclosure/no disclosure dichotomy. Consequently, this study introduces different indices in order to analyse not only the extent but also the specificity of disclosure.

Originality/value

Establishing the quality of overall disclosure on intangibles, as well as the categories on which the specificity is higher, should be relevant for management teams when they design their disclosure strategies. In addition, understanding why firms disclose information on intangibles to financial analysts and why its quality varies among them is also useful to the users of accounting information as well as to accounting policy makers.
Supplier selection and controlling using multivariate analysis
Authors: Lasch Rainer , Janker Christian G.
Published: August 2005

Purpose

An efficient supplier management is of central importance for successful supply chain management. It begins with the identification of potential suppliers and leads to the controlling of the supplier‐buyer‐connection. This paper aims to design a new supplier‐rating system that fits the practical needs of supplier rating and supports many other steps of the suppliers management process.

Design/methodology/approach

An empirical study on supplier rating among 193 industrial companies revealed that the existing methods for supplier rating do not satisfy the needs in practice. This paper describes a multivariate analysis tool for managing a pool of engaged or future suppliers. A constructed ideal supplier serves as a reference to compare all suppliers by means of multivariate analysis methods. A case study illustrates the application of the tool.

Findings

The empirical study found out new needs for supplier‐rating methods such as graphical representation of the suppliers. The designed supplier‐rating system uses principal component analysis to create a classification and ranking of the potential suppliers by means of ellipsoid clusters. If this new supplier‐rating system is applied repeatedly, a dynamic observation of the suppliers is guaranteed, always corresponding to real market conditions.

Originality/value

The new system has to run computerized and can be used for pre‐qualification, selection and controlling of suppliers. It is easy to handle and practicable without using manual criteria‐weighting.
Gendered dilemmas of the work‐life balance in Hungary
Authors: Toth Herta
Published: August 2005

Purpose

The aim of this paper is to examine the gendered nature of work‐life policies in and the work‐life conflicts of managers in a multinational corporation in Hungary.

Design/methodology/approach

The research is based on 30 qualitative interviews with male and female managers at junior, middle and senior management levels located in Unilevers Eastern European headquarters in Budapest.

Findings

The results show that while legislative measures for family‐leave related policies are being encouraged in the EU, this is not the case with employer organizations in transition states, yet this is an important aspect of gender and employment policy as accession states begin to redesign their programmes to fall in line with EU guidelines. The research reveals that attempts to introduce family‐friendly policies still create gendered effects and gendered dilemmas for individual managers. The results reveal that men and women have different perceptions of work‐life balance and adopt different coping strategies to manage work and family commitments. Overall it is found that work‐life balance is constructed as an individual, rather than a corporate responsibility and this also creates gendered inequalities.

Research limitations/implications

The study focuses on one organisation in a transition context and so results cannot be generalised.

Originality/value

The paper aims to contribute to the limited knowledge that currently exists on work‐life initiatives in a transition context and attempts to clarify how gender equality measures can be understood and further developed within the Hungarian context.
Western and Eastern views on social networks
Authors: Ordóñez de Pablos Patricia
Published: August 2005

Purpose

The aim of this paper is to examine social networks from a Western and Eastern view.

Design/methodology/approach

The paper uses case study methodology to gather evidence of how world pioneering firms from Asia and Europe measure and report their social connections from a Western perspective.

Findings

It is examined the basic indicators firms use to measure these networks and the major issues managers should consider when measuring and reporting these knowledge‐based resources. These indicators can be classified into four categories: customer description, customer portfolio, stakeholder capital and social networks. In total the study finds 29 relevant indicators for organizational social connections.

Originality/value

The paper provides great value both for academics and executives interested in the analysis of social networks both from a Western and Eastern view.
Contextual prerequisites for the application of ILS principles to the building services industry
Authors: John G.A. , Clements‐Croome D.J. , Fairey V. , Loy H.M.
Published: August 2005

Purpose

This paper proposes assessing the context within which integrated logistic support (ILS) can be implemented for whole life performance of building services systems.

Design/methodology/approach

The use of ILS within a through‐life business model (TLBM) is a better framework to achieve a well‐designed, constructed and managed product. However, for ILS to be implemented in a TLBM for building services systems, the practices, tools and techniques need certain contextual prerequisites tailored to suit the construction industry. These contextual prerequisites are discussed.

Findings

The case studies conducted reinforced the contextual importance of prime contracting, partnering and team collaboration for the application of ILS techniques. The lack of data was a major hindrance to the full realisation of ILS techniques within the case studies.

Originality/value

The paper concludes with the recognition of the value of these contextual prerequisites for the use of ILS techniques within the building industry.
The developing direct relationship between a manufacturer and consumers
Authors: Endo Seiji , Kincade Doris H.
Published: August 2005

Purpose

To investigate consumers' characteristics during internet shopping for customized products in order to reduce the distance between a manufacturer and consumers.

Design/methodology/approach

Qualitative methods were conducted with longitudinal interviewing with 20 participants. For the shopping experiment, a web site was used by participants to order two pair of customized shoes based on each participant's needs.

Findings

Four groups were identified during the shopping experiments. The result suggested that each group of participants had different priorities for a satisfying shopping experience in terms of customized products.

Originality/value

This paper identified the relationship between a manufacturer and consumers by ordering customized products through online.
An empirical study of university spin‐off development
Authors: Gübeli Manuel H. , Doloreux David
Published: August 2005

Purpose

The paper is concerned with spin‐off firms and the process by which a new firm is created and formed from a university. The objectives are to examine characteristics of firms generated by this process, and the intensity of the spin‐off firms' network activity with the parent organisation and the local environment during this process.

Design/methodology/approach

The findings are based on a case‐study consisting out of three firms spun‐off from a research centre at Linköping University in the area of visualisation and computer graphics. The source data are gathered from semi‐structured interviews. No generalisation should be drawn from this study due to the small number of firms interviewed and the scope of the technological area addressed.

Findings

The results show the importance of collaboration between the university spin‐off, with both the parental organisation and outside organisms, to acquire external competencies in the technological area. The parental organisation plays a pivotal role in the spin‐off process, especially in its early stage where its catalyses the emergence of the business idea by supporting the spin‐off firm with infrastructure and expertise in a specific field of mentorship. However, as the spin‐off evolves, this pre‐incubation service complements yet more support services of municipality and region, which stand to be more important in the technological and business development of the spin‐off.

Originality/value

University spin‐offs have an important place in the innovation process, but their promotion must be part of a wider policy package encouraging networking not only with the host university, but with industry and the public sector as well. For universities and public research organisations, it is advisable to take a more active role in the spin‐off process beyond the pre‐incubation stage.
Basic and clinical aspects of visceral sensation: transmission in the CNS
Authors: Bielefeldt K. , Christianson J. A. , Davis B. M.
Published: August 2005

Abstract  Pain and discomfort are the leading cause for consultative visits to gastroenterologists. Acute pain should be considered a symptom of an underlying disease, thereby serving a physiologically important function. However, many patients experience chronic pain in the absence of potentially harmful stimuli or disorders, turning pain into the primary problem rather than a symptom. Vagal and spinal afferents both contribute to the sensory component of the gut–brain axis. Current evidence suggests that they convey different elements of the complex sensory experience. Spinal afferents play a key role in the discriminatory dimension, while vagal input primarily affects the strong emotional and autonomic reactions to noxious visceral stimuli. Drugs, surgical and non‐pharmacological treatments can target these pathways and provide therapeutic options for patients with chronic visceral pain syndromes.
Branchio–oculo–facial syndrome with bilateral linear scars of the neck
Authors: El Darouti Mohammad A. , Marzouk Salonas A. , Azzam Omar A. , Nada Hanan R. , Sobhi Rehab M. , El Nabarawi Iman
Published: August 2005

A case of branchio–oculo–facial syndrome with bilateral linear scars affecting both sides of the neck is described. The disease occured in a male patient aged 20 years and presented with facial asymmetry, pre and postauricular pits, lip pits, microphthalmia, broad malformed nose, colobomas and dystrophic right kidney. In addition, there were bilateral linear hypertrophic scars on both sides of the neck. We believe that the latter lesions may represent the end stage of dermal thymus; a rare condition which has been reported so far in only four cases, two of which had branchio–oculo–facial syndrome.
Effectiveness of kukui nut oil as a topical treatment for psoriasis
Authors: Brown Amy C. , Koett Jamie , Johnson Douglas W. , Semaskvich Nicole M. , Holck Peter , Lally David , Cruz Luis , Young Ryan , Higa Brice , Lo Serena
Published: August 2005

Background  No cure for psoriasis exists for the 1–3% of the American population who suffer from it; however, anecdotal reports from patients with psoriasis visiting Hawaii who purchased kukui nut oil, claim it helped reduce the severity of their lesions.

Objective  This pilot study was a double‐blind, placebo‐controlled clinical trial to determine the effectiveness of kukui nut oil as a topical treatment for psoriasis.

Methods  Thirty adult subjects (18–78 year) were recruited from the community for a 12‐week randomized, double‐blind, placebo‐controlled pilot study. Subjects were previously diagnosed with mild, stable plaque psoriasis (less than 15% of total body surface area [TBSA]) and agreed to abstain from other treatments during the course of the study. Following a 4‐week washout period the subjects were randomized into a treatment group (15 subjects applying kukui nut oil) or a control group (15 applying the mineral oil placebo). Patients were seen every 2 weeks (seven visits at 0, 2, 4, 6, 8, 10, and 12 weeks) by a dermatological nurse practitioner under the general supervision of a board certified dermatologist. Measurable outcomes included evaluation of one targeted lesion and of the overall severity of their psoriasis using clinical evaluation, Psoriasis Area and Sensitivity Index (PASI), Global Severity of Psoriasis Scale, and photographs. Each patient also evaluated their own lesions daily using the Global Severity of Psoriasis Scale, and noted any side‐effects or other treatments used.

Results  Although both groups improved, we found no significant difference between the treatment (kukui nut oil) and the placebo (mineral oil) among the 24 out of 30 subjects (80%) who completed the study. No side‐effects or adverse events were reported.

Conclusion  Kukui nut oil did not significantly reduce symptoms of psoriasis; however, this was a small pilot study, and the use of this oil cannot be dismissed without using a larger study population of patients with psoriasis.
Opinions of women with high inherited breast cancer risk about prophylactic mastectomy: an initial evaluation from a screening trial including magnetic resonance imaging and ductal lavage
Authors: Kurian Allison W. , Hartman Anne‐Renee , Mills Meredith A. , Ford James M. , Daniel Bruce L. , Plevritis Sylvia K.
Published: August 2005

Objective  Prophylactic mastectomy (PM) is often considered, but variably chosen by women at high inherited risk of breast cancer; few data exist on patient tolerance of intensive breast screening as an alternative to PM. We performed an evaluation of high‐risk women's tolerance of a breast screening protocol using clinical breast examination, mammography, breast magnetic resonance imaging (MRI) and ductal lavage (DL), and of change in attitudes toward PM after screening.

Design  A questionnaire assessing tolerance of screening procedures and change in opinion towards PM was designed and administered to 43 study participants, after a median follow‐up of 13 months. Responses were evaluated according to patient characteristics, including type of study‐prompted interventions, BRCA mutation status, and prior history of cancer, via univariate analysis.

Results  Most patients [85.3% (68.9–95.1%)] were more opposed or unchanged in their attitudes towards PM after study participation, with only 14.7% (5.0–31.1%) less opposed (P = 0.017) despite a short‐interval follow‐up MRI rate of 71.7% and a biopsy rate of 37%. Lower rates of maximal discomfort were reported with mammogram [2.8% (0–14.5%)] and MRI [5.6% (0–18.7%)] than with DL [28.6% (14.6–46.3%)], with P = 0.035.

Conclusions  Most high‐risk women tolerated intensive breast screening well; they were not more inclined towards PM after participating. Future studies should prospectively evaluate larger numbers of high‐risk women via multivariate analysis, to determine characteristics associated with preference for breast screening vs. PM.
Psychosexual health 5 years after hysterectomy: population‐based comparison with endometrial ablation for dysfunctional uterine bleeding
Authors: McPherson Klim , Herbert Aleks , Judge Andrew , Clarke Aileen , Bridgman Stephen , Maresh Michael , Overton Chris
Published: August 2005

Background  We report a population‐based comparison of psychosexual health 5 years after contrasting amounts of surgical treatments for heavy periods [dysfunctional uterine bleeding (DUB)]. Women's fears about sexual function after hysterectomy might not be unfounded. The psychosexual problems may return and/or develop with time. The removal of ovaries at the time of hysterectomy is associated with greater deterioration of self‐reported sexual function. Surgical menopause significantly impairs sexual wellbeing. We failed to observe uniform beneficial effects of hormone replacement therapy (HRT) on reported psychosexual health.

Objective  To compare self‐reported bothersome sexual function; loss of interest in sex, difficulty in becoming sexually excited and vaginal dryness 5 years after surgical management of DUB [transcervical endometrial resection/ablation (TCRE) or subtotal and total hysterectomy, with and without prophylactic bilateral oophorectomy (BO)].

Design  Prospective cohort study up to 5 years post‐surgery for DUB, TCRE or hysterectomy, with or without BO.

Setting  Over 400 NHS and private hospitals in England, Northern Ireland and Wales.

Cohort  Of 11 325 women who responded to the 5‐year questionnaire, over 9500 (84%) were valid cases, and over 8900 (94%) did complete the questions relating to psychosexual function. Most were between the ages of 39 and 45 years, married or cohabiting.

Main outcomes  Self‐reported experience of bother, recorded as ‘some’, ‘severe’ and ‘extreme’, to questions on (1) libido loss, (2) difficulty with sexual arousal, and (3) vaginal dryness during the past 4 weeks, 5 years after surgery.

Results  Five years after surgery for DUB, the crude and adjusted prevalence of psychosexual problems was higher after hysterectomy than after TCRE. Amongst the women with concurrent BO, the age‐ and HRT‐adjusted odds ratios for extreme psychosexual problems were increased by 80% (libido loss), 82% (difficult sex arousal) and 69% (vaginal dryness) compared with TCRE.

Conclusions  Five years after hysterectomy more women reported having bothersome psychosexual function than did the women who had a less invasive operation. Hormone therapy, although related to surgical method, did not reduce this long‐term detrimental effect. The odds were particularly high amongst women with concurrent BO. Women should be advised that they might be at higher risk of psychosexual problems following hysterectomy, compared with a less invasive procedure.
Structural changes in calcium‐binding allergens: use of circular dichroism to study binding characteristics
Authors: Hebenstreit D. , Ferreira F.
Published: August 2005

Background:  Several studies showed that calcium‐binding proteins have a fixed place in the spectrum of allergenic substances. Often the binding of a calcium ion induces conformational changes and affects immunoglobulin E‐binding to the allergen. Hence, the quantitative characterization of the binding to calcium is of importance to understand both the biologic and allergenic activity of these proteins.

Aims of the study:  In the present study we describe a procedure for determining the stoichiometry and dissociation constant (KD) of calcium‐binding allergens using circular dichroism (CD) techniques. For the experiments, we used recombinant Bet v 4, a two EF‐hand allergen from birch pollen.

Methods:  Solutions of Bet v 4 were titrated with calcium and the change in molar ellipticity at 222 nm was monitored with a CD spectropolarimeter.

Results:  The determination of the binding stoichiometry as well as of the KD for one EF‐hand (4 μM) demonstrated the applicability of the method.

Conclusions:  CD‐monitored calcium‐titration of protein solutions represents a fast and easy method for determining the binding characteristics of calcium‐binding allergens.
Use of a single silastic chest drain following thoracotomy: initial evaluation
Authors: Kejriwal Nand K. , Newman Mark A. J.
Published: August 2005

Background:  It is standard practice to use multiple large bore semi‐rigid chest tubes to drain the pleural cavity following thoracic procedures. These can cause pain and discomfort at the insertion site.

Methods:  We describe our experience with the use of a single small silastic drain following thoracotomy. From November 2001 to November 2003, size19‐F silastic chest tubes (Blake drains) were used for drainage of the pleural cavity in 37 patients at our institution. The patients ranged in age from 18 to 81 years (mean 65). The operations included 22 lobectomies, two bilobectomies, 10 wedge resections, and three other procedures.

Results:  Total drainage in each patient ranged from 420 to 5440 mL (mean 1387 mL). Tubes were left in place for an average of 4.3 days (range 1−12). The average postoperative length of stay was 7.6 days (range 3−44, median 5). Three patients required insertion of an additional tube for dislodgement, persistent air leak, and bronchopleural fistula, respectively. These complications occurred among the first 15 patients in the present series. None of the patients had persistent pleural effusion. Subjectively, these tubes were more comfortable for the patients and were easier to remove.

Summary:  The use of a single, small silastic chest drains following thoracotomy may be safe and effective in draining both fluid and air, though an additional tube may be necessary for persistent leaks.
Internal mammary node metastasis from primary cutaneous melanoma on the anterior chest
Authors: Thompson John F. , Uren Roger F. , Saw Robyn P. M. , Stevens Graham N.
Published: August 2005

Background:  Direct lymphatic drainage from the skin of the anterior chest and breast to internal mammary lymph nodes does not normally occur.

Methods:  Preoperative lymphoscintigraphy was performed in a 55‐year‐old man with a 3.7 mm‐thick primary melanoma on his right anterior chest, who had undergone surgery and radiotherapy to successfully treat a localized lymphosarcoma in his right axilla 35 years earlier.

Results:  The sentinel node in the lower right internal mammary chain, in the 5th interspace, was removed at the same time as the primary melanoma site was widely excised, and micrometastatic melanoma was subsequently identified in it. Second‐tier nodes in the 4th and 3rd right interspaces were therefore removed, and adjuvant radiotherapy was given to the entire internal mammary node chain.

Conclusions:  This case demonstrates that major disturbance of normal lymphatic drainage pathways can result from previous surgery and/or radiotherapy. Also, the rarity of this drainage pattern indicates that attempts to identify sentinel nodes in breast cancer patients by injecting tracer into the skin overlying a tumour rather than into the breast tissue immediately adjacent to it are likely to be inaccurate in some patients, because cutaneous injection will not demonstrate the sentinel nodes in the internal mammary chain that are present in up to 40% of patients with a breast cancer.
Digital ultraviolet reflectance photography can be used to quantify improvements in photodamage
Authors: Freedman B M , Earley R V , Balakrishnan T P
Published: August 2005

Objective  Increasing attention has focused on the treatment and reversal of ultraviolet‐ induced photodamage. This study was designed to determine whether ultraviolet reflectance photography could quantify the clinical effects of erbium:YAG laser resurfacing on photoaged skin.

Methods  Twenty patients (ages 46–67) with moderate to severe photodamage underwent dual‐mode variable pulsed erbium:YAG laser facial resurfacing. Pretreatment and post‐treatment evaluations at 3 and 6 months were performed clinically and photographically with white and ultraviolet reflectance photography.

Results  Image conversion of the ultraviolet reflectance imaging data demonstrated an average of 36% and 42% reduction in photodamage at 3 and 6 months, respectively. This correlated well with the wrinkle reduction and correction of dyspigmentation observed in all patients following laser resurfacing. Histologic examination confirmed a thicker, more orderly epidermis and dermal collagen remodeling after treatment.

Conclusion  Reduction in photodamage using the dual‐mode variable pulsed erbium:YAG laser can be quantitatively measured with ultraviolet reflectance photography using digital imaging. This model should prove useful in developing treatment regimens for photodamage.
Coexistence of Neoplasia and Cortical Dysplasia in Patients Presenting with Seizures
Authors: Prayson Richard A. , Estes Melinda L. , Morris Harold H.
Published: August 2005

Summary: Tumors and cortical dysplasia are associated with epilepsy, but few studies have examined the coexistence of neoplasia and dysplasia in these patients. We studied 13 patients (age 4–29 years) with recurrent seizures of 1 month to 21‐year’ duration (median 72 months). Ten patients were aged <21 years. Imaging studies localized the lesion to the temporal lobe (10 patients), parietal lobe (2 patients), and frontal lobe (1 patient). Tumors included ganglioglioma (8 patients), dysembryoplastic neuroepithelial tumor (DNT) (3 patients), and low‐grade as‐ trocytoma (2 patients). Cortical dysplasia, including atypical aggregates of neurons (6 patients), multifocal loss of the cortical laminar architecture (7 patients), and neurons in the molecular layer of the cortex (3 patients) were observed near but separate from the tumor. Coexistence of certain tumors with cortical dysplasia, most frequently observed in the pediatric population, suggests a hamar‐tomatous/dysplastic nature of the neoplasms.
Role of Child‐Mother Interaction in Predicting Competence of Children with Epilepsy
Authors: Lothman Deborah J. , Pianta Robert C.
Published: August 2005

Summary: Child‐mother interaction in two problem‐ solving situations was observed in 59 children with epilepsy aged 7–13 years and was related to their psychosocial adjustment in school and in an independent problem‐ solving activity. Mothers' support for their child's task completion, the availability of affective expressions in the interaction, and the child's self‐reliance in interacting with the mother were significantly correlated with the adjustment measures. Factor scores based on the ratings of child‐mother interaction accounted for significant increments in the adjustment measures after child age, gender, IQ, epilepsy variables, and family life stress were partialled out. The results support the view that child‐ parent relationships are important predictors of adjustment for children with epilepsy.
Study of Regional Cerebral Blood Flow in West Syndrome
Authors: Chiron C. , Dulac O. , Bulteau C. , Nuttin C. , Depas G. , Raynaud C. , Syrota A.
Published: August 2005

Summary: Focal cortical disturbances are frequent sequelae in West syndrome (WS) even though it is a generalized epileptic syndrome. Functional neuroimaging was used to determine whether focal perfusion abnormalities exist at WS onset and change during evolution. We studied regional cerebral blood flow (rCBF) at different stages of WS. Mean CBF (mCBF) and rCBF were measured using SPECT (single photon emission computed tomography) and 133Xe in 13 WS patients: at onset (20 cases), just after steroids (17 cases), and after a mean follow‐up of 2 years (26 cases). At WS onset, interictal mCBF was increased as the result of foci of hyper‐ and hypoperfusion, which were, respectively, mainly located in the frontal and posterior cortex. Just after steroid therapy, mCBF decreased without any focal predominance. During follow‐up, hypoperfused foci remained unchanged whereas the frontal hyperperfused foci decreased after spasm control. Our results show that focal abnormalities are present at WS onset. Focal hypoactivity could reflect a cortical lesion responsible for WS and focal hyperactivity could play a role in the persistence of generalized epilepsy.
Prenatal Etiologies of West Syndrome
Authors: Ohtahara Shunsuke , Ohtsuka Yoko , Yamatogi Yasuko , Oka Eiji , Yoshinaga Harumi , Sato Masahiro
Published: August 2005

Summary: We investigated the etiology of West syndrome (WS) with special reference to prenatal factors in 180 cases. Prenatal cause was the most frequent diagnosis (77 cases, 42.8%), followed by perinatal (25 cases, 13.9%) and postnatal factors (12 cases, 6.7%); 48 cases (26.7%) were of uncertain etiology; eighteen cases (10.0%) were idiopathic. Of the three forms of age‐dependent epileptic encephalopathy, prenatal cause was present in 12 of 15 cases (80.0%) of early‐infantile epileptic encephalopathy with suppression‐burst, 77 of 180 cases (42.8%) of WS, and 31 of 123 cases (25.2%) of Lennox‐Gastaut syndrome (LGS). Prenatal factors of WS included tuberous sclerosis (23), chromosome abnormalities (10), cerebral dysgen‐ esis (10), porencephaly (7), hydrocephalus (5), Aicardi syndrome (3), Aicardi syndrome associated with chromosome abnormality (1), and other causes (18). Chromosome abnormalities with WS consisted of 6 cases with 21 trisomy and one case each with 18q duplication, t(l;y) translocation, 7q duplication, and partial 2p trisomy. One patient with Aicardi syndrome also had a t(12;21) translocation. No significant difference was observed in the age of onset of WS among the five etiologic groups. The evolution from WS to LGS was not influenced by etiology, except for the idiopathic group. In patients followed for over 3 years, seizure remission occurred in 46.8% (22 of 47 cases) of the prenatal group. This was lower than the other four groups. Intellectual prognosis was also relatively poor in those with prenatal onset. Pyridoxal phosphate (PAL‐P) treatment was effective in 9 of 70 (12.9%) prenatal cases and 5 of 18 (27.8%) idiopathic cases. Notably, efficacy rates of 14.3, 14.8%, and 20.0% were observed in those with tuberous sclerosis, brain malformation, and chromosome abnormality, respectively. No significant difference in the effect of synthetic ACTH (Cortrosyn‐Z) was observed among the five groups. These findings suggested that WS due to prenatal etiologies and those due to other etiologies are essentially homogeneous in age of onset and clinicoelectrical features, although each has some individual characteristics. We conjecture that WS is one form of an age‐specific epileptic reaction to diverse nonspecific exogenous insults.
Carbamazepine‐Induced Tics
Authors: Robertson Patricia L. , Garofalo Elizabeth A. , Silverstein Faye S. , Komarynski Mary Ann
Published: August 2005

A variety of movement disorders are known to occur in association with carbamazepine (CBZ) therapy in adults and children, but development of tics has been described infrequently and only in patients with underlying Tourette's syndrome or other movement disorders. We report 3 children with epilepsy who developed facial motor tics after initiation of CBZ for complex partial seizures. All 3 had documented CBZ blood levels in the therapeutic range at the time, and none had other symptoms or signs of clinical intoxication. Neurologic examinations were normal in 2 and showed developmental de lay of expressive language in the third. Brain imaging was normal in all. After development of the tics in 2, CBZ was continued at the same or higher dose, and the tics abated and then ceased spontaneously ≤6 months. In the third child, the tics ceased after CBZ discontinuation. These cases demonstrate that CBZ can induce simple motor tics in children. These idiosyncratic reactions may be transient and do not always necessitate drug discontinuation.
Complexity of Focal Spikes Suggests Relative Epileptogenicity
Authors: Rodin Ernst , Litzinger M. , Thompson J.
Published: August 2005

Summary: The EEGs of 39 children with focal or multifocal spikes were subjected to singular value decomposition (SVD) as provided by a commercial software program. We noted that in children with spikes but no clinical seizures the variance accounted for by the first component averaged 91.9%, whereas in children with seizures it was 68.0% (p < .001). The first component accounted for 85.4% in children with single spike foci, for 71.5% in those with multifocal spikes, and for 61.4% (p < 0.002) in those with both focal spikes and generalized spike‐wave complexes. Spikes in the frontal and frontopolar areas were the most complex, suggesting that at least in children they tend to be the partial expression of a generalized seizure tendency rather than a result of strictly local pathology.
Age‐Related Differences in the Effects of GABA, Agonists Microinjected Into Rat Substantia Nigra: Pro‐ and Anticonvulsant Actions
Authors: Garant D. S. , Xu S. G. , Sperber E.F. , Moshé S. L.
Published: August 2005

Summary: GABAergic transmission in the substantia nigra pars reticulata (SNR) has an important role in the control of experimental seizures. In the flurothyl seizure model, SNR microinjection of the selective GABA, receptor agonist muscimol results in a biphasic dose‐response curve in adults: Intermediate doses are anticonvulsant, but high doses have proconvulsant effects. Another GABAA agonist, THIP (4,5,6,7‐tetrahydroisox‐azolo‐[5,4‐c]pyndin‐3‐01), also produces anticonvulsant effects at lower doses, whereas higher doses tend to produce a proconvulsant effect. In 16‐day‐old rat pups, no Both clinically and experimentally, it is recognized that the immature brain is at increased risk for sustaining epileptic seizures, particularly generalized seizures (1). An important goal of neuroscience research is to identify the neuronal circuitry and synaptic pharmacology underlying this ontogenic phenomenon. Such understanding will help direct the development of more efficacious and selective age‐specific therapies than those currently available.
Interactions of Phenobarbital and Phenytoin with Carbamazepine and Its Metabolites' Concentrations, Concentration Ratios, and Level/Dose Ratios in Epileptic Children
Authors: Liu Hua , Delgado Mauricio R.
Published: August 2005

Summary: The effects of phenytoin (PHT) or phenobarbital (PB) comedication on the concentrations, concentration ratios, and level/dose ratios of carbamazepine (CBZ) and its metabolites were investigated. The hetero‐induction effects of CBZ metabolism by PHT or PB were clearly demonstrated. Serum CBZ level/dose ratios in patients with CBZ polytherapy were decreased while CBZ‐ l0,11‐epoxide (CBZ‐E) and trans‐l0,11‐dihydroxy‐10, 1‐dihydro‐CBZ (CBZ‐H) concentrations were increased as compared with those of patients receiving CBZ alone. The concentration ratios of CBZ‐H/CBZ and CBZ‐E/ CBZ were also greater in patients receiving CBZ +PHT or CBZ+PB than in patients receiving CBZ alone. In addition, positive correlations between serum PHT concentration and CBZ‐H/CBZ or CBZ‐E/CBZ concentration ratios were observed. There were no significant differences in CBZ‐H/CBZ‐E concentration ratios, the free fractions of CBZ and its metabolites, and CBZ‐E or CBZ‐H 1eveYdose ratios among the three groups of patients. Because this approach investigates the in vivo relation between the substrates and products of the enzymes involved in CBZ biotransformation, more detailed information about the drug interactions was obtained. The results suggest that the PHT has a potent induction effect on CBZ epoxidase, whereas PB is a moderate inducer.
Aspartame and Seizure Susceptibility: Results of a Clinical Study in Reportedly Sensitive Individuals
Authors: Rowan A. James , Shaywitz Bennett A. , Tuchman Linda , French Jacqueline A. , Luciano Daniel , Sullivan Colleen M.
Published: August 2005

Summary: The high intensity sweetener aspartame has been implicated anecdotally in seizure provocation. This possibility was investigated with a randomized, double‐blind, placebo‐controlled, cross‐over study. After an extensive search, 18 individuals (16 adults and 2 children) who had seizures allegedly related to aspartame consumption were admitted to adult or pediatric epilepsy monitoring units where their EEG was monitored continuously for 5 days. Aspartame (50 mg/kg) or identically enpackaged placebo was administered in divided doses at 800, 1000, and 1200 h on study days 2 and 4. All meals were uniformly standardized on treatment days. No clin‐ical seizures or other adverse experiences were observed after aspartame ingestion. Mean plasma phenylalanine (Phe) concentrations increased significantly after aspar‐tame ingestion (83.6 pIM) as compared with placebo (52.3 μCM).Results suggest that aspartame, in acute dosage of ε50 mg/kg, is no more likely than placebo to cause seizures in individuals who reported that their seizures were provoked by aspartame consumption.
Tryggve Andersen: Epileptic Hallucinations in the 1890s, Fact or Fiction?
Authors: Aarli Johan A.
Published: August 2005

Summary: The Norwegian author Tryggve Andersen (1867–1920) had epilepsy, but was not aware of the diagnosis until late in life. In one novel, Towards Night (MotKvæld), published in 1900, he described in detail nocturnal attacks with formed visual hallucinations as the initial event, seeing always the same face. He was familiar with the works of Ernst Hoffmann and probably also with those of Fiodor Dostoyevsky, but deduction of the liter‐ ary influence leaves a precise description corresponding to an epileptogenic focus in the right posterotemporal region. Knowledge of his work may elucidate the subjective experience of initial epileptic manifestations, uncontaminated by previous knowledge of what can be expected in epilepsy. The descriptions provided by Andersen's writings are compared with more formal contemporary definitions of seizure events.
Serum Prolactin Levels and Neonatal Seizures
Authors: Morales Augusto , Bass Nancy E. , Verhulst Steven J.
Published: August 2005

Summary To assess the effects of neonatal seizures on the hypothalamus and to test clinical use of prolactin as a neonatal seizure marker, we studied postictal and recovery baseline serum prolactin levels in 19 neonates whose seizures were classified according to their clinical and EEG features. Postictal prolactin levels were obtained 30 min after the seizure, and recovery levels were ascer tained 2–4 days later. The ratio of Postictal prolactin level to recovery baseline level (prolactin ratio) was used as an indicator of postictal prolactin increase. The specificity and sensitivity of a prolactin ratio of >2 was compared with the current standard of diagnosis (seizure discharges recorded by ictal EEG). Infants with electroclinical seizures had significantly higher prolactin ratios than control infants or infants with seizures without EEG correlation. Marked prolactin increases were noted only in infants with focal tonic seizures and temporal electrode involvement. A prolactin ratio of >2 had a specificity of 100% and a sensitivity of 40%. We conclude that neonatal seizures have variable effects on the hypothalamus and that the low sensitivity and the need to await recovery levels limit the clinical value of prolactin ratio as a neonatal seizure marker.
Immunologic Aspects of Vigabatrin Treatment in Epileptic Children
Authors: Pacifici R. , Zuccaro P. , Iannetti P. , Raucci U. , Imperato C.
Published: August 2005

Summary Vigabatrin (VGB) is an antiepileptic drug (AED) that acts by irreversibly inhibiting γ‐aminobutyric acid transaminase (GABA‐T). To evaluate immune responses to GVG, we studied 29 idiopathic or symptomatic epileptic children and also examined a control group (n = 15). Epileptic children were tested before and after 1 and 3 months of VGB treatment. Whole blood was used to connect subsets with commercial monoclonal antibodies. Peripheral blood mononuclear cells (PBMC) were used to assess natural killer (NK) cell activity and lymphocyte response to phytohemagglutinin (PHA) and concavalin A (Con A). Immunoglobulin (Ig) levels were tested in serum. At baseline, no immunologic abnormalities were observed in either control or treated patients. During treatment, the percentage and absolute number of B lymphocytes, serum concentration of Ig, number of T total mature lymphocytes (CD3), T‐rosetting lymphocytes (CD11), T‐helper cells (CD4), and mitogenic response of lymphocytes remained unchanged. Several other immunologic responses showed a statistically significant increase after 1 and 3 months of VGB treatment, however, including the percentage and absolute number of T‐suppressor cells (CD8) and NK cells and NK cell activity. The correlation between number of NK cells and NK cell activity was significant. Data obtained demonstrated that VGB may interfere with the modulation of the immune system, especially cytotoxic cell populations.
Comparison of Mesial Versus Neocortical Onset Temporal Lobe Seizures: Neurodiagnostic Findings and Surgical Outcome
Authors: Burgerman Robert S. , Sperling Michael R. , French Jacqueline A. , Saykin Andrew J. , O'Connor Michael J.
Published: August 2005

Summary: We compared historical features, surface EEG findings, results of intracarotid sodium amobarbital memory testing (IAT), and outcome after anterotemporal lobectomy (ATL) in patients with mesiotemporal lobe seizure onset with those with more diffuse temporal lobe seizure onset (intracranial EEG). Forty‐eight patients evaluated consecutively between July 1985 and October 1991 with both scalp/sphenoidal and intracranial EEG were shown to have seizures originating in one temporal lobe. No patients had temporal lobe tumor or vascular malformation. Thirty‐seven of the 48 patients had seizure onset in the amygdale/hippocampus (amyg/hipp). Eleven of the 48 had either temporal neocortical onset or simultaneous amydhipp and neocortical onset. Patients with mesial onset seizures were more likely to have lateralized memory impairment on I AT (p = 0.05). We noted a trend toward a difference in age of first risk for epilepsy between the two groups (p = 0.09) but not for a difference in any specific risk factor. There were no significant differences in surface EEG interictal findings. Unlike in previous studies, comparison of outcome between the two groups showed no difference in seizure‐free outcome. Sudden unexpected death (SUD) was more frequent in neocortical seizure patients who were not seizure‐free (p < 0.05).
Frequency of the Electroencephalographic Discharge in Seizures of Focal and Widespread Onset in Intracerebral Recordings
Authors: Gotman J. , Levtova V. , Olivier A.
Published: August 2005

Summary: The information provided by the EEG during an epileptic seizure is of critical importance in the localization of an epileptic focus. Localizing information is usually provided by the region of onset, by the predominance of the discharge during the seizure, and by post‐ictal slow waves. In patients with intracerebral electrodes, we investigated another aspect of the discharge: its highest frequency. We divided seizures into those with a focal onset and those with a regional onset. Results indicated clearly that fast frequencies (15–30 Hz) were much more frequent during seizures of focal onset than during seizures of widespread onset. Highest frequencies were not necessarily observed at the onset of focal seizures but could be observed at any time during a seizure of focal onset. High frequencies appear to characterize small epileptogenic zones (EZ). Our results may be helpful in the interpretation of intracerebral EEGs when large brain areas remain unexplored and one is often uncertain of the extent of an EZ.
False Lateralization of Temporal Lobe Epilepsy with FDG Positron Emission Tomography
Authors: Sperling Michael R. , Alavi Abass , Reivich Martin , French Jacqueline A. , O'Connor Michael J.
Published: August 2005

Summary: We report 2 patients in whom visual interpretation of interictal positron emission tomography (PET) with [18F]fluorodeoxyglucose (FDG) suggested false lateralization of an epileptic focus. PET scans were interpreted as showing diffuse left temporal lobe hypometabolism in 1 patient and lateral temporal hypometabolism in the other. However, seizures began in the right mesial temporal lobe in both patients, and both responded favorably to right temporal lobectomy. In 1 patient, the intra‐cranial EEG showed continuous asymptomatic subclinical seizure activity emanating from the right amygdala. These limbic discharges probably caused unrecognized right temporal lobe hypermetabolism. In the other case, quantitative analysis of metabolic rates showed conflicting mesial and lateral metabolic indexes. Frequent mesial interictal discharges might have increased lateral temporal metabolism. We conclude that asymptomatic epileptiform activity may alter temporal lobe metabolism and that quantitative PET analysis helps clarify contradictory visual PET interpretations.
Brief Communication Nonphotosensitive Video Game‐Induced Partial Seizures
Authors: Takahashi Yukitoshi , Shigematsu Hideo , Kubota Hidemoto , Inoue Yushi , Fujiwara Tateki , Yagi Kazuichi , Seino Masakazu
Published: August 2005

Summary: We report a 9‐year‐old boy with a ring 20 chromosome anomaly whose complex partial seizures (CPS), presumably of frontal lobe origin, were often induced by playing video games. Neither photosensitivity nor pattern sensitivity was observed. An intensive video‐EEG investigation showed that video games as well as mental calculation elicited rhythmic runs of bilateral high‐voltage slow waves, which eventually evolved into ictal discharges. This case suggests that higher brain functions can be involved in seizure induction.