bluuebunny/crossref_metadata_2025 huggingface dataset:
The Contribution of EEG to the Understanding of Neonatal Seizures
Authors: Clancy Robert R.
Published: November 2007

Summary: The neonatal EEG is a thread that has linked past and present studies of neonatal seizures that have emerged over the last several decades. Instead of experiencing a waning of value or interest, the neonatal EEG has grown in significance for characterization and quantification of seizures in the neonate. At present, it serves as the ideal theoretical end point of antiepileptic drug (AED) therapy and provides invaluable prognostic information in the analysis of its interictal EEG background. The needs of the near future are to learn the real behavior of the electrographic neonatal seizure (ENS) burden as it erupts on the scene of an acute encephalopathy. The response of the neonatal seizure burden to AED treatment requires careful quantitative description and reliable, automated ENS detection by cerebral function monitors, which are on the technologic horizon.
Status Epilepticus and Acute Repetitive Seizures in Children, Adolescents, and Young Adults: Etiology, Outcome, and Treatment
Authors: Mitchell Wendy G.
Published: November 2007

Summary: Status epilepticus (SE) is one of the most common neurologic emergencies in children, adolescents, and young adults. SE may be due to acute neurologic conditions such as meningitis, encephalitis, or stroke, complicated febrile seizures, intractable epilepsy, degenerative diseases, intoxication, or may be the first manifestation of epilepsy. Initial treatment of convulsive SE is usually with an intravenous benzodiazepine (BZD) [lorazepam (LZP) or diazepam (DZP)], phenobarbital (PB), or phe‐nytoin (PHT). LZP is less likely to cause respiratory depression than DZP and is therefore preferred. Sequelae and risk for recurrence of SE are primarily related to the underlying cause. Refractory SE (RSE) is most often symptomatic of an acute neurologic condition or neuro‐degenerative disease. Treatment for RSE is difficult, usually requiring intensive support of vital functions. Reported treatments for RSE include very high dose PB, continuous infusions of pentobarbital or BZDs (DZP, mi‐dazolam), lidocaine, inhalation anesthesia, and propofol. Outcome is related to underlying cause. Nonconvulsive SE may present as confusion or may mimic psychiatric illness. Response to BZDs is usually rapid but may not be sustained. Rapid initiation of oral or rectal valproate may be useful. Epilepsia partialis continua (EPC) is almost always due to an acute or chronic destructive lesion. Surgical treatment may be the only effective modality in some children with EPC. Acute treatment of breakthrough seizures and clusters of seizures at home with rectal BZDs (usually DZP, 0.2–0.5 mg/kg) may prevent progression to SE in some children and adolescents and reduce the need for visits to emergency facilities.
The Epidemiology and Treatment of Chronic and Refractory Epilepsy
Authors: Shorvon Simon D.
Published: November 2007

Summary: In developed countries, the incidence of epilepsy is 50–100 cases per 100,000 population per year and the prevalence is approximately 5 to 8 cases per 1,000 population. Epilepsy is by far the most prevalent serious neurologic condition. Mortality rates in epilepsy are two to four times those found in matched nonepileptic populations. The prognosis of epilepsy can be classified into at least four categories, with chronic and refractory cases comprising about 40% of all cases. A detailed approach to the management of chronic epilepsy cases is recommended. Approximately 20% of patients cannot achieve seizure control with existing agents and new antiepileptic drugs are required for these patients.
Expanding Antiepileptic Drug Options: Clinical Efficacy of New Therapeutic Agents
Authors: Ben‐Menachem Elinor
Published: November 2007

Summary: Results of double‐blind, placebo‐controlled, add‐on trials of topiramate (TPM), lamotrigine (LTG), and vigabatrin (VGB) in refractory partial epilepsy were reviewed. In three European multicenter studies of TPM, the clinical efficacy of 400–, 600–, and 800‐mg/day target dosages was demonstrated. In a similarly designed United States trial, LTG was significantly superior to placebo at a 500‐mg/day dosage but not at a 300‐mg/day dosage. A meta‐analysis of a number of smaller trials of VGB suggests that a ≥50% reduction in seizures is observed in approximately 45% of patients with refractory partial epilepsy. All of these newer antiepileptic drugs have shown efficacy in well‐controlled trials and should contribute significantly to our ability to manage partial epilepsy.
The New Antiepileptic Drugs and Women: Efficacy, Reproductive Health, Pregnancy, and Fetal Outcome
Authors: Morrell Martha J.
Published: November 2007

Summary: As new antiepileptic drugs (AEDs) become available, physicians will define their appropriate use in particular patient populations. For women, the issues in clude gender‐specific efficacy and tolerability, including the impact of the AED on reproductive health. Women with epilepsy who are treated with established AEDs ap pear to be at risk for compromised bone health, for dis turbances in fertility, menstrual cyclicity, ovulatory func tion, and sexuality and, with some AEDs, for failure of hormonal contraception. Finally, pregnancy outcome may be adversely affected by the established AEDs, all of which are human teratogens. Felbamate (FBM), gabap‐entin (GBP), lamotrigine (LTG), oxcarbazepine (OCBZ), tiagabine (TGB), topiramate (TPM), and vigabatrin (VGB) were reviewed. The preclinical development pro cess had not addressed all the issues of concern to women. Although gender‐specific efficacy is routinely evaluated, impact on reproductive health is not. FBM, GBP, LTG, TGB, TPM, and VGB have similar efficacy in women and men. It is not known whether the new AEDs will affect bone health, fertility, the menstrual cycle, and sexuality. FBM, GBP, LTG, TGB, and probably VGB do not interfere with hormonal contraception. Whether these new AEDs are good choices for the pregnant woman with epilepsy awaits further experience in human pregnancy. However, animal reproductive toxicology studies appear promising. The limited number of human pregnancy ex posures do not, thus far, signal a significant number or particular type of adverse outcomes. However, only with improved postmarketing surveillance can essential infor mation about teratogenic effects be acquired in an accept ably short time.
The Challenges of Epilepsy in Children
Authors: Dulac Olivier , Bulteau Christine , Pedersen Søren , Uldall Peter
Published: November 2007

Summary: Among the most distinct and challenging characteristics of childhood epilepsy are the high incidence, the risk of cognitive function deterioration, the age relationship of various types of epilepsy, and the existence of particular clinical and EEG patterns that characterize epilepsy syndromes. With regard to antiepileptic drug (AED) treatment, one must take into account age‐dependent pharmacokinetics, response to treatment according to the type of epilepsy, and ethical constraints in the development of controlled trials that often prevent the early introduction of new AEDs to the pediatric market.
The Teenagers' Service: An Evaluation of Epilepsy Care
Authors: Hannah Jean A. , Maxwell Jan , Paul Audrey , Brodie Martin J.
Published: November 2007

Summary: We developed a specialist service for teenagers with epilepsy. A service development proposal was written after an audit that highlighted the increasing numbers of teenagers attending the Epilepsy Unit at Glasgow Western Infirmary. This led to the creation of the Teenagers' Service, an externally funded clinical research program dedicated to meeting the needs of teenagers with epilepsy and working to a model of evidence‐based medicine. The Teenagers' Service is led by an Epilepsy Nurse Specialist, a physician, and a research psychologist. In anticipation of a small cohort requiring intensive support, a single‐case, multiple‐baseline design was adopted. Patients were randomly allocated to one of three possible baselines and completed, along with their primary caregiver, a number of questionnaires pertaining to the psychosocial aspects of their condition. They received emotional and educational support from the Epilepsy Nurse Specialist throughout the study period. Participation was by informed consent. Analysis was primarily descriptive with some statistical comparisons made using within‐subject t tests. The intention of our study was to combine the establishment of a novel nurse‐led clinical service for teenagers with scientific evaluation encompassing the opinions and needs of the users.
Adults with Epilepsy: Is Monotherapy the Only Answer?
Authors: Berkovic Samuel F.
Published: November 2007

Summary: Monotherapy with antiepileptic drugs (AEDs) should be the aim in most patients with epilepsy and is achievable in most newly diagnosed cases. “Rational po‐lytherapy” is a valuable new concept that can be usefully applied to a minority of patients. Assessment of new AEDs as monotherapy is a challenging problem, and appropriate clinical trial methodology is currently evolving. Although tiagabine (TGB) is established as an effective add‐on agent in refractory partial epilepsy, its role in monotherapy is not yet clear. Preliminary studies suggest that TGB is effective and well tolerated as monotherapy. Ongoing large monotherapy studies should establish the comparative efficacy and tolerability of TGB vs. conventional AEDs.
Some Lessons Learned in the Care of the Elderly
Authors: Smythe Cheves M.
Published: November 2007

Summary: This article is designed to acquaint physicians not trained in geriatrics with some precepts concerning the care of the elderly. It presents a summary of the experience in the care of over 2,000 outpatients over the age of 65 who were seen at a community hospital geriatric evaluation unit and resource center. The findings reaffirmed the importance of concentrating on the preservation and restoration of function in the care of the frail elderly. Although there are no clinical skills unique to geriatrics, but the approach to the gathering of clinical data in people with multiple and overlapping problems and disabilities must be structured differently. There is less emphasis on precise diagnosis, much less emphasis on the concept of cure, and more emphasis on structuring a medical/social response to the dominant problem or problems.
Pharmacologic Advantages of Antiepileptic Drug Monotherapy
Authors: Perucca Emilio
Published: November 2007

Despite recent trends in re‐evaluating the effects of antiepileptic drug (AED) combinations, monotherapy remains the mainstay for treatment of epilepsy. Most patients with newly diagnosed epilepsy can become seizure‐free with administration of an appropriately selected AED, and a significant proportion (20–40%) of those refractory to initial treatment may respond after changing to monotherapy with an alternative AED. Monotherapy is also superior to polytherapy in terms of safety and tolerability. The incidence and severity of side effects increase in proportion to the number of AEDs received by the patient. In patients receiving monotherapy, dosage can be more easily optimized because the effects of individual AEDs can be evaluated separately. Additional advantages of monotherapy include lower treatment costs, simpler dosing schedule (expected to maximize compliance), and avoidance of adverse AED interactions. Admittedly, there are patients who may respond better to AED combinations, but the number is relatively small and, in some cases, the improvement in seizure control produced by an added AED may be more than offset by an excessive burden of side effects.
Monotherapy Trials of New Antiepileptic Drugs
Authors: Beydoun Ahmad
Published: November 2007

Summary: A number of clinical trials that test the efficacy and safety of the newer antiepileptic drugs (AEDs) have recently been concluded. Two dose‐response trials in inpatients with refractory partial seizures and outpatients with newly diagnosed partial epilepsy established the efficacy of gabapentin as monotherapy. Lamotrigine was found to have efficacy similar to that of phenytoin and carbamazepine (CBZ) and to be better tolerated than CBZ in patients with newly diagnosed epilepsy. It was also shown to have efficacy as monotherapy in partial seizures, based on the results of an active controlled trial, and in the treatment of absence seizures, based on the results of a responder‐enriched study. Topiramate as monotherapy was found to be efficacious for treatment of partial‐onset seizures, based on the results of a single‐center dose‐response trial. A dose‐response trial that tested the efficacy of tiagabine monotherapy in patients with refractory partial epilepsy was uninformative. Oxcarbazepine was found to be safe and efficacious in four comparative trials in patients with newly diagnosed epilepsy as well as in one placebo‐controlled inpatient trial in patients with refractory partial seizures.
Epilepsy Genes and the Genetics of Epilepsy Syndromes: The Promise of New Therapies Based on Genetic Knowledge
Authors: Berkovic Samuel F.
Published: November 2007

Summary: Treatment strategies based on the molecular biology of the epilepsies may soon become a reality. Critical steps in this process are identifying molecular genetic defects in specific epilepsies, understanding of the neurobiologic consequences of those defects, and developing methods to correct the molecular defects or their downstream consequences. Identification of molecular defects is easier in single‐gene epilepsies than in those with complex inheritance, although the latter are more common. A number of epilepsies have been mapped and, in two cases, specific genes have been identified. Unverricht‐Lundborg disease is caused by defects in the cystatin B gene, with absence of the gene product. Autosomal dominant nocturnal frontal lobe epilepsy in some families is caused by mutations in the a4‐subunit of the nicotinic acetylcholine receptor gene. In vitro studies suggest that the mutations lead to impaired function of the acetylcholine receptor, raising the possibility of cholinergic therapy for this condition. Advances in the molecular biology of the epilepsies are likely to change our understanding radically and to allow opportunities to develop innovative new treatments for epilepsy.
Risk Factors for Sudden Unexpected Death in Epilepsy
Authors: Shorvon S.
Published: November 2007

Summary: The exact mechanisms of sudden unexpected death in individuals with epilepsy (SUDEP) are unclear, and only an incomplete analysis of risk factors can be made. Clinical, epidemiologic, and electrophysiologic evidence suggests that most sudden deaths are related temporally to seizures, are unwitnessed, and that many occur during sleep. Individuals with generalized seizures, symptomatic epilepsy, severe or frequent seizures, and additional mental handicap or neurologic deficit are at greater risk, and the majority of cases probably occur in patients with chronic epilepsy. Young people are more at risk for SUDEP than older people with epilepsy, and risk factors in pediatric practice may differ from those in adult epileptology.
Recording Respiratory Parameters in Patients with Epileps)
Authors: Walker F. , Fish D. R.
Published: November 2007

Summary: Anecdotal evidence and data from small studies suggest that respiratory changes occur in both complex partial and generalized seizures. Our understanding of sudden unexpected death in epilepsy (SUDEP) may be furthered by recording and analyzing these changes. Investigators at the Jules Thorn Telemetry Unit at the National Hospital for Neurology and Neurosurgery have documented a range of respiratory parameters (respiratory effort, airflow, oxygen saturation) in conjunction with time‐locked audio‐video electroencephalograms and electrocardiograms to provide a more complete picture of the physiologic changes that occur during seizures. Cardiorespiratory information on 79 seizures (70 complex partial, nine generalized) in 37 patients (20 male, 17 female) is presented. Whereas tachycardia was a common ictal feature, bradycardia was seen only rarely and tended to follow a period of apnea. Apnea occurred in 100% of generalized seizures and 39% of complex partial seizures. Apnea was predominantly central and lasted for 10–75 s (mean duration 29 s). Central apnea may be one of the major, although by no means exclusive, ictal events predisposing to SUDEP.
Forensic Considerations in Sudden Unexpected Death in Epilepsy
Authors: Leestma J. E.
Published: November 2007

Summary: Sudden death in epilepsy has recently found its way into both civil and criminal litigation in the United States. Civil cases commonly involve actions or inactions by physicians with respect to antiepileptic drugs (AEDs) alleged to have caused sudden unexpected death in a patient with epilepsy (SUDEP). The context may be discontinuation or change of AEDs or failure to warn of the complication of SUDEP. A common issue in adjudication of such cases is the role of causality of medication type and level in SUDEP. Current knowledge does not permit an accurate assessment of risk for medication discontinuation or poor compliance. Related issues are discussed. In criminal litigation, SUDEP has been accepted by a Federal Court as a cause of death in a crime victim for whom the actions of the accused caused an epileptic state.
Mortality in a Consecutive Cohort of 248 Adolescents and Adults Who Underwent Diagnostic Evaluation for Epilepsy Surgery
Authors: Vickrey B. G.
Published: November 2007

Summary: A cohort analytic study of a broad set of outcomes was performed in a consecutive series of 248 adults and adolescents who underwent evaluation for surgery for intractable epilepsy at the University of California, Los Angeles (UCLA), U.S.A. from 1974 to 1990. In the analysis, 202 were designated as “surgery” patients and 46 were assigned to a “nonsurgery” group, based primarily on whether surgery for a localized surgical region was undertaken. Follow‐up at an average of 6 years revealed that 14 (7%) of the surgery and 9 (20%) of the non‐ surgery group had died (p < 0.01). Results were similar after adjusting for baseline differences between groups. These multivariate models also showed that female gender was significantly associated with lower mortality. A significantly higher proportion of the deceased experienced two or more seizures over the latest year of follow‐up compared with survivors (p < 0.01). Specific causes of death remain to be determined.
Information on Sudden Deaths from Epilepsy
Authors: Preston J.
Published: November 2007

Summary: Epilepsy Bereaved? is a charity representing those who have experienced the sudden death of a loved one due to epilepsy. Many individuals with epilepsy, as well as their partners, relatives, and friends, are unaware of the risk for sudden unexpected death in epilepsy (SUDEP). Much of the literature available does not include information on SUDEP. When information is given, the risk for SUDEP may be underestimated. Epilepsy Bereaved? believes that people with epilepsy and their partners, families, and friends have the same right to be informed as any others dealing with a chronic condition, unless they express a wish to the contrary. Information should include the risk for SUDEP. Bereaved families agree that they would rather have been informed of the risks than left ignorant. Increased awareness and understanding of this condition may help improve treatment compliance and enable individuals to take measures to reduce the risk for sudden death.
United States Perspective on Definitions and Classifications
Authors: Annegers J. F.
Published: November 2007

Summary: Interest in sudden unexpected and unexplained death in individuals with epilepsy (SUDEP) was rekindled in the United States by Jay and Leestma during the early 1980s and more recently by antiepileptic drug (AED) trials and medicolegal issues. The incidence of SUDEP has been and is being evaluated in North America and the United Kingdom. Specific criteria for the classification of definite, probable, possible, and unlikely SUDEP implemented in United States epidemiologic studies are presented. Evidence for the increased relative risk for sudden death in epilepsy compared with the general population is also discussed.
Aggravation of Focal Epileptic Seizures by Antiepileptic Drugs
Authors: Elger Christian E. , Bauer Juergen , Scherrmann Judith , Widman Guido
Published: November 2007

Summary: Aggravation of focal epileptic seizures in adults is common after the antiepileptic drug (AED) therapy is initiated. Sometimes aggravation is mimicked by clustering of the seizures. Therefore, it is always necessary to analyze the patient's history and therapy carefully before drawing any conclusions. It is likely that a paradoxical aggravation of epileptic seizures can be attributed to the given AED and is sometimes, but only rarely, due to drug interactions.
Symptomatic Occipital Lobe Epilepsy
Authors: Kuzniecky Ruben
Published: November 2007

Summary: Symptomatic occipital lobe epilepsy is increasingly recognized among patients with partial‐onset seizures. Although traditional clinical and electroencephalographic criteria had defined occipital lobe epilepsy in the past, new neu‐roimaging techniques and the recognition of specific syndromes associated with occipital lobe epilepsy have improved the diagnosis and management of these patients. These syndromes include, among others, lesional occipital lobe epilepsy (congenital vs. acquired), MELAS, and epilepsy with bilateral occipital calcifications. The diagnosis of symptomatic occipital lobe epilepsy is improving as functional and structural neuroimaging techniques enable the detection of subtle abnormalities in such patients. This has had a direct impact on the correct classification of patients with benign occipital lobe epilepsy, basilar migraine, and symptomatic occipital lobe epilepsy. The common clinical symptoms, EEG patterns, and neuroimaging findings of these patients are discussed.
The Benign Occipital Epilepsies of Childhood: An Overview of the Idiopathic Syndromes and of the Relationship to Migraine
Authors: Andermann Frederick , Zifkin Benjamin
Published: November 2007

Summary: Benign occipital epilepsy of childhood is an idiopathic partial epilepsy syndrome with elementary visual symptomatology, frequently associated with other ictal phenomena. Seizures are usually followed by postictal headache and are often associated with interictal occipital rhythmic paroxysmal EEG activity that appears only after eye closure. In some children the ictal visual symptoms or the interictal EEG abnormalities may not be demonstrated. The clinical and/or EEG manifestations of other forms of idiopathic partial or generalized epilepsy may be found in association. Occipital spikes in non‐epileptic children with defective vision, occipital slow spike‐and‐wave found in some patients with the Lennox‐Gastaut syndrome, focal epilepsy due to occipital lesions, seizures originating in the temporal lobe secondary to an occipital abnormality, and complicated or basilar migraine must be considered in the differential diagnosis. Early‐onset benign occipital epilepsy or seizure susceptibility syndrome deserves to be considered separately. It has been defined by Panayiotopoulos as consisting of brief, infrequent attacks or prolonged status epilepticus and characterized by ictal deviation of the eyes and/or head and vomiting, occurring in children usually between the ages of 3 and 7 years. Advances in molecular genetics will help decide whether these two disorders are indeed distinct. Benign occipital and benign rolandic epilepsy are commonly associated with migraine. The selective involvement of the occipital lobe in migraine has not been fully explained. The association between benign occipital epilepsy and migraine is likely related to this underlying mechanism as well. The “fixation off‘ phenomenon or blocking of occipital epileptic discharges by eye opening is not specific to benign occipital epilepsy of childhood and may be found in symptomatic epilepsies as well. Migraine and epilepsy are distinct disorders, both as far as their pathophysiologic mechanisms and clinical symptomatology are concerned. There is however an overlap in some patients and a causal relationship may exist in some, leading to clinically distinct migraine epilepsy syndromes. Here too, clarification of the molecular basis of migraine and of epilepsy will throw light on the nature of the relationship between the two conditions.
ACTH Therapy for Infantile Spasms: A Combination Therapy with High‐Dose Pyridoxal Phosphate and Low‐Dose ACTH
Authors: Takuma Yuichi
Published: November 2007

Summary: Combination therapy consisting of high‐dose pyridoxal phosphate (40–50 m/kg/day) and low‐dose synthetic ACTH (0.01 mg/kg/day) was prescribed in 28 children with infantile spasms. Monotherapy with pyridoxal phosphate provided excellent seizure control in 3 of the 28 (11%) patients. ACTH was subsequently added to the regimen of the remaining 25 patients. As of 1 month after discontinuing the ACTH treatment, 21 of the 25 (84%) patients had experienced no seizures. The mean interval until seizure control was achieved was 4.1 days after the start of treatment with ACTH. The 21 patients have been monitored for a mean of 34.9 months (range 2–81 months); 6 patients (29%) have had recurrences of infantile spasms, and 10 (48%) have experienced normal development. Fourteen of the 28 patients (50%) have had transient increases in liver enzymes, but none of the patients developed more serious side effects.
[11ClFlumazenil PET in Patients with Epilepsy with Dual Pathology
Authors: Juhász Csaba , Nagy Ferenc , Muzik Otto , Watson Craig , Shah Jagdish , Chugani Harry T.
Published: November 2007

Summary: Purpose: Coexistence of hippocampal sclerosis and a potentially epileptogenic cortical lesion is referred to as dual pathology and can be responsible for poor surgical outcome in patients with medically intractable partial epilepsy. [11C]Flumazenil (FMZ) positron emission tomography (PET) is a sensitive method for visualizing epileptogenic foci. In this study of 12 patients with dual pathology, we addressed the sensitivity of FMZ PET to detect hippocampal abnormalities and compared magnetic resonance imaging (MR1) with visual as well as quantitative FMZ PET findings.

Methods: All patients underwent volumetric MRI, prolonged video‐EEG monitoring, and glucose metabolism PET before the FMZ PET. MRI‐coregistered partial volume‐corrected PET images were used to measure FMZ‐binding asymmetries by using asymmetry indices (AIs) in the whole hippocampus and in three (anterior, middle, and posterior) hippocampal subre‐gions. Cortical sites of decreased FMZ binding also were evaluated by using AIs for regions with MRI‐verified cortical lesions as well as for non‐lesional areas with visually detected asymmetry.

Results: Abnormally decreased FMZ binding could be detected by quantitative analysis in the atrophic hippocampus of all 12 patients, including three patients with discordant or in‐ conclusive EEG findings. Decreased FMZ binding was restricted to only one subregion of the hippocampus in three patients. Areas of decreased cortical FMZ binding were obvious visually in all patients. Decreased FMZ binding was detected visually in nonlesional cortical areas in four patients. The AIs for these nonlesional regions with visual asymmetry were significantly lower than those for regions showing MRI lesions (paired t test, p = 0.0075).

Conclusions: Visual as well as quantitative analyses of FMZ‐binding asymmetry are sensitive methods to detect decreased benzodiazepine‐receptor binding in the hippocampus and neocortex of patients with dual pathology. MRI‐defined hippocampal atrophy is always associated with decreased FMZ binding, although the latter may be localized to only one sub‐region within the hippocampus. FMZ PET abnormalities can occur in areas with normal appearance on MRI, but FMZ‐binding asymmetry of these regions is lower when compared with that of lesional areas. FMZ PET can be especially helpful when MRI and EEG findings of patients with intractable epilepsy are discordant.
Function‐Specific High‐Probability “Nodes” Identified in Posterior Language Cortex
Authors: Schwartz Theodore H. , Devinsky Orrin , Doyle Werner , Perrine Kenneth
Published: November 2007

Summary: Purpose: Posterior, “Wenicke's,” language areas have a high degree of between‐subject variability, as shown by electrical‐stimulation mapping. We investigated the possibility of an organized structure in the distribution of posterior language areas.

Methods: Extraoperative subdural grid stimulation was performed on 67 left hemisphere‐dominant patients before resec‐tive epilepsy surgery during counting, naming, and reading. Intersubject‐averaged language maps were generated in which stimulation disrupted only one language function and not the others, or combinations of language functions.

Results: Language sites, although highly variable between subjects, were not organized randomly and appeared to be arranged into several focal, non‐contiguous, higher probability “nodes” devoted to different aspects of language processing. Speech‐arrest sites were concentrated in classic Wernicke's area. Areas where stimulation induced only reading errors were found in the posterior middle temporal gyrus and the inferior parietal lobule. These regions may correspond with an orthographic input lexicon. Areas eliciting only naming errors were found in the posterior inferior temporal gyrus extending into the mid‐middle temporal gyrus and may represent a visual‐representation input lexicon. Sites where stimulation elicited errors in both naming and reading were more variable in location than sites devoted to only one function, extended farther anteriorly along the temporal neocortex, and may correspond with a semantic lexicon.

Conclusions: The existence of high‐probability nodes in posterior language cortex supports a modality‐specific modular architecture and the possibility of a conserved, universal structure.
Early‐Onset Benign Childhood Occipital Seizure Susceptibility Syndrome: A Syndrome to Recognize
Authors: Panayiotopoulos C. P.
Published: November 2007

Summary: Early‐onset benign childhood occipital seizures (EBOS) described by Panayiotopoulos constitute the commoner after the rolandic phenotype of a childhood seizure susceptibility syndrome. EBOS are the clinical representative of occipital spikes. Their cardinal features are infrequent (often single) partial seizures manifested with deviation of the eyes and vomiting, frequently evolving to hemi‐ or generalized convulsions. Ictal behavioral changes, irritability, pallor, and rarely cyanosis, and eyes wide open are frequent. Retching, coughing, aphemia, oropharyngolaryngeal movements, and incontinence may occur. Consciousness is usually impaired or lost, either from the onset or the course of the fits, but in a few children, it may be preserved. Duration varies from a few minutes to hours (partial status epilepticus). Seizures are usually nocturnal, but semiology is similar in nocturnal or diurnal fits. Onset is between 1 and 12 years with a peak at 5 years. One third of children have a single seizure, the median total number of fits is two to three, and the prognosis is invariably excellent, with remission usually occurring within I year from onset. A few children may later develop rolandic or other benign partial seizures. The likelihood to have seizures after age 12 years is exceptional and rarer than that of febrile convulsions. EEG shows occipital paroxysms demonstrating fixation‐off sensitivity, but random occipital spikes, occipital spikes in sleep EEG alone, or normal EEG may occur. Centrotemporal and other spike foci may appear in the same or more frequently in subsequent EEGs. The EEG does not reflect clinical course and severity.
Anticonvulsant Action of Topiramate Against Motor Seizures in Developing Rats
Authors: Haugvicová Renata , Kubová Hana , Škutová Markéta , Mareš Pavel
Published: November 2007

Purpose: To study the anticonvulsant action of topiramate (TPM) in developing rats.

Methods: Motor seizures were elicited by administering pentylenetetrazol (100 mg/kg subcutaneously) in five age groups of Wistar rats (7, 12, 18, 25, and 90 days old). TPM was administered intraperitoneally in doses from 10 to 640 mg/kg 2 hours before pentylenetetrazol. The time course of TPM action was studied in 12‐ and 25‐day‐oId rats up to 24 hours after the 160‐mg/kg dose, and the incidence and pattern of seizures were evaluated.

Results: TPM did not influence minimal seizures (clonus of forelimb and head muscles with preserved righting ability). Generalized tonic‐clonic seizures, however, were reliably changed at all developmental stages studied. The tonic phase was suppressed so that the majority of animals exhibited generalized clonic seizures (with a loss of righting reflexes). In addition, the incidence of generalized seizures was decreased after the 20‐, 40‐, and 80‐mg/kg doses in the 7‐day‐old rat pups. The specific suppression of the tonic phase of generalized seizures was observed up to 12 hours in the 12‐day‐old rat pups. The same result was obtained over 6 hours after TPM administration in the 25‐day‐old animals, and with longer intervals the incidence of generalized seizures decreased in this age group.

Conclusions: TPM exhibits stable anticonvulsant action against the tonic phase of generalized tonic‐clonic seizures throughout development. In addition, it suppresses all phases of generalized seizures in 7‐day‐old rats. The anticonvulsant action of TPM lasted longer in 25‐day‐old than in 12‐day‐old rats. The two actions of TPM might be ascribed to two different mechanisms of action.
Efficacy and Tolerability of Levetiracetam 3000 mg/d in Patients with Refractory Partial Seizures: A Multicenter, Double‐Blind, Responder‐Selected Study Evaluating Monotherapy
Authors: Ben‐Menachem Elinor , Falter Ursula
Published: November 2007

Purpose: To evaluate the efficacy and tolerability of levetiracetam (LEV) monotherapy in selected patients with refractory partial seizures.

Methods: In this multicenter, double‐blind, placebo‐controlled, parallel‐group, responder‐selected study, patients were randomized (2:1 ratio) to receive oral LEV 1500 mg twice daily or placebo during a 12‐week add‐on phase. Treatment responders (patients with a reduction in partial seizure frequency of 50% or more compared with baseline) entered a monotherapy phase that included a maximum 12‐week down‐titration period and 12 weeks of monotherapy at 1500 mg twice daily. In both phases, responder rate, seizure frequency, and adverse events were analyzed.

Results: A total of 286 patients (placebo, n = 105; LEV, n = 181) entered the add‐on phase, and 86 patients (placebo, n = 17; LEV, n = 69) were eligible for the monotherapy phase. Thirty‐six of 181 patients (19.9%) who received LEV completed the entire study compared with only 10 of 105 patients (9.5%) in the placebo group (p = 0.029). The odds of completing the study on LEV were 2.36 times (95% confidence interval, 1.08, 5.57) higher than on placebo. The responder rate during the add‐on phase was significantly higher in the LEV group compared with the placebo group (42.1% vs. 16.7%, respectively; p < 0.001). In the LEV monotherapy group, the median percent reduction in partial seizure frequency compared with baseline was 73.8% (p = 0.037), with a responder rate of 59.2%. Nine patients (18.4%) remained seizure‐free on LEV monotherapy.

Conclusions: Conversion to LEV monotherapy (1500 mg twice daily) is effective and well tolerated in patients with refractory partial seizures who responded to 3000 mg/d LEV as add‐on therapy.
Does Neuroticism Influence Cognitive Self‐Assessment After Epilepsy Surgery?
Authors: Cañizares S. , Torres X. , Boget T. , Rumià J. , Elices E. , Arroyo S.
Published: November 2007

Purpose:To examine how cognitive, personality, and seizure outcome variables influence the subjective cognitive functioning of patients with refractory temporal lobe seizures after epilepsy surgery.

Methods:Thirty‐three consecutive patients with drug‐resistant partial epilepsy who underwent surgical treatment at a tertiary referral university epilepsy center were tested before surgery and 1 year after surgery. Objective cognitive and subjective cognitive functioning tests were used, and personality was assessed. Seizure control was operationalized as a dichoto‐mous variable.

Results:A significant inverse relationship was found between neuroticism and subjective cognitive functioning. None of the other pre‐ and postoperative cognitive and surgery outcome variables were significant predictors of subjective cognitive functioning, even after controlling for the effect of neuroticism.

Conclusions:Subjective and objective memory functioning are independent in patients with epilepsy after surgical treatment. Subjective memory functioning appears to be related not to seizure relief but to neuroticism. These data suggest that psychological factors such as personality traits predisposing to emotional distress should be taken into consideration in the clinical management and counseling of patients undergoing epilepsy surgery.
The “Forgotten” Cross‐Tolerance Between Phenobarbital and Primidone: It Can Prevent Acute Primidone‐Related Toxicity
Authors: Kanner Andres M. , Parra Jaime , Frey Marlis
Published: November 2007

Purpose: We report on the effect that pretreating patients with phenobarbital has on averting adverse events when primidone is introduced.

Methods: Thirty patients with intractable partial epilepsy were pretreated with phenobarbital before starting primidone. Therapy with primidone was started at a dosage of 500 mg/day, and the phenobarbital was stopped. The primidone dose was then increased by 125 to 250 mg every 3 weeks until adverse events or a seizure‐free state was reached. All previous antiep‐ileptic medications were tapered down to yield a primidone monotherapy regimen.

Results: Twenty‐six patients (87%) tolerated the introduction of primidone with minimal or no adverse events. Only one patient had to discontinue primidone during the initial 4 weeks because of severe dizziness. This was the only patient in whom primidone monotherapy could not be reached because of adverse events. Three other patients experienced dizziness severe enough to interfere with their activities. This symptom disappeared in two patients after the dose was lowered; in the other patient, primidone was stopped and phenobarbital was restarted for another 4 days. No symptoms recurred when primidone was reintroduced on the fifth day.

Conclusions: Pretreatment with phenobarbital can minimize the occurrence of intolerable adverse events associated with the introduction of primidone.
Does the Intracarotid Amobarbital Procedure Predict Global Amnesia After Temporal Lobectomy?
Authors: Kubu C. S. , Girvin J. P‐ , McLachlan R‐ S. , Pavol M. , Harnadek M. C. S.
Published: November 2007

Purpose: The intracarotid amobarbital procedure (LAP) is widely used to help predict who might be at risk for postoperative amnesia after unilateral temporal lobectomy for intractable seizures. We describe the memory outcome in 10 patients who underwent standard temporal lobectomy, including mesial temporal structures, despite failing the memory portion of the LAP after injections both ipsilateral and contralateral to the resected seizure focus.

Methods: Data for seven of the study subjects were obtained through a retrospective review of patients assessed on a surgical epilepsy unit during a 15‐year period who failed the Montreal Neurological Institute LAP memory protocol after both ipsilateral and contralateral injections and subsequently underwent unilateral temporal lobectomy. More recently, we have studied temporal lobectomy patients who failed the Medical College of Georgia memory protocol after both ipsilateral and contralateral injections (n = 3). Preoperative and postoperative memory test scores were compared, and data regarding seizure outcome and self‐perception of postoperative memory were collected.

Results: At follow‐up, none of the patients presented with a pattern indicative of a global amnesia, and 80% demonstrated >90% improvement in their seizure disorder or were seizure‐free.

Conclusions: These findings indicate that bilateral memory failure on the LAP does not preclude the removal of an epileptogenic temporal lobe or a successful surgical outcome. In addition, the findings raise questions regarding the validity of the LAP and the possibility that memory may be reorganized in patients with a long history of temporal lobe epilepsy.
Nonepileptic Seizure Outcome Varies by Type of Spell and Duration of Illness
Authors: Selwa Linda M. , Geyer James , Nikakhtar Nersi , Brown Morton B. , Schuh Lori A. , Drury Ivo
Published: November 2007

Purpose: To determine whether differences in clinical manifestations of psychogenic nonepileptic events are associated with differences in outcome and whether the length of illness before diagnosis correlates with outcome.

Methods: We reviewed ictal videotapes and EEGs in 85 patients diagnosed with exclusively nonepileptic psychogenic seizures during inpatient CCTV‐EEG monitoring at the University of Michigan between June 1994 and December 1996. They were classified into groups of similar ictal behaviors. Fifty‐seven of these patients were available to respond to a follow‐up telephone survey about their condition 2–4 years after discharge. We examined demographics, baseline EEG abnormalities, and outcome of treatment interventions. We also evaluated whether interventions were more likely to succeed if patients were diagnosed early in the course of the illness.

Results: We found that the largest groups consisted of patients with motionless unresponsiveness (“catatonic,” n = 19) and asynchronous motor movements with impaired responsiveness (“thrashing,” n = 19). Infrequent signs included tremor, automatisms, subjective events with amnesia, and intermittent behaviors. There was a higher incidence of baseline EEG abnormalities in the thrashing group (31%) than in the catatonic group (0%). There was a higher incidence of complete remission of spells in the catatonic group (53%) than in the thrashing group (21%). Patients who had a more recent onset of seizures (most often within 1 year) were much more likely to have remission of spells after diagnosis.

Conclusions: Classification of nonepileptic seizures is useful in predicting outcome and may be valuable in further investigation of this complex set of disorders.
Psychosocial Impact of Epileptic Seizures in a Dutch Epilepsy Population: A Comparative Washington Psychosocial Seizure Inventory Study
Authors: Swinkels W. A. M. , Shackleton D. P. , Trenité D. G. A. Kasteleijn‐Nolst
Published: November 2007

Purpose: The psychosocial functioning of epilepsy patients from the Netherlands was investigated and compared with results from other countries. The impact of epilepsy was also studied in two different groups of Dutch epilepsy patients, inpatients and outpatients.

Methods: The Washington Psychosocial Seizure Inventory (WPSI) was used to study the psychosocial problems of 134 Dutch outpatients and 181 Dutch inpatients. WPSI profiles were compared with those from the former German Democratic Republic (West Germany), Finland, Canada, the United States, Chile, and Japan.

Results: For the Dutch epilepsy patients, most of the psychosocial problems were experienced by inpatients; they had serious problems in emotional, interpersonal, and vocational adjustment, adjustment to seizures, and overall psychosocial functioning. Seizure‐free outpatients, however, experienced significant problems only in the emotional adjustment area. Comparing the outcomes of various countries, Dutch outpatients and patients from West Germany and Finland experienced the least psychosocial difficulties, whereas epilepsy patients from Chile, Japan, and Canada have serious problems in most areas of psychosocial functioning.

Conclusions: Patients with epilepsy experience psychosocial problems, although the amount of psychosocial difficulties depends on the seizure frequency and the culture that patients live in.
The Safety of Rapid Valproic Acid Infusion
Authors: Limdi Nita A. , Faught Edward
Published: November 2007

Purpose: The recommended rate of administration of valproic acid injection is 20 mg/min. Drug delivery at this rate may be inadequate for expeditious control of seizures. The safety of rapid infusion of valproic acid has not been established, and this study was designed to explore the effects of rapid infusion in patients with acute seizures.

Methods: Twenty patients with acute repetitive seizures received 20 mg/kg loading doses of valproic acid. Infusion rates ranged from 33.3 to 555 mg/min (median, 200 mg/min). Sixteen patients had received previous or concomitant antiepileptic drugs, with inadequate seizure control. Heart rate, blood pressure, and respiratory rate were measured before infusion and at frequent intervals for 1 hour after infusion. Patients were also observed for changes in level of alertness and signs of local irritation.

Results: No patient exhibited a decline in level of conscious ness or respiratory function. Two patients with significant con tributing factors exhibited declines in blood pressure requirinj vasopressors. No significant local irritation was reported. Al though efficacy was not a measured end point, seizures wen abolished in all patients.

Conclusions: Infusion of valproic acid at rates between 3! and 555 mg/min is well tolerated. No serious adverse effect attributable to the rapid infusion of valproic acid were encoun tered, although valproic acid, along with other factors, ma; have contributed to the hypotension in two patients. Intrave nous valproic acid is an option for the control of acute seizures.
Advances in Telecommunications Concerning Epilepsy
Authors: Elger Christian E. , Burr Wieland
Published: November 2007

Summary Telemedicine is a rapidly expanding discipline. Looking back on a long tradition of telemetric measurement and transmission of brain electrical data, one might ask how relevant telecommunication techniques have become for clinical work in epileptology. In principle, communication can be either between patient and doctor or between doctor and doctor. The former includes telephone reports on frequency and severity of seizures and on mental and physical state. Because of the special problems of patients with epilepsy, the need for traveling should be minimized. To maintain close contact, telemetric transmission of electroencephalograms (EEG), seizure video‐registration, and monitoring of anti‐epileptic drug (AED) blood levels from home are desirable, but the technical tools now available are not of sufficiently high performance for these applications. However, physicians and medical units can communicate using high‐rate data transfer. There are major problems with this technology. Transfer rates using the internet are not fixed. Moreover, using six digital telephone lines simultaneously, good‐quality transmission of a 3‐min video may take more than 1 h, restricting interactivity. In contrast to imaging (e.g., magnetic resonance imaging), there is no generally accepted protocol for handling EEG/electrocorticography data. There are also legal problems relating to the responsibility for failures and safety of personal or medical data. Nevertheless, the expenses of installation and use of such equipment appear justified by the expected benefits, for the patients (avoiding travel and multiple investigations, checking diagnosis and therapy, amending quality of life), for the physician (sparing equipment and manpower, accelerating and improving diagnosis), for the epilepsy center (increased database for expert systems, improved logistic and data storage) and, finally, for insurance providers (reduced overall costs). When the neurosurgical procedure is remote from the place of presurgical evaluation, telecommunication should be obligatory.