bluuebunny/crossref_metadata_2025 huggingface dataset:
Characteristics of Migraine Visual Aura
Authors: Queiroz Luiz P. , Rapoport Alan M. , Weeks Randall E. , Sheftell Fred D. , Siegel Sheryl E. , Baskin Steven M.
Published: March 2003

Visual auras (VAs) of 100 patients with migraine with aura were studied by questionnaire. Visual auras accompanied the patients' first headache (HA) in 39% of patients. Only 19% had VAs with every attack. Patients with VAs over the entire HA history had a high frequency (greater than 50%) of attacks with VA; patients with VA during only part of the HA history had a low frequency (less than 50%} of attacks with VA. The auras occurred exclusively prior to the HA in 57%. The free interval between the end of the VA and the start of the HA was usually (75%) shorter than 30 minutes. Most (59%) patients had VAs that lasted from 1 to 30 minutes. They started in the periphery of the visual fields in 56%. The most common phenomena described were: small bright dots (42%), flashes of light (39%), “blind spots” (32%), and “foggy vision” (27%). Fortification spectra was reported by only 20%. Although most (65%) patients had a combination of phenomena, the majority (72%) had only one uniform constellation of manifestations. There was no clear‐cut relationship between side of VA and side of HA.

Migraine VA is a pleomorphic and complex symptom. Many patients not qualifying for the diagnostic criteria of migraine with aura, as proposed by the International Headache Society (IHS) unequivocally present with visual phenomena that strongly suggest this diagnosis.
Headache in Sweden: The Importance of Working Conditions
Authors: Antonov Karolina , Isacson Dag
Published: March 2003

Headache is a common health problem that causes individual suffering as well as public expense. Because epidemiological studies have shown that headache is most prevalent among persons younger than 55 years, the influence of working conditions is of interest. In this study, we examined the importance of working conditions as a risk factor for frequent headache among the general Swedish population.

Data from the Swedish Survey of Living Conditions for the 2‐year period, 1988 and 1989, were used. In this survey, a probability sample of the Swedish population aged 16 years and older was interviewed. Frequent headache was defined as a positive answer to the question, "Have you (during the just 2 weeks) had recurrent headache or migraine?" Work stress was studied for two indices: physical work stress and mental work stress. The physical work stress index contained measurements of seven working conditions, and the mental work stress index contained measurements of three working conditions.

The proportion of persons who reported frequent headache was greater among women than men, and frequent headache was most common in the age group 25 to 44 years. The logistic regression analyses showed that both physical and mental work stress were strongly associated with frequent headache among both men and women even after controlling for potential confounders. The associations between work stress and frequent headache may be dose‐dependent. Heavy menial work stress was most strongly associated with frequent headache among men (odds ratio 3.03 [1,92 to 4.78]) while heavy physical work stress was most strongly associated with frequent headache among women (odds ratio 3.48 [1.13 to 10.65]).

Improved working conditions could be one way of preventing headache, thereby decreasing individual suffering a and employer as well as public expense.
Alcohol, Smoking, and Caffeine Use Among Headache Patients
Authors: Mannix Lisa K. , Frame Joy R. , Solomon Glen D.
Published: March 2003

We reviewed the charts of 151 headache patients, seen initially in a specialty headache center between 1988 and 1994, to collect information regarding reported alcohol consumption, smoking, daily number of caffeinated beverages, and medications. Charts of 50 patients in a general medicine clinic were reviewed for the same information.

No significant differences between headache patients and general medicine patients were found in consumption of alcohol, smoking, or caffeinated beverages. Thirty headache patients (20%) used caffeine‐containing medications more frequently than recommended; 24 of these patients used the products daily; 18 of those had a greater caffeine intake from medications than from beverages. Over‐the‐counter caffeine‐containing analgesics were overused by 12 of the patients compared to 21 patients who overused prescription caffeine‐containing preparations.

Headache patients consume minimal amounts of alcohol, tobacco, and caffeinated beverages. However, headache patients often use caffeine‐containing analgesics more frequently than recommended, which may lead to rebound and withdrawal headache.
Migrainous Stroke Causing Thalamic Infarction and Amnesia During Treatment With Propranolol
Authors: Mendizabal Jorge E. , Greiner Frank , Hamilton William J. , Rothrock John F.
Published: March 2003

We report a case of migraine‐associated ischemic stroke causing amnesia, wherein treatment with propranolol may have been contributory. The possible mechanisms involved in migrainous stroke occurring in association with use of propranolol are discussed.
Postmeningitis Headache
Authors: Neufeld Miriam Y. , Treves Therese A. , Chistik Vladimir , Korczyn Amos D.
Published: March 2003

Acute meningitis is associated with headache, but the natural history of the headache following recovery is unknown. We addressed this issue in 141 patients admitted during 1990 to 1993 with laboratory‐confirmed meningitis. We excluded patients younger than 5 years (n=44), elderly demented patients (n=6), and those with potential causes of headache other than meningitis (n=4). Seventeen candidates could not be traced. The remaining 70 patients were interviewed using a semistructured questionnaire that documented age, sex, type of meningitis, time of headache onset after infection, and headache description as well as any past and/or family history of headache. These patients were compared to age‐ and sex‐matched controls (n=70).

Prior to meningitis, 13 patients (19%) had had headaches (migrainous in 8) as did 18 controls (26%; migrainous in 8). Headache first appeared after meningitis in 19 patients (33%; migrainous in 6), increasing the total prevalence to 46%. We found no association between sex, type of meningitis, or family history and the development of postmeningitis headache. Patients who developed postmeningitis headache were significantly younger than those who did not. We conclude that there is an association between meningitis, either bacterial or aseptic, and subsequent persistent recurrent migrainous or nonmigrainous headache.
Longitudinal Prospective Study of Headache During Pregnancy and Postpartum
Authors: Marcus Dawn A. , Scharff Lisa , Turk Dennis
Published: March 2003

Chronic headache fluctuates in response to changes in hormonal levels. Headache generally improves with rising estrogen levels, and worsens with falling levels. Headache should, therefore, predictably improve with pregnancy and worsen postpartum. Several retrospective studies have confirmed this pattern. In this study, 49 pregnant women with chronic headache (18 with migraine, 16 with tension‐type, and 15 with combined migraine and tension‐type) were followed prospectively. Headache activity was recorded daily throughout pregnancy and for 3 months postpartum. Overall, there was a 30% improvement in headache between the second and third trimesters for the entire sample. This was not statistically significant. Headache improved significantly for 41% of the women, with a slightly greater tendency for headache to improve in women with migraine compared to those with tension‐type or combined migraine and tension‐type headaches. Headache activity was not influenced by history of menstrual migraine, history of headache change with prior pregnancies, parity, or breast‐feeding. In general, women reporting headache at the end of their first trimester continued to report headache throughout pregnancy and postpartum.
Identification of Patients With Headache at Risk of Psychological Distress
Authors: Marcus Dawn A.
Published: March 2003

Objective.–To test the hypothesis that anxiety and depression are associated with headache frequency, severity, and disability.

Background.–There is significant comorbidity between chronic headache and psychological distress. Headache associated with anxiety or depression tends to be more severe and often requires supplementary psychological treatment in addition to headache therapy. Therefore, the identification of patients with headache who are at risk of psychological distress is important.

Methods.–One hundred twenty‐seven consecutive patients with headache attending a university headache clinic were evaluated. Questionnaires about headache symptoms and psychological distress were completed. Comparisons were made between psychological distress and headache frequency, severity, and disability.

Results.–Depression and anxiety were significantly greater in the subjects of this study who had frequent headache (>4 days per week) and frequent headache‐associated disability (activities reduced or prohibited because of headache >3 days per week). Subjects who reported their headache severity as typically severe were no more likely to report depression or anxiety than those with mild or moderate headache severity. Quality‐of‐life measures of physical and social functioning, emotional distress, and general health and vitality were reduced in subjects with frequent episodes of headache‐associated disability. All areas, with the exception of general health perception, were reduced in subjects with frequent headache. Severe headache was associated with reductions in role and social functioning.

Conclusions.–Frequent headache and frequent disability are associated with depression, anxiety, and impaired quality of life. Reports of typical headache severity are less likely to correlate with psychological distress. Therefore, patients with headache who report frequent headache or frequent periods of headache‐related disability should be further evaluated for the presence of psychological disturbance.
Acute Intracranial Hemorrhage in the Brain Caused by Acupuncture
Authors: Choo Daniel Chung Ann , Yue Geng
Published: March 2003

A 44‐year‐old Chinese man developed severe occipital headache, nausea, and vomiting during acupuncture treatment of the posterior neck for chronic neck pain. Computed tomography of the head showed hemorrhage in the fourth, third, and lateral ventricles. A lumbar puncture confirmed the presence of blood. Magnetic resonance angiography with gadolinium did not reveal any saccular aneurysms or arteriovenous malformations. The patient's headache resolved over a period of 28 days without any neurological deficits. Acupuncture of the posterior neck can cause acute intracranial hemorrhage.
Treatment of Nonresponders to Oral Sumatriptan With Zolmitriptan and Rizatriptan: A Comparative Open Trial
Authors: Mathew Ninan T. , Kailasam J. , Gentry Paula , Chernyshev Oleg
Published: March 2003

In order to study the effect of zolmitriptan and rizatriptan in oral sumatriptan nonresponders (defined as lack of response in three or more of five attacks), 56 patients were studied in an open trial in a crossover fashion. Both zolmitriptan, 5 mg, and rizatriptan, 10 mg, were effective in the majority of sumatriptan nonresponders. The response to rizatriptan, 10 mg, appeared to be better than to zolmitriptan, 5 mg. Approximately 19% of sumatriptan nonresponders remained nonresponders to both zolmitriptan and rizatriptan.
Cardiac Risk Factors and the Use of Triptans: A Survey Study
Authors: Young William B. , Mannix Lisa , Adelman James U. , Shechter Aaron L.
Published: March 2003

Objective.—To describe current practice in triptan use.

Background.—Triptans are effective migraine treatments that cause chest symptoms in some patients. True cardiac ischemia is rare.

Design.—Headache specialists and family practitioners completed questionnaires regarding the times when triptans are contraindicated, obtaining electrocardiograms (ECGs), and giving the first dose in the office.

Results.—Sixty‐five headache specialists and 67 family practitioners responded. Headache specialists saw an average of 36.3 patients with headache per week. Family practitioners saw an average of 7.2.

Family practitioners and headache specialists had similar opinions regarding the age at which triptans were contraindicated with various numbers of risk factors. Sixty‐one percent of headache specialists and 50% of family practitioners would not use a triptan at any age for patients with more than three risk factors (P = NS). Ten percent of headache specialists obtained an ECG for all patients being prescribed triptans, while no family practitioners did (P = .008). Ten percent of both family practitioners and headache specialists never obtained an ECG, even with multiple cardiac risk factors. Headache specialists obtained ECGs more often than family practitioners (P < .002 for one to three risk factors). Family practitioners were more likely to give the first dose of the triptan in the office regardless of cardiovascular risk (58% versus 20%, P < .001). Forty‐five percent of headache specialists and 2% of family practitioners never gave the first dose in the office (P < .001). Family practitioners gave the first dose in the office more readily than headache specialists in patients with no risk factors (P = .001), but not for one or more risk factors.

Conclusions.—No consensus exists among family practitioners or headache specialists about when to avoid using a triptan due to excessive cardiac risk factors, when to obtain an ECG prior to using a triptan, and when to give the first dose of a triptan in the office. Headache specialists are more likely to obtain ECGs, whereas family practitioners are more likely to give the first dose of a triptan in the office.
Triptans in the Treatment of Basilar Migraine and Migraine With Prolonged Aura
Authors: Klapper J. , Mathew N. , Nett R.
Published: March 2003

Objective.—To report on the use of triptans in migraine with prominent neurologic symptoms.

Background.—As stated in their package inserts, the triptans are contraindicated in patients with basilar or familial hemiplegic migraine, and physicians are reluctant to prescribe these drugs to other patients with prominent or prolonged aura.

Methods.—We evaluated 13 patients with basilar migraine, familial hemiplegic migraine, or migraine with prominent or prolonged aura who had received triptans.

Results.—Excellent; no adverse events.

Conclusion.—The contraindication of triptans in basilar migraine should be reconsidered. Similarly, prominent or prolonged aura may not represent a reasonable contraindication to triptan therapy.
Visual Cortex Excitability in Migraine With and Without Aura
Authors: Mulleners Wim M. , Chronicle Edward P. , Palmer Joanne E. , Koehler Peter J. , Vredeveld Jan‐Willem
Published: March 2003

Objectives.—Previous research using transcranial magnetic stimulation has produced equivocal findings concerning thresholds for the generation of visual phosphenes in migraine with aura. These studies were methodologically varied and did not systematically address cortical excitability in migraine without aura. We therefore studied magnetophosphene thresholds in both migraine with aura and migraine without aura compared with headache‐free controls.

Methods.—Sixteen subjects with migraine with aura and 12 subjects with migraine without aura were studied and compared with 16 sex‐ and age‐matched controls. Using a standardized transcranial magnetic stimulation protocol of the occipital cortex, we assessed the threshold stimulation intensity at which subjects just perceived phosphenes via a method of alternating course and fine‐tuning of stimulator output.

Results.—There were no significant differences across groups in the proportion of subjects seeing phosphenes. However, the mean threshold at which phosphenes were reported was significantly lower in both migraine groups (migraine with aura=47%, migraine without aura=46%) than in controls (66%). Moreover, there was no significant correlation between individual phosphene threshold and the time interval to the closest migraine attack.

Conclusion.—Our findings confirm that the occipital cortex is hyperexcitable in the migraine interictum, both in migraine with and without aura.
Migraine With Aura After Administration of Sublingual Nitroglycerin Tablets
Authors: Bánk J.
Published: March 2003

As a nitric oxide donor, nitroglycerin can trigger migraine in migraineurs. The headache is not characteristically accompanied by an aura.

A patient with no personal or family history of migraine reported the development of a typical visual aura and a throbbing headache while using nitroglycerin for angina pectoris.

The possible mechanisms are discussed.
Migraine‐Associated Vomiting and Asystole in a Child
Authors: Buchhalter Jeffrey R. , Berland Gretchen , Konkol Richard , Silka Michael
Published: March 2003

A variety of symptoms that accompany migraine in the child and adult are mediated by the autonomic nervous system. Significant effects on cardiac rhythm are uncommon, but can be life threatening. We describe a 3‐year‐old girl in whom migraine‐associated vomiting precipitated cardiac asystole which was effectively treated with a cardiac pacemaker.
Migraine with Aura Versus Migraine Without Aura: Pain Intensity and Associated Symptom Intensities After Placebo
Authors: Bigal Marcelo E. , Bordini Carlos A. , Sheftell Fred D. , Speciali José G. , Bigal Janaína O. M.
Published: March 2003

Objective.—To compare the intensity of pain and associated symptoms after placebo administration in patients with migraine with aura and migraine without aura.

Background.—Studies that evaluate drugs used in the acute treatment of migraine ideally should include a placebo arm. The International Headache Society also recommends stratification according to age and sex but not by the presence versus absence of aura.

Methods.—The study was conducted as part of a placebo controlled randomized survey comparing four active drugs against placebo in the acute treatment of migraine. Patients were blinded as to treatment received. Placebo consisted of 10 mL of normal saline (0.9%) intravenously. Pain intensity was evaluated by a 10‐point analogical‐verbal scale. Nausea, photophobia, and phonophobia were evaluated by a four‐point analogical‐verbal scale. For statistical analysis, unpaired t‐test with Welch correction was used.

Results.—After placebo administration, reduction of symptom intensity (pain, nausea, photophobia, and phonophobia) in patients with migraine without aura was significantly greater than that observed in patients with migraine with aura.

Conclusions.—Our findings suggest that studies comparing placebo against an active drug should use stratification according to the presence versus absence of aura.
Almotriptan Increases Pain‐Free Status in Patients With Acute Migraine Treated in Placebo‐Controlled Clinical Trials
Authors: Mathew Ninan T.
Published: March 2003

Objectives.—Evaluate the efficacy of a single oral dose of almotriptan in achieving pain‐free status during treatment of acute migraine attacks.

Methods.—This pooled analysis (N=1321) used data from two randomized, placebo‐controlled, phase III trials (studies A and B) to determine the proportion of patients with migraine achieving pain‐free status 2 hours after a single oral dose of study medication (almotriptan or placebo). Pain was assessed using a 4‐point integer scale (0=no headache, 3=severe headache), and recorded in a patient self‐assessment booklet.

Results.—The proportion of patients pain‐free at 2 hours after study medication was significantly greater with almotriptan 6.25 mg (both studies P≤.002) and almotriptan 12.5 mg (both studies P≤.001) than with placebo. In study A, 11.6% of patients taking almotriptan 12.5 mg versus 2.5% of patients receiving placebo were pain‐free at 1 hour (P=.016). At 1.5 hours, 26.8% of patients taking almotriptan 12.5 mg versus 8.8% receiving placebo (P=.001) were pain‐free, and at 2 hours, 38.4% on almotriptan versus 11.3% on placebo were pain‐free (P<.001). In study B, 23.8% of patients taking almotriptan 12.5 mg were free from pain at 1.5 hours versus 10.2% receiving placebo (P<.001). At 2 hours, 39.2% taking almotriptan 12.5 mg versus 15.3% receiving placebo were pain‐free (P<.001). Increases in pain‐free status with almotriptan generally occurred in a dose‐dependent manner.

Conclusion.—Compared with placebo, almotriptan 12.5 mg significantly increases the proportion of patients who are pain‐free by as early as 1 hour, and consistently by 1.5 hours, after a single dose.
Status Epilepticus and Tiagabine Therapy: Review of Safety Data and Epidemiologic Comparisons
Authors: Shinnar Shlomo , Berg Anne T. , Treiman David M. , Hauser W. Allen , Hesdorffer Dale C. , Sackellares J. Chris , Leppik Ilo , Sillanpaa Matti , Sommerville Kenneth W.
Published: March 2003

Summary:  Purpose: To determine whether an increased risk of status epilepticus (SE) and complex partial status epilepticus (CPSE) is associated with tiagabine (TGB) therapy.

Methods: Thirteen cases in which an EEG, performed on patients with altered mental status taking TGB, was reported to demonstrate spike‐and‐wave discharges (SWDs) were reviewed by a panel of experts. In addition, all cases of suspected SE from TGB clinical trials were reviewed. The occurrence of SE in four epidemiologic cohorts from Rochester, Minnesota, Turku, Finland, Bronx, New York, and New Haven, Connecticut was analyzed as an external comparison.

Results: Review of the 13 cases with reported SWDs found that the majority had had prior EEGs with similar findings, and only three were thought to have electrographic evidence of SE. There was no difference in the frequency of SE or CPSE in the placebo‐controlled clinical trials between the TGB‐treated (1.0% SE, 0.8% CPSE) and placebo‐treated (1.5% SE, 1.5% CPSE) groups. The 5% frequency of SE and 3% frequency of CPSE in the TGB‐treated patients in the long‐term safety studies, which included 2,248 patients, were very similar to the rates of occurrence of SE and CPSE in the four external cohorts. The major risk factor for the occurrence of SE and CPSE in all groups was a prior episode of SE (p < 0.0001).

Conclusions: Over a 3‐year period, SE will occur in 5–10% of patients with epilepsy not in remission. At highest risk are those who have had a prior episode of SE. Treatment with TGB in recommended doses does not increase the risk of SE in patients with partial seizures.
Absence Seizures Aggravated by Valproic Acid
Authors: Lerman‐Sagie Tally , Watemberg Nathan , Kramer Uri , Shahar Eli , Lerman Pinchas
Published: March 2003

Summary: Purpose:To report on pediatric patients with absence epilepsy who experienced absence seizure aggravation while receiving valproic acid (VPA).

Methods:The charts of all children from four pediatric epilepsy clinics receiving VPA for absence epilepsy were reviewed. Patients were evaluated and followed up between 1994 and 2000.

Results:Eight cases (six boys) of absence seizure aggravation were detected. Mean age at seizure onset was 5.8 years (range, 3–12 years). Six patients had simple absence seizures, one had myoclonic absences, and one had absences with automatisms. The electroencephalogram in all cases depicted generalized 3‐Hz spike‐and‐wave activities. All eight patients experienced an increase in the frequency of absence seizures within days of VPA introduction. Dose increments resulted in further seizure aggravation. Serum levels of VPA were within therapeutic range in all patients. No case was attributed to VPA‐induced encephalopathy. All patients improved on VPA discontinuation. In five children, VPA was reintroduced, resulting in further seizure aggravation.

Conclusions:VPA can occasionally provoke absence seizure aggravation in patients with absence epilepsy.
Remission of Seizures in a Population‐Based Adult Cohort with a Newly Diagnosed Unprovoked Epileptic Seizure
Authors: Lindsten Hans , Stenlund Hans , Forsgren Lars
Published: March 2003

Summary: Purpose: To investigate the probability of achieving remission of seizures after a newly diagnosed unprovoked epileptic seizure in an adult population‐based cohort.

Methods: 107 patients aged 17 years or older with a newly diagnosed unprovoked epileptic seizure (index seizure) in 1985 through 1987 were followed up until the date of death or to the end of 1996. The proportion of cases during follow‐up that attained a 1‐year, 3‐year, 5‐year remission was calculated by actuarial analyses. Variables for stratification were age at diagnosis, seizure type, etiology, EEG, and the occurrence of seizures within 1 year of initiation of antiepileptic drug (AED) therapy.

Results: Cumulative 1‐, 3‐ and 5‐year remission rates were 68, 64, and 58%. There was no statistically significant difference regarding time points of achieving a 1‐year remission after epilepsy diagnosis and the subsequent probability during follow‐up of attaining a 5‐year remission. Having seizures within 1 year after beginning with an AED was a statistically significant predictor of never achieving 1‐year remission of seizures during follow‐up (refractory seizures). Other stratified variables were not statistically significant predictors.

Conclusions: Seizure prognosis for the majority of patients with newly diagnosed epilepsy is good. The time required after epilepsy diagnosis to achieve a 1‐year remission of seizures does not affect the probability of additionally achieving a 5‐year remission. Patients with refractory seizures can be identified within a few years from diagnosis of epilepsy. These patients must be targeted early for optimization of pharmacologic treatment, possible surgery, and psychosocial intervention.
Psychosocial Adjustment of People with Epilepsy in Hong Kong
Authors: Lau Vanessa W. Y. , Lee Tatia M. C. , Ng Philip K. K. , Wong Virginia C. N.
Published: March 2003

Summary:  Purpose: In light of the issues associated with the psychosocial adjustment of people with epilepsy that have been widely reported, this study examined these issues within a Chinese cultural context.

Methods: Fifty patients with epilepsy completed The Washington Psychosocial Inventory, the Coping Inventory for Stressful Situations, and a questionnaire that assessed their psychosocial difficulties and coping styles. Multiple regression procedure was used to examine the strength of various medical and social factors in predicting the psychosocial adjustment problems of these participants.

Results: Social factors, such as self‐perception and coping strategies, were more powerful predictors of psychosocial adjustment in people with epilepsy than the medical factors associated with epilepsy.

Conclusions: These findings showed that psychosocial maladjustment is a significant issue for people with epilepsy in Hong Kong. The emerging importance of social factors as predictors of psychosocial adjustment in epilepsy, as compared with medical factors, highlights the need for developing tailored counseling therapy and social support groups for people with epilepsy.
Circulating Levels of Allopregnanolone, an Anticonvulsant Metabolite of Progesterone, in Women with Partial Epilepsy in the Postcritical Phase
Authors: Galli Renato , Luisi Michele , Pizzanelli Chiara , Monteleone Patrizia , Casarosa Elena , Iudice Alfonso , Murri Luigi
Published: March 2003

Summary:  Purpose: Several lines of evidence indicate that there exists a relation between ovarian hormones and epilepsy. Estrogens decrease seizure threshold and increase brain excitability, whereas progesterone has an inhibitory effect and reduces epileptiform activity. Recently considerable interest has turned to neuroactive steroids, a group of progesterone metabolites, as endogenous modulators of excitability of the central nervous system (CNS). Their ability to alter neuronal firing rapidly occurs through interaction with γ‐aminobutyric acid (GABA) A receptor complex. In a previous experience, serum allopregnanolone (3α‐OH‐5α‐pregnan‐20‐one) levels were measured in 15 women with partial epilepsy in the intercritical phase, and no significant differences were found between patients and control subjects.

Methods: To find out if there are changes in serum allopregnanolone levels after epileptic seizure, blood samples were drawn immediately, 15 min, and 6 h after a seizure in seven fertile females with partial epilepsy.

Results: The most interesting finding is that allopregnanolone increases in serum during the first 15 min after partial seizures (p < 0.05) and decreases after 6 h.

Conclusions: These data are consistent with a role for allopregnanolone in the control of neuronal excitability and seizures.
Transplacental Passage of Oxcarbazepine and Its Metabolites In Vivo
Authors: Myllynen P. , Pienimäki P. , Jouppila P. , Vähäkangas K.
Published: March 2003

Summary:  Purpose: The purpose of this study was to investigate human fetal exposure to oxcarbazepine (OCBZ) in vivo.

Methods: Transplacental passage and placental tissue concentrations of OCBZ and its metabolites were determined. Maternal venous blood, cord blood, and placental tissue samples from 12 mothers using OCBZ during pregnancy alone or in combination with other antiepileptic drugs were collected. Samples were analyzed with high‐performance liquid chromatography.

Results: Maternal venous concentrations of OCBZ and its major metabolites were at same range as cord blood concentrations (OCBZ in maternal serum, 0.19 ± 0.16 μg/ml, and in cord serum, 0.21 ± 0.19 μg/ml; 10‐hydroxy‐10,11‐dihydrocarbamazepine (10‐OH‐CBZ) in maternal serum, 5.69 ± 2.49 μg/ml, and in cord serum, 5.23 ± 1.44 μg/ml; 10,11‐trans‐dihydroxy‐10,11‐dihydrocarbamazepine (10,11‐D) in maternal serum, 0.29 ± 0.22 μg/ml, and in cord serum, 0.28 ± 0.14 μg/ml). OCBZ (0.17 ± 0.16 μg/g placental tissue), 10‐OH‐CBZ (3.49 ± 1.34 μg/g placental tissue) and 10,11‐D (0.25 ± 0.11 μg/g placental tissue) were detected in the placental tissue. The amount of OCBZ detected from placental tissue was 0.01% of the daily dose.

Conclusions: OCBZ, like other antiepileptic drugss, is transferred significantly through the placenta in humans.
Pharyngeal Dysesthesias as an Aura in Temporal Lobe Epilepsy Associated with Amygdalar Pathology
Authors: Garganis K. , Papadimitriou C. , Gymnopoulos K. , Milonas J.
Published: March 2003

Summary:  Purpose: Pharyngeal dysesthetic auras are typically described with centrotemporal and opercular seizure‐onset localizations. In this report we describe the fourth case in literature with temporal lobe seizures, apparently secondary to an amygdalar lesion on magnetic resonance imaging (MRI), presenting with prominent pharyngeal dysesthesias as the initial, or only, seizure manifestation.

Methods: Because of diagnostic uncertainty regarding the nature of the pharyngeal sensations, our case underwent prolonged extracranial video‐EEG monitoring.

Results: Video‐EEG information documented the epileptic origin of the dysesthesias and was concordant with the side and location of the amygdalar lesion.

Conclusions: Pharyngeal dysesthetic auras may be produced by epileptic activity originating from the amygdala, and perhaps other mediotemporal structures. The underlying topography of this aura is not known with certainty, and it may reflect seizure spread from the amygdala and adjacent areas to the closely interconnected insular and opercular cortex, whose secondary activation could elicit similar sensations.
Hot Water Epilepsy: Clinical and Electrophysiologic Findings Based on 21 Cases
Authors: Bebek Nerses , Gürses Candan , Gokyigit Aysen , Baykan Betul , Ozkara Cigdem , Dervent Aysin
Published: March 2003

Summary:  Purpose: Our aim is to outline the clinical and electroencephalographic (EEG) features of patients with hot water epilepsy (HWE), a rare and unique form of reflex epilepsy.

Methods: Twenty‐one patients with HWE, seen in our clinic until 1999, were studied. Male outnumbered female subjects in a ratio of 3:1. The age at the onset of seizures ranged from 19 months to 27 years (mean age at onset, 12 years).

Results: The main factors precipitating seizures were bathing with hot water and/or pouring water over the head. Six patients reported self‐induction, either by increasing the heat or the amount of water and/or recalling earlier bathing experiences. Nine patients expressed feeling pleasure during the seizures. Twenty patients had partial seizures, eight of whom also had secondarily generalized seizures. One patient had apparent generalized seizures only. Spontaneous seizures were present in 62% of the cases. Interictal epileptogenic abnormalities were documented in the EEGs of eight patients; the other eight had normal EEGs. The major sites of epileptogenic activity were over the unilateral temporal regions (in 40% of patients). Neuroimaging studies available for 12 patients (four cranial computed tomography and eight cranial magnetic resonance imaging scans) revealed normal findings. Seizure control in patients who were followed up was achieved by reducing the temperature or the duration of the bath or shower; several of the patients required medication.

Conclusions: The major findings of this study are that HWE has a male preponderance, can be self‐induced, is often done for pleasure, has complex triggering factors, and shows temporally located abnormalities in the EEGs. Although HWE is generally known to be self‐limited, antiepileptic drug treatment may sometimes be necessary to control seizures. Hot water epilepsy should be classified separately among the epileptic syndromes.
Acetazolamide in Women with Catamenial Epilepsy
Authors: Lim Li‐Ling , Foldvary Nancy , Mascha Ed , Lee Julia
Published: March 2003

Summary:  Purpose: Catamenial epilepsy is a condition characterized by an increase in seizures during particular phases of the menstrual cycle. The incidence of catamenial epilepsy varies widely, partly because of a lack of a universally adopted definition. Specific treatment options for these patients are limited. The use of acetazolamide (AZ) has been based largely on anecdotal reports demonstrating efficacy in small or poorly characterized populations. The purpose of this study was to analyze retrospectively the efficacy, safety profile, and tolerability of AZ in women with catamenial epilepsy.

Methods: Women with catamenial epilepsy identified from 1990 through 1999 were invited to participate in a retrospective telephone questionnaire addressing the relationship of seizures and the menstrual cycle and the use, efficacy, and adverse effects of AZ. Seizure outcome was classified as: seizure free (SF), significantly improved (SI), or not significantly improved (NSI). Responses to AZ were compared in women with different types of epilepsy and comparing continuous versus intermittent dosing using Fisher's exact tests.

Results: Twenty women were identified who had received or were currently taking AZ. The drug was given continuously in 55% and intermittently in 45% of patients. A ≥50% decrease in the seizure frequency was reported by 40% of subjects. Response rates were similar in generalized and focal epilepsy and in temporal and extratemporal epilepsy. There was no significant difference in effectiveness comparing continuous with intermittent dosing. A loss of efficacy over 6–24 months was reported by 15% of women.

Conclusions: Despite our small sample and retrospective design, AZ appears to demonstrate efficacy for catamenial epilepsy.
The Regulation of Serum Sodium After REeplacing Carbamazepine with Oxcarbazepine
Authors: Isojärvi Jouko I. T. , Huuskonen Usko E. J. , Pakarinen Arto J. , Vuolteenaho Olli , Myllylä Vilho V.
Published: March 2003

Summary:  Purpose: To evaluate changes in serum electrolyte balance and underlying regulatory mechanisms in 10 male patients with epilepsy 2 and 6 months after replacing long‐term carbamazepine (CBZ) monotherapy with oxcarbazepine (OCBZ) monotherapy. Arginine vasopressin (AVP) is thought to be most important underlying mechanism of CBZ‐related hyponatremia via direct or kidney tubular mechanisms. Furthermore, AVP is as well hormonally regulated by the renin–angiotensin–aldosterone system and atrial natriuretic peptide (ANP).

Methods: The medication of the patients was changed from CBZ to OCBZ. Serum electrolytes, creatinine, albumin, aldosterone, and the N‐terminal fragment of ANP (NT‐proANP) concentrations were measured before and 2 and 6 months after the change in the medication.

Results: The mean serum sodium level diminished after the medication was changed. Serum sodium levels decreased below the reference range in two (20%) patients during OCBZ medication. Serum sodium levels decreased altogether in four patients, and remained unaltered in six patients. Serum aldosterone levels increased in the six patients whose serum sodium concentrations did not decrease, but no increase was found in the patients with decreased sodium levels during OCBZ medication. Serum NT‐proANP levels decreased in all patients.

Conclusions: Serum sodium levels decrease after replacing CBZ with OCBZ. The low serum NT‐proANP concentrations appear to reflect the decreased serum sodium levels, but a compensatory aldosterone response may prevent the development of hyponatremia in some patients during OCBZ medication.
Pre‐ Rather than Co‐application of Vigabatrin Increases the Efficacy of Tiagabine in Hippocampal Slices
Authors: Köhling Rüdiger , König Klaus , Lücke Anne , Mayer Thomas , Wolf Peter , Speckmann Erwin‐Joseph
Published: March 2003

Summary:  Purpose: The antiepileptic drug vigabatrin (VGB) increases intracellular availability of the inhibitory transmitter γ‐aminobutyric acid (GABA) by inhibition of GABA‐transaminase. A blockade of the GABA uptake is the main mechanism of action of tiagabine (TGB). Based on this, the two antiepileptic drugs (AEDs) can be speculated to act synergistically so that their combined antiepileptic efficacy is supraadditive.

Methods: To test this, experiments were performed on hippocampal slices of guinea‐pigs. As an epilepsy model, epileptiform field potentials (EFPs) were induced by omission of Mg2+ from the bath solution and recorded in stratum pyramidale of the CA3 region. VGB (7.5 μM) and TGB (0.75 μM) were added to the superfusate.

Results: VGB, given alone, failed to decrease the repetition rate of EFPs. Similarly, TGB applied alone only transiently led to a nonsignificant reduction of the EFP frequency. Combining VGB and TGB, their suppressive efficacy increased, yielding a significant reduction of EFP frequency, which, however, again did not persist. Pretreatment of the preparations with VGB for 2 h, followed by additional application of TGB, or TGB alone, drastically and persistently potentiated the effects.

Conclusions: These results demonstrate that VGB and TGB show favorable pharmacodynamic interactions, provided VGB is allowed to block intracellular GABA degradation before GABA uptake block by TGB.
The Epileptology of Théodore Herpin (1799–1865)
Authors: Eadie Mervyn J.
Published: March 2003

Summary:The Frenchman, Théodore Herpin (1799–1865), inDes Accès Incomplets d'Epilepsie,published posthumously in 1867, provided a very detailed account of a wide range of the possible manifestations of nonconvulsive epileptic seizures. However, he did not note the presence of absence seizures in any of his 300 patients who had experienced, at least in some of their attacks, what he considered were incomplete manifestations of epilepsy, the word “epilepsy” being taken to refer to full generalized tonic–clonic seizures. In the one patient, Herpin recognized that all epileptic seizures, whether complete or incomplete, began in the same way, and deduced that they must originate in the same place in that patient's brain. He did not develop the latter idea further. His observations, and his interpretation of them, seem to have preceded John Hughlings Jackson's independent development of similar concepts, but Jackson's more extensive intellectual exploration of the implications of his observations made him a more important figure than Herpin in the history of epileptology.
Occurrence of Psychosis in Patients with Epilepsy Randomized to Tiagabine or Placebo Treatment
Authors: Sackellares J. Chris , Krauss Gregory , Sommerville Kenneth W. , Deaton Roger
Published: March 2003

Summary:  Purpose: Patients with drug‐resistant epilepsy have a higher incidence of psychiatric problems and possibly greater intolerance to antiepileptic drugs (AEDs) than do other patients with epilepsy. Concern has been raised that γ‐aminobutyric acid (GABA)ergic drugs may be associated with treatment‐emergent psychosis. Tiagabine (TGB; Gabitril), a new AED that blocks synaptic GABA uptake, was developed in trials of drug‐resistant patients with epilepsy. We conducted ad hoc analyses of adverse events, drug intolerance, and treatment response to evaluate the association between TGB treatment and psychosis and whether psychiatric history might be predictive of tolerance or effectiveness of this GABAergic drug.

Methods: Data were analyzed from two multicenter, randomized, double‐blind, placebo‐controlled trials of add‐on TGB therapy (32 or 56 mg daily) in 554 adolescents and adults with complex partial seizures (CPSs). After an 8‐ or 12‐week baseline phase, double‐blind treatment consisted of a 4‐week titration period (with TGB dose gradually increased to 32 or 56 mg daily) and an 8‐ or 12‐week fixed‐dose period. Adverse events commonly associated with psychosis were evaluated. Treatment intolerance and effectiveness (≥50% reduction in CPS rate) were compared among patients with and without psychiatric histories.

Results: Psychotic symptoms (hallucinations) were observed in three (0.8%) of 356 TGB‐treated patients and none of 198 placebo‐treated patients (p = 0.556, NS). Statistical analysis showed no interaction between psychiatric history and drug intolerance or treatment outcome.

Conclusions: TGB administration appears to carry no significant increased risk of treatment‐emergent psychosis. Psychiatric history was not predictive of the tolerance or effectiveness of the drug.
Demonstration of Scolex within Calcified Cysticercus Cyst: Its Possible Role in the Pathogenesis of Perilesional Edema
Authors: Gupta Rakesh K. , Kumar Rajesh , Chawla Sanjeev , Pradhan Sunil
Published: March 2003

Summary:  Purpose: This study was performed to understand the relation between the scolex as demonstrated on gradient echo (GRE) imaging in a calcified cysticercus cyst and the development of perilesional edema that may be of value in understanding the pathogenesis of this entity.

Methods: Twenty‐one patients with solitary calcified lesion on computed tomography (CT), with seizures of recent onset (within 15 days), were selected for this study. All the patients were subjected to magnetic resonance imaging (MRI) including GRE imaging. The patients were grouped on the basis of presence or absence of perilesional edema around the calcified lesion on MRI.

Results: There were 14 patients with perilesional edema, and seven patients had no evidence of edema. Of these 14 patients with perilesional edema, rim enhancement was detected in 13 patients on postcontrast MRI, whereas no enhancement was observed in one patient. The scolex was seen in all these 14 patients on GRE images. Of the seven patients without evidence of edema, the scolex was not seen in any of these patients on GRE imaging. In addition, there was no evidence of any contrast enhancement on postcontrast study in any of the patients in this group.

Conclusions: We conclude that the calcified cysts with scolex seen on GRE imaging are associated with perilesional edema. This is probably due to preservation of antigenic material in these calcified cysts, the release of which provokes an inflammatory response that may be responsible for the perilesional edema.
Pentylenetetrazol‐induced Recurrent Seizures in Rat Pups: Time Course on Spatial Learning and Long‐term Effects
Authors: Huang Li‐Tung , Yang San Nan , Liou Chia‐Wei , Hung Pi‐Lien , Lai Ming‐Chi , Wang Chih‐Lu , Wang Tzu‐Jou
Published: March 2003

Summary:  Purpose: Recurrent seizures in infants are associated with a high incidence of neurocognitive deficits. Animal models have suggested that the immature brain is less vulnerable to seizure‐induced injury than is that in adult animals. We studied the effects of recurrent neonatal seizures on cognitive tasks performed when the animals were in adolescence and adulthood.

Methods: Seizures were induced by intraperitoneal injection of pentylenetetrazol (PTZ) for 5 consecutive days, starting from postnatal day 10 (P10). At P35 and P60, rats were tested for spatial memory by using the Morris water maze task. In adulthood, motor performance was examined by the Rotarod test, and activity level was assessed by the open field test. Seizure threshold was examined by inhalant flurothyl. To assess presence or absence of spontaneous seizures, rats were video recorded for 4 h/day for 10 consecutive days for the detection of spontaneous seizures. Finally, brains were examined for histologic evidence of injury with cresyl violet stain and Timm staining in the supragranular zone and CA3 pyramidal cell layers of the hippocampus.

Results: PTZ‐treated rats showed significant spatial deficits in the Morris water maze at both P35 and P60. There were no differences in seizure threshold, motor balance, or activity level during the open field test. Spontaneous seizures were not recorded in any rat. The cresyl violet stain showed no cell loss in either the control or experimental rats. PTZ‐treated rats exhibited more Timm staining in the CA3 subfield. However, the control and experimental rats showed similar Timm staining within the supragranular zone.

Conclusions: Our findings indicate that recurrent PTZ‐induced seizures result in long‐term cognitive deficits and morphologic changes in the developing brain. Furthermore, these cognitive deficits could be detected during pubescence.
Ictal EEG Patterns in Band Heterotopia
Authors: Grant Arthur C. , Rho Jong M.
Published: March 2003

Summary: Band heterotopia (BH) or “double cortex” syndrome is a neuronal migration disorder resulting in a diffuse band of subcortical grey matter and variable abnormality of the overlying cortex. Patients with BH have a spectrum of psychomotor delay and seizures. Associated epileptic syndromes and interictal EEG findings have been described, but ictal EEG patterns are lacking.

Methods: We describe the clinical, interictal, and ictal EEG findings in two girls with BH and intractable seizures.

Results: Ictal EEG patterns correlated well with clinical seizure types, and did not have features unique to BH. Similarly, seizure behaviors and interictal EEG findings were typical of those seen in symptomatic generalized epilepsies.

Conclusions: Despite evidence implicating the ectopic grey matter in seizure discharges, we conclude that seizure semiology and associated ictal EEG patterns in BH are no different from those seen in other causes of symptomatic generalized epilepsies.
Ictal Urinary Urge: Further Evidence for Lateralization to the Nondominant Hemisphere
Authors: Loddenkemper Tobias , Foldvary Nancy , Raja Shanker , Neme Silvia , Lüders Hans O.
Published: March 2003

Summary:  Purpose: To determine the lateralizing value of ictal urinary urgency.

Methods: A retrospective database search was performed for patients with ictal urinary urgency admitted to the Epilepsy Monitoring Unit at the Cleveland Clinic between 1994 and 2001.

Results: Six patients were identified; intracarotid amytal test demonstrated left hemispheric speech dominance in five cases. The sixth patient continued to speak during right temporal seizures. EEG and imaging data supported right temporal or frontotemporal epilepsy in all six cases. Two patients were seizure free after focal right hemispheric resection.

Conclusions: Ictal urinary urge appears to be a lateralizing sign for nondominant temporal lobe epilepsy.