bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of Menstrually Related Migraine and Nonmigraine Primary Headache in Female Students of Belgrade University
Authors: Dzoljic E. , Sipetic S. , Vlajinac H. , Marinkovic J. , Brzakovic B. , Pokrajac M. , Kostic V.
Published: March 2003

Objectives.—To determine prevalence and characteristics of menstrually related migraine and nonmigraine headache in female students of Belgrade University.

Method.—A questionnaire was administered to female students during randomly selected classes of the Schools of Medicine and Pharmacy. Diagnoses were assigned according to the criteria of the International Headache Society and MacGregor's stricter definition of “menstrual” migraine.

Results.—Of 1943 female students (18 to 28 years old), 1298 (66.8%) had primary headaches. Among 1298 students with headache, 245 (12.6%) had migraine and 1053 (54.2%) had nonmigraine headache. The prevalence rates of migraine versus nonmigraine headache in relation to the menstrual cycle were: premenstrual, 0.9% versus 4.4%; menstrual, 1.5% versus 1.5%; menstrually associated, 6.1% versus 10.1%; menstrually unchanged, 2.7% versus 19.2%; and menstrually unrelated, 1.4% versus 18.9%. Female students with migraine had menstrually related attacks more frequently than students with nonmigraine headache (67.7% versus 29.5%). This difference was most prominent among students with menstrual migraine compared with students with menstrual nonmigraine headache (12.2% versus 2.7%). Exacerbation of migraine during menstruation was slightly more severe and more complex than exacerbation of nonmigraine headache. Female students with migraine versus nonmigraine headache did not differ significantly in age, age at onset of menarche, or age at onset of headache. Female students with migraine were significantly more likely to report a positive family history for migraine and menstrual migraine, severe attacks, reduced work activity, and aura.

Conclusion.—The results obtained are in accord with the prevailing opinion that there is a relationship between migraine and female sex hormones, and suggest that women with nonmigraine headache are also susceptible to hormonal fluctuations.
Valsalva‐Induced Cluster: A New Subtype of Cluster Headache
Authors: Ko James , Rozen Todd D.
Published: March 2003

We report the case of a man who suffered from Valsalva‐induced cluster headaches. The headaches deviated from classic cluster in that they were solely induced by activity involving the Valsalva maneuver, such as coughing and sneezing, and never occurred spontaneously. The attacks were prevented by treatment with indomethacin. This may be the first reported case of cluster that only occurs after a defined trigger and never spontaneously. It also may be the first cluster headache subtype that is indomethacin responsive.
Central Cholinergic Challenging of Migraine by Testing Second‐Generation Anticholinesterase Drugs
Authors: Nicolodi M. , Galeotti N. , Ghelardini C. , Bartolini A. , Sicuteri F.
Published: March 2003

The antinociceptive activity of donepezil, a novel cholinesterase inhibitor, was investigated in the mouse hot plate test. Donepezil (5 to 10 mg kg−1 i.p.) induced a dose‐dependent antinociception that reached its maximum effect 15 minutes after injection. Donepezil antinociception was prevented by the antimuscarinic drug scopolamine. At analgesic doses, donepezil did not alter gross animal behavior. These results indicate that donepezil is endowed by muscarinic antinociceptive properties, suggesting this compound as a potential therapeutic approach for the treatment of painful pathologies. Therefore, we investigated donepezil's effect in migraine. Donepezil (5 mg per os, evening assumption) was effective as a prophylatic agent in patients suffering from migraine with or without aura by reducing the number of hours with pain, the number of attacks, and the severity of the pain attack. The efficacy of donepezil was compared with that of the β‐blocker propranolol (40 mg bid per os), showing higher activity. Response rates of a large‐sized open study devoid of entry criteria regarding migraine subtypes suggest the drug as an excellent prophylactic compound for migraine in general practice. Clinical results also indicate that the activation of the cholinergic system can represent a novel prophylactic approach to migraine.
SUNCT Syndrome Responsive to Lamotrigine
Authors: Gutierrez‐Garcia Jose M.
Published: March 2003

Background.—Short‐lasting, unilateral, neuralgiform headache attacks with conjunctival injection, tearing, rhinorrhea (SUNCT syndrome) is a headache form generally refractory to drug therapy. Occasional patients with SUNCT have been reported with a successful response to lamotrigine.

Objective.—To report two patients with SUNCT treated with lamotrigine.

Methods.—Clinical history, neurologic examination, and brain magnetic resonance imaging.

Results.—Both patients with SUNCT syndrome were successfully treated with lamotrigine. In both cases, when lamotrigine was tapered off, the attacks reappeared, only to disappear when the dose was again increased. In addition, lamotrigine was well tolerated and no undesired side‐effects were reported.

Conclusion.—If the positive effect of lamotrigine in patients with SUNCT is confirmed in other cases, lamotrigine could become the first specific treatment for SUNCT syndrome.
Efficacy and Tolerability of Prochlorperazine Buccal Tablets in Treatment of Acute Migraine
Authors: Sharma Sangeeta , Prasad Atul , Nehru Ravi , Anand K. S. , Rishi R. K. , Chaturvedi Sujata , Bapna J. S. , Sharma Deepika Rohtagi
Published: March 2003

Objectives.—To study the efficacy and tolerability of prochlorperazine (PCZ) management of acute migraine.

Design and methods.—A double blind comparative study was conducted to assess the efficacy of buccal PCZ 3 mg compared with oral ergotamine tartarate 1 mg plus caffeine 100 mg (ERG) or placebo (buccal or oral) for treatment of acute migraine. In all, 114 episodes of acute migraine were evaluated. Patients graded symptoms on a four‐point scale before and up to 4 hours after treatment. The primary efficacy parameters included headache resolution within 2 hours (grade 3 or 2 to grade 0) and alleviation of other accompanying symptoms of migraine. The supplementary endpoints included improvement in quality of life (QOL).

Results.—The percentage of patients reporting resolution of headache (to grade 0) was 51.4% for buccal PCZ and 21.7% for buccal placebo, 23.1% for oral ERG and 28.6% for oral placebo, headache tended to recur in both the placebo and ERG groups after initial improvement. Buccal PCZ was well tolerated; no signs of local irritation were evident, and patients found the formulation easy to use. Mild but transient sedation and drowsiness were observed in 41%.

Conclusion.—In the present study, PCZ 3 mg via the buccal route produced faster improvement and greater efficacy than placebo (oral as well as buccal) or oral ERG. The global QOL score 2 hours after treatment scores was higher in the PCZ group. Buccal PCZ may represent a particularly effective alternative for acute migraine treatment.
Migraine Aggravation Caused by Cephalic Venous Congestion
Authors: Doepp Florian , Schreiber Stephan J. , Dreier Jens P. , Einhäupl Karl M. , Valdueza José M.
Published: March 2003

Background.—Cerebral venous distension is thought by some to serve as a source of migraine pain. Previous investigators have tried to modify pain intensity by induction of additional venous congestion via compression of both internal jugular veins (Queckenstedt's maneuver). The magnitude of blood flow within the internal jugular veins depends markedly on body position, and inconsistencies in positioning may have influenced their results.

Objective.—To investigate the effect of Queckenstedt's maneuver, performed both in the upright and in the supine body position, in migraineurs during an acute attack.

Methods.—Twenty‐five patients (18 women, 7 men; mean age  ±  SD, 35.4  ±  13.3 years) with International Headache Society‐defined migraine without aura were evaluated. Queckenstedt's maneuver was performed in both body positions during an acute migraine attack, involving constant application of manual pressure to both internal jugular veins for 30 seconds. Headache intensity was rated before, during, and after Queckenstedt's maneuver on a scale extending from 1 (mild) to 10 (intolerable).

Results.—Seventeen patients (68%) reported an increase of headache intensity in the supine position during Queckenstedt's maneuver. In the sitting position, pain increase was observed only in 6 patients (24%). The magnitude of pain increase was significantly greater in the supine position compared to the upright position (P  =  .02).

Conclusions.—Our results support a role for cerebral venous congestion in the generation of migraine pain and suggest body position may influence the clinical expression of that process.
Pharmacokinetics of Levetiracetam and Its Enantiomer (R)‐α‐ethyl‐2‐oxo‐pyrrolidine acetamide in Dogs
Authors: Isoherranen Nina , Yagen Boris , Soback Stefan , Roeder Michael , Schurig Volker , Bialer Meir
Published: March 2003

Summary:  Purpose: The new antiepileptic drug, levetiracetam (LEV, ucb LO59), is a chiral molecule with one asymmetric carbon atom whose anticonvulsant activity is highly enantioselective. The purpose of this study was to evaluate and compare the pharmacokinetics (PK) of LEV [(S)‐α‐ethyl‐2‐oxo‐pyrrolidine acetamide] and its enantiomer (R)‐α‐ethyl‐2‐oxo‐pyrrolidine acetamide (REV) after i.v. administration to dogs. This is the first time that the pharmacokinetics of both enantiomers has been evaluated.

Methods: Optically pure LEV and REV were synthesized, and 20 mg/kg of individual enantiomers was administered intravenously to six dogs. Plasma and urine samples were collected until 24 h, and the concentrations of LEV and REV were determined by an enantioselective assay. The levels of 2‐pyrrolidone‐N‐butyric acid, an acid metabolite of LEV and REV, were determined by high‐performance liquid chromatography (HPLC). The data were used for PK analysis of LEV and REV.

Results: LEV and REV had similar mean ± SD values for clearance; 1.5 ± 0.3 ml/min/kg and volume of distribution; 0.5 ± 0.1 L/kg. The half‐life (t1/2) and mean residence time (MRT) of REV (t1/2, 4.3 ± 0.8 h, and MRT, 6.0 ± 1.1 h) were, however, significantly longer than those of LEV (t1/2, 3.6 ± 0.8 h, and MRT, 5.0 ± 1.2 h). The renal clearance and fraction excreted unchanged for LEV and REV were significantly different.

Conclusions: In addition to the enantioselective pharmacodynamics, α‐ethyl‐2‐oxo‐pyrrolidine acetamide has enantioselective PK. The enantioselectivity was observed in renal clearance. Because REV has more favorable PK in dogs than LEV, the higher antiepileptic potency of LEV is more likely due to intrinsic pharmacodynamic activity rather than to enantioselective PK.
The Amygdala and Temporal Lobe Simple Partial Seizures: A Prospective and Quantitative MRI Study
Authors: Van Paesschen Wim , King Martin D. , Duncan John S. , Connelly Alan
Published: March 2003

Summary:  Purpose: To determine whether specific temporal lobe simple partial seizures (SPSs) are associated with an abnormal amygdala T2 (AT2) ipsilateral to the seizure focus in patients with intractable unilateral temporal lobe epilepsy (TLE). AT2 relaxation time mapping is a sensitive method for the detection of abnormal tissue in the amygdala in patients with refractory TLE. The relation between an abnormal AT2 in the epileptic temporal lobe and amygdala seizure onset has not been established.

Methods: Fifty patients with intractable unilateral TLE and concordant data during presurgical evaluation were included. Patients with a foreign‐tissue lesion on standard magnetic resonance imaging (MRI) were excluded. All had AT2 mapping. Fifteen types of SPSs were ascertained prospectively, systematically, and blinded to the results of AT2 mapping. The SPSs of patients with a normal AT2 (n = 25) were compared with those of patients with an abnormal AT2 ipsilateral to the seizure focus (n = 25).

Results: The group of patients with an abnormal AT2 reported a median of six types of SPSs (range 1–11), in comparison with a median of three types of SPSs (range, 0–7) for the group with a normal AT2 (p<0.01). Déjà vu, a warm sensation, an indescribable strange sensation, a cephalic sensation, and fear were associated with an abnormal AT2. The combination of déjà vu, a cephalic sensation, a warm sensation, a gustatory hallucination, and an indescribable strange sensation discriminated best between the 25 patients with a normal and the 25 patients with an abnormal AT2.

Conclusions: A high number and the types of different SPSs provide clinical evidence for early involvement of the amygdala during seizures in patients with refractory unilateral TLE and an abnormal AT2 in the epileptic temporal lobe
Gait Epilepsy. A Case Report of Gait‐Induced Seizures
Authors: Iriarte Jorge , Sánchez‐Carpintero Rocío , Schlumberger Emilie , Narbona Juan , Viteri César , Artieda Julio
Published: March 2003

Summary: Reflex epilepsy includes a group of epileptic syndromes in which seizures are induced by a stimulus, either simple (visual, somatosensory, olfactory, auditory) or more complex (e.g., eating, thinking, reading). We document a case of reflex epilepsy in which focal seizures are triggered exclusively by gait. The patient is a young boy whose walking was impaired by abnormal motor phenomena on the left side. These phenomena were elicited by gait and were accompanied by a distinctive ictal pattern with centro‐temporal discharges. After comparing this patient with others reported in the literature, we determined that he has an unusual type of reflex epilepsy for which we coined the term “gait epilepsy.” This disorder must be considered when physicians are making a differential diagnosis in patients who have symptoms that suggest paroxysmal kinesigenic dystonia (PKD) or selective epileptic gait disorder.
The Impact of Epilepsy on Graham Greene
Authors: Reynolds E. H.
Published: March 2003

Summary: As a young man, Graham Greene (1904–1991) experienced several episodes of loss of consciousness, which were confidently diagnosed as epilepsy by a Harley Street specialist who saw him on two occasions during the 1920s. The diagnosis was initially concealed from him by his family and the specialist, but when it was revealed, it had a profound effect such that he contemplated suicide. He was particularly concerned about his impending marriage and the risk of having children. His anxiety was not relieved by being told that the famous author, Dostoevsky, had epilepsy. Graham Greene is the only public figure in the United Kingdom, of whom I am aware, who has admitted and discussed the impact of epilepsy, even though this was more than 40 years later when there was some doubt about the diagnosis.
Multiple Subpial Transections: The Yale Experience
Authors: Mulligan Lisa P. , Spencer Dennis D. , Spencer Susan S.
Published: March 2003

Summary:  Purpose: Although resection of an epileptogenic region is the mainstay of epilepsy surgery, epileptogenic areas in functionally critical cortex cannot be approached in that manner. Multiple subpial transection (MST) was developed to treat those refractory seizures without causing unacceptable neurologic deficit. We review our experience with this technique.

Methods: Twelve patients who underwent MST with or without resection between 1990 and 1998 were retrospectively reviewed with regard to seizure and neurologic outcome, and predictive factors.

Results: Five (42%) of 12 patients obtained a significant improvement in seizure frequency, and two other patients had a marked decrease in the severity of their seizures. Resection with MST reduced seizure frequency more, but this was not a significant difference. No predictive factors for outcome were identified. Only one patient sustained any persistent neurologic deficit.

Conclusions: In selected patients, MST may be a viable alternative when the epileptogenic focus lies in unresectable cortex. A multicenter study with appreciable patient numbers will be necessary to define predictive factors for success.
Absence Epilepsy with Fast Rhythmic Discharges During Sleep: An Intermediary Form of Generalized Epilepsy?
Authors: Guye M. , Bartolomei F. , Gastaut J. L. , Chauvel P. , Dravet C.
Published: March 2003

Summary:  Purpose: To describe a particular form of absence epilepsy (AE) characterized by an atypical EEG pattern (fast rhythmic discharges) during sleep and an unfavorable course with the persistence of seizures at a late age and drug resistance.

Methods: We reviewed the medical files of 31 patients diagnosed with AE at our institution been 1995 and 1999 for whom an EEG during sleep had been recorded. Patients with fast rhythmic discharges during sleep were selected for the study.

Results: Five patients showed the usual criteria of childhood absence epilepsy (CAE) or juvenile absence epilepsy (JAE), but with fast discharges of rhythmic spikes (10–15 Hz) during sleep, such as those typically observed in Lennox–Gastaut syndrome. Four patients were of adult age at the time of the last examination. Intellectual capacities were “borderline” in each case, with visible social and learning handicaps. Absences were the initial seizure event in all patients, but four patients developed generalized tonic–clonic seizures during the course of the disease. Treatment using a combination of antiabsence drugs such as valproate and lamotrigine led to only marginal improvement.

Conclusions: These findings illustrate the utility of sleep EEG in detecting the fast rhythmic discharges that are markers of drug resistance in AE and suggest the existence of transitional forms of AE that are intermediate between idiopathic and cryptogenic/symptomatic generalized epilepsies.
Parents' Perceptions of Adversity Introduced by Upheaval and Uncertainty at the Onset of Childhood Epilepsy
Authors: Oostrom K. J. , Schouten A. , Kruitwagen C. L. J. J. , Peters A. C. B. ,   A. Jennekens‐Schinkel for the Dutch Study Group of Epilepsy in Childhood
Published: March 2003

Summary:  Purpose: We report the parent's perceptions of and reactions to the onset of “epilepsy only” and the implications for continuity of parenting.

Methods: Content analysis was used to extract data on perceived (dis)continuity of parenting, from interviews held with parents of 69 schoolchildren in whom idiopathic or cryptogenic epilepsy (“epilepsy only”) had recently been diagnosed.

Results: Almost half of the parents (42%) perceived neither themselves nor their child as having been thrown off balance by the onset of epilepsy. Quite a few parents (33%) perceived themselves rather than their child as having been thrown off balance. More parents of children with cryptogenic than with idiopathic epilepsy perceived themselves as being off balance. However, parents' perceptions of their children's reactions to the epilepsy‐related changes were not influenced by any epilepsy variable. Rather, family trouble, long‐standing behavioral problems, and adolescence contributed to the child's maladaptive reaction. Three extremely off‐balance parents had children with seizures of “unclassifiable” epilepsy that later were found to be nonepileptic and psychogenic.

Conclusions: The majority of the parents perceived their child as adapting well to the onset of epilepsy only. Children with seizure onset in adolescence and children with other adversities were perceived as adapting poorly to the additional adversity of epilepsy. Cryptogenic rather than idiopathic etiology leaves parents in great suspense. In behavioral studies, it is advisable to treat children with unclassifiable epilepsy as a separate group.
Proton Spectroscopic Imaging Shows Abnormalities in Glial and Neuronal Cell Pools in Frontal Lobe Epilepsy
Authors: Lundbom N. , Gaily E. , Vuori K. , Paetau R. , Liukkonen E. , Rajapakse J. C. , Valanne L. , Häkkinen A‐M. , Granström M‐L.
Published: March 2003

Summary:  Purpose: Proton magnetic resonance spectroscopic imaging (1H MRSI) can lateralize the epileptogenic frontal lobe by detecting metabolic ratio abnormalities in frontal lobe epilepsy (FLE). We used 1H MRS to lateralize and localize the epileptogenic focus, and we also sought to characterize further the metabolic abnormality in FLE.

Methods: We measured signals from N‐acetyl aspartate (NAA), choline‐containing compounds (Cho), and creatine + phosphocreatine (Cr) in the supraventricular brain of 14 patients with frontal or frontoparietal epilepsy and their matched controls. The supratentorial brain also was segmented into gray matter, white matter, and cerebrospinal fluid classes. Regional metabolite alterations were compared with localizing and lateralizing results from other examination modalities and with histology from three patients.

Results: Spectroscopy lateralized the epileptogenic focus in 10 patients in agreement with video‐EEG and functional imaging. In four patients, spectroscopy showed bilateral, focal metabolic abnormality, whereas video‐EEG suggested unilateral or midline abnormality. In the epileptogenic focus, Cho and Cr were increased by 23% and 14%, respectively, and NAA was decreased by 11%, suggesting metabolic disturbances both in the glial and in the neuronal cell pools. Two Taylor dysplasia lesions confirmed by histology and one with radiologic diagnosis showed high Cho and low or normal NAA, whereas two dysembryoplastic neurogenic tumors had normal Cho and low NAA. Contralateral hemisphere NAA/(Cho + Cr) was decreased in FLE, indicating diffusely altered brain metabolism. Segmentation of brain tissue did not reveal atrophic changes in FLE.

Conclusions: Spectroscopy is useful in lateralizing frontoparietal epilepsy and shows promise as a “noninvasive biopsy” in epileptogenic lesions.
Alcohol and Marijuana: Effects on Epilepsy and Use by Patients with Epilepsy
Authors: Gordon Elisabeth , Devinsky Orrin
Published: March 2003

Summary:We review the safety of alcohol or marijuana use by patients with epilepsy. Alcohol intake in small amounts (one to two drinks per day) usually does not increase seizure frequency or significantly affect serum levels of antiepileptic drugs (AEDs). Adult patients with epilepsy should therefore be allowed to consume alcohol in limited amounts. However, exceptions may include patients with a history of alcohol or substance abuse, or those with a history of alcohol‐related seizures. The most serious risk of seizures in connection with alcohol use is withdrawal. Alcohol withdrawal lowers the seizure threshold, an effect that may be related to alcohol dose, rapidity of withdrawal, and chronicity of exposure. Individuals who chronically abuse alcohol are at significantly increased risk of developing seizures, which can occur during withdrawal or intoxication. Alcohol abuse predisposes to medical and metabolic disorders that can lower the seizure threshold or cause symptoms that mimic seizures. Therefore, in evaluating a seizure in a patient who is inebriated or has abused alcohol, one must carefully investigate to determine the cause.

Animal and human research on the effects of marijuana on seizure activity are inconclusive. There are currently insufficient data to determine whether occasional or chronic marijuana use influences seizure frequency. Some evidence suggests that marijuana and its active cannabinoids have antiepileptic effects, but these may be specific to partial or tonic–clonic seizures. In some animal models, marijuana or its constituents can lower the seizure threshold. Preliminary, uncontrolled clinical studies suggest that cannabidiol may have antiepileptic effects in humans. Marijuana use can transiently impair short‐term memory, and like alcohol use, may increase noncompliance with AEDs. Marijuana use or withdrawal could potentially trigger seizures in susceptible patients.
Prospective Study of Seizures in the Elderly in the Marshfield Epidemiologic Study Area (MESA)
Authors: Ruggles Kevin H. , Haessly Sharon M. , Berg Richard L.
Published: March 2003

Summary:  Purpose: To assess the incidence, etiology, antiepileptic drug (AED) use, and quality of life in patients having their first seizure at age 50 years or older.

Methods: All patients in the Marshfield Epidemiologic Study Area (MESA) aged 50 years or older having their first seizure between July 1, 1996, and June 30, 1998, were identified through the diagnostic coding system. Patients were followed up for 12 months for recurrent seizures. Etiologies, drug treatments, magnetic resonance imaging (MRI), computed tomography (CT), or EEG results and medication adverse effects were recorded. Those patients who reached 1‐year follow‐up received a quality of life (QOLIE‐31) survey.

Results: Forty‐eight patients having a first seizure were identified (162 of 100,000). Twelve patients had had recurrent seizures, and 36 had a single seizure at the time of study entry. Fourteen of these 36 had had an abnormal MRI, CT, or EEG. The remaining 22 had a single seizure and normal imaging and EEG. Six of these had one or more subsequent seizures, and all six were in the group with normal tests. Etiologies included vascular, neoplasm, trauma, dementia, metabolic, and unknown. Seventy‐five percent of the patients achieved seizure control with phenytoin, carbamazepine, and/or valproate. Twenty‐seven percent experienced adverse side effects. None had been given second‐generation AEDs as an initial treatment. Thirty‐one patients received the QOLIE‐31 survey; 20 did not complete the survey for various reasons. The mean QOLIE‐31 scores for those completing the survey were significantly higher than those of the reference cohort.

Conclusions: The incidence of first seizure in MESA is high in the elderly and increases with advancing age. As in other studies, vascular causes accounted for the largest etiology. Use of new AEDs was uncommon. There was a high incidence of untoward side effects related to the traditional AEDs. High morbidity and mortality unrelated to seizures limits follow‐up analysis in the elderly. Quality‐of‐life analysis via QOLIE questionnaires is problematic in this population.
Benzodiazepine–GABAAReceptor Binding Is Very Low in Dysembryoplastic Neuroepithelial Tumor: a PET Study
Authors: Richardson M. P. , Hammers A. , Brooks D. J. , Duncan J. S.
Published: March 2003

Summary: Purpose:To determine the nature of abnormalities of γ‐aminobutyric acid (GABA)A–central benzodiazepine (BZD) receptor binding in patients with dysembryoplastic neuroepithelial tumor (DNET) in comparison with normal controls.

Methods:Five patients with DNET and 24 normal controls underwent (11C)flumazenil positron emission tomography (PET) to measure (11C)flumazenil volume of distribution (FMZVD) at the voxel level. Patients were compared with normal controls by using statistical parametric mapping (SPM) and also a partial‐volume effect (PVE) corrected volume‐of‐interest (VOI) analysis covering the entire brain. First, using SPM, the highest Z‐score for the entire image representing FMZVD decreases in comparison with the normals was found. Second, regions of abnormal FMZVD were located using SPM, p < 0.001 uncorrected, corrected p < 0.05. Finally, PVE‐corrected measures of FMZVD were calculated for each patient VOI and compared wih those of normals, using significance levels of >2.5 standard deviations (SD) for the DNET and >3 SD for all other regions.

Results:In all cases, the highest Z‐score across the whole image representing decreased FMZVD was within the DNET. In three cases SPM revealed a single region of significantly reduced FMZVD, within the DNET in all three. VOI analysis showed PVE‐corrected FMZVD was significantly low in the DNET in four cases. VOI analysis also showed seven other regions of abnormal FMZVD; three were adjacent to a DNET, and two were in mesial temporal areas not affected by DNET.

Conclusions:FMZVD is low in DNET, probably contributing to epileptogenicity.
Prevalence of Anti‐cardiolipin, Anti‐β2 Glycoprotein I, and Anti‐prothrombin Antibodies in Young Patients with Epilepsy
Authors: Cimaz R. , Romeo A. , Scarano A. , Avc̆in T. , Viri M. , Veggiotti P. , Gatti A. , Lodi M. , Catelli L. , Panzeri P. , Cecchini G. , Meroni P. L.
Published: March 2003

Summary:  Purpose: To measure anti‐cardiolipin (aCL), anti‐β2 glycoprotein I (anti‐β2GPI), and anti‐prothrombin (aPT) antibodies in young patients with epilepsy, and to correlate their presence with demographic data, clinical diagnoses, laboratory and neuroradiologic findings, and antiepileptic drugs (AEDs).

Methods: Sera from one hundred forty‐two consecutive patients with epilepsy with a median age of 10 years were tested for aCL and anti‐β2GPI autoantibodies by solid‐phase assays. aPT antibodies also were assayed in sera from 90 patients. Positive results were confirmed after a minimum of 6 weeks. Antinuclear antibodies (ANAs) and antibodies against extractable nuclear antigens (ENAs) also were tested.

Results: An overall positivity of 41 (28.8%) of 142 sera was found. Fifteen patients were positive for aCL, 25 for anti‐β2GPI, and 18 for aPT antibodies. Several patients (12%) displayed more than one specificity in their serum. Only one of these patients had a concurrent positivity for ANAs and ENAs. A predominance of younger patients was found in the antibody‐positive group. All types of epilepsy were represented in the positive group. No relation between antibody positivity and AEDs was found. Diffuse ischemic lesions at computed tomography (CT)/magnetic resonance imaging (MRI) scans were present in higher percentages in patients who were antibody positive. No positive patient had a history of previous thrombosis or other features related to systemic lupus erythematosus (SLE), and no patient was born of a mother with SLE.

Conclusions: Our study suggests a relation between epilepsy and aPL in young patients. A pathogenetic role for these autoantibodies cannot be excluded, and their determination might prove useful even from a therapeutic point of view.
Psychostimulants and Epilepsy
Authors: Zagnoni P. G. , Albano C.
Published: March 2003

Summary: Purpose: The aim of this article is to review the literature on the effects of psychostimulants in epileptic subjects in order to reach a consensus statement regarding the use or abuse of these substances.

Methods: Psychostimulant substances have been considered the drugs that share the ability to produce excitation of the CNS leading to convulsions. The stimulation may be at cortical, brainstem, or spinal levels. In this article, the following cortical stimulants are analyzed and discussed: cocaine, amphetamine and related agents, caffeine, cannabinoids, and psychedelic drugs. This review is based on research done using pharmacological textbooks and Medline.

Results: The use of cocaine is associated with the occurrence of seizures. The reported frequency varies from 1% to 40% of addicted subjects, based on the typology of the considered study. Amphetamines and related drugs rarely induce epileptic seizures at therapeutic doses, but seizures may occur after the first dosing. Caffeine at high doses may induce epileptic seizures because of its adenosine receptor‐antagonizing properties. Marijuana, at variance with other psychostimulants, owing to its serotonin‐mediated anticonvulsant action, could have a medical use for the treatment of epilepsy. Psychedelic compounds rarely induce epileptic seizures, but the most common clinical CNS complication after ingestion of ecstasy is the occurrence of seizures.

Conclusions: The use of psychostimulants, except for marijuana, can induce single or multiple seizures in healthy subjects.
Memory Deficits after Resection from Left or Right Anterior Temporal Lobe in Humans: A Meta‐Analytic Review
Authors: Lee Tatia M. C. , Yip James T. H. , Jones‐Gotman Marilyn
Published: March 2003

Summary:  Purpose: Memory deficits in epileptic patients have been found in some, but not all studies assessing the effects of side of seizures and resection from a temporal lobe on cognitive performance. The purpose of this study was to provide a quantitative review of previous studies on this issue.

Methods: Based on conventional meta‐analytic procedures, we identified 33 studies that assessed verbal and nonverbal memory performance before and after anterior temporal lobectomy. The Logical Memory and Visual Reproduction subtests from the Wechsler Memory Scale were used. These studies were then subjected to two levels of analyses: (a) vote‐counting procedure, and (b) effect‐size calculations and comparisons.

Results: Overall, the data confirmed previous findings that verbal memory tasks are sensitive to left hemisphere dysfunction. The efficacy of a “nonverbal” task for tapping function in the nondominant (right) hemisphere was not confirmed, although a trend supporting this speculation was observed. With regard to the comparison of changes in verbal and nonverbal memory before and after resection from a temporal lobe, a clear trend was observed for decline in verbal memory function after resection from the left, especially significant for immediate verbal recall. A trend for contralateral improvement on nonverbal memory also was observed. The pattern of memory change after resection from the right temporal lobe was less clear.

Conclusions: The findings of this study suggest that side of epileptic seizure and surgical resection from a temporal lobe affect verbal memory functions. The relations between the laterality of epileptic seizure, surgical resection from the temporal lobe, and nonverbal memory are to be verified by further research.
Effectiveness of Muscimol‐containing Microparticles against Pilocarpine‐induced Focal Seizures
Authors: Kohane Daniel S. , Holmes Gregory L. , Chau Ying , Zurakowski David , Langer Robert , Cha Byung Ho
Published: March 2003

Summary:  Purpose: To investigate the efficacy of in situ lipid–protein–sugar particles (LPSPs) in mitigating the epileptogenic and histologic effects of intrahippocampal pilocarpine in rats.

Methods: LPSPs with and without muscimol were produced by spray‐drying, sized by Coulter counter, and muscimol content determined by high‐pressure liquid chromatography (HLPC). Particles, free muscimol or saline, were injected into the hippocampi of Sprague–Dawley rats before 40 mM pilocarpine, and seizure activity was scored. The trajectories of behavioral scores between groups were compared with two‐way repeated measures analysis of variance. Animals were killed after 2 weeks. Brain sections were stained (Timm and thionin) and scored.

Results: LPSPs were 4 to 5 μm in diameter, and contained 0 or 2% (wt/wt) muscimol. In vitro, muscimol was released over a 5‐day period. Intrahippocampal injections of normal saline and blank LPSPs did not deter seizure activity from pilocarpine. The rise of the trajectory in behavior scores in animals given LPSPs containing 5 μg muscimol was significantly slower than in those receiving saline, blank particles, or 5 μg of unencapsulated muscimol. There was less apparent neuronal injury and CA3 and supragranular mossy fiber sprouting in hippocampi of animals receiving muscimol‐containing particles than in animals that did not receive muscimol. Hippocampi of animals that received 5 μg of encapsulated muscimol showed less supragranular sprouting than did those receiving 5 μg of unencapsulated muscimol, but showed no difference in cell loss or CA3 sprouting.

Conclusions: Focally delivered biodegradable microparticles loaded with muscimol are effective in reducing seizure activity from pilocarpine in animals and mitigate the histologic effects.
Ictal Pattern of EEG and Muscular Activation in Symptomatic Infantile Spasms: A Videopolygraphic and Computer Analysis
Authors: Bisulli Francesca , Volpi Lilia , Meletti Stefano , Rubboli Guido , Franzoni Emilio , Moscano Milena , D'Orsi Giuseppe , Tassinari Carlo Alberto
Published: March 2003

Summary: Purpose:To investigate ictal muscular phenomena characterizing symptomatic infantile spasms (ISs) and their relation to ictal EEG.

Methods:Four children with severe encephalopathy, neurologic impairment, and refractory ISs related to different dysplastic lesions, underwent videopolygraphic recordings collecting surface electromyogram (EMG) activity from several cranial and limb muscles to evaluate the pattern of muscular recruitment, duration, and side‐to‐side asymmetry of ISs. Acquired data were stored for off‐line analysis by a computerized polygraphic system.

Results:Spasms were characterized by a complex pattern of muscular activation. A constant or rostrocaudal propagation pattern was lacking in all patients. Intervals between the onset of EMG activity in different muscles in each spasm were very long: ≤100–200 ms. Two patients, with hemispheric cortical dysplasia and agenesis of the corpus callosum, had asymmetric and asynchronous spasms in which the EMG onset of the muscles contralateral to the affected hemisphere constantly anticipated that of the ipsilateral ones. Backaveraging of EEG activity disclosed a high‐amplitude EEG complex on the same side as the dysplastic lesion, preceding or succeeding the contralateral muscle activity onset. In the other two patients with diffuse cortical dysplasia, no EEG transient was related to EMG activity onset.

Conclusions:Despite clinical similarity between spasms in the same patient, our data demonstrate the complexity and heterogeneity of these motor phenomena. Our findings cannot be explained simply in terms of cortical or reticular generators like other motor phenomena such as cortical myoclonus or startle reflex.
Dynamic Variations of Local Cerebral Blood Flow in Maximal Electroshock Seizures in the Rat
Authors: André Véronique , Henry Didier , Nehlig Astrid
Published: March 2003

Summary:  Purpose: Measurement of cerebral blood flow is routinely used to locate the areas involved in generation and spread of seizures in epilepsy patients. Because the nature of the hyperperfused regions varies with the timing of injection of tracer, in this study, we used a rat model of maximal electroshock seizures to follow up the time‐dependent changes in the distribution of seizure‐induced cerebral blood flow (CBF) changes.

Methods: CBF was measured by the quantitative autoradiographic [14C]iodoantipyrine technique over a 30‐s duration. The tracer was injected either at 15 s before seizure induction, simultaneous with the application of the electroshock (tonic phase), at the onset of the clonic phase, or at 3 and 6 min after the seizure (postictal phase).

Results: Rates of CBF underwent dynamic changes during the different phases of seizure activity and largely increased over control levels (≤400%) in the 45 regions studied during all phases of the seizure (first 3 times). CBF remained higher than control levels in 35 and 15 areas at 3 and 6 min after the seizure, respectively.

Conclusions: The distribution of maximal CBF increases showed a good correlation with their known involvement in the circuits underlying the clinical expression of the different types of seizure activity, tonic versus clonic.
Chromosomal Abnormalities and Epilepsy: A Review for Clinicians and Gene Hunters
Authors: Singh Rita , McKinlay Gardner R. J. , Crossland Kathryn M. , Scheffer Ingrid E. , Berkovic Samuel F.
Published: March 2003

Summary: Purpose:We analyzed databases on chromosomal anomalies and epilepsy to identify chromosomal regions where abnormalities are associated with clinically recognizable epilepsy syndromes. The expectation was that these regions could then be offered as targets in the search for epilepsy genes.

Methods:The cytogenetic program of the Oxford Medical Database, and the PubMed database were used to identify chromosomal aberrations associated with seizures and/or EEG abnormalities. The literature on selected small anomalies thus identified was reviewed from a clinical and electroencephalographic viewpoint, to classify the seizures and syndromes according to the current International League Against Epilepsy (ILAE) classification.

Results:There were 400 different chromosomal imbalances described with seizures or EEG abnormalities. Eight chromosomal disorders had a high association with epilepsy. These comprised: the Wolf–Hirschhorn (4p‐) syndrome, Miller–Dieker syndrome (del 17p13.3), Angelman syndrome (del 15q11‐q13), the inversion duplication 15 syndrome, terminal deletions of chromosome 1q and 1p, and ring chromosomes 14 and 20. Many other segments had a weaker association with seizures. The poor quality of description of the epileptology in many reports thwarted an attempt to make precise karyotype–phenotype correlations.

Conclusions:We identified certain chromosomal regions where aberrations had an evident association with seizures, and these regions may be useful targets for gene hunters. New correlations with specific epilepsy syndromes were not revealed. Clinicians should continue to search for small chromosomal abnormalities associated with specific epilepsy syndromes that could provide important clues for finding epilepsy genes, and the epileptology should be rigorously characterized.
Independent Component Analysis of Ictal EEG in Medial Temporal Lobe Epilepsy
Authors: Nam Hyunwoo , Yim Tae‐Gyu , Han Seung Kee , Oh Jong‐Bai , Lee Sang Kun
Published: March 2003

Summary:  Purpose: Application of independent component analysis (ICA) to interictal EEGs and to event‐related potentials has helped noise reduction and source localization. However, ICA has not been used for the analysis of ictal EEGs in partial seizures. In this study, we applied ICA to the ictal EEGs of patients with medial temporal lobe epilepsy (TLE) and investigated whether ictal components can be separated and whether they indicate correct lateralization.

Methods: Twenty‐four EEGs from medial TLE patients were analyzed with the extended ICA algorithm. Among the resultant 20 components in each EEG, we selected components with an ictal nature and reviewed their corresponding topographic maps for the lateralization. We then applied quantitative methods for the verification of increased quality of the reconstructed EEGs.

Results: All ictal EEGs were successfully decomposed into one or more ictal components and nonictal components. After EEG reconstruction with exclusion of artifacts, the lateralizing power of the ictal EEG was increased from 75 to 96%.

Conclusions: ICA can separate successfully the manifold components of ictal rhythms and can improve EEG quality.
Neocortical Seizure Termination by Focal Cooling: Temperature Dependence and Automated Seizure Detection
Authors: Yang Xiao‐Feng , Duffy David W. , Morley Robert E. , Rothman Steven M.
Published: March 2003

Summary:  Purpose: The therapy for focal neocortical epilepsy remains suboptimal. We have, therefore, worked to develop techniques to cool small regions of the neocortical surface for seizure mapping and, ultimately, for long‐term suppression of focal seizures.

Methods: We induced focal neocortical seizures in halothane‐anesthetized rats by the microinjection of 4‐aminopyridine (4‐AP) into the motor cortex. The dura over the injection site was cooled with a Peltier device, and the temperature at the interface between dura and Peltier was measured with a thermocouple. In some experiments, seizures were automatically detected by a computer program that activated the Peltier device.

Results: Monopolar EEG indicated that our seizures were focal and suppressed when cooling was applied directly over the injection site. The threshold temperature required to observe any reduction in seizure duration was 24°C. The temperature gradient across the cooled neocortex was sharp, with the temperature increasing to 31°C at 4 mm below the Peltier, which was cooled to 20°C. Automatic seizure detection reduced the total seizure duration from 43.4 ± 33.6 s to 5.6 ± 5.3 s.

Conclusions: Cooling terminates neocortical seizures when applied very close to the epileptogenic focus. The threshold for seizure termination (24°C) may be lower than the threshold for termination of normal cortical activity, suggesting that this technique will not dissociate the anticonvulsant effect of cooling from the disruption of normal behavior. However, when coupled with automatic seizure detection, focal cooling remains an attractive option for development as a treatment for focal epilepsy.
Development of Visual Attention in West Syndrome
Authors: Guzzetta Francesco , Frisone Maria Flavia , Ricci Daniela , Randò Teresa , Guzzetta Andrea
Published: March 2003

Summary:  Purpose: To study prospectively the evolution of visual attention in children with West syndrome to evaluate its development before the onset of spasms, its possible deterioration as a consequence of epileptic disorders, and its outcome at the age of 2 years, and the possible relation between the impairment of visual attention and cognitive development.

Methods: Infants with symptomatic West syndrome were examined before the onset of spasms and until age 24 ± 2 months. Visual attention study (through a clinical observation and the fixation‐shift test), cognitive assessment, and complete clinical examination including brain magnetic resonance imaging were performed.

Results: A maturation defect of fixation shift skills was generally observed in infants with West syndrome. In some cases, the impaired visual‐attention abilities paralleled a cognitive deterioration, even months before the onset of spasms. During the acute stage of West syndrome, infants lost the previously acquired visual and cognitive abilities, with a typical fluctuation of arousal. Usually at 2 years, there was a persistent defective visual attention detected with the fixation‐shift test.

Conclusions: The parallel defect of visual attention and of cognitive competencies is a constant finding in infants with West syndrome; these can precede the clinical onset of epileptic spasms. The severity and persistence of visual inattention might be explained by the age of visual maturation, corresponding to the usual onset of West syndrome.
Olfactory Auras in Patients with Temporal Lobe Epilepsy
Authors: Chen Chien , Shih Yang‐Hsin , Yen Der‐Jen , Lirng Jiing‐Feng , Guo Yuh‐Cherng , Yu Hsiang‐Yu , Yiu Chun‐Hing
Published: March 2003

Summary:  Purpose: To investigate olfactory auras in patients with temporal lobe epilepsy (TLE).

Methods: We reviewed medical records of 217 Chinese patients who underwent temporal lobectomy for medically intractable TLE between 1987 and 1998 in Taiwan. Patients with olfactory auras asked for detailed characteristics of their auras.

Results: In all, 12 (5.5%) patients had olfactory auras, seven men and five women. All patients except one described and characterized the unpleasant olfactory auras. Olfactory auras were usually combined with other auras, most frequently sensations of epigastric rising, nausea, and fear. Association with gustatory hallucination was uncommon, in only one patient. On neuroimaging study, 11 patients had structural lesions involving the mesial temporal structures, two exclusively involving the amygdala. Histologic diagnosis included gliosis of the mesial temporal regions in seven (58.3%) patients, neoplasm in four (33.3%) patients, and arteriovenous malformation in one patient. Postoperatively, eight patients were seizure free. Three patients had rare seizures; however, none reported residual olfactory auras.

Conclusions: Olfactory auras are infrequent in TLE. In this study, mesial temporal sclerosis is the most common etiology rather than tumors. Mesial temporal structures, especially the amygdala, may play important roles in the genesis of olfactory auras.