bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Chronic Electrical Stimulation of the Centromedian Thalamic Nuclei on Various Intractable Seizure Patterns: II. Psychological Performance and Background EEG Activity
Authors: Velasco Marcos , Velasco Francisco , Velasco Ana Luisa , Velasco Gabriela , Jiménez Fiacro
Published: August 2005

We studied the effect of electrical stimulation of centromedian thalamic nuclei (ESCM) on seizure control and paroxysmal EEG activity in 23 patients. We report the effect of chronic ESCM on psychological performance and background EEG activity of patients with various intractable seizure patterns. In each patient, a simple specifically designed neuropsychological scales (one for adults and one for children) was administered at the end of the baseline (BL), ESCM, and poststimulation (Post) periods; and 14 consecutive EEG recordings during these periods were performed to determine the degree of neuropsychological improvement and the temporal course of EEG changes. A significant increase in psychological scores and the number of background EEG waves per 10 s was noted in groups A (generalized tonic‐clonic seizures, GTC), C (complex partial seizures, CPS), and D (generalized tonic seizures) and the total group of patients from BL to ESCM and from BL to Post periods. Group B patients showed a substantial increase (partial motor seizures) during the same periods. Improvement on psychological performance correlated better with age and baseline degree of deterioration than with the nature of the particular psychological improvement in any given subtest. The improvement in EEG background rhythm was most noticeable at the end of ESCM and at the beginning of the Post periods. Complete normalization of neuropsychologic scores and EEG rhythms was rare, but improvement was significant for both. Psychological scores increased from BL 14 ± 2 to ESCM 21 ± 2 and Post 23 ± 2 (normal expected 26), and EEG background rhythm increased from BL 42 ± 2 to ESCM 62 ± 2 and Post 54 ± 2 EEG waves/10 s. (normal expected >80).
Benign Rolandic Epilepsy: High Central and Low Central Subgroups
Authors: Legarda S. , Jayakar P. , Duchowny M. , Alvarez L. , Resnick T.
Published: August 2005

Summary: The spikes in benign rolandic epilepsy (BRE) typically involve both the central and midtemporal regions as recorded on standard EEG montages, but the seizures are characterized by sensorimotor manifestations that are rarely referable to the temporal lobe. To study this apparent disparity, we evaluated the field distribution of interictal spikes in 33 BRE patients using closely spaced electrodes (AEEGS 1990) arranged over perisylvian cortex. None of the 33 patients showed maximum negativity in the midtemporal regions (T3/T4). Instead, maximum negativity was evident in the high central region (C3/C4) in 10 children (30.3%) and in the low central region (C5/C6) in 23 (69.7%). Hand involvement was significantly frequent (50%) in the high central group, and drooling with oromotor involvement was a distinctive symptom (65.2%) in the low central group. Our findings indicate that the spikes in patients with BRE are exclusively suprasylvian in origin and correlate with two electroclinical subgroups.
EEG Changes and Seizure Exacerbation in Young Children Treated with Carbamazepine
Authors: Talwar Dinesh , Arora Maninder S. , Sher Phyllis K.
Published: August 2005

Summary: Carbamazepine (CBZ) has been reported to exacerbate some seizure types in children. We studied the correlation between CBZ‐associated EEG changes and seizure exacerbation in 59 children aged <6 years treated with CBZ. All patients had EEGs before and after initiation of treatment; initial EEGs were not significantly different among the patients. In 33 children (56%), the subsequent EEGs were either unchanged or improved or demonstrated minor changes (Group I), and excellent to complete seizure control was achieved in 67% of patients. In 26 children (44%), the EEG became significantly more abnormal and was characterized predominantly by new appearance of generalized spikelpolyspike‐and‐wave discharges (group 11). The majority of these patients (65%) experienced seizure exacerbation (p <0.001). For group I, symptomatic partial epilepsy, idiopathic focal epilepsy, and complex febrile seizures were significantly more common; in group 11, cryptogenic seizure disorders were more common (p < 0.005). Children in group I were more likely to remain on CBZ or to be weaned from medication after successful treatment, whereas children in group II required additional medication(s) or complete discontinuation of CBZ. Our results suggest that new appearance of generalized paroxysmal discharges after treatment is highly correlated with seizure exacerbation or suboptimal control as well as with adverse outcome. Conversely, absence of significant EEG deterioration on CBZ is usually associated with good seizure control.
Imaging Studies in Partial Epilepsy in Children and Adolescents
Authors: Resta Maurizio , Palma M. , Dicuonzo F. , Spagnolo P. , Specchio L. M. , Laneve A. , Bellomo R. , Lauriero F. , La Selva L.
Published: August 2005

Summary: We reviewed the results of imaging studies on 111 children and adolescents with partial epilepsy to determine which imaging procedure had the greatest sensitivity and specificity for partial epilepsy in this age range. All cases were classified as idiopathic, lesional, and cryptogenic epilepsy based on the 1989 International League Against Epilepsy Classification. All patients had magnetic resonance imaging (MRI) and 98 also had computed tomography (CT). Thirty patients with negative CT had MRI lesions that were most likely the cause of the epilepsy, and the initial diagnosis of cryptogenic partial epilepsy was changed to lesional partial epilepsy. We concluded that CT use is unwarrantedly common. MRI should be considered the procedure of first choice. CT has a complementary role, and functional neuroimaging should be encouraged.
A Comprehensive Study of the Relation Between Serum Concentrations, Concentration Ratios, and Level/Dose Ratios of Carbamazepine and Its Metabolites with Age, Weight, Dose, and Clearances in Epileptic Children
Authors: Liu Hua , Delgado Mauricio R.
Published: August 2005

Summary: We made a comprehensive study of the relation between age, weight, carbamazepine (CBZ) dose, total clearance (TC), and intrinsic clearance (IC) and concentrations, concentration ratios, and level/dose ratios of CBZ, carbamazepine‐10,11‐epoxide (CBZ‐E) and trans‐10,11‐dihydroxy‐10,11‐dihydro‐carbamazepine (CBZ‐H) in a group of epileptic children receiving CBZ monotherapy. Body weight and age showed negative correlations with TC, IC, CBZ dose, and CBZ‐E/CBZ and CBZ‐HI CBZ concentration ratios, and had positive relation with CBZ, CBZ‐E, and CBZ‐H level/dose ratios. These results indicate decreased CBZ metabolism with patient maturity. Correlations between CBZ dose with TC, IC, and the concentration ratios of CBZ‐E/CBZ, CBZ‐H/CBZ‐E, and CBZ‐H/CBZ were positive. CBZ dose also had negative associations with CBZ and CBZ‐E level/dose ratios, indicating dose‐dependent autoinduction of CBZ metabolism. Our data suggest that weight, age, and CBZ dose have less influence on epoxidehydrolase activities than on epoxidase activities. The CBZ‐E/CBZ concentration ratio can be used as an indicator of the degree of autoinduction of CBZ metdbohn, even in patients receiving CBZ monotherapy.
Clinimetric Analysis of Treatment Objectives and Clinical Status: Individualized Treatment in Epileptic Patients
Authors: Lammers M. W. , Hekster Y. A. , Keyser A. , Meinardi H. , Renier W. O. , Van Lier H. , Wijsman D. J. P.
Published: August 2005

Summary: The achievement of treatment objectives for patients with epilepsy, as defined by the treating clinicians, was compared with scoring of clinimetric indexes. Patients with the treatment objectives “complete seizures remission” or “treatment impairment/benefit balance” were included in this study. The clinimetric indexes were also compared with a clinical status rating, as assessed by the clinician. No correlation was observed between clinimetric indexes and achievement of the treatment objective. The difference noted in outcome of treatment objectives and index scores may have resulted because the indexes were group‐intended and the clinician's judgment was individual‐oriented. The clinician's assessment of clinical status of the patient did correlate with the composite index of impairments (CII), however, a clinimetric scale for severity of impairments caused by epilepsy. The advantage of the CII over the clinical status rating is that the CII is constructed with objective data and shows the cause of change observed during follow‐up.
Simple Dysphasic Seizures as the Sole Manifestation of Relapse in Multiple Sclerosis
Authors: Spatt Josef , Goldenberg Georg , Mamoli Bruno
Published: August 2005

Summary: In a patient with multiple sclerosis (MS), dysphasic seizures were the only manifestation of a relapse. There was a strong correlation between time course of seizures and EEG, and between a localized EEG focus and a magnetic resonance imaging (MRI)‐verified encephalitic plaque in the left temporal lobe.
Localization of Focal Cortical Lesions Influences Age of Onset of Infantile Spasms
Authors: Koo Betty , Hwang Paul
Published: August 2005

Summary: Purpose: To determine whether the localization of focal cerebral lesions affects age of onset of infantile spasms (IS).

Methods: We reviewed 216 cases of IS and identified patients with focal cerebral lesions confined to frontal, centrotemporoparietal, or occipital regions. The age of onset of spasms in each of the three groups was analyzed.

Results: Ninety‐three patients were found to have focal cerebral lesions confined to one of the three regions previously described. The mean age of onset of IS was 3·36 ± 1·71 months in patients with occipital lesions, 6·26 ± 2·68 months in centrotemporoparietal lesions, and 9·83 ± 2·56 in frontal lesions.

Conclusions: Occipital lesions are found to be associated with earliest onset of spasms, whereas frontal lesions are rare and associated with latest spasms onset. The age distribution pattern of spasms onset according to localization of cortical lesion is in close correlation with that of normal sequence of brain maturation. This supports the hypothesis that cerebral lesions located in critical areas of brain maturation have a role in the genesis of infantile spasms.
Surgical Treatment of Extratemporal Epilepsy: Clinical, Radiologic, and Histopathologic Findings in 60 Patients
Authors: Zentner Josef , Hufnagel Andreas , Ostertun Burkhard , Wolf Helmut K. , Behrens Elga , Campos Manuel G. , Solymosi Laszlo , Elger Christian E. , Wiestler Otmar D. , Schramm Johannes
Published: August 2005

Summary: Purpose and Methods: The aim of this study was to analyze clinical, radiologic, and histopathologic findings in 60 consecutive patients with medically intractable extratemporal epilepsy who were operated on between November 1987 and May 1993.

Results: Histologically, there were distinct structural abnormalities in 50 (83%) of the surgical specimens. Signal abnormalities on magnetic resonance imaging (MRI) were present in all patients with neoplastic lesions (n = 17) and in 94% of patients with nonneoplastic focal lesions (n = 32). Overall, structural abnormalities were detected by MRI in 47 (96%) of 49 patients with focal lesions. During a mean follow‐up of 4 years, 30 (54%) patients remained completely seizure free, 11 (20%) had ≤2 seizures per year, seven (12%) showed a seizure reduction of ≥75%, and eight (14%) had <75% reduction in seizure frequency. The fraction of seizure‐free patients was 12 (80%) of 15 in patients with neoplastic lesions, 16 (52%) of 31 in patients with nonneoplastic focal lesions, and two (20%) of 10 for those without histopathologic abnormalities. The differences in seizure outcome between patients with and without focal lesions were statistically significant (p < 0.05), if seizure‐free outcome was compared with persistent seizures.

Conclusions: Focal lesions and particularly neoplasms are associated with improved postoperative seizure control compared with patients without histopathologic abnormalities. We advise caution in considering surgery to treat extratemporal epilepsy in patients who have normal MRI scans, because the outcome with the approach described in this study is poor in such cases.
Intracartotid Amobarbital Procedure Memory Performance and Age at First Risk for Seizures Distinguish Between Lateral Neocortical and Mesial Temporal Lobe Epilepsy
Authors: Hamberger Marla J. , Walczak Thaddeus S. , Goodman Robert R.
Published: August 2005

Summary: Purpose: To determine whether intracarotid amobarbital procedure (IAP) memory‐performance asymmetries and early risk factors for epilepsy distinguish between lateral neocortical temporal lobe epilepsy (LNTLE) and mesiobasal temporal lobe epilepsy (MBTLE).

Methods: We studied 10 patients with LNTLE and 22 with MBTLE. All LNTLE patients showed (a) presence of temporal neocortical lesion or lateral seizure onset by intracranial recording, and (b) absence of mesial temporal sclerosis (MTS) by histopathologic analysis. All patients with MBTLE showed (a) video‐scalp EEG seizures consistent with mesial TLE, and (b) presence of unilateral MTS by histopathologic analysis. All patients had good surgical outcomes (Engel I or II). Unilateral IAP memory performance was defined as percentage of memory items presented during hemispheric anesthesia that was recognized after recovery. IAP asymmetry scores were the differences in memory performance after right and left injections.

Results: Mean memory‐asymmetry scores were significantly lower in the LNTLE than in the MBTLE group. An IAP memory asymmetry of <25% correctly classified seven of 10 patients with LNTLE, and an asymmetry of ≥25% correctly classified 18 of 22 patients with MBTLE. Age at first risk for epilepsy was significantly younger in those with MBTLE than in those with nonlesional LNTLE. Results suggest that both IAP memory performance and age at first risk can help distinguish between MBTLE and LNTLE.
Mutual Interaction Between Remacemide Hydrochloride and Carbamazepine: Two Drugs with Active Metabolites
Authors: Leach John Paul , Blacklaw Jackie , Jamieson Virginia , Jones Tracey , Richens Alan , Brodie Martin J.
Published: August 2005

Summary: Purpose: We wished to determine mutual interaction of two drugs with active metabolism: remacemide, hydrochloride and carbamazepine (CBZ).

Methods: A randomized, double‐blind, placebo‐controlled cross‐over study of add‐on remacemide hydrochloride was performed in 10 of 14 recruited patients being treated with CBZ monotherapy. Forty‐eight‐hour concentration profiles of CBZ, its active epoxide metabolite (CBZ‐E), remacemide, and its desglycinyl metabolite (ARL12495XX) were assayed after single and multiple dosing.

Results: After patients were treated with 300 mg remacemide hydrochloride twice daily for 14 days, the mean area under the concentration‐time curve (AUC) of CBZ was increased by 22% (p = 0.12), Cmax was increased by 27% (p = 0.07), and Cmin was increased by 22% (p = 0.29). Trough concentrations of CBZ were higher (p = 0.0037) during active treatment as compared with placebo treatment. CBZ‐E levels were unaffected. No symptoms of CBZ toxicity were reported. There was no evidence of autoinduction of remacemide metabolism. However, in CBZ‐treated patients, the AUC of remacemide and its active metabolite was 60 and 30%, respectively, of values observed in healthy volunteers treated previously with the same dose.

Conclusions: Remacemide hydrochloride inhibits CBZ metabolism, which itself induces that of remacemide hydrochloride and its active metabolite. This mutual interaction between remacemide hydrochloride and CBZ is predictable and modest and should not present a barrier to their clinical use in combination.
Vagus Nerve Stimulation Induces a Sustained Anticonvulsant Effect
Authors: Takaya Mikio , Terry Wendy J. , Naritoku Dean K.
Published: August 2005

Summary: Purpose: Stimulation of the vagus nerve can effectively abort several types of experimentally induced seizures in animals when administered near the time of seizure onset. Indirect evidence from human trials and animal studies suggests that the anticonvulsant effects of vagus nerve stimulation (VNS) extend beyond the duration of stimulation. We used the pentylenetetrazol model to determine whether VNS exerts a persistent anticonvulsant effect.

Methods: VNS (1 mA, 30 Hz, 500 μs pulse width) was administered continuously for 0, 1, or 60 min, or intermittently (30 s on, 5 min off) for 60 min, to awake and freely moving animals. After the end of stimulation, pentylenetetrazol (50 mg/kg i.p.) was administered to induce seizures. Time‐course studies were also performed, consisting of 60 min of VNS followed by pentylenetetrazol injection after 0, 3‐, 5‐, and 10‐min intervals.

Results: The greatest anticonvulsant effect occurred after 60 min of continuous VNS, which prevented convulsions in four of 12 rats and reduced significantly seizure duration, the total number of seizures, and number of tonic seizures. Intermittent VNS was less effective than continuous stimulation for 60 min, but more effective than that for 1 min. The anticonvulsant effect declined in a time‐dependent fashion after discontinuation of VNS, with return to nonstimulated control values by 10 min.

Conclusions: The results of this study verify a persistent VNS‐induced anticonvulsant effect and indicate that its efficacy is dependent on the cumulative stimulus duration.
Mesial Temporal Lobe Epilepsy: Clinical Features and Seizure Mechanism
Authors: Mayanagi Y. , Watanabe E. , Kaneko Y.
Published: August 2005

Summary: To study the clinical features of mesial temporal lobe epilepsy, 24 cases were selected based on two criteria: (a) the origin of seizure was localized to the mesiotemporal region on phase 2 monitoring, and (b) a class 1 or 2 postoperative result was obtained after selective mesiotemporal resection. A history of febrile convulsion, particularly in the form of status epilepticus, seems to be a prognostic factor. As for presurgical evaluation, electroencephalography (EEG), magnetic resonance imaging (MRI), magnetoencephalography (MEG), and ictal single‐photon emission‐computed tomography (SPECT) are important tests. Recording of spontaneous seizures by means of intracranial electrodes is the most reliable for diagnosis. Ammon's horn sclerosis and mesial temporal sclerosis are the most frequent pathologic findings. The seizure mechanism was studied by means of depth EEG recordings and ictal SPECT. The hippocampal formation is more responsible than the amygdala for the origin of seizures. Preferential pathways for seizure spread may be the fornix and stria terminalis, amygdalofugal fibers, and uncinate fasciculus. The concept of mesial temporal lobe epilepsy is valid for selecting medically refractory but surgically remediable patients for surgical treatment.
Lamotrigine Adjunctive Therapy in Childhood Epileptic Encephalopathy (the Lennox Gastaut Syndrome)
Authors: Donaldson Jennifer A. , Glauser Tracy A. , Olberding Lynn S.
Published: August 2005

Summary: Purpose: We assessed efficacy and safety of adjunctive lamotrigine (LTG) therapy in patients with the Lennox‐Gastaut syndrome (LGS).

Methods: The study was a single‐center, retrospective chart review of open‐label adjunctive LTG therapy in patients with LGS. Initial LTG dose and titration was dependent on concomitant antiepileptic drugs (AEDs). Efficacy was based on the change in seizure frequency between the initiation of LTG therapy and December 1, 1995 (or LTG discontinuation). Seizure diaries were used to count patient seizures. A secondary evaluation of efficacy was a parental or guardian assessment of the patient's global status. The evaluation of safety involved chart review for treatment‐emergent adverse events (AE).

Results: Data from 16 LGS patients were analyzed. Fifty‐three percent (8 of 15) had a >50% reduction in seizure frequency with LTG adjunctive therapy. Tonic, atonic, generalized tonic‐clonic (GTCS), and atypical absence seizure frequency but not myoclonic seizure frequency decreased significantly during LTG therapy. Fifty‐three percent of the patient's parents (8 of 15) reported that their child's quality of life (QOL) was much or very much improved during the study. The major treatment‐emergent AE were infection (50%, 8 of 16) and sleep disturbance (19%, 3 of 16). A rash was noted in 13% (2 of 16) of the patients and resulted in LTG discontinuation in 1. No clinically significant changes were noted in neurologic examination or laboratory tests during the study.

Conclusions: Our results indicate that LTG adjunctive therapy is effective and well tolerated in patients with LGS.
Hippocampal Atrophy Is Not a Major Determinant of Regional Hypometabolism in Temporal Lobe Epilepsy
Authors: O'Brien T. J. , Newton M. R. , Cook M. J. , Berlangieri S. U. , Kilpatrick C. , Morris K. , Berkovic S. F.
Published: August 2005

Summary: Purpose: The pathophysiologic basis for the [18F]fluorodeoxyglucose positron‐emission tomography (FDG‐PET) temporal lobe hypometabolism in patients with hippocampal sclerosis (HS) is uncertain. We tested the hypothesis that hippocampal atrophy, which is strongly correlated with hippocampal cell loss, is largely responsible for the regional hypometabolism in HS.

Methods: Regions of interest (ROIs) on FDG‐PET scanning were determined in the medial, lateral, and posterior temporal lobe, thalamus, and basal ganglia. A right/left asymmetry index for each ROI was calculated. These results were correlated with hippocampal magnetic resonance imaging (MRI) volume ratios.

Results: There was no correlation between the magnitudes of the FDG‐PET asymmetry index and the MRI volume ratio for the mesial or lateral temporal regions (r =−0.09, r =−0.04). When the right/left asymmetry index was compared with the right/left hippocampal volume ratio, correlations for the mesial temporal ROI (r = 0.79, p < 0.0001) and lateral temporal ROI (r = 0.57, p < 0.0005) were found. These, however, simply indicated that both tests accurately reflect the side of the epileptogenic region. The concordance of the side of relative hypometabolism of the FDG‐PET with the side of the hippocampal atrophy was higher for the mesial temporal region (100%) than for the lateral (77.5%).

Conclusions: The lack of correlation between the magnitudes of the ratios argues against hippocampal atrophy and cell loss having a central role in the FDG‐PET temporal hypometabolism.
FDG‐Positron Emission Tomography and Invasive EEG: Seizure Focus Detection and Surgical Outcome
Authors: Theodore William H. , Sato Susumu , Kufta Conrad V. , Gaillard William D. , Kelley Kathy
Published: August 2005

Summary: Purpose: To study the value of [18F]2‐deoxyglucose (FDG)‐positron emission tomography when surface ictal EEG is nonlocalizing.

Methods: FDG‐PET scans were performed in 46 patients with complex partial seizures (CPS) not localized by ictal SUT‐face‐sphenoidal video‐EEG (VEEG) telemetry. Interictal PET was performed with continuous EEG monitoring, and images were analyzed with a standard template. Forty patients subsequently had subdural and 6 had depth electrodes (invasive EEG, IEEG); 22 had bilateral implants. A focus was detected in 40, and 35 had temporal lobectomy based on IEEG localization.

Results: There was a close association between IEEG and PET localization (p < 0.01): 26 patients had relative unilateral temporal FDG‐PET hypometabolism, all had congruent IEEG, and 18 of 23 were seizure‐free after temporal lobectomy. Five patients had unilateral frontotemporal hypometabolism (3 of 5 were seizure‐free), 1 had frontal hypometabolism, and 14 had no lateralized PET abnormality (4 of 7 were seizure‐free). Patients who became seizure‐free had significantly higher lateral temporal asymmetry index (AI). PET showed 315% relative temporal hypometabolism (AI) in 12 of 22 patients with non‐lateralized surface ictal VEEG and was capable of distinguishing between frontal and temporal foci in 16 of 24 patients with lateralized, but not localized, surface ictal video‐EEG.

Conclusions: FDG‐PET provides valuable data in patients with unlocalized surface ictal EEG and can reduce the number of patients who require IEEG studies. Quantitation is necessary for optimal PET interpretation.
Temporal Changes in Proton MRS Metabolites After Kainic Acid‐Induced Seizures in Rat Brain
Authors: Najm I. M. , Wang Y. , Hong S. C. , Luders H. O. , Ng T. C. , Comair Y. G.
Published: August 2005

Summary: Purpose: In situ 1H‐magnetic resonance spectroscopy (MRS) was used to study temporal metabolic changes in a rat model of temporal lobe epilepsy (TLE) by using kainic acid (KA).

Methods: Rat brains were scanned at the level of the hippocampal body for MRS measurements. Relative ratios of N‐ acetyl groups (NA: N‐acetylaspartate and N‐acetylaspartyl glutamate), choline, and lactate (Lac) over creatine (Cr) were calculated.

Results: NA/Cr ratios increased significantly during the ictal phase. During the postictal and interictal phases, the NA/Cr ratio decreased. There was a significant and prolonged increase of the lactate/Cr ratio in the hippocampi of rats that started 1 h after the onset of KA‐induced seizure activity and persisted up to 24 h after the injection. The prolonged lactate/Cr increase in an area susceptible to neuronal damage (e.g., hippocampus) correlated with the onset of seizure activity but remained elevated thereafter.

Conclusions: The ictal and early postictal increase in lactate ratios may reflect increased cellular activity and metabolism resulting from KA excitotoxicity. Assuming that the changes in NA/Cr ratios are due to NAA increase, we speculate that an activation of the N‐acetylaspartylglutamate (NAAG) dipeptidase pathway may explain the ictal increase in NA/Cr ratios. The late postictal decrease in NNCr ratios is a reflection of KA‐induced neuronal cell loss.
Carbamazepine‐Induced Release of Serotonin from Rat Hippocampus In Vitro
Authors: Dailey John W. , Reith Maarten E. A. , Steidley Kevin R. , Milbrandt Joseph C. , Jobe Phillip C.
Published: August 2005

Summary: Purpose: Carbamazepine is one of several antiepileptic drugs (AEDs) that release the inhibitory neurotransmitter serotonin as part of their pharmacodynamic action on brain neurons. We undertook this study to investigate the cellular processes by which carbamazepine (CBZ) releases serotonin from brain tissue.

Methods: Tissue slices were prepared from hippocampi of Sprague‐Dawley rats. These hippocampal slices were preincubated in vitro in a buffer so that neurons within the slice would take up tritium‐labeled serotonin. Subsequently the slices were superfused with buffer containing CBZ or other chemicals (or both) that increase the overflow of serotonin radioactivity.

Results: Carbamazepine produced a concentration‐dependent (50, 125, 250, or 500 μM) increase in basal overflow of serotonin radioactivity from superfused rat hippocampal slices in vitro. In contrast, these concentrations did not alter potassium‐stimulated release, suggesting that the CBZ‐induced release does not depend on depolarization or exocytosis. Blockade of the neuronal membrane serotonin transporter by fluoxetine (1 μM) or citaloprarn (2 μM) did not alter overflow of serotonin radioactivity produced by 250 μM CBZ. p‐chloramphetamine (10 μM) produced a substantial increase in overflow of serotonin radioactivity, and this effect appears to be antagonized by 250 μM CBZ. Uptake of [3H]‐labeled serotonin into hippocampal synaptosomes was inhibited by CBZ with a median inhibitory concentration (IC50) of 511 ± 33 μM and a Hill coefficient of 0.87 ± 0.11, suggesting competitive inhibition of uptake by CBZ.

Conclusions: We conclude that CBZ (a) releases serotonin from hippocampal slices independent of exocytosis and by a mechanism not involving the neuronal membrane serotonin transporter, and (b) at high enough concentration, blocks the neuronal serotonin transporter.
Typical Absence Status in Adults: Diagnostic and Syndromic Considerations
Authors: Agathonikou A. , Panayiotopoulos C. P. , Giannakodimos S. , Koutroumanidis M.
Published: August 2005

Summary: Purpose: To study the electroclinical features of typical absence status (TAS) in adults with syndromes of idio‐pathic generalized epilepsies (IGEs).

Methods: Twenty‐one patients with one or more spells of TAS were identified among 136 consecutive adult patients with IGEs. All patients with TAS had comprehensive electroclinical investigations and EEG or video‐EEG recorded absences.

Results: TAS occurred in 24.4% of 86 patients who had IGEs with typical absences alone or in combination with other seizures presisting in adult life. The prevalence of TAS appeared to be syndrome related, ranging from as high as 57.1% in perioral myoclonia with absences and 46.2% in “phantom” absences with GTCS to as low as 6.7% in juvenile myoclonic epilepsy. A varying degree of impairment of cognition was the cardinal clinical symptom shared in all TAS, but corresponding syndromes of IGE were often betrayed by other symptoms such as eyelid or perioral myoclonia. In phantom absences with GTCS, TAS was more numerous (p S 0.05) and more frequently the first overt seizure type (p = 0.006) than in any other IGE. Only in the syndrome of eyelid myoclonia with absences, TAS was always situation related, mainly as a result of antiepileptic drug discontinuation.

Conclusions: The clinical EEG semiology and prevalence of TAS appear to be syndrome related with the highest prevalence in the syndromes of perioral myoclonia with absences and phantom absences with GTCS (p = 0.0024).
Analysis of Ictal EEGs of Epilepsy Associated with Tuberous Sclerosis
Authors: Ohmori Iori , Ohtsuka Yoko , Ohno Shigeru , Oka Eiji
Published: August 2005

Summary: Purpose: To investigate the significance of cortical pathology of tonic spasms in patients with tuberous sclerosis.

Methods: The subjects were 38 patients with epilepsy associated with tuberous sclerosis. We analyzed ictal EEGs of tonic spasms and partial seizures by means of video‐EEG monitoring for a total of 763 tonic spasms in 20 patients and 107 partial seizures in 15 patients. We also investigated the relation between partial seizures and magnetic resonance imaging (MRI) findings of these patients.

Results: Ictal EEG patterns of tonic spasms were divided into generalized and focal patterns. Thirteen patients had only generalized patterns, whereas seven had both patterns. In five patients who had focal ictal patterns of tonic spasms and partial seizures, the location of focal patterns corresponded with the location of onset of partial seizures. Focal discharges were seen immediately before, after, and in the middle of tonic spasms in series in 13 patients. The location of focal discharges also corresponded with the location of the onset of partial seizures in 10 of the 13 patients. Regarding partial seizures, four patients had multiple active epileptogenic foci during the same period, and two others had shifting epileptogenic foci with increasing age.

Conclusions: These findings indicate that cortical pathology plays an important role in the occurrence not only of partial seizures but also of tonic spasms in patients with tuberous sclerosis.
Cerebral Hemodynamic Response to Generalized Spike‐Wave Discharges
Authors: Diehl B. , Knecht S. , Deppe M. , Young C. , Stodieck S. R. G.
Published: August 2005

Summary: Purpose: Data in the literature concerning metabolic demand during generalized spike‐wave activity (gSW) are conflicting. We investigated instantaneous changes in cerebral blood flow velocities (CBFV) in both middle cerebral arteries (MCAs) by transcranial Doppler sonography (TCD) during gSW paroxysms recorded by scalp EEG.

Methods: In 13 patients, CBFVs in both MCAs were averaged, time‐locked to the occurrence of the gSW; respiratory rate (RR) and end‐expiratory pco, were measured in one patient.

Results: Nine patients showed significant changes in CBFV during gSW. Four had biphasic flow changes with an initial increase (p < 0.05) and a subsequent decrease (p < 0.01). This was partially paralleled by an increase in RR (p < 0.01) and a decrease in pco, (p < 0.01). In three patients, an increase in CBFV that preceded the onset of gSW by several seconds was observed, followed by a decrease in CBFV. Two patients showed a significant decrease only of CBFV. Only gSWs of a median duration of >0.8 s were associated with significant changes in CBFV.

Conclusions: We were able to demonstrate that gSWs of several seconds duration lead to cortical perfusion changes. We suggest that the initial increase of CBFV demonstrated in some patients reflects neuronal activation, whereas the subsequent decrease might in part be due to hyperventilation‐induced hy‐pocapnia.
Interictal Spiking Increases with Sleep Depth in Temporal Lobe Epilepsy
Authors: Malow Beth A. , Lin Xihong , Kushwaha Ramesh , Aldrich Michael S.
Published: August 2005

Summary: Purpose: To test the hypothesis that deepening sleep activates focal interictal epileptiform discharges (IEDs), we performed EEG‐polysomnography in 21 subjects with medically refractory temporal lobe epilepsy.

Methods: At the time of study, subjects were seizure‐free for 224 h and were taking stable doses of antiepileptic medications (AEDs). Sleep depth was measured by log delta power (LDP). Visual sleep scoring and visual detection of IEDs also were performed. Logistic‐regression analyses of IED occurrence in relation to LDP were carried out for two groups of subjects, nine with frequent IEDs (group 1) and 12 with rare IEDs (group 2).

Results: The LDP differentiated visually scored non‐rapid eye movement (NREM) sleep stages (p = 0.0001). The IEDs were most frequent in NREM stages 3/4 and least frequent in REM sleep. Within NREM sleep, in both groups, IEDs were more frequent at higher levels of LDP (p < 0.05). In group 1, after accounting for the level of LDP, IEDs were more frequent (a) on the ascending limb of LDP and with more rapid increases in LDP (p = 0.007), (b) in NREM than in REM sleep (p = 0.002), and (c) closer to sleep onset (p < 0.0001). Fewer than 1% of IEDs occurred within 10 s of an EEG arousal.

Conclusions: Processes underlying the deepening of NREM sleep, including progressive hyperpolarization in thalamocortical projection neurons, may contribute to IED activation in partial epilepsy. Time from sleep onset and NREM versus REM sleep also influence IED occurrence.
An Automated Injection System (with Patient Selection) for SPECT Imaging in Seizure Localization
Authors: Sepkuty Jehuda P. , Lesser Ronald P. , Civelek Cahid A. , Cysyk Barbara , Webber Robert , Shipley Roy
Published: August 2005

Summary: Purpose: Ictal single‐photon‐emission computed tomography (Spect) provides lateralization but has technical limitations: (a) a “truly ictal” injection must be shortly after seizure onset; (b) therefore, a seizure of brief duration may be missed; (c) more than one patient may need testing at any given time: (d) a trained health professional must stay next to each patient to inject; and (e) because the radionuclide is placed in the syringe in advance of the injection, decay of the radioactive element could result in less than optimal uptake, if the same volume of material were to be used regardless of the time after ligand preparation.

Methods: We developed an automated method of ligand injection that shortens time and increases efficiency of ictal SPECT ligand injection. By using an experimental setup, we compared manual injection times with times using an automated injection system. We determined relative costs and efficiency in work hours for the manual and automated methods.

Results: Injection times were 8–14 s with automated versus 19–26 s with manual injection. Readjusting volume for “ligand” decay was simple and accurate with the automated system. Injection times for clinical SPECT studies in three patients were 13, 13, and 12 s, respectively. The price of one pump equals 120 work hours of a nurse or 24 ictal injection attempts. Much of the nurse's time is “wasted” because no seizure occurs.

Conclusions: The method can be more efficient of staff, shorten injection time, and facilitate obtaining “truly ictal” injections. It allows more cost‐effective use of personnel.
De Novo Status Epilepticus as the Presenting Sign of Neurosyphilis
Authors: Primavera Alberto , Solaro Claudio , Cocito Leonard
Published: August 2005

Summary: Although the incidence of seizures in neurosyphilis ranges from 14 to 60%, status epilepticus (SE) as a presenting complaint of neurosyphilis is definitely rare. A 44‐year‐old human immunodeficiency virus (H1V)‐negative man with no history of epilepsy suddenly presented with acute mental confusion and was diagnosed as having a de novo complex partial nonconvulsive SE. Cerebrospinal fluid (CSF) findings, neuroimaging, and clinical course indicated that SE was the presenting symptom of an undiagnosed syphilitic meningovasculitis. The case is presented with a review of previous reports to emphasize the differential features and to underscore the importance of considering neurosyphilis among the possible causes of de novo SE.
Abdominal Epilepsy in an Adolescent with Bilateral Perisylvian Polymicrogyria
Authors: García‐Herrero D. , Fernhndez‐Torre J. L. , Barrasa J. , Calleja J. , Pascual J.
Published: August 2005

Summary: Purpose: We report a patient with recurrent episodes of severe periumbilical pain accompanied by headache, pallor, dizziness, and visual hallucinations who was subsequently diagnosed as having abdominal epilepsy and a bilateral sylvian cortical malformation.

Methods and Results: During an EEG examination, the patient had a simple partial seizure, manifested as intense abdominal pain. The ictal EEG showed a focal electrographic seizure arising from the left frontotemporal region. Computed tomography scan was normal; however, magnetic resonance imaging (MRI) revealed asymmetric lesions involving both sylvian fissures compatible with polymicrogyria. Onset of treatment with sodium valproate was followed by a significant reduction of seizures.

Conclusions: Abdominal epilepsy should be suspected in adolescents or adults with paroxysmal episodes of abdominal pain associated with migraine‐like symptoms. EEG and MRI investigations are indicated. A developmental brain disorder should be considered as a possible etiology.
Enhanced Coagulation Activation by In Vitro Lipopolysaccharide Challenge in Patients with Ventricular Fibrillation Complicating Acute Myocardial Infarction
Authors: KÄLSCH THORSTEN , ELMAS ELIF , NGUYEN XUAN DUC , GREBERT NADINE , WOLPERT CHRISTIAN , KLÜTER HARALD , BORGGREFE MARTIN , HAASE KARL KONSTANTIN , DEMPFLE CARL ERIK
Published: August 2005

Background: Indicators of coagulation and inflammation are elevated in patients with coronary heart disease. A role of coagulation activation in ventricular fibrillation during acute myocardial infarction has not been described.

Methods and Results: Whole blood samples of 21 patients with a history of acute myocardial infarction complicated by ventricular fibrillation and whole blood samples of 18 patients without ventricular fibrillation were incubated with lipopolysaccharide (LPS). In both groups, the in vitro blood coagulation time was measured with the ReoRox®, a viscometric whole blood coagulometer. CD62P expression on platelets, tissue‐factor binding on monocytes, and platelet‐monocyte aggregates were measured with flow cytometry. Without LPS, no difference in the coagulation times were observed in both patient groups. After incubation with LPS, patients with a history of ventricular fibrillation showed a significantly decreased coagulation time compared to patients without ventricular fibrillation. The decrease of coagulation time after incubation with LPS also differed significantly in both groups. Expression of CD62P on platelets was significantly higher in patients with a history of ventricular fibrillation after incubation with LPS. Although in each patient group incubation with LPS induced a significantly increased amount of tissue factor on monocytes and a significantly increased the number of platelet‐monocyte aggregates, the two groups did not differ significantly concerning tissue factor binding on monocytes and the amount of platelet‐monocyte aggregates.

Conclusions: After in vitro LPS challenge, patients with a history of ventricular fibrillation during myocardial infarction show an enhanced coagulation activation, which may partly be due to an enhanced platelet activation.
Genetics of Right Ventricular Cardiomyopathy
Authors: SEN‐CHOWDHRY SRIJITA , SYRRIS PETROS , McKENNA WILLIAM J.
Published: August 2005

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited heart muscle disease that may result in arrhythmia, heart failure, and sudden death. The hallmark pathological findings are progressive myocyte loss and fibrofatty replacement, with a predilection for the right ventricle. However, variants of ARVC that preferentially affect the left ventricle are increasingly recognized. ARVC is distinguished from dilated cardiomyopathy by a propensity toward ventricular arrhythmia and sudden death in the absence of significant ventricular dysfunction.

In the majority of families, ARVC shows autosomal dominant inheritance with incomplete penetrance. Recessive forms are also described, often in association with cutaneous disorders. Causative mutations have so far been identified in plakoglobin, desmoplakin, and plakophilin, all of which encode key components of the desmosome. Desmosomes are protein complexes that anchor intermediate filaments to the cytoplasmic membrane in adjoining cells, thereby forming a three‐dimensional scaffolding that provides tissues with mechanical strength. Unraveling of the genetic etiology of ARVC has elicited a new model for pathogenesis. Impaired functioning of cell adhesion junctions during exposure to shear stress may lead to myocyte detachment and death, accompanied by inflammation and fibrofatty repair. At least three mechanisms contribute to the arrhythmic substrate: bouts of myocarditis, fibrous and adipose infiltrates that facilitate macroreentry, and gap junction remodeling secondary to altered mechanical coupling. The latter may underlie arrhythmogenicity in early disease.

Although ARVC can be considered a disease of the desmosome, a variety of other genetic defects give rise to phenocopies, which may ultimately enhance our understanding of the broad phenotypic spectrum.
Clinicopathological analysis of T‐cell lymphoma in Taiwan according to WHO classification: high incidence of enteropathy‐type intestinal T‐cell lymphoma
Authors: Lee Ming‐Yuan , Tsou Mei‐Hua , Tan Tran‐Der , Lu Mei‐Chun
Published: August 2005

Abstract:  Objectives: The clinicopathological characteristics of malignant lymphomas vary according to geography, especially for the T‐cell lymphoma (TCL). The aim of this study is to demonstrate the incidence and clinicopathological characteristics of TCL in Taiwan according to WHO classification. Methods: Archival tissue from 600 malignant lymphomas during the period of 1995–2002 was retrieved, there were 74 cases diagnosed with TCL. Hematoxylin and eosin slides stained and other special studies were reviewed. All cases were reclassified according to the WHO classification. Clinical data, including age, gender, clinical staging, and follow‐up, were scrutinized. Results: There were 52 males and 22 females with male predilectation. The incidence of TCL in malignant lymphoma was 12.3%. The most prevalent histologic subtype was peripheral T‐cell lymphoma (PTCL), followed by nasal T‐cell/Natural killer‐ (T‐/NK‐) cell lymphoma, T‐lymphoblastic lymphoma (LBL), anaplastic large cell lymphoma, and enteropathy‐type intestinal lymphoma (ETCL). Clinically, 39 cases (49%) had higher clinical stage (III/IV). Overall 2‐year and 5‐year survival rate was 51.4% and 34.7%, respectively. It was noteworthy that ETCL had high incidence rate (8.1%) and high mortality. There was significant difference in survival rates in respect of clinical stages and histological subtypes. Conclusions: TCL is relatively less frequent in Taiwan, compared to other countries in Asian and western countries. The most common histological subtypes are PTCL, unspecified and T‐/NK‐cell lymphoma. Five‐year survival rate is 34.7%. ETCL has higher incidence rate in Taiwan. The clinical stage and histological subtypes are prognostic parameters in determining the survival rates.
Effect of varicella zoster virus infection on bone marrow function
Authors: Al‐Anazi Khalid Ahmed , Al‐Jasser Asma Marzouq , Evans David Alan Price
Published: August 2005

Abstract:  Background: Most viral infections are known to exert adverse effects on bone marrow function. However, certain viruses have recently been found to be therapeutically beneficial in the treatment of some malignant disorders. Methods and materials: A retrospective study was conducted at the Armed Forces Hospital, Riyadh, Saudi Arabia. The changes in the hematological parameters following varicella‐zoster virus (VZV) infection in patients with a variety of hematological disorders were compared with those in a control group having the same spectrum of disorders and treated in the same unit over the same period of time but never had VZV infection. Both groups of patients received the same treatment protocols for their primary hematological disorders. Definitive treatment (DT) such as chemotherapy alone, anti‐thymocyte globulin or bone marrow transplant was also employed in the management of patients belonging to both groups. Results: White blood cell counts, platelet counts and hemoglobin concentrations in the study group started to increase 40 d after chickenpox or herpes zoster infection and these increases lasted for periods as long as 1050 d. The changes in platelet counts were more pronounced than those in other hematological parameters. There was a significant difference (P < 0.0001) between the two groups of patients in the values of platelet counts achieved between 280 and 1050 d after DT (mean platelet count: 262 × 109/L in the study group vs. 180 × 109/L in the control group, median: 288.17 × 109/L in the study group vs. 180 × 109/L in the control group, range: 102 to 415 × 109/L in the study group vs. 26 to 365 × 109/L in the control group of patients). Compared to the control group, the study group of patients achieved their maximum blood counts much earlier after DT. The maximum leucocytic count was achieved at a mean duration of 269.21 d in the study group and 349.61 d in the control group. The maximum hemoglobin level was achieved at a mean duration of 319.5 d in the study group and 402.6 d in the control group. The maximum platelet count was achieved at a mean duration of 271.4 d in the study group and 318.9 d in the control group of patients. Conclusion: VZV may behave differently from other members of the herpes group of viruses e.g. human cytomegalovirus and Epstein‐Barr virus. Our observations suggest that VZV infection causes stimulation of bone marrow activity.