bluuebunny/crossref_metadata_2025 huggingface dataset:
Hemispheric Specialization in Children with Unilateral Epileptic Focus, With and Without Computed Tomography‐Demonstrated Lesion
Authors: Riva Daria , Pantaleoni Chiara , Milani Nicoletta , Giorgi Cesare
Published: October 2005

Summary: We evaluated 24 testable children with unilateral epileptic foci, with and without radiologically demonstrable lesions, to determine if the normal pattern of cerebral dominance is changed by the presence of an epileptic focus. Verbal and figural stimuli were presented tachistoscopically to the right and left visual hemifields to investigate the specific abilities of the two hemispheres. Three blocks of stimuli consisting of two‐letter patterns, three‐letter patterns, and meaningful two‐syllable words were used as verbal stimuli to assess the abilities of the left hemisphere. A test consisting of localizing a dot on a 3x3 matrix was used to assess the abilities of the right hemisphere. Six normal children were chosen as controls. In all groups, specialization of the epileptic hemisphere was lost. The presence or absence of a radiologically demonstrable lesion did not influence this pattern.
Corpus Callosotomy for Seizures Associated with Band Heterotopia
Authors: Landy Howard J. , Curless Richard G. , Ramsay R. Eugene , Slater Jeremy , Ajmone‐Marsan Cosimo , Quencer Robert M.
Published: October 2005

Summary: Band heterotopia is a severe form of neuronal migration disorder associated with intractable epilepsy and neurologic impairment. Surgical treatment of seizures associated with this malformation has not been reported previously. We report a patient with band heterotopia and poorly controlled atonic seizures causing falls and injury. The patient was treated with anterior corpus callosotomy, with significant postoperative decrease in seizure frequency. Corpus callosotomy is a reasonable alternative to consider in management of patients with cortical heterotopia and intractable seizures.
Occipitotemporal Epilepsies: Evaluation of Selected Patients Requiring Depth Electrodes Studies and Rationale for Surgical Approaches
Authors: Palmini A. , Andermann F. , Dubeau F. , Gloor P. , Olivier A. , Quesney L. F. , Salanova V.
Published: October 2005

Summary: In 8 patients in whom it was uncertain whether they had occipital or temporal lobe (TL) epilepsy, clinical, scalp EEG, and radiologic features were correlated with the sites of seizure onset as determined by depth EEG. The 8 patients were selected from >40 with occipital epilepsy because they had (a) an aura considered to be of occipital lobe (OL) origin, (b) an occipital interictal epileptic focus, (c) an OL lesion, or (d) a combination of all of these. Scalp EEG and clinical patterns suggested temporal involvement in all, however. Extracranial EEG recordings were often misleading, showing multilobar interictal epileptic abnormalities, and seizure onset was of poor localizing value and did not clarify the problem sufficiently. Intracranial EEG recordings showed that seizure onset could be ordered along an Occipitotemporal gradient. Consistent OL seizure onset was observed in patients who had only elementary visual auras. Those who had inconsistent aura or no aura, suggesting OL origin, had onset of most attacks in the TL. All patients had a seizure spread pattern suggesting early TL involvement. To prevent visual field defect, surgical approaches included temporal resection when temporal seizure origin or spread was demonstrated; although occasionally this produced excellent results, it was of limited benefit in most patients, even when some seizures were proven to originate in TL structures. In patients with malignant epilepsy and in those with an occipital lesion, occipital resection should be considered.
Facilitation of Infantile Spasms by Partial Seizures
Authors: Carrazana Enrique J. , Lombroso Cesare T. , Mikati Mohamad , Helmers Sandra , Holmes Gregory L.
Published: October 2005

Summary: We report 16 patients with infantile spasms in whom onset of the clusters of spasms appeared to be triggered by close temporal association with partial seizures. Common features included the presence of focal cerebral lesions in 12 infants (3 were classifiable as cryptogenic); all had partial seizures with EEG localization, clusters of bilateral spasms always preceded by partial seizures, and response to adrenocorticotropic hormone (ACTH) and traditional antiepileptic drugs (AEDs) generally was poor. Three had complete agenesis of the corpus callosum, which argues against interhemispheric callosal spread of focal discharges resulting in the generalized spasms. Surgical cortical resections were performed in 6 of the infants, with good outcomes. This group of patients supports a model in which the spasms, although probably generated at a subcortical level, are facilitated or possibly induced by focal discharges from cortical pathology.
Hypnic Tonic Postural Seizures in Healthy Children Provide Evidence for a Partial Epileptic Syndrome of Frontal Lobe Origin
Authors: Vigevano Federico , Fusco Lucia
Published: October 2005

Summary: In the pediatric age period, three idiopathic partial epileptic syndromes are recognized: benign childhood epilepsy with centrotemporal spikes, childhood epilepsy with occipital paroxysms, and primary reading epilepsy. All other partial epilepsies are considered cryptogenic, and no other idiopathic partial epilepsies have been recognized. We observed 10 children with tonic partial postural seizures, mainly hypnic, coinciding with a recognizable ictal epileptiform EEG pattern. The children all had normal neuropsychological development before and after seizure onset. The seizures were tractable in all. Onset was in the early pediatric age period; no other type of seizure was recognized. The occurrence of a family history of epilepsy was high. The seizure pattern was typical of supplementary motor area origin. Because of the normal neuropsychological status, high familial incidence of epilepsy, and benign course of this partial epilepsy, we believe it should be considered idiopathic, using the criteria of the International Classification of Epilepsies and Epileptic Syndromes. We therefore suggest the existence of a partial idiopathic epileptic syndrome having onset with seizures of frontal lobe origin.
Electroclinical Seizures in Lennox‐Gastaut Syndrome
Authors: Yaqub Basim A.
Published: October 2005

Summary: We analyzed electroclinical seizures observed by long video split‐screen recording in 21 patients with Lennox‐Gastaut syndrome (LGS). All patients had atypical absence seizures, 18 (81%) had tonic seizures, and 4 (21%) had myoclonic‐atonic seizures. Tonic seizures were axial with flexion or extension of the head or trunk, or global with generalized tonic spasm mimicking infantile spasm, or involved the eyeballs only (either brief, with upward deviation of eyeballs or long, with oscillatory nystagmus). EEG showed either a bilateral 10–13‐Hz rhythm or generalized synchronous spike wave at 3 Hz. Myoclonic‐atonic seizures involving limbs, trunk, or neck were either brief or massive; the discharges were 2–3.5‐Hz spike wave. Atypical absence seizures evolved gradually, terminated abruptly, and manifested alone or with subtle motor activity or oral automatism. EEG discharges were variable and of different types: (a) Diffuse irregular spike wave at 2–2.5 Hz with or without fragmentation (consciousness was regained during fragmentation or when spike wave discharges were >2 Hz), (b) irregular diffuse fast activity at 10–13 Hz, or (c) a combination of fast spike wave or sharp waves of increasing amplitude followed by synchronous spike wave discharges at 3 Hz.
Primary Generalized Seizure Disorder: Correlation of Epileptiform Discharges with Seizure Frequency
Authors: Miller H. , Blume W. T.
Published: October 2005

Summary: The role of routine follow‐up EEG in assessment of severity of a seizure disorder is not known. This retrospective chart review study of patients with primary generalized seizure disorders explored the relation between parameters of epileptiform discharge bursts on EEG and number of seizures experienced in the preced ing months. Eighty‐seven such patients were found, each with one to seven EEGs and corresponding clinical records, comprising a total of 201 clinicoelectrographic epochs. The 56 chronically attending patients (more than two attendances) differed from the 31 nonchronic attenders in receiving more antiepileptic drugs (AEDs) and having fewer EEG poly spikes; otherwise, the two groups were similar and were analyzed together. We noted a strong relation between number and maximum length of epileptiform bursts in the resting EEG record and number of absence seizures reported in the months preceding the EEG. Age did not affect this relation. After stepdown regression analysis, only the maximum length of epileptiform bursts remained significantly related to the reported number of absence seizures. These findings may prove useful in assessing clinical progress, e.g., in patients whose ability to estimate numbers of attacks is suspect. Neither number nor maximum length of epileptiform bursts in the resting EEG record had a significant relation with the number of generalized tonic‐clonic seizures. Presence of polyspikes on resting or “activated” EEG had no added predictive value. The presence of epileptiform bursts after activation by sleep, hyperventilation, or photic stimulation was not associated with an increased likelihood of having had seizures.
Episodic Psychic Symptoms in the General Population
Authors: Ardila Alfredo , Niño Carmen Rosa , Pulido Elizabeth , Rivera Dora Beatriz , Vanegas Claudia Janeth
Published: October 2005

Summary: The frequency of some episodic psychic symptoms (dysmnesic, perceptual, and experiential) was determined in a 2,500‐subject general population sample. Correlations with some risk factors eventually associated with nervous system dysfunctions (seizure history, head injury, car accident, hospitalization, febrile illness, and birth injury) were calculated. Subjects with one or several risk factors were more likely to report episodic psychic phenomena in daily life. Significant correlations of episodic psychic phenomena with sleep disorders, headache, allergies, and a history of learning disabilities were observed. We propose that some subclinical dysfunctions can be associated with the appearance of episodic psychic phenomena in otherwise normal subjects.
Risk Factors for Developing Seizures After a Stroke
Authors: Lancman Marcelo Elias , Golimstok Angel , Norscini Jorge , Granillo Rubens
Published: October 2005

Summary: We evaluated development of seizures in 219 consecutive patients who had ischemic or hemorrhagic stroke. Subjects with transitory ischemic attacks, sub‐arachnoid, subdural, and epidural hemorrhages or those with previous history of epilepsy were excluded. Mean follow‐up time was 11.5 months (range 1–72 months). Twenty‐two of 219 stroke patients (10.04%) had seizures. Twelve (54.55%) were of early onset (<1 month after the stroke), and 10 (45.45%) were of late onset. No statistically significant differences were evident between the early‐ and late‐onset seizure group in comparisons of type of stroke, localization, and size of the lesion. Six of 22 patients (27%) had seizure recurrence. Seizures developed in (a) 13 of 183 patients with ischemic stroke (7.1%) and 9 of 36 patients with hemorrhagic stroke (25%) (p = 0.01); (b) 16 of 93 patients with cortical lesions (17%) and 6 of 126 patients with subcortical lesions (4.7%) (p = 0.01); and (c) 14 of 66 patients with a lesion comprising more than one lobe (21.2%) and 8 of 153 patients with a lesion comprising less than one lobe (5.2%) (p < 0.01). We conclude that patients with hemorrhagic stroke, cortical lesions, and lesions involving more than one lobe are at higher risk of developing seizures.
Phenytoin Monitoring in Status Epilepticus in Infants and Children
Authors: Richard M. O. , Chiron C. , D'Athis P. , Rey E. , Aubourg P. , Dulac O. , Olive G.
Published: October 2005

Summary: Two successive protocols of phenytoin (PHT) plasma concentration monitoring were tested in 60 children with status epilepticus (SE). In each protocol, a loading dose of 15 mg/kg was injected and followed by three injections during the first 24 h. Clinical evaluation was performed at the end of the study by grouping patients into three classes according to seizure frequency during treatment: complete effect, partial effect, and no effect. In protocol 1, a complementary dose at the fourth hour was adjusted from individual plasma concentrations. Plasma concentrations at the 40th hour were within the therapeutic range in the 19 patients with complete effect (CE, mean 19 mg/L) and in the 5 patients with no effect (NE, mean 23 mg/L) whereas in the 11 patients with partial effect (PE), plasma concentrations were higher (mean Received July 1991; revision accepted March 1992.
Submandibular Salivary Gland Hypertrophy Induced by Phenytoin
Authors: Brandenburg A. H. , Smits M. G. , Voorbrood B. S. , Hemmes A. M. , Ros J. J. W.
Published: October 2005

Summary: A 16‐year‐old boy with epilepsy developed hypertrophy of the submandibular salivary glands, with high phenytoin (PHT) serum levels. The submandibular salivary glands became normal in 12 days after discontinuation of PHT. Other causes of salivary gland hypertrophy were excluded and we suggest that the hypertrophy was due to PHT.
Effects of Carbamazepine and Phenytoin on EEG and Memory in Healthy Adults
Authors: Meador K. J. , Loring D. W. , Abney O. L. , Allen M. E. , Moore E. E. , Zamrini E. Y. , King D. W.
Published: October 2005

Summary: Using a randomized, double‐blind, cross over design, we investigated the effects of carbamazepine (CBZ) and phenytoin (PHT) on memory and spectral EEG components in 15 healthy adults. Each subject was treated with each drug for 1 month, separated by a 1‐month washout. Evaluations were conducted at baseline, at the end of each treatment month, and 1 month after the last treatment phase. EEG was collected during an eyes‐closed resting condition and a verbal memory activation task. Spectral analysis of the EEG in the nondrug conditions showed that the memory task significantly reduced theta components and increased delta components. As compared with nondrug conditions, the antiepileptic drugs (AEDs) significantly impaired memory performance and produced mild EEG slowing. Memory performance did not differ statistically between the AEDs, but minor differences in spectral EEG components were noted. The results suggest that differences in the cognitive and EEG effects of CBZ and PHT are not clinically significant.
Comparative Pharmacokinetic Study of Chewable and Conventional Carbamazepine in Children
Authors: Cornaggia Cesare , Gianetti Silvia , Battino Dina , Granata Tiziana , Romeo Antonino , Viani Francesco , Limido Gianluca
Published: October 2005

Summary: Fifteen children (7 boys and 8 girls) with generalized tonic‐clonic seizures (GTCS) and partial seizures with elementary or complex symptomatology, treated with carbamazepine (CBZ) alone (n = 7) or in combination with either phenobarbital (PB, n = 6) or clobazam (CLB, n = 2) given for at least 3 months at stable individualized doses and regimens, entered an open, withinpatient, change‐over study of consecutive periods, each lasting 2 weeks. During period 1, conventional CBZ was given; during period 2, a chewable CBZ formulation was substituted for conventional CBZ and given at the same total daily dosage with the same schedule as in period 1. Blood samples for measuring plasma concentration of both total CBZ and CBZ‐10, 11 epoxide (CBZ‐E) were taken on the last day of each period. No significant difference between the two periods was noted in the mean ±SD of Cmax, Css mean, and area under the curve (AUC) of total CBZ and CBZ‐E. The two different CBZ formulations, administered at the same total daily dosage, can be considered bioequivalent.
Clarithromycin‐Carbamazepine Interaction: A Case Report
Authors: Albani Fiorenzo , Riva Roberto , Baruzzi Agostino
Published: October 2005

Summary: We report a clinically relevant interaction between a new macrolide antibiotic, clarithromycin, and carbamazepine (CBZ). In a patient receiving CBZ monotherapy, 10‐day antibiotic treatment increased CBZ concentration despite concomitant CBZ dose reduction and doubled the CBZ concentration/dose ratio. Concentration of the CBZ epoxide (CBZ‐E) metabolite was reduced, suggesting that the interaction occurs at a metabolic level.
Cross‐Reactive Skin Eruption with Both Carbamazepine and Oxcarbazepine
Authors: Beran Roy G.
Published: October 2005

Summary: Oxcarbazepine (OCBZ), a 10‐keto derivative of carbamazepine (CBZ) has been reported to have a similar range of efficacy and fewer unwanted effects than CBZ since it is a prodrug for the monohydroxy derivative (MHD). A cross‐reactivity of only 1 in 4 has been reported between OCBZ and CBZ. For these reasons, we tried OCBZ with 3 consecutive patients with poorly controlled epilepsy who had had a therapeutic response to CBZ but in whom CBZ was discontinued because of serious skin reaction. Each patient had a similar skin response after exposure to only 600–900 mg OCBZ, which suggests a need to practice caution when substituting OCBZ for CBZ in patients known to have serious skin reaction to CBZ.
Carbamazepine and Lamotrigine in Healthy Volunteers: Relevance to Early Tolerance and Clinical Trial Dosage
Authors: Hamilton M. J. , Cohen A. F. , Yuen A. W. C. , Harkin N. , Land G. , Weatherley B. C. , Peck A. W.
Published: October 2005

Summary: This study was conducted to examine the effects of acute doses of lamotrigine (LTG) and carbamazepine (CBZ) in healthy subjects and determine whether the low tendency to impairment with LTG observed in animals applied to humans. Twelve healthy men participated in a placebo‐controlled, balanced, doubleblind comparison of the drugs on a series of psychomotor, autonomic, sensory, and subjective variables. Variables were analyzed by analysis of variance, and p < 0.05 was considered significant. Adaptive tracking and body sway were impaired by CBZ 600 mg. CBZ 400 and 600 mg impaired smooth pursuit eye movements and also reduced mean peak saccadic velocity. No differences from placebo occurred after LTG. CBZ 600 mg increased heart rate (HR), but no drug‐related changes were noted in pupil size, salivary secretion, visual near point, or subjective effects. During the controlled study, mean plasma CBZ concentrations at 2 and 6.5 h after the 600‐mg dose were 5.28 and 5.36 μg/ml; after LTG 300 mg, they were 3.16 and 3.00 μg/ml. Increased CBZ saliva concentrations were significantly associated (p < 0.01) with impaired adaptive tracking, smooth and saccadic eye movements, and increased HR, and plasma concentrations were associated with impaired eye movements and body sway.
Acute Chemical Pancreatitis Associated with Carbamazepine Intoxication
Authors: Tsao Chang Y. , Wright Francis S.
Published: October 2005

Summary: A 5‐year‐old mentally retarded child developed laboratory evidence of pancreatitis during accidental acute carbamazepine (CBZ) intoxication. He had been seizure‐free with CBZ for 4 years for a seizure disorder with no obvious toxicity. CBZ had been discontinued 5 months before he was admitted to the hospital. After he accidentally ingested a CBZ overdose, he was found vomiting and lethargic. Serum amylase and lipase levels were increased for several days. With supportive treatment and no CBZ, he recovered and serum amylase and lipase levels returned to normal. No other causes of pancreatitis were identified. Therefore, most likely the chemical pancreatitis was associated with the acute CBZ intoxication.
Valproate‐Associated Pancreatitis
Authors: Asconapé Jorge J. , Penry J. Kiffin , Dreifuss Fritz E. , Riela Anthony , Mirza Waqar
Published: October 2005

Summary: To assess the clinical characteristics of valproate (VPA)‐associated pancreatitis, information from three sources was gathered: (a) a survey among 507 physicians with a special interest in treatment of epilepsy, (b) a review of the authors’ patient population, and (c) a review of the literature. Of 366 physicians answering the survey, 53 (14.5%) reported a case of pancreatitis. Thirty‐nine cases were available for review (24 from the medical literature, 12 from the survey, and 3 from the authors). Pancreatitis appeared to be more frequent in young persons (mean age 16.4 years) but may occur at any age. The highest risk appears to exist during the first months of treatment: 43.8% of the cases developed during the first 3 months, and 68.8% developed during the first year. Seventy‐six percent of patients were receiving polytherapy, and 41% had some form of associated chronic encephalopathy. In most patients, the reaction was rapidly reversible when VPA was discontinued. It was severe in 6 patients, with 3 deaths reported. Rechallenge with VPA was attempted in 9 patients, with a high incidence of relapses. Asymptomatic elevation of serum amylase in patients receiving VPA was reported by 40 (10.9%) of the physicians surveyed. Awareness of the problem and early discontinuation of VPA may be effective in preventing serious reactions.
Metaphit‐Induced Audiogenic Seizures in Mice: II. Studies on N‐Methyl‐d‐Aspartic Acid, GABA, and Sodium Channel Receptors and on the Disposition of Metaphit in the Brain
Authors: Lipovac M. N. , Debler E. A. , Zlokovic B. V. , Jacobson A. E. , Rice K. C. , de Costa B. , Selmeci G. , Chi L. , Reith M. E. A.
Published: October 2005

Summary: We previously demonstrated that metaphit (a phencyclidine analogue with an acylating isothiocyanate group) induces occurrence of audiogenic seizures in mice exposed to audio stimulation 24 h after metaphit administration. We have studied various receptor systems associated with excitatory and inhibitory networks: sites for competitive and noncompetitive antagonists of the N‐methyl d‐aspartic acid (NMDA) receptor complex, for [3H]muscimol on the ‐γ‐aminobutyric acid (GABA) receptor complex, and for [3H]batrachotoxinin A20‐a‐benzoate on the voltage‐dependent sodium channel. Mice were examined for neurochemical changes at 24 h after pretreatment with metaphit, when susceptibility to audiogenic seizures is greatest. Ex vivo receptor binding studies detected no changes; in vivo labeling of the phencyclidine site in the NMDA receptor complex was reduced by 20% in cortical and midbrain regions. A separate group of experiments was aimed at measuring brain levels of metaphit. One minute after retroorbital administration of [3H]metaphit at a dose sufficient to produce susceptibility to audiogenic seizures 24 h later, the brain level of [3H]metaphit (determined by high‐performance liquid chromatography, HPLC) was 49 pmol/mg tissue; at 1, 4, and 24 h, the level was 12, 6, and 1.4 pmol/mg tissue or μM if metaphit was evenly distributed throughout the brain. Although the observed metaphit concentrations during the first 4 h are high enough to acylate receptors, no firm evidence for acylation was found for most of the examined receptors. Finally, the time course of the brain level of metaphit showing a continuous decrease is entirely different from that of development of the seizure susceptibility, which peaks at 18–24 h.
Effect of Experimental Limbic Epilepsy on the Estrus Cycle and Reproductive Success in Rats
Authors: Mellanby Jane , Dwyer Jonathan , Hawkins Catherine A. , Hitchen Caroline
Published: October 2005

Summary: Epilepsy was induced in female rats by the injection of tetanus toxin (5 mouse LD50) unilaterally into the ventral hippocampus under anesthesia. During the 2–4 weeks that the rats exhibited intermittent spontaneous convulsions, daily vaginal smear tests showed that their estrous cycle was interrupted. In control rats such interruption only occurred for just a few days after the operation. Investigation of mating behavior, on the first night of proestrus, which occurred after 7 weeks from the operation, showed that there were fewer mounts, intromissions or ejaculations from the males, which were caged with previously epileptic animals. These females produced slighly smaller litters than their controls and there was a marked failure of their young to thrive in comparison with those of the control females. This failure appeared to be related to relatively high “stress” levels in the general laboratory environment. The impairment of reproductive success only lasted about 3 months after the original induction of epilepsy since subsequent litters to the same animals thrived normally.
Comparison of 5α‐Pregnan‐3α‐ol‐20‐one and Phenobarbital on Cortical Synaptic Activation and Inhibition Studied In Vitro
Authors: Taubøll Erik , Gjerstad Leif
Published: October 2005

Summary: The effects of 5Ø‐pregnan‐3Ø‐ol‐20‐one (3Ø‐OH‐DHP) and phenobarbital (PB) on synaptic excitation and inhibition in rat hippocampal slices in vitro were compared. Stimulations were made orthodromically and antidromically while we recorded extracellularly from the dendritic and the somatic layer of the CA1 region. Perfusion with 5 μg/ml of 3Ø‐OH‐DHP for 30 min significantly increased the recurrent inhibition evoked by antidromic stimulation. The effect was most pronounced at short interstimulus intervals. The duration of the recurrent inhibition also was prolonged. There was no effect on the conditioned population spike after orthodromic paired‐pulse stimulation. Furthermore, no effect was observed on the amplitude of the orthodromic fiber volley, the rate of increase in the field excitatory postsynaptic potential (EPSP) and the latency and amplitude of the CA1 population spike. Qualitative and quantitative similar findings were observed during perfusion with PB 0.1 mg/ml, (i.e., a concentration 20 times higher than that of 3Ø‐OH‐DHP). Higher concentrations of PB also affected synaptic excitation. The findings suggest a similar effect of 3Ø‐OH‐DHP and PB on recurrent GABA‐ergic inhibition; however, 3Ø‐OH‐DHP appears to be much more potent.
Correlation of Unit Recordings with Regional Cell Counts in Epileptogenic Human Temporal Lobe
Authors: Frysinger R. C. , Lévesque M. F.
Published: October 2005

Summary: The previously reported diminished incidence of neuronal activity recorded from areas ipsilateral to a seizure focus may result from either cell loss or pathophysiologic changes in hippocampus and related structures. We examined records of single‐cell discharge from 471 electrode bundles in 62 patients who later had cell counts taken from samples of resected tissue. Analysis of variance showed that amygdala and parahippocampal gyrus had more activity than hippocampus and the subicular complex and that the resected side had less activity overall. Only the posterior subicular complex showed more high‐amplitude (>50 μV) activity on the epileptogenic side; all other areas showed more activity contralaterally. Activity between 25 and 50 μV did not differ across sides or structures. Percentage of maximal cell count was correlated with the number of electrodes with high‐amplitude activity only in the subicular complex. Low‐amplitude activity in nonresected hippocampus, however, was strongly negatively correlated with cell counts on the resected side, perhaps owing to compensatory mechanisms. Cell counts in hippocampus correlated negatively with high‐amplitude unit activity in resected amygdala, suggesting reciprocity between these areas. These results suggest that the amount of cell activity recorded from mesiotemporal structures involves bilateral factors more complex than simple cell loss.
Surgical Treatment of Children with Medically Intractable Frontal or Temporal Lobe Epilepsy: Results and Highlights of 40 Years' Experience
Authors: Fish David R. , Smith Shelagh J. , Quesney Luis F. , Andermann Frederick , Rasmussen Theodore
Published: October 2005

Summary: Etiologic, pathologic, and clinical features of possible prognostic significance were studied in 118 children who underwent frontal or temporal lobe epilepsy surgery at the Montreal Neurological Institute (MNI) between 1940 and 1980 (excluding tumor cases). Mean age of seizure onset was 5.1 years (range 0–12 years), mean age at operation was 11.7 years (range 0.6–15 years), and median duration of follow‐up was 15 years (range 2–31 years). Thirteen of 45 frontal surgery patients and 43 of 73 temporal surgery patients had an excellent outcome. In the frontal surgery group, this was restricted almost entirely to patients with an established etiology, particularly if this included a circumscribed resectable structural abnormality. In the temporal surgery group, a history of early, prolonged febrile seizures was usually associated with good outcome, unless there was additional evidence of extratemporal epilepsy. In the entire series, the presence of a nonresectable structural lesion or secondarily generalized seizures was associated with a poor outcome.
Psychosocial Consequences of Postoperative Seizure Relief
Authors: Seidman‐Ripley Judith G. , Bound Verna K. , Andermann Frederick , Olivier André , Gloor Pierre , Feindel William H.
Published: October 2005

Summary: To address the question of whether complete seizure relief has a positive effect on psychosocial functioning in patients with temporal lobe epilepsy, a follow‐up study was conducted at the Montreal Neurological Institute. The approach was one of “before‐after” study, with focus on the successfully operated patients, those in whom complete seizure relief was obtained. The Washington Psychosocial Seizure Inventory, specifically developed and validated for use with epilepsy patients, was used for psychosocial assessments. Of 30 surgically treated patients screened for the study, 15 gained complete relief from seizures. At 1‐year postoperative followup, they showed reductions in their problem scores on all but one of eight psychosocial scales; the average reduction ranged from 24% in Vocational Adjustment to 60% in Adjustment to Seizures. In the areas of Emotional Adjustment and Interpersonal Adjustment reductions were 37 and 48%, respectively. Among the component items, improvement was greatest in ability to concentrate and make decisions, confidence in interpersonal skills, ability to express personal opinions, and perception by others. No appreciable changes occurred in the 15 patients who did not gain complete relief of seizures; indeed, on six of the eight scales they showed a modest increase in their problem scores. This study provides evidence that complete relief from seizures leads to appreciable improvements in psychosocial well‐being, manifest as early as 1‐year postoperatively, in young adult patients.
Cerebrospinal Fluid Levels of Neuropeptides, Cortisol, and Amino Acids in Patients with Epilepsy
Authors: Devinsky Orrin , Emoto Sherrie , Nadi N. Suzan , Theodore William H.
Published: October 2005

Summary: We measured lumbar cerebrospinal fluid (CSF) levels of somatostatin, cholecystokinin, neurotensin, atrial natriuretic factor, vasoactive inhibitory peptide, neuropeptide Y, adrenocorticotrophic hormone, corticotropin releasing hormone, β‐endorphin, metenkephalin, cortisol, alanine, glycine, aspartate, glutamate, taurine, and γ‐aminobutyric acid in 25 inpatients with epilepsy at known interictal and postictal times and in 11 neurologically normal volunteers. There were no significant differences between interictal or postictal complex partial seizures (CPS), postictal generalized tonic‐clonic seizures (GTC), and control CSF neuropeptide, cortisol, and amino acid (AA) levels. However, there were nonsignificant trends for CSF levels of several neuropeptides to be increased after CPS and GTC as compared with interictal baseline levels. There were significant correlations between levels of certain CSF neuropeptides or (AAs) and serum antiepileptic drug (AED) levels. Several correlations were noted between CSF levels of AAs, including a correlation between the excitatory neurotransmitters aspartate and glutamate identified only after CPS.
Midline Spikes: Is It Another Benign EEG Pattern of Childhood?
Authors: Bagdorf Robert , Lee Soo Ik
Published: October 2005

Summary: Clinical and electrographic features were retrospectively studied in 57 patients with midline (Fz, Cz, Pz) spikes as the only epileptiform activity in their EEG to determine possible predictors of outcome. Our study confirmed previous reports of early age of onset, activation by sleep, and Cz as the most frequent spike location. In contrast to previous studies with smaller numbers of patients, midline spikes were more common in males and most often associated with partial complex seizures and were not activated by sleep at an older age. Of the 29 patients who were followed for 6 months to 9 years, only 15 (52%) achieved good seizure control. Although a tendency toward a poor outcome was noted with several independent variables (positive family history of epilepsy, later age of seizure onset, abnormal EEG background activities, abnormal neuroimaging, abnormal neurologic examination), none was of statistical significance. This study suggests that epilepsy with midline spikes is not necessarily benign and that future studies with larger patient groups may be necessary to identify factors that influence prognosis.
Reassessment of the Clinical Significance of Periodic Lateralized Epileptiform Discharges in Pediatric Patients
Authors: Raroque Henry G. , Wagner William , Gonzales Peter C. W. , Leroy Robert F. , Karnaze Dean , Riela Anthony R. , Roach E. S.
Published: October 2005

Summary: A review of clinical data from 18 pediatric patients with periodic lateralized epileptiform discharges and bilateral independent periodic lateralized epileptiform discharges (PLEDs and BIPLEDs) showed 2 with chronic neurologic illness, 6 with a history of prior seizures, 14 with depressed sensorium at the time of EEG, 5 deaths, and 8 of 13 survivors with neurologic deficits. These findings are similar to the combined data from reports involving adult patients only. Separating pediatric patients with PLEDs from those with BIPLEDs shows some influence from patients with BIPLEDs. Overall, our data do not suggest significant clinical differences for PLEDs between children and adults.
Defining the Role of Structural Lesions and Metabolic Abnormalities in Periodic Lateralized Epileptiform Discharges
Authors: Raroque Henry G. , Gonzales Peter C. W. , Jhaveri Harish S. , Leroy Robert F. , Allen Elizabeth C.
Published: October 2005

Summary: We reviewed the EEG, clinical manifestations, computed tomography (CT) and magnetic resonance imaging (MRI) scans of 39 patients with periodic lateralized epileptiform discharges (PLEDs) or bilateral periodic lateralized epileptiform discharges (BIPLEDs) to determine the role of structural lesions (SL) and metabolic abnormalities (MA) in their pathogenesis. Thirty‐eight patients had CT and 7 had MRI scans. Thirty‐eight had lesions on CT or MRI. All those with PLEDs consistently had lesions on the side of the discharges, and 5 of 6 with BIPLEDs had lesions on both hemispheres. A subgroup of 23 patients with metabolic determination within 24 h of EEG all showed mild to moderate MA. They all also had SL. These findings support a primary role for SL but cannot exclude an additional role for MA.
Ictal and Interictal Electrographic Seizure Durations in Preterm and Term Neonates
Authors: Scher Mark S. , Hamid Marisha Y. , Steppe Doris A. , Beggarly Marquita E. , Painter Michael J.
Published: October 2005

Summary: The effect of gestational age on neonatal ictal and interictal durations has not been investigated. Sixty‐eight neonates with 644 electrographic seizures were identified retrospectively. Thirty‐five full‐term (FT) neonates were compared with 33 preterm (PT) neonates. Eighteen older preterm infants (OPT) [>31 weeks estimated gestational age (EGA)] were also compared with 15 young preterm infants (YPT) of ≤31 weeks EGA. Ictal/ interictal durations were calculated for the total cohort with and without status epilepticus (SE). Statistical analyses were two‐tailed t tests, chi‐square calculations, and one‐way analysis of variance (ANOVA) with Duncan's multiple‐range test. Eleven of 35 (33%) FT had SE as compared with 3 of 33 (9%) PT (chi‐square = 7.8, p < 0.05). The mean ictal duration was 14.2 min for FT infants as compared with 3.1 min for PT infants (p < 0.01); only borderline differences were noted after those with SE were excluded. Interictal durations were longer for OPT than YPT (p < 0.05). By ANOVA and Duncan's multiple‐range tests, group differences included longer mean ictal durations for FT infants as compared with OPT infants (p = 0.06, ANOVA; p < 0.05, Duncan's), and longer mean interictal durations for FT infants versus OPT and OPT versus YPT (p = 0.02, ANOVA; p < 0.05, Duncan's). More developed neuronal networks result in longer ictal durations in FT than in PT neonates, including FT infants with SE. Inhibitory networks responsible for longer interictal periods are more dominant in OPT infants than in YPT infants, reflecting maturational changes that suppress seizure activity during the latter part of the third trimester before the infant reaches an FT corrected age.
Unusual Form of Seizures Induced by Eye Closure
Authors: Barclay C. L. , Murphy W. F. , Lee M. A. , Darwish H. Z.
Published: October 2005

Summary: Seizures induced by eye closure are a rare but well‐recognized form of reflex epilepsy. Two types have been reported: those induced by movement of the eyelids and those caused by lack of visual input. The EEG pattern is typically that of spike and wave discharges, either isolated to the occipital regions or greatest there. We report the case of a 19‐year‐old woman with a previously undescribed form of seizures induced by eye closure in whom both the physical act of eye closure and total lack of visual input were required for induction of a seizure. Both the EEG pattern of paroxysmal high‐amplitude generalized beta activity and poor response to medication were different from what has been previously noted in patients with seizures induced by eye closure. We believe that a third form of seizures induced by eye closure exists and that its prognosis may be significantly worse than that of previously reported forms.
Stiripentol in Atypical Absence Seizures in Children: An Open Trial
Authors: Farwell Jacqueline R. , Anderson Gail D. , Kerr Bradley M. , Tor Jacques A. , Levy René H.
Published: October 2005

Summary: Stiripentol (STP) was added to the antiepileptic drug (AED) regimen of 10 patients with uncontrolled atypical absence seizures (more than one seizure a day). Seven boys and three girls aged 6–16 years participated in the study. Concomitant AEDs included various combinations of phenobarbital (PB), phenytoin (PHT), carbamazepine (CBZ), and valproate (VPA). Parents counted daily seizures over a 4‐week baseline period before institution of STP, and in a 20‐week period during STP therapy. To compensate for drug interactions, doses of other AEDs were adjusted during STP administration to keep serum levels close to levels of the baseline period. Maintenance doses of STP were 1,000–3,000 mg/day, giving serum levels of 4–22 μg/mL. All patients experienced a decrease in atypical absence seizures. Average decrease was 70% (range 5–95%). Side effects experienced by some patients were dose related and included anorexia, nausea, vomiting, and lethargy. In only 1 patient did an adverse effect (vomiting) require discontinuation of STP. We conclude that STP shows promise in treatment of atypical absence seizures in children, and further trials are warranted.
Outcomes of Add‐on Treatment with Lamotrigine in Partial Epilepsy
Authors: Smith D. , Baker G. , Davies G. , Dewey M. , Chadwick D. W.
Published: October 2005

Summary: The need for new antiepileptic drugs (AEDs) and more sensitive methods of assessing their efficacy is well recognized. This study was designed to evaluate the efficacy and safety of lamotrigine (LTG), a potential new AED and to develop and test new outcome measures. A health‐related quality of life (HRQL) model was developed which contains previously validated measures of anxiety, depression, happiness, overall mood, self‐esteem, and mastery and a specifically designed seizure severity scale with patient‐ and caregiver‐based components. This HRQL model was used in a randomized, placebo‐controlled, double‐blind, cross‐over study of LTG in 81 patients with refractory partial seizures. Seizure frequency was the primary measure and seizure severity and the HRQL were secondary measures of efficacy. The reduction in seizure frequency with LTG, relative to placebo, was 29.7% [95% confidence interval (CI) 17.8%, 39.9%] for total seizure count, 33.4% (95% CI 14.8%, 47.9%) for complex partial seizures (CPS) and 20.3% (95% CI 0.3%, 36.2%) for secondarily generalized tonic‐clonic seizures (GTCS). However, although 41 patients elected to continue with LTG, only 11 experienced at least 50% reduction in total seizures, indicating that other factors influenced their decision. The score with LTG, relative to placebo, was significantly lower for the ictal (p = 0.017) and caregivers (p = 0.035) subscales of the seizure severity scale and significantly higher for happiness (p = 0.003) and mastery (p = 0.003). Simple correlation and multiple‐regression analyses indicate that the effects on seizure frequency, seizure severity, and psychological variables appear to be independent of each other. This study indicates that LTG is effective in reducing seizure frequency and has additional favorable effects on seizure severity, mood, and perceived internal control. Some of the scales used indicate the potential of secondary measures of efficacy to enhance the sensitivity of trials of new AEDs.
Antiepileptic Drugs and Peripheral Nerve Function: A Multicenter Screening Investigation of 141 Patients with Chronic Treatment
Authors: Bono Adele , Beghi Ettore , Bogliun Graziella , Cavaletti Guido , Curto Natale , Marzorati Laura , Frattola Lodovico ,   The Collaborative Group for the Study of Epilepsy
Published: October 2005

Summary: One hundred forty‐one adult patients treated for no less than 6 months with standard daily doses of the commonest antiepileptic drugs (AEDs) were recruited in five Italian centers and submitted to intensive clinical and electrophysiologic investigation to assess the effects of AEDs on peripheral nerves. Eighty percent of the patients were receiving monotherapy. Carbamazepine (CBZ) was the most common AED (51 cases), followed by phenytoin (PHT) (46), phenobarbital (PB) (42), and valproate (VPA) (25). Fifty‐three percent of the patients had one or more symptoms of polyneuropathy (paresthesias being the most common complaint). The neurologic examination was abnormal in 32%. Electrophysiologic findings in two or more separate nerves were abnormal in 77 patients (54.6%); of these, 27 (19.1%) had abnormal neurologic findings and 21 (14.9%) also had symptoms of polyneuropathy. Sensory functions were most frequently impaired. Sural nerve biopsy was performed in 4 patients receiving monotherapy with CBZ, PHT, PB, and VPA. Except in patients receiving VPA (in whom no morphologic abnormalities were detected), mild predominantly axonal damage with secondary myelin changes was noted. A correlation was noted between polyneuropathy, age of the patient and, to a lesser extent, receipt of two or more AEDs.
Valproate (VPA) Metabolites in Various Clinical Conditions of Probable VPA‐Associated Hepatotoxicity
Authors: Siemes Hartmut , Nau H. , Schultze K. , Wittfoht W. , Drews E. , Penzien J. , Seidel U.
Published: October 2005

Summary: Of a cohort of 470 epileptic patients in whom valproate (VPA) serum metabolites had been measured, 170 subjects without symptoms or signs of hepatic side effects were chosen as a reference group to establish the usual metabolic pattern. A wide interindividual variation of VPA metabolite concentrations was noted. Infants receiving VPA monotherapy and comedication with other antiepileptic drugs (AEDs) showed lower concentrations of the potential hepatotoxin 4‐ene‐VPA than did older children. In 11 patients with early symptoms and signs of possible fatal VPA‐associated hepatotoxicity, the following spectrum of benign clinical conditions was observed: unusually severe side effect during initiation of VPA therapy (1 patient), high VPA dosage (2 patients), reversible impairment of coagulation with bleeding manifestations in association with a slight increase in transaminase levels (1 child), and reversible liver dysfunction associated with febrile illness (7 patients). Reversible or irreversible fulminant liver failure had occurred in 5 children. Three of the 4 children with a fatal outcome had massive lactic acidosis. In all patients with probable VPA‐associated hepatotoxicity, some aspects of VPA metabolism differed distinctly from that of the reference group, but the interindividual profile of metabolites varied considerably, even in the subgroup of 4 children who died. Impairment of VPA β‐oxidation and increase of metabolites of alternative metabolic pathways (ω‐ and ω1‐hydroxylation, dehydrogenation reactions) were the most frequent findings. Increased values of 2‐n‐propyl‐4‐pentenoic acid metabolite of VPA (4‐ene‐VPA), could be detected only in 1 of the 5 patients with fulminant liver failure and in one other child with a slight hepatic dysfunction, indicating that this VPA metabolite is not the decisive hepatotoxin or indicator of hepatotoxicity. Because we cannot distinguish between benign and life‐threatening hepatic adverse reactions on the basis of VPA metabolites, all identified changes are considered secondary to an as‐yet‐unknown primary metabolic event. The most toxic compound could be VPA itself, which may unmask an inborn or an acquired metabolic defect in the processing of fatty acids.
Serum Amino Acids, Liver Status, and Antiepileptic Drug Therapy in Epilepsy
Authors: Rao Marie Luise , Stefan Hermann , Scheid Christof , Kuttler Anja D. S. , Froscher Walter
Published: October 2005

Summary: Serum amino acid (AA) profiles are altered in epilepsy. It is not clear whether this is due to the disease process itself or to other variables such as seizure type, seizure frequency, duration of illness, medication, or altered liver function. We investigated serum AA profiles and liver enzymes in 73 epileptic patients and 90 healthy subjects and evaluated the data by analysis of variance to discriminate between age, sex, seizure type, duration of illness, seizure frequency, antiepileptic drug (AED) and increased serum liver enzyme levels, and their putative interaction with the serum A A profile. There was no correlation between the changes in the AA profile and age, duration of illness, seizure frequency, and seizure type. Seventy‐two percent of the AED‐treated patients and 33% of the unmedicated patients showed an increase in one or several serum liver enzymes [alanine aminotransferase (ALT), aspartate aminotransferase (AST), and/or γ‐glutamyl transferase (γ‐GT)]; particularly γg‐GT. We observed a significant increase in serum concentrations of glutamine and glycine and decreased levels of taurine, threonine, serine, valine, methionine, isoleucine, leucine, phenylalanine, histidine, tryptophan, and arginine in AED‐treated patients but not in unmedicated patients. These results show that the changes in the serum AA profiles of epileptic patients treated with AEDs occur in patients with alteration of serum liver enzymes; whether this implies a causal relation is still uncertain.
Neuroprotective Effect of Felbamate After Kainic Acid‐Induced Status Epilepticus
Authors: Chronopoulos Antonia , Stafstrom Carl , Thurber Sam , Hyde Pamela , Mikati Mohamad , Holmes Gregory L.
Published: October 2005

Summary: Felbamate (FBM), a newly developed antiepileptic drug (AED), was previously shown to offer some neuroprotective effects against hypoxic injury in both in vivo and in vitro studies. We administered FBM (100 or 300 mg/kg) to 30‐day‐old rats 1 h after they received a convulsant dosage of kainic acid (KA). Animals were then tested at age 80 days in the water maze, open field, and handling tests. Seizure latency was then tested by flurothyl inhalation. Animals that received 300 mg/kg FBM performed better in all three tests and had longer latencies to flurothyl‐induced seizures than did animals that received vehicle. This study suggests that FBM may have some neuroprotective effects after KA‐induced status epilepticus (SE).