bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcome After Diagnosis of Psychogenic Nonepileptic Seizures
Authors: Walczak Thaddeus S. , Papacostas Savvas , Williams Daniel T. , Scheuer Mark L. , Lebowitz Nina , Notarfrancesco Adrianna
Published: August 2005

Summary: Information regarding outcome in patients with psychogenic nonepileptic seizures (PNES) is limited. We attempted to contact 72 consecutive patients with PNES confirmed by video‐EEG monitoring: 51 of 72 (71%) were reached a mean of 15 months (range 12–27 months) after diagnosis and agreed to answer a structured telephone questionnaire. The questionnaire assessed the number of PNES in the last 6 months, antiepileptic drug (AED) use, occupational status, global self‐rating, and extent of psychotherapeutic treatments. PNES had ceased in 18 of 51 (35%), decreased >80% in 21 of 51 (41%), and decreased <80% in 12 of 51 (24%). Thirtythree of 51 (65%) were not taking AEDs. Occupational stotus improved in 20% and did not change in 75%. Overall, 29 of 51 (57%) rated themselves markedly improved and 15 of 51 (29%) rated themselves unchanged or worse. Persisting PNES were associated with longer duration of PNES before diagnosis (p < 0.02) and presence of additional psychiatric disease (p < 0.01). Persisting PNES were not associated with gender, presence of epileptic seizures, or extent of psychotherapeutic treatments after diagnosis. Placebo saline infusion had been administered in some patients to help precipitate PNES. This did not affect the number of psychotherapy visits or outcome. We conclude that PNES cease or significantly decrease in most patients, but occupational status does not improve as often. Earlier diagnosis may improve outcome.
Is Interictal Temporal Hypometabolism Related to Mesial Temporal Sclerosis? A Positron Emission Tomography/Magnetic Resonance Imaging Confrontation
Authors: Semah F. , Baulac M. , Hasboun D. , Frouin V. , Mangin J.‐F. , Papageorgiou S. , Leroy‐Willig A. , Philippon J. , Laplane D. , Samson Y.
Published: August 2005

Summary: The mechanism of interictal glucose hypometabolism remains unclear, but this abnormality occurs more frequently in temporal lobe epilepsy (TLE) than in other types of partial epilepsy. Therefore temporal hypometabolism has been suggested to reflect mesial temporal sclerosis (MTS). To investigate this, we selected 22 patients with refractory partial epilepsy of mesial temporal lobe origin (MTLE) who had hippocampal atrophy based on magnetic resonance imaging (MRI) volumetric analysis. We then analyzed the metabolic correlates of unilateral hippocampal atrophy. Thirteen temporal regions of interest (ROI) were defined on MRI scans for each individual and then applied to high‐resolution FDG‐positron emission tomography (PET) images obtained parallel to the long axis of the hippocampus. The most hypometabolic regions were the temporal pole and the hippocampal region. When we analyzed ensembles of temporal regions grouped into related networks, the temporolimbic network, which included the hippocampal region and the temporal pole, was abnormal in 95% of the patients at a 3‐SD threshold. PET hypometabolism was highly correlated with the degree of hippocampal atrophy in this network, but not in other parts of the temporal lobe, which were less frequently hypometabolic. These data indicate that hypometabolism is a consequence of MTS in the temporolimbic region but not necessarily in the other parts of the temporal lobe. Our results also suggest that the combination of PET and MRI may facilitate the noninvasive diagnosis of MTLE.
Role of Associated Cortical Lesions in Motor Partial Seizures and Lenticulostriate Infarcts
Authors: Giroud Maurice , Dumas Raymond
Published: August 2005

Summary: In a population‐based study, we evaluated seizures occurring in the first 15 days after strokes among 1,640 consecutive patients who had ischemic (814 infarcts with atheroma and 126 with cardiogenic embolism, 273 lacunar infarcts, 259 transient ischemic attacks) or hemorrhagic stroke (129 supratentorial hematomas and 24 subarachnoïd hemorrhage) on computed tomography (CT) scan. Ninety patients had an epileptic seizure in the first 15 days after stroke onset. Thirteen of the 90 had a lenticulostriate infarct, diagnosed on CT scan, without an apparent ipsilateral cortical ischemic lesion. No lenticulostriate hematoma was observed with seizures. To determine the possible existence of an ipsilateral cortical lesion, magnetic resonance imaging (MRI) with gadolinium perfusion, and HMPAO single photon emission CT (SPECT)were performed in the 13 patients with seizures. MRI showed an associated ipsilateral posterofrontal or anterotemporal cortical ischemic lesion in 11 cases, and SPECT showed decreased blood flow in the ipsilateral frontal area in all cases (superficial sylvian territory). Overall, 56 patients had a lenticulostriate infarct and clinical, CT, and MRI data from the 13 with seizures was compared with those of the 43 without seizures. Two criteria differentiated the two groups: the size of the lenticulostriate infarct was larger (8.3 vs. 3.9cm3) and ipsilateral cortical ischemic lesions were more frequent in the group with seizures (84 vs. 9%).
NBQX Blocks Acute and Late Epileptogenic Effects of Perinatal Hypoxia
Authors: Jensen F. E. , Blume H. , Alvarado S. , Firkusny I. , Geary C.
Published: August 2005

Summary: Clinically, and in experimental models, perinatal hypoxic encephalopathy is commonly associated with seizures. We previously described a rat model in which hypoxia induces seizures and permanently increases in seizure susceptibility in immature rats [postnatal day (P) 10–121 but not in older rats. In the present study, we compared the effect of pretreatment with the excitatory amino acid antagonists MK‐801 and NBQX versus lorazepam in our rat model of perinatal hypoxia. Animals exposed to hypoxia at P10 without treatment have frequent seizures during hypoxia and subsequently exhibit increased seizure susceptibility to flurothyl. Treatment with 6‐nitro‐7‐sulfamoylbenzo(f)quinoxaline‐2,3‐dione(NBQX 20 mglkg) effectively suppressed hypoxia‐induced seizures in immature rats and also protected against permanent changes in flurothyl threshold in adult‐hood, whereas treatment with MK‐801 (1 mg/kg) or lorazepam (LZP 1 mg/kg) did not prevent these hypoxia‐related epileptogenic effects. These results suggest that activation of a‐amino‐3‐hydroxy‐5‐methyl‐4‐isoxazol propionic acid (AMPA) receptors may partly mediate the age‐dependent epileptogenic effect of hypoxia in the perinatal period
Action of GP 47779, the Active Metabolite of Oxcarbazepine, on the Corticostriatal System. II. Modulation of High‐Voltage‐Activated Calcium Currents
Authors: Stefani Alessandro , Pisani Antonio , De Murtas Marco , Mercuri Nicola B. , Marciani Maria Grazia , Calabresi Paolo
Published: August 2005

Summary: GP 47779, the active metabolite of oxcarbazepine (OCBZ) inhibits glutamatergic excitatory postsynaptic potentials (EPSPs) in rat striatum (described in the accompanying article). This effect was presumed to involve the modulation of the calcium (Ca2+) signals at either pre‐ or postsynaptic level. Therefore, we directly tested whether GP 47779 could modulate Ca2+ conductances in cortical as well as in striatal neurons. GP 47779 produced a reversible dose‐dependent decrease in high‐voltage‐activated (HVA) Ca2+ currents evoked by membrane depolarization in isolated cortical pyramidal cells. GP 47779‐mediated reduction in HVA Ca2+ currents, if occurring also at corticostriatal axon terminals, might explain the reduction of glutamate release in the striatum. An inhibitory action of GP 47779 on HVA Ca2+ currents was also observed in isolated striatal neurons. The effect on HVA Ca2+ currents in cortical and striatal neurons persisted in the presence of nifedipine, suggesting that dihydropyridine‐sensitive channels were not involved in the GP 47779‐mediated responses. We propose that the modulation of HVA Ca2+ channels by this carbamazepine (CBZ) analogue may account for its inhibitory action on transmitter release.
Relationship of Age at Onset, Chronologic Age, and Adequacy of Preoperative Performance to Verbal Memory Change After Anterior Temporal Lobectomy
Authors: Hermann Bruce P. , Seidenberg Michael , Haltiner Allan , Wyler Allen R.
Published: August 2005

Summary We examined the relationship of age of onset of epilepsy, chronological age at time of operation, and adequacy of preoperative memory performance to pre‐ to postoperative verbal memory decline. Patients who underwent left (n = 50) or right (n = 51) anterior temporal lobectomy (ATL) were administered tests of verbal episodic (list learning, paragraph recall) and semantic memory (visual naming, vocabulary), both preoperatively and 6 months postoperatively. As a group, left ATL patients showed the classic selective decrease on measures of episodic but not semantic memory. However, examination of episodic memory outcome showed considerable individual variability. Stepwise regression analyses indicated that both later age at onset and older chronologic age were significant and selective predictors of episodic memory decrease for left ATL patients. Adequacy of preoperative memory performance was a nonspecific predictor, associated with decrease in postoperative memory performance for both left and right ATL patients and for multiple types of memory indices. The clinical and theoretical implications are discussed.
ACTH Does Not Control Neonatal Seizures Induced by Administration of Exogenous Corticotropin‐Releasing Hormone
Authors: Baram Tallie Z. , Schultz Linda
Published: August 2005

Summary ACTH has been used extensively for treatment of massive infantile spasms (MIS) and other intractable seizures. The mechanisms by which ACTH exerts anticonvulsant effects are unknown. ACTH is a neuropeptide with both endocrine and neuromodulatory properties; its efficacy against MIS could derive from intrinsic anticonvulsant properties or from hormonal effects, either directly or through glucocorticoids. We tested ACTH activity against exogenous corticotropin‐releasing hormone (CRH)‐induced seizures in the infant rat model. CRH was administered into the cerebral ventricles of 85 infant rats aged 5–13 days. ACTH was used either 20–60 min before CRH administration or “chronically” (pretreatment with four doses of ACTH every 6 h, before CRH administration). In a separate group of rat pups, we measured plasma corticosterone to ascertain ACTH availability. Administration of CRH, an age‐specific endogenous convulsant, resulted in a prolonged series of seizures after 2‐ to 55‐min latency. There was no difference in latency between controls (9.5 ± 1.2 min) and ACTH‐treated rats (12.4 ± 2.8 min for combined acute and chronic groups). CRH‐induced seizure duration (88.2 ± 9 vs. 74.7 ± 9.4 min) and severity of seizures was also unchanged by ACTH treatment. ACTH reached the circulation and caused significant increase in plasma glucocorticoids. ACTH does not block the convulsant action of exogenous CRH in infant rats. An alternative mechanism for the anticonvulsant effect of ACTH may be suppression of synthesis and secretion of an endogenous convulsant, i.e., CRH.
Histamine in Cerebrospinal Fluid of Children with Febrile Convulsions
Authors: Kiviranta Tuula , Tuomisto Leena , Airaksinen Eila M.
Published: August 2005

Summary: Febrile convulsions (FC) are frequent acute neurologic disturbances of childhood. The cellular and neurochemical mechanisms causing FC are unclear. Among other mechanisms, the CNS histamine (HA) has been suggested to participate in seizure control and thermoregulation. We evaluated the possible role of HA in regulation of FC by measuring HA and tele‐methylhis‐ tamine (t–MH) concentrations in the cerebrospinal fluid (CSF) of children with FC. The study group consisted of 35 children treated for acute FC in the hospital. The control groups consisted of (a) feverish children without seizures (n=23), (b) convulsive children without fever (n=7), and (c) children with neither fever nor convulsions (n=21). HA was assayed by high‐performance liquid chromatography (HPLC) with fluorescence detection, and t‐MH was measured by gas chromatography‐mass spectrometry. CSF HA concentration in the group of febrile Convulsions occur rather frequently in connection with febrile children without seizures was significantly higher (0.69 ± 0.16 pmol/ml, mean k SE) than in children with FC (0.36 ± 0.07 pmol/ml, p <0.05, analysis of variance, ANOVA). HA concentration was 0.37 ± 0.18 pmoVml in the group of nonfebrile convulsive children and 0.36 k 0.08 pmol/ml in the nonfebrile nonconvulsive group. No statistical differences in t–MH were detected between groups. The increased susceptibility to seizures during fever may be connected to the lack of increase in CSF HA in the FC group. The data support the hypothesis that the central histaminergic neuron system may be involved in inhibition of seizures associated with febrile illnesses in childhood.
Opercular Myoclonic‐Anarthric Status Epilepticus
Authors: Thomas Pierre , Borg Michel , Suisse Georges , Chatel Marcel
Published: August 2005

Summary: We report 3 cases of opercular myoclonic status epilepticus (OMASE), characterized by fluctuating cortical dysarthria without true aphasia associated with epileptic myoclonus involving bilaterally the glossopharyngeal musculature. In this syndrome, the inferior rolandic area of either one or the other hemisphere is involved by an epileptogenic lesion of various etiology. Ictally, clonic expression was consistent with epilepsia partialis continua (EPC) and bilaterally and symmetrically involved palatal muscles (cases 1–3), tongue (cases 2 and 3), lips and chin (case 3), and inferior jaw (case 1) due to In adulthood, rhythmical palatal movements of bilateral projections of the inferior corticonuclear pathways. Postictally, the main clinical sign was pseudobulbar palsy, consistent with Todd's palsy. In our cases, OMASE was either of vascular (cases 1 and 2) or tumoral origin (case 3). In adulthood, early recognition of OMASE, although nonspecific, may be important for early management of carotid occlusive disease because it usually indicates an acute opercular infarction.
Zonisamide: Electrophysiological and Metabolic Changes in Kainic Acid‐Induced Limbic Seizures in Rats
Authors: Takano Katsunobu , Tanaka Tatsuya , Fujita Tsutomu , Nakai Hirofumi , Yonemasu Yukichi
Published: August 2005

Summary: We studied the pharmacological mechanism of zonisamide (ZNS) using an electrophysiological and autoradiographical method in a limbic seizure model in rats. Limbic seizure status epilepticus was induced by a unilateral microinjection of kainic acid (KA) into the amygdala. Initially, observed seizures were limited to the side of the injected amygdala and then propagated to bilateral sensorimotor cortex. Eighty minutes after injection, secondarily generalized seizure status epilepticus was induced, with each seizure lasting ∼30 s and recurring every 5 min. ZNS 100 mg/kg was administered intravenously (i.v.) during the generalized seizure. Forty minutes after ZNS administration, epileptic activity was observed only at the KA‐injected amygdalar site and spikes were not observed in the bilateral sensorimotor cortex. We studied local cerebral glucose utilization (LCGU) after ZNS or saline administration using an autoradiographical method in the same limbic seizure preparation. In the ZNS group, LCGU decreased in the ipsilateral sensorimotor cortex and hippocampus, whereas in the controls LCGU increased in these structures. On the other hand, ZNS did not suppress the epileptic activity of the primary focus and no decrease in LCGU was observed in the KA‐injected amygdala. ZNS inhibited seizure propagation from the epileptogenic focus but did not suppress the epileptic activity of the focus. Our results suggest that ZNS is effective for the treatment of secondarily generalized seizure.
Menstrual Disorders in Women with Epilepsy Receiving Carbamazepine
Authors: Isojärvi Jouko I. T. , Laatikainen Timo J. , Pakarinen Arto J. , Juntunen Kaisa T. S. , Myllylä Vilho V.
Published: August 2005

Summary: We measured concentrations of serum sex hormones and sex hormone binding globulin (SHBG) in relation to regularity of the menstrual cycles in 8 women before carbamazepine (CBZ) treatment was initiated and after 1 and 5 years of CBZ therapy. In addition, we evaluated menstrual cycle regularity and related endocrine changes in 56 women receiving CBZ treatment for >5 years. Serum SHBG levels increased, and serum concentrations of 17β‐estradiol (estradiol) and estradiol/SHBG ratio decreased during CBZ treatment. Two of the 8 patients (25%) in the prospective study group developed menstrual irregularities during the first 5 years of therapy. In the cross‐sectional study group of patients treated with CBZ for >5 years, the frequency of menstrual disturbances was also 25.0% (14 of 56 patients). Concentrations of serum sex hormones and SHBG were measured in 13 women with menstrual disorders and in 11 randomly selected women with regular cycles. In most cases, menstrual disorders were associated with increased serum SHBG and decreased serum estradiol levels and low estradiol/SHBG ratio. Long‐term CBZ treatment results in increased serum SHBG levels and decreased estradiol effect, which correlate with the frequency of menstrual disorders in CBZ‐treated women with epilepsy.
Serum Prolactin in Neonates with Seizures
Authors: Legido Agustin , Lago Paola , Chung Hee Jung , Sperling Michael , Clancy Robert R.
Published: August 2005

Summary: We studied serum prolactin (PRL) in 28 newborn infants with acute encephalopathy. Six patients had electrographically confirmed seizures. Twenty‐two patients comprised the nonictal group. In the seizure group, PRL was determined at the first onset of the seizure (baseline) and at 15 and 30 min postictal. In the nonseizure group, PRL was determined at the end of the EEG and 15 min later. EEGs were visually analyzed for the presence of seizures and background abnormality (normal or mildly, moderately, or markedly abnormal). Etiologic diagnoses included congenital heart disease (12), hypoxic‐ischemic encephalopathy (4), sepsis (4), respiratory distress syndrome (5) meconium aspiration (1), and metabolic disease (2). Serum PRL was significantly higher (p < 0.05) at baseline and 15 min postictally in the patients with seizures than in the nonictal group. However, PRL levels 15 and 30 min postictally were not statistically different from baseline values. Baseline PRL correlated significantly (p < 0.001) with EEG background abnormality in both groups; therefore, patients with the most abnormal EEG backgrounds had higher levels of PRL than those with a relatively normal EEG background. We conclude that newborns with EEG‐confirmed seizures, particularly if seizures are not associated with clinical signs, have high baseline serum PRL levels that do not increase significantly in the immediate postictal period. Serum PRL levels correlate with the severity of the brain insult as evaluated by EEG background. Further studies are needed to enhance our understanding of the dynamics of PRL secretion in newborns with seizures and acute encephalopathy.
Hematoma‐Related Seizures Detected During Subdural Electrode Monitoring
Authors: Malow Beth A. , Sato Susumu , Kufta Conrad V. , Blaxton Teresa A. , Figlozzi Christina M. , Theodore William H.
Published: August 2005

Summary: A 28‐year‐old woman with epilepsy developed the new onset of paroxysmal tongue tingling during subdural electrode monitoring. Her symptoms coincided with electrographic seizure activity arising from an area of the perisylvian region that had not previously been involved in her habitual seizures. At electrode removal, a focal 2x2 cm hematoma was detected and evacuated from beneath these electrode contacts. Unexpected episodic events may represent nonhabitual seizure activity related to the surgical procedure.
Complex Partial Seizures of Temporal Lobe Origin in Children of Different Age Groups
Authors: Brockhaus Anke , Elger Christian E.
Published: August 2005

Summary: The semiology of complex partial seizures(CPS) of temporal lobe origin in adults is well known and is important in establishing seizure localization in patients considered for epilepsy surgery. In contrast, the behavioral features of temporal lobe seizures (TLS) in children described in the literature have not been consistent. In the present study, we investigated children with TLS to compare their attacks to TLS occurring in adults. The study was based on video recordings of 29 children with TLS aged 18 months to 16 years. Children were included, if they became seizure‐free after temporal lobectomy (except 4 children with a marked reduction in seizure frequency and 1 with isolated auras), and if clear unitemporal seizure onset in ictal EEG‐recordings, unilateral radiological lesions, and corresponding histopathological findings were detected. Children aged >6 years had TLS with features similar to those of adults. In younger children, typical semiology included symmetric motor phenomena of the limbs, postures similar to frontal lobe seizures in adults, and head nodding as in infantile spasms. We concluded that the clinical features of TLS in younger children can be misleading and should therefore be considered with caution in selecting patients for surgical procedures on the temporal lobe.
Northern Epilepsy Syndrome: Clinical Course and the Effect of Medication on Seizures
Authors: Hirvasniemi Aune , Herrala Pirjo , Leisti Jaakko
Published: August 2005

Summary: We describe the clinical course and treatment of 19 patients with the Northern epilepsy syndrome, an autosomal recessively inherited epilepsy with associated mental deterioration. The clinical course could be divided into three successive stages. The first stage continued from the onset of epilepsy until puberty. Seizures began at a mean age of 6.6 years and consisted predominantly of generalized tonic‐clonic convulsions (GTC) and, transiently, also of complex partial seizures (CPS). Until puberty, seizure frequency increased in most patients from one attack in 1–2 months to one to two attacks weekly. Seizures did not respond to phenytoin (PHT) or carbamazepine (CBZ), were transiently controlled by valproate (VPA) and phenobarbital (PB), but were effectively treated only by clonazepam (CZP). Mental deterioration began 2–5 years after the onset of epilepsy and was most rapid before adulthood, a time when the seizures were also most frequent. The second stage is marked by fewer seizures, further mental deterioration, and less rapid progression. All patients were demented (I.Q.<70) by age of 30 years. The first signs of motor clumsiness also appeared then. The third stage was one of permanent disability and usually began in middle age. Seizures were few, but the patients were clumsy and had marked equilibrium difficulties.
Wada Memory Disparities Predict Seizure Laterality and Postoperative Seizure Control
Authors: Perrine Kenneth , Westerveld Michael , Sass Kimberlee J. , Spencer Dennis D. , Devinsky Orrin , Dogali Michael , Nelson Peter Kim , Luciano Daniel J.
Published: August 2005

Summary: We examined the efficacy of a memory difference score (DS: right minus left hemisphere memory) during the Wada test (intracarotid amobarbital procedure, IAP) for predicting seizure laterality and postoperative seizure outcome in 70 left speech dominant patients from two epilepsy centers. DS ≥2, after addition of 1 point to the left hemisphere injection score to account for aphasia, were noted in 71. 4% of patients and correctly predicted surgery side for 98. 0% of these patients. The DS related significantly to seizure outcome at 1–year follow‐up (p < 0.002) and correctly predicted 80% of patients who were The Wada test, or intracarotid amobarbital procedure (IAP), is traditionally used to determine the laterality of language dominance and to assess the memory competence in the hemisphere contralateral to the proposed temporal lobectomy in an effort to avoid postoperative amnesia (1–6). Ipsilateral memory testing (adequacy of the hemisphere ipsilateral to anticipated resection) also is frequently examined. The validity of IAP memory testing as a measure of temporal lobe function is demonstrated by correlating IAP memory scores of the affected hemisphere with hippocampal cell counts (7,8) and with hippocampal volume assessed by magnetic resonance imaging (MRI) (9). The disparity between ipsilateral and contralateral memory scores is often predictive of seizure focus laterality (1 1–18). However, most studies have examined group means rather than the utility of the DS for predicting the seizure focus in specific patients. To date, only Loring et al. (9) have reported Presented in part at the Annual Meeting of the International Neuropsychological Society, Galveston, Texas, February 1993. seizure‐free. Patients whose DS did not correctly predict seizure laterality more frequently required invasive studies to establish seizure onset. The relationship of the DS to laterality did not differ significantly by class of IAP memory stimuli. When seizures originate from the temporal lobe, the IAP memory DS predicts seizure laterality by assessing the functional adequacy of the involved hemisphere and is predictive of seizure control.
Fast Spin‐Echo, Magnetic Resonance Imaging‐Measured Hippocampal Volume: Correlation with Neuronal Density in Anterior Temporal Lobectomy Patients
Authors: Lee Namsoo , Tien Robert D. , Lewis Darrell V. , Friedman Allan H. , Felsberg Gary J. , Crain Barbara , Hulette Christine , Osumi Alan K. , Smith Jean S. , VanLandingham Kevan E. , Radtke Rodney A.
Published: August 2005

Summary: To assess the value of magnetic resonance imaging (MRI)‐measured hippocampal volume in the detection of hippocampal sclerosis, we studied 28 patients undergoing anterior temporal lobectomy for medically intractable mesial temporal lobe epilepsy. Hippocampal volumetry and visual analysis of T2 signal change were performed using fast spin‐echo T2‐weighted MRI. Quantitative neuronal density measurements were performed in the resected hippocampal specimens. There was a significant correlation between MRI‐measured absolute hippocampal volume (AHV) and neuronal density in CA1, CA2, and CA3 subfields (p<0. 0001, p < 0.01, and p < 0.05, respectively). Differential hippocampal volume (side‐to‐side volume difference) failed to detect bilateral atrophy in three patients, but the bilateral hippocampal atrophy was recognized by considering AHV in these patients. This study suggests that MRI‐measured AHV can be of value in evaluating patients with mesial temporal lobe epilepsy, especially when there is no side‐to‐side difference in hippocampal volumetry.
Frontal Lobe Seizures: Electroclinical Syndromes
Authors: Salanova V. , Morris H. H. , Van Ness P. , Kotagal P. , Wyllie E. , Lüders H.
Published: August 2005

Summary: To define further the electroclinical manifestations of frontal lobe epilepsy (FLE), we studied 150 seizures manifested by 24 patients; 18 patients had subdural electrode arrays (SEA). The findings in these patients clearly overlapped presumably reflecting the interconnections between functionally related frontal zones; yet the manner in which the symptoms clustered and the sequence in which they occurred generally indicated the anatomic site of the epileptogenic zone. We divided the patients into three major groups: (a) those with supplementary motor seizures, (b) those with focal motor seizures, and (c) those with complex partial seizures (CPS, psychomotor seizures). Supplementary motor seizures began with tonic posturing of the extremities. Focal motor seizures generally began with conscious contralateral version or unilateral clonic focal motor activity; tonic posturing was noted only late in the seizure. CPS (psychomotor) began with unresponsiveness at onset, followed by staring or unconscious contraversion. We compared frontal lobe seizures with temporal lobe seizures reported previously; oral‐alimentary automatisms, repetitive hand movements, or looking around, were more common in temporal lobe seizures, whereas tonic posturing and bicycling movements were more common in frontal lobe psychomotor seizures.
Injury and Death as a Result of Seizures
Authors: Kirby Sarah , Sadler R. Mark
Published: August 2005

Summary: The literature contains little information regarding the incidence of injury or death in the general population caused by seizures. We prospectively surveyed all patient visits to the four emergency departments serving adults in the Halifax‐Dartmouth metropolitan area (adult population 260,935) from September 1, 1990 to August 31, 1991 to identify patients treated as a result of a seizure. The medical examiner's records were also surveyed for deaths related to seizures. We identified 560 patient visits precipitated by seizures of all types and etiologies except those secondary to acute trauma. Injuries or deaths occurred during 84 of 560 seizures (15%). Sixty‐three patients incurred 89 injuries during 77 seizures (some patients had more than one injury, and some patients had injuries on more than one occasion). The incidence of seizures resulting in injury was 29.5 in 100,000 population. The most common injuries were head contusions and head lacerations. Most injuries were minor and required little or no treatment. Deaths occurred during seven seizures (1.2%). The incidence of death as a complication of seizures was 2.68 in 100,000 population. Deaths were not restricted to patients with epilepsy. We conclude that the incidence of seizures causing injury or death in the general population was 32.2 in 100,000 population and that 15% of seizures brought to medical attention resulted in injury or death. Most injuries were minor but seven patients died during seizures, indicating that seizures remain a life‐threatening event.
Cohort Study of Incidence of Sudden Unexplained Death in Persons with Seizure Disorder Treated with Antiepileptic Drugs in Saskatchewan, Canada
Authors: Tennis Patricia , Cole Thomas B. , Annegers John F. , Leestma Jan E. , McNutt Mary , Rajput Ali
Published: August 2005

Summary: To measure the incidence of sudden unexplained death in treated persons with epilepsy (SUDEP) and to identify risk factors for SUDEP, a cohort of 6,044 persons aged 15–49 years with more than four prescriptions for antiepileptic drugs (AEDs) was identified from the Saskatchewan Health prescription drug file. To exclude subjects whose sudden deaths (SUDs) might be misattributed to another chronic underlying disease, subjects with hospitalizations for cancer or heart problems were excluded. To exclude subjects without epilepsy, subjects with >2‐year AED treatment followed by AED‐free time and subjects receiving < 1 U/day were excluded. The final cohort consisted of 3,688 subjects. Follow‐up was started at the first AED prescription listed in the prescription drug file and ended at the earliest of the following: age 50 years, death, or last registration in the Saskatchewan Health. For 153 of 163 deaths occurring in the cohort, copies of anonymized death certificates were obtained and copies of anonymized autopsy reports of potential SUDEP cases were examined. There were 18 definite/probable SUDs and 21 possible SUDEPs, yielding a minimum incidence of 0.54 SUDEP per 1,000 person‐years and a maximum of 1.35 SUDEP per 1,000 person‐years. SUDEP incidence increased with male sex, number of AEDs ever prescribed, and prescription of psychotropic drugs and was highest in males with a history of treatment with three or more AEDs and four or more psychotropic drug prescriptions. Poisson regression showed a 1.7‐fold increase in risk of SUDEP for each increment in maximum number of AEDs administered, a likely surrogate for severity and persistence of seizures.
Panic Attacks Mistaken for Relapse of Epilepsy
Authors: Genton Pierre , Bartolomei Fabrice , Guerrini Renzo
Published: August 2005

Summary: Panic attacks, a frequent type of pseudoepileptic seizures, occur more frequently in epilepsy patients than in the general population and are often misdiagnosed, leading to pseudosevere epilepsy. We evaluated 4 patients with a past history of epileptic seizures long in remission who were misdiagnosed as having relapsing seizures although they had fairly typical panic attacks. To avoid unnecessary and ineffective antiepileptic drug (AED) treatment, recurrence of seizures after long remission should be carefully evaluated to identify patients with a panic disorder who require specific treatment. In patients who unexpectedly exhibit seizures after long remission, an accurate retrospective diagnosis of the epileptic syndrome and a precise description of the attack symptomatology should be obtained, if possible with EEG‐video monitoring.
Neuron‐Specific Enolase Is Increased After Single Seizures During Inpatient Video/EEG Monitoring
Authors: Rabinowicz Adrian L. , Correale Jorge , Boutros Raja B. , Couldwell William T. , Henderson Carlton W. , DeGiorgio Christopher M.
Published: August 2005

Neuron‐specific enolase (NSE) is a marker of brain injury after acute neurologic insults. We report changes in serum NSE (s‐NSE) in 25 patients (15 with epilepsy and 10 patients with nonepileptic events) during continuous inpatient video/EEG monitoring. s‐NSE was significantly increased as compared with baseline and normal controls after the first ictal event in the epileptic group, especially in patients with secondarily generalized tonic‐clonic seizures (p = 0.01), but s‐NSE was not increased in patients with nonepileptic events. These preliminary data indicate that s‐NSE may be increased after complex partial seizures‐and generalized tonic‐clonic seizures (GTCS).
Prevalence of Epilepsy in the Elderly: The Rotterdam Study
Authors: de la Court Annette , Breteler Monique M. B. , Meinardi Harry , Hauser W. Allen , Hofman Albert
Published: August 2005

We assessed the prevalence of epilepsy in an elderly population in The Netherlands. The study was conducted from 1991 to 1993 as part of the Rotterdam Study, a population‐based door‐to‐door study of all elderly people living in Ommoord, a suburb of Rotterdam, and included 5,559 persons aged 55–95 years. All subjects were screened for epilepsy through direct questions regarding the existence of epilepsy and antiepileptic drug (AED) use, in addition to relevant questions from the World Health Organization (WHO) protocol for epidemiologic studies of neurologic diseases. Further evaluation of screen positives was made by a panel of 1 study physician and 4 epileptologists, who also classified all confirmed cases of epilepsy according to the classifications of ‘the International League Against Epilepsy (ILAE). The overall prevalence of active epilepsy in our study population was 0.9% including special syndromes and 0.8% excluding special syndromes. The prevalence increased with age from 0.7% for those aged 55–64 years to 1.2% for those aged 85–94 years. The increase with age was detected among men and women both. Our study confirms other findings showing that the prevalence of active epilepsy increases with age in the elderly. The prevalence figures in our study were high as compared with those of other population‐based studies. Epilepsy appears to be a major cause of morbidity in the elderly.
The Clinical Course of Epilepsy and Its Psychosocial Correlates: Findings from a U.K. Community Study
Authors: Jacoby Ann , Baker Gus A. , Steen Nick , Potts Pauline , Chadwick David W.
Published: August 2005

As part of a large community‐based study, we retrospectively examined the clinical course of epilepsy in an unselected population of people who had a recent history of seizures or were receiving antiepileptic drugs (AEDs). Clinical information was collected from medical records, and information about psychosocial functioning was obtained by means of postal questionnaires sent to identified subjects. The response rate to the postal questionnaire was 71%. There were some deficiencies in the recording of clinical data, which is not unusual since data were taken from records held by primary physicians rather than from hospital clinics. Nevertheless, findings regarding the clinical course of epilepsy corresponded to those of earlier studies. Fifty‐seven percent of the sample had had at least a 2‐year seizure‐free period and 46% of subjects were currently in a remission of at least 2‐year duration. There was a clear relationship between current seizure frequency and levels of anxiety and depression, perceived impact of epilepsy, perceived stigma, and marital and employment status. The relationship of seizure frequency and other clinical variables to psychosocial function was explored by multivariate analysis techniques. The amount of variation in scores on the various measures of function accounted for by the clinical variables was small. The most important predictor was current seizure activity, which was the first variable to enter the regression analyses for six of the eight measures of psychosocial function considered. Age at epilepsy onset also emerged as a significant predictor for depression, stigma, and marital status. In individuals with epilepsy in remission, there was little evidence that psychosocial functioning was associated with length of remission, a finding which may in part reflect the nature of this study population. The results indicate that there are several more important predictors of psychopathology and social dysfunction in epilepsy and suggest several implications for treatment interventions.
Cognitive Consequences of Two‐Thirds Anterior Temporal Lobectomy on Verbal Memory in 144 Patients: A Three‐Month Follow‐Up Study
Authors: Helmstaedter C. , Elger C. E.
Published: August 2005

Previous studies have shown that left temporal lobectomy for intractable epilepsy can lead to verbal memory deficits. However, patients with left temporal lobe epilepsy (LTLE) frequently have impaired verbal memory preoperativel. The present analysis of 144 patients who underwent temporal lobe resections for either left (n = 68) or right (n = 76) temporal lobe epilepsy (LTLE, RTLE) addressed the questions of (a) whether a left two‐thirds anterior temporal lobectomy (ATL) increases deficits in these qualitative aspects of verbal memory already impaired preoperatively, and (b) whether other aspects of verbal memory are additionally affected. We also evaluated possible determinants of preoperative abilities and postoperative changes, using multiple regression analysis. Preoperatively, patients with LTLE differed from patients with RTLE only in poorer performance on measures of long‐term consolidation/retrieval (delayed recall). This was related to hippocampal pathology and seizure severity. Only left temporal lobe resections resulted in significant deterioration in verbal learning and memory. Acquisition over learning trials and recognition deteriorated most markedly, whereas performance in long‐term consolidation/retrieval showed only minor changes. Preoperative performance levels, chronological age, the extent of the en bloc resection, preoperative performance on figural memory, and preoperative seizure severity were valuable determinants of postoperative changes in acquisition and recognition. In contrast, changes in consolidation/retrieval related only to preoperative ability. Left two‐thirds ATL leads to new impairment in addition to preexisting memory deficits. The finding that left temporal lobectomy affects verbal acquisition and recognition more than long‐term consolidatiodretrieval, including the different determinants of these changes, most likely reflects the differential effects of surgery on mesial temporal and neocortical temporal functions.
Incidence and Clinical Characterization of Unprovoked Seizures in Adults: A Prospective Population‐Based Study
Authors: Forsgren Lars , Bucht Gösta , Eriksson Sture , Bergmark Lars
Published: August 2005

In a population‐based prospective study of epileptic seizures in adults aged ≥17 years, we identified 563 patients with possible seizures in a period of 34 months. Seizures were unprovoked in 160 patients, an incidence of 56 in 100,000 person‐years. There was no difference in incidence between sexes. Age‐specific incidences of unprovoked seizures increased sharply in men from age 60 years and in women from age 70 years. The incidence of unprovoked seizures in those aged ≥65 years was 139 (men 166, women 116). The cumulative incidence of unprovoked seizures between the ages of 17 and 84 years was 4.6%. The proportion with an identified presumptive cause for unprovoked seizures increased with advancing age. A presumed etiology was identified in 77% of persons aged ≥60 years. Stroke was the most common etiology, detected in 30% (incidence 16) and in 45% at ages ≥60 years. Tumors were detected in 11% (incidence 6) and Alzheimer's disease was detected in 7% (incidence 4). Eighteen percent of patients were demented. Unprovoked seizures were partial in 68% of cases (incidence 38), and generalized in 16% (incidence 9). Another 13% of patients had generalized seizures, but seizure onset was not witnessed (incidence 7). In 16%, there was a delay of ≥1 year from the first unprovoked seizure to initial diagnosis.
Epidemiology and Clinical Characteristics of Seizures in Patients with Acute Intermittent Porphyria
Authors: Bylesjö Ingemar , Forsgren Lars , Lithner Folke , Boman Kurt
Published: August 2005

The objectives of this study were to investigate the lifetime prevalence of epileptic seizures in a population with acute intermittent porphyria (AIP) and to characterize the seizures and the seizure‐triggering factors. A letter was sent to all patients with known AIP in Sweden registered at the National Porphyria Center (n = 294). The medical records of patients who had had epileptic seizures were reviewed in detail. The letter was answered by 268 patients (91.2%). Ten patients (3.7%) reported epileptic seizures. Eight were women (mean age 54.1 years, range 30–81 years), and 2 were men (mean age 19 years, range 9–29 years). Six patients had tonic‐clonic seizures and 4 had partial seizures becoming secondarily generalized. Serum sodium levels were low in 3 patients (mean 110, range 103–120 mM), and normal in 5. Excretion of 5–aminolevulinic acid (ALA) in the urine was increased in 4 patients at the time of the seizures. In 6 patients, the seizures were associated with an acute attack of AIP (all patients with hyponatremia included). The lifetime prevalence of AIP‐associated seizures was 2.2% of all those with known AIP and 5.1% of all those with manifest AIP. Epileptic seizures among persons with AIP are less common than has been previously described.
Cortical Stimulation Elicits Regional Distinctions in Auditory and Visual Naming
Authors: Malow Beth A. , Blaxton Teresa A. , Sato Susumu , Bookheimer Susan Y. , Kufta Conrad V. , Figlozzi Christina M. , Theodore William H.
Published: August 2005

We used electrical stimulation mapping to compare performance on auditory and visual naming tasks in inferotemporal, lateral temporal, frontal, and parietal cortex in 8 temporal lobe epilepsy (TLE) patients with subdural electrodes placed for preoperative language localization. Performance on auditory responsive naming (ARN) and visual confrontation naming (VCN) was best during stimulation of parietal cortex and was equally impaired during stimulation of inferotemporal and frontal cortex. In contrast, ARN performance was significantly poorer than VCN performance during stimulation of anterior and posterior lateral temporal cortex. In most patients, stimulation of inferotemporal cortex at relatively low stimulus intensities (≥ 5 mA) during either ARN or VCN elicited reproducible errors in which patients could describe, gesture, spell, or draw, but not name, in response to auditory or visual cues. Inferotemporal and frontal cortex appear to be multimodality language regions distinct from lateral temporal cortex.
Concentrations and Effects of Oral Midazolam are Greatly Reduced in Patients Treated with Carbamazepine or Phenytoin
Authors: Backman Janne T. , Olkkola Klaus T. , Ojala Mikael , Laaksovirta Hannu , Neuvonen Pertti J.
Published: August 2005

Midazolam is a short‐acting benzodiazepine which is used as an oral hypnotic agent in several countries. We studied the pharmacokinetic and pharmacody‐namic aspects of an oral 15–mg dose of midazolam in 6 patients with epilepsy who are also taking carbamazepine (CBZ) or phenytoin (PHT). We compared results with those obtained in 7 noninduced control subjects. Plasma concentrations and effects of midazolam were measured for 10 h. In patients with epilepsy, the area under the plasma concentration‐time curve (AUC) of midazolam (mean 2 SEM) was only 5.7% (0.60 ± 0.16 vs. 10.5 ± 0.6 μg ‐ min/ml), and the peak midazolam concentration was 7.4% (5.2 ± 1.2 vs. 70.4 ± 9.0 μg/ml) of its value in control subjects (p < 0.001). The elimination half‐life (t1/2) of midazolam was 1.3 ± 0.2 h in patients and 3.1 ± 0.1 h in controls (p < 0.001). The low plasma midazolam concentrations in the patient group were associated with reduced pharmacodynamic effects as compared with control subjects [e.g., the Critical Flicker Fusion Test (CFFT), p < 0.05]. Induction of CYP3A (cytochrome P‐450IIIA) enzymes by CBZ and PHT is the most likely explanation of the great difference in the pharmacokinetic and pharmacodynamic profiles of oral midazolam in the two groups.
Relapse and Survival After Barbiturate Anesthetic Treatment of Refractory Status Epilepticus
Authors: Krishnamurthy Kaarkuzhali B. , Drislane Frank W.
Published: August 2005

Summary: Purpose: Pentobarbital is standard treatment for refractory status epilepticus (SE) and is almost uniformly effective, but the morbidity of treatment and the mortality of refractory SE are high. Recurrence of SE after pentobarbital discontinuation may predict a worsened outcome. We sought to determine the optimal use of barbiturate anesthetic treatment of refractory SE.

Methods: We reviewed 44 episodes of barbiturate anesthetic treatment for refractory SE in 40 patients, seeking factors predicting freedom from relapse to clinical or electrographic SE after treatment and predicting survival.

Results: Eight of 9 patients with relapse of seizures after barbiturate treatment died, whereas only 9 of 26 with persistently controlled seizures died (p < 0·005). Both likelihood of relapse and survival correlated strongly with etiology, with 19 of 20 patients with chronic epilepsy, infections, or focal lesions having good control as compared with 2 of 9 with multiple medical problems (p < 0·001). Treatment delay did not predict a worsened outcome. Hypotension caused dose reduction but never required treatment discontinuation. Patients with more prolonged treatment and those receiving phenobarbital (PB) at the time of pentobarbital taper were less likely to relapse.

Conclusions: Relapse of SE after barbiturate anesthetic treatment is a poor prognostic sign and should be prevented, if possible. Etiology was the primary predictor of outcome, but more prolonged treatment and the use of PB during pentobarbital withdrawal appeared to provide protection against relapse.