bluuebunny/crossref_metadata_2025_split huggingface dataset:
Video‐EEG and ictal SPECT in three patients with both epileptic and non‐epileptic seizures
Authors: Biraben Arnaud , Taussig Delphine , Bernard Anne‐Marie , Vignal Jean‐Pierre , Scarabin Jean‐Marie , Chauvel Patrick , Duncan Roderick 
Published: March 2024

ABSTRACT
We report scalp EEG and ictal SPECT findings in epileptic (complex partial) and non‐epileptic seizures in three patients who experienced both types of event during presurgical investigation of medically intractable epilepsies. In all three patients, ictal SPECT showed localizing changes in cerebral blood flow during epileptic seizures, but showed no change during pseudoseizures. In two patients, the physical manifestations of the pseudoseizures were similar to those of the epileptic seizures, supporting the contention that physiological activation is unlikely to mimic ictal perfusion changes. In one patient, the EEG recording was rendered difficult to interpret by muscle artefact, while SPECT was clear and showed no change. SPECT is not a primary tool for diagnosis of pseudoseizures, but when patients undergoing presurgical investigation are injected during pseudoseizures, then SPECT is unlikely to show misleading perfusion changes due to activation effects, and may aid diagnosis where there is muscle artefact on EEG.
Epilepsy and perisylvian lipoma/cortical dysplasia complex
Authors: Guye Maxime , Gastaut Jean‐Louis , Bartolomei Fabrice 
Published: March 2024

ABSTRACT
Intracranial lipomas are congenital malformations composed of mature adipocytes. They are usually located in the midline, particularly in the pericallosal region, a hemispheric location accounting for only 3 to 7% of cases. Review of the literature found 21 previous cases of hemispheric lipoma. Although hemispheric cerebral lipomas are rare, association with epilepsy appears to be frequent.
We have recently studied two patients in whom epilepsy was the first clinical manifestation of hemispheric cerebral lipoma in the sylvian region. The patients presented with simple motor partial seizures as the first manifestation of the lesion. Neurological examination was normal. MRI disclosed in both cases a lesion involving the sylvian fissure with characteristics of the lipid signal. MRI also demonstrated abnormalities involving the cerebral cortex in the vicinity of the lesion (pachygyria‐like aspect). Partial excision of the lesion was achieved in one patient but was followed by a worsening of seizures and neurological condition (hemiparesis). According to the literature, the prognosis for epilepsy in patients with hemispheric lipoma appears good. Several other arguments support non‐surgical management: the lesion is benign and can be identified with a high degree of certainty by imaging; surgery is technically difficult due to adherence to adjacent vascular and cerebral structures and hypervascularity; location near functional brain tissue increases the risk of postoperative sequelae. In addition, mechanisms of epilepsy probably involve vascular and cortical dysplasic abnormalities. In consideration of the complexity of the lesion, hemispheric lipomas are more appropriately classified with localized cortical malformations rather than as simple extracerebral malformations.
Reading epilepsy in a patient with previous idiopathic focal epilepsy with centrotemporal spikes
Authors: Valenti Maria Paola , Tinuper Paolo , Cerullo Angelina , Carcangiu Roberta , Marini Carla 
Published: March 2024

ABSTRACT

Rationale
Reading epilepsy (RE) is a form of reflex epilepsy currently classified as an idiopathic localization‐related epilepsy (ILAE, 1989).

Methods
We describe a 30 year‐old right‐handed male who suffered since the age of 8 from nocturnal partial motor seizures. Clinical features were typical of BECT. We reviewed the EEG recorded at that time which showed centrotemporal spike and waves. He was seizure‐free from the age of 12 to the age of 17 when seizures evoked only by reading appeared. No other stimuli provoked seizures. Neurological and neuroradiological (CT and MR) investigations were normal. Baseline video‐polygraphic EEG recordings were normal while reading aloud provoked myoclonic jerks in the facial muscles related to bilateral spike and wave discharges. Therapy with carbamazepine and valproic acid strongly reduced seizure frequency.

Conclusion
Recent papers have debated the difficulties in classifying RE among the generalized or focal syndromes. Literature reports describe an association with RE and juvenile myoclonic epilepsy, supporting the hypothesis of an idiopathic generalized form. We report the first documented case with a clear‐cut idiopathic localization‐related epilepsy evolving to a primary reading epilepsy.
Psychosocial functioning in chronic epilepsy: relation to hippocampal volume and histopathological findings
Authors: Seeck M. , Lazeyras F. , Murphy K. , Naimi A. , Pizzolatto G.P. , de Tribolet N. , Delavelle J. , Villemure J.‐G. , Landis T. 
Published: March 2024

ABSTRACT
MRI volumetric measurements of the ipsi‐ and contralateral hippocampal volume (HV) were performed in a group of 37 patients with lesional and non‐lesionai temporal (TLE), and extratemporal lobe (ETLE) lobe epilepsy. Twenty‐six patients underwent surgery and the resected tissues subjected to histopathological examination. Psychosocial scores were calculated on the basis of employment, partnership/family status and presence of a positive psychiatric history. Poorest values were obtained for the group with right lesional and non‐lesional TLE (RTLE, p < 0.001). In this group, significant positive correlations between psychosocial functioning and the left hippocampal volume or age of onset were observed. We found that the left hippocampal volume in RTLE was smaller with increasing epilepsy duration. We conclude that patients with RTLE represent a particular group with regard to the structural and psychosocial consequences of chronic epilepsy. With regard to histopathological analysis, no particular type of lesion was identified as the major determinant of the results described above.
Can protrusion of the tongue stop seizures in Rolandic Epilepsy?
Authors: Veggiotti P. , Beccaria F. , Gatti A. , Papalia G. , Resi C. , Lanzi G. 
Published: March 2024

ABSTRACT
We report the case of a child with benign partial epilepsy with centro‐temporal spikes (BECT) in whom protrusion of the tongue stopped the interictal abnormalities, and describe the polygraphic EEG recording of a seizure which terminated upon voluntary protrusion of the tongue.
We mention the close link between the post‐central (somatosensory) cortex and pre‐central (motor) cortex, and how the primary sensory area has direct access to the motor cortex. We also examine how a tactile stimulus may provoke the inhibition of an epileptic discharge.
Exceptionally long absence status: multifactorial etiology, drug interactions and complications
Authors: D'Agostino Maria Daniela , Andermann Frederick , Dubeau Francois , Fedi Marco , Bastos Alexandre 
Published: March 2024

ABSTRACT
To our knowledge, petit mal status lasting longer than 2‐3 days has been documented only once [1]. We report a 66 year‐old man with well‐documented, idiopathic generalized epilepsy who developed petit mal status lasting 6 weeks. Valproate levels remained low because of interactions with phenytoin. When phenytoin was discontinued, valproate levels increased, and he progressively improved. Chronic ischemic changes in the white matter may have been an additional factor in the causation and, most likely, in the duration of his status.
Exceptionally long status and stupor increase the risk of medical complications. Valproate remains the medication of choice for the treatment of petit mal status. Despite the extraordinary course in this patient, complete recovery took place, confirming the benign nature of even such a prolonged episode.
Mesial temporal lobe epilepsy
versus
amygdalar epilepsy: Late seizure recurrence after initially successful amygdalotomy and regained seizure control following hippocampectomy
Authors: Wieser Heinz Gregor 
Published: March 2024

ABSTRACT

We summarise the concept of mesial temporal lobe epilepsy and the
pros and cons
in order to define amygdala epilepsy. We present a patient with stereotactically proven right amygdalar seizure onset, associated with fear and vegetative autonomic signs and symptoms as the most prominent clinical ictal features. Following a right stereotactic amygdalotomy, the patient experienced an 11‐year seizure‐free period. Similar, but not identical, semeiology of complex partial seizures then recurred. A right‐sided selective hippocampectomy and excision of the previously lesioned amygdala was performed. Except for 2 complex partial seizures associated with withdrawal of antiepileptic drugs, the patient remained seizure‐free 9.5 years.

This case underscores the important role of the amygdala in generating the semiology, and raises several questions concerning the existence of “amygdalar epilepsy”. The 11‐year seizure‐free period following the stereotactic destruction of the amygdala is a strong argument for this notion. The late seizure recurrence requiring a second operation might, however, be seen as an argument for the important role of the hippocampal formation in the syndrome of mesial temporal lobe epilepsy even when the amygdala has been identified as the seizure onset zone. The role of stereotactic amygdalotomy is briefly reviewed.
Multifactorial pathogenesis of neonatal seizures – relationships to the benign partial epilepsies
Authors: Doose Hermann , Koudriavtseva Katharina , Neubauer Bernd A. 
Published: March 2024

ABSTRACT
Elevated incidence of neonatal seizures (NS) in children with idiopathic partial epilepsies, as well as reports on the transition of NS into benign partial epilepsy, point to pathogenetic relationships between these conditions. Further insight into the nature of these relationships can be expected only from NS patients with long‐term follow‐up, which includes the age range of maximum manifestation of subsequent seizures or epilepsies (SSE), and age‐dependent genetic EEG traits. A sample of such cases will necessarily be selected and thus prohibit any quantitative inferences regarding the incidence of SSE and special EEG characteristics. Nevertheless, the data provide new aspects with regard to a possibly multifactorial pathogenesis of NS and SSE. Children in the present study were selected applying the following inclusion criteria: cerebral seizures during the first 14 days of life; follow up of more than two years with at least two EEG recordings beyond the age of two. Children with metabolic NS or subsequent West syndrome were not included. Seventy‐six cases were confirmed, 42 with SSE, 34 without. The incidence of EEG symptoms of a generalized genetic seizure liability (theta rhythms, generalized spikes and waves, photoparoxysmal response) was significantly elevated, equally in children with and without SSE. Beyond the age of two years, 50% of the probands had focal sharp waves foci characteristic of idiopathic partial epilepsy (e.g. rolandic epilepsy). Among SSE, febrile convulsions and partial epilepsies with benign course dominated. Idiopathic generalized epilepsies were not observed. These findings indicate that in a certain proportion of cases, NS have genetic factors in common with idiopathic partial epilepsies. Quantitative representative data cannot be obtained to determine the incidence of such pathogenetic mechanisms in NS and SSE.
Antimyoclonic effect of levetiracetam
Authors: Genton Pierre , Gélisse Philippe 
Published: March 2024

ABSTRACTTreatment of severe, incapacitating action myoclonus is difficult. Piracetam has been shown to be a very potent antimyoclonic agent, but only at very high, impractical doses, ranging from 24 to 40 g/d. Levetiracetam (LEV), a new antiepileptic drug, is a structurally related compound that has a distinct pharmacological profile and appears to be efficient at much lower doses. We gave LEV, 4,000 mg/d, without titration, to three volunteers with post‐anoxic myoclonus (PAM) (one case) and Unverricht‐Lundborg disease (two cases), over 2, 2 and 10 weeks, respectively. LEV produced a clear abatement of myoclonus, which is demonstrated on video for the patient with post‐anoxic myoclonus, without any unwanted side‐effects. These preliminary findings suggest that LEV may have interesting antimyoclonic properties that deserve further investigation.
Selection criteria and preoperative investigation of patients with focal epilepsy who lack a localized structural lesion
Authors: Duchowny Michael , Jayakar Prasanna , Koh Susan 
Published: March 2024

ABSTRACT
Children with medically resistant epilepsy are often referred for surgical evaluation. The absence of a specific focal lesion on MRI may render the work‐up difficult. In response to the need to localize the primary area of epileptogenesis, surgery protocols are being developed which rely on clinical semiology, EEG and functional imaging data. In selected cases, intracranial EEG monitoring may be required. While testing more often depends on the convergence of modalities, it is possible to localize seizure origin in the majority of children, and fully excise the epileptogenic region. This review presents the etiology and preoperative modalities available for children with intractable, non‐lesional epilepsy.
Autonomic symptoms during epileptic seizures
Authors: Baumgartner Christoph , Lurger Stefanie , Leutmezer Fritz 
Published: March 2024

ABSTRACT
Autonomic symptoms frequently occur during epileptic seizures either as an accompaniment to other seizure symptoms or as the predominant seizure manifestation. They do not represent simple reactions to motor manifestations of seizures, but are mediated by an activation of the central autonomic network. Autonomic symptoms can be divided into cardiovascular changes, respiratory manifestations, gastrointestinal symptoms, cutaneous manifestations, pupillary symptoms, genital and sexual manifestations as well as urinary symptoms. Due to a hemispheric‐specific representation of the central autonomic network, certain autonomic symptoms may provide lateralizing and sometimes localizing information on the seizure onset zone, although some of these signs may appear as a result of discharge spreading. Autonomic symptoms indicating a seizure onset in the non‐dominant hemisphere include ictal vomiting and retching, spitting automatisms and ictal urinary urge. Autonomic symptoms range from subtle seizure manifestations which become apparent only during meticulous seizure analysis, to severe, sometimes life‐threatening events. Cardiovascular and respiratory autonomic symptoms are discussed as the mechanisms underlying sudden unexplained death in epilepsy. When autonomic symptoms represent the sole seizure manifestation, they can pose problems for differential diagnosis of various nonepileptic conditions. Finally, autonomic seizure symptoms open a unique window on the functional organization of the central autonomic network and on brain function in general. (Published with videosequences.)
Functional MRI assessment of the hemispheric predominance for language in epileptic patients using a simple rhyme detection task
Authors: Baciu Monica , Kahane Philippe , Minotti Lorella , Charnallet Annik , David Danielle , Bas Jean‐François Le , Segebarth Christoph 
Published: March 2024

ABSTRACT
This study assesses the interest of a simple fMRI rhyme detection paradigm to determine hemispheric predominance for language in epileptic patients. Nineteen patients were examined. The findings derived from the fMRI examinations were compared with those obtained on the same patients using the Wada test, stereotactic intracerebral EEG stimulations and recordings, and/or video‐EEG recordings. For the seventeen patients for whom language dominance could be assessed by means of at least one of the latter procedures, the fMRI examination provided concordant results in sixteen. In two patients, the hemispheric predominance for language could only be determined by fMRI. Nine patients underwent surgery subsequent to the fMRI examination. None of them exhibited any aphasic problems following surgery. The rhyme detection task used in the fMRI examination generates robust responses in the language areas, permits easy monitoring of the patient's task performance and can be easily undertaken by the epileptic patients. Thus, this study demonstrates that the fMRI rhyme detection paradigm is particularly well‐suited for determining hemispheric language predominance in epileptic candidates for surgery.
Is the left cerebral hemisphere more prone to epileptogenesis than the right?
Authors: Holmes Mark D. , Dodrill Carl B. , Kutsy Roman L. , Ojemann George A. , Miller John W. 
Published: March 2024

ABSTRACT

Purpose

To determine if there is evidence that the left cerebral hemisphere is more prone to epileptogenesis than the right hemisphere.
Methods.
We examined 532 patients with localization‐related epilepsy, as documented by long‐term EEG‐video monitor studies. We identified those with interictal epileptiform patterns on EEG confined to one hemisphere, those with clinical seizures that arose only from one side, and individuals with neuropsychological deficits lateralizing more to one cerebral hemisphere than the other. These data were then related to the handedness of the subjects.

Results
For left‐handed patients, interictal discharges were significantly more likely to be confined to the left side, seizures more frequently arose from only the left hemisphere, and neuropsychological deficits lateralized more often to the left brain. In contrast, for right‐handed subjects, there were no significant differences in unilateral localization of either interictal discharges or of seizure onsets, nor did neuropsychological deficits lateralize more often to one side or the other. Although, as a group, left‐handers had an earlier age of onset of epilepsy than right‐handers, the lateralizing EEG and neuropsychological patterns seen in left‐handers were not related to age of onset of epilepsy, febrile seizures, family history of either epilepsy or left‐handedness, or other risk factors.

Conclusion
In localization‐related epilepsy, there is a significant association of left‐handedness with left hemispheric lateralization of epileptiform EEG patterns and neuropsychological deficits. These findings do not clearly reflect a greater left than right cerebral hemispheric vulnerability to epileptogensis, except possibly in left‐handers.
Efficacy of lamotrigine add‐on therapy in severe partial epilepsy in adults with drop seizures and secondary bilateral synchrony on EEG
Authors: Bisulli Francesca , Baruzzi Agostino , Rosati Anna , Riva Roberto , Avoni Patrizia , Cerullo Angelina , Tinuper Paolo 
Published: March 2024

ABSTRACT

Objectives
To evaluate the efficacy of lamotrigine (LTG) add‐on therapy in drug‐resistant, partial epilepsy with epileptic drop attacks (EDA) and secondary bilateral synchrony (SBS) on EEG.

Methods
We carried out a single‐center, open‐label, prospective study on a restricted group of patients experiencing an EDA frequency of at least one/month during the previous year regardless of multiple antiepileptic drug (AED) trials. Study design consisted of three phases: a 3‐month baseline period, a 4‐month period in which LTG was titrated and a 9‐month maintenance dose observational period. LTG add‐on therapy depended on valproate (VPA) association, with a maximum of 200 mg/day with VPA and 600 mg/day in the absence of VPA. Every three months, patients underwent clinical, hematological and EEG evaluation including plasma level of AEDs. To assess the efficacy of LTG add‐on therapy, patients were required to keep a detailed seizure diary throughout the study.

Results
Fourteen patients (nine men and five women), aged from 21 to 51, were included in the study. All of them had complex partial seizures (CPS), besides EDA, and half of them had secondarily generalized seizures (SGS). Two of the 14 patients had to stop LTG due to side effects, although one of them was seizure‐free after LTG. Twelve patients completed the study. The improvement was more than 50% for every type of seizure. SGS disappeared in three cases and improved by more than 50% in another three cases. EDA disappeared in six patients; and improved with more than 50% EDA reduction in five patients. CPS disappeared in two patients and improved by more than 50% in eight. EEG improved in nine cases, with SBS disappearing in six patients.

Conclusions
We have demonstrated a good efficacy of LTG adjunctive therapy on EDA. Results include control of SGS and improvement of EEG tracing.
Atypical evolution in childhood epilepsy with occipital paroxysms (Panayiotopoulos type)
Authors: Caraballo Roberto Horacio , Astorino Francisco , Cersósimo Ricardo , Soprano Ana M. , Fejerman Natalio 
Published: March 2024

ABSTRACT
We report, on two, school‐age girls with clinical and electroencephalographic features of early onset childhood epilepsy with occipital paroxysms (CEOP) of the “Panayiotopoulos type” that showed atypical evolution. Neurological examination and brain imaging were normal in both. One child presented at age 2.5 years episodes of oculocephalic deviation, and ictal vomiting during nocturnal sleep. The EEG showed left occipital spikes during wakefulness and sleep. One year later, frequent inhibitory seizures appeared in the lower limbs causing, “pseudoataxic gait”. At the same time she presented with behavioral disturbances and aphasia. EEG showed bilateral spike‐waves while awake and continuous spike‐waves during slow sleep (CSWSS). After switching AEDs to benzodiazepines, control of seizures along with improvement of behavior, and partial restoration of cognitive functions were achieved. The CSWSS disappeared and the last EEG at age 8 years only showed only isolated right occipital spikes.
The other girl had a personal and familial history of febrile seizures. At 4 years of age she presented the first non‐febrile seizures during sleep, with oculocephalic deviation and ictal vomiting, followed by a generalized tonic‐clonic seizure. Partial control of seizures was obtained with antiepileptic drugs. At age 7, the child began to have weekly episodes of oculocephalic version, occasionally with secondary generalization. Repeated inhibitory seizures and absences also appeared. EEG showed frequent bilateral spikes occupying predominantly the posterior regions while awake, and CSWSS. At 7.5 years the same electro‐clinical picture persisted. Ethosuximide was added to sodim valproate and clobazam. Fifteen days later, the seizures disappeared and the EEG showed less frequent bilateral occipital spikes. She is now 9 years old and she has been seizure‐free for 18 months. Her present neuropsychological profile shows mild mental retardation.
The two children with typical electroclinical features of “Panayiotopoulos Type” CEOP developed an atypical evolution which, to our knowledge, has not been described previously.