bluuebunny/crossref_metadata_2025_split huggingface dataset:
Status Epilepticus in 12‐day‐old Rats Leads to Temporal Lobe Neurodegeneration and Volume Reduction: A Histologic and MRI Study
Authors: Nairismägi Jaak , Pitkänen Asla , Kettunen Mikko I. , Kauppinen Risto A. , Kubova Hana 
Published: March 2006

Summary:  Purpose: Whether status epilepticus (SE) in early infancy, rather than the underlying illness, leads to temporal lobe neurodegeneration and volume reduction remains controversial. Methods: SE was induced with LiCl‐pilocarpine in P12 rats. To assess acute neuronal damage, brains (five controls, five with SE) were investigated at 8 h after SE by using silver and Fluoro‐Jade B staining. Some brains from the early phase were processed for electron microscopy. To assess chronic changes, brains from nine controls and 13 rats with SE at P12 were analyzed after 3 months by using histology and magnetic resonance imaging (MRI). Results: MRI analysis of the temporal lobe of adult animals with SE at P12 indicated that 23% of the rats had hippocampal, 15% had amygdaloid, and 31% had perirhinal volume reduction. Histologic analysis of sections from the MR‐imaged brains correlated with the MRI data. Analysis of neurodegeneration 8 h after SE by using both silver and Fluoro‐Jade B staining revealed degenerating neurons located in the same temporal lobe regions as the volume reduction in chronic samples. Electron microscopic analysis revealed irreversible ultrastructural alterations. As with the chronic histologic and MRI findings, interanimal variability was seen in the distribution and severity of acute damage. Conclusions: Our data indicate that SE at P12 can cause acute neurodegeneration in the hippocampus as well as in the adjacent temporal lobe. It is likely that acute neuronal death contributes to volume reduction in temporal lobe regions that is detected with MRI in a subpopulation of animals in adulthood.
The Effect of Antiepileptic Drugs on 5‐HT1A–Receptor Binding Measured by Positron Emission Tomography
Authors: Theodore William H. , Giovacchini Giampiero , Bonwetsch Robert , Bagic Anto , Reeves‐Tyer Patricia , Herscovitch Peter , Carson Richard E. 
Published: March 2006

Summary:  Purpose: To study the effect of antiepileptic drugs (AEDs) on 5‐HT1A–receptor binding in patients with temporal lobe epilepsy. 5‐HT1A–receptor binding, measured by positron emission tomography, is reduced in patients with temporal lobe epilepsy. Antiepileptic drugs may act on the serotonergic system, as shown in animal models, and thus affect receptor‐binding measurements. Methods: We analyzed the effect of AEDs on 5‐HT1A–receptor binding in 31 patients and 10 normal controls. Patients with structural lesions, progressive neurologic disorders, or taking other medications were excluded. None had a seizure for ≥2 days before positron emission tomography (PET). [18F]FCWAY PET was performed on a GE Advance scanner with continuous EEG monitoring. Functional images of the distribution volume (V) were generated. Anatomic regions of interest were applied to coregistered PET images, after correction for partial‐volume effect. Results: Patients had significantly higher [18F]FCWAY free fraction (f1) than did controls. No AED effects were observed on interictal [18F]FCWAY binding after correction for plasma free fraction. [18F]FCWAY V/f1 reduction in epileptic foci was not affected by AEDs. Conclusions: 5‐HT1A‐receptor binding is reduced in temporal lobe epileptic foci after partial‐volume correction. AED plasma free fractions should be measured when PET receptor studies are performed in patients with epilepsy.
Changes in the Disposition of Oxcarbazepine and Its Metabolites during Pregnancy and the Puerperium
Authors: Mazzucchelli Iolanda , Onat Filiz Yilmaz , Ozkara Cigdem , Atakli Dilek , Specchio Luigi M. , Neve Angela La , Gatti Giuliana , Perucca Emilio 
Published: March 2006

Summary:  Purpose: To determine potential changes in the plasma concentrations of oxcarbazepine (OXC) and its metabolites during pregnancy and puerperium. Methods: Five women receiving OXC monotherapy were followed prospectively during pregnancy and the puerperium. Four women were enrolled in the first trimester, and one woman, 2 weeks before delivery. Steady‐state concentrations of OXC, its active R‐(‐)‐ and S‐(+)‐monohydroxy derivatives (MHD), and the additional metabolite carbamazepine‐10,11‐trans‐dihydrodiol (DHD) were measured at regular intervals by an enantioselective HPLC assay. Results. In all samples, S‐(+)‐MHD was the most abundant compound in plasma and accounted almost entirely for the amount of active moiety (defined as the molar sum of OXC, R‐(‐)‐MHD, and S‐(+)‐MHD) found in the circulation. The dose‐normalized concentrations of active moiety decreased markedly during gestation and, in four of the five patients, increased strikingly after delivery. Plasma concentrations of S‐(+)‐MHD mirrored closely the levels of the active moiety. Plasma concentrations of the parent drug and other metabolites also tended to decrease during pregnancy and to increase after delivery. Conclusions: During treatment with OXC, S‐(+)‐MHD is by far the most abundant active compound in plasma. The concentration of this metabolite as well as the active moiety may decrease markedly during pregnancy and may increase severalfold after delivery. Because of these striking pharmacokinetic changes, the clinical response should be monitored closely in OXC‐treated women throughout pregnancy and the puerperium.
Vitamin D Levels and Bone Turnover in Epilepsy Patients Taking Carbamazepine or Oxcarbazepine
Authors: Mintzer Scott , Boppana Prashanthi , Toguri Jeanne , DeSantis Anthony 
Published: March 2006

Summary:  Purpose: Evidence suggests that enzyme‐inducing antiepileptic drugs (AEDs) may decrease serum 25‐hydroxyvitamin D (25‐OHD) levels and increase bone turnover. We sought to determine whether these are affected by treatment with carbamazepine (CBZ) or oxcarbazepine (OXC). Methods: We measured serum levels of 25‐OHD, parathyroid hormone (PTH), osteocalcin (OCLN), bone alkaline phosphatase (BAP), and urinary N‐telopeptides of type I collagen cross‐links (NTX) in normal controls (n = 24) and in epilepsy patients taking CBZ (n = 21) or OXC (n = 24) in monotherapy. CBZ patients were subsequently switched overnight to OXC monotherapy, and after 6 weeks, the tests were repeated. Results: 25‐OHD levels were lower in each drug‐treated group (OXC, 19.4 ± 2.3 pg/ml; CBZ, 20.4 ± 2.4) than in the controls (27.5 ± 2.8) (ANOVA, p = 0.052). This difference was significant for the OXC group (p < 0.05). PTH, BAP, and NTX did not differ significantly among groups. OCLN levels were somewhat elevated in the OXC group (2.79 ± 0.47 ng/ml) and more clearly and significantly elevated in the CBZ group (3.63 ± 0.36) compared with controls (2.38 ± 0.41) (p = 0.053). Because the data were very similar between OXC and CBZ groups, they were combined to increase statistical power. The combined drug‐treatment group had significantly higher BAP (p = 0.02) and lower 25‐OHD (p = 0.015) than did controls. The latter remained significant even after accounting for the confounding effects of age on 25‐OHD levels (p < 0.05). No significant differences were found after CBZ patients were switched to OXC. Conclusions: Epilepsy patients taking OXC or CBZ have significantly lower 25‐OHD than do normal controls, with a pattern of changes in other bone biomarkers suggestive of secondary hyperparathyroidism. It may be prudent for patients taking CBZ or OXC to be prescribed 25‐OHD replacement.
Onset of Action of Levetiracetam: A RCT Trial Using Therapeutic Intensive Seizure Analysis (TISA)
Authors: Stefan Hermann , Wang‐Tilz Ying , Pauli Elisabethe , Dennhöfer Stephanie , Genow Alexandra , Kerling Frank , Lorber Bogdan , Fraunberger Britta , Halboni Petra , Koebnick Corinna , Gefeller Olaf , Tilz Christian 
Published: March 2006

Summary:  Objectives: To correlate the onset of clinical effects of add‐on levetiracetam (LEV) therapy with daily serum LEV concentration, in pharmacoresistant focal epilepsies, using the TISA method. Methods: 25 adult patients (aged >16 years) with pharmacoresistant focal epilepsies undergoing presurgical evaluation at the Epilepsy Center Erlangen were enrolled in the study. Eligible patients on a maximum of one other antiepileptic drug (AED) were recruited into the 48‐hour baseline phase. Those who had at least two seizures during this phase were randomized into the seven‐day treatment phase, when they received either LEV or placebo, under continuous day‐and‐night video‐EEG monitoring. The starting daily dose of LEV was 500 mg bid, titrated from the second treatment day to 1000 mg bid. The peak serum concentration of LEV was monitored daily at 8:00 am (one hour after drug administration) for every patient. The number and duration of seizures per 24h (N/24h and D/24h respectively) were investigated. Results: 23 patients completed the study (LEV group n = 11 and placebo group n = 12). Seven patients in the LEV group and two patients in the placebo group achieved seizure‐freedom during the treatment phase. The intergroup comparison of the decrease in N/24h and D/24h from the baseline phase to the treatment phase was in favor of the LEV group (p < 0.05). A significant effect of LEV on D/24h was seen as early as the second treatment day (p = 0.013), becoming more apparent on the third treatment day (p = 0.009). Conclusion: The present study objectively quantified the correlation between the anticonvulsant effects of LEV in focal epilepsies and the peak serum concentration of the drug. For the first time, direct measurement was used to demonstrate the onset of action of LEV to be two days after drug initiation.
EEG Features in Idiopathic Generalized Epilepsy: Clues to Diagnosis
Authors: Betting Luiz Eduardo , Mory Susana Barreto , Lopes‐Cendes Iscia , Li Li M. , Guerreiro Marilisa M. , Guerreiro Carlos A. M. , Cendes Fernando 
Published: March 2006

Summary:  Purpose: To investigate the EEG profile and its contribution for diagnosis and management in a group of patients with a clinical diagnosis of idiopathic generalized epilepsy (IGE) who were referred to a tertiary hospital. Methods: We retrospectively studied clinical and EEG features of 180 consecutive patients with IGE. Eighty patients were diagnosed with juvenile myoclonic epilepsy (JME), 35 had absence epilepsy (AE), 13 had generalized tonic–clonic seizures on awakening (GTCS‐A), 28 had generalized tonic–clonic seizures only (TCS), and 24 had adult‐onset idiopathic generalized epilepsy (AIGE). The EEGs were classified in typical (synchronous generalized spike or polyspikes‐and‐wave discharges with normal background), atypical (with clear focalities or asymmetries), and normal. Results: The 493 EEG exams were analyzed. The first EEG was normal in 45% of the 180 patients, and only 33% had typical abnormalities. AE had a higher proportion of typical examinations and needed fewer sequential examinations to register a typical abnormality compared with the other groups. By contrast, the serial EEG profile of TCS and AIGE showed a higher proportion of normal and atypical EEG findings. Conclusions: These findings support previous recommendations that IGE patients should be treated with appropriate therapy based on clinical history. Waiting for a typical abnormal EEG pattern can generate an unacceptable delay in the correct diagnosis and treatment of these patients. In patients with long‐term epilepsy, the diagnosis may be difficult. Furthermore, serial EEGs can help to elucidate the syndromic diagnosis, especially in patients with TCS and AIGE.
Early Pattern of Epilepsy in the Ring Chromosome 20 Syndrome
Authors: Ville Dorothée , Kaminska Anna , Bahi‐Buisson Nadia , Biraben Arnaud , Plouin Perrine , Telvi Louise , Dulac Olivier , Chiron Catherine 
Published: March 2006

Summary:  Purpose: The characteristics of epilepsy in ring chromosome 20 have been reported in adolescents and adults. The mode of onset most often remains imprecise. To clarify this onset period, we studied the early‐onset features in our personal series and in the reported pediatric cases. Methods: Our series comprises one child with an onset of epilepsy in the neonatal period and five others with an onset before age 8 years. The cases in the literature with an epilepsy onset before 8 years also were reviewed. Results: Seizures in the neonatal period were described as motor seizures. Our personal patient with a neonatal onset had severe psychomotor delay. In both infancy and early childhood, the EEG showed no interictal frontal localization of the anomalies, and no long‐lasting seizure was recorded. Seizures with terror and hallucinations usually appeared from about age 4 years. It is not before the age of 8 years that the usual interictal EEG pattern appeared of rhythmic theta slow‐waves activity with spikes predominating in frontal areas described in adolescence and adulthood. The interictal EEG showed 1‐ to 2‐Hz delta slow waves and spike‐and‐waves predominating in frontal areas, but no physiologic activity. Conclusions: In ring 20 chromosome, specific epilepsy features are lacking in the neonate, but the whole phenotype shows a more severe expression in terms of mental delay. The characteristic frontal EEG pattern and ictal terror do not appear before age 4 to 5 years.
Cardiac Autonomic Control in Patients with Refractory Epilepsy before and during Vagus Nerve Stimulation Treatment: A One‐Year Follow‐up Study
Authors: Ronkainen Eija , Korpelainen Juha T. , Heikkinen Esa , Myllylä Vilho V. , Huikuri Heikki V. , Isojärvi Jouko I. T. 
Published: March 2006

Summary:  Purpose: To elucidate possible effect of vagus nerve stimulation (VNS) therapy on interictal heart rate (HR) variability in patients with refractory epilepsy before and after 1‐year VNS treatment. Methods: A 24‐hour electrocardiogram (ECG) was recorded at the baseline and after 12 months of VNS treatment in 14 patients with refractory epilepsy, and once in 28 healthy age‐ and sex‐matched control subjects. Time and frequency domain measures, along with fractal and complexity measures of HR variability, were analyzed from the ECG recordings. Results: The mean value of the RR interval (p = 0.008), standard deviation of N‐N intervals (SDNN) (p < 0.001), very‐low frequency (VLF) (p < 0.001), low‐frequency (LF) (p = 0.001), and high‐frequency (HF) (p = 0.002) spectral components of HR variability, and the Poincaré components SD1 (p = 0.005) and SD2 (p < 0.001) of the patients with refractory epilepsy were significantly lower than those of the control subjects before VNS implantation. The nocturnal increase in HR variability usually seen in the normal population was absent in patients with refractory epilepsy. VNS had no significant effects on any of the HR‐variability indexes despite a significant reduction in the frequency of seizures. Conclusions: HR variability was reduced, and the nocturnal increase in HR variability was not present in patients with refractory epilepsy. One‐year treatment with VNS did not have a marked effect on HR variability, suggesting that impaired cardiovascular autonomic regulation is associated with the epileptic process itself rather than with recurrent seizures.
Late Seizures in Patients Initially Seizure Free after Epilepsy Surgery
Authors: Schwartz Theodore H. , Jeha Lara , Tanner Adrianna , Bingaman William , Sperling Michael R. 
Published: March 2006

Summary:  Purpose: Surgery for medically intractable epilepsy is currently the most effective means of achieving seizure control. Although relatively few long‐term outcome studies have been performed, evidence is mounting that the possibility of late seizure recurrence exists, even after an early seizure‐free period. No published reports document the rate and predictors of late recurrence in a large series of patients undergoing surgery in the magnetic resonance imaging (MRI) era. Methods: We retrospectively queried the databases of two epilepsy surgery centers. Patients eligible for study had preoperative MRI scans, were seizure free for 1 year after surgery, and had a minimal follow‐up period of 3 years. Patients with tumors or vascular lesions were excluded. We performed log‐rank comparison of Kaplan–Meier product limit estimates for categoric variables and used a Cox proportional hazards model for continuous variables. Variables that were significant (p < 0.05) on a univariate screen were entered into a multivariate forward step‐wise Cox regression. Results: The study included 285 patients, 254 with medial temporal lobe (MTLE) and 31 with neocortical epilepsy. The probability of having a single seizure after being seizure free for 1 year was 18.3% at 5 years and 32.7% at 10 years. However, only 13% were not seizure free at the last follow‐up. Predictors of late recurrences on both uni‐ and multivariate analysis were the presence of preoperative generalized tonic–clonic (GTC) seizures in patients with neocortical epilepsy and late age at surgery in patients with MTLE. MRI results and location of surgery were not predictive. Conclusions: Although the risk of at least one recurrent seizure after initially successful epilepsy surgery is relatively high, the rate of recurrent intractability is low. The finding that late age at surgery and presence of preoperative GTC seizures are predictors of late recurrence indicates the importance of patient selection and early surgery for persistent seizure control.
Discontinuation of Anticonvulsant Medication after Epilepsy Surgery in Children
Authors: Hoppe Christian , Poepel Annkathrin , Sassen Robert , Elger Christian E. 
Published: March 2006

Summary:  Purpose: To evaluate the long‐term outcome of medication‐reduction/discontinuation trials after epilepsy surgery in pediatric patients. Methods: Of the total Bonn pediatric surgical sample (1988–2001; n = 251), we were able to obtain postsurgical follow‐up data for 232 patients. We surveyed 140 of these patients by using a standardized telephone interview that addressed medication‐reduction/discontinuation trials. Results: Of the 140 surveyed patients, 102 completely discontinued medication. Seven of these patients had recurring seizures that were controlled again after restarting the medication. Of 102 patients, 101 were completely seizure free during the 3 months before the survey. Postsurgical epileptic events before the trial significantly increased the risk for recurring epileptic events after the trial. Two surveyed patients lost postsurgical seizure freedom after medication reduction. We were also able to identify from the records another nine patients with complete medication discontinuation and seven patients with medication reduction. Two of these latter patients lost postsurgical seizure freedom despite restarting their medication. The total rate of patients with medication‐reduction/discontinuation trials was 55%. The seizure recurrence rate in these patients was 10%. Recurring seizures could not be controlled by restarted medication in 3% of the trials. Currently, 90% of patients with discontinuation trials were seizure free without medication. Conclusions: The reduction/withdrawal of anticonvulsant medication after successful epilepsy surgery has a low risk of seizure recurrence for pediatric patients in long‐term follow‐up, particularly in cases of complete postsurgical seizure freedom before the trial.
Effects of Temporal Lobe Epilepsy on Retrograde Memory
Authors: Lah Suncica , Lee Teresa , Grayson Sandra , Miller Laurie 
Published: March 2006

Summary: Purpose:In a previous investigation (Lah et al., 2004), we found deficits in retrograde memory in patients who had undergone temporal lobectomy (TL). In this study, we set out to determine whether such deficits are present before surgery in patients with temporal lobe epilepsy (TLE).Methods:Memory for public and autobiographic facts and events was assessed in patients with focal left‐sided (n = 15) or right‐sided (n = 14) TLE and healthy control subjects (n = 15). The impact of epilepsy and underlying cognitive deficits on retrograde memory also was examined.Results:Patients with left TLE demonstrated retrograde memory deficits across domains. Patients with right TLE showed defective recall only in the autobiographic domain. Young age at onset (younger than 14 years) was associated with greater difficulties in recall of famous events, and patients receiving polytherapy had significantly reduced recall of autobiographic events compared with those receiving monotherapy. In most cases, deficient memory for the past was associated with impairments in other cognitive skills, especially language abilities.Conclusions: In unoperated‐on patients with TLE, we found deficits in retrograde memory that were similar to those seen after TL, with the pattern of deficits being influenced by side of lesion, anticonvulsant medication, and word‐finding deficits. Unlike patients tested after right TL, patients with right TLE did not have difficulty recalling details of famous events, which raises the possibility that right TL results in a decline in this aspect of retrograde memory.
Prevalence of Childhood Epilepsy and Distribution of Epileptic Syndromes: A Population‐based Survey in Okayama, Japan
Authors: Oka Eiji , Ohtsuka Yoko , Yoshinaga Harumi , Murakami Nagako , Kobayashi Katsuhiro , Ogino Tatsuya 
Published: March 2006

Summary:  Methods: Information on patients younger than 13 years with active epilepsy was collected from medical records. Patients diagnosed with epilepsy according to clinical and EEG findings were put on the list even if those patients had had a single seizure or seizures occurring during febrile episodes. Results: In total, 2,220 cases were identified from a background population of 250,997. The prevalence rate was 8.8 per 1,000. If we exclude patients who had experienced a single seizure or seizures occurring during febrile episodes to compare our results with previous reports, the prevalence rate was 5.3 per 1,000. Of the 2,220 cases, 2,030 (91.4%) were classified into three major categories by ILAE classification. They consisted of 1,556 (76.7%) with localization‐related epilepsy, 453 (22.3%) with generalized epilepsy, and 21 (1.0%) with undetermined epilepsy. Of the 2,030 cases, 309 (15.2%) were classified into epileptic syndrome categories, and 84.8% of the total were nonspecific types of epilepsy. Conclusions: The prevalence rate of childhood epilepsy was distributed from 5.3 to 8.8 per 1,000. The appearance rate of various types of epileptic syndromes was low. Most cases could not be classified into the detailed categories of the International Classification (ILAE, 1989).