bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Removal of Phenytoin, Carbamazepine, and Valproate on Cognitive Function
Authors: Duncan John S. , Shorvon Simon D. , Trimble Michael R. 
Published: November 2007

Summary: Changes in cognitive function were noted in a double‐blind, prospective, placebo‐controlled study of discontinuation of phenytoin (PHT), carbamazepine (CBZ), and valproate (VPA) in 58 patients with active epilepsy, receiving multiple antiepileptic drugs (AEDs). A control group of 25 patients continued with existing therapy. A simple test battery, which would be directly applicable to a clinical setting, with measures of mental speed, attention, performance of a learned skill, shortterm memory, concentration, and simple coordinated hand movements was used. Cognitive assessments were made before and at the end of discontinuation of a drug and 4 weeks later. Simple motor skills became faster on discontinuation of PHT, CBZ, and VPA (p < 0.0005), with a further improvement in the subsequent 4 weeks (p = 0.03) and no significant difference between the AEDs. Performance on a measure of attention and concentration improved on discontinuation of PHT (p = 0.005) and did not alter with removal of CBZ or VPA; the improvement in the PHT discontinuation group was significantly different from that in the control group (p = 0.001). These results suggest that all three AEDs studied may adversely affect motor function and that PHT may be more deleterious to function in higher cognitive tasks than is CBZ or VPA.RÉSUMÉLes auteurs ont étudié les modifications des fonctions cognitives relevées lors d'une étude prospective, en double‐aveugle, contrôlées contre placebo, de l'arrêt de la phénytoine (PHT), de la carbamazépine (CBZ) et du valproate (VPA) chez 58 patients présentant une épilepsie active, traités par une polythérapie. Un groupe contrôle de 25 patients a été maintenu sous le traitement antérieur. Une simple batterie de tests, tout à fait transférable à une situation clinique habituelle, a permis de mesurer la rapidité mentale, l'attention, la réalisation d'une tâche apprise, la mémoire à court terme, la concentration, et les mouvements simples des mains. L'évaluation cognitive a été effectuée avant et à la fin de l'arrêt du médicament, ainsi que 4 semaines plus tard. Les performances motrices simples sont devenues plus rapides après arrêt de PHT, CBZ et valproate (p < 0.0005), avec une amélioration encore accentuée pendant les 4 semaines suivantes (p = 0.03), sans qu'il y ait eu de différences significatives entre les différentes drogues. Les performances d'attention et de concentration ont été améliorées après arrêt de la PHT (p = 0.005), mais n'ont pas été modifiées après l'arrêt de CBZ ou de VPA; l'amélioration du groupe d'arrêt de la phénytoine a évé significativement différente de celle du groupe contrôle (p = 0.001). Ces résultats suggèrent que les 3 antiépileptiques étudiés peuvent retentir sur la fonction motrice, et que la PHT peut Être plus nocive sur les fonctions cognitives supérieures que la CBZ ou le VPA.
Gaze‐Evoked Visual Seizures in Nonketotic Hyperglycemia
Authors: Duncan Max B. , Jabbari Bahman , Rosenberg Michael L. 
Published: November 2007

Summary: Focal motor seizures are commonly a symptom of nonketotic hyperglycemia (NKH). Posture‐induced motor seizures are less common but have been reported in some patients with this disorder. We report the first case of gaze‐evoked sensory (visual) seizures in nonketotic hyperglycemia. Both seizures and ictal ÉEG findings disappeared shortly after hyperglycemia was corrected.RÉSUMÉDes crises motrices focales sont un symptôme fréquent de l'hyperglycémie non cétosique. Des crises motrices induites par la posture sont moins fréquentes et ont été rapportées chez quelques patients présentant cette affection. Les auteurs rapportent le premier cas de crises sensorielles (visuelles) provoquées par la fixation dans le cadre d'une hyperglycémic non cétosique. Les crises et les constatations ÉEG critiques ont disparu rapidement après correction de l'hyperglycémie.ZUSAMMENFASSUNGEin Symptom der nicht‐ketotischen Hyperglykämie sind gewöhnlich fokal‐motorische Anfälle. Haltungsinduzierte motorische Anfälle sind weniger häufig, wurden jedoch bei einigen Patienten mit dieser Erkrankung berichtet. Wir berichten über den ersten Fall von durch Starren hervorgerufenen, sensorischen (visuellen) Anfällen bei nichtketotischer Hyperglykämie. Sowohl Anfälle als auch iktale ÉEG‐Befunde verschwanden kurz nach Besserung der Hyperglykämie.
Seizure‐Induced Protein Tyrosine Phosphorylation in Rat Brain Regions
Authors: Jope Richard S. , Johnson Gail V. W. , Baird M. Shane 
Published: November 2007

Summary: Phosphorylation of protein tyrosines is an important modulatory process for cell signaling and other cellular functions. Rat brain regions were examined for altered protein phosphotyrosines, using Western blot analysis and microwave irradiation to limit postmortem alterations, after administration of two convulsants: lithium plus pilocarpine or kainic acid (KA). Most phospho‐tyrosine proteins were unaltered by these treatments, but there was a large, specific increase in the tyrosine phosphorylation of a 40‐Kd protein. This increase was evident in all three regions examined: cerebral cortex, hippocampus, and striatum; it occurred abruptly with onset of generalized status epilepticus (SE) and remained elevated for at least 90 min. Most of the tyrosine phosphorylated 40‐Kd protein was in the cytosolic fraction. These results demonstrate a large, specific effect of chemically induced seizures on a single phosphotyrosine protein in rat brain.RÉSUMÉLa phosphorylation des tyrosines protéiques est un processus de modulation important pour la communication intercellulaire et d'autres fonctions cellulaires. Des régions cérébrales de rat ont été examinées a la recherche de modification de phosphoty‐rosines protéiques, au moyen d'une analyse de type Western blot et d'une irradiation par micro‐ondes afin de limiter les altérations post‐mortem, aprés administration de 2 produits convulsivants, lithium + pilocarpine ou acide kainique. La plupart des protéines avec phosphotyrosines n'étaient pas modifées par ces traitements, les auteurs ont constaté une augmentation importante, spécifique de la phosphorylation de la tyrosine dans une protéine 40 kD. Cette élévation a été mise en eAvidence au niveau des 3 régions cérébrates examinées, le cortex cérébral, ľhippo‐campe et le striatum. Cette augmentation s'est produite de façon brutale au moment de la mise en place d'un état de mal généralisé, ľéiévation s'est maintenue pendant au moins 90 mn. La majorité de la protéine 40 kD avec tyrosine phosphoryiée a été trouvée au niveau de la fraction cytosolique. Ces résultats démontrent un effet important, spécifique des crises induites par convulsivants chimiques, sur une protéine particuliére du cerveau du rat.
Chronic, Habitual Cocaine Abuse and Kindling‐Induced Epilepsy: A Case Report
Authors: Dhuna Anil , Pascual‐Leone Alvaro , Langendorf Frederick 
Published: November 2007

Summary: Kindling has been suggested as a possible mechanism for cocaine‐induced seizures in chronic cocaine abusers, even though no convincing examples have been reported. We report a 37‐year‐old woman who initially experienced generalized tonic‐clonic seizures (GTC) only immediately after “crack” use. She had a normal examination, negative family or past history for seizures, and normal cranial computed tomography and EEG. After she had abused cocaine almost daily for 2 years, her EEG demonstrated bitemporal slowing with independent spikes, and seizures were no longer temporally associated with acute cocaine use. Thereafter, despite complete abstinence from cocaine and treatment with phenytoin, she continued to experience four to six GTC a month. In light of the lack of other predisposing factors for epilepsy, this case may represent an example of cocaine‐induced kindling in humans.RESUMENA pesar de que no se han publicado ejemplos convincentes se ha sugerido que un proceso de condicionamiento (kindling) po‐dría ser el mecanismo de los ataques inducidos por la cocaina en adictos a esta droga. Publicamos una mujer de 37 años que, inicialmente, experimentó ataques generalizados tónico‐clónicos (GTC) solo inmediatamente después de usar “crack.” La exploratión clinica era normal y la historia familiar o personal negativa para ataques con un CT y un EEG normales. Tras 2 años de abuso casi diario de cocaina el EEG demostró una lentificación bitemporal con puntas independientes en el EEG. Los ataques ya no se asociaban temporalmente al uso agudo de cocaina. Después, y a pesar de una abstinencia completa y con un trat‐amiento con fenitoina, continuó con 4–6 GTC al mes. Al no existir otros factores que predisponen a padecer epilepsía, este caso puede representar un ejemplo de “kindling” (condicionamiento) por cocaina en humanos.
Reflex Epilepsy Induced by Calculation Using a “Soroban,” a Japanese Traditional Calculator
Authors: Yamamoto Junji , Egawa Isao , Yamamoto Shinobu , Shimizu Akira 
Published: November 2007

SUMMARY: We report three cases of reflex epilepsy with myoclonic jerks of the right arm and fingers precipitated by calculation using a Soroban, An EEG spike‐wave complex with left central prevalence was induced. Various types of stimulation were used to induce epileptic discharges, and a simultaneous mental task requiring a high degree of concentration and complicated and delicate finger movements was necessary to induce the epileptic discharges. Comparison of our cases with previously reported reflex epilepsy induced by higher mental activity led to the assumption that the neural mechanism inducing seizures in our cases is similar to that of writing epilepsy. Valproate was effective in reducing epileptic discharges, and all patients became seizure‐free.RÉSUMÉLes auteurs rapportent 3 cas d'épilepsie réflexe avec secousses myocloniques du bras droit et des doigts, provoqués par le calcul au moyen d'un soroban. Sur l'EEG, des pointes‐ondes prédominant sur la région centrale gauche ont également été induites. Différents types de stimulations ont été réalisés, et les auteurs ont constaté qu'il était indispensable qu'il y ait de façon simultanée un travail mental impliquant un degréélevé de concentration et des mouvements compliqués et délicats au niveau des doigts, pour obtenir l'induction des décharges épileptiques. La comparaison entre ces cas et ceux ayant rapporté une épilepsie réflexe induite par une activité mentale a conduit les auteurs àévoquer un mécanisme semblable à celui qui provoque les crises dans l'épilepsie de l'écriture. Le valproate s'est montré efficace dans la réduction des décharges et tous les patients ont été totalement contrôlés par ce médicament.ZUSAMMENFASSUNGWir berichten über 3 Fälle von Reflexepilepsie mit myoklonischen Zuckungen von rechtem Arm und Fingern, die durch Benutzung des Soroban augelöst wurden und im EEG mit linkszen‐traler Betonung von spike‐wave‐Komplexen einhergingen. Verschiedene Stimulations‐Modi wurden angewandt um epileptische Entladungen auszulösen: nur hohe Konzentration und komplizierte, feine Fingerbewegungen konnten epileptische Entladungen auslösen. Wenn wir unsere Fälle mit den bisher beschriebenen Reflexepilepsien vergleichen, die jeweils durch höhere mentale Aktivität ausgelöst wurden, kommen wir zu der Annahme, daβ die Anfälle induzierenden neuralen Mechanismen von unseren Fällen den der Schreibepilepsie ähnlich sind. Die epileptischen Entladungen sprachen gut auf Valproat an, die Patienten wurden anfallsfrei.
Photosensitive Epilepsies and Photoconvulsive Responses in Arabs
Authors: Obeid T. , Daif A. K. , Waheed G. , Yaqub B. , Panayiotopoulos C. P. , Tahan A. R. , Shamena A. 
Published: November 2007

SUMMARY: The occurrence of photosensitivity (PS) was examined in 327 Arabs ≥15 years of age with epilepsy by intermittent photic stimulation (IPS). A control group of 192 nonepileptic Arabs ≥15 years of age were also examined by IPS. Of the epileptic patients, 24 (7.3%) were photosensitive, an incidence comparable to that in whites in contradistinction to the reported rarity among African blacks. This finding indicates that environmental factors, particularly excessive sunshine, does not appear to influence the occurrence of PS among epileptic patients. The occurrence of PS among epileptic patients may depend more strongly on the presence of an epileptic syndrome known to have association with PS.RÉSUMÉLa survenue d'une photosensibilité a étéétudiée chez 327 patients arabes présentant une épilepsie, âgés de 15 ans et plus. Un groupe contrôle de 192 arabes non épileptiques âgés de 15 ans et plus a également été examiné au moyen d'une stimulation lumineuse intermittente. Parmi les patients épileptiques, 24 (7.3%) présentaient une photosensibilité. Cette incidence est comparable à celle constatée dans les populations caucasiennes, en contraste avec la rareté de ce trait parmi les noirs africains. Ces constatations indiquent que les facteurs d'environnement, particulièrement l'ensoleillement excessif, ne semblent pas influencer la survenue d'une photosensibilité parmi les patients épileptiques. La survenue d'une photosensibilité chez les patients épileptiques pourrait dépendre davantage de la présence d'un syndrome épileptique fortement associéà la photosensibilité.RESUMENLa aparición de fotosensibilidad (PS) ha sido examinada en 327 árabes con epilepsía de 15 años de edad y mayores. También se examinó un grupo control de 192 árabes de 15 años y mayores pero no epilépticos. Del grupo de epilépticos, 24 (7.3%), fueron fotosensibles lo que constituye una incidencia comparable a la publicada entre los individuos caucasianos y está en contradictión con lo que se ha publicado como una rareza entre los negros africanos. Este hallazgo indica factores ambientales, particularmente el excesivo sol, no parecen influenciar la aparición de PS entre los enfermos epilépticos. La presencia de PS en enfermos epilépticos puede depender más de la presencia de un síndrome epiléptico que, en si, muestra una fuerte asociación con la PS.ZUSAMMENFASSUNGDas Auftreten von Photosensibilität (PS) wurde bei 327 Ara‐bern mit Epilepsie nach dem 15. Lebensjahr untersucht. Als Kontrollgruppe dienten 192 nicht‐epileptische Personen ab 15 Jahren. Von den Epilepsiekranken waren 24 (7.3%) photosensibel. Dies entspricht der Häufigkeit bei Kaukasiern, nicht aber der schwarzer Afrikaner, die seltener PS aufweisen. Diese Ergebnisse zeigen, daß Umweltfaktoren wie starke Sonneneinstrahlung das Auftreten von PS nicht beeinflussen. Das Merkmal PS bei epileptischen Patienten könnte eher von der Existenz eines epileptischen Syndroms abhängig sein, welches eng mit der PS verbunden ist.
New Antiepileptic Drugs: From Serendipity to Rational Discovery
Authors: Porter Roger J. , Rogawski Michael A. 
Published: November 2007

Summary: Antiepileptic drug discovery has made enormous progress from the serendipity and screening processes of earlier days to the rational drug development of today. The modern era of research began with the recognition that enhancement of inhibitory processes in the brain might favorably influence the propensity for seizures, γ‐aminobutyric acid (GABA) being the main inhibitory transmitter. Work in this field led to the development of vigabatrin, which inhibits the enzyme responsible for the degradation of GABA. More recently, research has focused on the therapeutic potential of blocking excitatory amino acids—in particular glutamate. Of the three receptors for glutamate, the N‐methyl‐d‐aspartate (NMDA) receptor is considered the one of most interest in epilepsy, and research on a series of competitive NMDA receptor antagonists—especially those that are orally active—is in the forefront of antiepileptic drug development today. A further alternative for diminishing neuronal excitability is to modulate sodium, potassium, or calcium channels. The latter are especially implicated in absence seizures.Antiepileptic drug discovery has evolved from serendipity through random screening to a scientific era where drugs are designed rationally according to modern principals of neuroscience and the art of medicinal chemistry. Of the research directions currently being pursued, the following appear to be particularly promising: enhancement of inhibition, reduction in excitation, and modulation of the ionic channels that are the fundamental mediators of neuronal excitability. The application of modern approaches to drug discovery provides some optimism that effective new compounds will be marketed in the coming decade, with the promise of diminished suffering by persons with uncontrolled epilepsy.
Pharmacologic Advantages of Antiepileptic Drug Monotherapy
Authors: Perucca Emilio 
Published: November 2007

SummaryDespite recent trends in re‐evaluating the effects of antiepileptic drug (AED) combinations, monotherapy remains the mainstay for treatment of epilepsy. Most patients with newly diagnosed epilepsy can become seizure‐free with administration of an appropriately selected AED, and a significant proportion (20–40%) of those refractory to initial treatment may respond after changing to monotherapy with an alternative AED. Monotherapy is also superior to polytherapy in terms of safety and tolerability. The incidence and severity of side effects increase in proportion to the number of AEDs received by the patient. In patients receiving monotherapy, dosage can be more easily optimized because the effects of individual AEDs can be evaluated separately. Additional advantages of monotherapy include lower treatment costs, simpler dosing schedule (expected to maximize compliance), and avoidance of adverse AED interactions. Admittedly, there are patients who may respond better to AED combinations, but the number is relatively small and, in some cases, the improvement in seizure control produced by an added AED may be more than offset by an excessive burden of side effects.
[11ClFlumazenil PET in Patients with Epilepsy with Dual Pathology
Authors: Juhász Csaba , Nagy Ferenc , Muzik Otto , Watson Craig , Shah Jagdish , Chugani Harry T. 
Published: November 2007

Summary: Purpose: Coexistence of hippocampal sclerosis and a potentially epileptogenic cortical lesion is referred to as dual pathology and can be responsible for poor surgical outcome in patients with medically intractable partial epilepsy. [11C]Flumazenil (FMZ) positron emission tomography (PET) is a sensitive method for visualizing epileptogenic foci. In this study of 12 patients with dual pathology, we addressed the sensitivity of FMZ PET to detect hippocampal abnormalities and compared magnetic resonance imaging (MR1) with visual as well as quantitative FMZ PET findings. Methods: All patients underwent volumetric MRI, prolonged video‐EEG monitoring, and glucose metabolism PET before the FMZ PET. MRI‐coregistered partial volume‐corrected PET images were used to measure FMZ‐binding asymmetries by using asymmetry indices (AIs) in the whole hippocampus and in three (anterior, middle, and posterior) hippocampal subre‐gions. Cortical sites of decreased FMZ binding also were evaluated by using AIs for regions with MRI‐verified cortical lesions as well as for non‐lesional areas with visually detected asymmetry. Results: Abnormally decreased FMZ binding could be detected by quantitative analysis in the atrophic hippocampus of all 12 patients, including three patients with discordant or in‐ conclusive EEG findings. Decreased FMZ binding was restricted to only one subregion of the hippocampus in three patients. Areas of decreased cortical FMZ binding were obvious visually in all patients. Decreased FMZ binding was detected visually in nonlesional cortical areas in four patients. The AIs for these nonlesional regions with visual asymmetry were significantly lower than those for regions showing MRI lesions (paired t test, p = 0.0075). Conclusions: Visual as well as quantitative analyses of FMZ‐binding asymmetry are sensitive methods to detect decreased benzodiazepine‐receptor binding in the hippocampus and neocortex of patients with dual pathology. MRI‐defined hippocampal atrophy is always associated with decreased FMZ binding, although the latter may be localized to only one sub‐region within the hippocampus. FMZ PET abnormalities can occur in areas with normal appearance on MRI, but FMZ‐binding asymmetry of these regions is lower when compared with that of lesional areas. FMZ PET can be especially helpful when MRI and EEG findings of patients with intractable epilepsy are discordant.
Function‐Specific High‐Probability “Nodes” Identified in Posterior Language Cortex
Authors: Schwartz Theodore H. , Devinsky Orrin , Doyle Werner , Perrine Kenneth 
Published: November 2007

Summary: Purpose: Posterior, “Wenicke's,” language areas have a high degree of between‐subject variability, as shown by electrical‐stimulation mapping. We investigated the possibility of an organized structure in the distribution of posterior language areas. Methods: Extraoperative subdural grid stimulation was performed on 67 left hemisphere‐dominant patients before resec‐tive epilepsy surgery during counting, naming, and reading. Intersubject‐averaged language maps were generated in which stimulation disrupted only one language function and not the others, or combinations of language functions. Results: Language sites, although highly variable between subjects, were not organized randomly and appeared to be arranged into several focal, non‐contiguous, higher probability “nodes” devoted to different aspects of language processing. Speech‐arrest sites were concentrated in classic Wernicke's area. Areas where stimulation induced only reading errors were found in the posterior middle temporal gyrus and the inferior parietal lobule. These regions may correspond with an orthographic input lexicon. Areas eliciting only naming errors were found in the posterior inferior temporal gyrus extending into the mid‐middle temporal gyrus and may represent a visual‐representation input lexicon. Sites where stimulation elicited errors in both naming and reading were more variable in location than sites devoted to only one function, extended farther anteriorly along the temporal neocortex, and may correspond with a semantic lexicon. Conclusions: The existence of high‐probability nodes in posterior language cortex supports a modality‐specific modular architecture and the possibility of a conserved, universal structure.