bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preliminary efficacy of levetiracetam in monotherapy
Authors: Ben‐Menachem Elinor 
Published: March 2024

ABSTRACT
The standard of care for prescribing antiepileptic drugs (AEDs) has come to favor the use of monotherapy when possible; i.e., when comparable efficacy can be achieved with fewer risks of adverse events and drug interactions. Most patients with epilepsy are started on one of the classic AEDs and, if it proves ineffective, another drug is tried, usually as monotherapy. While most of the newer AEDs that have come into clinical use in recent years are initially used as add‐on therapy, their success at improving seizure control in combination treatments has led to their cautious use as monotherapy even before they have been approved for this indication. As a first study to determine the potential efficacy of levetiracetam in monotherapy, a withdrawal trial model was used. Patients who achieved adequate seizure control with levetiracetam as add‐on therapy in a double‐blind, placebo‐controlled study entered a monotherapy phase of the trial in which the baseline AED was gradually withdrawn. Also, long‐term data of 505 patients who received levetiracetam for refractory partial seizures were reviewed and found to include 49 patients still treated with levetiracetam monotherapy at the end of the study for a duration between 3 months and 5.5 years. Data from patients in the two trials lend supportive evidence that levetiracetam monotherapy is safe and effective for partial seizures.
MR imaging of epilepsy: State of the art at 1.5 T and potential of 3 T
Authors: Briellmann Regula S. , Pell Gaby S. , Wellard R. Mark , Mitchell L. Anne , Abbott David F , Jackson Graeme D. 
Published: March 2024

ABSTRACT
Shortly after being introduced in the nineteen eighties, magnetic resonance imaging (MRI) became a key tool for the investigation of patients with epilepsy, due to its ability to acquire high quality images. The strength of the magnetic field of a scanner is measured in tesla (T). This review addresses the clinical and research potential in epilepsy of MR imaging at 1.5 T and 3 T. A typical clinical scanning protocol at 1.5 T for a patient with refractory epilepsy may include T1‐ and T2‐weighted imaging, fluid‐attenuated inversion recovery (FLAIR) imaging, and a 3D volume acquisition sequence. A research protocol may add quantification of structural imaging, such as volumetric assessment and T2‐relaxometry, together with functional measures, such as MR‐spectroscopy, functional MRI and diffusion weighted sequences. MR‐spectroscopy assesses the metabolites of the seizure focus and other brain areas. Functional MRI allows localisation of cognitive and sensori‐motor function and the ability to assess the spatial relationship of these functions to the seizure focus. Whereas these techniques can be performed at 1.5 T, particularly MR‐spectroscopy and functional MRI benefit from increased magnetic field‐strength. Higher magnetic field‐strength is associated with a higher signal‐to‐noise ratio (SNR). The increased SNR can allow shorter imaging times for a given resolution, higher resolution for a given imaging time, or combination of both. The use of higher magnetic field‐strengths is therefore indicated for the (fast) imaging of ill subjects, for long protocols, including structural, metabolic and functional imaging, and for novel applications, such as continuous EEG recording and functional MRI for the detection of the seizure focus. Disadvantages of MR imaging in epilepsy at a high field‐strength of 3 T and above are, apart from engineering and technical challenges, the greater energy deposition into tissue and increased susceptibility to artefacts. So far, magnets of 3 T and above have been used mainly for research applications, however the benefits of high field‐strength for MR spectroscopy and functional MRI, and the usefulness of these techniques for the investigation of epilepsy patients are obvious incentives for the use of 3 T systems in routine clinical investigations. [Published with neuroimaging sequences.]
Mesial temporal lobe epilepsy with focal photoparoxysmal response
Authors: Fiore Lia A. , Valente Kette , Gronich Gary , Ono Carla R , Buchpiguel Carlos A. 
Published: March 2024

ABSTRACT
Intermittent photic stimulation (IPS) may produce epileptiform discharges and seizures, most of which are generalized. There are several cases of focal seizures of occipital origin induced by IPS and only five reported cases originating from the temporal lobe (TL). We report an unusual case of TL epilepsy, supported by electroclinical and neuroimaging data, with rhythmic focal TL discharges precipitated by photic stimulus. Case report: A 37 year old male with refractory epilepsy due to a right mesial temporal sclerosis presented a focal right TL photoparoxysmal response during IPS. A routine, interictal SPECT study obtained with injection of HMPAO, carried out during continuous pulses of the photic stimulus at 16 Hz, disclosed hyperperfusion over the right TL. Presurgical ictal studies demonstrated seizures arising from the same region. A temporal lobectomy rendered the patient seizure‐free and further EEGs with IPS were normal. Conclusion: To our knowledge, this is the sixth case in medical literature showing evidence of photosensitivity associated with a TL lesion and it is the first in which photic stimulation induced a focal electrographic response of the involved TL. We hypothesize that in rare cases, photosensitivity may be related to a mesial TL lesion without occipital cortex involvement.
Subdural electrodes in focal cortical dysplasia
Authors: Noachtar Soheyl 
Published: March 2024

ABSTRACT
Subdural electrodes are useful in selected patients with cortical dysplasia for planning resective epilepsy surgery. Their potential risks have to be balanced against the diagnostic yield and expected benefit of epilepsy surgery for the patient. Recent advances in imaging techniques now allow more accurate placement of the subdural electrodes and also limit the number required.
Childhood epilepsy: a critical review of cost‐of‐illness studies
Authors: Argumosa Ana , Herranz José Luis 
Published: March 2024

ABSTRACT
Epilepsy is an illness with multiple consequences and costs for children, families and society. There are only a few studies published on the cost of childhood epilepsy. The different methodologies used in these studies make it difficult to compare them or even to compare the cost of childhood epilepsy treatment with that of adult epilepsy. Nevertheless, studies highlight important differences in the distribution of costs associated with childhood epilepsy and epilepsy in adults. It is understandable that direct costs represent the higher percentage of the total cost associated with childhood epilepsy treatment, given the higher number of hospital admissions and investigations, as well as the complexity of therapeutic trials, while indirect costs represent the greater proportion in adult epilepsy treatment. In addition to age, the total cost associated with epilepsy also depends on other factors such as seizure frequency, the moment at which the illness cost is estimated and the local health care system. In summary, chronic illnesses not only have an influence on the physical and psychological development of children, they also impose costs on the family and society. Childhood epilepsy has greater economic costs than those generated by more prevalent, chronic illnesses.
Memory function decline over 18 months after selective amygdalohippocampectomy
Authors: Ogino Tatsuya , Ohtsuka Yoko , Ido Yumiko , Mayanagi Yoshiaki , Watanabe Eiju , Oka Eiji 
Published: March 2024

ABSTRACT
We report on a 22 year‐old woman with left temporal lobe epilepsy who had suffered complex partial seizures since childhood. At 19 years 10 months of age she underwent selective amygdalohippocampectomy, which resulted in a complete cessation of seizures. Preoperatively, the Logical Memory II section of the WMS‐R revealed poor logical memory function. Postoperatively, the patient's scores on several neuropsychological tests had deteriorated, namely, the Miyake Paired‐Associate Word Learning Test (related and unrelated pairs), several sections of the WMS‐R (Figural Memory, Logical memory I, Visual Reproduction II, Visual Paired Associates I, and Verbal Paired Associates I and II), and the BVRT‐R. In particular, her scores on the Visual Paired Associates I, Verbal Paired Associates I and II sections of the WMS‐R, and the BVRT‐R not only declined at one and three months post‐surgery, but also showed progressive deterioration at 16 and 18 months post‐surgery. It should be kept in mind that selective amygdalohippocampectomy can result in progressive postoperative, deterioration in some aspects of memory function.
Adverse motor effects induced by antiepileptic drugs
Authors: Zaccara G. , Cincotta M. , Borgheresi A. , Balestrieri F. 
Published: March 2024

ABSTRACT
Cognitive effects of anti‐epileptic drugs (AEDs) have been already extensively reported. In contrast, motor disturbances, frequently induced by these drugs, have not received similar attention. We review subjective and objective adverse motor effects of traditional and new AEDs. We discuss the methodological issues caused by the heterogeneous sources of information on drug adverse effects (controlled clinical studies, open studies, and case reports). We describe specific disturbances (vestibulocerebellar, dyskinesias, parkinsonism, tics, myoclonus, and tremor) as the effects of different AEDs on distinct motor circuitries. Finally, we summarize the role of sophisticated technical studies which provide a valuable insight into the specific or subtle effects of AEDs on the central nervous system.
Infection du système nerveux central et épilepsies
Authors: Vespignani Hervé , Najjar A. Al , Kremer S. , Maillard L. 
Published: March 2024

RÉSUMÉ
La survenue récente de crises d'épilepsie (CE) partielles, partielles secondairement généralisées ou apparemment généralisées d'emblée de type tonicocloniques représente une circonstance diagnostique fréquente d'une infection du système nerveux central (méningites, encéphalites, abcès unique ou multiples, empyhèmes sous‐duraux). Le déclenchement d'un état de mal d'origine infectieuse correspond à un facteur de gravité dans la prise en charge thérapeutique. Le diagnostic évoqué selon le contexte clinique, l'origine géographique, est confirmé par le scanner ou l'IRM encéphalique dont les aspects peuvent être caractéristiques d'une étiologie parasitaire, mycotique, bactérienne ou virale. La normalité des explorations morphologiques n'écarte pas cependant l'origine infectieuse de CE récentes, notamment d'une méningite quel que soit l'âge, mais surtout chez l'enfant. De même, la survenue de CE au cours d'une méningite doit faire rechercher un abcès cérébral. Le traitement antiépileptique à la phase aiguë est de règle. Ses indications à distance dans le but de prévenir une épilepsie séquellaire dépendent du type d'infection et des possibilités de thérapeutiques anti‐infectieuses. Le risque de récidive de CE est le plus important en cas d'encéphalite ou d'abcès cérébral. Dans un contexte traumatique, l'infection du système nerveux central majore le risque de survenue d'une CE post‐traumatique.
Temporal lobe epilepsy: clinical semiology and age at onset
Authors: Villanueva Vicente , Serratosa José Maria 
Published: March 2024

ABSTRACT
The objective of this study was to define the clinical semiology of seizures in temporal lobe epilepsy according to the age at onset. We analyzed 180 seizures from 50 patients with medial or neocortical temporal lobe epilepsy who underwent epilepsy surgery between 1997‐2002, and achieved an Engel class I or II outcome. We classified the patients into two groups according to the age at the first seizure: at or before 17 years of age and 18 years of age or older. All patients underwent intensive video‐EEG monitoring. We reviewed at least three seizures from each patient and analyzed the following clinical data: presence of aura, duration of aura, ictal and post‐ictal period, clinical semiology of aura, ictal and post‐ictal period. We also analyzed the following data from the clinical history prior to surgery: presence of isolated auras, frequency of secondary generalized seizures, and frequency of complex partial seizures. Non‐parametric, chi‐square tests and odds ratios were used for the statistical analysis.

There were 41 patients in the “early onset” group and 9 patients in the “later onset” group. A relationship was found between early onset and mesial temporal lobe epilepsy and between later onset and neocortical temporal lobe epilepsy (p = 0.04). The later onset group presented a higher incidence of blinking during seizures (p = 0.03), a longer duration of the post‐ictal period (p = 0.07) and a lower number of presurgical complex partial seizures (p = 0.03). The other parameters analyzed showed no significant differences between the two groups. We conclude that clinical and semiological differences exist between patients with temporal lobe epilepsy according to the age at onset.
[Published with video sequences]
Improving quality of life beyond seizure control
Authors: Schachter Steven C. 
Published: March 2024

ABSTRACT
More than 50 years ago, Lennox and Markham urged physicians who treated patients with epilepsy to “match modern drug and surgical therapy with practical sociopsychological therapy” and to be “concerned not only with turbulent brain waves but with disturbed emotions”. Indeed, while seizure frequency and severity correlate with quality of life and psychosocial outcomes for patients with drug‐resistant epilepsy, numerous other epilepsy‐related factors may also be significant determinants. These factors include medical and psychiatric co‐morbidities, side effects of therapy, stigma, parental anxiety, employment status, seizure worry, self‐esteem and self‐mastery. Importantly, these epilepsy‐related factors may be amenable to educational or therapeutic interventions, which if successful may benefit patients even without a concomitant reduction in seizure frequency or severity. Therefore, while further research is needed, physicians and other health care providers should comprehensively attend to these factors and refer patients with treatment‐resistant seizures, when appropriate, for further evaluation and treatment to improve their quality of life beyond seizure control.
Implacable images: why epileptiform events continue to be featured in film and television
Authors: Kerson Toba Schwaber , Kerson Lawrence A. 
Published: March 2024

ABSTRACT
Epileptiform events have been portrayed in film since 1900 and on television since the 1950's. Over time, portrayals have not reflected medicine's understanding of epilepsy. At present, it is unlikely that individuals who do not have a close relationship with someone with a seizure‐disorder will witness a seizure. Because fictive and often incorrect images appear increasingly, many think of them as accurate depictions. The research addresses three questions in relation to these images: How do directors use the images? Why do uses of seizures in visual media not reflect contemporary scientific knowledge? Why have they persisted and increased in use? Data consist of material from 192 films and television episodes. The general category of seizures includes seizures in characters said to have epilepsy or some other condition, seizures related to drug or alcohol use, pseudoseizures and feigned seizures, and, a category in which, for example, someone is described as “having a fit.” The research demonstrates how epileptiform events drive the narrative, support the genre, evoke specific emotional reactions, accentuate traits of characters with seizures, highlight qualities of other characters through their responses to the seizures, act as catalysts for actions, and enhance the voyeuristic experience of the audience. Twenty video sequences are included in the manuscript. The authors conclude that the visual experience of seizures remains so enthralling that its use is most likely to increase particularly on television, and that as the public has less experience with real seizures, depictions in film will continue to be more concerned with what the image can do for the show and less interested in accurate portrayals. Ways to influence depictions are suggested.

[Published with video sequences]
Intractable cryptogenic frontal lobe epilepsy in a patient with MURCS association
Authors: Dericioglu Nese , Saygi Serap 
Published: March 2024

ABSTRACT
The MURCS association is a rare, nonrandom association of müllerian duct aplasia, renal aplasia and cervicothoracic somite dysplasia. The etiology is unknown. Although it is usually a sporadic disorder, familial cases with uterovaginal anomalies have been reported. Occasionally, it may be accompanied by abnormalities involving various other organs or systems. Malformations related to the central nervous system are very rare and the presence of seizures has not been reported previously. We present a 26‐year‐old female with MURCS association who had late onset, drug resistant partial seizures presumably originating in the frontal lobe.
Progressive myoclonic epilepsies: myth or reality?
Authors: Genton Pierre , Bureau Michelle 
Published: March 2024

ABSTRACT
The progressive myoclonus epilepsies (PME) are rare diseases and many clinicians, who have only few opportunities to encounter such patients, may think of them as mythical. However, the category of PME has been retained by the latest classification scheme proposal of the International League Against Epilepsy. PMEs are defined by: 1) generalized epileptic seizures (focal seizures may also occur in certain etiologies), 2) a sometimes invalidating myoclonus, and 3) other neurological symptoms (ataxia, dementia, sensory deficits) that vary according to etiology. Indeed, PMEs are a heterogenous group of conditions, with diverse etiologies. Their prevalence varies according to the ethnic context, and PMEs may appear as fairly frequent in some settings, because of genetic factors (isolate and/or inbreeding, for instance, in PMEs with recessive inheritance). The genetic and biochemical mechanisms underlying PMEs are increasingly recognized. We must nowadays follow a logical diagnostic scheme that will take into account the ethnic and genetic context, the age at onset of symptoms and the respective weight of symptoms. New therapeutic approaches are under development, and the available purely symptomatic treatments can be used to best possible effect. It is thus possible to recognize PMEs as a group of conditions appearing either as epilepsy, or as a movement disorder, or still under the mask of various neurological or cognitive symptoms. It is also possible to organize a logical, comprehensive care for patients with PME.
Towards a definition of the “practical” epileptogenic zone: a case of epilepsy with dual pathology
Authors: Chassagnon Serge , Valenti Maria Paola , Sabourdy Cécile , Esposito Philippe , Kehrli Pierre , Arzimanoglou Alexis , Ryvlin Philippe , Kahane Philippe , Hirsch Edouard 
Published: March 2024

ABSTRACT
Presurgical evaluation for patients with drug‐resistant epilepsy requires the definition of various zones that have a variable spatial relationship with the epileptogenic zone. All the available mehods to directly measure the actual seizure‐onset zone and to define “the minimum amount of cortical tissue that must be resected to produce seizure‐freedom” have significant limitations. We report on the case of a patient with dual pathology (hippocampal sclerosis and a post‐traumatic scar) and discuss the contribution of the various presurgical investigations that led to surgery and seizure‐freedom.
Euphoric (hedonic) theta hypersynchrony in early childhood
Authors: Koutroumanidis Michael 
Published: March 2024

ABSTRACT

Euphoric or hedonic theta hypersynchrony appears to be an unusual finding in the electroencephalography of the child, and it has been rarely reported. This case report presents a 4‐year‐old child who responded to pleasurable stimulation with a robust, diffuse theta activity, and also samples some of the thoughts that such a response can generate.
[Published with video sequences]
A clinical study to compare the efficacy of crushing of middle turbinate with lateral partial turbinectomy for concha bullosa
Authors: Ninnekar Savita Z. , Gadag Raveendra P. , Doreyawar Venkatesh , Jasmine Kadeeja P. 
Published: March 2024

Background: Concha bullosa (CB), a pneumatized middle turbinate is most common variations of sino-nasal anatomy. Identified in approximately ~35% (range 14-53%) of patients, a large CB cause nasal obstruction, recurrent sinus infections and headache, may develop into mucocele or mucopyocele or affect olfaction. Endoscopic lateral partial turbinectomy (LPT) is the standard procedure for the treatment of CB. However, the recurrence of contact points and postoperative synechiae with subsequent frontal recess obstruction are common complications of this technique. Crushing of a pneumatized turbinate preserves the mucosa, less time consuming and carry less risk of complications. The aim of the study was to compare the efficacy of crushing with LPT for the treatment of CB.
Methods: This was a prospective cohort study conducted by convenient sampling in the Department of ENT, KIMS, Hubli, Karnataka, India. In 53 patients, 43 with unilateral and 10 with bilateral CB satisfying the inclusion and exclusion criteria were subjected to either crushing (group A) or LPT (group B). The success of both techniques were compared based on the relief of symptoms assessed by the visual analogue scale, nasal endoscopy and computed tomography (CT) scan after 6 months of surgery.
Results: The overall success rate of the outcome was equal between the two groups, with no statistical (p>0.05) difference.
Conclusions: Crushing the CB is as efficient as LPT for the treatment of pneumatized middle turbinate. However, surgically crushed CB can get re-pneumatization in some patients.
Unraveling a rare medical anomaly: a case report on the incidental discovery of a mixed fungal ball with parasitic elements
Authors: Ahmed Saud , Kunnumal Ayisha , Koratagere Prathima , Rane Vishakha Vijay 
Published: March 2024

Fungal ball is a type of fungal rhinosinusitis (FRS) that is chronic, non-invasive, and extramucosal. A fungal ball is a non-invasive accumulation of dense conglomeration of fungal hyphae in one sinus cavity Sinonasal fungal ball is known to be the most common form of fungal sinusiti. It typically affects immunocompetent individuals and appears as a unilateral lesion between the fourth and sixth decades of life. The most commonly involved sinus is the maxillary sinus. Patients are often asymptomatic, but some patients develop chronic mucopurulent rhinorrhea. Treatment is surgical, with removal of the fungal contents of the involved sinus, and no subsequent treatment is indicated, given the process is noninvasive. Here in we report the case of a 64-year-old gentleman diagnosed with fungal ball of maxillary sinus. Patient was asymptomatic and the fungal ball was identified as an incidental finding on imaging for stroke. The histopathological examination necrotizing lesion showing entangled septate, aseptate and pigmented fungal structures and non-viable parasitic structures noted. No viable tissue was seen.
Carbon dioxide laser: a novel approach for vallecular cyst excision in pediatric population
Authors: Shendge Neha Anand , Panja Shantanu , Bose Alokendu , Ghosh Suvojit 
Published: March 2024

In the pediatric population, vallecular cysts are most commonly found at the base of the tongue and the vallecula. They may present with sudden, life-threatening airway obstructions due to their anatomical position. A 4-year-old presented with a change in voice from the past 2 months and was diagnosed with a vallecular cyst. The patient was planned to undergo CO2 laser micro-laryngeal surgery due to its precision and accuracy. In postoperative studies, the emerging CO2 laser technology demonstrated superior results. In particular, in complex cases, this innovative approach has the potential to achieve the desired results.