bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Potential for Vigabatrin‐Induced Intramyelinic Edema in Humans
Authors: Cohen Jeffrey A. , Fisher Robert S. , Brigell Mitchell G. , Peyster Robert G. , Sze Gordon 
Published: August 2005

Summary: Purpose: Vigabatrin (Sabril, Hoechst Marion Roussel) is an antiepilepsy drug (AED) presently marketed in 64 countries for the treatment of partial and secondarily generalized seizures. Vigabatrin (VGB) is marketed in a subset of these countries for the treatment of infantile spasms. Clinical experience in humans has shown that VGB provides effective seizure control with a wide margin of safety. However, animal toxicity studies raised concern when prolonged administration of VGB was shown to induce intramyelinic edema (IME) in some laboratory animal species. Methods: Animal and human data were reviewed with respect to the potential for VGB‐induced IME. Surveillance of patients receiving VGB in clinical trials or by prescription has been conducted for <15 years to identify patients developing clinical abnormalities that might be IME related. Results: The histologic lesions of VGB‐induced IME in animals are reliably reproduced and correlate with changes in multimodality evoked potentials (EPs) and magnetic resonance imaging (MRI). Numerous studies of the effects of VGB on EP and MRI in epilepsy patients have demonstrated no clear‐cut IME‐related changes in these modalities. Additionally, autopsy and surgical brain samples from VGB‐treated patients have been scrutinized for potential IME histopathology. In an estimated 350,000 patient‐years of VGB exposure (‐175,000 patients exposed for 2 years at an average dose of 2 g/day), no definite case of VGB‐induced IME has been identified. Conclusions: Comprehensive review of a variety of sources of data failed to identify any definite case of IME in humans treated with VGB.
The Value of Early Postictal EEG in Children with Complex Febrile Seizures
Authors: Maytal J. , Steele R. , Eviatar L. , Novak G. 
Published: August 2005

Summary: Purpose: To assess the usefulness of an early post‐ictal EEG in neurologically normal children with complex febrile seizures. Methods: We conducted a retrospective chart review of all neurologically normal children who were hospitalized over a period of 2.5 years after complex febrile seizures, and had an EEG up to 1 week after the seizure. Results: Thirty‐three patients (mean age, 17.8 months) qualified for inclusion into the study. Twenty‐four patients were qualified as complex cases based on one factor (prolonged in 9, repetitive in 13, and focal in 2). Nine other patients had two complex factors: in six patients, the seizures were long and repetitive; in two patients, the seizures were focal and repetitive; and in one patient, the seizures were long, focal, and repetitive. Thirteen (39%) patients experienced prior febrile seizures. All 33 patients had a normal postictal sleep EEG. Our results indicate with a 95% probability that the true rate of abnormalities in an early postictal EEG performed on otherwise normal children with complex febrile seizures is 8.6% or less. Conclusions: The yield of abnormalities of an early postictal EEG in this population is low and similar to the reported rate of abnormalities in children with simple febrile seizures. The routine practice of obtaining an early EEG in neurologically normal children with complex febrile seizures is not justified.
Seizures in Rural Zambia
Authors: Birbeck Gretchen L. 
Published: August 2005

Summary: Purpose: To describe the period prevalence of epilepsy and febrile seizures in a bush hospital and discuss the medical sequelae and social impact of seizures in this population. Methods: For 13 weeks, an evaluation of inpatients was made at Chikankata Hospital in rural Zambia. Inpatients identified as having seizures, “fits,”“spells,” or “fainting,” were evaluated by a medical records review, basic demographic data, a neurological history and physical examination, and a treatment history. A semistructured questionnaire was administered to evaluate the social impact of seizures and assess factors associated with delayed care seeking. Results: Seizures composed 44% of all inpatient neurologic disease and resulted in 84 admissions. Epilepsy patients received treatment primarily from traditional healers; only 31% reported ever receiving antiepileptic drugs (AEDs). Among those who had received treatment, AEDs were frequently underdosed. Patients with epilepsy had significantly less education than their sex‐matched siblings. Patients with untreated epilepsy for >2 years were more likely to have experienced serious burns or falls requiring hospitalization. Children with febrile seizures whose parents held supernatural beliefs regarding seizures were more likely to be treated with traditional medicines, had higher malarial parasite counts, and required longer hospitalizations than children with febrile seizures whose parents recognized the association between seizures and hyperthermia. Conclusions: Epilepsy and febrile seizures are responsible for a significant burden of disease in rural Zambia. Serious medical complications often result from seizures, especially if untreated for >2 years. Social stigma decreases educational opportunities and misperceptions regarding seizures may result in delayed care for children with febrile seizures. Some evidence suggests that epilepsy is underreported, underrecognized, and undertreated in this population.
Prognostic Factors Affecting Long‐Term Retention of Topiramate in Patients with Chronic Epilepsy
Authors: Lhatoo S. D. , Wong I. C. K. , Sander J. W. A. S. 
Published: August 2005

Summary:Purpose: To determine the long‐term retention rate of topiramate (TPM) therapy in patients with chronic epilepsy and to identify the relevant prognostic factors that influence retention.Methods: All patients with chronic epilepsy (n = 393) prescribed TPM between October 1, 1995, and December 31, 1998, at a tertiary referral centre for epilepsy were analysed. The retention rate for TPM was calculated by using Kaplan‐Meier survival analysis, and the prognostic factors influencing retention were analysed by using Cox regression.Results: Of patients prescribed TPM, 30% continued taking the drug beyond 3 years. Discontinuation was mainly due to adverse events and lack of efficacy. Use of more than one new concurrent antiepileptic drug (AED) and lower maximal daily doses were more likely to result in treatment discontinuation due to adverse events. Older age at onset of epilepsy, a history of having previously taken more than one new AED [lamotrigine (LTG), gabapentin (GBP), or vigabatrin (VGB)], and lower maximal daily doses were more likely to lead to discontinuation due to lack of efficacy.Conclusions: A third of patients with chronic epilepsy started on TPM therapy will continue on treatment for >3 years. Absence of learning disabilities, late age at onset of seizures, previous use of more than one new AED, two or more concurrent AED use, and low maximal daily doses of TPM are more likely to result in discontinuation of medication. These factors should be taken into account when considering the use of TPM for the treatment of chronic epilepsy.
Bilateral Periventricular and Subcortical Heterotopia in a Man with Refractory Epilepsy
Authors: Sisodiya S. M. , Free S. L. , Duncan J. S. , Stevens J. M. 
Published: August 2005

Summary: Purpose: To report a novel malformation in a male subject with refractory partial seizures. Methods: Magnetic resonance imaging (MRI) and data reformatting in a subject referred for management of partial seizures. Results: The patient had four distinct partial seizure types, without learning disability. MRI demonstrated the novel association of bilateral laminar subcortical heterotopia, bilateral temporal periventricular heterotopia, and hippocampal malformation. Conclusions: This previously unreported complex bilateral neocortical and archicortical malformation in a male patient cannot be explained by known genetic causes of heterotopia, raising the possibility of a novel gene involved in brain formation.
Oxygen Desaturations Triggered by Partial Seizures: Implications for Cardiopulmonary Instability in Epilepsy
Authors: Blum Andrew S. , Ives John R. , Goldberger Ary L. , Al‐Aweel Issa C. , Krishnamurthy K. B. , Drislane Frank W. , Schomer Donald L. 
Published: August 2005

Summary: Purpose: The occurrence of hypoxemia in adults with partial seizures has not been systematically explored. Our aim was to study in detail the temporal dynamics of this specific type of ictal‐associated hypoxemia. Methods: During long‐term video/EEG monitoring (LTM), patients underwent monitoring of oxygen saturation using a digital Spo2 (pulse oximeter) transducer. Six patients (nine seizures) were identified with oxygen desaturations after the onset of partial seizure activity. Results: Complex partial seizures originated from both left and right temporal lobes. Mean seizure duration (±SD) was 73 ± 18 s. Mean Spo2 desaturation duration was 76 ± 19 s. The onset of oxygen desaturation followed seizure onset with a mean delay of 43 ± 16 s. Mean (±SD) Spo2 nadir was 83 ± 5% (range, 77–91%), occurring an average of 35 ± 12 s after the onset of the desaturation. One seizure was associated with prolonged and recurrent Spo2 desaturations. Conclusions: Partial seizures may be associated with prominent oxygen desaturations. The comparable duration of each seizure and its subsequent desaturation suggests a close mechanistic (possibly causal) relation. Spo2 monitoring provides an added means for seizure detection that may increase LTM yield. These observations also raise the possibility that ictal ventilatory dysfunction could play a role in certain cases of sudden unexpected death in epilepsy in adults with partial seizures.
EKG Abnormalities During Partial Seizures in Refractory Epilepsy
Authors: Nei Maromi , Ho Reginald T. , Sperling Michael R. 
Published: August 2005

Summary: Purpose: This study assessed the frequency and character of ictal cardiac rhythm and conduction abnormalities in intractable epilepsy. Sudden unexpected death in epilepsy (SUDEP) is a major cause of excess mortality in people with refractory epilepsy, and cardiac arrhythmias during seizures may be responsible. The frequency of cardiac abnormalities during seizures in patients with refractory epilepsy must be determined. Methods: Fifty‐one seizures in 43 patients with intractable partial epilepsy were analyzed prospectively from CCTV‐EEG monitoring with one ECG channel. Arrhythmias, repolarization abnormalities, and PR and QTC intervals were determined for preictal (3 min), ictal, and postictal (3 min) periods for one or more seizures per patient. Parametric statistics were used for continuous variables, and nonparametric statistics were used for categoric variables. Results: Of the patients, 39% had one or more abnormalities of rhythm and/or repolarization during or immediately after seizures. Abnormalities included asystole (one), atrial fibrillation (one), marked or moderate sinus arrhythmia (six), supraventricular tachycardia (one), atrial premature depolarizations (APDs; eight), ventricular premature depolarizations (VPDs; two), and bundle‐branch block (three). Mean seizure duration was longer in patients with abnormalities than in those without (204 vs. 71 s; p < 0.001). Generalized tonic–clonic seizures were also associated with increased occurrence of ictal ECG abnormalities (p = 0.006) as compared with complex partial seizures. There were no clinically significant differences in mean preictal and ictal/postictal PR and QTC intervals. Conclusions: Cardiac rhythm and conduction abnormalities are common during seizures, particularly if they are prolonged or generalized, in intractable epilepsy. These abnormalities may contribute to SUDEP.
Focal Cortical–Subcortical Calcifications (FCSCs) and Epilepsy in the Indian Subcontinent
Authors: Singh Gagandeep , Sachdev M. S. , Tirath A. , Gupta A. K. , Avasthi G. 
Published: August 2005

Summary: Purpose: A focal cortical–subcortical calcification (FCSC) is a common finding on computed tomography (CT) in individuals with focal or generalized seizures in the Indian subcontinent. We sought to determine the relation of FCSCs to epilepsy by comparing the lobe of seizure origin by electro‐clinical and CT evaluations and to study the nature and severity of epilepsy associated with FCSCs. Methods: The relation of these FCSCs to epilepsy/seizures was studied in 40 patients, seen for the first time to the neurology outpatient department of a tertiary care hospital. An attempt was made to classify seizures and determine their lobe of origin based on clinical–electroencephalographic (EEG) criteria of the International League Against Epilepsy (ILAE). The clinical lobe of origin was compared with the location of the FCSC on CT scan. In addition, records of the CT unit of the same hospital were reviewed retrospecitvely, to identify cases with an FCSC and their referral diagnoses. Results: Thirty‐one (77.5%) patients with FCSCs were considered to have localization‐related epilepsy (frontal lobe epilepsy, 20; temporal lobe epilepsy, three; parietal lobe epilepsy, one; occipital lobe epilepsy, three; and definitely localization related but having ambiguous localization features, four) based on ictal semiology and EEG studies. Other ILAE categories in the cohort included epilepsy without unequivocal focal or generalized features (four patients; 10%), isolated seizures (one patient; 2.5%), juvenile absence epilepsy (one patient; 2.5%), and insufficient data to classify epilepsy (three patients; 7.5%). Radiologic sites for FCSCs included frontal (20; 50%), temporal (six; 15%), parietal (seven; 17.5%), and occipital (seven; 17.5%). Electroclinical and radiologic data were congruent in localizing and lateralizing seizures in 22 (55%) patients. The FCSC was truly incidental in one patient with juvenile absence epilepsy. Discordance between the clinical and radiologic localizations was noted in five (12.5%) instances. Magnetic resonance imaging (MRI) did not reveal additional lesions corresponding to lobes of origin as determined by electroclinical analysis. Discordance was surmised to be a result of seizure spread from a silent region to symptomatic cortex. In 12 (30%) patients, electroclinical and radiologic congruence could not be ascertained because ictal descriptions were either inadequate or ambiguous, and EEG findings were noncontributory. Review of 4,452 CT scans of brain performed in the CT unit revealed 29 (0.65%) cases with FCSCs in individuals with nonseizure disorders, that could be labeled as incidental. Conclusions: An FCSC is an important radiologic finding in localization‐related epilepsy in the Indian subcontinent. The severity of epilepsy ranges from asymptomatic cases to daily seizures.
An Assessment of Epilepsy Patients' Knowledge of Their Disorder
Authors: Long Lucretia , Reeves Andrew L. , Moore J. Layne , Roach Jessica , Pickering Carolyn T. 
Published: August 2005

Summary: Purpose: Patient education is an effective component of comprehensive care. Studies assessing patient's knowledge of their epilepsy are scarce. We report the first objective study evaluating knowledge of epilepsy patients referred to an American tertiary care center. Methods: Two hundred twenty epilepsy patients referred to an epilepsy center completed a knowledge questionnaire. The questionnaire included topics related to safety, compliance, and legal issues of driving and employment. Questionnaire scores were correlated with demographics, number of years with epilepsy, and educational background. Results: Of 220 patients, 175 were included in study analysis. Thirteen percent (n = 28) were excluded because of the diagnosis of nonepileptic seizures, and 8% (n = 17) were excluded because of having a diagnosis other than epilepsy. The average age and number of years with epilepsy was 34.7 ± 13 and 14.4 ± 13.1, respectively. Neither age (r= 0.20, p 0.01), number of years with epilepsy (r= 0.09, p = 0.2), nor years of education (r= 0.34, p 0.01) correlated with questionnaire scores. Thirty percent believed that epilepsy is a mental disorder or contagious. Forty‐one percent believed it is appropriate to place an object in a patient's mouth during a seizure to prevent injury. Two of the lowest scores, 13.6% and 47.5%, pertained to the legal issues of driving and employment, respectively. Conclusions: Patients with epilepsy are not knowledgeable about their disorder. This is true regardless of age, educational background, or number of years with epilepsy. There is a need for educational intervention in this population, particularly related to injury prevention and the legalities of driving and employment.
Social Aspects of Epilepsy in the Adult in Seven European Countries
Authors:   The RESt‐1 Group
Published: August 2005

Summary: Purpose: The social implications of epilepsy are ill‐defined, and there are no comparative findings from different countries. A multicenter cohort study has recently been completed on the risk of morbidity and accidents. The main social issues in the study population (patients with epilepsy and control subjects) are investigated and correlated to the clinical features of the disease. Methods: Seven hundred six adult patients with idiopathic or remote symptomatic epilepsy and 662 matched controls without epilepsy were enrolled by secondary and tertiary centers in seven European countries (Italy, Germany, Spain, the Netherlands, England, Portugal, and Russia). At entry, patients and controls were interviewed, and data were collected on social variables (education, current occupation, marital status, driving, involvement in sports, and insurance). The main clinical features of epilepsy (seizure types, frequency and timing, disease duration, and syndrome) were also recorded. Results: The sample included 690 men and 678 women aged 18 to 86 years. The level of education (mostly basic or high school) was slightly higher among patients with epilepsy. More patients than controls were single (56% versus 50%) or unemployed (18% versus 13%). Fewer patients than controls held a driver's license (44% versus 67%) or practiced sports (30% versus 41%). The distribution of each social variable varied significantly across countries, but with few exceptions, the differences between patients and controls were fairly similar. Based on multivariate analysis, for patients with epilepsy the odds ratio for driving was 0.27, and the corresponding odds ratios for sports involvement, better education, better occupation, and insurance were 0.59, 1.30, 0.60, and 1.49. Among patients with epilepsy, social variables were correlated to seizure remission and selected clinical features. Conclusions: Comparative findings from different European countries support the concept that epilepsy has a considerable impact on driving and–to a lesser extent–on education, occupation, leisure activities, and insurance. The social implications of epilepsy in this sample are partly related to its severity and clinical features.
Effects of Vagus Nerve Stimulation on Progressive Myoclonus Epilepsy of Unverricht‐Lundborg Type
Authors: Smith Brien , Shatz Rhonna , Elisevich Kost , Bespalova Irina N. , Burmeister Margit 
Published: August 2005

Summary: Purpose: A 34‐year‐old woman with progressive myoclonus epilepsy of Unverricht‐Lundborg type was considered for vagus nerve stimulation (VNS) therapy. Methods: After demonstration of intractability to multiple antiepileptic regimens and progressive deterioration in cerebellar function, the patient was implanted with a vagus nerve stimulator and followed for 1 year. Neurological status, seizure frequency, and parameter changes were analyzed. Results: VNS therapy resulted in reduction of seizures (more than 90%) and a significant improvement in cerebellar function demonstrated on neurological examination. The patient reported improved quality of life based in part on her ability to perform activities of daily living. Conclusions: VNS therapy may be considered a treatment option for progressive myoclonus epilepsy. The effects of VNS on seizure control and cerebellar dysfunction may provide clues to the underlying mechanism(s) of action.
Claustral Lesions Delay Amygdaloid Kindling in the Rat
Authors: Mohapel Paul , Hannesson Darren K. , Armitage Lisa L. , Gillespie Greg W. , Corcoran Michael E. 
Published: August 2005

Summary: Purpose: Lesions of the claustrum in cats and primates have been shown to disrupt the development and expression of amygdaloid‐kindled seizures in cats and primates. Because the structure and connectivity of the claustrum can vary between species, we wanted to examine the effects of claustral lesions on kindling in rats. Methods: One group of rats received bilateral radiofrequency lesions of both anterior and posterior regions of the claustrum before amygdaloid kindling. Another group of rats received bilateral anterior and posterior radiofrequency lesions of the claustrum after amygdaloid kindling. Some rats were tested for transfer of kindling to the contralateral amygdala after claustral lesions. Results: Small lesions that destroyed 13% of the claustrum were capable of delaying, but not blocking, amygdaloid kindling. The delay in kindling was due to an increase in the stimulation trials required to kindle to stage 5 seizures. The lesions had no effect on established kindled seizures or on transfer to the contralateral amygdala. Conclusions: As in other species, the claustrum in the rat appears to play a role in kindling from the amygdala. Because of the restricted size of our claustral lesions, however, we were unable to conclusively assess the full extent of the claustrum's participation in limbic kindling.
Prospective Long‐Term Study of Vagus Nerve Stimulation for the Treatment of Refractory Seizures
Authors: DeGiorgio C. M. , Schachter S. C. , Handforth A. , Salinsky M. , Thompson J. , Uthman B. , Reed R. , Collin S. , Tecoma E. , Morris G. L. , Vaughn B. , Naritoku D. K. , Henry T. , Labar D. , Gilmartin R. , Labiner D. , Osorio I. , Ristanovic R. , Jones J. , Murphy J. , Ney G. , Wheless J. , Lewis P. , Heck C. 
Published: August 2005

Summary: Purpose: To determine the long‐term efficacy of vagus nerve stimulation (VNS) for refractory seizures. VNS is a new treatment for refractory epilepsy. Two short‐term double‐blind trials have demonstrated its safety and efficacy, and one long‐term study in 114 patients has demonstrated a cumulative improvement in efficacy at 1 year. We report the largest prospective long‐term study of VNS to date. Methods: Patients with six or more complex partial or generalized tonic‐clonic seizures enrolled in the pivotal EOS study were prospectively evaluated for 12 months. The primary outcome variable was the percentage reduction in total seizure frequency at 3 and 12 months after completion of the acute EO5 trial, compared with the preimplantation baseline. Subjects originally randomized to low stimulation (active‐control group) were crossed over to therapeutic stimulation settings for the first time. Subjects initially randomized to high settings were maintained on high settings throughout the 12‐month study. Results: The median reduction at 12 months after completion of the initial double‐blind study was 45%. At 12 months, 35% of 195 subjects had a >50% reduction in seizures, and 20% of 195 had a >75% reduction in seizures. Conclusions: The efficacy of VNS improves during 12 months, and many subjects sustain >75% reductions in seizures.