bluuebunny/crossref_metadata_2025_split huggingface dataset:
Morbidity of Nonfebrile Status Epilepticus in Rochester, Minnesota, 1965–1984
Authors: Cascino Gregory D. , Hesdorffer Dale , Logroscino Giancarlo , Hauser W. Allen 
Published: August 2005

Summary: Purpose: To analyze the nonfatal adverse events (AE) associated with a first episode of status epilepticus (SE). Methods: We performed a population‐based retrospective cohort study to determine the morbidity of SE. Participants included 184 residents of Rochester, Minnesota who experienced nonfebrile SE between 1965 and 1984. Results: The etiology of SE was acute symptomatic in 100 patients and unprovoked in 84 patients. The most common seizure‐types were continuous partial (n = 56, 30%), generalized convulsive (n = 52, 28%). and generalized with focal features (n = 32, 17%). Morbidity related to SE was noted in 5 of the 146 patients (3.4%) surviving 30 days. The AE included hemiparesis (n = 3), encephalopathy (n = 2), mental retardation (n = l), and aphasia (n = 1). All patients with morbidity had an acute symptomatic (n = 4) or remote symptomatic (n = 1) etiology. Thirty‐four patients (18.5%) had a second episode of SE. Conclusions: Based on this retrospective study, significant morbidity related to SE is uncommon and is associated with the underlying etiology.
What is the Significance of Subjective Events Recorded During Long‐Term EEG Video Monitoring?
Authors: Holmes Mark D. , Dodrill Carl B. 
Published: August 2005

Summary: Purpose: Purely subjective events, identified as “seizures” by patients but not accompanied by any clinical or EEG changes, commonly occur during evaluation of patients for intractable epilepsy. We wished to determine the significance of such events. Methods: We analyzed the frequency of subjective episodes in 379 adults who underwent EEG video monitoring as part of their evaluation for intractable epilepsy and the relationship of these experiences to epileptic and psychogenic nonepileptic (NES) seizures. We examined the results of tests of mental ability and of emotional, psychosocial, and quality of life (QOL) adjustment to determine if individuals with subjective events alone could be distinguished from those with epileptic seizures only, NES only, or no events, by these measures. Results: We noted subjective events in 39% (147 of 379) of the patients. Of patients with subjective episodes, 52% also had epileptic seizures, 7% had NES, 1% had both epileptic seizures and NES, and 40% had subjective events alone. As a group, patients with subjective events alone were slightly more intelligent and less impaired neuropsychologically than people in the other groups, hut they performed more poorly on several important measures of adjustment. Conclusions: The identification of persons with purely subjective episodes apart from all other episodes is important both phenomenologically and from a practical viewpoint.
Ictal Behaviors During Nonepileptic Seizures Differ in Patients with Temporal Lobe Interictal Epileptiform EEG Activity and Patients Without Interictal Epileptiform EEG Abnormalities
Authors: Henry Thomas R. , Drury Ivo 
Published: August 2005

Summary: Purpose: Ictal behaviors during psychogenic non‐epileptic seizures (NES) vary considerably among individuals, and can closely resemble common semiologies of epileptic seizures (ES). We tested the hypothesis that behaviors during NES in patients who have temporal spikes would more closely resemble behaviors during ES in patients with temporal lobe epilepsy than would behaviors during NES in patients who do not have EEG spikes. Methods: We identified 20 patients who had interictal temporal EEG spikes and EEG‐video recorded NES (Study Group), 133 patients with temporal EEG spikes and recorded ES, without NES (Epileptic Group), and 24 patients with recorded NES and no epileptiform EEG abnormalities, without ES (Nonepileptic Group). Results: The hypothesis was supported with regard to ictal motor behaviors. Motionless staring or complex automatisms occurred mainly during NES in the Study Group and during ES in the Epileptic Group. In contrast, convulsive movements or flaccid falls were most common during NES in the Nonepileptic Group. Duration of unresponsiveness was longer, and there were fewer postictal states in NES both in the Study and Non‐epileptic Groups. Unresponsiveness was briefer and postictal states were more consistent in ES in the Epileptic Group, however. Conclusions: Stereotyped motor activities during NES presumably represent learned behaviors. Processes underlying acquisition of ictal behaviors of NES probably differ in patients with interictal epileptiform EEG abnormalities compared to those without. Prior experiences and temporal lobe dysfunctions that are associated with epilepsy, and psychological characteristics that are unrelated to interictal epileptic dysfunctions, may determine ictal behaviors during NES.
Ganglioglioma and Intractable Epilepsy: Clinical and Neurophysiologic Features and Predictors of Outcome After Surgery
Authors: Morris H. H. , Matkovic Z. , Estes M. L. , Prayson Y. A. , Comair Y. G. , Turnbull J. , Najm I. , Kotagal P. , Wyllie E. 
Published: August 2005

Summary: Purpose: To review the clinical, neurophysiologic, and radiological data of patients with ganglioglioma who had undergone evaluation and surgery in our Epilepsy Program. Methods: The medical and neurophysiologic records of 38 patients with intractable epilepsy and ganglioglioma were re‐ viewed. Data underwent statistical analysis. Results: There were 28 temporal and 10 extratemporal resections, with a mean age at seizure onset of 10.5 years and mean age at surgery of 22 years. Five tumor resections performed earlier were recorded. Twenty‐nine patients had auras and 20 had secondarily generalized seizures. All 28 patients with temporal tumor had complex partial seizures. Preoperative MRI demonstrated the tumor in 36 of 36 patients: 17 of 29 demonstrated gadolinium enhancement, and 17 of 36 had mass effect. Scalp interictal sharp waves were present in 32 patients, and in 15 they were multiregional. In two patients, scalp EEG seizure onset was from the hemisphere contralateral to the tumor. Postoperatively, 79% of patients (30 of 38) were seizure‐free (Engel's class I) at 6 months, 72% at 1 year (26 of 36), and 63% at 2 years (20 of 32). Excellent outcome was associated with a lower age at operation (p = 0.008), shorter duration of epilepsy (p = <0.01), absence of generalized seizures (p = <0.01), and no epileptiform discharges on a postoperative EEG (p = 0.01). Conclusions: Good surgical outcome is expected in patients with ganglioglioma despite years of medically resistant seizures. Good outcome may be achieved despite EEG findings that may conflict with tumor location, and is more likely when surgery is performed relatively soon after epilepsy onset.
Developmental Background and Outcome in Patients with Nonepileptic Versus Epileptic Seizures: A Controlled Study
Authors: Berkhoff Magdalena , Briellmann Regula S. , Radanov Bogdan P. , Donati Filippo , Hess Christian W. 
Published: August 2005

Summary: Purpose: This study was designed to evaluate the relevance of developmental emotional stress factors, which are considered to influence emotional functioning, as contributing factors in the development of psychogenic symptoms. Methods: Ten patients with nonepileptic seizures (non‐ESs)(frequently referred to as psychogenic seizures), in whom diagnosis had been confirmed by a placebo‐infusion test (PT), and 10 control patients with complex partial seizures (ESs) were evaluated with regard to developmental background by using structured in‐depth interviews performed by a single interviewer blinded to the diagnosis. In addition, outcome assessment in the non‐ES group after PT was done. Results: There were no significant differences between groups in developmental psychosocial stress or in any single developmental stress factor. Six months after PT, the outcome was favorable in patients with non‐ES: six were seizure free, and two had a considerable reduction in frequency of seizures. Conclusions: Our research indicates the following: (a) a high incidence of developmental stress factors and functional disturbances may be found in patients with non‐ESs and ESs; (b) assessment of developmental emotional stress and functional disturbances as a basis for validating the diagonsis of non‐ES should be treated with caution; (c) use of PT followed by supportive information about the nonepileptic origin of the attacks may have a positive therapeutic effect or help to introduce psychotherapeutic treatment.
Evaluating Health‐Related Quality of Life Outcomes in Clinical Trials of Antiepileptic Drug Therapy
Authors: Leidy Nancy Kline , Rentz Anne M. , Grace Eileen M. 
Published: August 2005

Summary: Purpose: To provide an overview of condition‐specific health‐related quality of life (HRQL) assessment in clinical trials of antiepileptic drug (AED) therapy in adults. We describe the key measurement issues in HRQL evaluation, identify the instruments that have been used in this population, summarize the psychometric characteristics of these instruments, propose areas of HRQL most likely to change with treatment, and offer recommendations for further research. Methods: We conducted a comprehensive review of the literature using repeated searches of the MEDLINE database together with a review of reference lists from published papers. Psychometric information on the instruments was gathered from published literature. Results: Three epilepsy‐specific HRQL measures were identified: the Epilepsy‐Surgery Inventory (ESI‐55), the Liverpool Assessment Battery, and the Quality of Life in Epilepsy Inventory (QOLIE, the 89‐, 31‐, and 10‐item versions). One new measure, the Epilepsy Foundation of America (EFA) Concerns Index was also found. The psychometric characteristics of these instruments are discussed in relationship to performance or expected performance in a clinical trial setting. A review of descriptive studies and trials to date suggests that subscales reflecting the psychological and social domains of HRQL may be most sensitive to treatment designed to increase seizure‐free periods, reduce seizure severity, and minimize undesirable side effects. Conclusions: Although evaluation of HRQL outcomes in clinical trials of epilepsy is still in its infancy, several reliable and valid condition‐specific measures are available for understanding the impact of disease and treatment on HRQL. Further research is needed to determine minimal clinically important change scores and to assess the psychometric stability of measures across cultures and mode of administration (self, interview, telephone). Studies of patient p for health outcomes in the form of utilities will provide needed data for evaluating the cost‐effectiveness of new treatments.
Aspiration: A Potential Complication to Vagus Nerve Stimulation
Authors: Lundgren Johan , Ekberg Olle , Olsson Rolf 
Published: August 2005

Summary: Purpose: Vagus nerve stimulation (VNS) is reported to reduce the frequency of seizures in children and adults without causing serious side effects. However, clinical observation of swallowing difficulties in 2 children treated with VNS made further investigation necessary. Methods: Seven patients aged 4–18 years and treated with VNS for 6–14 months were investigated with videoradiography during barium swallow. The children performed 5–30 barium swallow investigations with the VNS device turned off, running as programmed, or set at continuous stimulations. The degree of aspiration was scored from 0 to 3. Results: In 5 of 7 children, of whom reported transient swallowing difficulties, no change in the degree of aspiration was noted. The 2 children with swallowing difficulties, however, showed increased aspiration score when the stimulator was set at continuous stimulations. In 1 the score also appeared to increase with the VNS running as programmed (p > O.05). Both children had severe mental and motor disabilities. Conclusions: Before and during VNS treatment patients should be evaluated with regard to swallowing problems. There needs to be an easy way to turn the device on and off to avoid aspirations, a hazardous and potentially life‐threatening complication of VNS.
Ictal Patterns of Neocortical Seizures Monitored with Intracranial Electrodes: Correlation with Surgical Outcome
Authors: Kutsy Roman L. , Farrell Donald F. , Ojemann George A. 
Published: August 2005

Summary: Purpose: Numerous factors have been analyzed in attempts to predict the outcome of surgical resections in patients with neocortical epilepsy. We examined the correlation between surgical outcome and electrocorticographic features of neocortical ictal patterns. Methods: Twenty six patients with neocortical epilepsy underwent monitoring with subdural grid electrodes before surgery. Ictal patterns were analyzed retrospectively and correlated with three types of outcome: seizure free, worthwhile improvement (>75% reduction of seizure frequency), and no worthwhile improvement. The duration of follow‐up was 2–5 years. Results: Ictal patterns were divided according to the size of epileptogenic zone (focal, regional, multifocal); velocity and type of seizure propagation (fast contiguous, slow contiguous, noncontiguous); pattern of the onset of ictal activity; part of the cortex involved in the origin of the seizure (frontal, frontocentroparietal, etc.). Spread to medial temporal structures (as assessed by subtemporal strips) also was evaluated in selected cases. Statistically significant correlation with surgical outcome (p = 0.026) was shown for only one variable: type of spread. Patients with slow spread (n = 8) demonstrated the best outcomes (five are seizure free), whereas patients with noncontiguous spread (n = 5) demonstrated the worst outcomes (four did not improve significantly). Patients with fast contiguous spread (n = 13) showed intermediate outcomes. Conclusions: Types of propagation of ictal neocortical activity correlate with surgical outcome. Analysis of ictal pattern during intracranial recordings may help to predict surgical outcome for neocortical epilepsy.
Periictal SPECT Localization Verified by Simultaneous Intracranial EEG
Authors: Spanaki Marianna V. , Zubal I. George , MacMullan John , Spencer Susan S. 
Published: August 2005

Summary: Purpose: We investigated whether blood‐flow changes measured by ictal or immediate postictal single photon emission computed tomography (SPECT) reflect with accuracy the actual location of ictal discharge as measured by simultaneous intracranial EEG. In addition, we evaluated the reliability of ictal SPECT obtained with implanted electrodes by comparing results with those of ictal SPECT performed during scalp EEG monitoring in selected patients. Methods: Eleven patients with intractable partial epilepsy who had both ictal and interictal SPECT scans during invasive EEG monitoring were studied. We analyzed perfusion differences based on registration, normalization, and subtraction of perüctal and interictal SPECT images. SPECT results were interpreted in relation to location and evolution of ictal EEG change, as reflected by simultaneous intracranial EEG. In five patients, we also compared ictal SPECT results that were obtained during both scalp and intracranial EEG monitoring. Results: In 10 of 11 patients, localized increases or decreases in blood flow or both were identified in regions of ongoing or prior seizure discharge, respectively, at the time of SPECT brain perfusion. In one patient, SPECT localization could not be verified by the available electrode array. Conclusions: Localization of ictal discharge during or before SPECT injection accurately determines increase or decrease in perfusion, respectively, and both are of equal validity in reflecting the region of epileptic discharge. SPECT perfusion changes can be reliably obtained during intracranial monitoring.
Once‐Daily Versus Twice‐Daily Vigabatrin: Is There a Difference? The Results of a Double‐Blind Pilot Study
Authors: Zahner B. , Stefan H. , Blankenhorn V. , Krämer G. , Richens A. , Thümler R. , Mumford J. P. 
Published: August 2005

Summary: Purpose: Vigabatrin (VGB) has been approved in Europe and is prescribed for either once or twice‐daily administration. This choice has been based on the pharmacodynamic activity of VGB. The purpose of this study was to compare the efficacy and tolerability of these two different medication regimens. Methods: The study design was a double‐blind randomized two‐period cross‐over study in adults who had responded to add‐on VGB for previously uncontrolled seizures. Each study period consisted of three months. Patients were maintained on the same daily dose of VGB to which they had demonstrated a clinical response. In addition to the primary efficacy criteria of seizure frequency on the two treatment regimens, this study included blinded ratings of overall efficacy and “well being” by both physician and patient. The primary tolerability criterion was the reported incidence of adverse events by phase. Results: Fifty patients were initially entered into the study, and 13 patients withdrew before completion, only one reported as due to an adverse event. There was no statistical difference in seizure frequency or the tolerability of the medication. Blinded physician and patient rating scales for seizure control, and patient well being showed a nonstatistical trend toward once‐daily administration as compared with twice‐daily administration. Conclusions: This clinical study provides support for the pharmacological evidence that this preparation may be administered on a once or twice daily basis, depending on the individual patient's preference, total dosage and co‐medication.
Lamotrigine Associated with Insomnia
Authors: Sadler Mark 
Published: August 2005

Summary: Purpose: To review the incidence of lamotrigine (LTG)‐associated insomnia in an adult tertiary care epilepsy outpatient clinic. Methods: The records of all patients who had received LTG were reviewed to identify patients who had experienced insomnia after introduction of this drug. Patients were included if they had experienced a sleep disturbance of sufficient severity to require a discontinuation of LTG or a dose reduction. Results: Among 109 patients exposed to LTG, seven (6.4%) had a sleep disturbance of a severity to required a change in therapy. The descriptions of the sleep disturbance were similar among the patients, and the LTG‐induced insomnia appeared to be dose dependent. Unlike the few previous descriptions of LTG‐induced insomnia in the literature, no factors predisposing to this adverse effect were identified. Conclusions: The results of this retrospective review suggest an association between LTG and intolerable insomnia in a small proportion of patients. Physicians should inquire about sleep disturbances in patients treated with LTG.
Depression in Temporal Lobe Epilepsy Before Epilepsy Surgery
Authors: Kohler Christian , Norstrand Julie A. , Baltuch Gordon , O'Connor Michael J. , Gur Raquel E. , French Jacqueline A. , Sperling Michael R. 
Published: August 2005

Summary: Purpose: This study examined the association of depression with laterality of epilepsy surgery in patients with temporal lobe epilepsy before standard lobectomy. Methods: Forty‐nine patients presented for EEG telemetry for localization of epilepsy and eventual temporal lobectomy. Patients underwent routine neuropsychiatric evaluation blinded for epileptic focus, including ratings on depression. Patients were grouped according to right (n = 25, M = 10/F = 15) and left (n = 24, M = 13/F = 11) temporal lobectomy. Analysis of variance included side of surgery as grouping variable and sex, general depressive, cognitive depressive, and vegetative depressive symptoms as dependent variables. χ2 Analyses included categoric variables of sex, handedness, education, neuropathologic findings, and current affective disorders. t Tests were performed on variables of age, epilepsy duration, and cognitive function. Results: Right and left temporal epilepsy groups did not differ with regard to sex, handedness, age, duration of epilepsy, education, cognitive function, and neuropathology. Patients with right temporal epilepsy rated higher on general, cognitive, and vegetative depression scores. Women scored higher on general, cognitive, and vegetative depression scores. Current affective disorders were more common in the right temporal epilepsy group. Conclusions: Depression ratings and diagnoses were more prominent in patients with right temporal lobe epilepsy and in women in particular. The strength of this laterality finding lies in the selection of patients, as all underwent epilepsy surgery. The finding on gender difference partly reflects the higher incidence of depression in women and needs further exploration. The laterality finding contrasts with recent findings in epilepsy, stroke, and trauma that associate depression with left hemispheric lesions. However, our results are consistent with findings in electrically hyperactive lesions such as gelastic and dacrystic epilepsy.
Hippocampal Cell Density and Subcortical Metabolism in Temporal Lobe Epilepsy
Authors: Dlugos Dennis J. , Jagg Jurg , O'Connor William M. , Ding Xin‐Sheng , Reivich Martin , O'Connor Michael J. , Sperling Michael R. 
Published: August 2005

Summary: Purpose: Correlations between hippocampal cell density and subcortical metabolism in patients with temporal lobe epilepsy (TLE) were studied to explore possible links between subcortical function and the regulation of hippocampal excitability. Methods: Resected hippocampal cell densities were correlated with cortical and subcortical regional cerebral metabolic rate for glucose (CMRglu), as measured by [18F]‐fluorodeoxyglucose positron emission tomography (18‐FDGPET), in 39 patients with intractable TLE who underwent anterior temporal lobectomy (ATL). CMRglu was measured ipsilateral and contralateral to the resected temporal lobe. Linear regression techniques were used for statistical analysis. Results: Hilar cell densities correlated positively and significantly with CMRglu in the bilateral thalamus, putamen and globus pallidus, and the ipsilateral caudate. Dentate granule cell densities correlated positively and significantly with CMRglu in the bilateral thalamus and putamen. There was no significant correlation between cell densities and CMRglu in any cortical region, including the hippocampus. Conclusions: We postulate that hippocampal cell loss results in decreased efferent synaptic activity to the thalamus and basal ganglia, causing decreased neuronal activity in these structures with consequent hypometabolism. This synaptic activity has a significant bilateral component. Subcortical hypometabolism in patients with TLE may reinforce the epileptogenic potential of mesial temporal lobe discharges.