bluuebunny/crossref_metadata_2025_split huggingface dataset:
Valproate Metabolites in High‐Dose Valproate Plus Phenytoin Therapy
Authors: Sugimoto Tateo , Muro Hideki , Woo Man , Nishida Naoki , Murakami Kiyotaka 
Published: August 2005

Summary: Purpose: We wished to determine the relation between liver function, β‐, and ω‐, and ω‐1‐oxidation metabolites and 4‐en‐valproate (VPA). Methods: We measured the serum levels of VPA and its metabolites in children and adolescent receiving high‐dose VPA plus phenytoin (PHT) therapy using gas chromatography‐mass spectrometry with selected ion monitoring (GC/MS/SIM). Results: In high‐dose VPA plus PHT polytherapy, the total VPA serum concentration was distinctly low, the concentrations of total β ‐oxidation metabolites were decreased, the percentage values of VPA (percent of VPA) of total β ‐oxidation metabolites were increased, and the E‐2‐en‐VPM3‐keto‐VPA ratios were decreased, as compared with those in high‐dose VPA monotherapy. In high‐dose VPA plus PHT polytherapy, 4‐en‐VPA (μM) was decreased and the concentrations of (ω+ (ω ‐ 1)]‐oxidation metabolites (μ M) were decreased as compared with those in high‐dose VPA monotherapy. In high‐dose VPA plus PHT, serum glutamic‐oxaloacetic transarninase (GOT), glutarnic‐pyruvic transaminase (GPT) and lactic dehy‐drogenase (LDH) did not correlate significantly with the (β/ω+ (ω ‐ 1) metabolites ratio and 4‐en‐VPA levels, but serum GOT, GPT, and LDH were increased as compared with those in high‐dose VPA therapy. We were not able to establish a significant relation between the formation of metabolites of VPA metabolites and liver dysfunction in patients receiving high‐dose VPA and PHT concurrently. Conclusions: Metabolic levels do not appear to be a reliable predictor of hepatotoxicity in children receiving pharrnacological antiepileptic drug (AED) therapy.
Double Pathology in Rasmussen's Encephalitis: Etiologic Considerations
Authors: Yacubian Elza M. T. , Rosemberg Sérgio , Marie Suely K. N. , Valerio Rosa M. F. , Jorge Carmen L. , Cukiert Arthur 
Published: August 2005

Summary:In a 7‐year‐old girl with epilepsia partialis continua (EPC) involving the left face, arm, and leg for 1 year, serial neuroimaging studies showed progressive, brain atrophy. Because medical treatment was ineffective, she underwent a large fronto‐temporal surgical resection. Neuropathological examination showed loss of lamination and dysplastic neurons, gliosis, microglial nodules, and perivascular cuffing. Such “double pathology” (dysgenesia and a chronic inflammatory process) may have implications for the pathophysiology of Rasmussen's syndrome.
Effects of Clobazam and Its Active Metabolite on GABA‐Activated Currents in Rat Cerebral Neurons in Culture
Authors: Nakamura Fumihiro , Suzuki Setsuo , Nishimura Shigeko , Yagi Kazuichi , Seino Masakazu 
Published: August 2005

Summary: Purpose: The antiepileptic effects of clobazam, a 1,5‐benzodiazepine, have been well documented in animal experiments and clinical trials. However, the drug's mechanisms of antiepileptic actions are still undetermined. The purpose of this study was to learn how clobazam and its active metabolite modulate γ‐aminobutyric acid (GABA)‐activated currents in rat cerebral neurons in culture. Methods: Whole‐cell voltage‐clamp recordings were performed on cultured cerebral neurons of the rat. Clobazam or its metabolite N‐desmethylclobazam was dissolved in the extracellular solution and applied for 2 s by pressure ejection from a micropipette. To maintain GABA‐activated currents, 2 mM Mg adenosine triphosphate (ATP) was added to the intracellular solution. Results: GABA elicited outward currents that were mediated by GABAA receptor‐coupled Cl‐ channels. Applying clobazam with 10 μM GABA elicited enhanced outward currents. Flumazenil, an antagonist of the benzodiazepine receptor, inhibited the enhancing effect of clobazam. The enhancement ratio increased as much as 2.28‐fold in a dose‐dependent manner at a concentration of 3 μM clobazam. However, it started to decrease at a concentration of 10 μM clobazam. The metabolite N‐desmethylclobazam was tested in the same manner, and exhibited an identical dose‐dependent enhancement of GABA‐activated currents. Conclusions: The antiepileptic effects of the 1,5‐ benzodiazepines are attributed to the enhancement of GABAergic inhibitory neurotransmission. The antiepileptic effects of clobazam are thought to depend mainly on its active metabolite N‐desmethylclobazam, which is present in high concentrations in patients who receive long‐term clobazam. Clobazam's enhancement of GABAactivated currents was most marked on weaker GABA currents. We therefore infer that clobazam acts more efficiently on tissues in which the release of GABA is diminished.
Severe, Uncontrolled Hypertension and Adult‐Onset Seizures: A Case‐Control Study in Rochester, Minnesota
Authors: Hesdorffer D. C. , Hauser W. A. , Annegers J. F. , Rocca W. A. 
Published: August 2005

Summary: Purpose: Hypertension is an established risk factor for clinically detected stroke, which is in turn a risk factor for epilepsy. This relation suggested that hypertension, particularly severe and uncontrolled, might increase the risk of epilepsy in the absence of prior clinically detected stroke. Methods: Subjects in this population‐based case‐control study were the 145 incident cases of first unprovoked seizure aged 55 years or older and 290 controls matched to cases on age, gender, and duration of medical follow‐up. Using the records‐linkage system of the Rochester Epidemiology Project, we obtained, for both cases and matched controls, all blood pressure readings before each case's first seizure came to medical attention. Subjects were classified as hypertensive if they had at least two readings of 160/95 mm Hg or if there was electrocardiographic evidence for left ventricular hypertrophy. Results: Severe uncontrolled hypertension increased the risk of unprovoked seizure. Left ventricular hypertrophy without diuretic treatment was associated with an 11‐fold increased risk of unprovoked seizure: left ventricular hypertrophy treated with diuretics did not increase the risk. Conclusions: In the absence of clinically detected stroke, left ventricular hypertrophy without diuretic use may increase the risk of unprovoked seizures, and diuretic treatment may protect against this increased risk.
Dipole Modeling in Epilepsy Surgery Candidates
Authors: Boon P. , D'Havé M. , Adam C. , Vonck K. , Baulac M. , Vandekerckhove T. , Reuck J. De 
Published: August 2005

Summary: Purpose: The validity and clinical significance of dipole modeling in epilepsy surgery candidates is not fully established. Patients and Methods: Interictal and ictal dipole modeling was performed in 43 patients with refractory complex partial seizures (CPS) and intracranial structural abnormalities demonstrated with optimum magnetic resonance imaging (MRI: space–occupying, n = 15; atrophic, n = 26; dysplastic, n = 2). Video–EEG monitoring showed CPS in all patients. In 12 patients, additional intracranial EEG monitoring demonstrated hippocampal seizure onset in 11 patients and medial occipital ictal onset in 1. Results: Spatiotemporal dipole mapping of averaged interictal spikes and epochs of early ictal discharges revealed two distinct dipole patterns. Patients with lesions located in the medial (± lateral) temporal lobe (n = 34) and medial occipital lobe (n = 1) uniformly presented a combined interictal dipole that consisted of a radial and a tangential component with a high degree of elevation relative to the axial plane. Eight of 9 patients with extratemporal lesions had a less stable dipole with a predominant radial component. Ictal dipole modeling identified the ictal onset zone correctly as compared with intracranial EEG recordings from bilateral hippocampal depth electrodes. Ictal dipoles showed a striking correspondence with the interictal dipoles in individual patients. Conclusions: Interictal and ictal dipole mapping provided additional, reliable, and relevant localizing information in surgical candidates for refractory CPS. Ictal dipole analysis may limit the number of patients who require intracranial electrodes.
A Comparison Between One and Three Years of Treatment in Uncomplicated Childhood Epilepsy: A Prospective Study. II. The EEG as Predictor of Outcome After Withdrawal of Treatment
Authors: Andersson Thomas , Braathen Gunnar , Persson Anders , Theorell Klas 
Published: August 2005

Summary: Purpose: We wished to evaluate the prognostic usefulness of various EEG parameters with respect to remission rates after discontinuation of antiepileptic drug (AED) therapy in children treated for epileptic seizures. Methods: Two hundred forty‐four children with uncomplicated epileptic seizures were randomized to either 1 or 3 years of treatment with AEDs. The treatment was then discontinued in patients who had been seizure‐free during the last 6 months of their allotted time of treatment (n = 154). After treatment discontinuation, the children were followed for at least 2 years. EEG recordings were performed before treatment was initiated and at regular intervals during treatment. Results: The overall relapse rate was 37%. In many children, the amount of epileptiform activity varied considerably between subsequent recordings made during the treatment. The remission rate was slightly higher for children whose last recordings before AED discontinuation were free of epileptiform activity as compared with children in whom such activity was present. However, children who had irregular generalized spike–wave (SW) activity in the recordings made before discontinuation of treatment had a clearly higher relapse rate (67%) both as compared with children without epileptiform activity (33%) and as compared with children with other types of epileptiform activity (33%) in their last EEG recordings before discontinuation. All children treated for only 1 year whose final EEGs displayed generalized irregular SW activity relapsed. Conclusions: We conglude that the presence of epileptiform activity does not in itself necessarily influence prognosis after discontinuation of treatment but that certain types of such activity signal a high risk of relapse.
Cortical and Hippocampal Volume Deficits in Temporal Lobe Epilepsy
Authors: Marsh Laura , Morrell Martha J. , Shear Paula K. , Sullivan Edith V. , Freeman Hope , Marie Ariane , Lim Kelvin O. , Pfefferbaum Adolf 
Published: August 2005

Summary: Purpose: To use quantitative magnetic resonance imaging (MRI) methods to examine the extent of volume abnormalities in the hippocampus and in extrahippocampal brain regions in localization‐related epilepsy of temporal lobe origin (TLE). Methods: Hippocampal, temporal lobe, and extratemporal lobe volumes were examined with 3–mm spin‐echo coronal MRI scans in patients with unilateral TLE who were candidates for temporal lobe resection. Measures were adjusted for normal variation due to intracranial volume and age based on 72 healthy male controls. Group differences between 14 male TLE [7 left TLE (LTLE), 7 right TLE (RTLE)] patients and a subset of 49 age range‐matched controls were examined with analysis of variance (ANOVA). Results: As compared with controls, patients with TLE had smaller temporal lobe and frontoparietal region gray matter volumes, bilaterally, smaller temporal lobe white matter volumes bilaterally, and larger ventricular volumes. In contrast to these bilateral tissue volume deficits, hippocampal volume deficits in TLE were ipsilateral to the epileptogenic temporal lobe. Conclusions: Extrahippocampal volume abnormalities were bilateral and occurred in both temporal and extra‐temporal cortical regions in TLE, whereas hippocampal deficits were related to the side of the epileptogenic focus. These data suggest that brain abnormalities in TLE are not limited to the epileptogenic region.
What is the Relationship Between Arachnoid Cysts and Seizure Foci?
Authors: Arroyo Santiago , Santamaria Joan 
Published: August 2005

Summary: Purpose: Arachnoid cysts are sometimes encountered in MRIs performed for a variety of reasons. In patients with epilepsy, particularly those with refractory epilepsy, arachnoid cysts are often assumed to be related to their seizure focus. We conducted a study to investigate this putative relationship. Methods: A retrospective study on the incidence of arachnoid cysts was performed in patients seen in our Epilepsy Clinic who had CT or MRI scans, interictal EEGs or ictal EEGS. Locations of seizure foci in these patients were defined from clinical and electrophysiologic data. Results: Seventeen of 867 patients had arachnoid cysts. Twelve patients had temporal lobe cysts and only 3 of them had temporal lobe seizures. Four patients had frontal lobe cysts and only 1 had frontal lobe seizures ipsilateral to the cyst. One patient had a cerebellopontine angle cyst and frontal lobe seizures. Thus, clinical manifestations of seizures and EEG findings (interictal and/or ictal) indicated that the seizure focus was adjacent to the cysts in only 4 patients (23.5%). Conclusions: Our findings suggest that arachnoid cysts are often an incidental finding in patients with epilepsy and do not necessarily reflect the location of the seizure focus.
Continuous Source Imaging of Scalp Ictal Rhythms in Temporal Lobe Epilepsy
Authors: Assaf Bassam A. , Ebersole John S. 
Published: August 2005

Summary: Purpose: We wished to determine whether continuous EEG source imaging can predict the location of seizure onset with sublobar accuracy in temporal lobe epilepsy (TLE). Methods: We retrospectively analyzed the earliest scalp ictal rhythms, recorded with 23‐ to 27‐channel EEG, in 40 patients with intractable TLE. A continuous source analysis technique with multiple fixed dipoles (Focus 1.1) decomposed the EEG into source components representing the activity of major cortical sublobar surfaces. For the temporal lobe, these were basal, anterior tip, anterolateral, and posterolateral cortex. Ictal EEG onset was categorized according to its most prominent and leading source component. All patients underwent intracranial EEG studies before epilepsy surgery, and all had a successful surgical outcome (follow‐up >1 year). Results: Most patients with ictal rhythms having a predominant basal source component had hippocampal‐onset seizures, whereas those with seizures with prominent lateral source activity had predominantly temporal neocortical seizure origins. Seizures with a prominent anterior temporal tip source component mostly had onset in entorhinal cortex. Seizures in some patients had several equally large and nearly synchronous source components. These seizures, which could be modeled equally well by a single oblique dipole, had onset predominantly in either entorhinal or lateral temporal cortex. Conclusions: Multiple fixed dipole analysis of scalp EEG can provide information about the origin of temporal lobe seizures that is useful in presurgical planning. In particular, it can reliably distinguish seizures of mesial temporal origin from those of lateral temporal origin.
Periventricular Nodular Heterotopia: Epileptogenic Findings
Authors: Battaglia Giorgio , Granata Tiziana , Farina Laura , D'Incerti Ludovico , Franceschetti Silvana , Avanzini Giuliano 
Published: August 2005

Summary: Purpose: We studied 17 patients with periventricular nodular heterotopia (PNH) to further investigate the electroclinical pictures and semiology of the associated seizures. Methods: PNH was diagnosed by means of magnetic resonance imaging (MRI). The patients’ clinical and familial histories were carefully analyzed, and their electroclinical features and course of epilepsy followed for periods ranging from 10 months to 22 years. The electroclinical data were compared with those of previously reported PNH cases. Results: The patients were subdivided into those with bilateral (7) and unilateral (10) PNH. The former were mainly characterized by structural abnormalities in the posterior cerebral fossa and multiple seizure types; the latter were characterized by the paratrigonal location of the malformation and, frequently, by elementary seizures with a visual or auditory onset. Focal seizures were drug resistant in most cases. The interictal EEG abnormalities were always focal and consistent with the location of the PNH. A previously unreported photic driving of posterior background activity was observed in all patients and was always consistent with the PNH location. Conclusions: Conclusions: Our present findings and previously reported data show that bilateral and unilateral PNH cases are different in their morphological and electroclinical features and may be determined by different etiologies. The female predominance, frequent familial occurrence, and positive family history for epilepsy suggest that genetic factors may be involved in the genesis of bilateral and symmetrical PNH, whereas the presence of prenatal risk factors and its location in the watershed paratrigonal area suggest that vascular mechanisms may determine unilateral PNH.
Social Adjustment and Competence 35 Years After Onset of Childhood Epilepsy: A Prospective Controlled Study
Authors: Jalava Merja , Sillanpää Matti , Camfield Carol , Camfield Peter 
Published: August 2005

Summary:Purpose:To study the effect of childhood‐onset epilepsy without other neurologic deficit on adult social adjustment and competence.Methods:Social competence was studied in a prospective, population‐based cohort of childhood‐onset epilepsy after a mean follow‐up of 35 years. One hundred patients (60% of the total cohort) had no other neurologic problems (“epilepsy only”), and for each patient, two matched controls, a “random” control and an “employee” control were chosen.Results:Good social outcome was significantly reduced in the “epilepsy only” cohort compared with random controls: education [cumulative odds ratio (COR), 2.4; 95% confidence interval (CI), 1.4–4.11; employability (COR, 7.3; 95% CI, 2.7–20.0); and marriage rate (COR, 3.7; 95% CI, 1.9–7.3). The patients with epilepsy rated their own ability to control their lives as “poor or missing” four times more frequently than the employee controls. Patients receiving antiepileptic polytherapy, but not monotherapy, were significantly less satisfied with their present life (OR, 6.7; 95% CI, 1.9–24.1) and felt their general health was significantly poorer (OR, 5.1; 95% CI, 1.2–21.3) than did the employee controls. Furthermore, patients with continuing seizures were significantly less satisfied with their present life (OR, 4.1; 95% CI, 1.1–15.1) than were employee controls.Conclusions:Many patients with “epilepsy only” beginning in childhood have persistent and significant social‐adjustment and competence problems in adulthood.
Persistent Nonconvulsive Status Epilepticus After the Control of Convulsive Status Epilepticus
Authors: DeLorenzo R. J. , Waterhouse E. J. , Towne A. R. , Boggs J. G. , KO D. , DeLorenzo G. A. , Brown A. , Garnett L. 
Published: August 2005

Summary: Purpose: Convulsive status epilepticus (CSE) is a major medical and neurological emergency that is associated with significant morbidity and mortality. Despite this high morbidity and mortality, most acute care facilities in the United States cannot evaluate patients with EEG monitoring during or immediately after SE. The present study was initiated to determine whether control of CSE by standard treatment protocols was sufficient to terminate electrographic seizures. Methods: One hundred sixty‐four prospective patients were evaluated at the Medical College of Virginia/VCU Status Epilepticus Program. Continuous EEG monitoring was performed for a minimum of 24 h after clinical control of CSE. SE and seizure types were defined as described previously. A standardized data form entry system was compiled for each patient and used to evaluate the data collected. Results: After CSE was controlled, continuous EEG monitoring demonstrated that 52% of the patients had no after‐SE ictal discharges (ASIDS) and manifested EEG patterns of generalized slowing, attenuation, periodic lateralizing epileptiform discharges (PLEDS), focal slowing, and/or burst suppression. The remaining 48% demonstrated persistent electrographic seizures. More than 14% of the patients manifested nonconvulsive SE (NCSE) predominantly of the complex partial NCSE seizure (CPS) type (2). These patients were comatose and showed no overt clinical signs of convulsive activity. Clinical detection of NCSE in these patients would not have been possible with routine neurological evaluations without use of EEG monitoring. The clinical presentation, mortality, morbidity, and demographic information on this population are reported. Conclusions: Our results demonstrate that EEG monitoring after treatment of CSE is essential to recognition of persistent electrographic seizures and NCSE unresponsive to routine therapeutic management of CSE. These findings also suggest that EEG monitoring immediately after control of CSE is an important diagnostic test to guide treatment plans and to evaluate prognosis in the management of SE.
Evidence of Late‐Onset Infantile Spasms
Authors: Bednarek N. , Motte J. , Soufflet C. , Plouin P. , Dulac O. 
Published: August 2005

Summary: Purpose: To underline the unusual but possible Occurrence of epileptic spasms (ES) in children >1 year of age. Methods: Cases in whom onset of spasms occurred after 1 year of age were identified through a retrospective review of the records of all patients referred for ES to the Saint‐Vincent de Paul Hôpital (Paris) and American Memorial Hospital (Reims) between 1974 and 1994. Results: Eighteen cases were identified among the 734 children referred for ES, 18 cases were identified where spasm onset time ranged from 12 to 38 months of age. In 1/3 of the cases, the diagnosis was suspected from the onset of clinical manifestations; in the remaining 2/3, diagnosis was delayed by a mean 6 months (range, 2–25 months). Neurobehavioral regression affected two‐thirds of the patients. Modified hypsarrhythmia was present in 11 patients; all but one exhibited major and diffuse spike‐ and slow‐wave activity. EEG abnormalities were detected in the frontal areas in 11 patients. Spasms were cryptogenic in 9 patients. Steroids were administered to 13 patients; these controlled the spasms in 6 patients. Outcome was favorable for both seizures; cognition favorable in only 2 of the 18 patients. Conclusions: Beginning after the first year of life, ES, or late‐onset infantile spasms, are distinct from early Lennox‐Gastaut syndrome, although etiology, prognosis and treatment are similar to that for the classical infantile spasms.