bluuebunny/crossref_metadata_2025_split huggingface dataset:
Seizure‐Related Injuries in Multihandicapped Patients with Therapy‐Resistant Epilepsy
Authors: Nakken K. O. , Lossius R. 
Published: August 2005

Summary:A prospective study on seizure‐related inju ries in Norway's two nursing homes for persons with ep ilepsy was conducted. Sixty‐two multihandicapped pa tients with mostly difficult‐to‐treat epilepsy were as sessed for 13 months: 6,889 seizures, 2,696 with ensuing falls, resulted in 80 injuries. The seizure‐related injury risk was 1.2%. The most frequent injuries were mild soft tissue injuries with and without cuts. Six serious injuries were recorded: two leg fractures, one mandibular fracture, one neck of the femur fracture, one skull fracture, and one subdural hematoma. A 71‐year‐old woman with subdural hematoma died during operation for the he matoma. Seizure types most often causing injury were atonic and tonic‐clonic seizures. Prophylactic measures can be taken. Because the seizure‐induced injury risk was slight, we concluded that even persons with refractory epilepsy should be encouraged to lead active lives.
Effect of Isoflurane (Forane) on Intraoperative Electrocorticogram
Authors: Fiol M. E. , Boening Jean A. , Cruz‐Rodriguez Raul , Maxwell Robert 
Published: August 2005

Summary:Isoflurane, an inhalation agent often used for general anesthesia during craniotomy, has been reported to suppress spike activity in the intraoperative electrocor‐ticogram (ECoG) during epilepsy surgery. We studied the effect of isoflurane concentrations of 0.25, 0.5, 0.75, 1, and 1.25% on the number of spike bursts per 5‐min epochs in 15 patients undergoing ECoG during epilepsy surgery. N2O in O2 was maintained at 50% in 10 patients, at 60% in 2, and at 70% in 3. End tidal CO2 concentration was maintained in the hypocarbic range, and analgesia was maintained with the narcotic alfentanil in the range of 0.5–2 μg/kg/min. The median number of spikes for each isoflurane concentration was 29 (range 3–107) at 0.25%, 27 (range 2–73) at 0.5%; 29 (range 5–90) at 0.75%, 33 (range 2–100) at 1%, and 40 (range 32–140) in 5 patients who tolerated 1.25% without occurrence of burst suppression pattern. No significant difference (Student's paired t test) was noted in the number of spikes for each isoflurane concentration. Therefore, if isoflurane concentrations are maintained between 0.25 and 1.25% or before burst suppression pattern occurs and N2O/O2 is maintained in the 50–70% range, isoflurane has no significant effect on spike activity.
Decreased Neuronal Burst Discharge Near Site of Seizure Onset in Epileptic Human Temporal Lobes
Authors: Colder Brian W. , Frysinger Robert C. , Wilson Charles L. , Harper Ronald M. , Engel Jerome 
Published: August 2005

Summary:We examined auto‐correlation and interval distribution characteristics of neuronal discharge from patients with complex partial seizures. The objective was to compare the interictal firing patterns of neurons in mesial temporal structures ipsilateral to the site of seizure onset with firing patterns of neurons in homologous contralateral structures. Spontaneous interictal recordings of 258 single neurons were acquired from 23 patients. A “burst area” measure was derived from the neuronal auto‐correlation to assess the likelihood of grouped action potential discharge (burst discharge). Large burst area measures indicate a tendency for single neuronal burst discharge, but do not disclose information about interspike intervals within bursts. Although several measures based on single neuronal interspike interval distributions showed no overall difference between hemispheres, burst area was significantly reduced in mesial temporal structures ipsilateral to the site of seizure onset. Possible mechanisms of decreased burst discharge in epileptogenic regions include selective loss of burst‐discharging neurons and increased recurrent inhibition.
Anticonvulsant Activity of Phenobarbital and Valproate Against Maximal Electroshock in Mice During Chronic Treatment with Caffeine and Caffeine Discontinuation
Authors: Gasior Maciej , Borowicz Kinga , Buszewicz Grzegorz , Kleinrok Zdzislaw , Czuczwar Stanistaw Jerzy 
Published: August 2005

Summary:We evaluated the protective activity (expressed as ED50, values in mg/kg) of phenobarbital (PB, 120 min before testing) and valproate (30 min) alone or combined with caffeine in male mice with seizures induced by maximal electroshock (MES). Both antiepilep‐tic drugs (AEDs) were administered by intraperitoneal (i.p.) injection in a single dose to mice receiving intraperitoneal caffeine either in a single dose 30 min before the test or as pretreatment every 12 h for 3 and 14 days. In addition, we determined the ED50, values of the AEDs 24 and 72 h after 14–day treatment with caffeine. Finally, we studied the influence of a challenge dose of caffeine, injected in mice 24 and 72 h after 14 days of treatment with caffeine, on the protective activity of PB or VPA. Caffeine in a single dose of 23.1 mg/kg reduced the anticonvulsant effect of PB. Its protective activity was further impaired after 3 and 14 days of caffeine treatment. The ED50, for VPA was significantly increased both by the single dose of caffeine and by chronic treatment. The anticonvulsant activity of PB and VPA measured 24 and 72 h after 14–day treatment with caffeine did not differ from control values, but a challenge dose of caffeine injected 24 or 72 h after daily injections for 14 days resulted in a significant reduction in the protective activity of both AEDs. Measurement of the total plasma levels of caffeine, VPA, and PB did not suggest pharmacokinetic interactions as an explanation for our results. Our results indicate that chronic caffeine exposure may progressively reduce the antiepileptic potency of VPA and PB.
Patients' Experiences of and Satisfaction with Care for Their Epilepsy
Authors: Buck Deborah , Jacoby Ann , Baker Gus A. , Graham‐Jones Susanna , Chadwick David W. 
Published: August 2005

Summary: Purpose: To determine condition‐specific satisfaction with care, we studied patients'experience of general practitioner (primary physician) and hospital clinic care for their epilepsy and their views about the provision of information concerning the management of their condition.Methods: A postal questionnaire was sent to an unselected, community‐based population of patients with epilepsy. In addition to clinical and demographic details and previously validated scales of psychosocial well‐being, the instrument contained a series of questions about patients'experiences and views of the care they received for epilepsy from both general practice and the hospital services.Results: Doctors'interpersonal skills were the most influential factors affecting both patient satisfaction overall and the likelihood that doctors might discuss with patients certain clinical and social issues surrounding the management of the patient's condition. A sizable proportion of patients reported that they received insufficient information, about epilepsy, both from hospital doctors and general practitioners.Conclusions: Patients with epilepsy place great importance on having a doctor who is approachable, communicative, and knowledgeable and on receiving adequate information about their condition. Clinicians may need to be made more aware of the importance of accessibility and sensitivity to the nonclinical needs of their patients. Such easily implemented changes in the delivery of care would improve services in the United Kingdom for people with epilepsy.
Cerebellar Hypometabolism in Focal Epilepsy Is Related to Age of Onset and Drug Intoxication
Authors: Seitz Rüdiger J. , Piel Sabine , Arnold Stephan , Schlaug Gottfried , Ebner Alois , Holthausen Hans , Tuxhorn Ingrid , Witte Otto W. 
Published: August 2005

Summary: Purpose: We wished to investigate the cerebellar depression of regional cerebral glucose metabolism (rCMRGlu) in patients with focal epilepsy. Method: In 170 consecutive patients with medically refractory, focal epilepsy the rCMRGlu was measured in cerebellum and brain. Results: rCMRGlu was markedly decreased in both cerebellar hemispheres and slightly in brain. The cerebellum to brain rCMRGlu ratio was significantly decreased in patients with seizure manifestation in infancy, but was normal due to a progressive decrease in brain rCMRGlu in later age. A subgroup of patients with focal epilepsy involving the frontal lobe had a reduced cerebellum/brain rCMRGlu ratio, whereas in patients with mesiotemporal lobe epilepsy (MTLE), the rCMRGlu was decreased to the same degree in cerebellum and brain. The difference in the cerebellum/brain rCMRGlu ratio between the two groups was accounted for by the younger age of the patients with focal epilepsy involving the frontal lobe, however. In another subgroup of patients with a documented history of critical drug intoxications, the cerebellar rCMRGlu was severely decreased, resulting in a significantly reduced cerebellum/brain rCMRGlu ratio. Conclusion: Our retrospective study suggests that the cerebellum is particularly vulnerable in infancy to ongoing epileptic activity and high dosage of antiepileptic drugs (AEDs).
How Easy are Randomized Controlled Trials in Epilepsy to Find on Medline? The Sensitivity and Precision of Two Medline Searches
Authors: Marson Anthony G. , Chadwick David W. 
Published: August 2005

Summary:Recognition of the need for more scientifically acceptable review strategies is increasing. Systematic reviews have rarely been performed on randomized controlled trials (RCTs) in the field of epilepsy. We have 355 published RCTs on a database, which will be used as a data source for systematic reviews. We wished to test the sensitivity and precision of two Medline search strategies, and to identify reasons why RCTs were missed. Both a basic and a comprehensive search strategy were used to search Medline from 1966 to 1993. Three journals (Epilepsia, Epilepsy Research, Acta Neurologica Scandinavica) were searched by hand. The sensitivity and precision of these Medline search strategies in these three journals was calculated. We investigated articles missed by our comprehensive search to ascertain why they had been missed. Of the 308 RCTs on the database published between 1966 and 1993, 275 were found by our comprehensive Medline search, whereas 103 were found by our basic search. The overall precision of our comprehensive and basic searches was 35 and 72%, respectively. The overall sensitivity of our comprehensive and basic searches was 86 and 66%, respectively. Our comprehensive search failed to find 16 RCTs published in the three journals searched by hand. Articles were missed because they were inadequately indexed on Medline and/or did not contain adequate methodological information in their titles or abstracts. To find all relevant trials, a search strategy must be as sensitive as possible, but this sensitivity inevitably involves loss of precision. The National Library of Medicine is addressing indexing problems with Medline, but the quality of reports also must be improved to enhance retrieval.
Localization of Temporal Lobe Foci by Ictal EEG Patterns
Authors: Ebersole John S. , Pacia Steven V. 
Published: August 2005

Summary:Identifying patients whose complex partial seizures originate in temporal neocortex rather than in hippocampus is important because such patients have less favorable outcomes with standard anteromesial temporal resections. We reviewed scalp‐recorded ictal EEGs of 93 epilepsy surgery candidates who either underwent intracranial EEG monitoring (n= 58) or who were referred directly for temporal lobectomy (n= 35). We defined seven patterns of early seizure discharges, grouped patients according to their seizure pattern, and correlated these with the site of seizure onset determined by intracranial EEG. Categorization by seizure pattern was also compared with brain magnetic resonance imaging (MRI) findings and intracarotid amobarbital (Wada) testing. An initial, regular 5‐ to 9‐Hz inferotemporal rhythm (type 1A) was most specific for hippocampal‐onset seizures. Less commonly, a similar vertex/parasagittal positive rhythm (type 1B) or a combination of types 1B and 1A rhythms (type 1C) was recorded. Seizures originating in temporal neocortex were most often associated with irregular, polymorphic, 2‐ to 5‐Hz lateralized activity (type 2A). This pattern was commonly followed by a type 1A theta rhythm (type 2B) or was preceded by repetitive, sometimes periodic, sharp waves (type 2C). Seizures without a clear lateralized EEG discharge (type 3) were most commonly of temporal neocortical origin. These associations between type of seizure pattern and probable site of cerebral origin were statistically significant. MRI and Wada testing did not have as much specificity as ictal patterns in differentiating among seizure origins. We conclude that the initial pattern of ictal discharge on scalp EEG can assist in distinguishing seizures of temporal neocortical onset from those of hippocampal onset. This information can be used to identify patients for invasive monitoring.
The Effects of Neonatal Hypoxia on Kindled Seizure Development and Electroconvulsive Shock Profiles
Authors: Applegate Craig D. , Jensen Frances , Burchfiel James L. , Lombroso Cesare 
Published: August 2005

Summary: Purpose: Our previous research indicated that the exposure of rat pups to an hypoxic environment during a discrete developmental period (postnatal days 10‐ 15) produces short‐term seizures and confers an enduring increase in susceptibility to pentylenetetrazol‐ and flurothyl‐ induced seizures. In this study, we evaluated the effects of hypoxic insult in this neonatal period on susceptibility to electrical kindling and corneal electroconvulsive shock. Methods: Ten‐day‐old rat pups were exposed to a 3% O2 environment, as previously described, and were either kindled or exposed to corneal electroshock at adulthood (70 days old). Results: Neither kindled seizure development from the septal nucleus or amygdala nor electroconvulsive shock profiles were significantly altered by hypoxic pretreatment. Conclusions: Results indicate that hypoxia produces increases in seizure susceptibility that are observable in only some experimental seizure models but not in others. This outcome serves to target some anatomic systems more than others in the mechanisms involved in hypoxia‐induced neural reorganization.
Delayed Complications Thirty‐Six Years After Hemispherectomy: A Case Report
Authors: Kalkanis Steven N. , Blumenfeld Hal , Sherman Janet C. , Krebs David E. , Irizarry Michael C. , Parker Stephen W. , Cosgrove G. Rees 
Published: August 2005

Summary: Purpose: To describe a late complication of hemispherectomy in a patient in whom symptoms of hydrocephalus developed 36 years after her left‐sided hemispherectomy, the longest delay on record. Methods: Hemispherectomy has been successfully used in the treatment of intractable epilepsy associated with infantile‐type hemiplegia for a half century. Of the patients, however, up to 33% have late increased cerebrospinal fluid pressure complications attributed to superficial cerebral hemosiderosis. Through a retrospective case analysis, we describe such complications in a 52‐year‐old woman with cognitive impairment, gait instability, urinary incontinence, and right hemineglect 36 years after her initial procedure. Results: Quantitative, objective measures of cognition and gait‐laboratory testing confirmed the patient's favorable clinical response to ventriculoperitoneal shunting, as well as the complete resolution of her symptoms, including the atypical occurrence of right‐sided hemineglect. Conclusions: This case uniquely demonstrates the clinical features of a late complication of hemispherectomy while documenting the longest reported delay for developing such adverse sequelae. We also emphasize the need for more extensive follow‐up studies to assess the extent of posthemispherectomy complications.
Localized Cerebellar Hypometabolism in Patients with Complex Partial Seizures
Authors: Savic Ivanka , Altshuler Lori , Passaro Erasmo , Baxter Lew , Engel Jerome 
Published: August 2005

Summary: Purpose: We sought to determine the cause of cerebellar dysfunction in epilepsy and whether this dysfunction was directly related to seizures. Methods: Cerebellar metabolism was evaluated in 48 patients with a well‐defined region of seizure onset and with corresponding hypometabolism. Regions of interest (ROI) were drawn according to a standardized template. If the ROI/honepileptogenic cortex count rate ratio was outside the 95% confidence interval (CI) of controls, the ROI was defined as abnormal. The ratios from cerebellar hemispheres (defined as ipsi‐ or contralateral to the seizure onset region), were compared among controls (n = 8); patients who had seizure onsets and corresponding hypometabolism mesially in a temporal lobe (patient group 1, n = 19); patients whose seizures had onset mesially in a temporal lobe but spread rapidly to the ipsilateral frontal lobe and who had hypometabolism both in the affected temporal lobe and frontal lobe (patient group 2, n = 23); and patients who had seizure onsets and corresponding hypometabolism in the frontal lobe (patient group 3, n = 6). Results: Significant hypometabolism was noted in the contralateral cerebellum of patients in groups 2 and 3 [p = 0.007 and p = 0.008, respectively; two‐way analysis of variance (ANOVA)]. In contrast, patients in group 1 tended to have lower values in the ipsilateral cerebellum (p = 0.057). Conclusions: The observed cerebellar changes are consistent with animal data showing that cerebellar connections to frontal lobes are numerous and crossed, whereas the connections to mesial temporal lobes are less abundant, bilateral, with an ipsilateral predominance. The difference between the two groups of patients with mesial temporal seizures suggests that cerebellar dysfunction in partial epilepsy, at least to a certain extent, is related to mechanisms involved in seizure generation and spread.
Local Perfusion of Diazepam Attenuates Interictal and Ictal Events in the Bicuculline Model of Epilepsy in Rats
Authors: Eder Hans G. , Jones David B. , Fisher Robert S. 
Published: August 2005

Summary: Purpose: We evaluated the efficacy of local perfusion of diazepam (DZP) in suppression of EEG spikes and behavioral seizures produced by bicuculline methiodide (BMI) applied to rat sensory motor cortex and hippocampus. Methods: Data were obtained from 37 rats implanted with EEG head plugs and perfusion cannulas. BMI 4 mM, 5 μl was infused on neocortex through the epidural space in 23 rats. BMI 0.1 mM, 2 μl was infused into the left hippocampus in 14 rats. Results: DZP 0.75–1.0 mg markedly reduced the spiking to a level of 9.9 ± 15.8% of baseline for DZP as compared with 90.2 ± 57.9% of baseline for vehicle‐treated rats. DZP reduced spiking in a hippocampal BMI focus to 1.9 ± 2.4% of baseline spiking, as compared with 98.0 ± 95.6% of that in vehicle‐treated animals. The amount of spread of solution was estimated with methylene blue (MB) injections. Ictal events also were attenuated. In most of the animals, systemic levels of DZP were unmeasurable and injection on the contralateral side did not reduce spiking. Conclusions: These findings suggest that focal application of antiepileptic drugs (AEDs) in brain may be a useful new avenue for therapy of intractable partial seizures.
Three Patterns of Catamenial Epilepsy
Authors: Herzog Andrew G. , Klein Pavel , Rand Bernard J. 
Published: August 2005

Summary: Purpose: On the basis of the neuroactive properties of estradiol and progesterone and the menstrually related cyclic variations of their serum concentrations, we propose the existence of three hormonally based patterns of seizure exacerbation. Because previous reports both support and refute the concept of catamenial epilepsy, we test the hypothesis by charting seizures and menses and measuring midluteal serum progesterone levels to estimate the frequency of epileptic women with catamenial seizure exacerbation. Methods: One hundred eighty‐four women with intractable complex partial seizures (CPS) charted their seizure occurrence and onset of menstruation on a calendar for one cycle during which they had a midluteal blood sample taken for serum progesterone determination on day 22. Levels >5 ng/ml were considered ovulatory. The cycle was divided into four phases with onset of menstruation being day 1: menstrual (M) = ‐3 to +3, follicular (F) = 4 to 9, ovulatory (O) = 10 to ‐13, and luteal (L) =−12 to −4. Average daily seizure frequency for each phase was calculated and compared among phases by repeated‐measures analysis of variance (ANOVA) and the Student‐Newman‐Keul's test, separately for ovulatory and anovulatory cycles. Results: The 1,324 seizures recorded during 98 ovulatory cycles occurred with significantly greater (p < 0.001) average daily frequency during the M (0.59) and O (0.50) phases than during the F (0.41) and L (0.40) phases, offering support for perimenstrual (catamenial 1) and preovulatory (catamenial 2) patterns of seizure exacerbation. The 1,523 seizures recorded during 86 anovulatory cycles occurred with significantly lower (p < 0.001) average daily frequency during the F phase (0.49) than during all other phases (M = 0.78, O = 0.74, L = 0.74), offering support for seizure exacerbation throughout the second half of inadequate luteal phase cycles (catamenial pattern 3). Although 71.4% of the women with ovulatory cycles and 77.9% with inadequate luteal phase cycles had seizure exacerbation in relation to one of the three patterns of catamenial epilepsy, approximately one third of the women showed at least a twofold increase in average daily seizure frequency. We propose a twofold or greater increase as a reasonable definition of catamenial epilepsy. Conclusions: Charting of seizures and menses and determination of day 22 progesterone levels during each cycle may be sufficient to establish the existence of three distinct patterns of catamenial epilepsy. Approximately one third of women with intractable CPS may have catamenial epilepsy.
Anticonvulsant Activity of Felbamate in Amygdala Kindling Model of Temporal Lobe Epilepsy in Rats
Authors: Wlaź Piotr , Löscher Wolfgang 
Published: August 2005

Summary: Purpose: Previous studies have demonstrated that felbamate (FBM, 2‐phenyl‐1,3‐propanediol dicarbamate) at nontoxic doses exerts potent anticonvulsant activity in a variety of animal epilepsy or seizure models. We further characterized the anticonvulsant activity of FBM by using the kindling model of temporal lobe epilepsy (TLE). Methods: The experiments were performed in fully kindled rats. The anticonvulsant effect of FBM was assessed by determining seizure severity, after discharge (AD) duration and seizure duration either at the focal seizure threshold, or after supra threshold stimulation. In addition, the neurological performance of kindled rats after FBM administration was evaluated in the open field and by the rotorod test. Results: FBM at doses of 12.5–50 mg/kg, given intraperitoneally (i.p.) 60 min before testing, dose‐dependently increased the AD threshold (ADT). The maximal effect was achieved after the highest dose tested and reached almost 600% of the control ADT. This dose of FBM significantly diminished other seizure parameters, e.g., seizure severity, seizure duration, and AD duration. When the rats were stimulated with suprathreshold current (500 μA) seizure severity was moderately but significantly reduced. No behavioral abnormalities were noted in kindled rats after administration of either of the doses. Conclusions: FBM potently increases the threshold for focal seizures and reduces seizure severity, seizure duration, and AD duration at doses that produce no adverse behavioral effects in amygdala‐kindled rats. These data are thus compatible with clinical experience with FBM in TLE and substantiate that kindling is a good predictor of anticonvulsant activity against TLE.