bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgery for the Treatment of Medically Intractable Infantile Spasms: A Cautionary Case
Authors: Shields W. Donald , Shewmon D. Alan , Peacock Warwick J. , LoPresti Christine M. , Nakagawa JoAnne , Yudovin Sue 
Published: August 2005

Summary: The most appropriate time to consider cortical resection to treat medically intractable infantile spasms has not been clearly defined. The risks that need to be reconciled to make this decision are: What is the risk of loss of developmental potential if surgery is delayed too long versus what is the risk of unnecessary surgery if it is done too soon. We propose that, in addition to evaluation of seizures, developmental assessment is a key factor in the surgical decision. The case report illustrates this concept. Case Report: HC had onset of seizures at 9 days of age and developed infantile spasms due to mild right hemimegancephaly. At 19 months, she was having up to 50 seizures/day and was evaluated and approved for right hemispherectomy but surgery was delayed. Despite the seizures, her development had been much better than most patients with hemimegencephaly and infantile spasms. At 25 months her seizure control was much improved but she had several seizures/week. EcoG at the time of surgery did not demonstrate the usual abnormalities so no resection was performed. She has had only 5 seizures in the 2½ year since. Conclusions: (a) Hemimegalencephaly is not always associated with severe mental retardation; (b) normal or near‐normal development may, in some cases, indicate the possibility of medical control of seizures as the child grows; (c) a localized developmental brain abnormality in a child with intractable seizures should not necessarily lead to cortical resection; and (d) when a child meets developmental milestones, it may be appropriate to delay surgical intervention.
Status Epilepticus: An Overview of the Clinical Problem
Authors: Lowenstein Daniel H. 
Published: August 2005

Summary:Status epilepticus has been recognized since antiquity. The terms état de mal and “status epilepticus” are derived from the slang used by epilepsy patients housed in Salpêtrière and Bicêtre hospitals in Paris during the 1800s. The definition of status epilepticus has been evolving, and is still not precise. In 1903–04 it was described as a development of epilepsy in which seizures are so frequent that “coma and exhaustion are continuous between seizures.” In 1964 the International League Against Epilepsy adopted the definition “a seizure [that] persists for a sufficient length of time or is repeated frequently enough to produce a fixed and enduring epileptic condition.” 30 min has been the most common specified duration of seizures for the diagnosis of status epilepticus, although a duration of 10 or 20 min has been suggested as well. However, a new set of definitions for generalized, convulsive status epilepticus in adults has been proposed and includes an operational definition (specifying a seizure duration of a least 5 min) and a mechanistic definition. In the future, laboratory tests will provide the means for detecting and defining the critical factors that distinguish a single epileptic seizure from status epilepticus. Recent epidemiological studies suggest status epilepticus occurs in 100,000 to 150,000 people in the US each year, and is associated with substantial morbidity and mortality. Etiology, duration of the seizures, and the patient's age seem to be important determinants of the outcome in status epilepticus.
Wavelength Dependence of Photoparoxysmal Responses in Photosensitive Patients with Epilepsy
Authors: Takahashi Yukitoshi , Fujiwara Tateki , Yagi Kazuichi , Seino Masakazu 
Published: August 2005

Summary:Purpose: We tried to specify the relation between the photoparoxysmal response (PPR) and the wavelength spectra of flashing light in various photosensitive epileptic syndromes in the physiologic state.Methods: Intermittent photic stimulation (IPS) by a Grass PS22 photic stimulator was performed with wavelength‐specific optical filters in photosensitive patients with epilepsy (idiopathic generalized epilepsy, IGE; hereditary dentatorubral‐pallidoluysian atrophy, DRPLA) and photosensitive subjects without epilepsy.Results: Five of 19 normal trichromat patients with IGE and an IGE patient with deuteranomaly showed wavelength‐dependent PPRs. The wavelength‐dependent PPRs were elicited only by IPS containing wavelength spectra ∼700 nm in the normal trichromat patients. Two of four patients with DRPLA showed wavelength‐dependent PPRs, and two other DRPLA patients showed quantity‐of‐light‐dependent PPRs. Quantity‐of‐light‐dependent PPRs are elicited by IPS containing more than a certain quantity of light, independent of the wavelength composition of the flashing light. Two of five subjects without epilepsy showed wavelength‐dependent PPRs.Conclusions: There are wavelength‐dependent and quantity‐of‐light‐dependent pathophysiologic mechanisms for eliciting PPRs by low‐luminance IPS. Consideration of the quantity and wavelength composition of light from electronic screens will lead to the prevention of photosensitive seizures induced by electronic screen games.
Callosotomy for Epilepsy After West Syndrome
Authors: Pinard J. M. , Delalande O. , Chiron C. , Soufflet C. , Plouin P. , Kim Y. , Dulac O. 
Published: August 2005

Summary: Purpose: To analyze the results of callosotomy in 17 children with symptomatic generalized epilepsy after West syndrome, according to the different seizure types and surgical procedures, to define selection criteria for candidates to callosotomy. Methods: Callosotomy was performed in two successive stages. Partial callosotomy, anterior in 13 and posterior in three, was followed by completion in 14 cases in all but four patients (complete callosotomy in one stage in one, no completion in three). All patients had clinical, video‐EEG, and neuropsychological evaluation before and after each stage of callosotomy, with a mean final follow‐up of 4 years. Results: Seizure frequency improved in only two of 13 patients after anterior callosotomy, in none of three after posterior callosotomy, but in nine of 14 after complete callosotomy. After complete callosotomy, spasms disappeared in 80% of the cases, and drop attacks, the most severe ictal event, completely stopped or were dramatically reduced in 90% of the children. One patient no longer had episodes of status epilepticus, and another one acquired the ability to walk after complete callosotomy. From the cognitive viewpoint, nine patients with improved seizure frequency after complete callosotomy also had improved behavior and cognitive functions, but two others experienced speech deterioration after posterior callosotomy at age 11 years and completion of callosotomy at age 16 years. Conclusions: As in other severe generalized epilepsies in childhood, drop attacks provide the best indication for complete callosotomy in patients with previous West syndrome. Because drop attacks can be identifiable by falls only, the previous acquisition of walking should be considered as a key feature for any benefit to be obtained.
Effects of Pregnancy on the Pharmacokinetics of Lamotrigine in Dogs
Authors: Matar K. M. , Nicholls P. J. , Tekle A. , Bawazir S. A. , Al‐Hassan M. I. 
Published: August 2005

Summary: Purpose: This study was designed to evaluate the effects of pregnancy on the kinetics of lamotrigine (LTG). Methods: Five pregnant dogs were given a daily dose of LTG (100 mg) for a period of 1 week. Two months after parturition, the same subjects were given the LTG dose (100 mg) over the same period. On both occasions, plasma LTG concentrations were determined by a sensitive, high‐performance liquid chromatographic (HPLC) method, over a 30‐h period after the last dose. Results: The mean maximum plasma concentration (Cmax), volume of distribution (Vd/F), and oral body clearance (Cl/F) for LTG (± SD) during pregnancy were 7.63 ± 2.46 μg/ml 1.74 ± 0.29 L/kg, and 0.19 ± 0.04 L/h/kg, respectively. After pregnancy, the same variables were 6.12 ± 2.24 μg/ml, 2.36 ± 1.10 L/kg, and 0.30 ± 0.13 L/h/kg, respectively. None of these pharmacokinetic parameters was found to be significantly different between the two groups. Conclusions: The apparent lack of change in the relevant pharmacokinetic parameters of LTG during pregnancy may indicate that pregnancy has little or no effect on glucuronidation; the principal pathway for the drug's elimination.
Epileptiform Propagation Patterns Mediated by NMDA and Non‐NMDA Receptors in Rat Neocortex
Authors: Telfeian Albert E. , Connors Barry W. 
Published: August 2005

Summary: Purpose: The neocortex can generate various forms of epileptiform activity, including one that depends on N‐methyl‐D‐aspartate (NMDA)‐type glutamate receptors (NMDARs), and another dependent on non‐NMDA‐type (AMPA) glutamate receptors (AMPARs). Previous work in vitro suggests that both forms of activity are initiated by neurons of layer 5, but the spatial patterns of horizontal propagation have been studied only for the AMPAR form. We have tested the hypothesis that both types of epileptiform activity spread via common pathways in one cortical layer, suggesting that lamina‐specific intervention might selectively interrupt both. Methods: Slices of rat somatosensory cortex were maintained in vitro and treated with the γ‐aminobutyric acid type A (GABAA)‐receptor antagonist picrotoxin. Single all‐or‐none epileptiform discharges were evoked with an electrical stimulus, and extracellular microelectrodes were used to track the vertical and lateral spread of the discharges. Results: In both high and low concentrations of picrotoxin, the non‐NMDAR antagonist 6‐cyano‐7‐nitroquinoxaline‐2,3‐dione (CNQX) completely blocked propagation, whereas the NMDAR antagonist D‐2‐amino‐5‐phosphonovaleric acid (DAPV) only shortened the duration of discharges. When extracellular [Mg2+] was reduced in the presence of picrotoxin and CNQX, NMDAR‐dependent epileptiform discharges could be initiated. NMDAR‐dependent discharges spread at about one fifth the conduction velocity of AMPAR‐dependent events. Analysis of spatiotemporal field‐potential patterns suggested that both NMDAR‐ and AMPAR‐mediated propagation involved early activity in layers 5 and 6, followed by larger‐amplitude activity in upper cortical layers along the path of propagation. Conclusions: Our results imply that a common pathway mediates the propagation of these two forms of epileptiform activity, and suggests that lamina‐specific surgical intervention might maximize anticonvulsant effect while minimally disrupting cortical function.
NMDA‐ But Not Kainate‐Mediated Events Reduce Efficacy of Some Antiepileptic Drugs Against Generalized Tonic‐Clonic Seizures in Mice
Authors: Urbanska Ewa M. , Tomczyk Tomasz , Haberek Grzegorz , Pilip Slawomir , Matyska Joanna , Turski Waldemar A. , Kleinrok Zdzislaw , Czuczwar Stanislaw J. 
Published: August 2005

Summary: Purpose: The aim of this study was to evaluate the efficacy of conventional antiepileptic drugs (AEDs) against the generalized tonic‐clonic seizures in mice subjected to the subconvulsive doses of N‐methyl‐D‐aspartate (NMDA) or kainate. Methods: Mice were given NMDA and kainate in the doses of 50.0 and 9.0 mg/kg i.p., respectively [i.e., equal to 75% of their CD16 values (convulsive dose in 16% of the animals studied)]. Subsequently the anticonvulsive potential of conventional AEDs against the maximal electroshock‐induced seizures was estimated. Where necessary, the plasma levels of AEDs were assessed. Results: NMDA or kainate application did not affect the electroconvulsive threshold. NMDA, but not kainate, diminished the antiepileptic activity of diazepam (DZP) and carbamazepine (CBZ), increasing their 50% effective doses (ED50S) from 14.1 and 8.6 to 19.0 and 12.1 mg/kg i.p., respectively. Neither NMDA nor kainate affected the ED50 for valproate (VPA), phenobarbital (PB), or diphenylhydantoin (DPH) against electroconvulsions. NMDA‐evoked effects were reversed with the use of the NMDA antagonist, D‐(E)‐2‐amino‐4‐methyl‐5‐phosphono‐3‐pentenoic acid (CGP 40116) and were not accompanied by the alterations in the free plasma levels of AEDs. Conclusions: The NMDA‐mediated events, but not kainate‐related ones, seem to be involved in the protective action of DZP and CBZ against maximal electroshock‐induced seizures. Moreover, it might be concluded that when subthreshold activation of NMDA receptors adds to other epileptogenic factors, DZP and CBZ are less efficacious. Presented data indicate that in such situations, adding the NMDA receptor antagonist (at very low doses) to the AED may yield beneficial therapeutic effects.
Gamma Knife Surgery for Mesial Temporal Lobe Epilepsy
Authors: Régis Jean , Bartolomei Fabrice , Rey Marc , Genton Pierre , Dravet Charlotte , Semah Franck , Gastaut Jean‐Louis , Chauvel Patrick , Peragut Jean‐Claude 
Published: August 2005

Summary: Purpose: Gamma knife radiosurgery (GK) allows precise and complete destruction of chosen target structures containing healthy and/or pathologic cells, without significant concomitant or late radiation damage to adjacent tissues. All the well‐documented radiosurgery of epilepsy cases are epilepsies associated with tumors or arteriovenous malformations (AVMs). Results prompted the idea to test radiosurgery as a new way of treating epilepsy without space‐occupying lesions. Methods: To evaluate this new method, we selected seven patients with drug‐resistant “mesial temporal lobe epilepsy” (MTLE). The preoperative evaluation program was the one we usually perform for patients selected for microsurgery of TLE [video‐EEG analysis of seizures, foramen ovale electrode recording, magnetic resonance imaging (MRI) positron emission tomography (PET) scan, neuropsychological testing]. In lieu of microsurgery, the amygdalohippocampectomy was performed by using GK radiosurgery. Results: Morphologic (MRI) signs of destruction of the target took place at 9 months after GK surgery. Since the treatment day, the first patient has been seizure free. Seizure improvement came more gradually for the following patients, and complete cessation of seizures occurred around the tenth month (range, 8–15 months). MRI shows that the amygdaloentorhinohippocampal target was selectively injured. No significant side effect (except one case of homologous quadrantanopia) or morbidity and no mortality was observed. The current follow‐up is 24–61 months, and all (but one) patients are seizure free. Conclusions: This initial experience proves clearly the short‐to middle‐term efficiency and safety of GK for MTLE surgery. These results need further confirmation of long‐term efficiency, but the introduction of GK surgery into epilepsy surgery can reduce dramatically its invasiveness and morbidity.
Validity of Diagnosis Using the French Translation of the Semi‐Structured Interview for Seizure Classification
Authors: Picot Marie‐Christine , Crespel Arielle , Tricot Marie , Daurès Jean‐Pierre , Valton Luc , Malafosse Alain , Baldy‐Moulinier Michel 
Published: August 2005

Summary: Purpose: The purpose of this study was to assess the acceptability and validity of the French cross‐cultural translation of a semistructured interview for seizure classification (SISC). We used the first revised version, the original of which was validated in 1990. Methods: We administered the French SISC to a sample of 67 adults older than 15 years, comprising 17 controls and 50 patients with epilepsy (without provoked or isolated seizures). A cross‐cultural translation was made from American English into French. Medical records were reviewed by epileptologists, who classified seizures, syndromes, and risk factors in accordance with the International League Against Epilepsy (ILAE) classifications. Agreement between interview‐ and physician‐based diagnoses was assessed with a kappa coefficient (K) at each level of the recognized schemes for the classification of seizures (both broad and specific categories), syndromes, and risk factors. Results: The sensitivity of the French SISC in diagnosing an epileptic seizure was 100%, with a specificity of 94%. Interview‐based diagnoses agreed with those of physicians in 90% of patients for broad seizure categories [ie, generalized or focal in origin (K = 0.74)]. When diagnoses agreed on focal origin, the agreement on seizure types—simple or complex—was 91% (K = 0.84). Among generalized seizures, the agreement was 73% (K = 0.60). Agreement on epilepsy syndromes was excellent for generalized epilepsy but moderate for focal epilepsy. Agreement on identified risk factors was 93%. Conclusions: The K coefficients demonstrated a good level of reliability. These results support the acceptability of this type of interview and the validity of the French version of the SISC.
Felbamate in Experimental Model of Status Epilepticus
Authors: Mazarati Andrey M. , Baldwin Roger A. , Sofia R. Duane , Wasterain Claude G. 
Published: August 2005

Summary: Purpose: To examine the putative seizure‐protective properties of felbarnate in an animal model of self‐sustaining status epilepticus (SSSE). Methods: SSSE was induced by 30‐min stimulation of the perforant path (PPS) through permanently implanted electrodes in free‐running male adult Wistar rats. Felbarnate (FBM; 50, 100, and 200 mg/kg), dizepam (DZP; 10 mg/kg), or phenytoin (PHT; 50 mg/kg) were injected i.v. 10 min after SSSE induction. Electrographic manifestations of SSSE and the severity of SSSE‐induced neuronal injury were analyzed. Results: Felbamate injected during the early stages of SSSE (10 min after the end of PPS), shortened the duration of seizures in a dose‐dependent manner. Total time spent in seizures after FBM and 290 ± 251 min (50 mg/kg), 15.3 ± 9 min (100 mg/kg), and 7 ± 1 min (200 mg/kg), whereas control animals spent 410 ± 133 min seizing. This effect of FBM was stronger than that of DZP (10 mg/kg, 95 ± 22 min) and comparable to that of PHT (50 mg/kg, 6.3 ± 2.5 min). In the applied doses, FBM (200 mg/kg) was more effective than PHT (50 mg/kg) or DZP (10 mg/kg) in shortening seizure duration and decreasing spike frequency, when administered on the pleateau of SSSE (injection 40 min after the end of PPS). Anticonvulsant action of FBM was confirmed by milder neuronal injury compared with control animals. Conclusions: Felbamate, a clinically available AED with a moderate affinity for the glycine site of the NMDA receptor, displayed a potent seizure‐protective effect in an animal model of SSSE. These results suggest that FBM might be useful when standard AEDs fail in the treatment of refractory cases of SE.
Can Early Postnatal Closed Head Injury Induce Cortical Dysplasia?
Authors: Lombroso Cesare T. 
Published: August 2005

Summary: Purpose: Increased availability of surgically resected epileptogenic tissues reveals often unsuspected cortical dysplasia (CD). There is some controversy about the ontogenic stages in which these occur. Although most take place during neuroblast proliferation and migration, there is some evidence for some CD occurring during postmigrational intrinsic cortical organization. It has been shown that various kinds of focal cortical manipulations in rats, if performed within 3–4 postnatal days, lead to the genesis of various cortical malformations including a four‐layered microgyrus or an unlayered CD. It is not known whether such events also might occur in the human brain. Methods: Two children sustained minor head trauma within 4 postnatal days and later developed intractable epilepsy, which was relieved by surgery. Neuropathologic analysis of the resected tissues revealed an unsuspected microdysplastic cortex immediately adjacent to a focal, modest meningeal fibrosis, presumably secondary to the old closed head trauma. Results: The main histologic features were a disorganized, unlayered cortex; abnormal clusters of neurons, often with complex, randomly oriented proximal dendritic patterns with absent apical orientation; the presence of a number of heterotopic small and large neurons in the white matter; absence of inflammatory infiltrates, of hemosiderine, of reactive gliosis, or of an excessive number of blood vessels. The morphologic features in these surgical specimens suggest that these focal malformations occur because of a regional disorder of postmigrational intrinsic cortical remodeling. Conclusions: The clinical histories and the pathologic findings lend some support to the hypothesis that minor morbid events occuring in the immediate postnatal period may lead to microdysplasia in the human similar to those induced in rat pups. The animal model could be helpful to clarify the genesis of some cases of CD and of the epileptogenicity often manifesting later in life.
Intracranial EEG Seizure‐Onset Patterns in Neocortical Epilepsy
Authors: Lee Sang‐Ahm , Spencer Dennis D. , Spencer Susan S. 
Published: August 2005

Summary: Purpose: We investigated neocortical seizure‐onset patterns recorded by intracranial EEG with regard to anatomic location, pathologic substrate, and prognostic value for surgical outcome. Methods: Seizure onset was analyzed in 53 neocortical re‐sective epilepsy surgery patients. Anatomic location was divided into temporal and extratemporal. Pathologic substrate was classified as developmental, mature, and negative or non‐specific gliosis. Onset frequency was categorized by visual analysis into tradition EEG frequency bands. Spatial extent was divided into focal (fewer than four contacts) and regional (more than five contacts). Waveform at seizure onset was divided into several types based on their morphology. Onset features were examined with respect to anatomic location, pathologic substrate, and surgical outcome. Results: Seizure‐onset frequency was significantly related to spatial distribution and to anatomic location. Extratemporal and regional onset were more commonly in the gamma range, and temporal and focal onset in the beta frequency range or slower. Waveform could be categorized into five different patterns, of which low voltage fast activity (LVFA) was the most common form (57%). LVFA and rhythmic alpha‐theta spike activity were more common in developmental than in mature pathology, whereas rhythmic sinusoidal waves at onset were found in only mature substrates. Waveform pattern showed a possible correlation with surgical outcome (p = 0.097): LVFA and rhythmic sinusoidal waves onset patterns were associated with favorable outcome more often (40.4%) than the other three patterns (6.3%). Slow onset suggested poor outcome in the subgroup of developmental pathology (p = 0.062). Conclusions: Certain electrographic seizure‐onset features are associated with specific substrates and outcomes, whereas others reflect the anatomic location and its connections independent of the pathology.