bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development and Cross‐Cultural Translations of a 31‐Item Quality of Life in Epilepsy Inventory
Authors: Cramer Joyce A. , Perrine Kenneth , Devinsky Orrin , Bryant‐Comstock Lynda , Meador Kimford , Hermann Bruce 
Published: August 2005

Summary: Purpose: We report the development of a questionnaire to assess health‐related quality of‐life (HRQOL) in people with epilepsy and the process of cross‐cultural translations of the questionnaire. Methods: A sample of 304 adults with epilepsy from 25 seizure clinics in the United States was used to derive an abbreviated questionnaire focusing on epilepsy‐related issues from a longer, 89‐item instrument (QOLIE‐89). A rigorous forward‐backward‐forward system was used for cross‐cultural translation. Results: A 31‐item questionnaire (QOLIE‐31, version 1.0) resulted, comprising seven subscales covering genral and epilepsy‐specific domains. Subscale and total scores can be calculated. The subscales were grouped into two factors: Emotional/Psychological Effects (seizure worry, overall QOL, emotional well‐being, energy/fatigue subscales) and Medical/Social Effects (medication effects, work‐driving‐social limits, cognitive function subscales). Cross‐cultural translations were made from U.S.‐English into Danish, Dutch, German, Canadian French, French, Italian, Spanish, Swedish, and U.K. English Versions 1.1. Conclusions: Our results support the reliability and validity of the QOLIE‐31 (U.S.‐English version 1.0) as a measure of HRQOLIE. Cross‐cultural translations into nine other languages make it feasible to use the QOLIE‐31 (version 1.1) in multinational clinical trials after validation in each population or concurrent with clinical trial.
Vagus Nerve Stimulation for Symptomatic Generalized Epilepsy: A Pilot Study
Authors: Labar Douglas , Nikolov Blagovest , Tarver Brent , Fraser Richard 
Published: August 2005

Summary: Purpose: Patients with symptomatic generalized epilepsy (SGE) may have antiepileptic drug (AED)‐resistant mixed generalized seizures. Vagus nerve stimulation (VNS) reduces partial seizures and may help SGE. Methods: We added VNS to stable AED therapy in five SGE patients. Nine‐month postoperative VNS treatment seizure rates were compared to a 1 ‐month preoperative baseline. Results: All patients had mixed generalized seizures, EEG generalized slow spike‐and‐wave and behavioral abnormalities. Median number of previous AEDs taken was 6 (range 5–12). Median baseline seizure rate was 75honth (range 29–1 10). VNS produced a median seizure rate production of ‐41% (range ‐40%–85%). Adverse events reported in one patient each were: incisional infection, choking sensation and voice change; and coughing (noted by two patients). One patient discontinued VNS due to coughing. Conclusions: We conclude that VNS may be useful add‐on therapy for SGE. A larger, controlled, and blinded trial may be warranted.
Epilepsy, Vagal Nerve Stimulation by the NCP System, Mortality, and Sudden, Unexpected, Unexplained Death
Authors: Annegers J. F. , Coan Sharon P. , Hauser W.A. , Leestma J. , Duffell William , Tarver Brent 
Published: August 2005

Summary: Purpose: To determine rates of all‐cause mortality and of sudden, unexpected, unexplained deaths in epilepsy (SUDEP) in a cohort of individuals treated with the Neuro Cybernetic Prosthesis (NCP) System for intractable epilepsy, and; to contrast the NCP experience with other epilepsy cohorts. Methods: A cohort of 791 individuals were followed for 1, 335 person‐years from implantation. Of the total cohort, 120 individuals had their NCP System devices deactivated. The 15 deaths which occurred during NCP System activation were reviewed for SUDEP by a panel. There were three additional deaths and 242.5 person‐years of monitoring after deactivation. Results: The standardized mortality ratios for NCP System were 5.3, 95% confidence interval (CI) 3.0–8.7; and for the time period after device deactivation, 4.4, 95% CI 0.9–12.8. Six of the deaths during stimulation were considered definite or probable SUDEP and two as possible SUDEP. Seven were not considered to be SUDEP. The incidence of definite/probable SUDEP was 4.5 per 1,000 person‐years and 6.0 per 1,000 person‐years for definite/probable/possible SUDEP. Conclusions: The mortality rates and standardized mortality ratios are comparable with studies of young adults with intractable epilepsy who were not treated with NCP System. These SUDEP rates are not significantly different from those reported in the recent studies of lamotrigine (LTG), gabapentin (GBP), and tiagabine (TGB). The higher rates of SUDEP in the NCP System cohort, as compared with recent drug trials, presumably is explained by the selection of relatively higher‐risk patients for the NCP System device.
Comparison of Effects of Valproate and Trans‐2‐en‐Valproate on Different Forms of Epileptiform Activity in Rat Hippocampal and Temporal Cortex Slices
Authors: Sokolova S. , Schmitz D. , Zhang C. L. , Löscher W. , Heinemann U. 
Published: August 2005

Summary: Purpose: Reducing the extracellular magnesium or calcium or increasing the extracellular potassium induces different patterns of epileptiform activity in the hippocampus and the entorhinal cortex. Although in the low Ca2+ and K+ models, seizure‐like events (SLEs) develop in area CA1 of the hippocampus, only short recurrent discharges develop in the low Mg2+ model. In contrast, in low Mg2+, SLEs and late recurrent discharges (LRDs) are observed in the entorhinal cortex. Methods: We compared the effects of valproate (VPA) and its major metabolite, trans‐2‐en‐VPA (TVPA), on all these different model activities using extracellular field potential measurements. We also investigated the equilibration time course of VPA in the slice by using VPA‐sensitive microelectrodes. Results: Both drugs reversibly blocked most forms of epileptiform activity. The only exception was the LRDs in the entorhinal cortex. In paired experiments, TVPA appeared to be more effective than VPA bath applied with the same concentration to the same slice. With our measurements of the VPA concentrations in slices, we showed that the concentrations used were close to therapeutic drug levels. Conclusions: If TVPA stands the toxicological tests, it might be a useful alternative in the treatment of seizures.
Clinical Usefulness of the Dipole Tracing Method for Localizing Interictal Spikes in Partial Epilepsy
Authors: Shindo Katsuro , Ikeda Akio , Musha Toshimitsu , Terada Kiyohito , Fukuyama Hidenao , Taki Waro , Kimura Jun , Shibasaki Hiroshi 
Published: August 2005

Summary: Purpose: To clarify the clinical usefulness of the dipole tracing method in evaluation of interictal EEG spikes in patients with partial epilepsy. Methods: Eight patients with partial epilepsy were studied. We compared the generator source of interictal spikes detected by the dipole tracing method with the results of magnetic resonance imaging (MRI), interictayictal measurement of cerebral blood flow (CBF) by single photon emission computed tomography (SPECT), interictal measurement of glucose metabolism by positron emission tomography (PET) and invasive electrocorticogram (ECoG). Results: In 5 patients with mesial temporal lobe epilepsy (TLE), including 3 patients who underwent standard temporal lobectomy, the dipole tracing method showed results consistent with those of other examinations and better correlation with ECoG than with other noninvasive examinations. In a patient with mesial TLE who had defects in the skull due to previous surgery, the dipoles were located more laterally than expected. In a patient with frontal lobe epilepsy (FLE) who was finally proved to have an epileptogenic area in the lateral frontal area, the spike dipoles were identified in the medial side of the frontal lobe. Conclusions: The dipole tracing method used in the present study is useful for localizing epileptogenic areas in patients with mesial TLE. However, in patients with partial skull defects and in those with FLE, the reliability of this method is still in accuracy of the lobe level.
Characterization and Comparison of Local Onset and Remote Propagated Electrographic Seizures Recorded with Intracranial Electrodes
Authors: Schiller Yitzhak , Cascino Gregory D. , Busacker Neil E. , Sharbrough Frank W. 
Published: August 2005

Summary: Purpose: To compared the ictal discharge patterns between local onset and remote propagated electrographic seizures recorded with chronic intracranial electrodes. Methods: The electrophysiological data from 88 consecutive patients who underwent chronic intracranial EEG monitoring were retrospectively reviewed. The early and late discharge patterns of electrographic seizures at local onset and distant propagated sites were determined by blinded visual inspection and computerized analysis. Results: Four early and three late electrographic seizure patterns were observed at the local onset sites. The four early patterns consisted of a rhythmic discharge in the beta range (“beta buzz”), rhythmic alpha‐theta activity, rhythmic sharp waves in the delta range, and an irregular spike discharge. The three distinct late‐discharge patterns consisted of a late beta buzz, rhythmic sharp theta activity, and a rhythmic polyspike and wave discharge. At remote propagated sites, electrographic seizures could be divided into two different types according to their early discharge pattern. The first was unique to remote propagated electrographic seizures and consisted of a rhythmic theta‐delta activity correlated with the concurrent activity at the local‐onset site. The second remote initiation type consisted of patterns indistinguishable from the earlier discharge patterns recorded at the local onset site. Conclusions: The initial ictal discharge pattern recorded with intracranial electrodes can assist in differentiating local onset and remote propagated electrographic seizures, with rhythmic round theta‐delta activity being unique to distant propagated sites. Nevertheless, the initial discharge of a subclass of remote propagated electrographic seizures consists of an independent pattern indistinguishable from that observed at local onset sites.
A Single‐Blind, Crossover Comparison of the Pharmacokinetics and Cognitive Effects of a New Diazepam Rectal Gel with Intravenous Diazepam
Authors: Cloyd James C. , Lalonde Richard L. , Beniak Thomas E. , Novack Gary D. 
Published: August 2005

Summary: Purpose: The objective of this study was to compare the pharmacokinetics and cognitive effects of a new diazepam (DZP) rectal gel (Diastat®) with intravenously administered DZP. Methods: Twenty healthy volunteers were enrolled in a single‐blind, randomized, double‐dummy, two‐period, crossover study. Subjects received either 15 mg of DZP rectal gel or 7.5 mg of DZP by intravenous infusion. Blood samples for DZP and desmethyldiazepam analysis were obtained before the dose and from 3 min to 240 h after the dose. Heart rate and blood pressure were measured over the first 24‐h period. Subjects also completed five repetitions of a neuropsychological test battery over the first 8‐h period. Results: Diazepam rapidly appeared in plasma after rectal administration, exceeding 200 ng/mL within 15 min and reaching an initial maximum of 373 ng/ml at 45 min and a second maximum of 447 ± 91.1 ng/ml at ∼70 min. The absolute bioavailability of DZP rectal gel was 90.4%. Subjects receiving intravenous DZP were less alert and performed less efficiently on the WAIS Digit Symbol test 6 min after the dose. Subjects receiving DZP rectal gel performed less well on the WAIS Digit Span test 1 h after the dose and required more time to complete the Letter Cancellation and Grooved Pegboard tests 1 and 2 h after drug administration. Conclusions: Diastat® displayed rapid, consistent absorption and was well tolerated. Alterations in cognition were mild and dissipated within 4 h of drug administration. This new rectal drug‐delivery system offers an easy, safe, and bioavailable method to administer DZP.
Seizure Patterns of Mongolian Gerbils Subjected to a Prolonged Weekly Test Schedule: Evidence for a Kindling‐Like Phenomenon in the Adult Population
Authors: Scotti A. L. , Bollag O. , Nitsch C. 
Published: August 2005

Summary: Purpose: Mongolian gerbils (Meriones unguiculatus) seize in response to sensory stimulation and forced exploratory behavior, but the incidence and severity of their seizures are variable. We wished to characterize the seizure pattern of gerbils from our breeding colony. Methods: Ninety‐three gerbils aged 1–16 months were tested for a mean of 24 consecutive weeks and assigned to a category according to their seizure pattern. Frequency distribution histograms of the mean scores assigned every 5 weeks were plotted for each category. Mean age, number of seizures, onset of the first facial and forelimb myoclonus, and of the first generalized tonic‐clonic seizure (GTCS) were compared among categories. We performed correlation analysis between onset of seizures and animal age. Results: From the 93 tested, no seizure‐resistant gerbils could be isolated. Four major categories were distinguished. Category 1, highly seizure‐sensitive gerbils (39%), exhibited seizures from the first few weeks of test on. Category 2, consisting of ‐37%, were seizure‐free for the first three to six consecutive tests, later developing facial and forelimb myoclonus and eventually GTCS. Because such progressive development of seizures was similar to that occurring upon electrical kindling, the gerbils were classified as kindled‐like (KL). Among KL gerbils, older individuals were significantly more refractory to seizures. In category 3, gerbils (10%) exhibited inconsistent seizure behavior. Category 4 consisted of significantly younger animals (11%) with rapid progress to generalized seizures. Conclusions: Seizures of progressive severity can be induced in adult gerbils with a prolonged test regimen. As a consequence, the number of regularly seizing gerbils in a colony can be increased. Prolonged tests starting at a defined age may help characterize seizure development better in this genetic model of limbic epilepsy.
Ictal Scalp EEG in Unilateral Mesial Temporal Lobe Epilepsy
Authors: Pataraia Ekaterina , Lurger Stefanie , Serles Wolfgang , Lindinger Gerald , Aull Susanne , Leutmezer Fritz , Bacher Johanna , Olbrich Achim , Czech Thomas , Novak Klaus , Deecke Lüder , Baumgartner Christoph 
Published: August 2005

Summary: Purpose: We wished to determine the predictive significance of unilateral hippocampal atrophy and interictal spikes on localization of ictal scalp EEG changes and assess whether ictal EEG provides information that might change treatment or influence prognosis in patients with such characteristics of epilepsy. Methods: We analyzed EEG seizure patterns in 118 seizures in 24 patients with unilateral mesial temporal lobe epilepsy (MTLE) defined by typical clinical seizure semiology, unilateral hippocampal atrophy on magnetic resonance imaging (MRI) and unitemporal spikes on interictal EEG. Two blinded electroencephalographers independently determined morphology, location, and time course of ictal EEG changes. Results: Lateralization was possible in 88.4–92.0% of seizures and always corresponded to the side of the interictal spike focus and of hippocampal atrophy on MRI. Although only 30.4–33.9% of seizures were lateralized at onset, a later significant pattern emerged (12.6–13.3 s after EEG seizure onset) that allowed lateralization in 82.4–91.O% of seizures with non‐lateralized onset. Interobserver reliability for lateralization was excellent, with a K‐value of 0.85. In most patients, either all (79.2–83.3%) or >50% (8.3–16.7%) of seizures were lateralized. In only a small proportion of patients (4.2–8.3%) were 40% of seizures lateralized. In 1 patient, no seizure could be lateralized by 1 electroencephalographer. The results of ictal EEG recordings did not alter the surgical approach and did not correlate with surgical outcome. Conclusions: We conclude that unilateral hippocampal atrophy on MRI and unitemporal interictal spikes can predict localization of ictal scalp EEG changes with a high degree of reliability and that ictal EEG provides no additional localizing information in this particular patient group.
Brain Blood Flow Alterations Induced by Therapeutic Vagus Nerve Stimulation in Partial Epilepsy: I. Acute Effects at High and Low Levels of Stimulation
Authors: Henry Thomas R. , Bakay Roy A. E. , Votaw John R. , Pennell Page B. , Epstein Charles M. , Faber Tracy L. , Grafton Scott T , Hoffman John M. 
Published: August 2005

Summary: Purpose: Left cervical vagus nerve stimulation (VNS) decreases complex partial seizures (CPS) by unknown mechanisms of action. We hypothesized that therapeutic VNS alters synaptic activities at vagal afferent terminations and in sites that receive polysynaptic projections from these medullary nuclei. Methods: Ten patients with partial epilepsy underwent positron emission tomographic (PET) measurements of cerebral blood flow (BF) three times before and three times during VNS. Parameters for VNS were at high levels for 5 patients and at low levels for 5. Resting BF measurements were subtracted from measurements during VNS in each subject. Subtraction data were averaged in each of 2 groups of 5 patients. t Tests were applied to BF changes in brain regions that receive vagal afferents and projections (significant at p < O.05, corrected for repeated measures). Results: In both the low‐ and high‐stimulation groups during VNS, brain BF was (a) increased in the rostral, dorsal‐central medulla; (b) increased in the right postcentral gyrus, (c) increased bilaterally in the hypothalami, thalami, and insular cortexes, and in cerebellar hemispheres inferiorly; and (d) decreased bilaterally in hippocampus, amygdala, and posterior cingulate gyri. The high‐stimulation group had greater volumes of activation and deactivation sites. Conclusions: Our findings suggest that left cervical VNS acutely increases synaptic activity in structures directly innervated by central vagal structures and areas that process left‐sided somatosensory information, but VNS also acutely alters synaptic activity in multiple limbic system structures bilaterally. These findings may reflect sites of therapeutic actions of VNS.
Newly Diagnosed Epilepsy in Children: Presentation at Diagnosis
Authors: Berg Anne T. , Shinnar Shlomo , Levy Susan R. , Testa Francine M. 
Published: August 2005

Summary: Purpose: The current understanding of epilepsy has changed significantly in the past 2 decades. This report presents a description of newly diagnosed childhood‐onset epilepsy, with a special emphasis on epilepsy syndromes, in a large, prospectively ascertained community‐based cohort evaluated and diagnosed in the mid‐1990s. Methods: Children, aged 0 through 15 years at the time of the first seizure, were prospectively identified at the time of diagnosis of epilepsy through the practices of 16 of the 17 child neurologists in Connecticut as well as five adult neurologists and seven pediatricians from January 1993 through December 1997. Parents were interviewed, and all relevant medical records were reviewed. Classification of seizures and of epilepsy syndromes was done for each child by each of three pediatric neurologists, Discrepancies were resolved in conference. Results: A total of 613 children was recruited into the study. The median age at time of the first seizure was 5.3 years. Half the cohort was boys. Eighteen percent had a remote symptomatic etiology. Epilepsy syndromes were classifiable in all but four children, although some syndromes are, by definition, relatively nonspecific. In this childhood‐onset cohort, 58.6% of the syndromes were localization related, 29.0% generalized, and 12.4% undetermined as to whether focal or generalized. Benign rolandic epilepsy occurred in 10% of the cohort. Primarily generalized syndromes accounted for 20.6%, with childhood absence being the single most common syndrome in this subgroup (12.1% of the cohort). Secondarily generalized syndromes accounted for 8.5% of the total, with infantile spasms being the most common in this grouping (3.9% of the cohort). Conclusions: This study presents a description of childhood‐and adolescent‐onset epilepsy as it is diagnosed and evaluated in the 1990s in one state in the United State and based on current classification guidelines. The results should be generalizable to the rest of the country. The prognostic value of early identification of epilepsy syndromes will be determined through subsequent follow‐up of this cohort.
Valproate‐Induced Biochemical Abnormalities in Pregnancy Corrected by Vitamins: A Case Report
Authors: Baggot Paddy Jim , Kalamarides Jeremy A. , Shoemaker James D. 
Published: August 2005

Summary: Purpose: Valproate (VPA) is a teratogenic anticonvulsant (AED), but vitamin supplementation has been suggested to limit the effect of VPA on the fetus. Maternal urinary metabolites were monitored to assess the metabolic effects of VPA before and after vitamin supplementation. Methods: A pregnant woman with epilepsy receiving VPA and ethosuximide (ESM) was given high‐dose multivitamins from 13 to 28 weeks' gestation. Maternal urinary metabolites were measured throughout the pregnancy by gas chromatography/mass spectrometry. Results: Before multivitamin supplementation began, the patient had significantly increased excretion rates of α‐ketoglutarate, β‐lactate, pyruvate, lactate, methylmalonate, and other metabolites compared with normal pregnant women. During multivitamin supplementation, many previously increased excretion rates decreased significantly. Fetal head growth was normal up to 30 weeks, but then lagged. Bitemporal narrowing was noted at birth. Conclusions: VPA may cause metabolic abnormalities in pregnancy. Many biochemical abnormalities attributable to VPA in this patient were corrected with high‐dose multivitamin supplementation. The specific relation between biochemical abnormalities and VPA teratogenesis remains to be determined.
Unidirectional Olfactory Hallucination Associated with Ipsilateral Unruptured Intracranial Aneurysm
Authors: Mizobuchi Masahiro , Ito Naoki , Tanaka Chiharu , Sako Kazuya , Sumi Yoshihiro , Sasaki Takehiko 
Published: August 2005

Summary: Purpose: We describe a patient with complex partial seizure with unidirectional olfactory aura associated with ipsilateral unruptured aneurysm. Methods and Results: The patient felt a sweet pleasant smell coming from behind her right side every time before the attack. Cranial magnetic resonance imaging (MRI) and three‐dimensional computed tomography (CT) angiography revealed a large aneurysm at the bifurcation of the right middle cerebral artery and compression of the right orbitofrontal cortex. Small spikes were recorded from the right orbitofrontal and superior temporal gyri and from the uncus by the cortical electrodes during clipping of the aneurysm. Conclusions: The orbitofrontal cortex may have a function related to the ipsilateral directional olfactory sensation.