bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early‐onset Absence Epilepsy and Paroxysmal Dyskinesia
Authors: Guerrini Renzo , Sanchez‐Carpintero Rocio , Deonna Thierry , Santucci Margherita , Bhatia Kailash P. , Moreno Teresa , Parmeggiani Lucio , Bernardina Bernardo Dalla 
Published: March 2003

Summary: Purpose:To report on the association of childhood absence epilepsy and paroxysmal dyskinesia (PD).Methods:We describe six patients aged 6 to 27 years (mean, 14 years) who were identified in five centers participating in a European study group. Patients had been followed up clinically from the first symptoms and had been studied with video‐EEG recordings of absence seizures, videotaping of dyskinetic attacks, and brain magnetic resonance imaging (MRI).Results:Four patients were sporadic, and two were siblings. Age at onset of absence seizures was unusually early (range, 3 months to 3 years 6 months; mean, 16 months), with four children having their first episodes within the first year of life, and the remaining two by age 3 years 6 months. Resistance to multiple appropriate drugs was seen in five children, in four of whom absences improved remarkably when ethosuximide was added. Absences remitted between age 8 and 13 years in the three patients in whom follow‐up was long enough. Different types of PD were seen including paroxysmal kinesigenic dyskinesia (one patient), paroxysmal exercise‐induced dystonia (three patients), and paroxysmal tonic upgaze (two siblings). In most patients, PD appeared at a later age than, co‐occurred with, and outlasted absence seizures. Only in the two siblings with tonic upgaze, dyskinetic attacks had an earlier onset. PD improved with increasing age and did not usually produce severe disability.Conclusions:There is a widening spectrum of epilepsy and PD syndromes, within which epilepsy has the characteristics of the common idiopathic syndromes, with some atypical features.
Maternal Deprivation Stress Exacerbates Cognitive Deficits in Immature Rats with Recurrent Seizures
Authors: Huang Li‐Tung , Holmes Gregory L. , Lai Ming‐Chi , Hung Pi‐Lien , Wang Chih‐Lu , Wang Tzu‐Jou , Yang Chin‐Hwa , Liou Chia‐Wei , Yang San Nan 
Published: March 2003

Summary:  Purpose: Maternal deprivation is stressful for the neonate. The aim of this study was to investigate the short‐ and long‐term effects of maternal separation on recurrent seizures in the developing brain.Methods: Rats were divided into four groups according to whether the rat pups were treated with maternal deprivation from postnatal day 2 (P2) to P9 or neonatal seizures induced by intraperitoneal (i.p.) injection of pentylenetetrazol (PTZ) from P10 to P14. Rats in the control group received saline i.p. injection from P10 to P14; rats in the isolation group underwent daily separation from their dams from P2 to P9; rats in the PTZ‐treated group were subjected to PTZ‐induced recurrent seizures from P10 to P14; rats in the isolation plus PTZ–treated group were subjected to maternal deprivation from P2 to P7 followed by serial seizures from P10 to P14. In addition, subsets of rats at P15 were killed and the brains assessed for acute neuronal degeneration. Visual–spatial memory test using the Morris water maze task was performed at P80. After testing, the hippocampus was evaluated for histologic lesions and cyclic adenosine monophosphate (cAMP)‐responsive element‐binding protein phosphorylation at serine‐133 (pCREBSer‐133), an important transcription factor underlying learning and memory.Results: All rats given PTZ developed recurrent seizures. After PTZ administration, rats with a history of maternal deprivation had more intense impairment than did rats with maternal deprivation and neonatal seizures than those without deprivation. Neuronal degeneration was most prominent in the rats exposed to maternal deprivation plus recurrent seizures. Rats receiving maternal deprivation or PTZ‐induced recurrent seizures exhibited only spatial deficits, but no morphologic changes in the hippocampus. However, rats with maternal deprivation plus PTZ‐induced recurrent seizures exhibited worse visual–spatial learning compared with rats with either isolation or PTZ‐induced recurrent seizures alone. The levels of pCREBSer‐133 may play a role in the decrease in the hippocampus from the rats subjected to maternal deprivation and/or PTZ‐induced recurrent seizures, as compared with rats exposed to vehicle‐control saline. These results indicate that repeated maternal deprivation can exacerbate long‐term cognitive deficits resulting from neonatal seizures. In addition, impaired phosphorylation of CREBSer‐133.Conclusions: Repeated maternal deprivation stress has synergistic effects with recurrent seizures in inducing neurologic damage in the developing brain.
Effects of the Novel Antiepileptic Drug Levetiracetam on Spontaneous Recurrent Seizures in the Rat Pilocarpine Model of Temporal Lobe Epilepsy
Authors: Glien Maike , Brandt Claudia , Potschka Heidrun , Löscher Wolfgang 
Published: March 2003

Summary:  Purpose: Animal models in which seizures are elicited by chemical or electrical means are commonly used for identification and preclinical testing of novel antiepileptic drugs (AEDs). Such models have been successful in discovering all the new AEDs. However, despite the high efficacy of AEDs against elicited seizures in rodent models, a significant proportion of epilepsy patients with spontaneous recurrent seizures is resistant to these drugs. It is not known whether drug testing in rodent models with spontaneous recurrent seizures would yield a more predictive result with respect to AED efficacy in the clinic. This led us to test one of the novel AEDs, levetiracetam (LEV), in a rat model of temporal lobe epilepsy (TLE) with spontaneous recurrent seizures.Methods: Wistar rats were subjected to pilocarpine‐induced status epilepticus and recorded for spontaneous recurrent seizures in the months after pilocarpine treatment. A group of rats with frequent spontaneous seizures was used for the drug trial with LEV. The experimental protocol for drug testing in these rats was as follows. For 2 weeks, rats received subcutaneous implantation of osmotic minipumps filled with saline (predrug control period), followed by a 2‐week period with implantation of LEV‐filled minipumps (drug period), after which pumps were replaced by drug‐free pumps for 2 weeks (postdrug control period). The LEV concentration in the pumps during the drug period was adjusted to give daily doses resulting in the maximal plasma concentration range determined previously in patients with TLE during prolonged treatment with LEV. During the 6 weeks of the experiment in epileptic rats, seizures were recorded by video monitoring.Results: Average seizure frequency during the pre‐ and postdrug control period in a group of eight epileptic rats was 21 and 25 seizures. This was reduced to an average seizure frequency of 8 seizures during the 2 weeks of treatment with LEV. However, the individual response of rats to LEV varied markedly from complete seizure control to no effect at all, although plasma drug levels were within the therapeutic range in all rats. When seizure frequency was separately calculated for the first and second week of treatment, the significant anticonvulsant effect determined in the first week was partially diminished in the second week, suggesting that tolerance may have developed in some of the rats.Conclusions: The data demonstrate that interesting results can be obtained by drug testing in epileptic rats, giving a more realistic prediction of clinical efficacy than results from drug testing in animal models with elicited seizures. Thus, although drug trials in rats with spontaneous recurrent seizures are laborious and time‐consuming, such trials should be added to the preclinical characterization of novel AEDs.
Psychiatric Comorbidity and Hostility in Patients with Psychogenic Nonepileptic Seizures Compared with Somatoform Disorders and Healthy Controls
Authors: Mökleby Kjell , Blomhoff Svein , Malt Ulrik Fr. , Dahlström Astri , Tauböll Erik , Gjerstad Leif 
Published: March 2003

Summary: Purpose:To investigate the prevalence of psychiatric comorbidity and level of anxiety, depression, and aggression in patients with psychogenic nonepileptic seizures compared with those in patients with somatoform disorders and healthy controls.Methods:Twenty‐three patients with psychogenic nonepileptic seizures (PNESs) and 23 age‐ and sex‐matched patients with somatoform disorders (SDs) underwent a clinical and a semistructured psychiatric interview (MINI) and filled in the Hospital Anxiety and Depression scale (HAD) and the Aggression Questionnaire (AQ). Twenty‐three sex‐ and age‐matched controls without psychopathology also underwent a clinical interview and completed the HAD and AQ.Results:PNES reported more minor head injuries in the past than did the two comparison groups, and more unspecific EEG dysrhythmias were observed on EEG. Twenty‐one PNES patients and 18 with SDs had comorbid psychiatric diagnoses. However, the mean number of comorbid psychiatric diagnoses was higher in the PNES group (1.9 ± 0.3 compared with 1.5 ± 0.5 in the SD group; p = 0.003). Ten PNES patients additionally had a somatoform pain disorder, and seven had an undifferentiated somatoform disorder. Both patient groups reported significantly higher levels of anxiety, depression, and anger than did the healthy controls, but the PNES patients had significantly higher level of hostility than both comparison groups.Conclusions:Increased psychiatric comorbidity is known to be associated with poorer response to regular interventions, and hostility is associated with more hostile coping patterns, often interfering with treatment compliance. Thus the increased prevalence of soft neurologic signs and comorbid psychiatric disorders and increased hostility as well in the PNES group, emphasizes that assessment and treatment of patients with PNES referred to a tertiary center requires an integrated approach involving both neurologic and psychiatric resources.
Autonomic Auras: Left Hemispheric Predominance of Epileptic Generators of Cold Shivers and Goose Bumps?
Authors: Stefan H. , Pauli E. , Kerling F. , Schwarz A. , Koebnick C. 
Published: March 2003

Summary: Purpose:Autonomic seizures in temporal lobe epilepsies associated with “cold shivers and goose bumps” as a principal ictal sign or aura have only rarely been studied.Methods:Sixteen patients with autonomic auras [cold shivers or cold sweats (n = 11), goose bumps (n = 4), one patient showed both ictal signs] were analyzed.Results:Lesions were detected in 12 patients. The etiology was heterogeneous [cryptogenic, arteriovenous (AV)‐malformation cyst, trauma, hippocampal sclerosis]. Eight patients underwent epilepsy surgery. The localization and lateralization of the focal epileptic activity in the temporal lobes was determined either by magnetic resonance imaging lesions, EEG, ictal signs, or single‐photon emission computed tomography imaging.Conclusions:The patients with temporal lobe epilepsies associated with ”cold shivers and/or goose bumps” showed a left hemispheric predominance of the focal abnormality in the temporal lobe.
Selective Blockade of N‐Type Calcium Channels by Levetiracetam
Authors: Lukyanetz E. A. , Shkryl V. M. , Kostyuk P. G. 
Published: March 2003

Summary:  Purpose: We investigated the effect of the new antiepileptic drug (AED) levetiracetam (LEV) on different types of high‐voltage–activated (HVA) Ca2+ channels in freshly isolated CA1 hippocampal neurons of rats.Methods: Patch‐clamp recordings of HVA Ca2+ channel activity were obtained from isolated hippocampal CA1 neurons. LEV was applied by gravity flow from a pipette placed near the cell, and solution changes were made by electromicrovalves. Ca2+ channel blockers were used for separation of the channel subtypes.Results: The currents were measured in controls and after application of 1–200 μM LEV. LEV irreversibly inhibited the HVA calcium current by ∼18% on the average. With a prepulse stimulation protocol, which can eliminate direct inhibition of Ca2+ channels by G proteins, we found that G proteins were not involved in the pathways underlying the LEV inhibitory effect. This suggested that the inhibitory effect arises from a direct action of LEV on the channel molecule. The blocking mechanism of LEV was not related to changes in steady‐state activation or inactivation of Ca2+ channels. LEV also did not influence the rundown of the HVA Ca2+ current during experimental protocols lasting ∼10 min. Finally, LEV at the highest concentration used (200 μM) did not influence the activity of L‐, P‐ or Q‐type Ca2+ channels in CA1 neurons, while selectively influencing the activity of N‐type calcium channels. The maximal effect on these channels separated from other channel types was ∼37%.Conclusions: Our results provide evidence that LEV selectively inhibits N‐type Ca2+ channels of CA1 pyramidal hippocampal neurons. These data suggest the existence of a subtype of N‐type channels sensitive to LEV, which might be involved in the molecular basis of its antiepileptic action.
Add‐on Phenytoin Fails to Prevent Early Seizures after Surgery for Supratentorial Brain Tumors: A Randomized Controlled Study
Authors: De Santis Antonio , Villani Roberto , Sinisi Marco , Stocchetti Nino , Perucca Emilio 
Published: March 2003

Summary:  Purpose: To determine the potential effectiveness of phenytoin (PHT) in preventing early postoperative seizures in patients undergoing craniotomy for supratentorial brain tumors.Methods: Two hundred patients requiring elective craniotomy for supratentorial brain tumors were randomized to two groups of equal size, with a prospective, open‐label, controlled design. One group received PHT (18 mg/kg as an intravenous intraoperative load, followed by additional daily doses aimed at maintaining serum PHT concentrations within the 10‐ to 20‐æg/ml range) for 7 consecutive days. In the other group, PHT was not administered. More than 90% of patients in both groups continued to take preexisting anticonvulsant medication (AEDs) with carbamazepine or phenobarbital throughout the study. The primary efficacy end point was the number of patients remaining free from seizures during the 7‐day period after the operation.Results: Of 100 patients allocated to PHT, 13 experienced seizures during the 7‐day observation period, compared with 11 of 100 patients in the placebo group (p > 0.05). Most seizures occurred in the first day after surgery in both groups. There were no differences between groups in the proportion of patients experiencing more than one seizure, but there was a trend for generalized seizures to be more common in PHT‐treated patients than in controls (11 vs. five patients, respectively). Status epilepticus occurred in one patient in the PHT group and in two patients in the control group. Of the 13 PHT‐treated seizure patients, 11 had serum PHT concentrations within the target range, and only two had concentrations below range on the days their seizures occurred.Conclusions: PHT, given at dosages producing serum concentrations within the target range, failed to prevent early postoperative seizures in patients treated with concomitant AEDs. Prophylactic administration of PHT cannot be recommended in these patients.
Optimizing Epilepsy Surgery with Intraoperative MR Imaging
Authors: Kaibara Taro , Myles S. Terence , Lee Mary Anne , Sutherland Garnette R. 
Published: March 2003

Summary:  Purpose: The surgical treatment of medically intractable temporal lobe epilepsy includes the resection of temporal lobe structures. Although the reported seizure‐free outcomes are highly variable, there is growing evidence that the extent of resection of the mesiotemporal lobe directly correlates with seizure control.Methods: A moveable, high‐field intraoperative magnetic resonance (MR) system was used to monitor and optimize the resection of the amygdala and hippocampus in 14 epilepsy patients. Fourteen patients with intractable seizures of temporal lobe origin underwent standard preoperative investigations including MR imaging, EEG telemetry, single‐photon emission computed tomography, and neuropsychologic and sodium amytal testing. Anterior temporal lobectomy was performed on 10 patients, whereas four were treated with selective amygdalohippocampectomy. Intraoperative electrocorticography was applied as required. For all procedures, the objective was to resect the amygdala completely, and hippocampus to the posterior margin of the brainstem.Results: Interdissection intraoperative MR imaging taken when optimal resection was thought to have been achieved revealed residual unresected amygdala or hippocampus in seven of 14 patients. An unexpected acute hematoma was found in one patient. At 17 months' follow‐up, 13 (93%) of 14 patients are seizure free or have significantly improved seizure control.Conclusions: The mobile high‐field intraoperative MR system provides high‐resolution images without restriction on surgical instruments or techniques. The ability to identify and resect residual mesial temporal lobe targets before craniotomy closure is of potentially tremendous value in optimizing seizure control.
Frontal Lobe Tumoral Epilepsy: Clinical, Neurophysiologic Features and Predictors of Surgical Outcome
Authors: Zaatreh Megdad M. , Spencer Dennis D. , Thompson James L. , Blumenfeld Hal , Novotny Edward J. , Mattson Richard H. , Spencer Susan S. 
Published: March 2003

Summary:  Purpose: To review the clinical, neurophysiologic features and surgical outcomes in patients with frontal lobe tumors and chronic intractable seizures.Methods: Medical records of patients with intractable epilepsy who underwent resection or stereotactic biopsy of frontal lobe tumor (confirmed by surgical pathology) seen between 1985 and 1999 at Yale University School of Medicine Epilepsy Center were reviewed for age at diagnosis, age at onset of seizures, delay between seizure onset and tumor diagnosis, types and frequencies of seizures, EEG results, use of anticonvulsants, extent of surgery, pathological diagnosis, and tumor recurrence.Results: Thirty‐seven patients were included. Mean age at seizure onset was 31.6 years, and at tumor diagnosis was 36.2 years. Mean duration between onset of seizures and tumor diagnosis was 6.1 years. Seventeen patients had auras. Seizure frequency averaged 7.6 seizures per week, with 58% of patients having more than one seizure type. All patients used anticonvulsants, with 90% eventually using polytherapy. All patients eventually underwent at least one surgical procedure. Only 13 (35.1%) patients were class I. Twelve (32.4%) patients were class II, seven (18.9%) class III, and five (13.5%) class IV. No statistically significant differences were seen between good and poor long‐term seizure outcome in relation to specific tumor pathology, seizure types, or type of resection.Conclusions: Long‐term surgical outcomes in tumoral frontal lobe epilepsy are more favorable than those in nontumoral intractable frontal lobe epilepsy (65% class I or II) and less favorable than those in other tumoral epilepsy (overall, 70% class I). Frontal location of intracranial neoplasm may predict a less favorable long‐term epilepsy prognosis than tumoral epilepsy in general, an observation for which several explanations are proposed.
Seizure‐related Injuries in Children with Newly Diagnosed and Untreated Epilepsy
Authors: Appleton Richard E. 
Published: March 2003

Summary: Purpose:Patients with epilepsy are reported to have an increased risk of physical injury. One of clinicians' concerns for diagnosing epilepsy early is to try to prevent such injuries and also to allay parental anxiety that seizures may cause injuries. The purpose of this study was to investigate injuries in children with newly diagnosed epilepsy and before starting antiepileptic medication.Methods:A prospective study was undertaken of all newly diagnosed and untreated patients with at least two unprovoked, afebrile seizures of any type, aged 1–16 years, presenting consecutively to seven paediatric/paediatric neurology outpatient departments over a 12‐month period. Information was collected on the duration of epilepsy before diagnosis, the epilepsy syndrome, the seizure type causing the injury, how and the age at which the injury was sustained, and whether hospital treatment was required for the injury.Results:One hundred ninety‐eight patients (116 boys) were surveyed. No patient died as a result of an injury. Twenty‐five (12.6%) children experienced an injury before the diagnosis of epilepsy was established. Only four of the 25 patients (2% of all 198 patients) required medical attention for the injury. The injuries occurred at a mean age of 10.3 years (range, 4–15.1 years), and epilepsy was diagnosed at a mean age of 11.1 (range, 4.2–15.8) years. Fifteen patients were injured at home, six at school, and four outside the home. The seizures causing the injuries were tonic–clonic (17), complex partial (four), myoclonic (one), and of uncertain type (three). None of the 32 patients with childhood‐onset typical absence epilepsy had accidental injuries.Conclusions:Injuries caused by epileptic seizures were uncommon in this newly diagnosed and untreated, consecutive paediatric outpatient series. These unique data could help to reassure clinicians that the diagnosis of epilepsy should not be influenced by any concern that accidental injuries caused by seizures are common in children before starting medication.
Physical and Hormonal Profile of Male Sexual Development in Epilepsy
Authors: El‐Khayat Hamed A. , Shatla Hamed M. , Ali Gihan K. H. , Abdulgani Mohammad O. , Tomoum Hoda Y. , Attya Hussein A. 
Published: March 2003

Summary:  Purpose: This study was designed to investigate the effect of epilepsy and antiepileptic drugs (AEDs) on both the physical and hormonal aspects of the sexual development of male patients with epilepsy.Methods: One hundred thirty male subjects with epilepsy, their age ranging between 8 and 18 years (mean, 14 ± 2.9 years), entered the study; all were taking AEDs. Anthropometric measurements [height, weight, and body mass index (BMI)], testicular volume, penile length, and pubarche were assessed in the studied groups, as well as measurement of the levels of testosterone (T), free testosterone (FT), estradiol (E2), lutenizing hormone (LH), follicle‐stimulating hormone (FSH), and prolactin (PRL), and the results were compared with those of a control group.Results: In this study, male patients older than 16 years were significantly shorter than their matched controls. The mean values of testicular volume and penile length were significantly lower in the patients in the different age subgroups, and the pubic hair staging (pubarche) was delayed in the patients older than 16 years. The mean values of total testosterone, estradiol, LH, and FSH serum levels were significantly higher, whereas the mean values of free testosterone, total‐T/E2, total. T/LH, and FT/E2 ratios were lower in the patient subgroups compared with their age‐matched controls. There were no significant changes in the mean basal PRL serum levels in the patients compared with the controls. The present study demonstrated a reduction in the testicular volume and penile length, significantly lower mean values of free testosterone and total‐T/E2, and a higher mean value of E2 in the patients receiving polytherapy in the age subgroup older than 16 years compared with those on monotherapy; however, there was no demonstrable effect of seizure control or the duration of illness in any of the studied parameters.Conclusions: There is a delay in the sexual development of male patients with epilepsy in the different age subgroups, with endocrine changes in the form of increase in the total testosterone, but the free testosterone is lower, and an increase in estradiol, with lower T/LH levels. Patients receiving polytherapy, especially those older than 16 years, were more likely to have delayed gonadarch and disturbances in their hormonal profile.