bluuebunny/crossref_metadata_2025_split huggingface dataset:
Low Concentration of DL‐2‐Amino‐5‐phosphonovalerate Induces Epileptiform Activity in Guinea Pig Hippocampal Slices
Authors: Gorji Ali , Speckmann Erwin‐Josef 
Published: March 2003

Summary:   Purpose: The specific mechanisms by which low concentrations of cyclosporine induce seizures and low concentrations of phencyclidine provoke behavioral excitation remain to be elucidated. Both compounds block N‐methyl‐d‐aspartate (NMDA) receptors. The aim of this study was to determine if low concentrations of the NMDA‐receptor blockers increase the seizure susceptibility.Methods: Guinea pig hippocampal slices were exposed to artificial cerebrospinal fluid containing the NMDA blocker dl‐2‐amino‐5‐phosphono‐valerate (APV; 0.1–10 μM). Extracellular field potentials were recorded from CA1 and CA3 regions.Results: Low concentrations of APV induced epileptiform burst discharges (0.1–0.25 μM), whereas higher doses failed to decrease the seizure threshold (1–10 μM).Conclusions: The results indicate that the excitatory effect of low concentrations NMDA blockers may play a role in the neurotoxicity of aforementioned substances.
The Relationship Between Quantitative T2 Relaxometry and Memory in Nonlesional Temporal Lobe Epilepsy
Authors: Wendel J. D. , Trenerry M. R. , Xu Y. C. , Sencakova D. , Cascino G. D. , Britton J. W. , Lagerlund T. D. , Shin C. , So E. L. , Sharbrough F. W. , Jack C. R. 
Published: March 2003

Summary:  Purpose: We investigated the relationship between preoperative quantitative magnetic resonance imaging (MRI) T2 relaxometry and volumetry of the hippocampi and pre‐ and postoperative verbal memory in temporal lobectomy patients who had nonlesional temporal lobe epilepsy.Methods: Pre‐ and postoperative memory data based on the Logical Memory (LM) subtest of the Wechsler Memory Scale–Revised (WMS–R) and the 30‐min delayed recall trial of the Rey Auditory Verbal Learning Test (AVLT) were obtained from 26 left and 15 right temporal lobectomy patients. Coronal MRI T2 maps were generated for these 41 temporal lobectomy patients as well as 61 control patients. Hippocampal T2 relaxation times and hippocampal volumes, converted to z scores using control group data, were correlated with neuropsychological performance in the patients.Results: In left temporal lobe–onset patients, high T2 in the left hippocampal body predicted higher LM performance after surgery. Asymmetrically high T2 in the left hippocampal body (i.e., the right‐minus‐left difference), compared with the right hippocampal body, also predicted higher LM performance after surgery. In right temporal lobe–onset patients, high T2 in the left hippocampal body predicted relatively lower AVLT performance after surgery. Multiple regression analysis in left temporal–onset patients revealed that high T2 in the left hippocampal body together with higher preoperative LM performance predict higher postoperative LM performance.Conclusions: Our findings suggest that elevated (i.e., abnormal) hippocampal T2 signal is associated with memory ability (or hippocampal functional capacity) independent of MRI‐determined hippocampal atrophy. Therefore, our findings support the use of quantitative T2 relaxometry as an independent predictor of verbal memory outcome in both left and right TLE patients who are candidates for temporal lobectomy.
Development and Validation of the Glasgow Epilepsy Outcome Scale (GEOS): A New Instrument for Measuring Concerns about Epilepsy in People with Mental Retardation
Authors: Espie Colin A. , Watkins Jessamy , Duncan Roderick , Espie Audrey , Sterrick Mark , Brodie Martin J. , McGarvey Christine , Curtice Lisa 
Published: March 2003

Summary:  Purpose: To develop a measure for use with adults with epilepsy and mental retardation, capable of assessing both clinical and care concerns and of quantifying treatment outcomes.Methods: Extensive validational and other psychometric evaluation was undertaken, comprising initial scale development work with 48 carers and 46 health practitioners, followed by formal field testing on a sample of 186 patients, using 384 respondents (160 clinicians, 141 staff, 83 family). Recognised qualitative methods were applied to identify central themes, and psychometric procedures generated data on validity, reliability, and component structure.Results: A total of 1,007 items of concern was generated, which was reduced systematically to a representative set of 90 items. The GEOS‐90 comprises four subscales: concerns about “seizures,”“treatment,”“caring,” and “social impact,” each explaining ∼70% of variance. Subscales and factor scales had strong internal consistency (α≥ 0.82). Stepwise linear regression was applied to derive a short‐form version with similar structure. Thirty‐five items were retained (GEOS‐35; α≥ 0.89). Both scales discriminated moderately on clinical variables (number of seizure types, mono‐ vs. polytherapy, seizure frequency; all values of p < 0.05) and demonstrated concurrent validity with interview ratings from the ELDQOL (p < 0.05).Conclusions: The GEOS scales appear valid and reliable for use with clinical populations of people with mental retardation.
Topiramate and Metabolic Acidosis in Pediatric Epilepsy
Authors: Takeoka Masanori , Holmes Gregory L. , Thiele Elizabeth , Bourgeois Blaise F. , Helmers Sandra L. , Duffy Frank H. , Riviello James J. 
Published: March 2003

Summary:  Purpose: Topiramate (TPM) has been widely used as an adjunctive therapy for treating epilepsy. TPM is reported to have multiple mechanisms of action, including inhibition of carbonic anhydrase, which may result in metabolic acidosis from decreased serum bicarbonate (HCO3‐).Methods: Clinical data from 30 children who received TPM as adjunctive therapy for medically refractory epilepsy were reviewed at Children's Hospital, Boston. Serum HCO3‐levels were assessed before, during, and after discontinuing TPM (n = 9). When multiple data were available, mean values were used for analysis.Results: Of the 30 patients, 21 had a >10% decrease in HCO3‐ levels. The mean decrease in HCO3‐ among the 21 patients was 4.7 mEq/L, and maximum was 10 mEq/L. No clinical symptoms occurred, and HCO3‐ supplement was not needed, except for one patient who developed tachypnea from worsened acidosis after prolonged status epilepticus during a suspected viral illness. Among the 21 patients, TPM was discontinued in seven children because of a lack of efficacy, and in two because of anorexia. After discontinuing TPM, the serum HCO3‐ returned to the previous level before starting TPM in all nine.Conclusions: Decreased HCO3‐ levels occurred in the majority of patients reviewed, usually only to a small to moderate extent, but by 8 and 10 mEq/L in two cases. In patients at risk for acidosis, the decrease in HCO3‐ may cause significant consequences, such as severe acidosis or renal calculi. Monitoring HCO3‐ levels before and during TPM therapy may be indicated, especially with conditions that predispose to acidosis.
Antiepileptic Drug Withdrawal in Patients with Temporal Lobe Epilepsy Undergoing Presurgical Video‐EEG Monitoring
Authors: Yen Der‐Jen , Chen Chien , Shih Yang‐Hsin , Guo Yuh‐Cherng , Liu Li‐Ting , Yu Hsiang‐Yu , Kwan Shang‐Yeong , Yiu Chun‐Hing 
Published: March 2003

Summary:  Purpose: To investigate antiepileptic drug (AED) withdrawal during video‐EEG monitoring in adult patients with temporal lobe epilepsy (TLE).Methods: Between 1995 and 1997, 102 consecutive patients with refractory TLE were admitted to the epilepsy monitoring unit for presurgical evaluation. Patients were monitored with ongoing AEDs being rapidly decreased and discontinued in 4–6 days. The monitoring was continued until sufficient numbers of seizures were recorded. Serum AED levels were checked at admission and after the first complex partial seizure (CPS).Results: In all, 89 patients had 429 CPSs (mean, 4.8 per patient), including 156 (36.4%) secondarily generalized. A mean of 153.8 h (16–451 h) was required for completing the monitoring in each patient. Forty‐three (48.3%) patients experienced seizure clusters, and eight (9.0%) had generalized seizures that had never occurred or had been absent for years. However, none evolved to status epilepticus. Carbamazepine was the most commonly used AED in 71.9% of patients, followed by valproate and phenytoin. When the first CPS occurred, mean 77.2 h since the beginning of the monitoring, serum levels of these three AEDs were mostly subtherapeutic rather than minimal.Conclusions: Acute AED withdrawal effectively provoked seizures in TLE patients undergoing presurgical video‐EEG monitoring. However, nearly 50% of patients had seizure clusters or secondarily generalized seizures. Serum AED levels were mostly subtherapeutic when the first CPS occurred.
Genetic Predisposition to Severe Myoclonic Epilepsy in Infancy
Authors: Benlounis A. , Nabbout R. , Feingold J. , Parmeggiani A. , Guerrini R. , Kaminska A. , Dulac O. 
Published: March 2003

Summary:  Purpose: To address genetic predisposition to febrile convulsions (FCs) and epilepsy as an etiologic background of severe myoclonic epilepsy in infancy (SMEI).Methods: Familial antecedents of epilepsy and FCs were analyzed in four groups of patients with SMEI (65 cases), FCs (57 cases), childhood absences (67 cases), and a control group of patients with no neurologic problems (64 cases).Results: Patients with SMEI and those with FCs had significantly increased incidence of FCs in their relatives compared with those with absence epilepsy and with the control group. The incidence of epilepsy in relatives of patients with SMEI and absence epilepsy was increased compared with that in the control group and reached statistical significance. Epilepsy in relatives with SMEI had the characteristics of idiopathic generalized epilepsy.Conclusions: A genetic predisposition could determine three types of epileptic syndromes: FCs, idiopathic generalized epilepsy, and SMEI.
Newly Diagnosed Unprovoked Epileptic Seizures: Presentation at Diagnosis in CAROLE Study
Authors: Jallon Pierre , Loiseau Pierre , Loiseau Jérome ,   on behalf of Groupe CAROLE (Coordination Active du Réseau Observatoire Longitudinal de l'Epilepsie)
Published: March 2003

Summary:  Purpose: We describe first unprovoked seizures and newly diagnosed epilepsies at initial presentation, with a special emphasis on epilepsy syndromes, in a large cohort recruited in the mid‐1990s in France.Methods: The French Foundation for Research on Epilepsy set up a network to conduct a prospective study of patients with newly diagnosed unprovoked seizures. Information was provided by 243 child or adult neurologists. Four neurologists classified each case according to the International League Against Epilepsy (ILAE) criteria. First‐seizure patients and patients with previously undiagnosed seizures were compared.Results: Between May 1, 1995, and June 30, 1996, 1,942 patients aged from 1 month to 95 years were identified: 926 (47.7%) with a single seizure and 1,016 (52.3%) with newly diagnosed epilepsy. All but 17 patients had EEGs. In the first‐seizure and newly‐diagnosed‐epilepsy groups, neuroimaging studies were performed in 78.2 and 68.3% of patients, and medication prescribed in 54.1 and 89.6%, respectively. There were significant differences between the two groups with respect to age at onset and diagnosis, sex, etiology, several specific syndromes, as well as the type and presentation of initial seizure. In patients for whom the first seizure was convulsive, only sex, multiple seizures in a day or status epilepticus, and cryptogenic localization‐related syndrome differed between the two groups.Conclusions: Approximately half of patients who first came to attention for an unprovoked seizure already met epidemiologic criteria for epilepsy. There were significant differences between the types of patients with a first seizure and those with newly diagnosed epilepsy. One or several seizures at diagnosis did not influence the diagnostic assessment of the patients but had a strong influence on the initiation of treatment.
The Effect of Lamotrigine on Epileptiform Discharges in Young Patients with Drug‐Resistant Epilepsy
Authors: Eriksson A‐S. , Knutsson E. , Nergårdh A. 
Published: March 2003

Summary:  Purpose: In a double‐blind crossover study with lamotrigine (LTG), we investigated a possible relationship between the clinical responses and changes of the amount of epileptiform activity in EEG.Methods: Twelve patients, aged 4–21 years, with generalized drug‐resistant epilepsy who had responded to LTG, completed the study. Twenty‐four‐hour video‐EEGs were taken during control, placebo, and drug phases. The amounts of epileptiform discharges were estimated and compared with the clinical effects.Results: The duration of periods of repeated epileptiform discharges was significantly reduced during the LTG phase compared with the placebo phase (n = 12, p = 0.04). Ten patients showed a reduction of the amount of epileptiform discharges in the LTG phase by a mean of 81% (range, 17–100%). Periods of repeated epileptiform discharges with duration longer than 30 s were significantly reduced in length (p = 0.03) and number (p = 0.04) during the LTG phase compared with the placebo phase. Shorter periods of epileptiform discharges and the numbers of single epileptiform discharges were not affected. In five patients there was a seizure reduction (≥50%) concomitant with the reduction of epileptiform discharges in the EEG. The behavior improved during LTG treatment in all patients. The patients became more alert, and their concentration and performance improved, according to their parents and the medical personnel.Conclusions: LTG in dosages of 1–8 mg/kg body weight was found to depress relatively long episodes of interictal, repetitive, epileptiform activity in young patients with drug‐resistant epilepsy, whereas short episodes were not affected. It depressed seizures in about half of the patients studied but gave improvements of behavior in all patients.
The Absence of Interictal Spikes with Documented Seizures Suggests Extratemporal Epilepsy
Authors: Stüve O. , Dodrill C. B. , Holmes M. D. , Miller J. W. 
Published: March 2003

Summary:  Purpose: To determine the demographic and clinical characteristics of patients who have documented epileptic seizures on long‐term video‐EEG monitoring who do not have interictal spikes.Methods: The records of 1,223 monitoring studies from 919 patients who underwent noninvasive long‐term video‐EEG monitoring were reviewed. In 28 patients (3.0% of monitored patients, 4.4% of patients with electrographic evidence of epilepsy), no interictal spikes were found despite the occurrence of at least one recorded electrographic seizure. The demographic, medical, neuropsychological, and EEG data of these patients were compared with those of 28 matched control patients with documented interictal spikes.Results: Extratemporal seizures were significantly more frequent in the patients with at least one recorded epileptic seizure but without interictal spikes compared with patients with epileptic seizures and interictal spikes (p = 0.031). The only other significant difference between the groups (p = 0.016) was a later age at seizure onset (18.3 vs. 10.7 years) for the patients without interictal spikes. Age at evaluation, gender, handedness, clinical seizure type, family history of epilepsy, history of febrile seizures, neuropsychological testing, and neurologic and psychiatric history did not differ between the two groups.Conclusions: In patients with documented epilepsy without interictal spikes on EEG monitoring, the possibility of an extratemporal focus should be considered.
Pharmacokinetic Study of Levetiracetam in Children
Authors: Pellock John M. , Glauser Tracy A. , Bebin E. Martina , Fountain Nathan B. , Ritter Frank J. , Coupez René M. , Shields W. Donald 
Published: March 2003

Summary:  Purpose: The pharmacokinetics of the novel antiepileptic drug (AED) levetiracetam and its major metabolite, ucb L057, were studied in children with partial seizures in a multicenter, open‐label, single‐dose study.Methods: Twenty‐four children (15 boys, nine girls), 6 to 12 years old, received a single dose of levetiracetam (20 mg/kg) as an adjunct to their stable regimen of a single concomitant AED, followed by a 24‐h pharmacokinetic evaluation.Results: In children, the half‐lives of levetiracetam and its metabolite ucb L057 were 6.0 ± 1.1 and 8.1 ± 2.7 hours, respectively. The Cmax and area under the curve (AUC) of levetiracetam equated for a 1‐mg/kg dose were lower in children (Cmax, norm = 1.33 ± 0.35 μg/ml; AUCnorm = 12.4 ± 3.5 μg/h/ml) than in adults (Cmax, norm = 1.38 ± 0.05 μg/ml; AUCnorm = 11.48 ± 0.63 μg/h/ml), whereas the renal clearance was higher. The apparent body clearance (1.43 ± 0.36 ml/min/kg) was ∼30–40% higher in children than in adults. Levetiracetam was generally well tolerated.Conclusions: On the basis of these data, a daily maintenance dose equivalent to 130–140% of the usual daily adult maintenance dosage (1,000–3,000 mg/day) in two divided doses, on a weight‐normalized level (mg/kg/day) is initially recommended. Clinical efficacy trials in children are ongoing with dosages of 20 to 60 mg/kg/day.
Clinical Features and Prognosis of Nonepileptic Seizures in a Developing Country
Authors: Silva W. , Giagante B. , Saizar R. , D′Alessio L. , Oddo S. , Consalvo D. , Saidón P. , Kochen S. 
Published: March 2003

Summary:  Purpose: To determine the predictive value of clinical features and medical history in patients with nonepileptic seizures (NESs).Methods: One hundred sixty‐one consecutive ictal video‐EEGs were reviewed, and 17 patients with 41 NESs identified. NES diagnosis was defined as paroxysmal behavioral changes suggestive of epileptic seizures recorded during video‐EEG without any electrographic ictal activity. Clinical features, age, sex, coexisting epilepsy, associated psychiatric disorder, social and economic factors, delay in reaching the diagnosis of NES, previous treatment, and correlation with outcome on follow‐up were examined.Results: The study population included 70% female patients with a mean age of 33 years. Mean duration of NESs before diagnosis was 9 years. Forty‐one percent had coexisting epilepsy. The most frequent NES clinical features were tonic–clonic mimicking movements and fear/anxiety/hyperventilation. The most common psychiatric diagnosis was conversion disorder and dependent and borderline personality disorder. Seventy‐three percent of patients with pure NESs received antiepileptic drugs (AEDs), and 63.5% of this group received new AEDs. Fifty‐nine percent of the patients received psychological/psychiatric therapy. At follow‐up, 23.5% were free of NESs.Conclusions: All seizure‐free patients had two good prognostic factors: having an independent lifestyle and the acceptance of the nonepileptic nature of the episodes. Video‐EEG monitoring continues to be the diagnostic method to ensure accurate seizure classification. Establishing adequate health care programs to facilitate access to new technology in public hospitals as well as the implementation of continuous education programs for general practitioners and neurologists could eventually improve the diagnosis and treatment of patients with NESs.
Focal Cortical Dysplasias in Eloquent Cortex: Functional Characteristics and Correlation with MRI and Histopathologic Changes
Authors: Marusic Petr , Najm Imad M. , Ying Zhong , Prayson Richard , Rona Sabine , Nair Dileep , Hadar Eldad , Kotagal Prakash , Bej Mark D. , Wyllie Elaine , Bingaman William , Lüders Hans 
Published: March 2003

Summary:  Purpose: Focal cortical dysplasia (CD) is increasingly recognized as a common pathologic substrate of medically intractable epilepsy. As these lesions are often localized in the frontal lobe (therefore in potentially eloquent cortex), an understanding of the functional status of the involved region(s) and of its anatomic and pathologic correlates is of prime importance. The purpose of this study is to assess the function of focal CD in relation to magnetic resonance imaging (MRI) and histopathologic features.Methods: Eight patients operated on for medically intractable epilepsy with histologically proven focal CD involving putative eloquent cortex in the frontal lobe (perirolandic and Broca's areas) were included in the study. Functional regions (motor and language) and epileptogenic areas were assessed by extraoperative electrocorticographic recording and electrical cortical mapping. Cortical functions were correlated with the extent of epileptogenicity on electrocorticographic recordings, MRI features, and histologic characteristics.Results: Language or motor areas were colocalized with epileptogenic regions (n = 6 of 8, 75%), but were not mapped in regions of increased signal on fluid‐attenuated inversion recovery (FLAIR) MRI (when they were identified) on preoperative MRI (n = 5 of 5, 100%). Histologically, balloon cells were almost exclusively found in nonfunctional regions with FLAIR MRI abnormalities. When resected, regions of motor cortex were characterized by cortical dyslamination, columnar disorganization, and dysmorphic neurons, but were devoid of balloon cells.Conclusions: We found an absence of language or motor functions in perirolandic and Broca's areas that showed decreased epileptogenicity, histopathological evidence of CD with balloon cells and FLAIR MRI signal increase. Language and motor functions were present in epileptogenic and dysplastic areas with no balloon cells and no FLAIR signal abnormalities. These findings have implications on options for epilepsy surgery in patients with CD.
Lack of Neuronal Damage in Atypical Absence Status Epilepticus
Authors: Shirasaka Yukiyoshi 
Published: March 2003

Summary:  Purpose: Whether status epilepticus of nonconvulsive epileptic seizures is harmful still remains controversial. To investigate this, the presence and/or extent of neuronal damage in patients with absence status epilepticus (ASE) and patients with complex partial status epilepticus (CPSE) was examined and compared.Methods: Neuron‐specific enolase (NSE) in CSF was examined in the patients with ASE and compared with that of the patients having CPSE. Clinical aspects of these patients also were investigated.Results: CSF NSE levels in ASE patients were lower than those of CPSE patients and were considered as the normal values. No clinical symptoms indicated neuronal damage in the ASE patients.Conclusions: This study suggests that ASE does not induce neuronal damage. Serum NSE is not always correlated to CSF NSE, and determination of serum NSE levels may be an inappropriate method of estimating neuronal damage in some cases of ASE.
An Association between Mesial Temporal Lobe Epilepsy with Hippocampal Sclerosis and Human Leukocyte Antigens
Authors: Özkara Çigdem , Altintas Ayse , Yilmaz Erkan , Eskazan Esat , Erkol Gökhan , Özyurt Emin , Erdogan Ergun , Kuday Cengiz 
Published: March 2003

Summary:  Purpose: Mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE‐HS) is one of the medically intractable epilepsies that may be remediable with surgery. Although the pathogenesis of HS still remains obscure, genetics may play a role as a predisposing factor, with the genetically controlled immune system as one of its aspects. Our aim in this study was to investigate whether there is any association between human leukocyte antigens (HLAs) that are related to chromosome 6 and this specific type of epilepsy.Methods: HLA class I and II typing were performed with the microlymphocytotoxicity method on 65 Turkish patients with MTLE‐HS and on 184 healthy controls.Results: Our study revealed a significantly high frequency of class II antigens HLA‐DQ2, ‐DR4, and ‐DR7 alleles and the combination of HLA‐DR4‐DQ2, and DR7‐DQ2 alleles.Conclusions: The HLA alleles that occur with increased frequency in many HLA‐ associated conditions appear to serve as risk factors that increase susceptibility but are not essential for disease expression. Our data support the role of genetic factors in the development of HS, possibly related to early childhood events that may act as a trigger factor to initiate the cascade in genetically prone patients with specific HLA types to give rise to MTLE eventually.