bluuebunny/crossref_metadata_2025_split huggingface dataset:
FOS Induction in Brain Associated with Seizure and Sustained Cortical Vasodilation in Anesthetized Rat
Authors: Mraovitch Sima , Calando Yolande 
Published: August 2005

Summary: Purpose: By estimating the anatomical distribution of neurons expressing c‐fos protein, we sought to establish whether the intrinsic neurol systems known to be implicated in the cerebrovascular regulation were activated during the increase in cortical blood flow associated with epileptic seizures. Methods: A single unilateral microinjection of the cholinergic agonist, carbachol, in the thalamic generalized convulsive seizure area was used in anesthetized rats to elicit recurrent episodes of electrocortical epileptiform activity and an increase in cortical blood flow. Neuronal expression of Fos protein was analyzed to identify activated brain regions. Results: We identified two cortical vasodilatory responses: a sustained cortical vasodilatory response associated with the continuous low‐frequency, high‐amplitude spiking and a transient cortical vasodilatory response invariably related to the recurrent spike‐burst activity. The sustained cortical blood flow began to increase at 55–65 min, remaining significantly (p < 0.05) increased and reaching at the end of the experiment ≤182 ≤17% of the prestimulated control. The electrocortical epileptic activity and the cerebral cortical vasodilation were associated with a marked increase in Fos immunoreactivity in the entorhinal and piriform cortices, the dentate gyrus, the hippocampus, and the amygdala. Fos‐positive neurons also were found in specific thalamic nuclei, the cerebral cortex, the caudate‐putamen, the hypothalamus, the pontine parabrachial nuclei, the dorsal raphe, and the rostral ventrolateral medulla. Conclusions: These results provide evidence that convulsive seizures elicited by cholinergic stimulation of the thalamus, in addition to limbic and somatic motor systems, activate central autonomic nuclei and their pathways, including those implicated in cerebrovascular regulation.
The Descriptive Epidemiology of Infantile Spasms Among Atlanta Children
Authors: Trevathan Edwin , Murphy Catherine C. , Yeargin‐Allsopp Marshalyn 
Published: August 2005

Summary: Purpose: To determine the population‐based epidemiology of infantile spasms (IS) among Atlanta children. Methods: By using data from a cross‐sectional, population‐based surveillance system that included 21 EEG laboratories, we identified children born in 1975–1977 in metropolitan Atlanta with IS. Cumulative incidence up to age 2 years was estimated from the number of children with IS born in the study area in 1975–1977, and age‐specific prevalence was calculated from the number of children previously diagnosed with IS who lived in the study area at age 10 years. Data regarding coexisting disabilities were available from the surveillance system for developmental disabilities. Results: The cumulative incidence of IS was 2.9/10,000 live births; half of the children with IS had cryptogenic IS. The age‐specific prevalence of IS was 2.0/10,000 among 10‐year‐old children. Eighty‐three percent of 10‐year‐old children with a history of IS had mental retardation (MR, IQ ≤70); 56% of children with a history of IS had profound MR (IQ <20). Developmental outcome did not differ between the children with cryptogenic IS and those with symptomatic IS. Among the 10‐year‐old children with profound MR who were living in Atlanta at age 10 years, 12% had a history of IS. Fifty percent of children with IS developed Lennox‐Gastaut syndrome (LGS) before age 11 years. Conclusions: The syndrome of IS is rare in the general population, yet a significant percentage of all children with profound MR and severe childhood epilepsy syndromes in the general population have a history of IS.
Benign Partial Seizures of Adolescence
Authors: King Mark A. , Newton Mark R. , Berkovic Samuel F. 
Published: August 2005

Summary: Purpose: A benign syndrome of partial seizures in adolescents (BPSA) was described by Loiseau et al. in 1978, but confirmation of this syndrome has been lacking. We sought to identify BPSA among teenagers with new‐onset focal seizures enrolled in our prospective first‐seizure study and to assess the EEG and magnetic resonance imaging (MRI) findings. Methods: We searched the study database for patients aged between 10 and 20 years with focal seizures who did not have idiopathic partial epilepsies, epileptogenic lesions on MRI, or recurrent tonic‐clonic seizures during 2 years of follow‐up. Results: The database contained 92 adolescents, including 37 with partial epilepsy, of whom eight (22%) patients matched the description of BPSA. All eight patients had seizures with a sensory/motor “march.” Six had a secondarily generalized seizure and two had simple partial seizures alone. Epileptiform abnormalities were documented in five cases but lacked a distinctive morphology or distribution. No lesions were seen on MRI. Conclusions: BPSA can be provisionally diagnosed in teenagers with unprovoked focal seizures characterized by a march of sensory/motor symptoms, whose MRI is normal. The psychosocial consequences of chronic epilepsy in adolescence are considerable, so early recognition of this benign syndrome is important.
Functional Magnetic Resonance Imaging Identifies Abnormal Visual Cortical Function in Patients with Occipital Lobe Epilepsy
Authors: Masuoka Lorianne K. , Anderson Adam W. , Gore John C. , McCarthy Gregory , Spencer Dennis D. , Novotny Edward J. 
Published: August 2005

Summary: Purpose: To determine whether functional magnetic resonance imaging (fMRI) can reliably identify lateralized cortical dysfunction in patients with suspected occipital lobe epilepsy. Methods: We compared visual cortical function of 10 patients with intractable occipital lobe epilepsy with nine control subjects' fMRI. Visual stimulation by using an alternating checkerboard pattern results in transient increases in the intensity of the proton magnetic resonance signal of water in the occipital lobes during echo‐planar imaging. We used these stimulus‐dependent changes in signal intensity to construct functional activation maps, which we registered onto anatomic images. Results: After full‐field stimulation, none of the patients with occipital lobe epilepsy had normal activation patterns, whereas eight of the nine control subjects had normal patterns (p = 0.001). Abnormalities consisted of either a markedly asymmetric activation pattern in six of 10 patients (p = 0.04), or a complete absence of activation in four of 10 patients (p = 0.05). The abnormal side of activation was concordant with the side of seizure onset in all six patients with asymmetric activation maps. Half‐field stimulation produced less reliable results. Although more patients had abnormal activation maps than did controls with half‐field stimulation (p = 0.04), the abnormal side was discordant with the side of seizure onset in three of the five patients who had markedly asymmetric activation patterns. Conclusions: These results suggest that fMRI with full‐field stimulation is a reliable, noninvasive method for identifying areas of abnormal visual cortical function ipsilateral to the epileptogenic region in patients with occipital lobe epilepsy.
Status Epilepticus‐induced Neuronal Injury and Network Reorganization
Authors: Sloviter Robert S. 
Published: August 2005

Summary:It is now evident that prolonged febrile seizures in childhood, or an episode of status epilepticus at any age, can produce the highly characteristic pattern of hippocampal cell loss and shrinkage that is seen later in life, when patients develop temporal lobe epilepsy. Seizure‐induced and presumably excitotoxic pathology includes neuronal loss, reactive gliosis, aberrant synaptic reorganization of surviving cells, and hippocampal tissue shrinkage that may alter extracellular space and affect ionic homeostasis. Whether any of these pathological effects of prolonged excitation play a causal role in the epileptogenic process that ultimately leads to spontaneous afebrile seizures remains a subject of intense interest. Two hypotheses have been suggested to explain how seizure‐induced neuronal loss might initiate the epileptogenic process. One hypothesis suggests that normal inhibition and excitability is maintained by vulnerable non‐principal cells, and that their loss deactivates inhibitory neurons, rendering principal cells disinhibited and hyperexcitable. The other hypothesis regards the initial loss as a stimulus for normally unconnected principal cells to form aberrant recurrent excitatory connections. Additional influences undoubtedly include a “kindling” process that gradually overcomes polysynaptic inhibition, and changes in extracellular space that may facilitate synaptic and ephaptic depolarization. Identification of the suspected substrates of epileptogenesis will serve as a stimulus for future progress and provide direction for new experimental designs.
Social Phobia: Issues in Assessment and Management
Authors: Connor Kathryn M. , Davidson Jonathan R. T. , Sutherland Suzanne , Weisler Richard 
Published: August 2005

Summary:Social phobia was initially classified with phobic anxiety states and was believed to be quite rare, but it is now gaining due recognition as a widespread and often crippling disorder. The boundaries of social phobia merge into traits of shyness and universal performance anxiety, with symptoms commonly appearing in the teenage years. If left untreated, social phobia is a remarkably persistent condition, leading to potentially lifelong impairment in social development and occupational functioning. It may also give rise to other co‐morbid disorders, particularly dysthymia, depression, obsessive‐compulsive disorder, other phobic disorders, and substance abuse. Over the years, social phobia has been all too frequently viewed as a somewhat trivial, minor form of psychiatric illness and has received little clinical attention. This erroneous perception is now giving way under the mounting evidence in support of the extensive morbidity and disability associated with social phobia and the probable role of genetic and environmental influences. Furthermore, data from multiple controlled clinical trials reveal that this is a treatable condition, responding to both psychosocial and pharmacologic interventions. Here we examine issues to consider in the differential diagnosis of social phobia, review the goals of treatment, and summarize evidence in support of the effectiveness of individual pharmacologic treatments.
Efficacy of Five Days’ Barbiturate Anesthesia in the Treatment of Intractable Epilepsies in Children
Authors: Rantala Heikki , Saukkonen Anna‐Liisa , Remes Mikko , Uhari Matti 
Published: August 2005

Summary: Purpose: To analyze the efficacy of barbiturate anesthesia in the treatment of intractable epilepsies in childhood. Methods: Anesthesia for 4–5 days with thiopentone sodium was used to treat children with intractable epilepsy in the Department of Pediatrics, Oulu, Finland, from November 1980 through December 1995. The number of epileptic seizures, the number and dosage of antiepileptic drugs (AEDs), and psycho‐motor development before and after anesthesia were compared. Results: Fifty‐four children with intractable epilepsy were treated with barbiturate anesthesia. Twenty‐four children had infantile spasms; 22, Lennox‐Gastaut syndrome; seven, complex partial epilepsy; and one, myoclonic epilepsy. Twentyfour (44.4%) children had complications during the anesthesia. The seizures recurred in 53 of the 54 patients in a median time of 12 days after the anesthesia. In 42 (78%) children, the seizure frequency returned to a level equal to or higher than that before the anesthesia in a median time of 211 days. The number of AEDs was significantly greater after than before the anesthesia (6.33 vs. 4.8; p < 0.001). Seventeen (32.5%) children were treated surgically after the anesthesia. Conclusions: Although the seizures are eliminated or the seizure frequency decreases for a short period after the barbiturate anesthesia, the anesthesia does not change the long‐term outcome and is therefore inefficient in the treatment of childhood intractable epilepsies.
The Association Between Seizure Clustering and Convulsive Status Epilepticus in Patients with Intractable Complex Partial Seizures
Authors: Haut Sheryl R. , Shinnar Shlomo , Moshé Solomon L. , O'Dell Christine , Legatt Alan D. 
Published: August 2005

Summary: Purpose: We examined the association between seizure clustering and convulsive status epilepticus (SE) in patients with intractable complex partial seizures, to identify whether patients whose seizures typically cluster are at high risk for convulsive SE (CSE). Methods: Seventy‐six patients with intractable complex partial epilepsy who underwent presurgical evaluation in the Montefiore Epilepsy Management Unit from 1993 to 1997 were contacted and interviewed about typical seizure frequency and distribution and history of CSE. Seizure clustering was defined as three or more complex partial seizures within a 24‐h period, with return to baseline between seizures. Results: Of the 76 patients contacted, 21 (28%) had experienced at least one episode of CSE, and 36 (47%) typically experienced clustered seizures. SE occurred in 16 (44%) of 36 patients with clustered seizures, and in five (12.5%) of 40 patients with nonclustered seizures (p < 0.002). Of 53 patients with temporal lobe epilepsy, CSE occurred in 13 (50%) of 26 patients with clustered seizures, and four (14.8%) of 27 patients with nonclustered seizures (p < 0.006). Conclusions: Patients with intractable complex partial or localization‐related epilepsy who typically experience seizure clustering are at a significantly higher risk for CSE than are patients with nonclustered seizures.
Correlation of Hippocampal Neuronal Density and FDG‐PET in Mesial Temporal Lobe Epilepsy
Authors: Foldvary N. , Lee N. , Hanson M. W. , Coleman R. E. , Hulette C. M. , Friedman A. H. , Bej M. D. , Radtke R. A. 
Published: August 2005

Summary: Purpose: Interictal [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET) reveals regional hypometabolism in 60–80% of patients with mesial temporal lobe epilepsy (MTLE). The extent of hypometabolism generally extends beyond the epileptogenic zone. The pathophysiology underlying this widespread change is unknown. This study evaluated the relation between hippocampal neuronal loss and hypometabolism in patients with MTLE. Methods: Forty‐three patients with MTLE after anterior temporal lobectomy were included. Pathology demonstrated mesial temporal sclerosis (n = 41) or endfolium sclerosis (n = 2). Interictal FDG‐PET scans were graded by visual analysis on a scale ranging from normal (grade 1) to severe (grade 5) hypometabolism. Neuronal counting was performed in the subiculum, hippocampal subfields, and dentate granular cell layer (DG). Neuronal density of patients was compared with that of seven autopsy controls. Data were compared by using Student's t tests and Kruskal‐Wallis one‐way analysis of variance (ANOVA). Results: Significant neuronal loss in CA1 through CA4 and DG was found in patients compared with controls. Neuronal density in the subiculum, CA1, CA4, and DG did not correlate with severity of hypometabolism. However, patients with abnormal FDG‐PET had higher neuronal density in CA2 and CA3 versus patients with normal studies. Conclusions: This study supports a previous observation that degree of FDG‐PET hypometabolism does not parallel severity of hippocampal neuronal loss in MTLE.
Noninvasive Continuous Monitoring of Cerebral Oxygenation Periictally Using Near‐Infrared Spectroscopy: A Preliminary Report
Authors: Adelson P. David , Nemoto Edwin , Scheuer Mark , Painter Michael , Morgan John , Yonas Howard 
Published: August 2005

Summary: Purpose: To report on the use of near‐infrared spectroscopy (NIRS) to examine the changes in cerebral oxygenation in the periictal period in patients with seizures. Methods: Cerebral hemoglobin oxygen availability was monitored continuously and noninvasively with NIRS in three patients (one in the pediatric intensive care unit (ICU) and two in epilepsy‐monitoring units) in conjunction with continuous EEG monitoring. Ictal events were recorded and compared with the pre‐, intra‐, and postictal periods for cerebral oxygen availability, as defined by oxygenated hemoglobin (HbO2), deoxygenated hemoglobin (Hb), and the redox state of cytochrome oxidase (cytox). Results: Several important preliminary observations were made by using this technology. First, a preictal increase in cerebral oxygenation began between 1 and 2 h and <10 h before the ictal event. Second, despite adequate perfusion, based on an observed increased HbO2, reduction in cytox indicates a perfusion‐metabolism mismatch during seizure activity. Third, continued seizure activity and even isolated ictal events were associated with decreased cerebral oxygen availability. Fourth, differences in cerebral oxygen availability were noted between different types of seizures (e.g., electrographic seizures were accompanied by rapid reductions in HbO2 and cerebral blood volume without reduction of cytox, whereas electroclinical seizures were characterized by marked increases in HbO2 with or without reduction of cytox). Conclusions: In this preliminary report on the use of NIRS for patients with seizures, we believe that NIRS allows continuous and noninvasive monitoring of changes in cerebral oxygenation periictally, thereby permitting investigations into the pathophysiology of seizures and the exploration of the potential of cerebral oximetry as a tool for seizure localization.
Lateralizing Value of Interictal Spikes on Overnight Sleep‐EEG Studies in Temporal Lobe Epilepsy
Authors: Malow Beth A. , Selwa Linda M. , Ross Donald , Aldrich Michael S. 
Published: August 2005

Summary: Purpose: To determine the lateralizing value of interictal epileptiform discharges (IEDs) recorded during overnight sleep‐EEG studies in temporal lobe epilepsy. Because IEDs are more prevalent in non‐rapid eye movement (NREM) sleep than in wakefulness, overnight sleep‐EEG recordings may contribute additional lateralizing information to the epilepsy surgery evaluation beyond daytime EEGs. Methods: Twenty‐four subjects with medically refractory temporal lobe epilepsy underwent continuous overnight sleep‐EEG recordings. Subjects were seizure free ≤24 h before study and receiving stable doses of medication. The IED foci recorded on overnight studies were compared with daytime EEGs, interictal samples, and ictal recordings during long‐term monitoring, brain magnetic resonance images (MRIs), and surgical outcome. Results: (a) In all 24 subjects, including 13 without IEDs on daytime EEGs, temporal IEDs were present during NREM sleep and were exclusively or predominantly (<95%) unilateral in 15 and bitemporal in nine. (b) Unilateral NREM IEDs were concordant with surface or depth ictal‐onset regions in 14 subjects, even if MRIs were normal (three subjects) or surface ictal‐onset regions were bilateral (five subjects). Eleven of 12 subjects with unilateral concordant NREM IEDs who have undergone surgery are seizure free. (c) Bitemporal IEDs were associated with postoperative seizures in all subjects with normal MRIs or widespread MRI abnormalities. However, all subjects with bitemporal IEDs and MRI hippocampal abnormalities concordant with ictal‐onset regions had good to excellent surgical outcomes. Conclusions: When combined with other investigations, IEDs recorded on overnight studies add prognostic data to the epilepsy surgery evaluation not provided by daytime EEGs.
An Open‐Label Study of Repeated Use of Diazepam Rectal Gel (Diastat) for Episodes of Acute Breakthrough Seizures and Clusters: Safety, Efficacy, and Tolerance
Authors: Mitchell Wendy G. , Conry J. A. , Crumrine P. K. , Kriel R. L. , Cereghino J. J. , Groves L. , Rosenfeld W. E. ,   North American Diastat Group
Published: August 2005

Summary: Purpose: To assess safety of diazepam rectal gel (DZPRG) for control of acute seizures in epilepsy patients and to evaluate tolerance with repeated use of DZPRG at intervals of ≤5 days. Methods: Subjects were persons with epilepsy, age 2 years or older, with seizure clusters or prolonged seizures. Onset of a treatable episode was defined; caregivers were trained to administer DZPRG and to monitor respiration, seizures, and adverse effects (AEs). DZPRG was dispensed in a single‐use, prefilled syringe; dosage was determined by age and weight. Maximal use was ≤5‐day intervals, ≥5 times/month. After use, caregivers returned data booklets and syringe. Caregivers and physicians completed global ratings yearly. Results: In 149 subjects treated, 77% of 1,578 administrations resulted in seizure freedom for the next 12 h. One hundred twenty‐five received two or more treatments (two to 78; median, 8), 0.03–4.3/month (median, 0.4). To evaluate tolerance, subjects with two or more episodes were divided into low (two to seven episodes) and high use (eight to 78 episodes treated). There was no difference in proportion seizure free 12 h after the first administration versus last administration, for either infrequent or frequent administration. Sedation occurred in 17%, attributed to DZPRG in 9%. No respiratory depression was attributable to DZPRG. Three subjects withdrew because of AEs attributable to (agitation) or possibly attributable to DZPRG (chest pain, rash). Five subjects withdrew because of AEs unrelated to DZPRG. Caregiver and physician global ratings were highly positive at both 12 and 24 months. Conclusions: DZPRG is safe and effective in children and adults with epilepsy with breakthrough seizures. Neither tolerance nor significant medication‐related AEs were seen with repeated DZPRG administration at intervals ≤5 days.
Stiripentol: Efficacy and Tolerability in Children with Epilepsy
Authors: Perez J. , Chiron C. , Musial C. , Rey E. , Blehaut H. , D'Athis P. , Vincent J. , Dulac O. 
Published: August 2005

Summary: Purpose: Stiripentol (STP) is a new antiepileptic drug (AED) that inhibits cytochrome P450′ resulting in increased plasma concentrations of concomitant AEDs. The efficacy and tolerability of STP as an add‐on therapy in children were assessed. Methods: Two hundred twelve patients with refractory epilepsy, aged from 1 month to 20.5 years, received STP either in a single‐blind, placebo‐controlled trial (108 patients) or in a further open trial (104 other patients selected by epilepsy syndrome for possible efficacy based on the results of the previous trial). Results: Among the 97 patients who could be analyzed for efficacy in the placebo‐controlled study, the median seizure frequency was lower at 3 months with STP than with the placebo (p > 0.0001); 49% responded to the drug, including 10% who became seizure free. Patients with partial epilepsy had the highest response rate (57%). Results were confirmed in the open study where 68% of the 91 patients receiving STP responded at 3 months. These patients were mainly those with partial epilepsy (73%) who were receiving carbamazepine (CBZ) (75%) as comedication (p > 0.001). Ten of the 20 children with severe myoclonic epilepsy in infancy also responded with clobazam (CLB) as comedication. Efficacy was sustained long term in 74% of the 94 patients still receiving STP at a mean 30‐month follow‐up. Adverse events were reported in 48% of the 212 patients, mainly anorexia and loss of weight, but these events required STP discontinuation in only nine cases. Side effects were minimized in the open trial by optimizing the dose of comedication. Conclusions: STP seems to be a promising add‐on drug, particularly when combined with CBZ in patients with partial childhood epilepsy refractory to vigabatrin (VGB) and with CLB in patients with severe myoclonic epilepsy in infancy.