bluuebunny/crossref_metadata_2025_split huggingface dataset:
Partial and Generalized Seizures Affect Reproductive Physiology Differentially in the Male Rat
Authors: Edwards Heather E. , Burnham W. McIntyre , MacLusky Neil J. 
Published: August 2005

Summary: Purpose: Reproductive dysfunction and endocrine disorders occur frequently among men with epilepsy. This study tested the hypothesis that focal limbic seizures and generalized seizures may both contribute to reproductive dysfunction. Methods: The rat kindling model was used to mimic focal limbic seizures. Kindling electrodes were placed in the basolateral amygdala. Male rats were either intact, gonadectomized (GDX) or GDX + testosterone (T) replaced and then kindled. Controls were left intact and sham‐kindled. Maximal electro‐convulsive shock (MES) treatment was used to model generalized seizures, by using eight stimulations, one every other day, for 2.5 weeks. Animals were killed either 3 h or 6 weeks after MES treatment to determine short‐ and long‐term effects. Results: Kindled seizures resulted in an increase in serum testosterone, estradiol, and prolactin in intact males, accompanied by a significant increase in testis, epididymis, and pituitary weight, as well as a significant decrease in prostate weight. MES treatment caused a short‐term reduction in serum testosterone and testis, epididymis, and prostate weight. All parameters were restored to control values within 6 weeks of the last MES seizure, with the exception of pituitary weight and serum prolactin, which remained significantly elevated 6 weeks after MES treatment. Conclusions: Our results indicate that both focal limbic (amygdaloid) seizures and generalized MES seizures disturb normal reproductive physiology in the male rat. Amygdaloid‐kindled seizures have mixed effects on different parameters of reproductive function, whereas MES seizures induce a transient hypogonadal state. These results suggest that reproductive dysfunction in men with epilepsy may result from seizure‐related interference with the normal functions of the hypothalamic‐pituitary‐testicular axis.
Modulation of Sodium Currents in Rat CA1 Neurons by Carbamazepine and Valproate After Kindling Epileptogenesis
Authors: Vreugdenhil Martin , Wadman Wytse J. 
Published: August 2005

Summary: Purpose: To determine the modulation of sodium currents in hippocampal CA1 neurons by carbamazepine (CBZ) and valproate (VPA), before and after kindling epileptogenesis. Methods: Voltage‐dependent sodium current was measured in isolated hippocampal CA1 neurons, by using the whole‐cell voltage‐clamp technique. CBZ (15–100 μM) or VPA (0.5‐5 mM) was applied by bath perfusion. Cells from fully kindled rats were compared with controls, 1 day and 5 weeks after the tenth generalized seizure. Results: CBZ did not affect sodium current activation but selectively shifted the voltage dependence of steady‐state inactivation to more hyperpolarized potentials. One day after the last kindled generalized seizure, the shift induced by 15 μM CBZ was 2.1 ± 0.5 mV (mean ± SEM; n = 20) compared with 4.3 ± 0.3 mV (n = 16; p > 0.001) in matched controls. The EC50 of the concentration‐effect relation was 57 ± 6 μM compared with 34 ± 2 μM (p > 0.01) in controls. Five weeks after kindling, these values had recovered to a level not different from control. VPA induces at a relatively high concentration a similar but smaller shift in voltage dependence of inactivation than does CBZ. After kindling, the shift induced by 2 mM VPA (2.8 ± 0.6 mV; n = 19) was not different from controls (3.0 ± 0.5 mV; n = 22). The EC50 for VPA was 2.6 ± 0.3 mM compared with 2.5 ± 0.4 mM in controls. Conclusions: Both CBZ and VPA selectively modulate the voltage dependence of sodium current steady‐state inactivation and as a consequence reduce cellular excitability. The effect of CBZ was reduced immediately after kindling epileptogenesis, apparently by a reduced affinity of its receptor. In contrast, the shift induced by VPA was not different at any stage after kindling epileptogenesis. The change in CBZ sensitivity after kindling is related to epileptic activity rather than to the epileptic state, because it almost completely recovers in a period without seizures.
Paradoxic Reaction to Lamotrigine in a Child with Benign Focal Epilepsy of Childhood with Centrotemporal Spikes
Authors: Catania Santiago , Cross Helen , Sousa Carlos de , Boyd Stewart 
Published: August 2005

Summary: A girl aged 5 years developed nocturnal seizures (mouth twitching, salivation, anarthria, with right arm jerking and occasional secondary generalisation), with frequent focal sharp waves over the left centrotemporal region in her EEG, suggesting benign childhood epilepsy with centrotemporal spikes (BECTS). Seizures became diurnal and frequent, not modified by carbamazepine (CBZ) or valproate (VPA) but responding to VPA and lamotrigine (LTG) with recommended dosage schedules for this combination.Her school performance then deteriorated insidiously, with poor memory and concentration, clumsiness, stuttering, and emotional lability. After 4 months, new episodes, ≥10 per day, occurred. These lasted a few seconds; she stared into space, her jaw dropped, her head dropped to the right, and her eyelids flickered. She usually maintained awareness. Attacks were often provoked by blowing or sneezing. Ictal EEG showed anterior‐predominant 3/s sharp‐slow wave complexes lasting ≥8 s, with bilateral rolandic discharges interictally. Withdrawal of LTG resulted in rapid improvement in cognitive function and gradual remission of the new attacks. Conclusions: This appears to be a paradoxic reaction to LTG in the setting of BECTS.
Phenytoin Penetration into Brain After Administration of Phenytoin or Fosphenytoin
Authors: Walton Nancy Y. , Uthman Basim M. , El Yafi Karim , Kim Jae Moon , Treiman David M. 
Published: August 2005

Summary: Purpose: This study was designed to measure the brain penetration of phenytoin (PHT) after intravenous (i.v.) administration of either standard PHT or fosphenytoin (FPHT), a PHT prodrug. The study was formulated to answer the question whether the time required for FPHT to be converted to PHT in the bloodstream would delay the accumulation of PHT in brain. Methods: Four rats were sampled at various times after intravenous infusion of 30 mg/kg PHT i.v. or 30 mg/kg PHT equivalents of FPHT i.v. PHT was measured in serum, protein‐free ultrafiltrate, and in brain, by using high‐performance liquid chromatography. Results: Although the initial PHT‐free fraction was significantly higher for FPHT‐treated rats than it was for PHT‐treated rats, brain PHT levels were significantly reduced after infusion of FPHT. Conclusions: When FPHT is used for treatment of generalized status epilepticus, it should be anticipated that lower initial brain PHT levels will be achieved than are typically found with standard PHT.
Male Monozygotic Twins Discordant for Periventricular Nodular Heterotopia and Epilepsy
Authors: Sisodiya S. M. , Marques W. , Everitt A. , Sander J. W. A. 
Published: August 2005

Summary: Purpose: To determine zygosity and study cerebral structure in apparently identical twins with discordant manifestation of focal epilepsy. Methods: Male twins in their fifth decade were scanned by using magnetic resonance imaging (MRI) to detect structural abnormalities. Zygosity was determined by using 10 microsat‐ellite markers. Results: DNA analysis showed that the twins were >99.99% likely to be monozygous; they were discordant for bilateral symmetric periventricular nodular heterotopia (PNH) and epilepsy. Conclusions: The discordant occurrence of PNH and epilepsy in monozygotic male twins carries implications with respect to somatic mosaicism, currently held to be responsible for PNH in affected male subjects.
Do Reactive Post‐Resection “Injury” Spikes Exist?
Authors: Schwartz Theodore H. , Bazil Carl W. , Forgione Mennato , Bruce Jeffrey N. , Goodman Robert R. 
Published: August 2005

Summary: Purpose: New post‐resection spikes on electrocorticography (ECoG) after lesionectomy in patients with seizures may represent residual epileptogenic tissue or presumed reactive injury spikes. We investigated the existence of post‐resection injury spikes by eliminating the possibility of residual epileptogenic tissue. Methods: Preresection and post‐resection ECoG was performed on seven patients with an intra‐axial neocortical tumor (glioblastoma multiforme or metastasis) and no history of seizures. All tumors were gross‐totally resected. Results: The mean age of the patients was 59 years. The tumor location was frontal in four patients, parietal in two, and temporal in one. Two patients had preresection spikes with an average rate of 68 spikes/min that disappeared after surgery. Two different patients had new post‐resection spikes, with an average firing rate of 4 spikes/min, despite normal preresection ECoG. In one of these patients, the new spikes were superimposed over a burst suppression pattern. Neither patient developed seizures after surgery. Conclusions: Surgical irritation of the neocortex is sufficient to produce reactive post‐resection epileptogenic discharges surrounding an intra‐axial neocortical tumor even in the absence of preoperative seizures and spikes. Injury spikes fire at a slow rate and are not predictive of clinical seizures.
A Multicenter Randomized Controlled Trial on the Clinical Impact of Therapeutic Drug Monitoring in Patients with Newly Diagnosed Epilepsy
Authors: Jannuzzi G. , Cian P. , Fattore C. , Gatti G. , Bartoli A. , Monaco F. , Perucca E. ,   The Italian TDM Study Group in Epilepsy
Published: August 2005

Summary: Purpose: To assess the clinical impact of monitoring serum concentrations of antiepileptic drugs (AEDs) in patients with newly diagnosed epilepsy. Methods: One‐hundred eighty patients with partial or idiopathic generalized nonabsence epilepsy, aged 6 to 65 years, requiring initiation of treatment with carbamazepine (CBZ), valproate (VPA), phenytoin (PHT), phenobarbital (PB), or primidone (PRM) were randomly allocated to two groups according to an open, prospective parallel‐group design. In one group, dosage was adjusted to achieve serum AED concentration within a target range (10–20 μg/ml for PHT, 15–40 μg/ml for PB, 4–11 μg/ml for CBZ, and 40–100 μg/ml for VPA), whereas in the other group, dosage was adjusted on clinical grounds. Patients were followed up for 24 months or until a change in therapeutic strategy was clinically indicated. Results: Baseline characteristics did not differ between the two groups. Most patients with partial epilepsy were treated with CBZ, whereas generalized epilepsies were most commonly managed with PB or VPA. PHT was used only in a small minority of patients. A total of 116 patients completed 2‐year follow‐up, and there were no differences in exit rate from any cause between the monitored group and the control group. The proportion of assessable patients with mean serum drug levels outside the target range (mostly below range) during the first 6 months of the study was 8% in the monitored group compared with 25% in the control group (p ≤0.01). There were no significant differences between the monitored group and the control group with respect to patients achieving 12‐month remission (60% vs. 61%), patients remaining seizure free since initiation of treatment (38% vs. 41%), and time to first seizure or 12‐month remission. Frequency of adverse effects was almost identical in the two groups. Conclusions: Only a small minority of patients were treated with PHT, the drug for which serum concentration measurements are most likely to be useful. With the AEDs most commonly used in this study, early implementation of serum AED level monitoring did not improve overall therapeutic outcome, and the majority of patients could be satisfactorily treated by adjusting dose on clinical grounds. Monitoring the serum levels of these drugs in selected patients and in special situations is likely to be more rewarding than routine measurements in a large clinic population.
Chemical Shift Imaging Spectroscopy and Memory Function in Temporal Lobe Epilepsy
Authors: Pauli E. , Eberhardt K. W. E. , Schäfer I. , Tomandl B. , Huk W. J. , Stefan H. 
Published: August 2005

Summary: Purpose: Hippocampal neuron loss and associated memory deficits are characteristic of intractable temporal lobe epilepsy (TLE). Proton chemical shift imaging (CSI) spectroscopy is a sensitive tool for detecting neuronal loss. The aim of this study was to investigate the correlation between memory functions and results provided by CSI spectroscopy of the hip‐pocampal structures. Methods: Ten patients with cryptogenic TLE participated. The study protocol involved both the acquisition of high‐spatial‐resolution CSI spectroscopy and neuropsychological evaluation, including memory testing and intracarotid sodium amytal test (IAT). The analysis of the CSI data was based on normative data obtained in 30 healthy volunteers. Memory functions were represented by verbal, visual, and general memory indices. Results: A significant correlation was found between CSI spectroscopy of the hippocampal formation and the verbal memory indices for the dominant hemisphere. In addition, there was a significant correspondence of the qualitative judgment “hippocampal pathology indicated by CSI spectroscopy” and both “material specific memory deficit” and “memory deficits in the IAT.” Conclusions: Our results demonstrate that CSI spectroscopy of the hippocampal structures is strongly related to lateralized memory deficits in patients with TLE. This suggests that CSI spectroscopy may be useful in the prediction of postoperative outcome in respect of seizure control and memory.
Reduction of Epileptiform Activity in Response to Low‐Dose Clonazepam in Children with Epilepsy: A Randomized Double‐Blind Study
Authors: Dahlin Maria , Knutsson Evert , Åmark Per , Nergårdh Arne 
Published: August 2005

Summary: Purpose: To evaluate the effect of low‐dose clonazepam (CZP) on the amount of epileptiform activity in children with focal and generalized epilepsy. Methods: In a single‐blind pilot study, followed by a double‐blind, placebo‐controlled, randomized, crossover study, 15 children with epilepsy were evaluated by using 24‐h long‐term EEG recordings during baseline days and days after injections of placebo and CZP. The drug was given as a single i.m. injection of 0.02 mg/kg BW. Blood samples were obtained regularly for analysis of plasma concentrations of CZP. The number of epileptiform discharges was determined during corresponding periods with the individual child in the same state of alertness, the same real time of day, and with concomitant antiepileptic drugs (AEDs) unchanged. Results: In the double‐blind study, low‐dose CZP produced a highly significant (p = 0.0015) decrease in the amount of epileptiform activity (mean, ‐69% vs. placebo, ‐2%) obtained during periods when median plasma concentrations ranged from 18 to <14 nM. The maximal plasma level (median, 24 nM) was reached before the start of the analysis periods. The pilot study showed reductions of epileptiform discharges within the same range as the double‐blind study. In the children with daily seizures, a parallel decrease in seizures and the number of epileptiform discharges was seen after the administration of CZP. Conclusions: Our data demonstrate a significant reduction of epileptiform discharges on long‐term EEGs after a single low dose of CZP with concomitant low plasma levels, which were considerably lower than the doses and plasma levels usually recommended. A concomitant reduction of seizures also was seen.
Improved Prediction of Nonepileptic Seizures with Combined MMPI and EEG Measures
Authors: Storzbach D. , Binder L. M. , Salinsky M. C. , Campbell B. R. , Mueller R. M. 
Published: August 2005

Summary: Purpose: Nonepileptic seizures (NESs) are frequently mistaken for epileptic seizures (ESs). Improved detection of patients with NESs could lead to more appropriate treatment and medical cost savings. Previous studies have shown the MMPI/MMPI‐2 to be a useful predictor of NES. We hypothesized that combining the MMPI‐2 with a physiologic predictor of epilepsy (routine EEG; rEEG) would result in enhanced prediction of NES. Methods: Consecutive patients undergoing CCTV‐EEG monitoring underwent rEEG evaluation and completed an MMPI‐2. Patients were subsequently classified as having epilepsy (n = 91) or NESs (n = 76) by using standardized criteria. Logistic regression was used to predict seizure type classification. Results: Overall classification accuracy was 74% for rEEG, 71% for MMPI‐2 Hs scale, and 77% for MMPI‐2 Hy scale. The model that best predicted diagnosis included rEEG, MMPI‐2, and number of years since the first spell, resulting in an overall classification accuracy of 86%. Conclusions: The high accuracy achieved by the model suggests that it may be useful for screening candidates for diagnostic telemetry.
Neuropsychological Functions in Idiopathic Occipital Lobe Epilepsy
Authors: Gülgönen Sibel , Demirbilek Veysi , Korkmaz Bariş , Dervent Ayşm , Townes Brenda D. 
Published: August 2005

Summary: Purpose: Despite the benign prognoses of idiopathic partial epilepsies, particularly regarding the response of seizures to treatment, some evidence now exists that patients with such disorders may have subtle neuropsychological deficits. This study was designed to investigate several modalities of neuropsychological functioning in a group of 21 patients, ranging from 6 to 14 years of age, with idiopathic occipital lobe epilepsy (IOLE). The case patients were compared with 21 healthy controls matched for age, sex, and socioeconomic status. Methods: A battery of age‐appropriate neuropsychological tests was administered individually to all the participants. Tests were chosen on the basis of age‐appropriate norms, their ability to represent a wide variety of functional domains, and their appropriateness in a cross‐cultural setting. The tests were selected to measure functioning in six domains: intellectual functioning, attention, memory, academic achievement, visual‐motor functioning, and executive functioning; some were further subdivided by their verbal‐versus‐visual modality of functioning. Results: The results revealed no significant difference in basic neurophysiological functions between the patient and control groups, although the case patients' performance scores were lower in attention (p <0.01) and memory (p <0.01), as well as in intellectual functioning (p <.05). Conclusions: The possibility of subtle cognitive deficits in IOLE patients should always be considered, though further studies are necessary to elaborate their precise and long‐term effects.
Antiepileptic Therapies in the Mifi Province in Cameroon
Authors: Preux P.‐M. , Tiemagni F. , Fodzo L. , Kandem P. , Ngouafong P. , Ndonko F. , Macharia W. , Dongmo L. , Dumas M. 
Published: August 2005

Summary: Purpose: To evaluate the availability and accessibility of antiepileptic drugs (AEDs) in two health districts in Cameroon. Methods: The study included 33 patients with epilepsy, 26 physicians, 13 private pharmacists, eight hospital pharmacists, three distributors, and eight traditional healers. Structured questionnaires were used to assess the knowledge of the disease, treatment accessibility, the methods of prescriptions, and the availability and the frequency of delivery of drugs. Results: Only one of 33 patients did not take modern treatment; 91% of the patients were followed up by a traditional healer, and 78%, by an hospital physician. Phenobarbitone (PB) was the most frequently prescribed drug by 69% of the doctors; 54% of the physicians considered the traditional therapies to be incompatible with modern drug treatment. By pharmacists, PB was delivered regularly. Other drugs went out of stock frequently. The number of packages in stock varied significantly directly with the frequency of delivery. The mean price per package and the mean number of packages in stock were higher in the public hospital pharmacies than in the private pharmacies. A majority of healers explained epilepsy as the presence of excess foam in the abdomen. The remedies proposed were to stop foam secretion. Conclusions: Availability of AEDs was quite high, but with no strict correspondence between the rate of prescriptions and the supply of the drugs.
Clinical Relevance of Quantified Intracranial Interictal Spike Activity in Presurgical Evaluation of Epilepsy
Authors: Hufnagel A. , Dümpelmann M. , Zentner J. , Schijns O. , Elger C. E. 
Published: August 2005

Summary: Purpose: Electrocorticograms of 32 patients with medically intractable seizures, recorded through intracranial electrodes, were retrospectively analyzed. The objective was to assess whether quantitative analysis of interictal spikes may be used for delineation of the epileptogenic zone. Methods: We used a newly developed computer program for automatic detection of interictal spikes and averaging procedures. This allowed determination of the earliest spike of each spike cluster, the maximal averaged spike amplitude, the highest spike frequency, and the shortest averaged spike duration at each recording site. Results: The following results were obtained: (a) Within a zone ≤2 cm from the site of seizure origin, we localized the averaged earliest spike of a spike cluster in 27 (84%) of 32 patients, the highest averaged spike amplitude in 24 (75%) of 32, the shortest averaged spike duration in 22 (69%) of 32, and the maximal spike frequency in 17 (53%) of 32; (b) No correlation was found between spike occurrence and histopathology; (c) No evidence was found for decreased postoperative seizure control in patients with several multilobar or bihemispheric occurrence of spike clusters. Conclusions: The zones of the earliest spike and seizure origin demonstrate a high correlation that favors a common epileptic generator. Removal of all brain areas demonstrating spike clusters is unnecessary to achieve seizure control. Quantification of interictal spike activity is a valuable tool for localization of the seizure generator.
Myoclonus Associated with the Use of Gabapentin
Authors: Asconapé Jorge , Diedrich Andrea , DellaBadia John 
Published: August 2005

Summary: Purpose: To report on the occurrence of myoclonus in patients receiving gabapentin (GBP) for the treatment of epilepsy. Methods: Clinic charts of 104 consecutive patients started on GBP were reviewed. All patients were treated by the same physician, and most were specifically asked about the presence of myoclonus. Results: We found 13 cases of myoclonus. All patients had refractory epilepsy and were taking other antiepileptic drugs (AEDs). Six patients had a severe chronic static encephalopathy; five patients had no medical diagnosis other than seizures. Ten patients developed multifocal myoclonus. Three patients developed focal myoclonus, contralateral to their epileptic focus. Two patients had an exacerbation of preexistent myoclonus. An EEG performed during myoclonus on three patients showed no correlate. The myoclonus tended to persist as long as GBP was maintained, whereas discontinuance of GBP resulted in rapid cessation of the myoclonus. In all cases the myoclonus was subtle and did not significantly interfere with daily activities. Conclusions: GBP‐associated myoclonus appears to be relatively frequent. It is usually mild and can easily be overlooked. Discontinuation of therapy is not necessary in most cases.