bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lamotrigine in Pregnancy and Lactation: A Case Report
Authors: Tomson Torbjörn , Öhman Inger , Vitols Sigurd 
Published: August 2005

Summary: Purpose: We investigated the effect of pregnancy on the kinetics of lamotrigine (LTG), passage of LTG over the placenta and the excretion of the drug in breast milk. Methods: We used high‐performance liquid chromatography to determine concentrations of LTG in plasma and in breast milk in a woman who was treated with LTG monotherapy during pregnancy and lactation. Results: Plasma levels of LTG decreased as pregancy progressed. The ratio of dose to plasma concentration was 5.8 times higher at delivery and 3.6 times higher in late pregnancy as compared with 5 months postpartum, suggesting enhanced clearance of LTG during pregnancy. The concentration ratio of umbilical cord to mother's plasma was 1.2 indicating extensive passage of LTG over the placenta. The LTG plasma concentration in the newborn was still 48 h after birth similar to the plasma levels of the mother at delivery and in the umbilical cord. The ratio of milk to plasma concentration was 0.6 2 weeks after delivery and the plasma concentration in the breastfed child was 25% of the mother's plasma levels. No adverse effects were observed in the newborn. Conclusions: The kinetics of LTG may be influenced by pregnancy to such a degree that dose adjustments may be indicated. Due to an extensive passage of LTG into breast milk, and a slow elimination in the newborn, LTG concentrations in the nursed infant may reach levels at which pharmacological effects can be expected.
Outcome Assessment in Epilepsy: Comparative Responsiveness of Quality of Life and Psychosocial Instruments
Authors: Wiebe Samuel , Rose Kris , Derry Paul , McLachlan Richard 
Published: August 2005

Summary: Purpose: Few data exist on the ability of instruments to detect within‐patient change over time in epilepsy, a property referred to as responsiveness. Our aim was to compare the responsiveness of three instruments [i.e., Epilepsy Surgery Inventory‐55 (ESI‐55) and Washington Psychosocial Inventory (WPSI), both epilepsy specific, and Symptom Checklist‐90–Revised (SCL‐90–R), non‐epilepsy specific].Methods: Instruments were administered at baseline and at 1 year in a prospective cohort of surgically (43) and medically (14) treated patients with temporal lobe epilepsy. Coefficient of Responsiveness and relative efficiency were computed for each scale and for the dimensions of mental health, physical health, and role function.Results: The ESI‐55 contained the most responsive scales, whereas SCL‐90–R contained the largest number of scales with moderate responsiveness. The largest number of scales with low responsiveness belonged to the WPSI. Sensitivity to between‐treatment differences in change was highest for ESI‐55 and SCL‐90–R. The most efficient scales in detecting differences between treatment groups in the mental, physical, and role‐function dimensions were ESI‐55 emotional well‐being, ESI‐55 health perceptions, and SCL‐90–R hostility, respectively.Conclusions: Our results support the responsiveness of ESI‐55 scales and suggest that SCL‐90–R is a responsive tool for the assessment of psychologic function and distress in epilepsy. Comparatively, WPSI is relatively unresponsive to small or medium‐size changes.
Usefulness of Ictal and Interictal 99mTC Ethyl Cysteinate Dimer Single Photon Emission Computed Tomography in Patients with Refractory Partial Epilepsy
Authors: Lancman Marcelo E. , Morris Harold H. , Raja Shanker , Sullivan M. Jo , Saha Gopal , Go Raymundo 
Published: August 2005

Summary: Purpose: Ictal perfusion single photon emission computed tomography (SPECT), using HMPAO, has been shown to localize epileptic foci in ∼90% of studies. Unfortunately, HMPAO decomposes rapidly, precluding the performance of ictal studies. Ethyl cysteinate dimer (ECD) is a SPECT perfusion agent recently approved by the Food and Drug Administration. After preparation, this compound is stable for ∼6 h. facilitating the performance of ictal studies.Methods: In a prospective, open‐label, uncontrolled, non randomized study, we evaluated the potential benefits of the use of 99mTc‐ECD SPECT for lateralization of the epileptic focus. Ten consecutive adult epilepsy surgery candidates were studied with ictal and interictal 99mTc‐ECD SPECT.Results: The mean delay between seizure onset and ictal SPECT injection was 23.2 s. The mean seizure duration was 84.1 s. Ictal studies agreement between the epilepsy focus and area of hyperperfusion was evident in 8 of 10 cases. In one case, SPECT was lateralized in a patient with bilateral temporal lobe epilepsy (TLE); however, hyperperfusion was observed on the same side of that particular seizure. In another case, there was location disagreement. Interictal SPECT showed focal hypoperfusion in three cases.Conclusions: 99mTc‐ECD proved to be an optimal tracer for ictal studies. Although this is a small series, the results of ictal and interictal findings using 99mTc‐ECD are similar to those reported with 99mTc‐HMPA0. Because 99mTc‐ECD has a longer decomposition time, true ictal studies are easier to obtain. This new tracer will probably allow the use of ictal SPECT to become widely accepted in most epilepsy centers.
Layer‐Specific Pathways for the Horizontal Propagation of Epileptiform Discharges in Neocortex
Authors: Telfeian Albert E. , Connors Barry W. 
Published: August 2005

Summary: Purpose: Epileptiform discharges that resemble interictal spikes can be generated by slices of neocortex treated with antagonists of γ‐aminobutyric acid A (GABAA) receptors. These discharges can propagate horizontally for long distances. We tested the hypothesis that propagation occurs through preferred horizontal pathways that lie in a particular cortical layer. Methods: Slices were prepared from the primary somatosensory cortex of rats, maintained in vitro, and bathed with the GABAA receptor antagonist picrotoxin. Electrical stimuli were used to evoke single all‐or‐none paroxysmal field potentials (PFP) that were recorded with pairs or arrays of field potential electrodes. Results: To test which laminae are necessary for propagation, vertical cuts were made to force the PFP to spread horizontally through particular layers. If slices were bathed in a high dose of picrotoxin (35 μM, a bridge of cortex 350 μm thick placed at any lamina was sufficient to support PFP propagation. However, in low picrotoxin doses (2.5 μM), similarly sized bridges had to include tissue from layers 415 or 516 to support propagation. When slices were cut horizontally (i.e., parallel to the pia) in strips, either upper‐, middle‐, or lower‐layer strips were sufficient to support PFP propagation if the picrotoxin concentration was high; however, in low picrotoxin doses, only horizontal strips that included layer 5 could support propagation. Finally, in intact picrotoxin‐treated slices, focal applications of GABA were systematically applied to different laminae as the PFP propagated past; GABA was most effective at blocking or delaying propagation when it was applied to layer 5b. Conclusions: We conclude that epileptiform propagation can occur through a variety of horizontal pathways when cortical inhibition is strongly impaired. However, when inhibition is reduced only moderately, axonal pathways in layer 5 are critical for seizure spread.
Replication Analysis of a Putative Susceptibility Locus (EGI) for Idiopathic Generalized Epilepsy on Chromosome 8q24
Authors: Sander Thomas , Kretz Rebekka , Schulz Herbert , Sailer Ulrike , Bauer Gerhard , Scaramelli Alejandro , Epplen Jörg T. , Rieß Olaf , Janz Dieter 
Published: August 2005

Summary: Purpose: The present replication study was designed to test the validity of a previously mapped susceptibility locus (EGI) for common subtypes of idiopathic generalized epilepsy (IGE) in chromosomal region 8q24. Methods: Thirty‐eight multiplex families of probands with common IGE syndromes were included in the present study. Parametric and nonparametric multipoint linkage analyses were conducted between the IGE trait (either “idiopathic” generalized seizure or generalized spike‐wave EEG discharges) and three microsatellite polymorphisms (D8S256, D8S284, 0881128) encompassing the putative EGI locus. Results: Parametric and nonparametric multipoint linkage analysis provided no evidence for linkage between the IGE trait and the markers encompassing the putative EGI locus. Moreover, we noted no indication favoring linkage to this chromosomal region in two distinct subsets of families subdivided by the absence (n = 18) or presence (n = 20) of family members with juvenile myoclonic epilepsy (JME). Conclusions: We failed to replicate evidence of a major locus (EGI) for common familial IGE in chromosome region 8q24. On the contrary, our present parametric linkage results provide evidence against linkage across the region under a broad range of genetic models. If there is a susceptibility locus for IGE in this region, the effect size or the proportion of linked families is too small to detect linkage in these families. Taking into account the problems in replicating initial linkage claims in oligogenic traits, further linkage studies in additional family sets are necessary to evaluate the validity of the previous linkage finding.
Morphometric Analysis of the Temporal Lobe in Temporal Lobe Epilepsy
Authors: Lee J. W. , Andermann F. , Dubeau F. , Bernasconi A. , MacDonald D. , Evans A. , Reutens D. C. 
Published: August 2005

Summary: Purpose: Using high‐resolution magnetic resonance imaging (MRI), we examined the temporal neocortex and the underlying white matter in patients with unilateral temporal lobe epilepsy (TLE) and in control subjects. Methods: The images of 27 patients and 42 control subjects were registered into stereotaxic space, corrected for image intensity inhomogeneity, and automatically segmented into gray matter, white matter, and cerebrospinal fluid (CSF) over a predetermined extent of the temporal lobe. The surface between the gray matter and CSF was extracted, indices of curvature (IOC) of the surface were calculated, and a frequency histogram of the IOC was obtained. Results: There was significant bilateral reduction in the total volume of the temporal lobe and in the volume of gray matter. White matter volume was significantly reduced only in the temporal lobe ipsilateral to the seizure focus. There were significant changes in the position and amplitude of peaks in the frequency histogram of the IOC. Conclusions: The volume of gray matter was negatively correlated with duration of epilepsy, suggesting that neocortical changes may be a consequence of seizures. Changes in the frequency histogram of the IOC suggested an additional alteration in the surface morphology of the temporal lobe in TLE, possibly related to sulcal widening.
Uptake and Costs of Care for Epilepsy: Findings from a U.K. Regional Study
Authors: Jacoby Ann , Buck Debbie , Baker Gus , McNamee Paul , Graham‐Jones Susannah , Chadwick David 
Published: August 2005

Summary: Purpose: Epilepsy is a common neurological condition, with significant resource implications for the health services, but few studies to date have examined the uptake and costs of care for this condition. As part of a large prevalence study of epilepsy conducted in one U.K. Health Region, we investigated both direct and indirect costs of epilepsy care and measured and valued the direct costs. Methods: Data about service use were obtained from primary physician records and patient questionnaires. Unit costs for each item of resource use were generated from several sources. Results: The greatest direct health care cost is that of hospital‐based care. Pharmaceutical services also represent a significant element of the cost of epilepsy, the financial costs of prescribing newly developed antiepileptic drugs (AEDs) being large relative to those of the older drugs; therefore, the benefits derived from their use must be carefully assessed. The importance of good seizure control is amply illustrated by the findings about the differential costs associated with epilepsy of varying severity. The direct costs of caring for people with poorly controlled epilepsy are significant, with more than half the total cost of epilepsy care accounted for by patients with frequent seizures even though this group represented only a quarter of all patients in the present study. Conclusions: Our data emphasize the importance of optimizing seizure control as a means of reducing the costs of epilepsy, not only to the person with the condition, but also to society.
Correlation Between Interictal Regional Cerebral Blood Flow and Depth‐Recorded Interictal Spiking in Temporal Lobe Epilepsy
Authors: Guillon Benoit , Duncan Roderick , Biraben Arnaud , Bernard Anne‐Marie , Vignal Jean‐Pierre , Chauvel Patrick 
Published: August 2005

Summary: Purpose: Single photon emission computed tomography (SPECT) is used as an adjunctive method in preoperative localization of epileptic foci. In temporal lobe epilepsy (TLE), interictal hypoperfusion is observed in 60–70% of cases. Correlation with ictal EEG changes is observed in ∼50–60% of cases. Relationships with interictal EEG have been studied less. We compared interictal SPECT data obtained in 20 patients with their interictal intracerebral electrical activity recorded by depth electrodes to evaluate a potential relationship. Methods: We studied 20 sequential patients whose clinical, surface, and depth EEG data indicated seizure originating in the temporal lobe and who had interictal [99mTc]hexamethyl‐propylene amine oxime (HMPAO)‐SPECT stereo‐EEG (SEEG). Intracerebral electrodes were placed according to the patient's profile. The interictal extent of epileptiform activity allowed delineation of the irritative zone. Interictal spike frequency was also analyzed semiquantitatively. Visual and numerical SPECT analysis was performed blind to SEEG data. Results: Interictal hypoperfusion was observed in 16 patients, involving the epileptogenic temporal lobe in 14. Except for 1 patient who manifested lateral temporal hypoperfusion corresponding to a mass lesion, two distinctive patterns of hypoperfusion were noted: (a) mesial hypoperfusion (5 patients), and (b) global temporal hypoperfusion (8 patients). In 8 patients, hypoperfusion had also extended into the adjacent cortex. Temporal mesial hypoperfusion was associated with spiking limited to the mesial structures, whereas global temporal hypoperfusion or hypoperfusion extending beyond the temporal lobe was associated with a similar topographic pattern of spikes. Conclusions: Comparison between SPECT and SEEG data collected in the interictal phase indicated that the extent of the hypoperfused area correlated topographically with that of the underlying irritative zone.
NER Rat Strain: A New Type of Genetic Model in Epilepsy Research
Authors: Noda Atsushi , Hashizume Ryoichi , Maihara Toshiro , Tomizawa Yasuhiro , Ito Yoshihiko , Inoue Maki , Kobayashi Kinji , Asano Yuzo , Sasa Masashi , Serikawa Tadao 
Published: August 2005

Summary: Purpose: We characterized and evaluated as an animal model of epilepsy NER, a new epileptic rat strain, which was developed by inbreeding rats with spontaneous tonic‐clonic seizures in a stock of Crj:Wistar. Methods: Animals were monitored through the inbreeding course, and video‐EEGs were recorded selectively. External seizure‐provoking stimuli were applied to NER and to a control parental strain. F1, F2, and backcross progenies were produced between NER and a nonepileptic unrelated strain. Pathologic study included hematoxylin‐and‐eosin (HE), Klüver‐Barrera's, modified Bodian silver, and neo‐Timm's staining. Results: After the F9 generation, 94%‐98% of NER exhibited spontaneous tonic‐clonic convulsions, beginning with neck and forelimb clonus, wild jumping/running, opisthotonic posturing, and evolving to tonic, then clonic convulsion, followed by postictal flaccidity. Most seizure onsets occurred between 2–4 months of age, and the incidence was 0.45 ± 0.21 seizures in 12 h. Ictal cortical and hippocampal EEGs were characterized by high‐voltage spikes followed by diffuse spike‐and‐wave or polyspike‐and‐wave complexes. NER revealed seizure susceptibility to pentylenetetrazol, tossing, and transcorneal electroshock, but not to tactile, photic, or acoustic stimuli, or to transauricular electroshock. Mating experiments revealed that 0% (0/46) of the animals in F1, 25.5% (13/51) in F2, and 63.6% (56/88) in backcross progenies exhibited spontaneous tonic‐clonic convulsions without sex difference. For all these epileptic traits, no pathologic changes were demonstrated in the CNS. Conclusions: NER frequently exhibited spontaneous convulsions, controlled by a major autosomal recessive gene for epilepsy, that are comparable to generalized tonic‐clonic seizures in humans. This can serve as a new genetic model in epilepsy research.
Nonconvulsive Status Epilepticus in the Critically Ill Elderly
Authors: Litt Brian , Wityk Robert J. , Hertz Sharon H. , Mullen Paul D. , Weiss Howard , Ryan Dawn D. , Henry Thomas R. 
Published: August 2005

Summary: Purpose: To describe the electrographic and clinical features of nonconvulsive status epilepticus (NCSE) in the critically ill elderly and to identify potential predictors of outcome. Methods: We prospectively identified 25 episodes of altered mentation and NCSE in 24 critically ill elderly patients associated with generalized, focal, or bihemispheric epileptiform EEG patterns. Patients with anoxic encephalopathy were excluded. Results: Of 25 hospitalizations, 13 (52%) resulted in death, and 12 (48%) patients survived to discharge. Death was associated with the number of acute, life‐threatening medical problems on presentation (survivors, 1.8; fatalities, 2.8; p = 0.013) and with generalized EEG pattern (p = 0.017). Higher doses or greater number of antiepileptic drugs (AEDs) did not improve outcome. Treatment with intravenous benzodiazepines was associated with increased risk of death (p = 0.033). Ten patients with advance directives were managed outside the intensive care unit (ICU). Mean hospitalization was 39 days in the ICU group and 22 for those with advance directives (p = 0.017). Conclusions: Severity of illness correlates with mortality in critically ill elderly patients with NCSE. Treatment with intravenous benzodiazepines may increase their risk of death. Aggressive ICU management may prolong hospitalization at considerable cost, without improving outcome. It is unclear whether NCSE affects outcome in the critically ill elderly or is merely a marker for severity of disease in predisposed patients. The benefits of aggressive therapy are unclear. Carefully controlled, prospective trials will be necessary to determine the best therapies for NCSE in the critically ill elderly and the appropriate role of the ICU in their management.
Quality of Life and Personality in Adults with Epilepsy
Authors: Zhu Dan‐tong , Jin Li‐juan , Xie Guang‐jie , Xiao Bo 
Published: August 2005

Summary: Purpose: This study was undertaken to understand the quality of life, personality, and associated factors in patients with epilepsy. Methods: 117 patients with epilepsy and 84 healthy people were studied and tested using the Social Support Scale, the General Well‐being Schedule, the Life‐Event Scale, the Behavior Pattern Scale, and the Eysenck Personality Questionnaire WQ). Results: There were no significant differences between the patients with epilepsy and the control group in the Social Support Scale results. The General Well‐being Schedule scores were lower for the case patients than for the control group (p < 0.01). Scores for patients with frequent seizures (once a month or more) were lower than those without frequent seizures (less than once per month). The case patients had higher negative scores in the family‐related problem section of the Life Events Scale, compared with the control group (p < 0.05). The patients with epilepsy were also more likely to lie (p < 0.05); their emotions were more changeable (p < 0.01), and their character more introverted (p < 0.05), although their behavior patterns were similar to the controls. We also studied associated factors related to personality, general well‐being, and familial‐negative life‐events. Conclusions: These results provide information about patients with epilepsy that may be useful in their psychological treatment.
Hyposexuality Produced by Temporal Lobe Epilepsy in the Cat
Authors: Feeney Dennis M. , Gullotta Frank P. , Gilmore Wendy 
Published: August 2005

Summary: Purpose: The hypothesis tested in this study was that a unilateral irritative focal epileptic lesion in the temporal lobe results in hyposexuality. Methods: Focal epilepsy was produced in male cats by unilateral injection of aluminum hydroxide into either the basolatera1 amygdala (temporal lobe group) or anterior sigmoid gyrus (motor cortex group). Weekly sex testing trials with estrous females were conducted prior to and after aluminum hydroxide injection, and mating performance scores were compared with those of normal, unoperated cats (normal control group). Results: All animals receiving aluminum hydroxide developed electroencephalographic and behavioral manifestations of epilepsy; i.e., interictal EEG spiking and partial or generalized seizures. Cats in the temporal lobe group exhibited a dramatic and complete suppression of sexual behavior at periods from 6 to 26 weeks after aluminum hydroxide injection. The duration of the hyposexuality varied between individual animals and returned to normal as suddenly as the onset occurred, despite the use of AEDs to prevent or control generalized seizure activity. Interictal EEG epileptiform spiking in the amygdala preceded the onset of hyposexuality by 1–12 weeks. By contrast, cats in the motor cortex and normal control groups showed no sign of sexual dysfunction throughout the experimental period, independent of seizure activity andor antiepileptic drug (AED) treatment. Conclusions: These data support the hypothesis that hyposexuality occurs as a result of epileptiform activity in the temporal lobe, but not in the motor cortex. The precise mechanisms by which this occurs are unknown, but are likely to involve abnormally high‐frequency neuronal activity in temporal lobe structures known to connect with and/or to regulate hypothalamic nuclei that organize male sexual behavior toward receptive females.