bluuebunny/crossref_metadata_2025_split huggingface dataset:
Classification of Epileptic Seizures: A Comparison of Two Systems
Authors: Parra Jaime , Augustijn Paul B. , Geerts Yvette , Van Emde Boas Walter 
Published: March 2003

Summary:  Purpose: Extensive experience with video‐EEG seizure monitoring, notably in the setting of epilepsy surgery programs, has exposed the limited value of the current International Classification of Epileptic Seizures (ICES) for providing relevant localizing information. To overcome this limitation, a Semiologic Seizure Classification (SSC) has recently been proposed. This study aimed to assess and to compare the usefulness and reliability of both systems in the setting of a tertiary epilepsy center.Methods: Three epileptologists independently reviewed video‐taped seizures, randomly selected from the archive of the Epilepsy Monitoring Unit. They were blinded to the EEG findings and final diagnosis and classified all seizures according to both classifications.Results: One hundred thirty‐eight seizures from 60 patients (age range, 2–59 years) were reviewed (maximum, three seizures per patient). Fifty‐five seizures from 20 patients were recorded in the setting of presurgical evaluations, and the remainder as part of regular diagnostic evaluations. The average interobserver agreement was higher for SSC (63.3%, κ = 0. 56) than for ICES (38.6%, κ = 0.41). Some categories of SSC, such as hypermotor or automotor, had the best interobserver agreement, and were strongly correlated with the anatomic localization of the seizures (frontal and temporal lobe, respectively). All reviewers agreed that SSC provided a better description of the seizures than did ICES, in 60% of the patients.Conclusions: SSC provides a more comprehensive picture of epileptic seizures than does ICES, notably in patients with localized epilepsy syndromes, and appears to be very useful and reliable, particularly in the setting of specialized epilepsy centers.
Neuropathological Findings in a Patient with Epilepsy and the Parry–Romberg Syndrome
Authors: DeFelipe Javier , Segura Tomás , Arellano Jon I. , Merchán Angel , DeFelipe‐Oroquieta Jesús , Martín Pilar , Maestú Fernando , Y Cajal Santiago Ramón , Sánchez Alicia , Sola Rafael G. 
Published: March 2003

Summary:  Purpose: The Parry–Romberg syndrome is an unusual disorder frequently associated with epilepsy. The origin of this disease, and the cause of epilepsy, are unknown. This study is the first reported case of the Parry–Romberg syndrome, with intractable temporal lobe epilepsy, in which detailed microanatomic analyses have been performed on resected brain tissue obtained after surgical intervention.Methods: Standard histopathologic methods and correlative light and electron microscopy, combined with immunocytochemical techniques, were used to study in detail the synaptic microorganization of the resected hippocampal formation.Results: After surgery, the patient was seizure free (follow‐up period of 4 years and 7 months). The resected temporal lobe showed a variety of dramatic microanatomic alterations (small groups of ectopic cells, neuronal loss, gliosis, and activated microglial cells) in mesial structures, including the entorhinal cortex, subiculum, and dentate gyrus. At the electron‐microscopic level, we found that in the dentate gyrus, the number of synapses in the cell‐sparse region adjacent to the ectopic mass of neurons was almost twice that found in the molecular and polymorph cell layers, indicating the intrusion of neuritic processes and synapse formation. In addition, the symmetrical axosomatic synapses characteristically found on granule cells, which are likely derived from γ‐aminobutyric acid (GABA)ergic inhibitory basket cells, were not observed.Conclusion: The complete seizure relief after surgery suggests that the pacemaker region(s) of seizure activity were within the resected tissue. However, we do not know which of the multiple neuropathologic findings reported here were the primary cause of seizure activity. Nevertheless, the changes found in the dentate gyrus circuitry appear to be among the most important alterations that would lead to epilepsy.
Long‐term Outcome Is Unchanged by Antiepileptic Drug Treatment after a First Seizure: A 15‐year Follow‐up from a Randomized Trial in Childhood
Authors: Camfield Peter , Camfield Carol , Smith Stephanie , Dooley Joe , Smith Edythe 
Published: March 2003

Summary:  Purpose: In 1989 we reported that 1 year of daily treatment with carbamazepine (CBZ) significantly reduced the recurrence rate after a first afebrile seizure in children compared with no treatment in a randomized open trial. We sought to determine if the long‐term clinical course and rate of remission were changed by treatment starting after the first seizure.Methods: Participants of the original trial (14 CBZ, 17 no medication) were contacted in 2001.Results: Sixteen controls and 10 CBZ (84%) cases were followed up for 15 years. After randomization and follow‐up, 12 controls and five treated patients had at least one more seizure (p = NS). For those with recurrences, the number of recurrences appeared to be the same in both groups. Number of medications used was also the same. Terminal remission (>2 years seizure free with or without medication) was achieved by eight (80%) of 10 CBZ and 14 (88%) of 16 controls, and terminal remission off medication in six (60%) of 10 CBZ (p = NS).Conclusions: Based on this small study with long follow‐up, it appears that for children treated with CBZ after a first seizure, the subsequent clinical course and remission rates are not improved in comparison with a no‐treatment strategy. Delaying treatment after a first seizure appears defensible.
Metabolic and Electrophysiological Alterations in Subtypes of Temporal Lobe Epilepsy: A Combined Proton Magnetic Resonance Spectroscopic Imaging and Depth Electrodes Study
Authors: Guye Maxime , Le Fur Yann , Confort‐Gouny Sylviane , Ranjeva Jean‐Philippe , Bartolomei Fabrice , Régis Jean , Raybaud Charles A. , Chauvel Patrick , Cozzone Patrick J. 
Published: March 2003

Summary:  Purpose: This study compared the metabolic regional alterations, characterized by proton magnetic spectroscopic imaging (1H‐MRSI), with electrophysiological abnormalities recorded by using depth electrodes and with structural lesions, in patients with several subtypes of temporal lobe epilepsy (TLE).Methods: Twenty‐five subjects were investigated, including 15 controls and 10 patients with drug‐resistant unilateral TLE, nine of whom had structural abnormalities identified by MRI. All patients underwent noninvasive presurgical evaluation and then stereoelectroencephalography (SEEG). We performed an original metabolic exploration combining two 1H‐MRS imaging acquisitions associated with two single‐voxel acquisitions (temporal poles) to map the most informative regions of interest (ROIs) including mesial and neocortical localizations. The N‐acetyl aspartate/(choline+creatine) ratio was chosen as a metabolic index. SEEG analysis allowed the classification of each ROI as electrically normal or abnormal (i.e., involved in ictal and/or interictal discharges). Groups were compared by using a nonparametric Mann–Whitney U test.Results: N‐Acetyl aspartate/(choline+creatine) was significantly lower in all regions involved in SEEG electrophysiological epileptic abnormalities than in controls (p < 0.05). In contrast, the regions without any electrophysiological abnormalities were not metabolically different from those in controls (p > 0.05) except in one ROI. No differences between the metabolic profiles of epileptogenic and irritative zones were found. The metabolic alterations included, but also extended beyond, the lesions. The presence of metabolic abnormalities in mesial structures was not specific for the mesial subtype and generally extended outside the mesial structures.Conclusions: These results indicate that metabolic abnormalities are linked to ictal and interictal epileptiform activities rather than to structural alterations in TLE.
The Use of Stereotactic Radiosurgery to Treat Intractable Childhood Partial Epilepsy
Authors: Dunoyer Catalina , Ragheb John , Resnick Trevor , Alvarez Luis , Jayakar Prasanna , Altman Nolan , Wolf Aizik , Duchowny Michael 
Published: March 2003

Summary: Purpose:Although conventional surgery is presently used to treat seizures of temporolimbic and neocortical origin, deep‐seated lesions are often associated with morbidity. Stereotactic radiosurgery is a noninvasive procedure that effectively treats patients with vascular malformations and brain tumors, but its efficacy for epileptogenic foci is limited, especially in children.Methods:Between 1995 and 1999, four candidates who had medically uncontrolled seizures and localized seizure foci were selected for stereotactic radiosurgery, with a mean age of 9.75 years at the time of surgery (range, 4–17 years). Seizure foci were identified on the basis of ictal and interictal video‐EEG. Magnetic resonance (MR) images were obtained before and after surgery. Ictal single‐photon emission computed tomography (SPECT) was performed by using stabilized hexamethyl‐propyleneamine oxime (HMPAO; 300 microcuries/kg) with early injection after electrographic ictal onset. The clinical features of the patients are given. All radiosurgical procedures were performed with the gamma knife unit with the Leksell stereotactic frame, stereotactic MRI imaging, and the Gamma Plan workstation. Seizure outcome was scored according to Engel's classification.Results:Two patients had hypothalamic hamartoma (HH), and two had neocortical epilepsy. At mean follow‐up of 39.2 months (range, 26–69 months), two patients were seizure free, one with a HH and one with a suggestive developmental tumor in the insular cortex by MRI findings. The other patient with HH had 90% reduction of seizures. One patient with a widespread seizure focus that involved the motor strip was unimproved. The two patients with HH also exhibited markedly improved neurobehavioral status after surgery. There were no significant complications of radiosurgical therapy.Conclusions:Our findings suggest that gamma knife surgery is a potentially valuable treatment modality for children with medically intractable epilepsy due to a well‐localized seizure focus that is difficult to excise by conventional techniques or for whom they are deemed unsuitable. More widespread application in childhood epilepsy should be investigated in larger series.
Increased Bone Turnover in Prepubertal, Pubertal, and Postpubertal Patients Receiving Carbamazepine
Authors: Verrotti Alberto , Greco Rita , Latini Giuseppe , Morgese Guido , Chiarelli Francesco 
Published: March 2003

Summary:  Purpose: To study the markers of bone turnover in epilepsy patients in the different stages of the pubertal growth before and after the beginning of carbamazepine (CBZ) monotherapy.Methods: We have investigated bone turnover in 60 epilepsy patients treated with CBZ. They were stratified according to pubertal stage and compared with a control group of 60 sex‐ and age‐matched healthy children.Results: After 2 years of therapy, we found higher values of the serum markers of bone formation [bone alkaline phosphatase (bone ALP), osteocalcin (OC), carboxy‐terminal propeptide of type I procollagen (PICP), amino‐terminal propeptide of type III procollagen (PIIINP)], and of bone resorption [carboxy‐terminal telopeptide of type I collagen (ICTP) and the urinary cross‐linked N‐telopeptides of type I collagen (NTX)] in patients than in control subjects, in presence of a normal vitamin D metabolism.Conclusions: CBZ induces an increase of bone formation and of bone resorption that seems to be independent of the pubertal stage.
Quantitative Analysis of Benzodiazepine Receptor in Temporal Lobe Epilepsy: [125I]Iomazenil Autoradiographic Study of Surgically Resected Specimens
Authors: Sata Yoshimi , Matsuda Kazumi , Mihara Tadahiro , Aihara Masao , Yagi Kazuichi , Yonekura Yoshiharu 
Published: March 2003

Summary:  Purpose: To evaluate the changes of the inhibitory neurotransmitter receptor system related to epileptogenesis by measuring central benzodiazepine receptors (BZDRs) in surgically resected specimens of temporal lobe epilepsy by using [125I]iomazenil autoradiography.Methods: Surgically resected specimens were obtained from 66 temporal lobe epilepsy patients [51 with mesial temporal lobe epilepsy (MTLE) and 15 with non‐MTLE] receiving no BZDs and seven MTLE patients receiving BZDs. BZDR densities in brain sections were measured by using [125I]iomazenil autoradiography. Cell densities were measured from cresyl violet–stained sections.Results: Compared with non‐MTLE patients, non–BZD‐treated MTLE patients showed remarkable reduction of BZDR density in the pyramidal cell region of cornu ammonis (CA) 1, CA3, and CA4, and a smaller but significant reduction in CA2 and the molecular and granule cell layers of dentate gyrus (mDG). In the MTLE group, the BZDR density in the mDG correlated with that in lateral cortex. Significant correlations between BZDR density and cell density were found in all hippocampal regions. A significant difference in BZDR density/cell‐density ratio was observed in CA1 region between MTLE and non‐MTLE. BZD‐treated patients tended to have lower BZDR densities than did non–BZD‐treated patients, although the differences did not reach significance. In all MTLE cases, [123I]iomazenil singlephoton emission computed tomography (SPECT) showed decreased BZDR binding in MTL.Conclusions: In MTLE, BZDR densities decreased parallel to reduction in cell density in most hippocampal subfields, but BZDR density appeared to decrease in excess of neuron loss in CA1. [123I]Iomazenil SPECT might be useful for detecting in vivo changes of BZDR density.
Morbidity and Accidents in Patients with Epilepsy: Results of a European Cohort Study
Authors: Beghi Ettore , Cornaggia Cesare ,   the RESt‐1 Group
Published: March 2003

Summary: Purpose:To assess the risk of illnesses and accidents in patients with epilepsy and to evaluate the proportion of those risks attributable to epilepsy.Methods:Nine hundred fifty‐one referral patients with idiopathic, cryptogenic, or remote symptomatic epilepsy and 909 matched controls (relatives or friends) were followed up prospectively for 1–2 years in eight European countries (Italy, Germany, Holland, England, Portugal, Russia, Estonia, and Slovenia). Each patient and control received a diary to keep notes regarding any illness or accident. Patients with epilepsy specifically recorded relations with seizures.Results:Six hundred forty‐four patients recorded 2,491 illnesses compared with 1,665 illnesses in 508 controls. The cumulative probability of illness in patients was 49% by 12 months and 86% by 24 months (controls, 39 and 75%; p < 0.0001). One hundred ninety‐nine patients and 124 controls had 270 and 140 accidents, respectively. The cumulative probability of accident in the cases was 17 and 27% by 12 and 24 months (controls, 12 and 17%; p < 0.0001). The chance of two or more illnesses or accidents was modestly but significantly greater in the patients. Illnesses and accidents were mostly trivial. Thirty percent of illnesses and 24% of accidents were seizure related. When illnesses and accidents related to seizures were excluded, the chance of illnesses and accidents was fairly similar in the two groups.Conclusions:Patients with idiopathic, cryptogenic, or remote symptomatic epilepsy have a moderately higher risk of illnesses and accidents than do the general population. With few exceptions, the events are trivial. When seizure‐related events are excluded, patients with epilepsy are not at any significantly higher risk of illnesses and accidents.
Contribution of SISCOM Imaging in the Presurgical Evaluation of Temporal Lobe Epilepsy Related to Dysembryoplastic Neuroepithelial Tumors
Authors: Valenti M. P. , Froelich S. , Armspach J. P. , Chenard M. P. , Dietemann J. L. , Kerhli P. , Marescaux C. , Hirsch E. , Namer I. J. 
Published: March 2003

Summary: Purpose:Dysembryoplastic neuroepithelial tumors (DNTs) are a group of glioneuronal supratentorial and intracortical lesions often associated with the early onset of intractable and crippling partial seizures. They are characterized by their location, multinodular architecture, and heterogeneous cell composition, with a specific glioneuronal element in the specific form. Foci of cortical dysplasia may be associated with the tumoral lesion, and identifying the presence and the extent of cortical dysplasia is not always easy on magnetic resonance images (MRIs). The purpose of this article is to evaluate, retrospectively, the usefulness of ictal single‐photon emission computed tomography (SPECT) imaging to assess the presence and the extent of cortical dysplasia associated with DNTs in nine patients with intractable temporal lobe epilepsy related to histopathologically confirmed DNTs.Methods:The results of the subtraction of ictal and interictal SPECT coregistered to MRI (SISCOM) were compared with the results of the examinations of pathological material after surgery.Results:SISCOM showed a strongly hyperperfused area corresponding anatomically to electroclinical abnormalities and to the location of DNTs on MRI. A circumscribed hyperperfusion was present in DNTs without cortical dysplasia, limited to the location of the tumor on MRI. In cases of associated cortical dysplasia, a widespread hyperperfusion including areas corresponding to normal perilesional regions on MRI was found.Conclusions:SISCOM, used among presurgical investigations, contributes to detecting cortical dysplasia associated with DNTs. Concordance between the symptomatogenic zone (defined from the medical history and electroclinical data), MRI scans, SISCOM pattern, and complete resection of the epileptic zone was predictive of a good postsurgical outcome.
Recurrent Seizures and Behavior Problems in Children with First Recognized Seizures: A Prospective Study
Authors: Austin Joan K. , Dunn David W. , Caffrey Helena M. , Perkins Susan M. , Harezlak Jaroslaw , Rose Douglas F. 
Published: March 2003

Summary:  Purpose: Children with epilepsy have high rates of behavior problems. The purpose was to describe prospectively the association of seizures and behavior problems in children with new‐onset seizures.Methods: Subjects were 224 children with new‐onset seizures (aged 4–14 years) and 159 siblings (4–18 years). Caregiver's ratings of the behavior were collected 4 times: at baseline, and at 6, 12, and 24 months. During the 2‐year period, 163 (73%) children had at least one additional seizure, and 61 (27%) had none. Data were analyzed by using repeated measures analysis of variance both with and without covariates [site, age, gender, race, caregiver education (years), and seizure medications].Results: On average, children had higher CBCL Total and Internalizing Behavior Problems scores across all times when experiencing recurrent seizures than when not experiencing recurrent seizures (Total Problems, p = 0.041, controlling for demographics and seizure medications). Siblings had significantly lower Total and Internalizing Problems scores than both children experiencing (Total Problems adjusting for covariates, p = 0.0001) and not experiencing recurrent seizures (p = 0.0004). Externalizing Problems scores were not significantly different among children with recurring seizures, children without recurring seizures, and siblings.Conclusions: Recurrent seizures significantly predicted behavior problems very early in the course of a seizure condition, even when key child, demographic, and seizure variables were controlled. Explanations for these findings include the possibilities that both seizures and behavior problems are caused by an underlying neurological disorder, that seizures per se disrupt behavior, or that children have negative psychological responses to seizure activity.
Cognitive Skills in Children with Intractable Epilepsy: Comparison of Surgical and Nonsurgical Candidates
Authors: Smith Mary Lou , Elliott Irene M. , Lach Lucyna 
Published: March 2003

Summary:  Purpose: To compare neuropsychological performance of two groups of children with intractable epilepsy: those who are surgical candidates, and those who are not.Methods: Intelligence, verbal memory, visual memory, academic skills, and sustained attention were measured in children aged 6–18 years. The effects of number of antiepileptic drugs (AEDs), seizure frequency, age at seizure onset, and duration of seizure disorder were examined.Results: Both groups had high rates of impairment. Group differences were found only on the verbal memory task. Children who experienced seizures in clusters had higher IQ, reading comprehension, and arithmetic scores. Age at seizure onset and proportion of life with seizures were related to IQ. Performance did not vary with AED monotherapy versus polytherapy.Conclusions: Few differences exist in cognitive performance between children with intractable seizures who are and those who are not surgical candidates. These findings suggest that children who are not surgical candidates can serve as good controls in studies on cognitive outcome of surgery.
Public Awareness, Attitude, and Understanding of Epilepsy in Hong Kong Special Administrative Region, China
Authors: Fong Chung‐yan Gardian , Hung Anchor 
Published: March 2003

Summary:  Purpose: Because of the nature of the epileptic seizure, the social stigma attached to epilepsy is a major handicap to persons with epilepsy compared with the disability associated with seizures or the side effects from medications. Measuring the awareness, attitude, and understanding of epilepsy is the first step in alleviating discrimination.Methods: We conducted a face‐to‐face questionnaire interview survey in five different locations (HKSAR) that represented the population structure, administrative function, and occupations of inhabitants. Subjects with epilepsy or with relatives who had epilepsy were excluded.Results: We interviewed 1,128 subjects; 58.2% had heard about epilepsy before. Of these, 55% had witnessed one or more epileptic seizure, and 18.9% knew one or more persons with epilepsy; 52.7% would put an object into a patient's mouth during an epileptic seizure to prevent injury of the tongue (32.2% learned this from a local television program), and 94.1% agreed that persons with epilepsy could be married. However, only 72.5% considered pregnancy to be appropriate; 11.2% would not let their children play with others with epilepsy; 32.2% would not allow their children to marry persons with epilepsy. Employers (22.5%) would terminate the employment contract after an epileptic seizure in an employee with unreported epilepsy.Conclusions: This study documented the public attitude toward epilepsy in HKSAR; although it was more negative than that in Western societies, it was more positive than that of the Chinese in China or Taiwan. We suggest that more effort be made to improve public awareness of, attitude toward, and understanding of epilepsy through school education and epilepsy‐related organizations in HKSAR.