bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence of Status Epilepticus in Adults in Germany: A Prospective, Population‐Based Study
Authors: Knake Susanne , Rosenow Felix , Vescovi Mathias , Oertel Wolfgang H. , Mueller Hans‐Helge , Wirbatz Angelika , Katsarou Niki , Hamer Hajo M. ,   for the Status Epilepticus Study Group Hessen (SESGH)
Published: March 2003

Summary:  Purpose: To determine the incidence and case‐fatality rate of status epilepticus (SE) in adults in Hessen, Germany, we performed a prospective, population‐based study from July 1997 through June 1999.Methods: All adult patients residing within the zip‐code area 35 (area‐35) with SE were included. Area‐35 had 743.285 adult inhabitants, including 123.353 adult inhabitants of the primary service area of the University Hospital Marburg (PS‐area). Patients were reported by 16 hospitals in the area and were prospectively identified and carefully reviewed within 5 days by one of the authors. Based on the crude annual incidence of SE and a rate of underascertainment of 10% determined for the PS‐area, the corrected, age‐adjusted incidence of SE in area 35, more representative of the population of Germany, was calculated.Results: The crude annual incidence in the PS‐area was 15.8/100,000 [95% confidence interval (CI), 11.2–21.6]. The calculated, corrected, age‐adjusted incidence of SE in area 35 was 17.1/100,000. It was higher for men compared with women (26.1 vs. 13.7) and for those aged 60 years and older (54.5 vs. 4.2/100,000, p < 0.0001). The etiology was mainly remote symptomatic due to cerebrovascular disease. Epilepsy was previously diagnosed in only 50% of the patients. The case‐fatality rate was 9.3%.Conclusions: Based on our data, at least 14,000 patients would be affected by SE in Germany, associated with ∼1,300 deaths annually. The incidence of SE in Germany is similar to that found in the white United States population. Furthermore, this study confirms the higher incidence of SE in male patients and in the elderly population. This may be due to a higher incidence of cerebrovascular disease in these subpopulations.
A Pharmacoepidemiologic Study of Factors Influencing the Outcome of Treatment with Lamotrigine in Chronic Epilepsy
Authors: Wong Ian C. K. , Mawer George E. , Sander Josemir W. A. S. , Lhatoo Samden D. 
Published: March 2003

Summary: Purpose:To identify prognostic factors for freedom from seizures and long‐term retention of treatment in patients receiving lamotrigine (LTG).Methods:A multicenter, retrospective, case record study of 1,050 patients with chronic epilepsy was carried out. Logistic regression and Cox regression analyses were used to identify clinical features associated with freedom from seizures and retention of treatment, respectively. Long‐term retention rates of LTG therapy were estimated using Kaplan–Meier survival analysis.Results:The 1,050 patients with chronic epilepsy were included in the study. Patients with generalized epilepsy (p = 0.01), who were not receiving carbamazepine (CBZ; p = 0.02) were more likely to become seizure‐free. Sixty percent of patients continued on LTG therapy >1 year and estimated retention at 8 years was 38%. Patients with generalized epilepsy (p = 0.002), patients receiving concurrent sodium valproate (VPA; p < 0.0001), those not previously exposed to gabapentin and vigabatrin (p < 0.0001), and those in whom the starting dose was lower (p < 0.0012), were more likely to remain on long‐term treatment with LTG. The relationships with exposure to other antiepileptic drugs remained significant in patients with focal and with generalized epilepsy when considered separately.Conclusions:The best results from LTG treatment in terms of freedom from seizures and long‐term retention of treatment were obtained in patients with generalized epilepsy. Retention of treatment was enhanced by VPA not only in generalized but also in focal epilepsy. The importance of a low starting dose of LTG was again confirmed. The apparent negative effect of CBZ in patients taking LTG merits further investigation.
Vagus Nerve Stimulation: Analysis of Device Parameters in 154 Patients during the Long‐Term XE5 Study
Authors: DeGiorgio Christopher M. , Thompson Jaye , Lewis Paul , Arrambide Stacey , Naritoku Dean , Handforth Adrian , Labar Doug , Mullin Paul , Heck Christi ,   the VNS U.S. Study Group
Published: March 2003

Summary:  Purpose: To determine the effect of changes in device settings and duty cycle (on and off times) on the efficacy of vagus nerve stimulation (VNS) for refractory epilepsy. In the long‐term XE5 study of VNS for intractable epilepsy, the median reduction in seizure frequency improved significantly after 1 year of follow‐up. A central question is whether device changes improve efficacy. We analyzed the effects of device parameter changes on seizure frequency in 154 subjects who completed the study and who had complete data for analysis.Methods: Retrospective analysis of device changes during the XE5 long‐term study of VNS. During the XE5 long‐term follow‐up study, the subject's device settings were modified within a Food and Drug Administration (FDA)‐approved range of output current, pulse duration, frequency, on time, and off time. Significant changes in device settings occurred after 3 months. We investigated the relationship between percentage reduction in seizures and changes in device parameters between the 3‐ and 12‐month visits. Within‐group comparisons were performed for those who continued on standard on/off cycle of 30 s on and 5 min off, and those with the most common off times of 3, 1.8, and <1.1 min.Results: Output current, pulse duration, frequency, and off time changed significantly between the 3‐ and 12‐month long‐term follow‐ups. For the group as a whole, changes in device settings were not correlated with an improvement in efficacy. However, a significant improvement in efficacy occurred in a subgroup whose off time was reduced to ≤1.1 min. In this group, the median reduction in seizures improved from 21% before the change in off time, to 39% after the change in off time (Wilcoxon Signed‐Rank, p = 0.011). The responder rate (>50% reduction in seizures) also significantly improved from 19 to 35% (McNemar's test, p = 0.046).Conclusions: The data from this retrospective analysis indicate that device changes were not the primary determinant of increased efficacy at 12 months of long‐term follow‐up. In general, patients who remained on the original settings of 30 s on and 5 min off continued to respond or improve in their response over the 1‐year period. However, some patients may benefit from reductions in off time (increases in duty cycle). In a subgroup initially resistant to VNS, a change in off time to ≤1.1 min off did result in significant improvements in efficacy.
Relevance of Residual Histologic and Electrocorticographic Abnormalities for Surgical Outcome in Frontal Lobe Epilepsy
Authors: Ferrier C. H. , Alarcon G. , Engelsman J. , Binnie C. D. , Koutroumanidis M. , Polkey C. E. , Janota I. , Dean A. 
Published: March 2003

Summary:  Purpose: To estimate the significance of residual electrocorticographic and neuropathologic abnormalities on seizure control after surgery for frontal lobe epilepsy with the purpose of determining their relevance in deciding the extent of the surgical procedure.Methods: The presence of epileptiform discharges in intraoperative electrocorticograms (ECoGs) and the nature and extent of neuropathologic abnormalities were reviewed for 35 patients who underwent frontal lobe resections for the treatment of epilepsy at our institution. The relations between surgical outcome and presence of the following features were studied: (a) presence of abnormal tissue at the limits of the resection; (b) presence of sporadic spikes and seizure patterns in the preresection ECoG; (c) their abolition in the postresection ECoG; and (d) the topography of residual discharges with respect to the margins of the resection.Results: On neuropathologic examination, 18 patients showed focal cortical dysplasia (CD), and 17 showed other abnormalities (non‐CD). Ten CD patients and 11 non‐CD patients experienced a favourable outcome. Seizure patterns were significantly more common in patients with focal cortical dysplasia than in those without, with a sensitivity of 94% and a specificity of 75%. Abolition of seizure patterns was associated with a favourable surgical outcome (p = 0.031). Abolition of sporadic spikes or their presence in the postresection ECoG did not influence outcome. There was no clear relation between outcome and location of residual sporadic discharges. Seizure patterns persisted in the postresection ECoG in three CD patients, were located at the margins of the resection in all three, and these patients had a poor outcome. Incomplete removal of abnormal tissue was not associated with a poorer outcome in either patient group or in the complete sample.Conclusions: Seizure patterns were significantly more common in patients with cortical dysplasia, and their abolition on postresection ECoG recordings was associated with a favourable surgical outcome. Persistence of sporadic ECoG spikes and incomplete removal of histologic abnormalities did not affect outcome significantly.
Adverse Event Monitoring in Lamotrigine Patients: A Pharmacoepidemiologic Study in the United Kingdom
Authors: Wong Ian C. K. , Mawer George E. , A .S. Sander Josemir W. 
Published: March 2003

Summary:  Purpose: This postmarketing surveillance study of lamotrigine (LTG) was performed to provide complementary data to large‐scale Prescription–Event Monitoring study with a retrospective case records survey in five tertiary referral epilepsy centres in the United Kingdom.Methods: Adverse events were recorded and compared with those of two other new antiepileptic drugs (AEDs), gabapentin (GBP) and vigabatrin (VGB). All deaths were followed up and standardised mortality ratios (SMRs) were calculated. Serious adverse events were assessed individually.Results: A total of 2,701 patients was identified as being exposed to LTG and/or the comparators. It was necessary to exclude 1,326 patients because LTG and/or comparators had been commenced outside the study centres. The adverse events with LTG reported by this study were similar to those reported in the literature. Skin rash was the major adverse event. Life‐threatening hepatic failure, acute exacerbation of ulcerative colitis, disseminated intravascular coagulation, and renal failure were reported. No death could be directly attributed to the use of LTG. The SMR was slightly higher than that reported in the literature; this probably reflects severity of epilepsy in the study population.Conclusions: The safety profile of LTG was similar to that in the large‐scale Prescription‐Event Monitoring study and generally acceptable. Life‐threatening adverse reactions were rare.
Familial Infantile Myoclonic Epilepsy: Clinical Features in a Large Kindred with Autosomal Recessive Inheritance
Authors: De Falco Fabrizio A. , Majello Luigi , Santangelo Roberto , Stabile Mariano , Bricarelli Franca Dagna , Zara Federico 
Published: March 2003

Summary: Purpose:To describe the clinical features of a large kindred with familial infantile myoclonic epilepsy (FIME) with autosomal recessive inheritance, and to discuss the nosology of the early infantile myoclonic epilepsies (IMEs).Methods:The family descends from the intermarriage of two couples of siblings. In a previous study, we mapped the genetic locus to chromosome 16p13.We analyzed results of family records and personal history, psychomotor development, neurologic examination, epilepsy features, and EEG recordings for each subject.Results:FIME has a strong penetrance (eight affected of 14 subjects) and a homogeneous clinical picture. Like the benign form of infantile myoclonic epilepsy (BIME), FIME is a true idiopathic IME with unremarkable history, no neurologic or mental impairment, good response to treatment, and normal interictal EEG pattern. Conversely, onset with generalized epileptic seizures without fever (four patients) or with fever (one patient), frequency and duration of the myoclonic seizures, occurrence of generalized tonic–clonic seizures (GTCSs) in all patients and persistence of seizures into adulthood are characteristics of the severe infantile myoclonic epilepsy (SIME).Conclusions:Clinical overlap probably exists among the myoclonic epilepsies of infancy. FIME differs from other forms of IME in its phenotypic features. The peculiar mode of inheritance is explained by the genetic background of the family. Genetic studies suggest linkage to chromosome 16 in familial cases of true IME.
Propofol and Midazolam in the Treatment of Refractory Status Epilepticus
Authors: Prasad Avinash , Worrall Bradford B. , Bertram Edward H. , Bleck Thomas P. 
Published: March 2003

Summary:  Purpose: To explore outcome differences between propofol and midazolam (MDL) therapy for refractory status epilepticus (RSE).Methods: Retrospective chart review of consecutive patients treated for RSE between 1995 and 1999.Results: We found 14 patients treated primarily with propofol and six with MDL. Propofol and MDL therapy achieved 64 and 67% complete clinical seizure suppression, and 78 and 67% electrographic seizure suppression, respectively. Overall mortality, although not statistically significant, was higher with propofol (57%) than with MDL (17%) (p = 0.16). Subgroup mortality data in propofol and MDL patients based on APACHE II (Acute Physiology and Chronic Health Evaluation) score did not show statistically significant differences except for propofol‐treated patients with APACHE II score ≥20, who had a higher mortality (p = 0.05). Reclassifying the one patient treated with both agents to the MDL group eliminated this statistically significant difference (p = 0.22).Conclusions: In our small sample of RSE patients, propofol and MDL did not differ in clinical and electrographic seizure control. Seizure control and overall survival rates, with the goal of electrographic seizure elimination or burst suppression rather than latter alone, were similar to previous reports. In RSE patients with APACHE II score ≥20, survival with MDL may be better than with propofol. A large multicenter, prospective, randomized comparison is needed to clarify these data. If comparable efficacy of these agents in seizure control is borne out, tolerance with regard to hemodynamic compromise, complications, and mortality may dictate the choice of RSE agents.
Transient Oromotor Deficits in Children with Benign Childhood Epilepsy with Central Temporal Spikes
Authors: Kramer Uri , Ben‐Zeev Bruria , Harel Shaul , Kivity Sarah 
Published: March 2003

Summary:  Purpose: To describe transient oromotor deficits in benign childhood epilepsy with centrotemporal spikes (BCECTS), an idiopathic age‐specific epileptic syndrome with a benign course.Methods: Five children with BCECTS and intermittent dysarthria and drooling not in the context of typical clinical seizures are presented.Results: The periods of oromotor deficits correlated with increased seizure frequency in all children. Concomitant EEGs that were recorded during periods of dysarthria in four of the children revealed focal electrographic seizures. The reported children did not differ from other patients with BCECTS in any other respect.Conclusions: Transient oromotor dysfunction is a rare ictal phenomenon that occurs in children with BCECTS with no other unique clinical features.
Is Amygdalohippocampectomy Really Selective in Medial Temporal Lobe Epilepsy? A Study Using Positron Emission Tomography with 18Fluorodeoxyglucose
Authors: Dupont Sophie , Croizé Anne‐Claire , Semah Franck , Hasboun Dominique , Samson Yves , Clémenceau Stéphane , Baulac Michel 
Published: March 2003

Summary:  Purpose: Selective amygdalohippocampectomy (SAH) is a surgical technique effective for the treatment of medial temporal lobe epilepsy, which selectively removes the epileptogenic hippocampus and amygdala but spares the temporal neocortex. However, the benefit of SAH in terms of functional outcome is debated. In this study, we aimed to assess the metabolic consequences of SAH.Methods: Volumetric magnetic resonance imaging (MRI) and fluorodeoxyglucose positron emission tomography (PET) studies were performed in nine patients with medial temporal lobe epilepsy associated with hippocampal sclerosis before and after SAH. Regions of interest were delineated on MRIs and then replaced on PET images using an automatic 3D image registration. We calculated absolute metabolic rates of glucose and normalized metabolic values in each region of interest.Results: The comparison between preoperative and postoperative metabolic values showed a statistically significant worsening of the hypometabolism on the ipsilateral temporal pole on the superior and the hippocampal levels (p < 0.05 and 0.0045, respectively). A postoperative increase of the metabolic activity also was noted in the contralateral anterior hippocampus (p < 0.05) and the orbitofrontal cortex bilaterally (p < 0.002 and 0.001, respectively)Conclusions: SAH functional benefit is controversial. SAH worsened significantly the hypometabolism of a temporal structure that was not surgically removed (i.e., the temporal pole), and it improved postoperatively the metabolic activity in the contralateral hippocampus and the orbitofrontal cortex. Whether this postoperative improvement is linked to the selectivity of the surgical procedure must be further clarified.
Silent Celiac Disease in Patients with Childhood Localization‐Related Epilepsies
Authors: Labate A. , Gambardella A. , Messina D. , Tammaro S. , Le Piane E. , Pirritano D. , Cosco C. , Doldo P. , Mazzei R. , Oliveri R. L. , Bosco D. , Zappia M. , Valentino P. , Aguglia U. , Quattrone A. 
Published: March 2003

Summary:  Purpose: To evaluate how many patients with a clinical picture of idiopathic childhood localization‐related epilepsies may also have silent celiac disease (CD). This will help determine whether investigation for CD should be restricted to those patients with childhood partial epilepsy with occipital paroxysms (CPEO) or should be extended to all patients with childhood partial epilepsy (CPE) regardless of seizure type and electroencephalographic (EEG) paroxysms.Methods: The study group consisted of 72 patients (31 girls and 41 boys; mean age, 12.6 ± 4.28 years; age at onset, 6.4 ± 3.7 years) who were observed consecutively over a 5‐year period and who received an initial diagnosis of idiopathic CPE. A diagnosis of CD was confirmed by using enzyme‐linked immunosorbent assay (ELISA) to assess the presence of antigliadin antibodies and the immunofluorescent undirected test to assess the presence of antiendomysium antibodies.Results: Twenty‐five patients had CPEO, whereas the remaining 47 had CPE with centrotemporal spikes (CPEC). None of the patients with CPEC had positive antibody tests. Of the 25 patients with CPEO, two (8%) had antiendomysium immunoglobulin (Ig) A antibodies. In both of these patients, the jejunal biopsy showed atrophy of the villi and hyperplasia of the crypts, consistent with a diagnosis of CD. Brain computed tomography (CT) was normal in one of these patients and revealed occipital corticosubcortical calcifications in the other.Conclusions: Our study indicates that CD screening should be performed routinely only in patients with CPEO.
An Epilepsy Questionnaire Study of Knowledge and Attitudes in Canadian College Students
Authors: Young G. Bryan , Derry Paul , Hutchinson Ingrid , John Verity , Matijevic Suzan , Parrent Lisa , Wiebe Samuel 
Published: March 2003

Summary: Purpose:Controversy exists about the relation of societal knowledge and attitudes regarding epilepsy. We conducted a survey to examine knowledge and attitudes, to note gender and occupational influences, and to examine the effect of an informational brochure.Methods:We administered a standardized questionnaire that noted demographics and examined knowledge and attitudes regarding epilepsy and persons with epilepsy, respectively, to a wide variety of Canadian college students. In a separate class we gave every other student a brochure regarding epilepsy and then administered the questionnaire to both the naïve and brochure‐exposed students.Results:Knowledge was patchy and weakest for the approximate prevalence of epilepsy in the population, hereditary epilepsy and several other etiologies, recognition of nonconvulsive seizures as a type of epilepsy, and knowledge of antiepileptic drug–induced teratogenicity. In contrast, attitudes were more uniformly favorable. However, 11 and 14%, respectively, showed negative bias against persons with epilepsy having children and equal opportunity for occupational employment. Women were slightly but significantly more tolerant than men. The brochure‐exposed group showed better knowledge but equivalent attitudes compared with the naïve group.Conclusions:Results compare favorably with surveys in other countries. Although knowledge was patchy, it could be easily improved on with an educational brochure. Attitudes were positive but show some discrepancies from knowledge and a gender effect.
Informative Value of Magnetic Resonance Imaging and EEG in the Prognosis of Infantile Spasms
Authors: Saltik Sema , Kocer Naci , Dervent Aysin 
Published: March 2003

Summary:  Purpose: To investigate the informative value of EEG and cranial magnetic resonance imaging (cMRI) in the prognosis of infantile spasms (ISs); 86 patients with ISs were included in this study.Methods: All cases had epileptic spasms, psychomotor retardation, and hypsarrhythmia in at least one of their EEGs. cMRIs and laboratory tests necessary for etiologic diagnosis were completed in all cases. Patients were followed up periodically both clinically and by video‐EEGs for >1 year. Clinical information was categorized on the basis of four spheres as epilepsy, psychosocial development, motor development, and overall clinical condition, with each category being evaluated under three levels of involvement as good, moderate, and severe, depending on selected parameters. A similar scale was applied for the EEG results and for the cMRI findings. Clinical parameters were correlated to EEG and cMRI results, by Spearman test. Other statistical tests used were Kruskal–Wallis χ2 and Mann–Whitney U analysis as multiple comparison by post hoc Bonferroni correction.Results: A severe overall clinical course was observed in 64% of patients, whereas this incidence was 58% and 44% in the EEG follow‐up and cMRI parameters, respectively. In regard to prognosis, a significant correlation was determined between the clinical and the EEG course. This relation was the most prominent in psychosocial developmental parameters and least prominent in the motor development. cMRI findings, however, were correlated only with motor development.Conclusions: cMRI and repeated EEG recordings, especially when assessed together, may provide complementary information regarding the prognosis in ISs.