bluuebunny/crossref_metadata_2025_split huggingface dataset:
Involvement of Proprioceptive Feedback in Brainstem‐Triggered Convulsions
Authors: Maton Bruno , Vergnes Marguerites , Hirsch Edouard , Marescaux Christian 
Published: August 2005

Summary: Purpose: In rodents, specific motor components of generalized convulsive seizures depend on two distinct anatomic substrates: (a) forebrain networks are responsible for facial and forelimb clonus with or without rearing and falling; and (b) brainstem networks are responsible for running‐bouncing fits and tonic convulsions. To investigate the requirement of proprioceptive inputs in the generation of these two different types of seizures, we compared the effects of neuromuscular blockade by D‐tubocurarine on the EEG expression of brainstem and forebrain‐triggered seizures. Methods: Unilateral electrical stimulations were applied for 50 consecutive days in freely moving male adult rats through a bipolar electrode aimed at the dorsal hippocampus (n = S), the occipital cortex (n = 4), the inferior colliculus (n = 6), or the midbrain reticular formation (n = 6). Two days after the last stimulation, rats were paralyzed with d‐tubocurarine and stimulated in the same way. Results: In brainstem structures, the first electrical stimulation induced tonic seizures concomitant with low‐voltage cortical activity; repetition of daily stimulations progressively induced tonic‐clonic seizures associated with high‐amplitude cortical spike‐wave discharges. After immobilization by d‐tubocurarine, brainstem stimulations failed to induce any EEG paroxysm. In forebrain structures, repeated electrical stimulations produced a classic kindling with progressive occurrence of clonic seizures associated with large cortical discharges; d‐tubocurarine left unchanged the EEG pattern of these latter seizures. Conclusions: These data suggest that proprioceptive reafferentation resulting from movement is necessary for the generation of self‐sustained brainstem seizures but is not implicated in the elaboration of forebrain seizures.
Abnormal Cortical Activation During Planning of Voluntary Movement in Patients with Epilepsy with Focal Motor Seizures: Event‐Related Desynchronization Study of Electroencephalographic mu Rhythm
Authors: Derambure P. , Bourriez J. L. , Defebvre L. , Cassim F. , Josien E. , Duhamel A. , Destée A. , Guieu J. D. 
Published: August 2005

Summary: Purpose: The spatiotemporal distribution of EEG mu rhythm desynchronization was analyzed in patients with partial epilepsy to determine whether frequent focal motor seizures could induce a change of cortical activation during the planning of a voluntary movement. Methods: The event‐related desynchronization (ERD) of the mu rhythm was quantified during a self‐paced voluntary movement of the thumb. The results were compared betyeen two groups of patients with epilepsy: in one group (n = 12), the patients had frontal lobe epilepsy with frequent focal motor seizures (FMS); in the second group (n = 12), they had temporal lobe epilepsy (TLE) with complex partial seizures but no ictal movement disorder. The results were also compared with those of control subjects of same age (n = 10). Results: In the control group, desynchronization of murhythm began over the contralateral central region 2,000 ms before the movement onset. In the FMS group, the desynchronization of mu rhythm was delayed, appearing only 500 ms before the movement onset, and the amplitude of ERD was increased over the frontocentral region. In the TLE group, the spatiotemporal pattern of ERD was the same as in normal subjects, but the amplitude of ERD was increased. Conclusions: These results indicate that there is a change of reactivity of mu rhythm in patients with partial epilepsy. The change in spatiotemporal pattern of ERD in patients with frequent focal motor seizures suggests that there is an abnormal cortical activation during the planning of a voluntary movement.
Magnetic Source Imaging of Abnormal Low‐Frequency Magnetic Activity in Presurgical Evaluations of Epilepsy
Authors: Gallen C. C. , Tecoma E. , Iragui V. , Sobel D. F. , Schwartz B. J. , Bloom F. E. 
Published: August 2005

Summary: Purpose: Regional cortical dysfunction associated with epileptogenic activity was predicted from interic‐tal localized abnormal low frequency neuromagnetic activity (ALFMA) using Magnetic Source Imaging (MSI). ALFMA can be detected in patients who show no interictal spikes.Methods: A large array biomagnetometer was used in a blinded, rapid screening protocol. The MSI procedure required no alteration in epileptic medications. MSI results were compared with the presumed epileptogenic region as determined by a consensus of standard techniques, which included MR and electroclinical monitoring.Results: One or more sites of localized abnormality were detected by MSI ALFMA in 29 of the 33 epileptic patients. ALFMA mapped with MSI showed a 48.5% specificity with respect to the presumed epileptogenic region. MSI ALFMA was in agreement with the final consensus as often as was ictal noninvasive video EEG monitoring, and was exceeded in specificity overall only by invasive ictal video EEG monitoring, which was required for conventional localization in 21 of the 33 patients tested with MSI.Conclusions: ALFMA measurements with MSI may augment the array of noninvasive methods used for reaching a consensus for epilepsy surgery.
Is Partial Epilepsy Progressive? Ten‐Year Follow‐Up of EEG and Neuropsychological Changes in Adults with Partial Seizures
Authors: Holmes Mark D. , Dodrill Carl B. , Wilkus Robert J. , Ojemann Linda M. , Ojemann George A. 
Published: August 2005

Summary: Purpose: This study was undertaken to determine what changes, if any, occur in the electroencephalogram (EEG) and in neuropsychological test findings of adults with medically intractable complex partial epilepsy over a 10‐year period. Methods: We studied 35 adults, with a mean age of 32 years (range, 16–59 years) at time of initial testing. We compared the distribution of epileptiform patterns documented on the initial pair of waking and sleeping EEGs to those observed on another pair obtained 10 years later. During this same 10‐year period, we also examined changes in the Wechsler Adult Intelligence Scale (WAIS) and on the tests from the Neuropsychological Battery for Epilepsy. Results: The EEGs of 28 (80%) of patients at the tenth year were identical to those seen initially. Five (14%) of patients demonstrated EEGs after 10 years with either no discharges or only unilateral discharges, where bilateral discharges were seen a decade earlier. Only two (6%) of patients had EEGs at the tenth year that showed bilateral discharges where only unilateral discharges were seen originally. We found no general change in intelligence or neuropsychological functioning after 10 years, although a few subtle losses were noted on several neuropsychological measures. Conclusions: For most adults with medically intractable complex partial epilepsy, the EEG and neuropsychological test scores remain reasonably stable over a decade.
Conversion to High Dose Gabapentin Monotherapy in Patients with Medically Refractory Partial Epilepsy
Authors: Beydoun A. , Fakhoury T. , Nasreddine W. , Abou‐Khalil B. 
Published: August 2005

Summary: Purpose: To evaluate the safety and efficacy of high dose gabapentin (GBP) monotherapy (3,0004,800 mg/ day) in patients with medically refractory partial epilepsy. Methods: GBP monotherapy at daily doses up to 4,800 mg was attempted in patients participating in the open‐label phase of a double‐blind, dose‐controlled, GBP monotherapy trial. For those who achieved monotherapy, the types and severity of adverse events were assessed and the average seizure frequency per 28 days while maintained on the highest daily GBP dose was compared to the seizure frequency during the baseline phase of the double blind trial. Correlation analysis between GBP serum level, total daily dose, and percentage of seizure change from baseline was performed. Results: A total of 45 patients participated in the open‐label phase of the trial and 23 (51%) were converted successfully to GBP monotherapy. In those patients, the average daily gabapentin dose was 3,900 mg and the mean length of follow‐up was 252 days. Compared to baseline, there was a mean reduction of 54%, 43%, and 14% for simple partial, complex partial and secondarily generalized seizures respectively, while maintained on high‐dose GBP monotherapy. A significant linear correlation between daily GBP dosage (2,4004,800 mg) and resultant mean serum levels was found (r = 0.51; p < 0.01). There was no significant correlation between seizure frequency and total daily GBP dose or with serum levels. High‐dose GBP monotherapy was well tolerated; only one patient exited the trial because of adverse events. The most common adverse event was tiredness/sleepiness and was not dose‐related. Conclusions: GBP monotherapy is well tolerated in daily doses of up to 4,800 mg and is effective in a subgroup of patients with medically refractory partial epilepsy.
Rapid Switchover to Carbamazepine Using Pharmacokinetic Parameters
Authors: Kanner Andres M. , Bourgeois Blaise F. D. , Hasegawa Hisanori , Hutson Paul 
Published: August 2005

Summary: Purpose: The standard practice of switching patients to carbamazepine (CBZ) involves initiating a low dose and raising it by small increments until the desired dose is reached, to avoid intolerable adverse effects (AE). In a pilot study, a protocol using single‐dose kinetic studies was developed to switch patients to CBZ through rapid‐dose increments and to manage concurrent rapid taper of the previous antiepileptic drugs (AEDs) without causing AE. The purpose of this prospective study was (a) to reassess whether a rapid switchover to CBZ could be done with minimal or no AE and without causing an increase in seizures; (b) to determine whether the maintenance dose of CBZ predicted at the time of the singledose kinetic study can yield the desired concentration at steady state (Css); and (c) to determine the degree to which the calculated maintenance dose of CBZ will need to be adjusted after the previous AED has been discontinued for a four‐week period. Methods: Twenty‐five patients taking phenytoin (PHT) and/ or phenobarbital (PB) andor primidone (PRM) underwent a rapid switchover to CBZ following a 10 mg/kg single‐dose kinetic study (day 1) which allowed calculation of a maintenance dose necessary to yield a mean Css of 10.2 (±2.2) mgA. On day 2, patients received a CBZ dose equivalent to 10 mgkg + 200 mg; thereafter, they underwent daily dose increments of 200 mg until the calculated maintenance dose was reached. Dose increments were modified in the case of AE. Concurrent tapering of the previous AED was started as of day 1: PHT by 100 mg/day, while PB and PRM were stopped on day 1: PB was restarted before patients were to be discharged from the hospital if a PB serum concentration above 10 mgA was identified at that time. Pharmacokinetic data and occurrence of AE were compared between the two groups at the time of the single‐dose kinetic study, at the completion of the switchover to CBZ, and 4 weeks after discontinuation of the previous AED. Results: All patients completed the switchover to CBZ within a mean time period of 6 days (±2), reaching a mean maintenance dose of 1, 639 mg/day (±370) which yielded a mean CSS of 11.3 (±3.2) mg/l. The maintenance dose had to be lowered by 20.4% (±8.3) in 59% of patients within the four‐week period following discontinuation of at least one of the previous AEDs. None of the patients experienced an increase in seizure frequency relative to baseline. Fifteen (60%) patients had no AE; five (20%) experienced AE of mild severity. AE rated as moderately severe (n = 4) or severe (n = 1) occurred in patients with a static encephalopathy (p = 0.02, Fisher's exact test) and among patients 2–55 years (p = 0.017, Fisher's exact test). Conclusions: A rapid switch‐over to CBZ from PHT, PB, or PRM can be carried out safely with no, or minimal, AE in young adults, unless they suffer from static encephalopathy.
Intracranial EEG Seizure‐Offset Termination Patterns: Relation to Outcome of Epilepsy Surgery in Temporal Lobe Epilepsy
Authors: Brekelmans Geert J. F. , Velis Demetrios N. , van Veelen Cees W. M. , van Rijen Peter C. , Lopes da Silva Fernando H. , van Emde Boas Walter 
Published: August 2005

Summary: Purpose: Studies using stereo‐EEG (SEEG) and electrocorticography (ECoG) should not only identify a patient's epileptogenic zone, but also should provide prognostic information for surgical outcome. In this respect, seizure‐offset patterns have so far been the subject of only one study, in which they were shown to be associated with poor outcome when recorded over cortical areas outside the temporal lobe of seizure onset. To clarify whether seizure‐offset patterns are reliable in predicting seizure outcome, we studied SEEG/ECoG in a similar group of patients with temporal lobe epilepsy (TLE). Methods: SEEGECoG records of 44 patients with refractory TLE were analyzed. The areas of seizure termination were classified as ipsilateral or contralateral (mesial and/or lateral) temporal, (temporal and) frontal, and diffusehilateral. Patients were classified with respect to seizure outcome as either seizure‐free (UCLA class la) or not seizure free (UCLA class 2–4); both groups were correlated with specific seizure‐offset categories using Fisher's exact probability test and analysis of variance (ANOVA). Results: Of the 44 patients, the majority (n = 36) had at least part of their seizure offsets in the ipsilateral temporal lobe, whereas 8 patients manifested no seizure offsets in this lobe. Only 9 patients (20%) showed exclusive offsets in the ipsilateral temporal lobe. No statistically significant difference was evident between patients with all seizure offsets in the ipsilateral temporal lobe and those with offsets elsewhere. Similarly, no statistically significant difference was evident between patients with a diffuse seizure offset and those with seizure offsets of a different category. Conclusions: Seizure‐offset patterns in SEEGECoG are unreliable in predicting seizure outcome after resective activity surgery for TLE.
Brain Distortions in Patients with Primarily Generalized Tonic‐Clonic Seizures
Authors: Savic Ivanka , Seitz Rudiger J. , Pauli Stefan 
Published: August 2005

Summary: Purpose: A precondition for the diagnosis of primarily generalized epilepsy with tonic‐clonic seizures (GTCS) is absence of brain pathology. This definition, based on normal findings on computed tomography (CT) and magnetic resonance imaging (MRI) is challenged however, by observation of microscopic migrational disturbances in patients with GTCS. In the present study, we examined whether hitherto undiscovered gross manifestations of the reported migrational disturbances may be detected by analysis of CT and MRI scans with a computerized anatomic brain atlas. Methods: The atlas program permitted group comparisons of size, intrinsic proportion, and shape of the brain. Healthy men (n = 20), patients with partial seizures (n = 8), secondarily generalized partial seizures (n = 8), and patients with GTCS (n = 10) were studied. The contours of the brain of the computerized atlas were first transformed and adjusted to the contours, central structures, and ventricles of each subject's MRI scans. During this process, the specific parameters for the shape, size, and proportion of the brain were determined, resulting in a set of values for each subject. These values were then applied for comparisons between the four investigated groups. Results: In relation to the controls, patients with GTCS had brains significantly flattened in the craniocaudal direction (p = 0.002), with a disproportionally small caudal part. The anterior portion of their brain was also, relatively elongated as compared with the posterior portion (p = 0.04). Similar systematic abnormalities were not observed in patients with partial epilepsy. Conclusions: The observed deformations are compatible with previously reported findings of Purkinje cell degeneration and frontal lobe microdysgenesis in GTCS. The study suggests a new approach to identify effects of morphologic abnormalities in the brain when results of conventional structural neuroimaging are normal.
Regional Distribution of Interictal 31P Metabolic Changes in Patients with Temporal Lobe Epilepsy
Authors: van der Grond Jeroen , Gerson Jack R. , Laxer Kenneth D. , Hugg James W. , Matson Gerald B. , Weiner Michael W. 
Published: August 2005

Summary: Purpose: We compared the 31P metabolites in different brain regions of patients with temporal lobe epilepsy (TLE) with those from controls. Methods: Ten control subjects and 11 patients with TLE were investigated with magnetic resonance imaging (MRI) and [31P]MR spectroscopic imaging (MRSI). [31P]MR spectra were selected from a variety of brain regions inside and outside the temporal lobe. Results: There were no asymmetries of inorganic phosphate (Pi), pH, or phosphomonoesters (PME) between regions in the left and right hemispheres of controls. In patients with TLE, Pi and pH were higher and PME was lower throughout the entire ipsilateral temporal lobe as compared with the contralateral side and there were no significant asymmetries outside the temporal lobe. The degree of ipsilateral/contralateral asymmetry for all three metabolites was substantially greater for the temporal lobe than for the frontal, occipital, and parietal lobes, and these asymmetries provided additional data for seizure localization. As compared with levels in controls, Pi and pH were increased and PME were decreased on the ipsilateral side in patients with TLE. There were changes in Pi, pH, and PME on the contralateral side in persons with epilepsy as compared with controls, contrary to changes on the ipsilateral side. Conclusions: Our findings provide some insight into the metabolic changes that occur in TLE and may prove useful adjuncts for seizure focus lateralization or localization.
Postictal Nosewiping Lateralizes and Localizes to the Ipsilateral Temporal Lobe
Authors: Hirsch Lawrence J. , Lain Aurelio H. , Walczak Thaddeus S. 
Published: August 2005

Summary: Purpose: We observed many patients with temporal lobe epilepsy (TLE) wiping their nose postictally, usually with the hand ipsilateral to their seizure focus. We wished to determine if this had lateralizing or localizing significance. Methods: We retrospectively studied 87 patients: 47 with unilateral TLE defined by successful surgical outcome [30 with medial TLE (MTLE) and 17 with neocortical TLE (neoTLE)]; and 40 with extratemporal epilepsy (ExTLE). Videotapes of 319 complex partial seizures (CPS) without generalization were reviewed by 1 neurologist, blinded to patient identity, who recorded each episode of nosewiping and the hand with which it was performed. Results: With regard to localizing potential, postictal nosewiping (PINW) was significantly more common in patients with unilateral TLE than in those with ExTLE. In the TLE group, PINW within 60 s of electrographic seizure offset occurred in 60% of patients (28 of 47) and 43% of seizures (74 of 171). In the ExTLE group, PINW was noted in 33% of patients (13 of 40; p < O.05 as compared with TLE) and 15% of seizures (22 of 148; p < O.001). Similar results were obtained with PINW within 30 s of seizure offset. Although PINW was more frequent in MTLE than in neoTLE (67% of patients vs. 47%), this finding did not reach significance. With regard to lateralizing potential, in the TLE group, unilateral PINW (performed with a single hand only) within 60 s of seizure offset was observed in 53% of patients (25 of 47) and was performed with the hand ipsilateral to the seizure focus in 92% (23 of 25). Thirteen patients (9 with TLE) wiped their nose more than once with the same hand in a single seizure within 60 s of offset in 18 seizures; this was done with the hand ipsilateral to the seizure focus in all 18 instances (predictive value = 100%). Conclusions: PINW is more common in unilateral TLE, particularly MTLE, than in ExTLE. PINW performed exclusively with one hand occurs in ∼50% of patients with TLE and is highly predictive (92%) of seizure onset ipsilateral to the hand used, especially when it occurs repetitively. We hypothesize that ictal activation of the central autonomic nervous system, particularly the amygdala, results in ictal nasal secretions and causes nosewiping as the patient regains awareness postictally. The ipsilateral hand is used due to contralateral neglect or weakness.
Carbamazepine Effects on Na+ Currents in Human Dentate Granule Cells from Epileptogenic Tissue
Authors: Reckziegel G. , Beck H. , Schramm J. , Urban B. W. , Elger C. E. 
Published: August 2005

Summary: Purpose: Carbamazepine (CBZ) is a well‐established drug in the therapy of temporal lobe epilepsy (TLE). The anticonvulsant action of CBZ has been explained mainly by use‐dependent effects on voltage‐dependent Na+ channels in various nonhuman cell types. However, it is unclear whether Na+ currents in neurons within the focal epileptogenic area of patients with medically intractable TLE show similar characteristics. Methods: Therefore we used the whole‐cell patch‐clamp technique to investigate the effects of CBZ on voltage‐dependent Na+ currents in 23 acutely isolated dentate granule cells (DGCs) from the resected hippocampus of eight patients with medically intractable TLE. Results: As in findings in animal preparations, CBZ significantly reduced the amplitude of the Na+ current and significantly shifted the current‐voltage dependence of the steady‐state inactivation in the hyperpolarizing direction. In contrast, the rapid component of the recovery from inactivation of the Na+ currents was not affected by CBZ. In addition, the reduction of the Na+ current amplitude observed during repetitive stimulation with depolarizing pulses was not significantly altered by CBZ. Conclusions: In summary, CBZ strongly affects the voltage‐dependent steady‐state inactivation, with no effects on the removal of inactivation in Na+ currents of human DGCs. In spite of the lack of suitable control material, the CBZ insensitivity of the removal of inactivation may be an interesting concept to explain the medically intractable TLE in these patients.
Epilepsy Awareness Among School Teachers in Thailand
Authors: Kankirawatana Pongkiat 
Published: August 2005

Summary: Purpose: Epilepsy is one of the most common neurologic disorders of childhood. However, in Thailand, as well as in most of other developing countries, little attention has been paid to improve the public knowledge regarding epilepsy. Currently public attitude toward epilepsy is rather negative, full of prejudices and bias. Children with epilepsy in Thailand still find themselves confronted with social barriers that prevent them from academic achievements, in addition to the limitation that the disease itself has already placed on them. To delineate the magnitude and scope of this problem, we performed a small pilot study to assess the knowledge, attitude, and practice of epilepsy in the schoolteachers in Thailand whose major impact on the children is manifested by attitudes and learning. Methods: The study was conducted by sending simple self‐administered questionnaires to 360 schools all over Thailand. The questionnaires contained 14 questions relating to epilepsy awareness, attitudes, and first‐aid management of seizures. Results: We found that 38% of respondents had not heard of or read about epilepsy, and 46.6% believed that epilepsy is a chronic incurable disease. Fifteen percent of the respondents preferred to place all children with epilepsy in a special classroom. Furthermore, half of the respondents who had experience with first‐aid management of seizures used improper and potentially harmful measures. Conclusions: Besides the proper management of epilepsy, a general public education campaign for epilepsy and the need to address and correct the existing biases are necessary to improve the quality of life of children with epilepsy in Thailand.