bluuebunny/crossref_metadata_2025_split huggingface dataset:
Interrater Reliability among Epilepsy Centers: Multicenter Study of Epilepsy Surgery
Authors: Haut Sheryl R. , Berg Anne T. , Shinnar Shlomo , Cohen Hillel W. , Bazil Carl W. , Sperling Michael R. , Langfitt John T. , Pacia Steven V. , Walczak Thaddeus S. , Spencer Susan S. 
Published: March 2003

Summary:  Purpose: To measure the interrater reliability of presurgical testing and surgical decisions among epilepsy centers.Methods: Seven centers participating in an ongoing, prospective multicenter study of resective epilepsy surgery agreed to conform to a detailed protocol regarding presurgical evaluation and surgery. To assess quality assurance, each center independently reviewed 21 randomly selected surgical cases for preoperative study lateralization and localization, and surgical decisions. Interrater reliability was assessed by using intraclass correlation coefficients (ICCs), validated for use with multiple raters, and calculated in a two‐way random model based on absolute agreement.Results: Agreement for ICC values: ≥0.75, excellent; 0.60–0.74, good; 0.40–0.59, fair; ≤0.39, poor. One center was excluded for missing data. Agreement was excellent for extracranial EEG lateralization (0.8039), magnetic resonance imaging (MRI) lateralization (0.9521) and localization (0.9130), Wada lateralization (0.9453), and intracranial EEG localization (0.7905). Agreement was good for extracranial EEG localization (0.7384) and neuropsychological testing lateralization (0.7178) and localization (0.6891). Consensus about the decision to perform intracranial monitoring was fair (0.5397), in part reflecting one center's tendency toward intracranial monitoring. Overall agreements on whether to perform surgery (0.8311) and specific surgery recommended (0.8164) were excellent.Conclusions: High interrater reliability among six epilepsy centers was present for interpretation of most components of presurgical testing. Although consensus for the decision to perform intracranial monitoring was only fair, agreements for the ultimate decision about resective surgery and specific choice of resection were excellent. We believe that this study demonstrates the feasibility of implementing multicenter protocols for neurologic management, especially those involving localization, as well as protocols combining study results with clinical decision making.
Psychoses and Epilepsy: Are Interictal and Postictal Psychoses Distinct Clinical Entities?
Authors: Adachi Naoto , Matsuura Masato , Hara Tsunekatsu , Oana Yasunori , Okubo Yoshiro , Kato Masaaki , Onuma Teiichi 
Published: March 2003

Summary:  Purpose: To evaluate further the relevance of designating psychotic episodes as either postictal or interictal, we compared several biologic variables between epilepsy patients with and without psychosis.Methods: The study subjects comprised 282 patients with psychosis (36 with postictal psychosis, 224 with interictal psychosis, and 22 with both postictal and interictal psychoses, i.e., bimodal psychosis), and 658 epilepsy patients without psychosis. The clinical characteristics of these patients were reviewed retrospectively by experienced neuropsychiatrists. Factors predicting the development of each type of psychosis were determined by serial multivariate logistic regression analyses.Results: Factors that were comparable between postictal and interictal psychoses were intellectual function, family history of psychosis, epilepsy type, and the presence of complex partial seizures. In contrast, age at the onset of epilepsy and at the onset of psychosis and the presence of generalized tonic–clonic seizures differed for the three types of psychosis. Patients with bimodal psychosis showed characteristics associated with both postictal and interictal psychoses.Conclusions: This study documented conditions, including both general factors and epilepsy‐related factors, common to epilepsy patients with psychosis, regardless of chronologic distinctions. Certain epileptic processes appear to have equal influence on postictal and interictal psychoses. However, some differences between postictal and interictal psychoses suggest that these chronologic descriptors are valid. Our findings confirmed that psychosis associated with epilepsy should not be defined as a single, simple condition but rather as a complex condition with several possible subcategories.
Do Nonspecific Focal EEG Slowing and Epileptiform Abnormalities Favor One Hemisphere?
Authors: Doherty Michael J. , Walting Paul J. , Morita Denise C. , Peterson Rich A. , Miller John W. , Holmes Mark D. , Watson Nathaniel F. 
Published: March 2003

Summary:  Purpose: Several EEG‐based studies suggest that epileptiform activity originates from the left more than the right hemisphere. In contrast, other pathophysiologies such as stroke lateralize relatively symmetrically. Study of focal slowing and other EEG abnormalities allows assessment of favoring as well as referral and interpretation bias.Methods: The 1,331 consecutive adult EEG reports were reviewed for epileptiform discharges (EDs) and nonepileptiform focal slowing. Side of slowing or EDs, interpreting electoencephalographer, and whether the patient was undergoing long‐term monitoring or routine EEG were tallied. Results were statistically analyzed.Results: Focal slowing occurred symmetrically; EDs favored the left hemisphere (p < 0.01).Conclusions: The left hemisphere may be more prone to epileptiform abnormalities in adults, but not to the nonspecific pathophysiologic processes that cause slowing. These findings suggest that potential interpretation bias does not influence left hemispheric favoring of EDs and instead may implicate a biologic etiology.
Video‐EEG Monitoring in the Elderly: A Review of 94 Patients
Authors: McBride Alexandra E. , Shih Tina T. , Hirsch Lawrence J. 
Published: March 2003

Summary:  Purpose: We sought to determine the utility and results of video‐EEG monitoring in elderly patients. There is an increased incidence of epilepsy in the elderly population. Few studies have assessed the characteristics of epileptic and nonepileptic seizures in this age group. Diagnostic evaluation with video‐EEG monitoring is a means to distinguish these different types of events.Methods: The authors reviewed all patients aged 60 years and older who were admitted to the epilepsy monitoring unit at Columbia–Presbyterian Medical Center from January 21, 1991, to April 12, 1999.Results: A total of 94 patients and 99 patient admissions were identified, accounting for 8% of all admissions. The average age was 70 years, and the mean length of stay was 3.8 days. Typical events were recorded in 75 of the 99 patient admissions. A total of 118 seizures was recorded in 46 patients, and 98 nonepileptic events were seen in 27 patients. Of the patients with nonepileptic events, 13 had psychogenic seizures. The majority of patients with nonepileptic events were taking antiepileptic medication. Whereas 76% of the patients with epileptic events had interictal epileptiform discharges, 26% of the patients with nonepileptic events had epileptiform discharges as well.Conclusions: Video‐EEG monitoring in the elderly leads to a definitive diagnosis in the majority of patients in a relatively short time. Interictal recordings are inadequate in determining the nature of paroxysmal events. Nonepileptic events are common in the elderly, including psychogenic seizures, and these are often misdiagnosed and mistreated as epileptic seizures.
Treatment of Refractory Status Epilepticus with Pentobarbital, Propofol, or Midazolam: A Systematic Review
Authors: Claassen Jan , Hirsch Lawrence J. , Emerson Ronald G. , Mayer Stephan A. 
Published: March 2003

Summary:  Background: New continuous infusion antiepileptic drugs (cIV‐AEDs) offer alternatives to pentobarbital for the treatment of refractory status epilepticus (RSE). However, no prospective randomized studies have evaluated the treatment of RSE. This systematic review compares the efficacy of midazolam (MDL), propofol (PRO), and pentobarbital (PTB) for terminating seizures and improving outcome in RSE patients.Methods: We performed a literature search of studies describing the use of MDL, PRO, or PTB for the treatment of RSE published between January 1970 and September 2001, by using MEDLINE, OVID, and manually searched bibliographies. We included peer‐reviewed studies of adult patients with SE refractory to at least two standard AEDs. Main outcome measures were the frequency of immediate treatment failure (clinical or electrographic seizures occurring 1 to 6 h after starting cIV‐AED therapy) and mortality according to choice of agent and titration goal (cIV‐AED titration to “seizure suppression” versus “EEG background suppression”).Results: Twenty‐eight studies describing a total of 193 patients fulfilled our selection criteria: MDL (n = 54), PRO (n = 33), and PTB (n = 106). Forty‐eight percent of patients died, and mortality was not significantly associated with the choice of agent or titration goal. PTB was usually titrated to EEG background suppression by using intermittent EEG monitoring, whereas MDL and PRO were more often titrated to seizure suppression with continuous EEG monitoring. Compared with treatment with MDL or PRO, PTB treatment was associated with a lower frequency of short‐term treatment failure (8 vs. 23%; p < 0.01), breakthrough seizures (12 vs. 42%; p < 0.001), and changes to a different cIV‐AED (3 vs. 21%; p < 0.001), and a higher frequency of hypotension (systolic blood pressure <100 mm Hg; 77 vs. 34%; p < 0.001). Compared with seizure suppression (n = 59), titration of treatment to EEG background suppression (n = 87) was associated with a lower frequency of breakthrough seizures (4 vs. 53%; p < 0.001) and a higher frequency of hypotension (76 vs. 29%; p < 0.001).Conclusions: Despite the inherent limitations of a systematic review, our results suggest that treatment with PTB, or any cIV‐AED infusion to attain EEG background suppression, may be more effective than other strategies for treating RSE. However, these interventions also were associated with an increased frequency of hypotension, and no effect on mortality was seen. A prospective randomized trial comparing different agents and titration goals for RSE with obligatory continuous EEG monitoring is needed.
Temporal Lobe Epilepsy Surgery: Outcome, Complications, and Late Mortality Rate in 215 Patients
Authors: Salanova V. , Markand O. , Worth R. 
Published: March 2003

Summary:  Purpose: We studied the surgical outcome, complications, and the late mortality rate in a large group of patients with medically refractory temporal lobe epilepsy (TLE).Methods: Two‐hundred fifteen patients with TLE were treated surgically between 1984 and 1999 after a comprehensive presurgical evaluation. Patients were followed up at 6 weeks, 3–6 months, and yearly thereafter. In addition, questionnaires were sent on the anniversary of their surgery. Surgical outcome (Engel's classification), complication rate, and factors contributing to late mortality were analyzed. Standardized mortality ratios (SMRs) were calculated.Results: There was no surgical mortality. Two (0.9%) had mild hemiparesis, one (0.4%) had a hemianopia, seven (3.2%) had transient cranial nerve palsies, and eight (3.7%) had transient postoperative language difficulties. One hundred forty‐eight (69%) became seizure free, 43 (20%) had rare seizures, 14 (6.5%) had worthwhile seizure reduction, and 10 (4.6%) had no improvement (follow‐up, 1–15 years). Three (2%) of 148 seizure‐free patients died during follow‐up, compared with eight (11.9%) of 67 not seizure‐free patients. The mean duration of epilepsy before surgery for the surviving patients was 17.8 years, and for those patients who died, 25.9 years (p < 0.05). Six (5.7%) of 104 patients with right‐sided resections died during follow‐up, compared with five (4.5%) of 111 with left‐sided resections.Conclusions: Eighty‐nine percent of patients became seizure free or had rare seizures, with low morbidity, and no surgical mortality. The late mortality occurred predominantly in patients with persistent seizures (SMR, 7.4). Those patients who died had a longer duration of epilepsy before surgery. In contrast, among those patients who became seizure free, the mortality rate was much lower, and similar to the general population of Indiana (SMR, 1.7).
Mild Generalized Epilepsy and Developmental Disorder Associated with Large Inv Dup(15)
Authors: Chifari Rosanna , Guerrini Renzo , Pierluigi Mauro , Cavani Simona , Sgrò Vincenzo , Elia Maurizio , Canger Raffaele , Canevini Maria Paola 
Published: March 2003

Summary:  Purpose: Several studies attempted to clarify the genotype–phenotype correlations in patients with inverted duplication of chromosome 15 [inv dup(15)], which is usually characterized by severe mental retardation and epilepsy in individuals with large duplications including the Prader–Willi/Angelman region. We report two patients with inv dup(15) who, in spite of a large duplication, had a mild phenotype including adult‐onset epilepsy. This report may help to define the milder spectrum of the syndrome.Methods: A 25‐year‐old girl with mild mental retardation had a 6‐year history of absence seizures, with occasional head drop. Interictal EEG revealed diffuse spike–wave complexes. Epilepsy was well controlled by a combination of lamotrigine (LTG) and valproate (VPA). The other patient, a 27‐year‐old man with mild mental retardation, had a 5‐year history of rare generalized tonic–clonic seizure during sleep, and frequent episodes of unresponsiveness, which appeared to be atypical absence seizures on video‐EEG recordings. A combination of VPA and LTG led to a remarkable improvement, although no complete control.Results: Molecular analysis revealed a large inv dup15 in both patients.Conclusions: The discrepancy between the mild phenotype and the severe chromosomal abnormality detected in these two patients further supports the notion that the site of breakpoint might be contributory to the inv dup(15) phenotype. Inv dup(15) should be considered in atypical cases of generalized epilepsy of adult onset without clear‐cut etiology.
Anticonvulsant Actions of Lamotrigine on Spontaneous Thalamocortical Rhythms
Authors: Gibbs John W. , Zhang Yun‐Fu , Ahmed Hasan S. , Coulter Douglas A. 
Published: March 2003

Summary:  Purpose: This study examined the actions of lamotrigine (LTG) on epileptiform discharges resembling generalized absence (GA) and primary generalized tonic–clonic (GTC) seizures in rat thalamocortical (TC) brain slices and attempted to characterize further the cellular mechanisms of action of LTG on neuronal ionic conductances.Methods: Rat TC slices generated spontaneous generalized epileptiform discharges after perfusion with a medium containing no added Mg2+. Using multiple channel extracellular field‐potential recordings in thalamus and cortex, the effects of LTG were characterized on two principal variants of activity that are similar to spike–wave discharges (SWDs) of GA epilepsy and GTC seizure discharges. These were termed simple TC burst complexes (sTBCs) and complex TC burst complexes (cTBCs), respectively. With whole‐cell patch‐clamp recording techniques in acutely dissociated TC neurons, the effects of LTG on GABA (γ‐aminobutyric acid)A‐receptor–mediated currents and the low‐threshold calcium current (IT) were examined.Results: In field‐potential recording studies in TC slices, both sTBCs and cTBCs were blocked by clinically relevant concentrations of LTG. In patch‐clamp recording studies, LTG was found to be ineffective in the modulation of both GABAA receptors (GABARs) and IT in TC neurons.Conclusions: The efficacy of LTG on both variants of epileptiform discharges in TC slices clearly parallels its broad human clinical spectrum of action. This demonstrates that neurons within the TC system constitute one probable therapeutic target of LTG. However, LTG did not block either GABAR‐mediated responses or IT in TC neurons. Modulation of these conductances represent likely cellular mechanisms of action of other antiepileptic drugs effective in the control of GA epilepsy. This suggests that LTG may have as yet uncharacterized effects that could combine with its previously defined sodium channel–blocking actions to explain its clinical utility in the control GA seizures.
Cardiac Dysrhythmia Associated with the Immediate Postictal State after Maximal Electroshock in Freely Moving Rat
Authors: Darbin Olivier , Casebeer Doris J. , Naritoku Dean K. 
Published: March 2003

Summary:  Purpose: Cardiac autonomic changes accompany complex partial seizures and generalized tonic–clonic seizures, and participate, at least partially, in the sudden and unexpected death in epilepsy (SUDEP). The analysis of the heart rate variability (HRV) is one of the simplest ways of providing insight into autonomic functions. The entropy quantifies the repetition of complex patterns in a signal and refers to systems randomness, regularity, and predictability. Clinical investigations have reported that entropy decreases in patients with a high risk of sudden cardiac death. The goal of this study was to evaluate the effects of the maximal electroshock (MES) on the entropy of HRV, monitored in the immediate postictal stage in the model of the freely moving rat.Methods: Entropy changes were correlated with the high and low frequencies of spectral analysis, which reflect the participation of the sympathetic and parasympathetic activities.Results: MES‐induced arrhythmia is characterized by an HRV increase, an imbalance in favor of the parasympathetic activity, and a decrease in the entropy. Entropy decrease was restricted to the duration of the arrhythmia, suggesting that the postictal arrhythmia may be associated with a higher risk of lethal cardiac complications. Nevertheless, entropy changes did not correlate with spectral changes.Conclusions: The results suggest that the imbalance demonstrated in the spectral domain explains only partially the contribution of each autonomic system in the complexity of the heart rate during the postictal state.
Focal Ictal β Discharge on Scalp EEG Predicts Excellent Outcome of Frontal Lobe Epilepsy Surgery
Authors: Worrell Gregory A. , So Elson L. , Kazemi John , O'Brien Terence J. , Mosewich Russell K. , Cascino Gregory D. , Meyer Frederic B. , Marsh W. Richard 
Published: March 2003

Summary:  Purpose: To determine whether a focal β‐frequency discharge at seizure onset on scalp EEG predicts outcome of frontal lobe epilepsy (FLE) surgery.Methods: We identified 54 consecutive patients with intractable FLE who underwent epilepsy surgery between December 1987 and December 1996. A blind review of EEGs and magnetic resonance images (MRIs) was performed. Lesional epilepsy is defined as presence of an underlying structural abnormality on MRI.Results: Overall, 28 (52%) patients were seizure free, with a mean follow‐up of 46.5 months. Presence of a focal β‐frequency discharge at seizure onset on scalp EEG predicted seizure‐free outcome in lesional (p = 0.02) and nonlesional (p = 0.01) epilepsy patients. At least 90% of patients who had either lesional or nonlesional epilepsy were seizure free if scalp EEG revealed a focal β discharge at ictal onset. Moreover, logistic regression analysis showed that focal ictal β pattern and completeness of lesion resection were independently predictive of seizure‐free outcome. Ictal onset with lateralized EEG activity of any kind and postresection electrocorticographic spikes did not predict surgical outcome (p > 0.05).Conclusions: Only about 25% of FLE surgical patients have a focal β‐frequency discharge at seizure onset on scalp EEG. However, its presence is highly predictive of excellent postsurgical seizure control in either lesional or nonlesional FLE surgical patients.
Direct Medical Costs of Refractory Epilepsy Incurred by Three Different Treatment Modalities: A Prospective Assessment
Authors: Boon P. , D'Havé M. , Van Walleghem P. , Michielsen G. , Vonck K. , Caemaert J. , De Reuck J. 
Published: March 2003

Summary:  Purpose: More than 20% of epilepsy patients have refractory seizures. Treatment options for these patients include continued polytherapy with/without novel antiepileptic drugs (AEDs), epilepsy surgery (ES), or vagus nerve stimulation (VNS). The purpose of this study was prospectively to compare epilepsy‐related direct medical costs (ERDMCs) incurred by these different treatment modalities.Methods: Eighty‐four patients underwent a complete presurgical evaluation protocol at our institution. As a result, 24 (29%) patients were treated with continued AED polytherapy only; 35 (40%) underwent ES; and 25 (30%) had VNS. In each patient, annual costs in the 2 years preceding the therapeutic decision (ERDMC‐pre) and during the follow‐up afterward (ERDMC‐post) were prospectively calculated. Furthermore, frequency of complex partial seizures with/without secondary generalization (CPS±SG), dosage and number of AEDs, number of hospital admission days, clinic visits, and laboratory tests before and after the therapeutic decision also were prospectively assessed. ERDMC‐pre and ERDMC‐post were compared in and among the three treatment groups.Results: In patients conservatively treated with AEDs, mean frequency of CPSs decreased from 12 per month to nine per month, whereas mean ERDMCs decreased from $2,525 U.S. to $2,421 U.S. In surgical patients, mean seizure frequency decreased from six to fewer than one per month; mean ERDMCs per year decreased from $1,465 U.S. preoperatively to $1,186 U.S. postoperatively. In the VNS group, mean seizure frequency decreased from 21 per month to seven per month. ERDMCs in this subgroup decreased from $4,826 U.S. to $2,496 U.S. Mean seizure frequency changes were significant when conservatively treated patients were compared with surgically treated and VNS patient groups (χ2 test, p<0.001 and p = 0.0019, respectively). ERDMC changes in conservatively treated patients also were statistically significant when compared with surgically treated and VNS patients (χ2 test, p = 0.0007 and p = 0.0036, respectively). No statistically significant differences were found in ERDMC changes between the surgical and VNS groups (χ2 test, p = 0.387).Conclusions: Ongoing daily treatment of patients who underwent resective surgery costs significantly less than conservative treatment. For patients in whom resective surgery is not an option, ERDMC show a significant decrease in VNS‐treated patients compared with conservatively treated patients.