bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acute Pancreatitis Coincident with Valproate Use: A Critical Review
Authors: Pellock John M. , Wilder B. J. , Deaton Roger , Sommerville Kenneth W. 
Published: March 2003

Summary:  Purpose: Acute pancreatitis has been associated with a number of medications, including valproate (VPA). Valproate‐coincident pancreatitis is uncommon and is usually associated with other risk factors; however, the United States Food and Drug Administration has issued a box warning for risk of acute pancreatitis with VPA products. We reviewed cases of pancreatitis in VPA‐treated patients from the clinical database of VPA/divalproex trials and compared the incidence of elevated amylase levels between VPA‐ and placebo‐treated patients.Methods: Report rates of acute pancreatitis coincident with VPA use in 34 clinical trials were calculated. Incidence rates of amylase elevations above the normal range in three clinical placebo‐controlled migraine trials were compared between VPA‐ and placebo‐treated patients.Results: Among 3,007 VPA‐treated patients in 34 clinical trials, two reports of pancreatitis were considered by investigators to be probably related to VPA. Both patients recovered. Similar rates of amylase elevations were observed in VPA‐ (5.9%) and placebo‐treated (6.1%) patients in the three migraine headache trials.Conclusions: VPA‐coincident acute pancreatitis is uncommon and idiosyncratic. Checking amylase levels in the absence of other clinical signs and symptoms provides little value for predicting pancreatitis. Physicians should be guided by clinical symptoms of pancreatitis to identify cases.
Determining Reliable Cognitive Change after Epilepsy Surgery: Development of Reliable Change Indices and Standardized Regression‐based Change Norms for the WMS‐III and WAIS‐III
Authors: Martin Roy , Sawrie Stephen , Gilliam Frank , Mackey Melissa , Faught Edward , Knowlton Robert , Kuzniekcy Ruben 
Published: March 2003

Summary:  Purpose: Reliable change indices (RCIs) and standardized regression‐based (SRB) change scores norms were established for the recently revised Wechsler Adult Intelligence Scale–III (WAIS‐III) and Wechsler Memory Scale–III (WMS‐III) in patients with complex partial seizures. Establishment of such standardized change scores can be useful in determining the effects of epilepsy surgery on cognitive functioning independent of test–retest artifacts including practice effects.Methods: Forty‐two nonoperated‐on adult patients with complex partial seizures (primarily of temporal lobe onset) were administered the WMS‐III and WAIS‐III on two occasions (mean 7‐month interval). All patients were receiving stable antiepileptic drug (AED) treatment at both testings. RCI and SRB change scores were calculated. Confidence interval cutoff scores (90% and 80%) and standardized regression equations were calculated for each of the WAIS‐III and WMS‐III Primary Indices and individual subtests. Age, gender, education, test–retest interval, preoperative test performance, seizure onset, and seizure duration were predictor variables for the SRB equations.Results: Test–retest reliabilities for the WAIS‐III and WMS‐III Primary Indices were within acceptable ranges, although considerable individual subtest variability was found. Preoperative performance was the single largest contributor to each of the predictive regression equations. Age, gender, education, seizure onset, and seizure duration contributed modest variance to several of the regression equations.Conclusions: We calculated both RCI and SRB change score indices for the recently revised Wechsler instruments. These formulas help control for test–retest methodologic artifacts and provide a standardized method with which to examine both individual and group level cognitive change after epilepsy surgery.
Serum and CSF Glutamine Levels in Valproate‐related Hyperammonemic Encephalopathy
Authors: Vossler David G. , Wilensky Alan J. , Cawthon David F. , Kraemer Diana L. Abson , Ojemann Linda M. , Caylor Lisa M. , Morgan John D. 
Published: March 2003

Summary:  Purpose: To investigate ammonia and glutamine levels in valproate (VPA)‐related hyperammonemic encephalopathy (VHE).Methods: We reviewed the medical records and EEG recordings of seven adults diagnosed with VHE.Results: Venous ammonia levels were elevated in five (71%) of the seven patients. Elevated serum or cerebrospinal fluid (CSF) glutamine levels were found in four (80%) of five cases tested, including two who had normal ammonia levels. Initial behavioral signs included violent outbursts in three patients, paranoid ideation severe enough to require restraint in two cases, and milder abnormalities in two instances. The severity of encephalopathy was not related to any particular serum VPA level. In four patients serum VPA levels did not exceed 100 μg/ml, and in one case, VHE developed after taking only one 250‐mg dose. Symptoms eventually cleared after reducing the dose of, or discontinuing, VPA. Liver‐function tests were normal. Each of six patients tested had EEG findings that supported the diagnosis of VHE and excluded nonconvulsive status epilepticus. The rate of normalization of one patient's serum glutamine level and the EEGs of two cases correlated better with the timing of their delayed clinical recovery than did the more rapid rate of decline of the serum ammonia levels.Conclusions: Serum or CSF glutamine levels are initially elevated in a majority of patients with suspected VHE, sometimes in the absence of hyperammonemia. Glutamine levels may be useful adjunctive laboratory tests for the diagnosis of VHE.
Seizure Clustering during Epilepsy Monitoring
Authors: Haut Sheryl R. , Swick Cynthia , Freeman Katherine , Spencer Susan 
Published: March 2003

Summary:  Purpose: To identify risk factors associated with seizure clustering during epilepsy monitoring and to assess the effect of clustering on localization of the epileptogenic zone.Methods: Patients undergoing presurgical epilepsy monitoring at Montefiore Medical Center or Yale–New Haven Hospital were recruited. Seizure clustering was defined as three or more seizures within 24 h. Risk factors for seizure clustering were examined by using regression analysis. The effect of clustering on localization was examined by Student's t test evaluation of mean interseizure interval for consecutive concordant and discordant seizures.Results: Of 91 patients, clustering was present in 56 (61.5%). Variables significantly associated with clustering included a history of seizure clustering at home (p = 0.0003) and the presence of mesial temporal sclerosis (MTS) on magnetic resonance imaging (MRI; p = 0.0172). Clustering was present in nine of 10 patients with more than one seizure‐onset zone. Ictal EEG localization was not associated with clustering, nor was rapid medication withdrawal. Mean interseizure intervals were not significantly different for concordant and discordant seizures.Conclusions: Seizure clustering during epilepsy monitoring is common. Risk factors include history of clustering at home, MTS on MRI, and possibly more than one seizure focus. In this study, seizures that occurred in clusters had as important a role in localization as did nonclustered seizures.
Clinical and Electrographic Features of Epileptic Spasms Persisting Beyond the Second Year of Life
Authors: De Menezes Márcio A. Sotero , Rho Jong M. 
Published: March 2003

Summary:  Purpose: Few reports detailing the electroclinical features of epileptic spasms persisting beyond infancy have been published. We sought to characterize this unique population further.Methods: We retrospectively reviewed the clinical and video‐EEG data on 26 patients (4–17 years; mean, 93 months) with a confirmed diagnosis of epileptic spasms and who were evaluated at our tertiary referral center between 1993 and 2000.Results: In half of our cases, epileptic spasms were associated with disorders of neuronal migration, severe perinatal asphyxia, and genetic anomalies. Interictal EEGs showed generalized slowing in the majority of patients, and a slow‐wave transient followed by an attenuation of the background amplitude was the most common ictal EEG pattern associated with an epileptic spasm (19 cases). Other seizure types (number of cases in parentheses) included tonic seizures with or without a preceding spasm (13), partial seizures (11), myoclonic seizures (11), generalized tonic–clonic seizures (six), atypical absence seizures (two), and atonic seizures (one). Cases with a more organized EEG background (especially with frequencies ≥7 Hz) were more likely to have better cognition. Continued disorganization of the EEG background and persistence of hypsarrhythmia were associated with poor developmental outcome.Conclusions: Patients with epileptic spasms persisting beyond age 2 years constitute a truly refractory population, one that should be better recognized by clinicians. Interestingly, although many therapies resulted in a >50% reduction in seizures, neither neurocognitive function nor quality of life was substantially improved with intervention. The interictal EEG background is the most helpful in predicting neurologic outcome.
Surgical Implications of Neuromagnetic Spike Localization in Temporal Lobe Epilepsy
Authors: Iwasaki Masaki , Nakasato Nobukazu , Shamoto Hiroshi , Nagamatsu Ken‐ichi , Kanno Akitake , Hatanaka Keisaku , Yoshimoto Takashi 
Published: March 2003

Summary:  Purpose: To investigate the clinical usefulness of magnetoencephalography (MEG) as a guide to the surgical treatment of temporal lobe epilepsy (TLE).Methods: Preoperative spike localization by MEG was compared with seizure outcome and postoperative spike localization at 12 months after resective surgery in 16 patients with TLE. Spike localization was classified into anterior temporal (AT) and non‐AT localization in 11 patients without neocortical lesion treated with anterior temporal lobectomy (ATL); and lesion and lobar localization in five patients with neocortical lesion treated with lesionectomy (n = 3) or lesionectomy with medial temporal resection (n = 2).Results: All five patients with AT localization became seizure free and spike free after surgery. Among the six patients with non‐AT localization, two became seizure free and spike free, two became seizure free with residual spikes, one had residual seizures but no spikes, and one had both residual seizures and spikes. All three patients with lesion localization and two with lobar localization had favorable seizure outcome and became spike free after surgery.Conclusions: MEG spike localization can identify neocortical sources remote from the presumed epileptogenic area. Favorable seizure outcome can be expected in patients with AT localization after ATL and patients with lesion localization after lesionectomy. In contrast, non‐AT localization indicates either nonmedial TLE or spike propagation to the posterior and extratemporal neocortex. Similarly, lobar localization indicates spike propagation from an epileptogenic lesion or extensive epileptogenicity. Patients with non‐AT localization or lobar localization should undergo intensive evaluations, such as intracranial EEG, for improved seizure outcome.
Iron Status: A Possible Risk Factor for the First Febrile Seizure
Authors: Daoud Azhar S. , Batieha Anwar , Abu‐Ekteish Faisel , Gharaibeh Nayef , Ajlouni Saleh , Hijazi Saad 
Published: March 2003

Summary:  Purpose: We conducted a controlled study to investigate the relation of iron status and first febrile seizure (FFS).Methods: Measures of iron sufficiency including hemoglobin concentration (HB), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and plasma ferritin (PF) were prospectively measured in 75 children with FFS and compared with 75 controls matched for age and sex with febrile illnesses without convulsions.Results: Mean ferritin level was significantly lower in cases with FFS (29.5 ± 21.3 μg/L) than in controls (53.3 ± 37.6 μg/L) with p = 0.0001. The proportion of subjects with a PF level ≤30 μg/L was significantly higher among children with FFS (49 of 75 vs. 24 of 75) than in controls (p = 0.000). Mean levels of HB, MCV, and MCH also were lower among FFS cases, but differences failed to attain statistical significance. A higher proportion of cases with FFS had an HB <110 g/L, MCV <72 fL, and MCH <24 pg than did the controls, but the differences were not statistically significant. There were no statistically significant differences between the cases and the controls in the mean peak temperature on admission, types of underlying illness, or family history of epilepsy and of febrile convulsion.Conclusions: PF level was significantly lower in children with FFS than in the reference group, suggesting a possible role for iron insufficiency in FFS.
Glutamate–glutamine Cycling in the Epileptic Human Hippocampus
Authors: Petroff Ognen A. C. , Errante Laura D. , Rothman Douglas L. , Kim Jung H. , Spencer Dennis D. 
Published: March 2003

Summary:  Purpose: Several findings suggest that energy metabolism and the glutamate–glutamine cycle may be impaired in epilepsy. Positron emission tomography often shows interictal hypometabolism of the epileptogenic hippocampus. In vivo microdialysis studies show that seizure‐associated glutamate release is doubled, and clearance is slowed. We hypothesized that the glutamate–glutamine cycle between neurons and glia may be decreased in the epileptic human hippocampus.Methods: A 20% solution of 2‐13C‐glucose was infused before resection of the epileptogenic hippocampus. Blood glucose isotopic fractions were measured every 30 min. Blood and brain specimens were frozen quickly; perchloric acid extracts of the small metabolites were prepared and analyzed by proton and carbon magnetic resonance spectroscopy (MRS) at 11.75 Tesla.Results: Standard histology showed 12 with hippocampal sclerosis and five with minimal neuron loss. The relative rates of glutamate–glutamine cycling with respect to glutamate synthesis were decreased in biopsies affected by hippocampal sclerosis (mean, 0.08; 95% confidence interval, 0.04–0.12) compared with those with minimal neuron loss (0.52; 95% CI, 0.30–0.75). Mean cellular glutamate concentrations were higher in minimal neuron loss (8.9 mM; 95% CI, 7.4–10.4) than hippocampal sclerosis (7.3 mM; 95% CI, 5.9–8.7). Cellular glutamine concentrations (mean, 2.8 mM; 95% CI, 2.4–3.2; n = 17) were the same in all groups.Conclusions: The epileptogenic, gliotic human hippocampus appears to be characterized metabolically by slow rates of glutamate–glutamine cycling, decreased glutamine content, and a relative increase in glutamate content. We hypothesize that the low rate of glutamate–glutamine cycling that results from a failure of glial glutamate detoxification could account for slow glutamate clearance from synapses and continuing low‐grade excitotoxicity.
Brain Diffusion after Single Seizures
Authors: Hufnagel Andreas , Weber Johannes , Marks Sonja , Ludwig Tanja , De Greiff Armin , Leonhardt Georg , Widmann Guido , Stolke Dietmar , Forsting Michael 
Published: March 2003

Summary:  Purpose: Diffusion‐weighted magnetic resonance imaging (DWI) after focal status epilepticus has demonstrated focal alterations of the apparent diffusion coefficient (ADC) in the epileptogenic zone. We hypothesized that localized dynamic alterations of brain diffusion during the immediate postictal state will be detectable by serial DWI and correlate with the epileptogenic zone.Methods: Nine adult patients (four men, five women) with medically intractable epilepsy were prospectively examined with a total of 25 DWI scans taken 2–210 min after a seizure.Results: The interictal ADC was significantly (p < 0.05) elevated in the ictogenic hippocampus in all patients with temporal lobe epilepsy. The following postictal changes of the ADC were seen: (a) decreases by maximally 25–31%, which were most pronounced in the epileptogenic zone (n = 2); (b) generalized ADC changes after generalized seizures (n = 1) or prolonged complex partial seizures (n = 2); (c) no major changes after short‐lived seizures or if the time to first DWI scan was >15 min or both (n = 3); and (d) widespread bilateral ADC increases after a flumazenil‐induced seizure (n = 1).Conclusions: ADC changes seen during serial postictal DWI are complex and appear to reflect origin and spread of the preceding seizure. A delineation of the epileptogenic zone appears to be possible only in complex‐partial seizures of >60 s duration that do not secondarily generalize.
Epilepsy‐induced Changes in Signaling Systems of Human and Rat Postsynaptic Densities
Authors: Wyneken Ursula , Marengo Juan‐Jose , Villanueva Sergio , Soto Dagoberto , Sandoval Rodrigo , Gundelfinger Eckart D. , Orrego Fernando 
Published: March 2003

Summary:  Purpose: To study seizure‐induced changes in signaling proteins present in postsynaptic densities (PSDs) isolated from human epileptic neocortex and from rat cortex in which seizures were induced by injection of kainic acid.Methods: We performed Western blot analysis of signaling proteins in PSDs isolated from cortical tissue.Results: Seizures induce a strong upregulation of TrkB, the receptor for brain‐derived neurotrophic factor (BDNF), whereas components of the N‐methyl‐d‐aspartate (NMDA)‐receptor complex are downregulated in both human and rat PSDs.Conclusions: These data show that long‐term changes in PSD composition occur as a consequence of epileptic seizure activity.
Quality of Life in Psychogenic Nonepileptic Seizures
Authors: Szaflarski Jerzy P. , Hughes Cynthia , Szaflarski Magdalena , Ficker David M. , Cahill William T. , Li Maureen , Privitera Michael D. 
Published: March 2003

Summary:  Purpose: Psychogenic nonepileptic seizures (PNESs) are events that alter or seem to alter the neurologic function and, in their appearance, resemble epileptic seizures (ESs). In patients with ESs the psychological and medical aspects of epilepsy greatly influence the health‐related quality of life (HRQOL). The relation between these factors and PNESs is not well established. In this study, we compared HRQOL in patients with PNESs with that of patients with ESs.Methods: We evaluated 105 patients admitted to the Epilepsy Monitoring Unit of University Hospital between January 20, 2001, and January 20, 2002. Only patients with the definite diagnosis of ESs or PNESs were analyzed (n = 85). Patients completed an epilepsy‐specific quality‐of‐life instrument (QOLIE‐89), the Profile of Mood States (POMS), and Adverse Events Profile (AEP). We used t tests and regression analyses to contrast HRQOL in PNESs and ESs and to elucidate the main factors associated with HRQOL in patients with PNESs.Results: In our sample, 45 patients had PNESs, and 40 had ESs. The overall HRQOL and scores on 13 of 19 QOLIE‐89 subscales were significantly lower (i.e., worse) in PNES than in ES patients. AEP and scores on five of six POMS subscales also were worse in PNES patients than in ES patients. PNES versus ES diagnosis, POMS depression/dejection, and AEP were significant predictors of HRQOL, jointly explaining 65% variation in HRQOL. The lower HRQOL in PNESs versus ESs was in part explained by depression and AEP.Conclusions: Patients with PNESs have a lower HRQOL and worse mood problems than do patients with ESs. This disadvantage is primarily due to depression and medication side effects, although these factors influence QOL in much the same way in PNES and ES patients. These baseline HRQOL data on patients with PNESs can be used to evaluate the effects of treatment in this patient population.
Correlation of Hippocampal Glucose Oxidation Capacity and Interictal FDG‐PET in Temporal Lobe Epilepsy
Authors: Vielhaber Stefan , Von Oertzen Joachim H. , Kudin Alexei F. , Schoenfeld Ariel , Menzel Christian , Biersack Hans‐Juergen , Kral Thomas , Elger Christian E. , Kunz Wolfram S. 
Published: March 2003

Summary:  Purpose: Interictal [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET) demonstrates temporal hypometabolism in the epileptogenic zone of 60–90% of patients with temporal lobe epilepsy. The pathophysiology of this finding is still unknown. Several studies failed to show a correlation between hippocampal FDG‐PET hypometabolism and neuronal cell loss. Because FDG is metabolized by hexokinase bound to the outer mitochondrial membrane, we correlated the glucose‐oxidation capacity of hippocampal subfields obtained after surgical resection with the corresponding hippocampal presurgical FDG‐PET activity.Methods: In 16 patients with electrophysiologically confirmed temporal lobe epilepsy, we used high‐resolution respirometry to determine the basal and maximal glucose‐oxidation rates in 400‐μm‐thick hippocampal subfields obtained after dissection of human hippocampal slices into the CA1 and CA3 pyramidal subfields and the dentate gyrus.Results: We observed a correlation of the FDG‐PET activity with the maximal glucose‐oxidation rate of the CA3 pyramidal subfields (rp = 0.7, p = 0.003) but not for the regions CA1 and dentate gyrus. In accordance with previous studies, no correlation of the FDG‐PET to the neuronal cell density of CA1, CA3, and dentate gyrus was found.Conclusions: The interictal hippocampal FDG‐PET hypometabolism in patients with temporal lobe epilepsy is correlated to the glucose‐oxidation capacity of the CA3 hippocampal subfield as result of impaired oxidative metabolism.
Delayed Sclerosis, Neuroprotection, and Limbic Epileptogenesis After Status Epilepticus in the Rat
Authors: Ebert Ulrich , Brandt Claudia , Löscher Wolfgang 
Published: March 2003

Summary:  Purpose: Hippocampal sclerosis and massive neurodegeneration in other parts of the limbic system are considered hallmarks of temporal lobe epilepsy. Using the rat model of kainate‐induced status epilepticus, we sought to determine if limbic sclerosis after an excitotoxic insult follows a delayed type of neurodegeneration and is thus accessible to neuroprotective intervention after the insult. Effective pharmacologic neuroprotection after status epilepticus also addresses the old question of whether degenerative morphologic changes after an epilepsy‐inducing event like status epilepticus are the primary cause of epileptogenesis (i.e., the development of recurrent spontaneous seizures) during the following weeks.Methods: Female Wistar rats after 90 min of generalized status epilepticus were used. Molecular biologic and histologic techniques were used to demonstrate markers of delayed cell death (apoptosis) 48 h after the status. The neuroprotective effects of i.c.v. injections of caspase inhibitors and systemic injections of the anticonvulsant drugs (AEDs) dizocilpine and retigabine after the status epilepticus were studied. The effect of neuroprotective intervention on the development of recurrent spontaneous seizures was investigated by behavioral observation of the rats.Results: After generalized status epilepticus in Wistar rats, massive sclerosis of the hippocampus and the piriform cortex occurred. TUNEL labeling and electron microscopy revealed that apoptosis is involved in the degenerative processes. Immunohistochemical analysis of the time course of the expression of the proapoptotic protein Bax suggested a maximal induction of apoptosis 24–48 h after the status. Application of caspase inhibitors before or after the status did not reduce lesions, although Bax labeling was reduced. Injection of dizocilpine and to a lower extent also of retigabine after the status prevented limbic neurodegeneration and expression of markers of apoptosis. However, the neuroprotection by dizocilpine did not prevent the development of recurrent spontaneous seizures.Conclusions: Prolonged seizure activity can induce delayed sclerosis in the hippocampus and other parts of the limbic system. This delayed cell loss can be prevented by neuroprotective drugs after a status epilepticus. However, the damage in limbic brain regions is not the main reason for limbic epileptogenesis and the occurrence of recurrent spontaneous seizures.