bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transient Facial Palsy in Sphenoidal Electrode Placement
Authors: Iriarte Jorge , Parra Jaime , Kanner Andres M. 
Published: August 2005

Summary: Purpose: Sphenoidal electrode (SE) insertion can cause pain, for which local anesthesia with lidocaine or intravenous administration of fentanyl has been advocated by different epilepsy treatment centers. Transient facial palsies have been observed after SE insertion. Their frequency of occurrence, distribution, and duration have not been well characterized, however. We hypothesized that this complication is due to the effect of local anesthesia on the peripheral branches of the seventh cranial nerve. To test this hypothesis, we compared the incidence and characteristics of facial palsy during SE insertions performed with either local anesthesia or after intravenous fentanyl administration. Methods: We performed a retrospective study in two patient groups. Group A consisted of 25 patients aged 28 ± 8·2 years who underwent a prolonged video‐EEG (VEEG) monitoring study with SE after subcutaneous infusion of 1% lidocaine in the insertion area. Group B included 25 patients aged 30·1 ± 8·9 years whose SE were inserted after intravenous administration of 100‐200 μ fentanyl. Blood pressure (BP) was monitored every 3‐5 min throughout the procedure. Results: Five patients (20%) from group A had a transient facial palsy; in 4, it was complete and in 1 it was partial; 1 patient had a bilateral facial palsy. Paresis lasted 1‐7 min (mean 3·2 min). In all patients, the recovery was complete. None of the patients in group B had complications (p = 0·025, Fisher's exact test). Conclusions: Transient facial palsy is a relatively frequent complication of SE insertion when SE are placed under local anesthesia; patients should be forewarned of its possible occurrence.
Preliminary Report on Teratogenic Effects of Zonisamide in the Offspring of Treated Women with Epilepsy
Authors: Kondo Tsuyoshi , Kaneko Sunao , Amano Yoshiyuki , Egawa Isao 
Published: August 2005

Summary: Purpose: We wished to assess the risk of terato‐genicity of zonisamide (ZNS) in humans. Methods: Pregnant epileptic women treated with ZNS and their offspring were prospectively monitored from June 1989 to December 1994. The outcome of pregnancy and status of neonates were examined based on the same standardized protocol. Results: Twenty‐six offspring exposed to ZNS with or without other antiepileptic drugs (AEDs) were studied. Malformations were detected in 2 offspring (7·7%) exposed to ZNS polypharmacy. Anencephaly was detected in one case at 16 weeks of gestation (case 1, artificial abortion), and atrial septa1 defect was detected in another case at 37 weeks of gestation (case 2, delivery by cesarean section). Serum concentrations of ZNS during the first trimester of pregnancy were 6·1 μg/ml in case 1 and 6·3μ/ml in case 2; in both cases, the levels were below the therapeutic concentration range of ZNS. Conclusions: Teratogenic effects of ZNS were not clearly defined from these results since malformations were detected in two polypharmacy cases but not in four monopharmacy cases. The present data do not indicate that the risk of ZNS teratogenicity is greater than that of other conventional AEDs. However, such risk cannot be neglected even at therapeutic dosages or concentrations of ZNS, especially in patients receiving polypharmacy.
Vigabatrin as Initial Therapy for Infantile Spasms: A European Retrospective Survey
Authors: Aicardi J. ,   Sabril IS Investigator and Peer Review Groups, Mumford J. P. , Dumas C. , Wood S. 
Published: August 2005

Summary: Purpose: The efficacy and tolerability of vigabatrin (VGB) as an add‐on therapy in the treatment of infantile spasm (IS) prompted physicians to explore its use as the first drug in this seizure type. Methods: Our retrospective study included 250 infants diagnosed with IS; the data obtained were subjected to peer‐group review. Of this infant population, 192 infants were considered to have classic IS and had received VGB as their first treatment for the spasms. There was a slight preponderance of boys (57%) in this population. Mean age of IS onset was 5.8 months; 60% had typical hypsarrhythmia. Results: Initial suppression of spasms was obtained in 68% of infants with a median time to response of 4 days at an average VGB dose of 99 mg/kg/day. The best response was seen in those infants with tuberous sclerosis (96% response) and in those younger than 3 months at onset of spasms (90% response). Of these infants, 43 (22%) of 192 subsequently had other types of seizures, and a recurrence of infantile spasms occurred in 28 (21%) of 131 responders. At the end of this study, 96 of 192 infants who could be evaluated were seizure free with VGB monotherapy. Treatment appeared to be well tolerated, with only 33 (13%) infants with adverse events, of which the most common were somnolence (15 patients) and hyper‐kinesia (eight patients). In only two cases did adverse events require VGB withdrawal. Conclusion: This study supports the opinion that VGB may be considered an initial treatment for IS regardless of cause.
Nonconvulsive Status Epilepticus in the Emergency Room
Authors: Kaplan Peter W. 
Published: August 2005

Summary: Purpose: The study reviewed emergent cases of nonconvulsive status epilepticus (NCSE) to evaluate causes of diagnostic and management delay and examined frequent diagnostic features suggestive of NCSE. Methods: In a retrospective study, we assessed the clinical presentation of 23 patients with one or more NCSE episodes, their medical history, EEG, and antiepileptic drug (AED) treatment. We also evaluated causes of diagnostic delay in patients referred to the emergency room (ER) in confusional states. Results: There was considerable overlap in clinical features of patients with complex partial SE (CPSE) and generalized nonconvulsive SE (GNSE). Delays in seeking medical attention were common. Diagnosis was significantly delayed in 10 patients. Three cases illustrate the possible markedly different presentations of NCSE. Conclusions: NCSE often goes unrecognized or is mistaken for behavioral or psychiatric disturbance. The pleo‐morphic clinical presentation of NCSE indicates that EEG and a therapeutic trial of AEDs afford the best diagnostic measures in acute waxing and waning confusional states associated with agitation, bizarre behavior, staring, increased tone, mutism, or subtle myoclonus.
Learned Helplessness, Attributional Style, and Depression in Epilepsy
Authors: Hermann Bruce P. , Trenerry Max R. , Colligan Robert C. ,   The Bozeman Epilepsy Surgery Consortium
Published: August 2005

Summary: Purpose: We wished to examine the relevance of the theory of learned helplessness in general, and attributional style in particular, to the understanding of depression among patients with epilepsy. Methods: Patients with lateralized temporal lobe epilepsy (TLE) (right = 73, left = 70) were administered two self‐report depression inventories [Beck Depression Inventory (BDI), Center for Epidemiological Studies‐Depression scale (CES‐D)]. Depression scores were examined in relation to a key component of the revised theory of learned helplessness (attributional style) using the Optimism/Pessimism Scale. Results: Attributional style was significantly associated with increased self‐reported depression and remained significant when the effects of several confounding variables were controlled [age, age at onset, laterality of TLE, sex, and method variance]. Conclusions: The results indicate that the concepts of learned helplessness in general, and attributional style in particular, are related to the genesis of depression in epilepsy. Because they are known to be related to depression in the general population, and because specific techniques for intervention and prevention are available, greater consideration of learned helplessness and attributional style in the genesis of depression in epilepsy may be worthwhile.
Pharmacokinetic Interactions Between Lamotrigine and Other Antiepileptic Drugs in Children with Intractable Epilepsy
Authors: Eriksson Ann‐Sofie , Hoppu Kalle , Nergårdh Arne , Boreus Lars 
Published: August 2005

Summary: Purpose: We wished to determine the oral pharmacokinetics of lamotrigine LTG and to assess possible interactions with other AEDs in an unselected population of children. Concentration data in plasma and in CSF for lamotrigine as well as for the other AEDs are presented. Methods: Thirty‐one children, children and young adults aged > 2 years with intractable generalized epilepsy despite adequate duration and dose of at least three conventional AEDs were studied. Results: There was a linear relation between the dose administered and the maximal plasma concentration, indicating that saturation of absorption or elimination mechanisms did not occur in the dose range studied. The median elimination half‐life (t1/2) in patients receiving concomitant valproate (VPA) was 43.3 h; in patients receiving carbamazepine (CBZ) and/or phenobarbital (PB), it was 14.1 h; and in patients receiving both VPA and CBZI PB or other antiepileptic drugs (AEDs), it was 28.9 h. No clinically important changes in the plasma levels of CBZ, VPA, valproate, ethosuximide, or PB were observed in the follow‐up period (2–12 months). No dose adjustments of concomitant AEDs were necessary. The plasma concentration of clonazepam (CZP) was reduced when LTG was introduced. Conclusions: The complex interaction between LTG and other AEDs in children with intractable epilepsy makes therapeutic drug monitoring (TDM) desirable.
Vigabatrin Versus ACTH as First‐Line Treatment for Infantile Spasms: A Randomized, Prospective Study
Authors: Vigevano Pederico , Cilio Maria Roberta 
Published: August 2005

Summary: Purpose: To compare the efficacy and tolerability of vigabatrin (VGB) and adrenocorticotrophic hormone (ACTH) as first‐line therapy in infantile spasms.Methods: Forty‐two infants (22 males, 20 females) aged 2–9 months with newly diagnosed infantile spasms, were included in the trial. Patients were randomized to receive VGB 100–150 mg/kg/day or Depot ACTH 10 IU/day. The alternative drug was given if spasms were not controlled within 20 days or in cases of intolerance to initial therapy. Twenty‐three patients (7 cryptogenic, 16 symptomatic) received VGB as first‐line therapy; 19 patients (8 cryptogenic, 11 symptomatic) received ACTH as the first drug.Results: Cessation of spasms was observed in 11 (48%) of the patients randomized to VGB and in 14 (74%) of those randomized to ACTH. Response to VGB was observed within 1–14 days, but two‐thirds of patients (7/11) responded within 3 days. In the group treated with VGB, side effects such as drowsiness, hypotonia and irritability were observed in 13% of patients, compared with 37% in the group treated with ACTH. VGB was more effective than ACTH as treatment for cerebral malformations or tuberous sclerosis, whereas ACTH proved more effective in perinatal hypoxic/ischemic injury. The efficacy of the two drugs was similar in cryptogenic cases. Disappearance of interictal EEG abnormalities occurred sooner in patients randomized to ACTH than in those who received VGB as initial therapy. During the second phase, the alternative drug was given to the resistant patients. Spasms ceased in 2 of 5 patients treated with VGB and in 11 of 12 patients treated with ACTH. After 3 months, relapses of spasms were observed in 6 patients treated with ACTH and in 1 treated with VGB. VGB produced a therapeutic response in nearly half the patients receiving this drug.Conclusions: Our data lend further support to the view that VGB may be considered a first‐choice drug in the treatment of IS.
Effect of Wada Memory Stimulus Type in Discriminating Lateralized Temporal Lobe Impairment
Authors: Loring David W. , Hermann Bruce P. , Perrine Ken , Plenger Patrick M. , Lee Gregory P. , Meador Kimford J. 
Published: August 2005

Summary: Purpose: To examine the effects of memory stimulus type on Wada memory performance. Method: Ninety‐six patients (left, 47; right, 49) from four epilepsy centers who were candidates for anterior temporal lobectomy (ATL) and who have subsequently undergone surgery were studied. Patients with atypical cerebral language lateralization or with evidence on magnetic resonance imaging (MRI) to suggest a lesion other than hippocampal sclerosis were excluded. Wada memory performance was obtained by using both real objects and line drawings as memory stimuli. Results: Wada memory laterality scores with either real objects or line drawings as memory stimuli discriminated left from right‐ATL groups. However, objects were superior to line drawings in making this differentiation. Further, objects were superior to line drawings in individual patient classification of candidates for left ATL, with no difference in the classification rates using either objects or line drawings in candidates for right ATL. Conclusions: Type of memory stimuli is an important factor affecting memory results during the Wada test.
Pharmacokinetics of Oxcarbazepine and Carbamazepine in Human Placenta
Authors: Pienimäki P. , Lampela E. , Hakkola J. , Arvela P. , Raunio H. , Vähäkangas K. 
Published: August 2005

Summary: Purpose: To study the transfer and metabolism of oxcarbazepine (OCBZ) and 10‐hydroxy‐10,11‐dihydrocarbamazepine (10‐OH‐CBZ) and carbamazepine (CBZ) metabolism and its possible induction in human placenta. Methods: A dual recirculating human placental perfusion system, blood sampling, high performance liquid chromatography (HPLC), reverse transcriptase‐polymerase chain reaction (RT‐PCR), and enzyme assays. Results: OCBZ was metabolized into 10‐OH‐CBZ in five human placental cotyledons perfused for 2 h in a dual recirculating perfusion system. The same metabolite was found by HPLC in three sample pairs of maternal and cord blood taken during delivery from patients on OCBZ therapy. In all of the clinical samples, 10, 11‐trans‐dihydroxy‐10, 11‐dihydrocarbamazepine (l0, 11‐D) was also found, but not in the perfusions. In addition, 10‐OH‐CBZ was not metabolized in the placental perfusions. The transfer of OCBZ through the perfused placentas was quicker than the transfer of antipyrine, while the transfer of 10‐OH‐CBZ was slower. Both OCBZ and 10‐OH‐CBZ also accumulated in placental tissue. CBZ metabolism was studied in three perfusions using placentas from mothers on CBZ therapy. No metabolism could be detected in the perfused placentas, while metabolites were found in both maternal and cord blood of the same mothers. Another series of placentas of mothers on CBZ therapy did not differ significantly from the placenta of a healthy mother as to CYP activities or the level of CYP3A4 mRNA. Conclusions: OCBZ is metabolized into 10‐OH‐CBZ to some extent in human placenta in vitro, suggesting that the placenta also participates in the metabolism of OCBZ in vivo. On the contrary, the placenta does not participate in the metabolism of CBZ. No induction of placental CBZ metabolism in vitro can be detected after maternal CBZ treatment during pregnancy.
Epilepsy in Pakistan: Stigma and Psychosocial Problems. A Population‐Based Epidemiologic Study
Authors: Aziz Hasan , Akhtar Syed Wasim , Hasan K. Zaki 
Published: August 2005

Summary: Purpose: To assess the stigmatization and psycho‐social problems of persons with epilepsy in Pakistan. Methods: A population‐based, cross‐sectional epidemiologic study of 241 persons with epilepsy identified from an at‐risk population of 24,130 individuals (64.7% from urban and 35.3% from rural areas). Of these patients, 77% suffered from recurrent non‐febrile generalized convulsions. We evaluated degree of stigmatizations (i.e., avoidance by friends, neighbors, and others), and the effect of epilepsy on other psychosocial aspects (e.g., marriage), and also the relationships between gender and level of education of the patients, and stigmatization. Results: Patients with epilepsy in Pakistan do not appear to be highly stigmatized, but their education and grades are affected by the disorder. They have difficulty performing activities of daily living and find it hard to make decisions about whether to marry or to have children. Women believed that they were more dangerous to others, received less help from their families, and, more frequently than men, encouraged others to avoid them. Women were also more likely than men to express the belief that people with epilepsy should not marry, but in fact, women more frequently married as compared men—a fact influenced by social and cultural pressures, including pressure from family, because it is nearly always the responsibility of the parents to arrange the marriage of a daughter. Influence of education indicates that people with epilepsy who have higher education, as compared with those with less education, had fewer children, were less often avoided by their classmates and neighbors, had fewer problems with plans for education, less frequently encouraged others to avoid them, were more frequently married, and believed that they were more dangerous to others. Most people believed that their conditions had a physical basis; only 3.1% attributed their epilepsy to supernatural causes. Conclusions: Stigmatization regarding epilepsy has not been proven to be an important feature in the culture of Pakistan because none of the observations are statistically significant as per P‐value.
Sexual Function in Women with Epilepsy
Authors: Duncan Susan , Blacklaw Jackie , Beastall G. H. , Brodie M. J. 
Published: August 2005

Summary: Purpose: To examine certain aspects of sexual behaviour and attitudes in a group of women with epilepsy using a validated questionnaire (Sexuality Experience Scales), and effects of antiepileptic drugs (AEDs) on sex hormone binding globulin (SHBG), total testosterone (TT), and free testosterone (FT). Methods: One hundred ninety‐five women all attending a hospital‐based epilepsy clinic were recruited. One hundred fifty‐nine received AED therapy and 36 women did not. A control group of 48 women was also recruited. All women completed the first two Sexuality Experience Scales (SES 1 and SES 2), and those women in stable heterosexual relationships completed SES 3 and SES 4. At the same time blood was taken for TT and SHBG levels. FT was calculated using the method of Nanjee and Wheeler (22). Results: Women receiving AED therapy achieved significantly higher SES 1 and SES 2 scores than the rest of the women, suggesting that they adhered to a stricter sexual morality and were less open to psychosexual stimulation than the rest of the women treated. Women in the treated group were less likely to have received further education than the controls, a factor that influences SES 1 and SES 2 scores. There were no significant differences between the three groups on SES 3 or SES 4, with the exception of the orgasmic adequacy (OE) scale of SES 3 where those women in the treated group attained a higher mean score than the controls, suggesting that they found orgasm less satisfying. Women receiving AEDs had significantly higher SHBG and TT than controls and untreated patients. There were no differences in FT between the groups. Those women receiving AEDs also exhibited the expected mid‐cycle rise in FT. There was no significant correlation between FT and the desired frequency of intercourse or enjoyment of it for the three groups. Conclusions: Women in the treated group appeared to be more “moral” and less open to sexual approach, but those who had regular partners appeared to desire and enjoy intercourse as much as the control and untreated groups. This could be explained by differences in demographic characteristics of the study groups or be indicative of a bimodal distribution of sexual interest in these women. As FT was within physiological norms for each study group this cannot be cited as a cause for hyposexuality.
Altered Seizure Patterns After Temporal Lobectomy
Authors: Blume Warren T. , Girvin John P. 
Published: August 2005

Summary: Purpose: We compared features of seizures occurring after temporal lobectomy with those of preoperative seizures in the same patients to determine whether aspects of postoperative partial seizures presage ultimate seizure control. Methods: Seizure descriptions of 100 consecutive patients who underwent anterior temporal lobectomy (ATL) were obtained by our epileptologists before and after surgery. Follow‐up for seizure control for all patients was obtained for a median of 5.5 years. Results: Twenty‐six of the 100 patients had at least one diurnal complex partial seizure (CPS) after lobectomy. The proportion of patients with an aura for their CPS decreased from 86% preoperatively to 58% postoperatively. Fifty–five percent had two or more aura features before surgery, as compared with 31% after lobectomy. Eleven of 18 (61%) with fewer than two postoperative aura features, as compared with 2 of 8 (25%) with two or more aura features ultimately had >90% seizure reduction postoperatively. Nineteen (95%) of 20 patients with only simple partial seizures (SPS) postoperatively ultimately obtained ≥90% reduction, and 7 (35%) of them became seizure‐free. Although generalized tonic‐clonic seizures (GTCS) decreased from 70% to 39% after lobectomy, 7 (23%) of 30 patients who had not had GTCS preoperatively had at least one after lobectomy, usually while receiving a lesser amount of antiepileptic drug (AED) therapy. Among the 27 patients with residual CPS, ultimate outcome was better among patients with removal of >6 cm as measured along the inferior temporal gyrus than among those with less extensive resections. Conclusions; In addition to eliminating or reducing the frequency of temporal lobe seizures, lobectomy may simplify or eliminate the aura features of residual CPS. The number of CPS aura features correlated inversely with ultimate postoperative seizure reduction. Ultimate seizure control among patients with only SPS was better than that of patients with CPS postoperatively. First‐ever GTCS may occur when AED dosages are reduced after surgery.