bluuebunny/crossref_metadata_2025_split huggingface dataset:
Status Epilepticus Causes Long‐Term NMDA Receptor‐Dependent Behavioral Changes and Cognitive Deficits
Authors: Rice Ann C. , Floyd Candace L. , Lyeth Bruce G. , Hamm Robert J. , DeLorenzo Robert J. 
Published: August 2005

Summary: Purpose: The role of N‐methyl‐d‐aspartate (NMDA)‐receptor activation on behavioral and cognitive changes after status epilepticus (SE) is unknown. In this study, behavioral and cognitive changes after SE were evaluated in the short and long term and in rats in which the NMDA receptor was inactivated during SE. Methods: Pilocarpine (350 mg/kg) was injected to induce SE. Inhibition of the NMDA receptor during SE was achieved with MK‐801 (4 mg/kg). Seizure intensity during SE was monitored by electroencephalography (EEG). After SE, behavioral studies were performed to identify abnormal behavior by using behavioral tests adapted from Moser's funetional observational battery. Cognitive changes were assessed by using the Morris Water Maze (MWM). Results: Pilocarpine–treated animals scored significantly higher on two of the behavioral tests: the Touch test and the Pick‐Up test. These behavioral changes occurred very soon after SE, with the earliest changes observed 2 days after SE and persisting for the life of the animal. Inhibition of the NMDA receptor with MK‐801 completely inhibited these behavioral changes under conditions that did not alter the duration of SE. In addition, pilocarpine‐treated animals exhibited cognitive deficits as determined by using the MWM. Six weeks after SE, the animals displayed significantly longer latencies to locate the hidden platform on this test. The impaired performance on the MWM also occurred as early as 5 days after SE. These cognitive deficits were prevented in animals treated with MK‐801 during SE. Conclusions: The results indicate that behavioral and cognitive changes occur soon after SE, are permanent, and are dependent on NMDA‐receptor activation during SE. NMDA receptor activation may play an important role in causing cognitive and behavioral morbidity after recovery from SE.
Effects of Phenytoin, Carbamazepine, and Gabapentin on Calcium Channels in Hippocampal Granule Cells from Patients with Temporal Lobe Epilepsy
Authors: Schumacher Thekla B. , Beck Heinz , Steinhauser Christian , Schramm Johannes , Elger Christian E. 
Published: August 2005

Summary: Purpose: The anticonvulsants phenytoin (PHT), carbamazepine (CBZ), and gabapentin (GBP) are commonly used in the treatment of temporal lobe epilepsy. Ca2+ current modulation has been proposed to contribute to the antiepileptic activity of these drugs. The purpose of this study was to determine the effects of these anticonvulsants on voltage‐dependent calcium channels in pathologically altered neurons from patients with chronic temporal lobe epilepsy. Methods: Acutely isolated human hippocampal granule cells were examined by using the whole‐cell configuration of the patch‐clamp technique. Results: PHT and CBZ produced a reversible, concentrationdependent inhibition of high‐voltagectivated (HVA) Ca2+ currents without affecting voltage‐dependent activation. The concentration‐response curves of PHT and CBZ indicated maximal inhibition of 35 and 65%, respectively, with halfmaximal inhibition being obtained at 89 and 244 μM, respectively. At therapeutic cerebrospinal fluid (CSF) concentrations, HVA currents were not significantly altered by PHT and CBZ. However, PHT but not CBZ showed a reduction of HVA currents of 16% at a therapeutic whole‐brain concentration of 80 μM. In ontrast to CBZ, PHT produced a small hyperpolarizing shift in the voltage dependence of steady‐state inactivation. PHT, 80 μ4, shifted the potential of half‐maximal inactivation by ‐3.1 ± 0.5 mV (p < 0.05). GBP, which was recently found to bind to the à2 subunit of a neuronal Ca2+ channel, showed no modulation of Ca2+ conductances. Conclusions: These results suggest that, in contrast to GBP and CBZ, modulation of postsynaptic Ca2+ channels can contribute to the anticonvulsant action of PHT in human hippocampal granule cells.
Interictal Cardiovascular Autonomic Responses in Patients with Epilepsy
Authors: Isojärvi Jouko I. T. , Ansakorpi Hanna , Suominen Kalervo , Tolonen Uolevi , Repo Marja , Myllylä Vilho V. 
Published: August 2005

Summary: Purpose: To evaluate the interictal autonomic nervous system function in 84 patients with epilepsy: 37 with newly diagnosed, previously untreated epilepsy, and 47 patients receiving long‐term carbamazepine (CBZ), phenytoin (PHT), or valproate (VPA) monotherapy, or CBZ plus PHT, or CBZ plus VPA for their seizure disorder. Methods: We assessed autonomic control of the cardiovascular regulatory system, by standardized cardiovascular reflex tests measuring changes in heart rate (HR) and blood pressure (BP) at rest and after certain stimuli. Results: The HR and BP responses were similar to those of control subjects in patients with newly diagnosed epilepsy. However, HR variation during normal breathing and maximum systolic BP increase in isometric work were diminished in patients, who had been treated with antiepileptic drugs (AEDs) for epilepsy for a long time. Diminished HR responses to the Valsalva maneuver were noted in patients receiving CBZ as monotherapy and during deep breathing in patients receiving CBZ combined with PHT or VPA. Furthermore, patients receiving CBZ had diminished BP responses in isometric work. When analyzed in relation to epilepsy type, suppressed HR responses in normal breathing were associated with primary generalized epilepsy (PGE), whereas diminished BP responses in isometric work were associated with partial epilepsy. Two patients with recently diagnosed partial epilepsy and 1 patient receiving long‐term CBZ monotherapy for partial epilepsy had two abnormal cardiovascular response test results. Conclusions: Our results show that cardiovascular responses mediated by both the parasympathetic and sympathetic nervous system are diminished in patients with epilepsy. However, the changes appear to be clinically significant in only a few of them and appear to be associated with CBZ medication. Further studies are needed to detect the underlying complex interactions and clinical significance of autonomic nervous system dysfunction in patients with epilepsy.
Nonepileptic Posttraumatic Seizures
Authors: Barry Elizabeth , Krumholz Allan , Bergey Gregory K. , Chatha Herlene , Alemayehu Shimellis , Grattan Lynn 
Published: August 2005

Summary: Purpose: Epileptic posttraumatic seizures (PTSs) are a well‐recognized consequence of head injury (HI), but HI and nonepileptic seizures (NESs) have not been related. We describe a significant subset of patients with NESs who had their seizures attributed to HI. Methods: We reviewed the records of all patients diagnosed with NES at the University of Maryland Medical Center over a 6‐year period (1989–1995) and selected patients with seizures attributed to a head injury occurring ≥3 years before the onset of their seizures. Results: Of 157 patients with video‐EEG confirmed NES, 37 (24%) had the onset of their seizures attributed to an HI. Their average age was 34 years (range, 15–56 years); 68% were women. Nonepileptic PTS usually developed within the first year after HI (89%). Convulsive symptoms were present in 54%. Whereas epileptic PTSs characteristically follow severe HI, the majority (78%) of our patients with nonepileptic PTSs sustained only mild HI. Before their HI, 76% of our patients were employed, working in the home, or students, but only 11% could continue those activities after developing nonepileptic PTSs. Conclusions: Nonepileptic PTSs are frequently mistaken for epileptic PTSs and result in serious disability. The misdiagnosis of nonepileptic PTSs leads to ineffective and inappropriate treatment. Patients with intractable seizures after HIS, articularly mild HIS, should be carefully evaluated for NESs.
Lamotrigine and Seizure Aggravation in Severe Myoclonic Epilepsy
Authors: Guerrini Renzo , Dravet Charlotte , Genton Pierre , Belmonte Anna , Kaminska Anna , Dulac† Olivier 
Published: August 2005

Summary: Purpose: In severe myoclonic epilepsy of infancy (SME), multiple drug‐resistant focal and generalized seizure types occur. Lamotrigine (LTG), found effective in many generalized and partial seizures, has been little used in severe childhood epilepsy syndromes with multiple seizure types. We studied the effects of LTG in SME. Methods: Twenty‐one patients with SME, aged 2–18 years, were treated with LTG, 20 in add‐on and one in monotherapy. LTG was started at 0.2–2.5 mg/kg/day and increased to 2.5–12.5 mg/kg/day. For each seizure type, excluding atypical absences, >50% variations compared with the 2 months preceding LTG were considered indicators of response, also taking into account the degree of disability each seizure type produced. Results: LTG induced worsening in 17 (80%) patients, no change in three, and improvement in one. There was >50% increase in convulsive seizures in eight (40%) of 20 patients. Myoclonic seizures worsened in six (33%) of 18 patients. Of five patients improving in at least one seizure type, four had concomitant worsening of more invalidating seizures. Clear‐cut worsening appeared within 3 months in most patients but was insidious in some. LTG was suspended in 19 patients after 15 days‐5 years (mean, 14 months) with consequent improvement in 18. Conclusions: The pronounced seizure deterioration during LTG treatment was not attributable to the natural course of the disease and could be a direct effect of therapeutic LTG doses. LTG treatment seems inappropriate in SME.
EEG Background as Predictor of Electrographic Seizures in High‐Risk Neonates
Authors: Laroia Nirupama , Guillet Ronnie , Burchfiel James , McBride Margaret C. 
Published: August 2005

Summary: Purpose: Experience with continuous EEG monitoring in 29 consecutive infants at risk of neonatal seizures demonstrated that background abnormalities on the initial EEG were strongly associated with electrographic seizures in the subsequent 18–24 h. To test this association prospectively, we examined the relationship between EEG background and the presence of electrographic seizures in the next 22 at‐risk infants monitored for seizures. Methods: A standard EEG was recorded for each infant at risk for seizures. Based on specific criteria, the background was graded as normal; immature for age; or mildly, moderately, or severely abnormal. The EEG was then monitored continuously until no electrographic seizures were recorded for 18–24 h. Results: Findings in the retrospective group of 29 infants and the prospective group of 22 infants did not differ. For the combined 51 infants, a normal or immature initial EEG background predicted the absence of seizures in the subsequent 18–24 h with a sensitivity of 96% [confidence interval (CI) 0.88, 1.01 and specificity of 81% (CI 0.67, 0.96). Administration of antiepileptic drugs (AEDs) before the start of the EEG recording did not affect this association. Conclusions: In 51 consecutively monitored infants at risk for neonatal seizures, a normal or immature EEG background strongly predicted the absence of electrographic seizures in the subsequent 18–24 h; background abnormalities strongly predicted the occurrence of electrographic seizures concomitantly or in the subsequent 18–24 h of recording. Screening infants at risk for neonatal seizures with a routine EEG allows identification of infants at highest risk for seizures, thus conserving resources required for continuous EEG monitoring and facilitating early intervention for seizures.
Oral Health and Dental Treatment Needs in Nigerian Patients with Epilepsy
Authors: Ogunbodede E. O. , Adamolekun B. , Akintomide A. O. 
Published: August 2005

Summary: Purpose: We determined the prevalence of oral disorders and the dental treatment needs of outpatients with epilepsy. Methods: A questionnaire was administered to 56 consecutive patients (35 males, 21 females) presenting to an outpatient clinic. All patients underwent dental examinations. The clinical and diagnostic features of each patient's epilepsy were also obtained. Results: The mean age (±SD) of the patients was 25.1 ± 12.1 years (range, 12–56 years). Of 9 patients receiving phenytoin (PHT) monotherapy, 3 (33.3%) had gingival hypertrophy; 15 of 18 (83.3%) patients receiving PHT in combination with phenobarbital (PB) manifested the disorder. Traumatized anterior teeth were found in 26 (46.4%) patients with the males significantly more affected than females (p = 0.02). When the dental treatment needs were considered, 24 (42.9%) patients required dental prophylaxis with oral hygiene instruction, and an equal number required various types of restorative treatments. Only 13 patients (23.2%) had previously visited a dental clinic; the 43 (76.8%) who had never sought dental treatment claimed they did not see any need for it. Conclusions: Our study showed an increased predilection to anterior dental injuries in patients with epilepsy as compared with the prevalence earlier reported for those without epilepsy in Nigeria (p = 0.00). There is a clear need for effective interaction between medical and dental practitioners in the management of epilepsy.
Surgical Outcome in Patients with Epilepsy with Occult Vascular Malformations Treated with Lesionectomy
Authors: Abson Kraemer Diana L. , Griebel May L. , Lee Namsoo , Friedman Allan H. , Radtke Rodney A. 
Published: August 2005

Summary: Purpose: This retrospective study reports the long‐term surgical outcome of patients with medically refractory epilepsy and vascular malformations who were treated with lesionectomy. A detailed analysis of surgical failures had been performed in an attempt to define predictors of surgical success and failure. Methods: Fifteen patients with medically intractable epilepsy and angiographically occult vascular malformations (AOVMs) were treated surgically with lesionectomy at Duke University Medical Center. Lesionectomy consisted of removal of the AOVM and surrounding hemosiderin‐stained brain only, without the use of electrocorticography (ECoG) to guide resection. Results: Eleven (73%) patients are seizure free after lesionectomy. Three showed no significant improvement, and one patient died, presumably after a seizure. Age of onset, duration of seizures, age at resection, and gender did not affect outcome. All patients with neocortical AOVMs in whom EEG findings correlated with the site of the lesion were seizure free after lesional resection. Treatment failures were associated with the presence of multiple intracranial lesions, poorly localized or diffuse EEG findings, discordant positron emission tomography (PET) imaging, or with a lesion in close proximity to the limbic system. Conclusions: Lesionectomy, with removal of surrounding hemosiderin‐stained brain, can be considered the procedure of choice in carefully selected patients with epilepsy with occult vascular malformations.
Longitudinal Quantitative Hippocampal Magnetic Resonance Imaging Study of Adults with Newly Diagnosed Partial Seizures: One‐Year Follow‐Up Results
Authors: Van Paesschen W. , Duncan J. S. , Stevens J. M. , Connelly A. 
Published: August 2005

Summary: Purpose: We wished to establish whether hippocampal changes occur in 1 year in adults with newly diagnosed partial seizures and, if so, to identify possible causes and mechanisms. Methods: Thirty‐six adult patients with newly diagnosed partial seizures underwent a magnetic resonance imaging (MRI) scan of the brain including hippocampal volume and T, relaxation time (HCT2) measurement and had a follow‐up quantitative MRI scan ∼1 year after the baseline MRI scan. Results: At baseline, 4 patients (11%) had hippocampal sclerosis (HS), 4 (11%) had abnormalities other than HS, and 28 had a normal MRI scan (78%). Twenty‐three patients (64%) had recurrent seizures in the period between the two MRI scans. One of the 4 patients with HS, who had daily seizures, had significantly increased HCT2 values on follow‐up, possibly reflecting progressive hippocampal damage. None of the 32 patients with MRI findings other than HS at baseline progressed to HS on follow‐up. However, 2 of the 32 patients had significant hippocampal changes, probably related to resolution of inflammatory swelling or edema after seizures were controlled. Conclusions: Subtle changes in hippocampi can occur in 1 year in adults with newly diagnosed partial seizures, which could be due to resolution of edema after seizure control or to hippocampal changes associated with frequent and daily seizures. Follow‐up of the studied cohort for several years will be required to settle the question of whether progressive hippocampal damage occurs in temporal lobe epilepsy (TLE).
Fixation‐Off and Eyes Closed Catamenial Generalized Nonconvulsive Status Epilepticus with Eyelid Myoclonic Jerks
Authors: Ming Xue , Kaplan Peter W. 
Published: August 2005

Summary: Purpose: Eyelid myoclonic jerks have been described in fixation‐off‐sensitive (FOS) epilepsy, but their relationship to nonconvulsive status epilepticus (NCSE) or to catamenial exacerbations is little reported. Methods: We describe a woman of normal intelligence with catamenial periods of prolonged NCSE who exhibited various intra‐ and interseizure thresholds of polyspike suppression when her eyes were open, with particular visual inputs and with antiepileptic drug (AED) treatment. Results: In one episode, on the first day of the woman's menstrual period, bursts of bilateral synchronous polyspike activity were briefly suppressed with visual fixation but were more lastingly suppressed after administration of lorazepam (LZP). During another period of NCSE, the SE was completely suppressed by visual fixation on objects and patterned checkerboard screens and by ocular convergence, was incompletely suppressed when her eyes were open in a dark room and when her eyes were open without visual fixation, but was not suppressed by mental activation alone. Conclusions: FOS polyspike bursts with eyelid myoclonic jerks may exhibit catamenial exacerbations, varying from completely suppressible with visual fixation to nonsuppressible during NCSE. These findings suggest an interplay between humoral factors, AEDs, and seizure threshold in this condition.
Occurrence, Outcome, and Prognostic Factors of Infantile Spasms and Lennox‐Gastaut Syndrome
Authors: Rantala Heikki , Putkonen Tuuli 
Published: August 2005

Summary: Purpose: To analyze the occurrence, outcome, and prognostic factors of infantile spasms (IS) and the Lennox‐Gastaut syndrome (LGS) in a defined population. Methods: All children treated because of IS and LGS in the Department of Pediatrics, University of Oulu, from January 1, 1976, until December 31, 1993, who came from the primary catchment area of the hospital were included. Detailed information concerning their individual pre‐, peri‐, and postnatal medical histories and medical and laboratory examinations were compiled. Results: Thirty‐seven children (18 boys) had IS, and 25 (14 boys) had LGS. The occurrence of IS of 0.41/1,000 live births [95% confidence interval (CI), 0.29–0.57/1,000] did not differ significantly from that of LGS, which was 0.28/1,000 live births (95% CI, 0.18–0.41/1,000). Ten (27%) of the 37 patients with IS evolved to LGS, which was 40% of the LGS cases. All the 10 children with both IS and LGS had symptomatic epilepsy, were mentally retarded, and had active epilepsy at the end of −10 years' follow‐up. Twenty‐six (87%) of the 30 symptomatic IS cases and all the 17 symptomatic LGS cases were due to either congenital or genetic etiologies. The outcome in cryptogenic IS cases was favorable; the risk for a poor neurologic and mental outcome was extremely low; odds ratio, 0.015 (95% CI, 0.001–0.196), as it was for therapy‐resistant epilepsy; odds ratio, 0.013 (95% CI, 0.001–0.166). In LGS patients, cryptogenic etiology did not decrease the risk for a poor outcome. Conclusions: Cryptogenic etiology is associated with a very low risk for a poor outcome in IS patients, but not in LGS patients. The outcome of IS children and the relation of IS to LGS are determined by the underlying brain disease, not by the epilepsy itself.
Valproate Treatment and Platelet Function: The Role of Arachidonate Metabolites
Authors: Kis Béla , Szupera Zoltán , Mezei Zsófia , Gecse Árpád , Telegdy Gyula , Vécsei László 
Published: August 2005

Summary: Purpose: Valproate (VPA) is an extensively used drug in the therapy of epilepsies. One of the most frequently reported side effects of VPA is hemorrhagic diathesis. Some authors emphasized the decreased platelet count as the basis of VPA‐induced hemorrhagic diathesis, but some reports suggested that a significant proportion of patients with normal platelet count may still have an altered platelet function. The mechanism of the VPA‐induced platelet dysfunction has not yet been elucidated. A determining element of platelet functions is the arachidonate cascade. Present ex vivo experiments were designed to determine whether a relation exists between the incidence of hemostasis caused by VPA and the effect of this drug on the arachidonate cascade of platelets. Methods: Platelets were isolated from patients receiving long‐term VPA treatment (serum level, 36.04 ± 16.12 μg/ml; n = 10) or carbamazepine (CBZ) treatment (serum level, 5.24 ± 2.67 μg/ml; n = 10) and were labeled with [14C]arachidonic acid. (CBZ‐treated patients were chosen as a control group, because CBZ causes blood dyscrasias similar to those elicited by VPA, but there has been no report that CBZ induces a platelet dysfunction.) The 14C‐eicosanoids were separated by means of overpressure thin‐layer chromatography and determined quantitatively by liquid scintillation. Results: Even when the mean plasma concentration of the drug was low, VPA treatment reduced the activity of the arachidonate cascade in platelets. VPA effectively inhibited the cyclooxygenase pathway and the synthesis of the strong platelet aggregator thromboxane A2. Conclusions: Inhibition of the platelet arachidonate cascade may contribute to the platelet‐function alterations caused by VPA.
Classification of Childhood Epilepsy Syndromes in Newly Diagnosed Epilepsy: Interrater Agreement and Reasons for Disagreement
Authors: Berg Anne T. , Levy Susan R. , Testa Francine M. , Shinnar Shlomo 
Published: August 2005

Summary: Purpose: The International League Against Epilepsy (ILAE) classification of the epilepsies is in increasingly widespread use. The following analysis was done to assess the interrater agreement in classifying epilepsy syndromes in children with newly diagnosed epilepsy. Methods: In a prospective, community‐based study, 613 children with newly diagnosed epilepsy were recruited. Based on information available at diagnosis or generated as part of the initial diagnostic assessment, three pediatric neurologists independently classified epilepsy syndromes. Interrater agreement was assessed with K. Results: Interrater agreement was extremely good, with k scores ≥0.80 for almost all comparisons. Relatively limited quality of the EEG and seizure information in some cases, as well as discrepancies between the two, were associated with a tendency for more disagreement. Conclusions: A high degree of interrater agreement was obtained in this study, indicating that the system for classifying syndromes can be meaningfully used in a community‐based sample. Quality of the information, which is often, by necessity, less than optimal in newly diagnosed epilepsy, is a potential barrier to identification of syndromes. A substantial proportion of children were classified into relatively nonspecific syndromes. Over time, additional information may come to light to allow more precise identification of their forms of epilepsy. In an epidemiologic setting, the ILAE classification of the epilepsies can be successfully used with a high degree of reliability to classify newly diagnosed epilepsy in children.