bluuebunny/crossref_metadata_2025_split huggingface dataset:
Profile of Antiepileptic Pharmacotherapy in a Tertiary Referral Center in South India: A Pharmacoepidemiologic and Pharmacoeconomic Study
Authors: Radhakrishnan K. , Nayak S. Dinesh , Kumar S. Pradeep , Sarma P. Sankara 
Published: August 2005

Summary: Purpose: To study the current pharmacotherapy practices of epilepsy and its economics in a developing country by correlating the epidemiology and economics of antiepileptic drug (AED) treatment in general epilepsy care and comprehensive epilepsy care. Methods: We compared the AED‐use profiles, efficacy, and tolerability at entry and at last follow‐up for 972 patients seen at a comprehensive epilepsy care program in South India from 1993 to 1995. The relative cost was expressed as the average percentage of the per capita gross national product (GNP/capita) each individual spent for AED treatment. Results: At entry, 562 (57.8%) subjects were receiving poly‐therapy; at last follow‐up, 743 (76.4%) patients were receiving monotherapy, an increase of 34.3% in the use of monotherapy. One or more adverse drug reactions were reported by 28.6% of patients at entry and by 19.8% at last follow‐up. The proportion of patients who were seizure free increased from 29.0 to 44.8%. Carbamazepine (CBZ) was the most frequently used AED, followed by diphenylhydantoin (DPH), valproate (VPA), and phenobarbitone (PB). The relative cost (% GNP/capita) for standard AEDs were as follows: PB, 4.4%; DPH, 7.1%; CBZ, 16.8%; and VPA, 29.5%. The average annual cost of AED treatment per patient in U.S. dollars was $64.32 at entry and $47.73 at last follow‐up. Reduction in polytherapy resulted in the net annual saving of $16,128 ($16.59 per patient, or 5.4% GNP/capita). Conclusions: The more frequent use of relatively expensive drugs like CBZ and VPA and the use of polytherapy—still quite prevalent in developing countries—has escalated the cost of AED therapy. Although in recent years AEDs have become more available in developing regions, primary and secondary care physicians have not been adequately educated about the current trends in the pharmacotherapy of epilepsy.
Referral Patterns of Family Physicians May Allow Population‐Based Incidence Studies of Childhood Epilepsy
Authors: Speechley Kathy Nixon , Levin Simon D. , Wiebe Samuel , Blume Warren T. 
Published: August 2005

Summary: Purpose: To evaluate the burden of illness of childhood epilepsy on patient, care giver, and society, representative incidence cohorts must be followed longitudinally. Case ascertainment through pediatricians and neurologists would be a valid method if family physicians refered all new cases of childhood epilepsy. The study objective was to determine whether family physicians' physicians patterns in Southwestern Ontario make it possible to conduct a population‐based incidence study of childhood epilepsy by sampling only from specialists' specialists. Methods: Of the 1,718 family physicians practicing in South‐western Ontario, a systematic sample participated in a mailed survey. Case simulations describing seven types of childhood seizures were presented to physicians with instructions to respond as to whether they would investigate/manage without referral; refer to a specialist only if problems occurred; or refer to a specialist always. Results: Of 214 family physicians, 185 (86.4%) returned completed surveys; 86% would not refer a child with a febrile seizure. Referral to a specialist would be made always by 93% of family physicians for patients with status epilepticus, 95% for worsening partial epilepsy, 82% for a first, brief, generalized clonic seizure, 80% for absence epilepsy, and 99% for neonatal seizures. Only 50% of family physicians would always refer a neurodevelopmentally abnormal child with generalized clonic epilepsy, but a further 37% would refer if problems occurred. Conclusions: It is feasible to recruit a representative population‐based cohort of recently diagnosed patients for epide‐miologic studies of childhood epilepsy by surveying pediatricians and neurologists. These survey results could be used to adjust estimates of incidence obtained through specialists' specialists for the bias in case ascertainment that may result from this practical method.
Family Studies and Human Leukocyte Antigen Class II Typing in Indian Probands with Seizures in Association with Single Small Enhancing Computed Tomography Lesions
Authors: Jain S. , Padma M. V. , Kanga U. , Mehra N. K. , Puri A. , Maheshwari M. C. 
Published: August 2005

Summary: Purpose: To define the clinical features of the syndrome of seizures associated with single, small, enhancing computed tomography (CT) lesions (SSELs) in 235 Indian probands and seizure types among their family members. Human leukocyte antigen (HLA) class II genomic typing in randomly selected 41 probands was done to identify the role of hereditary factors in this syndrome. Methods: The seizure types among 235 probands, their clinical outcome, and seizures in their family members were studied. Family data were collected on relatives of 212 additional probands with neurologic diseases other than epilepsy. HLA class II antigens were studied by using polymerase chain reaction (PCR) amplified DNA and sequence‐specific oligonucleotide probe (PCR‐SSOP) hybridization. Results: The seizures in 86% were partial with or without generalization; 77% had fewer than five seizures before the first CT scan. Evanescent focal neurologic deficits after seizures were noted in 40%. Most patients (97%) were treated with a single antiepileptic drug (AED). Significant resolution of the CT scan lesion was noted within 6 months in 125 (53%) of 235 cases. Two thirds of patients had no seizures while taking a single AED, and an additional 18% had no seizures even after their AEDs were discontinued. Epilepsy among relatives of Indian probands having seizures in association with SSELs was more common as compared with relatives of probands with other neurologic diseases. A family history of seizures was noted in 21% probands, the ratio of affected first‐ to second‐ degree relatives was 4.3:1, and 60% of affected sibs had syndromic concordance with probands. There was a positive association of HLA‐DRB1*13 (Pc= 0.036) with this syndrome. Conclusions: The syndrome of seizures in association with SSELs seems to be a benign localization‐related epileptic syndrome. Our results of HLA studies point to an inherited susceptibility to an infective agent, which in most cases is of cysticercal etiology.
Prognostic Implication of Contralateral Secondary Electrographic Seizures in Temporal Lobe Epilepsy
Authors: Lee Ki Hyeong , Park Yong D. , King Don W. , Meador Kimford J. , Loring David W. , Murro Anthony M. , Smith Joseph W. 
Published: August 2005

Summary: Purpose: Interhemispheric propagation of seizures in temporal lobe epilepsy is frequently noted during intracranial EEG monitoring. We hypothesized that a distinct secondary electrographic seizure (DSES) in the temporal lobe contralateral to primary seizure onset may be an unfavorable prognostic indicator. Methods: We reviewed intracranial depth electrode EEG recordings, 1‐year outcome, and medical records of 51 patients (M 29, F 22: age 15–64 years) who underwent anterior temporal lobectomy during 1988–96. We defined DSES as a seizure that spread to the contralateral temporal lobe and produced distinct contralateral EEG features. The distinct feature was focal involvement of one or two electrode contacts at onset, which starts and evolves independently from the ipsilateral temporal lobe. We considered DSES as the predominant seizure pattern when it occurred in more than one half of the patients' recorded seizures. Results: Only nine of 19 (47%) patients with predominant DSES had a 1‐year seizure‐free outcome, whereas 27 of 32 (84%) patients without predominant DSES had a 1‐year seizure‐free outcome (p <0.01). Bitemporal independent seizures were more common in patients with predominant DSES (9/19 versus 0/32; p <0.001). Conclusion: Our results suggest that distinct contralateral secondary electrographic seizure is a predictor of unfavorable outcome and is also more likely to be associated with bitemporal seizures.
The Clinical Usefulness of Ictal Surface EEG in Neocortical Epilepsy
Authors: Lee Sang Kun , Kim Joo‐Yong , Hong Keun‐Sik , Nam Hyun‐Woo , Park Sung‐Ho , Chung Chun‐Ki 
Published: August 2005

Summary: Purpose: Localizable scalp EEGs, during ictal episodes, appear to be rare in neocortical epileptic syndromes. However, studies based on large numbers of patients are also rare. This study aims to identify the characteristic patterns of variable neocortical epilepsies and to evaluate their clinical usefulness in the localization of epileptogenic focuses. Methods: We retrospectively assessed 394 noninvasive ictal recordings from 86 patients who subsequently underwent invasive study and resective surgery. Ictal EEGs were recorded using a video‐EEG monitoring system with electrodes placed according to the International 10–20 system, with additional anterior temporal electrodes. The ictal recordings were analyzed according to localizing accuracy and frequency characteristics. The durations of discrete or regional ictal rhythms were also measured. Results: The percentage of discrete or regional EEGs was 23% in frontal lobe epilepsy, 52% in lateral temporal lobe epilepsy, 70% in occipital lobe epilepsy, and 10% in parietal lobe epilepsy. In order of frequency, the localizable ictal rhythms were theta, beta, alpha, delta, and rhythmic spike‐and‐wave. The duration of discrete or regional ictal rhythms was significantly shorter in frontal lobe epilepsy and parietal lobe epilepsy than in other epilepsies. Ictal beta activity was the most common rhythm in discrete‐patterned EEGs. Structural lesions found on MRI did not significantly affect the localization of epileptogenic focuses in the patients. The type of seizure was not related to the degree of localization, with the exception of simple partial seizure. Conclusions: Ictal surface EEG was clinically helpful in the localization of epileptogenic focuses in at least some neocortical epileptic syndromes.
Neurocognitive Attention and Behavior Outcome of School‐Age Children with a History of Febrile Convulsions: A Population Study
Authors: Chang Ying‐Chao , Guo Nai‐Wen , Huang Chao‐Ching , Wang Shan‐Tair , Tsai Jing‐Jane 
Published: August 2005

Summary: Purpose: A prospective population‐based case‐control study was performed to ascertain whether febrile convulsion (FC) in early childhood is associated with neurocognitive attention deficits in school age. Methods: A total of 103 children, confirmed to have FC by age 3 years from a population survey of 4,340 live‐birth new‐borns in Tainan City, Taiwan, was followed up until at least age 6 years. An achievement test, behavioral ratings, and computerized neurocognitive battery assessing various subcomponents of attention were given to 87 FC children (FC group) and 87 randomly selected population‐matched control (CC group). Results: Compared with the CC group, the FC group did not have scholastic performance or behavioral outcome disadvantage. Overall FC group performance was distinguished by significantly higher scores in the achievement test and fewer missing errors (p <0.005) and commission errors (p <0.05), less variability in reaction time (p <0.005), and a nonsignificant trend of impulsivity. Attention performance of the FC and CC groups were comparable. Within the FC group, age at onset, complex FC, recurrence of FC, development of unprovoked seizures, or prior use of phenobarbital had no adverse effects on neurocognitive attention outcome. Conclusions: This population study suggests that FC in early childhood does not have adverse effects on behavior, scholastic performance, and neurocognitive attention. On the contrary, the FC group demonstrated significantly better control of distractibility and attention at school age.
Functional Mapping of the Insular Cortex: Clinical Implication in Temporal Lobe Epilepsy
Authors: Ostrowsky Karine , Isnard Jean , Ryvlin Philippe , Guénot Marc , Fischer Catherine , Mauguière Francois 
Published: August 2005

Summary: Purpose: We report the results of 75 intracortical electrical stimulations of the insular cortex performed in 14 patients during stereo‐electroencephalography (SEEG) investigation of drug‐resistant partial epilepsy. The insular cortex was investigated on electroclinical arguments suggesting the possibility of a perisylvian spread or a rapid multilobar diffusion of the discharges during video EEG. Methods: In these 14 patients, 27 stereotactically implanted transopercular electrodes reached the insular cortex (11 the right insula, 16 the left insula). Square pulses of current were applied between the two deepest adjacent contacts of each transopercular electrode using low (1 Hz) or high‐frequency (50 Hz) stimulation. Only symptoms evoked in the absence of afterdischarges were analyzed. Results: Clinical responses were evoked in 10 of the 14 patients (in 20 of the 27 insular sites) and showed a clear topographic specificity inside the insular cortex. Viscerosensitive and visceromotor responses, similar to those evoked by temporomesial stimulation, were evoked by anterior insular stimulation and somesthetic sensation, similar to those evoked by opercular cortex stimulation, by posterior insular stimulation. Conclusions: The topographic organization of the induced responses within the insular cortex suggest that two different cortical networks, a visceral network extending to the temporomesial structures and a somesthetic network reaching the opercular cortex, are disturbed with stimulation of the anterior or the posterior insula, respectively. Thus ictal symptoms associated with the spread of the epileptic discharges to the insular cortex might be difficult to distinguish from those usually reported during temporomesial or opercular discharges.
Relationships Between Seizure Severity and Health‐Related Quality of Life in Refractory Localization‐Related Epilepsy
Authors: Vickrey Barbara G. , Berg Anne T. , Sperling Michael R. , Shinnar Shlomo , Langfitt John T. , Bazil Carl W. , Walczak Thaddeus S. , Pacia Steven , Kim Sehyun , Spencer Susan S. ,   for the Multicenter Epilepsy Surgery Study
Published: August 2005

Summary: Purpose: To evaluate relationships between self‐report measures of seizure severity and health‐related quality of life (HRQOL) in people with refractory localization‐related epilepsy. Methods: A sample of 340 adults enrolled in a seven‐center, prospective study of resective epilepsy surgery completed baseline questionnaires that included the Quality of Life in Epilepsy (QOLIE)‐89 and a seven‐item adaptation of the National Hospital Seizure Severity Scale. Associations between QOLIE‐89 summary measures and both the total seizure severity scale score and individual seizure severity items were assessed, after adjustment for seizure frequency. Results: The seizure severity measure had adequate scale score variability and reliability in this sample. Correlations between individual items in the scale did not exceed 0.43. Product‐moment partial correlations between the seizure severity scale and QOLIE‐89 summary measures ranged from −0.17 to −0.29 (all p values <0.01). Of the seven seizure severity items, the average time before individuals perceived they were “really back to normal” after their seizures was broadly related to all domains of HRQOL (r values ranged from −0.16 to −0.30; p values <0.01). Severity of injury during seizures was the only other item having more than minimal associations with HRQOL, and it was selectively related to the physical health measure. Higher frequency of falls during seizures was modestly related to less employment. Conclusions: This seizure severity measure assesses constructs that are generally distinct from HRQOL, except for moderate and broad associations between HRQOL and patient's perceptions of the average duration of recovery time after seizures. Recovery time may potentially be a useful clinical indicator of seizure severity that reflects meaningful impairment of HRQOL in adults with frequent seizures.
Effect of Ganaxolone on Flurothyl Seizures in Developing Rats
Authors: Liptáková Soňa , Velíšek Libor , Velíšková Jana , Moshé Solomon L. 
Published: August 2005

Summary: Purpose: To determine the effects of a newly synthesized epalon, ganaxolone (GNX), on primarily generalized seizures in rats of various ages during development. Epalons are classified as neuroactive steroids that interact at unique site of the GABAA receptor‐Cl− channel complex in the central nervous system. Methods: Sprague‐Dawley male rats were used at 9, 15, 30, and 60 postnatal days (PN). GNX dissolved in 2‐hydroxypropyl‐β‐cyclodextrine was administered intraperitoneally in different doses at various time points before flurothyl testing. The incidence and threshold of clonic and tonic‐clonic flurothyl seizures were evaluated. Behavioral changes were also assessed. Results: In all age groups, the effects of GNX were dose dependent and more prominent 10 min after its administration. In PN 60 and PN 30 rats, GNX had dose‐dependent anticon‐vulsant effects; tonic‐clonic seizures were more sensitive to GNX treatment than clonic seizures. In PN 15 and PN 9 rats, GNX demonstrated dose‐ and time‐dependent anticonvulsant effects against both types of flurothyl‐induced seizures. GNX was more effective in PN 15 rats than in other age groups, but at doses that altered motor behavior. Conclusions: GNX has anticonvulsant effects against flurothyl‐induced seizures in all age groups tested. Its effects are more prominent in the two younger age groups, especially in PN 15 rats, but are associated with motor side effects.
Factors Predictive of the Outcome of Frontal Lobe Epilepsy Surgery
Authors: Mosewich R. K. , So E. L. , O'Brien T. J. , Cascino G. D. , Sharbrough F. W. , Mars W. R. , Meyer F. B. , Jack C. R. , O'Brien P. C. 
Published: August 2005

Summary: Purpose: To identify factors that predict the outcome in seizure control after frontal lobe epilepsy surgery (FLES). FLES is the second most frequent type of epilepsy surgery, but the results are generally not as good as those after anterior temporal lobectomy. Methods: Our cohort consisted of 68 consecutive patients whose first epilepsy surgery involving the frontal lobe occurred between 1987 and 1994. Clinical history and results of imaging and electroencephalographic studies were reviewed in detail. Excellent outcome was defined as being seizure free or having only nondisabling seizures at last follow up. Results: Forty of the 68 patients (58.8%) had an excellent outcome; none of the patients with a history of childhood febrile seizures had an excellent outcome, whereas outcome was excellent in 63% of those without that history (p 0.01). The other significant presurgical factor was the presence of a potentially epileptogenic lesion in the frontal lobe on neuroimaging (excellent outcome in 72% when present versus 41% when absent, p 0.001). The only significant postsurgical factor was early postoperative seizure control in the first year (excellent outcome in 96% with early control versus 25% without, p 0.01). Conclusions: History of childhood febrile seizures is a poor prognostic factor in FLES patients. It may suggest that the structural basis of all or some of the patients' intractable seizures is mesial temporal sclerosis. On the other hand, neuro‐imaging detection of a potentially epileptogenic frontal lobe lesion and early postoperative seizure control are associated with subsequent excellent outcome.
Refractory Idiopathic Absence Status Epilepticus: A Probable Paradoxical Effect of Phenytoin and Carbamazepine
Authors: Osorio Ivan , Reed R. C. , Peltzer Jill N. 
Published: August 2005

Summary: Purpose: To compare the frequency of seizures and status epilepticus and their response to first‐line drugs in patients with idiopathic generalized epilepsies receiving carba‐mazepine or phenytoin to those receiving other drugs or no treatment. Methods: We performed a retrospective chart review of all cases of idiopathic generalized epilepsies treated by the authors between 1985 and 1994. We compared seizure frequency and mean intravenous benzodiazepine dose required to control absence status epilepticus, intraindividually in subjects on carba‐mazepine or phenytoin before and after discontinuation of these compounds, and interindividually to subjects without treatment or receiving other drugs. Results: Bouts of absence or tonic‐clonic status epilepticus and seizures in subjects treated with phenytoin or carbamaze‐pine at therapeutic concentrations were considerably more frequent and proved intractable to treatment with valproic acid or benzodiazepines, compared with a cohort of subjects also with idiopathic generalized epilepsies, but naive to, or receiving sub‐therapeutic or therapeutic doses of other agents. Conclusions: Our observations strongly suggest that therapeutic concentrations of phenytoin and carbamazepine exacerbate idiopathic generalized epilepsies. Subjects in whom absence is one of the seizure types seem at a particularly high risk for responding paradoxically. These findings underscore the value of accurate classification of seizures and particularly the syndromic approach to diagnosis and point to the potential for iatrogenic complications with indiscriminate use of antiseizure drugs.
Fenfluramine Blocks Low‐Mg2+‐Induced Epileptiform Activity in Rat Entorhinal Cortex
Authors: Gentsch K. , Heinemann U. , Schmitz B. , Behr J. 
Published: August 2005

Summary: Purpose: The entorhinal cortex (EC) represents the main input structure to the hippocampus and seems to be critically involved in temporal lobe epilepsy. Considering that the EC receives a strong serotonergic projection from the raphe nuclei and expresses a high density of serotonin (5‐HT) receptors, the effect of the 5‐HT–releasing drug fenfluramine (FFA) on epileptiform activity generated in the EC was investigated in an in vitro model of epilepsy. Methods: The experiments were performed on 43 horizontal slices containing the EC, the subiculum, and the hippocampal formation obtained from 230–250 g adult Wistar rats. Using extracellular recording techniques, we investigated the effect of bath‐applied FFA (200 μmol/L to 1 mmol/L) on epileptiform activity induced by omitting MgSO4 from the artificial cerebrospinal fluid. Results: We demonstrate that FFA reversibly blocks epileptiform activity in the EC. Surprisingly, in the presence of the 5‐HT uptake blocker paroxetine, the FFA‐induced effect was diminished. Coapplication of the 5‐HTIA receptor antagonist WAY 100635 prevented the FFA‐induced anticonvulsive effect, suggesting that (a) the FFA‐induced suppression of epileptiform activity is mediated by the release of 5‐HT from synaptic terminals within the EC rather than by an unspecific effect of FFA and (b) released 5‐HT most likely blocks the activity by activation of 5‐HTIA receptors. Conclusion: FFA, which is primarily used because of its anorectic activity, might get an additional therapeutic value in the treatment of temporal lobe epilepsy with parahippocampal involvement.