bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk Factors for Unsuccessful Testing During the Intracarotid Amobarbital Procedure in Preadolescent Children
Authors: Hamer Hajo M. , Wyllie Elaine , Stanford Lisa , Mascha Edward , Kotagal Prakash , Wolgamuth Barbara 
Published: August 2005

Summary: Purpose: Identification of risk factors for unsuccessful testing during intracarotid amobarbital procedure (IAP) in preadolescent children. Methods: A pediatric IAP protocol was attempted in 42 candidates for epilepsy surgery (5–12 years old; mean, 10 years) based on the ability to pass a practice test. Language dominance was defined by marked asymmetry until first verbal response and paraphasic errors. Intact hemispheric memory was defined by recall of 60% of test items. The odds ratios of baseline variables (age at IAP, Full‐Scale IQ, side of disease, age at seizure onset, amobarbital dose) were calculated for various IAP outcomes. Results: IAPs were accomplished in 40 children. Language dominance was established in 25 (62.5%) of 40 patients: all 21 focal resection candidates were left language dominant; four hemispherectomy candidates had intact language after injection of the damaged hemisphere. In 12 (30%) of 40 patients, language testing failed because of agitation or obtundation. Compared with the 21 children with language dominance established by bilateral IAP, these 12 children had lower mean Full‐Scale IQ (66.4 vs. 87.9; p = 0.014), and more frequently, the epileptogenic lesion in the left hemisphere (presumed dominant by right‐handedness; 78 vs. 33%; p = 0.04). Excluding hemispherectomy candidates (intentionally only one injection), memory testing could not be completed in 13 (36%) of 36 children because of obtundation or agitation. These children were significantly younger than the 23 (64%) of 36 with successful bilateral memory testing (mean age, 107.6 vs. 128.7 months; p = 0.006). The eight (25%) of 32 children with failing retention scores after ipsilateral injection had lower Full‐Scale IQ than did the 24 (75%) patients who passed (mean, 59.6 vs. 81.7 months; p = 0.03). Conclusions: The IAP successfully established hemispheric language dominance and memory representation for just under two thirds of the preselected preadolescent children. Risk factors for unsuccessful testing included low Full‐Scale IQ (especially <80), young age (especially <10 years), and seizures arising from the left hemisphere presumed dominant by right‐handedness.
Acute Single Photon Emission Computed Tomographic Study of Vagus Nerve Stimulation in Refractory Epilepsy
Authors: Vonck K. , Boon P. , Van Laere K. , D'Havé M. , Vandekerckhove T. , O'Connor S. , Brans B. , Dierckx R. , De Reuck J. 
Published: August 2005

Summary: Purpose: Left‐sided vagus nerve stimulation (VNS) is an efficacious treatment for patients with refractory epilepsy. The precise mechanism of action remains to be elucidated. Only limited data on VNS‐induced changes in regional cerebral blood flow (rCBF) are available. The aim of this study was to investigate rCBF changes during initial VNS with single‐photon emission computed tomography (SPECT). Methods: In 12 patients (8 women, 4 men) with mean age of 32 years and mean duration of epilepsy of 19 years, VNS‐induced rCBF changes were studied by means of a 99mTc‐ethyl cysteinate dimer activation study with a single‐day split‐dose protocol before and immediately after initial stimulation. Images were acquired on a triple‐head camera with fan‐beam collimators and were reconstructed with scatter and attenuation correction. After coregistration to a standardized template, both a semiquantitative analysis using predefined volumes‐of‐interest (VOIs) as well as voxel‐by‐voxel analysis of the intra‐subject activation were performed. During follow‐up, efficacy of VNS in terms of seizure‐frequency reduction was studied. Results: The semiquantitative analysis, with reference to the total counts in all VOIs, revealed a significant decrease of activity in the left thalamus immediately after the initial stimulation train. These results agreed with voxel‐by‐voxel analysis. In our study ipsilateral thalamic hypoperfusion was the most significant finding. Mean frequency of complex partial seizures was reduced from 30 per month before implantation to six per month after implantation. Conclusions: VNS induces rCBF changes immediately after initial stimulation that can be studied with SPECT. VNS‐induced changes in the thalamus may play an important role in suppression of seizures. However, no significant relation between the level of hypoperfusion and subsequent clinical efficacy was found.
Effect of Long‐Term Vigabatrin Administration on the Immature Rat Brain
Authors: Qiao M. , Malisza K. L. , Del Bigio M. R. , Kozlowski P. , Seshia S. S. , Tuor U. I. 
Published: August 2005

Summary: Purpose: To determine whether the neuropathologic changes produced by vigabatrin (VGB; γ‐vinyl GABA) administration in the developing rat brain are reversible. Methods: We injected rats daily with VGB (25–40 mg/kg/day, s.c.) from age 12 days for 2 weeks followed by 2 weeks of a drug‐free period. Behavioral testing, magnetic resonance (MR) imaging, biochemical assays, and histologic technique were used to assess the adverse effect of VGB in developing brain and its reversibility. Results: At the end of 2 weeks' VGB administration: (a) there was a hyperactivity and a shortened latency to escape out of cool water; (b) white matter appeared hyperintense in T2 and diffusion‐weighted MR images with 4–15% increases in T2; (c) microvacuolation, TUNEL‐positive nuclei, and swollen axons were observed in the corpus callosum; (d) myelin staining indicated a reduction in myelination, as did the reduction in activities of myelin and oligodendrocyte‐associated enzymes and the decrease in myelin basic protein on Western blots. Two weeks after stopping VGB administration: (a) MR images were normal, and microvacuolation was no longer in the white matter; (b) reduction in myelination reversed partially; (c) the T2 relaxation time remained elevated in the hypothalamus; and (d) the behavioral response remained abnormal. Conclusions: Long‐term VGB administration to young rats causes brain injury, which recovers partially on its cessation. The observed cell death, disrupted myelination, and alterations in behavior indicate a need for further safety assessment in infants and children.
Spatial Extent of Neuronal Metabolic Dysfunction Measured by Proton MR Spectroscopic Imaging in Patients with Localization‐Related Epilepsy
Authors: Li L. M. , Cendes F. , Andermann F. , Dubeau F. , Arnold D. L. 
Published: August 2005

Summary: Purpose: To assess the spatial extent of the decrease in the neuronal marker N‐acetyl‐aspartate (NAA) relative to creatine (Cr) in patients with localization‐related epilepsy, and to assess clinical differences between patients with and without widespread NAA/Cr reduction. Methods: We studied 51 patients with localization‐related epilepsy. Patients were divided into three groups according to the EEG investigation: (a) temporal lobe epilepsy (TLE, n = 21), (b) extratemporal lobe epilepsy (extra‐TLE, n = 20), and (c) multilobar epilepsy (patients with a wider epileptogenic zone, n = 10). We acquired proton magnetic resonance (MR) spectrocopic imaging (1H‐MRSI) of temporal and frontocentroparietal regions in separate examinations for both patients and controls. NAA/Cr values 2 standard deviations below the mean of normal controls were considered abnormal. Results: Twenty‐three (45%) patients including 12 with TLE had normal MR imaging including volumetric studies of the hippocampus. Forty‐nine (96%) patients had low NAA/Cr, indicating neuronal dysfunction in either temporal and/or extra‐temporal 1H‐MRSIs; 38% of patients with TLE and 50% of patients with extra‐TLE also had NAA/Cr reduction outside the clinical and EEG‐defined primary epileptogenic area. The NAA/Cr reduction was more often widespread in the multilobar group [six (60%) of 10] than in temporal or extratemporal groups [five (31%) of 16]. Nonparametric tests of (a) seizure duration, (b) seizure frequency, and (c) lifetime estimated seizures showed no statistically significant difference (p > 0.05) for TLE and extra‐TLE patients with or without NAA/Cr reduction outside the seizure focus. Conclusions: Of patients with localization‐related epilepsy, 40–50% have neuronal metabolic dysfunction that extends beyond the epileptogenic zone defined by clinical‐EEG and/or the structural abnormality defined by MRI.
Cortical Excitability in Cryptogenic Localization‐Related Epilepsy: Interictal Transcranial Magnetic Stimulation Studies
Authors: Cantello R. , Civardi C. , Cavalli A. , Varrasi C. , Tarletti R. , Monaco F. , Migliaretti G. 
Published: August 2005

Summary: Purpose: To assess whether single‐ and paired‐pulse transcranial magnetic stimulation (TMS) can measure the interictal brain excitability of medicated patients with cryptogenic localization related epilepsy (CLE). Changes in the balance between excitation and inhibition are the core phenomena in focal epileptogenesis. TMS can assess this balance in the primary motor cortex. Methods: We selected 18 patients with CLE and similar clinical features in whom we located the epileptogenic area reliably, with 11 age‐ and sex‐matched healthy controls. For both motor cortices, we determined the threshold to TMS, the duration of the cortical silent period, and the corticocortical inhibition and facilitation curve. Results: TMS was safe. The more antiepileptic drugs (AEDs) taken by the patients, the higher their threshold to TMS. The silent period duration failed to show significant changes. On paired TMS, a cluster analysis identified a homogeneous subgroup of patients (n = 7) who showed a significantly defective corticocortical inhibition and excess facilitation. With respect to the epileptogenic area, the phenomenon was bilateral in four of these patients, ipsilateral in two, and contralateral in one. The phenomenon was independent of AEDs and many other clinical variables. However, this patient group had a higher seizure frequency and a higher proportion of electroencephalograms (EEGs) showing interictal generalized epileptic discharges than the rest of the patients. Conclusion: Paired TMS provided a valuable pathophysiologic insight into the interictal excitatory state of the cortex in CLE. This method can potentially supply useful prognostic clinical information.
Markedly Elevated Nitrate/Nitrite Levels in the Cerebrospinal Fluid of Children with Progressive Encephalopathy with Edema, Hypsarrhythmia, and Optic Atrophy (PEHO Syndrome)
Authors: Vanhatalo Sampsa , Riikonen Raili 
Published: August 2005

Summary: Purpose: To compare the levels of brain nitric oxide production in patients with PEHO or PEHO‐like syndrome and in controls with other neurologic disease. Methods: Nitric oxide metabolites, nitrates, and nitrites (NNx), were measured in the cerebrospinal fluid (CSF) of children with PEHO syndrome or PEHO‐like syndrome, and in controls with other neurologic diseases. Results: The NNx levels were markedly higher in both PEHO (mean, 48 μM; p < 0.001) and PEHO‐like (22 μM; p < 0.003) patients as compared with the controls (6 μM), but did not correlate with age or with brain atrophy or CSF levels of insulin‐like growth factor‐1 (IGF‐1). Conclusions: Our findings suggest that in PEHO syndrome, production of nitric oxide is markedly increased, suggesting that nitric oxide is involved in the pathologic phenomena (i.e., seizures and neurodegeneration) of the disease.
Lateralization of Temporal Lobe Epilepsy (TLE) and Discrimination of TLE from Extra‐TLE Using Pattern Analysis of Magnetic Resonance Spectroscopic and Volumetric Data
Authors: Li Li Min , Caramanos Zografos , Cendes Fernando , Andermann Frederick , Antel Samson B. , Dubeau François , Arnold Douglas L. 
Published: August 2005

Summary: Purpose: To examine whether or not pattern analysis of magnetic resonance volumetric (MRVol) and proton magnetic resonance spectroscopic imaging (1H‐MRSI) data would enable (a) the accurate lateralization of temporal lobe epilepsy (TLE) and (b) the discrimination of TLE from extra‐temporal epilepsy (E‐TLE). Methods: For lateralization analysis, we used data from 150 nonforeign tissue lesional TLE patients [88 left‐sided (L‐TLE), 46 right‐sided (R‐TLE), and 16 bilateral (Bi‐TLE)]. For the discrimination of TLE from E‐TLE, we used data from 174 patients (145 with unilateral TLE, 14 with unilateral E‐TLE, and 15 with widespread epileptogenic zones involving both the TL and extra‐TL regions—multilobar epilepsy). A series of “leave‐one‐out” cross‐validated linear discriminant analyses were performed using the MRVol and 1H‐MRSI data sets to lateralize TLE and discriminate it from E‐TLE. Results: Lateralization: The leave‐one‐out linear discriminant analyses were able to correctly lateralize (with a posterior probability >0.50) 120 (90%) of the 134 L‐TLE and R‐TLE patients. Imposing higher posterior probability (>0.95) increased accuracy of lateralization to 98%, with only two discordant cases who underwent surgery on the side of electroencephalogram, and both had bad outcome. Discrimination: the leave‐one‐out linear discriminant analyses were able to correctly classify (with a posterior probability >0.50) 142 (89%) of the 159 TLE and E‐TLE patients. Accuracy increased slightly as higher posterior probability cutoffs were imposed, with fewer patients being classified. Conclusions: Pattern analysis of 1H‐MRSI and MRVol data can accurately lateralize TLE. Discriminating TLE from E‐TLE was less accurate, probably due to the presence of temporal lobe damage in some patients with E‐TLE reflecting dual pathology.
Rectal Absorption of Lamotrigine Compressed Tablets
Authors: Birnbaum Angela K. , Kriel Robert L. , Burkhardt R. Todd , Remmel Rory P. 
Published: August 2005

Summary: Purpose: Interruption of oral drug administration poses a significant clinical problem for antiepileptic drugs that have no parenteral formulation. If a drug is absorbed rectally, rectal administration can be a useful alternative when the oral route of administration is not possible. The purpose of this study was to compare the single‐dose pharmacokinetics of la‐motrigine (LTG) compressed tablets after rectal and oral administration in healthy volunteers. Methods: A single LTG compressed tablet (100 mg) was administered orally and rectally to 12 volunteers in this single‐dose, two‐period, crossover study with a 2‐week washout between doses. For rectal administration, tablets were crushed and suspended in 10 mL of water. Plasma samples were collected from 0 to 120 hr after each dose and analyzed for LTG by an HPLC method developed for this investigation. Results: LTG plasma concentrations were lower after rectal administration versus oral administration. The average area under the curve was 28.90 ± 9.5 μg/mL/hr after rectal administration and 51.71 ± 19.2 μg/mL/hr after oral administration. The average maximum LTG concentration was 0.53 ± 0.14 μg/mL after rectal administration and 1.45 ± 0.35 μg/mL after oral administration. The relative bioavailability for LTG compressed tablets was 0.63 ± 0.33 for rectal administration. There were no drug‐related rashes or serious side effects. Conclusions: LTG suspension prepared from LTG compressed tablets is absorbed rectally, although not to the same extent or rate as when given orally.
Valproic Acid‐Induced Hyperammonemic Encephalopathy with Triphasic Waves
Authors: Kifune Akira , Kubota Fumio , Shibata Nobuyoshi , Akata Takushirou , Kikuchi Senichirou 
Published: August 2005

Summary: Purpose: To examine a patient with valproic acid (VPA)‐induced hyperammonemic encephalopathy accompanied by triphasic waves. Methods: A 61‐year‐old male patient with epilepsy experienced disturbance of consciousness after VPA dose was increased because of poor seizure control. The electroencephalogram (EEG) taken on admission revealed triphasic waves and high‐amplitude δ‐activity with frontal predominance. Although serum hepatic enzymes, such as AST and ALT, were normal, serum ammonium level was high at 96 μg/dl (normal range, 3–47 μg/dl). Serum amino acid analysis showed multiple minor abnormalities. Administration of VPA was discontinued immediately after admission, while other anticonvulsants were continued. Results: The patient's condition was improved on the fourth day of admission. An EEG, serum ammonium level, and amino acid profile were normal on the eighth day. Based on VPA administration, serum ammonium levels, and results of amino acid analysis, this patient had VPA‐induced hyperammonemic encephalopathy. Conclusions: Our case indicates that caution is required if triphasic waves appear in VPA‐induced hyperammonemic encephalopathy.
Status Epilepticus–Induced Neuronal Loss in Humans Without Systemic Complications or Epilepsy
Authors: Fujikawa Denson G. , Itabashi Hideo H. , Wu Aiguo , Shinmei Steve S. 
Published: August 2005

Summary: Purpose: To determine the regional distribution of neuronal damage caused strictly by status epilepticus (SE) without systemic complications, underlying brain pathology, or a history of preexisting epilepsy. Methods: The medical records and electroencephalograms (EEGs) of three deceased patients who developed SE in the hospital were reviewed. Their brains were formalin‐fixed, and 17 brain regions were selected, embedded in paraffin, and sectioned. Alternate sections were stained with either hematoxylin and eosin and cresyl violet to determine the extent of neuronal loss and gliosis or glial fibrillary astrocytic protein to confirm the extent of astrocytic proliferation. Results: The three patients died 11 to 27 days after the onset of focal motor SE; none had hypotension, hypoxemia, hypoglycemia, or significant hyperthermia. Two patients had no prior seizures and no underlying brain pathology. The third patient, who had leptomeningeal carcinomatosis, had one seizure 2 months before the onset of SE. The duration of SE was 8.8 hours to 3 days. EEGs showed unilateral temporal lobe sharp‐wave discharges in one patient and independent temporal lobe sharp‐wave discharges bilaterally in the other two patients. In addition to widespread neuronal loss and reactive gliosis in the hippocampus, amygdala, dorsomedial thalamic nucleus, and Purkinje cell layer of the cerebellum, we report for the first time periamygdaloid (piriform) and entorhinal cortical damage occurring acutely after SE in humans. Conclusions: In the absence of systemic complications or preexisting epilepsy, SE produces neuronal loss in a distribution similar to that from domoic acid‐induced SE in humans and from kainic acid‐ and pilocarpine‐induced SE in rats.
Prevalence, Knowledge, Attitude, and Practice of Epilepsy in Kerala, South India
Authors: Radhakrishnan K. , Pandian J. D. , Santhoshkumar T. , Thomas S. V. , Deetha T. D. , Sarma P. S. , Jayachandran D. , Mohamed E. 
Published: August 2005

Summary: Purpose: To ascertain the prevalence and pattern of epilepsy and to characterize and quantify knowledge, attitude, and practice (KAP) toward epilepsy among the people of the state of Kerala, which is distinguished from the rest of India by a high level of literacy and health awareness of its population. Methods: We conducted a door‐to‐door survey covering the entire population of 238,102 people residing in 43,681 households in a semiurban area of central Kerala. The screening questionnaire administered by medical social workers had a sensitivity of 100% for identifying persons with epilepsy. Neurologists examined all the individuals suspected of having epilepsy. We evaluated KAP toward epilepsy among 1,118 subjects (439 males and 679 females; mean age, 33.3 years; age range, 15–85 years) from households without epilepsy in the study area. Results: Through a three‐phased survey, we ascertained 1,175 cases (616 males and 559 females) with active epilepsy, providing a crude point prevalence ratio of 4.9 cases per 1,000 people and an age‐adjusted prevalence ratio of 4.7 cases per 1,000 population. The highest age‐specific prevalence rate of 6.5 per 1,000 occurred in the 10‐ to 19‐year‐old age group. Sex‐specific prevalence rates did not significantly differ. The proportion of generalized and localization‐related epilepsies was 58.8% and 30.6%, respectively. Ninety‐nine percent of the KAP respondents had read or heard about epilepsy. Thirty‐one percent and 27% thought epilepsy was a hereditary disorder and a form of insanity, respectively. About 40% of the respondents felt that individuals with epilepsy could not be properly educated or employed. Eleven percent would object to their children having contact with epileptic children. Conclusions: The prevalence and pattern of epilepsy in central Kerala, South India, do not differ from that of developed countries. Although the awareness of epilepsy among the people of Kerala was comparable to that of developed countries, the attitudes were much more negative. The need for educating the people of Kerala on epilepsy and for incorporating an adequate knowledge of epilepsy in the school curricula cannot be overemphasized.
Autonomic Seizures Versus Syncope in 18q‐ Deletion Syndrome: A Case Report
Authors: Sturm Kerstin , Knake Susanne , Schomburg Ulrich , Wakat Jörg‐P. , Hamer Hajo M. , Fritz Barbara , Oertel Wolfgang H. , Rosenow Felix 
Published: August 2005

Summary: Purpose: The 18q‐ deletion syndrome (18qDS) is frequently associated with cardiac anomalies. Patients with this syndrome may also have epilepsy, which presents certain diagnostic difficulties. This case report aims to illustrate these diagnostic problems, document the usefulness of heart rate‐based seizure detection algorithms in this setting, and define the epilepsy syndrome associated with 18qDS. Methods: Closed‐circuit video electroencephalogram (EEG) monitoring using a heart rate–based seizure detection software was used to identify the event in question and to establish the diagnosis of epilepsy. Chromosomal analysis and magnetic resonance imaging (MRI) were used to further define the epilepsy syndrome. Results: We report on a patient with an atrial septal defect, enlargement of the right heart, and incomplete right bundle branch block, who developed episodes of tachycardia, loss of consciousness, and pallor, for which he was amnesic. Chromosomal analysis demonstrated karyotype 46, XY, del(18)(q21.3). ish del(18)(wcp18+, D18Z1+) with a loss of the gene for myelin basic protein. MRI revealed multifocal dysmyelination. Video‐EEG monitoring using an electrocardiogram (ECG)‐triggered seizure detection software proved to be indispensable in detecting an autonomic seizure and establishing the correct diagnosis; the procedure also allowed for the definition of the epilepsy syndrome. The patient was treated with carbamazepine and remained seizure‐free. Conclusions: Video‐EEG monitoring using a heart rate‐based seizure detection software can be helpful in diagnostically differentiating autonomic seizures from syncope. Dysmyelination due to loss of the myelin basic protein gene on 18q and cortical dysgenesis may be of pathogenic relevance.