bluuebunny/crossref_metadata_2025_split huggingface dataset:
Migraine and Coronary Heart Disease in Women and Men
Authors: Cook Nancy R. , Benseñor Isabela M. , Lotufo Paulo A. , Lee I‐Min , Skerrett Patrick J. , Chown Marilyn J. , Ajani Umed A. , Manson JoAnn E. , Buring Julie E. 
Published: March 2003

Objective.—We evaluated migraine as an independent risk factor for subsequent coronary heart disease (CHD) events among women in the Women's Health Study (WHS) and men in the Physicians' Health Study (PHS).Background.—Although several studies have suggested that migraine is associated with increased risk of stroke, there are few and conflicting data on whether migraine predicts risk of future CHD events.Methods.—The WHS is an ongoing randomized, double‐blind, placebo‐controlled trial of low‐dose aspirin and vitamin E in the primary prevention of cardiovascular disease and cancer in 39,876 women health professionals aged 45 years in 1993, and the PHS is a completed randomized, double‐blind, placebo‐controlled trial of aspirin and β‐carotene in the primary prevention of cardiovascular disease and cancer in 22,071 men physicians aged 40 to 84 years in 1982. Primary endpoints were defined as major CHD (nonfatal myocardial infarction [MI] or fatal CHD) and total CHD (major CHD plus angina and coronary revascularization).Results.—After adjusting for other CHD risk factors, female health professionals and male physicians reporting migraine were not at increased risk for subsequent major CHD (women: relative risk [RR], 0.83; 95% confidence interval [CI], 0.53 to 1.29; men: RR, 1.02; 95% Cl, 0.79 to 1.31) or total CHD (women: RR, 1.01; 95% Cl, 0.76 to 1.34; men: RR, 0.98; 95% Cl, 0.82 to 1.18). When considered separately, there was also no increase in risk of MI or angina.Conclusion.—These prospective data suggest that migraine is not associated with increased risk of subsequent CHD events in women or men.
Prognostic Significance of Failure of the Initial Antiepileptic Drug in Children with Absence Epilepsy
Authors: Wirrell Elaine , Camfield Carol , Camfield Peter , Dooley Joseph 
Published: March 2003

Summary:  Purpose: In children with childhood absence epilepsy (CAE) and juvenile absence epilepsy (JAE), to determine the impact of failure of initial antiepileptic drug (AED) for lack of efficacy in eventual seizure control and long‐term remission of epilepsy.Methods: Centralized EEG records for the province of Nova Scotia allowed identification of all children seen with CAE or JAE between 1977 and 1985. Information regarding success or failure of initial AED in fully controlling seizures and long‐term seizure control and remission of epilepsy was collected by patient questionnaire and chart review.Results: Eighty‐six of 92 eligible patients were followed up (75 CAE, 11 JAE). Initial AED treatment was successful in 52 (60%) of 86. Success tended to be greater for valproate (VPA) than for other AEDs (p = 0.07), and lower if generalized tonic–clonic or myoclonic seizures coexisted (p < 0.004 and p < 0.03). Terminal remission was more likely if the initial AED was successful than if it had failed (69% vs. 41%; p < 0.02). Compared with those in whom the initial AED was successful, subjects whose initial AED had failed were more likely to progress to juvenile myoclonic epilepsy (JME) at last follow‐up (32% vs. 10%; p < 0.02) and to develop intractable epilepsy (17% vs. 2%; p < 0.04).Conclusions: Initial AED was successful in 60% of children with AE. If the first AED failed, the outcome was less favorable, with a lower rate of terminal remission and a higher rate of progression to JME and intractable epilepsy.
Interictal 99mTc‐HMPAO SPECT in Temporal Lobe Epilepsy: Relation to Clinical Variables
Authors: Avery Robert A. , Zubal I. George , Studholme Colin , Slawski Jessica , Corsi Maria , Spencer Dennis D. , Spencer Susan S. 
Published: March 2003

Summary:  Purpose: Factors affecting blood flow observed by interictal single‐photon emission computed tomography (SPECT) images in temporal lobe epilepsy (TLE) have not been systematically studied or consistently demonstrated. We evaluated interictal SPECT results with respect to many clinical variables in a large population of TLE patients, all of whom underwent temporal lobectomy.Methods: Interictal 99mTc‐HMPAO SPECT scans from 61 TLE patients were obtained before an anterior temporal lobectomy. SPECT was analyzed using a region of interest analysis (ROI) in the cerebellum, anterior temporal lobe, lateral temporal lobe, mesial temporal lobe, whole temporal lobe, and inferior frontal lobe. Asymmetry indices (AIs) were calculated. Correlative analysis of AIs and clinical variables was performed.Results: The AIs from TLE patients differed significantly from those of controls in the anterior temporal (p < 0.01), lateral temporal (p < 0.001), and whole temporal (p < 0.01) regions. No consistent overall correlation between the AIs and clinical variables existed. In right TLE (RTLE) only, AIs in the lateral and whole temporal lobe were positively correlated with age of onset (r = 0.470, p < 0.05; r = 0.548, p < 0.01, respectively). Similarly, in RTLE only, duration of epilepsy was negatively correlated with the anterior (r = −0.395, p < 0.05) and mesial (r = −0.45, p < 0.05) temporal lobe AI. No correlations were found between clinical variables and AIs in left TLE (LTLE) patients.Conclusions: Significant correlation of age at onset and duration of epilepsy with AIs in RTLE but not LTLE suggests physiologic processes may be determined in part by laterality of TLE. Clinical applications are problematic.
Medically Intractable, Localization‐related Epilepsy with Normal MRI: Presurgical Evaluation and Surgical Outcome in 43 Patients
Authors: Siegel Adrian M. , Jobst Barbara C. , Thadani Vijay M. , Rhodes C. Harker , Lewis Petra J. , Roberts David W. , Williamson Peter D. 
Published: March 2003

Summary:  Purpose: High‐resolution magnetic resonance imaging (MRI) plays a crucial role in the presurgical evaluation of patients with medically refractory partial epilepsy. Although MRI detects a morphologic abnormality as the cause of the epilepsy in the majority of patients, some patients have a normal MRI. This study was undertaken to explore the hypothesis that in patients with normal MRI, invasive monitoring can lead to localization of the seizure‐onset zone and successful epilepsy surgery.Methods: A series of 115 patients with partial epilepsy who had undergone intracranial electrode evaluation (subdural strip, subdural grid, and/or depth electrodes) between February 1992 and February 1999 was analyzed retrospectively. Of these, 43 patients (37%) had a normal MRI.Results: Invasive monitoring detected a focal seizure onset in 25 (58%) patients, multifocal seizure origin in 12 (28%) patients, and in six patients, no focal seizure origin was found. Of the 25 patients with a focal seizure origin, cortical resection was performed in 24, of whom 20 (83%) had a good surgical outcome with respect to seizure control. Six of the 12 patients with multifocal seizure origin underwent other forms of epilepsy surgery (palliative cortical resection in two, anterior callosotomy in two, and vagal nerve stimulator placement in two).Conclusions: Successful epilepsy surgery is possible in patients with normal MRIs, but appropriate presurgical evaluations are necessary. In patients with evidence of multifocal seizure origin during noninvasive evaluation, invasive monitoring should generally be avoided.
Bilateral Medial Prefrontal and Temporal Neocortical Hypometabolism in Children with Epilepsy and Aggression
Authors: Juhász Csaba , Behen Michael E. , Muzik Otto , Chugani Diane C. , Chugani Harry T. 
Published: March 2003

Summary: Purpose:To identify brain regions with abnormal function in children with intractable partial epilepsy and aggressive behavior by using 2‐deoxy‐2‐[18F]fluoro‐d‐glucose (FDG) positron emission tomography (PET).Methods:Six children (mean age, 9.9 years) with intractable partial epilepsy and aggressive behavior underwent detailed psychodevelopmental assessment and FDG‐PET scanning. The objective technique of statistical parametric mapping (SPM) was applied to define focal abnormalities of glucose metabolism, and compared those with those of a group of normal adult subjects (n = 17) as well as age‐matched children with epilepsy with similar seizure characteristics but without aggression (n = 7). The findings were analyzed further by using a region‐of‐interest (ROI) approach.Results:The aggressive children all showed developmental delay, and four of them also manifested autistic symptoms. SPM analysis demonstrated extensive glucose hypometabolism in the aggressive group bilaterally in the temporal and prefrontal cortex compared with that in normal adult controls. A focal area of medial prefrontal glucose hypometabolism was defined in the aggressive children as compared with the nonaggressive pediatric group with SPM, whereas ROI comparison of these groups confirmed prefrontal hypometabolism and also showed glucose hypometabolism of the temporal neocortex in the aggressive children. Severity of aggression correlated inversely with glucose metabolism of the left temporal as well as bilateral medial prefrontal cortex.Conclusions:Bilateral prefrontal and temporal neocortical brain glucose hypometabolism in children with epilepsy and aggressive behavior may indicate a widespread dysfunction of cortical regions, which normally exert an inhibitory effect on subcortical aggressive impulses. PET studies may be used to elucidate the neurobiologic basis of aggressive behavior in children.
Hypohidrosis Related to the Administration of Topiramate to Children
Authors: Arcas Joaquín , Ferrer Teresa , Roche María C. , Martínez‐Bermejo Antonio , López‐Martín Valentín 
Published: March 2003

Summary:  Purpose: Topiramate (TPM) is an antiepileptic agent, first licensed in the United Kingdom in 1994, that is used in the treatment of patients with refractory seizure disorders. TPM is a monosaccharide d‐fructose derivate, with sulfamate function, and so far, few adverse side effects have been reported.Methods: We describe three patients with epilepsy who were treated with TPM and developed hypohidrosis, heat and exercise intolerance, as well as fever. The sudomotor function was assessed after peripheral stimulation with pilocarpine iontophoresis.Results: Sweat response was reduced in all three patients. Signs and symptoms ceased after drug suppression.Conclusions: This side effect associated with TPM, which has not been described previously, can be clinically significant during heat stress and exercise challenge.
Overexpression of Multiple Drug Resistance Genes in Endothelial Cells from Patients with Refractory Epilepsy
Authors: Dombrowski Stephen M. , Desai Shailesh Y. , Marroni Matteo , Cucullo Luca , Goodrich Kris , Bingaman William , Mayberg Marc R. , Bengez Ljiljana , Janigro Damir 
Published: March 2003

Summary: Purpose:It has been suggested that altered drug permeability across the blood–brain barrier (BBB) may be involved in pharmacoresistance to antiepileptic drugs (AEDs). To test this hypothesis further, we measured multiple drug resistance (MDR) gene expression in endothelial cells (ECs) isolated from temporal lobe blood vessels of patients with refractory epilepsy. ECs from umbilical cord or temporal lobe vessels obtained from aneurysm surgeries were used as comparison tissue.Methods:cDNA arrays were used to determineMDRexpression. MDR protein (MRP1) immunocytochemistry and Western blot analysis were used to confirm cDNA array data.Results:We found overexpression of selected MDR and significantly higher P‐glycoprotein levels in “epileptic” versus “control” ECs. Specifically,MDR1,cMRP/MRP2,andMRP5were upregulated in epileptic tissue, whereasPgp3/MDR3levels were comparable to those measured in comparison tissue. The gene encoding cisplatin resistance–associated protein (hCRA‐α) also was overexpressed in epileptic tissue. Immunocytochemical analysis revealed thatMDR1immunoreactivity was localized primarily in ECs; MRP1 protein levels also were significantly higher in epileptic tissue.Conclusions:Complex MDR expression changes may play a role in AEDs pharmacoresistance by altering the permeability of AEDs across the BBB.
Fosphenytoin: Pharmacokinetics and Tolerance of Intramuscular Loading Doses
Authors: Pryor Flavia M. , Gidal Barry , Ramsay R. Eugene , DeToledo John , Morgan Robert O. 
Published: March 2003

Summary:  Purpose: Fosphenytoin (FPHT; Cerebyx) is well absorbed when given intramuscularly (IM). All prior pharmacokinetic studies had the first plasma sample obtained 30 min after IM administration. The objectives of this study were to determine the rate and extent of FPHT absorption and to evaluate the tolerability of IM FPHT compared with IM saline.Methods: This was an open‐label, double‐blinded study in which patients received 10 mg/kg dose of IM FPHT in one gluteus and IM saline in the other gluteus. Half the patients received saline injection of equal volume to FPHT (up to 19.5 mL); the other half received 2 mL of saline. Neurologic examination, vital signs, PHT blood samples, injection site examination, and subjective pain scores at injection site were obtained before and at timed intervals for 6 h.Results: Total PHT serum concentrations 10 μg/mL were obtained in 5 min in 14.3% of patients and in 26.3% after 10 min. More than half the patients had therapeutic serum concentrations at 30 min; 45.8% of patients reported no pain at either the FPHT or saline injection site. No significant difference in pain was noted between FPHT and saline injection sites at 60 min and thereafter. Early decrease in blood pressure occurred but was not clinically significant. Classic PHT‐induced central nervous system (CNS) side effects were evident in one third of patients within 1 h after injection.Conclusions: (a) IM FPHT is rapidly absorbed (therapeutic levels achieved as early as 5–20 min). (b) IM FPHT is well tolerated by most patients irrespective of injection volume.
Disparity of Perfusion and Glucose Metabolism of Epileptogenic Zones in Temporal Lobe Epilepsy Demonstrated by SPM/SPAM Analysis on 15O Water PET, [18F]FDG‐PET, and [99mTc]‐HMPAO SPECT
Authors: Lee Dong Soo , Lee Jae Sung , Kang Keon Wook , Jang Myoung Jin , Lee Sang Kun , Chung June‐Key , Lee Myung Chul 
Published: March 2003

Summary:  Purpose: To elucidate uncoupling of perfusion and metabolism and its significance in epilepsy, 15O water and 18F fluorodeoxyglucose (FDG) positron emission tomography (PET) and Tc‐99m hexamethyl‐propyleneamine‐oxime (HMPAO) single‐photon emission computed tomography (SPECT) were examined by SPM (statistical parametric mapping) and quantitation by using SPAM (statistical probabilistic anatomic map).Methods: [15O]water and [18F]FDG‐PET, and [99mTc]‐HMPAO SPECT were performed in 25 patients (SPECT in 17 of 25) with medial temporal lobe epilepsy. For volume of interest (VOI) count analysis, the normalized counts using VOI based on SPAM templates of PET and SPECT were compared with those of the normal controls. Perfusion or metabolism was found abnormal if the Z score was >2 for each VOI. For SPM analysis, the differences between each patient's image and a group of normal control images (t statistic for p < 0.01) on a voxel‐by‐voxel basis were examined to find significant decreases in perfusion or metabolism.Results: With SPAM VOI count analysis, areas of hypoperfusion were found in 13 patients in the epileptogenic temporal lobes by [15O]water PET and areas of hypometabolism in 21 patients by [18F]FDG‐PET. With voxel‐based SPM analysis, the epileptogenic zones were localized in 15 by [15O]water PET and in 23 patients by [18F]FDG‐PET. The localization by [15O]water PET was concordant with that of [18F]FDG‐PET. The areas of hypoperfusion on [15O]water PET were absent or smaller than the areas of hypometabolism on [18F]FDG‐PET. Interictal [99mTc]‐HMPAO SPECT revealed the hypoperfused zones in seven of 17 patients on visual assessment.Conclusions: SPAM VOI count and SPM analysis of [15O]water and [18F]FDG‐PET and [99mTc]‐HMPAO SPECT revealed that in the same patients, the areas of hypoperfusion were concordant with but smaller than the areas of hypometabolism. Discordance of perfusion and metabolic abnormalities represents an uncoupling of perfusion and metabolism in the epileptogenic zones, and this might explain the lower diagnostic accuracy of perfusion imaging in temporal lobe epilepsy.
Diagnostic Performance of [18F]FDG‐PET and Ictal [99mTc]‐HMPAO SPECT in Occipital Lobe Epilepsy
Authors: Kim Seok‐Ki , Lee Dong Soo , Lee Sang Kun , Kim Yu Kyeong , Kang Keon Wook , Chung Chun Kee , Chung June‐Key , Lee Myung Chul 
Published: March 2003

Summary:  Purpose: We investigated whether interictal F‐18 fluorodeoxyglucose positron emission tomography ([18F]FDG‐PET) or ictal [99mTc]‐HMPAO single‐photon emission computed tomography (SPECT) was useful to find epileptogenic zones in occipital lobe epilepsy (OLE).Methods: We reviewed visually and quantified patterns of hypometabolism in interictal [18F]FDG‐PET and those of hyperperfusion in ictal SPECT in 17 OLE patients (27 ± 6.8 years old; M/F, 10/7; injection time, 30 ± 17 s). OLE was diagnosed based on invasive electroencephalography, surgery, and postsurgical outcome (Engel class I in all at an average of 26 months after surgery).Results: Epileptogenic zones were correctly localized in nine (60%) of 15 patients by interictal [18F]FDG‐PET, and asymmetric indices corroborated visual diagnosis. Epileptogenic hemispheres were correctly lateralized in 14 (93%) of 15 patients on [18F]FDG‐PET. Epileptogenic hemispheres were correctly lateralized in 13 (76%) of 17 patients using ictal SPECT, but localization was possible in only five (29%) patients. Interictal [18F]FDG‐PET was helpful in two of the patients who showed no abnormality on magnetic resonance imaging (MRI) and no possible localization with ictal SPECT.Conclusions: In OLE, ictal SPECT was helpful in lateralization, but less helpful in localization. Interictal [18F]FDG‐PET was helpful in localization or lateralization of epileptogenic zones, even in patients with ambiguous MRI or ictal SPECT findings.
Seizure‐Associated Headache in Epilepsy
Authors: Leniger Tobias , Isbruch Katrin , Von Den Driesch Sandra , Diener Hans Christoph , Hufnagel Andreas 
Published: March 2003

Summary:  Purpose: Headache is often ignored as a symptom of epileptic seizures. The purpose of this prospective study was to analyze frequency, classification, and characteristics of seizure‐associated headache (SH) according to the criteria of the International Headache Society.Methods: Over a period of 15 months, 341 patients with epilepsy, consecutively evaluated at our outpatient clinic for SH, completed a standardized questionnaire.Results: Of the 341 epilepsy patients, 115 (34%) experienced SH with a pain intensity of 6.1 ± 1.6 (SD) on the visual analogue scale and a duration of 12.8 ± 15.7 (SD) h. Seizures were always accompanied by headache in 69 (60%) of these 115 patients. SH occurred in four (3%) of 115 patients only preictally, in 31 (27%) of 115 patients periictally, and in 80 (70%) of 115 patients only postictally. In the majority of the 115 patients (55.7%), SH could be classified as migraine headache, whereas in 36.5%, as tension‐type headache. The type of SH was not correlated with sex, an epilepsy syndrome, or a seizure type. Migraine‐like SH was significantly associated with a history of migraine (p < 0.001). In 20 (77%) of the 26 patients experiencing migraine‐like SH with a history of migraine, the phenomenology of migraine‐like SH and migraine attacks was identical.Conclusions: SH is a frequent, long‐lasting, and severe symptom of epileptic seizures, causing major impairment of daily living. A history of migraine significantly increases the risk for developing migraine‐like SH.
Electroencephalographic Characterization of an Adult Rat Model of Radiation‐Induced Cortical Dysplasia
Authors: Kondo Shinji , Najm Imad , Kunieda Takeharu , Perryman Scott , Yacubova Karina , Lüders Hans O. 
Published: March 2003

Summary:  Purpose: Cortical dysplasia (CD) is a frequent cause of medically intractable focal epilepsy. The mechanisms of CD‐induced epileptogenicity remain unknown. The difficulty in obtaining and testing human tissue warrants the identification and characterization of animal model(s) of CD that share most of the clinical, electroencephalographic (EEG), and histopathologic characteristics of human CD. In this study, we report on the in vivo EEG characterization of the radiation‐induced model of CD.Methods: Timed‐pregnant Sprague–Dawley rats were irradiated on E17 using a single dose of 145 cGy or left untreated. Their litters were identified and implanted with bifrontal epidural and hippocampal depth electrodes for prolonged continuous EEG recordings. After prolonged EEG monitoring, animals were killed and their brains sectioned and stained for histologic studies.Results: In utero–irradiated rats showed frequent spontaneous interictal epileptiform spikes and spontaneous seizures arising independently from the hippocampal or the frontal neocortical structures. No epileptiform or seizure activities were recorded from age‐matched control rats. Histologic studies showed the presence of multiple cortical areas of neuronal clustering and disorganization. Moreover, pyramidal cell dispersion was seen in the CA1>CA3 areas of the hippocampal formations.Conclusions: Our results further characterize the in vivo EEG characteristics of the in utero radiation model of CD using long‐term EEG monitoring. This model may be used to study the molecular and cellular changes in epileptogenic CD and to test the efficacy of newer antiepileptic medications.
Typical and Atypical Perfusion Patterns in Periictal SPECT of Patients with Unilateral Temporal Lobe Epilepsy
Authors: Wichert‐Ana Lauro , Velasco Tonicarlo Rodrigues , Terra‐Bustamante Vera Cristina , Araújo David , Júnior Veriano Alexandre , Kato Mery , Leite João Pereira , Assirati João Alberto , Machado Hélio Rubens , Bastos Alexandre Cunha , Sakamoto Américo Ceiki 
Published: March 2003

Summary:  Purpose: To characterize perfusion patterns of periictal single‐photon emission tomography (SPECT) in patients with unilateral temporal lobe epilepsy (TLE) and to determine their relationship to the epileptogenic zone (EZ).Methods: We studied periictal SPECT scans of 53 patients after anterior mesial temporal lobectomy who had good seizure outcome after surgery. Ictal SPECT scans were performed during video‐EEG monitoring. Typical SPECT patterns consisted of ipsilateral ictal hyperperfusion or ipsilateral postictal hypoperfusion. Atypical ictal patterns included normal scans, bilateral temporal hyperperfusion, or contralateral patterns. These perfusion patterns were retrospectively analyzed searching for concordance rate with the EZ.Results: We obtained 51 ictal and two early postictal scans. In the typical group, 40 (75.4%) patients had ipsilateral ictal temporal lobe hyperperfusion, and one (1.9%) patient had ipsilateral postictal temporal lobe hypoperfusion. Twelve (22.7%) patients exhibited atypical perfusion patterns: seven (13.2%) patients had bitemporal ictal hyperperfusion (four cases showed asymmetric temporal lobe changes), four (7.6%) patients had contralateral hyperperfusion, and one (1.9%) patient had a normal SPECT scan. All four patients with bitemporal asymmetric hyperperfusions showed greater perfusion lateralized to the side of the EZ. Three of the four patients who had contralateral hyperperfusion also had a complex postictal‐like pattern in the ipsilateral temporal lobe consisting of anteromesial hyperperfusion with adjacent lateral hypoperfusion.Conclusions: This study analyzed typical and atypical perfusion patterns in unilateral TLE, and suggested that not only typical, but also some atypical perfusion patterns may contribute to the lateralization of EZ.