bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nonepileptic Seizures After Head Injury
Authors: Westbrook Lauren E. , Devinsky Orrin , Geocadin Romergryko 
Published: August 2005

Summary: Purpose: To examine the role of head injury as a risk factor in the development of nonepileptic seizures (NES). Specifically, we will determine the relative frequency of head injury among NES patients referred to our center and will describe several pertinent clinical features and personal characteristics. Methods: Retrospective record review of patients referred to our center for evaluation of seizures over a 4‐year period. All patients with NES were evaluated as in a previously described protocol, which included intensive video EEG monitoring, provocation by suggestion, and psychiatric interview. All NES patients with a history of head injury were extracted for this report. Results: Of 102 patients with NES, nearly one‐third (32%) had an antecedent head injury; 52% were male, mean age was 34 years, and 12% had coexisting epilepsy. Multiple psychiatric disorders were not uncommon (79%), and a history of abuse was found in 35%. All but four patients had documented financial gain from their injury. Follow‐up at 1 year found poor long‐term outcome with lasting disability; despite that, the majority (91%) of head injuries were minor. Conclusions: Our preliminary findings suggest that prior head injury is associated with the development of NES and may contribute to the pathogenesis of NES in vulnerable patients. Head injury and sexual or physical abuse appear to occur in comparable proportions in patients with NES. This suggests that head injury and abuse may be equally important risk factors in the development of NES.
Lamotrighe‐Induced Severe Cutaneous Adverse Reactions
Authors: Schlienger Raymond G. , Shapiro Lori E. , Shear Neil H. 
Published: August 2005

Summary: Purpose: We systematically reviewed and analyzed published and unpublished cases of Stevens‐Johnson syndrome (SJS), or toxic epidermal necrolysis (TEN) associated with lamotrigine (LTG) therapy to identify characteristics of these reactions.Methods: We performed a MEDLINE search (January 1985 to April 1998) and citation tracking for published reports. In addition, reports were requested from the Uppsala Monitoring Centre of the World Health Organization (WHO). Published and WHO cases of LTG‐associated SJS or TEN were included if the causal relationship was assessed as either possible, probable, or definite.Results: We identified a total of 57 cases (43 cases of SJS, 14 cases of TEN), of which 13 (23%) were published. Cases in the SJS group were significantly younger than in the TEN group (21 years vs. 31 years). The median time to onset (17 days for SJS and TEN) and the median dosage at onset (50 mg vs. 87.5 mg) for SJS and TEN did not differ significantly. Concomitant use of valproate (VPA) was reported in 74% of the SJS cases and 64% of the TEN cases. In three cases, TEN was the cutaneous manifestation of the antiepileptic drug hypersensitivity syndrome (AHS).Conclusions: The main features of severe cutaneous drug reactions, such as dosage, onset, and concomitant VPA use, do not differ in patients with LTG‐induced SJS or TEN. SJS or TEN may also be the cutaneous manifestations of LTG‐induced AHS. Further epidemiologic studies are needed to identify the incidence of severe LTG‐induced cutaneous adverse reactions and the relative risk compared with other AEDs.
The Prognosis for Control of Seizures with Medications in Patients with MRI Evidence for Mesial Temporal Sclerosis
Authors: Kim Won‐Joo , Park Soo‐Chul , Lee Se‐Jin , Lee Joon‐Hong , Kim Jung‐Yeon , Lee Byung‐In , Kim Dong‐Ik 
Published: August 2005

Summary: Purpose: Mesial temporal sclerosis (MTS) is the most common and important pathology in temporal lobe epilepsy (TLE), and its presence in magnetic resonance imaging (MRI) scans is strongly correlated with a successful surgical outcome. Despite the general assumption that patients with MTS respond poorly to medication, the long‐term prognosis for such patients has not yet been investigated. We studied the overall clinical prognosis of patients with MTS and analyzed the factors related to the degree of medical responsiveness. Methods: Case patients were actively followed up at the Yonsei Epilepsy Clinic in Seoul, Korea, for >2 years. A structured interview and a thorough clinical evaluation were conducted. MRI scans, at the field strength of 1.0 or 1.5 Tesla, were performed with T1‐ and T2‐weighted coronal and axial spin‐echo images. All coronal slices were ≤5‐mm thick with no gap. Two neurologists and one radiologist determined the presence of MTS in MRIs by visual analysis. Results: The MTS group consisted of 104 patients. Of these, 26 (25%) were completely controlled with adequate therapy, and 40 (38%) were intractable, despite aggressive anticonvulsant polytherapy. The remaining 37% had their seizure frequencies reduced by ≥50%, but were not seizure free. The age of seizure onset was significantly younger in the intractable group than in the well‐controlled group. Patients with a history of febrile convulsions or with epileptiform discharges in their electroencephalogram (EEG) had poorer seizure control (p < 0.05) than those who did not. Among the 16 patients who had no previous treatment, five (31%) became seizure free, and two were intractable. Conclusions: Not all patients with MTS are medically intractable; 25% of the patients in our study achieved complete control while receiving medication. Poor seizure control was related to an early age of seizure onset, a history of febrile convulsions, and epileptiform discharges on the EEG.
Gelastic Epilepsy: Symptomatic and Cryptogenic Cases
Authors: Striano Salvatore , Meo Roberta , Bilo Leonilda , Cirillo Sossio , Nocerino Cristofaro , Ruosi Patrizia , Striano Pasquale , Estraneo Anna 
Published: August 2005

Summary: Purpose: To describe the etiology, characteristics, and clinical evolution of epilepsy in patients with gelastic seizures (GSs). Methods: Nine patients whose seizures were characterized by typical laughing attacks were observed between 1986 and 1997. Patients were selected based on electroencephalogram (EEG) or video‐EEG recordings of at least one GS and on magnetic resonance imaging (MRI) study. Results: Five patients were affected by symptomatic localization‐related epilepsy (LRE), with four of the patients' disorders related to a hypothalamic hamartoma (HH) and one to tuberous sclerosis (TS) without evident hypothalamic lesions. In four patients (the cryptogenic cases) MRI was negative also in these cases, clinical and EEG data suggested a focal origin of the seizures. The epileptic syndrome in the HH cases was usually drug‐resistant, and was surgically treated in two of the patients. The patient with TS became seizure free with vigabatrin. In the cryptogenic cases, the ictal, clinical, and EEG semiology were similar to the symptomatic cases; the clinical evolution was variable, with patients having transient drug resistance or partial response to treatment. No cognitive defects were observed in the cryptogenic patients. None of the nine patients had precocious puberty. Conclusions: We confirm the frequent finding of HHs in GSs and further underline how GSs may also be observed in patients without MRI lesions and with normal neurologic status. In these patients, clinical and EEG seizure semiology is similar to symptomatic cases, but the clinical evolution is usually more benign.
Allergic Skin Reactions to Anticonvulsant Medications in Patients Receiving Cranial Radiation Therapy
Authors: Mamon Harvey J. , Wen Patrick Y. , Burns Anne C. , Loeffler Jay S. 
Published: August 2005

Summary: Purpose: Erythema multiforme and Stevens‐Johnson syndrome have been associated with anticonvulsant medications (AEDs) in patients with brain tumors receiving cranial irradiation. AEDs are also known to cause mild drug rashes. The incidence of these complications has not been well studied among patients with brain tumors. We reviewed the records of patients with brain tumors treated with cranial radiation and AEDs to assess the frequency of both severe and mild skin reactions. Methods: Retrospective review of 289 radiotherapy records of consecutively treated patients from 1988 to 1993. Results: Only one of 289 patients developed erythema multiforme. Milder rashes, however, occurred in 18% of exposures to AEDs including 22% of exposures to phenytoin, compared with the expected rate of 5‐10%. Most of the mild drug rashes occurred before the initiation of radiotherapy, suggesting that radiation was not the cause of these reactions. Conclusions: Severe skin rashes are rare among patients with brain tumors receiving radiation therapy and AEDs. There is, however, an increased frequency of mild drug rashes among patients with brain tumors that does not appear related to radiation.
Elevated Plasma Concentrations of Homocysteine in Antiepileptic Drug Treatment
Authors: Schwaninger Markus , Ringleb Peter , Winter Ralph , Kohl Brigitte , Fiehn Walter , Rieser Peter A. , Walter‐Sack Ingeborg 
Published: August 2005

Summary: Purpose: Homocysteine is an experimental convulsant and an established risk factor in atherosclerosis. A nuritional deficiency of vitamin B6, vitamin B12, or folate leads to increased homocysteine plasma concentrations. During treatment with carbamazepine (CBZ), phenytoin, or phenobarbital, a deficiency in these vitamins is common. The objective of the study was to test the hypothesis that antiepileptic drug (AED) treatment is associated with increased homocysteine plasma concentrations. Methods: A total of 51 consecutive outpatients of our epilepsy clinic receiving stable, individually adjusted AED treatment and 51 sex‐ and age‐matched controls were enrolled in the study. Concentrations of total homocysteine and vitamin B6 were measured in plasma; vitamin B12 and folate were measured in the serum of fasted subjects. Results: Patients and controls differed significantly in concentrations of folate (13.5 ± 1.0 vs. 17.4 ± 0.8 nM and vitamin B6 (39.7 ± 3.4 vs. 66.2 ± 7.5 nM), whereas serum concentrations of vitamin B12 were similar. The homocysteine plasma concentration was significantly increased to 14.7 ± 3.0 μM in patients compared with controls (9.5 ± 0.5 μM; p < 0.05, Wilcoxon rank‐sum test). The number of patients with concentrations of >15 μM was significantly higher in the patient group than among controls. The same result was obtained if only patients with CBZ monotherapy were included. Patients with increased homocysteine plasma concentrations had lower folate concentrations. Conclusions: These data support the hypothesis that prolonged AED treatment may increase plasma concentrations of homocysteine, although the alternative explanation that increased homocysteine plasma concentrations are associated with the disease and not the treatment cannot be completely excluded at the moment.
Payer Costs of Patients Diagnosed with Epilepsy
Authors: Griffiths Robert I. , Schrammel Peggy N. , Morris George L. , Wills Stacey H. , Labiner David M. , Strauss Michael J. 
Published: August 2005

Summary: Purpose: To identify the annual cost to a third‐party payer of inpatient and outpatient services and prescription drugs for patients diagnosed with epilepsy or convulsions. Methods: Retrospective study using administrative and claims data from a private insurer in the Northeast United States with >1.8 million covered lives. Health plan members were included if they had a claim for epilepsy or convulsions and a claim for an antiepileptic drug (AED) between January 1992 and December 1996. Annual costs and frequencies of all medical services, and of services related to epilepsy, were compared among five groups of patients defined by the most intensive procedure they received: invasive therapeutic procedure (group I); invasive diagnostic procedure without an invasive therapeutic procedure (group 2); noninvasive diagnostic procedure without an invasive procedure (group 3); neurologist or neurosurgeon visit without an invasive procedure or noninvasive diagnostic procedure (group 4); or none of the preceding services (group 5). Results: In the cohort of 9,090 patients meeting the inclusion criteria, mean age was 38 years, 53% were female, 30% had malignant disease, and 25% had cardiac disease. The mean annual cost of all medical services was $9,617. Mean annual costs of all services were $43,333, $29,847, $11,300, $4,362, and $5,855, and annual costs of inpatient and outpatient encounters coded as epilepsy plus AEDs were $24,369, $10,330, $3,127, $1,079, and $1,086, in groups 1‐5, respectively. Services used to stratify patients into the groups accounted for 37% of the total costs. Conclusions: The annual costs of medical services for patients with epilepsy are high and vary considerably because of treatment of epilepsy and management of comorbidities.
Clinical Significance of EEG Abnormalities During Photic Stimulation in Patients with Photosensitive Epilepsy
Authors: Fylan F. , Edson A. S. , Harding G. F. A. 
Published: August 2005

Summary: Purpose: The continued presence of EEG abnormalities in patients with a history of photosensitive seizures is used to signify the persistence of photosensitive epilepsy. The extent to which this approach places patients at risk of seizures is unclear, however. We describe those EEG abnormalities that may be tolerated with low risk of further seizures, and those that are indicative of poor seizure control. Methods: Fifty patients with EEG evidence of persistent photosensitive epilepsy underwent photosensitivity testing with diffuse and patterned light; 58% of patients continued to experience seizures, and 42% were seizure free. The incidence of EEG abnormalities to diffuse and patterned intermittent photic stimulation (IPS) was analysed as a function of recent seizures. Results: All patients showed EEG abnormalities to patterned IPS; there was no significant association between patterned IPS and poor seizure control. EEG abnormalities to diffuse IPS occurred in 58% of patients, and 76% of these patients had experienced a seizure within the previous year. These patients were more than twice as likely to be poorly controlled than those who showed abnormalities only to patterned IPS. These results were consistent for both medicated and unmedicated patients. Conclusions: EEG abnormalities to patterned IPS can be used to signify the persistence of photosensitive epilepsy, but abnormalities to diffuse IPS are more likely to indicate the patient is poorly controlled and at risk of further seizures.
Normative Volumetric Data of the Developing Hippocampus in Children Based on Magnetic Resonance Imaging
Authors: Pfluger Thomas , Weil Sabine , Weis Serge , Vollmar Christian , Heiss Dirk , Egger Joseph , Scheck Roland , Hahn Klaus 
Published: August 2005

Summary: Purpose: To acquire normative data of the hippocampus and its postnatal growth in 50 children (age, 1 month to 15 years) without epilepsy. Methods: Morphometry of the hippocampus was carried out by using a spoiled FLASH 3D sequence (sagittal orientation), whereas the volume of the brain was assessed with a T2‐weighted spin‐echo sequence (transverse orientation). The volume of the hippocampus and the brain was determined by following Cavalieri's principle. Growth curves of the brain and hippocampus were fitted to a nonlinear Boltzmann sigmoidal equation. Results: Intra‐/interobserver coefficient of variation was 2.0/4.9% for hippocampal volume measurements and 2.0/2.1% for brain volumetry. A significant difference in volume was noted between the right and left hippocampus (p < 0.001), with the right side being larger on average by 0.10 cc. Correlation coefficients of growth curves ranged between 0.71 and 0.94. Growth curves demonstrated a faster development of the hippocampus in girls. A steeper slope of hippocampal growth as compared with brain growth was found in girls, whereas in boys, the slope of brain growth was steeper. Conclusions: Our findings will be of help in evaluating vulnerable phases of the hippocampal formation with accelerated growth, thereby leading to a better understanding of the development of hippocampal sclerosis in early childhood.
GABA Changes with Vigabatrin in the Developing Human Brain
Authors: Novotny Edward J. , Hyder Fahmeed , Shevell Michael , Rothman Douglas L. 
Published: August 2005

Summary: Purpose: Changes in γ‐aminobutyric acid (GABA) physiology are important in determining seizure susceptibility in the developing nervous system. Noninvasive measurements of brain GABA in adults with epilepsy have demonstrated important relations among seizure control, brain GABA levels, and changes in brain GABA with drugs designed to alter GABA metabolism. The purpose of this study was to demonstrate the changes in GABA in the occipital lobes of children with epilepsy after treatment with vigabatrin (VGB). Methods: Ten proton nuclear magnetic resonance spectroscopic (NMRS) studies were obtained on four subjects with epilepsy. The subjects were between ages 1 and 5 years. Occipital lobe GABA levels were measured before and after treatment with VGB. Results: Brain GABA levels increased significantly in these subjects after VGB treatment (p < 0.05, paired Student's t test). In one subject, brain GABA was decreased in the region of the epileptic focus compared with the homologous region of the opposite hemisphere. A nearly fivefold increase in GABA occurred in the epileptic region after VGB treatment in this subject. Conclusions: VGB increases brain GABA levels in children with epilepsy. NMRS can be used to monitor the response of brain GABA levels to drugs known to alter GABA physiology and serve as an important tool to understand the role of GABA‐mediated inhibition in pediatric epilepsies.
Epilepsy in Ehlers‐Danlos Syndrome
Authors: Jacome Daniel E. 
Published: August 2005

Summary: Purpose: Ehlers‐Danlos syndrome (EDS) is a complex hereditary connective tissue disorder infrequently reported in association with epilepsy. Seven patients with ages ranging from 28 to 70 years with EDS and epilepsy are described. Methods: Case review of clinical and diagnostic data. Results: Two patients had occipital horn syndrome (EDS type IX) and partial seizures of probable supplementary motor area origin. Of these two, one had an area of frontal gliosis and was able to abate his seizures by hyperextending his neck; the other had a Dandy Walker malformation and also had pseudoseizures. The third patient of the series had complex partial seizures, pain asymbolia, and basilar artery hypoplasia. The fourth had ictal aphasia, left hemispheric hypotrophy, and distal right arm and left leg atrophy. The fifth patient had focal seizures, a venous parietal angioma, hyperekplexia, nocturnal head oscillations (jactatio capitis nocturna), monoclonal gammopathy‐associated neuropathy, and Tourette syndrome. The sixth had affective illness, chronic fatigue, and complex partial seizures with autoscopic phenomena after intracranial bleed. The seventh patient had a previous stroke, peripheral neuropathy, and grand mal seizures. Conclusions: EDS may be accompanied by congenital or acquired central nervous system disorders and epilepsy. Additional neurologic conditions that are unrelated to EDS may be present.
Male Infertility: Possible Association with Valproate Exposure
Authors: Yerby Mark S. , McCoy Gregory B. 
Published: August 2005

Summary: Purpose: To describe a potential association between male infertility and valproate (VPA) exposure. VPA has been implicated in the development of polycystic ovarian disease and subsequent menstrual and infertility problems in women with epilepsy. Infertility has been well described in population‐based studies of persons with epilepsy. The low marital rates for men with epilepsy have previously been thought to play a major contributing role. Methods: We report a case of a 32‐year‐old man whose wife and he were able to bear a child before the development of his epilepsy. With VPA monotherapy, the family were unable to conceive despite 4 years of unprotected intercourse. An infertility evaluation of the man revealed a very low sperm count of <50,000/ml, no motile sperm, <10% viability, and 100% with abnormal structure. Follicle‐stimulating hormone, luteinizing hormone, and testosterone levels were normal. Results: Felbamate (FBM) was initiated and VPA discontinued for improved seizure control. Within 4 months, the couple conceived their second child. A seminal analysis revealed a sperm count of >16 million, 50% motility, 78% viability, and 72% with abnormal structure. Conclusions: One must be cautious in extrapolating from a case report, but these findings strongly suggest a direct effect of VPA on spermatic structure and function.
Kinetics of Serum Neuron‐Specific Enolase and Prolactin in Patients After Single Epileptic Seizures
Authors: Tumani Hayrettin , Otto Markus , Gefeller Olaf , Wiltfang Jens , Herrendorf Gregor , Mogge Sebastian , Steinhoff Bernhard J. 
Published: August 2005

Summary: Purpose: To investigate and compare the temporal profile of serial levels of neuron‐specific enolase (NSE) and prolactin in serum from patients after single epileptic seizures. Methods: Measurement of NSE and prolactin by sensitive immunoassays in 21 patients with complex partial seizure (CPSs; n = 11) and secondarily generalized tonic‐clonic seizures (SGTCSs; n = 10) during continuous video‐EEG monitoring at four different time points (1, 3, 6, and 24 h after ictal event). Statistical analysis was performed by using a repeated‐measures analysis of variance (ANOVA) model. Results: Mean ± SD values for NSE levels (ng/ml) were 12.5 ± 4.4 (1 h), 10.8 ± 3.8 (3 h), 11.1 ± 4.9 (6 h), and 8.2 ± 1.9 (24 h). The corresponding prolactin levels (mU/L) were 1,311 ± 1,034, 232 ± 158, 237 ± 175, and 251 ± 98. There was a significant decrease of NSE and prolactin levels over time (p < 0.001). The pair‐wise comparison of NSE levels showed significant differences between the time points 1 vs. 24 h (p < 0.001), 3 vs. 24 h (p = 0.007), and 6 vs. 24 h (p = 0.009). In contrast, serum prolactin levels showed a significant difference between 1 vs. 3 h (p < 0.001) only. Most of the NSE levels remained normal after CPSs and SGTCSs. At 1 h after the seizure, only 33% of the subjects had increased NSE, whereas abnormal prolactin levels occurred with a sensitivity of 80%. Conclusions: In contrast to prolactin, serum NSE is not a sensitive marker of individual seizures. Only some individuals showed an increase of NSE beyond the prolactin‐sensitive time frame after a single seizure, and mean NSE levels were not significantly increased compared with those of normal controls.
Depth of EEG Suppression and Outcome in Barbiturate Anesthetic Treatment for Refractory Status Epilepticus
Authors: Krishnamurthy Kaarkuzhali B. , Drislane Frank W. 
Published: August 2005

Summary: Purpose: Barbiturate anesthetic treatment of patients with refractory status epilepticus (RSE) is often titrated to a burst‐suppression record on the EEG. We sought to determine whether the depth of EEG suppression correlated with persistent seizure control in such patients. Methods: We reviewed the EEGs and clinical course of patients treated with pentobarbital (PTB) for RSE. Persistent seizure control or relapse to status epilepticus after the taper of PTB was determined with reference to the depth of EEG suppression during treatment. Results: Of 35 patients tapering PTB, persistent seizure control was achieved in six of 12 patients reaching a burst‐suppression record at greatest depth of EEG suppression and in 17 of 20 patients reaching a “flat” record; three patients with neither pattern had persistent control. Survival also was somewhat better in the more suppressed group. Isolated epileptiform discharges during the barbiturate infusion did not correlate with outcome. Recurrence of electrographic status after PTB taper predicted clinical relapse. Conclusions: The EEG is important in managing PTB treatment for patients with RSE. Some period of intense seizure and EEG suppression may help in preventing relapse of status after the PTB taper. It is not necessary to suppress all epileptiform discharges, but persistent clinical and EEG monitoring is necessary to avoid relapses.