bluuebunny/crossref_metadata_2025_split huggingface dataset:
Systematic Testing of Medical Intractability for Carbamazepine, Phenytoin, and Phenobarbital or Primidone in Monotherapy for Patients Considered for Epilepsy Surgery
Authors: Hermanns Guido , Noachtar Soheyl , Tuxhorn Ingrid , Holthausen Hans , Ebner Alois , Wolf Peter 
Published: August 2005

Summary: Purpose: To assess medical intractability in patients considered for restrictive epilepsy surgery. Methods: Seventy‐four patients received single drug treatment with carbamazepine (CBZ), phenytoin (PHT), and either phenobarbital (PB) or primidone (PRM). Medical intractability was established if seizure control was not obtained despite maximum tolerable doses of the drug. In all, 120 single drug treatments were administered with the drugs that has not been administered at maximal doses in monotherapy before the study. Results: Complete seizure control was not achieved in any patient. However, 7 patients (9.5%) had significant seizure reduction of at least 80%. In 4 patients, only the third antiepileptic drug (AED) proved effective. Conclusion: The poor result of AED monotherapy in our patients may be attributed to the patients’long‐standing chronic epilepsies and high seizure frequencies. Our findings suggest that despite the failure of one or two major AEDs in controlling seizures completely, further single drug treatment may still improve the quality of life in some patients who are candidates for epilepsy surgery.
Electrocerebral Recovery During the Intracarotid Amobarbital Procedure: Influence of Interval Between Injections
Authors: Selwa Linda M. , Buchtel Henry A. , Henry Thomas R. 
Published: August 2005

Summary: Purpose and Methods: During the intracarotid amobarbital procedure (IAP) at the University of Michigan, continuous scalp EEG monitoring guides the timing for presentation of memory items and postinjection testing. Most of our patients have undergone bilateral injections. The interval between injections varied from 22 to 60 min, depending on the test and recovery time, as well as the time to catheterize the second side. After noting a trend toward prolonged electro‐graphic recovery following the second injection, we tested our clinical impression that recovery of the second hemisphere may be influenced by (a) the time between injections and (b) which hemisphere is injected first (epileptogenic or nonepileptogenic).To study these questions, we analyzed EEG recovery data from 48 consecutive IAPs. Approximately half the patients had the epileptogenic side injected first.Results: We found that (a) electrographic recovery after the second injection is prolonged if the interval between bilateral injections is less than 40 minutes and (b) electrographic recovery is more rapid after injection of the epileptogenic hemisphere.Conclusions: We now recommend waiting at least 45 min between injections. The pathophysiology of more prolonged amobarbital effect on the nonepileptogenic hemisphere than on the epileptogenic hemisphere remains unclear.
Scalp‐Recorded, Ictal Focal DC Shift in a Patient with Tonic Seizure
Authors: Ikeda Akio , Yazawa Shogo , Kunieda Takeham , Araki Kasumi , Aoki Tomokazu , Hattori Hamo , Taki Waro , Shibasaki Hiroshi 
Published: August 2005

Summary: Purpose: We recorded focal ictal DC shifts from scalp electrodes in a 9–year‐old boy with intractable, clinically generalized tonic seizures. The patient had a high intensity signal abnormality of the left temporal cortex with thickening of the gyri on T2–weighted MRI.Methods: Scalp digital EEGs were recorded using electrodes made of silver/silver chloride. The low frequency filter (LFF) was set at 0.016 Hz. Recorded seizures were subsequently analyzed with LFF settings of 1.0, 0.016 and 0.03 Hz.Results: All recorded seizures initially showed diffuse, low voltage, high frequency activity (electrodecremental pattern) followed 10–20 s later by quasirhythmic activity over the left frontotemporal region. In two seizures, LFF of 0.016–0.03 Hz revealed a slow negative shift over the left frontotemporal area simultaneously with onset of the bilateral electrodecremental pattern. However, in the other seizures, this initial slow negative shift was obscured by artifacts. Subsequent electrocorticography (ECoG) delineated frequent epileptiform discharges in the left temporal as well as frontal cortex.Conclusions: Scalp‐recorded ictal DC shifts may help identify focal epileptogenic brain area in patients with clinically generalized seizures although the technique is vulnerable to artifact.
“Periodic” Seizures
Authors: Blume Warren T. , Wiebe Samuel 
Published: August 2005

Summary: Purpose: To describe regularly recurring ictal phenomena as recorded in a single patient whose seizure disorder related to a left temporal cavernous angioma.Methods: Seizures were recorded by left temporal subdural strip electrodes which were bilaterally placed because of ambiguous seizure origin and right temporal memory dysfunction at Wada testing. Seizure length, interseizure intervals, and interseizure onset intervals were visually assessed. The coefficient of variation was used as an estimate of variability in seizure periodicity.Results: Mean seizure durations varied from 68 to 95 s; coefficients of variation varied from 0.08 to 0.18, values similar to other periodic biological phenomena. Mean daily seizure intervals varied from 96 to 152 s with coefficients of variation ranging from 0.12 to 0.35. Interseizure onset intervals had smaller coefficients of variation (0.03–0.20). Manifestations of these simple partial seizures included a rising epigastric sensation and nausea.Conclusions: Previously described periodic EEG phenomena are interictal events or appear with peripheral events of similar cadence. Therefore, we remain unaware of any documentation of periodic ictal electrographic events. The restricted propagation and duration of these recorded seizures may have simplified their pathophysiology allowing a stereotyped involvement of excitatory and inhibitory mechanisms producing the periodicity.
Epilepsy in Peroxisomal Diseases
Authors: Takahashi Yukitoshi , Suzuki Yasuyuki , Kumazaki Kaori , Tanabe Yuzo , Akaboshi Shinjiro , Miura Kiyokuni , Shimozawa Nobuyuki , Kondo Naomi , Nishiguchi Toshihiro , Terada Kihei , Orii Tadao 
Published: August 2005

Summary: Purpose: To clarify the electroclinical manifestation of epileptic seizures and the evolution of epilepsy in patients with peroxisomal diseases. Methods: Retrospective review of the medical records and EEGs of 14 patients with peroxisomal diseases: seven with Zellweger syndrome (ZS), two with neonatal adrenoleuko‐dystrophy (NALD), two with acyl‐CoA oxidase deficiency (AOXD), two with bifunctional enzyme deficiency (BFED), and one with rhizomelic chondrodysplasia punctata (RCDP). The diagnoses were made by biochemical analysis and pathological examinations in our laboratory. Results: Patients manifested serious neurologic deficits in the neonatal period or in early or late infancy. Patients with ZS or AOXD had partial motor seizures originating in the arms or legs or corners of the mouth. Their seizures did not culminate in generalized tonic‐clonic seizures and were easily controlled by antiepileptic drugs (AEDs). Interictal EEGs of the patients with ZS showed infrequent bilateral independent multifocal spikes, predominantly in the frontal motor cortex and its surrounding regions. The EEGs of patients with AOXD showed interictal fast theta activity, predominantly in the frontocentral regions. Patients with BFED also had partial motor seizures in early infancy, but the seizures were intractable, evolving in one case to myoclonic seizures. Interictal EEGs of patients with BFED showed bilateral independent multifocal spikes that evolved to bilateral diffuse high‐voltage slow waves in one case and to a hypsarythmic pattern in another case as the disease progressed. Patients with NALD had intractable tonic seizures or epileptic spasms. Interictal EEGs showed high‐voltage slow waves and bilateral independent multifocal spikes, evolving in one patient to a flat pattern. The patient with RCDP, whose interictal EEGs showed frequent multifocal independent spikes, did not have epileptic seizures. Conclusions: The age of epilepsy onset or the duration of survival is related to the types of seizures occurring in patients with peroxisomal diseases. Neonates or young infants usually have partial motor seizures (facial twitching or clonic convulsions of the arms or legs) of various multifocal origins. Older infants may have generalized seizures at the onset of the disease or evolutionally. Seizure intractability is usually less severe in patients with ZS or AOXD than in patients with NALD or BFED. There is no relation between the electroclinical characteristics of epilepsy and the genetic complementation groups in peroxisomal diseases.
Does Physical Exercise Influence the Occurrence of Epileptiform EEG Discharges in Children?
Authors: Nakken Karl O. , Løyning Alvhild , Løyning Tone , Gløersen Gunvor , Larsson Pål G. 
Published: August 2005

Summary: Purpose: To determine if, and how, epileptiform EEG discharges in children were influenced by physical exercise. Methods: Twenty‐six children with intractable partial and generalized epilepsy exercised during video‐telemetry recording, aiming at exhaustion after ∼10 min. Results: During the exercise, epileptiform discharges decreased in 20 of 26 children (17 children had at least 25% reduction) and showed a rebound increase after the exercise (17 of 26 children) compared to baseline conditions. This exercise‐induced reduction in epileptiform discharges reached statistical significance only in the 16 patients with localization‐related epilepsy. Five patients showed an atypical EEG response to exercise with either unchanged or increased epileptiform activity while exercising. As compared to the other patients, these 5 children had experienced frequent clinical seizures during or immediately after exercise in their leisure time. Conclusions: In the majority of the tested children, epileptiform EEG discharges decreased during exercise. “Exercise‐EEG” may be a helpful diagnostic tool to identify patients who are disposed to have exercise‐induced seizures.
No Effect of Long‐Term Vigabatrin Treatment on Central Nervous System Conduction in Patients with Refractory Epilepsy: Results of a Multicenter Study of Somatosensory and Visual Evoked Potentials
Authors: Mauguière F. , Chauvel P. , Dewailly J. , Dousse N. ,   the PMS Study Multicenter Group
Published: August 2005

Summary: Purpose: In dogs, vigabatrin (VGB) has been associated with intramyelinic edema producing delayed central conduction in somatosensory and visual evoked potentials (SEP, VEP). No such effects have been reported in humans. We assessed whether abnormalities of central conduction could be detected prospectively in patients with epilepsy treated with VGB as long‐term add‐on medication. Methods: Two hundred one patients with refractory partial epilepsy were enrolled and monitored for as long as 2 years. VGB was added to the treatment at an average dose of 2–3g/ day. Conduction in somatosensory and visual pathways was assessed by median nerve SEP and pattern VEP recordings performed at inclusion and once every 6 months. The upper limit and test‐retest variability of EP latencies were evaluated at time of enrollment in the patient group. Prolonged N13‐N20 or P14‐N20 SEP intervals and P100 VEP latency >2.5 SD above the baseline mean, observed on repeated runs in the same session and exceeding the test‐retest variability at enrollment were considered to indicate central conduction slowing. Results: One hundred nine patients completed the 2‐year study period, and 92 discontinued VGB, of whom 37 were monitored with regard to EP until the end of the study. No consistent change in SEP or VEP was observed in the entire group during VGB treatment. The number of occasional EP values outside the baseline range in patients treated with VGB similar to that in patients whose VGB treatment had been discontinued. Conclusions: We detected no evidence of changes in SEP and VEP attributable to altered neuronal conduction in the CNS during long‐term VGB treatment.
Incidence of Epilepsy in Rural Central Ethiopia
Authors: Tekle‐Haimanot Redda , Forsgren Lars , Ekstedt Jan 
Published: August 2005

Summary: Purpose: To study the incidence of epilepsy in a rural area of Ethiopia. Methods: A community‐based study was performed in a random sample of villages with 61,686 inhabitants in a rural area of central Ethiopia. In a door‐to‐door survey, all inhabitants in the study area were interviewed about seizures. A standardized protocol was used. All new cases with epilepsy that had occurred since a previous study was made 3.5 years earlier were included. Fifty‐three of the subjects were investigated with EEG. Results: One‐hundred thirty‐nine incident cases were identified, corresponding to an annual incidence of 64 in 100,000 inhabitants [95% confidence interval (CI) 44–84]. The corresponding rate for males was 72 (CI 42–102); for females, it was 57 (CI 31–84). The highest age‐specific incidence occurred in the youngest age groups (0–9 years); the next highest was in the group aged 10–19 years. Generalized convulsive seizures occurred in 69%, partial seizures occurred in 20%, and unclassifiable seizures occurred in 11%. Seizures occurred daily in 10% and weekly in another 14%; 33% had monthly seizures. Twenty‐two percent had a family history of epilepsy. A history of head trauma was ascertained in 5.7% and was the most common possible etiologic factor identified. Thirteen percent were treated with antiepileptic drugs (AEDs). Conclusions: The incidence of epilepsy in Ethiopia is high. A high incidence in combination with a prevalence of epilepsy in the study area comparable to that in the rest of the world may be explained by a high degree of spontaneous remission of epilepsy and/or a high mortality due to epilepsy. Despite health education on epilepsy given to the community, a minority of subjects were treated with AEDs, which may reflect the inadequacies of the health services and transportation difficulties faced by the patients.
Volumetric Magnetic Resonance Imaging Evidence of Bilateral Hippocampal Atrophy in Mesial Temporal Lobe Epilepsy
Authors: Quigg Mark , Bertram Edward H. , Jackson Theodore , Laws Edward 
Published: August 2005

Summary: Purpose: We measured absolute volumes and volume differences of hippocampi in patients with mesial temporal lobe epilepsy (MTLE) using volumetric magnetic resonance imaging (MRI) to determine the extent of bilateral atrophy in MTLE and to relate hippocampal volumes (HV) to outcome of temporal lobectomy. Methods: HV and hippocampal differences (HD) were measured in 40 patients with MTLE determined by pathology of hippocampal sclerosis (HS) and compared with those of age‐matched controls. Results were matched with surgical outcome. Results: Hippocampi contralateral to lobectomy (right hippocampi 2.96 ± 0.49 cm3, left 3.14 ± 0.51 cm3) were significantly smaller than those of controls (right hippocampi 3.73 ± 0.52 cm3, left 3.60 ± 0.51 cm3 but were significantly larger than hippocampi ipsilateral to lobectomy (right hippocampi 2.63 ± 0.61 cm3, 2.18 cm3) as compared across groups by analysis of variance (ANOVA: F= 27.2, p < 0. 0001). The smaller hippocampus was ipsilatera1 to lobectomy in 39 of 40 cases. Seven of 40 MTLE patients (18%) had bilateral atrophy, defined by volumes of each hippocampi 2 SD lower than control means. Surgical outcome was independent of hippocampal asymmetry and bilateral atrophy measured by chi‐square and Fisher's exact tests. Conclusions: We determined that most patients with MTLE have some degree of bilateral, asymmetric hippocampal pathology. However, asymmetry and bilateral atrophy have no clear relation to surgical outcome.
Asymmetries in the Effect of Side of Seizure Onset on Recognition Memory Following Intracarotid Amobarbital Injection
Authors: Breier J. I. , Thomas A. B. , Plenger P. M. , Wheless J. W. , Brookshire B. L. , Papanicolaou A. , Willmore L. J. 
Published: August 2005

Summary: Purpose: To assess inter hemispheric differences in recognition memory for objects during the intracarotid amobarbital sodium procedure (IAP). Methods: The recognition memory for real objects of patients with either right (RTLE, n = 28) or left (LTLE; n = 22) temporal lobe epilepsy was assessed at baseline, and after left and right intracarotid amobarbital sodium injection. Results: There were no differences between groups on baseline performance. Performance following injection ipsilateral to the side of seizure focus was relatively lower for the LTLE as compared with the RTLE group, but this difference did not reach statistical significance. However, performance following injection contralateral to the side of seizure focus was significantly lower for the RTLE as compared with the LTLE group. Within‐group differences in performance after ipsilateral as compared with contralateral injection were significant for the RTLE but not the LTLE group. The difference in inter hemispheric asymmetry in IAP memory performance between RTLE and LTLE groups was reflected in decreased ability to classify LTLE patients as compared with RTLE patients about side of seizure onset, using a clinically applicable decision rule. Conclusions: Recognition memory during the IAP for real objects, simultaneously named and presented visually during encoding, is mediated effectively by both the left and right hemisphere when there is no seizure focus present. However, memory appears to be more vulnerable to the presence of a seizure focus in the right as compared with the left hemisphere.
A Double‐Blind, Placebo‐Controlled Study on the Effect of Vigabatrin on In Vivo Parameters of Hepatic Microsomal Enzyme Induction and on the Kinetics of Steroid Oral Contraceptives in Healthy Female Volunteers
Authors: Bartoli A. , Gatti G. , Cipolla G. , Barzaghi N. , Veliz G. , Fattore C. , Mumford J. , Perucca E. 
Published: August 2005

Summary: Purpose: This study was conducted to determine whether vigabatrin affects in vivo indices of hepatic microsomal enzyme activity and the pharmacokinetics of steroid oral contraceptives in healthy subjects. Methods: Under double‐blind conditions, 13 female healthy volunteers received, in random order and with a washout interval of ≤= 4 weeks, two oral 4‐week treatments with vigabatrin (VGB) (maintenance dosage, 3,000 mg daily) and placebo, respectively. The clearance and half‐life of antipyrine (a broad marker of drug oxidation capacity), the urinary excretion of 6‐β‐hydroxycortisol (a selective marker of cytochrome CYP3A‐mediated oxidation), and the activity of serum γ‐glutamyltransferase (a nonspecific index of microsomal enzyme activity) were determined after 3 weeks of each treatment. The single‐dose kinetics of a combined oral contraceptive containing 30 μg ethinyl estradiol and 150 μg levonorgestrel were also determined after 3 weeks of treatment by specific radioimmunologic assays. Results: VGB treatment had no influence on antipyrine clearance (28 ± 5.6 vs. 30 ± 4.5 ml/h/kg on placebo), antipyrine half‐life (15.5 ± 3.5 vs. 14.1 ± 2.1 h), urinary 6–β‐hydroxycortisol excretion (488 ± 164 vs. 470 ± 228 nmol/day), 6‐β‐hydroxycortisol‐to‐cortisol concentration ratio (6.8 ± 3.1 vs. 6.1 ± 3.1) and serum γ‐glutamyltransferase activity (12 ± 3 vs. 11 ± 3 IUIL). No difference in pharmacokinetic parameters between VGB and placebo sessions were found for ethinyl estradiol (half‐life, 12.5 ± 3.2 vs. 13.9 ± 3.2 h; AUC, 874 ± 301 vs. 939 ± 272 ng/L/h) and levonorgestrel (half‐life, 17.7 ± 5.2 vs. 23.1 ± 9.8 h; AUC, 27.5 ± 9.6 vs. 30.0 ± 12.0 μg/L/h). Two subjects, however, showed a 50 and a 39% reduction in ethinyl estradiol AUC during VGB treatment. Conclusions: At therapeutic dosages, VGB did not modify in vivo indices of hepatic microsomal enzyme activity and did not interfere significantly with the CYP3A‐mediated metabolism of ethinyl estradiol and levonorgestrel. Based on these data, VGB is unlikely to affect consistently the efficacy of steroid oral contraceptives or interact pharmacokinetically with drugs that are eliminated mainly by oxidative pathways, particularly those involving cytochrome CYP3A.
Semiology of Temporal Lobe Seizures: Value in Lateralizing the Seizure Focus
Authors: Marks William J. , Laxer Kenneth D. 
Published: August 2005

Summary: Purpose: To determine the lateralizing value of the clinical manifestations of seizures in patients with temporal lobe epilepsy (TLE), we made a retrospective videotape analysis of complex partial seizures (CPS) in 55 patients who underwent temporal lobectomy and were seizure‐free postopera‐tively for >2 years. Methods: Blinded to clinical details, we reviewed videotapes from video‐EEG telemetry monitoring with attention paid to seizure semiology. Results: Useful lateralizing features included unilateral clonic activity (with the seizure focus contralateral in all patients), unilateral dystonic or tonic posturing (with the seizure focus contralateral in 90 and 86%, respectively), unilateral automatisms (with the seizure focus ipsilateral in 80%), and ictal speech preservation (with the seizure focus contralateral to the language‐dominant hemisphere in 80%). Versive head rotation occurring ≤10 s before seizures secondarily generalized consistently predicted a contralateral focus. Seizure manifestations less predictive but suggestive of lateralization included ictal speech arrest and postictal speech status, with predictive values of 67%. Seizure manifestations not providing reliable lateralizing information included eye deviation, type of aura, and versive head movements occurring at times other than immediately before seizures secondarily generalized. Conclusions: In TLE, several clinical seizure manifestations are useful in lateralizing the seizure focus, although some provide no reliable information. Therefore, ictal semiology can assist in the evaluation of patients for seizure surgery, providing additional information in the lateralization of TLE.
Vagus Nerve Stimulation in 16 Children with Refractory Epilepsy
Authors: Lundgren J. , Åmark P. , Blennow G. , Strömblad L. G. , Wallstedt L. 
Published: August 2005

Summary: Purpose: Vagus nerve stimulation (VNS) has been reported to produce >90% reduction in the number of seizures in children with intractable epilepsy. These encouraging results need confirmation. Methods: Sixteen children, 10 boys and 6 girls aged 4‐19 years, were treated with VNS (Cyberonics, Webster, TX, U.S.A.) for 12‐24 months. Seizure frequency, seizure severity, changes in quality of life (QOL: visual analogue scale), and side effects were recorded. Eight children had partial and 8 had generalized seizures; 4 of the latter had Lennox‐Gastaut syndrome (LGS). Results: During the tenth to twelfth month of VNS, 6 of 16 children experienced ≥50% reduction in seizure frequency. One girl became seizure‐free. Seizure severity showed an average decrease in the score from 15 to 11. After 10 months of treatment, QOL was estimated to have improved ≥50% in 6 of 16 children. Reduction in seizure frequency, decreased seizure severity, and reported improvement in QOL did not entirely coincide. Six children experienced hoarseness, 1 had neck pain, 2 had hypersalivation, 2 experienced tiredness, 2 had aspiration episodes during liquid intake, and 6 had electrical transmission problems; in 4 the problem has been surgically corrected. Five stimulators were turned off due to lack of efficacy. Conclusions: Six of 16 children with refractory epilepsy treated with VNS improved, with a reduction not only in seizure frequency but also in seizure severity and in QOL.