bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Prospective Study of the Incidence of the Purple Glove Syndrome
Authors: Burneo Jorge G. , Anandan J. V. , Barkley Gregory L. 
Published: March 2003

Summary:  Purpose: Phenytoin (PHT) has been widely used intravenously for the treatment of seizures since 1956, and for many years, it has been considered first‐line therapy for status epilepticus. It is routinely administered intravenously in emergency departments and hospitals for patients who have had isolated seizures and for many patients undergoing neurosurgical procedures who are unable to receive oral medication. Adverse reactions from PHT have been widely studied for years, but in the past decade, new adverse reactions have been identified. One of these adverse reactions is the purple glove syndrome (PGS), characterized by edema, discoloration, and pain distal to the site of i.v. administration of PHT. Because there have been no prospective reports of the incidence of PGS, the objective of the study was to report the incidence of this syndrome.Methods: We enrolled 179 consecutive exposures to i.v. PHT at Henry Ford Hospital. Distal portions of the upper extremities were examined and digitally photographed by one of the authors (J.G.B.). The photos were blindly evaluated by the third author (G.L.B.) for PGS. Demographic and pertinent medical history was recorded for all patients, and outcome for those who experienced PGS was recorded. Associations between PGS, demographic, and medical history information were assessed.Results: In only three of the 179 exposures did PGS develop. In both patients, the severity of the clinical picture was mild and did not required prolonged hospitalization or specialized treatment.Conclusions: PGS is an infrequent and mild adverse effect of i.v. PHT administration.
Focal Functional Deficits in Temporal Lobe Epilepsy on PET Scans and the Intracarotid Amobarbital Procedure: Comparison of Patients with Unitemporal Epilepsy with Those Requiring Intracranial Recordings
Authors: Salanova V. , Markand O. , Worth R. 
Published: March 2003

Summary:  Purpose: To analyze the relationship between the intracarotid amobarbital procedure (IAP) and positron emission tomography (PET) and study the lateralizing value of these tests in patients with unitemporal epilepsy and those requiring intracranial recordings.Methods: We compared 51 patients with unitemporal epilepsy (group1) with 26 patients in whom surface recordings failed to reveal a distinct unitemporal focus, necessitating invasive recordings (group 2).Results: The brain magnetic resonance imaging (MRI) scans for group 1 showed mesial temporal sclerosis in 70.5% of the patients. PET showed unilateral temporal hypometabolism in 88%. In addition, 74.5% of the patients in group 1 had impaired memory on the epileptogenic side on the IAP, and 89.4% of those patients also had ipsilateral temporal hypometabolism on PET scans. All the group 1 patients underwent temporal resections. The pathologic examination showed hippocampal sclerosis in 72% of the patients. Eighty percent of group 1 patients became seizure free, and 16% had rare seizures (follow‐up, 2–7 years). MRIs for group 2 showed mesial temporal sclerosis in 31% of the patients; PET scans showed temporal hypometabolism in 39%. The IAP was lateralized in 47.8%. Sixty‐nine percent had temporal lobe resections. The pathologic examination showed hippocampal sclerosis in 44% of the patients. Forty‐four percent of group 2 patients became seizure free, and 27.7% had rare seizures (follow‐up, 2–8 years).Conclusions: Ninety‐six percent of the patients with unitemporal foci had focal functional deficits on the epileptogenic side on 18‐fluorodeoxyglucose‐(FDG) PET scans, the IAP, or both. The results of the FDG‐PET were predictive of impaired memory on the IAP. Memory impairment contralateral to the temporal hypometabolism found on the PET scans was never seen. These patients had an excellent outcome. In contrast, <50% of the patients requiring intracranial recordings had focal functional deficits, suggesting that more a diffuse pathology may account for their less favorable outcome.
Two‐Year Remission and Subsequent Relapse in Children with Newly Diagnosed Epilepsy
Authors: Berg Anne T. , Shinnar Shlomo , Levy Susan R. , Testa Francine M. , Smith‐Rapaport Susan , Beckerman Barbara , Ebrahimi Nader 
Published: March 2003

Summary:  Purpose: Although remission is the ultimate measure of seizure control in epilepsy, and epilepsy syndrome should largely determine this outcome, little is known about the relative importance of syndrome versus other factors traditionally examined as predictors of remission or of relapse after remission. The purpose of this study was to examine remission and relapse with respect to the epilepsy syndrome and other factors traditionally considered with respect to seizure outcome.Methods: A prospectively identified cohort of 613 children with newly diagnosed epilepsy was assembled and is actively being followed to determine seizure outcomes. Epilepsy syndrome and etiology were classified at diagnosis and again 2 years later. Remission was defined as 2 years completely seizure‐free, and relapse as the recurrence of seizures after remission. Multivariable analysis was performed with the Cox proportional hazards model.Results: Five hundred ninety‐four of the original 613 children were followed ≥2 years (median follow‐up, 5 years). Remission occurred in 442 (74%), of whom 107 (24%) relapsed. On multivariable analysis, idiopathic generalized syndromes and age at onset between 5 and 9 years were associated with a substantially increased remission rate, whereas remote symptomatic etiology, family history of epilepsy, seizure frequency, and slowing on the initial EEG were associated with a decreased likelihood of attaining remission. Young onset age (<1 year) and seizure type were not important after adjustment for these predictors. Relapses occurred more often in association with focal slowing on the initial EEG and with juvenile myoclonic epilepsy. Benign rolandic epilepsy and age at onset <1 year were associated with markedly lower risks of relapse. About one fourth of relapses were apparently spontaneous while the child was taking medication with good compliance, and more than half occurred in children who were tapering or had fully stopped medication.Conclusions: A large proportion of children with epilepsy remit. Symptomatic etiology, family history, EEG slowing, and initial seizure frequency negatively influence, and age 5–9 years and idiopathic generalized epilepsy positively influence the probability of entering remission. Factors that most influence relapse tend to be different from those that influence remission.
Dynamic Susceptibility Contrast (DSC) MRI and Interictal Epileptiform Activity in Cryptogenic Partial Epilepsy
Authors: Placidi Fabio , Floris Roberto , Bozzao Alessandro , Romigi Andrea , Tombini Mario , Baviera Maria Elena , Sperli Francesca , Izzi Francesca , Mattia Donatella , Marciani Maria Grazia 
Published: March 2003

Summary:  Purpose: To study the possible correlation between interictal EEG patterns and neuroradiologic data obtained by dynamic susceptibility contrast (DSC) magnetic resonance imaging (MRI) in patients with partial epilepsy.Methods: Seventeen subjects with cryptogenic partial epilepsy underwent long‐term video‐EEG monitoring and DSC‐MRI in the same session. Ten patients had temporal lobe epilepsy (TLE) and seven, epilepsy of extratemporal origin (ExTE). MRI data were compared with EEG findings, and the accuracy of DSC‐MRI was analyzed considering spiking rate (number of interictal epileptiform abnormalities, IEA/min) and type of epilepsy.Results: DSC‐MRI showed a relevant asymmetry in the frontal, temporal, and occipital regions in eight (47%) of 17 patients, consisting of a relative regional cerebral blood volume (rCBV) increase in these areas. Because this region corresponded to the interictal EEG focus (IEF) or to the hemisphere involved in the genesis of epileptic discharges in most patients showing a higher spiking rate, patients were classified in two groups: patients with high spiking rate (HSR, n = 9) and with low spiking rate (LSR, n = 8); the cutoff corresponded to the median value of IEA/min. The rCBV increase corresponded to the IEF or to the hemisphere involved in the genesis of epileptic discharges in seven (77.7%) of nine HSR patients. No patients with LSR showed significant asymmetries in rCBV pattern. In five of six patients with TLE‐HSR (83.3%), DSC‐MRI showed a relative rCBV increase concordant with IEF or hemisphere involved in the genesis of epileptic discharges; in patients with ExTE‐HSR, the concordance was 66%.Conclusions: DSC‐MRI is a noninvasive procedure that may provide useful additional information to lateralize and/or localize the IEF when interictal epileptiform activity is sufficiently elevated.
Systemic Overexpression of the α1B‐Adrenergic Receptor in Mice: An Animal Model of Epilepsy
Authors: Kunieda Takeharu , Zuscik Michael J. , Boongird Atthaporn , Perez Dianne M. , Lüders Hans O. , Najm Imad M. 
Published: March 2003

Summary:  Purpose: A lack of selective α1‐adrenergic receptor (α1‐ARs) agonists and antagonists has made it difficult to clarify the precise function of these receptors in the CNS. We recently generated transgenic mice that overexpress either wild‐type or a constitutively active mutant α1B‐AR in tissues that normally express the receptor. Both wild‐type and mutant mice showed an age‐progressive neurodegeneration with locomotor impairment and probable stress‐induced motor events, which can be partially reversed by α1‐AR antagonists. We hypothesized that the wild‐type and mutant mice may exhibit spontaneous epileptogenicity as compared with normal (nontransgenic) mice.Methods: Normal, wild‐type, and mutant mice were studied. Twenty mice (1 year old) underwent prolonged video‐EEG monitoring over a 4‐week period. Raw EEG data were blindly analyzed by visual inspection for the presence of interictal and ictal epileptic activities.Results: During the acute postoperative period (≤3 days), both wild‐type (26.1 ± 8.07 spikes/day) and mutant mice (116.87 ± 55.13) exhibited more frequent interictal spikes than did normal mice (2.17 ± 0.75; p value, <0.05), but all three groups showed EEG and clinical seizures. During the later monitoring periods (>3 days), wild‐type and mutant mice showed more frequent interictal spikes (15.44 ± 4.07; p < 0.01; and 6.05 ± 2.46; p < 0.05, respectively) as compared with normal mice (0.41 ± 0.41), but only mutant mice had spontaneous clinical seizures (means ± SEM).Conclusions: The selective overexpression of the α1B‐AR is associated with increased in vivo spontaneous interictal epileptogenicity and EEG/behavioral seizures. These results suggest a possible role (direct or indirect) for the α1B‐ARs in the development and expression of epileptogenicity.
Cerebral Activation during Vagus Nerve Stimulation: A Functional MR Study
Authors: Narayanan Jaishree T. , Watts Richard , Haddad Naim , Labar Douglas R. , Li P. Mark , Filippi Christopher G. 
Published: March 2003

Summary:  Purpose: To study the short‐term effects of vagus nerve stimulation (VNS) on brain activation and cerebral blood flow by using functional magnetic resonance imaging (fMRI).Methods: Five patients (three women, two men; mean age, 35.4 years) who were treated for medically refractory epilepsy with VNS, underwent fMRI. All patients had a nonfocal brain MRI. The VNS was set at 30 Hz, 0.5–2.0 mA for intervals of activation of 30 s on and 30 s off, during which the fMRI was performed. Statistical parametric mapping (SPM) was used to determine significant areas of activation or inhibition during vagal nerve stimulation (p < 0.05).Results: VNS‐induced activation was detected in the thalami bilaterally (left more than right), insular cortices bilaterally, ipsilateral basal ganglia and postcentral gyri, right posterior superior temporal gyrus, and inferomedial occipital gyri (left more than right). The most robust activation was seen in the thalami (left more than right) and insular cortices.Conclusions: VNS‐induced thalamic and insular cortical activation during fMRI suggests that these areas may play a role in modulating cerebral cortical activity, and the observed decrease in seizure frequency in patients who are given VNS may be a consequence of this increased activation.
Brain Sterols in the AY‐9944 Rat Model of Atypical Absence Seizures
Authors: Cortez Miguel A. , Cunnane Stephen C. , Snead O. Carter 
Published: March 2003

Summary:  Purpose: The AY‐9944 (AY)‐treated rat is a reproducible and clinically relevant animal model of atypical absence seizures. AY inhibits cholesterol synthesis, but the relation between brain sterol levels and the spontaneously recurrent absence seizures has not been determined.Methods: Long–Evans hooded rats were treated every 6 days from postnatal day (P)2 to P20 with AY (7.5 mg/kg, s.c.) or saline. Electrodes were permanently implanted under pentobarbital anesthesia at P50. Spike‐and‐wave discharge (SWD) duration and amplitude were quantified at P55. Changes in brain sterols after AY were examined in three different experiments, looking at brain regions (experiment 1), recovery after stopping AY (experiment 2), or gender differences (experiment 3).Results: Experiment 1: AY caused spontaneously recurrent slow SWD that lasted 59 times longer and had a 3.2‐fold higher amplitude than that in controls. At P55, brain cholesterol was reduced and 7‐dehydrocholesterol was increased in all brain regions (p < 0.0001). Experiment 2: Four hundred days after stopping AY‐9944 treatment (P420), brain sterol levels had returned to normal levels, but the AY‐induced SWD lasted twice as long as at P55. Experiment 3: At P55, AY‐induced changes in plasma and liver (but not brain) sterols were significantly more severe in females compared with males.Conclusions: AY‐induced seizures appear to be related to AY‐induced changes in brain sterols but persisted long after the sterols had returned to normal after the last AY injection. Hence, there appears to be a critical developmental window during which the AY must be given but after which the AY‐induced change in brain sterols is no longer essential to sustaining the seizures.
Effect of Levetiracetam on Epileptiform Discharges in Human Neocortical Slices
Authors: Gorji Ali , Höhling Jorg‐Michael , Madeja Michael , Straub Heidrun , Köhling Rüdiger , Tuxhorn Ingrid , Ebner Alois , Wolf Peter , Panneck H. W. , Behne F. , Lahl Rainer , Speckmann Erwin‐Joseph 
Published: March 2003

Summary:  Purpose: The anticonvulsant effects of the novel antiepileptic drug (AED) levetiracetam (LEV) were tested in neocortical slice preparations from 23 patients who underwent surgery for the treatment of refractory epilepsy.Methods: Slices were used to evaluate the effects of LEV on two different models of epilepsy: low‐Mg2+–induced untriggered and bicuculline‐evoked stimulus‐triggered epileptiform burst discharges and spontaneously appearing rhythmic sharp waves.Results: LEV (0.1–1 mM) did not influence spontaneously appearing rhythmic sharp waves or Mg2+‐free aCSF‐induced epileptiform field potentials. LEV affected neither the amplitudes or duration nor the repetition rates of burst discharges in these epilepsy models. However, LEV (100–500 μM) significantly suppressed the ictal‐like discharges elicited by the γ‐aminobutyric acid subtype A (GABAA)‐receptor antagonist bicuculline. A marked reduction of the amplitude and duration of bicuculline‐evoked field response in the presence of LEV was observed.Conclusions: The results indicate the potential for LEV to inhibit epileptiform burst discharges in human neocortical tissue, which is consistent with its effects in animal models of epilepsy. These results also support the seizure reduction observed in clinical trials and support that this may, in part, be related to the ability of LEV to inhibit epileptiform discharges.
Digital Photography and 3D MRI–based Multimodal Imaging for Individualized Planning of Resective Neocortical Epilepsy Surgery
Authors: Wellmer Jörg , Von Oertzen Joachim , Schaller Carlo , Urbach Horst , König Roy , Widman Guido , Van Roost Dirk , Elger Christian E. 
Published: March 2003

Summary:  Purpose: Invasive presurgical work up of pharmacoresistant epilepsies presumes integration of multiple diagnostic modalities into a comprehensive picture of seizure onset and eloquent brain areas. During resection, reliable transfer of evaluation results to the patient's individual anatomy must be made. We investigated the value of digital photography–based grid localization in combination with preoperative three‐dimensional (3D) magnetic resonance imaging (MRI) for clinical routine.Methods: Digital photographs of the exposed cortex were taken before and after grid placement. Location of electrode contacts on the cortex was identified and schematically indicated on native cortex prints. Accordingly, transfer of contact positions to a 3D MRI brain‐surface rendering was carried out manually by using the rendering software. Results of the electrophysiologic evaluation were transferred to either electrode contact reproduction and co‐registered with imaging‐based techniques such as single‐photon emission computed tomography (SPECT), positron emission tomography (PET), and functional MRI (fMRI).Results: Digital photography allows precise and highly realistic documentation of electrode contact positions on the individual neocortical surface. Lesions underneath grids can be highlighted by semitransparent MRI surface rendering, and lobar boundaries can be identified. Because of integrating electrode contact positions into the postprocessed 3D MRI data set, imaging‐based techniques can be codisplayed with the results of the electrophysiologic evaluation. Comparison with CT/MRI co‐registration showed good accuracy of the method. However, grids not sewn to the dura at implantation can become subject to significant displacement.Conclusions: Digital photography in combination with preimplantation 3D MRI allows the generation of reliable tailored resection plans in neocortical epilepsy surgery. The method enhances surgical safety and confidence.
Four New Families with Autosomal Dominant Partial Epilepsy with Auditory Features: Clinical Description and Linkage to Chromosome 10q24
Authors: Winawer Melodie R. , Boneschi Filippo Martinelli , Barker‐Cummings Christie , Lee Joseph H. , Liu Jianjun , Mekios Constantine , Gilliam T. Conrad , Pedley Timothy A. , Hauser W. Allen , Ottman Ruth 
Published: March 2003

Summary:  Purpose: Autosomal dominant partial epilepsy with auditory features (ADPEAF) is a rare form of nonprogressive lateral temporal lobe epilepsy characterized by partial seizures with auditory disturbances. The gene predisposing to this syndrome was localized to a 10‐cM region on chromosome 10q24. We assessed clinical features and linkage evidence in four newly ascertained families with ADPEAF, to refine the clinical phenotype and confirm the genetic localization.Methods: We genotyped 41 individuals at seven microsatellite markers spanning the previously defined 10‐cM minimal genetic region. We conducted two‐point linkage analysis with the ANALYZE computer package, and multipoint parametric and nonparametric linkage analyses as implemented in GENEHUNTER2.Results: In the four families, the number of individuals with idiopathic epilepsy ranged from three to nine. Epilepsy was focal in all of those with idiopathic epilepsy who could be classified. The proportion with auditory symptoms ranged from 67 to 100%. Other ictal symptoms also were reported; of these, sensory symptoms were most common. Linkage analysis showed a maximum 2‐point LOD score of 1.86 at (θ = 0.0 for marker D10S603, and a maximum multipoint LOD score of 2.93.Conclusions: These findings provide strong confirmation of linkage of a gene causing ADPEAF to chromosome 10q24. The results suggest that the susceptibility gene has a differential effect on the lateral temporal lobe, thereby producing the characteristic clinical features described here. Molecular studies aimed at the identification of the causative gene are underway.
Current Status of Surgery in the Management of Epilepsy
Authors: Shaefi Shahzad , Harkness William 
Published: March 2003

Summary:  Purpose: To review systematically the available evidence with regard to the current status of epilepsy surgery in the management of patients with epilepsy.Methods: A careful search of published literature, including Medline, published reviews, chapters, and cross‐references thereof.Results: With medical treatment of epilepsy being unsuccessful in many cases, the importance of surgical approaches cannot be underscored. Early surgery is the treatment of choice for patients with clear‐cut mesial temporal sclerosis and results in significant clinical improvement in up to 80% of cases, provided the EEG, neuropsychological, and neuropsychiatric results are in concordance with this approach. In patients with poorly defined, widespread, or dual pathology, however, invasive recordings may be necessary, and while this is performed in major centres, the outcome is rather more variable in this group. Improved surgical techniques, and the use of stereotactic approaches and image guidance procedures, have resulted in surgical resections becoming more selective. With isolated structural lesions such as dysembryoplastic tumours, low‐grade astrocytomas, or focal vascular abnormalities, total macroscopic and radiological evidence of lesional excision is associated with excellent seizure‐free outcome. The first randomised controlled trial of epilepsy surgery has demonstrated clearly the efficacy of these techniques, and the risk of complications. Discussion: Increasing sophistication of noninvasive presurgical evaluation enables surgical candidates to be identified at an earlier stage and presents a realistic alternative to medical treatment in many cases. The introduction of minimally invasive techniques has had a significant impact on surgical practice and its associated morbidity. The future of epilepsy surgery lies with continued basic science research and its application to clinical medicine.