bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lateralizing Value and Semiology of Ictal Limb Posturing and Version in Temporal Lobe and Extratemporal Epilepsy
Authors: Bleasel Andrew , Kotagal Prakash , Kankirawatana Pongkiat , Rybicki Lisa 
Published: August 2005

Summary: Purpose: Unilateral dystonic limb posturing in partial seizures has been shown to be an accurate lateralizing sign indicating seizure onset in the contralateral hemisphere. However, its clinical utility may be reduced by confusion with other lateralized ictal motor phenomena. In this study, the ictal phenomena of dystonic limb posturing, tonic limb posturing, unilateral immobile limb, and version were distinguished and examined in patients with temporal and extratemporal seizures. Methods: Partial seizures in 54 patients, successfully treated by surgery (34 temporal, 20 extratemporal; 14 frontal, 3 parietal, and 3 occipital), were analyzed blindly by 3 reviewers. Interobserver agreement was tested with kappa indexes and positive predictive value (PPV) was determined for each sign. Results: In patients with temporal lobe epilepsy (TLE), dystonic posturing occurred in 35.3% (kappa 0.78, positive predictive value (PPV) for the sign being contralateral to seizure onset 92%); tonic limb posturing occurred in 17.7% (kappa 0.36, PPV 40%); unilateral immobile limb occurred in 11.8% (kappa 0.23, PPV 100%); and version occurred in 35.3% (kappa 0.77, PPV 100%). In patients with extratemporal epilepsy, dystonic posturing occurred in 20.0% (kappa 0.31, PPV 100%); tonic limb posturing occurred in 15.0% (kappa 0.08, PPV 67%); and version occurred in 40.0% (kappa 0.54, PPV 100%). The higher kappa indexes were significant for dystonic posturing (p < 0.001) and tonic limb posturing (p = 0.032) in TLE. Dystonic posturing (p = 0.034), tonic posturing (p = 0.07), and version (p = 0.0038) occurred earlier in extratemporal seizures than in temporal seizures. Conclusions: Of the limb ictal motor phenomena, only dystonic posturing was accurate and had good interobserver agreement.
Occipital Lobe Developmental Malformations and Epilepsy: Clinical Spectrum, Treatment, and Outcome
Authors: Kuzniecky Ruben , Gilliam Frank , Morawetz Richard , Faught Edward , Palmer Cheryl , Black Lorie 
Published: August 2005

Summary: Purpose: Cortical developmental malformations (CDM) are increasingly recognized in association with epilepsy. We describe 10 patients (age range 14–35 years) with symptomatic occipital lobe epilepsy and CDM. Methods: Neurologic, neuroophthalmologic and electro‐physiologic studies were performed. Patients had MRI, SPECT, and in some cases intracranial EEG investigators. Results: Mean age of seizure onset was 8 years. We noted strong correlations between the presence of visual auras, the scalp EEG pattern, and the subtype of underlying pathology. Magnetic resonance imaging (MRI) showed CDM in all patients, with polymicrogyria and focal dysplasia being the most frequent malformations. Despite the presence of occipital lobe structural malformations in all patients, visual field deficits were present in only 2. Those who underwent cortical resections were seizure–free or showed major improvement at a mean follow–up of 3.5 years. Conclusions: Intracranial stimulation studies and the low frequency of pre‐ and postoperative deficits suggest that some degree of cortical visual reorganization may occur in patients with occipital lobe malformations. Occipital lobe CDM should be sought as a cause of symptomatic occipital lobe epilepsy even though they may become symptomatic after childhood.
Occurrence of Epilepsies in Family Members of Indian Probands with Different Epileptic Syndromes
Authors: Jain S. , Padma M. V. , Jyoti A. Puri , Maheshwari M. C. 
Published: August 2005

Summary: Purpose: Large numbers of families with many members having seizures have been used to understand the role of hereditary factors in the pathogenesis of human epileptic syndromes. We aimed to establish a genetic database to form a hypothesis on the possible genetic contributions in different epileptic syndromes. Methods: The occurrence and patterns of different epilepsies and epileptic syndromes in 1,219 Indian probands and their relatives were studied. The concordance of epilepsies between probands and relatives was also analyzed. Results: Of probands, 231 (19% of 1219) had first– or second‐ degree relatives affected with seizures. Incidence of family history in probands with generalized epilepsies (GES) and syndrome of single, small, enhancing lesions (SSEL) was comparable and significantly higher than that in probands with localization‐related epilepsies (LRES). The ratio of affected first‐ to second‐degree relatives was close to 4:1. Generalized epilepsies were the commonest type of epileptic syndromes seen among all relatives. The proportion of sibs and second‐degree relatives with epileptic syndromes similar to probands was significantly greater in the GES group as compared with the concordant relatives of probands with LRES and SSEL. Conclusions: A significant percentage of first‐ and second–degree relatives of probands with all types of epileptic syndromes have seizures. The risk of relatives being affected varied as a function of the relation with the proband. Concordance of epileptic syndromes between probands and relatives was related to the epileptic syndromes in probands. The syndrome of SSEL is probably a benign epileptic syndrome seen in Indians genetically predisposed to seizures. Hereditary factors may play an almost equal role in the predisposition of relatives to epilepsy in families of probands with different epileptic syndromes.
Poststroke Late Seizures and Their Role in Rehabilitation of Inpatients
Authors: Paolucci Stefano , Silvestri Giulia , Lubich Sergio , Pratesi Luca , Traballesi Marco , Gigli Gian Luigi 
Published: August 2005

Summary: Purpose: This study was designed to (a) identify the prevalence of poststroke late seizures in a population of patients admitted to rehabilitation of neurologic sequelae of their first stroke, (b) recognize reliable prognostic factors associated with the occurrence of poststroke late seizures, and (c) evaluate the impact of seizures on the results of rehabilitation treatment. Methods: In a prospective study of 306 consecutive patients admitted to a rehabilitation hospital for sequelae of their first stroke, we assessed the relation among 15 independent variables and the development of seizures by using multiple regression analysis (forward stepwise). In addition, we evaluated the impact of occurrence of poststroke seizures on both efficiency and effectiveness of rehabilitation and length of stay. Results: Poststroke late seizures occurred in 46 (15.03%) patients, with a mean interval from stroke of 101.98 ± 37.96 days. In multiple regression analysis, putaminal and lobar hemorrhages showed a significant positive association with the development of seizures (p < 0.005), whereas high scores on the Canadian Neurological Scale (CNS) (indicating less severe strokes) and increasing age were negatively associated (p < 0.01 and p < 0.05, respectively). Patients with putaminal and lobar hemorrhages and patients with severe stroke (CNS score at admission, <7) were at significantly greater relative risk of seizures [relative risk (RR) = 1.99, 95% confidence interval (CI), 1.11–1.39; RR = 3.00, CI, 1.06–1.13; and RR = 2.41, CI, 1.01–1.27, respectively). No significant association was found between poststroke seizures and results of rehabilitation. Conclusions: Poststroke late seizures occurred mainly in patients with putaminal and lobar hemorrhagic strokes but, if treated, did not affect rehabilitation therapy.
Early‐Onset Benign Occipital Seizure Susceptibility Syndrome
Authors: Ferrie C. D. , Beaumanoir A. , Guerrini R. , Kivity S. , Vigevano F. , Takaishi Y. , Watanabe K. , Mira L. , Capizzi G. , Costa P. , Valseriati D. , Grioni D. , Lerman P. , Ricci S. , Vigliano P. , Goumas‐Kartalas A. , Hashimoto K. , Robinson R. O. , Panayiotopoulos C. P. 
Published: August 2005

Summary: Purpose: Childhood epilepsy with occipital paroxysms (CEOP) is characterised by ictal visual hallucinations and occipital epileptiform activity on interictal EEG. A variant has been described with nonvisual symptoms including tonic head and eye deviation, vomiting, and episodes of partial status epilepticus. We fully documented the electroclinical features of such patients to determine whether classification separate from CEOP is justified. Methods: This was a multicentre study with participating investigators submitting details of patients with idiopathic occipital seizures characterised by ictal head or eye deviation and vomiting. Results: One hundred thirteen patients were recruited. Seizures began in early childhood (mean, 4.6 years) and occurred infrequently (mean total seizures, 3); 30% of patients had only a single seizure. Two thirds of seizures were nocturnal. Ictal eye deviation occurred in 79%, vomiting in 70%, and head deviation in 35%. Seizures were predominantly complex partial in type. Partial status epilepticus occurred in 44% of patients. Seventy‐four percent of patients had occipital interictal EEG epileptiform activity, predominantly right sided, with fixation‐off sensitivity. Extraoccipital EEG abnormalities occurred in 35% of patients. Prognosis was excellent: the mean duration of active seizures was 1 year. Conclusions: Although the two groups shared identical EEG features, the distinct clinical symptoms probably justify separate classification. Early‐onset benign occipital seizure syndrome (EBOSS) is suggested as an appropriate name for the variant group.
Comparison of the Steady‐State Pharmacokinetics of Topiramate and Valproate in Patients with Epilepsy During Monotherapy and Concomitant Therapy
Authors: Rosenfeld W. E. , Liao S. , Kramer L. D. , Anderson G. , Palmer M. , Levy René H. , Nayak R. K. 
Published: August 2005

Summary: Purpose: The steady‐state pharmacokinetics of valproate (VPA) and topiramate (TPM) were compared during VPA monotherapy, concomitant VPA and TPM therapy, and TPM monotherapy to evaluate pharmacokinetic interactions. Methods: After a 3‐week baseline period, 12 patients receiving VPA monotherapy (500 to 2,250 mg every 12 h) received TPM at three escalating doses (from 100 to 200 to 400 mg every 12 h), each for 2 weeks. Thereafter, the VPA dose was tapered by 25% weekly. Blood and urine samples were collected over 12‐h intervals during VPA monotherapy and at the end of each stage of TPM dose escalation and TPM monotherapy. Results: All patients reached TPM monotherapy, and nine achieved satisfactory seizure control for 2 weeks without VPA. TPM plasma peak concentration (Cmax) and area under the concentration‐versus‐time curve during a 12–h dosing interval (AUC0–12) were slightly higher (17%; n = 8) during TPM monotherapy than during concomitant VPA therapy. TPM oral and renal clearances (n = 8) were 25.9 ± 4.6 and 11.6 ± 3.2 ml/min during TPM monotherapy and were 29.8 ± 4.2 and 12.4 ± 2.7 ml/min during VPA concomitant therapy. VPA AUC(0–12) decreased (11.3%; n = 10) with the addition of TPM 400 mg every 12 h. VPA oral clearance was 12.8 ± 4.1 ml/min during monotherapy and was 13.8 ± 4.0,14.1 ± 3.9, and 14.5 ± 5.2 ml/min during coadministration of TPM 100, 200, and 400 mg every 12 h, respectively. Cognitive dysfunction, observed in some patients receiving high doses of VPA with TPM, reversed or improved with VPA dose reduction and discontinuation. The lower‐than‐normal prestudy platelet count measured in one patient increased to normal levels when VPA was discontinued. Conclusions: Because changes in TPM and VPA pharmacokinetics were small, it is unlikely that their concomitant use will have a significant impact on the clinical condition of the patient.
Lamotrigine Reduces Voltage‐Gated Sodium Currents in Rat Central Neurons in Culture
Authors: Zona Cristina , Avoli Massirno 
Published: August 2005

Summary: Purpose: To study the mechanism or mechanisms of action of lamotrigine (LTG) and, in particular, to establish its effects on the function of NA+ channels in mammalian central neurons. Methods: Rat cerebellar granule cells in culture were subjected to the whole‐cell mode of voltage clamping under experimental conditions designed to study voltage‐gated Na+ currents. Results: Extracellular application of LTG (10–500 μM, n = 21) decreased in a dose‐related manner a tetrodotoxin‐sensitive inward current that was elicited by depolarizing commands (from −80 to +20mV). The peak amplitude of this Na+‐mediated current was diminished by 38.8 ± 12.2% (mean ± SD, n = 6) during application of 100 μM LTG, and the dose‐response curve of this effect indicated an IC50 145 μM. The reduction in the inward currents produced by LTG was not associate with any signficant change in the current decay, whereas the voltage dependency of the steady‐state inactivation shifted toward more negative values (midpoint of the inactivation curve: –47.5 and –59.0 mV under control conditions and during application of 100 μM LTG, respectively, n = 4). Conclusions: Our findings indicate that LTG reduces the amplitude of voltage‐gated Na+ inward current in rat cerebellar granule cells and induces a negative shift of the steady‐state inactivation curve. Both mechanisms may be instrumental in controlling the repetitive firing of action potentials (AP) that occurs in neuronal networks during seizure activity.
Incidence of First Epileptic Seizures in the Canton of Geneva, Switzerland
Authors: Jallon Pierre , Goumaz Michel , Haenggeli Charles , Morabia Alfredo 
Published: August 2005

Summary: Purpose: We wished to determine the incidence of first provoked and nonprovoked epileptic seizures in the canton of Geneva, Switzerland. Methods: Between June 1, 1990: and May 31, 1991, we collected all cases of suspected epileptic seizures referred to the two hospitals of the county of Geneva, Switzerland and to the private neurologists of the town. The diagnosis probability was based on clinical data from the patient chart and the EEG data. The classification of risk factors proposed by the International League Against Epilepsy (ILAE) Commission on Epidemiology and Prognosis was used. Results: In all, 273 cases were collected. The age‐adjusted incidence rate (U.S. population as standard) is 69.4 in 100.000. We observed a bimodal distribution of the cases with age (71 in the group aged 0–10 years and 107.5 in those aged >60 years). Ninety‐seven cases were classified as having provoked seizures (incidence: 25.2 in 100,000). Alcohol consumption (29.8%) and cerebrovascular diseases were the most frequent causes (16.4%). One hundred seventy‐six cases were classified as having unprovoked seizures (incidence: 45.6 in 100,000) with the following distribution: seizures in relation with a stable cerebral condition, 69 cases (incidence: 17.9); seizures in relation with an evolutive cerebral condition, 27 cases (incidence: 7); and seizures of unknown etiology, 80 cases (incidence: 20.8). Conclusions: The incidence rate of first epileptic seizures in the canton of Geneva is quite similar to that reported in a French study (Epilepsia 1990;31:391–394) in which the same methodology for case ascertainment was used. Our data clearly demonstrate that the classification of risk factors proposed by the ILAE Commission on Epidemiology and Prognosis is useful and particularly easy to use in epidemiological surveys.
Recognition and Classification of Seizures in Infants
Authors: Nordli Douglas R. , Bazil Carl W. , Scheuer Mark L. , Pedley Timothy A. 
Published: August 2005

Summary: Purpose: We wished to assess the reliability of the International League Against Epilepsy (ILAE) seizure classification system applied to infantile seizures and to test a proposed new classification. Methods: We first analyzed 39 seizures in 20 infants (aged 1–26 months) recorded with simultaneous closed‐circuit television and EEG (CCTV/EEG). EEGs and videotapes of all seizures were independently analyzed by two epileptologists blinded to clinical histories. Videotapes of each seizure were reviewed without simultaneous EEG (phase I), and printouts of ictal EEGs were assessed without behavioral correlates (phase II). The observers classified seizures according to ILAE criteria. Interrater agreement was assessed by the kappa statistic. Results: Agreement on EEG features (phase II) was moderate (= 0.54) in identifying focal ictal onsets and substantial (= 0.79) in identifying generalized onsets. In contrast, analysis of videotapes showed substantial disagreement between observers in terms of classifying seizures as partial or generalized. Therefore, agreement between observers for partial was slight (= 0.14) and fair for generalized seizures (= 0.26). Similarly, conclusions of the observers as compared with those of a consensus panel were divergent for both partial (= 0.18) and generalized seizures (= 0.30). We therefore developed an alternative classification scheme and retested interrater agreement in a review of 50 seizures in 25 other infants. With this classification scheme, there was substantial agreement between observers (= 0.72). Conclusions: With clinical observations and interictal EEGs, seizures in infants cannot be reliably classified by current ILAE criteria. In contrast, a proposed new classification scheme based solely on semiology showed substantial reliability.
Reappraisal of Polytherapy in Epilepsy: A Critical Review of Drug Load and Adverse Effects
Authors: Deckers C. L. P. , Hekster Y. A. , Keyser A. , Meinardi H. , Renier W. O. 
Published: August 2005

Summary: Purpose: We reviewed the literature to determine whether an analysis of published data could clarify the relationship between antiepileptic drug (AED) polytherapy and adverse affects (AE). We highlight the problems encountered. Methods: We made a Medline‐search for articles published between 1974 and 1994 reporting the number of AE and doses or serum levels of every AED, per patient or treatment group, and used the PDD/DDD ratio to calculate AED load per patient from doses or the OSL/AToxL ratio to do so from serum levels of individual drugs. The PDD/DDD is the sum of ratios of the actual prescribed daily doses divided by the published average therapeutic dose of each drug. The OSL/AToxL is the sum of each observed serum level divided by its average toxic level. Results: We retrieved 118 trial reports. Most had to be excluded because of incomplete reporting of concomitant medication or AE. The data of the 15 articles selected for further analysis indicate a relationship between drug load and number of AE. We noted no relationship between the number of AEDs administered and AE. In add‐on studies, the difference in neurotoxicity between the active and placebo arm may be obscured if the relative increase in drug load is small, as exemplified by the study of McGuire et al. (35). Conclusions: Articles reporting add‐on trials of new AEDs generally do not provide detailed information about the basic medication to which the new AED is added, which makes calculation of total drug load impossible. Furthermore, often only frequency of AE is reported, not severity or development of tolerance, making it difficult to judge the impact of AE. However, despite the paucity of available information, we present some evidence that toxicity in AED polytherapy may be related to total drug load, rather than to the number of drugs administered. Therefore, the present trend to reject polytherapy for fear of increased toxicity is not warranted, which removes one of the objections to initiating specific research to prove or disprove the value of AED combinations as long as the drug load is appropriate.
Age at Onset and Neuropsychological Function in Frontal Lobe Epilepsy
Authors: Upton Dominic , Thompson Pamela J. 
Published: August 2005

Summary: Purpose: Previous studies into the cognitive consequences of frontal lobe epileptic dysfunction may have proved inconclusive, due to a factor not commonly accounted for: Damage or disturbance during different epochs of development may give rise to different levels of neuropsychological dysfunction. In this study, we investigated the influence of age at onset on cognitive performance in a group of subjects with frontal lobe epilepsy (FLE). Methods: Seventy‐four subjects (42 with left, and 32 with right) FLE were classified into early (0–6 years), intermediate (7–11 years) or late onset (12 years) and their performance recorded on a battery of measures assessing both executive and motor skills. Results: On the measures of executive functioning, no consistent pattern emerged, whereas on the measures of motor skill, the results suggested that a right‐sided early onset (i.e., 0–6 years) did not impair performance compared to a later lesion within the same hemisphere. Furthermore, this sparing of performance was not observed within the left hemisphere. Conclusions: Overall, the results suggest that individuals with differing ages of epilepsy onset will be differentially impaired on certain cognitive tasks. Several tentative ramifications of these results are suggested.
The Effect of Television Frame Rate on EEG Abnormalities in Photosensitive and Pattern‐Sensitive Epilepsy
Authors: Fylan F. , Harding G. F. A. 
Published: August 2005

Summary: Purpose: Seizures provoked by television viewing may be triggered by patterns in the television image or by flicker from the display itself. We examined the incidence of EEG abnormalities elicited by patterns displayed on television sets with two different frame rates to evaluate the likely contribution of photosensitive and pattern‐sensitive mechanisms to television‐ and video‐game epilepsy. Methods: Televisions with frame rates of 50 and 100 Hz were used to present 35 patients who were photosensitive or pattern‐sensitive with grating patterns. These patterns comprised vertical square‐wave and sine‐wave gratings of 90% contrast, and the spatial frequency was varied between 0.25–7 cycles/degree. EEGs were analysed for laboratory sensitivity to patterned and unpatterned intermittent photic stimulation (IPS). Results: Significantly fewer EEG abnormalities were elicited by patterns displayed on the 100 Hz frame‐rate television than on the 50‐Hz frame‐rate television. No abnormalities were observed in response to the blank screens of either television. Thirty‐three patients showed abnormalities in response to patterned IPS but only 15 in response to diffuse flash. Two patients showed no laboratory evidence of photosensitivity. Patients who were sensitive to patterned IPS at 50 Hz were significantly more likely to demonstrate abnormalities to patterns displayed on the 100‐Hz frame‐rate television than were patients who were not sensitive to 50‐Hz patterned IPS. Conclusions: We suggest that for many patients, the combination of high‐contrast patterns and screen flicker may elicit the observed EEG abnormalities. For patients with sensitivity to screen flicker, the use of a high frame‐rate television may be beneficial in reducing the risk of seizures.