bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pre‐ and Postoperative Socioeconomic Development of 151 Patients with Focal Epilepsies
Authors: Lendt Michael , Helmstaedter Christoph , Elger Christian Erich 
Published: August 2005

Summary: Purpose: We evaluated retrospectively the socio‐economic development of epilepsy patients after temporal or extratemporal epilepsy surgery and analyzed the relationship to clinical and neuropsychological data.Methods: 151 patients (from ages 11–65 years; mean postoperative followup: 3 years) replied to a structured questionnaire, which referred to objective data of the patient's educational and vocational development. Neuropsychological data were obtained from pre‐ and postoperative (1–year follow‐up) examinations.Results: The preoperative development data indicated that patients exposed to epilepsy at any delopmental stage had a higher prevalence of educational/vocational difficulties as compared with patients with a later onset of epilespy. Postopera‐tively, the integration of the formerly unemployed improved and the unemployment rate decreased from 33 to 16%. Out of those patients who had been schooled or who were employed, 79%‐91% made progress in development, or were at least able to keep their status. Only 2 of 14 patients, who had been retired early because of their epilepsy, returned to employment. In general, a deterioration of the socioeconomic status was significantly related to insufficient seizure control. A reemploy‐ment of patients who were formerly unemployed depended mainly on age and neuropsychological outcome.Conclusions: Our results suggest that early and successful surgical intervention improves or at least maintains the socio‐economic situation, especially the employment status.
Evolution of Epilepsy and EEG Findings in Angelman Syndrome
Authors: Laan Laura A. E. M. , Renier Willy O. , Arts Willem Frans M. , Buntinx Inge M. , Burgt Ineke J. A. M. v.d. , Stroink Hans , Beuten Joke , Zwinderman Koos H. , van Dijk J. Gert , Brouwer Oebele F. 
Published: August 2005

Summary: Purpose: To evaluate the evolution of epileptic seizures and EEG features in a large group of patients with Angelman syndrome (AS). Methods: Thirty‐six patients with AS with a proven chromosome 15qll–13 deletion were retrospectively analyzed with regard to their epilepsy and EEG findings by examination of patient files and EEGs. All EEGs were reviewed by one of the authors. A logistic regression model, with a follow‐up from 1 to 39 years (mean, 15 years), was used for statistical analysis. Results: Epileptic seizures had occurred in 30 (83%) patients. In 43% of them, the initial symptoms of epilepsy were febrile convulsions in infancy. In childhood, epilepsy could start with almost any type of seizure. Atypical absences and myoclonic seizures prevailed in adulthood. Epileptic seizures were present in 92% of the adult patients. The most typical EEG findings were rhythmic triphasic delta waves of high amplitude with a maximum over the frontal regions, identified in 99 (66%) of 150 EEGs, and continuously or intermittently, in 30 (83%) of 36 patients with AS. In 47% it was present even before a clinical diagnosis of AS was considered. High‐amplitude rhythmic 4–6/s slow activity, seen in 44 (29%) of 150 EEGs, was not present after the age of 12 years. Conclusions: In contrast to previous reports suggesting a decreasing frequency of epileptic seizures with age, we found that 92% of the adult patients with AS continued to have epileptic seizures. The most typical EEG finding in AS, in both children and adults, was the presence of frontal triphasic delta waves. In mentally retarded patients, this EEG pattern should point the physician in the direction of AS.
Musicogenic Epilepsy: Review of the Literature and Case Report with Ictal Single Photon Emission Computed Tomography
Authors: Wieser Heinz Gregor , Hungerböhler Hansjörg , Siegel Adrian M. , Buck Alfred 
Published: August 2005

Summary: Purpose: We report a case of musicogenic epilepsy with ictal single photon emission computed tomography (SPECT) study and discuss the findings of this patient in the context of 76 cases with musicogenic epilepsy described in the literature and seven other cases followed in Zurich. Methods: We analyzed the 83 patients according to the precipitating musical factors, type of epilepsy, presumed localization of seizure onset, and demographic data. Results: Fourteen of 83 patients (17%) had seizures triggered exclusively by music. At time of examination, music was the only known precipitating stimulus in 65 of 83 patients (78%). Various characteristics of the musical stimulus were significant, e.g., musical category, familiarity, and instruments. Conclusions: Musicogenic epilepsy is a particular form of epilepsy with a strong correlation to the temporal lobe and a right‐sided preponderance. A high musical standard might predispose for musicogenic epilepsy. Moreover, the majority of cases do not fall into the category of a strictly defined “reflex epilepsy”, but appear to depend on the indermediary of a certain emotional reaction mediated through limbic mesial temporal lobe structures.
Patient‐Validated Content of Epilepsy‐Specific Quality‐of‐Life Measurement
Authors: Gilliam Frank , Kuzniecky Ruben , Faught Edward , Black Lorie , Carpenter Gordon , Schrodt Rita 
Published: August 2005

Summary: Purpose: To study the effects of epilepsy from the patients’perspective and assist determination of content validity of health‐related quality‐of‐life (HRQOL) measures. Methods: We asked 81 consecutive patients with moderately severe epilepsy to list in order of importance their concerns of living with recurrent seizures. To minimize investigator bias, patients completed the procedure in a private setting without staff involvement. Results: Twenty‐four distinct domains were generated by the patients. Concerns about driving (64%), independence (54%), employment (51%), social embarrassment (36%), medication dependence (33%), mood/stress (32%), and safety (31%) each were listed by >30% of patients. Driving was listed as the most important concern by 28% of patients, followed by employment (21%), independence (9%), safety (6%), antiepileptic‐drug side effects (5%), seizure unpredictability (5%), and seizure aversion (5%). Conclusions: The effect of epilepsy on HRQOL is not vague or obscure from the patients’perspective but is defined by a limited number of domains. Independence is an important concern that may not be evaluated adequately by currently available HRQOL instruments.
Effect of Topiramate on the Pharmacokinetics of an Oral Contraceptive Containing Norethindrone and Ethinyl Estradiol in Patients with Epilepsy
Authors: Rosenfeld William E. , Doose Dennis R. , Walker Sally A. , Nayak R. K. 
Published: August 2005

Summary: Purpose: Because enzyme‐inducing antiepileptic drugs (AEDs) can affect pharmacokinetics of oral contraceptives and thereby cause contraceptive failure, the potential effect of topiramate, a new AED, on the pharmacokinetics of the combination oral contraceptive norethindrone/ethinyl estradiol was evaluated. Methods: Twelve women receiving stable valproic acid (VPA) monotherapy for epilepsy received a combination norethindrone 1.0 mg/ethinyl estradiol 35‐μg tablet daily for 21 days followed by seven daily doses of inert tablets for four 28‐day cycles. After a baseline cycle (cycle 1), topiramate 100, 200f and 400 mg every 12 h was administered in cycles 2 through 4, respectively. Serial blood samples were obtained on day 20 of each cycle and were analyzed for norethindrone, ethinyl estradiol, and progesterone by using validated radioimmunoassay methods. Results: Compared with cycle 1, none of the norethindrone pharmacokinetic parameters changed significantly in the presence of topiramate, 100–400 mg every 12 h. Individual patient serum progesterone concentrations measured during each cycle were at or close to the limit of quantification with no apparent differences among cycles. However, mean area under the concentration‐versus‐time curve over the 24‐h period (AUC0–24) values for ethinyl estradiol were 18–30% lower in cycles 2 through 4 compared with cycle 1 (p 0.05 for all pairs), whereas mean oral serum clearance (CL/F) values were 14.7–33.0% higher (p 0.05 for cycles 2 and 4 vs. cycle 1). Mean time of peak concentration (Tmax values determined during topiramate therapy were not significantly different from those at baseline. Conclusions: When prescribing an oral contraceptive for patients receiving topiramate, clinicians should consider initial therapy with an agent containing 235 μg of ethinyl estradiol.
Alteration of Cardiac Function in Patients with Temporal Lobe Epilepsy: Different Roles of EEG‐ECG Monitoring and Spectral Analysis of RR Variability
Authors: Massetani Roberto , Strata Giancarlo , Galli Renato , Gori Sara , Gneri Carlo , Limbruno Ugo , Di Santo Domenica , Mariani Mario , Murri Luigi 
Published: August 2005

Summary: Purpose: Because several reports have described the relation between epilepsy and cardiac arrhythmias and suggest that changes in autonomic neural control of the heart could be involved in the pathogenesis of sudden unexplained death in patients with epilepsy, the aim of this study was to evaluate cardiac function in patients with temporal lobe epilepsy. Methods: Sixty‐five patients with epilepsy were evaluated by simultaneous ambulatory 24‐h EEG‐ECG monitoring, and in 30 of these, power spectral analysis of relative‐risk (RR) variability also was carried out, both in the supine position and in a passive tilt position at 60°. The power spectrum of RR variability, the two major spectral components detectable at low frequency (LF) and at high frequency (HF), respectively, and the LF/HF ratio were calculated. Results: By EEG‐ECG monitoring, we recorded six partial seizures, and in four cases, discharges were associated with sinus tachycardia. However, interictally the occurrence of ventricular and supraventricular arrhythmias was not different from that in normal subjects. The spectral analysis of RR variability, on the other hand, demonstrated in patients with epilepsy a significant decrease in the total RR variability and in both of its components (LF and HF) in the supine position, and of the LF/HF ratio in orthostatic position. Conclusions: These findings suggest that the spectral analysis of RR variability may detect disorders of autonomic cardiac control in patients with epilepsy, even in the absence of abnormal findings during ECG monitoring. This alteration, which is more severe in cases with right EEG focus, could play a role in the pathogenesis of cardiac arrhythmias.
Reproductive Activity and Offspring Health of Young Adults with Childhood‐Onset Epilepsy: A Controlled Study
Authors: Jalava Merja , Sillanpää Matti 
Published: August 2005

Summary: Purpose: To study reproductive activity and offspring health in a prospective follow‐up setting. Methods: After a 35‐year follow‐up of a population‐based patient cohort with childhood‐onset “epilepsy only”, 100 (56.8%) of 176 surviving patients were shown to have “epilepsy only”, i.e., recurrent unprovoked seizures with no associated neuroimpairment. Their reproductivity and offspring health were compared with those of matched controls. Results: The marriage rate and fertility of patients with “epilepsy only” were significantly reduced as compared with those of matched controls. Continuation of antiepileptic drug (AED) treatment was significantly associated with reduced reproduction, whereas occurrence of seizures during the previous 5 years was not. The incidence of epilepsy was nine times greater among the children of patients than among those of controls. No higher risks were observed in pregnancy or delivery in patients, nor were increased rates of birth defects in their offspring than in those of contols. Exposure to AEDs during pregnancy did not increase these risks. Conclusions: Patients with “epilepsy only” since childhood have fewer marriages and fewer children than expected. However, when they marry, their pregnancies and deliveries are unremarkable and their children do not have increased congenital health problems. Obviously, etiologies causative of both epilepsy and associated neurological impairments are more harmful to the course of pregnancy and delivery and offspring health than are those resulting in “epilepsy only”.
Early Discontinuation of Treatment in Children with Uncomplicated Epilepsy: A Prospective Study with a Model for Prediction of Outcome
Authors: Braathen Gunnar , Melander Hans 
Published: August 2005

Summary: Purpose: The main purpose of the present study was to identify predictor variables with significant influence on seizure outcome after discontinuation of treatment in children with uncomplicated epilepsy and to analyze whether these variables, included in a prognostic model could identify children in whom 1‐year treatment would be sufficient. Methods: Before initiation of treatment in children aged 2–16 years with uncomplicated epilepsy, the duration of treatment was randomized to 1 year (group I) or 3 years (group II). At the end of the allotted period, treatment was discontinued in 161 children who had been seizure free during the previous 6 months. The mean follow‐up period after treatment was 5.8 years. Twenty‐three predictor variables were analyzed by survival methods regarding their influences on the outcome. Results: At the latest follow‐up check, 60 children (37%) had relapsed. The following predictor variables were selected by multiple regression analysis and constituted a model with a simple scoring system: age at seizure onset; seizure type; generalized, irregular spike‐wave activity on EEG after 1 year of treatment; and persistent 3‐Hz spike‐wave activity after 6 months of treatment in children with absence epilepsy. In group I, the remission rate was 73% in children with high prognostic scores, 10% in children with low scores, and 40% in those with intermediate scores (log‐rank test, p = 0.0001). Conclusions: After 1 year of treatment, our prognostic model identified children in whom treatment could be withdrawn at that time. Our model should be easily applicable in clinical practices and may be of clinical importance in determining the duration of treatment in children with uncomplicated epilepsy.
The Diagnostic Yield of a Second EEG After Partial Sleep Deprivation: A Prospective Study in Children with Newly Diagnosed Seizures
Authors: Carpay J. A. , de Weerd A. W. , Schimsheimer R. J. , Stroink H. , Brouwer O. F. , Peters A. C. B. , van Donselaar C. A. , Geerts A. T. , Arts W. F. M. 
Published: August 2005

Summary: Purpose: To assess the diagnostic yield of a repeated EEG (REPEEG) after partial sleep deprivation (SD) in children and adolescents with one or more seizures who previously had had a standard EEG (STDEEG) without epileptiform abnormalities (EAs). In the literature, 32–75% of such REPEEGs after SD were reported to show EA. Methods: In a prospective, multicentred study, we selected children aged 1 month to 16 years with one or more idiopathic or remote symptomatic newly diagnosed seizures. A REPEEG was recorded in children without EAs in their STDEEG. Results: Of 552 children and adolescents who entered the study, 243 (44%) had a STDEEG without EAs. In 177 (73% of eligible children), REPEEGs were recorded after SD. We found EAs in 61 (34.5%) REPEEGs and new nonepileptiform abnormalities in five (1%). In 552 children in the total cohort, the REPEEG thus added 11% with EAs to the 56% with EAs in the STDEEG. Of REPEEGs, 81% included sleep compared with 20% of STDEEGs. In about half the REPEEGs, EAs occurred during sleep only. One child had tonic‐clonic seizures probably related to the SD. Conclusions: One third of REPEEGs yielded new diagnostic information. Partial, age‐dependent SD was highly effective in inducing sleep, which is important because in many cases EAs were found only during EEG recording in sleep. The procedure was safe and convenient.
Neuronal Generators of Visual Evoked Potentials in Humans: Visual Processing in the Human Cortex
Authors: Arroyo Santiago , Lesser Ronald P. , Poon Wai‐Tat , Robert W. , Webber S. , Gordon Barry 
Published: August 2005

Summary: Purpose: We wished to define the localization of cortical generators of visual (pattern) evoked potentials (VEP) and the temporal sequence of activation in the occipital region. Methods: In 4 candidates for epilepsy surgery, a large array of subdural electrodes was placed over occipital areas. Checkerboard pattern reversal stimuli were generated and the epileptogenic focus was localized and functionally mapped. Magnetic resonance imaging did not show any occipital lesions in any of the 4 patients. Results: The area first activated was the lingual gyrus in the mesial occipital lobe (negative potential peaks at ∼70 ms), followed by an area superior to the calcarine fissure (negative peaks at ∼80 ms). Later (starting at ∼90 ms), there were positive potentials over the occipital pole and lingual gyrus, followed by potentials at the lateral occipital lobe. Conclusions: These data support the idea that VEP are generated in the mesial and lateral occipital cortex by different circumscribed neuronal generators with different latencies of activation. The scalp‐recorded N1 and P1 potential peaks most likely derive from the progressive activation of neuronal masses in different regions of the occipital lobe.
Cause‐Specific Mortality in Epilepsy: A Cohort Study of More Than 9,000 Patients Once Hospitalized for Epilepsy
Authors: Nilsson Lena , Tomson T. , Farahmand B. Y. , Diwan V. , Persson P. G. 
Published: August 2005

Summary: Purpose: We studied overall and cause‐specific mortality rates in a large cohort of patients with epilepsy compared with mortality rates of the general population in the same geographic area. Methods: The cohort consisted of all patients (N = 9,061) aged >15 years admitted with a diagnosis of epilepsy for inpatient care in Stockholm during the years 1980–1989. All patients were followed in the National Cause‐of‐Death Register, from which the causes of death were obtained, until December 31, 1992. Thus, 53,520 person‐years were observed. Mortality rates were compared with those of the general population of Stockholm. Results: We observed 4,001 deaths in the cohort, compared with an expected number of 1,109 deaths in the general population. This yielded a standardized mortality ratio (SMR) of 3.6 [95% confidence interval (CI) 3.5–3.71] Although highest in the younger patients, the SMR was significantly increased in all age groups. The excess mortality rate in the cohort was due to a wide range of causes of death, including malignant neoplasms [SMR 2.6 (2.4–2.8)], diseases of the circulatory system, [SMR 3.1 (3.0–3.3)], diseases of the respiratory system [SMR 4.0 (3.64.5)], diseases of the digestive system [SMR 5.1 (4.4–5.8)], and injuries and poisoning [SMR 5.6 (5.0–6.3)]. Conclusions: Our results demonstrate that this large subgroup of patients with a diagnosis of epilepsy, once hospitalized and discharged, is a population at risk, with an excess mortality rate due to several different causes.
Central Benzodiazepine/γ‐Aminobutyric AcidA Receptors in Idiopathic Generalized Epilepsy: An [11C]Flumazenil Positron Emission Tomography Study
Authors: Koepp Matthias J. , Richardson Mark P. , Brooks David J. , Cunningham Vin J. , Duncan John S. 
Published: August 2005

Summary: Purpose: Previous [11C]flumazenil (FMZ) positron emission tomography (PET) investigations in patients with idiopathic generalized epilepsy (IGE) have demonstrated nonsignificant global cortical decreases in central benzodiazepine γ‐aminobutyric acid, (GABAA) receptor (cBZR) binding or focal decreases in the thalamus and increases in the cerebellar nuclei with no changes in cerebral cortex. We previously reported lower [11C]FMZ binding in cerebral cortex of IGE patients treated with valproate (VPA) than in cerebral cortex of controls. We now report high‐resolution three‐dimensional [11C]FMZ PET studies in a larger number of subjects using an improved method to detect differences in cBZR between IGE patients and controls and a more powerful longitudinal design to determine the functional effect of VPA. Methods: We compared parametric images of [11C]FMZ volume of distribution (FMZVD) in 10 IGE patients before and after addition of VPA and in 20 normal subjects. Results: Mean FMZVD was significantly higher in the cerebral cortex (11%, p = 0.009), thalamus (14%, p = 0.018), and cerebellum (15%, p = 0.027) of the 10 IGE patients as compared with that of 20 normal controls. Using statistical parametric mapping, no significant areas of focal abnormality of FMZVD were detected. Addition of VPA was not associated with a significant change in mean FMZVD in any brain area. Conclusions: Our finding of increased FMZVD in IGE could reflect microdysgenesis or a state of cortical hyperexcitability. Our data suggest that short‐term VPA therapy does not affect the number of available cBZR in patients with IGE.
Significance of Spikes Recorded on Intraoperative Electrocorticography in Patients with Brain Tumor and Epilepsy
Authors: Tran Teresa A. , Spencer Susan S. , Javidan Manoucher , Pacia Steven , Marks David , Spencer Dennis D. 
Published: August 2005

Summary: Purpose: Patients with medically intractable epilepsy due to brain tumors may undergo resective surgery for treatment of both the tumor and the epilepsy. In this instance, the extent of surgical resection is sometimes guided by spikes recorded on intraoperative electrocorticography (ECoG). Whether spikes recorded by electrocorticography imply active epileptogenicity has not been addressed adequately. Methods: We performed preresection and postresection electrocorticography on 36 patients with brain tumor and seizures. There were 3 I low‐grade gliomas, 4 high grade gliomas, and 1 dysembryonic neuroepithelial tumor. Patients had resection of the tumor to normal tissue margins only. No additional surgery was performed, based on electrocorticography findings. Patients were divided into 2 groups: Group I (no seizures or rare seizures after resection) and Group I1 (recurrent seizures). Recorded spikes were analyzed for spike distribution and spike discharge rate. Results: On preresection ECoG, 85% of patients in Group I and 88% of patients in Group I1 had spikes. In Group I, 70% of patients had spikes over the tumor bed, and 63% of patients had spikes in the surrounding tissue. In Group 11, 55% of patients had spikes over the tumor bed and 89% of patients had spikes in the surrounding tissue. Spike distribution and discharge rate did not correlate with outcome. On postresection ECoG, 60% of patients in Group I and 67% of patients in Group II had residual spikes. In Group I, 46% of patients had spikes along the margin of resection and 26% of patients had extramarginal spikes. In Group 11, 50% had spikes along the margin of resection and 67% of patients had extramarginal spikes. Conclusions: The difference in spike distribution in the extramarginal area between the 2 groups was not statistically significant, but showed a trend toward a relationship between postresection spikes and seizure recurrence.