bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lamotrigine High‐Dose Tolerability and Safety in Patients with Epilepsy: A Double‐Blind, Placebo‐Controlled, Eleven‐Week Study
Authors: Matsuo Fumisuke , Gay Patricia , Madsen Jack , Tolman Keith G. , Rollins Douglas E. , Risner Marcus E. , Lai Allen A. 
Published: August 2005

Summary: Purpose: This study was undertaken to evaluate the dose tolerability and safety of a chronic ascending twice‐daily (b.i.d.) dosage regimen of 700 mg/day larnotrigine (LTG) and to include determination of the LTG pharmacokinetic profile at doses 500 mg/day in patients receiving concomitant enzyme‐inducing antiepileptic drugs (AEDs).Methods: Twelve adult male epileptic patients treated with enzyme‐inducing AEDs received 700 mg/day (b.i.d.) oral LTG (n = 8) or placebo (controls, n = 4). For 3 weeks, as outpatients they had their LTG dosage increased from 100 to 400 mg/day. Then, in a clinical research study unit, patients received regimens of 500, 600, and 700 mg/day for 1 week each. Controls received matching placebo in the same sequence. At study end, dosages were tapered in 2 weeks. Follow‐up evaluations were made 7 days later.Results: Five LTG patients tolerated 700 mg/day for 1 week. LTG was reduced to 600 mg/day in a patient with mild diplopia and to 500 mg/day in a patient with mild oscillopsia and diplopia. One patient discontinued 300‐mg/day therapy with a moderately intense diffuse papular skin rash, attributed to LTG. Headache, drowsiness, faintness, and diplopia, the common adverse events (AEs), were mild to moderate in intensity and occurred in 50–75% of patients in both groups (except for diplopia, occurring only with LTG). Concomitant AED plasma concentrations were not markedly changed by LTG. LTG pharmacokinetics were linear over the range of 500–700 mg/day.Conclusions: LTG doses 700 mg/day can be tolerated in patients receiving concomitant enzyme‐inducing AEDs.
Seizure Occurrence During Long‐Term Monitoring
Authors: Swick Cynthia T. , Bouthillier Alain , Spencer Susan S. 
Published: August 2005

Summary: Purpose: Intensive long‐term monitoring (LTM) for patients with refractory seizures is common and expensive. Methods to decrease the length of stay would improve patient experience and reduce cost. Therefore, we prospectively analyzed seizure occurrence in 36 patients who had LTM. Methods: Antiepileptic drug (AED) levels and reduction were monitored and seizures were related to these changes. Patients were divided into temporal and extratemporal groups. Results: Twenty patients had partial seizures of temporal lobe origin. The temporal lobe partial seizures occurred between LTM days 1 and 16. All but 4 of the patients required reduction or discontinuation of a least one AED and had subtherapeutic levels of the tapered medications. In 16 patients with extratemporal partial seizures, seizures occurred between LTM days 1 and 8. Six of these patients required reduction of at least one AED, and 5 of the 6 had subtherapeutic levels of that medication. These differences between length of monitoring monitoring and AED reduction in temporal and extratemporal patients were statistically significant. The groups did not differ significantly with respect to number or identity of tapered or nontapered medications or levels of nontapered medications. Reported seizure frequency at home was significantly related to number of seizures recorded in the temporal group only. The only significant predictor of secondarily generalized seizure activity during monitoring was a history of such activity occurring at home. Conclusions: We conclude that patients with extratemporal partial seizures need little reduction of AED for seizures to be captured in a minimal time period. Patients with temporal lobe seizures, however, required drastic reduction of AEDs to allow capture of seizures in a long time period.
Leisure Time Activity and Physical Fitness in Patients with Epilepsy
Authors: Steinhoff Bernhard J. , Neusiiss Karin , Thegeder Harald , Reimers Carl D. 
Published: August 2005

Summary: Purpose: To assess social and physical activity by means of a controlled study based on a questionnaire and standardized clinical tests of physical fitness. Methods: In this controlled study, we assessed several issues of social and physical activity in 136 patients with epilepsy and 145 controls by using a questionnaire. In addition, we investigated physical fitness based on physical parameters such as body mass index and body composition and standardized tests of aerobic and muscle strength endurance and physical flexibility in 35 adult patients and 36 healthy controls. Results: Leisure time habits both at home and outside the home were mainly similar except for visits of friends, which were significantly reduced in patients. Although the general attitude toward sports and physical activity was positive in both groups, and although controls judged sports to be dangerous significantly more often (p = 0.007), controls participated in regular sports significantly more frequently (p = 0.005). The clinical study demonstrated a lack of physical fitness, as suggested by the questionnaire data. Statistical analysis demonstrated significant differences of aerobic endurance (p < 0·001), muscle strength endurance (p < 0.001), and physical flexibility (p < 0.001) in favor of the control subjects. The body mass index was significantly higher in patients (p = 0.03), whereas the body composition revealed a higher body fat ratio only in female patients (p − 0.04). Conclusions: We conclude that patients with epilepsy suffer from a considerable lack of physical fitness that might have an important impact on their general health and quality of life. In addition to overprotection and reduced mobility, the questionnaire revealed insufficient knowledge among health professionals and sport instructors as a major factor contributing to these results.
Gabapentin Associated with Aggressive Behavior in Pediatric Patients with Seizures
Authors: Tallian Kimberly B. , Nahata Milap C. , Lo Warren , Tsao Chang‐Yong 
Published: August 2005

Summary:Gabapentin (GBP) is a new antiepileptic drug (AED) approved for adjunctive treatment of complex partial seizures with or without seizures secondarily generalization in adults. We report 2 children who received GBP for intractable seizures and who developed intolerable aggressive behavior requiring dose reduction or drug discontinuation. Behavioral changes should be recognized as a possible side effect of GBP, especially in mentally retarded children.
Epilepsy Surgery in Infants
Authors: Wyllie Elaine , Comair Youssef G. , Kotagal Prakash , Raja Shanker , Ruggieri Paul 
Published: August 2005

Summary: Purpose: We report 12 infants who had frontal (n = 3), temporal (n = 2), or temporoparieto‐occipital (n = 2) resection or functional hemispherectomies (n = 5) at age 2.5–29 (mean 15.3) months for catastrophic epilepsy due to focal cortical dysplasia (n = 5), Sturge‐Weber syndrome (n = 3), ganglioglioma (n = 3), or hemimegalencephaly (n = 1). Seizures began at 1 day to 14 months (mean, 4.0 months) after birth, occurred frequently (often many times per day, and were refractory to antiepileptic drugs. Patients were evaluated for surgery at 2.5–24 (mean 12.4) months of age. Seven patients had hemiparesis and eight had slowed cognitive development. Seizures were characterized by arrest or marked reduction of behavioral motor activity with unclear level of consciousness (n = 4, with temporal or temporoparietal EEG seizures), focal clonic activity (n = 3, with perirolandic EEG seizures), generalized tonic stiffening (n = 3, with temporoparieto‐occipital, parietal, or frontal EEG seizures), or infantile spasms and hypsarrhythmia (n = 2, with a frontal tumor or temporoparieto‐occipital cortical dysplasia). Methods: Magnetic resonance imaging (MRI) revealed the epileptogenic lesion in all but two patients, both with cortical dysplasia localized by interictal positron‐emission tomography (PET) and other clinical or EEG features and confirmed on histopathologic examination of resected tissue. Results: At follow‐up 4‐86 (mean 32) months after surgery, six patients were seizure free (Engel outcome class I), three had rare seizures with none in at least the previous 6 months (Engel class II), and two had worthwhile improvement (Engel class III). Except for the severely developmentally delayed infant with hemimegalencephaly, several patients had marked “catch‐up” developmental progress after class I, 11, or III outcome. Postoperative complications included subdural hematoma over the contralateral hemisphere (one patient) and entrapment and enlargement of the ipsilateral temporal horn (one patient) after hemispherectomy, both corrected uneventfully with a second surgical procedure. One patient died of unexplained causes several hours after frontal lobectomy. No patients had new neurologic deficits after surgery, and one patient had resolution of progressive fluctuating hemiparesis after resection of temporoparieto‐occipital cortical dysplasia. Conclusions: Our results agree with previous reports that epilepsy surgery can provide relief from catastrophic epilepsy in carefully selected infants.
Association of Combined MRI, Interictal EEG, and Ictal EEG Results with Outcome and Pathology After Temporal Lobectomy
Authors: Gilliam F. , Bowling S. , Bilir E. , Thomas J. , Faught E. , Morawetz R. , Palmer C. , Hugg J. , Kuzniecky R. 
Published: August 2005

Summary: Purpose: Magnetic resonance imaging, interictal scalp EEG, and ictal scalp EEG each have been shown to localize the primaly epileptic region in most patients with mesial‐basal temporal lobe epilepsy (MBTLE), but the association of surgical outcome and pathology with each combination of these test results is not known.Methods: We reviewed the MRI, interictal scalp EEG, and ictal scalp EEG results of 90 consecutive patients with MBTLE. Twelve patients were excluded from the analysis because inconclusive bitemporal intracranial EEG results precluded anterior temporal lobectomy (ATL); none had concordant MRI and interictal scalp EEG results. We compared all combinations of presurgical MRI, interictal EEG, and ictal EEG results to seizure outcome and tissue pathology in the 78 patients who underwent an ATL.Results: Forty‐eight (61%) patients had concordant lateral‐ized MRI and interictal EEG temporal lobe abnormalities, with no discordant ictal EEG results; 77% of these patients were seizure‐free after ATL. Concordance of MRI and interictal EEG abnormalities correlated with seizure cessation (p < 0.05), compared to all combinations with discordant or nonlateralizing MRI and interictal EEG results. Mesial temporal sclerosis (MTS) was confirmed pathologically in about 80% of both groups (p = 0.5). Outcome in patients with concordant MRI and ictal EEG with nonlateralizing interictal EEG was significantly worse than combinations with concordant MRI and interictal EEG (p < 0.02).Conclusions: Compared to other combinations of test results, concordance of MRI and interictal EEG is most closely associated with surgical outcome in MBTLE. However, most selected patients have pathologic confirmation of MTS regardless of test results or outcome. This information may be useful for planning the presurgical evaluation of patients with medically intractable MBTLE.
Quality of Life of People with Epilepsy: A European Study
Authors: Baker Gus A. , Jacoby Ann , Buck Deborah , Stalgis Carlos , Monnet Dominique 
Published: August 2005

Summary: Purpose: To study the impact of epilepsy and its treatment on people with epilepsy in Europe. We therefore aimed to collect data from as many countries as possible. Methods: Clinical and demographic details and information about psychosocial functioning was collected using self‐completed questionnaires mailed to members of epilepsy support groups. Results: Quality of life data was collected from >5,000 patients living in 15 countries in Europe. Over a third of all respondents had frequent seizures, and a fifth believed that their seizures were not well enough controlled by antiepileptic medication. Reported levels of side effects from medication were high. A significant number of respondents reported changing their medication because of side effects or poor control. Respondents reported that epilepsy and its treatment had a significant impact on a number of different aspects of their daily lives. Half of all respondents felt stigmatised by their epilepsy. There were significant differences by seizure type and frequency in the way respondents scored on measures of the perceived impact of their condition, the stigma associated with it and their health status as measured by a generic scale, the SF36. Conclusions: This study confirms the findings of previous smaller‐scale studies that reducing side effects and achieving better control of seizures are key to improving the quality of life of people with epilepsy, as is reducing the stigma and handicap associated with it.
Multiple Kainic Acid Seizures in the Immature and Adult Brain: Ictal Manifestations and Long–Term Effects on Learning and Memory
Authors: Sarkisian Matthew R. , Tandon Pushpa , Liu Zhao , Yang Yili , Hori Ariyuki , Holmes Gregory L. , Stafstrom Carl E. 
Published: August 2005

Summary: Purpose: While there is increasing evidence that the adverse effects of prolonged seizures are less pronounced in the immature than in the mature brain, there have been few investigations of the long‐term effects of recurrent seizures during development. This study examined the effects of multiple administrations of the convulsant kainic acid (KA) on seizure characteristics and spatial learning as a function of brain development. Method: To determine the long‐term effects of serial KA seizures during ontogeny, saline or convulsant doses of KA were given intraperitoneally 4 times, at 2‐day intervals. Immature rats were given KA on P20, P22, P24 and P26; adult rats got KA on P60, P62, P64 and P66. Ictal characteristics and EEGs were recorded. To examine the effects of multiple KA seizures on the retention of spatial learning, water maze testing was performed before (immature group: from P16–19, adult group: from P56–P59) and after (immature: from P60–P63, adult: from P1OO–Pl03) KA injections. Finally, histology was performed to compare KA‐induced damage at each age. Results: In immature animals, serial KA administration resulted in seizures with a progressively longer onset latency anddecreased severity. In contrast, KA serially administered to adult rats caused severe seizures after each of the 4 injections. In immature rats, epileptiform EEG changes were most prominent after the first KA injection, whereas in adults, prolonged paroxysmal EEG patterns were seen after all 4 KA injections. Before KA, both rat pups and adults acquired place learning in the water maze. One month after the final KA injection, there was no deficit in spatial learning retention in the immature group, whereas the adult group had profound impairment compared to age‐matched, saline‐injected controls. Histology revealed no lesions in immature rats treated multiple times with KA but profound cell loss in hippocampal fields CA4, CA3 and CAI in rats treated serially with KA as adults. Conclusions: Previous studies have shown that a single KA injection causes prolonged status epilepticus (which persists for several hours), leading to severe histologic and behavioral sequelae in adult rats but not in pups. Our study extends those findings, demonstrating that immature rats are spared the cognitive and pathological sequelae of multiple injections of convulsant doses of KA as well.
Intracranial EEG Substrates of Scalp Ictal Patterns from Temporal Lobe Foci
Authors: Pacia Steven V. , Ebersole John S. 
Published: August 2005

Summary: Purpose: To determine the intracranial EEG features responsible for producing the various ictal scalp rhythms, which we previously identified in a new EEG classification for temporal lobe seizures. Methods: In 24 patients, we analyzed simultaneous intracranial and surface ictal EEG recordings (64 total channels) obtained from a combination of intracerebral depth, subd‐ural strip, and scalp electrodes. Results: Four of four patients with Type 1 scalp seizure patterns had mesial temporal seizure onsets. However, discharges confined to the hippocampus produced no scalp EEG rhythms. The regular 5‐ to 9‐Hz subtemporal and temporal EEG pattern of Type 1a seizures required the synchronous recruitment of adjacent inferolateral temporal neocortex. Seizure discharges confined to the mesiobasal temporal cortex produced a vertex dominant rhythm (Type 1c) due to the net vertical orientation of dipolar sources located there. Ten of 13 patients with Type 2 seizures had inferolateral or lateral, temporal neocortical seizure onsets. Initial cerebral ictal activity was typically a focal or regional, low voltage, fast rhythm (20–40 Hz) that was often associated with widespread background flattening. Only an attenuation of normal rhythms was reflected in scalp electrodes. Irregular 2‐ to 4‐Hz cortical ictal rhythms that commonly followed resulted in a comparably slow and irregular scalp EEG pattern (Type 2a). Type 2C seizures showed regional, periodic, 1– to 4‐Hz sharp waves following intracranial seizure onset. Seven patients had Type 3 scalp seizures, which were characterized by diffuse slowing or attenuation of background scalp EEG activity. This resulted when seizure activity was confined to the hippocampus, when there was rapid seizure propagation to the contralateral temporal lobe, or when cortical ictal activity failed to achieve widespread synchrony. Conclusions: Type 1, 2, and 3 scalp EEG patterns of temporal lobe seizures are not a reflection of cortical activity at seizure onset. Differences in the subsequent development, propagation, and synchrony of cortical ictal discharges produce the characteristic scalp EEG rhythms.
Persistence of Photosensitivity
Authors: Harding G. F. A. , Edson A. , Jeavons P. M. 
Published: August 2005

Summary: Purpose: One hundred patients with photosensitive epilepsy were investigated as part of an ongoing follow‐up study. Average duration of follow‐up was 14 years; mean age at follow‐up was 27 years. Methods: All patients were EEG investigated using a standard technique of intermittent photic stimulation (IPS). The presence of a photoparoxysmal response (PPR) or a degraded PPR indicated the presence of photosensitivity. Results: Seventy‐seven patients became seizure free. Of the untreated patients, photosensitivity disappeared in 14 patients but was present in 32 patients. Of the patients who were treated, 31 showed evidence of PPRs or degraded PPRs, but 23 patients no longer showed evidence of photosensitivity. Thirty‐two mothers had 67 children during the follow‐up period. Thirteen have so far proved to be sensitive to IPS in the laboratory and four have also had photosensitive seizures induced in the outside environment. Nine of the children have been found not to be photosensitive nor have they had seizures. Conclusions: This study suggests that photosensitivity persists in at least two thirds of patients with photosensitive epilepsy and that valproate is effective in controlling this photosensitivity.
Resection of Frontal Encephalomalacias for Intractable Epilepsy: Outcome and Prognostic Factors
Authors: Kazemi N. J. , So Elson L. , Mosewich R. K. , O'Brien T. J. , Cascino G. D. , Trenerry M. R. , Sharbrough F. W. 
Published: August 2005

Summary: Purpose: Because focal encephalomalacia is an important cause of medically intractable partial epilepsy and few studies have evaluated the efficacy and the safety of resecting focal encephalomalacias to improve seizure control, we studied a cohort of 17 consecutive patients who underwent resection of encephalomalacias in the frontal lobes as a treatment of their intractable epilepsy. Methods: We evaluated several factors for their value in predicting postsurgical seizure control. Pre‐ and postsurgical magnetic resonance imaging (MRI) scans were reviewed independently by 2 blinded investigators. Results: At a median of 3 years of follow‐up (range 0.6–7.5 years), 12 patients (70%) were seizure‐free or had only rare seizures. The presence of a focal fast frequency discharge (focal ictal β pattern) at the beginning of seizures on scalp EEG was predictive of seizure‐free outcome (p = 0.017), even among patients who had complete resection of their encephalomalacias (p = 0.016). There was no significant differences in outcome with regard to age at the time of the injury that caused encephalomalacia, interval between injury and onset of seizures, duration of presurgical seizure history, presurgical seizure frequency, age at surgery, or the completeness of encephalomalacia resection. The analysis regarding completeness of encephalomalacia resection almost reached significance, suggesting that it may also be an important predictive factor (p = 0.051). Conclusions: We conclude that surgery is a very effective treatment for intractable frontal lobe epilepsy (FLE) secondary to encephalomalacias. Patients are more likely to become seizure‐free if they have a focal ictal β discharge on their scalp EEG. Complete resection of the encephalomalacia should be attempted, since our results suggest that this may be a favorable predictive factor. Moreover, the operative strategy for our patients entailed, whenever possible, complete resection of the encephalomalacias and of the adjacent electrophysiologically abnormal tissues.
“Cavernous Sinus EEG”: A New Method for the Preoperative Evaluation of Temporal Lobe Epilepsy
Authors: Mikuni Nobuhiro , Ikeda Akio , Murao Kenichi , Terada Kiyohito , Nakahara Ichiro , Taki Waro , Kikuchi Haruhiko , Shibasaki Hiroshi 
Published: August 2005

Summary: Purpose: In presurgical evaluation of temporal lobe epilepsy (TLE), invasive methods are necessary if results of various noninvasive methods are not sufficiently convergent enough to identify the epileptogenic area accurately. To detect the epileptiform discharges originating specifically from the mesial temporal lobe, we applied the cavernous sinus catheterization technique.Methods: We placed Seeker Lite‐10 guide wire electrodes into bilateral cavernous sinus through the internal jugular veins to record EEG (cavernous sinus EEG) in 6 patients with intractable TLE. Scalp EEG was simultaneously recorded in all 6 and electrocorticogram (ECoG) was also recorded in 4.Results: The cavernous sinus EEG demonstrated clear epileptiform discharges, sometimes even when they were absent on the simultaneously recorded scalp EEG. The epileptiform discharges recorded from the cavernous sinus electrodes were specifically associated with those in the mesial temporal region.on ECoG. Ictal EEG pattern originating from mesial temporal lobe was also clearly documented on the cavernous sinus EEG.Conclusions: This new, semi‐invasive method of identifying epileptogenic areas can detect the epileptiform discharges specifically arising from the mesial temporal lobe; it is as useful as or complements the invasive techniques such as foramen ovale or depth recording.
Rasmussen's Syndrome: Longitudinal EEG Study from the First Seizure to Epilepsia Partialis Continua
Authors: Capovilla G. , Paladin F. , Bernardina B. Dalla 
Published: August 2005

Summary: Purpose: The aim of our work was to describe the initial electroencephalographic characteristics of Rasmussen's syndrome (RS).Methods: We performed repeated EEG recordings in an 11–year 5–month‐old girl affected by RS, as demonstrated through the progressive evolution of the illness. All EEGs were carried out in polygraphy and videorecordered, both in waking and in sleep.Results: In our opinion, our patient's EEG picture is absolutely unusual in childhood partial epilepsy form without any neuroradiologic perturbation. Delta focal activity persistence in such a clinical context should be considered an RS sign, among the possible causes.Conclusioits: We are not aware of any early‐stage RS EEG description. We think that the initial RS EEG picture is so unusual as to suggest such pathology. We hope that analogous reports can confirm our belief.