bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dietary Fat, Ketosis, and Seizure Resistance in Rats on the Ketogenic Diet
Authors: Likhodii Sergei S. , Musa Kathy , Mendonca Antonio , Dell Cynthia , Burnham W. McIntyre , Cunnane Stephen C. 
Published: August 2005

Summary: Purpose: Fat is the major component of the ketogenic diet (KD), yet no studies have examined whether the type of fat used in the diet can be optimized to provide additional benefits. The purpose of the present experiments was to compare the efficiency of different fats in inducing ketosis and affording seizure resistance. Methods: The effects of KDs that incorporate lard, butter, medium‐chain triglycerides (MCT), or flaxseed oil or a mixture of the latter three fats were examined in rats fed KD for up to 98 days. The maximal electroshock (MES) or pentylenetetrazole (PTZ) threshold tests were used to assess seizure susceptibility in two separate experiments. Results: The rank order of induced ketosis was MCT < mixture < flaxseed oil ± lard = butter < control. MES failed to reveal anticonvulsant effects, but the PTZ test indicated that up to 50% of rats fed the KD were seizure protected (p <0.05). The measures of seizure protection, seizure incidence and score, did not correlate, however, with the level of ketosis in the range of 0.7–5.2 mmol/L for β‐hydroxybutyrate. In the long‐term study, flaxseed oil KD maintained stable ketosis throughout 98 days, whereas ketones declined with lard and butter KD to the control level. Conclusions: Seizure protection with the versions of the KD did not improve with the higher level of ketosis. The focus of the KD improvement, therefore, is not the achievement of higher ketosis per se but rather designing a diet that provides steady ketosis, exploits advantages of certain fats for neurological development or seizure protection via a nonketogenic mechanism, and is nutritionally balanced.
Cerebral and Cerebellar Volume Reduction in Children with Intractable Epilepsy
Authors: Lawson John A. , Vogrin Simon , Bleasel Andrew F. , Cook Mark J. , Bye Ann M. E. 
Published: August 2005

Summary: Purpose: Adult epilepsy studies have demonstrated cerebral and cerebellar volume reduction beyond the epileptogenic zone, correlating this with an inferior surgical outcome. We determined whether brain volumes were reduced in childhood epilepsy and the significance of this. Methods: Cerebral, cerebellar, and hippocampal volumes were measured by quantitative magnetic resonance imaging on 112 children (ages 4–18) with epilepsy syndrome determined by video‐EEG telemetry. Eighty‐seven had partial epilepsy and 25 had generalized epilepsy or indeterminate syndrome. Normative volumes were obtained from 44 child controls from the community. Results: A significant reduction in cerebral (12.6%) and cerebellar (7.9%) volume was present in the epilepsy group compared with controls. Analysis of subgroups revealed that cerebral volume was significantly decreased in frontal lobe and nonlocalized partial epilepsies. The mean hippocampal ratio of 0.73 for mesial temporal lobe epilepsy was significantly less than for all other syndromes and controls. There was no difference in the rate of hippocampal volume reduction between syndromes. There was a significant correlation between IQ and cerebral and cerebellar volume, but not duration or age of onset of epilepsy. Conclusions: Cerebral and cerebellar volume reduction is common in intractable epilepsy syndromes of childhood. These cross‐sectional data suggest that brain volume reduction is present at epilepsy onset and is not a result of intractable seizures. Hippocampal asymmetry is more sensitive than volume reduction as a marker for mesial temporal lobe epilepsy, but neither measure is specific.
Parent‐ and Patient‐ Validated Content for Pediatric Epilepsy Quality‐of‐Life Assessment
Authors: Arunkumar G. , Wyllie E. , Kotagal P. , Ong H. T. , Gilliam F. 
Published: August 2005

Summary: Purpose: The purpose of this study was to assess the parent‐ and patient‐validated content of quality‐of‐life measurement for use in children with epilepsy. Methods: We asked the parents of 80 consecutive children and adolescents with epilepsy to list in order of importance their concerns about living with or caring for their children with epilepsy. Patients were 3 months to 18 years of age (mean, 10 years) and identified at the outpatient clinic or during hospital stay. To minimize investigator bias, parents and children listed their concerns in a private setting without staff involvement. Results: Twenty‐six distinct domains were generated by the parents and children. Concerns listed by more than 20 of parents included medication adverse effects (58), cognitive effects of epilepsy (46), prospects for the future (41), safety (35), independence (31), and brain damage caused by seizures (30). Concerns ranked by parents as most important included safety (18), brain damage from seizures (12), enigma of epilepsy (12), cognitive effects of epilepsy (11), and prospects for the future (10). Concerns listed by more than 20 of children included social problems (35), cognitive effects of epilepsy (29), driving (29), sports (27), medication adverse effects (25), and schooling (21). Concerns ranked by children as most important included issues related to medication adverse effects (13), cognitive effects of epilepsy (10), hatred of epilepsy (8), social embarrassment (6), fear of seizures (6), injury (6), and dislike of hospital visits (6). Conclusion: The effect of epilepsy on health‐related quality of life in pediatric patients is defined by a limited number of domains. A 20‐item inventory was chosen from the 26 domains generated by the parents and children. Our study provides insight into parents' and children's perception of seizures and the impact of epilepsy on everyday life.
Evidence Favoring Genetic Heterogeneity for Febrile Convulsions
Authors: Racacho Lemuel J. , McLachlan Richard S. , Ebers George C. , Maher John , Bulman Dennis E. 
Published: August 2005

Summary: Purpose: Two large Canadian kindreds appearing to segregate febrile convulsions as an autosomal dominant trait were evaluated for linkage to three known FC loci, as well as other epilepsy loci. Methods: Members of the two families were genotyped with microsatellite markers linked to the previously identified febrile convulsion loci, FEB1, FEB2, and GEFS+, and we performed two‐point linkage analyses by assuming an autosomal dominant mode of inheritance. Results: We report the exclusion of the FC trait in our families to FEB1 on 8q13–21 and to a second febrile convulsion locus on 19p13. Furthermore, we also excluded the GEFS+ locus on 19q13.1 as the cause of febrile convulsions in both kindreds. Microsatellite markers linked to juvenile myoclonic epilepsy (EJM1), benign neonatal familial convulsions EBN1 and EBN2, autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE), idiopathic generalized epilepsy (EGI), progressive myoclonic epilepsy of Unverricht‐Lundborg (EPM1), and partial epilepsy with auditory features (EPT), were also excluded as potential loci linked to the FC trait in our families. Conclusions: These findings favor considerable genetic heterogeneity for febrile convulsions.
Induction of Partial Epileptic Seizures by Flumazenil
Authors: Schulze‐Bonhage A. , Elger C. E. 
Published: August 2005

Summary: Purpose: This study addressed the efficacy of flumazenil (FMZ) to induce or activate interictal or ictal epileptic discharges in patients with medically intractable partial epilepsies. Methods: Flumazenil, 1 mg, was injected intravenously in 67 patients undergoing presurgical monitoring for epilepsy surgery, 49 of whom had been treated with benzodiazepines (BZDs) before flumazenil was given. Continuous video electroencephalogram (EEG) monitoring with surface or intracranial electrodes was used to evaluate interictal EEG activity, ictal discharges, and the occurrence and semiology of clinically manifest epileptic seizures. Results: Interictal epileptiform potentials did not change in frequency or distribution after FMZ. In patients not pretreated with BZDs, epileptic seizures could not be provoked. In eight of the 49 patients pretreated with BZDs, epileptic seizures occurred within 30 min of FMZ application. Seizure semiology and regional EEG onset were identical to seizures recorded without FMZ. Patients operated on according to seizure‐onset localization with FMZ had a >75% reduction in seizure frequency or became seizure free. Conclusions: Seizure induction by FMZ seems to be a valid method for evaluating seizure semiology and localization of the seizure‐onset zone during presurgical monitoring of patients with medically intractable localization‐related epilepsies.
Planned Ictal FDG PET Imaging for Localization of Extratemporal Epileptic Foci
Authors: Meltzer Carolyn Cidis , Adelson P. David , Brenner Richard P. , Crumrine Patricia K. , Van Cott Anne , Schiff David P. , Townsend David W. , Scheuer Mark L. 
Published: August 2005

Summary: Purpose: This work demonstrates the feasibility of planned ictal positron emission tomography (PET) with [18F]fluoro‐2‐deoxy‐glucose (FDG) for localization of epileptic activity in patients with frequent partial seizures of extratem‐poral origin. Methods: Ictal PET imaging was performed in four patients (two men and two women, ages 28–61) with continuous or very frequent (every 3–15 min) partial seizures. All patients had abnormalities apparent on magnetic resonance (MR) or computed tomographic (CT) imaging, two with extensive brain lesions that precluded precise localization of the seizure focus with interictal PET or single‐photon emission tomography (SPECT) imaging. Results: Ictal PET imaging demonstrated a restricted area of focal hypermetabolism concordant with surface electroen‐cephalographic (EEG) recording in all cases. The PET images were registered to MR imaging data for further anatomic localization of hypermetabolic regions in three cases. The ictal PET data were used to guide neurosurgical intervention in one case. Conclusions: We conclude that planned ictal PET imaging may be a useful and potentially superior approach to ictal SPECT for identifying the epileptic focus in a selected group of patients with continuous or frequent simple partial seizures.
Contralateral EEG Slowing and Amobarbital Distribution in Wada Test: An Intracarotid SPECT Study
Authors: Hong Seung Bong , Kim Kyung‐won , Seo Dae Won , Kim Sang Eun , Na Dong Gyu , Byun Hong Sik 
Published: August 2005

Summary: Purpose: To relate the occurrence of contralateral electroencephalogram slowing (CES) to amobarbital distribution, we performed electroencephalogram (EEG) monitoring and intracarotid single photon emission computed tomography (SPECT) during an intracarotid amobarbital procedure (IAP). Methods: IAP was performed on 22 patients with temporal lobe epilepsy. CES was defined as the occurrence of significant EEG slowing on the contralateral hemisphere (>50% of the ipsilateral hemisphere slowing) after amobarbital injection. To map the distribution of the amobarbital, we injected a mixture of amobarbital and 99m technetium‐ethylcysteinate dimer (99m Tc‐ECD) into the internal carotid artery and performed a brain SPECT 2 h later. In the SPECT images, regions of interest were determined by ipsilateral and contralateral anterior cerebral artery territories (iACA, cACA), ipsilateral and contralateral middle cerebral artery territories (iMCA, cMCA), and ipsilateral and contralateral posterior cerebral artery territories (iPCA, cPCA), as well as ipsilateral and contralateral anterior and posterior mesial temporal regions (iAMT, cAMT, iPMT, cPMT). The perfusion of amobarbital was interpreted visually in each region. Results: Amobarbital was distributed in the iMCA in all the patients; in the iACA in 20 (90.9%) patients; in the iAMT in 14 (63.5%); and in the iPCA and iPMT in only two (9.1%). CES was observed in 13 (59.1%) patients. Cross‐perfusion of amobarbital in limited areas of the cACA were observed in only four of 13 patients. Wada retention memory scores (WRMS) showed no significant difference between the CES‐ (n = 9) and CES+ (n = 13) groups. Conclusions: Amobarbital rarely perfused the iPCA territory and the iPMT region and was rarely delivered to the contralat‐eral hemisphere. The occurrence of CES was not related to the cross‐perfusion of amobarbital. CES appears to be produced by a transient functional disconnection from the ipsilateral hemisphere.
Ictal Spiking Patterns Recorded from Temporal Depth Electrodes Predict Good Outcome After Anterior Temporal Lobectomy
Authors: Schuh Lori A. , Henry Thomas R. , Ross Donald A. , Smith Brien J. , Elisevich Kost , Drury Ivo 
Published: August 2005

Summary: Purpose: Investigators have shown that the presence of ictal spiking (IS) recorded from temporal depth electrodes is associated with mesial temporal sclerosis (MTS). We investigated the relation of IS to seizure control and pathology after anterior temporal lobectomy (ATL). Methods: All patients undergoing intracranial ictal monitoring from a single institution since 1989 were identified. Those who did not undergo ATL or had postoperative follow‐up of <1 year were excluded. All received at a minimum bilateral temporal depth electrodes. Ictal recordings were reviewed for the presence of IS, and the proportion of seizures with IS was determined for each patient. Outcome was determined by using Engel's classification. Surgical specimens were reviewed for pathology. Statistics used were X2, Fisher exact test, and Wilcoxon rank sum. Results: Forty patients with 571 seizures were reviewed. In 292 seizures from 32 patients, IS was seen. Outcomes were 24 class I (22 with IS), five class II (four with IS), three class III (one with IS), seven class IV (four with IS), and one lost to follow‐up (with IS). Pathologic review revealed 25 with MTS, 22 of whom had IS. The presence of IS was associated with class I outcomes (p = 0.04), but not MTS (p = 0.06). Patients with class I outcomes had a significantly greater proportion of seizures with IS (mean, 0.58 ± 0.3) compared with other outcomes (mean, 0.30 ± 0.3, p = 0.02). Conclusions: The presence of IS and higher proportion of seizures with IS correlated with good seizure outcome after ATL. This information may be used in preoperative counseling.
Atypical Evolutions of Benign Localization‐Related Epilepsies in Children: Are They Predictable?
Authors: Fejerman Natalio , Caraballo Roberto , Tenembaum Silvia N. 
Published: August 2005

Summary: Purpose: To emphasize that, in some patients, different atypical evolutions occur in the course of so‐called benign focal epilepsies of childhood (BFEC) and to promote interest in finding clinical and/or electroencephalographic (EEG) clues to which patients might be prone to these risky evolutions. Methods: Twenty‐six patients who started with the typical clinical and EEG features of benign childhood epilepsy with centrotemporal spikes (BCECTS) but who had reversible or persistent, serious epileptic events including status epilepticus and language, cognitive, or behavioral impairments were followed for <14 years. Repeated neurologic examinations, EEG records, and neuropsychological evaluations were done, and brain‐imaging studies [computerized axial tomography (CAT) or magnetic resonance imaging (MRI)] were obtained in all patients. Results: The 26 patients were in four separate groups according to the nature of their atypical evolution. Eleven children had atypical benign focal epilepsy of childhood (ABFEC), three with Landau–Kleffner syndrome (LKS), seven with status epilepticus of BCECTS, and five with mixed features of the other three groups. All the children whose BCECTS evolved into ABFEC have finally recovered and are attending normal schools, although five have learning difficulties. Two of the three patients diagnosed with LKS recovered from aphasia, although some language difficulties persist in one. The seven who showed status epilepticus of BCECTS are now normal after 3–14 years of follow‐up, and three of the five children showing mixed features fulfilled the criteria for a diagnosis of epilepsy with continuous spikes and waves during slow sleep (CSWS). Conclusions: A small proportion of cases starting with BCECTS evolve into ABFEC, LKS, status of BCECTS, or epilepsy with CSWS. In such cases, BCECTS is not always benign. Clinical and EEG markers should be sought to predict these atypical evolutions.
Long‐Term Seizure Outcome in 74 Patients with Lennox–Gastaut Syndrome: Effects of Incorporating MRI Head Imaging in Defining the Cryptogenic Subgroup
Authors: Goldsmith Ian L. , Zupanc Mary L. , Buchhalter Jeffrey R. 
Published: August 2005

Summary: Purpose: To determine if using more stringent criteria for cryptogenic Lennox‐Gastaut syndrome (LGS) would result in an improved prognosis for that group. Cryptogenic, symptomatic, and non‐cryptogenic LGS patients without etiology (indeterminate) were compared with respect to seizure and cognitive outcome. Methods: Retrospective chart review was performed on 245 patients seen at the Mayo Clinic Rochester from 1976 to 1997, with a diagnosis of either LGS or slow spike wave on EEG. LGS was confirmed in 107 (64 male, 43 female) patients. This group was divided into cryptogenic, symptomatic, and indeterminate groups containing 23, 47, and 37 patients, respectively. In this study, cryptogenic patients all had normal development before onset of LGS, absence of dysmorphic features, normal neurologic examination, and normal magnetic resonance (MRI) brain imaging. Of the 107 patients, 74 had ≥3 years of follow‐up. Results: LGS onset in the 107 patients occurred at a median age of 4.0 years (range, 0.6–28.9 years). When last seen, 63% of those with symptomatic LGS had more than three seizures a day compared with 50% of cryptogenic and 34% of indeterminate patients. The most common seizure types were tonic (77%), atypical absence (61%), and generalized tonic‐clonic (56%). Only three patients, all part of the indeterminate group, were seizure free at last follow‐up. Conclusions: Using stringent criteria in defining the cryptogenic subgroup resulted in no significant difference in seizure outcome. Individuals with a normal cognitive outcome did not segregate into one etiologic subgroup, but did have LGS onset at an older age.
A Comparative Study of Trauma and Posttraumatic Stress Disorder Prevalence in Epilepsy Patients and Psychogenic Nonepileptic Seizure Patients
Authors: Rosenberg Harriet J. , Rosenberg Stanley D. , Williamson Peter D. , Wolford George L. 
Published: August 2005

Summary: Purpose: This study tests the hypothesis that trauma histories, including histories of physical and sexual abuse, and posttraumatic stress disorder (PTSD) are more prevalent in psychogenic non–epileptic seizure (NES) patients than in epilepsy patients. Methods: Thirty‐five inpatients with intractable seizures were evaluated for trauma history and PTSD. After these assessments, patients were diagnosed as having either epileptic or nonepileptic seizures through EEG monitoring. Results: NES diagnosis correlated with PTSD and total number of lifetime traumas, adult traumas, and abuse traumas. Contrary to previous hypotheses, reported childhood sexual abuse (CSA) did not correlate significantly with NES diagnosis. However, CSA predicted PTSD in a discriminant analysis. Conclusions: We found evidence for the hypothesized relations between trauma, abuse, PTSD, and NES diagnosis. However, elevated levels in both seizure‐disorder groups suggest that routine assessment for abuse, trauma, and PTSD might facilitate medical care and treatment for all intractable seizure patients.
Repeated Acute Testing of Anticonvulsant Drugs in Amygdala Kindled Rats: Increase in Anticonvulsant But Decrease in Adverse Effect Potential
Authors: Löscher Wolfgang , Fiedler Mia 
Published: August 2005

Summary: Purpose: Because preparation of kindled rats is laborious, time‐consuming, and expensive, such animals are often used for several experiments in the evaluation of anticonvulsant drugs (AEDs). Furthermore, for comparison with data on new drugs, often “historical” data on standard drugs obtained in previous experiments in other groups of kindled rats are used. Without knowing how factors such as repeated drug testing or seasonal variation in drug responses affect drug potencies in the kindling model, false conclusions and predictions might be drawn from such comparisons. In this study, we examined the anticonvulsant and adverse effects of the three clinically established AEDs carbamazepine (CBZ), phenobarbital (PB), and valproate (VPA) once per month in the same two groups of amygdala‐kindled rats over a period of 9 (group 1) or 6 (group 2) consecutive months. To evaluate the possible effect of the season, experiments in group 1 were started in autumn, and experiments in group 2 in spring. Methods: For quantification of anticonvulsant activity, the focal seizure threshold (threshold for afterdischarges; ADT) was determined after each acute drug treatment and compared with a control ADT determined 2–3 days before. Results: The repeated acute (single‐dose) drug testing in the same groups of amygdala‐kindled rats led to three pronounced alterations in the animals: (a) a significant decrease in ADT, (b) a marked potentiation of AED effects on ADT, and (c) a striking reduction in ataxia produced by drug treatments. Drug levels in plasma, which were determined in each drug trial, showed only moderate variation over the period of the experiments, so that the observed alterations in drug responses were certainly not due to pharmacokinetic factors. PB and VPA, but not CBZ, showed a more potent anticonvulsant effect when experiments were started in October (group 1) compared with April (group 2), but this difference was rapidly overridden by the marked and progressive potentiation of anticonvulsant activity on repeated drug testing. Conclusions: These data demonstrate that repeated use of the same kindled rats for acute drug testing significantly alters the sensitivity of the animals to the anticonvulsant and adverse effects of drugs. Because the anticonvulsant potency increases, whereas the adverse effect potential decreases during repeated acute drug testing, this may lead to false‐positive data on a test compound. The mechanisms involved in these observations deserve further studies.