bluuebunny/crossref_metadata_2025_split huggingface dataset:
Optimizing Parameters for Terminating Cortical Afterdischarges with Pulse Stimulation
Authors: Motamedi Gholam K. , Lesser Ronald P. , Miglioretti Diana L. , Mizuno‐Matsumoto Yuko , Gordon Barry , Webber William R. S. , Jackson Darryl C. , Sepkuty Jehuda P. , Crone Nathan E. 
Published: May 2003

Summary:  Purpose: We previously reported that brief pulses of electrical stimulation (BPSs) can terminate afterdischarges (ADs) during cortical stimulation. We investigated conditions under which BPS is more likely to suppress ADs.Methods: We analyzed parameters altering BPS effectiveness on 200 ADs in seven patients with implanted subdural electrodes.Results: The odds of BPSs stopping ADs was 8.6 times greater at primary sites (directly stimulated electrodes) than at secondary sites (adjacent electrodes) (p = 0.016). BPS applied within 4.5 s after onset of AD had 2 times greater odds of stopping ADs (p = 0.014). BPS applied when AD voltage was negative was 1.9 times more likely to stop ADs (p = 0.012). ADs with rhythmic pattern responded best (p < 0.0001). BPS stopped 100% of ADs not starting immediately after localization stimulus (LS) versus 29% of those starting immediately (p < 0.0001).Conclusions: BPS is more likely to terminate ADs at primary electrodes, if given early, if applied to the negative peak of the AD waveform, if AD has a rhythmic pattern, and if AD did not start immediately after LS.
Is There an Association between Maternal Carbamazepine Use during Pregnancy and Eye Malformations in the Child?
Authors: Kroes Hester Y. , Reefhuis Jennita , Cornel Martina C. 
Published: May 2003

Summary:  Purpose: To check for an association between carbamazepine (CBZ) use by the mother during pregnancy and congenital eye malformations (i.e., anophthalmia, microphthalmia, and coloboma) in the child, as suggested by Sutcliffe et al. (1998), who reported four cases.Methods: We checked all the cases with these eye malformations for CBZ use by the mother in the EUROCAT Northern Netherlands dataset, which registers infants with congenital malformations and records possible teratogenic exposures (including medication taken by the mother). We also reviewed 13 studies in the literature.Results: The EUROCAT dataset recorded 77 cases of anophthalmia, microphthalmia, or coloboma, but none with prenatal exposure to CBZ. Prenatal CBZ exposure was recorded in seven other cases without congenital eye malformation. Large studies in the literature on the teratogenic effects of CBZ (and other antiepileptic drugs), including data from the MADRE database, revealed no association between these congenital eye malformations and prenatal CBZ exposure. One case reported bilateral anophthalmia and other congenital anomalies after prenatal exposure to CBZ in combination with vigabatrin and dexamethasone.Conclusions: Our data do not support Sutcliffe's suggestion that prenatal CBZ exposure may result in congenital eye malformations. However, despite the large population represented, both the low birth prevalence of these congenital eye malformations and the low prevalence of CBZ exposure during pregnancy make it difficult to exclude an increased relative risk. The many large prospective and retrospective studies in the literature seem to agree with our findings, although there is still uncertainty about the teratogenic effect of CBZ in polytherapy.
Frequency and Significance of Acute Postoperative Seizures Following Epilepsy Surgery in Children and Adolescents
Authors: Park Kristen , Buchhalter Jeffrey , McClelland Robyn , Raffel Corey 
Published: May 2003

Summary:  Purpose: To determine the frequency and prognostic features of acute postoperative seizures (APOSs), within the first postoperative week, in a group of children undergoing surgery for the treatment of medically refractory epilepsy.Methods: Patients younger than 18 years who underwent surgery for the relief of medically intractable epilepsy at the Mayo Clinic between 1985 and 1998 with a minimum of 12 months of follow‐up were eligible. A retrospective chart review was conducted to abstract information regarding demographics, epilepsy history, and preoperative, intraoperative, and postoperative risk factors, APOSs, and outcome. A multivariate analysis was conducted to control for confounding variables.Results: The study group was composed of 148 patients (mean age at surgery, 13 years; range, 5 months to 18 years). Twenty‐five percent of patients experienced APOSs. Risk factors associated with a statistically significant (p < 0.05) greater likelihood of experiencing APOS were non–complex partial seizure type, extratemporal surgery, postoperative fever, non–temporal lobe epilepsy, and postoperative interictal epileptiform activity. At last follow‐up, patients who did not experience APOSs had a significantly greater chance of being seizure free (80 vs. 51%; p < 0.001). With a multivariate analysis, APOS was found to be an independent predictor of outcome.Conclusions: This study indicates that APOSs are predictive of a less favorable outcome in the pediatric postsurgical patient; however, 51% remained seizure free at last follow‐up. Finally, the effects of APOSs on outcome were shown to be stable over a 12‐month follow‐up period.
Seizure Suppression by Adenosine‐releasing Cells Is Independent of Seizure Frequency
Authors: Boison Detlev , Huber Alexander , Padrun Vivianne , Déglon Nicole , Aebischer Patrick , Möhler Hanns 
Published: May 2003

Summary:  Purpose: Intraventricular cellular delivery of adenosine was recently shown to be transiently efficient in the suppression of seizure activity in the rat kindling model of epilepsy. We tested whether the suppression of seizures by adenosine‐releasing grafts was independent of seizure frequency.Methods: Adenosine‐releasing cells were encapsulated and grafted into the lateral brain ventricle of rats kindled in the hippocampus. During 4 weeks after grafting, electric test stimulations were delivered at a frequency of either once a week or 3 times per week. Seizure activity was evaluated by visual scoring of seizure severity and by the recording of EEGs.Results: Adenosine released from encapsulated cells exerted potent antiepileptic activity for ≥2 weeks. One week after grafting, treated rats displayed a complete protection from clonic seizures, and a protection from focal seizures was observed in the majority of animals. Seizure suppression was accompanied by a reduction of afterdischarges in EEG recordings. The protective efficacy of the grafted cells was the same irrespective of whether electrical test stimulations were delivered 1 or 3 times per week. Rats receiving control grafts continued to display full clonic convulsions.Conclusions: This study demonstrated that the frequency of test stimulations did not influence the seizure‐suppressive potential of adenosine‐releasing grafts. Thus the local delivery of adenosine is likely to be effective in seizure control over a threefold range of seizure‐discharge frequency.
Epilepsy inThe Alienist and Neurologist, 1880–1920
Authors: Lipson Scott E. , Montes Jennifer A. , Devinsky Orrin 
Published: May 2003

Summary: Purpose:To study the history of epilepsy from 1880 to 1920.Methods:We reviewed all 40 volumes ofThe Alienist and Neurologistand identified articles concerning primarily epilepsy. We analyzed three of these articles in greater detail.Results:The Alienist and Neurologistpublished “Original Contributions,”“Selections,” (abstracts from other journals written by the editorial board), “Editorials,” and (book) “Reviews.” Of 258 epilepsy articles, there were 40 Original Contributions, 164 Selections, 39 Editorials, and 15 Reviews. These articles included 71 on therapy (41 medication, 13 surgery, and 17 other therapies); 66 general discussions; 46 on etiology or symptoms; 34 case studies; 28 social/legal articles; and 13 autopsy or pathology articles.Conclusions:Analysis ofThe Alienist and Neurologistprovides a unique and valuable perspective on the clinical practice and academic world of epileptology during the decades around the turn of the twentieth century.
Amygdaloid Kindling in Glutamate Transporter (GLAST) Knockout Mice
Authors: Tsuru Noriko , Ueda Yuto , Doi Taku 
Published: May 2003

Summary:  Purpose: Glutamate is the predominant excitatory neurotransmitter in the mammalian central nervous system. We previously reported abnormal glutamate release during seizures after kindling. GLAST and GLT‐1 are astrocytic glutamate transporters, highly concentrated in the cerebellum and the telencephalon, respectively. We have investigated whether stages of amygdala kindling in knockout (KO) mice deficient in GLAST are the same as those of wild mice.Methods: Electrodes were implanted into the basolateral amygdala, bilaterally, in C57BL/6J mice and GLAST KO mice under anesthesia. Once‐daily stimulation was applied on one side through these electrodes, and bilateral EEG recordings were obtained.Results: The behavioral manifestations of kindling in mice were (a) arrest of behavior, (b) head nodding, (c) forelimb clonus, (d) bilateral forelimb clonus with rearing, (e) tonic generalized convulsion with elevation of tail and falling with generalized tonic convulsion (GTC). Results of kindling: (a) Mutant mice kindled more slowly than wild‐type mice (more stimulations were required to reach each stage in mutants); (b) after kindling was completed, additional stimulations induced shorter afterdischarges (ADs) in mutants than in wild‐type mice; (c) Interictal epileptic spikes were more frequent in the mutants than in the wild‐type mice, both in the stimulated amygdala and in the contralateral amygdala.Conclusions: GLAST KO mice, which are missing one type of astrocytic glutamate transporter, demonstrate kindling of an epileptic focus. However, the kindling is significantly slower in the GLAST mutant than in wild‐type mice. These findings suggest that glutamate transport by the astrocytic GLAST transporter may have a role in normal epileptogenesis.
Lack of an Effect of Topiramate on Lamotrigine Serum Concentrations
Authors: Berry David J. , Besag Frank M. C. , Pool Felicity , Natarajan Jaya , Doose Dennis 
Published: May 2003

Summary:  Purpose: Pharmacokinetic interactions between the older antiepileptic drugs (AEDs) and topiramate (TPM) were assessed during the clinical development of this drug. Lamotrigine (LTG) has become established as an important new drug in treating a wide spectrum of seizure types, but there are no published data on whether LTG serum concentrations change when TPM is added to treatment.Methods: Escalating doses of TPM were added to stable LTG treatment in 24 young patients (8–21 years) with epilepsy. Blood samples taken before the morning dose were collected for drug‐concentration measurement in all patients before starting treatment with TPM and after stabilisation at each dose escalation. Several patients had been maintained on unchanged therapy with drug‐concentration monitoring for many months before introducing TPM, and a sequence of baseline LTG serum concentrations were available on these patients.Results: The mean of all baseline LTG concentrations for the group as a whole was 10.4 ± 4.4 mg/L compared with 9.7 ± 4.3 mg/L after addition of TPM. A comparison of last baseline LTG concentration with first test LTG concentration (i.e., after 2 weeks' TPM treatment) gave mean values of 10.7 ± 4.7 and 10.8 ± 4.6 mg/L, respectively. The mean LTG concentration for patients while taking their highest TPM dose was 9.5 ± 4.3 mg/L. The analysis‐of‐variance modeling for the effect of TPM on LTG concentration yielded a mean LTG concentration ratio (with TPM vs. without TPM) of 94.2%, with a 90% confidence interval of 89.5–99.1%.Conclusions: TPM did not cause a significant change in LTG serum concentration in this group of patients.
Heart Rate Changes and ECG Abnormalities During Epileptic Seizures: Prevalence and Definition of an Objective Clinical Sign
Authors: Zijlmans Maeike , Flanagan Danny , Gotman Jean 
Published: May 2003

Summary: Purpose:To determine the prevalence of heart rate changes and ECG abnormalities during epileptic seizures and to determine the timing of heart rate changes compared to the first electrographic and clinical signs. To assess the risk factors for the occurrence of ECG abnormalities.Methods:We analyzed retrospectively 281 seizures in 81 patients with intractable epilepsy who had prolonged video‐EEG and two‐channel ECG. The nature and timing of heart rate changes compared to the electrographic and clinical seizure onset was determined. The ictal period (including one minute preictally and three minutes postictally) was analyzed for cardiac arrhythmias, conduction and repolarization abnormalities. Risk factors for cardiac abnormalities were investigated using parametric and non‐parametric statistics.Results:There was an increase in heart rate of at least 10 beats/minute in 73% of seizures (93% of patients) and this occurred most often around seizure onset. In 23% of seizures (49% of patients) the rate increase preceded both the electrographic and the clinical onset. ECG abnormalities were found in 26% of seizures (44% of patients). One patient had an asystole for 30 seconds. Long seizure duration increased the occurrence of ECG abnormalities. No other risk factor was found.Conclusions:Heart rate changes occur frequently and occur around the time or even before the earliest electrographic or clinical change. The change can clarify the timing of seizure onset and the specific rate pattern may be useful for seizure diagnosis and for automatic seizure detection. ECG abnormalities occur often and repeatedly in several seizures of the same patient.
Self‐discontinuation of Antiepileptic Medication in Pregnancy: Detection by Hair Analysis
Authors: Williams John , Myson Vicki , Steward Sandra , Jones Glenda , Wilson John F. , Kerr Michael P. , Smith Philip E.M. 
Published: May 2003

Summary:  Purpose: Concerns over teratogenicity of antiepileptic drugs (AEDs) during pregnancy must be balanced against the risks of seizures to the mother and developing fetus. Pharmacokinetic changes and vomiting may alter drug levels, but more important may be the patient's decision to stop medication before or during pregnancy. Compliance assessment traditionally relies either on self‐reporting or on AED plasma level monitoring; neither provides reliable information on drug‐taking behaviour over an extended interval (e.g., before, during, and after pregnancy).Methods: We have used hair analysis to assess AED‐taking behavior in pregnant women compared with nonpregnant female controls. Twenty‐six pregnant women [mean age, 27.5 ± 6.7 (SD) years] and 13 nonpregnant female epilepsy outpatients (mean age, 31.9 ± 8.3 years) were studied. Carbamazepine (CBZ) or lamotrigine (LTG) concentrations were measured in 1‐cm hair segments, and the within‐subject variance in segmental hair concentrations of these drugs was calculated for each group. The variances of each group were then compared by using a variance ratio test.Results: The variance of AED concentration in hair differed significantly between the pregnant and nonpregnant groups [variance ratio, 1.59 (p < 0.01)]. Four (15%) of the 26 pregnant patients had little or no AED in their proximal hair segments compared with more distal segments, apparently having discontinued their medication during pregnancy. Only one of these later disclosed having stopped her medication. One pregnant woman whose hair profile was similar to controls died suddenly at 30 weeks of gestation.Conclusions: This study confirms the perception that pregnant women with epilepsy frequently stop or greatly reduce their prescribed medication, usually without reference or acknowledgement to their clinician.
The Effect on Vision of Associated Treatments in Patients Taking Vigabatrin: Carbamazepine Versus Valproate
Authors: Arndt Carl F. , Salle Marc , Derambure Philippe H. , Defoort‐Dhellemmes Sabine , Hache Jean‐Claude 
Published: May 2003

Summary:  Purpose: To evaluate the effect on visual function of a concomitant antiepileptic drug (AED) in patients treated with vigabatrin (VGB).Methods: Sixty‐four consecutive patients with a history of partial seizures currently treated with VGB with either carbamazepine (CBZ) or valproate (VPA) were examined with automated kinetic perimetry, static perimetry, electrooculogram (EOG), and electroretinogram (ERG). An original device based on kinetic perimetry was developed to quantify the area of perception for each isopter.Results: Fifty‐two patients were finally included. The results showed a significant difference in patients treated with VGB‐VPA compared with patients treated with VGB‐CBZ concerning the mean defect of static perimetry and the peripheral and midperipheral isopter (III 4e and III 1a Goldmann equivalent, respectively) in kinetic perimetry. EOG and ERG results did not differ significantly between the two groups.Conclusions: The visual impairment due to visual field constriction was more important in patients treated with VGB and VPA compared with patients treated with VGB and CBZ. The origin of this difference between the two associations could not be related to any particular retinal electrophysiologic abnormality.
Benefit of Simultaneous Recording of EEG and MEG in Dipole Localization
Authors: Yoshinaga Harumi , Nakahori Tomoyuki , Ohtsuka Yoko , Oka Eiji , Kitamura Yoshihiro , Kiriyama Hideki , Kinugasa Kazumasa , Miyamoto Keiichi , Hoshida Toru 
Published: May 2003

Summary:  Purpose: In this study, we tried to show that EEG and magnetoencephalography (MEG) are clinically complementary to each other and that a combination of both technologies is useful for the precise diagnosis of epileptic focus.Methods: We recorded EEGs and MEGs simultaneously and analyzed dipoles in seven patients with intractable localization‐related epilepsy. MEG dipoles were analyzed by using a BTI Magnes 148‐channel magnetometer. EEG dipoles were analyzed by using a realistically shaped four‐layered head model (scalp–skull–fluid–brain) built from 2.0‐mm slice magnetic resonance imaging (MRI) images.Results: (a) In two of seven patients, MEG could not detect any epileptiform discharges, whereas EEG showed clear spikes. However, dipoles estimated from the MEG data corresponding to the early phase of EEG spikes clustered at a location close to that of the EEG‐detected dipole. (b) In two of seven patients, EEG showed only intermittent high‐voltage slow waves (HVSs) without definite spikes. However, MEG showed clear epileptiform discharges preceding these EEG‐detected HVSs. Dipoles estimated for these EEG‐detected HVSs were located at a location close to that of the MEG‐detected dipoles. (c) Based on the agreement of the results of these two techniques, surgical resection was performed in one patient with good results.Conclusions: Dipole modeling of epileptiform activity by MEG and EEG sometimes provides information not obtainable with either modality used alone.
Long‐term Psychosocial Outcomes of Anterior Temporal Lobectomy
Authors: Jones Jana E. , Berven Norman L. , Ramirez Lincoln , Woodard Austin , Hermann Bruce P. 
Published: May 2003

Summary:  Purpose: To examine the long‐term psychosocial outcomes of a consecutive series of patients who underwent anterior temporal lobectomy (ATL) compared with medically managed patients. This study focused primarily on actual long‐term changes (mean, 5 years) in life performance. There are relatively few long‐term controlled studies of actual lifetime performance changes.Methods: The sample consisted of 61 adults who underwent ATL and 23 individuals who were evaluated for surgery but did not proceed to surgery and continued to receive medical management. Participants were interviewed 2–9 years after surgery. A structured clinical interview and review of medical records was conducted to obtain information regarding seizure frequency and psychosocial status, focusing on employment, education, driving status, financial assistance, and independent living. In addition, two questions regarding quality of life were included. Seizure frequency was evaluated for the year before the interview.Results: Significant differences in psychosocial outcome were found between the surgery group and medical management group. Favorable psychosocial outcomes were more common among those who had surgery (46 vs. 4%). Results indicated that 68% of the surgery group exhibited improved psychosocial status compared with 5% of the medical management group. Individuals who had surgery were more likely to be driving, working full‐time, living independently, and being financially independent. Remaining seizure free was not a prerequisite for improvements in psychosocial outcomes.Conclusions: Compared with medical management, surgery has a significant positive impact on psychosocial outcomes in terms of employment, independent living, driving, and financial independence. Additionally, a person does not necessarily have to be seizure free to achieve positive changes in psychosocial outcomes.
Use of Intraoperative Magnetic Resonance Imaging in Tailored Temporal Lobe Surgeries for Epilepsy
Authors: Buchfelder Michael , Fahlbusch Rudolf , Ganslandt Oliver , Stefan Hermann , Nimsky Christopher 
Published: May 2003

Summary:  Purpose: We investigated whether intraoperative magnetic resonance imaging (MRI) was able to assess immediately the extent of a tailored temporal lobe resection for epilepsy in comparison to delayed postoperative MRI. The recently proposed concept of an individually tailored procedure, preserving tissue not involved in seizures, leads to a variety of differently shaped resections.Methods: For intraoperative imaging we used a Magnetom Open 0.2 Tesla scanner. Fifty‐eight patients undergoing temporal lobe resections for pharmacoresistant epilepsy were investigated. Half of these were nonlesional. All patients had delayed postoperative follow‐up scans, which were compared with the intraoperative, postresection images.Results: In 49 (84%) of 58 cases, intraoperative MRI depicted the resection cavity identical to delayed postoperative studies. Complete resection of the visible lesion was primarily proved in 23 of the 29 cases. In two patients with lesions and in one nonlesional case, the resection was extended after intraoperative imaging, thus increasing the rate of total resections in gliomas from 73 to 87%. In four patients, an extension into eloquent areas did not allow complete removal. In the nonlesional cases (n = 29), the extent of tailored temporal resections also could be exactly documented intraoperatively.Conclusions: Intraoperative MRI allowed a reliable evaluation of the localization and extent of resection in epilepsy surgery within the operative procedure. Furthermore, it provided the possibility of an image‐based correction of an initially incomplete resection, particularly in lesional cases. In the majority of patients, the intraoperative images would have been able to replace delayed postoperative MRI. However, in 16%, there were postoperative changes in the resection volume.