bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Animal Model of Nonconvulsive Status Epilepticus: A Contribution to Clinical Controversies
Authors: Kršek Pavel , Mikulecká Anna , Druga Rastislav , Hliňák Zdeněk , Kubová Hana , Mareš Pavel 
Published: May 2003

Summary Purpose: To characterize electroencephalographic and behavioral effects as well as electrophysiologic and morphologic consequences of a subconvulsive dose of pilocarpine in lithium chloride—pretreated rats. Methods: Pilocarpine (15 mg/kg) was administered intraperitoneally to adult rats pretreated with lithium chloride (3 mEq/kg, i.p.). Behavior was observed for 2 h and videotaped in three consecutive sessions. At the same time, EEG was recorded from the sensorimotor cortex and the dorsal hippocampus. Threshold intensities of currents necessary to elicit hippocampal afterdischarges were determined 24 h and 1 week after the pilocarpine administration. The brains were histologically examined 1 week after pilocarpine administration using Nissl stain. Results: Pilocarpine induced time‐limited nonconvulsive status epilepticus (NCSE). Epileptic EEG activity concurrent with prominent behavioral features was observed both in the neocortex and, predominantly, in the hippocampus. No changes in afterdischarge thresholds were observed in the dorsal hippocampus 24 h and 1 week after NCSE. One week after NCSE, seizure‐related brain damage was found mainly in the motor neocortical fields. Conclusions: Pilocarpine‐induced NCSE in rats strongly resembles a short‐term human complex partial status epilepticus. Our animal model is suitable for studying the possible adverse effects of prolonged nonconvulsive seizures.
Altered Activities of Rat Brain Metabolic Enzymes in Electroconvulsive Shock—Induced Seizures
Authors: Erakovićl V. , Župan G. , Varljen J. , Laginja J. , Simonić A. 
Published: May 2003

Summary Purpose: Electroconvulsive shock (ECS) induces generalized seizure activity and provides an excellent experimental model for studying the effects of global electrical stimulation on various biochemical parameters. The aim of this work was to investigate the influence of a single or repeated ECS‐induced seizures on rat brain metabolism. Methods: Experiments were carried out on female Hannover—Wistar rats divided into four groups: (a) the control group, which was intact; (b) the 1ECS group, which was killed 2 h after single ECS; (c) the 5ECS group with 24 h rest, which was killed 24 h after the fifth daily ECS; and (d) the 10ECS group with 48 h rest, which was given ECS every 48 h and killed 24 h after the tenth ECS. Activities of glutamate dehydrogenase (GLDH), aspartate‐aminotransferase (AST), alanine‐aminotransferase (ALT), γ‐glutamyltransferase (GGT), alkaline phosphatase (ALP), lactate dehydrogenase (LDH), and creatine kinase (CK) in the frontal cortex, cerebellum, hippocampus, and pons/medulla regions were determined. Results: Increased AST, ALP, LDH, and CK activities were detected in all examined regions of the 1ECS and 5ECS groups. ALT activity was increased in both these groups, except in the hippocampus of the 5ECS group, where increased GGT activity was detected. In the hippocampus of 1ECS group, GLDH activity was decreased. Increased hippocampal AST and cortical CK activities, together with increased LDH activities in the cortex, cerebellum, and pons/medulla, were found. Conclusions: ECS treatment induces region‐specific changes in metabolic activity. Neither a 24‐h nor a 48‐h rest period between two ECSs was sufficient for complete brain recovery, although most of the observed increased enzyme activities present in 1ECS and 5ECS were not present in 10ECS.
Contribution of the MHC Class II Antigens to the Etiology of Infantile Spasm in Mexican Mestizos
Authors: Suastegui Roberto A. , de La Rosa Gabriela , Carranza Juan M. , Gonzalez‐Astiazaran Adalberto , Gorodezky Clara 
Published: May 2003

SummaryPurpose:Infantile spasms (ISs) are age‐dependant epileptic seizures, which may be flexor, extensor, lightning or nods, or mixed. The aim of this study was the analysis of genetic factors within the human leukocyte antigen (HLA) complex associated with ISs.Methods:Sixty‐five patients diagnosed according to the established international criteria were compared with 229 healthy individuals; all of them were Mexican Mestizos. Five families were also analyzed (seven affected and five healthy sibs); HLA class I and class II antigens were typed using the standard microlymphocytotoxicity methods.Results:The findings showed female gender preference (2:1). Two thirds were symptomatic, and prevalent seizures were of mixed type (67%). A strong association with HLA‐DR17 was detected in the IS group (pc <0.01; OR = 3.6; EF = 0.20). DR17 was also found increased in the symptomatic patients (p = 0.009; OR = 3.16) and in those with other types of seizures (p = 0.001; OR = 2.0). Conversely, HLA‐DQ6 was significantly decreased (pc <0.002; PF = 0.37) in the total and in the symptomatic groups (p <0.01). Haplotype linkage was not confirmed in the families; however, those with more than one affected sib shared at least one haplotype.Conclusions:These findings suggest the contribution of DR locus to the susceptibility and the participation of DQ region in the resistance to IS. Severity seems also to be influenced by HLA‐DR17, and therefore class II typing may be a helpful tool for disease prognosis.
Multiple Subpial Transections: The Yale Experience
Authors: Mulligan Lisa P. , Spencer Dennis D. , Spencer Susan S. 
Published: May 2003

Summary Purpose: Although resection of an epileptogenic region is the mainstay of epilepsy surgery, epileptogenic areas in functionally critical cortex cannot be approached in that manner. Multiple subpial transection (MST) was developed to treat those refractory seizures without causing unacceptable neurologic deficit. We review our experience with this technique. Methods: Twelve patients who underwent MST with or without resection between 1990 and 1998 were retrospectively reviewed with regard to seizure and neurologic outcome, and predictive factors. Results: Five (42%) of 12 patients obtained a significant improvement in seizure frequency, and two other patients had a marked decrease in the severity of their seizures. Resection with MST reduced seizure frequency more, but this was not a significant difference. No predictive factors for outcome were identified. Only one patient sustained any persistent neurologic deficit. Conclusions: In selected patients, MST may be a viable alternative when the epileptogenic focus lies in unresectable cortex. A multicenter study with appreciable patient numbers will be necessary to define predictive factors for success.
The Effect of Lamotrigine on Epileptiform Discharges in Young Patients with Drug‐Resistant Epilepsy
Authors: Eriksson A‐S. , Knutsson E. , Nergårdh A. 
Published: May 2003

Summary Purpose: In a double‐blind crossover study with lamotrigine (LTG), we investigated a possible relationship between the clinical responses and changes of the amount of epileptiform activity in EEG. Methods: Twelve patients, aged 4–21 years, with generalized drug‐resistant epilepsy who had responded to LTG, completed the study. Twenty‐four‐hour video‐EEGs were taken during control, placebo, and drug phases. The amounts of epileptiform discharges were estimated and compared with the clinical effects. Results: The duration of periods of repeated epileptiform discharges was significantly reduced during the LTG phase compared with the placebo phase (n = 12, p = 0.04). Ten patients showed a reduction of the amount of epileptiform discharges in the LTG phase by a mean of 81% (range, 17–100%). Periods of repeated epileptiform discharges with duration longer than 30 s were significantly reduced in length (p = 0.03) and number (p = 0.04) during the LTG phase compared with the placebo phase. Shorter periods of epileptiform discharges and the numbers of single epileptiform discharges were not affected. In five patients there was a seizure reduction (≥50%) concomitant with the reduction of epileptiform discharges in the EEG. The behavior improved during LTG treatment in all patients. The patients became more alert, and their concentration and performance improved, according to their parents and the medical personnel. Conclusions: LTG in dosages of 1–8 mg/kg body weight was found to depress relatively long episodes of interictal, repetitive, epileptiform activity in young patients with drug‐resistant epilepsy, whereas short episodes were not affected. It depressed seizures in about half of the patients studied but gave improvements of behavior in all patients.
Adverse Event Monitoring in Lamotrigine Patients: A Pharmacoepidemiologic Study in the United Kingdom
Authors: Wong Ian C. K. , Mawer George E. , Sander Josemir W. A. S. 
Published: May 2003

Summary Purpose: This postmarketing surveillance study of lamotrigine (LTG) was performed to provide complementary data to large‐scale Prescription—Event Monitoring study with a retrospective case records survey in five tertiary referral epilepsy centres in the United Kingdom. Methods: Adverse events were recorded and compared with those of two other new antiepileptic drugs (AEDs), gabapentin (GBP) and vigabatrin (VGB). All deaths were followed up and standardised mortality ratios (SMRs) were calculated. Serious adverse events were assessed individually. Results: A total of 2,701 patients was identified as being exposed to LTG and/or the comparators. It was necessary to exclude 1,326 patients because LTG and/or comparators had been commenced outside the study centres. The adverse events with LTG reported by this study were similar to those reported in the literature. Skin rash was the major adverse event. Life‐threatening hepatic failure, acute exacerbation of ulcerative colitis, disseminated intravascular coagulation, and renal failure were reported. No death could be directly attributed to the use of LTG. The SMR was slightly higher than that reported in the literature; this probably reflects severity of epilepsy in the study population. Conclusions: The safety profile of LTG was similar to that in the large‐scale Prescription‐Event Monitoring study and generally acceptable. Life‐threatening adverse reactions were rare.
Fosphenytoin: Pharmacokinetics and Tolerance of Intramuscular Loading Doses
Authors: Pryor Flavia M. , Gidal Barry , Ramsay R. Eugene , DeToledo John , Morgan Robert O. 
Published: May 2003

Summary Purpose: Fosphenytoin (FPHT; Cerebyx) is well absorbed when given intramuscularly (IM). All prior pharmacokinetic studies had the first plasma sample obtained 30 min after IM administration. The objectives of this study were to determine the rate and extent of FPHT absorption and to evaluate the tolerability of IM FPHT compared with IM saline. Methods: This was an open‐label, double‐blinded study in which patients received 10 mg/kg dose of IM FPHT in one gluteus and IM saline in the other gluteus. Half the patients received saline injection of equal volume to FPHT (up to 19.5 mL); the other half received 2 mL of saline. Neurologic examination, vital signs, PHT blood samples, injection site examination, and subjective pain scores at injection site were obtained before and at timed intervals for 6 h. Results: Total PHT serum concentrations 10 μg/mL were obtained in 5 min in 14.3% of patients and in 26.3% after 10 min. More than half the patients had therapeutic serum concentrations at 30 min; 45.8% of patients reported no pain at either the FPHT or saline injection site. No significant difference in pain was noted between FPHT and saline injection sites at 60 min and thereafter. Early decrease in blood pressure occurred but was not clinically significant. Classic PHT‐induced central nervous system (CNS) side effects were evident in one third of patients within 1 h after injection. Conclusions: (a) IM FPHT is rapidly absorbed (therapeutic levels achieved as early as 5–20 min). (b) IM FPHT is well tolerated by most patients irrespective of injection volume.
Distribution of Valproate to Subdural Cerebrospinal Fluid, Subcutaneous Extracellular Fluid, and Plasma in Humans: A Microdialysis Study
Authors: Lindberger Martin , Tomson Torbjörn , Wallstedt Lars , Ståhle Lars 
Published: May 2003

SummaryWe sought to study the time course of the distribution of valproate (VPA) to subdural cerebrospinal fluid (CSF) in relation to subcutaneous extracellular fluid (ECF) and plasma after a single oral dose and to study the distribution to these three compartments under steady‐state conditions. Microdialysis was used to estimate unbound VPA concentrations in subdural CSF and subcutaneous ECF, and blood samples were drawn for estimation of total and unbound VPA plasma concentrations in four patients with drug‐resistant partial epilepsy undergoing presurgical evaluation with subdural EEG monitoring. Three patients were given a single oral dose of VPA, and one patient was receiving regular VPA treatment. VPA was analyzed by gas chromatography with flame ionization detection. The distribution of VPA to subdural CSF was rapid (Tmax, 3.5 h in two patients and 5.5 h in one patient) and subject to a minor delay in all three patients compared with that in the subcutaneous tissue ECF (Tmax, 2.5 h in all three patients), which in turn exhibited no evidence of a distribution delay compared with plasma. Subdural CSF levels of VPA were slightly lower than subcutaneous ECF levels (mean ratio, 0.78) and unbound plasma levels (mean ratio, 0.91). VPA rapidly enters the subdural CSF in unbound concentrations marginally lower than those obtained in subcutaneous ECF and plasma. These findings provide a pharmacokinetic rationale for acute administration of VPA. The good correlation between VPA concentrations in subcutaneous ECF and subdural CSF indicates that estimation of unbound VPA concentrations in subcutaneous tissue using microdialysis sampling has the potential to be useful for monitoring purposes.
Epileptic Seizures in Behçet Disease
Authors: Aykutlu Ebru , Baykan Betül , Serdaroǧlu Piraye , Gökyiǧit Aysen , Akman‐Demir Gülsen 
Published: May 2003

Summary:  Purpose: To outline the clinical characteristics of seizures in our large series of Behçet disease (BD) patients with neurologic involvement.Methods: All files of 223 patients with neuro‐BD were evaluated retrospectively, and the group with clearly documented seizures was included in the current study. Clinical characteristics, EEG, neuroimaging and cerebrospinal fluid findings were reevaluated, and the seizures were classified according to the new proposed criteria of the International League Against Epilepsy. On excluding the patients in whom the seizures were due to possible seizure‐provoking factors, the seizures that appeared during a neurologic exacerbation were noted.Results: Seizures were seen in 10 (4.48%) of 223 patients. There were one female and nine male patients. In five of the patients, seizures occurred during neurologic exacerbation. Therefore, the actual prevalence of seizures due to BD in our group is 2.2%. In the remaining five patients, the seizures were not related to neurologic BD attacks, but probably were due to some seizure‐provoking factors. The predominating seizure type was generalized tonic–clonic convulsions accompanied by focal motor seizures. It is notable that four patients died 1–5 years after the onset of the seizures.Conclusions: Our study showed that seizures are rare in BD. As the seizures due to some interventions and drugs are as frequent as neuro‐BD–related seizures, seizure‐provoking factors must be considered before attributing them to the pathogenetic mechanism of BD. The occurrence of seizures seems to be associated with a high mortality rate.
Increased Plasma Levels of Pro‐ and Anti‐inflammatory Cytokines in Patients with Febrile Seizures
Authors: Virta Miia , Hurme Mikko , Helminen Merja 
Published: May 2003

Summary:  Purpose: Pro‐ and antiinflammatory cytokines regulate the febrile response during infection. Febrile seizures (FSs) conversely are associated with rapid onset of high fever. Activation of the cytokine network has been shown in previous studies of FSs and cytokines. In this study, the association between cytokines and FSs was further investigated.Methods: Interleukin‐1β (IL‐1β), interleukin‐1 receptor antagonist (IL‐1RA), interleukin‐6 (IL‐6), interleukin‐10, and tumor necrosis factor‐α plasma levels were measured with enzyme‐linked immunosorbent assay in 55 children with FSs and in 20 age‐matched febrile controls immediately on arrival at the hospital. Cerebrospinal fluid cytokine levels also were measured in 16 FS children.Results: The plasma IL‐1RA/IL‐1β ratio (mean, 2,133 vs. 119; median, 790 vs. 105; p < 0.0001) and plasma IL‐6 (mean, 41.7 pg/ml vs. 16.1 pg/ml; median, 19.6 pg/ml vs. 10.5 pg/ml; p = 0.005) were significantly higher in FS patients compared with control children. Logistic regression analysis was used to find the most significant predisposing factors for FSs. In this analysis, the high plasma IL‐1RA/IL‐1β ratio was the most significant factor connected to FSs (OR, 41.5; 95% CI, 4.9–352.8), but high plasma IL‐6 also was significantly associated with FSs (OR, 5.3; 95% CI, 1.4–20.3).Conclusions: Present results support the hypothesis that the cytokine network is activated and could have a role in the pathogenesis of FS.
Focal Cooling Suppresses Spontaneous Epileptiform Activity without Changing the Cortical Motor Threshold
Authors: Karkar Kameel M. , Garcia Paul A. , Bateman Lisa M. , Smyth Matthew D. , Barbaro Nicholas M. , Berger Mitchel 
Published: May 2003

Summary:  Purpose: Focal cerebral cooling has been shown to reduce epileptiform activity in animals. There are, however, few reports of this phenomenon in humans.Methods: Electrocorticography was performed before resection of a right frontal tumor in a patient with partial seizures. Cold saline was applied to the interictal spike focus, and its effect on the epileptiform discharges was observed.Results: Application of cold saline to the spike focus resulted in a transient, complete cessation of spiking. This effect was reproduced with a second application of cold saline. The motor threshold for electrical stimulation remained unchanged during the application of saline.Conclusions: In this patient with tumor‐related epilepsy, focal cooling of the cortex reproducibly abolished interictal epileptiform discharges without changing the motor threshold to electrical stimulation.
A Sheep Model for the Study of Focal Epilepsy with Concurrent Intracranial EEG and Functional MRI
Authors: Opdam Helen I. , Federico Paolo , Jackson Graeme D. , Buchanan Joanne , Abbott David F. , Fabinyi Gavin C. A. , Syngeniotis Ari , Vosmansky Milosh , Archer John S. , Wellard R. Mark , Bellomo Rinaldo 
Published: May 2003

Summary:  Purpose: We describe a sheep model of penicillin‐induced seizure activity using electroencephalography (EEG) and functional MRI (fMRI).Methods: Ten adult sheep were used. Spikes and seizures were generated by instillation of 8,000–10,000 IU of penicillin into the right prefrontal cortex via a specially designed port. Bilateral intracranial EEG was acquired by using carbon fiber electrodes. Animals had behavioral characterization of their seizures and were then anesthetized for fMRI studies. Functional MRI was performed at 1.5 and 3 Tesla by measuring blood oxygen level–dependent (BOLD) weighted signal intensity at different times during the evolution of seizures.Results: Behavioral seizures were associated with electrographic seizures. Intracranial EEG obtained in the MR scanner was of high quality. Focal spiking and seizures were seen in all animals and developed 11.3 ± 11.2 s and 17.3 ± 12.1 min after penicillin administration, respectively. An average of 13 ± 4.8 seizures were seen per animal, each lasting 27.3 ± 12.3 s. Functional MR images with little parenchymal artefact were obtained. Regional BOLD signal‐intensity changes were observed during seizures at the seizure focus and ipsilateral amygdala.Conclusions: We have developed an animal model of partial epilepsy in which seizures can be reliably elicited with concurrent fMRI and intracranial EEG. During unilateral electrographic seizures, focal BOLD signal changes occurred at the seizure focus and ipsilateral amygdala, suggesting the presence of a cortico–subcortical loop. This observation illustrates the potential of the model for understanding seizure generation, spread, and possibly the consequences of repeated seizures on the brain.
Hypomotor Seizures in Infants and Children
Authors: Källén Kristina , Wyllie Elaine , Lüders Hans O. , Lachhwani Deepak , Kotagal Prakash 
Published: May 2003

Summary:  Purpose: Hypomotor seizures (characterized by diminished behavioral activity with indeterminate level of consciousness) have been identified as an important seizure type in infants. Our goal was to investigate further the clinical and EEG features of hypomotor seizures.Methods: We retrospectively reviewed 110 hypomotor seizures from 34 patients recorded with video‐EEG.Results: Twenty‐seven (79%) patients were younger than 48 months, and seven (21%) were aged 4 to 15 years. Seventy‐one (64%) seizures had regional or lateralized EEG onset, arising predominantly from temporal or parietal lobe regions. The other 39 (35%) seizures had generalized onset, usually with abrupt onset of diffuse rhythmic high‐amplitude theta activity or diffuse electrodecrement and only rarely (two patients) with slow spike–wave complexes or 3‐Hz spike–wave complexes. Hypomotor seizures with generalized EEG onset were significantly shorter than those with regional or lateralized onset (p = 0.01, GEE model). Unsustained head or eye movements and subtle mouth automatisms were commonly seen in hypomotor seizures with either focal or generalized onset. Seventeen percent of hypomotor seizures with focal onset evolved to include version of head and eyes or jerking of one arm, whereas 2% of generalized hypomotor seizures evolved to a cluster of spasms.Conclusions: Hypomotor seizures may be either focal or generalized. Regional EEG onsets were most often temporal or parietal, suggesting that focal hypomotor seizures may be a bland form of “complex partial” seizures with no or minimal automatisms, seen predominantly in infants. Generalized hypomotor seizures were rarely associated with an ictal pattern of generalized spike–wave complexes, suggesting a different mechanism from absence seizures seen later in life.
Memory Lateralization in Medial Temporal Lobe Epilepsy Assessed by Functional MRI
Authors: Golby Alexandra J. , Poldrack Russell A. , Illes Judy , Chen David , Desmond John E. , Gabrieli John D. E. 
Published: May 2003

Summary:  Purpose: To determine the utility of functional magnetic resonance imaging (fMRI) in preoperative lateralization of memory function in patients with medial temporal lobe epilepsy (MTLE).Methods: Nine patients with MTLE underwent standard preoperative assessment including video‐EEG and intracarotid amytal testing (IAT). fMRI was performed while subjects encoded four types of stimuli (patterns, faces, scenes, and words). Activation maps were created for each subject representing areas more active for novel than for repeated stimuli. Regions of interest were drawn around the MTL in individual subjects, suprathreshold voxels were counted, and an asymmetry index was calculated.Results: In eight of nine subjects, lateralization of memory encoding by fMRI was concordant with that obtained from the IAT. Group‐level analysis demonstrated greater activation in the MTL contralateral to the seizure focus such that in the left MTLE group, verbal encoding engaged the right MTL, whereas in the right MTLE group, nonverbal encoding engaged the left MTL.Conclusions: fMRI is a valid tool for assessing of memory lateralization in patients with MTLE and may therefore allow noninvasive preoperative evaluation of memory lateralization. FMRI revealed that memory encoding may be reorganized to the contralateral MTL in patients with MTLE.