bluuebunny/crossref_metadata_2025_split huggingface dataset:
Components of Attention in Children with Complex Partial Seizures With and Without ADHD
Authors: Semrud‐Clikeman Margaret , Wical Beverly 
Published: August 2005

Summary: Purpose: To evaluate attentional difficulties in children with complex partial seizures, we reviewed the records of 12 children with complex partial seizures with attention deficient hyperactivity disorder (CPS/ADHD); 21 children with CPS without ADHD (CPS); 22 children with ADHD; and 15 control children. Methods: Each child completed a computerized performance test (CPT), which evaluated sustained attention, inhibition of response, response time, and consistency of response. The ADHD groups also completed the CPT after a dose of methylphenidate. Results: The results found poorest performance on the CPT by the CPS/ADHD group. Particular difficulty in attention was found for children with epilepsy regardless of the ADHD diagnosis. When methylphenidate was administered to the ADHD groups, both groups improved in performance on the CPT. Conclusions: Epilepsy may predispose children to attention problems that can significantly interfere with learning. Similar improvement for children with CPS/ADHD was found with methylphenidate compared with baseline as for children with ADHD but without CPS.
Teratogenic Effects of Antiepileptic Drugs: Use of an International Database on Malformations and Drug Exposure (MADRE)
Authors: Arpino Carla , Brescianini Sonia , Robert Elisabeth , Castilla Eduardo E. , Cocchi Guido , Cornel Martina C. , de Vigan Catherine , Lancaster Paul A. L. , Merlob Paul , Sumiyoshi Yoshio , Zampino Giuseppe , Renzi Cristina , Rosano Aldo , Mastroiacovo Pierpaolo 
Published: August 2005

Summary: Purpose: The study goal was to assess teratogenic effects of antiepileptic drugs (AEDs) through the use of a surveillance system (MADRE) of infants with malformations. Methods: Information on all malformed infants (1990–1996) with maternal first‐trimester drug exposure was collected by the International Clearinghouse for Birth Defects and Monitoring Systems (ICBDMS). Cases were defined as infants presenting with a specific malformation, and controls were defined as infants presenting with any other birth defect. Exposure was defined by the use of AEDs during the first trimester of pregnancy. The association of AEDs with malformations was then estimated by calculating the odds ratios with 95% confidence intervals and testing their homogeneity among registries. Results: Among 8005 cases of malformations, 299 infants were exposed in utero to AEDs. Of those exposed to monotherapy, 65 were exposed to phenobarbital, 10 to methylphenobarbital, 80 to valproic acid, 46 to carbamazepine, 24 to phenytoin, and 16 to other AEDs. Associations were found for spina bifida with valproic acid. Infants exposed to phenobarbital and to methylphenobarbital showed an increased risk of oral clefts. Cardiac malformations were found to be associated with phenobarbital, methylphenobarbital, valproic acid, and carbamazepine. Hypospadias was associated with valproic acid. Porencephaly and other specified anomalies of brain, anomalies of face, coarctation of aorta, and limb reduction defects were found to be associated with valproic acid. Conclusions: Using the MADRE system, we confirmed known teratogenic effects of AEDs. We also found increased risks for malformations that had never been reported associated with AEDs or for which the association was suggested by case reports.
Effects of Vigabatrin on Sleep–Wakefulness Cycle in Amygdala‐Kindled Rats
Authors: Raol Y. H. , Meti B. L. 
Published: August 2005

Summary: Purpose: Our aim was to study the effect of prolonged administration of vigabatrin (VGB) on sleep‐wakefulness cycle in kindled seizure‐induced rats. Methods: Adult male Wistar rats were implanted stereotaxically with electrodes for kindling and polysomnography. The rats were divided into two groups, kindled and VGB‐treated kindled rats. VGB was administered intraperitonially every day for 21 days, and polysomnographic recordings were taken after doses 1, 7, 14, and 21. The drug effects were evaluated by comparing the records of kindled and drug‐treated kindled rats. Results: The VGB‐administered kindled rats showed an increase in total sleep time (TST) due to an increase in total non‐rapid eye movement (NREM) and light slow‐wave sleep stage I (SI) with a decrease in wakefulness. The number of episodes and REM onset latencies were found to be decreased after drug treatment. Conclusions: It can therefore be concluded that VGB has a somnolence‐inducing effect and that it might mediate its anti‐convulsant effect by altering sleep architecture through sleep‐regulating areas.
The Cost of Epilepsy in the United States: An Estimate from Population‐Based Clinical and Survey Data
Authors: Begley Charles E. , Famulari Melissa , Annegers John F. , Lairson David R. , Reynolds Thomas F. , Coan Sharon , Dubinsky Stephanie , Newmark Michael E. , Leibson Cynthia , So E. L. , Rocca Walter A. 
Published: August 2005

Summary: Purpose: To provide 1995 estimates of the lifetime and annual cost of epilepsy in the United States using data from patients with epilepsy, and adjusting for the effects of comorbidities and socioeconomic conditions. Methods: Direct treatment‐related costs of epilepsy from onset through 6 years were derived from billing and medical chart data for 608 population‐based incident cases at two sites in different regions of the country. Indirect productivity‐related costs were derived from a survey of 1,168 adult patients visiting regional treatment centers. Direct costs separate the effects of epilepsy and comorbidity conditions. Indirect costs account for the effects of other disabilities and socioeconomic conditions on foregone earnings and household activity. The estimates were applied to 1995 population figures to derive national projections of the lifetime and annual costs of the disorder. Results: The lifetime cost of epilepsy for an estimated 181,000 people with onset in 1995 is projected at $11.1 billion, and the annual cost for the estimated 2.3 million prevalent cases is estimated at $12.5 billion. Indirect costs account for 85% of the total and, with direct costs, are concentrated in people with intractable epilepsy. Conclusions: Direct costs attributable to epilepsy are below previous estimates. Indirect costs adjusted for the socioeconomic conditions of patients are above previous estimates. Findings indicate that epilepsy is unique in the large proportion of costs that are productivity‐related, justifying further investment in the development of effective interventions.
Are Negative Mood States Associated with Cognitive Function in Newly Diagnosed Patients with Epilepsy?
Authors: Pulliainen Veijo , Kuikka Pekka , Kalska Hely 
Published: August 2005

Summary: Purpose: The association of self‐reported subclinical depressive symptoms and negative mood states with cognitive functioning was evaluated in 51 consecutive newly diagnosed adult persons with epilepsy. Methods: Emotional state was assessed with Profile of Mood States (POMS) and Brief Depression Scale (BDS) and was correlated with a battery of neuropsychological tests. Results: Patients with epilepsy reported more depressive symptoms in BDS than in controls. They also had more feeling of bewilderment and less vigor on POMS. Higher scores in BDS and in POMS inefficiency scale were associated with slower nondominant hand tapping, but emotional state did not correlate with cognitive measures within the epilepsy group. Conclusions: Self‐reported symptoms of depression and negative mood states were not extensively or significantly associated with cognitive function, and they do not explain the cognitive impairments observed in cognition in newly diagnosed patients with epilepsy.
Burns in Patients with Epilepsy: Changes in Epidemiology and Implications for Burn Treatment and Prevention
Authors: Josty I. C. , Narayanan V. , Dickson W. A. 
Published: August 2005

Summary: Purpose: To determine the epidemiology of burns in patients with epilepsy and to identify changes in epidemiology compared with previous studies; to identify further strategies that can be used in the primary and secondary prevention of such injuries in this group of patients. Methods: A retrospective case note review of 111 patient episodes to a regional burns unit where the admission criterion was a burn secondary to an epileptic seizure. Results: The majority (60 of 111) of burns were due to scald injury and were sustained in a domestic setting. This group of patients (mean age, 42.7 years) accounted for 1.6% of admissions during the study period. The data demonstrate a change in the epidemiology when compared with previous studies. Most burns were small (mean area burnt, 2.2%) but deep, and 72 of 111 patient episodes required surgery, and 12% of patients had reburn injuries requiring readmission. Conclusions: Scald injuries are now the major cause of burns in those with epilepsy, and the proportion of such patients admitted to a regional burns unit has reduced. Patients and health professionals need to be aware of such injuries and of appropriate prevention strategies.
Ictal SPECT and Interictal PET in the Localization of Occipital Lobe Epilepsy
Authors: Sturm Jonathan W. , Newton Mark R. , Chinvarun Yotin , Berlangieri Salvatore U. , Berkovic Samuel F. 
Published: August 2005

Summary: Purpose: To compare the localizing value of ictal single photon emission computed tomography (SPECT) and interictal fluorodeoxyglucose–positron emission tomography (FDG‐PET) in refractory occipital lobe epilepsy. Methods: Six patients who underwent surgery for refractory epilepsy associated with pathology in the occipital lobe were retrospectively selected from records of the Austin & Repatriation Centre Comprehensive Epilepsy Programme. Interictal SPECT and PET and ictal SPECT were obtained by standard methods. All studies were read by a nuclear medicine expert blinded to clinical data except the diagnosis of epilepsy. Results: Ictal SPECT showed unilateral occipital hyperperfusion in five of six cases often accompanied by temporal lobe hyperperfusion. These patterns were seen in cases with or without magnetic resonance imaging (MRI) abnormality. Interictal SPECT was not localizing in any case, in contrast to PET, which showed occipital hypometabolism in three of five studies. Conclusions: Ictal SPECT can provide novel localizing data in MRI‐negative occipital lobe epilepsy. Interictal PET can provide useful localizing information, but its role in providing novel information was not demonstrated. Interictal SPECT is useful only as a baseline to aid in interpretation of ictal studies.
Cluster Analysis of Clinical Seizure Semiology of Psychogenic Nonepileptic Seizures
Authors: Gröppel G. , Kapitany T. , Baumgartner C. 
Published: August 2005

Summary: Purpose: To develop an objective classification of psychogenic nonepileptic seizures (NES) based on cluster analysis of clinical seizure semiology. Methods: We studied the clinical seizure semiology in 27 patients with psychogenic NES documented by prolonged video‐EEC monitoring. We analyzed the following clinical symptoms: clonic and hypermotor movements as well as trembling of the upper and/or lower extremities, pelvic thrusting, head movements, tonic posturing backward of the head, and falling. We used cluster analysis to identify symptoms occurring together in a systematic way and thus tried to achieve a clinical classification of psychogenic NES. Results: We could identify three symptom clusters. Cluster 1 was characterized by clonic and hypermotor movements of the extremities, pelvic thrusting, head movements, and tonic posturing of the head, and therefore was named “psychogenic motor seizures.” Cluster 2 comprised trembling of the upper and lower extremities and was termed “psychogenic minor motor or trembling seizures.” Cluster 3 consisted of falling to the floor as the only symptom and was referred to as “psychogenic atonic seizures.” Conclusions: Our study represents the first study to analyze the clinical semiology of psychogenic NES by cluster analysis, which should be useful for an objective classification of psychogenic NES. This classification should allow both a better characterization of psychogenic NES and an easier differential diagnosis against specific epileptic seizures.
Methsuximide Lowers Lamotrigine Blood Levels: A Pharmacokinetic Antiepileptic Drug Interaction
Authors: Besag F. M. C. , Berry D. J. , Pool F. 
Published: August 2005

Summary: Purpose: To determine whether methsuximide (MSM) affects lamotrigine (LTG) blood levels and whether any change is of clinical significance. Methods: LTG serum levels in 16 patients taking MSM were compared with those before starting or after stopping the MSM. The 16 patients, (11 boys, five girls) were young people (mean age, 15.5 years; range, 9–19 years) with a variety of seizure types and syndromes. In six cases, LTG levels were available both before MSM was started and after it was stopped. Results: The mean LTG serum concentration before starting or after stopping MSM was 13.4 mg/L, and the mean level while taking MSM was 6.3 mg/L. This difference was highly significant (p < 0.0005, paired t test). MSM lowered the LTG serum concentration in every case, with a mean decrease of 53% (range, 36–72%). In some patients this led to a deterioration in seizure control when MSM was added or an improvement in seizure control after MSM was stopped. Conclusions: Although MSM is a valuable add‐on, broad‐spectrum drug when used in combination with LTG, adjustment of the LTG dose may be necessary when MSM is started or stopped, to allow for the fact that MSM lowers LTG blood levels.
Health‐Related Quality of Life Outcome in Medically Refractory Epilepsy Treated with Anterior Temporal Lobectomy
Authors: Markand Omkar N. , Salanova Vicenta , Whelihan Eileen , Emsley Christine L. 
Published: August 2005

Summary: Purpose: A prospective study to investigate health‐related quality of life (HRQOL) outcome in patients with temporal lobe epilepsy treated with anterior temporal lobectomy (ATL). Methods: The majority of the patients with medically refractory focal epilepsy had Quality of Life in Epilepsy‐89 (QOLIE‐89) assessment at the time of prolonged video/EEG monitoring as part of their presurgical evaluation. Thirty‐seven patients who were not treated surgically constituted the control group, and 53 patients who underwent ATL made up the surgery group. Both control and surgery groups had HRQOL assessment repeated at ∼1‐ and 2‐year intervals. Repeated measures analysis of variance (ANOVA) was used to test for differences between the two groups. Results: For the overall score and almost every scale, the surgery group had a higher baseline mean than the control group. Because of this baseline difference, change scores were used in further analysis. The overall score and 10 of 17 scales in QOLIE‐89 showed significant HRQOL improvement after ATL, and the improvement was significant relative to score changes of the nonsurgical comparison group. Scores improved in overall QOL, emotional well‐being, attention/concentration, language, social isolation, health perception, role limitations‐physical, work/drive/social, health discouragement, and seizure worry. For the first five scales, there was group‐time interaction; the improvement was significantly more on the 2‐year than on the 1‐year follow‐up. When the surgery patients were divided into four categories (class IA‐, completely seizure free; class IA+, seizure free with aura; class II, rare seizures; class III, worthwhile improvement in seizure control; and class IV, no improvement), the improved HRQOL in the surgery group was almost entirely contributed by the class IA‐ outcome patients who were totally seizure free. The class IA+ patients with continuing aurae and class II/III/IV patients had no significant improvement in their overall HRQOL scores at 1‐ or 2‐year follow‐up. Conclusions: Overall score and 10 of the 17 scales of QOLIE‐89 significantly improved in patients with medically refractory temporal lobe epilepsy after ATL. For some scales, there was delay in the improvement to manifest. The HRQOL improvement was related to achieving an entirely seizure‐free status (i.e., no seizures or aurae postoperatively).
Prevalence, Classification, and Severity of Epilepsy in Children in Western Norway
Authors: Waaler P. E. , Blom B. H. , Skeidsvoll H. , Mykletum A. 
Published: August 2005

Summary: Purpose: To determine prevalence of active epilepsy in school children in a defined area and assess the usefulness of International League Against Epilepsy classification of seizures and epileptic syndromes, with special emphasis on frequency, additional handicaps, and therapeutic problems of severe cases. Methods: The latest International League Against Epilepsy International Classification of Epileptic Seizures (ICES, 1981) and Epilepsies and Epileptic Syndromes (ICE, 1989) were used for determination of prevalence rates, seizure types, epilepsies and epileptic syndromes, and additional neurological deficits in all 6‐ to 12‐year‐old children with epilepsy in a Norwegian county. Children had neuropediatric and EEG examination, intelligence evaluation, and, when necessary, additional investigations. Results: Prevalence of active epilepsy on January 1, 1995, was 5.1 per 1,000. Main seizure type and epilepsy syndrome could be classified in 98% and 90% of patients, respectively. Seizure types/epileptic syndromes were more often partial/localization related than generalized. Among generalized epilepsies, idiopathic forms were more frequent in girls, and cryp‐togenic and symptomatic forms more frequent in boys. Epileptogenic EEG activity was most often generalized or localized to one or two areas of the brain and was never found in 14% of patients. Symptomatic etiology was found in 46% of all children and in 81% of therapy‐resistant cases, respectively. Over the years, 11% of children had never used antiepileptic drugs (AED), 62% had tried one or two AEDs, and 26% had tried from three to 15 AEDs. Twenty‐five percent of children were without present AED treatment. Complementary/alternative medicine had been tried by 12% of children. Conclusions: Although most epilepsies could be classified, the number of cases in non‐specific categories was relatively high. Symptomatic etiology was frequent, especially in therapy‐resistant cases. Multidisciplinary therapeutic and ha‐bilitation approaches are often needed in childhood epilepsy.
Conduct of Trials in Private Clinical Practice
Authors: Beran Roy G. , Beran Maureen E. 
Published: August 2005

Summary: Purpose: Trials of antiepileptic medications are usually based in tertiary referral centers with teaching hospital resources. Epilepsy Research & Services (ERS) is part of a private outpatient neurological clinic that is involved in research as part of multicenter clinical trials, adhering to Good Clinical Research Practice. ERS is subject to external monitoring and auditing, but does so outside of the teaching hospital environment. Methods: The clinic is operated by a neurologist supported by a research assistant, administrative and nursing staff and has no formal university attachment. Patients are recruited for trials from routine referrals for clinical care. The center has formal ties with the ethics committee of the local teaching hospital, but none of the team is formally attached to that hospital. Results: The center conducted trials of zonisamide, oxcar‐bazepine, gabapentin, remacemide, tiagabine, vigabatrin, felbamate, and lamotrigine both as add‐on trials in refractory seizure disorders and as monotherapy trials in de novo epilepsy. More than 200 patients have been recruited for trials at ERS (with some patients being involved in more than one trial). External review endorsed ERS as a superior environment for such research and as a model for other centers. Conclusions: Private practice is a viable alternative for the conduct of clincial trials and should be considered when establishing such protocols. Simplicity of administration and clinical practice, which more closely mirrors standard patient care, may enhance recruitment and management.
Successful Use of Intravenous Immunoglobulin as Initial Monotherapy in Landau‐Kleffner Syndrome
Authors: Mikati Mohamad A. , Saab Raya 
Published: August 2005

Summary: Purpose: There is a need for new and more effective therapies for Landau‐Kleffner syndrome. In this article we present the first case in which a patient with Landau‐Kleffner syndrome was given intravenous immunoglobulin (IVIG) as his first and only therapy and responded to it. Methods: This previously healthy, left‐handed boy presented at 31 months of age with a 3‐month history of auditory agnosia, behavioral abnormalities, and progressive, eventually complete loss of speech. Electroencephalography (EEG) showed frequent and, in sleep, continuous right central and temporal spike slow wave discharges. Metabolic workup, magnetic resonance imaging, and auditory evoked potentials were normal. Cere‐brospinal fluid IgG index was high (18%). The patient was treated with IVIG, as his initial and only therapy, receiving 500 mg/kg/day over four consecutive days. Results: On the third day of IVIG, the patient started using single words, and on the fourth, two‐word sentences. Two weeks later his speech and behavior returned to normal. At the end of 4 days of IVIG therapy, EEG was within normal limits. Two months later, however, he had a severe relapse clinically and by EEG. He promptly responded to another course of IVIG. A subsequent cerebrospinal fluid IgG index showed normalization (6%). Three months later he had essentially normal speech and behavior. Conclusions: Repeated, immediate, and remarkable clinical and EEG responses of this patient suggest that IVIG was helpful as first‐line therapy in the treatment of Landau‐Kleffner syndrome. It also supports the hypothesis that immunological mechanisms contributed to his symptoms.
Chromosomal Mapping of Genes for Epilepsy in NER: A Rat Strain with Tonic‐Clonic Seizures
Authors: Maihara Toshiro , Noda Atsushi , Yamazoe Hiroshi , Voigt Birger , Kitada Kazuhiro , Serikawa Tadao 
Published: August 2005

Summary: Purpose: NER is a mutant rat strain that exhibits spontaneous tonic‐clonic convulsions accompanied by epileptic discharges on ictal EEG and serves as a model for generalized tonic‐clonic seizures in humans. Our previous experiments have suggested that a major autosomal recessive gene and several minor genes regulate the inheritance of tonic‐clonic seizures in NER. The purpose of this study was to confirm the mode of inheritance and to locate the causative genes for epilepsy in NER on the rat genetic map. Methods: We developed F1 hybrid (F1) and reciprocal back‐cross progenics of NER with a seizure‐resistant strain, F344, and evaluated their seizure susceptibility under tossing‐stimulated and nonstimulated conditions. Backcross animals were genotyped using simple sequence length polymorphism markers for polymerase chain reactions. Linkage between seizure susceptibility and marker loci was analyzed by χ2 statistic tests and by the computer programs MAPMAKER/EXP and MAPMAKER/QTL. Results: Under tossing‐stimulating conditions, tonic‐clonic seizures were provoked in 90% of NER and 66% of (F1 × NER) backcross animals, but no seizures occurred in the F344, F1, or (F1 × F344) backcross animals. Routine monitoring of nonstimulated animals revealed spontaneous tonic‐clonic convulsions in 100% of NER and 64.2% of (F1 × NER) backcross animals, but no seizures in F344 or F1. Gender effect on seizure susceptibility was negligible in (F1 × NER) backcross in both conditions. Preliminary genome‐wide scanning and subsequent precise location of the causative genes revealed seizure susceptibility loci, designated Nerl and Ner2, on rat chromosomes 1 and 3, respectively. Conclusions: Nerl is a locus that controls the inheritance of spontaneous tonic‐clonic seizures in an autosomal recessive mode, whereas Ner2 affects the occurrence of tossing‐induced seizures. Orthologous genes in the vicinity of these loci may be related to epileptogenesis in other species, including humans.