bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of Clobazam as Add‐On Therapy in Patients with Refractory Partial Epilepsy
Authors: Montenegro M. A. , Cendes F. , Noronha A. L. A. , Mory S. B. , Carvalho M. I. , Marques L. H. N. , Guerreiro C. A. M. 
Published: March 2003

Summary:  Purpose: Clobazam (CLB) has an important antiepileptic effect and is less expensive than the new antiepileptic drugs (AEDs), but still has not been considered as first‐line drug in the treatment of epilepsy. We evaluated the efficacy of CLB as add‐on therapy in patients with refractory partial epilepsy.Methods: This was an open, retrospective study, conducted at the epilepsy clinic of our university hospital. All patients had chronic epilepsy and were being evaluated for epilepsy surgery. CLB was introduced as add‐on therapy (starting with 10 mg/day) in patients with previous failure of at least two AEDs. Information was obtained from clinical notes and follow‐up visits.Results: We evaluated 97 patients, 37 men and 60 women. Ages ranged from 15 to 70 years (mean, 35.8 years). Etiology of epilepsy was hippocampal atrophy in 67 (69%), cortical dysgenesis in nine (9.3%), and other etiologies in nine (9.3%). In 12 (12.3%) patients, the etiology of epilepsy was not identified despite clinical and neurologic investigation. Patients used CLB for a period ranging from 1 month to 7 years and 9 months (mean, 16.7 months) with doses ranging from 10 to 60 mg/day (mean, 29.7 mg/day). Seven (7.2%) patients were seizure free, 48 (49.4%) had ≥50% of improvement in seizure control, 39 (40.2%) had <50% of improvement in seizure control, and in three (3.1%), no data were available.Conclusions: We conclude that CLB may have efficacy equivalent to that of the new AEDs when used as add‐on therapy in patients with refractory epilepsy. CLB should be considered an economic alternative in the treatment of patients with refractory epilepsy.
Tiagabine: Efficacy and Safety in Adjunctive Treatment of Partial Seizures
Authors: Crawford P. , Meinardi H. , Brown S. , Rentmeester TH. W. , Pedersen B. , Pedersen P. C. , Lassen L. C. 
Published: March 2003

Summary:  Purpose: To assess the efficacy and safety of tiagabine (TGB), a new antiepileptic drug (AED), as add‐on therapy in patients with refractory partial seizures.Methods: This response‐dependent study used an open‐label screening phase (in which patients were titrated to their optimal TGB dose, ≤64 mg/day) followed by a double‐blind, placebo‐controlled, crossover phase. Initial eligibility criteria included (a) seizures inadequately controlled by existing AEDs, and (b) six or more partial seizures during an 8‐week baseline period. Patients showing benefit from TGB (≥25% reduction in total seizure rate relative to baseline) were eligible for randomization into the double‐blind phase, which comprised two 7‐week assessment periods separated by a 3‐week crossover period.Results: Forty‐four (50%) of the 88 enrolled patients entered the double‐blind phase of the study during which there were significant reductions compared with placebo in all partial (p < 0.01), complex partial (p < 0.001), and secondarily generalized tonic–clonic seizure rates (p < 0.05). Thirty‐three percent of patients experienced a reduction of ≥50% in the all partial seizure rate. Eight (22%) patients receiving TGB during the double‐blind phase reported adverse events, of which dizziness and incoordination were the most frequent. Three patients withdrew from treatment during the double‐blind phase because of adverse events; two during treatment with TGB and one during treatment with placebo. TGB did not affect plasma concentrations of other coadministered AEDs.Conclusions: TGB was significantly better than placebo in terms of seizure rate reduction and was generally well‐tolerated in patients with difficult to control seizures.
Social Functioning, Psychological Functioning, and Quality of Life in Epilepsy
Authors: Suurmeijer Theo P. B. M. , Reuvekamp Marieke F. , Aldenkamp Bert P. 
Published: March 2003

Summary:  Purpose: Part of our research intended to explain “Quality of Life” (QoL) differences between people with epilepsy. To this end, a series of already existing generic and disease‐specific health status measures were used. In this study, they were considered as determinants of people's QoL, whereas QoL itself was conceived as a general “value judgment” about one's life.Methods: From the records of four outpatient clinics, 210 persons with epilepsy were randomly selected. During their visit to the outpatient clinic, they completed a questionnaire assessing, among other things, health perceptions and social and psychological functioning. Additional information about their medical and psychosocial status was gathered from the patient files. Data were analysed by using a hierarchical regression analysis.Results: In decreasing order of importance, “psychological distress,”“loneliness,”“adjustment and coping,” and “stigma perception” appeared to contribute most significantly to the outcome QoL as judged by the patients themselves, regardless of their physical status. In the final model, none of the clinical variables (onset, seizure frequency, side effects of antiepileptic drugs) contributed significantly anymore to the patients' “quality‐of‐life judgement.” Apparently the effect of other variables such as seizure frequency and health perceptions, medication and side effects, life fulfilment, self‐esteem, and mastery is mediated by these variables.Conclusions: Because all of the variance in QoL of the patients was explained by the psychosocial variables included in this study, health professionals should be aware of the significance of the psychosocial functioning of the patients and the role it plays in the achievement of a good QoL. Both informal and professional support may be an adjunct to conventional treatment. In future research, this issue should be given high priority.
Long‐Term Valproate and Lamotrigine Treatment May Be a Marker for Reduced Growth and Bone Mass in Children with Epilepsy
Authors: Guo Chun‐Yuan , Ronen Gabriel M. , Atkinson Stephanie A. 
Published: March 2003

Summary:  Purpose: To determine whether long‐term treatment with valproate (VPA) and/or lamotrigine (LTG) in children with epilepsy is associated with altered growth and/or bone metabolism.Methods: Twenty‐seven boys and 26 girls, aged 3 to 17 years (9.2 ± 3.9, mean ± SD), with epilepsy treated with VPA and/or LTG for ≥2 years were evaluated for growth, nutrient intakes, physical activity, bone mineral density (BMD), and blood biochemical indices of mineral and bone metabolism.Results: Twenty‐three (43.4%) of the children had a body height below the 10th percentile. Z‐scores for BMD below –1.5 occurred in 24.4% of the children. When patients were divided into two groups according to daily activity score, a significantly lower Z‐score for total body BMD (p = 0.007), percentile for body height (p = 0.05), and plasma parathyroid hormone (PTH; p = 0.04), osteocalcin (p = 0.04) and 25‐hydroxyvitamin D (25OHD) (p = 0.01) were found in the inactive compared with the active group. Z‐score for total body BMD was correlated with daily activity score (r = 0.43, p = 0.008). Plasma intact osteocalcin and intact PTH values correlated significantly (r = 0.36, p = 0.02). Plasma 1,25‐dihydroxyvitamin D was within normal range for all subjects. When patients were divided into LTG‐alone, VPA‐alone, and LTG‐plus‐VPA treatment groups, significantly lower (p < 0.05) plasma osteocalcin and percentile for body height were found in the VPA‐plus‐LTG treatment group.Conclusions: Long‐term VPA and LTG therapy, particularly when combined, is associated with short stature, low BMD, and reduced bone formation. These alterations may be mediated primarily through reduced physical activity rather than through a direct link to the VPA and/or LTG therapy.
Lack of Association Between an Interleukin 1 Beta (IL‐1β) Gene Variation and Refractory Temporal Lobe Epilepsy
Authors: Buono Russell J. , Ferraro Thomas N. , O'Connor Michael J. , Sperling Michael R. , Ryan Stephen G. , Scattergood Theresa , Mulholland Nicole , Gilmore Joan , Lohoff Falk W. , Berrettini Wade H. 
Published: March 2003

Summary:  Purpose: We attempted to confirm recent findings of Kanemoto et al. that demonstrated a positive association (p < 0.017) between a polymorphism in the promoter region of the interleukin 1‐β (IL‐1β) gene and the clinical phenotype of temporal lobe epilepsy with hippocampal sclerosis (TLE+HS).Methods: We determined the frequency of this polymorphism in a group of 61 TLE+HS patients of European ancestry and compared it with that found in 119 ethnically matched control subjects.Results: Analysis of genotype and allele frequencies showed no statistically significant difference in the distribution of the polymorphism between the two groups (p = 0.10).Conclusions: These data suggest that this IL‐1β promoter polymorphism does not act as a strong susceptibility factor for TLE+HS in a population of individuals of European ancestry.
Long‐Term Seizure Outcome and Antiepileptic Drug Treatment in Surgically Treated Temporal Lobe Epilepsy Patients: A Controlled Study
Authors: Bien Christian G. , Kurthen Martin , Baron Karin , Lux Silke , Helmstaedter Christoph , Schramm Johannes , Elger Christian E. 
Published: March 2003

Summary:  Purpose: To evaluate the long‐term impact of surgical treatment on seizure outcome and antiepileptic drug (AED) use in patients with pharmacoresistant temporal lobe epilepsy (TLE).Methods: Comparison of seizure outcome and AED us in operated‐on TLE patients (n = 148) and nonsurgically treated TLE patients (n = 94) at a baseline visit and a follow‐up visit after a mean period of 4.8 years.Results: At follow‐up, 44.6% of the surgical patients and 4.3% of the nonsurgical patients had been continuously seizure‐ free since the baseline visit (including the immediate postoperative period). A further 17.6% of the operated‐on and 3.2% of the not operated‐on patients had been seizure‐free for at least the previous year; 37.8% of the surgical and 92.5% of the nonsurgical patients had had seizures during the previous 12 months (p < 0.001). Of the surgical patients, 8.8% versus none of the nonsurgical patients were AED free at follow‐up; 55.4% versus 20.2% were receiving monotherapy, and 35.8% versus 79.8% were receiving polytherapy (p < 0.001). Mean number of AEDs and mean change in number of AEDs were significantly more favorable in operated‐on than in non–operated‐on patients. Further subgroup analysis revealed that not only the continuously seizure‐free surgical patients, but also the operated‐on patients with ongoing seizures took fewer AEDs than their respective non–operated‐on counterparts.Conclusions: This controlled study for the first time provides comprehensive information on long‐term seizure outcome and AED use in surgical TLE patients. It shows a more favorable seizure outcome and AED use in the surgically treated patients. The latter holds true even for the not seizure‐free patient subgroup.
Low Serum Biotinidase Activity in Children with Valproic Acid Monotherapy
Authors: Schulpis K. H. , Karikas G. A. , Tjamouranis J. , Regoutas S. , Tsakiris S. 
Published: March 2003

Summary:  Purpose: Valproic acid (VPA) is an effective antiepileptic drug (AED), which is associated with dose‐related adverse reactions such as skin rash, hair loss (alopecia), etc. Profound as well as partial biotinidase deficiency causes dermatologic manifestations similar these. Therefore, it was of interest to evaluate serum biotinidase activity in patients receiving VPA monotherapy.Methods: Seventy‐five patients with seizures, mean age, 8.6 years (±1.9 years) were divided into three groups. Group A (n = 25) was treated with VPA 28.7 ± 8.5 mg/kg/24 h, group B (n = 25) with 41.6 ± 4.9 mg/kg/24 h, and group C with 54.5 ± 5.8 mg/kg/24 h. Their “trough” VPA serum levels were 40.9 ± 13.2, 86.25 ± 11.5, and 137 ± 14.5 μg/ml, respectively. Fifty healthy children were the controls. Patients and controls underwent clinical and laboratory evaluations including liver function data, complete blood counts, NH3, and so on, after 45 days of VPA treatment. Biotinidase serum levels were evaluated fluorometrically.Results: Liver function data were found elevated in the groups B and C. On the contrary, biotinidase activity was significantly statistically lowered (p < 0.001) in groups B and C (1.22 ± 1.11, 0.97 ± 0.07 mmol/min/L respectively), as compared with controls (5.20 ± 0.90 mmol/min/L). Strong inverse correlations were observed between liver enzymes and VPA blood levels with the activity of the enzyme. Additionally, no inhibitory effect on biotinidase activity was found, when the enzyme was incubated in vitro with high (1.2 mM) concentrations of the drug. Skin lesions (seborrheic rash, alopecia) were improved in our patients after biotin (10 mg/day) supplementation.Conclusions: It is suggested that VPA impairs the liver mitochondrial function, resulting in a low biotinidase activity and or biotin deficiency. Biotin supplementation could restore some of the side effects of the drug.
Seizures after Spontaneous Supratentorial Intracerebral Hemorrhage
Authors: Passero Stefano , Rocchi Raffaele , Rossi Símone , Ulivelli Monica , Vatti Giampaolo 
Published: March 2003

Summary:  Purpose: To characterize seizures after intracerebral hemorrhage (ICH), evaluating the risk of occurrence and relapse, predisposing factors, and prognostic significance, and to assess the utility of antiepileptic drug (AED) therapy as used in clinical practice.Methods: The study sample consisted of 761 patients with spontaneous, nonaneurysmal, supratentorial ICH. Seizures were classified as immediate (within 24 h of ICH) and early (within 30 days of ICH). Baseline variables and clinical events were compared in the seizure and nonseizure group by using a multivariate regression model of failure time data.Results: Fifty‐seven patients had one or more seizures. The 30‐day actuarial risk of a post‐ICH seizure was 8.1%. Lobar location and small volume of ICH were independent predictors of immediate seizures. Early seizures were associated with lobar location and neurologic complications, mainly rebleeding. In patients with lobar ICH, the risk of early seizures was reduced by prophylactic AED therapy. Among seizure patients, history of alcohol abuse increased the risk of status epilepticus. Immediate and early seizures were not independent predictors of in‐hospital mortality.Conclusions: Patients with ICH are exposed to a substantial risk of seizures; however, short‐term mortality was not affected, and the risk of epilepsy was lower than previously thought. The likelihood of immediate seizures is influenced by factors that are inherent characteristics of ICH, whereas the chance of developing early seizures is influenced not only by certain characteristics of ICH, but also by unpredictable events. A brief period of therapy soon after ICH onset may reduce the risk of early seizures in patients with lobar hemorrhage.
Epileptic Spikes: Magnetoencephalography versus Simultaneous Electrocorticography
Authors: Oishi Makoto , Otsubo Hiroshi , Kameyama Shigeki , Morota Nobuhito , Masuda Hiroshi , Kitayama Masaomi , Tanaka Ryuichi 
Published: March 2003

Summary:  Purpose: To test the sensitivity of extracranial magnetoencephalography (MEG) for epileptic spikes in different cerebral sites.Methods: We simultaneously recorded MEG and electrocorticography (ECoG) by using subdural electrodes with 1‐cm interelectrode distances for one patient with lateral frontal epilepsy and one patient with basal temporal epilepsy. We analyzed MEG spikes associated with ECoG spikes and compared the maximal amplitude and number of electrodes involved. We estimated and evaluated the locations and moments of the equivalent current dipoles (ECDs) of MEG spikes.Results: In patient 1, MEG detected 100 (53%) of 188 ECoG lateral frontal spikes, including 31 (46%) of 67 spikes that activated three subdural electrodes. MEG spike amplitudes correlated with ECoG spike amplitudes and the number of electrodes activated (p < 0.01). ECDs were perpendicular to the superior frontal sulcus. In patient 2, MEG detected 31 (26%) of 121 ECoG basal temporal spikes, but none that activated only three subdural electrodes. ECDs were localized in the entorhinal and parahippocampal gyri, oriented perpendicular to those basal temporal cortical surfaces. The ECD strength was 136.6 ± 71.5 nAm in the frontal region, but 274.5 ± 150.6 nAm in the temporal region (p < 0.01).Conclusions: When lateral frontal ECoG spikes extend >3 cm2 across the fissure, MEG can detect >50%, correlating with spatial activation and voltage. In the basal temporal region, MEG requires higher‐amplitude discharges over a more extensive area. MEG shows a significantly higher sensitivity to lateral convexity epileptic discharges than to discharges in isolated deep basal temporal regions.
Gabapentin Increases Slow‐wave Sleep in Normal Adults
Authors: Foldvary‐Schaefer Nancy , De Leon Sanchez Isabel , Karafa Matthew , Mascha Ed , Dinner Dudley , Morris Harold H. 
Published: March 2003

Summary:  Purpose: The older antiepileptic drugs (AEDs) have a variety of effects on sleep, including marked reduction in rapid‐eye‐movement (REM) sleep, slow‐wave sleep (SWS), and sleep latency, and an increase in light sleep. The effects of the newer AEDs on sleep are unknown. Our purpose was to study the effect of gabapentin (GBP) on sleep.Methods: Ten healthy adults and nine controls were the subjects of this study. All underwent baseline and follow‐up polysomnography (PSG) and completed sleep questionnaires. After baseline, the treated group received GBP titrated to 1,800 mg daily. Polygraphic variables and Epworth Sleepiness Scale (ESS) scores, a subjective measure of sleep propensity, were compared by using the Wilcoxon signed rank test.Results: Nine of the treated subjects achieved the target dose; one was studied with 1,500 mg daily because of dizziness experienced at the higher dose. GBP‐treated subjects had an increase in SWS compared with baseline. No difference in the ESS or other polygraphic variables was observed. However, a minor reduction in arousals, awakenings, and stage shifts was observed in treated subjects.Conclusions: GBP appears to be less disruptive to sleep than are some of the older AEDs. These findings may underlie the drug's therapeutic effect in the treatment of disorders associated with sleep disruption.
Comparison of Statistical Parametric Mapping and SPECT Difference Imaging in Patients with Temporal Lobe Epilepsy
Authors: Chang David J. , Zubal I. George , Gottschalk Chris , Necochea Alejandro , Stokking Rik , Studholme Colin , Corsi Maria , Slawski Jessica , Spencer Susan S. , Blumenfeld Hal 
Published: March 2003

Summary:  Purpose: Statistical parametric mapping (SPM) is an image‐analysis tool that assesses the statistical significance of cerebral blood flow (CBF) changes on a voxel‐by‐voxel basis, thereby removing the subjectivity inherent in conventional region‐of‐interest (ROI) analysis. Our platform of single‐photon emission computed tomography (SPECT) ictal–interictal difference imaging in clinical epilepsy has been validated for localizing seizure onset. We extend the tools of SPM by further applying statistical measures for the significance of perfusion changes in individual patients to localize epileptogenic foci in patients with defined temporal lobe epilepsy by using paired scans in this preliminary study.Methods: Twelve patients with pairs of periictal and interictal SPECT scans were analyzed in this comparison study between SPECT difference imaging and SPM difference analysis by using a reference database of paired normal healthy images. These 12 patients possessed seizure foci localized to the mesial temporal lobe as confirmed by surgical outcome and by hippocampal sclerosis on pathology. SPM was used to identify clusters of increased or decreased CBF in each patient in contrast to our control group.Results: The regions having the most significant increased or decreased CBF by SPM analysis were in agreement with regions identified by conventional difference imaging and visual analysis by viewers blinded to the results of the SPM analysis. Differentiated further by time of radiopharmaceutical injection, six of seven patients injected within 100 s of seizure onset displayed hyperperfusion changes localized to the corresponding epileptogenic temporal lobe by both techniques. Among patients receiving injections after 100 s, both techniques showed primarily regions of hypoperfusion, which again were similar between these two methods.Conclusions: The results provide strong evidence supporting SPM difference analysis in assessing regions of significant CBF change from baseline in concordance with our current clinically used technique of SPECT ictal–interictal difference imaging in epilepsy patients. Difference analysis using SPM could serve as a useful diagnostic tool in the evaluation of seizure focus in temporal lobe epilepsy.
Memory Outcome after Selective Amygdalohippocampectomy: A Study in 140 Patients with Temporal Lobe Epilepsy
Authors: Gleissner Ulrike , Helmstaedter Christoph , Schramm Johannes , Elger Christian E. 
Published: March 2003

Summary:  Purpose: The technique of selective amygdalohippocampectomy (SAH) was originally developed in epilepsy surgery to spare unaffected brain tissue from surgery, thus minimizing the cognitive consequences of temporal lobe surgery. The results of previous studies, however, are equivocal in this regard. This study evaluated memory after SAH in a large sample of patients with mesial temporal lobe epilepsy.Methods: The 140 patients received material‐specific memory tests before and 3 months after unilateral SAH.Results: Significant declines in all aspects of verbal learning and memory were found particularly for the left resected group. With reliability‐of‐change indices, a high number of patients showed postoperative verbal memory declines, ≤51% in left SAH and ≤32% in right SAH. For left SAH, a higher preoperative verbal memory performance, a lower preoperative nonverbal memory score, an older age at surgery, and a later onset of epilepsy predicted a stronger decline in verbal memory. After right SAH, the risk for a verbal memory decline was slightly increased when patients had surgical complications or a presurgical evaluation with bilateral intrahippocampal depth electrodes. Results concerning nonverbal memory were less clear.Conclusions: The results clearly indicate, that particularly left SAH can lead to a significant decline in memory functions. Predictors of postoperative verbal memory were similar to those reported for temporal lobectomy. Postoperative deteriorations were broader and stronger in our study than in previous studies. We discuss methodologic differences (sample size, retest interval, extent of resection) and other factors as possible reasons.