bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlation of Scalp EEG and 1H‐MRS Metabolic Abnormalities in Temporal Lobe Epilepsy
Authors: Maton B. , Gilliam F. , Sawrie S. , Faught E. , Hugg J. , Kuzniecky R. 
Published: March 2003

Summary:  Purpose: To correlate the interictal spike field and region of seizure onset with the distribution of 1H‐MRS abnormalities in temporal lobe epilepsy (TLE) and improve our understanding of the clinical significance of 1H‐MRS abnormalities.Methods: Scalp electroencephalogram (EEG) monitoring and proton magnetic resonance spectroscopy (1H‐MRS) results were correlated in 31 consecutive patients with TLE.Results: Lateralized 1H‐MRS–based hippocampal abnormalities were recorded in 95% of the patients with unilateral interictal spikes, with a high degree of concordance for the lateralization side (90%). In 64% of the patients with normal or bilateral interictal EEG spikes, 1H‐MRS provided lateralizing information. Bilateral 1H‐MRS abnormalities, with or without lateralization, were 3 times more frequent than bitemporal EEG spikes. Anterior predominance of the 1H‐MRS abnormalities was more frequent in patients with anterior temporal EEG spiking (50%), than in patients without this EEG distribution (18%). Similar association was noted between distribution of 1H‐MRS abnormalities and region of EEG seizure onset.Conclusions: Our results show a moderate level of concordance between the distribution of 1H‐MRS and EEG abnormalities. 1H‐MRS identifies abnormalities contralateral to the predominant seizure focus more often than does EEG and may provide lateralizing information in patients with nonlateralizing interictal EEG.
Verbal Retention Lateralizes Patients with Unilateral Temporal Lobe Epilepsy and Bilateral Hippocampal Atrophy
Authors: Sawrie Stephen M. , Martin Roy C. , Gilliam Frank , Knowlton Robert , Faught Ed , Kuzniecky Ruben 
Published: March 2003

Summary:  Purpose: To examine the lateralization utility of preoperative verbal retention in patients with and without bilateral hippocampal atrophy.Methods: The sample consisted of 74 patients with EEG‐defined unilateral temporal lobe epilepsy (TLE) who had also undergone volumetric magnetic resonance imaging (MRI). Verbal retention was operationalized by the Logical Memory percentage retention subtest (LM%) of the Wechsler Memory Scale. Patients were divided into groups with (a) bilaterally normal hippocampal volumes, (b) unilateral atrophy, or (c) bilateral atrophy. Two different thresholds (empirically derived vs. normative) were used to lateralize on the basis of LM%. LM% lateralization was then examined by group using χ2, sensitivity, positive predictive values, and odds ratios. Analyses were also conducted separately in the subset of patients who were seizure free after surgery.Results: Mean LM% performance was significantly lower in patients with left versus right TLE in the subset with bilateral hippocampal atrophy (p = 0.018), but not in patients with a normal MRI (p = 0.918) or unilateral atrophy (p = 0.087). The odds of a correct lateralization by LM% increased from 1.67 in patients with normal MRI to 36.11 in patients with bilateral hippocampal atrophy. The power of a right and left lateralization prediction by LM% was 100% and 75%, respectively, in patients with bilateral hippocampal atrophy. Similar results were obtained when analysis was restricted to patients who were seizure free after surgery.Conclusions: Preoperative verbal retention as measured by LM% may provide meaningful lateralization information in patients who are difficult to lateralize via MRI.
Comparison of Epilepsy and Asthma Perception Among Preschool Teachers in Taiwan
Authors: Hsieh Liang‐Po , Chiou Hua‐Huei 
Published: March 2003

Summary:  Purpose: The purpose of this study was to investigate preschool teachers' perceptions to children with epilepsy and asthma in middle areas of Taiwan.Methods: Two‐hundred sixteen preschool teachers were investigated with a questionnaire regarding their knowledge, attitude, and practice. There were 22 questions in the questionnaire (half of the questions were for epilepsy, and others for asthma). Differences between teachers' perceptions of children with epilepsy and asthma were analyzed.Results: More teachers thought epilepsy was a hereditary disease and asthma was an acquired disease. Over 30% of participants thought epileptic seizures were associated with insanity but asthma attacks were not. Acceptance of children with epilepsy was significantly lower than that of children with asthma. Children with epilepsy were less encouraged by teachers to play with others. Teachers have more consideration for aggression of children with epilepsy than of those with asthma. More teachers were worried about the objection from the other parents if there were a child with epilepsy in the class.Conclusions: Perceptions of epilepsy and asthma among preschool teachers were different significantly. The finding may explain why the children with epilepsy showed lower school performance among the children with chronic illness in past studies.
Regional Analyses of CNS Microdialysate Glucose and Lactate in Seizure Patients
Authors: Cornford Eain M. , Shamsa Kamran , Zeitzer Jamie M. , Enriquez Cathleen M. , Wilson Charles L. , Behnke Eric J. , Fried Itzhak , Engel Jerome 
Published: March 2003

Summary:  Purpose: To correlate glucose (and lactate) results obtained from microdialysate to recent studies suggesting that glucose transporter activity may be significantly altered in seizures.Methods: We used a fluorometric technique to quantify glucose and lactate levels in microdialysates collected from two to four depth electrodes implanted per patient in the temporal and frontal lobes of a series of four patients. Hour‐by‐hour and day‐to‐day changes in brain glucose and lactate levels at the same site were recorded. Additionally we compared regional variations in lactate/glucose ratios around the predicted epileptogenic region.Results: Lactate/glucose ratios in the range of 1–2:1 were the most commonly seen. When the lactate/glucose ratio was <1:1, we typically observed a relative increase in local glucose concentration (rather than decreased lactate), suggesting increased transport, perhaps without increased glycolysis. In some sites, lactate/glucose ratios of 3:1–15:1 were seen, suggesting that a circumscribed zone of inhibition of tricarboxylic acid cycle activity may have been locally induced. In these dialysates, collected from probes closer to the epileptogenic region, the large increase in lactate/glucose ratios was a result of both increased lactate and reduced glucose levels.Conclusions: We conclude that regional variations in brain extracellular glucose concentrations may be of greater magnitude than previously believed and become even more accentuated in partial seizure patients. Data from concomitant assays of microdialysate lactate and glucose may aid in understanding cerebral metabolism.
Models for Epilepsy and Epileptogenesis: Report from the NIH Workshop, Bethesda, Maryland
Authors: Stables James P. , Bertram Edward H. , White H. Steve , Coulter Douglas A. , Dichter Marc A. , Jacobs Margaret P. , Loscher Wolfgang , Lowenstein Daniel H. , Moshe Solomon L. , Noebels Jeffrey L. , Davis Mirian 
Published: March 2003

Summary:  Purpose: The workshop explored the current problems, needs, and potential usefulness of existing methods of discovery of new therapies to treat epilepsy patients. Resistance to medical therapy (pharmacoresistance) and the development of epilepsy (epileptogenesis) are recognized as two of the major problems in epilepsy treatment today. At the same time, there is growing awareness that the development of new therapies has slowed, a trend that has economic and scientific roots. To move toward new and more effective therapies, novel approaches to therapy discovery are needed.Methods: A workshop was held in March 2001 with the charge to develop a plan to move the exploration and discovery process forward. Participants from academia, government, and industry reviewed the current status of epilepsy therapy and explored the identification of potential new therapies.Results: At the end of the 2‐day meeting, the panel made a series of recommendations. The two major recommendations were (a) to establish a means for continuing the examination of new approaches to therapy discovery, and (b) to identify models and approaches to therapy discovery that may identify treatments that are more successful than those available. Further recommendations were made to support the development of technology (miniaturization, computerization, video monitoring, etc.) to facilitate the use of the new models and to identify the mechanisms of therapy success and failure.Conclusions: Understanding the epidemiology of therapy resistance and providing support for new approaches to therapy development were identified as key issues for introduction of new and more effective treatments.
Survival of Patients with Epilepsy: An Estimate of the Mortality Risk
Authors: Shackleton Darian P. , Westendorp Rudi G. J. , Kasteleijn‐Nolst Trenité Dorotheé G. A. , De Craen Anton J. M. , Vandenbroucke Jan P. 
Published: March 2003

Summary:  Purpose: To investigate the extent and causes of the differences in mortality found in studies on mortality in epilepsy based on a quantitative review of the literature.Methods: We used MEDLINE database and Cumulative Index Medicus for 1960–2001, Excerpta Medica for 1948–1965, and relevant journals and bibliographies. We selected comparative studies investigating mortality in epilepsy patients conducted in the last 100 years. The Standardized Mortality Ratio (SMR) was selected as primary outcome. Nineteen studies were included. Pooled estimates were precision weighted and tested for homogeneity. Sources of variability between risk estimates were explored by using multivariate fixed‐effects models.Results: SMRs ranged from 1.3 to 9.3. Risk estimates proved heterogeneous (χ2 test statistic: 1,177; df = 18; p < 0.001). The most important determinant was “source population,” explaining half of the variance of the estimates (R2, 0.47; p = 0.006). SMRs in community studies ranged from 1.3 to 3.1, and for institutionalized populations, from 1.9 to 5.1.Conclusions: Our results show that the mortality risk in patients with epilepsy is dependent on source population of patients. Within the different source populations, considerable unexplained variance remains. Hence no uniform summary estimate for the elevated mortality could be determined.
Diet Enriched with Omega‐3 Fatty Acids Alleviates Convulsion Symptoms in Epilepsy Patients
Authors: Schlanger Simon , Shinitzky Meir , Yam Daniel 
Published: March 2003

Summary:  Purpose: We examined whether a dietary supplement containing omega‐3 polyunsaturated fatty acids (n‐3 PUFAs) can alleviate and/or reduce the frequency of epileptic seizures in patients with central nervous system (CNS) diseases treated with anticonvulsive drugs (ACDs).Methods: A special spread containing 65% n‐3 PUFAs was added to the daily diet. The patients consumed 5 g of this spread at every breakfast for 6 months.Results: Five patients completed the study. In all of them, a marked reduction in both frequency and strength of the epileptic seizures was recorded.Conclusions: Incorporation of the dietary supplement containing n‐3 PUFAs may be beneficial in suppression of some cases of epileptic seizures.
Regional Expression of Multidrug Resistance Genes in Genetically Epilepsy‐prone Rat Brain after a Single Audiogenic Seizure
Authors: Kwan Patrick , Sills Graeme J. , Butler Elaine , Gant Timothy W. , Meldrum Brian S. , Brodie Martin J. 
Published: March 2003

Summary:  Purpose: The multidrug resistance (mdr) gene family encodes the drug transport macromolecule P‐glycoprotein (P‐gp), which contributes to the functionality of the blood–brain barrier. Recent evidence suggests that P‐gp–mediated drug extrusion may play a facilitatory role in refractory epilepsy. We investigated the regional expression of mdr genes in genetically epilepsy‐prone rat (GEPR) brain after a single audiogenic seizure.Methods: Three groups of adult male GEPRs (n = 5/group) were exposed to a seizure‐inducing audiogenic stimulus and killed at 4 h, 24 h, and 7 days thereafter. A further group (n = 5) served as a stimulus‐naïve control. Expression of mdr1a and mdr1b in distinct anatomic brain regions (cortex, midbrain, pons/medulla, hippocampus) was determined by quantitative reverse transcriptase–polymerase chain reaction (RT‐PCR) in the presence of competitive internal standards.Results: When compared with control, mdr1a expression in cortex and midbrain was significantly (p < 0.05) increased at 24 h after a single audiogenic seizure. Cortical mdr1a expression remained elevated at 7 days after stimulus. In contrast, mdr1a expression in pons/medulla and hippocampus was unchanged. The mdr1b isoform was quantifiable in hippocampus alone and not influenced by seizure activity.Conclusions: These findings suggest that acute seizures in the GEPR can induce the expression of mdr genes. The pattern of increased expression appears to follow the anatomic pathway of audiogenic seizures in these animals, with initiation in the midbrain and propagation to the cortex. Further studies are required to investigate the effects of recurrent seizure activity and to characterise mdr expression in other experimental seizure models.
Resistance to Propagation of Amygdaloid Kindling Seizures in Rats with Genetic Absence Epilepsy
Authors: Eşkazan Esat , Onat Filiz Yõlmaz , Aker Rezzan , Öner Gülay 
Published: March 2003

Summary:  Purpose: The existence of absence epilepsy and temporal partial seizure pattern in the same patient is an uncommon state. In the present study, we aimed to evaluate whether the process of kindling as a model of complex partial seizures with secondary generalization is altered in rats with genetic absence epilepsy.Methods: Six‐ to 12‐month‐old nonepileptic control Wistar rats and genetic absence epileptic rats from Strasbourg (GAERS) were used in the experiments. One week before the experiments, bilateral stimulation and recording electrodes were implanted stereotaxically into the basolateral amygdala and cortex, respectively. Animals were stimulated at their afterdischarge threshold current twice daily for the process of kindling and accepted as fully kindled after the occurrence of five grade 5 seizures. Bilateral EEGs from amygdala and cortex were recorded continuously during 20 min before and 40 min after each stimulus.Results: All control Wistar rats were fully kindled after stimulus 12 to 15. Although the maximal number of stimulations had been applied, GAERS remained at stage 2, and no motor seizures were observed. The afterdischarge duration in bilateral amygdala and the cortex after the kindling stimulus was shorter in GAERS when compared with control rats.Conclusions: Occurrence of only grade 2 seizures and no observation of grade 3–5 seizures in GAERS with the maximal number of stimulations would suggest that the generalized absence seizures may be the reason of the resistance in the secondary generalization of limbic seizures during amygdala kindling.
Topiramate and Metabolic Acidosis in Infants and Toddlers
Authors: Philippi Heike , Boor Rainer , Reitter Bernd 
Published: March 2003

Summary:  Purpose: Topiramate (TPM) inhibits carbonic anhydrase, with metabolic acidosis as a possible side effect, although this has been reported in only two adult cases. We investigated the acid–base metabolism in infants and toddlers treated with TPM.Methods: Nine infants and toddlers aged 5 months to 2.3 years (median, 6 months) were treated with TPM at maximal doses of 8.2–26 mg/kg/day (median, 11 mg/kg/day). The maximal TPM dose was achieved after 8–35 days (median, 17 days). TPM was given in addition to other antiepileptic drugs (AEDs) in five cases and as a sole AED in four patients with refractory epilepsy resistant to multiple AEDs. The diagnoses were infantile spasms (n = 5), epilepsia partialis continua (n = 1), infantile epileptic encephalopathy (n = 1), and Lennox–Gastaut syndrome (n = 2).Results: The blood gases were normal before treatment with TPM in all nine children. Metabolic acidosis developed in eight children after 8–26 days (median, 14 days) of TPM treatment with a minimum of serum bicarbonate between 15 to 18 mM (median, 17 mM), a minimal base excess between –6.2 and –11.2 mM (median, –7.9 mM), and pH between 7.22 and 7.40 (median, 7.35). Four of nine children showed clinical signs of hyperventilation and received oral sodium bicarbonate (1–2 mmol/kg), while TPM was still effective.Conclusions: Because metabolic acidosis developed in eight of the nine infants and toddlers taking TPM, we would suggest that the acid–base metabolism be monitored in young children who receive TPM.
Epilepsy and Mortality: A Record Linkage Study in a U.K. Population
Authors: Morgan Christopher Ll. , Kerr Michael P. 
Published: March 2003

Summary: Purpose:To examine patterns of mortality for a population with epilepsy compared with the nonepilepsy population.Methods:The study used cross‐sectional record linkage, combining an electronic death register with an epilepsy patient register constructed from a variety of routine health data sources collected from 1991 to 1997. The study was conducted in Cardiff and the Vale of Glamorgan, Wales, U.K., and included all deaths recorded between 1993 and 1996.Results:There were 352 deaths for patients with epilepsy, 2.0% of all deaths. The crude mortality rates for patients with and without epilepsy were 36.2 and 9.9 per 1,000. The Standardised Mortality Ratio was 2.14 (95% CI, 1.74–2.55) for 1996 deaths. The single most common disease group was cancer, accounting for 66 (18.8%) of deaths for people with epilepsy (SMR, 1.47; 95% CI, 1.11–1.82). Significant excesses were demonstrated for cerebrovascular disease, diseases of the digestive system, respiratory diseases, and other causes of death.Conclusions:People with epilepsy have an increased mortality over the population as a whole. The main causes of death are those most common in the population as a whole and those that underlie the epilepsy itself.
Increased Excitability and Decreased Sensitivity to GABA in an Animal Model of Dysplastic Cortex
Authors: Benardete Ethan A. , Kriegstein Arnold R. 
Published: March 2003

Summary: Purpose:Cortical dysplasia (CD) is associated with epilepsy in both the pediatric and adult populations. The mechanism underlying seizures with cortical malformations is still poorly understood. To study the physiology of dysplastic cortex, we developed an experimental model of CD.Methods:Pregnant rats were given intraperitoneal injections of carmustine (1‐3‐bis‐chloroethyl‐nitrosourea; BCNU) on embryonic day 15 (E15). Cortical histology was examined in the resulting pups at P0, P28, and P60. In addition, evoked and spontaneous field potential recordings were obtained in cortical slices from adult control and BCNU‐exposed rats. Finally, we used whole‐cell recordings to compare physiologic properties of pyramidal neurons and γ‐aminobutyric acid (GABA) responses in control and BCNU‐treated animals.Results:Features characteristic of CD were found in the offspring, including laminar disorganization, cytomegalic neurons, and neuronal heterotopias. Dysplastic cortex also contained abnormal clusters of Cajal–Retzius (CR) cells and disruption of radial glial fibers, as demonstrated with immunohistochemistry. Under conditions of partial GABAA‐receptor blockade with 10 μMbicuculline methiodide (BMI), slices of dysplastic cortex demonstrated a significant increase in the number of spontaneous and evoked epileptiform discharges. Individual pyramidal neurons in dysplastic cortex were less sensitive to application of GABA compared with controls.Conclusions:BCNU exposure in utero produces histologic alterations suggestive of CD in rat offspring. Dysplastic cortex from this model demonstrates features of hyperexcitability and decreased neuronal sensitivity to GABA. Such physiologic alterations may underlie the increased epileptogenicity of dysplastic cortex.
Influence on Ictal Seizure Semiology of Rapid Withdrawal of Carbamazepine and Valproate in Monotherapy
Authors: Zhou Dong , Wang Ying , Hopp Peter , Kerling Frank , Kirchner Annette , Pauli Elisabeth , Stefan Hermann 
Published: March 2003

Summary:  Purpose: To quantify changes in ictal seizure semiology during rapid withdrawal of carbamazepine (CBZ) and valproate (VPA) from a monoregimen in presurgical evaluation.Methods: Therapeutic intensive seizure analysis (TISA) with video‐EEG monitoring was used in 33 patients with pharmacoresistant partial epilepsy undergoing complete withdrawal of CBZ (20 patients) or VPA (13 patients) from a monoregimen. Monitoring phases included a 3‐day baseline phase, a 3‐day rapid antiepileptic drug (AED) withdrawal phase, and another 3‐day AED‐free phase with AEDs in subtherapeutic levels. Seizure variables as complete processes and their various elements (ictal signs) were analyzed, including duration (seconds), intensity (on a scale of 0 to 3), frequency (number per 3 days), and total duration of seizures and ictal signs in 3 days (seconds). The localization of seizure patterns on ictal EEG recording (EEG seizure onset) and the first appearing clinical ictal phenomena (initial ictal signs) were recorded.Results: A total of 188 seizures in the CBZ group and 57 seizures in the VPA group were investigated. Compared with the baseline phase, the CBZ group showed increases in duration, frequency of seizures, various ictal signs, and secondarily generalized tonic and clonic signs during the following two phases. Significantly increased values of the VPA group were observed in seizure duration and frequency of hypermotoric phenomena during the AED‐free phase. More patients in the CBZ group had secondarily generalized clonic signs during the AED‐free phase. EEG seizure onset and initial ictal signs showed no obvious changes between study phases.Conclusions: Withdrawal of CBZ is followed more quickly by an increase of seizure frequency and severity than is the case for VPA withdrawal. Both CBZ and VPA withdrawal influences seizure propagation rather than the seizure‐onset characteristics, which speaks in favor of its use in presurgical evaluation.
Benign Epilepsy with Centro‐temporal Spikes: Spike Triggered fMRI Shows Somato‐sensory Cortex Activity
Authors: Archer John S. , Briellman Regula S. , Abbott David F. , Syngeniotis Ari , Wellard R. Mark , Jackson Graeme D. 
Published: March 2003

Summary:  Objective: We performed spike triggered functional MRI (fMRI) in a 12 year old girl with Benign Epilepsy with Centro‐temporal Spikes (BECTS) and left‐sided spikes. Our aim was to demonstrate the cerebral origin of her interictal spikes.Methods: EEG was recorded within the 3 Tesla MRI. Whole brain fMRI images were acquired, beginning 2–3 seconds after spikes. Baseline fMRI images were acquired when there were no spikes for 20 seconds. Image sets were compared with the Student's t‐test.Results: Ten spike and 20 baseline brain volumes were analysed. Focal activiation was seen in the inferior left sensorimotor cortex near the face area. The anterior cingulate was more active during baseline than spikes.Conclusions: Left sided epileptiform activity in this patient with BECTS is associated with fMRI activation in the left face region of the somatosensory cortex, which would be consistent with the facial sensorimotor involvement in BECT seizures. The presence of BOLD signal change in other regions raises the possibility that the scalp recorded field of this patient with BECTs may reflect electrical change in more than one brain region.