bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Status Epilepticus with Prolonged Seizure Episodes Lasting from 10 to 29 Minutes
Authors: DeLorenzo R. J. , Garnett L. K. , Towne A. R. , Waterhouse E. J. , Boggs J. G. , Morton L. , Choudhry M. Afzal , Barnes T. , Ko D. 
Published: August 2005

Summary: Purpose: Status epilepticus (SE) is a major medical and a neurologic emergency associated with significant morbidity and mortality. The current definition of SE is continuous seizure activity or intermittent seizure activity without regaining consciousness, lasting ≥30 min. Epilepsy monitoring unit data indicate that many seizures self‐terminate within minutes. Thus consideration was recently given to include seizure episodes lasting ≥10 min in the definition of SE. Because no large studies have been conducted on seizures lasting 10–29 min, this study was initiated to compare cases of SE and 10 to 29‐min seizure episodes seen within the same period. Methods: Patients seen at the Medical College of Virginia Hospitals of Virginia Commonwealth University over the same 2‐year period were studied. Two hundred twenty‐six prospective SE cases (91 children and 135 adults) and 81 retrospective 10‐ to 29‐min seizure episodes (31 children and 50 adults) were compared. A standardized data‐entry‐form system was compiled on each patient and was used to evaluate the data collected. Results: The 10‐ to 29‐min seizure patients and the SE cases had similar demographic characteristics, such as sex, race, and age, and also had similar etiologies. The majority (93%) of SE cases required anticonvulsant (AED) treatment to control and stop seizure activity. In the 10‐ to 29‐min group, 43% stopped seizing spontaneously, and the remainder (57%) required AED treatment to stop seizure activity. The mortality for the SE patients was 19% compared with 2.6% for 10‐ to 29‐min group (p <0.001). In the 10‐ to 29‐min group that stopped seizing spontaneously, the mortality was 0. In the 10‐ to 29‐min patients that required AED treatment, the mortality was 4.4%. Conclusions: The results demonstrate that a significant number of patients experience seizure activity lasting from 10‐ to 29‐min. Approximately half of these seizure events stopped spontaneously and did not require AED treatment. The other half of the patients responded quickly to medications and stopped seizing before the 30‐min definition for SE. The overall mortality of this group was significantly lower than that of the patients with SE. The results demonstrate that further studies on the 10‐ to 29‐min seizure group are needed to differentiate seizures that will stop spontaneously and those that will only stop with AED treatment. Because almost half of the prolonged seizures stopped spontaneously, further studies are needed before including prolonged seizure activity in the definition of SE.
Effects of Menopause on Seizures in Women with Epilepsy
Authors: Abbasi Fariha , Krumholz Allan , Kittner Steven J. , Langenberg Patricia 
Published: August 2005

Summary: Purpose: Although important associations between epilepsy and women's hormonal phases are described, the relation of menopause to epilepsy has received little attention. Methods: By using a structured interview, we studied menopausal women with epilepsy seen at the University of Maryland Epilepsy Center over a 1‐year period from 1994 to 1995. We analyzed the characteristics and temporal relation of the seizures to menopause and compared the frequency and severity of the seizures with those in a similar group of premenopausal women. Results: We identified 61 menopausal women (46 who were postmenopausal and 15 perimenopausal) and compared them with 46 premenopausal women. No statistically significant differences were noted in either the frequency or the severity of seizures comparing all menopausal or only postmenopausal with premenopausal women. However, 12 (20%) of the 61 menopausal women noted that their seizures first began during or after menopause, with eight having no proven cause for their seizures. Many individual women described changes in their seizures with menopause. Among the 61 menopausal women, 49 had established epilepsy before the onset of menopause, and 20 (41%) reported worsening of their seizures with menopause, 13 (27%) noted improvement, and 16 (33%) described no changes. These observations were similar for peri‐ and post‐menopausal women. Of the 15 menopausal women taking hormone replacement therapy, the six taking progestin were significantly less likely to report worsening of their seizures. Conclusions: These findings support the view that hormonal influences are important in women with seizures. Although, in aggregate, menopausal (combined perimenopausal and post‐menopausal) and postmenopausal women's seizures were similar in frequency and severity to those of other women, menopause was associated with changes in seizures for some women. Moreover, menopause may be a previously unrecognized factor for some new‐onset seizures. The relations between menopause and epilepsy deserve to be more fully investigated.
Mortality Risk in an Adult Cohort with a Newly Diagnosed Unprovoked Epileptic Seizure: A Population‐Based Study
Authors: Lindsten Hans , Nyström Lennart , Forsgren Lars 
Published: August 2005

Summary: Purpose: We sought to investigate mortality risk in an adult cohort with newly diagnosed unprovoked epileptic seizures. Methods: One hundred seven patients who were at least 17 years old and had newly diagnosed unprovoked epileptic seizures were prospectively identified during a period of 20 months between 1985 and 1987. Patients were followed until the date of death or the end of 1996. The standard mortality ratio (SMR) was analyzed in the whole cohort and in the portion of the cohort with recurrent seizures at inclusion. The influences on the SMR of time since diagnosis, sex, age at diagnosis, seizure cause, seizure type, and cause of death were also investigated. Results: The SMR was significantly increased (SMR, 2.5; 95% confidence interval [CI], 1.2–3.2). This significantly increased risk was found during the first 2 years after diagnosis (year 1: SMR, 7.3; 95% CI, 4.4–12.1; year 2: SMR, 3.6; 95% CI, 1.6–8.1) and at years 9–11 (SMR, 5.4; 95% CI, 2.7–11.2). The increased mortality risk was most pronounced when the seizures occurred before the age of 60 years. Mortality risk was elevated among patients with remote symptomatic epilepsy (SMR, 3.3; 95% CI, 2.4–4.5) but not idiopathic epilepsy. Conclusions: There is increased mortality risk in an adult cohort with newly diagnosed unprovoked epileptic seizures. This increase is found in symptomatic patients, young patients, and during the first 2 years after the diagnosis.
Frontal Nonconvulsive Status Epilepticus Associated with High‐Dose Tiagabine Therapy in a Child with Familial Bilateral Perisylvian Polymicrogyria
Authors: Piccinelli P. , Borgatti R. , Perucca E. , Tofani A. , Donati G. , Balottin U. 
Published: August 2005

Summary: Purpose: Antiepileptic drugs are known to exacerbate absence and myoclonic seizures, especially in patients with idiopathic generalized epilepsies. Exacerbation of nonconvulsive generalized seizures in patients with partial epilepsy is less common. Recently, however, a number of cases of putative generalized nonconvulsive status epilepticus (NCSE) or NCSE without further specification have been reported in patients with chronic partial epilepsy treated with the γ‐aminobutyric acid reuptake inhibitor tiagabine. Although complex partial status epilepticus during tiagabine therapy has also been reported, possible precipitation of NCSE specifically associated with frontal lobe discharges does not appear to have been recognized. In this communication, we describe the case of a boy with familial bilateral perisylvian polymicrogyria who developed frontal NCSE after being stabilized on high‐dose tiagabine Methods: A 12‐year‐old boy with familial bilateral perisylvian polymicrogyria, mental retardation, and refractory partial seizures was administered tiagabine in addition to sodium valproate. The tiagabine dosage was increased gradually up to 10 mg t.i.d. (1 mg/kg per day), resulting in complete seizure control. Results: After 1 week on maintenance treatment, seizures were completely controlled, but the child developed hypoactivity, decreased reactivity, and affective detachment. An EEG recording revealed subcontinuous sharp‐wave discharges with irregular runs of atypical spike‐wave complexes over the anterior regions of both hemispheres, consistent with a diagnosis of frontal NCSE. A reduction in tiagabine dosage to 15 mg/day led to complete regression of the behavioral and affective changes and to disappearance of the subcontinuous EEG discharges. Conclusions: Although tiagabine‐induced NCSE has been described previously, particularly in patients with preexisting spike‐wave abnormalities, this is the first report that identifies its potential role in the precipitation of frontal NCSE.
The Impact of a Single Seizure on Health Status and Health Care Utilization
Authors: Dworetzky Barbara A. , Hoch Daniel B. , Wagner Anita K. , Salmanson Eileen , Shanahan Christopher W. , Bromfield Edward B. 
Published: August 2005

Summary: Purpose: To assess the health status of patients after a single seizure. Methods: We compared single‐seizure patients (SS) with patients who had well‐controlled epilepsy (WC), and uncomplicated hypertension (HT). Patients were adults screened from emergency and outpatient units of two urban teaching hospitals using predefined criteria. The 83 patients (SS, 30; WC, 29; HT, 24) were interviewed by phone about functional status (SF‐36), comorbid illness, cause of illness, number of visits to health providers, and drug side effects. Results: No significant differences were found among groups for health status, SF‐36 domain, or occurrence of drug side effects. SS patients had significantly lower scores on vitality (p <0.03) and a trend toward lower role physical function (p <0.07) compared with age‐adjusted population norms. SS reported more visits to health providers than WC or HT, and the number of visits remained high at interview 1 year later. Patient knowledge of the “reason” for the seizure was not associated with health status or number of visits. Conclusions: Health status of patients within 1 year of a single seizure is similar to that of patients with well‐controlled epilepsy or hypertension, but SS patients have greater health care utilization.
Remote Memory in Epilepsy
Authors: Bergin P. S. , Thompson P. J. , Baxendale S. A. , Fish D. R. , Shorvon S. D. 
Published: August 2005

Summary: Purpose: There is now a considerable amount of research relating to memory functioning in epilepsy. The majority of studies have focused on the retention of new information, and few reports have measured memory for past events. This study aims to redress this and measure the efficiency of remote memory in epilepsy. Methods: A remote memory questionnaire was prepared and administered to three groups of patients with epilepsy and a control group without epilepsy. The questionnaire assessed knowledge of public events that occurred between 1980 and 1991, inclusive. The epilepsy groups comprised 33 patients with temporal lobe epilepsy (TLE), 33 with extratemporal epilepsy (ExTE), and 10 with primary generalized epilepsy (PGE). Thirty control subjects were tested. Results: Patients with TLE performed significantly less well on the questionnaire than all other groups (p = 0.001), but no effect of laterality was recorded; patients with extratemporal or primary generalised epilepsy did not differ from controls. Performance on the questionnaire was not determined by verbal IQ, educational achievement, social class, or drug treatment, but was related to the number of generalised convulsions that had occurred since 1980. The strongest neuropsychological predictors of performance on this questionnaire were measures of verbal memory. Conclusions: The study demonstrated weak memory for past events in patients with TLE, thereby providing evidence of a broader memory disturbance in this group than has been previously highlighted. A test of remote memory, such as the one designed for this study, is easy to administer and provides clinically important information not available from conventional neuropsychological tests.
Anticonvulsant Efficacy of Topiramate in Phenytoin‐Resistant Kindled Rats
Authors: Reissmüller Elke , Ebert Ulrich , Löscher Wolfgang 
Published: August 2005

Summary: Purpose: We evaluated the anticonvulsant efficacy of topiramate (TPM), a structurally novel antiepileptic drug (AED), in amygdala kindled rats that had been preselected with respect to their response to phenytoin (PHT). Methods: Anticonvulsant response was tested by determining the afterdischarge threshold (ADT;i.e., a sensitive measure for drug effects on focal seizure activity). By repeated testing with the PHT prodrug fosphenytoin (FOS) three groups of kindled rats were separated: rats in which consistent anticonvulsant effects were obtained (PHT responders), rats that showed no anticonvulsant response (PHT nonresponders), and rats with variable responses (variable PHT responders). The latter, largest group was used to evaluate at which doses and pretreatment times TPM exerted significant anticonvulsant effects on ADT. For this purpose, TPM was tested at four doses (20, 40, 80, 160 mg/kg i.p.) and two pretreatment times (1 and 4 h). The most effective treatment protocol was then used for TPM testing in PHT responders and nonresponders. Results: TPM proved to be an effective AED in the kindling model. At 40 mg/kg, significant ADT increases were obtained after both 1 and 4 h after administration. In addition to the effect on focal seizure threshold, seizure severity and duration recorded at ADT were decreased by TPM, indicating that this drug acts on both seizure threshold and seizure spread. In PHT nonresponders, TPM significantly increased ADT, which is in line with its proven efficacy in patients with refractory partial epilepsy in whom phenytoin has failed. However, TPM was more efficacious in increasing ADT in PHT responders than in nonresponders, substantiating that the difference between these groups of kindled rats extends to other AEDs. Repeated testing of kindled rats with TPM indicated that, similar to PHT, there are individual kindled rats without anticonvulsant response to TPM (i.e., TPM nonresponders). Conclusions: The data of this study substantiate that PHT nonresponders are a unique model for the search of new AEDs with improved efficacy in refractory partial epilepsy.
Relation of Cortical Language Distribution and Cognitive Function in Surgical Epilepsy Patients
Authors: Devinsky Orrin , Perrine Kenneth , Hirsch Joseph , McMullen William , Pacia Steven , Doyle Werner 
Published: August 2005

Summary: Purpose: To investigate the relation between the number and spatial distribution of language sites and specific patient‐ and epilepsy‐related variables. Methods: Patients with stimulation‐induced reading or naming errors from anterior or inferior temporal cortex (i.e., atypical temporal language sites) were compared with those with language sites confined to Wernicke's area (WA) in the posterosuperior temporal and inferior parietal perisylvian area. In a consecutive series of 44 left hemisphere language dominant patients with complex partial seizures before left temporal lobectomy, correlations were compared between cortical language distribution and measures of cognitive function. Results: Patients with atypical temporal language sites (group 1) had significantly fewer years of education that did patients with language sites in WA (group 2). Patients in group 1 had poorer verbal learning and fluency than did patients in group 2. Patients with IQ <80 were significantly more likely to have multiple sites where stimulation disrupted language than did patients with normal IQ. Number of language sites had significant negative correlations with full‐scale IQ, and measures of confrontation naming, verbal fluency, and immediate verbal memory. Conclusions: Language cortex has a wider spatial distribution in epilepsy surgery patients with lower intelligence, poorer education, and worse verbal and memory skills.
The Value of the Number‐Needed‐to‐Treat Method in Antiepileptic Drug Trials
Authors: Lesaffre Emmanuel , Boon Paul , Pledger Gordon W. 
Published: August 2005

Summary: Purpose: There is controversy between clinicians and statisticians on the appropriateness of the number needed to treat (NNT) as a summary statistic to report the effectiveness of a treatment. We examine the two viewpoints and make proposals concerning the reporting of clinical trial results. Methods: In the context of antiepileptic treatments, we explain the two different viewpoints and illustrate the use of the odds ratio, relative risk, absolute difference, and NNT on the results of randomized clinical trials with topiramate (TPM). Special attention is paid to the use of these summary statistics in meta‐analyses. Here, the NNT is the expected number of patients one would need to treat to achieve a single occurrence of a specified good outcome (e.g., 50% reduction in seizure rate) in comparison to no (or placebo) treatment. Results: Although the NNT is readily interpretable in some instances, it exhibits undesirable statistical behavior in other cases. In particular, confidence intervals for the NNT may split into two intervals and extend to positive and negative infinity when treatment efficacy is not clearly established by the data. Meta‐analyses cannot be sensibly conducted directly on the NNT scale. Conclusions: Although other measures, such as the odds ratio, have been more commonly used in the context of meta‐analyses, clinicians prefer the NNT because it gives them a clearer clinical interpretation of the effectiveness of a (new) treatment. On the other hand, statisticians do not recognize the value of the NNT, as it has undesirable statistical properties. Some reconciliation between the two views could be achieved when the clinicians acknowledge the weak aspects of the NNT and when statisticians realize that statistical appropriateness is not the same as clinical relevance. It is suggested that the NNT be used as a secondary reporting tool not on an equal footing with the classic scales.
Interictal EEG and Ictal Scalp EEG Propagation Are Highly Predictive of Surgical Outcome in Mesial Temporal Lobe Epilepsy
Authors: Schulz R. , Lüders H.O. , Hoppe M. , Tuxhorn I. , May T. , Ebner A. 
Published: August 2005

Summary: Purpose: Surgical outcome in patients with mesial temporal lobe sclerosis (MTS) is worse than that in patients with temporal lobe activity (TLE) with tumors. Previous studies of the ictal EEG focused on ictal EEG onset in scalp EEG or ictal EEG propagation in invasive recordings. Ictal EEG propagation with scalp electrodes has not been reported. Methods: Ictal scalp EEG propagation patterns were studied in 347 seizures of 58 patients with MTS or nonlesional TLE. Interictal epileptiform discharges (IEDs) and the presence of unilateral mesial temporal lobe atrophy in magnetic resonance imaging (MRI) also were studied in these 58 patients. Fortynine patients were operated on (minimal follow‐up of 1 year). Results: Postoperatively, seizure‐free outcome was seen in (a) 82.8% of patients with regionalized EEG seizure without contralateral propagation, but in only 45.5% of patients with contralateral propagation (p = 0.007); (b) 84.6% of patients with 100% IED lateralized to one temporal lobe, but in only 52.2% with <100% unitemporal IED (p = 0.015); (c) 88.9% with 100% unitemporal IED and regionalized ictal EEG combined, 73.7% with one of both variables, and only 33.3% with <100% ipsitemporal IED combined with contralateral ictal EEG propagation (p = 0.007). Conclusions: Switch of lateralization or bitemporal asynchrony in the ictal scalp EEG and bitemporal IED are most probably an index of bitemporal epileptogenicity in MTS and are associated with a worse outcome.
Concentric Contraction of the Visual Field in Patients with Temporal Lobe Epilepsy and Its Association with the Use of Vigabatrin Medication
Authors: Hardus P. , Verduin W. M. , Postma G. , Stilma J. S. , Berendschot T. T. J. M. , van Veelen C. W. M. 
Published: August 2005

Summary: Purpose: To describe concentric visual field loss found in the presurgical evaluation of patients with drug‐resistant temporal lobe epilepsy and relate the findings to potential causative factors. Methods: A series of 157 consecutive patients with drug‐resistant temporal lobe epilepsy, who had been selected for neurosurgical treatment, was examined in a study set up as a prospective investigation of their visual fields, to document the loss of visual field resulting from surgery. Pre‐ as well as postoperative visual field examinations were performed following a standard protocol using static and kinetic perimetry. As a number of patients appeared to have an unexplained concentric visual field contraction in the presurgical examination, a relation with potentially causative factors was analyzed in a cross‐sectional study of all these patients. Correlations were sought with duration and severity of the seizure disorder, underlying pathology as indicated by magnetic resonance imaging (MRI) and demonstrated by pathology, any type of antiepileptic drug (AED) ever prescribed, and gender. Results: In this cross‐sectoinal analysis of 157 consecutive patients who were candidates for surgery for temporal lobe epilepsy, absolute concentric contraction of the visual field of 10 to 30 degrees was found in the presurgical examination in 20 (17%) of 118 patients who had ever used vigabatrin (VGB) and in none of 39 who had not had this medication. This difference was significant (p = 0.004). In addition, men [15 (21%) of 72] were significantly more often affected (p = 0.007) than women [five (6%) of 85]. The degree of visual field loss, as indicated by the Esterman grid, showed a positive correlation with the duration of VGB medication. There was no correlation of visual field contraction with a history of meningitis as potential cause of the epilepsy, duration of the epilepsy, status epilepticus in the medical history, or histologic abnormality of the brain tissue removed. Ophthalmologic examination of the patients with concentric contraction revealed no abnormalities. None of the patients with concentric contraction complained spontaneously of their visual field loss. Conclusions: VGB medication is a causative factor in concentric visual field loss. Visual field examination of patients using VGB should be seriously considered.