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Biomedical subjects

D Luciano

Publications and source records attributed to D Luciano.

At least 19 recordsLinked to original sources
PubMed1997

Frontal functions in juvenile myoclonic epilepsy.

The authors investigated cognition in juvenile myoclonic epilepsy (JME), focusing on frontal functions as suggested by maximal spatial distribution of epileptiform activity seen over frontocentral regions. Fifteen patients with JME (mean age, 34.3 years; mean estimated IQ 101) were administered a battery of tests sensitive to frontal dysfunction. The number of patients with impaired test performance and the frequency of impairment per test were calculated. Performance on selected tests was compared with that of 15 patients with temporal lobe epilepsy (TLE) who were matched for estimated IQ using paired t-tests. Although the performance of the group with JME was not uniform--some patients showed marked impairment whereas others showed little or no deficit--a high frequency of impairment was found on tests of concept formation-abstract reasoning and mental flexibility, cognitive speed, and planning and organization. Significant differences were found between the group with JME and the group with TLE on tests requiring mental flexibility and concept formation-abstract reasoning. In conjunction with studies demonstrating intractable seizures in approximately 20% of patients, the results from this study suggest that JME is not a uniformly benign condition. Frontal deficits may have maladaptive behavioral consequences suggestive of personality dysfunction, as described anecdotally by previous investigators.

Adolescent↗
PubMed1996

Clinical features of neocortical temporal lobe epilepsy.

Few studies have examined the clinical features of neocortical temporal lobe epilepsy (NTLE) in carefully selected patients. We reviewed records from 21 patients with NTLE, defined by intracranial electroencephalogram (EEG), who have been seizure free for 1 year or more following temporal lobectomy. The mean age of onset at the time of first seizure was 14 years (range, 1-41 years). Febrile seizures were reported in only 2 patients (9.5%). In contrast to prior mesial temporal lobe epilepsy (MTLE) studies, seizure-free intervals between the initial cerebral insult or first seizure and habitual seizures were uncommon. Possible or known risk factors for epilepsy were reported in 13 of 21 patients (62%). Fifteen (71%) patients reported auras, with experiential phenomena being the most common type. Magnetic resonance imaging was normal or nonspecific in 15 patients, revealed mild hippocampal atrophy in 2, tumors in 2, and heterotopic gray matter and hippocampal atrophy in 1, and cortical dysgenesis in 1. Neuropsychological testing showed deficits consistent with the seizure focus in 13 patients (62%), and Wada test showed ipsilateral memory deficits in 10 (48%). The most common behavioral manifestation was a motionless stare at ictal onset (48%). In contrast to prior studies of MTLE, only 1 NTLE patient had frequent independent, contralateral temporal lobe epileptiform spikes on scalp EEG.

Adolescent↗
PubMed1996

Clinical profile of patients with epileptic and nonepileptic seizures.

Epileptic seizures (ES) and nonepileptic seizures (NES) often coexist in patients with treatment-refractory seizures. There are few data on ictal features of these different seizure types in the same patient. We identified 20 patients with ES from a group of 99 NES patients (ES/NES) and compared this group with patients with only ES or NES. All 20 ES/NES patients developed NES after ES. Clinical features of NES clearly differed from ES in 18 of 20 cases. In patients with ES/NES their ES were similar to seizures in patients with only ES, and their NES were similar to spells in patients with only NES. ES/NES patients were similar to ES patients in electrodiagnostic and neuroimaging studies, and similar to NES patients in psychiatric interviews and inventories. The clinical manifestations of ES and NES in the same patient are usually different. Both types of events may be stereotypic and can be distinguished and characterized during video-EEG recording. Determining what events are more prevalent or disturbing is critical. Psychiatric and antiepileptic drug treatment may be provided accordingly.

Amnesia↗
PubMed1995

Psychiatric classification of nonconversion nonepileptic seizures.

OBJECTIVE: To determine the frequency and type of non-conversion nonepileptic seizures (NES). BACKGROUND: Although conversion disorder is the most common psychiatric disorder among patients with NES, many patients with nonepileptic paroxysmal behavioral events have other psychiatric disorders, with natural histories and treatments different from those of conversion disorder. DESIGN: Retrospective review of a series of consecutive admissions for video-electroencephalography monitoring. All patients identified with NES were interviewed by a psychiatrist. Patients with conversion and other psychiatric disorders were divided into separate groups. SETTING: A comprehensive epilepsy center. RESULTS: Twenty-one patients evaluated for possible epileptic seizures had a psychiatric disorder other than conversion that accounted for their events. Among these patients, Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R) anxiety disorders (n = 9) were the most common diagnosed category, followed by all forms of psychotic disorders (n = 7) and impulse control problems in the setting of attention deficit disorder residual type (n = 2). In contrast to 71 patients with conversion NES seen over the same period of time, the non-conversion group showed no female predominance and the nonconversion patients were significantly less likely than the conversion patients to have been physically or sexually abused in childhood or adolescence. CONCLUSIONS: These results support the validity of the nosologic distinction of nonconversion from conversion NES and suggest that DSM-III-R anxiety disorders are an important diagnostic confound in clinical epilepsy.

Conversion Disorder↗
PubMed1995

Postictal psychosis: a case control series of 20 patients and 150 controls.

We compared clinical data, EEG, and video-EEG studies in a consecutive series of 20 patients with postictal psychosis (PP) to 150 consecutive epilepsy patients with complex partial (CPS) or generalized tonic-clonic (GTCS) seizures but without PP. There was a lucid interval between last seizure and onset of psychosis ranging from 2.3 to 72 h (mean, 25 h). Duration of PP ranged from 16 to 432 h (mean, 83 h). Age, sex, epilepsy type (partial vs. generalized), and history of febrile seizures were similar in the PP and control groups. Patients with PP had more frequent GTCS during monitoring than controls (2.8 vs. 1.3; P < 0.001). Patients with PP were more likely to have a history of encephalitis (P < 0.0001) and psychiatric hospitalization (P < 0.002). More patients with PP had bilateral interictal epileptiform discharges during monitoring than controls (P < 0.0002). Postictal psychosis most often develops in patients with bilateral dysfunction following a cluster of GTCS.

Adult↗
PubMed1995

Aspartame and seizure susceptibility: results of a clinical study in reportedly sensitive individuals.

The high intensity sweetener aspartame has been implicated anecdotally in seizure provocation. This possibility was investigated with a randomized, double-blind, placebo-controlled, cross-over study. After an extensive search, 18 individuals (16 adults and 2 children) who had seizures allegedly related to aspartame consumption were admitted to adult or pediatric epilepsy monitoring units where their EEG was monitored continuously for 5 days. Aspartame (50 mg/kg) or identically enpackaged placebo was administered in divided doses at 0800, 1000, and 1200 h on study days 2 and 4. All meals were uniformly standardized on treatment days. No clinical seizures or other adverse experiences were observed after aspartame ingestion. Mean plasma phenylalanine (Phe) concentrations increased significantly after aspartame ingestion (83.6 microM) as compared with placebo (52.3 microM). Results suggest that aspartame, in acute dosage of approximately 50 mg/kg, is no more likely than placebo to cause seizures in individuals who reported that their seizures were provoked by aspartame consumption.

Adolescent↗
PubMed1995

Psychogenic basilar migraine: report of four cases.

We discuss four patients with the clinical diagnosis of basilar migraine and suspected coexisting epilepsy who were referred to our epilepsy center. Their symptoms suggested episodic dysfunction in the distribution of the basilar artery, followed by pulsating headache with nausea. Verbal unresponsiveness and sensory symptoms occurred in all four patients; two also had focal paresis or jerking movements. Diagnostic studies excluded other disorders with similar symptoms. None of the patients improved with antimigraine or antiepileptic drugs. Provocation tests with suggestion elicited typical events in three patients and aura and headache in one patient. There were no EEG or ECG abnormalities during spontaneous or provoked episodes. Two patients improved with psychiatric treatment. Conversion disorder or malingering should be considered in patients whose symptoms of basilar migraine are atypical or refractory to treatment.

Adult↗
PubMed1994

Decreased seizure frequency after withdrawal and reinstitution of antiepileptic drug therapy.

We reviewed the seizure frequencies of 38 patients with medically refractory epilepsy 6 weeks before (baseline) and 3 weeks after withdrawing their antiepileptic drugs (AEDs) for video-EEG monitoring. Seizure frequency during the first 3 weeks after restarting AEDs was diminished compared with baseline (P < 0.05). We found no correlation between seizure frequency and patient age, specific antiepileptic drugs, number of seizures during the video-EEG monitoring, number of days without AEDs, or partial vs total withdrawal of AEDs. Medication tachyphylaxis, functional tolerance, or long term post-ictal depression of the seizure threshold is hypothesized. The diminished seizure frequency after reinstitution of medications in four of five patients who did not have seizures during their hospitalization suggests that drug tachyphylaxis is a relevant mechanism.

Adolescent↗
PubMed1994

Invasive intracranial monitoring, cortical resection and multiple subpial transection for the control of intractable complex partial seizure of cortical onset.

Invasive intracranial monitoring with subdural grids has led to a greater appreciation of cortical function and the discovery of ictal onset either independently or in conjunction with deep structures. With the description of multiple subpial transections the armamentarium for surgical control of intractable seizures has been expanded. Utilizing invasive intracranial monitoring with subdural grids and strips, a large series of patients with intractable complex partial seizures originating in exquisite cortex, and in some cases additionally in deep structures, have undergone surgery. These patients would previously have been judged not to be candidates for surgical control of seizures. We will present 9-month or greater follow-up in an ongoing series of patients undergoing cortical resection and subpial transections in whom there has been a statistical improvement in control or alleviation of their seizure disorder. The report will specifically discuss outcomes as related to exquisite cortex, motor, sensory and language functions, as well as clinical results and EEG.

Adult↗
PubMed1994

New antiepileptic drugs for children: felbamate, gabapentin, lamotrigine, and vigabatrin.

After a 15-year hiatus, several new antiepileptic drugs have been approved or are under Food and Drug Administration investigation for use in the United States. This article reviews four of these new drugs--felbamate, gabapentin, lamotrigine, and vigabatrin. Although these drugs have been primarily developed for use in adults with partial seizures, they will also likely be used in children with partial epilepsy. Pediatric experience with several of these drugs has demonstrated safety and efficacy in other seizure types and epilepsy syndromes. These drugs will be an important addition to the therapeutic armamentarium for pediatric epilepsy. Additional studies are needed to fully explore the safety and efficacy of these drugs in a variety of pediatric epilepsies and to compare them to existing antiepileptic drugs.

Acetates↗
PubMed1994

Epilepsy and sleep apnea syndrome.

We identified seven patients with refractory partial epilepsy and sleep apnea. Treatment of the sleep apnea with nasal continuous positive airway pressure (CPAP), protriptyline, trazodone, acetazolamide, or tracheostomy reduced seizure frequency and severity in six patients. Success with CPAP depended largely on compliance. Four of five patients had a clear reduction in seizure frequency with the use of CPAP. Sleep apnea may exacerbate epilepsy by causing sleep disruption and deprivation, hypoxemia, and decreased cerebral blood flow. In epilepsy patients with risk factors (eg, obesity) or markers (eg, habitual snoring, daytime somnolence) for sleep apnea, a careful sleep history should be elicited and a polysomnogram obtained when indicated. Treatment of the sleep disorder can improve seizure control.

Adult↗
PubMed1993

Nonepileptic seizures during apparent sleep.

We report 12 patients with nonepileptic seizures (NESs) documented with video-electroencephalographic monitoring during apparent sleep. There were 7 females and 5 males, ages 11 to 67 years (mean, 33 yr). In all patients there was a well-organized posterior alpha rhythm present immediately before onset of clinical changes despite the appearance of sleep. Patients later "confirmed" that these attacks occurred during sleep. Features of these episodes were typical of NESs and none were associated with ictal or postictal electroencephalographic changes other than muscle and movement artifact. Provocative testing with suggestion confirmed the nonepileptic nature of these episodes in 9 patients. Three patients had epileptiform discharges during prolonged interictal recordings and 1 had a documented complex partial seizure. Our findings indicate that reports of seizures during sleep are not uncommon among patients with NESs.

Adolescent↗
PubMed1993

Multiple subpial cortical transections for the control of intractable epilepsy in exquisite cortex.

In 5 cases suffering from intractable seizures and ictal onset in exquisite (primary somatosensory or language related) cortex, surgical therapy has been done consisting wholly or in part of multiple subpial transections. In two cases with involvement of the primary somatosensory cortex, good seizure control without detectable neurological deficit was achieved. In the other three cases with involvement of the language cortex, deficits were minimal and cleared with time. Patients became seizure-free.

Adolescent↗
PubMed1993

Nonepileptic seizures and childhood sexual and physical abuse.

Nonepileptic seizures (NES) must be distinguished from epilepsy to avoid the adverse effects of unnecessary antiepileptic drugs and to initiate appropriate psychiatric treatment. A higher frequency of prior sexual abuse has been suspected in NES, although no prospective controlled study has compared patients with NES and epilepsy. A series of patients with conversion disorder presenting as epilepsy and 140 patients with complex partial epilepsy (CPE) without evidence of conversion were selected from a series of consecutive admissions to a comprehensive epilepsy center. The groups did not differ with respect to age, years of education, race, or marital status, but the percentage of women was greater in the conversion NES group (73.2%) than in the CPE control group (50.7%; p < 0.002). The frequency of a history of sexual or physical abuse was greater in the NES group (32.4%) than in the CPE controls (8.6%; p < 0.000). Severity of sexual but not physical abuse was significantly greater in the NES group relative to controls (p < 0.05). There was a trend for a closer relationship of the perpetrator of sexual abuse to the victim among the NES patients compared with CPE controls (p < 0.1). These results support the impression that childhood abuse is more common among patients with conversion NES than with epilepsy, and suggests that in some cases childhood abuse may be a contributory pathogenetic factor.

Adult↗
PubMed1993

Crying seizures.

We report seven patients with crying during video-EEG-documented simple or complex partial seizures. During simple partial seizures, crying occurred with or without appropriate affect. Crying occurred postictally in two patients and was associated with persistent spiking in one of them. Six patients had ictal activity in the nondominant hemisphere, maximal in the anteromesial temporal region in five and in the mesial frontal region in another. These cases support theories proposing a lateralization of emotion, with right hemisphere dominance for negative affective states.

Adult↗
PubMed1993

Partial seizures of frontal and temporal origin.

The majority of medically refractory partial epilepsies arise in the frontal and temporal lobes and represent a major challenge to the neurologist. The phenomenology of seizures from these regions is diverse and fascinating, at times lying on the border of many medical specialties. An appreciation of the wealth of potential phenomena can lead to more accurate diagnosis and treatment.

Diagnosis, Differential↗