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PubMed1993

[Partial epilepsy and corpus callosum involvement].

We report two cases of partial complex epilepsy associated with a lesion of the corpus callosum: a cavernoma in one case and a lesion of undetermined nature in the other. Similar cases have already been reported, notably with lipomas or agenesis of the corpus callosum, but they remain exceptional. Two mechanisms could explain such epilepsies: either the lesion extends to the cingulate gyrus whence the epileptic discharge may reach internal temporal structures (our case n. 1), or a temporal focus becomes autonomic after interruption of inhibitory callosal fibres (our case n. 2).

Adult↗

PubMedDate not supplied

Anticonvulsant effect of fluoxetine on focally evoked limbic motor seizures in rats.

Fluoxetine was evaluated for anticonvulsant effects in a rat model of focally evoked complex partial seizures (CPS) secondarily generalized. Fluoxetine was administered intraperitoneally (i.p.) 1 h before seizures were induced by focal intracerebral application of the GABAA receptor antagonist, bicuculline methiodide (118 pmol) unilaterally into a discrete epileptogenic site in the deep prepiriform cortex ("area tempestas," AT) of rats. Significant dose-dependent protection from clonic motor seizures was obtained after 5-, 10-, and 20-mg/kg doses of fluoxetine, with 50% protection occurring after the 5-mg/kg dose. Suppression of electrographic seizure activity was concomitant with suppression of motor seizures. These observations support and extend previous findings of other investigators who showed that fluoxetine exerts anticonvulsant actions against maximal electroshock (MES) convulsions and audiogenic convulsions in genetically seizure-prone rodents.

Acoustic Stimulation↗

PubMed1983

[Clinico-electroencephalographical significance of small sharp spikes].

Clinical and electroencephalographical investigations were made on the 234 patients with neuropsychiatric disorders, showing small sharp spikes (sss) on EEG. Incidence of sss was significantly higher in patients with epilepsy (8.6%) than in the non-epileptic cases (2.5%), especially in early age groups (11-35 years). Some differences in clinical features and in characteristics of sss were found between the epileptic patients and the non-epileptic patients; namely, 1) In majority of the subjects (97%), sss were observed exclusively in stage 1 and 2 of sleep, however, 8 epileptic patients exhibited sss in deep sleep (stage 3) or in awake state, as well as in light sleep. 2) In the non-epileptic group, females (3.4%) showed significantly higher incidence of sss than males (1.7%), while there was no sex difference in the epileptic group. 3) Of the non-epileptic patients, 45% had autonomic symptoms, such as headache, dizziness, tinnitus, nausea and vomiting, while there was no significant correlation between particular neuropsychiatric diagnosis and the EEG pattern. Among the non-epileptics, 72% showed normal EEG except for sss and in 89% sss appeared bilaterally but commonly bilaterally independently. 4) As to relation of sss to seizure types of epilepsy, complex partial seizures showed significantly higher incidence of sss (25.2%) than simple partial seizures (7.5%) and generalized tonic-clonic seizures (6.5%). In the patients with epilepsy, sss were often observed unilaterally predominantly (49%), especially in the patients with complex partial seizure (57%). In complex partial seizure, unilateral sss coincided with laterality of anterior-temporal seizure discharges in 68%. According to the results, the authors suggested that sss has some electroencephalographical significance, probably on mechanisms relating to epileptogenic dysfunction, particularly that of complex partial seizures.

Adolescent↗

PubMed1995

Fasting studies in cerebrospinal fluid and blood in children with epilepsy of unknown origin.

Alterations in the cerebral energy supply are likely to cause cerebral function disturbances. Fasting is a suitable method for studying the energy metabolism. As the cerebrospinal fluid (CSF) compartment reflects the brain metabolism, data in CSF might give information about the metabolism of fuel substrates in brain. We compared the biochemical data on several fuel-related components in blood and CSF at the end of a 40-hours fast of epileptic children with unknown origin of epilepsy (aged 6-15 years) with the values of a reference group of children. In children with primary generalized epilepsy no abnormalities were found. In children with complex partial epilepsy many significant abnormalities were found, such as low blood lactate and alanine and low CSF ketones and CSF blood ratio for ketones. The possible significance of the observed abnormalities are discussed.

Adolescent↗

PubMed1999

Rorschach findings for patients with pseudoseizures.

This study used the Rorschach test to investigate the possible differences between a carefully selected group of 16 patients with pseudoseizures, defined as spontaneous behavior resembling partial complex epilepsy and with or without tonic clonic generalization, and a group of 12 epileptic patients with partial complex seizures. Analysis of the structural data of protocols does not support a significant difference in the Rorschach findings between the two groups.

Adult↗

PubMed1998

Serum prolactin levels are elevated also after pseudo-epileptic seizures.

The aim of the study was to evaluate the sensitivity, specificity and the predictive values of repeated serum prolactin measurements in relation to epileptic seizures versus pseudoseizures. The method used was prospective measuring of serum prolactin from blood samples drawn (1) 15 min after seizure and (2) 2 hr after the first sample. Two parameters were used: the absolute maximal level; and the relative rise in blood level. In the study 38 had epilepsy (simple or complex partial seizures with or without secondary generalisation); and 20 had pseudo-epileptic seizures. In all cases, the diagnoses were made independent of the prolactin levels. In 30/38 (79%) of epilepsy patients and 17/20 (85%) of pseudoseizure patients, the diagnoses were corroborated by intensive EEG monitoring (video or cassette telemetry). There was a statistically significant rise in prolactin levels in both groups (p < 0.0001 and < 0.02, respectively), and also a significant difference between the two groups. However, repeated measurements in a number of patients (epilepsy: mean 1.5 measurements; pseudo; mean 2.1) showed also considerable intra-patient variations. The sensitivity for the maximal rise in pseudoseizures (5.5x) was only 20% and the negative predictive value 40%. For the cut-off in absolute level (1025 microU/ml), the corresponding figures were 34% and 44%, respectively. The rather limited discriminative power of prolactin measurements makes it of questionable value in discerning between epileptic and pseudo-epileptic seizures.

Adolescent↗

PubMed1994

Vigabatrin use in 72 patients with drug-resistant epilepsy.

OBJECTIVE: To determine the efficacy of a new anti-epileptic medication vigabatrin in adults and children with drug-resistant epilepsy. DESIGN AND SETTING: An open, uncontrolled study in a tertiary referral clinic setting with vigabatrin used as add-on therapy. SUBJECTS: All persons with intractable epilepsy, predominantly with complex partial seizures, with or without secondary generalization. MAIN OUTCOME MEASURES: Outcome was assessed by the patient and physician in terms of reduction of seizure frequency and severity balanced against drug side effects. RESULTS: Of 72 patients studied, seven are seizure-free and a total of 41/72 (57%) continue to take vigabatrin as they are deriving benefit therefrom. The results were most striking in patients with complex partial seizures with, or without, secondary generalization (65.6 and 60.9% ongoing treatment, respectively). Most of the 31 patients who ceased taking vigabatrin did so due to a lack of effect, but 9/31 did so because of adverse events: behavioural change, increased seizure frequency and oedema. CONCLUSIONS: Vigabatrin has a definite role to play in the management of persons with intractable complex partial seizures where standard anti-epileptic therapy has failed to achieve control.

Adolescent↗

PubMed1984

Effects of amobarbital and methohexital on epileptic activity in mesial temporal structures in epileptic patients. An EEG study with depth electrodes.

Bilateral intracarotidal Amytal (amobarbital) tests for evaluation of speech and memory function were performed during preoperative evaluation of 30 patients with drug-resistant epilepsy. In 8 of these patients (16 tests), having partial complex epilepsy, EEG was recorded with depth electrodes, implanted bilaterally in anterior mesial temporal structures. The EEGs during 13 tests could be quantified with regard to spike activity. A rapid increase in spike frequency was observed ipsilateral to the injection in all tests but one. No seizure activity or clinical seizures were provoked. This previously unnoticed effect of amobarbital could be due to a direct excitatory effect of the drug on epileptic temporal neurones or, alternatively, to a release of interictal inhibition, exerted upon these neurons by other structures. In 4 patients, the effect was compared with that of methohexital, another barbiturate known to have excitatory effects upon epileptic activity.

Action Potentials↗

PubMed1984

The use and impact of positron computed tomography scanning in epilepsy.

Through the effective combination of instrumentation, tracer kinetic principles, and radiopharmaceuticals, positron computed tomography (PET) allows for the analytic, noninvasive measurement of local tissue physiology in humans. A large number of studies have already been performed in patients with epilepsy using 18F-fluorodeoxyglucose (FDG) to measure local cerebral glucose utilization. In patients with complex partial epilepsy who are candidates for surgery, hypometabolic zones have been seen consistently (70%) in the interictal state. These areas of hypometabolism have been related to electroencephalographic findings, surgical pathology, and clinical symptomatology. The complex anatomical and pathophysiological investigation of these hypometabolic zones is discussed. Ictal studies of patients with partial seizures have demonstrated a much more variable metabolic pattern which usually consists of hypermetabolism relative to baseline or interictal studies. Generalized epilepsy produced by electroconvulsive shock and petit mal epilepsy have been studied using FDG to estimate glucose metabolism. These studies demonstrated hypermetabolism in the ictal state, relative to interictal or postictal scans, but with a more generalized pattern than ictal studies of partial seizures. Methodological problems in the study of epilepsy with PET are discussed in detail. The investigation of interictal hypometabolism through animal models of epilepsy and quantitative autoradiography is described as a means to understand the human PET results. The impact and future direction of PET studies in epileptic populations will probably employ the use of behavioral, pharmacological, and electrophysiological maneuvers to provide more specific details about the fundamental pathophysiological mechanisms of specific aspects of epilepsy. These techniques may allow for a truly pathophysiological classification system for the common and unusual types of epilepsy, and through this classification system improve the therapeutic and prognostic clinical approach to patients.

Animals↗

PubMed2006

Classification of benign infantile afebrile seizures.

PURPOSE: The aim of this study is to classify infantile cases with benign seizures into known epileptic syndromes, thereby facilitating discussion of clinical factors that could play an important role in diagnosis. SUBJECTS: Fifty-seven patients with afebrile seizures fulfilling all of the following criteria were enrolled: (1) normal development prior to the onset, (2) no underlying disorders nor neurological abnormalities, (3) onset before the age of four and (4) normal interictal EEG and neuroimaging findings. RESULTS: Thirty-nine cases (Group A) were characterized by an association of mild gastroenteritis. The remaining 18 cases were divided into two groups according to the seizure type. One group had partial seizures (Group B, 13 cases) while the other was suspected to have generalized seizures (Group C, 5 cases). Age at onset was significantly higher for Group A (19.5 +/- 5.5 months) than Groups B (5.3 +/- 1.8 months) (p<0.001) and C (5.8 +/- 3.5 months) (p=0.038). Positive family history of seizure disorder, seizure cluster tendency, and the efficacy of lidocaine against seizure clusters were common in the three groups. CONCLUSIONS: Features in Group A were consistent with benign convulsions with mild gastroenteritis (proposed by Morooka) [Morooka, K., 1982. Mild diarrhea and convulsions. Shonika 23, 134-137 (in Japanese)], those of Group B with benign partial epilepsy in infancy [Watanabe, K., Yamamoto, N., Negoro, T., Takaesu, E., Aso, K., Furune, S., Takahashi, I., 1987. Benign complex partial epilepsies in infancy. Pediatr. Neurol. 3, 208-211], and those of Group C with benign infantile convulsions [Fukuyama, Y., 1963. Borderland of epilepsy with special reference to febrile convulsions and so-called infantile convulsions. Seishin Igaku 5, 211-223 (in Japanese)]. The distinction between these syndromes depends upon age at onset, association with gastroenteritis, and ictal symptomatology. In our experience, however, it was not easy to catch seizure type accurately in clinical situations. As far as the results of ictal video-EEG monitoring ever carried out concern, focal initiation of parxysmal discharges was demonstrated in all cases, not only of BPEI but also of apparent generalized seizures examined without exception. These observations led the authors to conclude that the identity of BIC is dubious, most probably it will represent a subtype of BPEI.

Age of Onset↗

PubMed1984

[Status epilepticus in adult epileptics followed in a neurologic hospital].

One or several status were observed in 90 chronic adult epileptics. Partial status, especially motor and of similar type, is rare in the clinical course of usual partial epilepsy. Generalized status, chiefly petit mal (PM) status, appears in more severe generalized epilepsies. Partial status epilepticus is observed in motor attacks and rarely in partial complex epilepsies, although the latter are more frequent. In 40% of cases the aetiology is unknown. Delay of the first status is variable, from 2 to 30 years. Status does not make previous epilepsy worse. Generalized status, mainly PM status, appears in patients with absences and generalized attacks, sometimes some decades after the beginning of the disease. In half of the cases PM status are frequent but are sometimes the only expression of the epilepsy.

Adolescent↗

PubMed1998

Psychopathology in pediatric complex partial and primary generalized epilepsy.

Structured psychiatric interviews were administered to 60 children with complex partial seizure disorder (CPS), 40 children with primary generalized epilepsy with absences (PGE), and 48 control children, aged 5 to 16 years. Significantly more patients with epilepsy had psychiatric diagnoses compared with the control children. There were no statistically significant differences, however, in the number of patients with CPS and PGE with psychiatric diagnoses. Other than a schizophrenia-like psychosis found only in the patients with CPS, the two groups of patients had similar psychiatric diagnoses. The presence of psychopathology was related to significantly lower IQ scores and socioeconomic status, but not to seizure-related factors. These findings suggest that the psychopathology of children with CPS and PGE reflects different subtle neuropsychological deficits.

Adolescent↗

PubMed1989

Mossy fiber synaptic reorganization in the epileptic human temporal lobe.

The distribution of the mossy fiber synaptic terminals was examined using the Timm histochemical method in surgically excised hippocampus and dentate gyrus from patients who underwent lobectomy of the anterior part of the temporal lobe for refractory partial complex epilepsy. The dentate gyrus of epileptic patients demonstrated intense Timm granules and abundant mossy fiber synaptic terminals in the supragranular region and the inner molecular layer. In contrast, the dentate gyrus of presenescent nonepileptic primates demonstrated no Timm granules in the supragranular region. In nonepileptic senescent primates, occasional very sparse supragranular Timm granules were results are morphological evidence of mossy fiber synaptic reorganization in the temporal lobe of epileptic humans, and suggest the intriguing possibility that mossy fiber sprouting and synaptic reorganization induced by repeated partial complex seizures may play a role in human epilepsy.

Adolescent↗

PubMedDate not supplied

[Use of 24-hour casette monitoring of the EEG recording in the differential diagnosis of attacks of unconsciousness in adults].

24-hour cassette recording of EEG using the Medilog 9000 system was done in 36 patients referred for observations because of diagnostic difficulties in cases of refractors unconsciousness attacks. The method made possible isolation of 3 groups: 1. 6 patients with attacks not suggestive of epilepsy 2. 12 patients with false unconsciousness attacks which were in fact short partial complex seizures (temporal lobe absence) 3. 17 patients with actual unconsciousness attacks. The study demonstrated a high usefulness of 24-hour EEG monitoring in the differential diagnosis of unconsciousness attacks increasing the likelihood of attack recording and making possible their precise clinical and EEG characteristics which is often impossible with routine EEG and history taking.

Adult↗

PubMed1983

The epilepsy of Fyodor Mikhailovitch Dostoevsky (1821-1881).

Over 100 years ago, on the 27th of January 1881, Fyodor Mikhailovitch Dostoevsky died. Since that time, many biographies, monographs, memoirs, and, to a lesser extent, articles in the medical literature have discussed the fact that Dostoevsky was a patient with epilepsy. An attempt is made here to integrate the details of his illness into a medical case history, as we now do for every patient who visits a physician for the first time. The information pertinent to the case history includes: a description of all seizures, frequency of seizures, provocative factors, course of the disease, treatment, and family history. Even though we do not have the benefits of the results of electroencephalography (invented by Hans Berger in 1929), classification of the type of epilepsy Dostoevsky had is attempted. The existence or absence of the so-called ecstatic aura is crucial to such classification. Based on the data, it is likely that Dostoevsky suffered from partial complex epilepsy with secondarily generalized nocturnal seizures rather than primary generalized epilepsy.

Epilepsies, Partial↗

PubMed1990

Why are so few patients with epilepsy treated surgically? A United Kingdom perspective.

The reasons why many patients with drug resistant complex partial epilepsy who might benefit from surgery are not appropriately assessed are examined, and include the attitudes and prejudices of Neurologists, Neurophysiologists, Neuroradiologists, Neurosurgeons and the patients themselves. Finally, the implications of provision of the necessary resources in the United Kingdom are presented.

Attitude of Health Personnel↗

PubMed2001

Symptomatic or cryptogenic partial epilepsy of childhood onset: fourteen-year follow-up.

This study reports on the seizure and psychosocial outcome of 29 patients with electroclinically well-defined childhood-onset symptomatogenic or cryptogenic partial epilepsy with complex partial seizures who were followed prospectively over 14 years. Many were refractory at the time of enrollment. At 14-year follow-up, we acquired information on seizure type and frequency, psychiatric history, substance abuse, criminal activity, in addition to educational, vocational, and marital status through chart reviews and/or structured telephone interviews. Sixteen patients were only treated medically. They were divided by their following responses to medications: eight patients with less than one seizure per month were in the medically responsive group and eight patients with at least one seizure per month constituted the medically refractory group. Thirteen patients underwent focal resection for medically refractory epilepsy. Medically refractory patients displayed worse educational, vocational, social, and behavioral outcomes than medically responsive patients. Behavioral abnormalities persisted or evolved in five medically refractory patients when they became seizure free. Other studies have indicated that patients with medically refractory complex partial seizures have poor psychosocial outcomes. Although behavioral problems can occur even when seizures are well controlled, their early detection and treatment may be essential to the improvement of psychosocial outcomes.

Adult↗

PubMed1999

Immunoglobulin G and complement immunoreactivity in the cerebral cortex of patients with Rasmussen's encephalitis.

OBJECTIVE: To provide evidence that complement (C')-dependent processes may be involved in Rasmussen's encephalitis (RE). BACKGROUND: RE is a rare, progressive, childhood epilepsy syndrome associated with inflammation and neuronal cell loss in a single cerebral hemisphere. Recent work suggests an autoimmune immunoglobulin (Ig) G-mediated process is important in disease pathogenesis. METHODS: Brain samples from RE and complex partial epilepsy control patients were analyzed immunohistochemically. Sections were stained for IgG and the C' factors C4, C8, and the membrane attack complex (MAC). RESULTS: Brain samples from three of five patients with active, progressive RE but neither of two chronic RE nor five control epilepsy patients demonstrated immunoreactivity for IgG, C4, C8, and MAC on discrete patches of cerebrocortical neurons. Intensely activated glial fibrillary acid protein-positive astrocytes were found in areas overlapping these patches. CONCLUSION: Focally distributed IgG- and C'-positive neurons were found to colocalize with activated astrocytes, suggesting focal IgG-dependent classical C' cascade pathway activation with attendant tissue damage in this subset of RE patients. Intraparenchymal C' activation triggered by pathogenic antibodies may contribute to the development of focal inflammation, neuronal cell loss, and pharmacoresistant seizures in some patients with this disease. This process may be an important component in the initial, active phase of RE.

Cerebral Cortex↗