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Results for “Epilepsy, Complex Partial”

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PubMed1997

Electroclinical study of localization-related epilepsies in early infancy.

To clarify the characteristics of localization-related epilepsies in early infancy, we performed an electroclinical study of 28 epileptic patients whose first seizures occurred before 6 months of age. The patients were retrospectively divided into two groups: the seizure-controlled group (8 patients) and the refractory group (20 patients). The seizure-controlled group included the patients whose seizures were suppressed within 1 year after onset; the refractory group included all other patients. The characteristics of the refractory group were as follows: (1) most patients had serious underlying pathologies; (2) the seizure type in most cases was simple partial seizure or complex partial seizure without secondary generalization; (3) the interictal EEG showed focal abnormalities and severe dysrhythmia on the basic pattern associated with multifocal spikes in most cases; and (4) in some patients, West syndrome developed after localization-related epilepsies and generalized seizures appeared later in some cases.

Age of Onset↗

PubMed1984

Gustave Flaubert's illness: a case report in evidence against the erroneous notion of psychogenic epilepsy.

The concept of psychogenic epilepsy was recently revived by Sartre (L'Idiot de la Famille, 1971-2) in relation to Gustave Flaubert's epilepsy, which he believed was secondary to hysterical neurosis and not due to a cerebral lesion. A detailed clinical description of Gustave Flaubert's personal and medical history from birth to death is provided. The relationships between his epileptic seizures and both his personal life and the response of others to the attacks are discussed, as is the interaction between seizure occurrence and his literary work and productivity. The various diagnoses made by medical and nonmedical persons during and after Flaubert's lifetime are then reviewed. Particular emphasis is given to Sartre's purely psychogenic interpretation of the seizures, to his total disinterest in their medical aspects, and to the fact that he did not obtain any medical opinions. It is shown that a definitive diagnosis can be made for Flaubert's illness--that of epilepsy associated with a quite normal psychosocial response by current standards. Moreover, the clinical nature of the seizures and other clinical details permit the more specific diagnosis of "complex partial epilepsy of occipital-temporal origin, secondary to lesion of the left posterior hemisphere with occasional secondary generalization of seizures." The concept of the existence of "psychogenic epilepsy" is reaffirmed as erroneous, despite the occasional precipitation of seizures in some individuals by psychological factors. Finally, Gustave Flaubert's case, like Dostoevski's, points to the possible coexistence of a serious and poorly controlled form of epilepsy with true literary genius without the latter being dependent in any way on the former.

Epilepsy↗

PubMed2000

Comparison of fluorine-18 deoxyglucose and O-15 water PET in temporal lobe epilepsy.

This study reports a comparison of Fluorine-18 deoxyglucose positron emission tomography (FDG-PET) and O-15 water (H2(15)O) PET with regard to lateralization of the seizure focus in patients with complex partial epilepsy. The analysis of 35 patients who had an anterior temporal lobectomy for medically intractable seizures indicated that FDG- and H2(15)O-PET were highly correlated in demonstrating the epileptic focus. FDG- and H2(15)O-PET showed significant asymmetries in 83% and 77% of cases respectively. The lateralization with visual analysis of MRI was found to be lower than both FDG and blood flow imaging. Ictal electroencephalography (EEG) lateralizations were concordant with sites of blood flow and FDG-PET abnormalities. Thirty-three patients (94%) were seizure-free or improved significantly after surgery. In conclusion, blood flow PET yielded similar results compared to FDG-PET and can be a valuable modality in preoperative evaluation of patients with temporal lobe epilepsy.

Adolescent↗

PubMed1989

Specificity of vigabatrin for the GABAergic system in human epilepsy.

The therapeutic action of vigabatrin (gamma vinyl GABA, GVG) has been reported to be mediated by GABAergic neurotransmission. In the present study, we evaluated different neurotransmitter systems in the cerebrospinal fluid (CSF) of patients with complex partial epilepsy, before and during GVG treatment. The markers of the GABAergic system (free GABA, total GABA, homocarnosine) showed a two- to threefold elevation. There was also an increase in glycine during the 6 months of GVG treatment. In contrast, we did not find any constant CSF changes in either excitatory amino acids or in markers of the cholinergic (acetylcholinesterase), dopaminergic (homovanillic acid), serotonergic (5-hydroxyindoleacetic acid), or peptidergic (somatostatin, prolactin, beta-endorphin) systems. This finding (except an elevation in glycine) was in agreement with previous studies which suggest a specific action of GVG on the GABAergic system. The role of glycine in antiepileptic efficacy of GVG needs further evaluation.

Adult↗

PubMed2006

Generalized tonic-clonic seizures detected by implantable loop recorder devices: diagnosing more than cardiac arrhythmias.

BACKGROUND: Both syncope and seizures are important causes of recurrent, unexplained episodes of loss of consciousness. Implantable loop recorders have identified serious arrhythmias in patients with repeated syncope; however, implantable loop recorder detection of seizures is less well established. OBJECTIVES: The purpose of this study was to provide in-depth analysis of a characteristic myopotential pattern recorded by implantable loop recorders during generalized tonic-clonic seizures. METHODS: Fourteen patients with refractory, video-EEG-documented epilepsy (complex partial, atonic, tonic, or generalized tonic-clonic seizures) underwent implantable loop recorder placement as part of a study protocol evaluating cardiac rhythm abnormalities in patients at high risk for sudden unexpected death in epilepsy. RESULTS: Twelve generalized tonic-clonic seizure episodes were detected by the implantable loop recorder in six patients. Implantable loop recorder and EEG recordings of generalized tonic-clonic seizures were identical and revealed a tonic phase (sustained, rapid, high-frequency myopotentials) transitioning to a clonic phase (periodic bursts of high-frequency myopotentials with a decelerating burst frequency from 3-6 Hz to 1-2 Hz) prior to seizure termination. With the nonprogrammable bandpass filter of 0.85 to 32 Hz in the implantable loop recorder, all generalized tonic-clonic seizure episodes had escaped automatic detection and required activation by family members. None of the 76 nongeneralized tonic-clonic seizure episodes recorded on the implantable loop recorder in the 14 patients exhibited the stereotypical tonic-clonic pattern that defines generalized seizures. CONCLUSION: Recognizing this specific myopotential pattern on an implantable loop recorder might help diagnose generalized tonic-clonic seizures as a cause of recurrent, unexplained episodes of loss of consciousness. Having a programmable bandpass filter in the implantable loop recorder might increase its diagnostic yield for such patients.

Adult↗

PubMed1998

[Diagnostic focus on the child with epilepsy and neuropsychological deterioration].

Symptomatic epilepsy secondary to hereditary metabolic or degenerative disorders, is usually associated to neurological deterioration. Though epilepsy by itself does not induce neurological deterioration, we should remind that some epileptics encephalopathies, such as the West or Lennox-Gastaut syndromes, do actually induce limited neurological deterioration. Furthermore, in some forms of complex partial epilepsy, motor problems and behavior disorders can be observed, specially in adolescents with temporary lobe epilepsy. Other forms of epilepsy, such as the atypical benign partial epilepsy or the Landau-Kleffner syndrome, can present a certain degree of cognitive deterioration in the evolution, although they can recover later lost functions, totally or partially. The evolution of some refractory epilepsy, as patients are submitted to a multiple treatments, can make us suspect a degenerative disease. In some cases, the diagnosis of the hereditary metabolic and heredodegeneratives diseases can be made by the characteristics of the seizures but in most cases the diagnosis will be established by the symptoms of the basic disease and the lab data.

Adolescent↗

PubMed1984

Access to the posterior medial temporal lobe structures in the surgical treatment of temporal lobe epilepsy.

The authors describe a surgical technique that allows access to the posterior temporal horn of the lateral ventricle with preservation of the most functional lateral temporal cortex. Development of the technique was stimulated by the need to resect posteromedial temporal lobe structures in patients with intractable complex partial epilepsy and well-identified unilateral posterior hippocampal foci. This technique has also been of value in the resection of some lateral ventricular and posteromedial temporal lobe masses. The operation consists of three steps. No more than 4.5 cm of the anterolateral temporal lobe is removed en bloc such that the most anterior aspect of the temporal horn is entered. An incision is carried from the floor of the temporal horn through the inferior longitudinal fasciculus to the middle fossa dura mater and posteriorally into the lateral ventricular atrium. The lateral temporal cortex and white matter are then elevated with a self-retaining retractor. This exposes the posteromedial temporal horn or intraaxial mass for excision or allows en bloc resection of the entire hippocampus and medial temporal lobe structures while preserving the functional association areas of the lateral temporal cortex, including speech and visual spatial function.

Epilepsy, Temporal Lobe↗

PubMed2005

Comparison of voxel-based 3-D MRI analysis and subtraction ictal SPECT coregistered to MRI in focal epilepsy.

While voxel-based 3-D MRI analysis methods as well as assessment of subtracted ictal versus interictal perfusion studies (SISCOM) have proven their potential in the detection of lesions in focal epilepsy, a combined approach has not yet been reported. The present study investigates if individual automated voxel-based 3-D MRI analyses combined with SISCOM studies contribute to an enhanced detection of mesiotemporal epileptogenic foci. Seven consecutive patients with refractory complex partial epilepsy were prospectively evaluated by SISCOM and voxel-based 3-D MRI analysis. The functional perfusion maps and voxel-based statistical maps were coregistered in 3-D space. In five patients with temporal lobe epilepsy (TLE), the area of ictal hyperperfusion and corresponding structural abnormalities detected by 3-D MRI analysis were identified within the same temporal lobe. In two patients, additional structural and functional abnormalities were detected beyond the mesial temporal lobe. Five patients with TLE underwent epileptic surgery with favourable postoperative outcome (Engel class Ia and Ib) after 3-5 years of follow-up, while two patients remained on conservative treatment. In summary, multimodal assessment of structural abnormalities by voxel-based analysis and SISCOM may contribute to advanced observer-independent preoperative assessment of seizure origin.

Adult↗

PubMed2000

Benign partial epilepsy in infancy and early childhood with vertex spikes and waves during sleep: a new epileptic form.

International epilepsy classification includes different epileptic syndromes with favourable outcomes in paediatric age, both partial and generalised. This is true in childhood while no partial benign forms are accepted in infancy. In 1987, Watanabe first described a new entity and he defined it as 'benign complex partial epilepsies in infancy'. In 1992, Vigevano referred similar but familial cases whose seizures had secondary generalisation. Both these forms had no interictal EEG abnormalities neither awake nor during sleep. This article presents a survey of 12 cases of partial epilepsy with favourable outcome differing from Watanabe and Vigevano's cases, both for the presence of interictal EEG abnormalities only during sleep and for seizure picture. All our patients are neurologically and neuroradiologically normal. Psychomotor development is unremarkable. Age onset range is 13-30 months. All cases present characteristic spikes and waves during slow-sleep in vertex cerebral areas. Awake EEG is always normal, at follow-up too. Our cases have such homogeneous electroclinical features as to hypothesise a new partial idiopathic epileptic syndrome with favourable outcome in infancy and early childhood. We propose to define it as 'benign partial epilepsy in infancy and early childhood with vertex spikes and waves' (BVSE).

Child↗

PubMed1993

Hot water epilepsy with pineal cyst and cavum septi pellucidi.

A case of reflex epilepsy accompanied by pineal cyst and cavum septi pellucidi induced by hot water bathing is presented. The patient is a 25-year-old male who has had six episodes of convulsions during the last three years. The seizures were diagnosed as a complex partial epilepsy followed by generalized tonic seizures. We have succeeded in recording his electroencephalogram (EEG) during convulsions. Moreover, a magnetic resonance imaging (MRI) study revealed a pineal cyst and cavum septi pellucidi. This is quite a rare form of adult hot water epilepsy accompanied by intracranial malformations.

Adult↗

PubMedDate not supplied

[Open randomized comparative trial of sodium valproate and carbamazepine in adult onset epilepsy].

An open randomized comparative study was carried out on the efficacy and tolerance of carbamazepine--Tegretol CR (CBZ) and sodium valproate--Depakine chrono (VPA) in adult patients with newly diagnosed epilepsy with partial complex seizures with or without secondary generalization. The trial included 60 patients aged 18-50 years. Thirty patients were randomized to an initial CBZ dose of 2 x 200 mg daily, and the remaining 30 patients to an initial VPA dose of 2 x 300 mg daily. The follow-up was carried out for 3 years. If clinically necessary, the doses were increased while monitoring blood serum drug levels until the therapeutic effect was achieved or side effects developed. A maximum dose of CBZ was established at 2000 mg/day, and that of VPA at 3000 mg/day. Within the first 6 months of the therapy, 5 patients on CBZ (16.6%) and 2 patients on VPA (6.6%) were excluded from the trial due to poor seizure control or adverse side effects. Between the seventh month and the end of the third year of the study, the number of patients additionally excluded for the above reasons was 5 (16.6%) individuals on CBZ and 6 (20%) patients on VPA. Out of the patients who were followed up for 3 years, 16 (80%) on CBZ and 16 (72.7%) on VPA achieved 12-month remission, while 12 patients on CBZ (60%) and 13 (59%) on VPA achieved a 24-month remission. It can be thus concluded, that the patients administered CBZ achieved the remission faster than the patients on VPA, but after 3-year therapy the effectiveness of the two drugs was comparable. There was no difference in effectiveness between patients with partial complex seizures with and without secondary generalization. The number of patients with adverse effects in both groups was comparable.

Adolescent↗

PubMedDate not supplied

Inhibitory and excitatory amino acids in CSF of patients suffering from complex partial seizures during chronic treatment with gamma-vinyl GABA (vigabatrin).

The effect of chronic administration of gamma-vinyl GABA (GVG; vigabatrin) on levels of neurotransmission-related amino compounds was studied in lumbar cerebrospinal fluid of 65 patients with complex partial epilepsy. The first sample of cerebrospinal fluid was taken before a 3-month period of treatment with 3 g gamma-vinyl GABA/day, and the second was taken afterwards. From patients who showed a greater than 50% reduction in seizures (responders) or marked improvement in global performance, a third sample was taken at the end of the next 3-month phase, during which 3 g or 1.5 g gamma-vinyl GABA had been administered daily. During treatment with 3 g gamma-vinyl GABA/day, 55% of the patients showed more than 50% reduction in complex partial seizures; and at the same time free GABA, total GABA, homocarnosine, and glycine concentrations in the cerebrospinal fluid increased by 104%, 151%, 194% and 16%, respectively. After reduction of the daily dose to 1.5 g, the levels of free GABA, total GABA and homocarnosine were still increased by 65%, 115% and 102%, respectively. gamma-Vinyl GABA correlated with the levels of free GABA (P less than 0.002) and glycine (P less than 0.001). Concentrations of homocarnosine at baseline and homocarnosine and total GABA during gamma-vinyl GABA treatment were lower (P less than 0.005) in the group of non-responders than in the responder group. Glutamic acid, glutamine, aspartic acid, asparagine, and taurine levels did not change during gamma-vinyl GABA treatment. In conclusion, administration of gamma-vinyl GABA reduces epileptic seizures and produces dosage-dependent increases in levels of free GABA, GABA-containing peptides and of glycine in cerebrospinal fluid, without concomitant change in levels of excitatory amino acids.

Adolescent↗

PubMedDate not supplied

Transient global amnesia as a postictal state from recurrent partial seizures.

A 60-year-old patient had a 3-year history of recurrent memory disturbances. The video electroencephalographic (EEG) recording of one attack showed that the amnesic state, which clinically resembled transient global amnesia, was characterized by a normal EEG tracing followed by electroclinical complex partial seizures. We suggest that "epileptic" transient global amnesia is postictal in nature.

Alpha Rhythm↗

PubMed2003

Accumulation of 7S SNARE complexes in hippocampal synaptosomes from chronically kindled rats.

Kindling is a model of complex partial epilepsy wherein periodic application of an initially subconvulsive stimulus leads to first limbic and then generalized tonic-clonic seizures. Several laboratories have reported that augmented neurotransmitter release of l-glutamate is associated with the chronically kindled state. Neurotransmitter release requires membrane proteins called SNAREs, which form transmembrane complexes that participate in vesicle docking and are required for membrane fusion. We show here that kindling by entorhinal stimulation is associated with an accumulation of 7S SNARE complexes in the ipsilateral hippocampus. This increase of 7S SNARE complexes appears to begin early in the kindling process, achieves a peak with full kindling, and remains at this level for at least a month following cessation of further kindling stimuli. The increase is focal and permanently limited to the ipsilateral hippocampus despite progression to generalized electrographic and behavioral seizures. It is not seen in animals that receive electroconvulsive seizures, suggesting it is related to the kindling process itself. The duration and focality of increased 7S SNARE complexes with entorhinal kindling suggest that this is an altered molecular process associated with epileptogenesis.

Animals↗

PubMed2003

Recurrent postictal psychosis after remission of interictal psychosis: further evidence of bimodal psychosis.

PURPOSE: To ascertain whether bimodal psychosis (i.e., independent postictal and interictal psychosis) in patients with epilepsy can be characterized by postictal psychosis that develops after interictal psychosis remits. METHODS: We reviewed the records of 14 patients with bimodal psychosis treated at a national center hospital. Clinical and psychopathological characteristics of the patients were examined. RESULTS: Among the 14 patients with bimodal psychosis, four initially had interictal psychosis, and 10 initially had postictal psychosis. That is, interictal-antecedent bimodal psychosis characterized four cases, and postictal-antecedent bimodal psychosis characterized 10 cases. Patients with interictal-antecedent bimodal psychosis composed 2.2% of the total patients with epilepsy and psychosis (n = 180) and 28.5% of total patients with bimodal psychosis. All four patients with interictal-antecedent bimodal psychosis had partial epilepsy with complex partial seizures, bilateral EEG abnormalities, and borderline (or decreased) intellectual functioning. Most of these clinical features are common to both types of bimodal psychosis. Among patients with interictal-antecedent bimodal psychosis, the mean age at the onset of the initial symptoms was 10.8 years (SD, 4.3 years) for epilepsy, 24.4 (6.1) years for interictal psychosis, and 33.8 (4.5) years for postictal psychosis. CONCLUSIONS: In a few patients, postictal psychosis develops after the remission of interictal psychosis. Interictal-antecedent bimodal psychosis is not likely a discrete entity because of several characteristics common to both types of bimodal psychosis. Patients may have greater vulnerability to psychosis and develop psychotic episodes easily, regardless of the presence of preceding seizures.

Adult↗

PubMedDate not supplied

Acquired aphasia, dementia, and behavior disorder with epilepsy and continuous spike and waves during sleep in a child.

Severe persistent neuropsychological disorders sometimes develop in the course of a focal epilepsy of unknown origin in previously normal children. Very frequent bilateral focal or generalized discharges are often noted on the sleep EEG records of these patients with no evidence of clinical seizures. The relation between these paroxysms and the observed deterioration remains unclear. We report a child with a partial complex epilepsy and severe disturbances of language, cognition, and behavior acquired in the early years of development who was followed for 15 years. A correlation between the evolution of the striking EEG abnormalities during sleep and the neuropsychological disorders could be established retrospectively. The observed sequence of onset and recovery of the aphasia, the dementia, and the "psychotic" behavior makes a direct causal relation between the deficits quite unlikely. Rather it suggests an association of independent symptoms with a specific language disorder becoming manifest in the course of the evolution. This child shows many of the main characteristics of the syndromes of "acquired aphasia with convulsive disorder" (Landau-Kleffner syndrome) and "epilepsy with continuous spike waves during sleep." Both syndromes describe probably different facets of a similar underlying, still unexplained cerebral dysfunction.

Adolescent↗

PubMed2000

Predictive variables of interictal psychosis in epilepsy.

OBJECTIVE: To evaluate which variables predict interictal psychosis in epilepsy. METHODS: The authors reviewed the biological backgrounds, clinical characteristics, and EEG findings in 246 patients with epilepsy and interictal psychosis and in 658 control patients with epilepsy and no psychotic history. With a logistic regression approach, the significance of each variable for the development of interictal psychosis was evaluated. RESULTS: There are significant differences in family history of psychosis, age at onset of epilepsy, type of epilepsy, lateralization of epileptiform discharges, and level of intelligence between patients with interictal psychosis and those without it. Subsequent logistic regression analysis with all variables demonstrated that family history of psychosis, age at onset of epilepsy, type of seizures, and level of intelligence significantly correlated with psychosis. CONCLUSIONS: A family history of psychosis, earlier age at onset of epilepsy, complex partial seizures or generalized tonic clonic seizures, and borderline intellectual functioning were the most important predictors for development of interictal psychosis.

Adolescent↗

PubMed1992

Biological profile of the metabolites and potential metabolites of the anticonvulsant remacemide.

Remacemide hydrochloride ((+/-)-2-amino-N-(1-methyl-1,2-diphenylethyl)- acetamide hydrochloride or FPL 1292AA) is a novel compound undergoing clinical trials for patients with generalized tonic/clonic and complex partial epilepsy. Remacemide exhibits efficacy against maximal electroconvulsive shock (MES) in rodents and seizures elicited by N-methyl-D,L-aspartate (NMDLA) in mice. Using rat synaptic membrane fractions, remacemide was shown to possess relatively weak noncompetitive binding to the ionic channel site of the NMDA (N-methyl-D-aspartic acid) receptor complex. With the hypothesis that activity against NMDLA-elicited seizures might be reflected by transformation to a more active metabolic species, the aim of the present study was to evaluate potential pharmacological effects of the 9 identified metabolites of remacemide which were all found in human and dog urine. Moreover, specific entities were recognized in plasma (including the rat's), as well as dog and rat cerebrospinal fluid. Five putative metabolites were also examined. A major route of metabolic transformation of remacemide in rats yields the formation of a pharmacologically active more potent desglycine derivative, namely FPL 12495 (+/-). Potency over the parent compound is revealed in the MES test in mice and rats, the NMDA-induced convulsions/mortality test in mice, and especially involving in vitro displacement of MK801 binding to the channel subsite of the NMDA receptor. The S isomer (FPL 12859) of this desglycinate is even more potent, while the R isomer is less potent than the corresponding racemate. Unlike the non-competitive NMDA antagonist, MK801, these desglycinates did not prevent kindled seizures. Three other identified metabolites show efficacy in the mouse and rat in vivo tests, namely the N-hydroxy-desglycinate (FPL 15053) and the p-hydroxy-desglycinates (FPL 14331 and FPL 14465). FPL 15053 exhibited modest activity in all tests. The only in vivo activity exhibited by the 2 p-hydroxy-desglycinates was evidenced in the MES test following i.p. and i.v. dosing. However, FPL 14331 was active in the MK801 binding assay. An oxoacetate metabolite, PFL 15455, failed to demonstrate any biological activity. Of potential metabolites tested 2 beta-hydroxy-desglycinates (FPL 14991 and FPL 14981) displayed modest activity in the MES test, however, only FPL 14981 prevented NMDLA-induced convulsions/mortality in mice and was 2-fold more active regarding MK801 binding. The hydroxy-methyl derivative of remacemide (FPL 13592) and its desglycinate (FPL 15112) prevented MES-induced convulsions only after i.v. administration; only the desglycine derivative displaced MK801 binding.(ABSTRACT TRUNCATED AT 400 WORDS)

Acetamides↗