Physical interpretation of frontal lobe seizures. The dipole approximation and sensorimotor cortex.
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Behavior↗
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Results for “Epilepsy, Complex Partial”
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Temporal lobe epilepsy in children: overview of clinical semiology.
Temporal lobe epilepsy in children has been less well studied compared to that seen in adults. Whereas hippocampal sclerosis is the most common etiology for the adult temporal lobe epilepsy syndromes, tumors and malformations of cortical development are more commonly seen in children. Differences in seizure semiology are also apparent. Temporal lobe epilepsy in very young infants may exhibit prominent motor manifestations reminiscent of extra-temporal seizures. These motor manifestations however decrease with increasing age and are less abundant in adults. Automatisms, which are commonly seen in temporal lobe epilepsy in all age groups, are simple at a younger age and become increasingly more complex and discrete with age. Several case studies, illustrated on the video are included in this review. They highlight the differences in temporal lobe seizure semiology between children and adults. [Published with video sequences].
Adolescent↗
A comparative study of mismatch negativity (MMN) in epilepsy and non-epileptic seizures.
This study investigated mismatch negativity (MMN) differences between subjects with non-epileptic seizures (NES), subjects with epilepsy, and healthy controls. Event-related potentials (ERPs) were obtained from 14 patients with NES, 15 patients with epilepsy and 16 healthy control subjects. A conventional MMN procedure was used with a random sequence of 12% deviant tones (922 Hz) and 88% standard tones (1000 Hz). Subjects were instructed to ignore the tones delivered through headphones whilst reading a book. Significant differences in distribution of the mismatch negativity (MMN) in patients with NES compared to controls were obtained (F3, p <or= 0.019; Cz, p <or= 0.044) and longer MMN duration in patients with epilepsy compared with patients with NES (p <or= 0.039) was observed. The change that has been analyzed is one of relative (or scaled) amplitude rather than absolute amplitude. These differences observed at Cz/F3 suggest an increase in emphasis of the MMN in the frontocentral region in patients with NES compared to healthy controls, suggesting that the MMN is generated in a different way in NES compared with controls. This could indicate that one of the normal MMN generator areas does not function normally in NES. Increased absolute amplitude of the MMN has previously been observed in anxiety disorders particularly in post-traumatic stress disorder (PTSD). We discuss similarities between NES and PTSD, suggesting that the increased relative amplitude obtained in this study may be related to mechanisms of generation of NES. The prolonged duration of the MMN in epilepsy could be related to difficulties in processes associated with novelty discrimination (closure of MMN generating mechanism). This information processing dysfunction could be associated with the concentration and memory difficulties that are observed in some patients with epilepsy. This study provides electrophysiological evidence of abnormal processing of auditory stimuli in both clinical conditions when compared to healthy controls, and interictal differences between a group of patients with epilepsy and a group of patients with non-epileptic seizures, as measured by the MMN.
Acoustic Stimulation↗
Prolonged use of phenytoin, carbamazepine or valproate monotherapy on plasma levels of folate and B(12): a comparison between epileptic patients with or without cardiovascular disorders.
PURPOSE: Previous studies showed an association between the blood levels of folate and vitamin B(12) and the risk for cardiovascular disease. The aim of this study is to investigate the effect of chronic use of phenytoin, carbamazepine or valproate monotherapy on the plasma levels of folate and B(12), and to compare folate and B(12) levels in epileptic patients with or without cardiovasular disorders. METHODS: The study was conducted in the outpatient neurology clinic at Bahrain Defence Force (BDF) Hospital between January-July, 2005. Medical information was obtained by interviewing the patients and examining their hospital records. Blood folate and vitamin B(12) were measured by Immulite immunoanalysis assay using chemoluminescence. RESULTS: A total of 26 consecutive outpatients (17 males, 9 females) were recruited in the study. Their mean age +/- SD was 38.2 +/- 20.1 year (range 15-77 year). Five (19.2%) had complex partial epilepsy and the remainder had tonic-clonic seizures. They had epilepsy for 15.7 +/- 8.1 years (range 2-35 years). Thirteen of them used phenytoin, nine carbamazepine and four used valproate. The duration of the treatment (years), dose (mg/day) and serum concentration (micromol/l) were 18.3 +/- 10.6, 376.9 +/- 180.4, 41.6 +/- 25.6, for phenytoin, 14.5 +/- 11.7, 422.2 +/- 175.0, 31.1 +/- 15.9 for carbamazepine and 18.3 +/- 6.3, 400, 567.7 +/- 78.1 for valproate, respectively. Eleven (42.3%) had established cardiovascular disorders such as hypertension, myocardial infarction or stroke. The mean level of plasma folate (12.94 +/- 6.76 ng/ml) and B12 (484.94 +/- 191.25 pg/ml) in epileptic patients with cardiovascular disorders compared to their values (11.27 +/- 5.84), (514.49 +/- 225.31) respectively in epileptics with no cardiovascular disorders were not statistically significant in the two groups. CONCLUSION: In epileptic patients on chronic therapy with phenytoin, carbamazepine or valproate folate and B(12) levels were not different in patients with or without cardiovascular disorders.
Adolescent↗
[Consciousness disorders in patients with epilepsy].
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Adult↗
[Valproic acid and stupor].
A patient treated with valproic acid and phenytoin for complex partial epilepsy developed a stupor at therapeutic serum levels of the anti-epileptic agents. A few days after discontinuation of valproic acid, complete recovery occurred. The pathogenic mechanism involved is still obscure.
Drug Therapy, Combination↗
Pituitary adenoma with seizures: PET demonstration of reduced glucose utilization in the medial temporal lobe.
A patient with a benign chromophobe adenoma, who had incomplete surgical removal followed by radiotherapy, continued to have epileptic seizures up to two or three times a day. She was studied with positron emission tomography using 18F-2-deoxyglucose (FDG). This technique showed a high level of glucose utilization in the area of the operated tumor but also clear reduction of glucose utilization in the left medial temporal region adjacent to the sella and the scar tissue from the neoplasm. This area of reduced glucose utilization corresponded well to the same finding observed in other patients with complex partial epilepsy. A left temporal anterior lobectomy was carried out followed by improved control of the epilepsy. Positron emission tomography using FDG, together with electrophysiological examinations, may assist in the management of epilepsy related to pituitary tumors.
Adenoma, Chromophobe↗
Limbic kindling and animal behavior--implications for human psychopathology associated with complex partial seizures.
The latest thinking concerning the neural mechanisms of limbic kindling is briefly reviewed. It is proposed that three types of lasting neural changes accompany the increases in epileptogenicity resulting from repetitive electrical stimulation of the limbic system in animals. Two of these, long-lasting synaptic potentiation and increased susceptibility to failure, under high drive, of neurotransmitter systems antagonistic to seizure expression, are proposed to underly the lasting interictally maintained changes in species-characteristic behavior in animals. It is proposed that similar processes may occur in some humans afflicted with complex partial epilepsy, and that these processes could explain the paradoxical relationship between seizures and psychopathology.
Aggression↗
[New approaches to the study of memory impairment in epileptics].
Some memory functions were evaluated in 56 adult epileptic patients. A memory battery scale with verbal and visual material was used. Patients' scores were statistically worse than those of controls matched according for age and cultural level. No differences were observed between generalized and complex partial epilepsies. Left interictal E.E.G. abnormalities were correlated with verbal efficiency impairment. Length of illness and seizure frequency were consistently correlated with poor memory ability. Surprisingly antiepileptic drugs were not a major factors. However, none of these parameters if considered alone accounts for this impairment, which is obviously multifactorial. These poor memory performances are mainly due to a learning decrement. Epileptic patients have difficulties to learn but they well remember what they have learnt.
Child↗
The problem of subclinical localised paroxysmal rhythmic discharges (psychomotor variant discharges). Report of two cases.
Two cases are reported of patients whose EEGs showed localised rhythmic seizure activity in the midtemporal regions of one or both hemispheres, unaccompanied by any clinical symptoms: the patients' histories differed: one was of classic migraine and the other complex partial epilepsy. The frequency and morphology of the paroxysmal anomalies was identical in the waking state and in sleep. The nosographic classification of the phenomenon is discussed with reference to Gibbs' reports regarding the "psychomotor variant type of seizure discharge", to the work of Lipman and Hughes on "rhythmic mid-temporal discharge" and to that of Westmoreland and Klass on the "subclinical rhythmic EEG discharge of adults". But in contrast to the last phenomenon there were no signs pointing to a diffuse cerebrovascular disease. Reports of such a pattern are rare in the European literature and nonexistent in the Italian literature, facts which make an ordinary interpretation of the phenomenon difficult.
Aged↗
Use of frameless stereotaxy with location of electroencephalographic electrodes on three-dimensional computed tomographic images in epilepsy surgery.
Epileptiform activity corresponding to structural lesions was identified by three-dimensional (3D) imaging using computed tomographic (CT) scan data concurrently with scalp EEG electrodes. The electrodes, placed according to the international 10-20 system, were used to record interictal and ictal epileptogenic foci in eight patients. Electrodes placed where marked or moderate epileptiform activity was detected were replaced with markers detectable on CT. Scans with these markers on the skin were obtained and the data transferred to a 3D imaging system, and correlated with underlying cerebral structures. The reformatted images were used to assess the relation among intracranial lesions, brain surface structures, and epileptogenic zones depicted by the markers. The images help the surgeon plan a craniotomy with enough space for both lesionectomy and resection of the epileptogenic zone. In the central regions where crucial motor functions are located, the markers indicate the central fissure or postcentral gyrus. An intraoperative 3D frameless stereotactic pointing device helps in directing further examination of the epileptogenic zone. This system improves on the precision available through intraoperative electrocorticographic recording in the extratemporal lobes, thus avoiding only approximate excision of lesion and epileptogenic zone and enabling the neurosurgeon to perform epilepsy surgery with greater confidence.
Adolescent↗
Reactive synaptogenesis and neuron densities for neuropeptide Y, somatostatin, and glutamate decarboxylase immunoreactivity in the epileptogenic human fascia dentata.
This study determined differences of fascia dentata (FD) peptide and inhibitory neuroanatomy between patients with epileptogenic hippocampal sclerosis (HS), those with extrahippocampal seizure pathologies, and autopsy comparisons. Surgically treated temporal lobe epilepsy patients were clinically classified into two pathogenic categories: (1) HS with focal mesial temporal neuroimaging and histories of initial precipitating injuries to the brain (n = 18) and (2) non-HS patients with extrahippocampal mass lesions or idiopathic seizures (i.e., without lesions or HS; mass lesion/idiopathic; n = 9). The hippocampal sections were studied for (1) granule cell, hilar, CA4, and CA3 neuron densities; (2) hilar densities and the percentage of neurons immunoreactive (IR) for neuropeptide Y (NPY), somatostatin (SS), and glutamate decarboxylase (GAD); (3) densities of GAD neurons in the lower granule cell and infragranular zone (basket-like cells); (4) the semiquantitative pattern of IR peptides/GAD FD molecular layer axon sprouting; (5) IR gray values (GV) of the FD molecular layers; and (6) the thickness of the supragranular molecular layer. Results showed the following. (1) Compared to autopsies, both HS and mass lesion/idiopathic patients showed less granule cell and CA3 neuron densities, but there were no statistical differences between the latter two pathogenic categories. (2) By contrast, compared to autopsies and mass lesion/idiopathic cases, HS patients showed less hilar and CA4 neuron densities, and there were no differences between autopsies and mass lesion/idiopathic. (3) Compared to autopsies, the NPY and SS hilar neuron densities in HS patients, but not mass lesion/idiopathic cases, were less. (4) Compared to autopsies, the hilar GAD neuron densities for HS and mass lesion/idiopathic patients were not less. (5) In HS patients the averaged percentages of hilar SS neurons were less than autopsies, and no other differences of IR hilar percentages were found. (6) The densities of GAD basket-like neurons and the thickness of the supragranular molecular layer were not different between any combination of pathogenic categories and autopsies. (7) By semiquantitative visual assessments, peptides/GAD axon sprouting into the FD was greater in HS compared to mass lesion/idiopathic or autopsies. (8) Compared to mass lesion/idiopathic cases, in HS NPY outer molecular layer GVs were lower, SS GVs were not different, and GAD inner molecular layer GVs were higher. (9) Analyses comparing the two pathogenic categories and neuron densities with peptides/GAD axon sprouting found six comparisons that correlated sprouting with hilar and CA4 neuron losses, and four comparisons showing greater sprouting in HS compared to mass lesion/idiopathic.(ABSTRACT TRUNCATED AT 400 WORDS)
Analysis of Variance↗
Frontal lobe epilepsy. Some clinical characteristics.
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Adolescent↗
[Temporal-lobe epilepsy with psychosensory and gustatory attacks].
A variety of temporal epilepsy that manifested by paroxysms in the form of psychosensory and gustatory ones is described. A 20-year-old man was placed under observation. Since 14 years of age he demonstrated attack-like conditions with a sensation of the pushing apart and swelling in the head, of an increase of the head size, and unpleasant sickly sweet taste in the mouth. The attacks were accompanied by anxiety and general weakness. Neurological examination revealed left-handed hemisymptomatology, EEG demonstrated activity prevailing in the occipitotemporal leads on the right. The neuropsychological findings attested to the impairment of the structures of the right temporal lobe. Analysis of the clinical manifestations of epilepsy, of the neurological findings, and the neuropsychologist's conclusion made it possible to suggest the site of the epileptic focus in the field of the hippocamp on the right.
Adult↗
[Comments on the contribution by G. Homma and E. Niedermeyer. Subacute encephalopathy with seizures in chronic alcoholism].
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Adult↗
Handling seizure data: special problems.
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Anticonvulsants↗
Antiepileptic drug status in adult outpatients with mental retardation.
Charts of 100 patients with mental retardation and epilepsy from the community were reviewed to survey use of antiepileptic drugs and examine the relation of mental retardation and seizure type to antiepileptic drug status. Sixty patients were on monotherapy and 40, on two or three antiepileptic drugs. Most subjects had generalized tonic-clonic seizures (68%), but there was a trend for those with profound retardation to have relatively more mixed seizures. Subjects on more than one antiepileptic drug were less likely to have fully controlled seizures (50%). Individuals with mixed seizures were comparatively more likely to be on more than one antiepileptic drug and have uncontrolled seizures. Implications for clinical management of epilepsy in adults with mental retardation were discussed.
Adolescent↗
Subtemporal amygdalohippocampectomy for treating medically intractable temporal lobe epilepsy.
A SUBTEMPORAL AMYGDALOHIPPOCAMPECTOMY technique has been developed for mesial temporal lobe epilepsy. The conventional subtemporal approach has been modified to diminish temporal lobe retraction and the risk of damage to the temporal lobe. In the new technique, the surgeons' position has moved from above to below and the approach has been changed from anterolateral to posterolateral, thereby avoiding the voluminous and steeply inclined anterior temporal lobe. By this modified approach, it was unnecessary to remove the roof of the external auditory meatus and it was estimated that both the retraction pressure and the extent of temporal lobe retraction were reduced. To date, surgeons using this approach have operated on four patients with temporal lobe epilepsy whose epileptic foci were in the mesial temporal structure; the inferior temporal gyrus, the temporal tip, the vein of Labbé, and the ventral bridging veins were preserved. After surgery, two patients became completely free of seizures and the other two showed over 90% reduction in seizure frequency without neurological sequelae. Postoperative visual field examination revealed full visual fields without quadrantanopsia. This approach can preserve the temporal stem and lateral temporal lobe, it can be used to remove as much of the posterior hippocampus as necessary, and it can be extended to conventional lobectomy if it is indicated.
Adult↗