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Results for “Epilepsy, Generalized”

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PubMed2000

Epilepsy in the elderly.

PURPOSE: The aim of this study was to evaluate the clinical characteristics of elderly patients with epilepsy. METHODS: We retrospectively reviewed the clinical records of 190 patients (104 males and 86 females) aged 60 years or older at the time of study. RESULTS: Epilepsies were classified as generalized in 33 patients (17.4%), partial in 145 (76.3%), and undetermined in 12 (6.3%). Twenty-nine of 33 patients with generalized epilepsy were idiopathic, whereas all patients with partial epilepsy were symptomatic. Symptomatic partial epilepsy (SPE) began at all ages (2 to 81 years). Patients with early onset (< 20 years) showed the most unfavorable course in both seizure control and social adaptability. Patients with late onset (50 years or older) had no family history of epilepsy, and half of them had a past history of cerebrovascular disease or head injury as a presumed etiology. In patients with idiopathic generalized epilepsy (IGE), 25 of 29 had early onset, and a family history of epilepsy was found in 31%. Nineteen patients continued to have seizures after 50 years of age, albeit infrequently. Furthermore, 10 of them showed exacerbation around the age of 50. CONCLUSIONS: Most of the late onset epilepsies were SPE with a relatively good prognosis. General belief has held that seizure outcome in IGE is favorable, but some IGE patients show an increased seizure propensity in old age.

Adult↗

PubMed1997

Specificity of volumetric magnetic resonance imaging in detecting hippocampal sclerosis.

BACKGROUND: Magnetic resonance imaging (MRI)-based volumetric measurements of the hippocampal formation are useful in detecting unilateral hippocampal sclerosis (HS) in patients with temporal lobe epilepsy. In this pathologic entity, volumetric MRI analysis shows the epileptogenic structure to be atrophic when compared with the normal, nonepileptogenic side. Some authors have suggested that the radiological features of atrophy of medial temporal lobe structures are common in patients with complex partial seizures, but also are seen frequently in other seizure types and can occur even in patients without epilepsy. OBJECTIVE: To determine if seizures originating in extrahippocampal sites cause gliosis, cell loss, and atrophy of medial temporal lobe structures (i.e., HS). METHODS: We studied 110 patients with chronic epilepsy using volumetric MRI measurements of the hippocampal formation. Seventeen patients had pathologically proven HS, 27 patients had seizures due to extratemporal structural lesions, 15 patients had seizures caused by extrahippocampal temporal lobe lesions, 29 patients had primary generalized epilepsy, and 22 patients had secondary generalized epilepsy. RESULTS: All 17 patients with HS showed significantly reduced absolute hippocampal formation volumes of greater than 2 SDs below the mean of the control groups. The preoperative hippocampal formation volume measurements correlated well with the severity of HS on pathological examination. Hippocampal volumes were within the normal range in all patients with primary generalized epilepsy, secondary generalized epilepsy, extratemporal structural lesions, and extrahippocampal temporal lobe lesions. CONCLUSIONS: Seizures originating at extrahippocampal sites do not cause gliosis, cell loss, or atrophy of medial temporal structures. Significant reduction in hippocampal volumes is a specific marker for HS.

Adolescent↗

PubMed2001

Depression and Anxiety in Patients with Epilepsy.

The aim of this investigation was to study the interaction between depression/anxiety and epilepsy. One hundred fifty individuals with partial epilepsy, 70 with idiopathic generalized epilepsy, and 100 controls were administered two self-rating mood questionnaires (Zung and Stai) for the evaluation of depression and anxiety, respectively. The group with epilepsy was much more severely impaired than the controls according to both mood questionnaires; the patients with partial epilepsy, especially those with temporal lobe epilepsy (TLE), were more depressed and anxious than the patients with generalized epilepsy. The group with left TLE appeared to have the highest levels of depression and anxiety. The final results of our study confirmed that some mood disorders are common throughout the epilepsy population, especially in patients with left TLE. No correlation was noted between the frequency of seizures and onset of epilepsy and the results of the mood questionnaires. Moreover, no differences were found in depression and anxiety between males and females among both left focus and right focus epilepsy patients.

Journal Article↗

PubMedDate not supplied

[Etiology of epilepsy in adolescents].

OBJECTIVE: To review the etiology of epilepsies in adolescent patients treated at the Child Neurology Clinic, during the years 1995-1997. PATIENTS AND METHODS: All 13 years old patients, or older, were selected and considered adolescents. RESULTS AND CONCLUSIONS: A total of 863 patients with epileptic seizures were reviewed. Among them, 225 were epileptic adolescents and another 8 were adolescents with a single seizure or with several seizures clustering into a single event. Among the former, 163 suffered from partial epilepsy and 62 from generalized epilepsy. Partial epilepsies were distributed as: idiopathic (69), remote symptomatic (49) and cryptogenic (45). Generalized epilepsies were: idiopathic (22), cryptogenic (16) and cryptogenic-remote symptomatic (24). The latter included the Lennox-Gastaut syndrome, West syndrome, polymorphic epilepsy, etc. The etiology of these patients and related literature are reviewed in order to study the proper nosologic location of these entities.

Adolescent↗

PubMedDate not supplied

[Myoclonias and epilepsy].

INTRODUCTION: The myoclonias and epilepsies may be closely related as in the so-called myoclonic epilepsies. The myoclonic epilepsies form a heterogeneous group of epilepsies in which myoclonias and myoclonic seizures are the most relevant symptom. DEVELOPMENT: Following the classification of epileptic disorders into syndromes, we consider the most relevant electroclinical characteristics of the different epilepsies seen from the first year of life to old age. Regarding the idiopathic focal epilepsies we consider epilepsy with Rolandic paroxysms in which, in some patients, negative myoclonus and a myoclonic variant of reading epilepsy may occur. Negative epilepsy and continuous partial epilepsy are considered with the cryptogenic and symptomatic focal epilepsies. In the idiopathic generalized epilepsies we consider the benign myoclonic epilepsy of infancy and its reflex variant, juvenile myoclonic epilepsy and palpebral myoclonias with absences. In the group of cryptogenic and symptomatic generalized epilepsies we analyze epilepsy with myoclonic absences, myoclonic-static epilepsies, the myoclonic variant of the Lennox-Gastaut syndrome, progressive myoclonic epilepsies, adult familial myoclonic epilepsies and the myoclonic epilepsies of the elderly. Finally, among the unclassified group of epilepsies, we briefly consider severe myoclonic epilepsy of infancy and the myoclonic epilepsies associated with static encephalopathy.

Epilepsies, Myoclonic↗

PubMed1980

Interictal memory and language impairment in temporal lobe epilepsy.

Memory and language were evaluated in patients with temporal lobe epilepsy and generalized epilepsy. Subjects were matched for age, duration of illness, and seizure frequency, and grouped according to the electroencephalographic results and seizure type into right temporal, left temporal, and generalized. In formal tests of intelligence, auditory and visual memory, and language, a significant difference was noted only on a confrontation naming test. The mean score on this test was considerably lower in the left temporal group; right temporal and generalized groups scored in the normal range. This correlated with impairment on many verbal subtests of intelligence and memory. These results suggest that the interictal memory impairment of temporal lobe epilepsy may be an anomia and that the anomia may contribute to impairment of verbal learning and memory; both circumlocution and circumstantiality may compensate for anomia.

Adult↗

PubMed1991

Double-blind placebo-controlled trial of flunarizine as add-on therapy in refractory childhood epilepsy.

Flunarizine (FLN) has been suggested as an add-on treatment in drug-resistant epilepsy patients. In view of the discordant experiences and of the paucity of controlled trials in children, we studied its effectiveness in 20 patients aged 6 to 18 years (10 males and 10 females), affected by drug-resistant epilepsy. 14 had symptomatic generalized epilepsy (the Lennox-Gastaut syndrome in 10; other forms in 4); 3 had cryptogenic generalized epilepsy (the Lennox-Gastaut syndrome in 2; myoclonic absences epilepsy in 1); 3 had symptomatic partial epilepsy (temporal lobe epilepsy). 7 of them were withdrawn: only 1 because of side effects. An initial four-month baseline pretrial period was followed by two four-month periods of administration of FLN or a placebo, under double blind conditions, in a randomized sequence. Preexisting antiepileptic (AEDs) medication was maintained at a constant dose throughout the study. FLN was administered as drops in a single evening dose of 5 mg (patients less than 10 years) or 10 mg. (patients greater than 10 years). During the pretrial phase, after phase 1 and phase 2, a waking EEG was recorded and blood samples were taken for hematology, hepatic-function tests, and AED serum levels. The evaluation of the activity of FLN was based on the total number of seizures. A 30-60% reduction in seizure frequency was found in 5 out of the 13 patients completing the trial (no changes occurred in the remainders). This result did not appear to be due to changes in the plasma levels of the AEDs. No significant differences were seen in the EEG paroxysmal activity in the three phases of the study. Side effects were rare. The serum FLN levels ranged between 16.4 and 109 ng/ml. It seems that the antiepileptic properties of FLN need further validation, particularly in childhood.

Adolescent↗

PubMed1997

An audit of the organization of adult epilepsy services in the UK: a comparative review of epilepsy and general neurology clinics.

A survey of all consultant neurologists was carried out to investigate the current provision of hospital-based adult epilepsy services in the UK and to compare the level of services offered by epilepsy and general neurology clinics. The valid response rate was 75%. Fifty-four epilepsy clinics were identified led by 43 neurologists in 46 hospitals. Over half the major neurological centres represented in the dataset had epilepsy clinics (31/58). Epilepsy clinics were significantly more likely than general neurology clinics to have on-site provision of a wide range of relevant investigations and associated specialists, and also shorter waiting times to see new patients with suspected seizures. There were also significant differences between epilepsy clinics and general neurology clinics in the provision of written information and counselling. Epilepsy clinics have definite advantages for patients over general neurology clinics in improving access to investigations and specialists and provision of psychosocial support, but the extent to which these translate into positive health outcomes needs further evaluation. A second survey of directors of public health concerning purchasing arrangements for epilepsy services confirmed that purchasers, as yet, are making little use of the contracting process to influence the quality of epilepsy services offered by providers of care.

Ambulatory Care Facilities↗

PubMed2004

[Genetic background of epilepsies].

In this article we review epilepsies with monogenic inheritance. Most of these diseases are caused by abnormal function of ligand- and voltage gated ion channels caused by a genetic defect, therefore belonging to the channelopathies. From the inherited epilepsies the genetics of the autosomal dominant partial epilepsies is clarified the best. Mutations of the nicotinic acetylcholine receptor subunits are found in familial nocturnal frontal lobe epilepsy, while defects in the voltage gated potassium channels (KCNQ2 and KCNQ3) have been identified in benign familial neonatal convulsions. Familial temporolateral epilepsy was associated with mutations of a tumor suppressor gene. From the generalized epilepsies, the syndrome of generalized epilepsy with febrile seizures plus (GEFS+) can be caused by mutations of the sodium channel subunits and of the GABAA receptor subunits. These important results would probably lead to new findings in the genetics of the more common forms of idiopathic generalized epilepsies, which have presumed polygenic origin. Although without definite conclusions, sodium channel and GABA receptor dysfunction is presumed. The accumulated knowledge about channelopathies enables insight to the cellular mechanism of epileptogenesis as well.

Chromosomes, Human, X↗

PubMed2005

Cerebral damage in epilepsy: a population-based longitudinal quantitative MRI study.

PURPOSE: Whether cerebral damage results from epileptic seizures remains a contentious issue. We report on the first longitudinal community-based quantitative magnetic resonance imaging (MRI) study to investigate the effect of seizures on the hippocampus, cerebellum, and neocortex. METHODS: One hundred seventy-nine patients with epilepsy (66 temporal lobe epilepsy, 51 extratemporal partial epilepsy, and 62 generalized epilepsy) and 90 control subjects underwent two MRI brain scans 3.5 years apart. Automated and manual measurement techniques identified changes in global and regional brain volumes and hippocampal T2 relaxation times. RESULTS: Baseline hippocampal volumes were significantly reduced in patients with temporal lobe epilepsy and could be attributed to an antecedent neurologic insult. Rates of hippocampal, cerebral, and cerebellar atrophy were not syndrome specific and were similar in control and patient groups. Global and regional brain atrophy was determined primarily by age. A prior neurologic insult was associated with reduced hippocampal and cerebellar volumes and an increased rate of cerebellar atrophy. Significant atrophy of the hippocampus, neocortex, or cerebellum occurred in 17% of patients compared with 6.7% of control subjects. Patients with and without significant volume reduction were comparable in terms of seizure frequency, antiepileptic drug (AED) use, and epilepsy duration, with no identifiable risk factors for the development of atrophy. CONCLUSIONS: Overt structural cerebral damage is not an inevitable consequence of epileptic seizures. In general, brain volume reduction in epilepsy is the cumulative effect of an initial precipitating injury and age-related cerebral atrophy. Significant atrophy developed in individual patients, particularly those with temporal lobe and generalized epilepsy. Longer periods of observation may detect more subtle effects of seizures.

Adolescent↗

PubMed2000

Refractory childhood epilepsy and factors related to refractoriness.

To clarify the characteristics of refractory childhood epilepsy, we compared recent refractory cases and those of approximately 15 years ago, all of which were seen at the Okayama University Hospital. We also analyzed predictive factors related to refractoriness in the recent refractory cases. Among the recent refractory cases, the proportion of localization-related epilepsies increased, and the proportion of generalized epilepsies decreased compared to historical cases. In generalized epilepsies, the proportion of cases with Lennox-Gastaut syndrome decreased to less than half. In localization-related epilepsies, the proportion of cases with frontal lobe epilepsy increased. The proportion of cases with unknown causes decreased to less than half. Of the cases with known causes, postencephalitis/postencephalopathy and focal cortical malformation, including tuberous sclerosis, accounted for most of the cases. More of the recent refractory cases were treated with high-dose AED monotherapy, compared to more polytherapy in the cases of 15 years earlier. The following factors were related to future refractoriness: less than 1 year of age at onset of seizures, the presence of underlying pathology, status epilepticus. changes in type of epilepsy during the clinical course, and neonatal seizures. Regarding EEG findings of cases that had localization-related epilepsies at the end of follow-up, focal spike-waves associated with diffuse spike-waves on the first EEGs indicated future refractoriness.

Age of Onset↗

PubMed1999

Possibilities of non-pharmacological conservative treatment of epilepsy.

This study set out to assess the effect of non-pharmacological conservative (NPC) interventions as alternatives to antiepileptic pharmacotherapy. A prospective follow-up cohort study was conducted in an outpatient seizure clinic of a referral center for epilepsy. Twenty-five patients (nine males, 16 females) aged 16-45, with at least two well-described epileptic seizures, were included who had rejected antiepileptic pharmacotherapy. Twelve had idiopathic generalized epilepsy, 11 had symptomatic or cryptogenic localization-related epilepsy, and two had epilepsy with generalized and focal signs. Twenty-three of the patients were followed for more than 2 years. The patients were treated with arrest after focal seizure onset (2 cases), sensory protection against reflex seizures (3 cases), avoidance of non-specific seizure-precipitating factors ('life hygiene', 16 cases), and/or miscellaneous interventions (8 cases). The main outcome measures were complete seizure control (more than 2 years) or sufficient improvement to continue with NPC treatment alone. Eight of the 23 patients were completely seizure free for more than 4 years, and three were sufficiently improved to continue NPC treatment without drugs. Trends were observed for patients with idiopathic generalized epilepsies with less than seven convulsive seizures, and with only one seizure type to respond better to NPC treatment. The duration of epilepsy, and the finding of generalized epileptiform discharge in the EEG had no influence on the outcome. Rational NPC treatments which are aimed at specific factors in the precipitation and development of epileptic seizures can be useful therapeutic alternatives for patients with milder forms of epilepsy. Apart from photosensitive patients, those most likely to profit are patients with idiopathic generalized epilepsy, a maximum of six generalized tonic-clonic seizures which were precipitated by lack of sleep or excessive alcohol intake, and with no or rare concomitant absences. In such cases, NPC treatment may be as effective as pharmacotherapy and gives the patient a positive experience of regained self-control.

Adolescent↗

PubMed1997

Development of hippocampal atrophy: a serial magnetic resonance imaging study in a patient who developed epilepsy after generalized status epilepticus.

PURPOSE: To investigate changes in hippocampal volume. METHODS: We used serial magnetic resonance imaging (MRI) in a patient who developed chronic epilepsy after having generalized tonic-clonic status epilepticus (SE). Five MRI investigations were performed during SE and a 58-month follow-up period. Hippocampal volumetric measurements and coregistration of scans were performed to detect hippocampal atrophy. RESULTS: During status both mesiotemporal regions returned a high signal on T2-weighted images. Two months after the onset of SE, bilateral hippocampal atrophy was detected. Further progressive hippocampal atrophy was detected in the subsequent 58 months by both hippocampal volumetric measurements and coregistration of scans. CONCLUSIONS: Our findings suggest that hippocampal atrophy is a process that may continue after the end of the SE.

Adult↗

PubMed2000

Refractory idiopathic absence status epilepticus: A probable paradoxical effect of phenytoin and carbamazepine.

PURPOSE: To compare the frequency of seizures and status epilepticus and their response to first-line drugs in patients with idiopathic generalized epilepsies receiving carbamazepine or phenytoin to those receiving other drugs or no treatment. METHODS: We performed a retrospective chart review of all cases of idiopathic generalized epilepsies treated by the authors between 1985 and 1994. We compared seizure frequency and mean intravenous benzodiazepine dose required to control absence status epilepticus, intraindividually in subjects on carbamazepine or phenytoin before and after discontinuation of these compounds, and interindividually to subjects without treatment or receiving other drugs. RESULTS: Bouts of absence or tonic-clonic status epilepticus and seizures in subjects treated with phenytoin or carbamazepine at therapeutic concentrations were considerably more frequent and proved intractable to treatment with valproic acid or benzodiazepines, compared with a cohort of subjects also with idiopathic generalized epilepsies, but naive to, or receiving subtherapeutic or therapeutic doses of other agents. CONCLUSIONS: Our observations strongly suggest that therapeutic concentrations of phenytoin and carbamazepine exacerbate idiopathic generalized epilepsies. Subjects in whom absence is one of the seizure types seem at a particularly high risk for responding paradoxically. These findings underscore the value of accurate classification of seizures and particularly the syndromic approach to diagnosis and point to the potential for iatrogenic complications with indiscriminate use of antiseizure drugs.

Acute Disease↗

PubMed2006

Bilateral perysilvian polymicrogyria in Chiari I malformation.

CASE REPORT: We report on a 7-year-old girl with generalized epilepsy and mental retardation. DISCUSSION: Neurologic examination was normal and only facial dysmorphic features, compatible with frontonasal dysplasia, were observed. However, magnetic resonance imaging (MRI) revealed Chiari I malformation together with bilateral opercular polymicrogyria. To our knowledge, this is the first report of the association of these developmental disorders. This condition raises questions regarding the ethiopathogenetic classification of Chiari spectrum and as to whether embryologic and genetic causes could be potentially interconnected.

Arnold-Chiari Malformation↗

PubMed1992

Kindling and electrode effects on the benzodiazepine receptors density of olfactory bulb and hippocampus after olfactory bulb kindling.

The olfactory bulb (OB) kindling is a model of limbic secondary generalized epilepsy. Ten days after the completion of OB kindling, we have studied the long term effects of both electrode insertion and kindling on the binding of [3H]diazepam to crude mitochondrial fractions. On the one hand, we have shown that electrode implantation in sham-operated controls induced an obvious increase in benzodiazepine (BZD) receptor density (Bmax) only at the site of the electrode in comparison to sham-unoperated rats. These results might indicate an additional mechanism extending earlier observations reported by others, who have shown that prolonged electrode implantation induced changes in sham-operated and kindled rats. On the other hand, the long lasting effect of OB kindling on the binding parameters of [3H]diazepam was examined in the focus and in the hippocampus. The results indicate a bilateral increase of BZD receptors in the OB and an ipsilateral increase in the hippocampus. These changes might be a regulation phenomenon in response to a hyperexcitability state and to focal stimulations.

Animals↗

PubMedDate not supplied

Brain perfusion SPECT in children with frequent fits.

We studied 14 children with frequent fits using 99mTc-HM-PAO single photon emission computed tomography (SPECT). There were 11 patients with partial secondary generalized epilepsy (PSGE) and 3 with Lennox-Gastaut syndrome (LGS). The typical regional cerebral blood flow (rCBF) finding in PSGE was a single area of abnormally low perfused cortex, and that in LGS, multiple hypoperfused areas. Clinically, the LGS patients were more severely affected. SPECT was more sensitive in detecting abnormalities than EEG, CT or MRI. Extensive impairment of rCBF may thus indicate unfavourable development of intellectual performance and poor seizure control.

Adolescent↗

PubMed2005

Interictal EEG as a physiological adaptation. Part I. Composition of brain oscillations in interictal EEG.

OBJECTIVE: In the present experimental study, we examined the compositions of brain oscillations and their temporal behavior in broad frequency band (0.5-30 Hz) in interictal EEG without epileptiform abnormalities during generalized epilepsy in resting conditions. METHODS: The exact compositions of brain oscillations and their percent ratio were assessed by a probability-classification analysis of short-term EEG spectral patterns (SPs), which reveals temporal dynamics of these SPs and results in the probability-classification profile. RESULTS: It has been demonstrated that the interictal EEG was characterized by (a) a shift towards higher frequencies in all observed brain oscillations, (b) an increased amount of polyrhythmic activity, (c) a decrease in SP types diversity, (d) a decreased relative incidence of the SP type change in the transition between neighboring EEG epochs of the same EEG, and (e) an increased temporal stabilization periods of polyrhythmic activity. All these were observed in distributed brain areas. CONCLUSIONS: It was suggested that these findings reflect a disorganization of neurodynamics in the epileptic brain. At the same time, the fact that all these indices were significantly different from surrogate EEG reflects a non-occasional and thus, most likely, an adaptive nature of the microstructural reorganization of interictal EEG. SIGNIFICANCE: Parameters of interictal EEG without the signs of epileptiform activity can be considered as additional information in premorbid diagnostics of epistatus.

Adaptation, Physiological↗