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Results for “Epilepsy, Complex Partial”

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PubMed1996

Postictal psychosis: a comparison with acute interictal and chronic psychoses.

We studied 30 patients with postictal psychosis and compared them with 33 patients with acute interictal psychosis and 25 patients with chronic psychosis. All patients had either complex partial seizures (CPS) or EEG temporal epileptogenic foci. Patients with postictal psychosis had a high incidence of psychic auras and nocturnal secondarily generalized seizures. The most striking feature that distinguished postictal psychosis from both acute interictal and chronic psychoses was phenomenological: the relatively frequent occurrence of grandiose delusions as well as religious delusions in the setting of markedly elevated moods and feeling of mystic fusion of the body with the universe. In addition, postictal psychosis exhibited few schizophreniform psychotic traits such as perceptual delusions or voices commenting. Reminiscence, mental diplopia, and a feeling of impending death were also fairly frequent complaints of patients with postictal psychosis. Interictal acute psychosis and chronic epileptic psychosis were psychopathologically similar. Although acute interictal and chronic epileptic psychoses could simulate schizophrenia, postictal psychosis results in a mental state quite different from that of schizophrenic psychosis.

Adult↗

PubMed1993

Wisconsin Card Sorting Performance: effects of age of onset of damage and laterality of dysfunction.

Wisconsin Card Sorting Performance was examined in patients with complex partial seizures of left (n = 35) or right (n = 42) temporal-lobe origin. Our findings suggest that poor performance, in the form of perseveration, occurs in the context of nonfrontal dysfunction and depends not only on the laterality of the epileptogenic disturbance but also on the age of onset of the damage. The ability to shift set is most impaired by left temporal-lobe dysfunction, but only when the damage occurs very early in life. Left temporal-lobe dysfunction after one year of age leaves sorting behavior relatively intact. Perseveration may also occur in the context of right temporal-lobe dysfunction, regardless of the age of onset of the damage, although the deficit tends to be less marked. Finally, the occurrence of the deficit does not depend upon the status of the cerebral speech pattern or general intellectual level.

Adult↗

PubMed2006

[A case of Sturge-Weber syndrome with severe temper tantrum].

We report a case of Sturge-Weber syndrome with intractable epilepsy presenting complex partial seizures(CPSs) and severe temper tantrum successfully treated with anterior temporal lobectomy. A 23-month-old girl without facial angioma presented with seizures from 8 months after birth. Neuroradiological examination demonstrated angioma in the left temporooccipital lobes and calcification in the left occipital lobe. Thus she was diagnosed as having Sturge-Weber syndrome. Her parents sought medical advice because of intractable and more frequent CPSs and a change in temperament manifesting as severe temper tantrums. Interictal electroencephalogram (EEG) showed relatively mild abnormal slow wave discharges in the left temporal region. The patient underwent left anterior temporal lobectomy based on intraoperative electrocorticography (ECoG) findings. Histopathological examination demonstrated gliotic change in the amygdala. After the surgery, she has remained seizure-free for 14 months while taking anticonvulsants and temper tantrums ultimately showed remission 10 months following surgery. This case may indicate that severe temper tantrum was associated with a change in amygdala structures.

Amygdala↗

PubMed1996

The effects of human hippocampal resection on the serial position curve.

The purpose of this study was to examine the contribution of the human hippocampal formation to the classic serial position curve. Seventy-seven patients who underwent anterior temporal lobectomy (ATL) (47 left, 30 right) were administered a list learning task before and after surgery, and changes in the serial position curve were examined. Forty nonsurgical patients with complex partial seizures were tested at comparable intervals and served as controls. Changes in the serial position curve were seen only after left ATL, and almost exclusively among patients without hippocampal sclerosis. Patients without left hippocampal sclerosis, and who therefore underwent resection of hippocampus that was to a considerable degree structurally (and presumably functionally) intact, showed significant declines in recall from the primacy and middle portions of the list compared to all other groups. There was no change in the recency portion of the list. Patients with left hippocampal sclerosis showed only a modest decline in recall from the middle region compared only to the control group, and the right ATL groups did not show any significant changes in serial position recall. These findings demonstrate the contribution of the left hippocampus to those discrete portions of the serial position curve which rely on secondary memory, and have implications for assessing the effects of ATL on memory function.

Adult↗

PubMed1994

[Clinical manifestations in complex partial crisis of the temporal lobe: a video-electroencephalographic study].

We analysed 27 complex partial seizures arising from the temporal lobes recorded on videotape simultaneously with the EEG emphasizing the motor manifestations specially dystonic posturing, ictal paresis and head and eye forced deviation (version). The temporal lobe origin of the seizures was based on the agreement of many scalp-sphenoidal or zygomatic interictal and ictal EEG recordings, CT and MRI findings, interictal and, in some patients, ictal SPECT studies. 8 patients had surgery. In 5 from 7 patients who had temporal lobectomy, mesial temporal sclerosis was the anatomopathological finding and in one patient who had selective amigdalohippocampectomy, hemosiderosis and gliosis probably due to bleeding of a posterior cerebral artery giant aneurysm was found. All patients have been seizure free after surgery. While dystonic posturing and ictal paresis, present in 18 seizures (66.6%), were excellent as lateralizing seizure signs, since they were always contralateral to the ictal onset, contralateral and ipsilateral versive head and eye movements were observed.

Adult↗

PubMed1997

Cognitive and quality of life effects of differing dosages of tiagabine in epilepsy.

Tiagabine blocks the uptake by neurons or glia of synaptically released GABA resulting in prolonged GABAergic activity and decreased likelihood of epileptic seizures. We evaluated the cognitive and quality of life effects of tiagabine in a double-blind, add-on, placebo-controlled, parallel, multicenter, dose-response efficacy study in patients with focal epilepsy whose complex partial seizures were difficult to control. One hundred sixty-two patients provided cognitive and quality of life data for the analyses and received the following treatments: placebo (n = 57), 16 mg/d tiagabine (n = 34), 32 mg/d tiagabine (n = 45), or 56 mg/d tiagabine (n = 26) at a fixed-dose for 12 weeks after a 4-week dose titration period. Eight cognitive tests and three measures of mood and adjustment were administered during the baseline period and again during the double-blind period near the end of treatment (or at the time of dropout). The patient groups were similar at entry into the study. Results showed no clinically important changes with the addition of tiagabine on the test battery. Although this is an encouraging finding, it remains for future investigations to determine the cognitive and behavioral effects of tiagabine either as monotherapy or in relation to other antiepileptic drugs.

Adolescent↗

PubMed2003

Seizure detection: correlation of human experts.

OBJECTIVE: The description and application of a new, overlap-integral comparison method and the quantification of human vs. human accuracies that can be used as goals for algorithms. METHODS: Four human experts marked ten 8 h electroencephalography (EEG) records from seizure patients. The seizures varied in origin and type, including complex partial, generalized absence, secondarily generalized and primary generalized tonic-clonic. The traditional any-overlap comparison method is used in addition to the overlap-integral method, which is sensitive to the correct placement of the seizure endpoints. RESULTS: The number of events marked by each reader ranged from 57 to 77. The average any-overlap sensitivity and false positives per hour rate are 0.92 and 0.117. The average overlap-integral correlation, sensitivity and specificity are 0.80, 0.82 and 0.9926. As expected, the correspondence between readers is high, but confounding issues resulted in overlap-integral sensitivities less than 0.5 for 10% of the records. Seven percent of the any-overlap sensitivities are less than 0.5. A comparison of the methods by record shows that the overlap-integral specificity and the any-overlap false positive rate measure different features. CONCLUSIONS: There was little variation between readers and they were essentially interchangeable. High seizure rate (many per hour), short seizure durations (<10 s) and long seizure durations (approximately 10 min) with ambiguous offsets can complicate the analysis and result in poor correlation. There may be any number of unmarked events in rigorously marked records and it may be preferable to use records from non-epilepsy patients to compute the false positive rate. The any-overlap and overlap-integral comparison methods are complementary. SIGNIFICANCE: Correlation between expert human readers can be low on some records, which will complicate testing of seizure detection algorithms.

Algorithms↗

PubMed2001

Time from ictal subdural EEG seizure onset to clinical seizure onset: prognostic value for selecting temporal lobectomy candidates.

Long-term subdural EEG recording was performed to test the hypothesis that the duration from ictal subdural EEG seizure onset (ECOT) is prognostic for seizure-free outcome following temporal lobectomy. In 48 patients with complex partial seizures, temporal lobectomy was based on invasive localization of the ictal seizure focus. Subdural EEG data were analyzed for association with seizure-free outcome (seizure-free: yes or no) at a minimum of one year following temporal lobectomy. As the duration from ictal subdural EEG seizure onset to clinical seizure onset increased, the odds of being seizure-free postoperatively increased. The best fitting statistical model for predicting seizure-free outcome included seizure onset (unilateral vs. bilateral) and duration from ictal subdural EEG seizure onset to clinical seizure onset. While selection of temporal lobectomy candidates has increasingly emphasized noninvasive recording, some scalp-EEG monitored patients cannot be offered surgery for various reasons, one of which may include ictal EEG seizure onset following clinical seizure onset. When subdural EEG monitoring is performed for selection of temporal lobectomy candidates, analysis of the duration from subdural EEG seizure onset to clinical seizure onset should improve the prognostic value of the subdural EEG data for seizure-free outcome following temporal lobectomy.

Adolescent↗

PubMed2005

The effect of age and structural lesions on postictal language impairment.

The duration of postictal language dysfunction following a temporal lobe complex partial seizure (TLCPS) is longer when the seizure originates in the dominant hemisphere. However, the effects of older age and the presence of a structural lesion ipsilateral to the area of origin of the seizure remain unknown. Postictal language delay (PILD) was analyzed in relation to age and presence of a structural lesion in 47 patients, 28 with dominant TLCPSs and 19 with nondominant TLCPSs (total 173 seizures). Mean ages of the groups were 32.5 years (range: 16-68) and 36.1 years (range: 21-50), respectively. Nonsclerotic structural lesions were found by magnetic resonance imaging in 13 patients, eight with seizures in the dominant hemisphere and five with seizures in the nondominant hemisphere. Age did not affect PILD regardless of the lateralization of the seizures. The presence of a structural lesion significantly prolonged PILD only in the patients with nondominant TLCPS (p = 0.019). In conclusion, the anatomical site of seizure onset may not be the only determinant of the nature of the postictal state. PILD can provide important information on seizure localization and spread.

Adolescent↗

PubMed2006

Interictal regional cerebral blood flow and electrical source analysis in patients with complex partial seizures.

BACKGROUND: Recently, new methods of EEG source analysis have been developed. Dipole modeling and brain distributed source analysis localize in three-dimensions the origin of the electrical source of spikes registered in EEG. With single photon emission computed tomography (SPECT), it is possible to detect hypo- and hyperperfusion zones. Our aim in this study is to compare the regions where the electrical sources are detected, with the hypoperfusion regions in patients with complex partial seizures (CPS). METHODS: The concordance of localization with dipole analysis, brain distributed source analysis and regional cerebral flow blood in patients with CPS was studied. The hypoperfusion zones detected with interictal SPECT were compared with electrical sources localized with brain electric source analysis (BESA) and brain distributed source analysis with variable resolution electromagnetic tomography (VARETA). RESULTS: Hypoperfusion zones were found to localize with the origin of dipoles in 18 cases (90%), between lobes in 17 (85%) and between mesial or lateral regions in the temporal lobe in 12 cases (60%). With VARETA, agreement between side of hypoperfusion and electrical current source localization was found in 18/20 cases (90%), with lobes in 17 (85%) and with mesial or lateral regions of the temporal lobe only in 2 cases (10%). CONCLUSIONS: Hypoperfusion zones in interictal SPECT of patients with CPS are in agreement with the origin of dipoles in 85% of the cases, but in specifics zones of temporal lobe the agreement falls to 60%. The concordance of hypoperfusion zones was better with dipole analysis than with VARETA.

Brain Mapping↗

PubMed1997

Gabapentin monotherapy: II. A 26-week, double-blind, dose-controlled, multicenter study of conversion from polytherapy in outpatients with refractory complex partial or secondarily generalized seizures. The US Gabapentin Study Group 82/83.

This study evaluated gabapentin monotherapy in 275 patients with medically refractory complex partial or secondarily generalized seizures who were taking one or two antiepileptic drugs (AEDs). Following an 8-week baseline, patients received randomized dosages of gabapentin (600, 1,200, or 2,400 mg/d) during a 26-week double-blind phase comprising 2 weeks gabapentin add-on therapy, an 8-week AED taper, and a 16-week gabapentin monotherapy period. Patients exited the study if they experienced a protocol-defined exit event. Results of outcome measures, including time to exit, completion rate, and mean time on monotherapy, showed no significant differences among dosage groups. Possible reasons for this lack of a dose-response relationship include withdrawal seizures and the limited range of gabapentin dosages studied. Overall, 20% of patients completed the study. Completion rates were higher among patients who had discontinued one AED (23%) than two AEDs (14%), and higher among patients who were not withdrawn from carbamazepine (27%) than among those who were (16%).

Acetates↗

PubMedDate not supplied

Benign partial epilepsy with secondarily generalized seizures in infancy.

Seven infants with benign idiopathic partial epilepsy presented with apparently generalized tonic-clonic seizures (GTCs) which proved to be partial seizures evolving to secondarily generalized seizures. All were easily controlled with phenobarbital (PB) or carbamazepine (CBZ), and remained seizure-free > 3 years even after discontinuation of medication, and had a normal developmental outcome. The initial seizure manifestation consisting of motion arrest, staring or blank eyes, or crying associated with focal paroxysmal discharges was followed by GTCs in accordance with generalization of paroxysmal discharges. Four infants had a family history of benign type of childhood convulsions. The term "benign partial epilepsy in infancy" is proposed to combine this syndrome with the previously described benign infantile epilepsy with complex partial seizures.

Age Factors↗

PubMedDate not supplied

Rapid cessation of focally induced generalized seizures in rats through microinfusion of lidocaine hydrochloride into the focus.

An experimental animal model of complex partial seizures which become secondarily generalized is produced by microinfusion of the GABA antagonist bicuculline (BIC) into the deep prepiriform cortex (DPC) of rats. In the present study, we investigated the effects of microinfusion of the local anesthetic, lidocaine hydrochloride, directly into the BIC focus in the DPC and demonstrated that direct inactivation of the focus arrested a focal seizure that was in progress. A measure of the integrated amplitude of the electrocorticogram (ECoG) and behavioral seizure scores from unanesthetized and freely moving rats were used to address this question quantitatively. Microinfusion of 2% lidocaine hydrochloride into the BIC focus significantly reduced the integrated amplitude of the ECoG to levels that did not differ from baseline in either hemisphere (mean = 112% ipsilateral, 99% contralateral), whereas saline microinfusion had no effect (mean = 175% ipsilateral, 125% contralateral). Moreover, ECoG reductions after lidocaine were present as soon as the microinfusion was complete. Behaviorally, clonic seizure severity was assessed on a rating scale of 0-5. Lidocaine microinfusion significantly reduced the seizure scores to values not different from baseline during the first postinfusion measurement period (i.e., 30 s). Microinfusion of saline alone also significantly reduced behavioral seizure severity, although to a lesser degree and not as rapidly as lidocaine. This effect suggests the need for caution in interpretation and design of studies investigating the anticonvulsant effects of various pharmacologic agents when microinfusions are used.

Animals↗

PubMedDate not supplied

Regional "rigidity" of background EEG activity in the epileptogenic zone.

Spectral analysis of interictal background EEG activity recorded through foramen ovale (FO) electrodes during monitoring (mean 5.8 days per patient) was studied in 10 medically refractory complex partial seizure (CPS) patients who were candidates for epilepsy surgery. Data of the spectral analysis was plotted as compressed spectral array (CSA) with spectral edge frequency (SEF) markers. For each patient, time-varying fluctuations of the SEF markers were compared visually and by a computer-assisted method between two symmetrical FO electrode EEG channels recording from both mesiobasotemporal lobes (MTL). The amount of asymmetrical variations of the SEF markers ("rigidity" phenomenon) was first determined visually and then quantified by the computer-assisted method. These findings were correlated with the results of other clinical tests, including FO electrode-recorded seizure onset (FO ict), positron emission tomography with [18F]fluorodeoxyglucose (FDG-PET), and magnetic resonance imaging (MRI) to investigate whether the rigidity phenomenon could lateralize the primary epileptogenic zone. The rigid side had 80, 70, and 60% coincidence rates with the pathologic side indicated by FDG-PET, FO ict, and MRI, respectively, in a single test. We conclude that the rigidity phenomenon of FO electrode-recorded interictal background EEG activity is a valuable sign for lateralization of the primary epileptogenic zone in MTL epilepsy. The relative invariance of SEF may be caused by interictal deafferentation of epileptic neurons.

Adult↗

PubMed1996