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PubMed1985

Intracortical inhibitory mechanisms are preserved in feline generalized penicillin epilepsy.

Intracortical inhibition elicited by direct cortical stimulation or by stimulation of the cerebral peduncle, the latter inducing recurrent inhibition of cortical neurons, is not significantly affected by intramuscular injection of penicillin sufficient for inducing the syndrome of feline generalized penicillin epilepsy characterized by generalized spike and wave (SW) discharges in the EEG. This raises to four the number of paradigms of presumably postsynaptic inhibition resistant to penicillin concentrations sufficient to produce generalized SW discharges, a form of epileptic discharge which thus cannot be attributed to blockage of the forms of intracortical postsynaptic inhibition so far tested.

Animals↗

PubMed1999

Postictal nose-rubbing in the diagnosis, lateralization, and localization of seizures.

BACKGROUND: Semiology is very useful in the diagnosis and classification of seizures. Some clinical signs occur primarily with specific localization-related epilepsies. OBJECTIVE: To evaluate postictal nose-rubbing as a potential diagnostic sign and a potential lateralizing or localizing indicator. METHODS: We reviewed presurgical prolonged video-EEG results of 50 consecutive patients with right temporal lobe epilepsy (TLE), 50 consecutive patients with left TLE, 50 consecutive patients with frontal lobe epilepsy, 11 consecutive patients with generalized epilepsy, and 100 consecutive patients with nonepileptic events. Videotapes of all events were reviewed independently by two investigators who were blinded to the results of the monitoring. The episodes of nose-rubbing and the hand with which the patient rubbed the nose were recorded. RESULTS: Nose-rubbing occurred in 25 of 50 (50%) right TLE patients and in 21 of 50 (42%) left TLE patients. Approximately 90% of patients rubbed his or her nose with the ipsilateral hand. Nose-rubbing occurred in 5 of 50 (10%) frontal lobe epilepsy patients. Nose-rubbing was not seen in any patient with generalized epilepsy or nonepileptic events. Postictal nose-rubbing did not occur after secondarily generalized seizures. CONCLUSIONS: Nose-rubbing is an easily observed phenomenon, has high interobserver reliability, and provides useful lateralizing information in patients with TLE. It was less frequently seen in extratemporal lobe epilepsy and was not seen after generalized seizures or nonepileptic events.

Adolescent↗

PubMed1994

Progress in mapping human epilepsy genes.

The chromosomal loci for seven epilepsy genes have been identified in chromosomes 1q, 6p, 8q, 16p, 20q, 21q, and 22q. In 1987, the first epilepsy locus was mapped in a common benign idiopathic generalized epilepsy syndrome, juvenile myoclonic epilepsy (JME). Properdin factor or Bf, human leukocyte antigen (HLA), and DNA markers in the HLA-DQ region were genetically linked to JME and the locus, named EJM1, was assigned to the short arm of chromosome 6. Our latest studies, as well as those by Whitehouse et al., show that not all families with JME have their genetic locus in chromosome 6p, and that childhood absence epilepsy does not map to the same EJM1 locus. Recent results, therefore, favor genetic heterogeneity for JME and for the common idiopathic generalized epilepsies. Heterogeneity also exists in benign familial neonatal convulsions, a rare form of idiopathic generalized epilepsy. Two loci are now recognized; one in chromosome 20q (EBN1) and another in chromosome 8q. Heterogeneity also exists for the broad group of debilitating and often fatal progressive myoclonus epilepsies (PME). The gene locus (EPM1) for both the Baltic and Mediterranean types of PME or Unverricht-Lundborg disease is the same and is located in the long arm of chromosome 21. Lafora type of PME does not map to the same EPM1 locus in chromosome 21. PME can be caused by the juvenile type of Gaucher's disease, which maps to chromosome 1q, by the juvenile type of neuronal ceroid lipofuscinoses (CLN3), which maps to chromosome 16p, and by the "cherry-red-spot-myoclonus" syndrome of Guazzi or sialidosis type I, which has been localized to chromosome 10. A point mutation in the mitochondrial tRNA(Lys) coding gene can also cause PME in children and adults (MERFF).

Chromosome Mapping↗

PubMed1983

Feline generalized penicillin epilepsy: changes of glutamic acid and taurine parallel the progressive increase in excitability of the cortex.

A coinciding temporal sequence of electrophysiological and biochemical correlates of developing generalized penicillin epilepsy in cats may indicate a "cause and effect" relationship between the two phenomena. After intramuscular injection of penicillin, in the pre-epileptic state prior to the onset of spike-and-wave discharge, the cortical content of glutamic acid decreases. This change occurs when an increased amplitude of visual evoked potentials in association cortex heralds the approach of spike-and-wave activity. The decrease of glutamic acid and that of aspartic acid occur in parallel with an almost stoichiometric increase of glutamine, gamma-aminobutyric acid (GABA), or both, while taurine levels in the pre-epileptic state remain near normal. As the pre-epileptic progresses to the epileptic state, characterized by generalized 4-5 cycles/s spike-and-wave discharges, a failure of the glial capture mechanisms for taurine and glutamate appears to occur, since both amino acids are lost from the tissue and glutamine levels fall while GABA levels are maintained or become elevated but increasingly at the expense of aspartic acid. A presumed increase in interstitial glutamic acid concentration possibly in combination with subsequent failure of GABA inhibition appears the most plausible explanation for the increasing hyperexcitability during the development of feline generalized penicillin epilepsy.

Animals↗

PubMed1992

Neurocysticercosis and epilepsy in Peru.

This study was carried out to determine the prevailing type of epilepsy in neurocysticercosis. We also evaluated if it could account for the predominance of generalized epilepsy in Peru. We studied the records and EEGs of 49 cases of neurocysticercosis, representing 5.9% of all hospital admissions. Cysticercosis was diagnosed using clinical, blood, CSF (complement fixation, ELISA, immunoblot) and CT scan criteria. We found 49 epileptic patients. Their type of epilepsy was as follows: 35 subjects had generalized epilepsy and 14 had partial epilepsy (5 motor partial, 5 complex partial, both with secondary generalization and 4 motor partial). All but 3 patients were over 25 years old (mean 33 years). We conclude that generalized epilepsy is frequent among cysticercosis patients and that it may account, partially, for the predominance of generalized seizures in Peru and in other areas of South America where cysticercosis is endemic.

Adolescent↗

PubMed1981

[Electro-clinical and developmental forms of epilepsy as a function of their appearance at different ages of life].

The authors review the different electroclinical varieties and the evolution of epilepsy that appear in the six principal age groups: newborn, infancy, childhood, adolescence, adult and aged. The aim of this study is to answer the following questions: on one hand to find out if there exists in newborn, infant or young child, a form of epilepsy entirely functional, dependent on a constitutional epileptic predisposition transmitted on a genetic basis, which correspond to the primary generalized epilepsy of the other age groups. If that is so, to find out this mode of expression. On the other hand, to confirm whether the proportion of primary generalized epilepsy varies according to the different ages of life, revealing a chance in the predisposition during life. The authors propose the following answers to the above-mentioned questions: there exists at birth a principally, functional form of epilepsy in relation to a constitutional predisposition. The usual electroclinical criteria are not applicable in this age group due to brain immadurity, so it is not possible to identify this variety. The progressive development of the brain in the infant and young child permits the clinical and electrical individualization of generalized fits as distinct from Petit or Gran Mal. These facts make it possible to confirm the existence of a principally functional epilepsy which corresponds to the primary generalized epilepsy of the adolescent and older child. The epileptic predisposition, principal factor responsible for primary generalized epilepsy, varies considerably during life. The authors presume that its incidence differs in each age group. Based on the frequency of hyperthermic fits in the infant and young child, the predisposition should be important in this age group, although the actual proportion of primary generalized epilepsy is difficult to quantify. In the older child it is possible to admit that the epileptic predisposition is greater because primary generalized epilepsy represents more than a third of the types of fits observed. This tendence is even greater in adolescence, where this form of epilepsy represents over three quarters of the patients. In the adult and aged patients, the epileptic tendency diminishes progressively, as can be seen comparing the proportion of primary forms of epilepsy with other types (25% young adult, 9% mature adult and 1% in the aged).(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

PubMedDate not supplied

Epilepsy in general practice: the Dutch situation.

Treatment and supervision of epileptic patients is part of specialist medicine. A possible change in the role of specialists and general practitioners in the care of these patients was explored by a questionnaire mailed to all Dutch neurologists and a random sample of general practitioners. Patients were also asked their opinion. The real situation was studied in a group of patients retrieved from the registers of general practitioners. Demographic, psychosocial, and epilepsy characteristics were sampled. Specialists tend not to want a change in their role; general practitioners desire a change. At present, patients do not want a change, but in future a change might be acceptable to them. More patients than expected were supervised by their general practitioner only. Their demographic and psychosocial characteristics did not differ from those in the population at large. Epilepsy characteristics corresponded with those in other studies.

Adolescent↗

PubMed1987

A clinical approach to the child with seizures and epilepsy.

Generalized tonic-clonic seizures in children may have different causes and a different natural history than seizures and epilepsy in adults. The effects of medication may also be of greater importance during childhood. In making decisions about whether or not to treat a child who has had only one or a few seizures, the physician must consider the chance of further seizures and the possible consequences of further seizures. Since the major consequence of seizure recurrence is psychosocial, and since the psychosocial consequences of infrequent seizure recurrence vary with age during childhood and differ from those in adults, decisions about therapy should take these differences into account. The potential effects of anticonvulsants on learning and behavior should also be considered. Seizures should not be treated just "because they are there," but rather only when the risks and consequences outweight the benefits of being free of medication and its effects.

Child↗

PubMed1986

Immunological and genetic studies in primary generalized corticoreticular epilepsy.

Serum immunoglobulin and HLA investigations were carried out in 21 probands with primary generalized corticoreticular epilepsy (PGCE) and in 26 of their first degree relatives. The mean serum levels of IgG, IgA and IgM in the epileptic probands were not significantly different from controls. In the relatives, however, the mean serum levels of IgA and IgM were significantly decreased as compared to controls. With respect to HLA investigations, the frequencies of 63 HLA specificities determined and of 5 most commonly occurring haplotypes were not significantly different in the experimental groups as compared to controls. These findings are in agreement with a previous HLA investigation of PGCE but are in contrast with a similar study of partial epilepsy. It is suggested that the contrasting HLA findings between PGCE and partial epilepsy may reflect underlying differences in the etiology of these disorders.

Adolescent↗

PubMed1995

Juvenile myoclonic epilepsy and human leukocyte antigens.

The idiopathic generalized epilepsies (IGE) occur with a high aggregation within families. Juvenile myoclonic epilepsy (JME) is recognized as a commonly occurring form of idiopathic generalized epilepsy. A possible association between JME and HLA antigens was investigated by serological typing of human leukocyte antigens (HLA) class I antigens and by DNA oligotyping of class II antigens. Twenty-four patients and 129 controls, all Caucasians of Scandinavian descent, were tested. Uncorrected there was a significant positive association (Relative risk (RR) = 8.07) to B17 and a significant negative association (RR = 0.13) to B8 as well as DRB1*3. The negative association to DQ alleles DQA1*0501 and DQB1*0201, which are in strong linkage disequilibrium with the alleles B8 and DRB1*3, was weaker and not significant, thus giving no clue as to a primary HLA-DQ association of JME.

Adolescent↗

PubMed1982

Laminar analysis of spindles and of spikes of the spike and wave discharge of feline generalized penicillin epilepsy.

Intracortical laminar profiles of spindles and spikes of spike and wave complexes in feline generalized penicillin epilepsy were studied using two methods: (i) sequential microelectrode recordings at various cortical depths, and simultaneous recordings at multiple cortical depths using a fine multi-contact electrode. Raw EEG data and EEG epochs averaged with respect to peaks of surface EEG waves were analyzed. Spindles and the spikes of the spike and wave complexes showed similar laminar profiles. This supports the hypothesis that the two are basically the same cortical electrophysiological phenomenon, the spike being a spindle wave enhanced and slightly altered because of the penicillin-induced increased cortical excitability. The latter causes the weight of the thalamic input to shift from superficial to more deep lying synapses. Both surface negative and surface positive phases of spindles and of spikes of spike and wave complexes show similar laminar profiles, those of the former suggesting activation of excitatory synapses in the superficial cortical layers, those of the latter suggesting activation of more deeply located excitatory synapses. The profiles generally conform to the dipole hypothesis of cortical electrogenesis and suggest that spindles and spikes of spike and wave complexes are generated by the same pyramidal neurons, probably through activation of the same sets of synapses. Some inconstant and relatively minor deviations of the laminar profiles from the pattern predicted by the dipole theory of cortical electrogenesis were encountered and are tentatively explained in the light of some of the complexities of the microanatomical organization of mammalian neocortex.

Action Potentials↗

PubMed2001

Continuing professional development: medico-legal aspects of epilepsy.

Generally protection against possible litigation and good clinical practice go hand in hand. Situations in which the law has special relevance for people with epilepsy, those who work with them, and their clinicians are reviewed with special reference to the topics of driving, employment, duties of social carers, the clinician's everyday role, the responsibilities of researchers and epilepsy and the criminal law. What constitutes professional negligence is discussed, with special reference to the United Kingdom. Clinicians are advised to think clearly, write clearly, communicate clearly and have a good relationship with their patients.

Automobile Driving↗

PubMed2002

Continuing professional development: medico-legal aspects of epilepsy.

Anticonvulsants↗

PubMed1987

[Discontinuation of treatment in epileptic seizures in adolescence].

A retrospective survey on the frequency of seizure-recurrence after drug withdrawal in all forms of adolescent seizures has been undertaken to detect possible prognostic criteria. Patients were selected according to 3 criteria: first seizure between 11 and 19 years of age; out-patients seen by one of us between 1955 and 1979 within the year of onset of epilepsy; all patients followed for at least 5 years after the first seizure. Two-hundred and seventy two patients entered the study. One-hundred and four patients (49 per cent) relapsed, most of them (83 per cent) within the first year after drug withdrawal. In univariate analysis, partial seizures, a normal initial EEG, an isolated seizure, a short length of illness, a long seizure-free period, one seizure only during the first year were significantly linked to a low relapse rate. The probability of being seizure-free after drug withdrawal was about 73 per cent in partial epilepsy, 20 per cent in idiopathic generalized epilepsy, and 36 per cent in undetermined generalized epilepsy. In patients having had a single seizure a dramatic difference was noted according to the seizure type: 12 per cent of relapses after a partial seizure, 69 per cent after a generalized seizure. Neither the age of onset of epilepsy nor the presence of an etiological factor were significant variables in predicting the outcome. When all factors were analysed simultaneously with Cox's hazard function, the type of seizure and the initial EEG appeared to be the only two independent factors significant for a risk of relapse.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1980

Aggression and epilepsy: seizure-type comparisons and high-risk variables.

One hundred fifty-three patients with temporal lobe epilepsy and 79 patients with generalized epilepsy were compared on a measure of aggression (derived from the Minnesota Multiphasic Personality Inventory). Analysis of covariance indicated that seizure type was not related to aggression. Multiple-regression analyses for each seizure group indicated that in temporal lobe epilepsy the chronologic age was inversely correlated with aggression scores. In the group with generalized epilepsy, chronologic age and myoclonic seizures were inversely correlated with aggression, while akinetic seizures were directly associated with increased aggression.

Adult↗

PubMed1994

P300 event-related potentials in epileptic children.

To evaluate the cognitive function of epileptic children, we examined P300 in 50 patients, 32 with idiopathic generalized epilepsy (IGE) and 18 with temporal lobe epilepsy (TLE), and 39 normal children. There were significant negative correlations between age and P300 latencies at Pz and Cz in normal controls. For data analysis, we used the age-corrected latency, which was calculated as the interval between the actual and predicted P300 latencies. The predicted latency was calculated with the regression equation as the relationship between P300 latency and age in normal controls. The age-corrected P300 latencies recorded from Pz and Cz were significantly longer in patients with IGE (41.5 +/- 13.1, 42.0 +/- 12.5) than in control subjects (0 +/- 7.5, 0 +/- 7.9). There were no significant differences in age-corrected P300 latencies between patients with TLE (21.2 +/- 17.6, 31.5 +/- 17.0) and controls, or IGE and TLE. Recently, it was considered that the mesencephalic reticular formation and thalamus may play major roles in the genesis of generalized epilepsy, so we speculate that dysfunction of these systems may contribute to the prolongation of P300 in children with idiopathic generalized epilepsy.

Adolescent↗

PubMed1997

Genetic study of epilepsy.

This study comprised 32 patients with epilepsy. They were referred to the Human Genetics Department, Medical Research Institute, Alexandria University, Egypt. They were mentally retarded with the exception of three patients who had normal mentality. Their ages ranged from 2 months to 16 years. Females and males were equally affected (M/F=1). All patients were evaluated to identify the specific etiology of epilepsy. They were classified into symptomatic generalized epilepsy (29 cases) and idiopathic generalized epilepsy (3 cases). After evaluation they were classified according to their diagnosis into those displaying mendelian inheritance, norunendelian inheritance and chromosome disorders. The symptomatic group showed a mendelian inheritance and chromosomal aberrations while the idiopathic group showed a nonmendelian inheritance.

Adolescent↗

PubMed1991

Fos expression in GHB-induced generalized absence epilepsy in the thalamus of the rat.

Using the model of gamma-hydroxybutyrate (GHB)-induced generalized absence epilepsy, the present work investigated the distribution of fos oncoprotein expression in the rat thalamus with fos antibody immunohistochemistry. Thirty minutes after absence-like seizures, some fos-immunoreactive cell nuclei were found in bilateral thalamic paraventricular nuclei (PV). After a further 30 min, a massive bilateral induction of fos was observed in the lateral habenular nucleus (LHb), the PV, the rhomboid thalamic nucleus, and the intralaminar nuclei of the thalamus. These results suggest that the LHb and the midline and intralaminar thalamic nuclei may very likely be involved in the pathophysiology of absence seizures.

Animals↗