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PubMed2006

Postictal autoscopy in a patient with partial epilepsy.

Autoscopy is an experience of seeing oneself in external space, viewed from within one's own physical body. It is a complex psycho-sensorial hallucinatory perception of one's own body image projected into external visual space, with epilepsy one of the common disorders reported to be associated with the experience. A survey of the literature revealed that there are few case reports of postictal autoscopic phenomena. Herein, we report a case of a patient with partial epilepsy who has experienced postictal autoscopy for nearly 30 years. Although the neurological mechanisms that cause autoscopic phenomena are not fully understood, wish-fulfilling fantasies released as a result of a shaken integrity regarding personal bodily image may contribute to the shaping of the symptoms, at least in the case of postictal autoscopy.

Adult↗
PubMed2004

The relationship between bilateral spike and wave complexes and focal discharges in patients with partial epilepsy.

The goal of this study was to investigate in patients with partial epilepsy the relationship between bilateral spike and wave (BSW) complexes of a generalized epilepsy and the focal spikes of partial epilepsy. For the study 300 patients were collected, all with focal epilepsy on their last hospital visit: 150 were well controlled (C) and 150 were uncontrolled (U), and the number of EEGs was 674 in the C and 804 in the U groups. BSW were seen at some time in 25% of all patients, more often in the U than C patients, especially the irregular 3/sec form. The bilateral complexes at times appeared at the onset of the epilepsy, usually at the same time with focal discharges, mainly from temporal or frontal areas. The U patients showed these complexes at a younger age than the C group and continued to be seen often into the 30s, occasionally into the 60s age group. The other presentation of the BSW was years after the onset of the focal discharges, usually temporal or frontal in location and more often seen in the U than C group. The U group showed spikes, many in number as active foci, more often than the C group. The discussion deals with the possibility that these bilateral spike and wave complexes may represent a reflection of a lowered threshold to a seizure.

Adolescent↗
PubMed2003

The clinical spectrum of epilepsy in children and adults with hypothalamic hamartoma.

PURPOSE: Hamartomas of the hypothalamus (HH) cause an uncommon and unusual epilepsy syndrome. The condition is recognized to affect children, but the presentation in adults is not well understood. We present 19 children and adult patients with HH, including three patients whose epilepsy began in adult life. The patterns of clinical presentation, evolution of the epilepsy from childhood to adult life, and electroclinical diagnostic features are presented. METHODS: Nineteen patients, both children and adults with HH and epilepsy, were evaluated clinically, with EEG, video-EEG, and magnetic resonance imaging (MRI) scanning. Seven patients underwent surgical resection of the hamartoma. Stereotactic thermocoagulation of the hamartoma was performed in two patients. RESULTS: Gelastic seizures occurred at onset of epilepsy in 15 of 16 early-onset cases. Subsequently, multiple seizures types occurred, which then evolved to mainly partial epilepsy with tonic or complex partial seizures (five of eight adults), or became entrenched symptomatic generalized epilepsy with atypical absences, drop attacks, and secondarily generalized seizures, and cognitive impairment (three of eight adults). In the adult-onset patients, gelastic seizures were not prominent, the epilepsy was milder, and they functioned normally. Stereotactic thermocoagulation of the hamartoma resulted in improvement in seizure control in two patients. CONCLUSIONS: Gelastic seizures are not a prominent feature of epilepsy in adult patients with HH. The epilepsy associated with HH, although severe at onset, can evolve into a milder syndrome in later life. For less severely affected patients, minimally invasive alternatives to the traditionally difficult open surgical treatment should be considered.

Adolescent↗
PubMed1996

Efficacy and safety of add-on divalproex sodium in the treatment of complex partial seizures. The M88-194 Study Group.

We studied the efficacy of divalproex sodium in patients with complex partial seizures taking concomitant carbamazepine or phenytoin as monotherapy. Patients were selected because of inadequate seizure control by current therapy. The primary efficacy measure was median reduction of seizure frequency during add-on treatment compared with baseline. A secondary measure was the percentage of patients achieving > or = 50% reduction in seizure frequency. In the intent-to-treat analysis (137 patients), divalproex-treated patients experienced a median reduction of 7.9 complex partial seizures per 8 weeks compared with 2.5 in the placebo group (p = 0.001). Also, 38% of divalproex-treated patients completed the study with a seizure reduction of > or = 50% compared with 19% receiving placebo (p = 0.011). Six divalproex- and one placebo-treated patient became free of complex partial seizures. We conclude that divalproex sodium is an effective drug for treating patients with complex partial seizures.

Anticonvulsants↗
PubMedDate not supplied

[Partial seizures in childhood].

INTRODUCTION AND OBJECTIVE: Partial seizures make up 49.3% of the epilepsies of school-age children and adolescents, and is the most prevalent type of epilepsy. Patients with complex partial seizures have more recurrences than other patients who have generalized seizures. We analyze the factors which worsen the prognosis in refractory partial epilepsies, their cost in childhood, the characteristics of the new drugs, and the few comparative studies of combinations of these drugs in resistant partial crises of childhood. DEVELOPMENT: The essential factors for prediction are previous brain damage, early onset of the seizures and presence on the EEG recording of marked paroxystic anomalies. Convincing studies on the economic aspects of the epilepsies should not be limited to the cost of the disease, but be descriptive studies which measure all the costs caused by epilepsy. It has been shown that the economic impact of the disorder on children with refractory epilepsy is 2.7 times the average cost of children whose seizures are well-controlled. There are no marked differences between the new antiepileptic drugs in the treatment of seizures of this type. Their appearance has led to reconsideration of what is rational bitherapy and what benefit may be obtained with it. CONCLUSIONS: When possible associations of antiepileptic drugs are considered, one should take into account criteria of efficacy and toxicity, the pharmacodynamic characteristics of the drugs to be used together and their pharmacokinetic interactions. It is necessary to avoid drugs with a low therapeutic index to which tolerance may develop or which interact frequently, and antiepileptic drugs with a broad spectrum, high therapeutic index and few pharmacokinetic interactions should be preferred. The association of valproate and viagabatrin may be very beneficial, since it has been suggested that there is a synergistic reaction in patients with partial seizures that are resistant to other drugs. The efficacy of the association of valproate and viagabatrin has been shown in patients with refractory partial seizures, since they have different modes of action and different spectrums, different profiles of toxicity and no pharmacokinetic interactions. Finally, we describe the basic principles of treatment of refractory partial seizures of childhood.

Anticonvulsants↗
PubMed1995

Tics and fits. The current status of Gilles de la Tourette syndrome and its relationship with epilepsy.

The Gilles de la Tourette syndrome (GTS) is a neurobehavioural disorder characterized by multiple motor and vocal tics. Accessory symptoms include coprophenomena, echophenomena and obsessive-compulsive behaviours. There is a significant genetic contribution to their aetiology. Simple tics may be mistaken for myoclonic epilepsy and complex tics for complex partial seizures. Like epilepsy, GTS is a brain disorder that leads to general disturbances in behaviour not just the cardinal symptoms (i.e. tics or seizures).

Antipsychotic Agents↗