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A case of cerebral aneurysm associated with complex partial seizures.

We report a 20-month-old girl with an unruptured aneurysm of the middle cerebral artery. The initial sign was complex partial seizures. Magnetic resonance angiography showed an aneurysm of the right middle cerebral artery. Cerebral angiography confirmed the presence of a saccular aneurysm. After 3 months, the aneurysm spontaneously thrombosed without neurological deficit. The seizures were controlled by anti-convulsants. The aneurysm was probably near the focus of the complex partial seizures. This is a rare case of a childhood cerebral artery aneurysm that first manifested itself by complex partial seizures.

Cerebral Arteries↗

Disproportionate loss of CA4 parvalbumin-immunoreactive interneurons in patients with Ammon's horn sclerosis.

We studied differences in the number and morphology of parvalbumin-immunoreactive (PV-IR) interneurons in 43 hippocampal specimens from patients with classical Ammon's horn sclerosis (AHS) who underwent anterior temporal lobectomy, as compared with 14 autopsy and non-AHS surgical control specimens. PV-IR neuronal loss in the AHS specimens varied significantly from that expected based on overall AHS-associated pyramidal and granule neuron loss. Most striking was the loss of PV-IR interneurons in CA4 of the AHS specimens, which was 12 times greater than AHS-associated pyramidal neuron loss, and significantly exceeded the PV-IR interneuron loss observed in the other sectors of the hippocampus. In addition, the PV-IR interneurons in the AHS specimens had markedly smaller and less defined cell bodies and shortened and simplified dendritic arbors compared with the PV-IR interneurons in the control specimens. Other differences noted in the AHS specimens included prominent dendritic varicosities; the loss or interruption of a band formed by PV-IR terminals in the dentate gyrus; and the virtual absence of a small, intensely staining PV-IR interneuron with a short, exuberant dendritic arbor that was readily identified in the autopsy specimens. We discuss these findings in relationship to the development of classical AHS and complex partial seizures (CPS).

Adolescent↗

Spinocerebellar ataxia type 2 with focal epilepsy--an unusual association.

INTRODUCTION: The spinocerebellar ataxias are a rare group of inherited neurodegenerative disorders. Epilepsy has not previously been associated with spinocerebellar ataxia type 2 (SCA2). CLINICAL PICTURE: We describe a family with 3 affected members who had typical phenotypic and MRI features of SCA2. Two had focal epilepsy with complex partial seizures and epileptiform discharges on electroencephalography. Trinucleotide expansions in the pathological range were found in the SCA2 gene, confirming SCA2. Sequencing of the expanded SCA2 gene did not reveal any new mutations that could account for epilepsy. TREATMENT AND OUTCOME: The focal epilepsy was well-controlled with carbamazepine. CONCLUSION: We hypothesise that the new feature of focal epilepsy is due to co-existence of a separate unlinked epilepsy susceptibility gene with the expanded SCA2 gene. Under this oligogenic model, both genes must be present, and co-inheritance of this susceptibility gene with the expanded SCA2 gene causes a complex interaction which triggers epilepsy.

Ataxins↗

Ring 14 chromosome with complex partial seizures: a case report.

A two-year-old girl was found to have a ring 14 chromosome: [46, XX, r(14) (P13 q32.3)]. Her development, including verbal ability, was retarded, her CT scan displayed a low density area anterior to the left temporal lobe, and she suffered from complex partial seizures. Focal central nervous system abnormalities may be present in patients with ring 14 chromosome, and their seizures are not exclusively of the primary generalized type. This is the first case with ring 14 chromosome and complex partial seizures.

Child↗

[An enlarging dysembryoplastic neuroepithelial tumor during a 6-year period: a case report].

A 16-year-old boy who had been found at the age of 9 years to have complex partial seizures was referred to our department by a psychiatrist for evaluation for surgical treatment of epilepsy, in 1994. A diagnosis of multiple cerebral infarction accompanied with arachnoid cyst was made when he was 11 years old, in 1988, by computed tomography (CT) and magnetic resonance imaging (MRI) findings. Results of a neurological examination on admission revealed marked mental and speech retardation. MRI and CT studies demonstrated an enlarged Sylvian fissure and a mass lesion in the left frontal lobe which was enlarged, compared to the findings of MRI in 1988. A left fronto-temporal craniotomy with excision of the frontal lesion was performed. Histological examination revealed cortical dysplasia, multi-nodular pattern, and glioneuronal components, whose findings coincide with criteria for diagnosing dysembryoplastic neuroepithelial tumors. MIB1 antibody immunostaining study revealed no positivity, but immunostaining study for PCNA (proliferation of cell nuclear antigen) revealed from 0 to 6.5% positivity in each nodule. PCNA high positivity was observed in the nodules which were composed of packed oligodendrocyte-like cells. Enlargement in the size of the lesion in our case suggests increased cell proliferation activity during a 6-year period.

Adolescent↗

Adult-onset temporal lobe epilepsy associated with smoldering herpes simplex 2 infection.

A 40-year-old man with chronic genital herpes simplex infection developed partial complex temporal lobe seizures of insidious onset, with EEG and MRI evidence of a unilateral temporal lobe destructive, atrophic process. Extensive workup did not reveal an infectious etiology. Three years of escalating number and severity of daily seizures with memory loss led to temporal lobectomy. Histologic study revealed active, low-level viral infection in the resected hippocampus and temporal lobe cortex, with immunohistochemical evidence for infection by herpes simplex 2, principally in neurons. In situ hybridization confirmed the presence of herpes simplex virus in neurons. Anticonvulsant-resistant seizure episodes began to recur several times daily soon after surgery, but the addition of acyclovir to the treatment regimen resulted in a substantial reduction in seizure occurrence, maintained for the subsequent 2.5 years.

Acyclovir↗

Panic attacks, complex partial seizures, and multiple meningiomas.

A 39-year-old woman presented with typical panic disorder symptoms of two years duration. Imipramine (IMI) treatment yielded complete remission of her symptoms for three years. At that time, however, her symptoms recurred. Neither increasing the IMI dose nor an adequate trial of fluoxetine controlled her symptoms. Further history revealed subtle changes in her symptoms suggestive of complex partial seizures. Scalp EEG was normal, but an MRI revealed multiple meningiomas. Her symptoms remitted completely on carbamazepine. This case illustrates the phenomenologic overlap between panic attacks and complex partial seizures, and a neuroanatomic overlap between the two syndromes is hypothesized.

Adult↗

Partial seizures in leukoencephalopathy with swelling and a discrepantly mild clinical course.

We report a patient with 'Leukoencephalopathy with swelling and a discrepantly mild clinical course', an entity of leukoencephalopathy recently clarified. Our patient presented with complex partial seizures in addition to characteristic radiological findings and clinical course. A review of the literature revealed that this new neurodegenerative disease complicates epilepsy in more than half of the patients, and that partial components in the seizure symptomatology are not infrequent.

Adolescent↗

Time dependencies in the occurrences of epileptic seizures.

A new method of analysis, developed within the framework of nonlinear dynamics, is applied to patient recorded time series of the occurrence of epileptic seizures. These data exhibit broad band spectra and generally have no obvious structure. The goal is to detect hidden internal dependencies in the data without making any restrictive assumptions, such as linearity, about the structure of the underlying system. The basis of our approach is a conditional probabilistic analysis in a phase space reconstructed from the original data. The data, recorded from patients with intractable epilepsy over a period of 1-3 years, consist of the times of occurrences of hundreds of partial complex seizures. Although the epileptic events appear to occur independently, we show that the epileptic process is not consistent with the rules of a homogeneous Poisson process or generally with a random (IID) process. More specifically, our analysis reveals dependencies of the occurrence of seizures on the occurrence of preceding seizures. These dependencies can be detected in the interseizure interval data sets as well as in the rate of seizures per time period. We modeled patient's inaccuracy in recording seizure events by the addition of uniform white noise and found that the detected dependencies are persistent after addition of noise with standard deviation as great as 1/3 of the standard deviation of the original data set. A linear autoregressive analysis fails to capture these dependencies or produces spurious ones in most of the cases.

Adult↗

Seizures in Chiari I malformation: a clinical and electroencephalographic study.

Seven subjects with Chiari I malformations and seizures (four males, three females; age range 11 years, 7 months to 36 years; mean, 22.28 +/- 7.58 years; median, 21) were identified in four different centers from among a group of 10 patients. Our aim was to analyze clinical and electroencephalographic characteristics of seizures in this etiologically homogeneous group of patients. Most of the seizures were of the complex partial type, and paroxysmal abnormalities were mainly localized over the frontal and temporal regions. The course of the epilepsy was rather benign, with complete control of seizures in four patients and an important reduction in frequency in the remaining three subjects. Other cortical alterations are not usually associated with the typical abnormalities of the posterior fossa in Chiari I malformation; thus, it is possible to hypothesize that cerebral microdysgenesis or, alternatively, a cerebellar dysfunction could underlie epileptogenesis in these patients.

Adolescent↗

"I would kill in God's name:" role of sex, weekly church attendance, report of a religious experience, and limbic lability.

Data collected during the last 15 years for the Personal Philosophy Inventory from 1.48 thousand university men (n = 629) and women (n = 853) were analyzed to discern the response characteristics of individuals who stated "yes" to Item 136 "If God told me to kill, I would do it in His name." The percentage (7%, range between 2% and 8% per year) of affirmative responses did not change significantly over time. The odds ratio for men: women for an affirmative response was 1.4:1. As predicted a four-way interaction for sex, weekly church attendance, history of a religious experience, and elevated complex partial epileptic-like signs was statistically significant. Of the men who reported a religious experience, attended church weekly, and displayed elevated complex partial epileptic like signs (5.7% of all males), 44% stated they would kill another person if God told them to do so.

Adult↗