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PubMed1997

Tourette syndrome, epilepsy, and emotional disorder, a case of triple comorbidity.

We present a case report illustrating the complexity encountered in the diagnosis and treatment of patients with multiple diagnoses. The clinical presentation in Tourette syndrome, and the behavioural manifestations in some cases of complex partial seizures can both be misunderstood and misdiagnosed. The paper, within the framework of a case, emphasises the need for a multidisciplinary approach in the assessment and management of such cases.

Affect↗
PubMed1992

MRI findings in epileptic patients on vigabatrin for more than 5 years.

Although vigabatrin is a promising new antiepileptic drug, its safety has been challenged by the report of dose-dependent central nervous system myelin vacuolation in some preclinical animal studies. Since it has been shown that vacuolation is associated with specific magnetic resonance imaging (MRI) findings in rats and dogs, MRI of the brain was performed in 11 patients with complex partial seizures who had been receiving vigabatrin for 64-78 months (mean 74.0 +/- 5.0 sd) as additional treatment for epilepsy, with a cumulative exposure ranging 4200 to 9360 g. In no case did MRI show white matter changes similar to the pathological findings of microvacuolation observed in animals. These results would appear to confirm that current doses of vigabatrin do not cause myelin vacuolation in humans, even for treatment periods of longer than 5 years.

Adult↗
PubMed1992

Results of anterior temporal lobectomy that spares the amygdala in patients with complex partial seizures.

In December, 1980, the authors modified their anterior temporal lobectomies to exclude the amygdala from resection, a decision influenced by the dearth of pathology in the amygdala compared to the hippocampus. Furthermore, it had never been demonstrated that a good result was contingent upon including the amygdala per se in the lobectomy. Fifty-five (79%) of 70 patients in whom the amygdala was not resected were benefited by surgery. This result is similar to that achieved in series of anterior temporal lobectomies that include the amygdala in the resection. The results take on a special significance when considered together with those of amygdala-hippocampectomy which has been effective for controlling complex partial seizures of temporal mesiobasal origin (the region of the hippocampus, parahippocampal gyrus, and amygdala). A survey of the combined results strongly suggests that the anterior hippocampus and/or associated entorhinal cortex may be all that need be removed to control complex partial seizures caused by a temporal mesiobasal focus.

Adolescent↗
PubMed2002

Cerebral arteriovenous malformation mimicking acute coronary syndrome.

We report a case of cerebral arteriovenous malformation in a 34 year-old male patient presenting with chest pain. Electrocardiographic findings showed ST elevations in the precordial leads. However, a coronary angiogram showed no coronary lesions. Laboratory tests suggested that troponin and cardiac enzymes were within normal limits. Further investigation led to the diagnosis of a cerebral arterio-venous malformation occupying the left temporal and parietal lobes. The chest pain may be explained by the occurrence of a complex partial seizure.

Adult↗
PubMed2002

Surgery for complex partial seizures.

Dr. Girvin discusses the technique of surgery for complex partial seizures, some of the questions and controversies related to this technique and the probability of a successful outcome.

Cerebral Cortex↗
PubMed1995

Ictal contralateral paresis in complex partial seizures.

Certain behaviors that occur during a complex partial seizure (CPS) are useful in lateralizing the side of seizure onset. In 5 (5.3%) of 94 consecutive patients with partial epilepsy, we observed ictal unilateral arm and hand paresis during 27 of 34 CPS. In all these seizures, this behavior occurred contralateral to an epileptogenic temporal lobe, as determined by video-EEG monitoring and surgical outcome. In 5 of the 27 seizures, an observer demonstrated that the paretic arm and hand were flaccid. None of these patients had postictal (Todd's) paralysis. In most of the seizures, the arm ipsilateral to seizure onset had simultaneous purposeful movements or automatisms, sometimes with awkward posturing. Ictal unilateral paresis is distinctly different from ictal dystonia or postictal paralysis and consistently lateralizes seizure onset to the contralateral temporal lobe. Recognition of this particular ictal behavior and comparison to other simultaneous behaviors can aid in the lateralization and possibly localization of the epileptogenic zone.

Behavior↗
PubMed2000

Venous angiomas and epilepsy.

The purpose of this study was to evaluate the frequency and characteristics of epilepsy associated with cerebral venous angiomas (VA). We examined epileptic patients in which magnetic resonance imaging (MRI) showed VA. The characteristics of epilepsy and its relationships to VA were studied. Out of 1020 epileptic patients submitted to MRI in a 10-year period, 4 presented with VA. All had partial seizures, most frequently complex partial, with secondary generalizations in 3. Drug resistance was observed in 2. One patient had a small area of cortical dysplasia near the VA; another had a cutaneous angioma. In 2 patients, there was no topographic concordance between the VA and the focus on electroencephalography. Our study reveals that VA are rarely found in epileptic patients, differently from other vascular malformations, in particular cavernomas. Topographic and/or etiological relationships between VA and epilepsy are still undefined.

Adult↗
PubMed1997

[Experimental bilateral focus model of complex partial seizure: clinical, electrophysiological and pathological studies].

Stereotactic surgery was performed in Wistar rats and stainless steel injection chemitrode were inserted in bilateral amygdala (AM). Stainless steel screws were placed on the dura over bilateral motor cortex (Cx). One week after the surgery, rats were placed in the recording chamber. Kainic acid (KA) injection was performed into the left AM and focal AM seizure status was induced. Seizures evolved into limbic seizure status during 3 days. Seven days after the first KA injection, KA was injected into the right AM. The limbic seizure status was elicited again, however, these seizures subsided within 3 days. About 3 week after the first KA injection, spontaneous limbic seizures developed. Three ictal EEG patterns were seen (1) Bilateral independent seizures, (2) Synchronous ictal discharge over the bilateral AM, and (3) Switch of lateralized ictal activity from one to the other AM. The histological study demonstrated bilateral hippocampal cell loss and hippocampal atrophy. These changes are very similar to those observed in human intractable complex partial seizures with bilateral mesial temporal focus. The result suggests that this model will be a good tool in order to resolve intractability of complex partial seizure in patients with bilateral temporal focus.

Animals↗
PubMedDate not supplied

Reduction of seizure frequency with clomipramine in patients with complex partial seizures.

Two patients with complex partial seizures who had been refractory to various antiepileptics were treated with clomipramine. The frequency of the seizures was reduced to 0-30% of the original levels. It has been reported that imipramine is effective in absence and minor motor seizures, and its antiepileptic effect is thought to be related to the inhibition of the presynaptic re-uptake of serotonin and norepinephrine. The basic effect of clomipramine is the same as that of imipramine except that the inhibitory action of clomipramine on serotonin re-uptake is 5- to 10-times more potent than that of imipramine. It is implied that clomipramine may be of use in the treatment of partial epilepsies.

Adolescent↗
PubMed1989

Aetiological factors in Tanzanian epileptics.

The study deals with 428 patients with epilepsy who were referred to the neurology clinic, Muhimbili Medical Centre, Dar es Salaam; and analysed for aetiological factors. Of these, 146(34%) had identifiable causes which were acquired in 95%. Sixty seven (46%) of patients with identifiable causative factors were children below the age of fifteen and 35(24%) adults were above the age of thirty. The cause of epilepsy in 71% of children was childhood febrile convulsions and CNS infections while in 74% adults, it was due to head injury, tumours and vascular disease. Twice as many patients with partial epilepsy had identifiable aetiological factors than those with generalised epilepsy. Childhood febrile convulsion was commonly associated with partial epilepsy with complex symptoms while birth injury and CNS infections were associated with generalised epilepsy. Vascular causes and tumours were associated with partial epilepsy. The significance of identifiable aetiological factors and their association to various types of epilepsy is discussed. This study is a preliminary report of a major study which commenced in January, 1983 dealing with classification, clinical presentation, social factors and management of epileptic patients referred to this Clinic.

Adolescent↗
PubMed1999

Proton MR spectroscopy in patients with complex partial seizures: single-voxel spectroscopy versus chemical-shift imaging.

BACKGROUND AND PURPOSE: Proton MR spectroscopy has recently been applied to the evaluation of seizures, but few comparisons have been made between different clinical spectroscopic techniques. Our goal was to determine whether there is a significant difference between hippocampal NAA/(Cho+Cr) ratios obtained by single-voxel spectroscopy (SVS) and by chemical-shift imaging (CSI). METHODS: Twelve healthy adults and eight patients with complex partial seizures were studied on a 1.5-T MR scanner using a proton SVS method. Another 12 healthy adults and 10 patients with complex partial seizures were recruited for a proton CSI study, which was performed on a different 1.5-T MR system. The NAA/(Cho+Cr) ratio was calculated from the integral peak areas by curve fitting. The two-tailed t-test was used for statistical analysis. RESULTS: The mean value +/- standard deviation of the hippocampal NAA/(Cho+Cr) ratio in healthy control subjects was 0.63 +/- 0.07 by SVS, with 0.62 +/- 0.15 for the anterior hippocampus and 0.65 +/- 0.11 for the posterior hippocampus by CSI. There was no significant difference between the control group data obtained by SVS and those by CSI, nor was there a regional difference in the CSI NAA/(Cho+Cr) ratio in the hippocampus. Relative to the control group, the patients with seizures had a significant decrease in the NAA/(Cho+Cr) ratio in the abnormal hippocampus: -28% by SVS, and -24% in the anterior hippocampus and -18% in the posterior hippocampus by CSI. Proton SVS and CSI detected hippocampal abnormalities, unilateral or bilateral, in all patients of each group. CONCLUSION: Under similar measurement conditions, proton SVS and CSI provide similar NAA/(Cho+Cr) ratios among healthy control subjects, and they possess comparable ability for detecting hippocampal abnormalities in patients with complex partial seizures.

Adolescent↗
PubMed1993

Early detection of abnormalities in partial epilepsy using magnetic resonance.

The incidence of brain abnormalities determined by magnetic resonance in 30 consecutive children presenting with intractable complex partial seizures is reported. Images were optimised to visualise the hippocampus and cortical grey matter. Abnormalities of the hippocampus or temporal lobe were seen in all 19 children with clinical features of temporal lobe epilepsy and in six of the seven children with clinically unlocalised epilepsy. By contrast, in the four children with a clinical diagnosis of extratemporal epilepsy, no temporal or hippocampal abnormalities were seen. Generalised cortical abnormalities of uncertain significance were found in a total of 14 children from all groups. The identification of focal brain abnormalities using optimised magnetic resonance imaging enables early non-invasive assessment of children with intractable seizure disorders and the identification of patients for whom epilepsy surgery may be appropriate. It may also lead to a better understanding of the structural basis of intractable epilepsy, and thereby contribute to early treatment decisions.

Adolescent↗
PubMedDate not supplied

A case of infantile spasms: epileptic apnea as partial seizures at onset.

We report a 2-month-old boy who presented with apneic attacks as a manifestation of epileptic seizures at onset and eventually progressed to infantile spasms. At onset, at 2 months of age, apneic attacks were the sole symptom of epileptic fits. Although these seizures were accompanied by cyanosis, bradycardia was not noted. An ictal electroencephalogram showed focal paroxysmal discharges in the temporal area. Treatment with sodium valproate was not effective to control his seizures. By 6 months of age, he progressed to infantile spasms. Although his seizures could be completely controlled with the use of zonisamide, vitamin B6 or high-dose immunoglobulin, his mental and behavioral development was retarded severely. There have been no previously published cases with infantile spasms that evolved from epileptic apnea as partial seizures.

Apnea↗