Incidence of psychomotor epilepsy in an Army psychiatric consultation service.
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Epilepsy↗
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Results for “Epilepsy, Complex Partial”
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Airway effects of direct left-sided cervical vagal stimulation in patients with complex partial seizures.
Airway nerves have been implied in obstructive lung diseases for many years. In experimental animals, vagal stimulation produces several features of asthma, including airflow obstruction and airway plasma exudation. Vagal stimulation is a novel and effective therapy in patients with refractory epilepsy. We evaluated the airway response to left-sided cervical electrical stimulation using 1 Hz (low stimulation: 30 s, once every 90 min) and 30 Hz (high stimulation: 30 s, every 5 min) in a randomized double-blinded fashion for 3 months in epileptic patients participating in a phase two efficacy study. In eight patients with high stimulation and six with low stimulation, no effect on FEV1 (forced expiratory volume in 1 s) was seen over 3 months chronic stimulation. In a follow-up, up to 9 months, no further deterioration of lung function was observed. Of five patients without concomitant lung disease who consented to more extended experiments, one patient produced a reduction of FEV1 with variable frequency and current stimulation (10-87 Hz and 0.5-2.5 mA respectively). In one patient with obstructive lung disease, however, increased frequency and current stimulation led to a stimulation-dependent decrease in FEV1. After the addition of inhaled ipratropium bromide (160 micrograms, dry powder) to this patient, there was a clear improvement of baseline FEV1, but only a slight improvement of the stimulation-induced deterioration of FEV1. We conclude that long-term vagal stimulation in patients without concomitant lung disease does not induce any significant changes in FEV1. However, in patients with obstructive lung disease, intense vagal stimulation can cause a deterioration of lung function.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Changes in brain complexity during valproate treatment in patients with partial epilepsy.
OBJECTIVE: The effect of valproate (VPA) on human electroencephalography (EEG) was studied using nonlinear dynamics analysis to investigate changes in brain complexity. METHODS: We propose a spatial linear mode complexity (SLMC) measure to quantify the complexity of spatial linear modes in multichannel EEGs. Nine patients with complex partial seizures who had not previously been exposed to antiepileptic drugs (AEDs) were included in this study. Eighteen-channel EEG data were collected before and after VPA therapy. Changes in brain complexity were examined using the proposed SLMC measure, which reflects brain complexity. Fifteen normal, healthy subjects were included as a control group. To compare SLMC with spectral analysis, we performed spectral analysis within the conventional frequency bands. RESULTS: Spectral analysis showed that the patient group had decreased relative power of the alpha2 band in the T7, P3, O1 and C4 leads before VPA treatment and an increased relative theta power in the O1 lead relative to the control group. However, no significant changes occurred in any lead at any frequency band after VPA treatment. The mean SLMC value was significantly lower in the patient group before treatment than in the control group (p = 0.026). The average SLMC value for all patients increased after treatment and neared that of the control group, although statistical significance was not attained (p = 0.074). CONCLUSIONS: These results suggest that epilepsy patients have interictal abnormalities that are demonstrated by reduced brain complexity, and that VPA partially reverses this trend. Nonlinear analysis of EEG data may be useful in evaluating the effect of AEDs.
Adolescent↗
Use of clobazam for the treatment of refractory complex partial seizures.
Clobazam (CLB) add-on therapy was attempted in 183 patients with intractable complex partial seizures in whom conventional benzodiazepines had been successfully discontinued before initiation of CLB. Although complete remission was initially achieved in 61, tolerance developed in almost half (49.2%) within the first 3 months, whereas 23 out of 31 patients (74.2%) who remained seizure free for the first 3 months continued to be so over the next 3 months. CLB add-on therapy proved to be significantly more effective when concurrent GTC occurred more often than yearly. In the current series, no frank psychotic episodes were elicited among the 61 patients who achieved complete suppression of long-standing complex partial seizures, which was in agreement with previous studies. From these results, we believe that CLB is an effective, safe, and inexpensive medication for add-on therapy in difficult to treat focal epilepsies, especially without concurrent use of conventional benzodiazepine compounds.
Adult↗
SPECT perfusion changes during complex partial seizures in patients with hippocampal sclerosis.
Cerebral perfusion changes reliably reflect changes in neuronal activity. Our aim was to obtain new insights into the pathophysiology of complex partial seizures (CPS) in patients with hippocampal sclerosis (HS) using interictal and ictal single photon emission computed tomography (SPECT). We studied 24 patients with refractory temporal lobe epilepsy (TLE) associated with HS. All had an interictal and ictal SPECT with early injection during a CPS. Images were normalized and co-registered. Using statistical parametric mapping (SPM99), brain regions with significant ictal perfusion changes were determined. To assess possible interrelationships between these regions, Pearson correlation coefficients were calculated. The temporal lobe ipsilateral to the seizure focus, the border of the ipsilateral middle frontal and precentral gyrus, both occipital lobes and two small regions in the contralateral postcentral gyrus showed ictal hyperperfusion. The frontal lobes, contralateral posterior cerebellum and ipsilateral precuneus showed hypoperfusion. Further exploratory analysis suggested an association between ipsilateral temporal lobe hyperperfusion and ipsilateral frontal lobe hypoperfusion, and an inverse association between seizure duration and hyperperfusion in the ipsilateral anterior cerebellum and contralateral postcentral gyrus. We conclude that there is a network of perfusion changes during CPS in patients with HS. Studying a particular seizure type in patients with HS with peri-ictal SPECT performed during a defined time window will allow further analysis of the cerebral network activities, and excitatory, inhibitory and gating mechanisms during seizures associated with HS.
Adult↗
Oxcarbazepine in focal epilepsy and hepatic porphyria: a case report.
PURPOSE: Despite the development of new antiepileptic agents (AEDs), the therapy of epilepsies along with hepatic porphyrias remains difficult. Most AEDs such as carbamazepine (CBZ), phenytoin (PHT), valproate (VPA), and lamotrigine (LTG) may precipitate clinically latent porphyria by inducing hepatic metabolism and increasing hepatic heme synthesis. Actually, only gabapentin (GBP), an AED without any hepatic metabolism, is known as a potential therapy for partial seizures in patients having hepatic forms of porphyria. METHODS: We present the case of a 28-year-old man with porphyria cutanea tarda (PCT) who has had pharmacoresistant epilepsy with complex partial and secondarily generalized seizures since early childhood. Despite having undergone several AED therapies over the years, no seizure-free interval had been observed. Only CBZ could cause a seizure reduction, but this treatment had to be discontinued as an elevation of the transaminases as well as pruritus and erythema were noted. The patient was then started on oxcarbazepine (OCBZ), a ketoanalogue of CBZ similar in its pharmacologic mechanism as well as its clinical use, but which, in contrast to CBZ, has only a low hepatic induction of microsomal enzymes. A final maintenance dose four times higher than that of CBZ was prescribed. RESULTS: In the follow-up, the patient stopped having seizures, and his liver functions became normal. CONCLUSIONS: It can be concluded that OCBZ can successfully be administered to patients with hepatic porphyria and focal epilepsy who did not respond to treatment with GBP.
Acetates↗
Distribution of partial seizures during the sleep--wake cycle: differences by seizure onset site.
OBJECTIVE: To evaluate the effects of sleep on partial seizures arising from various brain regions. METHODS: The authors prospectively studied 133 patients with localization-related epilepsy undergoing video-EEG monitoring over a 2-year period. Seizure type, site of onset, sleep/wake state at onset, duration, and epilepsy syndrome diagnosis were recorded. Periorbital, chin EMG, and scalp/sphenoidal electrodes were used. A subset of 34 patients underwent all-night polysomnography with scoring of sleep stages. RESULTS: The authors analyzed 613 seizures in 133 patients. Forty-three percent (264 of 613) of all partial seizures began during sleep. Sleep seizures began during stages 1 (23%) and 2 (68%) but were rare in slow-wave sleep; no seizures occurred during REM sleep. Temporal lobe complex partial seizures were more likely to secondarily generalize during sleep (31%) than during wakefulness (15%), but frontal lobe seizures were less likely to secondarily generalize during sleep (10% versus 26%; p < 0.005). CONCLUSIONS: Partial-onset seizures occur frequently during NREM sleep, especially stage 2 sleep. Frontal lobe seizures are most likely to occur during sleep. Patients with temporal lobe seizures have intermediate sleep seizure rates, and patients with seizures arising from the occipital or parietal lobes have rare sleep-onset seizures. Sleep, particularly stage 2 sleep, promotes secondary generalization of temporal and occipitoparietal, but not frontal, seizures. These findings suggest that the hypersynchrony of sleep facilitates both initiation and propagation of partial seizures, and that effects of sleep depend in part on the location of the epileptic focus.
Adolescent↗
Glial cell nuclear hypertrophy in complex partial seizures.
The white matter of resected temporal lobes from patients with intractable complex partial seizures shows increased cellularity which appears to be related to glia and neurons. This study, using quantitative methods, defines an increase in glial cell numbers and a significant increase in glial nuclear size within a defined area of white matter in the lateral temporal lobe. Evaluation was made on specimens from ten patients with complex partial seizures compared with two patients with non-epileptic brain lesions and five autopsy patients with no neurologic disease. The importance of recognizing these alterations in glia and the possible relevance to the pathoetiology of epilepsy are discussed.
Adolescent↗
Incidental detection of hippocampal sclerosis on MR images: is it significant?
BACKGROUND AND PURPOSE: The prevalence of hippocampal sclerosis in the general nonepileptic patient population is not well described. While reports of its association with partial complex seizures are abundant, its absence in nonafflicted patients is generally presumed but not well documented. To test the hypothesis that hippocampal sclerosis is specific for epilepsy, we reviewed the MR imaging studies of 207 patients referred for hearing loss to determine whether high-resolution MR imaging could detect unsuspected hippocampal sclerosis in nonepileptic patients. METHODS: Our institution screens patients with hearing loss by using high-resolution coronal and axial temporal bone MR imaging that includes the hippocampus within the imaging volume. We retrospectively reviewed 207 studies randomly selected from this database. RESULTS: The hippocampus was normal in 205 patients; in the remaining two patients we identified one or more primary determinants for hippocampal sclerosis. Subsequent retrospective chart review revealed that both patients had had previously diagnosed seizure disorders. CONCLUSION: The imaging determinants of hippocampal sclerosis are not prevalent in nonepileptic patients. Incidental identification of hippocampal sclerosis on MR images is uncommon and significant, and should prompt further clinical investigation to exclude a seizure disorder.
Adolescent↗
Transient bulimia-anorexia and hypersexuality following pneumoencephalography in a case of psychomotor epilepsy.
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Anorexia↗
Cerebral metabolism and depression in patients with complex partial seizures.
Twenty-three patients with complex partial seizures were evaluated with 18F-2-deoxyglucose positron emission tomography and with the Beck Depression Inventory. Five of 10 patients with left and zero of eight with right temporal electroencephalographic foci had depressive symptoms; one of five patients with poorly localized electroencephalographic foci also scored in the depressed range. Temporal, frontal, caudate, and thalamic normalized glucose metabolic rates among five patients with depressive symptoms and well-localized left temporal epileptogenic regions were compared with five patients without depressive symptoms but with similar electroencephalographic characteristics. Multifactorial analysis of variance yielded a significant nonlateralized mood by region interaction. Of nine individual regions compared, only inferior frontal cortex showed a significant difference in normalized regional metabolic rate between depressed and nondepressed patients. Metabolism in this region also distinguished patients with depressive symptoms from normal control subjects. Depressive symptoms in patients with complex partial seizures are associated with a bilateral reduction in inferior frontal glucose metabolism, compared with patients without depressive symptoms and normal control subjects. The frontal lobe hypometabolism observed in patients with depressions associated with epilepsy, Parkinson's disease, and primary affective disorder suggests that similar frontal lobe metabolic disturbances could underlie these conditions.
Adolescent↗
Complex partial seizures and aphasia as initial manifestations of non-ketotic hyperglycemia. Case report.
We describe a case of non-ketotic hyperglycemia (NKH), heralded by complex partial seizures and aphasia of epileptic origin, besides versive and partial motor seizures. This clinical picture was accompanied by left fronto-temporal spikes in the EEG. The seizures were controlled by carbamazepine only after the control of the diabetes. A month later, carbamazepine was discontinued. The patient remained without seizures, with normal language, using only glybenclamide. Complex partial seizures, opposed to simple partial seizures, are rarely described in association to NKH. Epileptic activity localized over language regions can manifest as aphasia.
Anticonvulsants↗
Anticonvulsant activity of PNU-151774E in the amygdala kindled model of complex partial seizures.
PURPOSE: PNU-151774E [(S)-(+)-2-(4-(3-fluorobenzyloxy) benzylamino) propanamide, methanesulfonate] is a novel antiepileptic drug (AED) with a broad spectrum of activity in a variety of chemically and mechanically induced seizures. The objective of this study was to evaluate the activity of PNU-151774E in the amygdala fully kindled rat model of complex partial seizures, and to compare its effects with those of carbamazepine (CBZ), phenytoin (PHT), lamotrigine (LTG), and gabapentin (GBP), drugs used to treat this disease state. METHODS: Male Wistar rats were stimulated daily through electrodes implanted in the amygdala with a threshold current until fully generalized seizures developed. The rats were then treated with various doses of a single compound. Control values for each rat and drug dose were determined after vehicle administration followed by electrical stimulation 1 day before drug treatment. RESULTS: PNU-151774E (1, 10, 30 mg/kg; i.p.) reduced the duration of behavioral seizures significantly and dose-dependently at doses starting from 1 mg/kg. Higher doses significantly reduced seizure severity and afterdischarge duration. In contrast, no dose-related effects were noted after administration of PHT, whereas after CBZ treatment, a plateau of activity was noted from the intermediate to higher doses. The effects of PNU-151774E were comparable to those of LTG and GBP. CONCLUSIONS: The activity shown by PNU-151774E at doses similar to those that are active in models of generalized seizures indicates that PNU-151774E would also have potential efficacy in the treatment of complex partial seizures.
Acetates↗
Complex partial status epilepticus in a patient with dural metastases.
We describe a 68-year-old man with invasive transitional cell carcinoma of the bladder metastatic to the dura who presented with complex partial status epilepticus (CPSE). To our knowledge, the association of CPSE and dural metastases has not been previously reported.
Aged↗
Arterial supply to the hippocampal formation.
Arterial supply of hippocampal formation in humans has been studied by many investigators in the past. More recently, investigation of correlation of complex partial seizure with mesial temporal sclerosis has brought a resurgence of interest in studying the hippocampus. This article discusses arterial architecture of the hippocampal formation.
Angiography↗
Vigabatrin.
OBJECTIVE: To introduce the reader to the use of a new agent, vigabatrin, in the treatment of refractory complex partial seizures. Clinical trials and pharmacokinetic data are reviewed, as well as neuropathology, adverse effects, drug interactions, and dosage guidelines. DATA SOURCES: A MEDLINE search through March 1992 was used to identify pertinent English-language literature, including clinical trials, reviews, abstracts, and conference proceedings. Indexing terms included vigabatrin and anticonvulsants. STUDY SELECTIONS: All clinical trials (total of 21) were reviewed, as were all pharmacokinetic studies (total of 8). Selected studies highlighting chemistry, pharmacology, neuropathology, and adverse effects were also reviewed. DATA EXTRACTION: Performed subjectively by the author. Trials were assessed by design, sample size, types of seizures of the subjects, and clinical response. DATA SYNTHESIS: Vigabatrin represents the first of a new class of antiepileptic drugs (AEDs)--the gamma-aminobutyric acid transaminase (GABA-T) inhibitors. Vigabatrin works by selective, irreversible inhibition of GABA-T, thus preventing the breakdown of GABA. It has been shown to produce dose-dependent increases in cerebrospinal fluid GABA concentrations, and decreases in GABA-T activity. Vigabatrin may also cause a decrease in excitation-related amino acids. It is well absorbed, is not protein bound, and is eliminated by glomerular filtration. However, even with a short half-life (5-7 h), vigabatrin may be given once or twice daily because of its mechanism of action. Few drug interactions have been reported with this agent, although decreases in phenytoin concentration may reach clinical significance. Concern over neuropathologic findings (microvacuolization of white matter) in animals caused trials of vigabatrin to be halted in 1983, but trials have now resumed as there is no evidence of toxicity in humans. Clinical efficacy of vigabatrin has been evaluated in controlled trials and appears to be most effective in complex partial seizures, producing a 50 percent or greater reduction in seizure frequency in approximately 50 percent of the adult patients studied. Efficacy in children with partial seizures also appears promising, and one uncontrolled study suggests that further study of vigabatrin in infantile spasms may be warranted. CONCLUSIONS: Vigabatrin appears to be effective in treating refractory complex partial seizures in adults and refractory partial seizures in children. Its relatively benign adverse-effect profile and few known drug interactions may given this agent an advantage over existing anticonvulsants. However, definitive conclusions about the role of vigabatrin in epilepsy treatment should await the completion of ongoing Phase II and Phase III trials.
Adult↗
[Complex partial seizures: the localization value of automatisms].
INTRODUCTION: The clinical findings in complex partial crises may help our understanding of the different foci and vias of epileptogenesis. MATERIAL AND METHODS: We analyse automatisms and findings on EEG and neuroimaging in 151 patients with different types of partial epilepsy, seeking to establish a possible correlation between the type of automatism and cerebral localization. RESULTS AND CONCLUSIONS: The relative frequency of automatisms was: oro-alimentary 30%, mimicking 11%, gestures 35%, ambulatory 19% and verbal 13%. There was a statistically significant difference between the type of automatism and the topography of the EEG and neuroimaging findings. There were more gesture and oro-alimentary automatisms in patients with temporal anomalies, both on EEG and on neuroimaging, than in those with extratemporal alterations.
Adolescent↗
Psychoses and epilepsy: are interictal and postictal psychoses distinct clinical entities?
PURPOSE: To evaluate further the relevance of designating psychotic episodes as either postictal or interictal, we compared several biologic variables between epilepsy patients with and without psychosis. METHODS: The study subjects comprised 282 patients with psychosis (36 with postictal psychosis, 224 with interictal psychosis, and 22 with both postictal and interictal psychoses, i.e., bimodal psychosis), and 658 epilepsy patients without psychosis. The clinical characteristics of these patients were reviewed retrospectively by experienced neuropsychiatrists. Factors predicting the development of each type of psychosis were determined by serial multivariate logistic regression analyses. RESULTS: Factors that were comparable between postictal and interictal psychoses were intellectual function, family history of psychosis, epilepsy type, and the presence of complex partial seizures. In contrast, age at the onset of epilepsy and at the onset of psychosis and the presence of generalized tonic-clonic seizures differed for the three types of psychosis. Patients with bimodal psychosis showed characteristics associated with both postictal and interictal psychoses. CONCLUSIONS: This study documented conditions, including both general factors and epilepsy-related factors, common to epilepsy patients with psychosis, regardless of chronologic distinctions. Certain epileptic processes appear to have equal influence on postictal and interictal psychoses. However, some differences between postictal and interictal psychoses suggest that these chronologic descriptors are valid. Our findings confirmed that psychosis associated with epilepsy should not be defined as a single, simple condition but rather as a complex condition with several possible subcategories.
Adult↗