Clinical and electroencephalographic study of unilateral or predominantly unilateral seizures.
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Adolescent↗
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Results for “Epilepsy, Complex Partial”
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Studies on chromosomal anomaly syndrome with epilepsy.
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Adolescent↗
Antiepileptic effects of allopurinol involved in hippocampal specific SOD (superoxide dismutase) induction in the mutant El mouse.
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Administration, Oral↗
Occurrence of epileptiform activity in the routine EEG of epileptic patients.
In a retrospective study, the occurrence of epileptiform activity (EA) in routine EEG records of epileptic patients was investigated. Data were obtained from 1078 EEGs of 373 patients (199 men and 174 women; aged 17-87 (mean 34.2 +/-14.7)). The percentage of 38% of patients with EA in a single EEG could be increased to 77% by repeated records. After the 5th record however, the gain in new information decreased remarkably. No differences between seizure types could be detected. There was a relationship between EA and nonspecific EEG abnormalities. High EA rates were found for short time intervals since last seizure, young patients, long durations of the seizure disorder and for high seizure frequencies.
Adolescent↗
Medial temporal lobe heterotopia as a cause of increased hippocampal and amygdaloid MRI volumes.
Magnetic resonance imaging (MRI)-based volumetric measurements of the hippocampus and amygdala are useful in detecting hippocampal and amygdaloid sclerosis in patients with temporal lobe epilepsy. In these pathological entities, volumetric MRI analysis shows the epileptogenic structures to be atrophic when compared to the normal, nonepileptogenic side. Described are 2 patients with increased hippocampal and amygdaloid volumes on the side of seizure onset due to medial temporal lobe heteroto pias. Care must be taken in the interpretation of volumetric MRI data to make certain that asymmetries in hippocampal and amygdaloid measurements are due to atrophy and sclerosis of the abnormal side and not to increased tissue such as heterotopic gray matter.
Adult↗
Quality of life after vagus nerve stimulation for intractable epilepsy: is seizure control the only contributing factor?
We assessed the impact of vagus nerve stimulation on a cohort of patients with intractable epilepsy. A 1-year prospective trial of vagus nerve stimulation for intractable epilepsy was done in 26 patients. Seizure frequency, anti-epileptic drugs, and quality of life were assessed using QOLIE-89, ELDQOL, and a Likert scale of impact of treatment. Seizures were reduced by more than 50% in 19% of the patients, by less than 50% in 46%, and were unchanged in 35% of them. Antiepileptic drugs were reduced in 43% of the patients. There was a significant improvement in the mean overall QOLIE-89 score and other measures of quality of life, but these did not correlate with changes in seizure frequency. Subjective improvement occurred in 84% of the patients. The quality of life improves in some patients following vagus nerve stimulation for intractable epilepsy. The favorable effects of this treatment may be attributable to additional factors besides seizure control which in this study was modest.
Adaptation, Psychological↗
Parietal lobe epilepsy: surgical treatment and outcome.
OBJECTIVE: Parietal lobe epilepsy (PLE) is neither common nor easily diagnosed because of its variable clinical features. To elucidate its characteristics and surgical outcome, the authors reviewed their surgical experiences. METHODS: Between September 1994 and August 2001, 38 patients with PLE received surgical treatment at the Seoul National University Hospital. All patients underwent resection, mainly involving the parietal lobe. RESULTS: Preoperatively, over 60% of the cases were not considered to be PLE, even though PLE was the most common diagnosis (15/38, 39.8%). An invasive study was performed in 37 of the 38 patients. Awake operations under regional anesthesia were performed in 20 patients (52.6%). Seizure disappeared in 15 (Engel's classification I, 39.5%), and rare seizure remained in 5 (Engel II, 13.2%). Thirteen patients showed a worthwhile improvement (Engel III, 34.2%), whereas 5 exhibited no worthwhile improvement (Engel IV, 13.2%). Pathologies were diverse, the most common being cortical dysplasia (94.3%). CONCLUSION: Since PLE is difficult to diagnose preoperatively, an invasive study covering the parietal lobe is mandatory, if PLE is suspected. Cortical dysplasia was the most common etiology, thus awake operation under regional anesthesia and intraoperative brain mapping is helpful during extensive resection in order to spare the eloquent cortex.
Adolescent↗
Epileptic syndromes in children with somatosensory evoked spikes.
We studied 186 children with frequent EEG paroxysms evoked by tapping of the feet or hands (ES). Seventy-five (40.3%) patients had a history of epileptic seizures. Febrile convulsions alone occurred in 31 (16.7%) of the children and nonfebrile in 44 cases (23.7%). Non-febrile seizures occurred in a greater proportion among patients with ES than in a control group with normal EEG. Spontaneous epileptiform activity was recorded in 39.6% of the patients without epileptic seizures but in a great percentage of the children with seizures (85.3%). The non-febrile seizures were partial in 26 cases and generalized in 18. In 39 of these cases the EEG also showed spontaneous focal spikes, which occurred predominantly in the parietal regions in 24 cases. ES were observed in different types of partial and generalized epilepsies of childhood. Our findings also suggest that in an important proportion of cases there is a benign condition of a functional nature that is age-dependent, involving mainly the parietal lobe but in which seizure type does not so easily permit definition as a clearly characterized epileptic entity compared to other recognized idiopathic partial childhood epilepsies.
Adolescent↗
A meta-analysis of individual patient responses to lamotrigine or carbamazepine monotherapy.
OBJECTIVE: To compare the effects of carbamazepine and lamotrigine monotherapy for people with partial onset seizures or generalized onset tonic-clonic seizures. METHODS: A systematic review and meta-analysis using data on individual patients from randomized trials comparing lamotrigine with carbamazepine monotherapy. The review draws on the search strategy developed for the Cochrane Epilepsy Group, which searches MEDLINE and the Cochrane Controlled Trials register, and hand searches relevant journals. The outcomes considered were time to antiepileptic drug withdrawal, which would usually be for either inadequate seizure control or unacceptable adverse effects, time to first seizure, and 6-month remission. RESULTS: Five randomized trials were identified containing data for 1,384 participants. Time to treatment withdrawal significantly improved with lamotrigine compared to carbamazepine (hazard ratio 0.55, 95% CI 0.35 to 0.84, random effects), while time to first seizure (hazard ratio 1.14, 95% CI 0.92 to 1.43, fixed effects) and seizure freedom at 6 months (relative risk 0.92, 95% CI 0.81 to 1.04, fixed effects) favor carbamazepine although the results are not significant. CONCLUSIONS: Lamotrigine is significantly less likely to be withdrawn than carbamazepine, but results for time to first seizure suggest a nonsignificant trend that carbamazepine may be superior in terms of seizure control. Trials were of too short a duration to measure clinically important efficacy outcomes such as time to 12-month remission. Current industry-sponsored trials fail to adequately inform clinical practice and further more clinically relevant trials are needed in which longer-term outcomes are assessed before the place of lamotrigine in the treatment of epilepsy is defined.
Adult↗
In vivo MRI in different models of experimental epilepsy.
In order to investigate epilepsy, that is one of the most common neurological disorders, in the last decades different animal models have been proposed. Prevention, diagnosis, treatment and basic knowledge have been improved by the mean of these models. Numerous animal models have been developed in epilepsy research, both for generalized and for simple/complex partial seizures. Animal models for generalized seizures include sensory (light, noise, movement, etc) or electrical stimulations and genetic models. Models for focal seizures include topical or systemic application of pro-convulsive compounds or electrical stimulation. Baboons, mice, rats, rabbits, and Fayoumi chicken have been extensively used in this regard. Since 1983, when magnetic resonance spectroscopy was used to evaluate for the first time in vivo alterations induced by status epilepticus in rabbit, an increasing interest for the neuroimaging perspective has led to new insights in the study of epileptic disorders. In the early 1990s experimental studies provided evidence for the feasibility of magnetic resonance imaging analysis and detection of tissue damage in kainic acid-induced epilepsy in rat. In the following years a wealth of data has been obtained by the mean of functional MRI and/or by diffusion-weighted images. The studies reported in the literature of the last decades indicate in vivo magnetic resonance of epilepsy model as valuable and extremely informative tool.
Animals↗
Improved sexual function in three men taking lamotrigine for epilepsy.
Little information exists about the effects of newer antiepileptic drugs (AEDs) on sexual function in men with epilepsy. We report a series of three male veterans whose sexual disorders improved with lamotrigine. All three had partial seizures. One patient was taking phenobarbital and gabapentin and complained of decreased potency and anorgasmia. After lamotrigine was added for better seizure control and the dosage of gabapentin was tapered, anorgasmia improved. The second patient complained of impotence after a rash while taking phenytoin and carbamazepine. Impotence persisted with phenobarbital, valproate, and gabapentin. Eight months after gabapentin was replaced with lamotrigine, impotence improved. The third patient complained of long-standing impotence. Treatment with five AEDs had no effect on the dysfunction. Lamotrigine was added to the carbamazepine regimen; impotence improved with decrease in carbamazepine and increase in lamotrigine. The favorable effect of lamotrigine on sexual disorders in these three patients suggests this drug should be considered under appropriate circumstances for men who have sexual dysfunction while taking other antiepileptic agents.
Acetates↗
Natural history of drug resistant seizures: clinical aspects.
In an effort to determine the long-term efficacy of surgical therapy for epilepsy, a control group of patients was identified. Both the surgically treated and non-surgical groups were evaluated before and after 5- or 10-year follow-ups for seizure frequency in the preceding 2 years. To date 39 patients have had bona fide partial seizures, with or without secondary generalization, and EEGs with focal epileptiform patterns. Prior to first evaluation, these patients had had seizures for an average of 10 years and were treated with an average of 54 AEDs with documented therapeutic serum levels in most; one-third of the patients participated in experimental studies. After treatment for another 5 years with an average of 2.5 AEDs or 10 years with an average of 4.0 AEDs, no one was seizure free. Fifteen percent had a 75% decrease in seizure frequency and 85% continued to have no significant improvement in seizure control. Thus despite vigorous treatment, these patients who might have been considered surgical candidates continued to have uncontrolled seizures.
Adolescent↗
Thrombophilia interpretation in childhood stroke: a cautionary tale.
Several authors have reported a link between childhood stroke and inherited thrombophilia in recent years. The impact of such a relationship on management and outcome is yet to be determined, as is the potential cost-benefit ratio associated with the performance of thrombophilic screening in children presenting with ischemic stroke. We present a case that highlights the need for clinical and radiologic examinations to remain the definitive criteria used to diagnose stroke in children. The diagnosis should not be influenced by the finding of a thrombophilic marker.
Blood Coagulation Factors↗
Dose-response study of vigabatrin in children with refractory epilepsy.
Twenty children aged 2 months to 18 years were included in a dose-response study of vigabatrin as add-on therapy to preexisting antiepileptic drugs (up to two per patient). All children had severe refractory epilepsy: partial seizures with or without secondary generalization in 19, and myoclonic seizures in one. After a 2-month observation period and a 1-month add-on placebo period, a fixed dose of add-on vigabatrin was given for 2 months: 1, 1.5, or 2 g/day, according to body weight (mean dose, 60 mg/kg/day). Three patients (15%) became seizure free, and nine (45%) showed a 50% to 99% reduction in seizure frequency. In the 17 patients whose seizures were not totally suppressed, vigabatrin dose was increased for a further 2 months, and in 7 patients who still showed less than 50% reduction in seizure frequency, vigabatrin dose was increased again. Efficacy appeared unchanged by these higher doses. During a 9-month follow-up phase, no tolerance to the effects of vigabatrin was observed, with three children seizure free and 13 (65%) reporting a 50% to 99% reduction in seizure frequency. During the study, adverse effects were recorded in three children (15%), namely drowsiness, constipation, fatigue, and apathy. These effects were generally transient, being observed during the dose-modification phase and disappearing either spontaneously or on reduction of vigabatrin dose. Clinical and laboratory tolerability to vigabatrin appeared to be very good, with no patients having withdrawn from the study because of side effects. A slight reduction in red blood cell count and hemoglobin levels was noted but was of doubtful clinical significance.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[Allergic vasculitis caused by Vigabatrin].
A patient with focal epilepsy that was resistant to medical treatment received add-on therapy with vigabatrin. Six months after commencement of vigabatrin therapy, allergic vasculitis caused by vigabatrin was diagnosed. The patient displayed unilateral anterior ischaemic optic neuropathy with impairment of vision and concentric loss of visual field. The diagnosis was based on the lymphocyte transformation test and the clinical course. The allergic vasculitis was healed by cortisone therapy.
Adult↗
Computed tomography in patients with recurrent seizures.
Eighty patients had Computed Tomography (CT) performed for evaluation of epileptic seizures. Abnormal scans were found in 37 of the 80 patients (46.3%). Focal CT abnormalities were seen in 26 of the 80 patients (32.5%). Tumors were present in four and arteriovenous malformation (AVM) in three. Simple partial motor seizures were most strongly correlated with abnormal scans (five, 45.4%). Nineteen out of 21 patients with focal electro-encephalographic (EEG) abnormalities had focal CT abnormality compared to one out of 15 of those with generalised abnormality. 88.9% of patients with hemiplegia had abnormal scans. Whilst focal EEG abnormalities and abnormal neurologic signs pointed to a higher likelihood of CT abnormality, two subjects who were shown to have vascular malformations had normal EEG and neurologic exams. Routine CT scanning for evaluation of patients with recurrent seizures is advocated.
Adolescent↗
[Diagnosis of seizures originating in the amygdala and the hippocampus].
INTRODUCTION: Lesions in the hippocampus of some epileptic patients were first described one hundred and seventy years ago. Since then our knowledge of the relationship between epileptic seizures and temporal lobe lesions has greatly improved. DEVELOPMENT: The aim of this paper is to systematize the symptomatology of the hippocampus and amygdala seizures. These seizures may have a great number of different clinical features: special 'loss' or 'impairment of consciousness', epileptic automatisms and autonomic changes. Moreover, at the beginning of seizures some patients have reported experiences having subjective qualities similar to those experienced in everyday life. P Gloor named them 'experiential phenomena' and subdivided them into affective (eg: fear), perceptual (eg: visual hallucinations) and mnemonic (eg: 'déjà vu' illusion). CONCLUSION: It is very important to know the contribution of the hippocampus and the amygdala to the symptomatology of temporal lobe seizures due to the progress of MRI diagnostic possibilities that are improving the surgical outcome.
Amygdala↗
Electrophysiologic assessment of autonomic function in epilepsy.
Sudden unexpected death associated with epilepsy (SUDEP) is an important clinical problem. Peri-ictal autonomic dysfunction is thought to play a role in SUDEP and few means exist for clinical identification of patients at risk. Sympathetic function was assessed by measuring sympathetic skin responses (SSR) elicited in the hand by auditory or tactile stimulation or by inspiration. Parasympathetic function was assessed by recording the R-R interval (RRI) and determining its variability in subsequent heartbeats. Fifty epilepsy patients had significantly greater SSR amplitudes and latencies than controls. The RRI was shorter in patients than in controls and the mean successive difference (MSD) was less, but significance was not reached. Twenty patients at possible risk for SUDEP (male, generalized seizures, intermittent medication noncompliance, drug and alcohol abuse, traumatic or structural aetiology) differed significantly from controls in SSR and RRI. Epilepsy patients may differ in autonomic function from the general population, and these differences may be relevant to SUDEP. The SSR and the RRI may be a simple means of assessing autonomic function in epilepsy outpatients.
Adolescent↗