Psychiatric disorders and pregnancy.
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Chronic Disease↗
Biomedical subjects
O Devinsky
Publications and source records attributed to O Devinsky.
Epilepsy and pregnancy.
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Anticonvulsants↗
Nonepileptic seizures during apparent sleep.
We report 12 patients with nonepileptic seizures (NESs) documented with video-electroencephalographic monitoring during apparent sleep. There were 7 females and 5 males, ages 11 to 67 years (mean, 33 yr). In all patients there was a well-organized posterior alpha rhythm present immediately before onset of clinical changes despite the appearance of sleep. Patients later "confirmed" that these attacks occurred during sleep. Features of these episodes were typical of NESs and none were associated with ictal or postictal electroencephalographic changes other than muscle and movement artifact. Provocative testing with suggestion confirmed the nonepileptic nature of these episodes in 9 patients. Three patients had epileptiform discharges during prolonged interictal recordings and 1 had a documented complex partial seizure. Our findings indicate that reports of seizures during sleep are not uncommon among patients with NESs.
Adolescent↗
Anterior temporal language areas in patients with early onset of temporal lobe epilepsy.
Eighteen consecutive patients undergoing dominant temporal lobectomy underwent preoperative cortical stimulation for language localization. Patients with naming deficits on anterior (4.5 cm from the temporal pole) temporal lobe stimulation had earlier seizure onset vs those without such deficits (5.8 yr vs 12.9 yr; p < 0.04). There was a similar trend for reading errors (6.3 yr vs 12.4 yr; p < 0.052). Resections always spared at least 1 cm anterior to any language area. There was no significant difference in postoperative neuropsychological tests between patients with and without anterior language representation. Early onset of dominant temporal lobe seizure foci leads to a more widespread or atypical distribution of language areas. Individual variability should be considered in epilepsy surgery to reduce postoperative language deficits.
Adolescent↗
Multiple subpial cortical transections for the control of intractable epilepsy in exquisite cortex.
In 5 cases suffering from intractable seizures and ictal onset in exquisite (primary somatosensory or language related) cortex, surgical therapy has been done consisting wholly or in part of multiple subpial transections. In two cases with involvement of the primary somatosensory cortex, good seizure control without detectable neurological deficit was achieved. In the other three cases with involvement of the language cortex, deficits were minimal and cleared with time. Patients became seizure-free.
Adolescent↗
Premonitory symptoms in epilepsy.
We studied premonitory symptoms in 128 patients with partial and 20 patients with primary generalized epilepsy. Sixty symptoms were reported by 43 (29%) patients, all of whom had partial seizure disorders (P < .01). Symptoms began at least 30 minutes before seizure onset, lasted 10 minutes to 3 days, and were continuous. Irritability, depression, headache, 'funny feeling', and confusion were the most common symptoms. Premonitory symptoms are a warning system in some patients and may permit therapeutic interventions.
Adolescent↗
Clinical uses of the quality-of-life in epilepsy inventory.
The quality-of-life in epilepsy (QOLIE) inventory was designed to assess adult epilepsy patients. Responses to a draft 99-question inventory administered to patients with low to moderate seizure frequency will be used to generate two or three separate instruments. The largest and most comprehensive of these will serve as a research tool for investigators and may be helpful in designing studies that compare the effects of approved or investigational antiepileptic drugs. This instrument may also be useful in documenting patient outcomes following expensive diagnostic studies, such as video-electroencephalogram monitoring, or other therapeutic interventions, such as epilepsy surgery. An intermediate-sized instrument may serve as a clinical tool for neurologists and epileptologists. A brief instrument may serve as a quick clinical survey for primary care physicians, neurologists, and specialists in epileptology. The abbreviated clinical inventories are intended to provide rapid assessment of quality-of-life issues in the office setting. Such assessments can help physicians and patients identify previously unrecognized problems and may lead to changes in care.
Anticonvulsants↗
Quality of life in epilepsy: the clinician's view.
Quality of life in patients with epilepsy may be impaired by seizures, side effects of medication, and psychosocial problems. Doctors tend to focus their attention on managing the seizures and the side effects, but may not be meeting all of the patient's needs because of differences between their perception of these concerns and the patient's. Further, psychosocial problems often are addressed only superficially or not at all during office visits. The challenge is to integrate quality-of-life issues into clinical practice and to better assess the patient's perception of the disorder, the seizures, and the medications, as they impact on cognitive function, emotional well-being, and social and economic functioning.
Adult↗
Nonepileptic seizures and childhood sexual and physical abuse.
Nonepileptic seizures (NES) must be distinguished from epilepsy to avoid the adverse effects of unnecessary antiepileptic drugs and to initiate appropriate psychiatric treatment. A higher frequency of prior sexual abuse has been suspected in NES, although no prospective controlled study has compared patients with NES and epilepsy. A series of patients with conversion disorder presenting as epilepsy and 140 patients with complex partial epilepsy (CPE) without evidence of conversion were selected from a series of consecutive admissions to a comprehensive epilepsy center. The groups did not differ with respect to age, years of education, race, or marital status, but the percentage of women was greater in the conversion NES group (73.2%) than in the CPE control group (50.7%; p < 0.002). The frequency of a history of sexual or physical abuse was greater in the NES group (32.4%) than in the CPE controls (8.6%; p < 0.000). Severity of sexual but not physical abuse was significantly greater in the NES group relative to controls (p < 0.05). There was a trend for a closer relationship of the perpetrator of sexual abuse to the victim among the NES patients compared with CPE controls (p < 0.1). These results support the impression that childhood abuse is more common among patients with conversion NES than with epilepsy, and suggests that in some cases childhood abuse may be a contributory pathogenetic factor.
Adult↗
Crying seizures.
We report seven patients with crying during video-EEG-documented simple or complex partial seizures. During simple partial seizures, crying occurred with or without appropriate affect. Crying occurred postictally in two patients and was associated with persistent spiking in one of them. Six patients had ictal activity in the nondominant hemisphere, maximal in the anteromesial temporal region in five and in the mesial frontal region in another. These cases support theories proposing a lateralization of emotion, with right hemisphere dominance for negative affective states.
Adult↗
Material-specific memory in the intracarotid amobarbital procedure.
We examined material-specific memory in 45 left hemisphere language dominant patients with temporal complex partial seizures (24 right, 21 left) during the intracarotid amobarbital procedure (IAP) by showing eight cards displaying two line drawings of common objects, two printed words, one colored shape, one math expression, one face, and one abstract shape following amobarbital injection (mean = 109.9 mg). We assessed delayed recall and recognition following clearing. Patients with right foci recognized significantly fewer verbally mediated stimuli (words, object drawings, colored shape) with left than with right injection. Patients with left foci recognized a nonverbal stimulus (abstract shape) more poorly following right versus left injection. Discriminant function analysis lateralized 85% of the sample from memory predictors, upheld to 81% on crossvalidation. Material-specific memory remains intact in the hemisphere contralateral to a seizure focus, but wider representation may occur for stimuli normally dominant for the hemisphere with the seizure focus. The IAP significantly lateralizes a seizure focus with use of both types of stimuli.
Amobarbital↗
Lateralizing significance of head and eye deviation in secondary generalized tonic-clonic seizures.
We studied 92 secondary generalized tonic-clonic seizures (SGTCS) in 29 patients with a clearly lateralized seizure focus using video-EEG telemetry. An examiner, blind to the EEG, reviewed direction and type (forced versus nonforced) of head/eye deviation (HD). Forced HD consisted of sustained, unnatural tonic or clonic movements. Nonforced HD consisted of sustained deviations that were neither tonic nor clonic and were similar to volitional head movements. Eighty-three of the 92 SGTCS (26 of 29 patients) had lateralized and sustained HD. The direction of HD was contralateral in over 90% of seizures when the movement either (1) continued as the seizure generalized, or (2) occurred in the 10 seconds prior to generalization. The direction of HD was ipsilateral in over 90% of seizures if the movement ended before the seizure began to generalize (in all cases, the movement ended more than 10 seconds before generalization). HD occurring within the first 10 seconds after seizure onset was not of lateralizing significance. Forced HD was 89% contralateral, while nonforced HD was not of lateralizing significance. HD in SGTCS provides information on seizure focus lateralization.
Adolescent↗
New antiepileptic medications.
Several new compounds are undergoing extensive investigation in the United States and Europe. The available animal and human studies suggest that these new antiepileptic drugs are very promising. Some or all of them will be approved for clinical use during the next decade. New antiepileptic drugs offer new options in the treatment of epilepsy. Although there already has been considerable testing of these drugs, additional studies that incorporate traditional medical outcome measures and quality of life measures remain to be done to establish the ultimate role of the new antiepileptic drugs in the treatment hierarchy for epilepsy.
Animals↗
Epilepsy surgery.
Epilepsy surgery is assuming greater importance in treating patients with partial epilepsy whose seizures are uncontrolled with antiepileptic drugs. Many good candidates for surgical treatment are not presented with the option of surgery. The evaluation for epilepsy surgery is extensive and includes several stages of noninvasive and invasive testing. As more sophisticated noninvasive tests develop, fewer patients require invasive monitoring studies such as depth or subdural electrodes. The principal forms of surgical treatment include focal resection, corpus callosotomy, and hemispherectomy. Temporal lobectomy remains the most common and effective form of epilepsy surgery. Frontiers of epilepsy surgery include resective surgery for intractable infantile spasms and multiple subpial transections for patients whose seizure foci are in sensory, motor, or languages cortex. Additional studies are needed to define the safety and efficacy of these new procedures.
Animals↗
Electrical and magnetic stimulation of the central nervous system. Historical overview.
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Animals↗
Functional mapping of memory and other nonlinguistic cognitive abilities in adults.
The review of previous research and the studies undertaken at our center suggest an important role for mapping of nonlinguistic cognitive functions with cortical stimulation. Such mapping is usually restricted to language functions, which is understandable given the importance of language to daily activities and the reports of postoperative declines in naming. However, memory functions are also critical to adaptive daily living, and these studies show that memory may be effectively addressed through mapping procedures. Both Ojemann's studies and those at our center suggest an important role for much of the temporal convexity in memory processing, and we believe that postoperative memory declines can be minimized with mapping of the temporal lobe prior to resection. Patients presenting with unique abilities that may be susceptible to postoperative declines can also be effectively mapped with stimulation studies tailored to their unique abilities. We encourage the expansion of mapping paradigms beyond just the language domain and believe that such studies will both improve the quality of our patients' functioning and further our knowledge of brain-behavior relationships.
Adult↗
Electrocorticography during cortical stimulation.
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Animals↗
Behavioral changes associated with epilepsy.
Epilepsy can be accompanied by changes in cognition, personality, affect, and other elements of behavior. There is no single epileptic constitution or personality complex. A unifying theme to the behavior in epilepsy is diversity. As one looks at the behavioral traits reported in epilepsy, a specific and consistent pattern is lacking. Rather, extremes of behavior are accentuated: sometimes in one direction, often in both directions. Changes in emotional state are prominent among behavioral features in epilepsy. Some authors describe a prominent deepening or increase in emotionality, whereas others identify a global decrease in emotional life and content. Emotional lability is also reported. Sexuality and libido are typically decreased, but fetishism, transvestism, exhibitionism, and hypersexual episodes also occur. Concerns over morality may be lacking or exaggerated. Patients may be irritable and aggressive or timid and apathetic. The impressive list of people with epilepsy in politics, religion, arts, and sciences suggests a positive expression of this behavioral spectrum. Psychosis, depression, paranoia, and personality disorders may represent a negative pole of epilepsy-related behavioral changes. The most important aspect of behavioral changes in epilepsy for physicians is to recognize and treat dysfunctional behavior. Depression is a common problem that is often unrecognized and untreated. Other treatable problems include impotence, anxiety, panic attacks, and psychosis. Identifying risk factors will, it is hoped, assist in developing methods to prevent these disorders.
Anxiety Disorders↗