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PubMed2004

[Treatment protocol for long-term anti-epilepsy drugs in children with refractory epilepsy].

Long-term treatment of children with drug-resistant epilepsy has not been addressed in detail in the literature. Contraindications for surgery must be reassessed periodically. The epileptic nature and the focal characteristic of seizures must be verified, the absence of tumor, malformation or another indication for surgery (i.e. obstructed valve.), the choice of anti-epileptic drugs depending on the epilepsy syndrome, even following callosotomy, and the dose, that is often over-estimated, must also be re-evaluated.

Adolescent↗
PubMed2004

[Cost-effectiveness of epilepsy surgery in a cohort of patients with medically intractable partial epilepsy--preliminary results].

OBJECTIVE: Patients with medically intractable epilepsy are potential candidates for surgery if the epileptogenic tissue is localized and resectable. Surgical therapy can eliminate seizures but is very expensive. We followed a prospective adult cohort of intractable epileptic patients in order to perform a cost-effectiveness analysis. POPULATION AND METHODS: Adult patients with a suspected partial medically intractable and operable epilepsy were eligible for evaluation, explorations and/or surgery. Clinical and economical data were collected at the inclusion and every 6 months over at least two years. Two patient groups were analyzed: some underwent a surgery, others did not. Clinical data were compared between both groups. As the data collection was not yet complete, we compared the surgery to a continuation of the preoperative medical management in a cost-effectiveness analysis. Direct medical and nonmedical costs were evaluated according to a societal perspective. The effectiveness was defined as one year without seizure. We assessed the incremental cost-effectiveness ratio (ICER) for the first two years after the surgery. We also modeled long-term costs and effectiveness and extrapolated the results over the patients' lifetime with a Markov model. We computed the ICER and performed a sensitivity analysis. Indirect costs were measured in physical units and intangible costs were assessed with quality-of-life measures (QOLIE-31, SEALS). Data were compared before and after surgery. RESULTS: Among the 286 patients included, 119 did not enter in the analysis: 7 were not eligible, 44 not operable, 31 did not present a follow-up, 37 still underwent exams. Finally, 89 underwent a surgical treatment, and 78 were medically treated. Disease was more severe in surgical patients than in medical patients: seizures frequency, depressive disorders and cognitive impairment were greater. One year after the surgery, 83% patients were seizure free. During the year before inclusion and the year after surgery, direct costs were mainly due to hospitalization. During the second year after surgery, the cost of antiepileptic drugs predominated. One additional year without seizure costs 23 531 euro one year after surgery and 9533 euro two years after surgery. In a long-term perspective, the surgery became cost-effective between 7 and 8 years after the surgery. CONCLUSION: Surgical therapy is a cost-effective treatment in a middle-term even without indirect costs consideration.

Adolescent↗
PubMed1989

[CT in children with epilepsy. The value of cerebral CT in children with epilepsy].

In a retrospective material of 66 children with epilepsy, computed tomographic scanning had been undertaken in 30 cases. Abnormal computed tomographic findings were observed in five children in the form of cerebral tumour or sequelae of head injuries or perinatal asphyxia. All five children had focal EEG changes but none of these as the only positive finding. The investigation had therapeutic consequences in one case only, viz the case where computed tomographic scanning confirmed the clinical suspicion of tumour. The value of computed tomographic scanning in children with epilepsy is discussed, particularly in children with focal EEG changes.

Adolescent↗
PubMed1983

[Electroclinical and developmental aspects of epilepsy in the aphasia-epilepsy syndrome].

76 children are studied--66 from the literature and 10 from a personal series--who developed epileptic seizures, paroxysmal EEG abnormalities and language deterioration after a period of normal development of language. The clinical features of the fits, the age at which the seizures appear and disappear, the age of the EEG normalization and the normal clinical and radiological examinations were reminiscent of partial benign epilepsies of childhood. Shortly after the language deteriorates, the awake EEG exhibits slow spikes that are diffuse or predominate in the temporal areas, sometimes asymmetrically. During sleep, the paroxysmal abnormalities are clearly bilateral and continuous or subcontinuous. Spontaneously or under medications, the intensity of the paroxysmal abnormalities decreases before clinical improvement occurs. In comparison with the mutism resulting from acquired hearing loss, it is suggested that the language disturbances in these children result from a functional disorganization of the language centers due to the important intercritical EEG abnormalities. In some children, these functional disturbances could result from a benign epilepsy. This view leads to discuss the prognosis and the therapeutic possibilities.

Anticonvulsants↗
PubMed1982

[A further role on the structuro-functional organization of the vegetatovisceral manifestations of epilepsy (diencephalic epilepsy?)].

The authors present the results of examining 138 patients whose disease could be classed with the so-called "diencephalic epilepsy" proceeding from the structure of the paroxysmal vegetovisceral manifestations, the degree of the neuroendocrinal syndromes, the complicate scope of the organic and functional anomalies, and hydrocephalus of the IIId ventricle. Stereoelectroencephalographic examinations made in the course of spontaneous vegetovisceral and polymorph seizures have shown that the aura correlates with the reaction of desynchronization in the deep and cortical structures of the brain; the specific manifestations of the seizures are combined with epileptic discharges in the limbic and neocortical structures and absence of the discharges in the thalamus and hypothalamus. It has been shown that the limbic system, the neocortical and truncal divisions of the brain take part in the structural and functional organization of the vegetovisceral paroxysms. It is supposed that the hypothalamus plays a non-specific role in the realization of the vegetovisceral paroxysms. On the basis of recognizing the system organization of epileptic process the authors cast doubt on the term "diencephalic epilepsy".

Adolescent↗
PubMed1994

Women with epilepsy. Reproduction and effects of pregnancy on epilepsy.

Conventional wisdom and prevailing medical practice strongly support the belief that medication should be avoided during pregnancy. For the nearly one million women of childbearing age with epilepsy in the United States this is often difficult, if not impossible, and for many of these women becoming pregnant raises many conflicting issues. Women with epilepsy may face a possible increase in the frequency and severity of seizures, and in generalized tonic-clonic seizures there is a small but increased risk of miscarriage.

Abnormalities, Drug-Induced↗
PubMed1993

Knowledge and beliefs about epilepsy in mothers of children with epilepsy: a view from a developing country.

Twenty two mothers of children with epilepsy attending an EEG department were interviewed using a semi-structured interview schedule examining knowledge about epilepsy, attitudes towards their children and the pathways to treatment. The overwhelming impression is of a lack knowledge and uncertainty in the mothers about the condition. This is discussed in terms of effects on treatment and health educational programmes.

Child↗
PubMed1998

["El Informe Médico-Moral de la Penosissima y Rigorosa Enfermedad de la Epilepsi" (1763) by the Spaniard Pedro de Horta, the 1st American treatise on epilepsy].

In 1763 Pedro de Horta was requested by the prioress of the convent of San Gerónimo in Puebla de los Angeles to draw up a report to establish whether the epidemic of queer turns, violent shaking or epilepsy which affected the novices was caused by the Devil or was due to natural causes. Pedro de Horta, a doctor qualified in Mexico, methodically and thoroughly prepared an extensive monographic treatise on the illness which included all that was known at the time. The report showed the fierce debates provoked by the subject of epilepsy in the eighteenth century regarding whether it was of natural or supernatural origin. It also contained detailed accounts of the episodes, their causes and treatment. The Spaniard Pedro de Horta should be justly recognized as the first American epileptologist.

Adult↗
PubMed1998

[A review of idiopathic generalized epilepsies: absence epilepsy].

We studied the clinical characteristics observed at diagnosis of the initial seizure in different types of epilepsy, particularly in idiopathic generalized epilepsy (IGE), and evaluated the importance of these in the classification of syndromes. The present study analyzes only those IGE initiated by absences leaving the cases initiated by GTC or myoclonic onset for a successive report. We observed differences between cases initiated by absences, those presenting simultaneously with absences and TCG, and those where TCG preceded the absences. Prognosis and evolution are considerably more favourable in cases initiated by absences than in cases with onset preceded by, or simultaneously with, other types of seizures. Besides this difference regarding evolution, it should also be emphasized that the form initiated by absences are more frequent in females, are generally pycnoleptic, appear more often in childhood with a second more moderate peak between 10 and 11 years of age, present more typical clinical-EEG characteristics, and the presence of previous febrile seizures is more notable.

Adolescent↗
PubMedDate not supplied

Reflex epilepsy in the Papio-papio baboon, particularly photosensitive epilepsy.

Papio-papio baboons may present two types of reflex paroxysmal manifestations: --Myoclonia and generalized seizures are induced by intermittent light stimulation in predisposed animals; this photosensitive epilepsy resembles that observed in some human patients; it involves mainly the cerebral cortex during myoclonia which are accompanied by EEG paroxysmal discharges, and the mesencephalic reticular formation during seizures; --Myoclonia of a different type, never accompanied by EEG paroxysmal discharged and never evolving into seizures, may occur during movement or agitation of predisposed animals; these myoclonia are considered "non-epileptic" since they do not involve the cerebral cortex but probably the lower brain stem; they resemble that observed in startle disease or in some human degenerative disorders. The paper demonstrates that these manifestations constitute two different entities with clinical and electrophysiological characteristics as well as pharmacological reactivities completely different one from the other. Their "epileptic" or "non-epileptic" nature is discussed.

Animals↗
PubMed1998

Neuropsychological consequences of epilepsy surgery in frontal lobe epilepsy.

The present study investigated the effect of frontal lobe surgery on "cognitive functions", which have previously been shown to be discriminative in the evaluation of non-resected patients with frontal lobe epilepsy (FLE). The cognitive outcome was evaluated with particular consideration of the side (left/right), the site (lateral, orbital, mesial, premotor/SMA), the type of surgery (resections vs. resections plus multiple subpial transections; MST), and seizure outcome. The evaluation is based on 33 patients with left (n = 17) or right (n = 16) frontal surgery. Forty-five patients who underwent successful left (n = 21) or right (n = 24) temporal lobectomy served as controls. The neuropsychological examination covered speed/attention, motor sequencing/coordination, response maintenance/inhibition, short-term memory, and language. With the exception of short-term memory, the chosen tests were discriminative in determining preoperative frontal lobe dysfunctions but they did not differentiate patients with a different lateralization or localization of the frontal focus. At the 3 month follow-up examination, patients with temporal lobectomy had improved frontal functions, whereas patients with frontal lobe surgery showed a mild deterioration. Within the frontally resected group, completely seizure-free patients had significantly improved short-term memory. Further consideration of the side, site and the type of the frontal resection indicated that patients with premotor/SMA surgery and patients with precentral/central MST had additional impairment after surgery. Premotor/SMA resections led to a deterioration in response maintenance/inhibition and if performed left sided also to deteriorated language functions. The latter impairment could be clearly related to transient aphasia directly after surgery. Irrespective of pareses observed immediately after surgery, patients with MSTs of the precentral/central areas displayed additional problems in motor coordination at the follow-up examination. In this group the seizure outcome was also less favourable. In summing up, frontal lobe surgery does not cause any considerable additional impairment in the short-term follow-up. However, caution is recommended when surgery or MST affect functional relevant cortex (here the prefrontal/SMA and precentral/central area). Finally, a release of functions associated with frontal areas not affected by surgery is suggested, when seizures are successfully controlled by surgery.

Adult↗
PubMed1975

A controlled trial on clonazepam INN (Ro 5-4023, Rivotril (R)) in the treatment of focal epilepsy and secondary generalized grand mal epilepsy.

In a controlled clinical investigation based on 14 patients with focal seizures and 3 patients with secondary generalized grand mal epilepsy, all with insufficient response to conventional anti-epileptic treatment, clonazepam (Rivotril(R)) combined with previous anti-epileotic drugs was compared with placebo combined with the same drugs. The trial was singleblind cross-over with sequential analyses. With a daily dose, depending upon age, of usually 3-6 mg, the antiepileptic effect of Clonazepam was significantly superior to placebo and was estimated as remarkably good. Side-effects in the form of somnolence, fatique, drowsiness and co-ordination disturbances occurred in most of the patients but subsided spontaneously or could be managed by slow increase or slight reduction in dosage.

Adolescent↗
PubMed1999

Chromatic sensitive epilepsy: a variant of photosensitive epilepsy.

We herein report 4 Japanese children who suffered epileptic seizures while watching a popular animated TV program. They showed a photoparoxysmal response that is more frequently observed in response to rapid color (blue/red) frame changes than monochromatic ones. These patients were all considered to have photosensitive epilepsy; however, chromatic sensitivity also plays an important role in the generation of such seizures.

Adolescent↗
PubMed1990

Hyperprolactinemia and temporal lobe epilepsy in a woman: concomitant and persistent prolactin suppression and temporal lobe epilepsy relief.

It has been reported that hyperprolactinemia may be associated with increased temporal lobe activity. Coexisting hyperprolactinemia (97.5 +/- 3.2 ng/ml) related to a pituitary tumefaction (8 mm) and Temporal Lobe Epilepsy (TLE), were observed in a 37-year-old woman. Carbamazepin (CBZ) therapy induced a marked improvement in TLE symptoms and EEG recordings, but did not influence hyperprolactinemia and related symptoms. Long-lasting (27 months) normoprolactinemia (19.4 +/- 0.6 ng/ml) and TLE relief were achieved on a dopamine (DA) agonist medication, e.g. pergolide mesylate, 25-50 micrograms/day given over 8 months, and persisted as long as 27 months after drug withdrawal. Posttreatment CT scans showed progressive shrinkage of the pituitary tumor (2 mm) associated with an empty-sella. It is proposed that, whenever TLE and hyperprolactinemia coexist, therapy with a DA agonist such as pergolide mesylate, resulting in normoprolactinemia, may be beneficial in TLE control.

Adult↗
PubMed1999

Epilepsy surgery for 5- to 18-year old patients with medically refractory epilepsy--is it cost efficient?

This study was designed to examine the question of whether cortical resection for children and adolescents with medically refractory epilepsy was less costly and more effective than the medical alternative. The study design used a decision analysis model. Data on outcome probabilities were based on literature review and local experience. The time span of the study was 25 years. Though the initial costs for the surgically treated group were significantly greater than those for the medical group, the time-cost lines intersected at 14 years after surgery. Surgery remained cheaper thereafter.

Adolescent↗
PubMedDate not supplied

"Magnetic resonance imaging negative positron emission tomography positive" temporal lobe epilepsy: FDG-PET pattern differs from mesial temporal lobe epilepsy.

PURPOSE: Some patients with temporal lobe epilepsy (TLE) lack evidence of hippocampal sclerosis (HS) on MRI (HS-ve). We hypothesized that this group would have a different pattern of 2-deoxy-2-[F-18]fluoro-D-glucose (FDG)-positron emission tomography (PET) hypometabolism than typical mesial TLE/HS patients with evidence of hippocampal atrophy on magnetic resonance imaging (MRI) (HS+ve), with a lateral temporal neocortical rather than mesial focus. PROCEDURES: Thirty consecutive HS-ve patients and 30 age- and sex-matched HS+ve patients with well-lateralized EEG were identified. FDG-PET was performed on 28 HS-ve patients and 24 HS+ve patients. Both groups were compared using statistical parametric mapping (SPM), directly and with FDG-PET from 20 healthy controls. RESULTS: Both groups showed lateralized temporal hypometabolism compared to controls. In HS+ve, this was antero-infero-mesial (T = 17.13); in HS-ve the main clustering was inferolateral (T = 17.63). When directly compared, HS+ve had greater hypometabolism inmesial temporal/hippocampal regions (T = 4.86); HS-ve had greater inferolateral temporal hypometabolism (T = 4.18). CONCLUSIONS: These data support the hypothesis that focal hypometabolism involves primarily lateal neocortical rather than mesial temporal structures in 'MRI-negative PET-positive TLE.'

Adult↗
PubMed2005

'Benign focal epilepsy in infancy with vertex spikes and waves during sleep'. Delineation of the syndrome and recalling as 'benign infantile focal epilepsy with midline spikes and waves during sleep' (BIMSE).

PURPOSE: To better delineate the electroclinical features of infants who presented with focal seizures and typical midline sleep EEG abnormalities with a benign outcome. We discuss the significance of the typical EEG marker in non-epileptic patients. METHODS: Patients were selected from a group of epileptic subjects with seizure onset less than 3 years we observed from 1st November 1990 and 31st December 2003. Inclusion criteria were the presence of typical sleep EEG marker and focal seizures with benign outcome. Cases with less than 18 month follow-up period were excluded from this study. RESULTS: There were 19 patients (12 males, 7 females). Pre-, peri- and post-natal personal history was negative in all patients. Psychomotor development was normal, both before and after seizure onset. Neuroradiological investigations gave normal results. Seizure manifestations were typical, characterized by cyanosis, staring and rare lateralizing signs, of short duration. Age at onset was comprised between 4 and 30 months. The typical EEG marker, a spike followed by a bell-shaped slow-wave, localized in the midline regions, was present in all subjects only during sleep. All had a favorable outcome and the overwhelming majority of the patients were not treated. CONCLUSIONS: Our patients have an homogeneous electroclinical picture to constitute a new epileptic syndrome not included in the ILAE classification. We propose to call it 'benign focal epilepsy in infancy with midline spikes and waves during sleep' (BIMSE).

Age of Onset↗
PubMed2006

Zincergic innervation of the forebrain distinguishes epilepsy-prone from epilepsy-resistant rat strains.

Zinc is released from a subset of cerebral cortical neurons whereupon it exerts a powerful modulatory influence on excitatory and inhibitory neurotransmission. A number of studies have suggested that alterations in the regulation of zinc may contribute to the genesis of epilepsy. Here, we tested this hypothesis by examining the distribution of zinc-containing axon terminals in rats selectively bred for an innate susceptibility (FAST) or resistance (SLOW) to the development of kindling-induced seizures. Zinc was stained histochemically and levels of staining were quantitatively assessed. We found that the levels of synaptic zinc were significantly lower in the SLOW rats throughout the telencephalon. This relative reduction was most pronounced in limbic cortices where levels were less than 30% of FAST rats. These results suggest that innate differences in the homeostatic regulation of synaptic zinc, particularly in limbic cortices, may underlie differences in epileptogenicity.

Afferent Pathways↗