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PubMed1998

Epileptic seizures and pseudoseizures from the viewpoint of the hierarchy of consciousness.

Epileptic seizures and pseudoseizures in temporal lobe epilepsies were studied from the viewpoint of the hierarchy of consciousness. Twenty-two patients with temporal lobe epilepsies (TLE) who showed true amnesia or impairment of consciousness developing from the dreamy state, even though their actions and movement continued, were selected among 160 patients with TLE, nine patients with manifested pseudoseizures, pseudoseizure status, and complex partial seizure status (CPSE) were investigated. Twelve patients in whom impairment of consciousness followed the dreamy state recognized their own existence and maintained some self-directed consciousness. The other 10 patients with amnesia were aware of their goals. Furthermore, pseudostatus ranged from epileptic seizures during pseudoseizure status to pseudoseizures during status epilepticus (SE). In some cases of CPS, awareness and self-directed consciousness were only partially pseudoseizures, disorders of self-directed consciousness are assumed to influence awareness and arousal.

Adult↗
PubMedDate not supplied

Calcium channel blockers verapamil and nimodipine inhibit kindling in adult and immature rats.

The calcium channel blockers verapamil (VPM) and nimodipine (NMD) were administered to adult or immature (16-day-old) rats to determine their effects on amygdala-kindled seizures. The afterdischarge threshold (ADT) kindling rate and degree of postictal refractoriness were determined for two doses of VPM (0.5 and 5.0 mg/kg in rat pups and 2 and 10 mg/kg in adult rats) or 30 mg/kg nimodipine (NMD). Neither VPM nor NMD affected the ADT of the amygdala in adult or immature rats. VPM retarded the rate of kindling in both adult and immature rats in a dose-dependent manner; the number of stimulations required to progress through seizure stages were increased. NMD 30 mg/kg reduced the kindling rate and AD duration in both adult and immature rats. Neither drug was able to suppress recurrent seizures elicited by repetitive stimulation. These results suggest that verapamil, and possibly NMD may be of clinical utility in treatment of epilepsy, especially complex partial seizures.

Amygdala↗
PubMedDate not supplied

Action of antiepileptic drugs against kainic acid-induced seizures and automatisms during ontogenesis in rats.

Kainic acid (KA 4-14 mg/kg) administered intraperitoneally (i.p.) produces automatisms (scratching until third postnatal week, "wet dog" shakes thereafter), and clonic and tonic-clonic seizures in rats aged 7, 12, 18, 25, and 90 days. Administration of carbamazepine (CBZ) i.p. (25 or 50 mg/kg), phenobarbital (PB 20-80 mg/kg), clonazepam (CZP 0.2 or 1 mg/kg), or valproate (VPA 200 mg/kg) influenced neither incidence nor latency of automatisms. Clonic seizures that are regularly observed after the third postnatal week in controls were either abolished or substantially suppressed by any of the aforementioned antiepileptic drugs (AEDs). Tonic-clonic seizures observed in the first 3 postnatal weeks were suppressed only by solvent [including propyleneglycol (PEG), ethanol, and water]; the effect of AEDs on tonic-clonic seizures was proconvulsant instead. The automatisms were most resistant to AED therapy. These results induce some doubts about the adequacy of the KA model for identifying AEDs effective against complex partial seizures, but forthcoming AEDs that suppress automatisms in the KA rat model might also be active against human complex partial seizures.

Animals↗
PubMed2000

Dysgenetic mesial temporal sclerosis: an unrecognized entity.

Mesial temporal sclerosis (MTS) is the most frequently encountered lesion in adult patients with intractable temporal epilepsy; it is found in isolation in approximately two-thirds of surgically treated cases. Whereas the exact etiology of MTS is still controversial, several reports suggest that this pathologic lesion is both the cause and the consequence of chronic seizures and develops progressively during childhood secondary to recurrent seizures. In order to evaluate the clinical importance of MTS in children, we retrospectively reviewed the clinical charts of children who underwent surgery for medically intractable temporal epilepsy and report cases presenting an amygdalo-hippocampic dual pathology. Six children aged 1.5-16 years (mean +/- SD: 7.5 +/- 3 years) presenting with partial complex seizures (5 cases) or extension spasms (1 case), with onset from 6 months to the age of 8.5 years (mean seizure onset +/- SD: 3 +/- 5 years) underwent anterior temporal lobectomy including resection of the amygdala and hippocampus. All patients exhibited variable degrees of severity of neuronal loss and gliosis in the amygdala and/or hippocampus. The pathological picture of MTS was not isolated, however. Careful pathological examination has thus shown foci of amygdalo-hippocampic neuronal dysplasia in six patients, with concomitant bilaminated fascia dentata in two cases. Postoperatively, no mortality or morbidity was encountered. After a mean follow-up of 2.5 years, four patients are seizure free. One patient had a 80% rate of improvement in seizure frequency, though still having occasional febrile convulsions. In another patient, complex partial seizures resolved, but rare episodes of absence were still observed. These data are in keeping with the hypothesis that MTS could be secondary to repeated seizures. The analysis of this series of patients could suggest that mesiotemporal dysplastic lesions within the amygdalo-hippocampic structures induce seizures, which, in turn, will favor the development of MTS during childhood. MTS could then lead to synaptic reorganization, which can express abnormal hyperexcitability and result in more recurrent seizures. In this way a vicious circle is set up, which may explain the progression of seizures in some patients.

Adolescent↗
PubMed1999

Video-EEG and ictal SPECT in three patients with both epileptic and non-epileptic seizures.

We report scalp EEG and ictal SPECT findings in epileptic (complex partial) and non-epileptic seizures in three patients who experienced both types of event during presurgical investigation of medically intractable epilepsies. In all three patients, ictal SPECT showed localizing changes in cerebral blood flow during epileptic seizures, but showed no change during pseudoseizures. In two patients, the physical manifestations of the pseudoseizures were similar to those of the epileptic seizures, supporting the contention that physiological activation is unlikely to mimic ictal perfusion changes. In one patient, the EEG recording was rendered difficult to interpret by muscle artefact, while SPECT was clear and showed no change. SPECT is not a primary tool for diagnosis of pseudoseizures, but when patients undergoing presurgical investigation are injected during pseudoseizures, then SPECT is unlikely to show misleading perfusion changes due to activation effects, and may aid diagnosis where there is muscle artefact on EEG.

Adult↗
PubMed1997

Contingent negative variation in epilepsy.

The contingent negative variation (CNV) is a long-latency event-related potential elicited by paired or associated stimuli. We recorded contingent negative variation in 50 patients with complex partial and secondarily generalized seizures and in 20 neurologically and psychiatrically normal unmedicated controls. CNV was recorded from Fz, Cz, and Pz. A 2000 Hz tone was followed after 1.5 s by 1000 microseconds light flash, at which a button press was to be executed. Filter band pass was 0.1-20 Hz, analysis time was 10 s and 10 responses were replicated. Patients with complex partial seizures with and without secondary generalization had lower measurements of area under the CNV curve (AUC) than did controls, and CNV amplitude was significantly reduced. Patients with interictal behavioural symptoms had significantly smaller AUC and lower amplitude. No significant difference was found between depressed and non-depressed seizure patients with respect to AUC, but amplitude was significantly lower in depressed patients. Seizure patients with psychosis had significantly lower AUC but did not differ from non-psychotic patients in CNV amplitude. No differences were found between seizure patients with and without personality disorder with respect to CNV AUC or amplitude. Post-imperative negative variation was significantly more common in seizure patients than in controls and among patients with epilepsy, was significantly increased in those with inter-ictal behaviour disturbance generally and psychosis particularly. No specific effect of anticonvulsant monotherapy on AUC or amplitude was identified. These findings suggest that CNV may differ between partial epilepsy patients and controls, and that inter-ictal behaviour disturbance may particularly affect CNV measures. They also agree with previous evidence for a frontal lobe generator for the CNV, and a possible role for central dopaminergic pathways in the production of PINV.

Adult↗
PubMed1991

Frontal lobe complex partial seizures in children: a form of epilepsy at particular risk of misdiagnosis.

The clinical and EEG findings are described of six children considered to have complex partial seizures of frontal lobe origin. The findings correspond generally with those reported for adult patients. Video-recordings of attacks in some cases and ictal cassette EEG recordings provided important diagnostic information. A definite frontal abnormality on neuro-imaging was seen in only one case. The seizures were closely associated with sleep, and anti-epileptic drug treatment was usually of limited value. The considerable diagnostic confusion surrounding seizures of this type, including their misdiagnosis as pseudoseizures or primary sleep disorder, is partly the result of the clinical peculiarities of this type of seizure, but also of clinicians' limited awareness of the condition.

Adolescent↗
PubMed1995

Complex partial seizures of temporal lobe origin in children of different age groups.

The semiology of complex partial seizures (CPS) of temporal lobe origin in adults is well known and is important in establishing seizure localization in patients considered for epilepsy surgery. In contrast, the behavioral features of temporal lobe seizures (TLS) in children described in the literature have not been consistent. In the present study, we investigated children with TLS to compare their attacks to TLS occurring in adults. The study was based on video recordings of 29 children with TLS aged 18 months to 16 years. Children were included, if they became seizure-free after temporal lobectomy (except 4 children with a marked reduction in seizure frequency and 1 with isolated auras), and if clear unitemporal seizure onset in ictal EEG-recordings, unilateral radiological lesions, and corresponding histopathological findings were detected. Children aged > 6 years had TLS with features similar to those of adults. In younger children, typical semiology included symmetric motor phenomena of the limbs, postures similar to frontal lobe seizures in adults, and head nodding as in infantile spasms. We concluded that the clinical features of TLS in younger children can be misleading and should therefore be considered with caution in selecting patients for surgical procedures on the temporal lobe.

Adolescent↗
PubMed2003

Complex partial seizures of frontal lobe onset statistical analysis of ictal semiology.

OBJECTIVE: To identify the ictal semiology of complex partial seizures originating from the frontal lobe (FLCPS) and mesial temporal lobe (MTLE) in patients who became seizure free after surgery. METHODS: We analysed 149 seizures from 42 patients, 28 with MTLE (75 seizures) and 14 with FLCPS (74 seizures) seizure free for at least 1 year after surgery. Fifty-eight symptoms and signs were looked for in every seizure and their time of onset and ending noted. Statistical analysis was then used to define the frequency, time of onset and cluster analysis of these symptoms/signs. RESULTS: Epigastric aura was more frequent in MTLE while an aura of a general body sensation or indescribable feeling occurred only in FLCPS. Alimentary automatisms were more common and occurred earlier in MTLE (P<0.001). Perseverative automatisms, retching and vomiting occurred exclusively in MTLE while bicycling movements occurred only in FLCPS. Abdominal, psychic or olfactory aura followed by behavioural arrest, alimentary automatisms, repetitive distal upper extremity movements, complete loss of consciousness, looking around and whole body movements were typical of MTLE. Repetitive coarse upper extremity movements, complete loss of consciousness, complex motor and hypermotor activity were typical of FLCPS. CONCLUSION: The earliest symptoms and signs as well as their order of appearance allow one to distinguish between complex partial seizures arising from the frontal lobe and mesial temporal lobe.

Adolescent↗
PubMed2006

Long-term follow-up of patients with benign partial epilepsy in infancy.

PURPOSE: The aim of this study was to investigate the long-term outcome of children with benign partial epilepsy in infancy (BPEI). METHODS: A telephone-interview survey using a structured questionnaire was conducted with patients who were diagnosed as having possible BPEI at age 2 years and who were 8 years or older at the time of the survey. The data from 39 of 48 patients were available. The median age at the time of the survey was 11.3 years; 18 boys and 21 girls were included. RESULTS: Three patients had a recurrence of unprovoked seizure beyond age 2 years. Four patients had cognitive problems (mild mental retardation in three and Asperger syndrome in one). An association of paroxysmal kinesigenic choreoathetosis was observed in three patients, and another three had experienced seizures associated with mild gastroenteritis. Major behavioral problems were not recognized in any patients. Four patients were excluded from having definite BPEI at age 5 years, and another two were excluded for having definite BPEI at the last follow-up. Eventually, 33 of 39 patients were categorized as having definite BPEI beyond 8 years of age. CONCLUSIONS: A large majority of patients diagnosed as possibly having BPEI at age 2 years did not have a recurrence of unprovoked seizures and cognitive problems beyond 8 years of age.

Age Factors↗