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PubMedDate not supplied

Complex partial seizure mimicking psychotic reaction in an adolescent.

A previously healthy 15-year-old boy initially diagnosed to have acute psychotic reaction had a history of a single generalized seizure and prolonged amnestic states of varying intensity and duration. An ictal electroencephalogram (EEG) showed bitemporal ictal discharges starting from the left side. Carbamazepine was started. A magnetic resonance imaging (MRI) obtained on the 10th day of the antiepileptic therapy showed increased signal intensity on the T2 weighted images. The patient's memory function markedly improved during 10 months' follow-up with antiepileptic treatment, although he described brief attacks of dizziness. A repeat MRI examination showed normal findings. The amnesticstates were thought to be due to frequent complex partial seizures, and transient MRI changes to hippocampal edema. This case illustrates the importance of epileptic disorders in the differential diagnosis of psychiatric conditions.

Adolescent↗
PubMed1998

Extratemporal atrophy in patients with complex partial seizures of left temporal origin.

Total cerebral, temporal lobe, hippocampal, caudate, and lenticular nuclei volumes were quantified from magnetic resonance images of 21 patients with left temporal lobe epilepsy and medically intractable complex partial seizures. These regional brain volumes were compared with the same measures in 19 controls. No significant differences in total cerebral, left temporal lobe, right temporal lobe, or total temporal lobe volumes were found. As expected, left hippocampal volumes were significantly smaller in the patients with epilepsy than in control subjects. The left hippocampus-to-right hippocampus volume ratio was significantly lower in patients than in control subjects. In addition to left hippocampal volumes, mean left thalamic, left caudate, and bilateral lenticular volumes were significantly smaller in the patients with epilepsy than in control subjects. The left-to-right thalamic volume ratio was also significantly lower in the patients with epilepsy compared with control subjects, but there were no significant group differences in caudate or lenticular ratios. These results show that medically intractable temporal lobe epilepsy is associated with volume loss in brain structures outside the presumably involved hippocampus. The pathophysiological significance of our findings is uncertain. They could be related to the underlying cause of the disorder. However, volume loss also may reflect damage due to involvement of these structures in recurrent seizure activity.

Adult↗
PubMed2001

Bathing epilepsy.

A patient who had complex partial seizures provoked by bathing is reported. All the attacks occurred during or immediately after bathing, irrespective of water temperature. The semiology was suggestive of a seizure focus in the mesial temporal lobe. Though there are some similarities with hot-water epilepsy, this case appears to be a distinct type of reflex epilepsy.

Adult↗
PubMed2005

[Transient lesion in the splenium of the corpus callosum in epileptic child with cerebral low grade glioma].

We report on a seven years-old boy with complex partial seizures and the presence of low grade glioma in left fronto-parietal region. The magnetic resonance imaging showed focal non-hemorrhagic lesion in the splenium of the corpus callosum. The description of the transient lesion in the splenium of the corpus callosum was related in three previous studies, in patients with epilepsy. Thus, the observed transient focal lesion in the splenium of the corpus callosum of this child, probably, has correlation with to prolonged focal partial seizures and not to the presence of glioma low grade.

Anticonvulsants↗
PubMed1994

Elicitation of "childhood memories" in hypnosis-like settings is associated with complex partial epileptic-like signs for women but not for men: implications for the false memory syndrome.

20 male and 20 female undergraduate students were exposed singly for 20 min. to an exotic setting (partial sensory deprivation and weak, bilateral transtemporal pulsed magnetic fields) that enhances relaxation and exotic experiences. The numerical incidence of subjective experiences described as old memories, dreams, emotions, or vestibular sensations did not differ significantly between the sexes; however, women who reported a greater prevalence of preexperimental complex partial epileptic-like signs were more likely to report experiences of "old memories" (r = 0.61) while men who exhibited these signs were more likely to report dream-like (r = 0.49) experiences. Because complex partial epileptic-like signs are positively associated with suggestibility, the potential contribution of this differential gender effect to the etiology of the False Memory Syndrome requires further investigation.

Adolescent↗
PubMed2003

Out-of-body experience and autoscopy of neurological origin.

During an out-of-body experience (OBE), the experient seems to be awake and to see his body and the world from a location outside the physical body. A closely related experience is autoscopy (AS), which is characterized by the experience of seeing one's body in extrapersonal space. Yet, despite great public interest and many case studies, systematic neurological studies of OBE and AS are extremely rare and, to date, no testable neuroscientific theory exists. The present study describes phenomenological, neuropsychological and neuroimaging correlates of OBE and AS in six neurological patients. We provide neurological evidence that both experiences share important central mechanisms. We show that OBE and AS are frequently associated with pathological sensations of position, movement and perceived completeness of one's own body. These include vestibular sensations (such as floating, flying, elevation and rotation), visual body-part illusions (such as the illusory shortening, transformation or movement of an extremity) and the experience of seeing one's body only partially during an OBE or AS. We also find that the patient's body position prior to the experience influences OBE and AS. Finally, in five patients, brain damage or brain dysfunction is localized to the temporo-parietal junction (TPJ). These results suggest that the complex experiences of OBE and AS represent paroxysmal disorders of body perception and cognition (or body schema). The processes of body perception and cognition, and the unconscious creation of central representation(s) of one's own body based on proprioceptive, tactile, visual and vestibular information-as well as their integration with sensory information of extrapersonal space-is a prerequisite for rapid and effective action with our surroundings. Based on our findings, we speculate that ambiguous input from these different sensory systems is an important mechanism of OBE and AS, and thus the intriguing experience of seeing one's body in a position that does not coincide with its felt position. We suggest that OBE and AS are related to a failure to integrate proprioceptive, tactile and visual information with respect to one's own body (disintegration in personal space) and by a vestibular dysfunction leading to an additional disintegration between personal (vestibular) space and extrapersonal (visual) space. We argue that both disintegrations (personal; personal-extrapersonal) are necessary for the occurrence of OBE and AS, and that they are due to a paroxysmal cerebral dysfunction of the TPJ in a state of partially and briefly impaired consciousness.

Body Image↗
PubMed1997

Recurrent seizures in metachromatic leukodystrophy.

The unusual presentation of juvenile onset metachromatic leukodystrophy (MLD) and frequent complex partial seizures in a patient led us to perform a retrospective study of 18 patients with MLD to identify the prevalence and type of recurrent seizures during the first 2 years of the disease. Five of 17 patients (29%) had developed recurrent seizures within 12 months of the onset of symptoms, and one patient was lost to follow-up. By 24 months after onset of symptoms, 5 patients were lost to follow-up, and 6 of the remaining 13 patients (46%) had developed recurrent seizures. In all, 7 patients, 4 with late infantile-onset and 3 with juvenile-onset disease, developed recurrent seizures. Four patients, including 3 with juvenile-onset disease had complex partial seizures. We conclude that recurrent seizures are common in MLD and may occur at any stage of the disease, particularly in patients with juvenile onset. Generalized seizures are more frequent in patients with late infantile-onset, whereas partial seizures are more common in those with juvenile-onset disease.

Child↗
PubMed1992

Cognitive motor function after electrical stimulation of the vagus nerve.

Chronic stimulation of the vagus nerve does not seem to produce significant differences between high frequency and low frequency stimulation groups. Individuals within each group show significant changes between preoperative assessment and after 6-month stimulation. Some subjects showed significant improvement and some showed significant slowing of responses. Subjects who showed improvement are still considerably slower than normals, but all patients have a very long history of complex partial seizures and exposure to multiple medications. Larger homogeneous sample sizes are needed to delineate more clearly the correlation between cognitive performance, medication effects, and stimulation effects.

Adult↗
PubMedDate not supplied

Melanotic differentiation in dysembryoplastic neuroepithelial tumor.

Dysembryoplastic neuroepithelial tumor (DNT) is an uncommon intracranial tumor which is usually encountered in patients with medically intractable complex partial seizures of temporal lobe origin. Melanotic differentiation in a DNT has not been reported previously. Herewith we report a case of DNT with unique melanotic differentiation in a 23-year-old female who presented with medically intractable epilepsy. She underwent craniotomy and tumor decompression with a good outcome. We present the histopathological features of DNT with melanotic differentiation and discuss its prognostic significance.

Adult↗
PubMed1992

A long-term follow-up study of first episodes of idiopathic status convulsivus in childhood: in relation to subsequent epilepsy (second report).

Fifty-four idiopathic status convulsivus (SC) cases were followed prospectively for a period between 5 and 21 years, the average being 13 years. Three-fourths of the cases had no residuals. There were two patterns of subsequent epilepsy; 1) complex partial seizures (CPS) with or without secondarily generalization (GTS) developed 4.3 +/- 3.5 years after febrile SC, 2) unilateral seizures or CPS +/- GTS developed 1.2 +/- 1.0 years after afebrile SC. The seizure prognosis of these cases was good except for some cases in the former group. There have been two kinds of theories regarding SC and epilepsy until now. One was derived from retrospective studies: SC and/or complex febrile convulsion (FC) were considered the main causes of temporal lobe epilepsy (TLE) producing mesial temporal sclerosis (MTS). Another was derived from prospective studies, in which the relation between FC and TLE was considered weak. Our results revealed that 6 cases (15%) out of 30 febrile SC developed epilepsy, and that five of those six cases were diagnosed as CPS. Three of 5 CPS cases were diagnosed as TLE. Recently the seizure prognosis of operative therapy for TLE--especially the MTS type--has been very favorable. Furthermore, it has become easy to find MTS by Magnetic Resonance Imaging (MRI). So, we emphasize that a precise follow-up study of SC using MRI, EEG, etc., is important in deciding the appropriate therapy for TLE, as well as in the study of the pathogenesis of TLE.

Child↗
PubMed1994

Postictal behavior. A clinical and subdural electroencephalographic study.

OBJECTIVE: To examine postictal behaviors after temporal lobe complex partial seizures (CPSs) and to correlate these behavioral phenomena with side of origin and ictal spread pattern. DESIGN: Review language and other behavioral phenomena after seizures defined by subdural electroencephalography. SETTINGS: A surgical epilepsy center. PATIENTS: We studied postictal behavior following 65 CPSs in 18 patients with left hemisphere language dominance using subdural electrode recordings. INTERVENTION: Subdural electrodes. MAIN OUTCOME MEASURES: Language function, affect, orientation, and postictal automatisms. RESULTS: Following the CPS ictal discharge, the mean interval for initial nonreflexive response to an environmental stimulus was 43 seconds (left foci, 57 seconds; right foci, 29 seconds; not significantly) and for first correct verbal response was 219 seconds (left foci, 275 seconds; right foci, 167 seconds; not significant). Impaired comprehension with fluent but unintelligible speech, as well as anomia, occurred after seizures arising from either temporal lobe. All nine seizures followed by global or nonfluent aphasia originated on the left side. Paraphasic errors were significantly more common after left temporal CPSs. Prolonged disorientation for place and flat affect were significantly more common after right temporal CPS. Postictal automatisms were frequent and included rubbing of the face, fumbling and picking hand movements, and repetitive oral movements. CONCLUSIONS: Postictal paraphasias, disorientation for place, and flat affect most likely reflect the functions of the area from which seizures arise but not the areas involved by spread.

Adolescent↗
PubMed1992

Psychosocial functioning in adolescents with complex partial seizures.

This pilot study examined psychosocial functioning in adolescents (age 12.5-18.5 years) with complex partial seizures. Twenty-five subjects were divided into three groups: Group I (N = 11), medically treated with uncontrolled seizures; Group II (N = 6), medically managed with controlled seizures; and Group III (N = 8), epilepsy refractory to medical management with seizure control following surgery. Psychosocial functioning was measured using the "Adolescent Psychosocial Inventory" of Batzel and Dodrill. Findings revealed significant differences (F 4.80. p less than 0.02) in psychosocial functioning between the three groups. Group I showed the poorest overall adjustment; Group II, the best adjustment; Group III was better adjusted than Group I, but less than Group II. Significant difficulties were evident in the areas of school, interpersonal, emotional, seizure adjustment and overall psychosocial functioning in Group III. No problems were evident in Group II. School, emotional and overall adjustment were moderately problematic in Group III. Analysis of biological and demographic data revealed a significant association between increased numbers of medications and poorer psychosocial functioning (r = 58, p less than 0.02). The study results provide direction for clinic and community nurse specialists to set priorities with regard to assessment and supportive interventions.

Adolescent↗
PubMed1996

Paroxysmal staring and masticatory automatisms during postural hypotension in a patient with multiple system atrophy.

PURPOSE: We studied a 51-year-old man with multiple system atrophy and autonomic insufficiency. He had repeated episodes of loss of contact, staring, and masticatory automatisms. METHODS: Blood pressure during these events documented a systolic pressure of 60 mm Hg. Cardiovascular reflex tests provided evidence of autonomic failure. Head computed tomography (CT) revealed moderate, diffuse cortical and cerebellar atrophy. RESULTS: These events were strictly related to blood pressure decreases and could be reproduced consistently by having the patient sit up after a meal. Ictal polygraphic recordings showed EEG changes consistent with anoxia, preceded by sudden hypotension with fixed heart rate. CONCLUSIONS: Cerebral anoxia during a syncopal attack may therefore precipitate transient, sudden neurologic dysfunction that closely mimics complex partial seizures. Masticatory automatisms may represent a release phenomenon resulting from inactivation of neocortical structures by cerebral anoxia or reticular disconnection.

Automatism↗
PubMed1976

Plasma levels of carbamazepine and carbamazepine-10,11-epoxide during treatment of epilepsy.

Carbamazepine and its epoxide in plasma were measured by liquid chromatography in 25 patients treated with a mean dose of carbamazepine of 12.5 +/- 3.3 mg/kg body weight. The mean concentrations of parent drug and metabolite were 5.4 +/- 2.5 mug/ml and 1.10 +/- 0.42 mug/ml, respectively. A singificant correlation was found between the plasma concentrations of the two compounds (r = 0.64; p less than 0.001), but marked interindividual variation existed in the ratio of carbamazepine to carbamazepine to epoxide. Based on simultaneous measurements in plasma and cerebrospinal fluid, the unbound fraction of carbamazepine in plasma was of the order of 20% as compared to 45% for the epoxide. Thirteen ambulant patients suffering from partial epilepsy with complex symptomatology, who were already being treated with phenytoin in optimal doses (plasma level 14-20 mug/ml) were also given carbamazepine. At plasma levels of the latter of about 5 mug/ml there was no further reduction in the frequency of partial or generalized epileptic seizures. In five patients the dose was increased to produce plasma concentrations of 7 - 8 mug/ml. There was still no improvement and side-effects were seen in three patients.

Carbamazepine↗
PubMed1992

Interhemispheric dissociation of expressive and receptive language functions in patients with complex-partial seizures: an amobarbital study.

Bilateral intracarotid amobarbital procedures (IAP) were performed in 144 patients with medically intractable complex-partial seizures. As a result of language testing, 29 patients (20.1%) were found to have bilateral language representation to different degrees. In four (2.8%) of these patients--all right-handers with early onset of epilepsy and/or evidence of early brain damage--there was strong evidence of an interhemispheric dissociation of expressive and receptive language functions. Two of these patients had circumscribed temporal foci (one left, one right), and receptive language functions were represented in the hemisphere contralateral to the focus. One patient with a right frontal focus showed left-hemisphere dominance for expressive functions, while the fourth patient exhibited left-hemisphere dominance for receptive functions associated with a right temporo-parietal focus. It is argued that in these four cases the circumscribed functional and/or structural impairments have led to a shift of the anatomically associated language functions to the opposite hemisphere (rather than to neighboring regions of the same hemisphere). These findings substantiate the hypothesis that in special circumstances the anterior (expressive) language area can be located in one hemisphere and the posterior (receptive) area in the other.

Adolescent↗
PubMed1978

Classification of the epilepsies. An investigation of 1,508 consecutive adult patients.

The relative frequency of different types of epilepsy in accordance with the International Classification of Epilepsies is reported, concerning 1,508 consecutive outpatients with epilepsy, who at the time of investigation were at age 15 years and above. The investigation showed a marked preponderance for partial epilepsies as against generalized epilepsies; partial epilepsies with complex symptomatology were especially frequent, contributing by more than one third of all cases.

Adolescent↗
PubMed1992

Complete atrio-ventricular conduction block during complex partial seizure.

Cardiac arrhythmias are a well known cause of epileptic seizures. Epileptic seizures resulting in cardiac arrhythmias are less well recognised and cardiac arrhythmias are commonly presumed to be of primary cardiac origin. This paper describes a patient with complete AV heart-block during a partial complex seizure. Simultaneous EEG/ECG monitoring was used to show the secondary nature of the bradyarrhythmia.

Bradycardia↗
PubMed1995

Treatment of complex partial status epilepticus unmasking acute intermittent porphyria in a patient with resected anaplastic glioma.

We report a 42-year-old woman with an established complex partial seizure disorder, who presented in refractory complex partial status epilepticus, the treatment of which with lorazepam, phenytoin, carbamazepine, and pentobarbital precipitated an attack of acute intermittent porphyria (AIP). The subsequent clinical course and management with gabapentin is discussed.

Adult↗