[Complex partial epilepsy: etiological, clinical and evolutive aspects].
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Adolescent↗
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Surgical therapy of complex partial epilepsy.
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Adolescent↗
Mechanism of epilepsy.
Epilepsy is a collection of diverse disorders that together affect approximately 1% of the general population. Current therapies are largely symptomatic and are aimed at controlling seizures in affected individuals. This review focuses on emerging insights into mechanisms underlying the most common form of epilepsy--complex partial epilepsy--and also addresses progress in molecular genetic approaches. Such developments will hopefully lead to more effective therapies.
Animals↗
Epilepsy in congenital lipodystrophy. Case report.
A case of congenital lipodystrophy complicated by complex-partial epilepsy is reported in a nine-year-old girl. The peculiarity of this rare case is represented by partial complex epilepsy with diffuse electroencephalographic alterations represented by a continuous seizure-like pattern that persisted unmodified despite the successful antiepileptic treatment. Although the etiopathology of lipodystrophy is, at present, still elusive, we hypothesize that the primitive dysfunction of lipidic metabolism plays a critical role in both determining central nervous system (CNS) alterations and the findings that characterized this extremely rare disease.
Adipose Tissue↗
The neuropathology of temporal lobe epilepsy.
Complex partial epilepsy arising in the temporal lobe has been associated with several types of pathologic lesions including Ammon's horn sclerosis, malformations, neoplasms, and inflammatory scars from infarcts or infection. These lesions are usually situated at various sites in the medial temporal lobe, so that one of the enigmas of attempting to understand the pathogenesis of TLE pertains to the clinical manifestation of a single epileptic disorder which is associated with dissimilar lesions at dissimilar sites. Recent demonstrations of an alteration in temporal lobe anatomy, i.e. malformations of the normal circuitry of the temporal lobe and foci of microdysgenesis, have given rise to the hypothesis that insults which occur during a critical period of brain development could alter the connections within the hippocampus and predispose it to increased excitability and seizurogenesis. Such a hypothesis forces us to reconsider TLE in reference to risk factors which may act as "teratogens" and produce these malformations. These malformations may range from a subtle alteration in the neurotransmitters of the dentate gyrus to large areas of cortical dysplasia or the hamartomatous neoplasms seen in TLE. A reevaluation of the neuroanatomical disruptions created by the various lesions may allow us to define a minimal optimal surgical resection for each lesion; or, the definitions of neurotransmitter deficits may lead to alternative pharmacologic therapies. As neuropathologists we have the exciting opportunity to participate in the definition of the neuropathology of temporal lobe epilepsy.
Animals↗
Therapeutic plasma levels of phenytoin, phenobarbital, and carbamazepine: individual variation in relation to seizure frequency and type.
The range and clinical features that influence the individual variation of the therapeutic plasma concentration of phenytoin, phenobarbital, and carbamazepine were studied in 84 epileptic patients on single-drug therapy. Complete cessation of seizures was observed at plasma concentrations of 17.9 (3 to 50) micrograms/ml phenytoin, 24.5 (3 to 43) micrograms/ml phenobarbital, and 6.5 (4.8 to 9.7) micrograms/ml carbamazepine. Fifty-one percent of the 53 patients receiving phenytoin were completely controlled at either below or above the 10 to 20 micrograms/ml range, suggesting that individual dosage adjustment is preferably based on clinical judgment rather than numerical limits of published therapeutic ranges. Fifty patients with therapeutic plasma concentrations of or above 15 micrograms/ml phenytoin, 25 micrograms/ml plasma concentrations of or above 15 micrograms/ml phenytoin, 25 micrograms/ml phenobarbital, or 6 micrograms/ml carbamazepine more often had partial epilepsies, complex partial seizures and, most markedly, a higher number of seizures in the first year of epilepsy and during the year prior to the present drug therapy, when compared with 34 patients with lower therapeutic plasma concentrations. The variation in therapeutic plasma concentration is primarily related to the type and to the severity of the individual epilepsy, as indicated by the seizure frequency at the onset of the epilepsy or prior to the treatment.
Adolescent↗
Benign infantile epilepsy with complex partial seizures.
Benign infantile epilepsy with complex partial seizures is characterized by a high incidence of family history of benign childhood convulsions, normal development prior to onset, infantile onset, no underlying disorders, no neurological abnormalities, normal interictal EEGs, good response to treatment, and complete remission with normal developmental outcome. Seizures often occur in clusters, consisting of motion arrest, decreased responsiveness, staring or blank eyes mostly with simple automatisms, and mild convulsive movements associated with focal paroxysmal discharges, most frequently in the temporal area.
Electroencephalography↗
[Acute encephalopathy and myoclonic status induced by vigabatrin monotherapy] .
Vigabatrin (VGB) is a new antiepileptic drug useful in refractOry partial seizures. Psychosis as a secondary effect of VGB is well known. This drug may even induce new epileptic seizures. We report a 69-year-old hypertensive patient with multiple cerebral infarcts. She was diagnosed as having late onset symptomatic partial epilepsy (complex partial seizures and generalized secondary motor partial seizures). She had been receiving VGB 3 g/day in monotherapy. She came to the emergency room in a psychotic state with new epileptic seizures. We performed an EEG and video during the ictal phase. The patient was awake, conscious and partially oriented. The video showed generalized myoclonic jerks involving facial and limb muscles, separated by non-convulsive intervals lasting three minutes. The EEG showed spike and wave discharges over a diffuse slow-wave background activity. The patient was conscious throughout the recording. The electroclinical picture was considered as an encephalopathy-associated generalized myoclonic status. VGB was replaced by phenytoin. Two weeks later, and after a clinical improvement, a new recording showed the disappearance of signs of encephalopathy and the myoclonic status. Epileptic seizures induced by VGB are well reported. Several pathogenic mechanisms have been suggested. In our case the myoclonic status was related to a non-dose dependent encephalopathy induced by VGB. The electroclinical improvement after withdrawal of the drug supports this possibility.
Acute Disease↗
Organic disorders in children with epileptic seizures.
1) Brain C-T scan was done in 1,005 epileptic children as one of the diagnostic methods, and 32% showed abnormal findings. 2) Infantile spasm showed abnormal scan most frequently at 52.9%, persistent subtle seizure 46.7%, simple partial epilepsy 37.7%, and myoclonic epilepsy 37.5%, in order of frequency. 3) In partial epilepsy the positive scan detection rate was 35.2% of the total, with simple partial epilepsy 37.7%, complex partial epilepsy 36.1% and secondary generalized epilepsy 33.5%. These rates are higher than those of generalized epilepsy (27.1%). 4) In generalized epilepsy, generalized tonic clonic showed abnormal scan in 26.1%, generalized tonic in 23.6%, generalized clonic in 20.5%, atypical absence in 15% and typical absence in none. 5) Brain tumor was detected in 2.18%. 6) Positive scan is commonly detected in seizures starting in young age group, and in epileptic patients with focal neurologic signs as well as focal EEG abnormality. 7) The curable lesions were brain tumor, some granulomas, and arachnoid cyst. 8) Brain C-T scan is an effective diagnostic method in epileptic children to identify structural abnormalities of the brain and to make sure that the abnormality does not progress, but it would be better to perform C-T scan case by case rather than as a routine diagnostic procedure.
Adolescent↗
Mental aspects of temporal lobe epilepsy. Follow-up of 74 patients after resection of a temporal lobe.
Psychiatric disorders were investigated in 74 patients with drug-resistant temporal lobe epilepsy (complex partial epilepsy). In all cases unilateral anterior temporal lobectomy had been performed during the period 1960-69. At follow-up in 1970-71, 45 patients were free from seizures, and in a further group of 15 patients seizure frequency had been substantially reduced. There were four postoperative deaths. Six patients were psychiatrically normal and had no history of any such disorder. Behavioural disturbances were observed in 55 patients. Before operation 11 patients displayed schizophrenia-like psychoses, and nine others became psychotic during follow-up. Fourteen patients attempted suicide on one or more occasions. Half the patients had diminished sexual drive. Improvement in psychiatric status was clearly correlated with relief from seizures and, in those cases with only a few or no seizures after operation, led directly to social rehabilitation. The presence or absence of a psychiatric disorder was not useful as a criterion for or against surgery.
Adolescent↗
Interictal brain 99Tc-HM-PAO SPECT hypoperfusion in patients with unstable partial epilepsy and normal CT.
Brain perfusion was studied interictally with 99mTc-HM-PAO SPECT in 47 adult patients with partial epilepsy and normal brain CT. Epilepsy was classified as secondarily generalized in 24 patients, as complex partial in 17 patients and as simple partial in 6 patients. In 24 patients good seizure control was not achieved as these patients had a median number of 78 seizures during the preceding month, while in the rest of the patients seizure control was relatively good (less than 6 seizures during preceding month). Local brain hypoperfusion was observed in 41 or 87% of the patients. Hypoperfusion was located close to the EEG foci in 76% and equally often with temporal and frontal foci. Hypoperfusion and the EEG focus were located on the same side in 83%. Hypoperfusion was more frequent in secondarily generalized epilepsy and simple partial epilepsy than in complex partial epilepsy. Left-sided hypoperfusion was especially associated with complex partial epilepsy. It is likely that the significant epileptogenic brain area was revealed in patients with SPECT focus and EEG focus in the same brain area. In one of our patients MRI showed a small temporal lesion which on successful removal was identified as a low-grade oligodendroglioma. Abnormalities of regional brain uptake of HM-PAO demonstrated by SPECT in patients with partial epilepsy and normal brain CT give further information about pathophysiology in partial epilepsy; this may be of use both for selecting appropriate therapy and in presurgical localization of foci.
Adult↗
[Difficulties in the treatment of psychosis in young patients with epilepsy].
UNLABELLED: Diagnostic considerations and treatment strategies in adolescents with partial complex epilepsy and emerging psychosis are discussed. We will argue for considering clozapine early in treatment if other antipsychotics have failed based on two cases; these patients both developed epilepsy in early childhood and schizophrenia in mid adolescence. Their partial complex epilepsy were unsuccessfully treated with different antiepileptic drugs. Clozapine was tried with a distinct improvement in psychotic symptoms and functional level. In both cases there was an early unexpected improvement in seizure control on clozapine. It appears that a reduction of psychotic activity improved seizure control. Later on, there appeared to be a trade off between clozapines effect on psychotic symptoms and recurrence of seizure activity. CONCLUSION: A schizophrenic development must be taken into consideration if psychiatric symptoms emerge in adolescents with a partial complex epileptic disorder. Clozapine treatment can be considered if other antipsychotic drugs are ineffective or cause motor side effects.
Adolescent↗
A comparison of the circadian rhythms and the levels of melatonin in patients with diurnal and nocturnal complex partial seizures.
The aim of the present work was to assess serum melatonin levels and melatonin circadian rhythm in patients with diurnal and nocturnal complex partial epilepsy. Daily rhythms of melatonin were studied in patients with diurnal complex partial epilepsy (n=10), patients with nocturnal complex partial epilepsy (n=10), and a control group (n=10). All patients were under carbamazepine treatment. Serum melatonin samples were taken at 1000, 2200, 0100, and 0500 hours. We found that melatonin circadian rhythm was normal in all patients when compared with controls. Melatonin levels were low in both patients with nocturnal and patients with diurnal complex partial epilepsy compared with the control group at 1000, 2200, 0100, and 0500 hours; a statistically significant decrease in melatonin levels was observed in the patients with epilepsy at 1000 hours only. These findings suggest that melatonin levels and circadian rhythm of melatonin do not differ between patients with nocturnal and patients with diurnal complex partial epilepsy. Further detailed research is necessary to determine the factors that govern the nocturnal or diurnal occurrence of complex partial seizures.
Adolescent↗
Lamotrigine: clinical experience in 200 patients with epilepsy with follow-up to four years.
This open, clinical study describes the use of lamotrigine in 200 adults and children with drug resistant epilepsy. Lamotrigine was used largely as add-on therapy and outcome was assessed by the patients, parents and carers and the physician in terms of reduction of seizure frequency, drug side-effects and improvement in quality of life. Of the 200 patients, 70 (35%) were rendered seizure free. Lamotrigine was especially helpful in resistant primary generalized epilepsy, complex partial seizures, mixed seizures subsequent to brain damage, Lennox-Gastaut syndrome and in complex partial seizures which secondarily generalized. Fifty-three patients ceased lamotrigine; 30 due to lack of effect, and 13 due to side-effects. Lamotrigine is a very useful antiepileptic medication of a "broad spectrum' nature being effective in primary generalized epilepsy and partial seizures as add-on therapy. The side-effect profile is good with most side-effects being avoidable.
Adolescent↗
Benign partial epilepsy in infancy with complex partial seizures (Watanabe's syndrome): 12 non-Japanese new cases.
International epilepsy classification includes different epileptic syndromes with favourable outcomes in pediatric age. In addition to these, other forms probably exist and in various papers in international literature they are proposed as new entities. This article presents a survey of benign complex partial epilepsy in infancy, a new epileptic syndrome first proposed by Watanabe, in 1987. Our work represents the only description of non-Japanese cases although similar but familial cases had been referred by Vigevano in 1992. We present data for 12 children (aged up to 9 years) followed over 2 years who had all the typical clinical features characterizing Watanabe's cases. For all of them we obtained EEG seizure recordings demonstrating the partial nature of their fits, arising from occipital or temporal regions. Interictal EEG were completely normal, both in waking and sleep. Evolution demonstrated benign outcome and all the children are seizure-free (eight of them have already stopped all medication) and all have normal psychomotor development.
Age of Onset↗
Clinical study on localization-related epilepsy in infancy without underlying disorders.
A clinical study of 15 patients without underlying disorders whose first seizures occurred before 1 year of age was performed to determine the characteristics of localization-related epilepsies in infancy. The patients were retrospectively divided into two groups: the seizure-controlled group (10 patients) and the refractory group (five patients). The seizure-controlled group included patients whose seizures were controlled completely within 1 year after onset; the refractory group included all other patients. The characteristics of the refractory group were as follows: (1) interictal electroencephalography showed focal abnormalities, particularly on the left side, and (2) all of the patients exhibited developmental retardation. Even in the seizure-controlled group, 40% of the patients exhibited developmental retardation, and all of them were indistinguishable from patients with benign complex partial epilepsies in infancy at the onset of the seizures. Aggressive treatment should be re-evaluated for early-onset localization-related epilepsies.
Anticonvulsants↗
Influence of waking and sleep stages on the inter-ictal paroxysmal activity in partial epilepsy with complex seizures.
Twenty-six patients suffering from partial epilepsy with complex seizures underwent polysomnographic recording. Paroxysmal activity (PA) densities in waking and sleep stages were assessed. Total PA densities of one night were found to be an increasing function of the seizure frequency in the previous period. Nineteen patients had more PA during sleep, 5 others in the waking state and the two remaining patients exhibited no differences in PA densities between sleep and waking. Nocturnal seizures were reported by patients showing the sleep PA increase pattern; they also used more anti-convulsants than patients showing the waking PA increase pattern. Differences in PA densities between these two groups were more pronounced in the more desynchronized (waking) and the more synchronized (stages 3 + 4) cortical states. The modulation by slow wave sleep stages was independent of, and superimposed on, the sleep/waking one.
Adolescent↗
Brain source imaging of focal and multifocal epileptiform EEG activity.
Brain electric source analysis (BESA) of the scalp EEG has been used to identify multiple equivalent current sources in the brain during during interictal spikes and seizure onset. To obviate the need for fitting dipole sources to every EEG segment, a new method has been developed on the basis of multiple fixed dipoles, each designed to emphasize functional imaging of particular cortical areas. "FOCUS" can quickly display EEG in various montages including new "sources montages" which provide a high sensitivity for source currents near each dipole while largely suppressing contributions from other brain areas. By comparing this "source EEG" to routine digital EEG in patients with complex partial epilepsy, we have observed that "FOCUS" can more readily determine whether an epileptiform discharge is consistent with a discrete or multifocal generator, characterize likely cerebral source(s), differentiate between spikes and seizures of mesio-basal versus lateral temporal or frontal origin, and estimate the presence and direction of propagation from source potential timing differences. Improved non-invasive EEG evaluations of partial epilepsy will undoubtedly result from this advance.
Brain↗