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PubMed1976

Temporal lobe epilepsy: types of seizures, age, and surgical results.

Types of seizures, age at onset of epilepsy, preoperative duration of epilepsy, and age at operation were studied in the literature and in 74 patients who underwent unilateral temporal lobe resection in 1960-1969 in Denmark. The medical and surgical series were compared. The age at onset was significantly lower in the surgical series. Prognostically favourable factors were: i) preoperative presence of a single type of seizure; ii) duration of epilepsy of less than 4 years, and in grand mal epilepsy of less than 1 year; iii) operation for epilepsy in or before early adulthood. Prognostically unfavourable factors were i) preoperative presence of grand mal; ii) age at onset of epilepsy or of the first grand mal seizure between 5 and 20 years; iii) preoperative duration of psychomotor epilepsy over 10 years.

Adolescent↗
PubMed1976

Sodium valproate in the treatment of resistant epilepsy.

A series of 115 patients was treated with sodium valproate (Epilim) for periods ranging from 6 to 24 months and in dosages ranging from 400 mg to 2400 mg daily. All but six of these patients had intractable epilepsies and had been previously treated unsuccessfully with other anti-epileptic agents. Eighty patients had generalised seizures and 35 had partial seizures which, in 26 cases, were secondarily generalised. Reduction of seizure frequency by over 50 per cent occurred in about 70 per cent of patients with generalised seizures but in only 37 per cent of those with partial seizures. A number of patients reported increased alertness, improvement of mood, increased appetite and improved performance at school. The adverse effects encountered were gastro-intestinal symptoms, weight gain and hair loss.

Adolescent↗
PubMed1992

Six-year follow-up study on the efficacy and safety of vigabatrin in patients with epilepsy.

Twenty-five patients with epilepsy (mostly with partial seizures) who had responded favourably to a short-term trial of add-on vigabatrin entered maintenance treatment. After 52 to 78 months, 15 patients continue to take the drug with good therapeutic response. Median monthly seizure frequency during the last 2 months on vigabatrin in all patients, including drop-outs, was 3.5 (range 0-74) as compared with 10 (range 3-98) during an initial placebo period (p < 0.01). Drop-outs were caused by adverse events in 2 cases (ataxia and psychotic symptoms respectively), seizure breakthrough in 4 cases and reasons unrelated to treatment in 4 patients. In most patients, side effects were absent or mild, the most frequent complaint being weight gain. It is concluded that the antiepileptic efficacy and good clinical tolerability of vigabatrin are generally maintained during long-term treatment for up to 6 years.

Adolescent↗
PubMed1993

Significance of centro-temporal spikes on the EEG.

In a prospectively studied group of 43 children with centro-temporal spikes on the EEG, only 26 had the classical epileptic syndrome related to this EEG abnormality. Ten patients never had epileptic manifestations. In the other seven cases two types of epileptiform activity were encountered: in addition to the centro-temporal spikes generalized spike-and-wave complexes or--in other patients--occipital epileptiform phenomena occurred. In these cases the clinical signs and symptoms correlated best with the non-Rolandic EEG abnormalities. Some patients had only a few centro-temporal spikes during the recording of the EEG; in others this epileptiform activity was almost continuously present. This quantitative difference had no clinical correlation. Centro-temporal spikes should probably be looked upon as an (epi)phenomenon of cerebral disfunction with a wide range of clinical and electroencephalographic expressions.

Adolescent↗
PubMed1982

Chronic psychosis in epilepsy. A clinical investigation of 29 patients.

A clinical study comprising psychiatric, psychological and neurological examination of 29 patients suffering from long-term psychosis and severe epilepsy was performed. Only five patients fulfilled the diagnostic criteria of schizophrenia. They differed from the rest of the patients by being less organic and having infrequent laterality to the left of their epileptogenic focus. They were regarded as genuine schizophrenics, while the pathogenesis of the remaining sample was considered multifactorial, including both organic and psycho-social causes.

Adult↗
PubMed1988

Ego functions in epilepsy.

Two groups of epilepsy patients (28 patients with temporal lobe epilepsy and 15 patients with primary generalized epilepsy) entered a study of personality traits related to epilepsy, based on a modification of Bellak's semistructured interview for assessment of ego strength. Two groups of subjects served as controls: 15 patients with a non-neurological but relapsing disorder, psoriasis, and 15 healthy volunteers. Compared with the group of healthy volunteers, a decreased adaptive level of ego functioning was found in the epilepsy groups, regardless of seizure types and EEG findings, and, to a lesser extent, compared with the psoriasis group. Areas of ego functioning most affected were "reality testing", "cognitive functioning", "integrative functioning" and "regulation and control of drives". Patients with more than one type of seizure were the most affected, as were patients who were younger than 15 years when the disease began. The number of anticonvulsants administered did not influence the results. No difference on adaptive level of ego functioning was found between the group with primary generalized epilepsy and the group with temporal lobe epilepsy. Similarly, the temporal lobe epilepsy group with predominantly right-sided and left-sided EEG changes, respectively, showed similar adaptive levels of ego functioning.

Adult↗
PubMed1989

Personality characteristics and epilepsy.

Patients with a long history of temporal lobe epilepsy or primary generalized epilepsy entered a questionnaire study of personality characteristics, based on a modification of the Bear-Fedio inventory for temporal lobe behavioural syndrome. Psoriasis patients and healthy volunteers served as controls. Four clinical meaningful dimensions of included personality traits were identified: ixoide, ideational, obsessive-compulsive and affective features. Analyses based on the Rasch model approved of all dimensions except for affective features. The epilepsy group obtained the highest scores on all 3 dimensions, healthy volunteers the lowest, while the psoriasis group repeatedly held an intermediate position in all sets of assessment (subjects, interviewers and relatives). A logistic regression analysis showed ixoide features being most important when the entire epilepsy group was compared with other study groups, while the dimension ideational features was significant when the temporal lobe epilepsy group was entered as target group and opposed to primary generalized epilepsy. The intermediate position of the psoriasis group, however, suggests that in addition to the presence of a cerebral dysfunction in the epilepsy group, the mere presence of a chronic disorder with potential social stigmatization influences personality.

Adult↗
PubMed1976

Experiences on the use of dipropylacetate in the treatment of childhood epilepsy.

The antiepileptic efficiency of dipropylacetate (DPA) was studied in 80 epileptic children who suffered either from seizures resistant to previous medication, so-called idiopathic epilepsy or progressive myoclonus epilepsy. The average peroral daily dosage of DPA was 21 mg/kg divided into 2 to 3 doses. DPA was most effective in cases with 1) so-called idiopathic epilepsy (genuine petit mal, photogenic epilepsy, myoclonic petit mal in older children), 2) seizures beginning in later childhood years, 3) photosensitive and hyperventilation-sensitive seizures, 4) EEG showing symmetric generalized spike-slow wave complexes provoked by photostimulation, 5) EEG without generalized disturbance or focal findings, 6) normal neurological and mental status, 7) progressive myoclonus epilepsy. DPA may thus be recommended for the treatment of the above-mentioned cases and, due to good treatment results, also tried in other types of epilepsy.

Adolescent↗
PubMed1988

Dynamic aspects in transient hyperphosphatasaemia of infancy.

A 20-month-old boy with absence epilepsy was found to have a strikingly elevated serum alkaline phosphatase (AP) at start of treatment with valproic acid. The monitoring of this therapy made it possible to follow the elimination of AP which was shown to be a first order kinetic with a half-life of 6.1 days. A concurrent adenovirus infection was diagnosed.

Adenoviridae Infections↗
PubMed2003

Enhanced G protein-dependent modulation of excitatory synaptic transmission in the cerebellum of the Ca2+ channel-mutant mouse, tottering.

Tottering, a mouse model for absence epilepsy and cerebellar ataxia, carries a mutation in the gene encoding class A (P/Q-type) Ca2+ channels, the dominant exocytotic Ca2+ channel at most synapses in the mammalian central nervous system. Comparing tottering to wild-type mice, we have studied glutamatergic transmission between parallel fibres and Purkinje cells in cerebellar slices. Results from biochemical assays and electrical field recordings demonstrate that glutamate release from parallel fibre terminals of the tottering mouse is controlled largely by class B Ca2+ channels (N-type), in contrast to the P/Q-channels that dominate release from wild-type terminals. Since N-channels, in a variety of assays, are more effectively inhibited by G proteins than are P/Q-channels, we tested whether synaptic transmission between parallel fibres and Purkinje cells in tottering mice was more susceptible to inhibitory modulation by G protein-coupled receptors than in their wild-type counterparts. GABAB receptors and alpha2-adrenergic receptors (activated by bath application of transmitters) produced a three- to fivefold more potent inhibition of transmission in tottering than in wild-type synapses. This increased modulation is likely to be important for cerebellar transmission in vivo, since heterosynaptic depression, produced by activating GABAergic interneurones, greatly prolonged GABAB receptor-mediated presynaptic inhibition in tottering as compared to wild-type slices. We propose that this enhanced modulation shifts the balance of synaptic input to Purkinje cells in favour of inhibition, reducing Purkinje cell output from the cerebellum, and may contribute to the aberrant motor phenotype that is characteristic of this mutant animal.

Adrenergic alpha-Antagonists↗
PubMed2006

Acetylcholine release at neuromuscular junctions of adult tottering mice is controlled by N-(cav2.2) and R-type (cav2.3) but not L-type (cav1.2) Ca2+ channels.

The mutation in the alpha(1A) subunit gene of the P/Q-type (Ca(v)2.1) Ca(2+) channel present in tottering (tg) mice causes ataxia and motor seizures that resemble absence epilepsy in humans. P/Q-type Ca(2+)channels are primarily involved in acetylcholine (ACh) release at mammalian neuromuscular junctions. Unmasking of L-type (Ca(v)1.1-1.2) Ca(2+) channels occurs in cerebellar Purkinje cells of tg mice. However, whether L-type Ca(2+) channels are also up-regulated at neuromuscular junctions of tg mice is unknown. We characterized thoroughly the pharmacological sensitivity of the Ca(2+) channels, which control ACh release at adult tg neuromuscular junctions. Block of N- and R-type (Ca(v)2.2-2.3), but not L-type Ca(2+) channels, significantly reduced quantal content of end-plate potentials in tg preparations. Neither resting nor KCl-evoked miniature end-plate potential frequency differed significantly between tg and wild type (WT). Immunolabeling of Ca(2+) channel subunits alpha(1A), alpha(1B), alpha(1C), and alpha(1E) revealed an apparent increase of alpha(1B), and alpha(1E) staining, at tg but not WT neuromuscular junctions. This presumably compensates for the deficit of P/Q-type Ca(2+)channels, which localized presynaptically at WT neuromuscular junctions. No alpha(1C) subunits juxtaposed with pre- or postsynaptic markers at either WT or tg neuromuscular junctions. Thus, in adult tg mice, immunocytochemical and electrophysiological data indicate that N- and R-type channels both assume control of ACh release at motor nerve terminals. Recruitment of alternate subtypes of Ca(2+) channels to control transmitter release seems to represent a commonly occurring method of neuronal plasticity. However, it is unclear which conditions underlie recruitment of Ca(v)2 as opposed to Ca(v)1-type Ca(2+) channels.

Acetylcholine↗
PubMed1999

Reciprocal inhibitory connections and network synchrony in the mammalian thalamus.

Neuronal rhythmic activities within thalamocortical circuits range from partially synchronous oscillations during normal sleep to hypersynchrony associated with absence epilepsy. It has been proposed that recurrent inhibition within the thalamic reticular nucleus serves to reduce synchrony and thus prevents seizures. Inhibition and synchrony in slices from mice devoid of the gamma-aminobutyric acid type-A (GABAA) receptor beta3 subunit were examined, because in rodent thalamus, beta3 is largely restricted to reticular nucleus. In beta3 knockout mice, GABAA-mediated inhibition was nearly abolished in reticular nucleus, but was unaffected in relay cells. In addition, oscillatory synchrony was dramatically intensified. Thus, recurrent inhibitory connections within reticular nucleus act as "desynchronizers."

Animals↗