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PubMed1997

Wada memory and timing of stimulus presentation.

We compared Wada memory performance for stimuli presented at two timing intervals following amobarbital injection in 47 non-lesional patients with complex partial seizures (L = 26; R = 21). A significant interaction between seizure focus and timing of presentation was present (P < 0.03). Memory performance for objects whose presentation began approximately 50-55 s following amobarbital administration differed as a function of ipsilateral vs. contralateral injection at a very high level of statistical significance (P < 0.00001). Items presented approximately 4 min, 30 s post injection were also related to seizure onset literality, but at a lower statistical level (P < 0.01). Presentation of Wada memory stimuli earlier during hemispheric anaesthesia yields results that are more sensitive to lateralized temporal lobe seizure onset than does presentation of items later during the procedure.

Adult↗
PubMed1993

Differential effects of first antiepileptic drug application on cognition in lesional and non-lesional patients with epilepsy.

It has been shown that carbamazepine (CBZ) and valproic acid (VPA) have no significant negative or even positive side effects upon cognition in patients with epilepsy. The present study evaluated cognitive effects of CBZ or VPA in 16 patients with newly diagnosed epilepsy. Twelve patients had complex partial seizures, four patients primarily generalized seizures. Special attention was directed towards seizure type, presence of structural lesions and seizure control. Neuropsychological testing was carried out prior to medication and when drugs were within therapeutic ranges. Nineteen untreated healthy subjects served as controls. The following results were obtained: first of all, no general effect of antiepileptic drugs upon cognition could be detected. Only a subgroup with lesion (n = 8) and pre-existing cognitive deficits showed a significant decrease in memory performance during medication. This group additionally obtained poor seizure control. In conclusion, adverse cognitive changes under medication cannot be explained by antiepileptic drugs alone. The presence of cerebral lesions and obtained seizure control have to be considered as essential risk factors.

Attention↗
PubMed2001

Epileptic seizures are characterized by changing signal complexity.

OBJECTIVE: Epileptic seizures are brief episodic events resulting from abnormal synchronous discharges from cerebral neuronal networks. The traditional methods of signal analysis are limited by the rapidly changing nature of the EEG signal during a seizure. Time-frequency analyses, however, such as those produced by the matching pursuit (MP) method can provide continuous decompositions of recorded seizure activity. These accurate decompositions can allow for more detailed analyses of the changes in complexity of the signal that may accompany seizure evolution. METHODS: The MP algorithm was applied to provide time-frequency decompositions of entire seizures recorded from depth electrode contacts in patients with intractable complex partial seizures of mesial temporal onset. The results of these analyses were compared with signals generated from the Duffing equation that represented both limit cycle and chaotic behavior. RESULTS: Seventeen seizures from 12 different patients were analyzed. These analyses reveal that early in the seizure, the most organized, rhythmic seizure activity is more complex than limit cycle behavior, and that signal complexity increases further later in the seizure. CONCLUSIONS: Increasing complexity routinely precedes seizure termination. This may reflect progressive desynchronization.

Algorithms↗
PubMed1996

Severe transitory encephalopathy with reversible lesions of the claustrum.

Reversible bilateral lesions of the claustrum and external capsule in a 12-year-old girl suffering from a severe, transitory encephalopathy are reported. After a prodromal stage of feeling uncomfortable a sudden onset of status epilepticus occurred, followed by recurrent complex partial and myoclonic seizures for 3 weeks, with psychotic symptoms and temporary loss of vision, speech and hearing. After treatment with phenytoin the patient became free of seizures and recovered completely without neurological deficit. The initial cranial CT was normal; however, cranial MRI 7 days later showed bilateral selective lesions of the claustrum and external capsule, which disappeared completely 5 weeks later. The aetiology of these lesions remains obscure; repeated cerebrospinal fluid and blood tests were negative for herpes simplex virus and other infectious agents. The clinical and radiological improvement were concomitant. This may indicate a functional disturbance of the claustrum grey matter, rather than lesions of the white matter of the external and extreme capsules.

Aphasia↗
PubMed2000

Persistent postictal hyperperfusion demonstrated with PET.

Four patients with complex partial seizure disorder whose positron emission tomography (PET) scans show sustained hyperperfusion of the epileptiform focus 12-24 h after a seizure episode are presented. Three of these patients underwent same day Fluorine-18 (18F) deoxyglucose (FDG) PET scans, which showed hypometabolism of the epileptic temporal lobe. In one patient who underwent repeated blood flow and concurrent glucose metabolism scans 4 days after a seizure, hyperperfusion was not present and the FDG-PET demonstrated hypometabolism. Persistent hyperperfusion was noted in six out of 65 cases studied. Four out of six patients who were followed clinically were presented in this report. The cause of the rare occurrence of persistent postictal or interictal hyperperfusion and the differences of postictal blood flow dynamics and glucose metabolism need to be clarified further with future studies.

Adult↗
PubMedDate not supplied

Depression and dementia of cerebrovascular origin.

We report the case of a patient who presented various psychiatric syndromes at the time of evaluation - partial complex epileptic seizures, personality change, and severe depression, which eventually progressed to dementia - resulting from multiple cerebral infarctions of probable neuro-angiopathic origin, of unknown etiology. Aspects related to depression following cerebrovascular accidents, as well as how cerebrovascular accidents can result in different disorders depending on the variables, are discussed based on the data from current literature.

Aged↗
PubMed1995

Seizure frequency and CSF parameters in a double-blind placebo controlled trial of gabapentin in patients with intractable complex partial seizures.

Gabapentin (GBP) is a non-protein-bound gamma amino acid which is not subjected to metabolic degradation in man. As part of a placebo-controlled double-blind study, patients suffering from intractable complex partial seizures with or without secondary generalization were followed with lumbar punctures at baseline and after three months of GBP treatment (900 mg/day or 1200 mg/day). Cerebrospinal fluid (CSF) was analyzed for concentrations of GBP, amino acids including GABA, homovanillic acid (HVA), and 5 hydroxyindoleacetic acid (5-HIAA). The results indicate that there were no changes in the selected amino acids, HVA, or 5-HIAA after GBP treatment. At steady state the CSF/plasma ratios of GBP ranged from 0.056 to 0.34, indicating that there may be some type of active out-transport of GBP across the blood-brain barrier. No linear relationship was observed between plasma and CSF levels in these patients.

Acetates↗
PubMedDate not supplied

Carbamazepine effects on afterdischarge, memory retrieval, and conditioned avoidance response latency in hippocampally kindled cats.

Carbamazepine (CBZ) effects on (a) complex partial seizures and afterdischarges (AD), (b) memory retrieval, and (c) conditioned avoidance response (CAR) latencies were studied in a group of 9 hippocampally kindled cats. Significant AD and epileptic seizure suppression was observed in kindled cats after administration of CBZ concurrent with significant improvement in percentage scores on the memory retrieval test. The CAR latencies were longer in kindled cats with or without CBZ than in the conditioned group of cats without both kindling and CBZ. CAR latencies were not significantly different between kindled and kindled-CBZ-treated cats. Thus, the longer latencies in kindled animals cannot be due to CBZ but apparently are related to the effects of kindling. In some kindled animals, longer CAR latencies were reversed by CBZ.

Animals↗
PubMed1997

Congenital encephalocele of the medial skull base.

Meningoencephaloceles of the temporal bone are rare. Although most often seen following otologic surgery or trauma, congenital meningoencephaloceles can exist. The clinical presentation, diagnostic evaluation, and surgical management of three patients with congenital meningoencephalocele are presented. Two of the three patients presented to our institution with recurrent episodes of meningitis; one presented with partial complex seizures. Diagnostic evaluation included temporal bone computed tomography with magnetic resonance imaging. In two patients, defects were imaged following high-pressure subarachnoid cisternography with computed tomography. All three patients were found to have congenital defects in the area of Meckel's cave. Early recognition of congenital meningoencephalocele is important to avoid delay of definitive surgical management and neurologic sequelae.

Adult↗
PubMed1996

Human brain gamma-aminobutyric acid levels and seizure control following initiation of vigabatrin therapy.

Vigabatrin is a novel antiepileptic drug designed to control seizures by raising brain gamma-aminobutyric acid (GABA) concentrations. Seizure control is not improved significantly when the daily dose is increased beyond 50 mg/kg. Serial, in vivo measurements of GABA levels in human occipital lobe were made using 1H NMR spectroscopy before and after the start of vigabatrin treatment. We used a 2.1-T magnetic resonance imagerspectrometer and an 8-cm surface coll to examine serially a 14-cm3 volume in the occipital lobe of 26 patients with complex partial seizures. Brain GABA content increased following the start of vigabatrin treatment up to a daily dose of 60 mg/kg. Additional increases in dose falled to increase brain GABA content further. GABA synthesis may decrease with sustained elevations of human brain GABA levels. Starting vigabatrin treatment reduced seizure frequency by > 50%, from six to seven per month to three. Improved seizure control was not associated with further increases of vigabatrin dose. Increased brain GABA concentration was associated with improved seizure control. Starting vigabatrin treatment improved seizure control twofold when GABA levels increased above 1.8 mmol/kg. Further increases in brain GABA content above 2.5 mmol/kg provided less protection. Measuring occipital lobe GABA concentrations may predict improved seizure control when using antiepileptic drugs designed to increase brain GABA levels.

Adult↗
PubMed1991

Sleep organization and epilepsy.

Sleep is known to facilitate epileptic manifestations but can also protect the sleeper against the recurrence of seizures. This has been demonstrated in studies on sleep deprivation, and is particularly evident in alcoholic epilepsy and matutinal myoclonus epilepsy. Sleep organization in the epileptic patient is permanently altered by frequent awakenings and stage shifts. Nocturnal grand mal and repetitive partial seizures worsen the sleep disorder by reducing total sleep time and decreasing REM percentage by half. The cumulative effect of these sleep disorders may act on day-time vigilance in epileptics, and may even exert an influence on the recurrence of seizures.

Adult↗
PubMed2000

Behaviors induced or disrupted by complex partial seizures.

We reviewed the neural mechanisms underlying some postictal behaviors that are induced or disrupted by temporal lobe seizures in humans and animals. It is proposed that the psychomotor behaviors and automatisms induced by temporal lobe seizures are mediated by the nucleus accumbens. A non-convulsive hippocampal afterdischarge in rats induced an increase in locomotor activity, which was suppressed by the injection of dopamine D(2) receptor antagonist in the nucleus accumbens, and blocked by inactivation of the medial septum. In contrast, a convulsive hippocampal or amygdala seizure induced behavioral hypoactivity, perhaps by the spread of the seizure into the frontal cortex and opiate-mediated postictal depression. Mechanisms underlying postictal psychosis, memory disruption and other long-term behavioral alterations after temporal lobe seizures, are discussed. In conclusion, many of the changes of postictal behaviors observed after temporal lobe seizures in humans may be found in animals, and the basis of the behavioral change may be explained as a change in neural processing in the temporal lobe and the connecting subcortical structures.

Animals↗
PubMed2004

Serum prolactin levels for differentiation of nonepileptic versus true seizures: limited utility.

Frequently occurring nonepileptic psychogenic seizures (PNES) are a cause of substantial morbidity. Differentiation of these from true seizures may sometimes be very difficult. Serum prolactin level estimation following the event has been described as a useful test for this purpose. We conducted this study to assess the role of this test in diagnosis of PNES. Serum prolactin was estimated from venous blood samples of 19 patients (13 females, 6 males) with PNES and 17 patients (5 females, 12 males) with true complex partial seizures with or without secondary generalization. The age range was 12-39 years in the PNES group and 9-42 years in the true seizure group. Five patients (all females) in the PNES group (26.3%) had raised prolactin levels, all of them having greater than twice normal levels. In the true seizure group, 10 of 17 (58.8%) patients had raised levels; only 3 (17.6%) of these had greater than twice normal levels. The difference in percentage of patients with abnormal prolactin levels between these groups was not found to be significant. We demonstrate that serum prolactin level estimation is not a useful method for differentiation of psychogenic nonepileptic from true epileptic seizures.

Adolescent↗
PubMed2001

The short-term impact of adjunctive tiagabine on health-related quality of life.

Combinations of tiagabine (TGB), carbamazepine (CBZ), and phenytoin (PHT) were compared for their impact on health-related quality of life (HRQOL) and adverse effects related to treatment efficacy for people with frequent complex partial seizures. Two independent, randomized, double-blind clinical trials for efficacy and safety were conducted simultaneously with treatment groups: CBZ+PHT versus CBZ+TGB, and PHT+CBZ versus PHT+TGB. Treatment was initiated at week 0 and continued through week 16. HRQOL was evaluated with the QOLIE-89. Treatment success was defined as > or =50% reduction in complex partial seizures. Among patients who achieved a > or =50% reduction in seizures, addition of TGB to baseline PHT enhanced patient perceptions of attention/concentration (13%; p = 0.002), memory (17%; p = 0.042), and language subscales (22%; p = 0.004). Addition of CBZ to PHT led to positive change in the work/driving/social relations subscale (14%; p = 0.004). These improvements were significantly different only between visits, not between the two treatment groups. Seizure worry subscale scores showed improvement among all treatment groups and was probably related to participation in the clinical trial. These exploratory analyses suggest a possible early positive effect of TGB on patient-perceived cognitive domains using the QOLIE-89. These findings are limited by the small sample size and could be related to reduction in seizures.

Adult↗
PubMed1992

[Hashimoto's encephalopathy: toxic or autoimmune mechanism?].

A 36-year-old woman presented with partial complex status epilepticus. Magnetic resonance imaging with T2-weighted sequences showed a high-intensity signal in the left posterior frontal area. Hashimoto's thyroiditis was then discovered. The disappearance of the high-intensity signal after corticosteroid therapy was suggestive of an autoimmune mechanism. However, improvement could be obtained only with a hormonal treatment, which supports the hypothesis of a pathogenetic role of the Tyrosine-Releasing Hormone (TRH).

Adult↗
PubMed2000

MR imaging evaluation of seizures.

It is imperative for a radiologist to determine the type of seizure a patient has prior to magnetic resonance (MR) imaging to optimally provide the clinician with the information he or she requires. Specifically, complex partial seizures require evaluation of the frontal lobes and the hippocampus (for mesial temporal sclerosis). These are best evaluated with fluid-attenuated inversion recovery (FLAIR) imaging; the use of intravenously administered contrast material is not required. Other types of chronic seizures are best evaluated with nonenhanced FLAIR or T2-weighted imaging for low-grade tumors, vascular malformations, gliosis after infarction, inflammation, or trauma. The presence of new-onset seizures in an adult or the worsening of chronic seizures warrants T2-weighted or FLAIR imaging and gadolinium-enhanced T1-weighted imaging (to look for primary or metastatic tumors, infections, or inflammatory lesions). If available, echo-planar diffusion imaging should be used also (to look for acute infarcts).

Adult↗
PubMed1998

Hyperammonaemic encephalopathy after initiation of valproate therapy in unrecognised ornithine transcarbamylase deficiency.

Ornithine transcarbamylase deficiency is an X linked disorder and the most common inherited cause of hyperammonaemia. Fluctuating concentrations of ammonia, glutamine, and other excitotoxic amino acids result in a chronic or episodically recurring encephalopathy. A heterozygous female patient first presented with protein intolerance, attacks of vomiting, and signs of mental retardation in early childhood. At the age of 16 complex partial seizures occurred which were treated with sodium valproate. Seven days after initiation of valproate therapy, she developed severe hyperammonaemic encephalopathy with deep somnolence. The maximum concentration of ammonia was 480 micromol/l. After withdrawal of valproate, three cycles of plasma dialysis, and initiation of a specific therapy for the inborn metabolic disease, ammonia concentrations fell to normal values. The patient remitted, returning to her premorbid state. Valproate can cause high concentrations of ammonia in serum in patients with normal urea cycle enzymes and may worsen a pre-existing hyperammonaemia caused by an enzymatic defect of the urea cycle. Sufficient diagnostic tests for the detection of metabolic disorders must be performed before prescribing valproate for patients with a history of encephalopathy.

Adolescent↗
PubMed1995

Gabapentin toxicity in children manifesting as behavioral changes.

Pediatric experience with gabapentin (GBP), a new antiepileptic drug (AED), is limited. We described 3 learning disabled children, 1 aged 7 and 2 aged 10 years, with intractable partial seizures who developed severe behavioral problems while receiving modest doses of GBP. The children became hyperactive and had explosive outburst consisting of aggressive and oppositional behavior. The behavioral problems were sufficiently severe to require discontinuation of GBP despite moderately improved seizure control.

Acetates↗