Interictal focal or lateralized discharges occurring in the electroencephalograms of patients suffering from centrencephalic epilepsy.
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The EEGs of 16 newly diagnosed children with primary generalized epilepsy were examined before and during up to 3 years of antiepileptic therapy with valproic acid. Spectral analysis was performed and parameters of the relative power within the conventional frequency bands were compared with norm data. Before treatment no significant differences of the background activity between epileptic children and healthy controls were found. While treatment was able to reduce seizures and spike-wave activity, EEG parameters did not change systematically. There was no relation between valproate serum levels and parameters of the background activity.
In a survey of 29 hydrocephalic children treated by ventriculoatrial shunt (Holter valve) with a follow-up of 4 years, EEG records before the operation and at least once a year thereafter, the authors can support the view that an epileptogenic focus has developed around the place of insertion of the ventricular catheter in 19 cases, leading to epileptic seizures in 17 up to now. Thus the incidence of convulsions in this particular group of patients is 0.59 (17/29), the limits of confidence 95% being 0.39-0.76. The irritative abnormalities occur usually during the second year after the operation and the delay for the onset of clinical seizures is variable. The age at operation seems to influence the occurrence of the epileptogenic scar. The type of hydrocephalus and especially the presence of an associated cerebral focal lesion can be of importance in the development of clinical seizures.
The authors report the case of a psychotic preschool child who manifested a seizure disorder while on imipramine treatment. They note that according to his history and physical exam, the child fell within a group which seems predisposed to this side effect. Although tricyclic antidepressant compounds can be used judiciously with seizure-prone individuals, the authors recommend that alternative modalities be given first consideration.
Seizure disorders may present with signs and symptoms that are usually associated with psychiatric disorders. Physicians must be alert to this possibility; they should use careful history taking in conjunction with EEGs to avoid misdiagnosing certain cases of psychomotor, petit male, and grand mal epilepsy.
OBJECTIVE: The author's goal was to evaluate theories of the conditions that exist before onset of psychological and somatic symptoms by assessing these preconditions clinically and quantitatively. METHOD: He assembled a set of texts from the cases of seven patients who had recurrent psychological or somatic symptoms and examined the segments of texts that came before the symptoms occurred; he then compared these segments with segments of text that occurred before control points in the same case. The recurrent psychological symptoms were momentary forgetting, shifts in level of depression, and phobic behavior; the recurrent somatic symptoms were stomach ulcer pains, migraine headaches, absence epilepsy (petit mal) episodes, and premature ventricular contractions of the heart. RESULTS: 1)Independent ratings of presymptom segments compared with precontrol segments revealed some significant differences in all seven cases. 2) Some variables that distinguished the presymptom from the precontrol segments occurred in all of the cases. In rank order of their effect size across cases, these variables were hopelessness, lack of control, anxiety, feeling blocked, helplessness, concern about "supplies," depression, and hostility toward the therapist. For example, hopelessness was significant in seven of the seven cases. CONCLUSIONS: For the first time, segments of texts of psychotherapy sessions that occurred before recurrent symptoms have been assembled and analyzed. These brief segments before recurrent symptoms showed more of certain qualities than did segments before control points where no symptoms appeared. On the basis of these results the author constructed a new symptom-context theory of symptom formation and compared this new theory with five classical theories of symptom formation, drawing implications for research and for treatment techniques.
The diagnosis and treatment of epilepsy relies heavily on descriptions of behavioral changes noted during seizure episodes. A pilot study was completed to determine the frequency of occurrence of behaviors commonly associated with seizures in a pediatric population (n = 153). Caretakers of the children (ages = 4 months to 19 years) were asked to respond to a checklist containing 40 behavioral descriptors. Thirteen descriptors were found to differentiate between seizure and nonseizure events. Twelve of these behaviors were endorsed significantly more frequently by caretakers of children with seizures including the following: does not remember what happened, moves mouth funny, drools, jerking/twitching, becomes stiff, changes in breathing, stares off, bites or chews tongue, eyes look glassy, will not respond, mumbles or slurs words, and eyes or head turn to one side. One behavior, fidgets in seat, was significantly more associated with nonseizure episodes. The behavioral descriptors may be presented in a checklist format or incorporated within a clinical interview in primary care settings for initial screening of children with possible seizure disorders.
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Lennox-Gastaut syndrome is a type of childhood epilepsy that has enormous detrimental effects on the patient's physical and developmental health and can also take a dramatic toll on the well-being of the patient's family. Lennox-Gastaut syndrome is characterized by variable etiology, multiple types of intractable seizures, and cognitive impairment in most patients. It is one of the most difficult epilepsy syndromes to treat and is frequently resistant to treatment with standard antiepilepsy drugs. This article reviews the etiology of Lennox-Gastaut syndrome, characteristics of predominant seizure types, methods of evaluating patients for Lennox-Gastaut syndrome, and available treatments including antiepilepsy drug therapy, ketogenic diet, and surgical options.