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Results for “Epilepsy, Complex Partial”

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PubMed2003

Thalamic hypometabolism in a patient undergoing vagal nerve stimulation seen on F-18 FDG PET imaging.

A 31-year-old man with a vagal nerve stimulator for seizure control was noted to have decreased metabolism within the thalamus as visualized by F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET). Some investigators think the thalamus plays an important role in the regulation of seizure activity. Vagal nerve stimulation (VNS) may reduce thalamic activity, which in turn may reduce seizure activity. However, because the thalamus has diffuse connections throughout the brain, its role in seizure activity is likely complex. Observing decreased thalamic activity during VNS is just 1 small step toward understanding this role.

Adult↗
PubMed1995

Self-management in persons with epilepsy.

The purpose of this study was to assess the extent to which people with epilepsy use recommended self-management strategies. Questionnaires on epilepsy self-management were mailed to 450 persons with epilepsy as part of a larger study on epilepsy self-management. One hundred ninety five people returned completed questionnaires and met the study criteria. The respondents were on average 35.8 years old and bad experienced seizures for a mean of 18.5 years. In general, the respondents reported compliance with medications but less adherence to other recommended practices such as safety and lifestyle behaviors. The results of this study offer some suggestions for nursing practice including an increased awareness of the teaching needs of persons with epilepsy.

Adolescent↗
PubMed1997

Using a health promotion model to enhance medication compliance.

Noncompliance with antiepileptic medication regimens is a leading cause of treatment failure. As a behavior, its causes are multifactorial and the degree to which it is exhibited varies from patient to patient. Interventions to encourage positive behavioral change need to be based on an understanding of the psychological, physiological and psychosocial aspects which explain noncompliance. Pender's Health Promotion Model provides a framework that can be used by the nurse to identify factors which interfere with the patient's ability to practice compliance and develop a treatment plan.

Adult↗
PubMed1991

Biochemical abnormalities in developing E1 mouse.

Complex biochemical abnormalities were found in the early developmental stage of the E1 mouse. First, the E1 mouse has abnormal levels of specific amino acid concentration within a week from birth. Second, an unusual expression of poly(A)+ RNA from the one-day newborn liver of the E1 mouse was detected by use of Cot 100 DNA as a probe. Third, sodium channels are increased in synaptosomes and at the mRNA expression level of the 3 or 4-week-old E1 mouse brains, compared with the ddY mouse. These results suggest that the biochemical abnormalities described in this study may affect greatly the epileptogenesis of E1 mouse.

Age Factors↗
PubMedDate not supplied

Effects of a broad-spectrum behavioral medicine treatment program on children with refractory epileptic seizures: an 8-year follow-up.

We present an 8 year follow-up on a group of children with refractory epileptic seizures who participated in the early 1980s in a controlled group study on the effects of a broad-spectrum behavior modification treatment program on children with refractory epileptic seizures. In the original study, 18 children were divided into three groups: behavior modification group, attention control group, and control group. The purpose was to investigate the effects of a learning-based treatment program superimposed on a regular medical treatment program. Also, the effects of professional attention were evaluated. At the 10 week and 1 year follow-ups, only the group receiving the behavior modification intervention had a significantly reduced rate of seizure index. The present study investigates these same children 8 years later using the same methods of investigation for an additional 10 week period. The results indicate that a significant reduction in seizures was obtained only for the behavior modification group at the 8 year follow-up.

Adolescent↗
PubMedDate not supplied

Coexistence of neoplasia and cortical dysplasia in patients presenting with seizures.

Tumors and cortical dysplasia are associated with epilepsy, but few studies have examined the coexistence of neoplasia and dysplasia in these patients. We studied 13 patients (age 4-29 years) with recurrent seizures of 1 month to 21-year' duration (median 72 months). Ten patients were aged < 21 years. Imaging studies localized the lesion to the temporal lobe (10 patients), parietal lobe (2 patients), and frontal lobe (1 patient). Tumors included ganglioglioma (8 patients), dysembryoplastic neuroepithelial tumor (DNT) (3 patients), and low-grade astrocytoma (2 patients). Cortical dysplasia, including atypical aggregates of neurons (6 patients), multifocal loss of the cortical laminar architecture (7 patients), and neurons in the molecular layer of the cortex (3 patients) were observed near but separate from the tumor. Coexistence of certain tumors with cortical dysplasia, most frequently observed in the pediatric population, suggests a hamartomatous/dysplastic nature of the neoplasms.

Adolescent↗
PubMedDate not supplied

Submandibular salivary gland hypertrophy induced by phenytoin.

A 16-year-old boy with epilepsy developed hypertrophy of the submandibular salivary glands, with high phenytoin (PHT) serum levels. The submandibular salivary glands became normal in 12 days after discontinuation of PHT. Other causes of salivary gland hypertrophy were excluded and we suggest that the hypertrophy was due to PHT.

Adolescent↗
PubMedDate not supplied

Nonconvulsive status epilepticus: EEG analysis in a large series.

We analyzed EEG characteristics comprehensively in a large series of nonconvulsive status epilepticus (NCSE) cases. Eighty-five ictal episodes in 78 patients were analyzed. The ictal discharges were generalized (group G) in 59 episodes (69%), diffuse with focal predominance (group GF) in 15 (18%), and focal (group F) in 11 (13%). The morphologies and patterns of persistence varied greatly. Frequency of ictal discharge was also variable and was almost always < 3 Hz. Demonstration of focal epileptic features in response to intravenous (i.v.) diazepam (DZP) and the presence of interictal focal epileptiform discharges in some cases in groups G and GF suggested possible focal onset secondarily generalized in these cases. This study suggests that electrographically NCSE is a highly heterogeneous epileptic state, and i.v. DZP may serve as a valuable diagnostic tool in differentiating generalized from focal onset NCSE.

Adolescent↗
PubMed1995

Dose frequency and dose interval compliance with multiple antiepileptic medications during a controlled clinical trial.

Compliance with medication regimens and clinical trial schedules was evaluated during a study of vigabatrin (VGB), an antiepileptic drug (AED). Medication Event Monitors (MEMS, Aprex Corp., Fremont, CA, U.S.A.) were provided to monitor use of VGB and other AEDs administered to 111 patients at 10 sites. MEMS reports showed the number of doses administered daily, times of doses, and intervals between doses. The 66 patients whose data were evaluable took VGB as prescribed (twice daily, b.i.d.) on 89 +/- 7% of days in the clinical trial (mean 189 +/- 63 days). However, only 66 +/- 24% of doses were taken within the 9-15-h dose interval window for twice-daily dosing, a lower rate than that for dose frequency compliance (p < 0.001). Concomitant medications prescribed b.i.d. (n = 66) (86 +/- 11% dose frequency compliance) were taken at lower rates than VGB (p < 0.02). Interval compliance also was lower for concomitant b.i.d. medications (59 +/- 26%) than for VGB (p < 0.01). Dose frequency compliance for thrice-daily (t.i.d.) medications (n = 36) was 80 +/- 18 and 40 +/- 19% for interval compliance (6-10 h) (both p < 0.0001 vs. VGB). Dose frequency compliance for four times daily (q.i.d.) medications (n = 23) was 80 +/- 23 and 33 +/- 18% for interval compliance (4-8 h) (both p < 0.0001 vs. VGB). Patients at eight sites did not use MEMS properly, often for practical reasons, voiding including of data for 93 medications (32%) because of noncompliance with the study design to monitor compliance.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Language function after temporal lobectomy without stimulation mapping of cortical function.

We studied 95 patients who underwent standard anterior temporal lobectomy (ATL) without stimulation mapping of language areas, using neuropsychological parameters of language function preoperatively and 1 year postoperatively [Boston Naming Test and Verbal Fluency, and the Information, Comprehension, Arithmetic, Similarities, Digit Span, and Vocabulary subtests of the Wechsler Adult Intelligence Scale (WAIS)]. Verbal IQ (VIQ), Performance IQ (PIQ), Full-Scale IQ (FSIQ), and Verbal Deviation Quotient were also evaluated, as were parameters of memory function. All patients had hemisphere dominance for language assessed by an intracarotid amytal test. Fifty-three patients had a left dominant (LHDL) ATL with a mean extent of lateral resection of 4.8 cm, and 10 had a left ATL with right or mixed hemisphere dominance (RHDL, MDL). Thirty-two patients had a right nondominant ATL. Seizure outcome was 57 and 59% seizure-free for LHDH and right nondominant group, respectively, 1 year after operation. Comparison of preoperative scores showed the LHDL group to have significantly lower scores than the right nondominant group for several parameters of language function and memory. The group undergoing left dominant ATL showed no significant loss of language function postoperatively and actually showed gains in many parameters. Standard ATL without stimulation mapping of language areas and with conservative lateral resection is safe for long-term language function. In addition, evidence shows preexisting language dysfunction in patients undergoing left dominant ATL.

Adolescent↗
PubMed1995

Intracarotid amobarbital procedure as a predictor of material-specific memory change after anterior temporal lobectomy.

Memory testing during the intracarotid amobarbital procedure (IAP) is used extensively to identify temporal lobe surgery candidates "at risk" for developing severe postoperative anterograde amnesia. However, the utility of the IAP in predicting commonly observed material-specific memory deficits has not been thoroughly investigated. We examined the utility of contralateral IAP memory testing, as an index of the functional capacity of the surgical temporal lobe, to predict postoperative material-specific memory changes on the Wechsler Memory Scale-Revised (WMS-R) in patients with left hemisphere speech dominance undergoing left (n = 32) and right (n = 31) temporal lobectomy (TL). Left TL patients who "passed" contralateral IAP memory testing (> or = 68% recognition of memory items) had significantly greater verbal memory decrements than those who "failed" the IAP, presumably as a result of removal of functional tissue. A similar relationship between contralateral IAP performance and visual memory performance was not observed among right TL patients. Thus, the functional adequacy of the tissue to be resected appears to be inversely related to postoperative verbal memory decrement, at least among left TL patients. This relationship is consistent with results of recent studies demonstrating an inverse relationship between verbal memory decrements after left TL and preoperative neuropsychological verbal memory performance, magnetic resonance imaging (MRI) hippocampal volumes, and degree of mesiotemporal sclerosis (MTS).

Adolescent↗
PubMed1995

Intraoperative thermal inactivation of the hippocampus in an effort to prevent global amnesia after temporal lobectomy.

In an effort to assess the risk of amnesia after anterior temporal lobectomy (ATL), we conducted localized thermal inactivation (cooling) of the hippocampus with memory testing. Thirty-three ATL patients whose preoperative evaluation suggested risk for postoperative amnesia underwent hippocampal cooling. Cooling consisted of inserting a catheter in the temporal horn and irrigating it with an iced solution until a stable hippocampal temperature of approximately 20 degrees C was reached. Memory was assessed before and after cooling. In 12 of the 33 patients, memory testing was either aborted or suggested poor contralateral support, and the hippocampus was resected in 2 of these patients. The remaining 21 patients showed evidence of contralateral memory support, and the hippocampus was resected in 18. No patient became amnestic. These results suggest that intraoperative hippocampal cooling may be useful in selected cases. However, even among many patients who could cooperate with testing, discomfort, sedation, attentional deficits, confusion, and anxiety made test interpretation difficult.

Adolescent↗
PubMed1996

Significance of spikes at temporal lobe electrocorticography.

Among 87 consecutive patients operated on under local anesthesia, few aspects of pre- and posttemporal lobe resection electrocorticograms (ECoG) yielded prognostic data. Preresection spikes were most common in the hippocampus, followed in order of frequency by the anterior temporal convexity and the inferior temporal surface. Moderately frequent (>10 spikes/100 s) preresection spikes appeared beyond the subsequent resection line in the posterior temporal region in 16 of 87 (18%) and in orbital frontal cortex in 12 of 87 (14%). Although many hippocampus spikes portended a favorable outcome and rare spikes an unfavorable one, preresection spike quantity otherwise failed to distinguish outcome groups. Absolute quantity of postresection spikes and change from preresectrion quantity in any region did not correlate with outcome except for the insula, where relatively abundant spikes portended favorable outcomes. Postresection electrographic seizures were rare but occurred equally in all outcome groups. No significant change in spike incidence occurred between the first and last 10-min epoch of the 30-min postresection recording.

Adult↗
PubMed1996

Five-year outcome after epilepsy surgery in nonmonitored and monitored surgical candidates.

PURPOSE: We wished to compare outcome 5 years after temporal lobectomy in 28 patients selected for surgery on the basis of interictal EEG patterns with that in 46 patients who underwent EEG-video monitoring studies as part of their preoperative evaluation during the same era. METHODS: The 28 nonmonitored patients had interictal EEG patterns that demonstrated a consistent, unilateral, anterior-midtemporal epileptiform focus, without discordant findings from other studies. Outcomes were assessed for years 4 and 5 after operation. RESULTS: Twenty-six of 28 (92.9%) nonmonitored patients were seizure-free or had at least 75% reduction in seizures. Twenty-nine of 46 (63.0%) monitored patients were seizure-free or had at least 75% reduction in seizures. Preoperative interictal EEGs of 29 of these patients showed independently localized bitemporal, extratemporal, midposterior temporal, or diffuse epileptiform patterns. The remaining 17 monitored patients had preoperative strictly unilateral anterior-midtemporal interictal discharges, and their outcome was comparable to the nonmonitored group, with 15 (88.8%) seizure-free or with at least 75% reduction in seizures. CONCLUSIONS: A proportion of candidates for epilepsy surgery can be selected without ictal recordings provided that interictal EEGs demonstrate consistent unilateral anterior-midtemporal epileptiform discharges and that other data are not discordant.

Adolescent↗