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PubMed1993

Seizure benefit: grand mal or grand bene?

The adverse stresses and injuries associated with epileptic seizures are prevented routinely when programmed, controlled grand mal seizures are administered. According to the described concepts of clinical benefit, symptoms of brain illnesses that are without substantial neuronal deterioration, but that have a sense of neurotransmitter dysregulation, are candidates for mitigation by administration of programmed seizures. Such symptoms include delirium, dementia, neuroleptic malignant syndrome, movement disorder, psychosis, and depression. Prior to recommending cortical excision for management of offtial complex epilepsy, a course of programmed seizures should be considered routinely.

Electroconvulsive Therapy↗
PubMed1997

Hippocampal pathology.

Medial temporal sclerosis of the hippocampus and other lesions in the adjacent temporal lobe that can cause epilepsy are discussed in this article. The technical factors to consider to optimally image the hippocampus and criteria to diagnose medial temporal sclerosis are emphasized.

Atrophy↗
PubMed1997

[Concurrence of short and long lasting episodes of nocturnal paroxysmal dystonia in an epileptic patient].

We report the case of a patient with nocturnal paroxysmal dystonia (NPD) meeting not only the diagnostic criteria described by Lugaresi et al. in 1981, but also presenting with features suggestive of underlying epilepsy as well as other differences from the diagnostic criteria originally described for NPD, such as short- and long-lasting episodes and poor response to antiepileptic drugs. The case we describe suggests a different entity, one that is unrelated to epilepsy or true NPD.

Adult↗
PubMed1997

[Epileptic seizures and immune disorders].

UNLABELLED: The links of epileptic seizures with febrile diseases, as well as with common infections are generally known. Similarly, physicians are aware of the coincidence of epileptic activity with immunity disturbances, as well as of the effects of the antiepileptic drug phenytoin on the immunity system. Disturbances of immunity are commonly reported in 30% of the population. Our clinic is a consilliary regional centre for torpid epilepsies and sleep defects. The aim of study is to document the occurrence of immunity disturbances in unsuccessfully treated patients (5-25 years of age) with generalised convulsive epilepsy (GENKONV-GK) in a group containing 50 patients, and with partial epilepsy with complex symptomatology (PARTKOMP-PK) in a group containing 75 patients. At the same time, this studys objective resided in seeking evidence of the positive effect of immunomodulatory therapy. In all patients, the basic diagnosis had been stated in coincidence with the origin of epilepsy during hospitalisation in neurologic wards. In 1993-1995 our clinic supplemented the electrodiagnosis by a series of routine EEG which was focused at the recurrence of the disease. As a rule, each of the patients was subdued to a 24-hour EEG monitoring on the 12-canal apparatus. Individual supplementation by CT, MR and USG of the brain, the arrangement of anti-epileptic therapy and basic immunological examination were made during the first year of investigation. Still, after the stabilisation of anti-epileptic therapy (monitoring) and indicated immunomodulatory therapy was added. RESULTS: The immunologic examination was negative in 4 patients, all being members of GENKONV group. Atopy was found in 56% of GK group, and in 65% of PK group. Disturbances of specific cellular immunity were revealed in 80% of the patients of the GK group, and in 85% of PK group. The signs of inflammatory activity and other signs of allergy were present to a lesser extent. CONCLUSIONS: Out of the amount of 125 patients only 3.2% yielded no disturbances of immunity. The application of immunomodulatory therapy appears to represent a promising supplementary-stabilisation therapy. (Tab. 2, Fig. 4, Ref. 5.)

Adolescent↗
PubMed1999

Focal lesion in the splenium of the corpus callosum in epileptic patients: antiepileptic drug toxicity?

BACKGROUND AND PURPOSE: Discrete focal lesions in the splenium of the corpus callosum on MR images in epileptic patients have received little attention in the literature. Our purpose was to describe these lesions, which may be related to the toxicity of antiepileptic drugs (AEDs), and to discuss the possible mechanisms of their development. METHODS: We examined six patients with epilepsy whose brain MR imaging findings showed a discrete focal nonhemorrhagic lesion in the splenium of the corpus callosum. The medical records and MR images were reviewed retrospectively with respect to the patients' clinical history, medication, and laboratory findings to determine the etiology of the lesion. RESULTS: In all six patients MR imaging showed a focal lesion in the splenium of the corpus callosum, which was ovoid in shape and 15 to 19 mm in size. In the three patients who received contrast material, there was no enhancement of the lesion. Four of six patients had a history of medication with dilantin, in two of whom the level of serum dilantin was found to be elevated (22.3 micrograms/mL and 70.4 micrograms/mL, respectively). Vigabatrin was administered in three patients, one of whom took dilantin together with vigabatrin. In two patients, the focal lesion in the corpus callosum disappeared on follow-up MR images after withdrawal of dilantin and/or vigabatrin. CONCLUSION: A discrete, focal, ovoid, nonhemorrhagic lesion in the splenium of the corpus callosum may be seen on brain MR images of patients with epilepsy. The lesion is considered to be reversible demyelination related to AEDs toxicity.

Adult↗
PubMed1997

[Epilepsy, cerebral calcifications and celiac disease].

Epilepsy, frequently with complex partial seizures, is observed in 5.5 p. 100 of all cases of celiac sprue. Bilateral parieto-occipital calcifications in the cortical or subcortical areas are found in about one-half of these patients. This triple association is apparently not fortuitous. Prognosis of epilepsy would depend on how early the gluten-free diet was started. The diagnosis of celiac sprue should be entertained in patients with brain calcifications and epilepsy. Search for anti-endomysium antibodies could provide useful information although villosity atrophy in the proximal portion of the small bowel and its regression with gluten-free diet remain the essential elements for the diagnosis of celiac sprue.

Brain Diseases↗
PubMed2003

Complex partial seizures and depression.

A long-recognized association exists between epilepsy and affective disturbance, especially depression. People with complex partial seizures that result from temporal lobe seizure foci are highly vulnerable to psychiatric disorders. Accurate diagnosis of such disorders is an important key to treatment. Interictal depression or dysphoria is the most clinically significant problem of this type. Pharmacotherapeutic treatments that have positive effects in other types of depressive illness are also effective for depression associated with epilepsy. Electroconvulsive therapy is helpful to some patients with depression that is refractory to drug treatment or psychotherapy. Surgical resection of seizure foci may lead to psychiatric improvement for some individuals, but can also have psychiatric complications.

Anticonvulsants↗
PubMed1995

FDG-PET in children and adolescents with partial seizures: role in epilepsy surgery evaluation.

We used FDG-PET to measure interictal glucose metabolism in 16 children and adolescents (mean age 14.7 years) and complex partial seizures (CPS) (mean seizure onset age 5.0 years). Video-EEG localized the epileptic foci. Glucose metabolism was determined in 14 paired anatomic areas using a standard template. PET hypometabolism was defined as greater than 15% asymmetry. Nine of the 13 (69%) patients with a unilateral EEG focus had regional hypometabolism ipsilateral to the epileptogenic zone. Three subjects had bilateral EEG foci; all had nonfocal PET. MRI (15 patients) concurred with EEG and PET in two, and was normal in seven of nine with focal hypometabolism. One of seven patients with normal PET had a focal MRI abnormality. FDG-PET results are similar to those found in adults, but are present earlier in the natural history of CPS (9.7 vs 22.2 years duration epilepsy) than previously reported. The presence of FDG-PET hypometabolism may be associated with a poor response to drug treatment. PET can identify metabolic abnormalities associated with epileptic foci in children and adolescents and is useful in directing surgical intervention for the control of refractory complex partial epilepsy.

Adolescent↗
PubMed1983

Single drug therapy for intractable epilepsy.

Single drug therapy with either phenytoin or primidone resulted in complete seizure control in 11 of 35 patients (31%) referred to an epilepsy clinic for treatment of uncontrolled chronic epilepsy with complex-partial seizures. Complete seizure control was associated with an increase in the mean plasma concentrations from 14 micrograms/ml to 23 micrograms/ml phenytoin and from 34 micrograms/ml to 40 micrograms/ml phenobarbitone with no change in the antiepileptic drug. Insufficiently low plasma concentrations of less than 11 micrograms/ml phenytoin or phenobarbitone were measured at the first visit in 14 patients (40%). Non-compliance was admitted by eight patients (23%). Optimum single drug therapy is of considerable clinical value in intractable epilepsy with complex-partial seizures.

Adult↗
PubMed1998

An institutional experience with cervical vagus nerve trunk stimulation for medically refractory epilepsy: rationale, technique, and outcome.

OBJECTIVE: Intermittent stimulation of the left cervical vagus nerve trunk is emerging as a novel adjunct in the treatment of medically refractory seizures. We sought to evaluate theoretical and practical issues attendant to this concept. We review the anatomic and physiological background arguing for clinical application of vagus nerve stimulation, discuss salient aspects of patient selection and the nuances of surgical technique, and present our observations of and results from application of the method. METHODS: Each of 18 patients with medically refractory epilepsy and at least six complex partial or secondarily generalized seizures per month underwent placement of a NeuroCybernetic Prosthesis pulse generator (Cyberonics, Webster, TX) in the chest, connected to helical platinum leads applied to the left cervical vagus nerve trunk. The patients were then randomized in a double-blinded fashion to receive either high (presumably therapeutic) or low (presumably less therapeutic) levels of vagus nerve stimulation. Reduction in seizure frequency, global assessments of quality of life, physiological measurements, and adverse events were recorded during a 3-month period. Patients in the low group were then crossed over to high-stimulation paradigms during a 15-month extension trial. RESULTS: All operations were successful, uneventful, and without adverse postoperative sequelae. One patient was excluded from analysis because of inadequate seizure calendars. Of the seven patients initially assigned to high stimulation, the mean reduction in seizure frequency was 71% at 3 months and 81% at 18 months. Five (72%) of these patients had a greater than 75% reduction in seizure frequency, and one (14%) remained seizure-free after more than 1.5 years of follow-up. The mean reduction in seizure frequency among the low-stimulation group was only 6% at 3 months. No serious complications, device failures, or physiological perturbations occurred. CONCLUSION: In our experience, vagus nerve stimulation has proven to be a safe, feasible, and potentially effective method of reducing seizures in select patient populations. However, the elements of strict definition for the application of the method require further study.

Adult↗