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PubMed1989

The evaluation of patients with intractable complex partial seizures.

Conceptual advantages, together with advances in both technique and technology, have considerably altered the approach to intractable epilepsy over the past two decades. Appropriate utilization of these advances allows our evaluation of patients with intractable seizures to be much more precise and specific than was once the case and allows us to improve considerably our ability to treat patients with intractable epilepsy. We propose an algorithm for the evaluation and treatment of patients with intractable complex partial seizures. Other forms of intractable epilepsy may benefit from similar diagnostic and therapeutic approaches.

Decision Trees↗
PubMed2005

Type 1 diabetes mellitus and drug-resistant epilepsy: presence of high titer of anti-glutamic acid decarboxylase autoantibodies in serum and cerebrospinal fluid.

A 55-year-old man who was diagnosed as having type 1 diabetes mellitus (DM) at the age of 50 years was started on insulin therapy. At 54 years old of age, he suddenly developed complex partial seizures, which frequently occurred despite intensive anti-epileptic drug therapy. Neurological examination on admission revealed hyporeflexia in bilateral upper and lower extremities without any muscle rigidity, painful spasm or cerebellar ataxia. Laboratory examination showed poor glycemic control with increased glycated hemoglobin levels. Positive anti-thyroglobulin antibodies and anti-thyroid peroxidase (TPO) antibodies and slight elevation of TSH levels are consistent with subclinical hypothyroidism due to Hashimoto's thyroiditis. A high titer of anti-glutamic acid decarboxylase (GAD) antibodies was detected in the patient's serum and cerebrospinal fluid (CSF). Electroencephalography showed temporal spikes, consistent with complex partial seizure. This is a very rare case presenting with concomitant type 1 diabetes and drug-resistant epilepsy associated with high titers of circulating and CSF anti-GAD antibodies.

Anticonvulsants↗
PubMed1995

Personality traits in school children with epilepsy.

An alternative way of looking at epilepsy has been restricted to the observation of personality characteristics and behavioral cognitive impairments, as these are the most important secondary handicaps. The term "behavioural disorders" is connected with the problem of the development of personality. For this reason, in clinical work a sensitive and standardized psychometric instruments for measuring personality constructs are required. One of the most frequent used instruments in our child neurowork is Eysenck's Personality Inventory (EPI--junior questionnaire), based on Eysenck's theory. In this study, EPI-junior questionnaire was given to a group of 60 boys and girls aged 10-14 years with various forms of epilepsy (single partial seizures--N = 28; complex partial seizures--N = 18; typical absence--N = 8; atypical absence--N = 6. All children were receiving anticonvulsant drugs in doses within or below therapeutic limits. The possible influence of drug administration on personality characteristics of these children was not specifically analyzed for insufficient data in their medical histories. Results of personality characteristics obtained on the EPI junior test of the children with epilepsy were compared to the results of "normal" school children matched by age, sex and social conditions. Its was found (on the "extroversion-introversion" scale) that the children with epilepsy were more introverted than the control group children, which is contrary to the common clinical experience. On the other hand, there were no statistical differences between these two groups in the category of "neuroticism". Finally, the children with epilepsy had significantly higher results on the "lie scale", which indicated greater unreliability of their results obtained on EPI-junior "lie" scale as compared to the control group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1999

Can patients perform volitional motor acts at the start of a seizure?

A seizure warning device might allow some individuals with partial seizures to protect themselves against consequences of seizures, but a prerequisite is the ability to take volitional action in response to a warning. The authors reviewed consecutive seizures in their epilepsy monitoring unit to determine whether patients could squeeze an event bulb, as instructed, at the start of their seizure. Only complex partial seizures with EEG changes and with the patient on camera were analyzed. Data were obtained from 77 patients, 42 with scalp monitoring and 35 with depth electrodes. Forty-seven percent had a left-hemisphere focus, 42% a right-hemisphere focus, and 11% multifocal seizures. The seizure focus was temporal in 68%. A magnetic resonance imaging consistent with mesial temporal sclerosis was seen in 29% of patients. Overall, 44% of the patients made at least one attempt to reach for the event bulb at the start of their seizures. Among the 72% of patients who gave a history of auras, 53% were able to press the event bulb compared to 20% with no history of auras (P = 0.016). EEG changes occurred a mean of 2.9+/-30.5 seconds after reaching for the bulb for scalp-recorded seizures (n = 20), and 16.2+/-13.7 seconds before behavior for depth-recorded seizures (n = 14, difference significant at P = 0.02). Neither seizure focus nor seizure laterality influenced the ability to press the event bulb. The authors conclude that nearly half of individuals with complex partial seizures can take volitional motor action at the start of their seizure. A method to enhance the intensity and timeliness of a seizure warning would not be wasted.

Adolescent↗
PubMedDate not supplied

[Benign partial epilepsies of childhood].

OBJECTIVE: To carry out, by means of a literature review, an update of the entities that can be included within the group of benign partial epilepsies of childhood. DEVELOPMENT: Among partial epilepsies with onset in the first stages of life, a group extended in the last years with a favourable course and a trend to reverse, even spontaneously, has been identified. Some of these entities have a genetic origin but we do not know the mechanisms by which these epilepsies show a self limited course, which have given rise to the denomination of epilepsy that comes and goes; nevertheless, an evolution to other more complex forms is also possible. CONCLUSIONS: Benign partial epilepsies of childhood constitute a wide group of conditions of varied semiology, usually with a good prognosis even without treatment. Occasionally, these epilepsies may show a more unfavourable course with a worsening, in spite of medication, and the appearance of neurologic and neuropsychologic disorders. All these aspects must be known and considered by the physician in charge of these patients management.

Adolescent↗
PubMedDate not supplied

Electroencephalographic correlations of extracranial and epidural electrodes in temporal lobe epilepsy.

Thirty patients with medically intractable complex partial seizures of temporal lobe origin, but no structural abnormalities on neuroradiologic investigations, had both extracranial (scalp) and epidural EEG recordings. Fifteen patients (50%) had localized, unilateral, ictal, scalp EEGs, but one of these had bilateral independent temporal seizure onset according to epidural recordings. Of the 15 patients in whom scalp EEGs were non-localizing, 12 had well-localized epidural ictal EEGs, and 3 had multifocal or bilateral independent temporal ictal recordings. Epidural recordings provide information for determination of site of onset of temporal lobe seizures in selected patients.

Adult↗
PubMed2006

Population-based survey on prevalence of adult patients with epilepsy in Taiwan (Keelung community-based integrated screening no. 12).

PURPOSE: To determine the prevalence rate and patterns of adult patients with epilepsy in Taiwan, we conducted a community-based neuroepidemiological survey. METHODS: Epilepsy was detected by neurologists using one-stage method. It was integrated into a community health screening service and performed from 1 January 2001 to 31 December 2001 in Keelung, a northern city in Taiwan. A total of 13,663 subjects aged 30 years or older participated in this survey. RESULTS: There were 52 patients with epilepsy in this study. Among them, 37 were patients with active epilepsy. The age-adjusted prevalence rate of active epilepsy above 30 years old was 2.77/1000 (to the 1980 US population) with the highest rate in subjects aged 40-49 years (4.0/1000). There was a trend of higher prevalence rate in male than in female. The most common seizure type was complex partial seizure (46.0%). Using one-stage detection method, we found nine (24.3%) patients with active epilepsy who had never been diagnosed before. Among the patients with active epilepsy, 35.1% were symptomatic cases. Head injury (13.5%) is the leading cause, followed by CNS infection (8.1%), stroke (5.4%) and perinatal insult (5.4%). The lifetime prevalence rate of epilepsy (including active epilepsy and epilepsy in remission) was 3.14/1000 for age above 30 years. CONCLUSIONS: Comparing to previous epilepsy survey in 1993, our results showed that the prevalence rate of epilepsy was rather stable over the past decade in northern Taiwan. Head injury is the leading cause responsible for active epilepsy. Improving public safety is an important public health issue which may help to reduce occurrence of epilepsy.

Adult↗
PubMed2005

Sleepwalking and other ambulatory behaviours during sleep.

Different pathological conditions may lead to somnambulic automatisms arising from nocturnal sleep. Video polysomnography represents the diagnostic tool but, due to the difficulty of capturing complex episodes in the sleep laboratory, audio-video recordings at home of the episodes may help in the differential diagnosis also. Sleepwalking is a disorder of arousal in which the subject arises from deep sleep, even displaying long complex behaviour, including leaving the bed and walking, with memory impairment of the event. Disordered arousal mechanisms with an inability of the brain to fully awaken from slow-wave sleep are thought to lead to these motor automatisms. REM sleep behaviour disorders begin during REM sleep and are accompanied by features of REM sleep. The motor behaviour may be violent and injurious to the patient and/or bed partner. In some patients, however, the behaviour may be similar to that observed in sleepwalking and some patients have an overlap syndrome. In nocturnal frontal lobe epilepsy in particular, and in complex partial seizures in general, stereotypic and repetitive motor attacks may recur, at any time, on the same night and on different nights, with a continuum between minimal or minor attacks and major or prolonged episodes up to agitated epileptic nocturnal wanderings.

Brain↗
PubMedDate not supplied

[The assessment of lamotrigine effectiveness in patients with drug-resistant epilepsy].

The aim of the study was to evaluate the efficacy of lamotrigine (LTG, Lamictal) in patients with long-lasting epilepsy. The group of 11 patients, 4F, 7M aged 16-45 years, mean 31.3 years was included in the study. Complex partial seizures and complex partial with sec. generalization ones occurred in 5 patients, only simple and complex partial seizures in 4 and in 2 cases we observed primary generalized nonconvulsive seizures. The mean seizure frequency was 20/month before LTG treatment. The mean duration of epilepsy was 20 years. Monotherapy with carbamazepine was used in 2 patients, 9 took 2 antiepileptic drugs. The time of investigation and treatment was 4 months with 3 control visits. During LTG treatment the number of conventional antiepileptic drugs was reduced in 7 patients. The dose of the basic antiepileptic drug was not changed. We evaluated how LTG had influenced the frequency, severity and duration of seizures, patients' mental state and adverse events appearance. Good result of treatment--seizure frequency reduction at least 50%--was observed in 5 patients (45.5%), moderate--seizure frequency reduction below 50%--in 1 patient (9%), bad result--no change in seizure frequency or its increase--in 5 cases (45.5%). In 5 patients the drug influenced positively seizure severity and duration. Beneficial psychotropic effect of the drug was found in 2 patients with mental disturbances. Adverse effects occurred in 3 patients. They were vertigo and ataxia in 1 patient, drowsiness in 1 case and dyspeptic symptoms in 1 patient. Adverse events were mild and transient in 2 patients. In 1 patient with vertigo and ataxia they resulted in the drug being discontinued after 3 month treatment. On the whole lamotrigine shows a positive influence on the frequency, severity and duration of seizures in some patients with therapy resistant epilepsy. The drug is well tolerated and seems to have positive psychotropic effects.

Adolescent↗
PubMed2003

Benign focal epilepsy with onset in infancy in a patient with 18q-syndrome.

CASE REPORT: The 18q-syndrome is sometimes associated with epilepsy. We report a child with a 18q deletion who showed the typical manifestations of the syndrome. In addition, she had benign focal epilepsy with onset in infancy characterized by complex partial seizures with a frequency from 1 to 20 per day. This type of epilepsy is a rare condition and this is the first report of benign focal epilepsy with onset in infancy in a child with 18q-syndrome. The EEGs performed during sleep showed low-voltage spikes over the fronto-central region of the left hemisphere. The magnetic resonance imaging of the brain was normal. CONCLUSION: In conclusion, benign focal epilepsy with onset in infancy could be a condition associated with 18q-syndrome.

Chromosomes, Human, Pair 18↗
PubMed1997

Seizure control after stimulation of the vagus nerve: clinical outcome measures.

BACKGROUND: Currently, decreases in seizure frequency are the accepted efficacy outcome measure of therapeutic interventions in the management of patients with epilepsy. In a longitudinal randomized controlled trial of 10 subjects with intractable complex partial seizures who received left vagal nerve stimulation (VNS) to control seizures, it was found that the total number of consecutive seizure-free days is a significant efficacy outcome measure. Unlike measures in which percentage decreases in seizure frequency are calculated, measures of consecutive seizure days indicate improvement in the amount of time for which patients may function at a higher level in activities of daily living. METHODS: Fourteen day blocks of consecutive seizure-free days and 14 day blocks of consecutive days in which subjects had seizures were tabulated. RESULTS: A Pearson correlation coefficient showed that prior to VNS subjects had few, if any, seizure free blocks of time and after VNS they had more blocks of time seizure free r = -1.00 and r = -0.99. The blocks of seizure-free days increased tenfold (mean 0.85 to mean 8.00) from 1991-1995 while mean seizure frequency in those blocks in which subjects had seizures only decreased from (mean 20.14 to mean 17.59) for the same time period. Correlations between total number of seizures after 24 months of VNS and after 50 months of VNS were r = 0.85 showing a consistency in the effect of VNS. CONCLUSIONS: Monitoring the number of consecutive seizure-free days is a significant clinical outcome measure of VNS.

Adult↗
PubMed1995

Successful epilepsy surgery without intracranial EEG recording: criteria for patient selection.

Twenty-two patients with intractable complex partial seizures (CPS) were treated with temporal lobectomy. Eighteen of 22 (82%) are seizure-free while receiving medication, with a mean follow-up time of 4 years. In each case, the clinical seizure pattern, interictal and ictal scalp EEG, magnetic resonance imaging (MRI), neuropsychological testing, and results of the intracarotid amobarbital procedure (IAP) converged to indicate a localized abnormality. None of the patients in this series had mass lesions, vascular malformations, or cortical scars, but 18 of 22 had hippocampal atrophy on MRI and 20 had hippocampal sclerosis (HS) on pathologic examination. We believe it is possible, on the basis of the preoperative evaluation described, to identify a population of epileptic patients who will do very well postoperatively. Such patients do not require invasive EEG monitoring, and they represent approximately 20% of the patients treated surgically in our epilepsy unit in the past several years.

Adolescent↗
PubMed1987

Magnetic resonance imaging-based computer-assisted stereotactic resection of the hippocampus and amygdala in patients with temporal lobe epilepsy.

In patients with medically intractable complex partial seizures of temporal lobe origin, stereotactic amygdalohippocampectomy can now provide excellent results. Target structures can be accurately identified and completely resected with use of a carbon dioxide laser. In a series of 18 patients who underwent this computer-interactive procedure, all experienced a cessation or dramatic reduction in frequency of seizure activity. Because the inferior optic radiations are disrupted with use of the posterolateral approach, nondisabling postoperative visual field deficits always ensue. In addition, two of our patients who underwent left-sided procedures had transient minor speech problems, perhaps attributable to postoperative swelling of the lateral temporal lobe. Patients in whom a surface electroencephalogram discloses a posterior temporal focus of seizure activity are candidates for stereotactic amygdalohippocampectomy.

Adolescent↗
PubMed1997

[Felbamate: a long-term study in subjects with refractory epilepsy].

UNLABELLED: 18 patients with refractory complex partial seizures with or without secondary generalization resistant at common AED were studied. They were treated in a open label study with felbamate for a 22 months period. Felbamate monotherapy show a statistical significant improvement in the control of seizures in these patients versus CBZ therapy. No severe side effects were reported specially aplastic anemia or hepatic failure. At present, after 2 years, all the patients are still treated with felbamate. CONCLUSIONS: felbamate appears to be an effective new AED: the most adverse effects occurring during administration of FBM are mild to moderate gastrointestinal (nausea, vomiting and anorexia) and central nervous system (headache, sonnolence, diplopia, dizziness and insomnia) disturbances. These adverse effects last, generally, for three weeks and allow to continue the treatment.

Adolescent↗
PubMed1987

Localization of magnetic interictal discharges in temporal lobe epilepsy.

Three young adults with intractable complex partial seizures were studied by electroencephalography, magnetoencephalography, and electrocorticography. Interictal electroencephalographic (EEG) spikes for each patient were grouped according to their morphological characteristics and distribution across channels. Mapping of simultaneously recorded magnetoencephalographic signals produced dipolar patterns from which the three-dimensional locations of equivalent current dipoles were calculated, whereas the mapping of EEG spikes showed single regions of electronegativity. The magnetic spikes were localized to the anterotemporal lobe, and the EEG spikes were localized somewhat anterior or posterior to the magnetic spikes. The magnetoencephalographic findings corresponded well with intraoperative electrocorticographic and depth-electrode findings of discharging areas located over the lateral temporal lobe and on the basal and mesial surfaces of the temporal cortex.

Adult↗
PubMed2002

Basic mechanisms of psychotropic drugs.

Many epilepsy patients, particularly those with complex partial seizures, also develop psychiatric disorders during the course of their illness and have to be treated with psychotropic drugs in addition to their antiepileptic medication. However, the brains of epileptic patients can be considered pathologically altered and psychotropic drugs may thus have profound and stronger effects on seizure threshold or unwanted side effects than in purely psychiatric patients. Thus, the knowledge of the mechanisms of psychotropic drugs is necessary to predict their effects in epilepsy patients. In this review, current concepts of the mechanisms of neuroleptic, antidepressant, and anxiolytic drugs emerging from basic and preclinical research are summarized, and the potential impact of using these drugs in epilepsy patients is discussed.

Animals↗
PubMedDate not supplied

Basal temporal subdural electrodes in the evaluation of patients with intractable epilepsy.

In evaluation of patients with complex partial seizures who are candidates for surgical treatment, exact definition of the epileptogenic focus is essential for a good surgical outcome. We report a new technique which permits detailed mapping of the epileptogenic activity in the basal temporal lobe and the convexity of the temporal lobe. The technique consists of placement of at least 16 basal temporal electrodes and an additional 64 electrodes covering the temporal convexity. This extensive coverage permits accurate definition of the limits of the epileptogenic focus and also of adjacent functional areas and therefore allows more significant determination than have previous techniques of the ideal extent of the surgical resection. This accuracy cannot be achieved with depth electrodes or the limited coverage provided by previously reported epidural or subdural electrode techniques.

Action Potentials↗
PubMed1983

Cyclic vomiting and recurrent abdominal pains as migraine or epileptic equivalents.

A retrospective method was used to estimate the incidence of recurring motion-sickness, cyclic vomiting and abdominal pain considered as different manifestations of a so-called periodic syndrome in 100 migraine sufferers, 100 epileptics and 100 control subjects in the pediatric age group. Such recurrent symptoms are significantly more frequent in those suffering from migraine than in the other two groups. Examination of subgroups of patients affected by particular forms of migraine (classical and common) and of epilepsy (generalized seizures, simple partial seizures, complex partial seizures) contributed little new to our understanding of the nature of periodic syndrome. It is concluded that the above symptoms of periodic syndrome should generally be considered as manifestations of a migrainous rather than of an epileptic disorder.

Abdomen↗