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Factors associated with poor control in partial complex epilepsy.

To evaluate the predictive factors of response to anticonvulsant therapy in children with complex partial epilepsy, we studied prospectively 74 children and adolescents suffering from this type of epilepsy. All children were prospectively followed for at least 2 years after the beginning of anticonvulsant therapy. At the end of follow-up, the children were subdivided into two groups according to the frequency of seizures: group A, children who were seizure free in the last year, and group B, children with at least six seizures in the previous year. Children with a poor response to anticonvulsant therapy had a more frequent personal history of neonatal seizures, an interval of less than 6 months between the first and the second seizures, and persistent abnormal electroencephalograms than the seizure-free patients and were often treated with polytherapy.

Age of Onset↗

[Regional cerebral blood flow in partial complex epilepsy with and without the presence of lesions].

Regional cerebral blood flow (r CBF) was measured by the I.V. 133 Xenon method and use of 27 detectors in 91 patients with complex partial epilepsy in interictal periods (at least 48 h over a complex partial seizure). Some were also examined less than 48 h before or after seizures. All were studied with ictal and interictal electroencephalography (EEG), polysomnography, computed tomography (CT), some had nuclear magnetic resonance scans (MR). The blood flow values were compared with a group of a 20 normal subjects matching for age. A significant decrease of r CBF ranged from 15% to 25% was found in the temporal region in three groups of epileptic patients: with repeated normal CT scans and lateralized EEG abnormalities (N = 46); with cortical atrophy in CT scan (N = 12); with neurosurgical focal lesions on CT and or MR scans glioma, arteriovenous malformation) (N = 10). r CBF was normal or decreased by less than 15% in the other regions of the brain. Patients with repeated normal CT scans and bilateral EEG abnormalities either asynchronous or alternatively observed in the right side or left side on waking EEG or during NREM sleep and REM sleep, did not show reduction in r CBF. In a previous study, r CBF distribution was also found normal during interictal phase in patients with primary generalized epilepsy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Results of temporal lobectomy for the treatment of partial complex epilepsy.

Epilepsy is the third most common cause of neurologic disability. The disease carries a 15 prevalence and a 3.5% lifetime risk. Seventy percent of patients can achieve good seizure control with medication. The remaining 30%, some 360,000 people across the United States, have intractable epilepsy and would benefit from evaluation at an epilepsy specialty center where surgical intervention is an option. The following report reviews a series of 50 patients referred to the Arkansas Comprehensive Epilepsy Program for treatment of intractable complex partial epilepsy. In this series, we evaluate results of temporal lobectomy, commenting upon factors in the patients' histories which may influence their outcomes.

Adolescent↗

[Grouped crises and status epilepticus in complex partial epilepsy].

INTRODUCTION: In complex partial crises (CPC) some characteristics of the way in which they occur may be helpful in localizing the focus of origin in the cerebral cortex. Thus, the appearance of any kind of status epilepticus will not predominate depending on the origin of the epileptic focus, but the complex partial state will be rare when the origin is temporal and more frequent when the origin is frontal. The appearance of CPC in a cluster form is, on the other hand, characteristic of crises originating in the frontal lobe. MATERIAL AND METHODS: We review the clinical history of 151 epileptics with CPC, evaluating the way in which the crises appear, together with other clinical data. We define the start of the crisis in a specific lobe, when this was the site of maximum voltage of the epileptic anomaly or of maximum phase opposition. RESULTS: 10% of the patients showed grouping of their CPC; in the remainder the appearance was isolated, 15% showed status epilepticus at some point in their illness. We found a statistical difference when relating this to the anomalous topography of the EEG; between 15% and 42% more patients with status epilepticus were counted when the topography of the anomaly in the EEG was extratemporal. There was also between 37.2% and 76.4% more patients with cluster crises in the cases with an extratemporal focus.

Adolescent↗

Intelligence functions disorders in patients with complex partial epilepsy.

OBJECTIVES: To compare the performance of patients with complex partial epilepsy with the normal controls in the subtests of an instrument used to assess intelligence function. METHOD: Fifty epileptic patients, whose ages ranged from 19 to 49 years and 20 normal controls without any neuropsychiatric disorders. The Wechsler-Bellevue adult intelligence test was applied in groups, epileptic patients and control subjects. This test is composed of several subtests that assess specific cognitive functions. A statistical analysis was performed using non-parametric tests. RESULTS: All the Wechsler-Bellevue subtests revealed that the intelligence functions of the patients were significantly inferior to that of the controls (p<0.05). This performance was supported by the patient's complaints in relation to their cognitive performance. CONCLUSION: Patients with complex partial epilepsy presented poorer results in the intelligence test when compared with individuals without neuropsychiatric disorders.

Adult↗

Sphenoidal electrodes: their use and value in the electroencephalographic investigation of complex partial epilepsy.

The diagnostic value of sphenoidal electrode EEG recordings in patients with seizures characteristic for epilepsy with complex partial symptomatology was assessed in a study comprising 404 patients; 71.3% of the patients had seizures with automatisms and amnesia, and 28.7% had psychic seizures with subjective phenomena such as hallucinations and illusions. A total of 59.6% of the patients had diagnostic EEG changes in routine waking or sleep EEG. In sphenoidal EEG recording including thiopenthone activation, diagnostic changes were found in 40.5% of the patients without specific changes in waking or sleep EEG, the chance of a positive finding being more than five times higher in patients with automatisms than patients with psychic seizures. Apart from cases where surgical treatment of temporal lobe epilepsy is considered, sphenoidal electrode EEG recording, including intravenous thiopenthone activation, should be performed in patients with seizure phenomena raising suspicion of epilepsy with complex partial symptomatology but where waking and sleep EEGs fail to demonstrate specific abnormalities.

Electrodes↗

Kindling: an animal model of complex partial epilepsy.

Kindling is an animal model of complex partial epilepsy induced by focal electrical stimulation of the brain. This paper describes the phenomenon and underscores the limited nature of current insights into its basic mechanisms. Anatomical delineation of the underlying neural network is a necessary first step for elucidating the basic cellular and molecular mechanisms. Recent evidence suggests that the substantia nigra may be a crucial component of the network underlying limbic kindled seizures and possibly kindling itself.

Amygdala↗

Barbiturate effects on EEG abnormality in complex partial epilepsy.

Sixteen patients with drug-resistant complex partial epilepsy were, during preoperative investigations for surgical treatment, subjected to intravenous methohexital and amobarbital EEG activation tests. The interictal epileptic spike discharges were visually counted on the seizure-generating side and compared with those found in the contralateral hemisphere. The invasive recordings were made with depth electrodes implanted in the mesial temporal lobes of 5 patients, and with subdural strip electrodes in varying lateral positions over the frontotemporal-parietal lobes of the other 11 patients. The doses of 10% amobarbital, 50-200 mg, were too low to induce any significant activation. In eight patients with unilateral epileptic lesions, 10, 25 and 50 mg 1% methohexital, induced a dose-dependent increase in the interictal spiking, always higher on the side of the seizure-gererating focus. Asymmetric induction of beta activity was noted in five patients. The test gave valuable information when determining the type or location of the epileptic abnormality. Parallels were drawn with earlier studies on spike-activation tests after intracarotid amobarbital injections. Although administered differently, the barbiturates are supposed to act directly on the neurons, and not via integrative wakening mechanisms.

Adult↗

Spike voltage topography and equivalent dipole localization in complex partial epilepsy.

The EEG of 45 patients with complex partial epilepsy was recorded from standard and supplementary inferior temporal electrode sites for 2 or more days via cable telemetry onto video (VHS) tape (22-25 channels, common reference). Epochs with "temporal spikes" were read into a topographic EEG device where individual spikes were visually identified and averaged in sums of 8-32. Analysis of spike voltage topography revealed two distinct patterns - dipolar, Type 1 and non-dipolar, Type 2. One or the other spike type predominated in all but two patients. Application of source modeling techniques (3 shells, single dipole, 6 parameters) to the spike topography data revealed that both spike types had similar equivalent dipoles in terms of location and orientation, except for vector elevation. However, calculated dipoles for Type 1 spikes were more stable over the course of the spike peak. Correlations with clinical data and intracranial EEG suggest that Type 1 spikes originate in mesial temporal structures, while Type 2 spikes arise from temporal or frontal neocortex. Spike voltage topography and equivalent dipole localization appear to be useful in the presurgical evaluation of patients with focal epilepsy.

Action Potentials↗

High-resolution (2.6-mm) PET in partial complex epilepsy associated with mesial temporal sclerosis.

Eleven patients with medically refractory partial seizures underwent positron emission tomography (PET) with a 600-crystal tomograph and fluorine-18 fluorodeoxyglucose. All patients had been selected for temporal lobe resection, and the side of the epileptogenic focus had been demonstrated with electroencephalography (EEG). Only patients in whom structural lesions had been excluded with magnetic resonance (MR) imaging were studied. Ten of 11 patients were found to have temporal cortical hypometabolism on the same side as the focal abnormality that was demonstrated with EEG. In two patients, PET showed hypometabolism in the mesial temporal cortex only. There were no incorrectly lateralizing PET results. MR imaging showed an abnormality in the corresponding temporal lobe in seven patients. In one patient, both PET and MR images were normal. All patients underwent anterior temporal resection, and histologic examination of resected tissue showed mesial temporal sclerosis in all cases.

Adult↗

Efficacy of the Continuous Visual Memory Test in lateralizing temporal lobe dysfunction in chronic complex-partial epilepsy.

The Continuous Visual Memory Test (CVMT) was hypothesized to measure nondominant temporal lobe dysfunction in patients with refractory complex-partial epilepsy. Thirty-seven temporal lobectomy candidates, of whom 20 had a right temporal seizure focus (RT) and 17 had a left temporal seizure focus (LT), were selected for study. Contrary to the hypothesis, initial results indicated that the LT group performed below the RT group for both the CVMT Total score and the Delayed Recognition score; however, group differences disappeared after accounting for Full Scale IQ scores. Both CVMT scores correlated positively and significantly with Full Scale IQ, Block Design, and the Meier Visual Discrimination Test, suggesting that overall cognitive functioning and visual-perceptual processing are positively related to CVMT performance. These results are consistent with other recent findings which suggest that extant nonverbal memory tests may be inadequate in lateralizing nondominant hemisphere lesions in complex-partial epilepsy.

Adolescent↗

[MR-scanning in complex partial epilepsy].

In a prospective investigation concerning 50 consecutive patients suffering from complex partial epilepsy who all had a normal CT investigation pathological findings were recognized in 80% using MRI. The MRI examination included volume estimation of the hippocampus. The volume estimations were compared to a reference material. In 24% a focal pathology was recognized, that was suspected of being responsible for the epileptic condition. Only 20% of the examinations were evaluated as normal. Hippocampal atrophy was recognized in 50%. In the latter group a diagnosis of hippocampal sclerosis was established in 16%. It is concluded that MRI is the investigation of choice in complex partial epilepsy and that volume estimation of the hippocampus is important.

Epilepsies, Partial↗

[A case with mild subdural hematoma presenting with a transient cluster of convulsions--problems concerning differentiation from benign infantile convulsion and benign complex partial epilepsies in infancy].

A 1-month-old girl showed frequent partial seizures of sudden onset. Continuous spikes were observed in left central area during the ictal period, although interictal EEG showed neither epileptiform discharges nor focal signs. Optimal seizures control was obtained with intravenous administration of diazepam and subsequent oral administration of phenobarbital. She showed neither abnormal physical and neurological signs after seizures nor sequelae. CT examination on two days after the onset of seizures showed no obvious abnormal high density area. However, MRI examination on 10 days after the onset showed subdural hematoma in the left front-temporal area and right occipital area. Except for MRI findings, this case may be diagnosed as benign infantile convulsion or benign complex partial epilepsies in infancy. This case suggested that serial neuroradiological examinations were recommended for prospective studies about benign infantile convulsion and benign complex partial epilepsies in infancy.

Acute Disease↗

Effect of commissurotomy on complex partial epilepsy in patients without a resectable seizure focus.

Twenty-five patients in a series of 51 undergoing partial or complete section of the corpus callosum for the treatment of intractable epilepsy experienced complex partial seizures among their seizure types preoperatively. Ten of these 25 patients have experienced no further complex partial seizures. Reduction in severity of seizures has been found in 11 of the 15 patients still experiencing this seizure type, and 3 have had greater than 80% frequency reduction. These findings are consistent with the electrophysiologic observations of Lieb on the relative unimportance of the hippocampal commissure in man and the behavioral observations of Quesney on unilateral versus bilateral temporal lobe seizure activity.

Corpus Callosum↗

[Multiple sclerosis as a cause of partial complex epilepsy].

INTRODUCTION: Although the epileptic seizures (ES) have been described on patients with multiple sclerosis (MS), the causal relationship is not clear. Seizure's prevalence in this illness is low and their apparition concerning the MS course is variable, but more common after MS diagnosis. The predominant crises are generalized or partial with secondary generalization; the partial complex seizures have rarely referred. CLINICAL CASES AND CONCLUSIONS: We presented two patients with ES in the MS course. In the first case is arrived to MS diagnosis upon appearing the crisis, having presented two previous cerebral lesions in another level. In both cases demyelinating lesion was located in the temporal lobe, agreeing with EEG anomaly and seizures type.

Adult↗