Epilepsia via MedWorm.com

Pregnancy registries: Differences, similarities, and possible harmonizationReport of a working group of the Commission on Therapeutic Strategies of the International League Against Epilepsy

Epilepsia — Sat, 27 Feb 2010 00:00:00 +0100

This report summarizes these discussions. (Source: Epilepsia)

Electrical source imaging for presurgical focus localization in epilepsy patients with normal MRI

Epilepsia — Fri, 26 Feb 2010 00:00:00 +0100

Discussion: The results highlight the diagnostic value of ESI and encourage broadening its application to patients with MRN-E. If the surface EEG contains fairly localized spikes, ESI contributes to the presurgical decision process. (Source: Epilepsia)

Revised terminology and concepts for organization of seizures and epilepsies: Report of the ILAE Commission on Classification and Terminology, 2005–2009

Epilepsia — Fri, 26 Feb 2010 00:00:00 +0100

The International League Against Epilepsy (ILAE) Commission on Classification and Terminology has revised concepts, terminology, and approaches for classifying seizures and forms of epilepsy. Generalized and focal are redefined for seizures as occurring in and rapidly engaging bilaterally distributed networks (generalized) and within networks limited to one hemisphere and either discretely localized or more widely distributed (focal). Classification of generalized seizures is simplified. No natural classification for focal seizures exists; focal seizures should be described according to their manifestations (e.g., dyscognitive, focal motor). The concepts of generalized and focal do not apply to electroclinical syndromes. Genetic, structural[ndash]metabolic, and unknown represent modified c...

Δ9-Tetrahydrocannabivarin suppresses in vitro epileptiform and in vivo seizure activity in adult rats

Epilepsia — Fri, 26 Feb 2010 00:00:00 +0100

Discussion: These data demonstrate that [Delta]9-THCV exerts antiepileptiform and anticonvulsant properties, actions that are consistent with a CB1 receptor[ndash]mediated mechanism and suggest possible therapeutic application in the treatment of pathophysiologic hyperexcitability states. (Source: Epilepsia)

Extrafocal threshold reductions in amygdala-kindled rats

Epilepsia — Fri, 26 Feb 2010 00:00:00 +0100

Discussion: These data suggest that threshold reduction occurs outside the primary kindling site in rats as well as in cats. Extrafocal changes in afterdischarge threshold may be functionally important, and might possibly relate to extrafocal neurochemical changes and progressive generalization of seizure discharge from discrete focal sites. (Source: Epilepsia)

Epileptic phenotypes in children with respiratory chain disorders

Epilepsia — Sun, 21 Feb 2010 00:00:00 +0100

Discussion: In RCD, epilepsy is not only difficult to control but its occurrence often indicates a severe turn in the course of the disease. For one-third of the patients, classical biochemical measures failed to reveal any abnormality and RCD could be detected in the liver only. (Source: Epilepsia)

Surgery for temporal lobe epilepsy associated with mesial temporal sclerosis in the older patient: A long-term follow-up

Epilepsia — Fri, 19 Feb 2010 00:00:00 +0100

Discussion: Patients 50 years or older with intractable seizures from hippocampal sclerosis have seizure outcomes following temporal lobectomy that are comparable to young patients over the long term. Older patients should not be denied treatment on the basis of age. (Source: Epilepsia)

High-dose intravenous levetiracetam for acute seizure exacerbation in children with intractable epilepsy

Epilepsia — Sun, 14 Feb 2010 00:00:00 +0100

We review our experience with high-dose intravenous levetiracetam (IV-LEV) for acute seizure exacerbations in nine children with medically intractable epilepsy. All children had acute repetitive seizures[mdash]while on chronic antiepileptic drugs[mdash]that either led to hospitalization (eight) or occurred during hospitalization (one), and received doses of IV-LEV of 150 mg/kg/day or greater, with a mean dose of 228 ± 48 mg/kg/day. Eight of nine children had resolution of the acute repetitive seizures. Seizure frequency was reduced to less than baseline in seven children (seizure-free in two, [ge]80% reduction in four, and 50% reduction in one). Except for one child with increased seizures, IV-LEV was well tolerated in all children without complications. (Source: Epilepsia)

Posterior glucose hypometabolism in Lafora disease: Early and late FDG-PET assessment

Epilepsia — Fri, 12 Feb 2010 00:00:00 +0100

We describe two cases of LD presenting as myoclonus and tonic[ndash]clonic seizures, initially suggesting idiopathic generalized epilepsy. The subsequent course of the disease was characterized by drug-resistant myoclonic epilepsy, cognitive decline, and visual symptoms, which oriented the diagnosis toward progressive myoclonic epilepsy and, more specifically, LD. Early in the evolution in the first case, and before histopathologic and genetic confirmation of LD in both cases, [18]Fluorodeoxyglucose positron emission tomography (FDG-PET) revealed posterior hypometabolism, consistent with the well-known posterior impairment in this disease. This suggests that FDG-PET could help to differentiate LD in early stages from other progressive myoclonic epilepsies, but confirmation is required by a...

Insulin-like growth factor-1 is associated with cognitive outcome in infantile spasms

Epilepsia — Fri, 12 Feb 2010 00:00:00 +0100

Discussion: In children with IS, insults or stress in early life may affect the synthesis of IGF-1, which might play a role in the reduction of certain cognitive functions. (Source: Epilepsia)

Etomidate accurately localizes the epileptic area in patients with temporal lobe epilepsy

Epilepsia — Fri, 12 Feb 2010 00:00:00 +0100

Discussion: Etomidate activation is a safe, specific, and quick test that can be used to identify the epileptic region in patients evaluated as candidates for temporal lobe epilepsy surgery. (Source: Epilepsia)

Long-term employment of adults with childhood-onset epilepsy: A prospective population-based study

Epilepsia — Fri, 12 Feb 2010 00:00:00 +0100

Conclusions: Normal intelligence, onset of epilepsy at age older than 6, and good vocational education appear to predict employment in early adulthood. Normal intelligence, having offspring, uninterrupted remission, and no history of status epilepticus appear to predict lasting employment into middle age. (Source: Epilepsia)

Extrahippocampal gray matter loss and hippocampal deafferentation in patients with temporal lobe epilepsy

Epilepsia — Fri, 12 Feb 2010 00:00:00 +0100

This study aimed to investigate the relationship between hippocampal deafferentation and brain atrophy in MTLE.Methods: Three different MRI studies were performed involving 23 patients with unilateral MTLE (8 left and 15 right) and 34 healthy controls: (1) voxel-based morphometry (VBM), (2) diffusion tensor imaging (DTI) and (3) probabilistic tractography (PT). VBM was employed to define differences in regional gray matter volume (GMV) between controls and patients. Voxel-wise analyses of DTI evaluated differences in fractional anisotropy (FA), mean diffusivity (MD) and hippocampal PT. Z-scores were computed for regions-of-interest (ROI) GMV and peri-hippocampal FA and MD (to quantify hippocampal fiber integrity). The relationship between hippocampal deafferentation and regional GMV was in...

Genetic risk perception and reproductive decision making among people with epilepsy

Epilepsia — Fri, 12 Feb 2010 00:00:00 +0100

We investigated estimated offspring risk among people with epilepsy and factors important in the family-planning process. Data were collected for 88 participants using a questionnaire assessing perceived risk of offspring to develop epilepsy, importance of factors in the reproductive decision-making process, decision to have fewer children, and association between risk perception and family planning decisions. Thirty-four percent of participants had fewer children because of their epilepsy. Concerns about the ability to care for a child (p < 0.0001) and passing epilepsy onto a child (p = 0.003) were associated with the decision to have fewer children. The mean estimated risk of offspring to develop epilepsy was 26%, a 4-fold increase over estimated population risks. Genetic counseling may ...

Adverse effects of valproate on bone: Defining a model to investigate the pathophysiology

Epilepsia — Fri, 12 Feb 2010 00:00:00 +0100

Conclusion: Mouse strains sensitive and resistant to the adverse bone effects of chronic valproate treatment were identified. The strain-specific effects suggest a role of genetic factors in the pathogenesis of AED-induced bone disease. This novel model provides a new, powerful tool to investigate the pathophysiology and therapy of AED-associated bone disease. (Source: Epilepsia)

The prevalence of seizures in comatose children in the pediatric intensive care unit: A prospective video-EEG study

Epilepsia — Fri, 12 Feb 2010 00:00:00 +0100

Discussion: The lower prevalence of epileptic seizures and the shorter length of ICU stay in children compared to adults and neonates suggest a different spectrum of disease and neurologic response. Short-duration v-EEG in patients with a history of prior seizures, epilepsy, or clinical events suspected to be seizures seems more appropriate than routine v-EEG in all comatose children in the pediatric ICU. (Source: Epilepsia)

Respiratory changes with seizures in localization-related epilepsy: Analysis of periictal hypercapnia and airflow patterns

Epilepsia — Fri, 12 Feb 2010 00:00:00 +0100

Conclusions: Severe and prolonged increases in ETCO2 occur with seizures. Postictally, respiratory effort is not impaired. Ictally triggered ventilation[ndash]perfusion inequality from pulmonary shunting or transient neurogenic pulmonary edema may account for these findings. (Source: Epilepsia)

A ketogenic diet does not impair rat behavior or long-term potentiation

Epilepsia — Fri, 05 Feb 2010 00:00:00 +0100

The effect of the ketogenic diet on behavior and cognition is unclear. We addressed this issue in rats behaviorally and electrophysiologically. We fed postnatal day 21 rats a standard diet (SD), ketogenic diet (KD), or calorie-restricted diet (CR) for 2[ndash]3 weeks. CR controlled for the slower weight gain experienced by KD-fed rats. We assessed behavioral performance with a locomotor activity and a conditioned fear test. To evaluate possible parallel effects of diet on synaptic function, we examined paired-pulse modulation (PPM) and long-term potentiation (LTP) in the medial perforant path in vivo. KD-fed rats performed similarly to SD-fed rats on the behavioral tests and electrophysiologic assays. These data suggest that the KD does not alter behavioral performance or synaptic plastici...

100 years of Epilepsia: Landmark papers and their influence in neuropsychology and neuropsychiatry

Epilepsia — Wed, 03 Feb 2010 00:00:00 +0100

As part of the 2009 International League Against Epilepsy (ILAE) Centenary Celebration, a special symposium was dedicated to Epilepsia (100 Years of Epilepsia: Landmark Papers and Their Influence). The Associate Editors were asked to identify a particularly salient and meaningful paper in their areas of expertise. From the content areas of neuropsychology and neuropsychiatry two very interesting papers were identified using quite different ascertainment techniques. One paper addressed the problem of psychosis in temporal lobe epilepsy, whereas the other represents the first paper to appear in Epilepsia presenting quantitative assessment of cognitive status in epilepsy. These two papers are reviewed in detail and placed in historical context. (Source: Epilepsia)

Safety profile of oxcarbazepine: Results from a prescription-event monitoring study

Epilepsia — Wed, 03 Feb 2010 00:00:00 +0100

Discussion: There were no serious adverse drug reactions reported during this study. Results of the study should be taken in context with other epidemiologic studies. (Source: Epilepsia)

Impaired maturation of cortical GABAA receptor expression in pediatric epilepsy

Epilepsia — Wed, 03 Feb 2010 00:00:00 +0100

Discussion: Maturation of cortical GABAA receptor subunit expression continues over the first several years of postnatal human development. Intractable focal epilepsy in children is associated with disruption of this normal developmental pattern. These findings have significant implications for the treatment of children with medications that modulate GABAA receptor function. (Source: Epilepsia)

Altered white matter integrity in temporal lobe epilepsy: Association with cognitive and clinical profiles

Epilepsia — Wed, 03 Feb 2010 00:00:00 +0100

Conclusion: TLE is associated with widespread disturbances in white matter tracts and these changes have important cognitive and clinical consequences. (Source: Epilepsia)

Impaired gist memory in patients with temporal lobe epilepsy and hippocampal sclerosis

Epilepsia — Wed, 03 Feb 2010 00:00:00 +0100

Discussion: HS has a dose effect and a probable right dominance effect on gist memory; good item memory supports gist memory performance; and a disproportionate deficit was noted in tasks with high relational demand but not in tasks with simple association. We should develop memory skills for patients with TLE by enhancing performance of gist memory related to simple association task. (Source: Epilepsia)

WAG/Rij rats show a reduced expression of CB1 receptors in thalamic nuclei and respond to the CB1 receptor agonist, R(+)WIN55,212-2, with a reduced incidence of spike-wave discharges

Epilepsia — Wed, 03 Feb 2010 00:00:00 +0100

Discussion: These data indicate that the development of absence seizures is associated with plastic modifications of CB1 receptors within the thalamic-cortical-thalamic network, and raise the interesting possibility that CB1 receptors are targeted by novel antiabsence drugs. (Source: Epilepsia)

Sociocultural and psychological features of perceived stigma reported by people with epilepsy in Benin

Epilepsia — Wed, 03 Feb 2010 00:00:00 +0100

Discussion: Perceived stigma is an important issue in epilepsy in Benin. Social factors seem to be more influential than sociocultural representation of epilepsy. Insofar as research is needed in other African countries to determine the nature and relevant features of stigma to improve treatment and control. (Source: Epilepsia)

Characteristics of a large population of patients with refractory epilepsy attending tertiary referral centers in Italy

Epilepsia — Wed, 03 Feb 2010 00:00:00 +0100

The characteristics of 1,124 consecutive adults and children with refractory epilepsy attending 11 tertiary referral centers in Italy were investigated at enrollment into a prospective observational study. Among 933 adults (age 16[ndash]86 years), the most common syndromes were symptomatic (43.7%) and cryptogenic (39.0%) focal epilepsies, followed by idiopathic (8.1%) and cryptogenic/symptomatic generalized (6.2%) epilepsies. The most common syndrome among 191 children was symptomatic focal epilepsy (35.1%), followed by cryptogenic focal (18.8%), cryptogenic/symptomatic generalized (18.3%), undetermined whether focal or generalized (16.8%), and idiopathic generalized (7.3%). Primarily and secondarily generalized tonic[ndash]clonic seizures were reported in 27.8% of adults and 16.8% of chil...

Ictal hypoventilation contributes to cardiac arrhythmia and SUDEP: Report on two deaths in video-EEG–monitored patients

Epilepsia — Wed, 03 Feb 2010 00:00:00 +0100

We report two cases of SUDEP in patients with intractable temporal lobe epilepsy undergoing video-EEG (electroencephalography) telemetry at two centers. Both had secondarily generalized convulsions. EEG, electrocardiography (ECG), and respiratory changes in these two patients are reported herein. Ictal/postictal hypoventilation may contribute to SUDEP with the resulting hypoxemia and acidosis leading to failure of recovery of cortical function and eventual cardiac failure. (Source: Epilepsia)

Can BIS monitoring be used to assess the depth of propofol anesthesia in the treatment of refractory status epilepticus?

Epilepsia — Wed, 03 Feb 2010 00:00:00 +0100

Discussion: The cEEG can be considered as the primary monitoring technique in the assessment of the depth of anesthesia in the treatment of RSE. If cEEG is not available, the BIS monitor can be used to guide the level of anesthesia, targeting BS in patients with RSE. (Source: Epilepsia)

Interictal cerebral blood flow abnormality in cryptogenic West syndrome

Epilepsia — Wed, 03 Feb 2010 00:00:00 +0100

Discussion: Broad cerebral hypoperfusion with posterior predominance involving the hippocampus and lenticular nucleus implies that even cryptogenic West syndrome has a widespread cerebral dysfunction at least transiently, which would correspond to clinical manifestations of hypsarrhythmia and epileptic spasms. Hippocampal hypoperfusion suggests the dysfunction of hippocampal circuitry in the brain adrenal axis, and may contribute to subsequent cognitive impairment of cryptogenic West syndrome. (Source: Epilepsia)

Impact of severe epilepsy on development: Recovery potential after successful early epilepsy surgery

Epilepsia — Mon, 01 Feb 2010 00:00:00 +0100

Discussion: Cessation of epileptic activity after early surgery can be followed by substantial cognitive gains, but not in all children. In the short term, lack of catch-up may be explained by loss of retained function in the removed epileptogenic area; in the longer term, by decreased intellectual potential of genetic origin, irreversible epileptic damage to neural networks supporting cognitive functions, or reorganization plasticity after early focal lesions. Cognitive recovery has to be considered as a "bonus," which can be predicted in some specific circumstances. (Source: Epilepsia)

Long-term outcomes of children treated with the ketogenic diet in the past

Epilepsia — Mon, 01 Feb 2010 00:00:00 +0100

Discussion: This is the first study to report on the long-term effects of the ketogenic diet after discontinuation. The majority of subjects are currently doing well with regard to health and seizure control. (Source: Epilepsia)

Lacosamide as adjunctive therapy for partial-onset seizures: A randomized controlled trial

Epilepsia — Thu, 28 Jan 2010 00:00:00 +0100

Discussion: Adjunctive treatment with lacosamide 400 and 600 mg/day reduced seizure frequency for patients with uncontrolled partial-onset seizures. Lacosamide 400 mg/day provided a good balance of efficacy and tolerability; lacosamide 600 mg/day may provide additional benefit for some patients as suggested by secondary efficacy analyses, including response in patients with secondarily generalized tonic[ndash]clonic seizures. (Source: Epilepsia)

Genetic testing in the epilepsies—Report of the ILAE Genetics Commission

Epilepsia — Thu, 21 Jan 2010 00:00:00 +0100

In this report, the International League Against Epilepsy (ILAE) Genetics Commission discusses essential issues to be considered with regard to clinical genetic testing in the epilepsies. Genetic research on the epilepsies has led to the identification of more than 20 genes with a major effect on susceptibility to idiopathic epilepsies. The most important potential clinical application of these discoveries is genetic testing: the use of genetic information, either to clarify the diagnosis in people already known or suspected to have epilepsy (diagnostic testing), or to predict onset of epilepsy in people at risk because of a family history (predictive testing). Although genetic testing has many potential benefits, it also has potential harms, and assessment of these potential benefits and ...

Pattern of P450 expression at the human blood–brain barrier: Roles of epileptic condition and laminar flow

Epilepsia — Fri, 15 Jan 2010 00:00:00 +0100

Discussion: These results support the hypothesis of local drug metabolism at the diseased BBB. The direct association between BBB CYP enzymes and the drug-resistant phenotype needs to be further investigated. (Source: Epilepsia)

The Epilepsy Genetic Association Database (epiGAD): Analysis of 165 genetic association studies, 1996–2008

Epilepsia — Wed, 13 Jan 2010 00:00:00 +0100

We have created the Epilepsy Genetic Association Database (epiGAD, http://www.epigad.org, an online database of epilepsy genetic association studies. A systematic search using several search engines identified 165 studies. Herein we analyze the types of studies available, the sample sizes used, and the strength of the findings. Common questions examined were susceptibility to idiopathic generalized epilepsy, focal epilepsy, or febrile seizures, and pharmacogenomic approaches to drug-resistant epilepsy. Sample sizes were generally small; 80% of studies had 200 or fewer cases, although more recent studies published from 2005[ndash]2008 incorporated slightly larger sample sizes. No association was judged as "strong" using current criteria for assessing genetic associations[mdash]this is proba...

New open-source ictal SPECT analysis method implemented in BioImage Suite

Epilepsia — Wed, 13 Jan 2010 00:00:00 +0100

Ictal single photon emission computed tomography (SPECT) is a powerful tool for noninvasive seizure localization, but it has been underutilized because of practical challenges, including difficulty in implementing ictal-interictal SPECT difference analysis. We previously validated a freely available utility for this purpose, ictal-interictal subtraction analysis by statistical parametric mapping (SPM) (ISAS). To further simplify and improve the difference imaging technique, we now compare a new algorithm, ISAS BioImage Suite (see http://spect.yale.edu and http://bioimagesuite.org), to the original ISAS method in 13 patients with known seizure localization. We found that ISAS BioImage Suite was in agreement with the original algorithm in all cases for which ISAS correctly identified a singl...

Alcohol consumption, unprovoked seizures, and epilepsy: A systematic review and meta-analysis

Epilepsia — Wed, 13 Jan 2010 00:00:00 +0100

Discussion: The relationship between alcohol consumption and epilepsy and unprovoked seizures was quantified and several pathogenic mechanisms were suggested, although none of them has been proven to be the unique causative pathway for epilepsy. Certain limitations underlying this study require further research to clarify the outstanding statistical issues and pathogenesis of epilepsy in heavy drinkers. (Source: Epilepsia)

Visual field deficits following anterior temporal lobectomy: Long-term follow-up and prognostic implications

Epilepsia — Wed, 13 Jan 2010 00:00:00 +0100

Purpose: The aim of this study was to assess the incidence of mild ([le]90°) versus severe (>90° from vertical) visual field defects (VFDs) in patients after anterior temporal lobectomy (ATL), and their postoperative improvement over time.Methods: The angles of postoperative VFDs of 75 patients who underwent ATL were recorded at various time points (1, 2, 6, 12, 18, 24, and 36+ months).Results: Of all 23 patients who came in for their (Source: Epilepsia)

Joining the benefits: Combining epileptic seizure prediction methods

Epilepsia — Fri, 08 Jan 2010 00:00:00 +0100

This study shows that combinations of prediction methods are promising new approaches to enhance seizure prediction performance considerably. It allows merging the individual benefits of prediction methods in a complementary manner. Because either sensitivity or specificity of seizure prediction methods can be improved depending on the needs of the desired clinical application, the combination opens a new window for future use in a clinical setting. (Source: Epilepsia)

A new experimental model of focal seizures in the entorhinal cortex

Epilepsia — Thu, 07 Jan 2010 00:00:00 +0100

Conclusions: By offering the unique opportunity to repetitively evoke an ID from the same restricted site, this model represents a powerful approach to study the cellular and molecular events at the basis of initiation, propagation, and cessation of focal seizures. (Source: Epilepsia)

Health status and health-related behaviors in epilepsy compared to other chronic conditions—A national population-based study.

Epilepsia — Thu, 07 Jan 2010 00:00:00 +0100

Discussion: Our study demonstrated that those with epilepsy have a poorer pattern of HRBs and poorer health status compared to the general population. Screening for and managing comorbidities, and promoting exemplary HRBs, should improve overall health and quality-of-life in those with epilepsy. (Source: Epilepsia)

Spontaneous recurrent seizures after status epilepticus induced by soman in Sprague-Dawley rats

Epilepsia — Thu, 07 Jan 2010 00:00:00 +0100

Discussion: The presence of SRS after seizures induced by soman highlights the importance of quantifying SRS in studies where the objective is to find new therapeutics against soman-induced seizures. (Source: Epilepsia)

Autonomic alterations and cardiac changes in epilepsy

Epilepsia — Thu, 07 Jan 2010 00:00:00 +0100

Studies with heart rate variability have revealed interictal autonomic alterations in patients with epilepsy. In addition, epilepsy is frequently associated with ictal tachycardia or bradycardia, which sometimes precedes the onset of seizures. Ictal tachycardia is sometimes associated with electrocardiography (ECG) morphologic changes and ictal bradycardia often progresses to asystole. Such cardiac manifestations of seizures have been hypothesized as possible causes for sudden unexplained death in epilepsy (SUPEP). The present review relates to interictal and ictal cardiac manifestations of epilepsy with focus on heart rate, heart rate variability, and ECG changes. Aspects of the supporting mechanisms are discussed and attention is drawn to the interaction between central and peripheral ef...

Aggravation of seizure-associated microvascular injuries by ibuprofen may involve multiple pathways

Epilepsia — Thu, 07 Jan 2010 00:00:00 +0100

Conclusions: Experiments suggest that in our model, inhibition of COX pathway early after GCS may increase rather than reduce the inflammatory consequences of GCS, suggesting that COX products may have a negative feedback effect on the development of edema by modifying the expression of "proinflammatory" cytokines. There is also a possibility that ibuprofen may exert its action through other than COX-associated pathways. (Source: Epilepsia)

Estimation of the burden of active and life-time epilepsy: A meta-analytic approach

Epilepsia — Thu, 07 Jan 2010 00:00:00 +0100

Conclusions: This study estimates the global burden of epilepsy and the proportions with AE, which may benefit from treatment. There are systematic differences in reported prevalence estimates, which are only partially explained by study characteristics. (Source: Epilepsia)

Potentiation of the anticonvulsant efficacy of sodium channel inhibitors by an NK1-receptor antagonist in the rat

Epilepsia — Thu, 07 Jan 2010 00:00:00 +0100

Discussion: These results suggest that there may be benefit in adding treatment with a suitable NK1-receptor antagonist to treatment with a sodium channel blocker in patients with refractory epilepsy. (Source: Epilepsia)

Parental and physician beliefs regarding the provision and content of written sudden unexpected death in epilepsy (SUDEP) information

Epilepsia — Thu, 07 Jan 2010 00:00:00 +0100

Discussion: The majority of parents wanted to know about SUDEP and its associated risks. Whenever possible, SUDEP information should be given by the physician accompanied by an information leaflet. (Source: Epilepsia)

Visual and visuoperceptual function in children with Panayiotopoulos syndrome

Epilepsia — Thu, 07 Jan 2010 00:00:00 +0100

Discussion: Our results suggest that, although most of our patients had focal or diffuse EEG abnormalities involving the occipital regions, abnormalities of visual and visuoperceptual function were relatively uncommon. Age at onset of seizure (Source: Epilepsia)

Effect of sildenafil on the anticonvulsant action of classical and second-generation antiepileptic drugs in maximal electroshock-induced seizures in mice

Epilepsia — Thu, 07 Jan 2010 00:00:00 +0100

Conclusions: Sildenafil significantly raised the threshold for electroconvulsions in mice without any impairment of motor performance and long-term memory, but it enhanced muscle strength. Treatment of patients on CBZ or VPA with sildenafil may not be recommended due to pharmacokinetic interactions. Coadministration of sildenafil with other AEDs, especially with TPM, seems to be a reasonable choice. (Source: Epilepsia)

How common is ictal hypoxemia and bradycardia in children with partial complex and generalized convulsive seizures?

Epilepsia — Thu, 07 Jan 2010 00:00:00 +0100

Purpose: Autonomic effects of seizures, including cardiorespiratory abnormalities, may be involved in sudden unexpected death in epilepsy (SUDEP). The purpose of this study was to determine the prevalence and risk factors for ictal hypoxemia (oxygen saturation (Source: Epilepsia)

Disparities in hospital outcomes for injured people with epilepsy/seizures

Epilepsia — Thu, 07 Jan 2010 00:00:00 +0100

Discussion: Disparities in hospital outcomes for people with epilepsy deserve further attention. Identifying the underlying causes of these disparities will allow for the development of targeted prevention interventions. (Source: Epilepsia)

Transient improvement after brief antiepileptic drug withdrawal in the epilepsy monitoring unit—possible relationship to AED tolerance

Epilepsia — Thu, 07 Jan 2010 00:00:00 +0100

Discussion: SIP does occur after brief AED withdrawal. This effect is greater in patients on monotherapy and tends to be larger in patients with a history of AED tolerance. The SIP effect may be related to the phenomenon of tolerance, clinically seen as resistance to AED therapeutic effect. (Source: Epilepsia)

Interictal dysphoric disorder and periictal dysphoric symptoms in patients with epilepsy

Epilepsia — Wed, 06 Jan 2010 00:00:00 +0100

This study aimed at identifying clinical correlates of the IDD, with special attention to the relationship between symptoms and seizures.Methods: A sample of 142 consecutive adult outpatients with epilepsy were assessed using the Interictal Dysphoric Disorder Inventory (IDDI), a 38-item, self-report questionnaire specifically developed to evaluate presence and severity of IDD symptoms as well as their habitual association with seizures (coded as before, after, during, or when seizure-free) and their duration.Results: IDD was diagnosed in 31 subjects but symptoms showed a clear-cut relationship with epileptic seizures in 54.8% of cases, leading to an operative distinction between true IDD and periictal dysphoric symptoms (PDS). There was no significant difference among patients with IDD, PD...

Infantile spasms and pigmentary mosaicism

Epilepsia — Thu, 24 Dec 2009 00:00:00 +0100

We present a 3-year-old boy with pigmentary mosaicism and persistent intractable infantile spasms due to mosaicism of chromosome 7. Getting the diagnosis of pigmentary mosaicism in a child with infantile spasms may not be easy, as most diagnostic work-up is done in infancy, at a time when skin manifestations can be subtle. We stress the need for a meticulous search for an etiology in cases of infantile spasms. Diagnostic work-up should include a dermatologic evaluation with skin biopsies for fibroblast culture (and karyotyping) from abnormal pigmented skin areas. (Source: Epilepsia)

Intravenous lacosamide as short-term replacement for oral lacosamide in partial-onset seizures

Epilepsia — Tue, 22 Dec 2009 00:00:00 +0100

Discussion: This comprehensive evaluation supports the safety of an intravenous lacosamide infusion duration as short as 15 min for short-term (2[ndash]5 days) replacement for patients temporarily unable to take oral lacosamide. (Source: Epilepsia)

Prevalence of interictal psychiatric disorders in patients with refractory temporal and extratemporal lobe epilepsy in Spain. A comparative study

Epilepsia — Tue, 22 Dec 2009 00:00:00 +0100

We aim to investigate whether temporal origin of epilepsy increases the risk of developing a psychiatric disorder and more specifically a major depressive disorder. The lack of standardized diagnostic instruments and the methodologic differences between studies highlight the fact that this issue warrants further, systematic, study. Three-hundred eight patients with complex partial seizures were classified according to temporal or extratemporal origin, following the Commission on Classification and Terminology of the International League Against Epilepsy (ILAE), 1989 localization-related concept. All patients were assessed using the Structured Interview for DSM-IV axis I psychiatric disorders (SCID-I). Lifetime and previous-year prevalence of psychiatric disorders were compared in temporal ...

A long-term follow-up study of Dravet syndrome up to adulthood

Epilepsia — Tue, 22 Dec 2009 00:00:00 +0100

Purpose: We intended to elucidate the whole clinical course of Dravet syndrome (DS) comprehensively, from infancy through adulthood.Methods: Subjects were 31 patients with DS (14 with typical DS, and 17 with borderline DS) who were followed from childhood to at least 18 years of age. Their seizures, abilities, and electroencephalography (EEG) findings were investigated and statistically analyzed.Results: The clinical findings of the patients with typical DS and those with borderline DS became largely similar in adolescence and adulthood. Seizures were intractable in childhood in all patients, but suppressed in five (16.1%) during follow-up. Thirty-five (87.5%) of the 40 apparently generalized convulsive seizures that were captured by ictal EEG recording at 7 years of age or later were of f...

Successful antiepileptic drug withdrawal in infants with epilepsy and cytomegalovirus neuroinfection: Longitudinal study

Epilepsia — Tue, 22 Dec 2009 00:00:00 +0100

Conclusion: Early introduction of antiepileptic and antiviral GCV regimens in epilepsy and CMV neuroinfection may result in discontinuation of antiepileptic treatment and normal psychomotor development in infants. (Source: Epilepsia)

High-density SNP screen of sodium channel genes by haplotype tagging and DNA pooling for association with idiopathic generalized epilepsy

Epilepsia — Tue, 22 Dec 2009 00:00:00 +0100

We have investigated seven voltage-gated sodium channel genes for association with idiopathic generalized epilepsy (IGE). Probands and control DNA were grouped into pools and used to screen 85 single-nucleotide polymorphisms (SNPs), mostly HapMap SNPs tagging the common variation in these genes. Twelve SNPs exhibiting an allele frequency difference between pools were genotyped individually in our sample of 232 probands, 313 controls, and 95 parent[ndash]proband trios. Two SNPs, in SCN1A and SCN8A, were associated by allele and genotype at nominal level of significance, but were not significant after Bonferroni correction. Two SCN2A SNPs (rs3943809 and rs16850331) were associated by case[ndash]control with a subgroup with IGE and history of febrile seizures and also by transmission disequil...

The natural history of epilepsy in tuberous sclerosis complex

Epilepsia — Tue, 22 Dec 2009 00:00:00 +0100

Background: Although epilepsy affects most patients with tuberous sclerosis complex (TSC), little is known about the natural history of epilepsy in this genetic disease.Methods: A retrospective chart review of all patients with TSC seen between January 2002 and October 2008. Charts were reviewed for a history of infantile spasms (IS), seizure other than IS, refractory epilepsy, Lennox-Gastaut syndrome (LGS), anticonvulsant medication use, ages of seizure onset, last seizure, last clinic visit, clinical seizure phenotype(s), cognitive impairment, and genetic mutation.Results: Two hundred ninety-one patients were included. Among these patients, 37.8% had a history of IS; 85.2% had a history of seizure; 54.1% developed multiple seizure types, not including IS; 63.2% had seizure onset in the f...

Selection of two lines of mice based on latency to onset of methionine sulfoximine seizures

Epilepsia — Wed, 09 Dec 2009 00:00:00 +0100

Discussion: The model that we have developed for MSO "sensitive" and "resistant" mice could allow for a better understanding of MSO mechanisms of epileptogenesis, and it may also constitute a useful approach for therapeutic actions of drugs. (Source: Epilepsia)

Hippocampal malrotation in pediatric patients with epilepsy associated with complex prefrontal dysfunction

Epilepsia — Mon, 07 Dec 2009 00:00:00 +0100

Discussion: Because the prefrontal cortical regions have been shown to be active during dual-task performance, the MRI results converge with the neuropsychological findings of impairment on these tasks. We conclude that HIMAL had no direct memory repercussions, but was secondary to subtle but widespread neurologic abnormalities that also affected morphology and functioning of the prefrontal cortex. (Source: Epilepsia)

Spatiotemporal patterns of electrocorticographic very fast oscillations (>80 Hz) consistent with a network model based on electrical coupling between principal neurons

Epilepsia — Mon, 07 Dec 2009 00:00:00 +0100

Discussion: These data provide further evidence, albeit indirect, that preseizure VFOs are generated by networks of pyramidal neurons coupled by gap junctions, each predominantly confined to pairs of neurons having somata separated by < [sim]1[ndash]2 mm. Plausible antiepileptic targets are tissue mechanisms, such as pH regulation, that influence gap-junction conductance. (Source: Epilepsia)

Cortical stimulation for language mapping in focal epilepsy: Correlations with tractography of the arcuate fasciculus

Epilepsia — Mon, 07 Dec 2009 00:00:00 +0100

Purpose: Diffusion tensor imaging (DTI) provides information about magnitude (diffusivity) and directionality (fractional anisotropy, FA) of water diffusion and allows visualization of major white matter tracts. The arcuate fasciculus (AF) connects anterior (Broca's) and posterior (Wernicke's) language areas. We hypothesized that essential language areas identified by direct cortical stimulation would colocalize with areas revealing subcortical connectivity via the AF.Methods: Fourteen patients with pharmacoresistant left hemispheric epilepsy and left hemisphere language dominance underwent invasive evaluations for localization of epileptogenicity and functional mapping. DTI and T1-weighted volumetric magnetic resonance imaging (MRI) scans were coregistered, and subdural grid electrodes id...

Direct and indirect costs associated with epileptic partial onset seizures among the privately insured in the United States

Epilepsia — Mon, 07 Dec 2009 00:00:00 +0100

Conclusion: Patients with POS had significantly higher costs compared with matched controls. Epilepsy-related costs underestimate the excess costs of patients with partial onset seizures. (Source: Epilepsia)

Language lateralization correlates with verbal memory performance in children with focal epilepsy

Epilepsia — Thu, 03 Dec 2009 00:00:00 +0100

This study explores whether language lateralization and cognitive performance are systematically related in young patients with focal epilepsy.Methods: Language fMRI and neuropsychological data (language, visuospatial functions, and memory) of 40 patients (7[ndash]18 years of age) with unilateral, refractory focal epilepsy in temporal and/or frontal areas of the left (n = 23) or right hemisphere (n = 17) were analyzed. fMRI data of 18 healthy controls (7[ndash]18 years) served as a normative sample. A laterality index was computed to determine the lateralization of activation in three regions of interest (frontal, parietal, and temporal).Results: Atypical language lateralization was demonstrated in 12 (30%) of 40 patients. A correlation between language lateralization and verbal memory per...

Examining the prevalence of epilepsy and delivery of epilepsy care in Ireland

Epilepsia — Wed, 02 Dec 2009 00:00:00 +0100

This study is distinguished as the first nationwide prevalence study of epilepsy in Europe and provides previously unavailable data on this population in Ireland. Moreover, this study illustrates the merits of secondary data analysis of existing sources when access to clinical sources for the purpose of identifying epidemiologic samples is limited. (Source: Epilepsia)

Health care resource utilization in patients with active epilepsy

Epilepsia — Tue, 01 Dec 2009 00:00:00 +0100

Purpose: To evaluate health care resource utilization (HRU) in active epilepsy.Methods: Thomson-Reuters insurance databases included 14 million persons in 2005[ndash]2007. We extracted information for individuals with insurance claims suggestive of epilepsy. Using iterative expert classification, we sorted patients by type of epilepsy. For each type we calculated prevalence and HRU. A distance analysis identified closely similar types, and a principal components analysis revealed dimensions of variation in HRU.Results: The prevalence of active epilepsy was 3.4 per 1,000. Most common diagnoses among 46,847 patients were generalized convulsive epilepsy (33.3%) and complex partial seizures (24.8%). Patients averaged 10 physician visits per year, 24 diagnostic tests/procedures per year, >30 dr...

Theiler's virus infection chronically alters seizure susceptibility

Epilepsia — Tue, 01 Dec 2009 00:00:00 +0100

The objective of the present study was threefold: (1) to assess pathologic changes associated with acute TMEV infection and infection-induced seizures, (2) to determine whether Theiler's virus infection and associated acute seizures lead to chronically altered seizure susceptibility, and (3) to determine whether genetic background influences seizure susceptibility following Theiler's virus infection.Methods: Immunohistochemical techniques were used to assess Theiler's virus antigen localization in the brain and associated neuronal cell death. A battery of electroconvulsive threshold (ECT) tests and corneal kindling studies were conducted to assess whether there were chronic alterations in seizure susceptibility and kindling development. Studies were conducted in both B6 and SJL/J mice to a...

Prognosticating acute symptomatic seizures using two different seizure outcomes

Epilepsia — Tue, 01 Dec 2009 00:00:00 +0100

This study examined the profiles and prognosis of first acute symptomatic seizure (ASS). Because seizure recurrences may occur in the setting of a persisting or reemerging acute symptomatic cause or in the setting of an unprovoked seizure, we documented the prognosis of ASS in terms of acute symptomatic seizure (AS) or unprovoked seizure (US) recurrence.Methods: We conducted a prospective study of patients with suspected seizures between April 2004 and December 2005. Patients were classified according to medical history taking, routine clinical evaluation, and expert adjudication, and they were followed for a minimum of 2 years or until death. The Kaplan-Meier method and univariate/multivariate statistical analysis were used to determine prognosis.Results: One hundred five patients with fi...

De novo epileptic confusion in the elderly: A 1-year prospective study

Epilepsia — Tue, 01 Dec 2009 00:00:00 +0100

Purpose: Nonconvulsive status epilepticus (NCSE) is clinically difficult to diagnose, especially in old patients without epilepsy, and requires electroencephalography (EEG) for diagnosis. Its incidence among elderly patients with confusion of unknown origin (CUO) remains undetermined.Methods: A 1-year prospective study was conducted in patients aged 60 years or older, for whom EEG was requested because of confusion considered to be of unknown origin after initial clinical, biologic, and imaging investigations. Diagnosis criteria included a validated clinical assessment scale to confirm confusion.Results: Of 44 patients with confirmed CUO, 7 presented with de novo NCSE. NCSE population had a mean age of 76 years (range, 60[ndash]97 years). No statistically significant differences were found...

Prevalence of epileptiform discharges in healthy children—New data from a prospective study using digital EEG

Epilepsia — Tue, 01 Dec 2009 00:00:00 +0100

Conclusions: Our study further highlights the urgent need to reevaluate the prevalence of epileptiform EEG discharges in healthy children using DEEG recordings in a large cohort. (Source: Epilepsia)

Inhibition of long-term potentiation by valproic acid through modulation of cyclic AMP

Epilepsia — Tue, 01 Dec 2009 00:00:00 +0100

Conclusions: These results indicate that VPA through an action on cAMP accumulation can inhibit synaptic plasticity, but this cannot fully explain its anticonvulsant effect. (Source: Epilepsia)

Involvement of the thalamocortical network in TLE with and without mesiotemporal sclerosis

Epilepsia — Tue, 01 Dec 2009 00:00:00 +0100

This study investigated how structural abnormalities in the focus, ipsilateral thalamus and extrafocal cortical structures relate to each other in TLE with mesiotemporal sclerosis (TLE-MTS) and without hippocampal sclerosis (TLE-no).Methods: T1 and high-resolution T2 images were acquired on a 4T magnet in 29 controls, 15 TLE-MTS cases, and 14 TLE-no. Thalamus volumes were obtained by warping a labeled atlas onto each subject's brain. Deformation-based morphometry was used to identify regions of thalamic volume loss and FreeSurfer for cortical thickness measurements. CA1 volumes were obtained from high-resolution T2 images. Multiple regression analysis and correlation analyses for voxel- and vertex-based analyses were performed in SPM2 and FreeSurfer.Results: TLE-MTS had bilateral volume lo...

Proceedings of the Innsbruck Colloquiumon Status Epilepticus