MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Epilepsia' source. Wed, 08 Feb 2012 20:43:05 +0100 http://www.medworm.com/index.php?rid=5664708&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03394.x We report the efficacy of the ketogenic diet in refractory epilepsies focusing on outcomes with regard to epilepsy syndromes and etiology in children and adults with refractory epilepsy. Sixty‐four consecutive children and four adults were prospectively enrolled from 2002 to 2009; seven were excluded from analysis. The classical ketogenic diet was initiated on an inpatient basis with dietary ratios ranging from 2:1 to 4:1 fat to carbohydrate and protein. Patients were classified according to syndrome and etiology using the 1989 and more recent 2010 International League Against Epilepsy (ILAE) classification systems. Responders were defined as >50% reduction in seizure frequency compared to baseline. Syndromes included symptomatic generalized (52), genetic (idiopathic) generalized (7),... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5664708 Mon, 06 Feb 2012 05:00:00 +0100 5664708 http://www.medworm.com/index.php?rid=5664707&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03395.x In this study from sub‐Saharan Africa, CWE predominantly had focal features that support the suggestion that most epilepsy in this region has a symptomatic etiology. Adverse perinatal events were strongly associated with epilepsy. Genetic and social factors may also be important. Epilepsy may be preventable in a significant proportion of children with better antenatal and perinatal care. (Source: Epilepsia) Epilepsia journals http://www.medworm.com/rss/comments.php?id=5664707 Mon, 06 Feb 2012 05:00:00 +0100 5664707 http://www.medworm.com/index.php?rid=5664706&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03396.x In this study we present a fully automated volumetric approach applied to serial MRI scans of 12 patients with Rasmussen encephalitis.Methods:  We retrospectively analyzed 12 patients with Rasmussen encephalitis with a disease onset between 2001 and 2008. All patients underwent a total of 66 serial MRI scans including a three‐dimensional T1 data set. The volumetric analysis was based on standard procedures of the freely available software FMRIB Software Library (FSL) and required about 45 min per scan. Furthermore, planimetric analyses were performed on 51 scans as described previously.Key Findings:  The relative and absolute volume loss of the affected hemisphere was significantly higher compared to the unaffected hemisphere. Referring to regional atrophy differences our results s... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5664706 Mon, 06 Feb 2012 05:00:00 +0100 5664706 http://www.medworm.com/index.php?rid=5664705&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03399.x SummaryPurpose:  Despite the reported diagnostic value of the intracarotid amobarbital procedure (IAP) or “Wada test” for determining hemispheric lateralization and memory functioning, it has never undergone formal reliability testing because a prospective test–retest study design is neither feasible nor ethical. However, some patients require repeat testing for clinical purposes, a circumstance that allows for exploration of issues related to reliability. The current investigation sought to: (1) evaluate the frequency of and reasons for repeated IAPs and (2) describe the test–retest reliability of repeated IAPs in a large tertiary epilepsy center.Methods:  A 10‐year review (2001–2011) of the New York University Langone Medical Center Comprehensive Epilepsy Center patient r... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5664705 Mon, 06 Feb 2012 05:00:00 +0100 5664705 http://www.medworm.com/index.php?rid=5664704&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03400.x We present an illustrative case of intractable epilepsy where judicious use of intraoperative neurophysiologic–techniques guided resection of precentral CD, under general anesthesia and in the absence of preoperative electrophysiologic mapping data. Ictal onset was accurately delineated using electrocorticography (ECoG). Phase reversal of the median somatosensory‐evoked potentials (MSSEPs) localized the central sulcus (CS). Motor evoked potentials (MEPs) triggered by high‐frequency monopolar anodal electrical cortical stimulation at the primary motor cortex (PMC) threshold delineated the PMC. Using this technique, PMC and the corticospinal tract (CST) were continuously monitored during resection. No changes in MEPs from the preresection baseline were seen; no residual abnormal activi... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5664704 Mon, 06 Feb 2012 05:00:00 +0100 5664704 http://www.medworm.com/index.php?rid=5664703&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03401.x SummaryPurpose:  Hypoxic ischemic encephalopathy (HIE) accounts for 60% of all neonatal seizures. There is emerging evidence that seizures cause additional injury to the developing brain that has sustained hypoxic ischemic injury. Temporal evolution of clinical seizure burden in HIE has been characterized, with maximum clinical seizure burden (the period of maximum seizure activity) being observed between 12 and 24 h of age. The purpose of our study was to investigate the distribution of electrographic seizure burden (the accumulated duration of seizures over a defined time period), following the initial hypoxic ischemic insult.Methods:  Fifteen full‐term newborns with HIE and seizures, and a minimum of 48 h of continuous video–electroencephalography (EEG), were included in thi... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5664703 Mon, 06 Feb 2012 05:00:00 +0100 5664703 http://www.medworm.com/index.php?rid=5664702&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03402.x SummaryPurpose:  Acute encephalopathy is the most serious complication of pediatric viral infections, such as influenza and exanthema subitum. It occurs worldwide, but is most prevalent in East Asia. Recently, there have been sporadic case reports of epilepsy/febrile seizure and acute encephalopathy with a neuronal sodium channel alpha 1 subunit (SCN1A) mutation. To determine whether SCN1A mutations are a predisposing factor of acute encephalopathy, we sought to identify SCN1A mutations in a large case series of acute encephalopathy including various syndromes.Methods:  We analyzed the SCN1A gene in 87 patients with acute encephalopathy, consisting of 20 with acute necrotizing encephalopathy (ANE), 61 with acute encephalopathy with biphasic seizures and late reduced diffusion (AESD), a... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5664702 Wed, 01 Feb 2012 05:00:00 +0100 5664702 http://www.medworm.com/index.php?rid=5644871&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2012.03415.x (Source: Epilepsia) Epilepsia journals http://www.medworm.com/rss/comments.php?id=5644871 Wed, 01 Feb 2012 05:00:00 +0100 5644871 http://www.medworm.com/index.php?rid=5644870&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2012.03412.x (Source: Epilepsia) Epilepsia journals http://www.medworm.com/rss/comments.php?id=5644870 Wed, 01 Feb 2012 05:00:00 +0100 5644870 http://www.medworm.com/index.php?rid=5644869&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03378.x (Source: Epilepsia) Epilepsia journals http://www.medworm.com/rss/comments.php?id=5644869 Wed, 01 Feb 2012 05:00:00 +0100 5644869 http://www.medworm.com/index.php?rid=5644868&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03367.x (Source: Epilepsia) Epilepsia journals http://www.medworm.com/rss/comments.php?id=5644868 Wed, 01 Feb 2012 05:00:00 +0100 5644868 http://www.medworm.com/index.php?rid=5644867&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03355.x SummaryPurpose:  How long after starting a new medication must a patient go without seizures before they can be regarded as seizure‐free? A recent International League Against Epilepsy (ILAE) task force proposed using a “Rule of Three” as an operational definition of seizure freedom, according to which a patient should be considered seizure‐free following an intervention after a period without seizures has elapsed equal to three times the longest preintervention interseizure interval over the previous year. This rule was motivated in large part by statistical considerations advanced in a classic 1983 paper by Hanley and Lippman‐Hand. However, strict adherence to the statistical logic of this rule generally requires waiting much longer than recommended by the ILAE task force. Th... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5644867 Wed, 01 Feb 2012 05:00:00 +0100 5644867 http://www.medworm.com/index.php?rid=5644861&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03391.x SummaryPreclinical research has facilitated the discovery of valuable drugs for the symptomatic treatment of epilepsy. Yet, despite these therapies, seizures are not adequately controlled in a third of all affected individuals, and comorbidities still impose a major burden on quality of life. The introduction of multiple new therapies into clinical use over the past two decades has done little to change this. There is an urgent demand to address the unmet clinical needs for: (1) new symptomatic antiseizure treatments for drug‐resistant seizures with improved efficacy/tolerability profiles, (2) disease‐modifying treatments that prevent or ameliorate the process of epileptogenesis, and (3) treatments for the common comorbidities that contribute to disability in people with epilepsy. New ... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5644861 Wed, 01 Feb 2012 05:00:00 +0100 5644861 http://www.medworm.com/index.php?rid=5644865&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03388.x SummaryPurpose:  Focal brain cooling is effective for suppression of epileptic seizures, but it is unclear if seizures can be suppressed without a substantial influence on normal neurologic function. To address the issue, a thermoelectrically driven cooling system was developed and applied in free‐moving rat models of focal seizure and epilepsy.Methods:  Focal seizures limited to the unilateral forelimb were induced by local application of a penicillin G solution or cobalt powder to the unilateral sensorimotor cortex. A proportional integration and differentiation (PID)–controlled, thermoelectrically driven cooling device (weight of 11 g) and bipolar electrodes were chronically implanted on the eloquent area (on the epileptic focus) and the effects of cooling (20, 15, and 10°C) ... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5644865 Tue, 31 Jan 2012 05:00:00 +0100 5644865 http://www.medworm.com/index.php?rid=5644864&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03389.x SummaryPurpose:  A mutation in the β1 subunit of the voltage‐gated sodium (NaV) channel, β1(C121W), causes genetic epilepsy with febrile seizures plus (GEFS+), a pediatric syndrome in which febrile seizures are the predominant phenotype. Previous studies of molecular mechanisms underlying neuronal hyperexcitability caused by this mutation were conducted at room temperature. The prevalence of seizures during febrile states in patients with GEFS+, however, suggests that the phenotypic consequence of β1(C121W) may be exacerbated by elevated temperature. We investigated the putative mechanism underlying seizure generation by the β1(C121W) mutation with elevated temperature.Methods:  Whole‐cell voltage clamp experiments were performed at 22 and 34°C using Chinese Hamster Ovary (CHO... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5644864 Tue, 31 Jan 2012 05:00:00 +0100 5644864 http://www.medworm.com/index.php?rid=5644863&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03390.x SummaryFor many years, there has been interest in a possible link between epilepsy and schizophrenia. A recent study found a strong, bidirectional link between the two conditions: people with one had a higher than average risk of having the other. Using two large data sets of hospital admission data, we investigated whether schizophrenia and epilepsy occur together in individuals more commonly than expected by chance. We undertook a retrospective cohort study using the Oxford Record Linkage Study (ORLS) and English national linked Hospital Episode Statistics to investigate the coexistence of these conditions. There was an elevated risk of epilepsy in people admitted to hospital with schizophrenia (ORLS rate ratio 2.1, 95% confidence interval 1.6–2.6; England 3.0, 2.9–3.1) and an elevat... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5644863 Tue, 31 Jan 2012 05:00:00 +0100 5644863 http://www.medworm.com/index.php?rid=5644862&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03392.x SummaryPurpose:  Previous work has shown that levetiracetam (LEV) binds the vesicular protein SV2A and reduces excitatory neurotransmitter release during trains of high‐frequency activity, most likely by accessing its binding site through vesicular endocytosis into excitatory synaptic terminals. Because there are differences in excitatory and inhibitory transmitter release mechanisms, and there are suggestions that neurons differ in their SV2A expression, we were curious whether LEV also reduces inhibitory transmission.Methods:  We used patch‐clamp recording from CA1 neurons in rat brain slices to quantify the effects of LEV on inhibitory postsynaptic currents (IPSCs). We were able to elicit pure IPSCs by stimulating inhibitory terminals close to neuronal soma and blocking excitato... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5644862 Tue, 31 Jan 2012 05:00:00 +0100 5644862 http://www.medworm.com/index.php?rid=5644866&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03386.x SummaryIn areas where cysticercosis is endemic, calcified neurocysticercosis lesion(s) (CNL) and hippocampal sclerosis (HS) commonly coexist in patients with localization‐related epilepsies. To understand the pathogenesis of HS associated with CNL, we compared the characteristics of three groups of patients with antiepileptic drug–resistant epilepsies: CNL with HS, CNL without HS (CNL alone), and HS without CNL (HS alone). In comparison to patients with CNL alone, those with CNL with HS had CNL more frequently located in the ipsilateral temporal lobe. Those with CNL with HS had a lower incidence of febrile seizures, older age at initial precipitating injury and at onset of habitual complex partial seizures, and more frequent clustering of seizures and extratemporal/bitemporal intericta... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5644866 Fri, 13 Jan 2012 05:00:00 +0100 5644866 http://www.medworm.com/index.php?rid=5581611&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03377.x SummaryPurpose:  Children with epilepsy have a significant risk for attention‐deficit/hyperactivity disorder (ADHD), which is often accompanied by deficits in working memory performance. However, it is not yet clear whether there are specific differences in the underlying mechanisms of working memory capability between children with epilepsy‐related ADHD and those with developmental ADHD. There is evidence that methylphenidate can improve the behavioral difficulties in children with developmental ADHD. Whether this medication has the same effect on ADHD symptoms in patients with epilepsy is not yet well understood. The aim of the present study is, therefore, to evaluate whether boys with epilepsy‐related ADHD and developmental ADHD share a common behavioral, pharmacoresponsive, and... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5581611 Fri, 13 Jan 2012 05:00:00 +0100 5581611 http://www.medworm.com/index.php?rid=5581610&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03379.x SummaryPurpose:  Genetic generalized epilepsies (GGEs) have a lifetime prevalence of 0.3% with heritability estimates of 80%. A considerable proportion of families with siblings affected by GGEs presumably display an oligogenic inheritance. The present genome‐wide linkage meta‐analysis aimed to map: (1) susceptibility loci shared by a broad spectrum of GGEs, and (2) seizure type–related genetic factors preferentially predisposing to either typical absence or myoclonic seizures, respectively.Methods:  Meta‐analysis of three genome‐wide linkage datasets was carried out in 379 GGE‐multiplex families of European ancestry including 982 relatives with GGEs. To dissect out seizure type–related susceptibility genes, two family subgroups were stratified comprising 235 families wit... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5581610 Fri, 13 Jan 2012 05:00:00 +0100 5581610 http://www.medworm.com/index.php?rid=5581609&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03380.x We describe a cohort of patients with improved seizure control following IM without resective surgery.Methods:  Over 12.5 years, 161 children underwent 496 surgeries including intracranial monitoring. We retrospectively reviewed the patients’ charts, operative reports, and radiologic scans, under an institutional review board–approved protocol.Key Findings:  Seventeen patients underwent only IM, without additional resective surgery, and seven had a dramatic improvement in their epilepsy; six of the seven patients are seizure‐free (Engel class I), and one rarely has seizures (Engel class II). All seven patients had frequent seizures that led to IM: either daily (five patients) or 1–2 per week (two patients). The mean age (± standard deviation, SD) at seizure onset was 1.6 �... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5581609 Fri, 13 Jan 2012 05:00:00 +0100 5581609 http://www.medworm.com/index.php?rid=5581608&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03381.x SummaryThis critical review refers to the new report on terminology and concepts for the organization of epilepsies by the Commission of the International League Against Epilepsy (ILAE). It is unfortunate that most of the proposals in the Commission’s report are modified interpretations and nomenclature of previous ILAE classifications; new terms are not better than the old ones, and recent advances have not been incorporated. Hence, the new ILAE report met with considerable dissatisfaction from several expert epileptologists. The Commission abandoned (1) the disease‐syndrome distinction, although “disease” is generally differentiated from “syndrome” in most medical texts as well as in the ILAE classification itself; (2) the distinction of “generalized” and “focal” for ... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5581608 Fri, 13 Jan 2012 05:00:00 +0100 5581608 http://www.medworm.com/index.php?rid=5581607&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03382.x SummaryThe accuracy of visual diagnosis of seizures based on semiologic features among different health care professionals is largely unknown. We evaluated the ability of health care professionals to correctly diagnose epileptic seizures (ES) and psychogenic nonepileptic seizures (PNES) from a random selection of 10 ES and 10 PNES videos. The 20 videos (without accompanying electroencephalography) were shown only once, in a random mix to different groups of health care professionals. These individuals, blinded to the diagnosis, were asked to classify the seizure as ES or PNES. We used summary receiver operating characteristic (SROC) curves to determine the accuracy for each group. Next we calculated the difference between the area under the curve (AUC) of SROC between neurologists (as the ... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5581607 Fri, 13 Jan 2012 05:00:00 +0100 5581607 http://www.medworm.com/index.php?rid=5581606&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03383.x SummaryPurpose:  Given serious concerns over the adverse effects of enzyme induction, modern nonenzyme‐inducing antiepileptic drugs (AEDs) may be preferable, provided they have similar efficacy as enzyme‐inducing AEDs. This is currently unclear.Methods:  Therefore, we performed a meta‐analysis of the evidence to determine the placebo‐corrected efficacy of adjunctive treatment with modern nonenzyme‐inducing AEDs versus modern enzyme‐inducing AEDs that are on the market for refractory focal epilepsy.Key Findings:  Of 322 potentially eligible articles reviewed in full text, 129 (40%) fulfilled eligibility criteria. After excluding 92 publications, 37 studies dealing with a total of 9,860 patients with refractory focal epilepsy form the basis for the evidence. The overall wei... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5581606 Fri, 13 Jan 2012 05:00:00 +0100 5581606 http://www.medworm.com/index.php?rid=5581605&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03384.x SummaryPurpose:  The mammalian target of rapamycin (mTOR) pathway has been implicated in contributing to progressive epileptogenesis in models of chronic epilepsy. Conversely, seizures themselves may directly cause acute activation of the mTOR pathway. To isolate the direct effects of seizures on the mTOR pathway, the time course and mechanisms of mTOR activation were investigated with acute seizures induced by pentylenetetrazole (PTZ), which does not lead to chronic epilepsy.Methods:  Western blot analysis was used to assay the phosphorylation of Akt and S6, as measures of activation of the phosphoinositide 3‐kinase (PI3K)/Akt and mTOR pathways, respectively, at various time points after PTZ‐induced seizures in rats. The ability of wortmannin, a PI3K inhibitor, to inhibit PTZ seiz... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5581605 Fri, 13 Jan 2012 05:00:00 +0100 5581605 http://www.medworm.com/index.php?rid=5581604&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03385.x SummaryPurpose:  Electroencephalography–functional magnetic resonance imaging (EEG‐fMRI) coregistration has recently revealed that several brain structures are involved in generalized spike and wave discharges (GSWDs) in idiopathic generalized epilepsies (IGEs). In particular, deactivations and activations have been observed within the so‐called brain default mode network (DMN) and thalamus, respectively. In the present study we analyzed the dynamic time course of blood oxygen level–dependent (BOLD) changes preceding and following 3 Hz GSWDs in a group of adolescent and adult patients with IGE who presented with absence seizures (AS). Our aim was to evaluate cortical BOLD changes before, during, and after GSWD onset.Methods:  Twenty‐one patients with IGE underwent EEG‐fMR... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5581604 Fri, 13 Jan 2012 05:00:00 +0100 5581604 http://www.medworm.com/index.php?rid=5570023&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03353.x SummaryPurpose:  (1) To determine whether health resource utilization (HRU) and unmet health care needs differ for individuals with epilepsy compared to the general population or to those with another chronic condition (asthma, diabetes, migraine); and (2) to assess the association among epilepsy status, sociodemographic variables and HRU.Methods:  Data on HRU were assessed using the 2001–2005 Canadian Community Health Surveys, a nationally representative population‐based survey. Weighted estimates of association were produced as adjusted odds ratio with 95% confidence intervals, and logistic regression was used to explore the association between sociodemographic variables and HRU in those with epilepsy. All data on disease status, HRU, and unmet health care needs were self‐repor... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5570023 Thu, 05 Jan 2012 05:00:00 +0100 5570023 http://www.medworm.com/index.php?rid=5570022&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03361.x SummaryPurpose:  Epilepsy is associated with near‐fatal and fatal arrhythmias, and sudden unexpected death in epilepsy (SUDEP) is partly related to cardiac events. Dysfunction of the autonomous nervous system causes arrhythmias and, although previous studies have investigated the effects of epilepsy on the autonomic control of the heart, the results are still mixed regarding whether imbalance of sympathetic, vagal, or both systems is present in epilepsy, and also the importance of anticonvulsant treatment on the autonomic system. Therefore, we aimed to investigate epilepsy and its treatment impact on heart rate variability (HRV), assessed by sympathetic and parasympathetic activity expressed as low‐frequency (LF) and high‐frequency (HF) power spectrum, respectively.Method:  We pe... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5570022 Thu, 05 Jan 2012 05:00:00 +0100 5570022 http://www.medworm.com/index.php?rid=5570021&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03363.x SummaryPurpose:  Type II focal cortical dysplasia (TTFCD), a highly epileptogenic lesion with severe epilepsy curable by surgery, is missed by magnetic resonance imaging (MRI) in about one third of cases. Little is known about the electroclinical presentation in these MRI‐negative patients and a poor surgical outcome is frequently reported. We compared the clinical and neurophysiologic features in MRI‐negative and MRI‐positive cases in order to better identify candidates for surgery.Methods:  Among 62 consecutive TTFCD patients (38 male, 24 female; 7–52 years old; 22 children) operated for intractable epilepsy, 25 (40%) presented negative MRI findings. We compared the history of epilepsy; the type, frequency, and distribution of seizures; neurologic examination cognitive and ... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5570021 Thu, 05 Jan 2012 05:00:00 +0100 5570021 http://www.medworm.com/index.php?rid=5570020&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03364.x SummaryRetigabine [RTG (international nonproprietary name); ezogabine (EZG; U.S. adopted name)] is a first‐in‐class antiepileptic drug (AED) that reduces neuronal excitability by enhancing the activity of KCNQ (Kv7) potassium (K+) channels. RTG/EZG has recently been approved by the European Medicines Agency and the U.S. Food and Drug Administration as adjunctive therapy in adults with partial‐onset seizures. In this review we discuss the activity that RTG/EZG has demonstrated across a broad spectrum of in vitro/in vivo animal models of seizures, including generalized tonic–clonic, primary generalized (absence), and partial seizures, in addition to the compound’s ability to resist and block the occurrence of seizures induced by a range of stimuli across different regions of the br... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5570020 Thu, 05 Jan 2012 05:00:00 +0100 5570020 http://www.medworm.com/index.php?rid=5570019&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03365.x SummaryThe pharmacologic profile of retigabine [RTG (international nonproprietary name); ezogabine, EZG (U.S. adopted name)], is different from all currently approved antiepileptic drugs (AEDs). Its primary mechanism of action (MoA) as a positive allosteric modulator of KCNQ2–5 (Kv7.2–7.5) ion channels defines RTG/EZG as the first neuronal potassium (K+) channel opener for the treatment of epilepsy. KCNQ2–5 channels are predominantly expressed in neurons and are important determinants of cellular excitability, as indicated by the occurrence of human genetic mutations in KCNQ channels that underlie inheritable disorders including, in the case of KCNQ2/3, the syndrome of benign familial neonatal convulsions. In vitro pharmacologic studies demonstrate that the most potent action of RTG/... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5570019 Thu, 05 Jan 2012 05:00:00 +0100 5570019 http://www.medworm.com/index.php?rid=5570018&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03368.x SummaryPurpose:  To accurately determine the frequency and nature of the family history of seizures in patients with benign childhood epilepsy with centrotemporal spikes (BECTS).Method:  Participants with BECTS were recruited from the electroencephalography (EEG) laboratories of three pediatric centers and by referral. Pedigrees were constructed for up to three degrees of relatedness for each proband. All available affected and unaffected individuals underwent phenotyping using a validated seizure questionnaire. The proportion of affected relatives according to degree of relatedness was calculated and phenotypic patterns were analyzed.Key Findings:  Fifty‐three probands with BECTS had a mean age of seizure onset at 7.8 years (range 2–12 years). Thirty‐four (64%) of 53 patie... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5570018 Thu, 05 Jan 2012 05:00:00 +0100 5570018 http://www.medworm.com/index.php?rid=5570017&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03369.x SummaryCerebral hyaline astrocytic inclusions have been observed in a subset of patients with early onset epilepsy, brain structural anomalies, and developmental delay, which indicates that it may represent a unique clinicopathologic entity. To further characterize this condition we use proteomics to investigate differentially expressed proteins in epileptic brain tissue from three pediatric epileptic patients with cerebral hyaline astrocytic inclusions, ranging in age from 5–13 years, and compare to brain tissue from two normal controls. Catalase and carbonic anhydrase I both exhibited increased expression in epileptic brain tissue compared to controls. These findings were confirmed by Western blot analysis. Furthermore, both proteins were localized to astrocytes and in epileptic brai... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5570017 Thu, 05 Jan 2012 05:00:00 +0100 5570017 http://www.medworm.com/index.php?rid=5570016&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03370.x In this study, we investigated the sites within the thalamocortical circuit that NPY acts to suppress seizures in genetic absence epilepsy rats from Strasbourg (GAERS).Methods:  In conscious freely moving GAERS, NPY was administered via intracerebral microcannulae implanted bilaterally into one of the following regions: primary somatosensory cortex (S1), secondary somatosensory cortex (S2), the primary motor cortex (M1), caudal nucleus reticular thalamus (nRT), or ventrobasal thalamus (VB). Animals received vehicle and up to three doses of NPY, in a randomized order. Electroencephalography (EEG) recordings were carried out for 30 min prior to injection and 90 min after the injection of NPY or vehicle.Key Findings:  Focal microinjections of NPY into the S2 cortex suppressed seizures... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5570016 Thu, 05 Jan 2012 05:00:00 +0100 5570016 http://www.medworm.com/index.php?rid=5570015&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03371.x SummaryPurpose:  Children with rolandic epilepsy (RE) experience difficulties with reading, language, and attention. Their siblings are at high risk of dyslexia but are not otherwise known to have neurocognitive deficits. We therefore sought evidence for an RE‐associated neurocognitive endophenotype.Methods:  Thirteen probands (male‐to‐female ratio 9:4) and 11 epilepsy‐free siblings (male‐to‐female ratio 5:6) completed a neurocognitive evaluation within the domains of reading, language, and attention. Frequencies of impairment were compared, and mean standardized scores of children with RE and their siblings were each compared against population means.Key Findings:  Frequency of impairment in each domain was comparable for siblings and probands: 9% of siblings and 31% of ... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5570015 Thu, 05 Jan 2012 05:00:00 +0100 5570015 http://www.medworm.com/index.php?rid=5570014&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03372.x SummaryWe aimed to assess rates of bipolar symptoms versus bipolar disorder in epilepsy, and the effect of bipolar symptoms on quality of life (QOL) in epilepsy. Bipolar, disability, and QOL instruments were administered to 99 tertiary epilepsy center patients. Patients who scored positive on the Mood Disorder Questionnaire (MDQ) also completed depression scales and a structured psychiatric interview. Results indicated MDQ+ patients (10.1%) had worse QOL and more work, social, and family life disruptions. Most MDQ+ patients did not have bipolar disorder. There was close overlap between depressive and bipolar symptomatology. Based on results of this study, bipolar symptom is not synonymous with bipolar disorder. Symptoms picked up by the MDQ may be epilepsy‐related depressive symptoms. Bi... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5570014 Thu, 05 Jan 2012 05:00:00 +0100 5570014 http://www.medworm.com/index.php?rid=5570030&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03393.x (Source: Epilepsia) Epilepsia journals http://www.medworm.com/rss/comments.php?id=5570030 Sun, 01 Jan 2012 05:00:00 +0100 5570030 http://www.medworm.com/index.php?rid=5570029&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03397.x (Source: Epilepsia) Epilepsia journals http://www.medworm.com/rss/comments.php?id=5570029 Sun, 01 Jan 2012 05:00:00 +0100 5570029 http://www.medworm.com/index.php?rid=5570028&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03366.x (Source: Epilepsia) Epilepsia journals http://www.medworm.com/rss/comments.php?id=5570028 Sun, 01 Jan 2012 05:00:00 +0100 5570028 http://www.medworm.com/index.php?rid=5570027&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03321.x (Source: Epilepsia) Epilepsia journals http://www.medworm.com/rss/comments.php?id=5570027 Sun, 01 Jan 2012 05:00:00 +0100 5570027 http://www.medworm.com/index.php?rid=5570026&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03330.x (Source: Epilepsia) Epilepsia journals http://www.medworm.com/rss/comments.php?id=5570026 Sun, 01 Jan 2012 05:00:00 +0100 5570026 http://www.medworm.com/index.php?rid=5570025&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03335.x SummaryA joint panel of the American Academy of Neurology (AAN) and the International League Against Epilepsy (ILAE) convened to develop guidelines for selection of antiepileptic drugs (AEDs) among people with HIV/AIDS. The literature was systematically reviewed to assess the global burden of relevant comorbid entities, to determine the number of patients who potentially utilize AEDs and antiretroviral agents (ARVs), and to address AED–ARV interactions. Key findings from this literature search included the following: AED–ARV administration may be indicated in up to 55% of people taking ARVs. Patients receiving phenytoin may require a lopinavir/ritonavir dosage increase of approximately 50% to maintain unchanged serum concentrations (Level C). Patients receiving valproic acid may requir... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5570025 Sun, 01 Jan 2012 05:00:00 +0100 5570025 http://www.medworm.com/index.php?rid=5570013&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03373.x SummaryPurpose:  Whether a specific lesion such as mesial temporal sclerosis (MTS) increases the risk for a mood disorder in epilepsy remains subject to debate. Despite evidence of limbic system involvement in the genesis of emotional symptoms, recent studies fail to support an association between depression and MTS. We aimed to clarify this controversial issue by overcoming prior methodologic limitations, hypothesizing that rates of major depressive disorder (MDD) would be higher in patients with MTS.Methods:  Three hundred eight patients with focal epilepsy (International League Against Epilepsy [ILAE] criteria), were classified into three groups on the basis of neuroimaging findings: MTS, a lesion different from MTS, or absence of lesion. Patients were assessed using the Structured ... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5570013 Sun, 01 Jan 2012 05:00:00 +0100 5570013 http://www.medworm.com/index.php?rid=5570024&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03362.x SummaryWe aimed at determining the lateralizing and localizing values of “hemiballic‐like” ictal movements observed in some partial seizures. Among 20 patients disclosing ictal hyperkinetic features and explored by stereotactic‐EEG (SEEG), this sign was observed in four patients. In these cases, hemiballic movement was ipsilateral to the ictal‐onset zone and was associated with contralateral ictal dystonia. Noninvasive and subsequent invasive recording revealed seizure origin in the inferior parietal lobule or the parietal operculum in three patients and in the inferior prefrontal cortex in one. (Source: Epilepsia) Epilepsia journals http://www.medworm.com/rss/comments.php?id=5570024 Thu, 22 Dec 2011 05:00:00 +0100 5570024 http://www.medworm.com/index.php?rid=5540052&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03339.x SummaryStereotactic radiosurgery, well established in the noninvasive treatment of focal lesions that are otherwise difficult to access through open surgery, is an emerging technology in the treatment of focal epileptic lesions. Recent studies suggest that seizures from hypothalamic hamartomas and mesial temporal lobe epilepsy remit at clinically significant rates with radiosurgery, but large variations among different studies have raised questions about appropriate treatment protocols and mechanisms. Proposed anticonvulsant mechanisms include neuromodulatory effects or ischemic necrosis of epileptic tissue. An ongoing trial that directly compares efficacy, morbidities, and cost of radiosurgery versus open surgery for mesial temporal lobe epilepsy is underway. (Source: Epilepsia) Epilepsia journals http://www.medworm.com/rss/comments.php?id=5540052 Thu, 22 Dec 2011 05:00:00 +0100 5540052 http://www.medworm.com/index.php?rid=5540051&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03351.x SummaryPurpose:  To examine whether family history of unprovoked seizures is associated with behavioral disorders in epilepsy probands, thereby supporting the hypothesis of shared underlying genetic susceptibility to these disorders.Methods:  We conducted an analysis of the 308 probands with childhood onset epilepsy from the Connecticut Study of Epilepsy with information on first‐degree family history of unprovoked seizures and of febrile seizures whose parents completed the Child Behavior Checklist (CBCL) at the 9‐year follow‐up. Clinical cutoffs for CBCL problem and Diagnostic and Statistical Manual of Mental Disorders (DSM)–Oriented scales were examined. The association between first‐degree family history of unprovoked seizure and behavioral disorders was assessed separate... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5540051 Thu, 22 Dec 2011 05:00:00 +0100 5540051 http://www.medworm.com/index.php?rid=5540050&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03350.x SummaryPurpose:  Febrile infection–related epilepsy syndrome (FIRES) is an increasingly recognized epileptic syndrome that presents with multifocal refractory status epilepticus in previously normal children and evolves into a chronic, refractory, focal epilepsy with associated cognitive and behavioral difficulties. Herein we describe the features of the chronic epilepsy and critically review evidence for the etiology of this syndrome.Methods:  Seven patients with FIRES were studied. The duration of follow‐up in six survivors was 5–17 years. Clinical, electroencephalography (EEG), neuroimaging, and other investigative findings during the acute and chronic phases were reviewed.Key Findings:  These previously normal children presented with a febrile illness and status epileptic... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5540050 Thu, 22 Dec 2011 05:00:00 +0100 5540050 http://www.medworm.com/index.php?rid=5540049&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03352.x SummaryPurpose:  Photosensitive epilepsy (PSE) is the most common form of reflex epilepsy presenting with electroencephalography (EEG) paroxysms elicited by intermittent photic stimulation (IPS). To investigate whether the neuronal network undergoes dynamic changes before and during the transition to an EEG epileptic discharge, we estimated EEG connectivity patterns in photosensitive (PS) patients with idiopathic generalized epilepsy.Methods:  EEG signals were evaluated under resting conditions and during 14 Hz IPS, a frequency that consistently induces photoparoxysmal responses (PPRs) in PS patients. Partial directed coherence (PDC), a linear measure of effective connectivity based on multivariate autoregressive models, was used in 10 PS patients and 10 controls. Anterior versus pos... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5540049 Thu, 22 Dec 2011 05:00:00 +0100 5540049 http://www.medworm.com/index.php?rid=5540048&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03354.x SummaryPurpose:  In an analysis of four case–control studies of sudden unexpected death in epilepsy (SUDEP), we found that yearly frequency of generalized tonic–clonic seizures (GTCS) and antiepileptic drug (AED) polytherapy were associated with an increased risk for SUDEP. The prior analysis, however, did not evaluate AEDs and GTCS frequency concurrently.Methods:  We combined data from the three case–control studies with information on the frequency of GTCS and AED therapy, that is, carbamazepine, phenytoin, valproic acid, and other AED therapy. Number of AEDs was also considered. Lamotrigine and GTCS frequency were considered separately in two of the case–control studies. Logistic regression analysis was used to evaluate GTCS frequency, each of the AEDs, and number of AEDs. A... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5540048 Thu, 22 Dec 2011 05:00:00 +0100 5540048 http://www.medworm.com/index.php?rid=5540047&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03355.x SummaryPurpose:  How long after starting a new medication must a patient go without seizures before they can be regarded as seizure‐free? A recent International League Against Epilepsy (ILAE) task force proposed using a “Rule of Three” as an operational definition of seizure freedom, according to which a patient should be considered seizure‐free following an intervention after a period without seizures has elapsed equal to three times the longest preintervention interseizure interval over the previous year. This rule was motivated in large part by statistical considerations advanced in a classic 1983 paper by Hanley and Lippman‐Hand. However, strict adherence to the statistical logic of this rule generally requires waiting much longer than recommended by the ILAE task force. Th... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5540047 Thu, 22 Dec 2011 05:00:00 +0100 5540047 http://www.medworm.com/index.php?rid=5540046&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03357.x SummaryWe have developed a new model of cryptogenic infantile spasms with prenatal betamethasone brain priming to increase susceptibility to development‐specific spasms triggered by N‐methyl‐d‐aspartate (NMDA). A recent clinical study linked severe prenatal stress to increased risk for development of infantile spasms. Here, we determined whether prenatal restraint stress (2 × 45 min) in rats on gestational day 15 would increase susceptibility to develop spasms on postnatal day 15. Prenatal stress significantly accelerated onset and increased number of NMDA‐triggered spasms compared to handled controls. A single adrenocorticotropic hormone (ACTH or corticotropin) dose delivered acutely had no effects, whereas long‐term (3 day) ACTH pretreatment significantly increased l... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5540046 Thu, 22 Dec 2011 05:00:00 +0100 5540046 http://www.medworm.com/index.php?rid=5540045&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03356.x SummaryPurpose:  Early seizures are a frequent consequence of stroke. The main goal of the present study is to verify whether anoxic ischemia per se is able to induce early changes in excitability that may be a prelude to the generation of seizures and, ultimately, to epileptogenesis. Excitability changes in the very acute postischemic phase are here analyzed in a new model of ischemia developed in the isolated guinea pig brain preparation.Methods:  Permanent bilateral occlusion of the anterior cerebral arteries (ACAs) was performed in the isolated guinea pig brain maintained in vitro by arterial perfusion. Magnetic resonance imaging and immunohistochemistry were utilized to identify the penumbra and core regions induced by ACA occlusion (ACAo). Slow potentials and evoked responses rec... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5540045 Thu, 22 Dec 2011 05:00:00 +0100 5540045 http://www.medworm.com/index.php?rid=5540044&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03358.x SummarySudden unexpected death in epilepsy (SUDEP) is a category of death in people with epilepsy occurring in the absence of a known structural cause of death and is most likely heterogeneous with regard to mechanisms and circumstances. SUDEP is particularly difficult to investigate in research studies for several reasons, including its relatively low incidence, its unpredictable occurrence often in unwitnessed settings, and its low rate of complete autopsy examinations. Over the past two decades, two complementary definitions have been used in most SUDEP studies, but often with variations. We propose here a unified SUDEP definition and classification to resolve current ambiguities and to retrieve cases that would not have been further studied if the previous definitions were used. The pr... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5540044 Thu, 22 Dec 2011 05:00:00 +0100 5540044 http://www.medworm.com/index.php?rid=5540043&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03359.x We examined surgical outcomes in a group of PET‐positive, MRI‐negative patients and compared them with those of patients with MTS.Methods:  We queried the Thomas Jefferson University Surgical Epilepsy Database for patients who underwent anterior temporal lobectomy (ATL) from 1991 to 2009 and who had unilateral temporal PET hypometabolism without an epileptogenic lesion on MRI (PET+/MRI−). We compared this group to the group of patients who underwent ATL and who had MTS on MRI. Patients with discordant ictal electroencephalography (EEG) were excluded. Surgical outcomes were compared using percentages of Engel class I outcomes at 2 and 5 years as well as Kaplan‐Meier survival statistic, with time to seizure recurrence as survival time. A subgroup of PET+/MRI− patients who under... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5540043 Thu, 22 Dec 2011 05:00:00 +0100 5540043 http://www.medworm.com/index.php?rid=5540042&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03360.x SummaryPurpose:  Most people with epilepsy who die suddenly and whose death is attributed to sudden unexpected death in epilepsy (SUDEP) are found in or by the bed for unknown reasons. We assessed whether those with sleep‐related SUDEP were more likely to have nocturnal seizures, and whether seizure patterns (diurnal vs. nocturnal) differed from people dying suddenly and living controls with epilepsy.Methods:  Seizure patterns in a cohort of 154 people with epilepsy who died suddenly and after autopsy conformed to the definition of SUDEP and 616 controls living with epilepsy were classified as having “exclusively diurnal” or “nocturnal seizures.” Comparisons were made between the groups. SUDEP was classified as sleep‐related or non–sleep‐related based on eyewitness acco... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5540042 Thu, 22 Dec 2011 05:00:00 +0100 5540042 http://www.medworm.com/index.php?rid=5499756&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03338.x SummaryPurpose: sec‐Butyl‐propylacetamide (SPD) is a one‐carbon homolog of valnoctamide (VCD), a central nervous system (CNS)–active amide derivative of valproic acid (VPA) currently in phase II clinical trials. The study reported herein evaluated the anticonvulsant activity of SPD in a battery of rodent seizure and epilepsy models and assessed its efficacy in rat and guinea pig models of status epilepticus (SE) and neuroprotection in an organotypic hippocampal slice model of excitotoxic cell death.Methods:  The anticonvulsant activity of SPD was evaluated in several rodent seizure and epilepsy models, including maximal electroshock (MES), 6‐Hz psychomotor; subcutaneous (s.c.) metrazol‐, s.c. picrotoxin, s.c. bicuculline, and audiogenic, corneal, and hippocampal kindled sei... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5499756 Fri, 09 Dec 2011 05:00:00 +0100 5499756 http://www.medworm.com/index.php?rid=5499755&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03340.x SummaryPurpose:  Status epilepticus (SE) remains a potentially devastating condition that quickly becomes refractory to antiepileptic drug treatment and arises as a result of a failure of the brain’s endogenous antiepileptic mechanisms. Understanding these mechanisms and how they are disrupted in SE is necessary in order to identify novel therapeutic approaches. Adenosine is considered an endogenous anticonvulsant. Extracellular concentrations increase coinciding with seizure termination; activation of A1 receptors (A1Rs) reduces seizure‐induced damage and epileptiform activity. The present study examines the effectiveness of focal drug delivery in a model of limbic SE that closely resembles the human condition and describes, for the first time, alterations in A1R signaling during pr... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5499755 Fri, 09 Dec 2011 05:00:00 +0100 5499755 http://www.medworm.com/index.php?rid=5499754&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03341.x SummaryPurpose:  Impaired consciousness in epileptic seizures has a major negative impact on patient quality of life. Prior work on epileptic unconsciousness has mainly used retrospective and nonstandardized methods. Our goal was to validate and to obtain initial data using a standardized prospective testing battery.Methods:  The responsiveness in epilepsy scale (RES) was used on 52 patients during continuous video–electroencephalography (EEG) monitoring. RES begins with higher‐level questions and commands, and switches adaptively to more basic sensorimotor responses depending on patient performance. RES continues after seizures and includes postictal memory testing. Scoring was conducted based on video review.Key Findings:  Testing on standardized seizure simulations yielded goo... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5499754 Fri, 09 Dec 2011 05:00:00 +0100 5499754 http://www.medworm.com/index.php?rid=5499753&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03342.x We present a 9‐year‐old girl whose seizures were provoked mainly by emotional stress. In most cases of emotional stress–related seizures, especially when a specific confrontational incidence preceded the seizure, the suspicion for a nonepileptic event is high. In our patient we were able to show that the seizures were epileptic. Further investigation to clarify the pathophysiology of stress‐related seizures is needed. (Source: Epilepsia) Epilepsia journals http://www.medworm.com/rss/comments.php?id=5499753 Fri, 09 Dec 2011 05:00:00 +0100 5499753 http://www.medworm.com/index.php?rid=5499752&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03344.x SummaryIdiopathic generalized epilepsy (IGE) is classified into several subsyndromes based on clinical and electroencephalography (EEG) features. The EEG signature of IGE is bisynchronous, symmetric, and generalized spike‐wave complex; although focal, irregular, and so called “fragments” of discharges are not uncommon. Other characteristic EEG features include polyspikes, polyspike‐wave discharges, occipital intermittent rhythmic delta activity, and photoparoxysmal response. Both human and animal data suggest involvement of the thalamus and the cortex in the generation of spike‐wave discharges in IGE. Circadian variations of generalized epileptiform discharges are well described, and these can be useful in diagnostic confirmation. Those discharges tend to occur more often after a... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5499752 Fri, 09 Dec 2011 05:00:00 +0100 5499752 http://www.medworm.com/index.php?rid=5499751&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03345.x SummaryPurpose:  To correlate kindling‐associated alterations of the neurotransmitter secretory machinery, glutamate release in the trisynaptic hippocampal excitatory pathway, and the behavioral evolution of kindling‐induced epileptogenesis.Method:  Neurotransmitter release requires the fusion of vesicle and plasma membranes; it is initiated by formation of a stable, ternary complex (7SC) of SNARE [soluble N‐ethylmaleimide sensitive factor (NSF) attachment protein receptor] proteins. Quantitative Western blotting was used to monitor levels of 7SC and SNARE regulators [NSF, SV2 (synaptic vesicle protein 2)] in hippocampal synaptosomes from amygdala‐kindled animals. Hippocampal synaptic glutamate release was measured in vivo with a unique microelectrode array (MEA) that uses glut... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5499751 Fri, 09 Dec 2011 05:00:00 +0100 5499751 http://www.medworm.com/index.php?rid=5499750&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03346.x SummaryPurpose:  Dravet syndrome (DS), a devastating epileptic encephalopathy, is mostly caused by mutations of the SCN1A gene, coding for the voltage‐gated Na+ channel NaV1.1 α subunit. About 50% of SCN1A DS mutations truncate NaV1.1, possibly causing complete loss of its function. However, it has not been investigated yet if NaV1.1 truncated mutants are dominant negative, if they impair expression or function of wild‐type channels, as it has been shown for truncated mutants of other proteins (e.g., CaV channels). We studied the effect of two DS truncated NaV1.1 mutants, R222* and R1234*, on coexpressed wild‐type Na+ channels.Methods:  We engineered R222* or R1234* in the human cDNA of NaV1.1 (hNaV1.1) and studied their effect on coexpressed wild‐type hNaV1.1, hNaV1.2 or hNaV... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5499750 Fri, 09 Dec 2011 05:00:00 +0100 5499750 http://www.medworm.com/index.php?rid=5499749&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03348.x SummaryPurpose:  To investigate the effects of low frequency stimulation (LFS) of a fiber tract for the suppression of spontaneous seizures in a rat model of human temporal lobe epilepsy.Methods:  Stimulation electrodes were implanted into the ventral hippocampal commissure (VHC) in a rat post‐status epilepticus (SE) model of human temporal lobe epilepsy (n = 7). Two recording electrodes were placed in the CA3 regions bilaterally and neural data were recorded for a minimum of 6 weeks. LFS (60 min train of 1 Hz biphasic square wave pulses, each 0.1 ms in duration and 200 μA in amplitude, followed by 15 min of rest) was applied to the VHC for 2 weeks, 24 h a day.Key Findings:  The baseline mean seizure frequency of the study animals was 3.7 seizures per day. The ... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5499749 Fri, 09 Dec 2011 05:00:00 +0100 5499749 http://www.medworm.com/index.php?rid=5499748&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03347.x SummaryPurpose:  Psychogenic nonepileptic seizures (PNES) are among the most common clinical manifestations of conversion disorder and consist of paroxysmal behavior that resembles epileptic seizures. Preliminary data from functional neuroimaging studies gave plausible evidence that limbic circuits and sensorimotor cortex might be engaged in conversion disorder. Nonetheless, no advanced magnetic resonance imaging (MRI) studies have focused on patients with PNES.Methods:  We enrolled 20 consecutive patients in whom the diagnosis of PNES was based on ictal video–electroencephalography (EEG) of the habitual episodes and 40 healthy subjects matched for age and sex All patients underwent a formal neuropsychological investigation and a neuropsychiatric assessment. All of the patients also ... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5499748 Fri, 09 Dec 2011 05:00:00 +0100 5499748 http://www.medworm.com/index.php?rid=5499747&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03349.x SummaryThe clinical anticipation in Japanese benign adult familial myoclonus epilepsy (BAFME), defined as earlier onset age of either cortical tremor or generalized seizures or new appearance of those symptoms in the next generation, remains unknown. The onset age and the degree of both cortical tremor and generalized seizures were investigated in nine patients of four BAFME families (mean age: 46.6 ± 18.7 years). Clinical anticipation in the onset age of cortical tremor or generalized seizures was observed in three families, and generalized seizures newly appeared in the next generation in those two families and in another family. Clinical anticipation was observed in four families, which suggests the clinical progression over generation in Japanese BAFME families. (Source: Epileps... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5499747 Thu, 01 Dec 2011 05:00:00 +0100 5499747 http://www.medworm.com/index.php?rid=5482775&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03374.x (Source: Epilepsia) Epilepsia journals http://www.medworm.com/rss/comments.php?id=5482775 Thu, 01 Dec 2011 05:00:00 +0100 5482775 http://www.medworm.com/index.php?rid=5482774&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03305.x (Source: Epilepsia) Epilepsia journals http://www.medworm.com/rss/comments.php?id=5482774 Thu, 01 Dec 2011 05:00:00 +0100 5482774 http://www.medworm.com/index.php?rid=5482773&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03219.x SummaryPurpose:  In patients with drug‐refractory focal epilepsy, nonlesional magnetic resonance imaging (MRI) or discordant data of presurgical standard investigations leads to failure generating a sufficient hypothesis for electrode implantation or epilepsy surgery. The seizure‐onset zone can be further investigated by subtraction ictal single‐photon emission computed tomography (SPECT) coregistered to MRI (SISCOM). This is an observational study of a large consecutive cohort of patients undergoing prospective SISCOM to generate hypothesis for electrode implantation or site of epilepsy surgery.Methods:  One hundred seventy‐five consecutive patients undergoing presurgical evaluation with either nonlesional MRI or discordant data of standard investigations preventing the genera... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5482773 Thu, 01 Dec 2011 05:00:00 +0100 5482773 http://www.medworm.com/index.php?rid=5482772&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03325.x SummaryPurpose:  To evaluate the relative contribution of demographic and epilepsy‐related variables, depressive symptoms, and adverse effects (AEs) of antiepileptic drugs (AEDs) to health‐related quality of life (HRQOL) in adults with pharmacoresistant epilepsy.Methods:  Individuals with epilepsy whose seizures failed to respond to at least one AED were enrolled consecutively at 11 tertiary referral centers. HRQOL was assessed by the Quality of Life in Epilepsy Inventory‐31 (QOLIE‐31), AEs by the Adverse Event Profile (AEP), and depressive symptoms by the Beck Depression Inventory‐II (BDI‐II). Multivariate linear regression models were used to identify variables associated with QOLIE‐31 total score and subscale scores.Key Findings:  Of 933 enrolled individuals aged 16�... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5482772 Thu, 01 Dec 2011 05:00:00 +0100 5482772 http://www.medworm.com/index.php?rid=5482771&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03375.x (Source: Epilepsia) Epilepsia journals http://www.medworm.com/rss/comments.php?id=5482771 Thu, 01 Dec 2011 05:00:00 +0100 5482771 http://www.medworm.com/index.php?rid=5482770&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03324.x (Source: Epilepsia) Epilepsia journals http://www.medworm.com/rss/comments.php?id=5482770 Thu, 01 Dec 2011 05:00:00 +0100 5482770 http://www.medworm.com/index.php?rid=5482769&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03337.x SummaryPurpose:  The adenosinergic system is known to exert an inhibitory affect in the brain, and as such adenosine has been considered an endogenous anticonvulsant. Entorhinal cortex (EC) layer II neurons, which serve as the primary input to the hippocampus, are spared in temporal lobe epilepsy (TLE) and become hyperexcitable. Because these neurons also express adenosine receptors, the activity of these neurons may be controlled by adenosine, specifically during seizure activity when adenosine levels are thought to rise. In light of this, we determined if the actions of adenosine on medial EC (mEC) layer II stellate neurons are augmented in TLE and by which receptor subtype.Methods:  Horizontal brain slices were prepared from rats exhibiting spontaneous seizures (TLE) induced by elec... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5482769 Thu, 01 Dec 2011 05:00:00 +0100 5482769 http://www.medworm.com/index.php?rid=5465326&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03327.x SummaryDetermining a prognosis for functional recovery after prolonged status epilepticus can be difficult. Prior case studies have shown that despite seizure control, functional outcomes are typically poor unless a reversible cause is identified. Herein we present a case of idiopathic status epilepticus with a surprisingly good outcome after a 125‐day drug‐induced coma. (Source: Epilepsia) Epilepsia journals http://www.medworm.com/rss/comments.php?id=5465326 Tue, 29 Nov 2011 05:00:00 +0100 5465326 http://www.medworm.com/index.php?rid=5465325&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03329.x SummaryPurpose:  Presurgical language mapping in dominant hemisphere epilepsy to evaluate the risk of postoperative deficit is particularly difficult in children. Extraoperative invasive cortical stimulation can show some areas critical to language, but not all of them, due to scarce sampling, poor cooperation, cortical immaturity, or network reorganization, whereas functional magnetic resonance imaging (fMRI) displays entire networks involved in, but not necessarily critical to, language. In a homogeneous series of children with epilepsy, we compared the contributions of language fMRI and depth electrode stimulations to optimize language mapping.Methods:  Eight children (7.5–15.5 years) with left frontal or temporal epilepsy underwent language fMRI and language stimulation with de... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5465325 Tue, 29 Nov 2011 05:00:00 +0100 5465325 http://www.medworm.com/index.php?rid=5465324&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03332.x SummaryPurpose:  We studied geographic variation in age‐ and gender‐specific prevalence and incidence of epilepsy in four different areas of Taiwan.Methods:  By using large‐scale, National Health Insurance (NHI)–based data from 2000–2003 in Taiwan, we identified 131,287 patients diagnosed with epilepsy (ICD code 345) receiving at least of one of 11 antiepileptic drugs (AEDs). Information on age, gender, and location were also collected. The multivariable Poisson regression analysis was used to assess the heterogeneity of the morbidity of epilepsy in different regions. External data validation was also performed to assess the accuracy of capturing epilepsy cases through our NHI data set.Key Findings:  The age‐adjusted prevalence and incidence of epilepsy were 5.85 (per 1... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5465324 Tue, 29 Nov 2011 05:00:00 +0100 5465324 http://www.medworm.com/index.php?rid=5465323&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03333.x SummaryPurpose:  Patient studies have not provided consistent evidence for interictal neuronal hyperexcitability inside the seizure‐onset zone (SOZ). We hypothesized that gray matter (GM) loss could have important effects on neuronal firing, and quantifying these effects would reveal significant differences in neuronal firing inside versus outside the SOZ.Methods:  Magnetic resonance imaging (MRI) and computational unfolding of mesial temporal lobe (MTL) subregions was used to construct anatomic maps to compute GM loss in presurgical patients with medically intractable focal seizures in relation to controls. In patients, these same maps were used to locate the position of microelectrodes that recorded interictal neuronal activity. Single neuron firing and burst rates were evaluated i... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5465323 Tue, 29 Nov 2011 05:00:00 +0100 5465323 http://www.medworm.com/index.php?rid=5465322&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03334.x SummaryPurpose:  To estimate the incidence of sudden unexpected death in epilepsy (SUDEP) in Rogaland County, Norway, in the period August 1 1995–July 31 2005, and to investigate whether use of lamotrigine (LTG) was associated with increased risk in female patients or other subgroups.Methods:  SUDEP victims were identified from autopsy reports and data from the Norwegian Cause of Death Registry. In all cases where SUDEP was considered as a possible cause of death, the hospital records were also reviewed. For each deceased, at least three living patients with epilepsy were randomly selected as controls. The market share in defined daily doses was collected for each year to estimate the number of patient‐years at risk on each antiepileptic drug.Key Findings:  We identified 26 cases... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5465322 Tue, 29 Nov 2011 05:00:00 +0100 5465322 http://www.medworm.com/index.php?rid=5465321&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03343.x SummaryPurpose:  To report mortality, after a longer interval, in a cohort of patients with drug‐resistant epilepsy treated by temporal lobe surgery between 1975 and 1995. A previous audit of these patients ending December 1, 1997 observed a standardized mortality ratio (SMR) of 4.5.Methods:  We analyzed mortality in a cohort of 306 patients with temporal lobe epilepsy (TLE) who underwent temporal lobe resections between December 1, 1975 and December 1, 1995. Deaths occurring after December 1,1997 and until December 1, 2009 were evaluated. Medical records, death certificates, postmortem examination reports, coroner officer’s reports, and coroner’s inquest reports were sought, and causes of death were ascertained. Sudden unexpected death in epilepsy (SUDEP) cases were identified.K... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5465321 Tue, 29 Nov 2011 05:00:00 +0100 5465321 http://www.medworm.com/index.php?rid=5465327&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03331.x SummaryAlthough seizure control is a critical goal for persons with epilepsy (PWE) from the biomedical perspective, there is growing support for approaches that take into account the effect of epilepsy on the whole person (the biopsychosocial perspective). We hypothesized that PWE who report normal activity limitations due to epilepsy and poor social/emotional support would report poor mental health regardless of whether they report having seizures in the past 3 months or currently taking medication for their epilepsy. In 2005 and 2006, twenty‐two states asked about epilepsy in the Behavioral Risk Factor Surveillance System (BRFSS). A set of survey weight‐adjusted logistic regression analyses were conducted to examine self‐reported poor mental health. Our findings reveal that both ... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5465327 Wed, 16 Nov 2011 05:00:00 +0100 5465327 http://www.medworm.com/index.php?rid=5428992&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03306.x SummaryPurpose:  Adenosine kinase (ADK), a largely astrocyte‐based metabolic enzyme, regulates adenosine homeostasis in the brain. Overexpression of ADK decreases extracellular adenosine and consequently leads to seizures. We hypothesized that dysfunction in the metabolism of tumor astrocytes is related to changes in ADK expression and that those changes might be associated with the development of epilepsy in patients with tumors.Methods:  We compared ADK expression and cellular distribution in surgically removed tumor tissue (n = 45) and peritumoral cortex (n = 20) of patients with glial and glioneuronal tumors to normal control tissue obtained at autopsy (n = 11). In addition, we compared ADK expression in tumor patients with and without epilepsy. To investigate ADK exp... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5428992 Wed, 16 Nov 2011 05:00:00 +0100 5428992 http://www.medworm.com/index.php?rid=5428991&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03311.x This study clarified the features of acute encephalopathy in children with Dravet syndrome.Methods:  Through the mailing list of the Annual Zao Conference on Pediatric Neurology, we collected 15 patients with clinically diagnosed Dravet syndrome, who had acute encephalopathy, defined as a condition with decreased consciousness with or without other neurologic symptoms, such as seizures, lasting for >24 h in association with infectious symptoms.Key Findings:  There were seven boys and eight girls. A mutation of the SCN1A gene was present in nine (truncation in six and missense in three). The frequency of seizures during the 3 months before the onset of acute encephalopathy was monthly in seven children and none in three. The median age at the onset of acute encephalopathy was 44�... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5428991 Wed, 16 Nov 2011 05:00:00 +0100 5428991 http://www.medworm.com/index.php?rid=5428990&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03312.x SummaryPurpose:  Seizure‐like activities generated in anterior cingulate cortex (ACC) are usually classified as simple partial and are associated with changes in autonomic function, motivation, and thought. Previous studies have shown that thalamic inputs can modulate ACC seizure, but the exact mechanisms have not been studied thoroughly. Therefore, we investigated the role of thalamic inputs in modulating ACC seizure‐like activities. In addition, seizure onset and propagation are difficult to determine in vivo in ACC. We studied the spatiotemporal changes in epileptiform activity in this cortex in a thalamic–ACC slice to clearly determine seizure onset.Methods:  We used multielectrode array (MEA) recording and calcium imaging to investigate the modulatory effect of thalamic inpu... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5428990 Wed, 16 Nov 2011 05:00:00 +0100 5428990 http://www.medworm.com/index.php?rid=5428989&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03313.x SummaryPurpose:  By definition idiopathic generalized epilepsy (IGE) is not associated with structural abnormalities on conventional magnetic resonance imaging (MRI). However, recent quantitative studies suggest white and gray matter alterations in IGE. The purpose of this study was to investigate whether there are white and/or gray matter structural differences between controls and two subsets of IGE, namely juvenile myoclonic epilepsy (JME) and IGE with generalized tonic–clonic seizures only (IGE‐GTC).Methods:  We assessed white matter integrity and gray matter volume using diffusion tensor tractography–based analysis of fractional anisotropy and voxel‐based morphometry, respectively, in 25 patients with IGE, all of whom had experienced generalized tonic–clonic convulsions.... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5428989 Wed, 16 Nov 2011 05:00:00 +0100 5428989 http://www.medworm.com/index.php?rid=5428988&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03314.x SummaryPurpose:  Convenient and effective methods for administering potential antiepileptic drugs (AEDs) chronically should facilitate many experiments in animal models of chronic epilepsy with spontaneous recurrent seizures. This proof‐of‐principle study aimed to optimize a once‐per‐day, drug‐in‐food protocol by testing the effect of carbamazepine (CBZ) on the frequency of convulsive seizures in rats with kainate‐induced epilepsy.Methods:  Adult male rats were given repeated low‐dose kainate injections until convulsive status epilepticus persisted for >3 h. After the rats developed spontaneous recurrent seizures, food pellets with CBZ (30, 100, or 300 mg/kg/day) were provided once per day in three 2‐week trials (n = 7–9 rats) involving 5 days of CBZ or... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5428988 Wed, 16 Nov 2011 05:00:00 +0100 5428988 http://www.medworm.com/index.php?rid=5428987&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03315.x SummaryPurpose:  Dentate granule cell axon (mossy fiber) sprouting creates an aberrant positive‐feedback circuit that might be epileptogenic. Presumably, mossy fiber sprouting is initiated by molecular signals, but it is unclear whether they are expressed transiently or persistently. If transient, there might be a critical period when short preventative treatments could permanently block mossy fiber sprouting. Alternatively, if signals persist, continuous treatment would be necessary. The present study tested whether temporary treatment with rapamycin has long‐term effects on mossy fiber sprouting.Methods:  Mice were treated daily with 1.5 mg/kg rapamycin or vehicle (i.p.) beginning 24 h after pilocarpine‐induced status epilepticus. Mice were perfused for anatomic evaluation ... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5428987 Wed, 16 Nov 2011 05:00:00 +0100 5428987 http://www.medworm.com/index.php?rid=5428986&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03317.x This study was designed to determine whether seizures can lead to changes in somatosensory representations and whether those changes are persistent.Methods:  Twice‐daily seizures were elicited by delivering 1 s of electrical stimulation through carbon fiber electrodes implanted in both the corpus callosum and sensorimotor neocortex of young adult male Long‐Evans rats until a total of 20 seizures were elicited. Either 1–3 days or 3–5 weeks following the last seizure, functional magnetic resonance imaging (MRI) was used to image the brain during electrical stimulation of each forepaw independently.Key Findings:  Forepaw stimulation in control rats resulted in a focused and contralateral fMRI signal in the somatosensory neocortex. Rats that had repeated seizures had a 151% i... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5428986 Wed, 16 Nov 2011 05:00:00 +0100 5428986 http://www.medworm.com/index.php?rid=5428985&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03318.x SummaryThe rapid achievement of effective levels of antiepileptic drugs (AEDs) is required in patients with epilepsy who have a higher risk of seizures, and oral loading of AEDs may be an important consideration in these patients. We performed the present study to investigate the efficacy and tolerability of oral loading of oxcarbazepine in patients with recurrent seizures, or after temporary discontinuation of AEDs for diagnostic or presurgical evaluation of epilepsy. Forty adult patients were studied and oxcarbazepine was administered orally at a single loading dosage of 30 mg/kg. The plasma levels of oxcarbazepine and its active metabolite, 10,11‐dihydro‐10‐hydroxy‐carbazepine (monohydroxy derivative, MHD), were measured, and clinical assessment of adverse events was performed... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5428985 Wed, 16 Nov 2011 05:00:00 +0100 5428985 http://www.medworm.com/index.php?rid=5428984&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03319.x SummaryIntermittent photic stimulation (IPS) is a common procedure performed in the electroencephalography (EEG) laboratory in children and adults to detect abnormal epileptogenic sensitivity to flickering light (i.e., photosensitivity). In practice, substantial variability in outcome is anecdotally found due to the many different methods used per laboratory and country. We believe that standardization of procedure, based on scientific and clinical data, should permit reproducible identification and quantification of photosensitivity. We hope that the use of our new algorithm will help in standardizing the IPS procedure, which in turn may more clearly identify and assist monitoring of patients with epilepsy and photosensitivity. Our algorithm goes far beyond that published in 1999 (Epileps... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5428984 Wed, 16 Nov 2011 05:00:00 +0100 5428984 http://www.medworm.com/index.php?rid=5428983&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03320.x We describe an elderly population with newly diagnosed epileptic seizures using data from the EPIREUN study conducted between July 1, 2004 and June 30, 2005. The methodology is described in detail in the EPIREUN study report (Mignard et al., 2009).Key Findings:  There were 153 single unprovoked seizures (84.1%); their incidence was 278.1 [95% confidence interval (CI) 237.4–325.9] per 100,000. The incidence of newly diagnosed epilepsy was 125.4 (95% CI, 99.1–158.8) per 100,000. Twenty‐eight acute symptomatic seizures occurred (15.4%); the incidence was 50.9 (95% CI 35.1–73.7) per 100,000. The annual incidence of newly diagnosed epileptic seizure in the elderly was 330.8 (95% CI 286.1–382.6) per 100,000: 403.0 (95% CI 328.5–494.3) per 100,000 in men and 279.6 (95% CI, 227.4–... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5428983 Wed, 16 Nov 2011 05:00:00 +0100 5428983 http://www.medworm.com/index.php?rid=5428982&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03322.x SummaryTopiramate is an antiepileptic drug that has marked treatment‐limiting side effects on specific aspects of cognitive performance in both patients and healthy volunteers. Because these severe side effects occur only in certain individuals, identifying genetic or environmental variables that influence cognitive response would be of great utility in determining whether to administer this drug to a patient. We gave an acute 100 mg oral dose of topiramate to 158 healthy volunteers and measured how the drug changed their performance on a diverse battery of cognitive tests. We found a wide range of responses to topiramate, and we demonstrated that not all tests in the battery were equally affected. There was no correlation between the effect of topiramate and either education level or ... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5428982 Wed, 16 Nov 2011 05:00:00 +0100 5428982 http://www.medworm.com/index.php?rid=5428981&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03323.x SummaryPurpose:  To examine baseline and prospective (2‐year) changes in third, fourth, and lateral ventricle volumes in children with new‐onset idiopathic epilepsies and controls (age 8–18 years).Methods:  Structural magnetic resonance imaging (MRI) were collected from children with idiopathic generalized epilepsy (IGE, n = 29), idiopathic localization‐related epilepsy (ILRE, n = 30), and healthy controls (HCs, n = 49). Volumes of the third, fourth, and lateral ventricles were derived and compared across groups, followed by shape analyses, to identify specific regions of ventricular abnormality. Of the initial cohort, a consecutive sample of 71 children returned 2 years later for reimaging and determination of progressive changes in the ventricular system.Key Fin... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5428981 Wed, 16 Nov 2011 05:00:00 +0100 5428981 http://www.medworm.com/index.php?rid=5428980&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03328.x SummaryIn sedation of dental patients with moderate or severe mental retardation, it is difficult to identify the optimum sedation level and to maintain it appropriately. Moreover, many patients have concomitant epilepsy and are medicated with oral antiepileptic drugs (AEDs), which influence the drug‐metabolizing enzymes. In particular, valproate (VPA) has been demonstrated to inhibit propofol metabolism in vitro. Therefore, the objective of the present study was to investigate the clinical influence of oral VPA on the required dose of propofol for sedation, with use of a prospective cohort study design. We studied 45 patients with moderate or severe mental retardation who underwent dental treatment under sedation. Propofol was infused, and sedation was maintained at the same level in al... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5428980 Wed, 16 Nov 2011 05:00:00 +0100 5428980 http://www.medworm.com/index.php?rid=5428979&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03326.x SummaryPurpose:  Methylmalonic acidemias are inherited metabolic disorders characterized by methylmalonate (MMA) accumulation and neurologic dysfunction, including seizures. It is known that metabolic crises in affected patients are precipitated by infections. Although growing evidence supports that inflammation facilitates seizures, it is not known whether inflammatory mediators facilitate MMA‐induced seizures. Therefore, in this study we investigate the involvement of cyclooxygenase‐2 (COX‐2) and prostaglandin E2 (PGE2) in MMA‐induced seizures.Methods:  Adult male Wistar rats were implanted with electrodes over the parietal cortex for electroencephalography (EEG) recording and a cannula in the right lateral ventricle. Animals were injected with PGE2 (100 ng/2 μl, i.c.v.)... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5428979 Wed, 16 Nov 2011 05:00:00 +0100 5428979 http://www.medworm.com/index.php?rid=5428993&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03316.x SummaryPurpose:  Long‐term therapy with antiepileptic drugs (AEDs) has been associated with metabolic consequences that lead to an increase in risk of atherosclerosis in patients with epilepsy. We compared the long‐term effects of monotherapy using different categories of AEDs on markers of vascular risk and the atherosclerotic process.Methods:  One hundred sixty adult patients who were receiving AED monotherapy, including two enzyme‐inducers (carbamazepine, CBZ; and phenytoin, PHT), an enzyme‐inhibitor (valproic acid, VPA), and a noninducer (lamotrigine, LTG) for more than 2 years, and 60 controls were enrolled in this study. All study participants received measurement of common carotid artery (CCA) intima media thickness (IMT) by B‐mode ultrasonography to assess the exten... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5428993 Tue, 15 Nov 2011 05:00:00 +0100 5428993 http://www.medworm.com/index.php?rid=5364014&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03295.x SummaryPurpose:  To validate the use of 18F‐fluorodeoxyglucose–positron emission tomography/magnetic resonance imaging (FDG‐PET/MRI) coregistration for epileptogenic zone detection in children with MRI nonlesional refractory epilepsy and to assess its ability to guide a second interpretation of the MRI studies.Methods:  Thirty‐one children with refractory epilepsy whose MRI results were nonlesional were included prospectively. All patients underwent presurgical evaluation following the standard protocol of our epilepsy unit, which included FDG‐PET and FDG‐PET/MRI coregistration. Cerebral areas of decreased uptake in PET and PET/MRI fusion images were compared visually and then contrasted with presumed epileptogenic zone localization, which had been obtained from other clini... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5364014 Wed, 02 Nov 2011 04:00:00 +0100 5364014 http://www.medworm.com/index.php?rid=5364013&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03296.x SummarySudden unexpected death in epilepsy (SUDEP) has on rare occasions occurred during electroencephalography (EEG) telemetry, and in such cases postictal EEG suppression (PI EEG‐SUP) was frequently observed. More recently a retrospective case–control study reported this pattern as a risk factor for SUDEP. We retrospectively audited frequency and electroclinical features of this pattern as well as immediate management following tonic–clonic seizures during telemetry. Forty‐eight patients with tonic–clonic seizures were identified from 470 consecutive EEG‐videotelemetry reports. Thirteen patients (27%) with PI EEG‐SUP (mean duration 38.1 s, range 6–69 s, median 38 s) were compared to 12 randomly selected controls. One seizure was analyzed per individual. Those with P... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5364013 Wed, 02 Nov 2011 04:00:00 +0100 5364013 http://www.medworm.com/index.php?rid=5364012&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03297.x SummaryThe induction of neuronal apoptosis throughout many regions of the developing rat brain by phenobarbital and phenytoin, two drugs commonly used for the treatment of neonatal seizures, has been well documented. However, several limbic regions have not been included in previous analyses. Because drug‐induced damage to limbic brain regions in infancy could contribute to emotional and psychiatric sequelae, it is critical to determine the extent to which these regions are vulnerable to developmental neurotoxicity. To evaluate the impact of antiepileptic drug (AED) exposure on limbic nuclei, we treated postnatal day 7 rat pups with phenobarbital, phenytoin, carbamazepine, or vehicle, and examined nucleus accumbens, septum, amygdala, piriform cortex, and frontal cortex for cell death. ... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5364012 Wed, 02 Nov 2011 04:00:00 +0100 5364012 http://www.medworm.com/index.php?rid=5364011&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03298.x SummarySurgical resection of the hippocampus is the most successful treatment for medication‐refractory medial temporal lobe epilepsy (MTLE) due to hippocampal sclerosis. Unfortunately, at least one of four operated patients continue to have disabling seizures after surgery, and there is no existing method to predict individual surgical outcome. Prior to surgery, patients who become seizure free appear identical to those who continue to have seizures after surgery. Interestingly, newly converging presurgical data from magnetic resonance imaging (MRI) and intracranial electroencephalography (EEG) suggest that the entorhinal and perirhinal cortices may play an important role in seizure generation. These areas are not consistently resected with surgery and it is possible that they continue ... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5364011 Wed, 02 Nov 2011 04:00:00 +0100 5364011 http://www.medworm.com/index.php?rid=5364010&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03299.x In this study, we confirm a direct correlation between the rhythmic activities in the DNFFV and HFS using intraoperative electroencephalography (EEG) and electromyography (EMG) monitoring. Our results support the theory that a DNFFV provokes ipsilateral HFS via the facial nerve nucleus. (Source: Epilepsia) Epilepsia journals http://www.medworm.com/rss/comments.php?id=5364010 Wed, 02 Nov 2011 04:00:00 +0100 5364010 http://www.medworm.com/index.php?rid=5364009&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03300.x SummaryPurpose:  To evaluate the long‐term efficacy and tolerability of adjunctive levetiracetam (LEV) in patients with uncontrolled idiopathic generalized epilepsy (IGE).Methods:  This phase III, open‐label, long‐term, follow‐up study (N167; NCT00150748) enrolled patients (4 to <65 years) with primary generalized seizures (tonic–clonic, myoclonic, absence). Patients received adjunctive LEV at individualized doses (1,000–4,000 mg/day; 20–80 mg/kg/day for children/adolescents weighing <50 kg). Efficacy results are reported for all seizure types [intention‐to‐treat (ITT) population, N = 217] and subpopulations with tonic–clonic (n = 152), myoclonic (n = 121), and/or absence (n = 70) seizures at baseline.Key Findings:  One hundred twenty... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5364009 Wed, 02 Nov 2011 04:00:00 +0100 5364009 http://www.medworm.com/index.php?rid=5364008&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03301.x Summary15q13.3 microdeletions are the most common genetic findings identified in idiopathic generalized epilepsies to date, and they are present in up to 1% of patients. In addition, 15q13.3 microdeletions have been described in patients with epilepsy as part of a complex neurodevelopmental phenotype. We analyzed a cohort of 570 patients with various pediatric epilepsies for 15q13.3 microdeletions. Screening was performed using quantitative polymerase chain reaction; deletions were confirmed by array comparative genomic hybridization (CGH). We carried out detailed phenotyping of deletion carriers. In total, we identified four pediatric patients with 15q13.3 microdeletions, including one previously described patient. Two of four deletions were de novo, one deletion was inherited from an una... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5364008 Wed, 02 Nov 2011 04:00:00 +0100 5364008 http://www.medworm.com/index.php?rid=5364007&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03302.x In conclusion, the helix B–derived erythropoietin peptide pHBSP can modulate the cellular and cognitive consequences of a status epilepticus. The impact of pHBSP on spatial learning might indicate that the peptide allows beneficial effects on epileptogenesis‐associated cognitive deficits. However, it needs to be considered that learning deficits were not abolished by pHBSP and that the effects were not observed consistently until the end of the study. Therefore, adjustment of timing, duration, and dose of peptide administration might be necessary to further evaluate the efficacy of pHBSP. (Source: Epilepsia) Epilepsia journals http://www.medworm.com/rss/comments.php?id=5364007 Wed, 02 Nov 2011 04:00:00 +0100 5364007 http://www.medworm.com/index.php?rid=5364006&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03304.x SummaryEpilepsy with myoclonic absences (EMA) is a rare form of generalized epilepsy occurring in childhood and is often difficult to treat. The underlying etiology of EMA is unknown in the majority of patients. Herein, we describe a patient with EMA and intellectual disability who carries a de novo balanced translocation: t(6;22)(p21.32;q11.21). We mapped the translocation breakpoints by fluorescence in situ hybridization (FISH), and the breakpoint at 6p21.32 was found to truncate the N‐methyl‐d‐aspartate (NMDA)–receptor associated gene SYNGAP1. The breakpoint at 22q11.21 was within a highly variable region without known protein‐coding genes. Mutations of SYNGAP1 are associated with nonsyndromal intellectual disability (NSID). Two‐thirds of the patients described so far also h... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5364006 Wed, 02 Nov 2011 04:00:00 +0100 5364006 http://www.medworm.com/index.php?rid=5364005&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03307.x We describe the clinical and neurophysiologic features of PME associated with SCARB2 mutations without renal impairment.Methods:  Clinical and neurophysiologic investigations, including wakefulness and sleep electroencephalography (EEG), polygraphic recording (with jerk‐locked back‐averaging and analysis of the EEG–EMG (electromyography) relationship by coherence spectra and phase calculation), multimodal evoked potentials, and electromyography were performed on five Italian patients with SCARB2 mutations.Key Findings:  The main clinical features were adolescent–young adulthood onset, progressive action myoclonus, ataxia, absence of cognitive deterioration and, in most cases, epilepsy. The severity of the epilepsy could vary from uncontrolled seizures and status epilepticus in ... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5364005 Wed, 02 Nov 2011 04:00:00 +0100 5364005 http://www.medworm.com/index.php?rid=5364004&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03309.x We examined the relationships among verbal memory performance, depression, and 5HT1A‐receptor binding measured with 18F‐trans‐4‐fluoro‐N‐2‐[4‐(2‐methoxyphenyl)piperazin‐1‐yl]ethyl‐N‐(2‐pyridyl) cyclohexane carboxamide (18FCWAY) PET in a cross‐sectional study.Methods:  We studied 40 patients (24 male; mean age 34.5 ± 10.7 years) with TLE. Seizure diagnosis and focus localization were based on ictal video–electroencephalography (EEG) recording. Patients had neuropsychological testing with Wechsler Adult Intelligence Score III (WAIS III) and Wechsler Memory Score III (WMS III) on stable antiepileptic drug (AED) regimens at least 24 h since the last seizure. Beck Depression Inventory (BDI) scores were obtained. We performed interictal PET with 18FCWAY, ... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5364004 Wed, 02 Nov 2011 04:00:00 +0100 5364004 http://www.medworm.com/index.php?rid=5364003&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03308.x SummaryReproductive factors are associated with seizures in women with epilepsy. We prospectively examined the association between reproductive factors and the risk of adult‐onset isolated seizure, epilepsy, or any unprovoked seizure (defined as single unprovoked seizure or epilepsy) among 114,847 Nurses’ Health Study II participants followed from 1989 to 2005. Validated seizure questionnaires and medical records were used to confirm incident cases of isolated seizure (n = 95) or epilepsy (n = 151). Overall, there were no significant associations between any reproductive factor and risk of any unprovoked seizure (n = 196). However, menstrual irregularity at ages 18–22 years was specifically associated with an increased risk of epilepsy [relative risk (RR) 1.67, 95% co... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5364003 Wed, 02 Nov 2011 04:00:00 +0100 5364003 http://www.medworm.com/index.php?rid=5364021&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03336.x (Source: Epilepsia) Epilepsia journals http://www.medworm.com/rss/comments.php?id=5364021 Tue, 01 Nov 2011 04:00:00 +0100 5364021 http://www.medworm.com/index.php?rid=5364020&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03285.x (Source: Epilepsia) Epilepsia journals http://www.medworm.com/rss/comments.php?id=5364020 Tue, 01 Nov 2011 04:00:00 +0100 5364020 http://www.medworm.com/index.php?rid=5364019&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03275.x (Source: Epilepsia) Epilepsia journals http://www.medworm.com/rss/comments.php?id=5364019 Tue, 01 Nov 2011 04:00:00 +0100 5364019 http://www.medworm.com/index.php?rid=5364018&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03211.x SummaryPurpose:  We evaluated the ability of the ketogenic diet (KD) to improve thresholds to flurothyl‐induced seizures in two mouse lines with Scn1a mutations: one that models Dravet syndrome (DS) and another that models genetic (generalized) epilepsy with febrile seizures plus (GEFS+).Methods:  At postnatal day 21, mouse models of DS and GEFS+ were fasted for 12–14 h and then placed on either a 6:1 (fats to proteins and carbohydrates) KD or a standard diet (SD) for 2 weeks. At the end of the 2‐week period, we measured thresholds to seizures induced by the chemiconvulsant flurothyl. Body weight, β‐hydroxybutyrate (BHB) levels, and glucose levels were also recorded every 2 days over a 2‐week period in separate cohorts of mutant and wild‐type mice that were either ... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5364018 Tue, 01 Nov 2011 04:00:00 +0100 5364018 http://www.medworm.com/index.php?rid=5364017&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03198.x SummaryPurpose:  We assessed lateralization of interictal epileptiform discharges (IEDs) in children with intractable epilepsy secondary to tuberous sclerosis complexes (TSCs) during rapid eye movement sleep (R), compared with non–rapid eye movement sleep (NR) and wakefulness (W), to determine epileptogenicity of R‐IEDs.Methods:  We retrospectively studied 23 children with TSC, who underwent prolonged scalp video–electroencephalography (EEG) and magnetic resonance imaging (MRI). We determined the lateralization of ictal EEG, clinical semiology, and the largest tuber on MRI. We analyzed a minimum of 100 IEDs during R, NR, and W to classify right/left/generalized spikes to compare the lateralization with ictal EEG, clinical semiology, and MRI.Key Findings:  R‐IEDs were laterali... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5364017 Tue, 01 Nov 2011 04:00:00 +0100 5364017 http://www.medworm.com/index.php?rid=5364016&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03272.x SummaryPurpose:  The present study aims to describe the cognitive profile of children with medically refractory extratemporal epilepsies who undergo focal surgery and to identify determinants for preoperative and postoperative cognitive level.Methods:  This is a retrospective cohort study. Children who underwent operations between 1997 and 2008 with a focal lesion in frontal, parietal, or occipital cortices and with a presurgical or postsurgical cognitive evaluation, were eligible for the study.Key Findings:  Sixty‐six children (53% male) with a mean age of 9.3 ± 8.8 years were enrolled. The overall full‐scale IQ (FSIQ) at cognitive testing was 77.4 ± 44.4 before surgery. Children did not show any significant change in their FSIQ after surgery. Duration of presurgical... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5364016 Tue, 01 Nov 2011 04:00:00 +0100 5364016 http://www.medworm.com/index.php?rid=5364002&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03310.x We describe a case of focal seizures secondary to cortical dysplasia presenting with bilateral pupillary miosis, rendered seizure free by resective surgery. The seizure‐onset zone was localized within the left middle parietal gyrus by intracranial electrographic recording. Seizure onset was coincident with focal left centroparietal fast spike activity on electroencephalography (EEG). A large region of the left frontocentral cortical dysplasia was demonstrated on magnetic resonance imaging (MRI). Complete resection of the area of cortical dysplasia and additional cortical regions of ictal activity, identified using intracranial EEG, rendered the patient seizure free. (Source: Epilepsia) Epilepsia journals http://www.medworm.com/rss/comments.php?id=5364002 Tue, 01 Nov 2011 04:00:00 +0100 5364002 http://www.medworm.com/index.php?rid=5364015&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03294.x SummaryPurpose:  Epilepsy may have far‐reaching consequences for patients, other than having seizures and medication. At 15 years after diagnosis, this study investigates health perception, restrictions due to epilepsy, living arrangements (including marital status and offspring), and the educational and occupational attainment of patients with childhood‐onset epilepsy.Methods:  A total of 453 patients with epilepsy had a 5‐year follow‐up since diagnosis with regular visits and data collection. Ten years later, a questionnaire addressing epilepsy was completed by 413 patients, resulting in a mean follow‐up of 15 years. Subjects were compared with age peers of the Dutch population for each etiologic group separately, and also for subjects with/without a 5‐year terminal rem... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5364015 Mon, 17 Oct 2011 04:00:00 +0100 5364015 http://www.medworm.com/index.php?rid=5334321&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03287.x SummaryThe ketogenic diet (KD) has been used to treat children with epilepsy who are resistant to antiepileptic drugs (AEDs) since the 1920s, and has undergone a resurgence in popularity over the last 15 years Its use in adolescents and adults has been more restrained. During the past few decades, more liberal regimens have emerged that may seem more attractive to older people while still proving effective, often independent of ketone levels. The KD and its variants may lead to similar reductions in seizure frequency in adolescents and adults as seen in children, although studies are limited and of poor quality. A total of only 122 adults and 82 adolescents have been included in open‐label studies on the KD, and only 56 adults and 10 adolescents on the Modified Atkins Diet. Side effects ... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5334321 Mon, 17 Oct 2011 04:00:00 +0100 5334321 http://www.medworm.com/index.php?rid=5334320&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03288.x SummaryThe International League Against Epilepsy (ILAE) standardized classification and terminology for “epileptic seizures” of 1981 and “epilepsies and epileptic syndromes” of 1989 provide a fundamental framework for organizing and differentiating the epilepsies. However, a revision of these classifications is mandated by recent major technologic and scientific advances. Since 1997, the relevant ILAE Commissions have made significant efforts to achieve better and internationally uniform classifications as reflected in their reports of 2001, 2006, and 2010. Their initial aim to construct a “new scientific classification from application of methods used in biology that determines separate species and natural classes” proved elusive and, therefore, the last Commission in their re... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5334320 Mon, 17 Oct 2011 04:00:00 +0100 5334320 http://www.medworm.com/index.php?rid=5334319&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03289.x SummaryKetogenic diet (KD) is known to be effective in intractable epilepsy. However, the role of KD in refractory status epilepticus (RSE) has not been well described. The aim of this study is to explore the role of KD in patients with RSE. We retrospectively reviewed the medical records of four children and one adult with RSE between October 2006 and August 2010. All presented with status epilepticus (SE) that was presumed to be associated with viral encephalitis. After we failed to control the seizures with standard measures for SE, we tried KD. The overall seizure frequency decreased to <50% of baseline in median eight (1–19) days. At one month of KD, two patients were seizure‐free, one patient showed >90% seizure reduction, and the others had >75% decrease without general... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5334319 Mon, 17 Oct 2011 04:00:00 +0100 5334319 http://www.medworm.com/index.php?rid=5334318&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03290.x SummaryPurpose:  To evaluate morning dream recall frequency and content in patients with temporal lobe epilepsy (TLE).Methods:  Fifty‐two patients with pharmacoresistant TLE submitted to a written dream diary during five consecutive days and continuous video–electroencephalographic (video‐EEG) monitoring. A matched control group of 41 healthy subjects completed the same diary at home. The number of recalled dreams (including long dreams) and nonrecalled dream mentation were collected, and the Dream Recall Rate (DRR) was calculated. Hall and Van de Castle dream content analysis was performed.Key Findings:  Greater than 70% of patients with TLE (37 of 52) recall their dreams, but DRR rate in these patients is lower than in controls (p ≤ 0.001). Dream recall does not appear ... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5334318 Mon, 17 Oct 2011 04:00:00 +0100 5334318 http://www.medworm.com/index.php?rid=5334317&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03291.x We examined the indications for monitoring, the clinical characteristics of monitored patients, the occurrence and timing of seizures, and clinical and EEG characteristics associated with nonconvulsive seizures.Key Findings:  One hundred twenty‐one patients underwent diagnostic continuous EEG monitoring, for a mean duration of 26 h. Seizures were detected in 32% of these patients, of which 90% experienced some nonconvulsive seizures, and 72% experienced exclusively nonconvulsive seizures. Patients with nonconvulsive seizures had significantly greater odds of having acute epilepsy, acute structural brain injury, prior in‐hospital convulsive seizures, and the presence of interictal epileptiform abnormalities on EEG.Significance:  Seizures are common among critically ill children un... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5334317 Mon, 17 Oct 2011 04:00:00 +0100 5334317 http://www.medworm.com/index.php?rid=5334316&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03292.x SummaryPurpose:  To develop an epilepsy‐specific comorbidity risk adjustment index for mortality outcomes research.Methods:  Data were extracted from five linked administrative databases in Calgary, Canada from April 1, 1996 to March 31, 2004. Epilepsy patients were defined using a validated ICD‐9‐CM– and ICD‐10‐CA–based case definition. An epilepsy‐specific comorbidity index was developed using comorbidities from the Charlson and Elixhauser indexes and other relevant epilepsy comorbidities. In the final model, 14 comorbidities significantly associated with mortality remained and each was assigned a value of 1–6 based on the hazard ratio from the survival analysis. Total prognostic scores were calculated and compared for all subjects using the epilepsy‐specific inde... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5334316 Mon, 17 Oct 2011 04:00:00 +0100 5334316 http://www.medworm.com/index.php?rid=5334315&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03293.x SummaryIn this review, we report a case of an adolescent girl presenting with epileptic encephalopathy preceded by febrile illness, demarcate the clinical phenotypic homogeneity among previously reported cases, and hypothesize on potential mechanisms based on current experimental evidence. Our literature review revealed >249 cases that share several main features: febrile illness with no preceding condition, negative laboratory studies including cerebrospinal fluid (CSF) analysis, status epilepticus refractory to conventional pharmacotherapy, and long‐term developmental delays. This condition appears to have many names, the most recent of which is “FIRES” (fever‐induced refractory epileptic encephalopathy). It seems likely that the described cases are representing the same entit... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5334315 Mon, 17 Oct 2011 04:00:00 +0100 5334315 http://www.medworm.com/index.php?rid=5284785&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03278.x This study investigated the relationship between cortical thinning, white matter compromise, epilepsy variables, and the side of seizure onset, in patients with TLE.Methods:  We performed diffusion tensor imaging tractography and cortical thickness analyses of 18 patients with left TLE (LTLE), 18 patients with right TLE (RTLE), and 36 controls. We investigated the relationship among brain structural abnormalities, side of seizure onset, age of seizure onset, and disease duration.Key Findings:  Patients with TLE displayed cortical thinning and white matter compromise, predominately on the side ipsilateral to the seizure onset. Relative to RTLE, patients with LTLE showed more widespread abnormalities, particularly in white matter fiber tracts. Greater compromise in white matter integrity... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5284785 Wed, 05 Oct 2011 04:00:00 +0100 5284785 http://www.medworm.com/index.php?rid=5284784&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03280.x SummaryPurpose:  Increased activity of mTOR Complex 1 (mTORC1) has been demonstrated in cortical dysplasia and tuberous sclerosis complex, as well as in animal models of epilepsy. Recent studies in such models revealed that inhibiting mTORC1 with rapamycin effectively suppressed seizure activity. However, seizures can recur after treatment cessation, and continuous rapamycin exposure can adversely affect animal growth and health. Here, we evaluated the efficacy of an intermittent rapamycin treatment protocol on epilepsy progression using neuron subset‐specific‐Pten (NS‐Pten) conditional knockout mice.Methods:  NS‐Pten knockouts were treated with a single course of rapamycin during postnatal weeks 4 and 5, or intermittently over a period of 5 months. Epileptiform activity was ... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5284784 Wed, 05 Oct 2011 04:00:00 +0100 5284784 http://www.medworm.com/index.php?rid=5284783&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03279.x SummaryPurpose:  To investigate the incidence and duration of transient hyperammonemia in seizures and to verify the significant confounders related to transient hyperammonemia in seizures.Methods:  One hundred twenty‐one noncirrhotic adult patients with seizures admitted to the emergency department were enrolled in the study. Laboratory examination was performed, including plasma ammonia level assessment. In addition, the basic parameters, underlying systemic diseases, and seizure‐related conditions were assessed. The patients were classified into a group with hyperammonemia on arrival and a group without, in order to compare seizure‐related adverse events that occurred during a 9‐month period.Key Findings:  The incidence of hyperammonemia in patients with seizures was 67.77... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5284783 Wed, 05 Oct 2011 04:00:00 +0100 5284783 http://www.medworm.com/index.php?rid=5284782&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03281.x SummaryPurpose:  The aim of this study was to evaluate phospholipid metabolism in patients with malformations of cortical development (MCDs).Methods:  Thirty‐seven patients with MCDs and 31 control subjects were studied using three‐dimensional phosphorus magnetic resonance spectroscopy (31P‐MRS) at 3.0 T. The voxels in the lesions and in the frontoparietal cortex of the control subjects were compared (the effective volumes were 12.5 cm3). Robust quantification methods were applied to fit the time‐domain data to the following resonances: phosphoethanolamine (PE); phosphocholine (PC); inorganic phosphate (Pi); glycerophosphoethanolamine (GPE); glycerophosphocholine (GPC); phosphocreatine (PCr); and α‐, β‐, and γ‐adenosine triphosphate (ATP). We also estimated the tot... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5284782 Wed, 05 Oct 2011 04:00:00 +0100 5284782 http://www.medworm.com/index.php?rid=5284781&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03282.x SummaryPurpose:  Guidelines for refractory epilepsy recommend timely referral of potential surgical candidates to an epilepsy center for evaluation. However, this approach is seldom a priority for treating neurologists, possibly because of inertia of previous practice and personal attitudes, leading to a buildup of psychosocial disabilities and increased risk of morbidity and mortality. The aim of this study was to assess knowledge and attitudes toward epilepsy surgery among practicing neurologists and identify the barriers that delay the treatment.Methods:  We surveyed 183 Italian adult and child neurologists with an ad hoc questionnaire exploring physicians’ willingness to refer patients for epilepsy surgery when such treatment may be indicated. Thirteen of 14 questions had graded ... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5284781 Wed, 05 Oct 2011 04:00:00 +0100 5284781 http://www.medworm.com/index.php?rid=5284780&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03283.x SummaryPurpose:  Failure to respond to the initial antiepileptic drug (AED) is a predictor of increased risk of pharmacoresistant epilepsy. Whether response to the first AED also predicts adverse health outcomes is unknown.Methods:  This longitudinal study compared rates of major adverse health outcomes (loss of driving privileges, unemployment, divorce/separation, injury, emergency room admission, hospitalization, and death) in 33 patients who failed the first AED (cases) and 30 patients who became seizure‐free with the first AED (controls). Patient data were obtained by chart review and confirmed through a structured interview with each subject at 5–7 years after starting AED treatment. We also assessed between‐group differences in quality of life, depression, and adverse AED... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5284780 Wed, 05 Oct 2011 04:00:00 +0100 5284780 http://www.medworm.com/index.php?rid=5284779&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03284.x SummaryDual‐sided subdural electrodes are used in the localization and lateralization of seizure‐onset zones when the area of interest is within the interhemispheric fissure. We designed the current study to test the validity of the assumption that each side of the dual‐sided electrodes records from the hemisphere it faces. We recorded with dual‐sided strip and grid electrodes implanted in the occipital interhemispheric space in two patients with nonoccipital epilepsy during two visual stimulation tasks in which subjects were presented with visual stimuli in the ipsilateral or contralateral visual hemifields. Our findings show substantial contamination of recordings from the opposite hemisphere. Although, as expected, electrodes recording through the falx record faintly from the co... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5284779 Wed, 05 Oct 2011 04:00:00 +0100 5284779 http://www.medworm.com/index.php?rid=5284791&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03303.x (Source: Epilepsia) Epilepsia journals http://www.medworm.com/rss/comments.php?id=5284791 Sat, 01 Oct 2011 04:00:00 +0100 5284791 http://www.medworm.com/index.php?rid=5284790&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03251.x (Source: Epilepsia) Epilepsia journals http://www.medworm.com/rss/comments.php?id=5284790 Sat, 01 Oct 2011 04:00:00 +0100 5284790 http://www.medworm.com/index.php?rid=5284789&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03201.x We describe five patients who presented with severe respiratory depression following benzodiazepine administration for seizures with autonomic manifestations. We also discuss the relationship between the complications observed in our patients and the rescue treatment. A reduction in the dosage of benzodiazepines in the setting of epileptic patients with predominant autonomic symptoms may need to be considered. (Source: Epilepsia) Epilepsia journals http://www.medworm.com/rss/comments.php?id=5284789 Sat, 01 Oct 2011 04:00:00 +0100 5284789 http://www.medworm.com/index.php?rid=5284788&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03204.x This study aimed to investigate efficacy and tolerability of intravenous (IV) lacosamide (LCM) in treatment of SC and SE. Data of patients with SE or SC who were treated with IV LCM between December 2009 and February 2011 in two Austrian centers were analyzed retrospectively. Clinical information was extracted from patients’ charts. Forty‐eight patients (26f/22m) aged median 62 years (range 17–95 years) were identified. Thirty‐five percent of patients (17 of 48) had SC and 65% (31 of 48) had SE. SE was nonconvulsive in 10 (32%), convulsive in 11 (36%), and focal in 10 (32%) patients. SE was acute symptomatic in six (20%) and remote symptomatic in 11 (35%) patients. Fourteen (45%) had preexisting epilepsy. Median initial bolus dose was 200 mg (range 200–400 mg) in patients... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5284788 Sat, 01 Oct 2011 04:00:00 +0100 5284788 http://www.medworm.com/index.php?rid=5284787&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03199.x SummaryPurpose:  High‐frequency oscillations (HFOs), termed ripples at 80–200 Hz and fast ripples (FRs) at >200/250 Hz, recorded by intracranial electroencephalography (EEG), may be a valuable surrogate marker for the localization of the epileptogenic zone. We evaluated the relationship of the resection of focal brain regions containing high‐rate interictal HFOs and the seizure‐onset zone (SOZ) determined by visual EEG analysis with the postsurgical seizure outcome, using extraoperative intracranial EEG monitoring in pediatric patients and automated HFO detection.Methods:  We retrospectively analyzed 28 pediatric epilepsy patients who underwent extraoperative intracranial video‐EEG monitoring prior to focal resection. Utilizing the automated analysis, we identified int... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5284787 Sat, 01 Oct 2011 04:00:00 +0100 5284787 http://www.medworm.com/index.php?rid=5284778&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03286.x SummaryPurpose:  Tonic seizures and the tonic phase of tonic–clonic epileptic seizures are defined as “sustained tonic” muscle contraction lasting a few seconds to minutes. Visual inspection of the surface electromyogram (EMG) during seizures contributed considerably to a better understanding and accurate diagnosis of several seizure types. However, quantitative analysis of the surface EMG during the epileptic seizures has received surprisingly little attention until now. The aim of our study was to elucidate the pathomechanism of the tonic muscle activation during epileptic seizures.Methods:  Surface EMG was recorded from the deltoid muscles, on both sides, during 63 seizures from 20 patients with epilepsy (10 with generalized tonic and 10 with tonic–clonic seizures). Twenty a... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5284778 Sat, 01 Oct 2011 04:00:00 +0100 5284778 http://www.medworm.com/index.php?rid=5284786&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03276.x SummaryIn order to address the major impact on quality of life and epilepsy management caused by associated neuropsychiatric conditions, an international consensus group of epileptologists met with the aim of developing clear evidence‐based and practice‐based statements to provide guidance on the management of these conditions. Using a Delphi process, this group prioritized a list of key management areas. These included: depression, anxiety, psychotic disorders, nonepileptic seizures, cognitive dysfunction, antiepileptic drug (AED)–related neurobehavioral disorders, suicidality, disorders in children and adolescents, disorders in children with intellectual disability, and epilepsy surgery. Clinical practice statements were developed for each area and consensus reached among members o... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5284786 Wed, 28 Sep 2011 04:00:00 +0100 5284786 http://www.medworm.com/index.php?rid=5269010&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03273.x SummaryPurpose:  Neuroinflammation appears as a prominent feature of the mesiotemporal lobe epilepsy syndrome (MTLE) that is observed in human patients and animal models. However, the precise temporal relationship of its development during epileptogenesis remains to be determined. The aim of the present study was to investigate (1) the time course and spatial distribution of neuronal death associated with seizure development, (2) the time course of microglia and astrocyte activation, and (3) the kinetics of induction of mRNAs from neuroinflammatory‐related proteins during the emergence of recurrent seizures.Methods:  Experimental MTLE was induced by the unilateral intrahippocampal injection of kainate in C57BL/6 adult mice. Microglial and astrocytic changes in both ipsilateral and co... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5269010 Wed, 28 Sep 2011 04:00:00 +0100 5269010 http://www.medworm.com/index.php?rid=5269009&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03274.x SummaryPurpose:  Outcomes following unilobar surgeries for refractory epilepsy have been well described. However, little is known about long‐term seizure outcomes following multilobar resections. The aim of the current study was to identify long‐term seizure control and predictors of seizure recurrence in this patient population.Methods:  Records of patients who underwent multilobar epilepsy surgery at the Cleveland Clinic between 1994 and 2010 were retrospectively reviewed. A postoperative follow‐up of at least 6 months was required. Patients were classified as seizure free if they achieved an Engel class I at last follow‐up. Long‐term chances of seizure freedom were illustrated using a survival analysis, and predictors of recurrence were identified using Cox proportional ... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5269009 Wed, 28 Sep 2011 04:00:00 +0100 5269009 http://www.medworm.com/index.php?rid=5269011&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03271.x This study demonstrates the existence of significant increase in relative regional cerebral glucose metabolism in mesial and lateral temporal regions contralateral to the epileptic focus in patients with unilateral MTLE associated with HS. The positive correlation in these brain regions between IAT scores and metabolism supports the role of disease‐induced plasticity mechanisms contralateral to HS in the preservation of episodic memory processes. (Source: Epilepsia) Epilepsia journals http://www.medworm.com/rss/comments.php?id=5269011 Tue, 20 Sep 2011 04:00:00 +0100 5269011 http://www.medworm.com/index.php?rid=5235851&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03264.x SummaryPurpose:  Periventricular nodular heterotopia (PNH) is, in humans, often associated with difficult‐to‐control epilepsy. However, there is considerable controversy about the role of the PNH in seizure generation and spread. To study this issue, we have used a rat model in which injection of methylazoxymethanol (MAM) into pregnant rat dams produces offspring with nodular heterotopia‐like brain abnormalities.Methods:  Electrophysiologic methods were used to examine the activity of the MAM‐induced PNH relative to activity in the neighboring hippocampus and overlying neocortex. Recordings were obtained simultaneously from these three structures in slice preparations from MAM‐exposed rats and in intact animals. Bath application or systemic injection of bicuculline was used t... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5235851 Tue, 20 Sep 2011 04:00:00 +0100 5235851 http://www.medworm.com/index.php?rid=5235850&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03265.x This study aimed to analyze magnetoencephalography (MEG) localizations of epileptic clusters in different cortical regions of the frontal lobe and relate these findings to postoperative outcomes associated with frontal lobe epilepsy (FLE).Methods:  Thirty‐nine patients from the Epilepsy Center of Erlangen‐Nuremberg University with or without lesions on their magnetic resonance imaging (MRI) scans underwent MEG measurements and operation and were then analyzed retrospectively. MEG data were obtained using systems with either 74 or 248 channels. Single dipole analysis assuming a spherical head model was performed for localization.Key Findings:  Epileptic clusters were detected by MEG in 30 patients, corresponding to a sensitivity of 76.9%; there was a sensitivity of 66.7% (20 of 30) ... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5235850 Tue, 20 Sep 2011 04:00:00 +0100 5235850 http://www.medworm.com/index.php?rid=5235849&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03266.x SummaryPurpose:  Sudden unexpected death in epilepsy (SUDEP) occurs most frequently in people with chronic uncontrolled epilepsy. Tonic–clonic seizures are a well‐recognized risk factor for SUDEP. T‐wave alternans (TWA) is a novel independent marker of risk of sudden cardiac death and cardiovascular mortality. The aim of this study was to determine if the level of TWA in patients with epilepsy differed after complex‐partial and secondary generalized tonic–clonic seizures (sGTCS).Methods:  Electrocardiography (ECG) and electroencephalography (EEG) data from patients with drug‐resistant focal epilepsy who had both complex partial and sGTCS during video‐EEG telemetry were retrospectively reviewed. Periictal TWA, heart rate (HR), and heart rate variability (HRV) were analyzed... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5235849 Tue, 20 Sep 2011 04:00:00 +0100 5235849 http://www.medworm.com/index.php?rid=5235848&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03267.x This study documents multimodal cognitive deficits associated with CD and can serve as the foundation for future investigations into the mechanisms of and possible therapeutic interventions for this problem. (Source: Epilepsia) Epilepsia journals http://www.medworm.com/rss/comments.php?id=5235848 Tue, 20 Sep 2011 04:00:00 +0100 5235848 http://www.medworm.com/index.php?rid=5235847&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03269.x SummaryPurpose:  Gangliogliomas (GGs) and dysembryoplastic neuroepithelial tumors (DNETs) are low‐grade brain tumors of glioneuronal origin that commonly present with seizures. Achieving seizure control in patients with glioneuronal tumors remains underappreciated, as tumor‐related epilepsy significantly affects patients’ quality‐of‐life.Methods:  We performed a quantitative and comprehensive systematic literature review of seizure outcomes after surgical resection of GGs and DNETs associated with seizures. We evaluated 910 patients from 39 studies, and stratified outcomes according to several potential prognostic variables.Key Findings:  Overall, 80% of patients were seizure‐free after surgery (Engel class I), whereas 20% continued to have seizures (Engel class II–IV).... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5235847 Tue, 20 Sep 2011 04:00:00 +0100 5235847 http://www.medworm.com/index.php?rid=5235846&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03270.x SummaryPurpose:  There has been growing interest in cardiac disturbances in epilepsy patients and their etiologic role in the context of sudden death. Ventricular late potentials (VLPs) recorded on signal‐averaged electrocardiography (SAECG) reflects delayed ventricular depolarization and identifies the structural or functional substrate for the ventricular tachycardia in the reentry mechanism. Therefore, abnormal SAECG poses the potential of identifying patients at increased risk of malignant ventricular arrhythmias and sudden cardiac death. The aim of this exploratory study was to screen epilepsy patients who were treated with established doses of antiepileptic drugs (AEDs) on the presence of VLPs.Methods:  Forty‐five consecutive patients with the diagnosis of epilepsy and 19 hea... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5235846 Tue, 20 Sep 2011 04:00:00 +0100 5235846 http://www.medworm.com/index.php?rid=5235852&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03268.x This study examined the bidirectional relation between the two disorders.Methods:  We used claims data obtained from the Taiwan National Health Insurance database to conduct retrospective cohort analyses. Analysis 1 compared 5,195 patients with incident schizophrenia diagnosed in 1999–2008 with 20,776 controls without the disease randomly selected during the same period, frequency matched with sex and age. Analysis 2 comprised a similar method to compare 11,527 patients with newly diagnosed epilepsy with 46,032 randomly selected sex‐ and age‐matched controls. At the end of 2008, analysis 1 measured the incidence and risk of developing epilepsy and analysis 2 measured the incidence and risk of developing schizophrenia.Key Findings:  In analysis 1, the incidence of epilepsy was hig... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5235852 Mon, 19 Sep 2011 04:00:00 +0100 5235852 http://www.medworm.com/index.php?rid=5222341&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03263.x SummaryPrevious studies of epileptic spasms reported that ictal events were associated with high‐frequency oscillations (HFOs) or delta waves involving widespread regions. We determined whether ictal HFOs at 80–200 Hz were coupled with a phase of slow‐wave, whether ictal slow‐waves were diffusely or locally synchronous signals, and whether the mode of coupling between HFOs and slow‐wave phases differed between ictal and interictal states. We studied 11 children who underwent extraoperative electrocorticography (ECoG) recording. The phases and amplitudes of slow‐waves were measured at the peak of ictal and interictal HFOs in the seizure‐onset sites. Ictal HFOs were locked tightly to the phase of slow‐wave at ≤1 Hz. Ictal slow‐waves propagated from the seizure‐onset... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5222341 Tue, 13 Sep 2011 04:00:00 +0100 5222341 http://www.medworm.com/index.php?rid=5222342&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03259.x SummaryPurpose:  Febrile seizures (FS) are the most common type of convulsive events in children. FS are suggested to result from a combination of genetic and environmental factors. However, the pathophysiologic mechanisms underlying FS remain unclear. Using an animal model of experimental FS, it was demonstrated that hyperthermia causes respiratory alkalosis with consequent brain alkalosis and seizures. Hewre we examine the acid–base status of children who were admitted to the hospital for FS. Children who were admitted because of gastroenteritis (GE), a condition known to promote acidosis, were examined to investigate a possible protective effect of acidosis against FS.Methods:  We enrolled 433 age‐matched children with similar levels of fever from two groups presented to the eme... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5222342 Mon, 12 Sep 2011 04:00:00 +0100 5222342 http://www.medworm.com/index.php?rid=5222348&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03255.x SummaryPurpose:  The need for comparable epidemiologic data on epilepsy from various locations in tropical areas has led in 1994 to the creation of a questionnaire able to standardize information. The Limoges’ questionnaire was created to collect information independently of the objectives of each survey performed, and since it has been employed in various continents under tropics latitude. In Africa between 1994 and 2004, 13 epidemiologic surveys in 12 countries were performed by this means. Authors of these works were solicited to communicate their raw data on people with epilepsy (PWE).Methods:  Information collected was aggregated in a database upon which operations of data management were processed. Undernutrition status was determined using an anthropologic method, according Wo... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5222348 Sun, 11 Sep 2011 04:00:00 +0100 5222348 http://www.medworm.com/index.php?rid=5222347&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03256.x SummaryPurpose:  Mapping seizure susceptibility loci in mice provides a framework for identifying potentially novel candidate genes for human epilepsy. Using C57BL/6J × A/J chromosome substitution strains (CSS), we previously identified a locus on mouse chromosome 10 (Ch10) conferring susceptibility to pilocarpine, a muscarinic cholinergic agonist that models human temporal lobe epilepsy by inducing initial limbic seizures and status epilepticus (status), followed by hippocampal cell loss and delayed‐onset chronic spontaneous limbic seizures. Herein we report further genetic mapping of pilocarpine quantitative trait loci (QTLs) on Ch10.Methods:  Seventy‐nine Ch10 F2 mice were used to map QTLs for duration of partial status epilepticus and the highest stage reached in respons... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5222347 Sun, 11 Sep 2011 04:00:00 +0100 5222347 http://www.medworm.com/index.php?rid=5222346&cid=s_32232_25_f&fid=32232&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1528-1167.2011.03258.x We examined the efficiency of lexical and semantic processing and associated brain activation using functional magnetic resonance imaging (fMRI) in patients with left temporal lobe epilepsy (TLE).Methods:  Twenty patients with left TLE (10 with hippocampal sclerosis, the HS group; and 10 with nonlesional MR scans, the NL group) and 12 healthy controls underwent an event‐related fMRI analysis during a lexical decision task (LDT). Lexical and semantic processing were examined by comparing behavioral and imaging data associated with words and nonwords (lexicality) or with concrete and abstract words (concreteness).Key Findings:  Although the control group showed greater activation associated with word stimuli than with nonword stimuli in a bilateral language network, both TLE groups sho... Epilepsia journals http://www.medworm.com/rss/comments.php?id=5222346 Sun, 11 Sep 2011 04:00:00 +0100 5222346