Partial Seizure Disorder Research Articles

Long-term significance of postictal psychotic episodes: I. Are they predictive of bilateral ictal foci?

Objective The aim of this study was to determine the degree to which postictal psychotic episodes (PIPE) are predictive of bilateral independent ictal foci. Methods This was a retrospective study of 18 consecutive adults with a partial seizure disorder and PIPE (study group) and 36 patients with a partial seizure disorder but without PIPE (control group). The two groups were compared with respect to the number and location of ictal foci identified with video/EEG monitoring, seizure type, etiology, age at seizure onset, duration of seizure disorder, MRI abnormalities, and psychiatric history prior to the index video/EEG monitoring (other than PIPE). Statistical analyses consisted of logistic regression models, one to identify the variables predictive of bilateral ictal foci and the other to identify the variables predictive of PIPE. Results The occurrence of PIPE ( P < 0.0001) and cryptogenic partial epilepsy ( P = 0.004) was predictive of bilateral independent ictal foci in univariate analyses. In multivariate analyses, cryptogenic partial epilepsy was the only significant variable ( P = 0.03). Conversely, bilateral independent ictal foci on video/EEG monitoring ( P < 0.0001) and having secondarily generalized tonic–clonic seizures ( P = 0.035) were independent predictors of the development of PIPE in univariate and multivariate analyses. Surgery was performed in 20 controls and 3 patients with PIPE; 17 controls and 2 patients with PIPE became seizure-free. Conclusions The presence of PIPE appears to be a predictor of bilateral ictal foci.

Long-term significance of postictal psychotic episodes: II. Are they predictive of interictal psychotic episodes?

Objective The aim of this study was to determine whether postictal psychotic episodes (PIPE) are predictive of the development of interictal psychotic episodes (IPE). Methods This was a retrospective study of 18 consecutive adults with a partial seizure disorder and PIPE (study group) and 36 patients with a partial seizure disorder but without PIPE (control group). These two groups were compared with respect to the likelihood of developing IPE over an 8-year follow-up period and the variables operant in the development of IPE. Statistical analyses consisted of logistic regression models to identify the variables predictive of the development of IPE. Predictors included: number and location of ictal foci, seizure type, etiology, age at seizure onset, duration of seizure disorder, MRI abnormalities, and psychiatric history prior to the index video/EEG monitoring (other than PIPE). Results Seven patients with PIPE and one control patient went on to develop an IPE. Predictors of IPE in univariate logistic regression analyses included a history of PIPE ( P = 0.006), male gender ( P = 0.028), and having bilateral ictal foci ( P = 0.048). Significance disappeared for all of these variables when they were entered into a multivariate analysis. Conclusions A history of PIPE may be a risk factor for the development of IPE. Yet, the disappearance of significance on multivariate analysis indicates that it is not an independent predictor.

PLEDS : corrélations cliniques

We reviewed our experience in 96 consecutive patients exhibiting periodic lateralized epileptiform discharges (PLEDs) on EEG. EEG reports from January 1, 1999 to September 30, 2006 were screened for the term 'PLEDs' and its variants. A retrospective chart review, including examination of neuroimaging and other investigations, was conducted on each patient identified. Acute stroke, tumor and central nervous system infection were the most common etiologies, accounting for 26%, 12% and 12% of cases respectively. Acute hemorrhage and traumatic brain injury combined accounted for another 12%. Previously unreported etiologies included posterior reversible encephalopathy syndrome (PRES), familial hemiplegic migraine and cerebral amyloidosis. There were 9 cases of chronic PLEDs attributable to underlying cortical dysplasia or severe remote cerebral injury, all with an accompanying partial seizure disorder. A prominent role for alcohol withdrawal was noted, and in 6 cases was the sole etiological factor. Fever was present as a potential contributing factor in 40% of cases, and significant metabolic abnormalities in 35%. Seizure activity occurred in 85% of patients overall, but in 100% of patients with PLEDs Plus and BiPLEDs Plus. The overall mortality rate was 27%. Mortality among patients with BiPLEDs however was almost twice that, at 52%. This case series demonstrates the wide variety of potential PLED etiologies. It also emphasizes that despite advances in neurocritical care, the morbidity and mortality associated with PLEDs has changed little since their recognition four decades ago.

Complex Partial Seizures

Complex partial seizures arise from a single focus in the brain and cause an impaired level of consciousness. Although these seizures can occur at any age, they are more common in adults. The true incidence of complex partial seizures is difficult to determine. In this article, a case of complex partial seizure disorder is reported in an airline transport pilot, along with a discussion of the seizure disorder and its aeromedical implications.

Vocal cord paralysis after vagus nerve stimulator battery replacement successfully treated with medialization thyroplasty

The vagus nerve stimulator (VNS) has been used effectively for partial seizure disorders, however many patients suffer from side effects of alterations in voice. This case describes a new remediable adverse effect of the VNS. A patient with medically intractable epilepsy had improvement of his seizure control with VNS therapy after titrating him to a high output and rapid cycling paradigm with essentially no side effects. After a battery replacement, he was restarted on his previous settings and subsequently developed a hoarse voice. He was found to have complete left vocal cord paralysis, an adverse effect attributed to a rapid titration to his previous high output and rapid cycling paradigm. This side effect has not been previously described in the literature. The patient subsequently had a medialization thyroplasty with resolution of his hoarse voice.

A Report of Successful Treatment of Psychosis in Epilepsy With Risperidone

A Report of Successful Treatment of Psychosis in Epilepsy With Risperidone

A Report of Successful Treatment of Psychosis in Epilepsy With Risperidone

A Report of Successful Treatment of Psychosis in Epilepsy With Risperidone

IV levetiracetam in the management of non-convulsive status epilepticus

Status epilepticus (SE) is a medical emergency requiring prompt treatment to try to limit mortality and improve outcome. So far, newer antiepileptic drugs (AED) have not assumed a noticeable role in the treatment of SE. This may be in part due to the lack of IV forms for the newer AEDs. The IV form of Levetiracetam (IV-LEV) has recently become available and has a potential role in the treatment of SE. We report two cases of non-convulsive SE that responded favorably to IV-LEV. The first patient is an 83-year-old male with a history of complex partial seizure disorder who presented with impaired consciousness. The second patient is an 82-year-old male with history of old left middle cerebral artery ischemic infarction, who presented with confusion. Both patients were found to have a non-convulsive status epilepticus on electroencephalography (EEG) and treated with IV-LEV. In both cases, electrographic SE stopped with marked clinical improvement. Both patients tolerated the medication well and no significant side effects occurred. IV-LEV may have a potential role in the treatment of non-convulsive status epileptics.

Safe and Effective Use of the Ketogenic Diet in Children with Epilepsy and Mitochondrial Respiratory Chain Complex Defects

To evaluate the clinical efficacy and safety of the ketogenic diet (KD) for patients with intractable childhood epilepsy and mitochondrial respiratory chain (RC) complex defects. A retrospective analysis evaluated outcomes in 14 children with intractable epilepsy and RC complex defects who were treated with the classic KD involving a 4:1 lipid to nonlipid ratio (% by weight), but without an initial fast and fluid restriction. Outcome measures included seizure frequency, electroencephalography (EEG) findings, the number of antiepileptic drugs, and adverse reactions. Of the 14 patients, 9 had Complex I defects, 1 had a Complex II defect, 3 had Complex IV defects, and 1 had combined Complex I and IV defects. Two patients with Complex IV defects showed clinical progress compatible with the Leigh disease. The epileptic diagnoses were as follows: 5 patients were diagnosed with infantile spasms, 4 with the Lennox-Gastaut syndrome, 1 with the Landau-Kleffner syndrome, 1 with nonspecific generalized seizure disorder, and 3 with partial seizure disorder. The study found that 7 patients became seizure-free after commencing the KD, three of whom successfully completed the diet without relapse. One patient with a greater than 90% seizure reduction, and 2 patients with seizure reductions between 50% and 90%, remained on the diet. Four patients, including two diagnosed with the Leigh disease, did not show any favorable responses to the diet or ceased the diet due to complications. The KD was a safe and effective therapy for seizures in children with intractable epilepsy and RC complex defects.

Two rare clinical manifestations of coenurosis in sheep

Two rare clinical manifestations of coenurosis in sheep are reported. (i) A case of partial seizure disorder in a ram of 11 months old. During seizure episodes the animal lay down in lateral recumbency displaying initially a stuporous condition and subsequently began to revolve its head from the base of the cervix. At the necropsy of the case, Coenurus cerebralis cyst (young bladder worm) was found dorsally inside the brainstem, in the site of the tectum mesencephaly. (ii) The second-reported manifestation was a bacterial meningoengephalitis that was witnessed in two lambs of 6–7 weeks old. The lambs displayed lateral recumbency with seizure activity. At necropsy, meningoencephalitis with congestion and abscesses were observed in both of them. Interestingly, C. cerebralis cysts were also found in both brains. Streptococcus dysgalactiae was isolated from the abscesses. Possibly, S. dysgalactiae translocation of the blood–brain barrier was facilitated by the migration of the immature stages of C. cerebralis to and through the brain.

Non-ketotic hyperglycaemia-related paroxysmal bilateral hand paraesthesia misdiagnosed as diabetic neuropathy

Non-ketotic hyperglycaemia (NKH)-related partial seizure disorders are not uncommon in clinical practice but still deserve attention as they significantly affect neurologic outcome if unnoticed. The atypical presentation of sensorimotor symptoms can be seen in this setting, with paroxysmal character as the rule. Atypical manifestations could cause confusion and might lead to improper diagnosis and treatment. We report a case of inadequately controlled diabetes mellitus and NKH presenting as paroxysmal paraesthesia of both hands, which was misdiagnosed as diabetic neuropathy.

A cost comparison of alternative regimens fortreatment-refractory partial seizure disorder: An econometric analysis

Background: Partial seizure disorder is typically 1026 treated by monotherapy with antiepileptic drugs (AEDs). However, when the condition is refractory to the initial treatment regimen, patients may be switched to monotherapy with another AED or to combination therapy with the initial AED plus a second AED. Objectives: The purpose of this study was to examine1026 the economic costs associated with treatment-refractory partial seizure disorder and to compare the costs of 2 alternative approaches: a switch to oxcarbazepine (OXC) monotherapy or the addition to the regimen of another AED (AED add-on). Methods: Adult patients with a diagnosis of partial 1026 seizure disorder who received initial AED monotherapy between January 1, 2000, and March 31, 2003, were identified from the PharMetrics Patient-Centric Database, a health plan administrative claims database. The medical and pharmacy history of these patients was analyzed from 6 months before a change to either OXC monotherapy or AED add-on therapy through 12 months after the change in treatment. Total health care resource utilization and the associated costs were compared within each cohort before and after the change, as well as between cohorts, with statistical differences tested using Wilcoxon rank sum tests. Multivariate econometric analyses were performed to examine the impact of age, sex, geographic location, Charlson Comorbidity Index, and the presence of specific comorbidities. Results: Demographic and clinical characteristics 102 were similar between the OXC monotherapy cohort (n = 259) and the AED add-on cohort (n = 795). Annual direct treatment costs increased in both groups in the period after the failure of initial monotherapy, increasing from $10,462 to $11,360 in the OXC cohort and from $10,137 to $12,201 in the AED add on cohort ( P < 0.01). Increased pharmacy costs were the primary driver behind cost increases in both cohorts. Patients in the AED add-on cohort were significantly more likely to have an emergency department visit during the period after the failure of initial monotherapy compared with the OXC monotherapy cohort (odds ratio = 1.52; P < 0.05). Conclusion: Despite limitations, the results of thiConclusion:026 retrospective analysis of claims data suggest that the care of patients with treatment-refractory partial seizure disorder is costly and may vary significantly based on the pattern of care.

Effect of comorbidities on medical care use and cost among refractory patients with partial seizure disorder

Purpose The goal of this work was to assess the effect of comorbidities on medical care use and costs among patients with partial seizure disorder who are also refractory to initial antiepileptic drug (AED) monotherapy. Methods Retrospective data from the PharMetrics managed care claims database were collected for adult patients treated with AED monotherapy between January 1, 2000 and March 31, 2002. The associations of comorbidity, specifically the Charlson Comorbidity Index (CCI) and incidence of specific comorbid conditions, with total costs and with hospitalization were analyzed via econometric analysis and logistic regression. Results Five hundred forty-nine patients were identified and analyzed. The odds of hospitalization were 3.7 times greater among patients with a CCI ⩾ 1, than for patients without comorbidities (OR = 3.7, 95% CI = 1.7–7.9), while treatment costs for all medical care were 136% higher ( P < 0.05). Depression had the largest marginal effect on costs and on the likelihood of hospitalization. Conclusions For patients refractory to initial AED monotherapy, the presence of comorbidities, especially depression, is associated with a substantial increase in medical care use and costs.

Clinical characteristics and inheritance of idiopathic epilepsy in Vizslas.

Medical record, seizure survey, and telephone interview information was obtained for 29 Vizslas with idiopathic epilepsy (IE), 74 unaffected siblings, and 41 parents to determine the common clinical characteristics and most likely mode of inheritance. IE was diagnosed on the basis of the age of seizure onset, laboratory results, and neurologic examination findings. Computerized tomography (CT) or magnetic resonance imaging (MRI) scan with cerebrospinal fluid (CSF) analysis was required for the inclusion of dogs with an age of seizure onset of < 6 months or > 5 years. Simple segregation analysis was performed with an ascertainment correction and chi-square analysis. IE appeared to be familial in these pedigrees, with 79% of affected Vizslas exhibiting partial onset seizures. Partial seizure signs included a combination of limb tremors, staring, pupillary dilatation, or salivation without loss of consciousness in > 50% of the dogs with partial signs. The estimated segregation frequency of P = .22 (95% CI, P = .08 to .36) was consistent with autosomal recessive inheritance; however, polygenic inheritance could not be excluded as a possibility. Simulated linkage with FASTSLINK estimated that the average logarithm of odds (LOD) score would be 3.23 with a 10-centimorgan (cM) whole-genome scan for these families, indicating that these families would be useful for a whole-genome scan to potentially find the chromosomal segment(s) containing the epilepsy gene or genes. We conclude that IE in Vizslas appears to be primarily a partial onset seizure disorder that may be inherited as an autosomal recessive trait.

Clinical Characteristics and Inheritance of Idiopathic Epilepsy in Vizslas

Medical record, seizure survey, and telephone interview information was obtained for 29 Vizslas with idiopathic epilepsy (IE), 74 unaffected siblings, and 41 parents to determine the common clinical characteristics and most likely mode of inheritance. IE was diagnosed on the basis of the age of seizure onset, laboratory results, and neurologic examination findings. Computerized tomography (CT) or magnetic resonance imaging (MRI) scan with cerebrospinal fluid (CSF) analysis was required for the inclusion of dogs with an age of seizure onset of <6 months or > 5 years. Simple segregation analysis was performed with an ascertainment correction and chi-square analysis. IE appeared to be familial in these pedigrees, with 79% of affected Vizslas exhibiting partial onset seizures. Partial seizure signs included a combination of limb tremors, staring, pupillary dilatation, or salivation without loss of consciousness in > 50% of the dogs with partial signs. The estimated segregation frequency of P = .22 (95% CI, P = .08 to .36) was consistent with autosomal recessive inheritance; however, polygenic inheritance could not be excluded as a possibility. Simulated linkage with FASTSLINK estimated that the average logarithm of odds (LOD) score would be 3.23 with a 10-centi-morgan (cM) whole-genome scan for these families, indicating that these families would be useful for a whole-genome scan to potentially find the chromosomal segment(s) containing the epilepsy gene or genes. We conclude that IE in Vizslas appears to be primarily a partial onset seizure disorder that may be inherited as an autosomal recessive trait.

Depression and epilepsy: how closely related are they?

Article abstract Depressive disorders (DDs) are the most common type of psychiatric co-morbidity in patients with epilepsy. They are more likely to occur in patients with partial seizure disorders of temporal and frontal lobe origin and are more frequent among patients with poorly controlled seizures. Despite their relatively high prevalence, DDs remain unrecognized and untreated in a large proportion of patients. This article highlights the evidence of a close association between DDs and epilepsy, beginning with the bi-directional relationship between the two disorders. Not only are patients with epilepsy more likely to experience a DD, but a history of DD preceding the onset of the seizure disorder is more likely to be identified in patients with epilepsy than in a control group. In support of these observations, we review data from animal models of epilepsy showing that decreased activity of serotonin, norepinephrine, dopamine, and GABA facilitate the kindling process of seizure foci, worsen seizure frequency and severity, and are reversed or blocked by antidepressant drugs. Decreased activity of these neurotransmitters is a pivotal pathogenic mechanism of DDs and forms the basis of their pharmacotherapy. Thus, DDs and epilepsy may share common pathogenic mechanisms that facilitate the occurrence of one in the presence of the other. Contrary to long-held beliefs by patients and clinicians alike, in the sense that DDs are a "normal reaction" to the obstacles posed by epilepsy, we review evidence that points to their biologic or endogenous nature. We find a genetic predisposition to DDs, as evidenced by the frequent family history of mood disorders in these patients. Neuroimaging and neuropsychological data support a frontal lobe dysfunction in DDs, and a recent study documents concomitant dysfunction of mesial temporal structures. Depressive disorders have various clinical presentations, some typical of the different types of mood disorders in non-epileptic patients, others constituting rather frequent atypical presentations that can easily go unrecognized. A review of the pharmacologic treatment of DDs in epilepsy highlights the lack of scientific data and points to the empirical form in which these patients have been treated up to the present time. Contrary to clinicians' fears, most antidepressant drugs are safe in patients with epilepsy.

Social communication in children with epilepsy.

This study examined measures of social communication that involve the use of language in formulating and organizing thoughts and its relationship with seizure-related, developmental, cognitive, and behavioral variables in 92 children with complex partial seizure disorder (CPS), 51 with primary generalized epilepsy (PGE), and 117 normal children, aged 5.1-16.9 years. Coding the children's speech samples with the Kiddie Formal Thought Disorder Rating Scale (Caplan et al., 1989) and Halliday and Hasan's (1976) analysis of cohesion demonstrated social communication deficits in both seizure disorder groups. The CPS patients had both formal thought disorder and cohesion deficits and the PGE group had mild cohesion deficits. IQ, as well as fronto-temporal and bilateral spike and wave activity were associated with the severity of the social communication deficits of the CPS group. The social communication deficits of the PGE group, however, were related to IQ and seizure control. Recurrent CPS and PGE and fronto-temporal localization of epileptic activity might impair the development of children's communication skills.

Preface

The 33rd Annual Congress of the Japan Epilepsy Society was held October 22–23, 1999 in Sendai, Japan, under the auspices of the Japan Foundation for Neuroscience and Mental Health. The main theme of this Congress was Intractable Epilepsy and New Treatment. Two-hundred one of 206 applied papers were accepted as free communications. Two distinguished guest speakers were invited for special lectures: Dr. J.A. Wada, professor at the University of British Columbia, gave a lecture entitled “Predisposed Susceptibility and Partial Seizure Disorder,” and Dr. J. Engel, Jr., professor at the University of California, Los Angeles, lectured on “Intractable Epilepsy: Definition and Neurobiology.” The presidential lecture was given under the title “Progress in Epilepsy and Kindling.” Dr. H. Matsuoka gave an educational lecture entitled “Neuropsychological Approach to Epilepsy.” Two symposia were held: Symposium I, Neuropsychological Change After Epilepsy Surgery, was chaired by Drs. K. Yagi and A. Yamadori, and Symposium II, Cortical Dysplasia and Intractable Epilepsy, was chaired by Drs. H. Shimizu and M. Shimada. The special session, Molecular Biology of Neurotransmission in Epilepsy, which included five selected papers out of the 201 submitted as free communications, was organized and chaired by Drs. K. Morimoto and S. Sasa. This supplement contains papers and abstracts of the 33rd Annual Congress of the Japan Epilepsy Society. We believe that these papers should deepen our knowledge for treating patients with intractable epilepsy. We express our sincere appreciation to the overseas guests and to the Society members who have enabled us to hold this successful meeting in beautiful Sendai.

Predisposed susceptibility and partial seizure disorder.

Predisposed susceptibility and partial seizure disorder.

Predisposed Susceptibility and Partial Seizure Disorder

Predisposed Susceptibility and Partial Seizure Disorder