Ali Heidarianpour, Efat Sadeghian, Javad Mirnajafi-Zadeh, Yaghoub Fathollahi, Mohammad Mohammad-Zadeh
stimulation of the entorhinal cortex. In fully kindled rats, N
<sup>6</sup>-cyclohexyladenosine (CHA; a selective A1 receptor agonist) and 1, 3-dimethyl-8-cyclopenthylxanthine (CPT; a selective A1 receptor antagonist) were microinfused bilaterally into the hippocampal CA1 region. Rats were stimulated and seizure parameters were measured. Results obtained showed that CHA (10 and 50 μ moles) decreased the afterdischarge duration (ADD) in the hippocampal CA1 region and entorhinal cortex, stage 5 seizure duration (S5D) and seizure duration (SD) only at the dose of 50 μ moles, and significantly increased the latency to stage 4 (S4L). Intrahippocampal CPT increased ADD and S5D, and significantly reduced the latency to stage 4 (S4L) at the dose of 10 μmoles. Pretreatment of rats with CPT (5 μ moles) before CHA (50 μ moles), significantly reduced the effect of CHA on seizure parameters. The results suggest that the CA1 region of the hippocampus plays an important role in spreading seizure spikes from the entorhinal cortex to other brain regions and activation of adenosine A1 receptors in this region participates in the anticonvulsant effects of adenosine agonists.
Elena Gardella, Guido Rubboli, Carlo Alberto Tassinari
semiology. We analysed retrospectively the presurgical, video-EEG recordings of 35 “frontal hyperkinetic” seizures (FHS) in 14 patients (age range: 9-48 years) evaluating the features of ictal grasping by means of off-line, frame-by-frame video-analysis. Ictal grasping was observed in 97.1% of the frontal hyperkinetic seizures in 100% of the patients, with a mean latency of 3.2 seconds with respect to seizure-onset; a mean number of 7.7 IG per seizure were detected. During the same FHS, both arms could perform IG in an alternating fashion. Grasping was usually preceded by a reaching movement and followed by holding or pulling. The sites of prehension were restricted to relatively few sectors, either on the patient’s body (45.5%) or the peri-personal space (54.5%). In some cases, the grasping was elicited by hand touching. We did not find a consistent relationship between side of hand grasping and side of ictal EEG discharge or MRI lesion. In conclusion, ictal grasping is an extremely frequent clinical manifestation during FHS. It was an early, forced and repetitive motor behavior, without a clear lateralizing value. Ictal grasping appeared with consistent semiological features, similar to voluntary prehension, suggesting a probable ictal release of physiological grasping behavior. [Published with video sequences]
Ricardo Rego, Stephan Arnold, Soheyl Noachtar
tonic posturing, or head version. We report on a patient whose seizures were documented by video-EEG monitoring, but in whom the observable ictal semiology consisted solely of a brief, monotonous vocalization. Ictal EEGs showed left frontal seizure patterns. Isolated vocalizations can constitute an ictal epileptic event and may be the only observable clinical manifestation of a left frontal lobe epilepsy. [Published with video sequences]
Ignacio Valencia, Germán Lozano, Sanjeev V Kothare, Joseph J Melvin, Divya S Khurana, H Huntley Hardison, Sabrina S Yum, Agustín Legido
ranging from 0.8% to 3.3%, with vascular, metabolic abnormalities, and drug withdrawal being the most common etiologies. The objective of this study is to investigate the clinical characteristics of seizures in children admitted to the PICU at our institution. Methods. We performed a retrospective review of all patients with diagnoses of seizures or epilepsy, admitted to our PICU from 2002 to 2004. Of 6,820 admissions, 32 patients, aged one month to 19 years had seizures in the PICU. Results. The incidence of seizures was 0.5%. Developmental delay or mental retardation was present in 37% of patients. Seizures were generalized in 26 (81%), and focal in 6 (19%); 34% had status epilepticus. The etiology of seizures was epilepsy in 11 (34%). Seizures that do not meet the diagnosis of epilepsy were diagnosed in 21 (66%) including post-craniotomy in five (23%), febrile seizures in three (14%), encephalitis in three (14%), and hydrocephalus in three (14%). Thirty-one patients (97%) were initially treated with either lorazepam or fosphenytoin. Conclusions. Seizures in PICU have different clinical characteristics from those in adults. Recognizing the common seizure etiologies in PICU is likely to lead to a more prompt and effective treatment. Antiepileptic drug prophylaxis may be useful in post-craniotomy patients. A neurological consultation and EEG evaluation are of the utmost importance to help rule in or out epileptic disorders in the PICU.
Su Jeong You, Deok-Soo Kim, Tae-Sung Ko
examine features that could suggest refractoriness at onset. Methods. We retrospectively reviewed the medical records of 144 children with BCECTS diagnosed at the Division of Pediatric Neurology, Asan Medical Center, from March 1, 1995, to April 30, 2002 and treated with AEDs. The patients were subdivided into two groups according to the number of antiepileptic drugs used for effective seizure control. Results. Of the 144 patients, 75 were male and 69 were female, with a mean age at seizure-onset of 7.2 ± 2.3 years (range, 2.1-14.3 years); 119 children were taking one antiepileptic drug (AED) (Group A), and 25 were taking more than one (Group B). There were no significant group differences in female-to-male ratio, prescribed AEDs, number of seizures before the start of treatment, interval between seizure-onset and start of treatment, presence of secondarily generalized seizures, or presence of bilateral EEG abnormalities. The groups differed however, in mean age at seizure onset (7.6 ± 2.2 years versus 5.1 ± 1.9 years, p < 0.05) and percentage of patients with seizure-onset before 3 years (p < 0.05). Conclusions. When treated with AEDs, children with BCECTS usually respond well. However, an earlier onset of seizures is associated with more frequent seizures and initial refractoriness to medical treatment.