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Original article
Antiepileptic drugs and relapse after epilepsy surgery
Ali A Asadi-Pooya, Maromi Nei, Ashwini D Sharan, Scott Mintzer, Andro Zangaladze, James G Evans, Christopher Skidmore, Michael R Sperling
of action and possible neuroprotective effects. Methods. This was a retrospective study. Patients who had an anterior temporal lobectomy for refractory epilepsy, whose preoperative MRI indicated mesial temporal sclerosis, were included. Postoperative AED regimens were compared with regard to seizure-outcome, considering the putative mechanism of action (sodium channel blockers, non-sodium channel blockers, and mixed mechanisms) or possible neuroprotective effect (levetiracetam, topiramate, tiagabine and zonisamide versus others). Time-to-event (first seizure after surgery) analysis was used to produce a Kaplan-Meier estimate of seizure recurrence, and groups were compared using Cox proportional hazard analysis. Results. 226 patients (103 males and 123 females; mean age 42 ± 11 years) were studied. The rates of postoperative seizure recurrence were not significantly different between the three groups regardless of the use of AEDs with different mechanisms of action (p = 0.23). Fifty patients were receiving possibly neuroprotective AEDs and 176 patients were not. Rates of seizure recurrence were not significantly different between these two groups either (p = 0.11). The differences between one-year seizure-free rates were not significant when we compared levetiracetam versus phenytoin or carbamazepine. Discussion. There appeared to be no advantage or disadvantage to either prescribing drugs with different mechanisms of action or using drugs with possible neuroprotective effect after temporal lobectomy. Prospective studies with larger sample sizes may be of benefit to further explore this issue.
Poor presurgical performance on both verbal and visual memory measures is associated with low risk for memory decline following
Robyn M Busch, Jessica S Chapin, Gopalan Umashankar, Beate Diehl, Daniel Harvey, Richard I Naugle, Dileep Nair, Imad M Najm
however, if the risk of decline is increased in patients who also have reduced visual memory. Objective and subjective memory outcome following left ATL was examined in twelve patients with reduced presurgical visual and verbal memory scores. Only one patient demonstrated a meaningful decline in memory scores, with a decline in visual memory following surgery. Presurgically, this patient demonstrated poor memory bilaterally on Wada testing and small discrepancy in hippocampal volumes. She was also one of two patients who continued to have seizures post-surgery. This preliminary study suggests that patients with unilateral, left TLE and poor verbal and visual memory are unlikely to show meaningful memory declines following left ATL, particularly if they demonstrate expected patterns on Wada testing, hippocampal volume discrepancy (left < right), and postsurgical seizure-freedom.
Application of the 2001 diagnostic scheme and the 2006 ILAE report of seizure and epilepsy: a feedback from the clinical practi
Masako Kinoshita, Ryosuke Takahashi, Akio Ikeda
2001 Scheme) and the report of the ILAE classification core group in 2006 (the 2006 Report). Methods. One hundred consecutive patients with epilepsy who visited the Neurology Clinic (Group 1) and 100 patients with intractable epilepsy who had undergone prolonged scalp video-EEG monitoring (Group 2) in Kyoto University Hospital were enrolled. The 2001 Scheme (Axis 1 to 4) and the 2006 Report (seizure types and epileptic syndromes) were applied to Group 1. Axis 1 was applied to Group 2 to evaluate the diversity of seizure semiology. Results. Group 1 demonstrated 145 seizures of different types (generalized tonic-clonic seizures: 23%, complex partial seizures (CPS): 29%, simple partial seizures: 21% and secondarily generalized tonic-clonic seizures: 21% according to the 1981 classification. In Axis 1 (ictal phenomenology) of the 2001 scheme, 184 and 333 items were listed in Groups 1 and 2, respectively, and seizure semiology was described independent of EEG findings. However, there was duplications or discordance among the items. In Axis 2 (seizure types) of Group 1, 62% and 26% of CPS were further labeled as focal motor or sensory seizures, respectively; the remainder (24%) did not meet inclusion criteria for any category. In Axis 3 (epilepsy syndromes), 94% of patients were sorted, and familial temporal lobe epilepsy was added. Axis 4 described detailed etiology. Application of seizure types of the 2006 Report required consideration of ictal phenomenology to determine spread patterns. Epileptic syndromes of the 2006 Report were assignable to 70% of patients. Conclusions. It is important to achieve intra- and inter-axial accordance for the establishment of a more practical diagnostic scheme, which may provide a more useful tool for the diagnosis of less obvious aspects of epilepsy.
Bone mineral density following long-term use of antiepileptic drugs in a tropical Asian country
Kanitpong Phabphal, Kitti Limapichat, Ponchi Sathirapanya, Suwanna Setthawatcharawanich, Rattana Leelawattana, Natawan Thammakumpee, Atchara Thamaprasit, Alan Geater
aged 15 to 50 years who had been taking antiepileptic drugs for longer than six months. All were free of disease and none was taking any medication that might interfere with bone metabolism other than antiepileptic drugs. BMD at the left femoral neck and spine was measured with dual energy X-ray absorptiometry. Demographic data, basic laboratory studies and history of clinical epilepsy were obtained. One hundred and thirty patients (63 males and 67 females) were included. Mean age (+ SD) was 31.9 ± 9.7 year. There were 79 patients receiving monotherapy and 51 patients receiving polytherapy. All patients had normal serum calcium. Thirteen patients had slightly low serum phosphate levels. The BMD at the femoral neck had a mean Z-score – 0.15 ± 1.17 and the mean Z-score at the lumbar spine was – 0.56 ± 1.03. Thirty one patients had osteopenia at the spine and 30 patients at the femoral neck. Three patients had osteoporosis of the spine and 1 patient of the femoral neck. There was found to be no significant correlation between age, sex, body mass index, duration of treatment and type of antiepileptic drug with bone mineral density at the femur and spine. The mean BMD of long-term antiepileptic users was lower than that of the sex and age-adjusted mean.
Clinical commentary
Electrical status epilepticus “invisible” to surface EEG in late-onset Rasmussen encephalitis
Jinane Fattouch, Carlo Di Bonaventura, Giancarlo Di Gennaro, Pier Paolo Quarato, Simona Petrucci, Mario Manfredi, Massimilano Prencipe, Vincenzo Esposito, Anna Teresa Giallonardo
atypical electro-clinical features, and neuroimaging alterations usually help diagnosis. Unlike childhood forms, in which epilepsia partialis continua is usually observed, the EEG pattern in adult variants may be aspecific. We describe a highly interesting case of late-onset RE in which an electrical status epilepticus was not detected by the surface EEG, but by a recording with subdural electrodes.
Clinical commentary
Cough syncope misinterpreted as epileptic seizure
Philippe Gelisse, Pierre Genton
and Valsava maneuvre in a patient referred for the diagnosis of generalized tonic-clonic seizures. There were no signs of active epilepsy. The attacks were associated with overweight, obstructive sleep apnea and heavy consumption of cigarettes. [Published with video sequences]
Massive rhythmic axial myoclonus in post-anoxic coma
Stéphane Legriel, Yves Roger Tran-Dinh, Nicolas Bele, Guillaume Thiery
video sequences]
Absence status epilepticus in monozygotic twins with Jeavons syndrome
Tianhua Yang, Yonghong Liu, Ling Liu, Bo Yan, Qin Zhang, Dong Zhou
and continuous or repetitive generalized discharges of spikes, multiple spikes, and slow waves on EEG. Jeavons syndrome (JS) is a new type of epilepsy syndrome. Hitherto, only four sets of monozygotic twin with JS have been reported. Absence status epilepticus occurring in monozygotic twins with JS have not been reported. Here we report on monozygotic male twins of Chinese origin with JS. Both of them presented with status epilepticus with eyelid myoclonia and absences. [Published with video sequences]
Clinical impact of a high-frequency seizure onset zone in a case of bitemporal epilepsy
Premysl Jiruska, Martin Tomasek, David Netuka, Jakub Otahal, John GR Jefferys, Xiaoli Li, Petr Marusic
monitoring with depth and subdural electrodes revealed an ictal pattern with a build-up of high-frequency (> 80 Hz) activity originating in the cortex, with spread to both hippocampi. This observation was only revealed with the use of high-pass filtering, and represented crucial information that significantly influenced the decision about the side, localization and extent of resection. Removal of the cortex generating high-frequency activity, led to cessation of seizures in this patient. Current knowledge about the role of high-frequency activity and the case presented here support the importance of recording with equipment capable of detecting fast activity during the presurgical invasive monitoring. An active search for a high-frequency seizure onset zone in patients with structurally-unaffected hippocampi may improve the outcome beyond that possible with conventional bandwidth, invasive EEG recordings. [Published with video sequences]
Letter to the Editor
Topiramate-induced reversible auditory hallucination
Ertugrul Uzar, Süleyman Kutluhan, Vedat Ali Yurekli, Atilla Ilhan
Refusal of consent for video recording during standard EEG
Marie Pierre Noto, Laurent Vercueil
