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Letter from the editor
J. Aicardi
I wish to thank the Associated Editors, the members of the Editorial and Advisory Boards and the ad hoc reviewers whose work has been and remains essential for the quality of the Journal. I am glad to inform our readership that Epileptic Disorders is now indexed in both Current Contents Life Sciences and in Index Medicus and Medline and that this also applies to the back issues of the Journal. I expect indexation will encourage potential authors to submit first-class articles thus stimulating further improvement of the Journal quality. This issue includes a “Video Teaching Course” on the syndromes of epilepsy with absence seizures. We think it important to take advantage of our ability to publish audiovisual material to contribute to this novel form of teaching. We are prepared to consider for publication similar teaching material on other aspects of epilepsy that could be submitted to Epileptic Disorders. Acceptance of such material would require not only an excellent quality of the images and comments but also full permission from the patients and/or families to be used for exclusive medical purposes.
Synthèse
Long-term outcome of epilepsy
M. Sillanpää
than expected. The contribution of epilepsy is variable. Importantly, the type of epilepsy syndrome and gender must be considered in the estimation of mortality rates in epilepsy. Sudden unexpected death and its mechanisms also need further consideration. Approximately. two thirds of surviving patients will be in terminal remission twenty years after onset of epilepsy and half of them are seizure-free without medication. The best independent predictors of remission are absence of organic brain damage, low intensity seizure propensity and good early effect of drug therapy. The long-term outcome is often predictable by observation of the early outcome of seizures. One third of children with epilepsy are mentally retarded. Poor social outcome is related to associated neurological disabilities, drug resistant seizures and polytherapy. However, even patients with uncomplicated epilepsy, idiopathic etiology and terminal remission without medication do less favourably than their matched controls in basic and vocational education, and reproductive activity. The employability of this subgroup, however, does not differ significantly from that of controls, compared with approximately 60% of all people with epilepsy. Further research is needed particularly to enable a better determination of predictors of long-term outcome, recurrence of seizures after drug withdrawal and the role of drug therapy in long-term prognosis.
Articles originaux
Cardiac asystole in partial seizures
C. A. Scott, D. R. Fish
are being assessed for epilepsy surgery and found 2 out of more than 1,500 complex partial seizures, recorded in 589 consecutive patients, showing a significant period of asystole (13 and 15 seconds). Our previous studies of cardiac and respiratory parameters during partial seizures showed that a central apnoea occurred in 39%. It is probable that sudden death during seizures is due to the interaction of both cardiac and respiratory irregularities. Although rare (occurrence < 0.15%), the possibility of cardiac asystole occurring in an epilepsy monitoring unit highlights the need for resuscitation equipment to be readily available and for trained nursing staff. Furthermore, it is important to recognize that the semiology of seizures may be affected by the consequences of secondary cardiac asystole.
Eating epilepsy. Heterogeneity of ictal semiology: the role of video-EEG monitoring
V. Loreto, C. Nocerino, P. Striano, F.D’Aulos, P. Boccella, S. Striano
of ictal semiology of these seizures. However, in all the cases the inclusion of this kind of reflex epilepsy (RE) among the localization-related epilepsies (LRE) is confirmed. The usefulness of video EEG monitoring in studying these seizures and reflex epilepsy in general (RE) is stressed.
Piracetam and levetiracetam: close structural similarities but different pharmacological and clinical profiles
P. Genton, B. Van Vleymen
different clinical uses. Although the mode of action of neither drug has been fully elucidated, they do not interact with inhibitory or excitatory neurotransmission or alter membrane excitability. A brain-specific stereoselective binding site has been identified for which LEV and other S-enantiomers, but not PIR, have high affinity. In preclinical studies, PIR significantly improves learning and memory; in contrast, LEV has less effect but is much more active in preventing seizures. Both drugs have a high therapeutic index and are well tolerated. PIR, a nootropic drug, is used in the therapy of age-related cognitive disturbances and poststroke aphasia. Clinical experience has also shown that at high doses it is effective against cortical myoclonus. LEV is an antiepileptic drug. Clinical trials have confirmed its efficacy in partial seizures and preliminary findings suggest that it is also effective in generalized seizures and myoclonus.
Continuous spikes and waves during slow sleep (csws): outcome in adulthood
C. Hommet, C. Billard, M. A. Barthez, P. Gillet, D. Perrier, B. Lucas, B. de Toffol, A. Autret
course fluctuated, with temporary worsening or improvement of the paroxysmal abnormalities, epilepsy and cognitive functions. At the end of the follow-up period, seizures persisted. Evaluation of the boy’s behaviour, language and cognitive function suggested a dysexecutive syndrome. We discuss the relationship between paroxysmal abnormalities and neuropsychological disorders.
Article spécial
The role of gamma knife surgery in the treatment of severe epilepsies
J. Régis, F. Bartolomei, M. Hayashi, D. Roberts, P. Chauvel, J.-C. Peragut
current outcome and morbidity associated with established microsurgical treatment, as well as the associated advantages and disadvantages of open surgery, are reviewed. The preliminary evidence in support of radiosurgical treatment and the recent experience with gamma knife treatment for epilepsy associated with mesial temporal sclerosis, cavernous angioma, and hypothalamic hamartoma or other lesions are presented. The strengths and limitations of this application are discussed, and the challenges facing both microsurgical and radiosurgical approaches are considered. Gamma knife surgery can be a main approach among others in the arma-mentarium of epilepsy surgery. Although the benefits of comfort and reduced invasivity can be clearly perceived, larger series and long-term follow up are still required in order to evaluate the future of this particular surgical approach.
Compte-rendu de cas
Encephalopathy with epileptic spasms resolved with corticoids in a 69 year-old patient
B. Maton, F. Picard, A. Njamshi, S. Roth, D. Slosman, R. Sztajzel, P. Jallon, T. Landis
similar to those described in infantile spasms. Conventional antiepileptic drugs were ineffective but the introduction of corticoids induced a dramatic improvement with disappearance of the spasms. The etiology remains unknown. Epileptic spasms may occur in the elderly. If conventional antiepileptic drugs are ineffective, corticoids should be tried immediately.
Analyse d'ouvrages
Abnormal cortical development and epilepsy. From basic to clinical science
P. Gressens
F. Andermann following an international meeting held in Venice from October 2-4, 1997 within the framework of the Mariani Foundation Colloquia in Childhood Epilepsy. Chapters are divided into five main topics : i) mechanisms of cortical development, ii) animal models of cortical dysgeneses, iii) electroclinical, imaging and neuropathological studies of cortical malformations; iv) genetics of neuronal migration disorders; v) neurosurgery of cortical malformations. The book is generally well organised with well balanced chapters contributed by experts (mostly Italian, American and Canadian) in the field. Discussions are well presented overall, easily accessible to the non-specialist and include up-to-date literature (many papers quoted are from 1998). The different chapters are abundantly illustrated. However, the book clearly suffers from a rather poor quality of figure reproduction.The first group of chapters dealing with corticogenesis provides the necessary background for the understanding of the remaining sections of the book. However, one could regret that the role of glutamate and GABA, two critical neurotransmitters in epilepsy, in the control of neuronal migration and its disturbances, has not been specifically addressed in this book. Three exciting animal models of cortical dysgenesis (methylazoxymethanol injection, cortical freezing and spontaneous tish mutant rat) are nicely described in the following section. It is worth noting that this necessary selection of animal models left out several other interesting paradigms including gene knock-out models which not only permit the study of electrophysiological consequences of cortical dysgenesis but also allow hypotheses to be made on the molecular mechanisms leading to abnormal cortical development. The section devoted to human cortical dysgeneses is excellent, comprehensively covering clinical, radiological, electrophysiological and neuropathological aspects in relation to epilepsy. This section is the largest one and is the backbone of the book. Two chapters deal with the genetics of cortical development and neuronal migration disorders. Although the task is huge, these chapters provide an up-to-date overview of the available data and some promising new avenues for basic and clinical research. The last part of the book is dedicated to the surgical approaches. Two major chapters present the wide experience of two leading teams involved with surgery of epilepsy and cortical malformations. The present book is clearly an excellent effort to bring together investigators coming from different backgrounds and who are studying cortical dysgeneses and epilepsy. Although not exhaustive, this book is clearly a very appropriate, specialized tool for colleagues either new to this complex and intricate field or working on one particular aspect of this complex, multidisciplinary field. This book would be of great interest to neurobiology laboratories focused on mechanisms of cortical development and to clinical services taking care of patients with epilepsy.
Lettre de l'éditeur
Rotatory seizures are not as rare as described
E. Saka, S. Saygi
described by Ramelli et al. [1]. We previously reported 12 cases with circling seizures and emphasised that these types of seizures may occur in different epileptic syndromes and epilepsies: symptomatic partial epilepsy, cryptogenic partial epilepsy and idiopathic generalised epilepsy [2]. Pathologies underlying the symptomatic partial epilepsy cases were also diverse: grade 3 astrocytoma, oligodendroglioma, infarction and trauma. Turning direction did not show lateralizing value in our patients with symptomatic partial epilepsy. It is also known that head turning has no lateralizing value in adversive seizures [3]. Recently we reported the occurrence of circling seizures in a case of Wilson’s disease and proposed a reasonable explanation for development of this type of movements in relation to the cortico-basal ganglionic-thalamo-cortical circuit [4]. Vercueil et al. also suggested that basal ganglia involvement was a necessary part of the mechanism of rotational seizures [5]. Besides our reported 13 cases, we know from the literature that there are at least two additional reports [6-7]. We would like to draw attention to the fact that reviews of the literature on this subject do not include all of the relevant publications. Since 1996, we have observed an additional five cases of circling seizures. Three of them demonstrated other types of seizures in addition to circling seizures: complex-partial, myoclonic and generalised tonic-clonic. According to ILAE classification [8], two of them had idiopathic generalised epilepsy (one patient has juvenile myoclonic epilepsy), two patients had symptomatic partial epilepsy and one had cryptogenic partial epilepsy with a right frontal epileptic focus. One of the symptomatic, partial epilepsy cases had left hippocampal sclerosis and the other had bilateral frontal and left temporal gliotic lesions. Finally we would like to emphasise the interesting features of circling seizures. Firstly, frequent involvement of structures, which constitute the cortico-basal ganglionic-thalamo-cortical circuit, and characteristics of the behaviour suggest an imbalance in this circuit, as a cause of the circling behaviour; secondly, because circling may constitute the only ictal behaviour observed, patients may be misdiagnosed.
