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In Memoriam
Pierre Loiseau (1926 ‐‐ 2004)
Pierre Jallon
Review article
Antiepileptic drugs: indications other than epilepsy
Edoardo Spina, Giulio Perugi
the use of these agents in clinical disorders outside epilepsy is from case series, uncontrolled studies or small randomised clinical trials, and their apparent efficacy requires confirmation through well designed, large, phase III trials. With regard to neurological conditions other than epilepsy, experimental evidence for the efficacy of AEDs is only available for the treatment of patients with trigeminal neuralgia, neuropathic pain syndromes, migraine and essential tremor. Carbamazepine is commonly prescribed as first‐line therapy for patients with trigeminal neuralgia. Gabapentin has been recently marketed for the management of neuropathic pain syndromes, particularly diabetic neuropathy and postherpetic neuralgia. Valproic acid (sodium valproate), in the form of divalproex sodium, is approved for migraine prophylaxis. Primidone can be considered a valuable option for the treatment of essential tremor. AEDs are also used to treat psychiatric conditions, in particular bipolar disorder. So far, the most commonly utilized AEDs in the treatment of this disorder have been carbamazepine and valproic acid, which have showed an antimanic efficacy and a probable long‐term, mood‐stabilizing effect in many bipolar patients, including those refractory or intolerant to lithium. The availability of a new generation of AEDs has broadened the therapeutic options in bipolar disorder. Lamotrigine, oxcarbazepine, gabapentin and topiramate appear to be promising in the treatment of refractory bipolar disorder, as a monotherapy as well as in combination with traditional mood stabilizers. In addition, newer AEDs appear to have a more favourable tolerability and drug interaction profile as compared to older compounds, so thus improving compliance to treatment.
Original article
A critical review of the different conceptual hypotheses framing human focal epilepsy
Dileep R. Nair, Armin Mohamed, Richard Burgess, Hans Lders
and therapies in this disorder can be tested. There are three main models that are reviewed. The notion of epileptogenicity as described by Penfield and Jasper’s epileptogenic zone model postulates that specific regions of cerebral cortex have varying degrees of importance in the generation of focal epilepsy. A variation of this hypothesis comprises the second model put forth by Talairach and Bancaud. In this view the notion of the epileptogenic zone is expanded to incorporate a larger regions of cerebral cortex involved in the seizure propagation. A third concept and more separate hypothesis suggests that all components of the neural network involved in focal epilepsy are equally importance in the initiation and maintenance of the seizure. The various concepts underlying these models are reviewed in this paper and data from clinical and neurophysiologic observations are discussed in the context of these models. We suggest in this paper that the data best supports the epileptogenic zone hypothesis put forth by Penfield and Jasper.
Hypocalcemic generalised seizures as a manifestation of iatrogenic hypoparathyroidism months to years after thyroid surgery
Matthias Mrowka, Susanne Knake, Harald Klinge, Per Odin, Felix Rosenow
after surgery. The first signs can be less typical and include movement disorders such as chorea, as well as symptoms of increased intracranial pressure or epileptic seizures. We describe two cases with generalised tonic‐clonic seizures as the first manifestation of postoperative hypoparathyroidism, appearing months and years after thyroidectomy. Iatrogenic hypoparathyroidism needs to be considered in the differential diagnosis of adult‐onset, generalised, tonic‐clonic seizures even if the thyroidectomy was performed years earlier.
Factors underlying scalp‐EEG interictal epileptiform discharges in intractable frontal lobe epilepsy
Lata Vadlamudi, Elson L. So, Gregory A. Worrell, Russell K. Mosewich, Gregory D. Cascino, Fredric B. Meyer, Timothy G. Lesnick
factors associated with the location of scalp‐EEG IEDs in intractable frontal lobe epilepsy. Methods: Ten factors were assessed in a retrospective review of 53 patients with either concordant (frontal lobe seizure focus) or discordant (generalized or outside frontal seizure focus) IED or both, who had excellent surgical outcomes. The Fisher exact test and the Wilcoxon rank sum test determined statistically significant associations. Results: Thirty‐six patients (68%) had concordant IED, 24 (45%) discordant IED, and 17 (32%) both. Younger age at onset was significantly associated with discordant IED (mean, 7.5 years
<i>versus</i> 17 years for patients without discordant IED;
<i>P</i> < 0.01), whereas duration of epilepsy was not. Seizure foci at the frontal convexity were associated with concordant IED. About 72% of patients with a convexity seizure focus had concordant IED, compared with only 33% of patients with mesial frontal foci having concordant IED (
<i>P</i> ∓ 0.06). Conclusions: Early seizure onset in intractable frontal lobe epilepsy is associated with IEDs discordant with seizure focus. Frontal convexity seizure foci are more likely than mesial frontal seizure foci to be associated with concordant discharges.
Temporal lobe dysembryoplastic neuroepithelial tumour: significance of discordant interictal spikes
Angelo Labate, Regula S. Briellmann, Anthony S. Harvey, Samuel F. Berkovic, Paolo Federico, Renate M. Kalnins, Gavin C. Fabinyi, Graeme D. Jackson
to affect the temporal lobes. The EEG of these patients is characterised by slowing and\or epileptiform abnormalities with a multifocal distribution. We studied the EEG features of epilepsy patients with a temporal lobe DNET to assess the relationship of EEG abnormalities with the localisation of the tumour and the clinical features.
<i>Methods:</i> We retrospectively reviewed 16 patients with unilateral, temporal lobe DNET on MRI. The EEG abnormalities were classified as concordant to the lesion when the EEG discharges were confined to the ipsilateral temporal lobe or discordant when EEG discharges were found in other areas. Clinical and epilepsy characteristics were compared between patients with concordant and discordant EEG.
<i>Results:</i> Focal EEG abnormalities were found in 81% of the patients; 6\16 patients had concordant EEG abnormalities, and 7\16 patients had discordant EEG abnormalities. Epilepsy severity prior to the operation, antecedents and post‐operative outcome were not different between patients with concordant or discordant EEG abnormalities.
<i>Conclusion:</i> Patients with temporal lobe DNET often show EEG discharges discordant to the tumour. However, they do not appear to predict the clinical and epilepsy characteristics of these patients.
Memory function decline over 18 months after selective amygdalohippocampectomy
Tatsuya Ogino, Yoko Ohtsuka, Yumiko Ido, Yoshiaki Mayanagi, Eiju Watanabe, Eiji Oka
amygdalohippocampectomy, which resulted in a complete cessation of seizures. Preoperatively, the Logical Memory II section of the WMS‐R revealed poor logical memory function. Postoperatively, the patient’s scores on several neuropsychological tests had deteriorated, namely, the Miyake Paired‐Associate Word Learning Test (related and unrelated pairs), several sections of the WMS‐R (Figural Memory, Logical memory I, Visual Reproduction II, Visual Paired Associates I, and Verbal Paired Associates I and II), and the BVRT‐R. In particular, her scores on the Visual Paired Associates I, Verbal Paired Associates I and II sections of the WMS‐R, and the BVRT‐R not only declined at one and three months post‐surgery, but also showed progressive deterioration at 16 and 18 months post‐surgery. It should be kept in mind that selective amygdalohippocampectomy can result in progressive postoperative, deterioration in some aspects of memory function.
Video case report
Panayiotopoulos syndrome: video‐EEG illustration of a typical seizure
Veysi Demirbilek, Aysin Dervent
of the seizure, which not infrequently lack common epileptic motor and\or sensory phenomena. Instead, autonomic symptoms such as retching and vomiting, predominate. Semiological knowledge of the seizures in PS depends mainly on parental observations, but not enough ictal‐EEG data are available, possibly due to the rarity of seizures. In addition to previous knowledge regarding the occipital onset of seizures in PS, it has been recognized that other areas, mainly the frontal regions, may be involved. The present report demonstrates the video‐EEG findings of a seizure in a patient with PS. Subclinical ictal EEG discharges with occipital onset precede the clinical autonomic symptoms; eye deviation which is typical of occipital involvement, appears in later sequences. These findings suggest that at least for certain seizures an occipital origin may be considered, even in seizures without the early manifestations typical of this region. (Published with videosequences).
Paroxysmal autonomic alterations mimicking epilepsy: a case report
Kayihan Uluc, Serap Saygi, Arda Yilmaz, Gulay Nurlu
of the central autonomic network and syringomyelia. His physical and neurological examinations were unremarkable. Physiological testing included EEG, SPECT, serum\urine tests and autonomic testing. A poor response was achieved with the medical and interventional procedures employed. As the central autonomic network is an integral component of the internal regulation system of the brain, any lesion, no matter where in the network, may lead to paroxysmal autonomic alterations mimicking epilepsy (Published with videosequences).
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