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Sample records for chronic intractable epilepsy

  1. Mapping of cognitive functions in chronic intractable epilepsy: Role of fMRI

    OpenAIRE

    Kapil Chaudhary; S Senthil Kumaran; Chandra, Sarat P; Ashima Nehra Wadhawan; Manjari Tripathi

    2014-01-01

    Background: Functional magnetic resonance imaging (fMRI), a non-invasive technique with high spatial resolution and blood oxygen level dependent (BOLD) contrast, has been applied to localize and map cognitive functions in the clinical condition of chronic intractable epilepsy. Purpose: fMRI was used to map the language and memory network in patients of chronic intractable epilepsy pre- and post-surgery. Materials and Methods: After obtaining approval from the institutional ethics committee, s...

  2. Mapping of cognitive functions in chronic intractable epilepsy: Role of fMRI

    Directory of Open Access Journals (Sweden)

    Kapil Chaudhary

    2014-01-01

    Full Text Available Background: Functional magnetic resonance imaging (fMRI, a non-invasive technique with high spatial resolution and blood oxygen level dependent (BOLD contrast, has been applied to localize and map cognitive functions in the clinical condition of chronic intractable epilepsy. Purpose: fMRI was used to map the language and memory network in patients of chronic intractable epilepsy pre- and post-surgery. Materials and Methods: After obtaining approval from the institutional ethics committee, six patients with intractable epilepsy with an equal number of age-matched controls were recruited in the study. A 1.5 T MR scanner with 12-channel head coil, integrated with audio-visual fMRI accessories was used. Echo planar imaging sequence was used for BOLD studies. There were two sessions in TLE (pre- and post-surgery. Results: In TLE patients, BOLD activation increased post-surgery in comparison of pre-surgery in inferior frontal gyrus (IFG, middle frontal gyrus (MFG, and superior temporal gyrus (STG, during semantic lexical, judgment, comprehension, and semantic memory tasks. Conclusion: Functional MRI is useful to study the basic concepts related to language and memory lateralization in TLE and guide surgeons for preservation of important brain areas during ATLR. This will help in understanding future directions for the diagnosis and treatment of such disease.

  3. Predictors of intractable childhood epilepsy

    International Nuclear Information System (INIS)

    To determine the prognosis of seizures in epileptic children and identify early predictors of intractable childhood epilepsy. All children (aged 1 month to 16 years) with idiopathic or cryptogenic epilepsy who were treated and followed at the centre during the study period were included. The patients who had marked seizures even after two years of adequate treatment were labeled as intractable epileptics (cases). Children who had no seizure for more than one year at last follow-up visit were the controls. Adequate treatment was described as using at least three anti-epileptic agents either alone or in combination with proper compliance and dosage. Records of these patients were reviewed to identify the variables that may be associated with seizure intractability. Of 442 epileptic children, 325 (74%) intractable and 117 (26%) control epileptics were included in the study. Male gender (OR=3.92), seizures onset in infancy >10 seizures before starting treatment (OR=3.76), myoclonic seizures (OR=1.37), neonatal seizures (OR=3.69), abnormal EEG (OR=7.28) and cryptogenic epilepsy (OR=9.69) and head trauma (OR=4.07) were the factors associated with intractable epilepsy. Seizure onset between 5-7 years of age, idiopathic epilepsy, and absence seizures were associated with favourable prognosis in childhood epilepsy. Intractable childhood epilepsy is expected if certain risk factors such as type, age of onset, gender and cause of epilepsy are found. Early referral of such patients to the specialized centres is recommended for prompt and optimal management. (author)

  4. Imaging of intractable paediatric epilepsy

    Directory of Open Access Journals (Sweden)

    Sanjay Prabhu

    2015-10-01

    Full Text Available Approximately 20% of paediatric patients with epilepsy are refractory to medical therapies. In this subgroup of patients, neuroimaging plays an important role in identifying an epileptogenic focus. Successful identification of a structural lesion results in a better outcome following epilepsy surgery. Advances in imaging technologies, methods of epileptogenic region localisation and refinement of clinical evaluation of this group of patients in epilepsy centres have helped to widen the spectrum of children who could potentially benefit from surgical treatment. In this review, we discuss ways to optimise imaging techniques, list typical imaging features of common pathologies that can cause epilepsy, and potential pitfalls to be aware of whilst reviewing imaging studies in this challenging group of patients. The importance of multidisciplinary meetings to analyse and synthesise all the non-invasive data is emphasised. Our objectives are: to describe the four phases of evaluation of children with drug-resistant localisation-related epilepsy; to describe optimal imaging techniques that can help maximise detection of epileptogenic foci; to describe a systematic approach to reviewing magnetic resonance imaging of children with intractable epilepsy; to describe the features of common epileptogenic substrates; to list potential pitfalls whilst reviewing imaging studies in these patients; and to highlight the value of multimodality and interdisciplinary approaches to the management of this group of children.

  5. Surgical decisions regarding medically intractable epilepsy.

    Science.gov (United States)

    Spencer, D D; Pappas, C T

    1992-01-01

    The neurosurgeon's primary intention in epilepsy care is to cure patients with medically intractable seizures. If cure cannot be achieved, reduction of the frequency and intensity of the seizures may be worthwhile. With these goals, work-up of the patients must be thoroughly carried out to localize the seizure focus and to demarcate surrounding functional brain. Once the seizure focus and pattern are well understood, the surgical decision can be based on a logical and flexible decision tree. Potential complications and past statistics must also enter into the decision process. With these factors combined, the routine and special needs for each patient can be accommodated. The advancing modalities of AVEEG monitoring and imaging, coupled with more sophisticated surgical techniques resulting in predictably good outcomes, have moved surgery for medically intractable epilepsy from a few dedicated centers to universal component of our health care. Increasing numbers of young patients afflicted with this chronic debilitating disease can expect freedom from social and employer ostracism, a chance to drive, and an opportunity for freedom from family or other caretaker dependence. Advancement in this will continue as neurosurgeons blend their knowledge of basic neurobiology and the clinical sciences. PMID:1537203

  6. MODIFIED ATKINS DIET FOR INTRACTABLE CHILDHOOD EPILEPSY

    OpenAIRE

    Mohammad BARZEGAR; Poupak IRANDOUST; Ebrahimi Mameghani, Mehrangiz

    2010-01-01

    ObjectiveThe aim of the present study was to evaluate the efficacy and tolerability of a modified Atkins diet for intractable childhood epilepsy.Materials & MethodsTwenty one children with medically intractable epilepsy were enrolled in the study. Inclusion criteria were at least four seizures per month and a trial of at least three anticonvulsants without becoming seizure-free. The subjects received the diet over a 6-month period.ResultsThree months after diet initiation, 15 patients (71.4%)...

  7. MODIFIED ATKINS DIET FOR INTRACTABLE CHILDHOOD EPILEPSY

    Directory of Open Access Journals (Sweden)

    Mohammad BARZEGAR

    2010-12-01

    Full Text Available ObjectiveThe aim of the present study was to evaluate the efficacy and tolerability of a modified Atkins diet for intractable childhood epilepsy.Materials & MethodsTwenty one children with medically intractable epilepsy were enrolled in the study. Inclusion criteria were at least four seizures per month and a trial of at least three anticonvulsants without becoming seizure-free. The subjects received the diet over a 6-month period.ResultsThree months after diet initiation, 15 patients (71.4% remained on the diet and 12 (57.1% had >50% seizure reduction. Eleven patients (52.4% completed the 6-month study and 8 (38.1% chose to remain on the diet afterward. At 6 months, 9 patients (42.8% had >50% seizure reduction. The diet was more effective in cryptogenic epilepsy (p=0.032. Most complications were transient and successfully managed by careful follow-up and conservative strategies.ConclusionThe modified Atkins diet is an effective and well- tolerated therapy for intractable childhood epilepsy.Keywords:Atkins diet, ketogenic diet,intractable epilepsy, children

  8. MODIFIED ATKINS DIET FOR INTRACTABLE CHILDHOOD EPILEPSY

    Directory of Open Access Journals (Sweden)

    Mohammad BARZEGAR

    2010-11-01

    Full Text Available ObjectiveThe aim of the present study was to evaluate the efficacy and tolerability of a modified Atkins diet for intractable childhood epilepsy.Materials & MethodsTwenty one children with medically intractable epilepsy were enrolled in the study. Inclusion criteria were at least four seizures per month and a trial of at least three anticonvulsants without becoming seizure-free. The subjects received the diet over a 6-month period.ResultsThree months after diet initiation, 15 patients (71.4% remained on the diet and 12 (57.1% had >50% seizure reduction. Eleven patients (52.4% completed the 6-month study and 8 (38.1% chose to remain on the diet afterward. At 6 months, 9 patients (42.8% had >50% seizure reduction. The diet was more effective in cryptogenic epilepsy (p=0.032. Most complications were transient and successfully managed by careful follow-up and conservative strategies.ConclusionThe modified Atkins diet is an effective and well- tolerated therapy for intractable childhood epilepsy

  9. Structural and functional neuroimaging in intractable epilepsy

    OpenAIRE

    Chinchure Swati; Kesavadas Chandrasekharan; Thomas Bejoy

    2010-01-01

    Medical management remains unsatisfactory in about a third of patients with epilepsy and some of them are candidates for resective epilepsy surgery. Structural and functional neuroimaging plays an important role in the identification of the precise cortical region responsible for seizures and is very crucial for a good surgical outcome. Furthermore, identification of eloquent cortical areas near the region to be resected is essential to avoid postoperative neurologic deficit. The magnetic res...

  10. Structural and functional neuroimaging in intractable epilepsy

    Directory of Open Access Journals (Sweden)

    Chinchure Swati

    2010-01-01

    Full Text Available Medical management remains unsatisfactory in about a third of patients with epilepsy and some of them are candidates for resective epilepsy surgery. Structural and functional neuroimaging plays an important role in the identification of the precise cortical region responsible for seizures and is very crucial for a good surgical outcome. Furthermore, identification of eloquent cortical areas near the region to be resected is essential to avoid postoperative neurologic deficit. The magnetic resonance imaging (MRI protocol for epilepsy can be individually tailored depending on the seizure semiology and possibly electroencephalography. New MRI techniques demonstrate the structure of the brain in fine detail, help in understanding the underlying pathology, and demonstrate functional activity of the brain with high spatial and temporal resolution. Metabolic imaging techniques, such as positron emission tomography (PET and single photon emission tomography (SPECT visualize metabolic alterations of the brain in the ictal and interictal states. In MR-negative epilepsy patients, these techniques may have localizing value. The proper use and interpretation of the findings provided by these new technologies is crucial. In this review article, we discuss various conventional and advanced MRI techniques, interpretation of various findings, and the role of functional imaging modalities, such as functional MRI, PET, and SPECT in the localization of epileptogenic substrate as well as for understanding the pathophysiology, propagation, and neurochemical correlates of epilepsy.

  11. Chronic intractable diarrhea caused by gastrointestinal mastocytosis.

    Science.gov (United States)

    Seo, Hyungil; Park, Sang Hyoung; Byeon, Jeong-Sik; Woo, Chang Gok; Hong, Seung-Mo; Chang, Kiju; So, Hoonsub; Kwak, Minseob; Kim, Wan Soo; Lee, Jeong-Mi; Yang, Dong-Hoon; Kim, Kyung-Jo; Ye, Byong Duk; Myung, Seung-Jae; Yang, Suk-Kyun

    2016-07-01

    As mast cells have been highlighted in the pathogenesis of diarrhea-predominant irritable bowel syndrome, a new term "mastocytic enterocolitis" was suggested by Jakate and colleagues to describe an increase in mucosal mast cells in patients with chronic intractable diarrhea and favorable response to treatment with antihistamines. Although it is not an established disease entity, two cases have been reported in the English medical literature. Here, for the first time in Asia, we report another case of chronic intractable diarrhea caused by gastrointestinal mastocytosis. The patient was a 70-year-old male with chronic intractable diarrhea for 3 months; the cause of the diarrhea remained obscure even after exhaustive evaluation. However, biopsy specimens from the jejunum were found to have increased mast cell infiltration, and the patient was successfully treated with antihistamines. PMID:27433151

  12. Atypical language representation in children with intractable temporal lobe epilepsy.

    Science.gov (United States)

    Maulisova, Alice; Korman, Brandon; Rey, Gustavo; Bernal, Byron; Duchowny, Michael; Niederlova, Marketa; Krsek, Pavel; Novak, Vilem

    2016-05-01

    This study evaluated language organization in children with intractable epilepsy caused by temporal lobe focal cortical dysplasia (FCD) alone or dual pathology (temporal lobe FCD and hippocampal sclerosis, HS). We analyzed clinical, neurological, fMRI, neuropsychological, and histopathologic data in 46 pediatric patients with temporal lobe lesions who underwent excisional epilepsy surgery. The frequency of atypical language representation was similar in both groups, but children with dual pathology were more likely to be left-handed. Atypical receptive language cortex correlated with lower intellectual capacity, verbal abstract conceptualization, receptive language abilities, verbal working memory, and a history of status epilepticus but did not correlate with higher seizure frequency or early seizure onset. Histopathologic substrate had only a minor influence on neuropsychological status. Greater verbal comprehension deficits were noted in children with atypical receptive language representation, a risk factor for cognitive morbidity. PMID:27064828

  13. Qualitative and Quantitative Hippocampal MRI Assessments in Intractable Epilepsy

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    Paramdeep Singh

    2013-01-01

    Full Text Available Aims. To acquire normative data of hippocampal volumes and T2 relaxation times, to evaluate and compare qualitative and quantitative assessments in evaluating hippocampi in patients with different durations of intractable epilepsy, and to propose an imaging protocol based on performance of these techniques. Methods. MRI analysis was done in 50 nonepileptic controls and 30 patients with intractable epilepsy on 1.5T scanner. Visual assessment and hippocampal volumetry were done on oblique coronal IR/T2W and T1W MP-RAGE images, respectively. T2 relaxation times were measured using 16-echo Carr-Purcell-Meiboom-Gill sequence. Volumetric data was normalized for variation in head size between individuals. Patients were divided into temporal ( and extratemporal ( groups based on clinical and EEG localization. Results. In controls, right hippocampal volume was slightly more than the left with no effect of age or gender. In TLE patients, hippocampal volumetry provided maximum concordance with EEG. Visual assessment of unilateral pathology concurred well with measured quantitative values but poorly in cases with bilateral pathologies. There were no significant differences of mean values between extratemporal group and controls group. Quantitative techniques detected mild abnormalities, undetected on visual assessment. Conclusions. Quantitative techniques are more sensitive to diagnose bilateral and mild unilateral hippocampal abnormalities.

  14. Current management and surgical outcomes of medically intractable epilepsy.

    Science.gov (United States)

    Ramey, Wyatt L; Martirosyan, Nikolay L; Lieu, Corinne M; Hasham, Hasnain A; Lemole, G Michael; Weinand, Martin E

    2013-12-01

    Epilepsy is one of the most common neurologic disorders in the world. While anti-epileptic drugs (AEDs) are the mainstay of treatment in most cases, as many as one-third of patients will have a refractory form of disease indicating the need for a neurosurgical evaluation. Ever since the first half of the twentieth century, surgery has been a major treatment option for epilepsy, but the last 10-15 years in particular has seen several major advances. As shown in relatively recent studies, resection is more effective for medically intractable epilepsy (MIE) than AED treatment alone, which is why most clinicians now endorse a neurosurgical consultation after approximately two failed regimens of AEDs, ultimately leading to decreased healthcare costs and increased quality of life. Temporal lobe epilepsy (TLE) is the most common form of MIE and comprises about 80% of epilepsy surgeries with the majority of patients gaining complete seizure-freedom. As the number of procedures and different approaches continues to grow, temporal lobectomy remains consistently focused on resection of mesial structures such as the amygdala, hippocampus, and parahippocampal gyrus while preserving as much of the neocortex as possible resulting in optimum seizure control with minimal neurological deficits. MIE originating outside the temporal lobe is also effectively treated with resection. Though not as successful as TLE surgery because of their frequent proximity to eloquent brain structures and more diffuse pathology, epileptogenic foci located extratemporally also benefit from resection. Favorable seizure outcome in each of these procedures has heavily relied on pre-operative imaging, especially since the massive surge in MRI technology just over 20 years ago. However, in the absence of visible lesions on MRI, recent improvements in secondary imaging modalities such as fluorodeoxyglucose positron emission computed tomography (FDG-PET) and single-photon emission computed tomography (SPECT

  15. EFFICACY OF THE KETOGENIC DIET AS A THERAPY FOR INTRACTABLE EPILEPSY IN CHILDREN

    OpenAIRE

    MIRJAVADI Seyed Alireza; TONEKABONI, Seyed Hassan; GHAZAVI, Mohammadreza; Azargashb, Eznollah; ABDOLLAH GORJI, Fatemeh; Mohammad GHOFRANI

    2010-01-01

    ObjectiveTo determine the role of ketogenic diet in the treatment of intractable epilepsy in children.Materials & MethodsSixty six consecutive children (1-16 years old) with intractable epilepsy whose seizure were not neurodegenerative nor febrile in origin were recruited. They received the ketogenic diet and we evaluated its effect on seizure frequency for 3 months. All these children had more than five seizures per week despite adequate therapy with at least 3-4 anticonvulsant medications. ...

  16. Melatonin and sleep-related problems in children with intractable epilepsy.

    Science.gov (United States)

    Elkhayat, Hamed A; Hassanein, Sahar M; Tomoum, Hoda Y; Abd-Elhamid, Iman A; Asaad, Tarek; Elwakkad, Amany S

    2010-04-01

    Children with epilepsy have high rates of sleep problems. Melatonin has been advocated in treatment of sleep disorders, and its beneficial effect has been confirmed in insomnia. The aim of this study was to assess melatonin levels in children with intractable epilepsy and its relation to pattern of sleep and characteristics of seizure disorder, as well as the effect of melatonin therapy on those parameters. The study was conducted on 23 children with intractable epilepsy and 14 children with controlled seizures. Patients were evaluated by psychometric sleep assessment and assay of diurnal and nocturnal melatonin levels. Children with intractable epilepsy received oral melatonin before bedtime. They were reassessed after 3 months. Children with intractable epilepsy had higher scores for each category of sleep walking, forcible teeth grinding, and sleep apnea. At the end of therapeutic trial, patients with intractable epilepsy exhibited significant improvement in bedtime resistance, sleep duration, sleep latency, frequent nocturnal arousals, sleep walking, excessive daytime sleepiness, nocturnal enuresis, forcible teeth grinding, sleep apnea, and Epworth sleepiness scores. There was also significant reduction in seizure severity. Thus, use of melatonin in patients with intractable seizures was associated with improvement of both many sleep-related phenomena and the severity of seizures. PMID:20304327

  17. TCM Treatment for Two Cases of Chronic and Intractable Eczema

    Institute of Scientific and Technical Information of China (English)

    He Kuanqi; Zhu Hanting

    2008-01-01

    @@ The author treated 2 cases of chronic and intractable eczema,who were once treated by western drugs without good results,with Chinese medicine and obtained satisfactory therapeutic effects.Now it is reported as follows.

  18. Mirror Focus in a Patient with Intractable Occipital Lobe Epilepsy

    OpenAIRE

    Kim, Jiyoung; Shin, Hae kyung; Hwang, Kyoung Jin; Choi, Su Jung; Joo, Eun Yeon; Hong, Seung Bong; Hong, Seung Chul; Seo, Dae-Won

    2014-01-01

    Mirror focus is one of the evidence of progression in epilepsy, and also has practical points for curative resective epilepsy surgery. The mirror foci are related to the kindling phenomena that occur through interhemispheric callosal or commissural connections. A mirror focus means the secondary epileptogenic foci develop in the contralateral hemispheric homotopic area. Thus mirror foci are mostly reported in patients with temporal or frontal lobe epilepsy, but not in occipital lobe epilepsy....

  19. The Ketogenic and Atkins Diets Effect on Intractable Epilepsy: A Comparison

    OpenAIRE

    GHAZAVI, Ahad; Seyed Hassan TONEKABONI; Karimzadeh, Parvaneh; Ahmad Ali NIKIBAKHSH; Ali KHAJEH; FAYYAZI, Afshin

    2014-01-01

    How to Cite This Article: Ghazavi A, Tonekaboni SH, Karimzadeh P, Nikibakhsh AA, Khajeh A, Fayyazi A. The Ketogenic and Atkins Diets Effect on Intractable Epilepsy: A Comparison. Iran J Child Neurol. 2014 Summer;8(3): 12-17.AbstractObjectiveIntractable epilepsy is a major difficulty in child neurology, because the numbers of drugs that are available for treatment are limited and new treatments such as diets must be tried. Now there are some diets available for treating patients with intractab...

  20. Comparison of Serum Zinc and Copper levels in Children and adolescents with Intractable and Controlled Epilepsy

    OpenAIRE

    Zeynab KHERADMAND; Bahram YARALI; Ahad ZARE; POURPAK, Zahra; Shams, Sedigheh; Mahmoud Reza ASHRAFI

    2014-01-01

    How to Cite This Article: Kheradmand Z, Yarali B, Zare A, Pourpak Z, Shams S, Ashrafi MR. Comparison of Serum Zinc and Copper levels in Children and adolescents with Intractable and Controlled Epilepsy. Iran J Child Neurol. 2014; 8(3):49-54. AbstractObjectiveTrace elements such as zinc and copper have physiological effects on neuronal excitability that may play a role in the etiology of intractable epilepsy. This topic has been rarely discussed in Iranian epileptic patients.This study with th...

  1. Voxel based morphometry of FLAIR MRI in children with intractable focal epilepsy: Implications for surgical intervention

    International Nuclear Information System (INIS)

    Purpose: Magnetic resonance imaging (MRI), in particular fluid-attenuated inversion-recovery (FLAIR), has transformed the delineation of structural brain pathology associated with focal epilepsy. However, to date there is no literature on voxel based morphometry (VBM) of FLAIR in children with epilepsy. The aim of this study was to explore the role of visual and VBM assessment of FLAIR in pre-operative investigation of children with intractable focal epilepsy. Methods: Children with intractable epilepsy due to focal cortical dysplasia (FCD) and children with intractable cryptogenic focal epilepsy (CFE) were investigated. FLAIR and T1-weighted MRI were acquired on a 1.5T MRI scanner (Siemens, Erlangen, Germany). VBM was performed using SPM5 (Wellcome Institute of Cognitive Neuroscience, London). Results: Eight children with FCD (M = 5, age 7.9–17.3 years) and 14 children with CFE (M = 8, 7.8–16.8 years) were enrolled. VBM of FLAIR detected 7/8 (88%) of FCD whilst VBM of T1-weighted MRI detected only 3/8 (38%) FCD. VBM of FLAIR detected abnormality in 4/14 children with CFE, in 2/14 (14%) the abnormality was concordant with other data on the epileptogenic zone and with visible abnormality on repeat visual inspection of MR data. VBM of T1-weighed MRI detected abnormality in 2/14 children with CFE, none of which correlated with visible abnormality. Discussion: This study highlights the important role that FLAIR imaging has in the pre-operative assessment of children with intractable epilepsy. VBM of FLAIR may provide important information allowing selection of children with intractable CFE who are likely to benefit from further neuroradiological or neurophysiological evaluation.

  2. Modified Atkins diet to children and adolescents with medical intractable epilepsy

    DEFF Research Database (Denmark)

    Weber, Susanne; Mølgaard, Christian; Taudorf, Karen;

    2008-01-01

    The aim of the present study was to evaluate the tolerability and efficacy of the modified Atkins diet given to children and adolescents with antiepileptic drug (AED) treatment resistant epilepsy. 15 children with medically intractable epilepsy were enrolled in the study. Inclusion criteria were at...... increase in quality of life and cognition. At 12 months follow-up 3 (20%) continued the diet with an unchanged marked seizure reduction. The present study confirms the high tolerability and effect of the modified Atkins diet on seizure control in AED treatment resistant epilepsy. Further larger prospective...

  3. Outcomes of Disconnective Surgery in Intractable Pediatric Hemispheric and Subhemispheric Epilepsy

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    Santhosh George Thomas

    2012-01-01

    Full Text Available Objectives: To study the outcome of disconnective epilepsy surgery for intractable hemispheric and sub-hemispheric pediatric epilepsy. Methods: A retrospective analysis of the epilepsy surgery database was done in all children (age <18 years who underwent a peri-insular hemispherotomy (PIH or a peri-insular posterior quadrantectomy (PIPQ from April 2000 to March 2011. All patients underwent a detailed pre surgical evaluation. Seizure outcome was assessed by the Engel’s classification and cognitive skills by appropriate measures of intelligence that were repeated annually. Results: There were 34 patients in all. Epilepsy was due to Rasmussen’s encephalitis (RE, Infantile hemiplegia seizure syndrome (IHSS, Hemimegalencephaly (HM, Sturge Weber syndrome (SWS and due to post encephalitic sequelae (PES. Twenty seven (79.4% patients underwent PIH and seven (20.6% underwent PIPQ. The mean follow up was 30.5 months. At the last follow up, 31 (91.1% were seizure free. The age of seizure onset and etiology of the disease causing epilepsy were predictors of a Class I seizure outcome. Conclusions: There is an excellent seizure outcome following disconnective epilepsy surgery for intractable hemispheric and subhemispheric pediatric epilepsy. An older age of seizure onset, RE, SWS and PES were good predictors of a Class I seizure outcome.

  4. Understanding complexities of synaptic transmission in medically intractable seizures: A paradigm of epilepsy research

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    Jyotirmoy Banerjee

    2013-01-01

    Full Text Available Investigating the changes associated with the development of epileptic state in humans is complex and requires a multidisciplinary approach. Understanding the intricacies of medically intractable epilepsy still remains a challenge for neurosurgeons across the world. A significant number of patients who has undergone resective brain surgery for epilepsy still continue to have seizures. The reason behind this therapy resistance still eludes us. Thus to develop a cure for the difficult to treat epilepsy, we need to comprehensively study epileptogenesis. Although various animal models are developed but none of them replicate the pathological conditions in humans. So the ideal way to understand epileptogenecity is to examine the tissue resected for the treatment of intractable epilepsy. Advanced imaging and electrical localization procedures are utilized to establish the epileptogenic zone in epilepsy patients. Further molecular and cytological studies are required for the microscopic analysis of brain samples collected from the epileptogenic focus. As alterations in inhibitory as well as excitatory synaptic transmission are key features of epilepsy, understanding the regulation of neurotransmission in the resected surgery zone is of immense importance. Here we summarize various modalities of in vitro slice analysis from the resected brain specimen to understand the changes in GABAergic and glutamatergic synaptic transmission in epileptogenic zone. We also review evidence pertaining to the proposed role of nicotinic receptors in abnormal synaptic transmission which is one of the major causes of epileptiform activity. Elucidation of current concepts in regulation of synaptic transmission will help develop therapies for epilepsy cases that cannot me managed pharmacologically.

  5. Cognitive impairments in patients with intractable temporal lobe epilepsy

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    Mahgol Tavakoli

    2011-01-01

    Conclusions: These findings indicated that WMS-III and WAIS-R can differentiate patients with refractory temporal lobe epilepsy from normal subjects. However, the obtained cognitive profile could not differentiate between the right and the left TLE.

  6. Brain stimulation for intractable epilepsy: Anterior thalamus and responsive stimulation

    OpenAIRE

    2014-01-01

    Despite medications, resective surgery, and vagal nerve stimulation, some patients with epilepsy continue to have seizures. In these patients, other approaches are urgently needed. The biological basis of stimulation of anterior thalamic nucleus and epileptogenic focus is presented. Results from two large randomized controlled trials Stimulation of Anterior Nucleus of Thalamus for Epilepsy (SANTE) and Neuropace pivotal trial are discussed. Neuromodulation provides effective treatment for a se...

  7. Radiosurgery in the Management of Intractable Mesial Temporal Lobe Epilepsy.

    Science.gov (United States)

    Peñagarícano, José; Serletis, Demitre

    2015-09-01

    Mesial temporal lobe epilepsy (MTLE) describes recurrent seizure activity originating from the depths of the temporal lobe. MTLE patients who fail two trials of medication now require testing for surgical candidacy at an epilepsy center. For these individuals, temporal lobectomy offers the greatest likelihood for seizure-freedom (up to 80-90%); unfortunately, this procedure remains largely underutilized. Moreover, for select patients unable to tolerate open surgery, novel techniques are emerging for selective ablation of the mesial temporal structures, including stereotactic radiosurgery (SRS). We present here a review of SRS as a potential therapy for MTLE, when open surgery is not an option. PMID:26390538

  8. Expression of multidrug resistance 1 gene and C3435T genetic polymorphism in peripheral blood of patients with intractable epilepsy

    Institute of Scientific and Technical Information of China (English)

    Xueping Zheng; Lan Tan; Jinghui Song; Yan Wang; Yanping Sun

    2008-01-01

    BACKGROUND: Increased expression of multidrug resistance 1 (MDR1) mRNA in peripheral blood of patients with intractable epilepsy is not due to epilepsy drugs, but epilepsy behavior. Monitoring MDR1 expression in peripheral blood is a target for MDR1 gene evaluation. OBJECTIVE: To investigate the influence of antiepileptic drugs and seizures on MDR expression in intractable epilepsy, and to analyze the genetic polymnrphisms of C3435T in the MDR1 gene. DESIGN, TIME AND SETTING: Factorial designs and comparative observations at the experimental center of the Affiliated Hospital of Qingdao Medical College, Qingdao University between October 2003 and October 2004. PARTICIPANTS: A total of 120 subjects were recruited from the epilepsy clinical department of the Affiliated Hospital of Qingdao Medical College. Four groups (n = 30) were classified according to statistical factorial design: intractable epilepsy, treatment response, no treatment, and normal control groups. METHODS: One-step semi-quantitative reverse-transcription polymerase chain reaction technology was used to test expressions of the MDR1 gene in 120 subjects. C3435T polymorphisms in intractable epilepsy group and normal control groups were analyzed by polymerase chain reaction-restriction fragment length polymorphism. MAIN OUTCOME MEASURES: Expression of MDR1 mRNA in the four groups, and C3435T genetic polymorphisms in intractable epilepsy and normal control groups. RESULTS: MDR1 gene expression was increased in the intractable epilepsy group, due to the factor seizures, but not the antiepileptic drugs. However, the interaction between the two factors was not statistically significant. Of the 30 subjects in the intractable epilepsy group, the following genotypes were exhibited: 3 (10%) C/C genotype, 9 (30%) C/T genotype, and 18 (60%) T/T genotype at the site of C3435T, while 4 (13%), 10 (33%), and 16 (53%) subjects were determined to express these genotypes in the normal control group, respectively. C and T

  9. Comparison of Serum Zinc and Copper levels in Children and adolescents with Intractable and Controlled Epilepsy

    Directory of Open Access Journals (Sweden)

    Zeynab KHERADMAND

    2014-07-01

    Full Text Available How to Cite This Article: Kheradmand Z, Yarali B, Zare A, Pourpak Z, Shams S, Ashrafi MR. Comparison of Serum Zinc and Copper levels in Children and adolescents with Intractable and Controlled Epilepsy. Iran J Child Neurol. 2014; 8(3:49-54. AbstractObjectiveTrace elements such as zinc and copper have physiological effects on neuronal excitability that may play a role in the etiology of intractable epilepsy. This topic has been rarely discussed in Iranian epileptic patients.This study with the analysis of serum zinc and copper levels of children and adolescents with intractable and controlled epilepsy may identifies the potential role of these two trace elements in the development of epilepsy and intractabilityto antiepileptic drug treatment. Materials & MethodsSeventy patients between the ages of 6 months to 15 years that referred to Children’s Medical Center with the diagnosis of epilepsy, either controlled or intractable to treatment enrolled in the study. After informed parental consent the levels of serum zinc and copper were measured with atomic absorptionspectrophotometer and analyzed with SPSS version 11.Results35 patients were enrolled in each group of intractable (IE and controlled epilepsy (CE. 71.45% of the IE and 25.72% of the CE group had zinc deficiency that was statistically significant. 48.58% of the IE and 45.72 of the CE group were copper deficient, which was not statistically significant.ConclusionOur findings showed significant low serum zinc levels of patients with intractable epilepsy in comparison with controlled epilepsy group. We recommend that serum zinc level may play a role in the etiology of epilepsy and intractable epilepsy therefore its measurement and prescription may be regarded in the treatment of intractable epilepsy.ReferencesMikati MA. Seizures in childhood. In: Kliegman RM, Stanton BF, Schor NF, Geme JWS, Behrman R (eds. Nelson textbook of pediatrics. 19th ed. Elsevier:Saunders; 2011. Pp

  10. Affectivity and Subjective Memory in Patients with Intractable Medial Temporal Lobe Epilepsy

    Directory of Open Access Journals (Sweden)

    Marilyn Zaldivar Bermúdez

    2014-12-01

    Full Text Available Background: in the literature related to intractable medial temporal lobe epilepsy, some divergence is observed in terms of the factors that may be leading to memory complaints in patients with this condition. Objective: to identify the relationship between some manifestations of affectivity and subjective memory in patients with intractable medial temporal lobe epilepsy. Methods: a case series study was conducted in 32 patients aged 15 to 60 years treated at the International Center for Neurological Restoration from January 2008 through September 2011. The State-Trait Anxiety Inventory, State-Trait Depression Inventory and Questionnaire of Memory Efficiency were applied. The variables studied were anxiety, depression and subjective memory. Descriptive statistics and the Spearman correlation were used to process the data. Results: a prevalence of mean levels of state-trait anxiety and state depression was observed; however, trait depression reached high levels. Patients reported complaints about their memory functioning. A negative relationship between trait depression and subjective memory (r = -0.36, p <0.05 was obtained.Conclusion: some manifestations of affectivity (anxiety and depression, subjective memory impairment regardless of the lateralization of the ictal onset zone, and the relationship between trait depression and subjective memory were observed in patients with intractable medial temporal lobe epilepsy.

  11. Jervell and Lange-Nielson Syndrome masquerading as intractable epilepsy

    Directory of Open Access Journals (Sweden)

    Jagdish P Goyal

    2012-01-01

    Full Text Available The long QT syndrome (LQTS is a cause of syncope and sudden death. Jervell and Lange-Nielson syndrome (JLNS is an uncommon form of LQTS, having autosomal recessive transmission, and is associated with congenital deafness. We report a case of JLNS in a child who presented to us with refractory epilepsy. The cardiac cause of seizures was suspected as the child was hypotensive and pulseless during the episode of seizures. The child was diagnosed as JLNS based on Schwartz diagnostic criteria for LQTS and congenital sensorineural deafness. The child responded well to β-blocker therapy. Antiepileptic drugs were stopped. The screening of family members with ECG revealed a QT interval more than required for diagnosis of LQTS but they were asymptomatic. All asymptomatic family members were also put on metoprolol. All of them showed great improvement with the reduction of the QT interval on ECG. The patient was doing well on immediate follow-up.

  12. The Ketogenic and Atkins Diets Effect on Intractable Epilepsy: A Comparison

    Directory of Open Access Journals (Sweden)

    Ahad GHAZAVI

    2014-07-01

    Full Text Available How to Cite This Article: Ghazavi A, Tonekaboni SH, Karimzadeh P, Nikibakhsh AA, Khajeh A, Fayyazi A. The Ketogenic and Atkins Diets Effect on Intractable Epilepsy: A Comparison. Iran J Child Neurol. 2014 Summer;8(3: 12-17.AbstractObjectiveIntractable epilepsy is a major difficulty in child neurology, because the numbers of drugs that are available for treatment are limited and new treatments such as diets must be tried. Now there are some diets available for treating patients with intractable epilepsy. The oldest diet is the classic ketogenic diet and one of thenewest diets is the modified Atkins diet. Patients have a harder time accepting the classic ketogenic diet than the Atkins diet, which is easier to accept because the food tastes better. This study compares the efficacy of the ketogenic diet and the Atkins diet for intractable epilepsy in children.Materials & MethodsThis study is a clinical trial survey with sample size of 40 children with refractory epilepsy who were patients at Mofid hospital in Tehran, Iran. Initially, from Jan 2005–Oct 2007, 20 children were treated with the Atkins diet, and then from Oct 2007–March 2010, the other group was treated with the classic ketogenic diet and the results were compared. ResultsIn this study, response to treatment was greater than a 50% reduction in seizures and at the end of first, second, and third months for the ketogenic diet were 55%, 30%, and 70% and for the Atkins diet were 50%, 65%, and 70%, respectively.ConclusionThe results of this study show that there is no significant difference between the classic Ketogenic diet and the Atkins diet at the end of first, second, and third months and both had similar responses to the treatments.References Camfield CS, Canfield PR, Gordon K, Wirrell E, Dooley JM. Incidence of epilepsy in childhood and adolescents in Nova Scotia. Epilepsia, 1996 Jan;37(1:19-23.Gessner U, Sagmeister M, Horisberger B. The cost of Epilepsy in

  13. Upregulated P2X3 Receptor Expression in Patients with Intractable Temporal Lobe Epilepsy and in a Rat Model of Epilepsy.

    Science.gov (United States)

    Zhou, Xin; Ma, Li-Min; Xiong, Yan; Huang, Hao; Yuan, Jin-Xian; Li, Ruo-Han; Li, Jia-Ni; Chen, Yang-Mei

    2016-06-01

    Purinergic P2X3 receptors (P2X3Rs) play extensive roles in nerve cells in the central nervous system, particularly in hyperexcitability and calcium (Ca(2+)) influx. However, the role of P2X3Rs in epilepsy has not been previously investigated. To determine the relationship between P2X3Rs and epilepsy, the expression and cellular location of P2X3Rs in patients with intractable temporal lobe epilepsy (TLE) and in a lithium chloride-pilocarpine-induced chronic rat model of epilepsy were assessed. Furthermore, the function of P2X3Rs was assessed in vitro. Real-time quantitative polymerase chain reaction (RT-qPCR) and Western blot analysis were used to evaluate the expression levels of P2X3Rs in brain tissues from TLE patients and an epileptic rat model, whereas immunofluorescence labeling was applied to determine the distribution of target proteins. Whole-cell recording was subsequently performed to identify the influence of P2X3Rs on seizure-like discharges. P2X3Rs were located at the cell bodies and dendrites of neurons with significantly increased expression in the TLE patients and epileptic rat model. In vitro, P2X3R activation accelerated sustained repetitive firing, whereas P2X3R inhibition led to relatively low-frequency discharges. To the best of our knowledge, this is the first study provide evidence that upregulated P2X3R expression exists in both epileptic humans and rats and may aggravate the epileptic state in vitro. Thus, P2X3Rs may represent a novel therapeutic target for antiepileptic drugs. PMID:26738991

  14. Evaluation of the combination of multiple subpial transection and other techniques for treatment of intractable epilepsy

    Institute of Scientific and Technical Information of China (English)

    赵全军; 田增民; 刘宗惠; 李士月; 崔月汉; 林鸿

    2003-01-01

    Objective Multiple subpial transection (MST) is one approach to the surgical treatment of intractable epilepsy with epileptogenic lesion located in functional areas. To verify the effect of MST, an experimental study was performed first, followed by clinical application. Methods On the basis of the experimental study, MST was performed in 200 intractable epileptic patients from 1991 to 2000. Of them, 80 cases underwent MST only while 120 others underwent MST combined with other techniques, such as corpus callosotomy, temporal lobectomy and focus resection. A series of modifications of the surgical techniques were made. Results The results of the experimental study indicated that MST could inhibit the formation and spreading of epileptic discharge and limit the damage to neurons in a minimal area on the epileptogenic agent injected cortex. MST does not impair major functions of the cortex. After the clinical application and modifications, 160 patients were followed up for 1 to 8 years. Complete control of seizure was obtained in 100 cases (62.5%), significant reduction (more than 75%) in 32, reduction (more than 50%) in 20 and no change in 8. The total rate of effectiveness was 95.0%, and the significant rate of effectiveness was 82.5%. No functional defects were found in any patients. Conclusions The results indicate that MST is an effective approach to the surgical treatment of intractable epilepsy. MST can be combined with other approaches. The outcome of the subdivision of the MST only group indicates that MST on local epileptogenic lesion without structural changes is as effective as that of the combined operation group. To evade hemispheric disturbance, MST should be done first to avoid severe complications. Hemispherectomy should be performed only on poor effected cases of MST.

  15. Efficacy of and Patient Compliance with a Ketogenic Diet in Adults with Intractable Epilepsy: A Meta-Analysis

    OpenAIRE

    Ye, Fang; Li, Xiao-Jia; Jiang, Wan-Lin; Sun, Hong-Bin; Liu, Jie

    2015-01-01

    Background and Purpose Despite the successful use of a ketogenic diet in pediatric epilepsy, its application in adults has been limited. The aim of this meta-analysis was to summarize the findings of relevant published studies in order to identify the efficacy of and compliance with a ketogenic diet and its main subtypes (i.e., classic ketogenic diet and modified Atkins diet) in adults with intractable epilepsy, and to provide useful information for clinical practice. Methods Electronic searc...

  16. The usefulness of repeated ictal SPET for the localization of epileptogenic zones in intractable epilepsy

    International Nuclear Information System (INIS)

    This study investigated whether repeated ictal single-photon emission tomography (SPET) is helpful in the localization of epileptogenic zones and whether it can provide information confirming that an area of increased perfusion is really the culprit epileptogenic lesion. Fifty-four repeated ictal SPET studies were performed in 24 patients with ambiguous or unexpected findings on the first ictal SPET study. These patients were enrolled from among 502 patients with intractable epilepsy in whom pre-operative localization of epileptogenic zones was attempted with a view to possible surgical resection. Video monitoring of ictal behaviour and EEGs was performed in all patients. Repeated ictal SPET was performed using technetium-99m hexamethylpropylene amine oxime (HMPAO) when there was no prominently hyperperfused area or when unexpected findings were obtained during the first study. Two ictal SPET studies were performed in 19 patients, three studies in four patients and four studies in one patient. The average delay between ictal onset and injection was 28 s for the first study and 22 s for the second, third and fourth studies. Using interictal SPET, ictal-interictal subtraction images were acquired and co-registered with the population magnetic resonance imaging (MRI) template. Invasive study and surgery were performed in 18 patients, and in these cases the surgical outcome was known. In the other six patients, epileptogenic foci were determined using MRI, positron emission tomography (PET) and ictal EEG findings. Two patients were found to have mesial temporal lobe epilepsy, two lateral temporal lobe epilepsy, eight frontal lobe epilepsy, three parietal lobe epilepsy and one occipital lobe epilepsy. The other eight had multifocal epilepsy. The first study was normal in 12 patients (group I) and indicated certain zones to be epileptogenic in the other 12 (group II). Among group I, the correct epileptogenic zone or lateralization was revealed at the repeated study in

  17. Intractable chronic constipation in children: Outcome after anorectal myectomy

    Directory of Open Access Journals (Sweden)

    Seyed Abdollah Mousavi

    2014-01-01

    Full Text Available Background: Many children with constipation fail to respond with conventional medical therapy. Surgery can produce a good result in dysfunction of the colon secondary to aganglionosis. However, its role in treating idiopathic constipation is more controversial. Patients and Methods: A consecutive series of 44 patients with chronic idiopathic intractable constipation were included in this study. All children were investigated by barium enema and anorectal manometry. Due to inadequate response to medical therapy, all of these patients were selected for internal sphincter myomectomy. Patients were followed-up from 3 to 12 months. Results: Short-term (3 months and long-term (6 months follow-up was available for all patients. The histology examinations showed normal ganglion cells in 32, hypoganglionosis in eight and aganglionosis in four patients. In short-term, regular bowel habits, without the need for laxatives or low dose drugs were recorded in 35 patients (79.5%. Overall there was an improvement in 68.2% of the children after 6 months follow-up. There was not any correlation between histopathological findings, duration of symptoms, age and sex of operation and response to myectomy. Conclusion: anorectal myectomy is an effective procedure in patients with intractable idiopathic constipation. It relieves symptoms in 68.2% of patients with chronic refractory constipation.

  18. Application of statistical parametric mapping to SPET in the assessment of intractable childhood epilepsy

    International Nuclear Information System (INIS)

    Statistical parametric mapping (SPM) quantification and analysis has been successfully applied to functional imaging studies of partial epilepsy syndromes in adults. The present study evaluated whether localisation of the epileptogenic zone (determined by SPM) improves upon visually examined single-photon emission tomography (SPET) imaging in presurgical assessment of children with temporal lobe epilepsy (TLE) and frontal lobe epilepsy (FLE). The patient sample consisted of 24 children (15 males) aged 2.1-17.8 years (9.8±4.3 years; mean±SD) with intractable TLE or FLE. SPET imaging was acquired routinely in presurgical evaluation. All patient images were transformed into the standard stereotactic space of the adult SPM SPET template prior to SPM statistical analysis. Individual patient images were contrasted with an adult control group of 22 healthy adult females. Resultant statistical parametric maps were rendered over the SPM canonical magnetic resonance imaging (MRI). Two corresponding sets of ictal and interictal SPM and SPET images were then generated for each patient. Experienced clinicians independently reviewed the image sets, blinded to clinical details. Concordance of the reports between SPM and SPET images, syndrome classification and MRI abnormality was studied. A fair level of inter-rater reliability (kappa=0.73) was evident for SPM localisation. SPM was concordant with SPET in 71% of all patients, the majority of the discordance being from the FLE group. SPM and SPET localisation were concordant with epilepsy syndrome in 80% of the TLE cases. Concordant localisation to syndrome was worse for both SPM (33%) and SPET (44%) in the FLE group. Data from a small sample of patients with varied focal structural pathologies suggested that SPM performed poorly relative to SPET in these cases. Concordance of SPM and SPET with syndrome was lower in patients younger than 6 years than in those aged 6 years and above. SPM is effective in localising the potential

  19. Potential use and challenges of functional connectivity mapping in intractable epilepsy

    Directory of Open Access Journals (Sweden)

    Robert Todd Constable

    2013-05-01

    Full Text Available This review focuses on the use of resting-state functional magnetic resonance imaging data to assess functional connectivity in the human brain for surgical planning in intractable epilepsy. This approach has the potential to predict outcomes for a given surgical procedure based on the pre-surgical functional organization of the brain. Functional connectivity can also identify cortical regions that are organized differently in epilepsy patients either as a direct function of the disease or through indirect compensatory responses. Functional connectivity mapping can also potentially help identify epileptogenic tissue, whether this is a single focal location or a network of seizure-generating tissues and this information can assist in guiding the implantation of electrodes for invasive monitoring. This review covers the basics of connectivity analysis and discusses particular issues associated with analyzing such data. These issues include how to define nodes, as well as differences between connectivity analyses of individual nodes, groups of nodes, and whole-brain assessment at the voxel level. The need for arbitrary thresholds in some connectivity analyses is discussed and a solution to this problem is reviewed. Overall, functional connectivity analysis is becoming an important tool for assessing functional brain organization in surgical planning in epilepsy.

  20. Changes in EEG measurements in intractable epilepsy patients with neurofeedback training

    Institute of Scientific and Technical Information of China (English)

    Longlian Zhao; Wenqing Wu; Zuoqing Liang; Guangshu Hu

    2009-01-01

    To assess the effects of neurofeedback on brain electrophysiology and to determine how biofeedback works, power spectral density (PSD) and approximate entropy (ApEn) analyses are applied to the EEGs of six patients with intractable epilepsy who received neuro-feedback training. After sessions of treatment, the EEG sensorimotor rhythm to theta PSD ratio calculated from the C4 electrode site becomes larger than that before the treatment, which is consistent with the biofeedback protocol. The ApEn over 16-channel EEG recordings all increase to different degrees. Larger increases occur in channels located near the training position (CA). All these results suggest that these EEG measurements are new criteria that can be used to evaluate the effect of neurofeedback.

  1. Wada test for evaluation of language and memory function in medically intractable epilepsy

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Yong Kook; Chung, Tae Sub; Suh, Jung Ho; Kim, Dong Ik; Kim, Eun Kyung; Lee, Byung In; Huh, Kyun [College of Medicine, Yonsei University, Seoul (Korea, Republic of)

    1992-05-15

    The Wada test was performed for lateralization of language and memory function, using intracarotid injection of Sodium Amytal. But the internal carotid artery (ICA) Wada test has some limitations for testing memory function. The posterior cerebral artery (PCA) Wada test has been designed to modify the ICA Wada test for testing memory function selectively. In our study, 10 patients out of 12 patients with intractable seizure underwent only the ICA Wada test and the other 2 patients underwent both the ICA and the selective PCA Wada test. In all 12 patients undergoing the ICA Wada test, we successfully localized speech and language dominance. Four of 12 patients who underwent the ICA Wada test for evaluation of memory function displayed superior memory functions in one hemisphere, but the other hemisphere also significantly contributed to memory. The selective PCA Wada test, performed in 2 patients, showed successful results of memory function test in both patients. Four of 12 patients underwent temporal lobectomy and there was no major post-operative language or memory deficits. We concluded that the ICA and PCA Wada tests are useful for preoperative evaluation of medically intractable epilepsy, and the PCA Wada test is valuable in memory evaluation in some patients who have high risk of postoperative global amnesia after temporal lobectomy following equivocal results of memory function by the ICA Wada test.

  2. Wada test for evaluation of language and memory function in medically intractable epilepsy

    International Nuclear Information System (INIS)

    The Wada test was performed for lateralization of language and memory function, using intracarotid injection of Sodium Amytal. But the internal carotid artery (ICA) Wada test has some limitations for testing memory function. The posterior cerebral artery (PCA) Wada test has been designed to modify the ICA Wada test for testing memory function selectively. In our study, 10 patients out of 12 patients with intractable seizure underwent only the ICA Wada test and the other 2 patients underwent both the ICA and the selective PCA Wada test. In all 12 patients undergoing the ICA Wada test, we successfully localized speech and language dominance. Four of 12 patients who underwent the ICA Wada test for evaluation of memory function displayed superior memory functions in one hemisphere, but the other hemisphere also significantly contributed to memory. The selective PCA Wada test, performed in 2 patients, showed successful results of memory function test in both patients. Four of 12 patients underwent temporal lobectomy and there was no major post-operative language or memory deficits. We concluded that the ICA and PCA Wada tests are useful for preoperative evaluation of medically intractable epilepsy, and the PCA Wada test is valuable in memory evaluation in some patients who have high risk of postoperative global amnesia after temporal lobectomy following equivocal results of memory function by the ICA Wada test

  3. Pseudohypoparathyroidism type Ia manifesting as intractable epilepsy in a 23-year-old female

    Directory of Open Access Journals (Sweden)

    Raghavan P

    2012-07-01

    Full Text Available Pooja Raghavan,1 Charles M Katz21Department of Medicine, Mount Carmel Health, Columbus, OH, USA; 2Division of Endocrinology and Metabolism, Mount Carmel Health, Columbus, OH, USAAbstract: Pseudohypoparathyroidism is a rare disorder of calcium metabolism that involves target organ resistance to the action of the parathyroid hormone. As a result, calcium levels may become dangerously low, sometimes leading to seizures and other symptoms. We present a case of a 23-year-old Somalian female on antiepileptic therapy presenting with intractable epilepsy. She was subsequently found to have pseudohypoparathyroidism type Ia. She had multiple reasons accounting for loss of seizure control, including worsening hypocalcemia from resistance to the parathyroid hormone; vitamin D deficiency, which could have resulted from lack of exposure to direct sunlight and her antiepileptic medication; and extensive calcium deposition in the brain due to pseudohypoparathyroidism. The patient was stabilized with intravenous therapy and oral calcium, vitamin D, and calcitriol. Her antiepileptic therapy was changed to a medication that did not interfere with vitamin D metabolism or contribute to worsening hypocalcemia.Keywords: calcium, pseudohypoparathyroidism, epilepsy

  4. 99Tcm brain imaging for the assessment of patients with intractable partial epilepsy - our experience

    International Nuclear Information System (INIS)

    Full text: 99Tcm - Ethyl Cysteinate Diethylester (ECD) or Bicisate is a new radiopharmaceutical used for the assessment of cerebral perfusion. Unlike 99Tcm Hexamethylpropylene Amine Oxime (99Tcm- HMPAO) which is unstable and needs to be reconstituted immediately prior to injection, 99Tcm-ECD is stable for up to eight hours following reconstitution. Therefore, 99Tcm-ECD does not require mixing just prior to injection and is readily available on a daily inpatient basis to the epilepsy unit, facilitating earlier and faster injections, and the acquisition of true ictal studies. This is particularly important with patients who have extra temporal seizures which are typically brief in duration. 45 patients have undergone 99Tcm-ECD studies for epilepsy in our department over a period of one year. Image acquisition routinely commences within two hours of injection, and consists of a 360 degree elliptical SPECT using an ADAC Dual Headed Gamma Camera. Patients undergo both ictal and inter ictal SPECT studies, and an MRI. Visual comparison of the ictal, inter ictal and MRI images is performed, as well as subtraction and co-registration. The SISCOM analysis technique is used which allows subtraction of the SPECTs and co registration with MRI. This has the advantage of improved specificity, sensitivity, and accurate anatomical localisation. The results of our experience with 99Tcm-ECD will be presented. In conclusion, we have found that 99Tcm-ECD is ideally suited for peri-ictal SPECT studies as part of the pre-operative assessment of patients with intractable partial epilepsy. Copyright (2000) The Australian and New Zealand Society of Nuclear Medicine Inc

  5. Mesial temporal lobe morphology in intractable pediatric epilepsy: so-called hippocampal malrotation, associated findings, and relevance to presurgical assessment.

    Science.gov (United States)

    Leach, James L; Awwad, Reem; Greiner, Hansel M; Vannest, Jennifer J; Miles, Lili; Mangano, Francesco T

    2016-06-01

    OBJECTIVE Diagnostic criteria for hippocampal malrotation (HIMAL) on brain MRI typically include a rounded hippocampus, vertical collateral sulcus, and architectural blurring. Relationship to epileptogenesis remains speculative, and usefulness for surgical guidance is unknown. The study was performed to determine the prevalence of hippocampal rotational anomalies in a cohort of pediatric patients with intractable epilepsy undergoing evaluation for surgery and to determine the significance of this finding in the context of surgical planning. METHODS Forty-eight surgically treated children with intractable epilepsy were compared with matched healthy subjects; reviewers were blinded to surgical side. Each temporal lobe was evaluated for rounded hippocampus, blurring, vertical collateral sulcus, wide choroidal fissure, enlarged temporal horn, low fornix, hippocampal signal, and findings of hippocampal sclerosis. A mesial temporal lobe (MTL) score was calculated by summing the number of features, and the collateral sulcus angle (CSA) was measured in each temporal lobe. Surgical side, pathological diagnosis, and imaging findings elsewhere in the brain were tabulated. Presence of HIMAL, associated imaging features, and MTL score were compared between sides, between epilepsy and control groups, in relationship to side of surgery, and in relationship to postoperative outcome. RESULTS Only 3 epilepsy patients (6.2%) and no controls exhibited all 3 features of HIMAL (p = 0.12). Eight of 48 (16.7%) epilepsy versus 2 of 48 (4.6%) control subjects had both a rounded hippocampus and vertical collateral sulcus (suggesting HIMAL) (p = 0.045). In control and epilepsy subjects, most findings were more prevalent on the left, and the left CSA was more vertical (p prevalent and MTL scores were higher in patients with resections involving the temporal lobes. On group analysis, HIMAL findings did not predict eventual surgical side and did not predict outcome, although the numbers are

  6. Association of Microtubule Dynamics with Chronic Epilepsy.

    Science.gov (United States)

    Xu, Xin; Hu, Yida; Xiong, Yan; Li, Zhonggui; Wang, Wei; Du, Chao; Yang, Yong; Zhang, Yanke; Xiao, Fei; Wang, Xuefeng

    2016-09-01

    Approximately 30 % of epilepsy cases are refractory to current pharmacological treatments through unknown mechanisms. Much work has been done on the role of synaptic components in the pathogenesis of epilepsy, but relatively little attention has been given to the potential role of the microtubules. We investigated the level of microtubule dynamic in 30 human epileptic tissues and two different chronic epilepsy rat models. The administration of microtubule-modulating agent attenuated the progression of chronic epilepsy. By contrast, microtubule-depolymerizing agent aggravated the progression of chronic epilepsy. The electrophysiological index by whole-cell clamp was used to investigate the neuronal excitation and inhibitory synaptic transmission in brain slices after administration of microtubule-modulating agent and microtubule-depolymerizing agent. Interestingly, we found that microtubule-modulating agent significantly increased the frequency of action potential firing in interneurons, and significantly promoted the amplitudes and frequencies of miniature inhibitory postsynaptic currents. Microtubule-depolymerizing agent had an opposite effect. These findings suggest that modulating hyperdynamic microtubules may take an anti-epileptic effect via postsynaptic mechanisms in interneurons. It could represent a potential pharmacologic target in epilepsy treatment. PMID:26377107

  7. Detection of Lesions Underlying Intractable Epilepsy on T1-Weighted MRI as an Outlier Detection Problem.

    Science.gov (United States)

    El Azami, Meriem; Hammers, Alexander; Jung, Julien; Costes, Nicolas; Bouet, Romain; Lartizien, Carole

    2016-01-01

    Pattern recognition methods, such as computer aided diagnosis (CAD) systems, can help clinicians in their diagnosis by marking abnormal regions in an image. We propose a machine learning system based on a one-class support vector machine (OC-SVM) classifier for the detection of abnormalities in magnetic resonance images (MRI) applied to patients with intractable epilepsy. The system learns the features associated with healthy control subjects, allowing a voxelwise assessment of the deviation of a test subject pattern from the learned patterns. While any number of various features can be chosen and learned, here we focus on two texture parameters capturing image patterns associated with epileptogenic lesions on T1-weighted brain MRI e.g. heterotopia and blurred junction between the grey and white matter. The CAD output consists of patient specific 3D maps locating clusters of suspicious voxels ranked by size and degree of deviation from control patterns. System performance was evaluated using realistic simulations of challenging detection tasks as well as clinical data of 77 healthy control subjects and of eleven patients (13 lesions). It was compared to that of a mass univariate statistical parametric mapping (SPM) single subject analysis based on the same set of features. For all simulations, OC-SVM yielded significantly higher values of the area under the ROC curve (AUC) and higher sensitivity at low false positive rate. For the clinical data, both OC-SVM and SPM successfully detected 100% of the lesions in the MRI positive cases (3/13). For the MRI negative cases (10/13), OC-SVM detected 7/10 lesions and SPM analysis detected 5/10 lesions. In all experiments, OC-SVM produced fewer false positive detections than SPM. OC-SVM may be a versatile system for unbiased lesion detection. PMID:27603778

  8. Excitatory amino acid transporters EAAT-1 and EAAT-2 in temporal lobe and hippocampus in intractable temporal lobe epilepsy

    DEFF Research Database (Denmark)

    Sarac, Sinan; Afzal, Shoaib; Broholm, Helle;

    2009-01-01

    Intractable temporal lobe epilepsy (TLE) is an invalidating disease and many patients are resistant to medical treatment. Increased glutamate concentration has been found in epileptogenic foci and may induce local over-excitation and cytotoxicity; one of the proposed mechanisms involves reduced...... extra-cellular clearance of glutamate by excitatory amino acid transporters (EAAT-1 to EAAT-5). EAAT-1 and EAAT-2 are mainly expressed on astroglial cells for the reuptake of glutamate from the extra-cellular space. We have studied the expression of EAAT-1 and EAAT-2 in the hippocampus and temporal lobe...

  9. Occipital nerve stimulation in medically intractable, chronic cluster headache. The ICON study

    DEFF Research Database (Denmark)

    Wilbrink, Leopoldine A; Teernstra, Onno Pm; Haan, Joost;

    2013-01-01

    BACKGROUND: About 10% of cluster headache patients have the chronic form. At least 10% of this chronic group is intractable to or cannot tolerate medical treatment. Open pilot studies suggest that occipital nerve stimulation (ONS) might offer effective prevention in these patients. Controlled...

  10. Screening of inherited metabolic abnormalities in 56 children with intractable epilepsy

    Science.gov (United States)

    LIU, XIAOMING; LI, RUI; CHEN, SHENGZHI; SANG, YAN; ZHAO, JIAQIANG

    2016-01-01

    Epilepsy is a common children's neural disease that is largely controlled by anti-epileptic drugs. Nevertheless, children experience repeated attacks that develop into intractable epilepsy (IE). The aim of the present study was to examine the inherited metabolic abnormalities in children with IE to provide early etiological and symptomatic treatment. Urine and blood samples of 56 children with IE served as the experimental group and 56 cases of children with IE, who were successfully treated served as the control group, and analyzed by gas chromatography-mass spectrometry and tandem mass spectrometry for the metabolic screening of amino, organic, and fatty acids. Urine routine, hepatic function, blood biochemistry, imageology of encephalon and brain stem-evoked potential (auditory and optical) were also examined. Of the 27 IE children confirmed as abnormal in urine and blood screening, there were 19 cases (70.3%) of hypoevolutism or retrogression of intelligence and motor function, 15 cases (55.5%) of brain stem-evoked potential and of encephalic computed tomography (CT) or magnetic resonance imaging (MRI) abnormality, 6 cases (22.2%) of abnormal family history and of abnormal blood biochemistry and blood gas analysis, and 5 cases (18.5%) with skin change and of abnormal hepatic function. Of the 27 cases, 11 cases (19.6%) were diagnosed with inherited metabolic diseases. Among the children in the control group, 3 cases showed abnormal urine test results, one of which had family history, one had hypoevolutism or retrogression of intelligence and motor function, one had brain stem-evoked potential and encephalic CT or MRI abnormality, while two of the 3 cases had inherited metabolic abnormalities. The correlation analysis revealed that abnormal urine test was significantly correlated with inherited metabolic abnormalities (P<0.05). Of the 56 IE patients, 25 cases (44.6%) were identified as abnormal under urine screening, and of the 25 cases, 6 cases had simple

  11. Clinical effects of surgical and Gamma Knife treatments on hippocampal sclerosis-induced intractable epilepsy of children below age 10 years

    OpenAIRE

    Xiao, Aiju; Wang, Tuanjie; Tian, Yunjiao; Xu, Li; LI, SHUJUN; Zhu, Fenglian

    2013-01-01

    Objective: To discuss the treatment effects and costs of surgery and Gamma Knife on hippocampal sclerosis (HS)-induced intractable epilepsy of children below age 10 years. Methods: The children below age 10 years who suffered from HS-induced intractable epilepsy from June 2010 to June 2012 were subjected to surgical and Gamma Knife treatments respectively according to their preference. Results: The short-term curative rates of the surgical group and the Gamma Knife group were 93.51% and 54.87...

  12. Developing a comprehensive presurgical functional MRI protocol for patients with intractable temporal lobe epilepsy: a pilot study

    International Nuclear Information System (INIS)

    Our aim was to put together and test a comprehensive functional MRI (fMRI) protocol which could compete with the intracarotid amytal (IAT) or Wada test for the localisation of language and memory function in patients with intractable temporal lobe epilepsy. The protocol was designed to be performed in under 1 h on a standard 1.5 tesla imager. We used five paradigms to test nine healthy right-handed subjects: complex scene-encoding, picture-naming, reading, word-generation and semantic-decision tasks. The combination of these tasks generated two activation maps related to memory in the mesial temporal lobes, and three language-related maps of activation in a major part of the known language network. The functional maps from the encoding and naming tasks showed typical and symmetrical posterior mesial temporal lobe activation related to memory in all subjects. Only four of nine subjects also showed symmetrical anterior hippocampal activation. Language lateralisation was best with the word generation and reading paradigms and proved possible in all subjects. The reading paradigm enables localisation of language function in the left anterior temporal pole and middle temporal gyrus, areas typically resected during epilepsy surgery. The combined results of this comprehensive f MRI protocol are adequate for a comparative study with the IAT in patients with epilepsy being assessed for surgery. (orig.)

  13. Developing a comprehensive presurgical functional MRI protocol for patients with intractable temporal lobe epilepsy: a pilot study

    Energy Technology Data Exchange (ETDEWEB)

    Deblaere, K.; Vandemaele, P.; Achten, E. [MRI Department -1 K12, Department of Radiology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent (Belgium); Backes, W.H.; Hofman, P.; Wilmink, J. [Department of Neuroradiology, University Hospital Maastricht, Postbus 5800, 6202 AZ Maastricht (Netherlands); Boon, P.A.; Vonck, K. [Department of Neurology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent (Belgium); Boon, P. [Department of Medical Psychology, University Hospital Maastricht (Netherlands); Troost, J. [Department of Neurology, University Hospital Maastricht (Netherlands); Vermeulen, J. [S.E.I.N Heemstede, Psychological Laboratory, Achterweg 5, 2103 SW Heemstede (Netherlands); Aldenkamp, A. [Epilepsy Center ' Kempenhaeghe' , Postbus 61, 5900 AB Heeze (Netherlands)

    2002-08-01

    Our aim was to put together and test a comprehensive functional MRI (fMRI) protocol which could compete with the intracarotid amytal (IAT) or Wada test for the localisation of language and memory function in patients with intractable temporal lobe epilepsy. The protocol was designed to be performed in under 1 h on a standard 1.5 tesla imager. We used five paradigms to test nine healthy right-handed subjects: complex scene-encoding, picture-naming, reading, word-generation and semantic-decision tasks. The combination of these tasks generated two activation maps related to memory in the mesial temporal lobes, and three language-related maps of activation in a major part of the known language network. The functional maps from the encoding and naming tasks showed typical and symmetrical posterior mesial temporal lobe activation related to memory in all subjects. Only four of nine subjects also showed symmetrical anterior hippocampal activation. Language lateralisation was best with the word generation and reading paradigms and proved possible in all subjects. The reading paradigm enables localisation of language function in the left anterior temporal pole and middle temporal gyrus, areas typically resected during epilepsy surgery. The combined results of this comprehensive f MRI protocol are adequate for a comparative study with the IAT in patients with epilepsy being assessed for surgery. (orig.)

  14. Spinal cord stimulation in chronic intractable angina pectoris : A randomized, controlled efficacy study

    NARCIS (Netherlands)

    Hautvast, RWM; DeJongste, MJL; Staal, MJ; van Gilst, WH; Lie, KI

    1998-01-01

    Background Spinel cord stimulation is known to be a successful treatment for chronic intractable angina pectoris. its effect may be anti-ischemic. It is uncertain if the clinical effect is partly caused by a placebo effect of surgery For implantation of a stimulator. In this study, clinical efficacy

  15. Immunohistochemical characterization of the out-of frame splice variants GFAP Delta164/Deltaexon 6 in focal lesions associated with chronic epilepsy

    NARCIS (Netherlands)

    K. Boer; J. Middeldorp; W.G.M. Spliet; F. Razavi; P.C. van Rijen; J.C. Baayen; E.M. Hol; E.M.A. Aronica

    2010-01-01

    GFAP Delta164/Deltaexon 6 are two out-of frame splice variants of GFAP. The aim of this study was to investigate the distribution of GFAP Delta164/Deltaexon 6 expressing cells, in focal lesions associated with chronic intractable epilepsy, in light of the increasing interest in the role of specific

  16. Comparisons of 13NH3, 18FDG PET and MRS in the presurgical evaluation of intractable epilepsy

    International Nuclear Information System (INIS)

    Purpose: Surgery offers a high chance of seizure-free outcome in patients with intractable epilepsy. Other than EEG, several functional and morphologic imaging Methods are used to define the spatial seizure origin. Blood flow perfusion and metabolic abnormalities in those patients are well described respectively. Proton MR spectroscopy (MRS) is still in the early stages in the evaluation of epilepsy. Comparisons with 13NH3 perfusion, 18FDG metabolic PET imaging and MRS in the same patients have rarely been documented. The present study was undertaken to compare the merits of 13NH3 PET, 18FDG PET, magnetic resonance imaging (MRI) and MRS for the lateralization of seizure foci. Methods: Preoperative long-term-EEG, Video-EEG, 13NH3 perfusion PET, 18FDG metabolic PET, MRI, MRS and neuropsychological assessment were performed in 15 patients with intractable epilepsy within 2 weeks(mean age=24.8 years, range 4 to 44 years; mean epilepsy duration=11 years, range 2 to 36 years), who received electrocorticography (ECoG). Antiepileptic drug (AED) was stopped taking at least 2 days before PET scanning. 13NH3 and FDG PET was performed in one day and analyzed with a region of interest template. An absolute asymmetry index, |AI|, greater than 0.15 was considered abnormal. 13 subjects were underwent MRS obtained from the hippocampus bilaterally, who had a presumptive temporal seizure focus based on seizure semiology, video-EEG and MRI. Metabolite ratio of NAA/Cho+Cr was calculated from the relative peak height measurements. An NAA/Cho+Cr ratio of 0.72 or less was regarded as abnormal. All the examination Results were compared with EcoG to evaluate their values of seizure foci lateraliaztion. Results: 1. The results were divided into ictal (n=4) and interictal (n= 11) groups. In the ictal group, the sensitivity of 13NH3 PET and 18FDG PET were both 100%(4/4), and 13NH3 PET showed bilateral hippocampus hyperfusion foci in one case. In the interictal group, 13NH3 PET correctly

  17. Behavioural treatment of slow cortical potentials in intractable epilepsy: neuropsychological predictors of outcome.

    OpenAIRE

    Daum, Irene; Rockstroh, Brigitte; Birbaumer, Niels; Elbert, Thomas; Canavan, Anthony; Lutzenberger, Werner

    1993-01-01

    The study aimed to explore the predictive value of neuropsychological tests within the context of acquisition of slow cortical potential (SCP) self-control, a technique which has beneficial effects on seizure frequency in epilepsy. Patients with epilepsy who successfully achieved SCP control had longer digit or block-tapping spans than less successful patients. Patients who showed a better learning rate across training also displayed better verbal memory and learning abilities. Seizure reduct...

  18. Vagal nerve stimulation in intractable epilepsy: clinical experience on 100 patients and review of the literature

    Directory of Open Access Journals (Sweden)

    Franco RYCHLICKI

    2009-12-01

    Full Text Available Introduction: Vagus Nerve Stimulation (VNS is an effective alternative treatment for patients with refractory epilepsy. Nevertheless, information regarding VNS is still limited. Materials and Methods: In the present non randomized, prospectic study we report our clinical safety and effectiveness of VNS in 100 patients (52 Males and 48 Females with drug resistant epilepsy. Patient’s age at implant ranged from 0,64 to 51,04 years (mean age 15.3 years. The mean follow-up time was 54,8 months ( range 2 to 108,3 months. Seventeen patients suffered from Lennox-Gastaut Syndrome, 34 patients suffered from partial epilepsy with drop attacks and secondary bysinchronism on the EEG (Lennox Gastaut-like and 49 patients had Partial Epilepsy without drop attacks. Data collection forms were designed for prospectively gathering data on each patient’s history, seizures, drug therapy, implant device settings and side effects. Patients were assessed prior the implant and 3, 12 and 24 months after surgery. Results: Seventy-eight patients completed the 24 months follow-up session. VNS produced a mean seizure rate reduction of 32% at 3 months, 41% at 12 months, and 45% at 24 months. At 24 months, only the Partial Epilepsy patients showed a seizures reduction of 50%, which is considered clinically significant. Moreover both the age at implant and epilepsy duration were inversely correlated with the percentage of seizure reduction at 24 months. Side effects were minor and transient; the most common were voice alteration and coughing during stimulation. In 7 patients electrode breakage occurred three years after the surgical procedure. Conclusion: In our study, clinical effectiveness is higher in younger children implanted before than 12 years with shorter epilepsy duration suggesting a precocious useful role of VNS. Patients with Lennox Gastaut Syndrome show a worse clinical response rather than other epileptic syndromes.

  19. Omacetaxine mepesuccinate in the treatment of intractable chronic myeloid leukemia

    Directory of Open Access Journals (Sweden)

    Chen Y

    2014-01-01

    Full Text Available Yaoyu Chen,1 Shaoguang Li2 1Department of Oncology, Novartis Institutes for Biomedical Research, Cambridge, 2Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA Abstract: In a significant proportion of patients with chronic myeloid leukemia, resistance to BCR-ABL tyrosine kinase inhibitors develops due to acquisition of BCR-ABL kinase domain mutations and insensitivity of leukemia stem cells to tyrosine kinase inhibitors. Omacetaxine mepesuccinate (formerly called homoharringtonine is a natural alkaloid that inhibits protein synthesis and induces cell death. Omacetaxine mepesuccinate has been recently approved by the US Food and Drug Administration to treat patients with chronic myeloid leukemia who failed to respond to multiple tyrosine kinase inhibitors and/or acquired the BCR-ABL-T315I mutation. In this review, we discuss the use and effectiveness of omacetaxine mepesuccinate in the treatment of chronic myeloid leukemia, with coverage of its pharmacology, mode of action, and pharmacokinetics. We believe that omacetaxine mepesuccinate will be beneficial to many patients with chronic myeloid leukemia who do not respond well to tyrosine kinase inhibitors. Keywords: BCR-ABL, leukemic stem cells, chronic myeloid leukemia, biomarker, hematopoietic stem cells, cancer stem cells

  20. Multiple subpial cortical transections for the control of intractable epilepsy in exquisite cortex.

    Science.gov (United States)

    Dogali, M; Devinsky, O; Luciano, D; Perrine, K; Beric, A

    1993-01-01

    In 5 cases suffering from intractable seizures and ictal onset in exquisite (primary somatosensory or language related) cortex, surgical therapy has been done consisting wholly or in part of multiple subpial transections. In two cases with involvement of the primary somatosensory cortex, good seizure control without detectable neurological deficit was achieved. In the other three cases with involvement of the language cortex, deficits were minimal and cleared with time. Patients became seizure-free. PMID:8109292

  1. Intractable chronic inflammatory demyelinating polyneuropathy treated successfully with ciclosporin

    OpenAIRE

    M. Odaka; Tatsumoto, M.; Susuki, K.; Hirata, K; YUKI, N

    2005-01-01

    Background: Chronic inflammatory demyelinating polyneuropathy (CIDP) is a heterogeneous disorder and both clinical course and response to treatment vary widely. Because of the propensity for relapse, CIDP requires maintenance therapy after the initial response to treatment. There is no consensus regarding this in the published literature.

  2. Ondansetron Treatment in a Child Presenting with Chronic Intractable Pruritus

    OpenAIRE

    Chantal Frigon; Joëlle Desparmet

    2006-01-01

    The case of a seven-year-old boy with chronic pruritus secondary to a giant congenital melanocytic nevus is presented. The pruritus did not respond to conventional antipruritic drug treatment, but responded to ondansetron, a selective antagonist of 5-hydroxytryptamine type 3 receptors.

  3. Ondansetron Treatment in a Child Presenting with Chronic Intractable Pruritus

    Directory of Open Access Journals (Sweden)

    Chantal Frigon

    2006-01-01

    Full Text Available The case of a seven-year-old boy with chronic pruritus secondary to a giant congenital melanocytic nevus is presented. The pruritus did not respond to conventional antipruritic drug treatment, but responded to ondansetron, a selective antagonist of 5-hydroxytryptamine type 3 receptors.

  4. An outcome analysis of seventeen patients treated surgically for intractable extratemporal epilepsy.

    LENUS (Irish Health Repository)

    Mulholland, D

    2010-07-01

    We studied the outcomes of seventeen patients treated surgically for extratemporal lobe epilepsy. A retrospective case review of medical charts was performed. Seizure freedom post surgery was appraised using the Engel classification system. Post-operatively seven patients (41%) were seizure free (Engel class I), four patients were class II (23.5%), two in class III (11.76%) and four in class IV (23.5%). Three patients (17.6%) suffered traumatic injuries due to seizures. The mean duration of epilepsy prior to surgery was 12.2 years and the mean number of anti-epileptic medications given was 6.5. Seizure freedom rates for surgical treatment of extratemporal epilepsy in this centre are similar to those of other centres. Post-operative morbidity in this centre was similar to other centres. Any complications resolved with no lasting impairment.

  5. De novo mutations of KIAA2022 in females cause intellectual disability and intractable epilepsy

    DEFF Research Database (Denmark)

    de Lange, Iris M; Helbig, Katherine L; Weckhuysen, Sarah;

    2016-01-01

    , microcephaly, growth retardation, facial dysmorphisms and, less frequently, epilepsy. One female patient showed completely skewed X-inactivation, complete absence of RNA expression in blood and a phenotype similar to male patients. In the six other tested patients, X-inactivation was random, confirmed by a non...

  6. Intractable colitis associated with chronic granulomatous disease in a young girl.

    Science.gov (United States)

    Yaman, Aytaç; Kuloğlu, Zarife; Doğu, Figen; İkincioğulları, Aydan; Ensari, Arzu; Çiftçi, Ergin; Kansu, Aydan

    2015-01-01

    Chronic granulomatous disease (CGD) is an autosomal recessive or X-linked disorder caused by NADPH oxidase deficiency leading to an impaired ability of reactive superoxide anion and metabolite formation and recurring severe bacterial and fungal infections, with a high mortality rate. Diarrhea, colitis, ileus, perirectal abscess formation and anal fissures are reported gastrointestinal findings in these patients. We report a case of intractable colitis associated with CGD in a young girl. PMID:26690604

  7. Higher expression of monocyte chemoattractant protein 1 and its receptor in brain tissue of intractable epilepsy patients.

    Science.gov (United States)

    Wang, Chunyan; Yang, Lihua; Zhang, Jiadong; Lin, Zhiguo; Qi, Jiping; Duan, Shurong

    2016-06-01

    We aimed to explore the pathogenesis of monocyte chemoattractant protein-1 (MCP1) and CC chemokine receptor 2 (CCR2) in brain tissue of patients with intractable epilepsy (IE). Hippocampi or temporal lobe tissues were obtained from 40 patients with IE and five patients without IE who had undergone surgical decompression and debridement. The levels of MCP1 and CCR2 were evaluated using immunohistochemistry. Pearson correlation analysis was employed to evaluate the correlation between levels of MCP1 and CCR2 in IE with or without hippocampal sclerosis (HS) and the disease duration, along with age. Higher levels of MCP1 (11.68±4.68% versus 1.72±1.54%) and CCR2 (11.54±4.65% versus 1.52±1.29%; Pcorrelated with the disease duration. However, no correlation was found in IE patients without HS. There was also no correlation between levels of MCP1 and CCR2 in IE patients with age, either with HS or without HS. These results suggest that MCP1 and its receptor may play a role in the pathogenesis and progression of IE. PMID:26810469

  8. Research into the (Cost- effectiveness of the ketogenic diet among children and adolescents with intractable epilepsy: design of a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Hendriksen Jos GM

    2011-01-01

    Full Text Available Abstract Background Epilepsy is a neurological disorder, characterized by recurrent unprovoked seizures which have a high impact on the individual as well as on society as a whole. In addition to the economic burden, epilepsy imposes a substantial burden on the patients and their surroundings. Patients with uncontrolled epilepsy depend heavily on informal care and on health care professionals. About 30% of patients suffer from drug-resistant epilepsy. The ketogenic diet can be a treatment of last resort, especially for children. The beneficial effect of the ketogenic diet has been proven, but information is lacking about its cost-effectiveness. In the current study we will evaluate the (cost- effectiveness of the ketogenic diet in children and adolescents with intractable epilepsy. Methods/Design In a RCT we will compare the ketogenic diet with usual care. Embedded in this RCT will be a trial-based and model-based economic evaluation, looking from a societal perspective at the cost-effectiveness and cost-utility of the ketogenic diet versus usual care. Fifty children and adolescents (aged 1-18 with intractable epilepsy will be screened for eligibility before randomization into the intervention or the usual care group. The primary outcome measure is the proportion of children with a 50% or more reduction in seizure frequency. Secondary outcomes include seizure severity, side effects/complaints, neurocognitive, socio-emotional functioning, and quality of life. Costs and productivity losses will be assessed continuously by a prospective diary and a retrospective questionnaire. Measurements will take place during consults at baseline, at 6 weeks and at 4 months after the baseline period, and 3, 6, 9 and 12 months follow-up after the 4 months consult. Discussion The proposed research project will be the first study to provide data about the cost-effectiveness of the ketogenic diet for children and adolescents with intractable epilepsy, in comparison

  9. Advance in Research on the Treatment of Intractable Epilepsy in Children%儿童难治性癫痫的治疗进展

    Institute of Scientific and Technical Information of China (English)

    冯丽梅

    2012-01-01

    癫痫是儿童常见的神经系统疾病,儿童癫痫在病因、临床表现及治疗上明显不同于成年癫痫,抗癫痫药物(AEDs)的药动学特点也不同于成人.另外,癫痫发作及AEDs均可影响患儿的行为、学习、教育、社交及情感发育.随着AEDs的不断创新和扩展以及人们对癫痫及癫痫综合征认识的深入,近年来有关难治性癫痫的治疗取得一些突破性进展.目前治疗难治性癫痫的方法主要有药物、手术、迷走神经刺激术、生酮饮食以及病因与心理治疗等.%Epilepsy is a common nervous system diseases seen in children,which is obviously different from adults'epilepsy in pathogeny, clinical feature and therapy,the pharmacokinetics characteristics of anti-epilepsy drugs( AEDs ) in children are different from adults too. Besides, both epileptic seizure and AEDs affect children's behaviour, learning, education, social contact and development of emotion. Recently, with continuous innovations and expanding, and people have known more about epilepsy and epileptic syndrome,there is some breakthrough in the treatment of intractable epilepsy. Nowadays, the main treatment of intractable epilepsy are drugs,operation,vagus nerve stimulation,ketogenic diet and psychological cure.

  10. Chronic bilateral thalamic stimulation: a new therapeutic approach in intractable Tourette syndrome. Report of three cases.

    Science.gov (United States)

    Visser-Vandewalle, Veerle; Temel, Yasin; Boon, Peter; Vreeling, Fred; Colle, Henry; Hoogland, Govert; Groenewegen, Henk J; van der Linden, Chris

    2003-12-01

    Based on the results of thalamotomies described by Hassler in 1970, the authors performed bilateral thalamic high-frequency stimulation (HFS) in three patients with intractable Tourette syndrome (TS). In this report they describe the long-term effects. Three male patients (42, 28, and 45 years of age) had manifested motor and vocal tics since early childhood. The diagnosis of TS was made according to the criteria of the Tourette Syndrome Classification Study Group. Any drug or alternative treatment had been either ineffective or only temporarily effective in all three patients. There was no serious comorbidity. The target for stimulation was chosen at the level of the centromedian nucleus, substantia periventricularis, and nucleus ventrooralis internus. After 2 weeks of test stimulation, the pulse generators were implanted. After a follow-up period of 5 years in the patient in Case 1, 1 year in the patient in Case 2, and 8 months in the patient in Case 3, all major motor and vocal tics had disappeared and no serious complications had occurred. When stimulation was applied at the voltage necessary to achieve an optimal result on the tics, a slight sedative effect was noted in all three patients. In the patients in Cases 1 and 3 there were stimulation-induced changes in sexual behavior. Chronic thalamic HFS may be an effective and safe treatment for medically intractable TS in adult patients. Unwanted stimulation-induced side effects may occur. PMID:14705742

  11. Sustained reduction of seizures in patients with intractable epilepsy after self-regulation training of slow cortical potentials –10 year after

    Directory of Open Access Journals (Sweden)

    Ute Strehl

    2014-08-01

    This is the longest follow-up evaluation of the outcome of a psychophysiological treatment in patients with epilepsy ever reported. Reduced seizure frequency may be the result of patients continued ability to self-regulate their slow cortical potentials. Given such a long follow-up period, the possible impact of confounding variables should be taken into account. The small number of patients participating in this follow-up evaluation diminishes the ability to make causal inferences. However, the consistency and duration of improvement for patients who received SCP-feedback training suggests that such treatment may be considered as a treatment for patients with intractable epilepsy and as an adjunct to conventional therapies.

  12. Investigation into the mechanisms of vagus nerve stimulation for the treatment of intractable epilepsy, using 99mTc-HMPAO SPET brain images

    International Nuclear Information System (INIS)

    Vagus nerve stimulation (VNS) has gained recognition as a treatment for refractory epilepsies where surgical treatment is not possible. While it appears that this treatment is effective in some patients, the mechanism of action is not clearly understood. The purpose of this study was to clarify findings of other positron emission tomography and single-photon emission tomography (SPET) investigations by measuring the acute effect of VNS on patients who have normal cerebral anatomy on magnetic resonance imaging and who have not previously been exposed to VNS. We investigated six subjects (two males and four females, mean age 29.5 years, range 21-39 years) with intractable epilepsy. One patient had primary generalised epilepsy causing generalised tonic-clonic seizures; the remaining five patients had localisation-related epilepsy causing complex partial seizures. SPET imaging was performed using 250 MBq of 99mTc-HMPAO and a four-scan paradigm - two with and two without stimulation. The stimulation began at VNS current levels of 0.25 mA and was increased according to the limit of patients' tolerance, usually defined by coughing or discomfort. The stimulating waveform was of continuous square wave pulses of 500 μs duration at 30 Hz. Image analysis was by SPM99. Reduced perfusion during stimulation was observed in the ipsilateral brain stem, cingulate, amygdala and hippocampus and contralateral thalamus and cingulate. The study provides further evidence of the involvement of the limbic system in the action of vagal nerve stimulation. (orig.)

  13. Depression and Anxiety in Patients with Epilepsy, With or Without Other Chronic Disorders

    OpenAIRE

    Asadi-Pooya, A A; Sperling, M.R.

    2011-01-01

    Background Most people with epilepsy lead a normal emotional and cognitive life, however neurobehavioral problems can be found in a large number of patients. This study evaluates the prevalence of depression and anxiety among patients with epilepsy and determines whether having other chronic somatic illnesses increases the prevalence. Methods Adults with epilepsy were recruited in either the inpatient epilepsy monitoring unit or the Outpatient Epilepsy Clinic at Thomas Jefferson University in...

  14. Invasive Evaluations for Epilepsy Surgery: A Review of the Literature

    OpenAIRE

    Enatsu, Rei; Mikuni, Nobuhiro

    2016-01-01

    Invasive evaluations play important roles in identifying epileptogenic zones and functional areas in patients with intractable focal epilepsy. This article reviews the usefulness, methods, and limitations of invasive evaluations for epilepsy surgery. Invasive evaluations include various types of intracranial electrodes such as stereotactically implanted intracranial depth electrodes (stereo-EEG), chronic subdural electrodes, and intraoperative electrocorticography. Scalp EEG is distorted by t...

  15. A Descriptive Study of 100 Patients Undergoing Palliative Nerve Blocks for Chronic Intractable Headache and Neck Ache

    OpenAIRE

    Rothbart, Peter; Fiedler, Katherine; Gale, George D; Nussbaum, David; Hendlerb, Nelson

    2000-01-01

    OBJECTIVE: To ascertain whether repeated (palliative) nerve blocks over a long period of time provide benefit to patients with chronic intractable headache and neck ache.SUBJECTS AND METHODS: One hundred patients who were receiving repeated nerve blocks as part of their pain management regimen completed a structured interview questionnaire. The patients had all been investigated and received a diagnosis of cervicogenic headache. Changes in pain rating, depression rating, anxiety rating, activ...

  16. Chronic temporal lobe epilepsy: a neurodevelopmental or progressively dementing disease?

    Science.gov (United States)

    Helmstaedter, C; Elger, C E

    2009-10-01

    To what degree does the so-called 'initial hit' of the brain versus chronic epilepsy contribute towards the memory impairment observed in chronic temporal lobe epilepsy (TLE) patients? We examined cross-sectional comparisons of age-related regressions of verbal learning and memory in 1156 patients with chronic TLE (age range 6-68 years, mean epilepsy onset 14 +/- 11 years) versus 1000 healthy control subjects (age range 6-80 years) and tested the hypothesis that deviations of age regressions (i.e. slowed rise, accelerated decline) will reveal critical phases during which epilepsy interferes with cognitive development. Patients were recruited over a 20-year period at the Department of Epileptology, University of Bonn. Healthy subjects were drawn from an updated normative population of the Verbaler Lern- und Merkfähigkeitstest, the German pendant to the Rey Auditory Verbal learning Test. A significant divergence of age regressions indicates that patients fail to build up adequate learning and memory performance during childhood and particularly during adolescence. The learning peak (i.e. crossover into decline) is seen earlier in patients (at about the age of 16-17 years) than for controls (at about the age of 23-24 years). Decline in performance with ageing in patients and controls runs in parallel, but due to the initial distance between the groups, patients reach very poor performance levels much earlier than controls. Patients with left and right TLEs performed worse in verbal memory than controls. In addition, patients with left TLE performed worse than those with right TLE. However, laterality differences were evident only in adolescent and adult patients, and not (or less so) in children and older patients. Independent of age, hippocampal sclerosis was associated with poorer performance than other pathologies. The results indicate developmental hindrance plus a negative interaction of cognitive impairment with mental ageing, rather than a progressively

  17. Intractable Chronic Low-Back Pain Caused by Ligamentopathia Treated Using a Spinous Process Plate (S-plate

    Directory of Open Access Journals (Sweden)

    Yu-ichiro Ohnishi

    2010-03-01

    Full Text Available We report a case of intractable chronic low-back pain in a gymnast that was caused by ligamentopathia in the interspinous region of the lumbar vertebrae. Sprained interspinous ligaments are a common mechanical cause of acute low-back pain in athletes. Although conservative therapy is generally effective in such cases, in this case it was not. The patient experienced severe low-back pain during lumbar flexion with tension between the L5/S interspinous ligaments. We performed interspinous fixation by using a spinous process plate system, which has been developed for short in situ fusions, and following which the low-back pain resolved. Conservative therapy for low-back pain caused by ligamentopathia is first-line choice, but interspinous fixation with instrumentation might be recommended in intractable cases with conservative therapy.

  18. Predictors of seizure outcomes in children with tuberous sclerosis complex and intractable epilepsy undergoing resective epilepsy surgery: an individual participant data meta-analysis.

    Directory of Open Access Journals (Sweden)

    Aria Fallah

    Full Text Available OBJECTIVE: To perform a systematic review and individual participant data meta-analysis to identify preoperative factors associated with a good seizure outcome in children with Tuberous Sclerosis Complex undergoing resective epilepsy surgery. DATA SOURCES: Electronic databases (MEDLINE, EMBASE, CINAHL and Web of Science, archives of major epilepsy and neurosurgery meetings, and bibliographies of relevant articles, with no language or date restrictions. STUDY SELECTION: We included case-control or cohort studies of consecutive participants undergoing resective epilepsy surgery that reported seizure outcomes. We performed title and abstract and full text screening independently and in duplicate. We resolved disagreements through discussion. DATA EXTRACTION: One author performed data extraction which was verified by a second author using predefined data fields including study quality assessment using a risk of bias instrument we developed. We recorded all preoperative factors that may plausibly predict seizure outcomes. DATA SYNTHESIS: To identify predictors of a good seizure outcome (i.e. Engel Class I or II we used logistic regression adjusting for length of follow-up for each preoperative variable. RESULTS: Of 9863 citations, 20 articles reporting on 181 participants were eligible. Good seizure outcomes were observed in 126 (69% participants (Engel Class I: 102(56%; Engel class II: 24(13%. In univariable analyses, absence of generalized seizure semiology (OR = 3.1, 95%CI = 1.2-8.2, p = 0.022, no or mild developmental delay (OR = 7.3, 95%CI = 2.1-24.7, p = 0.001, unifocal ictal scalp electroencephalographic (EEG abnormality (OR = 3.2, 95%CI = 1.4-7.6, p = 0.008 and EEG/Magnetic resonance imaging concordance (OR = 4.9, 95%CI = 1.8-13.5, p = 0.002 were associated with a good postoperative seizure outcome. CONCLUSIONS: Small retrospective cohort studies are inherently prone to bias, some of which are overcome using individual participant data. The

  19. Application of hippocampotomy in surgery of intractable occipital epilepsy%选择性海马切除在枕叶癫痫手术中的应用

    Institute of Scientific and Technical Information of China (English)

    梁树立; 李安民; 姚世斌; 赵明; 张敏; 孙雅静

    2009-01-01

    Objective o analyze the surgical outcome and experience of the combination of cortex resection and hippocampotomy for surgical treatment of intractable occipital epilepsy.Methods 20 surgical cases of occipital epilepsy with conducting to hippocampus were studied retrospectively.The patient'S general clinical data,seizure features,surgical outcomes and surgical experiences were studied.There were 17 cases (85%)under partial seizures and secondary general tonic-clonic attack,9 patients with temporal aures or automasim,9 cases with temporal abnormal metabolizing in PET imaging and 13 cases with abnormal in MRI or MRS imaging in hippocampus.Epileptogenics Was located in lateral occipital lobe in 8 cases(40%),temporo-occipital lobe in 6 cases(30%)and mesial occipital lobe in 6 cases.All patients were performed the operation of combination of occipital cortex resection and hippocampotomy.Results The surgical results included 16 Engle I cases.2 II case and 2Ⅲgrade cases.Conclusion Intractable occipital epilepsy with conducting to hippocampus always has temporal aures or automasim and abnormal image of temporal lobe.The operation of the combination of occipital cortex resection with hippocampotomy could achieve good surgicat outcome.%目的 总结分析枕叶癫痫患者手术中联合选择性海马切除的手术治疗效果和经验.方法 回顾性分析2003年1月至2006年12月在我科接受手术治疗的20例向颢叶内侧传导的枕叶癫痫病例,统计患者的发病、检查及手术治疗情况,并介绍相关手术体会.17例(85%)为部分性发作继发强直.痉挛性发作为主,9例有颢叶先兆或口咽自动症,PET检查中9例有颞叶的代谢异常,MRI及MRS共发现有海马异常13例;脑电图确定癫痫灶位于枕叶外侧皮层8例.内侧皮层6例,枕颞交界区6例,发作期脑电图均显示明显向颢叶传导.手术均行枕叶致痫灶切除和经颞底海马结构切除术.结果 癫痫发作Engle分级示:I级16例,Ⅱ级2

  20. Epilepsy

    Science.gov (United States)

    Epilepsy is a brain disorder that causes people to have recurring seizures. The seizures happen when clusters ... may have violent muscle spasms or lose consciousness. Epilepsy has many possible causes, including illness, brain injury, ...

  1. A systems level, functional genomics analysis of chronic epilepsy.

    Directory of Open Access Journals (Sweden)

    Kellen D Winden

    Full Text Available Neither the molecular basis of the pathologic tendency of neuronal circuits to generate spontaneous seizures (epileptogenicity nor anti-epileptogenic mechanisms that maintain a seizure-free state are well understood. Here, we performed transcriptomic analysis in the intrahippocampal kainate model of temporal lobe epilepsy in rats using both Agilent and Codelink microarray platforms to characterize the epileptic processes. The experimental design allowed subtraction of the confounding effects of the lesion, identification of expression changes associated with epileptogenicity, and genes upregulated by seizures with potential homeostatic anti-epileptogenic effects. Using differential expression analysis, we identified several hundred expression changes in chronic epilepsy, including candidate genes associated with epileptogenicity such as Bdnf and Kcnj13. To analyze these data from a systems perspective, we applied weighted gene co-expression network analysis (WGCNA to identify groups of co-expressed genes (modules and their central (hub genes. One such module contained genes upregulated in the epileptogenic region, including multiple epileptogenicity candidate genes, and was found to be involved the protection of glial cells against oxidative stress, implicating glial oxidative stress in epileptogenicity. Another distinct module corresponded to the effects of chronic seizures and represented changes in neuronal synaptic vesicle trafficking. We found that the network structure and connectivity of one hub gene, Sv2a, showed significant changes between normal and epileptogenic tissue, becoming more highly connected in epileptic brain. Since Sv2a is a target of the antiepileptic levetiracetam, this module may be important in controlling seizure activity. Bioinformatic analysis of this module also revealed a potential mechanism for the observed transcriptional changes via generation of longer alternatively polyadenlyated transcripts through the

  2. Epilepsi

    DEFF Research Database (Denmark)

    Sabers, Anne; Kjær, Troels W

    2014-01-01

    Epilepsy affects around 33,000 people in Denmark. The classification of the epilepsies is currently under revision and the clinical course of the disease depends on the underlying aetiology. Diagnostic evaluation includes EEG and often long-term video-EEG monitoring to ensure the diagnosis and clas......-sification. More than two thirds of patients with epilepsy can obtain complete seizure control. The remainders, counting around 12.000 patients in Denmark, having medical refractory epilepsy should be considered for other treatment options; epilepsy surgery or other non-pharmacological treatment....

  3. MR 双反转恢复序列在难治性癫痫患者中的初步应用%The Preliminary Application of Double Inversion Recovery MR Imaging in the Patients with Intractable Epilepsy

    Institute of Scientific and Technical Information of China (English)

    张韶辉; 秦林娣; 陆钦池

    2014-01-01

    Objective:To investigate the imaging feature and diagnostic value of double invesion recov-ery (DIR) MR imaging in intractable epilepsy.Method: The clinical data,EEG and imaging manifestation of 7 cases with intractable epilepsy were retrospectively analyzed on the signal intensity on DIR sequence . Result:Abnormal DIR signal intensities of the DIR images were observed in 6 patients with complex partial seizure , none of abnormal DIR signal intensities of the DIR images was observed in 1 patient with generalized tonic clonic seizure .Conclusion: DIR can show superior delineation of gray matter and white matter .DIR MR imaging can be valuable for characterizing epileptic foci and may contribute to presurgical evaluation in the intractable epilepsy patients .%目的:探讨 MR双反转恢复( DIR)序列在难治性癫痫定位诊断中的价值。分析DIR显示难治性癫痫患者灰质、白质结构的改变。方法:回顾性分析7例难治性癫痫患者的临床、脑电图和影像学资料,观察患者在DIR上的表现。结果:6例复杂部分发作的患者在DIR上发现异常信号,1例全面性发作的癫痫患者在影像学上未发现异常。结论:DIR序列能突出显示灰质和白质结构,灰白质对比度高,对难治性癫痫术前定位诊断具有一定的价值。

  4. Spatiotemporal Accuracy of Gradient Magnetic-Field Topography (GMFT) Confirmed by Simultaneous Magnetoencephalography and Intracranial Electroencephalography Recordings in Patients with Intractable Epilepsy.

    Science.gov (United States)

    Shirozu, Hiroshi; Hashizume, Akira; Masuda, Hiroshi; Fukuda, Masafumi; Ito, Yosuke; Nakayama, Yoko; Higashijima, Takefumi; Kameyama, Shigeki

    2016-01-01

    Gradient magnetic-field topography (GMFT) is one method for analyzing magnetoencephalography (MEG) and representing the spatiotemporal dynamics of activity on the brain surface. In contrast to spatial filters, GMFT does not include a process reconstructing sources by mixing sensor signals with adequate weighting. Consequently, noisy sensors have localized and limited effects on the results, and GMFT can handle MEG recordings with low signal-to-noise ratio. This property is derived from the principle of the planar-type gradiometer, which obtains maximum gradient magnetic-field signals just above the electrical current source. We assumed that this characteristic allows GMFT to represent even faint changes in brain activities that cannot be achieved with conventional equivalent current dipole analysis or spatial filters. GMFT is thus hypothesized to represent brain surface activities from onset to propagation of epileptic discharges. This study aimed to validate the spatiotemporal accuracy of GMFT by analyzing epileptic activities using simultaneous MEG and intracranial electroencephalography (iEEG) recordings. Participants in this study comprised 12 patients with intractable epilepsy. Epileptic spikes simultaneously detected on both MEG and iEEG were analyzed by GMFT and voltage topography (VT), respectively. Discrepancies in spatial distribution between GMFT and VT were evaluated for each epileptic spike. On the lateral cortices, areas of GMFT activity onset were almost concordant with VT activities arising at the gyral unit level (concordance rate, 66.7-100%). Median time lag between GMFT and VT at onset in each patient was 11.0-42.0 ms. On the temporal base, VT represented basal activities, whereas GMFT failed but instead represented propagated activities of the lateral temporal cortices. Activities limited to within the basal temporal or deep brain region were not reflected on GMFT. In conclusion, GMFT appears to accurately represent brain activities of the

  5. 颅内电极脑电监测辅助下难治性枕叶癫痫的外科治疗%Surgical treatment of intractable occipital lobe epilepsy with intracranial video eletroencephalogram

    Institute of Scientific and Technical Information of China (English)

    郭毅; 郭金竹; 窦万臣; 周祥琴; 卢强; 金丽日; 苏长保; 孔燕国

    2012-01-01

    目的 初步探索在颅内有创脑电监测下进行难治性枕叶癫痫外科治疗的效果.方法 回顾性分析8例应用有创脑电监测的枕叶癫痫病例,所有病例均经过磁共振(MRI)、正电子发射断层扫描(PET)、头皮视频脑电监测(VEEG)等术前评估,初步判断癫痫起源在枕叶,再应用有创脑电监测,进一步明确致痫区的位置和范围,2期行致痫区手术切除.结果 术后无死亡及严重并发症,其中1例视野缺损稍有加重.6例患者术后随访超过1 a,2例患者随访超过半年,其中6例术后无癫痫发作,2例发作次数明显减少.结论 颅内电极长程脑电监测对于明确致痫区及视觉皮层、确定并精确切除致病区具有重要意义,在其辅助下难治性枕叶癫痫的外科疗效提高,并发症减少.%Objective To investigate the effect of surgical treatment using intracranial video electroencephalogram (iVEEC) in patients with intractable occipital lobe epilepsy. Methods The clinical data for eight patients undergoing implantation of intractable epilepsy were retrospectively reviewed. All patients underwent MR], position emission tomography (PET) and scalp video electroencephalogram (VEEG) that indicated occipital lobe'epilepsy, then iVEEG that contributed to confirm the location of seizure foci and the lesionectomy were performed. Results No severe complication occurred due to the implantation, only one patient' s field of vision was damaged lightly. Six patients were seizure-free, two patients' seizure frequencies reduced significantly. Conclusion iVEEG is considerable for identification of seizure foci and visual cortex. The therapeutic effect of operations to intractable occipital lobe epilepsy would improve with its help, and the complication would reduce simultaneously.

  6. Epilepsy

    Science.gov (United States)

    ... which can led to embarrassment and frustration or bullying, teasing, or avoidance in school and other social ... may enter trials of experimental drugs and surgical interventions. More about epilepsy research NIH Patient Recruitment for ...

  7. Epilepsy

    Science.gov (United States)

    Epilepsy is a brain disorder that causes people to have recurring seizures. The seizures happen when clusters of nerve cells, or neurons, in the brain send out the wrong signals. People may have strange sensations and emotions ...

  8. Neural Stem Cell Grafting in an Animal Model of Chronic Temporal Lobe Epilepsy

    OpenAIRE

    Hattiangady, Bharathi; Shetty, Ashok K.

    2011-01-01

    Neural stem cell (NSC) transplantation into the hippocampus could offer an alternative therapy to hippocampal resection in patients with drug-resistant chronic epilepsy, which afflicts ~30% of mesial temporal lobe epilepsy (TLE) cases. Multipotent, self-renewing NSCs could be expanded from multiple regions of the developing and adult brain, human embryonic stem cells (hESCs), induced pluripotent stem cells (iPSCs). However, to provide a comprehensive methodology involved in testing the effica...

  9. Epilepsy

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    2008481 Application of amplitude of low-frequency fluctuation to the temporal lobe epilepsy with bilateral hippocampal sclerosis: an fMRI study. ZHANG Zhiqiang(张志强), et al.Dept Med Imaging, Clin Sch, Med Coll, Nanjing Univ, Nanjing 210002.Natl Med J China 2008;88(23):1594-1598. Objective To study the changes of amplitude of low-frequency fluctuation (ALFF) of the resting-fMRI in the mesial temporal lobe epilepsy (mTLE) with

  10. Epilepsy

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    2008115 Effect of commonly used antiepileptic drugs on cognitive functions of rats with pentylenetetrazol-induced epilepsy. WANG Xiaopeng(王晓鹏), et al. Dept Neurol, 2nd Hosp, Hebei Med Univ, Shijiazhuang 050000. Shanghai Med J 2007;30(12):920-923. Objective To observe the effect of antiepileptic drugs on the cognitive functions of rats with induced epilepsy. Methods Seventy male SD rats in their puberty were randomized into 7 groups,

  11. Epilepsy

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    2005267 Expression and their clinical significances of five multidrug resistance gene products in refractory epilepsy brain tissues. XIAO Zheng (肖争), et al. Dept Neurol,Lab, Affili Hosp, Chongqing Med Univ, Chongqing 400016, Chin J Neurol, 2004;37(6) 500-503. Objective: To investigate the expression and their clinical significances of five multidrug resistance gene products in human epileptogenic pathologies. Methods: 17 refractory epilepsy patients were divided into two groups: long course group (≥10 years) and short course group (<10 years). The expression

  12. Autologous adipose-derived regenerative cells are effective for chronic intractable radiation injuries

    International Nuclear Information System (INIS)

    Effective therapy for chronic radiation injuries, such as ulcers, is prone to infection. Stiffness is expected since the therapeutic radiation often involves wider and deeper tissues and often requires extensive debridement and reconstruction, which are not sometimes appropriate for elderly and compromised hosts. Autologous adipose-derived regenerative cells (ADRCs) are highly yielding, forming relatively elderly aged consecutive 10 cases, 63.6±14.9 y (52-89 y), with mean radiation dose of 75.0±35.4 Gy (50-120 Gy) were included with at least 10-month follow-up. Minimal debridement and ADRC injection in the wound bed and margin along with the injection of mixture of fat and ADRCs in the periphery were tested for efficacy and regenerated tissue quality by clinically as well as imaging by computed tomography and magnetic resonance imaging. Uncultured ADRCs of 1.6±1.3 x 107 cells were obtained. All cases healed uneventfully after 6.6±3.2 weeks (2-10 weeks) post-operatively. The done site morbidity was negligible and without major complications, such as paralysis or massive haematoma. The regenerated tissue quality was significantly superior to the pre-operative one and the mixture of fat and ADRCs connected to the intact tissue was very soft and pliable. Mean follow-up at 1.9±0.8 y (0.9-2.9 y) revealed no recurrence or new ulceration after treatment. Thus, the ADRCs treatment for decades-long radiation injuries is effective, safe and improves the quality of wounds. (authors)

  13. Epilepsy

    International Nuclear Information System (INIS)

    As surgical treatments for adult and pediatric forms of epilepsy have become more refined, methods for noninvasive localization of epileptogenic foci have become increasingly important. Detection of focal brain metabolic or flow abnormalities is now well recognized as an essential step in the presurgical evaluation of many patients with epilepsy. Positron emission tomography (PET) scanning is most beneficial when used in the context of the total clinical evaluation of patients, including scalp EEG, invasive EEG, neuropsychologic testing, etc. Metabolic PET studies also give insight into pathophysiologic mechanisms of epilepsy. The dynamic nature of the interictal hypometabolism observed with 18[F]FDG in some patients suggests that excitatory or inhibitory neurotransmitters and their receptors may be involved. An exciting current application of PET scanning is the use of tracers for neurotransmitter receptors in the study of epilepsy patients. Mu and non-mu opiate receptors have been extensively studied and are beginning to give new insights into this disorder. Increased labeling of mu receptors in temporal neocortex using 11C-carfentanil has been demonstrated and, in some patients, supplements the clinical localization information from 18[F]FDG studies. Increased mu opiate receptor number or affinity is thought to play a role in anticonvulsant mechanisms. Specificity of increased mu receptors is supported by the absence of significant changes in non-mu opiate receptors. Other brain receptors are also of interest for future studies, particularly those for excitatory neurotransmitters. Combined studies of flow, metabolism, and neuroreceptors may elucidate the factors responsible for initiation and termination of seizures, thus improving patient treatment.95 references

  14. A Systems Level, Functional Genomics Analysis of Chronic Epilepsy

    OpenAIRE

    Winden, Kellen D.; Karsten, Stanislav L.; Anatol Bragin; Kudo, Lili C; Lauren Gehman; Josephine Ruidera; Geschwind, Daniel H.; Jerome Engel

    2011-01-01

    Neither the molecular basis of the pathologic tendency of neuronal circuits to generate spontaneous seizures (epileptogenicity) nor anti-epileptogenic mechanisms that maintain a seizure-free state are well understood. Here, we performed transcriptomic analysis in the intrahippocampal kainate model of temporal lobe epilepsy in rats using both Agilent and Codelink microarray platforms to characterize the epileptic processes. The experimental design allowed subtraction of the confounding effects...

  15. Danish study of a Modified Atkins diet for medically intractable epilepsy in children: Can we achieve the same results as with the classical ketogenic diet?

    DEFF Research Database (Denmark)

    Miranda, M. J.; Mortensen, M.; Povlsen, J. H.;

    2011-01-01

    Modified Atkins diet (MAD) is a less restrictive variety of the classical ketogenic diet (KD), used for treating patients with medically resistant epilepsy. There are only few reports comparing the two types of diets in terms of seizure reduction and tolerability. We compared the effect of a MAD ...

  16. Clinical application of functional MRI for chronic epilepsy

    International Nuclear Information System (INIS)

    Functional magnetic resonance imaging (fMRI) is frequently used in the presurgical diagnostic procedure of epilepsy patients, in particular for lateralization of speech and memory and for localization of the primary motor cortex to delineate the epileptogenic lesion from eloquent brain areas. fMRI is one of the non-invasive procedures in the presurgical diagnostic process, together with medical history, seizure semiology, neurological examination, interictal and ictal EEG, structural MRI, video EEG monitoring and neuropsychology. This diagnostic sequence leads either to the decision for or against elective epilepsy surgery or to the decision to proceed with invasive diagnostic techniques (Wada test, intra-operative or extra-operative cortical stimulation). It is difficult to evaluate the contribution of the fMRI test in isolation to the validity of the entire diagnostic sequence. Complications such as memory loss and aphasia in temporal lobe resections or paresis after frontal lobe resections are rare and rarely of disastrous extent. This further complicates the evaluation of the clinical relevance of fMRI as a predictive tool. In this article studies which investigated the concordance between fMRI and other diagnostic gold standards will be presented as well as the association between presurgical fMRI and postsurgical morbidity. (orig.)

  17. Coexistent ganglioglioma, focal cortical dysplasia, and hippocampal sclerosis (triple pathology) in chronic epilepsy.

    Science.gov (United States)

    Prayson, Richard A; Gales, Jordan M

    2015-10-01

    The most commonly identified pathologies in patients with medically intractable epilepsy include focal cortical dysplasia, hippocampal sclerosis, tumors, and remote ischemic damage. Surgery has proven to be an effective therapeutic modality in most of such patients. The coexistence of multiple pathologies in resected tissues is well documented, particularly ganglioglioma and focal cortical dysplasia. Cases of triple pathology are, however, extraordinarily unusual. We report 2 cases of triple pathology including hippocampal sclerosis, ganglioglioma, and focal cortical dysplasia. Cases of pathologically confirmed hippocampal sclerosis diagnosed between January 2000 to December 2012 (n= 349) were reviewed, and only 2 cases (0.6%) with triple pathology were identified. The histopathologic and clinical features of these 2 cases are reviewed. The patients included a 6-year-old girl and 10-year-old boy. The former patient presented with a 4-year history of epilepsy and oppositional defiant disorder. Imaging identified a lesion in the left parahippocampal gyrus and posterior hippocampus. The latter patient presented with an 8-year history of epilepsy, attention deficient hyperactivity disease, and a pervasive developmental disorder. Imaging identified a lesion in the left posterior temporal and occipital region. Resected tissues in both patients showed a ganglioglioma (World Health Organization grade I) with accompanying focal cortical dysplasia and hippocampal sclerosis. Both patients were seizure free on antiepileptic medication at last follow-up at 20 and 38 months, respectively. The prevalence of triple pathology including hippocampal sclerosis is low (<1% in the current study). Surgical intervention for triple pathology cases anecdotally appears effective in achieving seizure control. PMID:26235882

  18. Expressional changes of chloride channel in human temporal foci with intractable epilepsy%氯通道在难治性颞叶癫痫病灶内的表达变化

    Institute of Scientific and Technical Information of China (English)

    冯亚波; 姚红; 满晓; 杜怡峰; 陈春富; 尚伟; 郭华; 迟兆富

    2009-01-01

    目的 研究ClC-2、ClC-3氯通道在难治性癫痫病灶中表达的变化,并探讨这种分布和表达变化的意义.方法 取20例难治性癫痫患者手术切除的病灶及20例脑血管畸形患者手术切除的正常脑组织,分别采用SABC法对ClC-2、ClC_3氯通道免疫组化染色,采用RT-PCR方法检测ClC-2、ClC-3氯通道mRNA.RT-PCR凝胶电泳图像应用1D Image Analysis Software分析.结果 ClC-2、ClC-3氯通道在癫痫灶和正常脑组织中皆有表达,但RT-PCR半定量分析显示:在癫痫灶中ClC-2氯通道表达的相对密度(0.34±0.16)低于正常脑组织(0.81±0.11),差异具有显著性(P<0.05);而ClC-3氯通道在癫痫灶中的表达的相对密度(0.83±0.09)高于正常脑组织(0.53±0.14),差异具有显著性(P<0.05).结论 难治性癫痫病灶中ClC-2通道表达减少,ClC-3通道表达增加,可能是难治性癫痫发作频发且难以控制的原因之一,也可能为癫痫发作的继发性改变.%Objective To investigate the expressional changes of voltage-gated chloride channel CIC-2, CIC-3 in human temporal foci with intractable epilepsy. Methods The specimens were obtained from 20 patients with intractable temporal lobe epilepsy and 20 patients with arteriovenous malformation as control, lmmunohisto-chemistry and RT-PCR was used to detect the expression of CIC-2, CIC-3 chloride channel. The gel eleclrophore-sis images of RT-PCR were analysised by 1D Image Analysis Software. Results Chloride channel CIC-2 and CIC-3 expressed both in epileptic foci and the normal. Serni-quantitive RT-PCR showed that the relative density of CIC-2 mRNA expression in epileptic foci(0. 34 ±0. 16) was lower than that in the normal (0. 81 ±0. 11 ) (P< 0. 05 ) ;the relative density of CIC-3 mRNA in epileptic foci ( 0. 83 ± 0. 09 ) was higher than that in the normal (0.53 ±0. 14)(P<0.05). Conclusion The decrease of CIC-2 and the increase of CIC-3 in epileptic foci may be one of the reasons why the seizures in intractable

  19. The Putative Role of Viruses, Bacteria, and Chronic Fungal Biotoxin Exposure in the Genesis of Intractable Fatigue Accompanied by Cognitive and Physical Disability.

    Science.gov (United States)

    Morris, Gerwyn; Berk, Michael; Walder, Ken; Maes, Michael

    2016-05-01

    Patients who present with severe intractable apparently idiopathic fatigue accompanied by profound physical and or cognitive disability present a significant therapeutic challenge. The effect of psychological counseling is limited, with significant but very slight improvements in psychometric measures of fatigue and disability but no improvement on scientific measures of physical impairment compared to controls. Similarly, exercise regimes either produce significant, but practically unimportant, benefit or provoke symptom exacerbation. Many such patients are afforded the exclusionary, non-specific diagnosis of chronic fatigue syndrome if rudimentary testing fails to discover the cause of their symptoms. More sophisticated investigations often reveal the presence of a range of pathogens capable of establishing life-long infections with sophisticated immune evasion strategies, including Parvoviruses, HHV6, variants of Epstein-Barr, Cytomegalovirus, Mycoplasma, and Borrelia burgdorferi. Other patients have a history of chronic fungal or other biotoxin exposure. Herein, we explain the epigenetic factors that may render such individuals susceptible to the chronic pathology induced by such agents, how such agents induce pathology, and, indeed, how such pathology can persist and even amplify even when infections have cleared or when biotoxin exposure has ceased. The presence of active, reactivated, or even latent Herpes virus could be a potential source of intractable fatigue accompanied by profound physical and or cognitive disability in some patients, and the same may be true of persistent Parvovirus B12 and mycoplasma infection. A history of chronic mold exposure is a feasible explanation for such symptoms, as is the presence of B. burgdorferi. The complex tropism, life cycles, genetic variability, and low titer of many of these pathogens makes their detection in blood a challenge. Examination of lymphoid tissue or CSF in such circumstances may be warranted. PMID

  20. Glycophospholipid Formulation with NADH and CoQ10 Significantly Reduces Intractable Fatigue in Western Blot-Positive ‘Chronic Lyme Disease’ Patients: Preliminary Report

    Directory of Open Access Journals (Sweden)

    Garth L. Nicolson

    2012-03-01

    Full Text Available Background: An open label 8-week preliminary study was conducted in a small number of patients to determine if a combination oral supplement containing a mixture of phosphoglycolipids, coenzyme Q10 and microencapsulated NADH and other nutrients could affect fatigue levels in long-term, Western blot-positive, multi-symptom ‘chronic Lyme disease’ patients (also called ‘post-treatment Lyme disease’ or ‘post Lyme syndrome’ with intractable fatigue. Methods: The subjects in this study were 6 males (mean age = 45.1 ± 12.4 years and 10 females (mean age = 54.6 ± 7.4 years with ‘chronic Lyme disease’ (determined by multiple symptoms and positive Western blot analysis that had been symptomatic with chronic fatigue for an average of 12.7 ± 6.6 years. They had been seen by multiple physicians (13.3 ± 7.6 and had used many other remedies, supplements and drugs (14.4 ± 7.4 without fatigue relief. Fatigue was monitored at 0, 7, 30 and 60 days using a validated instrument, the Piper Fatigue Scale.Results: Patients in this preliminary study responded to the combination test supplement, showing a 26% reduction in overall fatigue by the end of the 8-week trial (p< 0.0003. Analysis of subcategories of fatigue indicated that there were significant improvements in the ability to complete tasks and activities as well as significant improvements in mood and cognitive abilities. Regression analysis of the data indicated that reductions in fatigue were consistent and occurred with a high degree of confidence (R2= 0.998. Functional Foods in Health and Disease 2012, 2(3:35-47 Conclusions: The combination supplement was a safe and effective method to significantly reduce intractable fatigue in long-term patients with Western blot-positive ‘chronic Lyme disease.’

  1. Clinical application of functional MRI for chronic epilepsy; Klinischer Einsatz der funktionellen MRT bei chronischer Epilepsie

    Energy Technology Data Exchange (ETDEWEB)

    Woermann, F.G.; Labudda, K. [Krankenhaus Mara, Epilepsiezentrum Bethel, Abteilung fuer Magentresonanztomographie, Bielefeld (Germany)

    2010-02-15

    Functional magnetic resonance imaging (fMRI) is frequently used in the presurgical diagnostic procedure of epilepsy patients, in particular for lateralization of speech and memory and for localization of the primary motor cortex to delineate the epileptogenic lesion from eloquent brain areas. fMRI is one of the non-invasive procedures in the presurgical diagnostic process, together with medical history, seizure semiology, neurological examination, interictal and ictal EEG, structural MRI, video EEG monitoring and neuropsychology. This diagnostic sequence leads either to the decision for or against elective epilepsy surgery or to the decision to proceed with invasive diagnostic techniques (Wada test, intra-operative or extra-operative cortical stimulation). It is difficult to evaluate the contribution of the fMRI test in isolation to the validity of the entire diagnostic sequence. Complications such as memory loss and aphasia in temporal lobe resections or paresis after frontal lobe resections are rare and rarely of disastrous extent. This further complicates the evaluation of the clinical relevance of fMRI as a predictive tool. In this article studies which investigated the concordance between fMRI and other diagnostic gold standards will be presented as well as the association between presurgical fMRI and postsurgical morbidity. (orig.) [German] Die funktionelle Magnetresonanztomographie (fMRT) wird im Rahmen der Epilepsiediagnostik vor epilepsiechirurgischen Eingriffen insbesondere zur Lateralisation von Sprache und Gedaechtnis und zur Lokalisation der Zentralregion eingesetzt, um den eloquenten Kortex von der epilepsieverursachenden, chirurgisch zugaenglichen Laesion abzugrenzen. Dabei ist die fMRT Teil einer Sequenz nichtinvasiver klinischer Tests (Anamnese, Anfall-Semiologie, neurologischer Status, interiktales und iktales EEG, strukturelles MRT, Video-EEG-Monitoring, Neuropsychologie). Das Ergebnis dieser Sequenz ist die Entscheidung fuer oder gegen einen

  2. Administration of Simvastatin after Kainic Acid-Induced Status Epilepticus Restrains Chronic Temporal Lobe Epilepsy

    OpenAIRE

    Xie, Chuncheng; Sun, Jiahang; Qiao, Weidong; Lu, Dunyue; Wei, Lanlan; NA, MENG; Song, Yuanyuan; Hou, Xiaohua; LIN, ZHIGUO

    2011-01-01

    In this study, we examined the effect of chronic administration of simvastatin immediately after status epilepticus (SE) on rat brain with temporal lobe epilepsy (TLE). First, we evaluated cytokines expression at 3 days post KA-lesion in hippocampus and found that simvastatin-treatment suppressed lesion-induced expression of interleukin (IL)-1β and tumor necrosis factor-α (TNF-α). Further, we quantified reactive astrocytosis using glial fibrillary acidic protein (GFAP) staining and neuron los...

  3. Prospective multicenter study on long-term ketogenic diet therapy for intractable childhood epilepsy%长期生酮饮食治疗儿童难治性癫(癎)的前瞻性多中心研究

    Institute of Scientific and Technical Information of China (English)

    中华医学会儿科学分会神经学组生酮饮食疗法协作组

    2013-01-01

    Objective To evaluate the efficacy and safety of long-term ketogenic diet (KD) on the children with intractable epilepsy.Method This was a prospective,open-label study of intractable epilepsy patients treated with the classic KD with a lipid-to-nonlipid ratio 4:1 between October 2004 and July 2011 at five Chinese epilepsy centers.A total of 299 patients were enrolled.The patients were divided into different groups according to age (including the below-l-year-old group,1-to-3-year-old group,3-to-6-year-old group,6-to-10-year-old group,and over-10-year-old group),etiology (cryptogenic epilepsy,symptomatic epilepsy,and idiopathic epilepsy),and the seizure types (included infantile spasm,Lennox-Gastaut syndrome,Ohtahara syndrome,tuberous sclerosis,Dravet syndrome,generalized epilepsy,and partial epilepsy).Parents were assigned to write seizure diaries which recorded the seizure presentations,tolerability,and complications associated with the KD.Patients' weight and height were measured every week.Blood β-hydroxybutyric acid,blood sugar,and urinary ketone bodies were monitored closely.Patients were followed up through telephone calls hy the nutritionists every month and regular outpatient visits or hospitalizations were recommended at all time-points which included the third,sixth and twelfth month after initiation.Efficacy was measured through seizure frequency.The variables related to the efficacy were also analyzed.SPSS 17.0 was used for all statistical analysis.Result At 3,6,and 12 months after initiation,65.9%,44.8%,and 26.4% patients remained on the diet,and 37.4%,26.1%,and 20.4% had a >50% reduction in their seizure frequency,including 21.7%,10.7%,and l l.0% who became seizure free,respectively.At 24 months after initiation,29 patients remained on the diet,and 28 patients had a >90% seizure reduction,including five became seizure free.At 36 months after initiation,7 patients remained on the diet,and all of them had a > 90% seizure

  4. Impact of ketogenic diet on emotional and social behavior in children with intractable epilepsy%生酮饮食对难治性癫痫患儿情绪和社会行为的影响

    Institute of Scientific and Technical Information of China (English)

    徐文成; 陶玺宬; 周自云; 吴德; 唐久来

    2015-01-01

    目的:了解生酮饮食( ketogenic diet,KD)对难治性癫痫患儿情绪和社会行为的影响。方法采用前瞻性病例对照研究,对66例难治性癫痫患儿,在告知相关生酮治疗疗效和不良反应后由家长选择入组,加用生酮饮食治疗的35例为生酮组,继续单用抗癫痫药物治疗的31例为对照组。研究启动前对两组患儿进行情绪和社会行为评估,生酮饮食治疗启动后,分别在第3、6、12个月再进行情绪和社会行为的评估,将评分结果转化成T分进行分析,比较生酮组和对照组之间,以及生酮组自身治疗前后患儿情绪和社会行为的改变情况。结果生酮组生酮饮食治疗后第3、6、12个月,患儿的问题维度(忧郁、焦虑、冲动性、攻击性)较对照组明显下降(P<0.05);能力维度(注意力、依从性、模仿)较对照组有明显提高(P<0.05),其中在治疗初3个月改善最为明显。结论生酮饮食能明显改善难治性癫痫患儿的情绪和社会行为,较为安全。%Objective To understand the impact of the ketogenic diet ( ketogenic diet, KD) on the emotional and social behavior in children with refractory epilepsy. Methods A prospective case-control study was performed in 66 cases of children with intractable epilepsy from June 2011 to December 2014 treated in the hospital. After the relevant ketogenic diet efficacy and adverse reactions were informed, the groups were selected by the parents(35 cases in the patient group received completely fasting ketogenic diet treatment regimen, and 31 cases in the control group continued to receive the antiepileptic drug treatment) . Before the onset of study, the motional and social behavior of two groups of children was assessed, and after the ketogenic diet treatment, the emotional and social behavior in the following 3, 6, 12 months was assessed again, then the results of the assessment were transformed into T points scoring and compared, and the changes in the

  5. Neural Stem Cell Grafting in an Animal Model of Chronic Temporal Lobe Epilepsy

    Science.gov (United States)

    Hattiangady, Bharathi; Shetty, Ashok K.

    2016-01-01

    Neural stem cell (NSC) transplantation into the hippocampus could offer an alternative therapy to hippocampal resection in patients with drug-resistant chronic epilepsy, which afflicts ~30% of mesial temporal lobe epilepsy (TLE) cases. Multipotent, self-renewing NSCs could be expanded from multiple regions of the developing and adult brain, human embryonic stem cells (hESCs), induced pluripotent stem cells (iPSCs). However, to provide a comprehensive methodology involved in testing the efficacy of transplantation of NSCs in a rat model of chronic TLE, NSCs derived from the embryonic medial ganglionic eminence (MGE) are taken as an example in this article. The topics comprise description of the required materials, reagents and equipment, and protocols for expanding MGE-NSCs in culture, generating chronically epileptic rats, the intrahippocampal grafting, the post-grafting evaluation of the effects of NSC grafts on spontaneous recurrent seizures and cognitive impairments, analyses of the yield and the fate of graft-derived cells, and the effects of NSC grafts on the host hippocampus. PMID:21913169

  6. Standard magnetic resonance imaging is inadequate for patients with refractory focal epilepsy.

    NARCIS (Netherlands)

    Oertzen, J. von; Urbach, H.; Jungbluth, S.; Kurthen, M.; Reuber, M.; Fernandez, G.S.E.; Elger, C.E.

    2002-01-01

    OBJECTIVES: Patients with intractable epilepsy may benefit from epilepsy surgery especially if they have a radiologically demonstrable cerebral lesion. Dedicated magnetic resonance imaging (MRI) protocols as performed at epilepsy surgery centres can detect epileptogenic abnormalities with great sens

  7. Association between human cytomegalovirus and onset of epilepsy

    OpenAIRE

    Lei, Hong-Yan; Yang, Dai-Qun; Li, Yu-xin; WANG, LI-QUAN; Zheng, Mei

    2015-01-01

    Objective: To explore the association between human cytomegalovirus (HCMV) and epilepsy. Methods: Epilepsy patients (n = 112) in neurology clinic of our hospital during January 2012 and December 2014 were allocated to the case groups, including intractable epilepsy group (n = 96) and non-intractable epilepsy group (n = 16). Healthy individual (n = 120) who received physical examination during the same period were allocated to the control group. The expression of serum HCMV late gene pp67-RNA ...

  8. Treatment of intractable chronic pelvic pain syndrome by injecting a compound of Bupivacaine and Fentanyl into sacral spinal space

    Institute of Scientific and Technical Information of China (English)

    ZHOU Zhan-song; SONG Bo; NIE Fa-chuan; CHEN Jin-mei

    2006-01-01

    Objective:To investigate the effect of injecting a compound of Bupivacaine and Fentanyl into sacral spinal space to treat chronic pelvic pain syndrome (CPPS). Methods: A total of 36 men with recalcitrant CPPS refractory to multiple prior therapies were treated with the injection of a compound of Bupivacaine and Fentanyl (10 ml of 0. 125% upivacaine, .05 mg Fentanyl, 5 mg Dexamethasone, 100 mg Vitamin B1 and 1 mg Vitamin B12) into sacral space once a week for 4 weeks. The National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI), maximum and average flow rate were performed at the start and the end of 4 weeks' therapy. Results :Mean NIH-CPSI total score was decreased from 26.5±.6 to 13.4±2.0 (P<0. 001). Significant improvement was seen in each subscore domain. A total of 32 patients (89%) had at least 25% improvement on NIH-CPSI and 22 (61%) had at least 50% improvement. Maximal and average flow rate were increased from 19. 5±3.8 to 23. 6±4. 2 and 10. 9±2.6 to 14.3± 2.4 respectively. Conclusion: Injection of this compound of Bupivacaine, Fentanyl and Dexamethasone into sacral spinal space is an effective and safe approach for recalcitrant CPPS. Further study of the mechanisms and prospective placebo controlled trials are warranted.

  9. Clinical Characteristics of Chronic Intractable Insomnia Combined with Hypereension%慢性顽固性失眠合并高血压临床特点分析

    Institute of Scientific and Technical Information of China (English)

    刘敏科; 刘立

    2014-01-01

    目的:探讨慢性顽固定失眠合并高血压患者的睡眠及血压变化特征,为临床治疗提供参考。方法:回顾性分析2009年4月-2012年5月本院脑病科收治的90例慢性失眠伴高血压患者的临床资料,按照降压药服用情况分为三组(A、B、C组),每组各30例。另选择同期健康门诊体检者30例作为对照组(D组)。全部对象接受多导睡眠监测、24 h动态血压监测,记录入院时催眠镇静药物的应用情况及各组睡眠、血压的变化。结果:镇静催眠药的应用率随着高血压的加重而不断升高,各组镇静催眠药的应用率比较差异有统计学意义(P<0.01);与D组相比,其他组PSQI总分增加(P<0.05),睡眠潜伏时间、觉醒时间均有明显延长(P<0.05),睡眠效率显著下降(P<0.01);A、B、C三组白天及夜晚SBP、DBP均显著高于D组(P<0.05),ΔSBP、ΔDBP明显低于D组(P<0.05)。结论:睡眠障碍的加剧与血压的升高有关,而失眠会影响血压的节律性变化。%Objective:To analyze the clinical characteristics of hypertension with chronic intractable insomnia,to observe the change of PSQI and blood pressure. Method:Clinical date of 90 cases with hypertension and chronic intractable insomnia were retrospectively analyzed from April 2009 to May 2012,all the patients were divided into three groups(group A,B,C)according to the antihypertensive use situation,each group had 30 cases. In addition,30 health check-up people were selected as a control group. All participants were underwent polysomnography recorded and ambulatory blood pressure monitoring to evaluate the change of sleep and blood pressure. Result:The sedative hypnotics use rate was increased with the rise of blood pressure,the use rate among groups had significant difference(P<0.01);Compared with the group D,all the patients’ PQSI were increased(P<0.05);sleep latency time,wake after sleep onset also enhanced

  10. Vigabatrin in childhood epilepsy

    DEFF Research Database (Denmark)

    Uldall, P; Alving, J; Gram, L;

    1995-01-01

    In an retrospective uncontrolled long-term study in 30 children with intractable epilepsy, it was found that treatment with vigabatrin resulted in a seizure reduction of more than 50% at 1-year follow-up in 40% of the children. The responders were all children with partial seizures. Side effects...

  11. Vigabatrin in childhood epilepsy

    DEFF Research Database (Denmark)

    Uldall, P; Alving, J; Gram, L;

    1995-01-01

    In an retrospective uncontrolled long-term study in 30 children with intractable epilepsy, it was found that treatment with vigabatrin resulted in a seizure reduction of more than 50% at 1-year follow-up in 40% of the children. The responders were all children with partial seizures. Side effects ...

  12. Sudden cardiac arrest in a patient with epilepsy induced by chronic inflammation on the cerebral surface

    Institute of Scientific and Technical Information of China (English)

    Yuxi Liu; Weicheng Hao; Xiaoming Yang; Yimin Wang; Yu Su

    2012-01-01

    The present study analyzed a patient with epilepsy due to chronic inflammation on the cerebral surface underwent sudden cardiac arrest. Paradoxical brain discharge, which occurred prior to epileptic seizures, induced a sudden cardiac arrest. However, when the focal brain pressure was relieved, cardiac arrest disappeared. A 27-year-old male patient underwent pre-surgical video-electroencephalogram monitoring for 160 hours. During monitoring, secondary tonic-clonic seizures occurred five times. A burst of paradoxical brain discharges occurred at 2-19 seconds (mean 8 seconds) prior to epileptic seizures. After 2-3 seconds, sudden cardiac arrest occurred and lasted for 12-22 seconds (average 16 seconds). The heart rate subsequently returned to a normal rate. Results revealed arachnoid pachymenia and adhesions, as well as mucus on the focal cerebral surface, combined with poor circulation and increased pressure. Intracranial electrodes were placed using surgical methods. Following removal of the arachnoid adhesions and mucus on the local cerebral surface, paradoxical brain discharge and epileptic seizures occurred three times, but sudden cardiac arrest was not recorded during 150-hour monitoring. Post-surgical histological examination indicated meningitis. Experimental findings suggested that paradoxical brain discharge led to cardiac arrest instead of epileptic seizures; the insult was associated with chronic inflammation on the cerebral surface, which subsequently led to hypertension and poor blood circulation in focal cerebral areas.

  13. [Current management of epilepsy].

    Science.gov (United States)

    Mizobuchi, Masahiro

    2013-09-01

    Epilepsy is one of the most common neurological disorders. Global neurological knowledge is essential for differential diagnosis of epileptic syndromes due to the diversity of ictal semiology, causes and syndromes. Neurologists play an important role in planning the medical care for patients with epilepsy, as medication is the most fundamental therapeutic strategy. Some patients with early-onset epilepsy require joint care by pediatric neurologists, those with intractable epilepsy by neurosurgeons, and those with psychological comorbidity by psychiatrists, and neurologists should play a coordinating role. While there is a great need for neurologists to participate in epilepsy care, neurologists in Japan currently do not participate substantially in the epilepsy management system. It is necessary to train more neurologists who can provide epilepsy care and conduct basic and clinical research on epilepsy by providing continuous education on epilepsy for general neurologists as well as pre- and post-graduate medical students. Most of the patients who require long-term treatment experience many medical problems and social handicaps, such as adverse effects of medication, social stigma, educational disadvantages and difficulties in obtaining driver's license. To improve the quality of life of patients with epilepsy, it is desirable to build broad medical-social networks participated by patients, doctors, neurological nurses, psychologists, social workers, school teachers, managers of employment support facilities and care givers. PMID:24018740

  14. Reviewing the history of epilepsy for defeating this chronic and stubborn disease

    OpenAIRE

    Han, Pu

    2014-01-01

    Human beings have been recognizing and treating epilepsy for more than 3000 years. The cause of this disease was understood as demons in ancient times. A theory of brain disease was firstly proposed by Hippocrates. Although there were many years of case observation and development of anatomy, epilepsy had not been better recognized. Before 1000 years, the word "epilepsy" was firstly called by Avicenna. Afterward scholars of many countries had made elementary progress in classification, ...

  15. Nuclear imaging in epilepsy

    International Nuclear Information System (INIS)

    Correct localization of epileptogenic zone is important for the successful epilepsy surgery. Both ictal perfusion single photon emission computed tomography (SPECT) and interictal F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) can provide useful information in the presurgical localization of intractable partial epilepsy. These imaging modalities have excellent diagnostic sensitivity in medial temporal lobe epilepsy and provide good presurgical information in neocortical epilepsy. Also provide functional information about cellular functions to better understand the neurobiology of epilepsy and to better define the ictal onset zone, symptomatogenic zone, propagation pathways, functional deficit zone and surround inhibition zones. Multimodality imaging and developments in analysis methods of ictal perfusion SPECT and new PET ligand other than FDG help to better define the localization

  16. Reviewing the history of epilepsy for defeating this chronic and stubborn disease

    Directory of Open Access Journals (Sweden)

    Pu HAN

    2014-12-01

    Full Text Available Human beings have been recognizing and treating epilepsy for more than 3000 years. The cause of this disease was understood as demons in ancient times. A theory of brain disease was firstly proposed by Hippocrates. Although there were many years of case observation and development of anatomy, epilepsy had not been better recognized. Before 1000 years, the word "epilepsy" was firstly called by Avicenna. Afterward scholars of many countries had made elementary progress in classification, signs and symptoms, pathology and treatment of epilepsy. The first monograph of epilepsy was published in 1881 by Gower. Then drug treatment and surgical treatment had been applied and developed. In recent 100 years, due to the establishment of International League Against Epilepsy (ILAE, publishing of Epilepsia and clinical employment of EEG, rapid progress has been made in basic and clinical study of epilepsy under the help of many other relative scientific knowledge. As early as over 3000 years before, there was already treatment of traditional Chinese medicine for epilepsy recorded in China. During the past 30 years, obvious advancement of learning and growing number of specialized personnel have been pushing epilepsy research forward in China. doi: 10.3969/j.issn.1672-6731.2014.11.003

  17. Deep Brain Electrical Stimulation in Epilepsy

    Science.gov (United States)

    Rocha, Luisa L.

    2008-11-01

    The deep brain electrical stimulation has been used for the treatment of neurological disorders such as Parkinson's disease, chronic pain, depression and epilepsy. Studies carried out in human brain indicate that the application of high frequency electrical stimulation (HFS) at 130 Hz in limbic structures of patients with intractable temporal lobe epilepsy abolished clinical seizures and significantly decreased the number of interictal spikes at focus. The anticonvulsant effects of HFS seem to be more effective in patients with less severe epilepsy, an effect associated with a high GABA tissue content and a low rate of cell loss. In addition, experiments using models of epilepsy indicate that HFS (pulses of 60 μs width at 130 Hz at subthreshold current intensity) of specific brain areas avoids the acquisition of generalized seizures and enhances the postictal seizure suppression. HFS is also able to modify the status epilepticus. It is concluded that the effects of HFS may be a good strategy to reduce or avoid the epileptic activity.

  18. Self-esteem, behavior, and concerns surrounding epilepsy in siblings of children with epilepsy.

    Science.gov (United States)

    Mims, J

    1997-04-01

    Researchers document the emotional impact of epilepsy on the child with seizures. Minimal data are available examining the effects of epilepsy on the siblings of children with seizures. Twenty children whose siblings had either frequent seizures or infrequent seizures were matched by age, gender, and birth order to control subjects with no chronic illness. These three groups were compared. Self-esteem, behavioral and social functioning, and family stress were measured by the Piers-Harris Self-Concept Scale, Child Behavior Checklist, and Family Inventory of Life Events. The siblings of children with epilepsy completed the Sibling Concern About Seizure Scale to define and measure their concerns surrounding epilepsy. There is no statistical difference in self-esteem or social functioning among the three groups. There is a trend toward increased incidence of externalizing behavior in siblings of children with frequent seizures. Data indicate a trend toward siblings of children with frequent seizures having more concerns about epilepsy than siblings of children with infrequent seizures. There is significantly more stress in families of children with frequent seizures compared to families of children with infrequent seizures and families of children with no chronic illness. Although there were no significant differences in the self-esteem, behavior, socialization, and concerns between the siblings in the family when compared to the control group or to each other, there were trends in the results that may be of clinical significance. These issues, along with the level of family stress, should be considered when coordinating and providing care to families of children with intractable epilepsy. PMID:9130093

  19. SURGERY: Can This Be a Cure for Epilepsy?

    Science.gov (United States)

    McGoldrick, Patricia E.

    2010-01-01

    Previous articles have discussed patients with intractable epilepsy who have benefited from epilepsy surgery to remove or disconnect the area of the brain that propagates their seizures. Another group of people who may benefit from epilepsy surgery is those who have generalized seizures--seizures where there is no clear onset in the brain. These…

  20. Intractable trigeminal neuralgia.

    OpenAIRE

    Paterson, J K

    1988-01-01

    In 49 cases of trigeminal neuralgia seen at the Abingdon Pain Relief Unit, Oxfordshire, the average time between initial onset of pain and first referral to the unit was 9.8 years. The pattern of presentation and distribution was no different from previously published studies, indicating that the more intractable cases cannot be predicted at first presentation.

  1. Chronic treatment with levetiracetam reverses deficits in hippocampal LTP in vivo in experimental temporal lobe epilepsy rats.

    Science.gov (United States)

    Ge, Yu-Xing; Tian, Xiang-Zhu; Lin, Ying-Ying; Liu, Xue-Yuan

    2016-08-15

    Temporal lobe epilepsy (TLE), the common form of epilepsy in adults, often displays complex partial seizures and cognitive deficits. The underlying mechanisms of such deficits are not yet well understood. Many contributing factors, such as initial epileptogenic lesion, seizure type, age of onset, and treatment side effects have been proposed. Levetiracetam (LEV) is a novel anti-epileptic drug (AED) used to treat partial seizures and idiopathic generalized epilepsy. It has been suggested that LEV exerts antiepileptic properties by modulation of synaptic release of neurotransmitters. However, its neuroprotective effects on learning and memory are not yet well demonstrated. Here we showed the impairment of spatial memory in the pilocarpine-induced experimental TLE rats, which can be improved by LEV. Furthermore, we found chronic LEV treatment partially reversed the SE-induced synaptic dysfunction in hippocampal LTP induction in vivo. In addition, LEV treatment can alleviate the SE-induced abnormal GluR1 phosphorylation at Ser(831) site, which may contribute to the rescue of synaptic transmission. These results indicate the neuroprotective role for LEV while it exhibits an antiseizure effect on experimental epileptic models. PMID:27345386

  2. Psychiatric Aspects of Childhood Epilepsy

    Directory of Open Access Journals (Sweden)

    Raman Deep PATTANAYAK

    2012-06-01

    -related, cognitive, and linguistic variables. Epilepsia 2005;45:273-81.7. International League Against Epilepsy- Epidemiology commission. Available from: URL: http://www.ilaeepilepsy.org/. Accessed September 1, 2011.8. Eriksson KJ, Koivikko MJ. Prevalence, classification and severity of epilepsy and epileptic syndromes in children. Epilepsia 1997;38:1275-82.9. Sillanpaa M, Jalava M, Kaleva O, Shinnar S. Long-term prognosis of seizures with onset in childhood. N Engl J Med 1998;338(24:1715-22.10. Berg AT, Shinnar S, Levy SR Testa FM, Smith-Rapaport S, Beckerman B. Early development of intractable epilepsy in children: a prospective study. Neurology 2001;56:1445-52.11. Rutter M, Graham P, Yule W. A neuropsychiatric study in childhood. Clinics in developmental medicine no 35/36.Philadelphia: JB Lippincott; 1970.P.175-85.12. Solomon, GE, Pfeffer C. Neurobehavioral abnormalities in epilepsy. In: Frank Y, editor. Pediatric behavioral epilepsy: New York: CRC press; 1996. P. 269-87.13. Farwell JR, Dodrill CB, Batzel LW. Neuropsychological abilities of children with epilepsy. Epilepsia 1985;26:395-400.14. Nolan MA, Redoblado MA, Lah S, Sabaz M, Lawson JA, Cunningham AM, et al. Intelligence in childhood epilepsy syndromes. Epilepsy Res 2003;53:139-50.15. Berg AT, Langfitt JT, Testa FM, Levy SR, DiMario F, Westerveld M, et al. Residual cognitive effects of uncomplicated idiopathic and cryptogenic epilepsy. Epilepsy Behav 2008;13:614-9.16. van Mil SG, Reijs RP, van Hall MH, Aldenkamp AP. Neuropsychological profile of children with cryptogenic localization related epilepsy. Child Neuropsychol 2008;14:291-302.17.Williams J, Griebel ML, Dykman RA. Neuropsychological patterns in pediatric epilepsy. Seizure 1998;7:223-8.18. Goodman R. Brain disorders. In: Rutter M, Taylor EA, editors. Child and adolescent psychiatry, 4th edition. Oxford: Blackwell Scientific Publications; 2002. P. 241-60.19. Elger CE, Helmstaedter C, Kurthen M. Chronic epilepsy and cognition. Lancet Neurol

  3. Positron emission tomography in epilepsy

    International Nuclear Information System (INIS)

    Positron emission tomography (PET) was performed with the 18F-fluoro-deoxy-glucose method on 29 patients with epilepsy (generalized epilepsy, 4; partial epilepsy, 24; undetermined type, 1). The subjects were restricted to patients with epilepsy without focal abnormality on X-CT. All the patients with generalized epilepsy showed a normal pattern on PET. Fourteen out of the 24 patients with partial epilepsy and the 1 with epilepsy of undermined type showed focal hypometabolism on PET. The hypometabolic zone was localized in areas including the temporal cortex in 11 patients, frontal in 2 and thalamus in 1. The location of hypometabolic zone and that of interictal paroxysmal activity on EEG were well correlated in most patients. The patients with poorly-controlled seizure showed a higher incidence of PET abnormality (12 out of 13) than those with well-controlled seizures (2 out of 11). The incidence of abnormality on PET and MRI and the location of both abnormality were not necessarily coincident. These results indicated that the PET examination in epilepsy provides valuable information about the location of epileptic focus, and that the findings on PET in patients with partial epilepsy may be one of the good indicators about the intractability of partial epilepsy, and that PET and MRI provide complementary information in the diagnosis of epilepsy. (author)

  4. Temporal Lobe Epilepsy in Children

    Directory of Open Access Journals (Sweden)

    Katherine C. Nickels

    2012-01-01

    Full Text Available The temporal lobe is a common focus for epilepsy. Temporal lobe epilepsy in infants and children differs from the relatively homogeneous syndrome seen in adults in several important clinical and pathological ways. Seizure semiology varies by age, and the ictal EEG pattern may be less clear cut than what is seen in adults. Additionally, the occurrence of intractable seizures in the developing brain may impact neurocognitive function remote from the temporal area. While many children will respond favorably to medical therapy, those with focal imaging abnormalities including cortical dysplasia, hippocampal sclerosis, or low-grade tumors are likely to be intractable. Expedient workup and surgical intervention in these medically intractable cases are needed to maximize long-term developmental outcome.

  5. Brain inflammation in a chronic epilepsy model : Evolving pattern of the translocator protein during epileptogenesis

    NARCIS (Netherlands)

    Amhaoul, Halima; Hamaide, Julie; Bertoglio, Daniele; Reichel, Stephanie Nadine; Verhaeghe, Jeroen; Geerts, Elly; Dam, van Debby; De Deyn, Peter Paul; Kumar-Singh, Samir; Katsifis, Andrew; Van der Linden, Annemie; Staelens, Steven; Dedeurwaerdere, Stefanie

    2015-01-01

    Aims: A hallmark in the neuropathology of temporal lobe epilepsy is brain inflammation which has been suggested as both a biomarker and a new mechanistic target for treatments. The translocator protein (TSPO), due to its high upregulation under neuroinflammatory conditions and the availability of se

  6. Intractable incontinence in the elderly.

    Science.gov (United States)

    Ouslander, J G

    2000-05-01

    The number of people living into extreme old age is rising exponentially in the USA, Europe and other developed countries. Urinary incontinence is prevalent in this population. While many very old (age > 75 years) incontinent individuals are relatively healthy and respond well to various treatments, a substantial proportion has impaired cognitive function and impaired mobility. These impairments make urinary incontinence much more difficult to assess, manage and cure than in younger populations. Irrespective of age and disability, a basic assessment of incontinence should be carried out to identify potentially reversible causes and indications for further evaluation. The outcome of such an assessment may not be cure or improvement of incontinence, but better quality of life and the prevention of morbid and expensive medical conditions that may result from poorly managed incontinence. Incontinence in this population should generally not be considered 'intractable' until a trial of noninvasive therapy (i.e. behavioural and/or pharmacological) has been undertaken. Some very frail elderly respond well to a toileting programme such as prompted voiding, and a small but significant proportion benefit from the careful addition of a bladder relaxant drug to the toileting programme. Others, depending on their ability and willingness to toilet and their preferences for further treatment, may be candidates for surgical intervention. Pads and garments should not be used so that they foster dependency, or as a primary treatment until other specific interventions have been tried. Indwelling catheters should be used only for specific and well-documented indications, because of the risks of urinary tract infection and sepsis associated with their long-term use. The dictionary defines 'intractable' as 'not easily relieved or cured'. In the elderly, cure for incontinence, and most other chronic conditions, is the exception rather than rule. Relief (or amelioration), improvement in

  7. Stress and childhood epilepsy

    OpenAIRE

    Campen, J.S. van

    2015-01-01

    Epilepsy is one of the most common chronic diseases in childhood, characterized by the enduring predisposition to generate epileptic seizures. Children with epilepsy and their parents often report seizures precipitated by stress. In order to increase our understanding of the pathophysiological mechanisms underlying the effects of stress on seizures in childhood epilepsy, we performed a variety of studies, which are described in this thesis. In part I we evaluate the extent of stress sensitivi...

  8. Molecular analysis of acute and chronic reactive astrocytes in the pilocarpine model of temporal lobe epilepsy.

    Science.gov (United States)

    Clasadonte, Jerome; Morel, Lydie; Barrios-Camacho, Camila M; Chiang, Ming Sum R; Zhang, Jinhua; Iyer, Lakshmanan; Haydon, Philip G; Yang, Yongjie

    2016-07-01

    Astroglia, the most abundant glial cells in the mammalian central nervous system (CNS), are considered an emerging key player in seizure induction and progression. Although astrocytes undergo reactive gliosis in temporal lobe epilepsy (TLE) with dramatic morphological and molecular changes, specific astrocyte targets/molecular pathways that contribute to the induction and progression of seizure remain largely unknown. By combining translating ribosomal affinity purification (TRAP) with the pilocarpine model of TLE in BAC aldh1l1 TRAP mice, we profiled translating mRNAs from hippocampal or cortical astrocytes at different phases (3days, 30days, and 60days post-pilocarpine injections) of pilocarpine-induced epilepsy models. Our results found that hippocampal (but not cortical) astrocytes undergo early and unique molecular changes at 3days post-pilocarpine injections. These changes indicate a potentially primary pathogenic role of hippocampal astrocytes in seizure induction and progression and provide new insights about the involvement of specific astrocytic pathways/targets in epilepsy. In particular, we validated expression changes of ocrl and aeg1 in pilocarpine models. Follow-up studies on these genes may reveal new roles of hippocampal astrocytes in TLE. PMID:27060558

  9. Effects of Low-frequency Repetitive Transcranial Magnetic Stimulation on Seizures, Resting Motor Threshold, and Single Photo Emission Computered Tomography in Patients with Intractable Epilepsy%低频重复经颅磁刺激对难治性癫(癎)发作频率、静息运动阈值、SPECT的影响

    Institute of Scientific and Technical Information of China (English)

    王莉; 余巨明; 余琴

    2011-01-01

    目的:观察低频重复经颅磁刺激(rTMS)的抗癫(癎)疗效及可能机制.方法:对4例难治性癫(癎)患者灶所在脑区给予rTMS治疗(0.5 Hz,45%最大输出强度,每天15串、100次/串、串间隔30 s,连续10 d),观察治疗前后各3个月患者的临床发作及1 h时长的脑电图癫(癎)波数量,并行单光子发射断层摄影(SPECT)和静息运动阈值检查,以观察感兴趣区(ROI)放射线摄取比值的变化和皮质兴奋性改变.结果:4例患者经rTMS治疗后,3例无发作,1例发作1次.脑电图:1例癫(癎)波减少了20%;4例静息运动阈值均增高.SPECT:4例均显示rTMS后ROI值进一步降低.结论:低频rTMS对难治性癫(癎)有治疗作用,其抗癫(癎)作用可能与减少癫(癎)灶局部脑血流灌注和增加静息运动阈值有关.%Aim: To investigate the effect of low-frequency repetitive transcranial magnetic stimulation (rTMS) on intractable epilepsy, and explore its underlying mechanisms by using resting motor threshold (RMT) and single photo emission computered tomography(SPECT), respectively. Methods: 4 intractable epileptic patients with well demarcated epileptogenic zones were enrolled. All patients were given 10-day consecutive rTMS treatment (0.5 Hz, 45% stimulator maximum output, 15 trains/d, 100 pulses/train, interval of 30 s). The frequency of seizures for 3 months, and the number of interictal spikes on 1-h EEG were counted before and after rTMS, respectively. The SPECT and RMT were used to detect the changes of cerebral blood flow and cortical excitability, respectively. Results: Compared with pre-rTMS treatment, 3 patients were seizure free and 1 patient only had one seizure in the 3-month follow-up period after rTMS; the number of interictal spikes in one patient decreased by 20% (the other three patients had no spikes on EEGs before and after rTMS); the RMT was clearly elevated and the SPECT analysis showed the ROI values further decreased in all of the 4 patients. Conclusion

  10. Standard magnetic resonance imaging is inadequate for patients with refractory focal epilepsy

    OpenAIRE

    von Oertzen, J; Urbach, H; Jungbluth, S; Kurthen, M.; Reuber, M; Fernandez, G.; Elger, C.

    2002-01-01

    Objectives: Patients with intractable epilepsy may benefit from epilepsy surgery especially if they have a radiologically demonstrable cerebral lesion. Dedicated magnetic resonance imaging (MRI) protocols as performed at epilepsy surgery centres can detect epileptogenic abnormalities with great sensitivity and specificity. However, many patients with epilepsy are investigated with standard MRI sequences by radiologist outside epilepsy centres ("non-experts"). This study was undertaken to comp...

  11. Structural magnetic resonance imaging in epilepsy

    Energy Technology Data Exchange (ETDEWEB)

    Deblaere, Karel [Ghent University Hospital, Department of Neuroradiology, Ghent (Belgium); Ghent University Hospital, MR Department - 1K12, Ghent (Belgium); Achten, Eric [Ghent University Hospital, Department of Neuroradiology, Ghent (Belgium)

    2008-01-15

    Because of its sensitivity and high tissue contrast, magnetic resonance imaging (MRI) is the technique of choice for structural imaging in epilepsy. In this review the effect of using optimised scanning protocols and the use of high field MR systems on detection sensitivity is discussed. Also, the clinical relevance of adequate imaging in patients with focal epilepsy is highlighted. The most frequently encountered MRI findings in epilepsy are reported and their imaging characteristics depicted. Imaging focus will be on the diagnosis of hippocampal sclerosis and malformations of cortical development, two major causes of medically intractable focal epilepsy. (orig.)

  12. Structural magnetic resonance imaging in epilepsy

    International Nuclear Information System (INIS)

    Because of its sensitivity and high tissue contrast, magnetic resonance imaging (MRI) is the technique of choice for structural imaging in epilepsy. In this review the effect of using optimised scanning protocols and the use of high field MR systems on detection sensitivity is discussed. Also, the clinical relevance of adequate imaging in patients with focal epilepsy is highlighted. The most frequently encountered MRI findings in epilepsy are reported and their imaging characteristics depicted. Imaging focus will be on the diagnosis of hippocampal sclerosis and malformations of cortical development, two major causes of medically intractable focal epilepsy. (orig.)

  13. Long-Term Social Outcomes in Childhood Epilepsy

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2007-12-01

    Full Text Available Population-based longitudinal and cross-sectional studies of social outcomes of children with epilepsy in different countries are reviewed by researchers at Dalhousie University, Halifax, Nova Scotia, Canada.Epilepsy, Chronic Disease, Idiopathic Epilepsy.

  14. Neuromodulation for epilepsy

    Directory of Open Access Journals (Sweden)

    Pranshu Bhargava

    2008-01-01

    Full Text Available Epilepsy is a common disease. WHO data suggests that 1 in 20 people may have an epileptic seizure in their lifetime and at least 1 in 200 go on to develop epilepsy. Anticonvulsant drug therapy using one or more drugs works as an effective tool to suppress seizures in only 70% of the patients, the remaining 30% are either not responsive or suffer major side effects. Surgical resection then forms the next line of management in selected patients. However in some cases surgical resection may not be possible, hence arises the need for alternative therapies. Neuromodulation of the Central Nervous system is a novel technique under evaluation for Medically Intractable epilepsy. CNS stimulation for epilepsy has been a matter of extensive research. We review the Neurophysiological basis of Neuromodulation in Epilepsy and various modalities viz Vagal nerve stimulation (VNS, Transcranial magnetic stimulation (TMS and Direct cortical stimulation (DCS. Deep brain stimulation (Hippocampal, Anterior thalamic and STN and RNS are newer modalities and are also reviewed.

  15. Occipital peripheral nerve stimulation in the management of chronic intractable occipital neuralgia in a patient with neurofibromatosis type 1: a case report

    OpenAIRE

    Calvillo Octavio; Skaribas Ioannis; Delikanaki-Skaribas Evangelia

    2011-01-01

    Abstract Introduction Occipital peripheral nerve stimulation is an interventional pain management therapy that provides beneficial results in the treatment of refractory chronic occipital neuralgia. Herein we present a first-of-its-kind case study of a patient with neurofibromatosis type 1 and bilateral occipital neuralgia treated with occipital peripheral nerve stimulation. Case presentation A 42-year-old Caucasian woman presented with bilateral occipital neuralgia refractory to various conv...

  16. STABILIZING DENDRITIC STUCTURE AS A NOVEL THERAPEUTIC APPROACH FOR EPILEPSY

    OpenAIRE

    Wong, Michael

    2008-01-01

    People with epilepsy often experience long-term cognitive dysfunction and other neurological deficits, including memory loss, learning disabilities, and neurobehavioral disorders, which may exhibit a progressive course correlating with worsening seizure control. Furthermore, one-third of epilepsy patients have seizures that are intractable to all available treatments. Thus, novel therapies for seizures and the neurological comorbidities of epilepsy are desperately needed. As most current trea...

  17. Value of prophylactic epilepsy surgery in contemporary neurosurgical practice

    International Nuclear Information System (INIS)

    We have examined the value of prophylactic epilepsy surgery in diseases leading to intractable epilepsy. We reviewed 11 glioneuronal tumors (GNT) including gangliogliomas and dysembryoplastic neuroepithelial tumors, 11 cortical dysplasia (CD), and 33 cavernous angiomas (CA) diagnosed with MRI between the years 2000 and 2008 at the Department of Neurosurgery of Juntendo University in this study. We analyzed retrospectively the followings. Age of seizure onset and seizure severity. Region of each disease leading to intractable epilepsy. Seizure outcome after the surgery. Surgical morbidity. Ages of seizure onset of GNT, CD, and CA were 21.0±12.1, 1.3±7.5, 24.8±18.1 years, respectively. 81.8% of CD and GNT were intractable, however CA progresses to intractable epilepsy in 48.5%. The 66.7% of GNT with intractable seizures located in the mesial temporal lobe and 66.7% of CD had entra-temporal location. CA located in the mesial temporal lobe progressed to intractable epilepsy in 80%. Seizure free ratios of GNT, CD, and CA were 87.5%, 50.0%, 81.3%, respectively. In CDs where was impossible to carry out complete resection resulted in residual seizures. Neurological sequelae after surgery were observed in 3 cases. Morbidity ratios of motor weakness, speech difficulty, and memory disturbances are 4.6%, 4.6%, 2.3%, respectively. Majority of CD, GNT, and CA located in the mesial temporal lobe progress towards intractable epilepsy. Prophylactic epilepsy surgery by experienced surgeon with low complication rates can be an acceptable alternative for these pathological conditions. Seizure outcome of surgery for CD does not reach the success rates of those in GNT and CA. The cause of the unfavorable result in CD is the inapplicability to eloquent areas. Aggressive early surgery for CD may improve outcome considering neuronal plasticity of childhood. (author)

  18. Dieta cetogênica no tratamento das epilepsias graves da infância: percepção das mães Ketogenic diet in the treatment of intractable epilepsy in children: mothers view

    Directory of Open Access Journals (Sweden)

    Alexsandra Tomé

    2003-06-01

    Full Text Available Este estudo teve como propósito perceber os sentimentos e dificuldades de mães de crianças com epilepsia resistente ao tratamento medicamentoso em relação à adoção e ao seguimento da dieta cetogênica, bem como auxiliar a influência dessa dietoterapia na rotina familiar. A metodologia utilizada foi a da pesquisa qualitativa, tendo como técnica de coleta de dados a entrevista semi-estruturada, realizada com três mães atendidas pelo Centro de Neuropediatria do Hospital de Clínicas da Universidade Federal do Paraná. Em virtude das características da dieta cetogênica, os resultados mostram que o período inicial, o da sua adoção, é bastante difícil, tanto para a criança como para toda a sua família. Entretanto, com a diminuição das crises epilépticas e a adaptação ao tratamento, uma mudança de sentimentos é observada. O estudo revela também a importância da atuação de profissionais, não apenas com competência técnica mas também com sensibilidade e empatia, no apoio às famílias das crianças em tratamento.The purpose of this study was to identify the feelings and difficulties experienced by mothers of children with drug-resistant epilepsy concerning the adoption of the ketogenic diet and its follow-up, as well as to evaluate the influence of this dietotherapy on the family routine. The qualitative research methodology was used, and data were collected through semi-structured interview, carried out with three mothers who attended the Neuropediatrics Center of the Clinical Hospital of the Federal University of Paraná, Brazil. Because of the characteristics of the ketogenic diet, the results show that the initial period, corresponding to the phase of adoption, is very difficult, for both the child and all the family. However, with the decrease in the epileptic crises and the adaptation to the treatment, a change in the feelings is observed. The study also reveals the importance of the performance of the

  19. [Dietary therapy of epilepsy].

    Science.gov (United States)

    Imai, Katsumi; Ishihara, Eiko; Ikeda, Hiroko

    2014-05-01

    Reappraisal of ketogenic diets (KD) were delayed in Japan compared to USA and Korea. The reasons are unknown, but possible explanations are (1) Japanese food culture prefers rice and less fat and (2) ACTH therapy is preferred for West syndrome in Japan. Since Japanese child neurologists were surprised at dramatic effects on glucose transporter 1 deficiency syndrome (Glut-1DS) in 2003, KD have been slowly accepted for treatment of epilepsy in Japan. New generation KD including modified Atkins diet (mAD) are preferred to classical KD. KD can be causal therapy in Glut-1DS and some of mitochondrial disorders, though anti-epileptic drugs are symptomatic therapy. KD can alleviate intractable seizures in epilepsies with brain malformation in addition to West syndrome and Dravet syndrome, etc. KD may work for brain tumor, cancer, neurodegenerative disorders including Alzheimer's disease. C7-8 triglycerides or fatty acid esters are under development as medicines replacing KD. PMID:24912289

  20. Invasive Evaluations for Epilepsy Surgery: A Review of the Literature.

    Science.gov (United States)

    Enatsu, Rei; Mikuni, Nobuhiro

    2016-05-15

    Invasive evaluations play important roles in identifying epileptogenic zones and functional areas in patients with intractable focal epilepsy. This article reviews the usefulness, methods, and limitations of invasive evaluations for epilepsy surgery. Invasive evaluations include various types of intracranial electrodes such as stereotactically implanted intracranial depth electrodes (stereo-EEG), chronic subdural electrodes, and intraoperative electrocorticography. Scalp EEG is distorted by the skull, meninges, and skin. On the other hand, intracranial electrodes provide spatial information with higher resolution than scalp electrodes, thereby enabling further delineation of epileptogenic zones and mapping of functional areas with electrical stimulation. In addition, intracranial electrodes record a wide frequency range of electrical activity, which is not possible with scalp electrodes. The very slow potentials in ictal recordings, known as ictal direct current (DC) shifts and ictal/interictal high frequency oscillations, such as ripples (100-200 Hz) and fast ripples (200-500 Hz), have been correlated with the ictal onset zone and are a sensitive and specific marker for epileptogenicity. Furthermore, several studies reported that the electrical stimulation of epileptogenic zones elicited enhanced cortical evoked potentials, abnormal delayed or repetitive responses, and fast ripples. These responses may assist in the delineation of the epileptogenic cortex as a potential new marker. There are definite risks of complications associated with the use of intracranial electrodes. However, when an invasive evaluation is selected based on careful consideration of the risks and benefits, it provides useful information for establishing a strategy for epilepsy surgery. PMID:26948700

  1. Application of interictal arterial spin labeling MR perfusion in intractable mesial temporal lobe epilepsy%动脉自旋标记在难治性颞叶内侧癫痫发作间期的应用

    Institute of Scientific and Technical Information of China (English)

    孙泓泓; 吕长磊; 白芝兰; 张晓娜; 师莉芳

    2012-01-01

    Objective To determine whether pulsed ASL(PASL) MR] using flow-sensitive alternating inversion recovery) FAIR) could be a useful clinical tool to detect intcrictal temporal hypopcrfusion in mesial temporal lobe cpilcpsy(TLEl) ,thcn on the base of changes of cerebral blood flow(CBF) to determine the seizure focus. Methods 15 normal controls and 15 patients were studied by using a FAIR pcrfusion mode to measure the CBF of mesial temporal lobe. According to the vidco-clcctrocnccphalography ( VEEG) findings, the origin sides of seizure were obtained in all patients. Results Pcrfusion in control participants was ( 167. 95 ± 15. 30) mL/( 100 g · min) on the right and (169.64 ± 13.24) mL/( 100 g · min) on the left. In patients, mesial temporal lobe pcrfusion was (158.42 ± 9.09) mL/(100 g- min) on the ipsilatcral (affected) side and (170. 11±7. 67) mL/(100 g · min) on the contralatcral (unaffected) side. The blood flow measurements were significantly different in ipsilatcral versus contralatcral sides in patients. In control participants, the mean absolute asymmetry index was 2. 49 ± 2. 09. For the patients, mean absolute asymmetry index was 7. 20 ± 4. 21. The difference was statistically significant P = 0. 001 ). The coefficient of agreement for detecting the asymmetry with FAIR and with vidco-EEG latcralization was 80%. Conclusion MR pcrfusion imaging based on the FAIR technique is capable of detecting intcrictal hypopcrfusion of mesial temporal lobe in patients with medically refractory temporal lobe epilepsy and provides complementary information to tests that assess structure.%目的 明确流动敏感交互反转恢复模式(FAIR)的脉冲式动脉自旋标记(PASL)能否检测出发作间期颞叶内侧的低灌注,根据脑血流灌注变化确定致痫灶位置.方法 15例经过视频脑电图(VEEG)确诊的颞叶癫痫(TLE)病人和15例正常对照者行FAIR测量感兴趣区脑血流量(CBF)并计算相关数值.结果 对照组左、

  2. Psychiatric Aspects of Childhood Epilepsy

    OpenAIRE

    Pattanayak, Raman Deep; Sagar, Rajesh

    2012-01-01

    How to Cite this Article: Pattanayak RD, Sagar R. Psychiatric Aspects of Childhood Epilepsy. Iran J Child Neurol 2012;6(2):9-18.Childhood epilepsy is a chronic, recurrent disorder of unprovoked seizures. Theonset of epilepsy in childhood has significant implications for brain growth anddevelopment. Seizures may impair the ongoing neurodevelopmental processes and compromise the child’s intellectual and cognitive functioning, leading totremendous cognitive, behavioral and psychosocial consequen...

  3. Danish experience with paediatric epilepsy surgery

    DEFF Research Database (Denmark)

    Underbjerg, Ebba von Celsing; Hoei-Hansen, Christina E; Madsen, Flemming Find;

    2015-01-01

    INTRODUCTION: Epilepsy surgery is increasingly used to treat children with medically intractable epilepsy. This study investigates the aetiology and seizure outcome in Danish children operated between 1996 and 2010. METHODS: Retrospectively collected data on structural magnetic resonance imaging...... (MRI) diagnoses, surgical procedures and seizure outcomes classified according to the Engel Classification were used. Changes over time grouped as 1996-2000, 2001-2005 and 2006-2010 were analysed. RESULTS: A total of 95 children underwent epilepsy surgery. Sixty-three operations were performed in...... majority of children who undergo epilepsy surgery have a good, worthwhile seizure outcome. The seizure outcome for Danish children corresponds to that of other epilepsy surgery centres. The clinical criteria for selection of patients changed over time. FUNDING: none. TRIAL REGISTRATION: The Danish Data...

  4. Neural Stem Cell or Human Induced Pluripotent Stem Cell-Derived GABA-ergic Progenitor Cell Grafting in an Animal Model of Chronic Temporal Lobe Epilepsy.

    Science.gov (United States)

    Upadhya, Dinesh; Hattiangady, Bharathi; Shetty, Geetha A; Zanirati, Gabriele; Kodali, Maheedhar; Shetty, Ashok K

    2016-01-01

    Grafting of neural stem cells (NSCs) or GABA-ergic progenitor cells (GPCs) into the hippocampus could offer an alternative therapy to hippocampal resection in patients with drug-resistant chronic epilepsy, which afflicts >30% of temporal lobe epilepsy (TLE) cases. Multipotent, self-renewing NSCs could be expanded from multiple regions of the developing and adult brain, human embryonic stem cells (hESCs), and human induced pluripotent stem cells (hiPSCs). On the other hand, GPCs could be generated from the medial and lateral ganglionic eminences of the embryonic brain and from hESCs and hiPSCs. To provide comprehensive methodologies involved in testing the efficacy of transplantation of NSCs and GPCs in a rat model of chronic TLE, NSCs derived from the rat medial ganglionic eminence (MGE) and MGE-like GPCs derived from hiPSCs are taken as examples in this unit. The topics comprise description of the required materials, reagents and equipment, methods for obtaining rat MGE-NSCs and hiPSC-derived MGE-like GPCs in culture, generation of chronically epileptic rats, intrahippocampal grafting procedure, post-grafting evaluation of the effects of grafts on spontaneous recurrent seizures and cognitive and mood impairments, analyses of the yield and the fate of graft-derived cells, and the effects of grafts on the host hippocampus. © 2016 by John Wiley & Sons, Inc. PMID:27532817

  5. Expression and function of Cx32 and Cx43 junctions in medically intractable temporal lobe epilepsy in human%缝隙连接蛋白Cx32、Cx43在难治性颞叶癫痫患者脑中表达的研究

    Institute of Scientific and Technical Information of China (English)

    姚丽芬; 王真奎; 王真刚; 隋丹; 张黎明

    2009-01-01

    Objective To study the expression of Cx32 and Cx43 in medically intractable temporal lobe epilepsy in human and investigate the pathogenic relationship between gap junctions and seizures. Methods The expression of Cx32 and Cx43 was detected by Western blot and immunohistochemistry in 14 consecutive samples of hippocampus from epileptic patients undergoing an amygdalohippocampectomy for the treatment of intractable seizures. During postmortem dissection, 8 samples of hippocampus in nonepileptic patients dying of other diseases were taken as control group. Results The expression of Cx32 and Cx43 was at a low level in the control group [Cx32 : count of positive cell (9.4± 1.1), ratios of gray scale (0.2±0.1) ; Cx43 : count of positive cell (9.2±4.7), ratios of gray scale (0.5±0.2)], but Cx43 and Cx32 appeared to be expressed at a higher level in epileptic patients compared with that of the control group by immunohistochemistry [Cx32 : count of positive cell (14.6±3.4), Cx43:count of positive cell (16.5±3.1) ] (P<0.01), and their expression significantly increased by Western blot [Cx32 : ratios of gray scale (1.5±0.2), Cx43 : ratios of gray scale (1.4±0.3)] (P<0.01). Over-expression of Cx32 and Cx43 was found in 14 consecutive samples of hippocampus from epileptic patients. Conclusion Gap junctions play an important role in the occurrence and progression of intractable seizures.%目的 探讨缝隙连接蛋白Cx32、Cx43在难治性颞叶癫痫患者病变海马组织中的表达及缝隙连接与难治性颞叶癫痫患者癫痫发作的关系.方法 实验组为14例难治颞叶癫痫(伴海马硬化)患者手术切除的病变海马组织,对照组为8例因其他非颅内疾病死亡进行尸体解剖者的正常海马组织,死者生前无癫痫发作,利用免疫组织化学与蛋白印迹检测方法检测两组间缝隙连接蛋白Cx32和Cx43的表达,并进行比较.结果 应用免疫组织化学方法发现连接蛋白在对照组中

  6. Epilepsy in children with subacute sclerosing panencephalitis

    Directory of Open Access Journals (Sweden)

    Jović Nebojša J.

    2013-01-01

    Full Text Available Introduction. Subacute sclerosing panencephalitis (SSPE is a rare, progressive, fatal neurodegenerative disease of childhood and early adolescence caused by defective measles virus. The initial symptoms of SSPE usually involve regression in cognitive functioning and behavior or recurrent myoclonic jerks. Seizures revealing SSPE and epilepsy during the clinical course can occur. Objective. The aim of the study was to analyze clinical and EEG characteristics of both initially occurred seizures and epilepsy which developed in the course of the disease. Methods. Retrospective study was carried out on 19 children (14 boys, 5 girls with SSPE diagnosed and treated at our Clinic from 1995 to 2010. Seizures revealed SSPE in our patients aged from 6.5 to 11.5 years (mean 8.6 years. Results. SSPE onset ranged from 4.5 to 16.5 years (mean 10.05. Complete vaccination was performed in nine patients. Cognitive and behavioral decline was preceeded by 6-18 months in two children with intractable focal motor seizures with secondary generalization, one child with complex partial seizures and one with atypical absences. During the clinical course of the disease epilepsy developed in 10 (52.6% cases, including four patients with seizures as the initial SSPE sign. It occurred mainly in the first year, while in three cases seizures appeared between 1 and 5 years of the disease evolution. Myoclonus was present independently from seizures. No significant inter-group differences were found relating to the type of SSPE progression and history of epilepsy. The only child with fulminant SSPE presented with initial seizures. Favorable seizure control was achieved in 60.0% patients. Intractable epilepsy developed in four patients. Conclusion. Atypical SSPE presentation can include mainly focal intractable seizures. Epilepsy developed during clinical course in 52.6% cases. No significant influence was found of the history of epilepsy on the type of SSPE progression.

  7. Impact of ketogenic diet on follicular helper T cells in children with intractable epilepsy%生酮饮食治疗对难治性癫(痫)患儿滤泡辅助性T淋巴细胞的影响

    Institute of Scientific and Technical Information of China (English)

    周厚福; 李成荣; 廖建湘; 王国兵; 林素芳; 陈黎

    2015-01-01

    胞数量及功能,抑制B淋巴细胞分化,这可能是少数患儿长期KD治疗导致低丙种球蛋白血症的原因之一.%Objective To explore the impact of ketogenic diet (KD) on follicular helper T cells(TFH) in children with intractable epilepsy.Methods Thirty-three cases with intractable epilepsy were selected between Jul.2013 and Jan.2014 in Shenzhen Children's Hospital,19 boys and 14 girls; average age was 39.6 months,and seventeen age-matched healthy children who took a physical examination in the same hospital were assigned as the healthy control group.Blood samples were collected from the children with refractory epilepsy before and after 1 week of KD treatment.The proportions of the various stages of B cells and TFH cells were detected by flow cytometry.The plasma concentration of interleukin-21 (IL-21) was determined by enzyme-linked immunosorbent assay(ELISA),and realtime quantitative PCR(RT-PCR) was performed to detect the levels of peroxisome proliferator-activated receptor gamma (PPAR-γ),B-lymphocyte-induced maturation protein-1 (Blimp-1),B-cell lymphoma 6 (Bcl6) and IL-21 mRNA expression in CD4 + T cells.Results (1) The number of TFH cells in children with intractable epilepsy [(3.57 ± 0.58) %] was remarkably decreased after KD treatment(P < 0.01),while there were no difference between after KD treatment and healthy control group[(4.93 ±0.70)% vs (5.03 ±0.63)%,P >0.05].(2) The levels of transcription factor Bcl6 expression after treatment were significantly decreased,while inhibitory factor Blimp-1 expression increased (P < 0.05).(3)The plasma concentration of IL-21 had a trend to decrease (P > 0.05),while there were no difference before and after KD treatment,and levels of IL-21 mRNA expressions in CD4 +T cells were significantly decreased after the treatment (8.28 × 10-3 ± 1.19 × 10-3 vs 1.72 × 10-2 ± 0.81 × 10-2,t =3.08,P < 0.05).(4) There was no significant difference in CD27-IgD + B cells before and after KD

  8. Nonpharmacological treatment of epilepsy

    Directory of Open Access Journals (Sweden)

    V S Saxena

    2011-01-01

    Full Text Available Nonpharmacological treatment of epilepsy includes surgery, vagal nerve stimulation, ketogenic diet, and other alternative/complementary therapies, e.g., yoga, Ayurveda, electroencephalography (EEG biofeedback technique, aerobic exercise, music therapy, transcranial magnetic stimulation, acupuncture, and herbal remedies (traditional Chinese medicine. Alternative therapies, despite the term, should not be considered as an alternative to antiepileptic medication; they complement accepted drug treatment. Alternative therapies like yoga, through techniques that relax the body and mind, reduce stress, improve seizure control, and also improve quality of life. Ketogenic diet is a safe and effective treatment for intractable epilepsies; it has been recommended since 1921. The diet induces ketosis, which may control seizures. The most successful treatment of epilepsy is with modern antiepileptic drugs, which can achieve control of seizures in 70-80% cases. Patients opt for alternative therapies because they may be dissatisfied with antiepileptic drugs due to their unpleasant side effects, the long duration of treatment, failure to achieve control of seizures, cultural beliefs and, in the case of women, because they wish to get pregnant Surgical treatment may lead to physical and psychological sequelae and is an option only for a minority of patients. This article presents supportive evidence from randomized controlled trials done to assess the benefit of non-pharmacological treatment.

  9. Epilepsy and radiological investigations

    International Nuclear Information System (INIS)

    Epilepsy is a heterogenous group of disorders with multiple causes. Clinical management of epilepsy patients requires knowledge of seizure syndromes, causes, and imaging features. The aim of radiological investigations is to recognize the underlying cause of epilepsy. The main indications for neuroimaging studies are partial and secondarily generalized seizures, patients with neurological signs and intractable seizures, and patients with focal signs on EEG. Partial seizures of any type are more likely to be associated with a focus that may be identified on neuroimaging. MRI is the method of choice for evaluating structural abnormalities of the brain. High resolution MRI and dedicated imaging technique are needed for detection of subtle pathological changes as cortical dysplasias and temporal medial sclerosis. Other lesions that may be detected include neoplasms, vascular malformations, destructive lesions following brain injury, stroke, infection, etc. CT continues to be the technique for the investigation of patients with seizures under certain conditions. New techniques such as functional MRI, MR spectroscopy, SPECT, receptor PET and magnetic source imaging are becoming clinical tools for improving diagnosis

  10. Epilepsy - overview

    Science.gov (United States)

    Epilepsy is a brain disorder in which a person has repeated seizures over time. Seizures are episodes ... Epilepsy occurs when permanent changes in the brain cause it to be too excitable or irritable. As ...

  11. Correlates of parental stress and psychopathology in pediatric epilepsy

    Directory of Open Access Journals (Sweden)

    Rania Shatla

    2011-01-01

    Full Text Available Background: Chronic conditions like epilepsy in a child can affect his/her entire family. The failure of the family members to adapt adequately to the unique demands of this childhood chronic illness can be considered as an important risk factor for development of psychopathology. Objectives: The objectives of this study were to study the profile of parenting stress in parents of children with epilepsy and its correlates; and, to examine the correlates of psychopathology in these children. Material and Methods: Twenty three epileptic children and their families were subjected to Parenting Stress Index (PSI, Scores for indices such as The Children′s Depression Inventory (CDI, Benton Visual Retention test, Spence anxiety scale for children, The Child Behavior Checklist (CBCL and Wechsler Intelligence Scale for Children were calculated. Results: Mean verbal and performance IQ score was 94, while the mean total IQ score was 95. Mean scores for all Wechsler IQ Scores as well as Benton Visual retention test were within the average range. Means for total internalizing CBCL t scores (M, Mean=70; Standard Deviation, SD=4.4, total externalizing CBCL t scores (M=60, SD=9.6, and total behavior problems CBCL t scores (M=67, SD=5.2 were above the standard cut off levels of 65 for clinical behavioral problems. Mean score on CDI was 42 ± 2. Scores of the PSI equal to or higher than 85 th percentile were considered pathologically high. Conclusion: The results of our study indicated that pediatric patients with epilepsy, specifically with intractable cases, are correlated with high levels of parental stress.

  12. Epilepsy, cognition and behavior.

    Science.gov (United States)

    Gulati, Sheffali; Yoganathan, Sangeetha; Chakrabarty, Biswaroop

    2014-10-01

    Epilepsy is defined as two or more unprovoked seizures. Epileptic patients have intellectual disability and behavioral co-morbidities to the tune of up to 25 and 75% respectively. Various factors like underlying etiology, socioeconomic environment at home, age at onset, seizure semiology, seizure descriptors like duration, severity and frequency, therapy related adverse effects secondary to antiepileptic drugs and epilepsy surgery have been implicated for the causation of cognitive and behavioral impairment in epilepsy. Cognitive epilepsy has emerged as a specific entity. This may manifest as a transient behavioral or cognitive change, insidous onset subacute to chronic encephalopathy or more catastrophic in the form of nonconvulsive status epilepticus. Cognitive impairment seen in epileptic children include difficulties in learning, memory, problem solving as well as concept formation. Anxiety, depression and attention deficit hyperkinetic disorders are the most common psychiatric co-morbidities seen. Investigating a child with epilepsy for cognitive and behavioral impairment is difficult as these tests would require cooperation from the patient's side to a significant extent. A rational approach towards treatment would be judicious selection of antiepileptic drugs, treatment of underlying cause, appropriate management of behavioral co-morbidities including psychopharmacotherapy and a trial of immunotherapy (particularly in cognitive epilepsies), wherever appropriate. PMID:25073691

  13. Partial Internal Biliary Diversion: A Solution for Intractable Pruritus in Progressive Familial Intrahepatic Cholestasis Type 1

    Science.gov (United States)

    Ganesh, Ramaswamy; Suresh, Natarajan; Sathiyasekeran, Malathi; Ramachandran, Priya

    2011-01-01

    Biliary diversion offers a potential option for intractable pruritus in children with chronic cholestatic disorders. Progressive familial intrahepatic cholestasis (PFIC) is an inherited disorder of impaired bile acid transport and excretion, which presents with jaundice and pruritus in the first few months of life and progresses to cirrhosis by infancy or adolescence. We report a child with PFIC type 1 who underwent internal biliary diversion for intractable pruritus and was relieved of his symptoms. PMID:21546727

  14. Role of HHV-6B Infection in Mesial Temporal Lobe Epilepsy

    Directory of Open Access Journals (Sweden)

    John J Millichap

    2015-05-01

    Full Text Available Investigators from Fujita Health University, Toyoake, and National Epilepsy Center, Shizuoka, Japan, studied the pathogenic role of HHV-6B in patients with mesial temporal lobe epilepsy (MTLE. Of 75 intractable MTLE patients, 52 had mesial temporal sclerosis (MTS and 23 were non-MTS patients.

  15. [11C]quinidine and [11C]laniquidar PET imaging in a chronic rodent epilepsy model: Impact of epilepsy and drug-responsiveness

    International Nuclear Information System (INIS)

    Introduction: To analyse the impact of both epilepsy and pharmacological modulation of P-glycoprotein on brain uptake and kinetics of positron emission tomography (PET) radiotracers [11C]quinidine and [11C]laniquidar. Methods: Metabolism and brain kinetics of both [11C]quinidine and [11C]laniquidar were assessed in naive rats, electrode-implanted control rats, and rats with spontaneous recurrent seizures. The latter group was further classified according to their response to the antiepileptic drug phenobarbital into “responders” and “non-responders”. Additional experiments were performed following pre-treatment with the P-glycoprotein modulator tariquidar. Results: [11C]quinidine was metabolized rapidly, whereas [11C]laniquidar was more stable. Brain concentrations of both radiotracers remained at relatively low levels at baseline conditions. Tariquidar pre-treatment resulted in significant increases of [11C]quinidine and [11C]laniquidar brain concentrations. In the epileptic subgroup “non-responders”, brain uptake of [11C]quinidine in selected brain regions reached higher levels than in electrode-implanted control rats. However, the relative response to tariquidar did not differ between groups with full blockade of P-glycoprotein by 15 mg/kg of tariquidar. For [11C]laniquidar differences between epileptic and control animals were only evident at baseline conditions but not after tariquidar pretreatment. Conclusions: We confirmed that both [11C]quinidine and [11C]laniquidar are P-glycoprotein substrates. At full P-gp blockade, tariquidar pre-treatment only demonstrated slight differences for [11C]quinidine between drug-resistant and drug-sensitive animals

  16. Pluronic P85-coated poly(butylcyanoacrylate) nanoparticles overcome phenytoin resistance in P-glycoprotein overexpressing rats with lithium-pilocarpine-induced chronic temporal lobe epilepsy.

    Science.gov (United States)

    Fang, Ziyan; Chen, Shuda; Qin, Jiaming; Chen, Bao; Ni, Guanzhong; Chen, Ziyi; Zhou, Jueqian; Li, Ze; Ning, Yuping; Wu, Chuanbin; Zhou, Liemin

    2016-08-01

    P-glycoprotein (Pgp) overexpression in the blood brain barrier (BBB) is hypothesized to lower brain drug concentrations and thus inhibit anticonvulsant effects in drug-resistant epilepsy. Recently, the poly(butylcyanoacrylate) (PBCA) nanoparticle system was shown to overcome the obstacle of the BBB to deliver drugs into the brain. To determine whether pluronic P85-coated phenytoin poly(butylcyanoacrylate) nanoparticles (P85-PHT-PBCA-NPs) target PHT to the brain, PHT-resistant rats overexpressing Pgp in the BBB were screened by response to PHT treatment after chronic temporal lobe epilepsy induced by lithium-pilocarpine, followed by direct verification of PHT transport via measurement of brain PHT concentrations using microdialysis. Thereafter, the PHT-resistant rats were divided into three groups, which were treated with PHT, PHT + tariquidar (TQD), or P85-PHT-PBCA-NPs. PHT + TQD and P85-PHT-PBCA-NPs showed anticonvulsant activity in the PHT-resistant rats and increased the ratio of the area under the curve of the PHT concentrations in the brain/plasma in comparison with that observed in animals subjected to PHT treatment. However, the ratios of the PHT concentrations in the liver/plasma and kidney/plasma following P85-PHT-PBCA-NPs treatment were much lower than those measured following PHT + TQD treatment. Thus, Pgp overexpression decreases therapeutic drug concentrations in the brains of subjects with drug-resistant epilepsy and P85-PHT-PBCA-NPs could increase these drug concentrations. PMID:27162079

  17. The application of functional brain imaging in diagnosis of epilepsy localization

    International Nuclear Information System (INIS)

    Surgical intervention has become an effective treatment method in properly selected patients with intractable epilepsy, but accurate resection of epileptogenic areas is the key for successful seizure control. Recently, functional brain imaging plays more and more important role in epilepsy localization. The application of SPECT, PET and fMRI has both advantages and disavantages in diagnosis of epilepsy localization. Therefore, different individuals should be taken different examinations to clinicians. (authors)

  18. Current Topics in Epilepsy Surgery.

    Science.gov (United States)

    Usui, Naotaka

    2016-05-15

    This article reviews the current topics in the field of epilepsy surgery. Each type of epilepsy is associated with a different set of questions and goals. In mesial temporal lobe epilepsy (MTLE) with hippocampal sclerosis (HS), postoperative seizure outcome is satisfactory. A recent meta-analysis revealed superior seizure outcome after anterior temporal lobectomy compared with selective amygdalohippocampectomy; in terms of cognitive outcome; however, amygdalohippocampectomy may be beneficial. In temporal lobe epilepsy with normal magnetic resonance imaging (MRI), postoperative seizure outcome is not as favorable as it is in MTLE with HS; further improvement of seizure outcome in these cases is necessary. Focal cortical dysplasia is the most common substrate in intractable neocortical epilepsy, especially in children, as well as in MRI-invisible neocortical epilepsy. Postoperative seizure-free outcome is approximately 60-70%; further diagnostic and therapeutic improvement is required. Regarding diagnostic methodology, an important topic currently under discussion is wideband electroencephalogram (EEG) analysis. Although high-frequency oscillations and ictal direct current shifts are considered important markers of epileptogenic zones, the clinical significance of these findings should be clarified further. Regarding alternatives to surgery, neuromodulation therapy can be an option for patients who are not amenable to resective surgery. In addition to vagus nerve stimulation, intracranial stimulation such as responsive neurostimulation or anterior thalamic stimulation is reported to have a modest seizure suppression effect. Postoperative management such as rehabilitation and antiepileptic drug (AED) management is important. It has been reported that postoperative rehabilitation improves postoperative employment status. Pre- and post-operative comprehensive care is mandatory for postoperative improvement of quality of life. PMID:26984452

  19. THE EFFECT OF NIGELLA SATIVA L. ON INTRACTABLE PEDIATRIC SEIZURES

    Directory of Open Access Journals (Sweden)

    J. AKHONDIAN MD

    2009-05-01

    Full Text Available Background:Despite availability and administration of numerous antiepileptic drugs (AEDs nearly 15% of childhood epilepsy cases are resistant to treatment; in traditional medicine however Nigella sativa L. (Black seed has been known for its anticonvulsant effects.Materials and Methods:In this double-blind clinical trial conducted on children with refractory epilepsy we administered the aqueous extract of black seed as an adjunct therapy and compared the effects with those of a placebo. The study was performed between Sep 2003 and Nov 2004. The subjects received either extract or placebo for a period of four weeks and between these two periods for two weeks they received only their pre-existing anti-epileptic drugs (AEDs.Results:The mean frequency of seizures decreased significantly during treatment with extract, (p-value =0/007.Conclusion:It can be concluded that the water extract of Nigella sativa L. has antiepileptic effects in children with refractory seizures that do not respond to known AEDS.keywords:Nigella sativa, Intractable seizures, Children

  20. Musicogenic epilepsy.

    Science.gov (United States)

    Stern, John

    2015-01-01

    Musicogenic epilepsy, which is a form of reflex epilepsy, is characterized by the triggering of epileptic seizures by specific music experiences. Individuals with musicogenic epilepsy differ in the music trigger, but may have similar seizures. Typically, these seizures are focal dyscognitive and have a temporal-lobe origin with a limbic system distribution. As such, the music trigger is likely related to either an emotional or memory aspect of music perception. Investigations into musicogenic epilepsy may lead to a better understanding of seizure propagation within the brain and of neurologic aspects of the music experience. Successful treatment of medication-resistant musicogenic epilepsy has been achieved with anterior temporal-lobe resection. PMID:25726285

  1. Psychotic illness in patients with epilepsy

    OpenAIRE

    Kanemoto, Kousuke; Tadokoro, Yukari; Oshima, Tomohiro

    2012-01-01

    Apart from the rather rare ictal psychotic events, such as non-convulsive status epilepticus, modern epileptic psychoses have been categorized into three main types; chronic and acute interictal psychoses (IIPs) and postictal psychosis (PIP). Together, they comprise 95% of psychoses in patients with epilepsy (PWE). Four major questions, that is, “Is psychosis in PWE a direct consequence of epilepsy or schizophrenia induced by epilepsy?”, “Is psychosis in PWE homogeneous or heterogeneous?”, “D...

  2. Presurgical evaluation for partial epilepsy: Relative contributions of chronic depth-electrode recordings versus FDG-PET and scalp-sphenoidal ictal EEG

    International Nuclear Information System (INIS)

    One hundred fifty-three patients with medically refractory partial epilepsy underwent chronic stereotactic depth-electrode EEG (SEEG) evaluations after being studied by positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) and scalp-sphenoidal EEG telemetry. We carried out retrospective standardized reviews of local cerebral metabolism and scalp-sphenoidal ictal onsets to determine when SEEG recordings revealed additional useful information. FDG-PET localization was misleading in only 3 patients with temporal lobe SEEG ictal onsets for whom extratemporal or contralateral hypometabolism could be attributed to obvious nonepileptic structural defects. Two patients with predominantly temporal hypometabolism may have had frontal epileptogenic regions, but ultimate localization remains uncertain. Scalp-sphenoidal ictal onsets were misleading in 5 patients. For 37 patients with congruent focal scalp-sphenoidal ictal onsets and temporal hypometabolic zones, SEEG recordings never demonstrated extratemporal or contralateral epileptogenic regions; however, 3 of these patients had nondiagnostic SEEG evaluations. The results of subsequent subdural grid recordings indicated that at least 1 of these patients may have been denied beneficial surgery as a result of an equivocal SEEG evaluation. Weighing risks and benefits, it is concluded that anterior temporal lobectomy is justified without chronic intracranial recording when specific criteria for focal scalp-sphenoidal ictal EEG onsets are met, localized hypometabolism predominantly involves the same temporal lobe, and no other conflicting information has been obtained from additional tests of focal functional deficit, structural imaging, or seizure semiology

  3. Neuraxial (epidural and intrathecal) opioids for intractable pain.

    Science.gov (United States)

    Farquhar-Smith, Paul; Chapman, Suzanne

    2012-02-01

    1. Neuraxial opioids are considered for use in patients who have resistant intractable pain that fails to respond to other treatment options or pain that responds to analgesia but for which the doses required result in unacceptable side-effects. 2. Neuraxial opiods can be considered for both chronic non-malignant pain and chronic cancer-related pain. 3. Effectiveness in chronic non-malignant pain and cancer pain is exerted through the use of either single-agent drugs (opioids) or a combination of drugs: opioids, local anaesthetics and other drugs such as clonodine and ziconotide. 4. Complications of long-term continuous infusion therapy are related to the insertion process (haematoma), the mechanical device (both pump and catheter) and the long-term effects of the drugs. 5. Patients will require ongoing ambulatory monitoring and supportive care. PMID:26516463

  4. American Epilepsy Society

    Science.gov (United States)

    ... a Doctor | Donate main search Search American Epilepsy Society CLINICAL RESOURCES FAQs GUIDELINES IOM EPILEPSY MEDICAL MARIJUANA ... RENEW VOLUNTEER FAES: FELLOW OF THE AMERICAN EPILEPSY SOCIETY MAILING LIST PURCHASE FOR PATIENTS EPILEPSY BENEFIT INTERNATIONAL ...

  5. Epilepsy care in general practice.

    LENUS (Irish Health Repository)

    Varley, J

    2009-06-01

    Epilepsy care in Ireland is shared between primary, secondary and tertiary care services with the General Practitioner (GP) managing the process. Barriers to effective epilepsy care in Irish general practice remain undocumented although sub-optimal and fragmented services are frequently anecdotally reported. This survey of Irish GPs reports on such barriers to epilepsy care and on the Information & Communication Technology (ICT) issues potentially relevant to the use of an epilepsy specific Electronic Patient Record (EPR). The response rate was 247\\/700 (35.3%). Respondents supported the concept of shared care for epilepsy 237 (96%) however they were very dissatisfied with existing neurology services, including pathways of referral 207 (84%) and access to specialist neurology advice and investigations 232 (94%). They reported that neurology services and investigations may be accessed more expeditiously by patients with private health insurance than those without 178 (72%). Consequently many patients are referred to the emergency department for assessment and treatment 180 (73%). A deficit in epilepsy care expertise among GPs was acknowledged 86 (35%). While computerisation of GP practices appears widespread 230 (93%), just over half the respondents utilise available electronic functionalities specific to chronic disease management. GP specific electronic systems infrequently link or communicate with external electronic sources 133 (54%). While the current pathways of care for epilepsy in Ireland appear fragmented and inadequate, further investigations to determine the quality and cost effectiveness of the current service are required.

  6. Epilepsy Foundation

    Science.gov (United States)

    ... Gastaut Syndrome Infantile Spasms and Tuberous Sclerosis Complex Facebook Epilepsy Foundation of America Join David Taplinger, MD, ... helping to make Hidden Truths, The Mind Unraveled art show happen! For more information and tickets to ...

  7. Psychiatric Disorders in Children and Adolescents with Epilepsy

    OpenAIRE

    Fevziye Toros; Ozalp Ekinci

    2013-01-01

    Epilepsy is a chronic disease with a high morbidity. Many recent studies have shown that psychiatric disorders are commonly encountered in children and adolescents with epilepsy. Depression, anxiety disorders and attention deficit hyperactivity disorder are among the most common psychiatric disorders. Many factors, including demographic variables, epilepsy related factors and psychosocial factors, have been suggested to have a role on the development of psychiatric disorders in epilepsy. In t...

  8. Elaboration about Epilepsy from Functional Activity of Qi%从气机升降出入论癫痫

    Institute of Scientific and Technical Information of China (English)

    江涛; 刘金民

    2016-01-01

    Epilepsy is a kind of chronic brain disease with paroxysmal abnormal nerve function. This paper elaborates epilepsy from the function activity of Qi, holding that most patients have the congenital factors or pathological constitution of viscera functions' unbalance, the ascending and descending of Qi is the key to the epilepsy's occurrence. In clinic, we should pay attention to treat liver and spleen simultaneously and the mutual causality between ascending and descending. Treating epilepsy from depression, wind, phlegm has obtained good therapeutic effect. The paper is supplemented by the theory of mysterious disease and collateral disease. Treatment of the epileptic state and intractable epilepsy is ultra structure's extension in human body of the the theory of ascending, descending, exiting and entering of Qi , and its related study should be further developed.%癫痫是一种发作性神经功能异常的慢性脑部疾病。本文从气机升降出入角度论癫痫,认为癫痫患者大多数具有“脏气不平”的先天因素或病理体质,其气机升降出入异常(气郁)是导致癫痫发病的关键。临床应重视肝脾同调、升降相宜,从郁、风、痰论治每获良效。本文还以“玄病”、“络病”理论为补充,论治癫痫持续状态及难治性癫痫,其实质是气机升降出入理论在人体超微结构的延伸与拓展,但相关研究仍需进一步完善发展。

  9. Optimization of epilepsy treatment with vagus nerve stimulation

    Science.gov (United States)

    Uthman, Basim; Bewernitz, Michael; Liu, Chang-Chia; Ghacibeh, Georges

    2007-11-01

    Epilepsy is one of the most common chronic neurological disorders that affects close to 50 million people worldwide. Antiepilepsy drugs (AEDs), the main stay of epilepsy treatment, control seizures in two thirds of patients only. Other therapies include the ketogenic diet, ablative surgery, hormonal treatments and neurostimulation. While other approaches to stimulation of the brain are currently in the experimental phase vagus nerve stimulation (VNS) has been approved by the FDA since July 1997 for the adjunctive treatment of intractable partial onset epilepsy with and without secondary generalization in patients twelve years of age or older. The safety and efficacy of VNS have been proven and duplicated in two subsequent double-blinded controlled studies after two pilot studies demonstrated the feasibility of VNS in man. Long term observational studies confirmed the safety of VNS and that its effectiveness is sustained over time. While AEDs influence seizure thresholds via blockade or modulation of ionic channels, inhibit excitatory neurotransmitters or enhance inhibitory neurotransmitters the exact mechanism of action of VNS is not known. Neuroimaging studies revealed that VNS increases blood flow in certain regions of the brain such as the thalamus. Chemical lesions in the rat brains showed that norepinephrine is an important link in the anticonvulsant effect of VNS. Analysis of cerebrospinal fluid obtained from patients before and after treatment with VNS showed modest decreases in excitatory neurotransmitters. Although Hammond et al. reported no effect of VNS on scalp EEG by visual analysis and Salinsky et al. found no effect of VNS on scalp EEG by spectral analysis, Kuba et al. suggested that VNS reduces interictal epileptiform activity. Further, nonlinear dynamical analysis of the electroencephalogram in the rat and man have reportedly shown predictable changes (decrease in the short term Lyapunov exponent STLmax and T-index) more than an hour prior to the

  10. Magnetic resonance imaging in temporal lobe epilepsy. Usefulness for the etiological diagnosis of temporal lobe epilepsy

    International Nuclear Information System (INIS)

    With improvement in magnetic resonance (MR) imaging techniques, the ability to identify lesions responsible for temporal lobe epilepsy has increased. MR imaging has also enabled the in vivo diagnosis of hippocampal sclerosis. Brain tumors are responsible for 2-4% of epilepsies in adult population and 10-20% of medically intractable epilepsy. The sensitivity of MR imaging in the diagnosis of tumors and other lesions of the temporal lobe (vascular malformations, etc.) is around 90%. Both hippocampal sclerosis and other temporal lobe lesions are amenable to surgical therapy with excellent postsurgical seizure outcome. In this article, we characterize and underline distinguishing features of the different pathological entities. We also suggest an approach to reviewing the MR images of an epileptic patient. (author)

  11. Sequencing intractable DNA to close microbial genomes.

    Directory of Open Access Journals (Sweden)

    Richard A Hurt

    Full Text Available Advancement in high throughput DNA sequencing technologies has supported a rapid proliferation of microbial genome sequencing projects, providing the genetic blueprint for in-depth studies. Oftentimes, difficult to sequence regions in microbial genomes are ruled "intractable" resulting in a growing number of genomes with sequence gaps deposited in databases. A procedure was developed to sequence such problematic regions in the "non-contiguous finished" Desulfovibrio desulfuricans ND132 genome (6 intractable gaps and the Desulfovibrio africanus genome (1 intractable gap. The polynucleotides surrounding each gap formed GC rich secondary structures making the regions refractory to amplification and sequencing. Strand-displacing DNA polymerases used in concert with a novel ramped PCR extension cycle supported amplification and closure of all gap regions in both genomes. The developed procedures support accurate gene annotation, and provide a step-wise method that reduces the effort required for genome finishing.

  12. Detecting Differential Memory Performance Among Spanish-speaking Patients with Temporal Lobe Epilepsy

    OpenAIRE

    Marquez de la Plata, C.; Lacritz, L.H.; Mitschke, R.; Van Ness, P.; Agostini, M.; Diaz-Arrastia, R.; Cullum, C.M.

    2009-01-01

    There is relatively little research pertaining to neuropsychological assessment of Spanish-speaking individuals with intractable temporal lobe epilepsy (TLE). The current study examined verbal and visual memory performances in 38 primarily Spanish-speaking patients with TLE (Right = 15, Left = 23) of similar epilepsy duration to determine if lateralizing differences can be found using verbal and nonverbal memory tests. On a test specifically designed to assess auditory learning and memory amo...

  13. Inhibition impairments in temporal lobe epilepsy patients: electroencephalography evidence from a Go/Nogo study

    OpenAIRE

    Yu, HM; Gao, JL; Chang, RSK; Mak, W; Cheung, RTF

    2016-01-01

    INTRODUCTION: Temporal lobe epilepsy (TLE) is a common type of epilepsy that easily run an intractable course. It can harm cognitive inhibition function, an essential executive function that enables us to suppress inappropriate actions in a given context at different levels. The aim of this study was to investigate whether TLE also affects related Go/Nogo-potentials related to the inhibition using high-resolution electroencephalography (EEG) technology ...

  14. Towards the development of integrated epilepsy services: an audit of documented epilepsy care.

    LENUS (Irish Health Repository)

    Varley, J

    2012-02-01

    Effective chronic disease management (CDM) requires the ready availability and communication of accurate, clinical disease specific information. Using epilepsy as a probe into CDM, we report on the availability and reliability of clinical information in the primary care records of people with epilepsy (PWE). The medical records of 374 PWE from 53 general practices in the Mid-West region of Ireland were examined. Confirmation of an epilepsy diagnosis by a neurologist was documented for 132 (35%) patients. 282 (75%) patients had no documented evidence of receiving specialist neurology review while 149 (40%) had not been reviewed by their GP in the previous two years for their epilepsy. Significant variation in documentation of epilepsy specific information together with an inadequacy and inconsistency of existing epilepsy services was highlighted.

  15. Towards the development of integrated epilepsy services: an audit of documented epilepsy care.

    LENUS (Irish Health Repository)

    Varley, J

    2011-11-17

    Effective chronic disease management (CDM) requires the ready availability and communication of accurate, clinical disease specific information. Using epilepsy as a probe into CDM, we report on the availability and reliability of clinical information in the primary care records of people with epilepsy (PWE). The medical records of 374 PWE from 53 general practices in the Mid-West region of Ireland were examined. Confirmation of an epilepsy diagnosis by a neurologist was documented for 132 (35%) patients. 282 (75%) patients had no documented evidence of receiving specialist neurology review while 149 (40%) had not been reviewed by their GP in the previous two years for their epilepsy. Significant variation in documentation of epilepsy specific information together with an inadequacy and inconsistency of existing epilepsy services was highlighted.

  16. Failure of antiepileptic drugs in controlling seizures in epilepsy: What do we do next?

    Directory of Open Access Journals (Sweden)

    Brahyan Galindo-Mendez

    2015-01-01

    Full Text Available Medically intractable epilepsy is a clinical condition of concern that arises when a patient with epilepsy suffers seizures, despite a trial of two or more antiepileptic drugs (AEDs suitable for the type of epilepsy that are prescribed at maximum tolerated doses, does not achieve control of seizures. This diagnosis could be related to cortical dysplasias. We report the case of a 5-year-old girl with a previous normal neurological development and no family history of epilepsy who presented with focal-type seizures at age 4. She started treatment by taking different AEDs for seizure control. She continued having frequent seizures that sometimes progressed to generalized seizures and status epilepticus. After a focal cortical resection performed in the area where interictal spikes were detected, the pathology confirmed a type IIb cortical dysplasia as the cause of the epilepsy. This article discusses cortical dysplasias as a cause of pharmacoresistant epilepsy and its treatment.

  17. Epilepsy and anxiety

    Directory of Open Access Journals (Sweden)

    Marly de Albuquerque

    1993-09-01

    Full Text Available We have analyzed 155 subjects with STAI (State-Trait Anxiety Inventory: 75 epileptic patients and 80 normal subjects used as a control group. A higher trait-anxiety score (chronic anxiety than that of controls was found for the epileptic group. For the epileptic group higher levels of the A-trait occurred in patients with EEG abnormalities with left temporal localization. We have also observed that the shorter the epilepsy lasts (less than two years, the higher the trait-anxiety levels. Convulsions and awareness loss during epileptic seizures do not modify state and trait-anxiety scores.

  18. SPECT-PET in Epilepsy and Clinical Approach in Evaluation.

    Science.gov (United States)

    Ergün, Eser Lay; Saygi, Serap; Yalnizoglu, Dilek; Oguz, Kader Karli; Erbas, Belkis

    2016-07-01

    In epilepsy, a detailed history, blood chemistry, routine electroencephalography, and brain MRI are important for the diagnosis of seizure type or epilepsy syndrome for the decision of appropriate drug treatment. Although antiepileptic drugs are mostly successful for controlling epileptic seizures, 20%-30% patients are resistant to medical treatment and continue to have seizures. In this intractable patient group, surgical resection is the primarily preferred treatment option. This particular group of patients should be referred to the epilepsy center for detailed investigation and further treatment. When the results of electroencephalography, MRI, and clinical status are discordant or there is no structural lesion on MRI, ictal-periictal SPECT, and interictal PET play key roles for lateralization or localization of epileptic region and guidance for the subsequent subdural electrode placement in intractable epilepsy. SPECT and PET show the functional status of the brain. SPECT and PET play important roles in the evaluation of epilepsy sydromes in childhood by showing abnormal brain regions. Most of the experience has been gained with (18)FDG-PET, in this respect. (11)C-flumazenil-PET usually deliniates the seizure focus more smaller than (18)FDG-PET and is sensitive in identifying medial temporal sclerosis. (11)C-alpha-methyl-l-tryptophan is helpful in the differentiation of epileptogenic and nonepileptogenic regions in children especially in tuberous sclerosis and multifocal cortical dysplasia for the evaluation of surgery. Finally, when there is concordance among these detailed investigations, resective surgery or palliative procedures can be discussed individually. PMID:27237440

  19. Estimation of brain network ictogenicity predicts outcome from epilepsy surgery

    OpenAIRE

    Goodfellow, M.; Rummel, C.; Abela, E.; M. P. Richardson; Schindler, K.; Terry, J.R.

    2016-01-01

    Surgery is a valuable option for pharmacologically intractable epilepsy. However, significant post-operative improvements are not always attained. This is due in part to our incomplete understanding of the seizure generating (ictogenic) capabilities of brain networks. Here we introduce an in silico, model-based framework to study the effects of surgery within ictogenic brain networks. We find that factors conventionally determining the region of tissue to resect, such as the location of focal...

  20. Clinical applications of functional MRI in epilepsy

    International Nuclear Information System (INIS)

    The role of functional MRI (fMRI) in the presurgical evaluation of patients with intractable epilepsy is being increasingly recognized. Real-time fMRI is an easily performable diagnostic technique in the clinical setting. It has become a noninvasive alternative to intraoperative cortical stimulation and the Wada test for eloquent cortex mapping and language lateralization, respectively. Its role in predicting postsurgical memory outcome and in localizing the ictal activity is being recognized. This review article describes the biophysical basis of blood-oxygen-level-dependent (BOLD) fMRI and the methodology adopted, including the design, paradigms, the fMRI setup, and data analysis. Illustrative cases have been discussed, wherein the fMRI results influenced the seizure team's decisions with regard to diagnosis and therapy. Finally, the special issues involved in fMRI of epilepsy patients and the various challenges of clinical fMRI are detailed

  1. Interleukin-6 levels are increased in temporal lobe epilepsy but not in extra-temporal lobe epilepsy.

    Science.gov (United States)

    Liimatainen, Suvi; Fallah, Mahdi; Kharazmi, Elham; Peltola, Maria; Peltola, Jukka

    2009-05-01

    Previous studies have reported activation of inflammatory cytokines in seizures, but clinical characteristics of epilepsy associated with cytokine activation have not been well established. In this study, serum levels of interleukin-6 (IL-6) and interleukin-1 receptor antagonist (IL-1RA) were measured, and clinical characteristics of epilepsy were assessed in 86 well-evaluated patients with refractory focal epilepsy and in 5 patients with controlled focal epilepsy. Epilepsy was evaluated based on patient histories, electroclinical findings, and high-resolution brain MRI scans. Sixty-three healthy blood donors served as controls. IL-6 concentrations were chronically increased in epilepsy patients (11%) compared with healthy controls (0%) (P = 0.007). Increased levels of IL-6 were more prevalent in patients with temporal lobe epilepsy (TLE) compared to patients with extra-TLE (P = 0.028). Also the mean and the median serum levels of IL-6 were higher in patients with TLE than in patients with extra-TLE (P = 0.042). Concentrations of IL-1RA were not significantly different in patients compared with controls. Indicated by increased levels of IL-6 in TLE, epilepsy type is important in determining chronic overproduction of cytokines in refractory focal epilepsy. The results may reflect a chronic immunological process in the brain in patients with refractory epilepsy. PMID:19252806

  2. A study of epilepsy-related psychosis

    Directory of Open Access Journals (Sweden)

    Roy A

    2003-07-01

    Full Text Available The association of epilepsy and psychosis is studied. Among the 500 patients of epilepsy evaluated, there were 12 patients, 8 males and 4 females with epilepsy-related psychosis. Their average age was 38 years. The interval between the age of onset of epilepsy and psychotic features was 9 years. Complex partial seizures were present in 7 patients and primary generalized tonic-clonic seizure was present in 1 patient. Four patients had post-ictal psychosis, 7 had acute interictal psychosis and 1 patient had chronic psychosis. The inter-ictal and chronic psychoses were schizophreniform whereas the post-ictal psychoses were not. EEG showed a temporal focus in 7 patients with complex partial seizures and an extra-temporal focus was identified in 4 out of the other 5 patients. Imaging (CT scan/MRI revealed abnormalities in 10 patients. This study attempts to define the characteristics of psychoses occurring in epileptics.

  3. MR imaging in epilepsy that is refractory to medical therapy

    Energy Technology Data Exchange (ETDEWEB)

    Cakirer, S.; Basak, M.; Mutlu, A.; Galip, G.M. [Department of Radiology, Neuroradiology Section, Istanbul Sisli Etfal Hospital, Istanbul (Turkey)

    2002-03-01

    The aim of this study was the assessment of detection rate on MRI and description of MRI findings in patients with medically intractable epilepsy. Seventy-three patients with medically intractable epilepsy between the ages of 0 and 68 years old were evaluated by MRI, on three planes with spin-echo T1, fast spin-echo T2, and fluid-attenuated inversion recovery sequences, and, if necessary, with contrast-enhanced SE T1 sequences. Cerebral infarct regions with atrophy and gliosis in 8 patients, cerebral tumors in 5 patients, hippocampal sclerosis in 16 patients, radial microbrain in 1 patient, cortical dysplasia in 3 patients, pachygyria in 2 patients, subcortical heterotopia in 2 patients, schizencephaly in 3 patients, cerebral hemiatrophy in 2 patients, tuberous sclerosis in 1 patient, herpes encephalitis in 2 patients, Rasmussen's encephalitis in 1 patient, vascular malformations in 5 patients, and no abnormality in 22 patients were detected. Magnetic resonance imaging has a high success rate in detecting structural brain abnormalities, of both temporal and extratemporal locations, associated with medically intractable epilepsy syndromes. So MRI plays a primary role in planning of the treatment, primarily surgical therapy, by detecting structural epileptogenic lesions. (orig.)

  4. MR imaging in epilepsy that is refractory to medical therapy

    International Nuclear Information System (INIS)

    The aim of this study was the assessment of detection rate on MRI and description of MRI findings in patients with medically intractable epilepsy. Seventy-three patients with medically intractable epilepsy between the ages of 0 and 68 years old were evaluated by MRI, on three planes with spin-echo T1, fast spin-echo T2, and fluid-attenuated inversion recovery sequences, and, if necessary, with contrast-enhanced SE T1 sequences. Cerebral infarct regions with atrophy and gliosis in 8 patients, cerebral tumors in 5 patients, hippocampal sclerosis in 16 patients, radial microbrain in 1 patient, cortical dysplasia in 3 patients, pachygyria in 2 patients, subcortical heterotopia in 2 patients, schizencephaly in 3 patients, cerebral hemiatrophy in 2 patients, tuberous sclerosis in 1 patient, herpes encephalitis in 2 patients, Rasmussen's encephalitis in 1 patient, vascular malformations in 5 patients, and no abnormality in 22 patients were detected. Magnetic resonance imaging has a high success rate in detecting structural brain abnormalities, of both temporal and extratemporal locations, associated with medically intractable epilepsy syndromes. So MRI plays a primary role in planning of the treatment, primarily surgical therapy, by detecting structural epileptogenic lesions. (orig.)

  5. Improved Cerebral Function in Mesial Temporal Lobe Epilepsy after Subtemporal Amygdalohippocampectomy

    Science.gov (United States)

    Takaya, Shigetoshi; Mikuni, Nobuhiro; Mitsueda, Takahiro; Satow, Takeshi; Taki, Junya; Kinoshita, Masako; Miyamoto, Susumu; Hashimoto, Nobuo; Ikeda, Akio; Fukuyama, Hidenao

    2009-01-01

    The functional changes that occur throughout the human brain after the selective removal of an epileptogenic lesion remain unclear. Subtemporal selective amygdalohippocampectomy (SAH) has been advocated as a minimally invasive surgical procedure for patients with medically intractable mesial temporal lobe epilepsy (MTLE). We evaluated the effects…

  6. [Quality of life in childhood epilepsy].

    Science.gov (United States)

    Herranz, J L; Casas, C

    1996-01-01

    We describe a Quality Life scale in childhood epilepsy (CAVE) composed by 8 items, behaviour, school compliance, learning, autonomy, social relation, frequency and intensity of seizures and the parents opinions. Each item may be answered as very bad (5), bad (2), medium (3), good (4), or very good (5), and we can obtain full scores before and after the beginning of epileptic treatment and we can compare them. Although other Quality Life questionnaires exist for adult epilepsy, CAVE is the first scale applied for chronic childhood epilepsy. PMID:8851997

  7. Pregabalin for Pain Treatment in Chronic Pancreatitis

    DEFF Research Database (Denmark)

    Olesen, Søren Schou; Bowense, S; Wilder-Smith, Oliver; van Goor, H; Drewes, Asbjørn Mohr

    2011-01-01

    Intractable pain usually dominates the clinical presentation of chronic pancreatitis (CP). Slowing of electroencephalogram (EEG) rhythmicity has been associated with abnormal cortical pain processing in other chronic pain disorders. The aim of this study was to investigate the spectral distribution...

  8. Hereditary epilepsy syndromes

    NARCIS (Netherlands)

    Callenbach, PMC; Brouwer, OF

    1997-01-01

    This paper reviews the present knowledge on the genetics of the epilepsies. Main clinical features, gene localization and pattern of inheritance of the idiopathic epilepsies, the progressive myoclonus epilepsies, and some other genetic disorders often associated with epilepsy, are described. (C) 199

  9. Ego functions in epilepsy

    DEFF Research Database (Denmark)

    Sørensen, A S; Hansen, H; Høgenhaven, H; Bolwig, T G

    1988-01-01

    Two groups of epilepsy patients (28 patients with temporal lobe epilepsy and 15 patients with primary generalized epilepsy) entered a study of personality traits related to epilepsy, based on a modification of Bellak's semistructured interview for assessment of ego strength. Two groups of subjects...

  10. Video game epilepsy.

    OpenAIRE

    Singh R; Bhalla A; Lehl S; Sachdev A

    2001-01-01

    Reflex epilepsy is the commonest form of epilepsy in which seizures are provoked by specific external stimulus. Photosensitive reflex epilepsy is provoked by environmental flicker stimuli. Video game epilepsy is considered to be its variant or a pattern sensitive epilepsy. The mean age of onset is around puberty and boys suffer more commonly as they are more inclined to play video games. Television set or computer screen is the commonest precipitants. The treatment remains the removal of the ...

  11. Childhood epilepsy and sleep

    OpenAIRE

    Al-Biltagi, Mohammed A

    2014-01-01

    Sleep and epilepsy are two well recognized conditions that interact with each other in a complex bi-directional way. Some types of epilepsies have increased activity during sleep disturbing it; while sleep deprivation aggravates epilepsy due to decreased seizure threshold. Epilepsy can deteriorate the sleep-related disorders and at the same time; the parasomnias can worsen the epilepsy. The secretion of sleep-related hormones can also be affected by the occurrence of seizures and supplementat...

  12. Animal models of epilepsy: use and limitations

    Directory of Open Access Journals (Sweden)

    Kandratavicius L

    2014-09-01

    Full Text Available Ludmyla Kandratavicius,1 Priscila Alves Balista,1 Cleiton Lopes-Aguiar,1 Rafael Naime Ruggiero,1 Eduardo Henrique Umeoka,2 Norberto Garcia-Cairasco,2 Lezio Soares Bueno-Junior,1 Joao Pereira Leite11Department of Neurosciences and Behavior, 2Department of Physiology, Ribeirao Preto School of Medicine, University of Sao Paulo, Ribeirao Preto, BrazilAbstract: Epilepsy is a chronic neurological condition characterized by recurrent seizures that affects millions of people worldwide. Comprehension of the complex mechanisms underlying epileptogenesis and seizure generation in temporal lobe epilepsy and other forms of epilepsy cannot be fully acquired in clinical studies with humans. As a result, the use of appropriate animal models is essential. Some of these models replicate the natural history of symptomatic focal epilepsy with an initial epileptogenic insult, which is followed by an apparent latent period and by a subsequent period of chronic spontaneous seizures. Seizures are a combination of electrical and behavioral events that are able to induce chemical, molecular, and anatomic alterations. In this review, we summarize the most frequently used models of chronic epilepsy and models of acute seizures induced by chemoconvulsants, traumatic brain injury, and electrical or sound stimuli. Genetic models of absence seizures and models of seizures and status epilepticus in the immature brain were also examined. Major uses and limitations were highlighted, and neuropathological, behavioral, and neurophysiological similarities and differences between the model and the human equivalent were considered. The quest for seizure mechanisms can provide insights into overall brain functions and consciousness, and animal models of epilepsy will continue to promote the progress of both epilepsy and neurophysiology research.Keywords: epilepsy, animal model, pilocarpine, kindling, neurodevelopment

  13. Epilepsy due to malformations of cortical development: correlation of clinical, MRI and Tc-99mECD SPECT findings

    OpenAIRE

    Sporiš, Davor; Hajnšek, Sanja; Boban, Marina; Bašić, Silvio; Petrović, Ratimir; Radoš, Marko; Babić, Tomislav

    2008-01-01

    Malformations of cortical development (MCD) have been increasingly recognized as an important cause of intractable epilepsy. The aim of our study was to define epileptogenicity of MCDs by correlating MRI, EEG and semiology of epileptic attacks, and to determine the effect of MCD on drug resistant epilepsy. We also intended to reveal the utility of interictal single photo emission computed tomography (SPECT) in verification of MCD lesions and relative prevalence of different MCDs. ...

  14. Photodynamic therapy for epilepsy

    Science.gov (United States)

    Zusman, Edie; Sidhu, Manpreet; Coon, Valerie; Scott, Nicholas; Bisland, Stuart; Tsukamoto, Tara

    2006-02-01

    Epilepsy is surgically curable if the seizure focus can be localized and does not include areas of eloquent cortex. Because epileptic cells are indistinct from surrounding brain, resection typically includes normal tissue. Using the rat kindling model of epilepsy, we evaluated Photodynamic Therapy (PDT) as a super-selective lesioning technique. We present a series of pilot studies to evaluate: 1) Protoporphyrin IX (PpIX) fluorescence, 2) the efficacy of PDT to raise seizure thresholds, 3) the safety of PDT using behavioral studies, and 4) histologic results. Bipolar electrodes were chronically implanted into the cortex and animals received successive low-level stimulation generating seizures of increasing severity. Following 5-aminolevulinic acid (ALA) administration, fully kindled rats received electrical stimulation to induce a generalized seizure. Animals were irradiated with laser light focused onto a temporal craniectomy. Our results show: 1) an increase in PpIX fluorescence in the seizure group, 2) PDT treated animals failed to demonstrate seizure activity following repeat stimulation, 3) no statistically significant difference between treated and control animals were observed on behavioral tests, 4) histology showed pyknotic hippocampal pyramidal cells in the CA3 region without areas of obvious necrosis. In conclusion, this is the first report of heightened PpIX-mediated fluorescence in epileptic brain. The selective accumulation of PpIX with laser PDT may provide a less invasive and more precise technique for obliteration of epileptic foci. PDT warrants additional research to determine if this technique may augment or replace existing procedures for the surgical management of epilepsy.

  15. Angiogenesis is associated with blood-brain barrier permeability in temporal lobe epilepsy.

    Science.gov (United States)

    Rigau, Valérie; Morin, Mélanie; Rousset, Marie-Claude; de Bock, Frédéric; Lebrun, Aurore; Coubes, Philippe; Picot, Marie-Christine; Baldy-Moulinier, Michel; Bockaert, Joël; Crespel, Arielle; Lerner-Natoli, Mireille

    2007-07-01

    Previous studies from our group, focusing on neuro-glial remodelling in human temporal lobe epilepsy (TLE), have shown the presence of immature vascular cells in various areas of the hippocampus. Here, we investigated angiogenic processes in hippocampi surgically removed from adult patients suffering from chronic intractable TLE, with various aetiologies. We compared hippocampi from TLE patients to hippocampi obtained after surgery or autopsy from non-epileptic patients (NE). We quantified the vascular density, checked for the expression of angiogenic factors and their receptors and looked for any blood-brain barrier (BBB) leakage. We used a relevant model of rat limbic epilepsy, induced by lithium-pilocarpine treatment, to understand the sequence of events. In humans, the vessel density was significantly higher in TLE than in NE patients. This was neither dependent on the aetiology nor on the degree of neuronal loss, but was positively correlated with seizure frequency. In the whole hippocampus, we observed many complex, tortuous microvessels. In the dentate gyrus, when the granular layer was dispersed, long microvessels appeared radially orientated. Vascular endothelial factor (VEGF) and tyrosine kinase receptors were detected in different types of cells. An impairment of the BBB was demonstrated by the loss of tight junctions and by Immunoglobulines G (IgG) leakage and accumulation in neurons. In the rat model of TLE, VEGF over-expression and BBB impairment occurred early after status epilepticus, followed by a progressive increase in vascularization. In humans and rodents, angiogenic processes and BBB disruption were still obvious in the chronic focus, probably activated by recurrent seizures. We suggest that the persistent leakage of serum IgG in the interstitial space and their uptake by neurons may participate in hypoperfusion and in neuronal dysfunction occurring in TLE. PMID:17533168

  16. Epilepsy in Adults with TSC

    Medline Plus

    Full Text Available ... for a listing of epilepsy centers go to www.naec-epilepsy.org or call 1-888-525- ... some individuals. Links Information for Women with Epilepsy: www.epilepsy.com/info/women Information for Men with ...

  17. Recognizing and preventing epilepsy-related mortality: A call for action.

    Science.gov (United States)

    Devinsky, Orrin; Spruill, Tanya; Thurman, David; Friedman, Daniel

    2016-02-23

    Epilepsy is associated with a high rate of premature mortality from direct and indirect effects of seizures, epilepsy, and antiseizure therapies. Sudden unexpected death in epilepsy (SUDEP) is the second leading neurologic cause of total lost potential life-years after stroke, yet SUDEP may account for less than half of all epilepsy-related deaths. Some epilepsy groups are especially vulnerable: individuals from low socioeconomic status groups and those with comorbid psychiatric illness die more often than controls. Despite clear evidence of an important public health problem, efforts to assess and prevent epilepsy-related deaths remain inadequate. We discuss factors contributing to the underestimation of SUDEP and other epilepsy-related causes of death. We suggest the need for a systematic classification of deaths directly due to epilepsy (e.g., SUDEP, drowning), due to acute symptomatic seizures, and indirectly due to epilepsy (e.g., suicide, chronic effects of antiseizure medications). Accurately estimating the frequency of epilepsy-related mortality is essential to support the development and assessment of preventive interventions. We propose that educational interventions and public health campaigns targeting medication adherence, psychiatric comorbidity, and other modifiable risk factors may reduce epilepsy-related mortality. Educational campaigns regarding sudden infant death syndrome and fires, which kill far fewer Americans than epilepsy, have been widely implemented. We have done too little to prevent epilepsy-related deaths. Everyone with epilepsy and everyone who treats people with epilepsy need to know that controlling seizures will save lives. PMID:26674330

  18. Pathology of temporal lobe epilepsy : An analysis of 100 consecutive surgical specimens from patients with medically refractory epilepsy.

    Directory of Open Access Journals (Sweden)

    Radhakrishnan V

    1999-07-01

    Full Text Available The neuropathological features of temporal lobe epilepsy were studied utilising 100 consecutive surgical specimens from patients with medically refractory complex partial seizures. A wide spectrum of neuropathological changes was recorded in 98 specimens. Fifty-eight specimens showed features of Ammon′s horn sclerosis. Diffuse accumulation of corpora amylacea were demonstrated in the resected temporal lobes from 54 patients. Six patients had neoplastic lesions of temporal lobe. One unique case of dysembryoplastic neuroepithelial tumour showed a melanotic component within the tumour. The neuropathological features were regarded as nonspecific in 31% of cases. Our results indicate that a majority of patients with medically intractable epilepsy of temporal lobe origin reveal significant neuropathological features. Careful documentation of the neuropathological features and its correlation with radiological, electrophysiological and pre- and post-surgical clinical features will help in predicting the seizure outcome after temporal lobectomy for medically refractory epilepsy.

  19. Epilepsy and sports.

    Science.gov (United States)

    van Linschoten, R; Backx, F J; Mulder, O G; Meinardi, H

    1990-07-01

    Millions of healthy people participate in sport on a regular basis. Moreover, in the last decade patients with chronic disorders have been encouraged to take part in sporting activities as a part of their rehabilitation. Can epileptic patients freely participate in sport or whether they are restricted to a certain extent by their disorder? An important factor is freedom from seizures. If seizures have been controlled for over 2 years the risk of relapse is the same as the risk of a first seizure. The risk of patients drowning or falling, or their epilepsy worsening because they are engaged in sport is thought to be low. Clinical data suggest that the incidence of seizures during sports and exercise is reduced. In the cooling down period, however, seizures tend to occur more frequently. Physicians should encourage epileptic patients to participate in sporting activities to enhance their physical fitness, self-esteem, and social integration. Before giving advice about the most suitable type of sport, the physician should known the patient's medical history, have a good insight into the different types of sport and be able to judge the role and function of sport to the particular patient. With certain precautions virtually all sports are suitable for most epileptic patients and should therefore be encouraged. However, a small minority of hospitalised patients with severe epilepsy need the supervision of qualified trainers, coaches and volunteers. PMID:2197701

  20. ASSESSMENT OF COGNITIVE AND MOTOR DEVELOPMENT IN 150 CHILDREN WITH REFRACTORY EPILEPSY

    OpenAIRE

    Eznallah AZARGHASHB; Farhad MAHVELATI-SHAMSABADI; Mohammad Mehdi NASEHI; Mohammad GHOFRANI

    2010-01-01

     ObjectiveNeuropsychological impairment is an important co-morbidity of chronic epilepsy. The aim of this study was to determine the state of the cognitive and motor development of patients with refractory epilepsy.Materials & Methods We studied 150 consecutive children with epilepsy who were referred to Mofid Children Hospital, a third level public referral University Hospital in Tehran, Iran, from October 2007 to October 2008. Refractory epilepsy was defined as therapeutic failure of three ...

  1. Ensuring Appropriate Care in Epilepsy: An Overview of Epidemiological and Cost of Illness Considerations

    OpenAIRE

    Heaney, Dominic C; Josemir W.A.S. Sander

    1998-01-01

    Epilepsy is an important health problem throughout the world. In order to best manage epilepsy within a population, its epidemiological profile should be established. Epidemiological studies have shown that epilepsy is a very common, chronic condition that particularly affects the young and those in developing countries. Although the reported rates vary widely, the annual incidence rate of epilepsy is estimated to be approximately 40 to 70 per 100 000 population, and the prevalence is estimat...

  2. International Veterinary Epilepsy Task Force recommendations for a veterinary epilepsy-specific MRI protocol

    OpenAIRE

    Rusbridge, Clare; Long, Sam; Jovanovik, Jelena; Milne, Marjorie; Berendt, Mette; Bhatti, Sofie; De Risio, Luisa; Farqhuar, Robyn G; Fischer, Andrea; Matiasek, Kaspar; Muñana, Karen; Patterson, Edward E.; Pakozdy, Akos; Penderis, Jacques; Platt, Simon

    2015-01-01

    Epilepsy is one of the most common chronic neurological diseases in veterinary practice. Magnetic resonance imaging (MRI) is regarded as an important diagnostic test to reach the diagnosis of idiopathic epilepsy. However, given that the diagnosis requires the exclusion of other differentials for seizures, the parameters for MRI examination should allow the detection of subtle lesions which may not be obvious with existing techniques. In addition, there are several differentials for idiopathic...

  3. Video game epilepsy.

    Directory of Open Access Journals (Sweden)

    Singh R

    2001-10-01

    Full Text Available Reflex epilepsy is the commonest form of epilepsy in which seizures are provoked by specific external stimulus. Photosensitive reflex epilepsy is provoked by environmental flicker stimuli. Video game epilepsy is considered to be its variant or a pattern sensitive epilepsy. The mean age of onset is around puberty and boys suffer more commonly as they are more inclined to play video games. Television set or computer screen is the commonest precipitants. The treatment remains the removal of the offending stimulus along with drug therapy. Long term prognosis in these patients is better as photosensitivity gradually declines with increasing age. We present two such case of epilepsy induced by video game.

  4. Towards precision medicine in epilepsy surgery.

    Science.gov (United States)

    Jin, Pingping; Wu, Dongyan; Li, Xiaoxuan; Ren, Liankun; Wang, Yuping

    2016-01-01

    Up to a third of all patients with epilepsy are refractory to medical therapy even in the context of the introduction of new antiepileptic drugs (AEDs) with considerable advantages in safety and tolerability over the last two decades. It has been widely accepted that epilepsy surgery is a highly effective therapeutic option in a selected subset of patients with refractory focal seizure. There is no doubt that accurate localization of the epileptogenic zone (EZ) is crucial to the success of resection surgery for intractable epilepsy. The pre-surgical evaluation requires a multimodality approach wherein each modality provides unique and complimentary information. Accurate localization of EZ still remains challenging, especially in patients with normal features on MRI. Whereas substantial progress has been made in the methods of pre-surgical assessment in recent years, which widened the applicability of surgical treatment for children and adults with refractory seizure. Advances in neuroimaging including voxel-based morphometric MRI analysis, multimodality techniques and computer-aided subtraction ictal SPECT co-registered to MRI have improved our ability to identify subtle structural and metabolic lesions causing focal seizure. Considerable observations from animal model with epilepsy and pre-surgical patients have consistently found a strong correlation between high frequency oscillations (HFOs) and epileptogenic brain tissue that suggest HFOs could be a potential biomarker of EZ. Since SEEG emphasizes the importance to study the spatiotemporal dynamics of seizure discharges, accounting for the dynamic, multidirectional spatiotemporal organization of the ictal discharges, it has greatly deep our understanding of the anatomo-electro-clinical profile of seizure. In this review, we focus on some state-of-the-art pre-surgical investigations that contribute to the precision medicine. Furthermore, advances also provide opportunity to achieve the minimal side effects and

  5. Ultrasound-Guided Nerve Block with Botulinum Toxin Type A for Intractable Neuropathic Pain.

    Science.gov (United States)

    Moon, Young Eun; Choi, Jung Hyun; Park, Hue Jung; Park, Ji Hye; Kim, Ji Hyun

    2016-01-01

    Neuropathic pain includes postherpetic neuralgia (PHN), painful diabetic neuropathy (PDN), and trigeminal neuralgia, and so on. Although various drugs have been tried to treat neuropathic pain, the effectiveness of the drugs sometimes may be limited for chronic intractable neuropathic pain, especially when they cannot be used at an adequate dose, due to undesirable severe side effects and the underlying disease itself. Botulinum toxin type A (BoNT-A) has been known for its analgesic effect in various pain conditions. Nevertheless, there are no data of nerve block in PHN and PDN. Here, we report two patients successfully treated with ultrasound-guided peripheral nerve block using BoNT-A for intractable PHN and PDN. One patient had PHN on the left upper extremity and the other patient had PDN on a lower extremity. Due to side effects of drugs, escalation of the drug dose could not be made. We injected 50 Botox units (BOTOX(®), Allergan Inc., Irvine, CA, USA) into brachial plexus and lumbar plexus, respectively, under ultrasound. Their pain was significantly decreased for about 4-5 months. Ultrasound-guided nerve block with BoNT-A may be an effective analgesic modality in a chronic intractable neuropathic pain especially when conventional treatment failed to achieve adequate pain relief. PMID:26761032

  6. Ultrasound-Guided Nerve Block with Botulinum Toxin Type A for Intractable Neuropathic Pain

    Directory of Open Access Journals (Sweden)

    Young Eun Moon

    2016-01-01

    Full Text Available Neuropathic pain includes postherpetic neuralgia (PHN, painful diabetic neuropathy (PDN, and trigeminal neuralgia, and so on. Although various drugs have been tried to treat neuropathic pain, the effectiveness of the drugs sometimes may be limited for chronic intractable neuropathic pain, especially when they cannot be used at an adequate dose, due to undesirable severe side effects and the underlying disease itself. Botulinum toxin type A (BoNT-A has been known for its analgesic effect in various pain conditions. Nevertheless, there are no data of nerve block in PHN and PDN. Here, we report two patients successfully treated with ultrasound-guided peripheral nerve block using BoNT-A for intractable PHN and PDN. One patient had PHN on the left upper extremity and the other patient had PDN on a lower extremity. Due to side effects of drugs, escalation of the drug dose could not be made. We injected 50 Botox units (BOTOX®, Allergan Inc., Irvine, CA, USA into brachial plexus and lumbar plexus, respectively, under ultrasound. Their pain was significantly decreased for about 4–5 months. Ultrasound-guided nerve block with BoNT-A may be an effective analgesic modality in a chronic intractable neuropathic pain especially when conventional treatment failed to achieve adequate pain relief.

  7. The Performance of Ictal Brain SPECT Localizing for Epileptogenic Zone in Neocortical Epilepsy

    International Nuclear Information System (INIS)

    The epileptogenic zones should be localized precisely before surgical resection of these zones in intractable epilepsy. The localization is more difficult in patients with neocortical epilepsy than in patients with temporal lobe epilepsy. This study aimed at evaluation of the usefulness of ictal brain perfusion SPECT for the localization of epileptogenic zones in neocortical epilepsy. We compared the performance of ictal SPECT with MRI referring to ictal scalp electroencephalography (sEEG). Ictal 99mTc-HMPAO SPECT were done in twenty-one patients. Ictal EEG were also obtained during video monitoring. MRI were reviewed. According to the ictal sEEG and semiology, 8 patients were frontal lobe epilepsy, 7 patients were lateral temporal lobe epilepsy, 2 patients were parietal lobe epilepsy, and 4 patients were occipital lobe epilepsy. Ictal SPECT showed hyperperfusion in 14 patients(67%) in the zones which were suspected to be epileptogenic according to ictal EEG and semiology. MRI found morphologic abnormalities in 9 patients(43%). Among the 12 patients, in whom no epileptogenic zones were revealed by MR1, ictal SPECT found zones of hyperperfusion concordant with ictal sEEG in 9 patients(75%). However, no zones of hyperperfusion were found in 4 among 9 patients who were found to have cerebromalacia, abnormal calcification and migration anomaly in MRI. We thought that ictal SPECT was useful for localization of epileptogenic zones in neocortical epilepsy and especially in patients with negative findings in MRI.

  8. Epilepsy Surgery Series: A Study of 502 Consecutive Patients from a Developing Country

    Directory of Open Access Journals (Sweden)

    Abdulaziz Alsemari

    2014-01-01

    Full Text Available Purpose. To review the postoperative seizure outcomes of patients that underwent surgery for epilepsy at King Faisal Specialist Hospital & Research Centre (KFSHRC. Methods. A descriptive retrospective study for 502 patients operated on for medically intractable epilepsy between 1998 and 2012. The surgical outcome was measured using the ILAE criteria. Results. The epilepsy surgery outcome for temporal lobe epilepsy surgery (ILAE classes 1, 2, and 3 at 12, 36, and 60 months is 79.6%, 74.2%, and 67%, respectively. The favorable 12- and 36-month outcomes for frontal lobe epilepsy surgery are 62% and 52%, respectively. For both parietal and occipital epilepsy lobe surgeries the 12- and 36-month outcomes are 67%. For multilobar epilepsy surgery, the 12- and 36-month outcomes are 65% and 50%, respectively. The 12- and 36-month outcomes for functional hemispherectomy epilepsy surgery are 64.2% and 63%, respectively. According to histopathology diagnosis, mesiotemporal sclerosis (MTS and benign CNS tumors had the best favorable outcome after surgery at 1 year (77.27% and 84.3%, resp., and 3 years (76% and 75%, resp.,. The least favorable seizure-free outcome after 3 years occurred in cases with dual pathology (66.6%. Thirty-four epilepsy patients with normal magnetic resonance imaging (MRI brain scans were surgically treated. The first- and third-year epilepsy surgery outcome of 17 temporal lobe surgeries were (53% and (47% seizure-free, respectively. The first- and third-year epilepsy surgery outcomes of 15 extratemporal epilepsy surgeries were (47% and (33% seizure-free. Conclusion. The best outcomes are achieved with temporal epilepsy surgery, mesial temporal sclerosis, and benign CNS tumor. The worst outcomes are from multilobar surgery, dual pathology, and normal MRI.

  9. Cerebral depression due to propylene glycol in a patient with chronic epilepsy--the value of the plasma osmolal gap in diagnosis.

    OpenAIRE

    Lolin, Y.; Francis, D A; Flanagan, R J; Little, P.; Lascelles, P. T.

    1988-01-01

    A case of propylene glycol poisoning is described in a 39 year old woman which resulted in her admission to hospital in status epilepticus. She had had a long-standing history of uncontrollable epilepsy. The diagnosis of propylene glycol poisoning resulted directly from the finding of a high plasma osmolal gap on admission. This finding would have been missed if later samples only had been analysed. Plasma osmolality and the osmolal gap should be considered first line investigations in patien...

  10. Epilepsy in Ireland: towards the primary-tertiary care continuum.

    LENUS (Irish Health Repository)

    Varley, Jarlath

    2010-01-01

    Epilepsy is a chronic neurological disease affecting people of every age, gender, race and socio-economic background. The diagnosis and optimal management relies on contribution from a number of healthcare disciplines in a variety of healthcare settings.

  11. Neuromyelitis Optica: An Often Forgotten Cause of Intractable Nausea and Vomiting

    Directory of Open Access Journals (Sweden)

    Chijioke Enweluzo

    2013-07-01

    Full Text Available Neuromyelitis optica, also known as Devic's disease, is a rare autoimmune disorder in which a patient's immune system affects the optic nerves and the spinal cord, leading to loss of vision and spinal cord dysfunction. We present our experience with a 38-year-old female who presented to our facility with complaints of intractable nausea and vomiting. After extensive evaluation, she was found to have neuromyelitis optica. Her symptoms completely resolved following institution of appropriate therapy. She made a significant recovery and has since been placed on chronic immunosuppressive therapy. Through this article we hope to bring attention to a significant cause of intractable nausea and vomiting that may often be forgotten in general medicine or gastroenterology services.

  12. Comorbidity in adults with epilepsy--United States, 2010.

    Science.gov (United States)

    2013-11-01

    Epilepsy, a spectrum disorder characterized by recurring seizures, affects approximately 2.3 million U.S. adults. Epilepsy poses challenges because of uncontrolled seizures, treatment complexity, social disadvantages (e.g., unemployment), and stigma. Persons with epilepsy are at increased risk for early mortality and for comorbidities that can complicate epilepsy management, increase health-care costs, and shorten the lifespan. Numerous studies have described higher rates of psychiatric comorbidity (e.g., depression and anxiety) in persons with epilepsy. However, fewer studies have examined nonpsychiatric comorbidity in a nationally representative U.S. sample of adults with epilepsy. To assess the prevalence of nonpsychiatric comorbidities, CDC analyzed data from the 2010 National Health Interview Survey (NHIS). Adults with epilepsy had a higher prevalence of cardiovascular, respiratory, some inflammatory, and other disorders (e.g., headache, migraine, and various other types of pain) than adults without epilepsy. Public health agencies can work with health-care providers, the Epilepsy Foundation, and other partners to ensure that adults with epilepsy have access to health promotion resources and chronic disease self-management programs. PMID:24172878

  13. [Anxiety disorder due to epilepsy: a case report].

    Science.gov (United States)

    Özyurt, Gonca; Öztura, İbrahim; Alkın, Tunç; Özerdem, Ayşegül

    2015-01-01

    Epileptic patients present with psychiatric disorders more frequently than the general population and patients with other chronic medical conditions. Psychiatric disorders can co-occur with epilepsy and can be caused by epilepsy. Personality changes, as well as psychosis, and mood or anxiety disorders can occur in association with epilepsy. Anxiety disorders due to epilepsy can manifest as generalized anxiety disorder, panic disorder, phobias, or obsessive-compulsive disorder. The risk of an anxiety disorder is higher in patients with focal epilepsy, especially those with temporal lobe epilepsy, but an anxiety disorder can also occur in patients with frontal lobe epilepsy or generalized tonic-clonic epilepsy. Herein we present a 41-year-old female patient with comorbid anxiety disorder and epilepsy that improved following initiation of antiepileptic medication. The patient's EEG showed abnormalities, particularly in the frontal lobe. Epileptic activation-associated anxiety disorder presented as phobia of swallowing and the patient exhibited features of generalized anxiety disorder. Following initiation of antiepileptic medication, the seizures stopped and the symptoms of anxiety disappeared in two weeks. The patient was receiving psychotherapy once every 2 weeks. The patient remained asymptomatic during 2-years of follow-up. This case highlights the importance of differential diagnosis of underlying epilepsy in patients with acute severe anxiety and the efficacy of proper medical treatment, which was given in the presented case for the underling pathology of anxiety. PMID:25742040

  14. Stigma and quality of life at long-term follow-up after surgery for epilepsy in Uganda.

    Science.gov (United States)

    Fletcher, Anita; Sims-Williams, Helen; Wabulya, Angela; Boling, Warren

    2015-11-01

    Epilepsy is a worldwide health problem with a 10-fold greater prevalence in the developing world. Commonly, the seizure focus is in the temporal lobe, and seizures in about 30% of people with epilepsy are intractable to medication. For these individuals, surgery for intractable temporal lobe epilepsy (iTLE) is more effective than medication alone and may be the only option for cure. Intractable temporal lobe epilepsy is associated with elevated morbidity and mortality, reduced quality of life (QOL), and associated stigma particularly occurring in the developing world. Individuals with intractable epilepsy who participated in an earlier Uganda pilot study were selected for the current study based on their undergoing previous surgery for iTLE or having comparable seizure type who did not have surgery. At long-term follow-up, 10 who underwent surgery for iTLE in addition to 9 patients with focal dyscognitive type epilepsy who did not have surgery were evaluated in the current study. Tests were administered to look at various outcome parameters: seizure severity, QOL, stigma, and self-esteem. Stigma and self-esteem were additionally evaluated in the parent/caregiver. Seventy-percent of surgical resection patients were seizure-free at 8 years postsurgery. The QOLIE-31 scores were higher in surgical patients. Child/patient and parent/proxy surveys identified lower stigma in seizure-free patients. The results suggest that surgery for iTLE is an effective treatment for epilepsy in the developing world and provides an opportunity to reduce stigma and improve QOL. PMID:26414342

  15. Viable Solutions for seemingly Intractable Problems

    Directory of Open Access Journals (Sweden)

    Ashok Natarajan

    2015-10-01

    Full Text Available Life is filled with seemingly intractable problems. But life wisdom affirms that if there is a problem, there must be a solution. Or better yet, the solution to the problem lies within the problem itself. Problems have their roots in disharmony. Disharmony arises when a part separates itself from the whole and acts independently of the wider reality of which it is a part, as financial markets have separated themselves from the real economy and economy has detached itself from social and ecological consequences. Insistence on out-moded approaches under new conditions generates intractable problems, as when the framework of a heterogeneous nation-state is employed for the dominance of a single ethnic or religious group. Knowledge and culture are the supreme values of a society and core element of its capacity for accomplishment and development, yet both tend to be exclusively possessed by elites for their own benefit, rather than freely distributed to maximize their impact on society as a whole. Society evolves by the transformation of ignorance into knowledge. Life evolves by organization. The linking and integration of social organizations spur development. Mind itself is an organization and powerful force for development. Energy makes organization more efficient. Any problem can be solved by raising the effectiveness of energy by converting it into skill or capacity and transforming it into power through organization. What one person sees as a problem is an opportunity for another with wider vision. The difference in perception accounts for the difference in levels of accomplishment. So, those with the right perspective see opportunities where others see insolvable problems. Current problems are the result of irrationality, refusal to benefit from past experience and insistence on repeating past errors. Modern science, which was born to fight the superstition of religion, has become a source of superstition. Fully availing of the latest

  16. Polymicrogyria-Associated Epilepsy

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2013-09-01

    Full Text Available Investigators from the Boston Children's Hospital, New York University, Brown University, and Birmingham School of Medicine, AL, studied the clinical epilepsy and imaging features of 87 patients with polymicrogyria (PMG and epilepsy, recruited through the Epilepsy Phenome/Genome Project.

  17. Neuroimaging in epilepsy

    Directory of Open Access Journals (Sweden)

    Shahina Bano

    2011-01-01

    Full Text Available Epilepsy is the most common neurological disease worldwide and is second only to stroke in causing neurological morbidity. Neuroimaging plays a very important role in the diagnosis and treatment of patients with epilepsy. This review article highlights the specific role of various imaging modalities in patients with epilepsy, and their practical applications in the management of epileptic patients.

  18. Compensatory brain activation for recognition memory in patients with medication resistant epilepsy

    OpenAIRE

    Eliassen, James C.; Holland, Scott K.; Szaflarski, Jerzy P.

    2008-01-01

    Progressive decline of memory functions has been observed in patients with chronic medication-resistant epilepsy. The progression likely relates to the effects of epileptiform discharges, seizures, and medications on the processes of encoding and retrieval. The goal of this study was to use functional MRI (fMRI) to examine the effects of chronic epilepsy on verbal recognition memory. We enrolled 12 patients with medication-resistant epilepsy (5 with right and 7 in left-hemispheric seizure ons...

  19. Memory Functioning in Children with Epilepsy: Frontal Lobe Epilepsy, Childhood Absence Epilepsy, and Benign Epilepsy with Centrotemporal Spikes

    OpenAIRE

    Ana Filipa Lopes; José Paulo Monteiro; Maria José Fonseca; Conceição Robalo; Mário Rodrigues Simões

    2014-01-01

    Specific cognitive deficits have been identified in children with epilepsy irrespective of results on intelligence tests. Memory deficits are traditionally attributed to temporal lobe epilepsy, whereas the impact of frontal lobe epilepsy on memory functions has remained controversial. The aim of this study was the examination of memory abilities in other childhood common epilepsy syndromes (frontal lobe epilepsy (FLE), childhood absence epilepsy (CAE), and benign epilepsy with centrotemporal ...

  20. Risks of Academic Underachievement in Epilepsy

    OpenAIRE

    J Gordon Millichap

    2004-01-01

    The relation between neuropsychological functioning and academic achievement and the role of family environment, seizures, and psychosocial variables were examined in 173 children with chronic epilepsy, ages 8 to 15 years, at Purdue School of Science; Indiana University School of Medicine, Indianapolis; and University of Wisconsin-Madison School of Medicine, WI.

  1. Treatment of intractable rheumatoid arthritis with total lymphoid irradiation

    International Nuclear Information System (INIS)

    Eleven patients with intractable rheumatoid arthritis were treated with total lymphoid irradiation (total dose, 2000 rad) in an uncontrolled feasibility study, as an alternative to long-term therapy with cytotoxic drugs such as cyclophosphamide and azathioprine. During a follow-up period of five to 18 months after total lymphoid irradiation, there was a profound and sustained suppression of the absolute lymphocyte count and in vitro lymphocyte function, as well as an increase in the ratio of Leu-2 (suppressor/cytotoxic) to Leu-3 (helper) T cells in the blood. Persistent circulating suppressor cells of the mixed leukocyte response and of pokeweed mitogen-induced immunoglobulin secretion developed in most patients. In nine of the 11 patients, these changes in immune status were associated with relief of joint tenderness and swelling and with improvement in function scores. Maximum improvement occurred approximately six months after irradiation and continued for the remainder of the observation period. Few severe or chronic side effects were associated with the radiotherapy

  2. Treatment of intractable rheumatoid arthritis with total lymphoid irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Kotzin, B.L.; Strober, S.; Engleman, E.G.; Calin, A.; Hoppe, R.T.; Kansas, G.S.; Terrell, C.P.; Kaplan, H.S.

    1981-10-22

    Eleven patients with intractable rheumatoid arthritis were treated with total lymphoid irradiation (total dose, 2000 rad) in an uncontrolled feasibility study, as an alternative to long-term therapy with cytotoxic drugs such as cyclophosphamide and azathioprine. During a follow-up period of five to 18 months after total lymphoid irradiation, there was a profound and sustained suppression of the absolute lymphocyte count and in vitro lymphocyte function, as well as an increase in the ratio of Leu-2 (suppressor/cytotoxic) to Leu-3 (helper) T cells in the blood. Persistent circulating suppressor cells of the mixed leukocyte response and of pokeweek mitogen-induced immunoglobulin secretion developed in most patients. In nine of the 11 patients, these changes in immune status were associated with relief of joint tenderness and swelling and with improvement in function scores. Maximum improvement occurred approximately six months after irradiation and continued for the remainder of the observation period. Few severe or chronic side effects were associated with the radiotherapy.

  3. Treatment of intractable rheumatoid arthritis with total lymphoid irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Kotzin, B.L.; Strober, S.; Engleman, E.G.; Calin, A.; Hoppe, R.T.; Kansas, G.S.; Terrell, C.P.; Kaplan, H.S.

    1981-10-01

    Eleven patients with intractable rheumatoid arthritis were treated with total lymphoid irradiation (total dose, 2000 rad) in an uncontrolled feasibility study, as an alternative to long-term therapy with cytotoxic drugs such as cyclophosphamide and azathioprine. During a follow-up period of five to 18 months after total lymphoid irradiation, there was a profound and sustained suppression of the absolute lymphocyte count and in vitro lymphocyte function, as well as an increase in the ratio of Leu-2 (suppressor/cytotoxic) to Leu-3 (helper) T cells in the blood. Persistent circulating suppressor cells of the mixed leukocyte response and of pokeweed mitogen-induced immunoglobulin secretion developed in most patients. In nine of the 11 patients, these changes in immune status were associated with relief of joint tenderness and swelling and with improvement in function scores. Maximum improvement occurred approximately six months after irradiation and continued for the remainder of the observation period. Few severe or chronic side effects were associated with the radiotherapy.

  4. Positron emission tomography in presurgical evaluation of epilepsy

    International Nuclear Information System (INIS)

    In a considerable proportion of patients with medically intractable partial epilepsies who are considered for surgery, the detection of a lesion with MRI or CT is not possible. Functional imaging methods can provide clinically useful information in these cases, being methods which enable localisation of functional abnormalities independent from EEG. There is an extensive knowledge about interictal PET-investigations with F-18 FDG. Many centers dealing with preoperative evaluation of epilepsy use this method as part of their diagnostic routine. Most studies report a decrease of glucose metabolism in topographic correlation to the EEG defined seizure origin in temporal lobe epilepsy in 70%-85% of the patients. The sensitivity reported for the detection of extratemporal foci is markedly lower. The mapping of neuronal structures with specific ligands, i.e. benzodiazepine receptor ligands has advantages compared to the detection of changes in flow and metabolism. It enables the differentiation of abnormalities in the neuronal texture of the brain from deactivated cortical areas. This is especially important when surgical procedures other than standard resection techniques are considered. The clinical importance of the functional imaging methods is that they help to decrease the amount of invasive EEG recordings in temporal lobe epilepsy. Furthermore, in extratemporal epilepsies functional imaging techniques facilitate the placement of the electrodes for invasive EEG recording. (orig.)

  5. Ego functions in epilepsy

    DEFF Research Database (Denmark)

    Sørensen, A S; Hansen, H; Høgenhaven, H;

    1988-01-01

    Two groups of epilepsy patients (28 patients with temporal lobe epilepsy and 15 patients with primary generalized epilepsy) entered a study of personality traits related to epilepsy, based on a modification of Bellak's semistructured interview for assessment of ego strength. Two groups of subjects...... served as controls: 15 patients with a non-neurological but relapsing disorder, psoriasis, and 15 healthy volunteers. Compared with the group of healthy volunteers, a decreased adaptive level of ego functioning was found in the epilepsy groups, regardless of seizure types and EEG findings, and, to a...... than 15 years when the disease began. The number of anticonvulsants administered did not influence the results. No difference on adaptive level of ego functioning was found between the group with primary generalized epilepsy and the group with temporal lobe epilepsy. Similarly, the temporal lobe...

  6. International Veterinary Epilepsy Task Force recommendations for a veterinary epilepsy-specific MRI protocol

    DEFF Research Database (Denmark)

    Rusbridge, Clare; Long, Sam; Jovanovik, Jelena;

    2015-01-01

    Epilepsy is one of the most common chronic neurological diseases in veterinary practice. Magnetic resonance imaging (MRI) is regarded as an important diagnostic test to reach the diagnosis of idiopathic epilepsy. However, given that the diagnosis requires the exclusion of other differentials for...... seizures, the parameters for MRI examination should allow the detection of subtle lesions which may not be obvious with existing techniques. In addition, there are several differentials for idiopathic epilepsy in humans, for example some focal cortical dysplasias, which may only apparent with special...... underlying causes of seizures not yet apparent in the veterinary literature.There is a need for a standardized veterinary epilepsy-specific MRI protocol which will facilitate more detailed examination of areas susceptible to generating and perpetuating seizures, is cost efficient, simple to perform and can...

  7. Graduated clinical manifestations according to mutation type in patients with severe myoclonic epilepsy in infancy

    DEFF Research Database (Denmark)

    Brusgaard, Klaus; Møller, Rikke; Dahl, Hans Atli;

    Background Severe myoclonic epilepsy in infancy (SMEI) is a severe form of generalized epilepsy with febrile seizures (GEFS+). SMEI is a rare disorder characterized by generalized tonic, clonic, and tonic-clonic seizures that are initially induced by fever and begin during the first year of life...... syndrome, while GEFS+ is usually benign. An autosomal dominant pattern of inheritance is observed with GEFS+. SCN1A-related seizure disorders encompass a spectrum that ranges from simple febrile seizures (FS) and generalized epilepsy with febrile seizures plus (GEFS+) at the mild end to Dravet syndrome and...... intractable childhood epilepsy with generalized tonic-clonic seizures (ICE-GTC) at the severe end Patients and methods 87 infants representing GEFS+ were analyzed by bidirectional sequencing of all exons of the SCN1A, SCN2A, GABRG2 or SCN1B genes. Additionally, MLPA analysis of SCN1A was performed. Results In...

  8. MRI and SPECT findings as a predictive factor for postencephalitic epilepsy

    International Nuclear Information System (INIS)

    Relationship between postencephalitic epilepsy and acute phase symptoms, CSF, EEG and MRI findings was assessed by Kaplan-Meier method. Thirteen of 34 patients manifestated epilepsy including four intractable cases. Women (7/11), herpes simplex virus (6/7), seizures in acute phase (12/18), abnormal findings or MRI (6/7) were statistically significant. Four of nine patients with hyperperfusion area by HMPAO-SPECT in acute phase and two of three patients with hypoperfusion area by IMP-SPECT in recovery phase had epilepsy. Hyperperfusion in acute phase reflected acute seizures and inflammations, whereas hypoperfusion in the recovery phase reflected hypometabolism caused by brain damage. These findings suggest epileptogenicity, MRI and SPECT findings may predict prognosis of postencephalitic epilepsy. (author)

  9. MRI and SPECT findings as a predictive factor for postencephalitic epilepsy

    Energy Technology Data Exchange (ETDEWEB)

    Mizobuchi, Masahiro; Tanaka, Chiharu; Sako, Kazuya; Murakami, Nobuto; Nihira, Atsuko [Nakamura Memorial Hospital, Sapporo (Japan)

    2000-04-01

    Relationship between postencephalitic epilepsy and acute phase symptoms, CSF, EEG and MRI findings was assessed by Kaplan-Meier method. Thirteen of 34 patients manifestated epilepsy including four intractable cases. Women (7/11), herpes simplex virus (6/7), seizures in acute phase (12/18), abnormal findings or MRI (6/7) were statistically significant. Four of nine patients with hyperperfusion area by HMPAO-SPECT in acute phase and two of three patients with hypoperfusion area by IMP-SPECT in recovery phase had epilepsy. Hyperperfusion in acute phase reflected acute seizures and inflammations, whereas hypoperfusion in the recovery phase reflected hypometabolism caused by brain damage. These findings suggest epileptogenicity, MRI and SPECT findings may predict prognosis of postencephalitic epilepsy. (author)

  10. Addressing the burden of epilepsy: Many unmet needs.

    Science.gov (United States)

    Beghi, Ettore

    2016-05-01

    Epilepsy is a heterogeneous clinical condition characterized by recurrent unprovoked seizures, their causes and complications. The incidence, prevalence and mortality of epilepsy vary with age, place and time contributing to a variable extent to the burden of the disease. Diagnostic misclassification may have strong impact on personal and societal reflections of the disease in light of its clinical manifestations and the need for chronic treatment. Epilepsy accounts for a significant proportion of the world's disease burden ranking fourth after tension-type headache, migraine and Alzheimer disease. Among neurological diseases, it accounts for the highest disability-adjusted life year rates both in men and in women. Although epilepsy is self-remitting in up to 50% of cases, variable long-term prognostic patterns can be identified based on the response to the available treatments. Epilepsy carries an overall increased risk of premature mortality with variable estimates across countries. Premature mortality predominates in patients aged less than 50 years, with epilepsies due to structural/metabolic conditions, with generalized tonic-clonic seizures, and seizures not remitting under treatment. Among deaths directly attributable to epilepsy or seizures, included are sudden unexpected death in epilepsy (SUDEP), status epilepticus, accidents, drowning, unintentional injuries, and suicide. Somatic and psychiatric disorders prevail in patients with epilepsy than in people without epilepsy. Asthma, migraine and cerebral tumors tend to occur more frequently in younger adults while cardiovascular disorders, stroke, dementia and meningioma predominate in the elderly. As being a fairly common clinical condition affecting all ages and requiring long-term (sometimes lifelong) treatment, epilepsy carries high health care costs for the society. Direct costs peak in the first year after diagnosis and then vary according to the severity of the disease, the response to treatment, and

  11. Experimental therapy of epilepsy with transcranial magnetic stimulation: lack of additional benefit with prolonged treatment

    OpenAIRE

    Brasil-Neto Joaquim P.; Araújo Doralúcia P. de; Teixeira Wagner A.; Araújo Valéria P.; Boechat-Barros Raphael

    2004-01-01

    OBJECTIVE: To investigate the effect of three months of low-frequency repetitive transcranial magnetic stimulation (rTMS) treatment in intractable epilepsy. METHODS: Five patients (four males, one female; ages 6 to 50 years), were enrolled in the study; their epilepsy could not be controlled by medical treatment and surgery was not indicated. rTMS was performed twice a week for three months; patients kept records of seizure frequency for an equal period of time before, during, and after rTMS ...

  12. Total lymphoid irradiation of intractable rheumatoid arthritis

    International Nuclear Information System (INIS)

    Eleven patients with intractable rheumatoid arthritis were treated with fractionated total lymphoid irradiation, (total dose 20 Gy). Lasting improvement in clinical symptoms was found in four patients during treatment and the remaining patients experienced similar benefit within 2 months of irradiation. There was marked reduction in exacerbations and number of joints involved. Morning stiffness, joint swelling and tenderness decreased. Complications included severe fatigue during treatment and acute bacterial arthritis in multiple joints in one patient. Four patients have since died, one of renal failure, another of cardiogenic shock following surgery 3 and 24 months after total lymphoid irradiation. Both had generalised amyloidosis. The third patient developed joint empyema and died of toxic cardiac failure. The fourth died 3 months after resection of a Kaposi's sarcoma complicated by wound infection which responded to treatment. Immunologically, total lymphoid irradiation resulted in suppression of the absolute lymphocyte count and reduction in T-helper cells, the number of T-suppressor cells remaining unchanged. These data provide evidence of T-cell involvement in the pathogenesis of rheumatoid arthritis. Total lymphoid irradiation can induce sustained improvement in clinical disease activity, but severe, possibly fatal, side-effects cannot be ignored. (author)

  13. Decompressive Craniectomy for Intractable Intracranial Hypertension

    Directory of Open Access Journals (Sweden)

    Bulent Bakar

    2012-10-01

    Full Text Available Aim: This retrospective study was established to analyse the effects of the decompressive craniectomy on patients with different causes of increased intracranial pressure. Material and Method: Nine patients at risk of developing malignant cerebral edema aged between 18 and 75 years were included in this study. Four patients suffered from severe traumatic brain injury, two patients from subarachnoid haemorrhage (SAH and vasospastic ischemia, and 3 patients from malignant infarction of the middle cerebral artery. Results: Nine patients underwent decompressive craniectomy as the last therapeutic choice. At first admission mean intracranial pressure (ICP was 22.6 ± 6.7 mmHg; mean preoperative ICP value was 40.8 ± 16.3 mmHg; and mean postoperative ICP value was 9.3± 3.6 mmHg. In two patients bilateral; and in seven patients unilateral frontotemporoparietal craniectomy was preferred. Mean time of the re-implantation of the bone flap was 25.75±10.0 days. One patient with SAH died postoperatively and eight patients survived (mortality rate 11.1%. Mean value of the Glasgow Outcome Scale score as evaluated at 36 months after the decompression was approximately 4. Discussion: This surgical procedure is successful for treatment of the acute or delayed intractable intracerebral hypertension with a low rate of complication if it is performed timely and carefully.

  14. [Management of intractable migraine in adults].

    Science.gov (United States)

    Pradalier, André; Baudesson, Gilles; Delage, Alain

    2003-01-01

    The management of intractable migraine is not yet standardised. The first point in the emergency department is to eliminate severe cephalalgic non-migrainous disease, then to confirm the diagnosis of migraine. The second point is to determine trigger factors responsible for the refractory migraine--principally inadequate therapy, such as too low a dosage, inadequate treatment compared with intensity, and delayed treatment. Examples of inadequate classical treatments are presented for the following four main oral therapies: a nonsteroidal anti-inflammatory drug (NSAID), analgesics, ergot derivatives, and triptans. When these drugs are ineffective, the following are used via injections: propacetamol, aspirin (lysine acetylsalicylate), injectable NSAIDs, and nefopam. These products differ from country-to-country. For example, morphinomimetics, phenothiazines and corticosteroids are widely prescribed in the US, while metamizole (dipyrone) is preferred in developing countries. The authors describe the different models of administration and the adverse effects of the substances. Finally, they describe the treatment of status migrainosus. Globally, triptans are underused in emergency departments. This review confirms the need for controlled trials of treatments for migraine in emergency departments in order to develop an international therapeutic consensus. PMID:14679670

  15. Epilepsy in Adults with TSC

    Medline Plus

    Full Text Available ... an epilepsy surgery program. Dietary Therapy: The ketogenic diet is a diet that is high in fat content and low ... treating epilepsy in some individuals with epilepsy. This diet is more often used for children rather than ...

  16. Genetics Home Reference: Northern epilepsy

    Science.gov (United States)

    ... Understand Genetics Home Health Conditions Northern epilepsy Northern epilepsy Enable Javascript to view the expand/collapse boxes. Download PDF Open All Close All Description Northern epilepsy is a genetic condition that causes recurrent seizures ( ...

  17. Epilepsy in Adults with TSC

    Medline Plus

    Full Text Available ... are often distributed throughout the brain. Devices to treat epilepsy include vagus nerve stimulation and responsive neurostimulation. Who Treats Epilepsy? A general neurologist can treat uncomplicated epilepsy ...

  18. Christianity and epilepsy.

    Science.gov (United States)

    Owczarek, K; Jędrzejczak, J

    2013-01-01

    Epileptic seizures have been known from time immemorial. Throughout the ages, however, ideas concerning the aetiology and treatment of epilepsy have changed considerably. Epilepsy is mentioned many times in the Pentateuch, where it is portrayed as a mysterious condition, whose symptoms, course and contingencies evade rational laws and explanations. In the Middle Ages, the accepted view which prevailed in social consciousness was that patients with epilepsy were possessed by Satan and other impure spirits. One common method of treatment of epileptic seizures was to submit the patient to cruel exorcisms. Patients were frequently injured in the process and some of them even died. Our understanding of epilepsy and its social consequences has improved considerably within the last century. The most significant progress as far as diagnosis and treatment of epilepsy is concerned took place in the last four decades of the twentieth century. Although we now know much more about epilepsy than we used to, this knowledge is still insufficiently popularized. PMID:23821425

  19. Approximating methods for intractable probabilistic models: Applications in neuroscience

    OpenAIRE

    Højen-Sørensen, Pedro; Hansen, Lars Kai; Rasmussen, Carl Edward; Larsen, Jan

    2002-01-01

    This thesis investigates various methods for carrying out approximate inference in intractable probabilistic models. By capturing the relationships between random variables, the framework of graphical models hints at which sets of random variables pose a problem to the inferential step. The approximating techniques used in this thesis originate from the field of statistical physics which for decades has been facing the same type of intractable computations when analyzing large systems of inte...

  20. Fractionated Stereotactic Gamma Knife Radiosurgery for Medial Temporal Lobe Epilepsy: A Case Report

    OpenAIRE

    Park, Hye Ran; Chung, Hyun-Tai; Lee, Sang Kun; Kim, Dong Gyu; Paek, Sun Ha

    2016-01-01

    An 18-year-old left-handed male harbored intractable medial temporal lobe epilepsy (MTLE) underwent fractionated gamma knife surgery (GKS) instead of open surgery, considering the mental retardation and diffuse cerebral dysfunction. GKS treatment parameters were: target volume, 8.8 cm3; total marginal dose, 24 Gy in 3 fractionations at the 50% isodose line. The patient has been free from seizures since 9 months after GKS, with notable improvement in cognitive outcome. Fractionated GKS could b...

  1. Epilepsy in Adults with TSC

    Medline Plus

    Full Text Available ... since the tubers are often distributed throughout the brain. Devices to treat epilepsy include vagus nerve stimulation and responsive neurostimulation. Who Treats Epilepsy? A general ...

  2. PET evaluation of refractory epilepsy in children and adolescents

    International Nuclear Information System (INIS)

    In many cases of intractable epilepsy, the focus is difficult to localize. In this paper positron emission tomography (PET) and MR imaging are compared for accuracy in identifying seizure foci. Cerebral glucose utilization was measured using conventional fluorodeoxyglucose technique in 29 children with epilepsy. All subjects also underwent MR imaging and were evaluated clinically and electrophysiologically. The authors evaluated 34 regions of interest (ROIs) within eight tomographic sections for rCMRglu metabolism. In 17 of 29 patients, MR imaging yielded normal results; PET results were abnormal in 12 of these patients, 11 of whom went on to surgery. The five patients in whom both PET and MR imaging results were normal did not go to surgery, and no definitive diagnoses were made

  3. Approaches to refractory epilepsy

    Directory of Open Access Journals (Sweden)

    Jerome Engel

    2014-01-01

    Full Text Available Epilepsy is one of the most common serious neurological conditions, and 30 to 40% of people with epilepsy have seizures that are not controlled by medication. Patients are considered to have refractory epilepsy if disabling seizures continue despite appropriate trials of two antiseizure drugs, either alone or in combination. At this point, patients should be referred to multidisciplinary epilepsy centers that perform specialized diagnostic testing to first determine whether they are, in fact, pharmacoresistant, and then, if so, offer alternative treatments. Apparent pharmacoresistance can result from a variety of situations, including noncompliance, seizures that are not epileptic, misdiagnosis of the seizure type or epilepsy syndrome, inappropriate use of medication, and lifestyle issues. For patients who are pharmacoresistant, surgical treatment offers the best opportunity for complete freedom from seizures. Surgically remediable epilepsy syndromes have been identified, but patients with more complicated epilepsy can also benefit from surgical treatment and require more specialized evaluation, including intracranial EEG monitoring. For patients who are not surgical candidates, or who are unwilling to consider surgery, a variety of other alternative treatments can be considered, including peripheral or central neurostimulation, ketogenic diet, and complementary and alternative approaches. When such alternative treatments are not appropriate or effective, quality of life can still be greatly improved by the psychological and social support services offered by multidisciplinary epilepsy centers. A major obstacle remains the fact that only a small proportion of patients with refractory epilepsy are referred for expert evaluation and treatment.

  4. Epilepsy: Indian perspective

    Directory of Open Access Journals (Sweden)

    Nandanavana Subbareddy Santhosh

    2014-01-01

    Full Text Available There are 50 million people living with epilepsy worldwide, and most of them reside in developing countries. About 10 million persons with epilepsy are there in India. Many people with active epilepsy do not receive appropriate treatment for their condition, leading to large treatment gap. The lack of knowledge of antiepileptic drugs, poverty, cultural beliefs, stigma, poor health infrastructure, and shortage of trained professionals contribute for the treatment gap. Infectious diseases play an important role in seizures and long-term burden causing both new-onset epilepsy and status epilepticus. Proper education and appropriate health care services can make tremendous change in a country like India. There have been many original researches in various aspects of epilepsy across India. Some of the geographically specific epilepsies occur only in certain regions of our country which have been highlighted by authors. Even the pre-surgical evaluation and epilepsy surgery in patients with drug-resistant epilepsy is available in many centers in our country. This article attempts to provide a complete preview of epilepsy in India.

  5. Temporal lobe epilepsy surgery in children versus adults: from etiologies to outcomes

    Directory of Open Access Journals (Sweden)

    Yun-Jin Lee

    2013-07-01

    Full Text Available Temporal lobe epilepsy (TLE is the most common type of medically intractable epilepsy in adults and children, and mesial temporal sclerosis is the most common underlying cause of TLE. Unlike in the case of adults, TLE in infants and young children often has etiologies other than mesial temporal sclerosis, such as tumors, cortical dysplasia, trauma, and vascular malformations. Differences in seizure semiology have also been reported. Motor manifestations are prominent in infants and young children, but they become less obvious with increasing age. Further, automatisms tend to become increasingly complex with age. However, in childhood and especially in adolescence, the clinical manifestations are similar to those of the adult population. Selective amygdalohippocampectomy can lead to excellent postoperative seizure outcome in adults, but favorable results have been seen in children as well. Anterior temporal lobectomy may prove to be a more successful surgery than amygdalohippocampectomy in children with intractable TLE. The presence of a focal brain lesion on magnetic resonance imaging is one of the most reliable independent predictors of a good postoperative seizure outcome. Seizure-free status is the most important predictor of improved psychosocial outcome with advanced quality of life and a lower proportion of disability among adults and children. Since the brain is more plastic during infancy and early childhood, recovery is promoted. In contrast, long epilepsy duration is an important risk factor for surgically refractory seizures. Therefore, patients with medically intractable TLE should undergo surgery as early as possible.

  6. Cognitive deterioration in adult epilepsy: Does accelerated cognitive ageing exist?

    Science.gov (United States)

    Breuer, L E M; Boon, P; Bergmans, J W M; Mess, W H; Besseling, R M H; de Louw, A; Tijhuis, A G; Zinger, S; Bernas, A; Klooster, D C W; Aldenkamp, A P

    2016-05-01

    A long-standing concern has been whether epilepsy contributes to cognitive decline or so-called 'epileptic dementia'. Although global cognitive decline is generally reported in the context of chronic refractory epilepsy, it is largely unknown what percentage of patients is at risk for decline. This review is focused on the identification of risk factors and characterization of aberrant cognitive trajectories in epilepsy. Evidence is found that the cognitive trajectory of patients with epilepsy over time differs from processes of cognitive ageing in healthy people, especially in adulthood-onset epilepsy. Cognitive deterioration in these patients seems to develop in a 'second hit model' and occurs when epilepsy hits on a brain that is already vulnerable or vice versa when comorbid problems develop in a person with epilepsy. Processes of ageing may be accelerated due to loss of brain plasticity and cognitive reserve capacity for which we coin the term 'accelerated cognitive ageing'. We believe that the concept of accelerated cognitive ageing can be helpful in providing a framework understanding global cognitive deterioration in epilepsy. PMID:26900650

  7. Role of Inflammatory Mediators in the Pathogenesis of Epilepsy

    OpenAIRE

    Tadayuki Shimada; Takako Takemiya; Hiroko Sugiura; Kanato Yamagata

    2014-01-01

    Epilepsy is one of the most common chronic brain disorders worldwide, affecting 1% of people across different ages and backgrounds. Epilepsy is defined as the sporadic occurrence of spontaneous recurrent seizures. Accumulating preclinical and clinical evidence suggest that there is a positive feedback cycle between epileptogenesis and brain inflammation. Epileptic seizures increase key inflammatory mediators, which in turn cause secondary damage to the brain and increase the likelihood of rec...

  8. Epilepsy in Ireland: Towards the primary-tertiary care continuum

    OpenAIRE

    Grimson, Jane; Normand, Charles; COYNE, IMELDA

    2010-01-01

    PUBLISHED Background Epilepsy is a chronic neurological disease affecting people of every age, gender, race and socio-economic background. The diagnosis and optimal management relies on contribution from a number of healthcare disciplines in a variety of healthcare settings. Objective To explore the interface between primary care and specialist epilepsy services in Ireland. Methods Using appreciative inquiry, focus groups were held with healthcare professionals (n = 33) f...

  9. Exploring the school attendance of children with epilepsy

    OpenAIRE

    Karina Piccin Zanni; Thelma Simões Matsukura; Heber Souza Maia Filho

    2009-01-01

    The childhood epilepsy is a chronic disease that can have an impact in various spheres of life of the child, including academic performance and school attendance. This study aimed to describe and compare the school attendance of children with epilepsy who attend mainstream and special schools. Participants were 56 children aged between 7 and 14 years who attended regular or special schools located in two Brazilian cities of medium size. To collect the information we used two instruments: Data...

  10. Hippocampal Changes in Febrile Infection-Related Epilepsy Syndrome (FIRES)

    OpenAIRE

    Agarwal, Amit; Sabat, Shyamsunder; Thamburaj, Krishnamurthy; Kanekar, Sangam

    2015-01-01

    Summary Background Febrile seizures are the most common seizure disorder in childhood, associated with a significant rise in body temperature. However, post-infectious refractory afebrile form of seizures in previously healthy children is being increasingly recognized in around the world, which evolves into a chronic refractory form of epilepsy. The term ‘Febrile infection-related epilepsy syndrome’ (FIRES) has been proposed for these conditions and represents a refractory severe post-infecti...

  11. Renal Stone Associated with the Ketogenic Diet in a 5-Year Old Girl with Intractable Epilepsy

    OpenAIRE

    Choi, Ji Na; Song, Ji Eun; Shin, Jae Il; Kim, Heung Dong; Kim, Myung Joon; Lee, Jae Seung

    2010-01-01

    In this paper, we report on a 5-year-old girl who developed a renal stone while following the ketogenic diet to treat refractory seizure disorder. Three months after initiating the ketogenic diet, she developed severe abdominal pain and vomiting. The spot urine calcium-to-creatinine (Ca/Cr) ratio and 24-hour urine evaluation showed hypercalciuria. Computed tomography (CT) imaging revealed a stone in the right ureteropelvic junction, resulting in hydronephrosis of the right kidney. The renal s...

  12. PIGO mutations in intractable epilepsy and severe developmental delay with mild elevation of alkaline phosphatase levels.

    Science.gov (United States)

    Nakamura, Kazuyuki; Osaka, Hitoshi; Murakami, Yoshiko; Anzai, Rie; Nishiyama, Kiyomi; Kodera, Hirofumi; Nakashima, Mitsuko; Tsurusaki, Yoshinori; Miyake, Noriko; Kinoshita, Taroh; Matsumoto, Naomichi; Saitsu, Hirotomo

    2014-02-01

    Aberrations in the glycosylphosphatidylinositol (GPI)-anchor biosynthesis pathway constitute a subclass of congenital disorders of glycosylation, and mutations in seven genes involved in this pathway have been identified. Among them, mutations in PIGV and PIGO, which are involved in the late stages of GPI-anchor synthesis, and PGAP2, which is involved in fatty-acid GPI-anchor remodeling, are all causative for hyperphosphatasia with mental retardation syndrome (HPMRS). Using whole exome sequencing, we identified novel compound heterozygous PIGO mutations (c.389C>A [p.Thr130Asn] and c.1288C>T [p.Gln430*]) in two siblings, one of them having epileptic encephalopathy. GPI-anchored proteins (CD16 and CD24) on blood granulocytes were slightly decreased compared with a control and his mother. Our patients lacked the characteristic features of HPMRS, such as facial dysmorphology (showing only a tented mouth) and hypoplasia of distal phalanges, and had only a mild elevation of serum alkaline phosphatase (ALP). Our findings therefore expand the clinical spectrum of GPI-anchor deficiencies involving PIGO mutations to include epileptic encephalopathy with mild elevation of ALP. PMID:24417746

  13. Pseudohypoparathyroidism type Ia manifesting as intractable epilepsy in a 23-year-old female

    OpenAIRE

    Raghavan, Pooja

    2012-01-01

    Pooja Raghavan,1 Charles M Katz21Department of Medicine, Mount Carmel Health, Columbus, OH, USA; 2Division of Endocrinology and Metabolism, Mount Carmel Health, Columbus, OH, USAAbstract: Pseudohypoparathyroidism is a rare disorder of calcium metabolism that involves target organ resistance to the action of the parathyroid hormone. As a result, calcium levels may become dangerously low, sometimes leading to seizures and other symptoms. We present a case of a 23-year-old Somalian female on ant...

  14. Epilepsi og orale manifestationer

    DEFF Research Database (Denmark)

    Jacobsen, Pernille Endrup; Haubek, Dorte; Østergaard, John Rosendahl

    2016-01-01

    Risiko for sygdom I mundhulen hos patienter med epilepsy Epilepsi er en kronisk neurologisk lidelse, der ofte vil kræve medicinsk behandling for at holde patienterne fri for anfald. Lidelsen kan have betydning for patientens psykosociale og kognitive udvikling, der indirekte kan have betydning for...

  15. Epilepsy and religion

    Directory of Open Access Journals (Sweden)

    Khwaja Geeta

    2007-01-01

    Full Text Available This study has focused on the interplay between epilepsy and religion. A total of 100 patients in the age range of 15-84 years were included in the study. The duration of epilepsy in these patients ranged from 1-35 years. The majority (66% had generalized seizures and good to complete seizure control (77%. Regarding social/religious beliefs, 6% of the patients attributed their epilepsy to the curse of God and 14% saw their affliction as a form of punishment for bad deeds committed in the current or past life. Epilepsy was regarded as contagious by 13%. After the onset of epilepsy, 7% of the subjects became skeptics and less religious, while 29% became more religious. Only 2% reported mystic experiences. There was, however, no significant impact of the duration of epilepsy or seizure type on the pattern of religiosity. In 44 cases with symptomatic epilepsy, no definite correlation was observed between the lesion site and laterality and the religious temperament. Delay in seeking treatment and poor compliance due to false religious beliefs, ignorance, and superstition was observed in 33%. However, all religious beliefs were not maladaptive and overall, 80% cases felt that religion had helped them in coping with epilepsy.

  16. Epilepsy treatment and creativity.

    Science.gov (United States)

    Zubkov, Sarah; Friedman, Daniel

    2016-04-01

    Creativity can be defined as the ability to understand, develop, and express, in a systematic fashion, novel orderly relationships. It is sometimes difficult to separate cognitive skills requisite for the creative process from the drive that generates unique new ideas and associations. Epilepsy itself may affect the creative process. The treatment of epilepsy and its comorbidities, by altering or disrupting the same neural networks through antiseizure drugs (ASDs), treatment of epilepsy comorbidities, ablative surgery, or neurostimulation may also affect creativity. In this review, we discuss the potential mechanisms by which treatment can influence the creative process and review the literature on the consequences of therapy on different aspects of creativity in people with epilepsy. This article is part of a Special Issue entitled "Epilepsy, Art, and Creativity". PMID:26831642

  17. ADHD in idiopathic epilepsy

    Directory of Open Access Journals (Sweden)

    Marcos H. C. Duran

    2014-01-01

    Full Text Available Our aim was to clarify the correlation of attention deficit hyperactivity disorder (ADHD with epilepsy and behavior problems. This was a cross-sectional study. Sixty children with idiopathic epilepsy were interviewed using the MTA-SNAP IV Teacher and Parent Rating Scale, Vineland Adaptive Behavior Scales and Conners’ Rating Scales. We used the chi-square test to analyze the correlation of epilepsy variables in patients with and without ADHD with a significance level of 0.05. Eight patients had ADHD symptoms (13%, seven had the inattentive ADHD subtype and only three had behavioral problems. When epileptic patients with and without ADHD symptoms were compared we found no significant difference in regard to epilepsy variables. All patients were controlled and 43% were either without AED or undergoing withdrawal. Our study revealed a low comorbidity of ADHD symptoms and epilepsy due to low interference of seizures and drug treatment on the comorbid condition.

  18. Epilepsy after stroke

    DEFF Research Database (Denmark)

    Olsen, T S; Høgenhaven, H; Thage, O

    1987-01-01

    Development of epilepsy was studied prospectively in a group of 77 consecutive stroke patients. Included were stroke patients less than 75 years old admitted within the first 3 days after the stroke. Excluded were patients with subarachnoid hemorrhage, vertebrobasilar stroke, and patients with...... other severe diseases. Cerebral angiography, CT, and EEG were performed in all patients. The patients were followed clinically for 2 to 4 years. Seven patients (9%) developed epilepsy. Of 23 patients with lesions involving the cortex, 6 (26%) developed epilepsy. Of 54 patients in whom the cortex was not...... involved, only 1 (2%) developed epilepsy. Patients with persisting paresis and cortical involvement seem to be at particularly high risk of developing epilepsy, as 50% of such patients (6 of 12) developed the disease....

  19. Astrocyte control of synaptic NMDA receptors contributes to the progressive development of temporal lobe epilepsy

    OpenAIRE

    Clasadonte, Jerome; Dong, Jinghui; Hines, Dustin J.; Haydon, Philip G.

    2013-01-01

    Temporal lobe epilepsy (TLE) is a chronic brain disorder characterized by the occurrence of spontaneous recurrent seizures. Much of our knowledge of epilepsy is based on how neurons contribute to this disorder. Here we provide a view in which glial cells (astrocytes) contribute to the progressive development of TLE. We have combined a model of epilepsy that more closely mimics the complex features of seizures in epileptic patients, with astrocyte-specific molecular genetics to identify how as...

  20. Relevance of the Glutathione System in Temporal Lobe Epilepsy: Evidence in Human and Experimental Models

    OpenAIRE

    Noemí Cárdenas-Rodríguez; Elvia Coballase-Urrutia; Claudia Pérez-Cruz; Hortencia Montesinos-Correa; Liliana Rivera-Espinosa; Aristides Sampieri; Liliana Carmona-Aparicio

    2014-01-01

    Oxidative stress, which is a state of imbalance in the production of reactive oxygen species and nitrogen, is induced by a wide variety of factors. This biochemical state is associated with diseases that are systemic as well as diseases that affect the central nervous system. Epilepsy is a chronic neurological disorder, and temporal lobe epilepsy represents an estimated 40% of all epilepsy cases. Currently, evidence from human and experimental models supports the involvement of oxidative stre...

  1. Multimodality Data Integration in Epilepsy

    Directory of Open Access Journals (Sweden)

    Otto Muzik

    2007-01-01

    Full Text Available An important goal of software development in the medical field is the design of methods which are able to integrate information obtained from various imaging and nonimaging modalities into a cohesive framework in order to understand the results of qualitatively different measurements in a larger context. Moreover, it is essential to assess the various features of the data quantitatively so that relationships in anatomical and functional domains between complementing modalities can be expressed mathematically. This paper presents a clinically feasible software environment for the quantitative assessment of the relationship among biochemical functions as assessed by PET imaging and electrophysiological parameters derived from intracranial EEG. Based on the developed software tools, quantitative results obtained from individual modalities can be merged into a data structure allowing a consistent framework for advanced data mining techniques and 3D visualization. Moreover, an effort was made to derive quantitative variables (such as the spatial proximity index, SPI characterizing the relationship between complementing modalities on a more generic level as a prerequisite for efficient data mining strategies. We describe the implementation of this software environment in twelve children (mean age 5.2±4.3 years with medically intractable partial epilepsy who underwent both high-resolution structural MR and functional PET imaging. Our experiments demonstrate that our approach will lead to a better understanding of the mechanisms of epileptogenesis and might ultimately have an impact on treatment. Moreover, our software environment holds promise to be useful in many other neurological disorders, where integration of multimodality data is crucial for a better understanding of the underlying disease mechanisms.

  2. Genetic determinants of common epilepsies

    DEFF Research Database (Denmark)

    Møller, Rikke Steensbjerre

    2014-01-01

    BACKGROUND: The epilepsies are a clinically heterogeneous group of neurological disorders. Despite strong evidence for heritability, genome-wide association studies have had little success in identification of risk loci associated with epilepsy, probably because of relatively small sample sizes and...... insufficient power. We aimed to identify risk loci through meta-analyses of genome-wide association studies for all epilepsy and the two largest clinical subtypes (genetic generalised epilepsy and focal epilepsy). METHODS: We combined genome-wide association data from 12 cohorts of individuals with epilepsy...... and controls from population-based datasets. Controls were ethnically matched with cases. We phenotyped individuals with epilepsy into categories of genetic generalised epilepsy, focal epilepsy, or unclassified epilepsy. After standardised filtering for quality control and imputation to account for...

  3. Predictive factors of seizure control in childhood onset epilepsy

    Directory of Open Access Journals (Sweden)

    Eli Shahar

    2008-01-01

    Full Text Available Background: Prediction of the long-term outcomes of childhood-onset epilepsy remains crucial for the future well-being of the affected children and their families and for planning proper therapeutic and educational programs. Objective: To identify and analyze the early predictive factors of seizure control in childhood-onset epilepsies referred at the age of 1 month up to the age of 18 years to the Epilepsy Service at the Meyer Children Hospital, Rambam Medical Center, Haifa, Israel. Materials and Methods: In this study, children who were newly diagnosed with epileptic disorders and treated with antiepileptic drug therapy - who became either completely controlled for at least twelve months or those remaining intractable - were included. Partially responding children were excluded from the analysis. The etiology was segregated into either symptomatic or nonsymptomatic epilepsy, referred to as idiopathic epilepsy. Results: Overall, 74 children (mean age: 4.27 ± 4 years at the first seizure were found eligible for analysis followed for a mean period of 4.5 years. Fifty-three (72% children became seizure-free for a mean period of 20 months on antiepileptic drug (AED therapy and 21 (28% remained uncontrolled. Sixty out of 74 children (81% had idiopathic epilepsy and 14 (19% had symptomatic epilepsy. In those with idiopathic epilepsy, 46 (77% children gained complete seizure control in comparison to 7 out of 14 (50% children in the symptomatic group ( P < 0.01. Thirty-nine out of 47 (83% children who had normal cognition became seizure-free, and 14 (52% out of 27 mentally retarded children also became seizure-free ( P < 0.01. The outcome of seizure control was not affected by age at onset and seizure type itself during the presentation. Conclusion: The present study reveals that the single most predictive factor of a favorable seizure control is preserved cognitive function in accordance with idiopathic epilepsy. However, a fairly high number of

  4. Family communication in the context of pediatric epilepsy: A systematic review.

    Science.gov (United States)

    O'Toole, S; Benson, A; Lambert, V; Gallagher, P; Shahwan, A; Austin, J K

    2015-10-01

    In childhood chronic illness, family communication can impact the child's and parents' psychosocial well-being. However, little is known about family communication in the context of epilepsy in childhood. The aim of this systematic review was to identify the existing evidence available on communication strategies adopted by families living with childhood epilepsy, including; the facilitators, barriers and challenges experienced by families when choosing to communicate, or not, about epilepsy; and the consequences of this communication. Papers published in the English language prior to March 2015 were identified following a search of six electronic databases: PubMed, MEDLINE, Web of Science, PsycINFO, CINAHL, and Scopus. Studies were included if they involved a sample of parents of children with epilepsy or children/young people with epilepsy (0-18years of age) and used qualitative, quantitative, or mixed methods. Following a comprehensive search and screening process, 26 studies were identified as eligible for inclusion in the review. No studies identified specific communication strategies adopted by families living with childhood epilepsy. Some studies found that talking about epilepsy with family members had positive consequences (e.g., communication as an effective coping strategy), with no negative consequences reported in any of the studies. The main barrier to communication for parents was an unwillingness to use the word "epilepsy" because of the perceived negative social connotations associated with the health condition. For children with epilepsy, barriers were as follows: parental desire to keep epilepsy a secret, parents' tendency to deny that the child had epilepsy, parental overprotection, and parents' tendency to impose greater restrictions on the child with epilepsy than on siblings without epilepsy. Future research investigating the communication strategies of families living with epilepsy is needed in order to create effective communication

  5. Animal models of epilepsy: use and limitations

    OpenAIRE

    Kandratavicius L; Balista PA; Lopes-Aguiar C; Ruggiero RN; Umeoka EH; Garcia-Cairasco N.; Bueno-Junior LS; Leite JP

    2014-01-01

    Ludmyla Kandratavicius,1 Priscila Alves Balista,1 Cleiton Lopes-Aguiar,1 Rafael Naime Ruggiero,1 Eduardo Henrique Umeoka,2 Norberto Garcia-Cairasco,2 Lezio Soares Bueno-Junior,1 Joao Pereira Leite11Department of Neurosciences and Behavior, 2Department of Physiology, Ribeirao Preto School of Medicine, University of Sao Paulo, Ribeirao Preto, BrazilAbstract: Epilepsy is a chronic neurological condition characterized by recurrent seizures that affects millions of people worldwide. Comprehension ...

  6. Epilepsy is Dancing.

    Science.gov (United States)

    Tuft, Mia; Gjelsvik, Bergljot; Nakken, Karl O

    2015-10-01

    In "Epilepsy is Dancing", in Antony and the Johnsons' album "The Crying Light"(2009), the lyrics and accompanying music video depicts an epileptic seizure in which the person is transferred to another beautiful and magical world. This may be called "enchanted epilepsy"; i.e., the experience of epilepsy as deeply nourishing and (positively) transforming, is conveyed not only in the lyrics but also the visual and auditory qualities of the video. The seizure in the video gives associations to Shakespeare's "A Midsummer Night's dream". If epilepsy appears in music lyrics, the focus is mostly on negative aspects of the illness, such as horror, fear and repulsive sexuality associated with the fits [1,2]. Contradictory to these lyrics, Anthony and the Johnsons' song is an example of a positive portrayal of epilepsy. It is open to a multitude of meanings, emotional valence and appraisal of epilepsy. By widening the experiential range associated with epileptic seizures, these lyrics highlight the inherently construed nature of epileptic experience. The song stands out in several ways. First, it describes epilepsy in positive terms, prioritising the euphoric, ecstatic, potentially empowering and enhancing aspects of epileptic seizures. Second, the lyrics and accompanying video point to divine experiences associated with epileptic seizures. Through the lyrics and the music video we are, as an audience, able to sense a snicket of an epileptic seizure, but also the universal experience of loosing control. PMID:26398488

  7. Mitochondrial disease and epilepsy.

    Science.gov (United States)

    Rahman, Shamima

    2012-05-01

    Mitochondrial respiratory chain disorders are relatively common inborn errors of energy metabolism, with a combined prevalence of one in 5000. These disorders typically affect tissues with high energy requirements, and cerebral involvement occurs frequently in childhood, often manifesting in seizures. Mitochondrial diseases are genetically heterogeneous; to date, mutations have been reported in all 37 mitochondrially encoded genes and more than 80 nuclear genes. The major genetic causes of mitochondrial epilepsy are mitochondrial DNA mutations (including those typically associated with the mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes [MELAS] and myoclonic epilepsy with ragged red fibres [MERRF] syndromes); mutations in POLG (classically associated with Alpers syndrome but also presenting as the mitochondrial recessive ataxia syndrome [MIRAS], spinocerebellar ataxia with epilepsy [SCAE], and myoclonus, epilepsy, myopathy, sensory ataxia [MEMSA] syndromes in older individuals) and other disorders of mitochondrial DNA maintenance; complex I deficiency; disorders of coenzyme Q(10) biosynthesis; and disorders of mitochondrial translation such as RARS2 mutations. It is not clear why some genetic defects, but not others, are particularly associated with seizures. Epilepsy may be the presenting feature of mitochondrial disease but is often part of a multisystem clinical presentation. Mitochondrial epilepsy may be very difficult to manage, and is often a poor prognostic feature. At present there are no curative treatments for mitochondrial disease. Individuals with mitochondrial epilepsy are frequently prescribed multiple anticonvulsants, and the role of vitamins and other nutritional supplements and the ketogenic diet remain unproven. PMID:22283595

  8. Experimental models of epilepsy

    Directory of Open Access Journals (Sweden)

    Stanojlović Olivera P.

    2004-01-01

    Full Text Available Introduction An epileptic seizure is a clinical event and epilepsy is rather a group of symptoms than a disease. The main features all epilepsies have in common include: spontaneous occurrence, repetitiveness, and ictal correlation within the EEG. Epilepsies are manifested with distinct EEG changes, requiring exact clinical definition and consequential treatment. Current data show that 1% of the world's population (approximately 50 million people suffers from epilepsy, with 25% of patients being refractory to therapy and requiring search for new substances in order to decrease EEG and behavioral manifestations of epilepsies. Material and methods In regard to discovery and testing of anticonvulsant substances the best results were achieved by implementation of experi- mental models. Animal models of epilepsy are useful in acquiring basic knowledge regarding pathogenesis, neurotransmitters (glutamate, receptors (NMDA/AMPA/kainate, propagation of epileptic seizures and preclinical assessment of antiepileptics (competitive and non-competitive NMDA antagonists. Results and conclusions In our lab, we have developed a pharmacologic model of a (metaphit, NMDA and remacemide-cilastatin generalized, reflex, and audiogenic epilepsy. The model is suitable for testing various anticonvulsant substances (e.g. APH, APV, CPP, Mk-801 and potential antiepileptics (e.g. DSIP, its tetra- and octaanalogues.

  9. How FDG-PET helps making decision for surgery in various difficult subgroups of temporal lobe epilepsy?

    International Nuclear Information System (INIS)

    Concordant pre-surgical data are the important predictors of good surgical outcome in patients with localization-related epilepsy. Medically intractable temporal lobe epilepsy with hippocampal sclerosis (HS) and concordant pre-surgical data is straightforward and may not need functional imaging. However, in other instances for example, HS with discordant data (HSD), bilateral HS with discordant data (BHSD), temporal lobe epilepsy with dual pathology (DP), non-lesional temporal lobe epilepsy (NL) are the difficult subgroups. In these groups, functional imaging eg. brain perfusion SPECT or brain PET may play a major role for surgical decision making. To our knowledge, there was no previous data in using FDG-PET in different subgroups as mentioned. Only some previous studies in single subgroup without analyzing impact of PET findings on decision-making have been reported. We thus aim to evaluate the usefulness of FDG-PET in these 4 subgroups

  10. Monotherapy for partial epilepsy: focus on levetiracetam

    Directory of Open Access Journals (Sweden)

    Antonio Gambardella

    2008-03-01

    Full Text Available Antonio Gambardella1,2, Angelo Labate1,2, Eleonora Colosimo1, Roberta Ambrosio1, Aldo Quattrone1,21Institute of Neurology, University Magna Græcia, Catanzaro, Italy; 2Institute of Neurological Sciences, National Research Council, Piano Lago di Mangone, Cosenza, ItalyAbstract: Levetiracetam (LEV, the S-enantiomer of alpha-ethyl-2-oxo-1-pyrollidine acetamide, is a recently licensed antiepileptic drug (AED for adjunctive therapy of partial seizures. Its mechanism of action is uncertain but it exhibits a unique profile of anticonvulsant activity in models of chronic epilepsy. Five randomized, double-blind, placebo-controlled trials enrolling adult or pediatric patients with refractory partial epilepsy have demonstrated the efficacy of LEV as adjunctive therapy, with a responder rate (≥50% reduction in seizure frequency of 28%–45%. Long-term efficacy studies suggest retention rates of 60% after one year, with 13% of patients seizure-free for 6 months of the study and 8% seizure-free for 1 year. More recent studies illustrated successful conversion to monotherapy in patients with refractory epilepsy, and its effectiveness as a single agent in partial epilepsy. LEV has also efficacy in generalized epilepsies. Adverse effects of LEV, including somnolence, lethargy, and dizziness, are generally mild and their occurrence rate seems to be not significantly different from that observed in placebo groups. LEV also has no clinically significant pharmacokinetic interactions with other AEDs, or with commonly prescribed medications. The combination of effective antiepileptic properties with a relatively mild adverse effect profile makes LEV an attractive therapy for partial seizures.Keywords: levetiracetam, partial epilepsy, antiepileptic drugs

  11. Changes in hippocampal volume are correlated with cell loss but not with seizure frequency in two chronic models of temporal lobe epilepsy

    Directory of Open Access Journals (Sweden)

    Roberson Saraiva Polli

    2014-07-01

    Full Text Available Kainic acid (KA or pilocarpine (PILO have been used in rats to model human temporal lobe epilepsy but the distribution and severity of structural lesions between these two models may differ. Magnetic resonance imaging (MRI studies have used quantitative measurements of hippocampal T2 (T2HP relaxation time and volume, but simultaneous comparative results have not been reported yet. The aim of this study was to compare the MRI T2HP and volume with histological data and frequency of seizures in both models. KA- and PILO-treated rats were imaged with a 2T MRI scanner. T2HP and volume values were correlated with the number of cells, mossy fiber sprouting and SRS frequency over the 9 months following SE. Compared to controls, KA-treated rats had unaltered T2HP, pronounced reduction in hippocampal volume and concomitant cell reduction in granule cell layer, CA1 and CA3 at 3 months post SE. In contrast, hippocampal volume was unchanged in PILO-treated animals despite detectable increased T2HP and cell loss in granule cell layer, CA1 and CA3. In the following 6 months, MRI hippocampal volume remained stable with increase of T2HP signal in the KA-treated group. The number of CA1 and CA3 cells was smaller than age-matched CTL group. In contrast, PILO group had MRI volumetric reduction accompanied by reduction in the number of CA1 and CA3 cells. In this group, T2HP signal was unaltered at 6 or 9 months after status. Reductions in the number of cells were not progressive in both models. Notably, the SRS frequency was higher in PILO than in the KA model. The volumetry data correlated well with tissue damage in the epileptic brain, suggesting that MRI may be useful for tracking longitudinal hippocampal changes, allowing the assessment of individual variability and disease progression. Our results indicate that the temporal changes in hippocampal morphology are distinct for both models of TLE and that these are not significantly correlated to the frequency of

  12. Mitochondrial diseases and epilepsy.

    Science.gov (United States)

    Bindoff, Laurence A; Engelsen, Bernt A

    2012-09-01

    The mitochondrial respiratory chain is the final common pathway for energy production. Defects affecting this pathway can give rise to disease that presents at any age and affects any tissue. However, irrespective of genetic defect, epilepsy is common and there is a significant risk of status epilepticus. This review summarizes our current understanding of the epilepsy that occurs in mitochondrial disease, focusing on three of the most common disorders: mitochondrial myopathy encephalopathy, lactic acidosis and stroke-like episodes (MELAS), myoclonus epilepsy and ragged-red fibers (MERRF), and polymerase gamma (POLG) related disease. In addition, we review the pathogenesis and possible treatment of these disorders. PMID:22946726

  13. Models of experimental epilepsy

    Directory of Open Access Journals (Sweden)

    Fatih Ekici

    2011-03-01

    Full Text Available Epilepsy is the most common serious neurological conditionin the world, with an estimated prevalence of 1% ofthe population. A large number of experimental modelsof seizure and epilepsy have been developed. These experimentalmodels are elicited by chemical convulsants,electrical stimulation, genetic models, structural lesions,physical stimuli (cold, pressure, hyperthermia, electricalin animals. Well-characterized animal models may allowthe understanding of the basic mechanisms underlyingepileptogenesis (it refers to the alteration of a normalneuronal network into a hyperexcitable network in whichrecurrent, spontaneous seizures occur. Moreover, thesemodels might also prove useful in identifying novel therapeuticapproaches to treatment of epilepsy. J Clin ExpInvest 2011; 2(1: 118-123

  14. Ketogenic Diet: An Early Option for Epilepsy Treatment, Instead of A Last Choice Only

    Directory of Open Access Journals (Sweden)

    Huei-Shyong Wang

    2012-02-01

    Full Text Available Ketogenic diet (KD was usually tried as a last resort in the treatment of intractable epilepsy after failure of many antiepileptics and even epilepsy surgery. Glucose transporter-1 deficiency and pyruvate dehydrogenase deficiency must be treated with KD as the first choice because of inborn errors of glucose metabolism. Infantile spasms, tuberous sclerosis complex, Rett syndrome, Doose syndrome, Dravet syndrome, etc., appear to respond to KD, and it has been suggested by the international consensus statement to use KD early. We believe that all patients with epilepsy, except those with contraindicated situations such as pyruvate carboxylase deficiency, porphyria, β-oxidation defects, primary carnitine deficiency, etc., may try KD before trying other regimens.

  15. Clinical characteristics of 41 patients with intractable asthma

    OpenAIRE

    Bai, Li; Zhang, Xu-Sheng; Wang, Bin; Xiao-ming CHENG; Zhang, Qiao; Hua-ping CHEN; Ma, Qian-li; Zou, Li-Guang; Wang, Chang-Zheng

    2011-01-01

    Objective To explore the clinical characteristics of intractable asthma,and to provide new knowledge for diagnosis and treatment of the disease.Methods Forty one patients with intractable asthma,admitted to the Institute of Respiratory Disease,Xinqiao Hospital of Third Military Medical University from Jan.2009 to Dec.2010,were included in present study.Spirometry tests were performed for all the 41 patients.Cell classification and counting were done in the induced sputum of 37 patients,and 34...

  16. Intractability of the Initial Arrangement of Input Data on Qubits

    Science.gov (United States)

    Kawano, Y.; Tani, S.; Takahashi, Y.; Kunihiro, N.

    2005-08-01

    We study the intractability of finding an optimal initial arrangement of input data on qubits when the qubits are arranged on the vertices of a d-dimensional grid (d is constant) and we can perform quantum operations only between nearest-neighbor qubits. The problem is called the d-IAP (d-dimensional initial arrangement problem) in this paper. We prove that the intractability of the d-IAP is equivalent to that of the weighted d-dimensional arrangement. Thus, there is no deterministic polynomial-time algorithm for finding an optimal initial arrangement of 1-IAP if P≠NP.

  17. Planning Ahead Can Save the Life of a Child with Epilepsy

    Science.gov (United States)

    Apel, Laura; Hollingsworth, Jan Carter

    2008-01-01

    Three million Americans have epilepsy, a chronic neurological condition characterized by recurrent epileptic seizures unprovoked by any known cause. Those at risk for epilepsy include individuals with mental retardation, cerebral palsy, autism, stroke, major head trauma, central nervous system (CNS) hemorrhage, CNS infection, dementia, and brain…

  18. Prenatal and Family Risks of Children Born to Mothers with Epilepsy: Effects on Cognitive Development

    Science.gov (United States)

    Titze, Karl; Koch, Sabine; Helge, Hans; Lehmkuhl, Ulrike; Rauh, Hellgard; Steinhausen, Hans-Christoph

    2008-01-01

    The offspring of mothers with epilepsy are considered to be at developmental risk during pregnancy from: (1) generalized maternal seizures (hypoxia); (2) teratogenicity of antiepileptic drugs (AEDs); and (3) adverse socio-familial conditions associated with having a chronically sick mother. Sixty-seven children of mothers with epilepsy and 49…

  19. Genetics Home Reference: juvenile myoclonic epilepsy

    Science.gov (United States)

    ... Home Health Conditions juvenile myoclonic epilepsy juvenile myoclonic epilepsy Enable Javascript to view the expand/collapse boxes. ... PDF Open All Close All Description Juvenile myoclonic epilepsy is a condition characterized by recurrent seizures (epilepsy). ...

  20. Certification of deaths attributable to epilepsy

    OpenAIRE

    Langan, Y.; Nashef, L; Sander, J

    2002-01-01

    Methods: All 1997 death entries mentioning epilepsy as a cause of death in those 16–50 years were examined and classified as sudden unexpected death in epilepsy (SUDEP), other epilepsy related deaths, or non-epilepsy deaths.

  1. Memory Functioning in Children with Epilepsy: Frontal Lobe Epilepsy, Childhood Absence Epilepsy, and Benign Epilepsy with Centrotemporal Spikes

    Directory of Open Access Journals (Sweden)

    Ana Filipa Lopes

    2014-01-01

    Full Text Available Specific cognitive deficits have been identified in children with epilepsy irrespective of results on intelligence tests. Memory deficits are traditionally attributed to temporal lobe epilepsy, whereas the impact of frontal lobe epilepsy on memory functions has remained controversial. The aim of this study was the examination of memory abilities in other childhood common epilepsy syndromes (frontal lobe epilepsy (FLE, childhood absence epilepsy (CAE, and benign epilepsy with centrotemporal spikes (BECTS and the influence of epilepsy-related variables. Memory was examined in 90 children with epilepsy (each epilepsy group consisted of 30 children, aged 6–15, and compared with 30 control children. Children with FLE showed significant deficits in verbal and visual memory. In addition, type of epilepsy, earlier age at epilepsy onset, and longer active duration of epilepsy were associated with memory problems. Seizure frequency and treatment, however, did not influence memory performance. This study indicates that children with FLE show greater risk of developing memory deficits than children with CAE or BECTS, thus highlighting the importance of assessing also memory functions in frontal lobe epilepsy.

  2. Managing information well: Toward an ontology-driven informatics platform for data sharing and secondary use in epilepsy self-management research centers.

    Science.gov (United States)

    Sahoo, Satya S; Zhang, Guo-Qiang; Bamps, Yvan; Fraser, Robert; Stoll, Shelley; Lhatoo, Samden D; Tatsuoka, Curtis; Sams, Johnny; Welter, Elisabeth; Sajatovic, Martha

    2016-09-01

    Epilepsy is a chronic neurological condition that requires active self-management to reduce personal and population burden. The Managing Epilepsy Well Network, funded by the US Centers for Disease Control and Prevention, conducts research on epilepsy self-management. There is an urgent need to develop an integrated informatics platform to maximize the secondary use of existing Managing Epilepsy Well Network data. We have implemented multiple steps to develop an informatics platform, including: (a) a survey of existing outcome data, (b) identification of common data elements, and (c) an integrated database using an epilepsy domain ontology to reconcile data heterogeneity. The informatics platform enables assessment of epilepsy self-management samples by site and in aggregate to support data interpretations for clinical care and ongoing epilepsy self-management research. The Managing Epilepsy Well informatics platform is expected to help advance epilepsy self-management, improve health outcomes, and has potential application in other thematic research networks. PMID:25769938

  3. Study on hippocampal volume with quantitative 3T magnetic resonance imaging in Chinese patients with epilepsy

    Institute of Scientific and Technical Information of China (English)

    GAO Mei-chun; LU Qin-chi; LI Yan-sheng; SHEN Jia-lin

    2012-01-01

    Background It was still rare for the quantitative magnetic resonance imaging (MRI) research of regional changes in hippocampus sclerosis (HS) in Chinese patients with epilepsy.This study aimed to study the hippocampal volumes (HVs)with quantitative MRI measurement in Chinese patients with epilepsy.Methods Forty-six Chinese patients with epilepsy (intractable epilepsy (IE),n=21; non-intractable epilepsy (NIE),n=25)and 25 normal controls were collected between July 2007 and March 2008.All of the subjects underwent a 3T high-resolution MRI with oblique coronal thin sections oriented perpendicular to the hippocampal long axis.Hippocampal structures were assessed by visual detection,and HVs were quantitatively studied with a Picture Archiving and Communication System (PACS).Results Our study suggested that there was no significant difference in gender (P >0.05) while the right hippocampal head volume (HHV),hippocampal body volume (HBV),and the whole hippocampal volume (HCV) were greater than the left one (P <0.05),but no significant difference was found in bilateral hippocampal tail volume (HTV) (P >0.05) in normal controls.That unilateral/diffuse (64%/21%) and bilateral/focal (86%/20%) hippocampal atrophy (HA)were significant in IE and NIE patients,respectively.Anterior hippocampus,especially HHV (26% in IE and 20% in NIE) and HBV (29% in IE and 12% in NIE),had more significant atrophy than the HTV (5% in IE and 0% in NIE) in patients with epilepsy.Conclusion By assessing the volumes of the regional hippocampus with 3T MRI,we could better define the range and distribution of HS,since regional or subtle changes in HVs could be detected earlier with 3T MRI.

  4. Evidence-based models of care for people with epilepsy.

    LENUS (Irish Health Repository)

    Fitzsimons, Mary

    2012-02-01

    Advances in medical science and technology, together with improved medical and nursing care, are continuously improving health outcomes in chronic illness, including epilepsy. The consequent increasing diagnostic and therapeutic complexity is placing a burgeoning strain on health care systems. In response, an international move to transform chronic disease management (CDM) aims to optimize the quality and safety of care while containing health care costs. CDM models recommend: integration of care across organizational boundaries that is supported with information and communication technology; patient self-management; and guideline implementation to promote standardized care. Evidence of the effectiveness of CDM models in epilepsy care is presented in this review article.

  5. Neuropsychological advocacy and epilepsy.

    Science.gov (United States)

    Loring, David W; Hermann, Bruce P; Cohen, Morris J

    2010-04-01

    Neuropsychologists are in a unique position to be active advocates for patients with epilepsy given their unique understanding of the behavioral and cognitive effects associated the disease, its progression, and its treatment. Neuropsychologists communicate the cognitive and behavioral consequences of epilepsy and its long-term implications to patients, family, school, and employers. In this article we review factors influencing the neuropsychological profile of patients with epilepsy, and discuss common behavioral comorbidities, as well as special issues associated with school placement and long-term planning. We also include a seizure action plan, which is designed to be both an educational tool for individuals with limited epilepsy knowledge, and a way to minimize stigma associated with an event should a seizure occur during school or work. PMID:19214828

  6. Personality characteristics and epilepsy

    DEFF Research Database (Denmark)

    Sørensen, A S; Hansen, H; Andersen, R;

    1989-01-01

    Patients with a long history of temporal lobe epilepsy or primary generalized epilepsy entered a questionnaire study of personality characteristics, based on a modification of the Bear-Fedio inventory for temporal lobe behavioural syndrome. Psoriasis patients and healthy volunteers served as...... controls. Four clinical meaningful dimensions of included personality traits were identified: ixoide, ideational, obsessive-compulsive and affective features. Analyses based on the Rasch model approved of all dimensions except for affective features. The epilepsy group obtained the highest scores on all 3...... dimensions, healthy volunteers the lowest, while the psoriasis group repeatedly held an intermediate position in all sets of assessment (subjects, interviewers and relatives). A logistic regression analysis showed ixoide features being most important when the entire epilepsy group was compared with other...

  7. Viral Encephalitis and Epilepsy

    OpenAIRE

    J Gordon Millichap

    2008-01-01

    The role of viral meningitis in the cause of epilepsy is reviewed by researchers from Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India; and University of Malaya, Kuala Lumpur, Malaysia.

  8. Role of biologics in intractable urticaria

    Directory of Open Access Journals (Sweden)

    Cooke A

    2015-04-01

    Full Text Available Andrew Cooke,1 Adeeb Bulkhi,1,2 Thomas B Casale1 1Department of Internal Medicine, Division of Allergy and Immunology, University of South Florida, Tampa, FL, USA; 2Department of Internal Medicine, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia Abstract: Chronic urticaria (CU is a common condition faced by many clinicians. CU has been estimated to affect approximately 0.5%–1% of the population, with nearly 20% of sufferers remaining symptomatic 20 years after onset. Antihistamines are the first-line therapy for CU. Unfortunately, nearly half of these patients will fail this first-line therapy and require other medication, including immune response modifiers or biologics. Recent advances in our understanding of urticarial disorders have led to more targeted therapeutic options for CU and other urticarial diseases. The specific biologic agents most investigated for antihistamine-refractory CU are omalizumab, rituximab, and intravenous immunoglobulin (IVIG. Of these, the anti-IgE monoclonal antibody omalizumab is the best studied, and has recently been approved for the management of CU. Other agents, such as interleukin-1 inhibitors, have proved beneficial for Schnitzler syndrome and cryopyrin-associated periodic syndromes (CAPS, diseases associated with urticaria. This review summarizes the relevant data regarding the efficacy of biologics in antihistamine-refractory CU. Keywords: chronic urticaria, omalizumab, intravenous immunoglobulin, anakinra, canakinumab

  9. Magnetic resonance imaging in 120 patients with intractable partial seizures: a preoperative assessment

    Energy Technology Data Exchange (ETDEWEB)

    Lefkopoulos, A.; Haritanti, A.; Papadopoulou, E.; Karanikolas, D.; Fotiadis, N.; Dimitriadis, A.S. [AHEPA University Hospital, Department of Radiology, Thessaloniki (Greece)

    2005-05-01

    The aim of this study was to describe magnetic resonance imaging (MRI) findings in patients with medically intractable epilepsy and to compare different magnetic resonance (MR) sequences in order to establish a dedicated and shorter scan time imaging protocol of choice. One hundred and twenty patients with seizures that were refractory to medical treatment were assessed by MRI with spin-echo (SE) T1, fast spin-echo (FSE) T2, fluid-attenuated inversion recovery (FLAIR), inversion recovery (IR) and contrast-enhanced T1 SE sequences. Pathological scans were acquired in 78 patients. Hippocampal sclerosis was detected in 30 patients (25%), cerebral, tumoral, mass lesions in 12 patients (10%), vascular malformations in nine patients (7.5%), cortical infarcts in eight patients (6.7%), cerebral infections in four patients (4.2%) and developmental disorders in 15 patients (12.5%). The most common location of the lesions was the temporal lobe (60%). Coronal, thin (slice thickness 4-5 mm) images have proven to be the most useful in the assessment of the hippocampus. FLAIR and IR are particularly useful in the detection of lesions abutting cerebrospinal fluid (CSF) spaces and developmental disorders, respectively, while T1 SE sequences before and after the intravenous administration of gadolinium offer great facility in identifying space-occupying lesions and infections. MRI is the most important diagnostic tool for the assessment of epileptogenic foci, thus playing the primary role in indicating the type of treatment to be applied. (orig.)

  10. Magnetic resonance imaging in 120 patients with intractable partial seizures: a preoperative assessment

    International Nuclear Information System (INIS)

    The aim of this study was to describe magnetic resonance imaging (MRI) findings in patients with medically intractable epilepsy and to compare different magnetic resonance (MR) sequences in order to establish a dedicated and shorter scan time imaging protocol of choice. One hundred and twenty patients with seizures that were refractory to medical treatment were assessed by MRI with spin-echo (SE) T1, fast spin-echo (FSE) T2, fluid-attenuated inversion recovery (FLAIR), inversion recovery (IR) and contrast-enhanced T1 SE sequences. Pathological scans were acquired in 78 patients. Hippocampal sclerosis was detected in 30 patients (25%), cerebral, tumoral, mass lesions in 12 patients (10%), vascular malformations in nine patients (7.5%), cortical infarcts in eight patients (6.7%), cerebral infections in four patients (4.2%) and developmental disorders in 15 patients (12.5%). The most common location of the lesions was the temporal lobe (60%). Coronal, thin (slice thickness 4-5 mm) images have proven to be the most useful in the assessment of the hippocampus. FLAIR and IR are particularly useful in the detection of lesions abutting cerebrospinal fluid (CSF) spaces and developmental disorders, respectively, while T1 SE sequences before and after the intravenous administration of gadolinium offer great facility in identifying space-occupying lesions and infections. MRI is the most important diagnostic tool for the assessment of epileptogenic foci, thus playing the primary role in indicating the type of treatment to be applied. (orig.)

  11. Managing epilepsy in pregnancy

    OpenAIRE

    Thomas, Sanjeev V.

    2011-01-01

    There are close to one and half million women with epilepsy (WWE) in reproductive age group in India. WWE have several unique gender-specific problems in the biological and social domains. Women experience more social stigma from epilepsy and have more difficulty with education and employment. They have more difficulty to get married and sustain successful family life. Reproductive hormones like estrogen and progesterone have opposing effect on seizure threshold. WWE have increased risk of in...

  12. Cerebral palsy and epilepsy

    OpenAIRE

    Knežević-Pogančev Marija

    2010-01-01

    Introduction. Cerebral palsy is the most common cause of physical disability in early childhood. Epilepsy is known to have a high association with cerebral palsy. All types of epileptic seizures can be seen in patients with cerebral palsy. Complex partial and secondary generalized ones are the most frequent seizure types. In persons with cerebral palsy and mental retardation, the diagnosis of epilepsy presents unique difficulties. Generally they are not able to describe the epileptic ev...

  13. GEM THERAPY AND EPILEPSY

    OpenAIRE

    Murthy, S.R.N.; Shenoy, Raghuram

    1990-01-01

    The authors present in this paper the status of treatment and cause of epilepsy. They propose further research to be undertaken to document the data and a study of human magnetic aura followed by blood spectral studies. They have suggested that based upon these studies it should be possible to determine the cause of epilepsy and its treatment by the physical application of suitable precious and semi-previous stones followed by administration of Ayurvedic formulation.

  14. Neuroimaging in epilepsy

    OpenAIRE

    Roy Trishit; Pandit Alak

    2011-01-01

    Epilepsy is a common neurological disorder with diverse etiologies. Neuroimaging plays an important role in workup of patients with epilepsy. It helps to identify brain pathologies that require specific treatment; and also in formulating syndromic and etiological diagnoses so as to give patients and their relatives an accurate prognosis. Magnetic resonance imaging, specially the 3 tesla MRI is the imaging of choice because of its ability to detect small lesions like mesial temporal sclerosis,...

  15. Chronic silent otitis media.

    Science.gov (United States)

    Paparella, Michael M; Schachern, Patricia A; Cureoglu, Sebahattin

    2002-01-01

    Otitis media occurs along a continuum. For example, otitis media with effusion characterized by fluid pathology can lead to chronic otitis media plus chronic mastoiditis, characterized by the presence of intractable tissue pathology such as cholesteatoma, cholesterol granuloma or granulation tissue. The literature defines chronic otitis media as having a tympanic membrane perforation and otorrhea. Amongst many other sequelae, which can result from the continuum, an important common one is chronic silent otitis media. This overlooked entity which includes pathology beneath an intact tympanic membrane is commonly seen in our human temporal bone laboratory and in patients. The clinical pathological correlates of this important disease are discussed herein. PMID:12021496

  16. Importance of Video-EEG Monitoring in the Diagnosis of Epilepsy in a Psychiatric Patient

    Directory of Open Access Journals (Sweden)

    Batool F. Kirmani

    2013-01-01

    Full Text Available Epilepsy is a chronic medical condition which is disabling to both patients and caregivers. The differential diagnosis of epilepsy includes psychogenic nonepileptic spells or “pseudoseizures.” Epilepsy is due to abnormal electrical activity in the brain, and pseudoseizure is a form of conversion disorder. The brain waves remain normal in pseudoseizures. The problem arises when a patient with significant psychiatric history presents with seizures. Pseudoseizures become high on the differential diagnosis without extensive work up. This is a case of woman with significant psychiatric issues which resulted in a delay in the diagnosis of epilepsy.

  17. Canine epilepsy as a translational model?

    Science.gov (United States)

    Potschka, Heidrun; Fischer, Andrea; von Rüden, Eva-Lotta; Hülsmeyer, Velia; Baumgärtner, Wolfgang

    2013-04-01

    Dogs with spontaneous diseases can exhibit a striking similarity in etiology, clinical manifestation, and disease course when compared to human patients. Therefore, dogs are intensely discussed as a translational model of human disease. In particular, genetic studies in selected dog breeds serve as an excellent tool to identify epilepsy disease genes. In addition, canine epilepsy is discussed as a translational platform for drug testing. On one hand, epileptic dogs might serve as an interesting model by allowing the evaluation of drug efficacy and potency under clinical conditions with a focus on chronic seizures resistant to standard medication, preventive strategies, or status epilepticus. On the other hand, several limitations need to be considered including owner-based seizure monitoring, species differences in pharmacokinetics and drug interactions, as well as cost-intensiveness. The review gives an overview on the current state of knowledge regarding the etiology, clinical manifestation, pathology, and drug response of canine epilepsy, also pointing out the urgent need for further research on specific aspects. Moreover, the putative advantages, the disadvantages, and limitations of antiepileptic drug testing in canine epilepsy are critically discussed. PMID:23506100

  18. [Epilepsy and Szondi test].

    Science.gov (United States)

    Andrade, L

    1976-05-01

    After having briefly recalled the different studies of epilepsy done on the basis of the Szondi test, the author proposes to study the drive structure of three groups of epileptics (19 cases of primary generalized epilepsy, 18 cases of partial temporal lobe epilepsy, 31 cases of partial non-temporal epilepsy) with the purpose of finding possible differences in psychological drive among the three groups and, at the same time, evaluating the test's capacity for discrimination by using the statistical method. The three groups show the same type of profile generally characterized by an extreme need for acceptance and affection (h + !, C- + !) counteracted by a strong repression (hy - !, k -) resulting in agressiveness (s + !). However, statistical analysis (chi square test), the drive formula, the drive class and the EKP showed that, beyond this shared area, there are differences among the three groups. The author then attempts to sort out the meaning of these differences. Finally, based on certain passages from Szondi as well as the test results, the author puts forward an hypothesis linking the psychological drive problematic in primary generalized epilepsies to a very early disturbance in the history of the individual's psychic development, the origins of which would go back to a split in the unity between mother and child. On the other hand, drive disturbances in partial epilepsies would be considered secondary to the illness. PMID:788602

  19. Coeliac disease and epilepsy.

    LENUS (Irish Health Repository)

    Cronin, C C

    2012-02-03

    Whether there is an association between coeliac disease and epilepsy is uncertain. Recently, a syndrome of coeliac disease, occipital lobe epilepsy and cerebral calcification has been described, mostly in Italy. We measured the prevalence of coeliac disease in patients attending a seizure clinic, and investigated whether cerebral calcification occurred in patients with both coeliac disease and epilepsy. Screening for coeliac disease was by IgA endomysial antibody, measured by indirect immunofluorescence using sections of human umbilical cord. Of 177 patients screened, four patients were positive. All had small-bowel histology typical of coeliac disease. The overall frequency of coeliac disease in this mixed patient sample was 1 in 44. In a control group of 488 pregnant patients, two serum samples were positive (1 in 244). Sixteen patients with both coeliac disease and epilepsy, who had previously attended this hospital, were identified. No patient had cerebral calcification on CT scanning. Coeliac disease appears to occur with increased frequency in patients with epilepsy, and a high index of suspicion should be maintained. Cerebral calcification is not a feature of our patients with epilepsy and coeliac disease, and may be an ethnically-or geographically-restricted finding.

  20. National Epilepsy Surgery Support Activity

    Directory of Open Access Journals (Sweden)

    K Radhakrishnan

    2014-01-01

    Full Text Available While there are over one million people with drug-resistant epilepsy in India, today, there are only a handful of centers equipped to undertake presurgical evaluation and epilepsy surgery. The only solution to overcome this large surgical treatment gap is to establish comprehensive epilepsy care centers across the country that are capable of evaluating and selecting the patients for epilepsy surgery with the locally available technology and in a cost-effective manner. The National Epilepsy Surgery Support Activity (NESSA aims to provide proper guidance and support in establishing epilepsy surgery programs across India and in neighboring resource-poor countries, and in sustaining them.

  1. Approximating methods for intractable probabilistic models: Applications in neuroscience

    DEFF Research Database (Denmark)

    Højen-Sørensen, Pedro

    2002-01-01

    This thesis investigates various methods for carrying out approximate inference in intractable probabilistic models. By capturing the relationships between random variables, the framework of graphical models hints at which sets of random variables pose a problem to the inferential step. The appro...

  2. Magnesium Therapy for Intractable Ventricular Tachyarrhythmias in Normomagnesemic Patients

    OpenAIRE

    Iseri, Lloyd T.; Chung, Peter; Tobis, Jonathan

    1983-01-01

    Intractable ventricular tachyarrhythmia associated with hypomagnesemia responds well to magnesium given intravenously. Two patients with recurrent ventricular tachycardia and ventricular fibrillation associated with normal serum magnesium levels and resistant to treatment with potassium chloride, lidocaine and bretylium tosylate responded dramatically to the administration of magnesium sulfate. A third patient in whom the serum magnesium level was unknown also showed dramatic response to magn...

  3. Individual classification of children with epilepsy using support vector machine with multiple indices of diffusion tensor imaging

    OpenAIRE

    Ishmael Amarreh; Meyerand, Mary E.; Carl Stafstrom; Hermann, Bruce P.; Birn, Rasmus M.

    2014-01-01

    Introduction: Support vector machines (SVM) have recently been demonstrated to be useful for voxel-based MR image classification. In the present study we sought to evaluate whether this method is feasible in the classification of childhood epilepsy intractability based on diffusion tensor imaging (DTI), with adequate accuracy. We applied SVM in conjunction DTI indices of fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD) and axial diffusivity (AD). DTI studies have rep...

  4. Neuropsychiatric porphyria in patients with refractory epilepsy: report of three cases

    OpenAIRE

    Winkler, A.; T. Peters; Elwes, R.

    2005-01-01

    Objectives: Although epileptic seizures are an infrequent feature of acute attacks of the neuropsychiatric porphyrias, there are no significant reports of porphyria in chronic epilepsy. This paper attempts to redress the balance.

  5. THE EFFECT OF NIGELLA SATIVA L. ON INTRACTABLE PEDIATRIC SEIZURES

    OpenAIRE

    J Akhondian; Parsa, A; H. RAKHSHANDE

    2009-01-01

    Background:Despite availability and administration of numerous antiepileptic drugs (AEDs) nearly 15% of childhood epilepsy cases are resistant to treatment; in traditional medicine however Nigella sativa L. (Black seed) has been known for its anticonvulsant effects.Materials and Methods:In this double-blind clinical trial conducted on children with refractory epilepsy we administered the aqueous extract of black seed as an adjunct therapy and compared the effects with those of a placebo. The ...

  6. Stress and epilepsy: fact or fiction, and what can we do about it?

    Science.gov (United States)

    Galtrey, Clare M; Mula, Marco; Cock, Hannah R

    2016-08-01

    People with epilepsy report that stress is their most common trigger for seizures and some believe it caused their epilepsy in the first place. The extensive preclinical, epidemiological and clinical studies examining the link between stress and epilepsy have given confusing results; the clinical studies in particular are fraught with confounders. However stress is clearly bad for health, and we now have substantial preclinical evidence suggesting that chronic stress worsens epilepsy; in selected cases it may even be a causal factor for epilepsy. Healthcare professionals working with people with epilepsy should pay more attention to stress in clinical practice. This review includes some practical advice and guidance for stress screening and management. PMID:26933239

  7. Periventricular Nodular Heterotopia, Surgical Goal in Drug-Resistant Epilepsy

    Directory of Open Access Journals (Sweden)

    Fernando Velandia-Hurtado

    2014-09-01

    Full Text Available Introduction: Neuronal heterotopia is a migration disorder in which these cells do not complete their movement toward the cerebral cortex. Periventricular nodular heterotopia is the most frequently reported form, characterized by neuronal conglomerates adjacent to the lateral ventricles walls. About 90 % of patients with this condition suffer epilepsy at some point in their lives and the major proportion of them will be resistant to pharmacologic treatment. This makes an appropriate diagnostic approach necessary in order to determine which patients would benefit from surgical resection of the lesion, which in most cases offers a high rate of crisis control. Development: This article presents a review of the most important topics approached from the practice of periventricular nodular heterotopia pathophysiology, clinical features, diagnosis and therapy. It is aimed at exploring the role of this condition as a cause of intractable epilepsy. Conclusion: Pharmacologic treatment for resistant epilepsy will have a severe impact on patient’s quality of life. Periventricular nodular heterotopia is frequently associated to this condition, which must be successfully approached by the medical team attempting to an opportune diagnosis and defining which patients would benefit from surgical management. This positively impacts the quality of life of these patients and their caregivers.

  8. Epilepsy in Adults with TSC

    Medline Plus

    Full Text Available ... of time. Epilepsy and Seizures Epilepsy is any brain disorder that causes repeated, spontaneous seizures of any ... called "fits" or convulsions) are episodes of disturbed brain function that cause changes in attention or behavior. ...

  9. Epilepsy in Adults with TSC

    Medline Plus

    Full Text Available ... brain. Devices to treat epilepsy include vagus nerve stimulation and responsive neurostimulation. Who Treats Epilepsy? A general ... imaging (MRI) of the brain throughout adolescence and early adulthood (at least until the age of 21 ...

  10. Epilepsy in Adults with TSC

    Medline Plus

    Full Text Available ... centers in a large city and/or an academic center near you (for a listing of epilepsy ... Men with TSC Many men with epilepsy will experience changes in sexual drive and performance. For example, ...

  11. 77 FR 59197 - Epilepsy Program

    Science.gov (United States)

    2012-09-26

    ... HUMAN SERVICES Health Resources and Services Administration Epilepsy Program AGENCY: Health Resources... to the Epilepsy Foundation of America. SUMMARY: The Health Resources and Services Administration will be issuing noncompetitive supplemental funding under the Maternal and Child Health Bureau's...

  12. Epilepsy in Adults with TSC

    Medline Plus

    Full Text Available ... International TSC Research Conference Text Size Get Involved EPILEPSY IN ADULTS WITH TSC Download a PDF of ... age, including either new-onset seizures or ongoing epilepsy. Recent studies indicate that more than 80% of ...

  13. Epilepsy in Adults with TSC

    Medline Plus

    Full Text Available ... might benefit their individual situation. Epilepsy Surgery: Surgical approaches to treating epilepsy in individuals with TSC are ... Facebook Twitter YouTube How to Make a Donation Research Directed Donations Tributes Planned Giving/Endowments Partner Offers ...

  14. Epilepsy in Adults with TSC

    Medline Plus

    Full Text Available ... centers in a large city and/or an academic center near you (for a listing of epilepsy ... epilepsy will experience changes in sexual drive and performance. For example, many men report a decrease in ...

  15. Epilepsy in Adults with TSC

    Medline Plus

    Full Text Available ... SEGAs that are not candidates for curative surgery. Evaluation of New-Onset Seizures All individuals with new- ... diet that are more palatable for some individuals. Links Information for Women with Epilepsy: www.epilepsy.com/ ...

  16. Epilepsy in Adults with TSC

    Medline Plus

    Full Text Available ... delay. Children outgrow infantile spasms because they either go away or transition to other types of seizures. ... near you (for a listing of epilepsy centers go to www.naec-epilepsy.org or call 1- ...

  17. Epilepsy in Adults with TSC

    Medline Plus

    Full Text Available ... time. Epilepsy and Seizures Epilepsy is any brain disorder that causes repeated, spontaneous seizures of any type. ... Government Action Team TS Alliance Online Support Community Facebook Twitter YouTube How to Make a Donation Research ...

  18. Epilepsy in Adults with TSC

    Medline Plus

    Full Text Available ... to experience a return of seizures after being well controlled for long periods of time. Epilepsy and ... general neurologist can treat uncomplicated epilepsy that is well controlled on one medication. However, most people with ...

  19. Hippocampal neuropathology of domoic acid-induced epilepsy in California sea lions (Zalophus californianus)

    OpenAIRE

    Buckmaster, Paul S.; Wen, Xiling; TOYODA, Izumi; Gulland, Frances M. D.; Van Bonn, William

    2014-01-01

    California sea lions (Zalophus californianus) are abundant human-sized carnivores with large gyrencephalic brains. They develop epilepsy after experiencing status epilepticus when naturally exposed to domoic acid. We tested whether sea lions previously exposed to DA (chronic DA sea lions) display hippocampal neuropathology similar to that of human patients with temporal lobe epilepsy. Hippocampi were obtained from control and chronic DA sea lions. Stereology was used to estimate numbers of Ni...

  20. Treatment for intractable anemia with the traditional Chinese medicines Hominis Placenta and Cervi Cornus Colla (deer antler glue

    Directory of Open Access Journals (Sweden)

    Yasuyo Hijikata

    2009-05-01

    Full Text Available Yasuyo Hijikata1, Takashi Kano2, Lu Xi31Toyodo Hijikata Clinic, Osaka, Japan; 2Kano Clinic, Osaka city, Osaka, Japan; 3Traditional Chinese Medicine Institute, Si-chuan Province, ChinaObjective: Intractable anemia, such as aplastic anemia or that presumably associated with chronic herpes virus infections, sometimes require bone marrow transplant. We investigated the use of traditional Chinese medicine (TCM for the treatment of intractable anemia. Method: Placenta Hominis (PH, steam boiled and roasted, and Cervi Cornus Colla (deer antler glue has been used in China for hundreds of years to treat anemia. After consent was obtained, we prescribed these two materials for a 74-year-old female with aplastic anemia and a 26-year-old male with presumably a virus-induced anemia. Concomitant conventional therapy was continued in both patients as prescribed by their respective attending physicians. Conclusion: Conventional therapy with steroid hormones, immunosuppressive drugs, platelet and erythrocyte transfusions were not effective in these patients. In addition, both patients suffered from serious side effects. In two patients, ingestion of Placenta Hominis and Cervi Cornus Colla with TCM prescriptions increased the platelet and enhanced the hemoglobin concentration in several months of therapy accompanied by a dramatic improvement in quality of life. The addition to conventional therapy of PH and Cervi Cornus Colla, the latter of which is very easy to obtain, may be one of the potentially advantageous choices in case of otherwise intractable anemia.Keywords: placenta, antler glue, Cervi Cornus Colla, anemia, aplastic anemia

  1. [Occupational disability in epilepsy. The assessment criteria].

    Science.gov (United States)

    Vicente-Herrero, M T; Terradillos García, M J; Capdevila García, L; Ramírez Iñiguez de la Torre, M V; López-González, Á A; Aguilar Jiménez, E

    2016-03-01

    Epilepsy is a chronic disease cursing with recurrent and paroxysmal crises due to anomalies in the electrical activity of brain, and is controllable in most of the patients by using antiepileptic drugs, in single or combination therapy. Probably one of the most complex aspects of epilepsy is the assessment of disability for work of the affected person. For this purpose, multiple factors need to be taken into account for homogeneous decision-making, and according to criteria of approval and within the principle of equity inherent in the granting of Social Security disability benefits. This requires the cooperation of all professionals involved in the different specialties, with reports using common criteria and taking into account the disease itself, as well as the effects of the prescribed treatments, the effects of which can contribute to the limitations in the performance of certain professions of risk. PMID:25440966

  2. Caprylic acid in the effective treatment of intractable medical problems of frequent urination, incontinence, chronic upper respiratory infection, root canalled tooth infection, ALS, etc., caused by asbestos & mixed infections of Candida albicans, Helicobacter pylori & cytomegalovirus with or without other microorganisms & mercury.

    Science.gov (United States)

    Omura, Yoshiaki; O'Young, Brian; Jones, Marilyn; Pallos, Andrew; Duvvi, Harsha; Shimotsuura, Yasuhiro

    2011-01-01

    There are many causes of frequent urination. Whenever water or fluids are consumed, the patient has to urinate within 10 or 20 min. Often urinary bladder examinations & blood tests show no significant abnormalities, & treatment by anti-bacterial or anti-viral agents does not improve the symptoms significantly. In intractable frequent urination with difficulty holding urine, as well as other intractable medical problems such as frequent coughing, white pus in gingiva, infection of the apex of a root canalled tooth, slow-healing wounds, & ALS, the authors often found coexisting mixed infections of Candida albicans (C.A.), Helicobacter pylori (H.P.), & Cytomegalovirus (CMV) with or without additional bacterial (Chlamydia trachomatis, etc.) or viral infections & increased Asbestos, with or without Hg deposits. We often found various degrees of mixed infections with C.A., H.P., & CMV in the external sphincters of the urethra & in the Trigone of the urinary bladder which consists of (1) a horizontal, band-like area between the 2 ureter openings & (2) the funnel shaped part of the Trigone at the lower half of the urinary bladder. In the coexistence of significant amounts of C.A., H.P. & CMV, the infection cannot be reduced by otherwise effective medicines for H.P. & CMV. However, one optimal dose of Diflucan, or Caprylic acid taken orally or externally applied, rapidly reduced the symptoms significantly. We found the best treatment is to give a combination of an optimal dose of Caprylic acid orally in the form of "CaprilyCare" or "Caprylic Acid," with a capsule of Omega-3 Fish Oil as an anti-viral agent, Amoxicillin, Substance Z & a Cilantro tablet. We found that an optimal dose of Caprylic acid increases normal cell telomere (NCT) to a desirable 750 ng BDORT units while Diflucan increases NCT by only 25 ng BDORT units, & with Omega-3 fish oil, leads to a mutual cancellation of both drugs. Thus, Caprylic acid is superior to & less expensive than Diflucan, & has potential

  3. Interictal to ictal transition in human temporal lobe epilepsy: insights from a computational model of intracerebral EEG

    OpenAIRE

    Wendling, Fabrice; Hernandez, Alfredo; Bellanger, Jean-Jacques; Chauvel, Patrick; Bartolomei, Fabrice

    2005-01-01

    International audience In human partial epilepsies and in experimental models of chronic and/or acute epilepsy, the role of inhibition and the relationship between the inhibition and excitation and epileptogenesis has long been questioned. Besides experimental methods carried out either in vitro (human or animal tissue) or in vivo (animals), pathophysiologic mechanisms can be approached by direct recording of brain electrical activity in human epilepsy. Indeed, in some clinical presurgical...

  4. Depression and Anxiety in Iranian Mothers of Children with Epilepsy

    Directory of Open Access Journals (Sweden)

    Atefeh SOLTANIFAR

    2012-03-01

    childrenwith epilepsy and their mothers. Epilepsy Behav 2004Dec;5(6:958-64.15. Yam WK, Ronen GM, Cherk SW, Rosenbaum P, ChanKY, Streiner DL, et al. Health-related quality of lifeof children with epilepsy in Hong Kong: how does itcompare with that of youth with epilepsy in Canada?Epilepsy Behav 2008 Apr;12(3:419-26.16. Ghassemzadeh H, Mojtabai R, Karamghadiri N,Ebrahimkhani N. Psychometric properties of a Persianlanguageversion of the Beck Depression Inventory Second edition: BDI-II-PERSIAN. Depress Anxiety2005;21(4:185-92.17. Hojat M, Shapurian R, Mehryar AH. Psychometricproperties of a Persian version of the short form of theBeck Depression Inventory for Iranian college students.Psychol Rep 1986 Aug;59(1:331-8.18. Kalkhoran MA, Karimollahi M. Religiousness andpreoperative anxiety: a correlational study. Ann GenPsychiatry 2007;6:17.19. Mu PF, Kuo HC, Chang KP. Boundary ambiguity, copingpatterns and depression in mothers caring for children withepilepsy in Taiwan. Int J Nurs Stud 2005 Mar;42(3:273-82.20. Lv R, Wu L, Jin L, Lu Q, Wang M, Qu Y, et al. Depression,anxiety and quality of life in parents of children withepilepsy. Acta Neurol Scand 2009 Nov;120(5:335-41.21. (Wood LJ, Sherman E, Hamiwka LD, Blackman M,Wirrell E. Depression, anxiety, and quality of life insiblings of children with intractable epilepsy. EpilepsyBehav 2008 Jul;13(1:144-8.22. Tosun A, Gokcen S, Ozbaran B, Serdaroglu G, Polat M,Tekgul H, et al. The effect of depression on academicachievement in children with epilepsy. Epilepsy Behav2008 Oct;13(3:494-8.23. Rodenburg R, Meijer AM, Dekovic M, Aldenkamp AP. Family factors and psychopathology in childrenwith epilepsy: a literature review. Epilepsy Behav 2005Jun;6(4:488-503.24. Wirrell EC, Wood L, Hamiwka LD, Sherman EM. Parenting stress in mothers of children with intractableepilepsy. Epilepsy Behav 2008 Jul;13(1:169-73.

  5. Prediction problem in quantum mechanics is intractable (NP-hard)

    International Nuclear Information System (INIS)

    The authors prove that both the prediction problem and the problem of reconstructing the state from given observations in quantum mechanics are in the general case intractable (or, using the precise mathematical notion from complexity theory, NP-hard). This result can be of interest to two groups of readers: those who are well acquainted with the mathematical problems of quantum physics and those who are well acquainted with algorithmic complexity and NP. They do our best to make this text understandable to both. Therefore they include brief explanations of both the quantum mechanics formalism and the formal notion of intractable (NP-hard) problems. Those readers already familiar with one of these notions can simply skip the corresponding part

  6. Persons with Epilepsy: Between Social Inclusion and Marginalisation

    Science.gov (United States)

    Mlinar, Simona; Petek, Davorina; Cotič, Živa; Mencin Čeplak, Metka; Zaletel, Marjan

    2016-01-01

    Background. Epilepsy is a chronic neurological disorder that can lead to complex psychosocial consequences. Epilepsy can change the social status of persons with epilepsy (PWE) and has an effect on their social inclusion as well as their perception of social inclusion. This study aims to explore subjective experiences with social inclusion of PWE in Slovenia. Methods. This study takes a qualitative approach. Eleven semistructured interviews were conducted with eleven participants. Interviews were analysed using thematic analysis. Results. Epilepsy has physical, emotional, and social consequences. Physical consequences of epilepsy are mainly tiredness and exhaustion following an epileptic episode, frequently accompanied by headaches. Emotional consequences are different forms of fear. The main social consequence identified is a negative effect on PWE's social network, which leads to (self-)isolation and social distrust. Conclusion. PWE experience of social inclusion depends on various psychosocial factors and differs from person to person. The consequences of epilepsy are shown in PWE social contacts and their sense of social inclusion and autonomy. PMID:27212802

  7. Astroglial networks and implications for therapeutic neuromodulation of epilepsy

    Directory of Open Access Journals (Sweden)

    Mark R Witcher

    2012-08-01

    Full Text Available Epilepsy is a common chronic neurologic disorder affecting approximately 1 percent of the world population. More than one-third of all epilepsy patients have incompletely controlled seizures or debilitating medication side effects in spite of optimal medical management. Medically refractory epilepsy is associated with excess injury and mortality, psychosocial dysfunction, and significant cognitive impairment. Effective treatment options for these patients can be limited. The cellular mechanisms underlying seizure activity are incompletely understood, though we here describe multiple lines of evidence supporting the likely contribution of astroglia to epilepsy, with focus on individual astrocytes and their network functions. Of the emerging therapeutic modalities for epilepsy, one of the most intriguing is the field of neuromodulation. Neuromodulatory treatment, which consists of administering electrical pulses to neural tissue to modulate its activity leading to a beneficial effect, may be an option for these patients. Current modalities consist of vagal nerve stimulation, open and closed loop stimulation, and transcranial magnetic stimulation. Due to their unique properties, we here present astrocytes as likely important targets for the developing field of neuromodulation in the treatment of epilepsy.

  8. Mouse models of human PIK3CA-related brain overgrowth have acutely treatable epilepsy

    Science.gov (United States)

    Roy, Achira; Skibo, Jonathan; Kalume, Franck; Ni, Jing; Rankin, Sherri; Lu, Yiling; Dobyns, William B; Mills, Gordon B; Zhao, Jean J; Baker, Suzanne J; Millen, Kathleen J

    2015-01-01

    Mutations in the catalytic subunit of phosphoinositide 3-kinase (PIK3CA) and other PI3K-AKT pathway components have been associated with cancer and a wide spectrum of brain and body overgrowth. In the brain, the phenotypic spectrum of PIK3CA-related segmental overgrowth includes bilateral dysplastic megalencephaly, hemimegalencephaly and focal cortical dysplasia, the most common cause of intractable pediatric epilepsy. We generated mouse models expressing the most common activating Pik3ca mutations (H1047R and E545K) in developing neural progenitors. These accurately recapitulate all the key human pathological features including brain enlargement, cortical malformation, hydrocephalus and epilepsy, with phenotypic severity dependent on the mutant allele and its time of activation. Underlying mechanisms include increased proliferation, cell size and altered white matter. Notably, we demonstrate that acute 1 hr-suppression of PI3K signaling despite the ongoing presence of dysplasia has dramatic anti-epileptic benefit. Thus PI3K inhibitors offer a promising new avenue for effective anti-epileptic therapy for intractable pediatric epilepsy patients. DOI: http://dx.doi.org/10.7554/eLife.12703.001 PMID:26633882

  9. Clinical characteristics of 41 patients with intractable asthma

    Directory of Open Access Journals (Sweden)

    Li BAI

    2011-09-01

    Full Text Available Objective To explore the clinical characteristics of intractable asthma,and to provide new knowledge for diagnosis and treatment of the disease.Methods Forty one patients with intractable asthma,admitted to the Institute of Respiratory Disease,Xinqiao Hospital of Third Military Medical University from Jan.2009 to Dec.2010,were included in present study.Spirometry tests were performed for all the 41 patients.Cell classification and counting were done in the induced sputum of 37 patients,and 34 patients underwent high-resolution chest computed tomography(HRCT.Results Incomplete reversibility of airflow obstruction(FEV1/FVC 0.03 of the total cells,13(35.1% and increased neutrophils( > 0.61 of total cells,6(16.2% showed increased both eosinophils and neutrophils,and only that of one patient showed normal percentage of the eosinophils and neutrophils.Chest HRCT of 34 patients showed thickening of bronchial wall in visible segment in 28 cases(82.3%,and in 22 cases(64.7% thickening of bronchial wall in secondary segments was accompanied with narrowed bronchus lumen,cylindrical bronchiectasis was predominant in 7 patients,and centrilobular emphysema was seen in 5 patients.Conclusion Airway remodeling,incomplete reversibility of airflow obstruction,airway inflammation appear to be the major clinical characteristics of intractable asthma.Combined use of chest HRCT,spirometry test,and cellular analysis of induced sputum may be helpful for identifying intractable asthma,and they provide the basis for individualized strategies to manage the disease.

  10. Intractable Rickets as Presenting Feature of Wilson's Disease

    OpenAIRE

    A Bahrami-Ahmadi; J Shakeri; Haghighi, A; MB owlia

    2004-01-01

    Rickets by definition is a condition in which the bone mineralization is defective. Among the large cause of Rickets (Vitamin D deficiency, gastrointestinal disorders, acidosis, renal tubular abnormalities...), Wilson's disease is a relatively rare cause. There are few cases of Wilson's disease presenting first as rickets in the literature. ‎ Here we present an Afghan girl with Wilson's disease presenting with intractable Rickets.‎

  11. Surgical repair of intractable chylous ascites following laparoscopic anterior resection

    OpenAIRE

    Ha, Gi Won; Lee, Min Ro

    2015-01-01

    Chylous ascites is the accumulation of a milk-like peritoneal fluid rich in triglycerides and it is an unusual complication following surgical treatment of colorectal cancer. Conservative management is usually sufficient in patients with chylous ascites after surgery. However, we describe a patient with intractable chylous ascites after laparoscopic anterior resection for sigmoid colon cancer who failed initial conservative treatment. This patient was successfully managed by surgery.

  12. Comparative Evaluation for Brain Structural Connectivity Approaches: Towards Integrative Neuroinformatics Tool for Epilepsy Clinical Research.

    Science.gov (United States)

    Yang, Sheng; Tatsuoka, Curtis; Ghosh, Kaushik; Lacuey-Lecumberri, Nuria; Lhatoo, Samden D; Sahoo, Satya S

    2016-01-01

    Recent advances in brain fiber tractography algorithms and diffusion Magnetic Resonance Imaging (MRI) data collection techniques are providing new approaches to study brain white matter connectivity, which play an important role in complex neurological disorders such as epilepsy. Epilepsy affects approximately 50 million persons worldwide and it is often described as a disorder of the cortical network organization. There is growing recognition of the need to better understand the role of brain structural networks in the onset and propagation of seizures in epilepsy using high resolution non-invasive imaging technologies. In this paper, we perform a comparative evaluation of two techniques to compute structural connectivity, namely probabilistic fiber tractography and statistics derived from fractional anisotropy (FA), using diffusion MRI data from a patient with rare case of medically intractable insular epilepsy. The results of our evaluation demonstrate that probabilistic fiber tractography provides a more accurate map of structural connectivity and may help address inherent complexities of neural fiber layout in the brain, such as fiber crossings. This work provides an initial result towards building an integrative informatics tool for neuroscience that can be used to accurately characterize the role of fiber tract connectivity in neurological disorders such as epilepsy. PMID:27570685

  13. Evaluation of emergency transcatheter arterial embolization in intractable postpartum hemorrhage

    International Nuclear Information System (INIS)

    Objective: To assess the efficacy and safety of emergency transcatheter arterial embolization in the management of intractable postpartum hemorrhage. Methods: Twenty-five patients with intractable postpartum hemorrhage were undertaken superselective catheterization into the bilateral internal iliac arteries or uterial arteries to find the causes and sites of bleeding through DSA and then followed by arterial embolization with gelfoam particles. Result: All of the 25 patients with obstetrical bleeding were successfully controlled by TAE, the procedure lasted for 25-60 min, (mean 42.5 ± 4.6 min); with both catheterization and bleeding halt successful rates of 100%. Comparison of hemoglobin and heartbeat before and after the procedure showed significance (t=29.49, P<0.01; t=16.51, P<0.01). The uterus showed reintegration on time and menstruation resumed in all patients. Conclusions: Emergency arterial embolization is a safe and effective means for control of intractable postpartum hemorrhage, providing less trauma and no severe complications, especially as an unique management for fetal postpartum hemorrhage. (authors)

  14. The effect of epilepsy and antiepileptic drugs on sexual, reproductive and gonadal health of adults with epilepsy.

    Science.gov (United States)

    Hamed, Sherifa A

    2016-06-01

    Epilepsy is a common chronic medical illness. Hyposexuality is the most frequent abnormality in men and women with epilepsy. In men with epilepsy, hypoandrogenimia, hypogonadism and sperm abnormalities are common. Testicular atrophy was also infrequently reported. In women with epilepsy, hyperandrogenism, polycystic ovaries (PCOs) and PCO syndrome are frequent. Decreased serum free testosterone, dehydroepiandrosterone levels, free androgen index and free testosterone/leutinizing hormone (LH) ratio and increased sex hormone binding globulin, estradiol, prolactin, LH, follicle stimulating hormone (FSH) levels and LH/FSH ratio are common with epilepsy. Disturbance of central and/or peripheral control of hypothalamic-pituitary-gonadal axis and alteration of central neurotrasmitters (GABA, glutamate and serotonin) by epileptic discharges or antiepileptic drugs (AEDs), direct gonadal toxicity by AEDs and pcyshicatric/psychosocial factors are all incriminated in sexual, reproductive and gonadal abnormalities associated with epilepsy. Patients may benefit from multidisplinary evaluation, tight seizure control, change the AED, androgen therapy, genital vasodilators, L-carnitine supplementation and psychotherapy. PMID:26934627

  15. 18F-DG PET and RCBF SPECT in epilepsy

    International Nuclear Information System (INIS)

    Functional imaging of cortical metabolism and perfusion is of growing importance in the presurgical evaluation of patients suffering from intractable epilepsy. PET and SPECT are of proven value in functional imaging prior to epilepsy surgery. To date the best clinical experience was gained by using 18-fluorodeoxyglucose for PET and tracers for measurement of regional cerebral blood flow (rCBF) like 99mTc-HMPO or 99mTc-ECD for SPECT respectively. Their relative contribution towards detection of a probable focus site in epilepsy is still controversial. To determine the relative value of both procedures the literature has been reviewed with special respect to ictal SPECT studies. With regard to different standards used for correlation a relative sensitivity of 62.4% was found for interictal rCBF SPECT. 71% for 18-FDG-PET and 87% for ictal rCBF SPECT studies. In conclusion, earlier reported advantages of PET over SPECT seem to closely reflect the better spatial resolution of PET. Modern SPECT systems, dedicated for brain SPECT, provide appropriate and almost equal sensitivity. Regarding the limited specificity of interictal studies, both rCBF SPECT and FDG-PET need precise indications. However, further to detection of a probable focus site, metabolism and rCBF studies seem to be of value to predicit the post-surgical patients outcome as to seizure frequency and mental functions secondarily affected by epilepsy surgery such as memory impairment. Ictal rCBF SPECT provides higher sensitivity and specificity and virtually allows the detection lateralisation in almost every case. This means that a relatively precise anatomical localisation of an epileptogenic focus is being found in a rising number of patients. (orig.)

  16. The biochemistry and epigenetics of epilepsy: focus on adenosine and glycine

    Directory of Open Access Journals (Sweden)

    Detlev eBoison

    2016-04-01

    Full Text Available Epilepsy, one of the most prevalent neurological conditions, presents as a complex disorder of network homeostasis characterized by spontaneous non-provoked seizures and associated comorbidities. Currently used antiepileptic drugs have been designed to suppress neuronal hyperexcitability and thereby to suppress epileptic seizures. However, the current armamentarium of antiepileptic drugs is not effective in over 30% of patients, does not affect the comorbidities of epilepsy, and does not prevent the development and progression of epilepsy (epileptogenesis. Prevention of epilepsy and its progression remains the Holy Grail for epilepsy research and therapy development, requiring novel conceptual advances to find a solution to this urgent medical need. The methylation hypothesis of epileptogenesis suggests that changes in DNA methylation are implicated in the progression of the disease. In particular, global DNA hypermethylation appears to be associated with chronic epilepsy. Clinical as well as experimental evidence demonstrates that epilepsy and its progression can be prevented by biochemical manipulations and those that target previously unrecognized epigenetic functions contributing to epilepsy development and maintenance of the epileptic state. This mini-review will discuss epigenetic mechanisms implicated in epileptogenesis and biochemical interactions between adenosine and glycine as a conceptual advance to understand the contribution of maladaptive changes in biochemistry as a major contributing factor to the development of epilepsy. New findings based on biochemical manipulation of the DNA methylome suggest that (i epigenetic mechanisms play a functional role in epileptogenesis, and (ii therapeutic reconstruction of the epigenome is an effective antiepileptogenic therapy.

  17. Nonpharmacological treatment of epilepsy

    OpenAIRE

    V S Saxena; Nadkarni, V. V.

    2011-01-01

    Nonpharmacological treatment of epilepsy includes surgery, vagal nerve stimulation, ketogenic diet, and other alternative/complementary therapies, e.g., yoga, Ayurveda, electroencephalography (EEG) biofeedback technique, aerobic exercise, music therapy, transcranial magnetic stimulation, acupuncture, and herbal remedies (traditional Chinese medicine). Alternative therapies, despite the term, should not be considered as an alternative to antiepileptic medication; they complement accepted drug ...

  18. 20.5.Epilepsy

    Institute of Scientific and Technical Information of China (English)

    1992-01-01

    920184 Clinical analysis of 25 cases ofchronic alcoholic intoxication with epilepsy.PANG Zhixing (庞治兴),et al.Dept Psychol,1stTeaching Hosp.Norman Bethune Med Univ,130021 Chin J Nerv & Ment Dis 1991; 17 (5):289-291.The clinical manifestations of 25 cases (male)

  19. Spect in epilepsy

    International Nuclear Information System (INIS)

    In the Federal Republic of Germany it is assumed that about 80 000 patients suffer from a focal form of epilepsy which can not be sufficiently controlled with medication. As potential candidates for surgery, these patients undergo stepwise monitoring procedure in which the epileptic focus is located by means of increasingly invasive methods. In Erlangen the periictal SPECT is performed, whereby the perfusion tracer is injected after onset (ictal SPECT), immediately after cessation of the seizure (postictal scan) or between the seizures (interictal scan). To administer the tracer strongly in ictal or postictal state a close functional cooperation between the neurology and nuclear medicine department must be arranged. Injection inside the monitoring unit must be attuned to federal antiradiation precaution law. In temporal lobe epilepsy, different injection-times demonstrate a large area of hyperperfusion after ictal onset, which refines in the first two postictal minutes to the generating focus together with a decreased parietal blood flow pattern. Later, the entire temporal lobe epilepsy an early tracer injection within 40 seconds has to be achieved, otherwise an ictal propagation into distant brain areas, possibly contralateral, may occur. Extratemporal epilepsy is often linked to trauma or congenital malformations, and is difficult to categorize. In difficult cases with equivocal results, efforts can be undertaken by means of receptor scintigraphy with, for example, iomazenil, to localize the focus as a cold lesion caused by neuronal loss. (orig.)

  20. Mobile EEG in epilepsy

    NARCIS (Netherlands)

    Askamp, Jessica; Putten, van M.J.A.M.

    2014-01-01

    The sensitivity of routine EEG recordings for interictal epileptiform discharges in epilepsy is limited. In some patients, inpatient video-EEG may be performed to increase the likelihood of finding abnormalities. Although many agree that home EEG recordings may provide a cost-effective alternative t

  1. Dreams and epilepsy.

    Science.gov (United States)

    Reami, D O; Silva, D F; Albuquerque, M; Campos, C J

    1991-01-01

    The relationship between dreams and epilepsy is illustrated by two patients whose awake epileptic seizures and recurrent dreams during night sleep had similar content. In both of our cases the EEG showed right anterior temporal spike discharge, suggesting a role for the temporal lobe in the association between dreams and seizures. PMID:1985830

  2. Neuroimaging in epilepsy

    Directory of Open Access Journals (Sweden)

    Roy Trishit

    2011-01-01

    Full Text Available Epilepsy is a common neurological disorder with diverse etiologies. Neuroimaging plays an important role in workup of patients with epilepsy. It helps to identify brain pathologies that require specific treatment; and also in formulating syndromic and etiological diagnoses so as to give patients and their relatives an accurate prognosis. Magnetic resonance imaging, specially the 3 tesla MRI is the imaging of choice because of its ability to detect small lesions like mesial temporal sclerosis, cortical dysplasias, small tumors, etc that are not detected by conventional MR or CT scan of brain. Identification of these lesions often helps in managing refractory epilepsies more effectively. However, cost and non-availability of MR in large part of the country necessitate the use of CT as an alternative. CT is often the initial investigation and also useful in acute situations. Functional imagings are used for pre-surgical work-up of refractory epilepsy cases with an aim to identify the epileptogenic focus and to delineate functional areas nearing the focus.

  3. Personality characteristics and epilepsy

    DEFF Research Database (Denmark)

    Sørensen, A S; Hansen, H; Andersen, R;

    1989-01-01

    dimensions, healthy volunteers the lowest, while the psoriasis group repeatedly held an intermediate position in all sets of assessment (subjects, interviewers and relatives). A logistic regression analysis showed ixoide features being most important when the entire epilepsy group was compared with other...

  4. Mitochondrial dysfunction in epilepsy

    Czech Academy of Sciences Publication Activity Database

    Folbergrová, Jaroslava; Kunz, W.S.

    2012-01-01

    Roč. 12, č. 1 (2012), s. 35-40. ISSN 1567-7249 R&D Projects: GA ČR(CZ) GA309/05/2015; GA ČR GA309/08/0292 Institutional research plan: CEZ:AV0Z50110509 Keywords : epilepsy * mitochondrial dysfunction * neurodegeneration Subject RIV: FH - Neurology Impact factor: 4.025, year: 2012

  5. Epilepsy in Adults with TSC

    Medline Plus

    Full Text Available ... modified over the years. In contrast, a large number of individuals with TSC will have intractable seizures— ... with TSC who have been previously undiagnosed, the first sign of the tumor may be blurring of ...

  6. Epilepsy in Adults with TSC

    Medline Plus

    Full Text Available ... and adults, so ask about the upper age limit for individuals with TSC seen at the clinic. ... will have intractable seizures—seizures that do not reduce in severity or frequency with the use of ...

  7. Epilepsy in Adults with TSC

    Medline Plus

    Full Text Available ... look for one of these centers in a large city and/or an academic center near you ( ... or modified over the years. In contrast, a large number of individuals with TSC will have intractable ...

  8. Calcium ion channel and epilepsy

    Institute of Scientific and Technical Information of China (English)

    Yudan Lü; Weihong Lin; Dihui Ma

    2006-01-01

    OBJECTIVE: To review the relationship between calcium ion channel and epilepsy for well investigating the pathogenesis of epilepsy and probing into the new therapeutic pathway of epilepsy.DATA SOURCES: A computer-based online research Calcium ion channel and epilepsy related articles published between January 1994 and December 2006 in the CKNI and Wanfang database with the key words of "calcium influxion, epilepsy, calcium-channel blocker". The language was limited to Chinese. At the same time,related articles published between January 1993 and December 2006 in Pubmed were searched for on online with the key words of "calcium influxion, epilepsy" in English.STUDY SELECTION: The materials were selected firstly. Inclusive criteria: ① Studies related to calcium ion channel and the pat1hogenesis of epilepsy. ② Studies on the application of calcium ion channel blocker in the treatment of epilepsy. Exclusive criteria: repetitive or irrelated studies.DATA EXTRACTION: According to the criteria, 123 articles were retrieved and 93 were excluded due to repetitive or irrelated studies. Altogether 30 articles met the inclusive criteria, 11 of them were about the structure and characters of calcium ion channel, 10 about calcium ion channel and the pathogenesis of epilepsy and 9 about calcium blocker and the treatment of epilepsy.DATA SYNTHESIS: Calcium ion channels mainly consist of voltage dependent calcium channel and receptor operated calcium channel. Depolarization caused by voltage gating channel-induced influxion is the pathological basis of epileptic attack, and it is found in many studies that many anti-epileptic drugs have potential and direct effect to rivalizing voltage-dependent calcium ion channel.CONCLUSION: Calcium influxion plays an important role in the seizure of epilepsy. Some calcium antagonists seen commonly are being tried in the clinical therapy of epilepsy that is being explored, not applied in clinical practice. If there are enough evidences to

  9. Intracerebroventricular Pain Treatment with Analgesic Mixtures including Ziconotide for Intractable Pain.

    Science.gov (United States)

    Staquet, Héléne; Dupoiron, Denis; Nader, Edmond; Menei, Philippe

    2016-07-01

    Intracerebroventricular (ICV) administration of opioids for control of intractable cancer pain has been used since 1982. We present here our experience of intracerebroventricular administration of pain treatments including ziconotide associated with morphine and ropivacaine for patients resistant to a conventional approach, with nociceptive, neuropathic, or mixed pain. These clinical cases were conducted with patients suffering from refractory pain, more than 6/10 on a numerical pain rating scale (NPRS) while on high-dose medical treatment and/or intolerance with significant side effects from oral medication. The baseline study visit included a physical examination and an assessment of pain intensity on a NPRS. Under general anesthesia, a neuronavigation device was used to place the catheter on the floor of the third ventricle, supported by an endoscope. Then, drugs were injected in the cerebroventricular system, through a pump (external or subcutaneous). The primary objective was to measure pain evaluation with ICV treatment after a complete withdrawal of other medications.Four patients were enrolled: 3 with intractable cancer pain and one with central neuropathic pain. The median NPRS at baseline was 9.5 [8.5; 19]. The mean NPRS after one month was 3.5 [3; 4.5]. Ziconotide was initiated at 0.48 µg/d and up to a median of 1.2 µg/d [1.0; 1.56]. The median dose of morphine and ropivacaine used initially was respectively 0.36 mg/d [0.24; 0.66] up to 0.6 mg/d [0.45; 4.63] and 1.2 mg/d [0; 2.4] up to 2.23 mg/d [1.2; 3.35]. Minor side effects were initially observed but transiently. One psychiatric agitation required discontinuation of ziconotide infusion. For intractable pain, using ziconotide by intracerebroventricular infusion seems safe and efficient, specifically for chronic neoplastic pain of cervicocephalic, thoracic, or diffuse origin and also for pain arising from a central neuropathic mechanism. PMID:27454282

  10. Resting state networks in temporal lobe epilepsy

    Science.gov (United States)

    Cataldi, Mauro; Avoli, Massimo; de Villers-Sidani, Etienne

    2016-01-01

    Summary Temporal lobe epilepsy (TLE) is typically described as a neurologic disorder affecting a cerebral network comprising the hippocampus proper and several anatomically related extrahippocampal regions. A new level of complexity was recently added to the study of this disorder by the evidence that TLE also appears to chronically alter the activity of several brain-wide neural networks involved in the control of higher order brain functions and not traditionally linked to epilepsy. Recently developed brain imaging techniques such as functional magnetic resonance imaging (fMRI) analysis of resting state connectivity, have greatly contributed to these observations by allowing the precise characterization of several brain networks with distinct functional signatures in the resting brain, and therefore also known as “resting state networks.” These significant advances in imaging represent an opportunity to investigate the still elusive origins of the disabling cognitive and psychiatric manifestations of TLE, and could have important implications for its pathophysiology and, perhaps, its therapy. Herein we review recent studies in this field by focusing on resting state networks that have been implicated in the pathophysiology of psychiatric disorders and cognitive impairment in patients with epilepsy: the default mode network, the attention network, and the reward/emotion network. PMID:24117098

  11. Ketogenic Diet for Children with Epilepsy: A Practical Meal Plan in a Hospital.

    Science.gov (United States)

    Lee, Eunjoo; Kang, Hoon-Chul; Kim, Heung Dong

    2016-01-01

    A ketogenic diet (KD) is a dietary approach to treat intractable epilepsy. The KD begins with hospitalization and the child and their parents can adapt to the KD for 1-2 weeks. Recently, various type of dietary intervention such as the modified Atkins diet (MAD) and the low glycemic index treatment (LGIT) have been performed. Since 2010, we carried out the KD, MAD, and LGIT for total of 802 patients; 489 patients (61%) for the KD, 147 patients (18.3%) with the MAD, and 166 patients (20.7%) for the LGIT. In this report, application of these dietary practices in Severance Hospital is shared. PMID:26839878

  12. Ketogenic Diet for Children with Epilepsy: A Practical Meal Plan in a Hospital

    OpenAIRE

    Lee, Eunjoo; Kang, Hoon-Chul; Kim, Heung Dong

    2016-01-01

    A ketogenic diet (KD) is a dietary approach to treat intractable epilepsy. The KD begins with hospitalization and the child and their parents can adapt to the KD for 1-2 weeks. Recently, various type of dietary intervention such as the modified Atkins diet (MAD) and the low glycemic index treatment (LGIT) have been performed. Since 2010, we carried out the KD, MAD, and LGIT for total of 802 patients; 489 patients (61%) for the KD, 147 patients (18.3%) with the MAD, and 166 patients (20.7%) fo...

  13. Fractionated Stereotactic Gamma Knife Radiosurgery for Medial Temporal Lobe Epilepsy: A Case Report.

    Science.gov (United States)

    Park, Hye Ran; Chung, Hyun-Tai; Lee, Sang Kun; Kim, Dong Gyu; Paek, Sun Ha

    2016-04-01

    An 18-year-old left-handed male harbored intractable medial temporal lobe epilepsy (MTLE) underwent fractionated gamma knife surgery (GKS) instead of open surgery, considering the mental retardation and diffuse cerebral dysfunction. GKS treatment parameters were: target volume, 8.8 cm(3); total marginal dose, 24 Gy in 3 fractionations at the 50% isodose line. The patient has been free from seizures since 9 months after GKS, with notable improvement in cognitive outcome. Fractionated GKS could be considered as a safe tool for seizure control and neuropsychological improvement in patients with MTLE. PMID:27122996

  14. Therapeutic efficacy of the Qing Dai in patients with intractable ulcerative colitis

    Directory of Open Access Journals (Sweden)

    Hideo Suzuki

    2013-01-01

    Full Text Available Ulcerative colitis (UC is a chronic inflammatory bowel disease that may become intractable when treated with conventional medications such as aminosalicylates, corticosteroids, and azathioprine. The herbal medicine Qing Dai has traditionally been used in Chinese medicine to treat UC patients, but there is a lack of published data on the efficacy of Qing Dai in UC treatment. We report several cases of patients with intractable UC who take Qing Dai in a retrospective observational study. Furthermore, we explore the mechanisms of action of Qing Dai. Nine patients with active UC who received conventional medications but wished to receive Qing Dai as an alternative medication were included in our analysis. The UC severity level was determined based on the clinical activity index (CAI. Additionally, 5 of the 9 patients were endoscopically evaluated according to the Matts grading system. Each patient received 2 g/d of Qing Dai orally and continued taking other medications for UC as prescribed. Electron spin resonance was applied to explore the mechanisms of action of Qing Dai. After 4 mo of treatment with Qing Dai, the CAI score decreased from 8.3 ± 2.4 to 2.4 ± 3.4 (mean ± SD; P < 0.001. Similarly, the endoscopic Matts grade decreased from 3.4 ± 0.5 to 2.2 ± 0.8 (P = 0.02. Six of 7 patients who were on prednisolone upon enrollment in the study were able to discontinue this corticosteroid. Electron spin resonance revealed that Qing Dai possesses strong hydroxyl radical scavenging activity. Qing Dai showed significant clinical and endoscopic efficacy in patients who failed to respond to conventional medications. Scavenging of hydroxyl radicals appears to be a potential mechanism through which Qing Dai acts, but the significance of the scavenging ability of Qing Dai with respect to the anti-inflammatory effect in UC patients warrants further investigation.

  15. Genetics Home Reference: Lafora progressive myoclonus epilepsy

    Science.gov (United States)

    ... Conditions Lafora progressive myoclonus epilepsy Lafora progressive myoclonus epilepsy Enable Javascript to view the expand/collapse boxes. ... Open All Close All Description Lafora progressive myoclonus epilepsy is a brain disorder characterized by recurrent seizures ( ...

  16. Epilepsy - what to ask your doctor - child

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000222.htm Epilepsy - what to ask your doctor - child To use ... this page, please enable JavaScript. Your child has epilepsy. Children with epilepsy have seizures. A seizure is ...

  17. Epilepsy - what to ask your doctor - adult

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000221.htm Epilepsy - what to ask your doctor - adult To use ... on this page, please enable JavaScript. You have epilepsy. People with epilepsy have seizures. A seizure is ...

  18. Genetics Home Reference: pyridoxine-dependent epilepsy

    Science.gov (United States)

    ... Home Health Conditions pyridoxine-dependent epilepsy pyridoxine-dependent epilepsy Enable Javascript to view the expand/collapse boxes. ... PDF Open All Close All Description Pyridoxine-dependent epilepsy is a condition that involves seizures beginning in ...

  19. The Effect of Lamotrigine on Epilepsy

    Directory of Open Access Journals (Sweden)

    Hossein Ali Ebrahimi

    2012-10-01

    Full Text Available Background:Epilepsy is a common neurologic disorder affecting about 1% of the population (1. The prevalence of active epilepsy in Kerman is 7.87/1000 populations (2. In 23 countries of Asia the rate of epilepsy is the same as USA and Europe. Pharmacotherapy with antiepileptic drugs is the major treatment modality for epilepsy, this could occur as a result of decreased excitation concurrent with increased inhibition (3. Management of epilepsy differs from the treatment of other chronic diseases in which a single breakthrough event has a major negative effect on the quality of life.The past decade has brought many advances to the treatment of epilepsy, including many new pharmacological agents. Lamotrigine is one of the new antiepileptic drugs, which has been used more than two decades. Lamotrigine is effective in partial-onset and secondarily generalized tonic-clonic seizures, primary generalized seizures (i.e., absence seizures and primary generalized tonic-clonic seizures, atypical absence seizures, tonic / atonic seizures and Lennox-Gaustaut syndrome. It is sometimes effective for myoclonic seizures but it can worsen myoclonic seizures in some patients with juvenile myoclonic epilepsy or myoclonic epilepsy of infancy.One of the main advantages of lamotrigine is that it causes less cognitive impairment or overt sedation compared with other treatments (4. An anti-aging effect on animal model in a study has found that lamotrigine decreases mortality and increases lifespan.Lamotrigine has many side effects; the most important ones are allergic reactions, Introducing lamotrigine gradually is one of the keys to reduce the frequency and severity of allergic reactions. Although the incidence of cutaneous reactions to lamotrigine is high, the incidence of serious eruptions such as erythema multiform, Stevens-Johnson syndrome, and toxic epidermal necrolysis is low (5. In this study we evaluated the effects of lamotrigine on epileptic patients

  20. Intractable gelastic seizures during infancy: ictal positron emission tomography (PET) demonstrating epileptiform activity within the hypothalamic hamartoma.

    Science.gov (United States)

    Shahar, Eli; Goldsher, Dorit; Genizi, Jacob; Ravid, Sarit; Keidar, Zohar

    2008-02-01

    Gelastic seizures comprise a very rare form of epilepsy. They present with recurrent bursts of laughter voices without mirth and are most commonly associated with the evolution of a hypothalamic hamartoma. The purpose of this article is to describe the second reported ictal fluorodeoxyglucose-positron emission tomography study in a unique case of an infant with intractable gelastic seizures since the neonatal period associated with a hypothalamic hamartoma. The patient presented at 4 months old with recurrent, almost persistent, gelastic seizures consisting of laughter bouts without mirth. The seizures were noticeable at the first week of life and increased in frequency to last up to 12 hours, namely status gelasticus. These gelastic fits were accompanied with focal motor seizures, including unilateral right-eye blinking and mouth twitching. Developmental mile-stones were intact for age. Magnetic resonance imaging of the cortex demonstrated a large hypothalamic hamartoma within the third ventricle, hampering cerebrovascular fluid drainage of the lateral ventricles. An electroencephalography was nondiagnostic. Ictal fluorodeoxyglucose-positron emission tomography demonstrated a large circumscribed hypermetabolic region within the location of the hypothalamic hamartoma, representing localized intense epileptiform activity. The infant became instantly free of all seizure types given minute doses of oral benzodiazepine (clonazepam) and remains completely controlled after 12 months. Her overall development remains intact. This ictal fluorodeoxyglucose-positron emission tomography is the second reported study verifying that the main source of the epileptic activity inducing gelastic seizures originates from the hypothalamic hamartoma itself; therefore, a complementary fluorodeoxyglucose-positron emission tomography study should be considered in any patient presenting with intractable gelastic seizures, especially in those associated with hypothalamic hamartoma, in order

  1. Management of epilepsy in elderly

    Directory of Open Access Journals (Sweden)

    Harsono Harsono

    2003-03-01

    Full Text Available Management of epilepsy in elderly requires understanding the unique biochemical and pharmacological characteristics of these patients. Management decisions must be based on accurate classification of seizures or epilepsy syndromes, a thorough neurological assessment to define etiology, and a comprehensive assessment of the patient’s health and living situation. Concomitant illnesses such as neurological, psychiatric, metabolic, or cardiac disorders will require individualization of plans and instructions. Specific problems of treatment of epilepsy in the elderly compared to childhood patients are as follows: distinctive range of causes of epilepsy, distinctive differential diagnosis, concurrent pathologies unrelated to epilepsy, pharmacokinetic and pharmacodynamic differences, and distinctive psychosocial effects. (Med J Indones 2003; 12: 40-7 Keywords:  epilepsy, elderly, management, concomitant illness, pharmacokinetic

  2. Diagnostic imaging in focal epilepsy

    International Nuclear Information System (INIS)

    Focal epilepsies account for 60% of all seizure disorders worldwide. In this review the classic and new classification system of epileptic seizures and syndromes as well as genetic forms are discussed. Magnetic resonance (MR) is the technique of choice for diagnostic imaging in focal epilepsy because of its sensitivity and high tissue contrast. The review is focused on the lack of consensus of imaging protocols and reported findings in refractory epilepsy. The most frequently encountered MRI findings in epilepsy are reported and their imaging characteristics are depicted. Diagnosis of hippocampal sclerosis and malformations of cortical development as two major causes of refractory focal epilepsy is described in details. Some promising new techniques as positron emission tomography computed tomography (PET/CT) and MR and PET/CT fusion are briefly discussed. Also the relevance of adequate imaging in focal epilepsy, some practical points in imaging interpretation and differential diagnosis are highlighted. (author)

  3. Confronting the stigma of epilepsy

    Directory of Open Access Journals (Sweden)

    Sanjeev V Thomas

    2011-01-01

    Full Text Available Stigma and resultant psychosocial issues are major hurdles that people with epilepsy confront in their daily life. People with epilepsy, particularly women, living in economically weak countries are often ill equipped to handle the stigma that they experience at multiple levels. This paper offers a systematic review of the research on stigma from sociology and social psychology and details how stigma linked to epilepsy or similar conditions can result in stereotyping, prejudice and discrimination. We also briefly discuss the strategies that are most commonly utilized to mitigate stigma. Neurologists and other health care providers, social workers, support groups and policy makers working with epilepsy need to have a deep understanding of the social and cultural perceptions of epilepsy and the related stigma. It is necessary that societies establish unique determinants of stigma and set up appropriate strategies to mitigate stigma and facilitate the complete inclusion of people with epilepsy as well as mitigating any existing discrimination.

  4. The Role of Investigative Modalities in Epilepsy Work-up

    Directory of Open Access Journals (Sweden)

    Helen Nayeri

    2009-01-01

    Full Text Available "nEpilepsy is a common disorder, affecting 50 million people worldwide. The prevalence of epilepsy has significant medical, social, and economic implications both for the individual and for the society. "nIn evaluating the epilepsy patient, it is helpful to be familiar with the etiologies commonly associated with this disease. Identifiable causes of partial epilepsy have been divided into 5 categories, namely neoplasms, vascular abnormalities, mesial temporal sclerosis (MTS, non-vascular developmental disorders and indeterminate substrates (consisting mostly of non-specific gliosis, traumatic, atrophic or inflammatory abnormalities. In studies of surgical epilepsy patients, hippocampal sclerosis is the most common cause (50% to 70%. "nLocalization of the epileptogenic focus is the major task in preoperative evaluation of surgical candidates. Presently, no single technique can precisely identify the epileptogenic zone. In the past, EEG was essentially the only method of localizing the seizure focus. Accuracy of the noninvasive scalp EEG is limited and often inadequate for preoperative evaluation. "nComputed tomography is the appropriate modality to evaluate the underlying cause of new-onset seizures in the emergent setting. It has little or no role in the evaluation of patients with intractable seizures. In cases of refractory seizures, MR has significantly greater sensitivity for lesion detection than does CT. Because of its ability to depict neuroanatomy, MR is ideally suited for identifying focal brain abnormalities, and it can detect structural lesions with a high degree of sensitivity. The accuracy of MR in determining the substrate category in intractable epilepsy has been reported to be 88%. "nMR and video monitoring EEG are widely available and are the most critical noninvasive studies in the evaluation of the epileptogenic zone. There is an approximately 70% correlation of MRI findings with EEG abnormality for patients with temporal lobe

  5. Neuroimaging of Epilepsy: Therapeutic Implications

    OpenAIRE

    Kuzniecky, Ruben I.

    2005-01-01

    Summary: Neuroimaging has important applications in the diagnosis and treatment of patients with seizures and epilepsy. Having replaced computed tomography (CT) in many situations, MRI is the preferred imaging technique for patients with epilepsy. Advances in radionuclide-based techniques such as single-photon emission CT/positron emission tomography and electromagnetic source imaging with magnetoencephalography are providing new insights into the pathophysiology of epilepsy. In addition, tec...

  6. Temporal lobe epilepsy in children

    Directory of Open Access Journals (Sweden)

    Jayanti Mani

    2008-01-01

    Full Text Available Temporal lobe epilepsy is a fairly homogenous syndrome in adults, with hippocampal sclerosis being the commonest etiology. In children, temporal lobe epilepsy is more commonly due to cortical dysplasia or tumors. The semiology and electrophysiology of temporal lobe seizures in children are distinct from adults and have age-dependent variations. The first-line treatment option in children includes antiepileptic drugs. Ketogenic diet and surgery are therapeutic options in refractory pediatric temporal lobe epilepsy.

  7. Epilepsy in pediatric patients. Selection of investigations; Epilepsie de l`enfant: quels examens

    Energy Technology Data Exchange (ETDEWEB)

    Bulteau, C.; Adamsbaum, C.; Cieuta, C.; Chiron, C. [Hopital Saint-Vincent-de-Paul, 75 - Paris (France)

    1996-04-01

    Epilepsy is a chronic condition whose diagnosis rests on clinical and electro-encephalographic criteria. Computed tomography or magnetic resonance imaging demonstrates a Cause in 25 % of cases. An international classification has been developed that is useful for evaluating the prognosis, the course, and the effect of treatments. Although the pathophysiology of epilepsy has not yet been elucidated, it is hoped that recently-developed functional imaging and genetic techniques will shed new light on this problem. Although neuro-psychologic studies can be of use for localizing the epileptic focus, few age specific reference values have been reported. Laboratory tests are indicated when occasional seizures or metabolic disorders are suspected, as well as in epileptic children with worsening seizures or possible side effects of drugs. (author). 13 refs., 2 figs., 2 tabs.

  8. The Gap between Intractable Problem and Adaptive Chosen Ciphertext Security

    Institute of Scientific and Technical Information of China (English)

    LU Xian-hui; LAI Xue-jia; HE Da-ke

    2009-01-01

    To describe the design approaches of IND-CCA2 (adaptive chosen ciphertext attack) secure public key encryption schemes systematically, the gaps between different kinds of intractable problems and IND-CCA2 security are studied. This paper points out that the construction of IND-CCA2 secure schemes is essentially to bridge these gaps. These gaps are categorized, analyzed and measured. Finally the methods to bridge these gaps are described. This explains the existing design approaches and gives an intuition about the difficulty of designing IND-CCA2 secure public key encryption schemes based on different types of assumptions.

  9. Reduction in temporal N-acetylaspartate and creatine (or choline) ratio in temporal lobe epilepsy: does this 1H-magnetic resonance spectroscopy finding mean poor seizure control?

    OpenAIRE

    Mendes-Ribeiro, J.; Soares, R.,; Simoes-Ribeiro, F.; Guimaraes, M

    1998-01-01

    BACKGROUND—Proton magnetic resonance spectroscopy (1H-MRS) is a potentially useful tool in the in vivo investigation of brain metabolites in intractable temporal lobe epilepsy (TLE). Focal N-acetylaspartatate (NAA) reductions have been correlated with mesial temporal sclerosis (MTS) in surgically resected epileptogenic foci.
OBJECTIVE—To evaluate the abnormalities in the metabolites NAA, creatine+ phosphocreatine (Cr), and choline containing compounds (Cho) in the tempora...

  10. Triple pathological findings in a surgically amenable patient with mesial temporal lobe epilepsy

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    Fumin Tong

    2015-01-01

    Full Text Available Mesial temporal sclerosis (MTS is a well-recognized cause of intractable epilepsy; however, coexistence with focal cortical dysplasia (FCD is less common. Middle fossa epidermoid cysts are rare and may involve the temporal lobe. Most epidermoids are clinically silent, slow-growing, and seldom associated with overt symptomatology, including seizures. We describe a patient with multiple comorbidities including left MTS and a large epidermoid cyst involving the left quadrigeminal plate cistern compressing upon the cerebellar vermis and tail of the left hippocampus, resulting in refractory left temporal lobe epilepsy. The patient underwent left anterior temporal lobectomy. The surgical pathology demonstrated a third pathological finding of left temporal FCD type Ia. The patient has been seizure-free since the surgery. This case provides additional information with regard to the understanding of epileptogenicity and surgical planning in patients with MTS and epidermoid cysts.

  11. Necessity of cooperation with government on publication of scientific research results for intractable diseases

    OpenAIRE

    Inagaki, Yoshinori; Song, Peipei

    2013-01-01

    The features of intractable diseases make it an important public health issue and a challenge to medical care worldwide. Investigation of intractable diseases with the support of government is urgently expected to activate clinical and pharmaceutical research to promote diagnosis and treatment for patients with intractable diseases. Moreover, linkage to the international database for research achievement is also necessary so that both researchers and other general citizens can assess research...

  12. Epilepsie u psů

    OpenAIRE

    Čechová, Aneta

    2013-01-01

    Epilepsy is one of the most common neurological disorders in dogs. It is manifested in the form of repeated seizures which arise by irritation of brain. Epilepsy can be caused by brain damage, but more often we meet with hereditary character of the disease with so-called idiopathic epilepsy. Idiopathic epilepsy can not be cured, only reduced. Therapy is for life, in the form of regular use of human anti – epileptics. In recent years the interest in this disease rises, because the...

  13. Rolandic epilepsy and dyslexia

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    Ecila P. Oliveira

    2014-11-01

    Full Text Available Objective Although benign epilepsy with centrotemporal spikes (BECTS is an idiopathic, age-related epilepsy syndrome with favorable outcome, recent studies have shown impairment in specific neuropsychological tests. The objective of this study was to analyze the comorbidity between dyslexia and BECTS. Method Thirty-one patients with clinical and electroencephalographic diagnosis of BECTS (group A and 31 paired children (group B underwent a language and neuropsychological assessment performed with several standardized protocols. Our findings were categorized as: a dyslexia; b other difficulties; c without difficulties. Our results were compared and statistically analyzed. Results Our data showed that dyslexia occurred in 19.4% and other difficulties in 74.2% of our patients. This was highly significant when compared with the control group (p<0.001. Phonological awareness, writing, reading, arithmetic, and memory tests showed a statistically significant difference when comparing both groups. Conclusion Our findings show significant evidence of the occurrence of dyslexia in patients with BECTS.

  14. Burns and epilepsy.

    Science.gov (United States)

    Berrocal, M

    1997-01-01

    This is a report of the first descriptive analytic study of a group of 183 burn patients, treated in the Burn Unit at the University Hospital of Cartagena, Colombia during the period since January 1985 until December 1990. There is presented experience with the selected group of 24 patients in whom the diagnosis of burn was associated with epilepsy. There is also analysed and described the gravity of the scars sequels, neurological disorders, the complication of the burn and an impact of this problem on the patient, his (her) family and the community. It is very important to report that there was found Neurocisticercosis in 66.6% of the group of burn patients with epilepsy, and it is probably the first risk factor of burn in this group. PMID:9212488

  15. Impaired Consciousness in Epilepsy

    OpenAIRE

    Blumenfeld, Hal

    2012-01-01

    Consciousness is essential to normal human life. In epileptic seizures consciousness is often transiently lost making it impossible for the individual to experience or respond. This has huge consequences for safety, productivity, emotional health and quality of life. To prevent impaired consciousness in epilepsy it is necessary to understand the mechanisms leading to brain dysfunction during seizures. Normally the “consciousness system”—a specialized set of cortical-subcortical structures—mai...

  16. Dietary Therapies for Epilepsy

    OpenAIRE

    Kossoff, Eric H.; Huei-Shyong Wang

    2013-01-01

    Since their introduction in 1921, high-fat, low-carbohydrate "ketogenic" diets have been used worldwide for refractory childhood epilepsy. Approximately half of the children have at least half their seizures reduced, including 15% who are seizure free. The mechanisms of action of dietary therapies are under active investigation and appear to involve mitochondria. Once perceived as a last resort, modifications to initiation and maintenance, as well as the widespread use of pre-made ketogenic f...

  17. Neuroreceptor imaging in epilepsy

    International Nuclear Information System (INIS)

    The neurochemical processes that mediate seizures in humans are not fully understood. PET has contributed to our understanding of the neurochemical abnormalities of epilepsy with studies of cerebral metabolism and, more recently, regional neuroreceptor binding. We have focused on inhibitory neurotransmitter receptors that may (1) be decreased, thus facilitating seizure initiation, or (2) increase in response to seizure activity. Opiate receptors are believed to mediate anticonvulsant effects of the endogenous opioids. Accordingly, [11 C]carfentanil, a ligand selective for the mu-opiate receptor, displays increased binding in temporal neocortex ipsilateral to seizure foci in complex partial epilepsy. This finding is consistent with activation of the endogenous opiate system in response to seizure activity. [11C]diprenorphine, a ligand that labels mu-, delta- and kappa-opiate receptors with equal affinity, shows little or no change in temporal cortex. Together, these findings suggest a decrease in delta- or kappa-receptors. The development of delta- and kappa-selective receptor ligands will help to elucidate the involvement of these opiate receptors in human epilepsy. The benzodiazepine-GABA receptor complex is the most prevalent in mediating inhibitory brain processes. Use of the benzodiazepine (BZD) receptor ligand [11C]RO 15-1788 has shown decreases in BZD receptors in human epilepsy in one study, but this has not been observed in a current study. Thus, the existence of reduced inhibitory processes that might enhance seizure initiation remains uncertain at present. Future studies of receptors for excitatory transmitters will provide additional insight into alternate factors potentially responsible for the initiation of seizures

  18. Citation classics in epilepsy

    Directory of Open Access Journals (Sweden)

    Maryann Wilson

    2013-01-01

    Full Text Available BACKGROUND: The impact of a scientific article is proportional to the citations it has received. In this study, we set out to identify the most cited works in epileptology in order to evaluate research trends in this field. METHODS: According to the Web of Science database, articles with more than 400 citations qualify as "citation classics". We conducted a literature search on the ISI Web of Science bibliometric database for scientific articles relevant to epilepsy. RESULTS: We retrieved 67 highly cited articles (400 or more citations, which were published in 31 journals: 17 clinical studies, 42 laboratory studies, 5 reviews and 3 classification articles. Clinical studies consisted of epidemiological analyses (n=3, studies on the clinical phenomenology of epilepsy (n=5 – including behavioral and prognostic aspects – and articles focusing on pharmacological (n=6 and non-pharmacological (n=3 treatment. The laboratory studies dealt with genetics (n=6, animal models (n=27, and neurobiology (n=9 – including both neurophysiology and neuropathology studies. The majority (61% of citation classics on epilepsy were published after 1986, possibly reflecting the expansion of research interest in laboratory studies driven by the development of new methodologies, specifically in the fields of genetics and animal models. Consequently, clinical studies were highly cited both before and after the mid 80s, whilst laboratory researches became widely cited after 1990. CONCLUSIONS: Our study indicates that the main drivers of scientific impact in the field of epileptology have increasingly become genetic and neurobiological studies, along with research on animal models of epilepsy. These articles are able to gain the highest numbers of citations in the time span of a few years and suggest potential directions for future research.

  19. Neuroimaging in Epilepsy

    OpenAIRE

    Mahmoud Motamedi

    2009-01-01

    Introduction: The assessment of the problem of seizures requires knowledge of the clinical details and features of the seizures, the functional abnormality in the brain as shown on the EEG, and the structural assessment of the brain with an MRI study optimized for epilepsy. Usually MRI or computed tomographic (CT) scan should be performed in evaluating the cause of a newly diagnosed seizure disorder. MRI is preferred over CT because of its greater sensitivity and specificity for identifying s...

  20. Safety of repetitive transcranial magnetic stimulation in patients with epilepsy: A systematic review.

    Science.gov (United States)

    Pereira, Luisa Santos; Müller, Vanessa Teixeira; da Mota Gomes, Marleide; Rotenberg, Alexander; Fregni, Felipe

    2016-04-01

    Approximately one-third of patients with epilepsy remain with pharmacologically intractable seizures. An emerging therapeutic modality for seizure suppression is repetitive transcranial magnetic stimulation (rTMS). Despite being considered a safe technique, rTMS carries the risk of inducing seizures, among other milder adverse events, and thus, its safety in the population with epilepsy should be continuously assessed. We performed an updated systematic review on the safety and tolerability of rTMS in patients with epilepsy, similar to a previous report published in 2007 (Bae EH, Schrader LM, Machii K, Alonso-Alonso M, Riviello JJ, Pascual-Leone A, Rotenberg A. Safety and tolerability of repetitive transcranial magnetic stimulation in patients with epilepsy: a review of the literature. Epilepsy Behav. 2007; 10 (4): 521-8), and estimated the risk of seizures and other adverse events during or shortly after rTMS application. We searched the literature for reports of rTMS being applied on patients with epilepsy, with no time or language restrictions, and obtained studies published from January 1990 to August 2015. A total of 46 publications were identified, of which 16 were new studies published after the previous safety review of 2007. We noted the total number of subjects with epilepsy undergoing rTMS, medication usage, incidence of adverse events, and rTMS protocol parameters: frequency, intensity, total number of stimuli, train duration, intertrain intervals, coil type, and stimulation site. Our main data analysis included separate calculations for crude per subject risk of seizure and other adverse events, as well as risk per 1000 stimuli. We also performed an exploratory, secondary analysis on the risk of seizure and other adverse events according to the type of coil used (figure-of-8 or circular), stimulation frequency (≤1Hz or >1Hz), pulse intensity in terms of motor threshold (safety review, the corresponding confidence intervals contained both risks

  1. Impact of Childhood Epilepsy on the Family

    Directory of Open Access Journals (Sweden)

    Kerim Fazlıoglu

    2010-08-01

    Full Text Available Whole family is affected when an illness appears in the family or when there is an uncertainty regarding the health of a member. Symptoms, therapy, course of the disorder, constraint of the daily activities and long term effects of childhood chronic diseases deeply impact health and structure of the families. Diagnosis of a chronic disease in children presents as a significant psychological and psychosocial risk factor to the parents and other family members. Despite these known facts, psychosocial problems of parents of epileptic children are often ignored and not even questioned. These parents frequently have to leave their jobs or ask for their elderly relatives to look after their children. This situation could lead to major financial and social problems, weakening in intrafamilial communication and disruption in family harmony. Childhood epilepsy brings a great strain on family’s resources as other chronic diseases do and alter the life of significant others. According to biopsychosocial model, schemas in family relations influence the psychological process of the family members while the biopsychosocial process of the sick individual affect the functionality of the family. In other words, epilepsy affects not only the sick individual but also the family union. The family has to face many problems after definite diagnosis of epilepsy. Majority of the studies conducted on this issue mainly focused on the quality of life and family relations of the sick child, whereas only a few studies searched for possible burden and resulting problems of family members caused by epilepsy. Physicians in charge should not only focus on physical and mental health of the sick children but also on the problems of other members in the family bearing in mind psychosocial influences of the disorder on them. Additionally, preventive methods should be administered to protect the family from developing mental health problems. A multidiscipline training program

  2. Dietary Therapies for Epilepsy

    Directory of Open Access Journals (Sweden)

    Eric H Kossoff

    2013-02-01

    Full Text Available Since their introduction in 1921, high-fat, low-carbohydrate "ketogenic" diets have been used worldwide for refractory childhood epilepsy. Approximately half of the children have at least half their seizures reduced, including 15% who are seizure free. The mechanisms of action of dietary therapies are under active investigation and appear to involve mitochondria. Once perceived as a last resort, modifications to initiation and maintenance, as well as the widespread use of pre-made ketogenic formulas have allowed dietary treatment to be used earlier in the course of epilepsy. For infantile spasms (West syndrome specifically, the ketogenic diet is successful about 50% of the time as a first-line treatment. New "alternative" diets such as the modified Atkins diet were created in 2003 and can be started more easily and are less restrictive. They may have particular value for countries in Asia. Side effects include constipation, dyslipidemia, growth slowing, acidosis, and kidney stones. Additionally, neurologists are studying ketogenic diets for conditions other than epilepsy, including Alzheimer's disease, autism, and brain tumors.

  3. [Epilepsy and Canon Law].

    Science.gov (United States)

    Bonduelle, M

    1987-01-01

    The Canon Law (Codex Iuris Canonici), promulgated in 1917, was a classification of laws and jurisprudence which ruled the early Church, governed the ecclesiastical condition of Roman Church until its reorganisation in 1983. It forbade to be ordained or to exercise orders already received to "those who are or were epileptics either not quite in their right mind or possessed by the Evil One". All the context and in particular the paragraph which treated of bodily lacks, indicated that between these three conditions, there was juxtaposition and no confusion. The texts specified the foundations of these dispositions, not in a malefic view of epilepsy inherited from Morbus Sacer of Antiquity, but in decency and on account of risk incured by Eucharist in case of fit. Some derogations could attenuate the severity of these dispositions--as jurisprudence had taken progresses of Epileptology and therapeutics into consideration. In the new Code of Canon Law (1983) physical disabilities were removed from the text and also possessed evil and epilepsy, the only impediment being "insanity or other psychic defect" appreciation of which is done by experts. Concerning poorly controlled epilepsies, we believe that experts will be allowed to express their opinion and a new jurisprudence will make up for the silence of the law. PMID:3310183

  4. Purinergic signaling in epilepsy.

    Science.gov (United States)

    Rassendren, François; Audinat, Etienne

    2016-09-01

    Until recently, analysis of the mechanisms underlying epilepsy was centered on neuron dysfunctions. Accordingly, most of the available pharmacological treatments aim at reducing neuronal excitation or at potentiating neuronal inhibition. These therapeutic options can lead to obvious secondary effects, and, moreover, seizures cannot be controlled by any known medication in one-third of the patients. A purely neurocentric view of brain functions and dysfunctions has been seriously questioned during the past 2 decades because of the accumulation of experimental data showing the functional importance of reciprocal interactions between glial cells and neurons. In the case of epilepsy, our current knowledge of the human disease and analysis of animal models clearly favor the involvement of astrocytes and microglial cells during the progression of the disease, including at very early stages, opening the way to the identification of new therapeutic targets. Purinergic signaling is a fundamental feature of neuron-glia interactions, and increasing evidence indicates that modifications of this pathway contribute to the functional remodeling of the epileptic brain. This Review discusses the recent experimental results indicating the roles of astrocytic and microglial P2X and P2Y receptors in epilepsy. © 2016 Wiley Periodicals, Inc. PMID:27302739

  5. Zonisamide Efficacy as Adjunctive Therapy in Children With Refractory Epilepsy

    Directory of Open Access Journals (Sweden)

    Parvaneh KARIMZADEH

    2013-06-01

    Full Text Available How to Cite This Article: Karimzadeh P, Ashrafi MR, Bakhshandeh Bali MK, Nasehi MM, Taheri Otaghsara SM, Taghdiri MM, Ghofrani M. ZonisamideEfficacy as Adjunctive Therapy in Children With Refractory Epilepsy. Iran J Child Neurol. 2013 Spring; 7(2:37-42.ObjectiveApproximately one third of epileptic children do not achieve complete seizure improvement. Zonisamide is a new antiepileptic drug which is effective as adjunctive therapy in treatment of intractable partial seizures.The purpose of the current study was to evaluate the effectiveness, safety, and tolerability of Zonisamide in epileptic children.Materials & MethodsFrom November 2011 until October 2012, 68 children who referred to Children’s Medical Center and Mofid Children Hospital due to refractory epilepsy (failure of seizure control with the use of two or more anticonvulsant drugs entered the study. The patients were treated with Zonisamide by dose of 2- 12 mg/kg daily in addition to the previous medication. We followed the children every three to four-weeks intervals based on daily frequency, severity and duration of seizures. During the follow-up equal and more than fifty percent reduction in seizurefrequency or severity known as response to the drug.ResultsIn this study 68 patients were examined that 61 children reached the last stage.35 (57.4% were male and 26 (42.6% patients were female.After first and six months of Zonisamide administration daily seizure frequency decreased to 2.95±3.54 and 3.73±3.5 respectively. There was significant difference between seizure frequency in first and six month after Zonisamide toward initial attacks. After six months ZNS therapy a little side effects were created in 10 patients (16.4% including stuttering(4.9%, decreased appetite (4.9%, hallucination (1.6%, dizziness(1.6%, blurred vision(1.6% and suspiring(1.6% as all of them eliminated later dosage reduction.ConclusionThis study confirms the short term efficacy and safety of Zonisamide in

  6. Plerixafor may treat intractable post-herpetic neuralgia.

    Science.gov (United States)

    Xie, Fang; Li, Xueyang; Bao, Mengmeng; Guo, Ruijuan; Zhang, Chen; Wu, Anshi; Yue, Yun; Guan, Yun; Wang, Yun

    2015-10-01

    Varicella-zoster virus (VZV) causes varicella (chicken pox) and establishes latency in ganglia. A reactivation of latent VZV leads to herpes zoster (shingles). Herpes zoster often causes herpetic pain that can last for months or years after the rash has healed. Prolonged herpetic pain is defined as post-herpetic neuralgia (PHN). There is an unmet need to explore novel therapeutic approaches for intractable PHN. Postmortem studies have shown that VZV induces neuro-inflammation and damage to the ganglia and spinal cord. These pathological changes may be critical factors resulting in PHN. Accumulated evidence suggests that stem cells may alleviate neuropathic pain in animal models through immunomodulatory actions and neuronal repair. Unfortunately, exogenous stem cell transplantation has limited clinical use due to safety concerns, immune rejection, and complications. Pharmacological mobilization of endogenous bone marrow stem cells may overcome these obstacles. Plerixafor is a SDF-1/CXCR4 axis blocker which can stimulate the release of stem cells from the bone marrow into blood circulation. We propose a hypothesis that endogenous stem cells mobilized by plerixafor may relieve the symptoms of PHN. If so, it may represent a novel approach for the treatment of intractable PHN. PMID:26175195

  7. Understanding of Epilepsy by Children and Young People with Epilepsy

    Science.gov (United States)

    Lewis, Ann; Parsons, Sarah

    2008-01-01

    There is a striking dearth of studies focusing sensitively and in depth on the mainstream educational experiences of children with epilepsy, as viewed by those children themselves. The one-year project (2006-7) reported here addresses that gap. Children's perceptions about mainstream teachers' understanding of epilepsy and school-based needs are…

  8. Metabolic changes in occipital lobe epilepsy with automatisms

    Directory of Open Access Journals (Sweden)

    ChongHWong

    2014-07-01

    Full Text Available Purpose: Some studies suggest that the pattern of glucose hypometabolism relates not only to the ictal-onset zone, but also reflects seizure propagation. We investigated metabolic changes in patients with occipital lobe epilepsy (OLE that may reflect propagation of ictal discharge during seizures with automatisms. Methods: Fifteen patients who had undergone epilepsy surgery for intractable OLE and had undergone interictal Fluorine-18-fluorodeoxyglucose positron emission tomography (18F-FDG-PET between 1994 and 2004 were divided into two groups (with and without automatisms during seizure. Significant regions of hypometabolism were identified by comparing 18F-FDG-PET results from each group with 16 healthy controls by using Statistical Parametric Mapping (SPM 2. Key Findings: Significant hypometabolism was confined largely to the epileptogenic occipital lobe in the patient group without automatisms. In patients with automatisms, glucose hypometabolism extended from the epileptogenic occipital lobe into the ipsilateral temporal lobe. Significance: We identified a distinctive hypometabolic pattern that was specific for OLE patients with automatisms during a seizure. This finding supports the postulate that seizure propagation is a cause of glucose hypometabolism beyond the region of seizure onset.

  9. Enhanced expression of potassium-chloride cotransporter KCC2 in human temporal lobe epilepsy

    DEFF Research Database (Denmark)

    Karlócai, Mária R; Wittner, Lucia; Tóth, Kinga;

    2016-01-01

    volume. Using immunocytochemistry, we examined the cellular and subcellular levels of KCC2 in surgically removed hippocampi of temporal lobe epilepsy (TLE) patients and compared them to control human tissue. We also studied the distribution of KCC2 in a pilocarpine mouse model of epilepsy. An overall...... increase in KCC2-expression was found in epilepsy and confirmed by Western blots. The cellular and subcellular distributions in control mouse and human samples were largely similar; moreover, changes affecting KCC2-expression were also alike in chronic epileptic human and mouse hippocampi. At the...

  10. Focal epilepsies in adult patients attending two epilepsy centers

    DEFF Research Database (Denmark)

    Gilioli, Isabella; Vignoli, Aglaia; Visani, Elisa;

    2012-01-01

    PURPOSE: To classify the grade of antiepileptic drug (AED) resistance in a cohort of patients with focal epilepsies, to recognize the risk factors for AED resistance, and to estimate the helpfulness of "new-generation" AEDs. METHODS: We included 1,155 adults with focal epilepsies who were observed...... consecutively after 1990 and followed regularly at two epilepsy centers. We systematically collected the clinical, diagnostic, and therapeutic data using a custom-written database. We classified the patients as seizure-free or AED resistant according to the International League Against Epilepsy (ILAE) criteria...... the 729 patients with symptomatic focal epilepsies and was positively associated with electroencephalography (EEG) abnormalities, seizure type, and the presence of mesial temporal sclerosis. Among 426 patients without detectable causes, the percentage of AED resistance was significantly lower (39...

  11. Developmental dyscalculia in children and adolescents with idiopathic epilepsies in a Brazilian sample

    OpenAIRE

    Ursula Thomé; Sandra Regina da Paixão Alves; Sabrina Mendonça Guerreiro; Célia Regina Carvalho Machado da Costa; Fernanda de Souza Moreira; Andrea Bandeira Lima; Maria Rita Ferreira Tavares; Heber de Souza Maia Filho

    2014-01-01

    Epilepsy is one of the most prevalent chronic disorders of childhood which can threaten child development and mental health. Among cognitive disorders, dyscalculia is one of the most important. In this study, 39 children and adolescents with idiopathic epilepsy underwent clinical and neuropsychological assessment to determine the intellectual level, math skills, reading and writing performance and neuropsychological profile. It was observed that the mathematical ability was below schooling ex...

  12. Validity of the Neurology Quality of Life (Neuro-QoL) Measurement System in Adult Epilepsy

    OpenAIRE

    Victorson, David; Cavazos, Jose E.; Gregory L Holmes; Reder, Anthony T.; Wojna, Valerie; Nowinski, Cindy; Miller, Deborah; Buono, Sarah; Mueller, Allison; Moy, Claudia; Cella, David

    2013-01-01

    Epilepsy is a chronic neurological disorder that results in recurring seizures and can have a significant adverse effect on health related quality of life (HRQL). Neuro-QoL is an NINDS-funded system of patient reported outcome measures for neurology clinical research, which was designed to provide a precise and standardized way to measure HRQL in epilepsy and other neurological disorders. Using mixed-methods and item response theory-based approaches, we developed generic ite...

  13. Experience in Endovascular Treatment of Recurrent Chronic Subdural Hematoma

    OpenAIRE

    Ishihara, H.; Ishihara, S.; Kohyama, S.; Yamane, F.; Ogawa, M.; A. Sato; Matsutani, M.

    2007-01-01

    Most cases with chronic subdural hematoma (CSDH) are treated by simple irrigation and drainage, then more than eighty percent of them result in good recovery. But we sometimes encounter intractable cases with hematoma re-collection, which is considered of repeated bleeding from macrocapillary in the hematoma capsule. Embolization of the middle meningeal artery (MMA) is considered to be useful to eliminate the blood supply to this structure. The authors experienced seven cases of intractable C...

  14. Neuroimaging in Epilepsy

    Directory of Open Access Journals (Sweden)

    Mahmoud Motamedi

    2009-01-01

    Full Text Available Introduction: The assessment of the problem of seizures requires knowledge of the clinical details and features of the seizures, the functional abnormality in the brain as shown on the EEG, and the structural assessment of the brain with an MRI study optimized for epilepsy. Usually MRI or computed tomographic (CT scan should be performed in evaluating the cause of a newly diagnosed seizure disorder. MRI is preferred over CT because of its greater sensitivity and specificity for identifying small lesions."nBecause there is an option of surgical excision of the "seizure focus," which may cure the patient, the detection of a focal abnormality of the brain is important for the formulation of the reason for the seizures and the options available for treatment. Knowledge of the brain abnormalities early in the course of treating the patient greatly helps the management of each individual. The challenge to epileptologists is that the problem of epilepsy is a special one, which requires optimized protocols dedicated to it."nMRI interpretation is different when used in a screening way and when viewed in the context of other investigations. This is particularly important when the patient has partial seizures and may be considered for surgical treatment."nMost centers that deal with epilepsy spend a great deal of time in ensuring the quality of their EEG and EEG interpretation. However, unless there is a radiologist with an interest in epilepsy or an epileptologist who spends time with radiologist colleagues, it can be difficult to establish good epilepsy-focused MRI with appropriate sequences, radiography, and interpretation. MRI acquisition and interpretation need to be focused on the problem of epilepsy."nIndication"nThe American academy of neurology has published practice parameters for neuroimaging (NI studies (MRI, CT of patients having a first seizure. Emergent NI (scan immediately should be performed when a health care provider suspects a serious

  15. Partial Epilepsy with Auditory Features

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2004-07-01

    Full Text Available The clinical characteristics of 53 sporadic (S cases of idiopathic partial epilepsy with auditory features (IPEAF were analyzed and compared to previously reported familial (F cases of autosomal dominant partial epilepsy with auditory features (ADPEAF in a study at the University of Bologna, Italy.

  16. Electroencephalography in dogs with epilepsy

    DEFF Research Database (Denmark)

    Berendt, Martin Ole; Høgenhaven, H; Flagstad, Annette Borgbjerg;

    1999-01-01

    To investigate the diagnostic value of electroencephalography (EEG) in dogs with epilepsy, applying human criteria for EEG abnormalities observed with this disorder.......To investigate the diagnostic value of electroencephalography (EEG) in dogs with epilepsy, applying human criteria for EEG abnormalities observed with this disorder....

  17. The Music Student with Epilepsy

    Science.gov (United States)

    Murdock, Matthew C.; Morgan, Joseph A.; Laverghetta, Thomas S.

    2012-01-01

    The teacher-student relationship can afford the music educator an opportunity to be the first to identify behaviors associated with epilepsy. A case of a student with epilepsy, based on the authors' experience, is described in which the music educators were the first and only individuals to become aware of a change in the student's behavior, after…

  18. The Mozart Effect and Epilepsy

    OpenAIRE

    J Gordon Millichap

    2011-01-01

    Researchers at Kaohsiung Medical University and other centers in Taiwan studied the long-term effect of listening to Mozart K-448 (Sonata for Two Pianos in D major) on the frequency of epileptiform discharges in children with epilepsy, and analyzed the relationship between the number of epileptiform discharges and foci of origin, epilepsy etiology, age, IQ, and gender.

  19. VNS in drug resistant epilepsy: preliminary report on a small group of patients

    Directory of Open Access Journals (Sweden)

    Iero Luisa

    2010-04-01

    Full Text Available Abstract Background In 1997 Vagus Nerve Stimulation (VNS received approval from the US Food and Drug Administration (FDA as an adjunctive therapy in the treatment of medically intractable partial epilepsy in people aged 12 years and older who are ineligible for resective epilepsy surgery. Although the exact mechanisms of action are unknown, the use of VNS with children has increased, including those younger than 12 years of age, or those with generalized epilepsy. Methods We describe the outcome for the first group of nine patients, aged 8-28 years, who had pharmaco-resistant epilepsy and were treated with VNS. During the follow up, we gradually and slowly increased the parameters of the stimulation in order to assess the efficacy of VNS even at parameters which would usually be considered "non-therapeutic", along with possible side effects and changes in quality of life. Results At the last follow, up 1 patient was "seizures free", 3 were "very good responders", 3 were "good responders" and 2 were "non responders". We obtained an initial seizure reduction with low stimulation parameters, the highest current reached being 2.00 mA. This observation supports the possibility that, for younger patients, lower stimulation intensities than those commonly used in clinical practice for adults can be therapeutic. We also wanted to underline the reduction in seizure frequency (~91,7% and the reduction in seizure duration (> 50% in the patients affected by drug-resistant absence epilepsy. Adverse effects were mild, tolerable and, in most of cases, easily resolved by adjusting the stimulation parameters. Hoarseness of voice was the most frequent side effect. The improvements in the quality of life are relevant and seem to be independent of the VNS effect in controlling seizures. Conclusions Our small experience seems to confirm the efficacy and safety of VNS in drug resistant partial and generalized epilepsy in developing age groups.

  20. 38 CFR 4.122 - Psychomotor epilepsy.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Psychomotor epilepsy. 4... Psychomotor epilepsy. The term psychomotor epilepsy refers to a condition that is characterized by seizures... psychomotor epilepsy vary from patient to patient and in the same patient from seizure to seizure. (b)...

  1. The social and economic consequences of epilepsy

    DEFF Research Database (Denmark)

    Jennum, Poul; Gyllenborg, Jesper; Kjellberg, Jakob

    2011-01-01

    Epilepsy causes a significant burden to patients and to society. We aimed to calculate the factual excess in direct and indirect costs associated with epilepsy.......Epilepsy causes a significant burden to patients and to society. We aimed to calculate the factual excess in direct and indirect costs associated with epilepsy....

  2. Intractable vomiting caused by vertebral artery compressing the medulla: A case report

    Directory of Open Access Journals (Sweden)

    Lauren Gorton

    2015-01-01

    Full Text Available Vertebral artery compressing the medulla and causing intractable vomiting has only been reported once previously. We report a case of a 69-year-old woman with intractable nausea and vomiting causing a 50 pound weight loss and who failed medical management and whose symptoms were completely reversed following microvascular decompression (MVD.

  3. Accounting for Comorbidity in Assessing the Burden of Epilepsy Among US Adults: Results from the National Comorbidity Survey Replication (NCS-R)

    OpenAIRE

    Lane, Michael C; Stang, Paul E.; Kessler, Ronald; Shahly, Vicki

    2012-01-01

    Although epilepsy is associated with substantial role impairment, it is also highly comorbid with other physical and mental disorders, making unclear the extent to which impairments associated with epilepsy are actually due to comorbidities. This issue was explored in the National Comorbidity Survey Replication (NCS-R), a nationally representative household survey of 5,692 US adults. Medically-recognized epilepsy was ascertained with self-report, comorbid physical disorders with a chronic con...

  4. Epilepsie und psychiatrische Erkrankungen

    Directory of Open Access Journals (Sweden)

    Baumgartner C

    2008-01-01

    Full Text Available Psychiatrische Erkrankungen treten bei Epilepsiepatienten signifikant häufiger auf als in der Allgemeinbevölkerung und als bei Patienten mit anderen chronischen Erkrankungen. Die Depression stellt die häufigste psychiatrische Begleiterkrankung bei Epilepsie dar. Die Häufigkeit von Depressionen korreliert mit der Anfallskontrolle: Sie liegt zwischen 3 und 9 % bei gut kontrollierter Epilepsie, jedoch zwischen 20 und 55 % bei Patienten mit therapieresistenten Epilepsien. Umgekehrt ist bei Patienten mit neu diagnostizierten Epilepsien anamnestisch signifikant häufiger eine Depression zu erheben als in einem Vergleichskollektiv. Diese bidirektionale Beziehung zwischen Epilepsie und Depression könnte durch gemeinsame Pathomechanismen beider Erkrankungen erklärt werden. Obwohl das Vorliegen und der Schweregrad einer Depression die wichtigsten Prädiktoren für die Lebensqualität bei Epilepsiepatienten darstellen, werden Depressionen bei Epilepsiepatienten unterdiagnostiziert und unterbehandelt. Eine psychopharmakologische Behandlung sollte bei Vorliegen einer Begleitdepression deshalb unverzüglich initiiert werden, das epileptogene Potential von Antidepressiva stellt dabei ein vernachlässigbares Risiko dar. Die Prävalenz psychotischer Störungen bei Epilepsiepatienten liegt zwischen 2 und 8 %, wobei sogenannte episodische Psychosen (iktale, postiktale und Alternativpsychosen, die in einem zeitlichen Bezug zum Anfallsgeschehen stehen, und chronische Psychosen (interiktale Psychosen ohne zeitlichen Bezug zu den Anfällen, unterschieden werden können. Die Prävalenz von Angststörungen bei Epilepsiepatienten liegt zwischen 15 und 25 %. Man kann zwischen präiktaler, iktaler, postiktaler und interiktaler Angst unterscheiden.

  5. [Palliative Care for Neurological Intractable Diseases and Home Medical Support].

    Science.gov (United States)

    Yokoyama, Kazumasa; Ogino, Mieko; Ishigaki, Yasunori; Hattori, Nobutaka

    2015-08-01

    Many medical doctors regard the end stage and palliative care of neurological intractable diseases as the point at which aggressive treatment should be interrupted and death is imminent. However, the definition of health by the World Health Organization as the physical, psychological, and social goal to achieve a fully favorable health condition should be revisited. In the real clinical setting, the health condition, as the ability to adapt and self-manage in the face of social, physical, and emotional challenges with the aim to overcome stress (resilience), is dynamic and involves a healthy condition and satisfaction with one's own living. The most important step in palliative therapy that is shared by neurologists is the maintenance of the health status with the help of multi-disciplinary team with the view to improving the quality of life. PMID:26241362

  6. Disembodiment and Identity in Literary Depictions of Epilepsy Surgery.

    Science.gov (United States)

    Vaccarella, Maria

    2015-01-01

    This article explores the often perplexing experience of being an epilepsy surgery candidate, as portrayed in four book-length accounts: Laura Doermer's Moritz mein Sohn (Moritz my son, 1990), David B.'s L'ascension du haut mal (The ascent of the high evil, 1996; published in English as Epileptic, 2003), Ray Robinson's Electricity (2006), and Alberto Capitta's Il giardino non esiste (The garden doesn't exist, 2009). Building upon critical disability studies and the work of French poststructuralists Gilles Deleuze and Félix Guattari, I analyze issues of embodiment, identity and narrative (re)construction in the postsurgical alleviation of chronic illness. I argue that these texts highlight the inevitable disruption of self that brain surgery entails and ultimately resist biomedical normativization. They also call for a narratological reconsideration of current illness narrative typologies, among which Arthur Frank's "chaos narrative" emerges as the best suited to accommodate the chronic fragmentation of consciousness and voice in epilepsy. PMID:26095838

  7. Video electroencephalogram telemetry in temporal lobe epilepsy

    OpenAIRE

    Jayanti Mani

    2014-01-01

    Temporal lobe epilepsy (TLE) is the most commonly encountered medically refractory epilepsy. It is also the substrate of refractory epilepsy that gives the most gratifying results in any epilepsy surgery program, with a minimum use of resources. Correlation of clinical behavior and the ictal patterns during ictal behavior is mandatory for success at epilepsy surgery. Video electroencephalogram (EEG) telemetry achieves this goal and hence plays a pivotal role in pre-surgical assessment. The ro...

  8. Efficacy of Iranian Traditional Medicine in the Treatment of Epilepsy

    OpenAIRE

    Mehri Abdollahi Fard; Asie Shojaii

    2013-01-01

    Epilepsy is a brain disorder which affects about 50 million people worldwide. Ineffectiveness of the drugs in some cases and the serious side effects and chronic toxicity of the antiepileptic drugs lead to use of herbal medicine as a form of complementary and alternative medicine. In this review modern evidences for the efficacy of antiepileptic medicinal plants in Traditional Iranian Medicine (TIM) will be discussed. For this purpose electronic databases including PubMed, Scopus, Sciencedire...

  9. Genetic Causes of Generalized Epilepsies.

    Science.gov (United States)

    Helbig, Ingo

    2015-06-01

    Generalized epilepsies, particularly the idiopathic or genetic generalized epilepsies (GGEs), represent some of the most common epilepsies. Clinical genetic data including family studies and twin studies provide compelling evidence for a prominent genetic impact. The first decade of the 21st century was marked by progress in understanding the basic biology of generalized epilepsies including generalized/genetic epilepsies with febrile seizures plus (GEFS+) and GGE through studies of large families, discovering causative mutations in SCN1A, SCN1B, GABRG2, and GABRA1. Subsequently, recurrent microdeletions at 15q13.3, 16p13.11, and 15q11.2 were found to be relevant risk factors for nonfamilial GGE. Genes for epileptic encephalopathies such as SLC2A1 were rediscovered in GGE, highlighting the biological continuum between different epilepsies. Genome-wide studies examining common genetic risk factors identified common variants in SCN1A, indicating a convergence of shared pathophysiological pathways in various types of epilepsies. In the era of next-generation sequencing, however, the GGEs appear more complex than expected, and small or moderately sized studies give only a limited genetic perspective. Thus, there is a strong impetus for large collaborative investigations on an international level. PMID:26060908

  10. Managing epilepsy in pregnancy

    Directory of Open Access Journals (Sweden)

    Sanjeev V Thomas

    2011-01-01

    Full Text Available There are close to one and half million women with epilepsy (WWE in reproductive age group in India. WWE have several unique gender-specific problems in the biological and social domains. Women experience more social stigma from epilepsy and have more difficulty with education and employment. They have more difficulty to get married and sustain successful family life. Reproductive hormones like estrogen and progesterone have opposing effect on seizure threshold. WWE have increased risk of infertility. About 10% of their babies may have major congenital malformations. Most of the adverse biological outcomes for WWE are related to adverse effects of antiepileptic drugs (AEDs. Traditional AEDs like phenobarbitone and sodium valproate are probably associated with increased risk of fetal malformations or other adverse fetal outcomes. Polytherapy and use of high dose of any AED is associated with higher risk fetal complications. It is very important that all WWE have a preconception evaluation done by a neurologist, when the need to continue AEDs or possibility of reducing AED load could be assessed. All WWE need to take folic acid 5 mg daily during preconception period and pregnancy. They should undergo a detailed screening for fetal malformations between 12 and 18 weeks of pregnancy. The neurologist, gynecologist, imageologist and pediatrician need to work as a team while managing pregnancy in WWE. It is important to reassure WWE and their relatives that pregnancy is safe in WWE and their children are healthy in more than 90% instances.

  11. Progressive Myoclonus Epilepsies.

    Science.gov (United States)

    Kälviäinen, Reetta

    2015-06-01

    The progressive myoclonus epilepsies (PMEs) comprise a group of rare and heterogeneous disorders defined by the combination of action myoclonus, epileptic seizures, and progressive neurologic deterioration. Neurologic deterioration may include progressive cognitive decline, ataxia, neuropathy, and myopathy. The gene defects for the most common forms of PME (Unverricht-Lundborg disease, Lafora disease, several forms of neuronal ceroid lipofuscinoses, myoclonus epilepsy with ragged-red fibers [MERRF], and type 1 and 2 sialidoses) have been identified. The prognosis of a PME depends on the specific disease. Lafora disease, the neuronal ceroid lipofuscinoses, and the neuronopathic form of Gaucher disease have an invariably fatal course. In contrast, Unverricht-Lundborg disease has a much slower progression, and with adequate care many patients have a normal life span. The specific diseases that cause PME are diagnosed by recognition of their age of onset, the associated clinical symptoms, the clinical course, the pattern of inheritance, and by special investigations such as enzyme measurement, skin/muscle biopsy, or gene testing. PMID:26060909

  12. Progressive myoclonic epilepsy.

    Science.gov (United States)

    Satishchandra, P; Sinha, S

    2010-01-01

    Progressive myoclonic epilepsy (PME) is a disease complex and is characterized by the development of relentlessly progressive myoclonus, cognitive impairment, ataxia, and other neurologic deficits. It encompasses different diagnostic entities and the common causes include Lafora body disease, neuronal ceroid lipofuscinoses, Unverricht-Lundborg disease, myoclonic epilepsy with ragged-red fiber (MERRF) syndrome, sialidoses, dentato-rubro-pallidal atrophy, storage diseases, and some of the inborn errors of metabolism, among others. Recent advances in this area have clarified molecular genetic basis, biological basis, and natural history, and also provided a rational approach to the diagnosis. Most of the large studies related to PME are from south India from a single center, National Institute of Mental Health and Neurological Sciences (NIMHANS), Bangalore. However, there are a few case reports and small series about Lafora body disease, neuronal ceroid lipofuscinoses and MERRF from India. We review the clinical and research experience of a cohort of PME patients evaluated at NIMHANS over the last two decades, especially the phenotypic, electrophysiologic, pathologic, and genetic aspects. PMID:20739785

  13. Progressive myoclonic epilepsy

    Directory of Open Access Journals (Sweden)

    Satishchandra P

    2010-01-01

    Full Text Available Progressive myoclonic epilepsy (PME is a disease complex and is characterized by the development of relentlessly progressive myoclonus, cognitive impairment, ataxia, and other neurologic deficits. It encompasses different diagnostic entities and the common causes include Lafora body disease, neuronal ceroid lipofuscinoses, Unverricht-Lundborg disease, myoclonic epilepsy with ragged-red fiber (MERRF syndrome, sialidoses, dentato-rubro-pallidal atrophy, storage diseases, and some of the inborn errors of metabolism, among others. Recent advances in this area have clarified molecular genetic basis, biological basis, and natural history, and also provided a rational approach to the diagnosis. Most of the large studies related to PME are from south India from a single center, National Institute of Mental Health and Neurological Sciences (NIMHANS, Bangalore. However, there are a few case reports and small series about Lafora body disease, neuronal ceroid lipofuscinoses and MERRF from India. We review the clinical and research experience of a cohort of PME patients evaluated at NIMHANS over the last two decades, especially the phenotypic, electrophysiologic, pathologic, and genetic aspects.

  14. SPECT in Focal Epilepsies

    Directory of Open Access Journals (Sweden)

    Roderick Duncan

    2000-01-01

    Full Text Available Brain perfusion changes during seizures were first observed in the 1930s. Single Photon Emission Computed Tomography (SPECT was developed in the 1970s, and tracers suitable for the imaging of regional cerebral perfusion (rCP became available in the 1980s. The method was first used to study rCP in the interictal phase, and this showed areas of low perfusion in a proportion of cases, mainly in patients with temporal lobe epilepsies. However, the trapping paradigm of tracers such as hexamethyl propyleneamine oxime (HMPAO provided a practicable method of studying changes in rCP during seizures, and a literature was established in the late 1980s and early 1990s showing a typical sequence of changes during and after seizures of mesial temporal lobe origin; the ictal phase was associated with large increases in perfusion throughout the temporal lobe, with first the lateral, then the mesial temporal lobe becoming hypoperfused in the postictal phase. Activation and inhibition of other structures, such as the basal ganglia and frontal cortex, were also seen. Studies of seizures originating elsewhere in the brain have shown a variety of patterns of change, according to the structures involved. These changes have been used practically to aid the process of localisation of the epileptogenic zone so that epilepsy surgery can be planned.

  15. Radiological diagnosis in epilepsy

    International Nuclear Information System (INIS)

    Results: Hippocampal sclerosis, the most frequent cause of focal epilepsy, can be detected with 90-98% sensitivity by visual analysis and quantitative signal and volume measurement of the hippocampi in high-resolution coronal T2-weighted MR images. Benign tumors, such as gangliogliomas and dysembryoplastic neuoepithelial tumors (DNT), as well as cortical dysplasias are frequently composed of cystic and solid parts, which may show calcification, but never edema. Bloodbrain-barrier disruption as seen in approximately 40% of the benign tumors are the only feature that allows to differentiate them from non-neoplastic dysplasias. In rare cases of totally calcified lesions, CT may be the only diagnostic imaging modality. Proton-density-weighted or FLAIR imaging is essential for the detection of small solid cortical lesion components, because they provide sufficient contrast with adjacent CSF. T1-weighted inversion recovery images are most sensitive for the detection of migration and gyration abnormalities. The depiction of calcified lesions and hemosiderin deposits after trauma is most efficient with T2* weighted gradient echo sequences. Conclusions: With further rapid improvent of high resolution MRI techniques, the near future will probably show that nearly 100% of focal epilepsies are caused by structural brain abnormalities. With refined imaging techniques applied, the sensitivity of neuroradiological evaluation is 90% at present. Therefore presurgical MRI plays a key role in epilespy surgery. (orig.)

  16. Natural approaches to epilepsy.

    Science.gov (United States)

    Gaby, Alan R

    2007-03-01

    This article reviews research on the use of diet, nutritional supplements, and hormones in the treatment of epilepsy. Potentially beneficial dietary interventions include identifying and treating blood glucose dysregulation, identifying and avoiding allergenic foods, and avoiding suspected triggering agents such as alcohol, aspartame, and monosodium glutamate. The ketogenic diet may be considered for severe, treatment-resistant cases. The Atkins diet (very low in carbohydrates) is a less restrictive type of ketogenic diet that may be effective in some cases. Nutrients that may reduce seizure frequency include vitamin B6, magnesium, vitamin E, manganese, taurine, dimethylglycine, and omega-3 fatty acids. Administration of thiamine may improve cognitive function in patients with epilepsy. Supplementation with folic acid, vitamin B6, biotin, vitamin D, and L-carnitine may be needed to prevent or treat deficiencies resulting from the use of anticonvulsant drugs. Vitamin K1 has been recommended near the end of pregnancy for women taking anticonvulsants. Melatonin may reduce seizure frequency in some cases, and progesterone may be useful for women with cyclic exacerbations of seizures. In most cases, nutritional therapy is not a substitute for anticonvulsant medications. However, in selected cases, depending on the effectiveness of the interventions, dosage reductions or discontinuation of medications may be possible. PMID:17397265

  17. Pulsed radiofrequency on radial nerve under ultrasound guidance for treatment of intractable lateral epicondylitis.

    Science.gov (United States)

    Oh, Dae Seok; Kang, Tae Hyung; Kim, Hyae Jin

    2016-06-01

    Lateral epicondylitis is a painful and functionally limiting disorder. Although lateral elbow pain is generally self-limiting, in a minority of people symptoms persist for a long time. When various conservative treatments fail, surgical approach is recommended. Surgical denervation of several nerves that innervate the lateral humeral epicondyle could be considered in patients with refractory pain because it denervates the region of pain. Pulsed radiofrequency is a minimally invasive procedure that improves chronic pain when applied to various neural tissues without causing any significant destruction and painful complication. This procedure is safe, minimally invasive, and has less risk of complications relatively compared to the surgical approach. The radial nerve can be identified as a target for pulsed radiofrequency lesioning in lateral epicondylitis. This innovative method of pulsed radiofrequency applied to the radial nerve has not been reported before. We reported on two patients with intractable lateral epicondylitis suffering from elbow pain who did not respond to nonoperative treatments, but in whom the ultrasound-guided pulsed radiofrequency neuromodulation of the radial nerve induced symptom improvement. After a successful diagnostic nerve block, radiofrequency probe adjustment around the radial nerve was performed on the lateral aspect of the distal upper arm under ultrasound guidance and multiple pulsed treatments were applied. A significant reduction in pain was reported over the follow-up period of 12 weeks. PMID:26896944

  18. Neuromodulation of chronic headaches

    DEFF Research Database (Denmark)

    Martelletti, Paolo; Jensen, Rigmor H; Antal, Andrea;

    2013-01-01

    The medical treatment of patients with chronic primary headache syndromes (chronic migraine, chronic tension-type headache, chronic cluster headache, hemicrania continua) is challenging as serious side effects frequently complicate the course of medical treatment and some patients may be even...... medically intractable. When a definitive lack of responsiveness to conservative treatments is ascertained and medication overuse headache is excluded, neuromodulation options can be considered in selected cases.Here, the various invasive and non-invasive approaches, such as hypothalamic deep brain...... proper RCT-based evidence is limited. The European Headache Federation herewith provides a consensus statement on the clinical use of neuromodulation in headache, based on theoretical background, clinical data, and side effect of each method. This international consensus further gives recommendations for...

  19. Submikroskopiske kromosomforandringer disponerer til epilepsi

    DEFF Research Database (Denmark)

    Møller, Rikke; Hjalgrim, Helle

    2011-01-01

    Idiopathic generalised epilepsies (IGEs) affect up to 0.3% of the general population. Genetic factors play a predominant role in the aetiology of IGEs. Molecular genetic studies have mainly identified causative gene mutations in rare monogenic forms of idiopathic epilepsies. However, the genetic...... variants predisposing to common IGE syndromes remain elusive. Identification of recurrent microdeletions at 1q21.1, 15q11.2, 15q13.3, 16p11.2, 16p13.11 and 22q11.2 as rare but significant risk factors for IGE has provided new insights into the complex genetic predisposition of common epilepsies....

  20. Talking about epilepsy: Challenges parents face when communicating with their child about epilepsy and epilepsy-related issues.

    Science.gov (United States)

    O'Toole, Stephanie; Lambert, Veronica; Gallagher, Pamela; Shahwan, Amre; Austin, Joan K

    2016-04-01

    The aim of this qualitative study was to explore the challenges that parents of children with epilepsy experienced when engaging in dialog with their child about epilepsy and epilepsy-related issues. Using a qualitative exploratory approach, interviews were conducted with 34 parents of children with epilepsy (aged 6-16years), consisting of 27 mothers and 7 fathers. Data were transcribed verbatim and thematically analyzed. Findings revealed five main themes: normalizing epilepsy, the invisibility of epilepsy, information concealment, fear of misinforming the child, and difficulty in discussing particular epilepsy-related issues. Many of the communicative challenges experienced by parents impacted on their ability to engage openly in parent-child dialog about epilepsy in the home. Parents face specific challenges when choosing to communicate with their child about epilepsy, relating to creating a sense of normality, reducing fear of causing their child worry, and having a lack of epilepsy-related knowledge. Healthcare professionals who work closely with families living with epilepsy should remain mindful of the importance of discussing family communication surrounding epilepsy and the challenges parents of children with epilepsy face when talking about epilepsy within the home. PMID:26900774

  1. [Parental attitude and adjustment to childhood epilepsy].

    Science.gov (United States)

    Ju, S H; Chang, P F; Chen, Y J; Huang, C C; Tsai, J J

    1990-01-01

    Parental attitude and adjustment were examined in 20 epileptic children (ages 6.8-16.6 yrs), using semi-structured interview. The results indicated that parental understandings of epilepsy were generally poor and incorrect. Fifteen (75%) of 20 parents had their own interpretations of causality and 19 (95%) had unrealistic hope for early and complete cure. Parents tended to overprotect and overrestrict their children. Sixteen (80%) concealed the illness for fear of social prejudice, therefore the social support systems were generally poorly utilized. As in other chronic diseases, all parents went through feelings of shock, denial, anger, guilt, fear, anxiety and depression. Family relationships were not affected much, however, poor communications were commonly found between parents and children. Thirteen (65%) parents never talked to their children about epilepsy. We concluded that parents of epileptic children showed negative attitudes toward their children and had difficulties in their psychosocial adjustment probably related to social stigmata and misunderstanding of the illness. Therefore, communication between physician and parents in both medical and psychosocial aspects should be encouraged. PMID:2275364

  2. Caregiver Burden in Epilepsy: Determinants and Impact

    Directory of Open Access Journals (Sweden)

    Ioannis Karakis

    2014-01-01

    Full Text Available Aim. Caregiver burden (CB in epilepsy constitutes an understudied area. Here we attempt to identify the magnitude of this burden, the factors associated with it, and its impact to caregiver quality of life (QOL. Methods. 48 persons with epilepsy (PWE underwent video-EEG monitoring and their caregivers completed questionnaires providing demographic, disease-related, psychiatric, cognitive, sleep, QOL, and burden information. Results. On regression analysis, higher number of antiepileptic drugs, poorer patient neuropsychological performance, lower patient QOL score, and lower caregiver education level were associated with higher CB. Time allocated to patient care approximated but did not attain statistical significance. A moderate inverse correlation between CB and caregiver QOL physical component summary score and a stronger inverse correlation between CB and caregiver QOL mental component summary score were seen. Conclusion. In a selected cohort of PWE undergoing video-EEG monitoring, we identified modest degree of CB, comparable to that reported in the literature for other chronic neurological conditions. It is associated with specific patient and caregiver characteristics and has a negative effect on caregiver QOL.

  3. Frequencies and implications of discordant findings of interictal SPECT and itcal SPECT in patients with intractable epilepsy

    International Nuclear Information System (INIS)

    Interictal SPECT could be used at best as a reference image to ictal SPECT, and cause sometimes confusion if it had given unexplained discordant findings from ictal SPECT. We investigated implications of discordant findings which occurred in 26 among 268 which found their epileptogenic zones using ictal EEG and/or operative outcome. Sensitivity of interictal SPECT was only 36%. Among these 268, 69 patients had no structural lesions on MR, 14 of whom had decreased perfusion on interictal SPECT (8 trues and 6 falses (adjacent or contralateral)). Structural lesion were found in 199 on MR, 103 of whom had decreased perfusion (89 trues and 14 falses). Among 26 having discordant cases, 10 interictal SPECT were proved wrong after operation and/or invasive EEG and the other 16 were on speculation using PET and ictal EEG. Ictal hyperperfusion was observed in 14 patients in these interictal SPECT. Six ictal studies were found postictal accompanied by contralateral propagation or not. Two patients had dual pathology, and the remaining 2 unknown. Interictal SPECT was done on the 2nd day after ictal study(24), the 3rd day (18), the 4th day(16), the 5th day (23). Four among 24 interictal studies (17%) of the 2nd day and the other 4 among 57 of 3rd to 5th day revealed ictal hyperperfusion on interictal SPECT. Six interictal studies (2.7% among 221) acquired on the indifferent day showed also ictal hyperperfusion. We could suggest that the next day is not desirable for interictal SPECT after ictal study, as ictal hyperperfusion on interictal study confounded more than postictal findings of ictal SPECT in the discrete localization than reassuring ictal study

  4. Epilepsy in Adults with TSC

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    Full Text Available ... epilepsy to discuss these medication issues with her health care providers. Additionally, some anticonvulsant medications can interact with ... hormones, seizures, and medications. Issues of Importance for Health Care Providers An important point for adults with TSC ...

  5. Epilepsy in Adults with TSC

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    Full Text Available ... Brochures, Books, & Booklets Information Sheets Perspective Magazine Archives Life Stages Guides & Personal Journals TSC Research Article Summaries ... will have epilepsy at some point in their life. The majority of individuals with TSC will face ...

  6. Epilepsy in Adults with TSC

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    Full Text Available ... either new-onset seizures or ongoing epilepsy. Recent studies indicate that more than 80% of individuals with ... trials and see a list of current trials/studies related to TSC. Enroll now in the Rare ...

  7. Absence Epilepsy and Moyamoya Disease

    OpenAIRE

    J Gordon Millichap

    2006-01-01

    The case of a 6-year-old girl with typical absence epilepsy associated with moyamoya disease (MMD) is reported from the Department of Neurosurgery, Kyoto University Graduate School of Medicine, Japan.

  8. Epilepsy in Adults with TSC

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    Full Text Available ... best quality of life possible, so they should work with the caregivers to reach a balance between ... the treatment of epilepsy in adults with TSC. Working with a knowledgeable neurologist, you should identify the ...

  9. Epilepsy in Adults with TSC

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    Full Text Available ... look depends on which part of the brain has the “lightning storm”. There are many underlying causes ... is critical for a woman with TSC who has epilepsy to discuss these medication issues with her ...

  10. Epilepsy in Adults with TSC

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    Full Text Available ... and Seizures Epilepsy is any brain disorder that causes repeated, spontaneous seizures of any type. Seizures (sometimes ... convulsions) are episodes of disturbed brain function that cause changes in attention or behavior. They are caused ...

  11. Epilepsy in Adults with TSC

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    Full Text Available ... vagus nerve stimulator, responsive neurostimulation, surgery and dietary therapies. Anti-Epileptic Medications: There are numerous choices of ... should consult with an epilepsy surgery program. Dietary Therapy: The ketogenic diet is a diet that is ...

  12. Epilepsy in Adults with TSC

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    Full Text Available ... effect of one medication. Hormones play an important role in sexual function, and some men with epilepsy ... Brochures & Booklets Information Sheets Life Stages Guides & Personal Journals Perspective Magazine Archives TSC Clinics Physician Referral TSC ...

  13. Epilepsy in Adults with TSC

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    Full Text Available ... History Database Tissue Donation Audio & Video Archives Brochures, Books, & Booklets Information Sheets Perspective Magazine Archives Life Stages ... Scientific Advisory Board 2015 International TSC Research Conference Text Size Get Involved EPILEPSY IN ADULTS WITH TSC ...

  14. Epilepsy in Adults with TSC

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    Full Text Available ... everolimus) was approved by the Food and Drug Administration (FDA) in October 2010 for treatment of TSC- ... epilepsy to discuss these medication issues with her health care providers. Additionally, some anticonvulsant medications can interact ...

  15. Epilepsy in Adults with TSC

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  16. Epilepsy in Adults with TSC

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    Full Text Available ... 525-4526). If you are transitioning from a pediatric neurologist to an adult neurologist then ask that ... epilepsy to discuss these medication issues with her health care providers. Additionally, some anticonvulsant medications can interact ...

  17. Epilepsy in Adults with TSC

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  18. Epilepsy in Adults with TSC

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    Full Text Available ... Epilepsy is any brain disorder that causes repeated, spontaneous seizures of any type. Seizures (sometimes called "fits" ... Rated Nonprofit by GreatNonprofits Member of the National Organization for Rare Disease Rare Disease Report America's Charities/ ...

  19. Epilepsy in Adults with TSC

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    Full Text Available ... complex (TSC) face many medical issues as they age, including either new-onset seizures or ongoing epilepsy. ... will face the onset of seizures before the age of 3. However, it is not uncommon for ...

  20. Epilepsy in Adults with TSC

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    Full Text Available ... Afinitor® (everolimus) was approved by the Food and Drug Administration (FDA) in October 2010 for treatment of ... pill might be appropriate for women using epilepsy drugs that affect the rate at which the liver ...

  1. Epilepsy in Adults with TSC

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    Full Text Available ... centers in a large city and/or an academic center near you (for a listing of epilepsy ... onset seizures. Occasionally, the onset of seizures will result from a buildup of pressure in the brain ...

  2. Epilepsy in Adults with TSC

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    Full Text Available ... should discuss with their doctors various treatment options. These might include increasing the dose of an anti- ... adults with epilepsy, so look for one of these centers in a large city and/or an ...

  3. Epilepsy in Adults with TSC

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    Full Text Available ... of life. If individuals with TSC experience an increase in frequency or severity of their seizures or ... advised for women with LAM, so it is critical for a woman with TSC who has epilepsy ...

  4. Epilepsy in Adults with TSC

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    Full Text Available ... epilepsy to discuss these medication issues with her health care providers. Additionally, some anticonvulsant medications can interact ... hormones, seizures, and medications. Issues of Importance for Health Care Providers An important point for adults with ...

  5. Epilepsy in Adults with TSC

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    Full Text Available ... ED is a side effect of one medication. Hormones play an important role in sexual function, and some men with epilepsy have alterations in normal hormone levels. Both seizures and anti-epileptic medications can ...

  6. Epilepsy and Fine Motor Function

    OpenAIRE

    J Gordon Millichap; Millichap, John J.

    2014-01-01

    Investigators at Kocaeli University, Pediatric Neurology OP Clinic, Turkey, studied the relationship between fine motor skills and seizure and treatment parameters in 44 children with rolandic epilepsy (RE) and compared to 44 healthy controls.

  7. Epilepsy in Adults with TSC

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    Full Text Available ... many medical issues as they age, including either new-onset seizures or ongoing epilepsy. Recent studies indicate ... not uncommon for adults with TSC to develop new seizures or to experience a return of seizures ...

  8. Epilepsy in Adults with TSC

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    Full Text Available ... seizures with 1-3 minute episodes of altered thinking, consciousness, or behaviors. Complex partial seizure is a ... advised for women with LAM, so it is critical for a woman with TSC who has epilepsy ...

  9. Epilepsy in Adults with TSC

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    Full Text Available ... SEGAs that are not candidates for curative surgery. Evaluation of New-Onset Seizures All individuals with new- ... epilepsy will experience changes in sexual drive and performance. For example, many men report a decrease in ...

  10. Epilepsy in Adults with TSC

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    Full Text Available ... have epilepsy is to achieve the best seizure control possible while maintaining the best quality of life. ... and ED. In fact, when seizures are under control, people seem to have improved sexual desire and ...

  11. Epilepsy in Adults with TSC

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    Full Text Available ... epilepsy will experience changes in sexual drive and performance. For example, many men report a decrease in ... people seem to have improved sexual desire and performance. Men experiencing ED should visit a urologist to ...

  12. Epilepsy in Adults with TSC

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    Full Text Available ... fits" or convulsions) are episodes of disturbed brain function that cause changes in attention or behavior. They ... medication. Hormones play an important role in sexual function, and some men with epilepsy have alterations in ...

  13. Experimental therapy of epilepsy with transcranial magnetic stimulation: lack of additional benefit with prolonged treatment

    Directory of Open Access Journals (Sweden)

    Brasil-Neto Joaquim P.

    2004-01-01

    Full Text Available OBJECTIVE: To investigate the effect of three months of low-frequency repetitive transcranial magnetic stimulation (rTMS treatment in intractable epilepsy. METHODS: Five patients (four males, one female; ages 6 to 50 years, were enrolled in the study; their epilepsy could not be controlled by medical treatment and surgery was not indicated. rTMS was performed twice a week for three months; patients kept records of seizure frequency for an equal period of time before, during, and after rTMS sessions. rTMS was delivered to the vertex with a round coil, at an intensity 5 % below motor threshold. During rTMS sessions, 100 stimuli (five series of 20 stimuli, with one-minute intervals between series were delivered at a frequency of 0.3 Hz. RESULTS: Mean daily number of seizures (MDNS decreased in three patients and increased in two during rTMS- one of these was treated for only one month; the best result was achieved in a patient with focal cortical dysplasia (reduction of 43.09 % in MDNS. In the whole patient group, there was a significant (p<0.01 decrease in MDNS of 22.8 %. CONCLUSION: Although prolonged rTMS treatment is safe and moderately decreases MDNS in a group of patients with intractable epilepsy, individual patient responses were mostly subtle and clinical relevance of this method is probably low. Our data suggest, however, that patients with focal cortical lesions may indeed benefit from this novel treatment. Further studies should concentrate on that patient subgroup.

  14. Epilepsy in Dante's poetry.

    Science.gov (United States)

    Mula, Marco

    2016-04-01

    Dante Alighieri is the greatest Italian poet and one of the most important writers in Western literature. He is best known for the epic poem "Commedia", later named "La Divina Commedia" that has profoundly influenced not only poetic imagination but also all subsequent allegorical creations of imaginary worlds in literature. This paper examines the poetic description of some episodes of loss of consciousness in Dante's poetry discussing how and why typical elements of epileptic seizures have been used. On the 750th anniversary of Dante's birth, his poetry still remains to be an inspiring source of debate and reflection. This article is part of a Special Issue entitled "Epilepsy, Art, and Creativity". PMID:26907926

  15. Presurgical evaluation of epilepsy

    Directory of Open Access Journals (Sweden)

    Manas Panigrahi

    2008-01-01

    Full Text Available The objective of the multimodality presurgical evaluation in patients with refractory epilepsy is to establish sufficient concordance among the various investigations. There should be maximum overlap in the epileptogenic zone, the irritative zone, the ictal onset zone, the functional deficit zone and the symptomatogenic zone. The ictal and interictal electroencephalogram measures the localization of epileptiform discharges, which should be concordant with structural abnormalities noted on MRI brain and functional abnormalities in the form of a zone of hypometabolism on fluorodeoxyglucose positron emission tomography, interictal single photon emission computerized tomography (SPECT or hyperperfusion of the epileptogenic zone on ictal SPECT for a good surgical outcome. There should be no conflicting data from any of these studies, neuropsychological evaluation or seizure semiology.

  16. Argon Plasma Coagulation Therapy Versus Topical Formalin for Intractable Rectal Bleeding and Anorectal Dysfunction After Radiation Therapy for Prostate Carcinoma

    International Nuclear Information System (INIS)

    Purpose: To evaluate and compare the effect of argon plasma coagulation (APC) and topical formalin for intractable rectal bleeding and anorectal dysfunction associated with chronic radiation proctitis. Methods and Materials: Thirty men (median age, 72 years; range, 49-87 years) with intractable rectal bleeding (defined as ≥1× per week and/or requiring blood transfusions) after radiation therapy for prostate carcinoma were randomized to treatment with APC (n=17) or topical formalin (n=13). Each patient underwent evaluations of (1) anorectal symptoms (validated questionnaires, including modified Late Effects in Normal Tissues–Subjective, Objective, Management, and Analytic and visual analogue scales for rectal bleeding); (2) anorectal motor and sensory function (manometry and graded rectal balloon distension); and (3) anal sphincteric morphology (endoanal ultrasound) before and after the treatment endpoint (defined as reduction in rectal bleeding to 1× per month or better, reduction in visual analogue scales to ≤25 mm, and no longer needing blood transfusions). Results: The treatment endpoint was achieved in 94% of the APC group and 100% of the topical formalin group after a median (range) of 2 (1-5) sessions of either treatment. After a follow-up duration of 111 (29-170) months, only 1 patient in each group needed further treatment. Reductions in rectal compliance and volumes of sensory perception occurred after APC, but no effect on anorectal symptoms other than rectal bleeding was observed. There were no differences between APC and topical formalin for anorectal symptoms and function, nor for anal sphincteric morphology. Conclusions: Argon plasma coagulation and topical formalin had comparable efficacy in the durable control of rectal bleeding associated with chronic radiation proctitis but had no beneficial effect on anorectal dysfunction

  17. Identifying Family History and Substance Use Associations for Adult Epilepsy from the Electronic Health Record.

    Science.gov (United States)

    Wang, Yan; Chen, Elizabeth S; Leppik, Ilo; Pakhomov, Serguei; Sarkar, Indra Neil; Melton, Genevieve B

    2016-01-01

    Epilepsy is a prevalent chronic neurological disorder afflicting about 50 million people worldwide. There is evidence of a strong relationship between familial risk factors and epilepsy, as well as associations with substance use. The goal of this study was to explore the interactions between familial risk factors and substance use based on structured data from the family and social history modules of an electronic health record system for adult epilepsy patients. A total of 8,957patients with 38,802 family history entries and 8,822 substance use entries were gathered and mined for associations at different levels of granularity for three age groupings (>18, 18-64, and ≥65 years old). Our results demonstrate the value of an association rule mining approach to validate knowledge of familial risk factors. The preliminary findings also suggest that substance use does not demonstrate significant association between social and familial risk factors for epilepsy. PMID:27570679

  18. NEW ASPECTS OF THE PATHOGENESIS OF EPILEPSY

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    Rano Bahodirovna Azizova

    2014-11-01

    Full Text Available We studied 52 patients with epilepsy with the average age of 36.2±14.7 years old. Of them, 38 patients had idiopathic epilepsy, 14 patients had symptomatic epilepsy. Our study has shown that epilepsy is accompanied with increased levels of autoantibodies to NF-200, GFAP, S100, MBP, DNA, GABA and dopamine receptors, testifying to the important role of autoimmune disturbances in the pathogenesis of epilepsy. More severe attacks are accompanied by worsening of neuroimmune dysregulation. The degree and duration of autoimmune process can serve additional diagnostic and prognostic criteria for epilepsies.

  19. Clinical characteristics of patients with benign nonlesional temporal lobe epilepsy

    Directory of Open Access Journals (Sweden)

    Kim J

    2016-07-01

    Full Text Available Jiyeon Kim,1 Seong Hoon Kim,2 Sung Chul Lim,2 Woojun Kim,2 Young-Min Shon3 1Department of Neurology, Korea University Ansan Hospital, College of Medicine, Korea University, Ansan, 2Department of Neurology, Catholic Neuroscience Institute, College of Medicine, The Catholic University of Korea, Seocho-gu, 3Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Purpose: To evaluate the evolution of nonlesional temporal lobe epilepsy (TLE-NL in patients treated exclusively with antiepileptic drugs and to elucidate clinical phenotypes related to the prognosis of these patients.Methods: Clinical, radiological, and electroencephalographic (EEG findings in 84 patients with TLE-NL were reviewed. A good response group (GRG and a poor response group (PRG were defined if the duration of their seizure-free period was >1 year, or <1 year, respectively.Results: There were 46 (54.8% patients in the GRG and 38 (45.2% patients in the PRG. The number of antiepileptic drugs administered was significantly lower in the GRG than that in the PRG (1.3±0.8 vs 2.8±1.0, respectively; P<0.05. The GRG had a significantly older age of onset than the PRG and a lower occurrence of initial precipitating events, such as febrile seizures, central nervous system infection, and head trauma (P<0.05. The prevalence of EEG abnormality, presence of aura, generalized seizures, and automatism was less frequently observed in the GRG (P<0.05. Multivariate analysis showed that the presence of automatism and initial precipitating events were significantly associated with a poor prognosis (P<0.05.Conclusion: In contrast to the commonly assumed intractability of TLE, we found that more than 54% of patients with TLE-NL achieved a long seizure-free period. Older age at onset of TLE-NL was associated with a better prognosis. However, the presence of automatism and initial precipitating events were related to a poor prognosis. Future prospective

  20. Sustained improvement of intractable rheumatoid arthritis after total lymphoid irradiation

    International Nuclear Information System (INIS)

    Total lymphoid irradiation (TLI) was administered to 11 patients who had intractable rheumatoid arthritis that was unresponsive to conventional medical therapy, including aspirin, multiple nonsteroidal antiinflammatory drugs, gold salts, and D-penicillamine. Total lymphoid irradiation was given as an alternative to cytotoxic drugs such as azathioprine and cyclophosphamide. After radiotherapy, 9 of the 11 patients showed a marked improvement in clinical disease activity as measured by morning stiffness, joint tenderness, joint swelling, and overall functional abilities. The mean improvement of disease activity in all patients ranged from 40-70 percent and has persisted throughout a 13-28 month followup period. This improvement permitted the mean daily steroid dose to be reduced by 54%. Complications included severe fatigue and other constitutional symptoms during radiotherapy, development of Felty's syndrome in 1 patient, and an exacerbation of rheumatoid lung disease in another. After therapy, all patients exhibited a profound T lymphocytopenia, and a reversal in their T suppressor/cytotoxic cell to helper cell ratio. The proliferative responses of peripheral blood mononuclear cells to phytohemagglutinin, concanavalin A, and allogeneic leukocytes (mixed leukocyte reaction) were markedly reduced, as was in vitro immunoglobulin synthesis after stimulation with pokeweed mitogen. Alterations in T cell numbers and function persisted during the entire followup period, except that the mixed leukocyte reaction showed a tendency to return to normal values

  1. Treatment with interventional peritoneovenous shunts for intractable ascites

    International Nuclear Information System (INIS)

    Objective: To evaluate the value of the interventional peritoneovenous shunts (IPVS)for intractable ascites (IA). Methods: The passageway was built between abdominal cavity and superior vena cava(SVC)in 45 patients with IA. The pressure of abdominal cavity and SVC were measured during operation, the abdominal girth and the amount of urine were recorded after the operation. Results: The successful rate of operation was 100% with operation time of 20-40 min. The average difference of pressure between abdominal cavity and SVC was 129.3 cm H2O. The abdominal girth began to reduce 2 days later, and reduced obviously since then with an average of 7.8 cm. Simultaneously, the amount of urine obviously increased after operation with an average of 770 ml/d. The total effective rate reached 77.8% with no serious complications. Conclusion: IPVS has advantages of simple operation, minimal trauma and convenient for patients with IA nursing themselves etc. and thus improve the living quality of patients exactly. (authors)

  2. Endovascular Treatment of Traumatic Pseudoaneurysm Presenting as Intractable Epistaxis

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Chang wei; Xie, Xiao dong; You, Chao; Mao, Bo yong; Wang, Chao hua; He, Min; Sun, Hong [Sichuan University West China Hospital, Chengdu (China)

    2010-12-15

    To investigate the clinical efficacy of individual endovascular management for the treatment of different traumatic pseudo aneurysms presenting as intractable epistaxis. For 14 consecutive patients with traumatic pseudo aneurysm presenting as refractory epistaxis, 15 endovascular procedures were performed. Digital subtraction angiography revealed that the pseudo aneurysms originated from the internal maxillary artery in eight patients; and all were treated with occlusion of the feeding artery. In six cases, they originated from the internal carotid artery (Inca); out of which, two were managed with detachable balloons, two with covered s tents, one by means of cavity embolization, and the remaining one with parent artery occlusion. All of these cases were followed up clinically from six to 18 months, with a mean follow up time of ten months; moreover, three cases were also followed with angiography. Complete cessation of bleeding was achieved in all the 15 instances (100%) immediately after the endovascular therapies. Of the six patients who suffered from Inca pseudo aneurysms, one presented with a permanent stroke and one had an episode of rebleeding requiring intervention. In patients presenting with a history of cranio cerebral trauma, traumatic pseudo aneurysm must be considered as a differential diagnosis. Individual endovascular treatment is a relatively safe, plausible, and reliable means of managing traumatic pseudo aneurysms

  3. Sustained improvement of intractable rheumatoid arthritis after total lymphoid irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Field, E.H.; Strober, S.; Hoppe, R.T.; Calin, A.; Engleman, E.G.; Kotzin, B.L.; Tanay, A.S.; Calin, H.J.; Terrell, C.P.; Kaplan, H.S.

    1983-08-01

    Total lymphoid irradiation (TLI) was administered to 11 patients who had intractable rheumatoid arthritis that was unresponsive to conventional medical therapy, including aspirin, multiple nonsteroidal antiinflammatory drugs, gold salts, and D-penicillamine. Total lymphoid irradiation was given as an alternative to cytotoxic drugs such as azathioprine and cyclophosphamide. After radiotherapy, 9 of the 11 patients showed a marked improvement in clinical disease activity as measured by morning stiffness, joint tenderness, joint swelling, and overall functional abilities. The mean improvement of disease activity in all patients ranged from 40-70 percent and has persisted throughout a 13-28 month followup period. This improvement permitted the mean daily steroid dose to be reduced by 54%. Complications included severe fatigue and other constitutional symptoms during radiotherapy, development of Felty's syndrome in 1 patient, and an exacerbation of rheumatoid lung disease in another. After therapy, all patients exhibited a profound T lymphocytopenia, and a reversal in their T suppressor/cytotoxic cell to helper cell ratio. The proliferative responses of peripheral blood mononuclear cells to phytohemagglutinin, concanavalin A, and allogeneic leukocytes (mixed leukocyte reaction) were markedly reduced, as was in vitro immunoglobulin synthesis after stimulation with pokeweed mitogen. Alterations in T cell numbers and function persisted during the entire followup period, except that the mixed leukocyte reaction showed a tendency to return to normal values.

  4. Endovascular Treatment of Traumatic Pseudoaneurysm Presenting as Intractable Epistaxis

    International Nuclear Information System (INIS)

    To investigate the clinical efficacy of individual endovascular management for the treatment of different traumatic pseudo aneurysms presenting as intractable epistaxis. For 14 consecutive patients with traumatic pseudo aneurysm presenting as refractory epistaxis, 15 endovascular procedures were performed. Digital subtraction angiography revealed that the pseudo aneurysms originated from the internal maxillary artery in eight patients; and all were treated with occlusion of the feeding artery. In six cases, they originated from the internal carotid artery (Inca); out of which, two were managed with detachable balloons, two with covered s tents, one by means of cavity embolization, and the remaining one with parent artery occlusion. All of these cases were followed up clinically from six to 18 months, with a mean follow up time of ten months; moreover, three cases were also followed with angiography. Complete cessation of bleeding was achieved in all the 15 instances (100%) immediately after the endovascular therapies. Of the six patients who suffered from Inca pseudo aneurysms, one presented with a permanent stroke and one had an episode of rebleeding requiring intervention. In patients presenting with a history of cranio cerebral trauma, traumatic pseudo aneurysm must be considered as a differential diagnosis. Individual endovascular treatment is a relatively safe, plausible, and reliable means of managing traumatic pseudo aneurysms

  5. Are Absence Epilepsy and Nocturnal Frontal Lobe Epilepsy System Epilepsies of the Sleep/Wake System?

    Directory of Open Access Journals (Sweden)

    Péter Halász

    2015-01-01

    Full Text Available System epilepsy is an emerging concept interpreting major nonlesional epilepsies as epileptic dysfunctions of physiological systems. I extend here the concept of reflex epilepsy to epilepsies linked to input dependent physiological systems. Experimental and clinical reseach data were collected to create a coherent explanation of underlying pathomechanism in AE and NFLE. We propose that AE should be interpreted as epilepsy linked to the corticothalamic burst-firing mode of NREM sleep, released by evoked vigilance level oscillations characterized by reactive slow wave response. In the genetic variation of NFLE the ascending cholinergic arousal system plays an essential role being in strong relationship with a gain mutation of the nicotinic acethylcholin receptors, rendering the arousal system hyperexcitable. I try to provide a more unitary interpretation for the variable seizure manifestation integrating them as different degree of pathological arosuals and alarm reactions. As a supporting hypothesis the similarity between arousal parasomnias and FNLE is shown, underpinned by overlaping pathomechanism and shared familiarity, but without epileptic features. Lastly we propose that both AE and NFLE are system epilepsies of the sleep-wake system representing epileptic disorders of the antagonistic sleep/arousal network. This interpretation may throw new light on the pathomechanism of AE and NFLE.

  6. Clinical Observation on Intractable Insomnia Treated by Point Pressure in 42 Cases

    Institute of Scientific and Technical Information of China (English)

    张庆萍

    2002-01-01

    @@ The author have in recent years treated 42 cases of intractable insomnia (with a history of over 2 years) by point pressure, yielding quite satisfactory results when compared with those treated with clonazepam. This is reported as follows.

  7. Novel Histopathological Patterns in Cortical Tubers of Epilepsy Surgery Patients with Tuberous Sclerosis Complex.

    Directory of Open Access Journals (Sweden)

    Angelika Mühlebner

    Full Text Available Tuberous Sclerosis Complex (TSC is a genetic hamartoma syndrome frequently associated with severe intractable epilepsy. In some TSC patients epilepsy surgery is a promising treatment option provided that the epileptogenic zone can be precisely delineated. TSC brain lesions (cortical tubers contain dysmorphic neurons, brightly eosinophilic giant cells and white matter alterations in various proportions. However, a histological classification system has not been established for tubers. Therefore, the aim of this study was to define distinct histological patterns within tubers based on semi-automated histological quantification and to find clinically significant correlations. In total, we studied 28 cortical tubers and seven samples of perituberal cortex from 28 TSC patients who had undergone epilepsy surgery. We assessed mammalian target of rapamycin complex 1 (mTORC1 activation, the numbers of giant cells, dysmorphic neurons, neurons, and oligodendrocytes, and calcification, gliosis, angiogenesis, inflammation, and myelin content. Three distinct histological profiles emerged based on the proportion of calcifications, dysmorphic neurons and giant cells designated types A, B, and C. In the latter two types we were able to subsequently associate them with specific features on presurgical MRI. Therefore, these histopathological patterns provide consistent criteria for improved definition of the clinico-pathological features of cortical tubers identified by MRI and provide a basis for further exploration of the functional and molecular features of cortical tubers in TSC.

  8. Novel Histopathological Patterns in Cortical Tubers of Epilepsy Surgery Patients with Tuberous Sclerosis Complex.

    Science.gov (United States)

    Mühlebner, Angelika; van Scheppingen, Jackelien; Hulshof, Hanna M; Scholl, Theresa; Iyer, Anand M; Anink, Jasper J; van den Ouweland, Ans M W; Nellist, Mark D; Jansen, Floor E; Spliet, Wim G M; Krsek, Pavel; Benova, Barbora; Zamecnik, Josef; Crino, Peter B; Prayer, Daniela; Czech, Thomas; Wöhrer, Adelheid; Rahimi, Jasmin; Höftberger, Romana; Hainfellner, Johannes A; Feucht, Martha; Aronica, Eleonora

    2016-01-01

    Tuberous Sclerosis Complex (TSC) is a genetic hamartoma syndrome frequently associated with severe intractable epilepsy. In some TSC patients epilepsy surgery is a promising treatment option provided that the epileptogenic zone can be precisely delineated. TSC brain lesions (cortical tubers) contain dysmorphic neurons, brightly eosinophilic giant cells and white matter alterations in various proportions. However, a histological classification system has not been established for tubers. Therefore, the aim of this study was to define distinct histological patterns within tubers based on semi-automated histological quantification and to find clinically significant correlations. In total, we studied 28 cortical tubers and seven samples of perituberal cortex from 28 TSC patients who had undergone epilepsy surgery. We assessed mammalian target of rapamycin complex 1 (mTORC1) activation, the numbers of giant cells, dysmorphic neurons, neurons, and oligodendrocytes, and calcification, gliosis, angiogenesis, inflammation, and myelin content. Three distinct histological profiles emerged based on the proportion of calcifications, dysmorphic neurons and giant cells designated types A, B, and C. In the latter two types we were able to subsequently associate them with specific features on presurgical MRI. Therefore, these histopathological patterns provide consistent criteria for improved definition of the clinico-pathological features of cortical tubers identified by MRI and provide a basis for further exploration of the functional and molecular features of cortical tubers in TSC. PMID:27295297

  9. Cortical Tubers: Windows into Dysregulation of Epilepsy Risk and Synaptic Signaling Genes by MicroRNAs.

    Science.gov (United States)

    Dombkowski, Alan A; Batista, Carlos E; Cukovic, Daniela; Carruthers, Nicholas J; Ranganathan, Ramya; Shukla, Upasana; Stemmer, Paul M; Chugani, Harry T; Chugani, Diane C

    2016-03-01

    Tuberous sclerosis complex (TSC) is a multisystem genetic disorder caused by mutations in the TSC1 and TSC2 genes. Over 80% of TSC patients are affected by epilepsy, but the molecular events contributing to seizures in TSC are not well understood. Recent reports have demonstrated that the brain is enriched with microRNA activity, and they are critical in neural development and function. However, little is known about the role of microRNAs in TSC. Here, we report the characterization of aberrant microRNA activity in cortical tubers resected from 5 TSC patients surgically treated for medically intractable epilepsy. By comparing epileptogenic tubers with adjacent nontuber tissue, we identified a set of 4 coordinately overexpressed microRNAs (miRs 23a, 34a, 34b*, 532-5p). We used quantitative liquid chromatography-tandem mass spectrometry (LC-MS/MS) proteomic profiling to investigate the combined effect of the 4 microRNAs on target proteins. The proportion of repressed proteins among the predicted targets was significantly greater than in the overall proteome and was highly enriched for proteins involved in synaptic signal transmission. Among the combinatorial targets were TSC1, coding for the protein hamartin, and several epilepsy risk genes. We found decreased levels of hamartin in epileptogenic tubers and confirmed targeting of the TSC1 3' UTR by miRs-23a and 34a. PMID:25452577

  10. Parenteral lidocaine for treatment of intractable renal colic: a case series

    OpenAIRE

    Vaezi Hassan; Mohammadi Dawood; Hassanzadeh Kamaleddin; Soleimanpour Hassan; Esfanjani Robab

    2011-01-01

    Abstract Introduction We report a case series of successful treatment of intractable renal colic using parenteral lidocaine. Case presentation Because of inconsistent responses to standard treatment with opioids and non-steroidal anti-inflammatory drugs in patients with renal colic pain, we decided to begin a trial of a single intravenous dose of lidocaine (approximately 1.5 mg/kg) slowly in eight patients with intractable renal colic who were referred to our emergency medicine department. Th...

  11. Epilepsy Surgery for Individuals with TSC

    Science.gov (United States)

    ... of epilepsy surgery in patients with tuberous sclerosis. Neurology 62(3):479-81 Kagawa K, Chugani DC, ... for epilepsy surgery in patients with tuberous sclerosis. Neurology 64(9):1651-4 Moshel YA, Elliott R, ...

  12. Vagus Nerve Stimulation for Treating Epilepsy

    Science.gov (United States)

    ... may help treat epilepsy. The American Academy of Neurology (AAN) is the world’s largest association of neurologists ... in people with epilepsy. ©2013 American Academy of Neurology www.aan.com CAN VNS BE ADJUSTED TO ...

  13. A study of epilepsy-related psychosis

    OpenAIRE

    Roy A; Rajesh S; Iby N; Jose J; Sarma G

    2003-01-01

    The association of epilepsy and psychosis is studied. Among the 500 patients of epilepsy evaluated, there were 12 patients, 8 males and 4 females with epilepsy-related psychosis. Their average age was 38 years. The interval between the age of onset of epilepsy and psychotic features was 9 years. Complex partial seizures were present in 7 patients and primary generalized tonic-clonic seizure was present in 1 patient. Four patients had post-ictal psychosis, 7 had acute interictal psychosis and ...

  14. Novel Animal Models of Pediatric Epilepsy

    OpenAIRE

    Auvin, Stéphane; Pineda, Eduardo; Shin, Don; Gressens, Pierre; Mazarati, Andrey

    2012-01-01

    When mimicking epileptic processes in a laboratory setting, it is important to understand the differences between experimental models of seizures and epilepsy. Because human epilepsy is defined by the appearance of multiple spontaneous recurrent seizures, the induction of a single acute seizure without recurrence does not constitute an adequate epilepsy model. Animal models of epilepsy might be useful for various tasks. They allow for the investigation of pathophysiological mechanisms of the ...

  15. History of Neuropsychology Through Epilepsy Eyes

    OpenAIRE

    Loring, David W.

    2010-01-01

    In the 19th century, Hughlings Jackson relied on clinical history, seizure semiology, and the neurologic examination as methods for seizure localization to inform the first epilepsy surgeries. In the 20th century, psychological and neuropsychological tests were first employed as both diagnostic and prognostic measures. The contemporary practice of epilepsy evaluation and management includes neuropsychology as a critical component of epilepsy care and research, and epilepsy and neuropsychology...

  16. Epilepsy in children with cerebral palsy

    OpenAIRE

    J Akhundian

    2013-01-01

    Epilepsy occurs in 15-60% of children with cerebral palsy (CP). However, its clinical course is not well defined. This retrospective study reviews the prevalence, nature and prognosis of epilepsy in cerebral palsy. 53 of 133 children with cerebral palsy seen in the neuropediatric clinic in Mashhad emam Reza hospital between 1999 and 2001 had epilepsy. A control group of 70 epileptic children with normal neurodevelopment status was seen during the same period. Epilepsy most commonly affected p...

  17. Epilepsy in children with cerebral palsy

    OpenAIRE

    Bruck Isac; Antoniuk Sérgio Antônio; Spessatto Adriane; Bem Ricardo Schmitt de; Hausberger Romeu; Pacheco Carlos Gustavo

    2001-01-01

    OBJECTIVE: To describe the prevalence and characteristics of epilepsy in patients with cerebral palsy in a tertiary center. METHODS: a total of 100 consecutive patients with cerebral palsy were retrospectively studied. Criteria for inclusion were follow-up period for at least 2 years. Types and incidence of epilepsy were correlated with the different forms of cerebral palsy. Other factors associated with epilepsy such as age of first seizure, neonatal seizures and family history of epilepsy w...

  18. Evaluation of anticonvulsant activity of ACE inhibitors (imidapril and quinapril) in experimentally induced animal models of epilepsy

    OpenAIRE

    VH, Pushpa; Poornima R.; HL, Kalabharathi; AM, Satish

    2016-01-01

    Background: Epilepsy is a chronic neurological disorder characterized by an enduring predisposition to generate seizures, may be associated with emotional and cognitive dysfunction. Objective of this study was to evaluate and compare the anticonvulsant activity of different doses of imidapril and quinapril in animal models of epilepsy. Methods: Swiss albino mice weighing around 25-30g of either sex were divided into 6 groups: control (R.O-10 ml/kg), standard-sodium valproate (40 mg/kg), Q1...

  19. A randomised trial of a medium-chain TAG diet as treatment for dogs with idiopathic epilepsy

    OpenAIRE

    Law, Tsz Hong; Davies, Emma S. S.; Pan, Yuanlong; Zanghi, Brian; Want, Elizabeth; Volk, Holger A.

    2015-01-01

    Despite appropriate antiepileptic drug treatment, approximately one-third of humans and dogs with epilepsy continue experiencing seizures, emphasising the importance for new treatment strategies to improve the quality of life of people or dogs with epilepsy. A 6-month prospective, randomised, double-blinded, placebo-controlled cross-over dietary trial was designed to compare a ketogenic medium-chain TAG diet (MCTD) with a standardised placebo diet in chronically antiepileptic drug-treated dog...

  20. Vascular anomalies associated with epilepsy - case report

    International Nuclear Information System (INIS)

    Epilepsy is a common neurological disorder in which the individual has recurrent seizures. These seizures occur when there is an imbalance in the electrical activity of the brain. The malfunction may be in a small area of the brain or spread to the entire brain. Epilepsy usually begins in childhood or adolescence. About 2.3 million people have seizures or epilepsy. (author)

  1. Epilepsy in prisons: a diagnostic survey.

    Science.gov (United States)

    Gunn, J; Fenton, G

    1969-11-01

    A previous study has suggested that epilepsy is commoner in prisons than in the general population. We devised a standard definition of "epilepsy" and then interviewed a representative sample of the "epileptics" in prisons. The results confirmed the initial conclusion, and showed the point prevalence of epilepsy in prison and Borstals to be at least 7.1/1,000 men. PMID:5386266

  2. Cerebral Hemispheric Lateralization Associated with Hippocampal Sclerosis May Affect Interictal Cardiovascular Autonomic Functions in Temporal Lobe Epilepsy

    Directory of Open Access Journals (Sweden)

    Rokia Ghchime

    2016-01-01

    Full Text Available It is well established that the temporal lobe epilepsy (TLE is linked to the autonomic nervous system dysfunctions. Seizures alter the function of different systems such as the respiratory, cardiovascular, gastrointestinal, and urogenital systems. The aim of this work was to evaluate the possible factors which may be involved in interictal cardiovascular autonomic function in temporal lobe epilepsy with complex partial seizures, and with particular attention to hippocampal sclerosis. The study was conducted in 30 patients with intractable temporal lobe epilepsy (19 with left hippocampal sclerosis, 11 with right hippocampal sclerosis. All subjects underwent four tests of cardiac autonomic function: heart rate changes in response to deep breathing, heart rate, and blood pressure variations throughout resting activity and during hand grip, mental stress, and orthostatic tests. Our results show that the right cerebral hemisphere predominantly modulates sympathetic activity, while the left cerebral hemisphere mainly modulates parasympathetic activity, which mediated tachycardia and excessive bradycardia counterregulation, both of which might be involved as a mechanism of sudden unexpected death in epilepsy patients (SUDEP.

  3. AN AYURVEDIC INSIGHT TOWARDS EPILEPSY

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    Singh Karam

    2012-10-01

    Full Text Available In Ayurveda, Mental disorders and psychological temperaments have been broadly described [e.g. vata vyadhi (nervous disorders, unmada (insanity, murccha, moha (loss of consciousness, vismriti (amnesia, apasmara (epilepsy etc.]. In Ayurveda, Apasmara (or epilepsy has been described among the maharoga (a group of eight diseases well-known for causing serious morbidity. In the Ayurvedic texts, Apasmara (Epilepsy is defined as sudden abhorrent bodily activities (vibhatsa-cheshta accompanied by momentary blackouts or loss of consciousness (tama-pravesha owing to disturbance in mental faculties of dhi (intelligence, dhriti (retention and smriti (memory. Epilepsy is a major public health problem all over world. The estimated proportion of the general population with active epilepsy (i.e. continuing seizures or the need for treatment at a given time ranges from 4-10 per 1,000 people. Herbal remedies have been recommended in various medical treatises for the cure of different diseases. In this regard, there is great prospective for identifying excellent Ayurvedic components or its active principles, particularly in consideration of the fact that such substances may provide maximum advantage with cost effectiveness, least side effects, and improvement of patient compliance.

  4. Epilepsy surgery: Recommendations for India

    Directory of Open Access Journals (Sweden)

    Chandra P

    2010-01-01

    Full Text Available The following article recommends guidelines for epilepsy surgery for India. This article reviews the indications, the various surgical options available and the outcome of surgery for drug resistant epilepsy based on current evidence. Epilepsy surgery is a well-established option for patients who have been diagnosed to have drug resistant epilepsy (DRE (on at least two appropriate, adequate anti-epileptic drugs (AEDs (either in monotherapy or in combination with continuing seizures, where the presurgical work-up has shown concordance of structural imaging (magnetic resonance imaging and electrical mapping data (electroencephalography (EEG, video EEG. There may be a requirement of functional imaging techniques in a certain number of DRE like positron emission tomography (PET, single photon emission tomography, (SPECT. Invasive monitoring should be restricted to a few when all noninvasive investigations are inconclusive, there is a dual pathology or there is a discordance of noninvasive data. The types of surgery could be curative (resective surgeries: amygdalo hippocampectomy, lesionectomy and multilobar resections; functional surgeries: hemispherotomy and palliative (multiple subpial transaction, corpus callosotomy, vagal nerve stimulation. Epilepsy surgery in indicated cases has a success range from 50 to 86% in achieving seizure freedom as compared with < 5% success rate with AEDs only in persons with DRE. Centers performing surgery should be categorized into Level I and Level II.

  5. The genetics of the epilepsies.

    Science.gov (United States)

    El Achkar, Christelle M; Olson, Heather E; Poduri, Annapurna; Pearl, Phillip L

    2015-07-01

    While genetic causes of epilepsy have been hypothesized from the time of Hippocrates, the advent of new genetic technologies has played a tremendous role in elucidating a growing number of specific genetic causes for the epilepsies. This progress has contributed vastly to our recognition of the epilepsies as a diverse group of disorders, the genetic mechanisms of which are heterogeneous. Genotype-phenotype correlation, however, is not always clear. Nonetheless, the developments in genetic diagnosis raise the promise of a future of personalized medicine. Multiple genetic tests are now available, but there is no one test for all possible genetic mutations, and the balance between cost and benefit must be weighed. A genetic diagnosis, however, can provide valuable information regarding comorbidities, prognosis, and even treatment, as well as allow for genetic counseling. In this review, we will discuss the genetic mechanisms of the epilepsies as well as the specifics of particular genetic epilepsy syndromes. We will include an overview of the available genetic testing methods, the application of clinical knowledge into the selection of genetic testing, genotype-phenotype correlations of epileptic disorders, and therapeutic advances as well as a discussion of the importance of genetic counseling. PMID:26008807

  6. Recovery of heavy metals from intractable wastes: A thermal approach

    Energy Technology Data Exchange (ETDEWEB)

    Kirk, D.W. [Univ. of Toronto (Canada)

    1996-12-31

    The generation of industrial solid wastes containing leachable species of environmental concern is a problem for developing and developed nations alike. These materials arise from direct processing of mineral ores, from production of metals and minerals, from manufacturing operations, and from air and water pollution treatment processes. The general characteristics that make these wastes intractable is that their content of hazardous species is not easily liberated from the waste yet is not bound so tightly that they are safe for landfill disposal or industrial use. The approach taken in this work is a thermal treatment that separates the inorganic contaminants from the wastes. The objective is to provide recovery and reuse of both the residual solids and liberated contaminants. The results from operating this technique using two very different types of waste are described. The reasons that the process will work for a wide variety of wastes are explored. By using the knowledge of the thermodynamic stability of the phases found from the characterization analyses, a thermal regime was found that allowed separation of the contaminants without capturing the matrix materials. Bench scale studies were carried out using a tube furnace. Samples of the wastes were heated in crucible boats from 750 to 1150{degrees}C in the presence of various chlorinating agents. The offgas contained 90{sup +}% of the targeted contaminants despite their complex matrix form. The residue was free of contamination. As a result of the efficient concentrating mechanism of the process, the contaminants in the offgas solids are attractive for reuse in metallurgical industries. As an additional benefit, the organic contaminants of the residues were eliminated. Dioxin traces in the solids before treatment were absent after treatment. 15 refs., 4 figs., 4 tabs.

  7. Overview of Nrf2 as Therapeutic Target in Epilepsy

    Directory of Open Access Journals (Sweden)

    Liliana Carmona-Aparicio

    2015-08-01

    Full Text Available Oxidative stress is a biochemical state of imbalance in the production of reactive oxygen and nitrogen species and antioxidant defenses. It is involved in the physiopathology of degenerative and chronic neuronal disorders, such as epilepsy. Experimental evidence in humans and animals support the involvement of oxidative stress before and after seizures. In the past few years, research has increasingly focused on the molecular pathways of this process, such as that involving transcription factor nuclear factor E2-related factor 2 (Nrf2, which plays a central role in the regulation of antioxidant response elements (ARE and modulates cellular redox status. The aim of this review is to present experimental evidence on the role of Nrf2 in this neurological disorder and to further determine the therapeutic impact of Nrf2 in epilepsy.

  8. MOYAMOYA INDUCED ACUTE PARAPLEGIA IN A CHILD WITH EPILEPSY

    Directory of Open Access Journals (Sweden)

    MM. Taghdiri

    2009-04-01

    Full Text Available ObjectiveMoyamoya disease (MMD is a chronic, occlusive, cerebrovascular disorder of unknown  pathogenesis, characterized by progressive stenosis of the bilateral supraclinoid internal carotid arteries, with concomitant formation of tortuous arterial collateral vessels at the base of the brain, which reconstitute distal branches of the cerebral circulation. In Japanese, "Moyamoya" means "hazy puff of smoke" and refers to the angiographic appearance of the abnormal network of vessels that develop at the base of the brain and basal ganglia to supply a collateral route of blood flow. We report here the case of Moyamoya disease in a 5 year-old girl with normal mentality with a one year history of epilepsy, with Todd's paralysis. This condition is rare and most patients are diagnosed in childhood. With this report we aim to underscore the possibility that a usual neurological sign could be associated with unusual neurological disorders.Keywords:Moyamoya disease, Todd's paralysis, Epilepsy

  9. Epilepsy and driving

    Directory of Open Access Journals (Sweden)

    Moetamedi M

    2000-09-01

    Full Text Available Epilepsy is a disease with high prevalence, which interferes driving and may lead to car accident; This case-control study has been done on 100 epileptic patients and 100 persons as control group, who had history of driving. We gathered our patients with face to face interview and registering their information in special forms which were prepared for this study. There were three times more accidents among epileptic cases comparing with control group and this difference was more considerable in men and in patients under 35 years old. The cause of accident were not seizure attack in more than 60% of the patients and these ordinary accidents were also more in case group. Epileptic patients with history of car accidents during driving had poor drug compliance comparing with the epileptics without history of an accident so drug compliance may be valuable in predicting accident in these patients. We have also found poor drug compliance in whom seizure attacks caused accident for them. 58% of the epileptics had not consulted their physician about driving. 43.3% of seizures during driving were of generalized type and none of the patients had inform police about their disease during getting driving license.

  10. Photosensitivity and epilepsy.

    Science.gov (United States)

    Verrotti, Alberto; Trotta, Daniela; Salladini, Carmela; di Corcia, Giovanna; Chiarelli, Francesco

    2004-08-01

    Photosensitive epilepsy is a well-known condition characterized by seizures in patients who show photoparoxysmal responses on electroencephalography (EEG) elicited by intermittent photic stimulation. Photoparoxysmal responses can be defined as epileptiform EEG responses to intermittent photic stimulation or to other visual stimuli of everyday life and are frequently found in nonepileptic children. The modern technologic environment has led to a dramatic increase in exposure to potential trigger stimuli; nowadays, television and video games are among the most common triggers in daily life. There is ample evidence for genetic transmission of photoparoxysmal responses; systematic family studies have provided data for an autosomal dominant mode of inheritance with age-dependent penetrance for photosensitivity. The age of maximum penetrance is between 5 and 15 years. The prognosis for control of seizures induced by visual stimulation is generally very good. The large majority of patients do not need anticonvulsant therapy, but, when needed, the drug of choice is valproate. Stimulus avoidance and stimulus modification can be an effective treatment in some patients and can sometimes be combined with antiepileptic drug treatment. PMID:15605465

  11. Alzheimer’s disease and epilepsy: insight from animal models

    OpenAIRE

    Scharfman, Helen E.

    2012-01-01

    Alzheimer’s disease (AD) and epilepsy are separated in the medical community, but seizures occur in some patients with AD, and AD is a risk factor for epilepsy. Furthermore, memory impairment is common in patients with epilepsy. The relationship between AD and epilepsy remains an important question because ideas for therapeutic approaches could be shared between AD and epilepsy research laboratories if AD and epilepsy were related. Here we focus on one of the many types of epilepsy, temporal ...

  12. Significant variables associated with epilepsy

    International Nuclear Information System (INIS)

    Objective: To study the characteristics of the epileptics and the risk factors contributing to the development of epilepsy. Results: Majority of the subjects were single (77.84%), 1st born among their siblings (25.95%), belonged to low social class (50.63%), and unemployed(25.31%). The major risk factors were family history of illness (23.52%) and positive medical problem around birth (12.66%). The presence of family history of illness, positive medical problem around birth and advanced maternal age at birth were associated with early onset of epilepsy. Vulnerability for the epilepsy also increases among hospital deliveries. Conclusion: Although the present study has identified various risk factors, yet the results need to be further confirmed through case-control studies. (author)

  13. Melatonin’s Effect in Febrile Seizures and Epilepsy

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    Abolfazl MAHYAR

    2014-07-01

    . Geme III JW, Behrman RE. Nelson textbook of pediatrics. 19th ed. Phila: Saunders, 2011:2013-2039.Camfield PR, Canfield CS. Epilepsy. In: Swaiman KF, Ashwal S, Ferriero DM, editors. Pediatric neurology: principles and practice. 4th ed. Philadelphia: Mosby, 2006:981-8.Chang BS, Lowenstein DH. Epilepsy, N Eng J Med 2003, 13:1257-1266.Aydin A, Ergor A, Ergor G, Dirik E. The prevalence of epilepsy amongst school children in Izmir, Turkey, Seizure 2002; 11: 392–396.10.Jan MM, Girvin JP. Febrile seizures. Update and controversies. Neurosciences (Riyadh 2004; 9:235-42.French JA. Febrile seizures: possible outcomes. Neurology2012; 28; 79:e80-2.Guo JF,Yao JF. Serum melatonin levels in children with epilepsy or FS, Zhongguo Dang Dai Er Ke Za Zhi2009, 11:288-90 (Medline.Reiter RJ. Melatonin: clinical relevance, Best Pract. Res Clin Endocrinol Metab 2003, 17: 273-285.Seithikurippu R, Perumal P, Trakh I, Srinivasan V, Spence DW, Maestroni GJM, Zisapel N, Cardinali DP. Physiological effects of melatonin Role of melatonin receptors and signal transduction pathways, Prog Neurobiol 85, 2008: 335-353.Ardura J, Andres J, Garmendia JR, Ardura F. Melatonin in epilepsy and FS.J Child Neurol 2010; 25:888-91.Ganesh R, Janakiraman L, Meenakshi B. Serum zinc levels are low in children with simple FS compared with those in children with epileptic seizures and controls.Ann Trop Paediatr 2011; 31:345-9.Bazil CW, Short D, Crispin D, Zheng W. Patients with intractable epilepsy have low melatonin, which increases following seizures. Neurology 2000; 55:1746-8.Yalyn O, Arman F, Erdogan F, Kula M. A comparison of the circadian rhythmsand the levels of melatonin in patients with diurnal and nocturnal complexpartial seizures. Epilepsy Behav 2006;8:542-6.Schapel GJ, Beran RG, Kennaway DL, McLoughney J, Matthews CD. Melatonin response in active epilepsy. Epilepsia 1995; 36:75-8.Ekmekcioglu C. Melatonin receptors in humans: biological role and clinical relevance,Biomedicine and Pharmacotherapy 2006,60: 97

  14. When your child with epilepsy die suddenly: febrile seizures are part of the process?

    Directory of Open Access Journals (Sweden)

    V C Terra

    2011-01-01

    Full Text Available Febrile seizures (FS affect almost 2-5% of children and factors related to an increase susceptibility of children to FS may involve an imbalance of inflammatory cytokines and genetic factors. FS had low morbidity, but may be associated with the occurrence of late chronic epilepsy. Here we describe factors related to FS and its possible correlation with SUDEP.

  15. Neurological morbidity of severe epilepsy.

    Science.gov (United States)

    Janz, D

    1988-01-01

    The "severity" of a disease is a relative expression and its definition will vary depending on the perspective of the observer. The patient's subjective perception of the disease, the way it is regarded socially by the community, and the doctor's objective assessment rarely coincide. In fact, they are frequently diametrically opposed. As far as the patient's personal perception of epilepsy is concerned, there has apparently been no satisfactory attempt thus far at a systematic grading of the subjective handicap, despite the growth of interest in psychological matters and the self-help movement. Similarly, social ability or disability cannot be adequately assessed on the basis of medical criteria such as frequency and type of seizures. We present a grading system which will serve as an example of an appropriate method of assessing social abilities, and which will permit the patient's occupational potential to be estimated in relation to the risk of accidents resulting from seizures. From the medical point of view, the impairment of a patient's abilities due to epilepsy is a function of the patient's responsiveness to treatment. We present a critical review of the factors which have an effect on the therapeutic prognosis: the causes of epilepsy, underlying structural lesions, the incidence of convulsive status epilepticus, various types of attacks, and the different epileptic syndromes. Taking two examples--epilepsy presenting in the form of absence and epilepsy with complex focal seizures--we show that ultimately the "severity of epilepsy" can only be defined from the medical standpoint on the basis of several factors whose value is of a predictive nature. PMID:3292232

  16. The combination of morphine and minocycline may be a good treatment for intractable post-herpetic neuralgia.

    Science.gov (United States)

    Chen, Suchang; Hui, Hui; Zhang, Deren; Xue, Yanzhi

    2010-12-01

    Post-herpetic neuralgia (PHN) is a devastating complication of shingles. The treatment of PHN with traditional pharmaceutical agents has various side effects. Therefore, the treatment of intractable PHN is often very time consuming, mainly because the available treatments often lead to intolerable side effects before the efficient dose can be reached. Opioids such as morphine and oxycodone are the most widely used drugs for the alleviation for severe chronic pain. A number of high quality studies demonstrated that opioids are effective in relieving neuropathic pain including PHN. Yet concerns of misuse, abuse and tolerance of opioids have, however, severely influenced their contribution to neuropathic pain, especially the tolerance that resulted in a loss of drug effect or the necessity for escalating doses to produce pain relief. The glia cells, particularly microglia and astrocytes are thought to play an important role in central sensitization. It is known that activated microglia cells produce NO, cytokines, and cyclooxygenase. All of these chemicals regulate synaptic transmissions in the central nervous system. Additionally, glia modulations showed antiallodynic and antihyperalgesic properties in various experimental pain models. Minocycline, a semisynthetic, second-generation tetracycline can potently inhibit microglial activation and proliferation. Also, the growing body of recent evidence indicates that minocycline attenuates morphine tolerance in neuropathic mice with a mechanism related to microglia. The combination of morphine and minocycline has synergetic effect. This can prevent the development of intractable PHN and attenuate morphine antinociceptive tolerance and further improve the efficacy of morphine and therefore reducing its dosage and side effects. We thereby hypothesize that the combination of morphine and minocycline may produce a duel effect of morphine antinociceptive and minocycline selectively inhibiting the activation of microglia. PMID

  17. Selective embolization of the internal iliac arteries for the treatment of intractable hemorrhage in children with malignancies

    Directory of Open Access Journals (Sweden)

    Sul Hee Bae

    2011-04-01

    Full Text Available Purpose : Acute internal hemorrhage is an occasionally life-threatening complication in pediatric cancer patients. Many therapeutic approaches have been used to control bleeding with various degrees of success. In this study, we evaluated the efficacy of selective internal iliac artery embolization for controlling acute intractable bleeding in children with malignancies. Methods : We retrospectively evaluated the cases of 6 children with various malignancies (acute lymphoblastic leukemia, acute myelogenous leukemia, chronic myelogenous leukemia, T-cell prolymphocytic leukemia, Langerhans cell histiocytosis, and rhabdomyosarcoma, who had undergone selective arterial embolization (SAE of the internal iliac artery at the Chonnam National University Hwasun Hospital between January 2004 and December 2009. SAE was performed by an interventional radiologist using Gelfoam&#9415; and/or Tornado&#9415; coils. Results : The patients were 5 boys and 1 girl with median age of 6.9 years (range, 0.7&#8211;14.8 years at the time of SAE. SAE was performed once in 4 patients and twice in 2, and the procedure was unilateral in 2 and bilateral in 4. The causes of hemorrhage were as follows: hemorrhagic cystitis (HC in 3 patients, procedure-related internal iliac artery injuries in 2 patients, and tumor rupture in 1 patient. Initial attempt at conservative management was unsuccessful. Of the 6 patients, 5 (83.3% showed improvement after SAE without complications. Conclusion : SAE may be a safe and effective procedure for controlling acute intractable hemorrhage in pediatric malignancy patients. This procedure may obviate the need for surgery, which carries an attendant risk of morbidity and mortality in cancer patients with critical conditions.

  18. Pregabalin in childhood epilepsy: a clinical trial study

    Directory of Open Access Journals (Sweden)

    Mohsen MOLLAMOHAMMADI*

    2014-12-01

    , Falip M, Becerra JL, et al. Pregabalin as add-on therapy for refractory seizures in every day clinical practice. Seizure 2007;16(8:709-12.Jan MM, Zuberi SA, Alsaihati BA. Pregabalin: Preliminary experience in intractable childhood epilepsy. Pediatr Neurol 2008;40(5:347-50.Chisanga E, Manford M. Pregabalin drug information. NHS foundation trust. March 2013.Gil-Nagel A. Zaccara G. Baldinetti F. Leon T. Add-on treatment with pregabalin for partial seizures with or without generalization: pooled data analysis of four randomized placebo-controlled trials. Seizure 2009;18(3:184-92.

  19. Effect of Antiepileptic Drugs for Acute and Chronic Seizures in Children with Encephalitis.

    Directory of Open Access Journals (Sweden)

    Kuang-Lin Lin

    Full Text Available Encephalitis presents with seizures in the acute phase and increases the risk of late unprovoked seizures and epilepsy. This study aimed to evaluate the effect of antiepileptic drugs in pediatric patients with acute seizures due to encephalitis and epilepsy.Cases of acute pediatric encephalitis between January 2000 and December 2010 were reviewed. Clinical data, including onset at age, seizure type, seizure frequency, effects of antiepileptic drugs, and prognosis were analyzed.During the study period, 1038 patients (450 girls, 588 boys were enrolled. Among them, 44.6% (463 had seizures in the acute phase, 33% had status epilepticus, and 26% (251 developed postencephalitic epilepsy. At one year of follow-up, 205 of the 251 patients with postencephalitic epilepsy were receiving antiepileptic drugs while 18% were seizure free even after discontinuing the antiepileptic drugs. Among those with postencephalitic epilepsy, 67% had favorable outcomes and were using <2 anti-epileptic drugs while 15% had intractable seizures and were using ≥ 2 antiepileptic drugs. After benzodiazepines, intravenous phenobarbital was preferred over phenytoin as treatment of postencephalitic seizures in the acute phase. For refractory status epilepticus, high-dose topiramate combined with intravenous high-dose phenobarbital or high-dose lidocaine had less side effects.Children with encephalitis have a high rate of postencephalitic epilepsy. Phenobarbital and clonazepam are the most common drugs used, alone or in combination, for postencephalitic epilepsy.

  20. Novel medications for epilepsy.

    Science.gov (United States)

    Fattore, Cinzia; Perucca, Emilio

    2011-11-12

    Despite the introduction of many second-generation antiepileptic drugs (AEDs) in the last 2 decades, the proportion of individuals with pharmacoresistant epilepsy has not been reduced substantially compared with the late 1960s. All currently available AEDs also have limitations in terms of adverse effects and susceptibility to be involved in clinically important drug-drug interactions. Therefore, the search for potentially more effective and better tolerated agents is continuing. This article reviews the pharmacological and clinical profile of the latest compounds to receive marketing authorization. Since the beginning of 2008, three novel AEDs, lacosamide, eslicarbazepine acetate and retigabine (also known as ezogabine), have become commercially available in Europe, with lacosamide and retigabine also being licensed in the US. All three agents are indicated for the adjunctive treatment of focal seizures in adults. Eslicarbazepine acetate is a produg for eslicarbazepine, which acts by blocking voltage-dependent sodium channels. Lacosamide enhances the slow inactivation phase of voltage-dependent sodium channels, and retigabine potentiates neuronal M-currents by opening Kv 7.2-7.5 potassium channels. All three agents, which are well absorbed from the gastrointestinal tract, exhibit linear pharmacokinetics. Lacosamide is also available as an intravenous formulation intended as replacement therapy for patients temporarily unable to take oral medications. All three drugs are eliminated partly unchanged in urine and partly by biotransformation through glucuronide conjugation (eslicarbazepine, retigabine), N-acetylation (retigabine) and oxidative demethylation (lacosamide). The half-life is in the order of 8-20 hours for eslicarbazepine, 12-16 hours for lacosamide and 6-10 hours for retigabine. Based on the limited information available to date, the ability of these agents to cause pharmacokinetic drug interactions appears to be relatively modest, although