Seizure: European Journal of Epilepsy - Articles in Press

A retrospective study comparing preoperative evaluations and postoperative outcomes in paediatric and adult patients undergoing surgical resection for refractory epilepsy - Corrected Proof

2012-05-16

Abstract: Purpose: To review and compare the preoperative characteristics and postsurgical outcomes in paediatric and adult patients who underwent surgical resections from 2001 to 2009.Methods: Combined data from noninvasive measures such as ictal semiology, interictal/ictal scalp EEGs, MRI and SPECT were utilised to identify the epileptogenic zones (EZ). When noninvasive investigations produced inconclusive or inconsistent findings, patients underwent intracranial EEG monitoring. Resective micro-surgical procedures were conducted according to the results of the anatomo-electro-clinical investigations and were carried out to remove the EZ. We then followed up 222 paediatric (≤18 years old) and 100 adult patients (≥19 years old) for 1–9 years postoperatively.Results: The mean age of seizure onset in paediatric group was significantly lower than that in adult group. 95 (43%) of the paediatric and 42 (42%) of the adult patients required long-term intracranial EEG recording. 54 (24.3%) of the paediatric and 62 (62%) of the adult patients were found to have temporal lobe epilepsy (TLE), while 149 (67.1%) of the paediatric and 37 (37.0%) of the adult patients had extra-temporal lobe epilepsy (ETLE) (p=0.000). 19 (8.6%) of the paediatric patients and 1 (1%) adult patient had hemispheric lesions (p=0.009). 148 (66.7%) of the paediatric and 61 (61.0%) of the adult patients were seizure-free during the follow-up period. 17 of 19 (89.5%) children who underwent hemispherectomy were seizure-free. In both paediatric and adult groups, the surgical outcome for patients with TLE was significantly better than that of patients with ETLE (p=0.018 in children, p=0.029 in adults). Both the location of EZs and seizure-free ratio were significantly different (p<0.001) between the preadolescent (≤12 years old) and adolescent (13–18 years old) group. Hippocampal sclerosis was the most common pathologic finding in patients with TLE in both groups, and was followed by focal cortical dysplasia. In patients with TLE, the proportion of tumour was significantly higher in the paediatric than the adult group (25.9% vs. 10%, p=0.021).Conclusion: Paediatric patients with refractory seizures had more extratemporal or hemispheric resectable epileptogenic foci and fewer temporal foci than adults. Our study demonstrates that resective surgery is an effective and safe early intervention in strictly selected paediatric patients with refractory epilepsy.

Effect of reducing the recording time of standard EEGs on the detection of EEG-abnormalities in the management of the epilepsies of childhood - Corrected Proof

John Agbenu, Richard W. Newton, Timothy Martland, Omar Ismayl, Susan Hargreaves — 2012-05-14

Abstract: Purpose: The ILAE recommends baseline recordings of 30min to detect abnormalities supporting a clinical diagnosis of epilepsy in children. A shorter recording time may be better tolerated by children and be more resource-efficient. Our aim was to determine how many abnormalities supporting a diagnosis of epilepsy would be missed by reducing the recording time of paediatric standard electroencephalograms (EEGs) from 20 to 15min.Methods: We evaluated standard EEGs of 300 patients aged 2 months to 17 years referred consecutively with confirmed or suspected epilepsy. EEGs were recorded for 20min on digital media. A digital copy of each EEG was truncated to give consecutive sequences of 10min (sequence “A”) and 5min duration (sequences “B” and “C” respectively). A panel of EEG raters blinded to the children's’ details other than age identified these sequences as “normal” or “abnormal” if they contained spike waves, discrete sharp waves or notched slow waves in the respective EEG period.Results: EEGs of 297 children were analysed (three were omitted for technical reasons). 109 out of 297 EEGs (37%) had specific abnormalities supportive of a diagnosis of an epilepsy. 17 of these EEGs showed the abnormality in EEG sequences “B” or “C” and 7 (95% CI: 1.9–12.2) out of these demonstrated the abnormality in sequence “C” only. 105 out of 297 EEGs had non-specific findings.Conclusion: We conclude that reducing the recording time of standard EEGs to 15min may miss abnormalities in 2.36% [95% CI: 0.63–4.09%] overall and 6.42% [95% CI: 2.2–11.8%] of those with an abnormality supportive of an epilepsy to explain the reported symptoms. This result should inform any future discussions on seeking resource-efficiencies.

Complementary use of video-electroencephalography and magnetoencephalography in frontal lobe epilepsy - Corrected Proof

2012-05-11

Abstract: Purpose: The aim of this study was to compare magnetoencephalography (MEG) and video-electroencephalography (VEEG) source localization in frontal lobe epilepsy (FLE) and determine if these methods can be complementary to each other in clinical practice.Method: Thirty patients with pharmaco-resistant FLE who underwent epilepsy surgery were retrospectively enrolled. Video EEG was recorded using an IT-med system using 10/20 system. Regional localization of spikes in VEEG was defined as spikes discharged from adjacent electrodes and no further propagation to a large and/or contralateral area. Magnetoencephalography was recorded for the purpose of focus assessment. Magnetoencephalography spikes were detected for dipole localization of the epileptogenic cortex and the epileptogenic area was classified as mono- or multi-focal.Results: Regional spike discharges were identified in the interictal VEEG of 20 patients and in the ictal VEEG of 17 patients. Thirteen patients had regional spikes in both interictal and ictal VEEG. Mono-focal localization was identified in the MEG of 20 patients. Fourteen of these patients had regional spike discharges in VEEG. In the remaining six patients, sources localization was only identified by MEG and there were no regional spike discharges either interictal or ictal VEEG.Conclusion: In clinical practice, VEEG is the routine procedure in the presurgical evaluation of FLE. However, we found six cases in which VEEG failed to locate the epileptogenic area that was identified by MEG. We therefore propose that combining VEEG and MEG will optimize the noninvasive presurgical evaluation of epileptiform activities in FLE.

Refractory coeliac disease associated with late onset epilepsy, ataxia, tremor and progressive myoclonus with giant cortical evoked potentials—A case report and review of literature - Corrected Proof

2012-05-07

Abstract: Population-based screening studies suggest an overall prevalence of coeliac disease in Western populations of about 1%. A variety of neurological problems have been associated with coeliac disease occurring in up to 10% of cases of adult coeliac disease. We report an interesting case of a patient with coeliac disease who subsequently developed neurological symptoms several years later. Furthermore, a literature review of all cases to date was performed.

Age of onset in idiopathic (genetic) generalized epilepsies: Clinical and EEG findings in various age groups - Corrected Proof

Ali A. Asadi-Pooya, Mehrdad Emami, Michael R. Sperling — 2012-05-07

Abstract: Purpose: The prevalence and differences of idiopathic (genetic) generalized epilepsies (IGEs) with atypical age of onset compared to classical IGEs is a matter of debate. We tried to determine the clinical and EEG characteristics of IGEs in various age groups.Methods: All patients with a clinical diagnosis of IGE were recruited at the outpatient epilepsy clinic at Shiraz University of Medical Sciences from 2008 through 2011. We subdivided the patients into four different age groups: 4years of age and under, 5–11years, 12–17years, and finally, 18years and above, at the time of their epilepsy onset. Syndromic diagnosis, sex ratio, seizure types and EEG findings were compared. Statistical analyses were performed using Pearson Chi square test.Results: 2190 patients with epilepsy were registered. 442 patients (20.2%) were diagnosed as having IGEs. Age of seizure onset was 12.4±6.9years. The peak age of onset had a bimodal appearance. Sixty-seven patients (15.2%) were four years and under at the time of the onset of their disease, 112 persons (25.3%) were 5–11years, 197 people (44.6%) were 12–17years of age, and 66 patients (14.9%) had 18years and above at the onset of their epilepsy. The sex ratio was significantly different between patients in group one compared to groups three and four. All expected seizure types (i.e., generalized tonic–clonic, absence or myoclonic seizures) and all expected EEG abnormalities were observed among all age groups, despite some differences in their prevalence.Conclusion: Although IGE syndromes are often age dependent and most of them appear within the first two decades of life, adult-onset IGE is not rare. Presentation of IGEs could be different in various age groups, but these differences do not offer pathognomonic or characteristic features at any age.

Progression of microstructural putamen alterations in a case of symptomatic recurrent seizures using diffusion tensor imaging - Corrected Proof

2012-04-30

Abstract: Microstructural alterations of the putamen were recently reported in patients with partial and generalized epilepsy disorders. However, it is unknown whether these alterations pre-exist or are secondary to recurrent seizures. Here we investigated the progression of putamen fractional anisotropy (FA) alterations in a case of recurrent psychomotor seizures using longitudinal diffusion tensor imaging (DTI) shortly before (DTI-1) and after a psychomotor seizure (DTI-2). We obtained FA values of a hypothesis-guided putamen region-of-interest (ROI) and seven exploratory ROIs. FA values from both DTIs were compared with reference values from 19 controls. Relative to controls, the patient's putamen FA was increased at DTI-1 (13% left putamen, 7% right putamen), an effect that was exacerbated at DTI-2 (24% left putamen (p<0.05), 20% right putamen). In the exploratory ROIs we found FA reductions in the corticospinal tract, temporal lobe, and occipital lobe (p<0.05) relative to controls at DTI-1 and DTI-2. In contrast to the putamen, all exploratory ROIs showed no relevant FA change between DTI-1 and DTI-2. These results suggest that recurrent seizures may lead to progressive microstructural putamen alterations.

Bone mineral density in adult patients treated with various antiepileptic drugs - Corrected Proof

2012-04-30

Abstract: There is considerable evidence suggesting, that older antiepileptic drugs (AEDs) and some of the newer ones decrease bone mineral density (BMD). However, there is only limited and conflicting data concerning the effect of levetiracetam on BMD. In this cross-sectional study we analysed data from 168 adult consecutive outpatients treated with AEDs for more than 2 years, and who underwent measurement of the BMD. We compared the incidence of decreased BMD among the patients treated with 6 different AEDs: carbamazepine (CBZ), oxcarbazepine (OXC), valproic acid (VPA), lamotrigine (LTG), topiramate (TPM) and levetiracetam (LEV). Among the patients on monotherapy, reduced BMD was present significantly most often in patients treated with LEV and those treated with OXC. In the group of patients on polytherapy there was no significant difference in the incidence of low BMD among patients treated with various AEDs. Our data suggest that patients on long-term treatment with LEV have a higher risk for affection of bone density.

Circadian profiles of focal epileptic seizures: A need for reappraisal - Corrected Proof

2012-04-26

Abstract: Circadian rhythm of seizure is underestimated in the study of focal epilepsies. A review of the current literature revealed a clear correlation between cortical epileptogenic focus and the circadian phase of seizure peak occurrence in adult patients. A single diurnal peak at 19:00 was found in seizures originating from the occipital lobe, between 5:00 and 7:00 in frontal lobe seizures, and between 16:00 and 17:00h in temporal lobe seizures. Two diurnal peaks, between 5:00 and 7:00, and at 23:00 are reported in seizures from the parietal lobe, and between 7:00 to 8:00 and 16:00 to 17:00 in mesial temporal onset seizures. This circadian character of seizure occurrence in focal epilepsies may not be unique to partial seizures since recent clinical and experimental data indicate that generalized seizures also demonstrate circadian effects. The clinical evidence on generalized seizures and epilepsies is not recent, but a formal integration of circadian rhythmicity in our understanding and clinical management of epilepsies may be warranted.

Diffusion tensor imaging in radiosurgical callosotomy - Corrected Proof

2012-04-20

Abstract: Callosotomy by radioneurosurgery induces slow and progressive axonal degeneration of white matter fibers, a key consequence of neuronal or axonal injury (radionecrosis). However, the acute effects are not apparent when using conventional MRI techniques. Diffusion tensor imaging (DTI) during the first week following radioneurosurgical callosotomy allowed evaluation of these microstructural changes. The present report details that the use of sequential DTI to evaluate axonal degeneration following radioneurosurgical callosotomy in a patient normalized with the data of six healthy subjects. We describe a 25-year old woman with symptomatic generalized epilepsy who underwent a radioneurosurgical callosotomy using LINAC (Novalis® BrainLAB). DTI was acquired at the baseline, 3 and 9 months and showed a progressive decrease of the fractional anisotropy values in the irradiated areas compared to the controls that could be interpreted as a progressive disconnection of callosal fibers related to the outcome.

WITHDRAWN: Cannabidiol exerts anti-convulsant effects in animal models of temporal lobe and partial seizures - Corrected Proof

2011-01-07

This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause.The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.