Autism-related behavioral abnormalities in synapsin knockout mice

Several synaptic genes predisposing to autism-spectrum disorder (ASD) have been identified. Nonsense and missense mutations in the SYN1 gene encoding for Synapsin I have been identified in families segregating for idiopathic epilepsy and ASD and genetic mapping analyses have identified variations in the SYN2 gene as significantly contributing to epilepsy predisposition. Synapsins (Syn I/II/III) are a multigene family of synaptic vesicle-associated phosphoproteins playing multiple roles in synaptic development, transmission and plasticity. Lack of SynI and/or SynII triggers a strong epileptic phenotype in mice associated with mild cognitive impairments that are also present in the non-epileptic SynIII(-/-) mice. SynII(-/-) and SynIII(-/-) mice also display schizophrenia-like traits, suggesting that Syns could be involved in the regulation of social behavior. Here, we studied social interaction and novelty, social recognition and social dominance, social transmission of food preference and social memory in groups of male SynI(-/-), SynII(-/-) and SynIII(-/-) mice before and after the appearance of the epileptic phenotype and compared their performances with control mice. We found that deletion of Syn isoforms widely impairs social behaviors and repetitive behaviors, resulting in ASD-related phenotypes. SynI or SynIII deletion altered social behavior, whereas SynII deletion extensively impaired various aspects of social behavior and memory, altered exploration of a novel environment and increased self-grooming. Social impairments of SynI(-/-) and SynII(-/-) mice were evident also before the onset of seizures. The results demonstrate an involvement of Syns in generation of the behavioral traits of ASD and identify Syn knockout mice as a useful experimental model of ASD and epilepsy.

Depression in patients with epilepsy: a study from enugu, South East Nigeria

Background:

Depression is a common psychiatric disorder in epilepsy patients. A bidirectional interaction is thought to be present between epilepsy and depression. There are few studies of this relationship in Nigerian Africans.

Objectives:

This was a cross-sectional study of the frequency and pattern of depression in a cohort of epilepsy patients in Enugu, South East Nigeria.

Materials and Methods:

Adult patients with epilepsy seen at the University of Nigeria Teaching Hospital, Enugu, from May to September 2009 were assessed for depression using the Becks Inventory for Depression. Informed consent was obtained from each patient. Clinical data obtained were analyzed using Statistical Package for the Social Sciences, version 15. The hospital's ethical review committee approved the study.

Results:

I0 n all, 83 subjects were studied (50 males and 33 females). They were aged from 18 to 75 years, with an average of 29.87 years. Most subjects were <25 years of age, single (53, 64%) and had at least secondary school education (65, 78%). Depression was present in 71 (85.5%) subjects – minimal 57 (68.7%), mild 10 (12%), and moderate 4 (4.8%). No case of severe depression was seen. Patients <25 years of age were the most affected. Depression was not significantly associated with age, gender, seizure type, or educational level.

Conclusion:

A significant proportion of Nigerian African epilepsy patients have depression, which may be easily overlooked, with far-reaching consequences on patients’ quality of life, morbidity, and mortality rates. There is need to regularly assess for and manage epilepsy-related depression in this population.

Clinical application of TMS to epilepsy

The role of transcranial magnetic stimulation in epileptology is discussed in this article. Usefulness of TMS are discussed as a diagnostic tool in testing altered cortical excitability in patients with epilepsy and the modes of action of antiepileptic drugs, which are helpful to evaluate the pathophysiology of epilepsy. Also potential therapeutic tool in epilepsy with repetitive transcranial magnetic stimulation would be mentioned.

The Human Body's Own Language to be Considered for Safe and Effective Neurostimulation

INTRODUCTION

The general objective of this study was to provide an improved software for safer and more effective neurostimulation therapy.

MATERIALS AND METHODS

Tulgar implants, employing combined modulation of stimulation synchronized with heart rate, breathing frequency, and position of the patient (HBP), were applied as vagus nerve stimulation (VNS) for the management of refractory epilepsy in 105 patients who were followed up for 1 year.

RESULTS

Fifty-nine out of 105 (56.19%) patients were seizure free, 34 (32.38%) patients had partial improvement in quality of life with a decrease in intensity and frequency of the seizures, and 12 (11.43%) patients did not respond to stimulation.

DISCUSSION

Other similar studies, undertaken with non-Tulgar equipment, reported a 10% full recovery, 60% partial improvement in quality of life, and 30% zero response. Comparisons of these results reveal an approximate fivefold increase in seizure freedom, and threefold decrease in the number of nonresponsive patients.

CONCLUSIONS

The findings of the present study imply that HBP-modulated mode of stimulation could be safer and more effective in neurostimulation, at least in VNS.

Magnetoencephalography interictal spike clustering in relation with surgical outcome of cortical dysplasia

OBJECTIVE

The aim of this study was to devise an objective clustering method for magnetoencephalography (MEG) interictal spike sources, and to identify the prognostic value of the new clustering method in adult epilepsy patients with cortical dysplasia (CD).

METHODS

We retrospectively analyzed 25 adult patients with histologically proven CD, who underwent MEG examination and surgical resection for intractable epilepsy. The mean postoperative follow-up period was 3.1 years. A hierarchical clustering method was adopted for MEG interictal spike source clustering. Clustered sources were then tested for their prognostic value toward surgical outcome.

RESULTS

Postoperative seizure outcome was Engel class I in 6 (24%), class II in 3 (12%), class III in 12 (48%), and class IV in 4 (16%) patients. With respect to MEG spike clustering, 12 of 25 (48%) patients showed 1 cluster, 2 (8%) showed 2 or more clusters within the same lobe, 10 (40%) showed 2 or more clusters in a different lobe, and 1 (4%) patient had only scattered spikes with no clustering. Patients who showed focal clustering achieved better surgical outcome than distributed cases (p=0.017).

CONCLUSION

This is the first study that introduces an objective method to classify the distribution of MEG interictal spike sources. By using a hierarchical clustering method, we found that the presence of focal clustered spikes predicts a better postoperative outcome in epilepsy patients with CD.

FMRI under sedation: what is the best choice in children?

Background

Pediatric fMRI may require sedation. The aim of this study is to compare different sedation schemes to determine which medication yields least failures and the best activation.

Methods

A total of 100 children who had fMRI performed as part of the work up for epilepsy surgery, were divided into different medication groups (Pentobarbital, Propofol, Dexmedetomidine, Sevoflurane). Comparison was performed among the groups for number of failures, rank of activation, adverse effects, anesthesia time, and recovery time. The study was approved by the IRB and followed all HIPAA guidelines. BOLD sequences were utilized to perform two block-design paradigms (auditory and visual). The activation was ranked into 5 categories according to the presence and localization of the activation. Descriptive and parametric statistics (ANOVA) were utilized to look for significant differences.

Results

Pentobarbital yielded the least amount of failures, for the auditory task, followed by propofol, while sevoflurane yielded the highest number of failures for both tasks. In the visual task, propofol administered after dexmedetomidine resulted in the least number of failures. Brain activations were not statistical different (auditory: ANOVA, P = 0.42; F = 1.01; visual: ANOVA, P = 0.077; F = 2.1). The shortest recovery time was obtained with sevoflurane, followed by propofol. Agitation and cardiac complications were seen in 28% of cases in the pentobarbital group.

Conclusion

No statistically significant difference in brain activation was found utilizing different sedative medications in children with intractable epilepsy. A trend toward less failures was obtained with pentobarbital and propofol; however pentobarbital was more frequently associated with undesirable side effects.

Low-dose lacosamide-induced atrial fibrillation: Case analysis with literature review

Lacosamide (LCM) is a novel antiepileptic drug (AED) approved by the FDA for adjunctive treatment of partial epilepsy with and without secondary generalization. Lacosamide dose-dependent dysrhythmias (PR-interval prolongation, AV block, and atrial fibrillation/flutter) have been reported. This case represents the first instance of LCM-induced atrial fibrillation following a low loading dose (200 mg). Risk factors for atrial fibrillation are addressed and discussed in the context of this case. Full cardiac history is recommended prior to patients being initiated on LCM. Cardiac monitoring may be required for at-risk patients on LCM. Clinicians need to be cognizant of this potential adverse effect.

Ventricular tachycardia associated with lacosamide co-medication in drug-resistant epilepsy

We report a case of sustained ventricular tachycardia following the initiation of lacosamide as adjunctive epilepsy treatment. A 49-year-old male with intractable frontal lobe seizures experienced severe ventricular tachycardia following the addition of 400 mg lacosamide to his existing regimen of carbamazepine, lamotrigine, clonazepam, and valproate. The tachycardia occurred during a cardiac stress test; stress tests prior to initiation of lacosamide were normal. Conduction defects, including QRS prolongation, persisted during hospitalization until lacosamide was discontinued. The patient had no prior history of cardiac arrhythmia but did possess cardiac risk factors, including hypertension, hypercholesterolemia, and low heart rate variability. This case represents one part of a growing body of literature suggesting a link between arrhythmia and use of lacosamide, which enhances slow inactivation of sodium channels in both the brain and the heart. We believe further study may be necessary to assess the safety of lacosamide in epilepsy patients with cardiac risk factors.

Radiosurgery for the treatment of dominant hemisphere periventricular heterotopia and intractable epilepsy in a series of three patients

Periventricular heterotopia (PVH) is a neuronal migration disorder characterized by masses of gray matter located along the lateral ventricles that commonly cause epilepsy. The benefit of surgical resection of the PVH has been demonstrated in case reports to date; however, the location of the PVH in the paratrigonal region of the lateral ventricles can present significant surgical challenges. Noninvasive modalities of ablating this epileptogenic focus must therefore be considered. We present a small series of three patients who underwent stereotactic radiosurgery (SRS) for inoperable unilateral dominant hemisphere PVHs in order to illustrate the potential benefits and risks of this treatment modality. A total dose of 37.5–65 Gy resulted in seizure freedom for at least 14 months at the time of their last follow-up, even in patients harboring a second independent epileptic focus. Whether intracranial electrode recording truly offers added value is therefore uncertain. The two patients who received higher radiation doses suffered from symptomatic radiation necrosis and associated cerebral edema, requiring further medical intervention, and persistent monocular visual loss in one patient. While a longer interval prior to re-treatment may have been attempted, neither patient demonstrated radiographic findings typically associated with seizure remission. Refractory epilepsy due to PVH may be successfully treated with radiation therapy; but further work is needed to define the optimal dosing parameters in order to lower toxicity to normal tissue.

Quality of life and its determinants in people with epilepsy in basrah, iraq

OBJECTIVE

The objective of this study was to assess the quality of life (QOL) in people with epilepsy and to evaluate various factors affecting their QOL.

METHODS

A total of 116 patients with epilepsy and a control group of 116 apparently healthy persons were included in this case-control study which was conducted at the neurology outpatient clinic of Basrah General Hospital, Iraq. An interview was performed with the use of a special questionnaire, which included data pertaining to socio-demographic characteristics, and clinical characteristics (for patients with epilepsy only). The QOL was assessed with the use of a Short Form (SF-36) health survey.

RESULTS

Epileptic patients showed lower overall QOL scores as compared to controls. In the univariate analysis, patients who were older, from rural areas, and with low education and income levels had low er overall QOL scores. Frequent seizures as well as increased duration of epilepsy were also significant factors associated with reduction in QOL scores. In the multivariate regression analysis, age, educational level, income and frequency of seizures were significant determinants of QOL.

CONCLUSION

Certain socio-demographic factors as well as clinical factors were crucial in determining QOL in epilepsy patients. Recognition of these factors will lead health professionals to develop different strategies to improve the QOL of those patients.

Picrotoxin-induced convulsions and lysosomal function in the rat brain

The effect of picrotoxin-induced convulsions on lysosomal function in rat brain were evaluated by measuring the free as well as total acid phosphatase, cathepsin D, acid ribonuclease (RNAse II) and acid deoxyribonuclease (DNAse II) activities. Following picrotoxin treatment the free RNAse II activity increased whereas the total activities of practically all the other enzymes decreased. Paradoxically, the cathepsin D activity, free as well the total was completely abolished. In case of all the enzymes the ratio of Total activity/Free activity decreased indicating increased lysosomal membrane fragility which could lead to process of neurodegeneration in the epileptic animals.

Neurofeedback in ADHD and insomnia: vigilance stabilization through sleep spindles and circadian networks

In this review article an overview of the history and current status of neurofeedback for the treatment of ADHD and insomnia is provided. Recent insights suggest a central role of circadian phase delay, resulting in sleep onset insomnia (SOI) in a sub-group of ADHD patients. Chronobiological treatments, such as melatonin and early morning bright light, affect the suprachiasmatic nucleus. This nucleus has been shown to project to the noradrenergic locus coeruleus (LC) thereby explaining the vigilance stabilizing effects of such treatments in ADHD. It is hypothesized that both Sensori-Motor Rhythm (SMR) and Slow-Cortical Potential (SCP) neurofeedback impact on the sleep spindle circuitry resulting in increased sleep spindle density, normalization of SOI and thereby affect the noradrenergic LC, resulting in vigilance stabilization. After SOI is normalized, improvements on ADHD symptoms will occur with a delayed onset of effect. Therefore, clinical trials investigating new treatments in ADHD should include assessments at follow-up as their primary endpoint rather than assessments at outtake. Furthermore, an implication requiring further study is that neurofeedback could be stopped when SOI is normalized, which might result in fewer sessions.

Scalp-recorded evoked potentials as a marker for afferent nerve impulse in clinical vagus nerve stimulation

BACKGROUND

Vagus nerve stimulation (VNS) is a palliative treatment for drug resistant epilepsy for which the efficacy and safety are well established. Accumulating evidence suggests that ascending vagal signals modulate abnormal cortical excitability via various pathways. However, there is no direct evidence for an ascending conduction of neural impulses in a clinical case of VNS.

OBJECTIVE

We recorded and analyzed the short-latency components of the vagus nerve (VN) evoked potential (EP) from the viewpoint of determining whether or not it is a marker for the ascending neural conduction.

METHODS

EPs within 20 ms were prospectively recorded simultaneously from a surgical wound in the neck and at multiple scalp sites during implantation surgery in 25 patients with drug-resistant epilepsy. Electrical stimulation was delivered using the clinical VNS Therapy system. A recording was made before and after a muscle relaxant was administered, when changing the rostrocaudal position of stimulation, or when stimulating the ansa cervicalis instead of the VN.

RESULTS

The short-latency components consisted of four peaks. The early component around 3 ms, which was most prominent in A1-Cz, remained unchanged after muscle relaxation while the later peaks disappeared. Rostral transition of the stimulation resulted in an earlier shift of the early component. The estimated conduction velocity was 27.4 ± 10.2 m/s. Stimulation of the ansa cervicalis induced no EP.

CONCLUSIONS

The early component was regarded as directly resulting from ascending neural conduction of A fibers of the VN, probably originating around the jugular foramen. Recording of VN-EP might document the cause of treatment failure in some patients.

Correlates of parental stress and psychopathology in pediatric epilepsy

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.

Knowledge, attitude and practice of epilepsy in Uttarakhand, India

Objectives:

This study was conducted to find out knowledge, attitude and practice (KAP) of epilepsy among 12^th-class students in Uttarakhand state. Secondly data of Uttarakhand was compared with KAP study from other parts of the country.

Materials and Methods:

All 12^th-class students studying in six schools of randomly selected 36 villages in Chakrata block of Dehradun district of Uttarakhand state were provided a printed questionnaire having answer as “yes or no”. This questionnaire used was used previously by various authors and validated for KAP analysis. These filled questionnaires were collected by village health workers and medical officer.

Results:

This study conducted on 219, 12^th-class students revealed that epilepsy was heard by 98%, 74.9% thought epilepsy a mental disease and 4.8% believed that it is contagious. Negative attitude showed as nearly 2/3^rd students stated that epilepsy is hindrance in marriage and occupation. Nearly 41% would use onion or shoe for terminating seizure attack. Ayurvedic treatment was preferred over allopathic drugs.

Conclusions:

Study on 12^th-class students of Uttarakhand revealed poor knowledge, attitude and practice for epilepsy and needs special education program to dispel these misconceptions.

Neuroimaging in epilepsy

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.

Risk factors of childhood epilepsy in Kerala

Background:

We aimed to identify the risk factors for epilepsy in children.

Materials and Methods:

This case–control retrospective study was carried out in the pediatric neurology outpatient service of the Trivandrum Medical College. All children (1–12 years) with epilepsy satisfying the selection criteria were included, after obtaining consent from parents. Those with single seizures or febrile seizures were excluded. Controls were children without epilepsy attending the same hospital. Parents were interviewed and clinical data were obtained from medical records. Statistical analysis included chi-square test, odds ratio (OR), and logistic regression.

Results:

There were 82 cases and 160 controls whose mean age was 6.9 + 3.6 and 5.2 + 3.1, years respectively. On univariate analysis, family history of epilepsy, prolonged labor, cyanosis at birth, delayed cry after birth, admission to newborn intensive care unit, presence of congenital malformations, neurocutaneous markers, incessant cry in the first week, delayed developmental milestones, meningitis, encephalitis, and head trauma were found to be significant. On logistic regression, family history of epilepsy (OR 4.7), newborn distress (OR 8.6), delayed developmental milestones (OR 12.6), and head trauma (OR 5.8) were found to be significant predictors. Infants who had history of newborn distress are likely to manifest epilepsy before 1 year if they are eventually going to have epilepsy (OR 3.4).

Conclusion:

Modifiable factors such as newborn distress and significant head trauma are significant risk factors for childhood epilepsy. Newborn distress is a risk factor for early-onset (<1 year age) epilepsy.

Attention deficit hyperactivity disorder in epileptic children

It is well-known that the prevalence of attention deficit hyperactivity disorder (ADHD) is higher in epileptic children than in the general pediatric population. The aim of this study was to compare the accompaniment of ADHD in epileptic children with well-controlled seizures and no significant intellectual disability with that in healthy controls. We included epileptic children between the ages of 6 and 12 yr visiting our clinic for six consecutive months and controls without significant medical or psychiatric illnesses. We excluded patients with intellectual disability or persistent seizures during the recent three months. The diagnosis of ADHD was based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). After exclusion of 84 patients, we enrolled 102 (54.8%) children (mean age, 9.4 ± 2.0 yr). Seven (7 of 102, 6.9%) were diagnosed with ADHD. As compared to control group (4 of 110, 3.6%), there was no difference in ADHD accompaniment (P = 0.29). No difference was observed in ADHD accompaniment according to seizure type and epilepsy syndrome. In conclusion, the accompaniment of ADHD in epileptic children with well-controlled seizures and no intellectual disability may not differ from that of the general pediatric population.

The use of ketogenic diet in special situations: expanding use in intractable epilepsy and other neurologic disorders

The ketogenic diet has been widely used and proved to be effective for intractable epilepsy. Although the mechanisms underlying its anti-epileptic effects remain to be proven, there are increasing experimental evidences for its neuroprotective effects along with many researches about expanding use of the diet in other neurologic disorders. The first success was reported in glucose transporter type 1 deficiency syndrome, in which the diet served as an alternative metabolic source. Many neurologic disorders share some of the common pathologic mechanisms such as mitochondrial dysfunction, altered neurotransmitter function and synaptic transmission, or abnormal regulation of reactive oxygen species, and the role of the ketogenic diet has been postulated in these mechanisms. In this article, we introduce an overview about the expanding use and emerging trials of the ketogenic diet in various neurologic disorders excluding intractable epilepsy and provide explanations of the mechanisms in that usage.

Glutamate biosensor imaging reveals dysregulation of glutamatergic pathways in a model of developmental cortical malformation

Cortical malformations can cause intractable epilepsy, but the underlying epileptogenic mechanisms are poorly understood. We used high-speed glutamate biosensor imaging to ask how glutamatergic signaling is altered in cortical malformations induced by neonatal freeze-lesions (FL). In non-lesion neocortical slices from 2 to 8week old rats, evoked glutamate signals were symmetrical in the medio-lateral axis and monotonic, correlating with simple, brief (≈50ms) local field potentials (LFPs). By contrast, in FL cortex glutamate signals were prolonged, increased in amplitude, and polyphasic, which paralleled a prolongation of the LFP. Using glutamate biosensor imaging, we found that glutamate signals propagated throughout large areas of FL cortex and were asymmetric (skewed toward the lesion). Laminar analysis demonstrated a shift in the region of maximal glutamate release toward superficial layers in FL cortex. The ability to remove exogenous glutamate was increased within the FL itself but was decreased in immediately adjacent regions. There were corresponding alterations in astrocyte density, with an increase within the lesion and a decrease in deep cortical layers surrounding the lesion. These findings demonstrate both network connectivity and glutamate metabolism are altered in this cortical malformation model and suggests that the regional ability of astrocytes to remove released glutamate may be inversely related to local excitability.

Attempt to suicide in young ages with epilepsy

OBJECTIVE

The suicidal rate among epileptic patients is up to 5 times more than general population and depression is the most common mood disturbance among them while usually under noticed. This study was performed to determine possible symptoms of psychiatric disorders for suicidal behavior in pediatric patients with epilepsy that had attempted suicide.

METHODS

Among medical records of 1169 patients under 17 years of age being admitted to the exclusive university hospital for poisoning in Tehran since April 2006 to Feb 2008 due to attempt to suicide, 31 cases (13 male and 18 female) with mean age 15.8±1.3 years had concomitant epilepsy. Mental status and epilepsy data sheet of these patients were analyzed.

FINDINGS

The psychological evaluation of these 31 cases revealed long lasting symptoms of psychological disorder in 21 (91.4%) cases before their attempt to suicide while only 5(16%) cases had been noticed for psychiatric care and merely 3 of them had been under treatment.

CONCLUSION

Despite strong correlation between affective disorders and epilepsy it is unfortunately under-diagnosed or undertreated. Since overdose of antiepileptic drugs used for treatment of epilepsy may be lethal, dismissing suicidal behavior can be life threatening.

Epilepsy prevalence in the 0-17 age group in trabzon, Turkey

OBJECTIVE

Epilepsy is a most common serious neurological disorder and is one of the world's most prevalent non-communicable diseases. The aim of this study was to determine the prevalence and risk factors of epilepsy in 0-17 year old children in Trabzon, Turkey.

METHODS

A cross-sectional epidemiological investigation was performed in two phases, a screening phase and a confirmation of the diagnosis phase. The gold standard was a clinical investigation and neurological examination. The diagnosis of epilepsy followed clinical guidelines proposed by the International League against Epilepsy (ILAE). The chi-square test was used in analysis of the results and P-value <0.05 was calculated.

FINDINGS

The prevalence per 1000 participants of epilepsy was 8.6 (5.9-11.4; (95%)CI). We detected 37 cases (18 males and 19 females) of epilepsy. The male/female ratio was 0.95. This study showed an increased risk for epilepsy with low socioeconomic level, a history of postpartum seizure, meningitis, head trauma, febrile convulsion and family history of epilepsy. More than one seizure type was present in 15 (40.5%) of epileptic children. Generalized tonic-clonic seizures were determined in 24 patients (64.9%) and absence type in 9 (24.3%). It was found that 25.0% of children with epilepsy had never visited the school at the time the study was performed due to the disease and attendant seizures.

CONCLUSION

The prevalence of epilepsy in Trabzon is low compared to other parts of Turkey and other developing countries.

Using Poisson marginal models for investigating the effect of factors on interictal epileptiform discharge in patients with epilepsy

BACKGROUND

Epilepsy is a common, chronic neurological disorder that affects more than 40 million people worldwide. Epilepsy is characterized by interictal and ictal functional disturbances. The presence of interictal epileptiform discharges (IEDs) can help to confirm a clinical diagnosis of epilepsy, and their location and characteristics can help to identify the epileptogenic zone or suggest a particular epilepsy syndrome. The aim of this study is to determine the factors that affect IEDs.

MATERIALS AND METHODS

Poisson marginal model was done on 60 epileptic patients who were referred to Shefa Neurological Research Center, Tehran, for Video-Electroencephalogram (V-EEG) monitoring from 2007 to 2011. The frequency of IEDs was assessed by visual analysis of interictal EEG samples for 2 h.

RESULTS

The results show that among age, epilepsy duration, gender, seizure frequency and two common anti-epileptic drugs (Valproic acid and Carbamazepine), only age and epilepsy duration had statistical significant effect on IED frequency.

CONCLUSION

Investigating the factors affecting IED is not only of theoretical importance, but may also have clinical relevance as understanding the evolution of interictal epileptogenesis may lead to the development of therapeutic interventions. Generalized estimating equation is a valid statistical technique for studying factors that affect on IED. This research demonstrates epilepsy duration has positive and age has negative effect on IED which means that IED increases with epilepsy duration and decreases with increasing age. So for monitoring IED, we should consider both age and epilepsy duration of each patient.

Preferential inactivation of Scn1a in parvalbumin interneurons increases seizure susceptibility

Voltage-gated sodium channels (VGSCs) are essential for the generation and propagation of action potentials in electrically excitable cells. Dominant mutations in SCN1A, which encodes the Nav1.1 VGSC α-subunit, underlie several forms of epilepsy, including Dravet syndrome (DS) and genetic epilepsy with febrile seizures plus (GEFS+). Electrophysiological analyses of DS and GEFS+ mouse models have led to the hypothesis that SCN1A mutations reduce the excitability of inhibitory cortical and hippocampal interneurons. To more directly examine the relative contribution of inhibitory interneurons and excitatory pyramidal cells to SCN1A-derived epilepsy, we first compared the expression of Nav1.1 in inhibitory parvalbumin (PV) interneurons and excitatory neurons from P22 mice using fluorescent immunohistochemistry. In the hippocampus and neocortex, 69% of Nav1.1 immunoreactive neurons were also positive for PV. In contrast, 13% and 5% of Nav1.1 positive cells in the hippocampus and neocortex, respectively, were found to co-localize with excitatory cells identified by CaMK2α immunoreactivity. Next, we reduced the expression of Scn1a in either a subset of interneurons (mainly PV interneurons) or excitatory cells by crossing mice heterozygous for a floxed Scn1a allele to either the Ppp1r2-Cre or EMX1-Cre transgenic lines, respectively. The inactivation of one Scn1a allele in interneurons of the neocortex and hippocampus was sufficient to reduce thresholds to flurothyl- and hyperthermia-induced seizures, whereas thresholds were unaltered following inactivation in excitatory cells. Reduced interneuron Scn1a expression also resulted in the generation of spontaneous seizures. These findings provide direct evidence for an important role of PV interneurons in the pathogenesis of Scn1a-derived epilepsies.

The quality of care provided to patients with chronic non-communicable diseases: a retrospective multi-setup study in jimma zone, southwest ethiopia

Background

Chronic Non-Communicable Diseases are among the major causes of morbidity and mortality worldwide. However, access to and quality of health care for patients is very low in developing countries including Ethiopia. Hospitals and Health Centers are the main sources of health care for such patients in Ethiopia. In this study we assessed the quality of care patients with Chronic Non-Communicable Diseases received in hospital and health center setups.

Methods

A retrospective multi-setup study was conducted in Jimma University Specialized Hospital and four Health Centers in Jimma Zone from February to March 2010. A total of 52 process indicators of quality covering three disease conditions: Diabetes, Hypertension and Epilepsy were measured by reviewing randomly selected medical records. Quality of care was measured as a proportion of recommended components of care actually provided to patients. And also outcome and structural measures were assessed to supplement process measures of quality.

Results

Six hundred seventy four medical records were reviewed. Recommended care components were actually provided to patients in 35.1% (95% CI:34.1%, 36.0%), 38.5% (95% CI:37.5%, 39.5%) and 60.1% (95% CI:59.3%, 61.0%) of times on which patients were eligible, among patients with Diabetes, Hypertension and Epilepsy, respectively. After case mix adjustment, it was found that 45.9% (95% CI:45.4%, 46.5%) of recommended components of care was actually provided to patients. This was 45.1% (95% CI:44.4%, 45.8%) in the hospital and 30.5% (95% CI:29.7%, 31.3%) in the health centers. Among patients for whom outcome data was available, optimal level of disease control was achieved only for 47 (30.5%), 40 (38.5%) and 193 (52.9%) of patients with Diabetes, Hypertension and Epilepsy, respectively.

Conclusion

The quality of care provided to patients with Chronic Non-Communicable Diseases is very low in both settings though it is relatively better in Jimma University Specialized Hospital. Therefore, a continuous process of quality improvement is recommended in both settings.

Epilepsy in Korean patients with Angelman syndrome

Purpose

The aim of this study was to investigate the natural history of epilepsy and response to anti-epileptic drug treatment in patients with Angelman syndrome (AS) in Korea.

Methods

We retrospectively reviewed the clinical records of 14 patients diagnosed with epilepsy out of a total of 17 patients with a genetic diagnosis of AS. These patients were seen at the Department of Pediatric Neurology at Severance Children's Hospital from March 2005 to March 2011.

Results

Fourteen (9 males and 5 females) subjects (82.3%) were diagnosed with epilepsy in AS. The most common seizure types were generalized tonic-clonic (n=9, 27%) and myoclonic (n=9, 27%), followed by atonic (n=8, 24%), atypical absence (n=4, 12%) and complex partial seizure (n=3, 9%). The most commonly prescribed antiepileptic drug (AED) was valproic acid (VPA, n=12, 86%), followed by lamotrigine (LTG, n=9, 64%), and topiramate (n=8, 57%). According to questionnaires that determined whether each AED was efficacious or not, VPA had the highest response rate and LTG was associated with the highest rate of seizure exacerbation. Complete control of seizures was achieved in 6 patients. Partial control was achieved in 7 patients, while one patient was not controlled.

Conclusion

Epilepsy is observed in the great majority of AS patients. It may have early onset and is often refractory to treatment. There are few reports about epilepsy in AS in Korea. This study will be helpful in understanding epilepsy in AS in Korea.

Cognitive function of idiopathic childhood epilepsy

Most children with epilepsy are of normal intelligence. However, a significant subset will have temporary or permanent cognitive impairment. Factors that affect cognitive function are myriad and include the underlying neuropathology of the epilepsy, seizures, epileptiform discharges, psychosocial problems, age at seizure onset, duration of epilepsy, and side effects associated with antiepileptic drugs. This review article discusses cognitive function in children with idiopathic epilepsy and the effects of antiepileptic drugs on cognitive function in children.

Risks of suicidality in adult patients with epilepsy

AIM: To determine the prevalence and risks of suicidality in a group of patients with epilepsy.

METHODS: Included were 200 adult patients and 100 matched healthy subjects. The clinical interview using The Diagnostic and Statistical Manual of Mental Disorders (4th edition), Beck Depression Inventory (2nd edition) (BDI-II), Hamilton Anxiety Rating Scale (HAM-A), Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and Eysenck Personality Questionnaire-Revised Rating Scale testings were used for diagnosis and assessment of severity of psychiatric symptoms. Blood concentrations of serotonin, catecholamines and dopamine were also measured.

RESULTS: Suicidality was reported in 35% (compared to 9% for controls), of them 80%, 72.86%, 55.71% and 52.9% had depression, anxiety, obsession and aggression respectively. Patients with suicidality had higher scores of BDI-II (P = 0.0001), HAM-A (P = 0.0001), and Y-BOCS (P = 0.037) and lower scores of psychotic (P = 0.0001) and extroversion (P = 0.025) personality traits. Regardless the presence or absence of suicidality, patients with epilepsy had low serotonin (P = 0.006), noradrenaline (P = 0.019) and adrenaline (P = 0.0001) levels. With suicidality, significant correlations were identified between: (1) age and scores of BDI-II (r = 0.235, P = 0.0001) and HAM-A (r = 0.241, P = 0.046); (2) age at onset and concentrations of noradrenaline (r = -0.502, P = 0.024); (3) duration of illness and scores of BDI-II (r = 0.247, P = 0.041), Y-BOCS (r = 0.270, P = 0.025) and neurotic personality trait (r = -0.284, P = 0.018); and (4) doses of antiepileptic drugs and scores of psychotic personality traits (r = -0.495, P = 0.006 for carbamazepine; r = -0.508, P = 0.0001 for valproate).

CONCLUSION: This is the first study which systematically estimated the prevalence and risks of suicidality in a homogenous group of patients with epilepsy. This study emphasizes the importance of epilepsy itself as a risk for suicidality and not its treatment.

Assessment of gray matter heterotopia by magnetic resonance imaging

AIM: To evaluate magnetic resonance imaging (MRI) features of different types of gray matter heterotopia.

METHODS: Between June 2005 and December 2009, the medical records and MRI studies of patients with gray matter heterotopia were reviewed. The MRI morphologic findings of heterotopia were recorded along with the presence and type of associated cranial malformations. Available clinical and electrophysiological data were also recorded.

RESULTS: 20 patients were included in the study. Their ages ranged from 9 mo to 39 years with a mean age of 15 years. All patients suffered from epileptic seizures. According to the location of heterotopia, patients were classified into three groups: subependymal (12), subcortical (5) and band (3) heterotopia.

CONCLUSION: MRI was useful in diagnosing and differentiating between various types of gray matter heterotopia. The severity of clinical manifestations of heterotopia was related to the location and pattern of heterotopia. Determination of heterotopia type and its extent is useful for management planning and predicting prognosis.

Seizure, spinal schwannoma, peripheral neuropathy and pulmonary stenosis - A rare combination in a patient of Neurofibromatosis 1

Neurofibromatosis 1 (NF1) is the most common neurocutaneous syndrome. It is estimated to occur in approximately 1 out of every 3300 infants. The manifestations of this condition are diverse and can arise from almost any system in the body. The neurofibroma is the hallmark lesion of NF1 that develops from peripheral nerves. Here, we are reporting an 18-year-old girl with NF1. Clinical diagnosis was made according to the diagnostic criteria established by the National Institutes of Health Consensus Development Conference in 1987. She presented with quadriparesis due to dumbbell-shaped spinal schwannoma in the cervical region. She had history of recurrent seizures in the past, with poor scholastic performance. There were clinical and electrophysiological features of peripheral neuropathy and clinical and echocardiographical features of pulmonary stenosis. These are uncommon features of NF 1. The presence of all these features in a single patient makes it a unique case.

Old Remedies for Epilepsy: Avicenna's Medicine

BACKGROUND

The history of epilepsy and its treatments dates back to at least 4 millennia. Avicenna, c. 980 AD in Bukhara, Khorasan-1037 in Hamedan was a Persian-speaking Iranian physician, who has many recommendations and suggested various therapies for epilepsy in his book, The Canon of Medicine.

METHODS

We first reviewed the most important ancient treatments for epilepsy mentioned by Avicenna and considered those as the key words for our next step. Then, we made a literature search (medline and scopus) with those key words to find out new scientific findings in modern medicine about the Avicenna's suggestions.

RESULTS

Among the Avicenna's recommended therapies for epilepsy, only Rue has been tested for anticonvulsant activities in modern medicine. Interestingly, it had a dose dependent anticonvulsant effect.

CONCLUSION

It is worthwhile to consider the Avicenna's recommended therapies for epilepsy and to design future scientific studies based on his suggestions.

Prevalence of treated epilepsy in Korea based on national health insurance data

The Korean national health security system covers the entire population and all medical facilities. We aimed to estimate epilepsy prevalence, anticonvulsant utilization pattern and the cost. We identified prevalent epilepsy patients by the prescription of anticonvulsants under the diagnostic codes suggesting seizure or epilepsy from 2007 Korean National Health Insurance databases. The information of demography, residential area, the kind of medical security service reflecting economic status, anticonvulsants, and the costs was extracted. The overall prevalence of treated epilepsy patients was 2.41/1,000, and higher for men than women. The age-specific prevalence was the lowest in those in their thirties and forties. Epilepsy was more prevalent among lower-income individuals receiving medical aid. The regional prevalence was the highest in Jeju Island and lowest in Ulsan city. New anticonvulsants were more frequently used than old anticonvulsants in the younger age group. The total annual cost of epilepsy or seizure reached 0.46% of total medical expenditure and 0.27% of total expenditure on health. This is the first nationwide epidemiological report issued on epilepsy in Korea. Epilepsy prevalence in Korea is comparable to those in developed countries. Economic status and geography affect the prevalence of epilepsy.

Depression in adults with epilepsy: Relationship to psychobiological variables

AIM: To characterize the relationship between depression and epilepsy-related seizures, treatment, hormonal and biological variables.

METHODS: Included were 200 Egyptian adults (male = 100, female = 100) with epilepsy (mean age: 30.87 ± 7.88 years; duration of illness: 13.89 ± 7.64 years) and 100 healthy matched subjects for comparison. Psychiatric interview, Beck Depression Inventory (BDI-II) and Hamilton Anxiety Rating Scale (HAM-A) were used to assess depression and anxiety. Blood levels of free testosterone, sex hormone binding globulin, prolactin, free thyroxin and thyroid stimulating hormone, serotonin, noradrenaline and adrenaline neurotransmitters were measured to assess endocrine and biological states.

RESULTS: Patients had higher rates of depressive disorder (25.5% or 51/200), mostly intermixed with anxiety (47.06%), psychotic features (19.61%), aggression (40%) and suicide (55%). Compared to controls, higher scores on the BDI-II were observed with right-sided epileptic foci (P = 0.011), polytherapy (P = 0.001) and lack of control on antiepileptic drugs (AEDs) (P = 0.0001). Patients had lower levels of serotonin (P = 0.001) [marked with depression (P = 0.012)] and adrenaline (P = 0.0001), while noradrenaline was lower with temporal lobe epilepsy (P = 0.039), left-sided foci (P = 0.047) and lack of control on AEDs (P = 0.017). Negative correlations were observed between levels of serotonin and BDI-II (P = 0.048) and HAM-A (P = 0.009) scores, but not with AEDs dose or drug level.

CONCLUSION: Comorbid depressive disorder with epilepsy appears to be closely related to seizure type, focus, side, intractability to medications and neurotransmitter changes. Thus, optimizing seizure control and early recognition and management of depression is necessary to improve patients’ quality of life.

Vagus nerve stimulation for epilepsy: A review of the peripheral mechanisms

Vagus nerve stimulation (VNS) is a unique epilepsy treatment in that a peripheral intervention is used to treat a disease that is entirely related to pathological events occurring within the brain. To understand how stimulation of the vagus nerve can be used to stop seizures, an understanding of the peripheral anatomy and physiology of the vagus nerve is essential. The peripheral aspects of the vagus nerve are discussed in this review, with an explanation of which fibers and branches are involved in producing these antiepileptic effects, along with speculation about the potential for improving the therapy.

Links between headaches and epilepsy: current knowledge and terminology

INTRODUCTION AND OBJECTIVES

Headaches (including migraines) and epilepsy have a high level of comorbidity and may be confused during diagnosis. Although physicians have known for centuries that these two conditions are somehow linked, their relationship remains poorly understood. Herein we describe the known associations between them, their underlying physiopathologic and genetic mechanisms, and the treatments recommended for them.

METHOD

We have reviewed the most relevant publication of headache/migraine and epilepsy by using the PubMed data base.

DESCRIPTION

An individual can suffer both from headaches (either migraine and/or other type of headache) and epilepsy, either by chance or because of a common underlying pathology. In these cases, the headache usually occurs at a different moment than the seizure ("interictal headache"). However, headaches sometimes occur simultaneously with, or very close in time to, the seizure: one that occurs at the same time as an epileptic seizure is known as an "ictal epileptic headache" or as "hemicrania epileptica"; one that precedes a seizure is known as a "pre-ictal headache"; and one that follows a seizure is known as a "post-ictal headache". There is a particular type of pre-ictal headache, known as "migralepsy", which occurs during or just after a migraine aura.

CONCLUSIONS

The terminology and concepts employed to describe possible associations between headaches (mainly migraines) and epilepsy have evolved over time with increasing clinical and physiopathogenic knowledge. Some researchers have suggested eliminating the term migralepsy and using the terms ictal epileptic headache and hemicrania epileptica exclusively and uniformly in all classification systems.

An update on the ketogenic diet, 2012

The ketogenic diet has been in use for the last 90 years, and its role in the treatment of epilepsy in the pediatric population has been gaining recognition. It can be helpful in many types of epilepsies, even the more severe ones, and has a beneficial effect on the child's alertness and cognition, which can be impaired by both the condition and the medications needed for controlling it. Parental compliance is good in spite of the inconveniences inherent in following the diet. The significant advancements in understanding the nature of the diet are in better defining when its use is contraindicated and in validating its application in severe epilepsies in infancy, such as infantile spasms. Although most neurologists do not consider it as being the preferred first-line therapy, it is often a reasonable option when two medications have already failed.

Antiepileptic and Antioxidant Effect of Brassica nigra on Pentylenetetrazol-Induced Kindling in Mice

Considering the high rate of epilepsy today, with respect to the insufficiency of the available therapies, new strategies and methods are recommended for medical treatment of epileptic patients. Therefore, the present study experimentally investigated the anticonvulsant effect of a herbal medicine candidate brassica nigra, by using kindling method. Sixty male mice were randomly selected and divided into six experimental groups (n = 10) including: 1-control, 2-pentylentetrazole (PTZ)-kindled mice, 3-positive control group received valproate (100 mg/Kg) as anti-convulsant drug, 4-5 and 6 received brassica nigra seed extract in three doses (75, 150 and 300 mg/Kg; IP). All groups except for the control ones were kindled by 11 period injections of PTZ (35 mg/Kg; IP). In the 12th injection, all groups except for the control group were tested for PTZ challenge dose (75 mg/Kg). However, the exhibited phases of seizure (0-6) were observed and noted till 30 min after the PTZ injection. At last, the brains of all the mice were removed and then malondialdehyde (MDA), superoxide dismutase (SOD) and nitric oxide (NO) levels of the brain tissues were determined. Statistical analysis of the data shows that the seed extract could reduce the intensity, improvement and duration of seizure. In addition, the brassica nigra extract increased the SOD and NO levels and decreased the MDA level in the brain tissues. Attained results show that the extract of Brassica nigra seed can be used in grand mal seizure treatment. Moreover, the antiepileptic effect of this extract is probably caused by its antioxidant properties and acts via enzyme activity mechanism.

Relation between Proepileptic Activity of Indomethacin and AdrenalGland Hormones

The role of inflammation has been shown in the pathogenesis of epilepsy, while glucocorticoids and adrenaline have anti-inflammatory effects. The aim of the present study was to investigate the effects of adrenaline, prednisolone, and indomethacin on caffeine-induced epilepsy (epileptiform activity) in rats and to examine the mechanism of the pro-epileptic effect of indomethacin. The adrenalectomized rats that had been given only adrenaline (the control group) did not die; however, adrenaline did not prevent the adrenalectomized rats which were given prazosin, phenoxybenzamine, yohimbine, metoprolol, and propranolol from dying. In the rats given propranolol + adrenaline, the rate of death was 100%, while this rate was 50% in the groups receiving prazosin + adrenaline, phenoxybenzamine + adrenaline, and metoprolol + adrenaline. The rate was 75% in the group given yohimbine + adrenaline. Prednisolone increased the degree of convulsion in adrenalectomized rats. Over-reduction in the blood catecholamine level made epileptogenesis more severe. It was observed that adrenaline pressed epileptogenesis via its own receptors (α - 1, α - 2, β - 1, β - 2). It was also revealed that all of the adrenergic receptors were responsible due to antiepileptic activity; β - 2 receptors played the most important role. It was observed that both acute and chronic indomethacin administration reduced the catecholamine levels. The situation in which acute administration of indomethacin did not affect epileptogenesis might originate from the fact that the structure of indomethacin did not significantly increase the corticosterone level.

Relationship between migraine and abnormal EEG findings in children

OBJECTIVE

Migraine is a disabling illness that causes absence from school and affects the quality of life. It has been stated that headache may represent an epileptic event. EEG abnormality is a prominent finding in children with migraine. The aim of this study was to evaluate EEG abnormalities in children with migraine.

MATERIALS & METHODS

Two-hundred twenty-eight children were enrolled into the study. Evaluation and following of cases was performed by one physician, paraclinical tests were used to increase the accuracy. The study was conducted under the supervision of pediatric neurology masters and the selected cases were from different parts of the country.

RESULTS

Comparing EEG abnormalities in different types of migraine revealed that there is an association between them. There was also a significant difference between EEG abnormalities in different types of aura. Migraine type was associated with the patient's age. Sleep disorders were more common in patients with a positive family history of seizure.

CONCLUSION

Our study dosclosed migraine as a common problem in children with abnormalities present in approximately 20% of the patients. Migraine and abnormal EEG findings are significantly associated.

Clinical and Para clinical Manifestations of Tuberous Sclerosis: A Cross Sectional Study on 81 Pediatric Patients

OBJECTIVE

Tuberous sclerosis complex is an autosomal dominant neurocutaneous disease that presents with dermatological, neurological, cardiac, renal and ocular symptoms. We described the variable clinical manifestations, neuroimaging findings, Age and sex distribution of tuberous sclerosis in a group of 81 patients referred to our clinic.

MATERIALS & METHODS

Based on the diagnostic criteria, totally 81 tuberous sclerosis patients with sufficient data were enrolled into the study. These children were referred by child neurologists.

RESULTS

The mean age of the patients was 52 months (range, 7-180 months). There were 28 girls and 53 boys. A positive familial history of TSC was seen in 29.6% of the patients. Hypo pigmented macules were the most common manifestation (82.7%). Facial angiofibroma, shagreen patches, café-au-lait lesions and seizure were observed in 32.1%, 12.3%, 7.4%. and 74.1% of the studied cases, respectively. Infantile spasm was present in the clinical course of 32.1 % of the patients. Cortical tubers were the most common MRI finding which were seen in 21 cases (25.9%). Subepandymal giant cell astrocytoma was seen in four (4.9%) patients and intracranial calcification (detected by CT scan) was observed in 18 (22.2%) of the patients.

CONCLUSION

Dermatological and neurological findings were the most common symptoms in tuberous sclerosis with a significant correlation between them. Thus, careful skin examination is necessary in epileptic patients for detection of the mentioned lesions.

Results of noncontrast brain computed tomography scans of 1-18 year old epileptic children

OBJECTIVE

The advent of computed tomography (CT) scan revolutionized the diagnostic evaluation of neurologic patients. The aim of this study was to evaluate brain CT results of epileptic children.

MATERIALS & METHODS

In a descriptive cross-sectional study, noncontrast brain CT scan of 150 consecutive 1-18 year old epileptic children whom were referred to pediatric neurology clinic of Shahid Sadoughi University of Medical Sciences, from May 2008 to October 2010 in Yazd-Iran, evaluated.

RESULTS

Sixty two girls and 88 boys with mean age of 6.6 ± 4.3 years were evaluated. In 38 (25.3 %) children, seizure onset age was under one year and 38 others had abnormal mental / developmental status. Fifty three children (35.3 %) and 97 (64.7%) had partial and generalized seizures, respectively. Partial seizures were more prevalent in children with seizure onset in < 1 year [41.5% (22/53) vs. 16.5% (16/97)] Result of CT was normal in 74 % (n=111). Among the patients with abnormal results, 18(46%) had brain atrophy, 10 (25.6%) structural CNS dysgenesia, six (15.4%) intracranial calcification, three (7.8%) hydrocephaly and two had (5.2%) brain tumor. Abnormal brain CT was more prevalent in patients with seizure onset in less than one year of age [60.5% (23 of 38) vs. 14.3% (16 of 112), p = 0.003], partial epilepsy [51% (27 of 53) vs. 12% (12/97)], and abnormal developmental status [ 81.5% (31 of 38) vs.7% (8 of 112]. Mean age of seizure onset in epileptic children with abnormal brain CT scan was less (M ± SD:1/17 ± 0.6 years versus 4.02±1.9 years).

CONCLUSION

Brain CT scan might be considered in evaluation of epileptic children with partial seizures, seizure onset in less than one year of age or neurodevelopmental delay.

Effects of antiepileptic drugs on sexual function and reproductive hormones of male epileptic patients

BACKGROUND

Diminished libido and sexual dysfunction are unusually common among male epileptic patients. The most important etiologic factor may be antiepileptic drugs (AEDs)-induced androgen deficiency. We compared reproductive hormone levels among men with epilepsy taking various AEDs and normal controls.

METHODS

Subjects were 59 male epileptic patients who aged 24 ± 5 years. They had been receiving lamotrigine (LTG) (n = 17), carbamazepine (CBZ) (n = 18), and sodium valproate (VPA) (n = 15) for at least 6 months. We also recruited 23 healthy controls. Testosterone, estradiol, dehydroepiandrosterone sulfate (DHEAS), sex hormone-binding globulin (SHBG), androstenedione (AND), luteinizing hormone (LH), and follicle stimulatin hormone (FSH) levels and gonadal efficiency (testosterone/LH) were compared between the four groups. The patients and the control group were examined and evaluated for male reproduction by urology and endocrinology services.

RESULTS

Subjects receiving CBZ, VPA, and LTG had significantly lower mean testosterone levels than the control group (P < 0.01). In addition, patients receiving LTG had significantly higher mean testosterone levels than CBZ and VPA groups (P < 0.01) and controls (P < 0.05). There were not any significant differences between the groups in mean estradiol levels. The mean AND level in VPA was higher than CBZ, LTG, and control groups (P < 0.01). Men receiving CBZ had significantly lower DHEAS levels than the other groups (P < 0.01). Testosterone/LH ratio in the control group was more than other groups (P < 0.01). On the other hand, this value in LTG group was higher than CBZ and VPA groups (P < 0.01). However, CBZ and VPA groups were not significantly different in terms of testosterone/LH ratio.

CONCLUSION

Although the mean levels of reproductive hormones were lower in the LTG group compared to the controls, among traditional antiepileptic drugs, LTG had fewer side effects on reproductive hormones. Therefore, it is a good adjuvant and substitute drug for epilepsy control instead of CBZ and VPA.

Is there an association between Fahr's disease and cardiac conduction system disease?: A case report

BACKGROUND

Fahr's disease is a rare neurodegenerative disorder of unknown cause characterized by idiopathic basal ganglia calcification that is associated with neuropsychiatric and cognitive impairment. No case of Fahr's disease with associated cardiac conduction disease has been described in the literature to date. The objective of this case report was to describe a young female with various cardiac conduction system abnormalities and bilateral basal ganglia calcification suggestive of Fahr's disease.

CASE REPORT

A 19-year-old female was transferred to our hospital for a pacemaker insertion. Her past medical history included cognitive impairment and asymptomatic congenital complete heart block since birth. Her manifestations included cognitive impairment, tremors, rigidity, ataxia, bilateral basal ganglia calcification without clinical manifestations of mitochondrial cytopathy. She also had right bundle branch block, left anterior fascicular block, intermittent complete heart block, atrial arrhythmias with advanced atrioventricular blocks and ventricular asystole manifested by Stokes-Adams seizures, which was diagnosed as epilepsy.

CONCLUSIONS

According to our knowledge, this was the first case report of a su spected association between Fahr's disease and isolated cardiac conduction system disease. In addition, this case illustrated that in patients with heart blocks and seizures, a diagnosis of epilepsy needs to be made with caution and such patients need further evaluations by a cardiologist or electrophysiologist to consider pacing and prevent future catastrophic events.

Changes in inhibitory CA1 network in dual pathology model of epilepsy

The combination of two precipitating factors appears to be more and more recognized in patients with temporal lobe epilepsy. Using a two-hit rat model, with a neonatal freeze lesion mimicking a focal cortical malformation combined with hyperthermia-induced seizures mimicking febrile seizures, we have previously reported an increase of inhibition in CA1 pyramidal cells at P20. Here, we investigated the changes affecting excitatory and inhibitory drive onto CA1 interneurons to better define the changes in CA1 inhibitory networks and their paradoxical role in epileptogenesis, using electrophysiological recordings in CA1 hippocampus from rat pups (16-20 d old). We investigated interneurons in CA1 hippocampal area located in stratum oriens (Or) and at the border of strata lacunosum and moleculare (L-M). Our results revealed an increase of the excitatory drive to both types of interneurons with no change in the inhibitory drive. The mechanisms underlying the increase of excitatory synaptic currents (EPSCs) in both types of interneurons are different. In Or interneurons, the amplitude of spontaneous and miniature EPSCs increased, while their frequency was not affected suggesting changes at the post-synaptic level. In L-M interneurons, the frequency of spontaneous EPSCs increases, but the amplitude is not affected. Analyses of miniature EPSCs showed no changes in both their frequency and amplitude. We concluded that L-M interneurons increase in excitatory drive is due to a change in Shaffer collateral axon excitability. The changes described here in CA1 inhibitory network may actually contribute to the epileptogenicity observed in this dual pathology model by increasing pyramidal cell synchronization.

Epilepsy as a rare neurologic manifestation of oculodentodigitalis dysplasia

Oculodentodigitalis dysplasia (ODDD) is an extremely rare inherited disorder involving the development of the face, eyes, teeth and limbs. In addition, some patients develop neurological problems mostly a spastic paraparesis associated with white matter abnormalities on magnetic resonance imaging. This report describes a patient with epilepsy, a rare neurologic manifestation of this syndrome.

Simple Partial Status of Forced Thinking Originated in the Mesial Temporal Region: Intracranial Foramen Ovale Electrode Recording and Ictal PET

Forced thinking (FT) is a rare epileptic phenomenon which is usually seen in patients with frontal lobe epilepsy. We report a rare case of mesial temporal lobe epilepsy presenting FT as simple partial status epilepticus. A 50-year-old woman with left hippocampal sclerosis developed a prolonged episode of continuous FT for five days after she experienced a clustering of complex partial seizures during the period of preoperative video-electroencephalography (EEG) monitoring. The EEG demonstrated continuous focal ictal discharges in the left foramen ovale electrodes. Positron emission tomography showed focal glucose hypermetabolism in the left mesial temporal region. This case indicates that the anatomical substrate for the development of FT is located in the mesial temporal region as well as the frontal lobe, and prolonged FT can occur as a seizure manifestation.

Nocturnal frontal lobe epilepsy presenting as obstructive type sleep apnea

A 20-year-old man presented with sleep apnea. Polysomnography was performed and it revealed nine apneas and two hypopneas. Contrary to typical apnea, however, rhythmic epileptiform discharges appeared at bifrontal area on EEG just before the start of apnoea. Video-EEG monitoring was performed to classify these events, and to evaluate the relationship of apnoea and ictal discharge. Ictal EEG revealed paroxysmal fast activity over the bifrontal area. Ictal SPECT showed hyperperfusion in right frontal area. Given these findings, we concluded that these events were epileptic seizures presenting as obstructive sleep apnea. Antiepileptic medication was initiated, and the events were decreased. This case demonstrates that nocturnal frontal love epilepsy may be the potential cause of obstructive sleep apnea (OSA).

Seizure duration determined by subdural electrode recordings in adult patients with intractable focal epilepsy

BACKGROUND AND PURPOSE

To investigate the duration of seizures and its relationship to seizure type, epilepsy syndrome, and seizure clustering.

METHODS

We examined 1,251 seizures from 152 patients who underwent video-electrocorticographic monitoring with subdural electrodes. Their seizure duration, seizure types, epilepsy syndromes, and seizure clusters were analyzed.

RESULTS

The median seizure duration was 91.5s (4-1016s). There were 34 (2.7%) seizures lasting > 5 minutes in 20 (13.2%) patients. There was a significant difference in seizure duration according to seizure types (p < 0.0001), but not to epilepsy syndromes. There were 99 seizure clusters in 67 (44.1%) patients. The first seizure in a cluster of seizures tended to last longer than non-cluster seizures (median 98s versus 89s, p = 0.033). Seizure duration was significantly longer in mesial temporal lobe epilepsy than in neocortical lobe epilepsy (median 103s versus 87s, p = 0.041). Rate of seizure cluster was lower in mTLE (38.0%) than in NLE (47.1%), but this difference was not significant.

CONCLUSIONS

Seizure durations were different among seizure types. Seizure clustering also differ between patients with mTLE and those with NLE, which suggests different seizure generation and propagation among different epileptogenic foci. This study has implications for the identification of abnormally prolonged seizures.