Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0014547 (focal epilepsy)
 1,627 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A patient with fits of laughter due to a tumorous alteration (hyperplasia) of the floor of the third ventricle is described with electroencephalographic findings indicative of focal epilepsy (complex partial seizures = psychomotor fits). The laughter is interpreted as an inborn emotional expression with structural substrate in the hypothalamus and neighboring brain. With structures remaining intact functional disorders in this area can cause epileptic phenomena with participation of the limbic system.
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PMID:Fits of laughter (gelastic epilepsy) with a tumour of the floor of the third ventricle. A video tape analysis. 6 51

We attempted to lateralize the epileptogenic focus (seven temporal lobe hippocampal foci, one frontal lobe focus) in medically refractory unilateral complex partial seizures, using noninvasive 31P magnetic resonance spectroscopic imaging (MRSI) blindly and interictally to compare hippocampal or frontal regions. The seizure foci were more alkaline (intracellular pH = 7.17 +/- 0.03) compared with the contralateral region (7.06 +/- 0.02, p < 0.01) in all eight cases; the inorganic phosphate was relatively increased (240 +/- 50% of contralateral, seven of eight cases, p < 0.01); and phosphomonoesters were relatively reduced (68 +/- 9% of contralateral, seven of eight cases, p < 0.01). Other phosphorus metabolites were symmetric (+/- 10%). 31P MRSI correctly lateralized the seizure focus in all eight cases. By comparison, imaging correctly lateralized four cases and SPECT, two cases. In conclusion, 31P MRSI is a useful tool for the noninvasive clinical assessment of focal epilepsy and can accurately lateralize the epileptogenic focus.
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PMID:Lateralization of human focal epilepsy by 31P magnetic resonance spectroscopic imaging. 140 85

Surgical management of uncontrolled focal epilepsy is most commonly carried out in young adults with good results, but there has been some doubt about the effectiveness of cortical resection in older individuals. We assessed the outcome of temporal lobectomy done after age 45 years in 20 patients with intractable epilepsy followed for more than 2 years after surgery. During a mean follow-up of 5 years, six patients (30%) were seizure-free following surgery and seven (35%) had greater than 90% reduction in seizure frequency. This compares with an outcome of 40% seizure-free and 44% with greater than 90% seizure reduction in 68 younger patients aged 17 to 45 years; the differences do not achieve statistical significance. The outcome was better for complex partial seizures than for secondarily generalized seizures. Complications were no greater than in the younger patients. The findings indicate that surgery is an effective treatment alternative for intractable temporal lobe epilepsy in older patients since two of three of these patients will obtain satisfactory seizure control.
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PMID:Temporal lobectomy for intractable epilepsy in patients over age 45 years. 154 33

One hundred patients suffering from focal epilepsy with complex partial seizures refractory to medical treatment and showing no abnormality at CT were explored by MRI with an 0.5 Tesla magnet. MRI detected an abnormality in 25 patients with, in 17 of them, good correlation between MRI and clinical as well as electroencephalographic findings. Abnormal morphology and signal was found in 5 patients, with positive CT results on reexamination of previous CT images or on new CT scans in 4 of them. There was a diffuse temporal lobe high-intensity signal in 3 cases and a localized high-intensity signal in 9 cases (temporal lobe 4, occipital lobe 3, frontal lobe 1, fronto-parietal and parietal lobes 1). Thus, in 13% of the cases MRI demonstrated a lesion that had not been detected at CT, and the location of the lesion was concordant with clinical and electroencephalographic data.
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PMID:Magnetic resonance imaging in refractory focal epilepsy with normal CT scans. 251 40

The effect of 1,5-benzodiazepine clobazam was assessed in a double-blind add-on trial in 20 patients with chronic complex partial seizures uncontrolled by maximally tolerable daily dosage of standard antiepileptic drug therapy. The number of seizures was lower during the three months of active treatment. At the end of the third month, eight (40%) of the patients had a seizure reduction by more than 75%, including four patients (20%) who had complete control. Tolerance to the antiepileptic effect of clobazam was noted in 56% of the patients, and mild transient sedation occurred in 40% of the patients. Despite these drawbacks, clobazam is an effective add-on drug for individual patients with refractory focal epilepsy.
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PMID:Clobazam for refractory focal epilepsy. A controlled trial. 308 2

Intensive neuromonitoring of seizure surgery candidates, with its associated medication withdrawal, involves increased seizure susceptibility. This can cause a confusing array of seizure patterns. This problem was examined in the candidates for seizure surgery in the Austin Hospital Comprehensive Epilepsy Programme, emphasis being placed on focal seizures. Generalized seizures were very common. Eleven (15%) patients showed multiple focal seizure patterns. Seven patients showed temporal lobe seizures originating from either side separately. Three showed persistent frontal and temporal complex partial seizures. One patient showed 2 separate species of focal epilepsy. Whilst the simplest and most effective way out of this diagnostic problem was close consultation and video review with parent or spouse, this process was ineffective in 6 of 11 patients. In patients with bitemporal lobe epilepsy there was often little to distinguish the fit coming from one side from that coming from the other and often elements of the fit from either side were recognized by the relative. In all patients with frontal and temporal complex partial seizures, elements of the seizure had been seen previously and in only 1 was there any preponderance on neuromonitoring. Therefore it is suspected that the confusing seizure detail seen on intensive neuromonitoring may in fact exist in real life and render the clinical history suspect--a problem which can be avoided only by initial neuromonitoring.
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PMID:Intensive neuromonitoring for complex partial seizures: focal seizure pattern variability in surgical patients. 311 58

Total withdrawal of antiepileptic drugs leads to a mean relapse rate of approximately 50 p. 100 in adults and 25 p. 100 in children. The relapse rates are lowest in patients with benign epilepsies of childhood and epilepsies with absence seizures only and those with a short duration of epilepsy. Relapse rates are higher in patients with complex partial seizures, absences with generalized tonic-clonic seizures, juvenile myoclonic epilepsy, patients with several types of seizures, high seizure frequency prior to control, in patients with neurological, psychiatric or social handicaps and in those with emotional ambivalence towards the reduction. Guidelines for slow and safe withdrawal are given. Reduction should be actively encouraged only in patients with absence seizures or benign focal epilepsy and those with epilepsy of short duration. Slow partial withdrawal is recommended in uncontrolled epilepsy because in 80 p. 100 of the patients it results in a decrease in seizure frequency and side effects or both.
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PMID:[Total or partial withdrawal of antiepileptic drugs]. 365 23

Kindling is traditionally viewed as a chronic, focal epilepsy model which consistently induces complex partial seizures from limbic structures in animals. This study revealed that primary or exceedingly rapid secondary generalized seizures could also be kindled when stimulation was applied to the lateral geniculate nucleus, a thalamic region involved in sleep regulation and possibly also photosensitive epilepsy. Two experiments were conducted in cats. Experiment 1 compared the development of generalized tonic-clonic convulsions and associated sleep disorders following electrical stimulation of the lateral geniculate nucleus (N = 4) and the amygdala (N = 4). Experiment 2 described the effects of intermittent light stimulation on seizure thresholds in both groups. Three primary findings distinguished the epileptogenic process in those two brain regions. First, generalized electroencephalographic and clinical seizures accompanied the first afterdischarge obtained with thalamic stimulation. In contrast, focal seizures with secondary generalization appeared during a 3- to 4-week period of afterdischarge elicitations from the amygdala. Second, amygdala-kindled cats showed fewer sleep spindles during slow-wave sleep whereas cats kindled in the lateral geniculate nucleus had abnormal sleep spindles approaching spike wave-like activity. Third, only the latter cats showed reduced seizure thresholds in response to photic stimulation. Based on the anatomic substrates involved, the clinical and electrographic profiles observed during kindling and the type of sleep disturbance shown, we concluded that lateral geniculate nucleus kindling may represent primary generalized epilepsy, possibly of a photosensitive nature; alternatively, the rapid propagation of abnormal discharge was also consistent with the important role of the thalamus in secondary seizure generalization.
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PMID:Thalamic kindling: electrical stimulation of the lateral geniculate nucleus produces photosensitive grand mal seizures. 643 40

A 9-year-old right-handed girl was admitted because of complex partial seizures, left-right disorientation and finger agnosia. At the age of 2 years, she began to have seizures, which were exacerbated by carbamazepine and diazepam. Subsequently she was treated with phenytoin and phenobarbital, and remained seizure-free for four years. After age 7, she began to have attacks of alteration of consciousness, which lasted 10 seconds and occurred every two or three months. At age 9, neuropsychological testing revealed borderline intellectual functioning (WISC-R:FSIQ 83, VIQ 94, PIQ 73), but selective deficits were found in tests of calculation and spatial-figural relationships. Axial spin echo (3,000/22) image showed an abnormal high signal intensity in the left temporo-parieto-occipital lobe, in which interictal IMP-SPECT demonstrated decreased cerebral blood flow. These results seemed to explain the relationship between clinical findings and focal migration disorder. It is important to detect a focal migration disorder in patients with intractable focal epilepsy or higher cortical dysfunctions.
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PMID:[Higher cortical dysfunctions and image diagnosis in a 9-year-old girl with complex partial epilepsy caused by focal neural migration disorder]. 761 91

Often, seizures in childhood are intractable to medical therapy. Intractable seizures and prolonged anticonvulsant medication can adversely affect intellectual development and psychosocial maturation in children. Temporal lobe resections for complex partial seizures and focal epilepsy in children can be performed with minimal morbidity. The higher morbidity lies with prolonged observation of these children with intractable seizures. The final result of surgical treatment shows that children can significantly benefit from an early developmental period without anticonvulsant medication or intractable seizures with improvements in both IQ and behavioral interactions. With improvements in neuroimaging techniques and evaluation procedures, more children can be identified who might benefit from a resective procedure. It is thus advocated that early evaluation and surgical intervention be performed to gain improvement in seizure control and psychosocial development.
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PMID:Temporal lobe resections in children. 767 Mar 25


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