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Query: UMLS:C0014547 (focal epilepsy)
 1,627 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Animal models are important in the study of the development and expression of focal seizures as well as in the preclinical evaluation of antiepileptic treatment. Many different models are available, including acute and chronic models for simple partial seizures and models for complex partial seizures. Work on models has revealed that the pathophysiology of seizure disorders includes several neurotransmitter and membrane channel alterations. In addition, epileptogenesis of focal epilepsy has been shown to involve the selective loss of neurons and axonal reorganization. Antiepileptic treatment still hinges on three general themes: modulation of voltage-dependent ion channels involved in spike propagation and burst generation, enhancement of GABA-mediated inhibition, and suppression of excitatory amino acidergic activity. Many antiepileptic drugs have proven efficacy against focal seizures in animal models as well as patients. More recently developed antiepileptic drugs may prove to be superior in the alleviation of intractable partial seizures. The three general themes of antiepileptic drug action still dominate the development of antiepileptic treatment strategies. Too much emphasis on the classical models of focal epilepsy may hamper the development of innovative strategies. On the other hand, continued research on new and existing models may broaden our knowledge of the pathophysiological processes underlying focal epilepsy, and inspire new avenues in antiepileptic treatment development.
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PMID:Animal models of focal epilepsy. 1067 38

We report the case of a 39-year-old woman with onset of daily epigastric sensations associated with brief episodes of unresponsive blank stare, which have been interpreted as complex partial seizures with occasional secondary generalisation. Phenytoin as monotherapy and in combination with valproate had not been effective. During video-EEG we recorded typical absences with brief 3 second spike, and slow-wave discharges of up to 5 seconds, which were recognized by the patient herself. All absences were preceded by epigastric sensations. There was no indication of focal epilepsy. Monotherapy with valproate substantially decreased the frequency of the absences. In conclusion, this case is peculiar for several reasons: 1) late onset of absence epilepsy, 2) epigastric sensation at onset of absence seizures, 3) recognition of brief "phantom" absences and 4) presumable adverse effects of phenytoin.
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PMID:Epigastric sensations as an unusual manifestation of adult absence epilepsy. 1131 17

This report involves a patient suffering from focal epilepsy caused by an unruptured, intracranial aneurysm (UIA), and her treatment using intravascular embolisation, with an excellent postoperative outcome in terms of the epilepsy. A 52 year-old, right-handed woman had been suffering for three years from focal seizures, characterized by loss of consciousness, and oroalimentary and hand automatisms. The epilepsy was not controlled by carbamazepine monotherapy. Magnetic resonance imaging and digital subtraction angiography revealed a saccular aneurysm at the bifurcation of the middle cerebral artery, in contact with the cortex of the temporal opercular region. An intra-arterial embolisation, using a detachable, mechanical spiral (MDS, Bold Platinum), was performed, with no complications. The purpose of embolisation was the treatment of the aneurysm. The patient had two more, complex partial seizures (CPS) in the early postoperative period, but was seizure-free between September 1998 and September 2002. This is the first case report that presents the successful treatment of UIA-related epilepsy by means of intravascular embolisation.
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PMID:Unruptured intracranial aneurysm as a cause of focal epilepsy: an excellent postoperative outcome after intra-arterial treatment. 1507 67

Postictal coughing has so far been reported to indicate a temporal origin of focal epilepsy. A trend towards non-dominant hemisphere lateralization and mesial temporal localization has been suggested. However, postictal coughing has also been reported in a few patients with extratemporal epilepsies. We have retrospectively evaluated the localizing and lateralizing value of ictal/postictal coughing in 197 patients with temporal and extratemporal epilepsy who received presurgical video-EEG long-term recordings from 1999 to 2001. There was no statistical significant difference in percentage of coughing patients in both groups. However, only patients belonging to the temporal group presented with coughing as a regular element of seizure semiology (simple partial and complex partial seizures) whereas in the extratemporal group coughing occurred more sporadically. Within the temporal group a statistically significant tendency to left-sided seizure onset and a statistically not significant preponderance of mesial seizure onset was observed. Additional vegetative signs were observed only in about half of the patients. These results suggest that coughing occurs in both temporal and extratemporal lobe epilepsy and may only be indicative of temporal lobe seizure onset if representing a regular semiologic element. Coughing may be due to two different mechanisms, one dependent and the other independent from additional vegetative symptoms.
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PMID:The localizing and lateralizing value of ictal/postictal coughing in patients with focal epilepsies. 1527 44

In the course of experiments on focal epilepsy in rats, we have recognized that there are no adequate models of subacute focal epilepsy in rodents. We have, therefore, reevaluated a previously described rat model that reliably generates subacute seizures over 2-3 weeks. After implantation of a short length of cobalt wire into the left motor cortex, the animals are monitored by standard EEG over the next 3 weeks. They develop three seizure types: 1. Simple partial seizures with contralateral clonic jerks, lasting 17.9 +/- 46.4 min; these seizures were characterized by repetitive single spikes; 2. Secondarily generalized seizures, lasting 34.5 +/- 19.0 s; and 3. Complex partial seizures with a paroxysmal EEG, lasting 39.6 +/- 55.5 s. Post mortem brains were imaged using standard magnetic resonance techniques, after removal of the ferromagnetic cobalt wire. There was a localized loss of the MR signal that differed by pulse sequence, indicating spread of the ferromagnetic cobalt into the brain tissue. The image disruption caused by the cobalt was quite abrupt, indicating a sharp cobalt concentration gradient. However, we saw no evidence of widespread cerebral injury. The unilateral cobalt wire model generates less frequent, but more persistent seizures than seen in most acute, focal models. The ferromagnetic signal present, even after wire removal, indicates that metallic cobalt leaches into the cortex and may be responsible for generating the seizures. This model should be useful for testing new therapies for neocortical epilepsy.
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PMID:The unilateral cobalt wire model of neocortical epilepsy: a method of producing subacute focal seizures in rodents. 1545 Oct 16

Ictal vomiting in patients with focal epilepsy has mostly been associated with an epileptogenic zone in the non-language-dominant hemisphere. Here we present the case of a left hemisphere language-dominant patient suffering from typical mesial temporal lobe epilepsy with histologically proven hippocampal sclerosis and ictal vomiting during complex partial seizures. He became seizure-free after selective left-sided amygdalohippocampectomy. This case implies that ictal vomiting may not necessitate invasive electrophysiological exploration of left hemisphere language-dominant patients with temporal lobe epilepsy if surface EEG and MRI indicate a left-sided epileptogenic zone. It thus corroborates that with concordant imaging and neurophysiological data, clinical signs become less valuable.
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PMID:Ictal vomiting in a left hemisphere language-dominant patient with left-sided temporal lobe epilepsy. 1633 34

Benign epilepsies during infancy are a wide topic, which needs both clinical and nosological clarifications. Already in 1963 Fukuyama reported patients with seizures during infancy with a benign outcome. In the late 80s and early 90s, Watanabe reported series of infants with complex partial seizures or partial seizures with secondary generalization, with a normal development before onset and a benign outcome. In the same years Vigevano focused on familial cases: he described several families with seizures with onset around the 6-month of age, and autosomal dominant mode of inheritance. To define this condition, he coined the term "benign familial infantile seizures" (BFIS). Afterwards, studying families with this phenotype, loci on chromosomes 19, 16 and 2 responsible for BFIS were detected. Similar loci were found in families affected by BFIS and subsequent choreoathetosis, and BFIS associated with familial hemiplegic migraine. In most recent years a new form of benign epilepsy has been proposed, with an intermediate onset between the neonatal and infantile age, which was defined with the term benign familial neonatal-infantile seizures (BFNIS). This condition could have some clinical and genetic features overlapping with BFIS. Seizures with a benign outcome have been reported also in infants during episode of mild gastroenteritis (BIS with MG) frequently with positive Rotavirus antigen. Lastly, sleep EEG abnormalities have been reported in children with a peculiar form of epilepsy by Capovilla, who defined this condition as benign infantile focal epilepsy with midline spikes and waves during sleep (BIMSE). Some of these entities have been included in the last classification proposed by the ILAE and have been differentiated in familial and non-familial forms. The aim of this review is to describe these entities, discuss their nosological aspects, pointing out the similarities and differences with benign neonatal seizures and benign focal epilepsies appearing later in life such as early-onset benign occipital seizure susceptibility syndrome (EBOSS), or benign epilepsy of childhood with centro-temporal spikes (BECTS).
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PMID:The spectrum of benign infantile seizures. 1683 67

There is currently increasing interest in identifying and classifying pediatric benign epilepsy syndromes and recently several new syndromes have been recognized. Benign epilepsy syndromes, by definition, occur in children with normal developmental history, respond well to therapy, and remit without sequelae. The large majority of children with benign epilepsy syndromes follow a truly benign course. The concept of benign epilepsy syndromes has, however, been challenged by the minority of patients who continue to have seizures despite therapy, develop new seizures after initial remission, or exhibit neuropsychological abnormalities. Without long-term follow-up, benignity can not be truly ascertained a priori. Thus it may be preferable to use the terms possible and probable before the name of a specific syndrome until such time that the diagnosis of a definite benign syndrome is confirmed on long-term follow-up. In this review of the pediatric benign localization-related epilepsy syndromes, we address the concept of benignity and the process of diagnosis of a benign epilepsy syndrome. In addition we review the epidemiology, clinical manifestations, EEG findings, work-up, diagnostic criteria, differential diagnosis, genetics, management and prognosis of benign infantile familial convulsions, benign partial epilepsy in infancy with complex partial seizures, benign partial epilepsy in infancy with secondarily generalized seizures, benign infantile convulsions associated with mild gastroenteritis, and benign infantile focal epilepsy with midline spikes and waves during sleep.
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PMID:Benign pediatric localization-related epilepsies. Part I. Syndromes in infancy. 1698 37

A cerebral network comprising precuneus, medial frontal, and temporoparietal cortices is less active both during goal-directed behavior and states of reduced consciousness than during conscious rest. We tested the hypothesis that the interictal epileptic discharges affect activity in these brain regions in patients with temporal lobe epilepsy who have complex partial seizures. At the group level, using electroencephalography-correlated functional magnetic resonance imaging in 19 consecutive patients with focal epilepsy, we found common decreases of resting state activity in 9 patients with temporal lobe epilepsy (TLE) but not in 10 patients with extra-TLE. We infer that the functional consequences of TLE interictal epileptic discharges are different from those in extra-TLE and affect ongoing brain function. Activity increases were detected in the ipsilateral hippocampus in patients with TLE, and in subthalamic, bilateral superior temporal and medial frontal brain regions in patients with extra-TLE, possibly indicating effects of different interictal epileptic discharge propagation.
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PMID:Temporal lobe interictal epileptic discharges affect cerebral activity in "default mode" brain regions. 1713 85

One thousand eight hundreds and eighty patients with symptomatic and cryptogenic forms of focal epilepsy have been studied. Ninety patients (4.7%) had the secondary bilateral synchronization (SBS) syndrome in the EEG. Criteria of the syndrome are the presence of focal epileptiform activity in the EEG and SBS detected during the long-term video-EEG monitoring. In this group of patients, secondary generalized tonic-clonic, myoclonic and complex partial seizures were found. The clinical presentations of focal epilepsy were similar to the syndromes of idiopathic epilepsy in most cases. Long-term video-EEG monitoring is a method of choice in the instrumental diagnostics of these forms of epilepsy which are different in genesis and prognosis but similar in the kinematic characteristics.
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PMID:[Clinical presentations of the secondary bilateral synchronization syndrome in adults with epilepsy]. 1942 94


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