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

The Gamma Knife is currently the only radiosurgical device which has been used in functional neurosurgery. This mode of utilization is possible because the instrument can make lesions in normal brains with a volume as small as 50 mm3. The experience of functional radiosurgery accumulated at the Karolinska Institute over 21 years is reviewed, and the possible implications of the new developments in imaging techniques for the future of functional radiosurgery are considered. The review covers gamma thalamotomy for pain and tremor, radiosurgery for trigeminal neuralgia, gamma capsulotomy for severe anxiety and obsessive-compulsive neurosis, and Gamma Knife surgery for focal epilepsy. The important role of stereotactic MRI localization in functional radiosurgery is pointed out, and a preliminary report of the recent experience with stereotactic magnetoencephalography combined with stereotactic MRI for physiological and anatomic target localization is given. It is concluded that functional radiosurgery should only be performed with radiation of very small volumes of brain, as the very high doses required would be devastating if delivered to even small volumes.
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PMID:Functional neurosurgery--a future for the gamma knife? 172 60

The authors studied the localizing or lateralizing value of painful epileptic auras in 25 patients with focal epilepsy. Painful auras were seen in 4.1% patients with focal epilepsy arising from temporal, frontal, perirolandic, or parieto-occipital regions. Abdominal pain was present in 5% of all abdominal auras in temporal lobe epilepsy and 50% of all abdominal auras in frontal lobe epilepsy. In perirolandic epilepsy, painful somatosensory auras were lateralized contralateral to the epileptic hemisphere but not consistently in temporal lobe epilepsy.
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PMID:Painful auras in focal epilepsy. 1152 83

Headache originating front-orbital area can be divided to (1) Which has no autonomic symptoms such as lacrimation, rhinorrea, rhinostasis. This include psychogenic headache and epileptic headache. In the case of psychogenic headache, pericranial tenderness is not observed, and headache is medium in intensity. Most often patient complains of a headache originating frontal area. There are more than five various symptoms such as general malaise, numbness, tingling sensation, vertigo, sleeplessness. However, although symptoms are multiple, patients spend a life commonly. In other words, a patient is protected by a headache against his or her stress. No medication is needed in such a case. In epileptic headache, pressing type pain is felt over the forehead for several minutes to a few hours. Tremor or convulsion sometimes follow the headache. EEG shows spike and wave activities. In the case of focal epilepsy, headache occurs contralateral to the focus. Anti-epileptic drugs such as VPA or CBZ is a choice in such case, and headache as well as seizure disappears. (2) Front-orbital headache with autonomic symptoms include various trigeminal autonomic cephalalgias. These include cluster headache, episodic paroxysmal hemicrania, hemicrania continua, among others. Precise history taking is necessary for the treatment, because no drug is 100% effective.
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PMID:[Headache originating front-orbital area]. 1565 1

Zonisamide (Zonegran, Eisai, Inc.) is a broad spectrum antiepileptic drug indicated for use as adjunctive therapy in the treatment of partial seizures. Zonisamide has multiple mechanisms of action, which may explain widespread reports of its utility in focal epilepsy and generalized epilepsy, and for nonseizure disorders such as headache and neuropathic pain. Zonisamide has been available in Japan since 1989 and became available in the USA in 2002. The rights to this drug in North America and Europe were recently acquired by Eisai Co. A review of the chemical properties, pharmacokinetics, metabolism, potential mechanisms of action, efficacy in seizure and nonseizure disorders, and tolerability was therefore thought to be timely.
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PMID:Zonisamide: newer antiepileptic agent with multiple mechanisms of action. 1585 20

In the industrialized nations headache prevalence is increasing in children and adolescents. The nosologic classification determines the therapeutic strategy to follow. Three case reports illustrate the optimal cooperation of both a pediatric outpatient pain clinic and a pediatric psychosomatic pain clinic. We report on (1) a girl aged 2 years and 7 months with a 4-month history of headache episodes lasting about 15 min each with concomitant symptoms; (2) an 11-year-old boy with Schimmelpenning-Feuerstein-Mims syndrome, symptomatic focal epilepsy, psychomotor retardation, mild postinfectious internal hydrocephalus, and repeated heat-triggered episodes of right-sided headache beginning suddenly with a duration of 5-30 min and concomitant flush of his hemiface; and (3) a 12-year-old boy who for about 2 years has suffered from "migraine" 3 times a week, significantly impairing his quality of life. We discuss the patients' courses, diagnostic pitfalls, and therapeutic options. For the optimal treatment of children with headache not easily fitting into one of the categories, with significant comorbidity present, or if there is no adequate response to therapy conforming with guidelines, the help of an interdisciplinary pediatric pain clinic is invaluable.
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PMID:[Unique children -- unique headaches. Case reports of pediatric headache patients from an outpatient children's pain department]. 1641 1

Receptors have a prominent role in brain function, as they are the effector sites of neurotransmission at the postsynaptic membrane, have a regulatory role on presynaptic sites for transmitter reuptake and feedback, and are modulating various functions on the cell membrane. Distribution, density, and activity of receptors in the brain can be visualized by radioligands labeled for SPECT and PET, and the receptor binding can be quantified by appropriate tracer kinetic models, which can be modified and simplified for particular application. Selective radioligands are available for the various transmitter systems, by which the distribution of these receptors in the normal brain and changes in receptor binding during various physiologic activities or resulting from pathologic conditions can be visualized. The quantitative imaging for several receptors has gained clinical importance-for example, dopamine (D2)) receptors for differential diagnosis of movement disorders and for assessment of receptor occupancy by neuroleptics drugs; serotonin (5-hydroxytryptamine, 5-HT) receptors and the 5-HT transporter in affective disorders and for assessment of activity of antidepressants; nicotinic receptors and acetylcholinesterase as markers of cognitive and memory impairment; central benzodiazepine-binding sites at the gamma-aminobutyric acid A (GABAA) receptor complex as markers of neuronal integrity in neurodegenerative disorders, epilepsy, and stroke and as the site of action of benzodiazepines; peripheral benzodiazepine receptors as indicators of inflammatory changes; opioid receptors detecting increased cortical excitability in focal epilepsy but also affected in perception of and emotional response to pain; and several receptor systems affected in drug abuse and craving. Further studies of the various transmitter/receptor systems and their balance and infraction will improve our understanding of complex brain functions and will provide more insight into the pathophysiology of neurologic and psychiatric disease interaction.
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PMID:Brain receptor imaging. 1645 37

The objective was to investigate and classify headaches in 109 consecutive adult patients with epilepsy. A semi-structured interview was performed in those who confirmed such symptoms (65%). Interictal headaches were present in 52%; 20% had interictal migraine. Postictal headache was reported in 44%. Migraine characteristics were present in 42% of these, and most of them (74%) also suffered from interictal migraine. Six percent had preictal headache. In partial epilepsy, there was an association between headache lateralisation and interictal EEG abnormalities (p=0.02). We conclude that headache, including migraine, is very common in patients with epilepsy. Unilateral headache may represent a lateralising sign in focal epilepsy. Seizures often trigger postictal headaches with migraine features, which often are associated with interictal migraine. Migrainous headaches sometimes proceed into epileptic seizures. The comorbidity of migraine and epilepsy should receive ample clinical attention, as it may influence antiepileptic drug choice, and the headache may need specific treatment.
J Headache Pain 2007 Sep
PMID:Headaches add to the burden of epilepsy. 1790 22

We analyzed sexual function in 29 women suffering from focal epilepsy using the Female Sexual Function Index, Beck Depression Inventory, Beck Anxiety Inventory and a battery of laboratory tests were performed to find possible correlations and differences. A total FSFI score lower than the predefined cut-off score was found in 20.7% women and the presence of at least one subtype of sexual dysfunction was found in 51.7% of them. The most frequent dysfunction was lack of lubrication, which occurred in 34.5% of patients. A higher depression score was significantly correlated with a worse total score of Female Sexual Function Index and with decreased score of lubrication, satisfaction and pain. Patients who were seizure-free had better total score of Female Sexual Function Index and score of lubrication, orgasm and pain in comparison to patients who were not seizure-free. A higher anxiety scale was correlated only with lower satisfaction. We found a statistically significant correlation of reduced desire and use of carbamazepine and with lower dehydroepiandrosterone sulphate and free-androgene index. Reduced arousal was also correlated with the use of carbamazepine and lower dehydroepiandrosterone sulphate. Patients with a combination of complex partial and generalized tonic-clonic seizures had a worse total sexual function score and pain score than those with complex partial and generalized tonic-clonic seizures only. Sexual dysfunctions are relatively common problems in epileptic women with focal epilepsy. Prospective studies, including a control group, are needed.
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PMID:Sexual functions in women with focal epilepsy. A preliminary study. 1831 5

Different lines of evidence have suggested an involvement of the insular cortex in pain processing. Direct electrical stimulation (ES) of the human insular cortex during surgical procedure sometimes induces painful sensations and painful stimuli induce activation of the insular cortex as shown by functional neuroimaging. Invasive evaluation of epileptic patients by deep brain stereotactically implanted electrodes provides an opportunity to analyze responses induced by ES of the insular cortex in awake and fully conscious patients. For this study, we included 25 patients suffering from drug refractory focal epilepsy with at least one electrode stereotactically implanted in the insular cortex using an oblique approach (transfrontal or transparietal). Out of the 83 responses induced by insular ES, eight (9.6%) were reported by five patients as painful sensations. Four were restricted to the cephalic region and four were felt on the ipsilateral or bilateral upper limbs, the shoulders and the trunk (pinprick sensations). The eight stimulation sites were anatomically localized via image fusion between pre-implantation 3D MRI and post-implantation 3D CT scans revealing the electrode contacts. All sites inducing painful sensations were restricted to the upper portion of the middle short gyrus of the insula. The findings of this study suggest that middle short gyrus is involved in the processing of pain-producing stimuli.
Pain 2008 Sep 15
PMID:Middle short gyrus of the insula implicated in pain processing. 1836 33

Pain is a rare manifestation of epileptic seizures. Yet, despite its rarity as a clinical entity, the pain associated with such seizures can be both severe and disabling. It thus remains important to consider epilepsy in the differential diagnosis of unexplained paroxysmal pain. By way of illustration, we present here a report of acute localised paroxysmal pain as the initial manifestation of focal epilepsy with EEG abnormalities in an otherwise neurodevelopmentally normal child. A brief discussion of the literature on epileptic pain then follows.
Pain 2009 Feb
PMID:Acute, localised paroxysmal pain as the initial manifestation of focal seizures: a case report and a brief review of the literature. 1913 99


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