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

Current trends and controversies in the antiepileptic drug therapy are reviewed from a clinical view. The usefulness of prophylactic therapy of febrile seizures and posttraumatic seizures or posttraumatic epilepsy is compromised by difficulties in the management of the patients especially by noncompliance. Previously untreated epilepsies can be treated successfully in 70--80% of the patients. Phenytoin or carbamazepine are equally effective for generalized tonic-clonic seizures of focal seizures, while absence seizures are controlled by ethosuximide or valproic acid. Only when the epilepsy is uncontrolled despite high plasma concentrations which cannot be raised because of side effects, a second drug should be given. A second drug is successful in about one out of six patients with focal epilepsy. Phenytoin, carbamazepine, phenobarbital and primidone seem to be equally effective for these drug-resistant cases. Status epilepticus can be treated with intravenous diazepam or phenytoin and, if necessary, with an infusion of phenytoin. Rectal diazepam is useful for acute pediatric therapy. Drugs of second choice are clonazepam, phenobarbital, lidocaine, and clomethiazole. In the pregnant epileptic patient a drop in the plasma concentration of antiepileptic drugs mainly through non-compliance and seizure provocation through sleep deprivation are major sources for the deterioration of epilepsies during pregnancy. The "fetal antiepileptic drug syndrome", malformations and an increased risk for epilepsy in the child are discussed as an interaction of parental epilepsy and drug-exposure during pregnancy. Finally, the interpretation of abnormal clinical chemistry data is reviewed. Disorders of the liver, bone, thyroid gland and blood are rarely seen in treated epileptic patients usually when specific risk factors are present. The over-interpretation of laboratory abnormalities e.g. an isolated increase of gamma-GT may lead to iatrogenic deterioration of epilepsy when the effective dose of the drug is reduced for unfounded fear of hepatic toxicity.
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PMID:[Pharmacotherapy of epilepsy--current problems and controversies]. 641 28

The authors report a retrospective study of 11 observations of partial frontal epilepsy. Cases have been selected on the basis of a complete lack of any associated neurological or psychiatric sign and a disappearance of seizures with normalization of the EEG trace for more than 5 years. This peculiar type of focal epilepsy characterized by an EEG frontal spike focus is first shown to share clinical and electroencephalographic signs with other forms of benign epilepsy of childhood and adolescence. Then the predictive value of some electro-clinical criteria to indicate a favourable outcome is examined.
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PMID:[Benign partial epilepsies: 11 cases of frontal partial epilepsy with favorable prognosis]. 642 89

One hundred and fifty-eight epileptic patients belonging to the Nguni tribe in Transkei were interviewed and examined; electro- encephalograms (EEGs) were recorded in 104. Partial epilepsy with secondary generalized seizures was diagnosed in 59%. Head trauma appeared to be the main aetiological factor in 18%. Thirty-five percent of the EEGs taken showed epileptiform activity. The community's attitude to the disease is described.
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PMID:The epilepsies among rural blacks. 642 50

Electrical stimulation of the human olfactory mucosa was performed by means of an electrode attached to a rhinoscope . Stimulation of the nasal mucosa did not evoke smell sensations, but suppressed smell sensations of presented odorants. When electrical stimulation followed the exposure to an odorant within a certain interval, the stimulus recalled the already faded sensation of the preceding odorant. Electrical stimulation without prior natural stimulation produced unpleasant sensations in 3 patients with a history of temporal lobe seizures and olfactory auras , but not in patients with primary, generalized or focal epilepsy.
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PMID:Effects of electrical stimulation of the human olfactory mucosa. 642 15

The facilitatory or inhibitory effect of paradoxical sleep (PxS) was investigated in two models of focal epilepsy: focal motor seizures induced by alumina cream in the frontal cortex and limbic seizures produced by intra-amygdaloid kainic acid microinjections in cats. We found that phasic episodes of PxS could trigger both types of seizures. Interictal spikes were generally blocked during PxS. We conclude that PxS exerts facilitatory or inhibitory effects depending on the particular event under analysis and the degree of epileptogenicity. The capacity of phasic PxS to precipitate focal ictal discharges may depend on ponto-limbic excitatory influences.
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PMID:Phasic paradoxical sleep precipitates focal motor and limbic seizures. 643 36

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

The magnetic fields associated with penicillin-induced focal epilepsy were measured in laboratory rats. Interictal magnetic spikes were similar to those previously observed in humans with focal seizure disorders. The magnetic fields of the seizure itself displayed both slow and fast phenomena, reversing in direction on opposite sides of the head.
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PMID:Fast and slow magnetic phenomena in focal epileptic seizures. 643 79

Data on 50 patients treated surgically for intractable focal epilepsy were analysed. There were 10 hemispherectomies, 32 temporal lobectomies and eight operations to other areas of the brain. The median age at operation was 14 years. 29 patients were found to have mesial temporal sclerosis or sclerotic hemispheres and 17 had alien tissue and one sclerosis with heterotopia. No lesion was found in three cases. The nature of the first seizure was found to relate significantly to pathology. 30 patients had suffered an early convulsion. Between the convulsive insult and the onset of focal epilepsy there was a silent interval, the duration of which was biased by sex and side of lesion. The remaining 20 patients, of whom a highly significant number had alien tissue, had not had an early convulsion before the onset of focal epilepsy. The importance of accurate clinical histories is stressed. Clinical considerations alone predicted the pathology and laterality of the lesion in more than half the series. Regular EEG recordings and repeat scanning were found to be important investigations. Major disorders of behaviour had occurred in 44 patients. As adults, the series were free of severe psychiatric symptoms, but many required years of careful rehabilitation. 31 children had been excluded from normal schools before operation. Postoperatively, many patients continued their education in normal schools. Some required basic remedial teaching, others successfully undertook higher education and training. 49 patients benefited over-all from neurosurgical treatment. 34 had no more habitual epilepsy at all. Full global gains often took at least five years to achieve.
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PMID:Developmental aspects of focal epilepsies of childhood treated by neurosurgery. 643 82

Hemispheric language dominance, as determined by intracarotid amobarbital sodium injections, and handedness, as reflected by writing and drawing preference, were evaluated in a select group of patients with intractable seizures who had documented focal epilepsy originating from one temporal lobe. Of the patients with left temporal lobe seizure focus, an unusually high percentage of right-handed patients (4/26 [15%]) had right hemisphere language dominance. Pathologic findings of the resected temporal lobe in these patients revealed microscopic damage (hippocampal sclerosis) of the hippocampus in three of three cases; one patient also had a small hamartoma in the midtemporal gyrus. We hypothesize that crossed dominance resulted from disruption by epileptiform activity during early development of selective areas of the left hemisphere.
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PMID:Right-hemisphere language dominance in right-handed epileptic patients. 647 15

Intellectual development and psychic problems were examined in thirty children, suffering from center - encephalic and focal epilepsy. Two parameters were taken into consideration: social insertion and family adaptation. Intellectual development was evaluated with the Terman-Merril test. At the same time, correlations between the epileptic form, the age of the onset of the seizures and their frequency, the precocity of therapeutic treatment were considered. The intellectual development and the personality were good in 23,7%, when the subjects were enclosed in valid familiar environment and when clinic disappearance of seizures was rapid; these aspects were compromised in 76,3%, when emotively valid family substractum was deficient and therapy was tardily started and barely efficient. On the basis of these data Authors affirm the importance of the precocity of therapy and the emotively valid substratum for preventing the behaviour disturbances in epileptic patients.
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PMID:[Psychological aspects of the epileptic child and his relationship to his family environment]. 653 Dec 28


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