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Query: UMLS:C0036572 (seizures)
 80,221 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

There is little evidence for significant intellectual deterioration in well-controlled seizure disorders. With recurrent convulsive seizures, the picture is less clear and depends on severity, type, age of onset, and frequency of toxic levels of antiepileptic drugs (see Table 1). In the interictal state, deficits in verbal language and memory have been observed, especially in patients with complex partial seizure foci in the left (dominant) hemisphere. The memory deficits appear to affect new learning and retention of material; the verbal deficits are more subtle, affecting word-finding, verbal fluency, and comprehension abilities. Both of these changes may either go unnoticed by the patient in day to day activities or be attributed to the effects of antiepileptic medication. Antiepileptic drugs can also affect interictal cognitive functioning. The worst of these appears to be phenobarbital; phenytoin has an intermediate effect; valproic acid and carbamazepine as single agents seem to produce fewer adverse effects. However, individual patients may be particularly sensitive to cognitive side effects of certain drugs. Finally, attention deficits and slowing of cognitive processes, either chronically or intermittently, appear to affect all seizure patients to some extent. The syndrome is more prominent in frontal or generalized seizure patterns. The intermittent nature of these disturbances has been emphasized in recent research on subclinical interictal spike-wave electrical phenomena.
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PMID:Interictal cognitive changes in epilepsy. 192 32

Alternating stimulation of two sites in the forebrain culminates in typical kindling of generalized seizures from one site (dominant), whereas the other site (suppressed) supports only nongeneralized seizures for as long as stimulation of the dominant site continues, a phenomenon referred to as kindling antagonism. With the termination of stimulation of the dominant site, however, seizures provoked from the suppressed site eventually generalize, a progression thought to reflect the resumption of kindling from a previous point of arrest. To further assess the nature of kindling antagonism, we established antagonism between the amygdala and the septal area and subsequently evaluated the development of seizures provoked by stimulation of sites distal to the dominant site (always the amygdala). In Experiment 1, a 30-d stimulation-free period imposed after the establishment of antagonism failed to result in immediate generalization of seizures provoked from the suppressed site (septal area) in seven of eight rats. Although these results suggest that antagonism reflects an actual arrest of kindling rather than a transient inhibition of seizures, they are not entirely unambiguous: Rats exposed to the prolonged stimulation-free period required only half the number of septal stimulations for the expression of a generalized seizure as compared to rats receiving septal stimulation immediately after the establishment of antagonism. The latter finding is suggestive of a transient component of antagonism. In Experiment 2, development of generalized seizures from the previously naive right amygdala was virtually identical in rats previously kindled from the left amygdala and in rats expressing antagonism between the septal area and left amygdala. Development of generalized seizures from the right amygdala was faster than from the left amygdala in both groups of rats, however, suggesting that the expression of seizures provoked from the suppressed site after the establishment of antagonism does not involve a general impairment or enhancement of transfer. Experiment 3 revealed that radio-frequency lesions of the dominant site (amygdala) after the establishment of antagonism did not alter the subsequent development of generalized seizures from the suppressed site (septal area). This suggests that the expression of generalized seizures from the suppressed site after the establishment of kindling antagonism is not dictated by the functional state of the dominant site.
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PMID:Further characterization of kindling antagonism. 758 86

Previous research has shown that concurrent alternating stimulation of paired limbic sites culminates in kindling of generalized seizures from 1 (dominant) site, whereas the other (suppressed) site supports only focal or partial seizures. This phenomenon has been referred to as kindling antagonism, and it has been proposed that antagonism reflects an arrest of kindling, which is therefore viewed as a non-continuous stepwise process. We have attempted to replicate these important observations in adult rats stimulated in various combinations of forebrain sites. Kindling antagonism was displayed by rats stimulated in the amygdala and the septal area, in the bilateral amygdala, the septal area and the splenium of the corpus callosum, and the amygdala and the cingulate cortex. We also found that antagonism between the amygdala and septal area as well as electrographic and behavioral correlates of alternating stimulation were sensitive to the hemispheric relation of the electrodes and to the order in which the sites received initial stimulations. That is, rats that carried ipsilateral amygdaloid and septal electrodes were less likely to display antagonism when the amygdala was the first site stimulated. On the other hand, we failed to obtain antagonism from rats stimulated in other limbic pairs (e.g. entorhinal cortex and septal areas.
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PMID:Kindling antagonism: mapping of susceptible sites. 835 9

Change in visual confrontation naming was examined following left (speech dominant) anterior temporal lobectomy (ATL) as a function of surgical technique and patient characteristics. Two hundred seventeen patients with intractable left temporal lobe epilepsy were selected according to standard criteria across 8 centers, and combined into 4 surgical approaches to ATL: (a) tailored resections with intraoperative mapping of eloquent cortex, (b) tailored resections with extraoperative mapping, (c) standard resections with sparing of superior temporal gyrus, and (d) standard resections including excision of superior temporal gyrus. Changes in visual confrontation naming were examined with an index of reliable change derived from an independent sample of 90 nonsurgical patients with complex partial seizures. Results showed significant decline in visual confrontation naming following left ATL, regardless of surgical technique. Across surgical approaches, the risk for decline in visual confrontation naming was associated with a later age of seizure onset and more extensive resection of lateral temporal neocortex.
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PMID:Visual confrontation naming following left anterior temporal lobectomy: a comparison of surgical approaches. 1006 70

In rats, the concurrent alternate elicitation of epileptiform activity in two forebrain structures can result in both the rapid production of severe seizures and the development of fully generalized seizures in one (dominant) site, while arresting the progress of seizure activity at intermediate stages in the other (suppressed) site. The latter phenomenon is known as kindling antagonism. In this study, we examined alternate-site kindling in the guinea-pig as they fail to express fully generalized (stage 5) convulsions during single-site kindling. We assessed both seizure stage and afterdischarge duration following inter-hemispheric alternate-site kindling stimulation of the amygdala and medial septal areas. Alternating-site kindling of the medial septal and amygdaloid areas bypassed the normal inhibitory mechanisms in some guinea-pigs, enabling them to reach a stage 5 seizure. Furthermore, alternate-site kindled guinea-pigs demonstrated three (absolute, relative, and mutual) types of kindling antagonism. Guinea-pig kindling as a model of human partial epilepsy is discussed.
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PMID:Alternate-site kindling in the guinea-pig results in accelerated seizure progression and generalization. 1021 30

Patients with left (i.e. language-dominant) temporal lobe epilepsy (TLE) typically report word finding difficulties. However, these deficits are not reliably detected with traditional visual object naming tests. We administered both visual and auditory naming tests to left and right TLE patients and normal controls. We hypothesized that an auditory naming test might be more sensitive since it better simulates the conditions under which word finding problems occur in daily living. The left TLE group obtained significantly lower scores than other groups on auditory naming, whereas their performance on visual naming was indistinguishable from that of right TLE patients and normals. Furthermore, whereas cut-off scores on the auditory naming task predicted seizure focus laterality in 85% of patients, performance on the visual naming task predicted laterality in only 60% of patients. These findings suggest that compared with visual naming, as assessed in the present study, auditory naming may more accurately characterize and lateralize TLE-associated language dysfunction. These results also propose a more complex understanding of word retrieval that incorporates modality and contextual information.
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PMID:Auditory naming and temporal lobe epilepsy. 1041 18

Mesial temporal lobe epilepsy (MTLE) developed in a boy receiving FK506 (tacrolimus) after liver transplantation. He had no history of convulsions. At the age of 7, he underwent liver transplantation 13 days after he developed the abdominal form (fulminant hepatitis) of Wilson's disease. On postoperative day 18, he had a generalized tonic seizure (duration 20 min.) with loss of consciousness. FK506 was discontinued under the suspicion of FK506-induced encephalopathy. His symptoms resolved within a few days. FK506 was readministered at 3 months after transplantation. Ten months later, he developed complex partial seizures characterized by right tonic posturing with oral automatism. EEG revealed sporadic spikes in the anterior temporal region. MRI and SPECT showed bilateral (left side dominant) hippocampal lesion, which suggested the diagnosis of MTLE. Since seizures became refractory to medical treatment with progressive worsening of memory functions, FK506 was discontinued again at 36 months after readministration. Six months later, his memory improved remarkably, but there were no changes in seizure frequency and in MRI and SPECT findings. Our findings indicate that FK506 might damage the hippocampus, thereby causing MTLE. Additional case reports, however, will be required to elucidate this new FK506-related neurological complication.
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PMID:[Mesial temporal lobe epilepsy in a patient with Wilson's disease receiving FK506 (tacrolimus) after liver transplantation]. 1149 78

INTRODUCTION. The last proposal for a classification of epileptic seizures and syndromes of the International League Against Epilepsy (ILAE) includes recognition of several groups of epileptic syndromes and among them one of idiopathic focal epilepsies of infancy and childhood, and another of familial (autosomal dominant) focal epilepsies. The syndromes here described belong to these two groups and are: benign familial infantile seizures, benign infantile seizures (nonfamilial), benign childhood epilepsy with centrotemporal spikes (BCECTS), idiopathic occipital epilepsy of childhood Gastaut type (IOEC) and benign occipital epilepsy of childhood Panayiotopoulos type (BOEC). Atypical evolutions of the cases with BCECTS, IOEC and BOEC diagnosed and followed in our group are described, showing that these conditions are not always so benign. Finally, the so called benign focal convulsions of adolescence are considered, even when they were not included in ILAE s last proposal.
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PMID:[Benign focal epilepsies in infancy, childhood and adolescence]. 1198 87

Purpose. Decline in confrontation naming ability occurs in a subset of temporal lobe epilepsy (TLE) patients following left (dominant) anterior temporal lobectomy (ATL). Patients with late age of onset of seizures are most vulnerable to such decline. In addition, object names typically acquired later in language development are the words most likely to be inaccessible after ATL. Early-onset left TLE patients may be at lower risk for post-ATL dysnomia either because they have a limited preoperative lexicon that does not include most late-age-of-acquistion names or they undergo early ipsilateral language reorganization, which results in a lexicon similar to that of late-onset TLE patients but offers protection from post-ATL naming decline.Methods. Sixty-five left hemisphere speech dominant left TLE patients who had undergone ATL were assessed pre- and postoperatively on the Boston Naming Test (BNT).Results. The early- and late-onset groups performed similarly across three BNT age-of-acquisition categories at the preoperative assessment. Words acquired relatively later in life were most likely to become inaccessible postoperatively for both groups, but the early-onset patients showed significantly less overall postoperative decline in naming ability compared with the late-onset group.Conclusions. The more stable pre- to postoperative naming performance exhibited by early-onset patients cannot be attributed to lack of acquisition of the words shown to be most vulnerable to postoperative decline (i.e., late-age-of-acquisition words). Their object naming stability suggests that early-onset left TLE patients undergo intrahemispheric reorganization of language early in life that provides protective benefits.
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PMID:Ipsilateral Reorganization of Language in Early-Onset Left Temporal Lobe Epilepsy. 1260 17

We report a two-year-old Caucasian boy who had neonatal seizures and was found to have bilateral occipito-temporal polymicrogyria on neonatal brain MRI. The child had no additional neurological abnormality other than the neonatal seizures, but serum CK was found to be elevated (5 - 7 times normal values) and the muscle biopsy showed evidence of early muscular dystrophy. Detailed protein and genetic studies did not allow the identification of a known form of muscular dystrophy. The boy has been followed regularly and he currently has mild global developmental delay but no clinical signs of muscle involvement. The association of polymicrogyria and muscular dystrophy is known to occur in Fukuyama and Walker Warburg muscular dystrophies, in muscle-eye-brain disease and in some patients with merosin deficient CMD. However the absence of weakness and of eye involvement, the normal expression of merosin and alpha dystroglycan and the pattern of brain involvement make it very unlikely that the child is affected by one of these forms. As the pattern of brain involvement and the muscle pathology is not typical of one of the forms of neuronal migration disorders secondary to a known gene defect, we suspect that the combination of muscle and brain involvement found in this child is not coincidental. Our findings suggest that serum CK should be determined in children with undiagnosed polymicrogyria, even in the absence of weakness. This may lead to an expansion of our understanding of muscle dystrophies and cortical dysplasias.
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PMID:Occipito-temporal polymicrogyria and subclinical muscular dystrophy. 1277 31


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