Coronal Sections Of The Hippocampus
The coronal views show eight sections moving progressively from anterior to posterior levels. FIG. 3.24. Coronal section of the hippocampal head. A. Three-dimensional drawing. B. T1 -weighted MR image. C. Anatomic section posterior view . FIG. 3.24. Coronal section of the hippocampal head. A. Three-dimensional drawing. B. T1 -weighted MR image. C. Anatomic section posterior view . 1 Anterior apex of the hippocampal head cornu ammonis 2' Amygdala, lateral nucleus 2 Amygdala, basal nucleus 2'...
Invasive EEG in Neocortical Epilepsy Seizure Onset
Source in Neocortical Epilepsies. Williamson, P.D. Siegel, A.M. Roberts, D.W. Thadani, V.M. Gazzaniga, M.S. eds. Philadelphia, PA, Lippincott Williams and Wilkins, pp. 275-285, September 2000. Contact Lippincott Williams and Wilkins, 530 Walnut Street, Philadelphia, PA 19106-3621. 215 521-8300. FAX 215 521-8902. Web site www.wwilkins.com home index.html Summary Invasive EEG in Neocortical Epilepsy Seizure Onset, a chapter in Neocortical Epilepsies, describes a study that examined 53 people with...
Digital EEG
The advantages of digital EEG over analog EEG include paperless storage, quantification, automatic event detection and networking capabilities.46,47 The flexibility of digital EEG allows modification of the recording parameters, such as montage, filters, amplitude and duration display scales retrospectively during review of the recording. These capabilities allow for more accurate interpretation of the EEG data.48 Since digital EEG machines are comparable in cost to analog EEG machines, they...
Newer antidepressant drugs
There have been several developments of antidepressants since the tricyclic era. Some drugs have briefly been mentioned above, which were nontricyclic, such as mianserin, maprotiline and viloxazine. However, the major development in the last few years has been of agents that selectively inhibit reuptake and either noradren-aline, or serotonin, or both. Table 20.3 shows a list of the newer drugs. Table 20.4 gives a receptor profile and the epileptogenic potential of these compounds. In brief,...
Epidemiology 1
Self-induced epilepsy is a rare condition.5,77 This phenomenon was observed in only one patient, of the 10,000 patients with epilepsy studied,78 in only two records, of the 20,000 EEG records studied,79 and in five patients, of the 460 patients with photosensitivity.1 Of the 22 patients with epilepsy and photosensitivity, studied by Darby et al,76 seven had self-induced paroxysmal activity and or seizures by slow eye closure. Self-induced epilepsy is more frequently reported from the Indian...
Pathogenic Mechanisms Wxx
As to why some patients with epilepsy deliberately evoke seizures remains a puzzle. Most of these patients are compulsively attracted to sunlight. They cannot offer a good explanation for their abnormal behavior, although some admit that it gives them a pleasurable or relaxing feeling. Many authors, including Radovici,71 have thought that psychological factors and stressful situations influenced the frequency of self-induced seizures. Associated behavioral abnormalities leading to social...
Epileptiform Activity In Organotypic Slice Cultures
Potentially the best suited preparations for studies on seizure generation and seizure-induced cell death are organ-otypic slice cultures. Organotypic cultures maintain some of the intrinsic properties of the tissue, including the most important aspects of connectivity. However, the preparations are usually made from pups P6-P10 and then studied after 7 to 30 days in vitro therefore these preparations do not necessarily represent adult tissue. The preparations are usually maintained in an...
Imaging Pgp transport in vivo with PET
Radiolabelled MDR-associated cytostatic agents can be used to study drug efflux pumps in vivo. One example is colchicine, a Pgp substrate which is a naturally occurring alkaloid Ford amp Hait 1990 . Mehta et al 1992 studied the biodistribution of 3H colchicine in mice xenografted with Pgp-negative and Pgp-positive human neuroblastoma tumours Mehta et al 1992 . The pharmacokinetics of colchicine are possibly favourable for PET studies due to their limited metabolism Hunter amp Klaassen 1975 ....
Exposure To Epileptogenic Stimuli Fever Infection Hypoxia During Development
Infants are exposed to a high risk of epileptogenic stimuli, represented by greater exposure to infectious agents that lead to fever and sometimes to cerebral infections. Neo-nates and infants may also often suffer from perinatal hypoxia ischemia. In susceptible subjects, these stimuli may induce seizures, and because of the higher susceptibility of the young brain to seizures, these seizures occur multiple times a day and may be difficult to control with currently available AEDs 239-245 ....
Ropireddy Deepak
Rise of the Machines - On the Threshold of a new Era in Epilepsy Research Daniel H. Lowenstein Introduction Applications and Emerging concepts of computational neuroscience in Epilepsy Research xv Computational Modeling Techniques and Databases 1 Simulation of Large Networks Technique and Progress 3 William W. Lytton, Mark Stewart and Michael Hines 2 The NEURON Simulation Environment in Epilepsy Research 18 3 The CoCoDat Database Systematically Organizing and Selecting Quantitative Data on...
Aggression and epilepsy
The relationship between epilepsy and aggressive behaviour is a particularly controversial issue Geschwind, 1975 . While in patients with episodic affective aggression, a history of epilepsy is reported to be more common Bach-Y-Rita et al., 1971 Elliot, 1982 most of the community-based studies did not find an increased prevalence of aggressive behaviour in patients with epilepsy Kligman and Goldberg, 1975 Lishman, 1998 . The prevalence of aggression in epilepsy in general, not regarding the...
Vagovagal Syncope
By contrast to vasovagal syncope, convincing vagovagal syncope is rare. The reflex is usually triggered by swallowing or vomiting cardiac standstill results if the asystole is sufficiently prolonged, with a convulsive syncope anoxic seizure . This is probably not a life-threatening disorder, but the symptoms can be troublesome, particularly if the patient also has migraine with associated vomiting. Pacemaker therapy can be considered if events are frequent and interfering with quality of life.
Neonatal Seizures Developing Countries Perspective
Seizures in the newborn period are a frequent clinical problem and represent the most distinctive signal of neurological disease. Neonatal seizures are usually related to specific illness requiring prompt therapy. Early diagnosis of underlying cause is important, as some of the risk factors are associated with high mortality or adverse neurological sequelae. Neonatal seizures show clearly differentiated characteristics from seizures in older children. Several unique characteristics of neonatal...
A Thalamocortical Loop Mechanism For Absence Seizures
The mechanism proposed for absence seizures can be summarized as follows. During sleep spindles, the oscillation is generated by intrathalamic interactions TC-RE loops and is reinforced by thalamocortical loops, as suggested in a previous model Destexhe et al., 1998a . The combined action of intrathalamic and thalamocortical loops provides RE cells with moderate excitation, which evokes GABAA-mediated IPSPs in TC cells and sets the frequency to 10Hz. During spike-and-wave seizures, due to...
Triage Of Epileptic Conditions
Most people with epilepsy have seizures that are easy to treat, respond to relatively low doses of all appropriate AEDs, and can usually be managed by primary care physicians. The majority of patients with these types of epilepsy will experience no disability if treatment is initiated appropriately, and for some, seizures will eventually remit and medication will no longer be necessary. In reality, 40 of patients with epilepsy have epileptic seizures that are difficult to control, but for many...
Pharmacological Manipulations In Cataplexy
Several compounds have been administered intravenously i.v. during H-reflex studies and during long-term investigation of cataplexy in humans more sophisticated studies have been performed using animal models, particularly narcoleptic-cataplectic Dobermans Delashaw et al., 1979 Foutz et al., 1981 Mignot et al., 1988 . The effects of REM sleep-modulating agents and tricyclic antidepressant compounds have been investigated. Compounds with norepinephrine and serotonin reuptake-blocking properties...
Nitrazepam
Nitrazepam is a benzodiazepine derivative with a nitro group at the 7 position of the benzodiazepine ring. Oral bioavailability is about 78 . Peak concentrations are reached in about 1.5 hours. Nitrazepam is 85-88 protein bound. The volume of distribution is 2.4 l kg, and is higher in the elderly. The plasma half-life is about 27 hours, but the drug is rapidly taken up into the CSF and brain tissue and the CSF elimination half-life is 68 hours. Nitrazepam is metabolized in the liver by...
OC144093 a novel P glycoprotein inhibitor for the enhancement of antiepileptic
Michael J. Newman, Ross Dixon and Barry Toyonaga Ontogen Corporation, 6451 El Camino Real, Carlsbad, CA 92009, USA Abstract. Inhibitors of P glycoprotein Pgp may be useful for the enhancement of blood-brain barrier penetration of anti-epileptic drugs AEDs . Due to polypharmacy and the need for chronic treatment, Pgp inhibitors used in epilepsy should be highly specific and non-toxic. In particular, it may be essential to use compounds that produce minimal inhibition of enzymes involved in...
IV Unforeseen complications and problems275
70 A 35-year-old man with poor surgical outcome after 276 temporal lobe surgery 71 When more is less 279 Carl Bazil 72 Change of antiepileptic drug treatment for fear of side effects 283 in a 45-year-old seizure-free patient 73 Personality and mood changes in a teenager 286 Ahmad Beydoun, Ekrem Kutluay and Erasmo Passaro 74 Monitoring patients may be more important than their 291 laboratory tests 75 Depression in a student with juvenile myoclonic epilepsy 296 Enrique J Carrazana 76 Osteomalacia...
Postictal Sleep
Postictal sleep is a common phenomenon after a generalized tonic-clonic seizure. The patient may pass through several stages from sleep to delirium to drowsiness before awakening. During the late postictal state, the heart rate begins to normalize from the typical ictal tachycardia. There is a decrease in muscle tone with bladder sphincter relaxation and incontinence that typically occurs in the early postictal phase. In the immediate postictal phase, there is partial obstruction of the airway...
Electrooculography
The electrooculogram EOG is the second parameter necessary for differentiating sleep stages, and at least two channels are the recommendation. Electrodes can be placed 1 cm lateral to and above one outer canthus, while a second is placed 1 cm lateral to and below the contralateral outer canthus. By referencing these electrodes either to one or to both ear or mastoid electrodes Al, MN1 , horizontal, vertical, and oblique eye movements can all be recorded. If the need arises to distinguish...
List of Contributors
David F. Abbott, Ph.D. Brain Research Institute, Melbourne, Victoria, Australia A. James Barkovich, M.D. Department of Radiology, Neuroradiology Section, University of California San Francisco, San Francisco, CA, USA Samuel F. Berkovic, M.D. Epilepsy Research Collaborative Centre, University of Melbourne, Melbourne, Victoria, Australia Andrea Bernasconi, M.D. Montreal Neurological Institute, McGill University, Montreal, Qu bec, Canada Jeffrey R. Binder, M.D. Department of Neurology, Medical...
case presentation Lhu
The patient is an 11-year-old ambidextrous female with symptomatic intractable epilepsy who was referred for evaluation and treatment . At three years of age, she developed a fever, became confused, and within 2-3 hours began having persistent right hemibody myoclonic clonic activity She was admitted to an intensive care unit, and multiple antiepileptic drugs were required to fully control her seizures . Cerebrospinal fluid studies were positive for herpes simplex virus HSV . Her initial EEG...
Sensory Stimulation
Seizures may be precipitated by a variety of sensory stimuli, particularly in certain specific epilepsy syndromes. Most common are patients with primary idiopathic generalized epilepsies who display photosensitivity. Intermittent photic stimulation from video games, stroboscopic lights, or a variety of alternating dark light patterns may induce myoclonic jerks or generalized convulsions in these patients. Photosensitive-related seizures are at times self-induced by intellectually disabled...
Treatment of aggression in epilepsy
If aggression is a problem in the clinical management of patients with epilepsy the most important point is to establish a correct diagnosis Figure 7.5 . A careful neurological, psychiatric and medical history and examination should be performed to answer the following questions 1. Is there any medical condition that contributes to the aggressive behaviour such as endocrinological or immunologi-cal diseases Is there any medication that might contribute to the aggressive behaviour 2. What is the...
Postvaccination encephalopathy
The possible role of vaccination particularly pertussis vaccination in causing a childhood encephalopathy and subsequent epilepsy and learning disability has been the subject of intense study, with contradictory claims. The UK National Childhood Encephalopathy Study found that children hospitalized with seizures and encephalopathy were more likely to have received diphtheria-tetanus-pertussis DTP vaccination in the previous 7 days than control children. However, the potential methodological...
The Reflex Epilepsies
The term reflex epilepsy is used to describe cases in which seizures are evoked consistently by a specific environmental trigger. In some cases the stimulus can be highly specific and in others less so. The term is not usually applied to patients whose seizures are precipitated by internal influences such as menstruation, nor to situations where the precipitating factors are vague or ill-defined e.g. fatigue, stress , nor to patients with existing epilepsy where seizures are more likely to...
Typical absence status epilepticus petit mal status
This occurs only in patients with idiopathic generalized epilepsy, usually as part of the subcategory childhood absence epilepsy, in which a history of absence status occurs in about 3 -9 . The attacks can recur, and can last for hours or occasionally days. The episodes are typically precipitated by factors such as menstruation, withdrawal of medication, hypoglycaemia, hyperventilation, flashing or bright lights, sleep deprivation, fatigue, stress, or grief. The principle clinical feature is...
Pgp in cancer
Drug resistance, either intrinsic or acquired, is a frequently encountered problem in the failure of antineoplastic agents. Pgp, an efflux pump that extrudes hydrophobic cytotoxic drugs from cancer cells, plays a key role in multidrug resistance MDR and may contribute to clinical drug resistance. Pgp is a 170 kDa cell-surface glycoprotein, encoded for by the MDR1 gene Riordan amp Ling 1985 . The presence of MDR has been correlated with poor outcome in acute myeloid leukaemia, non-Hodgkin's...
Neurocysticercosis
Neurocysticercosis NCC is not necessarily a tropical disease, it is related to unsanitary conditions, poverty and poor health-care systems of a country, regardless of its geographical location. Studies of highly selected patients with epilepsy or seizures in neurologic services of hospital settings from some developing countries report NCC as the main cause of epilepsy, accounting for 30 to 50 of patients.16,31 However, in the recent prospective multicenter study carried out in Ecuador, NCC was...
Drug resistance molecules lessons from oncology
George L. Scheffer and Rik J. Scheper1 Department of Pathology, Free University Medical Center, de Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands Abstract. Tumour cell insensitivity to anticancer drugs frequently appears as multidrug resistance MDR , associated with overexpression of one or more of a set of at least 10 different molecules, causing reduced drug levels at the intracellular target sites. They include transmembrane transporter proteins such as P glycoprotein, MRP1 9 and BCRP....
The Problem Of Depression Diagnosis In Epilepsy
To conclude, a definite diagnosis of depression in patients with epilepsy can be difficult because a number of symptoms, which are recognized as diagnostic criteria for a depressive episode by the ICD-10 and DSM-IV, may occur in epilepsy secondary to seizure activity or AED treatment e.g., loss of energy, insomnia or hypersomnia, increase or decrease in appetite, loss of libido, psychomotor agitation or retardation, diminished ability to think or concentrate . Because these symptoms may be...
Gene expression profiling of epothilone Aresistant cells
Peter Atadja, Yan Yan-Neale, Harry Towbin, Frank Buxton and Dalia Cohen Functional Genomics, Novartis Corporation, Summit, NJ 07901, USA Abstract. In the current study, we isolated sublines of the human breast adenocarcinoma cell line MDA 435 that exhibited increasing resistance to epothilone A, a microtubule-stabilizing cytotoxic agent. The resistant cells did not express P glycoprotein or multidrug resistance-associated protein MRP which are known mediators of multidrug resistance MDR . Two...
Changes In Serum Prolactin With Brain Stimulation
The first recognition of episodic hyperprolactinemia induced by seizures were the observations of investigators 11 who were seeking endocrine profiles to predict which patients would benefit from a full course of electrocon-vulsive therapy ECT . Although endocrine changes did not predict the likelihood of successful ECT in women with depression, reproducible elevations in serum PRL followed ECT. ECT produces similar endocrine changes in schizophrenics 12,13 . Subsequent to the ECT reports,...
Periventricular Leukomalacia
Periventricular leukomalacia PVL is a ischemic cerebral white matter disorder and occurs in the premature brain of about 24-35 weeks of gestation.29,38 In addition to arterial ischemia, other factors involved in the pathophysiology of these changes include immaturity of the brain, underdeveloped cerebral vasculature and nature of cell component such as intrinsic vulnerability of the oligodendroglia, hemorrhage during later pregnancy and perinatal period, vascular anastomosis in the placenta,...
Paraldehyde
Paraldehyde still has a minor role in premonitory stage given rectally, as an alternative to the benzodiazepines in situations where facilities for resuscitation are not available. Paraldehyde is rapidly and completely absorbed after IM injection or rectally. The risk of drug accumulation, hypotension or cardio-respiratory arrest is small, and seizures do not often recur after control has been obtained. Paraldehyde has been used for many years in status, and although there is wide experience in...
JJJL I f
FIGURE 36.1 An 8-year-old self inducing a photoconvulsive seizure by waving his fingers before his eyes. Note how the physical induction precedes the polyspike discharge and clinical absence. FIGURE 36.1 An 8-year-old self inducing a photoconvulsive seizure by waving his fingers before his eyes. Note how the physical induction precedes the polyspike discharge and clinical absence. Audiogenic Musicogenic Speech-induced Photosensitive Flash Partial Primary auditory cortex Generalized Nondominant...
Benzodiazepines
Available benzodiazepines for chronic use include clonazepam, clorazepate and clobezam. Most benzodiazepines are not good choices for long-term therapy and should not be used as first-line agents. Patients may develop tolerance to the therapeutic effects of many of the benzodiazepines. Seizures may initially be decreased, but as tolerance develops over time, seizures may recur, necessitating dosage increases to regain control. Among the available benzodiazepines, clobezam has been touted as...
Origins of neuropsychology
The origins of neuropsychology lie in direct clinical observation. Two nineteenth century landmarks in the understanding of structural and functional relationships in the brain were the observations of Broca and Wernicke. In 1861 Paul Broca identified the third frontal convolution of the left hemisphere as an area that if damaged, would result in a specific impairment of expressive language. In 1874 Karl Wernicke described specific impairment of receptive language associated with damage to an...
Behavioural correlates of frontal lobe epilepsy
If we propose problems with behaviour selection initiation and inhibition as a functional complex which is mainly affected in frontal lobe epilepsy, the obvious question is whether or not this dysfunction has a correlate in personality and behaviour. With respect to this question we applied several self-rating scales to a group of 95 patients with either frontal n 18 or mesial temporal lobe epilepsy n 77 . Epilepsy groups were matched regarding sex, the age at the onset of epilepsy mean 11...
Potassium Channels
Potassium channels play a major role in regulating neuronal excitability. Although more than 20 types of potassium channels have been identified by biophysical studies, there are four major groups calcium-activated, voltage-gated, sodium-activated, and inwardly rectifying potassium channels. These different types of potassium channels are regulated by neuromodulators, ions, and second messenger systems. The opening of potassium channels has the effect of hyperpolarizing neurons or reversing...
Myoclonic status epilepticus in coma
Myoclonic status epilepticus in coma is a well-recognized complication of the cerebral anoxia resulting from cardiorespiratory arrest typically after a myocardial infarction or cardiac surgery . It is characterized by spontaneous and stimulus-sensitive myoclonus usually occurring within 24 hours of the coma. To what extent this is really an 'epileptic' state, or is simply a sign of a severely damaged brain, is arguable. The patients generally have burst suppression on their EEGs, are deeply...
Benign Focal Epilepsy Of Childhood 1
The syndrome of benign focal epilepsy of childhood, also referred to as benign rolandic epilepsy or benign childhood epilepsy with centrotemporal spikes, is a common form of childhood epilepsy. The children are of normal intelligence, have a normal neurological examination, and present with sleep-related seizures. Approximately 75 of the seizures occur during sleep Lerman and Kivity, 1975 Loiseau et al, 1973 . The seizures are focal motor usually involving the face and arm , present with...
Kalogjera-sackellares D Sackellares Jc. Intellectual And Neuropsychological
Alper, K., Devinsky, O., Perrine, K., Vazquez, B. and Luciano, D. 1993 . Nonepileptic seizures and childhood sexual and physical abuse. Neurology, 43, 1950-3. Arnold, L.M. and Privitera, M.D. 1996 . Psychopathology and trauma in epileptic and psychogenic seizure patients. Psychosomatics, 37, 438-43. Binder, L.M., Kindermann, S.S., Heaton, R.K. and Salinsky, M.C. 1998 . Neuropsychologic impairment in patients with nonepileptic seizures. Arch Clin Neuropsychology, 13, 513-22. Boll, T.J. 1981 ....
Project Title RNA BINDING PROTEINS IN EPILEPSY AND NEUROLOGIC DISEASE
Principal Investigator amp Institution Toth, Miklos Associate Professor Pharmacology Weill Medical College of Cornell Univ of Cornell University New York, Ny 10021 Timing Fiscal Year 2001 Project Start 3-DEC-1995 Project End 1-MAY-2003 Summary from applicant's abstract This is a competing continuation proposal of a grant funded to study the novel Jerky protein and its role in epilepsy. The mouse line defective in the jerky gene shows epileptic seizures and our work has shown that consistent...
Reza Behrouz Selim R Benbadis
Idiopathic generalized epilepsies IGEs are a distinct group of epi- lepsies, clearly defined in the 1989 International Classification of Epileptic Syndromes and Epilepsies. This classification established an important dichotomy between the idiopathic epilepsies on the one hand, and the symptomatic or cryp-togenic epilepsies on the other 1 . In prior versions of this classification, IGEs were referred to as primary generalized epilepsies, and symptomatic cryptogenic generalized epilepsies were...
V Antiepileptic Drugs And Ketogenic Diet
Section Editors Blaise F. D. Bourgeois and Raman Sankar Rajesh RamachandranNair and O. Carter Snead, III 543 Kevin Farrell and Aspasia Michoulas 557 42. Carbamazepine and Oxcarbazepine 43. Ethosuximide, Methsuximide, and Trimethadione Gregory L. Holmes and Philip L. Pearl 593 Raman Sankar and W. Donald Shields 611 49. Phenytoin and Related Drugs Dietz Rating, Nicole Wolf, and Thomas Bast 653 Shlomo Shinnar, Richard Civil, and Kenneth W. Sommerville 661 G nter Kr mer and Gabriele Wohlrab 699 55....
Neurobiology of aggression
Behbehani, 1995 Brandao et al., 1994 . These structures are controlled by higher neuronal centres in the hypothalamus Bhatnagar and Dallman, 1998 Van de Poll and Van Goozen, 1992 which in addition to controlling these behavioural brainstem programs adjust the internal endocrinological and immunological environment to aggressive behaviour in flight-fight situations Luo, 1998 Reis, 1969 Shaikh, 1997 Zanchetti, 1968 . Frontal lobe functions are known to be crucial for the ability to suppress...
Cortical mapping
Cortical mapping of functionally important cortex is a vital function where neurosurgical procedures are planned in sensory, motor or speech areas, and is required to identify eloquent areas and thus avoid post-surgical neurological deficit. Techniques vary but all include the placement of grids over the proposed resection site, and the observation of the clinical effects of electrical stimulation of each cortical contact. Ictal and interictal EEG can be recorded at the same time. Mapping is...
Sustained Repetitive Firing Srf
Sustained high-frequency repetitive firing is an important property of vertebrate and invertebrate neurons that correlates with the excitability state of the neuron 6-10 . Many central nervous system CNS neurons exhibit SRF. Although no direct evidence has demonstrated the link between SRF and epilepsy, information from in vitro studies on isolated neurons may have some bearing on altered neuronal excitability and anticonvulsant action. Sustained repetitive firing is a nonsynaptic property of...