Epilepsy & Behavior
Off-label gabapentin masking ictal triphasic waves: Case analysis of neuropsychiatric and electrographic correlates
Publication year: 2011
Source: Epilepsy & Behavior, Available online 25 September 2011
Kenneth R. Kaufman, Peter J. Struck, Brenda Wu, Stephen Wong
Antiepileptic drugs (AEDs) are frequently used off-label for the treatment of psychiatric, pain, and other neurological disorders. Off-label AED use may confound the diagnosis for acute neuropsychiatric changes associated with delirium by fortuitously treating, or partially treating, underlying seizure disorders while masking ictal electrographic patterns on EEGs. Standard video/EEG monitoring includes weaning from AEDs to maximize ictal activity and better determine seizure focus. We report a case of off-label gabapentin use masking ictal electrographic activity, the neuropsychiatric and electrographic consequences of discontinuing gabapentin, and the therapeutic response when gabapentin was re-initiated and titrated to a total daily dose greater than that at time of admission. Weaning from AEDs with concurrent video/EEG monitoring is an important diagnostic tool in these complex cases.
Source: Epilepsy & Behavior, Available online 25 September 2011
Kenneth R. Kaufman, Peter J. Struck, Brenda Wu, Stephen Wong
Antiepileptic drugs (AEDs) are frequently used off-label for the treatment of psychiatric, pain, and other neurological disorders. Off-label AED use may confound the diagnosis for acute neuropsychiatric changes associated with delirium by fortuitously treating, or partially treating, underlying seizure disorders while masking ictal electrographic patterns on EEGs. Standard video/EEG monitoring includes weaning from AEDs to maximize ictal activity and better determine seizure focus. We report a case of off-label gabapentin use masking ictal electrographic activity, the neuropsychiatric and electrographic consequences of discontinuing gabapentin, and the therapeutic response when gabapentin was re-initiated and titrated to a total daily dose greater than that at time of admission. Weaning from AEDs with concurrent video/EEG monitoring is an important diagnostic tool in these complex cases.
Different cortical involvement pattern of generalized and localized spasms: A magnetoencephalography study
Publication year: 2011
Source: Epilepsy & Behavior, Available online 22 September 2011
Yosuke Kakisaka, Ajay Gupta, Zhong I. Wang, Anne-Sophie Dubarry, Andreas V. Alexopoulos, ...
We report successful magnetoencephalography (MEG) recording in a child who had generalized epileptic spasms (ESs) as well as ESs involving the legs only during the recording. MEG source localization results demonstrated that (1) the interictal epileptiform discharges and both types of ESs had the same origin, that is, the right parietal region, and (2) the two types of ESs had different cortical spread patterns, that is, epileptic involvement localized to the right parietal region in spasms of the legs and rapid diffuse involvement in generalized spasms. In this case, MEG provided new insight into the mechanisms underlying the two types of ESs: both types were generated from the same focus, and in generalized ESs, abnormal excitation spread to cortical areas diffusely.
Source: Epilepsy & Behavior, Available online 22 September 2011
Yosuke Kakisaka, Ajay Gupta, Zhong I. Wang, Anne-Sophie Dubarry, Andreas V. Alexopoulos, ...
We report successful magnetoencephalography (MEG) recording in a child who had generalized epileptic spasms (ESs) as well as ESs involving the legs only during the recording. MEG source localization results demonstrated that (1) the interictal epileptiform discharges and both types of ESs had the same origin, that is, the right parietal region, and (2) the two types of ESs had different cortical spread patterns, that is, epileptic involvement localized to the right parietal region in spasms of the legs and rapid diffuse involvement in generalized spasms. In this case, MEG provided new insight into the mechanisms underlying the two types of ESs: both types were generated from the same focus, and in generalized ESs, abnormal excitation spread to cortical areas diffusely.
Correlation between language impairment and problems in motor development in children with rolandic epilepsy
Publication year: 2011
Source: Epilepsy & Behavior, Available online 20 September 2011
Geke M. Overvliet, Albert P. Aldenkamp, Sylvia Klinkenberg, Joost Nicolai, Johan S.H. Vles, ...
ObjectiveAn association between impaired school performance and rolandic epilepsy is frequently reported. Language outcome, in particular, seems to be affected, although rolandic epilepsy originates from the motor–sensory cortex. In this study we tried to find a correlation between locomotion problems and language impairment.MethodsIn this noncontrolled, open, clinical cohort study of 48 children with rolandic epilepsy, a 24-hour EEG and a neuropsychological assessment were obtained for all children.ResultsChildren with rolandic epilepsy had a significant delay in reading skills (reading words: mean = 6 months, SD = 11.9,P < 0.002; reading sentences: mean = 8.6 months, SD = 12.7,P < 0.001), compared with the healthy population. There was a significant correlation between problems in motor development and delays in reading skills (reading words:r = − 0.426,P = 0.006; reading sentences:r = − 0.343,P = 0.03).ConclusionReading performance is impaired in children with rolandic epilepsy. Reading of sentences is more impaired than reading of words. There is a significant correlation between problems in motor development and language, suggesting their interaction at the level of the cortex.
Highlights► Children with rolandic epilepsy had a significant delay in reading skills compared with the healthy population. ► There was a significant correlation between problems in motor development and delays in reading skills. ► This correlation suggests an interaction of both at the level of the cortex.
Source: Epilepsy & Behavior, Available online 20 September 2011
Geke M. Overvliet, Albert P. Aldenkamp, Sylvia Klinkenberg, Joost Nicolai, Johan S.H. Vles, ...
ObjectiveAn association between impaired school performance and rolandic epilepsy is frequently reported. Language outcome, in particular, seems to be affected, although rolandic epilepsy originates from the motor–sensory cortex. In this study we tried to find a correlation between locomotion problems and language impairment.MethodsIn this noncontrolled, open, clinical cohort study of 48 children with rolandic epilepsy, a 24-hour EEG and a neuropsychological assessment were obtained for all children.ResultsChildren with rolandic epilepsy had a significant delay in reading skills (reading words: mean = 6 months, SD = 11.9,P < 0.002; reading sentences: mean = 8.6 months, SD = 12.7,P < 0.001), compared with the healthy population. There was a significant correlation between problems in motor development and delays in reading skills (reading words:r = − 0.426,P = 0.006; reading sentences:r = − 0.343,P = 0.03).ConclusionReading performance is impaired in children with rolandic epilepsy. Reading of sentences is more impaired than reading of words. There is a significant correlation between problems in motor development and language, suggesting their interaction at the level of the cortex.
Highlights► Children with rolandic epilepsy had a significant delay in reading skills compared with the healthy population. ► There was a significant correlation between problems in motor development and delays in reading skills. ► This correlation suggests an interaction of both at the level of the cortex.
Reading performance in children with rolandic epilepsy correlates with nocturnal epileptiform activity, but not with epileptiform activity while awake
Publication year: 2011
Source: Epilepsy & Behavior, Available online 20 September 2011
S.C.M. Ebus, G.M. Overvliet, J.B.A.M. Arends, A.P. Aldenkamp
ObjectiveAn association between language impairment and rolandic epilepsy is frequently reported. This impairment could be correlated with the amount of nocturnal epileptiform activity.MethodsWe retrospectively analyzed 26 children with rolandic epilepsy and/or rolandic spikes. All had undergone a 24-hour EEG and neuropsychological assessment within 2 weeks. Reading performance (reading words and sentences) and intelligence were measured.ResultsThere was a significant negative correlation between amount of nocturnal epileptiform activity and reading sentencesR = − 0.525 (P = 0.008). There was a trend in this correlation for reading wordsR = − 0.398 (P = 0.054). We found a negative correlation between amount of nocturnal epileptiform activity and Verbal IQ (R = − 0.51P = 0.08). No correlation was found between reading performance or Verbal IQ and amount of diurnal epileptiform activity.ConclusionsReading performance is impaired in children with rolandic epilepsy and is correlated with the amount of nocturnal epileptiform activity.
Highlights► Twenty-six children with rolandic epilepsy and/or rolandic spikes were analyzed. ► A 24-hour electroencephalogram was obtained and a neuropsychological assessment performed within 2 weeks. ► There was a negative correlation between amount of nocturnal epileptiform activity and reading sentences. ► There was a negative correlation between amount of nocturnal epileptiform activity and Verbal IQ.
Source: Epilepsy & Behavior, Available online 20 September 2011
S.C.M. Ebus, G.M. Overvliet, J.B.A.M. Arends, A.P. Aldenkamp
ObjectiveAn association between language impairment and rolandic epilepsy is frequently reported. This impairment could be correlated with the amount of nocturnal epileptiform activity.MethodsWe retrospectively analyzed 26 children with rolandic epilepsy and/or rolandic spikes. All had undergone a 24-hour EEG and neuropsychological assessment within 2 weeks. Reading performance (reading words and sentences) and intelligence were measured.ResultsThere was a significant negative correlation between amount of nocturnal epileptiform activity and reading sentencesR = − 0.525 (P = 0.008). There was a trend in this correlation for reading wordsR = − 0.398 (P = 0.054). We found a negative correlation between amount of nocturnal epileptiform activity and Verbal IQ (R = − 0.51P = 0.08). No correlation was found between reading performance or Verbal IQ and amount of diurnal epileptiform activity.ConclusionsReading performance is impaired in children with rolandic epilepsy and is correlated with the amount of nocturnal epileptiform activity.
Highlights► Twenty-six children with rolandic epilepsy and/or rolandic spikes were analyzed. ► A 24-hour electroencephalogram was obtained and a neuropsychological assessment performed within 2 weeks. ► There was a negative correlation between amount of nocturnal epileptiform activity and reading sentences. ► There was a negative correlation between amount of nocturnal epileptiform activity and Verbal IQ.
Temporal lobe epilepsy surgery: What do patients want to know?
Publication year: 2011
Source: Epilepsy & Behavior, Available online 17 September 2011
Hyunmi Choi, Kim Pargeon, Rebecca Bausell, John B. Wong, Anil Mendiratta, ...
Patients with pharmacoresistant temporal lobe epilepsy (TLE) contemplating brain surgery must make a complex treatment decision involving trade-offs. Patient decision aids, containing information on the risks and benefits of treatment interventions, increase patient knowledge and facilitate shared decision making between patients and physicians. We conducted five focus groups to describe the information patients need to make informed decisions about TLE surgery. Twenty patients who had undergone TLE surgery described the information used in their decision-making process, and evaluated the potential for a patient decision aid to assist other patients who are considering surgery. Thematic analysis revealed information needs that were both experiential (i.e., learning about other patients’ experiences through testimonials) and factual (i.e., individualized statistical information). Patients also made suggestions on how this information should be delivered to patients. These data will accelerate the development of a patient decision aid designed to assist TLE patients in their decision making about epilepsy surgery.
Highlights► Patients who had undergone temporal lobe epilepsy surgery described the information used in their decision-making process. ► Patients expressed a need for experiential (i.e., other patients’ experiences) information. ► Patients also described a need for factual (i.e., individualized statistical) information.
Source: Epilepsy & Behavior, Available online 17 September 2011
Hyunmi Choi, Kim Pargeon, Rebecca Bausell, John B. Wong, Anil Mendiratta, ...
Patients with pharmacoresistant temporal lobe epilepsy (TLE) contemplating brain surgery must make a complex treatment decision involving trade-offs. Patient decision aids, containing information on the risks and benefits of treatment interventions, increase patient knowledge and facilitate shared decision making between patients and physicians. We conducted five focus groups to describe the information patients need to make informed decisions about TLE surgery. Twenty patients who had undergone TLE surgery described the information used in their decision-making process, and evaluated the potential for a patient decision aid to assist other patients who are considering surgery. Thematic analysis revealed information needs that were both experiential (i.e., learning about other patients’ experiences through testimonials) and factual (i.e., individualized statistical information). Patients also made suggestions on how this information should be delivered to patients. These data will accelerate the development of a patient decision aid designed to assist TLE patients in their decision making about epilepsy surgery.
Highlights► Patients who had undergone temporal lobe epilepsy surgery described the information used in their decision-making process. ► Patients expressed a need for experiential (i.e., other patients’ experiences) information. ► Patients also described a need for factual (i.e., individualized statistical) information.
Cognition in epilepsy and its transient impairment
Publication year: 2011
Source: Epilepsy & Behavior, Available online 17 September 2011
Bruce Hermann
Source: Epilepsy & Behavior, Available online 17 September 2011
Bruce Hermann
Shared vulnerability between seizures and psychosis in cocaine addiction?
Publication year: 2011
Source: Epilepsy & Behavior, Available online 15 September 2011
Benjamin Rolland, Laurent Karila, Pierre A. Geoffroy, Olivier Cottencin
Cocaine-induced seizures (CIS) and cocaine-induced psychosis (CIP) may be complications of acute cocaine intoxication. CIS could result from a kindling process, involving the glutamate NMDA receptor (NMDAR) phosphorylation state, which is enhanced by activation of the dopamine D1 receptor (D1R). CIP is considered to be more specifically associated with the activity of the dopamine D2 receptor (D2R). The authors describe the case of a 21-year-old woman who presented with recurrent CIP during a period of increased cocaine abuse that ended in two consecutive CIS. This case report may illustrate a possible overlap in the mechanisms underlying CIS and CIP, disclosing some subtle interactions occurring between dopaminergic and glutamatergic receptors during cocaine chronic intoxication. Chronic cocaine exposure usually induces the formation of a NMDAR–D2R complex, which seems to be linked to the usual clinical effects of the drug, but also causes complex formation not to occur in both D2R-based CIP and D1R-based CIS. To explain the case of this patient, we propose a pharmacological hypothesis based on a literature review and implying the lack of formation of this complex, which triggers CIP and CIS. On a more practical level, this case report also encourages practitioners to be aware of the possible co-occurrence of CIP and CIS in cocaine abusers, especially with respect to antipsychotic medications that could be administered in such situations.
Source: Epilepsy & Behavior, Available online 15 September 2011
Benjamin Rolland, Laurent Karila, Pierre A. Geoffroy, Olivier Cottencin
Cocaine-induced seizures (CIS) and cocaine-induced psychosis (CIP) may be complications of acute cocaine intoxication. CIS could result from a kindling process, involving the glutamate NMDA receptor (NMDAR) phosphorylation state, which is enhanced by activation of the dopamine D1 receptor (D1R). CIP is considered to be more specifically associated with the activity of the dopamine D2 receptor (D2R). The authors describe the case of a 21-year-old woman who presented with recurrent CIP during a period of increased cocaine abuse that ended in two consecutive CIS. This case report may illustrate a possible overlap in the mechanisms underlying CIS and CIP, disclosing some subtle interactions occurring between dopaminergic and glutamatergic receptors during cocaine chronic intoxication. Chronic cocaine exposure usually induces the formation of a NMDAR–D2R complex, which seems to be linked to the usual clinical effects of the drug, but also causes complex formation not to occur in both D2R-based CIP and D1R-based CIS. To explain the case of this patient, we propose a pharmacological hypothesis based on a literature review and implying the lack of formation of this complex, which triggers CIP and CIS. On a more practical level, this case report also encourages practitioners to be aware of the possible co-occurrence of CIP and CIS in cocaine abusers, especially with respect to antipsychotic medications that could be administered in such situations.
Ictal yawning in a patient with drug-resistant focal epilepsy: Video/EEG documentation and review of literature reports
Publication year: 2011
Source: Epilepsy & Behavior, Available online 14 September 2011
Nicola Specchio, Antonio Carotenuto, Marina Trivisano, Simona Cappelletti, Federico Vigevano, ...
Yawning is an involuntary sequence of mouth opening, deep inspiration, brief apnea, and slow expiration. Few cases of yawning as a clinical sign of epileptic seizures, ictally or postictally, have been reported. We report the video/EEG documentation of yawning as an ictal sign in a 31-year-old patient affected by drug-resistant focal epilepsy symptomatic of bilateral perisylvian polymicrogyria. Since the age of 10 she has had seizures characterized by yawning, staring, and eye blinking. Bilateral rhythmic frontotemporal spikes and waves characterized her EEG. We reviewed all reported cases and compared clinical and EEG features. We believe that yawning as part of an epileptic seizure might be considered a rare automatic behavior, like other automatisms frequently reported in epileptic seizures. Automatisms are more frequently described in patients with temporal lobe epilepsy, and involvement of the temporal lobe in most of the published cases may have led to this explanation. It is possible that yawning within epileptic seizures could be considered activation of distinct symptomatogenic cortex rather than a release phenomenon. This rare ictal manifestation should be recognized as epileptic to avoid misdiagnosis and treatment failure.
Source: Epilepsy & Behavior, Available online 14 September 2011
Nicola Specchio, Antonio Carotenuto, Marina Trivisano, Simona Cappelletti, Federico Vigevano, ...
Yawning is an involuntary sequence of mouth opening, deep inspiration, brief apnea, and slow expiration. Few cases of yawning as a clinical sign of epileptic seizures, ictally or postictally, have been reported. We report the video/EEG documentation of yawning as an ictal sign in a 31-year-old patient affected by drug-resistant focal epilepsy symptomatic of bilateral perisylvian polymicrogyria. Since the age of 10 she has had seizures characterized by yawning, staring, and eye blinking. Bilateral rhythmic frontotemporal spikes and waves characterized her EEG. We reviewed all reported cases and compared clinical and EEG features. We believe that yawning as part of an epileptic seizure might be considered a rare automatic behavior, like other automatisms frequently reported in epileptic seizures. Automatisms are more frequently described in patients with temporal lobe epilepsy, and involvement of the temporal lobe in most of the published cases may have led to this explanation. It is possible that yawning within epileptic seizures could be considered activation of distinct symptomatogenic cortex rather than a release phenomenon. This rare ictal manifestation should be recognized as epileptic to avoid misdiagnosis and treatment failure.
Repeated amygdala-kindled seizures induce ictal rebound tachycardia in rats
Publication year: 2011
Source: Epilepsy & Behavior, Available online 13 September 2011
Aline P. Pansani, Diego B. Colugnati, Guus H.M. Schoorlemmer, Eliza Y.F. Sonoda, Esper A. Cavalheiro, ...
It is thought that cardiovascular changes may contribute to sudden death in patients with epilepsy. To examine cardiovascular alterations that occur during epileptogenesis, we measured the heart rate of rats submitted to the electrical amygdala kindling model. Heart rate was recorded before, during, and after the induced seizures. Resting heart rate was increased in stages 1, 3, and 5 as compared with the unstimulated control condition. In the initial one third of the seizures, we observed bradycardia, which increased in intensity with increasing stage and was blocked by injecting methyl atropine. During stage 5 seizures, a rebound tachycardia was observed that also increased in intensity with increasing number of seizures. This study demonstrated the influence of seizure frequency on cardiac autonomic modulation, providing a basis for discussion of potential mechanisms that cause patients with epilepsy to die suddenly.
Highlights► Heart rate responses were measured in rats submitted to the electric amygdala kindling model. ► Ictal bradycardia occurred and increased with progression of the kindling stages. ► Rebound tachycardia occurred after repeated stage 5 seizures. ► It is concluded that seizure recurrence alters cardiac autonomic modulation, which could predispose to sudden unexpected death in epilepsy.
Source: Epilepsy & Behavior, Available online 13 September 2011
Aline P. Pansani, Diego B. Colugnati, Guus H.M. Schoorlemmer, Eliza Y.F. Sonoda, Esper A. Cavalheiro, ...
It is thought that cardiovascular changes may contribute to sudden death in patients with epilepsy. To examine cardiovascular alterations that occur during epileptogenesis, we measured the heart rate of rats submitted to the electrical amygdala kindling model. Heart rate was recorded before, during, and after the induced seizures. Resting heart rate was increased in stages 1, 3, and 5 as compared with the unstimulated control condition. In the initial one third of the seizures, we observed bradycardia, which increased in intensity with increasing stage and was blocked by injecting methyl atropine. During stage 5 seizures, a rebound tachycardia was observed that also increased in intensity with increasing number of seizures. This study demonstrated the influence of seizure frequency on cardiac autonomic modulation, providing a basis for discussion of potential mechanisms that cause patients with epilepsy to die suddenly.
Highlights► Heart rate responses were measured in rats submitted to the electric amygdala kindling model. ► Ictal bradycardia occurred and increased with progression of the kindling stages. ► Rebound tachycardia occurred after repeated stage 5 seizures. ► It is concluded that seizure recurrence alters cardiac autonomic modulation, which could predispose to sudden unexpected death in epilepsy.
Wrestling fact from fiction
Publication year: 2011
Source: Epilepsy & Behavior, Available online 11 September 2011
Sallie Baxendale
Source: Epilepsy & Behavior, Available online 11 September 2011
Sallie Baxendale