PURPOSE: The aim of this study was to evaluate the efficacy and safety of levetiracetam in children younger than 4 years with intractable epilepsy. METHODS: A retrospective analysis of pediatric epilepsy patients was performed. Data were obtained from the medical records of 30 patients (male 19, female 11) with intractable epilepsy, who were treated with levetiracetam. RESULTS: Seizure types were partial in 18, and generalized in 12. Fifteen patients had symptomatic etiologies. The median age of the patients at the time of levetiracetam administration was 26 months old (range: 4-47 months). The median starting dose was 13 mg/kg/ day, and the median maintenance dose was 52 mg/kg/day (range: 10-123 mg/kg/day). Ten (10/30, 33%) patients experienced more than 50% reduction in seizure frequency, and 4 (4/30, 13%) partial epilepsy patients became seizure-free. Eight partial epilepsy patients (44%) had more than 50% seizure reduction, while 2 patients (17%) with generalized epilepsy did. All of patients with infantile spasms and Lennox-Gastaut syndrome except one, had less than 50% reduction in seizure frequency. Adverse events reported in 8 patients (27%), included lethargy, behavioral problems, sleep disturbance, and seizure aggravation. CONCLUSIONS:Levetiracetam is effective in children aged 4 years or less with intractable epilepsy, and also seems to be safe to use in this age group.
Aged ; Anticonvulsants ; Child ; Child, Preschool ; Epilepsies, Partial ; Epilepsy ; Epilepsy, Generalized ; Female ; Humans ; Infant ; Infant, Newborn ; Intellectual Disability ; Lethargy ; Medical Records ; Piracetam ; Retrospective Studies ; Seizures ; Spasms, Infantile

The gamma knife radiosurgery (GKS) is a safe and effective neurosurgical approach in the treatment of arteriovenous malformation (AVM). Seizures after GKS are rarely reported, but epilepsia partialis continua (EPC) has not been reported yet. We report a patient with EPC accompanied with cerebral edema after GKS in AVM. A 50-year-old man was admitted for EPC, dysarthria and monoparesis 20 days after GKS due to AVM. Brain MRI showed increased cerebral edema around AVM in the left premotor area. Symptoms were relieved by IV dexamethasone and antiepileptic drugs (AEDs). 15 weeks later, EPC recurred and aphasia and right hemiplegia were rapidly aggravated. The follow up brain MRI showed markedly increased cerebral edema compared with previous MRI. EPC was well controlled by AEDs, but aphasia and hemiplegia were not responsive to IV dexamethasone until trying oral prednisolon. We think that cerebral edema induced by EPC, as a complication of GKR, might aggravate hemiparesis.
Anticonvulsants ; Aphasia ; Arteriovenous Malformations ; Brain ; Brain Edema ; Dexamethasone ; Dysarthria ; Epilepsia Partialis Continua* ; Follow-Up Studies ; Hemiplegia ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Paresis ; Radiosurgery* ; Seizures

PURPOSE: In the pediatric patients who have medically intractable epilepsy the callosotomy is useful to prevent the propagation of seizure from one hemisphere to the other. The indications of callosotomy are drop attack, life threatening primarily or secondarily generalized seizure, medically refractory mixed seizure types such as Lennox-Gastaut syndrome. In addition, the retarded children are not contraindicated. The anterior callosotomy is used to perform to control medically intractable epilepsy which is believed to have some advantages to total callosotomy. But, we propose that the anterior callosotomy does not seem to be superior to total callosotomy for the prevention of the propagation of seizure or complication. We describe a series of 21 patients with medically intractable epilepsy who underwent total callosotomy in one stage. METHODS: The diagnoses in these patients included Lennox-Gastaut syndrome, atonic seizure, infantile hemiplegia, and no obvious solitary seizure focus on chronic video/EEG monitoring to characterize seizures, electrographic activity, and postictal behaviors. Preoperatively 16 patients suffered from disabling drop attacks or intense head drop seizures which caused frequent physical injuries. Other types of seizures are 12 generalized tonic-clonic seizures, 7 complex partial seizures, 1 absence seizure, and 7 myoclonic seizures. Male:Female=14:7, Age: 2-22 years (Mean: 9.4 years). The follow-up period ranged from 0.8 to 3.8 years (median 2.4 years). Seizure outcome, parental assessment of daily function, and parental satisfaction with outcome were assessed postoperatively. RESULTS: Drop attacks disappeared completely during the entire follow-up period in 13 patients and decreased to less than 10% of baseline in five. The corpus callosum of the one patient were not completely sectioned in Diffusion Tensor Image, tractography. Other types of seizures resolved completely in 14 patients and decreased in 7. 2 patients experienced a transient disconnection syndrome, but completely resolved within four weeks. Overall daily function improved and parents were satisfied with the surgical outcome in all patients except three who experienced recurrent of drop attacks after operation. There was no sign of significant and persistent neurological deficits in any case. CONCLUSION: Results of total callosotomy in patients with medically intractable epilepsy with diffuse epileptic foci were favorable in most cases. The procedure was particularly effective against drop attacks causing physical injuries and impaired quality of life in these patients.
Child ; Corpus Callosum ; Diagnosis ; Diffusion ; Epilepsy* ; Epilepsy, Absence ; Follow-Up Studies ; Head ; Hemiplegia ; Humans ; Parents ; Quality of Life ; Seizures ; Syncope

PURPOSE: Positive ratio of routine EEG in adult epilepsy was widely known, but small number was reported in child epilepsy. Thus, we studied the difference of positive ratios between ages. METHODS: We reviewed the clinical records of 756 patients, who visited the pediatric neurology clinic with more than 2 afebrile seizures except neonatal seizures, from March 1997 to December 2004. Excluded were children with previous history of antiepileptic medication or failure of EEG. Clinical aspects and EEG findings of left 609 patients were evaluated retrospectively. RESULTS: Median age of EEG examination was 7.0 years (range, 3 months to 19.8 years) and male was 339. Number of child under 2 years was 112, 2-4 was 96, 5-9 was 233, 10-14 was 160 and over 15 was 8. All 279 positive past history was known in 222 persons, 98 of them had previous febrile seizures, 37 had CP or MR, 11 had neonatal seizures, 11 had birth asphyxia, 28 was prematurity. Waking EEG was checked in 398, sleep EEG in 547. Abnormal findings were found in 443 (72.7%). Definite epileptiform discharges were found in 388 patients (63.7%), suspicious spike discharges in 37 (6.2%). Patients under 2 years had 50.0% positive ratio of epileptiform discharges, 2-4 had 62.5%, 5-9 had 85.8%, 10-14 had 66.3% and over 15 had 37.5%. CONCLUSIONS: High positive ratio of routine EEG was found in child epilepsy, thus routine EEG seems to be very useful for the first diagnostic examination in child epilepsy.
Adult ; Asphyxia ; Child* ; Electroencephalography* ; Epilepsy* ; Humans ; Male ; Neurology ; Parturition ; Retrospective Studies ; Seizures ; Seizures, Febrile

PURPOSE: Twenty percent or more of children with epilepsy may have attention deficit hyperactivity disorder (ADHD). The treatment of ADHD with epilepsy has been an important clinical issue. The aim of this study is to investigate the efficacy and safety of methylphenidate in children with epilepsy and ADHD. METHODS: The subjects were 38 children with ADHD accompanied by epilepsy diagnosed at Department of Pediatrics and Epilepsy Center, Sanggye Paik Hospital. They were examined with IQ testing and Conners scales at baseline before using methylphenidate, and follow-up study was repeated 1 year after methylphenidate. Efficacy was determined by Conners scales and IQ score results. Safety was determined by measuring changes in seizure frequency, and electroencephalographic findings. RESULTS: According to their parents and teachers' reports, methylphenidate improved ADHD symptoms in 24 children (63.2%). Three of them (7.9%) showed significant improvement in IQ scores and 7 children (18.4%) revealed significant improvement in cognitive function with rising IQ scores between 10 and 15 points. There were no worsening in seizure frequency, and electroencephalographic findings after methylphenidate. CONCLUSION: Methylphenidate is effective and safe treatment in children with epilepsy and ADHD, showing significant benefit on children's behavior and academic improvement in many cases.
Attention Deficit Disorder with Hyperactivity* ; Child* ; Epilepsy* ; Follow-Up Studies ; Humans ; Methylphenidate* ; Parents ; Pediatrics ; Seizures ; Weights and Measures

PURPOSE: There is no apparent consensus about the successful policy of antiepileptic drug (AED) withdrawal, nor about definite factors to make patients remain seizure-free. We attempted to find out the predictive factors for seizure relapse after withdrawal of AED in patients with cryptogenic partial epilepsy. METHODS: This is a case-controlled and hospital-based observational study. A total of 91 crytogenic partial epileptic patients in whom seizure had been successfully controlled by AED monotherapy for more than two years were subjected to drug withdrawal. Patients with history of febrile convulsion, status epilepticus, and abnormal intelligence were excluded. Subjects were divided into two groups; the first group consisted of patients with seizure free more than 2 years after withdrawal of AED and another group with seizure recurrence during tapering or after drug withdrawal. The group with successful withdrawal had 48 patients, and, in 43 patients, seizure was recurred. Clinical profiles were compared between the two groups. RESULTS: There was no significant difference in gender, family history, age at onset, number of seizure attacks before AED initiation, duration of illness before treatment, and seizure or epilepsy classifications between the two groups. However, an abnormal EEG finding was associated with seizure relapse (Chi-square test p<0.05). On the other hand, the number of seizure attacks and the interval between the AED initiation and the time when a seizure free period was achieved had a correlation with seizure relapse, but was not statistically significant. CONCLUSIONS: Abnormal EEG findings was the predictive factor for seizure relapse after withdrawal from AED monotherapy in cryptogenic partial epilepsy.
Case-Control Studies ; Classification ; Consensus ; Electroencephalography ; Epilepsies, Partial* ; Epilepsy ; Hand ; Humans ; Intelligence ; Observational Study ; Recurrence* ; Seizures* ; Seizures, Febrile ; Status Epilepticus

PURPOSE: Hippocampal sclerosis is known to strongly correlate with medical intractability of temporal lobe epilepsy. However, the informations about this have been biased due to improper selection of the sampling obtained from severe cases of tertiary epilepsy center and surgical epilepsy field. We tried to investigate the influence of hippocampal sclerosis on the pharmacoresistance in temporal lobe epilepsy by group comparison study. METHODS: The fifty patients with complex partial seizures of temporal lobe origin, and temporal spike on EEG and/or hippocampal sclerosis on brain MRI were selected. Follow-up period of them were more than 2 years. The patients who had a seizure or seizures during the last 1-year period and had already been in adequate doses of two or more antiepileptic drugs were considered to be poorly controlled epileptics. RESULTS: Five of 17 patients without hippocampal sclerosis (29. 4%) and 24 of 33 patients with hippocampal sclerosis (72.7%) were poorly controlled by medication and the difference was significant (p=0.003, chi-square). Other factors, including sex, age of onset, febrile convulsion, secondary generalization, familial history of epilepsy, duration of disease, and delay of initial therapy had no significant effects on medical response (p>0.05). The only independent predictor of intractable epilepsy after multiple logistic regression analysis was also hippocampal sclerosis (p=0.005). CONCLUSION: Medical response in temporal lobe epilepsy was significantly associated with hippocampal sclerosis. Hippocampal sclerosis on brain MRI itself may be a crucial factor determining pharmacoresistance of temporal lobe epilepsy.
Age of Onset ; Anticonvulsants ; Bias (Epidemiology) ; Brain ; Drug Resistance ; Electroencephalography ; Epilepsy ; Epilepsy, Complex Partial ; Epilepsy, Temporal Lobe* ; Follow-Up Studies ; Generalization (Psychology) ; Hippocampus ; Humans ; Logistic Models ; Magnetic Resonance Imaging* ; Sclerosis* ; Seizures ; Seizures, Febrile ; Temporal Lobe*

PURPOSE: Carbamazepine (CBZ) has little untoward effect in behavior, cognition and psychosocial aspects and commonly used in children. But, CBZ can sometimes worsen tonic-clonic seizures. The goal of the present study was to investigate the effect of CBZ, D-(-)-2-amino-5-phosphonopentanoic acid (D-AP5) and 6-cyano-7-nitroquinoxaline-dione (CNQX) on pentylenetetrazole (PTZ)-induced epileptiform activity in young rat visual cortex. METHODS: The visual cortex slices were obtained from 14-18 day-old Sprague-Dawley rats. We observed the effect of CBZ, D-AP5 and CNQX on PTZ-induced epileptiform activity from visual cortex slices in vitro. RESULTS: The latency of PTZ-induced epileptiform activity was prolonged by 0.5 and 1 mM CBZ, the duration and frequency were decreased by 1 mM CBZ and amplitude was decreased by 0.5 and 1 mM CBZ. 3 mM CBZ and 20 micrometer CNQX blocked PTZ-induced epileptiform activity and 50 micrometer D-AP5 attenuated. CONCLUSION: This study suggest that CBZ may have more effect on epileptiform activity originated from visual cortex and differential effect according to brain region in young rat. Also, NMDA and AMPA mechanism may involve in PTZ-induced epileptiform activity originated from young rat visual cortex.
6-Cyano-7-nitroquinoxaline-2,3-dione ; alpha-Amino-3-hydroxy-5-methyl-4-isoxazolepropionic Acid ; Animals ; Brain ; Carbamazepine* ; Child ; Cognition ; Humans ; N-Methylaspartate ; Pentylenetetrazole ; Rats* ; Rats, Sprague-Dawley ; Seizures ; Visual Cortex*

BACKGROUND: To investigate the effects of topiramate (TPM) or lamotrigine (LTG) on cerebral glucose metabolism, we performed 18F-fluorodeoxy glucose positron emission tomography (FDG-PET) before and after medication in patients with drug naive idiopathic generalized epilepsy. METHODS: Thiry-three patients with newly diagnosed as idiopathic generalized epilepsy (IGE) or IGE without antiepileptic drugs after diagnosis were included. Pre- and post-antiepileptic drug FDG-PET were performed (before and after TPM or LTG administration) in 33 subjects treated with TPM or LTG who had been seizure free for at least 8 weeks. Sixteen of patients received TPM (M/F=8/8, aged 29.2+/-12.3 years) and 17 LTG (M/F=8/9, 26.8+/-9.3 years). For statistical paramateric (SPM) analysis, all PET images were spatially normalized to the standard PET template and then smoothed using a 12-mm full width at half-maximum Gaussian kernel. The paired t-test was used to compare pre- and post-medication FDG-PET images. RESULTS: SPM analysis of post- and pre-medication FDG-PETs showed TPM reduced glucose metabolism markedly in the thalamus, corpus callosum, and white matters, whereas LTG decreased glucose metabolism in cortico-striato-entorhinal areas with a false discovery rate corrected p<0.05. No brain region showed post-medication hypermetabolism in either group. CONCLUSION: Our study demonstrates that both TPM and LTG affect the cerebral glucose metabolism in drug naive idiopathic generalized epilepsy patients.
Anticonvulsants ; Brain ; Corpus Callosum ; Diagnosis ; Epilepsy ; Epilepsy, Generalized* ; Glucose* ; Humans ; Immunoglobulin E ; Metabolism* ; Positron-Emission Tomography ; Seizures ; Thalamus

PURPOSE: Matrix metalloproteinases (MMPs) have been known to participate in various pathologic situations by modulating extracellular matrix. Although MMP-9 upregulation has been reported in some experimental seizure models, the exact role of MMP-9 in hippocampal cell death during epileptogenesis and subsequent mossy fiber sprouting (MFS) is not clear. Here, we investigated the role of MMP-9 on hippocampal cell death and MFS after pilocarpine-induced status epilepticus (SE) in mice, using highly specific hydroxamic MMP-9 inhibitor. METHODS: SE was induced by intraperitoneal pilocarpine administration in adult male C57BL/6 mice. MMP-9 specific inhibitor was administered intracerebroventrically 3 h after pilocarpine-induced SE. Expression and activation of MMP-9 were assessed by zymography and Western blot analysis. TdT-mediated UTP-biotin nick end labeling (TUNEL) and caspase-3 activity assay were also performed. MFS was investigated using Timm staining. RESULTS: Increased expression and activation of MMP-9 after pilocarpine-induced SE were observed in zymography and Western blot analysis. MMP-9 specific inhibitor decreased MMP-9 activity in in situ zymography and hippocampal cell death in cresyl violet staining. DNA fragmentation and caspase-3 activity were also attenuated by MMP-9 specific inhibitor. Four months after pilocarpine-induced SE, MFS was evident in vehicle-treated mice; in contrast, MFS was barely observed in MMP-9 specific inhibitor-treated mice. CONCLUSIONS: This study suggests MMP-9 is associated with hippocampal cell death and MFS after pilocarpine-induced SE. Furthermore, the findings that MMP-9 specific inhibitor ameliorates cell death and MFS offers the possibility of MMP-9 specific hydroxamic inhibitor as novel therapeutic strategy to reduce hippocampal damage and epileptogenesis.
Adult ; Animals ; Apoptosis ; Blotting, Western ; Caspase 3 ; Cell Death* ; DNA Fragmentation ; Extracellular Matrix ; Humans ; Male ; Matrix Metalloproteinase 9 ; Matrix Metalloproteinases ; Mice* ; Mossy Fibers, Hippocampal ; Neurons* ; Pilocarpine ; Seizures ; Status Epilepticus* ; Up-Regulation ; Viola