PURPOSE: Determination of medical intractability is primarily essential for planning a surgical treatment of epolepsy. Questions regarding intractability include the optimum duration of adequate antiepileptic drug (AED) treatment and the tolerable seizure frequency. Unfortunately, thereis no established guideline for determination of medical intractability in terms of the duration or the tolerability of AED resistance. In temporal lobe epilepsy (TLE) with mesial temporal sclerosis (MTS), a Well-Known surgically remediable epileptic syndrome, the inverstigation of relationship between short-term and long-term AED response may help us finding a way to solve the above questions. METHODS: From 2 epilepsy centers, 86 patients with TLE demonstrating MTS on MRI were evaluated. All of them were on AED treatment for at least 2 years. We investigated seizure free rate for 1st 1 year, for next 1 year and that for two years. We compared seizure number of 1st 1 year with that of 2nd 1 year and analyzed corrdlation coefficiency between seizure numbers of the two periods. Paired-t-test and Pearson correlation test were performed for statistical analysis. RESULTS: Two year terminal remission rate was 3.5%. Remission rate for the 1st 1 year was 4.7% Whereas in the 2nd 1 year it rose to 16.3%. Mean seizure number of 1st one year was 34.9 and that of next one year was 27.0. Mean paired differences between seizure numbers of the two periods was 7.95(95% dcnfidence interval:1.82-14.09) Which was statistically significant(p=0.012). Pearson correlation coefficiendy was 0.815 between seizure numbers fo the two periods. CONCLUSION: In TLE with MTS, seizure free outcome was very poor. However, seizurw-free rate rose and seizure number declined as AED treatment duration was prolonged for 2 years. Weizure munber of 1st year may predict that of 2nd year. To establish an appropriate index time for considering medical intractability, further studies on longer-term outcone by AED treatment duration was porlonged for 2 years. Seizure munber of 1st year further studies on longer-term outcome by AED treatment should be recommended in addition to studies on adequate tolerability of AED resistance.
Epilepsy ; Epilepsy, Temporal Lobe* ; Humans ; Magnetic Resonance Imaging ; Sclerosis* ; Seizures* ; Temporal Lobe*

BACKGROUND:Acute seizures that increase neuronal activity cause a rapid and transient induction of the immmediate early c-fos in specific brain regions. C-fos gene may mediate long-term changes in cell function, such as growth, differeniation, and development, in response to acute extracellular stimulation. This study is designed to compare the expression of Fos protein in hippocampus after single and repeated injections of kainic acid (KA). METHODS:In KA-single injection model, twelve adult male Sprague-Dawley rats were treated with single intraperitoneal injection of convulsive dose(20-30 mg/kg) of KA, and. in KA-multiple injections model, seven rats received KA by repeated daily intraperitoneal injections for 15 days. Eight control rats received normal saline. Expression of Fos protein was tested in hippocampus by immunohistochemical staining, and was scored by the degree of staining intensity and the ratio of stained cells to tested ones. RESULTS:The scores tended to increase in CA3 and dentate gyrus were significantly higher in KA-single injection model than in control (p<0.05). In comparison with scores in KA-model. CONCLUSION:These results show that repeated seizure produces some blockade of c-fos induction in CA2, CA3 and dentate gyrus. This may be a long-term adaptive response by the nervous system to repated neuronal activation
Adult ; Animals ; Brain ; Dentate Gyrus ; Genes, fos ; Hippocampus* ; Humans ; Injections, Intraperitoneal ; Kainic Acid* ; Male ; Nervous System ; Neurons ; Rats* ; Rats, Sprague-Dawley ; Seizures

BACKGROUND: Various neuronal and glial factors which participate in neural differentiation, including neural cell adhesion molecule (NCAM), are upregulated in pathogenesis of temporal lobe epilesy (TLE).This study aimed to investigate hte effect of (R-)-N6-phenylisopropyladenosine (RPIA), an adenosine A1 receptor agonist, on the morphological alteration of NCAM immunoreactivity (IR) in limbic system of Kainic acid (KA)-induced epileptic rats. METHODS: Experiment animals were divided into control group, KA treatment only (10 mg/kg. i.p.)group, and RPIA pretreatment (100 microgram/kg. i,p, 10 min prior to injection of KA) group. Animals were sacrificed at 24 hours and 1 week after KA treatment. Luxol fast blue-cresyl violet stain for histopathological observation, and NCAM immunohistochemistry to study alteration of NCAM IR in limbic system were performed. RESULTS: Neuronal loss in CA1 and CA3areas of hippocampus, piridorm cortex, basolateral amygdala nucleus and lateral dorsal thalamic nucleus were induced by KA unjection, and thoes were reduced by RPIA pretreatment. Inrease of NCAM-IR was observed in interneurons of all hippocampal areas. except CA2 area, pirform cortex and basolateral amygdala nucleus at 24 hours after KA injection. and increased NCAM-IR was observed in cell membrane and processes of neuroglia, dentate granule cells and pyramidal cells in CA1 area of hippocampus. and neurons in piriform cortex, amygdala and lateral dorsal thalamic nucleus 1 week after KA injection, but those changes were milder than those at 24 hours after KA injection. RPIA pretreatment significantly reduced KA-induced NCAM-IR in hippocampal CA3, CA1 area, piriform cortex, amtgdala and lateral dorsal thalamic nucleus. CONCLUSION: We suggest that decrease of NCAM immunoreactivity is associated with neuprotective effects of RPIA on limbic system against KA neurotoxiciy.
Amygdala ; Animals ; Cell Membrane ; Epilepsy, Temporal Lobe ; Hippocampus ; Immunohistochemistry ; Interneurons ; Kainic Acid ; Lateral Thalamic Nuclei ; Limbic System ; Neural Cell Adhesion Molecules ; Neuroglia ; Neurons ; Pyramidal Cells ; Rats ; Receptor, Adenosine A1 ; Temporal Lobe ; Viola

PURPOSE: In mesial temporal lobe epilepsy (TLE). Hippocampl sclerosis (HS) is a pathologic substrate and characterized by significant neuronal loss and band-like synaptic reorganization in dentate inner molecular layer (DGIML) og sclerotic hippocampus with either Timm`s staining or Dynorphin (Dyn)-immunohistochemical staining methods. Hippocampus has neuronal synaptic circuitries of both intralamellar and translamellar patterns, from which we may hypothesize that longitudinal extent of HS represents variable pathophysiologic implications of neuronal injury, ictogenesis and epileptogenesis in mesial TLE. We tested the hypothesis. METHODS: Eleven mesial TLE patients with HS on MRI were recruited from epilepsy surgery registry. Resected hippocampal slices were stained with Dyn immunohistochemical method. We classified them into cases with partial HS and thoes with extensive HS according to longitudinal HS extent,. Between the two groups, clinical characteristics of seizures or epilepaies, Hippocampal neuronal density and neuronal loss. and Dynimmunoreactivity (IR) patterns were compared and analyzed. Dyn-IR pattern was classified as presence or absence of DGIML band and of CA3-IR. RESULTS: Nine cases showed extensive HS whereas two were classified as partial HS. There appeared no significant differences in clinical characteristics, neuronal density, neuronal loss and Dyn-IR patterns between those with extensive and partial HS. CONCLUSION: In this study, we could not prove the hypothesis that difference in HS extend on MRI may represent distinctive variabliity in severity of hippocampal neuronal injury and in ictiogenetic or epileptogenetic pathophysiology.
Dynorphins ; Epilepsy ; Epilepsy, Temporal Lobe* ; Hippocampus ; Humans ; Magnetic Resonance Imaging ; Neurons* ; Sclerosis* ; Seizures ; Temporal Lobe*

No abstract available.
Epilepsy*

Valproate is a widely used antiepileptic drug with rarely occurring serious side effects. However, valproate may induce hyperammonemic encephalopathy. A 85-year-old woman was admitted with stuporous mental status. Brain MRI showed old cerebral infarction and EEG showed sharp waves in the right frontal region. Under the impression of postictal confusion, we used phenytoin and then she was improved. However, the intermittent vacant staring was seen, and valproate was administered additionally. On the 5th day after adding valproate, her mentality was deteriorated and intermittent triphasic waves appeared on EEG. Due to confused mentality and hyperactivities, we injected lorazepam and then semicomatous mentality was developed. Follow-up EEG showed nearly continuous triphasic waves and slightly elevated ammonia with normal liver function was shown. After stopping antiepileptic drugs, we used lactulose and flumazenil, and then she was fully recovered with normalized EEG. This is a rare case of valproate-induced hyperammonemic encephalopathy with triphasic waves.
Aged, 80 and over ; Ammonia ; Anticonvulsants ; Brain ; Cerebral Infarction ; Electroencephalography ; Female ; Flumazenil ; Follow-Up Studies ; Humans ; Lactulose ; Liver ; Lorazepam ; Magnetic Resonance Imaging ; Phenytoin ; Stupor ; Valproic Acid

Peripheral neuropathy has been uncommon reported as one of neurologic adverse effects associated with phenytoin. A 53 year-old man presented with clinical and electrophysiologic signs of peripheral neuropathy after 13 years of phenytoin administration. Despite a modest dose of phenytoin (300 mg/day), blood level was 40 microg/ml. After discontinuing phenytoin about eight months, the peripheral neuropathy was improved. We present a case of reversible peripheral neuropathy caused by chronic phenytoin intoxication.
Humans ; Middle Aged ; Peripheral Nervous System Diseases* ; Phenytoin*

PURPOSE: To reveal the pattern of surgical outcome according to the location of ictal onset zone in the patients who had a history of early onset (less than two years old) hemiparesis and delayed epilepsy. Many children with acute infantile hemiplegia (AIH) develop delayed epilepsy. This can lead to HHE (Hemiplegia, hemiconvulsion, and epilepsy) syndrome. Epilepsy patients associated with AIH or HHE syndrome generally have been thought to be medically intractable and difficult to treat surgically. METHODS: Patients with a history of early onset hemiparesis with epilepsy who had undergone surgical treatment from November 1995 to May 2002 at Seoul National University Comprehensive Epilepsy Center were recruited. Diagnostic criteria include convulsions, followed by a flaccid hemiplegia, and later epilepsy with partial seizures. Multidisciplinary presurgical evaluations were performed which include a complete neurological examination, brain MRI, long-term video-EEG monitoring, FDG-PET, intracarotid amobarbital test, and ictal and interictal SPECT if possible. Patients with epileptogenic zone outside the hippocampus underwent implantation of intracranial electrodes. The surgical side was localized by the clinical, neuroimaging, and electrophysiological results includeing results of invasive studies. Anterior temporal lobectomy (ATL), cortical resection, functional hemispherectomy, and callosotomy were performed according to the results of presurgical evaluation. RESULTS: Twenty-five patients were included. Mean age was 29.8 ranging from 19 to 60 years old. Fifteen were male and 10 were female. All had a previous history of febrile convulsions. The onset age of febrile convulsion and hemiplegia was one to 48 months (mean=18.0+/-13.2) and the onset age of epileptic seizures were 0.5 to 40 years (mean=9.9+/-8.2). Seventeen of them were right-handed, eight were left-handed and one was bilateral-handed. Follow-up periods after surgery were one to eleven years (mean=5.6+/-2.2). Twelve patients were diagnosed as medial TLE and underwent ATL. The other thirteen patients were diagnosed as neocortical or multifocal epilepsy. Eleven of medial TLE patients were seizure free after ATL and only one had aura. However, only four patients with neocortical epilepsy were seizure free and nine were not. Surgical outcome was significantly different between ATL only and other surgical procedures (p=0.004). CONCLUSION: In patients of early onset hemiparesis with epilepsy, various ictal onset zones can be possible. The medial TLE patients diagnosed by comprehensive presurgical evaluation, in spite of hemiatrophy on brain MRI, showed a good surgical outcome. Surgical treatment should be considered for the selected patients.
Age of Onset ; Amobarbital ; Anterior Temporal Lobectomy ; Brain ; Child ; Electrodes ; Epilepsy* ; Female ; Follow-Up Studies ; Hemiplegia ; Hemispherectomy ; Hippocampus ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neuroimaging ; Neurologic Examination ; Paresis* ; Seizures ; Seizures, Febrile ; Seoul ; Tomography, Emission-Computed, Single-Photon

PURPOSE: Recently have there been a few reports that raised the question that Benign Rolandic Epilepsy (BRE) could be a spectrum. This study was conducted to identify whether or not the clinical and electrophysiological characteristics of typical Rolandic Spikes (RS) are different from those of concomitantly additional frontal or occipital spikes with RS. METHODS: The consecutive 39 patients who showed centro-temporal spikes were divided into typical RS and RS+ groups. We defined RS+ groups as having concomitantly additional frontal or occipital spikes with RS. The independent variables included clinical data 0(age of onset, a significant antecedent event as part of their etiology of epilepsy, nocturnal seizure, abnormal development, abnormal neurologic examination, pattern of seizure, response to medication for at least 1 year and epilepsy syndrome) and electrophysiological data (dipoles, spikes accentuated during sleep). RESULTS: Eighty two percents (32/39) of patients were RS, whereas 18% (7/39) were RS+. The median age of onset was 7 years old and only 10% showed significant antecedent events. Eighty six percents (34/39) of patients had BRE as epilepsy syndrome. Neither clinical factors nor electrophysiological characteristics were different between both groups. CONCLUSION: Although RS+ showed additional spikes more than centro-temporal area, the clinical and electrophysiological characteristics of RS+ were not different from those of RS. Centro-temporal with or without additional spikes could be a homogeneous condition rather than a spectrum.
Age of Onset ; Child ; Electroencephalography ; Epilepsy* ; Epilepsy, Rolandic ; Humans ; Neurologic Examination ; Seizures

PURPOSE: To determine whether the change of end-tidal pCO2 (ETCO2) level by hyperventilation evokes seizures or epileptiform discharges in temporal lobe epilepsy. METHODS: Twenty-four temporal lobe epilepsy patients were enrolled in this study. Hyperventilation was done for 5 min during EEG recording. We gathered data on ETCO2 levels during hyperventilation. The data included baseline ETCO2 (B-ETCO2), ETCO2 after 5 min of hyperventilation (5 min-ETCO2), the mean value of the ETCO2 (M-ETCO2), and the change in ETCO2 between baseline and the level after 5 min of hyperventilation (delta ETCO2). We counted the numbers of interictal spikes and considered the cases with more than 120% increments of the number during hyperventilation as the cases with the increased number of spikes. We compared the four variables between two groups, divided according to the increment to hyperventilation. RESULTS: Seizures were not induced by hyperventilation in all the cases. Thirteen of 24 patients were in the increment group. The M-ETCO2 was 33.0+3.3 mmHg (mean+SD) in the increment group and 29.4+5.3 in the no-increment group (p=0.064). The delta ETCO2 was 13.0+5.3 and 14.0+5.3, respectively (p=0.622). The 5 min-ETCO2 was 28.2+4.8 and 24.8+5.9, respectively (p=0.077). CONCLUSION: In this study, the frequency of interictal spikes was increased well by hyperventilation. The spike increments were not associated with the ETCO2 level or the change of that, but maybe with the individual susceptibility.
Carbon Dioxide ; Electroencephalography ; Epilepsy, Temporal Lobe* ; Humans ; Hyperventilation* ; Seizures ; Temporal Lobe*