- Email: [email protected]
0042 Surgical treatment for the drug-resistant post-traumatic epilepsy
Poster Abstracts 0039 Child epilepsy - A ease report of hyperkinetic automatism
Zhang, J. Hunan Children's Hospital, Changsha, Hunan, P. R. China Background: An in-ward male patient, 7-year-7-month-old, was adntitted to hospital due to 'popliteal fossa pain' wiftmut any inducible reason. Seizure happened 43 days before the admission of hospital, and last 10-60 seconds when it occurred, accompanying with the patient's crouching swaying or screaming treading, and occasional flush. It happened 1 2 1 4 times/per day, often during sleeping. The patient was diagnosed arthritis, lack of calcium and treated as such before admitting in the current hospital. Methods: Diagnoses were established by standard pre-hospitalised evaluation, the neurological examinations, ESR, ASO, CRP (-), E4A, C a + + , M g + + , liver function, intracranial CT horizontal scan were normal. E E G was un-analysable during the occurrence. Results: The designated video-EEG monitor system in the ward was used. During the occurrence, background rhythm was un-analysable due to the extreme interferences of movements; left and right frontotemporal region spike waves demonstrated un-symmetrical discharge. The patient was diagnosed as: fi'ontal lobe epilepsy, hyperkinetic automatism. The patient was given carbamazepine medicine. After half a monftt, ftle seizure stopped, and the patient was adnfitted out of ftte hospital with the drug. Conclusion: The child's epilepsy was diagnosed through the hospital's closed circuit TV-video observation system, and recorded video-EEG. As the seizure often happened during the patience's sleep, and EEG was un-analysable due to the extreme interference of motions, videoEEG provided an observable image of the frontal lobe discharge during ftte seizure occurrence. The study suggests that video-EEG monitor is essential in the diagnosis, and useful in separating epilepsy from non-epileptic crisis. In a conjunction with a correct use of antiepilepsy drugs, they form an integral treatment in child epilepsy. 0040 Tile P~evalenee of Psydlosis and Depression in Patients with Medically Refactory Partial Epilepsy: Relationship to Epilepsy Syndrome Adams S ~'a, Lloyd j1, O'Brien T ~.~, Matkovic Z ~, Kilpatrick C ~, Salzberg M~and Velakoulis D ~.~. 1Melbourne Neuropsychiatry Centre,
The Royal Melbourne Hospital, Melbourne, Australia; 2Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia; 3The University of Melbourne, Melbourne, Australia. Background: Medically refractory focal epilepsy has been associated with high rates of neuropsychiatric co-morbidity, particularly in patients with mesial temporal lobe epilepsy (MTLE) and right sided seizures. However the studies have been limited by a lack of rigorously characterised epilepsy and psychiatric diagnoses. Aims: To investigate ftte prevalence of a lifetime diagnoses of psychiatric disorders in patients with focal epilepsy syndromes and to examine the relationship between depression, psychosis, epilepsy syndrome and laterality. Method: Detailed file review of 253 patients with medically refractory focal epilepsy who had a comprehensive epilepsy evaluation witlfin ftte R M H Video E E G monitoring unit and were assessed by full clinical psychiatric interview by the same neuropsychiatrist (JL). The epilepsy syndromes were divided into TLE with hippocampal sclerosis (MTLE), TLE without HS (non-MTLE) and extratemporal lobe epilepsy (ETLE). Results: 56 % of patients had at least one psychiatric diagnosis. 30.3% of patients had a history of depression, with no difference by epilepsy syndrome [TLE (157/196, 29.1%) and ETLE patients (116/45, 35.6%) (p -- 0.47)], but depression is less common in M T L E (23/101) than in non-MTLE (34/95) (p -- 0.06). The incidence of psychosis was 7% and did not differ significantly between TLE (115/196, %) and ETLE (12/45, 11.1%) (p -- 0.75) or the different subtypes MTLE (16/101, 5.9%) and n o n - M T L E (9/86, 10.4%) (]p - 0.43). MTLE had a somewhat
Monday, November 7, 2005
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higher inddence of having a personality disorder (118/101, 18%) than those with non MTLE TLE (114/140, 10%) (lJ -- 0.09). There were no significant differences with laterality in the prevalence of depression or psychosis. Discussion: Neuropsyclfiatric disorders represent a common co-morbidity in patients with medically refractory focal epilepsy. Our results suggest that the lifetime prevalence of depression and psychosis is not greater in MTLE than other epilepsy syndromes and does reflect not laterality. Personality disorders may be greater in patients with MTLE. 0041 Epilepsy Genetics in Israeli and Palegtinian Arabs
Afawi, Z l, Korczyn, A ~, Neufeld, M ~, Kivity, S~, Misk, A 3, Mazarib, A 4, Berkovic, S 5. 1Tel Aviv Nourasky Medical Center,
Beer Sheva, Israel; 2Schnider Medical Center; 3Al Qud~ University, Jerusalem; 4Ziv Hospital Center; 5University of Melbourne, Australia Objective: To identify novel genetic causes of epilepsy among Arabs in Israel and Palestine. Background: The molecular basis of human epilepsy is slowly being unraveled by analysis of carefully studied fanfilies. Population with large families and access to quality medical care allow ftte opportunity to accurately define syndromes, determine ftte clinical genetics of the disorder and eventually the molecular lesion. Methods: Index cases of familial epilepsy were identified in various ways: Search of computerized database of hospitals and outpatient clinics and through personal contacts. Index patients are then contacted by one of us (ZA). After informed consent is obtained, all available fanfily members are interviewed (in spite of political difficulties) a detailed family tree is drawn and blood is taken for D N A extraction and storage. The epilepsy syndrome is being diagnosed by a senior epileptologist based on clinical information, review of old record and investigation and where, appropriate, further EEG and M R I scan. The actual genetic-molecular analysis will be done in Melbourne, Australia. Results: So far 23 families were identified who altogether had 85 cases. It became clear that familial cases of epilepsy are quite coro_mon, probably reflecting the common practice of consanguineous marriage and the large number of offspring each couple has. Cond.usions: Our preliminary result demonstrates the benefit fotxn intensive studies of large inbred populations. 0042 Surgical Treatment for the Drug-resigtant Pogt-traumatie Epileps3~ Akamatsu, N l, Tsuji, S 1, Urasaki, E ~. University of Occupational arid
Environmental Heahh School of Medicine, ~Department of Neurology arid 2Neurosurgery Background: Epilepsy surgery has provided seizure freedom in many patients with localization-related epilepsy, especially with temporal lobe epilepsy. However, evaluation strategy and efficacy of the surgical treatment are not well known for the posttraumatic intractable epilepsy. Method: Case studies of the patients who underwent epilepsy surgery for their medically intractable epilepsy caused by head trauma. The presurgical evaluation includes history, neurologic examination, video/ EEG monitoring, brain MRI, SPECT, neuropshycological evaluation and Wada test. Based on the non-invasive evaluation, intracranial EEG monitoring with subdural grid electrodes were performed. Results: Patient 1; 41-year-old woman who suffered motor vehicle accident at the age of eight, since then she has complex partial and secondarily generalized seizures. M R I showed extensive right frontal destructive lesion, however, EEG showed right temporal discharges. Intracranial recording confirmed right mesial temporal seizure onset. She has been seizure free after temporal lobectomy. Patient 2; 21-year-old m a n who suffered head injury at the age of
Zhang, J. Hunan Children's Hospital, Changsha, Hunan, P. R. China Background: An in-ward male patient, 7-year-7-month-old, was adntitted to hospital due to 'popliteal fossa pain' wiftmut any inducible reason. Seizure happened 43 days before the admission of hospital, and last 10-60 seconds when it occurred, accompanying with the patient's crouching swaying or screaming treading, and occasional flush. It happened 1 2 1 4 times/per day, often during sleeping. The patient was diagnosed arthritis, lack of calcium and treated as such before admitting in the current hospital. Methods: Diagnoses were established by standard pre-hospitalised evaluation, the neurological examinations, ESR, ASO, CRP (-), E4A, C a + + , M g + + , liver function, intracranial CT horizontal scan were normal. E E G was un-analysable during the occurrence. Results: The designated video-EEG monitor system in the ward was used. During the occurrence, background rhythm was un-analysable due to the extreme interferences of movements; left and right frontotemporal region spike waves demonstrated un-symmetrical discharge. The patient was diagnosed as: fi'ontal lobe epilepsy, hyperkinetic automatism. The patient was given carbamazepine medicine. After half a monftt, ftle seizure stopped, and the patient was adnfitted out of ftte hospital with the drug. Conclusion: The child's epilepsy was diagnosed through the hospital's closed circuit TV-video observation system, and recorded video-EEG. As the seizure often happened during the patience's sleep, and EEG was un-analysable due to the extreme interference of motions, videoEEG provided an observable image of the frontal lobe discharge during ftte seizure occurrence. The study suggests that video-EEG monitor is essential in the diagnosis, and useful in separating epilepsy from non-epileptic crisis. In a conjunction with a correct use of antiepilepsy drugs, they form an integral treatment in child epilepsy. 0040 Tile P~evalenee of Psydlosis and Depression in Patients with Medically Refactory Partial Epilepsy: Relationship to Epilepsy Syndrome Adams S ~'a, Lloyd j1, O'Brien T ~.~, Matkovic Z ~, Kilpatrick C ~, Salzberg M~and Velakoulis D ~.~. 1Melbourne Neuropsychiatry Centre,
The Royal Melbourne Hospital, Melbourne, Australia; 2Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia; 3The University of Melbourne, Melbourne, Australia. Background: Medically refractory focal epilepsy has been associated with high rates of neuropsychiatric co-morbidity, particularly in patients with mesial temporal lobe epilepsy (MTLE) and right sided seizures. However the studies have been limited by a lack of rigorously characterised epilepsy and psychiatric diagnoses. Aims: To investigate ftte prevalence of a lifetime diagnoses of psychiatric disorders in patients with focal epilepsy syndromes and to examine the relationship between depression, psychosis, epilepsy syndrome and laterality. Method: Detailed file review of 253 patients with medically refractory focal epilepsy who had a comprehensive epilepsy evaluation witlfin ftte R M H Video E E G monitoring unit and were assessed by full clinical psychiatric interview by the same neuropsychiatrist (JL). The epilepsy syndromes were divided into TLE with hippocampal sclerosis (MTLE), TLE without HS (non-MTLE) and extratemporal lobe epilepsy (ETLE). Results: 56 % of patients had at least one psychiatric diagnosis. 30.3% of patients had a history of depression, with no difference by epilepsy syndrome [TLE (157/196, 29.1%) and ETLE patients (116/45, 35.6%) (p -- 0.47)], but depression is less common in M T L E (23/101) than in non-MTLE (34/95) (p -- 0.06). The incidence of psychosis was 7% and did not differ significantly between TLE (115/196, %) and ETLE (12/45, 11.1%) (p -- 0.75) or the different subtypes MTLE (16/101, 5.9%) and n o n - M T L E (9/86, 10.4%) (]p - 0.43). MTLE had a somewhat
Monday, November 7, 2005
SI 11
higher inddence of having a personality disorder (118/101, 18%) than those with non MTLE TLE (114/140, 10%) (lJ -- 0.09). There were no significant differences with laterality in the prevalence of depression or psychosis. Discussion: Neuropsyclfiatric disorders represent a common co-morbidity in patients with medically refractory focal epilepsy. Our results suggest that the lifetime prevalence of depression and psychosis is not greater in MTLE than other epilepsy syndromes and does reflect not laterality. Personality disorders may be greater in patients with MTLE. 0041 Epilepsy Genetics in Israeli and Palegtinian Arabs
Afawi, Z l, Korczyn, A ~, Neufeld, M ~, Kivity, S~, Misk, A 3, Mazarib, A 4, Berkovic, S 5. 1Tel Aviv Nourasky Medical Center,
Beer Sheva, Israel; 2Schnider Medical Center; 3Al Qud~ University, Jerusalem; 4Ziv Hospital Center; 5University of Melbourne, Australia Objective: To identify novel genetic causes of epilepsy among Arabs in Israel and Palestine. Background: The molecular basis of human epilepsy is slowly being unraveled by analysis of carefully studied fanfilies. Population with large families and access to quality medical care allow ftte opportunity to accurately define syndromes, determine ftte clinical genetics of the disorder and eventually the molecular lesion. Methods: Index cases of familial epilepsy were identified in various ways: Search of computerized database of hospitals and outpatient clinics and through personal contacts. Index patients are then contacted by one of us (ZA). After informed consent is obtained, all available fanfily members are interviewed (in spite of political difficulties) a detailed family tree is drawn and blood is taken for D N A extraction and storage. The epilepsy syndrome is being diagnosed by a senior epileptologist based on clinical information, review of old record and investigation and where, appropriate, further EEG and M R I scan. The actual genetic-molecular analysis will be done in Melbourne, Australia. Results: So far 23 families were identified who altogether had 85 cases. It became clear that familial cases of epilepsy are quite coro_mon, probably reflecting the common practice of consanguineous marriage and the large number of offspring each couple has. Cond.usions: Our preliminary result demonstrates the benefit fotxn intensive studies of large inbred populations. 0042 Surgical Treatment for the Drug-resigtant Pogt-traumatie Epileps3~ Akamatsu, N l, Tsuji, S 1, Urasaki, E ~. University of Occupational arid
Environmental Heahh School of Medicine, ~Department of Neurology arid 2Neurosurgery Background: Epilepsy surgery has provided seizure freedom in many patients with localization-related epilepsy, especially with temporal lobe epilepsy. However, evaluation strategy and efficacy of the surgical treatment are not well known for the posttraumatic intractable epilepsy. Method: Case studies of the patients who underwent epilepsy surgery for their medically intractable epilepsy caused by head trauma. The presurgical evaluation includes history, neurologic examination, video/ EEG monitoring, brain MRI, SPECT, neuropshycological evaluation and Wada test. Based on the non-invasive evaluation, intracranial EEG monitoring with subdural grid electrodes were performed. Results: Patient 1; 41-year-old woman who suffered motor vehicle accident at the age of eight, since then she has complex partial and secondarily generalized seizures. M R I showed extensive right frontal destructive lesion, however, EEG showed right temporal discharges. Intracranial recording confirmed right mesial temporal seizure onset. She has been seizure free after temporal lobectomy. Patient 2; 21-year-old m a n who suffered head injury at the age of