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2-17-21 Gabapentin add-on therapy in patients with refractory partial seizures
Epilepsy with oxcarbacepine resulting in total control of the seizures. After 1 to 4 years follow-up neuropsychological development was normal. Conclusions: Atypical clinical and EEG findings have been reported in Benign Childhood Partial Epilepsy (Panayiotopoulos 1993. Lerman 1992, Kivity 1989, Wirrell 1995). We sustain that these findings represent variable phenotypic expression of a common genotype.
12-l 7-17 1 Electroclinical E. Fossa Olandini, A. Alleva. Buenos Aires, Argentina
correlation in epileptic patients Neurology Section, Dr. E. Torn0 Hospital:
Objective:
To correlate the clinical data with the findings of the interictal digital EEG (idEEG) in epileptic patients. Materlal and Methods: We carded out a statistical descriptive retrospective analysis which assessed 151 idEEG from 135 epileptic patients from December, 1995 to January, 1997. The idEEG recording was performed using surface electrodes according to the International Federation IO-20 System. A simultaneous 20channels input to a PC was used through a 10 bits A-D interface. Monopolar and bipolar derivations were employed. Different activations were used: hiperventilation, photic stimulation, sleep deprivation, and spontaneous or drug-induced sleep recording. Finally, the visual analysis of the idEEG was carried out and the electroclinical correlation was evaluated. Reeults: The mean age of the patients was 30.3 years (3-81) 53.3% were women. 55.6% of the patients had partial seizures; 38.5% had generalized seizures and 5.9% had unclassified seizures. 40.4% of the idEEG were normal, 19.9% showed unspecific anomalies, and 39.7% presented paroxistical activity. The predominant patterns were sharp waves (63.4%) slow spike-andwave (18.3%), spike-and-wave (15.0%) and polyspikes (3.3%). The implicated cerebral areas were frontal (393%). temporal (33.3%), occipital (21.7%) and central (6.7%). We could perform an electmclinical correlation in 70.0% of the paroxistical idEEG (73.0% of the partial seizures and 65.2% of the generalized seizures). Conclusion: The visual analysis of the idEEG together with a meticulous anamnesis has allowed us to obtain a high electroclinical correlation. This has contributed to the definition of the epileptogenic zone.
2-l 7-l 8
epilepsy patients by FDG-positron emission tomography and neuropsycho logical assessment. The patients had corresponding unilateral temporal hypometabolism, left hemisphere speech dominance, full scale IQ of over 70, and no extratemporal lesion in MRls. The regional glucose metabolism was determined in each patient in homologous regions including prefrontal cortex, and normalized to whole brain metabolism. Regional differences of more than 10% were regarded as asymmetrical. A PFMA was more frequent in patients with left temporal lobe epilepsy (21 left, 6 right) and a history of secondary generalized seizures. A multivarfate ANOVA revealed a main effect for PFMA on neuropsychological ‘frontal lobe measures’ including verbal petformance intelligence measures. PFMA was not related to ‘measures of episodic memory’, presence of psychiatric symptoms, and frontal interfctal epileptiform discharges. We conclude that PFMA is associated with cognitive impairment. Left temporal lobe epilepsy patients with a history of generalized seizures are at considerable risk of developing PFMA.
2-l 7-20
Imaging studies in patients with periodic epileptiform discharges
0. Martinez, Argentina
R. Reisin,
M. Martinez.
Hospital
Britslnico,
Buenos
lateralized Aires,
“Cortical isolation” has been proposed as the main mechanism of the pathogenesis of periodic lateralized epileptiform discharges (PLEDs) or bilateral independent epileptiiorm discharges (BIPLEDs). To evaluate this possibility, we reviewed the results of imaging studies in 7 patients with PLEDs or BIPLEDs, admitted to our Hospital between 1991-1996 looking for purely subcortical lesions sparing the cortex. Clinical diagnosis of our patients included: herpes encephalitis, primary brain tumor, Creutfelt-Jackob disease, cerebral hemmorrage, cerebral arteriovenous malformation, hyponatremia and hepatic encephalopathy. 4 patients had focal motor seizures, 1 patient presented a confusional state which improved with the metabolic adjustment and 2 patients had mental deterioration. Brain MRI (6 patients) and CT (7 patients) studies, revealed cortical and subcortical lesions in 5 patients and cortical lesions only in 2 patients. None of the patients had only subcortical lesions. Our findings suggest that cortical disconnection is not a critical mechanism in the pathogenesis of PLEDs and BIPLEDs.
Gabapentin add-on therapy in focal epilepsy: Clinical and EEG findings
F. Spanedda 2, D. Mattia’, MA. Bassetti I, A. Romigi ‘, M.G. Marciani ’ Clinica Neurologica, Universitrl di Roma 7x Vergata’; Roma, Italy, 2 1.R. C. C.S. S. Lucia, Roma, ltaly
I.*.
Gabapentin (GBP) is a novel antiepileptic drug (AED) designed to act as GABA agonist whose clinical efficacy on partial and generalized seizures has been described. Thirteen patients (7 females and 6 males: mean age 34 f 11 years) suffering from focal epilepsy resistant to conventional AEDs were included in the study. At the time of the study, all patients were on polytherapy and GBP was added at the dosage of 900 to 1200 mg/die. On the basis of clinical, and neuroradiological (CT scan IMFII) characteristics the patients were classified as having crfptogenic (n = 8) and symptomatic (n = 5) focal epilepsy. All patients presented partial seizures (simple and/or complex) and 5 of them also displayed secondarily generalized tonic-clonic (g.t.c.) seizures. Each patients underwent long-term video-EEG recording before and 3 months after GBP therapy was started. A computerized analysis of the EEG signal was performed to evaluate the drug effect on ictal and interictal eptleptiform activity (IEA). Statistical evaluation included paired Student ‘t-test. Partial seizure frequency was significantly reduced in 11 patients; however in the remaining 2 patients a shortening in seizure duration was noted. In 4 of the five patients, a reduction of the g. t. crseizure frequency was observed. A trend towards a decrease in the total number of EEG ictal events was present after GBP therapy while the IEA appeared less sensitive to the drug. Cur findings suggest a more pronounced efficacy on partial clinical and EEG ictal events as compared to generalized seizure activity.
2-l 7-19
s99
Patients with temporal lobe epilepsy manifest prefrontal asymmetric interictal glucose hypometabolism and cognitive impairment
H.J. Markowitsch ‘, H. Jokeit”, Ft. Seitz3, A. Ebner’, O.W. Wittea. ’ Physiological Psychology, University of Bie/efe/d, Bielefe/d, Germany; *Epilepsy Centre Bethel, Epilepsy Surgery Program, Bielefeld, Germany 3 Department of Neurology; University Clinic of Diisseldorf, D&se/doff, Germany In patients with intractable temporal lobe epilepsy depressions of regional cerebral metabolism bevond the epileotoaenic zone have been demonstrated. However, clinical relevance and’causei of prefrontal metabolic asymmetries (PFMA) are less well understood. We investigated 96 temporal lobe
2-17-21
Gabapentin add-on therapy in patients with refractory partial seizures
J.A. Mauri, C. Ihiguez, C. Tejero, F. Espada, E. Mostacero, F. Morales. Servicio de Neurologia, Hospital Clinic0 Lozano Bless, Zaragoza, Spain Gabapentin (GBP), is a new antiepileptic drug, structurally analogue of gammabutiricacid (GABA). In clinical trials, GBP hasshown to havedose-related effect as add-on therapy in medically refractory focal epilepsies. We analyzed the seizure frequency in 25 patients (10 women and 15 men) with focal epilepsy treated with GBP. Mean age was 36.04 (Range 15-86 years); mean duration of epilepsy was 22.28 (Range 2-60 years). Etiology of epilepsy was 72% criptogenic and 28% symptomatic. Localization was temporal lobe 50%, extratemporal lobe 45% and multifocal 5%. Mean GBP dosage was 1812.5 mg. (Range 1200-3600 mg.). Most patients received only one concomitant antiepileptic. Seizure reduction of at least 50% was achieved in 64% of cases (12% in remission); 8% of patients showed a seizure increase. There was no difference in the effect of GBP in focal or secondarily generalized seizures, Undesirable side effects occurred in 4 patients (16%); the most common were vertigo, headache and fatigue. These results indicate the efficacy of GBP in drug-resistant partial seizures with a good tolerance.
12-l 7-22 ] Epileptic seizures in spontaneous cerebral hemorrhage
and hypertensive
I. Perez L.-Fraile, M. Best&, M. Uson, L. Brieva, V. Bertol. Neumlog)! Miguel Server Hospital, Zaragoza, Spain Objective: associated
Deparfment
of
Evaluation of clinical course and prognosis of epileptic seizures to intracerebral hemorraghe (ICH). Patlents: We followed 16 patients among 283 admitted into our Neurology Department with ICH, which a different cause that hypertensive was excluded. Results: The mean age of patients, 12 males and 4 women, was 63 years. Seven patients did no report precedents of arterial hypertension. Only one bleeding has with intraventricular spreading and four was deep seated (capsulothalamic). Nine patients suffered seizures of early onset, six of them between the ictal period. One debuted with status epilepticus. Seven had seizures appearing after two weeks of onset of ICH (late onset). Nine patients suffered generalized seizures and seven had partial seizures
12-l 7-17 1 Electroclinical E. Fossa Olandini, A. Alleva. Buenos Aires, Argentina
correlation in epileptic patients Neurology Section, Dr. E. Torn0 Hospital:
Objective:
To correlate the clinical data with the findings of the interictal digital EEG (idEEG) in epileptic patients. Materlal and Methods: We carded out a statistical descriptive retrospective analysis which assessed 151 idEEG from 135 epileptic patients from December, 1995 to January, 1997. The idEEG recording was performed using surface electrodes according to the International Federation IO-20 System. A simultaneous 20channels input to a PC was used through a 10 bits A-D interface. Monopolar and bipolar derivations were employed. Different activations were used: hiperventilation, photic stimulation, sleep deprivation, and spontaneous or drug-induced sleep recording. Finally, the visual analysis of the idEEG was carried out and the electroclinical correlation was evaluated. Reeults: The mean age of the patients was 30.3 years (3-81) 53.3% were women. 55.6% of the patients had partial seizures; 38.5% had generalized seizures and 5.9% had unclassified seizures. 40.4% of the idEEG were normal, 19.9% showed unspecific anomalies, and 39.7% presented paroxistical activity. The predominant patterns were sharp waves (63.4%) slow spike-andwave (18.3%), spike-and-wave (15.0%) and polyspikes (3.3%). The implicated cerebral areas were frontal (393%). temporal (33.3%), occipital (21.7%) and central (6.7%). We could perform an electmclinical correlation in 70.0% of the paroxistical idEEG (73.0% of the partial seizures and 65.2% of the generalized seizures). Conclusion: The visual analysis of the idEEG together with a meticulous anamnesis has allowed us to obtain a high electroclinical correlation. This has contributed to the definition of the epileptogenic zone.
2-l 7-l 8
epilepsy patients by FDG-positron emission tomography and neuropsycho logical assessment. The patients had corresponding unilateral temporal hypometabolism, left hemisphere speech dominance, full scale IQ of over 70, and no extratemporal lesion in MRls. The regional glucose metabolism was determined in each patient in homologous regions including prefrontal cortex, and normalized to whole brain metabolism. Regional differences of more than 10% were regarded as asymmetrical. A PFMA was more frequent in patients with left temporal lobe epilepsy (21 left, 6 right) and a history of secondary generalized seizures. A multivarfate ANOVA revealed a main effect for PFMA on neuropsychological ‘frontal lobe measures’ including verbal petformance intelligence measures. PFMA was not related to ‘measures of episodic memory’, presence of psychiatric symptoms, and frontal interfctal epileptiform discharges. We conclude that PFMA is associated with cognitive impairment. Left temporal lobe epilepsy patients with a history of generalized seizures are at considerable risk of developing PFMA.
2-l 7-20
Imaging studies in patients with periodic epileptiform discharges
0. Martinez, Argentina
R. Reisin,
M. Martinez.
Hospital
Britslnico,
Buenos
lateralized Aires,
“Cortical isolation” has been proposed as the main mechanism of the pathogenesis of periodic lateralized epileptiform discharges (PLEDs) or bilateral independent epileptiiorm discharges (BIPLEDs). To evaluate this possibility, we reviewed the results of imaging studies in 7 patients with PLEDs or BIPLEDs, admitted to our Hospital between 1991-1996 looking for purely subcortical lesions sparing the cortex. Clinical diagnosis of our patients included: herpes encephalitis, primary brain tumor, Creutfelt-Jackob disease, cerebral hemmorrage, cerebral arteriovenous malformation, hyponatremia and hepatic encephalopathy. 4 patients had focal motor seizures, 1 patient presented a confusional state which improved with the metabolic adjustment and 2 patients had mental deterioration. Brain MRI (6 patients) and CT (7 patients) studies, revealed cortical and subcortical lesions in 5 patients and cortical lesions only in 2 patients. None of the patients had only subcortical lesions. Our findings suggest that cortical disconnection is not a critical mechanism in the pathogenesis of PLEDs and BIPLEDs.
Gabapentin add-on therapy in focal epilepsy: Clinical and EEG findings
F. Spanedda 2, D. Mattia’, MA. Bassetti I, A. Romigi ‘, M.G. Marciani ’ Clinica Neurologica, Universitrl di Roma 7x Vergata’; Roma, Italy, 2 1.R. C. C.S. S. Lucia, Roma, ltaly
I.*.
Gabapentin (GBP) is a novel antiepileptic drug (AED) designed to act as GABA agonist whose clinical efficacy on partial and generalized seizures has been described. Thirteen patients (7 females and 6 males: mean age 34 f 11 years) suffering from focal epilepsy resistant to conventional AEDs were included in the study. At the time of the study, all patients were on polytherapy and GBP was added at the dosage of 900 to 1200 mg/die. On the basis of clinical, and neuroradiological (CT scan IMFII) characteristics the patients were classified as having crfptogenic (n = 8) and symptomatic (n = 5) focal epilepsy. All patients presented partial seizures (simple and/or complex) and 5 of them also displayed secondarily generalized tonic-clonic (g.t.c.) seizures. Each patients underwent long-term video-EEG recording before and 3 months after GBP therapy was started. A computerized analysis of the EEG signal was performed to evaluate the drug effect on ictal and interictal eptleptiform activity (IEA). Statistical evaluation included paired Student ‘t-test. Partial seizure frequency was significantly reduced in 11 patients; however in the remaining 2 patients a shortening in seizure duration was noted. In 4 of the five patients, a reduction of the g. t. crseizure frequency was observed. A trend towards a decrease in the total number of EEG ictal events was present after GBP therapy while the IEA appeared less sensitive to the drug. Cur findings suggest a more pronounced efficacy on partial clinical and EEG ictal events as compared to generalized seizure activity.
2-l 7-19
s99
Patients with temporal lobe epilepsy manifest prefrontal asymmetric interictal glucose hypometabolism and cognitive impairment
H.J. Markowitsch ‘, H. Jokeit”, Ft. Seitz3, A. Ebner’, O.W. Wittea. ’ Physiological Psychology, University of Bie/efe/d, Bielefe/d, Germany; *Epilepsy Centre Bethel, Epilepsy Surgery Program, Bielefeld, Germany 3 Department of Neurology; University Clinic of Diisseldorf, D&se/doff, Germany In patients with intractable temporal lobe epilepsy depressions of regional cerebral metabolism bevond the epileotoaenic zone have been demonstrated. However, clinical relevance and’causei of prefrontal metabolic asymmetries (PFMA) are less well understood. We investigated 96 temporal lobe
2-17-21
Gabapentin add-on therapy in patients with refractory partial seizures
J.A. Mauri, C. Ihiguez, C. Tejero, F. Espada, E. Mostacero, F. Morales. Servicio de Neurologia, Hospital Clinic0 Lozano Bless, Zaragoza, Spain Gabapentin (GBP), is a new antiepileptic drug, structurally analogue of gammabutiricacid (GABA). In clinical trials, GBP hasshown to havedose-related effect as add-on therapy in medically refractory focal epilepsies. We analyzed the seizure frequency in 25 patients (10 women and 15 men) with focal epilepsy treated with GBP. Mean age was 36.04 (Range 15-86 years); mean duration of epilepsy was 22.28 (Range 2-60 years). Etiology of epilepsy was 72% criptogenic and 28% symptomatic. Localization was temporal lobe 50%, extratemporal lobe 45% and multifocal 5%. Mean GBP dosage was 1812.5 mg. (Range 1200-3600 mg.). Most patients received only one concomitant antiepileptic. Seizure reduction of at least 50% was achieved in 64% of cases (12% in remission); 8% of patients showed a seizure increase. There was no difference in the effect of GBP in focal or secondarily generalized seizures, Undesirable side effects occurred in 4 patients (16%); the most common were vertigo, headache and fatigue. These results indicate the efficacy of GBP in drug-resistant partial seizures with a good tolerance.
12-l 7-22 ] Epileptic seizures in spontaneous cerebral hemorrhage
and hypertensive
I. Perez L.-Fraile, M. Best&, M. Uson, L. Brieva, V. Bertol. Neumlog)! Miguel Server Hospital, Zaragoza, Spain Objective: associated
Deparfment
of
Evaluation of clinical course and prognosis of epileptic seizures to intracerebral hemorraghe (ICH). Patlents: We followed 16 patients among 283 admitted into our Neurology Department with ICH, which a different cause that hypertensive was excluded. Results: The mean age of patients, 12 males and 4 women, was 63 years. Seven patients did no report precedents of arterial hypertension. Only one bleeding has with intraventricular spreading and four was deep seated (capsulothalamic). Nine patients suffered seizures of early onset, six of them between the ictal period. One debuted with status epilepticus. Seven had seizures appearing after two weeks of onset of ICH (late onset). Nine patients suffered generalized seizures and seven had partial seizures