- Email: [email protected]
3-17-30 Objective and subjective assessment of memory impairment in patients with epilepsy
S166
Epilepsy
13-l 7-25 1 Seizures involving analysis
the frontal lobe: A video-EEG
W. Silva, G. Polo, J. L6pez, A. Di Sciullo, D. Consalvo, E. Centuri6n, P. Said6n, S. Kochen. Municipal Center of Epilepsy, Neurology Division, Ramos Mejia Hospital, 6s. As, Argentina Frontal lobe epilepsy is a difficult diagnosis because of its atypical clinical manifestations, with variations according to the different topographic areas involved, which can cause diagnostic mistakes or misinterpretations, such as pseudoseizures or primary generalized seizures. We chose 14 patients, with the diagnosis of frontal lobe epilepsy, documented by video-EEG monitoring. We registered 21 seizures. Their duration was from 20 seconds to 13 minutes. lnterictal EEGs were normal in one patient. In the remaining 13 subjects, they showed sharp wave, spike wave, and slow wave paroxysms in frontal areas, bilaterally, in most cases. lctal EEGs showed, at the beginning of the seizure, paroxysmal activity foci on the unilateral frontal area in 8 seizures and bilaterally in 13. The main ictal clinical manifestations were: head-eyes turning (Rolandic area) in 16 seizures; tonic and clonic manifestations (Rolandic area and supplementary motor cortex) in 20 seizures; simple and complex gestual automatisms (Gyms Cingular) in 12 seizures; and oral vocalizations (supplementary motor cortex and/or orbital frontal cortex), in 8 seizures. The analysis made through ictal video-EEG turned out to be essential to arrive to a precise diagnosis in patients with frontal epilepsy, specially in cases with difficult diagnosis.
in 3 patients (4.4%). Lamotrigine could be considered as a drug with a great contribution in the treatment of epileptic syndromes. There remains a question how would the effect of lamotrfgine be evaluated in case of having lamotrigine as a first choice drug.
3-17-28
Neuronal migration disorders: A proton magnetic resonance spectroscopy study
I.L. Simone, C. Tortorella, R. De Blasi, R. Bellomo, P. Giannini, F. Fededco, M. Liguorl, E. Picciola, D. Carrara. institute of Neurofogx Service of Neuroradfoflog)! University of Bari, Bari, ltaly Combined magnetic resonance imaging (MRI) and proton MR spectroscopy (1 H-MRS) study was performed on 18 brain neuronal migration disorder (NMD) areas (n. 10 polymicrogyrfa, n. 5 cortical displasia and n. 3 gray matter heterotopia at MRI) of 14 patients clinically affected by partial seizures. Water suppressed spectra were acquired by using SE sequence and TE of 135 msec (Magnetom Siemens 1.5 T) on volumes of interest localized in both the lesion and the homologous contralateral MRI normal-appearing voxel. Choline (Cho), creatine (Cr), N-acetyl aspartate (NAA), lactate and lipids were evaluated in each spectrum. Analysis compared spectra from the two voxels of NMD patients and from gray and white matter voxels of 22 neurological controls (NC). NAA/Cr ratio was significantly lower in NMD areas (1.82 f 0.48) than in normal white (2.25 f 0.51) and gray (2.12 f 0.30) matter of NC (p = 0.007 and p = 0.03 by Mann Whitney test). NAA decrease in NMD cortex suggests a neuronal loss related either to seizure state or to structural dysplasia in these pathological areas. A significant decrease of Cho/Cr ratio was found in NMD sides (0.85 f 0.22) in comparison to both white (1.12 f 0.26) and gray (1 .Ol f 0.18) matter of NC (p = 0.004 and p = 0.04 respectively). Cho changes in NMD patients could depend on hypomyelination process associated to NMD. Low ChoICr ratio was found also in MRI normal-appearing contralateral hemisphere (0.87 f 0.10) of NMD patients compared to white (p = 0.004) and gray (p = 0.04) matter of NC. This 1 H-MRS finding suggests a more diffuse brain involvement than it appear at MRI. Three patients showed lactate signal both in NMD and in contralateral side, probably related to a very short time intercurrent from the last seizure. In conclusions IH-MRS can be expected to supply biochemical informations in vivo on neurobiological processes underlying NMD and to offer a non-invasive method to clarify their pathophysiology.
3-17-27
Lamictal (Lamotrlgine) treatment refractory epileptic syndromes
in children
with
R. Slaoal. A. Zouhar. H. MiSurcova l. J. Dolanskv. D. SiSkova2. V. Komarek. V. Sedrot+ov& M. Skutova. Clinics of Child New&g5 Mendel hosp., Brno, Czech Republic, ’ Thomayer Hosp., Prague, Czech Republic, 2 Motel Hosp., Prague, Czech Republic Authors from 3 clinics in the Czech Republic evaluate the results of add-on therapy with lamotrigine. Sixty-eight patients treated by lamotrigine suffered from refractory epileptic syndromes of childhood predominantly generalized convulsive ones- 73.5%. Average age of the patients was about 11 years, average dose of lamotrigine was 3.5 mg/kdday. Authors noted very good clinical effect, (minimal reduction of seizures 75%) in 21 patients (30.9%) good clinical effect (minimal reduction of seizures 50%) in 22 patients (32.4%). An improvement in EEG was apparently in 25 cases (39.7%). Significant positive impact in mentally handicapped children was found out in 9 children (19.2%). Lamotrigine was tolerated very well, the only side effect-rashwere recorded
in childhood
epilepsy Neuro/ogx
Medical Faculty
In their 5-year study the authors evaluated the effect of clobazam (Frisium) for 38 children suffering from various epilepsy syndromes. The secondary generalized syndromes (68.4%) significantly prevailed, followed by age-dependent syndromes (21 .I%). Partial epileptic syndromes (10.5%) were more frequent with complex symptomatology. Focal epileptic activity prevailed in EEG records. Clobazam was initially administered both adjuvantly and in the monotherapy with the same frequency to childem between the age of 2.0 and 18.5 years. The total dose of l-2 mg/kg/day was divided into three partial doses and usually did not exceed 40 mg/day. The authors reported a very good clinical effect for 24 children (63.2%). of who 21 got the complete compenzation. A very good effect was reported for another 7 patients (18.4%) whereas the administration of clobazam did not have any positive effect for 7 patients (18.4%) only. The only reported side effects were the fatigue and hypersomnia which occur very rarely and disappeared usually after the reduction of the dose. The authors consider clobazam to be at least the adjuvant antiepileptic drug.
3-17-29
I3 17 26
Effect of clobazam
R. Slapal, H. Misurcova. Department of Children’s of Masaryk Universi~ Brno, Czech Republic
Steady - state pharmacokinetics of valproic acid in epileptic children and adolescents on monotherapy and bitherapy with carbamazepine and vigabatrln
B. Steinbom, B. Galas-Zgorzalewicz. Department of Developmental Neurology; University of Medical Sciences, Poznari, Poland The aim of this study was the comparison of steady-state phamrawkinetics of valproic acid (VPA) and its free fraction in 30 epileptic children and adolescents treated by VPA and in polytherapy scheme with carbamazepine (CBZ) or with vigabatdn (VGB). VPA concentration in serum were measured by TDX Analyzer (Abbott Diagnostic Division, USA). Free fraction was selected by Amicon ultrafiltration method. The diurnal fluctuation of serum concentration of VPA were observed. The percentage of free VPA in plasma increased with increasing total VPA concentration in all of patients. The combination of VPA and CBZ were connected with prominent diurnal free serum fluctuation. No significant changes in fluctuation index of total and free VPA in monotherapy group and in group comedicated by VGB were observed. Pharmacokinetic parameters of total and free VPA in monotherapy and during bitherapy with VGB were similar. The changes of free and total VPA pharmacokinetics data with CBZ were noticed. An increasing of clearance and decreasing of half life of VPA in CBZ add-on therapy group we observed. Concomitant administration of CBZ alter the pharmacokinetics of VPA. Thus, no pharmacokinetic interaction exists between VPA and VGB.
3-l 7-30 E. Strube, Bordeaux,
Objective and subjective assessment impairment in patients with epilepsy P. Loiseau. France
Department
of Neurology
University
Rationale: This study examined whether neuropsychological
of memory Hospital,
testing is in keeping with patients’ personal feelings. Methods: Eleven adult patients with intractable epilepsy were seen for neuropsychological assessment because of memory complaints. They were administered Signoret’s Memory Battery Scale (BEM 144) Zazzo’s test for attention, and van der Linden’s memory self report questionnaire. Results: In BEM 144, the immediate recall was very low after listening at the short story and after the first presentation of figures. In Zazzo’ test, crossing of one sign was poorer than that of two signs, a more difficult task, but coming after the first one. The questionnaire revealed that the patients were particularly disturbed by provocative factors, such as fatigue, stress, emotions, noise etc.... They cannot easily follow a quick conversation or movie, or remember what they read. Listening at a story, or seeing for the first time a row of figures mimiks a conversation, or a movie. Conclusion: There is no doubt that even the classical neuropsychological tests do not show some of the subtle processing deficits which impair the quality of life of patients with epilepsy. They catch informations slower than nonepileptic persons.
Epilepsy
13-l 7-25 1 Seizures involving analysis
the frontal lobe: A video-EEG
W. Silva, G. Polo, J. L6pez, A. Di Sciullo, D. Consalvo, E. Centuri6n, P. Said6n, S. Kochen. Municipal Center of Epilepsy, Neurology Division, Ramos Mejia Hospital, 6s. As, Argentina Frontal lobe epilepsy is a difficult diagnosis because of its atypical clinical manifestations, with variations according to the different topographic areas involved, which can cause diagnostic mistakes or misinterpretations, such as pseudoseizures or primary generalized seizures. We chose 14 patients, with the diagnosis of frontal lobe epilepsy, documented by video-EEG monitoring. We registered 21 seizures. Their duration was from 20 seconds to 13 minutes. lnterictal EEGs were normal in one patient. In the remaining 13 subjects, they showed sharp wave, spike wave, and slow wave paroxysms in frontal areas, bilaterally, in most cases. lctal EEGs showed, at the beginning of the seizure, paroxysmal activity foci on the unilateral frontal area in 8 seizures and bilaterally in 13. The main ictal clinical manifestations were: head-eyes turning (Rolandic area) in 16 seizures; tonic and clonic manifestations (Rolandic area and supplementary motor cortex) in 20 seizures; simple and complex gestual automatisms (Gyms Cingular) in 12 seizures; and oral vocalizations (supplementary motor cortex and/or orbital frontal cortex), in 8 seizures. The analysis made through ictal video-EEG turned out to be essential to arrive to a precise diagnosis in patients with frontal epilepsy, specially in cases with difficult diagnosis.
in 3 patients (4.4%). Lamotrigine could be considered as a drug with a great contribution in the treatment of epileptic syndromes. There remains a question how would the effect of lamotrfgine be evaluated in case of having lamotrigine as a first choice drug.
3-17-28
Neuronal migration disorders: A proton magnetic resonance spectroscopy study
I.L. Simone, C. Tortorella, R. De Blasi, R. Bellomo, P. Giannini, F. Fededco, M. Liguorl, E. Picciola, D. Carrara. institute of Neurofogx Service of Neuroradfoflog)! University of Bari, Bari, ltaly Combined magnetic resonance imaging (MRI) and proton MR spectroscopy (1 H-MRS) study was performed on 18 brain neuronal migration disorder (NMD) areas (n. 10 polymicrogyrfa, n. 5 cortical displasia and n. 3 gray matter heterotopia at MRI) of 14 patients clinically affected by partial seizures. Water suppressed spectra were acquired by using SE sequence and TE of 135 msec (Magnetom Siemens 1.5 T) on volumes of interest localized in both the lesion and the homologous contralateral MRI normal-appearing voxel. Choline (Cho), creatine (Cr), N-acetyl aspartate (NAA), lactate and lipids were evaluated in each spectrum. Analysis compared spectra from the two voxels of NMD patients and from gray and white matter voxels of 22 neurological controls (NC). NAA/Cr ratio was significantly lower in NMD areas (1.82 f 0.48) than in normal white (2.25 f 0.51) and gray (2.12 f 0.30) matter of NC (p = 0.007 and p = 0.03 by Mann Whitney test). NAA decrease in NMD cortex suggests a neuronal loss related either to seizure state or to structural dysplasia in these pathological areas. A significant decrease of Cho/Cr ratio was found in NMD sides (0.85 f 0.22) in comparison to both white (1.12 f 0.26) and gray (1 .Ol f 0.18) matter of NC (p = 0.004 and p = 0.04 respectively). Cho changes in NMD patients could depend on hypomyelination process associated to NMD. Low ChoICr ratio was found also in MRI normal-appearing contralateral hemisphere (0.87 f 0.10) of NMD patients compared to white (p = 0.004) and gray (p = 0.04) matter of NC. This 1 H-MRS finding suggests a more diffuse brain involvement than it appear at MRI. Three patients showed lactate signal both in NMD and in contralateral side, probably related to a very short time intercurrent from the last seizure. In conclusions IH-MRS can be expected to supply biochemical informations in vivo on neurobiological processes underlying NMD and to offer a non-invasive method to clarify their pathophysiology.
3-17-27
Lamictal (Lamotrlgine) treatment refractory epileptic syndromes
in children
with
R. Slaoal. A. Zouhar. H. MiSurcova l. J. Dolanskv. D. SiSkova2. V. Komarek. V. Sedrot+ov& M. Skutova. Clinics of Child New&g5 Mendel hosp., Brno, Czech Republic, ’ Thomayer Hosp., Prague, Czech Republic, 2 Motel Hosp., Prague, Czech Republic Authors from 3 clinics in the Czech Republic evaluate the results of add-on therapy with lamotrigine. Sixty-eight patients treated by lamotrigine suffered from refractory epileptic syndromes of childhood predominantly generalized convulsive ones- 73.5%. Average age of the patients was about 11 years, average dose of lamotrigine was 3.5 mg/kdday. Authors noted very good clinical effect, (minimal reduction of seizures 75%) in 21 patients (30.9%) good clinical effect (minimal reduction of seizures 50%) in 22 patients (32.4%). An improvement in EEG was apparently in 25 cases (39.7%). Significant positive impact in mentally handicapped children was found out in 9 children (19.2%). Lamotrigine was tolerated very well, the only side effect-rashwere recorded
in childhood
epilepsy Neuro/ogx
Medical Faculty
In their 5-year study the authors evaluated the effect of clobazam (Frisium) for 38 children suffering from various epilepsy syndromes. The secondary generalized syndromes (68.4%) significantly prevailed, followed by age-dependent syndromes (21 .I%). Partial epileptic syndromes (10.5%) were more frequent with complex symptomatology. Focal epileptic activity prevailed in EEG records. Clobazam was initially administered both adjuvantly and in the monotherapy with the same frequency to childem between the age of 2.0 and 18.5 years. The total dose of l-2 mg/kg/day was divided into three partial doses and usually did not exceed 40 mg/day. The authors reported a very good clinical effect for 24 children (63.2%). of who 21 got the complete compenzation. A very good effect was reported for another 7 patients (18.4%) whereas the administration of clobazam did not have any positive effect for 7 patients (18.4%) only. The only reported side effects were the fatigue and hypersomnia which occur very rarely and disappeared usually after the reduction of the dose. The authors consider clobazam to be at least the adjuvant antiepileptic drug.
3-17-29
I3 17 26
Effect of clobazam
R. Slapal, H. Misurcova. Department of Children’s of Masaryk Universi~ Brno, Czech Republic
Steady - state pharmacokinetics of valproic acid in epileptic children and adolescents on monotherapy and bitherapy with carbamazepine and vigabatrln
B. Steinbom, B. Galas-Zgorzalewicz. Department of Developmental Neurology; University of Medical Sciences, Poznari, Poland The aim of this study was the comparison of steady-state phamrawkinetics of valproic acid (VPA) and its free fraction in 30 epileptic children and adolescents treated by VPA and in polytherapy scheme with carbamazepine (CBZ) or with vigabatdn (VGB). VPA concentration in serum were measured by TDX Analyzer (Abbott Diagnostic Division, USA). Free fraction was selected by Amicon ultrafiltration method. The diurnal fluctuation of serum concentration of VPA were observed. The percentage of free VPA in plasma increased with increasing total VPA concentration in all of patients. The combination of VPA and CBZ were connected with prominent diurnal free serum fluctuation. No significant changes in fluctuation index of total and free VPA in monotherapy group and in group comedicated by VGB were observed. Pharmacokinetic parameters of total and free VPA in monotherapy and during bitherapy with VGB were similar. The changes of free and total VPA pharmacokinetics data with CBZ were noticed. An increasing of clearance and decreasing of half life of VPA in CBZ add-on therapy group we observed. Concomitant administration of CBZ alter the pharmacokinetics of VPA. Thus, no pharmacokinetic interaction exists between VPA and VGB.
3-l 7-30 E. Strube, Bordeaux,
Objective and subjective assessment impairment in patients with epilepsy P. Loiseau. France
Department
of Neurology
University
Rationale: This study examined whether neuropsychological
of memory Hospital,
testing is in keeping with patients’ personal feelings. Methods: Eleven adult patients with intractable epilepsy were seen for neuropsychological assessment because of memory complaints. They were administered Signoret’s Memory Battery Scale (BEM 144) Zazzo’s test for attention, and van der Linden’s memory self report questionnaire. Results: In BEM 144, the immediate recall was very low after listening at the short story and after the first presentation of figures. In Zazzo’ test, crossing of one sign was poorer than that of two signs, a more difficult task, but coming after the first one. The questionnaire revealed that the patients were particularly disturbed by provocative factors, such as fatigue, stress, emotions, noise etc.... They cannot easily follow a quick conversation or movie, or remember what they read. Listening at a story, or seeing for the first time a row of figures mimiks a conversation, or a movie. Conclusion: There is no doubt that even the classical neuropsychological tests do not show some of the subtle processing deficits which impair the quality of life of patients with epilepsy. They catch informations slower than nonepileptic persons.