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PS-58-11 First ever seizures in emergency neurology a study of 1100 cases
Poster session 59. Epilepsy (3)
[PS-58-101 Cognitive troubles in epilepsy Edit Sisak, Rodica Todor. Departmentof Neurology, Hospital of Romanian Railways, Brasov, Romania We attempted to identify possible difference between the Fenitoin and the Carbamazepine regarding their effect on the cognitive functions of epileptic patients. We used an internationally standardised psychological test-battery and we compared the results of the two therapy-groups, correlating the duration of the treatment with their individual scores. After statistical processing and plotting we could conclude: a/the average values for concentrated attention/exactity/were significantly better by the Carbamazepinegroup; b/best scores were in the first five years of treatment with both drugs and less good during the years 6-20; c/the scores of the memory tests decrease less by Carbamazepine like by Fenitoin. 7
PS-58-11 J First ever seizures in emergency neurology a study of 1100 cases M. Zivkovic, M. Spasic, Z. Peric, D. Lukic. N Department of Neurology School of Medicine, Nis, Yugoslavia We evaluated retrospectively the occurrence of seizures in 1100 hospitalized patients in Neurology Intensive Care Unit, of all etiologies, in the period of May 1992 to May 1995. Seizures occurred in 119 patients (10.8%), including 29 (6%) of 489 with atherotrombotic infarcts, 32 (14%) of 385 with intracerebral hemorrhage and hematoma, 17 (11%) of 154 with subarahnoid hemorrhage, 12 (19%) of 66 with infarcts owing to embolus, 8 (9%) of 88 patients with tumor cerebri, 18 (6%) of 33 with metabolic encepfialopathies (uremia, Diabetes mellitus), and 3 of 9 patients with hypertensive encephalopathies, Seizures were initial sign of stroke in 42%, during stroke occurrences in 39%, and in 18% was post stroke sign. It was 32:37 focal versus general seizures, and partial onset with secundar generalisation occurred in 31% of patients. We conclude that first seizure may be very important symptom of brain injury, so the prompt recognition of underlying supstrat may lead to rational early tretman, and improve survival.
I PS-58-121 Prognostic value of monitoring serum levels of valproic acid in patients with epilepsy Mirjana Tomovic 1, Milivoje Mihajlovic 5, Zajmi Agron 2, Gorica Djokic 1. 1Department of Neurology, Military Medical
Academy, Beograd, 2 Centar of Medicine, Djakovica, Yugoslavia The daily dosage of valproic acid/v.a./in patients with epilepsy depends on successful seiZure control. The value of monitoring serum levels of v.a. during therapy is not precisely determine. The purpose of this study was to define the need of daily dose correction of v.a. in cases when there is good seizure control but the serum levels of v.a. are under therapeutic range. The two years study obtained 54 patients with epilepsy who were at v.a. monotherapy at least three months of baseline period. They were divided in two groups/A and B/, randomisely. The daily doses of v.a. were not changed in group A, and were changed in group B until the therapeutic serum level of v.a. were reached. Patients controls were performed after 1, 3, 6, 12, 18 and 24 months from the beginning, and they consisted of daily profile of v.a. serum levels and data of seizure control for previous period. Results were statistically analysed. Comparing both groups at each control period, there were no significant difference at seizure control. A wide range of daily doses of v.a. had same serum levels.
$241
Nausea, vomiting and diarrhea were most common side effects in treatment with v.a. The serum levels of v.a. are not in direct positive correlation. Seizure control is the leading parameter in v.a. dosage.
PS-59. EPILEPSY (3) I PS-59-1 ] Human neocortical slices from epileptic patients: spontaneously appearing sharp field potentials E.-J. Speckmann 1, R. K6hling 1, A. LOcke 1, H. Straub 1, I. Tuxhorn 2, P. Wolf z, H. Pannek 3, E Oppel 3. llnstitutfiir
Physiologic, Universitdt, D-48149 Miinster, Germany; 2 Epilepsie-Zentrum Bethel, Mara I, 3 Neurochirurgische Klinik, Gilead 1, D-33617 Bielefeld, Germany Human neocortical slice preparations were obtained from patients undergoing surgical treatment of refractory epilepsy. Repetitive sharp field potentials occurred spontaneously, i.e. without external manipulation (el. Schwartzkroin and Knowles (1984) Science 223: 709-712; McCormick (1989) J. Neurophysiol. 62: 1018-1027), in these preparations. These potentials resembled epileptiform potentials in the EEG (50--300/zV, 0.3-0.6 Hz) and were associated with sequences of excitatory and inhibitory potentials of surrounding neurons. In this investigation, these potentials were characterized pharmacologically. The slice preparations (n = 30 of 13 patients) were superfused with artificial cerebrospinal fluid. Field potential (FP) and intracellular recordings (n = 10) were done from layer IlI to V. The following agents were added to the superfusate: DL-2-amino-phosphonovalerate (APV, 100 #M, n = 11), 6-cyano7-nitroquinoxalin-2,3-dion (CNQX, 5/zM), bicuculline (10/zM), CGP 55845A (10/xM), verapamil (40 /zM), phenytoin and carbamazepine (50-100 /zM). FP and postsynaptic potentials were reversibly blocked by the non-NMDA antagonist CNQX, but not by the NMDA antagonist APV. Likewise, the GABAA antagonist bicuculline reversibly suppressed spontaneous potentials but not the GABAB antagonist CGP 55845A. The organic calcium channel blocker verapamil, as well as the standard antiepileptic drugs phenytoin and carbamazepine also reversily blocked all potentials. These findings suggest that the spontaneous activity is (1) mediated via non-NMDA receptors, (2) possibly synchronized via gabaergic interneurons, (3) generated involving calcium currents, and (4) suppressed by anti-epileptic drugs.
PS-59-2 ] The enhancement of entorhinal tetanic response by 50-Hz amygdala stimulation in kindling rats Katsuji Tanaka t, Ken Hirayama 1, Shiushi Matsuura 2, Ryosuke Murata 3. l Department of Pediatrics, 2Department of
Physiology, Osaka City University Medical School; 3Department of Pediatrics, Osaka City General Hospital To study the relation between the magnitude of the entorhinal tetanic responses during amygdala 50-Hz stimulation and the development of after discharges (AD) and behavioral seizures in conscious rats, stimulating and recording electrodes were inserted into the brain and fixed at the amygdala and the entorhinal cortex in the rats anesthetized with pentobarbiturate. Then, tetanic responses during kindling stimuli which produced the same behavioral seizure stage in each rat were averaged and the area between the negative (excitatory) potentials and the baseline of the averaged tetanic response was measured in terms of mV x ms.
[PS-58-101 Cognitive troubles in epilepsy Edit Sisak, Rodica Todor. Departmentof Neurology, Hospital of Romanian Railways, Brasov, Romania We attempted to identify possible difference between the Fenitoin and the Carbamazepine regarding their effect on the cognitive functions of epileptic patients. We used an internationally standardised psychological test-battery and we compared the results of the two therapy-groups, correlating the duration of the treatment with their individual scores. After statistical processing and plotting we could conclude: a/the average values for concentrated attention/exactity/were significantly better by the Carbamazepinegroup; b/best scores were in the first five years of treatment with both drugs and less good during the years 6-20; c/the scores of the memory tests decrease less by Carbamazepine like by Fenitoin. 7
PS-58-11 J First ever seizures in emergency neurology a study of 1100 cases M. Zivkovic, M. Spasic, Z. Peric, D. Lukic. N Department of Neurology School of Medicine, Nis, Yugoslavia We evaluated retrospectively the occurrence of seizures in 1100 hospitalized patients in Neurology Intensive Care Unit, of all etiologies, in the period of May 1992 to May 1995. Seizures occurred in 119 patients (10.8%), including 29 (6%) of 489 with atherotrombotic infarcts, 32 (14%) of 385 with intracerebral hemorrhage and hematoma, 17 (11%) of 154 with subarahnoid hemorrhage, 12 (19%) of 66 with infarcts owing to embolus, 8 (9%) of 88 patients with tumor cerebri, 18 (6%) of 33 with metabolic encepfialopathies (uremia, Diabetes mellitus), and 3 of 9 patients with hypertensive encephalopathies, Seizures were initial sign of stroke in 42%, during stroke occurrences in 39%, and in 18% was post stroke sign. It was 32:37 focal versus general seizures, and partial onset with secundar generalisation occurred in 31% of patients. We conclude that first seizure may be very important symptom of brain injury, so the prompt recognition of underlying supstrat may lead to rational early tretman, and improve survival.
I PS-58-121 Prognostic value of monitoring serum levels of valproic acid in patients with epilepsy Mirjana Tomovic 1, Milivoje Mihajlovic 5, Zajmi Agron 2, Gorica Djokic 1. 1Department of Neurology, Military Medical
Academy, Beograd, 2 Centar of Medicine, Djakovica, Yugoslavia The daily dosage of valproic acid/v.a./in patients with epilepsy depends on successful seiZure control. The value of monitoring serum levels of v.a. during therapy is not precisely determine. The purpose of this study was to define the need of daily dose correction of v.a. in cases when there is good seizure control but the serum levels of v.a. are under therapeutic range. The two years study obtained 54 patients with epilepsy who were at v.a. monotherapy at least three months of baseline period. They were divided in two groups/A and B/, randomisely. The daily doses of v.a. were not changed in group A, and were changed in group B until the therapeutic serum level of v.a. were reached. Patients controls were performed after 1, 3, 6, 12, 18 and 24 months from the beginning, and they consisted of daily profile of v.a. serum levels and data of seizure control for previous period. Results were statistically analysed. Comparing both groups at each control period, there were no significant difference at seizure control. A wide range of daily doses of v.a. had same serum levels.
$241
Nausea, vomiting and diarrhea were most common side effects in treatment with v.a. The serum levels of v.a. are not in direct positive correlation. Seizure control is the leading parameter in v.a. dosage.
PS-59. EPILEPSY (3) I PS-59-1 ] Human neocortical slices from epileptic patients: spontaneously appearing sharp field potentials E.-J. Speckmann 1, R. K6hling 1, A. LOcke 1, H. Straub 1, I. Tuxhorn 2, P. Wolf z, H. Pannek 3, E Oppel 3. llnstitutfiir
Physiologic, Universitdt, D-48149 Miinster, Germany; 2 Epilepsie-Zentrum Bethel, Mara I, 3 Neurochirurgische Klinik, Gilead 1, D-33617 Bielefeld, Germany Human neocortical slice preparations were obtained from patients undergoing surgical treatment of refractory epilepsy. Repetitive sharp field potentials occurred spontaneously, i.e. without external manipulation (el. Schwartzkroin and Knowles (1984) Science 223: 709-712; McCormick (1989) J. Neurophysiol. 62: 1018-1027), in these preparations. These potentials resembled epileptiform potentials in the EEG (50--300/zV, 0.3-0.6 Hz) and were associated with sequences of excitatory and inhibitory potentials of surrounding neurons. In this investigation, these potentials were characterized pharmacologically. The slice preparations (n = 30 of 13 patients) were superfused with artificial cerebrospinal fluid. Field potential (FP) and intracellular recordings (n = 10) were done from layer IlI to V. The following agents were added to the superfusate: DL-2-amino-phosphonovalerate (APV, 100 #M, n = 11), 6-cyano7-nitroquinoxalin-2,3-dion (CNQX, 5/zM), bicuculline (10/zM), CGP 55845A (10/xM), verapamil (40 /zM), phenytoin and carbamazepine (50-100 /zM). FP and postsynaptic potentials were reversibly blocked by the non-NMDA antagonist CNQX, but not by the NMDA antagonist APV. Likewise, the GABAA antagonist bicuculline reversibly suppressed spontaneous potentials but not the GABAB antagonist CGP 55845A. The organic calcium channel blocker verapamil, as well as the standard antiepileptic drugs phenytoin and carbamazepine also reversily blocked all potentials. These findings suggest that the spontaneous activity is (1) mediated via non-NMDA receptors, (2) possibly synchronized via gabaergic interneurons, (3) generated involving calcium currents, and (4) suppressed by anti-epileptic drugs.
PS-59-2 ] The enhancement of entorhinal tetanic response by 50-Hz amygdala stimulation in kindling rats Katsuji Tanaka t, Ken Hirayama 1, Shiushi Matsuura 2, Ryosuke Murata 3. l Department of Pediatrics, 2Department of
Physiology, Osaka City University Medical School; 3Department of Pediatrics, Osaka City General Hospital To study the relation between the magnitude of the entorhinal tetanic responses during amygdala 50-Hz stimulation and the development of after discharges (AD) and behavioral seizures in conscious rats, stimulating and recording electrodes were inserted into the brain and fixed at the amygdala and the entorhinal cortex in the rats anesthetized with pentobarbiturate. Then, tetanic responses during kindling stimuli which produced the same behavioral seizure stage in each rat were averaged and the area between the negative (excitatory) potentials and the baseline of the averaged tetanic response was measured in terms of mV x ms.