摘要:

Summary:: Recent epidemiological and hospital‐based studies of newly diagnosed epileptic patients suggest that the prognosis for epilepsy is much more favourable than had previously been reported and believed. Approximately three‐quarters of such patients may expect to go into prolonged remission with currently available drugs, utilised as monotherapy. For chronic epileptic patients, however, the outlook for seizure control is poor. Factors that contribute to the development of chronic epilepsy are partial or multiple seizure types, brain pathology, neuropsychiatric or social handicaps, poor compliance, and the early response to treatment. Evidence is presented that epilepsy should be viewed as a process in which early effective treatment may be important to prevent the evolution of chronic epilepsy, which is so difficult to cont

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1988.tb05788.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Summary:A patient with right hemisphere complex partial seizures exhibited extreme emotional lability resembling mania, neologisms resembling those found in fluent aphasia, and hallucinations during ictal periods. The electroencephalographic and clinical findings in this case suggest that cortical and subcortical structures of the right hemisphere may play a role in mediating the expression of language content.RÉSUMÉChez un patient présentant des crises partielles complexes de l'hémisphère droit, nous avons observé pendant les crises une labilitéémotionnelle évoquant le diagnostic de manie. des néologismes ressemblant à ceux de l'aphasie de Wernicke et des hallucinations. Nos constatation EEG et cliniques suggèrent que les structures corticales et sous‐corticales de l'hémisphère droit peuvent jouer un rôle dans la médiation de l'expression du contenu linguistique.RESUMENUn paciente con ataques parciales complejos originados en el hemisferio derecho mostró una labilidad emocional extrema semejante a la mania, neologismos comparables a los que se encuentran en la afasia fluida y alucinaciones durante los períodos ictales. Los hallazgos clínicos y del EEG en este caso sugieren que estructuras corticales y subcorticales del hemisferio derecho pueden jugar un papel en la función del contenido d

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1988.tb05093.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Summary:: It is now established that the overall prognosis for epilepsy is good and that remission will occur in at least 75% of patients following adequate treatment with monotherapy. Patients who fail to respond to monotherapy, who are not suitable for surgery, and who continue to have frequent seizures may have to be considered for an alternative drug regimen. A review of the literature indicates that complete seizure control with adjunctive treatment is rare, but improved seizure control can be obtained in up to 40% of patients. In a study of clobazam as adjunctive treatment, 60% (N = 20) of our patients responded to treatment initially and 33% maintained an improvement over an 18‐month period. In 31 patients who failed to respond to carbamazepine as monotherapy, primidone (N = 16) or valproate (N = 15) were prescribed as adjunctive treatment. One patient obtained complete freedom from seizures and 14 (45%) had a>50% reduction in seizure frequency. Suggested indications for the use of additive treatment in epilepsy are discusse

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1988.tb05789.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Summary:A 73‐year‐old patient with hyperglycemia and rheumatoid arthritis presented with attacks of involuntary lingual movements that were associated with pain at the base of the tongue, often followed by aversion of head and eyes to the left with clonic contractions of the left corner of the mouth. Seizures could be induced by a combination of specific movement and somesthetic stimuli. Ictal EEG recording revealed a focal epileptiform discharge in the right centrofrontal area, thus confirming that the patient had lingual seizures, an extremely unusual manifestation.RÉSUMÉUn patient âgé de 73 ans, hyperglycémique et porteur d'une polyarthrite rhumatoïde, présentait des épisodes de mouvements involontaires de la langue associés à une perception douloureuse à la base de la langue, et souvent suivis par une déviation de la tête et des yeux vers la gauche avec contractions cloniques du coin gauche de la bouche. Les crises pouvaient être induites par certaines associations de mouvements ou de stimulations. L'EEG critique a révélé une décharge épileptique au niveau de la région centro‐frontale droite, ce qui a confirmé que le patient présentait des crises linguales, lesquelles sont des manifestations extrêmement rares.RESUMENUn enfermo de 73 an̄os de edad con hiperglucemia y artritis reumatoide, presentó ataques involuntarios de movimientos linguales, que se asociaban a dolor en la base de la lengua, frecuentemente seguidos de adversión de la cabeza y ojos hacia la izquierda con contracciones clónicas de la comisura izquierda de la boca. Los ataques podían inducirse mediante una combinación de movimientos especificos y estímulos somatoestésicos. El EEG ictal reveló una descarga epileptiforme focal en la región centro‐frontal derecha lo que confirma que el paciente tenía ataques lingual

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1988.tb05094.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Summary:We describe the clinical and electroencephalographic (EEG) manifestations of four patients with simultaneous EEG‐video‐telemetry recording (VTR) documented partial seizures evolving to infantile spasms. Clinical manifestations of the partial seizures included cessation of activity, staring, automatisms, increased limb tone, and laughter. In each case, partial seizures were followed by a cluster of infantile spasms. Infantile spasms preceded by partial seizures have not been previously documented.RÉSUMÉNous décrivons les évènements cliniques et électroencephalographiques (EEG) survenus chez 4 patients qui ont bénéficié d'un enregistrement simultané EEG et vidéotélémetrique. Nous avons observé l'évolution de crises partielles en spasmes infancies. La traduction clinique des crises partielles comprenait une cessation de l'activité en cours, une fixité du regard, des automatismes, une augmentation de tonus au niveau des membres, et le rire. Dans chacun de ces cas, les crises partielles ont été suivies par une série de spasmes infantiles. La succession de crises partielles et de spasme n'avait pas encore été documentée.RESUMENSe describen las manifestaciones clínicas y electroencefalográficas de 4 enfermos con ataques parciales que evolucionaban a espasmos infantiles bien documentados con registros simultáneos de EEG, video y telemetría (VTR). Las manifestaciones clínicas de los ataques parciales incluían una interrupción de la actividad, mirada perdida, automatismos, incremento del tono de las extremidades y risa. En cada caso los ataques parciales se siguieron de un acúmulo de espasmos infantiles, precedidos de ataques parciales, que no se han documentado previamente.ZUSAMMENFASSUNGWir beschreiben den klinischen und elektroencephalographischen Befund von 4 Patienten mit Partialanfällen und Entwicklung zu BNS‐Krämpfen anhand von Doppelbildaufzeichnungen. Klinisch zeigten sich fokale Anfälle sowie Bewegungslosigkeit. Starren, Automatismen, erhöhter Tonus und Lachen. Beijedem Fall wurden die Partialanfälle von einer Serie BNS‐Krämpfe gefolgt. BNS‐Krämpfe mit vorausgehenden Partia

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1988.tb05095.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Summary:Understanding the mechanisms of action of anticonvulsant drugs has been a major research effort of neuroscientists for the last three decades. Numerous biochemical and electrophysiological processes have been shown to be modulated by anticonvulsant drugs. However, clear correlations of these effects with anticonvulsant activity are often difficult to determine. Over the last 5 years, several major research areas have developed that shed new light on the mechanisms of action of anticonvulsant drugs. Although a complete discussion of all aspects of anticonvulsant research are, not possible in the scope of this article, a description of benzodiazepine receptors, mechanisms involved in neuronal sustaining repetitive firing, and calcium regulation of neuronal function have direct bearing on neuronal excitability and ultimately on anticonvulsant drug effect. Each of these major research areas has opened new insights into our understanding of molecular mechanisms of how anticonvulsant drugs work.

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1988.tb05796.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Summary:: In this report, aspects of epilepsy that differ in developing and in developed countries are reviewed. This is inevitably an incomplete and impressionistic survey, because data on many aspects in developing countries are scarce, and because it is difficult to generalise meaningfully about the enormous diversity of countries and populations that make up the developing world. Epidemiological studies of prevalence and incidence are reviewed with an emphasis on the problems inherent in work in this area in developing countries. Data concerning seizure type, aetiology, and severity of seizures in the Third World are contrasted with those from developed countries. Sociocultural aspects of epilepsy have been poorly studied, and yet are fundamental to effective medical management. The social effects of epilepsy and the local perceptions of cause and of treatment are discussed from work in Africa, Asia, and South America. The principles and success of treatment in the Third World may differ considerably in developing and developed countries. In the Third World, medical manpower is scarce, and epilepsy is managed essentially by primary care resources, without specialised investigations or personnel. The principles of drug therapy may not be understood by patients, and the supply of drugs is often erratic; and these are major reasons for poor compliance with treatment. World Health Organisation (WHO) initiatives have stressed the extensive use of paramedical personnel and of an essential drugs list, but this emphasis may be misdirected, and in practice neither proposal has achieved much success. The recommendation that phenobarbital be extensively used in the Third World, because of its cheapness and efficacy, is also of doubtful merit, as there are well‐known and major drawbacks to the widespread use of this drug. Computations of treatment gap figures in three developing countries suggest that between 80–94% of patients with active epilepsy are not receiving anticonvulsant therapy, and cost is only one of a number of reasons for this. The key to improvements in medical treatment lie with a better understanding of the patients' cultural concepts of epilepsy and its treatment, improved drug supply and availability, and efforts to improve education amongst general practitioners and other primary care medical person

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1988.tb05790.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Summary:A clinical and EEG study of 12 fragile‐X syndrome subjects (six with epilepsy) is presented. All subjects had clinical‐family history examinations. EEG evaluations, and karyotyping. Spikes were present in the sleep EEG of one nonepileptic and four epileptic subjects; these spikes were similar in location, occurrence. voltage, frequency, and morphology (and similar to those of the Rolandic spikes). These data, together with the clinical similarities (type of epilepsy, responses to drugs. ages of seizure onset, etc.). have resulted in the postulation of EEG characteristics of epileptic and nonepileptic fragile‐X patients. However, further studies with fragile‐X patients are needed to confirm this hyp

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1988.tb05096.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Summary:Using PET with [18‐F]‐2‐deoxyglucose (FDG), we studied the effects of antiepileptic drugs on cerebral glucose metabolism. Serial scans were performed before and after the test drug was added to or removed from the patient's regimen. At least 3 weeks elapsed after achieving steady‐state plasma levels when drugs were added, or after plasma levels were undetectable when drugs were tapered, before repeat scans were obtained. Only a single drug was changed between scans. In the phenobarbital (PB) study, the “on‐drug” scan was performed first in each case. In this instance, a mean of 14 weeks elapsed between the time blood levels were undetectable and repeat scanning in order to avoid the possibility of withdrawal effects. Scanning in each group was performed 30 min after injection of 5 mCi of FDG, with EEG monitoring to exclude ictal activity. Regional glucose metabolic rates were calculated in 8 to 20 regions of interest. PB reduced LCMRglu in seven of eight regions studied, with a mean reduction over all regions of 37 ± 3%. Phenytoin (PHT) reduced LCMRglu in only two of 10 regions (mean =13%). We studied the effect of PHT on cerebellar metabolism in 42 patients using unpaired scans. Cerebellar LCMRglu was lower when patients were taking PHT at the time of scan, as well as in those who were taking PHT for 5 years or more, but the differences were not significant. There was a weak inverse correlation between PHT serum level and cerebellar LCMRglu in patients taking the drug at the time of scan (r = ‐ 0.36; 0.05

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1988.tb05797.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Summary:“Hot water epilepsy” (HWE). precipitated by a bath or shower in hot water, has been described infrequently in the literature. We report 279 cases of HWE that were seen between 1980 to 1983 in Bangalore, South India. We found HWE to be more common in children, with cases more frequent among male than female patients (2.6:1). Complex partial seizures constituted the main clinical presentation (67.0%); HWE accounted for 4.4% of all complex partial seizures and generalized tonic‐clonic seizures seen at our center during the 1980–1983 period. Although prognosis seems favorable, 25.4% of our patients developed nonreflex epilepsy within 1–3 years. They were managed with antiepileptic drugs and the use of lukewarm water for bathing.RÉSUMÉL'épilepsie à l'eau chaude (EEC), avec crises induites par un bain ou une douche d'eau chaude. a été décrite comme étant rare. Nous rapportons 279 observations d'EEC colligées entre 1980 et 1983 à Bangalore, dans le sud de l'inde. Nous avons constaté que l'EEC est plus fréquente chez l'enfant, avec un sex ratio de 2.6 en faveur des sujets masculins. Des crises partielles complexes sont le plus fréquemment observées (67.0% des cas). L'EEC représente 4.4% de l'ensemble des crises partielles complexes et généralisées tonico‐cloniques diagnostiquées dans notre centre pendant la même période. Bien que le pronostic semble favorable, 25.4% de nos patients ont vu s'installer une épilepsie non réflexe après une période de 1 à 3 ans. Le traitement associe les médications antiépileptiques et l'usage d'eau tiéde pour le bain.RESUMENLa epilepsyía precipitada por agua caliente (HWE) ya sea en ban̄os o en duchas de agua caliente, ha sido descrita en la literature. Se presentan 279 casos de HWE estudiados entre 1980 y 1983 en Bangalore. India del Sur. Hemos encontrado que la HWE es más común ninos y más en varones (2.6:1). La presentación clínica más frecuente fueron los ataques parciales complejos (67%). La HWE es causa del 4.4% de todos los ataques parciales complejos y ataques generalizados tónico‐clónicos estudiados en el mismo periodo de tiempo en nuestro centre A pesar de que el pronóstico es favorable el 25.4% de nuestros pacientes desarrollaron una epilepsyía no‐refleja en el plazo de 1 a 3 an̄os. Fueron tratados con fármacos anticomiciales y agua tibia para sus ban̄os.ZUSAMMENFASSUNGDie Heiß‐Wasser‐Epilepsie (HWE). Ausgelöst durch Baden oder Duschen in heißem Wasser, wurde in der Literatur beschrieben. Wir berichten über 279 Fälle von HWE zwischen 1980 und 1983 in Bangalore. HWE kommt häufiger bei Kindern und bei Knaben häufiger als bei Mädchen vor (2,6:1). Komplexe Partialanfälle stellen das häufigste klinische Bild dar (67%). 4,4% aller komplex‐partialer Anfälle und generalisierter tonisch‐klonischer Anfälle in unserem Zentrum ließen sich auf eine HEW zurückführen. Obwohl die Prognose günstig erscheint, entwickelten 25.4% der Patienten innerhalb von 1–3 Jahren eine nichtreflexogene Epilepsie. Beha

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1988.tb05098.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY