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1.
Neurology ; 64(5): 792-8, 2005 Mar 08.
Article in English | MEDLINE | ID: mdl-15753411

ABSTRACT

OBJECTIVE: To evaluate the cognitive effects of topiramate (TPM) and gabapentin (GBP). METHODS: Forty healthy volunteers were randomized to a 12-week course of TPM, GBP, or placebo. Doses were gradually escalated over 10 weeks to a maximum of 400 mg/day of TPM or 3,600 mg/day of GBP or to the highest tolerated dose. Subjects were interviewed and examined biweekly. Cognitive testing was performed prior to initiating the drug and again 12 weeks later, at least 2 weeks after achieving plateau dosing. For each subject and cognitive measure, test-retest Z scores were calculated based on regression equations derived from 73 healthy volunteers. Group comparisons utilized the Wilcoxon test. RESULTS: There were significant TPM vs GBP and TPM vs placebo differences in test-retest Z scores for four of six target cognitive measures (Digit Symbol, Story Recall, Selective Reminding, Controlled Oral Word Association), always indicating worse retest performance for subjects receiving TPM. Overall, 12 of 24 cognitive measures were similarly affected. TPM effects were large, and several target measures averaged >2 SD of negative change. One measure was significantly affected by GBP. CONCLUSIONS: Topiramate (TPM) impaired cognitive test performance, whereas gabapentin had minimal effects. The effects of TPM were of sufficient magnitude potentially to affect daily and occupational function.


Subject(s)
Amines/adverse effects , Brain/drug effects , Cognition Disorders/chemically induced , Cyclohexanecarboxylic Acids/adverse effects , Fructose/analogs & derivatives , gamma-Aminobutyric Acid/adverse effects , Activities of Daily Living , Adult , Anticonvulsants/adverse effects , Brain/physiopathology , Cognition/drug effects , Cognition/physiology , Cognition Disorders/physiopathology , Cognition Disorders/psychology , Dose-Response Relationship, Drug , Fructose/adverse effects , Gabapentin , Humans , Maximum Tolerated Dose , Middle Aged , Neuropsychological Tests , Patient Selection , Reference Values , Risk Factors , Topiramate , Treatment Outcome
2.
Seizure ; 12(8): 595-8, 2003 Dec.
Article in English | MEDLINE | ID: mdl-14630500

ABSTRACT

PURPOSE: EEG studies based on adult populations report interictal epileptiform discharges (EDS) favour the left hemisphere. It is not clear when favouring becomes apparent as similar paediatric studies have not been performed. METHODS: The authors reviewed 1,579 paediatric EEG interpretations for evidence of hemispheric favouring of focal epileptiform discharges. Analysis focused on first-time EEG results. RESULTS: Right hemispheric favouring of interictal epileptiform discharges occurs in childhood, it remits around 5 years of age whereupon left-sided favouring occurs more frequently (P=0.004, Fisher's Exact). CONCLUSION: Hemispheric vulnerabilities to interictal focal epileptiform activity may display discrete age-related favouring. These findings are discussed in context of normal hemispheric maturation.


Subject(s)
Electroencephalography/methods , Epilepsy/physiopathology , Telencephalon/physiopathology , Adolescent , Age Factors , Chi-Square Distribution , Child , Child, Preschool , Electroencephalography/statistics & numerical data , Humans , Infant , Infant, Newborn , Retrospective Studies
3.
Neurology ; 60(9): 1473-7, 2003 May 13.
Article in English | MEDLINE | ID: mdl-12743234

ABSTRACT

BACKGROUND: Previous studies have shown that interictal epileptiform discharges favor the left hemisphere in adults but the right side in children up until age 5. This may be due to sex-influenced asymmetric brain maturation. To clarify this relationship, the authors analyzed age at epilepsy onset by sex and by lateralization of epileptiform activity. METHODS: An adult epilepsy center long-term monitoring database was used to define patients with exclusively unilateral epileptiform findings. Three groups were studied: any epileptiform activity (n = 404), ictal activity (n = 287), and interictal activity (n = 265). The second and third groups were drawn from the first group and the second and third groups overlapped with each other. Side of lateralized finding and sex were analyzed via factorial two-way analysis of variance with the outcome variable being age at epilepsy onset. Comparison analysis included patients with generalized epilepsy (n = 114), nonepileptic seizures (NES, n = 232), and surgical mesial temporal sclerosis (MTS, n = 116). RESULTS: Patients with unilateral epileptiform activity displayed bimodal epilepsy onset ages with infant and adolescent peaks. For patients with a right-sided focus, epilepsy onset was earlier in men (14.4 years) than women (20.7 years). In contrast, among patients with a left-sided focus, epilepsy began earlier in women (18.2 years) than men (19.9 years, p < 0.01). Parallel results were found in unilateral ictal (p < 0.01) and unilateral interictal activity (p = 0.01). Patients with surgical MTS, NES, or generalized seizure showed no similar patterns. CONCLUSIONS: In adult patients with focal epilepsy, sex and lateralized epileptiform abnormalities may be related to age at epilepsy onset.


Subject(s)
Epilepsies, Partial/epidemiology , Adolescent , Adult , Age Distribution , Age of Onset , Aged , Brain/pathology , Child , Child, Preschool , Gonadal Steroid Hormones/physiology , Humans , Infant , Infant, Newborn , Middle Aged , Sex Distribution
4.
Neurology ; 60(6): 1042-4, 2003 Mar 25.
Article in English | MEDLINE | ID: mdl-12654981

ABSTRACT

The prevalence of atypical (right, bilateral) speech lateralization is unknown in normal populations. The authors investigated this by studying people with normal developmental histories but a later, specific adult neurologic event leading to intractable epilepsy. Fifty of 836 people receiving intracarotid amobarbital procedures (IAPs) met criteria of normal neurologic histories through age 15 years, with later head trauma or cerebral infection as probable cause of subsequent epilepsy. All 50 patients had left hemispheric speech on IAP. Atypical speech lateralization is rare unless there is also a positive neurologic history.


Subject(s)
Dominance, Cerebral , Human Development , Speech/physiology , Adult , Amobarbital , Carotid Artery, Internal , Craniocerebral Trauma/complications , Craniocerebral Trauma/physiopathology , Encephalitis/complications , Encephalitis/physiopathology , Epilepsy/etiology , Female , Functional Laterality , Humans , Injections, Intra-Arterial , Language , Language Development , Male , Middle Aged , Retrospective Studies
5.
Epileptic Disord ; 3(3): 137-41, 2001 Sep.
Article in English | MEDLINE | ID: mdl-11679305

ABSTRACT

PURPOSE: To determine if there is evidence that the left cerebral hemisphere is more prone to epileptogenesis than the right hemisphere. METHODS: We examined 532 patients with localization-related epilepsy, as documented by long-term EEG-video monitor studies. We identified those with interictal epileptiform patterns on EEG confined to one hemisphere, those with clinical seizures that arose only from one side, and individuals with neuropsychological deficits lateralizing more to one cerebral hemisphere than the other. These data were then related to the handedness of the subjects. RESULTS: For left-handed patients, interictal discharges were significantly more likely to be confined to the left side, seizures more frequently arose from only the left hemisphere, and neuropsychological deficits lateralized more often to the left brain. In contrast, for right-handed subjects, there were no significant differences in unilateral localization of either interictal discharges or of seizure onsets, nor did neuropsychological deficits lateralize more often to one side or the other. Although, as a group, left-handers had an earlier age of onset of epilepsy than right-handers, the lateralizing EEG and neuropsychological patterns seen in left-handers were not related to age of onset of epilepsy, febrile seizures, family history of either epilepsy or left-handedness, or other risk factors. CONCLUSION: In localization-related epilepsy, there is a significant association of left-handedness with left hemispheric lateralization of epileptiform EEG patterns and neuropsychological deficits. These findings do not clearly reflect a greater left than right cerebral hemispheric vulnerability to epileptogenesis, except possibly in left-handers.


Subject(s)
Dominance, Cerebral/physiology , Epilepsies, Partial/physiopathology , Adult , Brain Mapping , Electroencephalography , Epilepsies, Partial/diagnosis , Female , Functional Laterality/physiology , Humans , Male , Middle Aged , Monitoring, Physiologic , Neuropsychological Tests
6.
J Int Neuropsychol Soc ; 7(5): 597-605, 2001 Jul.
Article in English | MEDLINE | ID: mdl-11459111

ABSTRACT

The interpretation of neurobehavioral change over time requires knowledge of the test-retest characteristics of the measures. Without this information it is not possible to distinguish a true change (i.e., one reflecting the occurrence or resolution of an intervening process) from that occurring on the basis of chance or systematic bias. We tested a group of 72 healthy young to middle aged adults twice over a 12-to-16-week interval in order to observe the change in scores over time when there was no known intervention. The test battery consisted of seven commonly used cognitive measures and the Profile of Mood States (POMS). Test-retest regression equations were calculated for each measure using initial performance, age, education, and a measure of general intellectual function (Wonderlic Personnel Test) as regressors. Test-retest correlations ranged from .39 (POMS Fatigue) to .89 (Digit Symbol). Cognitive measures generally yielded higher correlations than did the POMS. Univariate regressions based only on initial performance adequately predicted retest performance for the majority of measures. Age and education had a relatively minor influence. Practice effects and regression to the mean were common. These test-retest regression equations can be used to predict retest scores when there has been no known intervention. They can also be used to generate statistical statements regarding the significance of change in an individual's performance over a 12-to-16-week interval.


Subject(s)
Neuropsychological Tests/statistics & numerical data , Adult , Data Interpretation, Statistical , Female , Humans , Male , Middle Aged , Psychometrics , Reproducibility of Results
7.
Epilepsia ; 42(6): 778-81, 2001 Jun.
Article in English | MEDLINE | ID: mdl-11422335

ABSTRACT

PURPOSE: To determine the demographic and clinical characteristics of patients who have documented epileptic seizures on long-term video-EEG monitoring who do not have interictal spikes. METHODS: The records of 1,223 monitoring studies from 919 patients who underwent noninvasive long-term video-EEG monitoring were reviewed. In 28 patients (3.0% of monitored patients, 4.4% of patients with electrographic evidence of epilepsy), no interictal spikes were found despite the occurrence of at least one recorded electrographic seizure. The demographic, medical, neuropsychological, and EEG data of these patients were compared with those of 28 matched control patients with documented interictal spikes. RESULTS: Extratemporal seizures were significantly more frequent in the patients with at least one recorded epileptic seizure but without interictal spikes compared with patients with epileptic seizures and interictal spikes (p = 0.031). The only other significant difference between the groups (p = 0.016) was a later age at seizure onset (18.3 vs. 10.7 years) for the patients without interictal spikes. Age at evaluation, gender, handedness, clinical seizure type, family history of epilepsy, history of febrile seizures, neuropsychological testing, and neurologic and psychiatric history did not differ between the two groups. CONCLUSIONS: In patients with documented epilepsy without interictal spikes on EEG monitoring, the possibility of an extratemporal focus should be considered.


Subject(s)
Electroencephalography/statistics & numerical data , Epilepsy/diagnosis , Seizures/diagnosis , Adolescent , Adult , Age of Onset , Child , Comorbidity , Epilepsy/epidemiology , Epilepsy, Temporal Lobe/diagnosis , Family , Female , Functional Laterality/physiology , Humans , Male , Monitoring, Physiologic/statistics & numerical data , Neurologic Examination , Neuropsychological Tests/statistics & numerical data , Retrospective Studies , Seizures/epidemiology , Seizures, Febrile/diagnosis , Seizures, Febrile/epidemiology , Videotape Recording
8.
Epilepsy Res ; 42(2-3): 123-32, 2000 Dec.
Article in English | MEDLINE | ID: mdl-11074185

ABSTRACT

The effects of tiagabine (TGB) on abilities and on adjustment and mood are as yet incompletely understood. These effects were compared with those of phenytoin (PHT) and carbamazepine (CBZ) in an add-on study. Patients included in the analysis were adults with uncontrolled partial seizures who at study entry were on CBZ alone (n=153) or on PHT alone (n=124). Of the patients receiving CBZ, 82 were randomized to add-on TGB and 71 were randomized to add-on PHT during the double-blind period. Of the patients receiving PHT, 58 were randomized to add-on TGB and 66 were randomized to add-on CBZ. Eight tests of mental abilities and three of mood and adjustment were given prior to assignment of add-on treatment and after up to 16 weeks of add-on treatment. For the baseline CBZ group, analyses were done to search for differential changes from baseline in the test scores of the add-on TGB and add-on PHT groups, and for the baseline PHT group in the add-on TGB and add-on CBZ groups. In the baseline CBZ group, no differences in test scores were found between PHT and TGB. In the baseline PHT group for the area of abilities, patients treated with TGB had improved verbal fluency, as well as quicker responses on a test of perceptual/motor speed compared with patients treated with CBZ. For the baseline PHT group in the area of adjustment and mood, patients treated with TGB reported less positive mood and more financial concerns compared to patients treated with CBZ. Overall, add-on TGB showed few or no differences in comparison with add-on CBZ and add-on PHT.


Subject(s)
Anticonvulsants/pharmacology , Carbamazepine/pharmacology , Epilepsy, Complex Partial/psychology , Nipecotic Acids/pharmacology , Phenytoin/pharmacology , Adaptation, Psychological/drug effects , Adult , Affect/drug effects , Anticonvulsants/therapeutic use , Carbamazepine/therapeutic use , Cognition/drug effects , Double-Blind Method , Epilepsy, Complex Partial/drug therapy , Female , Humans , Male , Middle Aged , Nipecotic Acids/therapeutic use , Phenytoin/therapeutic use , Statistics, Nonparametric , Tiagabine
9.
Epilepsy Res ; 35(2): 109-21, 1999 Jun.
Article in English | MEDLINE | ID: mdl-10372564

ABSTRACT

The cognitive and quality of life effects of gabapentin are not yet well explored. While preliminary work in the area has provided positive findings, a large double-blinded study has been needed to explore this area more thoroughly. From 24 sites in North America, 201 adults were studied who had uncontrolled complex partial seizures with or without secondary generalization. Attempts were made to convert each patient from one or two marketed antiepileptic drugs (AEDs) taken in baseline to gabapentin monotherapy (600, 1200, or 2400 mg/day). Tests of cognitive abilities and adjustment were administered at the end of the 8-week baseline period and at the end of the 26-week double-blind treatment period. Analyses of baseline to treatment period changes were conducted for each dose group in comparison with a reference group of placebo-treated patients from another study. In the area of cognitive functioning, no changes in any of the gabapentin groups were found in comparison with the reference group. In the area of adjustment and mood, however, improvement with gabapentin administration was noted on several variables pertaining to emotional and interpersonal adjustment. These results are consistent with findings from previous studies.


Subject(s)
Acetates/therapeutic use , Amines , Anticonvulsants/therapeutic use , Cyclohexanecarboxylic Acids , Epilepsy, Complex Partial/drug therapy , Epilepsy, Complex Partial/psychology , gamma-Aminobutyric Acid , Adult , Double-Blind Method , Female , Gabapentin , Humans , Male , Neuropsychological Tests
10.
Clin Neuropsychol ; 13(4): 562-72, 1999 Nov.
Article in English | MEDLINE | ID: mdl-10806469

ABSTRACT

The publication of "Myths of Neuropsychology" (Dodrill, 1997) has stimulated three responses, each of which takes issue with points in the original publication. These three responses especially address Myth #4 ("Above-average performances on neuropsychological tests are expected when intellectual abilities are above average") and to a lesser degree Myth #1 ("We have a good knowledge of the constructs that our tests measure"). The present paper reviews the thoughts and new data which these colleagues have provided in response to the original paper, and it also presents additional data bearing on the issues at hand. Based on the composite of information now available, it is conceded that Myth #4 was not accurately worded in the original paper. This was a mistake, and an alternate wording for Myth #4 is offered. Other changes in the original publication do not appear to be required. In order to resolve many of the issues at hand and thereby advance our profession, research in a number of areas is needed, many of which are specifically identified in the present paper.


Subject(s)
Cognition , Culture , Neuropsychological Tests/standards , Neuropsychology/standards , Data Interpretation, Statistical , Humans
11.
Epilepsia ; 39(11): 1189-93, 1998 Nov.
Article in English | MEDLINE | ID: mdl-9821983

ABSTRACT

PURPOSE: This study was undertaken to determine what changes, if any, occur in the electroencephalogram (EEG) and in neuropsychological test findings of adults with medically intractable complex partial epilepsy over a 10-year period. METHODS: We studied 35 adults, with a mean age of 32 years (range, 16-59 years) at time of initial testing. We compared the distribution of epileptiform patterns documented on the initial pair of waking and sleeping EEGs to those observed on another pair obtained 10 years later. During this same 10-year period, we also examined changes in the Wechsler Adult Intelligence Scale (WAIS) and on the tests from the Neuropsychological Battery for Epilepsy. RESULTS: The EEGs of 28 (80%) of patients at the tenth year were identical to those seen initially. Five (14%) of patients demonstrated EEGs after 10 years with either no discharges or only unilateral discharges, where bilateral discharges were seen a decade earlier. Only two (6%) of patients had EEGs at the tenth year that showed bilateral discharges where only unilateral discharges were seen originally. We found no general change in intelligence or neuropsychological functioning after 10 years, although a few subtle losses were noted on several neuropsychological measures. CONCLUSIONS: For most adults with medically intractable complex partial epilepsy, the EEG and neuropsychological test scores remain reasonably stable over a decade.


Subject(s)
Electroencephalography , Epilepsies, Partial/diagnosis , Neuropsychological Tests/statistics & numerical data , Adolescent , Adult , Disease Progression , Female , Follow-Up Studies , Humans , Intelligence Tests , Male , Middle Aged
12.
Epilepsia ; 39(8): 857-62, 1998 Aug.
Article in English | MEDLINE | ID: mdl-9701376

ABSTRACT

PURPOSE: Purely subjective events, identified as "seizures" by patients but not accompanied by any clinical or EEG changes, commonly occur during evaluation of patients for intractable epilepsy. We wished to determine the significance of such events. METHODS: We analyzed the frequency of subjective episodes in 379 adults who underwent EEG video monitoring as part of their evaluation for intractable epilepsy and the relationship of these experiences to epileptic and psychogenic nonepileptic (NES) seizures. We examined the results of tests of mental ability and of emotional, psychosocial, and quality of life (QOL) adjustment to determine if individuals with subjective events alone could be distinguished from those with epileptic seizures only, NES only, or no events, by these measures. RESULTS: We noted subjective events in 39% (147 of 379) of the patients. Of patients with subjective episodes, 52% also had epileptic seizures, 7% had NES, 1% had both epileptic seizures and NES, and 40% had subjective events alone. As a group, patients with subjective events alone were slightly more intelligent and less impaired neuropsychologically than people in the other groups, but they performed more poorly on several important measures of adjustment. CONCLUSIONS: The identification of persons with purely subjective episodes apart from all other episodes is important both phenomenologically and from a practical viewpoint.


Subject(s)
Electroencephalography/statistics & numerical data , Epilepsy/diagnosis , Monitoring, Physiologic/statistics & numerical data , Seizures/diagnosis , Videotape Recording/statistics & numerical data , Adolescent , Adult , Diagnosis, Differential , Electroencephalography/methods , Epilepsy/psychology , Female , Humans , MMPI , Male , Middle Aged , Neuropsychological Tests , Quality of Life
13.
Epilepsia ; 39(1): 33-42, 1998 Jan.
Article in English | MEDLINE | ID: mdl-9578010

ABSTRACT

PURPOSE: We evaluated the dose-related impacts of tiagabine (TGB) on cognition and mood in a monotherapy study. METHODS: Patients were 123 adults with uncontrolled partial seizures, each treated with a single currently available antiepileptic drug (AED) for management of clinical epilepsy. They completed a battery of neuropsychological tests during an 8-week prospective baseline period and once again at the end of the 12-week fixed-dose period (or earlier if they dropped out of the study). Sixty-six patients were randomized to 6 mg/day TGB and 57 were randomized to 36 mg/day TGB. RESULTS: Few changes in either abilities or adjustment and mood were noted when all patients were considered as a single group. However, analysis of both dose and attainment of TGB monotherapy showed that patients receiving TGB monotherapy did best, improving particularly in the areas of adjustment and mood with low-dose TGB and in the area of abilities with high-dose TGB. Patients who did not attain monotherapy showed no change except that the high-dose group did not perform as well on measures of mood and adjustment. Baseline AED and changes in seizure control did not affect the results. CONCLUSIONS: Patients' attainment of TGB monotherapy was associated with their achievement of positive changes of varying degree on psychological tests. Failure to attain TGB monotherapy was associated with no changes on the tests except in patients receiving high-dose TGB where it appeared that some alterations in mood might have been avoided if a slower titration schedule had been used.


Subject(s)
Affect/drug effects , Anticonvulsants/pharmacology , Anticonvulsants/therapeutic use , Cognition/drug effects , Epilepsy/drug therapy , Nipecotic Acids/pharmacology , Nipecotic Acids/therapeutic use , Adolescent , Adult , Anticonvulsants/administration & dosage , Brief Psychiatric Rating Scale , Dose-Response Relationship, Drug , Double-Blind Method , Drug Administration Schedule , Female , Humans , Male , Neuropsychological Tests/statistics & numerical data , Nipecotic Acids/administration & dosage , Personality Inventory , Psychomotor Performance/drug effects , Quality of Life , Social Adjustment , Tiagabine , Treatment Outcome
14.
Neurology ; 49(4): 1180-2; author reply 1183-5, 1997 Oct.
Article in English | MEDLINE | ID: mdl-9339727
15.
Brain Lang ; 58(1): 70-91, 1997 Jun 01.
Article in English | MEDLINE | ID: mdl-9184096

ABSTRACT

The role of the nondominant hemisphere in reading is controversial. We characterized the reading errors made by 64 right-handed adults with complex partial seizures (half with seizure foci on the right and half on the left), after right hemisphere injection of sodium amobarbital. Subjects were presented with 20 six-word sentences and all were found to have speech associated with the left hemisphere only. A variety of reading errors occurred, most of which fell under the syndrome of "neglect dyslexia" including deletions and substitutions of whole words on the left side of a line of text as well as within-word neglect errors. The nature of these errors indicated that they may have been caused by an interaction between a peripheral processing deficit and more centrally located conceptual knowledge of linguistic structure. Other errors could be attributed to a general decrease in attentional mechanisms. Neglect errors at the level of the sentence occurred in the absence of neglect errors at the level of the word although the converse was not true. This suggests that the latter may represent a more severe deficit in the mechanism that causes the former. A double dissociation existed between single word neglect dyslexia errors and "visual" errors, indicating separate processing mechanisms.


Subject(s)
Amobarbital , Attention/physiology , Dominance, Cerebral/physiology , Hypnotics and Sedatives , Reading , Visual Perception/physiology , Adult , Attention/drug effects , Brain Mapping , Cerebral Cortex/drug effects , Cerebral Cortex/physiopathology , Dominance, Cerebral/drug effects , Electroencephalography/drug effects , Epilepsy, Complex Partial/diagnosis , Epilepsy, Complex Partial/physiopathology , Female , Humans , Male , Psycholinguistics , Retrospective Studies , Visual Perception/drug effects
16.
Neurology ; 48(4): 1025-31, 1997 Apr.
Article in English | MEDLINE | ID: mdl-9109894

ABSTRACT

Tiagabine blocks the uptake by neurons or glia of synaptically released GABA resulting in prolonged GABAergic activity and decreased likelihood of epileptic seizures. We evaluated the cognitive and quality of life effects of tiagabine in a double-blind, add-on, placebo-controlled, parallel, multicenter, dose-response efficacy study in patients with focal epilepsy whose complex partial seizures were difficult to control. One hundred sixty-two patients provided cognitive and quality of life data for the analyses and received the following treatments: placebo (n = 57), 16 mg/d tiagabine (n = 34), 32 mg/d tiagabine (n = 45), or 56 mg/d tiagabine (n = 26) at a fixed-dose for 12 weeks after a 4-week dose titration period. Eight cognitive tests and three measures of mood and adjustment were administered during the baseline period and again during the double-blind period near the end of treatment (or at the time of dropout). The patient groups were similar at entry into the study. Results showed no clinically important changes with the addition of tiagabine on the test battery. Although this is an encouraging finding, it remains for future investigations to determine the cognitive and behavioral effects of tiagabine either as monotherapy or in relation to other antiepileptic drugs.


Subject(s)
Anticonvulsants/administration & dosage , Cognition , Epilepsy, Complex Partial/drug therapy , Epilepsy, Complex Partial/psychology , Nipecotic Acids/administration & dosage , Quality of Life , Adolescent , Adult , Aged , Anticonvulsants/therapeutic use , Dose-Response Relationship, Drug , Double-Blind Method , Epilepsy, Complex Partial/physiopathology , Female , Humans , Male , Middle Aged , Nipecotic Acids/therapeutic use , Tiagabine , Treatment Outcome
17.
Neurology ; 48(4): 1037-40, 1997 Apr.
Article in English | MEDLINE | ID: mdl-9109896

ABSTRACT

We reviewed outcome at least 1 year after temporal lobectomy in 44 patients with bitemporal, independent, interictal epileptiform patterns on EEG. All 44 underwent preoperative intracranial monitoring. Twenty-two (50%) were seizure-free, 14 (32%) had at a least 75% reduction in seizures, and eight (18%) had less than a 75% reduction in seizures. We analyzed age of seizure onset, duration of epilepsy, gender, side of operation, history and clinical findings, findings on MRI, results of intracranial EEG-video monitoring, presence or absence of lateralizing neuropsychological deficits, and pathology of resected tissue to identify factors associated with outcome. Three factors emerged as independently associated with a good outcome: concordance of MRI abnormality and side of operation (p = 0.01), history of febrile seizures (p = 0.04), and 100% lateralization of intracranially recorded ictal onsets to the side of operation (p = 0.05). A seizure-free outcome was much more likely to occur if more than one of these factors was present: with at least two factors co-existing, 83% (15/18) of patients were seizure-free, while only 35% (7/20) were seizure-free with a single factor present (p = 0.0009). Of the six patients without any of the three factors, none were seizure-free. We conclude that it is possible to predict reasonably which patients with bitemporal epileptiform abnormalities will have a good outcome after surgery.


Subject(s)
Electroencephalography , Epilepsy/physiopathology , Epilepsy/surgery , Adolescent , Adult , Epilepsy/diagnosis , Female , Functional Laterality , Humans , Magnetic Resonance Imaging , Male , Medical Records , Middle Aged , Seizures, Febrile/complications , Temporal Lobe/surgery , Treatment Outcome
18.
Brain Cogn ; 33(2): 210-23, 1997 Mar.
Article in English | MEDLINE | ID: mdl-9073374

ABSTRACT

This paper has two objectives. The first is to compare three methods of amobarbital memory assessment in 172 adults prior to epilepsy surgery. The three methods are significantly different from one another and there was only a moderate degree of concordance between them; concordance depended upon the method, the side of surgery, and the side of speech. The second objective of the paper is to evaluate the relative abilities of the methods of differentiate, prior to surgery, patients who did and who did not suffer mild to moderate postoperative losses in verbal memory following surgery. To meet this objective a subsample of patients was selected based on the presence or absence of this type of memory loss. Significant differences in the ability of the amobarbital methods to identify the patients at risk for postoperative memory loss were observed, with the method assessing recall memory during drug presence having the best prediction rate.


Subject(s)
Amobarbital , Cerebral Decortication/adverse effects , Epilepsy, Temporal Lobe/surgery , Hypnotics and Sedatives , Memory Disorders/diagnosis , Memory Disorders/etiology , Neuropsychology/methods , Adult , Dominance, Cerebral/physiology , Epilepsy, Temporal Lobe/physiopathology , Female , Follow-Up Studies , Humans , Male , Neuropsychology/standards , Predictive Value of Tests , Prospective Studies , Speech/physiology
19.
Epilepsia ; 37(8): 748-52, 1996 Aug.
Article in English | MEDLINE | ID: mdl-8764813

ABSTRACT

PURPOSE: We wished to compare outcome 5 years after temporal lobectomy in 28 patients selected for surgery on the basis of interictal EEG patterns with that in 46 patients who underwent EEG-video monitoring studies as part of their preoperative evaluation during the same era. METHODS: The 28 nonmonitored patients had interictal EEG patterns that demonstrated a consistent, unilateral, anterior-midtemporal epileptiform focus, without discordant findings from other studies. Outcomes were assessed for years 4 and 5 after operation. RESULTS: Twenty-six of 28 (92.9%) nonmonitored patients were seizure-free or had at least 75% reduction in seizures. Twenty-nine of 46 (63.0%) monitored patients were seizure-free or had at least 75% reduction in seizures. Preoperative interictal EEGs of 29 of these patients showed independently localized bitemporal, extratemporal, midposterior temporal, or diffuse epileptiform patterns. The remaining 17 monitored patients had preoperative strictly unilateral anterior-midtemporal interictal discharges, and their outcome was comparable to the nonmonitored group, with 15 (88.8%) seizure-free or with at least 75% reduction in seizures. CONCLUSIONS: A proportion of candidates for epilepsy surgery can be selected without ictal recordings provided that interictal EEGs demonstrate consistent unilateral anterior-midtemporal epileptiform discharges and that other data are not discordant.


Subject(s)
Electroencephalography/methods , Epilepsy, Complex Partial/surgery , Monitoring, Physiologic , Temporal Lobe/surgery , Adolescent , Adult , Astrocytoma/pathology , Brain Mapping , Brain Neoplasms/pathology , Choristoma/pathology , Electrodes, Implanted , Epilepsy, Complex Partial/diagnosis , Epilepsy, Complex Partial/pathology , Female , Follow-Up Studies , Functional Laterality/physiology , Gliosis/pathology , Hamartoma/pathology , Humans , Male , Preoperative Care , Temporal Lobe/pathology , Temporal Lobe/physiopathology , Tomography, X-Ray Computed , Treatment Outcome
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