Anti-epileptic drugs improved serial 7s scores on the Mini-Mental State Examination in elderly with cognitive impairment and epileptiform discharge on electroencephalography.

AIM: As the population ages, epilepsy among elderly people is increasing. Epileptic seizures in the elderly are mostly complex partial seizures without convulsions, so more caution is needed in the diagnosis of epilepsy. If epileptic seizures in the context of memory impairment are overlooked, epilepsy may be misdiagnosed as dementia. However, in older patients with epilepsy, there is a possibility that cognitive function may be impaired in the interictal phase. This study aims to investigate the efficacy of anti-epileptic drug (AED) treatment for patients with cognitive impairment and interictal epileptiform discharge (IED) on electroencephalography. METHODS: The outcome of AED administration in 50 patients who exhibited IED was retrospectively investigated. Their cognitive functions were assessed by the Mini-Mental State Examination (MMSE) at both baseline and after AED administration. RESULTS: In all patients who underwent electroencephalography, IED were temporal spikes, and re-examination of the 50 patients revealed that the frequency of temporal spikes had decreased or else disappeared in 41 patients (82%) after AED administration. In these 41 patients, the mean MMSE score significantly increased from 23.4 ± 3.7 at baseline to 24.7 ± 4.8 after AED treatment (P <0.01). Similarly, the mean serial 7s score (MMSE subscale) also improved significantly from 2.5 ± 1.8 to 3.6 ± 1.6 (P <0.01). The MMSE score was significantly improved only in the 41 patients with recovery of IED. CONCLUSION: AED treatment for elderly amnestic patients with temporal spikes was effective in improving cognitive decline and related electroencephalographic abnormalities. A more thorough search of IED is necessary in elderly amnesic patients because there is a possibility that IED modifies cognitive function.

A qualitative and quantitative electron microscopic study of differences in adrenomedullary adrenaline cells between golden hamsters and rats, with special reference to the Golgi apparatus.

Ultrastructural features of adrenomedullary adrenaline (A) cells in golden hamsters and rats were investigated qualitatively and quantitatively with special reference to the Golgi apparatus. The A cells displayed a characteristic follicular arrangement, with each cell showing structural polarity in hamsters, but not apparently in rats. In hamsters, the Golgi apparatus of A cells was larger (t-test: P<0.001) and more frequently showed large and complexly organized structures (chi(2)-test: P<0.005) compared with that of rats. Quantitative analysis of the Golgi apparatus revealed differences in the size and numerical density of Golgi vesicles in relation to the animal species and region. Two-way analysis of variance (ANOVA) confirmed species difference in the size of coated vesicles (P<0.005) and interaction between species and region concerning the size of smooth-clear vesicles (P<0.01) and numerical density of granular vesicles (P<0.05). One-way ANOVA revealed regional differences in the size and numerical density of smooth-clear vesicles in rats and hamsters (P<0.01 approximately 0.001), and in the numerical density of coated vesicles in hamsters (P<0.05). Data were further analyzed by Tukey-Kramer's method. These and other reported results suggest that, in hamster A cells, the Golgi apparatus has different structural, molecular, and functional mechanisms which are at least partly related to the distinct cellular polarity and higher concentration of peptide hormones in secretory vesicles, and that in rat A cells, in contrast, loading secretory vesicles with A during the post-Golgi stage is predominant. In conclusion, the Golgi apparatus in hamster A cells shows markedly different ultrastructural features compared with that in rat A cells.

Statistics on deliveries of mothers with epilepsy at Yokohama City University Hospital.

PURPOSE: To survey and summarize the treatment of pregnant women with epilepsy and to obtain data for the improvement of daily treatment regimens. METHODS: We reviewed medical records of 36 deliveries of 25 mothers with epilepsy at Yokohama City University Hospital from September 1991 to December 2000 and statistically compared the differences in drug-taking profiles, complications during pregnancy, types of delivery, and complications at delivery between the epilepsy group and a control group (656 total deliveries after 22 weeks except for epilepsy cases in 1991 and 1992 at Yokohama City University Hospital). RESULTS: Of the 25 mothers with epilepsy, three with idiopathic generalized epilepsy, 12 were symptomatic for partial epilepsy. Their mean age at delivery was 29.0 years. The mean age at onset of epilepsy was 13.9 years. Of the 36 pregnancies, 30 (83.3%) cases continued antiepileptic drug (AED) taking throughout the pregnancies; 23 (63.9%) cases received monotherapy. Phenobarbital was the most frequently used drug in monotherapies. Seven (19.4%) cases received polytherapy. Seven (19.4%) patients experienced epileptic seizures during pregnancy. One case showed a low serum AED level. No statistically significant difference was found in complications during pregnancy, types of delivery, or complications at delivery, excluding abnormal rotation in the birth canal. Congenital malformation (cleft lip with palate) was observed in one (2.9%) case. The mother was 39 years old at delivery and had myoma uteri. Onset of epilepsy was at 14 years. She had been taking three kinds of AEDs: 1,400 mg/day of sodium valproate (VPA), 1.5 mg/day of clonazepam (CZP), and 200 mg/day of zonisamide (ZNS). Serum concentrations at pregnancy week 10 were 85.3 microg/ml VPA, 18.1 microg/L CZP, and 10.5 microg/ml ZNS. She also had been taking folic acid, 5 mg/day, but the serum concentration was not measured. CONCLUSIONS: The method of treatment and the management of pregnancy were left to the discretion of each doctor. However, in most cases, monotherapy was selected; and the frequency of complications was not significantly different from that of the control group, excluding the frequency of abnormal rotation in the birth canal. However, we could have been more proactive in calculating the risks of pregnancy for women with epilepsy and adjusted treatment in anticipation of a planned pregnancy, before the patient actually became pregnant. Additionally, a closer working relationship between the obstetrician and the physician who treats the epilepsy would seem to be a further requirement for the patient's well-being, as well as her child's, during pregnancy.

[Signet ring cell carcinoma of the urinary bladder: a case report].

A 69-year-old man was admitted complaining of macroscopic hematuria. Cystoscopic examination revealed a non-papillary tumor at the anterior wall of the urinary bladder. A pelvic computed tomographic (CT) scan showed marked thickening of the anterior bladder wall. Radical cystectomy and bilateral ureterocutaneostomy were performed. Histopathological examination revealed signet ring cell carcinoma of the bladder, stage pT3bN1M0. This tumor is rare, and has a poor prognosis. Our patient has been well without any evidence of disease 6 months after surgery. To the best of our knowledge, there are 44 reported cases, and our case is the 45th in Japan.