1/7. Partial seizures with focal epileptogenic electroencephalographic patterns in three related female patients with fragile-X syndrome.epilepsy and abnormal electroencephalographic (EEG) patterns have been reported in mentally retarded males with fragile-X syndrome, but the high incidence of epilepsy in such persons has been recognized only recently. These individuals have focal spikes in the EEG similar to the benign rolandic pattern. female carriers have very rarely been reported to have epilepsy or nonspecific abnormal EEG patterns. We report partial seizures with a focal epileptogenic EEG pattern in two sisters and their grandmother, who are all carriers of fragile-X syndrome. The sisters have mild developmental delay, but the grandmother is of normal intelligence. The mother of the two sisters is known to be a carrier of the fragile-x chromosome and is of normal intelligence, with no history of seizures. It is important for physicians to be aware of the possibility that females presenting with partial seizures of unknown cause may be fragile-X carriers, and enquiry for a family history of intellectual disability should be pursued.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/7. A case of neurocysticercosis-differential diagnostic aspects.neurocysticercosis is no medical rarity but in non-endemic countries especially, a high degree of physician awareness is necessary for diagnosis. The case of a German female patient who had focal seizures for the first time at the age of 23 caused by a cerebral cyst of cysticercus cellulosae is presented. Only surgical removal and subsequent histological examination allowed diagnosis while diagnostic investigation yielded no pathological findings.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/7. High-velocity bullet causing indirect trauma to the brain and symptomatic epilepsy.epilepsy is a frequent consequence after missile wounds of the brain. So far, no epilepsy cases with missile injury have been described in which epilepsy ensued without direct missile injury of the brain. During world war ii, in 1941, our patient, then a soldier in the German army, suffered a bullet injury to the head; the bullet entered the cranium at the base of the nose. The bullet penetrated the head below the base of the cranium and remained stuck subcutaneously left of the second cervical vertebra. In the field hospital the patient suffered from focal seizures. The fits ceased within a few years under medication. In 1990 the seizures returned, this time with secondary generalization. In our case, a 7.62-mm bullet from the Russian Tokarev military pistol was used, which is known to have the highest muzzle velocity of all handguns available (> 500 m per second). We suspect that the so-called hydrodynamic effect of this high-velocity bullet caused an indirect trauma to the brain. This case shows that symptomatic epilepsy can occur after a penetrating head injury, without direct injury to brain tissue by a missile. High-velocity missiles are increasingly used in armed conflicts around the world. In light of the case reported here, in which the initial epilepsy was exacerbated more than 50 years after the wounding event, physicians must consider this possibility when dealing with veterans presenting with seizures. This case also has implications for the payment of benefits and pensions.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/7. Selective mutism and obsessive compulsive disorders associated with zonisamide.We treated 27 children with idiopathic epilepsy with zonisamide monotherapy over a period of 2 years and observed behaviour disturbances in a prospective study. In all cases, seizure control was excellent; however, two cases (7.4%) had behaviour disturbances. The first (Case 1) was a 14-year-old girl with partial epilepsy which began at age 4 years. Zonisamide was administered at age 6 years, which was effective against her seizures, but selective mutism, violent behaviour, and lack of concentration developed at age 10 years. The second (Case 2) was a 15-year-old girl with generalized tonic-clonic seizures which began at age 10 years. Zonisamide was also effective against her seizures, but obsessive compulsive disorders (OCD) developed at age 13 years. The patients have had no other physical or mental problems and decreasing the dosage of zonisamide reduced the problems. There are few reports of behaviour disturbances provoked by zonisamide monotherapy in epileptic children who are neither physically nor mentally disturbed. While problems can develop several years later, in the present study, decreasing the zonisamide dosage maintained adequate prevention of seizures and eliminated the behaviour disturbances. Zonisamide is still a useful anticonvulsant for epileptic seizures, but physicians should be wary of its adverse behavioural side effects, which may arise several years later.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/7. Benign familial infantile convulsions: a clinical study of seven Dutch families.Benign familial infantile convulsions (BFIC) is a recently identified partial epilepsy syndrome with onset between 3 and 12 months of age. We describe the clinical characteristics and outcome of 43 patients with BFIC from six Dutch families and one Dutch-Canadian family and the encountered difficulties in classifying the syndrome. Four families had a pure BFIC phenotype; in two families BFIC was accompanied by paroxysmal kinesigenic dyskinesias; in one family BFIC was associated with later onset focal epilepsy in older generations. Onset of seizures was between 6 weeks and 10 months, and seizures remitted before the age of 3 years in all patients with BFIC. In all, 29 (67%) of the 43 patients had been treated with anti-epileptic drugs for a certain period of time. BFIC is often not recognized as (hereditary) epilepsy by the treating physician. seizures often remit shortly after the start of anti-epileptic drugs but, because of the benign course of the syndrome and the spontaneous remission of seizures, patients with low seizure frequency do not necessarily have to be treated. If prescribed, anti-epileptic drugs can probably be withdrawn after 1 or 2 years of seizure freedom.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/7. Cryptococcal meningitis manifesting as epilepsia partialis continua of the abdomen.We report a case of epilepsia partialis continua that primarily involved the abdominal muscles. Thorough assessment ultimately showed that the condition was due to cryptococcal meningitis. Surface electrode electromyography and electroencephalography were helpful in analyzing this unusual epileptic phenomenon. An 8-week treatment regimen of amphotericin b and a 30-day course of 5-fluorocytosine abolished the epilepsia partialis continua and cured the meningitis. This case should alert physicians to the fact that patients with epilepsia partialis continua may have clonic movements of only the trunk and that the spectrum of neurologic manifestations of cryptococcal infection must now include this seizure disorder.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/7. carbamazepine substitution in severe partial epilepsy: implication of autoinduction of metabolism.Established partial seizures are often refractory to treatment and many patients receive polypharmacy. An attempt was made to improve seizure control with the substitution of carbamazepine (CBZ) for existing treatment in 7 consecutive unremitting cases of partial epilepsy referred by their physicians as 'intractable'. This produced a significant improvement in control of partial (P less than 0.02) and secondary generalized (P less than 0.01) seizures, with 5 patients experiencing a 50% or greater reduction in seizure frequency. A single patient suffered a generalized seizure during the period of changeover. In 3 cases auto-induction of CBZ metabolism resulted in temporary loss of seizure control which was restored by an increase in dose. A policy of planned substitution of CBZ in partial epilepsy previously regarded as intractable may be successful in selected patients. The possible deleterious effect of CBZ auto-induction should be anticipated.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |