1/11. Convulsive syncope following placement of sphenoidal electrodes.Two cases of convulsive syncope following the insertion of sphenoidal electrodes are reported. The episodes occurred shortly after an uneventful insertion of the needle. Both patients exhibited behavioral arrest with loss of muscle tone, followed by flexor posturing, jerking of the extremities, then followed by what appeared to be a panic attack. Episodes were clinically distinct from the patients' typical spells and were initially interpreted as representing psychogenic events. EEGs during the episodes showed diffuse slowing followed by generalized suppression of rhythms. Simultaneous EKG showed bradycardia followed by brief asystole and then resumption of normal heart rhythms in both cases. Vagally mediated cardioinhibitory reactions induced by fear, pain and possibly stimulation of branches of the trigeminal nerve in the face represent an uncommon but potentially serious complication of placement of sphenoidal electrodes.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
2/11. Preventive social work intervention with families of children with epilepsy.The need for preventive social work intervention with families of children with epilepsy is discussed. Issues in such counseling are identified as (a) exploring fantasies and fears about epilepsy, (b) interpreting facts about this disorder, (c) assisting parents in establishing realistic behavioral expectations and limits for the child, and (d) enabling parents to disclose information about the child's condition in such a way as to be beneficial to the child. This paper addresses itself to the needs of normal families with adjustment problems in coping with the child's epilepsy.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
3/11. Omental transplantation for epilepsy.Residual seizures after functional hemispherectomy occur in approximately 20% of patients with catastrophic epilepsy. These episodes are traditionally attributed to incomplete disconnection, persistent epileptogenic activity in the ipsilateral insular cortex, or bilateral independent epileptogenic activity. The authors report on the case of an 8-year-old boy with an intractable seizure disorder who had classic frontal adversive seizures related to extensive unilateral left hemispheric cortical dysplasia. The initial intervention consisted of extensive removal of the epileptic frontal and precentral dysplastic tissue and multiple subpial transections of the dysplastic motor strip, guided by intraoperative electrocorticography. Subsequently, functional hemispherectomy including insular cortex resection was performed for persistent attacks. After a seizure-free period of 6 months, a new pattern ensued, consisting of an aura of fear, dystonic posturing of the right arm, and unusual postictal hyperphagia coupled with an interictal diencephalic-like syndrome. electroencephalography and ictal/interictal single-photon emission computerized tomography were used to localize the residual epileptic discharges to deep ipsilateral structures. Results of magnetic resonance imaging indicated a complete disconnection except for a strip of residual frontobasal tissue. Therefore, a volumetric resection of the epileptogenic frontal basal tissue up to the anterior commissure was completed. The child has remained free of seizures during 21 months of follow-up review. Standard hemispherectomy methods provide extensive disconnection, despite the presence of residual frontal basal cortex. However, rarely, and especially if it is dysplastic, this tissue can represent a focus for refractory seizures. This is an important consideration in determining the source of ongoing seizures posthemispherectomy in patients with extensive cortical dysplasia. It remains important to assess them fully before considering their disease refractory to surgical treatment.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
4/11. Familial rectal pain: a type of reflex epilepsy?We studied 2 members of a family suffering from paroxysmal attacks elicited by tactile stimuli. The attacks consist of burning pain of the stimulated body part, followed by either complete collapse or tonic posturing. Noxious stimuli provoke episodes regardless of their somatic location, whereas it is only necessary for nonnoxious stimuli to be applied to specific trigger zones, such as the rectum, to provoke attacks. Episodes are most commonly precipitated by bowel movement, leading to extreme fear of defecation and resultant fecal retention. An ictal electroencephalographic video recording revealed only slowing of the background; however, serum prolactin was significantly elevated postictally. The attacks were completely suppressed by carbamazepine and resumed on discontinuing the medication. These attacks may represent a form of reflex epilepsy manifested by autonomic nervous system dysfunction.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
5/11. seizures of fronto-orbital origin: a proven case.Distinguishing characteristics of seizures of frontal origin have not been clearly delineated. We describe a case of seizures of proven fronto-orbital origin to provide further definition of characteristics of seizures arising in that lobe. A 36-year-old man had medically intractable seizures since age 8 years. Clinically the seizures were stereotyped, with cessation of activity followed by turning of head and body to the right and then by struggling, kicking, and vocalizations indicating fear. Total seizure duration was approximately 30 s, with an apparent abrupt return of consciousness. The interictal scalp EEGs were similar to those of primary generalized epilepsy, with bisynchronous though asymmetric epileptiform activity anteriorly. Ictal scalp recordings were not localizing. Recordings from bilateral frontal and temporal subdural electrodes showed an electrical focus in the right fronto-orbital region which was confirmed by electrocorticography (ECoG) at the time of craniotomy. The right fronto-orbital cortex was resected and on pathologic examination showed gliotic tissue and intracytoplasmic neuronal inclusions of periodic acid-Schiff (PAS)-positive granules consistent with lipofuscinosis. The patient has remained seizure-free for 6 years after operation.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
6/11. Ictus emeticus and the insular cortex.A 30-year-old man had a long history of seizures that began with feelings of tightness in his throat and fear, followed by projectile vomiting and head and eye deviation to the left. These episodes were not completely controlled by antiepileptic medications. Video EEG monitoring confirmed his clinical description. Corticography was performed before and after temporal lobectomy and revealed residual spikes in the unresectable tissue of the insula. Three years postoperatively he has had no seizures with vomiting but has occasional 'auras' of throat tightening and fear. The case suggests that the insula may be a trigger area for emesis but requires anterior-mesial temporal cortex for completion.- - - - - - - - - - ranking = 2keywords = fear (Clic here for more details about this article) |
7/11. Panic attacks as ictal manifestations of parietal lobe seizures.Although most panic attacks appear to be primary psychiatric disturbances, some evidence suggests a biologic basis for panic disorder, possibly associated with temporal lobe dysfunction. fear is a common affective change associated with some complex partial seizures (CPS) originating from the right temporal lobe. We describe a previously unreported association between panic attacks and seizures originating from the parietal lobe in 2 patients with right parietal lobe tumors. Intracranial monitoring documented correlations between the symptoms of fear and restricted regional parietal cortical discharges. Surgical resections of the lesions (one total, one subtotal) resulted in complete recovery or improvement.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
8/11. Impaired auditory recognition of fear and anger following bilateral amygdala lesions.The amygdalar complex is a medial temporal lobe structure in the brain which is widely considered to be involved in the neural substrates of emotion. Selective bilateral damage to the human amygdala is rare, offering a unique insight into its functions. There is impairment of social perception after amygdala damage, with defective recognition of facial expressions of emotion. Among the basic emotions, the processing of fear and anger has been shown to be disrupted by amygdala damage. Although it remains puzzling why this not found in all cases, the importance of the amygdala in negative emotion, and especially fear, has been confirmed by conditioning, memory and positron emission tomography (PET) experiments. Central to our understanding of these findings is the question of whether the amygdala is involved specifically in the perception of visual signals of emotion emanating from the face, or more widely in the perception of emotion in all sensory modalities. We report here a further investigation of one of these rare cases, a woman (D.R.) who has impaired perception of the intonation patterns that are essential to the perception of vocal affect, despite normal hearing. As is the case for recognition of facial expressions, it is recognition of fear and anger that is most severely affected in the auditory domain. This shows that the amygdala's role in the recognition of certain emotions is not confined to vision, which is consistent with its being involved in the appraisal of danger and the emotion of fear.- - - - - - - - - - ranking = 8keywords = fear (Clic here for more details about this article) |
9/11. Open trial lamotrigine in the treatment of self-injurious behavior in an adolescent with profound mental retardation.This single case reports an open trial of lamotrigine in the treatment of self-injurious behavior (SIB) and epilepsy in an 18-year-old female diagnosed with generalized seizure disorder, stereotypic movement disorder, and compulsive SIB in the context of profound mental retardation. Animal models of SIB suggest that the glutamate neurotransmitter systems, involved in the generation of epileptic seizures, may also have a role in the pathophysiology of SIB. Data suggesting that lamotrigine may decrease glutamate release encouraged an empirical trial of lamotrigine for treatment of SIB. After 4 weeks of treatment of lamotrigine 200 mg daily, decreases in agitation and fearfulness were clinically observed, along with a 50% reduction in the frequency of SIB as measured by standardized scales. Good seizure control was maintained throughout the trial. No significant adverse effects were observed. Positive effects persisted at 1-year follow-up. Symptoms of stereotypic movement disorder appeared unchanged. Because these findings are preliminary, no clinical recommendations for the treatment of SIB with lamotrigine can be made until controlled studies have been completed.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
10/11. Cavernous angioma presenting as pregnancy-related seizures.PURPOSE: To determine the reason that one-quarter to one-third of epileptic women experienced an increased number of seizures during pregnancy. The cause of this increase is not always clearly understood and the principle emphasis of the literature is on the pregnancy-associated changes of anticonvulsant pharmacokinetics. methods: Two patients presented with recurrent seizures occurring only during pregnancy. Both had MRI findings typical of cavernous angiomas of the temporal lobe. RESULTS: In addition to changes in anticonvulsant pharmacokinetics, potential mechanisms underlying the exacerbation of seizures from a vascular malformation during pregnancy include effects of estrogen on temporal structures critically involved in epileptogenesis and changes within the malformation itself secondary to direct actions of estrogen and the hemodynamic changes of pregnancy. CONCLUSIONS: The possibility of an occult lesion such as cavernous angioma should be considered for seizures occurring during pregnancy. Even in the presence of a normal CT scan, an MRI investigation should be pursued, despite the ill-defined fears of MRI in pregnancy.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
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