Cases reported "Epilepsy"

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1/145. lipoma of the corpus callosum.

    lipoma of the corpus callosum is a rare congenital condition, often asymptomatic, but which may present as epilepsy, hemiplegia, dementia, or headaches. This paper reviews the condition and reports the only two cases which are known to the Hospital for Sick Children, Great Ormond Street, london. The second case demonstrated the value of computerised axial tomography (EMI scan) in making the diagnosis and showing associated anomalies.
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2/145. Ictal paraphasia induced by language activity.

    Four patients with ictal speech disturbance were studied. Their seizures featured isolated, or series of, brief episodes of fluent paraphasia, paragraphia, and comprehension deficit. These episodes were often induced by language activity. Six patients with ictal paraphasia or paragraphia, as a recurrent habitual seizure, are reported in the literature. All ten cases, including the four cases described here and the six cases reported in the literature, featured patients who uttered meaningless speech fluently or displayed paragraphia. The syllables uttered during seizures contained many neologisms and resembled the neologistic jargon of patients with fluent aphasias of the Wernicke type. Nine patients had clusters or status of brief seizures and four patients had auditory hallucination as an ictal event. The seizures in six patients were easily induced by the use of language. Seizure focus was on the left side in all patients mentioned. The possibility of another type of language-induced seizures than those seen in reading epilepsy or language-induced epilepsy is suggested in which myoclonias of the jaw and face, or upper extremities are the main seizure types.
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3/145. Behavioral psychophysiological intervention in a mentally retarded epileptic patient with brain lesion.

    Behavioral psychophysiological treatment entailing Slow Cortical Potential (SCP) biofeedback training and behavioral self-control training was conducted with a 27-year-old male epileptic patient (seizures for 23 years) with Wechsler IQ 64 who underwent callosotomy. The patient had 12/week secondary generalized tonic-clonic seizures. The treatment, consisting of 43 SCP training sessions and 22 behavioral control sessions, yielded a highly significant reduction of seizure frequency to about 7.5/week; such a decrease had never been observed after administration of new anticonvulsant drugs, nor after the callosotomy. During SCP feedback training, the patient was able to produce highly-significant cortical differentiation of SCPs of about 4 microV. In addition, he developed several new behaviors indicating growing ability of self-perception and self-regulation. These findings suggest that a combination of SCP biofeedback with behavioral treatment of epilepsy can be used even in mentally retarded patients with organic brain disorders.
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4/145. Generalized absence seizures with 10-15 Hz fast discharges.

    OBJECTIVE: To report clinical and EEG features in 5 adults with unusual, fast rhythmic discharges accompanying absence seizures. DESIGN AND methods: The 5 patients presented with uncontrolled seizures. All had EEG-video monitoring with recorded seizures. Video seizures were reviewed and ictal as well as interictal epileptiform activity was analyzed. The patients were followed up after appropriate therapy for a minimum of 6 months. RESULTS: There were 3 women and two men, with a mean age of 37 years (range: 23-59). Two patients had onset of absence seizures in childhood, one in adolescence and two after age 20. All patients also had generalized tonic-clonic seizures. Ictal EEG recordings showed generalized spike and wave (SW) discharges of variable dominant frequencies (2.5-6 Hz) and intermingled 10-15 Hz generalized rhythmic discharges which also occurred in isolation or as the dominant activity. Interictal recordings showed similar but shorter 2.5-6 Hz generalized SW discharges. The background activity was normal in 3 patients and mildly slow in two who had very frequent absence seizures during the recording period. Four patients became seizure free and one had 75% improvement on appropriate antiabsence therapy. CONCLUSIONS: The fast 10-15 Hz rhythmic discharges that we report appear to occur mostly in adult patients with absence, as well as, generalized tonic-clonic seizures. They can occur in isolation or be embedded in more typical SW discharges accompanying typical absence seizures. Their presence does not imply a poor prognosis for seizure control.
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5/145. Fatal liver failure associated with valproate therapy in a patient with Friedreich's disease: review of valproate hepatotoxicity in adults.

    PURPOSE: Valproate (VPA)-associated hepatotoxicity is usually considered a problem of young children with polytherapy, mental retardation, and underlying metabolic defects. methods: An adult patient with fatal liver failure during treatment with VPA is presented, and a review of the literature on other adult patients is given. RESULTS: A 29-year-old female patient with Friedreich's ataxia and partial seizures with acute liver failure during VPA treatment is reported. The first symptoms of liver failure (i.e., apathy during febrile upper airway infection) occurred 2 months after starting VPA therapy. VPA was discontinued 10 days later on hospital admission, when she had hepatic encephalopathy and severe bleeding diathesis. The patient died of severe liver failure and bronchopneumonia after 4 weeks of supportive treatment. CONCLUSIONS: Twenty-six adult patients (>17 years) with VPA-associated fatal hepatotoxicity have been reported in the literature. Of the 26 adult patients, three were receiving VPA monotherapy. The age ranged between 17 and 62 years. The duration of VPA treatment before the first symptom varied between 7 days and 6 years. Twelve of the 26 affected adults had no underlying disease or a clearly nonmetabolic and non-hepatic disease. Therefore VPA-associated severe side effects also must be considered in adult patients without any evidence of a metabolic defect or underlying neurologic disease.
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6/145. MR artifact mimicking a temporal lobe lesion in an epilepsy patient.

    A ten-year-old healthy child presented with a right upper extremity focal seizure which secondarily generalized. magnetic resonance imaging (MR) revealed a 1-cm area of abnormal signal intensity in the left posterior temporal lobe at the gray-white junction. This did not appear on all imaging sequences, raising the suspicion of an artifact. Repeat MR revealed no intracranial or extracranial pathology. This case illustrates MR 'wrap around' artifact that mimicked a temporal lobe abnormality in an epilepsy patient. The physics of MR are reviewed as they pertain to this artifact.
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7/145. Reproducible localization of interictal epileptiform discharges using EEG-triggered fMRI.

    We report preliminary experiences using fMRI triggered by EEG to localize the site of interictal epileptiform activity. EEG was recorded in the scanner and monitored on-line; the recording quality was good enough to allow the clear identification of spikes in the EEG. Snap-shot EPI was performed 2-4 s after an epileptiform discharge ('spike') or after at least 10 s of background activity ('rest') was observed. A pixel-by-pixel t-test was performed between the 'rest' and the 'spike' images to determine areas of significant activation. Significant activation was obtained in a patient with epilepsy. To assess the reliability and reproducibility of the technique, the patient was scanned on four separate occasions with similar areas being activated in all the studies, confirming the validity of the result.
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8/145. Corpus callosotomy with radiosurgery.

    OBJECTIVE: Corpus callosotomy is a surgical option for medically uncontrolled generalized epilepsy in appropriate patients. Because numerous complications related to open callosotomy are still reported, we performed radiosurgical corpus callosotomy with the gamma knife. methods: Between October 1992 and June 1995, three patients underwent stereotactic radiosurgery to ablate the anterior third of the corpus callosum. The patients had intractable epilepsy: two had Lennox-Gastaut syndrome, and one had multifocal epilepsy with atonic, tonicoclonic, and atypical absence seizures. The history of seizures ranged from 20 to 37 years' duration. Stereotactic radiosurgery was performed with a cobalt-60 gamma knife using a 4-mm collimator, targeted to the rostrum, genu, and anterior third of body of the corpus callosum. Two patients were treated once with 150 and 160 Gy at maximum, respectively, and one patient was treated in two stages with 50 Gy and then 170 Gy at maximum. RESULTS: The severity and frequency of seizures were significantly reduced in all three patients. The types of seizures associated with the most improved outcome were atonic and generalized tonicoclonic seizures. The mean follow-up period was 38 months. hospitalization required for this procedure was 3 days. No complications related to irradiation were recorded except transient headache in one patient. CONCLUSION: The outcomes suggest that radiosurgical corpus callosotomy may be a promising alternative treatment to open callosotomy.
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keywords = headache
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9/145. Activation of the remaining hemisphere following stimulation of the blind hemifield in hemispherectomized subjects.

    We used functional magnetic resonance imaging (fMRI) to investigate the neural substrates mediating residual vision in the "blind" hemifield of hemispherectomized patients. The visual stimuli were semicircular gratings moving in opposite directions on a dynamic random-dot background. They were specifically constructed to eliminate intra- and extraocular light scatter and optimize the activation of extrastriate cortical areas and their subcortical relays. Multislice T2*-weighted gradient echo (GE) echoplanar imaging (EPI) images (TR/TE = 4 s/45 ms, flip angle 90 degrees ) were acquired during activation and baseline visual stimulation. An activation minus baseline subtraction was performed, and the acquired t statistic map transformed into the stereotaxic coordinate space of Talairach and Tournoux. In seven normal control subjects, right hemifield stimulation produced significant activation foci in contralateral V1/V2, V3/V3A, VP, and V5 (MT). Significant activation was also produced in homologous regions of the right occipital lobe with left hemifield stimulation. Stimulation of the intact hemifield in hemispherectomized patients resulted in activation of similar areas exclusively within the contralateral hemisphere. Stimulation of the anopic hemifield produced statistically significant activation in the ipsilateral occipital lobe (putative area V5 or MT) and areas V3/V3A in the only subject with blindsight. We conclude that the remaining hemisphere may contribute to residual visual functions in the blind hemifield of hemispherectomized patients, possibly through the collicular-pulvinar route since the activated areas are known to receive their afferents from these subcortical nuclei.
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10/145. The biological effects of magnetic stimulation in epileptic patients.

    BACKGROUND: The magnetoencephalogram (MEG) is the magnetic activity emitted by the brain, which can be measured using a superconductive quantum interference device (SQUID). This is a totally non-invasive method for localizing functional healthy, epileptic and other CNS brain disorders. methods: Using the MEG brain activity recorded from epileptic patients we were able to obtain a mapping technique characterized by the ISO-spectral amplitude of scalp distribution of the MEG Fourier power spectrum. In addition, by utilizing the above recorded MEG activity we energize an electronic device, which emits back to the abnormal brain points of the epileptic patients magnetic fields with proper frequencies and intensities. RESULTS: Using this method we present here in more detail three randomly selected epileptic patients in which application of external magnetic fields of low intensities and frequencies produced a substantial attenuation of their abnormal brain activity. Furthermore, we present a statistical analysis of 50 randomly selected epileptic patients who underwent magnetic stimulation for the treatment of their seizures and we found that the anticonvulsant response to magnetic stimulation was statistically significant (chi 2 = 6.55, df = 1, p < 0.02). CONCLUSIONS: Our findings indicate that the use of low external magnetic fields produce substantial attenuation in seizure activity in epileptic patients and therefore it may open new ways in the future for management of epileptic activity.
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