Successful epilepsy surgery in catastrophic postencephalitic epilepsy

The authors studied prognostic factors for surgical treatment in 22 patients with intractable postencephalitic epilepsy. A small subgroup of patients (9/22) had a positive outcome after resective surgery. They had a higher functional level after encephalitis as measured by Glasgow Outcome Score, a longer time interval between encephalitis and onset of seizures, and localization of ictal EEG to one temporal lobe. The other patients had devastating seizures with poor outcome after surgery.     

Object naming in epilepsy and epilepsy surgery

The ability to express oneself verbally is critical for success in academic, occupational, and social domains. Unfortunately, word-finding or “naming” difficulty is the most common cognitive complaint among individuals with temporal lobe epilepsy (TLE), and a substantial body of work over the past several decades has documented naming impairment in left (language-dominant) TLE, with further risk to naming ability following left temporal lobe resection for seizure control. With these findings well established, this paper reviews more recent work that has aimed to identify the neuroanatomical substrates of naming, understand how adverse structural and functional effects of TLE might impinge upon these brain regions, predict and potentially reduce the risk of postoperative naming decline, and begin to understand naming difficulty in TLE from a developmental perspective. Factors that have confounded interpretation and hindrances to progress are discussed, and suggestions are provided for improved empirical investigation and directions for future research.     

Intellectual functioning in children with epilepsy: Frontal lobe epilepsy,childhood absence epilepsy and benign epilepsy with centro-temporal spikes

PurposeThe purpose of our study is to describe intellectual functioning in three common childhood epilepsy syndromes – frontal lobe epilepsy (FLE), childhood absence epilepsy (CAE) and benign epilepsy with centro-temporal spikes (BECTS). And also to determine the influence of epilepsy related variables, type of epilepsy, age at epilepsy onset, duration and frequency of epilepsy, and treatment on the scores.MethodsIntellectual functioning was examined in a group of 90 children with epilepsy (30 FLE, 30 CAE, 30 BECTS), aged 6–15 years, and compared with a control group (30). All subjects obtained a Full Scale IQ ≥ 70 and they were receiving no more than two antiepileptic medications. Participants completed the Wechsler Intelligence Scale for Children – Third Edition. The impact of epilepsy related variables (type of epilepsy, age at epilepsy onset, duration of epilepsy, seizure frequency and anti-epileptic drugs) on intellectual functioning was examined.ResultsChildren with FLE scored significantly worse than controls on WISC-III Verbal IQ, Full Scale IQ and Processing Speed Index. There was a trend for children with FLE to have lower intelligence scores than CAE and BECTS groups. Linear regression analysis showed no effect for age at onset, frequency of seizures and treatment. Type of epilepsy and duration of epilepsy were the best indicators of intellectual functioning.ConclusionIt is crucial that children with FLE and those with a longer active duration of epilepsy are closely monitored to allow the early identification and evaluation of cognitive problems, in order to establish adequate and timely school intervention plans.     

Eating epilepsy

The clinical and EEG profiles of 13 cases of eating epilepsy are described. Temporal lobe epilepsy (TLE) formed the seizure type in 12 cases. In all but one case, the seizures were precipitated only by eating a heavy meal. In ten cases EEG showed interictal seizure discharges. EEG recordings were obtained from 12 patients during and after eating. In two patients clinical attacks (TLE) could be induced by eating in the laboratory. There was a good response to conventional anticonvulsants in only 3 cases. Alteration of eating habits helped in controlling reflex seizures in 2 cases. Various mechanisms of reflex precipitation of seizures by eating are discussed.     

Depression in temporal lobe epilepsy before epilepsy surgery

PURPOSE: This study examined the association of depression with laterality of epilepsy surgery in patients with temporal lobe epilepsy before standard lobectomy. METHODS: Forty-nine patients presented for EEG telemetry for localization of epilepsy and eventual temporal lobectomy. Patients underwent routine neuropsychiatric evaluation blinded for epileptic focus, including ratings on depression. Patients were grouped according to right (n = 25, M = 10/F = 15) and left (n = 24, M = 13/F = 11) temporal lobectomy. Analysis of variance included side of surgery as grouping variable and sex, general depressive, cognitive depressive, and vegetative depressive symptoms as dependent variables. Chi2 analyses included categoric variables of sex, handedness, education, neuropathologic findings, and current affective disorders. t Tests were performed on variables of age, epilepsy duration, and cognitive function. RESULTS: Right and left temporal epilepsy groups did not differ with regard to sex, handedness, age, duration of epilepsy, education, cognitive function, and neuropathology. Patients with right temporal epilepsy rated higher on general, cognitive. and vegetative depression scores. Women scored higher on general, cognitive, and vegetative depression scores. Current affective disorders were more common in the right temporal epilepsy group. CONCLUSIONS: Depression ratings and diagnoses were more prominent in patients with right temporal lobe epilepsy and in women in particular. The strength of this laterality finding lies in the selection of patients, as all underwent epilepsy surgery. The finding on gender difference partly reflects the higher incidence of depression in women and needs further exploration. The laterality finding contrasts with recent findings in epilepsy, stroke, and trauma that associate depression with left hemispheric lesions. However, our results are consistent with findings in electrically hyperactive lesions such as gelastic and dacrystic epilepsy.     

Reading epilepsy

This is a report of a 21-year-old woman with reading epilepsy. Clinical and electroencephalographic (EEG) observations are presented while the patient read a news magazine in Spanish, read a magazine in English, read an announcement repetitively, viewed comic strips without legends, made a mathematical calculation. Only reading in Spanish produced clinical and EEG paroxysms. This case report supports the "communication" hypothesis as opposed to hypotheses that emphasize proprioceptive and other "lower order" stimuli in evoking seizures while reading.     

Eating epilepsy

Summary The term reflex epilepsy denotes epilepsies characterized by a specific mode of seizure precipitation. Seventeen patients in whom the act of eating precipitated seizures are described. Interictal EEG showed generalized seizure discharges in three and focal discharges in five patients. In four patients EEG was recorded during eating. In one of these, the frequency of seizure discharge increased, but none had a clinical seizure during the recording. Eating epilepsy is predominantly a disorder of young adults, and the triggering mechanisms are extremely complex and elaborate. The role of the limbic system and amygdala in the precipitation of eating-induced seizures is discussed.     

Eating epilepsy

Fifty cases of eating epilepsy (EE) are reported. Mastication of food produced seizures in 49 (98%) and swallowing in 1 (2%). Complex partial seizure was found in 48 cases, the commonest form encountered (96%). EEG was abnormal in 15 cases (30%). The literature and possible mechanisms for seizure are discussed.     

Alcoholic epilepsy

The author analyzes a group of 83 patients with epileptic fits which developed in conjunction with drinking. She compares them with a group investigated 12 years previously. She mentions also some catamnestic findings pertaining to the group. The author describes signs of alcoholic epilepsy which include age above 30 years, in particular a 10-year history of drinking, altered reactivity of the brain to alcohol, high alcohol tolerance, development of fits without an aura and how frequency of fits. The author reflects on the causes of alcoholic epilepsy and emphasizes the basic therapy--strict abstinence. She proved also an increase of somatic and neurological damage and the number of deaths in subjects with the diagnosis of alcoholic epilepsy.     

Diagnosing epilepsy

We know how important it is to diagnose epilepsy correctly, but how to do so is surprisingly little validated. An inadequate history and misinterpretation of the electroencephalogram (EEG) are the major reasons 4 to 26% of children and adults in European studies are misdiagnosed with epilepsy. Error rates are not available for most countries, or for more precise diagnoses of seizure types, epilepsy syndrome, and cause.     

Writing epilepsy

Two patients complained of myoclonic jerks precipitated by writing. They had suffered only sporadic seizures triggered by reading. Laboratory assessment demonstrated that typing was the most powerful stimulus in triggering spike-wave discharges associated with myoclonic seizures. Sodium Valproate (20 mg/Kg/die) led to a complete remission of seizures in both cases.     

Sleep-related epilepsy

Sleep is important for the general health of all, but is particularly essential for individuals with epilepsy. In these patients, a complex relationship exists between seizures and sleep, and both must be considered for optimal care. In this review, recent advances in the field of epilepsy and sleep are considered. These include sleep disorders with a specific relationship to epilepsy, the influences of sleep and sleep deprivation on interictal epileptiform discharges, detrimental effects of seizures on sleep, and the effects (good and bad) of epilepsy treatments on sleep.