Transient Facial Palsy in Sphenoidal Electrode Placement

Summary: Purpose: Sphenoidal electrode (SE) insertion can cause pain, for which local anesthesia with lidocaine or intravenous administration of fentanyl has been advocated by different epilepsy treatment centers. Transient facial palsies have been observed after SE insertion. Their frequency of occurrence, distribution, and duration have not been well characterized, however. We hypothesized that this complication is due to the effect of local anesthesia on the peripheral branches of the seventh cranial nerve. To test this hypothesis, we compared the incidence and characteristics of facial palsy during SE insertions performed with either local anesthesia or after intravenous fentanyl administration.
Methods: We performed a retrospective study in two patient groups. Group A consisted of 25 patients aged 28 ± 8·2 years who underwent a prolonged video-EEG (VEEG) monitoring study with SE after subcutaneous infusion of 1% lidocaine in the insertion area. Group B included 25 patients aged 30·1 ± 8·9 years whose SE were inserted after intravenous administration of 100-200 μ fentanyl. Blood pressure (BP) was monitored every 3-5 min throughout the procedure.
Results: Five patients (20%) from group A had a transient facial palsy; in 4, it was complete and in 1 it was partial; 1 patient had a bilateral facial palsy. Paresis lasted 1-7 min (mean 3·2 min). In all patients, the recovery was complete. None of the patients in group B had complications (p = 0·025, Fisher's exact test).
Conclusions: Transient facial palsy is a relatively frequent complication of SE insertion when SE are placed under local anesthesia; patients should be forewarned of its possible occurrence.     

Nonepileptic Posttraumatic Seizures

Summary: Purpose: Epileptic posttraumatic seizures (PTSs) are a well-recognized consequence of head injury (HI), but HI and nonepileptic seizures (NESs) have not been related. We describe a significant subset of patients with NESs who had their seizures attributed to HI.
Methods: We reviewed the records of all patients diagnosed with NES at the University of Maryland Medical Center over a 6-year period (1989–1995) and selected patients with seizures attributed to a head injury occurring ≥3 years before the onset of their seizures.
Results: Of 157 patients with video-EEG confirmed NES, 37 (24%) had the onset of their seizures attributed to an HI. Their average age was 34 years (range, 15–56 years); 68% were women. Nonepileptic PTS usually developed within the first year after HI (89%). Convulsive symptoms were present in 54%. Whereas epileptic PTSs characteristically follow severe HI, the majority (78%) of our patients with nonepileptic PTSs sustained only mild HI. Before their HI, 76% of our patients were employed, working in the home, or students, but only 11% could continue those activities after developing nonepileptic PTSs.
Conclusions: Nonepileptic PTSs are frequently mistaken for epileptic PTSs and result in serious disability. The misdiagnosis of nonepileptic PTSs leads to ineffective and inappropriate treatment. Patients with intractable seizures after HIS, articularly mild HIS, should be carefully evaluated for NESs.     

Stereotactically-guided craniotomy for cavernous angiomas presenting with epilepsy

Summary With the wider availability of magnetic resonance imaging cavernous malformations are being recognised with increasing frequency in those patients presenting with intractable epilepsy. Surgical resection is the treatment of choice. However, because these lesions are usually small and may be located in eloquent areas stereotactic resection should be considered. Stereotactically-guided resection of pathologically verified cavernous angiograms was performed in 10 patients in this series presenting with epilepsy (8 males, 2 females, mean age 32 years). Eight patients presented with medically intractable epilepsy (5 complex partial seizures, 3 grand mal seizures). Of the remaining patients one experienced multiple episodes of haemorrhage and the other headaches (with a non-diagnostic scan) both in association with epilepsy. Pre-operative localisation of the motor strip was determined in one case by functional MRI. Following resection of these lesions all patients experienced improved seizure control with a mean follow-up period of 22 months. The mean postoperative hospital stay was 5.1 days with no surgical complications recorded. We conclude that stereotactically-guided resection offers significant advantages in the management of cavernous malformations.Surgical indications for operative resection would include medically refractory epilepsy, repeated haemorrhage and those cases where there is diagnostic uncertainty.     

戊四氮诱发大鼠全身强直-阵挛性癫痫发作诱导丘脑c-fos癌基因表达

首次运用Fos癌蛋白抗体免疫组化法详细研究了戊四氮诱发大鼠全身强直-阵挛性癫痫发作诱导丘脑c-fos癌基因表达的动态分布。主要结果是:腹腔内注入戊四氮诱导大鼠癫痫发作后0.5h,丘脑室旁核出现低密度的Fos-免疫阳性(Fos-ir)细胞核标记;3h时,中等密度的Fos-ir标记扩布至大部分丘脑中线和板内核群及网状核;6h时,所有上述丘脑核群的Fos-ir标记普遍增为中等至高密度。结合文献报道,上述结果提示:丘脑室旁核很可能是戊四氮诱发大鼠全身强直-阵挛性癫痫发作的重要起源部位之一;丘脑中线和板内核群及网状核很可能在此种癫痫发作的病理生理机制中起重要作用。     

Psychopathology and personality characteristics of epileptic patients: epilepsy, psychopathology and personality

The psychiatric investigation of a sample of 101 epileptic patients (65 temporal lobe epileptics (TLE) and 36 non-TLE) through various methods of evaluation, showed that only a minority of TLE with DSM-III diagnoses of Organic Brain Syndromes had severe psychopathology and manifested some personality traits. Thus, these patients seem to be differentiated from the rest of epileptics, TLE and non-TLE, who had quite "benign" psychological problems, if at all. It is quite probable that this sub-group of TLE could be the main instigators and perpetrators of the "bad image" of epileptics. The findings are discussed in relation to the pertinent literature and some hypotheses are offered for their explanation.     

Hot-Water Epilepsy: A Variant of Reflex Epilepsy in Southern India

"Hot water epilepsy" (HWE), precipitated by a bath or shower in hot water, has been described infrequently in the literature. We report 279 cases of HWE that were seen between 1980 to 1983 in Bangalore, South India. We found HWE to be more common in children, with cases more frequent among male than female patients (2.6:1). Complex partial seizures constituted the main clinical presentation (67.0%); HWE accounted for 4.4% of all complex partial seizures and generalize tonic-clonic seizures seen at our center during the 1980-1983 period. Although prognosis seems favorable 25.4% of our patients developed nonreflex epilepsy within 1-3 years. They were managed with antiepileptic drugs and the use of lukewarm water for bathing.     

Comparative analysis of seizures induced by intracerebroventricular administration of NMDA,kainate and quisqualate in mice

Summary The dose-related time course and occurrence of different seizure subtypes was examined in mice after i.c.v. administration of N-methyl-D-aspartate (NMDA), kainate (KA) or quisqualate (QA). At doses of 0.2 to 1 nmol, NMDA dose-dependently induced a single clonic-tonic seizure. Low doses (0.1 to 0.3 nmol) of KA induced only mild myoclonus and whole body clonus, which were dose-dependently replaced by short-delay clonic-tonic seizures at higher doses (0.4 to 1.2 nmol). In contrast, mice treated with 13 to 32 nmol of QA exhibited either mild myoclonus or whole body clonus as well as clonic-tonic seizures. Clonic-tonic seizures induced by NMDA or KA appeared at shorter latencies than those induced by QA, whereas whole body clonus induced by KA or QA appeared with long onset latencies. These results clearly show that i.c.v. administration of NMDA, KA and QA produces different patterns of seizures in mice. This study confirms that NMDA, KA and QA induce convulsions through different underlying mechanisms and suggests that different anatomical pathways are involved in these models.     

Prolonged action of tuftsin on penicillin-induced epilepsy

Brain Research Institute, Russian Academy of Medical Sciences, Moscow. Institute of Biological Research, Belgrade, Yugloslavia. Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 114, No. 7, pp. 56–58, July, 1992.     

Enhancement of activity of an epileptogenic focus in the frog hippocampus by kynurenins and its depression by serotonin

Experiments on frogs with an epileptogenic focus produced by injection of 1000 units penicillin (0.4 l) into the primordial hippocampus showed that preliminary injection of two kynurenins — quinolinic acid (QA, 0.1 g) and kynurenin itself (K, 1 g) — into the region of the focus or their injection into an already functioning epileptogenic focus led to an increase in the frequency of interictal epileptiform discharges and of electrographic correlates of fits on the EEG. Anthranilic acid (AA, 5 g) had no effect on activity of the focus whereas serotonin (S, 1 g) and 5-methoxytryptamine (1 g) substantially depressed it. The provoking action of the kynurenins on epileptically predisposed brain neurons, it is suggested, may play an important role in the pathogenesis of epilepsy.Department of Pharmacology, Leningrad Pediatric Medical Institute. (Presented by Academician of the Academy of Medical Sciences of the USSR V. V. Zakusov). Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 87, No. 2, pp. 158–160, February, 1979.