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Tremblay C, Robert M, Pascual-Leone A, Lepore F, Nguyen DK, Carmant L, Bouthillier A, Théoret H. Action observation and execution: Intracranial recordings in a human subject. Neurology 2004; 63:937-8. [PMID: 15365160 DOI: 10.1212/01.wnl.0000137111.16767.c6] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Bocti C, Robitaille Y, Diadori P, Lortie A, Mercier C, Bouthillier A, Carmant L. The pathological basis of temporal lobe epilepsy in childhood. Neurology 2003; 60:191-5. [PMID: 12552029 DOI: 10.1212/01.wnl.0000044055.73747.9f] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To characterize the pathologic findings of temporal lobe epilepsy (TLE) in children undergoing temporal lobectomy for refractory seizures and to correlate these findings with clinical presentation. METHODS The authors reviewed the charts of all children who underwent anterior temporal lobectomy for refractory TLE from 1979 through 1999. A new neuropathologic analysis was performed blinded to clinical features and outcome. RESULTS Twenty-two children met inclusion criteria. Mean age at onset of epilepsy was 3 years, 7 months (range 1 month to 10 years). Mean age at surgery was 10 years, 11 months (range 1 to 18 years). All patients had complex partial seizures, 48% with secondary generalization. Most had daily seizures. Auras were reported in 45% of patients. Post-resection follow-up averaged 5 years, 2 months (range 2 to 19 years). Seizure-free status was achieved in 41% of patients, and 14% had residual auras only. The most frequent neuropathologic abnormalities were cortical dysplasia (CD) of the temporal neocortex (14 of 22) and mesial temporal sclerosis (MTS) (12 of the 15 children with available hippocampal tissue). These two findings coexisted in seven children. MTS was associated with extra-hippocampal pathology in 8 of 12 (67%) of the cases. CONCLUSIONS MTS occurs frequently in association with CD in this population of children. The high incidence of dual pathology could explain the early age of seizure onset and high seizure frequency rate observed. TLE in childhood may constitute a different entity than in adults, from both the clinical and neuropathologic perspectives.
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Lebel D, Morin C, Laberge M, Achim N, Carmant L. The carbohydrate and caloric content of concomitant medications for children with epilepsy on the ketogenic diet. Can J Neurol Sci 2001; 28:322-40. [PMID: 11766777 DOI: 10.1017/s0317167100001542] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The ketogenic diet for children with refractory epilepsy requires a strict control of the amount of ingested carbohydrates. This can be altered by medication prescribed for the epileptic syndrome or for intercurrent illnesses. The goal of this paper is to compile the carbohydrate and caloric content of commonly used medications in this population. METHODS We compiled a list of frequently used medications with the help of Canadian manufacturers and the Compendium of Pharmaceuticals and Specialties. We also tested a worst case scenario calculation based on the weight of the tablet. RESULTS We list the carbohydrate and caloric content of 790 medications studied. Our worst case scenario gives an over-estimate in all cases, making adjustments based on this calculation in an emergency setting safe. CONCLUSION We propose this list as a tool for physicians, dietitians, nurses and pharmacists. The list can easily be adjusted, based on local practices and reviewed periodically.
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Meilleur S, Carmant L, Psarropoulou C. Immature rat convulsions and long-term effects on hippocampal cholinergic neurotransmission. Neuroreport 2000; 11:521-4. [PMID: 10718307 DOI: 10.1097/00001756-200002280-00019] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Generalized tonic-clonic convulsions were induced on 2 consecutive days by pentylenetetrazol (PTZ) in immature rats (postnatal days 10 and 20), and hippocampal slices were prepared at different intervals post-injection. The anticholinesterase eserine provoked interictal-like discharges in the CA3 area of PTZ-injected rats (19/33), but not in controls (0/15), an effect mimicked by carbachol and reversed by atropine. This enhanced response to eserine was recorded in slices from 25-100% of the PTZ-injected rats, the percentage varying with the age at injection and post-injection interval. These results suggest that seizures in immature brain may have long-term consequences in cholinergic neurotransmission, converting a rise in endogenous ACh into an epileptogenic stimulus, which in turn would presumably facilitate the recurrence of seizures.
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Lanthier S, Carmant L, David M, Larbrisseau A, de Veber G. Stroke in children: the coexistence of multiple risk factors predicts poor outcome. Neurology 2000; 54:371-8. [PMID: 10668698 DOI: 10.1212/wnl.54.2.371] [Citation(s) in RCA: 216] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To characterize the risk factors for stroke in children and their relationship to outcomes. METHODS We reviewed charts of children with ischemic and hemorrhagic stroke seen at Hopital Sainte-Justine, Montreal between 1991 and 1997. RESULTS We found 51 ischemic strokes: 46 arterial and 5 sinovenous thromboses. Risk factors were variable and multiple in 12 (24%) of the 51 ischemic strokes. Ischemic stroke recurred in 3 (8%) patients with a single or no identified risk factor and in 5 (42%) of 12 patients with multiple risk factors (p = 0.01). We also found 21 hemorrhagic strokes, 14 (67%) of which were caused by vascular abnormalities. No patient with hemorrhagic stroke had multiple risk factors. Hemorrhagic stroke recurred in two patients (10%). Outcome in all 72 stroke patients was as follows: asymptomatic, 36%; symptomatic epilepsy or persistent neurologic deficit, 45%; and death, 20%. Death occurred more frequently in patients with recurrent stroke (40%) than in those with nonrecurrent stroke (16%). CONCLUSIONS Multiple risk factors are found in many ischemic strokes and may predict stroke recurrence. Recurrent stroke tends to increase rate of mortality. Because of the high prevalence and importance of multiple risk factors, a complete investigation, including hematologic and metabolic studies and angiography, should be considered in every child with ischemic stroke, even when a cause is known.
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Dubois J, Hershon L, Carmant L, Bélanger S, Leclerc JM, David M. Toxicity profile of interferon alfa-2b in children: A prospective evaluation. J Pediatr 1999; 135:782-5. [PMID: 10586188 DOI: 10.1016/s0022-3476(99)70104-6] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The toxicity of interferon (IFN) alfa-2b therapy was prospectively evaluated in 53 children treated from 1991 to 1996 in 2 successive studies of IFN alfa therapy for severe hemangiomas at Sainte-Justine Hospital. Toxicity was generally mild and transient, with grade 1 toxicity occurring in 100% of patients, grade 2 toxicity in 89%, grade 3 toxicity in 58%, and grade 4 toxicity in 17%. Ten of 43 patients available for evaluation had an abnormal neurologic examination. Severe neurotoxicity in the form of spastic diplegia occurred in one patient. In conclusion, IFN alfa therapy is generally well tolerated in children. However, it may rarely be associated with severe toxicity and must be used with caution.
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Sarkisian MR, Holmes GL, Carmant L, Liu Z, Yang Y, Stafstrom CE. Effects of hyperthermia and continuous hippocampal stimulation on the immature and adult brain. Brain Dev 1999; 21:318-25. [PMID: 10413019 DOI: 10.1016/s0387-7604(99)00032-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Whether febrile seizures lead to hippocampal necrosis is a question of paramount clinical importance. This study attempted to simulate a complex febrile seizure, compared with hyperthermia (HYP) alone and prolonged seizure alone (produced by continuous hippocampal stimulation (CHS)). Four groups of rats were studied at each of two ages, immature (postnatal day, P20) and adult (P60). Group 1 was subjected to 45 min of HYP (body temperature 40 degrees C) plus CHS, Group 2 received 45 min of HYP alone, Group 3 got 45 min of CHS alone, and Group 4 was sham-handled control rats. Baseline and post-session EEGs were recorded in all groups. Subsequently, brains were examined histologically for evidence of hippocampal damage. Both CHS-treated groups (with and without HYP) exhibited behavioral and EEG seizures while the group undergoing HYP alone did not have seizures. There were no gross histological lesions in any group. Cell counts in regions CA1, CA3, dentate gyrus and dentate hilus did not differ in rats under any condition of hyperthermia and CHS, in either P20 or P60 rats compared to age-matched controls. These results indicate that both immature and mature rodents are resistant to hyperthermic brain damage and raises the question of whether febrile seizures play a role in the genesis of mesial temporal sclerosis.
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Cossette P, Riviello JJ, Carmant L. ACTH versus vigabatrin therapy in infantile spasms: a retrospective study. Neurology 1999; 52:1691-4. [PMID: 10331702 DOI: 10.1212/wnl.52.8.1691] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
ACTH is the standard treatment for infantile spasms (IS) in North America. Recent reports showed that vigabatrin is a valuable treatment for IS, but comparative studies with ACTH are limited. In this study, we compare the effectiveness of ACTH versus vigabatrin on IS. Our results support that vigabatrin is as effective as and better tolerated than ACTH. Because of their similar efficacy, we believe that vigabatrin should be the first intention drug for the treatment of IS.
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Kramer U, Carmant L, Mikati MA. Electroencephalographic discharges of temporal lobe seizures in children and young adults. ELECTROENCEPHALOGRAPHY AND CLINICAL NEUROPHYSIOLOGY 1998; 107:353-60. [PMID: 9872438 DOI: 10.1016/s0013-4694(98)00091-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We investigated the discharge morphology and propagation patterns of electroencephalographic seizures of temporal lobe onset in 21 children and young adults who underwent invasive long-term EEG monitoring (LTM). Of those, 15 subsequently underwent anterior temporal lobectomy. The onset was focal in 63%. The most frequent discharge morphology was low amplitude beta (30%) or rhythmic/semirhythmic theta discharge (30%). Thirteen patients displayed several sequences of propagation with different spreading stages along a fixed path. Initial spreading to the ipsilateral frontal lobe was associated with a higher frequency of secondary generalization than initial spreading to the contralateral temporal lobe (P = 0.18). A comparison of 13 patients older than 18 years of age with 8 patients younger than 14 years showed a trend towards a lower rate of propagating from the temporal lobe (P = 0.13) in the younger age group. Discharge morphology was not correlated with age, focality, or outcome of surgery.
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Bélanger S, Coulombe G, Carmant L. Role of vigabatrin and lamotrigine in treatment of childhood epileptic syndromes. Epilepsia 1998; 39:878-83. [PMID: 9701380 DOI: 10.1111/j.1528-1157.1998.tb01184.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE Vigabatrin (VGB) and lamotrigine (LTG) are two new antiepileptic drugs (AEDs) with different mechanisms of action for treatment of refractory epilepsies. Previous reports have indicated efficacy of both drugs in a number of epileptic syndromes. METHODS We compared these new AEDs drugs to determine their respective efficacy against different types of epileptic syndrome and to develop a rational approach to their use. We reviewed the charts of 105 children, with partial and generalized epilepsies. RESULTS VGB was to be significantly more effective in children with partial epilepsies, and LTG was more effective in those with generalized epilepsies. CONCLUSIONS VGB and LTG have different therapeutic profiles. Combination treatment with the two drugs may represent rational polytherapy for patients with epilepsy resistant to treatment with either drug alone or as add-on to other AED treatment.
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Carmant L, Décarie JC, Fon E, Shevell MI. Transient visual symptoms as the initial manifestation of childhood adrenoleukodystrophy. Pediatr Neurol 1998; 19:62-4. [PMID: 9682889 DOI: 10.1016/s0887-8994(98)00015-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
We report two patients with transient visual symptoms after an acute illness (hypoglycemia and head trauma) who went on to develop a progressive neurodegenerative disease (adrenoleukodystrophy). This report supports the suggestion that environmental factors play a role in the initial expression of the disease and reviews atypical visual manifestations of adrenoleukodystrophy. Proper diagnosis and institution of early treatment before the catastrophic deterioration typical of its natural history requires a high degree of suspicion.
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Lanthier S, Chevalier I, Larbrisseau A, Lortie A, Geoffroy G, Vanasse M, Carmant L. Etiology of stroke in children. J Stroke Cerebrovasc Dis 1997. [DOI: 10.1016/s1052-3057(97)80178-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Carmant L, Woodhall G, Ouardouz M, Robitaille R, Lacaille JC. Interneuron-specific Ca2+ responses linked to metabotropic and ionotropic glutamate receptors in rat hippocampal slices. Eur J Neurosci 1997; 9:1625-35. [PMID: 9283817 DOI: 10.1111/j.1460-9568.1997.tb01520.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Glutamate-mediated regulation of intracellular Ca2+ levels was examined in different populations of CA1 interneurons, using confocal microscopy and the Ca2+ indicator fluo 3-AM in rat hippocampal slices. Interneurons in basal [stratum oriens/alveus (OA)] and apical [strata radiatum and lacunosum-moleculare (R/LM)] dendritic layers responded heterogeneously to glutamate. In control medium, OA interneurons responded mostly with oscillatory Ca2+ responses, which consisted of a large Ca2+ transient and successive smaller elevations. R/LM interneurons responded mostly with biphasic responses, characterized by an initial large transient and a secondary prolonged elevation. Other interneurons in both R/LM and OA responded with transient elevations in Ca2+ levels. Ionotropic glutamate receptor antagonists (+/-)2-amino-5-phosphonopentanoic acid and 6-cyano-7-nitro-quinoxaline-2,3-dione reduced peak Ca2+ responses in OA and R/LM cells, and blocked biphasic responses in R/LM interneurons. The metabotropic glutamate receptor antagonist (RS)-alpha-methyl-4-carboxyphenylglycine reduced peak Ca2+ responses only in OA interneurons, and prevented oscillatory responses. In low Ca2+ medium, peak responses were reduced in R/LM but not in OA interneurons, and oscillatory responses were absent. Combination of ionotropic and metabotropic receptor antagonists blocked all glutamate-evoked Ca2+ responses. Activation of different types of glutamate receptors may thus produce heterogeneous Ca2+ signals in subpopulations of CA1 interneurons. Ionotropic receptors may generate biphasic responses in interneurons in apical dendritic layers, whereas combined activation of metabotropic and ionotropic receptors may trigger oscillatory responses in interneurons of basal dendritic layers. These heterogeneous Ca2+ responses indicate that glutamate-mediated Ca2+ processes and second messenger systems differ in subpopulations of hippocampal interneurons and suggest possible postsynaptic functional specialization of interneurons.
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Kramer U, Riviello JJ, Carmant L, Black PM, Madsen J, Holmes GL. Clinical characteristics of complex partial seizures: a temporal versus a frontal lobe onset. Seizure 1997; 6:57-61. [PMID: 9061825 DOI: 10.1016/s1059-1311(97)80054-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The site of origin of complex partial seizures (CPS) is predominantly in the temporal lobe, but frontal, parietal, and occipital lobes may also be involved. In order to correlate clinical behaviours with either a temporal or frontal site of origin, we analysed 211 seizures occurring during invasive monitoring in 26 patients with temporal lobe epilepsy (TLE) and in eight patients with frontal lobe epilepsy (FLE). Although leg movements, defined as thrashing, pedalling and kicking, hand posturing, facial twitching, sitting up, and tonic-clonic movements occurred more frequently in FLE, and hand automatisms were more frequent in TLE, no statistically significant difference was found between the two groups. When analysing only electrographic seizures that did not spread or propagated only to homologous controlateral lobes, leg movements and hand posturing were seen only with FLE, and oral automatisms only in TLE. Seizures of temporal lobe origin were longer in duration and had a higher frequency of auras. We therefore conclude that the reliability of clinical behaviour alone to predict the site of origin of an epileptic discharge is limited when the surface EEG is equivocal or the neuroradiologic evidence of a focus is not clear.
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Carmant L, Carrazana E, Kramer U, Helmers SL, Holmes GL, Black PM, Mikati MA. Pharyngeal dysesthesia as an aura in temporal lobe epilepsy. Epilepsia 1996; 37:911-3. [PMID: 8814105 DOI: 10.1111/j.1528-1157.1996.tb00045.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE Because oral, buccal, and sometimes oral-pharyngeal manifestations in epilepsy are linked to the central-temporal region, we studied 3 patients with childhood-onset partial seizures that consistently began with pharyngeal dysesthesias, described as either throat tingling or burning, to localize seizure onset. METHODS Because of an intractable clinical course, each patient underwent invasive video-EEG monitoring, which localized the epileptogenic zone to the mesial temporal lobe. The 3 patients underwent temporal lobe resections. RESULTS All 3 patients achieved remission of the pharyngeal auras and a 90-100% reduction in the frequency of their seizures. CONCLUSIONS Pharyngeal dysesthesias can be the initial manifestation of complex partial seizures (CPS) of temporal lobe origin.
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Packard AB, Roach PJ, Davis RT, Carmant L, Davis R, Riviello J, Holmes G, Barnes PD, O'Tuama LA, Bjornson B, Treves ST. Ictal and interictal technetium-99m-bicisate brain SPECT in children with refractory epilepsy. J Nucl Med 1996; 37:1101-6. [PMID: 8965177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
UNLABELLED Identification of epileptogenic foci in patients with refractory epilepsy remains a significant diagnostic challenge. Magnetic resonance imaging studies frequently fail to reveal an anatomic origin for the seizures, and scalp electroencephalography is often limited to identification of the involved hemisphere. Functional imaging modalities such as PET and SPECT are more promising tools for this application because they reflect the functional pathology associated with the seizure. These changes are more pronounced ictally, but until recently, no radiopharmaceutical was available that could be used routinely for ictal SPECT. The present study was therefore undertaken to determine whether 99mTc-bicisate could be used in ictal SPECT in pediatric patients with refractory epilepsy, to compare the patterns of ictal and interictal blood flow in these patients and to compare the localization information provided by ictal SPECT with that available from other techniques. METHODS Technetium-99m-bicisate/SPECT was compared prospectively with scalp EEG for its ability to identify a possible seizure focus in pediatric patients with refractory epilepsy. Ictal and interictal SPECT studies were performed in 10 patients (3-19 yr old, mean age 10.9 +/- 4.3 yr; 7 female, 3 male) in whom MRI scans revealed no lesions that might be responsible for the seizures. RESULTS Ictal SPECT was performed in all patients, and all ictal studies revealed focal perfusion abnormalities. By comparison, four of the interictal SPECT studies showed regional hypoperfusion that corresponded to the regions of hyperperfusion in the ictal studies, and three showed regional hyperperfusion corresponding to the hyperperfused regions in the ictal studies. Three interictal studies revealed no abnormal perfusion. Scalp EEG provided localization information in five patients. CONCLUSION These initial results suggest that ictal SPECT with 99mTc-bicisate is a more promising tool for the identification of epileptogenic foci than interictal SPECT or scalp EEG in patients without focal abnormalities on MRI.
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Carmant L, Kramer U, Holmes GL, Mikati MA, Riviello JJ, Helmers SL. Differential diagnosis of staring spells in children: a video-EEG study. Pediatr Neurol 1996; 14:199-202. [PMID: 8736402 DOI: 10.1016/0887-8994(96)00080-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Staring is frequently a nonepileptic manifestation in children. To differentiate epileptic versus nonepileptic staring, we reviewed clinical and video-EEG findings in 143 patients, aged 5 months to 43 years, monitored for staring episodes. In 79 patients staring was of epileptic origin; 46 had partial seizures and 33 atypical absence. Thirty-five had behavioral staring, 8 psychogenic seizures, 1 a migraine equivalent, and in 20 no staring spells were recorded. In all patients with epileptic staring, epilepsy was suspected clinically. Only 22 of the admissions for behavioral staring and 3 for pseudoseizures were to exclude a possible nonepileptic phenomenon. Review of their clinical histories revealed that certain findings strongly support a nonepileptic origin. In conclusion, a careful clinical history will differentiate between epileptic and nonepileptic staring episodes in most patients. Video-monitoring is helpful to adjust treatment or to exclude nonepileptic events in patients with refractory staring spells.
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Carmant L, Liu Z, Werner SJ, Mikati MA, Holmes GL. Effect of kainic acid-induced status epilepticus on inositol-trisphosphate and seizure-induced brain damage in mature and immature animals. BRAIN RESEARCH. DEVELOPMENTAL BRAIN RESEARCH 1995; 89:67-72. [PMID: 8575094 DOI: 10.1016/0165-3806(95)00110-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We investigated the role of excitatory amino acids in the activation of the phosphoinositide pathway during kainic acid-induced seizures in mature and immature animals. Kainic acid caused more severe seizures in the immature animals, but no hippocampal damage or induction of phosphoinositide hydrolysis. In mature animals, seizures were mild but severe hippocampal damage was seen and was associated with a marked and sustained release of inositol-trisphosphate, suggesting a role of this pathway and intracellular calcium stores in seizure-induced brain damage.
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Madsen JR, Carmant L, Holmes GL, Black PM. Corpus callosotomy in children. Neurosurg Clin N Am 1995; 6:541-8. [PMID: 7670327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
All of the reports of corpus callosotomy have been limited by their necessarily retrospective nature, lack of control groups, and failure to quantify seizure frequency and duration before and after the surgery. In addition, interpretation of results has been confusing by inconsistent selection criteria of patients, varying surgical procedures employed, and short duration of follow-up. Nevertheless, this procedure remains a last hope for many children with severe intractable epilepsy and unquestionably assists in the management of many such children. There is a need to evaluate this surgical procedure fully to optimize its utilization further.
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Carmant L, Kramer U, Mikati MA, Riviello JJ, Helmers SL, Holmes GL. Pseudoseizure manifestations in two preschool age children. Seizure 1995; 4:147-9. [PMID: 7670767 DOI: 10.1016/s1059-1311(95)80096-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
We report two patients with epilepsy with pseudoseizures at age 6 years. Both presented with intractable staring spells. Pseudoseizures were provoked and aborted by suggestion, leading to the diagnosis. In both patients, evidence of a neuropsychological disturbance was later found and psychotherapy started. Monitoring of intractable staring episodes is recommended prior to escalating antiepileptic drug levels or resorting to polytherapy. In addition, differentiation from other non-epileptic phenomena is necessary to initiate proper therapy.
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MESH Headings
- Anticonvulsants/adverse effects
- Anticonvulsants/therapeutic use
- Brain Damage, Chronic/diagnosis
- Brain Damage, Chronic/drug therapy
- Brain Damage, Chronic/psychology
- Child
- Child, Preschool
- Diagnosis, Differential
- Drug Therapy, Combination
- Epilepsy/diagnosis
- Epilepsy/drug therapy
- Epilepsy/psychology
- Epilepsy, Frontal Lobe/diagnosis
- Epilepsy, Frontal Lobe/drug therapy
- Epilepsy, Frontal Lobe/psychology
- Epilepsy, Generalized/diagnosis
- Epilepsy, Generalized/drug therapy
- Epilepsy, Generalized/psychology
- Female
- Humans
- Male
- Seizures/diagnosis
- Seizures/drug therapy
- Seizures/psychology
- Somatoform Disorders/diagnosis
- Somatoform Disorders/drug therapy
- Somatoform Disorders/psychology
- Suggestion
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Carmant L, Kramer U, Riviello JJ, Helmers SL, Mikati MA, Madsen JR, Black PM, Lombroso CT, Holmes GL. EEG prior to hemispherectomy: correlation with outcome and pathology. ELECTROENCEPHALOGRAPHY AND CLINICAL NEUROPHYSIOLOGY 1995; 94:265-70. [PMID: 7537198 DOI: 10.1016/0013-4694(95)98477-p] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Hemispherectomy, for the treatment of seizures, is highly successful but has a significant morbidity rate. The procedure is usually restricted to patients with an intractable seizure disorder and hemiparesis. Because of the inherent risk of surgery, patient selection is a critical issue. This report describes the evaluation of background activity and ictal patterns on surface and invasive EEG in 12 children who underwent both anatomical (7) and functional (5) hemispherectomy in order to determine the role of electroencephalography in the selection of patients for hemispherectomy, and to correlate EEG findings with underlying pathology and outcome. A favorable outcome was predicted by an interictal EEG with two or more of the following: suppression over the abnormal hemisphere, absence of contralateral slowing, absence of generalized discharges and absence of bilateral independent spiking; or by unilateral onset of ictal discharges on invasive intracerebral EEG recording. Outcome did not correlate with the underlying pathology. Hemispherectomy can be successful in patients with a variety of predominantly unilateral pathologic entities.
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Helmers SL, Carmant L, Flanigin D. Anterior neck recording of intraoperative somatosensory-evoked potentials in children. Spine (Phila Pa 1976) 1995; 20:782-6. [PMID: 7701390 DOI: 10.1097/00007632-199504000-00008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN The authors have developed technique of using anterior neck derivations to record posterior tibial nerve N28 during operative somatosensory-evoked potential monitoring. OBJECTIVE This prospective study of 10 patients compared the ease of application of electrodes and stability of waveforms with "traditional" posterior neck recordings. SUMMARY OF BACKGROUND DATA Somatosensory-evoked potential monitoring has been used in children since the 1980s. A number of important factors, patient related and technical, are unique to this age group, which can cause difficulty with execution and interpretation. A major patient-related problem is unreliability of the cortical response in somatosensory-evoked potential monitoring because of the effect of inhalation anesthesia. This has been described as occurring more often in the pediatric group, perhaps because of the continuing maturation of the complex somatosensory system. Thus, the authors have relied heavily on the cervical potential to monitor spinal cord integrity. Recording the cervical response using the traditional "posterior" montage may be technically impossible if the electrodes lie within the operative field. METHODS Posterior tibial somatosensory-evoked potentials were performed according to the guidelines of the American Electroencephalographic Society. Additional recordings were obtained from two anterior neck sites. Multiple reference electrodes were used to evaluate which montage rendered the most reliable waveform. RESULTS Optimal montage for recording an anterior neck potential was cricoid cartilage-Cz'. There were no significant differences in the onset latency or peak amplitudes between the anterior and posterior cervical recordings. CONCLUSIONS The anterior neck derivation was found to be an acceptable adjunct to posterior montages, being stable, of comparable latency, and of stable amplitude. Electrodes are easier to apply, less invasive than nasopharyngeal or esophageal electrodes. This technique allows one to examine patients who previously could not be monitored.
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Kramer U, Carmant L, Riviello JJ, Stauffer A, Helmers SL, Mikati MA, Holmes GL. Psychogenic seizures: video telemetry observations in 27 patients. Pediatr Neurol 1995; 12:39-41. [PMID: 7748358 DOI: 10.1016/0887-8994(94)00115-i] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Psychogenic seizures are unusual during the first decade of life. To compare the clinical features of psychogenic seizures in young children with those of teenagers, the long-term electroencephalographic and video monitoring studies of all patients younger than 18 years of age with recorded episodes diagnosed as psychogenic seizures were reviewed from a single hospital during the past 7 years. The 27 patients were divided into 2 age groups: group A, 6-9 years (n = 5), and group B, 10-17 years (n = 22). All patients had habitual episodes recorded during monitoring. Although the adolescents displayed clinical patterns similar to adult patients with psychogenic seizures, the children demonstrated a clinical pattern characterized mainly by prolonged staring and unresponsiveness. The most common behaviors in the adolescent group were tremor (45%), intermittent stiffening (41%), and out-of-phase movements of the extremities (36%). Fifteen percent of the patients had a history of seizures. This study suggests that young children with psychogenic seizures have clinical profiles different from that of teenagers.
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Carmant L, Holmes GL. Commissurotomies in children. J Child Neurol 1994; 9 Suppl 2:50-60. [PMID: 7806786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Although corpus callosotomy has been used since 1940 to treat severe, medically intractable seizure disorders, controversy remains as to when, or even if, the surgery should be performed. Unlike other types of surgical therapy of epilepsy where the epileptic focus is identified and removed, corpus callosotomy is used to interrupt the propagation of epileptic discharges. The procedure is primarily used in patients with secondarily generalized seizures in whom focal resections are not possible. Long-term follow-up studies of post-callosotomy patients are few and flawed by lack of accurate seizure counts and quality-of-life measures. Although it remains difficult to predict those patients who will benefit from the surgery, it appears that patients with "drop" attacks benefit the most from the procedure.
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Carmant L, O'Tuama LA, Roach PJ, Kramer U, Mikati MA, Riviello JJ, Helmers SL, Madsen JR, Black PM, Lombroso CT. Technetium-99m HmPAO brain SPECT and outcome of hemispherectomy for intractable seizures. Pediatr Neurol 1994; 11:203-7. [PMID: 7880333 DOI: 10.1016/0887-8994(94)90103-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
With recent descriptions of the modified hemispherectomies and hemicorticectomy, there has been renewed interest in hemispherectomy for treatment of intractable seizures with hemiparesis. Because long-term outcome remains uncertain, patient selection remains difficult. 99mTc-HmPAO brain SPECT has been a helpful adjunct in the evaluation of epilepsy surgery candidates. We report SPECT scan findings in 7 patients who underwent hemispherectomy and compare these results with scalp EEG findings. Six patients had unilateral SPECT findings and all had a favorable outcome, regardless of surface EEG findings.
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