Social behavior impairment in offspring exposed to maternal seizures in utero

Human and animal models have demonstrated that maternal seizures in utero could be deleterious to the development of the offspring. This study focused on the social behavior of offspring exposed to seizures in utero. A pilocarpine model of temporal lobe epilepsy was induced in female Wistar rats that were mated after the first spontaneous seizure. Early after birth, pups from an epileptic mother were reared by a control mother. To evaluate the influence of the adoption process, two other groups were added: rat pups from control mothers cross-fostered with other control mothers, and rat pups reared by their birth mother. Animals exposed to seizures in utero showed impaired social behavior with no signs of anxiety-like behavior. This study demonstrated that epileptic seizures during pregnancy could be harmful to brain development and may increase the risk of developing neurodevelopmental disorders. The mechanisms underlying the abnormalities of social behavior are not well understood, and further studies in this field are warranted.

[Serotoninergic mediator system in the pathogenesis and treatment of idiopathic generalized epilepsy]

Psychoemotional status and blood serotonin level were investigated in 69 patients with different forms of idiopathic epilepsy during the seizures and interictal period. Twenty-two patients with juvenile myoclonic epilepsy, 22 patients with absence forms and 22 patients with generalized convulsive seizures, aged 10-47 years, were included in the study. We found the significant decrease in blood serotonin levels during the interictal period, with the lower levels seen after generalized convulsive and myoclonic seizures. After the treatment with antidepressant fluvoxamine as add-on treatment, 16 patients revealed improved psychoemotional well-being and quality of life as well as a decreased number of generalized convulsive seizures along with the increasing of blood serotonin level.

[Epilepsy by bovine (zebu) goring: a case report in Burkina Faso]

The post-traumatic epilepsy is responsible for 20% of the symptomatic epilepsies. Accidents on public highway constitute more than 70% of the causes. We report a singular case of fronto-polar post-traumatic epilepsy by zebu goring which appeared two years after the traumatism. The neurological examination of the patient was normal apart from a inconspicuous expansiveness of humor underlined by an excess of familiarity and hypersyntony. The cerebral scanner revealed a left fronto-basal cortico-under-cortical low density up to the homolateral fronto-polar area. The electroencephalogram (EEG) showed some left fronto-polar bursts of spike and wave on a normal bottom line. This clinical observation draws our attention on the fact that in Sahelian tropical environment where bovine breeding holds a major place, the cranio-encephalic traumatism by goring is not rare and can be responsible for epilepsy in the same way as accidents on public highway, or ballistic traumatism.

Patient awareness of seizures as documented in the epilepsy monitoring unit

Treatment for epilepsy depends largely on seizure frequency reported by patients through their seizure diaries. However, patients may be unaware of some of their seizures, which may lead to incomplete diary data, impacting on appropriate treatment plans. The purpose of this study was to quantify awareness of seizures in patients admitted to an epilepsy monitoring unit through post event assessments by registered nurses. Results indicated that only 44.5% of complex partial and secondarily generalized tonic-clonic seizures were recognized by patients with epilepsy. Incomplete data in seizure diaries are likely a widespread problem, which may have an important impact on treatment and, thereby, on the safety and quality of life of individuals with epilepsy.

A case with atypical childhood occipital epilepsy "Gastaut type": an ictal migraine manifestation with a good response to intravenous diazepam

We report the history of a 14-year-old girl with atypical childhood occipital epilepsy "Gastaut type" whose first generalized tonic-clonic seizure was preceded by migraine without aura and followed by a status migrainosus. This status lasted for 3 days despite standard analgesic therapy. An EEG recording revealed an occipital status epilepticus during her migraine complaints. Seven minutes after intravenous administration of 10 mg diazepam under continuous EEG recording, a suppression of the epileptiform discharges over the right occipital was seen, while the headache subsided 3 min later. After precise questioning about the circumstances that possibly could have led to these events, it appeared that she had played for hours with a play station on the new color TV and she had visited an exhibition of Matisse and Bonnard with bright colors and contrast-rich text. Standardized extensive intermittent photic stimulation (IPS), 2 days after the status migrainosus, evoked besides asymmetrical right-sided driving, green spots in her left visual field, while in the EEG sharp waves were recorded over the right parietotemporal region. After further IPS with 20 Hz (eye closure), she started complaining of a light pulsating headache right occipitally and in the EEG right parietotemporal sharp-waves were seen. This lasted for about 10 min. Later, an interictal routine EEG was normal except for some theta over the right temporooccipital area. The most likely diagnosis is an atypical form of occipital epilepsy "Gastaut type." We would therefore advocate recording EEGs with photic stimulation in patients with atypical migraneous features.

Subacute postictal aggression in patients with epilepsy

Three men with epilepsy (age range, 38-62) who exhibited brief episodes of violent behavior during the postictal period are described. Disease duration ranged from 27 to 44 years. Patients had both complex partial seizures and secondarily generalized tonic-clonic seizures, which were refractory to antiepileptic drugs. Postictal aggression occurred shortly after a seizure and lasted 5-30 minutes. The patients displayed physically and verbally aggressive behavior toward others, but regained consciousness promptly and showed regret afterward. Interictal EEGs revealed temporal spikes, SPECT showed hypoperfusion in the temporal and frontal areas in two patients, and neuropsychological examination revealed poor frontal lobe function in two patients. Characteristics of our cases are consistent with subacute postictal aggression (SPA) reported previously. Epilepsy of prolonged duration and brain dysfunction involving a broad area including the temporal and frontal lobes may be associated with the occurrence of subacute postictal aggression.

Different types of status epilepticus lead to different levels of brain damage in rats

We investigated a possible correlation between behavior during status epilepticus (SE) and underlying brain damage. Adult rats were electrically stimulated in the left amygdala to induce SE, which was stopped 2 hours later. We observed two different types of SE: (1) typical SE (TSE), with facial automatisms, neck and forelimb myoclonus, rearing and falling, and tonic-clonic seizures; (2) ambulatory SE (ASE), with facial automatisms, neck myoclonus, and concomitant ambulatory behavior. TSE was behaviorally more severe than ASE (P<0.05). Histology revealed neuronal loss in several brain areas. There was a positive correlation between SE type and amount of injured areas 24 hours and 14 days after SE (P<0.01). The areas more affected were piriform cortex and hippocampal formation. We suggest quality of seizures during SE may be considered in further SE studies, as our results indicate its influence on the severity of brain damage following this paradigm.

Prolonged postictal stupor: nonconvulsive status epilepticus, medication effect, or postictal state?

We describe a patient who entered a stuporous state after receiving benzodiazepine treatment for generalized tonic-clonic status epilepticus. A diagnosis of generalized NCSE with tonic seizures was made on the basis of the clinical picture and response to barbiturate anaesthetic, although the EEG pattern was not typical of the changes previously described in tonic seizures-tonic status epilepticus. This report discusses the differential diagnosis of postictal stupor, nonconvulsive status epilepticus with tonic seizures and sedation caused by the emergency treatment of status epilepticus, and summarizes the literature on tonic seizures and tonic status epilepticus.

SCN1A mutation analysis in myoclonic astatic epilepsy and severe idiopathic generalized epilepsy of infancy with generalized tonic-clonic seizures

Severe myoclonic epilepsy in infancy (SMEI), severe idiopathic generalized epilepsy of infancy (SIGEI) with generalized tonic clonic seizures (GTCS), and myoclonic astatic epilepsy (MAE) may show semiological overlaps. In GEFS+ families, all three phenotypes were found associated with mutations in the SCN1A gene. We analyzed the SCN1A gene in 20 patients with non-familial myoclonic astatic epilepsy -- including 12 probands of the original cohort used by Doose et al. in 1970 to delineate MAE. In addition, 18 patients with sporadic SIGEI -- mostly without myoclonic-astatic seizures -- were analyzed. Novel SCN1A mutations were found in 3 individuals. A frame shift resulting in an early premature stop codon in a now 35-year-old woman with a borderline phenotype of MAE and SIGEI (L433fsX449) was identified. A splice site variant (IVS18 + 5 G --> C) and a missense mutation in the conserved pore region (40736 C --> A; R946 S) were detected each in a child with SIGEI. We conclude that, independent of precise syndromic delineation, myoclonic-astatic seizures are not predictive of SCN1A mutations in sporadic myoclonic epilepsies of infancy and early childhood.

Partial epilepsy with "ecstatic" seizures

Reports focusing on auras of ecstasy or pleasure have been limited largely to single case descriptions. We examined 11 consecutive patients with such ictal symptoms. Eight had sensory hallucinations, four had erotic sensations, five described "a religious/spiritual experience," and several had symptoms that were felt to have no counterpart in human experience. Ictal EEG recordings were performed in four patients; two had seizure onset in the right temporal lobe and two in the left. In seven the onset could not be definitely localized. The diagnosis of epilepsy was often delayed. Eight patients wished to experience seizures; self-induction was possible in five and four showed treatment noncompliance. In patients with insufficient drug intake, in whom good compliance should be expected, it is relevant to consider seizures with pleasant symptomatology. According to the literature, experiential and ecstatic seizures seem to have had a substantial impact on our cultural and religious history.

Mania following temporal lobectomy

OBJECTIVE

To determine clinical and diagnostic variables that predict the development of mania after temporal lobectomy for treatment of refractory epilepsy.

METHODS

From a large surgical database, 16 patients with new-onset mania after temporal lobectomy were identified. Mania patients were frequency matched for age, gender, and laterality of surgery to 16 temporal lobectomy patients with no postoperative mood disorder. These groups were compared on pre- and postoperative clinical and diagnostic data with each other and with 30 patients with depression after temporal lobectomy. Posthoc analyses compared mania and depression groups with the general surgical database matched for gender and laterality of surgery.

RESULTS

Preoperative evaluations in postoperative mania patients, in particular EEG, were more likely to yield findings of brain dysfunction localizing to the hemisphere contralateral to temporal lobectomy. Right temporal lobectomy was more common in the postoperative mania group. Duration of manic episodes was usually transient, and all but one case remitted within 1 year after onset. In comparison with the control group, mania and depression groups had a higher likelihood for preoperative generalized tonic-clonic seizures and lack of seizure freedom following surgery.

CONCLUSIONS

A limitation of this study was the relatively small number of patients. Despite this, clinical features that distinguish patients at risk for postoperative mania from those with depression and those with no psychiatric illness include bihemispheric abnormalities, in particular bitemporal EEG activity, and right temporal lobectomy.

Repeated hypoglycemia and cognitive decline. A case report

OBJECTIVE

Diabetes mellitus has a high incidence in general population and goes by high morbidity by specific micro vascular pathology in the retina, renal glomerul and peripheral nerves. In type 1 DM, intensive therapy can prevent or delay the development of long-term complications associated with DM but hypoglycaemia especially severe hypoglycaemia defined, as a low blood glucose resulting in stupor, seizure, or unconsciousness that precludes self-treatment is a serious threat. Hypoglycaemia that may preferentially harm neurons in the medial temporal region, specifically the hippocampus, is a potential danger for the brain cognitive function which several studies failed to detect any significant effects, whereas others indicated an influence on it. A young diabetic case presented here with severe cognitive defect. Great number of severe hypoglycaemic or hyperglycaemic attacks and convulsion episodes were described in his medical history.

RESULTS AND CONCLUSION

Neuroradiologic findings on CT and MRI, pointed that global cerebral atrophy that is incompatible with his age. Brain perfusion studies (SPECT, (99m)Tc-labeled HMPAO) also showed that there were severe perfusion defects at superior temporal region and less perfusion defects at gyrus cingulum in frontal region. These regions are related with memory processing. Severe cognitive defect in this patient seems to be closely related these changes and no another reason was found to explain except the repeated severe hypoglycaemic episodes.

NAALADase (GCP II) inhibition prevents cocaine-kindled seizures

The prediction that inhibition of NAALADase, an enzyme catalyzing the cleavage of glutamate from N-acetyl-aspartyl-glutamate, would produce antiepileptogenic effects against cocaine was tested. Cocaine kindled seizures were developed in male, Swiss-Webster mice by daily administration of 60 mg/kg cocaine for 5 days. The NAALADase inhibitor 2-(phosphonomethyl)pentanedioic acid (2-PMPA) produced dose-dependent protection (10-100 mg/kg) against both the development of seizure kindling and the occurrence of seizures during the kindling process without observable behavioral side-effects. It is not likely that 2-PMPA produced protection against cocaine kindling by altering the potency of the convulsant stimulus as daily administration of 2-PMPA did not alter the convulsant thresholds for cocaine. Lower daily doses of cocaine (40 mg/kg) did not increase the incidence of seizures but produced kindling, as evidenced by the increase in seizure susceptibility when mice were probed with a higher dose of cocaine. 2-PMPA was also effective in preventing the development of sensitization to this covert kindling process. In contrast to its efficacy against cocaine kindled seizures, 2-PMPA failed to attenuate the convulsions engendered by acute challenges with pentylenetetrazole, bicuculline, N-methyl-D-aspartate, maximal electroshock or cocaine. Similarly, acutely-administered 2-PMPA did not block cocaine seizures in fully-kindled mice. NAALADase inhibition thus provides a novel means of attenuating the development of cocaine seizure kindling.

Characteristics of flurothyl-induced seizures and the effect of antiepileptic drugs on flurothyl-induced seizures in Mongolian gerbils

We investigated the characteristics of the flurothyl-induced seizures and the effects of antiepileptic drugs on the flurothyl-induced seizure model in a previously untested Mongolian gerbil species. Mongolian gerbils demonstrated tonic extension immediately after or within 1 min after the appearance of clonic convulsion. Very high amplitude spike waves appeared in these regions concurrent with the appearance of clonic convulsion. When the tonic extension appeared immediately after the clonic convulsion, the high amplitude spike waves continued during tonic convulsion. When the tonic extension occurred, high amplitude spike waves appeared in these three regions within a very short time, and afterward Mongolian gerbils died. Administration of valproic acid-Na (200 mg/kg), ethosuximide (100 and 200 mg/kg), clonazepam (2 mg/kg) and diazepam (0.5, 1 and 2 mg/kg) significantly prolonged the latency of clonic convulsion. Zonisamide-Na, phenytoin and carbamazepine, however, had no such effect. In Mongolian gerbils, tonic extension was demonstrated immediately after the appearance of clonic convulsion, yet, this effect was inhibited by all these drugs in a dose-dependent manner. Diazepam completely blocked the appearance of any behavioral changes in animals. These findings suggest that diazepam has a significant effect on flurothyl-induced seizures. Flurothyl-induced convulsions are associated with GABA receptors; hence, benzodiazepine (BDP) suppression may result from the strong relation between BDP and GABAnergic neurons.

Psychoses and epilepsy: are interictal and postictal psychoses distinct clinical entities?

PURPOSE

To evaluate further the relevance of designating psychotic episodes as either postictal or interictal, we compared several biologic variables between epilepsy patients with and without psychosis.

METHODS

The study subjects comprised 282 patients with psychosis (36 with postictal psychosis, 224 with interictal psychosis, and 22 with both postictal and interictal psychoses, i.e., bimodal psychosis), and 658 epilepsy patients without psychosis. The clinical characteristics of these patients were reviewed retrospectively by experienced neuropsychiatrists. Factors predicting the development of each type of psychosis were determined by serial multivariate logistic regression analyses.

RESULTS

Factors that were comparable between postictal and interictal psychoses were intellectual function, family history of psychosis, epilepsy type, and the presence of complex partial seizures. In contrast, age at the onset of epilepsy and at the onset of psychosis and the presence of generalized tonic-clonic seizures differed for the three types of psychosis. Patients with bimodal psychosis showed characteristics associated with both postictal and interictal psychoses.

CONCLUSIONS

This study documented conditions, including both general factors and epilepsy-related factors, common to epilepsy patients with psychosis, regardless of chronologic distinctions. Certain epileptic processes appear to have equal influence on postictal and interictal psychoses. However, some differences between postictal and interictal psychoses suggest that these chronologic descriptors are valid. Our findings confirmed that psychosis associated with epilepsy should not be defined as a single, simple condition but rather as a complex condition with several possible subcategories.

Characteristics of postictal psychosis in a psychiatric center

The clinical characteristics of 12 cases of postictal psychosis treated at Taipei City Psychiatric Center, Taipei, Taiwan, were retrospectively reviewed. Increased seizure frequency, especially with generalized tonic-clonic seizures, was the major risk factor predisposing to postictal psychosis. The psychotic symptoms were variable with delusions and/or hallucinations. These patients showed a much longer history of epilepsy (21.9 +/- 10.7 years) prior to the development of postictal psychosis than has been previously reported. The possible mechanisms in the pathophysiology of psychosis in epileptics were discussed.

Prolonged generalized epileptic seizures triggered by breath-holding spells

We report a 3-year-old female with anoxic-epileptic seizures. Beginning at 11 months of age, she had repeated breath-holding spells with transition into generalized tonic-clonic seizures or status epilepticus. Interictal electroencephalography exhibited no abnormalities. A multidisciplinary diagnostic approach revealed a severely disturbed mother-daughter relationship that was the trigger of the breath-holding spells. Psychotherapy for the mother and daughter led to cessation of the breath-holding spells and, consequently, of the anoxic-epileptic seizures. Her further development was largely normal. We discuss the etiology and treatment of anoxic-epileptic seizures. This case is the first reported case of anoxic epileptic seizures that responded to psychologic rather than antiepileptic treatment. We advocate an initial psychologic assessment to help determine the appropriate treatment in children with recurrent anoxic-epileptic seizures.

Felt stigma and impact of epilepsy on employment status among Estonian people: exploratory study

This article examines the impact of epilepsy and its treatment on employment status and the extent of stigma among patients with epilepsy. Clinical and demographic data concerning patients examined during a recent epidemiological survey were obtained from medical notes and postal self-completed questionnaires. Information was collected from 90 patients aged 16-70 years. A third of the respondents had been seizure-free during the last year. Thirty-nine percent were working full-time, 24% were working part-time and 11% were unemployed. Sixty-three percent from those working part-time or unemployed considered their epilepsy to be a significant reason for this. Overall, 55.4% believed they had been treated unfairly at work or when trying to get a job. Fifty-one percent of respondents felt stigmatized by epilepsy, 14% of them highly so. The level of employment among epileptic people was not lower than in the general population. The percentage of stigmatization in general and the percentage of the severely stigmatized was as high or even higher than in other studies. Occurrence of stigma and its severity depended first and foremost on the type of seizures. The frequency of seizures was not clearly related to this.

Cocaine-induced seizure thresholds: quantitative trait loci detection and mapping in two populations derived from the C57BL/6 and DBA/2 mouse strains

Seizures are a well known consequence of human cocaine abuse, and in rodent models, sensitivity to cocaine seizures has been shown to be strongly influenced by genotype. For example, several studies have reported significant differences between the C57BL/6 (B6) and DBA/2 (D2) inbred mouse strains in their sensitivity to cocaine-induced seizures. This prompted our use of the BXD recombinant inbred (RI) strain set and an F(2) population derived from the B6 and D2 progenitor strains for further genetic analyses and for gene mapping efforts in this study. Cocaine was infused into the lateral tail vein, and the doses needed to induce a running bouncing clonic seizure and a tonic hindlimb extensor seizure were recorded for each mouse. In the BXD RI set, a genome-wide search was carried out for QTLs (quantitative trait loci), which are sites on a chromosome containing genes that influence seizure susceptibility. An F(2) population (B6D2F2, n = 408) was subsequently used as a second, confirmation step. Based on both RI and F(2) results, three QTLs emerged as significant (P <.00005): one for clonic seizures on chromosome 9 (distal), and two for tonic seizures on chromosomes 14 (proximal to mid) and 15 (distal). Two additional QTLs emerged as suggestive (P <.0015), both associated with clonic seizures on chromosomes 9 (proximal) and 15 (distal). Both QTLs on chromosome 9 were sex-specific, with much larger effects on the phenotype seen in females than in males.

[Orofaciodigital syndrome--a new variant? Psychiatric, neurologic and neuroradiological findings]

Oral-facial-digital (OFD) syndromes are a heterogeneous group of inherited syndromes that have in common anomalies of the face (median cleft lip), the tongue (bifid or lobulated tongue with harmartomas), and the digits (brachydactyly, polydactyly, syndactyly). Due to more or less subtle clinical features, at least seven causally different entities can be identified: 1) OFDS I; 2) OFDS II (Mohr syndrome); 3) OFDS III; 4) OFDS with tibial anomalies (OFDS IV); 5) OFDS V (Thurston syndrome); 6) OFDS VI (Váradi syndrome); and 7) OFDS VII (Whelan syndrome). The neuro-psychiatric clinical observations and MRI findings of a 40 year old woman with a OFD syndrome are described. The observed findings (leukoaraiosis, epilepsy, major depression) in combination with a proven OFD syndrome possibly reflect a new type of OFD syndrome.

Coping with refractory epilepsy

We investigated the coping behaviour and its correlation with demographic and illness-related data, depression, locus of control and psychosocial adaptation in 40 patients with intractable epilepsy with primarily or secondarily generalized tonic-clonic seizures. Three standardized self-reporting questionnaires were applied, which are the Freiburg Questionnaire of Coping with Illness (FKV), the von Zerssen Depression Scale (D-S), and the IPC-questionnaire measuring generalized locus of control beliefs; the Social Interview Schedule (SIS), a semi-structured interview, was used to measure the psychosocial adaptation. Active, problem-focused and compliance strategies were predominantly used and regarded as most helpful. Hence, the epileptic patients use similar coping patterns reported in patients with other non life-threatening chronic diseases. The level of depression was moderate and in the range of other chronic somatic diseases. The use of coping patterns, which are regarded as maladaptive, was correlated with distinct depression, a small degree of internal locus of control beliefs and poor psychosocial adaption. These results indicate the possibility to improve psychosocial adjustment by supporting effective strategies.

Truly a team effort

Jane was a healthy 16 year old girl who attended a high school dance and subsequently had a grand mal seizure--her first! She was taken home, developed a decreasing level of consciousness and was admitted to the local hospital, where it progressed to status epilepticus. We will describe the classifications of seizures including status epilepticus, which demands the highest level of clinical expertise and attention to preventative medicine, for a desirable outcome. During the eleven months of care a massive multi disciplinary team approach was instituted which extended across borders. Jane's story demonstrates a truly Neuroscience team effort from acute care to a rehabilitation center to home.

Complex partial and secondarily generalized seizure patients: cognitive functioning prior to treatment with antiepileptic medication. VA Epilepsy Cooperative Study 264 Group

This investigation of cognitive functioning in patients with symptomatic localization-related (partial) epilepsy prior to administration of antiepileptic medication is part of a nationwide prospective, double-blind study of drug efficacy and longitudinal changes in cognition associated with seizure disorders. Recently-diagnosed patients with complex partial or secondarily generalized tonic clonic seizures, equated for age, education and IQ, were compared with normal controls on a battery of neuropsychological tests: verbal and figural memory measures (Rey auditory verbal learning test, Rey Osterrieth complex figure), and a brief behavioral toxicity battery comprising measures of motor function, concentration and mental flexibility (Lafayette grooved pegboard, controlled word association test, Stroop, paced auditory serial addition test [PASAT]). Control subjects perform significantly better than both groups of seizure patients on several measures of motor speed/integration and memory, specifically the pegboard and the RAVLT learning (3-5) and recall trials. Secondarily generalized seizure patients show greatest impairment. They perform significantly worse than patients with complex partial seizures and control subjects on the controlled word association test and the most demanding Stroop color word trial, both measures of concentration and mental flexibility. These findings document deficits in memory as well as concentration and motor function in complex partial and in secondarily generalized seizure patients prior to treatment with antiepileptic medication.

Gender-related differences in non-epileptic attacks: a study of patients' cases in the literature

Gender-related differences for disorders of consciousness other than true epilepsy usually point to a larger number of women suffering especially from non-epileptic attacks or pseudoseizures. Recently, sexual abuse has been suggested as a possible cause for this increased prevalence in women. It has, however, not been very clear if women have a different phenomenology of these type of seizures from men. In the present study, patients' cases as published in the literature are analysed in a detailed way, using a working classification by Betts et al to look for gender-specificity. Of the 62 cases, 76% concern women and 24% men; a percentage comparable to those published elsewhere. Ages range from 14 to 77 years-of-age, but 89% of patients are younger than 40. Sexual abuse was proven in 18 cases, all women. The phenomenology of the attacks was divided into tonic-clonic type and complex partial type of attack, or a combination of the two. Also, special types of attacks (swoons, tantrums, abreactive attacks and forthright simulation) were looked for. Males tended to suffer especially from tonic-clonic type seizures (80% of cases), while in women as many tonic-clonic type as complex partial type attacks were observed. Special types of attacks were observed at the same frequency in both sexes. The group of sexual abuse victims did not differ from the total group of women in this respect. The clinically more impressive nature of a tonic-clonic-type attack, that is more easily suspected to be 'real', might make this type of seizure a more male form of acting out. A prospective study on the incidence and phenomenology of pseudo-epileptic seizures in the general population is suggested to answer the new questions raised in this survey.

Personality profiles of patients with pseudoseizures

Minnesota Multiphasic Personality Inventory profiles were analysed in 55 patients with pseudoseizures (40 patients with pseudoseizures only-pure group, and 15 patients with both pseudoseizures and epilepsy-mixed group). For each of the 10 clinical scales, there were no significant differences between the groups in mean T-score values or the incidence of pathological scores (T-score of 70 or above). In 87.3% of cases in the entire sample (groups combined), at least one clinical scale was elevated in the pathological range. For the combined groups, scales having the highest mean values as well as highest incidence of pathological scores were Schizophrenia, Hysteria and Depression. The mean profile of the entire sample (n = 55) had a two-point code of 8-3 with Schizophrenia and Hysteria as profile peaks. Application of three sets of published criteria for hysteria or conversion yielded markedly different results. This finding underscores the difficulty in evaluating the role of hysteria in pseudoseizures in the absence of a single standard. Mean values and the overall profile of this patient sample were remarkably similar to those found in two previous studies.

Echographia as a symptom of interictal state in an epileptic patient: a case report

Echographia is a phenomenon in which a patient continuously translates verbal stimuli into writing. We encountered a patient with epilepsy who developed visual echographia during interictal periods. In this case, echographia was observed during two different periods, namely the period of disturbed consciousness after the epileptic seizure and the period of clear consciousness after suppression of the seizures. Disinhibition due to disturbance of the consciousness is considered to have been the cause of echographia in the former period. In the latter period, it is considered that echographia was caused by the release of lower function from suppression of upper function by brain dysfunction, as the after effect of status epilepticus. As echographia can be observed in epileptic patients, attention and careful observation by epileptologists is needed.

Transient psychosis in a girl with epilepsy and continuous spikes and waves during slow sleep (CSWS)

A normally developed and healthy 6-year-old girl suffered the onset of epilepsy with generalized tonic-clonic seizures and atypical absences. Initially the EEG showed epileptiform activity over the temporal and parietal regions, later there were episodes of bilateral synchronous spike-wave activity with a frequency of 1.5-2.5 Hz. After a few months, deterioration of cognitive and behavioural functions appeared and gradually increased with the development of a full-blown disintegrative psychosis that went on for several months. Sleep EEG recordings showed the characteristic abnormality described as continuous spikes and waves during slow sleep. Later there was a remarkable improvement of neuropsychiatric functions but a second outbreak of psychosis seems to have left the girl, who is now 9 years of age, with severe mental impairment.

Is there a relationship between rat latent aggressiveness and susceptibility to convulsive crises?

Experiments were aimed at assessing a possible different sensitiveness to seizures in aggressive vs. nonaggressive rates. Thirty-nine muricidal rats were selected by using a sedated mouse. Six of these killer rats (K) showed electroencephalographic (EEG) spontaneous syncronous wave-and-spike discharges, 6-11 c/s. None of nonkiller animals (NK) showed a similar pattern. These 6 K were not used for the subsequent experiments. Intraperitoneal pentylentetrazole (PTZ; 10, 20, and 40 mg/kg) or bicuculline (BIC; 2 and 4 mg/kg) was given to both NK and K. K were more sensitive than NK to the epileptogenic effects of 20 mg/kg PTZ and 2 mg/kg BIC, as revealed by the significant increased number of convulsive rats and longer duration of EEG seizures. No difference in EEG or convulsant behavior was observed between K and NK after the administration of the lower dose of PTZ and the high dose of PTZ or BIC. The use of K rats as a possible new sensitive model of petit mal is discussed.

The relationship of epileptic auras and psychological attributes

Studies suggest a high frequency of epileptic auras with intellectual content among epileptic patients with psychopathology and personality disorders. This study compared measures of personality and psychosocial functioning between epileptic patients with cognitive auras and epileptic patients with noncognitive auras. Ten patients with complex partial seizures who experienced cognitive auras had consistently more depressive traits and psychosocial difficulties than 50 patients with other psychic or nonpsychic auras, particularly if the patients with cognitive auras had left hemisphere epileptiform foci. Cognitive auras may be associated with depressive traits among epileptic patients. The findings were also in agreement with studies that relate the left hemisphere to depression.

Antiepileptic drug behavioral side effects in individuals with mental retardation and the use of behavioral measurement techniques

Measurement methods from behavioral psychology were used to assess antiepileptic drug behavioral side effects in 5 individuals with mental retardation. When the suspected antiepileptic drug was altered, an 81% reduction of maladaptive behaviors occurred. Quality of life outcomes included successful community placement and termination of an aversive intervention procedure. Three cases demonstrated antiepileptic drug exacerbation of disruptive vocalizations, agitation, self-injurious behavior, and property destruction; 2 demonstrated improved aggression, but illustrated a common clinical problem. When seizure control must be maintained and a suspected antiepileptic drug cannot be reduced before a second antiepileptic drug with potential psychotropic properties is initiated, it was not possible to absolutely conclude that the first antiepileptic drug was responsible for the behavior problem. Overall, these measurement methods were instrumental in the systematic clinical evaluation of antiepileptic drug behavioral side effects in individuals unable to verbally communicate the presence of these side effects.

Age-dependent anticonvulsant action of clonazepam in the N-methyl-D-aspartate model of seizures

Seizures may result from an impaired balance between excitation and inhibition. We tested whether clonazepam [a benzodiazepine that enhances GABAA inhibitory transmission (0.2 or 1.0 mg/kg, intraperitoneally [i.p.])] suppresses an age-dependent pattern of N-methyl-D-aspartate (NMDA)-induced phenomena in 7-, 12-, 18-, 25-, and 60-day-old rats (10, 40, 100, 100, and 200 mg/kg of NMDA, i.p., respectively). There were no effects of clonazepam against the NMDA-induced automatisms and emprosthotonus. In 7-day-old rats, clonazepam was proconvulsant in clonic-tonic seizures (it decreased the latency to onset of seizures, whereas it was anticonvulsant in 25-day-old rats. There was no difference between anticonvulsant effects of clonazepam and its solvent in 12- and 60-day-old rats. Both cortical and hippocampal EEG seizures was extremely poor in this model. There was no improvement of EEG recording after clonazepam. The results demonstrate that impaired excitation cannot be simply balanced by an enhanced inhibition and that the drug effects in young animals cannot be predicted from the effects in adults.

Differential audiogenic seizure sensitization by selective unilateral substantia nigra lesions in resistant Wistar rats

Evaluation of the participation of different substantia nigra sites in the sensitization of resistant (R) animals to audiogenic seizures (AS), was performed after series of small (5 mC; n = 28), medium (10 mC; n = 57) and large (15 mC; 3 points of 5 mC each, n = 19) unilateral electrolytic lesions of the substantia nigra (SN) in R rats. Animals were evaluated at 5, 10, 15, and 30 days post surgery and behavior was measured by a neuroethological method. Small unilateral lesions induced AS susceptibility in 14% R animals with 3% of them displaying tonic-clonic AS. Medium sized lesions induced AS susceptibility in 50% of the animals with 18% of these exhibiting tonic-clonic seizures similar to those displayed by naturally susceptible (S) animals, but with predominance of wild running (gyri, jumping and atonic falling) contralateral to the lesioned SN. AS severity was significantly higher at day 5 postsurgery, decreasing at days 10, 15 and 30. Large unilateral lesions destroying the entire SN failed to cause tonic-clonic seizures although wild running occurred in 10% of the animals. Bilateral large SN lesions (15 mC; n = 24) did not modify AS severity in S animals, but only induced a statistically significant increase in the AS latency. The present data suggest: (i) AS severity after SN lesions is not a linear function of the lesion size; (ii) functionally different and antagonistic AS related substrates may exist in the SN; (iii) neurochemical and hodological characterization of these areas should be important for a better understanding of their role in AS.

Postictal psychosis: a case control series of 20 patients and 150 controls

We compared clinical data, EEG, and video-EEG studies in a consecutive series of 20 patients with postictal psychosis (PP) to 150 consecutive epilepsy patients with complex partial (CPS) or generalized tonic-clonic (GTCS) seizures but without PP. There was a lucid interval between last seizure and onset of psychosis ranging from 2.3 to 72 h (mean, 25 h). Duration of PP ranged from 16 to 432 h (mean, 83 h). Age, sex, epilepsy type (partial vs. generalized), and history of febrile seizures were similar in the PP and control groups. Patients with PP had more frequent GTCS during monitoring than controls (2.8 vs. 1.3; P < 0.001). Patients with PP were more likely to have a history of encephalitis (P < 0.0001) and psychiatric hospitalization (P < 0.002). More patients with PP had bilateral interictal epileptiform discharges during monitoring than controls (P < 0.0002). Postictal psychosis most often develops in patients with bilateral dysfunction following a cluster of GTCS.

[Differential diagnosis of aggressive behavior in epilepsy]

Aggressive behaviour in epileptics may have many causes which are connected more or less closely with epilepsy. Ictal aggression is very rare. In the case of a patient with complex partial seizures and a schizophrenia-like psychosis different forms of generation of aggressive behaviour are discussed.

Munchausen syndrome: case reports and literature overview

Munchausen syndrome is a subset of factitious disorders with a number of distinguishing characteristics. This article presents three case reports and brief discussions to facilitate recognition. Management techniques are also presented.

Mesial temporal lobe seizures presenting as anxiety disorders

Five patients had brief simple partial seizures that mimicked panic disorder. The following features assisted diagnosis: Seizures were briefer and more stereotyped than panic attacks; some progressed to typical complex partial seizures; and aphasia and dysmnesia occurred during seizures in some patients. Each patient had one mesial temporal structural lesion. Routine waking EEG was normal in 2 patients. Inadequate response to anti-epileptics necessitated partial temporal lobectomy in 4 patients, 3 of whom remain seizure free.

[Munchausen sydrome presenting repeated attacks of factitious status epilepticus (case report)]

A 27-year-old male patient with Munchausen syndrome presenting repeated pseudoseizures simulating grand mal status, is presented. Over a ten-year period there were more than hundred admissions to neurologic of psychiatric wards for suspected diagnosis of uncontrolled epilepsy. On many occasions the patient was admitted to the hospital under dramatic conditions of psychogenic seizures similar to grand mal status that initially demanted intensive antiepileptic treatment, in order to prove its pseudoepileptic nature. On the basis of his past history, our observation, and information obtained from other regional hospitals, we diagnosed epileptic Munchausen syndrome.

Treatment of nonepileptic psychogenic events in adolescent patients using the systems model for intervention

Nonepileptic psychogenic events in children, adolescents and adults can be difficult to treat. Using a systems framework intervention method resulted in significant reduction in nonepileptic psychogenic events. This method provides for a continuous flow of interaction, feedback and modification among the health care team, family and community. Common goals and plans are defined and implemented with a mechanism for feedback and modification. Using a systems model approach in educating the caregivers resulted in immediate and long-term reduction in nonepileptic psychogenic events.

Seizure suggestibility may not be an exclusive differential indicator between psychogenic and partial complex seizures: the presence of a third factor

Differential diagnosis between psychogenic or ('hysterical') pseudoseizures and clinical partial complex seizures has often employed an index or inference of suggestibility. However, recent research indicates a moderate association between complex partial epileptic-like signs and hypnotic capacity in the normal population as well as for complex partial epileptic patients. Consequently, the precipitation of overt, non-stereotyped seizures by instruction may not be a reliable diagnostic method when an insidious process is slowly elevating temporal/limbic lobe lability. Implications for treatment and contra-indication of antipsychotic (D2 antagonist) drugs are discussed.

Epileptic seizures and infantile states: some thoughts from psychodynamic therapy

A brief introduction to psychoanalytic thinking around epileptic seizures is given. It is notable how little attention has been paid by psychoanalysis to the psyche-soma links present in epilepsy. The psyche-soma world of the early infant is outlined, along with the impact of impingements on this fragile world. It is postulated that for certain individuals with epilepsy, the seizure state may generate a regression to an earlier developmental state of being involving a change in emotional state and the emergence of unconscious phantasies. Single case study material from the psychodynamically orientated art therapy of 'Gordon', a man with epilepsy and learning disabilities, is used to illustrate and support this hypothesis. This work took place in a specialized centre for epilepsy.

Verbal and visual memory impairment in children with epilepsy

Verbal and visual memory performances were evaluated in 60 epileptic children and 60 normal control subjects with Signoret's Memory Battery scale. Eighteen patients had idiopathic generalized epilepsy and 42 had partial epilepsy, mostly of the temporal (n = 28) and frontal (n = 10) lobes. Memory scores were statistically lower in epileptics than in controls and significant differences were found within each group: (1) children with idiopathic generalized epilepsy had a slight depression of visual memory; (2) memory disorder was more severe in partial epilepsy; and (3) children with left and right temporal lobe epilepsy had marked memory deficits related to hemispheric specialization.

'Phantom' typical absences, absence status and experiential phenomena

We present a case of mild typical absences (phantom absences) culminating in absence status and generalized tonic-clonic seizures. The patient has recorded his experience during an episode of absence status and provides a rare insight into a mind temporarily clouded by whirling thoughts and muffled responses. This case is important as it demonstrates the pitfalls which may hinder the diagnosis of this unusual condition.

[Contributive factors of intellectual disorders in epileptic patients]

Fifty-two patients with primary epilepsy of tonic-clonic seizure type, whose CT scans were negative, were examined by Wechsler adult intelligence scale-revised (WAIS-RC). Full intelligence quotient (FIQ) of 26 patients were lower than normal. Multivariate analysis of variance (MANOVA) was done to analyze the influence factors of FIQ. The result demonstrated that there was a negative correlation between FIQ and seizure frequency, epileptic course, antiepilepsy drugs (P < 0.05). FIQ was not correlated with onset ages and electroencephalography changes (P > 0.05).