David Lardizabal

Males with epilepsy, complete subcortical band heterotopia, and somatic mosaicism for DCX

Subcortical band heterotopia (SBH) is seen predominantly in females, resulting from mutations in the X-linked doublecortin (DCX) gene, and can present with mild mental retardation and epilepsy. Males carrying DCX mutations usually demonstrate lissencephaly and are clinically much more severely affected. This article reports two cases of males with SBH indistinguishable from the female phenotype, both resulting from somatic mosaicism for DCX mutation.

Modern technology calls for a modern approach to classification of epileptic seizures and the epilepsies

In the last 10–15 years the ILAE Commission on Classification and Terminology has been presenting proposals to modernize the current ILAE Classification of Epileptic Seizures and Epilepsies. These proposals were discussed extensively in a series of articles published recently in Epilepsia and Epilepsy Currents. There is almost universal consensus that the availability of new diagnostic techniques as also of a modern understanding of epilepsy calls for a complete revision of the Classification of Epileptic Seizures and Epilepsies. Unfortunately, however, the Commission is still not prepared to take a bold step ahead and completely revisit our approach to classification of epileptic seizures and epilepsies. In this manuscript we critically analyze the current proposals of the Commission and make suggestions for a classification system that reflects modern diagnostic techniques and our current understanding of epilepsy.

Proposal: Different types of alteration and loss of consciousness in epilepsy

There are at least five types of alterations of consciousness that occur during epileptic seizures: auras with illusions or hallucinations, dyscognitive seizures, epileptic delirium, dialeptic seizures, and epileptic coma. Each of these types of alterations of consciousness has a specific semiology and a distinct pathophysiologic mechanism. In this proposal we emphasize the need to clearly define each of these alterations/loss of consciousness and to apply this terminology in semiologic descriptions and classifications of epileptic seizures. The proposal is a consensus opinion of experienced epileptologists, and it is hoped that it will lead to systematic studies that will allow a scientific characterization of the different types of alterations/loss of consciousness described in this article.

Tolerability and Pharmacokinetics of Oral Loading with Lamotrigine in Epilepsy Monitoring Units

Summary:  Purpose: To investigate the tolerability and pharmacokinetics of oral loading with lamotrigine (LTG) among epilepsy patients after temporary drug discontinuation in an epilepsy monitoring unit.

Neuropsychological correlates of forgiveness

A recent study of individuals with traumatic brain injury suggests that forgiveness is a neurologically based function related to decreased self-orientation associated with decreased right parietal lobe (RPL) functioning. The current study attempted to replicate these results using 23 individuals with diagnosed seizure disorders. Neuropsychological tests of bilateral frontal, temporal, and parietal lobe functioning were used as indices of cerebral integrity and correlated with a self-report measure of forgiveness. Results indicated that frontal lobe and RPL functions were significantly and negatively correlated with forgiveness. A forward linear regression indicated that only RPL functions predict unique variance in forgiveness. The results support a neuropsychological model of forgiveness that suggests it is related to: (1) decreased self-orientation associated with decreased RPL function, which is experienced as a decreased focus on the perceived wrong to the self; and (2) decreased attention associated with decreased frontal lobe functioning, which is experienced as decreased rumination associated with feeling wronged. Research and practical implications are discussed.

Intracranial Hypertension and Levofloxacin: A Case Report

This is a case report of a 15‐year‐old boy who developed benign intracranial hypertension after 3 weeks of levofloxacin intake. The headache, diplopia, and papilledema resolved within a week after levofloxacin was withdrawn. Physicians must be aware that quinolone antibiotics can potentially cause intracranial hypertension.

Catatonia in encephalitis and nonconvulsive seizures: A case report and review of the literature

A 20-year-old woman was admitted for psychosis. On further investigation, she was found to be have viral encephalitis and generalized nonconvulsive seizures. After the seizures were controlled, she remained in a prolonged catatonic state. Repeated intravenous benzodiazepine administration, improved her cognition dramatically. This case emphasizes that catatonia may occur after encephalitis and nonconvulsive seizures.

Use of propofol to control refractory involuntary movements

The authors report the first case of propofol use for the control of non-epileptic involuntary movements in a patient with postviral encephalitis. The withdrawal from propofol was associated with re-emergence of involuntary movements. The patient was maintained on propofol infusion for 6 months while a series of medications were used in an attempt to control the movements. The movements were finally controlled with high doses of phenobarbital, diazepam, and olanzapine, and the propofol was slowly weaned.