Fumio Kubota

Bone mineral density of epileptic patients on long-term antiepileptic drug therapy: a quantitative digital radiography study

In order to assess the bone atrophy lesions of epileptic patients, the bone mineral densities (BMDs) of their lumbar spines and femoral necks were measured using quantitative digital radiography (QDR). The study groups were 44 patients on long-term medication for epilepsy and 62 healthy control subjects. We selected patients who had been taking phenytoin, barbiturates, and/or acetazolamide for at least 5 years. BMDs at both sites were significantly lower in the patient group than in the control group. No sex differences were found in BMDs. There were no significant correlations with the onset or the duration of illness and BMD. We compared BMD according to the type of epileptic drug being taken and theorized that phenytoin, barbiturates, and acetazolamide reduced BMD. BMDs of the 15 patients were measured again 7 years later, and were found to be significantly lower at both sites than in the previous examination. These results confirm the presence of bone atrophy lesions in epileptic patients on long-term antiepileptic drugs. Patients on antiepileptic therapy for long periods should have their BMDs checked, because they are prone to developing bone atrophy.

Valproic Acid‐Induced Hyperammonemic Encephalopathy with Triphasic Waves

Summary: Purpose: To examine a patient with valproic acid (VPA)‐induced hyperammonemic encephalopathy accompanied by triphasic waves.

Content and Cross Validity of the Todai Health Index Depression Scale in Relation to the Center for Epidemiologic Studies Depression Scale and the Zung Self-rating Depression Scale

Content and Cross Validity of the Todai Health Index Depression Scale in Relation to the Center for Epidemiologic Studies Depression Scale and the Zung Self‐rating Depression Scale: Tomoyuki Kawada, et al. Department of Public Health, Gunma University School of Medicine—The validity of the Todai Health Index (THI) depression scale was tested with outpatient data by comparing with a clinical diagnosis based on the DSM III‐R criteria of major depression. The cross validity of the Japanese versions of the CES‐D score and SDS index were also tested in comparison with the THI scale scores of survey data from Japanese female students. The main results obtained were as follows: 1) The sensitivity, specificity, positive predictive value and negative predictive value of the THI depression scale were 0.91, 0.84, 0.86 and 0.89, respectively, and were satisfactory for identifying clinical cases of depression. 2) The CES‐D score and the SDS index showed a high correlation with the THI scale scores, especially with the depression scale of THI. The coefficients of correlation for the THI depression scale and the CES‐D score or SDS index were 0.727 and 0.715, respectively. The partial coefficients of correlation for the THI depression scale and the CES‐D score or SDS index, when the variances of all other scale scores of the THI were kept constant, were 0.528 and 0.536, respectively. 3) Factor analysis was used to compare SDS and CES‐D with 12 THI scales. SDS was related mainly to the psychological complaints and partly related to the physical symptoms. The results indicate that the THI depression scale is valid for use not only in epidemiological surveys but also in monitoring the severity of the depressive state.

Cerebral activation focusing on strong tasting food: a functional magnetic resonance imaging study.

Very little research has been conducted on taste imagery because of the difficulty of doing so. We conducted a functional magnetic resonance imaging study to observe cerebral activation patterns produced in volunteers concentrating on pickled plums (umeboshi), a traditional Japanese food with a strong and sour taste. Activation was observed in the right insula, the bilateral opercula, the bilateral orbitofrontal cortices and the left Brocas area. Activation in the insula (primary gustatory area) was very weak and limited to one side. The activation pattern was similar to that of taste perception. Our results showed that it is possible for humans to imagine tastes.

Study on FIRDA and 3 Hz Rhythmic Slow Wave Bursts Occurring in the Frontal Area of Epileptic Patients

We classified epileptic patients with frontal-dominant rhythmic slow-wave bursts into a FIRDA group with frequencies of 1.5 to 2.5 Hz and a 3 Hz group with a frequency of 3 Hz. We compared the two groups in clinical background and EEG findings. The patients in the FIRDA group were older, and partial epilepsy was more common. In the 3 Hz group, idiopathic generalized epilepsy was more common. All of the partial epilepsy in the patients in the FIRDA group was symptomatic, and organic brain damage such as sequelae of brain tumor surgery, or cerebrovascular disorders, etc., were the most common primary diseases. There was no difference between the two groups in frequency of seizures, and VPA was the drug most often used to treat the patients in the 3 Hz group. No morphological differences between the two group, except the difference in frequency, were observed among the EEG findings. Accompaniment by localized spike waves or sharp waves was more common in the FIRDA group. When epilepsy was accompanied by rhythmic slow-wave bursts in the frontal area, its clinical significance depended on whether its frequency was 2.5 Hz or less or 3 Hz. When it was 2.5 Hz or less, symptomatic partial epilepsy was more common, suggesting the presence of large, prominent organic brain damage, such as sequelae of brain tumor surgery or cerebrovascular disorders. Idiopathic generalized epilepsy, on the other hand, was shown to be more common when the frequency was 3 Hz.

Ictal brain hemodynamics in the epileptic focus caused by a brain tumor using functional magnetic resonance imaging (fMRI).

Using functional magnetic resonance imaging (fMRI) we were able to observe, in detail, ictal brain hemodynamics during epileptic seizure caused by a brain tumor. A 53-year-old man was experencing partial motor seizures of the left side of his face and neck. In a brain MR image a mass lesion was found in the subcortical area of the right frontal lobe. We found focal spikes in his right hemisphere, though dominantly in C4 and T4 regions. fMRI investigations were carried out at 1.5 T (GE Signa Horizon) using gradient-echo echo-planar neuroimaging. We were able to perform the ictal examination twice. The activated regions were focalized and clearly found only on the lateral side of the tumor base. The region was in agreement with the epileptic focus examined using an electrocorticogram (ECOG). The signal intensity in the seizure focus rapidly increased 30 seconds before the convulsion was observed. After the end of the convulsion it also took 30 seconds to restore the signal intensity to the baseline value. fMRI is a very useful tool for various studies such as the identification of the epileptic focus, the mechanism of epileptic seizure, and so on.

Non-convulsive status epilepticus induced by antidepressants

We report on a 27-year-old woman of non-convulsive status epilepticus (NSE) very probably induced by antidepressants. She has no history of febrile convulsions, or epileptic seizures. There are no genetic factors for epilepsy in her family. As she developed depressive illness, she consulted a doctor. Clomipramine 25 mg i.v. drip/day and maprotiline 75 mg/os/day were started. Recently she began to doze, so an EEG was performed. Continuous generalized 2-3 Hz spike and wave complexes were observed. Clomipramine and maprotiline were stopped the same day, and the patients drowsiness gradually improved. There are some case reports of NSE induced by antidepressants. However, the patients in these reports had received frequent electroconvulsive therapy (ECT) and were middle aged and may have been affected by an organic brain disorder. The present patient was young, and had not received ECT. It is therefore very likely that antidepressants may have been responsible for the occurrence of NSE in this patient. It is concluded that NSE should be considered an adverse effect of any antidepressant.

A study of the relationship between the seizure focus and 1H-MRS in temporal lobe epilepsy and frontal lobe epilepsy

Abstract Several studies of temporal lobe epilepsy (TLE) patients have investigated the relationship between the seizure focus and 1H magnetic resonance spectroscopy (1H‐MRS). There have also been a few reports in other types of partial epilepsy. We examined the relationship between the seizure focus and the reduction in N‐acetylaspartate : creatine (NAA : Cr) ratio using 1H‐MRS in both TLE and frontal lobe epilepsy (FLE) patients. We studied 21 patients with unilateral TLE and seven patients with unilateral FLE. We used a 1.5 Tesla magnetic resonance unit (Signa Horizon; General Electric). Approximately 15 × 15 × 20 mm3 voxel of interest (VOI) was placed over the anterior portion of the bilateral hippocampus in the TLE patients, and the anterodorsal position of bilateral frontal lobe in the FLE patients. The seizure focus was identified by interictal scalp electro‐encephalogram (EEG). In the TLE patients the NAA : Cr ratios were reduced in the seizure focus, while in the FLE patients they were not always reduced in the seizure focus. In the TLE patients the coincidence rate between the seizure focus and the reduction in the NAA : Cr ratio was 90% (19 of 21 patients), while in the FLE patients the coincidence rate was only 57% (four of seven patients).

Annual transition of major depressive episode in university students using a structured self-rating questionnaire

Introduction: Depression frequently affects college and university students worldwide. The authors’ purpose was to estimate the positive rate of major depressive episodes (MDE) using a structured self‐report according to annual changes among Japanese university students. Data of freshmen were compared with those of students of other grades.

A study of the relationship between metabolism using1H-MRS and function using several neuropsychological tests in temporal lobe epilepsy

Abstract Several investigators have reported on the relationship between metabolism, using magnetic resonance spectroscopy (MRS), and function, using neuropsychological tests in temporal lobe epilepsy (TLE) patients , but the opinions regarding the results remain in contention. The aim of this study is to examine the relationship between metabolism, using proton MRS ( 1 H-MRS), and function using several neuropsychological tests in the temporal lobes of TLE patients. We studied 29 TLE patients at our hospital using 1 H-MRS and neuropsychological tests. We used a clinical 1.5 T MR unit. We conducted five neuropsychological tests to examine the function of the left or right temporal lobe. There were significant correlations between the N-acetylaspartate/creatine + phosphocreatine (NAA/Cr) ratios and the scores of almost all of the neuropsychological tests for the temporal lobe function ipsilateral to the spike focus. However, in two Wechsler Memory Scale-Revised (WMS-R) subtests we found no significant correlation in the ipsilateral side. These findings suggest that the NAA/Cr ratios, which reflect neural metabolism, are closely related to function in the temporal lobes of TLE patients . The disparity between the results in two subtests of WMS-R show that several tests may be necessary in order to assess temporal lobe function.