Giuseppe Erba

Photic- and Pattern-induced Seizures : A Review for the Epilepsy Foundation of America Working Group

Summary:  Purpose: This report summarizes background material presented to a consensus conference on visually provoked seizures, convened by the Epilepsy Foundation of America.

The concentration of homovanillic and 5-hydroxyindoleacetic acids in ventricular and lumbar CSF. Studies in patients with extrapyramidal disorders, epilepsy, and other diseases.

The concentration of homovanillic acid (HVA) in the cerebrospinal fluid (CSF) is now regarded as reflecting the metabolic activity of dopaminergic neurons in the CNS, for example, those of the nigrostriatal pathway, provided that no exogenous dopa is administered.l.2 A similar relation of the concentration of 5-hydroxyindoleacetic acid (5-HIAA) to the metabolism of serotonergic neurons has been demonstrated, at least in regard to those terminating in the lumbar cord? In a previous publication4 we reported that the concentration of HVA in the ventricular fluid of patients with Parkinson’s disease was significantly lower than that of patients coming to surgery for other extrapyramidal or nonextrapyramidal disorders. A moderate correlation was found between decrease of HVA and severity of akinesia of the parkinsonian patients but not with the degree of tremor or rigidity. There was no correlation of the concentration of HVA in the CSF with age or duration of illness. Some of the diagnostic groups investigatedattitudinal, or essential, tremor; attitudinal dystonia; and temporal lobe epilepsy-showed a concentration of HVA that was not as low as that in parkinsonian patients but was lower than in a group of nonneurological cases. As dopaminergic insufficiency characterizes Parkinson’s dise a ~ e ~ , ~ but not, as far as is known, these other disorders, there may be some question of the specificity of decreased HVA in the ventricular fluid as a sign of decreased striatal dopamine in Parkinson’s disease. Moreover, it has been claimed that the concentration of 5-HIAA, as well as of HVA, is decreased in the CSF of parkinsonian patients,7.8 although this finding is not con~istent.~J* Decreased 5-HIAA in the CSF in Parkinson’s disease would also reduce any special significance attributable to HVA concentration. For these reasons we decided to extend our earlier investigation to a larger number of patients and to include examination of both HVA and 5-HIAA in ventricular and lumbar CSF. In this

Ictal Contralateral Paresis in Complex Partial Seizures

Summary: Certain behaviors that occur during a complex partial seizure (CPS) are useful in lateralizing the side of seizure onset. In 5 (5.3%) of 94 consecutive patients with partial epilepsy, we observed ictal unilateral arm and hand paresis during 27 of 34 CPS. In all these seizures, this behavior occurred contralateral to an epileptogenic temporal lobe, as determined by video‐EEG monitoring and surgical outcome. In 5 of the 27 seizures, an observer demonstrated that the paretic arm and hand were flaccid. None of these patients had postictal (Todds) paralysis. In most of the seizures, the arm ipsilateral to seizure onset had simultaneous purposeful movements or automatisms, sometimes with awkward posturing. Ictal unilateral paresis is distinctly different from ictal dystonia or postictal paralysis and consistently lateralizes seizure onset to the contralateral temporal lobe. Recognition of this particular ictal behavior and comparison to other simultaneous behaviors can aid in the lateralization and possibly localization of the epileptogenic zone.

Factors distinguishing families of Patients with Psychogenic seizures from families of Patients with epilepsy

Summary: Purpose: Psychogenic seizures (PS) (emotionally based nonelectrical seizures) have been explained by psychodynamics and trauma. However, the family health literature suggests that somatization, of which psychogenic seizures are a form, may run in families and be determined by family patterns of response to distress. This study compared families of patients with PS and those of patients with epilepsy on variables of distress (anxiety and depression) and somatization.

Barriers toward epilepsy surgery. A survey among practicing neurologists

Purpose:  Guidelines for refractory epilepsy recommend timely referral of potential surgical candidates to an epilepsy center for evaluation. However, this approach is seldom a priority for treating neurologists, possibly because of inertia of previous practice and personal attitudes, leading to a buildup of psychosocial disabilities and increased risk of morbidity and mortality. The aim of this study was to assess knowledge and attitudes toward epilepsy surgery among practicing neurologists and identify the barriers that delay the treatment.

Photic- and Pattern-induced Seizures : Expert Consensus of the Epilepsy Foundation of America Working Group

Summary:  Purpose: In August, 2004, the Epilepsy Foundation of America convened a workshop to begin to develop an expert consensus on photosensitive seizures.

Temporal lobectomy for complex partial seizures that began in childhood

Forty-six consecutive patients who underwent surgery for intractable temporal lobe seizures originating in childhood are reported; invasive preoperative monitoring (e.g., depth electrodes and subdural arrays) was not used in the selection process. Our results, with respect to the control of seizures and improvement in behavior, are comparable to those of series in which invasive monitoring was used in the selection process. Eighty-five percent of the 46 patients (96% of the 28 operated after the introduction of long-term electroencephalographic monitoring) became either seizure free or experienced near total control of their seizures. Our results indicate that many patients can be selected successfully for temporal resection without exposure to the risk and expense of invasive presurgical procedures. A long duration of epilepsy prior to surgery in patients with neoplasia portended a less satisfactory outcome. Our results strengthen the argument for early operation in children with intractable epilepsy.

The Coordinated Psychosocial and Neurologic Care of Children with Seizures and Their Families

Summary: As the medical and surgical management of epilepsy continues to advance, issues associated with the quality of life of patients and their families can be addressed. Whenever associated with other handicaps, such as learning disabilities, attentional or behavioral disorders, and problems in psychological adjustment, dual‐diagnosis issues must be identified. To provide comprehensive care for children with epilepsy, a team approach to psychosocial assessment and treatment must be provided and coordinated with neurologic care. When the age‐related needs in the life stage of the individual and family are identified, the best possible adaptation of the patient and his or her family can be supported.

Electroencephalographic correlates of near-drowning encephalopathy in children

Findings of the serial EEGs of 9 children involved in fresh water near-drowning were correlated with neurological signs and final outcome. Our observations revealed that in young near-drowning victims there is a distinct evolution of the EEG which differs considerably from any stereotyped classification outlined for other types of encephalopathies. In patients with a poor clinical outcome, the early phase of near-drowning encephalopathy was characterized electrically by diffuse delta waves, often with alpha or beta frequencies superimposed (alpha-delta and beta-delta pattern). Additional features included poor sleep-waking differentiation and abnormal reactivity. Repetitive focal or multifocal biphasic or triphasic wave forms occurred exclusively in the group with a fatal outcome. The intermediate phase of the encephalopathy was signaled by an attenuation of all fast frequencies (alpha and beta rhythms), enhancement of delta activity, and disappearance of sleep parameters (if present in the earlier recordings). Finally, a modified burst suppression pattern occurred as a late EEG evolution in an encephalopathy of complex and protracted nature.

Family interactions as targets for intervention to improve social adjustment after epilepsy surgery

Summary: Purpose: To identify family interactions associated with psychosocial outcome of epilepsy surgery, to design interventions to improve patient outcome.