Shiro Ishida

Inter-ictal and post-ictal psychoses in frontal lobe epilepsy: A retrospective comparison with psychoses in temporal lobe epilepsy

There have been few studies of the psychopathology of patients with frontal lobe epilepsy (FLE). The majority of studies of both inter-ictal and post-ictal psychoses have strongly suggested the influence of temporal lobe disturbance on psychoses. Patients with organic brain damage or schizophrenia, however, sometimes show frontal lobe dysfunction. The purpose of this study was to better understand the effect, if any, of frontal lobe disturbance and seizure on psychopathology. Patients were divided into four groups based on epilepsy type and preceding seizures; 8 with FLE/inter-ictal psychosis, 3 with FLE/post-ictal psychosis, 29 with temporal lobe epilepsy (TLE)/inter-ictal psychosis, and 8 with TLE/post-ictal psychosis. Psychopathologic symptoms were retrospectively reviewed based on case notes, using a modified brief psychiatric rating scale (BPRS). Psychomotor excitement, hostility, suspiciousness, and hallucinatory behaviour were prominent features in all four groups. Six orthogonal factors were derived by factor analysis from the original data based on the 18 BPRS items. FLE patients with inter-ictal psychosis showed marked hebephrenic characteristics (i.e. emotional withdrawal and blunted effect). Our findings suggest that patients with FLE can exhibit various psychiatric symptoms. However, their psychotic symptoms, hebephrenic symptoms in particular, may often be overlooked.

Status Epilepticus in Childhood: A Retrospective Study of Intitial Convulsive Status and Subsequent Epilepsies

A retrospective study was carried out on 261 patients with various epilepsies who had undergone convulsive status epilepticus prior to the subsequent onset of epileptic seizures.

Manic episode in epilepsy and bipolar I disorder : A comparative analysis of 13 patients

Summary: Purpose: To determine whether the manic episode of patients with epilepsy has different characteristics from manic episode of patients with bipolar disorder.

Duration of postictal psychotic episodes

Summary:  Purpose: To clarify duration of postictal psychosis (PIP) episodes and identify factors that influence its duration.

Recurrent postictal psychosis after remission of interictal psychosis: further evidence of bimodal psychosis.

Summary:  Purpose: To ascertain whether bimodal psychosis (i.e., independent postictal and interictal psychosis) in patients with epilepsy can be characterized by postictal psychosis that develops after interictal psychosis remits.

Contrasting Effects of Zonisamide and Acetazolamide on Amygdaloid Kindling in Rats

Summary:  Purpose: Zonisamide (ZNS) and acetazolamide (AZM) are two antiepileptic drugs (AEDs) that differ in clinical efficacy. To elucidate the mechanisms of action of these compounds, we investigated their therapeutic and prophylactic effects in rats by using a kindling model of partial epilepsy.

Interictal cerebral and cerebellar blood flow in temporal lobe epilepsy as measured by a noninvasive technique using Tc-99m HMPAO.

The usefulness of noninvasive regional cerebral blood flow measurements using Tc-99m hexamethylpropylene amine oxime (HMPAO) was evaluated in 45 patients with interictal temporal lobe epilepsy. Seizure frequency did not show any influence on flow values or side-to-side asymmetry. Patients taking phenytoin had a significantly lower mean cerebral blood flow (mean 9.5%) and lower mean cerebellar blood flow (mean 12.9%) than those not taking it. Moreover, phenytoin reduced regional cerebral blood flow in the temporal regions more prominently on the contralateral side of the epileptic focus than on the ipsilateral side. Positive MRI findings of hippocampal sclerosis along with visually detected temporal hypoperfusion on SPECT showed a lower regional cerebral blood flow and greater flow asymmetry than other imaging findings in the temporal region. Results suggest that noninvasive cerebral blood flow measurements using Tc-99m HMPAO may give useful information about interictal cerebral blood flow around an epileptic focus and about the effects of antiepileptic drugs on brain function in temporal lobe epilepsy.

Seizure activity and individual vulnerability on first-episode interictal psychosis in epilepsy

OBJECTIVE Despite a theoretical consensus that interictal psychosis (IIP) is related to various epilepsy-related factors, the impact of seizure activity on development of IIP remains inconclusive. This is the first controlled study using quantitative seizure-activity measures at the onset of IIP. METHODS One hundred and eighty-one patients with epilepsy who exhibited first-episode IIP (IIP group) and 427 patients with epilepsy without psychotic episodes (control group) were enrolled. The control group was matched for age, epilepsy type, and duration of epilepsy. The two seizure-activity indices (seizure frequency at the time of onset of first-episode IIP and the number of seizures before the onset of IIP) were evaluated and compared between the IIP and control groups. Logistic regression analysis was used for extracting risk variables to develop first-episode IIP. RESULTS The sum of previous seizures was greater in the IIP than in control groups. This was particularly the case in the patients with partial epilepsies (PE). Higher seizure frequency in the patients with PE was associated with the development of first-episode IIP while no association was found in the whole cohort or in the patients with generalized epilepsies (GE). Subsequent multivariate analysis revealed the sum of previous seizures and family history of psychosis as risk variables to first-episode IIP. CONCLUSIONS The accumulation of seizure-related damages and family history of psychosis is associated with the onset of IIP episodes, particularly in the patients with PE. Seizure activity and individual vulnerability to psychosis are likely to be interacted for as the development of IIP in patients with epilepsy.

Brain SPECT imaging in a patient with epilepsy and memory dysfunction.

Brain SPECT of regional cerebral blood flow (rCBF) using Tc-99m-HMPAO was performed in an epileptic 49-year-old man who had prolonged amnesic dysfunction. Despite antiepileptic drugs, he suffered from frequent complex partial seizures, arising in the temporal lobe. SPECT imaging showed overall decreased rCBF more prominently in the cerebral cortex than in the subcortical nuclei. Right temporal pole cortex showed the most reduction of rCBF. After clinical improvement, a follow-up SPECT examination showed marked overall increase of rCBF especially in the cerebral cortex. Memory disturbance of this case may be associated with the overall cerebral hypoperfusion, which can be attributed to the frequent CPSs. It could also be attributed to the adverse effect of AEDs.

Nonconvulsive Status Epilepticus Accompanied by Both Generalized and Focal Seizure Characteristics

Unusual cases whose clinical manifestations were similar to nonconvulsive generalized status epilepticus but were accompanied by focal characteristics have recently been reported.2 In addition, cases of complex partial status epilepticus which have similar clinical symptoms to nonconvulsive generalized status epilepticus have also been r ep~r t ed .~ Therefore, it appears to be worthwhile to investigate whether these cases are nonconvulsive generalized or nonconvulsive partial status epilepticus. A total of 5 patients who exhibited prolonged episodes of confusion in conjunction with bilateral spikewaves accompanied by partial seizure manifestations as well as focal neurological signs was studied in this paper.