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Complex Partial Epilepsy (complex + partial_epilepsy)

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Medical Sciences100%

Selected Abstracts

Alfentanil-Induced Epileptiform Activity: A Simultaneous Surface and Depth Electroencephalographic Study in Complex Partial Epilepsy

EPILEPSIA, Issue 2 2001
J. Ross
Summary: ,Purpose: Alfentanil is a high potency mu opiate receptor agonist commonly used during presurgical induction of anesthesia. This and other opiate receptor agonists have demonstrated proconvulsant effects in animals, but these properties have been less consistently demonstrated in humans. Most human scalp EEG studies have failed to demonstrate induction of epileptiform activity with these agents, which is inconsistent with findings using intracranial EEG. Simultaneous scalp and depth EEG recordings have yet to be performed in this setting. The relationship between opiate dose and proconvulsant activity is unclear. Methods: Simultaneous scalp and depth electrode recordings were performed on five patients with complex partial epilepsy (CPE) who underwent alfentanil anesthesia induction before depth electrode removal. Consecutive equal bolus doses of alfentanil were administered to each patient according to strict time intervals so as to assess their correlation with any induced epileptiform activity. Results: Epileptiform activity was induced by alfentanil in three of five patients. Two of these patients had electrographic seizures. Epileptiform activity was only detected from the depth electrodes, occurring within 2 min of the first bolus dose in all three cases. Further increase or spread of epileptiform activity did not occur despite cumulative bolus doses of alfentanil. Conclusions: Alfentanil is proconvulsant in patients with CPE. Induced seizures may be subclinical and lack a scalp EEG correlate. There is a complex dose,response relationship. Alfentanil induction of anesthesia should be approached with caution in patients with CPE. [source]

Topiramate-induced metabolic acidosis: report of two cases

DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 10 2001
Chun-hung Ko MRCP FHKAM Medical Officer
Two children who presented with symptomatic metabolic acidosis after being put on topiramate (TPM) are reported. The first patient was an 11-year-old male with refractory complex partial epilepsy who was put on TPM for 13 months. He developed hyperventilation 1 week after increasing the dose to 300mg/day. Arterial blood gas revealed hyperchloraemic metabolic acidosis with partial respiratory compensation: pH 7.36, PCO2 27.2 mmHg, bicarbonate 14.9 mEq/L, base excess -8.9 mmol/L. Hyperventilation and acidosis resolved after administration of sodium bicarbonate and reduction of the dose of TPM. The second patient was a female who developed increasing irritability at age 16 months and 21 months, each time associated with introduction of TPM and resolved promptly upon withdrawal of the drug. Venous blood gas taken during the second episode revealed pH 7.34, PCO2 37.4 mmHg, bicarbonate 20.4 mEq/L, base excess -4.2 mmol/L. The predominant mechanism of TPM-induced hyperventilation involves inhibition of carbonic anhydrase at the proximal renal tubule, resulting in impaired proximal bicarbonate reabsorption. The occurrence of hyperpnoea or mental status change in any patient who is on TPM should prompt an urgent blood gas sampling, with correction of the acid-base disturbances accordingly. [source]

Alfentanil-Induced Epileptiform Activity: A Simultaneous Surface and Depth Electroencephalographic Study in Complex Partial Epilepsy

EPILEPSIA, Issue 2 2001
J. Ross
Summary: ,Purpose: Alfentanil is a high potency mu opiate receptor agonist commonly used during presurgical induction of anesthesia. This and other opiate receptor agonists have demonstrated proconvulsant effects in animals, but these properties have been less consistently demonstrated in humans. Most human scalp EEG studies have failed to demonstrate induction of epileptiform activity with these agents, which is inconsistent with findings using intracranial EEG. Simultaneous scalp and depth EEG recordings have yet to be performed in this setting. The relationship between opiate dose and proconvulsant activity is unclear. Methods: Simultaneous scalp and depth electrode recordings were performed on five patients with complex partial epilepsy (CPE) who underwent alfentanil anesthesia induction before depth electrode removal. Consecutive equal bolus doses of alfentanil were administered to each patient according to strict time intervals so as to assess their correlation with any induced epileptiform activity. Results: Epileptiform activity was induced by alfentanil in three of five patients. Two of these patients had electrographic seizures. Epileptiform activity was only detected from the depth electrodes, occurring within 2 min of the first bolus dose in all three cases. Further increase or spread of epileptiform activity did not occur despite cumulative bolus doses of alfentanil. Conclusions: Alfentanil is proconvulsant in patients with CPE. Induced seizures may be subclinical and lack a scalp EEG correlate. There is a complex dose,response relationship. Alfentanil induction of anesthesia should be approached with caution in patients with CPE. [source]

Effect of vagal nerve stimulation in a case of Tourette's syndrome and complex partial epilepsy

MOVEMENT DISORDERS, Issue 8 2006
Alan Diamond DO
Abstract We report on a 30-year-old man with Tourette's syndrome (TS) and medication-refractory epilepsy whose tics improved after implantation of a vagal nerve stimulator (VNS). To verify the patient's observation, we performed a blinded video assessment using the modified Rush video-based tic rating scale. The patient underwent two separate video recordings (VNS on and VNS off). A rater, blinded to patient's VNS status, evaluated the videos with the modified Rush video-based tic rating scale. There were improvements in total tic score and motor and phonic tic frequency. If verified by controlled clinical trials, this observation may provide insights into the pathophysiology of tics and may lead to a novel therapy for patients with severe TS. © 2006 Movement Disorder Society [source]