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In epileptic encephalopathy, the seizures and interictal epileptiform activity create additional neurocognitive dysfunction beyond that due to the underlying etiology. Treatment leading to a reduction in seizures or interictal abnormalities may help improve neurocognitive function in these situations. The focus of our discussion is reviewing data that support the concept that treatment can impact...
ObjectiveThe identification of “endophenotypes”—measurable variations along the pathways between genes and distal disease state—may help deconstruct focal epilepsies into more sensitive phenomena and improve future efforts to map the genetic underpinnings of the disorder. In this study, we set out to determine if diffusion tensor imaging (DTI)–inferred white matter (WM) alterations represent a suitable...
ObjectiveSeizures are common during and after treatment for a primary brain tumor. Our objective was to describe the incidence and risk factors for seizures in long‐term survivors of pediatric brain tumors.
MethodsIn a retrospective, longitudinal study, we reviewed all consecutive patients during a 12‐month period who were at least 2 years post initial diagnosis of a brain tumor. Data collection...
ObjectiveChildren with epilepsy have elevated rates of behavior problems. Research findings on the impact of epilepsy surgery on children's behavior have been mixed, with some studies showing improvements in behavior 3 to 18 months after surgery and other studies finding no change within this time interval. We examined behavior in a large surgical sample and in a nonsurgical comparison group. We also...
ObjectiveBenign epilepsy with centrotemporal spikes (BECTS), the most common focal childhood epilepsy, is associated with subtle abnormalities in cognition and possible developmental alterations in brain structure when compared to healthy participants, as indicated by previous cross‐sectional studies. To examine the natural history of BECTS, we investigated cognition, cortical thickness, and subcortical...
To evaluate the impact of epileptiform discharges (EDs) that do not occur within seizure patterns – such as spikes, sharp waves or spike waves – on cognitive function and to discuss the circumstances under which treatment of EDs might be considered. Methods used in this article is “Review of the literature”. EDs may disrupt short‐term cognition in humans. Frequent EDs for a prolonged period can potentially...
ObjectiveTo report the feasibility, safety, and clinical outcomes of an exploratory study of MR‐guided Laser Interstitial Thermal Therapy (MRgLITT) as a minimally invasive surgical procedure for the ablation of epileptogenic foci in children with drug‐resistant, lesional epilepsy.
MethodsRetrospective chart review of all MRgLITT procedures at a single tertiary care center. All procedures were performed...
The purpose of this study is to look at the prevalence, characteristics, and prognostic value of somatosensory auras (SSAs) in patients who have undergone temporal lobe epilepsy (TLE) surgery to treat drug‐resistant focal epilepsy. We retrospectively reviewed all patients with drug‐resistant epilepsy who underwent TLE surgery at Cleveland Clinic between 2005 and 2010 (n = 333) to study the prevalence,...
Mutations in the DEPDC5 (DEP domain–containing protein 5) gene are a major cause of familial focal epilepsy with variable foci (FFEVF) and are predicted to account for 12–37% of families with inherited focal epilepsies. To assess the clinical impact of DEPDC5 mutations in familial temporal lobe epilepsy, we screened a collection of Italian families with either autosomal dominant lateral temporal epilepsy...
The concept of epileptic encephalopathy is important in clinical practice, but its relevance to an individual must be assessed in the appropriate context. Except in rare situations, epileptic activity is a surrogate for an underlying etiology, and stopping the activity has a limited impact on developmental outcome. Labeling a group of epilepsies as “the epileptic encephalopathies,” risks minimizing...
The use of lamotrigine (LTG) can be limited by the occurrence of cutaneous adverse drug reactions (cADRs) that range from maculopapular eruption (MPE) to the more severe Stevens‐Johnson syndrome and toxic epidermal necrolysis. A few human leukocyte antigen (HLA)–related genetic risk factors for carbamazepine‐induced cADR have been identified. However, the HLA‐related genetic risk factors associated...
ObjectivesWe examined the associations of lifetime and current histories of psychiatric disorders and of suicidal thoughts and behaviors with childhood‐onset epilepsies in a community‐based cohort of young adults.
MethodsCases were neurotypical (normal neurologic, cognitive, and imaging examinations and no evidence of a brain insult responsible for the epilepsy) young adults with childhood‐onset...
ObjectiveUp to half of patients assessed for suspected new‐onset epileptic seizures report previous undiagnosed events. This suggests that delay to timely and expert assessment is a major issue. Very little is known about the degree of delay or nature of the undiagnosed events, impacting on our understanding of new‐onset epilepsy. In this study we aimed to examine events that occur before presentation,...
Cognitive and developmental outcomes in patients with epileptic encephalopathy are hypothesized to result from an interplay between the underlying epileptic pathologic substrate and the acquired consequences of frequent and repetitive seizures and epileptiform discharges that often straddle the interictal and ictal boundaries. This article briefly reviews the evidence related to this assumption, presents...
ObjectiveHippocampal sclerosis is a common finding in patients with temporal lobe epilepsy (TLE), and magnetic resonance imaging (MRI) studies associate the reduction of hippocampal volume with the neuron loss seen on histologic evaluation. Astrogliosis and increased levels of chondroitin sulfate, a major component of brain extracellular matrix, are also seen in hippocampal sclerosis. Our aim was...
The Commission on Classification and Terminology and the Commission on Epidemiology of the International League Against Epilepsy (ILAE) have charged a Task Force to revise concepts, definition, and classification of status epilepticus (SE). The proposed new definition of SE is as follows: Status epilepticus is a condition resulting either from the failure of the mechanisms responsible for seizure termination or from the initiation of mechanisms, which lead to abnormally, prolonged seizures (after time point t...
The aim of this retrospective case series analysis was to identify the predictors of postoperative depression (PostOp‐D) in a sample of 248 subjects with focal drug‐resistant focal epilepsy. The presence or absence of PostOp‐D during a 12‐month follow‐up period was the outcome variable. Demographic, neurologic, psychiatric characteristics, and antiepileptic therapy were the explanatory variables....
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