The clinical characteristics of 10 epileptic patients with pseudoseizures (pseudoseizure group; one male and 9 females, mean age: 29. 9 years old) were compared with those of 10 epileptic patients (control group), who did not have pseudoseizures. They were matched for sex, age at present, seizure onset age, epilepsy type, and seizure type. In pseudoseizure group, 7 patients who had had epileptic seizures in their childhood had pseudoseizures in their adolescence, and 6 patients suffered from temporal lobe epilepsy. Provocative factors were clarified in 5 patients with pseudoseizures. Pseudoseizures were convulsive in 7 patients and non-convulsive in 4. In 4 patients pseudoseizures resembled epileptic seizures which they originally had. In pseudoseizure group there were CT abnormalities in 8 patients, slowing in background EEG activity in 9, mental retardation in 10. On the other hand, in control group there were CT abnormalities in 3, slowing in background EEG activity in 6, mental retardation in 1.
In diagnosing pseudoseizures we have to consider sex, age, epilepsy type, CT findings, interictal EEG findings, intelligence as well as seizure manifestations or ictal EEG findings.

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In a case of epilepsy with diffuse spikes and waves of late onset, prolonged speech disturbances relatively independent of other cognitive functions followed clusters of tonic seizure. Corresponding to the aphasia-like symptoms, continuous polymorphous bilateral paroxysmal discharges were recorded electroencephalographically. We discussed this condition of transient speech disturbances with bilateral paroxysmal discharge in the frame of spike-wave-stupor with selective mental impairment and tried to differentiate it from other types of cognitive dysfunctions followed by convulsive seizures.

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In order to investigate pathophysiological changes in intractable partial epilepsy of childhood onset, magnetic resonance imaging (MRI), single photon emission computed tomography (SPECT) and positron emission computed tomography (PET) were performed on 24 patients (12 with temporal lobe epilepsy, 6 with occipital lobe epilepsy and 6 with frontal lobe epilepsy). All patients with frontal lobe epilepsy showed a frontal onset of ictal discharges on simultaneous EEG-VTR recording. Fourteen patients displayed MRI abnormalities, 15 SPECT and 20 PET abnormalities. MRI was abnormal in 10 of 12 patients with temporal lobe epilepsy, 5 of whom had MRI abnormalities suggesting mesial temporal sclerosis. Nine of these 12 patients had abnormalities on SPECT, and 11 on PET. Four of 6 patients with occipital lobe epilepsy showed abnormalities in the occipital area on MRI, 5 on SPECT and 6 on PET. Those who had visual seizuresdisplayed decreased glucose metabolism in the primary visual cortex, whereas those who did not showed normal metabolism in this region. In all 6 patients with frontal lobe epilepsy, MRI and SPECT were normal or equivocal, whereas PET displayed focal or regional hypometabolism in 3 patients. PET is the most sensitive neuroimaging technique to localize epileptogenic foci.

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To evaluate the laterality of ictal symptoms in temporal lobe epilepsy, we reviewed video/EEG of 32 complex partial seizures in 15 patients who were investigated with sphenoidal electrode to determine the indication of temporal lobectomy for intractable epilepsy. Ictal records were classified into three types, namely, localized, dominant, or undetermined. All unilateral dystonic posturings occurred contralaterally to the seizure foci. Patients with recurrent speech automatism had nondominant-sided seizure foci. All patients whose postictal language function recovered quickly had localized nondominantsided ictal discharge. Patients with amnesia to seizure had bilateral ictal discharge. This study shows that ictal symptoms in temporal lobe epilepsy provide useful information for lateralization of seizure onset.

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In 20 patients with epilepsy caused by the temporal lobe tumor, correlation between clinical manifestations, findings of neuroimagings and prognosis was studied. CT scan was obtained in all patients and MRI was carried out in 10 patients. Interictal positron emission tomography was performed to measure cerebral blood fiow (CBF) and cerebral metabolic rate for oxygen (CMRO₂) in eight glicma patients. And three of them were examined for cerebral metabolic rate for glucose (CMRGlc). In 11 patients, CT and/or MRI revealed pathological changes in “medial” temporal lobe including amygdala and hippocampus due to invasion of the tumors or marked com-pression by them. These patients presented seizures characterized by amygdalar or hippocampal epilepsy, namely, nausea, indescribable feelings, motionless stare and auto-matism. On the other hand, patients with tomor in “lateral” temporal lobe presented simple partial seizure, Jacksonian type seizure, auditory seizure, dreamy state and generalized tonic-clonic seizure (GTCS) without aura. CBF, CMRO₂ and CMRGlc by positoron emission tomography decreased in affected temporal lobe. But in tumor sites, CBF, and CMRG1c decreased in some patients and increased in the others according to the pathophysiology of the tumors. Epileptic seizures of these patients were well controlled after surgical and radiation therapy.

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We performed dot counting test for evaluating whether epilepsy type and antiepileptic drugs (AEDs) woul affect, the attention in epileptic patients. Fifty-three patients with epilepsy consisting of 28 temporal lobe epilepsy (TLEs) and 25 idiopathic generalized epilepsy (IGEs) were compared to 18 normal adult volunteers (normals).
There were no significant correlation between dot counting score (DC score) and clinical variables such as age, sex, duration of epilepsy and seizure frequency. Only the full scale IQ of WAIS showed significant correlation (r=0.35, p=0.021) to the DC score.
Regarding epilepsy type, the TLEs showed significantly lower DC score (p=0.006) in comparison with normals. The IGEs failed to show statistically significant difference.
Regarding the number of AEDs administered, the patients with polypharmacy showed significantly lower DC score (p=0.003) than normals. The patients with mono-pharmacy exhibited no significant difference in comparison with the normals.
There were no difference of the DC score between the kind of AED. Serum PHT cocentrations, however, correlated significantly (r=0.43, p=0.023) to the DC score.

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A comparative study of the anticonvulsant effect of GABA agonists on amygdala or hippocampal kindled seizures was performed in cats. Progabide (GABA receptor agonist, 25-100mg/kg) significantly reduced both the kindled seizure stage and afterdischarge (AD) duration in a dose-dependent manner. SKF89976A (GABA re-uptake inhibitor, 0.25-2mg/kg) also significantly reduced kindled seizures. At a toxic dose of SKF89976A, induction of the AD in the kindled focus was completely suppressed, although it caused EEG spike and myoclonus. Furthermore, γ-vinyl GABA (GVG: inhibitor of GABA transaminase, 50-200mg/kg) significantly reduced only the kindled seizure stage with the prolonged duration of ADs. In contrast, baclofen (selective GABA-B receptor agonist, 1 and 5mg/kg) did not show any anticonvulsant effects either on the seizure stage or on the AD duration. It is concluded that these GABA agonists, which potentiate the inhibitory function of the GABA-A system, have potent anticonvulsant effects on kindled seizures from the lymbic focus as well as secondary generalization in cats.

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We studied the clinical features of GTCs occurring only during sleep (so-called sleep-grand mal).
In most patients, seizures occurred early in the morning or soon after falling asleep. The occurrence of seizure is apparently related to sleep stage.
Age at onset was under 20 years in 15 cases (75%). Most of cases (75%) were seizure-free for more than three years with various antiepileptics therapy. Therefore, the prognosis of sleep-grand mal was fairly good. Refractory cases showed significantly longer duration from seizure onset to initiation of treatment than controlled cases.
Awake EEGs showed no epileptic discharges in all cases. But, sleep records, including polysomnography, demonstrated focal seizure discharges in the temporal or frontal region. There were no generalized seizure discharges at any recordings. It is therefore suggested that sleep-grand mal is primarily a localizat ion-related epilepsy.

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A girl at the age of sixteen was hospitalized because of frequent seizures with impaired consciousness. On admission, she was found not to use her left hand despite of absence of neurological deficits such as hemiplegia and cerebellar sign. Her left upper extremity could perform what was urged to do, while it was not utilized at all spontaneously. This clinical manifestation accompanied by corresponding repetitive right central spikes and right central theta wave bursts continued several months. By giving phenytoin at the dosage of 275mg, the seizures as well as the motor neglect improved dramatically. We proposed repetitive alternations of subliminal convulsion and excessive hyperpolarization as a possible mechanism of the motor neglect in the current case.

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Seventy-seven patients with intractable temporal lobe seizures were subjected to a series of verbal recognition tests during intracarotid amytal test (IAT) or Wada's Test as a part of presurgical evaluation. They included 11 patients whose speech dominant hemisphere was found to be lateralized on the right. In view of the side of speech dominance and of epileptogenic focus in temporal lobe, they were divided into the following 4 groups; 23 patients with left speech dominance and left focus (LL), 43 with left dominance and right focus (LR), 5 with right dominance and left focus (RL), and 6 with right dominance right focus (RR).
The Overall recognition rate in the verbal recognition test was 83.1%(80.2-93.3%) when it was performed without amytal injection. As a result of IAT to the right side, the recognition rate decreased markedly in patients with right speech dominance (RR and RL), and was fairly good only in patients with left speech dominance and right focus (LR). Conversely, IAT to the left brought about a marked decrease of the recognition rate in patients with left speech dominance (LL and LR) while maintaining a fairly good rate only in patients with right speech dominance and left focus (RL).
The present data indicate that 1) preservation of verbal memory function depends primarily on the speech dominant hemisphere regardless of whether it was either on the left or right, 2) there exists an underlying dysfunction in the focus side hemisphere in association with verbal memory impairment in patients with temporal lobe epilepsy, 3) both speech dominant hemisphere and memory circuits including hippocampus are responsible for preservation of verbal memory function.

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