Patients with dysmnesticc seizures were examined clinically. They were selected from five hundreds and sixty-three ambulatory patients with simple partial seizures. The dysmnestic seizures consisted of thirty-four cases of de ja vecu, twenty nine cases of derealizations (inclusive of depersonalizations), twenty cases of reminiscences.
In oder to elucidate clinical features of pa tients with dysmnestic seizure, we compared cases of dysmnestic seizures without autonomic seizures (DM group) with cases of autonomic seizures without dysmnestic seizures (AU group). As a result, the following points were statistically confirmed: DM group had higher age at onset; higher rate of anxiety aura; lower rate of severe complex febrile convulsion.
Interrelations between concepts related to the dysmnestic seizure such as intellectual aura, dreamy state and experiential phenomena by Gloor were discussed.

View full abstract

In a patient with temporal lobe epilepsy, pure amnestic seizures (PAS) were documented by long-term intracranial EEG/VTR monitoring, and postictal amnestic states in another patient. Pure amnestie seizures consisting of anterograde amnesia with preserved cognitive functions occurred after a transient spread of seizure discharges from the right medial temporal structures to the contralateral hippocampal region. Postictal amnestic states were characterized by retrograde as well as lengthy anterograde amnesia that followed a complex partial seizure, whereby contralateral medial structures was involved in seizure discharges more prominently and thus widespread. PAS was deemed to be attributed to a coexistence of ictal dysfuncton of unilateral temporal lobe and postictal dysfunction of contralateral hippocampus, whereas postictal amnestic states to a recovery process from profound ictal dysfunction of bilateral medial temporal structures. PAS represents a rare condition of simple partial seizure.

View full abstract

In thirty-three (54%) out of 61 patients with spontaneously occuring complex partial seizures of temporal lobe origin documented on CCTV/EEG by means of bilaterally implanted intracranial depth/subdural electrodes, 43 ictal vocalization or verbalization were disclosed. They were divided into vocalization (23), linguistically appropriate speech (11), and inappropriate speech (9). Vocalization and verbalization were likely to occurr in seizures arising either from language-dominant or from nondominant hemispheres. In two-thirds of the cases, seizure discharge activities were observed bilaterally at the time when the speech occurred. Most of the seizure discharges arising from temporal lobe of dominant side spreaded to the contralateral hemisphere when vocalization, though less often in the form of appropriate speech, occurred, to the contrary, the discharges arising from temporal lobe of nondominant side spreaded to the dominant side temporal lobe when inappropriate speech occurred. No demographic factors were found which favored the occurrence of ictal vocalization or verbalization. We concluded that either vocalization or verbalization as an ictal event does not help predict the location of seizure onset, but may reflect function of the cerebral dominance interfered by the spread of seizure discharges. We also stressed the possible role of the extratemporal structures such as supplementary motor area and/or cingulate gyrus in both vocalization and verbalization.

View full abstract

A multi-institutional study on long-tem prognosis of temporal lobe epilepsy was performed, to investigate possibility of prediction of outcome of seizure in the early stage therapy. The subjects were 76 cases with temporal lobe epilepsy who were examined between January 1971 and December 1980 and had been observed until December 1990 without interruption.
Statistically significant correlations were found between seizure condition in the second year of therapy and long-term prognosis and also between the presence of neuropsychiatric complications in the second year and the prognosis.
Namely, among 21 cases who had no seizure in the second year of therapy, 86%were in remission (seizure-free for 3 years or more) at the study, while only 29% of patients who had seizures in the period were in remission. In all of 11 cases with not only frequent seizures but also neuropsychiatric complications in the second year of therapy, their seizures have not been controlled at the time of study.
Accordingly, the authors concluded that the patients with frequent seizures and neuropsychiatric complications in the second year of therapy will have an unfavorable long-term prognosis.

View full abstract

We analysed changes of postictal language function in 202 complex partial seizures temporal lobe origin of 50 patients. Long-term intracranial CCTV/EEG monitoring was conducted in all patients by means of depth/subdural electrodes implanted bilaterally. The time intervals from cessation of seizure discharges to recovery of confrontation naming as well as of orientation capability for time and place were measured and correlated with lateralization of seizure onset and seizure spread. In 61 seizures of 14 patients whose seizures were originating from language nondominant temporal lobe without having ictal involvement of contralateral hemisphere, 7 patients were able to name the objects correctly within 60 seconds, another 7 patients even during seizure discharges. 60 seizures of 20 patients whose seizures originated from language dominant temporal lobe, the recovery time for naming and orientation usually required longer than 120 seconds. In 81 seizures of 22 patients whose seizure origin was in the language nondominant temporal lobe and accompanied by ictal involvement of contralateral hemisphere, the recovery time interval was variable. Phonemic paraphasias or neologisms ere observed not only in language dominant temporal lobe seizures, but also in nondominant temporal lobe seizures having ictal spread to contralateral temporal lobe.We emphasized that it is possible to utilize the time delay in the naming test in order determine the lateralization of seizure onset, especially when seizures originate from language nondominant temporal lobe.

View full abstract

We reported a 6-year-old girl suffering from epilepsy with myoclonic absences from the age of 6 months. Psychomotor development had been retarded before the seizure onset. Seizures occurred frequently, up to 100 times a day, were characterized by sudden impairment of consciousness accompanied by rhythmic jerking of the shoulders and arms, eye deviation and occasional falling. The ictal EEGs showed diffuse synchronous 3Hz spike and wave bursts. The spike of a spike-wave discharge related constantly with myoclonia. From an analysis of simultaneous video-EEG recording, the falling is likely due to a contraction of the erector spinae muscles. The seizure has been suppressed for 6 months with a combination of sodium valproate and ethosuaximide.

View full abstract

We investigated the clinical significance of the WPSI Validity Scale in a Japanese Version. Subjects were 652 adult ambulatory epileptics leadingordinary social life, who were collected by means of a multi-institutional study.
Mean values and standard deviations of the No. Blank, Lie Scale and Rare Items Scale belonging to the Validity Scale were 2.3, 4.4, 2.9 and 3.3, 2.1, 1.7, respectively. It was noteworthy that the mean value of the Lie Scale was remarkably high in Japanese patients
Scores of the Lie Scale showed statistically significant negative correlation with scores of all of the Clinical Scale. This trend was particularly notable refering to the Emotional Adjustment and Interpersonal Adjustment Scales. Regarding the relationship with clinical charateristics of subjects, the frequency of seizures correlated to the Lie Scale with statistical significance. The mean score of the latter was low in subjects with refractory seizures andvice versa.
From the above-mentioned results, we considered that the strict application of limitations of the original Validity Scale was not substantial operation of the WPSI in our country.

View full abstract

Characteristics of late onset epilepsy in childhood which appeared after 10 years of age were investigated by comparative study of a late onset group (n=109) and control group with onset 10 before years of age (n=207). The following results were obtained.
1) Localization-related epilepsy consisted of both idiopathic and symptomtic cases. However, generalized epilepsy was mostly idiopathic and rarely symptomatic.
2) On examining epileptic discharges, focal cortical discharge was detected in 50.4% of the children in the late onset group. The location of focus was noted commonly at the frontal and temporal regions and rather infrequently at the centro-parietal region.
3) The etiology was presumed to be genetic or was unknown in many cases of late onset group. These amounted to 68.7%.
4) The prognosis was favorable in many cases (75.9%) however, intractable cases were also noted in 11.5% of the cases.
5) Late onset epilepsy in childhood and adulthood epilepsy had many clinicoelectroencephalographic charactristics in common.
6) Prognostic check points at the onset of late onset epilepsy were presented.

View full abstract

The authors examined occupational status in 274 patients (141 males and 133 females) with epilepsy at December, 1990. Their age ranged from 20 to 60 years. Patients with moderate or severe mental retardation and students were excluded from this study. Ocuupational status of the subjects were as follows: 188 (125 males and 63 females) of the employed, including both blue-collar and white-collar workers, 47 of the unemployed and 39 housewives. Nine (5%) of the 188 patients with regular occupations engaged in the jobs, from which people with epliepsy were absolutely and/or relatively prohibited by the laws. Five of the nine patients were working as cooks which were defined as the absolute reasons for disqualification, and the remaining four patients had various lisenses which were defined as the relative reasons for disqualification. The four patients consisted of two nurses, one pharmacist and one dental technician. Of the nine illegal workers, four had left their jobs because of fits during working which did not disturb others, and eventually they had regular occupations at the time of this study. The authors emphasize that the law concerned with the restrictions of jobs for people with epilepsy should be amended.

View full abstract