In this study the Dipole Tracing method (DT; Nakajima et al. 1990) was applied to clarify the pathophysiological process of the gelastic seizure. The subject was a fifteen-year-old girl suffering from only gelastic seizures since age nine. The main ictal symptom was a laughter with mirth, and her interictal EEG showed right anterotemporal spike and waves in earlier periods. The ictal EEG at this time revealed fast desynchronization followed by rhythmic slow wave bursts. In the course of two years, the spike and waves had changed into multiple spike and waves. Corresponding to this EEG change, DT was applied to assess the source generators of the spikes; single spike and waves in the earlier and multiple spike and waves in the later period.
The equivalent current dipoles (ECDs) corresponding to the single spike were located in the right mesial temporal region (presumably amygdalo-hippocampal area). As to the multiple spikes, the ECDs of the first spikes were localized to the same region as of the single spike and those of the second were in the medial frontal lobe (presumably cingulate region). ¹²³I-IMP SPECT examination confirmed the presence of hyperperfusional areas in both the medial frontal and right temporal lobes.
These results present supporting evidence for the notion that the propagation of the epileptic discharges from the amygdalo-hippocampal region to the adjacent limbic areas, especially to the cingulate, plays an important role in the pathogenesis of gelastic seizures.

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Side effects in the central nervous system such as drowsiness and diplopia are often observed in carbamazepine (CBZ) therapy. Reports suggested the involvement of not only CBZ but also carbamazepine-10, 11-epoxide (CBZE) in the development of these side effects. Therefore, to examine the association between the side effects in the central nervous system and CBZE, we measured time courses of CBZ and CBZE levels in awake, freely moving rats by means of brain and blood microdialysis. The time course of CBZE levels was similar in the blood and the striatum. The elimination half life of CBZE in the striatum was significantly longer than that of CBZ. Because the CBZE level in the blood reflects that in the brain of patients receiving CBZ, measurement of CBZE levels may be important in preventing and reducting the side effects in the central nervous system.

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The relation of hand preference to cerebral speech representation, as determined by the Sodium Amobarbital Procedure, was investigated in 200 patients with partial epilepsy. Speech representation was found in left, right, and both hemispheres in 164 (90%), 9 (5%), and 9 (5%) of 182 dextral patients, and in 6 (40%), 6 (40%), and 3 (20%) of 15 non-dextral patients, respectively. Three non-dextral patients showed no speech representation on either side. Sex and the existence of non-dextral relatives did not affect the relationship between hand preference and speech representation. In 33 patients with surgically treated temporal lobe epilepsy with left-sided focus suffering from brain damage before the age of 2, we found a significantly higher rate of left/bilateral speech representation. In some of these patients, bimodal interhemispheric reorganization was suggested. In 11 of 12 patients with bilateral speech representation, a side of greater representation could be determined. Eight patients with left-sided speech dominance were dextral and 3 with right-sided speech dominance were non-dextral.

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Complex partial status epilepticus (CPSE) is not so rare as it was originally accepted. However, there have been not many case-reports of CPSE so far. Among the patients admitted to our epilepsy service for the last year, we have experienced 4 cases of CPSE. Two of them were continuous type and two cyclic type as it was documented by video/EEG. One patient showed periodic substuporous state and another confusional state following the generalized convulsion. The former diagnoses of the states of these two cases were non-epileptic substupor and postictal confusion, respectively. But video/EEG performed in our hospital revealed that both of the states were associated with continuous focal ictal activity over frontal area, which was quickly suppressed by diazepam intravenous injection. From these findings we diagnosed these states as continuous type of CPSE of frontal lobe origin. In the second patient, epileptic paroxysmal activity was detected only in the early phase of confusional state. It indicates the diagnostic importance of early EEG recording. In the last two cases, status consisted of recurrent total unresponsiveness and concomitant focal electroencephalographic ictal activity over temporal area. These findings confirmed the diagnosis of cyclic type of CPSE of temporal lobe origin. In this study we have stress on the difficulty in establishing the diagnosis of continuous type of CPSE.

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We investigated the occurrence rate of psychiatric symptoms in epipleptics and pathogenetic factors about 836 epileptics who were treated on Fukushima Medical College Hospital and this reffered hospitals and whose age were from 15-55 years old. Among the patients, 125 cases (15.0%) manifested psychiatric symptoms. The occurrence rate of psychiatric symptoms was significantly higher in partial epilepsy group, partial seizures group, borderline intelligence group, high seizure frequency group and abnormality of basic waves without paroxysm in EEG group. There was no significant difference between the occurrence rate of psychiatric symptoms in gender, the onset of epilepsy and the CT findings. The main psychiatric symptoms were as follows: schizophrenia-like state 42 cases (5.9%), manic-depressive state 27 cases (3.2%), neurotic state 14 cases (1.7%), personality change (4.9%)

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The clinical and EEG features of 187 cases with West syndrome (WS) were investigated after classifying the cases according to the etiology. The impact of its etiology and underlying diseases on the mental and seizure prognosis was also studied on 128 cases of the total, with follow up of more than three years. In the idiopathic group, the seizure and mental prognosis were significantly more favorable, whereas significantly more pyridoxal phosphate effective cases were seen than in the symptomatic group. The cases with disorders of organogenesis type of the brain malformations subgroup in the prenatal group showed significantly more cases having early seizure onset and/or preceding seizures than those in the other types within brain malformations subgroup. Cases with evolution from Ohtahara syndrome or to Lennox-Gastaut syndrome were also often seen in this type, and the seizure and mental prognosis were extremely poor. The postnatal group had significantly more cases with late seizure onset and/or asymmetric hypsarrhythmia, and the mental prognosis tended to be favorable than the other symptomatic cases. The perinatal group showed no significant characteristics. These findings suggest that the strict classification of WS according to its etiology is beneficial in elucidating its pathophysiology and prognostic evaluation.

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In papers, obsessive compulsive disorder (OCD) is related to emotional disorder and left hemispheric function. Furthermore, OCD of organic brain disease is influenced by visual symptoms. We investigated the characteristics of clinical EEG, symptomatology and photic driving response in 11 temporal lobe epilepsies (TLE) with OCD. In the control group, 112 temporal lobe epilepsies without OCD were selected. In clinical research, OCD, phobia, laterality of spikes in temporal regions, photic driving response, visual symptoms, sex and emotional disorder were studied. As a result, phobia was seen in 4/11 patients in the OCD group and 0/112 patients of control group. Right laterality disorder on temporal spikes was observed in 9/11 patients in the OCD group and 50/112 patients in the control group. photic driving response was 6-7/11 in TLE patients with OCD and 2/20 patients in the control group. Emotional disorder was seen in 7/11 OCD and 13/112 control group. Statistically, difference in the two group was recognized. Temporal atrophy in MRI was seen in 4-5/8 OCD and 7-9/18 control group. Women were 7/11 OCD and 51/112 control. Acordingly, OCD (8.9%) in TLE patients is related to right temporal spikes, emotional disorder, visual symptoms, phobia and photic driving response.

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We studied relationship between initial and long-term effects of ACTH therapy in 37 patients with refractory childhood epilepsy. The response to ACTH was evaluated both by the time necessary for seizure cessation from the initiation of ACTH and by the improvement of epileptic discharges in EEG during the ACTH therapy. Seizures ceased in 25 patients, relapsed in 2, and persisted in 10 during the ACTH therapy. There was no relationship between the time from starting ACTH to cessation of seizures and the relapse of seizures after the ACTH therapy. Among 25 patients who became free of seizures, those with no epileptic discharges (11) showed favorable outcome compared to those with focal, multifocal or diffuse epileptic discharges (14) in EEG during ACTH. Out of the 11 patients with no epileptic discharges, 6 patients were free of seizures and only one showed recurrent seizures within 1 year after the ACTH therapy. On the other hand, only 3 patients were free of seizures and 9 showed recurrence of seizures within 1 year after the ACTH therapy in 14 patients with persistent epileptic discharges during the ACTH therapy. These results suggest that EEG findings have a predictive value of long-term seizure prognosis of refractory childhood epilepsy treated by ACTH. We also discussed the prognostic value of EEG findings after the daily ACTH treatment for the first 2 weeks according to Fukuyama's original method of ACTH therapy.

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