We investigated the distribution changes between the early and delayed images of single photon emission computed tomography using N-isopropyl-p-[¹²³I] iodoamphetamine (IMP) in 15 children with symptomatic or cryptogenic localization-related epilepsies in the interictal phase. We found three types of distribution changes as follows: Type 1; a low uptake area on the early image persisted unchanged on the delayed image in 2 cases, Type 2; a low uptake area on the early image changed to normal distribution on the delayed image in 9 cases, Type 3; a low uptake area on the early image changed to a high uptake area on the delayed image in 4 cases.
We speculate that these phenomena may provide a considerable new information for interpreting ¹²³I-IMP SPECT scans in children with epilepsy.

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In four patients with intractable complex partial seizures, interictal epileptic discharges, i. e., epileptic spikes and wave complex, were measured using a newly developed helmet shaped whole head magnetoencephalography (MEG) system with scalp and sphenoidal EEG. Three dimensional MR images were obtained in each patient with MEG coordinate system. Current sources of interictal discharges were estimated using a single or a two dipole model within the best fit sphere for each subject's head. Position and orientation of the dipoles were superimposed on MRI. We observed bilateral two dipole patterns in two cases. These dipolar patterns overlap each other across the midline. A two dipole model estimated “spike” or “wave” dipoles in bilateral neocortices, unilateral neocortex and contralateral mesial temporal structure, or bilateral mesial temporal structures. In the other 2 cases, single dipole pattern appeared on unilateral hemisphere only; these spike or wave dipoles were estimated within one lobe. The whole head MEG system is useful to localize multifocal epileptic discharges, as well as to evaluate signal propagation between bilateral hemispheres.

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We examined twenty-one patients on Rey's Auditory Verbal Learning Test (AVLT), Paired Association Learning Test (PAL), and immediate recall of Rey's complex figure (RCF) in the course of presurgical evaluation for the anterior temporal lobectomy because of intractable temporal lobe epilepsy. Verbal/Visual Ratio (VE/VI), defined as a quotient of total immediate recall of AVLT by the scores of RCF, was also adopted as a memory scale. Ictal depth as well as sphenoidal EEG recording revealed left foci in twelve patients (L-group) and right foci in nine patients (R-group). All the memory scale except VE/VI failed to differentiate successfully between L-group and R-group, While all the patients with VE/VI exceeding 3.2 belonged to the R-group, VE/VI short of 2.0 was found only in the L-grtup. The efficacy of VE/VI as a predictor of the laterality of temporal lobe epilepsy was confirmed statistically. Both L-and R-group performed just as well as control subjects on the semantically related pairs of PAL; but R-group did worse than control subjects on the semantically unrelated pairs. This supports the view that the hippocampus might be necessary for organizing unstructured material in memory.

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We investigated the vocational adjustment and financial status in 116 adult patients with epilepsy by using the Washington Psychosocial Seizure Inventory (WPSI). The whole subjects were outpatients who were leading their ordinary social lives. The ratios of the subjects who belonged to the Problem Areas 3 or 4 of the WPSI were 49% on the Vocational Adjustment Scale and 61% on the Financial Status Scale.The Problem Areas of the both scales were on 3 or 4 in 38% of the cases, and on 1 or 2 in 28% of the cases. The clinical factors which showed the statistically significant correlation were duration of the illness, type of epilepsy, severity of the seizures, psychiatric symptoms, educational period, occupational status, marital status and driving status with the vocational adjustment and educational period with the financial status, respectively. The psychological factor which manifested by the Emotional Adjustment and the Interpersonal Adjustment Scales of the WPSI played the most important role on the principal component analysis. Moreover, the components of the chronological factor, educational period and the severity of the seizures were demonstrated.

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We presented a female case with temporal lobe epilepsy producing abundant formal nominal paraphasia and neologism following complex partial seizures. Depth EEG study confirmed left sided origin of the complex partial seizures in question. This characteristic post-CPS verbal aberration was interpreted to represent a partial realization of Wernicke's aphasia devoid of impairment of surface structure proposed by Brown.

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We analyzed pharmacokinetics of a slow-releasing preparation of sodium valproate (VPA-SR) in 11 epileptic children, in whom the agent was administered at least 6 months. From the results of their sequential blood sampling, we caluculated individual pharmacokinetic parameters. Each of the VPA-SR concentration fell and reached the minimum and maximum levels 3 and 8 hours after the drug ingestion, respectively. Most of the pharmacokinetic parameters in these children were similar to those in adults. These parameters proved to be greatly useful to know individual daily profiles of serum VPA-SR concentration by using Basian method from one-point blood sampling.

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Zonisamide alone was administered to 47 fresh cases of childhood epilepsy under the age of 15, and total and free fraction concentrations of zonisamide were determined over time. The 47 cases were divided into four groups composed of 15 cases in Group A under the age of 2, 10 cases in Group B between 2 and 5 years of age, 10 cases in Group C between 5 and 10 years of age, and 7 cases in Group D between 10 and 15 years of age. The following results were obtained.
1. The ratios of serum concentration (μg/ml) to total dose of zonisamide (mg/kg/day) were 2.50±0.54 in Group A, 2.62±1.06 in Group B, 2.56±0.76 in Group C, and 3.28±0.63 in Group D. Group D showed a significantly higher ratio than the other three groups.
2. The ratio of free fraction concentration to total concentration of zonisamide was serially determined. The average of free/total concentration ratio showed an almost constant value of 51-61% with on significant difference.
3. The cases were divided into four groups according to total zonisamide concentration of <10μg/ml, 10-20μg/ml, 20-30μg/ml, and>30μg/ml, and thereafter free/ total zonisamide concentration of the groups was compared by age, but no significant difference could be demonstrated.
4. Mean optimal serum zonisamide concentration in seizure-free cases (31 cases, 66% of total cases) was 9.7±5.4ug/ml.

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An acquired audiogenic seizure model was created in rats by exposing them to intense 1/3 octave band noise (4 kHz, 125 dB) delivered two times, on post-natal days (P) 14 and 28. On P 28, “wild-running” (WR) was induced by sound in rats which had been formerly exposed to the sound stimulus on P 14. In stimulated rats and/or those with seizures, changes in auditory brainstem response (ABR) were characterized by a rise in the sound level threshold, indicative of cochlear hearing impairment, a decrease in the amplitude ratio of waves II and III to wave I, and prolongation of the interpeak latency between waves I and IV.
In the rats with seizures, many cells showing Fos-like immuno-reactivity were found in the lateral lemniscus, inferior colliculus, medial geniculate body, and temporal cortex, and the nerve cells in these nuclei showed slight histopathological change.
The central part of the inferior colliculus which is critical for initiation of audiogenic seizure is not expressed in non wild running rats, suggesting that activation of this area by a single audiogenic seizure is not sufficient to induce long-lasting changes. Strong acoustic stimuli induce an abnormal response in the inferior colliculus, accompanied by a wild running phase. These results confirm that audiogenic seizures are brain-stem seizures relatred to dysfunction of auditory pathways.

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Vibratory phenomena of GTCS were analyzed by simultaneous video-EEG-polygraphic recordings in patients with severe myoclonic epilepsy (SME) and high-voltage grand mal epilepsy (HVS-grand mal). According to Gastaut, grand mal in adults consists of a tonic phase of 10-20 seconds, intermediate vibratory phase of several seconds, and clonic phase lasting for about 30 seconds. Our results demonstrated that;(1) the duration of the intermediate vibratory phase ranged 15-20 seconds, and it is significantly longer than that of adult grand mal, (2) the vibratory movements appeared when the frequency of muscular contractions decreased to 4-6 Hz, (3) the asynchronous muscular contractions of the extremities give the appearance of more rapid and tremorous movements than are actually happening, (4) the asynchrony is also observed in the clonic phase. It is speculated that such a very atypical GTCS can be ascribed to immaturity or disturbance of synchronization mechanism between the two hemispheres, which may be caused by incomplete myelination, immature synaptic structures, or disturbance of cellular interaction in patients with SME and HVS-grand mal.

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We report a male infant with tonic spasms (TS) preceeded by partial seizures (PS). He developed isolated TS in the neonatal period and in series at 1.5 months of age. PS and TS preceeded by PS occurred at the age of 3 months following cessation of TS during ACTH therapy. MRI revealed focal pachygyria in the left parietooccipital area. Interictal ¹²³I-IMP SPECT showed hyperperfusion in the left parietooccipital area at 4 months of age. We think the interactive electrical triggering system between extensive cortico-subcortical dysfunction responsible for TS and focal cortical epileptogenic lesions responsible for PS is requisite to the occurrence of these compound seizures.

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