We analysed 147 patients with epilepsy following meningo-encephalitis. Among them, there were forty three cases with temporal lobe epilepsy (TLE group), sixty cases with non-TLE localization-related epilepsy (non-TLE group), and twenty two cases with symptomatic generalized epilepsy (SGE group) who were selected and compared. The latent period between the onset of meningo-encephalitis and the onset of epilepsy was the longest in the TLE-group and the shortest in the SGE -group. The high incidence of crude limbic sensation and the low incidence of elaborate limbic sensations were salient features of the TLE caused by meningo -encephalitis. Episodes of delusory-hallucinatory experiences were reported more frequently in the TLE-group than in the non-TLE-group. The low incidence of mental retardation as well as hemiparesis in the TLE-group, together with radiological findings, suggested a confined nature of the brain damage. We speculated that extended damage to the brain lead to a symptomatic generalized epilepsy while a confined one was associated with TLE. We postulated also that temporal lobe epilepsy occurring as a sequel to the meningoencephalitis was mostly of the medial type and reconfirmed the prevailing view that epileptic psychosis was closely related to temporal lobe epilepsy.

View full abstract

The long-term outcome of epilepsies were investigated in a prospective randomized study when clonazepam (CZP) was given as a single drug to children with cryptogenic localization-related epilepsies.
The first group of patients comprised 40 previously untreated children aged 3 to 14 years (mean, 8 years and 6 months) with any types of partial seizures, who had been newly reffered to our pediatric seizure clinic. A daily dose of 0.025mg/kg of CZP was introduced and the dosage was increased gradually to the initial maintenance daily dose of 0.1mg/kg. Of the total 40 patients seizures were not controlled in 6 with CZP monotherapy. Seizures increased in 2 and behavior changes requiring discontinuance of the drug occurred in another 2 patients.Of the remaining 30 patients, in whom seizures were controlled for the first 12 months, and CZP monotherapy was continued for a median of 5 years and 2 months, 28 patients remained seizure-free with the maintenance dosage, excluding a recurrence of seizures related to non-compliance of medication in 5 patients. In 16 out of the 28 patients, whose seizures were controlled with CZP monotherapy, the drug therapy was successfully discontinued except in one, in whom seizure recurred 6 months after stopping the therapy. However, in the other 5 patients withdrawal seizures ocurred during decreasing the maintenance dosage or soon after stopping the therapy.
The long-term outcome of epileptic children with partial seizures treated with CZP monotherapy is excellent, but the attention should be paied for the extreme sensitivity to the development of generalized tonic-clonic seizures on withdrawal of the drug.

View full abstract

GABA uptake inhibitors are newly developed antiepileptic drugs. In this study, we analyzed the antiepileptic profile of GABA uptake inhibitors, Tiagabine, SKF-89976A and NNC-711, in the rat kindling model, which is a chronic experimental model of human complex partial seizures with secondary generalization. We examined the dosedependent anticonvulsant effects of the GABA uptake inhibitors in amygdala (AM) -and hippocampal (HIPP) -kindled seizures, and compared their anticonvulsant and behavioral side effects with those of Valproate (VPA) and Carbamazepine (CBZ). In AM-and HIPP-kindled rats, intraperitoneal administration of the GABA uptake inhibitors (2.5-20 mg/kg) significantly reduced the seizure stage and afterdischarge (AD) duration in dose-dependent manners, compared with vehicle treatment. The anticonvulsant potencies of the 3 GABA uptake inhibitors were in the order: NNC-711 > Tiagabine >> SKF89976A, which was related to the in vitro GABA uptake efficacy, and they were similar between AM-and HIPP-kindled seizures. High doses of GABA uptake inhibitors (20-40mg/kg) caused sedation, motor impairment and EEG paroxysms with myoclonus. When the correlation between the anticonvulsant and behavioral side effects was examined, GABA uptake inhibitors showed more potent anticonvulsant and less side effects, compared with VPA and CBZ. These results indicate the clinical usefulness of GABA uptake inhibitors in temporal lobe epilepsy.

View full abstract

Interictal noninvasive measurements of regional cerebral blood flow (r CBF) using ^99mTc-HMPAO SPECT were performed on 43 patients with temporal lobe epilepsy. Mean cerebral blood flow (m CBF) showed significant negative correlation with advancing age and duration of illness and mean cerebellar blood flow (m Cbl BF) showed weak negative correlation with duration of illness. Patients taking phenytoin had signigicantly lower m CBF and lower m Cb1BF than those not taking phenytoin. Patients with both visually detected temporal hypoperfusion on SPECT and hippocampal sclerosis on MRI showed quantitatively lower r CBF in the temporal region and more wide-spread hypoperfusion than patients without the both of image findings. Our results suggest that interictal noninvasive cerebral blood flow measure ments using ^99mTc-HMPAO may give useful information about not only cerebral blood flow in the epileptic focus and its adjacent area but also the effects of antiepileptic drugs on brain function in temporal lobe epilepsy.

View full abstract

A boy, 14 years of age, with Fukuyama-type congenital muscular dystrophy, suddenly fell into coma and respiratory arrest. From the next day, he suffered convulsive status. His convulsive status was interrupted not by parenteral phenobarbital, intravenous diazepam, or phenytoin, but by thiopental-Na.
About 4mg/kg/hr of continuous thiopental-Na iv injection was the successful dose for maintenance.
Although, his convulsion was completely controlled, A-V block in ECG appeared and worsened untill his sudden cardiac arrest occured.
From his right atrium, stone of 2cm in diameter was detected by autopsy.
The stone was made from 72% of thiopental and 8% of unsoluble plasma protein.
By the in vitro study, thiopental-Na showed cristal formation by mixture with IVH-solution used for him. And, the cristal formation was more remarkable in more thick thiopental-Na.
Continuous thiopental iv injection in intractable convulsion should be carefully observed especially on its use in accompany with alkaline materials.

View full abstract