Body weight gain has been reported in patients with epilepsy taking valproate (VPA). We retrospectively studied 32 patients with epilepsy receiving VPA for more than one year. We investigated the relation between body weight gain and clinical parameters, including sex, age, duration of epilepsy, subtype of epilepsy, seizure frequency, VPA dose, serum VPA level, concomitant antiepileptic drugs (AED) treatment. At baseline (before VPA treatment) mean body mass index (BMI: kg/m²) was 22.4. One year after VPA treatment, mean BMI was 23.3 (+0.9, +4.0%). Four patients had BMI>25 at baseline, and 8 patients had BMI>25 one year after. Younger patients had greater increase in BMI. Patients with VPA monotherapy had significantly higher increase in BMI than patients with concomitant AED treatment. Other clinical factors had no significant correlation with increase in BMI.

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Benign childhood epilepsy with centrotemporal spikes (BECT) is classified as an idiopathic localization-related epilepsy. We report eleven disabled children whose electroencephalographic findings were similar Rolandic discharges (RD). Six had mental retardation, one had autism, one had mental retardation and spastic quadriplegia according to asphyxia, one had mental retardation and hemiplegia due to a migration disorder, and one had hemiplegia. Epileptic seizures were observed in nine patients, of whom two having generalized tonic and clonic convulsions, three had hemiconvulsions, two had complex partial seizures, one had sylvian seizure, and one had complex partial seizure with secondary generalization.
All patients had similar electroencephalographic features of RD in tarms of localization and wave form. On the other hand, horizontal di-polatity was seen in only 3 cases and sleep activation were in only 4 cases, and the epileptic discharges with six cases were an atypical form for RD. There is a little examination of the minute study of RD found in disabled children. So, I think that, furthermore, the study on chronological changes in the clinical features and electroencephalograms in disabled children with RD is necessary in future.

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Purpose:Continuing neurogenesis in the hippocampal dentate gyrus has been accepted not only from animal experiments but also human samples. We examined neurogenesis and neural maturation in the dentate gyrus in human epileptic hippocampus. Methods: Neurogenesis was confirmed with immunohistohemical staining of NeuroD, PSA-NCAM, and NeuN. Age at surgery, hippocampal sclerosis, seizure duration, and seizure frequency were evaluated using statistical approach to the number of PSA-NCAM positive newborn neurons in the subgranular cell layer and granular cell layer. We compared the staining of NKCC1 and KCC2 to the newborn neurons between the hippocampal sclerosis and non-hippocampal sclerosis groups to examine the neural maturation. Results: The number of new born neurons was statistically low in the hippocampal sclerosis group (p=0.0003). Seventy-four percent of PSA-NCAM positive newborn neurons co-stained with NKCC1 and 36.0% of those were positive with KCC2 in the non-hippocampal sclerosis group. On the other hand, in the hippocampal sclerosis group, percentages of those ion-co-transporters were 67.6%, 6.3%, respectively. The KCC2 expression ratio in the hippocampal sclerosis group was statistically low (p=0.003). Conclusion: Neurogenesis still continues even in human epileptic hippocampus. In sclerotic hippocampus, neurogenesis is reduced and neural maturation is also restricted.

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We report a case of epilepsy presenting higher brain dysfunction with autistic-like symptoms incipient in adolescence. The patient is a 20-year-old male. He had grown without any problems in his childhood, but has been presenting progressing mental, cognitive and verbal deterioration since 15 years old. These mental and behavioral symptoms were so severe that he was forced to be hospitalized for a long time. On the other hand, he has had generalized tonic-clonic seizures beginning at 8 years of age, followed by frequent absence-like seizures and motor seizures. Most of these seizures disappeared when he reached 15 years old, but instead, mental symptoms as mentioned above had worsened. His electroencephalography showed bilateral frontal spikes and slow waves that often spread diffusely, which was in conjunction with his clinical features, suggestive of frontal lobe epilepsy. Mental symptoms of this case were thought to have emerged because of great influence of continuous epileptic discharge upon higher brain function.

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A right-handed, 39 year old male had meningitis at age one and two simple febrile convulsions at age five and six. From age 10, he had intractable complex partial seizures (CPS), consisting of impaired consciousness and cyanosis. From age 18, he experienced seizure symptoms of sensory aphasia, version of the head and eyes to the left and two types of postictal mental disorders after CPS. One (Type A) was observed seven times after CPS from age 18 years and 8 months. They lasted for a few minutes to two and half hours, and consisted of dysphoria with occasional postictal sensory aphasia.
Another (Type B) was observed four times after CPS and a postictal lucid period from age 20 years and 2 months. They lasted for four minutes to five days, and consisted of fluctuating disturbance of consciousness, stereotyped crying, severe psychomotor excitement and delusions. Long-term intracranial EEG/video monitoring confirmed two independent ictal onset zones in the left hippocampus (LH) and in the left orbitofrontal region (LOF). Left anterior temporal lobectomy was performed at age 22. Seizures and mental symptoms were not observed for 17 years after surgery, and nine years after discontinuation of anti-epileptic drugs. We consider that the dual ictal onset zones could have contributed to his postictal mental disorders, Type A was due to malfunction of LOF induced by propagation of LH onset ictal discharge, and Type B was postictal psychosis associated with dual zones.

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A patient was transferred to our hospital after being in a twilight state for 4 months as a result of rapid progression of cognitive disturbance following tonic-clonic status epilepticus. On EEG, various types of epileptic discharge, including frequent paroxysmal activities on P3, O1, T5, PLEDs on the left posterior quadrant and ictal discharges originated from F3, C3 were recorded. During this time, partial seizures occurred repeatedly, and non-convulsive status epilepticus was diagnosed. On MRI, high signal intensity extending over a wide area in the left posterior hemisphere was observed on FLAIR images. On SPECT, hyperperfusion was depicted in the left temporo-parieto-occipital region. The sites of abnormal MRI and SPECT were almost consistent with the site of continuous periodic lateralized epileptiform discharges (PLEDs) on EEG. Adjustment of antiepileptic drugs succeeded to control the non-convulsive status epilepticus. Improvement in EEG, MRI and SPECT findings was also observed. In this case, the reversible high signal intensity observed on MR FLAIR image was probably due to edema of the cortex adjacent to the focus, caused by prolonged epileptic seizures. This case indicates that MR FLAIR sequence and SPECT are useful for the diagnosis and follow-up observation of non-convulsive status epilepticus.

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Although ictal fear is not uncommon in childhood epilepsy, it is difficult to make a diagnosis of epileptic seizure when sensation of fear is the sole ictal manifestation. We report an 8-year-old girl with recurrent attacks of fear sensation as the first and only manifestation without any interictal EEG abnormality, who has been misdiagnosed as a psychogenic seizure for 5 years. When she was referred to our hospital, the attacks increased in frequency up to every 10 minutes and evolved to asymmetric tonic motor seizures and complex visual hallucination. The ictal EEG showed the rhythmic epileptiform discharges predominantly arising from the right centroparietal area. The treatment with intrarectal chloral hydrate controlled the clusters of the seizures while initial trials of intravenous diazepam, midazolam and phenytoin were not effective. Although the brain CT scan showed no abnormality, the brain MRI revealed a tiny focal transmantle dysplasia in the right central gyri. The ictal [99mTc]-HMPAO single-photon emission computed tomography demonstrated a localized hyperperfusion at the same area. We should consider to conduct the ictal EEG study and brain MRI for patients who have recurrent stereotypic emotional fits of unknown etiology, even if interictal EEG and CT screenings do not show any abnormalities.

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[in Japanese]

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[in Japanese]

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Diagnostic Scheme for People with Epileptic Seizures and with Epilepsy 2001 is characterized not only by its 5 axes classification system but also by change of concept on epileptic seizure and epilepsy syndrome; i.e. no longer divide partial seizures into "simple" and "complex" and epilepsy syndromes into "focal" and "generalized". We applied this new classification on 50 newly admitted patients, 44% of which were children, to our neurosurgical department in the year of 2006. As a result, unclassifiable patients were only 8% by axis 3 of new classification whereas 26% by syndrome classification of 1989. Since younger children often shows generalized ictal EEG patterns and seizure semiology even if associated with focal epileptogenic pathologies, new classification was considered more applicable to our cases.

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[in Japanese]

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Recent classification of epilepsy proposed by ILAE in 2001 contains diverse scientific observations to guide better approaches to epilepsy than prior one in 1989. But in clinical practice, there are significant discrepancies between etiologies (genetic defect, location of epileptic zone, etc) and clinical phenotypes (epilepsy types, AED responsiveness). There are still limitations for the classification to obtain essential diagnostic information from diagnostic modalities such as EEG and MRI, and many unknown determining factors influencing the onset of epileptic condition, clinical progress and evolution and prognosis.
This review is to provide current proposal and the direction of classification for better practical guide to epileptic patients.

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[in Japanese]

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