Journal of the Japan Epilepsy Society

Efficacy of Bromide for Intractable Epilepsy in Childhood

Junko Tanaka, Takashi Mimaki, Tetsuzo Tagawa, Jiro Ono, Yusuke Itagaki ...

1990 Volume 8 Issue 2 Pages 105-109
Published: October 31, 1990
Released on J-STAGE: January 25, 2011

DOIhttps://doi.org/10.3805/jjes.8.105

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The antiepileptic effect of bromide was studied in 20 epileptic patients with refractory seizures. Their ages were ranged from one year 5 months to 22 years (mean 9 years 7 months). Serum bromide levels were also determined in 14 patients. The types of epilepsy were partial epilepsy in 10 and secondary generalized epilepsy in 10 cases. The seizure types were secondarily generalized tonic clonic convulsions (pGTC) in 13, tonic seizures in 10, myoclonic seizures in 7 and atypical abscences in 6 cases. Six of 13 cases with pGTC and one with tonic seizure showed more than 50% reduction of seizure frequency. Two with pGTC and one with myoclonic seizure had slight improvement of seizure frequency. In one case with Lennox-Gastaut syndome, a transient improvement of frequent tonic seizures was observed. There was no direct relationship between serum bromide levels and clinical response. Side effects were observed in 5 cases (acneform rash in 3, diarrhea in one and drowsiness in one) between 1 to 5 months after the initiation of bromide therapy, despite their plasma bromide levels were not so high.
Although bromide has some untoward effects, the present study suggests this compound is an effective and benefical anticonvulsant for treatment of intractable epilepsy with pGTC.

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Neuropsychological Evaluation Related to Epilepsy with Continuous Spike Waves During Slow Sleep (CSWS) or Frequent Generalized Spike Waves

Reports of Three Cases Showing Remarkable Electroencephalograpbical and Clinical Improvement in a Short Period

Osamu Kanazawa, Toshiyuki Naruto, Akira Sengoku, Etsuko Uemura, Itsuo ...

1990 Volume 8 Issue 2 Pages 110-120
Published: October 31, 1990
Released on J-STAGE: January 25, 2011

DOIhttps://doi.org/10.3805/jjes.8.110

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We investigated the relation between neuropsychological evaluation and abnormal EEG findings throughout the clinical course in three patients in whom continuous spike waves during slow sleep (CSWS) or generalized frequent epileptic discharges were increased and finally decreased.
All patients demonstrat ed remarkable improvement in neuropsychological or behavior problems associated with the rapid change of only EEG findings (case 1) or both EEG findings and seizures (case 2 and 3) within several months.

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Plasma ACTH and Serum Cortisol Levels in Epileptic Patients on Antiepileptic Monotherapy

Yumi Horigome, Kenzo Hamano, Nobuaki Iwasaki, Koichiro Kawashima, Mits ...

1990 Volume 8 Issue 2 Pages 121-125
Published: October 31, 1990
Released on J-STAGE: January 25, 2011

DOIhttps://doi.org/10.3805/jjes.8.121

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Effects of antiepileptic drugs on the hypopituitary axis were evaluated on patients undergoing antiepileptic monotherapy. We measured the plasma ACTH and serum cortisol levels of patients taking sodium valproate (VPA group, n=19), phenobarbital (PB group, n=35) and carbamazepine (CBZ group, n=6) monotherapies. The plasma ACTH level of VPA group was 21.2±10. 9 pg/ml and significantly lower than those of PB group(28.0±14.3pg/mi, p<0.02), CBZ group(37.2±15. 8pg/ml, p<0.01) and the control group(32.5±13.7pg/ml, p<0.02). ACTH secretion from the anterior pituitary gland was assumed to be under the control of the hypothalamic GABA neuron, and VPA was assumed to exert its antiepileptic action by increasing GABA of the brain. The serum cortisol level was not decreased in the VPA group nor in the other groups. We presumed that VPA suppressed the secretion of ACTH, but its degree of suppression was mild and did not affect the adrenal gland function.

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The Role of Wet-Dog Shakes on Amygdaloid Electrical and Chemical Kindling with Met-Enkephalin

Takahiko Tanaka, Hisayoshi Takeshita, Ryuzo Kawahara, Hidebumi Hazama

1990 Volume 8 Issue 2 Pages 126-132
Published: October 31, 1990
Released on J-STAGE: January 25, 2011

DOIhttps://doi.org/10.3805/jjes.8.126

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The role of wet-dog shakes (WDS) on kindling phenomenon was investigated in the rat using amygdala (AM) electrical kindling (E-K group), Met-enkephalin (ME) chemical kindling (ME-K group) and ME chemical kindling after the completion of electrical kindling (E-M group). AM electrical kindling was carried out with 200μA stimulation. Repeated microinjection of 10μg ME into the AM was given to make the ME chemical kindling. EEG and behavioral seizure were recorded from 2 min before the electrical stimulation or ME microinjection to 2 min after the end of after-discharge (AD). The number of WDS in ME-K and E-M groups was significantly decreased as the kindling stages progressed. On the contrary, the number of WDS in E-K group was gradually increased as the kindling stages progressed. WDS completely disappeared in the ME-K group when the stage developed into the stage 5. In all the three groups, the maximum incidence of WDS in each stage coexisted with the termination of AD, which was accordant with the end of convulsive seizures.
These results suggest that WDS may be associated with the kindling stage and the end of convulsive seizure or AD and the disappearance of WDS could be a behavioral index of the fully kindled state in some kinds of kindling models.

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A Pathogenetic Role of NMDA Receptors in the Kindling Model of Epilepsy

Kahoru Katayama

1990 Volume 8 Issue 2 Pages 133-142
Published: October 31, 1990
Released on J-STAGE: January 25, 2011

DOIhttps://doi.org/10.3805/jjes.8.133

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To investigate the role of N-methyl-D-aspartate (NMDA) receptors in epilepsy, we examined the effects of competitive and non-competitive antagonists of NMDA receptors (CPP and MK-801) on;(i) amygdala kindling development;(ii) previously amygdala kindled seizures in freely moving rats ; and (iii) long-term potentiation (LTP) inthe hippocampal dentate gyrus of urethane-anesthetized rats.
The results were:(i) Both CPP (5 or 10mg/kg, i.p.) and MK-801 (1 or 2mg/kg) significantly retarded kindling development and growth of afterdischarge in a dosedependent manner, especially in the early stage of kindling.(ii) Although CPP and MK-801 significntly reduced the seizure stage of previously kindled seizures from the amygdala, these two agents showed no significant effects on the aftrdischarge duration.(iii) Both CPP and MK-801 almost completely blocked LTP of the excitatory postsynaptic potential (EPSP) induced by high frequency stimulation of the perforant path (400Hz, 20ms, 10 trains) and significantly suppressed LTP of the population spike in a dose-dependent manner.
We concluded that NMDA receptors play an important role in the potentiation of synaptic transmission and activation of NMDA receptors is a critical mechanism in kindling development.

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One Case of Temporal Lobectomy

about relationship between seizures and psychosis

Akira Sengoku, Kousuke Kanemoto, Ituo Kawai, Takasi Tokunaga, Juji Tak ...

1990 Volume 8 Issue 2 Pages 143-150
Published: October 31, 1990
Released on J-STAGE: January 25, 2011

DOIhttps://doi.org/10.3805/jjes.8.143

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We reported one woman of 26-years-old with temporal lobe epilepsy, who had refractory complex partial seizures. She had episodic psychotic state (delusion) with forced normalization in EEG which was induced by adding the new anti-epileptica, zonisamide, and after remission of psychosis, she complained of idea of references. Following left anterior temporal lobectomy, her seizures have been completely suppressed for one year until present. After the lobectomy, she transiently complained of idea of references, but delusion did not occur despite the disapperance of paroxysmal discharges. About this case, the psychiatric effect of surgery and the significance of rehabilitation after surgery are discussed.

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Interhemispheric Peak Delay of Spikes

A Method for Difect Measurement Using Micro-computer

Yutaka Watanabe, Masako Watanabe, Tadahiro Mihara, Kazuichi Yagi, Masa ...

1990 Volume 8 Issue 2 Pages 151-158
Published: October 31, 1990
Released on J-STAGE: January 25, 2011

DOIhttps://doi.org/10.3805/jjes.8.151

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The interhemispheric peak delay (IHPD) of spikess in bilateral spike-and-wave discharges recorded during absence seizures were quantified in a millisecond order by the use of micro-computer, and the physiological significance of the IHPDs was evaluated by their spatiotemporal distribution on histogram, mean values and standard deviations. Thirteen patients with idiopathic generalized epilepsy (IGE) and 15 with symptomatic generalized epilepsy (SGE) were subjected to this study. The IHPD indicated by absolute mean (IHPD-ABS) revealed neither physiologically meaningful nor statistically significant group differences between IGE and SGE. Whereas, the standard deviations (IHPD-SD) were obviously larger in SGE than in IGE, differnces of which was statistically significant.
In discussing the physiological significance of IHPD, it became evident that not only mean values but the scatterness expressed as standard deviations should be taken into consideration. In this regard, the direct measurement method the authors proposed is deemed superior to other conventionally used methods. The results that the IHPD-SDs were obviously larger in SGE compared with those in IGE suggest the unstable dysfunctional states involved in the intracerebral propagating pathways in SGE.

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Neuroimaging in Intractable Partial Epilepsy of Children

Comparison of MRI and SPECT

Kiyokuni Miura, Masao Kito, Fumio Hayakawa, Mitsuo Maehara, Tamiko Neg ...

1990 Volume 8 Issue 2 Pages 159-166
Published: October 31, 1990
Released on J-STAGE: January 25, 2011

DOIhttps://doi.org/10.3805/jjes.8.159

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Interictal single photon emission computed tomography (SPECT) with N-isopropylp-(¹²³I)-iodoamphetamine and magnetic resonance imaging (MRI) were performed on 44 children with intractable partial epilepsy. Abnormal SPECT findings were detected in 16 (80%) of 20 patients with temporal lobe epilepsy (TLE), in all (100%) of 7 with occipital lobe epilepsy (OLE) and in 4 (67%) of 6 with frontal lobe epilepsy (FLE). MRI was positive in 16 (80%) patients with TLE, in 5 (71%) with OLE and in 1 (17%) with FLE. SPECT abnormalities and EEG foci were localized in the same areas in 9 (50%) cases with TLE, in 3 (43%) with OLE and in 0 (0%) with FLE. Abnormal MRI signals and focal EEG abnormalities were seen in the same regions in 8 (44%) cases with TLE, in 57%with OLE and in 0% with FLE. And abnormal SPECT findings correlated with MRI findings with respect to the localization in 6 (30%) cases with TLE, in 4 (57%) with OLE and in 0 (0%) with OLE. These results indicate that SPECT and MRI are useful for localizing epileptic foci in patients with intractable partial epilepsy, especially in case of TLE and OLE.

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Elevated Glutamine and Decreased Lysine Concentration in CSF in Epileptic Patients

in Relation to Asterixis Induced by Antiepileptic Drugs

Nagafumi Doi, Masatake Uno

1990 Volume 8 Issue 2 Pages 167-175
Published: October 31, 1990
Released on J-STAGE: January 25, 2011

DOIhttps://doi.org/10.3805/jjes.8.167

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Plasma ammonia and 20 amino acids in plasma and in lumbar cerebrospinal fluid (CSF) were measured from two groups of epileptic patients receiving antiepileptic drugs (AED's) who showed asterixis (Group-1; n=9) and those who did not show asterixis (Group-2; n=8), and from neurologically normal controls (Group-3; n=9).
The results showed statistically significant increase in the level of glutamine and decrease in the level of lysine in the CSF of Group-1 as compared with the other two groups.Glutamine-lysine ratio in CSF (GLR) discriminated between Group-1 and the other two groups with accuracy 96.2%.The plasma ammonia level was higher in Group-1 as compared with the other groups but the difference was not statistically significant.
All the patients of Group-1 showed inactivity and EEG slowing as well as asterixis. After the reduction of AED's, those clinical symptoms disappeared and the disturbed CSF amino acid composition was improved with decreased plasma ammonia level.
These results suggest that asterixis induced by AED's is a symptom of encephalopathy associated with reversible disturbances of amino acid metabolism in the brain induced by AED's or secondary hyperammonemia.

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Weight Gain and Nocturnal Enuresis Associated with Sodium Valproate

Hideki Horita, Shinichirou Hamano, Kiyomi Fukushima

1990 Volume 8 Issue 2 Pages 176-178
Published: October 31, 1990
Released on J-STAGE: January 25, 2011

DOIhttps://doi.org/10.3805/jjes.8.176

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For the last 4.5 years, side effects of antiepileptic drugs (AEDs) were observed in 48 of patients recieving AEDs.Their age ranged from 1 year 7 months to 29 years 2 months.
All 7 patients with weight gain were treated with valproate (VPA). Increased degree of obesity for 3-24 months resulted in obesity more than 30% in all with weight gain.VPA was discontinued in 4 cases because of obesity, and consequently the body weight decreased in 3 cases.Nocturnal enuresis was associated with VPA in 5 cases, phenytoin in one and clonazepam in another.Enuresis occurred from the first day of treatment in 4 cases.Remission of the enuresis was achieved in all of the 4 cases in which AEDs were discontinued.
The weight gain and enuresis during VPA treatment may be associated with a modulatory effect of VPA on the regulating centers of appetite and micturition in the hypothalamus.

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Increased Activity of Superoxide Dismutase (SOD) in Kindled Brain and Suppression of Kindled Seizure Following Intracerebral Injection of SOD

Norio Mori, Masaru Watanabe, Hisashi Kumashiro

1990 Volume 8 Issue 2 Pages 179-183
Published: October 31, 1990
Released on J-STAGE: January 25, 2011

DOIhttps://doi.org/10.3805/jjes.8.179

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The possible role played by superoxide dismutase (SOD), a specific scavenger for superoxide, in the generalization and expression of kindled amygdaloid seizure was examined in rats.Significant increase of SOD activity was observed in the whole brain 30 days after full electrical kindling. When 3ng of SOD was injected into the kindled amygdala, marked suppression of kindled seizure was obtained.These results suggest that SOD participates in the persistence of amygdaloid kindled seizure susceptibility and the initiation of kindled amygdaloid seizure.

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