Symptoms and Signs Simple partial (focal, local) seizures begin with specific motor, sensory, or psychomotor focal phenomena without loss of consciousness. Isolated epileptic auras are simple partial seizures with a single sensory symptom (often olfactory) preceding a complex or generalized seizure. In jacksonian seizures (focal motor symptoms begin in one hand or foot and then "march" up the extremity, or spread similarly from a corner of the mouth), the dysfunction may remain localized or may spread to other parts of the brain, with consequent loss of consciousness and generalized convulsive movements. Infantile spasms (salaam seizures) are primarily generalized seizures characterized by sudden flexion of the arms, forward flexion of the trunk, and extension of the legs. Akinetic seizures are brief, primarily generalized seizures seen in children and characterized by complete loss of muscle tone and consciousness. "Benign" or "simple" febrile convulsions are brief, solitary, and generalized; "complicated" febrile seizures are either focal, last > 15 min, or recur 2 or more times in In status epilepticus, motor, sensory, or psychic seizures follow one another with no intervening periods of consciousness.

Characterized by sudden, brief massive muscle jerks of one or more extremitiesVery brief -->

also known as Chronic Focal Encephalitis or Chronic Progressive Epilepsia Paritalis Continua of Childhood this may represent an etiologically diverse disorder inwhich the common clinicopathologic features represent the terminal stage of expression of various viral brain infections, i.e., CMV, EBV (Farrell et al. there may be an abnormal immune attack against GluR3 as antibodies directed against GluR3 have been identified in patients this hypothesis suggests that a focal interruption of the blood-brain barrier must occur for the GluR3 antibodies to enter the brain and thus must look for a previous history of head injury or vascular malformations in each patient a viral infection may produce an autoimmune reaction resulting in an inflammatory response within the central nervous system (CNS) and then a slowly progressive destruction of the cortical and white matter the viral infection does not appear to produce the usual systemic features of encephalitis nor an inflammatory response in the cerebral spinal fluid (CSF) persistent inflammatory reaction in a localized area of the brain (suggestive of a viral or bacterial agent) thought to represent seizure foci and not the consequence of seizure activity perivascular lymphocytic infiltrates and astrogliosis microglial nodules throughout the grey and white matter neuronophagia with neuronal loss and gliosis immune complexes in affected brain tissue +/- evidence of viral (CMV, EBV) genomic material normal development prior to onset of seizures simple partial seizures before the age of 10 also may initially present with generalized seizures in about 50% of cases severe, progressive and chronic focal motor seizures initially affect both limbs on one side then the limbs on the other side

Figure 1: A 26-year-old woman who was positive for the human immunodeficiency virus presented with focal motor seizures, a CD4 cell count of 238 per cubic millimeter, a rapid plasma reagin titer of 1:32, and a positive test for serum treponemal IgG antibody.

FOCAL SEIZURES Two types of local seizures were observed: a) Stereotyped movements of the head (head bobbing).

For the first time, this year the annual meeting of the Italian League against Epilepsy is held in Verona. For the first time, this year the annual meeting of the Italian League against Epilepsy is held in Verona. The itinerary of the day, organised by Tinuper and Munari, is aimed at a better understanding of the intrinsic reasons why, and in relation to which preferential etiopathogenic mechanisms an epileptic seizure can be generated in the temporal lobe; what electroclinical patterns may characterise a temporal epileptic seizure, and which surgical approach are best advisable. Following the work carried out in Naples on absences and tonic seizures, under the auspices of Vigevano and Tassinari problems of electroclinical definition of the various types of Myoclonic seizures will be discussed, with the aim of standardising the pathological picture and the diagnostic approach method, as well as the pathological picture of the main forms of epilepsy involving myoclonic seizures. During the Round Table which will open the Congress, the problems involved in identifying and setting out Information Guide Lines for a correct Patient Help Organisation will be discussed, which while taking into account the complexities and severity of the various forms of epilepsy will nevertheless be adequate at the level of service, and realistic with regard to the economic resources available. I am certain that this meeting at Verona will be fruitful and worthwhile thanks to the precious contribution of you all.

A case was described in which transcranial magnetic stimulation (TMS) induced seizures in an epileptic patient. The patient was a 17-yr old, right-handed male with medically intractable epilepsy who was undergoing presurgical evaluation which included TMS. The patient had suffered from focal epilepsy since he was 10 yr old, and averaged 5-9 seizures per mo at the time of the evaluation. Two seizures were attributed to TMS since both were induced exclusively by the figure-8-shaped coil and their beginning could be documented by tonic EMG activity following the evoked early response. This is the first EMG-documented demonstration of a focal motor seizure directly triggered by TMS. The seizures were caused only by the figure-8-shaped coil. For clinical purposes, TMS with a circular coil can still be considered safe at stimulus intensities that are currently used. June 24, 1997 - L. Brown (lbrown@IntNet.net) I'm an R.N. that inadvertently ran into some research on seizures.

Fourier frequency analysis is the fundamental tool for understanding the frequency structure of such stationary signals. In Fourier analysis these waveforms are cosines and sines which provide localization in frequency but not in time. The wavelet transform methods use base waveforms with good localization both in time and frequency. Unfortunately, even wavelet bases are not well adapted for representing signal components whose localizations in time and frequency vary widely. The dynamic signal (e.g., the ictal EEG) must be decomposed into waveforms whose time-frequency properties are adapted to its local structure. Mallat and Zhang (1993) developed an algorithm, the matching pursuit algorithm (MP), in which a signal is decomposed into a sum of waveforms that belong to a redundant dictionary of functions.

Fourier frequency analysis is the fundamental tool for understanding the frequency structure of such stationary signals. In Fourier analysis these waveforms are cosines and sines which provide localization in frequency but not in time. The wavelet transform methods use base waveforms with good localization both in time and frequency. Unfortunately, even wavelet bases are not well adapted for representing signal components whose localizations in time and frequency vary widely. The dynamic signal (e.g., the ictal EEG) must be decomposed into waveforms whose time-frequency properties are adapted to its local structure. Mallat and Zhang (1993) developed an algorithm, the matching pursuit algorithm (MP), in which a signal is decomposed into a sum of waveforms that belong to a redundant dictionary of functions.

Figure 1: A 26-year-old woman who was positive for the human immunodeficiency virus presented with focal motor seizures, a CD4 cell count of 238 per cubic millimeter, a rapid plasma reagin titer of 1:32, and a positive test for serum treponemal IgG antibody.

Some may have several areas capable of generating abnormal seizures and some may experience a secondary generalization of the seizure activity with the seizure coming to resemble a generalized seizure in very short (within seconds) order after onset of electographic onset of the focal activity. Temporal lobe seizures can arise from the medial side of the lobe (mesial temporal lobe seizures, limbic seizures, rhinencephalic seizures) or the lateral side (lateral temporal lobe seizures). Anterior Frontopolar Seizures - With these seizures one sees forced thinking, loss of contact with the environment and aversive (movement toward the side of the body opposite side of brain generating seizure) head and eye movement. Opercular Seizures - A primary feature of these seizures are signs and symptoms of alimentary tract involvement including chewing, swallowing, salivation, epigastric sensation, speech arrest, and sound generation. Motor Seizures - These are usually simple partial seizures and are localized based on what part of the body has movement at the onset of the seizure. Childhood Epilepsy with Occipital Paroxysms - These seizures start with visual symptoms such as amaurosis, phosphenes, illusions or hallucinations and 25% of patients with this condition will have migraine headache prior to onset of their seizures.

Figure 1: A 26-year-old woman who was positive for the human immunodeficiency virus presented with focal motor seizures, a CD4 cell count of 238 per cubic millimeter, a rapid plasma reagin titer of 1:32, and a positive test for serum treponemal IgG antibody. One year earlier, she had received a single dose of intramuscular penicillin (dose and rapid plasma reagin titer not known). On admission, gadolinium-enhanced T1-weighted magnetic resonance imaging showed multiple syphilitic cerebral gummas (Panel A and Panel B). Studies of cerebrospinal fluid revealed a white-cell count of 20 per cubic millimeter (92 percent lymphocytes and 8 percent monocytes), protein concentration of 27 mg per deciliter, glucose concentration of 53 mg per deciliter (2.9 mmol per liter), and a nonreactive Venereal Disease Research Laboratory test. The patient was treated with 12 million U of penicillin G per day intravenously for seven days, followed by 24 million U per day for an additional seven days. Other possible causes of this radiographic appearance, such as toxoplasmosis, bacterial or fungal cerebral abscess, sarcoidosis, neuroborreliosis, tuberculosis, and lymphoma, were ruled out by tests and by the patient's clinical response to penicillin.

Figure 1: A 26-year-old woman who was positive for the human immunodeficiency virus presented with focal motor seizures, a CD4 cell count of 238 per cubic millimeter, a rapid plasma reagin titer of 1:32, and a positive test for serum treponemal IgG antibody.

Figure 1: A 26-year-old woman who was positive for the human immunodeficiency virus presented with focal motor seizures, a CD4 cell count of 238 per cubic millimeter, a rapid plasma reagin titer of 1:32, and a positive test for serum treponemal IgG antibody.

A 48 year old man with a history of left posterior frontal GBM presented with focal motor seizures in his right arm and legs one year following stereotactic removal of his tumor mass. An MRI suggested the possibility of tumor recurrence. Last updated: Oct 12, 1995.

Epileptic Phenotype of otx1 -/- mice Between postnatal day 10 and 30 all the from the hybrid genetic background (B6/D2) derived Otx1-/- mice, exhibited epileptic behaviour. During focal seizures, Otx1-/- mice showed automatisms including head bobbing and teeth chattering. After approximately 30 seconds (s), mice either recovered or developed generalized seizures. As compared to wild type and heterozygous control mice, homozygous animals showed typical electric seizures. Neither epileptic behaviour nor electrical seizures were detected in Otx1+/- mice after 10 hrs of electroencephalographic recording. It is worth noting that in older Otx1-/- mice the epileptic behaviour and frequency of seizures are somewhat reduced although they never disappear.

NIH Consensus Development Conference on Epilepsy Surgery A listing of organizations providing support and education for and about epilepsy The Bowman Gray Comprehensive Epilepsy Center operates a toll-free Epilepsy Information Service that provides information and referral assistance to about 8,000 callers a year (1-800-642-0500). US National Institute of Neurological Disorders and Stroke: Epilepsy Information Guide Epilespsy FAQ (Frequently asked questions) maintained by Andrew Patrick Epilepsy Foundation of Victoria, Australia: EpiNet Hamilton & District Chapter Epilepsy (Ontario) OTTAWA-CARLETON Chapter EPILEPSY (Ontario) Epilepsy Canada: French English Canadian League Against Epilepsy Epilepsy Foundation of America Homepage National Society for Epilepsy, UK People with Epilepsy Homepage Epilepsy Foundation of Louisiana Epilepsy Contact Database Yahoo's Epilepsy Links Sarah Pleasant's Epilepsy Resources Epilepsy e-mailing list To subscribe send mail to LISTSERV@HOME.EASE.LSOFT.COM Include The following in the body of the message: SUBSCRIBE EPILEPSY-L Firstname Lastname To post a message send mail to epilepsy-l@home.ease.lsoft.com News group: alt.support.epilepsy The MGH Neurology Epilepsy Web Forum (select Review Epilepsy ) Epilepsy Discusion Area WWW Bulletin Board A useful conversational hypertext system with information about epilepsy (telnet) Epilepsy-Pro e-mailing list (for professionals working in the field) To subscribe send mail to listserv@calvin.dgbt.doc.ca Include The following in the body of the message: subscribe epilepsy-pro Firstname Lastname To post a message send mail to epilepsy-pro@calvin.dgbt.doc.ca American Epilepsy Society Neurosource Epilepsy Page. A listing of general and physician-oriented resources related to epilepsy. The Bowman Gray/Wake Forest Neurosurgery Brain Tumor Index has more information on the treatment of tumors of the brain or spine and support for patients, family, and other caregivers. The Bowman Gray/Wake Forest Neurosurgery Meningioma Index has more information on the treatment of benign tumors of the brain or spine such as meningioma and hemangioblastoma.

This section enables you to find information about more than 7,000 prescription and over-the-counter medications, including common uses of a drug, the proper ways to use the medicine, possible side effects, and other helpful information. It is best to discuss this medication information with your pharmacist, doctor, or other health professional to find out how it applies to you and your particular case. The information is provided by Medi-Span®, one of the nation's most respected sources of drug and medication information. To use this guide, enter the partial or complete name of the medicine below and click on "Search for Match. " (for example, enter the letters "aspi" for aspirin). If you make an error in entering the drug name, click on "Clear Text," and type in the correct name.

MedWeb has once again evolved - the old version of MedWeb can be found under the keyword index link.

May 16, 1995: Nephrology Clinical Case Conference, details to be announced. Unless otherwise noted, all Clinical Case Conferences and Grand Rounds are held at 8:30 AM in the Harvey Morse Auditorium on Plaza Level, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, California, 90048. Maps to Cedars-Sinai are also available here for viewing. Created 3/1/95 / Last modified 4/27/95

Event Incidence of Late Seizures (%) Penetrating injury caused by missile 53 Intracerebral haematoma - laceration 39 Focal Brain Damage on early CT scan 32 Early Seizures 25 Depressed Fracture - torn dura 25 Extradural or subdural haemorrhage 20 Focal Signs (hemiplegia, aphasia, . ) 20 Depressed skull fracture 15 Loss of consciousness > 24 hours 5 Linear fracture 5 Mild Concussion 1

Decreased serum levels of ALT and AST have been observed during treatment with vigabatrin and may be the result of inhibition of these transaminases by vigabatrin. In clinical trials, including double-blind, placebo- controlled studies involving 354 patients with drug-resistant complex partial seizures, vigabatrin reduced seizure frequency by 50% or more in approximately half of the patients studied. Vigabatrin is eliminated via the kidney and caution should be exercised when administering the drug to elderly patients and to patients with renal impairment (see Dosage). -------------------------------------------------------- Table I Adverse Events Reported By More Than 1% of Patients -------------------------------------------------------- Number of Incidence Body System/Adverse Event Patients n=2081 -------------------------------------------------------- Nervous somnolence 261 12.5 headache 80 3.8 dizziness 79 3.8 nervousness 56 2.7 depression 52 2.5 memory disturbances 47 2.3 diplopia 46 2.2 aggression 42 2.0 ataxia 39 1.9 vertigo 39 1.9 hyperactivity 37 1.8 vision abnormal 34 1.6 confusion 29 1.4 insomnia 26 1.3 impaired concentration 25 1.2 personality disorder 23 1.1 agitation 21 1.0 -------------------------------------------------------- Digestive abdominal pain 34 1.6 constipation 29 1.4 vomiting 28 1.4 nausea 28 1.4 -------------------------------------------------------- Body as a Whole fatigue 192 9.2 weight gain 104 5.0 asthenia 23 1.1 -------------------------------------------------------- -------------------------------------------------------------- Table II Adverse Events Reported By More Than 1% of Pediatric Patients -------------------------------------------------------------- Number of Incidence Body System/Adverse Event Patients n=299 -------------------------------------------------------------- Nervous somnolence 24 8.0 hyperkinesia 23 7.7 aggression 8 2.7 insomnia 8 2.7 agitation 7 2.3 ataxia 7 2.3 emotional lability 3 1.0 headache 3 1.0 increased seizures 3 1.0 -------------------------------------------------------------- Digestive vomiting 6 2.0 nausea 3 1.0 increased saliva 3 1.0 -------------------------------------------------------------- Body as a Whole weight gain 9 3.0 fatigue 8 2.7 hypotonia 3 1.0 -------------------------------------------------------------- The recommended starting dose in children is 40 mg/kg/day, increasing to 80 to 100 mg/kg/day depending on response.

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