Faculty Bibliography

The purpose of this study was to determine whether patient reporting of a relationship between seizure exacerbation and menses helps distinguish premenopausal women with epileptic seizures from those with nonepileptic seizures (NES). We reviewed the responses to the question 'What tends to bring on your seizures?', administered during the initial evaluation of women ages 18-45 years with epileptic seizures (n = 27) and NES (n = 38) at our outpatient clinic. Only one out of 38 women with NES versus 13 of 27 women with epilepsy reported a relationship of seizures with the menstrual cycle (p =.0001). Other precipitants identified for seizure exacerbation such as stress, or emotional upset, did not distinguish these two groups. Patient reporting of a relationship between seizure exacerbation and menses can help distinguish epileptic from NES in premenopausal women. (C) 1998 by Elsevier Science Inc. All rights reserved

PURPOSE/OBJECTIVE:We assessed rates of symptoms of anxiety and depression among pediatric patients with epilepsy. METHODS:We administered the Revised Child Manifest Anxiety Scale (RCMAS), and Child Depression Inventory (CDI) to 44 epilepsy patients aged 7-18 years (mean age 12.4 years). Demographic, socioeconomic, and epilepsy-related information was examined in relation to depression and anxiety scores. RESULTS:No patients had been previously identified to have depression or anxiety. However, 26% had significantly increased depression scores and 16% met criteria for significant anxiety symptomatology. CONCLUSIONS:Symptoms of depression and anxiety are common among pediatric patients with epilepsy and appear to be overlooked by care providers.

Despite advances in video-electroencephalogram (EEG) technology, in many patients distinguishing epileptic seizures from nonepileptic seizures (NES) remains a challenge. Reliable methods to make this distinction are needed. In a pilot study, we performed postictal and interictal single photon emission computed tomography (SPECT) in 22 patients undergoing video-EEG monitoring who had altered responsiveness during an episode. Eleven had seizures, defined as episodes associated with EEG seizure patterns or postictal prolactin (PRL) elevations greater than 1.5 times the highest interictal baseline PRL; 11 had NES. Among the 11 seizures, postictal SPECT was abnormal in seven (regions of hypoperfusion in six and hyperperfusion in one) and normal in four. In six cases (55%), the interictal and postictal SPECT changed. Among the 11 NES cases, postictal SPECT was abnormal in three cases (all hypoperfusion abnormalities) and normal in eight cases. in no case did the interictal and postictal SPECT change. This small sample revealed a trend toward greater hypometabolism (postictal versus interictal) on SPECT for epileptic seizures compared to NES (p < 0.12). There were postictal SPECT changes in two of five seizures unassociated with postictal PRL elevation. Prolactin was elevated in two cases unassociated with change on SPECT. Comparision of postictal to interictal SPECT may help distinguish epileptic seizures from NES. Results from SPECT may also help identify epileptic seizures unassociated with PRL elevation. (C) 1998 by Elsevier Science Inc. All rights reserved

Fatigue is commonly reported as an adverse effect of antiepileptic drugs. Ln other disorders, fatigue has been closely correlated with depression. We examined the frequency of fatigue in epilepsy patients, the contribution of depression to fatigue, and the impact of fatigue upon quality of life. We measured fatigue and depression with the Fatigue Severity Scale (FSS) and Center for Epidemiological Studies-Depression scale (CES-D), respectively in 89 patients with epilepsy at an epilepsy center, 26 depressed controls (DC), and 30 normal health adults (NHA). Patients with epilepsy also completed the Quality of Life in Epilepsy (QOLIE-10) scale. Forty-four percent of epilepsy patients met criteria for severe fatigue, while 52% were depressed. The correlation between fatigue and depression was high among epilepsy patients (r = .60, p = .0001). Both fatigue and depression had an inverse relationship with quality of life in epilepsy (p < .0001). Fatigue in epilepsy is common and is closely associated with depression. Fatigue is associated with significant impairment in quality of life in epilepsy. (C) 1998 by Elsevier Science Inc. All rights reserved

The purpose of this study is to determine the etiologies of seizures in a Veterans' Affairs Medical Center (VAMC) population. We retrospectively reviewed the records of all VAMC patients discharged from the Northport VA

Although gabapentin (GPN) is commonly used as adjunctive therapy to treat recurrent self-limited seizures, little is known about its potential efficacy in treating prolonged partial seizures. We report two cases of refractory focal status epilepticus successfully treated with oral GPN. Ln both cases, GPN precluded the need for pentobarbital coma. We suggest that GPN may be an effective treatment for focal status epilepticus and should be studied further for its potential efficacy in this condition. (C) 1997 by Elsevier Science Inc. All rights reserved

We report three patients with focal prolonged myoclonic jerking movements suggestive of epilepsia partialis continua (EPC) but produced on a psychogenic basis [nonepileptic seizures-EPS (NES-EPC)]. NES-EPC was identified by (1) variability in the areas of motor activity in the same patient, (2) distribution and spread of motor activity without neuroanatomic basis, (3) transient abolition of movements with distraction (e.g., when other body parts are engaged in effortful tasks), (4) eliciting and abolishing typical episodes with suggestive techniques, (5) absence of motor weakness during or in between episodes, (6) absence of electroencephalogram (EEG) correlate of motor activity, and (7) absence of hyperperfusion on ictal SPECT scan. (C) 1997 by Elsevier Science Inc. All rights reserved