The prevalence of epilepsy and pharmacoresistant epilepsy in adults: a population-based study in a Western European country.

Purpose: To determine the prevalence of epilepsy in a defined adult population and identify the frequency and principal features of pharmacoresistant epilepsy.

Methods: From a population over 15 years of age residing in a medium-sized French city, all patients with epilepsy on June 30, 1995 were identified from multiple sources. Pharmacoresistance was defined as failure to control epilepsy by at least two first-line antiepileptic drugs, with a seizure frequency of at least one per month for 18 months.

Angiogenesis is associated with blood-brain barrier permeability in temporal lobe epilepsy.

Previous studies from our group, focusing on neuro-glial remodelling in human temporal lobe epilepsy (TLE), have shown the presence of immature vascular cells in various areas of the hippocampus. Here, we investigated angiogenic processes in hippocampi surgically removed from adult patients suffering from chronic intractable TLE, with various aetiologies. We compared hippocampi from TLE patients to hippocampi obtained after surgery or autopsy from non-epileptic patients (NE).

Lamotrigine associated with exacerbation or de novo myoclonus in idiopathic generalized epilepsies.

Five patients with idiopathic generalized epilepsies (IGE) treated with lamotrigine (LTG) experienced exacerbation or de novo appearance of myoclonic jerks (MJ). In three patients, LTG exacerbated MJ in a dose-dependent manner with early aggravation during titration. MJ disappeared when LTG dose was decreased by 25 to 50%.

Increased number of neural progenitors in human temporal lobe epilepsy.

An increased neurogenesis is reported in animal models of mesial temporal lobe epilepsy (MTLE) but the fate of newborn cells is unknown. Here, we attempted to demonstrate neurogenesis in adult epileptic tissue obtained after hippocampectomy. MTLE hippocampi showed increased expression of division markers and of Musashi-1, a marker of neural progenitors, compared to control hippocampi.

GABA receptor 1 polymorphism (G1465A) and temporal lobe epilepsy.

Purpose: To reevaluate the genetic contribution of the polymorphism G1465A of the gene coding for gamma-aminobutyric acid (GABA)(B) receptor 1 subunit [GABA(B)(1)] in a sample of French patients with temporal lobe epilepsy (TLE) and to perform an exploratory analysis in other phenotypic subgroups.

Methods: The 134 patients were genotyped for the polymorphism G1465A. This sample was divided in two groups.

Psychometric validation of the French version of the side-effects and life satisfaction inventory (SEALS) in epileptic patients: comparison with the QOLIE-31 inventory and a generic quality of life questionnaire.

A psychometric evaluation of a French version of the side-effects and life satisfaction inventory (SEALS) was carried out. SEALS was compared to the quality of life in epilepsy-31 questionnaire (QOLIE-31) and a generic, health-related quality-of-life questionnaire, the Nottingham health profile (NHP). The psychometric properties of SEALS, assessed in 190 adult subjects with epilepsy, included: acceptability, test-retest reliability and validity, multitrait analysis including internal consistency and item-to-scale correlations, construct validity using factor analysis and discriminative validity using associations with disease characteristics and treatment effects, and, correlations with NHP and QOLIE-31 scores for convergent and divergent validity.

Psychometric validation of the French version of the quality of life in epilepsy inventory (QOLIE-31): comparison with a generic health-related quality of life questionnaire.

A psychometric evaluation of a French transcultural version of the quality of life in epilepsy inventory-31 (QOLIE-31) was carried out. QOLIE-31 was compared to a generic health-related quality of life questionnaire, the Nottingham health profile (NHP). The psychometric properties of QOLIE-31, assessed in 190 adults with epilepsy, included: acceptability, test-retest reliability and validity (multi-trait analysis including internal consistency and item-to-scale correlations, construct validity using factor analysis, discriminative validity using relationship with disease characteristics, treatment effects, divergent and convergent validity using correlations with NHP scores).

[Neurogenesis in the adult brain: the demise of a dogma and the advent of new treatments].

Since the early sixties, many concepts concerning neurogenesis have been progressively ruled out. Proof of the persistence of a physiological neurogenesis in adult mammals, including humans, raised the concept of a unique precursor cell giving birth to neurons and glial cells. According to this concept, a real continuum between neuroepithelial cells, radial glia and astrocytes exists from the embryonic period to adult age and generates both neurons and glial cells.

Worsening of seizures by oxcarbazepine in juvenile idiopathic generalized epilepsies.

Purpose: Several studies have shown that carbamazepine (CBZ) may aggravate idiopathic generalized epilepsy (IGE). Oxcarbazepine (OXC) is a new drug chemically related to CBZ. We report six cases of juvenile IGE with a clear aggravation by OXC.

[What organisation to improve health care management of patients with partial refractory epilepsy?].

Management of refractory epilepsy requires a comprehensive approach with cooperation between primary care physicians, neurologists or neuropaediatricians and specialist epilepsy centres. A regional or interregional network organisation may provide improved access to care provision including inpatient facilities for emergencies, early referral to an epilepsy specialist centre. Such organisation should be appropriate to quality standards for neurophysiology and neuroimaging assessment, epilepsy surgery programme and psychological and social counselling services.

[Bupropion-induced epileptic seizures].

Introduction: Bupropion hydrochloride (Zyban) is prescribed for smoking cessation. It is contraindicated in patients with seizure disorders. We report three patients with generalized tonic-clonic seizure that occurred a few days after the intake of this drug.

Wicket spikes during rapid eye movement sleep.

Wicket spikes correspond to a normal variant activity. They usually occur in adults over 50 years of age during drowsiness and light nonrapid eye movement (NREM) sleep. No data exist in the precise distribution of this activity during all the different sleep stages, particularly during rapid eye movement (REM) sleep.

Dramatic effect of levetiracetam on epileptic negative myoclonus.

Objective: To investigate the properties of levetiracetam in a patient with severe epileptic negative myoclonus. Treatment of epileptic negative myoclonus relies on the drugs that are effective in focal epilepsies, but it is usually pharmacoresistant. Levetiracetam is a new antiepileptic drug with a broad-spectrum activity that includes efficacy against positive myoclonus.

Inflammatory reactions in human medial temporal lobe epilepsy with hippocampal sclerosis.

Many experimental studies suggest that NFkappaB, a transcription factor involved in acute inflammation, and cytokines participate in neuronal excitability and/or glial scar formation in epilepsy. In this report, we looked for the expression of NFkappaB in hippocampi surgically removed in patients with medial temporal lobe epilepsy (MTLE) and hippocampal sclerosis (HS) who had an history of febrile convulsions. We analyzed 18 hippocampi from epileptic patients with MTLE and HS, and we used as control specimens three hippocampi from non-epileptic patients and four hippocampi from patients with cryptogenic MTLE without HS.

Immature-like astrocytes are associated with dentate granule cell migration in human temporal lobe epilepsy.

In human temporal lobe epilepsy, a dispersion of dentate granule cells is frequently described in adults who had an early risk factor. To elucidate the role of glia in this phenomenon, we investigated neuronal dispersion, astrocyte organization and expression of intermediate filaments of mature and immature astrocytes (i.e.

Is there a lamotrigine withdrawal syndrome?

Objectives: To report a peculiar observation of a patient who developed a psychomotor inhibition state after a rapid cessation of lamotrigine (LTG).

Results: This man was referred to us at the age of 26 years for presurgical evaluation. His treatment [valproate (VPA), 1200 mg/day and LTG, 200 mg/day] was quickly decreased and discontinued after 4 days in order to record seizures.

[Localizing and prognosis value of 99Tcm-ECD spect in patients with refractory temporal lobe epilepsies].

Interictal and ictal 99Tcm ECD-SPECT were retrospectively studied in 46 patients with refractory temporal lobe epilepsy. Forty two of these patients underwent an anterior temporal lobectomy with amygdalo-hippocampectomy or a cortical resection. SPECT findings as indicator of localization for the epileptogenic zone (EZ) and surgical prognosis were validated by comparison with other investigations including video-EEG monitoring with surface electrodes in all the patients, intracranial electrodes in 18 patients and the results of post-surgery outcome.

[Optimal use of lamotrigine in clinical practice: results of an open multicenter trial in refractory epilepsy].

The study was designed to evaluate optimal use of add-on lamotrigine in the treatment of children and adults with refractory epilepsy of any type. Because of the available evidence from controlled studies, indicating the large spectrum of action of lamotrigine, we designed this prospective study to investigate the efficacy and safety of lamotrigine in everyday clinical practice, to collect useful information on its action in specific epilepsy syndromes and on the clinical results of specific co-medications. We studied 566 patients with a diagnosis of refractory epilepsy of any type currently receiving stable conventional regimens of antiepileptic therapy.

Incidence of drug-induced aggravation in benign epilepsy with centrotemporal spikes.

Purpose: Benign epilepsy with centrotemporal spikes (BECTS) is characterized by an excellent prognosis. Drug therapy is necessary in only a minority of patients. Carbamazepine (CBZ) and phenobarbital (PB) have been reported to cause electroclinical aggravation in some cases.

[Pathophysiology of epileptic seizures and status epilepticus].

Primary and secondary epileptogenesis involves multiple genetic and acquired factors. Epileptogenesis is a complex result of combined factors including membrane factors, neurotransmitter and environmental factors. Ion channel-related diseases, GABA and glutamate dysfunction, and glial reaction intervene in different epileptic conditions.

[Recent insights about genetics of human idiopathic epilepsies and febrile seizures].

We present here recent insight into idiopathic epilepsies and febrile convulsions. For each case, main clinical features are presented, concomitantly with genetic advances (transmission, penetrance and expressivity, locus, gene, gene function, identified mutations).

Sleep influence on seizures and epilepsy effects on sleep in partial frontal and temporal lobe epilepsies.

Objectives: A reciprocal effect is observed between sleep and epilepsy. Sleep effect on epilepsy is protective and facilitating. Reciprocally epilepsy alters sleep organization and microarchitecture.

Validity of diagnosis using the French translation of the semi-structured interview for seizure classification.

Purpose: The purpose of this study was to assess the acceptability and validity of the French cross-cultural translation of a semistructured interview for seizure classification (SISC). We used the first revised version, the original of which was validated in 1990.

Methods: We administered the French SISC to a sample of 67 adults older than 15 years, comprising 17 controls and 50 patients with epilepsy (without provoked or isolated seizures).