Language assessment in Wada test: comparison of methohexital and amobarbital.

Introduction: Methohexital has replaced amobarbital during Wada testing at many centers. The objective of our study was to compare the use of methohexital and amobarbital during Wada testing regarding language and memory lateralization quotients as well as speech arrest times.

Methods: A chart review of 582 consecutive patients undergoing 1041 Wada-procedures was performed (left=60, right=63, bilateral=459).

Evidence for a basal temporal visual language center: cortical stimulation producing pure alexia.

Background: Dejerine and Benson and Geschwind postulated disconnection of the dominant angular gyrus from both visual association cortices as the basis for pure alexia, emphasizing disruption of white matter tracts in the dominant temporooccipital region. Recently functional imaging studies provide evidence for direct participation of basal temporal and occipital cortices in the cognitive process of reading. The exact location and function of these areas remain a matter of debate.

Wada memory asymmetry scores and postoperative memory outcome in left temporal epilepsy.

Background: Memory asymmetry scores are used in intracarotid amobarbital procedure (IAP) to predict memory outcome after anterior temporal lobectomy (ATL) in patients with temporal lobe epilepsy (TLE). Reversed asymmetry (RA) of memory scores occurs in a minority of patients, with better memory performance observed following contralateral injection. Left ATL patients with RA are reported to have poorer postoperative verbal memory outcome.

Temporal lobe neoplasm and seizures: how deep does the story go?

[March 2008-Cleveland Case Report]. There is a well-described association between the occurrence of developmental tumors and the presence of cortical dysplasia in the neighboring brain tissue. The main surgical approaches in the treatment of medically refractory epilepsy related to such developmental tumors include a lesionectomy versus a tailored cortical resection, often guided by an invasive evaluation.

Video-electrographic and clinical features in patients with ictal asystole.

Objective: Ictal asystole (IA) is a rare event mostly seen in patients with temporal lobe epilepsy (TLE) and a potential contributor to sudden unexplained death in epilepsy (SUDEP). Clinical and video-electroencephalographic findings associated with IA have not been described, and may be helpful in screening for high risk patients.

Methods: A database search was performed of 6,825 patients undergoing long-term video-EEG monitoring for episodes of IA.

Surgical outcome and prognostic factors of frontal lobe epilepsy surgery.

Frontal lobe epilepsy (FLE) surgery is the second most common surgery performed to treat pharmacoresistant epilepsy. Yet, little is known about long-term seizure outcome following frontal lobectomy. The aim of this study is to investigate the trends in longitudinal outcome and identify potential prognostic indicators in a cohort of FLE patients investigated using modern diagnostic techniques.

Predictors of outcome after temporal lobectomy for the treatment of intractable epilepsy.

To assess short- and long-term seizure freedom, the authors reviewed 371 patients who underwent anterior temporal lobectomy to treat pharmacoresistant epilepsy. The mean follow-up duration was 5.5 years (range 1 to 14.

Accuracy of seizure detection using abbreviated EEG during polysomnography.

The purpose of this study was to determine the validity of abbreviated EEG montages for seizure detection during polysomnography. Three electroencephalographers reviewed files containing seizures or nonepileptic events using 8- and 18-channel montages. Files were rated as to whether they contained seizures and assigned a "probability of seizure" score from 0% to 100% reflecting the confidence that it was a seizure.

Restless legs syndrome associated with primary hyperparathyroidism.

Restless legs syndrome (RLS) is a poorly understood sleep-related movement disorder which can be primary or associated with other conditions, most commonly iron deficiency, uremia and peripheral nerve disease. We present a case of RLS with an unusual secondary cause: primary hyperparathyroidism with hypercalcemia. This patient experienced complete and sustained relief of RLS symptoms immediately after parathyroidectomy, with normalization of her serum parathyroid hormone (PTH) and calcium levels.

Seizure outcome after epilepsy surgery in patients with normal preoperative MRI.

Objective: To determine outcome after epilepsy surgery in patients with normal preoperative magnetic resonance imaging (MRI).

Methods: 24 adult and paediatric patients with normal preoperative MRIs were studied. They underwent epilepsy surgery between 1994 and 2001 and had at least one year of follow up.

Non-epileptic seizures of the elderly.

Objective: To characterize non-epileptic seizures (NES) in the elderly and compare their features with NES of a younger control group.

Methods: The database of the epilepsy monitoring unit of the Cleveland Clinic Foundation (CCF) was searched for patients aged 60 years and older having undergone long-term video-/EEG monitoring between 1994 and 2002, with the subsequent diagnosis of NES. Videotapes of all events were evaluated by independent observers.

Seizure semiology in the elderly: a video analysis.

Purpose: To describe the seizure semiology of patients older than 60 years and to compare it with that of a control group of younger adults matched according to the epilepsy diagnosis.

Methods: Available videotapes of all patients aged 60 years and older who underwent long-term video-EEG evaluation at the Cleveland Clinic Foundation (CCF) between January 1994 and March 2002 were analyzed by two observers blinded to the clinical data. A younger adult control group was matched according to the epilepsy diagnosis, and their seizures also were analyzed.

Aphasia after hemispherectomy in an adult with early onset epilepsy and hemiplegia.

A 55 year old left handed man with left hemisphere subcortical encephalomalacia, seizures, language impairment, and right hemiparesis from a motor vehicle accident at age five was evaluated for epilepsy surgery. The patient continued to speak and followed commands during a left intracarotid amobarbital test (IAT). Left functional hemispherectomy resulted in expressive aphasia.

Comparison of Epworth Sleepiness Scale scores by patients with obstructive sleep apnea and their bed partners.

Objectives: In some patients with obstructive sleep apnea (OSA), Epworth Sleepiness Scale scores (ESS) do not reflect the severity of disease. In many cases, bed partners (BPs) report more severe hypersomnia on the part of the patient than the patient him/herself. The purpose of this study was to assess the agreement between patients and BPs on ESS scores and to compare patients and BPs on the correlation between ESS and the severity of OSA.

Prediction of the final MSLT result from the results of the first three naps.

Objectives: To determine if the mean sleep latency (mSL) and the presence of significant sleep onset rapid eye movement periods (SOREMPs) can be predicted from the results of the first three naps in selected patients undergoing multiple sleep latency test (MSLT).

Methods: Retrospective analysis of a number of MSLTs to identify the tests in which the mSL category and the presence of > or =2 naps with SOREMPS can be accurately predicted from the sleep latencies (SLs) of and SOREMPs in the first three naps.

Results: The study included 588 consecutive MSLTs performed on 552 patients during a 3-year period.

Sleep-related eating disorder in fraternal twins.

Sleep-related eating disorder (SRED) is characterized by nocturnal partial arousals associated with compulsive consumption of food and altered levels of consciousness. Reports of an increased incidence of SRED in relatives of affected individuals suggest a genetic predisposition. We report a woman with SRED whose fraternal twin sister and father are also affected.

Effect of sleep on epilepsy.

There is an extremely intimate relationship between sleep and epilepsy. In this manuscript I will review the influence that sleep has on epilepsy. Sleep is a potent activator of interictal epileptiform discharges.

Gabapentin increases slow-wave sleep in normal adults.

Purpose: The older antiepileptic drugs (AEDs) have a variety of effects on sleep, including marked reduction in rapid-eye-movement (REM) sleep, slow-wave sleep (SWS), and sleep latency, and an increase in light sleep. The effects of the newer AEDs on sleep are unknown. Our purpose was to study the effect of gabapentin (GBP) on sleep.

EEG and evoked potential recording from the subthalamic nucleus for deep brain stimulation of intractable epilepsy.

Objectives: The substantia nigra in the animal model has been implicated in the control of epilepsy. The substantia nigra pars reticulata (SNpr) receives afferents from the subthalamic nucleus (STN), which thus may have an effect on the control of epilepsy. There is evidence in the animal model of a direct connection from the cortex to the STN.

The effects of lamotrigine on sleep in patients with epilepsy.

Purpose: The older antiepileptic drugs (AEDs) have a variety of effects on sleep, including marked reduction in REM, slow-wave sleep (SWS) and sleep latency, and increased percentage of light sleep. The effects of the newer AEDs on sleep are unknown. Our purpose was to study the effect of lamotrigine (LTG) on sleep.

Complications of invasive video-EEG monitoring with subdural grid electrodes.

Objective: To evaluate the risk factors, type, and frequency of complications during video-EEG monitoring with subdural grid electrodes.

Methods: The authors retrospectively reviewed the records of all patients who underwent invasive monitoring with subdural grid electrodes (n = 198 monitoring sessions on 187 patients; median age: 24 years; range: 1 to 50 years) at the Cleveland Clinic Foundation from 1980 to 1997.

Results: From 1980 to 1997, the complication rate decreased (p = 0.

Deep brain stimulation in epilepsy.

Since the pioneering studies of Cooper et al. to influence epilepsy by cerebellar stimulation, numerous attempts have been made to reduce seizure frequency by stimulation of deep brain structures. Evidence from experimental animal studies suggests the existence of a nigral control of the epilepsy system.