Proposal: different types of alteration and loss of consciousness in epilepsy.

There are at least five types of alterations of consciousness that occur during epileptic seizures: auras with illusions or hallucinations, dyscognitive seizures, epileptic delirium, dialeptic seizures, and epileptic coma. Each of these types of alterations of consciousness has a specific semiology and a distinct pathophysiologic mechanism. In this proposal we emphasize the need to clearly define each of these alterations/loss of consciousness and to apply this terminology in semiologic descriptions and classifications of epileptic seizures.

Noninvasive correlates of subdural grid electrographic outcome.

Purpose: To investigate reasons for patients not proceeding to resective epilepsy surgery after subdural grid evaluation (SDE). To correlate noninvasive investigation results with invasive EEG observations in a set of patients with nonlesional brain MRIs.

Methods: Retrospective study of adult epilepsy patients undergoing SDE during an 8-year period at Cleveland Clinic.

Phenobarbital withdrawal seizures may occur over several weeks before remitting: human data and hypothetical mechanism.

This case is the first report of a patient who had phenobarbital (PB) withdrawal seizures after having been seizure-free for 3 years following temporal lobe surgery. The patient had been taking PB for 14 years when a gradual taper of PB was started. When PB was at 60 mg/d, a titration of lamotrigine (LTG) was started.

Complications during the Wada test.

Objective: The intracarotid amobarbital procedure (IAP) is routinely used in the preoperative workup of patients with epilepsy. We previously reported dissections and seizures as complications of this procedure and now have reviewed our cohort for additional complications associated with the IAP.

Methods: Charts of 677 consecutive patients were reviewed for complications during the IAP.

Repeated intracarotid amobarbital tests.

Rationale: Our goal was to determine the frequency of repeated intracarotid amobarbital test (IAT) at our center and to estimate the retest reliability of the IAT for both language and memory lateralization.

Methods: A total of 1,249 consecutive IATs on 1,190 patients were retrospectively reviewed for repeat tests.

Results: In 4% of patients the IAT was repeated in order to deliver satisfactory information on either language or memory lateralization.

Evaluating the contributions of state-of-the-art assessment techniques to predicting memory outcome after unilateral anterior temporal lobectomy.

Purpose: Although anterior temporal lobectomy (ATL) is an effective treatment for many patients with medically refractory temporal lobe epilepsy (TLE), one risk associated with this procedure is postsurgical decline in memory. A substantial number of past studies examined factors that predict memory decline after surgery, but few have investigated multiple predictors simultaneously or considered measures that are currently in use.

Methods: This study compared the relative contributions made by presurgical neuropsychological test scores, MRI-based hippocampal volumetric analysis, and Wada test results to predicting memory outcome after ATL in a group of 87 patients.

Seizures during intracarotid methohexital and amobarbital testing.

Background: Methohexital and amobarbital have been used as agents for Wada testing in the presurgical evaluation of patients with epilepsy. Previous experience with methohexital as an anesthetic indicates that methohexital may decrease seizure threshold and may trigger seizures.

Methods: A retrospective chart review of 760 intracarotid amobarbital and methohexital tests was performed to determine the frequency of seizures associated with preoperative intracarotid barbiturate testing for language and memory lateralization.

Intracranial lipomas and epilepsy.

Introduction: Intracranial lipomas are rare, mostly congenital lesions. Sporadic case reports suggest an association with focal epilepsy.

Methods: All admissions to our epilepsy monitoring unit who had had brain MRI were reviewed for intracranial lipomas during 6 consecutive years.

Coexistence of focal and idiopathic generalized epilepsy in the same patient population.

Purpose: To review the clinical, electrographic, radiological, and pathological findings of patients with coexistent idiopathic generalized and partial epilepsy syndromes.

Methods: We performed a medical record review and a phone interview with all patients hospitalized to the Cleveland Clinic epilepsy monitoring unit (EMU) between 1992 and 2002 who fulfilled clinical and EEG criteria of coexistent partial and generalized epilepsy syndromes.

Results: Seven patients were identified.

Optimizing outcomes in pregnant women with epilepsy.

Women with epilepsy are more likely to have maternal and fetal complications during pregnancy. Risks can be minimized with preconception planning, careful obstetric care, and close postpartum follow-up.

Now we lay them down to sleep: ethical issues with the use of pharmacologic coma for adult status epilepticus.

The use of pharmacologic coma (PC) to treat status epilepticus (SE) is not always successful, and there are no guidelines for the duration of PC in an attempt to achieve seizure control. Using clinical cases, we explore three concepts: (1) SE as a terminal condition; (2) PC resulting in permanent unconsciousness; and (3) use of PC for extended periods. Regarding a patient's Advance Directive/Living Will, these three concepts can pose ethical complexities for the medical team due to the notions of unconsciousness, cognitive appreciation, and life support being relevant to both PC therapy as well as these documents.

The effect of total hip arthroplasty surgical approach on gait.

This study examined the effect of the surgical approach used in total hip arthroplasty (THA) on gait mechanics six months following surgery. Quantitative gait analysis was performed on 29 subjects: 10 anterolateral (A-L) and 10 posterolateral (P-L) THA patients and nine able-bodied, velocity-matched subjects. Discriminant function analysis was used to determine the distinction of the groups with respect to sagittal plane hip range of motion, index of symmetry, trunk inclination, pelvic drop, hip abduction, and foot progression angles.

Tolerability and pharmacokinetics of oral loading with lamotrigine in epilepsy monitoring units.

Purpose: To investigate the tolerability and pharmacokinetics of oral loading with lamotrigine (LTG) among epilepsy patients after temporary drug discontinuation in an epilepsy monitoring unit.

Methods: We conducted a pilot study among epilepsy patients (18 years or older) receiving maintenance doses of LTG. LTG was discontinued on admission and restarted at the end of epilepsy monitoring.

Carotid artery dissection after the intracarotid amobarbital test.

A retrospective chart review of 435 consecutive intracarotid amobarbital tests (IAT) was performed to determine the frequency of carotid artery dissection (CAD) associated with IAT. Three patients with a CAD were found (0.7%).

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.