'Benign focal epilepsy in infancy with vertex spikes and waves during sleep'. Delineation of the syndrome and recalling as 'benign infantile focal epilepsy with midline spikes and waves during sleep' (BIMSE).

Purpose: To better delineate the electroclinical features of infants who presented with focal seizures and typical midline sleep EEG abnormalities with a benign outcome. We discuss the significance of the typical EEG marker in non-epileptic patients.

Methods: Patients were selected from a group of epileptic subjects with seizure onset less than 3 years we observed from 1st November 1990 and 31st December 2003.

[Polymorphism of electroencephalographic pattern in benign epileptiform discharges in childhood].

Incidence and significance of benign epileptiform discharges of childhood (BECD), or rolandic spikes, have been studied in 2723 children, aged 2-15 years, with (841 patients) and without (1882) epilepsy. All the patients underwent standard electroencephalographic (EEG) study with video-EEG monitoring made in cases of epileptiform abnormalities. In the non-epileptic group, BECD frequency was 1.

[Diagnosis of epilepsy].

0.5-1% of the population suffers from epilepsy, while another 5% undergoes diagnostic evaluations due to the possibility of epilepsy. In the case of suspected epileptic seizures we face the following questions: Is it an epileptic seizure? The main and most frequent differential-diagnostic problems are the psychogenic non-epileptic seizures ("pseudo-seizures") and the convulsive syncope, which is often caused by heart disorders.

Are there physical risk factors for psychogenic non-epileptic seizures in patients with epilepsy?

Unlabelled: Patients with epilepsy may have additional psychogenic non-epileptic seizures (PNES). It has been suggested that PNES are more common if patients with epilepsy are female, develop epilepsy later in life and have right-sided brain lesions. We examine whether these or other physical factors affect the risk of PNES in patients with epilepsy in a controlled study.

Value of the early electroencephalogram after a first unprovoked seizure.

Studies on the predictive value of the electroencephalogram (EEG) concerning the risk of seizure recurrence have shown contradictory results. We prospectively studied the predictive value of the standard EEG and EEG with sleep deprivation for seizure relapse in adult patients presenting with a first unprovoked seizure. EEGs were performed on 157 adult patients within the first 48 hours of the first seizure.

Pearls, perils, and pitfalls in the use of the electroencephalogram.

Despite advances in neuroimaging techniques over the past three decades that have helped in identifying structural lesions of the central nervous system, electroencephalography (EEG) continues to provide valuable insight into brain function by demonstrating focal or diffuse background abnormalities and epileptiform abnormalities. It is an extremely valuable test in patients suspected of epilepsy and in patients with altered mental status and coma. Patterns in the EEG make it possible to clarify the seizure type; it is indispensable for the diagnosis of nonconvulsive status epilepticus and for separating epileptic from other paroxysmal (nonepileptic) episodes.

Neurophysiology of Rett syndrome.

Neurophysiological evaluations have been widely applied in the study of Rett syndrome (RS) to provide information concerning the developmental aspects of RS; the character and extent of involvement of the central, peripheral, and autonomic nervous system pathways; and evaluation of the clinical symptomatology of RS. The electroencephalogram (EEG) is invariably abnormal and shows characteristic, though not diagnostic, changes: loss of expected developmental features; the appearance of focal, multifocal, and generalized epileptiform abnormalities; and the occurrence of rhythmic slow (theta) activity primarily in the frontal-central regions. Epileptic seizures are reported to occur frequently in RS, and partial and generalized seizures may be experienced by RS girls.

Epileptic and non-epileptic cerebral palsy: EEG and cranial imaging findings.

The aims of the study were to compare the clinical types, electroencephalogram (EEG) and cranial magnetic resonance imaging/computed tomography findings of epileptic and non-epileptic cerebral palsy (CP) patients. Seventy-four patients with CP were evaluated in 2 years. Tetraplegic CP had a higher incidence of epilepsy (60.

An audit of ambulatory cassette EEG monitoring in children.

This audit evaluated the role and usefulness of ambulatory cassette EEG recordings without simultaneous video monitoring in children with paroxysmal episodes including epilepsy. Fifty-four children underwent ambulatory EEG recordings for 48 hours over a 12 month period. Only 31 of the 54 children experienced one of their typical clinical episodes during their recordings.

Nondominant hemisphere lesions and conversion nonepileptic seizures.

To explore the hypothesis that lateralized hemispheric dysfunction may contribute to the development of conversion symptoms, the authors studied frequency of unilateral cerebral physiological or structural abnormalities in 79 consecutive patients with conversion nonepileptic seizures (C-NES), who were also compared with two groups of epilepsy patients without C-NES. Sixty (76%) of the C-NES patients had unilateral cerebral abnormalities on neuroimaging, of which 85% were structural. Ictal or interictal epileptiform abnormalities on EEG were found in 78% of C-NES patients and focal slowing in another 10%.

Stimulant therapy and seizure risk in children with ADHD.

Stimulants are an effective treatment frequently prescribed for attention-deficit-hyperactivity disorder (ADHD), but they commonly are believed to lower the threshold for seizures. Although several studies have revealed that stimulants do not exacerbate well-controlled epilepsy, there is a paucity of data about seizure risk in nonepileptic children treated with stimulants. Two hundred thirty-four children (179 males, 9.

Brain plasticity and cellular mechanisms of epileptogenesis in human and experimental cortical dysplasia.

Purpose: The cellular mechanisms that may contribute to epilepsy in resected human cortical dysplasia (CD) were compared with the in utero radiated rat CD model. In human and rat focal hippocampal epilepsy, postsynaptic N-methyl-D-aspartate receptors are up-regulated and presynaptic axon collaterals hyperinnervate them. We hypothesized that in both human and rat CD: (a) the N-methyl-D-aspartate receptor subunits NR1 and NR2A/B would be increased and coassembled, and (b) aberrant axons would be in regions of CD.

Multimodality imaging for improved detection of epileptogenic foci in tuberous sclerosis complex.

Objective: Using interictal alpha-[11C]methyl-l-tryptophan ([11C]AMT) PET scan, the authors have undertaken a quantitative analysis of all tubers visible on MRI or 2-deoxy-2-[18F]fluoro-d-glucose ([18F]FDG) PET, to determine the relationship between [11C]AMT uptake and epileptic activity on EEG.

Background: Tuberous sclerosis complex (TSC) is an autosomal dominant disorder, often associated with cortical tubers and intractable epilepsy. The authors have shown previously that [11C]AMT PET scans show high tracer uptake in some epileptogenic tubers and low uptake in the remaining tubers.

NMDA-receptors 1 and 2A/B coassembly increased in human epileptic focal cortical dysplasia.

Purpose: This study was designed to quantify the relation between expressions of NMDA receptor (NMDAR) subunits (1 and 2A/B) and the epileptogenicity in human focal cortical dysplasia.

Methods: Immunoblotting and immunoprecipitation were used to quantify these receptor subunits in tissue resected from EEG-verified epileptic and distal nonepileptic frontal cortical areas in each of three patients as determined by chronic subdural electrode recordings. In each patient, adjacent sections were immunostained to verify that the numbers of dysplastic neurons were greater in epileptic than in nonepileptic cortex.

Alumina gel injections into the temporal lobe of rhesus monkeys cause complex partial seizures and morphological changes found in human temporal lobe epilepsy.

The goal of the present study was to determine whether alumina gel injections into temporal lobe structures cause complex partial seizures (CPS) and pathological changes observed in human temporal lobe epilepsy. Rhesus monkeys with alumina gel injections in the amygdala, perirhinal and entorhinal cortices, or Ammon's horn and dentate gyrus all initially displayed focal pathological electroencephalographic (EEG) slowing limited to the site of injection. After clinical seizures developed, they also displayed widespread pathological EEG slowing over both hemispheres, interictal and ictal epileptiform EEG abnormalities limited to the mesial-inferior temporal lobe on the side of injection, and different degrees of spread to other ipsilateral and contralateral structures.

The fundamental neural mechanisms of electroencephalography.

We are at an interesting time in the evolution of the EEG. Studies are opening the door to understanding the intrinsic neuronal properties and network operations responsible for the generation of EEG oscillations. I will review some of our knowledge regarding the physiology of the normal and abnormal EEG.

The benign occipital epilepsies of childhood: an overview of the idiopathic syndromes and of the relationship to migraine.

Benign occipital epilepsy of childhood is an idiopathic partial epilepsy syndrome with elementary visual symptomatology, frequently associated with other ictal phenomena. Seizures are usually followed by postictal headache and are often associated with interictal occipital rhythmic paroxysmal EEG activity that appears only after eye closure. In some children the ictal visual symptoms or the interictal EEG abnormalities may not be demonstrated.

Sleep and the epilepsies.

To review the numerous works concerning sleep and epilepsy, this review considers the effects of sleep, firstly on seizures and secondly on paroxysmal interictal EEG activity (PA), in the different types of epilepsy according to the International League against Epilepsy classification. Apart from the exceptions of the definite nocturnal preponderance of seizures in idiopathic rolandic epilepsy and of the mostly nocturnal occurrence of seizures in some types of familial or sporadic frontal-lobe epilepsy, assessing a seizure according to the time of day it occurs is of no diagnostic or predictive value. In generalised idiopathic epilepsy, as in partial symptomatic or cryptogenic epilepsy, only about 20% of the patients had a sleep increase in PA.

Response of human epileptic temporal lobe cortical blood flow to hyperventilation.

Bilateral long-term surface cortical cerebral blood flow (CBF) and electrocorticographic (ECoG) monitoring were performed in eight patients with complex partial seizures. In each patient, the epileptic temporal lobe was localized using ictal ECoG. Mean seizure interval (frequency-1) off anticonvulsant medication, a clinical measure of epileptogenicity, was 1.

[Risk of development of epileptic seizures in children with subclinical "epileptogenic" EEG abnormalities].

Sixty-six non-epileptic children with focal spikes in EEG and without cerebral palsy were followed for 16 to 35 years. The cumulative risk of developing one or more seizures was 33% when the first abnormal EEG was recorded, and increased to about 80% if abnormalities persisted three or more years. Focal spike activity was most persistent in children with retarded development or with organic brain diseases.

Focal electroencephalographic abnormalities and computerised tomography findings in children with seizures.

A persistent focal abnormality was observed in 157 (16%) electroencephalograms undertaken in 964 consecutive children with epileptic and non-epileptic seizures seen over one year. CT head scans were performed in 121 (77%) of the 157 children with a focus on the EEG; 26 (21%) showed an abnormality, and 21 (81%) of the abnormalities were localised. There was no difference in the proportion of abnormal scans associated with a delta or slow wave focus compared with a spike or sharp wave focus.

Intracerebral recordings: organization of the human epileptogenic region.

Intracranial recordings from patients with medically refractory partial epilepsy have demonstrated that the concept of a discrete epileptic focus, as derived from experiments with animals, does not exist in this human condition. Furthermore, an EEG spike focus, as defined by electroencephalographers, does not faithfully identify the site of ictal onset. Rather, the boundaries of an epileptogenic region, which is necessary and sufficient for generation of habitual spontaneous seizures, must be approximated by knowledge of the spatial distribution of interictal spike discharges, and ictal onset, as well as the location of an epileptogenic lesion demonstrated by structural imaging, and the location and extent of nonepileptic focal functional deficits.

[Sleep and epilepsy].

The frequency of epileptiform discharges shows a wide intraindividual variability; it is influenced by the sleep-waking cycle and by the different stages of sleep: generalized seizures (tonic-clonic, tonic and myoclonic) are activated in nonrapid eye movement sleep, partial seizures tend to have more complex relationships with sleep states. Generally, sleep stages I and II and transit stages have an activating effect on discharges. Rapid eye movement sleep has an "anticonvulsive" effect and focalizes paroxysmal activity.

[Clinical value of electroencephalographic monitoring in closed-circuit television (EEG-video). Analysis of 44 studies].

Video-EEG is a wellknown method for diagnostic evaluation of paroxysmal clinical events, providing the physician with a close correlation between clinical signs and electroencephalographic abnormalities. It has been widely used in the diagnosis of the different forms of epilepsy. It has proved to be useful in separating epileptic from nonepileptic crisis, in the characterization of the seizure type and frequently in the localization of the seizure onset.

Benign partial epilepsy and related conditions: multifactorial pathogenesis with hereditary impairment of brain maturation.

The main clinical and bioelectrical features of the benign partial epilepsies and related conditions are described. Based on highly selected groups, the definition of these suggested syndromes disregards the considerable overlap between borderline and intermediate cases. To understand the great phenotypic variability of these epilepsies, the complexity of causal especially genetic factors must be considered.