Atypical herpes simplex encephalitis: clinical, virologic, and neuropathologic evaluation.

An atypical form of herpes simplex encephalitis produced by HSV-1 documented in the present article demonstrates that (1) prominent EEG abnormality may correlate with subtle increase in signal intensity on MRI; (2) the disease may start with prominent involvement of the cingulate gyri; and (3) viral infection of the brainstem may cause early onset of severe neurologic dysfunction and coma.

Placebo-controlled study of the efficacy and safety of lamotrigine in patients with partial seizures. U.S. Lamotrigine Protocol 0.5 Clinical Trial Group.

We evaluated the efficacy and safety of lamotrigine (300 and 500 mg/day) as add-on therapy in a multicenter, randomized, double-blind, parallel-group, placebo-controlled study of 216 patients with refractory partial seizures. During 6 months of treatment, median seizure frequency decreased by 8% with placebo, 20% with 300 mg lamotrigine, and 36% with 500 mg lamotrigine. Seizure frequency decreased by > or = 50% in one-third of the 500-mg group and one-fifth of the 300-mg group. Reductions in seizure frequency and seizure days were statistically significant, compared with placebo, for the 500-mg group but not the 300-mg group. Most adverse events were minor and resolved over time. Nine percent of patients on lamotrigine withdrew because of adverse experiences. Lamotrigine plasma concentrations appeared to be a linear function of dose, and the drug did not affect plasma concentrations of concomitant antiepileptic drugs. Lamotrigine was safe, effective, and well tolerated as add-on therapy for refractory partial seizures.

Pilot study of fluzinamide (N-methyl-3-[3-(trifluoromethyl)phenoxy]-1-azetidinecarboxamide) in refractory partial seizures.

We conducted a pilot study of fluzinamide in 15 adults with refractory partial seizures. After a baseline period, fluzinamide was added to the existing regimen of phenytoin and carbamazepine and increased to maximum tolerated dose. Common side effects included dizziness, diplopia, ataxia, headache, nausea, and rash, resulting in patient withdrawal in six cases. Seizures became less frequent in four of the nine patients who completed the 8-week trial.

Magnetoencephalographic spikes not detected by conventional electroencephalography.

OBJECTIVE: To investigate some of the reasons why magnetoencephalographic (MEG) spikes are at times not apparent in conventional electroencephalograms (EEG) when the data are co-registered, and to explore to what extent modern EEG analysis methods can improve the yield. METHODS: Seventy seconds of MEG-EEG co-registration on a 122 channel Neuromag system were studied in a 10-year-old boy with Landau-Kleffner syndrome. Twenty-six EEG channels were originally recorded with a left ear reference. The EEG data were subsequently reformatted (BESA) to a variety of montages for the 10-20 and 10-10 electrode array. A 10 s data epoch was compared in detail for concordance between MEG and EEG spikes. To detect the characteristics of hidden low voltage EEG spikes, MEG spikes were averaged and compared with the concomitant averaged EEG spike. RESULTS: While there was an abundance of EEG as well as MEG spikes on the left; definite right-sided spikes were not visible in the EEG. Right hemispheric MEG spikes were, however, plentiful with an average strength of 757 fT. When the individual MEG spikes from the right hemisphere were compared with the corresponding EEG events their amplitude ranged between 24 and 31 microV and were, therefore, indistinguishable from background activity. The majority of them became visible, however, with further sophisticated data analysis. CONCLUSIONS: When the relative merits of MEG versus EEG recordings for the detection of epileptogenic spike are investigated the 10-20 system of electrode placement and conventional methods of EEG analysis do not provide optimal data assessment. The use of the 10-10 electrode array combined with modern methods of digital data analysis can provide better concordance with MEG data.

Subarachnoid hemorrhage due to anterior spinal artery aneurysm.

This case report describes a 29-year-old man with subarachnoid hemorrhage due to an anterior spinal artery aneurysm. Surgical obliteration of the aneurysm was successful. This is the sixth reported case of an isolated symptomatic aneurysm of a spinal artery.

Expanded head surface EEG electrode array: an application to display the voltage topography of focal epileptiform discharges of mesiotemporal origin.

Aided by computerized voltage topographic display, conventional time-series EEG display methods were expanded. Representations of both negative and positive ends of an equivalent current dipole can be localized in EEG sampled over the head surface. Intuitive EEG analysis can be applied to source localization in three dimensions of scalp focal epileptiform discharges.

Incidence of spikes and paroxysmal rhythmic events in overnight ambulatory computer-assisted EEGs of normal subjects: a multicenter study.

The incidences of spikes and paroxysmal rhythmic events (PREs) in 10-h overnight EEGs of normal adult volunteers (n=135) were studied at 11 sites with a computer-assisted ambulatory EEG monitoring system with automatic spike and PRE detection. Spikes were evident in the overnight EEG of 1 subject (0.7%), and PREs were apparent in the overnight EEG of the same subject (0.7%). The incidences of spikes of 24 other subjects with a history of migraine and/or a family history of epilepsy were 12.5 and 13.3%, respectively. The overnight EEGs of these subjects were significantly more likely to show spikes than the overnight EEGs of subjects without migraine or a family history of epilepsy.

Evaluation of multiple doses of milacemide in the treatment of senile dementia of the Alzheimer's type.

A multicenter, double-blind, placebo-controlled, parallel group study was conducted to assess the safety and efficacy of three doses of milacemide in the treatment of patients with senile dementia of the Alzheimer type of mild to moderate severity. Patients were randomly assigned to receive one of three dosages of milacemide (400, 800, or 1200 mg/day) or placebo for 4 weeks followed by a single-blind 4-week placebo period. One hundred forty-eight men and women older than 50 years of age were enrolled, and 129 patients completed the study. The differences among treatment groups were not statistically different with respect to total scores on the Alzheimer's Disease Assessment Scale or any items and subscales that were examined, nor were significant differences on the Clinical Global Impression Scale found. Clinically significant increases in liver function tests, specifically aspartate aminotransferase and alanine aminotransferase (AST and ALT), were reported for five of the patients receiving milacemide, requiring their withdrawal from the study.

Further observations on carbendazim-induced abnormalities of spermatid morphology in rats.

The effects of a microtubule poison, carbendazim, on rat spermiogenesis were examined for abnormalities of nuclei, acrosome and manchette in round and elongating spermatids in Stages VII-XII on days 7.5, 9.5, 10.0 and 10.5 post-treatment using routine electron microscopy. Spermatid nuclear abnormalities were observed in Stages IX-XI on day 9.5 and at greater post-treatment intervals. Nuclear abnormalities included nuclear distortions, various types of nuclear invaginations and abnormal positioning of the modified nuclear envelope. Acrosomal abnormalities were noted on day 7.5 and at greater intervals. Discontinuous, multiple granular and fragmentary acrosomes were observed in Stages VII-XI. In addition, spermatids with complete absence of acrosome (acrosome-deficient spermatids) were observed in Stages VII-X. Poorly-formed and absent ectoplasmic specializations were seen in the cytoplasm of Sertoli cells next to the acrosome-deficient spermatids. A major abnormality of the manchette was irregular positioning of the manchette microtubules in steps 9-11 spermatids on day 9.5 and at greater intervals, which resulted in nuclear invagination. The results indicate that carbendazim induces abnormalities in spermatid morphology that are common to those reported in testes treated with several chemical compounds and in testes of mutant animals.

The fungicide carbendazim induces meiotic micronuclei in the spermatids of the rat testis.

Whether the fungicide carbendazim affects the meiotic spermatocytes and consequently induces chromosome aberrations in the spermatids was determined in the adult rat testis using the micronucleus test. Round spermatids containing micronuclei (MN) were significantly increased in number at stages I and V on days 1 and 4.5 after treatment with carbendazim (100 mg/kg), respectively (p<0.05). Immunocytochemistry indicated that approximately 68% of the carbendazim-induced MN contained kinetochores. These results suggest that carbendazim induces chromosome aberrations in spermatids with a high incidence of aneuploidy.

Effectiveness of an acellular pertussis vaccine in Japanese children during a non-epidemic period: a matched case-control study.

The number of pertussis cases in Japan has decreased dramatically following the nationwide use of an acellular pertussis vaccine combined with diphtheria-tetanus toxoids (DTaP vaccines) which began in 1981. However, the effectiveness of the DTaP vaccine has not been systematically evaluated using appropriate epidemiological methods during a non-epidemic period in Japan. We evaluated the vaccine effectiveness (VE) of the Kaketsuken DTaP vaccine which contains two-component pertussis antigens in Japanese children from 1999 to 2001 using a matched case-control design and data from the Basic Resident Registration and Maternal and Child Health Handbooks. The DTaP vaccination history of 15 children with pertussis and 59 controls was obtained. The VE of 3 or 4 pertussis vaccinations compared with non-vaccination (baseline) was 96.9% for coughing attacks that lasted 7 days, 96.4% for those lasting 14 days, and 95.9% for those lasting 21 days. These findings suggest that DTaP vaccination effectively prevented pertussis during a non-epidemic period in Japan.

Recognition of REM sleep in standard EEG.

A practical method to identify REM sleep in a standard EEG utilizing International 10-20 electrode placements is described. Ordinarily, occurrence of REM sleep in a standard EEG indicates an abnormal sleep pattern and warrants further evaluation of sleep disorders.

Lamotrigine.

Clinical use of the antiepileptic drug (AED) lamotrigine (LTG) has dramatically increased since its introduction in Europe in 1991 and in the United States in 1994. This article surveys the English-language literature of LTG published before 1998. This literature is concerned with the molecular mechanisms of LTG's antiepileptic action, evaluation of its clinical antiepileptic efficacy, adverse experiences associated with its clinical use, and current guidelines for its initiation. LTG's efficacy has been extensively confirmed in multiple postmarketing studies, and its applications are broad. The most serious adverse experiences have involved skin rash. Valproic acid affects LTG metabolism, and a specific set of guidelines for the concurrent use of valproic acid and LTG has been developed. Unique issues are also associated with its pediatric use. LTG has a significant place in clinical management of a wide range of epilepsy syndromes, and the scope of its use is expanding. Accumulating clinical data enable the clinician to maximize its efficacy and minimize adverse experiences. Guidelines for its pediatric use must be followed diligently.

Partial epileptic seizures beginning in the truncal muscles.

3 patients suffered from partial epileptic seizures beginning in truncal muscles on one side. A gross anatomical lesion was demonstrated in the contralateral parietal area in 2. In the third patient, both interictal and ictal EEG features were consistent with an epileptogenic lesion in the similar location. Several factors seem to contribute to the rarity of this variety of partial seizures.