Epilepsy research
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Valproic acid, which is widely used to treat various types of epilepsy, may cause severe hyperammonemia. However, the mechanism responsible for this side effect is not readily apparent. Polymorphisms in the genes encoding carbamoyl-phosphate synthase 1 (CPS1) and N-acetylglutamate synthase (NAGS) were recently reported to be risk factors for the development of hyperammonemia during valproic acid-based therapy. ⋯ We observed a significant difference between the combination of valproic acid with phenytoin and the development of hyperammonemia in both univariate and multivariate analyses. With regard to the CPS1 4217C>A polymorphism, we did not observe a significant association with the development of hyperammonemia. In conclusion, CPS1 4217C>A polymorphism may not be associated with the development of hyperammonemia in Japanese population.
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[(18)F] Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) is a semi-invasive, interictal method of localization of hypometabolic epileptic foci. FDG-PET can be useful in the clinical work-up prior to epilepsy surgery, especially in equivocal cases. We investigated whether we could increase the yield of presurgical FDG-PET in patients with difficult epilepsy requiring chronic subdural electrocorticography (ECoG). ⋯ Pre-surgical re-assessment of PET scans is worthwhile in epilepsy patients who undergo ECoG, especially when results were reported as negative before. Visual re-assessment itself has a higher combined specificity, sensitivity and accuracy than SPM analysis alone. SPM analysis could be used as a guide for visual (re-)assessment, because of its high sensitivity.
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To test if postoperative prolonged awake and sleep EEG monitoring predict long-term seizure outcome in patients operated for drug-resistant temporal lobe epilepsy due to hippocampal sclerosis (TLE-HS). ⋯ The presence of IED in serial postoperative EEG including sleep recording may predict long-term seizure outcome after ATL for TLE-HS. Serial postoperative EEGs may contribute to outcome prediction and help making decision about medication withdrawal in patients operated for TLE-HS.
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The purpose of the current study was to use diffusion tensor imaging (DTI) to conduct tractography of the optic radiations (OR) and its component bundles and to assess both the degree of hemispheric asymmetry and the inter-subject variability of Meyer's Loop (ML). We hypothesized that there are significant left versus right differences in the anterior extent of ML to the temporal pole (TP) in healthy subjects. ⋯ The results support our hypothesis and demonstrate that left ML-TP distances are significantly shorter than right ML-TP distances. These asymmetries are also reflected in shorter left distances between ML-TH and ML-UF. Moreover, these results are of interest to left-sided temporal lobe epilepsy surgery because it is not only more likely to disturb the anterior extent of ML but also renders the often closely located posterior aspect of the left UF more vulnerable to potential surgical impact.
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This study aimed to measure utilities, which are quantitative terms incorporating preferences, for various health states of epilepsy with partial seizure in the general population in South Korea. It also aimed to find socio-demographic characteristics associated with the utility scores. ⋯ The withdrawal state of epilepsy had the lowest utility value and the seizure-free state had the highest by all three techniques of utility measurement used. There were significant differences in utilities between one severity level of epilepsy and another. Utility was associated with household income and the severity of disease. Utility scores for distinct epilepsy states obtained in this study could facilitate health economic analyses of epilepsy treatments and thus help decision making in resource allocation.