Orrin Devinsky, M.D.

Volume of the human septal forebrain region is a predictor of source memory accuracy
Butler, Tracy; Blackmon, Karen; Zaborszky, Laszlo; Wang, Xiuyuan; Dubois, Jonathan; Carlson, Chad; Barr, William B; French, Jacqueline; Devinsky, Orrin; Kuzniecky, Ruben; Halgren, Eric; Thesen, Thomas
2012 Jan;18(1):157-161, Journal of the International Neuropsychological Society
Septal nuclei, components of basal forebrain, are strongly and reciprocally connected with hippocampus, and have been shown in animals to play a critical role in memory. In humans, the septal forebrain has received little attention. To examine the role of human septal forebrain in memory, we acquired high-resolution magnetic resonance imaging scans from 25 healthy subjects and calculated septal forebrain volume using recently developed probabilistic cytoarchitectonic maps. We indexed memory with the California Verbal Learning Test-II. Linear regression showed that bilateral septal forebrain volume was a significant positive predictor of recognition memory accuracy. More specifically, larger septal forebrain volume was associated with the ability to recall item source/context accuracy. Results indicate specific involvement of septal forebrain in human source memory, and recall the need for additional research into the role of septal nuclei in memory and other impairments associated with human diseases. (JINS, 2012, 18, 157-161)
— id: 147692, year: 2012, vol: 18, page: 157, stat: Journal Article,

Epilepsy control following intracranial monitoring without resection in young children
Roth J; Olasunkanmi A; Ma TS; Carlson C; Devinsky O; Harter DH; Weiner HL
2012 Feb;53(2):334-41 L, Epilepsia
Purpose: Intracranial monitoring (IM) is a key diagnostic procedure for select patients with treatment-resistant epilepsy (TRE). Seizure focus resection may improve seizure control in both lesional and nonlesional TRE. IM itself is not considered to have therapeutic potential. We describe a cohort of patients with improved seizure control following IM without resective surgery. Methods: Over 12.5 years, 161 children underwent 496 surgeries including intracranial monitoring. We retrospectively reviewed the patients' charts, operative reports, and radiologic scans, under an institutional review board-approved protocol. Key Findings: Seventeen patients underwent only IM, without additional resective surgery, and seven had a dramatic improvement in their epilepsy; six of the seven patients are seizure-free (Engel class I), and one rarely has seizures (Engel class II). All seven patients had frequent seizures that led to IM: either daily (five patients) or 1-2 per week (two patients). The mean age (+/- standard deviation, SD) at seizure onset was 1.6 +/- 1.3 years (range 0.5-4 years). Etiologies were tuberous sclerosis (3 patients), trauma (1 patient), and unknown (3 patients). Mean age at surgery (+/- SD) was 4.1 +/- 2 years (range 1-7 years), and duration of epilepsy 2.5 +/- 1.1 years (range 0.5-4 years). Duration of IM was 11.7 +/- 5.6 days (5-19 days). Six patients had bilateral and one unilateral invasive electrodes. At last follow-up, four patients required fewer antiepileptic drugs (AEDs), one had the same medication but a higher dose, and two patients were taking additional AEDs. Follow-up was 30.6 +/- 9.5 months (range 19-41 months). Significance: Although uncommon, patients with TRE may improve after IM alone. The explanation for this observation remains unclear; however, perioperative medications including steroids, direct cortical manipulation, or other factors may influence the epileptogenic network
— id: 149914, year: 2012, vol: 53, page: 334, stat: Journal Article,

Structural evidence for involvement of a left amygdala-orbitofrontal network in subclinical anxiety
Blackmon K; Barr WB; Carlson C; Devinsky O; Dubois J; Pogash D; Quinn BT; Kuzniecky R; Halgren E; Thesen T
2011 Dec 30;194(3):296-303, Psychiatry research
Functional neuroimaging implicates hyperactivity of amygdala-orbitofrontal circuitry as a common neurobiological mechanism underlying the development of anxiety. Less is known about anxiety-related structural differences in this network. In this study, a sample of healthy adults with no history of anxiety disorders completed a 3T MRI scan and self-report mood inventories. Post-processing quantitative MRI image analysis included segmentation and volume estimation of subcortical structures, which were regressed on anxiety inventory scores, with depression scores used to establish discriminant validity. We then used a quantitative vertex-based post-processing method to correlate (1) anxiety scores and (2) left amygdala volumes with cortical thickness across the whole cortical mantle. Left amygdala volumes predicted anxiety, with decreased amygdala volume associated with higher anxiety on both state and trait anxiety measures. A negative correlation between left amygdala volume and cortical thickness overlapped with a positive correlation between anxiety and cortical thickness in left lateral orbitofrontal cortex. These results suggest a structural anxiety network that corresponds with a large body of evidence from functional neuroimaging. Such findings raise the possibility that structural abnormalities may result in a greater vulnerability to anxiety or conversely that elevated anxiety symptoms may result in focal structural changes
— id: 139495, year: 2011, vol: 194, page: 296, stat: Journal Article,

Structural evidence for involvement of a left amygdala-orbitofrontal network in subclinical anxiety
Blackmon, Karen; Barr, William B.; Carlson, Chad; Devinsky, Orrin; DuBois, Jonathan; Pogash, Daniel; Quinn, Brian T.; Kuzniecky, Ruben; Halgren, Eric; Thesen, Thomas (thomas.thesen@med.nyu.edu)
2011 DEC 30 ;194(3):296-303, Psychiatry Research Neuroimaging
Functional neuroimaging implicates hyperactivity of amygdala-orbitofrontal circuitry as a common neurobiological mechanism underlying the development of anxiety. Less is known about anxiety-related structural differences in this network. In this study, a sample of healthy adults with no history of anxiety disorders completed a 3T MRI scan and self-report mood inventories. Post-processing quantitative MRI image analysis included segmentation and volume estimation of subcortical structures, which were regressed on anxiety inventory scores, with depression scores used to establish discriminant validity. We then used a quantitative vertex-based post-processing method to correlate (1) anxiety scores and (2) left amygdala volumes with cortical thickness across the whole cortical mantle. Left amygdala volumes predicted anxiety, with decreased amygdala volume associated with higher anxiety on both state and trait anxiety measures. A negative correlation between left amygdala volume and cortical thickness overlapped with a positive correlation between anxiety and cortical thickness in left lateral orbitofrontal cortex. These results suggest a structural anxiety network that corresponds with a large body of evidence from functional neuroimaging. Such findings raise the possibility that structural abnormalities may result in a greater vulnerability to anxiety or conversely that elevated anxiety symptoms may result in focal structural changes. (C) 2011 Elsevier Ireland Ltd. All rights reserved. C1 Thesen, Thomas; NYU, Dept Neurol, Comprehens Epilepsy Ctr, 223 E 34th St, New York, NY 10016 USA
— id: 150857, year: 2011, vol: 194, page: 296, stat: Journal Article,

Individual differences in verbal abilities associated with regional blurring of the left gray and white matter boundary
Blackmon, Karen; Halgren, Eric; Barr, William B; Carlson, Chad; Devinsky, Orrin; Dubois, Jonathan; Quinn, Brian T; French, Jacqueline; Kuzniecky, Ruben; Thesen, Thomas
2011 Oct 26;31(43):15257-15263, Journal of neuroscience
Blurring of the cortical gray and white matter border on MRI is associated with normal aging, pathological aging, and the presence of focal cortical dysplasia. However, it remains unclear whether normal variations in signal intensity contrast at the gray and white matter junction reflect the functional integrity of subjacent tissue. This study explores the relationship between verbal abilities and gray and white matter contrast (GWC) in healthy human adults. Participants were scanned at 3 T MRI and administered standardized measures of verbal expression and verbal working memory. GWC was estimated by calculating the non-normalized T1 image intensity contrast above and below the cortical gray/white matter interface. Spherical averaging and whole-brain correlational analyses were performed. Sulcal regions exhibited higher contrast compared to gyral regions. We found a strongly lateralized and regionally specific profile with reduced verbal expression abilities associated with blurring in left hemisphere inferior frontal cortex and temporal pole. Reduced verbal working memory was associated with blurring in widespread left frontal and temporal cortices. Such lateralized and focal results provide support for GWC as a measure of regional functional integrity and highlight its potential role in probing the neuroanatomical substrates of cognition in healthy and diseased populations
— id: 139752, year: 2011, vol: 31, page: 15257, stat: Journal Article,

Cortical thickness abnormalities associated with depressive symptoms in temporal lobe epilepsy
Butler T; Blackmon K; McDonald CR; Carlson C; Barr WB; Devinsky O; Kuzniecky R; Dubois J; French J; Halgren E; Thesen T
2011 Jan;23(1):64-67, Epilepsy & behavior
Depression in patients with temporal lobe epilepsy (TLE) is highly prevalent and carries significant morbidity and mortality. Its neural basis is poorly understood. We used quantitative, surface-based MRI analysis to correlate brain morphometry with severity of depressive symptoms in 38 patients with TLE and 45 controls. Increasing severity of depressive symptoms was associated with orbitofrontal cortex (OFC) thinning in controls, but with OFC thickening in TLE patients. These results demonstrate distinct neuroanatomical substrates for depression with and without TLE, and suggest a unique role for OFC, a limbic region for emotional processing strongly interconnected with medial temporal structures, in TLE-related depressive symptoms
— id: 141935, year: 2011, vol: 23, page: 64, stat: Journal Article,

Imaging Inflammation in a Patient with Epilepsy Due to Focal Cortical Dysplasia
Butler T; Ichise M; Teich AF; Gerard E; Osborne J; French J; Devinsky O; Kuzniecky R; Gilliam F; Pervez F; Provenzano F; Goldsmith S; Vallabhajosula S; Stern E; Silbersweig D
2011 Jan 11;:?-?, Journal of neuroimaging
BACKGROUND AND PURPOSE: Evidence from animal models and examination of human epilepsy surgery specimens indicates that inflammation plays an important role in epilepsy. Positron emission tomography (PET) using [C11]PK11195, a marker of activated microglia, provides a means to visualize neuroinflammation in vivo in humans. We hypothesize that in patients with active epilepsy, [C11]PK11195 PET (PK-PET) may be able to identify areas of focally increased inflammation corresponding to the seizure onset zone. METHODS: A young woman with intractable epilepsy underwent PK-PET as part of an approved research study. PK-PET results were compared with results from other clinical studies. RESULTS: PK-PET revealed an area of focally increased radiotracer uptake in the right frontal lobe corresponding to this patient's seizure focus as identified by ictal and interictal 18F-fluorodeoxyglucose (FDG)-PET and EEG. Routine brain magnetic resonance imaging (MRI) was initially considered normal, though high-resolution studies showed possible subtle dysplasia of the right frontal lobe. The patient underwent a right frontal lobe resection, and pathological evaluation showed focal cortical dysplasia with activated microglia. CONCLUSIONS: PK-PET can identify neuroinflammation associated with subtle focal cortical dysplasia, and may therefore have a clinical role in guiding epilepsy surgery for patients with difficult-to-localize seizure foci. J Neuroimaging 2011;XX:1-3
— id: 120738, year: 2011, vol: , page: ?, stat: Journal Article,

Bilateral invasive electroencephalography in patients with tuberous sclerosis complex: a path to surgery?
Carlson, Chad; Teutonico, Federica; Elliott, Robert E; Moshel, Yaron A; LaJoie, Josiane; Miles, Daniel; Devinsky, Orrin; Weiner, Howard L
2011 Apr;7(4):421-430, Journal of Neurosurgery: Pediatrics
OBJECT: Many children with epilepsy and tuberous sclerosis complex (TSC) have multiple tubers on MR imaging and poorly localized/lateralized video electroencephalography (EEG) findings. Given the long-term risks associated with frequent seizures and multiple antiepileptic drugs, along with improved success in identifying focal epileptogenic zones in patients with multifocal lesions, the authors used bilateral intracranial EEG to lateralize the epileptogenic zone in patients with nonlateralizable noninvasive preoperative evaluations. METHODS: A retrospective analysis from January 1, 1998, to June 30, 2008, identified 62 children with TSC who were presented at a surgical conference. Of the 52 patients undergoing diagnostic or therapeutic procedures during the study period, 20 underwent bilateral intracranial EEG. The presurgical testing results, intracranial EEG findings, surgical interventions, and outcomes were reviewed. RESULTS: Fourteen of 20 patients had intracranial EEG findings consistent with a resectable epileptogenic zone. One patient is awaiting further resection. Five patients had findings consistent with a nonresectable epileptogenic zone, and 1 of these patients underwent a callosotomy. Seven patients had Engel Class I outcomes, 1 was Class II, 3 were Class III, and 3 were Class IV (mean follow-up 25 months). CONCLUSIONS: Bilateral intracranial EEG can identify potential resectable seizure foci in nonlateralizable epilepsy in TSC. Although 6 of 20 patients did not undergo resection (1 patient is pending future resection), significant improvements in seizures (Engel Class I or II) were noted in 8 patients. In the authors' experience, this invasive monitoring provided a safe method for identifying the ictal onset zone
— id: 132575, year: 2011, vol: 7, page: 421, stat: Journal Article,

Sudden, unexpected death in epilepsy
Devinsky, Orrin
2011 Nov 10;365(19):1801-1811, New England journal of medicine
— id: 141083, year: 2011, vol: 365, page: 1801, stat: Journal Article,

Differentiating between nonepileptic and epileptic seizures
Devinsky, Orrin; Gazzola, Deana; LaFrance, W Curt Jr
2011 Apr;7(4):210-220, Nature reviews. Neurology
Psychogenic nonepileptic seizures (PNES) resemble epileptic seizures and are often misdiagnosed and mistreated as the latter. Occasionally, epileptic seizures are misdiagnosed and mistreated as PNES. 70% of PNES cases develop between the second and fourth decades of life, but this disease can also affect children and the elderly. At least 10% of patients with PNES have concurrent epileptic seizures or have had epileptic seizures before being diagnosed with PNES. Psychological stress exceeding an individual's coping capacity often precedes PNES. Clinicians can find differentiating between PNES and epileptic seizures challenging. Some clinical features can help distinguish PNES from epileptic seizures, but other features associated with PNES are nonspecific and occur during both types of seizures. Diagnostic errors often result from an overreliance on specific clinical features. Note that no single feature is pathognomonic for PNES. When typical seizures can be recorded, video-EEG is the diagnostic gold standard for PNES, and in such cases a diagnosis can be made with high accuracy. When video-EEG reveals no epileptiform activity before, during or after the ictus, thorough neurological and psychiatric histories can be used to confirm the diagnosis of PNES. In this article, we review the clinical features that can help clinicians differentiate between PNES and epileptic seizures
— id: 134078, year: 2011, vol: 7, page: 210, stat: Journal Article,

Classifying seizures and epilepsies: limits of science and semantics
Devinsky, Orrin; Najjar, Souhel
2011 Sep;11(5):141-142, Epilepsy currents
'If I wished to show a student the difficulties of getting at truth from medical experience, I would give him the history of epilepsy to read.' Oliver Wendell Holmes (1)If the medical experience of epilepsy is obscured by uncertainties, then its classification is mired in the mud of expert opinion. The newly revised terms and concepts for 'organizing' (also known as 'classifying') seizures and epilepsy provide a humble and modern perspective, with many superb suggestions (2). The central points are well articulated and valid: 1) divorcing classification from 'expert opinion' and marrying it to science; 2) acknowledging what is unknown; and 3) simplifying and clarifying terminology. Yet, the revision lacks the crisp clarity needed to educate students, patients, and colleagues. And some recommendations lack a clear scientific or semantic basis
— id: 139494, year: 2011, vol: 11, page: 141, stat: Journal Article,

Abnormalities of cortical thickness in postictal psychosis
Dubois, J M; Devinsky, O; Carlson, C; Kuzniecky, R; Quinn, B T; Alper, K; Butler, T; Starner, K; Halgren, E; Thesen, T
2011 Jun;21(2):132-136, Epilepsy & behavior
Postictal psychosis (PIP), the occurrence of psychotic episodes following a seizure, is a common and serious comorbidity in patients with epilepsy. Yet, the anatomical correlates remain poorly defined. Here, we used quantitative MRI morphometry to identify structural abnormalities in the cortex of patients with PIP relative to patients with epilepsy without PIP and age- and gender-matched normal healthy controls. Comparison of patients with epilepsy and PIP with patients with epilepsy without PIP revealed increased cortical thickness in the right lateral prefrontal cortex, right anterior cingulate cortex, and right middle temporal gyrus. The PIP group was distinguished from the EC and NC groups by thicker cortex in the right rostral anterior cingulate cortex and thinner cortex in the right angular gyrus and the left middle temporal region. Findings indicate that PIP is associated with thickening of the right anterior cingulate cortex, which may serve as a marker for patients at risk for developing PIP
— id: 134446, year: 2011, vol: 21, page: 132, stat: Journal Article,

Impact of Failed Intracranial Epilepsy Surgery on the Effectiveness of Subsequent Vagus Nerve Stimulation
Elliott RE; Morsi A; Geller EB; Carlson CC; Devinsky O; Doyle WK
2011 Dec;69(6):1210-1217, Neurosurgery
BACKGROUND:: Using the Cyberonics registry, Amar and colleagues (2004) reported poorer efficacy of vagus nerve stimulation (VNS) in patients who failed intracranial epilepsy surgery (IES). OBJECTIVE:: To study the impact of failed IES and other surrogate marker of severe epilepsy on VNS effectiveness in a large cohort with treatment-resistant epilepsy (TRE). METHODS:: We retrospectively reviewed 376 patients (188 females; 265 adults; mean age of 29.4 years at implantation) with TRE who underwent VNS implantation between 1997 and 2008 and had at least 1 year of follow-up. One hundred ten patients (29.3%) had failed one or more prior craniotomies for TRE and 266 (70.7%) had no history of IES. RESULTS:: The mean duration of VNS therapy was 5.1 years. Patients with prior IES were more commonly male and adult, had a greater number of seizure types and more commonly had focal or multifocal versus generalized seizures (P<0.05). There was no significant difference in the mean percentage seizure reduction between patients with and without a history of IES (59.1% vs. 56.5%, P=0.42). There was no correlation between type of failed IES (callosotomy versus resection) and seizure reduction with VNS therapy. CONCLUSION:: Failed IES did not affect the response to VNS therapy. Unlike prior reports, patients with callosotomy did not respond better than those who had resective surgery. Nearly 50% of patients experienced at least 50% reduction in seizure frequency. VNS should be considered a palliative treatment option for patients with TRE, including patients who failed cranial epilepsy surgeries
— id: 134075, year: 2011, vol: 69, page: 1210, stat: Journal Article,

Vagus nerve stimulation in 436 consecutive patients with treatment-resistant epilepsy: Long-term outcomes and predictors of response
Elliott, Robert E; Morsi, Amr; Kalhorn, Stephen P; Marcus, Joshua; Sellin, Jonathan; Kang, Matthew; Silverberg, Alyson; Rivera, Edwin; Geller, Eric; Carlson, Chad; Devinsky, Orrin; Doyle, Werner K
2011 Jan;20(1):57-63, Epilepsy & behavior
OBJECTIVE: The goal of this study was to assess the efficacy and safety of vagus nerve stimulation in a consecutive series of adults and children with treatment-resistant epilepsy (TRE). METHODS: In this retrospective review of a prospectively created database of 436 consecutive patients who underwent vagus nerve stimulator implantation for TRE between November 1997 and April 2008, there were 220 (50.5%) females and 216 (49.5%) males ranging in age from 1 to 76years at the time of implantation (mean: 29.0+/-16.5). Thirty-three patients (7.6%) in the primary implantation group had inadequate follow-up (<3months from implantation) and three patients had early device removal because of infection and were excluded from seizure control outcome analyses. RESULTS: Duration of vagus nerve stimulation treatment varied from 10days to 11years (mean: 4.94years). Mean seizure frequency significantly improved following implantation (mean reduction: 55.8%, P<0.0001). Seizure control >/=90% was achieved in 90 patients (22.5%), >/=75% seizure control in 162 patients (40.5%), >/=50% improvement in 255 patients (63.75%), and <50% improvement in 145 patients (36.25%). Permanent injury to the vagus nerve occurred in 2.8% of patients. CONCLUSION: Vagus nerve stimulation is a safe and effective palliative treatment option for focal and generalized TRE in adults and children. When used in conjunction with a multidisciplinary and multimodality treatment regimen including aggressive antiepileptic drug regimens and epilepsy surgery when appropriate, more than 60% of patients with TRE experienced at least a 50% reduction in seizure burden. Good results were seen in patients with non-U.S. Food and Drug Administration-approved indications. Prospective, randomized trials are needed for patients with generalized epilepsies and for younger children to potentially expand the number of patients who may benefit from this palliative treatment
— id: 120645, year: 2011, vol: 20, page: 57, stat: Journal Article,

Efficacy of vagus nerve stimulation over time: Review of 65 consecutive patients with treatment-resistant epilepsy treated with VNS >10years
Elliott, Robert E; Morsi, Amr; Tanweer, Omar; Grobelny, Bartosz; Geller, Eric; Carlson, Chad; Devinsky, Orrin; Doyle, Werner K
2011 Mar;20(3):478-483, Epilepsy & behavior
OBJECTIVE: Studies have reported improved seizure control with increased duration of vagus nerve stimulation (VNS) but are prone to methodological biases. We analyzed the efficacy of VNS over time in patients with treatment-resistant epilepsy (TRE) who underwent VNS therapy 10 or more years. METHODS: We retrospectively reviewed 65 consecutive patients (29 females) who underwent VNS therapy >/=10years. The mean age at VNS insertion was 30.0years. Forty-four adults (>/=18years; 67.7%) and 21 children (32.3%) were included. Seizure frequency and antiepileptic drug (AED) regimens were recorded prior to VNS and, following VNS insertion, at 6months, 1year, 2years, and every 2years thereafter. RESULTS: The mean duration of VNS therapy for this group was 10.4years, and the mean decrease in seizure frequency at last follow-up was 76.3%. The mean reduction in seizures at 6months and years 1, 2, 4, 6, 8, and 10years was 35.7, 52.1, 58.3, 60.4, 65.7, 75.5, and 75.5%, respectively. Seizure frequency was significantly reduced from baseline at each of the recorded intervals (P<0.001). There was a trend toward increased AED burden in the latter years of the follow-up period. CONCLUSION: Following a 'ramp-up' and accommodation period throughout the initial 24months after VNS implantation, seizure control improved slightly over the subsequent years of therapy and eventually stabilized. Variation in seizure frequency, however, was common, and frequent changes in AED regimens or stimulation parameters were likely an important and possibly synergistic component of seizure control
— id: 128791, year: 2011, vol: 20, page: 478, stat: Journal Article,

Vagus nerve stimulation for children with treatment-resistant epilepsy: a consecutive series of 141 cases
Elliott, Robert E; Rodgers, Shaun D; Bassani, Luigi; Morsi, Amr; Geller, Eric B; Carlson, Chad; Devinsky, Orrin; Doyle, Werner K
2011 May;7(5):491-500, Journal of Neurosurgery: Pediatrics
Object The authors undertook this study to analyze the efficacy of vagus nerve stimulation (VNS) in a large consecutive series of children 18 years of age and younger with treatment-resistant epilepsy and compare the safety and efficacy in children under 12 years of age with the outcomes in older children. Methods The authors retrospectively reviewed 141 consecutive cases involving children (75 girls and 66 boys) with treatment-resistant epilepsy in whom primary VNS implantation was performed by the senior author between November 1997 and April 2008 and who had at least 1 year of follow-up since implantation. The patients' mean age at vagus nerve stimulator insertion was 11.1 years (range 1-18 years). Eighty-six children (61.0%) were younger than 12 years at time of VNS insertion (which constitutes off-label usage of this device). Results Follow-up was complete for 91.8% of patients and the mean duration of VNS therapy in these patients was 5.2 years (range 25 days-11.4 years). Seizure frequency significantly improved with VNS therapy (mean reduction 58.9%, p < 0.0001) without a significant reduction in antiepileptic medication burden (median number of antiepileptic drugs taken 3, unchanged). Reduction in seizure frequency of at least 50% occurred in 64.8% of patients and 41.4% of patients experienced at least a 75% reduction. Major (3) and minor (6) complications occurred in 9 patients (6.4%) and included 1 deep infection requiring device removal, 1 pneumothorax, 2 superficial infections treated with antibiotics, 1 seroma/hematoma treated with aspiration, persistent cough in 1 patient, severe but transient neck pain in 1 patient, and hoarseness in 2 patients. There was no difference in efficacy or complications between children 12 years of age and older (FDA-approved indication) and those younger than 12 years of age (off-label usage). Linear regression analyses did not identify any demographic and clinical variables that predicted response to VNS. Conclusions Vagus nerve stimulation is a safe and effective treatment for treatment-resistant epilepsy in young adults and children. Over 50% of patients experienced at least 50% reduction in seizure burden. Children younger than 12 years had a response similar to that of older children with no increase in complications. Given the efficacy of this device and the devastating effects of persistent epilepsy during critical developmental epochs, randomized trials are needed to potentially expand the indications for VNS to include younger children
— id: 134077, year: 2011, vol: 7, page: 491, stat: Journal Article,

Hemispheric asymmetries of cortical volume in the human brain
Goldberg E; Roediger D; Kucukboyaci NE; Carlson C; Devinsky O; Kuzniecky R; Halgren E; Thesen T
2011 Nov 19;:?-?, Cortex
Hemispheric asymmetry represents a cardinal feature of cerebral organization, but the nature of structural and functional differences between the hemispheres is far from fully understood. Using Magnetic Resonance Imaging morphometry, we identified several volumetric differences between the two hemispheres of the human brain. Heteromodal inferoparietal and lateral prefrontal cortices are more extensive in the right than left hemisphere, as is visual cortex. Heteromodal mesial and orbital prefrontal and cingulate cortices are more extensive in the left than right hemisphere, as are somatosensory, parts of motor, and auditory cortices. Thus, heteromodal association cortices are more extensively represented on the lateral aspect of the right than in the left hemisphere, and modality-specific cortices are more extensively represented on the lateral aspect of the left than in the right hemisphere. On the mesial aspect heteromodal association cortices are more extensively represented in the left than right hemisphere
— id: 149915, year: 2011, vol: , page: ?, stat: Journal Article,

Long-term association between seizure outcome and depression after resective epilepsy surgery
Hamid, H; Liu, H; Cong, X; Devinsky, O; Berg, A T; Vickrey, B G; Sperling, M R; Shinnar, S; Langfitt, J T; Walczak, T S; Barr, W B; Dziura, J; Bazil, C W; Spencer, S S
2011 Nov 29;77(22):1972-1976, Neurology
OBJECTIVE: This study explored the association between long-term epilepsy surgery outcome and changes in depressive symptoms. METHODS: Adults were enrolled between 1996 and 2001 in a multicenter prospective study to evaluate outcomes of resective epilepsy surgery. The extent of depressive symptoms and depression case status (none, mild, or moderate/severe) were assessed using the Beck Depression Inventory (BDI) preoperatively and 3, 12, 24, 48, and 60 months postoperatively. A mixed-model repeated-measures analysis was performed, adjusting for covariates of seizure location, gender, age, race, education, and seizure control. RESULTS: Of the total 373 subjects, 256 were evaluated at baseline and 5 years after surgery. At baseline, 164 (64.1%) were not depressed, 34 (13.3%) were mildly depressed, and 58 (22.7%) had moderate to severe depression. After 5 years, 198 (77.3%) were not depressed, 20 (7.8%) were mildly depressed, and 38 (14.8%) were moderately to severely depressed. Five years after surgery, the reduction in mean change from baseline in BDI score was greater in subjects with excellent seizure control than in the fair and poor seizure control groups (p = 0.0006 and p = 0.02 respectively). Those with good seizure control had a greater reduction in BDI score than the poor seizure control group (p = 0.02) and borderline significant reduction compared with the fair seizure control group (p = 0.055). CONCLUSION: Although study participants had initial improvement in depressive symptoms, on average, after resective surgery, only patients with good or excellent seizure control had sustained long-term improvement in mood
— id: 149924, year: 2011, vol: 77, page: 1972, stat: Journal Article,

Suicide outcomes after resective epilepsy surgery
Hamid, Hamada; Devinsky, Orrin; Vickrey, Barbara G; Berg, Anne T; Bazil, Carl W; Langfitt, John T; Walczak, Thaddeus S; Sperling, Michael R; Shinnar, Shlomo; Spencer, Susan S
2011 Mar;20(3):462-464, Epilepsy & behavior
People with epilepsy have a higher risk for suicide than people without epilepsy. The relationship between seizure control and suicide is controversial. A standardized protocol to record history, diagnostic testing, and neuropsychiatric assessments was administered. The Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were administered presurgically and yearly for up to 5 years. Among the 396 enrolled, 4 of 27 deaths were attributed to suicide. The standardized mortality ratio, compared with suicides in the U.S. population and adjusted for age and gender, was 13.3 (95% CI=3.6-34.0). Only one patient had a BDI score suggestive of severe depression (BDI=33), one had depressive symptoms that did not the meet the depressive range (BDI=7), and the other two reported no depressive symptoms. Two of the patients reported moderate to severe anxiety symptoms (BAI=17 and 21, respectively). Suicide may occur after epilepsy surgery, even when patients report excellent seizure control
— id: 133197, year: 2011, vol: 20, page: 462, stat: Journal Article,

Role of the left amygdala and right orbital frontal cortex in emotional interference resolution facilitation in working memory
Levens, Sara M; Devinsky, Orrin; Phelps, Elizabeth A
2011 Oct;49(12):3201-3212, Neuropsychologia
Previous research has shown that emotional information aids conflict resolution in working memory (Levens & Phelps, 2008). Using a Recency-probes working memory (WM) paradigm, Levens and Phelps found that positive and negative emotional stimuli reduced the amount of interference created when information that was once relevant conflicted with currently relevant information, suggesting that emotional information facilitates interference resolution in WM. To determine what regions of the prefrontal cortex (PFC) and temporal lobes are critical to the influence of emotional stimuli on interference resolution, we conducted a Recency-probes emotion paradigm with right and left unilateral frontal and temporal lobe lesion patients. The frontal lobe lesion patient group comprised individuals with unilateral ventral and dorsal PFC lesions. The temporal lobe lesion patient group comprised individuals with lesions of the amygdala and surrounding structures. Results indicate that when the left amygdala is damaged, emotional facilitation of interference resolution is absent (equal emotional and neutral interference levels), when the right orbital frontal cortex (OFC) is damaged, in contrast, emotional interference resolution is impaired (emotional interference levels are higher than neutral levels are). Based on these unique patterns we propose specific contributions for these regions in the emotional facilitation of interference resolution in WM
— id: 139493, year: 2011, vol: 49, page: 3201, stat: Journal Article,

An implantable triple-function device for local drug delivery, cerebrospinal fluid removal and EEG recording in the cranial subdural/subarachnoid space of primates
Ludvig N; Medveczky G; Rizzolo R; Tang HM; Baptiste SL; Doyle WK; Devinsky O; Carlson C; French JA; Kral JG; Charchaflieh J; Kuzniecky RI
2011 Oct 17;203(2):275-283, Journal of neuroscience methods
Transmeningeal pharmacotherapy for cerebral cortical disorders requires drug delivery through the subdural/subarachnoid space, ideally with a feedback controlled mechanism. We have developed a device suitable for this function. The first novel component of the apparatus is a silicone rubber strip equipped with (a) fluid-exchange ports for both drug delivery and local cerebrospinal fluid (CSF) removal, and (b) EEG recording electrode contacts. This strip can be positioned between the dura and pia maters. The second novel component is an implantable dual minipump that directs fluid movement to and from the silicone strip and is accessible for refilling and emptying the drug and CSF reservoirs, respectively. This minipump is regulated by a battery-powered microcontroller integrating a bi-directional radiofrequency (RF) communication module. The entire apparatus was implanted in 5 macaque monkeys, with the subdural strip positioned over the frontal cortex and the minipump assembly secured to the cranium under a protective cap. The system was successfully tested for up to 8months for (1) transmeningeal drug delivery using acetylcholine (ACh) and muscimol as test compounds, (2) RF-transmission of neocortical EEG data to assess the efficacy of drug delivery, and (3) local CSF removal for subsequent diagnostic analyses. The device can be used for (a) monitoring neocortical electrophysiology and neurochemistry in freely behaving nonhuman primates for more than 6months, (b) determining the neurobiological impact of subdural/subarachnoid drug delivery interfaces, (c) obtaining novel neuropharmacological data on the effects of central nervous system (CNS) drugs, and (d) performing translational studies to develop subdural pharmacotherapy devices
— id: 139939, year: 2011, vol: 203, page: 275, stat: Journal Article,

Transmeningeal muscimol can prevent focal EEG seizures in the rat neocortex without stopping multineuronal activity in the treated area
Ludvig, Nandor; Tang, Hai M; Artan, N Sertac; Mirowski, Piotr; Medveczky, Geza; Baptiste, Shirn L; Darisi, Sindhu; Kuzniecky, Ruben I; Devinsky, Orrin; French, Jacqueline A
2011 Apr 18;1385:182-191, Brain research
Muscimol has potent antiepileptic efficacy after transmeningeal administration in animals. However, it is unknown whether this compound stops local neuronal firing at concentrations that prevent seizures. The purpose of this study was to test the hypothesis that epidurally administered muscimol can prevent acetylcholine (Ach)-induced focal seizures in the rat neocortex without causing cessation of multineuronal activity. Rats were chronically implanted with a modified epidural cup over the right frontal cortex, with microelectrodes positioned underneath the cup. In each postsurgical experimental day, either saline or 0.005-, 0.05-, 0.5- or 5.0-mM muscimol was delivered through the cup, followed by a 20-min monitoring of the multineuronal activity and the subsequent delivery of Ach in the same way. Saline and muscimol pretreatment in the concentration range of 0.005-0.05mM did not prevent EEG seizures. In contrast, 0.5-mM muscimol reduced the average EEG Seizure Duration Ratio value from 0.30+/-0.04 to 0. At this muscimol concentration, the average baseline multineuronal firing rate of 10.9+/-4.4spikes/s did not change significantly throughout the 20-min pretreatment. Muscimol at 5.0mM also prevented seizures, but decreased significantly the baseline multineuronal firing rate of 7.0+/-1.8 to 3.7+/-0.9spikes/s in the last 10min of pretreatment. These data indicate that transmeningeal muscimol in a submillimolar concentration range can prevent focal neocortical seizures without stopping multineuronal activity in the treated area, and thus this treatment is unlikely to interrupt local physiological functions
— id: 129321, year: 2011, vol: 1385, page: 182, stat: Journal Article,

Extralimbic autoimmune encephalitis associated with glutamic acid decarboxylase antibodies: An underdiagnosed entity?
Najjar S; Pearlman D; Najjar A; Ghiasian V; Zagzag D; Devinsky O
2011 Jul;21(3):306-313, Epilepsy & behavior
Nonparaneoplastic glutamic acid decarboxylase antibody (GADAb)-related autoimmune encephalitis is a syndrome characterized by refractory seizures, progressive cognitive deficits, and psychiatric manifestations. The limbic subtype is well described, has characteristic affective and memory disturbances, and typical mesial temporal MRI abnormalities. We found only one single case report of the extralimbic subtype. We report clinical, radiological, and pathological findings of two additional cases with contrast-enhancing lesions. One of our cases presented as vasculitis, and the other imitated a tumor. Pathological evidence of both vasculitis and encephalitis has never been previously reported in any inflammatory condition affecting the brain. Our cases confirm prior reports that immune therapy can better control seizures associated with GADAb autoimmune encephalitis, and support the rationale for assaying for GADAb titers in patients with etiologically unclear extralimbic lesions and refractory epilepsy, independent of seizure types
— id: 134074, year: 2011, vol: 21, page: 306, stat: Journal Article,

Refractory epilepsy associated with microglial activation
Najjar, Souhel; Pearlman, Daniel; Miller, Douglas C; Devinsky, Orrin
2011 Sep;17(5):249-254, Neurologist
BACKGROUND: : Experimental and clinical studies support a pathogenic role of microglial activation and proliferation (MAP) in epileptogenesis. METHODS: : From a consecutive series of 319 surgically treated epilepsy cases, we retrospectively reviewed the histopathological sections of 92 cases to define the prevalence and severity of MAP after excluding the other 227 because of coexisting disorders that might contribute to MAP. Severity of MAP was compared with underlying abnormalities. We assessed the response to intravenous immunoglobulin and plasmapheresis in one patient with severe MAP who had failed multiple antiepileptic drugs and epilepsy surgery. RESULTS: : MAP was detected with routine (hematoxylin and eosin) stain in 46 of 92 cases (50%). MAP was mild in 32 cases (69.6%), moderate in 12 (26.1%), and severe in 2 (4.3%). The prevalence and severity of MAP were independent of underlying abnormalities. Immunomodulatory therapy was followed by a greater than 90% reduction in seizure activity in the treated patient. CONCLUSION: : MAP is prevalent in resected human epilepsy tissue. Failure to down-regulate MAP contributes to chronic neuronal hyperexcitability. We hypothesize that MAP initiates a cycle of inflammation-induced seizures and seizure-induced inflammation. Microglia-driven epilepsy may be a primary pathogenic process in a small number of cases, as suggested by the pathology and therapeutic response in our patient, but may contribute to epileptogenesis in many more
— id: 137008, year: 2011, vol: 17, page: 249, stat: Journal Article,

Spontaneously resolving seronegative autoimmune limbic encephalitis
Najjar, Souhel; Pearlman, Daniel; Zagzag, David; Devinsky, Orrin
2011 Jun;24(2):99-105, Cognitive & behavioral neurology
OBJECTIVE: We describe a patient with seronegative autoimmune limbic encephalitis (SNALE) masquerading as glioma. Brain magnetic resonance imaging (MRI) abnormalities, distinctive pathological findings, and spontaneous remission are highlighted. BACKGROUND: There are 15 previously reported SNALE cases, 1 with pathology. MATERIALS AND METHODS: A 66-year-old man presented with prominent amnestic syndrome, progressive cognitive decline, and refractory complex partial seizures. RESULTS: Initial brain MRI suggested herpes limbic encephalitis. A 3-week course of intravenous acyclovir was ineffective. Cerebrospinal fluid analysis revealed no pleocytosis. Repeat brain MRI showed a left uncal-hippocampal, contrast-enhancing lesion with mass effect, which was resected. Pathology revealed perivascular and parenchymal mixed lymphocytic inflammatory infiltrates, microglial nodules, neuronophagia, microglial activation, astrocytosis, and lymphocyte emperipolesis within neurons. Thorough searches for infectious pathogens and autoantibodies were negative. Six weeks later, a new enhancing right mesial temporal lesion appeared, with increased seizure activity and further cognitive impairment. Although immune therapy was declined, spontaneous resolution of the new enhancing lesion, with full seizure control and significant cognitive improvement, occurred. CONCLUSIONS: SNALE may masquerade as glioma. Pathologic changes in our case of SNALE are distinctive. Spontaneous resolution of a focal SNALE lesion may potentially occur without immune therapy
— id: 134726, year: 2011, vol: 24, page: 99, stat: Journal Article,

Coagulation abnormalities in children undergoing epilepsy surgery
Pacione, Donato; Blei, Francine; Devinsky, Orrin; Weiner, Howard L; Roth, Jonathan
2011 Jun;7(6):654-659, Journal of Neurosurgery: Pediatrics
Object Surgery is increasingly used to treat children with refractory epilepsy. Before surgery, the authors routinely evaluated the coagulation profile to identify coagulation abnormalities not established by personal and family history, physical examination, and routine screening tests. Methods Thirty-nine consecutive children undergoing testing prior to epilepsy surgery were prospectively evaluated. The authors evaluated a detailed hematological history and an elaborative hematological panel including complete blood count, hepatic panel, anticoagulant levels, coagulation profile (prothrombin time, partial thromboplastin time, international normalized ratio, fibrinogen, thrombin time, von Willebrand antigen, ristocetin cofactor, factor VIII, and individual factor assays when indicated) and platelet aggregation studies (in the presence of adenosine diphosphate, epinephrine, collagen, and ristocetin). Patient variables included tuberous sclerosis complex (TSC), age at epilepsy onset, age at surgery, seizure frequency, number and type of antiepileptic drugs, recent or present ketogenic diet, and use of selective serotonin reuptake inhibitors. Results Ten children (25.6%) had either coagulation or platelet function abnormalities. Abnormal coagulation was identified in 5 children, and abnormal platelet function was discovered in 6. A diagnosis of TSC was associated with a platelet function abnormality (p = 0.012), whereas children without TSC had a higher rate of coagulopathy (p = 0.041). None of the other characteristics reached statistical significance. In 2 patients (5.1%) with TSC and platelet aggregation abnormalities, the authors noted normal standard screening laboratory studies and an uneventful detailed personal and family history. One of these 2 patients developed a significant intraoperative bleeding complication. Conclusions A preoperative screening with standard laboratory studies and detailed history may not be adequate to fully examine underlying coagulation abnormalities in children with refractory epilepsy. Platelet aggregation studies should be considered in patients with TSC
— id: 134073, year: 2011, vol: 7, page: 654, stat: Journal Article,

Quality of life following epilepsy surgery for children with tuberous sclerosis complex
Roth, Jonathan; Olasunkanmi, Adeolu; Macallister, William S; Weil, Emily; Uy, Catherine C; Devinsky, Orrin; Weiner, Howard L
2011 Mar;20(3):561-565, Epilepsy & behavior
Parents of children with tuberous sclerosis complex who underwent multistage resections for treatment of refractory seizures were offered a telephone questionnaire regarding quality of life (QOL) of child and family since surgery. Of 53 families, 39 responded. Age at epilepsy onset was birth to 3months. Average duration of epilepsy before the first surgery was 5.1years, and average age at surgery was 5.8. The average follow-up was 3.9. Seventy-seven percent had a >90% reduction in disabling seizures. In all outcome categories, 46-85% had at least a moderate improvement in QOL. There was a significant correlation between QOL variables and Engel outcome class. Despite the potential burden posed by the aggressive surgical approach, including multiple surgeries and long hospitalization periods, 94% of parents would choose the same course once again. We conclude that aggressive surgical treatment of tuberous sclerosis complex-related refractory seizures is associated with significant control of epilepsy as well as improved QOL for the patient and family
— id: 128790, year: 2011, vol: 20, page: 561, stat: Journal Article,

Medically refractory epilepsy in autism
Sansa, Gemma; Carlson, Chad; Doyle, Werner; Weiner, Howard L; Bluvstein, Judith; Barr, William; Devinsky, Orrin
2011 Jun;52(6):1071-1075, Epilepsia
Purpose: Epilepsy and electroencephalographic abnormalities are frequent in idiopathic autism, but there is little information regarding treatment-resistant epilepsy (TRE) in this group. We sought to define the clinical and electrophysiologic characteristics and treatment outcomes in these patients. Methods: We retrospectively reviewed clinical and laboratory data of patients with idiopathic autism evaluated at NYU Epilepsy Center during a 20-year period. Key Findings: One hundred twenty-seven patients had idiopathic autism and at least one epileptic seizure; 33.9% had TRE and 27.5% were seizure free. The remaining 38.6% of patients had infrequent seizures or insufficient data to categorize. Patients with TRE had a significantly earlier onset of seizures than seizure-free patients, and a trend for more developmental regression and motor and language delays. Three patients had surgical resection (two had limited improvement and one had no improvement) and one had an anterior callosotomy (no improvement). Vagus nerve stimulator (VNS) implantation provided limited improvement (2 patients) and no improvement (7). Significance: This study found that TRE is common in idiopathic autism and more common with early age of seizure onset. Relatively few patients underwent surgical resection due to multifocal partial epilepsy, comorbid generalized epilepsy, or limited impact of ongoing partial seizures given other problems related to autism. Our small sample suggests that surgical and VNS outcomes in this group are less favorable than in other TRE populations
— id: 134461, year: 2011, vol: 52, page: 1071, stat: Journal Article,

Opposed hemispheric specializations for human hypersexuality and orgasm?
Suffren, Sabrina; Braun, Claude M J; Guimond, Anik; Devinsky, Orrin
2011 May;21(1):12-19, Epilepsy & behavior
With a multiple case report analysis we demonstrate that hypersexuality more often results from right hemisphere (RH) (n=26) than left hemisphere (LH) (n=7) lesions, possibly because of LH release after the RH lesion, and that ictal orgasm more often occurs in patients with right-sided (n=23) than left-sided (n=8) seizure foci, with the symptom probably resulting from RH activation. The LH may be specialized for increasing sexual tension, whereas the RH may be specialized for release of this tension (orgasm), the former being catabolic and the latter anabolic. Several other interpretations of the findings are also discussed
— id: 134076, year: 2011, vol: 21, page: 12, stat: Journal Article,

Periodic transmeningeal muscimol maintains its antiepileptic efficacy over three weeks without inducing tolerance, in rats
Tang, Hai M; French, Jacqueline A; Kuzniecky, Ruben I; Devinsky, Orrin; Ludvig, Nandor
2011 Apr 25;494(2):135-138, Neuroscience letters
Periodic transmeningeal administration of muscimol into the neocortical epileptogenic zone via a subdurally implanted device has been proposed for the treatment of intractable focal neocortical epilepsy. It is unknown whether such muscimol applications induce tolerance. The purpose of this study was to determine whether daily transmeningeal (epidural) muscimol applications into the rat parietal cortex induce tolerance to the antiepileptic effect of this drug. Rats were chronically implanted with an epidural cup and adjacent epidural EEG electrodes over the right parietal cortex. After recovery 1.0mM muscimol was delivered into the implanted cortical area through the cup while the animal behaved freely, once per day for 4 consecutive days in each week, with each delivery followed within 3min by the delivery of a seizure-inducing concentration of acetylcholine (Ach) into the same area. The study lasted for 3 weeks. In each week, one day was used to test the epileptogenicity of the examined cortical site by replacing muscimol with saline prior to Ach delivery. The duration of Ach-induced EEG seizures was measured in each experimental session to assess the antiepileptic efficacy of muscimol, while the rat's behavior was also monitored. The daily epidural muscimol pretreatments prevented Ach-induced EEG and behavioral seizures in all rats. This antiepileptic action did not diminish over time and was maintained throughout the 3-week test period. When muscimol was replaced with saline, the subsequent Ach administrations induced EEG and behavioral seizures. These results suggest that periodic transmeningeal administrations of a relatively low concentration of muscimol into the neocortex over three weeks do not induce tolerance to the localized antiepileptic effects of this drug
— id: 130302, year: 2011, vol: 494, page: 135, stat: Journal Article,

Detection of epileptogenic cortical malformations with surface-based MRI morphometry
Thesen, Thomas; Quinn, Brian T; Carlson, Chad; Devinsky, Orrin; DuBois, Jonathan; McDonald, Carrie R; French, Jacqueline; Leventer, Richard; Felsovalyi, Olga; Wang, Xiuyuan; Halgren, Eric; Kuzniecky, Ruben
2011 ;6(2):e16430-e16430, PLoS ONE
Magnetic resonance imaging has revolutionized the detection of structural abnormalities in patients with epilepsy. However, many focal abnormalities remain undetected in routine visual inspection. Here we use an automated, surface-based method for quantifying morphometric features related to epileptogenic cortical malformations to detect abnormal cortical thickness and blurred gray-white matter boundaries. Using MRI morphometry at 3T with surface-based spherical averaging techniques that precisely align anatomical structures between individual brains, we compared single patients with known lesions to a large normal control group to detect clusters of abnormal cortical thickness, gray-white matter contrast, local gyrification, sulcal depth, jacobian distance and curvature. To assess the effects of threshold and smoothing on detection sensitivity and specificity, we systematically varied these parameters with different thresholds and smoothing levels. To test the effectiveness of the technique to detect lesions of epileptogenic character, we compared the detected structural abnormalities to expert-tracings, intracranial EEG, pathology and surgical outcome in a homogeneous patient sample. With optimal parameters and by combining thickness and GWC, the surface-based detection method identified 92% of cortical lesions (sensitivity) with few false positives (96% specificity), successfully discriminating patients from controls 94% of the time. The detected structural abnormalities were related to the seizure onset zones, abnormal histology and positive outcome in all surgical patients. However, the method failed to adequately describe lesion extent in most cases. Automated surface-based MRI morphometry, if used with optimized parameters, may be a valuable additional clinical tool to improve the detection of subtle or previously occult malformations and therefore could improve identification of patients with intractable focal epilepsy who may benefit from surgery
— id: 134079, year: 2011, vol: 6, page: e16430, stat: Journal Article,

Comparison of the antiepileptic properties of transmeningeally delivered muscimol, lidocaine, midazolam, pentobarbital and GABA, in rats
Baptiste, Shirn L; Tang, Hai M; Kuzniecky, Ruben I; Devinsky, Orrin; French, Jacqueline A; Ludvig, Nandor
2010 Jan 29;469(3):421-424, Neuroscience letters
This study compared the potencies of epidurally delivered muscimol, lidocaine, midazolam, pentobarbital and gamma-aminobutyric acid (GABA) to prevent focal neocortical seizures induced by locally applied acetylcholine (Ach), in rats (n=5). An epidural cup was chronically implanted over the right somatosensory cortex in each animal, with epidural EEG electrodes placed posterior to the edge of the cup. After recovery, either artificial cerebrospinal fluid (ACSF; control solution) or one of the five drugs was delivered into epidural cup, followed by Ach administration into the cup to induce seizures. EEG seizure duration ratio was calculated for each drug delivery/seizure induction session to determine the potency of ACSF and the drugs to prevent the focal Ach-seizures. The concentration of all examined drug solutions was 1.0mM. ACSF, lidocaine, midazolam, pentobarbital and GABA all failed to prevent the Ach-induced neocortical EEG seizures, yielding EEG seizure duration ratios ranging from 0.41 to 0.80. In contrast, muscimol pretreatment fully prevented the development of ictal EEG in all animals. These results suggest that when used at low concentration muscimol was the best of the five drugs for transmeningeal pharmacotherapy trials for focal neocortical epilepsy
— id: 106495, year: 2010, vol: 469, page: 421, stat: Journal Article,

Phonetically irregular word pronunciation and cortical thickness in the adult brain
Blackmon, Karen; Barr, William B; Kuzniecky, Ruben; Dubois, Jonathan; Carlson, Chad; Quinn, Brian T; Blumberg, Mark; Halgren, Eric; Hagler, Donald J; Mikhly, Mark; Devinsky, Orrin; McDonald, Carrie R; Dale, Anders M; Thesen, Thomas
2010 Jul 15;51(4):1453-1458, Neuroimage
Accurate pronunciation of phonetically irregular words (exception words) requires prior exposure to unique relationships between orthographic and phonemic features. Whether such word knowledge is accompanied by structural variation in areas associated with orthographic-to-phonemic transformations has not been investigated. We used high-resolution MRI to determine whether performance on a visual word-reading test composed of phonetically irregular words, the Wechsler Test of Adult Reading (WTAR), is associated with regional variations in cortical structure. A sample of 60 right-handed, neurologically intact individuals were administered the WTAR and underwent 3T volumetric MRI. Using quantitative, surface-based image analysis, cortical thickness was estimated at each vertex on the cortical mantle and correlated with WTAR scores while controlling for age. Higher scores on the WTAR were associated with thicker cortex in bilateral anterior superior temporal gyrus, bilateral angular gyrus/posterior superior temporal gyrus, and left hemisphere intraparietal sulcus. Higher scores were also associated with thinner cortex in left hemisphere posterior fusiform gyrus and central sulcus, bilateral inferior frontal gyrus, and right hemisphere lingual gyrus and supramarginal gyrus. These results suggest that the ability to correctly pronounce phonetically irregular words is associated with structural variations in cortical areas that are commonly activated in functional neuroimaging studies of word reading, including areas associated with grapheme-to-phonemic conversion
— id: 109791, year: 2010, vol: 51, page: 1453, stat: Journal Article,

Response to Comment on "The Human K-Complex Represents an Isolated Cortical Down-State"
Cash, Sydney S.; Halgren, Eric; Dehghani, Nima; Rossetti, Andrea O.; Thesen, Thomas; Wang, ChunMao; Devinsky, Orrin; Kuzniecky, Ruben; Doyle, Werner; Madsen, Joseph R.; Eross, Lorand; Halasz, Peter; Karmos, George; Csercsa, Richard; Wittner, Lucia; Ulbert, Istvan
2010 OCT 1 ;330(6000):-, Science
— id: 113748, year: 2010, vol: 330, page: , stat: Journal Article,

Kluver-Bucy syndrome, hypersexuality, and the law
Devinsky, Julie; Sacks, Oliver; Devinsky, Orrin
2010 Apr;16(2):140-145, Neurocase : case studies in neuropsychology, neuropsychiatry, & behavioural neurology
A 51-year-old right-handed man developed hypersexuality after a second right temporal lobectomy to treat epilepsy. His hypersexuality started with increased marital intercourse and masturbation but he later downloaded child pornography. Hyperphagia and distractibility, other features of the Kluver-Bucy syndrome, also developed. Resection of the amygdala and/or temporal lobe neocortical areas that inhibit other limbic areas may contribute to the pathogenesis of hypersexuality. Neurological factors mitigate the criminal responsibility for hypersexual activity in patients with Kluver-Bucy syndrome. Most previously reported patients were never charged with a crime despite uninvited physical contact in some instances. Our patient was convicted and imprisoned
— id: 109036, year: 2010, vol: 16, page: 140, stat: Journal Article,

Hyperfamiliarity for faces
Devinsky, O; Davachi, L; Santchi, C; Quinn, B T; Staresina, B P; Thesen, T
2010 Mar 23;74(12):970-974, Neurology
OBJECTIVE: To report 4 cases of hyperfamiliarity for faces (HFF) and review 5 previously reported cases. METHODS: We identified cases of HFF from PubMed search and references in prior reports. RESULTS: Three of our 4 cases had pathologic findings that were most extensive in the left temporal lobe. HFF occurred after a tonic-clonic seizure (cases 1 and 3), during simple partial seizures (case 2), and in the setting of an increase in simple partial seizure frequency but not during seizures (case 4). All 9 cases were adults with 1 or more seizures; symptoms first occurred after seizures in 5 cases and during seizures in 1 case. Ictal symptoms lasted from seconds to minutes and from 2 days to more than 7 years in the other 6 cases. The duration of HFF was not associated with the presence or extent of a structural lesion. While in several cases HFF appears to result from a postictal Todd paralysis, the mechanism underlying persistent cases is uncertain. CONCLUSIONS: This modality (visual)-specific and stimulus (face)-specific syndrome is associated with diverse structural, functional imaging, and neurophysiologic findings. Lesions are more often left-sided and involve the temporal lobe. Epilepsy and seizures were present in all 9 cases, suggesting a pathophysiologic relationship, which likely varies among cases. Although only reported in 9 patients, HFF is probably much more common than it is diagnosed
— id: 108924, year: 2010, vol: 74, page: 970, stat: Journal Article,

Seizure prediction and recall
DuBois, J M; Boylan, L S; Shiyko, M; Barr, W B; Devinsky, O
2010 May;18(1-2):106-109, Epilepsy & behavior
Using separate generalized mixed-effects models, we assessed seizure recall and prediction, as well as contributing diagnostic variables, in 83 adult patients with epilepsy undergoing video/EEG monitoring. The model revealed that when participants predicted a seizure, probability equaled 0.320 (95% CI: 0.149-0.558), a significant (P<0.05) increase over negative predictions (0.151, 95% CI: 0.71-0.228]). With no seizure, the rate of remembering was approximately 0.130 (95% CI: 0.73-0.219), increasing significantly to 0.628 (95% CI: 0.439 to 0.784) when a seizure occurred (P<0.001). Of the variables analyzed, only inpatient seizure rate influenced predictability (P<0.001) or recollection (P<0.001). These models reveal that patients were highly aware of their seizures, and in many cases, were able to make accurate predictions, for which seizure rate may be an important factor
— id: 111369, year: 2010, vol: 18, page: 106, stat: Journal Article,

Impaired consciousness in temporal lobe seizures: role of cortical slow activity
Englot, Dario J; Yang, Li; Hamid, Hamada; Danielson, Nathan; Bai, Xiaoxiao; Marfeo, Anthony; Yu, Lissa; Gordon, Aliza; Purcaro, Michael J; Motelow, Joshua E; Agarwal, Ravi; Ellens, Damien J; Golomb, Julie D; Shamy, Michel C F; Zhang, Heping; Carlson, Chad; Doyle, Werner; Devinsky, Orrin; Vives, Kenneth; Spencer, Dennis D; Spencer, Susan S; Schevon, Catherine; Zaveri, Hitten P; Blumenfeld, Hal
2010 Dec;133(Pt 12):3764-3777, Brain
Impaired consciousness requires altered cortical function. This can occur either directly from disorders that impair widespread bilateral regions of the cortex or indirectly through effects on subcortical arousal systems. It has therefore long been puzzling why focal temporal lobe seizures so often impair consciousness. Early work suggested that altered consciousness may occur with bilateral or dominant temporal lobe seizure involvement. However, other bilateral temporal lobe disorders do not impair consciousness. More recent work supports a 'network inhibition hypothesis' in which temporal lobe seizures disrupt brainstem-diencephalic arousal systems, leading indirectly to depressed cortical function and impaired consciousness. Indeed, prior studies show subcortical involvement in temporal lobe seizures and bilateral frontoparietal slow wave activity on intracranial electroencephalography. However, the relationships between frontoparietal slow waves and impaired consciousness and between cortical slowing and fast seizure activity have not been directly investigated. We analysed intracranial electroencephalography recordings during 63 partial seizures in 26 patients with surgically confirmed mesial temporal lobe epilepsy. Behavioural responsiveness was determined based on blinded review of video during seizures and classified as impaired (complex-partial seizures) or unimpaired (simple-partial seizures). We observed significantly increased delta-range 1-2 Hz slow wave activity in the bilateral frontal and parietal neocortices during complex-partial compared with simple-partial seizures. In addition, we confirmed prior work suggesting that propagation of unilateral mesial temporal fast seizure activity to the bilateral temporal lobes was significantly greater in complex-partial than in simple-partial seizures. Interestingly, we found that the signal power of frontoparietal slow wave activity was significantly correlated with the temporal lobe fast seizure activity in each hemisphere. Finally, we observed that complex-partial seizures were somewhat more common with onset in the language-dominant temporal lobe. These findings provide direct evidence for cortical dysfunction in the form of bilateral frontoparietal slow waves associated with impaired consciousness in temporal lobe seizures. We hypothesize that bilateral temporal lobe seizures may exert a powerful inhibitory effect on subcortical arousal systems. Further investigations will be needed to fully determine the role of cortical-subcortical networks in ictal neocortical dysfunction and may reveal treatments to prevent this important negative consequence of temporal lobe epilepsy
— id: 134080, year: 2010, vol: 133, page: 3764, stat: Journal Article,

Heterogeneous neuronal firing patterns during interictal epileptiform discharges in the human cortex
Keller, Corey J; Truccolo, Wilson; Gale, John T; Eskandar, Emad; Thesen, Thomas; Carlson, Chad; Devinsky, Orrin; Kuzniecky, Ruben; Doyle, Werner K; Madsen, Joseph R; Schomer, Donald L; Mehta, Ashesh D; Brown, Emery N; Hochberg, Leigh R; Ulbert, Istvan; Halgren, Eric; Cash, Sydney S
2010 Jun;133(Pt 6):1668-1681, Brain
Epileptic cortex is characterized by paroxysmal electrical discharges. Analysis of these interictal discharges typically manifests as spike-wave complexes on electroencephalography, and plays a critical role in diagnosing and treating epilepsy. Despite their fundamental importance, little is known about the neurophysiological mechanisms generating these events in human focal epilepsy. Using three different systems of microelectrodes, we recorded local field potentials and single-unit action potentials during interictal discharges in patients with medically intractable focal epilepsy undergoing diagnostic workup for localization of seizure foci. We studied 336 single units in 20 patients. Ten different cortical areas and the hippocampus, including regions both inside and outside the seizure focus, were sampled. In three of these patients, high density microelectrode arrays simultaneously recorded between 43 and 166 single units from a small (4 mm x 4 mm) patch of cortex. We examined how the firing rates of individual neurons changed during interictal discharges by determining whether the firing rate during the event was the same, above or below a median baseline firing rate estimated from interictal discharge-free periods (Kruskal-Wallis one-way analysis, P<0.05). Only 48% of the recorded units showed such a modulation in firing rate within 500 ms of the discharge. Units modulated during the discharge exhibited significantly higher baseline firing and bursting rates than unmodulated units. As expected, many units (27% of the modulated population) showed an increase in firing rate during the fast segment of the discharge (+ or - 35 ms from the peak of the discharge), while 50% showed a decrease during the slow wave. Notably, in direct contrast to predictions based on models of a pure paroxysmal depolarizing shift, 7.7% of modulated units recorded in or near the seizure focus showed a decrease in activity well ahead (0-300 ms) of the discharge onset, while 12.2% of units increased in activity in this period. No such pre-discharge changes were seen in regions well outside the seizure focus. In many recordings there was also a decrease in broadband field potential activity during this same pre-discharge period. The different patterns of interictal discharge-modulated firing were classified into more than 15 different categories. This heterogeneity in single unit activity was present within small cortical regions as well as inside and outside the seizure onset zone, suggesting that interictal epileptiform activity in patients with epilepsy is not a simple paroxysm of hypersynchronous excitatory activity, but rather represents an interplay of multiple distinct neuronal types within complex neuronal networks
— id: 114446, year: 2010, vol: 133, page: 1668, stat: Journal Article,

Multimodal imaging of repetition priming: Using fMRI, MEG, and intracranial EEG to reveal spatiotemporal profiles of word processing
McDonald, Carrie R; Thesen, Thomas; Carlson, Chad; Blumberg, Mark; Girard, Holly M; Trongnetrpunya, Amy; Sherfey, Jason S; Devinsky, Orrin; Kuzniecky, Rubin; Dolye, Werner K; Cash, Sydney S; Leonard, Matthew K; Hagler, Donald J Jr; Dale, Anders M; Halgren, Eric
2010 Nov 1;53(2):707-717, Neuroimage
Repetition priming is a core feature of memory processing whose anatomical correlates remain poorly understood. In this study, we use advanced multimodal imaging (functional magnetic resonance imaging (fMRI) and magnetoencephalography; MEG) to investigate the spatiotemporal profile of repetition priming. We use intracranial electroencephalography (iEEG) to validate our fMRI/MEG measurements. Twelve controls completed a semantic judgment task with fMRI and MEG that included words presented once (new, 'N') and words that repeated (old, 'O'). Six patients with epilepsy completed the same task during iEEG recordings. Blood-oxygen level dependent (BOLD) responses for N vs. O words were examined across the cortical surface and within regions of interest. MEG waveforms for N vs. O words were estimated using a noise-normalized minimum norm solution, and used to interpret the timecourse of fMRI. Spatial concordance was observed between fMRI and MEG repetition effects from 350 to 450 ms within bilateral occipitotemporal and medial temporal, left prefrontal, and left posterior temporal cortex. Additionally, MEG revealed widespread sources within left temporoparietal regions, whereas fMRI revealed bilateral reductions in occipitotemporal and left superior frontal, and increases in inferior parietal, precuneus, and dorsolateral prefrontal activity. BOLD suppression in left posterior temporal, left inferior prefrontal, and right occipitotemporal cortex correlated with MEG repetition-related reductions. IEEG responses from all three regions supported the timecourse of MEG and localization of fMRI. Furthermore, iEEG decreases to repeated words were associated with decreased gamma power in several regions, providing evidence that gamma oscillations are tightly coupled to cognitive phenomena and reflect regional activations seen in the BOLD signal
— id: 134081, year: 2010, vol: 53, page: 707, stat: Journal Article,

DISRUPTIONS OF THE DEFAULT MODE NETWORK IN PATIENTS WITH PRIMARY GENERALIZED EPILEPSY
McGill, M.; Milhalm, M.; Carlson, C.; DuBois, J.; Quinn, B.; Wang, H.; Kuzniecky, R.; Devinsky, O.; French, J.; Halgren, E.; Castellano, X.; Thesen, T.
2010 JUN ;51(8):90-90, Epilepsia
— id: 112189, year: 2010, vol: 51, page: 90, stat: Journal Article,

Do tubers contain function? Resection of epileptogenic foci in perirolandic cortex in children with tuberous sclerosis complex
Moshel, Yaron A; Elliott, Robert; Teutonico, Federica; Sellin, Jonathan; Carlson, Chad; Devinsky, Orrin; Weiner, Howard L
2010 Jul;51(7):1242-1251, Epilepsia
PURPOSE: Surgical resection of single, dominant, epileptogenic lesions in patients with tuberous sclerosis complex (TSC) is now accepted as an effective therapy. However, patients with symptomatic tubers in eloquent cortex are sometimes not offered surgery because of the concern for postoperative neurologic morbidity. In this study, we examine our results in children undergoing surgery for resection of tubers and associated seizure foci in rolandic and perirolandic cortex. METHODS: Between 1998 and 2008, 52 pediatric patients (mean age 4 years) with TSC underwent epilepsy surgery at the NYU Comprehensive Epilepsy Center. Fifteen of these patients underwent multistage surgery for invasive mapping of seizure foci and surrounding functional cortex followed by resection of tubers/seizure foci in or near rolandic cortex. Data were retrospectively collected and neurologic outcomes were tabulated. RESULTS: Postoperatively, four patients (27%) had either new hemiparesis or worsening of a preexisting hemiparesis. However, all patients were back to their neurologic baselines at 3-month follow-up, yielding no permanent postoperative deficits. The modified Engel outcome was class I in nine patients (60%), class II in three patients (20%), class III in two patients (13%), and class IV in one patient (7%) after 40 months mean follow-up. DISCUSSION: Surgical resection of tubers and associated epileptogenic foci in rolandic and perirolandic cortex in children with TSC is feasible, with low neurologic morbidity, and yields good seizure control. These results suggest that tubers and perituberal epileptogenic foci can be safely resected even in eloquent regions because of reorganization of functional cortex or because these lesions contain no neurologic function
— id: 138143, year: 2010, vol: 51, page: 1242, stat: Journal Article,

Reliable change indices and regression-based measures for the Rey-Osterreith Complex Figure test in partial epilepsy patients
Nakhutina, L; Pramataris, P; Morrison, C; Devinsky, O; Barr, W B
2010 Jan;24(1):38-44, Clinical neuropsychologist
The Rey-Osterreith Complex Figure (ROCF) is commonly used in evaluations of patients undergoing epilepsy surgery. We assessed test-retest performance on ROCF in 30 partial epilepsy patients (mean interval = 33.7 months) to derive reliable change indices (RCIs) and regression-based measures for change. ROCF reproductions were rescored by three raters (IRR Copy: 0.963; Delayed Recall: 0.986). The derived adjusted RC (90% CI) cutoff values for the ROCF Copy were (<or=-6.5, >or=8.4) and were (<or=-6.8, >or=10.0) for the Delayed Recall. Results from regression-based analyses were negative, using age, education, seizure duration, and age of onset, whereas a baseline score was a significant predictor of a follow-up score. The results provide a means to evaluate long-term outcome in epilepsy patients using the ROCF
— id: 105958, year: 2010, vol: 24, page: 38, stat: Journal Article,

Effect of vicriviroc on the QT/corrected QT interval and central nervous system in healthy subjects
O'Mara, Edward; Kasserra, Claudia; Huddlestone, John Robert; Wan, Yuntao; Soni, Peter; Caceres, Maria; Medlock, Matthew; Morrison, Royce; Devinsky, Orrin
2010 Jun;54(6):2448-2454, Antimicrobial agents & chemotherapy
Vicriviroc is a CCR5 antagonist in clinical development for the treatment of HIV-1. Two phase I studies were conducted to assess the safety of vicriviroc. One study characterized the drug's potential to prolong the QT/corrected QT (QTc) interval and to induce arrhythmia. In this partially blind, parallel-group study, 200 healthy subjects aged 18 to 50 years were randomized in equal groups to the following regimens: (i) placebo for 9 days and a single dose of moxifloxacin at 400 mg on day 10, (ii) placebo, (iii) vicriviroc-ritonavir (30 and 100 mg), (iv) vicriviroc-ritonavir (150 and 100 mg), and (v) ritonavir (100 mg). The second study characterized the effects of a range of vicriviroc doses on the central nervous system (CNS). In this third-party-blind, parallel-group study, 30 healthy subjects aged 18 to 48 years were randomized to receive a single dose of either vicriviroc at 200, 250, or 300 mg or placebo, followed by multiple (seven) once-daily doses of either vicriviroc at 150, 200, or 250 mg or placebo, respectively. In the first study, vicriviroc produced no clinically meaningful effect on the QT/QTc interval when administered at a supratherapeutic or therapeutic dose concurrently with ritonavir. In the second study, vicriviroc produced no observable seizure activity, nor was it held to be associated with any clinically relevant changes in brain waveforms in the final consensus of reviewers. These findings showed that vicriviroc produced no clinically relevant QTc prolongation cardiac or epileptogenic effects in healthy individuals at exposures as high as five times those expected for HIV-infected patients receiving therapeutic doses of vicriviroc in a ritonavir-boosted protease inhibitor-containing regimen
— id: 134082, year: 2010, vol: 54, page: 2448, stat: Journal Article,

Bilateral intracranial electroencephalographic monitoring immediately following corpus callosotomy
Silverberg, Alyson; Parker-Menzer, Kimberly; Devinsky, Orrin; Doyle, Werner; Carlson, Chad
2010 Oct;51(10):2203-2206, Epilepsia
Although many patients with medically refractory focal epilepsy are candidates for resective surgery, patients with multifocal epilepsy and symptomatic generalized epilepsy remain difficult to treat medically and surgically. Corpus callosotomy has been utilized since 1940 for the treatment of seizures, with reports of efficacy in multiple seizure types. Previous studies have demonstrated subsequent lateralization of bilateral/bisynchronous epileptiform activity following callosotomy. To investigate the efficacy of bilateral intracranial electroencephalographic studies immediately following corpus callosotomy, we retrospectively identified 26 patients who underwent corpus callosotomy at our center, 18 of whom had intracranial monitoring following corpus callosotomy. Five of the 18 had focal resections following intracranial electroencephalography (EEG). No patients were seizure free following callosotomy or resection. No differences in postoperative outcomes were seen between patients with intracranial EEG versus those without
— id: 114166, year: 2010, vol: 51, page: 2203, stat: Journal Article,

Contributions to singing ability by the posterior portion of the superior temporal gyrus of the non-language-dominant hemisphere: first evidence from subdural cortical stimulation, Wada testing, and fMRI
Suarez, Ralph O; Golby, Alexandra; Whalen, Stephen; Sato, Susumu; Theodore, William H; Kufta, Conrad V; Devinsky, Orrin; Balish, Marshall; Bromfield, Edward B
2010 Mar;46(3):343-353, Cortex
INTRODUCTION: Although the substrates that mediate singing abilities in the human brain are not well understood, invasive brain mapping techniques used for clinical decision making such as intracranial electro-cortical testing and Wada testing offer a rare opportunity to examine music-related function in a select group of subjects, affording exceptional spatial and temporal specificity. METHODS: We studied eight patients with medically refractory epilepsy undergoing indwelling subdural electrode seizure focus localization. All patients underwent Wada testing for language lateralization. Functional assessment of language and music tasks was done by electrode grid cortical stimulation. One patient was also tested non-invasively with functional magnetic resonance imaging (fMRI). Functional organization of singing ability compared to language ability was determined based on four regions-of-interest (ROIs): left and right inferior frontal gyrus (IFG), and left and right posterior superior temporal gyrus (pSTG). RESULTS: In some subjects, electrical stimulation of dominant pSTG can interfere with speech and not singing, whereas stimulation of non-dominant pSTG area can interfere with singing and not speech. Stimulation of the dominant IFG tends to interfere with both musical and language expression, while non-dominant IFG stimulation was often observed to cause no interference with either task; and finally, that stimulation of areas adjacent to but not within non-dominant pSTG typically does not affect either ability. Functional fMRI mappings of one subject revealed similar music/language dissociation with respect to activation asymmetry within the ROIs. CONCLUSION: Despite inherent limitations with respect to strictly research objectives, invasive clinical techniques offer a rare opportunity to probe musical and language cognitive processes of the brain in a select group of patients
— id: 133473, year: 2010, vol: 46, page: 343, stat: Journal Article,

Ictal mnemestic aura and verbal memory function
Vederman, Aaron C; Holtzer, Roee; Zimmerman, Molly E; Devinsky, Orrin; Barr, William B
2010 Apr;17(4):474-477, Epilepsy & behavior
Deja vu aura is a well-known phenomenon experienced by some patients with epilepsy. This study sought to explore the relationship between verbal memory and the experience of deja vu or other types of mnemestic auras in 42 individuals with intractable seizures and 42 age- and education-matched patient controls. Verbal memory was assessed with indices of learning, long delay recall, and recognition from the California Verbal Learning Test. Results indicated that auras of any type were not associated with memory performance on the California Verbal Learning Test. As expected, age and education were related to verbal memory performance. Mnemestic auras were associated with clinical indices of illness, suggesting that the presence of these auras may be regarded as a risk factor for greater chronicity and severity in epilepsy
— id: 134083, year: 2010, vol: 17, page: 474, stat: Journal Article,

Historical perspectives and definitions of the postictal state
Widdess-Walsh, P; Devinsky, O
2010 Oct;19(2):96-99, Epilepsy & behavior
The postictal state and its features were recognized by physicians from Babylonian times through to the advent of modern neurology in the late 19th century. Among varied descriptions and definitions lies one of the best known and still used eponyms in medicine, Todd's paralysis. Despite a relative lack of biological insight, many key observations were made in an era mostly devoid of treatments for epilepsy
— id: 113801, year: 2010, vol: 19, page: 96, stat: Journal Article,

Forced spousal intercourse after seizures
Arnedo, Vanessa; Parker-Menzer, Kimberly; Devinsky, Orrin
2009 Nov;16(3):563-564, Epilepsy & behavior
Hypersexuality, a feature of Kluver-Bucy syndrome, is a rare but dramatic postictal symptom of temporal lobe epilepsy. We describe a 39-year-old patient with uncontrolled partial epilepsy who developed postictal periods of hypersexual aggression toward his wife after nocturnal convulsions. Following these seizures, he would have forced intercourse with his wife, followed by tremendous guilt and remorse when informed of his actions in the morning. Nocturnal convulsions and postictal hypersexuality resolved with a combination of lamotrigine and levetiracetam, more sleep, and stress management. The temporal features of the hypersexual behavior with respect to convulsions and the resolution of the behavior with seizure control support that aggressive hypersexuality can occur as a transient postictal behavioral change. The more intense nature of his symptoms compared with previously reported cases may reflect the occurrence of symptoms after tonic-clonic rather than partial seizures
— id: 105247, year: 2009, vol: 16, page: 563, stat: Journal Article,

AANTERIOR TEMPORAL LOBECTOMY & RADICAL AMYGDALOHIPPOCAMPECTOMY (ATLRA) FOR MESIAL TEMPORAL SCLEROSIS: PREOPERATIVE RISK FACTORS FOR LONG-TERM SEIZURE CONTROL IN A HIGHLY SELECTED POPULATION
Bollo, RJ; Elliott, RE; Berliner, JL; Silverberg, A; Geller, EB; Devinsky, O; Doyle, WK
2009 ;50:418-418, Epilepsia
— id: 106074, year: 2009, vol: 50, page: 418, stat: Journal Article,

Extraoperative functional mapping and staged resection of supratentorial tumors near eloquent cortex in children
Bollo, Robert J; Carlson, Chad; Schevon, Catherine; Wisoff, Jeffrey H; Devinsky, Orrin; Weiner, Howard L
2009 ;45(3):175-180, Pediatric neurosurgery
We present our technique for extraoperative functional mapping in awake children with supratentorial tumors near eloquent cortex. This technique may help optimize tumor resection and/or the functional outcome, especially when an awake craniotomy is not possible or in the setting of coincident seizures. After subdural electrode implantation, extraoperative functional mapping and seizure focus mapping were performed, followed by staged tumor resection. Gross total resection was achieved in 6 patients and subtotal resection in 2. No complications due to electrode placement or invasive monitoring were observed. Staged resection of pediatric brain tumors near the eloquent cortex appears safe, allows functional mapping in awake patients, and may assist in decisions between maximal tumor resection and optimal functional outcome
— id: 100605, year: 2009, vol: 45, page: 175, stat: Journal Article,

Expectations prior to epilepsy surgery: an exploratory comparison of men and women
Bower, C M; Hays, R D; Devinsky, O; Spencer, S S; Sperling, M R; Haut, S; Vassar, S; Vickrey, B G
2009 Apr;18(3):228-231, Seizure
Although the clinical goal of resective epilepsy surgery is seizure freedom, patients have a wide set of expectations for this invasive procedure. The goal of this study was to evaluate potential gender differences in expectations among patients undergoing resective epilepsy surgery. Ratings of the importance of 12 potential impacts ('expectations') of resective surgery were analyzed in a seven-center cohort study including 389 adults aged 16 and older who underwent resective epilepsy surgery. Men and women both ranked anticipated changes in driving and memory as the most important presurgical expectations. Women rated driving, physical activity limitations, and economic worries as less important, and fatigue and pregnancy concerns as more important than did men (p's< or =0.05). Exploratory factor analysis indicated a different pattern of associations among the 12 importance items for men and women. Whether gender differences in presurgical values are associated with outcomes needs exploration
— id: 139496, year: 2009, vol: 18, page: 228, stat: Journal Article,

Emotional recognition in depressed epilepsy patients
Brand, Jesse G; Burton, Leslie A; Schaffer, Sarah G; Alper, Kenneth R; Devinsky, Orrin; Barr, William B
2009 Jul;15(3):333-338, Epilepsy & behavior
The current study examined the relationship between emotional recognition and depression using the Minnesota Multiphasic Personality Inventory, Second Edition (MMPI-2), in a population with epilepsy. Participants were a mixture of surgical candidates in addition to those receiving neuropsychological testing as part of a comprehensive evaluation. Results suggested that patients with epilepsy reporting increased levels of depression (Scale D) performed better than those patients reporting low levels of depression on an index of simple facial recognition, and depression was associated with poor prosody discrimination. Further, it is notable that more than half of the present sample had significantly elevated Scale D scores. The potential effects of a mood-congruent bias and implications for social functioning in depressed patients with epilepsy are discussed
— id: 101883, year: 2009, vol: 15, page: 333, stat: Journal Article,

INTRA-OPERATIVE NEUROMOLECULAR IMAGING (NMI) IN NEOCORTEX OF EPILEPSY PATIENTS: COMPARISON WITH RESECTED EPILEPTOGENIC TISSUE
Broderick, PA; Doyle, WK; Pacia, SV; Kuzniecky, RI; Devinsky, O; Kolodny, EH
2009 NOV ;50(1):47-48, Epilepsia
— id: 106071, year: 2009, vol: 50, page: 47, stat: Journal Article,

QUANTITATIVE MAGNETIC RESONANCE IMAGING FINDINGS IN IDIOPATHIC GENERALIZED EPILEPSY
Carlson, C; DuBois, J; Marcuse, L; Kuzniecky, R; Devinsky, O; Boo, C; Mikhly, M; Blumberg, M; Thesen, T
2009 ;50:442-442, Epilepsia
— id: 106075, year: 2009, vol: 50, page: 442, stat: Journal Article,

Detecting nocturnal convulsions: Efficacy of the MP5 monitor
Carlson, Chad; Arnedo, Vanessa; Cahill, Maria; Devinsky, Orrin
2009 Apr;18(3):225-227, Seizure
Although the cause of sudden unexplained death in epilepsy patients (SUDEP) is unknown, evidence implicates respiratory compromise. Most cases occur while the patient is in bed and unsupervised. We investigated the efficacy of the Medpage bed seizure monitor to detect generalized tonic-clonic seizures. Patients with a history of tonic-clonic seizures were enrolled on a video-EEG unit. The MP5 device was placed between the mattress and bed base between midnight and 8:00 a.m. 64 subjects were enrolled (1528h). Five of eight tonic-clonic seizures were detected. There were 269 false positive alarms (146h with false positive alarms). The sensitivity and specificity of the alarm were 62.5% and 90.4%, respectively. The negative predictive value of 99.8% illustrates the potential for this device to provide additional security for patients with tonic-clonic seizures, however individual calibration would likely be necessary to improve the positive predictive value of 3.3%, which requires further validation
— id: 96912, year: 2009, vol: 18, page: 225, stat: Journal Article,

The Excitable Cerebral Cortex
Carlson, Chad; Devinsky, Orrin
2009 Jun;15(2):131-132, Epilepsy & behavior
— id: 96910, year: 2009, vol: 15, page: 131, stat: Journal Article,

The human K-complex represents an isolated cortical down-state
Cash, Sydney S; Halgren, Eric; Dehghani, Nima; Rossetti, Andrea O; Thesen, Thomas; Wang, Chunmao; Devinsky, Orrin; Kuzniecky, Ruben; Doyle, Werner; Madsen, Joseph R; Bromfield, Edward; Eross, Lorand; Halasz, Peter; Karmos, George; Csercsa, Richard; Wittner, Lucia; Ulbert, Istvan
2009 May 22;324(5930):1084-1087, Science
The electroencephalogram (EEG) is a mainstay of clinical neurology and is tightly correlated with brain function, but the specific currents generating human EEG elements remain poorly specified because of a lack of microphysiological recordings. The largest event in healthy human EEGs is the K-complex (KC), which occurs in slow-wave sleep. Here, we show that KCs are generated in widespread cortical areas by outward dendritic currents in the middle and upper cortical layers, accompanied by decreased broadband EEG power and decreased neuronal firing, which demonstrate a steep decline in network activity. Thus, KCs are isolated 'down-states,' a fundamental cortico-thalamic processing mode already characterized in animals. This correspondence is compatible with proposed contributions of the KC to sleep preservation and memory consolidation
— id: 114449, year: 2009, vol: 324, page: 1084, stat: Journal Article,

Delusional misidentifications and duplications: right brain lesions, left brain delusions
Devinsky, Orrin
2009 Jan 6;72(1):80-87, Neurology
When the delusional misidentification syndromes reduplicative paramnesia and Capgras syndromes result from neurologic disease, lesions are usually bifrontal and/or right hemispheric. The related disorders of confabulation and anosognosis share overlapping mechanisms and anatomic pathology. A dual mechanism is postulated for the delusional misidentification syndromes: negative effects from right hemisphere and frontal lobe dysfunction as well as positive effects from release (i.e., overactivity) of preserved left hemisphere areas. Negative effects of right hemisphere injury impair self-monitoring, ego boundaries, and attaching emotional valence and familiarity to stimuli. The unchecked left hemisphere unleashes a creative narrator from the monitoring of self, memory, and reality by the frontal and right hemisphere areas, leading to excessive and false explanations. Further, the left hemisphere's cognitive style of categorization, often into dual categories, leads it to invent a duplicate or impostor to resolve conflicting information. Delusions result from right hemisphere lesions. But it is the left hemisphere that is deluded
— id: 96911, year: 2009, vol: 72, page: 80, stat: Journal Article,

Neurofibromatosis: advances in molecular genetics, diagnosis, and treatment. Introduction
Devinsky, Orrin
2009 Spring;6(2):E45-E46, Reviews in Neurological Diseases
— id: 100631, year: 2009, vol: 6, page: E45, stat: Journal Article,

Norman Geschwind: influence on his career and comments on his course on the neurology of behavior
Devinsky, Orrin
2009 Aug;15(4):413-416, Epilepsy & behavior
Norman Geschwind (1926-1984) was a critical force in the emergence of behavioral neurology and neuropsychology as important disciplines in the 1960s and 1970s. Factors that influenced his early career are described, with extensive quotes from a document that Geschwind wrote in 1982, supplemented by interviews with his childhood friends, colleagues from his early career, and his daughter. He entered Harvard College as a math major, but became interested in psychology when he served in the Army infantry in World War II and observed soldiers who acted irrationally in combat. Returning to undergraduate studies, he was taught that knowledge of the brain would shed little light on behavior. His interest in behavioral neurology began with his medical student courses in physiology and neuroanatomy, where he first learned about epilepsy and aphasia. He then trained for 2 years at Queen Square, where his research focused on periodic paralysis, but was greatly influenced by the writings of Hughlings Jackson and Charles Bastian and the teachings of Sir Charles Symonds. Returning to Boston, Geschwind became Dr. Denny-Brown's Chief Resident at the Neurologic Unit of Boston City Hospital. Another unrecognized source of Norman Geschwind's intellectual legacy is the unpublished course he taught on The Neurology of Behavior at Harvard Medical School in the 1970s and 1980s. These lectures were an opportunity for Geschwind to formulate, share, and refine his ideas on behavioral neurology to an eclectic mixture of Boston academics, from linguists, philosophers, and anthropologists to physiologists and psychiatrists. From tape recordings of the Spring 1974 course, 10 lectures were transcribed. One of these slightly edited lectures, 'Personality Changes in Temporal Lobe Epilepsy,' is reproduced in this issue of Epilepsy & Behavior
— id: 101317, year: 2009, vol: 15, page: 413, stat: Journal Article,

Remembrance. In memoriam: Ed Bromfield, M.D., 1951-2009
Devinsky, Orrin
2009 Aug;15(4):402-403, Epilepsy & behavior
— id: 111660, year: 2009, vol: 15, page: 402, stat: Journal Article,

The influence of temporal lobectomy on the mental state of patients with psychomotor epilepsy. T. Alajouanine, J. Nehlil, R. Houdart Revue Neurol 1958;98(3):165-171
Devinsky, Orrin
2009 Sep;16(1):50-51, Epilepsy & behavior
— id: 102497, year: 2009, vol: 16, page: 50, stat: Journal Article,

Translations from history: Epilepsy and behavior
Devinsky, Orrin
2009 Mar;14(3):446-447, Epilepsy & behavior
— id: 134084, year: 2009, vol: 14, page: 446, stat: Journal Article,

STRUCTURAL BRAIN ABNORMALITIES IN POSTICTAL PSYCHOSIS
DuBois, J; Carlson, C; Kuzniecky, R; Devinsky, O; Alper, K; Blumberg, M; Mikhly, M; Starner, K; Thesen, T
2009 ;50:447-447, Epilepsia
— id: 106076, year: 2009, vol: 50, page: 447, stat: Journal Article,

VAGUS NERVE STIMULATION FOR REFRACTORY EPILEPSY: SINGLE SURGEON EXPERIENCE OF OVER 700 CONSECUTIVE OPERATIONS
Elliott, RE; Morsi, A; Kalhorn, S; Marcus, J; Sellin, J; Kang, M; Silverberg, A; Carlson, C; Geller, E; Devinsky, O; Doyle, W
2009 ;50:486-487, Epilepsia
— id: 106078, year: 2009, vol: 50, page: 486, stat: Journal Article,

Refractory epilepsy in tuberous sclerosis: Vagus nerve stimulation with or without subsequent resective surgery
Elliott, Robert E; Carlson, Chad; Kalhorn, Stephen P; Moshel, Yaron A; Weiner, Howard L; Devinsky, Orrin; Doyle, Werner K
2009 Nov;16(3):454-460, Epilepsy & behavior
OBJECTIVE: The goal of the work described here was to assess the efficacy and safety of vagus nerve stimulation in a cohort of patients with tuberous sclerosis complex with refractory epilepsy. Furthermore, we examined the impact of vagus nerve stimulation failure on the ultimate outcome following subsequent intracranial epilepsy surgery. METHODS: A retrospective review was performed on 19 patients with refractory epilepsy and TSC who underwent vagus nerve stimulator (VNS) implantation. There were 11 (58%) females and 8 (42%) males aged 2 to 44 years when the VNS was implanted (mean: 14.7+/-12 years). Twelve patients underwent primary VNS implantation after having failed a mean of 7.1 antiepileptic drugs. Two patients (17%) had generalized epilepsy, one had a single seizure focus, three (25%) had multifocal epilepsy, and six (50%) had multifocal and generalized epilepsy. Seven patients were referred for device removal and evaluation for intracranial procedures. One patient in the primary implantation group was lost to follow-up and excluded from outcome analysis. RESULTS: All implantations and removals were performed without permanent complications. The duration of treatment for primary VNS implants varied from 8.5 months to 9.6 years (mean: 4.9 years). Mean seizure frequency significantly improved following VNS implantation (mean reduction: 72%, P<0.002). Two patients had Engel Class I (18%), one had Class II (9%), seven had Class III (64%), and one had Class IV (9%) outcome. Three patients with poor response to vagus nerve stimulation therapy at our center underwent resection of one or more seizure foci (Engel Class I, two patients; Engel Class III, one patient). Seven patients referred to our center for VNS removal and craniotomy underwent seizure focus resection (6) or corpus callosotomy (1) (Engel Class II: 2, Engel III: 2; Engel IV: 3). In total, 8 of 10 (80%) patients experienced improved seizure control following intracranial surgery (mean reduction: 65%, range: 0-100%, P<0.05). CONCLUSIONS: VNS is a safe and effective treatment option for medically refractory epilepsy in patients with tuberous sclerosis complex. Nine of 11 patients (82%) experienced at least a 67% reduction in seizure burden. Lack of response to vagus nerve stimulation does not preclude subsequent improvement in seizure burden with intracranial epilepsy surgery
— id: 105245, year: 2009, vol: 16, page: 454, stat: Journal Article,

VAGUS NERVE STIMULATION IN PATIENTS WITH TUBEROUS SCLEROSIS COMPLEX: EFFICACY OF NEW IMPLANTATIONS AND ASSOCIATION OF DEVICE INEFFICACY WITH SUBSEQUENT OUTCOME OF INTRACRANIAL EPILEPSY SURGERY
Kalhorn, SP; Elliott, R; Carlson, C; Moshel, Y; Weiner, H; Devinsky, O; Doyle, W
2009 ;50:455-456, Epilepsia
— id: 106077, year: 2009, vol: 50, page: 455, stat: Journal Article,

Intracranial microprobe for evaluating neuro-hemodynamic coupling in unanesthetized human neocortex
Keller, Corey J; Cash, Sydney S; Narayanan, Suresh; Wang, Chunmao; Kuzniecky, Ruben; Carlson, Chad; Devinsky, Orrin; Thesen, Thomas; Doyle, Werner; Sassaroli, Angelo; Boas, David A; Ulbert, Istvan; Halgren, Eric
2009 May 15;179(2):208-218, Journal of neuroscience methods
Measurement of the blood-oxygen-level dependent (BOLD) response with fMRI has revolutionized cognitive neuroscience and is increasingly important in clinical care. The BOLD response reflects changes in deoxy-hemoglobin concentration, blood volume, and blood flow. These hemodynamic changes ultimately result from neuronal firing and synaptic activity, but the linkage between these domains is complex, poorly understood, and may differ across species, cortical areas, diseases, and cognitive states. We describe here a technique that can measure neural and hemodynamic changes simultaneously from cortical microdomains in waking humans. We utilize a 'laminar optode,' a linear array of microelectrodes for electrophysiological measures paired with a micro-optical device for hemodynamic measurements. Optical measurements include laser Doppler to estimate cerebral blood flow as well as point spectroscopy to estimate oxy- and deoxy-hemoglobin concentrations. The microelectrode array records local field potential gradients (PG) and multi-unit activity (MUA) at 24 locations spanning the cortical depth, permitting estimation of population trans-membrane current flows (Current Source Density, CSD) and population cell firing in each cortical lamina. Comparison of the laminar CSD/MUA profile with the origins and terminations of cortical circuits allows activity in specific neuronal circuits to be inferred and then directly compared to hemodynamics. Access is obtained in epileptic patients during diagnostic evaluation for surgical therapy. Validation tests with relatively well-understood manipulations (EKG, breath-holding, cortical electrical stimulation) demonstrate the expected responses. This device can provide a new and robust means for obtaining detailed, quantitative data for defining neurovascular coupling in awake humans
— id: 114450, year: 2009, vol: 179, page: 208, stat: Journal Article,

Epilepsy: Is localization-related epilepsy a progressive disorder? Maybe..
Kuzniecky, Ruben; Thesen, Thomas; Devinsky, Orrin
2009 Jul;5(7):356-357, Nature reviews. Neurology
— id: 101386, year: 2009, vol: 5, page: 356, stat: Journal Article,

Deficient Amygdala Responsivity to Positive Content May Underlie Positive Insensitivity in Depression: A Lesion Study
Levens, SM; Devinsky, O; Phelps, EA; Gotlib, IH
2009 APR 15 ;65(8):113-113, Biological psychiatry
— id: 104234, year: 2009, vol: 65, page: 113, stat: Journal Article,

Localized transmeningeal muscimol prevents neocortical seizures in rats and nonhuman primates: Therapeutic implications
Ludvig, Nandor; Baptiste, Shirn L; Tang, Hai M; Medveczky, Geza; von Gizycki, Hans; Charchaflieh, Jean; Devinsky, Orrin; Kuzniecky, Ruben I
2009 Apr;50(4):678-693, Epilepsia
Summary Purpose: To determine whether muscimol delivered epidurally or into the subarachnoid space can prevent and/or terminate acetylcholine (Ach)-induced focal neocortical seizures at concentrations not affecting behavior and background electroencephalography (EEG) activity. Methods: Rats (n = 12) and squirrel monkeys (n = 3) were chronically implanted with an epidural or subarachnoid drug delivery device, respectively, over the right frontal/parietal cortex, with adjacent EEG electrodes. Recordings were performed in behaving rats and chaired monkeys. Via the implants, either a control solution (artificial cerebrospinal fluid, ACSF) or muscimol (0.25-12.5 mm) was delivered locally as a 'pretreatment,' followed by the similar delivery of a seizure-inducing concentration of Ach. In five additional rats, the quantities of food-pellets consumed during epidural ACSF and muscimol (2.5 mm) exposures were measured. In a last group of four rats, muscimol (0.8-2.5 mm) was delivered epidurally during the ongoing, Ach-induced EEG seizure. Results: In contrast to ACSF pretreatments, epidural muscimol pretreatment in rats completely prevented the seizures at and above 2.5 mm. In the monkeys, subarachnoid muscimol pretreatments at 2.5 mm completely prevented the focal-seizure-inducing effect of Ach, whereas similar deliveries of ACSF did not affect the seizures. Furthermore, 2.5 mm epidural muscimol left the eating behavior of rats intact and caused only slight changes in the EEG power spectra. Finally, muscimol delivery during Ach-induced EEG seizures terminated the seizure activity within 1-3 min. Conclusions: The results of this study suggest that muscimol is a viable candidate for the transmeningeal pharmacotherapy of intractable focal epilepsy
— id: 95775, year: 2009, vol: 50, page: 678, stat: Journal Article,

Postictal psychosis in partial epilepsy: a case-control study
Alper, Kenneth; Kuzniecky, Ruben; Carlson, Chad; Barr, William B; Vorkas, Charles K; Patel, Jignasa G; Carrelli, Angela L; Starner, Karen; Flom, Peter L; Devinsky, Orrin
2008 May;63(5):602-610, Annals of neurology
OBJECTIVE: Divergent findings among prior studies on correlates of risk for postictal psychosis (PIP) suggest the value of a controlled study involving a relatively large number of patients. METHODS: The study population consisted of a consecutive series of 59 patients with partial epilepsy and a history of PIP, and 94 control patients with partial epilepsy and no history of PIP evaluated as inpatients with video-electroencephalography. The groups did not differ significantly regarding demographic features. Exact tests yielded a subset of variables and a tentative interpretation that were evaluated further utilizing principal components analysis and logistic regression. RESULTS: PIP was associated with extratemporal versus temporal (p = 0.036) or undetermined (p = 0.001) localization of seizure onset, bilateral interictal epileptiform activity (p = 0.017), secondary generalization (p = 0.049), and history of encephalitis (p = 0.018). Interictal slow activity was more frequently absent in control patients (p = 0.045). PIP was associated with family histories of psychiatric disorders (p = 0.007) and epilepsy (p = 0.042), which themselves were significantly intercorrelated (r = 0.225; p = 0.006). Age of onset or duration of epilepsy and lateralized electroencephalographic or magnetic resonance imaging asymmetries did not differ significantly between control and PIP groups. The analysis indicated four underlying domains of risk for PIP: ambiguous/extratemporal localization, family neuropsychiatric history, abnormal interictal electroencephalographic activity, and encephalitis. Each unit increase on a simple additive scale composed of 9 dichotomous independent variables multiplied the odds ratio for PIP by 1.71 (95% confidence interval, 1.36-2.15; p < 0.0001). INTERPRETATION: PIP in partial epilepsy is associated with relatively broadly and bilaterally distributed epileptogenic networks, genetic determinants of psychiatric disorders and seizures, and encephalitis
— id: 79550, year: 2008, vol: 63, page: 602, stat: Journal Article,

Quantitative measures of assessment
Baker, Gus; Devinsky, Orrin
Epilepsy : a comprehensive textbook Philadelphia PA : Wolters Kluwer/Lippincott Williams & Wilkins, 2008,
— id: 5447, year: 2008, vol: ?, page: ?, stat: Chapter,

EPIDURAL AND SUBDURAL MUSCIMOL DELIVERIES IN RATS AND MONKEYS, RESPECTIVELY, PREVENT FOCAL SEIZURES AT CONCENTRATIONS THAT CAUSE NO BEHAVIORAL SIDE-EFFECTS
Baptiste, SL; Tang, HM; Devinsky, O; Kuzniecky, RI; Charchaflieh, J; von Gizycki, H; Ludvig, N
2008 DEC ;49(12):375-376, Epilepsia
— id: 91398, year: 2008, vol: 49, page: 375, stat: Journal Article,

Multistage epilepsy surgery: safety, efficacy, and utility of a novel approach in pediatric extratemporal epilepsy
Bauman, Joel A; Feoli, Enrique; Romanelli, Pantaleo; Doyle, Werner K; Devinsky, Orrin; Weiner, Howard L
2008 Feb;62 Suppl 2:489-505, Neurosurgery
OBJECTIVE: To evaluate the safety, efficacy, and utility of a novel surgical strategy consisting of multiple (more than two) operative stages performed during the same hospital admission with subdural grid and strip electrodes in selected pediatric extratemporal epilepsy. METHODS: Subdural grid and strip electrodes were used for multistage chronic electroencephalographic monitoring in 15 pediatric patients (age, <19 yr) with refractory localization-related epilepsy and poor surgical prognostic factors. Initial resective surgery and/or multiple subpial transections were performed, followed by further monitoring and additional resection and/or multiple subpial transections. RESULTS: Mean patient age was 9.7 years. Mean duration of total invasive monitoring was 10.5 days (range, 8-14 d). The first monitoring period averaged 6.5 days, and the second averaged 3.9 days. Additional surgery was performed in 13 of 15 patients. Two patients who did not undergo additional surgery had a Class I outcome. Rationales for reinvestigation included incomplete localization, multifocality, and proximity to eloquent cortex. Complications were minimal, including two transfusions. There were no cases of wound infection, cerebral edema, hemorrhage, or major permanent neurological deficit. Minimum duration of follow-up was 31 months. Outcomes were 60% Engel Class I (9 of 15 patients), 27% Class III (4 of 15 patients), and 13% Class IV (2 of 15 patients). CONCLUSION: In a very select group of pediatric patients with poor surgical prognostic factors, the multistage approach can be beneficial. After failed epilepsy surgery, subsequent reoperation with additional intracranial investigation traditionally is used when a single residual focus is suspected. Our results, however, support the contention that multistage epilepsy surgery is safe, effective, and useful in a challenging and select pediatric population with extratemporal medically refractory epilepsy
— id: 86949, year: 2008, vol: 62 Suppl 2, page: 489, stat: Journal Article,

Epilepsy surgery and tuberous sclerosis complex: special considerations
Bollo, Robert J; Kalhorn, Stephen P; Carlson, Chad; Haegeli, Veronique; Devinsky, Orrin; Weiner, Howard L
2008 Sep;25(3):E13-E13, Neurosurgical focus
Epilepsy surgery for medically refractory seizures among patients with tuberous sclerosis complex (TSC) is a well-accepted treatment option. Many epilepsy centers around the world have published their experience over the past several years, supporting the idea that the best seizure control is obtained when a single tuber and associated epileptogenic zone is documented and targeted surgically. Recent advances in imaging and physiological techniques that reveal the epileptogenic zone have been used successfully in children with TSC who are being evaluated for surgery. As a result, a number of different surgical strategies have emerged, each reflecting the experience, strengths, and referral biases of the individual treating teams. Experience suggests that some patients with TSC who present with seizures that are difficult to localize and do not meet the classic selection criteria for epilepsy surgery may, nevertheless, benefit from surgery. Tuberectomy alone is often not sufficient for obtaining seizure control. Intracranial electrode recordings performed in a large number of children with TSC undergoing epilepsy surgery have raised new questions about the relationship of the cortical tuber to the epileptogenic zone in TSC. A careful assessment of the risks and benefits of any surgical strategy, compared with those associated with continued refractory epilepsy, should be considered by the treating team in conjunction with the patient's family. Epilepsy surgery has not only benefited many children with TSC, but it also facilitates the understanding of epileptogenesis in TSC
— id: 86950, year: 2008, vol: 25, page: E13, stat: Journal Article,

Emotional recognition ability in patients with epileptic vs. non-epileptic seizures
Brand, JG; Barr, WB; Schaffer, SG; Burton, LA; Alper, KR; Devinsky, O
2008 SEP ;22(4):747-747, Clinical neuropsychologist
— id: 104236, year: 2008, vol: 22, page: 747, stat: Journal Article,

Outcome of extratemporal epilepsy surgery experience of a single center - Comments
Clusmann, H; Schramm, J; Doyle, WK; Devinsky, O
2008 SEP ;63(3):525-526, Neurosurgery
— id: 104235, year: 2008, vol: 63, page: 525, stat: Journal Article,

Epilepsy : patient and family guide
Devinsky, Orrin
New York : Demos Medical Pub, 2008,
— id: 2262, year: 2008, vol: , page: , stat: ,

Behavioral neurology. The neurology of Capgras syndrome
Devinsky, Orrin
2008 Spring;5(2):97-100, Reviews in Neurological Diseases
— id: 86656, year: 2008, vol: 5, page: 97, stat: Journal Article,

Postictal psychosis: common, dangerous, and treatable
Devinsky, Orrin
2008 Mar-Apr;8(2):31-34, Epilepsy currents
'Occasionally, after a fit, or, more frequently, after a series of fits, an attack of mental disturbance may come on which lasts for several days. It may be simply a demented state, or there may be hallucinations, with irritability and even violence (1).'
— id: 96913, year: 2008, vol: 8, page: 31, stat: Journal Article,

Chapter 21 Visual agnosia
Devinsky, Orrin; Farah, Martha J; Barr, William B
2008 ;88:417-427, Handbook of clinical neurology
— id: 95084, year: 2008, vol: 88, page: 417, stat: Journal Article,

Spirituality and religion in epilepsy
Devinsky, Orrin; Lai, George
2008 May;12(4):636-643, Epilepsy & behavior
Revered in some cultures but persecuted by most others, epilepsy patients have, throughout history, been linked with the divine, demonic, and supernatural. Clinical observations during the past 150 years support an association between religious experiences during (ictal), after (postictal), and in between (interictal) seizures. In addition, epileptic seizures may increase, alter, or decrease religious experience especially in a small group of patients with temporal lobe epilepsy (TLE). Literature surveys have revealed that between .4% and 3.1% of partial epilepsy patients had ictal religious experiences; higher frequencies are found in systematic questionnaires versus spontaneous patient reports. Religious premonitory symptoms or auras were reported by 3.9% of epilepsy patients. Among patients with ictal religious experiences, there is a predominance of patients with right TLE. Postictal and interictal religious experiences occur most often in TLE patients with bilateral seizure foci. Postictal religious experiences occurred in 1.3% of all epilepsy patients and 2.2% of TLE patients. Many of the epilepsy-related religious conversion experiences occurred postictally. Interictal religiosity is more controversial with less consensus among studies. Patients with postictal psychosis may also experience interictal hyper-religiosity, supporting a 'pathological' increase in interictal religiosity in some patients. Although psychologic and social factors such as stigma may contribute to religious experiences with epilepsy, a neurologic mechanism most likely plays a large role. The limbic system is also often suggested as the critical site of religious experience due to the association with temporal lobe epilepsy and the emotional nature of the experiences. Neocortical areas also may be involved, suggested by the presence of visual and auditory hallucinations, complex ideation during many religious experiences, and the large expanse of temporal neocortex. In contrast to the role of the temporal lobe in evoking religious experiences, alterations in frontal functions may contribute to increased religious interests as a personality trait. The two main forms of religious experience, the ongoing belief pattern and set of convictions (the religion of the everyday man) versus the ecstatic religious experience, may be predominantly localized to the frontal and temporal regions, respectively, of the right hemisphere
— id: 79296, year: 2008, vol: 12, page: 636, stat: Journal Article,

Procedures in patients with epilepsy
Devinsky, Orrin; Nordli, Douglas R
Epilepsy : a comprehensive textbook Philadelphia PA : Wolters Kluwer/Lippincott Williams & Wilkins, 2008,
— id: 5445, year: 2008, vol: ?, page: ?, stat: Chapter,

Personality disorders
Devinsky, Orrin; Vorkas, Charles; Barr, William B; Hermann, Bruce P
Epilepsy : a comprehensive textbook Philadelphia PA : Wolters Kluwer/Lippincott Williams & Wilkins, 2008,
— id: 5444, year: 2008, vol: ?, page: ?, stat: Chapter,

Glioma-like proliferation within tissues excised as tubers in patients with tuberous sclerosis complex
Fischer, Ingeborg; Cunliffe, Clare; Bollo, Robert J; Weiner, Howard L; Devinsky, Orrin; Ruiz-Tachiquin, Martha-Eugenia; Venuto, Toni; Pearlman, Alexander; Chiriboga, Luis; Schneider, Robert J; Ostrer, Harry; Miller, Douglas C
2008 Jul;116(1):67-77, Acta neuropathologica
We describe diffuse glioma-like infiltrates in excised tubers in five out of forty Tuberous sclerosis complex (TSC) patients undergoing excision of a tuber at our institution within the last 10 years. All patients presented with refractory seizures. Resection specimens from four patients had the pathognomonic histologic features of neuroglial hamartomas (tubers) and in one case there was cortical microdysgenesis lacking cells typical of TSC. All lesions were associated with an infiltrate of atypical, mostly elongate, glioma-like small cells, which were immunoreactive for GFAP in three, and pS6 (a marker for activity of the mTOR pathway), in two cases. MAP-2 and CD34, were negative and MIB-1 (Ki67) immunostains ranged from <1-21%. Array-based comparative genomic hybridization revealed that these proliferative phenomena were associated with 21 different copy number aberrations in comparison with a tuber without atypical infiltrates. Postoperatively (follow-up period ranging from 8 to 34 months) none of the patients have any evidence of a glioma. We report that tubers resected for treatment of seizures are sometimes associated with glioma-like lesions, which are indistinguishable from infiltrating gliomas by morphology and immunohistochemistry. Genomic analysis with SNP arrays revealed copy number changes which may be associated with the pathogenesis of such infiltrates
— id: 79446, year: 2008, vol: 116, page: 67, stat: Journal Article,

Temporal lobe epilepsy does not impair visual perception
Grant, Arthur C; Donnelly, Kiely M; Chubb, Charlie; Barr, William B; Kuzniecky, Ruben; Devinsky, Orrin
2008 Apr;49(4):710-713, Epilepsia
Temporal lobe epilepsy (TLE) can impair interictal cognitive function. In the perceptual domain, previous psychophysical studies demonstrated specific deficits in auditory and tactile perception in patients with TLE. This study compared performance of 25 TLE subjects and 27 controls on two low-level, visual tasks: luminance discrimination and frequency discrimination. Both tasks were performed under a relatively easy and a relatively difficult condition, by adjusting the stimulus duration. TLE subjects performed as well as controls on both tasks at both stimulus durations. These results imply that interictal occipital lobe function, as reflected in performance on low-level visual tasks, is not impaired in TLE, consistent with functional imaging data. Furthermore, since TLE subjects performed normally while taking therapeutic doses of multiple AEDs, the data suggest that these AEDs do not impair visual perception
— id: 95086, year: 2008, vol: 49, page: 710, stat: Journal Article,

Use of the WAIS-III/WMS-III six factor structure in left and right temporal lobe epilepsy
Karantzoulis, S; Morrison, CE; Barr, WB; Devinsky, O
2008 MAR 11 ;22(3):409-410, Clinical neuropsychologist
— id: 104240, year: 2008, vol: 22, page: 409, stat: Journal Article,

Levetiracetam has no acute effects on brain gamma-aminobutyric acid levels
Kuzniecky, R; Pan, J; Burns, A; Devinsky, O; Hetherington, H
2008 Feb;12(2):242-244, Epilepsy & behavior
OBJECTIVE: The mechanism of action of levetiracetam (LEV), an antiepileptic drug, is related to a novel binding site, SV2, but LEV acts on GABA-A receptors. The objective of the study described here was to determine if LEV modulates brain GABA in vivo. METHODS: Concentrations of cerebral GABA and serum LEV were obtained in seven healthy individuals using 1H magnetic resonance spectroscopy at baseline and 3 and 6 hours following oral administration of 1 g of LEV. RESULTS: Brain cerebral GABA acutely concentrations did not change from baseline. CONCLUSION: The results indicate that LEV does not increase human cerebral GABA concentrations acutely in healthy individuals
— id: 76394, year: 2008, vol: 12, page: 242, stat: Journal Article,

Histological evidence for drug diffusion across the cerebral meninges into the underlying neocortex in rats
Ludvig, Nandor; Sheffield, Lynette G; Tang, Hai M; Baptiste, Shirn L; Devinsky, Orrin; Kuzniecky, Ruben I
2008 Jan 10;1188:228-232, Brain research
Transmeningeal pharmacotherapy has been proposed to treat neurological disorders with localized pathology, such as intractable focal epilepsy. As a step toward understanding the diffusion and intracortical spread of transmeningeally delivered drugs, the present study used histological methods to determine the extent to which a marker compound, N-methyl-D-aspartate (NMDA), can diffuse into the neocortex through the meninges. Rats were implanted with bilateral parietal cortical epidural cups filled with 50 mM NMDA on the right side and artificial cerebrospinal fluid (ACSF) in the contralateral side. After 24 h, the histological effects of these treatments were evaluated using cresyl violet (Nissl) staining. The epidural NMDA exposure caused neuronal loss that in most animals extended from the pial surface through layer V. The area indicated by this neuronal loss was localized to the neocortical region underlying the epidural cup. These results suggest that NMDA-like, water soluble, small molecules can diffuse through the subdural/subarachnoid space into the underlying neocortex and spread in a limited fashion, close to the meningeal penetration site
— id: 79135, year: 2008, vol: 1188, page: 228, stat: Journal Article,

Effects of subdural application of lidocaine in patients with focal epilepsy
Madhavan, Deepak; Mirowski, Piotr; Ludvig, Nandor; Carlson, Chad; Doyle, Werner; Devinsky, Orrin; Kuzniecky, Ruben
2008 Feb;78(2-3):235-239, Epilepsy research
Antiepileptic drug (AED) delivery directly into the neocortex has recently been shown to be able to both prevent and terminate focal seizures in rats. The present clinical experiment aimed to test the local effects of lidocaine delivered onto the pia mater adjacent to epileptogenic zones in human patients. Administration of lidocaine resulted in a marked diminishment of spike counts on all patients, with a decremental effect of lidocaine on the faster frequency elements of individual spikes and overall testing epochs. The direct cortical application of lidocaine appears to affect local epileptogenic activity in human patients with intractable focal epilepsy
— id: 78353, year: 2008, vol: 78, page: 235, stat: Journal Article,

Immunology and epilepsy
Najjar, Souhel; Bernbaum, Melissa; Lai, George; Devinsky, Orrin
2008 Summer;5(3):109-116, Reviews in Neurological Diseases
Immune mechanisms play a critical role in systemic disorders (systemic lupus erythematosus, Sjogren's syndrome, Crohn's disease, and sarcoidosis) and in localized central nervous system (CNS) disorders (CNS vasculitis, multiple sclerosis, acute disseminated encephalomyelitis, and encephalitides). Both humoral and cell-mediated mechanisms are involved in the systemic and CNS-limited disorders. Immune mechanisms may also be a factor in a number of epilepsies such as Rasmussen's encephalitis, Lennox-Gastaut syndrome, Landau-Kleffner syndrome, and temporal lobe epilepsy. Immunologic abnormalities are found in routine epilepsy surgical specimens, suggesting a broader role of immunopathology in the etiology of epilepsy. The prevalence and impact of immunopathology in epilepsy syndromes remains to be determined by future research
— id: 91975, year: 2008, vol: 5, page: 109, stat: Journal Article,

UTILITY OF BILATERAL SUBDURAL ELECTRODE IMPLANTATION FOLLOWING CORPUS CALLOSOTOMY IN PATIENTS WITH POORLY LOCALIZED, MEDICALLY REFRACTORY EPILEPSY
Silverberg, A; Menzer, KP; Devinsky, O; Doyle, WK; Carlson, C
2008 DEC ;49(12):306-306, Epilepsia
— id: 91396, year: 2008, vol: 49, page: 306, stat: Journal Article,

Effects of vagus nerve stimulation on cardiovascular regulation in patients with epilepsy
Stemper, B; Devinsky, O; Haendl, T; Welsch, G; Hilz, M J
2008 Apr;117(4):231-236, Acta neurologica Scandinavica
OBJECTIVE: To evaluate the impact of vagus nerve stimulation (VNS) on heart rate and blood pressure (BP) modulation in epilepsy patients. MATERIAL AND METHODS: Twenty-one epilepsy patients with VNS were tested during on (60 s) and off (5 min) phases. We monitored BP, RR intervals (RRI) and respiration. Spectral analysis was performed in low- (LF: 0.04-0.15 Hz) and high-frequency bands (HF: 0.15-0.5 Hz). For coherences above 0.5, we calculated the LF transfer function between systolic BP and RRI, and the HF transfer function gain and phase between RRI and respiration. Differences between the on and off phases were evaluated using Wilcoxon test. RESULTS: VNS did not change RRI and BP values. The LF power of BP and the LF and HF power of RRI increased significantly. There was a slight change in the RRI/BP LF gain and the RRI/respiration HF gain (ns). The HF phase between RRI and respiration decreased significantly. CONCLUSIONS: Our findings show that VNS influences both sympathetic and parasympathetic cardiovascular modulation. However, our results also show that VNS does not negatively influence autonomic cardiovascular regulation
— id: 104796, year: 2008, vol: 117, page: 231, stat: Journal Article,

EVIDENCE FOR INCREASED NEURONAL ELECTROPHYSIOLOGICAL ACTIVITY BEFORE EEG SEIZURE ONSET IN THE RAT NEOCORTICAL SEIZURE FOCUS
Tang, HM; Mirowski, P; Baptiste, SL; Devinsky, O; Kuzniecky, RI; Ludvig, N
2008 DEC ;49(12):382-382, Epilepsia
— id: 91399, year: 2008, vol: 49, page: 382, stat: Journal Article,

EPILEPSY SURGERY FOR CHILDREN WITH TUBEROUS SCLEROSIS COMPLEX AND MULTI-FOCAL EEG FINDINGS
Teutonico, F; Carlson, C; LaJoie, J; Miles, D; Devinsky, O; Weiner, HL
2008 DEC ;49(12):297-297, Epilepsia
— id: 91395, year: 2008, vol: 49, page: 297, stat: Journal Article,

Epilepsy surgery in tuberous sclerosis complex: early predictive elements and outcome
Teutonico, F; Mai, R; Devinsky, O; Lo Russo, G; Weiner, H L; Borrelli, P; Balottin, U; Veggiotti, P
2008 Dec;24(12):1437-1445, Child's nervous system : ChNS
AIM: The aim of the study was to evaluate the surgical treatment of epilepsy and detection of possible early surgery predictive elements in patients with tuberous sclerosis complex (TSC). MATERIALS AND METHODS: Forty-two TSC patients with epilepsy were selected and divided into two main groups: definite and fruste forms. Definite forms were divided into different groups: patients with pharmacologically controlled epilepsy, patients with pharmacoresistant epilepsy excluded from surgery after an extensive presurgical assessment, and patients with a pharmacoresistant epilepsy who underwent surgery. We compared the definite TSC groups to identify elements that predict surgical candidacy. Second, we compared all operated patients to assess surgical outcome. CONCLUSION: We found several factors that could predict a surgical intervention even if identification of patients with refractory epilepsy who can benefit from surgery is an evolving process. Also, several positive factors for good surgical outcome were identified. Patients with the fruste form had excellent surgical outcome
— id: 139497, year: 2008, vol: 24, page: 1437, stat: Journal Article,

Epilepsy and dental procedures. A review
Vorkas, Charles K; Gopinathan, Manju K; Singh, Anuradha; Devinsky, Orrin; Lin, Louis M; Rosenberg, Paul A
2008 Mar;74(2):39-43, New York state dental journal
This paper is a review of the dental management of patients with epilepsy. It includes discussion of the effects anti-epileptic drugs have on dental procedures and addresses complications and side effects of these drugs. A clinical case photo is presented to show gingival hyperplasia, along with four tables on which common antiepileptic medications are enumerated
— id: 79305, year: 2008, vol: 74, page: 39, stat: Journal Article,

Worsening of generalized epilepsy with the anti-epileptic drug oxcarbazepine
Widdess-Walsh, P; Bojko, A; Geller, E; Goldberg, R; Nadkarni, M; Devinsky, O
2008 MAR 11 ;70(11):A74-A74, Neurology
— id: 104239, year: 2008, vol: 70, page: A74, stat: Journal Article,

Gender and major depression in a sample of epilepsy patients
Wolkin, JR; Barr, WB; Alper, KR; Zemon, V; Devinsky, O
2008 SEP ;22(4):747-747, Clinical neuropsychologist
— id: 104237, year: 2008, vol: 22, page: 747, stat: Journal Article,

Frequency and predictors of autism in children with tuberous sclerosis complex
Zelleke, TZ; Rubin, MR; Cohen, BC; Lai, GL; LaJoie, JL; Miles, DM; Devinsky, OD; Zaroff, CZ; MacAllister, WM; Weiner, HW; Nass, RN
2008 SEP ;64(3):S115-S115, Annals of neurology
— id: 104238, year: 2008, vol: 64, page: S115, stat: Journal Article,

Treatment of physicians with epilepsy
Allen, Jason W; Devinsky, Orrin
2007 Sep 25;69(13):1374-1379, Neurology
BACKGROUND: Physicians with epilepsy (physician-patients) are an understudied, unique patient population due to the potential adverse outcomes that seizures or medication side effects might have on patients under their care, as well as their ability to modify treatments without consulting treating physicians. We examine the effect epilepsy has upon physician-patients as well as surveying epileptologists on their views and experiences in treating physician-patients. METHODS: We reviewed charts to assess the clinical course of all physician-patients treated and distributed a questionnaire to active physician-patients at our epilepsy center. We surveyed epileptologists throughout the United States on their experience and views on treating physician-patients. RESULTS: Seventy-three percent of responding physician-patients experienced seizures while in a medical setting, 55% while interacting with patients, and 18% during invasive procedures. Eighteen percent of physician-patients felt seizures impacted their work and 9% were on disability secondary to epilepsy. Among epileptologists surveyed, 35% would counsel and manage physician-patients differently than other patients and 26% favored establishing guidelines or regulations governing physician-patients. The majority of physician--patients and one-third of epileptologists felt that physician-patients were most analogous to professions that are currently regulated by the federal government. CONCLUSION: This study highlights the diverse ways that epilepsy can affect physician-patients and the challenges that arise in treating this unique patient population
— id: 74408, year: 2007, vol: 69, page: 1374, stat: Journal Article,

Vagus nerve stimulation in children with mitochondrial electron transport chain deficiencies
Arthur, Todd M; Saneto, Russell P; de Menezes, Marcio Sotero; Devinsky, Orrin; Lajoie, Josiane; Murphy, Patricia J; Cook, William B; Ojemann, Jeffrey G
2007 Jul;7(4):279-283, Mitochondrion
We retrospectively investigated outcome data for vagus nerve stimulation (VNS) in children less than 12 years of age with intractable seizures and mitochondrial disease. Five children with a mitochondrial disease, due to electron transport chain deficiency, were studied. Information was collected from clinic visits prior to, and subsequent to, VNS implantation. Data were collected by type and frequency of seizures, encephalogram and neuroimaging findings, and medication history. Four of the children had predominantly myoclonic seizures, while the other child had focal seizures with secondary generalization and myoclonic seizures. All five children did not have significant reduction in seizure frequency with VNS. VNS may not be an effective method to control myoclonic seizures in children with electron transport chain disorders
— id: 95781, year: 2007, vol: 7, page: 279, stat: Journal Article,

Seizure outcome after resection of supratentorial cavernous malformations: a study of 168 patients
Baumann, Christian R; Acciarri, Nicola; Bertalanffy, Helmut; Devinsky, Orrin; Elger, Christian E; Lo Russo, Giorgio; Cossu, Massimo; Sure, Uli; Singh, Anuradha; Stefan, Hermann; Hammen, Tilo; Georgiadis, Dimitrios; Baumgartner, Ralf W; Andermann, Frederick; Siegel, Adrian M
2007 Mar;48(3):559-563, Epilepsia
PURPOSE: The optimal management of cerebral cavernous malformations (CCMs) with epileptic seizures is still a matter of debate. The aim of our study was to examine seizure outcome in the largest published series of surgically treated patients with epilepsy due to a supratentorial CCM, and to define predictors for good surgical outcome. METHODS: We retrospectively studied 168 consecutive patients with a single supratentorial CCM and symptomatic epilepsy in a multicenter study. Pre- and postoperative clinical examinations, age at epilepsy onset, age at operation, type of symptoms due to the CCM (seizures, headache, hemorrhage, focal deficits), type and frequency of epileptic seizures, and the localization and size of the CCM were assessed. Seizure outcome was determined in the first, second, and third postoperative years. RESULTS: The CCM was completely resected in all patients. More than two thirds of the patients were classified as seizure free in the first 3 postoperative years. Predictors for good seizure outcome were age older than 30 years at the time of surgery, mesiotemporal CCM localization, CCM size <1.5 cm, and the absence of secondarily generalized seizures. No mortality occurred in our series, but only mild postoperative neurologic deficits in 12 (7%) patients. CONCLUSIONS: Considering the natural history of CCMs, the favorable neurologic and seizure outcome, surgical resection of CCMs should be considered in all patients with supratentorial CCMs and concomitant epilepsy, irrespective of the presence or absence of predictors for a favorable seizure outcome
— id: 71158, year: 2007, vol: 48, page: 559, stat: Journal Article,

Women with epilepsy: hormonal issues from menarche through menopause
Cramer, Joyce A; Gordon, Jacki; Schachter, Steven; Devinsky, Orrin
2007 Sep;11(2):160-178, Epilepsy & behavior
Epilepsy is a multilayered disorder complicated by numerous comorbid conditions and hormonal changes. More than 1.5 million girls and women with epilepsy face side effects that are compounded at different ages by menstruation, fertility, pregnancy, fetal health, bone health, and other health issues. Changes in hormonal balance during maturation, from menarche through menopause, affect seizure thresholds and antiepileptic drugs, and vice versa. This overview provides physicians with a background on the multiple issues relevant to women of all ages in the reproductive years, including those planning to conceive and those who are pregnant, and beyond the childbearing years
— id: 134087, year: 2007, vol: 11, page: 160, stat: Journal Article,

How to get the answer to nearly everything: Using the internet for epilepsy research
Devinsky, O; Lammert, W
2007 JUL ;48(7):1420-1421, Epilepsia
— id: 73978, year: 2007, vol: 48, page: 1420, stat: Journal Article,

Is behavior in temporal lobe epilepsy different than in other epilepsies? The jury is out
Devinsky, Orrin
2007 Jul-Aug;7(4):95-96, Epilepsy currents
— id: 134088, year: 2007, vol: 7, page: 95, stat: Journal Article,

Temporal lobe epilepsy does not impair visual perception
Donnelly, K; Barr, W; Kuzniecky, R; Devinsky, O; Grant, AC
2007 OCT ;48(4):237-237, Epilepsia
— id: 104241, year: 2007, vol: 48, page: 237, stat: Journal Article,

Pre-attentive processing of auditory stimuli : a human intracranial study of generators of mismatch negativity for phonemic and non-phonemic sounds
Fiebelkorn I; Sehatpour P; De Sanctis P; Thesen T; Devinsky O; Molholm S; Foxe JJ
2007 ;:181-181 #E92, Annual meeting abstract program (Cognitive Neuroscience Society)
— id: 74456, year: 2007, vol: , page: 181, stat: Journal Article,

Preictal increases in multi-unit firing inpatients with intractable focal epilepsy
Gopal, AA; Meng, NF; Melinosky, C; Bromfield, E; Cole, AJ; Devinsky, O; Doyle, W; Eskandar, E; Madsen, JR; Ulbert, I; Halgren, E; Cash, SS
2007 OCT ;48(4):309-310, Epilepsia
— id: 104243, year: 2007, vol: 48, page: 309, stat: Journal Article,

Quantifying deficits in the perception of fear and anger in morphed facial expressions after bilateral amygdala damage
Graham, Reiko; Devinsky, Orrin; Labar, Kevin S
2007 Jan 7;45(1):42-54, Neuropsychologia
Amygdala damage has been associated with impairments in perceiving facial expressions of fear. However, deficits in perceiving other emotions, such as anger, and deficits in perceiving emotion blends have not been definitively established. One possibility is that methods used to index expression perception are susceptible to heuristic use, which may obscure impairments. To examine this, we adapted a task used to examine categorical perception of morphed facial expressions [Etcoff, N. L., & Magee, J. J. (1992). Categorical perception of facial expressions. Cognition, 44(3), 227-240]. In one version of the task, expressions were categorized with unlimited time constraints. In the other, expressions were presented with limited exposure durations to tap more automatic aspects of processing. Three morph progressions were employed: neutral to anger, neutral to fear, and fear to anger. Both tasks were administered to a participant with bilateral amygdala damage (S.P.), age- and education-matched controls, and young controls. The second task was also administered to unilateral temporal lobectomy patients. In the first version, S.P. showed impairments relative to normal controls on the neutral-to-anger and fear-to-anger morphs, but not on the neutral-to-fear morph. However, reaction times suggested that speed-accuracy tradeoffs could account for results. In the second version, S.P. showed impairments on all morph types relative to all other subject groups. A third experiment showed that this deficit did not extend to the perception of morphed identities. These results imply that when heuristics use is discouraged on tasks utilizing subtle emotion transitions, deficits in the perception of anger and anger/fear blends, as well as fear, are evident with bilateral amygdala damage
— id: 134089, year: 2007, vol: 45, page: 42, stat: Journal Article,

The influence of hippocampal sclerosis on the cortical distribution of naming sites
Hamberger, M; Seidel, W; Williams, A; Goodman, R; Perrine, K; Devinsky, O; Barr, W; McKhann, G
2007 OCT ;48(1):221-221, Epilepsia
— id: 87153, year: 2007, vol: 48, page: 221, stat: Journal Article,

Evidence for cortical reorganization of language in patients with hippocampal sclerosis
Hamberger, Marla J; Seidel, William T; Goodman, Robert R; Williams, Alicia; Perrine, Kenneth; Devinsky, Orrin; McKhann, Guy M 2nd
2007 Nov;130(Pt 11):2942-2950, Brain
Naming is mediated by perisylvian cortex in the left (language-dominant) hemisphere, and thus, left anterior temporal lobe resection for pharmacologically intractable temporal lobe epilepsy (TLE) carries risk for post-operative naming decline. Interestingly, this risk is lower in patients with hippocampal sclerosis (HS) relative to those without HS (non-HS). Although the hippocampus has traditionally been considered a critical structure for memory, without contribution to naming, this pattern might implicate direct hippocampal naming involvement. On the other hand, critical naming sites have been found in anterior, lateral temporal (i.e. extra-hippocampal) neocortex, the region typically removed with 'standard' TLE resection. We, therefore, speculated that the relative preservation of naming in post-operative HS patients might reflect cortical reorganization of language to areas outside this region. Using pre-resection electrical stimulation mapping, we compared the topography of auditory and visual naming sites in 12 patients with HS and 12 patients without structural brain pathology. Consistent with previous work, non-HS patients exhibited post-operative naming decline, whereas HS patients did not. As hypothesized, HS patients had proportionally fewer overall naming sites in anterior temporal cortex, the region typically removed with standard anterior temporal resection, whereas non-HS patients exhibited a more even distribution of naming sites in anterior and posterior temporal regions (P = 0.03). Although both groups exhibited the previously reported pattern of auditory naming sites anterior to visual naming sites, auditory naming sites had a significantly more posterior distribution in HS patients (P = 0.02). Additionally, non-HS patients exhibited a greater proportion of visual naming sites above the superior temporal sulcus, whereas visual naming sites in HS patients were scattered across superior and inferior temporal cortex. Results suggest that preserved naming ability in HS patients following anterior temporal resection might be attributable, at least in part, to intrahemispheric reorganization of language in response to the likely, early development of sclerosis in the medial temporal region. Furthermore, their more posterior distribution of naming sites is consistent with the more anterior propagation of EEG discharges in TLE. These results hold theoretical implications regarding the role of the dominant hippocampus in determining the cortical representation of semantic and lexical information, and raise questions regarding the specific roles of medial and lateral temporal cortex in targeted word retrieval. The different patterns of naming areas identified in patients with and without HS may also carry clinical implications, potentially improving efficiency during the time-constrained process of stimulation mapping
— id: 134085, year: 2007, vol: 130, page: 2942, stat: Journal Article,

A subcortical network of dysfunction in TLE measured by magnetic resonance spectroscopy
Hetherington, H P; Kuzniecky, R I; Vives, K; Devinsky, O; Pacia, S; Luciano, D; Vasquez, B; Haut, S; Spencer, D D; Pan, J W
2007 Dec 11;69(24):2256-2265, Neurology
OBJECTIVE: The goal of this work was to evaluate the relationship between neuronal injury/loss in the hippocampus, thalamus, and putamen in temporal lobe epilepsy (TLE) patients using (1)H magnetic resonance spectroscopic imaging. METHODS: (1)H spectroscopic images from the hippocampus and thalamus of controls and patients with TLE were acquired at 4 T. The spectroscopic imaging data were reconstructed using an automated voxel-shifting method based on anatomic landmarks providing four, six, and three loci for the hippocampus, thalamus, and putamen, respectively. For correlation analysis, the hippocampal and striatal loci were averaged to provide single estimates of the entire structure, whereas the thalamus was divided into two regions, an anterior and posterior measure, using the average of three loci each. RESULTS: The ratio of N-acetyl aspartate to creatine (NAA/Cr), a measure of neuronal injury/loss, was significantly reduced in both the ipsilateral and contralateral hippocampi and thalami. NAA/Cr in the ipsilateral hippocampus was significantly correlated with the ipsilateral and contralateral anterior and posterior thalami, putamen, and contralateral hippocampus. In control subjects, the hippocampi were only correlated with each other. CONCLUSIONS: The data demonstrate that there is significant neuronal injury/loss in both the ipsilateral and contralateral thalami in temporal lobe epilepsy patients, with greater impairment in the anterior portions of the ipsilateral thalamus. The degree of injury/loss in the ipsilateral and contralateral thalamus and putamen is directly correlated with that of the ipsilateral hippocampus. This is consistent with the hypothesis that the impairment and damage associated with recurrent seizures as measured by N-acetyl aspartate originating in the hippocampus results in injury and impairment in other subcortical structures
— id: 104805, year: 2007, vol: 69, page: 2256, stat: Journal Article,

Paradoxical cardiovascular activation during emotional stimulation in patients with right ventromedial prefrontal lesions
Hilz, MJ; Devinsky, O; Szczepanska, H; Borod, JC; Marthol, H; Tutaj, M
2007 MAR 20 ;68(12):A362-A362, Neurology
— id: 104245, year: 2007, vol: 68, page: A362, stat: Journal Article,

Right ventromedial prefrontal lesions result in paradoxical cardiovascular activation with emotional stimuli (vol 129, pg 343, 2006)
Hilz, MJ; Devinsky, O; Szczepanska, H; Borod, JC; Marthol, H; Tutaj, M
2007 MAR ;130(12):879-879, Brain
— id: 104246, year: 2007, vol: 130, page: 879, stat: Journal Article,

Transmeningeal delivery of GABA to control neocortical seizures in rats
John, Jenine E; Baptiste, Shirn L; Sheffield, Lynette G; von Gizycki, Hans; Kuzniecky, Ruben I; Devinsky, Orrin; Ludvig, Nandor
2007 Jun;75(1):10-17, Epilepsy research
Transmeningeal drug delivery, using an implanted hybrid neuroprosthesis, has been proposed as a novel therapy for intractable focal epilepsy. As part of a systematic effort to identify the optimal compounds and protocols for such a therapy, this study aimed to determine whether transmeningeal gamma-aminobutyric acid (GABA) delivery can terminate and/or prevent neocortical seizures in rats. Rats were chronically implanted with an epidural cup and an adjacent EEG electrode in the right parietal cortex. While the rat was behaving freely, a seizure-inducing concentration of acetylcholine (Ach) was applied into the cup. In a seizure termination study, either artificial cerebrospinal fluid (ACSF) or GABA (0.25, 2.5, 25 or 50mM) was delivered into the exposed neocortical area during an ongoing seizure. In a seizure prevention study, either ACSF or 50mM GABA was delivered into the epidural cup before the application of Ach. Epidural delivery of 50mM GABA completely terminated ongoing Ach-induced EEG seizures and convulsions within 17-437s after its delivery. ACSF and lower concentrations of GABA did not produce this effect, but 25mM GABA reduced seizure severity. However, the used GABA concentration could not prevent the development, or affect the severity, of Ach-induced EEG seizures and convulsions. This study indicates that transmeningeal GABA delivery can be used for terminating neocortical seizures, but to achieve seizure prevention via this route either a more efficient GABA delivery method needs to be developed or other neurotransmitters/pharmaceuticals should be employed for this purpose.
— id: 72893, year: 2007, vol: 75, page: 10, stat: Journal Article,

Surgery Insight: surgical management of epilepsy
Kuzniecky, Ruben; Devinsky, Orrin
2007 Dec;3(12):673-681, Nature clinical practice. Neurology
Epilepsy surgery has been shown to be an effective treatment for patients with intractable epilepsy. The only randomized controlled trial conducted in this setting to date found a dramatic advantage for surgery over medical treatment in temporal lobe epilepsy. In carefully selected patients, epilepsy surgery can control seizures, improve quality of life and reduce costs of medical care. Advances in diagnostic techniques are likely to improve patient selection, facilitate localization of epileptic foci and functional areas, and enable better prediction of outcomes
— id: 75674, year: 2007, vol: 3, page: 673, stat: Journal Article,

Neocortical multi-neuron recording as a potential tool for predicting focal seizures
Ludvig, N; Tang, HM; Baptiste, SL; Kuzniecky, RI; Devinsky, O
2007 OCT ;48(1):388-388, Epilepsia
— id: 87156, year: 2007, vol: 48, page: 388, stat: Journal Article,

Characterization of epileptogenic networks in tuberous sclerosis using independent component analysis
Madhavan, D; Mirowski, P; Weiner, HL; Devinsky, O; Kuzniecky, R
2007 MAR 20 ;68(12):A71-A72, Neurology
— id: 104244, year: 2007, vol: 68, page: A71, stat: Journal Article,

Effects of the subdural application of lidocaine on EEG spiking in patients with focal epilepsy
Madhavan, D; Mirowski, PW; Ludvig, N; Carlson, C; Devinsky, O; Doyle, W; Kuzniecky, R
2007 OCT ;48(4):307-308, Epilepsia
— id: 104242, year: 2007, vol: 48, page: 307, stat: Journal Article,

Anterior cingulate epilepsy in an 18-year-old woman
Madhavan, Deepak; Liebman, Tracey; Nadkarni, Siddhartha; Devinsky, Orrin
2007 Winter;4(1):39-42, Reviews in Neurological Diseases
Anterior cingulate epilepsy is a diagnostic and therapeutic challenge, with a broad range of nonspecific symptoms. Seizures can arise from any region of the anterior cingulate cortex (ACC) and manifest distinctive features based on the area of onset and pattern of spread. These features may provide insight as to the origin of the seizures, but because the ACC integrates information from several networks involving emotional and executive functions and has a diverse cytoarchitecture, functional-structural correlates are complex. Further, the location of the ACC within the interhemispheric fissure limits the capacity of scalp electrodes to record seizure activity from this region. This case review illustrates one part of the spectrum of cingulate epilepsy and discusses clinical features of the disorder
— id: 73846, year: 2007, vol: 4, page: 39, stat: Journal Article,

Surgical outcome in tuberous sclerosis complex: a multicenter survey
Madhavan, Deepak; Schaffer, Sarah; Yankovsky, Alexei; Arzimanoglou, Alexis; Renaldo, Florence; Zaroff, Charles M; LaJoie, Josiane; Weiner, Howard L; Andermann, Eva; Franz, David N; Leonard, Jennifer; Connolly, Mary; Cascino, Greg D; Devinsky, Orrin
2007 Aug;48(8):1625-1628, Epilepsia
Multicenter, retrospective analysis of 70 subjects with TSC following surgery for relief of epilepsy revealed significant associations between younger age at seizure onset, present/prior history of infantile spasms, interictal focality (bilateral versus unilateral), and absence of residual postoperative predominant tuber, and poorer postoperative outcome (p < 0.01). Ictal multifocality, mental retardation, and discordant EEG and MRI data showed a negative trend toward outcome, but were not significant
— id: 73884, year: 2007, vol: 48, page: 1625, stat: Journal Article,

Local epileptogenic networks in tuberous sclerosis complex: a case review
Madhavan, Deepak; Weiner, Howard L; Carlson, Chad; Devinsky, Orrin; Kuzniecky, Ruben
2007 Aug;11(1):140-146, Epilepsy & behavior
OBJECTIVE: Cortical tubers are a pathognomonic finding in some patients with tuberous sclerosis complex (TSC), and are believed to be epileptogenic foci. Surgery is an effective option in selected patients with TSC who are refractory to medical therapy. This article describes three patients with TSC who underwent three-stage epilepsy surgery at our center, with the intention of examining local electrophysiological changes after each stage of the procedure. METHODS: Magnetic resonance images were obtained after initial implantation of electrodes and after resection and electrode reimplantation. These images were co-registered and overlaid. The intracranial grids were overlaid in a similar procedure and manually traced, and then added to the volumetric image. Mean spike counts were obtained for each patient and expressed in spikes per minute. Statistical analysis was performed on spike counts prior to and after resection. RESULTS: All three patients displayed intense spiking in the regions around the dominant epileptogenic tuber. On tuber removal, spike counts diminished significantly. In each case, new areas of spiking emerged in regions remote from the tuber periphery after tuber resection, with the emergence of secondary ictal onset zones in the resection margin. CONCLUSION: This retrospective study highlights some common electrophysiological features among the patients examined. The observed epileptogenic activity and regions of ictal onset suggest that it may be the region of brain tissue surrounding the tuber that is responsible for the majority of epileptogenic activity in these patients
— id: 73894, year: 2007, vol: 11, page: 140, stat: Journal Article,

Marijuana: an effective antiepileptic treatment in partial epilepsy? A case report and review of the literature
Mortati, Katherine; Dworetzky, Barbara; Devinsky, Orrin
2007 Spring;4(2):103-106, Reviews in Neurological Diseases
Although more data are needed, animal studies and clinical experience suggest that marijuana or its active constituents may have a place in the treatment of partial epilepsy. Here we present the case of a 45-year-old man with cerebral palsy and epilepsy who showed marked improvement with the use of marijuana. This case supports other anecdotal data suggesting that marijuana use may be a beneficial adjunctive treatment in some patients with epilepsy. Although challenging because of current federal regulations, further studies are needed to examine the role of marijuana in the treatment of this disorder
— id: 73857, year: 2007, vol: 4, page: 103, stat: Journal Article,

Psychosis in epilepsy patients
Nadkarni, Siddhartha; Arnedo, Vanessa; Devinsky, Orrin
2007 ;48 Suppl 9:17-19, Epilepsia
Epileptic psychoses reflect a fundamental disruption in the fidelity of mind and occur during seizure freedom or during or after seizures. The psychotic symptoms in epilepsy share some qualities with schizophrenic psychosis, such as positive symptoms of paranoid delusions and hallucinations. Psychotic syndromes in epilepsy are most common but not exclusively associated with temporal lobe epilepsy. De Novo psychosis following epilepsy surgery is rare. Forced normalization-psychosis associated with dramatic reduction of epileptiform activity or seizures is described in small series only. Ictal and postictal psychosis can be prevented with seizure control, but postictal and chronic interictal psychoses require multidisciplinary and psychopharmacologic management
— id: 75714, year: 2007, vol: 48 Suppl 9, page: 17, stat: Journal Article,

Temporal lobe epilepsy: a progressive disorder?
Nearing, Katherine; Madhavan, Deepak; Devinsky, Orrin
2007 Summer;4(3):122-127, Reviews in Neurological Diseases
Temporal lobe epilepsy (TLE) can be a progressive disorder, potentially resulting in structural damage and a decline of cognitive abilities over time. This is particularly evident in cases that are refractory to medication. This review examines the changes that occur in refractory TLE over time and the factors associated with these changes. Imaging and histologic studies on the brains of patients with TLE reveal anatomic and metabolic changes associated with continued seizures. These changes can impair cognitive and behavioral function. Seizure control may help minimize or prevent these changes
— id: 75711, year: 2007, vol: 4, page: 122, stat: Journal Article,

Communication between Broca's and Wernicke's areas detected with intracranial electrophysiology in awake humans
Sahin NT; Pinker S; Cash S; Thesen T; Wang C; Devinsky O; Kuzniecky R; Doyle W; Halgren E
2007 ;36(S1):S74-S74, Neuroimage
— id: 74452, year: 2007, vol: 36, page: S74, stat: Journal Article,

Cortical abnormalities in epilepsy revealed by local EEG synchrony
Schevon, C A; Cappell, J; Emerson, R; Isler, J; Grieve, P; Goodman, R; McKhann, G Jr; Weiner, H; Doyle, W; Kuzniecky, R; Devinsky, O; Gilliam, F
2007 Mar;35(1):140-148, Neuroimage
Abnormally strong functional linkage between cortical areas has been postulated to play a role in the pathogenesis of partial epilepsy. We explore the possibility that such linkages may be manifest in the interictal EEG apart from epileptiform disturbances or visually evident focal abnormalities. We analyzed samples of interictal intracranial EEG (ICEEG) recorded from subdural grids in nine patients with medically intractable partial epilepsy, measuring interelectrode synchrony using the mean phase coherence algorithm. This analysis revealed areas of elevated local synchrony, or 'hypersynchrony' which had persistent spatiotemporal characteristics that were unique to each patient. Measuring local synchrony in a subdural grid results in a map of the cortical surface that provides information not visually apparent on either EEG or structural imaging. We explore the relationship of hypersynchronous areas to the clinical evidence of seizure localization in each case, and speculate that local hypersynchrony may be a marker of epileptogenic cortex, and may prove to be a valuable aid to clinical ICEEG interpretation
— id: 139498, year: 2007, vol: 35, page: 140, stat: Journal Article,

Pediatric language mapping: sensitivity of neurostimulation and Wada testing in epilepsy surgery
Schevon, Catherine A; Carlson, Chad; Zaroff, Charles M; Weiner, Howard J; Doyle, Werner K; Miles, Daniel; Lajoie, Josiane; Kuzniecky, Ruben; Pacia, Steven; Vazquez, Blanca; Luciano, Daniel; Najjar, Souhel; Devinsky, Orrin
2007 Mar;48(3):539-545, Epilepsia
PURPOSE: Functional mapping of eloquent cortex with electrical neurostimulation is used both intra- and extraoperatively to tailor resections. In pediatric patients, however, functional mapping studies frequently fail to localize language. Wada testing has also been reported to be less sensitive in children. METHODS: Thirty children (4.7 - 14.9 years) and 18 adult controls (18-59 years) who underwent extraoperative language mapping via implanted subdural electrodes at the NYU Comprehensive Epilepsy Center were included in the study. Ten children and 14 adults underwent preoperative Wada testing. Success of the procedures was defined as the identification of at least one language site by neurostimulation mapping and determination of hemispheric language dominance on the Wada test. RESULTS: In children younger than 10.2 years, cortical stimulation identified language cortex at a lower rate than was seen in children older than 10.2 years and in adults (p<0.05). This threshold, demonstrated by survival and chi2 analysis, was sharply defined in our data set. Additionally, Wada testing was more likely to be successful than was extraoperative mapping in this younger age group (p<0.05). CONCLUSIONS: Analysis of our series demonstrates that language cortex is less likely to be identified in children younger than 10 years, suggesting that alternatives to the current methods of cortical electrical stimulation, particularly the use of preoperative language lateralization, may be required in this age group
— id: 71610, year: 2007, vol: 48, page: 539, stat: Journal Article,

Histological evidence for transmeningeal drug diffusion in the rat cerebral cortex: A study on the neuropathological effects of epidurally delivered NMDA
Sheffield, LG; Baptiste, SL; Tang, HM; Kuzniecky, RI; Devinsky, O; Ludvig, N
2007 OCT ;48(1):310-310, Epilepsia
— id: 87155, year: 2007, vol: 48, page: 310, stat: Journal Article,

Health-related quality of life over time since resective epilepsy surgery
Spencer, Susan S; Berg, Anne T; Vickrey, Barbara G; Sperling, Michael R; Bazil, Carl W; Haut, Sheryl; Langfitt, John T; Walczak, Thaddeus S; Devinsky, Orrin
2007 Oct;62(4):327-334, Annals of neurology
OBJECTIVE: Health-related quality of life (HRQOL) improves after resective epilepsy surgery, but data are limited to short follow-up in mostly retrospective reports, with minimal consideration of other potential factors that might influence HRQOL. METHODS: In a prospective multicenter study, 396 patients underwent resective epilepsy surgery. They completed the Quality of Life in Epilepsy Inventory-89 (QOLIE-89) before surgery, within 6 months, and at approximately yearly intervals after surgery. Seizure outcome was ascertained by phone calls every 3 months, and dates of postoperative seizures were chronicled. Overall HRQOL as measured by the QOLIE-89 was evaluated with respect to seizure outcome using logistic regression. RESULTS: QOLIE-89 scores increased significantly at the first postoperative measurement (within 6 months after surgery) in the cohort overall; subsequent changes over time were sensitive to seizure-free and aura-free status. After adjusting for baseline scores, the corresponding postsurgical QOLIE-89 overall, and four dimension scores, increased as a function of square root of time seizure-free, and independently as a function of square root of time aura free, leveling by 2 years of stable seizure (aura) status. HRQOL was not independently related to duration of epilepsy, duration of intractable epilepsy, or continuation of medications. INTERPRETATION: HRQOL improves early after surgery, regardless of seizure outcome. Subsequent changes parallel length of time seizure free or aura free, stabilize after 2 years, and are unrelated to duration of epilepsy, duration of intractable epilepsy, or continued medication use
— id: 134086, year: 2007, vol: 62, page: 327, stat: Journal Article,

Non-invasive mapping of language and memory cortex with fMRI and MEG
Thesen T; McDonald CR; Carlson CE; Kuzniecky RI; Huang MX; Ahmadi; Hagler DJ; Stout JD; Nearing KI; Dale AM; Barr WB; Devinsky O; Halgren E
2007 ;:256-256 #G144, Annual meeting abstract program (Cognitive Neuroscience Society)
— id: 74457, year: 2007, vol: , page: 256, stat: Journal Article,

Comparing fMRI and MEG in the study of language processing
Thesen, T; Carlson, CE; McDonald, CM; Kuzniecky, RI; Hagler, DJ; Stout, JD; Nearing, KI; Dale, AM; Barr, WB; Devinsky, O; Halgren, E
2007 OCT ;48(3):221-222, Epilepsia
— id: 98145, year: 2007, vol: 48, page: 221, stat: Journal Article,

MEG predicts outcome following surgery for intractable epilepsy in children with normal or nonfocal MRI findings: Commentary
Widdess-Walsh P.; Devinsky O.
2007 ;4(3):173-, Reviews in Neurological Diseases
— id: 74411, year: 2007, vol: 4, page: 173, stat: Journal Article,

Bilateral ischemic optic neuropathy after subdural electrode placement for epilepsy surgery and treatment with erythropoietin
Widdess-Walsh, P; Turbin, RE; Tutela, AC; Geller, EB; Bennett, HL; Doyle, WK; Devinsky, O
2007 OCT ;48(1):128-128, Epilepsia
— id: 87152, year: 2007, vol: 48, page: 128, stat: Journal Article,

Antiepileptic drug resistance and tolerance in epilepsy
Widdess-Walsh, Peter; Devinsky, Orrin
2007 Fall;4(4):194-202, Reviews in Neurological Diseases
Drug-resistant epilepsy is a prevalent problem despite the multiple antiepileptic drug (AED) options available. Despite variations in the definition of drug resistance, clinicians can identify risk factors for AED resistance. Drug-resistant partial epilepsy should be referred early to an epilepsy surgery center. Mimics of drug-resistant epilepsy abound and cause diagnostic confusion. Rapid advances in epilepsy research and pharmacogenomics are providing new insight into the mechanisms of drug resistance and tolerance. Rational AED strategies and promising interventions to treat or prevent drug resistance will reduce the impact on the patient
— id: 96914, year: 2007, vol: 4, page: 194, stat: Journal Article,

Prediction of false-positive recognition errors during Wada testing
Barr, William B; Raghavan, Manoj; Kim Nelson, Peter; Devinsky, Orrin
2006 Oct;28(7):1065-1072, Journal of clinical & experimental neuropsychology
False-positive (FP) errors during recognition memory testing often interfere with interpretation of Wada test results. This study examined which clinical and neuropsychological variables provide the best prediction of these errors. Fifty-six patients completed the Wada test and the California Verbal Learning Test (CVLT). Subjects with three or more FP errors on the recognition trials of the CVLT were nearly twice as likely to exhibit FP responding during the Wada test. Further analysis indicates that FP errors during the Wada test appear to be the primary result of a stable and liberal response-bias rather than a result of any other neurological or procedure-related factor
— id: 68659, year: 2006, vol: 28, page: 1065, stat: Journal Article,

Subpectoral implantation of the vagus nerve stimulator
Bauman, Joel A; Ridgway, Emily B; Devinsky, Orrin; Doyle, Werner K
2006 Apr;58(4 Suppl 2):ONS-322, Neurosurgery
OBJECTIVE: To report the technique of subpectoral (SP) implantation of the vagus nerve stimulator (VNS) generator. METHODS: We retrospectively reviewed and compared demographics and complications from patients receiving either subcutaneous (SQ; n = 107) or SP (n = 138) VNS implants, performed by one surgeon (WKD) between 1999 and 2003. Selection of implant location was made during the preoperative surgeon-patient consultation on the basis of surgeon recommendation and patient preference. RESULTS: The standard VNS generator implantation is performed within a SQ pocket in the left infraclavicular region of the chest. We have modified this technique by placing the generator into a deeper pocket SP, beneath the pectoralis major muscle, while tunneling the electrodes SQ in the usual fashion. The SP group was substantially younger (median age 19 yr) compared with the SQ group (median age 29 yr). At an average follow-up of 52 months for SQ implants and 28.4 months for SP implants, there were 2.9% infections per patient in the SQ group and 2.5% infections per patient in the SP group. There were three cases of excessive generator mobility in the SQ group; no cases occurred in the SP group. CONCLUSION: The SP implantation technique provides an attractive alternative to SQ VNS implantation. With increased soft tissue coverage, we provide improved cosmesis, increased wound durability to tampering and trauma, and a comparable infection rate with the SQ group
— id: 64237, year: 2006, vol: 58, page: ONS, stat: Journal Article,

Extraoperative functional mapping via staged resection of supratentorial tumors in children [Abstact]
Bollo, RJ; Carlson, C; Schevon, C; Wisoff, JY; Devinsky, O; Weiner, H
2006 APR ;104(4):634-634, Journal of neurosurgery
— id: 104255, year: 2006, vol: 104, page: 634, stat: Journal Article,

Preoperative gender differences in health related quality of life and expectations of resective epilepsy surgery
Bower, CM; Hays, RD; Berg, A; Spencer, SS; Langfitt, JT; Sperling, M; Bazil, C; Devinsky, O; Haut, S; Vassar, S; Vickrey, B
2006 MAR 14 ;66(5):A322-A323, Neurology
— id: 104259, year: 2006, vol: 66, page: A322, stat: Journal Article,

Auras are frequent in idiopathic generalized epilepsy
Boylan, L S; Labovitz, D L; Jackson, S C; Starner, K; Devinsky, O
2006 Jul 25;67(2):343-345, Neurology
The occurrence of an aura is often considered evidence of a partial rather than an idiopathic generalized epilepsy syndrome. The authors examined this hypothesis by prospectively recording reports of auras by patients being admitted for video-EEG monitoring. Auras were equally common (70%) among patients with idiopathic generalized epilepsy as they were among those with localization-related epilepsy. Presence of an aura is not a reliable indicator of localization-related epilepsy
— id: 67391, year: 2006, vol: 67, page: 343, stat: Journal Article,

Race/ethnicity, sex, and socioeconomic status as predictors of outcome after surgery for temporal lobe epilepsy
Burneo, Jorge G; Black, Lorie; Martin, Roy; Devinsky, Orrin; Pacia, Steve; Faught, Edward; Vasquez, Blanca; Knowlton, Robert C; Luciano, Daniel; Doyle, Werner; Najjar, Sohuel; Kuzniecky, Ruben I
2006 Aug;63(8):1106-1110, Archives of neurology
BACKGROUND: Several risk factors have been attributed to seizure recurrence after surgery. It is unknown whether race/ethnicity plays a role in outcome. OBJECTIVE: To evaluate whether race/ethnicity plays a role in seizure recurrence after surgery. DESIGN: Cohort study. SETTING: We evaluated data obtained from the epilepsy centers at the University of Alabama at Birmingham and New York University, New York, NY. PATIENTS: All patients included had a diagnosis of mesial temporal sclerosis and underwent temporal lobectomy. MAIN OUTCOME MEASURES: Occurrence of seizure after surgery was registered 1 year after surgery. We used multiple logistic regression analysis to model the presence of seizure recurrence after surgery and generated odds ratios (ORs) for seizure recurrence after surgery for African American and Hispanic patients relative to white patients. An unadjusted model incorporated only race/ethnicity as the independent variable, and an adjusted model included socioeconomic status, age, duration of epilepsy, education, history of febrile seizures, sex, handedness, lateralization of epileptogenic focus, and number of antiepileptics as the independent variables. RESULTS: Two hundred fifty-two patients underwent surgical treatment with pathological confirmation of mesial temporal sclerosis. No differences were found between racial/ethnic groups in terms of seizure recurrence in any models. For African American patients, the ORs were 0.9 (95% confidence interval [CI], 0.4-2.1) for the unadjusted model and 0.8 (95% CI, 0.3-2.0) for the adjusted model; for Hispanic patients, the ORs were 1.6 (95% CI, 0.8-3.2) for the unadjusted model and 1.1 (95% CI, 0.5-2.6) for the adjusted model, relative to white patients. CONCLUSION: Our data suggest that although sex appears to play a role in the outcomes of surgery for temporal lobe epilepsy, race and socioeconomic status do not
— id: 69045, year: 2006, vol: 63, page: 1106, stat: Journal Article,

Pediatric epilepsy surgery: The recent NYU experience
Cahan, B; Bollo, RJ; LaJoie, J; Miles, D; Devinsky, O; Weiner, H
2006 APR ;104(4):631-631, Journal of neurosurgery
— id: 104254, year: 2006, vol: 104, page: 631, stat: Journal Article,

Magnetic source imaging for pre-surgical lateralization of refractory epilepsy
Carlson, C; Schevon, C; Stout, J; Nadkami, S; Doyle, W; Weiner, H; Pacia, S; Devinsky, O; Kuzniecky, R
2006 MAR ;47(1):4-5, Epilepsia
— id: 104248, year: 2006, vol: 47, page: 4, stat: Journal Article,

Inter- and intra-modality reliability of magnetoencephalographic somatosensory localization utilizing pneumatic digit and median nerve stimulation
Carlson, C; Stout, J; Schevon, C; Kuzniecky, R; Devinsky, O; Pacia, S
2006 MAR 14 ;66(5):A180-A180, Neurology
— id: 104257, year: 2006, vol: 66, page: A180, stat: Journal Article,

Multi-staged epilepsy surgery in multifocal tuberous sclerosis complex
Carlson, C; Weiner, H; Ridgway, E; Zaroff, C; Miles, D; LaJoie, J; Kuzniecky, R; Devinsky, O
2006 MAR 14 ;66(5):A322-A322, Neurology
— id: 104258, year: 2006, vol: 66, page: A322, stat: Journal Article,

Introduction and overview
Devinsky, O; Camfield, P
2006 SEP ;47(9):1-2, Epilepsia
— id: 68958, year: 2006, vol: 47, page: 1, stat: Journal Article,

Impaired baroreflex function in temporal lobe epilepsy
Dutsch, Mathias; Hilz, Max J; Devinsky, Orrin
2006 Oct;253(10):1300-1308, Journal of neurology
Changes of cardiovascular function are frequent in temporal lobe epilepsy (TLE). The baroreflex - the most important reflex for cardiovascular stability - has not been studied systematically in TLE. We evaluated cardiovascular variability and baroreflex function in TLE.In 22 TLE patients and 20 controls, we continuously monitored heart rate (HR) and blood pressure (BP). Time-domain parameters were derived from recordings at rest and from standard cardiovascular reflex tests. Spectral analysis determined sympathetic and parasympathetic modulation of HR and BP in the low (LF-power) and high frequency range (HF-power). We calculated the relative LF- and HF-powers of HR in relation to the sum of LF- and HF-powers. LF/HF-ratio of HR was assessed as a parameter of sympatheticovagal balance. LF-transfer function gain between BP and HR determined baroreflex function.Time-domain parameters did not differ between TLE patients and controls. Spectral analysis showed decreased absolute LF- and HF-powers but increased relative LF-power and LF/HF-ratio of HR in TLE. LF-transfer function gain between BP and HR was reduced in TLE (p<0.05).The reduction of absolute LF- and HF-powers indicates decreased total autonomic variability in TLE. However, increased relative LF-power and LF/HF-ratio of HR in TLE show a relative increase of sympathetic tone. Most importantly, we demonstrate an impaired baroreflex function in TLE. These cardiovascular autonomic abnormalities may contribute to cardiac arrhythmia in TLE
— id: 96627, year: 2006, vol: 253, page: 1300, stat: Journal Article,

Sequential ordering of morphed faces and facial expressions following temporal lobe damage
Graham, Reiko; Devinsky, Orrin; LaBar, Kevin S
2006 ;44(8):1398-1405, Neuropsychologia
A card ordering task was developed to evaluate the role of the temporal lobe in perceiving subtle featural displacements of faces that contribute to judgments of facial expression and identity. Individuals with varying degrees of temporal lobe damage and healthy controls were required to manually sort cards depicting morphs of facial expressions or facial identities so that the cards were sequentially ordered from one morph endpoint to another. Four morph progressions were used-three emotion morphs (neutral-to-anger, neutral-to-fear, and fear-to-anger) and an identity morph. Five exemplars were given per morph type. Debriefing verified that participants were using feature-level cues to sort the cards. A patient with bilateral amygdala damage due to epilepsy did not differ in her sorting abilities from unilateral temporal lobectomy patients or controls. In contrast, a post-encephalitic patient with widespread left temporal lobe damage showed impairments that were most marked on the fear-to-anger and identity sorts. These results show that amygdala-damaged individuals can use information contained in facial expressions to solve tasks that rely on feature-level analysis, which recruits processing in other temporal lobe regions involved in making fine featural distinctions
— id: 64239, year: 2006, vol: 44, page: 1398, stat: Journal Article,

Interictal perceptual disturbances in temporal lobe epilepsy
Grant, AC; Donnelly, KM; Barr, WB; Kuzniecky, R; Devinsky, O
2006 MAR ;47(1):97-97, Epilepsia
— id: 104250, year: 2006, vol: 47, page: 97, stat: Journal Article,

Right ventromedial prefrontal lesions result in paradoxical cardiovascular activation with emotional stimuli
Hilz, Max J; Devinsky, Orrin; Szczepanska, Hanna; Borod, Joan C; Marthol, Harald; Tutaj, Marcin
2006 Dec;129(Pt 12):3343-3355, Brain
Ventromedial prefrontal cortex (VMPFC) lesions can alter emotional and autonomic responses. In animals, VMPFC activation results in cardiovascular sympathetic inhibition. In humans, VMPFC modulates emotional processing and autonomic response to arousal (e.g. accompanying decision-making). The specific role of the left or right VMPFC in mediating somatic responses to non-arousing, daily-life pleasant or unpleasant stimuli is unclear. To further evaluate VMPFC interaction with autonomic processing of non-stressful emotional stimuli and assess the effects of stimulus valence, we studied patients with unilateral VMPFC lesions and assessed autonomic modulation at rest and during physical challenge, and heart rate (HR) and blood pressure (BP) responses to non-stressful neutral, pleasant and unpleasant visual stimulation (VES) via emotionally laden slides. In 6 patients (54.0 +/- 7.2 years) with left-sided VMPFC lesions (VMPFC-L), 7 patients (43.3 +/- 11.6 years) with right-sided VMPFC lesions (VMPFC-R) and 13 healthy volunteers (44.7 +/- 11.6 years), we monitored HR as R-R interval (RRI), BP, respiration, end-tidal carbon dioxide levels, and oxygen saturation at rest, during autonomic challenge by metronomic breathing, a Valsalva manoeuvre and active standing, and in response to non-stressful pleasant, unpleasant and neutral VES. Pleasantness versus unpleasantness of slides was rated on a 7-point Likert scale. At rest, during physical autonomic challenge, and during neutral VES, parameters did not differ between the patient groups and volunteers. During VES, Likert scores also were similar across the three groups. During pleasant and unpleasant VES, HR decreased (i.e. RRI increased) significantly whereas BP remained unchanged in volunteers. In VMPFC-L patients, HR decrease was insignificant with pleasant and unpleasant VES. BP slightly increased (P = 0.06) with pleasant VES but was stable with unpleasant VES. In contrast, VMPFC-R patients had significant increases in HR and BP during pleasant and not quite significant HR increases (P = 0.06) with only slight BP increase during unpleasant VES. Other biosignals remained unchanged during VES in all groups. Our results show that VMPFC has no major influence on autonomic modulation at rest and during non-emotional, physical stimulation. The paradoxical HR and BP responses in VMPFC-R patients suggest hemispheric specialization for VMPFC interaction with predominant parasympathetic activation by the left, but sympathetic inhibition by the right VMPFC. Valence of non-stressful stimuli has a limited effect with more prominent left VMPFC modulation of pleasant and more right VMPFC modulation of unpleasant stimuli. The paradoxical sympathetic disinhibition in VMPFC-R patients may increase their risk of sympathetic hyperexcitability with negative consequences such as anxiety, hypertension or cardiac arrhythmias
— id: 96626, year: 2006, vol: 129, page: 3343, stat: Journal Article,

Degree of handedness and cerebral dominance
Isaacs, Keren L; Barr, William B; Nelson, Peter Kim; Devinsky, Orrin
2006 Jun 27;66(12):1855-1858, Neurology
OBJECTIVE: To examine the relationship between the degree of handedness and hemispheric language dominance in patients with epilepsy. METHODS: The authors examined the relationship between degree of handedness and hemispheric language dominance in 174 epilepsy surgery candidates using the intracarotid amobarbital procedure and results from a modified version of the Edinburgh Handedness Inventory. RESULTS: The incidence of atypical language dominance increased linearly with the degree of left-handedness, from 9% in strong right-handers (laterality quotient [LQ] = +100) to 46% in ambidextrous individuals and 69% in strong left-handers (LQ = -100). CONCLUSIONS: The incidence of atypical language dominance depends not only on the direction but also on the degree of handedness. In addition, direction of language dominance varies with hemisphere of seizure focus and degree of handedness. A familial history of sinistrality may have an additional effect on the likelihood of atypical dominance
— id: 69637, year: 2006, vol: 66, page: 1855, stat: Journal Article,

Epidural delivery of the combination of GABA and adenosine terminates locally induced neocortical seizures in rats
John, JE; Baptiste, SL; Medveczky, G; von Gizycki, H; Kuzniecky, RI; Devinsky, O; Ludvig, N
2006 SEP ;47(3):219-219, Epilepsia
— id: 69539, year: 2006, vol: 47, page: 219, stat: Journal Article,

Postictal psychosis: A case control study
Kuzniecky, R; Vorkas, CK; Alper, K; Carlson, C; Barr, W; Devinsky, O
2006 SEP ;47(3):279-279, Epilepsia
— id: 69541, year: 2006, vol: 47, page: 279, stat: Journal Article,

Epidural pentobarbital delivery can prevent locally induced neocortical seizures in rats: the prospect of transmeningeal pharmacotherapy for intractable focal epilepsy
Ludvig, Nandor; Kuzniecky, Ruben I; Baptiste, Shirn L; John, Jenine E; von Gizycki, Hans; Doyle, Werner K; Devinsky, Orrin
2006 Nov;47(11):1792-1802, Epilepsia
PURPOSE: To determine whether epidural pentobarbital (PB) delivery can prevent and/or terminate neocortical seizures induced by locally administered acetylcholine (Ach) in freely moving rats. METHODS: Rats were implanted permanently with an epidural cup placed over the right parietal cortex with intact dura mater. Epidural screw-electrodes, secured to the cup, recorded local neocortical EEG activity. In the seizure-termination study, Ach was delivered into the epidural cup, and after the development of electrographic and behavioral seizures, the Ach solution was replaced with either PB or artificial cerebrospinal fluid (aCSF; control solution). In the seizure-prevention study, the epidural Ach delivery was preceded by a 10-min exposure of the delivery site to PB or aCSF. Raw EEG recordings, EEG power spectra, and behavioral events were analyzed. RESULTS: Ach-induced EEG seizures associated with convulsions, which were unaffected by epidural aCSF applications, were terminated by epidurally delivered PB within 2-2.5 min. Epidural deliveries of PB before Ach applications completely prevented the development of electrographic and behavioral seizures, whereas similar deliveries of aCSF exerted no influence on the seizure-generating potential of Ach. CONCLUSIONS: This study showed for the first time that epidural AED delivery can prevent, as well as terminate, locally induced neocortical seizures. The findings support the viability of transmeningeal pharmacotherapy for the treatment of intractable neocortical epilepsy
— id: 69701, year: 2006, vol: 47, page: 1792, stat: Journal Article,

Macro- and microelectrode recordings show complex spatiotemporal evolution of focal seizures in human epilepsy
Madsen, J; Bromfield, E; Wang, C; Mehta, A; Doyle, W; Devinsky, O; Ulbert, I; Melinosky, C; Meng, N; Cash, SS; Halgren, E
2006 SEP ;47(3):208-208, Epilepsia
— id: 69538, year: 2006, vol: 47, page: 208, stat: Journal Article,

Seizures, cognitive abnormalities, and abnormal magnetic resonance imaging findings in a 19-year-old woman
Mayer, Tanya; Devinsky, Orrin
2006 Fall;3(4):190, 195-7, Reviews in Neurological Diseases
In this case scenario, the reader has the the opportunity to diagnose the patient described in the title, on the basis of the history, examination results, laboratory evaluations, and neurophysiologic and imaging findings. The diagnosis and a discussion of the case are presented on pages 195-197
— id: 74165, year: 2006, vol: 3, page: 190, 195, stat: Journal Article,

Acute language changes following epilepsy surgery
Morrison, CE; Barr, WB; Doyle, W; Carlson, C; Zaroff, CM; Devinsky, O
2006 MAR ;47(1):101-102, Epilepsia
— id: 104251, year: 2006, vol: 47, page: 101, stat: Journal Article,

Influence of demographically corrected norms on lateralizing seizures in African Americans
Morrison, CE; Barr, WB; Zaroff, CM; Gupta, S; Devinsky, O
2006 SEP ;20(3):598-598, Clinical neuropsychologist
— id: 104253, year: 2006, vol: 20, page: 598, stat: Journal Article,

Optimal evaluation of digital electroencephalograms
Rodin, E; Constantino, T; van Orman, C; Funke, M; Devinsky, O; Wong, P; McIntyre, H; Swartz, B
2006 Jul;37(3):178-189, Clinical EEG & neuroscience
Currently available digital EEG equipment provides considerably greater opportunities for clinical data analysis than is generally appreciated especially when appropriate software is used. Data from 7 different laboratories that had been obtained for routine diagnostic evaluations on 7 different EEG instruments and stored on compact disks were investigated. Since the instruments do not filter the data at input, ultra slow activity down to 0.01 Hz is currently being recorded but the attenuation factor is instrument dependent. Nevertheless, relevant clinical information is potentially available in these data and needs to be explored. Several examples in regard to epilepsy are presented. Determination of seizure onset may depend on the frequencies that are examined. The use of appropriate filter settings and viewing windows for the clinical question to be answered is stressed. Differentiation between simple and complex spike wave discharges, as well as spread of spikes, can readily be achieved by expanding the time base to 1 or 2 seconds and placing a cursor on the peak of the negative spike. Latencies in the millisecond range can then become apparent. EEGs co-registered with MEG should be evaluated with the same software in order to allow an adequate assessment of the similarities and differences between electrical and magnetic activity. An example of a comparison of EEG, planar gradiometers and magnetometers for an averaged spike is shown
— id: 139499, year: 2006, vol: 37, page: 178, stat: Journal Article,

Pediatric language mapping: Effectiveness of neurostimulation and Wada testing
Schevon, C; Carlson, C; Zaroff, C; Weiner, H; Kuzniecky, R; Devinsky, O
2006 MAR 14 ;66(5):A68-A68, Neurology
— id: 104256, year: 2006, vol: 66, page: A68, stat: Journal Article,

Hypersynchronous margins identify epileptogenic tubers
Schevon, CA; Carlson, C; Cappell, J; Emerson, RG; Devinsky, O; Weiner, HL
2006 MAR ;47(1):46-46, Epilepsia
— id: 104249, year: 2006, vol: 47, page: 46, stat: Journal Article,

Neuroradiology in the humanities and social sciences
Seidenwurm, David J; Devinsky, Orrin
2006 Apr;239(1):13-17, Radiology
— id: 64238, year: 2006, vol: 239, page: 13, stat: Journal Article,

Synchrony changes between hippocampal and neocortical EEG signals precede seizure activity induced by intrahippocampal NMDA application in freely behaving rats
von Gizycki, H; Baptiste, SL; Medveczky, G; Kuzniecky, RI; Devinsky, O; Ludvig, N
2006 SEP ;47(3):47-47, Epilepsia
— id: 69536, year: 2006, vol: 47, page: 47, stat: Journal Article,

Pediatric language mapping: Sensitivity of neurostimulation and Wada testing in epilepsy surgery
Weiner, HL; Schevon, C; Carlson, C; Doyle, W; Miles, D; LaJoie, J; Kuzniecky, R; Devinsky, O
2006 AUG ;59(2):480-481, Neurosurgery
— id: 104252, year: 2006, vol: 59, page: 480, stat: Journal Article,

Epilepsy surgery in young children with tuberous sclerosis: results of a novel approach
Weiner, Howard L; Carlson, Chad; Ridgway, Emily B; Zaroff, Charles M; Miles, Daniel; LaJoie, Josiane; Devinsky, Orrin
2006 May;117(5):1494-1502, Pediatrics
OBJECTIVE: Tuberous sclerosis complex (TSC) is associated with medically refractory epilepsy and developmental delay in children and usually results from cortical tubers. Seizures that begin in young patients are often refractory and may contribute to development delay. Functional outcome is improved when seizures are controlled at an early age. Previous reports have shown modest benefit from surgical resection of single tubers/seizure foci in older children; however, many children with TSC develop uncontrolled seizures before age 1. To identify patients who might benefit from surgery and to maximize outcome, we used a novel surgical approach in young children that consists of invasive intracranial monitoring, which is typically 3-staged and often bilateral. METHODS: Of 110 consecutive children who underwent epilepsy surgery by a single surgeon in the past 6 years, 25 patients (9 boys and 16 girls) had TSC. At the time of their first surgery at our institution, they were a median age of 4.0 years. A total of 31 separate admissions for epilepsy surgery in these 25 patients were identified. Bilateral electrode placement was performed in 13 children whose seizures could not be lateralized definitively preoperatively, and 22 patients underwent 3-stage surgeries. RESULTS: At 6 months or longer after the initial resection, 21 (84%) children were class I, 2 (8%) children were class II, and 2 (8%) children were class IV. At a mean follow-up of 28 months, 17 (68%) children were class I, 6 (24%) were class II, and 2 (8%) were class III. Four of the 5 children who initially were rejected as surgical candidates because of multifocality and who required initial bilateral electrode study are now seizure-free. CONCLUSIONS: This approach can help to identify both primary and secondary epileptogenic zones in young TSC patients with multiple tubers. Multiple or bilateral seizure foci are not necessarily a contraindication to surgery. Long-term follow-up will determine whether this approach has durable effects
— id: 64210, year: 2006, vol: 117, page: 1494, stat: Journal Article,

Mental retardation: Relationship to seizures and tuber burden in tuberous sclerosis
Zaroff, C; Barr, W; Devinsky, O; Miles, D; Nass, R
2006 MAR ;60(3):S127-S128, Annals of neurology
— id: 104247, year: 2006, vol: 60, page: S127, stat: Journal Article,

Mental retardation and relation to seizure and tuber burden in tuberous sclerosis complex
Zaroff, Charles M; Barr, William B; Carlson, Chad; LaJoie, Josiane; Madhavan, Deepak; Miles, Daniel K; Nass, Ruth; Devinsky, Orrin
2006 Oct;15(7):558-562, Seizure
In patients with tuberous sclerosis complex (TSC), the high rates of mental retardation are associated with cortical tubers, seizure activity, and genetic factors. The goal of the study was to investigate the relationship between bilateral cortical tubers and seizure variables and mental retardation in individuals with TSC. The records of 27 patients with TSC (age 6 months to 33 years) undergoing neuropsychological assessment and the following clinical variables were examined: bilateral versus non-bilateral cortical tubers, the age of seizure onset, and presence of infantile spasms. Results were statistically analyzed. Bilateral cortical tubers (p=0.02) and early age of seizure onset (p=0.04) were significantly related to impaired cognitive functioning. Only one of the seven patients with normal cognitive functioning had bilateral tubers, whereas 13/21 patients with intellectual impairment had bilateral tubers. Patients with normal cognitive functioning experienced a mean age of seizure onset after 6 years. A trend was observed between infantile spasms and cognitive functioning (p=0.06); the lack of statistical significance likely reflects the small sample size. Neither age nor gender was related to cognitive status. Further investigation incorporating additional neuroimaging factors, antiepileptic treatment effects, and genetic variables, is needed
— id: 69073, year: 2006, vol: 15, page: 558, stat: Journal Article,

Surgical outcome in tuberous sclerosis complex: A multicenter survey
Zaroff, CM; Madhavan, D; Arzimanoglou, A; Renaldo, F; LaJoie, J; Weiner, HL; Andermann, E; Andermann, F; Dubeau, F; Olivier, A; Yankovsky, A; Franz, DN; Leonard, J; Connolly, M; Cascino, GD; Devinsky, O
2006 SEP ;47(3):362-363, Epilepsia
— id: 69543, year: 2006, vol: 47, page: 362, stat: Journal Article,

Rates of invalid MMPI-2 responding in patients with epileptic and nonepileptic seizures
Barr, WB; Larson, E; Alper, K; Devinsky, O
2005 SEP ;46(11):60-60, Epilepsia
— id: 59584, year: 2005, vol: 46, page: 60, stat: Journal Article,

A group treatment approach to treating memory disorder in epilepsy
Barr, WB; Morrison, C; Isaacs, K; Devinsky, O
2005 JUN ;19(2):144-145, Clinical neuropsychologist
— id: 104261, year: 2005, vol: 19, page: 144, stat: Journal Article,

Multistage Epilepsy Surgery: Safety, Efficacy, and Utility of a Novel Approach in Pediatric Extratemporal Epilepsy
Bauman, Joel A; Feoli, Enrique; Romanelli, Pantaleo; Doyle, Werner K; Devinsky, Orrin; Weiner, Howard L
2005 Feb;56(2):318-334, Neurosurgery
OBJECTIVE: To evaluate the safety, efficacy, and utility of a novel surgical strategy consisting of multiple (more than two) operative stages performed during the same hospital admission with subdural grid and strip electrodes in selected pediatric extratemporal epilepsy. METHODS: Subdural grid and strip electrodes were used for multistage chronic electroencephalographic monitoring in 15 pediatric patients (age, <19 yr) with refractory localization-related epilepsy and poor surgical prognostic factors. Initial resective surgery and/or multiple subpial transections were performed, followed by further monitoring and additional resection and/or multiple subpial transections. RESULTS: Mean patient age was 9.7 years. Mean duration of total invasive monitoring was 10.5 days (range, 8-14 d). The first monitoring period averaged 6.5 days, and the second averaged 3.9 days. Additional surgery was performed in 13 of 15 patients. Two patients who did not undergo additional surgery had a Class I outcome. Rationales for reinvestigation included incomplete localization, multifocality, and proximity to eloquent cortex. Complications were minimal, including two transfusions. There were no cases of wound infection, cerebral edema, hemorrhage, or major permanent neurological deficit. Minimum duration of follow-up was 31 months. Outcomes were 60% Engel Class I (9 of 15 patients), 27% Class III (4 of 15 patients), and 13% Class IV (2 of 15 patients). CONCLUSION: In a very select group of pediatric patients with poor surgical prognostic factors, the multistage approach can be beneficial. After failed epilepsy surgery, subsequent reoperation with additional intracranial investigation traditionally is used when a single residual focus is suspected. Our results, however, support the contention that multistage epilepsy surgery is safe, effective, and useful in a challenging and select pediatric population with extratemporal medically refractory epilepsy
— id: 47908, year: 2005, vol: 56, page: 318, stat: Journal Article,

Time-frequency analysis as an adjunct to intracranial EEG interpretation
Carlson, C; Schevon, C; Doyle, W; Weiner, H; Cappell, J; Emerson, R; Hirsch, A; Goodman, R; Devinsky, O; Pacia, S; Kuzniecky, R
2005 SEP ;46(11):313-313, Epilepsia
— id: 59590, year: 2005, vol: 46, page: 313, stat: Journal Article,

Lamiinar microelectrode recordings of human interictal discharges in neocortical epilepsy reveal complex high-frequency oscillation patterns
Cash, SS; Ulbert, I; Devinsky, O; Bromfield, E; Madsen, J; Cole, A; Halgren, E; Doyle, W
2005 SEP ;46(11):93-94, Epilepsia
— id: 59585, year: 2005, vol: 46, page: 93, stat: Journal Article,

Juvenile Myoclonic Epilepsy: Diagnostic Issues and Therapeutic Alternatives
Devinsky O
2005 Fall;2(4):226-227, Reviews in Neurological Diseases
Literature Review
— id: 64236, year: 2005, vol: 2, page: 226, stat: Journal Article,

Changes in depression and anxiety after resective surgery for epilepsy
Devinsky, O; Barr, W B; Vickrey, B G; Berg, A T; Bazil, C W; Pacia, S V; Langfitt, J T; Walczak, T S; Sperling, M R; Shinnar, S; Spencer, S S
2005 Dec 13;65(11):1744-1749, Neurology
OBJECTIVE: To determine changes in depression and anxiety after resective surgery. METHODS: Data from subjects enrolled in a prospective multicenter study of resective epilepsy surgery were reviewed with the Beck Psychiatric Symptoms Scales (Beck Depression Inventory [BDI] and Beck Anxiety Inventory [BAI]) and Composite International Diagnostic Interview (CIDI) up to a 24-month period. chi2 analyses were used to correlate proportions. RESULTS: A total of 358 presurgical BDI and 360 BAI results were reviewed. Moderate and severe levels of depression were reported in 22.1% of patients, and similar levels of anxiety were reported by 24.7%. Postoperative rates of depression and anxiety declined at the 3-, 12-, and 24-month follow-up periods. At the 24-month follow-up, moderate to severe levels of depression symptoms were reported in 17.6 and 14.7% of the patients who continued to have postoperative seizures. Moderate to severe depression and anxiety were found in 8.2% of those who were seizure-free. There was no relationship, prior to surgery, between the presence or absence of depression and anxiety and the laterality or location of the seizure onset. There were no significant relationships between depression or anxiety at 24-month follow-up and the laterality or location of the surgery. CONCLUSIONS: Depression and anxiety in patients with refractory epilepsy significantly improve after epilepsy surgery, especially in those who are seizure-free. Neither the lateralization nor the localization of the seizure focus or surgery was associated with the risk of affective symptoms at baseline or after surgery
— id: 99309, year: 2005, vol: 65, page: 1744, stat: Journal Article,

Neurologist-induced sexual dysfunction: enzyme-inducing antiepileptic drugs
Devinsky, Orrin
2005 Oct 11;65(7):980-981, Neurology
— id: 60144, year: 2005, vol: 65, page: 980, stat: Journal Article,

Quality of life in the elderly with epilepsy
Devinsky, Orrin
2005 Feb;6(1):1-3, Epilepsy & behavior
— id: 60148, year: 2005, vol: 6, page: 1, stat: Journal Article,

The myth of silent cortex and the morbidity of epileptogenic tissue: implications for temporal lobectomy
Devinsky, Orrin
2005 Nov;7(3):383-389, Epilepsy & behavior
This article reviews two commonly held myths regarding temporal lobe epilepsy-it is a static disorder with minimal morbidity and mortality, and epileptogenic tissue impairs only the functions of the seizure focus-and one myth concerning temporal lobe functions-they contain areas of nonfunctional, 'silent' cortex. Chronic temporal lobe epilepsy can cause progressive structural, cognitive, and behavioral changes. Aside from the seizure focus, primary epileptogenic cortex may have a deleterious influence on distant brain areas. Removing this 'nociferous' cortex and reducing the antiepileptic drug burden can improve cognitive or behavioral and metabolic function in areas remote from the resection. Anterior temporal lobectomy often removes functional tissue that may or may not be epileptogenic. Because normal brain does not contain functionless, 'silent' areas, the procedure can have negative as well as positive cognitive or behavioral consequences. To improve the outcomes of focal cortical resections for seizure control, we need to better define functional and nociferous cortex and more clearly understand their boundaries and interactions
— id: 60145, year: 2005, vol: 7, page: 383, stat: Journal Article,

Evidence of cerebral reorganization following perinatal stroke demonstrated with fMRI and DTI tractography
Heller, Samantha L; Heier, Linda A; Watts, Richard; Schwartz, Theodore H; Zelenko, Natalie; Doyle, Werner; Devinsky, Orrin
2005 Jul-Aug;29(4):283-287, Clinical imaging
A 44-year-old man with a left perinatal stroke and recurrent refractory epilepsy underwent functional MRI (fMRI) for motor and language mapping to determine if further epilepsy surgery could be performed without loss of language. Language was activated excessively in the right hemisphere, with only small areas of left hemisphere activation. This suggests bilateral language dominance acquired secondary to the perinatal stroke with the right hemisphere activation resulting from neonatal neuronal reorganization. Functional data were overlaid onto 3D diffusion tensor tractography, providing a unique image of the right hemisphere language recruitment
— id: 60147, year: 2005, vol: 29, page: 283, stat: Journal Article,

Vector-analysis: Low-power-requiring software for real-time EEG seizure recognition/prediction in hybrid neuroprosthetic devices
Kovacs, L; Ludvig, N; Devinsky, O; Kuzniecky, RI
2005 SEP ;46(11):317-318, Epilepsia
— id: 59591, year: 2005, vol: 46, page: 317, stat: Journal Article,

The role of autonomic dysfunction in sudden unexplained death in epilepsy patients
Lee, Janet; Devinsky, Orrin
2005 Spring;2(2):61-69, Reviews in Neurological Diseases
The risk of death in people with epilepsy is increased because of disorders that cause epilepsy, known consequences of seizures, and SUDEP (sudden unexplained death in epilepsy). The incidence of sudden death is many times higher in an epilepsy population than for the general public. SUDEP risk increases with the severity of epilepsy but paradoxically affects young adults preferentially. Important risk factors for SUDEP include age 15 to 45 years, refractory epilepsy, tonic-clonic seizures, nocturnal seizures, and periods during which the patient is not observed. Analyses of epidemiologic studies, observations from witnessed near-deaths or deaths, and pathology data have helped focus attention on respiratory and cardiovascular dysfunction as potential mechanisms of SUDEP. Ictal and postictal effects on autonomic functioning and accidental suffocation are commonly cited as potential factors. Monitoring of patients with a history of nocturnal tonic-clonic seizures might help prevent SUDEP
— id: 104351, year: 2005, vol: 2, page: 61, stat: Journal Article,

Toward the development of a subdural hybrid neuroprosthesis for the treatment of intractable focal epilepsy
Ludvig, N; Kovacs, L; Medveczky, G; Kuzniecky, RI; Devinsky, O
2005 SEP ;46(11):270-270, Epilepsia
— id: 59588, year: 2005, vol: 46, page: 270, stat: Journal Article,

Correlation of apparent diffusion coefficient with neuropsychological testing in temporal lobe epilepsy
Lui, Yvonne W; Nusbaum, Annette O; Barr, William B; Johnson, Glyn; Babb, James S; Orbach, Darren; Kim, Alice; Laliotis, Georgia; Devinsky, Orrin
2005 Aug;26(7):1832-1839, AJNR. American journal of neuroradiology
BACKGROUND AND PURPOSE: Patients with nonlesional temporal lobe epilepsy have long been known to have abnormalities of memory. Recently, these patients have been shown to have increased diffusivity in the hippocampus. We hypothesized that in these patients, a negative correlation would exist between diffusivity measures of the mesial temporal lobe and performance on neuropsychological tests. METHODS: Twenty presurgical patients with temporal lobe epilepsy and 20 age- and sex-matched healthy controls underwent MR imaging of the brain. Apparent diffusion coefficient region of interest measures were taken in both hippocampi and parahippocampal gyri by 2 independent observers. Mean whole brain diffusivity was calculated. All patients completed neuropsychological testing. Electroencephalogram and pathology results were collected. Patients and controls were compared with respect to each apparent diffusion coefficient measure. In patients, apparent diffusion coefficients ipsilateral and contralateral to the seizure focus were compared. Associations were assessed between diffusivity measures and neuropsychological scores. RESULTS: Eleven patients had right-sided seizure foci and 9 had left-sided seizure foci. Patients demonstrated higher apparent diffusion coefficient values than controls over the whole brain, in the hippocampi, and in the parahippocampal gyri (P < .05). Patients demonstrated higher apparent diffusion coefficient within the ipsilateral hippocampus (1.19 +/- 0.22 x 10(-3) s/mm2) and parahippocampal gyrus (1.02 +/- 0.12 x 10(-3) s/mm2) compared with the contralateral side (1.02 +/- 0.16 x 10(-3) s/mm2 and 0.96 +/- 0.09 x 10(-3) s/mm2, respectively) (P < .05). Negative correlations were seen between hippocampal apparent diffusion coefficients and multiple memory tests (P < .05). CONCLUSION: Quantitative diffusion measurements in the hippocampus correlate with memory dysfunction in patients with temporal lobe epilepsy
— id: 57871, year: 2005, vol: 26, page: 1832, stat: Journal Article,

Psychotropic effects of antiepileptic drugs
Nadkarni, Siddhartha; Devinsky, Orrin
2005 Sep-Oct;5(5):176-181, Epilepsy currents
Antiepileptic drugs are important psychotropic agents that are commonly used to treat psychiatric disorders. The behavioral effects of antiepileptic drugs may differ between epilepsy and psychiatric patient populations. Randomized, double-blind, controlled data on the psychotropic efficacy of antiepileptic drugs are limited mainly to bipolar disorder
— id: 60146, year: 2005, vol: 5, page: 176, stat: Journal Article,

Current treatments of epilepsy
Nadkarni, Siddhartha; LaJoie, Josiane; Devinsky, Orrin
2005 Jun 28;64(12 Suppl 3):S2-11, Neurology
Medical therapy is the mainstay for epilepsy, with most patients well controlled on a single antiepileptic drug (AED). In this non-refractory group, many patients have medication side effects and occasional seizures. Approximately 30% of patients with partial epilepsy and 25% of patients with generalized epilepsy are not well controlled on medications. These patients are often receiving multiple AEDs, with disabling seizures and side effects. Although second-generation AEDs are safer and better tolerated than the older AEDs, there are scant data to support significant advantages in efficacy. In VA studies with older AEDS, therapy with two AEDs improved seizure control in 40% of patients but seizure freedom was achieved in only 9%. A meta-analysis of the second-generation AEDs used as adjunctive therapies shows that 12% to 29% of patients had a 50% or greater reduction in seizure frequency. Surgery and the vagus nerve stimulator provide important therapeutic options in patients whose seizures are not controlled by AEDs. Special considerations about epilepsy care must be made in pediatric populations, those with developmental delays, women, and the elderly
— id: 58984, year: 2005, vol: 64, page: S2, stat: Journal Article,

Adult-onset epilepsy in focal cortical dysplasia of Taylor type
Siegel, A M; Cascino, G D; Elger, C E; Devinsky, O; Laff, R; Najjar, S; Sperling, M R; LoRusso, G; Cossu, M; Urbach, H; Aronica, E; Meyer, F B; Scheithauer, B W; Dubeau, F; Andermann, F
2005 May 24;64(10):1771-1774, Neurology
Focal cortical dysplasia of Taylor type (FCDT) usually presents with seizures at an early age, whereas adult onset of epilepsy is uncommon. We reviewed the medical records of 213 patients with FCDT. In 21 patients (10%), age at seizure onset ranged from 18 to 55 years (mean 25.3). The outcome of seizures in patients with FCDT and adult-onset epilepsy seems favorable vs childhood-onset seizures
— id: 139500, year: 2005, vol: 64, page: 1771, stat: Journal Article,

Spatio-temporal stages in word processing: Intracranial-recorded potentials and current source density in the human frontal, temporal and occipital cortices
Wang, CM; Ulbert, I; Doyle, WK; Devinsky, O; Kuzniecky, R; Halgren, A
2005 NOV ;46(10):323-323, Epilepsia
— id: 98090, year: 2005, vol: 46, page: 323, stat: Journal Article,

Evolving concepts in pediatric epilepsy surgery: Tuberous sclerosis as paradigm
Weiner, HL; Miles, D; LaJoie, J; Devinsky, O
2005 JUL ;103(1):A101-A101, Journal of neurosurgery
— id: 104260, year: 2005, vol: 103, page: A101, stat: Journal Article,

Developmental outcome of epilepsy surgery in tuberous sclerosis complex
Zaroff, Charles M; Morrison, Chris; Ferraris, Nina; Weiner, Howard L; Miles, Daniel K; Devinsky, Orrin
2005 Dec;7(4):321-326, Epileptic disorders
In Tuberous sclerosis complex (TSC), neurological dysfunction, usually in association with epilepsy, is responsible for the greatest degree of disease-related disability. Epilepsy surgery is increasingly recognized as a therapeutic option given the often medication-resistant nature of the disease. Seven subjects with medically refractory epilepsy associated with TSC, who underwent surgery at a tertiary care epilepsy center and in whom both preoperative and postoperative neuropsychological data were available, were examined. The Vineland Adaptive Behavior Scales, and in one case, the WISC-III were utilized. Postoperatively, the composite standard scores declined in six of the seven subjects, although for the most part this decline was quite modest (8 points or less in 5/6 subjects). The mean overall developmental/intellectual quotients were comparable across assessments (preoperative M = 55, SD = 20.3; postoperative M = 49 SD = 16.6). Good outcomes appeared to be related to seizure relief. Age estimates of developmental level indicated developmental progress in the majority of subjects in the current sample, and may yield greater clinical information for individuals with developmental delay than do standard scores
— id: 60143, year: 2005, vol: 7, page: 321, stat: Journal Article,

Mental retardation and relation to seizure and tuber burden in tuberous sclerosis complex
Zaroff, CM; Barr, W; Devinsky, O; Miles, D; Nass, R
2005 SEP ;46(11):166-166, Epilepsia
— id: 59587, year: 2005, vol: 46, page: 166, stat: Journal Article,

Use of the Brief Visuospatial Memory Test-Revised (BVMT-R) in neuropsychological evaluation of epilepsy surgery candidates
Barr, W; Morrison, C; Zaroff, C; Devinsky, O
2004 May;5(2):175-179, Epilepsy & behavior
Many commonly used measures of figural reproduction have been found to be relatively insensitive to the effects of right temporal lobe dysfunction. More positive findings are present in studies using measures of figural learning over repeated trials. This study examined the use of a commercially available measure of figural learning in a sample of epilepsy patients undergoing presurgical neuropsychological testing. The Brief Visuospatial Memory Test-Revised (BVMT-R) was administered to 47 subjects undergoing comprehensive presurgical workups with video and EEG monitoring. Groups with left (N = 25) and right (N = 22) temporal lobe seizures did not differ on BVMT-R measures of learning, delayed recall, or yes/no recognition. Approximately 29% of the sample exhibited 'impaired' performance in comparison to published norms. The results of receiver operating curve analyses revealed little discrimination in performance between groups. The BVMT-R does not appear to have the sensitivity required for assessing nonverbal memory in this population
— id: 46045, year: 2004, vol: 5, page: 175, stat: Journal Article,

Group treatment of memory disorders in patients with epilepsy
Barr, WB; Morrison, C; Isaacs, K; Devinsky, O
2004 AUG-SEP ;45(3):171-171, Epilepsia
— id: 49019, year: 2004, vol: 45, page: 171, stat: Journal Article,

Subpectoral implantation of vagus nerve stimulator
Bauman, JA; Devinsky, O; Doyle, WK
2004 AUG-SEP ;45(3):327-327, Epilepsia
— id: 49022, year: 2004, vol: 45, page: 327, stat: Journal Article,

The neuropsychological performance of children with epilepsy on the NEPSY
Bender, HA; Zaroff, CM; Marks, BC; Brown, E; Devinsky, O; Barr, WB
2004 NOV ;19(7):939-940, Archives of clinical neuropsychology
— id: 104264, year: 2004, vol: 19, page: 939, stat: Journal Article,

Depression but not seizure frequency predicts quality of life in treatment-resistant epilepsy
Boylan, L S; Flint, L A; Labovitz, D L; Jackson, S C; Starner, K; Devinsky, O
2004 Jan 27;62(2):258-261, Neurology
BACKGROUND: The two-thirds of patients with epilepsy who become seizure-free have a quality of life (QOL) similar to the general population. The major treatment challenge is patients with refractory epilepsy. Whereas neurologists typically focus on seizure reduction in the treatment of these patients, results of studies relating seizure frequency to QOL are conflicting. As depression is associated with reduced QOL in epilepsy and antiepileptic medications (AEDs) can cause depression, it is important to determine the relative roles of depression and seizure frequency in QOL in refractory epilepsy. METHODS: Prospective evaluation was conducted of patients with refractory epilepsy being admitted to an inpatient video-EEG monitoring unit. The impact of clinical variables (age, sex, marital status, seizure frequency, duration and type of seizure disorder, seizure localization, number of AEDs, depression) on QOL was analyzed. RESULTS: Depression was a powerful predictor of QOL (n = 122, beta = -35.8, p < 0.0001). No other variable predicted QOL. Depression was common (54%), severe (19% with suicidal thoughts), underdiagnosed (37%), and largely untreated (17% on antidepressants). CONCLUSIONS: Treatment of depression may be inadequately prioritized in the management of intractable epilepsy
— id: 47901, year: 2004, vol: 62, page: 258, stat: Journal Article,

Depression but not seizure frequency predicts quality of life in treatment-resistant epilepsy - Reply from the authors
Boylan, LS; Labovitz, DL; Flint, LA; Devinsky, O
2004 SEP 14 ;63(5):942-943, Neurology
— id: 69277, year: 2004, vol: 63, page: 942, stat: Journal Article,

Letter from the editors of reviews in neurological diseases
Caplan, Louis R; Devinsky, Orrin
2004 Winter;1(1):1-1, Reviews in Neurological Diseases
— id: 64240, year: 2004, vol: 1, page: 1, stat: Journal Article,

"Neuroimaging: Advances and Applications - 2003 Annual Course - Sponsored by the American Epilepsy Society - December 7, 2003 - Boston, Massachusetts, USA - Introduction"
Cole, AJ; Devinsky, O
2004 AUG 15 ;45(16):1-1, Epilepsia
— id: 46548, year: 2004, vol: 45, page: 1, stat: Journal Article,

Effects of Seizures on Autonomic and Cardiovascular Function
Devinsky O
2004 Mar;4(2):43-46, Epilepsy currents
Parial and generalized seizures often affect autonomic function during seizures as well as during the interictal and postictal periods. Activation or inhibition of areas in the central autonomic network can cause cardiovascular, gastrointestinal, cutaneous, pupillary, urinary, and genital manifestations. Autonomic dysfunction during or after seizures may cause cardiac and pulmonary changes that contribute to sudden unexplained death in epilepsy
— id: 56019, year: 2004, vol: 4, page: 43, stat: Journal Article,

Neurobehavioral changes in epilepsy - Proceedings of a Symposium held at the Annual Meeting of the American Epilepsy Society, December 5, 2003, in Boston, Massachusetts, USA, and jointly sponsored by the American Epilepsy Society and IntraMed Scientific Solutions - Preface
Devinsky, O
2004 JUN ;45(3):3-4, Epilepsia
— id: 46615, year: 2004, vol: 45, page: 3, stat: Journal Article,

Diagnosis and treatment of temporal lobe epilepsy
Devinsky, Orrin
2004 Winter;1(1):2-9, Reviews in Neurological Diseases
Of the 1,200,000 Americans with partial epilepsy, temporal lobe epilepsy (TLE) occurs in more than 400,000. Temporal lobe seizures are usually stereotypic in their symptoms and duration. A typical sequence is an aura followed by arrest of motor behavior, blank stare, and automatisms. Patients with TLE often show impairments in attention, memory, mental processing speed, executive functions, mood, personality, and drive-related behaviors. Interictal depression occurs in approximately one third of TLE patients. TLE is diagnosed by a history of characteristic partial seizure symptoms. The diagnosis is confirmed by the capture of a typical episode during an electroencephalogram (EEG) or video-EEG, with epileptiform activity over one or both temporal regions. Video-EEG monitoring has revolutionized diagnosis and should be considered in patients in whom diagnosis is uncertain. TLE is treated with medications, resective surgery, and vagus nerve stimulation. Epilepsy surgery should be considered in all patients with refractory partial epilepsy
— id: 61867, year: 2004, vol: 1, page: 2, stat: Journal Article,

Introduction: managing epilepsy in special populations
Devinsky, Orrin
2004 ;1 Suppl 1:S1-S3, Reviews in Neurological Diseases
— id: 62373, year: 2004, vol: 1 Suppl 1, page: S1, stat: Journal Article,

Therapy for neurobehavioral disorders in epilepsy
Devinsky, Orrin
2004 ;45 Suppl 2(6):34-40, Epilepsia
Neurobehavioral disorders commonly affect patients with epilepsy. In addition to the behavioral changes during and immediately after seizures, the epileptogenic disorder of function often extends further into the postictal and interictal period. Cognitive impairments commonly affect attention, memory, mental speed, and language, as well as executive and social functions. Reducing seizure frequency and the antiepileptic drug burden can reduce these problems. Attentional deficits may respond to therapies for attention-deficit/hyperactivity disorder, but apart from patients with this comorbid disorder, their efficacy is unproven in other epilepsy patients. No effective therapies are established for other cognitive problems, but pragmatic, compensatory strategies can be helpful. Behavioral disorders include fatigue, depression, anxiety, and psychosis. Many of these disorders usually respond well to pharmacotherapy, which can be supplemented by psychotherapy. Cognitive and behavioral disorders can be the greatest cause of morbidity and impaired quality of life, often overshadowing seizures. Yet these problems often go unrecognized and, even when identified, are often undertreated or untreated
— id: 46054, year: 2004, vol: 45 Suppl 2, page: 34, stat: Journal Article,

Neurology of Cognitive and Behavioral Disorders
Devinsky, Orrin; D'Esposito, Mark
New York, NY, US: Oxford University Press, 2004,
This book covers the neurological bases of cognitive and behavioral disorders. It begins with an overview of brain anatomy, neuropsychological testing, and examination of mental status. Chapter two covers functional neuroimaging of cognition, including issues with neuroimaging and clinical applications of it. The third chapter covers the right hemisphere of the brain--including hemispheric dominance, interhemispheric communication, and consciousness. The next two chapters cover attention and perception, as well as disorders in each process. Language, aphasia, and other speech disorders are the subject of the sixth chapter. The motor system's relation to behavior is covered by chapter seven. In the eighth chapter, the authors discuss memory and memory disorders. After covering the anatomy of the frontal lobes, chapter nine discusses executive function, its assessment, and disorders related to the frontal lobe. The final two chapters cover emotion, the limbic system, and therapy for cognitive and neurobehavioral disorders
— id: 2236, year: 2004, vol: , page: , stat: ,

Three-stage epilepsy surgery
Doyle, WK; Devinsky, O; Silverberg, A
2004 NOV ;45(11):336-336, Epilepsia
— id: 104262, year: 2004, vol: 45, page: 336, stat: Journal Article,

Cerebral autoregulation improves in epilepsy patients after temporal lobe surgery
Dutsch, Matthias; Devinsky, Orrin; Doyle, Werner; Marthol, Harald; Hilz, Max J
2004 Oct;251(10):1190-1197, Journal of neurology
Patients with temporal lobe epilepsy (TLE) often show increased cardiovascular sympathetic modulation during the interictal period, that decreases after epilepsy surgery. In this study, we evaluated whether temporal lobectomy changes autonomic modulation of cerebral blood flow velocity (CBFV) and cerebral autoregulation. We studied 16 TLE patients 3-4 months before and after surgery. We monitored heart rate (HR), blood pressure (BP), respiration, transcutaneous oxygen saturation (sat-O(2)), end-expiratory carbon dioxide partial pressure (pCO(2)) and middle cerebral artery CBFV. Spectral analysis was used to determine sympathetic and parasympathetic modulation of HR, BP and CBFV as powers of signal oscillations in the low frequency (LF) ranges from 0.04-0.15Hz (LF-power) and in the high frequency ranges from (HF) 0.15-0.5Hz (HF-power). LF-transfer function gain and phase shift between BP and CBFV were calculated as parameters of cerebral autoregulation. After surgery, HR, BP(mean), CBFV(mean), respiration, sat-O(2), pCO(2) and HF powers remained unchanged. LF-powers of HR, BP, CBFV and LF-transfer function gain had decreased while the phase angle had increased (p<0.05). The reduction of LF powers and LF-gain and the higher phase angle showed reduced sympathetic modulation and improved cerebral autoregulation. The enhanced cerebrovascular stability after surgery may improve autonomic balance in epilepsy patients
— id: 60149, year: 2004, vol: 251, page: 1190, stat: Journal Article,

Obsessive-compulsive symptoms in patients with temporal lobe epilepsy
Isaacs, Keren L; Philbeck, John W; Barr, William B; Devinsky, Orrin; Alper, Kenneth
2004 Aug;5(4):569-574, Epilepsy & behavior
The goals of this work were to: (1) determine the prevalence of clinically significant obsessive-compulsive (OC) symptoms in patients with temporal lobe epilepsy (TLE), (2) characterize the differences in self-reported OC symptoms in patients with TLE and a normative control group, and (3) compare the severity of OC symptoms in right and left hemisphere TLE patients. Patients with TLE (n=30) were administered the Obsessive-Compulsive Inventory (OCI). As a group, patients with TLE had a higher prevalence of OC symptoms than the nonpatient normative sample. In addition, TLE patients exhibited elevated scores on all but 3 of the 16 OCI scales and subscales. There were no reliable differences in OC symptoms in patients with right versus left hemisphere seizure foci, although the right hemisphere patients tended to score higher on both scales of the OCI
— id: 55970, year: 2004, vol: 5, page: 569, stat: Journal Article,

The treatment of nonepileptic seizures: historical perspectives and future directions
LaFrance, W Curt Jr; Devinsky, Orrin
2004 ;45 Suppl 2:15-21, Epilepsia
Nonepileptic seizures (NES) are neuropsychiatric disorders presenting with a combination of neurologic signs and underlying psychological conflicts. For more than a century, the medical community has accumulated data and insights about the phenomenology, epidemiology, risks, comorbidities, and prognosis of NES. However, we have not progressed much beyond anecdotal reports of treatments for NES, and no randomized, controlled trials of treatment for the disorder have been conducted. We review the diagnosis and treatment of NES and suggest directions for future research in these areas
— id: 60150, year: 2004, vol: 45 Suppl 2, page: 15, stat: Journal Article,

Developing a kainic acid-induced temporal lobe epilepsy model in behaving squirrel monkeys
Ludvig, N; Kuzniecky, RI; Moshe, SL; von Gizycki, H; Devinsky, O
2004 AUG-SEP ;45(3):210-211, Epilepsia
— id: 49021, year: 2004, vol: 45, page: 210, stat: Journal Article,

Somatoform disorders after temporal lobectomy
Naga, Anjanette A; Devinsky, Orrin; Barr, William B
2004 Jul;17(2):57-61, Cognitive & behavioral neurology
OBJECTIVE: Depression, anxiety, and psychosis are the most frequent psychiatric disorders after epilepsy surgery. The only new-onset somatoform disorder reported postoperatively is conversion disorder. We identified 10 patients who developed somatoform disorder other than nonconversion epileptic seizures after anterior temporal lobectomy. METHOD: We retrospectively reviewed the charts of 325 anterior temporal lobectomy and 125 extratemporal surgeries between 1991 and 2000. RESULTS: Seven of the patients developed undifferentiated somatoform disorder after anterior temporal lobectomy, 1 had pain and body dysmorphia, another had pain disorder, and another had body dysmorphia alone, but none were found after extratemporal surgeries (chi-square = 3.93; P < or = 0.05). Somatoform disorder was significantly more common in right anterior temporal lobectomy (n = 9) than left anterior temporal lobectomy (n = 1) (chi-square = 6.5; P < or = 0.025). CONCLUSIONS: Our findings suggest that right temporal resection contributes to the development of somatoform disorders in our patients and that right temporal dysfunctions may contribute to idiopathic somatoform disorders
— id: 46093, year: 2004, vol: 17, page: 57, stat: Journal Article,

Vagus nerve stimulation for refractory idiopathic generalised epilepsy
Ng, Michael; Devinsky, Orrin
2004 May;13(3):176-178, Seizure
We reviewed our experience with vagus nerve stimulation (VNS) in 165 patients with medically refractory epilepsy (138 partial epilepsy (PE), 13 symptomatic generalised epilepsy (SGE), 14 idiopathic generalised epilepsy (IGE)). Average duration of VNS therapy was 21.6 months. A 50% or greater reduction in seizure frequency was achieved in 47.1% of the PE group, 46.1% of the SGE group, and 57.1% of the IGE group. A 50% or greater reduction in seizure frequency and reduced antiepileptic drug (AED) regimen were achieved in: PE (9.4%), SGE (7.7%), and IGE (35.7%). These preliminary results suggest that VNS is an effective therapy for some patients with medically refractory IGE
— id: 46035, year: 2004, vol: 13, page: 176, stat: Journal Article,

Epilepsy surgery in young children with tuberous sclerosis
Weiner, HL; Lajoie, J; Miles, D; Devinsky, O
2004 APR ;100(4):793-793, Journal of neurosurgery
— id: 104265, year: 2004, vol: 100, page: 793, stat: Journal Article,

Epilepsy surgery for children with tuberous sclerosis complex
Weiner, Howard L; Ferraris, Nina; LaJoie, Josiane; Miles, Daniel; Devinsky, Orrin
2004 Sep;19(9):687-689, Journal of child neurology
Tuberous sclerosis complex is associated with medically refractory seizures and developmental delay in children. These epilepsies are often resistant to antiepileptic drugs, can be quite severe, and usually have a negative impact on the child's neurologic and cognitive development. It is believed that functional outcome is improved if seizures can be controlled at an early age. The surgical treatment of intractable epilepsy in children and adults with tuberous sclerosis complex has gained significant interest in recent years. Previously published studies have shown a potential benefit from resection of single tubers, with most of the results noted in relatively older children. All of these reports support the idea that if a single primary epileptogenic tuber or region can be identified, then a surgical approach is appropriate. However, most children with tuberous sclerosis complex have multiple potentially epileptogenic tubers, rendering localization challenging, and they are therefore rejected as possible surgical candidates. We have used a novel surgical approach using invasive intracranial monitoring, which is typically multistaged and bilateral. This multistage surgical approach has been useful in identifying both primary and secondary epileptogenic zones in patients with tuberous sclerosis complex with multiple tubers. Multiple or bilateral seizure foci are not necessarily a contraindication to surgery in selected patients. Long-term follow-up will determine whether this approach has durable effects. We await better methods for identifying the epileptogenic zone, both noninvasive and invasive
— id: 47796, year: 2004, vol: 19, page: 687, stat: Journal Article,

Clinical features of patients with unilateral mesial temporal sclerosis (MTS) with persistent seizures following antero-mesial temporal resection
Yousef, TA; Pacia, SV; Barr, W; Cohen, E; Doyle, W; Devinsky, O; Luciano, D; Vazquez, B; Miles, D; Najjar, S; Kuzniecky, R
2004 AUG-SEP ;45(3):88-88, Epilepsia
— id: 49017, year: 2004, vol: 45, page: 88, stat: Journal Article,

Neuropsychological outcome of epilepsy surgery in tuberous sclerosis
Zaroff, C; Devinsky, O; Ferraris, N; Miles, D; Morrison, C; Weiner, H
2004 NOV ;19(7):852-853, Archives of clinical neuropsychology
— id: 104263, year: 2004, vol: 19, page: 852, stat: Journal Article,

Cognitive and behavioral correlates of tuberous sclerosis complex
Zaroff, Charles M; Devinsky, Orrin; Miles, Daniel; Barr, William B
2004 Nov;19(11):847-852, Journal of child neurology
Tuberous sclerosis complex is a multisystem disorder in which neurologic problems cause the greatest disability. High rates of mental retardation and autism spectrum disorders are associated with the diagnosis. Early-onset seizures and increased tuber burden are risk factors for cognitive impairment. Early-onset seizures, particularly infantile spasms, are risk factors for autism. Tubers within the temporal lobe and cerebellum are often mentioned as risk factors for autism, although the findings are inconsistent. Seizure control is important for developmental outcome and quality of life. Early behavioral assessment and therapeutic intervention, as well as seizure control, are the most effective means of promoting neurodevelopmental outcome
— id: 50288, year: 2004, vol: 19, page: 847, stat: Journal Article,

Group psychoeducation as treatment for psychological nonepileptic seizures
Zaroff, Charles M; Myers, Lorna; Barr, William B; Luciano, Daniel; Devinsky, Orrin
2004 Sep;5(4):587-592, Epilepsy & behavior
There is no consensus for the type(s) of treatment(s) that may be effective or ineffective for psychological nonepileptic seizures (PNES). We provided an open-ended group psychotherapy program to 10 patients with PNES, including a disorder-specific psychoeducation treatment component in the first 10 weeks. Seizure frequency and questionnaire responses were examined pre- and posttreatment in all 7 of 10 individuals who completed the majority of the psychoeducational sessions. Four individuals experienced no change in seizure frequency; in three of these this was due to a cessation of events at treatment initiation. Two individuals experienced a decline; and one, an increase, in seizure frequency. Significant decreases were reported in posttraumatic (P=0.003) and dissociative (P=0.04) symptoms and emotionally based coping mechanisms (P=0.03). There was also a trend toward improved quality of life (P=0.07). Experience/expression of anger remained stable. Psychoeducation may be an effective method of treating PNES and may improve coping strategies and reduce PNES-associated psychopathology in some patients. Additional controlled studies on larger samples are needed
— id: 46150, year: 2004, vol: 5, page: 587, stat: Journal Article,

Postictal laughter following absence status epilepticus
Boylan, Laura S; Kaley, Thomas J; Singh, Anuradha; Devinsky, Orrin
2003 Feb 15;4(6):773-775, Epilepsy & behavior
Acute pathologic neurologic laughter has been described as an ictal phenomenon in epilepsy, as a result of electrical brain stimulation to the cortex and to deep brain structures, in brain tumors, and in stroke. We report what is, to our knowledge, the first report of a case of postictal pathologic laughter. Previously diagnosed with medically refractory complex partial seizures, our patient was admitted to the hospital with phenytoin toxicity. During video-EEG monitoring she experienced multiple brief absence seizures as well as a prolonged episode of absence status epilepticus. Immediately following cessation of the seizure she began to laugh. Her laughter was mirthful and infectious. This lasted several minutes and was followed immediately by several minutes of crying and then a return to normal. We propose that diffuse cortical inhibition led to release of subcortical structures involved in emotional expression. Possible neural substrates of laughter are discussed
— id: 46275, year: 2003, vol: 4, page: 773, stat: Journal Article,

Levetiracetam-related behavioural adverse events among patients with epilepsy, cognitive or anxiety disorders
Cramer, J; de Rue, K; Devinsky, O; Edrich, P; Trimble, M
2003 JAN ;44(1):53-53, Epilepsia
— id: 42513, year: 2003, vol: 44, page: 53, stat: Journal Article,

A systematic review of the behavioral effects of levetiracetam in adults with epilepsy, cognitive disorders, or an anxiety disorder during clinical trials
Cramer, Joyce A; De Rue, Katrien; Devinsky, Orrin; Edrich, Pascal; Trimble, Michael R
2003 Apr;4(2):124-132, Epilepsy & behavior
This report reviews behavioral adverse events occurring among adults receiving levetiracetam (LEV) or placebo who participated in short-term, placebo-controlled studies in epilepsy (1023), cognitive disorders (719), or anxiety disorders (1510) and epilepsy patients (1393) observed in long-term trials. Behavioral events (affective, psychotic, and suicidal symptoms) were significantly more common among epilepsy patients than cognition or anxiety patients treated with LEV for similar durations (P=0.022). Affective symptoms occurring at 1% or more often in epilepsy placebo-controlled trials included depression (3.8% LEV-2.1% placebo), nervousness (3.8%-1.8%), hostility (2.3%-0.9%), anxiety (1.8%-1.1%), and emotional lability (1.7%-0.2%). Patients with cognitive and anxiety disorders had lower incidences of these symptoms. The incidence of behavioral events in LEV-treated epilepsy patients was lower than rates reported for some other antiepileptic drugs. These data support the hypothesis that some feature related to epilepsy is the cause of many behavioral events rather than the addition of a specific antiepileptic drug
— id: 34389, year: 2003, vol: 4, page: 124, stat: Journal Article,

Dramatic changes in artistic preference after left temporal lobectomy - Reply
Devinsky, O
2003 AUG ;4(4):450-451, Epilepsy & behavior
— id: 98233, year: 2003, vol: 4, page: 450, stat: Journal Article,

Temporal lobe epilepsy and auditory symptoms - Reply
Devinsky, O
2003 NOV 12 ;290(18):2407-2407, JAMA
— id: 104267, year: 2003, vol: 290, page: 2407, stat: Journal Article,

The preservation of consciousness, automatism, and movement control - In reply
Devinsky, O
2003 ;15(4):456-457 FAL, Journal of neuropsychiatry & clinical neurosciences
— id: 55409, year: 2003, vol: 15, page: 456, stat: Journal Article,

Comorbidities of epilepsy: Special topics - Foreword
Devinsky, O; Vazquez, B
2003 DEC ;4(6):S1-S1, Epilepsy & behavior
— id: 42547, year: 2003, vol: 4, page: S1, stat: Journal Article,

A 48-year-old man with temporal lobe epilepsy and psychiatric illness
Devinsky, Orrin
2003 Jul 16;290(3):381-392, JAMA
— id: 39140, year: 2003, vol: 290, page: 381, stat: Journal Article,

Psychiatric comorbidity in patients with epilepsy: implications for diagnosis and treatment
Devinsky, Orrin
2003 Feb;4 Suppl 4(1):S2-10, Epilepsy & behavior
Psychiatric disorders frequently occur in patients with epilepsy but the diagnosis is frequently missed and therapeutic opportunities are often lost. These comorbidities assume greater importance as epidemiological data show their frequent association with impaired function and quality of life, and advances in neurobiology better define their pathophysiological relationship and therapies. Epilepsy presents a model for understanding psychiatric illness. Deciphering the role of different biological and environmental risk factors may help identify high-risk patients and allow for early intervention. Antiepileptic drugs are frequently used to manage psychiatric syndromes although the mechanisms of their psychotropic action remain uncertain. As recognition and treatment of comorbid psychiatric disorders in epilepsy remain suboptimal, we need to increase the awareness of physicians, patients, their caregivers, and the health care system. Better recognition will help to develop and implement appropriate diagnostic and treatment programs, and improve functional outcomes and quality of life in people with epilepsy
— id: 46060, year: 2003, vol: 4 Suppl 4, page: S2, stat: Journal Article,

Religious experiences and epilepsy
Devinsky, Orrin
2003 Feb;4(1):76-77, Epilepsy & behavior
— id: 34395, year: 2003, vol: 4, page: 76, stat: Journal Article,

Efficacy of levetiracetam in partial seizures
Devinsky, Orrin; Elger, Christian
2003 May;5 Suppl 1:S27-S31, Epileptic disorders
Controlled clinical trials and routine clinical practice demon-strate that levetiracetam is effective as add-on therapy and appears to allow for withdrawal to monotherapy in patients who respond well in the add-on setting. In pivotal clinical trials of adjunctive therapy with levetiracetam 1000 to 3000 mg/day (pooled data), 40% to 54% of patients experienced a 50% or greater reduction in seizure frequency, compared with 18% to 28% of patients treated with placebo. The median percent reduction from baseline in seizure frequency ranged from 36% to 68% for levetiracetam, versus 10% to 23% for placebo. Seizure freedom was achieved by 11% to 35% of those in the levetiracetam treatment group, compared with 3% to 18% of those in the placebo group. (All comparisons statistically significant versus placebo for simple partial, complex partial, and secondarily generalized seizures except for percentage of seizure-free patients with simple partial seizures.) Clinical obser-vations are consistent with these findings
— id: 60153, year: 2003, vol: 5 Suppl 1, page: S27, stat: Journal Article,

Callosal lesions and behavior: history and modern concepts
Devinsky, Orrin; Laff, Rachel
2003 Feb 15;4(6):607-617, Epilepsy & behavior
Callosotomy has played a unique role in the treatment of epilepsy and in the understanding of human brain function. The pioneering work of Dejerine and Liepmann presenting the first findings of callosal lesion pathology at the turn of the 20th century was accepted but then quickly forgotten. Two schools resurrected the phoenix of callosal syndromes: Roger Sperry and Michael Gazzaniga leading in experimental neuroscience, and Norman Geschwind leading in clinical neurology. Callosotomy remains an effective technique to treat atonic, tonic, and tonic-clonic seizures, especially in patients with symptomatic generalized epilepsies such as Lennox-Gastaut syndrome. Neurologic, cognitive, and behavioral complications limit its use given that precise characterization of these complications as well as their frequency is difficult. The high frequencies of developmental delays, severe seizures, head injuries, antiepileptic drug burden, and other factors limit the ability to attribute a specific change to surgical intervention, since surgery can change multiple factors. For example, subtle behavioral changes in executive function and personality are difficult to delineate in a population with preexisting neurologic and psychiatric disorders. Despite this, a clearer picture of the effects of callosotomy, as defined by clinical neurology and neuropsychology as well as cognitive neuroscience, is emerging
— id: 46276, year: 2003, vol: 4, page: 607, stat: Journal Article,

Surgical treatment of multifocal epilepsy involving eloquent cortex
Devinsky, Orrin; Romanelli, Pantaleo; Orbach, Darren; Pacia, Steven; Doyle, Werner
2003 May;44(5):718-723, Epilepsia
PURPOSE: This report describes our long-term follow-up for combined resective surgery and multiple subpial transections (MSTs) in patients with refractory epilepsy involving eloquent and noneloquent cortex in multiple lobes. Multiple independent seizure foci made these patients poor candidates for conventional surgery. METHODS: MST and resective surgery were used in 13 patients to treat localization-related refractory epilepsy involving eloquent and noneloquent cortex of two or more lobes. Preoperative investigation was followed by invasive monitoring. RESULTS: Eleven patients had MST plus resection involving two different lobes, and two patients had MST plus resection involving three different lobes. MSTs were performed on the primary sensorimotor cortex (eight patients), temporal language area (two patients), Broca's area (one patient), and on both frontal motor and temporal language areas (two patients). Nine patients had a two-stage procedure, and four patients had a three-stage procedure (two consecutive subdural grid studies followed by resections). Average follow-up was 59.2 months (range, 42-98 months). With a modified Engel Outcome Scale, four patients (31%) had a class I outcome; three (23%), class II; three (23%), class III; and three (23%), class IV. Ten (77%) patients had a >50% reduction of seizure burden. CONCLUSIONS: Combined MST and resection can meaningfully improve seizure control in patients with multifocal epilepsy involving eloquent cortex. Prospective randomized studies are needed
— id: 60155, year: 2003, vol: 44, page: 718, stat: Journal Article,

Primary generalized epilepsy: a risk factor for seizures in labor and delivery?
Katz, Jeffrey M; Devinsky, Orrin
2003 Jun;12(4):217-219, Seizure
PURPOSE: Women in the United States who have epilepsy give birth to about 20000 newborns every year. Because seizures during late gestation and delivery may seriously affect the fetus, and because primary generalized tonic-clonic (GTC) seizures may occur during labor and delivery in 1-2% of women with epilepsy, we attempted to define the rate, risks, and causes of seizures during labor and delivery. METHODS: To characterize seizures during labor and delivery, we retrospectively analyzed 89 consecutive pregnancies of women with epilepsy on antiepileptic drugs (AEDs). Six epileptologists in our group had treated these patients. We confirmed data and acquired new information by telephone for 83.1% of the pregnancies, and categorized the women as having primary generalized or partial epilepsy. Most of the patients (78%) were on monotherapy during pregnancy; 20% took two AEDs, and 3% took three AEDs during that period. RESULTS: Seizures during labor and delivery occurred in 4/32 (12.5%) patients with primary generalized epilepsy, but in none of the 57 women with partial epilepsy (P<0.05). None of the 38 patients with therapeutic AED levels before labor and delivery had seizures, compared to 3/37 (8.1%) of the subtherapeutic group. However, drug levels were taken at variable times in relation to delivery, limiting their value. Also, the levels sampled were both total and free levels; the latter would be more helpful to determine the adequacy of AED drug coverage. CONCLUSIONS: Maintaining therapeutic AED levels during the last trimester may help prevent seizures during labor and delivery, especially in women with generalized epilepsy. Women with epilepsy who had subtherapeutic AED levels and had been seizure-free may be at-risk for seizures during labor and delivery. Our sample was small, and a random sampling bias may have affected the results
— id: 60154, year: 2003, vol: 12, page: 217, stat: Journal Article,

Stratifying Differences on Ictal/Interictal Subtraction SPECT Images
Koo, Chi Wan; Devinsky, Orrin; Hari, Kim; Balasny, Jennifer; Noz, Marilyn E; Kramer, Elissa L
2003 Mar;44(3):379-386, Epilepsia
PURPOSE: Subtraction of interictal from ictal single-photon emission computed tomography (SPECT) yields numerous foci that encompass a range of pixel values scattered in the brain. This preliminary study evaluated the significance of this range of values. METHODS: Subtraction images were obtained by registering, normalizing, and subtracting interictal from ictal SPECT for 13 patients. Pixel values of the resulting foci were divided into two groups: group I with 75-100% and group II with 50-75% of the maximal pixel value. Locations of these foci were determined, and concordance with surgical outcomes and scalp and invasive EEG findings was evaluated. RESULTS: In 10 of 13 cases, group I foci showed good concordance with ictal scalp EEG. In addition, group I foci corresponded well to invasive EEG findings in nine of 10 cases. Group I foci had bilateral distributions in seven of 13 cases. In 10 of 13 cases, group I foci corresponded well to regions of surgical resection. Of these 10 patients, nine showed good concordance with scalp EEG, eight showed good invasive EEG concordance, and eight were seizure free after resection. Conversely, group II foci had good concordance with ictal scalp EEG in only five of 13 cases, and invasive EEG findings, in only five of 10 cases. Group II foci had bilateral distributions in 10 of 13 cases. All 10 cases underwent unilateral surgical resections, and all had good surgical outcomes. In six of 13 cases, group II foci showed concordance with surgical sites. Of these six foci, four had poor concordance with scalp EEG, one had poor concordance with invasive EEG, and five had good surgical outcomes. Sensitivity and specificity for seizure localization of Group I foci were 40% and 88% respectively while sensitivity and specificity of Group II foci were 20% and 79% respectively. CONCLUSIONS: Our data demonstrate that foci with 75-100% of maximal pixel values show good concordance with seizure foci, whereas foci of 50-75% may not. Therefore stratifying ictal/interictal differences may improve the specificity and localizing value of subtraction SPECT
— id: 34390, year: 2003, vol: 44, page: 379, stat: Journal Article,

Epileptic kinetopsia: Ictal illusory motion perception
Laff, Rachel; Mesad, Salah; Devinsky, Orrin
2003 Nov 11;61(9):1262-1264, Neurology
A 38-year-old woman with a right posterior temporo-occipital brain tumor developed partial seizures with illusory motion perception of environmental objects going from the center to the periphery within her left visual field. Subdural EEG recordings during visual seizures revealed onsets in the right temporo-parieto-occipital junction. Her ictal visual distortion was probably caused by activation of V5, an area involved in motion perception. Given that the tumor location corresponds with the ictal onset in the V5 area, and the semiology of her seizures, this case supports that epileptic dysfunction in V5 can cause illusions of visual motion
— id: 39000, year: 2003, vol: 61, page: 1262, stat: Journal Article,

Resolution of eating disorders after right temporal lesions
Levine, Reed; Lipson, Scott; Devinsky, Orrin
2003 Feb 15;4(6):781-783, Epilepsy & behavior
We report two patients whose eating disorder resolved after right temporal lobe lesions. The first case report involves a woman with a history of bulimia nervosa and partial seizures arising from the occipital and right temporal regions. The second case is a woman with a history of anorexia nervosa that resolved after a head injury that resulted in right-sided inferofrontal and temporal encephalomalacia. Not only did both patients' eating disorders resolve, but their moods and libidos improved
— id: 46274, year: 2003, vol: 4, page: 781, stat: Journal Article,

Selective emotional detachment from family after right temporal lobectomy
Lipson, Scott E; Sacks, Oliver; Devinsky, Orrin
2003 Jun;4(3):340-342, Epilepsy & behavior
Behavioral changes, such as mood disorders, anxiety, psychosis, and nonepileptic seizures often occur after temporal lobectomy. We report a man who selectively lost emotional attachments to family members after right temporal lobectomy. However, emotional responsiveness to strangers was normal or increased
— id: 39204, year: 2003, vol: 4, page: 340, stat: Journal Article,

Epilepsy-associated dysfunction in the voltage-gated neuronal sodium channel SCN1A
Lossin, Christoph; Rhodes, Thomas H; Desai, Reshma R; Vanoye, Carlos G; Wang, Dao; Carniciu, Sanda; Devinsky, Orrin; George, Alfred L Jr
2003 Dec 10;23(36):11289-11295, Journal of neuroscience
Mutations in SCN1A, the gene encoding the brain voltage-gated sodium channel alpha1 subunit (NaV1.1), are associated with at least two forms of epilepsy, generalized epilepsy with febrile seizures plus (GEFS+) and severe myoclonic epilepsy of infancy (SMEI). We examined the functional properties of four GEFS+ alleles and one SMEI allele using whole-cell patch-clamp analysis of heterologously expressed recombinant human SCN1A. One previously reported GEFS+ mutation (I1656M) and an additional novel allele (R1657C), both affecting residues in a voltage-sensing S4 segment, exhibited a similar depolarizing shift in the voltage dependence of activation. Additionally, R1657C showed a 50% reduction in current density and accelerated recovery from slow inactivation. Unlike three other GEFS+ alleles that we recently characterized, neither R1657C nor I1656M gave rise to a persistent, noninactivating current. In contrast, two other GEFS+ mutations (A1685V and V1353L) and L986F, an SMEI-associated allele, exhibited complete loss of function. In conclusion, our data provide evidence for a wide spectrum of sodium channel dysfunction in familial epilepsy and demonstrate that both GEFS+ and SMEI can be associated with nonfunctional SCN1A alleles
— id: 60151, year: 2003, vol: 23, page: 11289, stat: Journal Article,

Transient postoperative prosopagnosia
Mesad, Salah; Laff, Rachel; Devinsky, Orrin
2003 Oct;4(5):567-570, Epilepsy & behavior
A 23-year-old right-handed woman developed isolated transient prosopagnosia following surgical resection of a right posterior temporal seizure focus. At 18 years of age she had developed secondarily generalized tonic-clonic seizures. Preoperative neuropsychological evaluation was normal, and neurological examination revealed only a left superior quadrant achromatopsia. MRI revealed a circumscribed lesion in the right inferolateral temporo-occipital junction. Following surgery she was agitated for 36 hours, and afterward, when her attention and orientation improved, she was unable to recognize familiar faces. She could, however, recognize familiar voices. Her prosopagnosia resolved over the next 6-7 days. This case demonstrates that isolated prosopagnosia can occur in patients with lesions restricted to the right inferior posterior temporal-anterior occipital region. The temporary nature of the prosopagnosia may result from postsurgical tissue injury, including focal cerebral edema, with compensation by ipsilateral or contralateral areas
— id: 42656, year: 2003, vol: 4, page: 567, stat: Journal Article,

An effective neuropsychological screening battery for Hispanic epilepsy patients
Myers, L; Barr, WB; Vazquez, B; Devinsky, O
2003 FEB ;17(1):92-92, Clinical neuropsychologist
— id: 104268, year: 2003, vol: 17, page: 92, stat: Journal Article,

Psychogenic, Nonepileptic Seizures Associated with Video-EEG-Verified Sleep
Orbach, Darren; Ritaccio, Anthony; Devinsky, Orrin
2003 Jan;44(1):64-68, Epilepsia
PURPOSE: Nonepileptic seizures (NES) are expressions of a psychiatric disease state, usually conversion disorder, that mimic epileptic seizures (ES) but are not associated with the neurophysiologic changes of epilepsy. Conversion has not been demonstrated to emerge from the sleeping state. Emergence out of sleep is usually considered a virtual exclusion criterion for NES, signifying the presence instead of ES. We sought to test this hypothesis. METHODS: We retrospectively reviewed the video-EEG of all patients admitted to our epilepsy unit over a 3-year period, who were suspected of manifesting NES. We examined the relation between NES and the patients' sleep/wake state in this cohort. Two epileptologists blindly reviewed an intermixture of cases suspected to represent NES emerging out of sleep, together with control cases. Classification of each case was made independently. RESULTS: We found that in a small minority of patients (<1%), NES began either while the patient was sleeping, or within several seconds of arousal, well before a plan to simulate a seizure could likely have been formulated in the wakeful state. CONCLUSIONS: In some cases, NES are not the product of the awake mind, but rather represent a psychiatric condition that can be manifest in sleep
— id: 34402, year: 2003, vol: 44, page: 64, stat: Journal Article,

Extent of ictal origin in mesial temporal sclerosis patients monitored with subdural intracranial electrodes predicts outcome
Prasad, Avinash; Pacia, Steven V; Vazquez, Blanca; Doyle, Werner K; Devinsky, Orrin
2003 Jul-Aug;20(4):243-248, Journal of clinical neurophysiology
In patients with mesiotemporal sclerosis, posterior hippocampal involvement at the ictal onset is not associated with an excellent outcome. A study confirmed that ictal onset in the posterior parahippocampal gyrus is associated with a less favorable outcome compared with ictal onset in the anterior parahippocampal gyrus in patients with mesiobasal temporal lobe epilepsy who are undergoing foramen ovale recording. The authors hypothesized that involvement of the two medial contact points of posterior basal temporal subdural (SD) strip at the ictal onset, representing ictal onset in the posterior parahippocampal gyrus, may also adversely influence the surgical outcome. With this objective, the authors assessed the incidence of posterior basal temporal SD strip (the two medial contact points) involvement at the ictal onset in patients with mesiotemporal sclerosis and determined whether presence of this finding influenced surgical outcome. Thirty-six patients with mesiotemporal sclerosis underwent a single SD grid (lateral frontotemporal) and strips (three basal temporal and one orbitosubfrontal) monitoring. Based on the earliest involvement of basal temporal strips (the two medial contact points) during the seizure, patients were classified into (1) anterior and/or middle basal temporal, or (2) posterior basal temporal (with or without involvement of anterior and/or middle basal temporal) ictal onset groups. A temporal lobectomy with adequate resection of the ictal onset zone was performed in all patients. Surgical outcome was based on Engel's classification. Six of 36 (17%) patients were classified into the posterior basal temporal ictal onset group. Only two patients from the posterior basal temporal ictal onset group experienced a good outcome compared with 26 of 30 patients from anterior and/or middle basal temporal ictal onset group (P = 0.01). In patients with mesiotemporal sclerosis who were monitored with SD electrodes, involvement of the two medial contact points of posterior basal temporal strip at the ictal onset (representing ictal onset in the posterior parahippocampal gyrus) occurred in 17% of the patients. These patients might not experience an excellent surgical outcome despite including the ictal onset zone in resection. These findings may be useful in presurgical counseling of patients with mesiotemporal sclerosis who undergo intracranial SD monitoring
— id: 44949, year: 2003, vol: 20, page: 243, stat: Journal Article,

Late-onset epilepsy in focal cortical dysplasia of Taylor's type: A study of 20 patients
Siegel, AM; Cascino, GD; Elger, CE; Devinsky, O; Sperling, M; Crook, D; Lo Russo, G; Cossu, M; Scheithauer, B; Dubeau, F; Andermann, F
2003 APR ;44(2):92-92, Epilepsia
— id: 104266, year: 2003, vol: 44, page: 92, stat: Journal Article,

Epilepsy and anxiety
Vazquez, Blanca; Devinsky, Orrin
2003 Dec;4 Suppl 4:S20-S25, Epilepsy & behavior
Studies in the general population demonstrate that anxiety disorders are associated with impaired quality of life and function. Available evidence suggests that comorbid anxiety disorders are frequent among patients with epilepsy but that neither the interrelationships between them nor the impact of anxiety disorders on functional outcome is well studied. The study and management of anxiety disorders are further complicated by the occurrence of seizures, the temporal relationship between seizures and anxiety symptoms/syndromes, and the influence of antiepileptic drugs. Increased recognition of anxiety disorders among patients with epilepsy and evaluation of the potential impact of these disorders on functional outcome and the beneficial and detrimental effects of antiepileptic drugs in clinical practice are needed
— id: 60152, year: 2003, vol: 4 Suppl 4, page: S20, stat: Journal Article,

Premorbid psychiatric risk factors for postictal psychosis: In reply
Alper, Kenneth R; Devinsky, Orrin; Boylan, Laura
2002 ;14(4):465-466 Fal, Journal of neuropsychiatry & clinical neurosciences
Responds to G. C. Fong et al's comments (see record 2002-06521-015) on K. Alper et al's article (see record 2001-09677-006) which reported interest in the relationship between seizure cluster characteristics, presence of mood disorder among first- and second-decree relatives, and postictal psychosis. The current authors agree that the approach would be useful. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
— id: 80779, year: 2002, vol: 14, page: 465, stat: Journal Article,

Epilepsy
Bassi, Vicky; Yerby, Mark S; Devinsky, Orrin
2002 ;90(6):185-212, Advances in neurology
— id: 34407, year: 2002, vol: 90, page: 185, stat: Journal Article,

Psychiatric uses of antiepileptic treatments
Boylan LS; Devinsky O; Barry JJ; Ketter TA
2002 Oct;3(5):S54-S59, Epilepsy & behavior
Antiepileptic drugs (AEDs) possess potent negative or positive psychotropic effects. Clear evidence of benefit exists for valproate, carbamazepine, and lamotrigine in bipolar disorder. Reports of benefit from various AEDs in mood, anxiety, impulse control, and personality disorder are reviewed. Further research is needed to clarify which patients are likely to benefit. Clinicians must closely attend to the ongoing risk/benefit analysis and consider possible iatrogenic worsening of neuropsychiatric symptoms
— id: 34392, year: 2002, vol: 3, page: S54, stat: Journal Article,

Therapy for Cognitive and Behavioral Disorders and Epilepsy - Foreword
Devinsky, O; Kanner, AM; Ettinger, AB
2002 OCT ;3(5):S1-S1, Epilepsy & behavior
— id: 104269, year: 2002, vol: 3, page: S1, stat: Journal Article,

A double-blind, placebo-controlled study of remacemide hydrochloride in patients with refractory epilepsy following pre-surgical assessment
Devinsky, O; Vazquez, B; Faught, E; Leppik, I E; Pellock, J M; Schachter, S; Alderfer, V; Holdich, T A H
2002 Sep;11(6):371-376, Seizure
This multicentre, randomised, double-blind, placebo-controlled, parallel-group study investigated the efficacy, safety and pharmacokinetics of remacemide hydrochloride in adult patients ( n= 59) with refractory epilepsy, undergoing reduced or discontinued antiepileptic drug (AED) usage, as part of an evaluation for epilepsy surgery. On discontinuation or reduction of maintenance AEDs, patients received remacemide hydrochloride, up to 600 mg daily, or placebo, for up to ten days or until they experienced a fourth complex partial (CPS) or a generalised tonic-clonic (GTC) seizure. Pre- and post-study blood and urine samples were taken for analysis. Remacemide hydrochloride showed a significantly ( P= 0.045) longer median time to fourth seizure compared with placebo (6.8 vs. 3.8 days). Median nine-day seizure counts were significantly ( P= 0.0327) lower with remacemide hydrochloride than placebo (6.2 vs. 12.8). Eleven remacemide hydrochloride patients and six placebo patients completed ten days' treatment. Remacemide and desglycinyl metabolite levels were lower in patients receiving concomitant carbamazepine or phenytoin than in those receiving non-inducing AEDs or remacemide hydrochloride alone. No serious adverse events occurred; all patients receiving remacemide hydrochloride completed the study. Remacemide hydrochloride was well tolerated and showed significant therapeutic activity in this patient population
— id: 34405, year: 2002, vol: 11, page: 371, stat: Journal Article,

Epilepsy : patient and family guide
Devinsky, Orrin
Philadelphia PA : F.A. Davis, 2002,
— id: 895, year: 2002, vol: , page: , stat: ,

What do you do when they grow up? Approaches to seizures in developmentally delayed adults
Devinsky, Orrin
2002 ;43 Suppl 3(6):71-79, Epilepsia
Epilepsy and developmental disabilities (DD) often occur together but affect individuals differently and have a complex causal relationship. Most epilepsy in the population with DD is partial or symptomatic generalized. Seizures and antiepileptic drugs (AEDs) can further delay development, and the DD can complicate treatment and adjustment to epilepsy. Medical care and decision making require careful coordination of health care providers and the family, especially because of the trend for the patients to live in group homes. Behavioral and psychiatric disorders are difficult to diagnose but common in those with DD and epilepsy; psychiatric disorders are perhaps up to sevenfold higher in this group than in the general population. Psychotropic medications-antidepressants, anxiolytics (but use caution with benzodiazepines), antipsychotics, and stimulants-are appropriate for those with psychiatric disorders. Diagnostic difficulties may lead to undertreatment, and the motivation to lessen certain behaviors may lead to overtreatment. Because those with DD may be unusually sensitive to adverse effects of both seizures and AEDs, cognitive and behavioral side effects must be carefully monitored. Few relevant studies exist. For some patients, comorbid psychiatric disorders may be treated with one AED, such as carbamazepine, lamotrigine, or valproate. Phenobarbital and phenytoin may be inappropriate for those with epilepsy and DD. Studies have shown some success with oxcarbazepine (for partial and generalized epilepsy) and with adjunctive lamotrigine. For those on medication regimens, perhaps taking combinations of drugs for numerous years, queries about earlier attempts to reduce AEDs and gradual efforts to substitute less toxic mediations are worthwhile. Vagus nerve stimulation and epilepsy surgery for those with medically refractory epilepsy may be options after careful evaluation
— id: 34408, year: 2002, vol: 43 Suppl 3, page: 71, stat: Journal Article,

Neurological complications of pregnancy
Devinsky, Orrin; Feldmann, Edward; Hainline, Brian
Philadelphia, PA. : Lippincott Williams & Wilkins, c2002,
— id: 736, year: 2002, vol: , page: , stat: ,

Psychiatric disorders
Devinsky, Orrin; Miceli, Mary T
2002 ;90(6):277-293, Advances in neurology
— id: 34406, year: 2002, vol: 90, page: 277, stat: Journal Article,

Epilepsy and developmental disabilities
Devinsky, Orrin; Westbrook, Lauren E.
Boston : Butterworth-Heinemann, c2002,
— id: 723, year: 2002, vol: , page: , stat: ,

Religious/spiritual beliefs and behavior in epilepsy
Hayton, T; Boylan, LS; Jackson, SC; Devinsky, O
2002 SEP ;52(3):S20-S20, Annals of neurology
— id: 104270, year: 2002, vol: 52, page: S20, stat: Journal Article,

Decrease of sympathetic cardiovascular modulation after temporal lobe epilepsy surgery
Hilz, M J; Devinsky, O; Doyle, W; Mauerer, A; Dutsch, M
2002 May;125(Pt 5):985-995, Brain
In temporal lobe epilepsy (TLE), there is evidence of ictal and interictal autonomic dysregulation, predominantly with sympathetic overactivity. The effects of TLE surgery on autonomic cardiovascular control and on baroreflex sensitivity (BRS) have not been studied. To evaluate such effects, we monitored heart rate (HR), systolic blood pressure (BP(sys)) and respiration in 18 TLE patients 3-4 months before and after TLE surgery. We used Blackman-Tukey spectral analysis to assess sympathetic and parasympathetic modulation as powers of HR and BP(sys) oscillations in the low frequency (LF, 0.04-0.15 Hz) and high frequency (HF, 0.15-0.5 Hz) bands. BRS was determined as the LF transfer function gain between BP and HR. After surgery, HR, BP(sys), respiration and HF powers remained unchanged, while LF powers of HR (1.57 +/- 1.54 bpm(2)) and BP(sys) (2.19 +/- 1.34 mmHg(2)) and BRS (0.68 +/- 0.31 bpm/mmHg) were smaller than pre-surgical LF powers of HR (3.87 +/- 3.26 bpm(2)) and BP(sys) (4.80 +/- 3.84 mmHg(2)) and BRS (1.12 +/- 0.39 bpm/mmHg; P < 0.05). After TLE surgery, there is a reduction of sympathetic cardiovascular modulation and BRS that might result from decreased influences of interictal epileptogenic discharges on brain areas involved in cardiovascular autonomic control. TLE surgery seems to stabilize the cardiovascular control in epilepsy patients by reducing the risk of sympathetically mediated tachyarrhythmias and excessive bradycardiac counter-regulation, both of which might be relevant for the pathophysiology of sudden unexpected death in epilepsy patients (SUDEP). Thus, TLE surgery might contribute to reducing the risk of SUDEP
— id: 34409, year: 2002, vol: 125, page: 985, stat: Journal Article,

Treatment of nonepileptic seizures
LaFrance, W Curt Jr; Devinsky, Orrin
2002 Oct;3(5S):19-23, Epilepsy & behavior
STUDIES ON NONEPILEPTIC SEIZURES (NES) PROVIDE DICHOTOMOUS DATA SETS: extensive observational findings, but a paucity of controlled treatment data. Psychosocial stressors, whose full impact may lie outside a patient's awareness, often underlie NES. These stressors, along with patient's learned patterns of coping, may bring forth or potentiate comorbid psychiatric disorders. Patients with NES often have dysfunction in emotion regulation and family dynamics, as well as unemployment/disability. High percentages of comorbid disorders such as major depressive disorder, post-traumatic stress disorder, and cluster B personality with impulsivity (all disorders associated with serotonin system function) also exist in the NES population. The preliminary observational evidence suggests that specific psychotherapies and pharmacotherapy directed at comorbid conditions may be the most effective treatment for NES
— id: 34393, year: 2002, vol: 3, page: 19, stat: Journal Article,

Epilepsy in The Alienist and Neurologist, 1880-1920
Lipson, Scott E; Montes, Jennifer A; Devinsky, Orrin
2002 Aug;43(8):912-919, Epilepsia
PURPOSE: To study the history of epilepsy from 1880 to 1920. METHODS: We reviewed all 40 volumes of The Alienist and Neurologist and identified articles concerning primarily epilepsy. We analyzed three of these articles in greater detail. RESULTS: The Alienist and Neurologist published 'Original Contributions,''Selections,' (abstracts from other journals written by the editorial board), 'Editorials,' and (book) 'Reviews.' Of 258 epilepsy articles, there were 40 Original Contributions, 164 Selections, 39 Editorials, and 15 Reviews. These articles included 71 on therapy (41 medication, 13 surgery, and 17 other therapies); 66 general discussions; 46 on etiology or symptoms; 34 case studies; 28 social/legal articles; and 13 autopsy or pathology articles. CONCLUSIONS: Analysis of The Alienist and Neurologist provides a unique and valuable perspective on the clinical practice and academic world of epileptology during the decades around the turn of the twentieth century
— id: 34404, year: 2002, vol: 43, page: 912, stat: Journal Article,

Evaluation of a first seizure. Is it epilepsy?
Prego-Lopez, Marisa; Devinsky, Orrin
2002 Jan;111(1):34-6, 43, Postgraduate medicine
The first step in evaluation of a presumed seizure is to determine whether the event was indeed a seizure and which diagnostic studies are needed. The second step is to correctly diagnose the seizure on the basis of the medical history and findings from the physical, neurologic, and laboratory evaluation. The third step is to decide whether drug treatment is necessary. Every paroxsymal event is unique, and not every seizure needs to be treated. When treatment is deemed appropriate, an antiepileptic drug should be chosen after discussion with the patient and consideration of the risk-benefit profile of the available agents
— id: 34413, year: 2002, vol: 111, page: 34, stat: Journal Article,

Cognition-induced epilepsy
Ritaccio AL; Singh A; Devinsky O
2002 Dec;3(6):496-501, Epilepsy & behavior
Cognition-induced epilepsy comprises a group of loosely tied syndromes characterized by seizures regularly precipitated by cognitive tasks. Linguistic operations (e.g., reading, writing) and decision making associated with visuospatial manipulation are the most frequent and best-characterized triggers. The syndromes reviewed have a high degree of overlap and clinical/EEG variability, suggesting that any of the neural networks subserving these complex tasks may promote seizures on either a topographic basis or a functional/connective basis. Treatment options include typical pharmacological and surgical interventions as well as stimulus alteration, threshold alteration, and avoidance conditioning. We postulate that more commonly encountered epilepsy syndromes also have complex triggers
— id: 34394, year: 2002, vol: 3, page: 496, stat: Journal Article,

Epilepsy surgery in tuberous sclerosis: multistage procedures with bilateral or multilobar foci
Romanelli, Pantaleo; Najjar, Souhel; Weiner, Howard L; Devinsky, Orrin
2002 Sep;17(9):689-692, Journal of child neurology
Refractory seizures are common in patients with tuberous sclerosis and can contribute to developmental delay and behavioral problems. Surgical intervention can reduce the seizure burden in selected patients with tuberous sclerosis and refractory epilepsy, thereby improving cognitive function, behavior, and quality of life. However, the risks of surgery are usually considered unacceptable when the epileptogenic focus lies over dominant hemisphere eloquent cortex or is multilobar. Multistage invasive monitoring can provide detailed data regarding the location and number of ictal foci and functional extraoperative mapping can precisely delineate the boundaries of eloquent areas of the brain. If independent ictal onsets are demonstrated, a staged surgical approach can allow a more aggressive yet safe procedure in selected patients. A combination of staged resection and multiple subpial transections may provide an opportunity to treat epileptogenic foci located over eloquent cortex. Bilateral staged resections can be used when independent bihemispheric foci are present in patients with tuberous sclerosis. This article presents two cases, one of which (case 2) was previously reported, on successful multistage surgical treatment of epileptogenic foci located over an eloquent cortex or in both hemispheres in children with tuberous sclerosis. This case is represented since there is additional follow-up available and the prior report was to a neurosurgical audience. This multistage approach permitted resection of epileptogenic foci that would traditionally have been considered inoperable
— id: 34403, year: 2002, vol: 17, page: 689, stat: Journal Article,

Multiple subpial transection for intractable partial epilepsy: an international meta-analysis
Spencer, Susan S; Schramm, Johannes; Wyler, Allen; O'Connor, Michael; Orbach, Darren; Krauss, Gregory; Sperling, Michael; Devinsky, Orrin; Elger, Christian; Lesser, Ronald; Mulligan, Lisa; Westerveld, Michael
2002 Feb;43(2):141-145, Epilepsia
PURPOSE: Because the number and variety of patients at any single facility is not sufficient for clinical or statistical analysis, data from six major epilepsy centers that performed multiple subpial transections (MSTs) for medically intractable epilepsy were collected. METHODS: A meta-analysis was performed to elucidate the indications and outcome, and to assess the results of the procedure. Overall, 211 patients were represented with data regarding preoperative evaluation, procedures, seizure types and frequencies before and after surgery, postoperative deficits, and demographic information. Fifty-three patients underwent MST without resection. RESULTS: In patients with MST plus resection, excellent outcome (>95% reduction in seizure frequency) was obtained in 87% of patients for generalized seizures, 68% for complex partial seizures, and 68% for simple partial seizures. For the patients who underwent MST without resection, the rate of excellent outcome was only slightly lower, at 71% for generalized, 62% for complex partial, and 63% for simple partial seizures. EEG localization, age at epilepsy onset, duration of epilepsy, and location of MST were not significant predictors of outcome for any kinds of seizures after MST, with or without resection. New neurologic deficits were found in 47 patients overall, comparable in MST with resection (23%) or without (19%). CONCLUSIONS: These preliminary results suggest that MST has efficacy by itself, with minimal neurologic compromise, in cases in which resective surgery cannot be used to treat uncontrolled epilepsy. MST should be investigated as a stand-alone procedure to allow further development of criteria and predictive factors for outcome
— id: 34410, year: 2002, vol: 43, page: 141, stat: Journal Article,

Premorbid psychiatric risk factors for postictal psychosis
Alper K; Devinsky O; Westbrook L; Luciano D; Pacia S; Perrine K; Vazquez B
2001 Fall;13(4):492-499, Journal of neuropsychiatry & clinical neurosciences
Postictal psychosis (PIP) is a common and clinically significant sequela of inpatient epilepsy monitoring. A series of 622 patients with complex partial epilepsy undergoing video-EEG evaluations as candidates for epilepsy surgery were evaluated, by structured psychiatric interview, for individual and family psychiatric histories, depression, anxiety, and features of personality disorders. No patient had psychotic symptoms at baseline. Twenty-nine developed a PIP episode during monitoring. The a priori hypotheses were that patients with PIP would have higher baseline schizotypal and paranoid personality ratings and a greater prevalence of histories of psychiatric treatment and family history of psychotic illness. However, only a higher prevalence of mood disorder among first- and second-degree relatives distinguished the patients who developed PIP on logistic regression analyses (odds ratio=3.49, P=0.001). Possible mechanisms linking vulnerability toward mood disorders and the development of psychotic symptoms in epilepsy are discussed
— id: 26525, year: 2001, vol: 13, page: 492, stat: Journal Article,

Monoamine neurotransmitters in resected hippocampal subparcellations from neocortical and mesial temporal lobe epilepsy patients: In situ microvoltammetric studies (vol 878, pg 48, 2000)
Broderick, PA; Pacia, SV; Doyle, WK; Devinsky, O
2001 JAN 5 ;888(1):189-189, Brain research
— id: 55228, year: 2001, vol: 888, page: 189, stat: Journal Article,

Adult-onset idiopathic generalized epilepsy: clinical and behavioral features
Cutting S; Lauchheimer A; Barr W; Devinsky O
2001 Nov;42(11):1395-1398, Epilepsia
PURPOSE: To identify and define clinical and behavioral features of patients with adult-onset idiopathic generalized epilepsy (IGE). METHODS: We reviewed the charts of 313 IGE patients at the NYU Comprehensive Epilepsy Center over the past 5 years to identify patients with adult onset (18 years old or older). We excluded patients with childhood or adolescent symptoms that suggested absence, myoclonic, or tonic-clonic seizures, as well as those with a history of significant head injury or other known causes of localization-related epilepsy. RESULTS: Forty-two (13.4%) patients had a clear onset of IGE in adulthood; average age of onset was early 20s (mean, 23.8 years; range, 18-55 years). Twenty-one patients had adult myoclonic epilepsy (AME, 50%), and three had generalized tonic-clonic seizures on awakening (GTCS-A, 7%). More than two thirds (n=30) are well controlled with current antiepileptic drugs (AEDs), and almost 90% are currently employed (n=37). One third were diagnosed and treated for mental disorders, including depression (n=12), anxiety (n=7), obsessive-compulsive personality disorder (n=2), and postictal psychosis (n=1). CONCLUSIONS: Adult-onset IGE is associated with a good prognosis. An association may exist between psychological disorders, psychotropic medication, and level of seizure control in adults with IGE
— id: 34412, year: 2001, vol: 42, page: 1395, stat: Journal Article,

Reply
Devinsky O
2001 Jun;2(3):298-299, Epilepsy & behavior
— id: 34391, year: 2001, vol: 2, page: 298, stat: Journal Article,

Nondominant hemisphere lesions and conversion nonepileptic seizures
Devinsky O; Mesad S; Alper K
2001 Summer;13(3):367-373, Journal of neuropsychiatry & clinical neurosciences
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%. Fifty (63%) of the C-NES patients had both structural and epileptiform abnormalities. Among the 60 with unilateral abnormalities, 43 (71%) had right hemisphere structural lesions or physiologic dysfunctions (C-NES>non-C-NES, P<0.02). This study supports prior studies and clinical observations that cerebral dysfunction can contribute to the pathogenesis of conversion disorder, and that nondominant hemisphere dysfunction may play a greater role
— id: 34414, year: 2001, vol: 13, page: 367, stat: Journal Article,

Alcohol and marijuana: effects on epilepsy and use by patients with epilepsy
Gordon E; Devinsky O
2001 Oct;42(10):1266-1272, Epilepsia
We review the safety of alcohol or marijuana use by patients with epilepsy. Alcohol intake in small amounts (one to two drinks per day) usually does not increase seizure frequency or significantly affect serum levels of antiepileptic drugs (AEDs). Adult patients with epilepsy should therefore be allowed to consume alcohol in limited amounts. However, exceptions may include patients with a history of alcohol or substance abuse, or those with a history of alcohol-related seizures. The most serious risk of seizures in connection with alcohol use is withdrawal. Alcohol withdrawal lowers the seizure threshold, an effect that may be related to alcohol dose, rapidity of withdrawal, and chronicity of exposure. Individuals who chronically abuse alcohol are at significantly increased risk of developing seizures, which can occur during withdrawal or intoxication. Alcohol abuse predisposes to medical and metabolic disorders that can lower the seizure threshold or cause symptoms that mimic seizures. Therefore, in evaluating a seizure in a patient who is inebriated or has abused alcohol, one must carefully investigate to determine the cause. Animal and human research on the effects of marijuana on seizure activity are inconclusive. There are currently insufficient data to determine whether occasional or chronic marijuana use influences seizure frequency. Some evidence suggests that marijuana and its active cannabinoids have antiepileptic effects, but these may be specific to partial or tonic-clonic seizures. In some animal models, marijuana or its constituents can lower the seizure threshold. Preliminary, uncontrolled clinical studies suggest that cannabidiol may have antiepileptic effects in humans. Marijuana use can transiently impair short-term memory, and like alcohol use, may increase noncompliance with AEDs. Marijuana use or withdrawal could potentially trigger seizures in susceptible patients
— id: 26557, year: 2001, vol: 42, page: 1266, stat: Journal Article,

Hemispheric influence on autonomic modulation and baroreflex sensitivity
Hilz MJ; Dutsch M; Perrine K; Nelson PK; Rauhut U; Devinsky O
2001 May;49(5):575-584, Annals of neurology
Several studies suggest hemispheric lateralization of autonomic cardiovascular control. There is controversy regarding which hemisphere dominates sympathetic or parasympathetic activity. Hemispheric influences on baroreflex sensitivity (BRS) have not yet been evaluated. To determine hemispheric autonomic control in epilepsy patients, we assessed cardiovascular and baroreflex modulation before and during hemispheric inactivation. For 15 patients with drug-refractory epilepsy, we analyzed autonomic heart rate (HR) and blood pressure (BP) modulation and BRS before and during left and right intracarotid amobarbital procedure (IAP). After Blackman-Tukey spectral analysis, we calculated the low-frequency (LF: 0.04-0.15 Hz) and high-frequency (HF: 0.15-0.5 Hz) power of HR and BP as well as BRS as the LF transfer function gain between BP and HR. Right hemispheric inactivation induced a significant decrease of BP and an increase of HF power of HR and BP (p < 0.05). Left inactivation increased HR, BP, and LF power of both signals and decreased BRS by nearly 30% (p < 0.05). The results confirm previous IAP studies showing sympathetic lateralization in the right hemisphere and, moreover, demonstrate parasympathetic predominance and up-regulation of BRS in the left hemisphere. In epilepsy patients, unilateral electrical activity might derange autonomic balance between both hemispheres and contribute to cardiovascular dysregulation and sudden fatalities
— id: 20660, year: 2001, vol: 49, page: 575, stat: Journal Article,

Effect of vagus nerve stimulation on baroreflex sensitivity and respiratory sinus arrhythmia in patients with epilepsy
Hilz, MJ; Stemper, B; Haendl, T; Welsch, G; Devinsky, O
2001 APR 24 ;56(8):A424-A425, Neurology
— id: 104271, year: 2001, vol: 56, page: A424, stat: Journal Article,

A long letter and an even longer reply about autism magnetoencephalography and electroencephalography - Reply
Kanner, AM; Smith, MC; Devinsky, O
2001 MAY ;107(5):1236-1236, Pediatrics
— id: 55085, year: 2001, vol: 107, page: 1236, stat: Journal Article,

Current Management of Epilepsy and Pregnancy: Fetal Outcome, Congenital Malformations, and Developmental Delay
Katz JM; Pacia SV; Devinsky O
2001 Apr;2(2):119-123, Epilepsy & behavior
Purpose. Women with epilepsy (WWE) reportedly have increased rates of pregnancy complications and poor fetal outcomes related to both their epilepsy and antiepileptic drugs (AEDs). These results influence decisions about conceiving. Most published studies evaluate WWE treated before 1990. We sought to better define risks to pregnant WWE at a tertiary care center, which used current epilepsy guidelines.Methods. We retrospectively analyzed 100 consecutive pregnancies in WWE from 1990 to 2000. Maternal data: epilepsy syndrome, duration, AEDs used, seizure occurrence and frequency, delivery type and complications. Fetal outcomes: fetal birth weight (FBW), gestational age, incidence of prematurity, major and minor congenital malformations, developmental delay.Results. Maternal factors: 37% generalized and 63% partial epilepsies, 59% seizure-free throughout pregnancy, 30% increased and 22% decreased seizure frequency, 90% used AEDs, 21% required polytherapy, 98% took folate, and 48% with gestational seizures delivered by cesarean section, compared with 18% without seizures (P < 0.01). Fetal outcome: Mean FBW and gestational ages similar regardless of AED usage or exposure to maternal seizures, 3.9% prematurity, no cases of still birth or neonatal hemorrhagic disorder, 1.1% of children exposed to AEDs had major congenital malformations, and 6.2% of offspring had pervasive developmental delay (PDD).Conclusions. All fetal outcomes were similar to outcomes for the general population, with the exception of higher rates of PDD and cesarean section. In our small sample of WWE treated with current epilepsy management, the majority had excellent outcomes. Future large studies must confirm this
— id: 34396, year: 2001, vol: 2, page: 119, stat: Journal Article,

The significance of submaximal differences on ictal/interictal SPECT images
Koo, CW; Hari, K; Belasmy, J; Devinsky, O; Noz, ME; Kramer, E
2001 MAY abstract #235;42(5):63P-63P, Journal of nuclear medicine
— id: 33362, year: 2001, vol: 42, page: 63P, stat: Journal Article,

Late seizure recurrence after multiple subpial transections
Orbach D; Romanelli P; Devinsky O; Doyle W
2001 Oct;42(10):1316-1319, Epilepsia
We studied long-term outcome (range, 28-89 months; mean, 56 months) after multiple subpial transections (MSTs) for medically refractory epilepsy. Forty-three (79.6%) of 54 patients had a consistent significant reduction in seizure frequency, and 27 (50%) of the 54 were either entirely seizure free or virtually so. However, 10 (18.6%) patients sustained an increase in seizure frequency several years after surgery, after showing initial postoperative improvement. This suggests that late seizure recurrence is a more important problem in cases in which MST has been performed than for pure resections
— id: 26556, year: 2001, vol: 42, page: 1316, stat: Journal Article,

Late seizure recurrence after multiple subpial transections
Orbach D; Romanelli P; Devinsky O; Doyle W
2001 Sep;42(9):1130-1133, Epilepsia
We studied long-term outcome (range, 28-89 months; mean, 56 months) after multiple subpial transections (MST) for medically refractory epilepsy. Forty-three (79.6%) of 54 patients had a consistent significant reduction in seizure frequency, and 27 (50%) of the 54 were either entirely seizure free or virtually so. However, 10 (18.5%) patients sustained an increase in seizure frequency several years after surgery, after showing initial postoperative improvement. This suggests that late seizure recurrence is a more important problem in cases in which MST has been performed than for pure resections
— id: 26612, year: 2001, vol: 42, page: 1130, stat: Journal Article,

Bilateral resective epilepsy surgery in a child with tuberous sclerosis: case report
Romanelli P; Weiner HL; Najjar S; Devinsky O
2001 Sep;49(3):732-734, Neurosurgery
OBJECTIVE AND IMPORTANCE: Surgical intervention can reduce the burden of seizures in selected patients with tuberous sclerosis and medically refractory epilepsy. CLINICAL PRESENTATION: A child presented with tuberous sclerosis and severe epilepsy beginning in the first month of life and delayed development before 1 year of age. Video-electroencephalographic monitoring at the age of 1 year revealed a left temporal seizure focus. Repeat videoelectroencephalography at 2 years of age revealed a right posterior quadrant seizure focus. Bilateral subdural electrodes were placed, confirming independent seizure onsets from the right parietal area (overlying a tuber) and prominent interictal activity over the left superior temporal region. INTERVENTION: The right parietal focus was resected, and electrodes were maintained over the left temporal focus. After right parietal resection, ictal discharges were recorded over the left temporal region; a corticectomy was performed 2 days later. No tonicoclonic or complex partial seizures have occurred during a follow-up period of more than 24 months. Simple partial motor seizures involving the right foot have been reduced by more than 80%, and other simple partial seizures have been eliminated. Postoperatively, there has been marked improvement in the patient's cognitive and motor developmental status. CONCLUSION: In selected patients with bilateral seizure foci involving separate lobes, aggressive bilateral surgery can be safe and effective
— id: 33905, year: 2001, vol: 49, page: 732, stat: Journal Article,

Progression of postictal to interictal psychosis
Tarulli A; Devinsky O; Alper K
2001 Nov;42(11):1468-1471, Epilepsia
PURPOSE: To describe a case series of patients with both postictal psychosis (PIP) and chronic interictal psychosis (IIP). METHODS: We retrospectively reviewed the records of 43 patients with PIP from a comprehensive epilepsy center to find evidence of both PIP and IIP in the same patient. RESULTS: Six (13.9%) of the 43 patients met all the criteria for both PIP and IIP. Five of our six patients had multiple documented PIPs before they became chronically psychotic. The range of length of time between PIP and IIP was 7 to 96 months. Postictal and interictal psychotic behavior was similar or identical in five of six cases. CONCLUSIONS: The results of this study suggest a progression from PIP to IIP: there is a similarity between the symptoms of the two psychoses, a history of multiple PIPs before the first IIP, and a period of months to years between PIP and IIP onset
— id: 34411, year: 2001, vol: 42, page: 1468, stat: Journal Article,

Monoamine neurotransmitters in resected hippocampal subparcellations from neocortical and mesial temporal lobe epilepsy patients: in situ microvoltammetric studies
Broderick PA; Pacia SV; Doyle WK; Devinsky O
2000 Sep 29;878(1-2):48-63, Brain research
It is known that epilepsy patients diagnosed with neocortical temporal lobe epilepsy (NTLE), differ from those diagnosed with mesial temporal lobe epilepsy (MTLE), e.g., in hippocampal (HPC) pathology. In the present studies, we tested the hypothesis that NTLE and MTLE subtypes of human epilepsy might differ in regards to their HPC monoamine neurochemistry. Monoamine neurotransmitters were studied in separate signals and within s with semiderivative microvoltammetry, used in combination with stearate indicator, Ag-AgCl reference and stainless steel auxiliary microelectrodes. Anterior HPC specimens from the patients' epileptogenic zone, defined by electrocorticography, were resected neurosurgically from 13 consecutive patients with intractable temporal lobe epilepsy. Four patients were diagnosed with NTLE and nine with MTLE. The criteria for the diagnosis of NTLE versus MTLE was absence versus presence of HPC sclerosis, respectively, based on MRI examination of resected tissue. In addition, NTLE patients demonstrated seizure onset in anterolateral temporal neocortex on electroencephalography (EEG). HPC subparcellations studied were: (a) Granular Cells of the Dentate Gyrus (DG), (b) Polymorphic Layer of DG and (c) Pyramidal Layer: subfields, CA1 and CA2. Dopamine (DA), serotonin (5-HT), norepinephrine (NE) and ascorbic acid (AA) (co-factor in DA to NE synthesis), exhibited separate and characteristic half-wave potentials in millivolts. Each half-wave potential, i.e., the potential at which maximum current was generated, was experimentally established in vitro. Concentrations of neurotransmitters found in HPC subparcellations were interpolated from calibration curves derived in vitro from electrochemical detection of monoamines and AA in saline phosphate buffer. Significant differences between subtypes in concentration of monoamines were analyzed by the Mann Whitney rank sum test and those differences in probability distribution of monoamines were analyzed by the Fisher Exact test; in each case, P<0.01 was the criteria selected for determining statistical significance. DA concentrations were higher in NTLE compared with MTLE in each HPC subparcellation [P=0.037, 0.024 and 0.007, respectively (P<0.01)] and DA occurred more frequently in NTLE in the Pyramidal Layer [P=0.077 (P<0.01)]. AA was present in one NTLE patient. NE concentrations were higher in MTLE vs. NTLE in each subparcellation [P=0.012, 0.067 and 0.07, respectively (P<0.01)] and NE occurred more frequently in MTLE in Granular Cells of DG and Pyramidal Layer [P=0.052 and 0.014, respectively (P<0.01)]. In MTLE, NE concentrations in the CA1 subfield of the Pyramidal Layer were decreased vs. the CA2 subfield [P=0.063 (P<0.01)]. Serotonin was found in every HPC subparcellation of each subtype but 5-HT concentrations were higher in NTLE vs. MTLE in the Granular Cells of DG and the Pyramidal Layer (CA1 subfield) [P=0.076 and 0.095, respectively (P<0.01)]. Thus, this preliminary study showed that marked differences in HPC monoamine neurochemistry occurred in NTLE patients as compared with MTLE patients
— id: 34418, year: 2000, vol: 878, page: 48, stat: Journal Article,

A mind that tics
Devinsky O
2000 Aug;57(8):753-753, Archives of general psychiatry
— id: 34419, year: 2000, vol: 57, page: 753, stat: Journal Article,

My mother recently had a stroke and was put on Dilantin (phenytoin) to prevent seizures. I've heard Dilantin can interfere with coordination and the ability to think clearly. Is there an alternative drug?
Devinsky O
2000 Nov;6(11):10-10, Health news
— id: 34416, year: 2000, vol: 6, page: 10, stat: Journal Article,

Quality of Life in Epilepsy: Time to Practice What We Preach
Devinsky O
2000 Apr;1(2):89-90, Epilepsy & behavior
— id: 34398, year: 2000, vol: 1, page: 89, stat: Journal Article,

The Meaning of Quality of Life to Patients with Epilepsy
Devinsky O
2000 Feb;1(1):S18-S20, Epilepsy & behavior
— id: 34399, year: 2000, vol: 1, page: S18, stat: Journal Article,

Safety and efficacy of standard and new antiepileptic drugs
Devinsky O; Cramer J
2000 ;55(11 Suppl 3):S5-10, Neurology
Knowledge about the comparative safety and efficacy of standard and new antiepileptic drugs (AEDs) is limited. Medications are selected on the basis of seizure type and epilepsy syndrome, adverse effect profiles, and cost. However, there are few data comparing the efficacy of the new AEDs for the treatment of recent-onset versus refractory partial seizures, simple versus complex partial seizures, frontal versus temporal lobe seizures, or other relevant clinical types. Few studies compare new AEDs. The next best approach has been the use of meta-analyses and compilation of data from clinical trials, which allow interstudy comparisons to define broad and rough comparative estimates. These analyses, however, do not define clear differences in the safety and efficacy of the new AEDs because of differences in study populations. The new AEDs have expanded our arsenal against seizures. As a group, they have favorable safety and efficacy profiles. The challenge is to define the differences in terms of clinical significance
— id: 34415, year: 2000, vol: 55, page: S5, stat: Journal Article,

Relation of cortical language distribution and cognitive function in surgical epilepsy patients
Devinsky O; Perrine K; Hirsch J; McMullen W; Pacia S; Doyle W
2000 Apr;41(4):400-404, Epilepsia
PURPOSE: To investigate the relation between the number and spatial distribution of language sites and specific patient-and epilepsy-related variables. METHODS: Patients with stimulation-induced reading or naming errors from anterior or inferior temporal cortex (i.e., atypical temporal language sites) were compared with those with language sites confined to Wernicke's area (WA) in the posterosuperior temporal and inferior parietal perisylvian area. In a consecutive series of 44 left hemisphere language dominant patients with complex partial seizures before left temporal lobectomy, correlations were compared between cortical language distribution and measures of cognitive function. RESULTS: Patients with atypical temporal language sites (group 1) had significantly fewer years of education that did patients with language sites in WA (group 2). Patients in group 1 had poorer verbal learning and fluency than did patients in group 2. Patients with IQ <80 were significantly more likely to have multiple sites where stimulation disrupted language than did patients with normal IQ. Number of language sites had significant negative correlations with full-scale IQ, and measures of confrontation naming, verbal fluency, and immediate verbal memory. CONCLUSIONS: Language cortex has a wider spatial distribution in epilepsy surgery patients with lower intelligence, poorer education, and worse verbal and memory skills
— id: 11763, year: 2000, vol: 41, page: 400, stat: Journal Article,

Stable weight during lamotrigine therapy: a review of 32 studies
Devinsky O; Vuong A; Hammer A; Barrett PS
2000 Feb 22;54(4):973-975, Neurology
A side effect associated with the use of some antiepileptic drugs (AEDs) is change in body weight. To evaluate the effect of lamotrigine on body weight in adult patients with epilepsy, we conducted a retrospective review of data from 463 patients treated with lamotrigine in 32 clinical trials. Mean daily dose was 259 (+/-155) mg and duration of therapy was 318 (+/-87) days. The mean change in body weight was 0.5 (+/-5) kg. Lamotrigine was associated with stable body weight in patients with epilepsy
— id: 11821, year: 2000, vol: 54, page: 973, stat: Journal Article,

Neurologic pearls
Devinsky, Orrin; Feldmann, Edward; Weinreb, Herman J.
Philadelphia : F.A. Davis, c2000,
— id: 707, year: 2000, vol: , page: , stat: ,

Psychotropic medication use in patients with epilepsy: effect on seizure frequency
Gross A; Devinsky O; Westbrook LE; Wharton AH; Alper K
2000 Fall;12(4):458-464, Journal of neuropsychiatry & clinical neurosciences
Physicians are often reluctant to use psychotropic medications in epilepsy patients with psychiatric disorders because of concern over the potential risk for lowering seizure threshold. This study assesses retrospectively the impact of psychotropic medications on seizure frequency in 57 patients seen consecutively at an epilepsy center. During psychotropic drug therapy, seizure frequency decreased in 33% of patients, was unchanged in 44%, and increased in 23%. Mean seizure frequency was not statistically different between pre-treatment and treatment periods (t = 0.23, df = 56). Simultaneous adjustments in antiepileptic drug regimen could not account for the findings. Results support the position that psychotropic medications, introduced slowly in low to moderate doses, can be safely used in epilepsy patients with comorbid psychiatric pathology during the regular course of clinical care
— id: 34417, year: 2000, vol: 12, page: 458, stat: Journal Article,

Brief report: Adolescents' attitudes toward epilepsy: further validation of the Child Attitude Toward Illness Scale (CATIS)
Heimlich TE; Westbrook LE; Austin JK; Cramer JA; Devinsky O
2000 Jul-Aug;25(5):339-345, Journal of pediatric psychology
OBJECTIVE: To examine adolescents' attitudes toward having epilepsy using the Child Attitude Toward Illness Scale (CATIS) and to provide further psychometric validation of the scale in this population. METHODS: Participants were 197 adolescents aged 11 to 17 years who completed the CATIS at two points and two external validation scales. Test-retest and internal consistency reliability and construct validity were computed. Analysis of variance was used to examine differences in attitudes according to gender, age, and epilepsy severity. RESULTS: Girls, older adolescents, and those with more severe epilepsy had more negative attitudes toward having epilepsy than boys, younger adolescents, and those with moderate or mild epilepsy, respectively. Psychometric analyses yielded excellent internal consistency reliability and good test-retest reliability. The CATIS was moderately correlated with self-esteem and mastery, supporting its construct validity. CONCLUSIONS: The CATIS is a useful and psychometrically sound tool to assess adolescents' attitudes toward having chronic illness
— id: 11625, year: 2000, vol: 25, page: 339, stat: Journal Article,

Epilepsy and Behavior: A Brief History
Masia SL; Devinsky O
2000 Feb;1(1):27-36, Epilepsy & behavior
Behavioral changes-both real and imagined-have formed a halo around epilepsy since antiquity. The myth of epilepsy as a curse has been largely vanquished in modern cultures, but the disorder remains a social stigma for many patients. In ancient Rome people with epilepsy were avoided for fear of contagion, in the Middle Ages they were hunted as witches, and in the first half of our century they were labeled deviants and their marriage and reproduction were restricted by eugenistic medical doctors. Religious conversion experiences can occur in temporal relationship to changes in seizure frequency. Many religious leaders may have had epilepsy. However, changes in religious sentiment are not characteristic of epilepsy patients. Recognized since the late 19th century, postictal psychosis has stimulated theories regarding the mechanism of mania and psychosis. Understanding the pathophysiology of behavioral changes in epilepsy may offer insight into the psychopathology of other diseases
— id: 34400, year: 2000, vol: 1, page: 27, stat: Journal Article,

Temporal Lobectomy and Dreams: An Insight into the Mechanism of Inhibition?. To the Editor
Masia SL; Devinsky O
2000 Apr;1(2):132-134, Epilepsy & behavior
— id: 34397, year: 2000, vol: 1, page: 132, stat: Journal Article,

Emotional outbursts and post-traumatic stress disorder during intracarotid amobarbital procedure
Masia SL; Perrine K; Westbrook L; Alper K; Devinsky O
2000 Apr 25;54(8):1691-1693, Neurology
Severe emotional outbursts (SEOs) during intracarotid amobarbital procedures (IAP) rarely jeopardize preoperative language and memory testing. Four of four patients (100%) with outbursts had experienced significant emotional trauma (three were raped and one witnessed a decapitation), compared with 26 of 546 patients (4.8%) without outbursts (chi2 = 69.8, p < 0. 0001). Evocative injections were ipsilateral to seizure focus. IAP may disrupt emotional balance in some traumatized patients. Counseling may prevent SEOs
— id: 34420, year: 2000, vol: 54, page: 1691, stat: Journal Article,

Wada testing in pediatric patients by use of propofol anesthesia [In Process Citation]
Masters LT; Perrine K; Devinsky O; Nelson PK
2000 Aug;21(7):1302-1305, AJNR. American journal of neuroradiology
BACKGROUND AND PURPOSE: Wada testing may provide important information for surgical planning in pediatric patients with medically refractory epilepsy, but it is often not used because of the difficulties in performing the angiographic portion of the procedure in conscious children. We reviewed our experience using propofol, a short-acting IV administered anesthetic agent, for pediatric patients undergoing Wada testing. METHODS: In a retrospective review of Wada tests performed on patients younger than 18 years, we identified 24 cases in which propofol anesthesia was used. We reviewed the medical records of these patients, with particular reference to dose of propofol, physiological parameters during anesthesia, and adequacy of neuropsychological testing after emergence from anesthesia. RESULTS: Patients ranged in age from 6 to 16 years (mean age, 12.5 years). Propofol induced mild reductions in blood pressure (12.4% for systolic and 13.9% for diastolic blood pressure) and heart rate (mean reduction of 4.7%), which did not require specific treatment in any patient. Recovery from anesthesia was smooth and rapid, allowing initiation of Wada testing within 15 to 25 minutes of cessation of propofol. Wada testing was successfully accomplished in all patients. CONCLUSION: Propofol provided rapid induction of anesthesia, was administered without endotracheal intubation, and did not cause substantial changes in cardiorespiratory parameters. Propofol anesthesia allowed controlled angiography among patients as young as 6 years and did not interfere with neuropsychological testing
— id: 11535, year: 2000, vol: 21, page: 1302, stat: Journal Article,

Cortical Mapping of Right Hemisphere Functions
Perrine K; Devinsky O; Uysal S; Santschi C; Doyle WK
2000 Feb;1(1):7-16, Epilepsy & behavior
Right hemisphere functions were examined during cortical stimulation in six patients undergoing epilepsy surgery. Two patients showed mild hemispatial neglect and constructional disability with stimulation of several sites in the inferior parietal lobule and posterior temporal lobe. Two other patients showed no disruption of visuospatial functions with stimulation of similar parietal or posterior temporal sites. Nonverbal acoustic perception of environmental sounds was not disrupted with stimulation of right superior temporal cortex in one patient, and musical abilities were not affected by right superior temporal stimulation in another patient. Nondominant hemisphere functions may be more widely distributed and less localized than linguistic functions in the dominant hemisphere
— id: 34401, year: 2000, vol: 1, page: 7, stat: Journal Article,

Topography and relationships of mind and brain
Vogt BA; Devinsky O
2000 ;122(4):11-22, Progress in brain research
— id: 34421, year: 2000, vol: 122, page: 11, stat: Journal Article,

Neural network analysis of preoperative variables and outcome in epilepsy surgery
Arle JE; Perrine K; Devinsky O; Doyle WK
1999 Jun;90(6):998-1004, Journal of neurosurgery
OBJECT: Because appropriate patient selection is essential for achieving successful outcomes after epilepsy surgery, the need for more robust methods of predicting postoperative seizure control has been created. Standard multivariate techniques have been only 75 to 80% accurate in this regard. Recent use of artificial intelligence techniques, including neural networks, for analyzing multivariate clinical data has been successful in predicting medical outcome. METHODS: The authors applied neural network techniques to 80 consecutive patients undergoing epilepsy surgery in whom data on demographic, seizure, operative, and clinical variables to predict postoperative seizures were collected. Neural networks could be used to predict postoperative seizures in up to 98% of cases. Student's t-tests or chi-square analysis performed on individual variables revealed that only the preoperative medication index was significantly different (p = 0.02) between the two outcome groups. Six different combinations of input variables were used to train the networks. Neural network accuracies differed in their ability to predict seizures: using all data (96%); all data minus electroencephalography concordance and operative side (93%); all data except intra- or postoperative variables such as tissue pathological category (98%); all data excluding pathological category, intelligence quotient (IQ) data, and Wada results (84%); only demographics and tissue pathological category (65%); and only IQ data (63%). CONCLUSIONS: Analysis of the results reveals that several networks that are trained with the usual accepted variables characterizing the typical evaluation of epilepsy patients can predict postoperative seizures with greater than 95% accuracy
— id: 34431, year: 1999, vol: 90, page: 998, stat: Journal Article,

Excellent outcome of surgical treatment for refractory epilepsy associated with extratemporal MRI identified disorders of cortical development
Bernadette, E; Doyle, W; Devinsky, O; Pacia, S; Vazquez, B; Luciano, D; Najjar, S; Mesad, S; Zupanc, M; Silverberg, A; Rivera, E
1999 OCT ;40(9):217-217, Epilepsia
— id: 53861, year: 1999, vol: 40, page: 217, stat: Journal Article,

Neurochemical signals from living neocortex of mesial temporal lore epilepsy (MTLE) patients, studied by Broderick probe (TM) lauric acid and stearic acid miniature sensors
Broderick, PA; Jean-Baptiste, P; Vuong, AV; Pacia, SV; Doyle, WK; Devinsky, O
1999 ;40(4):78-79 FAL, Epilepsia
— id: 104272, year: 1999, vol: 40, page: 78, stat: Journal Article,

Psychosis after epilepsy surgery
Bromfield, EB; Devinsky, O; Fricchione, GL; Frumin, M; Mesad, SM; Alper, K; Dickey, C
1999 ;40(4):242-242 FAL, Epilepsia
— id: 104275, year: 1999, vol: 40, page: 242, stat: Journal Article,

Development of the Quality of Life in Epilepsy Inventory for Adolescents: the QOLIE-AD-48
Cramer JA; Westbrook LE; Devinsky O; Perrine K; Glassman MB; Camfield C
1999 Aug;40(8):1114-1121, Epilepsia
PURPOSE: We report the development of an instrument to assess health-related quality of life (HRQOL) in adolescents with epilepsy. METHODS: A sample of 197 English-speaking adolescents (aged 11-17 years) with epilepsy completed a test questionnaire of 88 items. Also included were mastery and self-esteem scales to assess external validity. A parent simultaneously completed an 11-item questionnaire to evaluate the child's HRQOL. Both adolescent and parent questionnaires were repeated in 2-4 weeks. Demographic information and information pertaining to seizures were collected at baseline along with assessment of systemic and neurologic toxicity. RESULTS: The QOLIE-AD-48 contains 48 items in eight subscales: epilepsy impact (12 items), memory/concentration (10), attitudes toward epilepsy (four), physical functioning (five), stigma (six), social support (four), school behavior (four), health perceptions (three), and a total summary score, with higher scores indicating better HRQOL. Internal construct validity was demonstrated in a single-factor solution for the eight dimensions. All correlations were statistically significant at p < 0.05 level. Internal consistency reliability estimated by Cronbach's alpha coefficient was 0.74 for the summary score and ranged from a low of 0.52 (three-item Health Perceptions Scale) to 0.73-0.94 for the other individual scales. Good test-retest reliability was found for the overall measure (0.83). Summary score correlations with the two external validity scales, self-efficacy and self-esteem were 0.65 and 0.54, respectively. Statistically significant differences in summary scores indicating that HRQOL was increasingly better for adolescents as seizure severity decreases (no seizures = 77+/-13, low = 70+/-17, high = 63+/-17) were found among seizure-severity groups. CONCLUSIONS: These data describe the development of a robust instrument to evaluate HRQOL in adolescents with epilepsy. Empiric analyses provide strong evidence that the QOLIE-AD-48 is both a reliable and valid measure for adolescents with epilepsy
— id: 34428, year: 1999, vol: 40, page: 1114, stat: Journal Article,

Patients with refractory seizures
Devinsky O
1999 May 20;340(20):1565-1570, New England journal of medicine
— id: 12017, year: 1999, vol: 340, page: 1565, stat: Journal Article,

Evidence against the existence of a temporal lobe epilepsy personality syndrome
Devinsky O; Najjar S
1999 ;53(5 Suppl 2):S13-S25, Neurology
The existence and specificity of a characteristic behavioral syndrome among patients with temporal lobe epilepsy (TLE) remains controversial. The behavioral pattern of many epilepsy patients differs from that of age-, sex-, and socioeconomic-matched control subjects. Patients with TLE and other forms of epilepsy can experience changes in cognitive function, personality, affect, and drive-related behavior (e.g., libido, aggression). Biologic factors (e.g., underlying brain pathology, epileptogenic process, localization and lateralization, recurrent seizures, family history), antiepileptic drugs, and psychosocial factors interact pathogenically. Their roles vary among patients and among different neurobehavioral disorders. Behavioral changes occur in some epilepsy patients. However, the question of whether specific behavioral changes occur with different seizure types or epilepsy syndromes remains unanswered. For example, behavioral changes can occur in patients with absence epilepsy, juvenile myoclonic epilepsy, frontal lobe epilepsy, and tonic-clonic seizures. Many of these behavioral changes overlap with features of the purported TLE syndrome. We lack a clear delineation of the spectrum, frequency, and severity of changes in well-characterized partial and primary generalized epilepsy syndromes. Furthermore, the relative roles and the interplay among pathogenic factors remain poorly defined
— id: 11960, year: 1999, vol: 53, page: S13, stat: Journal Article,

Risk factors for poor health-related quality of life in adolescents with epilepsy
Devinsky O; Westbrook L; Cramer J; Glassman M; Perrine K; Camfield C
1999 Dec;40(12):1715-1720, Epilepsia
PURPOSE: To examine potential risk factors for poor health-related quality of life (HRQOL) among adolescents with epilepsy by using the newly developed QOLIE-AD-48. Risk factors were derived from sociodemographic, social, academic, and epilepsy- and health-related domains. METHODS: The QOLIE-AD-48 was administered to 197 English-speaking adolescents (age 11-17 years from >20 sites in the United States and in Canada). The self-report instrument yields an overall HRQOL score and eight subscale scores. Other data were obtained from family interviews, physician reports, and health records. Multiple regression analyses were conducted to study risk factors for impairment of HRQOL. RESULTS: Older adolescents (age 14-17 years), those with more severe epilepsy and more symptoms of neurotoxicity, and those living in households with lower socioeconomic status were more likely to report poor overall HRQOL. Risk factors in the eight HRQOL domains were found as follows: (a) Epilepsy Impact: older age in adolescence, more severe epilepsy and neurotoxicity, more hospitalizations during the past year, and fewer hours of extracurricular activities; (b) Memory and Concentration: longer duration of epilepsy, special education classes, and history of repeating a grade in school; (c) Attitude Toward Illness: older age, female gender, and more severe epilepsy and neurotoxicity; (d) Social Support: younger age, male gender, and fewer hospitalizations in the last year; (e) Stigma: lower socioeconomic status and special-education classes; and (f) Health Perceptions: older age, female gender, and lower socioeconomic status. None of the factors examined was significantly associated with HRQOL in (g) Physical Functioning or (h) School Behavior subscales. CONCLUSIONS: We identified several risk factors for poor HRQOL outcomes in adolescents with epilepsy. Age, increased seizure severity, and neurotoxicity were most consistently associated with poor HRQOL across domains. Older adolescents, independent of epilepsy severity, reported worse overall HRQOL than did their younger counterparts. Older adolescents also were more likely to perceive a greater negative impact on life and general health, and had more negative attitudes toward epilepsy. Adolescent boys and girls may show different sensitivities to various quality-of-life domains
— id: 11888, year: 1999, vol: 40, page: 1715, stat: Journal Article,

Factors identifying successful reoperations for refractory epilepsy in patients presenting with failed epilepsy surgery
Doyle, WK; Devinsky, O; Pacia, S; Luciano, D; Vazqueaz, B; Perrine, K
1999 ;40(4):216-217 FAL, Epilepsia
— id: 104274, year: 1999, vol: 40, page: 216, stat: Journal Article,

Two cases of nonconvulsive status epilepticus in association with tiagabine therapy
Ettinger AB; Bernal OG; Andriola MR; Bagchi S; Flores P; Just C; Pitocco C; Rooney T; Tuominen J; Devinsky O
1999 Aug;40(8):1159-1162, Epilepsia
We report two patients with intractable partial seizures who developed generalized nonconvulsive status epilepticus (NCSE) after receiving tiagabine (TGB). Neither had a history of absence seizures or generalized epileptic discharges on prior EEG monitoring. Clinicians need to be aware of a possible association between TGB and NCSE
— id: 34427, year: 1999, vol: 40, page: 1159, stat: Journal Article,

Headaches and other pain symptoms among patients with psychogenic non-epileptic seizures
Ettinger AB; Devinsky O; Weisbrot DM; Goyal A; Shashikumar S
1999 Oct;8(7):424-426, Seizure
Studies of patients with psychogenic non-epileptic seizures (NES) typically focus upon the phenomenology and outcome of NES episodes. Little is known, however, about the frequency and nature of other somatic symptoms such as pain, in this population. To assess the frequency, location and severity of symptoms of pain among NES patients, we administered structured interviews to 56 patients, 6 or more months following the diagnosis of psychogenic non-epileptic seizures (NES). Patients were recruited from a tertiary hospital-based epilepsy monitoring unit. Seventy-seven percent of patients suffered from moderate to severe pain, most commonly headache (61%), while neck pain and backache were also common. Twenty-six of 27 patients with persistent NES vs. 17 of 29 patients whose NES resolved experienced moderate to severe pain (P < 0.001). Pain is an under-recognized problem that occurs frequently and with significant severity among NES patients. Pain symptoms are more common among patients with persistent NES than those whose NES resolve
— id: 34422, year: 1999, vol: 8, page: 424, stat: Journal Article,

A comprehensive profile of clinical, psychiatric, and psychosocial characteristics of patients with psychogenic nonepileptic seizures
Ettinger AB; Devinsky O; Weisbrot DM; Ramakrishna RK; Goyal A
1999 Sep;40(9):1292-1298, Epilepsia
PURPOSE: To attain a comprehensive profile of clinical, psychiatric and psychosocial characteristics of patients with psychogenic nonepileptic seizures (NESs), and to assess the relation of these factors to NES outcome. METHODS: We administered a telephone-based structured questionnaire to 56 patients with NESs (16 male and 40 female patients; mean age, 35 years) at a mean follow-up time of 18 months after making the diagnosis of NES. RESULTS: Mean age of NES onset was 28 years with a mean duration of 8 years. Episodes resolved in 29 (51.8%) cases, decreased in 24 (42.9%), persisted unchanged in two (3.6%), and increased in frequency in one (1.8%). Thirty (53.6%) patients, including 13 (44.8%) of patients whose NESs resolved, were rehospitalized for NESs or for other symptoms. Twenty-nine (51.8%) had significant depressive symptoms, 22 (39.3%) had suicidal ideation, and 11 (19.6%) attempted suicide [including 6 (21%) of the patients whose NESs resolved]. Believing the NES diagnosis was associated with resolution or improvement of NES frequency (p<0.029), whereas anger in response to receiving the diagnosis did not predict a poorer outcome. Patients' perceptions of having good health (p<0.02) and good occupational functioning (p<0.04) were highly correlated with NES resolution. Only patients whose episodes resolved were employed at the time of follow-up. CONCLUSIONS: At a mean of 1.5 years, NES outcome was poor, with resolution in only half the group and with frequent rehospitalizations after NES diagnosis, even among patients whose NES resolved. Depressive symptoms, suicidal ideation, and suicide attempts were common. Believing the NES diagnosis and patient perceptions of having good health and good occupational functioning correlated well with NES resolution
— id: 34425, year: 1999, vol: 40, page: 1292, stat: Journal Article,

Predictive factors for outcome of nonepileptic seizures after diagnosis
Ettinger AB; Dhoon A; Weisbrot DM; Devinsky O
1999 Fall;11(4):458-463, Journal of neuropsychiatry & clinical neurosciences
The aim of this study was to assess prognosis among adult patients with nonepileptic seizures (NES) and to determine predictor variables for resolution of NES after diagnosis. Six to 9 months after receiving a video-EEG-documented diagnosis of NES, 43 adults responded by telephone interview to a detailed, structured questionnaire probing history of the episodes, psychiatric factors, socioeconomic variables, relationships, reactions to receiving the diagnosis, and potential history of litigation. At follow-up, only 18.6% were episode-free, 55.8% had improved, 16.3% reported no change, and 9.3% reported greater frequency of episodes. Patients who reported having many friends currently or having good relationships with friends as a child were significantly more likely to be episode-free. Subjects with pending litigation were significantly less likely to experience a reduction in episodes
— id: 34423, year: 1999, vol: 11, page: 458, stat: Journal Article,

Postictal symptoms help distinguish patients with epileptic seizures from those with non-epileptic seizures
Ettinger AB; Weisbrot DM; Nolan E; Devinsky O
1999 May;8(3):149-151, Seizure
The aim of the study was to assess whether post-ictal symptoms can help distinguish patients who have epileptic seizures from those with non-epileptic seizures (NES). We reviewed the spontaneous responses to the question 'What symptoms do you have after a seizure?' in 16 patients with epileptic seizures (predominantly focal with secondary generalization or generalized tonic-clonic) and 23 NES patients. Six of the 16 patients (38%) vs. only one of 23 NES patients (4.3%) noted post-ictal headache (P = 0.008). Nine epilepsy patients (56%) vs. three NES patients (13%) reported post-ictal fatigue (P = 0.004). Confusion or other symptoms did not distinguish epilepsy patients from those with NES. All epilepsy patients had at least one post-ictal symptom while 12 NES patients (52%) had none (P = 0.001). Therefore, patients evaluated for epileptic vs. non-epileptic seizures who have post-ictal fatigue or headache, are more likely to have epileptic seizures. Patients with a diagnosis of NES who note post-ictal fatigue or headache should be investigated further
— id: 34430, year: 1999, vol: 8, page: 149, stat: Journal Article,

Vagal nerve stimulator: a new approach to medically refractory epilepsy
FineSmith RB; Zampella E; Devinsky O
1999 Jun;96(6):37-40, New Jersey medicine
Repetitive vagal nerve stimulation (VNS) is a new, FDA-approved treatment for medically refractory epilepsy. The device is implanted subcutaneously in the left chest and sends intermittent impulses to the left vagus nerve through communicating leads. Twelve patients have been implanted to date. The ages of the patients range from 8 to 36 years and the average followup at this point is five months. Five patients have achieved a greater than 50 percent reduction in seizure frequency with no serious adverse effects
— id: 56450, year: 1999, vol: 96, page: 37, stat: Journal Article,

Marihuana: Effects on neuronal excitability and seizure threshold
Gordon, Elisabeth; Devinsky, Orrin
Marihuana and medicine Totowa, NJ : Humana Press,
— id: 2562, year: 1999, vol: , page: 619, stat: Chapter,

Prognostic factors and outcome after resective surgery in patients with non-lesional neocortical temporal lobe epilepsy
Jung, WY; Pacia, SV; Devinsky, O
1999 JUL ;40(7):81-81, Epilepsia
— id: 53961, year: 1999, vol: 40, page: 81, stat: Journal Article,

Psychiatric adverse events during vigabatrin therapy
Levinson DF; Devinsky O
1999 Oct 22;53(7):1503-1511, Neurology
OBJECTIVE: To determine the incidence of psychiatric adverse events associated with vigabatrin therapy, we reviewed data from US and non-US double-blind, placebo-controlled trials of vigabatrin as add-on therapy for treatment-refractory partial epilepsy. METHODS: 'Verbatim' terms from investigators' reports had been translated into standard 'preferred' terms using an adverse event dictionary. Terms for psychiatric events were then combined into categories for analysis of rates during vigabatrin versus placebo treatment. RESULTS: Compared with placebo, vigabatrin subjects had a higher incidence of events coded as depression (12.1% versus 3.5%, p < 0.001) and psychosis (2.5% versus 0.3%, p = 0.028); there were no significant differences between treatment groups for aggressive reaction, manic symptoms, agitation, emotional lability, anxiety, or suicide attempt. Although depression and psychosis were typically observed during the first 3 months, most studies were 12 to 18 weeks long, so that definitive conclusions could not be reached about timing of events. Psychosis was generally transient and reported to be responsive to reduction or discontinuation of vigabatrin or to neuroleptic treatment. Depression was typically mild. Serious depression, defined as discontinued from the study, hospitalized, or suicide attempt, or coded as psychotic depression, occurred in only 9 of the 49 vigabatrin-treated patients with depression. CONCLUSIONS: Vigabatrin use in treatment-refractory partial epilepsy is associated with increased occurrence of depression and of psychosis, although the frequency of psychosis is apparently lower than previously reported. Clinical experience suggests that these adverse events respond to reduction of vigabatrin dose or to counteractive psychotropic treatment
— id: 34424, year: 1999, vol: 53, page: 1503, stat: Journal Article,

Magnetoencephalographic patterns of epileptiform activity in children with regressive autism spectrum disorders
Lewine JD; Andrews R; Chez M; Patil AA; Devinsky O; Smith M; Kanner A; Davis JT; Funke M; Jones G; Chong B; Provencal S; Weisend M; Lee RR; Orrison WW Jr
1999 Sep;104(3 Pt 1):405-418, Pediatrics
BACKGROUND: One-third of children diagnosed with autism spectrum disorders (ASDs) are reported to have had normal early development followed by an autistic regression between the ages of 2 and 3 years. This clinical profile partly parallels that seen in Landau-Kleffner syndrome (LKS), an acquired language disorder (aphasia) believed to be caused by epileptiform activity. Given the additional observation that one-third of autistic children experience one or more seizures by adolescence, epileptiform activity may play a causal role in some cases of autism. OBJECTIVE: To compare and contrast patterns of epileptiform activity in children with autistic regressions versus classic LKS to determine if there is neurobiological overlap between these conditions. It was hypothesized that many children with regressive ASDs would show epileptiform activity in a multifocal pattern that includes the same brain regions implicated in LKS. DESIGN: Magnetoencephalography (MEG), a noninvasive method for identifying zones of abnormal brain electrophysiology, was used to evaluate patterns of epileptiform activity during stage III sleep in 6 children with classic LKS and 50 children with regressive ASDs with onset between 20 and 36 months of age (16 with autism and 34 with pervasive developmental disorder-not otherwise specified). Whereas 5 of the 6 children with LKS had been previously diagnosed with complex-partial seizures, a clinical seizure disorder had been diagnosed for only 15 of the 50 ASD children. However, all the children in this study had been reported to occasionally demonstrate unusual behaviors (eg, rapid blinking, holding of the hands to the ears, unprovoked crying episodes, and/or brief staring spells) which, if exhibited by a normal child, might be interpreted as indicative of a subclinical epileptiform condition. MEG data were compared with simultaneously recorded electroencephalography (EEG) data, and with data from previous 1-hour and/or 24-hour clinical EEG, when available. Multiple-dipole, spatiotemporal modeling was used to identify sites of origin and propagation for epileptiform transients. RESULTS: The MEG of all children with LKS showed primary or secondary epileptiform involvement of the left intra/perisylvian region, with all but 1 child showing additional involvement of the right sylvian region. In all cases of LKS, independent epileptiform activity beyond the sylvian region was absent, although propagation of activity to frontal or parietal regions was seen occasionally. MEG identified epileptiform activity in 41 of the 50 (82%) children with ASDs. In contrast, simultaneous EEG revealed epileptiform activity in only 68%. When epileptiform activity was present in the ASDs, the same intra/perisylvian regions seen to be epileptiform in LKS were active in 85% of the cases. Whereas primary activity outside of the sylvian regions was not seen for any of the children with LKS, 75% of the ASD children with epileptiform activity demonstrated additional nonsylvian zones of independent epileptiform activity. Despite the multifocal nature of the epileptiform activity in the ASDs, neurosurgical intervention aimed at control has lead to a reduction of autistic features and improvement in language skills in 12 of 18 cases. CONCLUSIONS: This study demonstrates that there is a subset of children with ASDs who demonstrate clinically relevant epileptiform activity during slow-wave sleep, and that this activity may be present even in the absence of a clinical seizure disorder. MEG showed significantly greater sensitivity to this epileptiform activity than simultaneous EEG, 1-hour clinical EEG, and 24-hour clinical EEG. The multifocal epileptiform pattern identified by MEG in the ASDs typically includes the same perisylvian brain regions identified as abnormal in LKS. When epileptiform activity is present in the ASDs, therapeutic strategies (antiepileptic drugs, steroids, and even neurosurgery) aimed at its control can lead to a significa
— id: 34426, year: 1999, vol: 104, page: 405, stat: Journal Article,

Autistic regression with rolandic spikes
Nass R; Devinsky O
1999 Jul;12(3):193-197, Neuropsychiatry neuropsychology & behavioral neurology
OBJECTIVE: This study was designed to further define the electroencephalographic abnormalities seen in the Landau-Kleffner syndrome variants and the associated clinical features. BACKGROUND: Landau-Kleffner syndrome is rare, but its putative variants are more common. METHOD: We report two patients with centro-temporal spikes, autistic epileptiform regression, and variably prominent oro-motor symptoms. RESULTS: The epileptic aphasia pattern found among patients with prominent Rolandic spikes may more frequently involve expressive language than is seen in the typical Landau-Kleffner syndrome, where verbal auditory agnosia is the rule. CONCLUSIONS: This clinical difference likely reflects the location of the epileptiform activity (centrotemporal as opposed to anterior or mid-temporal) on buccal-lingual function, vocalization, and language production
— id: 6181, year: 1999, vol: 12, page: 193, stat: Journal Article,

Outcome of multiple subpial transections for autistic epileptiform regression
Nass R; Gross A; Wisoff J; Devinsky O
1999 Jul;21(1):464-470, Pediatric neurology
Treatment options for atypical forms of Landau-Kleffner syndrome (LKS) are not well delineated. Many patients with typical LKS fail to respond to antiepileptic drug treatment, but some benefit from multiple subpial transections (MSTs). The authors report seven patients with autism or autistic epileptiform regression who responded in varying degrees to MSTs after failed medical management. These patients derived from an original cohort of 36 children (29 males, seven females, ranging from 2 years, 3 months to 11 years, 3 months, mean age = 5 years, 8 months) with a history of language delay or regression, as well as varying degrees of social and behavioral abnormalities, who were evaluated with video-electroencephalogram (EEG) monitoring over a 2-year period. Fifteen patients had clinical seizures (11 of the 19 children with autistic epileptiform regression and four of 12 autistic children). Epilepsy was refractory to medication in seven. Surgical treatment variously involved MSTs of the left neocortex in temporal, parietal, and frontal regions, often including regions within the classic perisylvian language areas. One patient also had a left temporal lobectomy. In all seven patients, seizure control or EEG improved after MSTs. Language, social, and overall behavior improved to a moderate degree, although improvements were temporary in most. Autistic epileptiform regression resembles LKS in that both may respond to MST. MST is used to treat epilepsy in eloquent regions. The responsiveness of autistic epileptiform regression to MST buttresses the argument that autistic epileptiform regression is a form of focal epilepsy
— id: 6167, year: 1999, vol: 21, page: 464, stat: Journal Article,

Extent of neocortical resection in anteromesial temporal resection (AMTR) for mesial temporal sclerosis (MTS) influences aura but not seizure outcome
Prasad, A; Pacia, SV; Devinsky, O; Doyle, WK
1999 OCT ;40(9):60-60, Epilepsia
— id: 53855, year: 1999, vol: 40, page: 60, stat: Journal Article,

Function-specific high-probability "nodes" identified in posterior language cortex
Schwartz TH; Devinsky O; Doyle W; Perrine K
1999 May;40(5):575-583, Epilepsia
PURPOSE: Posterior, 'Wenicke's,' language areas have a high degree of between-subject variability, as shown by electrical-stimulation mapping. We investigated the possibility of an organized structure in the distribution of posterior language areas. METHODS: Extraoperative subdural grid stimulation was performed on 67 left hemisphere-dominant patients before resective epilepsy surgery during counting, naming, and reading. Intersubject-averaged language maps were generated in which stimulation disrupted only one language function and not the others, or combinations of language functions. RESULTS: Language sites, although highly variable between subjects, were not organized randomly and appeared to be arranged into several focal, non-contiguous, higher probability 'nodes' devoted to different aspects of language processing. Speech-arrest sites were concentrated in classic Wernicke's area. Areas where stimulation induced only reading errors were found in the posterior middle temporal gyrus and the inferior parietal lobule. These regions may correspond with an orthographic input lexicon. Areas eliciting only naming errors were found in the posterior inferior temporal gyrus extending into the mid-middle temporal gyrus and may represent a visual-representation input lexicon. Sites where stimulation elicited errors in both naming and reading were more variable in location than sites devoted to only one function, extended farther anteriorly along the temporal neocortex, and may correspond with a semantic lexicon. CONCLUSIONS: The existence of high-probability nodes in posterior language cortex supports a modality-specific modular architecture and the possibility of a conserved, universal structure
— id: 34429, year: 1999, vol: 40, page: 575, stat: Journal Article,

Nonepileptic seizures in patients with systemic lupus erythematosus (SLE) and abnormal brain SPECT
Shih, TT; Hirsch, LJ; Devinsky, O
1999 ;40(4):90-90 FAL, Epilepsia
— id: 104273, year: 1999, vol: 40, page: 90, stat: Journal Article,

Multi-stage epilepsy surgery in children with extratemporal epilepsy due to cortical dysplasia
Weiner, HL; Mogilner, A; Doyle, WK; Pacia, SV; Wisoff, JH; Devinsky, O
1999 OCT ;40(9):125-126, Epilepsia
— id: 53857, year: 1999, vol: 40, page: 125, stat: Journal Article,

Staged, tailored hemispherectomy in the management of pediatric epilepsy: A rational approach for hemispheric malformations of cortical development
Woo, HH; Zupanc, ML; Wisoff, JH; Devinsky, O; Weiner, HL
1999 OCT ;40(9):134-134, Epilepsia
— id: 53859, year: 1999, vol: 40, page: 134, stat: Journal Article,

Feasibility and pharmacokinetics of carbamazepine oral loading doses
Cohen H; Howland MA; Luciano DJ; Rubin RN; Kutt H; Hoffman RS; Leung LK; Devinsky O; Goldfrank LR
1998 Jun 1;55(11):1134-1140, American journal of health-system pharmacy. AJHP
The pharmacokinetics and adverse effects of an oral loading dose of carbamazepine administered in tablet or suspension form were studied. Patients on a hospital epilepsy unit who were to receive carbamazepine as a discharge medication were randomly assigned to receive either an oral 8-mg/kg loading dose of the tablet formulation or the same dose of the suspension on an empty stomach. Blood samples were drawn before and at intervals up to 12 hours after the loading dose. Adverse effects were evaluated subjectively and objectively. Total and free serum carbamazepine and carbamazepine-10, 11-epoxide (CBZE) concentrations were determined by high-performance liquid chromatography. Six adult patients were enrolled in and completed the study. All the patients achieved therapeutic total carbamazepine levels; the suspension group did so within two hours and the tablet group within five hours. Maximum serum carbamazepine concentrations ranged from 7.10 to 9.92 mg/L, area under the concentration-versus-time curve from 54.85 to 82.23 micrograms.hr/L, and terminal elimination half-life from 14.05 to 15.71 hours. Adverse effects were mild, few, and short-lived; none of the patients developed gastrointestinal toxicity. Adverse effects were not associated with total or free carbamazepine and CBZE concentrations or with total or free CBZE:carbamazepine ratios. An oral loading dose of carbamazepine 8 mg/kg achieved therapeutic levels within two hours when given as a suspension and within five hours when given as tablets and was well tolerated in all patients
— id: 57121, year: 1998, vol: 55, page: 1134, stat: Journal Article,

Development and cross-cultural translations of a 31-item quality of life in epilepsy inventory
Cramer JA; Perrine K; Devinsky O; Bryant-Comstock L; Meador K; Hermann B
1998 Jan;39(1):81-88, Epilepsia
PURPOSE: We report the development of a questionnaire to assess health-related quality-of-life (HRQOL) in people with epilepsy and the process of cross-cultural translations of the questionnaire. METHODS: A sample of 304 adults with epilepsy from 25 seizure clinics in the United States was used to derive an abbreviated questionnaire focusing on epilepsy-related issues from a longer, 89-item instrument (QOLIE-89). A rigorous forward-backward-forward system was used for cross-cultural translation. RESULTS: A 31-item questionnaire (QOLIE-31, version 1.0) resulted, comprising seven subscales covering general and epilepsy-specific domains. Subscale and total scores can be calculated. The subscales were grouped into two factors: Emotional/Psychological Effects (seizure worry, overall QOL, emotional well-being, energy/fatigue subscales) and Medical/Social Effects (medication effects, work-driving-social limits, cognitive function subscales). Cross-cultural translations were made from U.S.-English into Danish, Dutch, German, Canadian French, French, Italian, Spanish, Swedish, and U.K. English Versions 1.1. CONCLUSIONS: Our results support the reliability and validity of the QOLIE-31 (U.S.-English version 1.0) as a measure of HRQOLIE. Cross-cultural translations into nine other languages make it feasible to use the QOLIE-31 (version 1.1) in multinational clinical trials after validation in each population or concurrent with the clinical trial
— id: 34433, year: 1998, vol: 39, page: 81, stat: Journal Article,

Nonepileptic psychogenic seizures: quagmires of pathophysiology, diagnosis, and treatment
Devinsky O
1998 May;39(5):458-462, Epilepsia
— id: 57133, year: 1998, vol: 39, page: 458, stat: Journal Article,

Epileptic seizures progressing into nonepileptic conversion seizures
Devinsky O; Gordon E
1998 Nov;51(5):1293-1296, Neurology
BACKGROUND: Epileptic and nonepileptic seizures can occur in the same patient, but usually occur at different times. In 1885, Gowers suggested that minor seizures can elaborate into hysterical seizures, but the concurrence of epileptic and nonepileptic seizures is not well documented. METHODS: We reviewed all patients with nonepileptic seizures documented with video-EEG recordings at our center to identify those with temporally associated epileptic seizures. RESULTS: Four patients were identified in whom video-EEG-documented epileptic seizures were temporally associated with nonepileptic seizures. In one woman, the nonepileptic event followed an absence seizure. Given the high frequency of absence seizures, the occurrence of the nonepileptic seizure may have been coincidental. In three patients, the seizures were partial and arose from right frontotemporal regions. In these patients, epileptic seizures were infrequent. CONCLUSIONS: Epileptic and nonepileptic seizures can be temporally related, and in patients with partial seizures, there may be a pathophysiologic relation in which ictal changes facilitate the development of conversion symptoms. Ictal activation or disinhibition of emotions or impulse control may contribute to these nonepileptic events
— id: 57374, year: 1998, vol: 51, page: 1293, stat: Journal Article,

Olfactory reference syndrome in a patient with partial epilepsy
Devinsky O; Khan S; Alper K
1998 Apr;11(2):103-105, Neuropsychiatry neuropsychology & behavioral neurology
A 49-year-old man with right temporal lobe epilepsy developed the chronic delusion that his body emitted a foul odor (olfactory reference syndrome). Before the delusional symptoms, he had partial seizures with unpleasant olfactory hallucinations. Subsequently ictal olfactory symptoms abated but a disabling delusional syndrome developed. The only prior case of the olfactory reference syndrome in a patient with epilepsy had a right frontal lesion. The case further supports the association of right hemisphere lesions and delusional disorders
— id: 7322, year: 1998, vol: 11, page: 103, stat: Journal Article,

Procedures in patients with epilepsy
Devinsky O; Paraiso JO; Rosenberg A; Nordli DR
Epilepsy : a comprehensive textbook Philadelphia : Lippincott-Raven, 1998,
— id: 3451, year: 1998, vol: , page: 1977, stat: Chapter,

Positive and negative psychotropic effects of lamotrigine in patients with epilepsy and mental retardation
Ettinger AB; Weisbrot DM; Saracco J; Dhoon A; Kanner A; Devinsky O
1998 Aug;39(8):874-877, Epilepsia
PURPOSE: To describe significant positive or negative psychotropic effects of lamotrigine (LTG) observed in epilepsy patients with mental retardation (MR). METHODS: Seven mentally retarded epilepsy patients, [5 with Lennox-Gastaut syndrome (LGS)] who experienced significant behavioral improvements or worsening after addition of LTG to their medication regimen were studied. RESULTS: LTG produced behavioral improvements in 4 patients. Patient 1, a 14-year-old girl, had LTG added to valproate (VPA) and thioridazine, resulting in diminished lethargy, less hyperactivity, and more appropriate speech. In a 17-year-old boy (patient 2) LTG added to VPA, phenytoin (PHT), and gabapentin (GBP) lessened irritability and hyperactivity. In patient 3, a 41-year-old woman, LTG added to PHT, VPA, and carbamazepine (CBZ) diminished lethargy and enhanced her social interactions. In patient 4, a 27-year-old man, LTG monotherapy diminished irritability and hyperactivity. Adverse behavioral effects were noted in 3 patients. In patient 5, a 43-year-old man, LTG added to PHT, phenobarbital (PB), lorazepam, sertraline, and thioridazine produced irritability, hyperactivity, and poor cooperation. In patient 6, a 29-year-old woman, LTG added to VPA produced frequent screaming, temper tantrums, increased rocking movements, and hyperactivity. In patient 7, a 29-year-old man, LTG added to VPA and PHT resulted in severe exacerbation of baseline behaviors, including self-injurious activity, temper tantrums, and failure to obey simple instructions. CONCLUSIONS: In some patients with epilepsy and MR, LTG has significant positive or negative effects on behavior
— id: 34432, year: 1998, vol: 39, page: 874, stat: Journal Article,

Postictal SPECT in epileptic versus nonepileptic seizures
Ettinger, AB; Coyle, PK; Jandorf, L; Cabahug, CJ; Oster, ZH; Atkins, HL; Weisbrot, DM; Devinsky, O
1998 MAR-APR ;11(2):67-73, Journal of epilepsy
Despite advances in video-electroencephalogram (EEG) technology, in many patients distinguishing epileptic seizures from nonepileptic seizures (NES) remains a challenge. Reliable methods to make this distinction are needed. In a pilot study, we performed postictal and interictal single photon emission computed tomography (SPECT) in 22 patients undergoing video-EEG monitoring who had altered responsiveness during an episode. Eleven had seizures, defined as episodes associated with EEG seizure patterns or postictal prolactin (PRL) elevations greater than 1.5 times the highest interictal baseline PRL; 11 had NES. Among the 11 seizures, postictal SPECT was abnormal in seven (regions of hypoperfusion in six and hyperperfusion in one) and normal in four. In six cases (55%), the interictal and postictal SPECT changed. Among the 11 NES cases, postictal SPECT was abnormal in three cases (all hypoperfusion abnormalities) and normal in eight cases. in no case did the interictal and postictal SPECT change. This small sample revealed a trend toward greater hypometabolism (postictal versus interictal) on SPECT for epileptic seizures compared to NES (p < 0.12). There were postictal SPECT changes in two of five seizures unassociated with postictal PRL elevation. Prolactin was elevated in two cases unassociated with change on SPECT. Comparision of postictal to interictal SPECT may help distinguish epileptic seizures from NES. Results from SPECT may also help identify epileptic seizures unassociated with PRL elevation. (C) 1998 by Elsevier Science Inc. All rights reserved
— id: 53529, year: 1998, vol: 11, page: 67, stat: Journal Article,

Seizure etiologies in a veterans' affairs medical center population
Ettinger, AB; Gatewood, CV; Dhoon, A; Newman, GC; Weisbrot, DM; Jandorf, L; Devinsky, O
1998 JAN-FEB ;11(1):20-24, Journal of epilepsy
The purpose of this study is to determine the etiologies of seizures in a Veterans' Affairs Medical Center (VAMC) population. We retrospectively reviewed the records of all VAMC patients discharged from the Northport VA
— id: 53554, year: 1998, vol: 11, page: 20, stat: Journal Article,

Patient reporting of seizure exacerbation near the time of menses helps distinguish epileptic from nonepileptic seizures
Ettinger, AB; Weisbrot, DM; Devinsky, O
1998 NOV-DEC ;11(6):332-334, Journal of epilepsy
The purpose of this study was to determine whether patient reporting of a relationship between seizure exacerbation and menses helps distinguish premenopausal women with epileptic seizures from those with nonepileptic seizures (NES). We reviewed the responses to the question 'What tends to bring on your seizures?', administered during the initial evaluation of women ages 18-45 years with epileptic seizures (n = 27) and NES (n = 38) at our outpatient clinic. Only one out of 38 women with NES versus 13 of 27 women with epilepsy reported a relationship of seizures with the menstrual cycle (p =.0001). Other precipitants identified for seizure exacerbation such as stress, or emotional upset, did not distinguish these two groups. Patient reporting of a relationship between seizure exacerbation and menses can help distinguish epileptic from NES in premenopausal women. (C) 1998 by Elsevier Science Inc. All rights reserved
— id: 53632, year: 1998, vol: 11, page: 332, stat: Journal Article,

Fatigue and depression in epilepsy
Ettinger, AB; Weisbrot, DM; Krupp, LB; Coyle, PK; Jandorf, L; Devinsky, O
1998 MAR-APR ;11(2):105-109, Journal of epilepsy
Fatigue is commonly reported as an adverse effect of antiepileptic drugs. Ln other disorders, fatigue has been closely correlated with depression. We examined the frequency of fatigue in epilepsy patients, the contribution of depression to fatigue, and the impact of fatigue upon quality of life. We measured fatigue and depression with the Fatigue Severity Scale (FSS) and Center for Epidemiological Studies-Depression scale (CES-D), respectively in 89 patients with epilepsy at an epilepsy center, 26 depressed controls (DC), and 30 normal health adults (NHA). Patients with epilepsy also completed the Quality of Life in Epilepsy (QOLIE-10) scale. Forty-four percent of epilepsy patients met criteria for severe fatigue, while 52% were depressed. The correlation between fatigue and depression was high among epilepsy patients (r = .60, p = .0001). Both fatigue and depression had an inverse relationship with quality of life in epilepsy (p < .0001). Fatigue in epilepsy is common and is closely associated with depression. Fatigue is associated with significant impairment in quality of life in epilepsy. (C) 1998 by Elsevier Science Inc. All rights reserved
— id: 53530, year: 1998, vol: 11, page: 105, stat: Journal Article,

Hemispheric inactivation during intracarotid amobarbital test suggests right hemispheric lateralization of sympathetic cardiac control
Hilz, MJ; Devinsky, O; Duetsch, M; Perrine, K; Rauhut, U; Nelson, PK
1998 SEP ;44(3):M35-M35, Annals of neurology
— id: 104276, year: 1998, vol: 44, page: M35, stat: Journal Article,

Autism and autistic epileptiform regression with occipital spikes
Nass R; Gross A; Devinsky O
1998 Jul;40(7):453-458, Developmental medicine & child neurology
The electroencephalographic abnormalities seen in Landau-Kleffner syndrome (LKS) (language deterioration) are non-specific, and consist of a variety of epileptiform discharge patterns including continuous slow spike-wave discharges during sleep, focal sharp waves with spikes, and centrotemporal (rolandic) spikes. Similarly, the EEG abnormalities seen in autistic epileptiform regression (language and social/behavioral deterioration) are non-specific and overlap with those seen in LKS. By contrast, distinct epilepsy syndromes in otherwise normal children occur in the EEG-defined benign focal epilepsies of childhood. Occipital spikes or spike-wave present either in the older child with visual symptoms and headache or in the younger child with autonomic symptoms followed by brief or prolonged partial motor seizures. Seven young children (five from a consecutive series of 42) presenting clinically with autism or autistic regression and possible or definite seizures, whose EEGs revealed occipital spikes or spike-wave characteristic of the benign epilepsies, are reported. Although occipital spikes are commonly seen in young children as an age-dependent EEG-defined benign focal epilepsy, their high frequency in this population with cognitive difficulties suggests a possible causal relation. The effects of the epileptiform discharge on cognitive functioning presumably reflect extension into temporal and parietal lobes, rather than occipital disturbances per se
— id: 57214, year: 1998, vol: 40, page: 453, stat: Journal Article,

Patterns of electroencephalographic abnormalities in autistic spectrum disorders: Correlation with clinical status and outcome
Nass, R; Gross, A; Devinsky, O
1998 SEP ;44(3):B56-B56, Annals of neurology
— id: 104278, year: 1998, vol: 44, page: B56, stat: Journal Article,

Autistic epileptiform regression: Response to multiple subpial resections
Nass, R; Gross, A; Wisoff, J; Devinsky, O
1998 SEP ;44(3):A24-A24, Annals of neurology
— id: 104277, year: 1998, vol: 44, page: A24, stat: Journal Article,

Localization of mesial temporal lobe seizures with sphenoidal electrodes
Pacia SV; Jung WJ; Devinsky O
1998 May;15(3):256-261, Journal of clinical neurophysiology
Few studies have compared sphenoidal electrodes with scalp electrodes to determine their localizing value in temporal lobe seizures. We reviewed 76 ictal recordings with the standard International 10-20 System and T1/2 and sphenoidal electrodes from 31 patients whose subsequent intracranial EEG studies precisely localized seizures in one temporal lobe. Ictal EEGs were reviewed in a blinded fashion in both longitudinal bipolar and referential montages. Of the 23 seizures in 11 patients with mesial temporal lobe epilepsy (MTLE), all seven seizures in 3 patients were localized exclusively to one sphenoidal electrode, before involvement of T1/2 and temporal scalp electrodes. The remaining 16 seizures from 8 MTLE patients and all 53 seizures in the 20 patients with neocortical temporal lobe epilepsy (NTLE) had simultaneous involvement of sphenoidal, T1/2, and temporal scalp electrodes at seizure onset when analyzed with referential montages. Sphenoidal electrodes may provide valuable localization data for presurgical evaluation of patients with possible TLE. In particular, seizure rhythms confined to the sphenoidal electrode at ictal onset, without involvement of scalp electrodes, occurred only in patients with MTLE (p < 0.04). Further studies comparing these electrodes with other types of surface electrodes are needed
— id: 7420, year: 1998, vol: 15, page: 256, stat: Journal Article,

Cognitive functioning after pallidotomy for refractory Parkinson's disease [see comments]
Perrine K; Dogali M; Fazzini E; Sterio D; Kolodny E; Eidelberg D; Devinsky O; Beric A
1998 Aug;65(2):150-154, Journal of neurology neurosurgery & psychiatry
BACKGROUND: Earlier approaches to pallidotomy for refractory Parkinson's disease had significant complication rates. More recent approaches show fewer complications, but the effect of pallidotomy on cognition is unclear. The current study was conducted to examine the neuropsychological effects of unilateral pallidotomy. METHODS: Neuropsychological testing was performed on patients with medically refractory, predominantly unilateral Parkinson's disease at baseline and after unilateral ventral pallidotomy (n=28) or after an equivalent period without surgery in control patients (n=10). RESULTS: Pallidotomy patients showed no significant changes from baseline to retesting relative to the control group for any measure. Across all of the tests administered, only five of the surgery patients showed a significant decline, and of these five none declined on more than one test. Depression did not relate to preoperative or postoperative cognition. The pallidotomy group showed a significant improvement in motor functioning and activities of daily living whereas the control group did not. These measures were not associated with the neuropsychological test scores at baseline or retest. CONCLUSIONS: Stereotactic unilateral ventral pallidotomy does not seem to produce dramatic cognitive declines in most patients
— id: 7740, year: 1998, vol: 65, page: 150, stat: Journal Article,

Interhemispheric memory transfer in the intracarotid amobarbital procedure
Perrine K; Donofrio N; Devinsky O; Gershengorn J; Luciano DJ; Nelson PK
1998 Jan;11(1):8-11, Neuropsychiatry neuropsychology & behavioral neurology
The authors examined interhemispheric memory transfer in 32 patients with lateralized temporal lobe complex partial epilepsy (15 right onsets, 17 left onsets). Visually presented verbal, nonverbal, and two types of dually encodable stimuli were displayed during amobarbital anesthesia, and recognition memory was tested with verbal and nonverbal (pointing) response modalities. No relationship was found between the material specificity of stimuli and response modality. The only significant findings were for poorer recognition memory after injection of the hemisphere contralateral to the seizure focus. Visual information presented predominantly to one hemisphere during anesthesia is available to the other hemisphere for recognition memory on clearing
— id: 7741, year: 1998, vol: 11, page: 8, stat: Journal Article,

Preoperative predictors of anterior temporal language areas
Schwartz TH; Devinsky O; Doyle W; Perrine K
1998 Dec;89(6):962-970, Journal of neurosurgery
OBJECT: Although it is known that 5 to 10% of patients have language areas anterior to the rolandic cortex, many surgeons still perform standard anterior temporal lobectomies for epilepsy of mesial onset and report minimal long-term dysphasia. The authors examined the importance of language mapping before anterior temporal lobectomy. METHODS: The authors mapped naming, reading, and speech arrest in a series of 67 patients via stimulation of long-term implanted subdural grids before resective epilepsy surgery and correlated the presence of language areas in the anterior temporal lobe with preoperative demographic and neuropsychometric data. Naming (p < 0.03) and reading (p < 0.05) errors were more common than speech arrest in patients undergoing surgery in the anterior temporal lobe. In the approximate region of a standard anterior temporal lobectomy, including 2.5 cm of the superior temporal gyrus and 4.5 cm of both the middle and inferior temporal gyrus, the authors identified language areas in 14.5% of patients tested. Between 1.5 and 3.5 cm from the temporal tip, patients who had seizure onset before 6 years of age had more naming (p < 0.02) and reading (p < 0.01) areas than those in whom seizure onset occurred after age 6 years. Patients with a verbal intelligence quotient (IQ) lower than 90 had more naming (p < 0.05) and reading (p < 0.02) areas than those with an IQ higher than 90. Finally, patients who were either left handed or right hemisphere memory dominant had more naming (p < 0.05) and reading (p < 0.02) areas than right-handed patients with bilateral or left hemisphere memory lateralization. Postoperative neuropsychometric testing showed a trend toward a greater decline in naming ability in patients who were least likely to have anterior language areas, that is, those with higher verbal IQ and later seizure onset. CONCLUSIONS: Preoperative identification of markers of left hemisphere damage, such as early seizure onset, poor verbal IQ, left handedness, and right hemisphere memory dominance should alert neurosurgeons to the possibility of encountering essential language areas in the anterior temporal lobe (1.5-3.5 cm from the temporal tip). Naming and reading tasks are required to identify these areas. Whether removal of these areas necessarily induces long-term impairment in verbal abilities is unknown; however, in patients with a low verbal IQ and early seizure onset, these areas appear to be less critical for language processing
— id: 57073, year: 1998, vol: 89, page: 962, stat: Journal Article,

Multi-stage epilepsy surgery for extratemporal epilepsy
Werner WK; Devinsky O; Mogilner AY; Weiner HL
1998 ;39:66-66, Epilepsia
— id: 34022, year: 1998, vol: 39, page: 66, stat: Journal Article,

Nonepileptic seizures after head injury
Westbrook LE; Devinsky O; Geocadin R
1998 Sep;39(9):978-982, Epilepsia
PURPOSE: To examine the role of head injury as a risk factor in the development of nonepileptic seizures (NES). Specifically, we will determine the relative frequency of head injury among NES patients referred to our center and will describe several pertinent clinical features and personal characteristics. METHODS: Retrospective record review of patients referred to our center for evaluation of seizures over a 4-year period. All patients with NES were evaluated as in a previously described protocol, which included intensive video EEG monitoring, provocation by suggestion, and psychiatric interview. All NES patients with a history of head injury were extracted for this report. RESULTS: Of 102 patients with NES, nearly one-third (32%) had an antecedent head injury; 52% were male, mean age was 34 years, and 12% had coexisting epilepsy. Multiple psychiatric disorders were not uncommon (79%), and a history of abuse was found in 35%. All but four patients had documented financial gain from their injury. Follow-up at 1 year found poor long-term outcome with lasting disability; despite that, the majority (91%) of head injuries were minor. CONCLUSIONS: Our preliminary findings suggest that prior head injury is associated with the development of NES and may contribute to the pathogenesis of NES in vulnerable patients. Head injury and sexual or physical abuse appear to occur in comparable proportions in patients with NES. This suggests that head injury and abuse may be equally important risk factors in the development of NES
— id: 57282, year: 1998, vol: 39, page: 978, stat: Journal Article,

Dissociation in epilepsy and conversion nonepileptic seizures
Alper K; Devinsky O; Perrine K; Luciano D; Vazquez B; Pacia S; Rhee E
1997 Sep;38(9):991-997, Epilepsia
PURPOSE: We examined the dimensionality of the item content of the Dissociative Experiences Scale (DES) in relation to the clinical diagnosis of conversion nonepileptic seizures (C-NES) versus complex partial epilepsy (CPE). METHODS: The DES was administered to a sex- and age-matched sample of 132 patients with C-NES and 169 with CPE and was factor analyzed with principal components analysis (PCA) with varimax rotation. RESULTS: The mean total DES score was 15.1 in the C-NES group and 12.7 in the CPE group (p = 0.079). The factors obtained by PCA differentiated the CPE and C-NES groups more strongly than did the total DES score. The factor accounting for the most variance, interpreted as 'depersonalization-derealization,' was significantly greater in C-NES than CPE (p = 0.005). An 'absorption-imaginative involvement' factor, which included some of the clinical features of posttraumatic stress disorder was elevated only in subjects reporting histories of childhood abuse (p = 0.001) regardless of the diagnosis of CPE or C-NES. An 'amnestic' factor appearing to represent memory problems related to neurologic impairment showed a trend toward elevation in CPE (p = 0.056) and may have confounded the CPE versus C-NES distinction using total DES scores. CONCLUSIONS: The DES has separate underlying dimensions that appear to relate distinctively to depersonalization and derealization, childhood trauma, and neurologic impairment. The heterogeneous item content of the DES is a potential confound that should be appreciated when this instrument is used to study dissociation in neuropsychiatric populations
— id: 12132, year: 1997, vol: 38, page: 991, stat: Journal Article,

Safety and efficacy of divalproex sodium monotherapy in partial epilepsy: A double-blind, concentration-response design clinical trial
Beydoun, A; Sackellares, JC; Shu, V; Bornhofen, JH; Borreson, T; Browne, TR; Cascino, GD; Deaton, R; Devinsky, O; Drake, ME; Fromm, GH; Gallagher, BB; Griggs, WL; Hirschorn, KA; Homan, RW; Kaplan, L; Krauss, GL; Kuzniecky, RI; Chi, WL; Mamdani, MB; McPherson, SL; Mirza, WU; Morris, GL; Murray, KR; Pakainis, A; Penovich, P; Ramsay, RE; Rask, C; Risinger, MW; Rogin, JB; Roos, K; Tennison, M; Thadani, V; Valeriano, JP; Weisberg, LA
1997 JAN ;48(1):182-188, Neurology
This is the first randomized, double-blind, parallel-group, multicenter trial that evaluated the efficacy of divalproex sodium monotherapy by comparing seizure frequency in 143 patients with poorly controlled partial epilepsy randomly assigned to high (80 to 150 mu g/mL; 555 to 1,040 mu mol/L) or low (25 to 50 mu g/mL; 175 to 345 mu mol/L) plasma valproate groups, There was a statistically significant reduction from baseline in the 8-week frequency of complex partial (p = 0.001) and secondarily generalized tonic-clonic seizures (p = 0.018) for patients in the high, compared with the low, plasma valproate group. Compared with baseline, there was a 30% median reduction in complex partial seizures for patients in the high group and a 19% increase for those in the low group. The median reduction for secondarily generalized tonic-clonic seizures was 70% for patients in the high group compared with a 22% increase in the low group. Adverse events that occurred significantly more frequently in the high group included tremors, thrombocytopenia, alopecia, asthenia, diarrhea, vomiting, and anorexia. This study demonstrates the efficacy of divalproex sodium as monotherapy for the treatment of partial-onset seizures and supports its role as one of the first-line antiepileptic drug treatments for patients with partial epilepsy
— id: 104284, year: 1997, vol: 48, page: 182, stat: Journal Article,

Neurological aspects of the conscious and unconscious mind
Devinsky O
1997 Dec 19;835:321-329, Annals of the New York Academy of Sciences
— id: 12118, year: 1997, vol: 835, page: 321, stat: Journal Article,

Frontal functions in juvenile myoclonic epilepsy
Devinsky O; Gershengorn J; Brown E; Perrine K; Vazquez B; Luciano D
1997 Oct;10(4):243-246, Neuropsychiatry neuropsychology & behavioral neurology
The authors investigated cognition in juvenile myoclonic epilepsy (JME), focusing on frontal functions as suggested by maximal spatial distribution of epileptiform activity seen over frontocentral regions. Fifteen patients with JME (mean age, 34.3 years; mean estimated IQ 101) were administered a battery of tests sensitive to frontal dysfunction. The number of patients with impaired test performance and the frequency of impairment per test were calculated. Performance on selected tests was compared with that of 15 patients with temporal lobe epilepsy (TLE) who were matched for estimated IQ using paired t-tests. Although the performance of the group with JME was not uniform--some patients showed marked impairment whereas others showed little or no deficit--a high frequency of impairment was found on tests of concept formation-abstract reasoning and mental flexibility, cognitive speed, and planning and organization. Significant differences were found between the group with JME and the group with TLE on tests requiring mental flexibility and concept formation-abstract reasoning. In conjunction with studies demonstrating intractable seizures in approximately 20% of patients, the results from this study suggest that JME is not a uniformly benign condition. Frontal deficits may have maladaptive behavioral consequences suggestive of personality dysfunction, as described anecdotally by previous investigators
— id: 12233, year: 1997, vol: 10, page: 243, stat: Journal Article,

Bradycardia and asystole induced by partial seizures: a case report and literature review
Devinsky O; Pacia S; Tatambhotla G
1997 Jun;48(6):1712-1714, Neurology
Bradyarrhythmias associated with partial seizures are uncommon, with most reported patients having temporal lobe seizure foci on scalp EEG recordings. We report a patient with bradycardia and sinus arrest during a complex partial seizure documented during bilateral subdural EEG and EEG and simultaneous video and EEG recordings. The seizure began in the left temporal lobe and spread to the right temporal region, with bradycardia occurring 55 seconds after ictal onset and asystole after 60 seconds
— id: 56938, year: 1997, vol: 48, page: 1712, stat: Journal Article,

Adult patients with epilepsy maintain stable weight during lamotrigine therapy: A review of data from 33 clinical trials
Devinsky, O; Gallagher, J; Donahue, R; Clements, B
1997 MAR ;48(3):2059-2059, Neurology
— id: 104282, year: 1997, vol: 48, page: 2059, stat: Journal Article,

Multiple subpial transections in language cortex: Effects on language functions
Devinsky, O; Perrine, K; Pacia, S; Vazquez, B; Buchwald, J; Luciano, DJ
1997 SEP-OCT ;10(5):247-253, Journal of epilepsy
Multiple subpial transections (MST) were made in language cortex in 13 patients with medically refractory partial epilepsy. Transections were made in posterior language cortex in 12 patients and in both anterior and posterior language areas in 1. Eleven patients had additional resective surgery in the anterior temporal (n = 10) or anterior temporal and frontopolar (n = 1) regions. Eleven of the 13 patients had at least 90% reduction in seizure frequency. Dysnomia was present >6 months postoperatively in 9 patients (mild, 6; moderate, 3). Other deficits included impaired memory (mild, 3; moderate, 1) and reading (mild, 2). We compared the postoperative neuropsychologic findings in 7 patients with MST and temporal lobectomy with those in 14 patients who underwent only dominant temporal lobectomy. MST patients had significantly (p < 0.05) poorer postoperative naming, verbal fluency, and oral reading than patients with dominant temporal resections that spared language functions. MST in language areas can contribute to or cause language disorders that persist >1 year postoperatively. (C) 1997 by Elsevier Science Inc. All rights reserved
— id: 104281, year: 1997, vol: 10, page: 247, stat: Journal Article,

The resident's neurology book
Devinsky, Orrin
Philadelphia : F.A. Davis, c1997,
— id: 553, year: 1997, vol: , page: , stat: ,

Nonepileptic-epilepsia partialis continua
Ettinger, AB; Devinsky, O
1997 SEP-OCT ;10(5):215-219, Journal of epilepsy
We report three patients with focal prolonged myoclonic jerking movements suggestive of epilepsia partialis continua (EPC) but produced on a psychogenic basis [nonepileptic seizures-EPS (NES-EPC)]. NES-EPC was identified by (1) variability in the areas of motor activity in the same patient, (2) distribution and spread of motor activity without neuroanatomic basis, (3) transient abolition of movements with distraction (e.g., when other body parts are engaged in effortful tasks), (4) eliciting and abolishing typical episodes with suggestive techniques, (5) absence of motor weakness during or in between episodes, (6) absence of electroencephalogram (EEG) correlate of motor activity, and (7) absence of hyperperfusion on ictal SPECT scan. (C) 1997 by Elsevier Science Inc. All rights reserved
— id: 104279, year: 1997, vol: 10, page: 215, stat: Journal Article,

Use of gabapentin to treat focal status epilepticus
Ettinger, AB; Devinsky, O
1997 NOV-DEC ;10(6):291-293, Journal of epilepsy
Although gabapentin (GPN) is commonly used as adjunctive therapy to treat recurrent self-limited seizures, little is known about its potential efficacy in treating prolonged partial seizures. We report two cases of refractory focal status epilepticus successfully treated with oral GPN. Ln both cases, GPN precluded the need for pentobarbital coma. We suggest that GPN may be an effective treatment for focal status epilepticus and should be studied further for its potential efficacy in this condition. (C) 1997 by Elsevier Science Inc. All rights reserved
— id: 53127, year: 1997, vol: 10, page: 291, stat: Journal Article,

Monotherapy with gabapentin for partial epilepsy: A review of 30 cases
Heilbroner, PL; Devinsky, O
1997 SEP-OCT ;10(5):220-224, Journal of epilepsy
We attempted to evaluate the efficacy of Gabapentin (GBP) monotherapy as a treatment for partial epilepsy. We reviewed the medical records of 30 consecutive patients treated. with GBP monotherapy at our epilepsy center. Twenty-nine of these patients had previously been treated with antiepileptic drugs (AEDs) (median number of two drugs). Only one patient had taken GBP as an adjunctive medication Median duration of GBP monotherapy was 6 months, and the median daily dose was 1200 mg. During treatment with GBP, 17 patients (57%) experienced a greater than or equal to 25% reduction in seizure frequency, with nine patients reporting a greater than or equal to 90% reduction. Twelve patients reported no change in seizure frequency; however, six of these patients had experienced less than one seizure every 6 months prior to treatment with GBP, and therefore maintained fairly good control. Six patients discontinued GBP due to poorly controlled seizures. Adverse effects were experienced by 13 patients, but led to discontinuation of GBP in only four cases. Our results suggest that monotherapy with GBP tan be effective in partial epilepsy and is often well tolerated. (C) 1997 by Elsevier Science inc. All rights reserved
— id: 104280, year: 1997, vol: 10, page: 220, stat: Journal Article,

Multiple subpial transection for intractable partial seizures: Seizure outcome
Pacia, SV; Devinsky, O; Perrine, K; Luciano, DJ; Vazquez, B; Doyle, WK; Dogali, M; Abramson, HS
1997 MAR-APR ;10(2):86-91, Journal of epilepsy
We studied 21 patients who underwent multiple subpial transections (MST) for the surgical treatment of intractable partial-onset seizures in whom the epileptogenic focus overlapped with primary sensorimotor or language cortex. All patients had intracranial EEG localization of seizures and functional mapping with electrical stimulation before surgery. Eighteen patients had cortical resections in addition to MST, At an average follow-up of 21 months, 13 patients either are seizure-free or are experiencing auras or simple partial seizures (SPS) only, 6 patients have had greater than 50% reduction in seizure frequency, 1 patient has had a modest reduction in seizures, and 1 patient is unchanged. MST in the 3 patients who did not undergo cortical resections reduced seizure frequency in all 3, although none are seizure-free. MST, combined with cortical resection, appears to be a safe and effective alternative to subtotal resection of the epileptogenic zone. MST alone, although not curative, reduced seizure frequency in all patients who underwent the procedure. (C) 1997 Elsevier Science Inc
— id: 104283, year: 1997, vol: 10, page: 86, stat: Journal Article,

Serial recovery of language during the intracarotid amobarbital procedure
Ravdin LD; Perrine K; Haywood CS; Gershengorn J; Nelson PK; Devinsky O
1997 Mar;33(2):151-160, Brain & cognition
There is considerable variability among epilepsy centers in the methods and interpretations of the intracarotid amobarbital procedure. Prominent among these differences is the determination of language representation and assessment of language functions. Some centers rely on speech arrest following amobarbital injection as a marker for language representation, whereas other centers examine verbal output for the presence of aphasic errors. The present study assessed the pattern of language recovery following amobarbital injection in epilepsy patients who were candidates for temporal lobectomy. Language recovery from dominant hemisphere injection (left or right) followed a stereotypical progression, with 71.8% of patients showing return of vocalization followed by return of naming and comprehension. Repetition deficits with paraphasic errors persisted the longest (mean = 12'30'), with a conduction aphasia persisting after the acute global aphasia resolved. Although two patients interpreted as left hemisphere language dominant were mute following right hemisphere injection, all language functions were intact immediately upon resumption of vocalization and they showed no other signs of aphasia such as paraphasias or anomia. Possible explanations for serial language recovery and persistent conduction aphasia are discussed. These findings have significant implications for the determination of cerebral language dominance
— id: 34435, year: 1997, vol: 33, page: 151, stat: Journal Article,

Inhibitory motor status: Two new cases and a review of inhibitory motor seizures
Smith, RF; Devinsky, O; Luciano, D
1997 JAN-FEB ;10(1):15-21, Journal of epilepsy
Transient paralysis is an uncommon seizure symptom. We report two new cases of inhibitory motor status and review 24 previously cases of inhibitory seizures. Among the 22 adult patients, 14 (64%) had a frontoparietal lesion (tumor, 7; stroke, 7); 5 (23%) had mesiotemporal sclerosis (MTS), and 3 (14%) had no identified lesion. In contrast, all 4 pediatric patients had no identified brain lesions. Inhibitory motor seizures were associated most commonly with lesions in frontoparietal primary and supplementary motor-sensory area and, less often, in the mesial temporal lobe. Inhibitory motor seizures arising from frontoparietal foci are often more prolonged (>2-3 min) than those arising from the mesial temporal area (<1.5 min). Patients with temporal lobe seizure foci manifest ictal flaccidity of an extremity during a complex partial seizure (CPS), which may represent motor neglect rather than ictal weakness since strength cannot be accurately assessed when consciousness is impaired. Inhibitory motor seizures from sensorimotor cortex seizure foci are probably more common than is recognized. (C) 1997 by Elsevier Science Inc
— id: 53209, year: 1997, vol: 10, page: 15, stat: Journal Article,

An open label trial of venlafaxine in adults with attention deficit disorder
Adler, LA; Resnick, S; Kunz, M; Devinsky, O
1996 APR 1 ;39(7):421-421, Biological psychiatry
— id: 52982, year: 1996, vol: 39, page: 421, stat: Journal Article,

A brief questionnaire to screen for quality of life in epilepsy: the QOLIE-10
Cramer JA; Perrine K; Devinsky O; Meador K
1996 Jun;37(6):577-582, Epilepsia
PURPOSE: To evaluate a brief questionnaire to screen aspects of health-related quality of life for persons with epilepsy. METHODS: A study of 304 adults with epilepsy was undertaken at 25 seizure clinics in the United States. It was used for derivation of a brief screening tool from a longer instrument (QOLIE-89). RESULTS: The 10-item questionnaire (QOLIE-10) covers general and epilepsy-specific domains, grouped into three factors: Epilepsy Effects (memory, physical effects, and mental effects of medication), Mental Health (energy, depression, overall quality of life), and Role Functioning (seizure worry, work, driving, social limits). Scale scores were significantly different among seizure groups (p = 0.003). CONCLUSIONS: The QOLIE-10 can be completed by a patient in several minutes and reviewed rapidly by the physician. This screening tool could provide potentially useful information for initial assessment or follow-up of problem areas that are not commonly evaluated during routine clinical visits with patients with epilepsy
— id: 34438, year: 1996, vol: 37, page: 577, stat: Journal Article,

Ethical use of placebos and provocative testing in diagnosing nonepileptic seizures
Devinsky O; Fisher R
1996 Oct;47(4):866-870, Neurology
— id: 56937, year: 1996, vol: 47, page: 866, stat: Journal Article,

Clinical profile of patients with epileptic and nonepileptic seizures
Devinsky O; Sanchez-Villasenor F; Vazquez B; Kothari M; Alper K; Luciano D
1996 Jun;46(6):1530-1533, Neurology
Epileptic seizures (ES) and nonepileptic seizures (NES) often coexist in patients with treatment-refractory seizures. There are few data on ictal features of these different seizure types in the same patient. We identified 20 patients with ES from a group of 99 NES patients (ES/NES) and compared this group with patients with only ES or NES. All 20 ES/NES patients developed NES after ES. Clinical features of NES clearly differed from ES in 18 of 20 cases. In patients with ES/NES their ES were similar to seizures in patients with only ES, and their NES were similar to spells in patients with only NES. ES/NES patients were similar to ES patients in electrodiagnostic and neuroimaging studies, and similar to NES patients in psychiatric interviews and inventories. The clinical manifestations of ES and NES in the same patient are usually different. Both types of events may be stereotypic and can be distinguished and characterized during video-EEG recording. Determining what events are more prevalent or disturbing is critical. Psychiatric and antiepileptic drug treatment may be provided accordingly
— id: 12601, year: 1996, vol: 46, page: 1530, stat: Journal Article,

Epilepsy after minor head trauma
Devinsky, O
1996 JUN ;9(2):94-97, Journal of epilepsy
Epidemiologic studies have shown no increased risk of epilepsy after mild head injury (i.e., brief loss of consciousness or amnesia). Twelve cases of new-onset epilepsy occurring less than or equal to 6 months after mild head injury were identified. None of the patients had other risk factors for epilepsy. There was no loss of consciousness in three cases; in the remaining nine, the duration of posttraumatic unconsciousness was less than or equal to 10 min, Nine patients had epileptiform activity or video-EEG documented epileptic seizures; two other patients had focal slowing on the EEG. Eight patients have medically refractory epilepsy, probably reflecting the selection bias. These cases suggest that in certain instances mild head trauma may cause epilepsy
— id: 52869, year: 1996, vol: 9, page: 94, stat: Journal Article,

Ictus emeticus - Reply
Devinsky, O
1996 JUN ;46(6):1785-1785, Neurology
— id: 104287, year: 1996, vol: 46, page: 1785, stat: Journal Article,

Psychogenic basilar migraine - Reply
Devinsky, O
1996 JUL ;47(1):302-303, Neurology
— id: 104285, year: 1996, vol: 47, page: 302, stat: Journal Article,

Psychogenic basilar migraine - Reply
Devinsky, O
1996 JUN ;46(6):1786-1787, Neurology
— id: 104288, year: 1996, vol: 46, page: 1786, stat: Journal Article,

The neurology of consciousness: Insights from epilepsy
Devinsky, O
1996 MAR ;12(1):67-67, Convulsive therapy
— id: 104289, year: 1996, vol: 12, page: 67, stat: Journal Article,

A comparison of health-related quality of life in patients with epilepsy, diabetes and multiple sclerosis
Hermann BP; Vickrey B; Hays RD; Cramer J; Devinsky O; Meador K; Perrine K; Myers LW; Ellison GW
1996 Oct;25(2):113-118, Epilepsy research
The purpose of this investigation was to compare self-reported health-related quality of life (HRQOL) in epilepsy compared to another neurological condition or a non-neurological chronic illness. Patients with epilepsy (N = 271), multiple sclerosis (N = 85) and diabetes (N = 555) completed a generic measure of HRQOL (RAND 36-Item Health Survey 1.0 (SF-36)), and the eight SF-36 scale scores were compared across groups, adjusting for differences in sociodemographic characteristics and co-morbid medical conditions. Patients with multiple sclerosis reported significantly worse HRQOL compared to both the epilepsy and diabetes groups (who did not differ from one another) on the Physical Functioning, Role Limitations-Physical, Energy, and Social Function scales. Patients with epilepsy and multiple sclerosis did not differ from one another but reported significantly lower HRQOL scores than the diabetes group on the Emotional Well-Being and Role Limitations-Emotional scales. However, the epilepsy group reported better health perceptions compared to the diabetes and multiple sclerosis patients. Generic measures of HRQOL appear useful in identifying some effects of neurological disease, but disease-targeted supplements may be required to more clearly identify the impact of epilepsy on quality of life
— id: 34437, year: 1996, vol: 25, page: 113, stat: Journal Article,

Clinical features of neocortical temporal lobe epilepsy
Pacia SV; Devinsky O; Perrine K; Ravdin L; Luciano D; Vazquez B; Doyle WK
1996 Nov;40(5):724-730, Annals of neurology
Few studies have examined the clinical features of neocortical temporal lobe epilepsy (NTLE) in carefully selected patients. We reviewed records from 21 patients with NTLE, defined by intracranial electroencephalogram (EEG), who have been seizure free for 1 year or more following temporal lobectomy. The mean age of onset at the time of first seizure was 14 years (range, 1-41 years). Febrile seizures were reported in only 2 patients (9.5%). In contrast to prior mesial temporal lobe epilepsy (MTLE) studies, seizure-free intervals between the initial cerebral insult or first seizure and habitual seizures were uncommon. Possible or known risk factors for epilepsy were reported in 13 of 21 patients (62%). Fifteen (71%) patients reported auras, with experiential phenomena being the most common type. Magnetic resonance imaging was normal or nonspecific in 15 patients, revealed mild hippocampal atrophy in 2, tumors in 2, and heterotopic gray matter and hippocampal atrophy in 1, and cortical dysgenesis in 1. Neuropsychological testing showed deficits consistent with the seizure focus in 13 patients (62%), and Wada test showed ipsilateral memory deficits in 10 (48%). The most common behavioral manifestation was a motionless stare at ictal onset (48%). In contrast to prior studies of MTLE, only 1 NTLE patient had frequent independent, contralateral temporal lobe epileptiform spikes on scalp EEG
— id: 34436, year: 1996, vol: 40, page: 724, stat: Journal Article,

Prolonged QT syndrome presenting as epilepsy - Reply
Pacia, SV; Devinsky, O
1996 APR ;46(4):1188-1188, Neurology
— id: 104290, year: 1996, vol: 46, page: 1188, stat: Journal Article,

Epilepsy - Reply
Perrine, K; Devinsky, O; Hermann, BP; Meador, KJ; Vickrey, BG; Cramer, JA
1996 JUN ;53(6):476-477, Archives of neurology
— id: 104286, year: 1996, vol: 53, page: 476, stat: Journal Article,

Social and medical outcome of nonepileptic seizures
ABRAMSON, H; BARKAN, M; ALPER, K; PERRINE, K; DEVINSKY, O
1995 NOV ;36(22):H9-H9, Epilepsia
— id: 52681, year: 1995, vol: 36, page: H9, stat: Journal Article,

Open-label trial of venlafaxine in adults with attention deficit disorder
Adler LA; Resnick S; Kunz M; Devinsky O
1995 ;31(4):785-788, Psychopharmacology bulletin
Antidepressants or stimulants are commonly used to treat attention deficit disorder (ADD). We report the results of an open-label trial of the recently marketed antidepressant venlafaxine in 16 adult patients with ADD. Patients were treated with venlafaxine (25 to 225 mg/day) for 8 weeks. Four patients discontinued treatment within the first week because of sedation, agitation, or nausea. In the remaining 12 patients, venlafaxine treatment decreased ADD ratings by almost half
— id: 12816, year: 1995, vol: 31, page: 785, stat: Journal Article,

Psychiatric classification of nonconversion nonepileptic seizures
Alper K; Devinsky O; Perrine K; Vazquez B; Luciano D
1995 Feb;52(2):199-201, Archives of neurology
OBJECTIVE: To determine the frequency and type of non-conversion nonepileptic seizures (NES). BACKGROUND: Although conversion disorder is the most common psychiatric disorder among patients with NES, many patients with nonepileptic paroxysmal behavioral events have other psychiatric disorders, with natural histories and treatments different from those of conversion disorder. DESIGN: Retrospective review of a series of consecutive admissions for video-electroencephalography monitoring. All patients identified with NES were interviewed by a psychiatrist. Patients with conversion and other psychiatric disorders were divided into separate groups. SETTING: A comprehensive epilepsy center. RESULTS: Twenty-one patients evaluated for possible epileptic seizures had a psychiatric disorder other than conversion that accounted for their events. Among these patients, Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R) anxiety disorders (n = 9) were the most common diagnosed category, followed by all forms of psychotic disorders (n = 7) and impulse control problems in the setting of attention deficit disorder residual type (n = 2). In contrast to 71 patients with conversion NES seen over the same period of time, the non-conversion group showed no female predominance and the nonconversion patients were significantly less likely than the conversion patients to have been physically or sexually abused in childhood or adolescence. CONCLUSIONS: These results support the validity of the nosologic distinction of nonconversion from conversion NES and suggest that DSM-III-R anxiety disorders are an important diagnostic confound in clinical epilepsy
— id: 12805, year: 1995, vol: 52, page: 199, stat: Journal Article,

DISSOCIATION IN PATIENTS WITH EPILEPTIC AND NONEPILEPTIC SEIZURES
ALPER, K; DEVINSKY, O; PERRINE, K; LUCIANO, D; VAZQUEZ, B; PACIA, S; ABRAMSON, H
1995 OCT ;36(4):640-640, Epilepsia
— id: 104295, year: 1995, vol: 36, page: 640, stat: Journal Article,

ADAPTATION OF AN EPILEPSY QUALITY-OF-LIFE INSTRUMENT FOR ADOLESCENTS
CRAMER, J; DEVINSKY, O; WESTBROOK, L; PERRINE, K; HERMANN, B; CAMFIELD, C; AUSTIN, J; VINING, P; DEAN, P
1995 OCT ;36(4):H8-H8, Epilepsia
— id: 104292, year: 1995, vol: 36, page: H8, stat: Journal Article,

INTRACRANIAL EEG FINDINGS AND SURGICAL OUTCOME IN NEOCORTICAL EPILEPSY
DAHBOUR, S; PACIA, SV; DOYLE, WK; DEVINSKY, O
1995 NOV ;36(22):380-380, Epilepsia
— id: 52679, year: 1995, vol: 36, page: 380, stat: Journal Article,

Cognitive and behavioral effects of antiepileptic drugs
Devinsky O
1995 ;36 Suppl 2:S46-S65, Epilepsia
All antiepileptic drugs (AEDs) have the potential for adverse effects on cognition and behavior. Most of the major AEDs, administered in therapeutic doses, cause little or no cognitive or behavioral impairment in group studies. However, individual variability is considerable, and some patients do not tolerate low serum levels, whereas others tolerate high levels without subjective or objective effects. In the past, carbamazepine (CBZ) and valproate (VPA) have been reported to have the fewest adverse cognitive and behavioral effects in children and adults. However, several recent, well-controlled studies have not found significant differences between the effects of phenytoin (PHT) and those of CBZ or VPA. Greater adverse effects have been found for phenobarbital (PB). However, we must use environmentally relevant measures of cognitive and behavioral functioning to measure effects on daily functioning. Future studies must define cognitive and behavioral toxicity in subpopulations (e.g., post-traumatic epilepsy, mental retardation, depression) and with the new AEDs
— id: 12821, year: 1995, vol: 36 Suppl 2, page: S46, stat: Journal Article,

Outcome research in neurology: incorporating health-related quality of life
Devinsky O
1995 Feb;37(2):141-142, Annals of neurology
— id: 56629, year: 1995, vol: 37, page: 141, stat: Journal Article,

Postictal psychosis: a case control series of 20 patients and 150 controls
Devinsky O; Abramson H; Alper K; FitzGerald LS; Perrine K; Calderon J; Luciano D
1995 Mar;20(3):247-253, Epilepsy research
We compared clinical data, EEG, and video-EEG studies in a consecutive series of 20 patients with postictal psychosis (PP) to 150 consecutive epilepsy patients with complex partial (CPS) or generalized tonic-clonic (GTCS) seizures but without PP. There was a lucid interval between last seizure and onset of psychosis ranging from 2.3 to 72 h (mean, 25 h). Duration of PP ranged from 16 to 432 h (mean, 83 h). Age, sex, epilepsy type (partial vs. generalized), and history of febrile seizures were similar in the PP and control groups. Patients with PP had more frequent GTCS during monitoring than controls (2.8 vs. 1.3; P < 0.001). Patients with PP were more likely to have a history of encephalitis (P < 0.0001) and psychiatric hospitalization (P < 0.002). More patients with PP had bilateral interictal epileptiform discharges during monitoring than controls (P < 0.0002). Postictal psychosis most often develops in patients with bilateral dysfunction following a cluster of GTCS
— id: 6818, year: 1995, vol: 20, page: 247, stat: Journal Article,

Efficacy of felbamate monotherapy in patients undergoing presurgical evaluation of partial seizures
Devinsky O; Faught RE; Wilder BJ; Kanner AM; Kamin M; Kramer LD; Rosenberg A
1995 Mar;20(3):241-246, Epilepsy research
The efficacy and safety of felbamate monotherapy were evaluated in 52 patients with refractory partial seizures with or without secondary generalization in a double-blind, randomized, placebo-controlled trial. Each patient completed a routine evaluation for epilepsy surgery and was randomized to receive either felbamate, titrated to a maximum daily dose of 3600 mg over 2 days, or placebo during the 10-day, inpatient, treatment phase. An intent-to-treat analysis was performed on the data of all 52 patients who received study medication, while a separate efficacy analysis also was performed on the data of 43 evaluable patients, which excluded protocol violators. The endpoint of the trial was completing 10 days of treatment or the occurrence of a fourth seizure. The primary efficacy variable was the average daily seizure frequency during the treatment phase for each patient. For the intent-to-treat analysis based on all 52 patients who received study medications, the mean rank of the daily seizure frequency for patients treated with felbamate was 21.6 compared to 29.6 for patients treated with placebo (P = 0.065). In the analysis based on the 43 evaluable patients, the mean rank of the daily seizure frequency for felbamate-treated patients was 17.0 compared to 25.4 for placebo-treated patients. This difference was statistically significant (P = 0.032) in favor of felbamate. Seizure frequency was decreased by 89.5% compared to baseline in nine patients who completed 10 days of felbamate therapy. This study permitted the rapid determination of the anticonvulsant activity of felbamate and demonstrated that felbamate is effective as monotherapy for the treatment of partial seizures
— id: 6819, year: 1995, vol: 20, page: 241, stat: Journal Article,

Ictus emeticus: further evidence of nondominant temporal involvement [see comments]
Devinsky O; Frasca J; Pacia SV; Luciano DJ; Paraiso J; Doyle W
1995 Jun;45(6):1158-1160, Neurology
We report two cases of ictal vomiting in patients who had left temporal lobe epilepsy. In one patient, vomiting developed when the discharge spread to the right temporal lobe as seen during depth electrode recording. In the second patient, ictal vomiting occurred with a restricted left temporal discharge, but the patient was left-handed and had right-hemisphere language dominance. These cases provide additional evidence of the involvement of the nondominant temporal lobe in ictus emeticus
— id: 12767, year: 1995, vol: 45, page: 1158, stat: Journal Article,

Safety of intravenous valproate
Devinsky O; Leppik I; Willmore LJ; Pellock JM; Dean C; Gates J; Ramsay RE
1995 Oct;38(4):670-674, Annals of neurology
This multicenter, open-label trial was designed to study the safety of intravenous (IV) sodium valproate in patients with epilepsy. All 318 patients (previously treated with antiepileptic drugs) were hospitalized for seizure control or anticipated seizures. The protocol allowed physicians to set the number of infusions and treatment duration. Adverse events, laboratory studies performed, and seizure activity were documented on case report forms. The patients' mean age was 34.4 years (range, 2-87 years). The most common reason for admission was lack of seizure control (235 patients, 185 of whom were admitted for video-electroencephalographic monitoring). The median dosage of valproate was 375 mg infused over 1 hour. The median number of doses was four, given over 2 days. In 54 patients (17%), transient adverse events were reported. The most frequent were headache, reaction at the injection site, and nausea (2.2% each); somnolence (1.9%); vomiting (1.6%); and dizziness and taste perversion (1.3% each). No persistent or severe hematologic or serum chemistry abnormalities were found. Vital signs were not significantly affected by the IV infusion of valproate. At the dosages and rates of administration studied, intravenous valproate appears to be safe and well tolerated
— id: 56809, year: 1995, vol: 38, page: 670, stat: Journal Article,

Contributions of anterior cingulate cortex to behaviour
Devinsky O; Morrell MJ; Vogt BA
1995 Feb;118(Pt 1):279-306, Brain
Assessments of anterior cingulate cortex in experimental animals and humans have led to unifying theories of its structural organization and contributions to mammalian behaviour. The anterior cingulate cortex forms a large region around the rostrum of the corpus callosum that is termed the anterior executive region. This region has numerous projections into motor systems, however, since these projections originate from different parts of anterior cingulate cortex and because functional studies have shown that it does not have a uniform contribution to brain functions, the anterior executive region is further subdivided into 'affect' and 'cognition' components. The affect division includes areas 25, 33 and rostral area 24, and has extensive connections with the amygdala and periaqueductal grey, and parts of it project to autonomic brainstem motor nuclei. In addition to regulating autonomic and endocrine functions, it is involved in conditioned emotional learning, vocalizations associated with expressing internal states, assessments of motivational content and assigning emotional valence to internal and external stimuli, and maternal-infant interactions. The cognition division includes caudal areas 24' and 32', the cingulate motor areas in the cingulate sulcus and nociceptive cortex. The cingulate motor areas project to the spinal cord and red nucleus and have premotor functions, while the nociceptive area is engaged in both response selection and cognitively demanding information processing. The cingulate epilepsy syndrome provides important support of experimental animal and human functional imaging studies for the role of anterior cingulate cortex in movement, affect and social behaviours. Excessive cingulate activity in cases with seizures confirmed in anterior cingulate cortex with subdural electrode recordings, can impair consciousness, alter affective state and expression, and influence skeletomotor and autonomic activity. Interictally, patients with anterior cingulate cortex epilepsy often display psychopathic or sociopathic behaviours. In other clinical examples of elevated anterior cingulate cortex activity it may contribute to tics, obsessive-compulsive behaviours, and aberrent social behaviour. Conversely, reduced cingulate activity following infarcts or surgery can contribute to behavioural disorders including akinetic mutism, diminished self-awareness and depression, motor neglect and impaired motor initiation, reduced responses to pain, and aberrent social behaviour. The role of anterior cingulate cortex in pain responsiveness is suggested by cingulumotomy results and functional imaging studies during noxious somatic stimulation. The affect division of anterior cingulate cortex modulates autonomic activity and internal emotional responses, while the cognition division is engaged in response selection associated with skeletomotor activity and responses to noxious stimuli. Overall, anterior cingulate cortex appears to play a crucial role in initiation, motivation, and goal-directed behaviours.(ABSTRACT TRUNCATED AT 400 WORDS)
— id: 12803, year: 1995, vol: 118, page: 279, stat: Journal Article,

Nonepileptic seizures
Devinsky O; Thacker K
1995 May;13(2):299-319, Neurologic clinics
The widespread use of video-electroencephalogram monitoring has dramatically increased our recognition of the high prevalence and diversity of nonepileptic seizures. Nonepileptic seizures stand squarely in the interface between psychiatry and neurology, an area that has been both claimed and denied by both sides. Collaborative exploration of this border zone has provided new insights into a disorder that may be as ancient as epilepsy
— id: 12780, year: 1995, vol: 13, page: 299, stat: Journal Article,

Development of the quality of life in epilepsy inventory
Devinsky O; Vickrey BG; Cramer J; Perrine K; Hermann B; Meador K; Hays RD
1995 Nov;36(11):1089-1104, Epilepsia
We developed an instrument to measure health-related quality of life (HRQOL) in epilepsy. A 99-item inventory was constructed from the RAND 36-Item Health Survey (generic core), with 9 additional generic items, 48 epilepsy-targeted items, and 6 other items concerning attitudes toward epilepsy and self-esteem. We administered the 99-item inventory to 304 adults with epilepsy at 25 epilepsy centers. Patients and patient-designated proxies completed the inventory and were retested 1-91 days later. A multitrait scaling analysis of these data led to retention of 86 items distributed in 17 multiitem scales (Cronbach's alpha ranged from 0.78 to 0.92). Factor analysis of the 17 multiitem scales yielded four underlying dimensions of health: an epilepsy-targeted dimension, a cognitive factor, mental health, and physical health. Construct validity was supported by significant patient-proxy correlations for all scales and correlations between neuropsychologic tests and self-reported emotional and cognitive function (all p values < 0.05). There were significant negative correlations between the four factor scores derived from the HRQOL scales and neurotoxicity, systemic toxicity, and health care utilization (except for the correlation between mental health factor and health care utilization; all p values < 0.05). Patients who were seizure-free in the preceding year reported better HRQOL for the overall score, three of the four factor scores, and 8 of the 17 scale scores than did patients with a high frequency of seizures. Relative validity analysis showed that the epilepsy-targeted factor and three of its four component scales were more sensitive to categorization of patients by severity of seizure frequency and type than scales tapping physical health, mental health, or cognitive function. These cross-sectional data support the reliability and validity of this measure of HRQOL in epilepsy. The addition of an epilepsy-targeted supplement to the generic core improved the sensitivity to severity of epilepsy. The 86 items included in the field testing were supplemented by three additional items to form the Quality of Life in Epilepsy (QOLIE-89) inventory
— id: 12717, year: 1995, vol: 36, page: 1089, stat: Journal Article,

Epilepsy and sleep apnea - Reply
Devinsky, O
1995 DEC ;45(12):2304-2304, Neurology
— id: 104291, year: 1995, vol: 45, page: 2304, stat: Journal Article,

SAFETY OF INTRAVENOUS VALPROATE
DEVINSKY, O; RAMSAY, RE
1995 OCT ;36(10):S67-S67, Epilepsia
— id: 86736, year: 1995, vol: 36, page: S67, stat: Journal Article,

Anatomic and physiological considerations in pallidotomy for Parkinson's disease
Dogali M; Beric A; Sterio D; Eidelberg D; Fazzini E; Takikawa S; Samelson DR; Devinsky O; Kolodny EH
1995 ;64:9-12, Acta neurochirurgica. Supplementum
Our ongoing study of ventral pallidotomy for the control of Parkinson's disease in selected patients has provided the opportunity to explore the topographical and somatotopic organization of the human globus pallidus. Utilizing microelectrode techniques we have obtained recordings which were correlated with data from MPTP-parkinsonian primates. In addition, we performed pre- and post-operative FDG/PET scans in these patients. Our studies reveal similarities between the MPTP-parkinsonian primate model and human Parkinson's disease in terms of physiologic recordings and responses. However, we have encountered significant differences between dominant and non-dominant hemisphere representations, particularly for the hand, in the human. In addition, our PET studies confirmed, as in previous parkinsonian primate models, glucose hypermetabolism in the lenticular area of Parkinson's disease patients. This hypermetabolism is dramatically altered by creation of a lesion in the globus pallidus medialis. This is demonstrated by follow-up PET scans which reveal not only a decrease in metabolism of the operated lenticular region, but also in the frontal cortical projections. These combined observations of the cellular activity in the globus pallidus and the observed changes in PET metabolism support the selection of the pallidum for lesioning and control of Parkinson's disease, and offer insight into the underlying physiology of this disorder. The above physiological and PET data will be clinically correlated with our ongoing series of 35+ patients
— id: 12822, year: 1995, vol: 64, page: 9, stat: Journal Article,

Stereotactic ventral pallidotomy for Parkinson's disease
Dogali M; Fazzini E; Kolodny E; Eidelberg D; Sterio D; Devinsky O; Beric A
1995 Apr;45(4):753-761, Neurology
Eighteen patients with medically intractable Parkinson's disease that was characterized by bradykinesia, rigidity, and marked 'on-off' fluctuations underwent stereotactic ventral pallidotomy under local anesthesia. Targeting was aided by anatomic coordinates derived from the MRI, intraoperative cell recordings, and electrical stimulation prior to lesioning. A nonsurgically treated group of seven similarly affected individuals was also followed. Assessment of motor function was made at baseline and at 3-month intervals for 1 year. Following the lesioning, patients improved in bradykinesia, rigidity, resting tremor, and balance with resolution of medication-induced contralateral dyskinesia. When compared with preoperative baseline, all quantifiable test scores after surgery improved significantly with the patients off medications for 12 hours: UPDRS by 65%, and CAPIT subtest scores on the contralateral limb by 38.2% and the ipsilateral limb by 24.2%. Walk scores improved by 45%. Medication requirements were unchanged, but the patients who had had surgery were able to tolerate larger doses because of reduced dyskinesia. Ventral pallidotomy produces statistically significant reduction in parkinsonism and contralateral 'on' dyskinesia without morbidity or mortality and with a short hospitalization in Parkinson's disease patients for whom medical therapy has failed
— id: 12789, year: 1995, vol: 45, page: 753, stat: Journal Article,

DEPRESSION AND ANXIETY IN PATIENTS WITH NONEPILEPTIC VERSUS EPILEPTIC SEIZURES
DONOFRIO, N; PERRINE, K; ALPER, K; ABRAMSON, H; DEVINSKY, O
1995 NOV ;36(22):H11-H11, Epilepsia
— id: 52682, year: 1995, vol: 36, page: H11, stat: Journal Article,

PRELIMINARY EXPERIENCE WITH INTERACTIVE IMAGE-DIRECTED TECHNIQUES FOR FUNCTIONAL MAPPING AND ELECTROGRAPHIC LOCALIZATION DURING EPILEPSY SURGERY
DOYLE, WK; PACIA, S; PERRINE, K; DEVINSKY, O
1995 NOV ;36(22):E7-E7, Epilepsia
— id: 52680, year: 1995, vol: 36, page: E7, stat: Journal Article,

FDG-PET in children and adolescents with partial seizures: role in epilepsy surgery evaluation
Gaillard WD; White S; Malow B; Flamini R; Weinstein S; Sato S; Kufta C; Schiff S; Devinsky O; Fazilat S; et al.
1995 Jan;20(1):77-84, Epilepsy research
We used FDG-PET to measure interictal glucose metabolism in 16 children and adolescents (mean age 14.7 years) and complex partial seizures (CPS) (mean seizure onset age 5.0 years). Video-EEG localized the epileptic foci. Glucose metabolism was determined in 14 paired anatomic areas using a standard template. PET hypometabolism was defined as greater than 15% asymmetry. Nine of the 13 (69%) patients with a unilateral EEG focus had regional hypometabolism ipsilateral to the epileptogenic zone. Three subjects had bilateral EEG foci; all had nonfocal PET. MRI (15 patients) concurred with EEG and PET in two, and was normal in seven of nine with focal hypometabolism. One of seven patients with normal PET had a focal MRI abnormality. FDG-PET results are similar to those found in adults, but are present earlier in the natural history of CPS (9.7 vs 22.2 years duration epilepsy) than previously reported. The presence of FDG-PET hypometabolism may be associated with a poor response to drug treatment. PET can identify metabolic abnormalities associated with epileptic foci in children and adolescents and is useful in directing surgical intervention for the control of refractory complex partial epilepsy
— id: 34440, year: 1995,