Cases reported "Epilepsy, Post-Traumatic"

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1/13. Effects of testosterone and clomiphene on spectral EEG and visual evoked response in a young man with posttraumatic epilepsy.

    The effects of testosterone and clomiphene on epilepsy was studied in a young man with posttraumatic seizures. In the control period, digital EEG and visual evoked potentials (VEPs) were recorded under carbamazapine therapy. After testosterone (T), seizures lessened and almost disappeared; the theta, delta, alpha, and beta powers decreased; VEPs increased. After clomiphene, VEPs considerably increased in size; clinical picture slightly improved; EEG power spectrum remained unchanged. It was suggested that T may be beneficial for epilepsy treatment by suppressing the EEG synchronization (slow wave activity) and attenuating the entropy state of the epileptic brain.
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2/13. Symptomatic epilepsy with facial myoclonus triggered by language.

    We report on a patient with a left frontal lesion who, many years after an injury, developed non-fluent aphasia and facial myoclonic jerks triggered by speaking and listening to spoken language. At age 57, the patient first noted that he would begin to stutter when delivering lectures at conferences. The stuttering would worsen if he continued talking. The video-polygraphic EEG recording shows brief paroxysms of spikes and polyspikes, followed by a slow wave, more evident in the left fronto-temporal region. The myoclonic jerks originating from the submental area correlate with EEG abnormalities. Clinically, these jerks determined a form of stuttering. The triggering factors were reading, speaking and listening to spoken language. This case had several characteristic features: facial myoclonus was the only seizure type experienced by the patient; the seizures and language impairment had a very late onset--about 50 years after the traumatic event that produced a dramatic lesion in the left fronto-polar region. (Published with videosequences.)
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3/13. Amygdalo-hippocampectomy for pathological aggression.

    Two patients are reported, one with severe brain damage and epilepsy, and the other with limbic epilepsy, who were treated with unilateral microsurgical amygdalo-hippocampectomy for the control of rage and aggression. Both had significant improvement in their aggressiveness, and the second patient also improved in the frequency of his seizures and psychotic episodes. The significance of these observations for our understanding of the morphophysiological basis of rage and aggression is discussed.
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keywords = frequency
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4/13. iron in cicatrix and abnormal CT findings in a patient with posttraumatic epilepsy.

    A 33-year-old male patient showed increasing frequency of seizures 12 years after a blunt head injury. From findings of x-ray computed tomography, the lesion was thought to be a benign glioma. Removal of the lesion was performed with the guidance of electrocorticography. Histological diagnosis was gliotic scar with calcification. Diffuse iron particles were detected in layers II-V of the cortex by hematoxylin and berlin-Blue stain. These findings suggest progressing traumatic epilepsy which may be explained by the mechanism of Willmore's model.
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5/13. post-traumatic headache with scintillating scotoma treated with phenytoin (Dilantin).

    A post-traumatic headache patient was experiencing "flashing lights" in her visual field that correlated with sharp waves on the EEG. phenytoin markedly improved the symptoms. The value of the EEG in post-traumatic headaches is reviewed. The use of phenytoin in headache syndromes and in prevention of post-traumatic epilepsy is discussed.
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6/13. electroencephalography in minor head injury in children.

    EEG and CT scans of 280 cases of minor head injury in children under 15 years of age were studied. Abnormality on initial EEG was shown in 42.5%. Those who lost consciousness had a higher incidence of abnormality than those who did not, and it was higher between 4 and 13 years of age. The sleep state has much influence on the finding. The patients should be awake or in a light sleep stage. The most frequent abnormality was slow waves, seen predominantly in the occipital regions, and which tended to disappear more easily than the paroxysmal ones. The EEGs became or remained normal in 95%, excluding incompletely followed-up cases. There was no case of post-traumatic epilepsy in our series, but 4 cases of post-traumatic early convulsions, in which the EEGs were variable. CT scan disclosed abnormality in 6%.
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7/13. Complex partial status epilepticus of frontal lobe origin.

    Nonconvulsive status epilepticus may be subdivided into generalized (absence) status and complex partial status. The latter is generally considered as a rare condition, whereas the former is fairly common to have been reported in many articles. We have reported here a case of complex partial status epilepticus in which the seizure origin was thought to be located in the frontal but not temporal lobe. After looking over the relevant literatures we commented that the incidence of complex partial status of extratemporal origin does not seem to be as rare as it has been believed to be. The main reason for this is the frequency with which it is misdiagnosed. The diagnostic errors are due to a failure to recognize the epileptic cause of the attacks or to appreciate localizing the clinical seizure characteristics and misleading scalp EEG findings. By making a closer observation of clinical manifestations, the likelihood that a correct diagnosis can be made will be increased.
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keywords = frequency
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8/13. Laughing and running fits as manifestation of early traumatic epilepsy.

    Early traumatic epilepsy, whose frequency is rather high, especially in children, is usually characterized by focal motor seizures (57%) or by generalized seizures (43%). The association of both running and laughing fits in the same patient on the contrary is quite exceptional, as only three cases have been reported in literature. There are no observations about temporal lobe epilepsy, nor, particularly, about running or laughing fits in early traumatic epilepsy. We report here the interesting case of a boy whose early traumatic epilepsy manifested itself as temporal lobe epilepsy characterized by running and laughter.
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keywords = frequency
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9/13. The role of stereotactic amygdalotomy in the treatment of temporal lobe epilepsy associated with behavioral disorders.

    The efficacy of bilateral stereotactic amygdalotomy for the treatment of aggressive behavioral disorders has been evaluated in a retrospective study of 67 cases. In addition 4 cases with complex partial seizures accompanied by aggressive outbursts revealing a unilateral epileptogenic focus in the amygdala or periamygdala region during preoperative stereoelectroencephalographic (SEEG) evaluation received a unilateral stereotactic amygdalotomy. Long-term follow-up of these 4 cases shows that 3 patients had considerable improvement in seizure frequency and severity as well as behavioral disturbances. The results in the remaining patients evaluated by surface EEG were inconclusive.
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keywords = frequency
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10/13. Recurrent postictal pulmonary edema: a case report and review of the literature.

    A 37-year-old woman with a post-traumatic seizure disorder had four well-documented episodes of postictal acute pulmonary edema and respiratory failure. Subtherapeutic blood concentrations of phenytoin were documented on each admission. Each episode followed one or more grand mal seizures and was characterized by the development of diffuse nodular-appearing alveolar infiltrates, tachypnea, and severe hypoxemia that rapidly resolved with supportive therapy. There was no evidence of gastric acid aspiration, acute lung infection, or underlying heart or lung disease. To determine the frequency of postictal pulmonary edema in our institution, we reviewed the clinical records and chest roentgenograms of 45 consecutive patients who were admitted to our emergency room following a well-documented grand mal seizure. Only one patient (described in this report) had chest roentgenographic evidence of pulmonary edema. A review of the English literature revealed only 11 reported cases of postictal pulmonary edema since 1965 and a total of 42 episodes in 27 patients since 1908. There were no clearly documented cases of postical pulmonary edema following electroconvulsive therapy in 18 published reports totaling more than 38,000 subjects. Our findings suggest that while postictal pulmonary edema may occur repeatedly in the same patient, the overall frequency of this complication is low.
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