Summary:Purpose: Malformations of cortical development (MCDs) are a frequent cause of refractory epilepsy in humans. The in utero radiation model in rats shares many clinical and histopathologic characteristics with human MCDs. Previous studies reported the presence of clinical seizures in radiated rats, but also suggested a dose-dependent differential effect.Methods: Time-pregnant Sprague-Dawley rats were irradiated on embryonic day E17 with 100 cGy (low dose), 145 cGy (medium dose), 175 cGy (high dose), or were left untreated. Their adult litters were implanted with bifrontal epidural and hippocampal depth electrodes and underwent long-term video-EEG monitoring. After 2 weeks of monitoring, the animals were killed and their brains processed for histological studies.Results: Spikes were most frequently found in the rats that were subjected to low-and medium-dose radiation at E17 and were less frequently seen in the animals that were subjected to high-dose radiation. No interictal spikes were found in any of the control animals. Seizures were recorded in three of five animals of the medium-dose group. Histological studies showed a dosedependent decrease in cortical thickness as well as an increase of cortical and hippocampal disorganization.Conclusions: In vivo epileptogenicity in radiated animals was present only in mild or moderate MCD. No in vivo epileptogenicity was seen in severe radiation-induced MCD. Key Words: Cortical dysplasia-In utero irradiationElectroencephalography-Dose dependent.Malformations of cortical development (MCDs) in the context of refractory epilepsy were described for the first time >30 years ago (1). With the improvement in imaging techniques, it has become evident that the various types of MCDs account for a large number of patients with refractory focal epilepsy (2-4). Surgery in patients with MCDs has a less favorable outcome than does surgery in patients with hippocampal sclerosis (5,6).Comparatively, little is known about the mechanisms leading to epileptogenicity in MCDs. Several animal models of MCDs have been established, such as the focal freeze lesion model (7,8), the in utero alkylating model (9), and the in utero irradiation model (10). All models share important histopathologic and in vitro electrophysiological characteristics of human focal MCDs (11,12). Spontaneous epileptic seizures have been reported in some genetic models of MCDs [e.g., the p35 knockout mouse (13) and the telencephalic internal structural heterotopia (TISH) rat (14)]. Among the injury-inducing models, sysAccepted January 25, 2004. Address correspondence and reprint requests to Dr. I.M. Najm at Section of Epilepsy, 9500 Euclid Avenue, S51, Cleveland, OH 44195, U.S.A. E-mail: najmi@ccf.org tematic long-term EEG monitoring has been performed only in the in utero irradiation model (15). We previously demonstrated that four of the seven rats exposed to 145 cGy in utero, but none of the control rats, exhibited spontaneous seizures. In addition, all radiated rats, but none of the normal controls, had frequen...

We systematically examined 226 epilepsy patients in a tertiary-referral center and found 6 (5.04%) to have valproate-induced Parkinsonism. There was a significantly higher prevalence of patients with Parkinsonism in the group of patients treated with valproate compared to those who were on other antiepileptic drugs (6 [5.04%] of 119 vs. 0 [0%] of 107; chi2 = 5.54; P = 0.025). These six patients had been on valproate for more than 3 years (mean, 75.67 +/- 25.32 months) at an average dose of 750 +/- 273.86 mg/day. The valproate doses were decreased or discontinued with supplementation from another antiepileptic medication. The mean UPDRS motor score significantly improved from 10.67 +/- 5.1 to 4.75 +/- 2.75 (P < 0.05). There was no relapse of seizures. Clinicians working in tertiary-referral centers should have a high index of suspicion for valproate-induced Parkinsonism. Early recognition and switching into another antiepileptic medication may help reduce unnecessary suffering in these patients.

Serial EEGs are not useful for patients with isolated striatal DWI hyperintensity but will increase diagnostic certainty from "possible" to probable" CJD for patients with cortical DWI hyperintensity.

Summary:  Purpose: Knowledge, attitudes, and perceptions of epilepsy (KAPE) among the public play a major role in determining the extent to which people with epilepsy can be integrated into their society. KAPE Surveys in Asia: Surveys conducted among Chinese in China, Taiwan, Malaysia, Singapore, and Hong Kong demonstrated similarities as well as differences in certain aspects of KAPE. These suggest that KAPE might not be uniform among other racial groups in the same or different regions of Asia. For KAPE to have usefulness to a country or community, it has to be location specific. Toward a Uniform Study Protocol: There are several advantages of using a uniform study protocol. Collection of KAPE data could be faster for any country or community that chooses to use any existing study protocol. Intraregional, interregional, intercontinental, interethnic, intercommunity, and longitudinal comparison within any subgroup could be carried out. Sharing of common information would enhance the regional effort in improving the quality of life of people affected by epilepsy. However, survey methods need not be uniform. Regional adaptation and flexibility of a unified protocol should be encouraged. After the study, concerted local and regional efforts in epilepsy education must be carried out systematically for the general public as well as for strategic groups. Conclusions: Determination of the KAPE in different parts of Asia would help to define the magnitude of and be the first step toward alleviating social discrimination against people with epilepsy in Asia.