No abstract

Ten patients suffering from drug-resistant complex partial seizures, with EEG abnormalities in the temporal region, were studied by means of non-invasive electrophysiological techniques (video-monitored, 16-channel, prolonged surface and sphenoidal EEG) as well as by imaging techniques (CT, MRI, SPECT and PET). Analysis of interictal and ictal EEG indicated the localization of epileptic activity in one side in eight cases. CT demonstrated focal abnormalities in three, SPECT in five unequivocally (in another four questionably, with the same lateralization as indicated by PET), MRI in eight, and PET in all cases. While only EEG provided specific diagnostic information, the focus definition was consistently good on PET images, poor on CT scans, and generally good but less consistent on MRI.

Sixty-three patients (32 women, 31 men), chronically treated with carbamazepine, phenytoin, valproate and/or phenobarbital, were investigated. Mean age at manifestation of epilepsy was 16.4 years; mean age at onset of documentation of seizure frequency was 33.7 years; mean duration of follow-up was 104.8 months; mean number of documented seizures per patient was 313.2. A statistical analysis of seizure diaries was performed. For each day the entries were the number of seizures per day. Linear trends, the amount of variance of the seizure frequency compared to randomly distributed events, were computed with the resulting coefficients fitting a general linear regression model. Non-random aggregations (clusters) were searched for as well as gaps of seizure manifestation. A similar number of patients exhibited a decrease (30%) or increase (29%) of seizure frequency during the course of epilepsy. The variance of the daily seizure frequency was in most patients (78%) significantly higher or lower (5%) than corresponding random distributions. The coupling coefficient to the day before was significantly larger than zero (indicating seizure clustering) in 57% of patients. Significant rhythmic components in seizure profiles (quasi-weekly or quasi-monthly) were found in 31 patients (both male and female). Periods of increased seizure frequency (clusters) manifested in 62% of patients; seizure gaps of at least 1 year occurred in 29 patients followed by seizure relapses in 20 patients. In conclusion, there is no evidence for a unique type of course in chronic focal epilepsy in patients on antiepileptic drugs.

We investigated the influence of ovulatory and anovulatory menstrual cycles on seizure occurrence in female patients with complex partial seizures. We prospectively documented seizures in relation to menstrual cycles (defined by measurement of basal body temperature and progesterone serum concentrations) in 39 female patients. One hundred and thirty-two cycles of 35 patients entered final analysis. Only eight patients had anovulatory cycles, in 18 patients all cycles were ovulatory. In the remaining nine patients anovulatory as well as ovulatory cycles were documented. In ovulatory cycles the mean frequency of seizures during the days of menstruation was significantly higher as compared to the periovulatory or the luteal phase of the cycles. During anovulatory cycles seizure frequency was significantly lower during menstruation than in the remaining days of the cycles. Since progesterone is known to exhibit anticonvulsant effects, seizure occurrence during menstruation seems to be related to ovulatory cycles, possibly due to the premenstrual decrease of progesterone. Therapeutic recommendations for the treatment of seizures related to the menstrual cycle (catamenial seizures) include the administration of hormones, as progesterone (recommended especially for women with catamenial epilepsy who have a documented inadequate luteal phase) or the suppression of the menstrual hormonal cycle by synthetic gonadotropin releasing hormone analogs.

In this study the chronic traumatic nightmares of men who had been in combat were found to differ from the lifelong nightmares of veterans with no combat experience in that they tended to occur earlier in the sleep cycle, were more likely to be replicas of actual events, and were more commonly accompanied by gross body movements. Traumatic nightmares may arise out of varying stages of sleep and are not confined to REM sleep alone. The group with lifelong nightmares showed evidence of thought disorder on the Rorschach. The men with posttraumatic stress disorder had failed to psychologically integrate their traumatic experiences and used dissociation as a way of dealing with strong affects.