No description available.

Thesis (Ph. D.)--UCLA, 2008. / Vita. Includes bibliographical references.

No description available.

Non-epileptic attack disorder (NEAD) is a disorder resembling epilepsy, but is caused by psychological processes rather than neurological disturbance. Approximately 15-30% of patients referred to specialist epilepsy centres have NEAD as opposed to epilepsy. Research into NEAD has largely focused on the differential diagnosis of NEAD and identifying risk factors, such as abuse and psychopathology. Whilst this is important, there remains a paucity of research exploring the processes involved in the development and maintenance of NEAD, which contributes to the lack of research investigating treatment effectiveness and prognosis. Furthermore, there remains a paucity of research investigating patient perceptions and experiences, despite such factors influencing prognosis. Subsequently, the current study used repertory grid methodology to explore the largely overlooked domain of how individuals with NEAD construe their world (i.e. how they perceive themselves, others and their disorder). Twelve individuals with a diagnosis of NEAD were recruited from a clinical neuropsychology department within North-West England. This study was an exploratory, cross-sectional study using the repertory grid technique to explore the participants' construals of themselves and others, including construals of their ideal self and self before NEAD. Based on personal construct theory, this method aimed to overcome some of the methodological limitations inherent within NEAD research, by minimising researcher bias, exploring implicit and explicit perceptions and exploring both individual and group perceptions.A case series of grids was presented. Individual and multiple analyses were used to explore participants' construct systems. A data driven approach enabled hypotheses to be developed from the individual grids, which were explored via a composite grid and SocioNet analysis. Despite some themes being identified, the findings revealed the uniqueness of the participants' ways of construing, including a lack of shared understanding amongst the participants. The participants were unhappy with their current self and no longer construed themselves to be the person they were before the onset of NEAD. They also construed themselves as being distinct and/or alienated from others, although some participants construed positive consequences as a result of their NEAD. Whilst most participants agreed with their NEAD diagnosis 'label', they were less accepting of the psychological factors that characterise the diagnosis. Finally, physical health difficulties were construed as being preferable to experiencing mental health difficulties. The findings were discussed in relation to previous research and theoretical implications were highlighted. Clinical implications were highlighted, particularly how the current diagnostic and treatment system for individuals with NEAD may threaten their self-identity. Methodological considerations and recommendations for future research were also suggested. The repertory grid technique was found to be a useful and effective method to investigate the subjective perceptions of individuals with NEAD.

A number of immune abnormalities have been found in epileptic patients treated with antiepileptic drugs (AED). The alterations seen range from mild suppression of immunoglobulins to severly impaired humoral and cellular immunities. There is evidence for both drug effects and genetic or acquired factors as contributors to these abnormalities. In order to examine the basis for immune abnormalities in patients with epilepsy, a number of experimental designs were employed: clinical studies, in vitro studies, and use of an animal model. Peripheral blood mononuclear cells (PBMC) isolated from epileptic patients currently receiving AED were found to have a reduced OKT4+/0KT8+ ratio. A reduced natural killer (NK) cell activity was found which may be due to a low proportion of Leu 11+ cells. A reduced NK cell activity was also found in healthy siblings of the patients, indicating a possible genetic basis for the level of this activity. Antibody-dependent cell-mediated cytotoxicity {ADCC), mitogenic responses, and total rosette-forming cells of PBMC isolated from patieots were found to be normal. The AED phenytoin has been associated with a variety of immune function alterations and lymphoma. In this study, phenytoin was found to depress basal and augmented NK cell activity of human cells in a dose-dependent manner in vitro. This depression was reversible following short-term exposure and at levels considered therapeutic. Phenytoin also depressed ADCC, thus one mechanism by which phenytoin alters immune function is by its depression of cell -mediated cytotoxicity. In contrast to results obtained with phenytoin, the AED carbamazepine did not significantly alter NK cell activity, but the diluent propylene glycol depressed activity. NFS mice given phenytoin produced lower specific antibody titers following antigen challenge. Body weights, specific organ weights for thymus, spleen, and liver, and blood cell counts were normal in these mice. The protocol was well tolerated by the animals at phenytoin dosages ranging from therapeutic to neurotoxic. Susceptibility to murine hepatitis virus was found to be increased in mice given a high dose of phenytoin. This animal model should allow investigations into toxic dose levels and mechanisms by which phenytoin and other AED alter immune function.

Epilepsy is a neurological disorder affecting 1-2 % of the population in the world. People diagnosed with epilepsy are put at high risk of getting injured due to the unpredictable seizures caused by the disorder. Electroencephalography (EEG) in combination with machine learning can be used for prediction of an epileptic seizure. Therefore, a portable prediction device is of great interest with high emphasis for it to be user-friendly. One way to achieve this is by minimizing the number of electrodes placed on the scalp. This study examines the number of electrodes that provide sufficient information for prediction of a seizure. The highest prediction accuracy of 91 %, 97 % sensitivity and 85 % specificity was achieved with as few as 16 electrodes. Due to the limitation of the intracranial EEG recordings further testing must be performed on scalp EEG recordings to provide valid results.

No description available.

Transient epileptic amnesia (TEA) is a form of epilepsy of which the principle manifestation is recurrent, transient episodes of isolated memory loss. Although the phenomenon has been recognised for over a century, it is scantily documented in the medical literature and is often misdiagnosed by clinicians. Recent work has highlighted a number of apparently consistent clinical features among the published cases. However, to date there has been no large, systematic study of the condition. The aim of the work reported in this thesis was to investigate a substantial number of prospectively recruited patients with TEA, and thus be able to provide a detailed and authoritative description of its clinical, neuropsychological and radiological characteristics. Fifty patients with TEA were recruited from around the United Kingdom using established diagnostic criteria, together with a group of matched healthy control subjects. Participants underwent a clinical interview, comprehensive neuropsychological testing and structural magnetic resonance imaging of the brain. The study demonstrated the following features. TEA typically begins in later life. The amnesic episodes are frequent, brief and often occur upon waking. They are characterised by a mixed anterograde and retrograde amnesia, the anterograde component of which is often incomplete. Attacks are commonly associated with olfactory hallucinations. They respond well to anticonvulsant medication. Nevertheless, many patients complain of persistent difficulties with memory. Despite generally performing well on standard tests of anterograde memory, many patients show i) accelerated forgetting of new information over a three-week delay and ii) temporally extensive deficits in autobiographical memory. TEA is associated with subtle medial temporal lobe atrophy on magnetic resonance imaging. This atrophy correlates with performance on standard memory tests, but not with long-term forgetting rates or autobiographical memory deficits. It is proposed that TEA is a distinctive syndrome of epilepsy, typically misdiagnosed at presentation, caused by medial temporal seizure activity and associated with accelerated long-term forgetting and autobiographical memory loss. These unusual forms of memory impairment have been documented in other forms of epilepsy. They pose challenges to current models of memory. The syndrome of TEA is therefore both clinically and theoretically important.

This thesis describes the preparation of 5-substituted-amino derivatives of 5-phenylhydantoin. The hydantoin derivatives are to be tested for anticonvulsant activity by the Pharmacology Department of the Eli Lilly Company of Indianapolis, Indiana.

Prior studies have demonstrated that a sizeable percentage of children presenting to the epilepsy monitoring unit for evaluation of paroxysmal events (seizures) are found to have non-epileptic seizures (NES) (Asano et al., 2005). The importance of identifying NES cannot be overstated since misdiagnosis often leads to treatment with antiepileptic drugs, which may have side effects that may negatively impact cognition (Chen, Chow, & Lee, 2001) and perhaps even cognitive development. While studies in adults with epilepsy or NES have demonstrated impaired executive functioning and social outcome compared to healthy peers, less work is present among pediatric populations (Cragar, Berry, Fakhoury, Cibula, & Schmitt, 2002; Rantanen, Eriksson, & Nieminen, 2012). Furthermore, research is void of information regarding social skills between these pediatric groups. The aims of this study were to examine group differences between social skills and executive functioning between pediatric epileptic and NES patients, determine if social skills predict diagnostic classification, and examine correlations between executive functioning and social skill measures. This study was conducted on the epilepsy monitoring units (EMU) at Phoenix Children's Hospital and Primary Children's Medical Center. The parent/caregiver of patients admitted to the EMU for video-EEG diagnosis of seizures was approached regarding study participation. A total of 43 children and parent/caregiver participated in this study. The NES group consisted of15 participants (67% female; M age at testing = 12.62, SD = 3.33), and the epilepsy (ES) group consisted of 28 participants (50% female, M age at testing = 11.79, SD = 3.12). Both the parents and children completed brief questionnaires measuring executive functioning and social skills. These measures included The Behavior Rating Inventory of Executive Functioning, The Behavioral Assessment System for Children, Second Edition, and the Social Skills Improvement System Rating Scales. Binomial logistic regression analysis showed social skills did not significantly predict diagnostic group. No group differences were found between children with epilepsy and NES on measures of executive functioning or social skills. Parents of both groups rated their children as having below average social skills, while children rated their social skills in the average range compared to healthy peers. Both children and parents of both groups rated their executive functioning within the average range. Executive functioning scores and social skill scores significantly correlated and regression analyses indicated that the Behavioral Regulation Index on the BRIEF significantly predicted Social Skills on the SSIS. Interpretationof results, limitations, and future directions are discussed.